Skin repair optimization for the airbus A350XWB cargo door surround

The aim of the thesis is to design and verify a doubler for the Airbus A350XWB cargo door surround. The software used for the design is Catia and the software used for the doubler verification are Patran and Nastran.

Induktion tolerogener dendritischer Zellen zur Suppression von experimenteller autoimmuner Enzephalomyelitis und Kontaktallergie

Dendritische Zellen (DC) spielen als professionelle antigenpräsentierende Zellen (APC) eine zentrale Rolle in der Aktivierung und Regulierung antigenspezifischer Immunantworten. Aus diesem Grund wird der therapeutische Einsatz von DC zur Behandlung von Autoimmunerkrankungen und Allergien sowie zur Tumorbekämpfung erforscht. Im ersten Teil der vorliegenden Arbeit untersuchten wir das Potenzial einer biolistischen DNA-Vakzinierung zur Induktion tolerogener DC in vivo. Im Tiermodell der Myelin-Oligodendrozyten-Glykoprotein Peptid 35-55 (MOGp35-55) induzierten experimentellen autoimmunen Enzephalomyelitis (EAE) sollte mittels präventiver biolistischer Kovakzinierung von Plasmid-DNA kodierend für MOG und die immunregulatorischen Zytokine TGFβ oder IL-10 eine protektive Immunität induziert werden. Die MOG-Expression stand dabei entweder unter der Kontrolle des ubiquitär aktiven CMV-Promotors oder des murinen Fascin-Promotors, um eine ektopische MOG-Expression spezifisch in dermalen DC und Langerhanszellen zu erreichen. Dass MOGp35-55-präsentierende DC nach biolistischer DNA-Vakzinierung von der Haut in die drainierenden Lymphknoten migrieren und dort T-Zellen aktivieren, konnte im Vorfeld anhand einer substanziellen Proliferation von MOGp35-55-reaktiven 2D2 T-Zellen nachgewiesen werden. Im präventiven Ansatz der MOGp35-55-induzierten EAE zeigten Mäuse, die mit MOG-kodierenden Plasmiden biolistisch transfiziert wurden, eine leicht reduzierte EAE-Symptomatik. Die Kotransfektion von MOG und TGFβ führte zu einer Verstärkung der EAE-Suppression – unabhängig davon, ob die MOG-Expression unter der Kontrolle des CMV- oder des Fascin-Promotors stand. Interessanterweise resultierte die Koapplikation von MOG- und IL-10-kodierender Plasmid-DNA nur bei DC-fokussierter MOG-Expression zu reduzierter EAE-Symptomatik. Für biolistische DNA-Vakzinierungen stellt somit der Fascin-Promotor eine potente Alternative zu viralen Promotoren dar. Entsprechend der milderen EAE-Symptome beobachteten wir bei behandelten EAE-Mäusen einen geringeren Grad an Demyelinisierung sowie eine reduzierte Infiltration des ZNS mit IFNγ-produzierenden CD4+ Th1- und IL-17-produzierenden CD4+ Th17-Zellen. Desweiteren zeigten Milzzellen ex vivo nach MOGp35-55-Restimulation eine inhibierte Proliferation und eine signifikant reduzierte IFNγ- und IL-17-Zytokinproduktion. Überraschenderweise ging die antigenspezifische Immunsuppression nicht mit der Expansion von Foxp3+ regulatorischen T-Zellen einher. Da die Milzen aber erhöhte Mengen an CD8+IFNγ+ T-Zellen aufweisen, könnte ein zytotoxisch-suppressiver Mechanismus für die Inhibition der Th1- und Th17-Immunantwort verantwortlich sein. Nachfolgende Untersuchungen sind notwendig, um die induzierten immunologischen Mechansimen mittels biolistischer DNA-Vakzinierung aufzuklären. Der zweite Teil der Arbeit befasst sich mit der Generierung von tolerogenen DC in vitro. Dafür wurden murine Knochenmarkszellen unter DC-differenzierenden Bedingungen in Gegenwart des synthetischen Glucocorticoids Dexamethason (DEX) kultiviert. Die DEX-Zugabe führte zur Differenzierung von APC mit geringer CD11c-Expression. DEX-APC waren in vitro weitestgehend gegen LPS stimulierungsresistent und zeigten eine reduzierte Expression von MHC-II und den kostimulatorischen Molekülen CD80, CD86 und CD40. Ihrem tolerogenen Phänotyp entsprechend besaßen DEX-APC ein geringeres syngenes T-Zellstimulierungspotenzial als unbehandelte BM-DC. Anhand der erhöhten Oberflächenexpression von CD11b, GR1 und F4/80 besteht eine phänotypische Ähnlichkeit zu myeloiden Suppressorzellen. Die Fähigkeit von DEX-APC in vivo antigenspezifische Toleranz zu induzieren, wurde durch einen therapeutischen Ansatz im murinen Krankheitsmodell der Kontaktallergie überprüft. Die therapeutische Applikation von DEX-APC führte hierbei im Vergleich zur Applikation von PBS oder unbehandelten BM-DC zu einer signifikant reduzierten Ohrschwellungsreaktion. Zusammenfassend demonstrieren die Ergebnisse dieser Arbeit, dass potente tolerogene DC sowohl in vivo als auch in vitro induziert werden können. Dass diese Zellpopulation effektiv antigenspezifische Immunreaktionen supprimieren kann, macht sie zu einem vielversprechenden Werkzeug in der Behandlung von Autoimmunerkrankungen und Allergien.rn

