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Ratliff M, Karimian-Jazi K, Hoffmann DC, Rauschenbach L, Simon M, Hai L, Mandelbaum H, Schubert MC, Kessler T, Uhlig S, Dominguez Azorin D, Jung E, Osswald M, Solecki G, Maros ME, Venkataramani V, Glas M, Etminan N, Scheffler B, Wick W, Winkler F. Individual glioblastoma cells harbor both proliferative and invasive capabilities during tumor progression. Neuro Oncol 2023; 25:2150-2162. [PMID: 37335907 PMCID: PMC10708941 DOI: 10.1093/neuonc/noad109] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Glioblastomas are characterized by aggressive and infiltrative growth, and by striking heterogeneity. The aim of this study was to investigate whether tumor cell proliferation and invasion are interrelated, or rather distinct features of different cell populations. METHODS Tumor cell invasion and proliferation were longitudinally determined in real-time using 3D in vivo 2-photon laser scanning microscopy over weeks. Glioblastoma cells expressed fluorescent markers that permitted the identification of their mitotic history or their cycling versus non-cycling cell state. RESULTS Live reporter systems were established that allowed us to dynamically determine the invasive behavior, and previous or actual proliferation of distinct glioblastoma cells, in different tumor regions and disease stages over time. Particularly invasive tumor cells that migrated far away from the main tumor mass, when followed over weeks, had a history of marked proliferation and maintained their proliferative capacity during brain colonization. Infiltrating cells showed fewer connections to the multicellular tumor cell network, a typical feature of gliomas. Once tumor cells colonized a new brain region, their phenotype progressively transitioned into tumor microtube-rich, interconnected, slower-cycling glioblastoma cells. Analysis of resected human glioblastomas confirmed a higher proliferative potential of tumor cells from the invasion zone. CONCLUSIONS The detection of glioblastoma cells that harbor both particularly high proliferative and invasive capabilities during brain tumor progression provides valuable insights into the interrelatedness of proliferation and migration-2 central traits of malignancy in glioma. This contributes to our understanding of how the brain is efficiently colonized in this disease.
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Affiliation(s)
- Miriam Ratliff
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kianush Karimian-Jazi
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk C Hoffmann
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Laurèl Rauschenbach
- DKFZ-Division Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
- Institute of Reconstructive Neurobiology, University of Bonn Medical Faculty and University Hospital Bonn, Bonn, Germany
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Matthias Simon
- Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany
- Department of Neurosurgery, Bethel Clinic, University of Bielefeld Medical Center, OWL, Bielefeld, Germany
| | - Ling Hai
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Henriette Mandelbaum
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc C Schubert
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Tobias Kessler
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Uhlig
- FlowCore Mannheim and Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Dominguez Azorin
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Erik Jung
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Osswald
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Gergely Solecki
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Máté E Maros
- Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health (CPD-BW), University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Varun Venkataramani
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Martin Glas
- DKFZ-Division Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Björn Scheffler
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- DKFZ-Division Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
- Institute of Reconstructive Neurobiology, University of Bonn Medical Faculty and University Hospital Bonn, Bonn, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Frank Winkler
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic and Neurooncology Program and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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2
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Karreman MA, Bauer AT, Solecki G, Berghoff AS, Mayer CD, Frey K, Hebach N, Feinauer MJ, Schieber NL, Tehranian C, Mercier L, Singhal M, Venkataramani V, Schubert MC, Hinze D, Hölzel M, Helfrich I, Schadendorf D, Schneider SW, Westphal D, Augustin HG, Goetz JG, Schwab Y, Wick W, Winkler F. Active Remodeling of Capillary Endothelium via Cancer Cell-Derived MMP9 Promotes Metastatic Brain Colonization. Cancer Res 2023; 83:1299-1314. [PMID: 36652557 PMCID: PMC7614438 DOI: 10.1158/0008-5472.can-22-3964] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
Crossing the blood-brain barrier is a crucial, rate-limiting step of brain metastasis. Understanding of the mechanisms of cancer cell extravasation from brain microcapillaries is limited as the underlying cellular and molecular processes cannot be adequately investigated using in vitro models and endpoint in vivo experiments. Using ultrastructural and functional imaging, we demonstrate that dynamic changes of activated brain microcapillaries promote the mandatory first steps of brain colonization. Successful extravasation of arrested cancer cells occurred when adjacent capillary endothelial cells (EC) entered into a distinct remodeling process. After extravasation, capillary loops were formed, which was characteristic of aggressive metastatic growth. Upon cancer cell arrest in brain microcapillaries, matrix-metalloprotease 9 (MMP9) was expressed. Inhibition of MMP2/9 and genetic perturbation of MMP9 in cancer cells, but not the host, reduced EC projections, extravasation, and brain metastasis outgrowth. These findings establish an active role of ECs in the process of cancer cell extravasation, facilitated by cross-talk between the two cell types. This extends our understanding of how host cells can contribute to brain metastasis formation and how to prevent it. SIGNIFICANCE Tracking single extravasating cancer cells using multimodal correlative microscopy uncovers a brain seeding mechanism involving endothelial remodeling driven by cancer cell-derived MMP9, which might enable the development of approaches to prevent brain metastasis. See related commentary by McCarty, p. 1167.
