Open Access

Objective: Edema and subjective leg complaints, such as pain, tightness, tiredness and heaviness after long standing or sitting, are defined as orthostatic leg complaints or occupational edema. Compression hosiery should help to prevent or decrease those symptoms. The objective was to assess the effects on leg discomforts and leg volume, and wearing comfort in two medical below-knee compression stocking types with an interface pressure of 18 – 20 mmHg (A vs. B) and a below-knee-low-pressure support stocking (LPSS) with an interface pressure of 8-10mmHg (C). Methods: Two different types of below-knee medical compression stockings with an interface pressure of 18 – 20 mmHg (A vs. B) and a below-knee-low-pressure support stocking (LPSS) with an interface pressure of 8-10mmHg (C) were examined in this randomized, blinded, crossover trial (RCT) with 49 healthy volunteers having leg discomforts and edema after being in an upright position during the day. Stocking Type B had special fabrication properties in the in heel and instep-area of the foot. Participants were divided into two cohorts, and each type of stocking was worn for three consecutive days in one week with a subsequent washout phase. The cohorts were named after the respective sequence of the wearing period (ABC/BAC). The assessment of effects and wearing comfort was ascertained by questionnaires. Volume changes in the lower leg were measured with the Bodytronic 600® (Bauerfeind AG, Zeulenroda, Germany). Results: A significant reduction of lower leg volume (mean Stocking Type A: 204.7 ml; mean Stocking Type B: 153.5 ml; mean stocking type C: 48.2ml) and a significant reduction of the life-quality dimension (LQD) leg-complaints (p = 0.0000) was achieved by all three types of stockings. Compared to the LPSS both compression stockings had a significant better fit (p<0.006). Conclusion: Below-knee medical compression stockings with an interface pressure 18-21mmHg and LPSS with an interface pressure of 8-10 mmHg can significantly reduce occupational orthostatic edema and leg discomforts which are due to long standing and sitting activities. Because of the custom fit, medical below-knee compression stockings are having a significant better wearing comfort than commercial LPSS and should be preferred when prescribing compression stockings to prevent occupational edema.

Methane (CH4) is a potent greenhouse gas with rising atmospheric concentrations. Microorganisms are essential players in the global methane cycle. In fact, the largest part of methane emissions derives from microbial production by methanogenic Archaea (methanogens). Microorganisms do not only produce methane: methanotrophs can also oxidize the methane produced by methanogens. In addition, soil methanotrophs are the only biological methane sink, oxidizing up to 30-40 Tg of this potent greenhouse gas per year worldwide. However, intensified management of grasslands and forests may reduce the methane sink capacity of soils. In general, the interaction of methanogens and methanotrophs determines whether a soil is a source or a sink for methane. It is, therefore, crucial to understand the microbial part of the methane cycle and which factors influence the abundance and activity of methane-cycling microbes. However, capturing the soil microbiome's abundances, activity, and identity is challenging. There are numerous target molecules and myriad methods, each with certain limitations. Linking microbial markers to methane fluxes is therefore challenging. This thesis aimed to understand how methane-cycling microbes in the soil are related to soil methane fluxes and how soil characteristics and human activity influence them. The first publication investigated the biotic and abiotic drivers of the atmospheric methane sink of soils. It assessed the influence of grassland land-use intensity (150 sites) and forest management type (149 sites) on potential atmospheric methane oxidation rates (PMORs) and the abundance and diversity of CH4-oxidizing bacteria (MOB) with qPCR in topsoils of three temperate regions in Germany. PMORs measured in microcosms under defined conditions were approximately twice as high in forest than in grassland soils. High land-use intensity of grasslands negatively affected PMORs (−40%) in almost all regions. Among the different aspects of land-use intensity, fertilization had the most adverse effect reducing PMORs by 20%. In contrast, forest management did not affect PMORs in forest soils. Upland soil cluster (USC)α was the dominant group of MOBs in the forests. In contrast, USCγ was absent in more than half of the forest soils but present in almost all grassland soils. USCα abundance had a direct positive effect on PMOR in forests, while in grasslands, USCα and USCγ abundance affected PMOR positively with a more pronounced contribution of USCγ than USCα. In the second publication, we used quantitative metatranscriptomics to link methane-cycling microbiomes to net surface methane fluxes throughout a year in two grassland soils. Methane fluxes were highly dynamic: both soils were net methane sources in autumn and winter and net methane sinks in spring and summer. Correspondingly, methanogen mRNA abundances per gram soil correlated well with methane fluxes. Methanotroph to methanogen mRNA ratios were higher in spring and summer when the soils acted as net methane sinks. Furthermore, methane uptake was associated with an increased proportion of USCα and γ pmoA and pmoA2 transcripts. High methanotroph to methanogen ratios would indicate methane sink properties. Our study links the seasonal transcriptional dynamics of methane-cycling soil microbiomes for the first time to gas fluxes in situ. It suggests mRNA transcript abundances as promising indicators of dynamic ecosystem-level processes. We conclude that reduction in grassland land-use intensity and afforestation can potentially increase the methane sink function of soils and that different parameters determine the microbial methane sink in forest and grassland soils. Furthermore, this thesis suggests mRNA transcript abundances as promising indicators of dynamic ecosystem-level processes. Methanogen transcript abundance may be used as a proxy for changes in net surface methane emissions from grassland soils.

Ödeme, die durch Orthostase verursacht werden, sind im medizinischen und beruflichen Kontext ein häufiges Krankheitsbild. Die Volumenzunahme in den Unterschenkeln und die damit verbunden Beschwerden treten insbesondere in Berufen auf, die mit langem Stehen und wenig Bewegung verbunden sind. Bisher ungeklärt ist, ob es einen Zusammenhang zwischen der Zunahme des Unterschenkelvolumens und der Entstehung von Missempfindungen bei Stehbelastungen gibt. Ebenfalls fraglich ist, ob die während einer Orthostase entstehenden Missempfindungen durch die Durchführung bestimmter Bewegungen beeinflusst werden können. Ziel dieser nicht-randomisierten, kontrollierten Studie war es, die Veränderungen und den zeitlichen Zusammenhang von einer V olumenzunahme und dem Auftreten von Beschwerden in den Unterschenkeln während einer Stehbelastung zu untersuchen. Dabei wurde durch die Probanden eine zeitlich begrenzte Stehbelastung von 15 min absolviert. Im Rahmen dessen wurde das Unterschenkelvolumen mit einem optischen dreidimensionalen Volumenmesssystem gemessen. Die aufgetretenen Missempfindungen und der Bewegungsdrang wurden anhand einer numerischen Rating- Skala (NRS) von null bis zehn Punkten abgefragt. Es wurde eine Korrelationsanalyse zwischen dem Unterschenkelvolumen und den Daten zu den Missempfindungen und dem Bewegungsdrang der einzelnen Probanden durchgeführt. Darüber hinaus wurden lineare Modelle mit gemischten Effekten berechnet, um das Vorhandensein einer kausalen Beziehung zwischen dem Unterschenkelvolumen und den Missempfindungen oder dem Bewegungsdrang im Stehen zu untersuchen. Die Stehversuche wurden ein zweites Mal durchgeführt, während die Probanden MKS trugen. Als Resultat konnte gezeigt werden, dass das Unterschenkelvolumen während der Stehphase ohne MKS durchschnittlich um 63 ml und mit MKS um 27 ml zu nahm (p < 0,001). Die Missempfindungen stiegen während der Orthostase ohne MKS im Mittel um 3,46 Punkte auf der NRS und mit MKS um 2,6 Punkte (p < 0,001). Der Bewegungsdrang der Teilnehmer erhöhte sich während der Stehphase ohne MKS um 3,47 Punkte auf der NRS und mit MKS um 3,73 Punkte (p < 0,001). Ein signifikanter Zusammenhang zwischen der Zunahme des Unterschenkelvolumens und dem Auftreten von Missempfindungen bzw. von Bewegungsdrang wurde bei der Mehrzahl der Probanden ohne MKS (p < 0,05) und mit MKS (p < 0,1) festgestellt. In den linear gemischten Modellen zeigte sich ein kausaler Zusammenhang zwischen der Volumenzunahme der Unterschenkel und dem Auftreten der Symptome (p < 0,001). Schlussendlich lässt sich feststellen, dass längeres Stehen mit Bewegungsmangel bei venengesunden Probanden zu einer Zunahme des Unterschenkelvolumens und zu einem Gefühl von Unbehagen führt. Durch einstudierte Bewegungen und das Tragen von MKS können unter kontrollierten Bedingungen die Missempfindungen in den Beinen und teilweise auch das Unterschenkelvolumen reduziert werden. Lineare Modelle mit gemischten Effekten weisen auf kausale Zusammenhänge zwischen diesen Variablen hin. Aufgrund der Schwierigkeit, subjektive Äußerungen über Beschwerden mit objektiven Messergebnissen wie der Volumenzunahme zu korrelieren, sind jedoch weitere Studien erforderlich, die auch Stoffwechselprozesse auf molekularbiologischer Ebene miteinbeziehen.

