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Das Glioblastom ist ein hochmaligner und aggressiver Hirntumor, der von der WHO als Grad IV eingestuft wird. Die Betroffenen haben eine mittlere Überlebenszeit von 12 bis 15 Monaten, was auf dem invasiven Wachstum und der Chemo- und Radioresistenz des Tumors beruht. Dadurch existiert keine kurative Behandlung und es kommt in nahezu allen Fällen zu Rezidiven. Zunehmend wird deutlich, dass das Glioblastom einen stark veränderten Energiestoffwechsel aufweist, wobei das sogenannte lipidomic remodelling (Koundouros und Poulogiannis, 2020), welches für maßgebliche Alterationen im Fettsäuremetabolismus sorgt, besonders interessant erscheint. Die Fettsäureoxidation sowie damit assoziierte Prozesse und Proteine sind als eine bedeutende Energiequelle in den Fokus der Forschung getreten. So auch der hoch-affine Carnitintransporter OCTN2 (SLC22A5), welcher essentiell für den Carnitinhaushalt und damit die β-Oxidation der Zelle ist. In der vorgelegten Arbeit wurde daher das komplexe OCTN2/L-Carnitin System in seiner Funktion als potenzielle pharmakologische Zielstruktur zur therapeutischen Intervention beim Glioblastom tiefergehend untersucht und vorhandenes Wissen weiter ausgebaut. Hierzu diente eine Vielzahl experimenteller Bedingungen und Methoden, um Teilcharakteristiken des Glioblastoms darzustellen und die Bedeutung des OCTN2/L-Carnitin System zu überprüfen.
Da in vorausgegangenen Studien eine erhöhte Expression von OCTN2 mit einem signifikant schlechteren Überleben von Patienten mit Glioblastom nachgewiesen werden konnte, wurden als weitere potentiell interessante Zielstrukturen der niedrig-affine Carnitintransporter OCTN1 (SLC22A4) sowie Komponenten der β-Oxidation (CPT1C, CRAT) in die Patientenanalysen eingeschlossen. Zwar konnte für OCTN1 eine signifikant erhöhte mRNA-Expression in den humanen Glioblastomproben festgestellt werden, diese war jedoch nicht mit dem Überleben der Patienten assoziiert. Auch CPT1C und CRAT zeigten sich nicht als relevante Zielstrukturen beim Glioblastom.
In den durchgeführten Zellkulturexperimenten mit humanen LN-18 und murinen GL261 Glioblastomzellen zeigten sich partiell signifikante Effekte auf die wachstumsfördernden Kinasen AKT1 und ERK1/2, deren Phosphorylierungsgrad durch L-Carnitin moduliert wurde und die damit möglicherweise an carnitinvermittelten Wirkungen beteiligt sein könnten. Auf die Zellviabilität und Zellvitalität ließen sich hemmende Wirkungen des OCTN2-Inhibitors Meldonium sowie des CPT1-Hemmstoffes Etomoxir nachweisen, welche teilweise durch die zusätzliche Gabe von L-Carnitin revertiert wurden. Hinsichtlich der durch Zytostatika (Doxorubicin, Carmustin, Vincristin und Temozolomid) induzierten Apoptose konnte L-Carnitin nur die durch Carmustin in niedriger Dosierung ausgelöste Caspase-3 Aktivierung verhindern. Ein durch L-Carnitin ausgelöster Effekt auf die Migration der Glioblastomzellen konnte nicht nachgewiesen werden, jedoch wurde die migratorische Aktivität durch die Zytostatika Temozolomid und Carmustin, sowie interessanterweise auch durch den CPT1-Inhibitor Etomoxir, beeinträchtigt.
Um die Möglichkeit einer zielgerichteten Therapie gegen das OCTN2/L-Carnitin System präklinisch zu evaluieren, wurden tierexperimentelle Studien durchgeführt. Unter Verwendung eines orthotopen Glioblastommodelles der Maus konnte gezeigt werden, dass Etomoxir und Meldonium einen hemmenden Einfluss auf das in vivo Tumorwachstum besitzen, wobei dieser Effekt nur für den OCTN2-Inhibitor Meldonium signifikant ausfiel. In den OCTN2-defizienten jvs(-/-)-Mäusen konnte keine ausreichende Anzahl von Versuchstieren erreicht werden, um zuverlässige und finale Aussagen zu tätigen. In den heterozygoten jvs(+/-)-Mäusen, die zwar phänotypisch unauffällig sind, aber durch die geringere OCTN2 Ausstattung verminderte Carnitin-Gewebespiegel aufweisen, zeigte sich eine leichte, nicht signifikante Reduktion des intrazerebralen Tumorwachstums im Vergleich zu den C57BL/6-Wildtyp Mäusen.
