7,823 research outputs found

    Enhanced external counterpulsation modulates the heartbeat evoked potential

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    Introduction: Accumulating evidence suggests that enhanced external counterpulsation (EECP) influences cardiac functions, hemodynamic characteristics and cerebral blood flow. However, little is known about whether or how the EECP affects the brain-heart coupling to produce these physiological and functional changes. We aimed to determine if the brain-heart coupling is altered during or after EECP intervention by assessing the heartbeat evoked potential (HEP) in healthy adults.Methods: Based on a random sham-controlled design, simultaneous electroencephalography and electrocardiography signals as well as blood pressure and flow status data were recorded before, during and after two consecutive 30-min EECP in 40 healthy adults (female/male: 17/23; age: 23.1 ± 2.3 years). HEP amplitude, frequency domain heart rate variability, electroencephalographic power and hemodynamic measurements of 21 subjects (female/male: 10/11; age: 22.7 ± 2.1 years) receiving active EECP were calculated and compared with those of 19 sham control subjects (female/male: 7/12; age: 23.6 ± 2.5 years).Results: EECP intervention caused immediate obvious fluctuations of HEP from 100 to 400 ms after T-peak and increased HEP amplitudes in the (155–169) ms, (354–389) ms and (367–387) ms time windows after T-peak in the region of the frontal pole lobe. The modifications in HEP amplitude were not associated with changes in the analyzed significant physiological measurements and hemodynamic variables.Discussion: Our study provides evidence that the HEP is modulated by immediate EECP stimuli. We speculate that the increased HEP induced by EECP may be a marker of enhanced brain-heart coupling. HEP may serve as a candidate biomarker for the effects and responsiveness to EECP

    Computertomographie-basierte Bestimmung von Aortenklappenkalk und seine Assoziation mit Komplikationen nach interventioneller Aortenklappenimplantation (TAVI)