Tafazzin is an acyltransferase with key functions in remodeling of the mitochondrial phospholipid cardiolipin (CL) by exchanging single fatty acids species in CL. Tafazzin-mediated CL remodeling determines the actual CL compositions and has been implicated in mitochondrial morphology and function. Thus, any deficiency of tafazzin leads to altered fatty acid composition of CL which is directly associated with impaired mitochondrial respiration and ATP production. Mutations in the tafazzin encoding gene TAZ, are the cause of the severe X-linked genetic disease, BARTH syndrome (BTHS). Previous work provided first hints on a linkage of CL composition and subsequent limitations in the cellular ATP levels which may contribute to the restriction of growth. However, in C6 cells ATP levels remained unaltered due to compensatory activation of glycolysis. Moreover, it has been demonstrated that the substantial changes in CL composition are similarly resulting from knocking down either cardiolipin synthase (CRLS) or TAZ. This has also been shown in C6 glioma cells. Most notably only the knock down of TAZ, but not that of CRLS, compromised proliferation of C6 glioma cells. Therefore, a CL- independent role of TAZ in regulating cell proliferation is postulated. In this study, any linkage of the lack of tafazzin to cellular proliferation should be investigated in more detail to allow first insight into underlying mechanisms. The results of the current study demonstrate that the tafazzin knockout in C6 glioma cells show changes in global gene expression by applying transcriptome analysis using the- microarray Clarion S rat Affymetrix array. Out of 22,076 total number of genes detected, 1,099 genes were differentially expressed in C6 knockout cells which were either ≥2 and ≥4 fold up or down regulated genes. Furthermore, expression of selected target genes was validated using RT-qPCR. We have hypothesised that the changes in TAZ dependent gene expression is via PPAR transcription factor. According to eukaryotic promoter database (EPD) for selected target genes, exhibited at least one putative binding site for PPARG and PPARA transcription factors. However, pioglitazone and LG100268, synthetic ligands of PPARG and RXR, could not show any effect on changes in gene expression in C6 TAZ cells. Another class of cellular lipids, oxylipins were found to occur in significantly higher amounts in C6 TAZ cells compared to C6 cells which makes them candidates for mediating cellular effects and regulating gene expression via PPARs. A computational tool CiiiDER was used to for the prediction of transcription factor binding site. The transcription factors enriched in TAZ- regulated genes were found to be HOXA5 and PAX2, binding sites of which could be detected in 100 % of TAZ- regulated genes (>2-fold). By applying IPA to the differentially expressed genes we could identify lipid metabolism, and cholesterol superpathway in particular as the most affected pathway in C6 TAZ cells. This pathway consists of 20 genes, of which all (20/20) appeared to be differentially regulated in C6 TAZ cells. Of all the 20 genes, 4 of the differentially expressed genes were selected for further validation by RT-qPCR. By IPA it was possible to identify the upstream regulators that might be responsible for the differential expression of genes in C6 deficient cells. Some of the genes ACACA, HMGCR, FASN, ACSL1, 3 and, 5 identified was decreased by predicted activation and inhibition of the regulators. Further we have analysed the levels of cellular cholesterol content in C6 and C6 TAZ (w/o Δ5 and FL) cells. In C6 cells cholesterol is present more in its free form. C6 TAZ cells have increased amount of cholesterol compared to C6 cells. However, Δ5 and FL expressed C6 TAZ cells showed less amount of cholesterol. Previous work established that knockout of tafazzin in C6 cells showed decreased cell proliferation in the absence of any changes in ATP content. To understand this phenomenon cellular senescence associated β-galactosidase in C6 and C6 TAZ cells was performed. C6 TAZ cells showed increased percentage of β-gal positive cells compared to C6 cells. Moreover, senescent associated secretory phenotype (SASP) represented by e.g. CXCL1, IL6, and IL1α was determined using RT-qPCR. Gene expression of these SASP factors was significantly upregulated in C6 TAZ cells. Several human tafazzin isoforms exists due to alternate splicing. However, whether these isoforms differ in function and in CL remodelling activity or specificity, in particular, is unknown. The purpose of this work was to determine if specific isoforms, such as human isoform lacking exon 5 (Δ5), rat full length tafazzin (FL) and enzymatically dead full length tafazzin (H69L), can restore the wild type phenotype in terms of CL composition, cellular proliferation, and gene expression profile. Therefore, in the second part, it was demonstrated that expression of Δ5 to some extent and rat full length tafazzin can completely restore CL composition, in C6 TAZ cells which is naturally linked to the restoration of mitochondrial respiration. As expected, a comparable restoration of CL composition could not be seen after re-expressing an enzymatically dead full-length rat TAZ, (H69L; TAZ Mut). Furthermore, re-expression of the TAZ Mut largely failed to reverse the alterations in gene expression, in contrast re-expression of the TAZ FL and the Δ5 isoforms reversed gene expression to a larger extent. Moreover, only rat full length TAZ was able to reverse proliferation rate. Surprisingly, the expression of Δ5 in C6 TAZ cells did not promote proliferation of the wild type. Different effects of Δ5 and FL on CL composition and cell proliferation points to the specific and in part non-enzymatic functions of tafazzin isoforms, but this certainly requires further analysis.

In welcher Beziehung stehen Schmuckobjekte zur eigenen Persönlichkeit? Mit welchen Erinnerungen, Erzählungen und Projektionen sind sie verbunden? Ausgehend vom Hiddenseer Goldschmuck, ein heute im Stralsund Museum bewahrtes Schatzkonvolut aus der Wikingerzeit, führen diese und weitere Fragen Schüler*innen an Vorstellungen von kulturellem Erbe, Identität und regionaler Zugehörigkeit heran. Wikingergold – eine Auseinandersetzung mit kulturellem Erbe und Identitäten im Kunstunterricht richtet sich an Schüler*innen der 7. bis 10. Klasse und ist fachübergreifend nutzbar. Drei Arbeitspakete – „Der Hiddenseer Goldschmuck“, „Goldschätze aus der Wikingerzeit – Kulturerbe des Ostseeraums“ und „‚Wikinger‘ darstellen und ausstellen“ – können komplementär, aber auch einzeln bearbeitet werden. Jedes enthält einen Einführungstext, Vorschläge zur Unterrichtskonzeption und Arbeitsblätter. Neben Text- und Bildmaterial kann ein eigens für das Projekt entwickelter Kurzfilm betrachtet oder eine digitale Ausstellung besucht werden. Ziel der Unterrichtsmaterialien ist es, Verbindungen von Geschichte und Geschichtsmythen mit dem Alltag der Schüler*innen aufzuzeigen und zu reflektieren. „Wikingerschmuck“ wird so zum Instrument der Reflexion des eigenen Selbstbildes und er kann Anstoß für identitätsbildende Prozesse sein.

Until today, more than 17% of the population in Mecklenburg Western-Pomerania suffer from chronic kidney disease (CKD) which was revealed by the SHIP study (Study of Health in Pomerania). 20% of CKD cases can be traced back to glomerulopathies. One common characteristic of glomerulopathies is the morphologic change of the glomerular filtration barrier which consists of endothelial cells, the glomerular basement membrane and podocytes. Under healthy conditions, the foot processes of the podocytes interdigitate with the foot processes of the neighboring podocytes with a filtration slit in between. Apart from the slit membrane protein nephrin, typical adherens junction proteins like occludin or JAM-A are also expressed at this cell-cell junction. This junction is therefore considered to be a specialized type of adherens junction, necessary to maintain the size-selectivity of the filtration barrier. During podocyte injury, podocyte foot processes lose their characteristic morphology and the typical meandering filtration slit becomes linearized, a process which is described as foot process effacement. Since morphological change is directly linked to change or loss of function, ultrastructural analysis of the foot processes is necessary for diagnostics and research. By using 3D-structured illumination microscopy (3D-SIM), we quantified these morphological changes as well as studied a possible biomarker, the tight junction protein claudin 5 (CLDN5). Our study showed a spatially restricted up-regulation of CLDN5 in effaced filtration slit areas in biopsies of patients suffering from minimal change disease (MCD), focal and segmental glomerulosclerosis (FSGS) as well as in mice after NTS injection and in the uninephrectomy DOCA-salt mouse model. CLDN5/nephrin ratios of biopsies from patients with glomerulopathies and of tissue received from NTS-treated mice were significantly higher compared to controls. We found that in patients the CLDN5/nephrin ratios were negatively correlated with the filtration slit density. Since CLDN5 up-regulation was observed in several areas of high filtration slit density, we hypothesized that CDLN5 upregulation preceded visible foot process effacement. Taken together, we suggest that CLDN5 could be a helpful biomarker to identify an early change of the foot process morphology in addition to filtration slit density measurement. Additionally, correlation analysis of foot process effacement with patient data showed a significant negative correlation of the filtration slit density with proteinuria in MCD patients.