Zusammenfassend wurde in der vorliegenden Arbeit das OCTN2/L-Carnitin System und seine Bedeutung für das Glioblastom umfassend dargelegt und experimentell überprüft. Als Endresultat dieser Studie können Etomoxir und Meldonium als Substanzen zur zielgerichteten Beeinflussung des Glioblastomwachstums angesehen werden und sollten in weiteren Versuchsreihen detailliert auf ihre Eignung für die Entwicklung neuer Therapieformen überprüft werden.
Bei spezifischen klinischen Konstellationen ist eine Lumbalpunktion zur Liquoranalytik
wichtig, um die Ätiologie der epileptischen Anfälle bzw. eines Status epilepticus zu klären und
alternative Erkrankungen auszuschließen. Die im Rahmen der vorliegenden Studie entwickelte
IDEAL-Checkliste stellt vor diesem Hintergrund einen einfach umzusetzenden und in den
klinischen Alltag leicht zu implementierenden Algorithmus dar, der behandelnde Ärztinnen
und Ärzte bei der Entscheidung für oder gegen die Durchführung einer Liquoruntersuchung
unterstützt. Gleichzeitig bewahrt die Anwendung der Checkliste Patientinnen und Patienten vor
einer nicht notwendigen Liquorpunktion mit entsprechenden Risiken. In den hier vorliegenden
Studien hätte bei etwa der Hälfte der Fälle (43 % in der prospektiven bzw. 49 % in der
retrospektiven Kohorte) auf eine Lumbalpunktion verzichtet werden können. Damit hätten die
periprozedurale Belastung der Patientinnen und Patienten sowie potentielle Komplikationen
einer Lumbalpunktion vermieden werden können.
Gleichzeitig besteht aufgrund des hohen negativen prädiktiven Wertes von 99-100 % eine hohe
Wahrscheinlichkeit eine liquorrelevante Ätiologie auch nicht zu übersehen, wenn kein Item der
kombinierten IDEAL-Checkliste zutrifft und damit auf eine Lumbalpunktion zur Liquoranalyse
verzichtet wird.
Eine multizentrische, prospektive Beobachtungsstudie sollte unter Anwendung der nationalen
und demographischen MoCA-Werte und auch im Hinblick auf unterschiedliche
Diagnostikstrategien bzw. Indikationskriterien, die breite klinische Anwendung, aber auch die
Erfassung seltener Ätiologien (z. B. immunsupprimierte Patientinnen und Patienten,
systemische Autoimmunerkrankungen) zur weiteren Validierung der IDEAL-Checkliste
erfolgen.
Purpose
The German Retina.net ROP registry and its Europe-wide successor, the EU-ROP registry, collect data from patients treated for ROP. This analysis compares input parameters of these two registries to establish a procedure for joint analyses of different registry data using exemplary datasets from the two registries.
Methods
Exemplary datasets from the two databases over a 1-year period each (German Retina.net ROP Registry, 2011, 22 infants; EU-ROP Registry, 2021, 44 infants) were compared. The parameters documented in the two databases were aligned and analysed regarding demographic parameters, treatment modalities, complications within first 24 h and retreatments.
Results
The current analysis showed that data can be aligned for joint analyses with some adjustments within the data structure. The registry with more detailed data collection (EU-ROP) needs to be reduced regarding granularity in order to align the different registries, as the registry with lower granularity determines the level of analyses that can be performed in a comparative approach. In the exemplary datasets, we observed that the overall most common ROP severity in both registries was zone II, 3+ (2011: 70.5%; 2021: 65%), with decreasing numbers of clock hours showing preretinal neovascularisations (2011: 10–12 clock hours in 29% of cases, 2021: 4–6 clock hours in 38%). The most prevalent treatment method was laser coagulation in 2011 (75%) and anti-VEGF therapy in 2021 (86.1%). Within the anti-VEGF group, all patients were treated with bevacizumab in 2011 and with ranibizumab in 2021. Retreatment rates were comparable in 2011 and 2021.
