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Die Arbeit setzt sich mit dem Begriff des raumbedeutsamen Vorhabens im Sinne des § 3 Abs. 1 Nr. 6 Raumordnungsgesetz (ROG) auseinander und versucht, diesen Begriff zu konkretisieren. Der Autor kommt zu dem Ergebnis, dass die Legaldefinition in § 3 Abs. 1 Nr. 6 ROG kaum zur Konkretisierung beiträgt und der Subsumtion nicht unmittelbar zugänglich ist. Er spricht sich aus diesem Grund dafür aus, dass eine Konkretisierung dieses Begriffs durch die Bildung von vorhabenbezogenen Fallgruppen zu erfolgen hat.
Sodann werden auf Basis der Methode des typisierenden Fallvergleichs Fallgruppen für die Vorhabentypen „Windenergieanlagen“, „Einzelhandelsbetriebe“ und „Abgrabungen“ erarbeitet. Hierzu wurde die einschlägige Rechtsprechung zu dieser Thematik ausgewertet. Die Fallgruppenbildung trägt dazu bei, den Begriff der Raumbedeutsamkeit zu konkretisieren und die Handhabung dieses wertungsoffenen Begriffs in der Praxis zu erleichtern.
Darüber hinaus diskutiert der Autor unter verschiedenen Gesichtspunkten den in Teilen der Literatur vertretenen Ansatz, unter bestimmten Bedingungen den Trägern der Raumplanung zuzugestehen, die Raumbedeutsamkeit eines Vorhabentypus (z.B. Windenergieanlagen) abstrakt-tatbestandlich in Form eines Ziels der Raumordnung festzusetzen. Diesem Ansatz schließt er sich im Ergebnis an.
Planning Modes for Major Transportation Infrastructure Projects (MTIPs): Comparing China and Germany
(2018)
The glioblastoma multiforme (GBM) not only presents the most common tumor of the central nervous system in adults, it is also the most aggressive brain tumor. Although patients suffering from GBM standardly receive a combination of multiple treatments including surgery, radiotherapy and chemotherapy, its prognosis is still poor with a median survival time of only 12-15 months. Therefore, new and effective treatment methods are urgently needed.
A signaling molecule which is both involved in proliferation, migration and invasion of a broad range of healthy and malignant cells is the lipid mediator sphingosine-1-phosphate (S1P). Previous studies have confirmed that sphingosine-1-phosphate (S1P) receptor 1 (S1PR1) is involved in the regulation of proliferation, invasion, metastasis, vascular maturation and angiogenesis of GBM cells, and is closely related to the occurrence and development of tumors. Thus, ACT-209905 (provided by Actelion Pharmaceuticals) as a selective S1PR1 modulator was applied to gain insights into the molecular processes activated by S1PR1 in GBM cells using two human (LN18, U87MG) and one murine (GL261) GBM cell line.
In our in vitro cell viability analyses, we found that ACT-209905 significantly reduced viability of LN18 cells in a concentration dependent manner. A combined administration of ACT-209905 with S1PR2 inhibitors (Compound 16, Compound 16ME – both provided by ONO Pharmaceuticals, and JTE-013 – commercially available) showed a stronger effect than the single administration demonstrating that both S1PR1 and S1PR2 are involved in growth of GBM cells and may interact with each other. Our results also demonstrated that ACT-209905 can induce apoptosis in GBM cells since caspase 3 activity was induced by the S1PR1 modulator which might therefore play an important role in inhibiting the proliferation of GBM cells. Further, we found a significant inhibitory effect of ACT-209905 on the migration and invasion of LN18 and U87MG GBM cells arguing for a participation of S1PR1 signaling in migration and invasion of GBM cells, too. Stimulation of S1P receptors results in the activation of several kinases such as AKT1 and ERK1/2, correspondingly our immunoblot analyses showed a strong activation of both kinases by S1P which was reduced by ACT-209905 in LN18 cells but not in GL261 cells suggesting that different pathways are activated by S1P in these GBM cell lines. Further studies have to be performed to clarify the role of AKT1 and ERK1/2 in the inhibitory effects of ACT-209905 on GBM proliferation, migration and invasion.
Currently, GBM stem cells are discussed as a reason for resistance against the radiochemotherapy and the recurrence of the tumor. Our immunoblot analyses showed that Nestin and CD133, two marker proteins for GBM stem cells, were higher expressed in GBM cells treated with ACT-209905 compared to control or S1P treated LN18 cells. Further investigations in the future might contribute to the elucidation of an involvement of the S1P receptors in the stem cell behavior of GBM cells. Paradoxically to the up-regulation of CD133 and Nestin by ACT-209905, treatment of LN18 stem-like neurospheres with ACT-209905 showed a significant cytotoxic effect of the compound which was even more pronounced in the stem-like neurosphere cells compared to the adherent parental LN18 cells.
