Evaluation of 3D cell culture systems for host-pathogen interaction studies

Traditional cell culture models have limitations in extrapolating functional mechanisms that underlie strategies of microbial virulence. Indeed during the infection the pathogens adapt to different tissue-specific environmental factors. The development of in vitro models resembling human tissue physiology might allow the replacement of inaccurate or aberrant animal models. Three-dimensional (3D) cell culture systems are more reliable and more predictive models that can be used for the meaningful dissection of host–pathogen interactions. The lung and gut mucosae often represent the first site of exposure to pathogens and provide a physical barrier against their entry. Within this context, the tracheobronchial and small intestine tract were modelled by tissue engineering approach. The main work was focused on the development and the extensive characterization of a human organotypic airway model, based on a mechanically supported co-culture of normal primary cells. The regained morphological features, the retrieved environmental factors and the presence of specific epithelial subsets resembled the native tissue organization. In addition, the respiratory model enabled the modular insertion of interesting cell types, such as innate immune cells or multipotent stromal cells, showing a functional ability to release pertinent cytokines differentially. Furthermore this model responded imitating known events occurring during the infection by Non-typeable H. influenzae. Epithelial organoid models, mimicking the small intestine tract, were used for a different explorative analysis of tissue-toxicity. Further experiments led to detection of a cell population targeted by C. difficile Toxin A and suggested a role in the impairment of the epithelial homeostasis by the bacterial virulence machinery. The described cell-centered strategy can afford critical insights in the evaluation of the host defence and pathogenic mechanisms. The application of these two models may provide an informing step that more coherently defines relevant molecular interactions happening during the infection.

Nucleation studies on graphics processing units

Ein System in einem metastabilen Zustand muss eine bestimmte Barriere in derrnfreien Energie überwinden um einen Tropfen der stabilen Phase zu formen.rnHerkömmliche Untersuchungen nehmen hierbei kugelförmige Tropfen an. Inrnanisotropen Systemen (wie z.B. Kristallen) ist diese Annahme aber nicht ange-rnbracht. Bei tiefen Temperaturen wirkt sich die Anisotropie des Systems starkrnauf die freie Energie ihrer Oberfläche aus. Diese Wirkung wird oberhalb derrnAufrauungstemperatur T R schwächer. Das Ising-Modell ist ein einfaches Mo-rndell, welches eine solche Anisotropie aufweist. Wir führen großangelegte Sim-rnulationen durch, um die Effekte, die mit einer endlichen Simulationsbox ein-rnhergehen, sowie statistische Ungenauigkeiten möglichst klein zu halten. DasrnAusmaß der Simulationen die benötigt werden um sinnvolle Ergebnisse zu pro-rnduzieren, erfordert die Entwicklung eines skalierbaren Simulationsprogrammsrnfür das Ising-Modell, welcher auf verschiedenen parallelen Architekturen (z.B.rnGrafikkarten) verwendet werden kann. Plattformunabhängigkeit wird durch ab-rnstrakte Schnittstellen erreicht, welche plattformspezifische Implementierungs-rndetails verstecken. Wir benutzen eine Systemgeometrie die es erlaubt eine Ober-rnfläche mit einem variablen Winkel zur Kristallebene zu untersuchen. Die Ober-rnfläche ist in Kontakt mit einer harten Wand, wobei der Kontaktwinkel Θ durchrnein Oberflächenfeld eingestellt werden kann. Wir leiten eine Differenzialglei-rnchung ab, welche das Verhalten der freien Energie der Oberfläche in einemrnanisotropen System beschreibt. Kombiniert mit thermodynamischer Integrationrnkann die Gleichung benutzt werden, um die anisotrope Oberflächenspannungrnüber einen großen Winkelbereich zu integrieren. Vergleiche mit früheren Mes-rnsungen in anderen Geometrien und anderen Methoden zeigen hohe Überein-rnstimung und Genauigkeit, welche vor allem durch die im Vergleich zu früherenrnMessungen wesentlich größeren Simulationsdomänen erreicht wird. Die Temper-rnaturabhängigkeit der Oberflächensteifheit κ wird oberhalb von T R durch diernKrümmung der freien Energie der Oberfläche für kleine Winkel gemessen. DiesernMessung lässt sich mit Simulationsergebnissen in der Literatur vergleichen undrnhat bessere Übereinstimmung mit theoretischen Voraussagen über das Skalen-rnverhalten von κ. Darüber hinaus entwickeln wir ein Tieftemperatur-Modell fürrndas Verhalten um Θ = 90 Grad weit unterhalb von T R. Der Winkel bleibt bis zu einemrnkritischen Feld H C quasi null; oberhalb des kritischen Feldes steigt der Winkelrnrapide an. H C wird mit der freien Energie einer Stufe in Verbindung gebracht,rnwas es ermöglicht, das kritische Verhalten dieser Größe zu analysieren. Die harternWand muss in die Analyse einbezogen werden. Durch den Vergleich freier En-rnergien bei geschickt gewählten Systemgrößen ist es möglich, den Beitrag derrnKontaktlinie zur freien Energie in Abhängigkeit von Θ zu messen. Diese Anal-rnyse wird bei verschiedenen Temperaturen durchgeführt. Im letzten Kapitel wirdrneine 2D Fluiddynamik Simulation für Grafikkarten parallelisiert, welche u. a.rnbenutzt werden kann um die Dynamik der Atmosphäre zu simulieren. Wir im-rnplementieren einen parallelen Evolution Galerkin Operator und erreichen

