OPUS 4 | Universitätspublikationen

Evaluating frequency, diagnostic quality, and cost of Lyme borreliosis testing in Germany: a retrospective model analysis (2011)

Iris Müller Michael H. Freitag Gabriele Poggensee Elke Scharnetzky Eberhard Straube Christof Schoerner Harald Hlobil Hans-Jochen Hagedorn Gerold Stanek Alexandra Schubert-Unkmeir Douglas E. Norris Jochen Gensichen Klaus-Peter Hunfeld

Background. Data on the economic impact of Lyme borreliosis (LB) on European health care systems is scarce. This project focused on the epidemiology and costs for laboratory testing in LB patients in Germany. Materials and Methods. We performed a sentinel analysis of epidemiological and medicoeconomic data for 2007 and 2008. Data was provided by a German statutory health insurance (DAK) company covering approx. 6.04 million members. In addition, the quality of diagnostic testing for LB in Germany was studied. Results. In 2007 and 2008, the incident diagnosis LB was coded on average for 15,742 out of 6.04 million insured members (0.26%). 20,986 EIAs and 12,558 immunoblots were ordered annually for these patients. For all insured members in the outpatient sector, a total of 174,820 EIAs and 52,280 immunoblots were reimbursed annually to health care providers (cost: 2,600,850€). For Germany, the overall expected cost is estimated at 51,215,105€. However, proficiency testing data questioned test quality and standardization of diagnostic assays used. Conclusion. Findings from this study suggest ongoing issues related to care for LB and may help to improve future LB disease management.

Aging in place in late life: theory, methodology, and intervention (2012)

Agneta Malmgren Fänge Frank Oswald Lindy Clemson

Editorial: This special issue focuses on aging in place in late life. Aging in place is about being able to continue living in one’s own home or neighborhood and to adapt to changing needs and conditions. It is of high concern due to the increasing number of old and very old people in all societies and challenges researchers, practitioners, and policy makers in many societal and scientific areas and disciplines. We invited authors to contribute original research papers as well as conceptually driven review papers that would stimulate the continuing efforts to understand the different aspects of aging in place in late life. The papers that were submitted came from very diverse disciplines, such as sociology, psychology, occupational therapy, nursing, architecture, public planning, and social work. Given the number and diversity of papers submitted, we can conclude that aging in place is an important concern throughout the world and that different kinds of measures are taken to come up with local, national, and international solutions that enhance aging in place. It remains a very complex issue that needs and deserves to be investigated from many different perspectives and assessed by means of different methodological origin, covering qualitative and quantitative measures, as well as mixed-method approaches. Subsequently, the selection of papers presented in this issue only sheds light on some aspects of sociophysical person-environment exchange as people age, contributing to the ongoing discussion in the field of environmental gerontology...

Acute ethanol gavage attenuates hemorrhage/resuscitation-induced hepatic oxidative stress in rats (2012)

Borna Relja Kerstin Wilhelm Minhong Wang Dirk Henrich Ingo Marzi Mark Lehnert

Acute ethanol intoxication increases the production of reactive oxygen species (ROS). Hemorrhagic shock with subsequent resuscitation (H/R) also induces ROS resulting in cellular and hepatic damage in vivo. We examined the role of acute ethanol intoxication upon oxidative stress and subsequent hepatic cell death after H/R. 14 h before H/R, rats were gavaged with single dose of ethanol or saline (5 g/kg, EtOH and ctrl; H/R_EtOH or H/R_ctrl, resp.). Then, rats were hemorrhaged to a mean arterial blood pressure of 30 ± 2 mmHg for 60 min and resuscitated. Two control groups underwent surgical procedures without H/R (sham_ctrl and sham_EtOH, resp.). Liver tissues were harvested at 2, 24, and 72 h after resuscitation. EtOH-gavage induced histological picture of acute fatty liver. Hepatic oxidative (4-hydroxynonenal, 4-HNE) and nitrosative (3-nitrotyrosine, 3-NT) stress were significantly reduced in EtOH-gavaged rats compared to controls after H/R. Proapoptotic caspase-8 and Bax expressions were markedly diminished in EtOH-gavaged animals compared with controls 2 h after resuscitation. EtOH-gavage increased antiapoptotic Bcl-2 gene expression compared with controls 2 h after resuscitation. iNOS protein expression increased following H/R but was attenuated in EtOH-gavaged animals after H/R. Taken together, the data suggest that acute EtOH-gavage may attenuate H/R-induced oxidative stress thereby reducing cellular injury in rat liver.

