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Biomedical subjects

H Keller

Publications and source records attributed to H Keller.

At least 19 recordsLinked to original sources

[Urinary tract infections in infants and children -- a consensus on diagnostic, therapy and prophylaxis].

Urinary tract infections (UTI) are among the most common bacterial infections in infants and children. The early diagnosis of a pyelonephritis and its rapid, calculated antibacterial therapy are decisive for the prognosis. Urogenital anomalies, renal damage and bladder dysfunction may influence the risk of recurrences of UTI and pyelonephritic scarring. Diagnostic strategies therefore should focus on their early recognition. Pediatricians, urologists and infectiologists are cooperating in diagnostic, therapy and prophylaxis of UTI. The aim of the interdisciplinary consensus presented was to work out a concept which may help to manage childhood UTI in daily practice.

Administration, Oral↗

Effect of pressure on the Ginzburg-Landau parameter kappa=lambda/xi in YB6.

Measurements of the transition temperature Tc, the upper critical field Hc2, and the magnetic penetration depth lambda under hydrostatic pressure (up to approximately 9.2 kbar) in the YB6 superconductor were carried out. A pronounced and negative pressure effect (PE) on Tc and Hc2 with dTc/dp=-0.0547(4) K/kbar and micro0dHc2(0)/dp=-4.84(20) mT/kbar, and zero PE on lambda(0) were observed. The PE on the coherence length dxi(0)/dp=0.28(2) nm/kbar was calculated from the measured pressure dependence of Hc2(0). Together with the zero PE on the magnetic penetration depth lambda(0), our results imply that the Ginzburg-Landau parameter kappa(0)=xi(0)/lambda(0) depends on pressure and that pressure "softens" YB6, e.g., moves it to the type-I direction.

Journal Article↗

Development and first validation of the shared decision-making questionnaire (SDM-Q).

OBJECTIVE: Due to a lack of valid German instruments measuring shared decision-making (SDM), a theory-driven questionnaire (SDM-Q) to measure the process of SDM was developed and validated. METHODS: As a theoretical basis steps of the SDM process were defined in an expert panel. Item formulation was then conducted according to the Delphi method. For the first validation on a mixed sample Rasch analysis was used to eliminate items not fitting the construct thus receiving a unidimensional scale. RESULTS: After eliminating 4 items the remaining 11 form a unidimensional scale with an acceptable reliability for person measures (0.77) and very good reliability for item difficulties (0.95). Analysis of subgroups revealed a different use of items in different conditions. Furthermore the scale showed high ceiling effects. CONCLUSION: A new theory-driven instrument to measure the process of SDM has been developed and validated by use of a rigorous method revealing first promising results. Yet the ceiling effects require the addition of more discriminating items, and the different use of items in different conditions demands an in depth analysis. PRACTICE IMPLICATIONS: While the concept of SDM is constantly receiving more attention in medical practice, its valid and reliable measurement remains challenging.

Decision Making↗

The risks of sumatriptan administration in patients with unrecognized subarachnoid haemorrhage (SAH).

Administration of sumatriptan in subarachnoid haemorrhage (SAH) patients, misdiagnosed as migraine patients, may induce symptomatic cerebral vasospasm with potentially dangerous consequences. Over a 5-year period, we observed three patients with a 3-15-year history of migraine, who received sumatriptan for acute headache. Two patients received 6 mg sumatriptan subcutaneously on days 4 and 6, and one patient 3 x 100 mg sumatriptan orally on day 1 after an acute headache episode. In all three cases, an alleviation of headache intensity from severe to moderate was observed. When headache recurred and meningeal signs appeared, SAH was diagnosed by computed tomography in all three cases. No neurological deficits occurred during the further course of the disease. In both patients with a SAH caused by an aneurysm, transcranial Doppler sonography demonstrated vasospasm of the basal cerebral arteries. An antinociceptive effect of sumatriptan can be observed in SAH patients in good clinical condition, which suggests a specific craniovascular antinociceptive action. This may lead to misdiagnosis as migraine and delayed appropriate diagnosis and treatment.

Adult↗

A simple, direct method for x-ray scatter estimation and correction in digital radiography and cone-beam CT.