Overall, the studies of this work improve our understanding of the complex mechanisms of S1P signaling in GBM cells and might drive the development of its pharmacological modulation as a new therapeutic principle in GBM. Furthermore, an extended knowledge about the molecular effects of ACT-209905 on GBM cells will broaden the understanding for possible future applications and clinical indications.
Cerebral palsy (CP) remains one of the most common debilitating diseases in the world.
Factors such as neuromuscular incoordination, use of soft diet and delayed oral
clearance of food make maintenance of optimum oral hygiene a challenging task in
these children. The compromised oral hygiene in turn make these children highly
vulnerable to dental disease. Maintaining optimal oral/dental health in CP children is of
utmost importance as these children usually suffer from several associated general
health problems in addition to their primary condition. Poor dental health further
compromises their general health. Nevertheless, CP children often suffer from dental
diseases including dental caries more than healthy children. This underscores the need
for improvement in oral health of the CP children. The CP children are dependent on
those around them for their oral hygiene maintenance and dietary intake. CP children
spend most of their time with health care workers in special centers for them or with
their parents/care takers at home. Therefore, the attitude of special health care workers
and parents towards their dental health is of prime importance. The purpose of this
project included to determine the attitude of special health care workers towards their
dental health and oral health comprehension by parents of CP children. In addition, a
study on caries experience of CP children and associated risk factors was also completed.
The final objective was to identify various potential areas of improvement with ultimate
goal of improving dental health of the CP children.
The study involving special health care workers in a Disabled Children’s Center revealed
that oral health knowledge and practices among the workers could generally be labeled
as satisfactory, however some weak areas (such as trend towards symptom-oriented
utilization of oral health care and lack of knowledge about fluoridated water) were
identified. There is a need to enhance the workers’ knowledge in these areas.
The study involving parents of the CP children showed mixed results. Some areas of
strong oral health comprehension (such as importance of good dental health, harmful
effects of sweetened foods), others satisfactory (such as need for routine dental visits,
use of fluoride) and some weak areas (use of flavored fizzy drinks, bottled/canned juices
and sweetened/flavored milks, seeking early treatment) were identified among parents
of CP children. The results strongly indicated a need for enhanced efforts towards
improvement of oral health comprehension in the parents of the CP children.
The study about caries experience and risk factors in CP children has provided useful
information in an area where literature has been scarce. Almost all the studied children
had clinical dental caries, and most of the caries were untreated. Very few children in
the present study had optimal oral hygiene. This study confirmed the strong correlation
between high dental caries experience and poor oral hygiene. Routine dental check-up
visits and topical fluoride application clearly resulted in lower caries experience. Bottled
juices and crispy potato chips were the two predictors for high caries experience.
As stated before, the goal of the project was to identify various potential areas of
improvement in oral health attitude of special health care workers, oral health
comprehension of the parents of CP children and risk factors for dental caries in CP
children. It is contemplated that by addressing the identified weak areas, an
improvement in dental health and care of the CP children is expected. It is also expected
that the collected information will help in improvement of clinical preventive as well as
restorative services for the CP children. CP children and their parents lead a challenging
life. This project was an effort to assist these children and their parents/care takers with
ultimate goal of improving their oral health and in turn their overall quality of life.