Type IV delayed-type hypersensitivity of the respiratory tract due to budesonide use: report of two cases and a literature review

Respiratory type-IV hypersensitivity reactions due to corticosteroids is a rare phenomenon. We describe two such cases. The first is a 37- year-old atopic woman who developed labial angioedema and nasal itching after the use of budesonide nasal spray. A month later, after the first puffs of a formoterol/budesonide spray prescribed for asthma, she noticed symptoms of tongue and oropharyngeal itching and redness with subsequent dysphagia, labial and tongue angioedema, and facial oedema. The second is a 15-year-old non-atopic woman who reported pruritic eruptions around the nostrils after using a budesonide nasal spray. A year later she presented with nasal pruritus with intense congestion and labial and facial oedema after using the same spray. Both patients were evaluated with patch-tests using the commercial T.R.U.E. test, a budesonide solution, and corticosteroid creams. Test evaluation was performed at 48 and 96 hours. In both patients, patch tests were positive to budesonide (++) on the second day. The first patient also had a positive (+) reaction to tixocortol-21-pivalate. All the other patch tests were negative. Clinicians should be aware that hypersensitivity reactions may occur during the use of nasal or inhaled corticosteroids.

The choice of anesthesia influences oxidative energy metabolism and tissue survival in critically ischemic murine skin

In surgical animal studies anesthesia is used regularly. Several reports in the literature demonstrate respiratory and cardiovascular side effects of anesthesiologic agents. The aim of this study was to compare two frequently used anesthesia cocktails (ketamine/xylazine [KX] versus medetomidine/climazolam/fentanyl [MCF]) in skin flap mouse models. Systemic blood values, local metabolic parameters, and surgical outcome should be analyzed in critical ischemic skin flap models. Systemic hypoxia was found in the animals undergoing KX anesthesia compared with normoxia in the MCF group (sO(2): 89.2% +/- 2.4% versus 98.5% +/- 1.2%, P < 0.01). Analysis of tissue metabolism revealed impaired anaerobic oxygen metabolism and increased cellular damage in critical ischemic flap tissue under KX anesthesia (lactate/pyruvate ratio: KX 349.86 +/- 282.38 versus MCF 64.53 +/- 18.63; P < 0.01 and glycerol: KX 333.50 +/- 83.91 micromol/L versus MCF 195.83 +/- 29.49 micromol/L; P < 0.01). After 6 d, different rates of flap tissue necrosis could be detected (MCF 57% +/- 6% versus KX 68% +/- 6%, P < 0.01). In summary we want to point out that the type of anesthesia, the animal model and the goal of the study have to be well correlated. Comparing the effects of KX and MCF anesthesia in mice on surgical outcome was a novel aspect of our study.

High numbers of DC-SIGN+ dendritic cells in lesional skin of cutaneous T-cell lymphoma

The role of dendritic cells (DCs) in disease progression of primary cutaneous T-cell lymphoma (CTCL) is not well understood. With their unique ability to induce primary immune responses as well as immunotolerance, DCs play a critical role in mediation of anti-tumor immune responses. Tumor-infiltrating DCs have been determined to represent important prognostic factors in a variety of human tumors.