In this work, 2-dimensional measurements in the THz frequency range with self-made spintronic THz emitters were presented. The STE were used to optimize the spatial resolution and determine the magnetization in geometric shapes. At the beginning, various combinations of FM and NM layers were produced and measured to achieve an optimal composition of the STE. The layer thickness of the ferromagnetic CoFeB layer and the nonmagnetic PT layer was also varied. The investigations have shown that a layer combination of 2 nm thick CoFeB and 2 nm thick Pt, applied to a fused silica glass substrate and covered with a 300 nm thick SiO2 layer, emits the highest THz amplitude. Based on these, a structured sample, consisting of an STE and an additional layer system of 5 nm Cr and 100 nm Au, was produced. Further, three wedge-shaped structures were removed from the gold layer by an etching process so that the THz radiation generated by the STE can pass through these areas. This enables the optimization of the resolution of the system. For this purpose, the sample was moved perpendicular to the laser beam by two stepping motors with a step size of 5 μm and imaged 2-dimensionally. By reducing the step size to 0.2 μm, the beam diameter could be measured at the edge of the structure using the knife-edge method. Based on this measurement, the resolution of the system could be determined as 5.1 ± 0.5 μm at 0.5 THz, 4.9 ± 0.4 μm at 1 THz, and 5.0 ± 0.5 μm at 1.5 THz. These results are confirmed by simulations considering the propagation of THz wave packets through the SiO2. The expansion of the FWHM of the waves, passing through the 300 nm thick layer, is about 1%. Only a SiO2 layer with a thickness in the μm range occurs an expansion of around 10%. This shows that it is possible to perform 2-dimensional THz spectroscopy with a resolution in the dimension of the exciting laser beam by using near-field optics. Afterward, the achieved spatial resolution was used to investigate the influence of external magnetic fields on the STE and the emitted THz radiation. By implementing a pair of coils above the sample, an external magnetic field could be applied parallel to the pattern. The used sample was designed in such a way that only certain geometric areas on the fused silica glass substrate were coated with an STE so that THz radiation is emitted only in those areas. The 2-dimensional images show the geometric structures for f = 1.0 THz and f = 1.5 THz clearly. By applying a permanent, positive magnetic field (+M), a positive course of the THz amplitude can be seen. A rotation of the magnetic field by 180° (-M) leads to a reversal of the orientation of the emitted THz radiation, whereby the magnetic field does not influence the corresponding frequency spectrum. By using minor loops, the sample was demagnetized by the constant reduction of the magnetic field strength with alternating magnetic field direction. The 2-dimensional representation of the pattern with a step size of 10 μm shows that the sample was demagnetized since both, positively and negatively magnetized structures, could be imaged. In addition, in the 2nd row from the top, a completely demagnetized circle and a rectangle with a division into two domains can be seen. These structures have both positive and negative magnetized areas, which are separated by a domain wall. To investigate this in more detail a 2-dimensional measurement of the divided regions was made with a step size of 2.5 μm. These images confirm the division of the structures into positive and negative domains, separated by a domain wall, which was verified by Kerr-microscope measurements. Both data show a similar course of the domains and the domain wall. However, to be able to examine the domain wall more precisely using 2-dimensional THz spectroscopy, the resolution of the system must be improved to a range of a few nm, because the expected domain wall width is between 𝑙𝑊 = 12.56 nm and 𝑙𝑊 = 125.6 nm. The improved resolution would make it possible to image foreign objects, such as microplastics in biological cells or tissue. For this purpose, different plastics, such as polypropylene, polyethylene, and polystyrene, were investigated in the THz frequency range up to 4 THz. While no specific absorption could be determined for PP, characteristic absorption peaks were found for PE and PS. The energy of the photons with a frequency of about 2.2 THz excites lattice vibrations in the PE. Therefore, this frequency is specifically absorbed, and the intensity in the transmission spectrum is lower than for other frequencies. PS absorbs especially THz radiation with a frequency of 3.2 THz. In addition, all of the investigated plastics are mostly transparent for THz radiation, which makes imaging of these materials feasible. Based on these basic properties, it will be possible to image and identify these types of plastic.

PMN are one of the most important cells of the innate immune system and are responsible for fast clearance of invading pathogens in most circumstances. The role of human PMN during mycobacterial infection have been widely studied. Nevertheless, there are contradicting results regarding their role in protection or pathology during TB. Similar studies focusing on bovine PMN and their role in M. bovis infection remain understudied. Also, not much is known about attenuation of M. tb in cattle and responses of PMN to this MTBC member. The major aims of this study were to i) gain insights into bovine PMN biology and the cellular processes triggered by challenge with virulent mycobacteria and to ii) find out whether interspecies differences result in different outcomes upon in vitro challenge. In the first part of the work, a new isolation method for bovine PMN from whole blood was developed. Human and bovine PMN have different buoyant properties and hence need to be isolated using different procedures. The magnetic isolation method developed within this thesis is robust and results in very good yields of highly pure, viable bovine PMN populations. This is extremely advantageous and indispensable for downstream functional assays that are required to be performed on a single day. The second goal of this study was to compare and contrast the functional differences between bovine and human PMN upon BCG infection. The findings reveal for the first time that human PMN phagocytose more BCG in comparison to bovine counterparts. Non-opsonized bacteria were internalized via the lectin-like C-domain, require cholesterol and an active cytoskeleton in human PMN, whereas opsonized bacteria entered cells via the CR3 and, in particular, CD11b. It remains unresolved why bovine PMN reacted differently, notably phagocytosis remained unaltered, to various treatments, including blocking monoclonal antibodies to CD11b and chemical inhibitors altering the cell membrane. Nonetheless, the increased uptake of BCG by human PMN correlates to more potent response of these cells in functional assays in comparison to bovine PMN. No PMN intrinsic differences were found in the basal cholesterol content. Comparative assays with the virulent strains would be essential in order to generalize these observations. The third aim was to investigate the responses of bovine PMN to BCG, M. tb and M. bovis. While there was no difference in uptake between BCG and M. tb, serum opsonized BCG was taken up at a higher amount. This finding suggests differential binding of bacterial epitopes to host cell receptors which modulates mycobacteria uptake. However, between the virulent strains M. tb and M. bovis, the human-adapted bacillus was phagocytosed at a higher rate which hints towards the possibility of rapid recognition and clearance of M. tb in bovine host thereby possibly preventing pathology. The release of selective cytokines by PMN post infection with the virulent strains offers baseline information relevant for processes that probably occur in vivo. This work for the first time provides insights into responses of bovine PMN to mycobacteria in a two-tier approach: by cross-species analysis of PMN responses to selected mycobacterium and by head-to-head analysis of bovine PMN to animal-adapted and human-adapted mycobacteria. As a prospect for future research in bovine PMN biology in the context of mycobacterial infection, it would be highly advantageous to compare the subcellular localization of M. tb and M. bovis in bovine PMN using confocal and/or electron microscopy. This analysis would confer proof on attachment or internalization of mycobacteria by PMN and identify the features of the mycobacteria-containing compartments. Also, in-depth investigations of additional entry pathways for the pathogen in bovine cells would be informative for unlocking downstream cell signaling events. In addition, PMN viability studies will be meaningful particularly in bovine PMN challenged with M. bovis and M. tb, given the impact of death patterns on tissue pathology. Current results and follow up studies will contribute to the understanding of the roles of PMN in controlling elimination or growth of M. bovis and M. tb in cattle.

Die Sepsis stellt ein hoch komplexes, klinisch heterogenes Krankheitsbild dar, das die Medizin und Wissenschaft auf der ganzen Welt vor große Herausforderungen stellt. Obwohl nahezu jeder erfahrene Intensivmediziner Unterschiede zwischen einem Patienten mit abdomineller Sepsis und einem Patienten mit Urosepsis benennen könnte, haben nur sehr wenige Forschungsgruppen diese Unterschiede weiter untersucht und beschrieben. Jede Sepsis beginnt in einem anatomischen Fokus der Infektion, der sich fast überall im menschlichen Körper befinden kann. Existieren Unterschiede zwischen Patienten mit unterschiedlichem Sepsisfokus? Ist Sepsis vielleicht nicht gleich Sepsis? Um diese Fragen zu beantworten, hat unsere Arbeitsgruppe über einen Zeitraum von acht Jahren die Daten von 816 Sepsispatienten ausgewertet, deren Fokus ausschließlich im Abdomen, Respirationstrakt, Urogenitaltrakt oder den Knochen und Weichteilen lag. Die Patienten wurden über den gesamten Studienzeitraum konsekutiv eingeschlossen und prospektiv auf das Vorliegen einer Sepsis gescreent. Wir verglichen klinische, mikrobiologische und laborchemische Daten zum Sepsiszeitpunkt zwischen den Fokusgruppen und konnten signifikante Unterschiede in allen drei Bereichen beobachten. Beispielsweise war die Inzidenz für das Auftreten eines septischen Schocks bei Patienten mit abdominellem und urogenitalem Fokus signifikant höher als bei den anderen Gruppen. In Bezug auf die mikrobiologischen Unterschiede waren die Urosepsis und die Knochen- und Weichteilsepsis mit deutlich höheren Blutkulturpositivitäten assoziiert. Außerdem unterschied sich das Erregerspektrum zwischen den Gruppen. Des Weiteren konnten wir Unterschiede in den Laborergebnissen der Patienten zum Sepsiszeitpunkt feststellen. Fast die Hälfte der Patienten mit Urosepsis zeigte pathologisch erhöhte PCT-Werte im Vergleich zu nur 15 % der respiratorischen Gruppe. Weiterhin hatten dreimal so viele Patienten mit Fokus im Bereich Knochen/Weichteile eine Hypoalbuminämie wie Patienten der urogenitalen und pulmonalen Gruppe. Darüber hinaus waren die verschiedenen Sepsisfokusse mit Unterschieden in den SOFA-Scores, SIRS-Kriterien und dem Auftreten von Organdysfunktionen zum Sepsisbeginn assoziiert. Die vorliegende Dissertation liefert eindeutige Hinweise auf klinische, laborchemische und mikrobiologische Unterschiede zwischen Sepsispatienten mit verschiedenen Sepsisfokussen zum Beginn der Sepsis. In großen randomisierten Studien sollte den deutlichen Unterschieden zwischen den verschiedenen Sepsisfokussen möglicherweise mehr Aufmerksamkeit geschenkt werden, damit therapeutische Ansätze, welche nur einer Subgruppe helfen, mit ausreichender Fallzahl herausgearbeitet werden können.

