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Background Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies. Methods This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated. Results Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; ORStage 1: 1.435 (95% CI 0.438–0.702), ORStage 2: 2.463 (95% CI 0.656–9.245), ORStage 3: 4.784 (95% CI 1.421–16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates. Conclusion The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.

Signaling pathways of regulated necrosis, such as necroptosis and ferroptosis, contribute to acute kidney injury (AKI), but the role of pyroptosis is unclear. Pyroptosis is mediated by the pore-forming protein gasdermin D (GSDMD). Here, we report a specific pattern of GSDMD-protein expression in the peritubular compartment of mice that underwent bilateral ischemia and reperfusion injury (IRI). Along similar lines, the GSDMD-protein expression in whole kidney lysates increased during the first 84 h following cisplatin-induced AKI. Importantly, unlike whole kidney lysates, no GSDMD-protein expression was detectable in isolated kidney tubules. In IRI and cisplatin-induced AKI, GSDMD-deficient mice exhibited hypersensitivity to injury as assessed by tubular damage, elevated markers of serum urea, and serum creatinine. This hypersensitivity was reversed by a combined deficiency of GSDMD and the necroptosis mediator mixed lineage kinase domain-like (MLKL). In conclusion, we demonstrate a non-cell autonomous role for GSDMD in protecting the tubular compartment from necroptosis-mediated damage in IRI.

Wir berichten uber den Fall einer 73-jahrigen Patientin bosnischer Herkunft, die mit einem akuten Nierenversagen aufgenommen wurde. Die Nierenbiopsie erbrachte die Diagnose einer infektassoziierten nekrotisierenden sowie extrakapillar proliferativen Glomerulonephritis. Die Patientin berichtete, etwa zwei Wochen zuvor einen fieberhaften Infekt gehabt zu haben. Unsere Diagnostik ergab keinen Hinweis auf einen aktuellen floriden Infekt. Es erfolgte eine systemische Steroidtherapie mit gutem Ansprechen. Sechs Wochen spater erfolgte die erneute stationare Aufnahme der Patientin in einem schwer kranken Zustand. Wir konnten bioptisch in der Magenschleimhaut eine Strongyloides-stercoralis-Infestation nachweisen. Unter der Steroidtherapie hatte sich ein sogenanntes Hyperinfektionssyndrom entwickelt, an dem die Patientin trotz intensivmedizinischer Bemuhungen verstarb. Dieser Fall illustriert, dass insbesondere bei Patienten aus Endemiegebieten auch hierzulande an diese Parasitose gedacht werden muss. Wir diskutieren eine wahrscheinliche kausale Verknupfung mit der Glomerulonephritis und geben eine Ubersicht uber die Diagnostik, den Krankheitsverlauf und die Therapie dieser Parasitose.

Die Ladedruckregelung ist ein wichtiger Bestandteil der Steuerung moderner Ottomotoren. Die Umsetzung moderner Regelungsverfahren fur diese nichtlineare Strecke ist seit Jahren Gegenstand wissenschaftlicher Publikationen. Stand der Technik fur den Serienbetrieb ist dagegen eine verhaltnismasig einfache Gain-Scheduling-Struktur basierend auf PID-Reglern und stationarer Vorsteuerung. Diese Arbeit prasentiert ein serientaugliches Konzept zur Regelung des Ladedrucks und dessen experimentelle Erprobung an einem Prufstand. Die verwendete Reglerstruktur entspricht weitgehend dem Stand der Technik, wobei die Vorsteuerung signifikant vereinfacht und ein Anti-Windup-Konzept zur systematischen Berucksichtigung von Stellgrosenbeschrankungen erganzt wurden. Hervorzuheben ist das verwendete systematische modellbasierte Vorgehen zur $$\text{H}_{\infty}$$-optimalen Auslegung der strukturierten Arbeitspunktregler. Der Einsatz $$\text{H}_{\infty}$$-optimaler Regler erlaubt die a priori Einbeziehung quantitativer Forderungen an das Verhalten der resultierenden lokalen Regelkreise in den Entwurfsprozess. Das zugrundeliegende Reglerentwurfsverfahren erlaubt lineare Regler beliebiger Struktur. Damit eroffnet sich die Moglichkeit im Einsatz befindliche, von anwendungsorientierten Ingenieuren akzeptierte Reglerstrukturen $$\text{H}_{\infty}$$-optimal zu parametrieren. Die Berechnung der Parameter erfolgt zuverlassig durch die Losung nichtkonvexer und nichtglatter Optimierungsprobleme unter Verwendung veroffentlichter Verfahren. Die Gewinnung der fur den modellbasierten Reglerentwurf erforderlichen mathematischen Systembeschreibungen geschieht durch Identifikation linearer zeitinvarianter Arbeitspunktsysteme. Die experimentell erzielten Resultate zeigen im Vergleich zu einer konventionell parametrierten Ladedruckregelung deutlich die Leistungsfahigkeit des vorgeschlagenen Regelungskonzeptes. Gegenuber dem konventionellen Vorgehen zur Parametrierung auf Basis von Expertenwissen und Fahrversuchen zeichnet sich der aufgezeigte Entwurfsprozess durch das strukturierte, methodische und theoretisch fundierte Vorgehen aus. Der resultierende Entwurfsprozess ist weitestgehend automatisiert und weist einen signifikant reduzierten Ressourcen- und Zeitbedarf auf.

Background Endothelial Progenitor Cells have been shown as effective tool in experimental AKI. Several pharmacological strategies for improving EPC-mediated AKI protection were identified in recent years. Aim of the current study was to analyze consequences of constitutive Atg5 activation in murine EPCs, utilized for AKI therapy. Methods Ischemic AKI was induced in male C57/Bl6N mice. Cultured murine EPCs were systemically injected post-ischemia, either natively or after Atg5 transfection (Adenovirus-based approach). Mice were analyzed 48 h and 6 weeks later. Results Both, native and transfected EPCs (EPCsAtg5) improved persisting kidney dysfunction at week 6, such effects were more pronounced after injecting EPCsAtg5. While matrix deposition and mesenchymal transdifferentiation of endothelial cells remained unaffected by cell therapy, EPCs, particularly EPCsAtg5 completely prevented the post-ischemic loss of peritubular capillaries. The cells finally augmented the augophagocytic flux in endothelial cells. Conclusions Constitutive Atg5 activation augments AKI-protective effects of murine EPCs. The exact clinical consequences need to be determined.

