Risks, Benefits, and Therapeutic Potential of Hematopoietic Stem Cell Transplantation for Autoimmune Diabetes

Type 1 diabetes mellitus is a chronic disease that results from the autoimmune response against pancreatic insulin producing beta cells. Apart of several insulin regimens, since the decade of 80s various immunomodulatory regimens were tested aiming at blocking some steps of the autoimmune process against beta cell mass and at promoting beta cell preservation. In the last years, some independent research groups tried to cure type 1 diabetes with an "immunologic reset" provided by autologous hematopoietic stem cell transplantation in newly diagnosed patients, and the majority of patients became free form insulin with increasing levels of C-peptide along the time. In this review, we discuss the biology of hematopoietic stem cells and the possible advantages and disadvantages related to the high dose immunosuppression followed by autologous hematopoietic stem cell transplantation.

CLONING AND EXPRESSION ANALYSIS OF ALLOGRAFT INFLAMMATORY FACTOR TYPE 1 IN COELOMOCYTES OF ANTARCTIC SEA URCHIN (STERECHINUS NEUMAYERI)

We have cloned and characterized for the first time an allograft inflammatory factor 1 (Sn-AIF-1) from the Antarctic sea urchin. We report the cloning of Sn-AIF-1 cDNA and the characterization of its expression in coelomocytes after a bacterial challenge. The cDNA Sn-AIF-1 has a size of 608 bp and encodes a polypeptide of 151 aa. The deduced amino acid sequence has a putative size of 17.430 Da, an isoelectric point of 4.92, and shows 2 elongation factor handlike motifs that normally bind calcium ions. BLAST analysis revealed close matches with other known AIF-1. The deduced amino acid sequence of Sn-AIF-1 showed high homology with AIF-1 in vertebrates such as fish, mice, and humans; and in the case of invertebrates, the major degree of identity (55%) was with a predicted sequence of the purple sea urchin AIF-1, and 52% corresponded to a sponge. Expression of Sn-AIF-1 mRNA was analyzed by qPCR. Sn-AIF-1 mRNA expression was measured from coelomocytes after a bacterial challenge using RT-PCR and revealed that the gene was upregulated after 24 h. Sn-AIF-1 could participate in the inflammatory response, particularly in the activation of coelomocytes and their survival.

Influence of cardiopulmonary bypass on cefuroxime plasma concentration and pharmacokinetics in patients undergoing coronary surgery

The aims of this study were to evaluate the influence of cardiopulmonary bypass (CPB) on the plasma concentrations and pharmacokinetics of cefuroxime and to assess whether the cefuroxime dose regimen (a 1.5 g dose, followed by 750 mg every 6 h for 24 h) is adequate for cardiac surgery antibiotic prophylaxis. A prospective, controlled, observational study compared patients undergoing coronary surgery with CPB (CPB group, n = 10) or off-pump surgery (off-pump group, n = 9). After each cefuroxime dose, blood samples were sequentially collected and analysed using high-efficiency chromatography. For demographic data and pharmacokinetic parameters, the authors used Fisher's exact test for nominal variables and Student's t-test and the Mann-Whitney U-test for parametric and non-parametric variables, respectively. Plasma concentrations were compared using ANOVA, and the percentage of patients with a remaining plasma concentration of > 16 mg/l within 6 h after each bolus was quantified in tabular form. After each cefuroxime bolus was administered, both groups presented a significant decrease in plasma concentration over time (P < 0.001), without differences between the groups. The mean CPB time of 59.7 +/- 21.1 min did not change cefuroxime plasma concentrations or pharmacokinetics. The mean clearance +/- SD (ml/kg/min) and median elimination half-life (h) of the CPB group versus the off-pump group were 1.7 +/- 0.7 versus 1.6 +/- 0.6 (P = 0.67), respectively, and 2.2 versus 2.3 (P = 0.49), respectively. Up to 3 h following the first bolus of 1.5 g, but not after 6 h, all patients had plasma concentrations > 16 mg/l (CPB group = 20% and off-pump group = 44%). However, after all 750 mg boluses were administered, concentrations < 16 mg/dl were reached within 3 h. CPB does not influence cefuroxime plasma concentrations. The dosing regimen is adequate for the intraoperative period, but in the immediate postoperative period, it requires further review.