Conclusion
Data from two different ROP registries can be aligned and jointly analysed. The analysis reveals a paradigm shift in treatment modalities, from predominantly laser to anti-VEGF, and within the anti-VEGF group from bevacizumab to ranibizumab in Germany. In addition, there was a trend towards earlier treatment in 2021.
Hibernation is a widespread adaptation in animals to seasonally changing environmental conditions. In the face of global anthropogenic change, information about plastic adjustments to environmental conditions and associated mortality costs are urgently needed to assess population persistence of hibernating species. Here, we used a five-year data set of 1047 RFID-tagged individuals from two bat species, Myotis nattereri and Myotis daubentonii that were automatically recorded each time they entered or left a hibernaculum. Because the two species differ in foraging strategy and activity pattern during winter, we expected species–specific responses in the timing of hibernation relative to environmental conditions, as well as different mortality costs of early departure from the hibernaculum in spring. Applying mixed-effects modelling, we disentangled population-level and individual-level plasticity in the timing of departure. To estimate mortality costs of early departure, we used both a capture mark recapture analysis and a novel approach that takes into account individual exposure times to mortality outside the hibernaculum. We found that the timing of departure varied between species as well as among and within individuals, and was plastically adjusted to large-scale weather conditions as measured by the NAO (North Atlantic Oscillation) index. Individuals of M. nattereri, which can exploit milder temperatures for foraging during winter, tuned departure more closely to the NAO index than individuals of M. daubentonii, which do not hunt during winter. Both analytical approaches used to estimate mortality costs showed that early departing individuals were less likely to survive until the subsequent hibernation period than individuals that departed later. Overall, our study demonstrates that individuals of long-lived hibernating bat species have the potential to plastically adjust to changing climatic conditions, although the potential for adjustment differs between species.
We apply the charge simulation method (CSM) in order to compute the logarithmic capacity of compact sets consisting of (infinitely) many “small” components. This application allows to use just a single charge point for each component. The resulting method therefore is significantly more efficient than methods based on discretizations of the boundaries (for example, our own method presented in Liesen et al. (Comput. Methods Funct. Theory 17, 689–713, 2017)), while maintaining a very high level of accuracy. We study properties of the linear algebraic systems that arise in the CSM, and show how these systems can be solved efficiently using preconditioned iterative methods, where the matrix-vector products are computed using the fast multipole method. We illustrate the use of the method on generalized Cantor sets and the Cantor dust.
An already existing shortage of nurses was exacerbated by the COVID-19 pandemic. Inactive (former) nurses were regarded as a so-called silent reserve and were called upon by various agencies to volunteer for nursing. The question arose as to what factors might encourage or hinder such volunteering and facilitate deployment.
First, inactive nurses were asked via an online survey whether they had registered for deployment or not and what the reasons were for this decision. Further information on professional background was collected, including the reason for having left the profession in the first place. Based on the results of the online survey, focus group discussions were conducted with registered and unregistered inactive nurses, with nurses who had returned to the profession permanently, and with care home managers.
Only one third of the participants in the online survey said they had registered for a temporary assignment during the pandemic. The main reasons for registering were that inactive nurses ‘wanted to do their bit’ to manage the crisis, felt it was their duty and/or felt a sense of belonging to the nursing profession. The main reasons given for not having registered was that respondents ‘could not see a reason at the moment’, had health concerns, and ‘other relevant job commitments’. The majority of respondents still had jobs related to health, care or nursing.
The topics covered in the focus group discussions included the following: perception of the pandemic as a crisis, identity as a nurse and sense of professional commitment, role of current occupation in the decision to register, winning over inactive nurses with a very negative attitude towards returning to care during a crisis situation, support measures and offers regarding a deployment in nursing.
Both in the online survey and in the focus group discussions, a sense of belonging to the nursing profession was evident among many participants. However, this identity does not necessarily lead to a willingness to return to nursing during a crisis situation. Weighing up the risk of deployment against the positive or negative experiences gained during the active period can influence willingness. However, the possibility of taking a break from current work and returning to nursing at short notice is not always given. Many inactive nurses continue to work in the health sector and fulfil equally important tasks during a crisis situation which render them unavailable for deployment.
Different kinds of support for those willing to return to nursing during a crisis situation and communication on conditions of deployments need to be implemented and continuously improved to offer the inactive nurses the greatest possible security and to enable a largely unbureaucratic deployment.
