Hereditary angioedema in children and adolescents - A consensus update on therapeutic strategies for German-speaking countries.

BACKGROUND/METHODS At a consensus meeting in August 2018, pediatricians and dermatologists from German-speaking countries discussed the therapeutic strategy for the treatment of pediatric patients with types I and II hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) for Germany, Austria, and Switzerland, taking into account the current marketing approval status. HAE-C1-INH is a rare disease that usually presents during childhood or adolescence with intermittent episodes of potentially life-threatening angioedema. Diagnosis as early as possible and an optimal management of the disease are important to avoid ineffective therapies and to properly treat swelling attacks. This article provides recommendations for developing appropriate treatment strategies in the management of HAE-C1-INH in pediatric patients in German-speaking countries. An overview of available drugs in this age group is provided, together with their approval status, and study results obtained in adults and pediatric patients. RESULTS/CONCLUSION Currently, plasma-derived C1 inhibitor concentrates have the broadest approval status and are considered the best available option for on-demand treatment of HAE-C1-INH attacks and for short- and long-term prophylaxis across all pediatric age groups in German-speaking countries. For on-demand treatment of children over 2 years of age, bradykinin-receptor icatibant is an alternative. For long-term prophylaxis in adolescents, the parenteral kallikrein inhibitor lanadelumab has recently been approved and can be recommended due to proven efficacy and safety

Linear, Deterministic, and Order-Invariant Initialization Methods for the K-Means Clustering Algorithm

Over the past five decades, k-means has become the clustering algorithm of choice in many application domains primarily due to its simplicity, time/space efficiency, and invariance to the ordering of the data points. Unfortunately, the algorithm's sensitivity to the initial selection of the cluster centers remains to be its most serious drawback. Numerous initialization methods have been proposed to address this drawback. Many of these methods, however, have time complexity superlinear in the number of data points, which makes them impractical for large data sets. On the other hand, linear methods are often random and/or sensitive to the ordering of the data points. These methods are generally unreliable in that the quality of their results is unpredictable. Therefore, it is common practice to perform multiple runs of such methods and take the output of the run that produces the best results. Such a practice, however, greatly increases the computational requirements of the otherwise highly efficient k-means algorithm. In this chapter, we investigate the empirical performance of six linear, deterministic (non-random), and order-invariant k-means initialization methods on a large and diverse collection of data sets from the UCI Machine Learning Repository. The results demonstrate that two relatively unknown hierarchical initialization methods due to Su and Dy outperform the remaining four methods with respect to two objective effectiveness criteria. In addition, a recent method due to Erisoglu et al. performs surprisingly poorly.Comment: 21 pages, 2 figures, 5 tables, Partitional Clustering Algorithms (Springer, 2014). arXiv admin note: substantial text overlap with arXiv:1304.7465, arXiv:1209.196

Assigning a function to a conserved archaeal metallo-β-lactamase from Haloferax volcanii

The metallo-β-lactamase family of enzymes comprises a large group of proteins with diverse functions in the metabolism of the cell. Among others, this superfamily contains proteins which are involved in DNA and RNA metabolism, acting as nucleases in e.g. repair and maturation. Many proteins have been annotated in prokaryotic genomes as being potential metallo-β-lactamases, but very often the function has not been proven. The protein HVO_2763 from Haloferax volcanii is such a potential metallo-β-lactamase. HVO_2763 has sequence similarity to the metallo-β-lactamase tRNase Z, a tRNA 3′ processing endonuclease. Here, we report the characterisation of this metallo-β-lactamase HVO_2763 in the halophilic archaeon Haloferax volcanii. Using different in vitro assays with the recombinant HVO_2763, we could show that the protein does not have tRNA 3′ processing or exonuclease activity. According to transcriptome analyses of the HVO_2763 deletion strain, expression of proteins involved in membrane transport is downregulated in the mutant. Therefore, HVO_2763 might be involved directly or indirectly in membrane transport