Effects of overinflation on procollagen type III expression in experimental acute lung injury

Abstract Introduction In acute lung injury (ALI), elevation of procollagen type III (PC III) occurs early and has an adverse impact on outcome. We examined whether different high-inflation strategies of mechanical ventilation (MV) in oleic acid (OA) ALI alter regional expression of PC III. Methods We designed an experimental, randomized, and controlled protocol in which rats were allocated to two control groups (no injury, recruited [alveolar recruitment maneuver after tracheotomy without MV; n = 4 rats] and control [n = 5 rats]) or four injured groups (one exposed to OA only [n = 10 rats] and three OA-injured and ventilated). The three OA-injured groups were ventilated for 1 hour according to the following strategies: LVHP-S (low volume-high positive end-expiratory pressure [PEEP], supine; n = 10 rats, tidal volume [VT] = 8 ml/kg, PEEP = 12 cm H2O), HVLP-S (high volume-low PEEP, supine; n = 10 rats, VT = 20 ml/kg, PEEP = 5 cm H2O), and HVLP-P (high volume-low PEEP, prone; n = 10 rats). Northern blot analysis for PC III and interleukin-1-beta (IL-1β) and polymorphonuclear infiltration index (PMI) counting were performed in nondependent and dependent regions. Regional differences between groups were assessed by two-way analysis of variance after logarithmic transformation and post hoc tests. Results A significant interaction for group and region effects was observed for PC III (p = 0.012) with higher expression in the nondependent region for HVLP-S and LVHP-S, intermediate for OA and HVLP-P, and lower for control (group effect, p < 0.00001, partial η2 = 0.767; region effect, p = 0.0007, partial η2 = 0.091). We found high expression of IL-1β (group effect, p < 0.00001, partial η2 = 0.944) in the OA, HVLP-S, and HVLP-P groups without regional differences (p = 0.16). PMI behaved similarly (group effect, p < 0.00001, partial η2 = 0.832). Conclusion PC III expression is higher in nondependent regions and in ventilatory strategies that caused overdistension. This response was partially attenuated by prone positioning.

Heme oxygenase-1 activity is involved in the control of Toxoplasma gondii infection in the lung of BALB/c and C57BL/6 and in the small intestine of C57BL/6 mice

Heme oxygenase-1 (HO-1) is an enzyme that catabolizes free heme, which induces an intense inflammatory response. The expression of HO-1 is induced by different stimuli, triggering an anti-inflammatory response during biological stress. It was previously verified that HO-1 is able to induce indoleamine 2,3-dioxygenase (IDO), an enzyme that is induced by IFN-γ in Toxoplasma gondii infection. To verify the role of HO-1 during in vivo T. gondii infection, BALB/c and C57BL/6 mice were infected with the ME49 strain and treated with zinc protoporphyrin IX (ZnPPIX) or hemin, which inhibit or induce HO-1 activity, respectively. The results show that T. gondii infection induced high levels of HO-1 expression in the lung of BALB/c and C57BL6 mice. The animals treated with ZnPPIX presented higher parasitism in the lungs of both lineages of mice, whereas hemin treatment decreased the parasite replication in this organ and in the small intestine of infected C57BL/6 mice. Furthermore, C57BL/6 mice infected with T. gondii and treated with hemin showed higher levels of IDO expression in the lungs and small intestine than uninfected mice. In conclusion, our data suggest that HO-1 activity is involved in the control of T. gondii in the lungs of both mouse lineages, whereas the hemin, a HO-1 inducer, seems to be involved in the control of parasitism in the small intestine of C57BL/6 mice.