A long-standing controversy in emotion research concerns the question whether stimuli must be conceptually interpreted, or semantically categorized, to evoke emotional reactions. According to the semantic primacy hypothesis, the answer to this question is positive; whereas according to the affective primacy hypothesis, it is negative: Emotions can also be, and perhaps often are, elicited by preconceptual stimulus representations, such as particular shapes or color patterns. In the present dissertation project, the semantic primacy hypothesis was tested in eight experiments using different latency judgment paradigms in which the perceptual latencies of object recognition and affect onset were measured and compared. The chronometric measurement methods comprised temporal judgments (temporal order judgments and simultaneity judgments: Publication A, Experiments 1–4; the rotating spot / rotating clock hand method: Publication B, Experiments 1–2) and speeded reaction time measurements (Publication C, Experiments 1–2). To elicit affective responses, pictures of pleasant (e.g., cats, children) and unpleasant objects (e.g., spiders, moldy food) from everyday life were presented. According to the semantic primacy hypothesis, object recognition is a necessary partial cause of affect. This implies the following three predictions that were tested in the studies: (1) Because causes must precede their effects, the time of the onset of object recognition must precede the time of the onset of affect. (2) The longer it takes a person to recognize an object, the longer it should also take them, other factors constant, to experience affect; therefore, the latencies of the two mental events should be positively correlated across individuals. (3) An experimental manipulation that delays the onset of object recognition (in this case a moderate blurring of the pictures) should also delay the onset of affect, and the effect of the manipulation on affect latency should be mediated by the delay in object recognition. In agreement with Prediction 1, regardless of the chronometric method used, the latency of object recognition consistently proved to be shorter than the latency of affect onset. According to the meta-analytically integrated latency differences estimated in the temporal judgment experiments, affect followed object recognition with a delay of 117 ms. This result was obtained for both pleasant and unpleasant stimuli and was independent of task order. Supporting Prediction 2, the latencies for object recognition and affect onset were positively correlated across participants (meta-analytic r = .50). Supporting Prediction 3, delaying object recognition by blurring the affective pictures was found to also delay the onset of affect and the effect of blurring on the latency of affect was found to be partly mediated by delayed object recognition. Two additional predictions tested and confirmed in Experiment C2 were: (4) False-coloring the affective pictures delays the onset of affect but not object recognition, and this effect is mediated by reduced affect intensity. (5) Judgments of the valence of the stimuli (i.e., whether the imaged object is pleasant or unpleasant) take more time than reports of object recognition, but less time than affect onset reports, for which valence judgments have often been used as a substitute in previous studies. Taken together, the results of the eight experiments provided consistent support for semantic primacy in the generation of pleasant and unpleasant feelings evoked by affective pictures: Object recognition can be considered a necessary partial cause of affect in the reported experiments. The results are compared to previous findings, possible reasons for deviant response patterns found in a small minority of the participants are considered, and several implications of the findings for emotion research are derived. Possible adaptations of the chronometric approach to investigate other questions of emotion research are suggested. Finally, limitations of the dissertation project are pointed out and possible ways to address these in future research are proposed.

Liver dysfunctions are commonly associated with diabetes and mortality in the general population. However, previous studies lack to define these disorders with hepatic markers from MRI, which have been shown to be more accurate and sensitive than hepatic ultrasound and laboratory markers. Further, previous studies defining different categories of prediabetes by oral glucose tolerance states revealed controversial findings. Hence, this dissertation contributed to understand the associations of liver dysfunctions with glucose intolerance states and all-cause mortality in the general population. In the first part of the dissertation, the associations of MRI-related hepatic steatosis and hepatic iron overload with prediabetes were investigated. Prediabetes was categorized into IFG, IGT, (alone or in combination) or previously unknown type 2 diabetes mellitus using OGGT data, as suggested by the ADA. For analyses, we included 1632 subjects with MRI who participated in an OGTT and reported no type 2 diabetes mellitus. We found that hepatic steatosis was positively associated with continuous markers of glucose metabolism. Similarly, subjects with hepatic steatosis as defined by MRI had a higher relative risk ratio to be in the prediabetes groups (i-IFG, i-IGT and IFG + IGT) or having undiagnosed diabetes than individuals without this condition. The observed associations were more obvious for MRI-derived hepatic steatosis compared to ultrasound. In comparison to hepatic steatosis, we found that MRI-assessed hepatic iron overload was positively associated only with both 2-hour plasma glucose and the combined IFG + IGT category. There were no significant associations between hepatic iron overload and other glucose tolerance states or biomarkers of glucose metabolism, regardless of possible confounding factors. In the second part, the associations of liver volume and other markers of hepatic steatosis with all-cause mortality in the general population were investigated. We included 2769 middle-aged German subjects with a median follow-up of 8.9 years (23,898 person-years). Serum liver enzymes and FIB-4 score were used as quantitative markers, while MRI measurements of liver fat content and total liver volume included as qualitative markers of hepatic steatosis. Compared to other markers of hepatic steatosis, larger liver volumes were significantly associated with a nearly three-fold increase in the long-term risk of all-cause mortality. Furthermore, this association was consistent across all subgroups considered (men vs. women; presence or absence of metabolic syndrome or type 2 diabetes at baseline). A positive association between FIB-4 score and all-cause mortality was found both in the entire cohort and in women. Likewise, positive associations of higher serum AST and GGT levels with all-cause mortality were found in the entire cohort and in men. To conclude, this dissertation acknowledges the fact that prevention and early intervention of liver dysfunction has major impact to reduce the burden of public health problems. Thus, our findings suggest that hepatic markers contributes to an increased risk of prediabetes and all-cause mortality, which might be helpful to identify high risk groups who need closer attention with respect to prevention of liver disorders and diabetes.

Coding constraints imposed by the very small genome sizes of negative-strand RNA viruses (NSVs) have led to the development of numerous strategies that increase viral protein diversity, enabling the virus to both establish a productive viral replication cycle and effectively control the host antiviral response. Arenaviruses are no exception to this, and previous findings have demonstrated that the nucleoprotein (NP) of the highly pathogenic Junín virus (JUNV) exists as three additional N-terminally truncated isoforms of 53 kD (NP53kD), 47 kD (NP47kD), and 40 kD (NP40kD). The two smaller isoforms (i.e. NP47kD and NP40kD) have been characterized as products of caspase cleavage, which appears to serve a decoy function to inhibit apoptosis induction. However, whether they have additional functions in the viral replication cycle remains unknown. Further, the origin and function of NP53kD has not yet been described. In order to first identify the mechanism responsible for production of the NP53kD variant, a possible role of additional caspase cleavage sites was first excluded using a site mutagenesis approach. Subsequently, alanine mutagenesis was then used to identify a region responsible for NP53kD production. As a result, three methionine residues were identified within the characterized sequence segment of NP, linking the production of NP53kD to an alternative in-frame translation initiation. Further site-directed mutagenesis of the previously identified putative in-frame methionine codons (i.e. M78, M80 and M100) finally led to the identification of translation initiation at M80 as being predominantly responsible for the production of NP53kD. Once the identity of all three NP isoforms was known, it was then of further interest to more deeply characterize their functional roles. Consistent with the N-terminal domain containing RNA binding and homotrimerization motifs that are relevant for the viral RNA synthesis process, it could be demonstrated that all three truncated NP isoforms lost the ability to support viral RNA synthesis in a minigenome assay. However, they also did not interfere with viral RNA synthesis by full-length NP, nor did they affect the ability of the matrix protein Z to inhibit viral RNA synthesis. Moreover, it was observed that loss of the oligomerization motifs in the N-terminus also affected the subcellular localization of all three NP isoforms, which were no longer localized in discrete perinuclear inclusion bodies, but rather showed a diffuse distribution throughout the cytoplasm, with the smallest isoform NP40kD also being able to enter the nucleus. Surprisingly, the 3'-5' exonuclease function of NP, which is associated with the C-terminal domain and plays a role in inhibiting interferon induction by digestion of double-stranded RNAs, was found to be retained only by the NP40kD isoform, despite that all three isoforms retained the associated domain. Finally, previous studies using transfected NP and chemical induction of apoptosis have suggested that cleavage of NP at the caspase motifs responsible for generating NP47kD and NP40kD plays a role in controlling activation of the apoptosis pathway. Therefore, to further characterize the connection between the generation of NP isoforms and the regulation of apoptosis in a viral context, recombinant JUNVs deficient in the respective isoforms were generated. Unlike infections with wild-type JUNV, mutations of the caspase cleavage sites resulted in the induction of caspases activation. Surprisingly, however, this was also the case for mutation of the alternate start codon responsible for NP53kD generation. Taken together, the data from this study suggest a model whereby JUNV generates a pool of smaller NP isoforms with a predominantly cytoplasmic distribution. As a result of this altered localization, NP53kD appears to be able to serve as the substrate for further generation of NP47kD and NP40kD by caspase cleavage. Not only does this cleavage inhibit apoptosis induction during JUNV infection, it also results in a cytoplasmic isoform of NP that retains strong 3'-5' exonuclease activity (i.e. NP40kD) and thus may play an important role in preventing viral double-stranded RNA accumulation in the cytoplasm, where it can lead to activation of IFN signaling. Overall, such results emphasize the relevance of alternative protein isoforms in virus biology, and particularly in regulation of the host response to infection.