X-ray scatter poses a significant limitation to image quality in cone-beam CT (CBCT), resulting in contrast reduction, image artifacts, and lack of CT number accuracy. We report the performance of a simple scatter correction method in which scatter fluence is estimated directly in each projection from pixel values near the edge of the detector behind the collimator leaves. The algorithm operates on the simple assumption that signal in the collimator shadow is attributable to x-ray scatter, and the 2D scatter fluence is estimated by interpolating between pixel values measured along the top and bottom edges of the detector behind the collimator leaves. The resulting scatter fluence estimate is subtracted from each projection to yield an estimate of the primary-only images for CBCT reconstruction. Performance was investigated in phantom experiments on an experimental CBCT bench-top, and the effect on image quality was demonstrated in patient images (head, abdomen, and pelvis sites) obtained on a preclinical system for CBCT-guided radiation therapy. The algorithm provides significant reduction in scatter artifacts without compromise in contrast-to-noise ratio (CNR). For example, in a head phantom, cupping artifact was essentially eliminated, CT number accuracy was restored to within 3%, and CNR (breast-to-water) was improved by up to 50%. Similarly in a body phantom, cupping artifact was reduced by at least a factor of 2 without loss in CNR. Patient images demonstrate significantly increased uniformity, accuracy, and contrast, with an overall improvement in image quality in all sites investigated. Qualitative evaluation illustrates that soft-tissue structures that are otherwise undetectable are clearly delineated in scatter-corrected reconstructions. Since scatter is estimated directly in each projection, the algorithm is robust with respect to system geometry, patient size and heterogeneity, patient motion, etc. Operating without prior information, analytical modeling, or Monte Carlo, the technique is easily incorporated as a preprocessing step in CBCT reconstruction to provide significant scatter reduction.

Algorithms↗

Behavior of gaseous microemboli in extracorporeal circuits: air versus CO2.

BACKGROUND: Open heart surgery is associated with serious risk of cerebral and peripheral organ dysfunction, attributed in part to air microbubbles generated in or not eliminated from the extracorporeal circuit (ECC). Venous air leakage leads to increased arterial bubble load. CO2 replacing air in cardiac chambers show faster resorption times, reducing possible cerebral or peripheral organ damage after heart valve interventions. In two models of ECC the effect of air entering closed circuits was demonstrated and compared to the effect of CO2 entry. METHODS: Fragmentation and dissolution of gas (0.5 mL) was evaluated in an in vitro model of ECC, using ultrasonic bubble detection. Air leakage (10 mL) in the venous line of the ECC was simulated and compared to the effect of the same quantity of CO2 entering the circuit. Both models used whole blood priming and physiological conditions, verified with blood gas analyses. RESULTS: Fragmentation and dissolution of gas bubbles injected into a closed ECC could be demonstrated, complete resorption of CO2 bubbles was observed earlier than complete resorption of room air (5.0+/-0.6 vs. 14.4+/-5.9 min, p=0.0009). CO2 entering the venous line lead to 40% less arterial bubble load as compared to the same amount of room air entering the circuit (2099+/-991 vs. 3555+/-632, p=0.005). CONCLUSIONS: Current ECC systems fail to eliminate gas entering the circuit, leading rather to microbubble dispersion. CO2 is much faster resorbed within the circuit than room air. In open heart surgery as valvular operations, CO2 insufflation into the operative field is protective, as we have demonstrated in our models.

Air↗

Selective expression of a dominant-negative form of peroxisome proliferator-activated receptor in keratinocytes leads to impaired epidermal healing.

Many nuclear hormone receptors are involved in the regulation of skin homeostasis. However, their role in the epithelial compartment of the skin in stress situations, such as skin healing, has not been addressed yet. The healing of a skin wound after an injury involves three major cell types: immune cells, which are recruited to the wound bed; dermal fibroblasts; and epidermal and hair follicle keratinocytes. Our previous studies have revealed important but nonredundant roles of PPARalpha and beta/delta in the reparation of the skin after a mechanical injury in the adult mouse. However, the mesenchymal or epithelial cellular compartment in which PPARalpha and beta/delta play a role could not be determined in the null mice used, which have a germ line PPAR gene invalidation. In the present work, the role of PPARalpha was studied in keratinocytes, using transgenic mice that express a PPARalpha mutant with dominant-negative (dn) activity specifically in keratinocytes. This dn PPARalpha lacks the last 13 C terminus amino acids, binds to a PPARalpha agonist, but is unable to release the nuclear receptor corepressor and to recruit the coactivator p300. When selectively expressed in keratinocytes of transgenic mice, dn PPARalphaDelta13 causes a delay in the healing of skin wounds, accompanied by an exacerbated inflammation. This phenotype, which is similar to that observed in PPARalpha null mice, strongly suggests that during skin healing, PPARalpha is required in keratinocytes rather than in other cell types.

Amino Acid Sequence↗

Muon-spin-rotation measurements of the penetration depth of the infinite-layer electron-doped Sr0.9La0.1CuO2 cuprate superconductor.

