Listen to the patients! Identifying CML patients' needs analyzing patient-generated content with AI-driven methodologies

Background

Various patient support programs exist to provide successful therapy options for patients. Pharmaceutical companies are increasingly recognizing the importance of actively supporting patients in their long-term treatment. In order to effectively assist patients, it is crucial to understand their current needs by taking a look at the patients' opinions.

Objective

This study focuses specifically on chronic myeloid leukemia (CML) and aims to determine if the current patient engagement offerings from pharmaceutical companies adequately address the needs of CML patients. To achieve this, the study uses content generated by CML patients to assess the patient engagement strategies of selected pharmaceutical companies, explore the relevance of medication, their products, and services, and analyze key concerns from the perspective of the patients.

Methods

To address the research questions, various methodologies were employed. Initially, desk research was conducted to identify relevant pharmaceutical companies and internet forums related to CML. Subsequently, content generated by patients was acquired and AI-driven techniques such as topic modeling and topic evolution analyses were used to examine this user-generated content (UGC) within the identified public forums. This involved analyzing topic models and tracking topic changes over time.

Results

The desk research revealed that pharmaceutical companies primarily offer information about the disease and available treatment options. The UGC analysis confirmed the significant role played by the industry in supporting CML patients. Key areas of interest for patients include the disease itself, potential treatment methods and associated side effects, dosage of active substances, and the possibility of switching therapies due to treatment failure or resistance. Stem cell transplantation was also discussed.

Conclusions

Overall, the pharmaceutical industry adequately addresses the needs of CML patients. However, there is room for improvement in educating patients about treatment options, drugs, and their side effects. Psychological support should not be neglected. Since CML patients frequently engage with clinical trial outcomes, there is potential for increased patient involvement in such trials. Further research in this area is recommended.

Engineering of a kinetically driven phase of phenoxazine by surface crystallisation

Surface crystallisation yields an unknown polymorph of the phenoxazine molecule. Tuning the crystallisation conditions causes a defined crystal growth of either the thermodynamically stable phase or the kinetic phase observed exclusively within thin films.

Intraventricular Flow Simulations in Singular Right Ventricles Reveal Deteriorated Washout and Low Vortex Formation

Purpose

Patients with a functionally univentricular heart represent one of the most common severe cardiac lesions with a prevalence of 3 per 10,000 live births. Hemodynamics of the singular ventricle is a major research topic in cardiology and there exists a relationship between fluid dynamical features and cardiac behavior in health and disease. The aim of the present work was to compare intraventricular flow in single right ventricle (SRV) patients and subjects with healthy left hearts (LV) through patient-specific CFD simulations.

Methods

Three-dimensional real-time echocardiographic images were obtained for five SRV patients and two healthy subjects and CFD simulations with a moving mesh methodology were performed. Intraventricular vortex formation and vortex formation time (VFT) as well as the turbulent kinetic energy (TKE) and ventricular washout were evaluated.

Results

The results show significantly lower values for the VFT and the TKE in SRV patients compared with healthy LV subjects. Furthermore, vortex formation does not progress to the apex in SRV patients. These findings were confirmed by a significantly lower washout in SRV patients.

Conclusions

The study pinpoints the intriguing role of intraventricular flows to characterize performance of SRVs that goes beyond standard clinical metrics such as ejection fraction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13239-021-00598-9.

Comparison of different detection methods for Ascaris suum infection on Austrian swine farms

Background

Ascaris suum, the large roundworm of pigs, is one of the economically most important pig parasites worldwide. In Austria it is commonly diagnosed by monitoring livers for milk spots at the slaughterhouse and intravital diagnosis (flotation for detection of fecal egg shedding). Recently, serological diagnosis based on the detection of specific antibodies with an ELISA (SERASCA®) with high sensitivity has been developed. To introduce and evaluate serology for A. suum screening in Austrian pigs, blood (for serology) (n = 177) and feces (for copromicroscopy) (n = 177) were taken from randomly selected slaughter pig batches from 18 farms at a slaughterhouse in Lower Austria. In addition, livers presented at slaughter (n = 844; max. 70/farm) were evaluated for milk spots.

Results

Overall, 19% of the livers were milk spot-positive (22% of those with complete diagnostic evaluations). Thirteen percent of the fecal samples contained A. suum eggs, while 69% of the blood samples were serologically positive. Despite we did not determine the sensitivity of the ELISA specifically, results ouf our study confirmed the high sensitivity of the ELISA, which was claimed by the manufacturer prior to our work (sensitivity: liver assessment: 23.5–27.0%; copromicroscopy: 8.5–9.0%; ELISA: 99.5%), and a high percentage of A. suum infections that remained undetected by standard liver assessment.