Skin cancers in renal transplant recipients: A description of the renal transplant cohort in Bern

BACKGROUND/AIMS: Skin tumours, in particular squamous-cell carcinomas (SCC), are the most common malignant conditions developing in transplant recipients. The aim of this study is to investigate the frequency and type of skin cancer in patients receiving immunosuppressive therapy after organ transplantation. METHODS: Multivariate logistic regression analysis was performed on data of 243 renal transplant patients who attended the dermatology outpatient clinic for the first time after transplantation in the period January 2002-October 2005. RESULTS: We found an increased risk of actinic keratosis (AK) and SCC in renal transplant recipients with a basal cell carcinoma (BCC) / SCC ratio of 1:7. Older patients had AK more frequently (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.06-1.15; p <0.0001) and SCC (OR 1.14, CI 1.07-1.22; p <0.0001) than younger patients. Men had AK (OR 0.19, CI 0.08-0.45; p = 0.0002) and SCC (OR 0.25, CI 0.07-0.89; p = 0.0332) more frequently than women. The duration of immunosuppressive therapy correlated significantly with the numbers of AKs (OR 1.15, CI 1.08-1.24; p <0.0001) and SCCs (OR 1.16, CI 1.05-1.28; p = 0.0025), and patients with fair skin had more AKs (OR 0.31, CI 0.14-1.24; p <0.0001) and SCCs (OR 0.11, CI 0.02-0.52; p = 0.0054) than darker skinned patients. We could not identify any specific immunosuppressive drug as a distinct risk factor for AK or non-melanoma skin cancer (NMSC). CONCLUSION: Skin cancers are increased in the renal transplant population. Main risk factors for skin cancers are fair skin type and long duration of immunosuppressive therapy. A follow-up programme is necessary for early detection of skin cancer and precancerous conditions. Preventive strategies should include specialist dermatological monitoring and self-examination.

Internet based health promotion campaign against skin cancer - Results of www.skincheck.ch in Switzerland

Conventional skin cancer prevention programs appeal to limited populations, and the middle aged male population responds less frequently. Our objective was to establish a complementary health promotion campaign tool for skin cancer prevention. Internet-based education, instruction for self assessment and teledermatological evaluation of skin lesions by an expert commission of dermatologists was used. Compliance and clinical diagnosis was assessed in a subgroup. 12,000 users visited the educational website. There was strong interest among the middle aged male population (53% (N = 262): male; mean age: 42). 28.5% of examined lesions (N = 494) were considered suspicious. Email requests, sent to the group whose lesions where considered suspicious, were answered by 46.0% of females (N = 29) and 59.7% of males (N = 46) with a female distribution predominantly in younger ages (52.6% of females with known age: < 30 years). Males were predominantly represented over 30 years (86.2% of all males). According to user's declarations, at least 8 (8.5%) malignant lesions (1 melanoma in situ, 1 squamous cell carcinoma, 4 basal cell carcinomas, 2 malignant lesions without declared diagnosis) were finally diagnosed by physicians. We conclude that internet-based, interactive, educational programs, in addition to existing health promotion campaigns, can enhance public participation in the middle aged male population in skin cancer prevention.

Organ-specific eosinophilic disorders of the skin, lung, and gastrointestinal tract

Eosinophils are multifunctional leukocytes that increase in various tissues in patients with a variety of disorders. Locally, they can be involved in the initiation and propagation of diverse inflammatory responses. In this review the clinical association of eosinophils with diseases of the skin, lung, and gastrointestinal tract is summarized. An approach to determining the causal role of eosinophils in these diseases is presented. Recent findings concerning molecular diagnosis, cause, and treatment are discussed.

The role of central hypersensitivity in the determination of intradiscal mechanical hyperalgesia in discogenic pain

OBJECTIVE: The primary aim of the present study was to investigate whether there is a relationship between central hypersensitivity (assessed by pressure pain thresholds of uninjured tissues) and intradiscal pain threshold during discography. The secondary aim was to test the hypothesis that peripheral noxious stimulation dynamically modulates central hypersensitivity. PATIENTS: Twenty-four patients with positive provocation discography were tested for central hypersensitivity by pressure algometry before and after the intervention with assessments of pressure pain detection and tolerance thresholds. Intradiscal pain threshold was assessed by measuring intradiscal pressure at the moment of pain provocation during discography. Correlation analyses between intradiscal pain threshold and pressure algometry were made. For the secondary aim, pressure algometry data before and after discography were compared. RESULTS: Significant correlation with intradiscal pain threshold was found for pressure pain detection threshold at the toe (regression coefficient: 0.03, P = 0.05) and pressure pain tolerance thresholds at the nonpainful point at the back (0.02, P = 0.024). Tolerance threshold at the toe was a significant predictor for intradiscal pain threshold only in multiple linear regression (0.036, P = 0.027). Detection as well as tolerance thresholds significantly decreased after discography at the painful and the nonpainful point at the back, but not at the toe. CONCLUSIONS: Central hypersensitivity may influence intradiscal pain threshold, but with a modest quantitative impact. The diagnostic value of provocation discography is therefore not substantially impaired. Regional, but not generalized central hypersensitivity is dynamically modulated by ongoing peripheral nociceptive input.