Muon-spin-rotation (muSR) measurements of the in-plane penetration depth lambda(ab) have been performed in the infinite-layer electron-doped Sr0.9La0.1CuO2 high-T(c) superconductor (HTS). Absence of the magnetic rare-earth ions in this compound allowed us to measure for the first time the absolute value of lambda(ab)(0) in electron-doped HTSs using muSR. We found lambda(ab)(0)=116(2) nm. The zero-temperature depolarization rate sigma(0) proportional, variant 1/lambda(2)(ab)(0)=4.6(1) micros(-1) is more than 4 times higher than expected from the Uemura line. Therefore, this electron-doped HTS does not follow the Uemura relation found for hole-doped HTSs.

Journal Article↗

Evidence for charged critical behavior in the pyrochlore superconductor RbOs2O6.

We analyze magnetic penetration depth (lambda) data of the recently discovered superconducting pyrochlore oxide RbOs(2)O(6). Our results strongly suggest that in RbOs(2)O(6) charged critical fluctuations dominate the temperature dependence of lambda near T(c). This is in contrast with the mean-field behavior observed in conventional superconductors and the uncharged critical behavior found in nearly optimally doped cuprate superconductors. However, this finding agrees with the theoretical predictions for charged criticality and the charged criticality observed in underdoped YBa(2)Cu(3)O(6.59).

Journal Article↗

Low dose fraction behavior of high sensitivity radiochromic film.

A high sensitivity (HS) model of radiochromic film is receiving increasing use. The film's linear sensitometric response in the range of 0.5-40 Gy would make this film an ideal candidate for complex dosimetry applications that require tissue equivalence. This study investigates the potential use for clinical dosimetry of typical radiotherapy fractions at relatively low doses (0.5-5 Gy). The experiment involved exposing 25 pre-exposed pieces of HS film to five equal fractions of doses from 0.5 to 5 Gy 24 hours apart. The cumulative dose for each film was carefully monitored and optical density measurements were used as the sole determination of film response to dose. The average behavior of the various fractionation schemes was roughly consistent with previous observations of the MD-55 radiochromic film with about twice the overall sensitivity as expected. However, at low doses and low dose increments, unexpected variations beyond a well-documented low dose nonlinearity were observed. These unexpected variations may indicate complex polymer kinetics at low doses. This type of film would require extra care beyond that described in TG-55 for accurate use at low doses or low dose fraction schemes.

Dose Fractionation, Radiation↗

The helical tomotherapy thread effect.

Inherent to helical tomotherapy is a dose variation pattern that manifests as a "ripple" (peak-to-trough relative to the average). This ripple is the result of helical beam junctioning, completely unique to helical tomotherapy. Pitch is defined as in helical CT, the couch travel distance for a complete gantry rotation relative to the axial beam width at the axis of rotation. Without scattering or beam divergence, an analytical posing of the problem as a simple integral predicts minima near a pitch of 1/n where n is an integer. A convolution-superposition dose calculator (TomoTherapy, Inc.) included all the physics needed to explore the ripple magnitude versus pitch and beam width. The results of the dose calculator and some benchmark measurements demonstrate that the ripple has sharp minima near p=0.86(1/n). The 0.86 factor is empirical and caused by a beam junctioning of the off-axis dose profiles which differ from the axial profiles as well as a long scatter tail of the profiles at depth. For very strong intensity modulation, the 0.86 factor may vary. The authors propose choosing particular minima pitches or using a second delivery that starts 180 deg off-phase from the first to reduce these ripples: "Double threading." For current typical pitches and beam widths, however, this effect is small and not clinically important for most situations. Certain extremely large field or high pitch cases, however, may benefit from mitigation of this effect.

Algorithms↗

Isolation of recombinant antibodies (scFvs) to grapevine virus B.

A panel of 15 recombinant single chain antibodies (scFv) specific to grapevine virus B (GVB) were recovered from a human combinatorial scFv antibody library using the phage display technique against purified virus particles. Two selected scFv-encoding genes were expressed in recombinant Escherichia coli cells as dimeric antibodies. Successful detection of GVB in tissues of herbaceous hosts and grapevine was obtained in a direct binding assay using dimeric scFvs. This reagent was also shown to substitute efficiently for a GVB polyclonal serum in standard DAS-ELISA test used routinely for diagnosis.

Antibodies, Viral↗

Pressure effects on the transition temperature and the magnetic field penetration depth in the pyrochlore superconductor RbOs2O6.

Magnetization measurements under hydrostatic pressure up to 8 kbar in the pyrochlore superconductor RbOs2O6 (T(c) approximately or equal 6.3 K at p=0) were carried out. A positive pressure effect on T(c) with dT(c)/dp=0.090(3) K/kbar was observed, whereas no pressure effect on the magnetic penetration depth lambda was detected. The pressure independent ratio 2 Delta(0)/k(B)T(c)=3.72(2) (Delta(0) is the superconducting gap at zero temperature) was found to be close to the BCS value 3.52. Magnetization and muon-spin rotation measurements of lambda(T) indicate that RbOs2O6 is an adiabatic s-wave BCS-type superconductor. The value of lambda extrapolated to zero temperature and ambient pressure was estimated to be 230(30) nm.