Background
Neuroinflammation and maladaptive neuroplasticity play pivotal roles in migraine (MIG), trigeminal autonomic cephalalgias (TAC), and complex regional pain syndrome (CRPS). Notably, CRPS shares connections with calcitonin gene-related peptide (CGRP) in its pathophysiology. This study aims to assess if the documented links between CRPS and MIG/TAC in literature align with clinical phenotypes and disease progressions. This assessment may bolster the hypothesis of shared pathophysiological mechanisms.
Methods
Patients with CRPS (n = 184) and an age-/gender-matched control group with trauma but without CRPS (n = 148) participated in this case–control study. Participant answered well-established questionnaires for the definition of CRPS symptoms, any headache complaints, headache entity, and clinical management.
Results
Patients with CRPS were significantly more likely to suffer from migraine (OR: 3.23, 95% CI 1.82–5.85), TAC (OR: 8.07, 95% CI 1.33–154.79), or non-classified headaches (OR: 3.68, 95% CI 1.88–7.49) compared to the control group. Patients with MIG/TAC developed CRPS earlier in life (37.2 ± 11.1 vs 46.8 ± 13.5 years), had more often a central CRPS phenotype (60.6% vs. 37.0% overall) and were three times more likely to report allodynia compared to CRPS patients with other types of headaches. Additionally, these patients experienced higher pain levels and more severe CRPS, which intensified with an increasing number of headache days. Patients receiving monoclonal antibody treatment targeting the CGRP pathway for headaches reported positive effects on CRPS symptoms.
Conclusion
This study identified clinically relevant associations of MIG/TAC and CRPS not explained by chance. Further longitudinal investigations exploring potentially mutual pathomechanisms may improve the clinical management of both CRPS and primary headache disorders.
Trial registration
German Clinical Trials Register (DRKS00022961).
Perception of climate change-related forest dieback in mountain forests among the local population
(2023)
Mountain forests provide multiple benefits but are threatened by climate change-induced forest dieback. Although many studies summarize perceptions of forest ecosystem services, relatively few deal with mountain forests. The local population’s perception of forest dieback in mountain forests in relation to climate change has rarely been investigated so far. Their perspective is relevant as local people are often deeply attached to “their” forests, they actively use forest ecosystems and—as voters and taxpayers—they need to support the state’s adaptation and funding measures. Therefore, this study investigates the climate change and forest dieback perception of local inhabitants in two mountain areas of Southern Germany (the German Alps and the Bavarian Forest) with a quantitative survey based on representative online samples (n = 709). Relying conceptually on van der Linden’s (J Environ Psychol 41:112–124, 2015. https://doi.org/10.1016/j.jenvp.2014.11.012) climate change risk perception model, the results show that experiential processing, cognitive and socio-cultural factors are related to locals’ forest dieback and climate change perception, while socio-demographics show no or few connections. Nearly two-thirds (64.7%) of the respondents perceive moderate to strong forest dieback, while more than half (55.0%) of the respondents already observe consequences of climate change. The perceptions of climate change and forest dieback are positively correlated with medium to high strength. This shows that forest dieback could be interpreted as an indicator of climate change, which is difficult to observe due to its long-term nature. We identify three groups of respondents regarding preferred forest adaptation strategies to climate change. In general, respondents support nature-based forest adaptation strategies over intense measures.
Toarciconiopteryx dipterosimilis gen. et sp. nov. is described from the Lower Toarcian of Grimmen (Western Pomerania, Germany) based on a hind wing. This enigmatic wing superficially resembles a dipteran forewing, but analysis in detail establishes that it belongs to the Neuroptera. We assign it to the Coniopterygidae with great confidence by its great concordance with the hind wings of that family, but a small possibility remains that it might belong to the Dipteromantispidae, although the very derived haltere-like hind wings of all its known members are entirely unlike it. We, therefore, consider it to be the oldest record of Coniopterygidae. We create the new subfamily Toarciconiopteryginae subfam. nov. for it, which is distinguished from other Coniopterygidae by its hind wings possessing two branches of RP and a proximal forking of M. These conditions are also known in some Sialidae (Megaloptera), supporting the hypothesis that Coniopterygidae is the sister group of all other Neuroptera, as Megaloptera is considered by most authors to be sister to Neuroptera. New interpretations of some aspects of the Coniopterygidae venation are proposed.
