ATRP-Synthese von Poly(N-Isopropylacrylamid)-Bürsten in wässrigem Medium und Anpassung des Nano-Plotters zur Beschichtung von Mikrocantilever-Sensoren

Das Ziel dieser Arbeit ist die Synthese von Polymerbürsten auf Silizium durch Aufbringen der Reaktionslösung mit einem Pipettiersystem. Dies ist für die Beschichtung von Microcantilever Sensoren interessant, um spezifische Fühler mit funktionellen Polymerschichten, die auf chemische oder physikalische Einflüsse reagieren, zu bauen. Bisherige Synthesemethoden werden in Lösung durchgeführt. Atom Transfer Radical Polymerization ist etabliert, um definierte Schichten von Polymerbürsten herzustellen. Die Kombination mit einer “Spot Printing”-Technik kann eine Alternative sein, um einzelne Cantilever mit einer Breite von 90 μm und einer Länge von 750 μm zu beschichten. Dafür wurde eine Chemie getestet, die mit dem Pipettiersystem Nano-Plotter der Firma Gesim umsetzbar ist. Aus einer Mischung aus Wasser und DMF wurden Poly(N-Isopropylacrylamid)-Bürsten auf Silizium mit Schichtdicken bis zu 40 nm hergestellt. Es war nötig den Nano-Plotter anzupassen, damit zum einen auf die Microcantilever Sensoren pipettiert werden kann und zum andern die Nanoliter großen Tropfen über den Reaktionszeitraum stabil sind. Auf diese Weise konnten Linien mit einer Schichtdicke von ca. 2 nm auf Siliziumwafer hergestellt werden. Die “Spot-Printing” Methode ist daher eine gute Ergänzung zur herkömmlichen Synthese.

Windkanalstudien zum Graupelwachstum und Bestimmung von Retentionskoeffizienten verschiedener Spurengase während der Bereifung

Am vertikalen Windkanal der Johannes Gutenberg-Universität Mainz wurden physikalische und chemische Bereifungsexperimente durchgeführt. Dabei lagen die Umgebungstemperaturen bei allen Experimenten zwischen etwa -15 und -5°C und der Flüssigwassergehalt erstreckte sich von 0,9 bis etwa 1,6g/m³, typische Bedingungen für Mischphasenwolken in denen Bereifung stattfindet. Oberflächentemperaturmessungen an wachsenden hängenden Graupelpartikeln zeigten, dass während der Experimente trockene Wachstumsbedingungen herrschten.rnZunächst wurde das Graupelwachstum an in einer laminaren Strömung frei schwebenden Eispartikeln mit Anfangsradien zwischen 290 und 380µm, die mit flüssigen unterkühlten Wolkentröpfchen bereift wurden, studiert. Ziel war es, den Kollektionskern aus der Massenzunahme des bereiften Eispartikels und dem mittleren Flüssigwassergehalt während des Wachstumsexperimentes zu bestimmen. Die ermittelten Werte für die Kollektionskerne der bereiften Eispartikel erstreckten sich von 0,9 bis 2,3cm³/s in Abhängigkeit ihres Kollektorimpulses (Masse * Fallgeschwindigkeit des bereifenden Graupels), der zwischen 0,04 und 0,10gcm/s lag. Bei den Experimenten zeigte sich, dass die hier gemessenen Kollektionskerne höher waren im Vergleich mit Kollektionskernen flüssiger Tropfen untereinander. Aus den aktuellen Ergebnissen dieser Arbeit und der vorhandenen Literaturwerte wurde ein empirischer Faktor entwickelt, der von dem Wolkentröpfchenradius abhängig ist und diesen Unterschied beschreibt. Für die untersuchten Größenbereiche von Kollektorpartikel und flüssigen Tröpfchen können die korrigierten Kollektionskernwerte in Wolkenmodelle für die entsprechenden Größen eingebunden werden.rnBei den chemischen Experimenten zu dieser Arbeit wurde die Spurenstoffaufnahme verschiedener atmosphärischer Spurengase (HNO3, HCl, H2O2, NH3 und SO2) während der Bereifung untersucht. Diese Experimente mussten aus technischen Gründen mit hängenden Eispartikeln, dendritischen Eiskristallen und Schneeflocken, bereift mit flüssigen Wolkenlösungströpfchen, durchgeführt werden.rnDie Konzentrationen der Lösung, aus der die Wolkentröpfchen mit Hilfe von Zweistoffdüsen erzeugt wurden, lagen zwischen 1 und 120mg/l. Für die Experimente mit Ammoniak und Schwefeldioxid wurden Konzentrationen zwischen 1 und 22mg/l verwendet. Das Schmelzwasser der bereiften hängenden Graupel und Schneeflocken wurden ionenchromatographisch analysiert und zusammen mit der bekannten Konzentration der bereifenden Wolkentröpfchen konnte der Retentionskoeffizient für jeden Spurenstoff bestimmt werden. Er gibt die Menge an Spurenstoff an, die bei der Phasenumwandlung von flüssig zu fest in die Eisphase übergeht. Salpetersäure und Salzsäure waren nahezu vollständig retiniert (Mittelwerte der gesamten Experimente entsprechend 99±8% und 100±9%). Für Wasserstoffperoxid wurde ein mittlerer Retentionskoeffizient von 65±17% bestimmt. rnDer mittlere Retentionskoeffizient von Ammoniak ergab sich unabhängig vom Flüssigwassergehalt zu 92±21%, während sich für Schwefeldioxid 53±10% für niedrige und 29±7% für hohe Flüssigphasenkonzentrationen ergaben. Bei einigen der untersuchten Spurenstoffe wurde eine Temperaturabhängigkeit beobachtet und wenn möglich durch Parametrisierungen beschrieben.rn