Optomechanical (om) systems are characterized by their nonlinear light-matter interaction. This is responsible for unique dynamic properties and allows the detection of a variety of classical and quantum mechanical phenomena on a microscopic as well as on a macroscopic scale. In this work we have studied the dynamic behavior of two laser-driven om systems, the single om cell ("cavity optomechanics / membrane-in-the-middle setup") and a two-dimensional hexagonal array of these cells ("om graphene"). The first case was motivated by the possibility to detect the transition from quantum mechanics to classical mechanics directly on the basis of the dynamic behavior. For this we focus on multistability effects of the optical and mechanical degrees of freedom, that are modeled by harmonic oscillators. Our description is based on the quantum optical master equation, which takes into account the environmental interaction assuming a vanishing temperature. As a consequence of decoherence, the dynamics occur near the semiclassical limit, i.e. it is characterized by quantum fluctuations. The quantum-to-classical transition is realized formally by rescaling the equations of motion. In the classical limit, quantum fluctuations disappear and the mean field equations were evaluated by analytical and numerical methods. We found that classical multistability is characterized by stationary signatures on the route to chaos, as well as by the coexistence of single-periodic orbits for the mechanical degree of freedom. The latter point was extensively evaluated by means of a self-consistent approach. For the dynamics in the quantum regime quantum fluctuations cannot be neglected. For this purpose, the master equation was solved by means of a numerical implementation of the Quantum State Diffusion (QSD) method. Based on Wigner and autocorrelation functions, we were able to show that quantum multistability is a dynamic effect: chaotic dynamics is suppressed and there is a time-dependent distribution of the phase space volume on classical simple-periodic orbits. The results can be interpreted within a semiclassical picture, which makes use of the single QSD quantum trajectory. Accordingly, the quantum-classical transition is explained as a time-scale effect, which is determined by tunneling probabilities in an effective mean-field potential. The subject of the second part of the work is the transport of low-energy Dirac quasiparticles in om graphene, propagating as light and sound waves. For this purpose, we investigated the scattering of a plane light wave by laser-induced photon-phonon coupling planar and circular barriers. The starting point is the om Dirac equation, which results from the continuum approximation of the Hamiltonian description of the two-dimensional array near the semiclassical limit. This work was motivated by the rich and interesting relativistic transport and tunneling phenomena found for electrons in graphene, which now appear in a new way. The reason is the presence of the new spin degree of freedom, which distinguishes the optical and mechanical excitations. In this spin space, the om interaction can be understood as a potential, which in our analysis consists of a time-independent and a time-dependent sinusoidal part. For the first case of a static barrier, the transport is elastic and is characterized by stationary scattering signatures. After solving the scattering problem via continuity conditions we were able to identify different scattering regimes depending on scattering parameters. In addition to relativistic phenomena such as Klein tunneling, simple parameter variation allows to use the barrier as a resonant light-sound interconverter and angle-dependent emitter. For the oscillating barrier, the transport is inelastic and is characterized by dynamic scattering signatures. To solve the time-periodic scattering problem, we have applied the Floquet theory for an effective two-level system. As a result of the barrier oscillation, photons and phonons can get and give away energy portions in the form of integer multiples of the oscillation frequency. The interference of short (classical) and long-wave (quantum) components leads to mixing of the scattering regimes. This allows to use the barrier as a time-periodic light-sound interconverter with interesting radiation characteristics. In addition, we have argued that the oscillating barrier provides the necessary energetic conditions for detecting zitterbewegung.
The Effect of the Patients Nutritional Status on Immune Alterations Induced by Ischemic Stroke
(2018)
Ischemic stroke is one of the leading causes of death and disability throughout the world.
One important aspect of stroke pathophysiology are immunological changes after stroke, especially a combination of post stroke immunodepression, leading to
infectious complications after stroke and an activation of the immune system, leading to cerebral injury. Adipose tissue has several immunological functions and obesity
leads to immunological complications and is accompanied by a chronic immune activation.
To study the effects of body weight and obesity on the immune system and measure weight and fat tissue changes after ischemic stroke we conducted the LIPS Trial and enrolled 50 stroke patients and 16 control subjects between July 2015 and July 2016. On the day of admission and on the days 1, 2, 3, 4, 5, 7, 30, 90 and 180 after admission stroke patients were weighed with an in-bed scale, body composition was measured with BIA, the triceps-skin fold thickness was measured, the NIHSS scale was obtained and blood was drawn. FACS-analysis was performed and triglycerides,cholesterol, CRP and PCT were measured at the central laboratory facility of the Universitätsmedizin Greifswald. Luminex-multiplex analysis for multiple cyto- and chemokines was performed at the Multiplex Facility at the University Leiden. A cerebral MRI and an abdominal MRI were performed shortly after admission and on days 5-7 for most patients and the infarct volume, abdominal fat and hepatic fat percentage were measured. On days 30, 90 and 180 after stroke Bartel Index and mRS were obtained.
After stroke our patients showed the typical immunological changes described previously as stroke induced immune alterations, namely a post stroke immunodepression as well as signs of an activated immune system and an acute
phase response. Our patients lost weight, but only 1.7 ± 0.5 kg. Skinfold thickness did not change during the course of our trial and abdominal fat measurement did not change in stroke patients. Immunological parameters (leukocytes, neutrophils,CRP, PCT, IL-6) did not differ between BMI subgroups (normal weight: BMI < 25,overweight: BMI ≥ 25, < 30, obese: BMI ≥ 30) and in this trial we could not detect a
difference in patients with normal weight, overweight or obesity in the post stroke periode. In an additional analysis we could show that rapid clinical improvement
did result in a rapid improvement of post stroke immune alterations, especially for leukocytes, neutrophils, IL-6 and CRP.
