Search

Abstract Background Chronic radiation-associated dysphagia (C-RAD) is considered to be one of the most severe functional impairments in head and neck cancer survivors treated with radiation (RT) or chemoradiation (CRT). Given the major impact of these late toxicities on patients’ health and quality of life, there is a strong need for evidence-based dysphagia management. Although studies report the benefit of strengthening exercises, transference of changes in muscle strength to changes in swallowing function often remains limited. Therefore, combining isolated strengthening exercises with functional training in patients with C-RAD may lead to greater functional gains. Methods This 3-arm multicenter randomized trial aims to compare the efficacy and possible detraining effects of mere strengthening exercises (group 1) with a combination of strengthening exercises and functional swallowing therapy (group 2) and non-invasive brain stimulation added to that combination (group 3) in 105 patients with C-RAD. Patients will be evaluated before and during therapy and 4 weeks after the last therapy session by means of swallowing-related and strength measures and quality of life questionnaires. Discussion Overall, this innovative RCT is expected to provide new insights into the rehabilitation of C-RAD to optimize post-treatment swallowing function. Trial registration International Standard Randomized Controlled Trials Number (ISRCTN) registry ID ISRCTN57028065. Registration was accepted on 15 July 2021.

Abstract Background Different gene expression patterns correlate with the altered phenotype in biofilm-associated bacteria. Iron and iron-linked genes are thought to play a key-role in biofilm formation. The expression of Fe-linked genes (sirR, sitABC operon) in Staphylococcus epidermidis, was compared in planktonic versus sessile bacteria in vitro and in vivo in a subcutaneous foreign body rat model. Results In vitro in a Fe-limited environment, the planktonic form of S. epidermidis produces siderophores and grows slower than in Fe-rich environment. The expression of sirR in planktonic bacteria, in vitro, was not different in medium without Fe or with 1 μM FeCl3. High Fe concentrations (25 μM FeCl3) increased expression of sirR transiently during the early phase of incubation. Expression of sitC in vitro, in planktonic bacteria, was inversely correlated with sirR expression in medium with 25 μM FeCl3: sitC expression decreased for the first 3 hours followed by an up regulation. In sessile bacteria in vitro, sirR expression was high and independent of the Fe concentration. The expression of sitC was not inversely correlated to sirR expression. In vivo, expression levels of sirR and of sitABC were high during the initial phase after implantation and, after a transient decrease, remained stable over a period of two weeks. Conclusion Our data suggest that the expression of sirR and the regulatory effect of sirR on the sitABC operon are different in planktonic and sessile bacteria.

Abstract Background The number of patients with yeast infection has increased during the last years. Also the variety of species of clinical importance has increased. Correct species identification is often important for efficient therapy, but is currently mostly based on phenotypic features and is sometimes time-consuming and depends largely on the expertise of technicians. Therefore, we evaluated the feasibility of PCR-based amplification of the internally transcribed spacer region 2 (ITS2), followed by fragment size analysis on the ABI Prism 310 for the identification of clinically important yeasts. Results A rapid DNA-extraction method, based on simple boiling-freezing was introduced. Of the 26 species tested, 22 could be identified unambiguously by scoring the length of the ITS2-region. No distinction could be made between the species Trichosporon asteroides and T. inkin or between T. mucoides and T. ovoides. The two varieties of Cryptococcus neoformans (var. neoformans and var. gattii) could be differentiated from each other due to a one bp length difference of the ITS2 fragment. The three Cryptococcus laurentii isolates were split into two groups according to their ITS2-fragment lengths, in correspondence with the phylogenetic groups described previously. Since the obtained fragment lengths compare well to those described previously and could be exchanged between two laboratories, an internationally usable library of ITS2 fragment lengths can be constructed. Conclusions The existing ITS2 size based library enables identification of most of the clinically important yeast species within 6 hours starting from a single colony and can be easily updated when new species are described. Data can be exchanged between laboratories.

Various approaches exist to quantify risks in supply chains. However, two aspects in risk assessments are not usually considered: monetarized risk quantification and use-case dependent model complexity. Monetarily quantifying risks means quantifying root-cause and severity of each single risk and aggregating these risks into an aggregated risk value. Thereby information uncertainty, complex interrelations and dynamic influences need to be considered. Depending on a use-case's goal information or process models need to be created at different levels of detail. This paper presents a Discrete Event Simulation (DES) approach providing all necessary features to monetarily quantify risks independent of the depth of information and thus allow adjusting the model dependent on the use-case. It provides graphical modeling language equipped with risk assessment probes enabling to capture all risk-relevant aspects. Based on this instrumented model, the framework is then able to compute and report about monetary risk quantification using an efficient DES engine driven by a Monte-Carlo procedure. Within this paper applicability of such an approach shall be assessed in use-case specific processes characterized by determined risks and parameter settings. [ABSTRACT FROM AUTHOR]

Model-driven engineering (MDE) promises to automate the cloud application management phases, including deployment and adaptive provisioning. However, most MDE approaches neglect the security aspect even if it is considered the number one factor for not migrating to the cloud. As such, this paper proposes a security meta-model that a cloud-based MDE approach can exploit to become security-aware. This meta-model captures both high- and low-level security requirements and capabilities to drive application deployment as well security-oriented scalability rules to guide application re-configuration. It is also coupled with OCL constraints enforcing the security domain semantics. A method for creating re-usable security elements facilitating rapid security model specification conforming to the meta-model is also proposed, to reduce the designer's modelling effort. [ABSTRACT FROM AUTHOR]

Multi-cloud adaptive application provisioning promises to solve the vendor lock-in problem and lead to optimizing the user re- quirements through the selection of the best from the great variety of services offered by cloud providers. As such, various research prototypes and platforms attempt to support this provisioning type. One major concern in using such platforms comes with respect to security in terms of improper access to user personal data and VMs as well as to platform services. To successfully address this concern, this paper proposes a novel model-driven approach and architecture able to secure multi-cloud platforms as well as enable users to have their own private space. Such a solution exploits state-of-the-art security standards and secure model manage- ment technology. This solution is able to cover different security scenarios involving external, web-based and programmatic user authentication. [ABSTRACT FROM AUTHOR]