PReS-FINAL-2170: Work disability in adult patients with juvenile idiopathic arthritis (JIA)

Introduction Approximately 20% JIA patients enters adulthood with clinically active disease and disabled, therefore work condition may be affected. Objectives To assess the prevalence of work disability among adult patients with JIA regularly attending a tertiary heumatology center and to determine possible associated risk factors. Methods This was a cross-sectional study that enrolled 43 JIA patients according to 2004 revised ILAR criteria. A questionnaire was developed in order to evaluate working status and labor activity: occupation, current/previous work, employment status and withdrawal rate were actively searched. Demographic data, JIA characteristics, clinical activity (DAS28>2.6), therapeutic intervention, comorbidities, physical activity, sedentarism (WHO definitions), functional class (1991 ACR criteria), HAQ and SF-36 were recorded. The prevalence of work disability was calculated using 95% confidence interval, and compared to all parameters; qualitative variables were analyzed using tests of association (chi-square test) and quantitative variables by Mann-Whitney or student test. Results Patients' mean age was 29+7.4 yrs (range 19-41) with mean JIA duration = 17.2+12.3 yrs (range 3-33); 63% were males and 37% females. JIA subtypes were 64% polyarticular, 11% oligoarticular, 9% systemic, 9% ERA, 2% extended oligoarticular, 2% psoriatic arthritis; 7% had uveitis. Serum RF was positive in 21% and ANA in 21%. The majority (72%, n = 31) of JIA patients were employed, whereas 28% (n = 12) were currently not working. In the latter group, 83% (10/12) were retired due to JIA related disability. Further analysis comparing those currently working vs. Those not working revealed similar age (25,3 yrs vs.29,5 yrs, p = 0,09). Although not significantly, most patients currently working had Poly onset JIA (22 vs. 6 p = 0,37), higher frequencies of good education level >12 yrs of school (31 vs.9, p = 0,38), functional class I (p = 0,96), practiced regular physical activity (9 vs. 0, p = 0,89), were singles (26 vs. 8, p = 0,15). Both groups had comparable HAQ and DAS 28 scores (0,62 vs. 0.59, p = 0,47 and 2,51 vs.2,07, p = 0,64) and similar arthroplasty rate (8 vs. 4, p = 0,427). Frequencies of hypertension (3 vs.1, p = 0,999), dyslipidemia (1 vs. 1, p = 0,125), diabetes (1 vs. 0 p = 0,999), depression (1 vs. 0, p = 0,999) and smokers (3 vs. 1, p = 0,99) were alike in both groups. Remarkably, employed patients had higher SF 36 mental health component (84.0 vs. 70.42, P = 0.01). Conclusion High prevalence of almost 1/3 work disability and of retirement due to disease related incapacity remain major problems for adult JIA individuals. We also identified worse mental health in employed patients indicating that further research is needed, in addition to intense affirmative disability actions in order to remove possible disabling barriers and to adapt restrictive environments for these patients. Moreover, enhanced strategies and policy for inclusion of JIA patients in the job market is urged.

Pulmonary gas exchange at maximal exercise in Danish lowlanders during 8 wk of acclimatization to 4,100 m and in high-altitude Aymara natives

[EN] We aimed to test effects of altitude acclimatization on pulmonary gas exchange at maximal exercise. Six lowlanders were studied at sea level, in acute hypoxia (AH), and after 2 and 8 wk of acclimatization to 4,100 m (2W and 8W) and compared with Aymara high-altitude natives residing at this altitude. As expected, alveolar Po2 was reduced during AH but increased gradually during acclimatization (61 +/- 0.7, 69 +/- 0.9, and 72 +/- 1.4 mmHg in AH, 2W, and 8W, respectively), reaching values significantly higher than in Aymaras (67 +/- 0.6 mmHg). Arterial Po2 (PaO2) also decreased during exercise in AH but increased significantly with acclimatization (51 +/- 1.1, 58 +/- 1.7, and 62 +/- 1.6 mmHg in AH, 2W, and 8W, respectively). PaO2 in lowlanders reached levels that were not different from those in high-altitude natives (66 +/- 1.2 mmHg). Arterial O2 saturation (SaO2) decreased during maximum exercise compared with rest in AH and after 2W and 8W: 73.3 +/- 1.4, 76.9 +/- 1.7, and 79.3 +/- 1.6%, respectively. After 8W, SaO2 in lowlanders was not significantly different from that in Aymaras (82.7 +/- 1%). An improved pulmonary gas exchange with acclimatization was evidenced by a decreased ventilatory equivalent of O2 after 8W: 59 +/- 4, 58 +/- 4, and 52 +/- 4 l x min x l O2(-1), respectively. The ventilatory equivalent of O2 reached levels not different from that of Aymaras (51 +/- 3 l x min x l O2(-1)). However, increases in exercise alveolar Po2 and PaO2 with acclimatization had no net effect on alveolar-arterial Po2 difference in lowlanders (10 +/- 1.3, 11 +/- 1.5, and 10 +/- 2.1 mmHg in AH, 2W, and 8W, respectively), which remained significantly higher than in Aymaras (1 +/- 1.4 mmHg). In conclusion, lowlanders substantially improve pulmonary gas exchange with acclimatization, but even acclimatization for 8 wk is insufficient to achieve levels reached by high-altitude natives.