Implantation of silicon dioxide-based nanocrystalline hydroxyapatite and pure phase beta-tricalciumphosphate bone substitute granules in caprine muscle tissue does not induce new bone formation (2013)

Shahram Ghanaati Samuel E. Udeabor Mike Barbeck Ines Willershausen Oliver Künzel Robert Alexander Sader C. James Kirkpatrick

Background: Osteoinductive bone substitutes are defined by their ability to induce new bone formation even at heterotopic implantation sites. The present study was designed to analyze the potential osteoinductivity of two different bone substitute materials in caprine muscle tissue. Materials and methods: One gram each of either a porous beta-tricalcium phosphate (β-TCP) or an hydroxyapatite/silicon dioxide (HA/SiO2)-based nanocrystalline bone substitute material was implanted in several muscle pouches of goats. The biomaterials were explanted at 29, 91 and 181 days after implantation. Conventional histology and special histochemical stains were performed to detect osteoblast precursor cells as well as mineralized and unmineralized bone matrix. Results: Both materials underwent cellular degradation in which tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and TRAP-negative multinucleated giant cells were involved. The ß-TCP was completely resorbed within the observation period, whereas some granules of the HA-groups were still detectable after 180 days. Neither osteoblasts, osteoblast precursor cells nor extracellular bone matrix were found within the implantation bed of any of the analyzed biomaterials at any of the observed time points. Conclusions: This study showed that ß-TCP underwent a faster degradation than the HA-based material. The lack of osteoinductivity for both materials might be due to their granular shape, as osteoinductivity in goat muscle has been mainly attributed to cylindrical or disc-shaped bone substitute materials. This hypothesis however requires further investigation to systematically analyze various materials with comparable characteristics in the same experimental setting.

Divergent Evolution of Male Aggressive Behaviour: Another Reproductive Isolation Barrier in Extremophile Poeciliid Fishes? (2011)

David Bierbach Moritz Klein Vanessa Sassmannshausen Ingo Schlupp Rüdiger Riesch Jakob Parzefall Martin Plath

Reproductive isolation among locally adapted populations may arise when immigrants from foreign habitats are selected against via natural or (inter-)sexual selection (female mate choice). We asked whether also intrasexual selection through male-male competition could promote reproductive isolation among populations of poeciliid fishes that are locally adapted to extreme environmental conditions [i.e., darkness in caves and/or toxic hydrogen sulphide (H(2)S)]. We found strongly reduced aggressiveness in extremophile P. oecilia mexicana, and darkness was the best predictor for the evolutionary reduction of aggressiveness, especially when combined with presence of H(2)S. We demonstrate that reduced aggression directly translates into migrant males being inferior when paired with males from non-sulphidic surface habitats. By contrast, the phylogenetically old sulphur endemic P. sulphuraria from another sulphide spring area showed no overall reduced aggressiveness, possibly indicating evolved mechanisms to better cope with H(2)S.

Inflammatory and angiogenic protein detection in the human vitreous: cytometric bead assay (2011)