Hintergrund: Die Intima-Media-Dicke der A. carotis communis (cIMT) ist als Biomarker für asymptomatische Atherosklerose bekannt und mit sowohl Gesamt- aus auch kardiovaskulärer (CV) Mortalität assoziiert. Eine größere cIMT wird von einem kompensatorischen Anstieg des Lumendurchmessers der Aa. carotides communes (LD) begleitet. Es ist nicht geklärt, welcher der beiden Parameter mehr Informationen zur Mortalität liefert. Methoden und Ergebnisse: Es wurden 2.751 Studienteilnehmer eingeschlossen (Alter: Median 53 Jahre, 52% weiblich). In der Nachverfolgungszeit im Median von 14,9 Jahren (12,8 – 16,5 Jahre) starben 506 Teilnehmer. In einer Ausgangsuntersuchung wurden cIMT und LD mittels Ultraschalluntersuchung vermessen. Mithilfe multivariabler Cox-Regressionsmodelle wurden cIMT, LD, LD adjustiert auf cIMT (LD + cIMT) und das LD/cIMT-Verhältnis mit CV-Morta-lität und Nicht-CV-Mortalität verglichen. Die Modelle wurden mittels Akaike-Informationskri-terium (AIC) eingestuft. Die Vorhersagekraft der Modelle zur Mortalität wurde mit Harrell’s-C-Statistik verglichen. Ein Anstieg des LD um einen Millimeter war mit einer größeren Gesamt-Mortalität assoziiert (HR 1,29; 95%-Konfidenzintervall [KI] 1,14 – 1,45; p < 0,01) und blieb nach Adjustierung auf cIMT signifikant (HR: 1,26; 95%-KI: 1,11 – 1,42; p < 0,01). Ein gleicher Anstieg der cIMT war mit einem erhöhten Risiko für Gesamtmortalität verbunden (HR: 1,73; 95%-KI: 1,09 – 2,75). Das LD/cIMT-Verhältnis und die Gesamtmortalität waren nicht assoziiert. Der LD zeigte bezüglich Gesamtmortalität das niedrigste AIC und verbesserte deren Vorhersage im Vergleich mit dem Null-Modell (p = 0,01). Verglichen mit dem LD lieferte die cIMT eine schwächere Vorhersagekraft der Gesamtmortalität. Schlussfolgerung: In dieser großen populationsbasierten Studie liefert der LD mehr Informationen zur Gesamtmortalität als die cIMT.

Zusammenfassung Die chronische Pankreatitis ist eine durch wiederkehrende Entzündungsschübe gekennzeichnete Erkrankung des Pankreas, die meist mit einem ausgeprägten Verlust der endokrinen und exokrinen Organfunktion verbunden ist. Der Übergang einer akut rekurrierenden in eine chronische Form ist meist fließend. Trotz der prinzipiell unbekannten Ätiologie sind mit Mutationen in u.a. dem SPINK1- und CFTR- Gen bereits genetische Risikofaktoren für die Entstehung einer idiopathischen Pankreatitis beschrieben. Für die bisher am umfangreichsten untersuchte Leu26Val-Mutation im CTSB existieren unterschiedliche Konklusionen in indischen und europäischen Arbeitsgruppen. Im Rahmen dieser Arbeit wurden zwei Patientenkohorten auf Sequenzvarianten im Bereich des Promotors, der 5’UTR und des Translationsstartes des CTSB als Risikofaktoren für die idiopathische Pankreatitis und deren möglicher Einfluss auf die Entstehung von Spleißvarianten und die Genexpression untersucht und mit lokalen Blutspendern sowie der europäischen Kontrollkohorte des 1000-Genome-Projektes verglichen. Hierfür wurden 278 Patienten mit einer idiopathisch chronischen und 83 Patienten mit einer idiopathisch akut rekurrierenden Pankreatitis mittels bidirektionaler Sanger-Sequenzierung und Taqman-Assays genotypisiert. Besonders hervorzuhebende SNP sind die beiden Missense-Varianten c.76C>G (Leu26Val) und c.157A>G (Ser53Gly) sowie der zwar nur bei einem Patienten detektierte, aber direkt innerhalb der Exon-/Intron-Grenze lokalisierte c.-100+1G>A. Die Varianten c.76C>G und c.157A>G zeigten bei Pankreatitis-Patienten eine signifikant geringere Prävalenz als bei den Kontrollen. Für weitere Varianten fanden sich keine signifikanten Assoziationen mit der idiopathischen Pankreatitis. Bei der Haplotypenanalyse kam der Haplotyp TCGCG mit den mutierten Allelen der beiden Missense-Mutationen ebenfalls bei Pankreatitis-Patienten signifikant seltener als bei den Kontrollen vor. Im zweiten Teil der Arbeit wurde die Grundlage für die Untersuchung der Assoziation zwischen unterschiedlichen Transkriptionsstartpunkten im Promotorbereich des CTSB-Gens und der Genexpression geschaffen. Hierfür wurden Reportergenkonstrukte aus dem pEGFP1-Vektor, SV40-Promotor und den Spleißvarianten 1, 2 und 4 des CTSB in HEK293- und PatuT-Zellen stabil transfiziert und die Genexpression mittels Fluoreszenzmikroskopie gezeigt. Anhand dieser Arbeit erscheinen Sequenzvarianten im CTSB zwar weiterhin möglich, wenn auch unwahrscheinlich als Risikofaktoren für die idiopathische Pankreatitis. Anhand der erstellten Reportergenkonstrukte kann der Hypothese zur unterschiedlichen Aktivität des CTSB in pankreatischem Gewebe, hervorgerufen durch verschiedene Spleißvarianten des Gens, weiter nachgegangen werden.

Objectives: This study investigates the effectiveness of the Cold AP on the alteration of the enamel surface without using acid etchant by using Conventional photo-activated resin bond to bond the orthodontic brackets. Materials and Methods: One hundred and twenty-five Enamel specimens are prepared from disinfected bovine mandibular incisors are divided into five groups. Group I: brackets are attached on the enamel surface with the standard adhesive technique (etch + primer +bond). Group II: the brackets are attached with the Standard Orthodontic adhesive technique without etching. Group III: the enamel surface is conditioned with pure Argon Cold atmospheric plasma before the application of the primer without using an acid etchant. Group IV: the enamel surface is conditioned with the admixture of Argon Cold atmospheric plasma with 0.5 % Oxygen before the application of the primer without using acid etchant Group V: after the application of Argon Cold atmospheric plasma with 0.5 % Oxygen the surface is rewetted by deionized water before the application of the primer and adhesive. After that, the samples are exposed to thermal cycling. The shear bond strength of the samples is tested by the universal testing machine which measured the maximum force at which the brackets are deboned from the tooth surface at a speed of 1mm/minute is measured. Results: Significant intergroup differences were found. Group V showed the highest shear bond strength followed by Group I, VI, III, II respectively. There isn’t a statistical difference in the values of The Shear bond strength values between Group III and IV. Conclusions: this study implies that Cold Atmospheric Plasma is a safe method to change the chemical surface characteristics of the enamel surface.in addition to the significant importance of plasma treatment followed by water rewetting, which could enhance adhesion between the orthodontic attachments and the enamel layer

The success of pregnancy depends on precisely adjusted, local immune mechanisms. In early pregnancy, fetal trophoblast cells implant into the endometrium to build and anchor the placenta. Simultaneously, they mediate fetal tolerance and defense against infections. To cover these versatile requirements, local immune factors must be in balance. A too tolerogenic milieu can lead to an inadequate placentation; while a too inflammatory milieu can cause rejection of the semi-allogenic fetus. Bacterial infections can provoke these inflammatory pregnancy complications as well. Therefore, the pregnant uterus was long thought to be sterile. Descriptions of a placental microbiome opened a scientific discourse, which is unsolved due to contrary studies. The colonization of the non-pregnant endometrium is, however, confirmed. It is supposed to affect both, uterine pathologies and fertility. Precise data are lacking. Aim of this work was to assess if and under which circumstances a bacterial colonization would be tolerable. One of the described species in placental and endometrial samples is Fusobacterium nucleatum. It is an opportunistic bacterium, which is known from the human oral cavity and associated with the development of colon carcinomas. F. nucleatum supports tumorigenesis by the induction of epithelial proliferation, survival, migration and invasion as well as angiogenesis and tumor tolerance. Since similar processes are required for implantation and placentation, F. nucleatum might support these as well. In this work, the effects of F. nucleatum on leukocyte-trophoblast-interactions, especially of macrophages and innate lymphoid cells type 3 (ILC3), were assessed. The monocytic cells (THP-1) were differentiated into inflammatory M1 (IFN-γ) or tissue-repairing and tolerogenic M2a (IL-4) and M2c (TGF-β) macrophages. Inactivated F. nucleatum, LPS or E. coli was added. Only small concentrations of inactivated bacteria were used (bacteria:leukocyte ratio of 0.1 or 1), since it was not the aim to analyze infections. Conditioned medium of treated leukocytes was added to trophoblastic cells (HTR-8/SVneo). Migratory, invasive and tube formation behavior of trophoblastic cells was quantified. Treated M1 macrophages impaired trophoblast function, whereas M2a macrophages induced trophoblast invasion. M2c macrophages supported trophoblast migration and tube formation if treated with the smaller, but not with the higher concentration of F. nucleatum. This treatment induced the accumulation of HIF-1α and the secretion of VEGF-A in M2c macrophages as well. Moreover, the higher concentration of F. nucleatum caused rather inflammatory responses (NF-κB activation and cytokine expression). The activation of the HIF-1α-VEGF-A axis under the influence of TGF-β might serve as a mild immune stimulation by low abundant commensal bacteria supporting placentation. In contrast to macrophages, the function of ILC3s during pregnancy is still unknown. In general, ILC3s are located in mucosal tissue, such as the gut. They participate in tolerance mechanisms and form the local micromilieu by the secretion of cytokines and the presentation of antigens. In order to characterize local, uterine ILC3s, murine ILC3s were compared to peripheral, splenic ILC3s. Uterine ILC3s were more activated and produced higher levels of IL-17 compared to splenic ILC3s. However, uterine ILC3s barely expressed MHCII on their surface. A reduced antigen presentation potential was confirmed in human ILC3s differentiated from cord blood stem cells by the addition of TGF-β or hCG. The treatment with bacteria increased MHCII expression, but not to the initial level. The higher bacterial concentration induced IL-8 secretion and led to an increased trophoblast invasion. ILC3s were less sensitive to bacterial stimulation than macrophages. Recent studies on the uterine or placental presence of bacteria during pregnancy are discrepant. The results of this project indicate that bacteria or bacterial residues might serve as a mild stimulus under certain circumstances to support implantation without negative effects. The current discussion must therefore not only be expanded by additional studies, but especially include differentiated local conditions. In this context, the sheer presence of bacteria or bacterial components must not be equated with an infection representing a known hazard.