Conclusions

This suggests that the current method of roundworm diagnostics is insufficient and antibody detection at the end of the fattening period should be established as the standard procedure.

A data-driven analysis of the potential of public transport for German commuters using accessibility indicators

Background

A significant mode shift will be required in order to meet the ambitious greenhouse gas emissions reduction targets in Germany and elsewhere. Such a mode shift can only be achieved by a combination of drastic push and pull measures. Getting commuters to switch modes might be particularly difficult and have a negative impact on their access to employment and welfare.

Methodology

We investigate the potential for a mode shift from car to public transport for German commuters using a data-driven approach based mainly on open data sources that avoids complex transport model runs. Different datasets on the home and workplace location of all employees in Germany are consolidated to create an origin-destination commuter matrix at traffic analysis zone level. The commuter matrix is merged with travel time data for car and public transport to calculate a spatially disaggregated and mode-specific measure of accessibility. The comparison of accessibility by car and public transport is used to derive the potential for a mode shift and identify potential challenges and barriers.

Results

Public transport accessibility to workplaces is poorer across the country compared to access by car. On average, public transport travel times are almost three times higher than the corresponding car travel times. The differences in accessibility are largely independent of the region type. Results are validated by an independent dataset from a household travel survey. Based on these results, the potential for a mode shift appears to be very low.

Maximizing the Carrier Mobilities of Metal-Organic Frameworks Comprising Stacked Pentacene Units

Charge transport properties of metal-organic frameworks (MOFs) are of distinct interest for (opto)electronic applications. In contrast to the situation in molecular crystals, MOFs allow an extrinsic control of the relative arrangement of π-conjugated entities through the framework architecture. This suggests that MOFs should enable materials with particularly high through-space charge carrier mobilities. Such materials, however, do not yet exist, despite the synthesis of MOFs with, for example, seemingly ideally packed stacks of pentacene-bearing linkers. Their rather low mobilities have been attributed to dynamic disorder effects. Using dispersion-corrected density functional theory calculations, we show that this is only part of the problem and that targeted network design involving comparably easy-to-implement structural modifications have the potential to massively boost charge transport. For the pentacene stacks, this is related to the a priori counterintuitive observation that the electronic coupling between neighboring units can be strongly increased by increasing the stacking distance.

Accelerated Aging Effects on Color Stability of Potentially Color Adjusting Resin-based Composites

The aim of this study was to compare the effects of accelerated aging on the overall color stability of potentially color adjusting commercial resin-based composite resins. Thirty specimens (10 mm diameter and 2.5 mm thick; n=6) were fabricated using five different materials: Estelite Omega, GC Kalore, Venus Pearl, Harmonize, and Omnichroma. Color measurements were taken for each sample using a spectrophotometer before and after submitting samples through the artificial aging process (Q-sun Xenon Test Chamber, 102 min light at 63°C black panel temperature; 18 min light and water spray per ASTM G155) for a total of 300 hours (12.5 days). The total color difference (ΔE*ab) was calculated using SpectraMagic NX software and analyzed using one-way analysis of variance and Tukey test. The results for color change (ΔE*ab) were statistically significant. Omnichroma and Venus Pearl presented superior color stability and the lowest overall color change, whereas GC Kalore and Harmonize presented significant color change that would be considered clinically unacceptable (ΔE*ab > 3.3).

Understanding the origin of serrated stacking motifs in planar two-dimensional covalent organic frameworks

Covalent organic frameworks (COFs) have attracted significant attention due to their chemical versatility combined with a significant number of potential applications. Of particular interest are two-dimensional COFs, where the organic building units are linked by covalent bonds within a plane. Most properties of these COFs are determined by the relative arrangement of neighboring layers. These are typically found to be laterally displaced, which, for example, reduces the electronic coupling between the layers. In the present contribution we use dispersion-corrected density-functional theory to elucidate the origin of that displacement, showing that the common notion that the displacement is a consequence of electrostatic repulsions of polar building blocks can be misleading. For the representative case of COF-1 we find that electrostatic and van der Waals interactions would, actually, favor a cofacial arrangement of the layers and that Pauli repulsion is the crucial factor causing the serrated AA-stacking. A more in-depth analysis of the electrostatic contribution reveals that the "classical" Coulomb repulsion between the boroxine building blocks of COF-1 suggested by chemical intuition does exist, but is overcompensated by attractive effects due to charge-penetration in the phenylene units. The situation becomes more involved, when additionally allowing the interlayer distance to relax for each displacement, as then the different distance-dependences of the various types of interactions come into play. The overall behavior calculated for COF-1 is recovered for several additional COFs with differently sized π-systems and topologies, implying that the presented results are of more general relevance.