: An enhanced indoleamine 2,3-dioxygenase 1 (IDO1) activity is associated with an increased
mortality risk in sepsis patients. Thus, the preventive inhibition of IDO1 activity may be
a promising strategy to attenuate the severity of septic shock. 1-methyltryptophan (1-MT)
is currently in the interest of research due to its potential inhibitory effects on IDO1 and
immunomodulatory properties. The present study aims to investigate the protective and
immunomodulatory effects of 1-methyltryptophan against endotoxin-induced shock in a porcine
in vivo model. Effects of 1-MT were determined on lipopolysaccharide (LPS)-induced tryptophan
(TRP) degradation, immune response and sickness behaviour. 1-MT increased TRP and its metabolite
kynurenic acid (KYNA) in plasma and tissues, suppressed the LPS-induced maturation of neutrophils
and increased inactivity of the animals. 1-MT did not inhibit the LPS-induced degradation of TRP
to kynurenine (KYN)—a marker for IDO1 activity—although the increase in KYNA indicates that
degradation to one branch of the KYN pathway is facilitated. In conclusion, our findings provide
no evidence for IDO1 inhibition but reveal the side effects of 1-MT that may result from the proven
interference of KYNA and 1-MT with aryl hydrocarbon receptor signalling. These effects should be
considered for therapeutic applications of 1-MT.
Shunts stellen eine therapeutische Option bei intrakranieller Drucksteigerung dar. Diese Arbeit beruht auf den Ergebnissen einer Studie mit 22 Patienten. Analysiert wurden die Blut- und Liquorproben dieser Patienten im Hinblick auf die Veränderung der Nieren- und Eisenparameter sowie die Verteilung des liquor-spezifischen Beta-Trace-Proteins.
Objective: To evaluate the efficacy and tolerability of brivaracetam (BRV) in a severely drug refractory cohort of patients with epileptic encephalopathies (EE).
Method: A multicenter, retrospective cohort study recruiting all patients treated with EE who began treatment with BRV in an enrolling epilepsy center between 2016 and 2017.
Results: Forty-four patients (27 male [61%], mean age 29 years, range 6 to 62) were treated with BRV. The retention rate was 65% at 3 months, 52% at 6 months and 41% at 12 months. A mean retention time of 5 months resulted in a cumulative exposure to BRV of 310 months. Three patients were seizure free during the baseline. At 3 months, 20 (45%, 20/44 as per intention-to-treat analysis considering all patients that started BRV including three who were seizure free during baseline) were either seizure free (n = 4; 9%, three of them already seizure-free at baseline) or reported at least 25% (n = 4; 9%) or 50% (n = 12; 27%) reduction in seizures. An increase in seizure frequency was reported in two (5%) patients, while there was no change in the seizure frequency of the other patients. A 50% long-term responder rate was apparent in 19 patients (43%), with two (5%) free from seizures for more than six months and in nine patients (20%, with one [2 %] free from seizures) for more than 12 months. Treatment-emergent adverse events were predominantly of psychobehavioural nature and were observed in 16%.
Significance: In this retrospective analysis the rate of patients with a 50% seizure reduction under BRV proofed to be similar to those seen in regulatory trials for focal epilepsies. BRV appears to be safe and relatively well tolerated in EE and might be considered in patients with psychobehavioral adverse events while on levetiracetam.
Unstable environments and habitats changing due to climate change force individuals to either respond by genetic adaptation, phenotypic plasticity or by dispersal to suitable environments. Theodoxus fluviatilis (Linneaus, 1758) is a good study organisms when researching phenotypic plasticity and genetic adaptation as it naturally appears in freshwater (FW) as well as brackish water (BW) and thus inhabits a wide range of environmental salinities (0-18‰). It is a euryhaline snail that can be found in shallow waters with stony ground or on Fucus spp. and has formed regional subgroups. The brackish water and the freshwater subgroups are spatially separated and the species cannot be found in areas inbetween, e.g. estuaries.
The species shows great variability in shell patterning and shell size and there is still debate whether the subgroups are distinguishable by these traits or not. The mitochdrial RNA marker cytochrome c subunit I did not show differences between the subgroups indicating that they must be closely related, but salinity tolerance has been observed to be higher in BW snails. This might be caused by the different protein expression patterns and osmolyte accumulation (measured as ninhydrin-positive substances) observed in this species in previous studies. The exact mechanisms regulating protein expression and osmolyte accumulation, however, are not fully understood yet.