Seventeen bacterial strains able to suppress plant pathogens have been isolated from healthy Vietnamese crop plants and taxonomically assigned as members of the Bacillus cereus group. In order to prove their potential as biocontrol agents, we perform a comprehensive analysis that included the whole-genome sequencing of selected strains and the mining for genes and gene clusters involved in the synthesis of endo- and exotoxins and secondary metabolites, such as antimicrobial peptides (AMPs). Kurstakin, thumolycin, and other AMPs were detected and characterized by different mass spectrometric methods, such as MALDI-TOF-MS and LIFT-MALDI-TOF/TOF fragment analysis. Based on their whole-genome sequences, the plant-associated isolates were assigned to the following species and subspecies: B. cereus subsp. cereus (6), B. cereus subsp. bombysepticus (5), Bacillus tropicus (2), and Bacillus pacificus. These three isolates represent novel genomospecies. Genes encoding entomopathogenic crystal and vegetative proteins were detected in B. cereus subsp. bombysepticus TK1. The in vitro assays revealed that many plant-associated isolates enhanced plant growth and suppressed plant pathogens. Our findings indicate that the plant-associated representatives of the B. cereus group are a rich source of putative antimicrobial compounds with potential in sustainable agriculture. However, the presence of virulence genes might restrict their application as biologicals in agriculture.
Peatlands contribute to a wide range of ecosystem services. They play an important role as carbon sinks in their natural state, but when they are drained, they cause carbon emissions. Rewetting drained peatlands is required to reduce carbon emissions and create new carbon sinks. However, drained peatlands are commonly used as grassland or croplands; therefore, alternative agriculture schemes are required following rewetting. Paludiculture, i.e., agriculture on wet and rewetted peatlands, is an option in these areas after rewetting to produce biomass sustainably. Monitoring of peatland management is challenging, yet needed to ensure a successful rewetting and plantation of, e.g., Phragmites australis and Typha spp., two plants which are commonly used in paludiculture. Remote sensing is an excellent tool for monitoring the vegetation composition of vast rewetted peatland regions. However, because many peatland species have similar spectral characteristics, such monitoring is ideally based on high-spatial, high-temporal hyperspectral images. Data that complies with all these requirements does not exist on a regular basis. Therefore, we assessed the potential for mapping peatland vegetation communities in the Peene and Trebel river basins of the federal state of Mecklenburg-Western Pomerania, Germany, using multi-date hyperspectral (PRISMA) data. We used regression-based unmixing to map fractions of different peatland vegetation classes. Results were analyzed with regard to the contribution of multi-date observations and, in comparison, to multispectral datasets (Landsat-8/Sentinel-2). Our results showed that different classes are best mapped at different observation dates. The multi-date hyperspectral datasets produced less Mean Absolute Error (MAE = 16.4%) than the single-date hyperspectral images (ΔMAE + 1%), with high accuracies for all classes of interest. Compared to the results obtained with multispectral data from similar acquisition dates and annual spectral-temporal metrics (STM), the results from hyperspectral data were always clearly superior (ΔMAE + 4%). Besides the superior performance during comparisons, our results also indicate that information that can be derived from the hyperspectral data with the regression-based unmixing goes clearly beyond that of discrete classification. With more hyperspectral sensors coming up and an expected higher availability of multi-data hyperspectral imagery, these data can be expected to play a bigger role in the future monitoring of peatlands.
The male genitalia of pholcid spiders, which is one of the most species-rich spider families, are characterized by a procursus, which is a morphologically diverse projection of the copulatory organ. It has been shown that the procursus interacts with the female genitalia during copulation. Here, we investigate the function of the procursus in Gertschiola neuquena, a species belonging to the early branched and understudied subfamily Ninetinae, using behavioural and morphological data. Although many aspects of the copulatory behaviour of G. neuquena follow the general pattern described for the family, males use only one pedipalp during each copulation. Based on our micro-CT analysis of cryofixed mating pairs using virgin females, we can show that the long and filiform procursus is inserted deeply into the unpaired convoluted female spermatheca, and the intromittent sclerite, the embolus, is rather short and stout only reaching the most distal part of the female sperm storage organ. Histological data revealed that sperm are present in the most proximal part of the spermatheca, suggesting that the procursus is used to allocate sperm deeply into the female sperm storage organ. This represents the first case of a replacement of the sperm allocation function of the intromittent sclerite in spiders.