The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective

Background Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Methods Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. Results The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. Conclusion The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

Anatomic study of the quadrigeminal cistern in patients with 3-dimensional magnetic resonance cisternography

The aim of this study was to demonstrate the anatomy of the quadrigeminal cistern, define the anatomic landmarks, and measure the extension of the cistern in the living by using magnetic resonance (MR) cisternography with 3-dimensional reconstruction.

MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value

We describe the spectrum of findings and the diagnostic value of MR defecography in patients referred with suspicion of dyssynergic defecation.

Percutaneous treatment of biliary cast syndrome after orthotopic liver transplantation: comparison of mechanical versus hydraulic rheolytic cast extraction

Biliary cast syndrome (BCS) is the presence of casts within the intrahepatic or extrahepatic biliary system after orthotopic liver transplantation. Our work compares two percutaneous methods for BCS treatment: the mechanical cast-extraction technique (MCE) versus the hydraulic cast-extraction (HCE) technique using a rheolytic system.

OPTIMIZING A SHORT-END ELECTROPHORETICALLY MEDIATED MICRO-ANALYSIS (EMMA) ASSAY FOR CREATININE

In this work electrophoretically mediated micro-analysis (EMMA) is used in conjunction with short end injection to improve the in-capillary Jaffé assay for creatinine. Key advances over prior work include (i) using simulation to ensure intimate overlap of reagent plugs, (ii) using OH- to drive the reaction, (iii) using short-end injection to minimize analysis time and in-line product degradation. The potential-driven overlapping time with the EMMA approach, as well as the borate buffer background electrolyte (BGE) concentration and pH are optimized with the short end approach. The best conditions for short-end analyses would not have been predicted by the prior long end work, owing to a complex interplay of separation time and product degradation rates. Raw peak areas and flow-adjusted peak areas for the Jaffé reaction product (at 505 nm) are used to assess the sensitivity of the short-end EMMA approach. Optimal overlap conditions depend heavily on local conductivity differences within the reagent zone(s), as these differences cause dramatic voltage field differences, which effect reagent overlap dynamics. Simul 5.0, a dynamic simulation program for capillary electrophoresis (CE) systems, is used to understand the ionic boundaries and profiles that give rise to the experimentally obtained data for EMMA analysis. Overall, fast migration of hydroxide ions from the picrate zone makes difficult reagent overlap. In addition, the challenges associated with the simultaneous overlapping of three reagent zones are considered, and experimental results validate the predictions made by the simulation. With one set of “optimized” conditions including OH- (253 mM) as the third reagent zone the response was linear with creatinine concentration (R2 = 0.998) and reproducible over the clinically relevant range (0.08 to 0.1 mM) of standard creatinine concentrations. An LOD (S/N = 3) of 0.02 mM and LOQ (S/N=10) of 0.08 mM were determined. A significant improvement (43%) in assay sensitivity was obtained compared to prior work that considered only two reagents in the overlap.

Milk cortisol concentration in automatic milking systems compared with auto-tandem milking parlors

Milk cortisol concentration was determined under routine management conditions on 4 farms with an auto-tandem milking parlor and 8 farms with 1 of 2 automatic milking systems (AMS). One of the AMS was a partially forced (AMSp) system, and the other was a free cow traffic (AMSf) system. Milk samples were collected for all the cows on a given farm (20 to 54 cows) for at least 1 d. Behavioral observations were made during the milking process for a subset of 16 to 20 cows per farm. Milk cortisol concentration was evaluated by milking system, time of day, behavior during milking, daily milk yield, and somatic cell count using linear mixed-effects models. Milk cortisol did not differ between systems (AMSp: 1.15 +/- 0.07; AMSf: 1.02 +/- 0.12; auto-tandem parlor: 1.01 +/- 0.16 nmol/L). Cortisol concentrations were lower in evening than in morning milkings (1.01 +/- 0.12 vs. 1.24 +/- 0.13 nmol/L). The daily periodicity of cortisol concentration was characterized by an early morning peak and a late afternoon elevation in AMSp. A bimodal pattern was not evident in AMSf. Finally, milk cortisol decreased by a factor of 0.915 in milking parlors, by 0.998 in AMSp, and increased by a factor of 1.161 in AMSf for each unit of ln(somatic cell count/1,000). We conclude that milking cows in milking parlors or AMS does not result in relevant stress differences as measured by milk cortisol concentrations. The biological relevance of the difference regarding the daily periodicity of milk cortisol concentrations observed between the AMSp and AMSf needs further investigation.