Michael Janusz Koss Marcel Pfister Frank H. Koch

Introduction. To evaluate clinical feasibility and reproducibility of cytometric bead assay (CBA) in nondiluted vitreous samples of patients with age-related macular degeneration (ARMD), diabetic macular edema (DME), and central retinal vein occlusion (CRVO). Methods. Twelve patients from a single clinics day qualified for intravitreal injections (ARMD n = 6, DME n = 3, CRVO n = 3) and underwent a combination treatment including a single-site 23 gauge core vitrectomy which yielded a volume of 0.6 mL undiluted vitreous per patient. Interleukin-6 (IL-6), vascular endothelial growth factor isoform A (VEGF-A), and monocyte chemo-attractant protein-1 (MCP-1) were assessed directly from 0.3 mL at the same day (fresh samples). To assess the reproducibility 0.3 ml were frozen for 60 days at -80°, on which the CBA was repeated (frozen samples). Results. In the fresh samples IL-6 was highest in CRVO (median IL-6 55.8 pg/mL) > DME (50.6) > ARMD (3.1). Highest VEGF was measured in CRVO (447.4) > DME (3.9) > ARMD (2.0). MCP-1 was highest in CRVO (595.7) > AMD (530.8) > DME (178). The CBA reproducibility after frozen storage was examined to be most accurate for MCP1 (P = 0.91) > VEGF (P = 0.68) > IL-6 (P = 0.49). Conclusions. CBA is an innovative, fast determining, and reliable technology to analyze proteins in fluids, like the undiluted vitreous, which is important to better understand ocular pathophysiology and pharmacology. There is no influence of intermittent storage at -80° for the reproducibility of the CBA.

The C-terminal domain of Fcj1 is required for formation of crista junctions and interacts with the TOB/SAM complex in mitochondria (2012)

Christian Körner Miguel Barrera Jovana Dukanovic Katharina Eydt Max Harner Regina Rabl Frank Vogel Doron Rapaport Walter Neupert Andreas S. Reichert

Crista junctions (CJs) are tubular invaginations of the inner membrane of mitochondria that connect the inner boundary with the cristae membrane. These architectural elements are critical for mitochondrial function. The yeast inner membrane protein Fcj1, called mitofilin in mammals, was reported to be preferentially located at CJs and crucial for their formation. Here we investigate the functional roles of individual domains of Fcj1. The most conserved part of Fcj1, the C-terminal domain, is essential for Fcj1 function. In its absence, formation of CJ is strongly impaired and irregular, and stacked cristae are present. This domain interacts with full-length Fcj1, suggesting a role in oligomer formation. It also interacts with Tob55 of the translocase of outer membrane β-barrel proteins (TOB)/sorting and assembly machinery (SAM) complex, which is required for the insertion of β-barrel proteins into the outer membrane. The association of the TOB/SAM complex with contact sites depends on the presence of Fcj1. The biogenesis of β-barrel proteins is not significantly affected in the absence of Fcj1. However, down-regulation of the TOB/SAM complex leads to altered cristae morphology and a moderate reduction in the number of CJs. We propose that the C-terminal domain of Fcj1 is critical for the interaction of Fcj1 with the TOB/SAM complex and thereby for stabilizing CJs in close proximity to the outer membrane. These results assign novel functions to both the C-terminal domain of Fcj1 and the TOB/SAM complex.

Development of cue integration with reward-mediated learning (2012)

Thomas Weißwange

This thesis will first introduce in more detail the Bayesian theory and its use in integrating multiple information sources. I will briefly talk about models and their relation to the dynamics of an environment, and how to combine multiple alternative models. Following that I will discuss the experimental findings on multisensory integration in humans and animals. I start with psychophysical results on various forms of tasks and setups, that show that the brain uses and combines information from multiple cues. Specifically, the discussion will focus on the finding that humans integrate this information in a way that is close to the theoretical optimal performance. Special emphasis will be put on results about the developmental aspects of cue integration, highlighting experiments that could show that children do not perform similar to the Bayesian predictions. This section also includes a short summary of experiments on how subjects handle multiple alternative environmental dynamics. I will also talk about neurobiological findings of cells receiving input from multiple receptors both in dedicated brain areas but also primary sensory areas. I will proceed with an overview of existing theories and computational models of multisensory integration. This will be followed by a discussion on reinforcement learning (RL). First I will talk about the original theory including the two different main approaches model-free and model-based reinforcement learning. The important variables will be introduced as well as different algorithmic implementations. Secondly, a short review on the mapping of those theories onto brain and behaviour will be given. I mention the most in uential papers that showed correlations between the activity in certain brain regions with RL variables, most prominently between dopaminergic neurons and temporal difference errors. I will try to motivate, why I think that this theory can help to explain the development of near-optimal cue integration in humans. The next main chapter will introduce our model that learns to solve the task of audio-visual orienting. Many of the results in this section have been published in [Weisswange et al. 2009b,Weisswange et al. 2011]. The model agent starts without any knowledge of the environment and acts based on predictions of rewards, which will be adapted according to the reward signaling the quality of the performed action. I will show that after training this model performs similarly to the prediction of a Bayesian observer. The model can also deal with more complex environments in which it has to deal with multiple possible underlying generating models (perform causal inference). In these experiments I use di#erent formulations of Bayesian observers for comparison with our model, and find that it is most similar to the fully optimal observer doing model averaging. Additional experiments using various alterations to the environment show the ability of the model to react to changes in the input statistics without explicitly representing probability distributions. I will close the chapter with a discussion on the benefits and shortcomings of the model. The thesis continues whith a report on an application of the learning algorithm introduced before to two real world cue integration tasks on a robotic head. For these tasks our system outperforms a commonly used approximation to Bayesian inference, reliability weighted averaging. The approximation is handy because of its computational simplicity, because it relies on certain assumptions that are usually controlled for in a laboratory setting, but these are often not true for real world data. This chapter is based on the paper [Karaoguz et al. 2011]. Our second modeling approach tries to address the neuronal substrates of the learning process for cue integration. I again use a reward based training scheme, but this time implemented as a modulation of synaptic plasticity mechanisms in a recurrent network of binary threshold neurons. I start the chapter with an additional introduction section to discuss recurrent networks and especially the various forms of neuronal plasticity that I will use in the model. The performance on a task similar to that of chapter 3 will be presented together with an analysis of the in uence of different plasticity mechanisms on it. Again benefits and shortcomings and the general potential of the method will be discussed. I will close the thesis with a general conclusion and some ideas about possible future work.