Fortbildungen sind zentrale Lerngelegenheiten für die Professionalisierung pädagogischen Personals in Kindertageseinrichtungen. Inwiefern Inhalte von Fortbildungen in der alltäglichen Praxis Anwendung finden, stellt ein zentrales Qualitätskriterium von Fortbildungen dar. Daher existieren vielfältige Vorstellungen und Konzepte darüber, wie diese Anwendung – der Transfer – unterstützt werden kann. Der vorliegende Beitrag greift theoretische und empirische Erkenntnisse aus der Bildungs- und Lehr-Lernforschung auf und stellt ein Modell der Wissenstransformation von der Theorie in Handlungen und von Handlungen in die Theorie vor. Zentral an diesem Modell ist die Vorstellung, dass Wissen durch verschiedene Akteure (Fortbildner_innen sowie pädagogische Fachkräfte) transformiert wird und kontextuelle sowie individuelle Merkmale diesen Transformationsprozess beeinflussen. Implikationen für Forschung und -praxis werden diskutiert.
The multi-cell Penning–Malmberg trap concept has been proposed as a way to accumulate and confine unprecedented numbers of antiparticles, an attractive but challenging goal. We report on the commissioning and first results (using electron plasmas) of the World's second prototype of such a trap, which builds and improves on the findings of its predecessor. Reliable alignment of both ‘master’ and ‘storage’ cells with the axial magnetic field has enabled confinement of plasmas, without use of the ‘rotating wall’ (RW) compression technique, for over an hour in the master cell and tens of seconds in the storage cells. In the master cell, attachment to background neutrals is found to be the main source of charge loss, with an overall charge-confinement time of 8.6 h. Transfer to on-axis and off-axis storage cells has been demonstrated, with an off-axis transfer rate of 50% of the initial particles, and confinement times in the storage cells in the tens of seconds (again, without RW compression). This, in turn, has enabled the first simultaneous plasma confinement in two off-axis cells, a milestone for the multi-cell trap concept.
Das Zurücktreten der Erzählstimme in der Literatur der Hebräischen Bibel wurde oft benannt. Dies wurde allerdings nur selten mit der erzähltheoretischen Analysekategorie des Modus fundiert. Letzteres gilt besonders für die Darstellung von Figurenrede. Dabei ist umstritten, ob sich neben direkter und indirekter Rede auch erlebte Rede in der Hebräischen Bibel nachweisen lässt. Diese vor allem von Meir Sternberg vertretene Möglichkeit hat Cynthia L. Miller abgelehnt. Millers Einwände lassen sich aber mit einer linguistisch fundierten Erzählanalyse hinterfragen, was die grundsätzliche Möglichkeit erlebter Rede bei wᵉhinne-Phrasen begründet.
The controlled formation and adjustment of size and density of magnetic skyrmions in Ta/CoFeB/MgO trilayers with low Dzyaloshinskii–Moriya interaction is demonstrated. Close to the out-of-plane to in-plane magnetic spin reorientation transition, we find that small energy contributions enable skyrmion formation in a narrow window of 20 pm in CoFeB thickness. Zero-field stable skyrmions are established with proper magnetic field initialization within a 10 pm CoFeB thickness range. Using magneto-optical imaging with quantitative image processing, variations in skyrmion distribution and diameter are analyzed quantitatively, the latter for sizes well below the optical resolution limit. We demonstrate the controlled merging of individual skyrmions. The overall demonstrated degree of comprehension of skyrmion control aids to the development of envisioned skyrmion based magnetic memory devices.
Recent experimental campaigns in the Wendelstein 7-X stellarator, a
plasma-confining device designed to investigate the Magnetic Confinement Fusion
(MCF) approach to generating electrical power, have shown that the injection of
fuelling pellets had an unexpected and considerable impact on the performance of
the plasma. Rather than simply refuelling the device and `diluting' the plasma
energy, pellet injection is followed by a significant increase in the ratio of
the ion temperature to the electron temperature. It has been suggested that this
is not merely due to the improved confinement following the reduction of
turbulent transport after the pellet material has homogenised with the bulk
plasma, but also due to a direct transfer of energy from electrons to ions. The
proposed mechanism for this energy transfer is the ambipolar expansion of the
pellet plasmoid, the localised plasma structure produced by the
ionisation of ablated pellet material, along magnetic field lines.