External effects of agglomeration and human capital is a more than a century old research topic. Their theory and empirics have evolved over time to interact with more economic factors and to dig more deeply into heterogeneous effects, whose empirical evidence remains scarce, especially for developing countries. Furthermore, local human capital and agglomeration are often introduced in separate models rather than a single model in explaining productivity. These limitations motivate the implementation of this thesis. To achieve this, firm-level panel data from Vietnam is employed. This developing country provides an interesting case because its level of agglomeration and human capital is still low but its socio-economic conditions are highly dynamic with the high growth rates of urbanization and university-educated labor force (production inputs) as well as income (production output), in comparison with developed countries. The heart of this thesis lies on its chapter 2 and chapter 3, which are summarized as follows. Chapter 2 aims at finding which agglomeration forces play the dominant role in affecting firms’ productivity and how agglomeration induces unequal influences across various firm characteristics. To achieve this, a six-year panel data set is employed, and the estimation is based on a production function that the left-hand side is firm’s total factor productivity while the righthand side is local technology which contains the agglomeration terms. In the first step of regression, consistent values of productivity are obtained following a strategy that combines the control function approach with the instrumental variables technique to tackle endogeneity caused by a possibility that firms choose their production inputs based on their productivity. In the second step, log of productivity is regressed on agglomeration proxies and controls, using multiple fixedeffects terms to control for unobserved factors and local shocks. Estimated results show that urbanization rather than specialization has a positive impact on productivity. Besides, the agglomeration effects are stronger for foreign-owned, small-sized, or young firms. Chapter 3 shows attempts to find evidence of human capital externalities along with urbanization economies, given that the two external terms are rarely placed together in a single specification in literature. The estimation is implemented based on a production function whose context is an unique spatial equilibrium resulting from migration behaviors of entrepreneurs and workers. In this function, the externalities play the role of a region-specific productivity shifter. The model is regressed primarily with the instrumental variables technique to tackle possible identification problems. Between the two external terms, the resulting estimates confirm only the existence of urbanization economies. However, human capital externalities are found to be strong and significant in high-tech industries, implying that the effects of local human capital are very heterogeneous across different technological levels.

Die Kenntnis über die im Gastrointestinaltrakt ablaufenden Prozesse spielt in der Entwicklung neuer Arzneiformen eine entscheidende Rolle. Besonders im Dickdarm ist dabei neben den physiologischen Bedingungen die bakterielle Besiedlung zu beachten, welche sowohl inter- als auch intraindividuell hoch variabel ist. Bislang gibt es keine einheitliche Methode zur Untersuchung des Einflusses der intestinalen Mikrobiota auf die Metabolisierung von Arzneistoffen. Diese Methoden sind jedoch entscheidend für das Verständnis des Einflusses der bakteriellen Metabolisierung auf die Pharmakokinetik und -dynamik der Arzneistoffe. Übergeordnetes Ziel dieser Arbeit war es, ein In vitro-Modell zu entwickeln und anzuwenden, welches die dynamischen Bedingungen im Colon ascendens, insbesondere im Hinblick auf die pH-Werte, Durchmischung und bakterielle Besiedlung, darstellt. Um dieses Ziel zu erreichen, wurde im Rahmen erster Versuche untersucht, wie es sowohl mit monographierten als auch biorelevanten Modellen möglich ist, die mechanische Belastung, die auf eine Arzneiform im GIT ausgeübt wird, darzustellen. Die Verwendung der SmartPill™ eröffnete die Möglichkeit, in den Apparaturen auftretende Drücke aufzuzeichnen. Außerdem konnten die gemessenen Drücke anschließend mit Daten aus In vivo-Studien verglichen werden. Die Untersuchungen ergaben, dass in den monographierten Apparaturen keine Drücke auftreten, die den während der Magen-Darm-Passage auftretenden Drücken entsprechen. Im Gegensatz dazu können im DOFTA gezielt Drücke und so auch vollständige Druckprofile simuliert werden. Im weiteren Verlauf der Arbeit waren die zuvor gewonnenen Erkenntnisse hilfreich für die Entwicklung des neuen Modells zur Darstellung des Colon ascendens. In das MimiCol wurden pH-Wert-Daten aus einer SmartPill™-Studie implementiert. Die Vorteile des neuartigen Bioreaktors MimiCol sind das kleinere Medienvolumen, das den In vivo-Bedingungen näherkommt, die Möglichkeit, Medienwechsel durchzuführen und dadurch Metabolite abzuführen und neue Nährstoffe hinzuzufügen sowie die genauere Simulation von In vivo-Durchmischungsmustern. Ziel der durchgeführten Untersuchung war der Vergleich der Metabolisierung des Modellarzneistoffs Sulfasalazin in dem neuartigen dynamischen Bioreaktor MimiCol und einem statischen Standard-Batch-Fermenter. Beide wurden mit der gleichen, kryokonservierten fäkalen Standardmikrobiota beimpft. Die Experimente zeigten, dass das MimiCol in der Lage ist, die dynamischen Bedingungen im aufsteigenden Dickdarm zu simulieren. Die dynamischen Bedingungen im MimiCol führten zu einer Verdopplung der Metabolisierungskonstanten im Vergleich zum statischen Batch-Fermenter. Das MimiCol ahmt, besonders in Bezug auf pH-Fluktuationen und Bakterienwachstum, die dynamischen Bedingungen im aufsteigenden Dickdarm nach und könnte sich in allen Phasen der Arzneimittel- und Formulierungsentwicklung als nützlich erweisen. Zur Erleichterung und Beschleunigung der Datengenerierung wurde im nächsten Schritt eine Erweiterung des Modells angestrebt. Hierbei war es die größte Herausforderung, die ursprünglichen Parameter auf ein erweitertes Modell mit einer anderen Steuerung und anderen Komponenten zu übertragen. Außerdem wurde in diesem Zuge die Charakterisierung komplexer Bakterienkulturen mittels 16S rRNA-Sequenzierung eingeführt. Bei der Erweiterung des Modells wurde besonderes Augenmerk auf die Einfachheit des Designs und die leichte Skalierbarkeit gelegt. Um zu beweisen, dass die Übertragung der Parameter erfolgreich war, wurde erneut der Abbau von Sulfasalazin untersucht und die bakterielle Zusammensetzung während des Experiments durch 16S rRNA-Sequenzierung analysiert. Die Übertragung der Versuchsbedingungen auf das neue Modell war erfolgreich. Kommerziell erhältliche Komponenten wurden in den Aufbau implementiert. Das Modell MimiCol³ repräsentierte das Colon ascendens in seinen Eigenschaften bezüglich des Volumens, pH-Werts und Redoxpotentials zufriedenstellend. Die 16S rRNA-Sequenzierung führte zu weiteren Erkenntnissen über die bakterielle Zusammensetzung in den drei Gefäßen. Der Abbau von Sulfasalazin stand in guter Übereinstimmung mit den In vivo-Daten und den im MimiCol gewonnenen Daten. Das neue Modell des Colon ascendens MimiCol³ ermöglichte es, zuverlässigere Daten zu sammeln, da drei Experimente gleichzeitig unter denselben Bedingungen durchgeführt wurden. Die durchgeführten Untersuchungen zeigen, dass ein wichtiges Instrument zur Untersuchung des Einflusses unseres Mikrobioms im Darm auf den Abbau von Arzneistoffen und Arzneiformen entwickelt wurde.