Analysing the impact of the COVID-19 outbreak on everyday travel behaviour in Germany and potential implications for future travel patterns

Introduction

The global Coronavirus (COVID-19) pandemic is having a great impact on all areas of the everyday life, including travel behaviour. Various measures that focus on restricting social contacts have been implemented in order to reduce the spread of the virus. Understanding how daily activities and travel behaviour change during such global crisis and the reasons behind is crucial for developing suitable strategies for similar future events and analysing potential mid- and long-term impacts.

Methods

In order to provide empirical insights into changes in travel behaviour during the first Coronavirus-related lockdown in 2020 for Germany, an online survey with a relative representative sample for the German population was conducted a week after the start of the nationwide contact ban. The data was analysed performing descriptive and inferential statistical analyses.

Results and Discussion

The results suggest in general an increase in car use and decrease in public transport use as well as more negative perception of public transport as a transport alternative during the pandemic. Regarding activity-related travel patterns, the findings show firstly, that the majority of people go less frequent shopping; simultaneously, an increase in online shopping can be seen and characteristics of this group were analysed. Secondly, half of the adult population still left their home for leisure or to run errands; young adults were more active than all other age groups. Thirdly, the majority of the working population still went to work; one out of four people worked in home-office. Lastly, potential implications for travel behaviour and activity patterns as well as policy measures are discussed.

Transport mode use during the COVID-19 lockdown period in Germany: The car became more important, public transport lost ground

As a result of the coronavirus pandemic, in spring 2020 numerous protective measures were taken in Germany and all over the world. This has changed our everyday life and our mobility considerably. It is in question whether and how the pandemic and the lockdown have impacted transport mode use, attitudes towards transport modes and the ownership of individual mobility options during the lockdown period. In order to shed light on these essential aspects of transport policy, we carried out a representative travel survey in Germany during the strictest period of lockdown in the beginning of April. We have analysed overall and individual changes in transport mode usage and attitudes towards transport modes, focussing on the bicycle, the car and public transport. Also, the changes in the perception of individual mobility options with a focus on car-free households were investigated. Our results indicate that public transport lost ground during the particularly restricted period of lockdown while individual modes of transport, especially the private car, became more important. Our findings are highly relevant for transport policy when developing measures for expanding the possibilities for sustainable individual transport and developing concepts that strengthen public transport. These aspects are key for achieving a sustainable transport system in the medium- and long-term despite the coronavirus pandemic.

Assessment of pressure-volume relations in univentricular hearts: Comparison of obtainment by real-time 3D echocardiography and mini pressure-wire with conductance technology

Objectives

The gold standard to obtain pressure-volume relations (PVR) of the heart, the conductance technology (PVR_Cond), is rarely used in children. PVR can also be obtained by 3D-echocardiography volume data combined with simultaneously measured pressure data by a mini pressure-wire (PVR_3DE). We sought to investigate the feasibility of both methods in patients with univentricular hearts and to compare them, including hemodynamic changes.

Methods

We studied 19 patients (age 2–29 years). PVR_3DE and PVR_Cond were assessed under baseline conditions and stimulation with dobutamine.

Results

Obtaining PVR_3DE was successful in all patients. Obtaining PVR_Cond was possible in 15 patients during baseline (79%) and in 12 patients under dobutamine (63%). Both methods showed that end-systolic elastance (Ees) and arterial elastance (Ea) increased under dobutamine and that Tau showed a statistically significant decrease. Intraclass correlation (95% confidence interval) showed moderate to good agreement between methods: Ees: 0.873 (0.711–0.945), Ea: 0.709 (0.336–0.873), Tau: 0.867 (0.697–0.942). Bland-Altman analyses showed an acceptable bias with wider limits of agreement: Ees: 1.63 mmHg/ml (-3.83–7.08 mmHg/ml), Ea: 0.53 mmHg/ml (-5.23–6.28 mmHg/ml), Tau: -0,76 ms (-10.73–9.21 ms).

Conclusion

Changes of PVR-specific parameters under dobutamine stimulation were reflected in the same way by both methods. However, the absolute values for these parameters could vary between methods and, therefore, methods are not interchangeable. Obtaining PVR_3DE in a single ventricle was easier, faster and more successful than PVR_Cond. PVR_3DE provides a promising and needed alternative to the conductance technology for the assessment of cardiac function in univentricular hearts.