Early work on pellet plasmoid expansion predicted that half the heating power
deposited in plasmoid electrons by collisions with hot ambient electrons is
transferred to plasmoid ions in the form of flow velocity as the plasmoid
expands. The complicated nature of the system of the pellet plasmoid embedded in
the ambient plasma, particularly the behaviour of electrons, which experience
many collisional and collisionless phenomena on multiple disparate timescales,
means that early models of the expansion were not wholly self-consistent, but
rather made use of strong approximations that apply in some regions of the
plasmoid but not in others. For example, only electrons and ions associated with
the plasmoid were rigorously treated, meaning that the framework was one of
`expansion into vacuum'. Combined with the assumption of Maxwellian electrons,
this led to an electric potential that was unbounded at infinity. Naturally, the
validity of the conclusions of such a model are called into question because the
approximations lose their validity far from the plasmoid and as time advances,
yet predictions about the final state of the plasma are desired. A deeper
investigation is required: careful consideration of the phenomena in question
and the timescales (and lengthscales) on which they act must be made in order to
rigorously construct a model that is valid throughout the entire expansion.
The first two papers presented in this thesis iterate on the model established
in the paper that first predicted the electron-to-ion energy transfer; their aim
was to find out how the character of the expansion changes with a more
sophisticated and accurate description of various phenomena, while remaining
within the existing framework of expansion into vacuum. Ultimately, we find that
the qualitative character is unchanged, and that approximately half the heating
power deposited in plasmoid electrons is transferred to ions.
Two other papers in this thesis address the limitations of the original model.
This is achieved by properly considering the electron kinetic problem in a
plasmoid. One paper considers the electron kinetic problem when electrons are
highly isotropised. In this case the kinetic equation can be integrated to
remove all but two independent variables, which is the maximum possible
reduction considering it is a time-dependent problem. The full nonlinear
integro-differential Landau self-collision operator is integrated exactly and
few approximations are made, leading to a rather general kinetic equation.
However, for fuelling pellets some anisotropy in the electron distribution is
expected. Another paper considers the electron kinetic problem (and the entire
plasmoid expansion) allowing for electron anisotropy. Careful consideration of
the ordering of timescales of electron phenomena in a pellet plasmoid leads to a
steady-state kinetic problem that we call collisional quasi-equilibrium (QE). QE
appears in many ways similar to the collisional steady-state characterising a
true thermal equilibrium. It was found that the time-dependent kinetic problem
of the earlier paper, with isotropic electrons, produces the QE distribution
function, corroborating the existence of the QE state. We then take moments of
the electron kinetic equation that is valid on the expansion timescale, assuming
that the electron distribution is that given as the solution to the QE kinetic
problem. This is completely analogous to what is done to obtain the Braginskii
equations or any Chapman-Enskog theory. The result is a set of equations for the
long-term evolution of the macroscopic quantities that describe the distribution
function existing in a quasi-steady-state at each point in time. It is from this
point that one may feasibly describe the plasmoid expansion with an accurate
picture of the electron kinetics and finally obtain the electron-to-ion energy
transfer so desired in a rigorous model of the expansion.
From a broader point of view, the two frameworks provided by these rigorous
investigations of the electron kinetic problem serve as a basis for the future
study of plasmoids. Such a `first-principles' approach to plasmoid dynamics is
novel and interesting in its own right, but it will be demonstrated that such an
approach is essential for pellet plasmoids owing to the fact that they are
poorly described by the `standard tools' of plasma physics.
Using the QE framework it was found that, once more, about half the heating
power experienced by plasmoid electrons is transferred to plasmoid ions. The
incredible robustness of the prediction of such an energy transfer is, in the
author's opinion, the result of the self-similar nature of the expansion found
as a solution to the original model. As a rule, the profiles of self-similar
solutions tend to be attractors for the `real', more complicated, system, and
the qualitative predictions involving no parameters, of which the
electron-to-ion energy transfer is one, tend to be very sturdy.
Aside from fuelling pellets, composed of hydrogen or deuterium, one paper in
this thesis investigates the physics of high-Z pellets that are designed to
terminate the plasma safely in the event of a `disruption', where much of the
magnetic field energy is channelled into a runaway electron beam with
potentially disastrous consequences if the beam encounters a plasma-facing
component. The paper draws on the work carried out in the paper concerning the
kinetic problem of isotropised electrons in a plasmoid.
This thesis is `cumulative'; the vast majority of the work carried out is
described within a set of Papers, labelled A-E, placed at the back of the text.