The aim of this work was to characterize the distribution of TULV in European common vole populations, to clarify the host association of TULV and to investigate correlations between host population dynamics and changes in TULV prevalence. Furthermore, the potential of common voles as reservoir for other rodent-borne pathogens was examined in comparison to other rodent species. Molecular and serological analysis of rodents captured at 87 locations in Germany, France, Luxembourg, and Austria revealed TULV infections at 53.6 % of all trapping locations. The seroprevalence in common voles was low with a mean of 8.5 % (range: 0 – 19 %). TULV RNA was more often detected (mean: 15.3 %, range 0 - 37.5 %). Field voles (Microtus agrestis) and water voles (Arvicola amphibius) were less often tested positive for TULV: mean seroprevalence was 7 % for field voles and 6.7 % for water voles. RNA could be detected in 5.4 % of all tested field voles and 3.2 % of water voles and with exception of a single field vole only when TULV-RNA-positive common voles were trapped at the same location. Those results indicate that TULV infections of field and water voles are spillover infections from sympatric TULV-infected common voles. Phylogenetic analysis revealed distinct genetic differences between TULV sequences of regions of greater geographical distance which were associated with different evolutionary common vole lineages. Furthermore, we could detect genetic differences between TULV strains from trapping sites close to each other (ca. 10 km). In a capture-mark-recapture study 1042 common voles captured in live traps in Germany were sampled as well as 225 captured in snap traps. When analyzing the seroprevalence of fluctuating common vole populations over several years and seasons we found a negative correlation between prevalence and population density in the current season but a delayed density-dependent positive correlation between the current population density and seroprevalence in the next season. However, this trend varied geographically between the four trapping locations. Usually, population density as well as seroprevalence peaked at the end of the reproductive period in autumn with the exception of Weissach (2010-2012), Jeeser (2010) and Gotha (2012) where population peaks in summer were observed. In a pilot study in Austria common voles were captured as well as three other rodent species. They were investigated not only for presence of different viruses (TULV, Dobrava- Belgrade orthohantavirus (DOBV), Puumala orthohantavirus (PUUV), Lymphocytic choriomeningitis mammarenavirus (LCMV), Cowpox virus (CPXV)) but also pathogenic bacteria and endoparasites (Leptospira spp., Toxoplasma gondii, Borrelia afzelii, Coxiella burnetii, Rickettsia spp. und Bartonella spp.). Of all four captured species, common voles were most often infected with at least one pathogen (66.7 %), followed by wood mice (Apodemus sylvaticus) (57.7 %), bank voles (Myodes glareolus) (35 %) and yellow-necked field mice (Apodemus flavicollis) (34.5 %). Common voles were also exceptionally susceptible to multiple infections: 66.7 % of them were infected with two or three different pathogens, compared to 6.9 % of yellow-necked field mice and 2.5 % of bank voles. No multiple infections could be detected in wood mice. The broad geographic distribution of TULV in its reservoir host is in contrast to the rare reports of human infection but might be explained with a low pathogenicity for humans or with the low prevalence in host populations. In addition, the rare detection of human TULV infections could be a result of the used diagnostic methods. Since the reservoir population is known for its dramatic changes in population density and recurring superabundances which facilitates frequent contact to humans, TULV should more often be considered as cause for human disease in future analysis. In addition, several other zoonotic pathogens could be detected in common voles which could influence TULV infections in the reservoir host but also TULV transmission to humans and therefore deserve more attention in future research.

Zusammenfassung Hintergrund: Diese Arbeit hatte neben der rein deskriptiven Auswertung einer Tumordatenbank das Ziel, einen statistisch haltbaren Nachweis zu führen, ob gemeinhin angelegte Maßstäbe zur Prognose von Tumorerkrankungen auch auf die direkte Stichprobe der Universitätsfrauenklinik Greifswald übertragbar wären. Hierzu erfolgte die Betrachtung der am stärksten wirkenden Abhängigkeiten der einzelnen Variablen. Ziel: Es wurde eine Follow-Up-Studie zu bereits bestehenden 3 Datenbanken (Endometriumkarzinom TEK, Ovarialkarzinom TOC und Zervixkarzinom ZEK) durchgeführt, mit Anschrift niedergelassener Fachärzte und darauffolgender Aktualisierung der bestehenden Datensätze. Gesucht werden sollten die statistisch größten Einflussfaktoren auf das rezidivfreie Überleben und das Gesamtüberleben von Patientinnen mit oben genannten Malignomgruppen. Methoden: Insgesamt umfasste die Datenbank der Universitätsfrauenmedizin für April 2004 bis Oktober 2018 516 Eintragungen mit ungleicher Aufteilung auf 3 Einzeldatenbanken. Zu maximal 15 Variablen wurden Daten erhoben: 1. Patientenanzahl, 2. Anzahl der einzelnen Entitäten, 3. Anzahl von Primarien, 4. Anzahl von Rezidiven, 5. Alter der Patientinnen bei Erstdiagnose, 6. histopathologischer Befund, 7. Grading, 8. Staging nach FIGO, 9. operatives Verfahren, 10. (nur bei ZEK) Unterscheidung zwischen laparoskopischem und offenem Verfahren über Zeit, 11. Lymphonodektomie, nonoperative Therapie mittels 12. Chemotherapie und/oder 13. Radiatio, 14. progressionsfreies Überleben und 15. Gesamtüberleben. Hauptvariablen der Arbeit waren die Punkte 14 und 15. Eine statistische Auswertung erfolgte mit Hilfe des Computerprogramms SPSS Statistics von IBM in der Version 22 beziehungsweise Version 25. Neben einfacher Deskription wurden kaplan-meier-geschätzte Überlebenszeitkurven und Cox-Regressionsanalysen zur statistischen Auswertung der Daten genutzt. Ergebnisse: Zu Beginn der Arbeit erfolgte eine deskriptive Auswertung der Datenbanken mit Aufschlüsselung der Kenngrößen jeder einzelnen Datenbank. Es konnten für alle 3 Datenbanken Ergebnisse im Kaplan-Meierschätzverfahren für das 60-Monate-Overall-Survival ermittelt werden. Es waren für TEK (primäres Endometriumkarzinom) = 78%, TOC (primäres Ovarialkarzinom) = 50%, ZEK (alle Histologien) = 82% der Frauen nach 5 Jahren noch am Leben (All-Cause-Mortality). Weiterhin wurden Berechnungen zum rezidivfreien Überleben und Auswertungen zu histologischen Subtypen genannter Karzinome angefertigt. Die Auswertung der Chancenverhältnisse für das Eintreten der Ereignisse in den 2 Hauptvariablen zeigt in der Cox-Regressionsanalyse für TEK ein 13,17 fach, für TOC ein 9,81 fach und für ZEK ein 11,04 fach erhöhtes Risiko im FIGO-Stadium IV, verglichen mit dem FIGO-Stadium I (TEK/TOC) oder hohe gegen niedrige FIGO-Stadiengruppen (ZEK) ein Ereignis (All-Cause-Mortality) zu erleiden. Ähnliche Berechnungen erfolgten auch für das rezidivfreie Überleben. Es konnte statistisch signifikant für alle 3 Datenbanken gezeigt werden, dass die Ereignisse der 2 Hauptvariablen mit sehr hoher Wahrscheinlichkeit unter anderem von der FIGO-Klassifikation eines Tumors abhingen. Ebenso wurden für die anderen genannten Variablen Abhängigkeiten festgestellt und diese in Beziehung zueinander gesetzt. Schlussfolgerung: Nur auf die oben genannten 15 Variablen reduziert zeigt sich ein Überleben (rezidivfrei oder gesamt) in starkem Maße von der FIGO-Klassifikation und somit von der Ausbreitungssituation des Tumors abhängig. Viele Faktoren zeigen in der Multivariatanalyse signifikante Ergebnisse. Einzelvariabel betrachtet sind die Ergebnisse teils noch valider. Keine Krankheitssituation lässt sich treffend mit nur 15 Variablen beschreiben, da jede individuell ist, wie der der Mensch der sie durchlebt. Diese Arbeit konnte somit die Datenbanken umfassend beschreiben und einen Einblick in die Verteilung der Risikoverteilung liefern, welche für Patientinnen der Frauenklinik Greifswald statistisch zutrafen, ein definiertes Endereignis zu erleiden. Weiterführende Aufarbeitungen müssen zeigen, ob sich die Odds-Ratios durch immer neue und bessere Behandlungen noch weiter zu Gunsten eines besseren Patientinnenoutcomes verschieben lassen.

An Serin139 phosphoryliertes gamma Histon H2A.X (γH2A.X) hat sich über die Jahrzehnte als sensitiver Surrogat-Endpunkt Strahlen-induzierter DNA-Schäden, insbesondere von DNA-Doppelstrangbrüchen (DSBs) etabliert. Daher wurde γH2A.X in seiner biomedizinischen Anwendung als geeigneter Marker und genereller Indikator direkter DNA-Schäden anderer Agenzien, beispielsweise niedrig konzentrierter primär exogener reaktiver Sauerstoffspezies (ROS), deren intrazelluläre Effekte weniger direkt auf eine DNA-Oxidation oder das Einfügen von Strangbrüchen abzielen, angesehen. Nicht-thermisches physikalisches Plasma (NTPP), ein teilweise ionisiertes Gas, dessen biochemische Wirkung in vitro hauptsächlich über Freisetzung reaktiver Sauerstoff- und Stickstoffspezies (RONS) in der flüssigen Phase der Zellumgebung vermittelt wird, setzt lebende Systeme dosisabhängig oxidativem Stress aus und wird therapeutisch in der Wundbehandlung sowie Krebsbehandlung angewendet. Die γH2A.X Quantifizierung wurde häufig zur Beurteilung der Genotoxizität in Plasma-behandelten Zellen verwendet, wobei die NTPP-Exposition in vitro bereits häufig einen γH2A.X Anstieg zeigte, was zu der Hypothese führte, dass ein (oxidativer) DNA-Schaden die direkte Konsequenz Plasma-generierter ROS sei. Darüber hinaus tritt γH2A.X auch während der Apoptose auf, die wiederum selbst mit der NTPP- und ROS-Exposition assoziiert ist. Die vorliegende Arbeit untersuchte die γH2A.X-Induktion in einer Lymphoblasten-Zelllinie bei ROS-Exposition (NTPP, H2O2 oder HOCl) bzw. Behandlung mit UVB-Licht. Durch Verwendung von Antioxidantien wurden sowohl die Zytotoxizität als auch die γH2A.X-Induktion bei allen Arten der ROS-Quellen außer bei UVB-Strahlung aufgehoben. Inhibition der Signalwege für oxidativen Stress (p38-MAPK) und Apoptose (Pan-Caspase) hemmten signifikant die γH2A.X-Induktion bei ROS, jedoch nicht bei UVB-Licht. Letztlich und trotz H2A.X Phosphorylierung führte die UVB-Licht- und eben nicht die NTPP-Exposition zu einer signifikanten Bildung von Mikronuklei (MN), die einen funktionellen Endpunkt genotoxischer DSBs darstellen, sodass trotz der γH2A.X Präsenz kein nachhaltiges mutagenes Potential der medizinischen Plasmabehandlung identifiziert werden konnte. Im Gegensatz zu Strahlen- oder Chemotherapeutika- induziertem und somit DNA-Schaden-assoziiertem γH2A.X zeigen die Daten dieser Arbeit die H2A.X Phosphorylierung weniger als Folge eines ROS-vermittelten primären DNA-Schadens, sondern vielmehr im Licht redox-sensitiver Signalwege der Apoptose, sodass künftige γH2A.X Messungen im medizinischen Bereich, insbesondere in der Plasmamedizin und Redoxbiologie einer sorgfältigen Interpretation bedürfen.