Hypersensitivity and oral tolerance in the absence of a secretory immune system

Mucosal immunity protects the epithelial barrier by immune exclusion of foreign antigens and by anti-inflammatory tolerance mechanisms, but there is a continuing debate about the role of secretory immunoglobulins (SIgs), particularly SIgA, in the protection against allergy and other inflammatory diseases. Lack of secretory antibodies may cause immune dysfunction and affect mucosally induced (oral) tolerance against food antigens.

[A dead man with a light reddish skin]

A 40-year-old man was found dead in his bathroom with a light reddish skin. The cause of death was asphyxia due to CO-intoxication.

Recurrent non-melanoma skin cancer: remission of field cancerization after conversion from calcineurin inhibitor- to proliferation signal inhibitor-based immunosuppression in a cardiac transplant recipient

Non-melanoma skin cancers (NMSCs) are the most common malignancies after solid organ transplantation. Their incidence increases with time after transplantation. Calcineurin-inhibitors (CNIs) and azathioprine are known as skin neoplasia-initiating and -enhancing immunosuppressants. In contrast, increasing clinical experience suggests a relevant antiproliferative effect of mammalian target of rapamycin inhibitors, also named proliferation signal inhibitors (PSIs). We report the case of a cardiac allograft recipient with an impressive and consolidated reduction of recurrent NMSC, observed after conversion from CNI-therapy to a PSI-based protocol.

Vaccine hypersensitivity--update and overview

Concerns about possible reactions to vaccines or vaccinations are frequently raised. However, the rate of reported vaccine-induced adverse events is low and ranges between 4.8-83.0 per 100,000 doses of the most frequently used vaccines. The number of true allergic reactions to routine vaccines is not known; estimations range from 1 per 500,000 to 1 per 1,000,000 doses for most vaccines. When allergens such as gelatine or egg proteins are components of the formulation, the rate for serious allergic reactions may be higher. Nevertheless, anaphylactic, potentially life-threatening reactions to vaccines are still a rare event (approximately 1 per 1,500,000 doses). The variety of reported vaccine-related adverse events is broad. Most frequently, reactions to vaccines are limited to the injection site and result from a non specific activation of the inflammatory system by, for example, aluminium salts or the active microbial components. If allergy is suspected, an accurate examination followed by algorithms is the key for correct diagnosis, treatment and the decision regarding revaccination in patients with immediate-type reactions to vaccines.

General considerations on rapid desensitization for drug hypersensitivity - a consensus statement

Drug hypersensitivity reactions can occur with most drugs, are unpredictable, may affect any organ or system, and range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. However, for certain patients, the particular drug may be essential for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance of a compound responsible for a hypersensitivity reaction. It is performed by administering increasing doses of the medication concerned over a short period of time (from several hours to a few days) until the total cumulative therapeutic dose is achieved and tolerated. It is a high-risk procedure used only in patients in whom alternatives are less effective or not available after a positive risk/benefit analysis. Desensitization protocols have been developed and are used in patients with allergic reactions to antibiotics (mainly penicillin), insulins, sulfonamides, chemotherapeutic and biologic agents, and many other drugs. Desensitization is mainly performed in IgE-mediated reactions, but also in reactions where drug-specific IgE have not been demonstrated. Desensitization induces a temporary tolerant state, which can only be maintained by continuous administration of the medication. Thus, for treatments like chemotherapy, which have an average interval of 4 weeks between cycles, the procedure must be repeated for every new course. In this paper, some background information on rapid desensitization procedures is provided. We define the drugs and drug reactions indicated for such procedures, describe the possible mechanism of action, and discuss the indications and contraindications. The data should serve as background information for a database (accessible via the EAACI-homepage) with standardized protocols for rapid desensitization for antibiotics, chemotherapeutic agents, monoclonal antibodies/fusion proteins, and other drugs.