Eine akzidentielle oder (para)suizidale Intoxikation mit Ethylenglykol kann zu einer schweren Acidose, zu verschiedenen Organsystemschaden und zum Tod fuhren. Wirksame Therapien stellen die Hamodialyse und die sofortige Gabe von Fomepizol bzw. von Ethanol dar. Wir beschreiben einen Patienten nach wiederholter Ethylenglykolintoxikation mit einer schweren metabolischen Acidose und einem akuten Nierenversagen. Durch Hamodialyse mit ethanolhaltigem Dialysat und i. v.-Gabe von Ethanol konnten wir gravierende Folgeschaden verhindern.

Ethical leadership has so far mainly been featured in the organizational behavior domain and, as such, treated as an intra-organizational phenomenon. The present study seeks to highlight the relevance of ethical leadership for extra-organizational phenomena by combining the organizational behavior perspective on ethical leadership with a classical marketing approach. In particular, we demonstrate that customers may use perceived ethical leadership cues as additional reference points when forming purchasing intentions. In two experimental studies (N = 601 and N = 336), we find that ethical leadership positively affects purchasing intentions because of customers’ concerns for moral self-congruence. We show this by means of both mediation and moderation analyses. Interestingly, the effect of perceived ethical leadership on purchasing intentions holds over and above the ethical advertising claims (e.g., cause-related marketing) that are commonly used in marketing. We conclude by discussing the possible ramifications of ethical leadership beyond its effects on immediate employees.

Background Transplant failure requires the consideration of numerous potential causes including rejection, acute tubular necrosis, infection, and recurrence of the original kidney disease. Kidney biopsy is generally required to approach these differential diagnoses. However, the histopathological findings on their own do not always lead to a definite diagnosis. Consequently, it is crucial to integrate them with clinical findings and patient history when discussing histopathological patterns of injury. The histopathologic finding of a membranoproliferative glomerulonephritis (MPGN) is one of the most challenging constellations since it does not refer to a specific disease entity but rather reflects a pattern of injury that is the result of many different causes. Whilst MPGN is occasionally classified as immune complex mediated, careful evaluation usually reveals an underlying disorder such as chronic infection, plasma cell dyscrasia, complement disorders, and autoimmune disease. Case presentation We describe the case of a 43-year-old woman who was referred to us because of a slowly rising serum creatinine 4 years after kidney transplantation. As in the native kidney, the biopsy revealed an MPGN pattern of injury. The cause of this finding had not been established prior to transplantation leading to a classification as idiopathic MPGN in the past. Further workup at the time of presentation and allograft failure revealed chronic infection of a ventriculoatrial shunt as the most probable cause. Conclusion This case underlines the fact that MPGN is not a disease but a histopathological description. Consequently, the causative disorder needs to be identified to avoid kidney failure and recurrence after transplantation.

Justice is a contested concept. There are many different and competing conceptions, i.e. interpretations of the concept. Different domains of justice deal with different fields of application of justice claims, such as structural justice, distributive justice, participatory justice or recognition. We present a formal conceptual structure of justice applicable to all these domains. We show that conceptions of justice can be described by specifying the following conceptual elements: the judicandum (that which is to be judged as just or unjust), the community of justice including claim holders and claim addressees, their claims (and obligations), the informational base for the assessment, the principles of justice, and on a more practical level, the instruments of justice. By specifying these conceptual elements of justice, it is possible to analyse and compare different conceptions of justice, to assess their internal consistency, to explore new definitions of justice in an analytical way, and to explicate an idea of justice in a manner that provides concrete links to the relevant context.

This manuscript reviews the data about the histopathologic and develops recommendations to standardise and improve the biopsy procedure, the biopsy handling, the histopathological evaluation, the communication of results and the collection of data from pretransplantation kidney biopsies of deceased donors in Germany. The recommendations are based on this literature review, on discussions at two workshops held by the German Society of Pathology and the German Organ Transplantation Foundation and on personal experiences of the authors. These German recommendations advocate the use of punch biopsies, paraffin embedding and detailed descriptive reporting of histopathological findings. These recommendations constitute only a starting point. Periodical revisions will help to simplify and optimise the recommendations with the ultimate goal to prospectively gather data for the elaboration of a computer-based algorithm that allows the exact prediction of transplantation outcome for a given match of donor and recipient.

In recent years, social media have become a popular channel through which customers and companies can interact. However, companies struggle to assess whether their investments in establishing and maintaining brand pages in social media actually meet their high expectations with respect to developing and retaining customers. Based on three empirical studies, the authors explore the role of interactions through corporate social media channels, such as Facebook brand pages, in customer relationship management. The results indicate that social media interactions indeed ease the upselling efforts and reduce the risk of churn. These positive effects offset the observed increases with regard to the number of service requests and the higher overall service cost. Thus, we ultimately find customers who interact with the brand on social media to be more profitable.

In recent years, management and academics have increasingly focused on quality management in public transport. In particular, many public transport operators regularly monitor their service quality over time and use these data to assess quality performance (e.g., for performance-based quality contracts) and to determine managerial decisions (e.g., budget allocations for service improvements). However, despite the widespread applications of service quality data in practice, it is unclear whether cross-sectional analyses and cross-temporal comparisons of service quality data provide valid insights for quality management purposes. In this study, we investigate the usability of cross-sectional analyses and cross-temporal comparisons of service quality data by conducting an empirical study that tracked a panel’s perceptions of the service quality of public transport and its choice over the course of three consecutive years. The results demonstrate that cross-sectional analyses provide valid insights for quality management. However, cross-temporal comparisons should be interpreted carefully because the results of these comparisons are surprisingly unreliable. In fact, we find that service quality data do not provide reliable results over time and therefore conclude that cross-temporal comparisons of service quality data must be interpreted with caution for quality management in public transport.