Prolonged inflammation following critical illness may impair long-term survival: a hypothesis with potential therapeutic implications

Despite successful intensive care a substantial portion of critically ill patients dies after discharge from the intensive care unit or hospital. Observational studies investigating long-term survival of critically ill patients reported that most deaths occur during the first months or year after discharge. Only limited data on the causes of impaired quality of life and post-intensive care unit deaths exist in the current literature. In this manuscript we hypothesize that the acute inflammatory response which characteristically accompanies critical illness is ensued by a prolonged imbalance or activation of the immune system. Such a chronic low-grade inflammatory response to critical illness may be sub-clinical and persist for a variable period of time after discharge from the intensive care unit and hospital. Chronic inflammation is a well-recognized risk factor for long-term morbidity and mortality, particularly from cardiovascular causes, and may thus partly contribute to the impaired quality of life as well as increased morbidity and mortality following intensive care unit and hospital discharge of critically ill patients. Assuming that critical illness is indeed followed by a prolonged inflammatory response, important implications for treatment would arise. An interesting and potentially beneficial therapy could be the administration of immune-modulating drugs during the time after intensive care unit or hospital discharge until chronic inflammation has subsided. Statins are well-investigated and effective drugs to attenuate chronic inflammation and could potentially also improve long-term outcome of critically ill patients after intensive care unit or hospital discharge. Future studies evaluating the course of inflammation during and after critical illness as well as its response to statin therapy are required.

Critical roles for Rac GTPases in T-cell migration to and within lymph nodes

Naive T cells continuously recirculate between secondary lymphoid tissue via the blood and lymphatic systems, a process that maximizes the chances of an encounter between a T cell and its cognate antigen. This recirculation depends on signals from chemokine receptors, integrins, and the sphingosine-1-phosphate receptor. The authors of previous studies in other cell types have shown that Rac GTPases transduce signals leading to cell migration and adhesion; however, their roles in T cells are unknown. By using both 3-dimensional intravital and in vitro approaches, we show that Rac1- and Rac2-deficient T cells have multiple defects in this recirculation process. Rac-deficient T cells home very inefficiently to lymph nodes and the white pulp of the spleen, show reduced interstitial migration within lymph node parenchyma, and are defective in egress from lymph nodes. These mutant T cells show defective chemokine-induced chemotaxis, chemokinesis, and adhesion to integrin ligands. They have reduced lateral motility on endothelial cells and transmigrate in-efficiently. These multiple defects stem from critical roles for Rac1 and Rac2 in transducing chemokine and sphingosine-1-phosphate receptor 1 signals leading to motility and adhesion.

Benefit of immediate revascularization in women with critical limb ischemia in an intention-to-treat analysis

Evidence for the best treatment strategy in women with critical limb ischemia (CLI) is limited and controversial with studies contradicting each other. Therefore, we determined the benefit of immediate revascularization compared to medical therapy (MT) with optional delayed revascularization in men and women with CLI.

[Prophylaxis and therapy of postdural puncture headache--a critical evaluation of treatment options]

Since the first description of spinal and epidural anaesthesia, postdural puncture headache (PDPH) is a well known complication. Its prophylaxis and treatment has been studied and discussed for more than 100 years, but the evidence is still limited. Due to relatively low prevalence of PDPH, prospective RCTs are often missing, and the frequently self-limiting character of PDPH impedes an adequate interpretation of results from studies without a control group. Taking side effects and complications into account, a prophylactic treatment of PDPH cannot be recommended. In case of PDPH, non-opioid analgesics are the first choice treatment. The epidural blood patch remains the mainstay of severe PDPH therapy. Noninvasive therapies like theophylline, sumatriptan and ACTH can be an alternative. However, an evidence-based recommendation is lacking. The development of standard operating procedures for accidental dural punctures and PDPH is recommended.

