Bacterial resistance to antibiotics has become a worldwide health problem, resulting in untreatable infections and escalating healthcare costs. Wastewater treatment plants are a critical point of control between anthropogenic sources of pathogens, antibiotic resistant bacteria (ARBs), antibiotic resistance genes (ARGs), and the environment through discharge of treated effluent and land application of biosolids. Recent studies observing an apparent resuscitation of pathogens and pathogen indicators and the widening realization of the importance of addressing environmental reservoirs of ARGs all lead toward the need for improved understanding of ARG fate and pathogen inactivation kinetics and mechanisms in sludge stabilization technologies. This research has investigated the fate of two pathogens, methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli, and various ARGs under pasteurization, anaerobic digestion, biosolids storage, and land application conditions. Pathogen die-off occurs at a rate specific to each pathogen and matrix in ambient and mesophilic temperature environments. Viable but nonculturable (VBNC) states are initiated by thermal treatments, such as thermophilic digestion and possibly pasteurization, and allow the persistence of pathogen cells and any ARGs contained therein through treatment and into the receiving environment where resuscitation or transformation could occur. Raw sludge ARG content does affect digester effluent quality, although the predominant mechanisms of ARG persistence may be different in mesophilic versus thermophilic digestion. In both thermophilic and mesophilic digestion, a correlation was observed between raw sludge and digester ARGs associated with Class 1 integrons, possibly as a result of horizontal gene transfer. ARB survival was shown to contribute to ARG content in mesophilic digestion, but not thermophilic digestion. Thermophilic digestion may achieve a higher ARG reduction because of reduced microbial diversity compared to mesophilic digestion. However, it is evident that horizontal gene transfer still does occur, particularly with highly mobile integrons, so that complete reduction of all ARGs would not be possible with thermophilic digestion alone. Surprisingly, the experiments that introduced various concentrations of antibiotic sulfamethoxazole and antimicrobial nanosilver did not induce enhanced rates of horizontal gene transfer. Finally, ARG concentrations in biosolids increased during cold temperature storage suggesting that there is a stress induction of horizontal gene transfer of integron-associated ARGs. / Ph. D.

Chez des patients allergiques, il est possible de retrouver dans leur sérum desanticorps spécifiques du médicament (IgE) et dans leur sang des lymphocytes T spécifiquesdu médicament. La présence de LT spécifiques du médicament chez des patients allergiquessuggère la présentation du médicament par des cellules présentatrices d’antigène telles queles cellules dendritiques.Nous nous sommes alors intéressés à mieux comprendre l’implication deslymphocytes T et des cellules dendritiques dans le développement des allergies auxantibiotiques comme la pénicilline G (ou Benzyl-Pénicilline) ou le sulfaméthoxazole.Ce travail de thèse a permis: i) de démontrer la présence de lymphocytes Tspécifiques de la pénicilline G dans le sang périphérique de donneurs non allergiques à unefréquence mesurable, ii) de développer deux approches expérimentales et de modélisationpour l’identification des épitopes potentiellement présentés aux lymphocytes T et iii)d’étudier l’effet des médicaments sur les cellules dendritiques.Les perspectives de ce travail sont de mieux comprendre les mécanismes impliquésdans les allergies médicamenteuses au niveau des lymphocytes T et des cellules dendritiqueset de développer des tests de prédiction du « potentiel allergique » des médicaments, afinde mieux prédire les allergies médicamenteuses lors du développement des médicaments. / In allergic patients, antibodies like IgE or T-lymphocytes specific for the drugimplicated can be detected and measured. Presence of T-lymphocytes specific for the drugin allergic patients suggested the presentation of the culprit drug to T-lymphocytes byantigen presenting cells like dendritic cells.We were interested in better understanding the implication of T-lymphocytes anddendritic cells in the development of antibiotics allergies such as penicillin G (or Benzyl-Penicillin) or sulfamethoxazole.The results obtained in this work allowed us: i) to demonstrate the presence ofbenzyl-penicillin-specific T cells in the peripheral blood of non-allergic donors, at adetectable frequency; ii) to develop two approaches: one experimental and one usingmodelisation for the identification of epitopes potentially presented to T-lymphocytes andiii) to study the effect of drugs on DC.The perspectives of this research work are to better understand the mechanismsimplicated in drug allergies and to develop predictive tests for “drug allergic potential", inorder to be able to better predict drug allergies during drug development.