Prevalencia del síndrome de burnout en tenistas según su orientación motivacional

[ES] El objetivo de este trabajo ha sido determinar el nivel de burnout en un grupo de tenistas de alto rendimiento y conocer la relación existente entre la orientación motivacional y los niveles de burnout, así como la influencia de las variables sociodemográficas.

Effetti degli accordi Euro-Mediterrani sul comparto dell'ortofrutta fresca

In 1995, the European Union (EU) Member States and 12 Mediterranean countries launched in Barcelona a liberalization process that aims at establishing a free trade area (to be realized by 2010) and at promoting a sustainable and balanced economic development by the adoption of a new generation of Agreements: the Euro-Mediterranean Agreements (EMA). For the Mediterranean partner countries, the main concern is a better access for their fruit and vegetable exports to the European market. These products represent the main exports of these countries, and the EU is their first trading partner. On the other side, for the EU the main issue is not only the promotion of its products, but also the protection of its fruit and vegetables producers. Moreover, the trade with third countries is the key element of the Common Market Organization of the sector. Fruit and vegetables represent a very sensitive sector since their high seasonality, high perishability, and especially since the production of the Mediterranean countries is often similar to the European Mediterranean’s countries one. In fact, the agreements define preferences at the entrance of the EU market providing limited concessions for each partner, for specific products, limited quantities and calendars. This research tries to analyze the bilateral trade volume for fresh fruit and vegetables in the European and Italian markets in order to assess the effects of Mediterranean liberalization on this sector. Free trade of agricultural products represents a very actual topic in international trade and the Mediterranean countries, recognised as big producers of fruit and vegetables, as big exporters of their crops and actually significantly present on the European market, could be high competitors with the inward production because the outlet could be the same. The goal of this study is to provide some considerations about the competitiveness of mediterranean fruit and vegetables productions after Barcelona Process, in a first step for the European market and then also for the Italian one. The aim is to discuss the influence of the euro-mediterranean agreements on the fruit and vegetables trade between 10 foreign Mediterranean countries (Algeria, Egypt, Israel, Jordan, Libya, Lebanon, Morocco, Tunisia, Syria, and Turkey) and 15 EU countries in the period 1995-2007, by means of a gravity model, which is a widespread methodology in international trade analysis. The basic idea of gravity models is that bilateral trade from one country to another (as the dependent variable) can be explained by a set of factors: - factors that capture the potential of a country to export goods and services; - factors that capture the propensity of a country to imports goods and services; - any other forces that either attract or inhibit bilateral trade. This analysis compares only imports’ flows by Europe and by Italy (in volumes) from Mediterranean countries, since the exports’ flows toward those foreign countries are not significant, especially for Italy. The market of fruit and vegetables appears as a high heterogeneous group so it is very difficult to show a synthesis of the analysis performed and the related results. In fact, this sector includes the so called “poor products” (such as potatoes and legumes), and the “rich product”, such as nuts or exotic fruit, and there are a lot of different goods that arouse a dissimilar consumer demand which directly influence the import requirements. Fruit and vegetables sector includes products with extremely different biological cycles, leading to a very unlike seasonality. Moreover, the Mediterranean area appears as a highly heterogeneous bloc, including countries which differ from the others for economic size, production potential, capability to export and for the relationships with the EU. The econometric estimation includes 68 analyses, 34 of which considering the European import and 34 the Italian import and the products are examined in their aggregated form and in their disaggregated level. The analysis obtains a very high R2 coefficient, which means that the methodology is able to assess the import effects on fruit and vegetables associated to the Association Agreements, preferential tariffs, regional integration, and others information involved in the equation. The empirical analysis suggests that fruits and vegetables trade flows are well explained by some parameters: size of the involved countries (especially GDP and population of the Mediterranean countries); distances; prices of imported products; local production for the aggregated products; preferential expressed tariffs like duty free; sub-regional agreements that enforce the export capability. The euro-mediterranean agreements are significant in some of the performed analysis, confirming the slow and gradual evolution of euro- Mediterranean liberalization. The euro-mediterranean liberalization provides opportunities from one side, and imposes a new important challenge from the other side. For the EU the chance is that fruit and vegetables imported from the mediterranean area represent a support for local supply and a possibility to increase the range of products existing on the market. The challenge regards the competition of foreign products with the local ones since the types of productions are similar and markets coincide, especially in the Italian issue. We need to apply a strategy based not on a trade antagonism, but on the realization of a common plane market with the Mediterranean countries. This goal could be achieved enhancing the industrial cooperation in addition to commercial relationships, and increasing investments’ flows in the Mediterranean countries aiming at transforming those countries from potential competitors to trade partners and creating new commercial policies to export towards extra European countries.