Journal Article↗

Direct observation of the oxygen isotope effect on the in-plane magnetic field penetration depth in optimally doped YBa2Cu3O7-delta.

We report the first direct observation of the oxygen-isotope ((16)O/(18)O) effect on the in-plane penetration depth lambda(ab) in a nearly optimally doped YBa(2)Cu(3)O(7-delta) film using the novel low-energy muon-spin rotation technique. Spin-polarized low-energy muons are implanted in the film at a known depth z beneath the surface and process in the local magnetic field B(z). This feature allows us to measure directly the profile B(z) of the magnetic field inside the superconducting film in the Meissner state and to make a straightforward determination of lambda(ab). A substantial isotope shift Delta lambda(ab)/lambda(ab)=2.8(1.0)% at 4 K is observed, implying that the in-plane effective supercarrier mass m*(ab) is oxygen-isotope dependent with Delta m*(ab)/m*(ab)=5.5(2.0)%. These results are in good agreement with magnetization measurements on powder samples.

Journal Article↗

Design of adaptive treatment margins for non-negligible measurement uncertainty: application to ultrasound-guided prostate radiation therapy.

Daily imaging during the course of a fractionated radiotherapy treatment has the potential for frequent intervention and therefore effective adaptation of the treatment to the individual patient. The treatment information gained from such images can be analysed and updated daily to obtain a set of patient individualized parameters. However, in many situations, the uncertainty with which these parameters are estimated cannot be neglected. In this work this methodology is applied to the adaptive estimation of setup errors, the derivation of a daily optimal pre-treatment correction strategy, and the daily update of the treatment margins after application of these corrections. For this purpose a dataset of 19 prostate cancer patients was analysed retrospectively. The position of the prostate was measured daily with an optically guided 3D ultrasound localization system. The measurement uncertainty of this system is approximately 2 mm. The algorithm finds the most likely position of the target maximizing an a posteriori probability given the set of measurements. These estimates are used for the optimal corrections applied to the target volume. The results show that the application of the optimal correction strategy allows a reduction in the treatment margins in a systematic way with increasing progression of the treatment. This is not the case using corrections based only on the measured values that do not take the measurement uncertainty into account.

Algorithms↗

Elimination of microbubbles from the extracorporeal circuit: dynamic bubble trap versus arterial filter.

BACKGROUND: Open heart surgery is associated with important risk of cerebral and peripheral organ dysfunction, attributed in part to microbubbles generated in or not eliminated from the ECC. For elimination of microbubbles, a dynamic bubble trap (DBT) was developed for the arterial line of ECCs. METHODS: Bubble eliminating properties of an arterial filter were evaluated in four CABG patients and compared to the performance of the DBT in four patients. One patient received both devices. RESULTS: Elimination of bubbles between 40-120 microm was significantly higher with the DBT (88% vs. 57% with arterial filter, p=0.034). Reduction of bubbles below 40 microm was equivalent in both groups. The combination of both devices was most effective (94% for bubbles >40 microm). CONCLUSION: Arterial filter and DBT are equally effective in elimination of smaller gas bubbles. However, bigger bubbles possibly causing cerebral and peripheral organ damage are eliminated to a greater degree by the DBT.

Coronary Artery Bypass↗

Gender and personality in alcoholism.

The topic gender and personality in alcoholism is discussed on the background of a research project on clinical aspects of alcoholism at the University of Würzburg, Germany. The data of this study are presented in the context of two questions: Which personality differences are there between women and men dependent on alcohol, and is there a connection between these personality differences and features of the alcohol dependence? Additionally, we take a look at gender-related differences in the development of alcoholism. In a first step, gender differences in the development and the course of alcoholism are investigated. The data revealed only weak differences between female and male alcoholics when important confounding variables like age and education are taken into consideration. Secondly, the female and male alcoholics are matched according to age and education and their personality structures are compared by using several well-established and standardized self-report questionnaires. No serious gender differences concerning the main characteristics of alcohol dependence could be discovered. However, some remarkable personality differences between female and male alcoholics are found: women scored significantly higher on Neuroticism and Harm-Avoidance while men reached significantly higher scores on Venturesomeness and Sensation-Seeking. In order to detect a possible connection between alcoholism and gender-related personality differences, both males and females are subdivided into two groups using the scores of Neuroticism, Harm-Avoidance, Venturesomeness and Sensation-Seeking, respectively. We have found no indication for a gender-specific relevance of personality differences between female and male alcoholics with regard to Harm-Avoidance, Venturesomeness or Sensation-Seeking. However, differences in Neuroticism have revealed a greater relevance in alcohol-dependent women than in men.

Adolescent↗