Data collected for this thesis shows differences in shell size and suggests a less strict grouping of FW and BW individuals as shell sizes of one FW site are more similar to BW individuals than the other FW ones. A better salinity tolerance towards high salinities and a higher physiological salinity limit of BW snails was confirmed and extended by demonstrating an expanded tolerance range through slow acclimation to challenging salinities in snails from both subgroups. This was achieved by a shift in the slope of their reaction norms that was much more pronounced in BW snails than FW ones. S3 individuals showed a shift similar to that of BW individuals. The data for the salinity tolerance indicates that the underlying mechanism for these tolerances are a combination of phenotypic plasticity and genetic adaptation. Despite an acclimation and shift in the slope of the reaction norms and therefore an increased tolerance towards high salinities (plasticity) FW individuals from two collection sites were not able to cope with salinities as high as BW individuals (local adaptation). The general ability to mobilise free amino acids (FAA) as organic osmolytes was not the reason for this tolerance difference. Individuals from BW and FW sites were capable of accumulating quantities of FAAs equally well. Proline, alanine and urea were the most important components of the accumulated cocktail of organic osmolytes. Even though the total amount of FAAs accumulated under hyperosmotic conditions was the same in both subgroups, there were differences in the metabolic pathways involved in osmolyte accumulation in the foot muscle. The data indicates that the hydrolysis of storage proteins and the synthesis of proline and alanine are the main processes to avoid detrimental body volume shrinkage in T. fluviatilis. While FW individuals seemed to rely on the degradation of proteins and synthesis of alanine, BW individuals depended on newly synthesising proline and alanine and accumulating urea as a side product of transamination. The accumulation of urea is a new finding in aquatic living snails and has not been reported as a mechanism to avoid cell volume shrinkage in these animals.
Differing protein expression patterns were observed under control conditions across all collection sites. 9 spots showed volume changes in BW snails opposite to those of FW snails from collection sites S1 and S2. For 6 of those spots, S3 individuals showed patterns similar to those of BW individuals and for the remaining 3 they showed patterns similar to those of FW animals. The patterns observed when exposing snails to hypo- or hyperosmotic stress were not conclusive in relation to pinpointing individual spots that show the same pattern in all collection sites, but revealed the heterogeneity of protein expression in snails from the different collection sites and in the process of osmoregulation. It also showed the general tendency of protein reduction when snails where under osmotic stress of either kind (hypo- or hyperosmotic), which supports the hypothesis of storage protein degradation.
The investigation of an ANP-receptor showed two variations of the encoding sequence expressed in T. fluviatilis. S3 individuals as well as BW individuals were found to express one type, while FW individuals, with the exception of one sample expressed the other type. This showed that the FW subgroup of T. fluviatilis seems to be more heterogeneous than the BW subgroup, but also raises the question of the dispersal history of this species. The collected data indicates that T. fluviatilis individuals are firstly capable of surviving the acidity of a duck's gizzard and secondly can tolerate acute salinity changes to 16‰ when introduced into a new environment. Hence, if snails from the FW were to be transported to waters with a salinity of up to 16‰ by man, bird, drifting plants or some other means of transport, they would most likely survive and possibly be able to thrive and spread.
The rapid anthropogenic climate change that is projected for the 21st century is predicted to have severe impacts on ecosystems and on the provision of ecosystem services. With respect to the longevity of trees, forestry in particular has to adapt now to future climate change. This requires profound multidisciplinary knowledge on the direct and indirect climate sensitivity of forest ecosystems on various spatial scales. Predictions on growth declines due to increasing drought exposition during climate change are widely recognized for European beech (Fagus sylvatica L.), which is the major forest tree in European temperate deciduous forests. However, research from other continents or other biomes has shown that winter climate change may also affect forest growth dynamics due to declining snow cover and increased soil cooling. So far, this winter cold sensitivity is largely unexplored in Europe. Thus, particularly focussing on forest growth dynamics and winter cold sensitivity, the goal of this PhD-project was to explore how climate sensitivity of forest ecosystems differs regionally. By doing so, the project aimed to deliver insights about possibilities and limits of upscaling regional knowledge to a global understanding of climate sensitivity. To achieve these goals, this PhD-project integrated five studies (Manuscripts 1–5) that investigated the climate sensitivity of biogeochemical cycles, plant species composition in forests, and forest growth dynamics across spatial scales. In particular, a large-scale gradient-design field experiment simulated the influence of winter climate change on forest ecosystems by snow cover and soil temperature manipulations (Manuscript 1). This study indicated that soil cooling and decreased root nutrient uptake may indirectly reduce growth of adult forest trees. Moreover, this study indicated uniform ecological sensitivity to soil temperature changes across sites along a large winter temperature