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Affiliation(s)
- Matthia A. Karreman
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Cell Biology and Biophysics Unit, European Molecular Biology
Laboratory, Heidelberg, Germany
| | - Alexander T. Bauer
- Department of Dermatology and Venereology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
| | - Gergely Solecki
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Business Unit Service and Customer Care, Carl Zeiss Microscopy GmbH,
Jena, Germany
| | - Anna S. Berghoff
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine I, Division of Oncology, Medical University
of Vienna, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Chanté D. Mayer
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katharina Frey
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils Hebach
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manuel J. Feinauer
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicole L. Schieber
- Cell Biology and Biophysics Unit, European Molecular Biology
Laboratory, Heidelberg, Germany
- Centre for Microscopy and Microanalyses, The University of
Queensland, Brisbane, Australia
| | - Cedric Tehranian
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Luc Mercier
- National Institute of Health and Medical Research (INSERM)
UMR_S1109, Tumor Biomechanics, Université de Strasbourg,
Fédération de Médecine Translationnelle de Strasbourg (FMTS),
Strasbourg, France
| | - Mahak Singhal
- European Center for Angioscience (ECAS), Medical Faculty Mannheim,
Heidelberg University, Germany
- Division of Vascular Oncology and Metastasis, German Cancer
Research Center Heidelberg (DKFZ-ZMBH Alliance), Germany
| | - Varun Venkataramani
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Functional Neuroanatomy, Institute for Anatomy and
Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
| | - Marc C. Schubert
- Department of Functional Neuroanatomy, Institute for Anatomy and
Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
| | - Daniel Hinze
- LAMPseq Diagnostics GmbH, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn,
University of Bonn, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn,
University of Bonn, Bonn, Germany
| | - Iris Helfrich
- Skin Cancer Unit of the Dermatology Department, Medical Faculty,
West German Cancer Center, University Duisburg-Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Dermatology and Allergology, Medical Faculty of the
Ludwig Maximilian University of Munich, Munich, Germany
| | - Dirk Schadendorf
- Skin Cancer Unit of the Dermatology Department, Medical Faculty,
West German Cancer Center, University Duisburg-Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefan W. Schneider
- Department of Dermatology and Venereology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
| | - Dana Westphal
- Department of Dermatology, Medical Faculty and University Hospital
Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hellmut G. Augustin
- European Center for Angioscience (ECAS), Medical Faculty Mannheim,
Heidelberg University, Germany
- Division of Vascular Oncology and Metastasis, German Cancer
Research Center Heidelberg (DKFZ-ZMBH Alliance), Germany
| | - Jacky G. Goetz
- National Institute of Health and Medical Research (INSERM)
UMR_S1109, Tumor Biomechanics, Université de Strasbourg,
Fédération de Médecine Translationnelle de Strasbourg (FMTS),
Strasbourg, France
| | - Yannick Schwab
- Cell Biology and Biophysics Unit, European Molecular Biology
Laboratory, Heidelberg, Germany
- Electron Microscopy Core Facility, European Molecular Biology
Laboratory, Heidelberg, Germany
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Winkler
- Neurology Clinic and National Center for Tumor Diseases, University
Hospital Heidelberg, INF 400, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium
(DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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3
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Abstract
Diffuse gliomas are primary brain tumors associated with a poor prognosis. Cellular and molecular mechanisms driving the invasive growth patterns and therapeutic resistance are incompletely understood. The emerging field of cancer neuroscience offers a novel approach to study these brain tumors in the context of their intricate interactions with the nervous system employing and combining methodological toolsets from neuroscience and oncology. Increasing evidence has shown how neurodevelopmental and neuronal-like mechanisms are hijacked leading to the discovery of multicellular brain tumor networks. Here, we review how gap junction-coupled tumor-tumor-astrocyte networks, as well as synaptic and paracrine neuron-tumor networks drive glioma progression. Molecular mechanisms of these malignant, homo- and heterotypic networks, and their complex interplay are reviewed. Lastly, potential clinical-translational implications and resulting therapeutic strategies are discussed.