2,3-Divinyl- und 2-Aryl-3-vinylindole als Bausteine zu Carbazolen und Versuche zur photochemischen und Ultraschall-induzierten 1,6-Elektrocyclisierung

Es wurden neue funktionalisierte Carbazole und anellierte Benzo[a]carbazole als potentielle pharmakologische Therapeutika durch 1,6-pi-Elektrocyclisierung auf photo-chemischem, thermischem und sonochemischem Weg synthetisiert und die Synthesemethoden der 1,6-pi-Elektrocyclisierung sowie der 2,3-Divinylindole und der 2-Aryl-3-vinylindole als entsprechende Ausgangsprodukte validiert und evaluiert. Es gelang weder das nach den Woodward-Hoffmann-Regeln erwartete primäre Cyclisierungsprodukt mit Indolochinodimethanstruktur noch die Existenz des in einer photochemischen Abfangreaktion daraus resultierenden Cycloprodukts NMR-spektroskopisch nachzuweisen, um den stereochemischen Verlauf der Cyclisierung vorherzusagen. Ergebnisse der quantenchemischen Berechnungen der Eduktmoleküle (AO-Koeffizienten der MO's, HOMO/LUMO-Energien) sowie der Übergangszustandsgeometrien der Cyclisierungen decken sich mit den experimentellen Daten. Divinyl- und 2-Aryl-3-vinylindole sind als Systeme mit Hexatriensymmetrie aufzufassen, deren Cyclisierungsverhalten sich mit den Woodward-Hoffmann-Regeln beschreiben läßt. Im Vergleich der verschiedenen 1,6-pi-Elektrocyclisierungsmethoden zeigte sich, daß die photochemische Variante eine elegante Synthesemethode darstellt, um funktionalisierte Carbazole und Benzo[a]carbazole mit unterschiedlichen pharmakologischen Aktivitäten unter schonenden Reaktionsbedingungen mit den vergleichbar höchsten Ausbeuten zu erhalten. Demgegenüber lieferten die Ultraschallreaktionen keine nachweisbaren Cyclisierungsprodukte. Die thermische Cyclisierung führte zur Gruppe der 1,2-Dihydrocarbazole. Sie bildeten sich in einer Folgereaktion durch [1,5s]-H-Verschiebung aus dem primär entstandenen Woodward-Hoffmann-Cyclisierungsprodukt. In abschließenden DNA-Bindestudien mit verschiedenen Testsystemen zeigte keine der synthetisierten Testsubstanzen DNA-Bindungsaktivität.

Espressione dell'Enzima ad Azione Immunoregolatoria Indoleamina 2,3-Diossigenasi nella Leucemia Mieloide Acuta dell'Adulto: correlazioni Clinico-Biologiche

