Mit zweierlei Maß: Die mangelnde Verbindlichkeit von Patientenverfügungen bei untergebrachten Personen mit psychischen Störungen in der Schweiz

Definition of the problem

Full age patients with mental disorders and preserved decision-making capacity are increasingly interested in drafting advance directives. Whereas in Switzerland (as well as in Germany) advance directives are binding in principle, an advance directive is not binding and has only to be considered in case of involuntary admission due to a mental disorder. Thereby, the virtual aim of an advance directive – the anticipated self-determination – is questioned.

Arguments

From an ethical perspective, patients with mental disorders have the same rights as patients with somatic diseases. Therefore, the question arises if there are good reasons for this unequal treatment. In the present contribution, four possible reasons are analyzed: (1) persons with mental disorders are “different”; (2) protection from self-harm; (3) often not present end-of-life context; (4) reduced bindingness as the more appropriate standard in general.

Conclusion

The authors come to the conclusion that patients with mental disorders are often capable of composing a valid advance directive, and just as any other human being, they have a principal and binding right for self-determination, even though they are particularly vulnerable in crisis situations.

     

Identification and optimization of key process parameters in noncontact laser scanning for reverse engineering

This Extended Technical Note shows that the final accuracy level of reverse engineered surfaces depends on scanning distance and scanning angle of the laser beam, hence it also depends on the morphology of the scanned objects. On scanning strongly curved objects, such as the ones with free form surfaces, the distance and impact angle of the laser beam are changing continuously during the scanning process. On the basis of these, two critical parameters are specified for the design model, which make it possible to predict these two factors in advance, depending on the morphology of the scanned object. First, a mathematical-statistical design model of the scanning process is generated, which relies on ANOVA (analysis of variance) and DOE (design of experiments). In the next step, a fitness function is optimized by the genetic algorithm (GA) program. This optimization improves the accuracy of the final scanned surfaces, in terms of the minimum standard deviation values of reverse engineered 3D surface model. The proposed approach was confirmed in a case study, which is presented at the end of this Technical Note.     

Addition of Synthetic Biomaterials to Deproteinized Bovine Bone Mineral (DBBM) for Bone Augmentation—A Preclinical In Vivo Study

(1) Aim: To investigate the effect of synthetic bone substitutes, α-tricalcium phosphate (α-TCP) or bi-layered biphasic calcium-phosphate (BBCP) combined with deproteinized bovine bone mineral (DBBM), on bone formation. (2) Methods: Thirty critical size defects were randomly treated with the following five different treatment modalities: (1) negative control (NC, empty), (2) DBBM, (3) α-TCP + DBBM (1:1), (4) BBCP 3%HA/97%α-TCP + DBBM (1:1), and (5) BBCP 6%HA/94%α-TCP + DBBM (1:1). The samples, at four weeks post-surgery, were investigated by micro-CT and histological analysis. (3) Results: A similar level of new bone formation was demonstrated in the DBBM with α-TCP bone substitute groups when compared to the negative control by histomorphometry. DBBM alone showed significantly lower new bone area than the negative control (p = 0.0252). In contrast to DBBM, the micro-CT analysis revealed resorption of the α-TCP + DBBM, BBCP 3%HA/97%α-TCP + DBBM and BBCP 6%HA/94%α-TCP + DBBM, as evidenced by a decrease of material density (p = 0.0083, p = 0.0050 and p = 0.0191, respectively), without changing their volume. (4) Conclusions: New bone formation was evident in all defects augmented with biomaterials, proving the osteoconductive properties of the tested material combinations. There was little impact of the HA coating degree on α-TCP in bone augmentation potential and material resorption for four weeks when mixed with DBBM.     