The brand personality of nonprofit service organizations (NPO) is a focal cue for individuals engaging in pro-social behavior. However, the positive effect of brand personality on donors’ intention to engage pro-socially may be affected in cases in which NPOs provide monetary incentives to those donors. Relying on social exchange theory, the authors examine how monetary incentives and brand personality commonly affect the intention to donate and whether this effect varies based on the perceived trustworthiness of the NPO. The results of two experimental studies show that branding and incentivizing decisions should not be developed independently because monetary incentives do indeed undermine the positive effects of brand personality on the intention to donate. However, the effectiveness of incentives varies with the perceived level of trust in the NPO: highly trusted NPO services are harmed by monetary incentives, whereas less-trusted NPOs may even benefit.

For the past decade, customer relationship management (CRM) has been one of the priorities in marketing research and practice. Hence, many companies have invested heavily in CRM systems that, unfortunately, did not meet their expectations. Because such shortcomings may have resulted from unrealistic expectations as well as inappropriate data input, this study provides insights into what companies may expect from CRM and what data they should use. Across the phases of the CRM process, the authors show which CRM objectives have been considered and which customer data have proven to be applicable in the empirical CRM literature. The results indicate that despite differences with respect to influence, a variety of customer data can be used to analyze CRM objectives throughout the entire customer life cycle. Overall, the study provides researchers with a comprehensive review of the empirical research on CRM and offers practitioners insights on the scope of CRM analyses and the applicability of customer data for CRM.

Book pricing is problematic for two main reasons. First, because legal restrictions make pricing decisions irreversible. Second, because publishers must set prices for many books every year. Therefore, a sound knowledge of consumer reaction to price is essential for good pricing decisions. Our research examines consumer reactions to prices, provides price elasticities based on a large sample of fiction books, and creates a comprehensive set of quality measures and control variables. Our results show that once price endogeneity is considered, consumers are price elastic. Moreover, we find that the price elasticity for hardcover books is substantially smaller than for paperbacks.

Deckungsbeitrag; Entscheidungsmodell; Internet; Konversionsrate; Kundenakquisition. Previous research has shown that targeting has helped companies to significantly increase the conversion rate for customer acquisition and, hence, conversion rates have been used to assess the performance of targeting campaigns. Unfortunately, it is not possible to infer the economic success of the targeting campaigns from this metric. In this study, the authors introduce an approach to assess targeting campaigns based on the profit margin. With this approach, companies are able to assess the profitability of targeting campaigns beforehand. On the basis of an empirical example, the paper describes in detail how profit margin-based targeting can be applied in practice and provides insights on when it is profitable for companies to target customers.

Customer retention is a major driver of customer lifetime value and is thus a key performance metric in marketing management. Consequently, companies try to retain customers by offering contracts with minimum contract durations (MCD). Using behavioral, psychometric, and advertising data for a large sample of DSL customers, the authors study the impact of minimum contract durations on actual customer churn behavior. The analyses demonstrate that subscriptions with minimum contract durations do indeed help companies to successfully retain customers. The effect is impaired though, as companies typically (must) provide incentives to convince customers to commit to those contracts. We find that incentives attract customers that either cannot or should not be retained and hence require companies to carefully apply both MCD and incentives.

Primary epithelial tumor of the renal pelvis is rare and only 100 cases are reported in the literature [1] . Histological examination of the tumor showed glands, cysts, and papillae lined by pseudostratified columnar epithelium with hyperchromatic nuclei. Scattered signet ring-type cells were also seen floating in large pools of extracellular mucin. Sections from the ureter showed a component of adenocarcinoma in situ. No invasive tumor was identified in ureteric tissue. One case was reported with carcinoma in situ of the ureter (2). Immunohistochemically: The tumor showed positivity for CK7, CK20, CK8/18, GATA-3, MSH-2, MSH-6, MLH-1, Ber-EP4, and S-100-P with focal positivity for CDX-2, weak positivity for PMS-2 and negativity in TTF-1 and Her-2. Molecular pathological analysis revealed microsatellite stability and without mutation in K-ras-gene. Thus, a diagnosis of mucinous adenocarcinoma of the renal pelvis with in situ adenocarcinoma of the ureter was made.

According to the Banff guidelines for renal transplants, pure endothelialitis without any tubulointerstitial infiltrates (with the Banff components v ≥ 1, i0, t0) has to be called acute cellular rejection (ACR). The pathophysiology of this rare lesion abbreviated as v_only is currently unclear, as well as its clinical, serological, and prognostic implications. Therefore, we conducted this retrospective comparative study. We compared all 23 biopsies with v_only from Hannover Medical School between 2003 and 2010 with 23 matched biopsies with the Banff components v ≥ 1, i ≥ 1, and t ≥ 1 (v_plus) and 23 biopsies with v0, i0, and t0 (v0i0t0). Serological (available in 10, 11, and 14 patients, respectively), histological, and clinical data were compared. Of all biopsies, 0.4 % had findings of v_only. v_only, v_plus, and v0i0t0 only showed minimal differences in the Banff components apart from the cohort-defining components. Endothelialitis in v_only more frequently involved the arcuate arteries than the smaller preglomerular vessels compared to v_plus and vice versa. Combining histopathological data and serological data, v_only more frequently showed criteria for acute humoral rejection than v0i0t0 (albeit not persistent after the Bonferroni-Holm correction in pairwise comparisons), while there was no difference between v_only and v_plus. No difference could be demonstrated regarding clinical presentation at biopsy or outcome. Our results show minimal differences regarding clinical presentation, outcome, and histological features between v_only and v_plus. Patients with v_only should be thoroughly investigated for evidence of acute humoral rejection.