Detecting multineuronal temporal patterns in parallel spike trains (2012)

Kai S. Gansel Wolf Singer

We present a non-parametric and computationally efficient method that detects spatiotemporal firing patterns and pattern sequences in parallel spike trains and tests whether the observed numbers of repeating patterns and sequences on a given timescale are significantly different from those expected by chance. The method is generally applicable and uncovers coordinated activity with arbitrary precision by comparing it to appropriate surrogate data. The analysis of coherent patterns of spatially and temporally distributed spiking activity on various timescales enables the immediate tracking of diverse qualities of coordinated firing related to neuronal state changes and information processing. We apply the method to simulated data and multineuronal recordings from rat visual cortex and show that it reliably discriminates between data sets with random pattern occurrences and with additional exactly repeating spatiotemporal patterns and pattern sequences. Multineuronal cortical spiking activity appears to be precisely coordinated and exhibits a sequential organization beyond the cell assembly concept.

Superimposed high-frequency jet ventilation combined with continuous positive airway pressure/assisted spontaneous breathing improves oxygenation in patients with H1N1-associated ARDS (2012)

Tobias Michael Bingold Bertram Scheller Timo Wolf Jens Meier Alexander Koch Kai Zacharowski Peter Rosenberger Thomas Iber

Background: Numerous cases of swine-origin 2009 H1N1 influenza A virus (H1N1)-associated acute respiratory distress syndrome (ARDS) bridged by extracorporeal membrane oxygenation (ECMO) therapy have been reported; however, complication rates are high. We present our experience with H1N1-associated ARDS and successful bridging of lung function using superimposed high-frequency jet ventilation (SHFJV) in combination with continuous positive airway pressure/assisted spontaneous breathing (CPAP/ASB). Methods: We admitted five patients with H1N1 infection and ARDS to our intensive care unit. Although all patients required pure oxygen and controlled ventilation, oxygenation was insufficient. We applied SHFJV/CPAP/ASB to improve oxygenation. Results: Initial PaO2/FiO2 ratio prior SHFJV was 58-79 mmHg. In all patients, successful oxygenation was achieved by SHFJV (PaO2/FiO2 ratio 105-306 mmHg within 24 h). Spontaneous breathing was set during first hours after admission. SHFJV could be stopped after 39, 40, 72, 100, or 240 h. Concomitant pulmonary herpes simplex virus (HSV) infection was observed in all patients. Two patients were successfully discharged. The other three patients relapsed and died within 7 weeks mainly due to combined HSV infection and in two cases reoccurring H1N1 infection. Conclusions: SHFJV represents an alternative to bridge lung function successfully and improve oxygenation in the critically ill.

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