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Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken: Vergleich der Befragungsergebnisse 2018 und 2024
No full textPilot study of cerebrospinal fluid biomarkers reveals inflammatory changes in patients with paranoid schizophrenia
No full textAbstract Paranoid schizophrenia is a severe mental illness with both positive and negative symptoms. Currently, the role of peripheral and central inflammation is increasingly suspected as possible factor in the pathogenesis of schizophrenia. This retrospective, monocentric pilot study investigated 35 patients (15/35 female) diagnosed with paranoid schizophrenia after exclusion of possible underlying neuroinflammatory disorders to assess for inflammatory changes of the cerebrospinal fluid (CSF) and associated signs of neurodegeneration. Kappa free light chains (KFLC), a panel of 21 cyto- and chemokines, and neurofilament light chains (NFL) as surrogate parameters for neuro-inflammation and -degeneration were determined in patients with paranoid schizophrenia as well as age- and sex-matched inflammatory ( n = 35) and non-inflammatory controls ( n = 40). Patients with paranoid schizophrenia exhibited significantly higher intrathecal synthesized fractions of KFLC than non-inflammatory controls. KFLC-positive patients with paranoid schizophrenia had significantly higher NFL concentrations in CSF than KFLC-negative patients according to Reiber´s diagram. NFL concentrations in CSF of patients with paranoid schizophrenia were associated with illness duration, frequency of psychotic episodes, and amount of antipsychotic treatment attempts. This pilot study highlights inflammatory changes in the CSF among a specific subgroup of patients with paranoid schizophrenia, positively correlating with elevated NFL levels in CSF
Brauchen wir eine Spezialsprechstunde? Wie Innovationen Interdisziplinarität in der Amputationsmedizin fördern
No full textZusammenfassung Die Amputation einer Extremität ist ein häufig notwendiger, jedoch irreversibler chirurgischer Eingriff, der mit weitreichenden funktionellen, psychosozialen und medizinischen Folgen einhergeht. Komorbiditäten und Begleitverletzungen können die Behandlung zusätzlich erschweren. Gleichzeitig eröffnen moderne chirurgische und technologische Fortschritte neue Möglichkeiten, stellen jedoch auch erhöhte Anforderungen an die Nachsorge. Vor diesem Hintergrund wurde an unserer Klinik eine interdisziplinäre Sprechstunde zur multiprofessionellen Versorgung von Amputierten eingerichtet. An einem deutschen universitären Maximalversorger wurde eine spezialisierte interdisziplinäre Sprechstunde etabliert. Ziel ist die strukturierte Indikationsstellung zur Amputation, die qualitätsgesicherte Durchführung orthopädisch-plastisch-chirurgischer Eingriffe sowie eine ganzheitliche Nachsorge, die funktionelle, psychosoziale und prothetische Aspekte berücksichtigt. Innerhalb eines Beobachtungszeitraums von zwölf Monaten wurden alle Patientenkontakte hinsichtlich Anzahl, Vorstellungsgründen sowie Patienten- und Amputationsmerkmalen systematisch erfasst und analysiert. Im Erhebungszeitraum wurden 474 Konsultationen bei 183 individuellen Patient:innen dokumentiert. Der Großteil der Fälle betraf die untere Extremität (86,25%), während 13,75% die obere Extremität betrafen. Das Patientenkollektiv bestand zu 63,9% aus Männern (n=117) und zu 36,1% aus Frauen (n=66), mit einem Altersmedian von 55,2±20 Jahren. Die häufigsten Amputationsursachen waren akute Traumata (n=74; 45,7%), gefolgt von Gefäßerkrankungen (n=24; 14,8%) und Infektionen/Sepsis (n=22; 13,6%). Die häufigsten Vorstellungsgründe waren standardisierte Kontrolluntersuchungen (n=49; 23,1%), postoperative Wundkontrollen (n=39; 18,4%) sowie prothetische Beratung (n=30; 14,2%). Die komplexen, oft lebenslang wirksamen Folgen einer Amputation erfordern eine koordinierte, interdisziplinäre Versorgung mit hoher medizinischer, therapeutischer und sozialer Kompetenz. Interdisziplinäre Sprechstunden sind in der Versorgung chronisch und multimorbid Erkrankter etabliert und bewährt. Auch in der Behandlung von Amputierten markiert dieses Modell einen notwendigen Paradigmenwechsel, um eine patientenzentrierte, sektorenübergreifende Versorgung zu ermöglichen
SynapseNet: Deep Learning for Automatic Synapse Reconstruction
