HIV-assoziierte tuberkulöse Meningoenzephalitis als Ursache abnormen Verhaltens in Haft

Zusammenfassung: Über Art und Häufigkeit psychoorganischer Syndrome bei Inhaftierten ist wenig bekannt. Wir berichten über einen 20-jährigen, HIV-I-positiven Asylbewerber aus Schwarzafrika mit bisher unauffälliger psychiatrischer Anamnese, der in Ausschaffungshaft ein zunehmend bizarres Verhalten entwickelte. Die paranoid-halluzinatorische Verwirrtheit mit tageszeitabhängiger Ausprägung und Desorientierung führte zur Diagnose Delir. Als Ursache hierfür fand sich eine AIDS-definierende tuberkulöse Meningoenzephalitis, die spezifisch und symptomatisch behandelt wurde. Dieser Fall illustriert die Schwierigkeiten der Diagnostik und die Bedeutung der Verhaltensbeobachtung bei eingeschränkten sprachlichen Verständigungsmöglichkeiten. Bei Häftlingen mit Verhaltensauffälligkeiten sollten stets auch somatische Differenzialdiagnosen in Betracht gezogen werden. Pathogenese und Diagnostik der tuberkulösen Meningoenzephalitis werden diskutier

Advances and visions in large-scale hydrological modelling: findings from the 11th Workshop on Large-Scale Hydrological Modelling

Large-scale hydrological modelling has become increasingly wide-spread during the last decade. An annual workshop series on large-scale hydrological modelling has provided, since 1997, a forum to the German-speaking community for discussing recent developments and achievements in this research area. In this paper we present the findings from the 2007 workshop which focused on advances and visions in large-scale hydrological modelling. We identify the state of the art, difficulties and research perspectives with respect to the themes "sensitivity of model results", "integrated modelling" and "coupling of processes in hydrosphere, atmosphere and biosphere". Some achievements in large-scale hydrological modelling during the last ten years are presented together with a selection of remaining challenges for the future

Optimization of the reconstruction and anti-aliasing filter in a Wiener filter system

This paper discusses the influence of the reconstruction and anti-aliasing filters on the performance of a digital implementation of a Wiener filter for active noise control. The overall impact will be studied in combination with a multi-rate system approach. A reconstruction and anti-aliasing filter will be selected and its parameters will be varied to optimize the system level performance of the Wiener filter for a feedback controller based on an internal model control principle. It will be shown that the selection of the reconstruction and anti-aliasing filter is an important decision that can largely influence the overall system performance. This method can be used in combination with standard optimization algorithms to automatically find the optimal filters that will give the largest reduction for the overall system

Implementation issues of a high-speed distributed multi-channel ADDA system

ABSTRACT A multi-channel ADDA controller is used in many active noise cancellation and active vibration control problems. Such a controller is able to yield good performance, however it also requires a lot of hardware on a centralized place and a lot of sensitive wiring. A practical work around for this problem would be to use a local single channel controller. However such a controller would reduce the overall system performance and may introduce instability. In this paper a system will be presented that acts as a hybrid form and combines the performance of a local feedback loop with a large multi-channel controller. To reduce the wiring and the influence of disturbances on this wiring a local analog to digital and digital to analog converter will be used. These systems will be interconnected using a high-speed serial communication system. To reduce the sample rate for the overall system, a local decimation and interpolation filter will be implemented. Further performance improvements will be realized by means of a simple local feedback system. The implementation issues concerning such a system are the subject of this paper

Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial

IMPORTANCE: Surgical resection has a potential benefit for patients with metastatic adenocarcinoma of the stomach and gastroesophageal junction. OBJECTIVE: To evaluate outcome in patients with limited metastatic disease who receive chemotherapy first and proceed to surgical resection. DESIGN, SETTING, AND PARTICIPANTS: The AIO-FLOT3 (Arbeitsgemeinschaft Internistische Onkologie-fluorouracil, leucovorin, oxaliplatin, and docetaxel) trial is a prospective, phase 2 trial of 252 patients with resectable or metastatic gastric or gastroesophageal junction adenocarcinoma. Patients were enrolled from 52 cancer care centers in Germany between February 1, 2009, and January 31, 2010, and stratified to 1 of 3 groups: resectable (arm A), limited metastatic (arm B), or extensive metastatic (arm C). Data cutoff was January 2012, and the analysis was performed in March 2013. INTERVENTIONS: Patients in arm A received 4 preoperative cycles of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) followed by surgery and 4 postoperative cycles. Patients in arm B received at least 4 cycles of neoadjuvant FLOT and proceeded to surgical resection if restaging (using computed tomography and magnetic resonance imaging) showed a chance of margin-free (R0) resection of the primary tumor and at least a macroscopic complete resection of the metastatic lesions. Patients in arm C were offered FLOT chemotherapy and surgery only if required for palliation. Patients received a median (range) of 8 (1-15) cycles of FLOT. MAIN OUTCOMES AND MEASURES: The primary end point was overall survival. RESULTS: In total, 238 of 252 patients (94.4%) were eligible to participate. The median (range) age of participants was 66 (36-79) years in arm A (n = 51), 63 (28-79) years in arm B (n = 60), and 65 (23-83) years in arm C (n = 127). Patients in arm B (n = 60) had only retroperitoneal lymph node involvement (27 patients [45%]), liver involvement (11 [18.3%]), lung involvement (10 [16.7%]), localized peritoneal involvement (4 [6.7%]), or other (8 [13.3%]) incurable sites. Median overall survival was 22.9 months (95% CI, 16.5 to upper level not achieved) for arm B, compared with 10.7 months (95% CI, 9.1-12.8) for arm C (hazard ratio, 0.37; 95% CI, 0.25-0.55) (P < .001). The response rate for arm B was 60% (complete, 10%; partial, 50%), which is higher than the 43.3% for arm C. In arm B, 36 of 60 patients (60%) proceeded to surgery. The median overall survival was 31.3 months (95% CI, 18.9-upper level not achieved) for patients who proceeded to surgery and 15.9 months (95% CI, 7.1-22.9) for the other patients. CONCLUSIONS AND RELEVANCE: Patients with limited metastatic disease who received neoadjuvant chemotherapy and proceeded to surgery showed a favorable survival. The AIO-FLOT3 trial provides a rationale for further randomized clinical trials. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT00849615.info:eu-repo/semantics/publishedVersio