基于众包的嵌套流形匹配室内定位方法

随着普适应用的兴起,室内定位变得越来越重要。传统的基于指纹的定位方法需要现场勘测,所需时间及工作量巨大,且需实时更新,以适应室内变化,这大大限制了其应用范围。采用众包形式进行室内信息采集,并记录其在室内的大量路径信息,利用嵌套在路径中的低维流形一致性进行地理位置匹配,以建立位置指纹库。通过高斯粒子滤波器对传感器数据进行去噪,进而解决步长差异问题。定位时,根据用户位置的连续性和路径信息筛选出合理的近邻点,继而实现精确定位。在84m²的会议室进行实验,在不需要现场勘测的情况下,所提方法可达到与传统方法可比的定位精度。该方法可以实时适应环境变化,在2周甚至1个月之后,其定位准确性优于传统定位方法。     

混合的SAR图像变化检测算法

为尽可能多地消除遥感图像变化检测过程中“伪变化”信息的影响,获得比较客观的感兴趣区域变化检测结果,针对遥感图像中SAR图像的特点,提出一种混合的SAR图像变化检测算法。对已配准好的图像进行Frost滤波,用邻域比值的方法构造差异图,对得到的差异图进行非下采样轮廓波变换（NSCT）,对变换得到的高频子带和低频子带分别处理,用模糊C均值（FCM）聚类算法得到变化检测的结果。实验结果表明,该算法模型很好地保留了图像变化区域的细节,提高了变化检测准确性。     

结合位图切割和区域合并的彩色图像分割

就经典分水岭图像分割算法中存在的过分割问题，提出一种结合位图切割和区域合并的彩色图像分割算法。对原始彩色图像通过空域梯度算子求其梯度图像，并利用位图切割重建梯度图像；对新梯度图像进行分水岭预分割；对预分割图像基于异质性最小原则进行区域合并，并获得最终分割结果。相比于现有的同类方法，该算法引入位图切割，抑制噪声对分割结果的影响，在边缘模糊处分割准确，得到符合人类视觉的较小分割区域数目，同时在运行效率上提高。     

Application of whey protein isolate in bone regeneration: Effects on growth and osteogenic differentiation of bone-forming cells

Recently, milk-derived proteins have attracted attention for applications in the biomedical field such as tissue regeneration. Whey protein isolate (WPI), especially its main component β-lactoglobulin, can modulate immunity and acts as an antioxidant, antitumor, antiviral, and antibacterial agent. There are very few reports of the application of WPI in tissue engineering, especially in bone tissue engineering. In this study, we tested the influence of different concentrations of WPI on behavior of human osteoblast-like Saos-2 cells, human adipose tissue-derived stem cells (ASC), and human neonatal dermal fibroblasts (FIB). The positive effect on growth was apparent for Saos-2 cells and FIB but not for ASC. However, the expression of markers characteristic for early osteogenic cell differentiation [type-I collagen (COL1) and alkaline phosphatase (ALP)] as well as ALP activity, increased dose-dependently in ASC. Importantly, Saos-2 cells were able to deposit calcium in the presence of WPI, even in a proliferation medium without other supplements that support osteogenic cell differentiation. The results indicate that, depending on the cell type, WPI can act as an enhancer of cell proliferation and osteogenic differentiation. Therefore, enrichment of biomaterials for bone regeneration with WPI seems a promising approach, especially due to the low cost of WPI.     

Structure–Function Relationships in the Human P-Glycoprotein (ABCB1): Insights from Molecular Dynamics Simulations

P-Glycoprotein (P-gp) is a transmembrane protein belonging to the ATP binding cassette superfamily of transporters, and it is a xenobiotic efflux pump that limits intracellular drug accumulation by pumping compounds out of cells. P-gp contributes to a reduction in toxicity, and has broad substrate specificity. It is involved in the failure of many cancer and antiviral chemotherapies due to the phenomenon of multidrug resistance (MDR), in which the membrane transporter removes chemotherapeutic drugs from target cells. Understanding the details of the ligand–P-gp interaction is therefore critical for the development of drugs that can overcome the MDR phenomenon, for the early identification of P-gp substrates that will help us to obtain a more effective prediction of toxicity, and for the subsequent outdesign of substrate properties if needed. In this work, a series of molecular dynamics (MD) simulations of human P-gp (hP-gp) in an explicit membrane-and-water environment were performed to investigate the effects of binding different compounds on the conformational dynamics of P-gp. The results revealed significant differences in the behaviour of P-gp in the presence of active and non-active compounds within the binding pocket, as different patterns of movement were identified that could be correlated with conformational changes leading to the activation of the translocation mechanism. The predicted ligand–P-gp interactions are in good agreement with the available experimental data, as well as the estimation of the binding-free energies of the studied complexes, demonstrating the validity of the results derived from the MD simulations.