No full textElectron microscopy is an important technique for the study of synaptic morphology and its relation to synaptic function. The data analysis for this task requires the segmentation of the relevant synaptic structures, such as synaptic vesicles, active zones, mitochondria, presynaptic densities, synaptic ribbons, and synaptic compartments. Previous studies were predominantly based on manual segmentation, which is very time-consuming and prevented the systematic analysis of large datasets. Here, we introduce SynapseNet, a tool for the automatic segmentation and analysis of synapses in electron micrographs. It can reliably segment synaptic vesicles and other synaptic structures in a wide range of electron microscopy approaches, thanks to a large annotated dataset, which we assembled, and domain adaptation functionality we developed. We demonstrated its capability for (semi-)automatic biological analysis in two applications and made it available as an easy-to-use tool to enable novel data-driven insights into synapse organization and function.The morphology and function of synapses are closely linked. Electron microscopy enables a better understanding of synaptic morphology. The datasets gathered for such studies are large and their analysis is currently limited by a lack of reliable methods for automation of time consuming steps, such as identification of synaptic vesicles. The authors developed SynapseNet, a method for the automatic segmentation of synaptic vesicles and other synaptic structures. It consists of deep neural networks that learn to solve these tasks based on a large annotated dataset assembled as part of this study. The authors made SynapseNet available as open-source, user-friendly software. They demonstrated that SynapseNet can automate the analysis of synaptic morphology for two distinct research areas regarding hippocampal Schaffer collateral and inner ear ribbon synapses.Electron microscopy is an important technique for the study of synaptic morphology and its relation to synaptic function. The data analysis for this task requires the segmentation of the relevant synaptic structures, such as synaptic vesicles, active zones, mitochondria, presynaptic densities, synaptic ribbons, and synaptic compartments. Previous studies were predominantly based on manual segmentation, which is very time-consuming and prevented the systematic analysis of large datasets. Here, we introduce SynapseNet, a tool for the automatic segmentation and analysis of synapses in electron micrographs. It can reliably segment synaptic vesicles and other synaptic structures in a wide range of electron microscopy approaches, thanks to a large annotated dataset, which we assembled, and domain adaptation functionality we developed. We demonstrated its capability for (semi-)automatic biological analysis in two applications and made it available as an easy-to-use tool to enable novel data-driven insights into synapse organization and function.The morphology and function of synapses are closely linked. Electron microscopy enables a better understanding of synaptic morphology. The datasets gathered for such studies are large and their analysis is currently limited by a lack of reliable methods for automation of time consuming steps, such as identification of synaptic vesicles. The authors developed SynapseNet, a method for the automatic segmentation of synaptic vesicles and other synaptic structures. It consists of deep neural networks that learn to solve these tasks based on a large annotated dataset assembled as part of this study. The authors made SynapseNet available as open-source, user-friendly software. They demonstrated that SynapseNet can automate the analysis of synaptic morphology for two distinct research areas regarding hippocampal Schaffer collateral and inner ear ribbon synapses
EORTC/USCLC/ISCL consensus recommendations for management and treatment of cutaneous lymphoproliferative disorders