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Affiliation(s)
- Yvonne Yang
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), INF 280, 69120, Heidelberg, Germany
| | - Marc C Schubert
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), INF 280, 69120, Heidelberg, Germany
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, INF 307, 69120, Heidelberg, Germany
| | - Thomas Kuner
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, INF 307, 69120, Heidelberg, Germany
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), INF 280, 69120, Heidelberg, Germany
| | - Frank Winkler
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), INF 280, 69120, Heidelberg, Germany
| | - Varun Venkataramani
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany.
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), INF 280, 69120, Heidelberg, Germany.
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, INF 307, 69120, Heidelberg, Germany.
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4
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Schubert MC, Stitz J, Cohen HS, Sangi-Haghpeykar H, Mulavara AP, Peters BT, Bloomberg JJ. Prototype tests of vertical and torsional alignment nulling for screening vestibular function. J Vestib Res 2018; 27:173-176. [PMID: 29064832 DOI: 10.3233/ves-170618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We have developed a non-invasive, behavioral measure of ocular alignment using a computer tablet, colored lenses, and touch screen software. OBJECTIVE The goal of this study was to determine if these tests differentiate healthy controls from patients with vestibular disorders. METHODS In the vertical alignment nulling test (VAN), subjects were asked to adjust a horizontal line that was offset vertically from a fixed horizontal line. In the torsional alignment nulling test (TAN) subjects were asked to adjust a line that was rotationally offset (i.e. clockwise) from a fixed horizontal line. We measured VAN and TAN in 14 healthy controls and 8 patients with known vestibular disorders. RESULTS Patients had significantly worse scores than controls on TAN, (mean 2.2 vs 0.75, p = 0.01), and no differences for scores compared to controls on VAN, (mean 0.4 vs 0.8, p = 0.07). CONCLUSIONS These results suggest that TAN, and possibly VAN, have potential for identifying misalignments in ocular position. After further technical development these tests might be useful in the future for screening patients in facilities that are not equipped to perform cervical and ocular vestibular evoked myogenic potentials.
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Affiliation(s)
- M C Schubert
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Stitz
- University of Applied Sciences/Upper Austria, Linz, Austria
| | - H S Cohen
- Baylor College of Medicine, Houston, TX, USA
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Mastroianni S, Heinz FD, Im JH, Veurman W, Padilla M, Schubert MC, Würfel U, Grätzel M, Park NG, Hinsch A. Analysing the effect of crystal size and structure in highly efficient CH3NH3PbI3 perovskite solar cells by spatially resolved photo- and electroluminescence imaging. Nanoscale 2015; 7:19653-62. [PMID: 26548804 DOI: 10.1039/c5nr05308k] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
CH3NH3PbI3 perovskite solar cells with a mesoporous TiO2 layer and spiro-MeOTAD as a hole transport layer (HTL) with three different CH3NH3I concentrations (0.032 M, 0.044 M and 0.063 M) were investigated. Strong variations in crystal size and morphology resulting in diversified cell efficiencies (9.2%, 16.9% and 12.3%, respectively) were observed. The physical origin of this behaviour was analysed by detailed characterization combining current-voltage curves with photo- and electroluminescence (PL and EL) imaging as well as light beam induced current measurements (LBIC). It was found that the most efficient cell shows the highest luminescence and the least efficient cell is most strongly limited by non-radiative recombination. Crystal size, morphology and distribution in the capping layer and in the porous scaffold strongly affect the non-radiative recombination. Moreover, the very non-uniform crystal structure with multiple facets, as evidenced by SEM images of the 0.032 M device, suggests the creation of a large number of grain boundaries and crystal dislocations. These defects give rise to increased trap-assisted non-radiative recombination as is confirmed by high-resolution μ-PL images. The different imaging techniques used in this study prove to be well-suited to spatially investigate and thus correlate the crystal morphology of the perovskite layer with the electrical and radiative properties of the solar cells and thus with their performance.