Atypical haemolytic-uremic syndrome (aHUS) is, in most cases, due to hereditary or acquired defects in complement regulation and a life-threatening disease. Despite the rapidly grown knowledge about the primary defects in aHUS, the pathogenesis that links complement dysregulation with microthrombus formation in aHUS is still unknown. Thus, we examined the glomerular microvascular expression of pro- and antithrombotic genes. Glomeruli were microdissected from 12 archival paraffin-embedded biopsies with aHUS and from seven control biopsies. Glomerular mRNA expression was quantified by single real-time PCR reactions after preamplification. In addition immunostains were performed for plasminogen activator inhibitor 1 (PAI-1) and for tissue plasminogen activator (tPA). Results were compared between cases and controls and with clinical data. Glomeruli in aHUS had increased mRNA expression of antifibrinolytic, prothrombotic PAI-1, antithrombotic thrombomodulin (THBD) and CD73 and decreased expression of profibrinolytic, antithrombotic tPA compared to controls. Impaired fibrinolysis due to increased microvascular expression of the antifibrinolytic PAI-1 in combination with the decreased expression of the profibrinolytic tPA seems to be a final common pathway in renal thrombotic microangiopathy that is also effective in aHUS. The concomitant induction of antithrombotic transcripts likely indicates counterregulatory efforts, demonstrating that the capillary bed is not a passive victim of complement attack. Future research should investigate if and how complement activation could induce the reported shift in the expression of PAI-1 and tPA.

Online-Netzwerke (z. B. Xing oder LinkedIn) werden zunehmend aus geschaftlichen Motiven genutzt, mitunter zur gezielten „Vermarktung“ der eigenen Person. So versuchen Fuhrungskrafte und Entrepreneure mit gezielten Informationen in Online-Business-Netzwerken ein Markenimage aufzubauen und nutzen ihr Profil als Marketing-Instrument, um Geschaftskontakte zu managen. Auf der theoretischen Basis des Customer-based-brand-equity-Modells nach Keller (1993) wird das Nutzungsverhalten von Entrepreneuren in geschaftlichen Online-Netzwerken untersucht. Auf der Grundlage eines groszahligen reprasentativen Samples von Mitgliedern einer fuhrenden kommerziellen Online-Plattform untersuchen wir empirisch, inwiefern Entrepreneure erfolgreich in Online-Netzwerken agieren und ob sich ihre Strategien von denen anderer Nutzer unterscheiden. Mit Hilfe von Seemingly-Unrelated-Regression-Schatzungen werden die Treiber der Seitenaufrufe bzw. der bestatigten Kontakte von Entrepreneuren ermittelt. Entrepreneure konzentrieren sich auf die Prasentation ihrer Nutzungsintention und Kompetenzen und sind wesentlich aktiver in der Community. Als zentrale Erfolgstreiber werden Gruppenmoderationen und Event-Teilnahmen identifiziert.

Exact pathological staging of bladder cancer is crucial for determination of further treatment. One limiting factor is the surgical ‘incise and scatter’ technique that might contribute to tumour recurrence. En bloc resection techniques are en emerging issue. We present initial results with Thulium:YAG (Tm:YAG) en bloc resection of bladder tumours for treatment and accurate staging of solitary transitional cell carcinoma of the bladder. From June through October 2010, six patients were treated by TmLRBT (Thulium laser resection of bladder tumour). Inclusion criteria were solitary lesions, treatment naive patients and tumour localisation of the lower bladder wall and trigonum. En bloc resection was applied on all of the tumours. Two cold-cut biopsies from the tumour base were extracted. On five of the six patients, a re-resection was performed after 6 weeks. Pathological evaluation revealed 1 patient with pTa G1, 2 patients with pTa G2 and 3 patients with pT1 G3. All of the resected specimens provided detrusor muscle, and all biopsies were positive for muscle cells. No intra-, peri- or post-operative complications were observed. Bladder irrigation was mandatory in only 50% of the patients. All patients were negative for residual TCC in re-resection 6 weeks after initial treatment. TmLRBT has been proven safe and effective for both, treatment and pathological staging of primary TCC of the bladder. Tm:YAG en bloc resection therefore could be an appropriate tool for accurate staging with possibly lower scattering potential for the assessment and treatment of patients with TCC.

Shared WiFi-Communities entstehen dadurch, dass Nutzer ihren privaten WLAN-Anschluss fur andere Nutzer offnen und im Gegenzug bei anderen Mitgliedern der Community online gehen konnen. Das Angebot von WLAN-Kapazitat und die Nachfrage nach WLAN werden in der Regel durch eine zentrale Instanz koordiniert, sodass Nachfrager gezielt einen Anbieter in der Community finden konnen. Es haben sich schon erste Unternehmen im Markt etabliert, die Shared WiFi-Communities kommerziell betreiben. Internationaler Marktfuhrer ist FON mit etwa 170.000 Hotspots weltweit. Fur den okonomischen Erfolg von Shared WiFi-Communities (wie z. B. FON) ist die Adoption eines speziellen Routers oder die Modifikation der bestehenden WLAN-Infrastruktur notwendig. Zudem ist es erforderlich, dass die Nutzer ihre WLAN-Kapazitat moglichst breitbandig und vor allem dauerhaft der Community zur Verfugung stellen. Nur so konnen Netzeffekte zu einer dauerhaften Nutzensteigerung fuhren. Auf der Basis einer Befragung von 268 deutschen FON-Nutzern wird deutlich, dass die Community eine hohe Kohasion aufweist. So verandern die Nutzer kaum die Standardeinstellungen fur die freigegebene Bandbreite des Routers. Zudem stellt die Mehrzahl der Befragten ihr WLAN nahezu 24 Stunden am Tag zur Verfugung. Trotz der Moglichkeit, mit der Freigabe von WLAN-Kapazitaten Einnahmen zu erzielen, bieten die Mitglieder der Community den WLAN-Zugang nicht mit rein okonomischer Zielsetzung an. Obgleich das Marktpotenzial von Shared WiFi-Communities enorm erscheint, existieren rechtliche Hindernisse und technische Einschrankungen, die die Penetration erschweren.