A Meta-Analysis of the Existing Knowledge of Immunoreactivity against Hepatitis C Virus (HCV)

Approximately 3% of the world population is infected by HCV, which represents a major global health challenge. Almost 400 different scientific reports present immunological data related to T cell and antibody epitopes derived from HCV literature. Analysis of all HCV-related epitope hosted in the Immune Epitope Database (IEDB), a repository of freely accessible immune epitope data, revealed more than 1500 and 1900 distinct T cell and antibody epitopes, respectively. The inventory of all data revealed specific trends in terms of the host and the HCV genotypes from which sequences were derived. Upon further analysis we found that this large number of epitopes reflects overlapping structures, and homologous sequences derived from different HCV isolates. To access and visualize this information we developed a novel strategy that assembles large sets of epitope data, maps them onto reference genomes and displays the frequency of positive responses. Compilation of the HCV immune reactivity from hundreds of different studies, revealed a complex and thorough picture of HCV immune epitope data to date. The results pinpoint areas of more intense reactivity or research activities at the level of antibody, CD4 and CD8 responses for each of the individual HCV proteins. In general, the areas targeted by the different effector immune functions were distinct and antibody reactivity was positively correlated with hydrophilicity, while T cell reactivity correlated with hydrophobicity. At the sequence level, epitopes frequently recognized by both T cell and B cell correlated with low variability, and our analysis thus highlighted areas of potential interest for practical applications. The human reactivity was further analyzed to pinpoint differential patterns of reactivity associated with acute versus chronic infection, to reveal the apparent impact of glycosylation on T cell, but not antibody responses, and to highlight a paucity of studies involved antibody epitopes associated with virus neutralization

HLA Class I Binding 9mer Peptides from Influenza A Virus Induce CD4+ T Cell Responses

BACKGROUND: Identification of human leukocyte antigen class I (HLA-I) restricted cytotoxic T cell (CTL) epitopes from influenza virus is of importance for the development of new effective peptide-based vaccines. METHODOLOGY/PRINCIPAL FINDINGS: In the present work, bioinformatics was used to predict 9mer peptides derived from available influenza A viral proteins with binding affinity for at least one of the 12 HLA-I supertypes. The predicted peptides were then selected in a way that ensured maximal coverage of the available influenza A strains. One hundred and thirty one peptides were synthesized and their binding affinities for the HLA-I supertypes were measured in a biochemical assay. Influenza-specific T cell responses towards the peptides were quantified using IFNgamma ELISPOT assays with peripheral blood mononuclear cells (PBMC) from adult healthy HLA-I typed donors as responder cells. Of the 131 peptides, 21 were found to induce T cell responses in 19 donors. In the ELISPOT assay, five peptides induced responses that could be totally blocked by the pan-specific anti-HLA-I antibody W6/32, whereas 15 peptides induced responses that could be completely blocked in the presence of the pan-specific anti-HLA class II (HLA-II) antibody IVA12. Blocking of HLA-II subtype reactivity revealed that 8 and 6 peptide responses were blocked by anti-HLA-DR and -DP antibodies, respectively. Peptide reactivity of PBMC depleted of CD4(+) or CD8(+) T cells prior to the ELISPOT culture revealed that effectors are either CD4(+) (the majority of reactivities) or CD8(+) T cells, never a mixture of these subsets. Three of the peptides, recognized by CD4(+) T cells showed binding to recombinant DRA1*0101/DRB1*0401 or DRA1*0101/DRB5*0101 molecules in a recently developed biochemical assay. CONCLUSIONS/SIGNIFICANCE: HLA-I binding 9mer influenza virus-derived peptides induce in many cases CD4(+) T cell responses restricted by HLA-II molecules