gradient (ΔT = 4 K across 500 km), irrespective of the site-specific history of snow cover conditions, which motivates upscaling from local winter climate change studies to the regional scale. Although regional climate drives growth of adult forest trees, local factors, such as site-specific edaphic conditions, might control plants in the forest understory. This assumption was tested by mapping the forest understory composition along the same winter temperature gradient as introduced above (Manuscript 2). Across sites, this study found that edaphic conditions explained the spatial turnover in the forest understory composition more than climate, which might moderate direct climate change impacts on the forest understory composition. However, edaphic conditions, forest structure, and climate are linked by triangular interactions. Thus, climate change might still indirectly affect the forest vegetation dynamics. Moreover, a dendroecological study focussed on the same winter temperature gradient from central to cold-marginal beech populations as above in order to identify gradual changes in summer drought and winter cold sensitivity in tree growth (Manuscript 3). Towards the cold distribution margin, the influence of drought on tree growth gradually decreased, while growth reductions were increasingly related to winter cold due to harsher winter climate. By a large-scale dendroecological network study assessed the relationship of growth dynamics to climate and reproductive effort in beech forests across Europe (Manuscript 4). Indeed, this study found the general pattern across the distribution range of beech that high temperature controlled growth indirectly via resource allocation to reproduction. However, the strong, direct drought signal that could be generally detected from dry-marginal to central populations vanished towards the cold-marginal populations, where the more focussed study of Manuscript 3 identified a stronger relationship of tree growth to winter cold. Further extending the scope of this PhD-thesis to global scales, litter decomposition rates were assessed across biomes (Manuscript 5). This study found a robust relationship between climate and decomposition rates, but it also demonstrated large within-biome variability on a local scale. These local scale differences might depend on habitat conditions that, in turn, could be modulated by climate change, which calls for a better exploration of indirect climate sensitivity. In conclusion, this PhD-thesis highlighted that multidisciplinary research can advance the understanding of ecological interactions in forest ecosystems under changing climate scenarios. In this PhD-project, a winter climate change experiment, where site-representative target trees were selected by means of dendroecology, contributed to a mechanistic understanding of winter cold sensitivity in forest growth dynamics. Dendroecological investigations then put the findings in a broader temporal and spatial context by describing local climate sensitivity of tree growth on different spatial scales. This thesis further shows that global generalizations about the relationship of climate and ecological processes in ecosystem models have to be critically reviewed for the need of local and regional adjustment because these processes might experience considerable regional- or local-scale variation. However, this thesis reports uniform sensitivity of ecological processes to altered winter soil temperature regimes across a large winter temperature gradient. Thus, upscaling from insights of previous winter climate change experiments to regional scales is encouraged.
Die klinischen Ergebnisse von Fusionsoperationen an der Lendenwirbelsäule sind von vielen Faktoren abhängig. Zwei Operationsverfahren stellen derzeit den Goldstandard bei dorsalen lumbalen interkorporellen Fusionsoperationen dar, das PLIF- und das TLIF-Verfahren.
Das Ziel der Entwicklung des neuen dPLIF-Operationsverfahrens und des hierfür entwickelten Cages und Werkzeugs war, die Vorteile der PLIF-Technik und der TLIF-Technik zu vereinen. Kern der Entwicklung war es, über den dorsomedialen PLIF-Zugang einen geraden Cage einzubringen und diesen sicher in eine diagonale Lage, entsprechend der Cagelage bei der TLIF-Technik, zu rotieren. In der Anwendungsbeobachtung sollte die technische Anwendbarkeit im operativen Regelbetrieb bei guten und zur Literatur vergleichbaren klinischen Ergebnissen nachgewiesen werden. Das Cagedesign und die Verfahrenstechnik wurden am Rinderkadaver entwickelt. Nach der CE-Zulassung wurde die prospektive Anwendungsbeobachtung zur lumbalen Fusion von der Ärztekammer genehmigt. Diese umfasste 105 Patienten zwischen 27 und 87 Jahren mit symptomatischer und radiologisch nachweisbarer Wirbelsäuleninstabilität. In 87 von 105 Fällen (82,9%) konnte der dPLIF-Cage in eine diagonale Lage rotiert werden. Wenn intraoperativ eine Cageinsertion oder -rotation aus anatomischen Gründen nicht durchführbar war, war der problemlose Umstieg auf die PLIF-Technik möglich. Es wurde eine Fusionsrate von 95,2% erzielt. In prä- und postoperativen Untersuchungen konnte eine Besserung der neurologischen Symptomatik, der Einschränkungen im Alltag (ODI) und der Schmerzen (VAS) verzeichnet werden. Die Patientenzufriedenheit lag bei 87,6%. Die vorliegende Anwendungsbeobachtung zeigt, dass es möglich ist, mit dem dPLIF-Operationsverfahren einen einzelnen Cage über einen dorsomedialen PLIF-Zugang so zu platzieren, dass seine diagonale Lage der eines TLIF-Cages entspricht. Die Wahl des Operationszugangs ermöglicht die Dekompression des Spinalkanals und die Cageinsertion von nur einer Seite und erspart einen gesonderten Zugang. Dies führt zu einer im Vergleich zur PLIF-Technik kürzeren Operationszeit. Alle klinischen Parameter entsprechen denen der bisherigen Verfahren. Die Daten der Anwendungsbeobachtung ergeben auch, dass die dPLIF-Operationstechnik als sicher zu bewerten ist.