Als Ursache eines Hirsutismus bei postmenopausalen Frauen mit sehr hohen Testosteronwerten kommen differentialdiagnostisch androgenproduzierende Tumoren (Ovarialtumoren, Nebennierentumoren) in Frage. Eine praoperative Lokalisation des Tumors kann sich als schwierig erweisen. Eine 61-jahrige Patientin klagte seit Einsetzen der Menopause vor 9 Jahren uber zunehmende Behaarung im Gesichts-, Brust- sowie Ober- und Unterschenkelbereich und uber eine tiefer werdende Stimme. Ursachlich wurden deutlich erhohte Testosteronwerte von knapp 30 nmol/l gemessen. Die initiale bildgebende Darstellung der Nebennieren sowie die gynakologische Untersuchung ergaben keinen Anhalt fur einen zugrundeliegenden Tumor. Zur weiteren Lokalisationsdiagnostik wurden bildgebende ([18F]FDG-PET/CT) und invasive Verfahren (Stufenkatheteruntersuchung) eingesetzt. Bei Verdacht auf einen androgenproduzierenden Adnextumor rechts erfolgte eine Adnexektomie. Histologisch konnte die Diagnose eines Leydig-Zell-Tumors des rechten Ovars gestellt werden. Postoperativ sank der Testosteronspiegel auf 2,28 nmol/l ab. Bei Hirsutismus und hohen Testosteronwerten stellt sich der Verdacht auf einen androgenproduzierenden Tumor des Ovars oder der Nebenniere. Zur Lokalisation des androgenproduzierenden Tumors konnen eine [18F]FDG-PET- und Stufenkatheteruntersuchung erganzende diagnostische Optionen darstellen.

Wilson disease is caused by accumulation of Cu(2+) in cells, which results in liver cirrhosis and, occasionally, anemia. Here, we show that Cu(2+) triggers hepatocyte apoptosis through activation of acid sphingomyelinase (Asm) and release of ceramide. Genetic deficiency or pharmacological inhibition of Asm prevented Cu(2+)-induced hepatocyte apoptosis and protected rats, genetically prone to develop Wilson disease, from acute hepatocyte death, liver failure and early death. Cu(2+) induced the secretion of activated Asm from leukocytes, leading to ceramide release in and phosphatidylserine exposure on erythrocytes, events also prevented by inhibition of Asm. Phosphatidylserine exposure resulted in immediate clearance of affected erythrocytes from the blood in mice. Accordingly, individuals with Wilson disease showed elevated plasma levels of Asm, and displayed a constitutive increase of ceramide- and phosphatidylserine-positive erythrocytes. Our data suggest a previously unidentified mechanism for liver cirrhosis and anemia in Wilson disease.

We report a 52-year-old patient with Miller Fisher syndrome and discuss Wernicke's encephalopathy as one important differential diagnosis. This article focuses on diagnostic criteria and possible nosological relations between Miller Fisher syndrome, Guillain-Barre syndrome with ophthalmoplegia, Bickerstaff's brainstem encephalitis, and acute ophthalmoparesis without ataxia.

Filesharing has recently proved to be one of the most controversial applications in the Internet. Millions of users enjoy downloads of billions of media files such as songs or movies. But where do these files come from? While the economic rationale to download files is obvious, the rationale of individuals to actually share and therefore internalize the costs (i.e. the risk of being sued for copyright infringement) is not obvious. Consequently empirical studies have shown a large proportion of users not offering any but demanding files and therefore freeride on their peers.

We present a combined measurement of $\Rb = \Gamma(\mathrm{Z \rightarrow b\overline{b}}) / \Gamma(\mathrm{Z} \rightarrow\mbox{hadro ns})$ and the semileptonic branching ratio of b quarks in Z decays, $\Brbl$, using double-tag methods. Two analyses are performed on one million hadronic Z decays collected in 1994 and 1995. The first analysis exploits the capabilities of the silicon microvertex detector. The tagging of b-events is based on the large impact parameter of tracks from weak b-decays with respect to the $\mathrm{e^+e^-}$ collision point. In the second analysis, a high-$p_t$ lepton tag is used to enhance the b-component in the sample and its momentum spectrum is used to constrain the model dependent uncertainties in the semileptonic b-decay. The analyses are combined in order to provide precise determinations of $\Rb$ and $\Brbl$: Rb = 0.2174 \pm 0.0015\mbox{(stat.)} \pm 0.0028\mbox{(sys.)}; $\Brbl = (10.16 \pm 0.13\mbox{(stat.)} \pm 0.30\mbox{(sys.)})\%.

Die Diffusion des Digitalen Fernsehens in Deutschland ist bislang hinter den hochgesteckten Erwartungen zuruckgeblieben. Diskussionen uber die entstehenden Machtstrukturen und deren Folgen behindern die Verbreitung des Mediums. Dieser Beitrag argumentiert, das es durchaus im Sinne des Wettbewerbs ist, dem Pionier ein zeitweiliges Monopol zu gewahren, da das Digitale Fernsehen nur einen Meilenstein auf dem Weg zum Interaktiven Fernsehen darstellt. Mit steigendem Interaktivitatsgrad werden sich die Serviceschwerpunkte verandern und damit neue Marktakteure hinzutreten. Daruber hinaus werden Moglichkeiten fur die Pioniere beschrieben, Vorteile aus ihrer Monopolstellung in den Wettbewerb zu retten.

Time-dependent \({{\rm B^{0}}\mbox{-}\bar{{\rm B}}^{0}}\) mixing is studied using about two million hadronic Z decays registered by L3 in 1994 and 1995. For this study three techniques are used. Tagging of the b-quark charge at decay time is performed by identifying leptons from semileptonic B decays. The flavour of the b quark at production time is determined from the charge of the lepton in the opposite hemisphere or by using a jet-charge technique. The proper time of the B-particle decay is obtained by reconstructing the production and decay vertices or by a measurement of the lepton impact parameter. The combined result for the frequency of \({{\rm B_d^0}}\) meson oscillations is \(\)

We examined 38 patients with an arthroscopic bioabsorbable tack repair for anterior shoulder instability in a prospective evaluation. The mean follow-up was 22 months (range 12 to 33). The average age was 28.4 years (range 15 to 57), the operation was performed at average of 50 months (3 to 244 months) after injury. Assessment using the Rowe score revealed excellent results in 33 and good results in 3 patients. 1 patient had a fair result and 1 had a poor result. 26 shoulders obtained full range of motion, 11 had minor (< 10 °) loss of external rotation, 1 experienced greater (< 20 °) loss of external rotation. 3 of the 38 patients (8 %) had recurrent instability, 1 patient with 2 preceding operations and atraumatic and voluntary dislocation, respectively. The recurrence rate of arthroscopic Bankart repair with bioabsorbable tacks are comparable to open Bankart procedures. Success of the procedure depends on appropriate surgical technique and suitable selection of patients with unidirectional, posttraumatic, anterior instability who are found to have well-developed ligamentous tissue.