L’enzima IDO interviene nella via di degradazione del triptofano, essenziale per la vita cellulare; l’iperespressione di IDO favorisce la creazione di un microambiente immunotollerante. Nelle LAM IDO è funzionalmente attivo nelle cellule blastiche e determina l’acquisizione di un fenotipo regolatorio da parte delle cellule T alloreattive; l’espressione della proteina aumenta in modo consensuale con l’evoluzione clinica della patologia. Scopo della Tesi è indagare l’esistenza di una correlazione tra l’iperespressione di IDO da parte delle cellule leucemiche, le caratteristiche di rischio alla diagnosi e l’outcome dei pazienti. Sono stati esaminati 45 pazienti adulti affetti da LAM afferiti all’Istituto di Ematologia di Bologna. I pazienti sono stati stratificati a seconda di: età di insorgenza della leucemia, secondarietà a Mielodisplasia o radio chemioterapia, iperleucocitosi, citogenetica, biologia molecolare (sono state valutate le alterazioni a carico dei geni FLT3 ed NPM). I pazienti sono stati analizzati per l’espressione del gene IDO mediante RT-PCR, seguita da Western Blot, allo scopo di stabilire la presenza di una proteina attiva; successivamente si è proceduto a verificare l’esistenza di una correlazione tra l’espressione di IDO e le caratteristiche di rischio alla diagnosi per identificare una relazione tra l’espressione del gene ed un subset di pazienti a prognosi favorevole o sfavorevole. Dei 45 pazienti adulti affetti da LAM il 28,9% è risultato negativo per l’espressione di IDO, mentre il rimanente 71,1% è risultato positivo ed è stato suddiviso in tre ulteriori categorie, in base ai livelli di espressione. I dati non sembrano al momento suggerire l’esistenza di una correlazione tra l’espressione di IDO e le caratteristiche di rischio alla diagnosi. Nel gruppo di pazienti ad elevata espressione di IDO si riscontra un rate di resistenza alla chemioterapia di induzione più elevato, con una quota di pazienti resistenti pari al 71,4%, contro il 23,1% nel gruppo di pazienti IDO-negativi.

Enantioselektive Synthese von Tetrahydroprotoberberinen und anderen Benzylisochinolinalkaloiden aus alpha-Aminonitrilen

Ziel dieser Arbeit war es, ausgehend von alpha-Aminonitrilen verschiedene Tetrahydroisochinolin-Alkaloide darzustellen. Es wurde gezeigt, dass sich das alpha-Aminonitril unter kontrollierten Bedingungen quantitativ in alpha-Position deprotonieren lässt und durch anschließende C-1-Alkylierung mit substituierten Benzylbromiden zu 1 Benzyl-3,4-dihydroisochinolinen umsetzen lässt. Diese konnten im nächsten Schritt mittels asymmetrischer Transferhydrierung nach Noyori in Alkaloid-Vorläufer mit hoher optischer Reinheit umgewandelt werden. Zur Überführung der (S)-1-Benzylisochinoline in die natürlich vorkommenden Alkaloide wurden diese N-methyliert und entschützt. Auf diese Weise konnten (+)-Laudanosin, (+)-Laudanidin und (+)-Armepavin dargestellt werden. Pictet-Spengler-Cyclisierung der Benzylisochinoline erzeugte Alkaloide vom Protoberberin-Typ. Die Ullmann-Kupplung zum Aufbau der Diaryletherbrücke bildete den Schlüsselschritt bei der Darstellung von Bisbenzylisochinolinalkaloiden. Unter Verwendung von N,N-Dimethylglycin, CuI und dem Einsatz von Mikrowellen-Strahlen wurden im folgenden Schritt (+)-O-Methylthalibrin und (+)-O-Tetramethylmagnolamin in enantiomerenreiner Form und mit guten Ausbeuten dargestellt. Die Synthese von (−)-Tetrahydropalmatin unter Reaktionsbedingungen nach Pictet und Spengler über ein in C-2’ blockiertes (S)-1-Benzylisochinolin gelang nicht. Stattdessen erfolgte eine exocyclische [1,3]-Umlagerung der Benzyl-Gruppe des Iminium-Ions. Diese Umlagerung ist mit der von Knabe gefundenen endocyclischen Umlagerung von 1,2-disubstituierten 1,2-Dihydroisochinolinen verwandt. Der Nachweis über das Auftreten freier Radikale während der hier gefundenen [1,3]-Benzyl-Umlagerung erfolgte über ein Crossover-Experiment, Isotopen-Markierung sowie Studien zur Inhibierung bzw. Initiierung freier Radikale. Die experimentellen Befunde und DFT Berechnungen von Straub unterstützen die Theorie zum Verlauf über eine diffusionskontrollierte Radikal-Ketten-Reaktion.