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Affiliation(s)
- S Mastroianni
- Fraunhofer Institute for Solar Energy Systems ISE, Heidenhofstr. 2, 79110 Freiburg, Germany. and Materials Research Center FMF, University of Freiburg, Stefan-Meier-Str. 21, 79104 Freiburg, Germany
| | - F D Heinz
- Fraunhofer Institute for Solar Energy Systems ISE, Heidenhofstr. 2, 79110 Freiburg, Germany.
| | - J-H Im
- Laboratory for Photonics and Interfaces, Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland. and School of Chemical Engineering and Department of Energy Science, Sungkyunkwan University, Suwon 440-746, Korea.
| | - W Veurman
- Fraunhofer Institute for Solar Energy Systems ISE, Heidenhofstr. 2, 79110 Freiburg, Germany.
| | - M Padilla
- Fraunhofer Institute for Solar Energy Systems ISE, Heidenhofstr. 2, 79110 Freiburg, Germany.
| | - M C Schubert
- Fraunhofer Institute for Solar Energy Systems ISE, Heidenhofstr. 2, 79110 Freiburg, Germany.
| | - U Würfel
- Fraunhofer Institute for Solar Energy Systems ISE, Heidenhofstr. 2, 79110 Freiburg, Germany. and Materials Research Center FMF, University of Freiburg, Stefan-Meier-Str. 21, 79104 Freiburg, Germany
| | - M Grätzel
- Laboratory for Photonics and Interfaces, Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland.
| | - N-G Park
- School of Chemical Engineering and Department of Energy Science, Sungkyunkwan University, Suwon 440-746, Korea.
| | - A Hinsch
- Fraunhofer Institute for Solar Energy Systems ISE, Heidenhofstr. 2, 79110 Freiburg, Germany.
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Herdman SJ, Schubert MC, Tusa RJ. Strategies for balance rehabilitation: fall risk and treatment. Ann N Y Acad Sci 2001; 942:394-412. [PMID: 11710480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Identification of fall risk for patients with known vestibular hypofunction is important because it affects the management and the level of independence of these patients. Patients with bilateral vestibular loss, overall, have a greater incidence of falls than the general community-dwelling population over the age of 65 years. In younger patients, the incidence of falls may be related to severity of vestibular loss and to overconfidence or a lack of caution in activities. Preliminary reports suggest that vestibular rehabilitation can reduce the fall risk in patients with vestibular loss.
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Affiliation(s)
- S J Herdman
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia 33022, USA.
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7
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Abstract
OBJECTIVE To determine the contribution of central preprogramming of eye movements to dynamic visual acuity (DVA) during head movement in patients with vestibular hypofunction. STUDY DESIGN Prospective, clinical study. SETTING Tertiary care, academic hospitals. PARTICIPANTS Twenty-six healthy subjects and 20 patients with unilateral (UVL) and 7 with bilateral vestibular loss (BVL) (age range, 20-86 years). INTERVENTIONS Diagnostic interventions, including caloric and rotational chair testing. MAIN OUTCOME MEASURE Measurements of DVA during predictable (DVA-predictable) and unpredictable (DVA-unpredictable) head movements using a computerized test. RESULTS There was a difference between DVA-predictable and DVA-unpredictable scores in all groups (P<.02). The difference between DVA-predictable and DVA-unpredictable scores for the BVL group was significantly greater than that for the other groups (P<.005). Age was a significant factor in DVA-unpredictable scores for the healthy subjects (P<.001) and UVL group (P<.02). Comparisons of DVA between groups were significant (P<.03), with the following exceptions: UVL group for head movements toward the unaffected side for DVA-predictable and DVA-unpredictable scores, compared with healthy subjects, and UVL group for head movements toward the affected side for DVA-predictable scores, compared with the BVL group. CONCLUSIONS Unpredictable head movements cause a greater decrement in visual acuity than do predictable head movements. This suggests that central programming of eye movements and/or efference copy contributes to gaze stability during predictable head movements in healthy subjects and patients with vestibular hypofunction. Patients with BVL use central programming of eye movements to maintain gaze stability more than do healthy subjects or patients with UVL.