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    Background: Severe aortic valve calcification (AVC) has generally been recognized as a key factor in the occurrence of adverse events after transcatheter aortic valve implantation (TAVI). To date, however, a consensus on a standardized calcium detection threshold for aortic valve calcium quantification in contrast-enhanced computed tomography angiography (CTA) is still lacking. The present thesis aimed at comparing two different approaches for quantifying AVC in CTA scans based on their predictive power for adverse events and survival after a TAVI procedure.   Methods: The extensive dataset of this study included 198 characteristics for each of the 965 prospectively included patients who had undergone TAVI between November 2012 and December 2019 at the German Heart Center Berlin (DHZB). AVC quantification in CTA scans was performed at a fixed Hounsfield Unit (HU) threshold of 850 HU (HU 850 approach) and at a patient-specific threshold, where the HU threshold was set by multiplying the mean luminal attenuation of the ascending aorta by 2 (+100 % HUAorta approach). The primary endpoint of this study consisted of a combination of post-TAVI outcomes (paravalvular leak ≥ mild, implant-related conduction disturbances, 30-day mortality, post-procedural stroke, annulus rupture, and device migration). The Akaike information criterion was used to select variables for the multivariable regression model. Multivariable analysis was carried out to determine the predictive power of the investigated approaches.   Results: Multivariable analyses showed that a fixed threshold of 850 HU (calcium volume cut-off 146 mm3) was unable to predict the composite clinical endpoint post-TAVI (OR=1.13, 95 % CI 0.87 to 1.48, p=0.35). In contrast, the +100 % HUAorta approach (calcium volume cut-off 1421 mm3) enabled independent prediction of the composite clinical endpoint post-TAVI (OR=2, 95 % CI 1.52 to 2.64, p=9.2x10-7). No significant difference in the Kaplan-Meier survival analysis was observed for either of the approaches.   Conclusions: The patient-specific calcium detection threshold +100 % HUAorta is more predictive of post-TAVI adverse events included in the combined clinical endpoint than the fixed HU 850 approach. For the +100 % HUAorta approach, a calcium volume cut-off of 1421 mm3 of the aortic valve had the highest predictive value.Hintergrund: Ein wichtiger Auslöser von Komplikationen nach einer Transkatheter-Aortenklappen-Implantation (TAVI) sind ausgeprägte Kalkablagerung an der Aortenklappe. Dennoch erfolgte bisher keine Einigung auf ein standardisiertes Messverfahren zur Quantifizierung der Kalklast der Aortenklappe in einer kontrastverstärkten dynamischen computertomographischen Angiographie (CTA). Die vorliegende Dissertation untersucht, inwieweit die Wahl des Analyseverfahrens zur Quantifizierung von Kalkablagerungen in der Aortenklappe die Prognose von Komplikationen und der Überlebensdauer nach einer TAVI beeinflusst.   Methodik: Der Untersuchung liegt ein umfangreicher Datensatz von 965 Patienten mit 198 Merkmalen pro Patienten zugrunde, welche sich zwischen 2012 und 2019 am Deutschen Herzzentrum Berlin einer TAVI unterzogen haben. Die Quantifizierung der Kalkablagerung an der Aortenklappe mittels CTA wurde einerseits mit einem starren Grenzwert von 850 Hounsfield Einheiten (HU) (HU 850 Verfahren) und andererseits anhand eines individuellen Grenzwertes bemessen. Letzterer ergibt sich aus der HU-Dämpfung in dem Lumen der Aorta ascendens multipliziert mit 2 (+100 % HUAorta Verfahren). Der primäre klinische Endpunkt dieser Dissertation besteht aus einem aus sechs Variablen zusammengesetzten klinischen Endpunkt, welcher ungewünschte Ereignisse nach einer TAVI abbildet (paravalvuläre Leckage ≥mild, Herzrhythmusstörungen nach einer TAVI, Tod innerhalb von 30 Tagen, post-TAVI Schlaganfall, Ruptur des Annulus und Prothesendislokation). Mögliche Störfaktoren, die auf das Eintreten der Komplikationen nach TAVI Einfluss haben, wurden durch den Einsatz des Akaike Informationskriterium ermittelt. Um die Vorhersagekraft von Komplikationen nach einer TAVI durch beide Verfahren zu ermitteln, wurde eine multivariate Regressionsanalyse durchgeführt.   Ergebnisse: Die multivariaten logistischen Regressionen zeigen, dass die Messung der Kalkablagerungen anhand der HU 850 Messung (Kalklast Grenzwert von 146 mm3) die Komplikationen und die Überlebensdauer nicht vorhersagen konnten (OR=1.13, 95 % CI 0.87 bis 1.48, p=0.35). Die nach dem +100 % HUAorta Verfahren (Kalklast Grenzwert von 1421 mm3) individualisierte Kalkmessung erwies sich hingegen als sehr aussagekräftig, da hiermit Komplikationen nach einer TAVI signifikant vorhergesagt werden konnten (OR=2, 95 % CI 1.52 bis 2.64, p=9.2x10-7). In Hinblick auf die postoperative Kaplan-Meier Überlebenszeitanalyse kann auch mit dem +100 % HUAorta Verfahren keine Vorhersage getroffen werden.   Fazit: Aus der Dissertation ergibt sich die Empfehlung, die Messung von Kalkablagerungen nach dem +100 % HUAorta Verfahren vorzunehmen, da Komplikationen wesentlich besser und zuverlässiger als nach der gängigen HU 850 Messmethode vorhergesagt werden können. Für das +100 % HUAorta Verfahren lag der optimale Kalklast Grenzwert bei 1421 mm3

    The development and applications of ceragenins and bone-binding antimicrobials to prevent osteomyelitis in orthopaedic patients