A paracoccidioidomicose (PCM) é uma micose sistêmica e endêmica na América Latina com maior prevalência no Brasil, Colômbia e Venezuela. A doença é causada pelos fungos P. brasiliensis e P. lutzii. As células dendríticas são eficientes apresentadoras de antígenos e quando utilizadas como adjuvante podem ser de 100 a 1000 vezes mais efetiva nesta função. O peptídeo P10 corresponde a um trecho específico de 15 aminoácidos derivado da gp43, principal antígeno diagnóstico, e é reconhecido pelos linfócitos T CD4+ capaz de induzir resposta preferencialmentedo tipo Th1 e conferindo proteção no modelo experimental. Células indiferenciadas foram obtidas a partir de medula óssea de camundongos machos BALB/c B10.A, cultivadas na presença de GM-CSF e IL-4 por 9 dias, para a diferenciação de células dendríticas (DC). As células foram incubadas na presença do P10 por 2 horas, em estufa com 5% de CO2 a 37°C, e foram utilizadas nas imunizações. A maturação das células foi observada por citometria de fluxo com os marcadores CD11c, MHC-II, CD80 e CD86. Camundongos da linhagem BALB/c e B10.A foram submetidos à imunossupressão com dexametasona, por 20 dias, seguido pela infecção intratraqueal com o isolado Pb18. Após 30 dias, os grupos foram tratados com DCs ou DCs pulsadas com P10 em associação ou não com sulfametoxazol/Trimetoprim, por um período de 15 dias. O sacrifício ocorreu 45 dias após a infecção e foram retirados os pulmões, baço e fígado para quantificação de carga fúngica, análise histológica e dosagem de citocinas. Observamos diminuição significativa da carga fúngica nos pulmões dos animais que receberam DCs pulsadas com P10 associada ou não ao tratamento medicamentoso. Não foi observado crescimento fúngico em outros órgãos como fígado e baço em ambos os grupos. A análise histológica revelou redução da carga fúngica e preservação do parênquima pulmonar nos grupos tratados com Dcs pulsadas com P10. As dosagens das citocinas indicaram uma resposta imune mista Th1/Th2. Inicialmente reportamos que as DCs pulsadas com P10 reduz a carga fúngica em camundongos infectados. Neste trabalho, reportamos que as DCs pulsadas com P10 podem também reduzir a carga fúngica em animais anérgicos, mimetizando pacientes com a forma aguda/subaguda da doença / Paracoccidioidomycosis (PCM) is a systemic and endemic mycosis in South America, with higher prevalence in Brazil, Colombia and Venezuela. This disease is caused by fungi P. brasiliensis and P. lutzii. The peptide P10 matches a specific path of 15 amonoacids which is derived from gp43, main diagnostic antigen. This peptide is recognized by the T CD4+ lymphocytes and induces a response type Th1, giving protection at an experimental mode. Some dendritic cells (DC) have an efficient antigen and, when used as adjuvant, they can be 100 to 1000 times more effective. Undifferentiated cells were obtained from bone marrow of male mice type BALB/c and B10.A and cultivated in the presence of GM-CSF and IL-4 for 9 days, so that DCs would be differentiated. The cells were incubated in the presence of P10 for 2 hours in incubator at 37°C with 5% of CO2, and later utilized in the immunizations. Maturation of the cells was observed by flow cytometry with CD11c, MHC-II, CD80 and CD86 markers. Mice types BALB/c and B10.A had been submitted to an immunosuppression with dexamethasone for 20 days, before being intratracheally infected with isolate Pb18. After 30 days, the group of animals received immunizations with DCs or DCs pulsed with P10 associated or not with the treatment by Sulfametoxazol/Trimetoprim, this for a period of 15 days. The sacrifice occurred 45 day after the animals had been infected, and their lungs, spleen and liver were taken out for quantification of fungal burden, histology and cytokine assay. We observed a significant decrease of fungal burden in the lungs of animal that received DC pulsed with P10, associated or not with the drug treatment. In both groups we didn\'t observe fungal growth in organs such as liver and spleen. The histological analyses showed reduced fungal burden and preservation of lung parenchyma. The dosages of cytokines showed an immune response mixed Th1/Th2 type. At first we reported that the DCs pulsed with P10 were responsible for reducing the fungal burden in infected mice. In this paper we report that the DCs pulsed with P10 may also be responsible for reducing fungal burden in anergic animals, mimicking patients with the acute/subacute form of the disease