In a series of 1850 consecutive knee arthroscopies between 1991 and 1995, plicasyndrome was diagnosed and resected by arthroscopy in 102 patients (5.5%). Clinical response was evaluated for 38 of 54 patients with an isolated plicasyndrome by use of a modified Lysholm questionnaire at an average follow-up of 31 months (range, 8-78 months). Excellent or good results were obtained in 90% of 21 patients without plica-induced lesions of the cartilage (group 1) and poor results in 10%. Only 64% of 17 patients with plica-induced lesions of the cartilage (group 2) had excellent or good results. Both groups showed an improvement for range of motion and swelling post-operatively. The mean time for rehabilitation was 3.2 and 1.7 months for patients with and without cartilage lesions, respectively.

Light and polarization microscopic appraisal of the pathways of fibers and blood vessels in the region of the rotator cuff shows branches of the suprascapular artery. These initially radiate into the insertion tendon parallel to the muscle fibers. They do not continue there, i.e. the vessel branches have blind endings, or they branch and anastomose with each other. Outliers of the transverse branch of the anterior circumflex artery of the humerus come from lateral (from the direction of the deltoid muscle). They pass from the bony insertion of the supraspinatus tendon into the tendon plate, but only run together with the fibers for a short distance. Consequently, a zone low in vessels or free of vessels can be constantly demonstrated under a magnifying glass in the course of the supraspinatus and to a small extent also of the infraspinatus in the fetus or neonate as well as in the adult in the region of the zone of interweaving of the tendinous muscle outlier with the capsule at length magnification. In the genesis of rotator cuff rupture, the presence of hypovascularity must be considered to be a predisposing factor which is present from birth onwards. It affects the clinical course during the process of aging as the point of least resistance in consequence of arteriosclerosis, collagen degeneration physiological wear and tear friction at the lower surface of the acromion and inflammatory swellings of the subacromial bursa.

Intraindividual length differences up to 1.2 cm in femora, up to 1.0 cm in tibiae and up to 1.4 cm in whole leg length can be regarded as physiological. Length differences in childhood are frequently compensated for by functional adaptation in the chain of adjacent limbs. In adults, however, that adaptability is diminished and correction osteotomy after post-traumatic shortening may therefore be indicated more generously dependent on local and general criteria of operability. A conscientious analysis of bone geometry by clinical means, radiology and computed tomography is mandatory for the indication and planning of any correction osteotomy. Intraindividual leg length differences of more than 4 cm are preferentially treated by continuous callus distraction techniques. Shortening by less than 4 cm, however, is suitable for a one-stage stepwise prolongation osteotomy in the metaphysis of the femur, i.e. in the subtrochanteric or supracondylar region. These osteotomies are than stabilized by long condylar plates; the bony defects are filled up by auto- or allogenous corticospongeous bone. Simple modifications of the stepwise prolongation osteotomy permit additional corrections of torsional deviations up to 20 degrees or of axial deviations in the frontal or sagittal plane up to 5 degrees. The results of 24 one-stage stepwise prolongation osteotomies of the subtrochanteric and supracondylar femur after congenital or post-traumatic shortening are presented as well as the reason and respective therapies for three important complications.

Using data obtained with the ALEPH detector at the Z resonance, a measure based on transverse momentum is shown to exhibit a correlation between the two halves of a hadronic event which cannot be explained by energy-momentum conservation, flavour conservation, the imposition of an event axis or imperfect event reconstruction. Two possible interpretations based on existing Monte Carlo models are examined: a) ARIADNE, with the correlation forming early in the parton shower and with the transition from partons to hadrons playing only a minor part; b) JETSET, with the correlation forming at the fragmentation stage. A correlation technique based on a jet cluster analysis is used to make a comparison of the models with the data. It is concluded that both non-perturbative and perturbative effects make important contributions to the observed correlation. RI ANTONELLI, ANTONELLA/C-6238-2011; Passalacqua, Luca/F-5127-2011; Murtas, Fabrizio/B-5729-2012; St.Denis, Richard/C-8997-2012; Sanchez, Federico/F-5809-2012; Forti, Francesco/H-3035-2011; Ferrante, Isidoro/F-1017-2012

Studies of QCD in $\mbox{e}^+\mbox{e}^- \rightarrow$ Hadrons at $E_{cm} = $} 130 and 136 GeV The ALEPH Collaboration An analysis of the properties of hadronic final states produced in electron-positron annihilation at centre-of-mass energies of 130 and 136 GeV is presented. The measurements are based on a data sample of 5.7 $\mbox{pb}^{-1}$ collected in November 1995 with the \Aleph detector at LEP. Inclusive charged particle distributions, jet rates and event-shape distributions are measured and the results are compared with the predictions of QCD-based models. From the measured distributions quantities are determined for which the dependence on the centre-of-mass energy can be predicted by QCD, including the mean multiplicity of charged particles, the peak position of the inclusive distribution of $\xi = -\ln x_p$ ($x_p = p / p_{beam}$), and the strong coupling constant $\alpha_s$. The QCD predictions are tested by comparing with corresponding measurements at $E_{cm} = 91.2$ GeV and at lower energies.