No full textAbstract Background In recent classifications several cutaneous lymphomas were reclassified as lymphoproliferative disorder (LPD). These include primary cutaneous CD4-positive small/medium T-cell LPD (PCSM-TCLPD), primary cutaneous acral CD8+ T-cell LPD (acral CD8+ TLPD) and primary cutaneous marginal zone LPD (PCMZLPD; still classified as primary cutaneous marginal zone lymphoma (PCMZL) in the 5th edition of the WHO classification). The results of a survey among 30 cutaneous lymphoma centres on the effects of this new terminology on clinical management revealed considerable heterogeneity and emphasized the need to develop uniform recommendations for management and treatment of these disorders. Objectives To develop consensus recommendations for staging, treatment and follow-up policy in PCSM-TCLPD, acral CD8+ TLPD and PCMZL/LPD. Methods Two surveys with questions regarding staging, treatment and follow-up strategy of cutaneous LPDs were distributed among 30 cutaneous lymphoma expert centres collaborating within the EORTC-CLTG, USCLC and ISCL. Based on the results of these surveys, an extensive literature search, two rounds of feedback and a final consensus meeting consensus recommendations were formulated. Results Important changes compared to current practise and literature include: staging examinations apart from thorough clinical examination of skin and peripheral lymph nodes not required in typical cases of PCSM-TCLPD and acral CD8+ TLPD; low-dose radiotherapy (4-8 Gy) rather than dose ≥20 Gy, for PCSM-TCLPD and acral CD8+ TLPD, and 4 Gy for PCMZL/LPD, with possibility to escalate to a higher dose (20-24 Gy) in case of local failure; increase in the use of intralesional corticosteroids as initial treatment in all three LPDs; limited follow-up period (2 years) in PCSM-TCLPD and acral CD8+ TLPD LPD. Conclusion These EORTC/USCLC/ISCL consensus recommendations reflect the state-of-the-art management and treatment as agreed upon by major cutaneous lymphoma centers. They may contribute to uniform staging, treatment and follow-up policy in patients with cutaneous LPDs
MetaboSERV—a platform for selecting, exchanging, and visualizing metabolomics data with controlled data access
No full textAbstract Background The growing number of metabolomics studies, based on high-dimensional data measured by hyphenated mass spectrometry (MS) and/or nuclear magnetic resonance (NMR) spectroscopy, has sparked the creation of several public metabolomics data repositories. Each repository emphasizes different aspects regarding data selection and representation, but most offer only limited options for privacy-preserving data sharing. Results We present MetaboSERV, an open-source, browser-based metabolomics platform dedicated to the selection, integration, and sharing of quantitative metabolomics data and metadata with controlled data access. MetaboSERV aims to aid researchers in analyzing their results by facilitating means to browse, visualize, and compare data across available datasets. It provides different access control functionalities, creating an environment in which data can be shared safely in a privacy-preserving manner to support collaborative and interdisciplinary research. Furthermore, it is designed to be extensible and adaptable to existing data management infrastructures through the creation of self-managed MetaboSERV instances, for which we provide the source code and a set of configurable Docker images. Conclusions The public MetaboSERV instance is available at https://metaboserv.ckdn.app, and the source code can be found at https://gitlab.gwdg.de/MedBioinf/metabolomics/metaboserv. The Research Resource Identifier (RRID) for MetaboSERV is SCR_025496
Machine‐learning‐based prediction of respiratory flow and lung volume from real‐time cardiac MRI using MR‐compatible spirometry
No full textAbstract Background Cardiac real‐time MRI (RT‐MRI) in combination with MR‐compatible spirometry (MRcS) offers unique opportunities to study heart‐lung interactions. In contrast to other techniques that monitor respiration during MRI, MRcS provides quantitative respiratory data. Though MRcS is well tolerated, shortening of the scanning time with MRcS would be desirable, especially in young and sick patients. Purpose The aim of the study was to predict airflow and lung volume based on RT‐MR images after a short learning phase of combined RT‐MRI and MRcS to provide respiratory data for subsequent short axis stack‐based volumetries. Methods Cardiac RT‐MRI (1.5 T; short axis; 30 frames/s) was acquired during free breathing in combination with MRcS in adult healthy subjects ( n = 10). MR