Mit der vorliegenden Buchserie werden erstmals Alfred Franzkeits Übersetzungen litauischer Lyrik ins Deutsche systematisch veröffentlicht.

Hintergrund: Chronischer Rückenschmerz ist weiterhin eine sozioökonomische Herausforderung. Die Rentenversicherung hat zur Behandlung dieser Erkrankung Rehabilitationsstandards erstellt. Die Ergebnisse einer orthopädischen Rehabilitation objektiv darzustellen ist bisher kaum gelungen, daher wird in dieser Studie mit Hilfe des Messinstrumentes Spineliner der Versuch unternommen, dies umzusetzen. Material und Methoden: Der Spineliner ist ein Instrument zur Erfassung von u.a. des Gewebewiderstandes. Dieser Parameter wurde in dieser Studie als objektivierbarer Messparameter zur Erfassung von Therapieeffekten bei der Behandlung chronischer Rückenschmerzpatient*innen untersucht. Zur Bestimmung der Intra - und Interraterreabilität wurden Messungen zu (zwei unterschiedlichen) Zeitpunkten bei zwei Gruppen gesunder Personen (n=15 und n=16) von zwei unterschiedlichen Untersuchern durchgeführt. Die Erhebung der Messwerte des Gewebewiderstandes erfolgte an 24 Punkten entlang der Wirbelsäule (7 HWS, 12 BWS und 5 LWS) und die Erfassung der klinischen Daten der Studie (bspw. BMI, FBA) erfolgte prospektiv bei Aufnahme und nach drei Wochen bei Entlassung. Im Verlauf erhielten die Probanden (n = 80) Therapien gemäß den RehabilitationsTherapieStandards der Deutschen Rentenversicherung. Neben der ärztlichen Untersuchung wurden die Funktionsverbesserung, die Symptomlinderung i.S. der Schmerzreduktion, sowie die Minderung der psychosozialen Problemlage anhand standardisierter Fragebögen (bspw. UKS, FFbH, ODI, NAS) zu Beginn und bei Abschluss der therapeutischen Intervention erhoben. Die rückengesunden Kontrollen erhielten keine Therapie. Aufgrund des messtechnischen Verfahrens kam es innerhalb der beiden Gruppen zu Dropouts in den Messreihen, so dass sich die Zahlen von n = 80 in der Probandengruppe und n = 64 in der Kontrollgruppe unterscheiden. Als statistische Verfahren kamen der T-Test und die ANOVA zum Einsatz. Ergebnis: Durch den Spineliner wurde eine signifikante Zunahme der Geweberesistenz (gemessen in Durometer) bei der Probandengruppe nach Rehabilitation (t2) erfasst (p(HWS) = 1.594E-05, p(BWS)= 0.045 und p(LWS)= 0.005). Die klinischen Parameter zeigten sich ebenfalls verbessert. Die Schmerzen zeigten sich nach erfolgter Therapie signifikant reduziert. Dies zeigte sich u.a. anhand des NAS in Ruhe mit einem p = 1.48E-09. Zusätzlich zeigten sich Probanden nach erfolgter Rehabilitation deutlich beweglicher, welches sich bspw. bei dem Finger-Boden-Abstand gemessen in cm mit einem p = 0.003 erfassen ließ. Die Minderung der psychosozialen Problemlage evaluiert mittels UKS zeigt sich statistisch signifikant in der Untersuchungsgruppe mit einem p = 1.596E-13. Die Verbesserung der Funktionskapazität bei Alltagstätigkeiten zeigt sich mittels des FFbHs mit einem p = 7.628E-0.5 und mittels des ODIs mit einem p = 2.556E-07. Schlussfolgerung: In diesem Zusammenhang konnten wir zeigen, dass die RTS zu einer signifikanten Verbesserung hinsichtlich des körperlichen und psychischen Befindens der Patienten beitragen. Es konnte in der Studie gezeigt werden, dass der Parameter Gewebewiderstand als objektivierbarer Messparameter geeignet ist, die o. g. Fragestellung zu beantworten. Der Spineliner scheint ein geeignetes Instrument zur Erfassung von objektiver Rehabilitationsergebnissen zu sein.

Podocytes are highly specialized kidney cells that are attached to the outer aspect of the glomerular capillaries and are damaged in more than 75% of patients with an impaired renal function. This specific cell type is characterized by a complex 3D morphology which is essential for proper filtration of the blood. Any changes of this unique morphology are directly associated with a deterioration of the size-selectivity of the filtration barrier. Since podocytes are postmitotic, there is no regenerative potential and the loss of these cells is permanent. Therefore, identification of small molecules that are able to protect podocytes is highly important. The aim of this work was to establish an in vivo high-content drug screening in zebrafish larvae. At first, we looked for a reliable podocyte injury model which is fast, reproducible and easy to induce. Since adriamycin is commonly used in rodents to damage podocytes, we administered it to the larvae and analyzed the phenotype by in vivo microscopy, (immuno-) histology and RT-(q)PCR. However, adriamycin did not result in a podocyte-specific injury in zebrafish larvae. Subsequently, we decided to use a genetic ablation model which specifically damages podocytes in zebrafish larvae. Treatment of transgenic zebrafish larvae with 80 µM metronidazole for 48 hours generated an injury resembling focal and segmental glomerulosclerosis which is characterized by podocyte foot process effacement, cell depletion and proteinuria. Following this, we established an in vivo high-content screening system by the use of a specific screening zebrafish strain. This screening strain expresses a circulating 78 kDa eGFP-labeled Vitamin D-binding fusion protein, which passes the filtration barrier only after glomerular injury. Therefore, we had an excellent readout to follow podocyte injury in vivo. We generated a custom image analysis software that measures the fluorescence intensity of podocytes and the vasculature automatically on a large scale. Furthermore, we screened a specific drug library consisting of 138 compounds for protective effects on larval podocytes using this in vivo high-content system. The analysis identified several initial hits and the subsequent validation experiments identified belinostat as a reliable and significant protective agent for podocytes. These results led to a patent request and belinostat is a promising candidate for a clinical use and will be tested in mammalian podocyte injury models.

The relevance of cold atmospheric plasmas (CAPs) in biomedicine has recently grown. The potential of CAPs has been discussed in multiple scientific works, highlighting its effectiveness in promoting wound healing, limiting cancer progression, and for sterilization of surfaces. Main bioactive molecules, such as reactive oxygen and nitrogen species (RONS), are proposed as key candidates in these processes. Indeed, the generation of cold plasma induces noble gas ionization which, reacting with atmospheric air molecules, generates species such as singlet oxygen, atomic oxygen radicals, nitric oxide radicals. Although molecular simulations have been conducted, the mechanism of action on biological molecules, as well as the possibility to tune plasmas to produce specific species cocktails (e.g., with different degree of oxidation power) has been not fully unleashed. In this dissertation, presented in form of 5 published scientific articles, focus has been placed on the interaction of plasmas with peptides and proteins, which are main biological effectors in cellular compartments. Precisely, through the development of liquid chromatography coupled mass spectrometry (LC-MS) methods, the effects of plasmas on peptides and proteins in form of oxidative post-translational modifications (oxPTMs) has been investigated. The characterization of these oxPTMs has been performed by treating peptide or protein aqueous solutions and on porcine skin tissues. It has been found that, introducing small amounts of different gases (oxygen, nitrogen, or both) or even water molecules, can made CAPs tunable tools to produce oxygen-species dominating effects versus nitrogen-species dominating effects. In addition to this, it was found that the amino acid position in a peptide or protein influences the quality and quantity of the resulting oxPTMs. Besides this, other important parameters like driven gases, admixture gases or treatment duration were identified as relevant factors for the modification of amino acids in the peptide structure. By comparing the effects between peptide solutions and complex matrices such as porcine skin, water has been identified as a valid vehicle to transport and amplify the plasma chemistry. In an experimental study, the inactivation of a protein (PLA2) was observed after CAP treatment and together with simulation studies, the specific dioxidation of tryptophane W128 was detected as a potential explanation for this inactivation, indicating the strong impact of plasma on biological targets. In summary, oxidative modifications found in peptide solutions were observed also in complex protein structures and sample matrices. In conclusion, this work provides a starting point for future studies of oxidative modifications in complex models and may thus be helpful for further investigations in the fields of plasma medicine and redox chemistry.