A simulated annealing methodology for clusterwise linear regression

In many regression applications, users are often faced with difficulties due to nonlinear relationships, heterogeneous subjects, or time series which are best represented by splines. In such applications, two or more regression functions are often necessary to best summarize the underlying structure of the data. Unfortunately, in most cases, it is not known a priori which subset of observations should be approximated with which specific regression function. This paper presents a methodology which simultaneously clusters observations into a preset number of groups and estimates the corresponding regression functions' coefficients, all to optimize a common objective function. We describe the problem and discuss related procedures. A new simulated annealing-based methodology is described as well as program options to accommodate overlapping or nonoverlapping clustering, replications per subject, univariate or multivariate dependent variables, and constraints imposed on cluster membership. Extensive Monte Carlo analyses are reported which investigate the overall performance of the methodology. A consumer psychology application is provided concerning a conjoint analysis investigation of consumer satisfaction determinants. Finally, other applications and extensions of the methodology are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45745/1/11336_2005_Article_BF02296405.pd

Small nucleoli are a cellular hallmark of longevity

Animal lifespan is regulated by conserved metabolic signalling pathways and specific transcription factors, but whether these pathways affect common downstream mechanisms remains largely elusive. Here we show that NCL-1/TRIM2/Brat tumour suppressor extends lifespan and limits nucleolar size in the major C. elegans longevity pathways, as part of a convergent mechanism focused on the nucleolus. Long-lived animals representing distinct longevity pathways exhibit small nucleoli, and decreased expression of rRNA, ribosomal proteins, and the nucleolar protein fibrillarin, dependent on NCL-1. Knockdown of fibrillarin also reduces nucleolar size and extends lifespan. Among wildtype C. elegans, individual nucleolar size varies, but is highly predictive for longevity. Long-lived dietary restricted fruit flies and insulin-like-peptide mutants exhibit small nucleoli and fibrillarin expression, as do long-lived dietary restricted and IRS1 knockout mice. Furthermore, human muscle biopsies from individuals who underwent modest dietary restriction coupled with exercise also display small nucleoli. We suggest that small nucleoli are a cellular hallmark of longevity and metabolic health conserved across taxa

The Leishmania donovani Lipophosphoglycan Excludes the Vesicular Proton-ATPase from Phagosomes by Impairing the Recruitment of Synaptotagmin V

We recently showed that the exocytosis regulator Synaptotagmin (Syt) V is recruited to the nascent phagosome and remains associated throughout the maturation process. In this study, we investigated the possibility that Syt V plays a role in regulating interactions between the phagosome and the endocytic organelles. Silencing of Syt V by RNA interference revealed that Syt V contributes to phagolysosome biogenesis by regulating the acquisition of cathepsin D and the vesicular proton-ATPase. In contrast, recruitment of cathepsin B, the early endosomal marker EEA1 and the lysosomal marker LAMP1 to phagosomes was normal in the absence of Syt V. As Leishmania donovani promastigotes inhibit phagosome maturation, we investigated their potential impact on the phagosomal association of Syt V. This inhibition of phagolysosome biogenesis is mediated by the virulence glycolipid lipophosphoglycan, a polymer of the repeating Galβ1,4Manα1-PO4 units attached to the promastigote surface via an unusual glycosylphosphatidylinositol anchor. Our results showed that insertion of lipophosphoglycan into ganglioside GM1-containing microdomains excluded or caused dissociation of Syt V from phagosome membranes. As a consequence, L. donovani promatigotes established infection in a phagosome from which the vesicular proton-ATPase was excluded and which failed to acidify. Collectively, these results reveal a novel function for Syt V in phagolysosome biogenesis and provide novel insight into the mechanism of vesicular proton-ATPase recruitment to maturing phagosomes. We also provide novel findings into the mechanism of Leishmania pathogenesis, whereby targeting of Syt V is part of the strategy used by L. donovani promastigotes to prevent phagosome acidification

Profiling the molecular destruction rates of temperature and humidity as well as the turbulent kinetic energy dissipation in the convective boundary layer