A espectrometria de massas, acoplada ou não a outras técnicas, tem sido de grande utilidade na determinação de novos compostos, produtos de transformação/degradação, metabólitos e na quantificação em nível de traços nas mais diferentes matrizes, devido à grande versatilidade dessa técnica, especialmente em relação aos modos de análise. Neste trabalho foi sistematizada uma metodologia para a aplicação das técnicas de espectrometria de massas na identificação de produtos de transformação/degradação de fármacos de uso humano e veterinário. Ferramentas da química computacional foram utilizadas para auxiliar na elucidação das estruturas dos compostos formados. A metodologia foi empregada para a identificação e quantificação dos produtos de transformação/degradação da rosuvastatina, gerados durante o processo de fotocatálise heterogênea com ZnO, para a identificação dos produtos de transformação/degradação gerados durante a fotólise em meio aquoso do sulfamentoxazol, ciprofloxacino e norfloxacino, e para a quantificação da amoxicilina transferida ao leite bovino. A viabilidade de se realizar a identificação de metabólitos da amoxicilina presentes no leite bovino por meio do mesmo processo de preparo de amostra e de análise utilizado para a quantificação também foi avaliada. Foram identificados dez principais produtos de transformação/degradação da fotocatálise da rosuvstatina, dez principais produtos de transformação/degradação da fotólise em meio aquoso do sulfametoxazol, quinze principais produtos de transformação/degradação da fotólise em meio aquoso do ciprofloxacino e quinze principais produtos de transformação/degradação da fotólise em meio aquoso do norfloxacino. A metodologia empregada para a quantificação da amoxicilina em leite bovino se demostrou adequada, mas estudos adicionais são necessários para que seja possível identificar os seus metabólitos nessa matriz. Os resultados dos cálculos ab initio que foram utilizados para o estudo dos produtos de transformação/degradação da rosuvastatina e sulfametoxazol mostram que essa técnica pode ser bastante útil na elucidação estrutural dos compostos que são formados. / Mass spectrometry, coupled or not with other techniques, is very useful for the determination of new compounds, transformation/degradation products, metabolites and quantification at trace levels in many different matrices, due to the versatility of such a technique, specially regarding to analysis modes. In the present work a methodology was systematized for the application of mass spectrometry techniques in order to identify metabolites and transformation/degradation products for human and veterinary drugs usage. Computational chemistry tools were used to assist in the elucidation of the structure of the compounds formed during the process. The methodology was employed for identification and quantification of rosuvastatin transformation/degradation products generated during the heterogeneous photocatalysis process with ZnO, for the identification of sulfamethoxazole, ciprofloxacin and norfloxacion transformation/degradation products generated during the photolysis in aqueous medium and for quantifying amoxicillin transferred to bovine milk. The feasibility of identification of amoxicillin metabolites present in bovine milk using the same sample preparation procedure exploited for the quantification analysis was also assessed. Ten main transformation/degradation products of rosuvastatin photocatalysis were identified, as well as ten main transformation/degradation products of sulfamethoxaxole photolysis in aqueous medium, fifteen main transformation/degradation products of ciprofloxacin photolysis in aqueous medium and fifteen main transformation/degradation products of norfloxacin photolysis in aqueous medium. The methodology applied for the bovine milk amoxicillin quantification was demonstrated to be adequate, but additional studies are needed to identify amoxicillin metabolites in the milk matrix. The results of ab initio calculations utilised for the study of rosuvastatin and sulfamethoxazole transformation/degradation products show that this technique can be very useful for the structural elucidation of chemical compounds which are formed.

The aim of the diploma thesis was to monitor seasonal concentration changes of 7 antibiotics norfloxacin, levofloxacin, ciprofloxacin, azithromycin, erythromycin, trimethoprim and sulfamethoxazole in wastewater influent and (cleaned) water effluent in the Sewage Treatment Plant (STP) České Budějovice. Time-proportional 24 hours pooled samples of wastewater were collected every month from March 2011 to February 2012 in the influent and effluent pof the STP. The concentrations of target compounds were determined by using in line SPE/LC-MS/MS analysis. The highest average concentration in the influent was detected in case of norfloxacin (0.563 microgram/l) and ciprofloxacin (0.406 microgram/l). The highest average concentration in the effluent was detected in the case of trimethoprim (0.255 microgram/l) and erythromycin (0.117 microgram/l). Higher concentration of antibiotics was measured in the colder periods of the year. It was connected with increased use of antibiotics and with less cleaning efficiency of the STP in this season. The highest removal efficiency was determined for norfloxacin and ciprofloxacin, the lowest for erythromycin. The influence of the season on the removal efficiency of antibiotics was found esp. for azithromycin,trimethoprim and sulfamethoxazole.