There is a preceding `wrapper text' (given in numbered Sections) tasked with
introducing the reader to the topic, guiding the reader through the papers, and
expounding some of their main results. Some amount of material not present in
the papers is also provided in the wrapper text. Naturally, the wrapper text
mainly focusses on the results of the papers which are under my first
authorship. In the course of publishing papers over an extended period of time
the nomenclature is bound to vary. Although it is mostly consistent between the
papers, a few difference do arise, and the section `Common symbols and
subscripts' is provided in the frontmatter to alleviate confusion. Particular
care should be taken with the symbols x and z; both can refer to the
coordinate parallel to the magnetic field line, but in papers where z is used
for this purpose x tends to have another definition. In the wrapper text the
choice of symbols is generally chosen to reflect those in the corresponding
paper.
Minced Cartilage Implantation in Acetabular Cartilage Defects: Case Series with 2-Year Results
(2023)
Objective
The objective was to evaluate clinical outcome and safety of arthroscopic, autologous minced cartilage implantation for acetabular cartilage lesions observed during hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS).
Design
Eleven male patients, average age: 29.4 ± 5.4 years, average body mass index (BMI): 24.2 ± 2.2 kg/m2, scheduled for hip arthroscopy due to FAIS accompanied by an acetabular cartilage lesion were included in the case series. Cartilage tissue was harvested and minced from the loose cartilage flap at the chondrolabral lesion by arthroscopic shaver, augmented with autologous conditioned plasma, implanted into the defect, and fixated by autologous thrombin. Concomitant interventions were performed as indicated. The patients were evaluated preoperatively and at 24-month follow-up, using the International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) pain score and by magnetic resonance imaging (MRI) using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) grading scale at the 2-year follow-up.
Results
The defect size was on average 3.5 cm2 (1.5-4.5 cm2). From preoperatively to 2 years postoperatively, the iHOT-12 significantly improved from 50.2 ± 18 to 86.5 ± 19 (P < 0.0001), and pain score decreased from 5.6 ± 1.8 to 1.0 ± 1.5 (P < 0.0001) on the Visual Analog Scale pain score. Regarding functional outcome and pain, 10 of the 11 patients and all patients reached the minimal clinically important difference (MCID), respectively. The postoperative average MOCART score was 87.2 (± 9.2). No adverse events or reoperations were observed.
Conclusions
Arthroscopic, autologous minced cartilage implantation for treating full-thickness acetabular cartilage lesions in FAIS shows statistically and clinically significant improvement at short-term follow-up.
Background:
Minced cartilage implantation (MCI) has seen a renaissance in recent years. In this evolved technique, human articular cartilage is harvested with an arthroscopic shaver, augmented with platelet-rich plasma (PRP), and implanted with autologous thrombin. This modified technique combines the possibility of cell-based surgical cartilage repair with a minimally invasive autologous 1-step procedure. However, evidence on cell survival and preserved function after shaver-based mincing and PRP supplementation is limited.
Purpose:
To evaluate the effects of arthroscopic shaver mincing and augmentation with PRP on human cartilage tissue.
Study Design:
Controlled laboratory study.
Methods:
Standardized samples were taken from 12 donors during autologous MCI. A comparison of cell outgrowth, cell viability, proliferation capacity, and ability to produce extracellular matrix–specific proteoglycans after chondrogenic redifferentiation was made between cartilage taken by curettage from the border of the cartilage defect, cartilage tissue minced by an arthroscopic shaver, and cartilage tissue minced by an arthroscopic shaver that was additionally augmented with autologous PRP.
Results:
There was no difference between all 3 groups in terms of cell outgrowth or proliferation capacity. Metabolic activity relative to the cell number of chondrocytes isolated from shaver-minced cartilage was higher compared with chondrocytes isolated from cartilage that was derived by curettage or shaver-minced cartilage that was augmented with PRP. After chondrogenic stimulation, the normalized proteoglycan content was higher in spheroids of cells derived from shaver-minced cartilage augmented with PRP than in spheroids of cells derived from curettage. A high correlation of cell outgrowth, proliferation capacity, and viability between isolated cells from all 3 groups taken from an individual donor was observed.
Conclusion:
Chondrocytes isolated from human cartilage tissue that was harvested and minced with an arthroscopic shaver remained viable and proliferative. The augmentation of shaver-minced cartilage with PRP led to the enhanced proteoglycan production of chondrogenic spheroids in vitro, pointing toward the development of a cartilage-specific extracellular matrix. This in vitro study yields promising results regarding the use of an arthroscopic shaver and augmentation with PRP in the context of MCI.
Clinical Relevance:
Knowledge that shaver mincing and augmentation with PRP are feasible for processing articular cartilage during MCI is highly relevant for surgical cartilage repair.