Investigation of acceptor dopants in ZrNiSn half-Heusler materials

Thermoelectric generators (TEG) are solid state devices and are able to convert thermal energy directly into electricity and thus could play an important role in waste heat recovery in the near future. Half-Heusler (HH) compounds with the general formula MNiSn (M = Ti, Zr, Hf) built a promising class of materials for these applications because of their high Seebeck coefficients, their environmentally friendliness and their cost advantage over conventional thermoelectric materials.rnrnMuch of the existing literature on HH deals with thermoelectric characterization of n-type MNiSn and p-type MCoSb compounds. Studies on p-type MNiSn-based HHs are far fewer in number. To fabricate high efficient thermoelectric modules based on HH compounds, high performance p-type MNiSn systems need to be developed that are compatible with the existing n-type HH compounds. This thesis explores synthesis strategies for p-type MNiSn based compounds. In particular, the efficacy of transition metals (Sc, La) and main group elements (Al, Ga, In) as acceptor dopants on the Sn-site in ZrNiSn, was investigated by evaluating their thermoelectric performance. The most promising p-type materials could be achieved with transition metal dopants, where the introduction of Sc on the Zr side, yielded the highest Seebeck coefficient in a ternary NiSn-based HH compound up to this date. Hall effect and band gap measurements of this system showed, that the high mobility of minority carrier electrons dominate the transport properties at temperatures above 500 K. It could be shown that this is the reason, why n-type HH are successful TE materials for high temperature applications, and that p-types are subjected to bipolar effects which will lead to diminished thermoelectric efficiencies at high temperatures.rnrnTo complement the experimental investigations on different metal dopants and their influence on the TE properties of HH compounds, numerical solutions to the Boltzmann transport equation were used to predict the optimum carrier concentration where the maximum TE efficiency occurs for p-type HH compounds. The results for p-type samples showed that can not be treated within a simple parabolic band model approach, due to bipolar and multi-band effects.rnrnThe parabolic band model is commonly used for bulk TE materials. It is most accurate when the transport properties are dominated by one single carrier type. Since the transport properties of n-type HH are dominated by only one carrier type (high mobility electrons), it could be shown, that the use of a simple parabolic band model lead to a successful prediction of the optimized carrier concentration and thermoelectric efficiency in n-type HH compounds. rn

Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer study

Our study group recently evaluated an ED(95) local anaesthetic volume of 0.11 ml.mm(-2) cross-sectional nerve area for the ulnar nerve. This prospective, randomised, double-blind crossover study investigated whether this volume is sufficient for brachial plexus blocks at the axillary level. Ten volunteers received an ultrasonographic guided axillary brachial plexus block either with 0.11 ('low' volume) or 0.4 ('high' volume) ml.mm(-2) cross-sectional nerve area with mepivacaine 1%. The mean (SD) volume was in the low volume group 4.0 (1.0) and 14.8 (3.8) ml in the high volume group. The success rate for the individual nerve blocks was 27 out of 30 in the low volume group (90%) and 30 out of 30 in the high volume group (100%), resulting in 8 out of 10 (80%) vs 10 out of 10 (100%) complete blocks in the low vs the high volume groups, respectively (NS). The mean (SD) sensory onset time was 25.0 (14.8) min in the low volume group and 15.8 (6.8) min in the high volume group (p < 0.01). The mean (SD) duration of sensory block was 125 (38) min in the low volume group and 152 (70) min in the high volume group (NS). This study confirms our previous published ED(95) volume for mepivacaine 1% to block peripheral nerves. The volume of local anaesthetic has some influence on the sensory onset time.

Assessment of letrozole and tamoxifen alone and in sequence for postmenopausal women with steroid hormone receptor-positive breast cancer: the BIG 1-98 randomised clinical trial at 8·1 years median follow-up

Postmenopausal women with hormone receptor-positive early breast cancer have persistent, long-term risk of breast-cancer recurrence and death. Therefore, trials assessing endocrine therapies for this patient population need extended follow-up. We present an update of efficacy outcomes in the Breast International Group (BIG) 1-98 study at 8·1 years median follow-up.