Strategies for Controlling Through-Space Charge Transport in Metal-Organic Frameworks via Structural Modifications

In recent years, charge transport in metal-organic frameworks (MOFs) has shifted into the focus of scientific research. In this context, systems with efficient through-space charge transport pathways resulting from π-stacked conjugated linkers are of particular interest. In the current manuscript, we use density functional theory-based simulations to provide a detailed understanding of such MOFs, which, in the present case, are derived from the prototypical Zn2(TTFTB) system (with TTFTB4- corresponding to tetrathiafulvalene tetrabenzoate). In particular, we show that factors such as the relative arrangement of neighboring linkers and the details of the structural conformations of the individual building blocks have a profound impact on bandwidths and charge transfer. Considering the helical stacking of individual tetrathiafulvalene (TTF) molecules around a screw axis as the dominant symmetry element in Zn2(TTFTB)-derived materials, the focus, here, is primarily on the impact of the relative rotation of neighboring molecules. Not unexpectedly, changing the stacking distance in the helix also plays a distinct role, especially for structures which display large electronic couplings to start with. The presented results provide guidelines for achieving structures with improved electronic couplings. It is, however, also shown that structural defects (especially missing linkers) provide major obstacles to charge transport in the studied, essentially one-dimensional systems. This suggests that especially the sample quality is a decisive factor for ensuring efficient through-space charge transport in MOFs comprising stacked π-systems.

Estimation of left ventricular stroke work based on a large cohort of healthy children

Left ventricular stroke work is an important prognostic marker to analyze cardiac function. Standard values for children are, however, missing. For clinicians, standards can help to improve the treatment decision of heart failures. For engineers, they can help to optimize medical devices. In this study, we estimated the left ventricular stroke work for children based on modeled pressure-volume loops. A lumped parameter model was fitted to clinical data of 340 healthy children. Reference curves for standard values were created over age, weight, and height. Left ventricular volume was measured with 3D echocardiography, while maximal ventricular pressure was approximated with a regression model from the literature. For validation of this method, we used 18 measurements acquired by a conductance catheter in 11 patients. The method demonstrated a low absolute mean difference of 0.033 J (SD: 0.031 J) for stroke work between measurement and estimation, while the percentage error was 21.66 %. According to the resulting reference curves, left ventricular stroke work of newborns has a median of 0.06 J and increases to 1.15 J at the age of 18 years. Stroke work increases over weight and height in a similar trend. The percentile curves depict the distribution. We demonstrate how reference curves can be used for quantification of differences and comparison in patients.

[Structure and efferences of the substantia nigra pars compacta in Parkinson's disease]

There is consensus that the neuropathological characteristic of Parkinson's disease (PD) is the neuronal cell loss of the substantia nigra pars compacta (SNc) in connection with a Lewy pathology. The transsynaptic spread of Lewy pathology is considered essential in PD pathogenesis. Therefore, the knowledge of pre-existing neuroanatomical connections of the SNc is essential. We describe recent animal experiments on the afferent and efferent projections of the SNc and discuss the evidence for and against the sequential transsynaptic spread of Lewy pathology in the pathogenesis of PD.

Physical activity and heart rate monitoring in Fontan patients - Should we recommend activities in higher intensities?

OBJECTIVE

Exercise capacity is impaired in Fontan palliated patients. The change in daily activity behaviour with an increase in sedentary lifestyle results in low physical activity levels. This might have a greater impact on patients with chronic heart disease in contrast to healthy controls. For a better understanding, we compared data from cardiopulmonary exercise testing (CPET) with heart rates and physical activity in daily life.

METHODS

21 Fontan patients and 20 age, sex and BMI matched controls underwent CPET and 5 days of daily life activity tracking with a triaxial accelerometer (wGT3x-BT, Actigraph) including heart rate monitoring with an optical heart rate sensor.

RESULTS

27% of our Fontan teenagers and 71% of the Fontan adults reached the specific WHO recommendations for moderate to vigorous physical activity (MVPA) during everyday life (EDL), without differences to controls. There was a strong correlation between MVPA and [Formula: see text] for all Fontan patients (p = 0.0035, Pearson r = 0.788). Daily MVPA correlated to peak oxygen uptake and lactate production. Up to workloads of 2 W/kg and in daily life heart rates in Fontan patients were similar to controls.

CONCLUSIONS

Daily MVPA is alarmingly low without any differences between Fontan patients and controls. Heart rate behaviour was similar and does not seem to be a limiting factor for physical activity in daily life. Higher intensity activities should be implemented regularly in EDL for Fontan patients. Proof is needed as to whether sports in moderate or possibly even in vigorous activity (e.g. high-intensity interval training) improve exercise capacity the most.

Zebrafish and medaka as models for biomedical research of bone diseases

The identification of disease-causing mutations has in recent years progressed immensely due to whole genome sequencing approaches using patient material. The task accordingly is shifting from gene identification to functional analysis of putative disease-causing genes, preferably in an in vivo setting which also allows testing of drug candidates or biotherapeutics in whole animal disease models. In this review, we highlight the advances made in the field of bone diseases using small laboratory fish, focusing on zebrafish and medaka. We particularly highlight those human conditions where teleost models are available.