Second international collaborative study evaluating performance characteristics of methods measuring the von Willebrand factor cleaving protease (ADAMTS-13)

BACKGROUND: Over the last 4 years ADAMTS-13 measurement underwent dramatic progress with newer and simpler methods. AIMS: Blind evaluation of newer methods for their performance characteristics. DESIGN: The literature was searched for new methods and the authors invited to join the evaluation. Participants were provided with a set of 60 coded frozen plasmas that were prepared centrally by dilutions of one ADAMTS-13-deficient plasma (arbitrarily set at 0%) into one normal-pooled plasma (set at 100%). There were six different test plasmas ranging from 100% to 0%. Each plasma was tested 'blind' 10 times by each method and results expressed as percentage vs. the local and the common standard provided by the organizer. RESULTS: There were eight functional and three antigen assays. Linearity of observed-vs.-expected ADAMTS-13 levels assessed as r2 ranged from 0.931 to 0.998. Between-run reproducibility expressed as the (mean) CV for repeated measurements was below 10% for three methods, 10-15% for five methods and up to 20% for the remaining three. F-values (analysis of variance) calculated to assess the capacity to distinguish between ADAMTS-13 levels (the higher the F-value, the better the capacity) ranged from 3965 to 137. Between-method variability (CV) amounted to 24.8% when calculated vs. the local and to 20.5% when calculated vs. the common standard. Comparative analysis showed that functional assays employing modified von Willebrand factor peptides as substrate for ADAMTS-13 offer the best performance characteristics. CONCLUSIONS: New assays for ADAMTS-13 have the potential to make the investigation/management of patients with thrombotic microangiopathies much easier than in the past.

Scepticism is warranted or when the CT scan reveals to be a pitfall

We report the case of a 72-year old woman with known metastatic breast cancer who presented to the emergency department with progressive dyspnea on exertion and chest pain. The diagnosis of pulmonary embolism could be established by pulmonary scintigraphy after computed tomography and ultrasound of the lower extremities had been negative in spite of a moderate clinical pretest probability (Wells score). This case shows that even if we manage suspected pulmonary embolism using algorithms combining clinical probability, computed tomography and ultrasound we must remain aware of eventually missing the diagnosis and carry on investigating cases with elevated clinical probability.

Foxo-mediated Bim transcription is dispensable for the apoptosis of hematopoietic cells that is mediated by this BH3-only protein

The BH3-only protein Bim is a critical initiator of apoptosis in hematopoietic cells. Bim is upregulated in response to growth factor withdrawal and in vitro studies have implicated the transcription factor Foxo3a as a critical inducer. To test the importance of this regulation in vivo, we generated mice with mutated Foxo-binding sites within the Bim promoters (Bim(ΔFoxo/ΔFoxo)). Contrary to Bim-deficient mice, Bim(ΔFoxo/ΔFoxo) mice had a normal hematopoietic system. Moreover, cytokine-dependent haematopoietic cells from Bim(ΔFoxo/ΔFoxo) and wt mice died at similar rates. These results indicate that regulation of Bim by Foxo transcription factors is not critical for the killing of hematopoietic cells.

A quantitative phenytoin GC-MS method and it's validation for samples from human ex situ brain microdialysis, blood and saliva using solid-phase extraction

This study describes the development and validation of a gas chromatography-mass spectrometry (GC-MS) method to identify and quantitate phenytoin in brain microdialysate, saliva and blood from human samples. A solid-phase extraction (SPE) was performed with a nonpolar C8-SCX column. The eluate was evaporated with nitrogen (50°C) and derivatized with trimethylsulfonium hydroxide before GC-MS analysis. As the internal standard, 5-(p-methylphenyl)-5-phenylhydantoin was used. The MS was run in scan mode and the identification was made with three ion fragment masses. All peaks were identified with MassLib. Spiked phenytoin samples showed recovery after SPE of ≥94%. The calibration curve (phenytoin 50 to 1,200 ng/mL, n = 6, at six concentration levels) showed good linearity and correlation (r² > 0.998). The limit of detection was 15 ng/mL; the limit of quantification was 50 ng/mL. Dried extracted samples were stable within a 15% deviation range for ≥4 weeks at room temperature. The method met International Organization for Standardization standards and was able to detect and quantify phenytoin in different biological matrices and patient samples. The GC-MS method with SPE is specific, sensitive, robust and well reproducible, and is therefore an appropriate candidate for the pharmacokinetic assessment of phenytoin concentrations in different human biological samples.