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    Bone infection remains a high-burden disease in orthopaedic and trauma patients with fractures and implantations. Osteomyelitis is difficult to cure in clinical settings, especially if antimicrobial resistance or biofilm is involved, which may prolong the treatments with antibiotics and require multiple surgeries, severely affecting the patients' quality of life and mobility. Osteomyelitis can lead to osteonecrosis, septicaemia, amputation, multi-organ dysfunction, and death in severe cases. Preclinical models are essential for efficacy testing to develop new prophylactic and therapeutic interventions. Previously bone infection models in rats involved fractures and implantations, making it complicated to perform. In this study, we have developed and optimised murine models with a tibial drilled hole (TDH) and needle insertion surgery (NIS) that are reliable, reproducible, and cost-effective for studying implant- related and biofilm bone infections and efficacy testing. Ceragenins (CSAs) are a novel class of broad-spectrum antimicrobials that mimic the activities of antimicrobial peptides. They are effective against bacterial, viral, fungal, and parasitic infections with low minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs). CSAs can also penetrate biofilm and kill antimicrobial-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). In recent years, CSA-131 has been approved by the FDA for endotracheal tube coating to prevent infection in intubated and critical patients. In our study, we applied CSA-90 (which belongs to the same family as CSA-131) to implant coating and prevented osteomyelitis in a mouse model and demonstrated the osteogenic properties of CSA- 90, which promotes bone healing and reunion of the bone defects. CSA-90 has been classified as a potential drug to prevent and treat osteomyelitis. However, conventional methods of antibiotic delivery to the bone are inefficient. To increase the bone-binding property of CSA-90, we invented a new molecule by attaching alendronate (bisphosphonate) to CSA-90 and named it bone-binding antimicrobial-1 (BBA-1). In vitro, we determined the bone-binding properties of BBA-1 and confirmed its antimicrobial activities against S. aureus. Later, we conducted a preclinical trial to test the in vivo efficacy of BBA-1 and showed that BBA-1 could prevent osteomyelitis in mice and has low cytotoxicity. Multiple myeloma (MM) is an aggressive cancer of plasma cells. Although chemotherapy, corticosteroids, and radiation therapy manage multiple myeloma, MM has no cure. Most MM patients (>90%) suffer myeloma-skeletal disease, including local osteolytic lesions and osteomyelitis. Thus, we dedicate the clinical application of BBA-1 to MM patients. To pursue clinical trials, preclinical trials must be conducted. In our attempts, we proposed a feasible murine model that can induce bone infections in MM mice and elucidated how MM patients will benefit from BBA-1

    The gastrointestinal tract:From healthy mucosa to colorectal cancer

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    In vitro investigation of the effect of disulfiram on hypoxia induced NFκB, epithelial to mesenchymal transition and cancer stem cells in glioblastoma cell lines

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    A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.Glioblastoma multiforme (GBM) is one of the most aggressive and lethal cancers with a poor prognosis. Advances in the treatment of GBM are limited due to several resistance mechanisms and limited drug delivery into the central nervous system (CNS) compartment by the blood-brain barrier (BBB) and by actions of the normal brain to counteract tumour-targeting medications. Hypoxia is common in malignant brain tumours such as GBM and plays a significant role in tumour pathobiology. It is widely accepted that hypoxia is a major driver of GBM malignancy. Although it has been confirmed that hypoxia induces GBM stem-like-cells (GSCs), which are highly invasive and resistant to all chemotherapeutic agents, the detailed molecular pathways linking hypoxia, GSC traits and chemoresistance remain obscure. Evidence shows that hypoxia induces cancer stem cell phenotypes via epithelial-to-mesenchymal transition (EMT), promoting therapeutic resistance in most cancers, including GBM. This study demonstrated that spheroid cultured GBM cells consist of a large population of hypoxic cells with CSC and EMT characteristics. GSCs are chemo-resistant and displayed increased levels of HIFs and NFκB activity. Similarly, the hypoxia cultured GBM cells manifested GSC traits, chemoresistance and invasiveness. These results suggest that hypoxia is responsible for GBM stemness, chemoresistance and invasiveness. GBM cells transfected with nuclear factor kappa B-p65 (NFκB-p65) subunit exhibited CSC and EMT markers indicating the essential role of NFκB in maintaining GSC phenotypes. The study also highlighted the significance of NFκB in driving chemoresistance, invasiveness, and the potential role of NFκB as the central regulator of hypoxia-induced stemness in GBM cells. GSC population has the ability of self-renewal, cancer initiation and development of secondary heterogeneous cancer. The very poor prognosis of GBM could largely be attributed to the existence of GSCs, which promote tumour propagation, maintenance, radio- and chemoresistance and local infiltration. In this study, we used Disulfiram (DS), a drug used for more than 65 years in alcoholism clinics, in combination with copper (Cu) to target the NFκB pathway, reverse chemoresistance and block invasion in GSCs. The obtained results showed that DS/Cu is highly cytotoxic to GBM cells and completely eradicated the resistant CSC population at low dose levels in vitro. DS/Cu inhibited the migration and invasion of hypoxia-induced CSC and EMT like GBM cells at low nanomolar concentrations. DS is an FDA approved drug with low toxicity to normal tissues and can pass through the BBB. Further research may lead to the quick translation of DS into cancer clinics and provide new therapeutic options to improve treatment outcomes in GBM patients