images with MRcS were recorded during a learning phase to collect training data. The iterative Lucas‐Kanade method was applied to estimate optical flow from the captured MR images. A ridge regression model was fitted to predict airflow and thus also the lung volume from the estimated optical flow. Hyperparameters were estimated using leave‐one‐out cross validation and the performance was assessed on a held‐out test dataset. Different durations and compositions of the learning phase were investigated to develop the most efficient measurement protocol. Coefficient of determination (R 2 ), relative mean squared error (rMSE), Bland‐Altman analysis on absolute tidal volume difference (aTVD), and absolute maximal airflow difference (aMFD) were used to validate the predictions on held‐out test data. Results MRI combined with MRcS can train a machine learning algorithm to provide excellent predictive quantitative respiratory volume and flow for the remaining study. The optimal trade‐off between predictive power and time necessary for training was reached with a shortened cardiac volumetry protocol covering only about two breaths per slice and every second slice (airflow: mean R 2 : 0.984, mean rMSE: 0.015, Bias aMFD: ‐0.01 L/s with +0.084/‐0.1 95% CI and volume: mean R 2 : 0.990, mean rMSE: 0.003, Bias aTVD: 4.27 mL with +33/‐24 95% CI) at a total duration of 100 s. Shorter protocols or application of the algorithm to subsequent studies in the same subject or even in different subjects still provided useful qualitative data. Conclusion Machine‐learning‐based prediction of respiratory flow and lung volume from cardiac RT‐MR images after a short training phase with MRcS is feasible and can help to shorten the time with MRcS while providing accurate respiratory data during RT‐MRI
Regionalization of gene expression and cell types in the silk gland of the pantry moth Plodia interpunctella
No full textAbstract Lepidopteran silk glands include a posterior silk gland (PSG) that secretes core fibers and a middle silk gland (MSG) that secretes adhesive sericins. While well-studied in the silkworm ( Bombyx mori ), little is known about the gene expression profiles underlying the diversity of lepidopteran silks. Here we characterized the silk gland from the pantry moth Plodia interpunctella using a combination of quantitative and spatial assays. RNA-seq analyses of differential gene expression between the MSG and PSG depict the transcriptomic divergence between these two secretory tissues. In the PSG, high expression of fibroin genes FibL and FibH were detected, whereas MSG samples were dominated by transcripts encoding major sericins— bioadhesive proteins that form the coating of the silk fiber. Hybridization Chain Reaction (HCR) mRNA profiling revealed sharp cellular boundaries within the silk gland: PSG cells exclusively expressed fibroins, while MSG comprised two compartments each expressing different combinations of sericins. Our findings corroborate the conserved organization of lepidopteran silk glands into specialized secretory subdivisions, and establish Plodia as a promising comparative model for studying silk diversity. This work provides a foundation for future research into the cellular and evolutionary basis of silk production across Lepidoptera
Wild ungulates and salvage logging modulate disturbance effects on moth communities in spruce‐dominated forests
No full textAbstract In Central Europe, natural forest disturbances are increasing due to climate change and management legacies. The consequences of the resulting habitat changes on biodiversity, with a higher availability of open and sparse forest stages shaped by varying post‐disturbance forest management, remain poorly understood. We aimed to disentangle the effect of stand‐replacing forest disturbance and associated post‐disturbance management on moths, a hyper‐diverse insect order with high ecological indicator value, in a spruce‐dominated low mountain range in Germany. We also assessed how these effects are modulated by structural heterogeneity and wild ungulate density. In 2021 and 2022, we sampled 40 sites each for macro‐moths using non‐lethal light traps. We compared unlogged and salvage‐logged sites disturbed by bark beetle outbreaks and windthrow 2–5 and 12–15 years ago. We used undisturbed