[Neurological and neurosurgical early rehabilitation in Lower Saxony and Bremen]

INTRODUCTION

We analyzed the delivery of healthcare services among patients in neurological and neurosurgical early rehabilitation programmes in the German states of Lower Saxony and Bremen.

METHODS

Patients´applications and admissions for neurological and neurosurgical early rehabilitation in Lower Saxony and Bremen were recorded during a period of two weeks both in November 2015 as well as 2016. The proportion of patients admitted to early rehabilitation within a six-week-period after disease onset was calculated. In addition, factors influencing the probability of admission were investigated.

RESULTS

Only 45 % of all patients transferred from a primary neurological / neurosurgical unit to an early rehabilitation facility in Lower Saxony / Bremen were successfully admitted. The probability of admission fell when patients were colonized with multi-drug resistant bacteria (21 % in comparison), in particular Methicillin-resistant Staphylococcus aureus (MRSA) with an admission rate of only 13 %. Deleterious effects were also observed in patients dependent on hemodialysis (20 %), or those with a primary diagnosis of polyneuropathy / Guillain-Barré-Syndrome (33 %) or hypoxic brain damage (37 %), as well as patients on mechanical ventilation (37 %). Patients had a higher probability of being admitted with the primary diagnoses of subarachnoid hemorrhage (52 %) or stroke (51 %). Age, Early Rehabilitation Index (ERI), monitoring, presence of tracheostomy, dysphagia, orientation or behavioral disturbances had no influence on the probability of admission, as well as other primary diagnoses or the number of admissions in one or more rehabilitation centers.

CONCLUSION

Over one-half of the patients applying for admission to neurological / neurosurgical early rehabilitation facilities in Lower Saxony and Bremen were not admitted. Apparently, the capacity of early rehabilitation treatment in these two German states is not optimal.

Physical activity is associated with lower insulin and C-peptide during glucose challenge in children and adolescents with family background of diabetes

AIMS

Children and adolescents with a family history of diabetes are at increased risk of overweight, but little is known about the potentially beneficial effects of physical activity on these children. The objective of this study was to investigate the association between moderate to vigorous physical activity (MVPA) and metabolic and inflammatory risks in children and adolescents with a family background of Type 1 diabetes or gestational diabetes.

METHODS

Valid MVPA measurements, made with accelerometers, were available from 234 participants (median age, 10.2 years) who had a first-degree relative with either Type 1 or gestational diabetes. Anthropometric and metabolic measurements were made and cytokines measured, and were correlated with MVPA measurements, with stepwise adjustment for confounding factors, in a cross-sectional analysis.

RESULTS

MVPA was negatively associated with insulin and C-peptide during challenge with an oral glucose tolerance test. MVPA was also significantly positively associated with the insulin sensitivity index, whereas no consistently significant associations were found between MVPA and BMI, blood pressure or cytokine levels.

DISCUSSION

Our findings indicate that physical activity may have beneficial effects on insulin and C-peptide metabolism in children and adolescents with a family background of diabetes, but show no evidence of a protective association with other health-related outcomes.

Continuous synthesis of Zn2Al–CO3layered double hydroxides: a comparison of bench, pilot and industrial scale syntheses

Zn₂Al–CO₃was produced continuously at bench (g h⁻¹), pilot (100s g h⁻¹) and industrial scale (10s kg h⁻¹).

CEDI — ein Computerprogramm zur praeoperativen Artdiagnostik hirnorganischer Prozesse

Es wird ein Computer-Verfahren beschrieben, das auf der Basis eines verallgemeinerten Bayes’schen Theorems eine Artdiagnostik von hirnorganischen Prozessen ermöglicht ; dabei können Abhängigkeiten unter den Symptomen explizite Berücksichtigung finden.

Aufgrund der programmtechnischen Konzeption, allediagnosespezifischen Eigenschaften durch ein besonderes Generatorprogramm mittels eines Masterstapels in den Kalkül einzubringen, entstand ein sehr anpassungsfähiges Diagnostik-Programm, das ohne weiteres auch in anderen medizinischen Bereichen zur Anwendung gelangen kann.

Geeignete Satelliten-Programme erleichtern die Durchführung statistischer Analysen bzw. wirken in Rückkoppelung auf die Inzidenzmatrizen ein, welche die Grundlage der wahrscheinlichkeitstheoretischen Auswertung sind. Dadurch erhält das Programm eine lernende Struktur. Bereits jetzt führen die Berechnungen in ca. 90% der untersuchten Fälle zu befriedigenden Resultaten, obwohl die pro-grammtechnischen Möglichkeiten wegen z.T. noch unzulänglicher statistischer Unterlagen bislang nicht voll ausgeschöpft werden konnten.