    Varastest embrüotest pärit ekstratsellulaarsed vesiikulid: potentsiaal embrüokvaliteedi markeritena ja roll embrüo-emaka suhtluses

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    Väitekirja elektrooniline versioon ei sisalda publikatsiooneViljatus on globaalne rahvatervise probleem, mis mõjutab miljoneid inimesi. Abistav reproduktiivtehnoloogia, sealhulgas in vitro viljastamine, on aidanud mitmeid viljatuid inimesi. Küll on sellel metoodikal üheks kitsaskohaks implantatsiooni ebaõnnestumine isegi morfoloogiliselt parimate embrüotega. Seetõttu toimuvad jätkuvalt uuringud tuvastamaks paremaid meetodeid, mis hindavad embrüo kvaliteeti ja ennustavad siirdamise edukust, olles peamiselt embrüokasvusöötme baasil. Rakuvälised ehk ekstratsellulaarsed vesiikulid (EV) on membraaniga ümbritsetud nanoosakesed, mida toodavad peaaegu kõik rakutüübid erinevates füsioloogilistes ja patoloogilistes konditsioonides. Nende kaudu toimub rakuvaheline suhtlus. Mitmed uuringud, eriti vähi korral, on uurinud EVde potentsiaali biomarkerina ja ravimkandursüsteemina. Antud doktoritöö uuris implantatsiooni-eelse perioodi embrüost vabanenud EVde potentsiaali embrüokvaliteedi markerina ja embrüo-emaka suhtluse vahendajana. Katsed viidi läbi kasutades veise-embrüoid ja inimrakukultuuride põhiseid eksperimentaalmudeleid. Esimene uuring tõestas, et individuaalselt kasvatatud implantatsiooni-eelse perioodi veise-embrüod eritavad EVsid kasvusöötmesse ning nende kontsentratsiooni- ja suurusprofiil sõltub embrüo kvaliteedist ja arengustaadiumist. Järgnevalt katsetati munajuharakkudel implantatsiooni-eelse perioodi embrüost pärit EVde funktsionaalsust. Katse käigus selgus, et EVd kõrge kvaliteediga embrüotest muutsid munajuharakkude geeniekspressiooni, mida aga ei teinud halva kvaliteediga embrüote EVd. Suurenenud ekspressiooniga geenide hulgas olid mitmed interferoon-τ raja interferooni stimuleerivad geenid. Interferoon-τ peetakse mäletsejaliste tiinuse tuvastusmolekuliks. See leid viitab, et munajuha tunneb ära kvaliteetse embrüo. Viimaseks uuriti embrüo EVde funktsionaalsuse spetsiifilisust. Leiti, et endomeetrium reageerib vaid embrüo päritolu EVdele. Uuringute käigus tuvastati embrüost vabanenud EVde potentsiaal ja spetsiifilisus embrüokvaliteedi biomarkerina.Infertility is a global public health problem that affects millions of people in their reproductive life. Assisted reproductive technologies (ARTs) such as in-vitro fertilization have enabled many patients to overcome this issue. However, a bottleneck in ART success is the implantation failure even after the transfer of morphologically best embryos. Hence, investigations continue to identify better or complementary methods of assessing embryo quality and predicting transfer success, mainly based on the embryo culture media. Extracellular vesicles (EVs) are membrane-bound nanoparticles released by almost all types of cells under different physiological and pathological conditions. They mediate intercellular communication. Many studies, especially related to cancer, have investigated EVs' potential as biomarkers and therapeutic drug delivery systems. This project investigated preimplantation embryo-derived extracellular vesicles as a potential embryo quality marker and a mediator of embryo-maternal communication. Experiments were performed using bovine embryos and human cell-culture based experimental models. The first study showed that individually cultured preimplantation bovine embryos release EVs to their culture media, and their concentration and size profile are dependent on the quality and development stage of embryos. Subsequently, the functionality of preimplantation embryo-derived EVs were tested in the oviduct. It was observed that EVs from good quality embryos, but not the EVs from embryos of low developmental potential quality, could alter the gene expression of the oviduct. Among the up-regulated genes, many were interferon-stimulated genes of the interferon-τ pathway. Interferon-τ is considered the pregnancy recognition molecule in ruminant pregnancy. This finding suggests that the oviduct can serve as a biosensor of embryo quality. Finally, the functional specificity of embryonic EVs were investigated. It was observed that endometrium only react to embryonic EVs but not to the non-embryonic EVs. All these studies support the potential and specificity of embryo-derived EVs as a biomarker of embryo quality.https://www.ester.ee/record=b548409