spruce plantations as controls. We caught 52,090 specimens of 393 macro‐moth species. Taxonomic and functional diversity were higher on disturbed sites but varied little with post‐disturbance management. Species of conservation concern benefited from forest disturbance. Higher wild ungulate densities enforced the positive effect of disturbance, especially 12–15 years after disturbance. Disturbance‐induced structural heterogeneity was positively associated with taxonomic and functional diversity. Community composition diversified by post‐disturbance management. Disturbance also triggered community changes, with an increase in the number of open forest species that outweighed a decrease in closed‐forest species. Synthesis and application. In an area of massive forest disturbance, taxonomic and functional moth diversity currently benefit from a re‐opening of dense, dark forests. At a landscape scale, management should aim at diverse management strategies creating vegetation heterogeneity, that is, combining unlogged and salvage‐logged sites. Ungulate management should allow access to disturbed areas for browsing and grazing.Zusammenfassung In mitteleuropäischen Wäldern nehmen natürliche Störungsereignisse zu. Dies ist durch den Klimawandel bedingt und wird durch historische forstwirtschaftliche Entscheidungen gefördert. Störungen führen zu einer höheren Verfügbarkeit offener und lichter Waldstadien und verändern damit die Habitatbedingungen für Tier‐ und Pflanzenarten grundlegend. Die Auswirkungen dieser Lebensraumveränderungen auf die Biodiversität, die durch unterschiedliche Waldbewirtschaftung nach Störung beeinflusst werden, sind nach wie vor kaum erforscht. Im Rahmen einer Feldstudie haben wir den Einfluss von natürlichen Störungsereignissen und dem sich anschließenden Forstmanagement in Fichtenbeständen des Harzes auf Nachtfalter, einer äußerst artenreichen Gruppe mit hohem indikativen Wert, untersucht. Zusätzlich wurde berücksichtigt, wie diese Effekte durch strukturelle Heterogenität und den Einfluss von Schalenwild verändert werden. Dafür wurden 40 Flächen jeweils in den Jahren 2021 und 2022 mit nicht‐letalen Lichtfallen auf Nachtfalter (Makrolepidoptera) beprobt. Wir verglichen nicht beräumte und beräumte Störungsflächen, die vor 2–5 und 12–15 Jahren durch Borkenkäfer oder Windwurf abgestorben sind. Als Kontrolle dienten ungestörte Fichtenbestände. 393 Nachtfalterarten (Makrolepidoptera) mit 52.090 Individuen wurden erfasst. Die taxonomische und funktionelle Diversität war auf den Störungsflächen höher als in ungestörten Fichtenbeständen, variierte jedoch wenig mit dem Forstmanagement nach Störung. Auch gefährdete Arten profitierten von den Störungsereignissen. Eine höhere Schalenwilddichte verstärkte den positiven Effekt von Störungen auf die Diversität, insbesondere in älteren Sukzessionsstadien. Eine störungsbedingt höhere strukturelle Heterogenität ging mit einer höheren taxonomischen und funktionellen Diversität einher. Es kam zu einer Diversifizierung der Artenzusammensetzung durch das unterschiedliche Forstmanagement nach Störung, wobei insbesondere Offenland‐ assoziierte Arten von Störungen profitierten und den Rückgang von Arten geschlossener Wälder kompensierten. Synthese und Anwendungen. In der gegenwärtigen Periode zunehmender Störungen profitiert die taxonomische und funktionelle Diversität von Nachtfaltern von der Öffnung dichter und dunkler Fichtenbestände. Auf Landschaftsebene schafft eine Kombination unterschiedlicher forstlicher Managementansätze nach Störung (Nicht‐Beräumung und Beräumung) heterogene Vegetationsstrukturen und fördert damit die Diversität von Nachtfaltergemeinschaften. Von den Auswirkungen von Schalenwild auf die Störungshabitate kann die Diversität profitieren, so dass Störungsflächen für Schalenwild zugänglich bleiben sollten.Abstract In Central Europe, natural forest disturbances are increasing due to climate change and management legacies. The consequences of the resulting habitat changes on biodiversity, with a higher availability of open and sparse forest stages shaped by varying post‐disturbance forest management, remain poorly understood. We aimed to disentangle the effect of stand‐replacing forest disturbance and associated post‐disturbance management on moths, a hyper‐diverse insect order with