Clinical Results of Immunoscintigraphy in a Variety of Malignant Tumors with Special Reference to Immunohistochemistry

Radioimmunoscintigraphy was performed in 52 patients with a variety of malignant tumors (colorectal, melanoma, lung, testicular, ovarian, bladder, carcinoid). Respective antibodies or their F(ab’)2 fragments against CEA (n = 23), melanoma antigen 225.28 S (n = 18), TPA (n = 4), ßHCG (n = 5) and HMFG2 (n = 2) were selected by immunohistochemistry of the primary tumor. Most patients were suspected of recurrence or of hitherto unknown distant or local metastases. Overall accuracy was 61 % (32/52). False negatives amounted to 33% (17/52). Useful additional clinical information – not available by CT, ultrasonics or serum levels of tumor markers – was obtained in 17 out of 52 patients (= 33%). From these results it seems obvious that antibodies used for radioimmunoscintigraphy should be selected on the basis of immunohistochemistry.

Assessment of Regional Myocardial Uptake and Metabolism of ω-(p-123I-Phenyl) Pentadecanoic Acid with Serial Single-Photon Emission Tomography

The utility of myocardial imaging and assessment of regional myocardial metabolism of ω-(123I-paraphenyl-)pen-tadecanoic acid (I-PPA) by means of serial single-photon tomography is demonstrated in animal experiments. High quality cross sectional images of dog hearts with clear delineation of left ventricular walls are obtained. Myocardial infarcts are visualized as areas of deficient radioactivity uptake. I-PPA elimination from non-infarcted myocardial regions is significantly (p < 0.001) prolonged when compared with unaffected controls. Hence, not only localized absence of uptake of free fatty acid by infarcted myocardium can be demonstrated with serial single-photon tomography but also general impairment of cardiac FFA-metabolism.

Relation of Myocardial Blood Flow and Initial Cardiac Uptake of 15-(p-123I-Phenyl)-Pentadecanoic Acid in the Canine Heart

In 8 pentobarbital-anaesthetized mongrel dogs the correlation between regional myocardial blood flow (RMBF) and regional cardiac uptake of 15-(p-123I-phenyl)-pentadecanoic acid (IPPA) was determined. Three animals were studied under control conditions, in three dogs an acute ischemia was produced by LAD ligation, and two dogs were paced at 195 beats/min. RMBF values were 20–50 ml/min-100 g in acutely ischemic myocardium. 90–120 ml/ min·100 g under normal conditions and 200–250 ml/min·100 g during pacing-induced stimulation. Total cardiac uptake of IPPA was 4.5–6% of the injected dose. In normal and acutely ischemic myocardium a good correlation between RMBF and IPPA uptake was obtained. Under stimulated conditions only a moderate increase of IPPA accumulation was found. At RMBF values above 150–170 ml/ min·100 g an upper limit of IPPA uptake was observed and can be explained by limited diffusion or an increased utilization of alternative substrates.

Should Treatment of Highly Differentiated Thyroid Carcinoma Be Conservative?

On the basis of three selected cases (one with clinically occult follicular and two with metastatic papillary carcinoma) the necessity of a comprehensive therapeutic concept even in highly differentiated thyroid cancer is stressed. Thyroid tissue and regional metastases should be eliminated by surgery, followed by radioiodine therapy in any event. Radiation teletherapy should be reserved to patients with invasive tumor growth exceeding the organ capsule, with lymph node metastases, and with massive angioinvasive growth.

Radiation treatment planning in brain tumours

Aim: Amino acid PET has become an important diagnostic tool for brain tumour imaging. In this data analysis, the potential impact of amino acid PET with 3-O-methyl- 6-[18F]fluoro-L-DOPA ([18F]OMFD) on radiation treatment planning is addressed by the following questions: 1. Was tumour tissue identified with OMFD-PET which was not covered by the conventionally derived planning target volume (PTV)? 2. Would the PTV have been changed incorporating OMFD-PET? Patients, methods: OMFD-PET of 25 patients after subtotal resection of malignant glioma was evaluated. The region of elevated tracer uptake of PET and of contrast enhancing masses on MRI were outlined as separate gross tumour volumes (GTVMRI and GTVOMFD) and reconstructed in the planning CT for comparison with the conventionally drawn GTVconv. A PTVnew based on GTVconv+MRI was calculated. Pairwise differential volumes were calculated to estimate overlap and differential volumes delineation by each image modality and the PTVconv and PTVnew respectively. Results: Differential volume analysis showed > 10 cm3 of GTVOMFD outside GTVconv and GTVMRI in 5/25 patients respectively. From GTVMRI >10 cm3 were found outside GTVOMFD in 8/25 patients. Although all tumour areas indicated by [18F]OMFD were covered by the conventionally derived PTV, based on a GTVOMFD+MRI, the PTVnew would have been enlarged >20% in seven patients. In seven patients the PTVnew would have been reduced. Conclusion: OMFD-PET indicated tumour tissue outside the tumour region identified with MRI, adding valuable information for the delineation of the GTV in radiation treatment planning. OMFD-PET contains the potential to tailor the high dose radiation to the appropriate tumour volume, especially if dose escalation is desired.