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Affiliation(s)
- S J Herdman
- Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA 30322, USA.
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8
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Affiliation(s)
- M C Schubert
- Center for Rehabilitation Medicine, Emory University, Atlanta, Georgia 30322, USA.
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9
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Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. Am J Otol 2000; 21:847-51. [PMID: 11078074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To determine to what extent patients with vestibular hypofunction experience falls. STUDY DESIGN Prospective clinical study. SETTING Outpatient tertiary care facility in a university. PATIENTS Patients with unilateral (n = 70) and bilateral (n = 45) vestibular hypofunction, confirmed on vestibular function testing, aged 24 to 89 years. INTERVENTION None. MAIN OUTCOME MEASURE Incidence of falls. RESULTS There was a significant difference in the incidence of falls reported since the onset of the vestibular deficit by patients with unilateral (UVL) and bilateral (BVL) vestibular hypofunction. The incidence of falls for BVL was significantly greater than that for UVL. The incidence of falls for UVL was not different from that expected in a community-based population when age was considered. The incidence of falls for BVL was significantly greater than that reported for the general population aged 65 through 74 years (51.1% for BVL, 25% for community-dwelling individuals) but was significantly less than expected for persons aged > or =75 years (18.2% for BVL, 49% for community-dwelling individuals). The lower incidence of falls in patients with BVL aged > or =75 years may be related to the use of assistive devices and to a decrease in risky behavior. All patients with serious injury were from the UVL group, and all were >65 years old. The incidence of fall-related injuries requiring medical attention among patients with UVL was similar to that in community-dwelling individuals. CONCLUSIONS Falls are an important consequence of bilateral vestibular hypofunction, and patients should be counseled about the increased risk of falling. Assistive devices should be considered, especially for persons aged >65 years with BVL.
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Affiliation(s)
- S J Herdman
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia 30322, USA
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10
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Abstract
Since the initial introduction of exercises as a treatment for patients with vestibular deficits, there have been numerous clinical reports on the benefits of treatment. Clinical reports, however, are of limited use as a basis for treatment because, without a control group, they offer only interesting descriptions of the patient populations. Fortunately, several prospective, randomized studies on the treatment of patients with vestibular hypofunction or with benign paroxysmal positional vertigo have been published recently, adding to the small number of previous publications. This review will examine the information provided by those studies. Advances in the use of outcome measures, assessment of otolith function and treatment of related balance problems are also presented.
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Affiliation(s)
- S J Herdman
- Department of Orthopaedics and Rehabilitation, University of Miami, Florida, USA.
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11
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Abstract
Abstract
Background and Purpose. This case report describes physical therapy for motion sickness in a 34-year-old woman. The purpose of the report is twofold: (1) to provide an overview of the literature regarding motion sickness syndrome, causal factors, and rationale for treatment and (2) to describe the evaluation and treatment of a patient with motion sickness. Case Description and Outcomes. The patient initially had moderate to severe visually induced motion sickness, which affected her functional abilities and prevented her from working. Following 10 weeks of a primarily home-based program of visual-vestibular habituation and balance training, her symptoms were alleviated and she could resume all work-related activities. Discussion. Although motion sickness affects nearly one third of all people who travel by land, sea, or air, little documentation exists regarding prevention or management.
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Affiliation(s)
- R M Rine
- Department of Orthopedics, Division of Physical Therapy, University of Miami School of Medicine, Plumer Bldg, Coral Gables, FL 33146, USA.
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