high ecological indicator value, in a spruce‐dominated low mountain range in Germany. We also assessed how these effects are modulated by structural heterogeneity and wild ungulate density. In 2021 and 2022, we sampled 40 sites each for macro‐moths using non‐lethal light traps. We compared unlogged and salvage‐logged sites disturbed by bark beetle outbreaks and windthrow 2–5 and 12–15 years ago. We used undisturbed spruce plantations as controls. We caught 52,090 specimens of 393 macro‐moth species. Taxonomic and functional diversity were higher on disturbed sites but varied little with post‐disturbance management. Species of conservation concern benefited from forest disturbance. Higher wild ungulate densities enforced the positive effect of disturbance, especially 12–15 years after disturbance. Disturbance‐induced structural heterogeneity was positively associated with taxonomic and functional diversity. Community composition diversified by post‐disturbance management. Disturbance also triggered community changes, with an increase in the number of open forest species that outweighed a decrease in closed‐forest species. Synthesis and application. In an area of massive forest disturbance, taxonomic and functional moth diversity currently benefit from a re‐opening of dense, dark forests. At a landscape scale, management should aim at diverse management strategies creating vegetation heterogeneity, that is, combining unlogged and salvage‐logged sites. Ungulate management should allow access to disturbed areas for browsing and grazing.Zusammenfassung In mitteleuropäischen Wäldern nehmen natürliche Störungsereignisse zu. Dies ist durch den Klimawandel bedingt und wird durch historische forstwirtschaftliche Entscheidungen gefördert. Störungen führen zu einer höheren Verfügbarkeit offener und lichter Waldstadien und verändern damit die Habitatbedingungen für Tier‐ und Pflanzenarten grundlegend. Die Auswirkungen dieser Lebensraumveränderungen auf die Biodiversität, die durch unterschiedliche Waldbewirtschaftung nach Störung beeinflusst werden, sind nach wie vor kaum erforscht. Im Rahmen einer Feldstudie haben wir den Einfluss von natürlichen Störungsereignissen und dem sich anschließenden Forstmanagement in Fichtenbeständen des Harzes auf Nachtfalter, einer äußerst artenreichen Gruppe mit hohem indikativen Wert, untersucht. Zusätzlich wurde berücksichtigt, wie diese Effekte durch strukturelle Heterogenität und den Einfluss von Schalenwild verändert werden. Dafür wurden 40 Flächen jeweils in den Jahren 2021 und 2022 mit nicht‐letalen Lichtfallen auf Nachtfalter (Makrolepidoptera) beprobt. Wir verglichen nicht beräumte und beräumte Störungsflächen, die vor 2–5 und 12–15 Jahren durch Borkenkäfer oder Windwurf abgestorben sind. Als Kontrolle dienten ungestörte Fichtenbestände. 393 Nachtfalterarten (Makrolepidoptera) mit 52.090 Individuen wurden erfasst. Die taxonomische und funktionelle Diversität war auf den Störungsflächen höher als in ungestörten Fichtenbeständen, variierte jedoch wenig mit dem Forstmanagement nach Störung. Auch gefährdete Arten profitierten von den Störungsereignissen. Eine höhere Schalenwilddichte verstärkte den positiven Effekt von Störungen auf die Diversität, insbesondere in älteren Sukzessionsstadien. Eine störungsbedingt höhere strukturelle Heterogenität ging mit einer höheren taxonomischen und funktionellen Diversität einher. Es kam zu einer Diversifizierung der Artenzusammensetzung durch das unterschiedliche Forstmanagement nach Störung, wobei insbesondere Offenland‐ assoziierte Arten von Störungen profitierten und den Rückgang von Arten geschlossener Wälder kompensierten. Synthese und Anwendungen. In der gegenwärtigen Periode zunehmender Störungen profitiert die taxonomische und funktionelle Diversität von Nachtfaltern von der Öffnung dichter und dunkler Fichtenbestände. Auf Landschaftsebene schafft eine Kombination unterschiedlicher forstlicher Managementansätze nach Störung (Nicht‐Beräumung und Beräumung) heterogene Vegetationsstrukturen und fördert damit die Diversität von Nachtfaltergemeinschaften. Von den Auswirkungen von Schalenwild auf die Störungshabitate kann die Diversität profitieren, so dass Störungsflächen für Schalenwild zugänglich bleiben sollten.Deutsche Bundesstiftung Umwelt https://doi.org/10.13039/10000763