Interpretation erhöhter D-Dimerkonzentration

Hintergrund: Die Bestimmung der D-Dimerkonzentration ist unverzichtbarer Bestandteil der Diagnostik thromboembolischer Erkrankungen (z. B. Beinvenenthrombosen, Lungenembolien). D-Dimere sind als Spaltprodukte des Fibrins bei fibrinolytischen Prozessen im Rahmen der reaktiven Fibrinolyse nach thrombotischen Prozessen nachweisbar. Fragestellung: In der klinischen Praxis bestehen immer wieder Probleme bei der Interpretation erhöhter D-Dimerkonzentrationen, vor allem, wenn keine thromboembolische Erkrankung vorliegt. Vor der Einleitung einer weiterführenden (meist bildgebenden) Diagnostik sollen andere Ursachen für die erhöhten D-Dimerwerte (z. B. Schwangerschaft, Tumorerkrankung, systemische entzündliche Erkrankung, fortgeschrittene Arteriosklerose) differenzialdiagnostisch berücksichtigt werden. Zusammenfassung: Die Bestimmung des D-Dimerkonzentration muss zielgerichtet bei thromboembolischen Erkrankungen erfolgen. Der Parameter ist jedoch ungeeignet als Screening-Verfahren im Rahmen der klinischen Routine. Gesichert ist sein hoher prädiktiv-negativer Wert zum Ausschluss einer Thrombose bzw. Lungenembolie bei negativem Testergebnis. Zahlreiche weitere Erkrankungen oder physiologische Zustände führen ebenfalls zu erhöhter D-Dimerkonzentration, so dass ein positiver D-Dimer-Test nicht die Basis zur Diagnose einer Thromboembolie sein darf.

Lipopolysaccharide induced Interleukin-6 production is mediated through activation of ERK 1/2, p38 MAPK, MEK, and NFκB in chicken thrombocytes

Thrombocytes express Toll-like receptor 4 and apparently use both mitogen-activated protein kinase (MAPK) and nuclear factor kappa-light-chain-enhancer of activated B cells (NFKB) pathways for nuclear signaling. However, it is not well known if the same enzyme systems found in mammalian cells are fully functional in chickens. Therefore, kinase inhibitors were used with thrombocytes to block kinases in lipopolysaccharide (LPS) stimulated cells to determine if interleukin (IL)-6 expression and production would be diminished. Results demonstrated that extracellular-signal-regulated kinase (ERK)1/2 and p38 MAPK pathways influence gene expression of IL-6 through treatment with either ERK or p38 MAPK inhibitor. In addition, thrombocyte lysates from cells treated with ERK, p38, mitogen-activated protein kinase kinase (MEK)1/2 and inhibitor of nuclear factor kappa-B kinase (IKK) inhibitor showed different levels of the phosphorylated form of ERK1/2, p38 and NFκB. Furthermore, IL-6 gene expression and production were significantly upregulated in LPS stimulated thrombocytes relative to all inhibitor-treated cells.

Telomerase Expression in Medaka ( Oryzias melastigma) Pharyngeal Teeth

Nonmammalian vertebrates have the capacity of lifelong tooth replacement. In all vertebrates, tooth formation requires contact and interaction between the oral or pharyngeal epithelium and the underlying mesenchyme. To secure lifelong replacement, the presence of odontogenic stem cells has been postulated, particularly in the epithelial compartment. This study uses an advanced teleost fish species, the marine medaka Oryzias melastigma, a close relative to Oryzias latipes, to examine the expression and distribution of telomerase reverse transcriptase (Tert), the catalytic unit of telomerase, in developing pharyngeal teeth and to relate these data to the proliferative activity of the cells. The data are complemented by expression analysis of the pluripotency marker oct4 and bona fide stem cell marker lgr5. Tert distribution and tert expression in developing tooth germs show a dynamic spatiotemporal pattern. Tert is present first in the mesenchyme but is downregulated as the odontoblasts differentiate. In contrast, in the epithelial enamel organ, Tert is absent during early stages of tooth formation and upregulated first in ameloblasts. Later, Tert is expressed and immunolocalized throughout the entire inner enamel epithelium. The pattern of Tert distribution is largely mutually exclusive with that of proliferating cell nuclear antigen (PCNA) immunoreactivity: highly proliferative cells, as revealed by PCNA staining, are negative for Tert; conversely, PCNA-negative cells are Tert-positive. Only the early condensed mesenchyme is both Tert- and PCNA-positive. The absence of tert-positive cells in the epithelial compartment of early tooth germs is underscored by the absence of oct4- and lgr5-positive cells, suggesting ways other than stem cell involvement to secure continuous renewal.