Das Kohärenzgefühl im höheren Lebensalter -Entwicklung und Validierung eines Messinstrumentes-
(2018)
In unserer Gesellschaft vollzieht sich ein demografischer Wandel, der zu einer zunehmend alternden Bevölkerung führt. Dies erfordert, Menschen höheren Lebensalters vermehrt in den Fokus von Forschung und Medizin zu rücken, einem Anspruch, dem die vorliegende Arbeit gerecht werden möchte. Zielsetzung war die Entwicklung eines auf das von Antonovsky begründeten Konzeptes der Salutogenese ausgerichteten Messinstrumentes, zur Erfassung des Kohärenzgefühls im höheren Lebensalter. Die neue Skala sollte einerseits die testspezifischen Gütekriterien Objektivität, Reliabilität und Validität erfüllen, gleichzeitig aber auch forschungsökonomischen Prinzipien gerecht werden und das vor dem Hintergrund einer zielgruppenorientierten Ausrichtung.
Die Fragebogenentwicklung vollzog sich in mehreren Teilschritten. Als Einstieg diente eine explorative Vorstudie in Form von Gruppendiskussionen, die der Itemgenerierung diente. Hieraus entstand ein Pool von 90 Items, der im Anschluss einer Expertenbefragung hinsichtlich seiner Eignung für den Fragebogen unterzogen wurde. Als Resultat entstand eine 30 Items umfassende Sammlung, in der jede SOC-Komponente quantitativ gleich vertreten war. Diese wurde einer Gruppe von sechs Probanden zur Testung auf Verständlichkeit zugeführt. In der Folge wurde ein Item umformuliert, die anderen konnten unverändert in die vorläufige Fragebogenversion, Meine Lebensorientierung, übernommen werden. Diese wurde, eingebettet in eine umfangreiche Fragebogenbatterie, im Rahmen der Greifswalder Studie zur Lebensorientierung im Alter, im Oktober 2011 in drei Kleinstädten in Norddeutschland eingesetzt. Im Anschluss fand die statistische Datenauswertung statt. Mittels Itemanalyse wurden nicht geeignete Items identifiziert und aus der Sammlung eliminiert. Als Resultat entstand eine neue Skala, Das Kohärenzgefühl im höheren Lebensalter, mit 15 Items, jeweils fünf pro SOC-Komponente. In der durchgeführten Studie zeigte diese Skala eine gute interne Konsistenz. Hingegen ließen sich die theoriegeleiteten drei SOC-Komponenten faktorenanalytisch nicht reproduzieren, auch von dem Vorliegen eines Generalfaktors ist, als weitere wichtige Erkenntnis, nicht auszugehen. Die externe Validität wurde in der Untersuchung als mittelstark berechnet.
Abschließend lässt sich festhalten, dass die finale Skala, Das Kohärenzgefühl im höheren Lebensalter, ein reliables und valides Messinstrument darstellt, das zur ökonomischen Erfassung des Kohärenzgefühls, z. B. als Screening-Methode im Rahmen der hausärztlichen oder geriatrischen Betreuung, sinnvoll seinen Einsatz finden kann.
Background: Iodine deficiency disorders (IDD) represent a global health threat to individuals and societies. IDD prevention programmes have been introduced in many parts of the world. However, challenges remain, particularly in Europe due to fragmentation and diversity of approaches that are not harmonized. Objectives: This review is dedicated to the public-health impact of IDD prevention programmes. It sums up experiences collected by the EUthyroid consortium so far and provides information on stakeholders that should be involved in actions directed to improve the impact of IDD prevention. Methods: A joint European database for combining registry-based outcome and monitoring data as well as tools for harmonizing study methods were established. Methods for analyzing thyroglobulin from a dried blood spot are available for assessing the iodine status in the general population and at-risk groups. Mother-child cohorts are used for in-depth analysis of the potential impact of mild-to-moderate iodine deficiency on the neurocognitive development of the offspring. A decision-analytic model has been developed to evaluate the long-term effectiveness and cost effectiveness of IDD prevention programmes. Results: EUthyroid has produced tools and infrastructure to improve the quality of IDD monitoring and follows a dissemination strategy targeting policymakers and the general public. There are tight connections to major stakeholders in the field of IDD monitoring and prevention. Conclusions: EUthyroid has taken steps towards achieving a euthyroid Europe. Our challenge is to inspire a greater sense of urgency in both policymakers and the wider public to address this remediable deficit caused by IDD.