    Investigating the mechanism of human beta defensin-2-mediated protection of skin barrier in vitro

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    The human skin barrier is a biological imperative. Chronic inflammatory skin diseases, such as Atopic Dermatitis (AD), are characterised by a reduction in skin barrier function and an increased number of secondary infections. Staphyloccocus aureus (S. aureus) has an increased presence on AD lesional skin and contributes significantly to AD pathology. It was previously demonstrated that the damage induced by a virulence factor of S. aureus, V8 protease, which causes further breakdown in skin barrier function, can be reduced by induction of human β- defensin (HBD)2 (by IL-1β) or exogenous HBD2 application. Induction of this defensin is impaired in AD skin. This thesis examines the mechanism of HBD2-mediated barrier protection in vitro; demonstrating that in this system, HBD2 was not providing protection through direct protease inhibition, nor was it altering keratinocyte proliferation or migration, or exhibiting specific localisation within the monolayer. Proteomics data demonstrated that HBD2 did not induce expression of known antiproteases but suggested that HBD2 stimulation may function by modulating expression of extracellular matrix proteins, specifically collagen- IVα2 and Laminin-β-1. Alternative pathways of protection initiated by IL-1β and TNFα stimulation were also investigated, as well as their influence over generalised wound healing. Finally, novel 3D human skin epidermal models were used to better recapitulate the structure of human epidermis and examine alterations to skin barrier function in a more physiological system. These data validate the barrier-protective properties of HBD2 and extended our knowledge of the consequences of exposure to this peptide in this context

    Statistical Learning for Gene Expression Biomarker Detection in Neurodegenerative Diseases

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    In this work, statistical learning approaches are used to detect biomarkers for neurodegenerative diseases (NDs). NDs are becoming increasingly prevalent as populations age, making understanding of disease and identification of biomarkers progressively important for facilitating early diagnosis and the screening of individuals for clinical trials. Advancements in gene expression profiling has enabled the exploration of disease biomarkers at an unprecedented scale. The work presented here demonstrates the value of gene expression data in understanding the underlying processes and detection of biomarkers of NDs. The value of novel approaches to previously collected -omics data is shown and it is demonstrated that new therapeutic targets can be identified. Additionally, the importance of meta-analysis to improve power of multiple small studies is demonstrated. The value of blood transcriptomics data is shown in applications to researching NDs to understand underlying processes using network analysis and a novel hub detection method. Finally, after demonstrating the value of blood gene expression data for investigating NDs, a combination of feature selection and classification algorithms were used to identify novel accurate biomarker signatures for the diagnosis and prognosis of Parkinson’s disease (PD) and Alzheimer’s disease (AD). Additionally, the use of feature pools based on previous knowledge of disease and the viability of neural networks in dimensionality reduction and biomarker detection is demonstrated and discussed. In summary, gene expression data is shown to be valuable for the investigation of ND and novel gene biomarker signatures for the diagnosis and prognosis of PD and AD

    SYSTEMS METHODS FOR ANALYSIS OF HETEROGENEOUS GLIOBLASTOMA DATASETS TOWARDS ELUCIDATION OF INTER-TUMOURAL RESISTANCE PATHWAYS AND NEW THERAPEUTIC TARGETS

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    In this PhD thesis is described an endeavour to compile litterature about Glioblastoma key molecular mechanisms into a directed network followin Disease Maps standards, analyse its topology and compare results with quantitative analysis of multi-omics datasets in order to investigate Glioblastoma resistance mechanisms. The work also integrated implementation of Data Management good practices and procedures
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