A simultaneous deployment of Doppler, temperature, and water-vapor lidars is able to provide profiles of molecular destruction rates and turbulent kinetic energy (TKE) dissipation in the convective boundary layer (CBL). Horizontal wind profiles and profiles of vertical wind, temperature, and moisture fluctuations are combined, and transversal temporal autocovariance functions (ACFs) are determined for deriving the dissipation and molecular destruction rates. These are fundamental loss terms in the TKE as well as the potential temperature and mixing ratio variance equations. These ACFs are fitted to their theoretical shapes and coefficients in the inertial subrange. Error bars are estimated by a propagation of noise errors. Sophisticated analyses of the ACFs are performed in order to choose the correct range of lags of the fits for fitting their theoretical shapes in the inertial subrange as well as for minimizing systematic errors due to temporal and spatial averaging and micro- and mesoscale circulations. We demonstrate that we achieve very consistent results of the derived profiles of turbulent variables regardless of whether 1 or 10 s time resolutions are used. We also show that the temporal and spatial length scales of the fluctuations in vertical wind, moisture, and potential temperature are similar with a spatial integral scale of ≈160 m at least in the mixed layer (ML). The profiles of the molecular destruction rates show a maximum in the interfacial layer (IL) and reach values of ϵm≃7×10-4 g2 kg−2 s−1 for mixing ratio and ϵθ≃1.6×10-3 K2 s−1 for potential temperature. In contrast, the maximum of the TKE dissipation is reached in the ML and amounts to ≃10-2 m2 s−3. We also demonstrate that the vertical wind ACF coefficient kw∝w′2‾ and the TKE dissipation ϵ∝w′2‾3/2. For the molecular destruction rates, we show that ϵm∝m′2‾w′2‾1/2 and ϵθ∝θ′2‾w′2‾1/2. These equations can be used for parameterizations of ϵ, ϵm, and ϵθ. All noise error bars are derived by error propagation and are small enough to compare the results with previous observations and large-eddy simulations. The results agree well with previous observations but show more detailed structures in the IL. Consequently, the synergy resulting from this new combination of active remote sensors enables the profiling of turbulent variables such as integral scales, variances, TKE dissipation, and the molecular destruction rates as well as deriving relationships between them. The results can be used for the parameterization of turbulent variables, TKE budget analyses, and the verification of large-eddy simulations.</p

Effects of flooding on germination, establishment and survival of woody species; a field and modeling study on the floodplains of the river Rhine

Climate change results in higher water levels and therefore more frequent flooding and longer inundation of the floodplains of the river Rhine. Retention basins are installed in Germany and anticipated in the Netherlands to reduce peak flows and to prevent loss of property. In Germany, many of the retention basins are covered with forests that have experienced few floodings and that may be severely damaged by an extensive flood. In the Netherlands, the allocation of retention basins provides opportunities for new forest development. In both cases, knowledge is required on the effects of flooding on germination, establishment and survival of woody species to support the selection of retention basins. We analyzed the effects of flooding regimes on germination, establishment and survival of both saplings and adult trees, using analyzing available data; by collecting observational data; by performing field experiments; and by integrating this knowledge in a simulation model. We found clear differences between species in their response to flooding characteristics. The model is available for future studies on selection of retention basin

Optimization of Topical Therapy for Leishmania major Localized Cutaneous Leishmaniasis Using a Reliable C57BL/6 Model

When initiating the cutaneous disease named cutaneous leishmaniasis (CL), Leishmania parasites develop within the parasitophorous vacuoles of phagocytes residing in and/or recruited to the dermis, a process leading to more or less chronic dermis and epidermis-damaging inflammatory processes. Topical treatment of CL could be a mainstay in its management. Any improvements of topicals, such as new vehicles and shorter optimal contact regimes, could facilitate their use as an ambulatory treatment. Recently, WR279396, a third-generation aminoglycoside ointment, was designed with the aim to provide stability and optimal bioavailability for the molecules expected to target intracellular Leishmania. Two endpoints were expected to be reached: i) accelerated clearance of the maximal number of parasites, and ii) accelerated and stable repair processes without scars. A mouse model of CL was designed: it relies on the intradermal inoculation of luciferase-expressing Leishmania, allowing for in vivo bioluminescence imaging of the parasite load fluctuation, which can then be quantified simultaneously with the onset and resolution of clinical signs. These quantitative readout assays, deployed in real time, provide robust methods to rapidly assess efficacy of drugs/compounds i) to screen treatment modalities and ii) allow standardized comparison of different therapeutic agents