Intranasal Vaccination With Lipoproteins Confers Protection Against Pneumococcal Colonisation
(2018)
Streptococcus pneumoniae is endowed with a variety of surface-exposed proteins representing putative vaccine candidates. Lipoproteins are covalently anchored to the cell membrane and highly conserved among pneumococcal serotypes. Here, we evaluated these lipoproteins for their immunogenicity and protective potential against pneumococcal colonisation. A multiplex-based immunoproteomics approach revealed the immunogenicity of selected lipoproteins. High antibody titres were measured in sera from mice immunised with the lipoproteins MetQ, PnrA, PsaA, and DacB. An analysis of convalescent patient sera confirmed the immunogenicity of these lipoproteins. Examining the surface localisation and accessibility of the lipoproteins using flow cytometry indicated that PnrA and DacB were highly abundant on the surface of the bacteria. Mice were immunised intranasally with PnrA, DacB, and MetQ using cholera toxin subunit B (CTB) as an adjuvant, followed by an intranasal challenge with S. pneumoniae D39. PnrA protected the mice from pneumococcal colonisation. For the immunisation with DacB and MetQ, a trend in reducing the bacterial load could be observed, although this effect was not statistically significant. The reduction in bacterial colonisation was correlated with the increased production of antigen-specific IL-17A in the nasal cavity. Immunisation induced high systemic IgG levels with a predominance for the IgG1 isotype, except for DacB, where IgG levels were substantially lower compared to MetQ and PnrA. Our results indicate that lipoproteins are interesting targets for future vaccine strategies as they are highly conserved, abundant, and immunogenic.
Halsschmerzen gehören zu den häufigen Beratungsanlässen in der Hausarztpraxis und sind zu circa 90% viral bedingt. Um nicht-indizierte Behandlungen mit Antibiotika zu vermeiden gibt es symptomatische Therapieoptionen. AMC / DCBA (Amylmetacresol und 2,4-Dichlorbenzylalkohol) ist eine nicht verschreibungspflichtige Wirkstoffkombination, die in Lutschtabletten (z.B. Strepsils®) enthalten ist. Die Wirkung ist antiseptisch und lokalanästhetisch.
Wir durchsuchten die Datenbanken Medline, Cochraine und EMBASE nach randomisiert kontrollierten Studien, in denen AMC / DCBA gegen Placebo oder andere lokale Behandlungsmethoden getestet wurde. Zwei Gutachter prüften unabhängig Relevanz, Einschlusskriterien und Bias der Studien. Aus den Daten der eingeschlossenen Studien wurden die gewichteten mittleren Differenzen der Schmerzreduktion berechnet.
Diese Metaanalyse fast 3 RCTs mit insgesamt 660 Patienten zusammen und vergleicht AMC / DCBA (0,6 mg Amylmetacresol, 1,2 mg 2,4-Dichlorbenzylalkohol) mit wirkstofffreien Lutschtabletten bei der Behandlung von Halsschmerzen. Berechnet wurden die gewichteten mittleren Differenzen (SMD). Hauptstudienergebnis war die Reduktion der Schmerzintensität von -1,04 Punkten (-1,28 bis -0,79; p<.00001) nach 2 Stunden im Vergleich zum Ausgangswert, gemessen auf einer 11-Punkte Ordinalskala, zum Vorteil für AMC / DCBA. Für die Nebenergebnisse wurden die Schmerzlinderung auf einer 7-Punkte-Skala von 0,89 (1,04 bis 0,73; p<0,00001) und die Linderung der Schluckbeschwerden auf der VAS100 von -0,90 (-1,06 bis -0,75; p<0,00001) nach 2h beobachtet, ebenfalls zugunsten von AMC / DCBA.
In beiden Gruppen berichteten 2 bis 16% der Probanden von Nebenwirkungen, welche meist mild und bezogen auf die eigentliche Atemwegsinfektion waren. 3 Patienten jedoch berichteten von Ulzerationen im Mund, ein Zusammenhang mit der Studienmedikation kann jedoch nicht bewiesen werden [21-23].