Altered miR-155 Expression in Allergic Asthmatic Airways

We and others have previously identified microRNAs (miRNAs) with pathological roles in animal models of asthma, where miR-146a and miR-155 have been described to play important roles in inflammatory responses. To date, few studies have investigated miRNA expression in human asthmatics. In the current study, significantly lower levels of miR-155 were detected in cell-free sputum from allergic asthmatics compared to healthy controls. Induced sputum isolated from allergic asthmatics in and out of pollen season revealed that miR-155 expression, but not miR-146a, is reduced in lymphocytes in season compared to post-season. In contrast, miR-155 was found to increase, whereas miR-146a decreased in PBMCs and cell-free PBMC culture media upon T cell receptor stimulation via αCD3/CD28 in both allergic asthmatics and healthy controls. Our findings suggest that miR-155 is differentially expressed ex vivo in airways of allergic asthmatics compared to healthy controls, which may have implications in the local immune response in allergic asthma.

Structural intermediates and directionality of the swiveling motion of Pyruvate Phosphate Dikinase

Pyruvate phosphate dikinase (PPDK) is a vital enzyme in cellular energy metabolism catalyzing the ATP- and Pi-dependent formation of phosphoenolpyruvate from pyruvate in C4 -plants, but the reverse reaction forming ATP in bacteria and protozoa. The multi-domain enzyme is considered an efficient molecular machine that performs one of the largest single domain movements in proteins. However, a comprehensive understanding of the proposed swiveling domain motion has been limited by not knowing structural intermediates or molecular dynamics of the catalytic process. Here, we present crystal structures of PPDKs from Flaveria, a model genus for studying the evolution of C4 -enzymes from phylogenetic ancestors. These structures resolve yet unknown conformational intermediates and provide the first detailed view on the large conformational transitions of the protein in the catalytic cycle. Independently performed unrestrained MD simulations and configurational free energy calculations also identified these intermediates. In all, our experimental and computational data reveal strict coupling of the CD swiveling motion to the conformational state of the NBD. Moreover, structural asymmetries and nucleotide binding states in the PPDK dimer support an alternate binding change mechanism for this intriguing bioenergetic enzyme.

Small teleost fish provide new insights into human skeletal diseases

Small teleost fish such as zebrafish and medaka are increasingly studied as models for human skeletal diseases. Efficient new genome editing tools combined with advances in the analysis of skeletal phenotypes provide new insights into fundamental processes of skeletal development. The skeleton among vertebrates is a highly conserved organ system, but teleost fish and mammals have evolved unique traits or have lost particular skeletal elements in each lineage. Several unique features of the skeleton relate to the extremely small size of early fish embryos and the small size of adult fish used as models. A detailed analysis of the plethora of interesting skeletal phenotypes in zebrafish and medaka pushes available skeletal imaging techniques to their respective limits and promotes the development of new imaging techniques. Impressive numbers of zebrafish and medaka mutants with interesting skeletal phenotypes have been characterized, complemented by transgenic zebrafish and medaka lines. The advent of efficient genome editing tools, such as TALEN and CRISPR/Cas9, allows to introduce targeted deficiencies in genes of model teleosts to generate skeletal phenotypes that resemble human skeletal diseases. This review will also discuss other attractive aspects of the teleost skeleton. This includes the capacity for lifelong tooth replacement and for the regeneration of dermal skeletal elements, such as scales and fin rays, which further increases the value of zebrafish and medaka models for skeletal research.

[Practical Use of the Levodopa Pump]

Patients with advanced Parkinson's disease and motor complications undergoing optimized oral therapy can significantly benefit from continuous intrajejunal levodopa/carbidopa infusion applied by means of a medication pump. However, this requires a correctly positioned PEG-J tube and finely adjusted pump settings. Although this method is a routine procedure in specialist centers, no standard procedure has been defined up to now. For this reason, an expert recommendation regarding the practical application has been developed in order to standardize the procedure and facilitate patient access to this treatment option.