We examined 30 patients with an arthroscopic suture repair for anterior shoulder instability in a retrospective evaluation. The follow-up period ranged from 12 to 58 months with an average of 22 months. Arthroscopic suture repairs were done on 14 patients (acute group, average age 26.1 years) with acute detached glenoid labrum, confirmed on arthro-CT, within 10 days after the injury and on 16 patients (secondary group, average age 25 years) with chronic should dislocation. The evaluation according to the Rowe scale resulted in a mean score of 97.1 for the acute group compared with 92.7 for the secondary group. In each group we found one recurrent dislocation, which in the acute group was due to an adequate trauma. Two of the 14 acute group patients showed a reduction in external rotation of up to 20 degrees, compared with 6 patients in the secondary group. The external rotation of one patient in the secondary group was reduced to 40 degrees. The isokinetic muscle strength was decreased in both groups, both for 60 degrees/s and for 120 degrees/s, to 85% compared with the healthy side. The primary surgical therapy of young patients (below 25 years) with an acute shoulder dislocation and a detached glenoid labrum is recommended owing to the lower redislocation rate, an overall shortened course of treatment and a trend to better postsurgical range of motion.

The inclusive semileptonic branching ratios b→eνX,μ νX,τ νX andνX have been measured at LEP with the L3 detector. The analysis is based on 2-jet hadronic Z decays obtained in the data collected between 1991 and 1992. Three separate event samples are analysed, containing electrons, muons and large missing energy (neutrinos), respectively. From the electron sample, we measure Br(b→eνX)=(10.89±0.20±0.51)% and, from the muon sample, Br(b→μ νX)=(10.82±0.15±0.59)%, where the first error is statistical and the second is systematic. From the missing energy sample, we measure Br(b→νX)=(23.08±0.77±1.24)%, assuming the relative semileptonic decay rates e:μ:τ=1:1:(0.25±0.05), according to theoretical expectations. From a combined analysis of all three samples and constraining the relative semileptonic rates, we measure Br(b→eνX)=Br(b→μ νX)=(10.68±0.11±0.46)%. Alternatively, we can remove the constraint on the relative semileptonic rates and measure Br(b→τ νX)=(1.7±0.5±1.1)%.

D + mesons produced inZ 0→bb events were separated from theZ 0→cc component using a lifetime tag. Using a sample of 1.5 million hadronicZ decays collected with theAleph detector theB 0 andD s + yields have been measured: $$\begin{gathered} \hfill B(b \to \bar B_s^0 )B(\bar B_s^0 \to D_s^ + ) = 0.088 \pm 0.020(stat.) \\ \hfill \pm 0.020(stat.) \\ \hfill B(c \to D_s^ + ) = 0.088 \pm 0.020(stat.)_{ - 0.016}^{ + 0.019} (syst.) \\ \end{gathered} $$ TheB 0 lifetime was measured in aB 0 enriched sample reconstructing the decay length from the vertex of theD + with a hadron from theB 0 decay. The result obtained is: $$\tau _{B_s } = 1.61_{ - 0.29}^{ + 0.30} (stat.)_{ - 0.016}^{ + 0.018} (syst.)$$ ps.

Dear Sirs, Protein kinase C (PRKC) is a family of at least twelve serine–threonine kinases and a key signaling pathway in diabetic vascular complications [1]. Our group recently demonstrated that deletion of distinct PRKC isoforms in vivo prevents from diabetes-induced kidney damage, probably depending on the individual cell type or tissue, which subsequently interferes with experimental diabetic nephropathy through independent molecular mechanisms [1]. Data on renal PRKC transcript expression profiles in the early development of human diabetic kidney damage are, however, still missing. Therefore, the aim of this pilot study was to determine the transcript expression levels of renal PRKC isoforms a, b1, c, d, e, g, h, i by real-time quantitative PCR (qPCR) in three consecutive archival control kidney biopsies of diabetic transplant recipients and to compare to case-matched, non-diabetic controls. We retrospectively analyzed data from diabetic patients (n = 11) and case-matched, non-diabetic controls (n = 11) enrolled in the protocol biopsy program of the transplant center of the Hannover Medical School which is part of the routine medical care following kidney transplantation [2]. From these two study groups, RNA-later-embedded frozen biopsy samples collected 6 weeks (K1), 3 months (K2), and 6 months (K3) after kidney transplantation were subjected to PRKC-isoform-specific qPCR. The program had been approved by the local ethical committee and is conducted in accordance with the Declaration of Helsinki. The key findings of this pilot study were that although (1) the main PRKC isoforms (a, b1, e, f) are expressed early in human kidney transplants, (2) PRKC-isoform mRNA expression does not dynamically increase over time in a diabetic milieu in the first 6 months after kidney transplantation (Fig. 1). In contrast, we observed that (3) mRNA expression of the PRKC-f isoform was significantly decreased at time point 3 (K 3; 6 months after kidney transplantation) in the diabetic group compared to non-diabetic controls. Interestingly, previous observations many years ago showed that, in addition to PRKC activation through increased serine/threonine phosphorylation under hyperglycemic condition, high glucose also induces protein expression of PRKC-isoforms a, b, and e in mesangial cells after 48 h, but not after 12 h [3]. Toyoda et al. [4] suggested for the first time that elevated expression of PRKC–MAPK pathway mRNAs correlates with glomerular lesions in patients with overt diabetic nephropathy. Recently, Langham et al. [5] postulated that increased PRKC-b transcription measured by qPCR occurs in advanced human diabetic nephropathy by analyzing human kidney biopsies with longterm DM. In contrast to the latter study, our results did not show any significant up-regulation of any PRKC-isoform transcript expression using archival biopsy tissue within the first 6 months following human kidney transplantation in diabetic compared to non-diabetic recipients. We did not find a significant correlation between PRKC-isoform mRNA expression levels and HbA1c at the three distinct time points of biopsy. We also did not observe any relationship between PRKC-isoform mRNA expression and other laboratory or Communicated by Renato Lauro.

Objectives: The aim of this study was to evaluate the phenomenon of electrical skin resistance (ESR) changes at different acupuncture points (APs). Setting: This single-blinded study was performed at the hospital of the University of Munich. Design: Six common APs were measured (TE5, PC6, LU6, ST36, SP6, GB39) in 53 subjects. Subgroups were formed with varying time intervals for follow-ups (1 minute, 1 hour, 1 week) and a varying grade of reduction of the stratum corneum. Methods: Electrical skin resistance measurements (ESRMs) were taken from a skin area of 6 × 6 cm using an array consisting of 64 (8 × 8) electrodes. The electrodes corresponding to the AP were located and the ESRM results were compared to those of the surrounding electrodes. The methodological setting made it possible to minimize major influence factors on electrical skin impedance measurements. Results: A total of 631 ESRMs was evaluated: In 62.8% of the measured APs, no significant ESR difference was found. In 234 (37.2%) of t...