Chapter IV: Treatment of critical limb ischaemia

Recommendations stated in the TASC II guidelines for the treatment of peripheral arterial disease (PAD) regard a heterogeneous group of patients ranging from claudicants to critical limb ischaemia (CLI) patients. However, specific considerations apply to CLI patients. An important problem regarding the majority of currently available literature that reports on revascularisation strategies for PAD is that it does not focus on CLI patients specifically and studies them as a minor part of the complete cohort. Besides the lack of data on CLI patients, studies use a variety of endpoints, and even similar endpoints are often differentially defined. These considerations result in the fact that most recommendations in this guideline are not of the highest recommendation grade. In the present chapter the treatment of CLI is not based on the TASC II classification of atherosclerotic lesions, since definitions of atherosclerotic lesions are changing along the fast development of endovascular techniques, and inter-individual differences in interpretation of the TASC classification are problematic. Therefore we propose a classification merely based on vascular area of the atherosclerotic disease and the lesion length, which is less complex and eases the interpretation. Lesions and their treatment are discussed from the aorta downwards to the infrapopliteal region. For a subset of lesions, surgical revascularisation is still the gold standard, such as in extensive aorto-iliac lesions, lesions of the common femoral artery and long lesions of the superficial femoral artery (>15 cm), especially when an applicable venous conduit is present, because of higher patency and limb salvage rates, even though the risk of complications is sometimes higher than for endovascular strategies. It is however more and more accepted that an endovascular first strategy is adapted in most iliac, superficial femoral, and in some infrapopliteal lesions. The newer endovascular techniques, i.e. drug-eluting stents and balloons, show promising results especially in infrapopliteal lesions. However, most of these results should still be confirmed in large RCTs focusing on CLI patients. At some point when there is no possibility of an endovascular nor a surgical procedure, some alternative non-reconstructive options have been proposed such as lumbar sympathectomy and spinal cord stimulation. But their effectiveness is limited especially when assessing the results on objective criteria. The additional value of cell-based therapies has still to be proven from large RCTs and should therefore still be confined to a research setting. Altogether this chapter summarises the best available evidence for the treatment of CLI, which is, from multiple perspectives, completely different from claudication. The latter also stresses the importance of well-designed RCTs focusing on CLI patients reporting standardised endpoints, both clinical as well as procedural.

Critical review of the use of erythropoietin in the treatment of anaemia during therapy for chronic hepatitis C

Combined pegylated interferon (PegIFN) and ribavirin represents the standard therapy for patients with chronic hepatitis C (CHC), which allows for sustained viral response (SVR) in up to 90% of patients depending on certain viral and host factors. Clinical studies have demonstrated the importance of adherence to therapy, that is, the ability of patients to tolerate and sustain a fully dosed therapy regimen. Adherence is markedly impaired by treatment-related adverse effects. In particular, haemolytic anaemia often requires dose reduction or termination of ribavirin treatment, which compromises treatment efficacy. Recent evidence points to a beneficial role of recombinant erythropoietin (EPO) in alleviating ribavirin-induced anaemia thereby improving quality of life, enabling higher ribavirin dosage and consequently improving SVR. However, no general consensus exists regarding the use of EPO for specific indications: its optimal dosing, treatment benefits and potential risks or cost efficiency. The Swiss Association for the Study of the Liver (SASL) has therefore organized an expert meeting to critically review and discuss the current evidence and to phrase recommendations for clinical practice. A consensus was reached recommending the use of EPO for patients infected with viral genotype 1 developing significant anaemia below 100 g/L haemoglobin and a haematocrit of <30% during standard therapy to improve quality of life and sustain optimal ribavirin dose. However, the evidence supporting its use in patients with pre-existing anaemia, non-1 viral genotypes, a former relapse or nonresponse, liver transplant recipients and cardiovascular or pulmonary disease is considered insufficient.

A survey of MRI-based medical image analysis for brain tumor studies

MRI-based medical image analysis for brain tumor studies is gaining attention in recent times due to an increased need for efficient and objective evaluation of large amounts of data. While the pioneering approaches applying automated methods for the analysis of brain tumor images date back almost two decades, the current methods are becoming more mature and coming closer to routine clinical application. This review aims to provide a comprehensive overview by giving a brief introduction to brain tumors and imaging of brain tumors first. Then, we review the state of the art in segmentation, registration and modeling related to tumor-bearing brain images with a focus on gliomas. The objective in the segmentation is outlining the tumor including its sub-compartments and surrounding tissues, while the main challenge in registration and modeling is the handling of morphological changes caused by the tumor. The qualities of different approaches are discussed with a focus on methods that can be applied on standard clinical imaging protocols. Finally, a critical assessment of the current state is performed and future developments and trends are addressed, giving special attention to recent developments in radiological tumor assessment guidelines.

Teaching the Millennial Generation in the Religious and Theological Studies Classroom

This essay provides an overview of the distinctive challenges presented to teaching and learning in religious and theological studies by the conditions and characteristics of “millennial” students. While the emerging literature on this generation is far from consistent, it is still instructive and important to engage, as students that are immersed in technology and social networking have different facilities and difficulties that educators would do well to carefully address and critically employ. Teachers in theological and religious studies are distinctly positioned to grapple with such conditions, particularly around the practices of identity formation, media literacy, and embodiment. Attention to the development of such practices engages key issues for both the millennial students and the religious and theological studies teacher: virtual reality, spiritual identity, globalization and violence, critical consumption and ethical creativity, focused and contemplative thinking, and intercultural and interpersonal respect.