A new method is presented for the measurement of the mean $\tau$ lepton lifetime using events in which $\tau$'s are pair-produced and both $\tau$'s decay to hadrons and $\nu_\tau$. Based on the correlation between the two $\tau$'s produced at a symmetric $e^+ e^-$ collider, the 3DIP method relies on the three-dimensional information from a double-sided vertex detector and on kinematic constraints for the precise measurement of the $\tau$ decay angles. Using the data collected from 1992 to 1994 with the ALEPH detector at LEP, a $\tau$ lifetime of $288.0 \pm 3.1 \pm 1.3 $\fs is obtained from the sample in which both $\tau$'s decay to one charged track, and $292.8 \pm 5.6 \pm 3.0 $\fs from the sample in which one $\tau$ decays to one prong and the other to three prongs. The results show small statistical correlations with those derived from other methods. When combined with the previously published ALEPH measurements, the resulting $\tau$ lifetime is $291.2 \pm 2.0 \pm 1.2 $\fs .

A study of the dependence of the charged hadronic multiplicity 〈nch〉 in μ-pair events on the dynamic parameters of the dimuon (dimuon massm and transverse momentumpT, and total hadronic energyMh) is presented for proton-proton collisions at √s=63 and 44 GeV. The full data collected in the R209 experiment at the ISR is used. With respect to already published data at √s=63 GeV, the present work has about a factor of four more statistics and includes data at two energies. In addition, we have corrected the data for background and we present absolute multiplicities. J/ψ events (m 4.5 GeV/c2) are studied separately, since the production dynamics is expected to be different in the two cases. 〈nch〉 is found to decrease slowly with increasingm and to be rather insensitive toMh. On the other hand, 〈nch〉 grows withpT in a different way in J/ψ and Drell-Yan events. The effect might be indicative of a low-multiplicity jet recoiling against the dimuon in J/ψ events. A model analysis of thepT distribution of the pair in the transverse event plane is reported, showing that a possible contamination of μ-pairs from c\(\bar c\) semileptonic decays should be small at all masses.

There are a great variety of optical nonlinearities that can lead to the phenomenon of laser-induced gratings (LIG) in semiconductors. In the present contribution the dynamic behaviour of an induced absorber with intrinsic bistability is investigated under excitation in a LIG self-diffraction arrangement. Using CdS as a model substance, the comparison of our theoretical model with our experimental findings gives an insight into the nonlinear dynamics of the degenerate carrier system and also an estimation of the transport properties of the electron-hole plasma.

Using the level crossing technique the ratios and absolute values of the hyperfine structure (hfs) constants of the levelsz4F9/2 andz4F7/2 of the configuration 3d74s4p of Co I were measured:z4F9/2: ¦A¦=(811±12)MHz; ¦B¦=(48±93) MHz;B/A=−0.06±0.11 A>0; B 0; B

For several years, a 4-12-fold increase of the upper normal limit in erythrocyte protoporphyrin concentrations persisted in two men 34 and 39 years of age who were chronically exposed to lead. We are dealing with a zinc protoporphyrinemia in both cases, without lead intoxication or anemia. The 34-year-old had been a regular blood donor for 10 years and had already been treated for iron deficiency several times. Hemoglobin, red cell counts, hematocrit, and iron were at the lower normal limit. The activity of porphobilinogen synthase (PBG-S), uroporphyrinogen-synthase and -decarboxylase as well as urinary porphyrin precursors and porphyrin excretion were normal. Protoporphyrinemia was said to be due to a prelatent/latent iron deficiency. In the 39-year-old, the activity of PBG-S was lowered to 388 mumol/1 . h, as compared to the mean of controls (1,190 +/- 210, x +/- SD, n = 50), in connection with a slightly elevated excretion of delta-aminolevulinic acid and coproporphyrin in the urine and a high-normal blood lead level. In his family there was no history of either a protoporphyrinemia or a hematological disturbance. Six of eight family members in three generations showed a diminished activity of PBG-S: 600 +/- 160, P less than 0.001 compared to controls. These family members are heterozygous with regard to the PBG-S deficiency; they are clinically unobtrusive in comparison to homozygotes with an acute prophyria syndrome. Activation by zinc and reactivation by dithiothreitol were normal in contrast to PBG-S from patients with lead intoxication. The cause of biochemical symptoms of subclinical lead intoxication developed by the propositus is probably due to the hereditary PBG-S deficiency which sensitizes him to low-level lead exposure. The determination of red cell PBG-S activity can be recommended as a test detecting heterozygotes. The hereditary PBG-S deficiency is recognized as a new molecular basis for the pathogenesis of lead intoxication.

Using a laser-induced grating arrangement we measure the probe beam diffraction intensity under stationary excitation conditions as function of the grating constant. We developed a mathematical model and extract by comparison with experimental data the diffusion lengths of the quasiparticles existing at various temperatures and excitation levels in the CdS sample from the experimental findings.

A 79-year-old patient, who had received a pacemaker after suffering two posterior myocardial infarctions, was treated with 2 × 100 mg flecainide daily for 9 days for ventricular extrasystoles (Lown IV b). On admission to the hospital the parameters of renal function were within the normal range. Ten days after flecainide treatment was begun a temporary electromechanic decoupling of the pacemaker occurred with reversible asystoly and progressive kidney failure. The flecainide plasma level at that time was 1460 ng/ml. Hemoperfusion for 3 h with activated charcoal removed only 35 mg flecainide in spite of an excellent flecainide clearance (164–180 ml/min). The patient's flecainide plasma level did not decrease sufficiently during the procedure, showing clearly that flecainide levels cannot be lowered fast enough by hemoperfusion to treat a flecainide intoxication.