A espectrometria de massas, acoplada ou não a outras técnicas, tem sido de grande utilidade na determinação de novos compostos, produtos de transformação/degradação, metabólitos e na quantificação em nível de traços nas mais diferentes matrizes, devido à grande versatilidade dessa técnica, especialmente em relação aos modos de análise. Neste trabalho foi sistematizada uma metodologia para a aplicação das técnicas de espectrometria de massas na identificação de produtos de transformação/degradação de fármacos de uso humano e veterinário. Ferramentas da química computacional foram utilizadas para auxiliar na elucidação das estruturas dos compostos formados. A metodologia foi empregada para a identificação e quantificação dos produtos de transformação/degradação da rosuvastatina, gerados durante o processo de fotocatálise heterogênea com ZnO, para a identificação dos produtos de transformação/degradação gerados durante a fotólise em meio aquoso do sulfamentoxazol, ciprofloxacino e norfloxacino, e para a quantificação da amoxicilina transferida ao leite bovino. A viabilidade de se realizar a identificação de metabólitos da amoxicilina presentes no leite bovino por meio do mesmo processo de preparo de amostra e de análise utilizado para a quantificação também foi avaliada. Foram identificados dez principais produtos de transformação/degradação da fotocatálise da rosuvstatina, dez principais produtos de transformação/degradação da fotólise em meio aquoso do sulfametoxazol, quinze principais produtos de transformação/degradação da fotólise em meio aquoso do ciprofloxacino e quinze principais produtos de transformação/degradação da fotólise em meio aquoso do norfloxacino. A metodologia empregada para a quantificação da amoxicilina em leite bovino se demostrou adequada, mas estudos adicionais são necessários para que seja possível identificar os seus metabólitos nessa matriz. Os resultados dos cálculos ab initio que foram utilizados para o estudo dos produtos de transformação/degradação da rosuvastatina e sulfametoxazol mostram que essa técnica pode ser bastante útil na elucidação estrutural dos compostos que são formados. / Mass spectrometry, coupled or not with other techniques, is very useful for the determination of new compounds, transformation/degradation products, metabolites and quantification at trace levels in many different matrices, due to the versatility of such a technique, specially regarding to analysis modes. In the present work a methodology was systematized for the application of mass spectrometry techniques in order to identify metabolites and transformation/degradation products for human and veterinary drugs usage. Computational chemistry tools were used to assist in the elucidation of the structure of the compounds formed during the process. The methodology was employed for identification and quantification of rosuvastatin transformation/degradation products generated during the heterogeneous photocatalysis process with ZnO, for the identification of sulfamethoxazole, ciprofloxacin and norfloxacion transformation/degradation products generated during the photolysis in aqueous medium and for quantifying amoxicillin transferred to bovine milk. The feasibility of identification of amoxicillin metabolites present in bovine milk using the same sample preparation procedure exploited for the quantification analysis was also assessed. Ten main transformation/degradation products of rosuvastatin photocatalysis were identified, as well as ten main transformation/degradation products of sulfamethoxaxole photolysis in aqueous medium, fifteen main transformation/degradation products of ciprofloxacin photolysis in aqueous medium and fifteen main transformation/degradation products of norfloxacin photolysis in aqueous medium. The methodology applied for the bovine milk amoxicillin quantification was demonstrated to be adequate, but additional studies are needed to identify amoxicillin metabolites in the milk matrix. The results of ab initio calculations utilised for the study of rosuvastatin and sulfamethoxazole transformation/degradation products show that this technique can be very useful for the structural elucidation of chemical compounds which are formed.

A espectrometria de massas, acoplada ou não a outras técnicas, tem sido de grande utilidade na determinação de novos compostos, produtos de transformação/degradação, metabólitos e na quantificação em nível de traços nas mais diferentes matrizes, devido à grande versatilidade dessa técnica, especialmente em relação aos modos de análise. Neste trabalho foi sistematizada uma metodologia para a aplicação das técnicas de espectrometria de massas na identificação de produtos de transformação/degradação de fármacos de uso humano e veterinário. Ferramentas da química computacional foram utilizadas para auxiliar na elucidação das estruturas dos compostos formados. A metodologia foi empregada para a identificação e quantificação dos produtos de transformação/degradação da rosuvastatina, gerados durante o processo de fotocatálise heterogênea com ZnO, para a identificação dos produtos de transformação/degradação gerados durante a fotólise em meio aquoso do sulfamentoxazol, ciprofloxacino e norfloxacino, e para a quantificação da amoxicilina transferida ao leite bovino. A viabilidade de se realizar a identificação de metabólitos da amoxicilina presentes no leite bovino por meio do mesmo processo de preparo de amostra e de análise utilizado para a quantificação também foi avaliada. Foram identificados dez principais produtos de transformação/degradação da fotocatálise da rosuvstatina, dez principais produtos de transformação/degradação da fotólise em meio aquoso do sulfametoxazol, quinze principais produtos de transformação/degradação da fotólise em meio aquoso do ciprofloxacino e quinze principais produtos de transformação/degradação da fotólise em meio aquoso do norfloxacino. A metodologia empregada para a quantificação da amoxicilina em leite bovino se demostrou adequada, mas estudos adicionais são necessários para que seja possível identificar os seus metabólitos nessa matriz. Os resultados dos cálculos ab initio que foram utilizados para o estudo dos produtos de transformação/degradação da rosuvastatina e sulfametoxazol mostram que essa técnica pode ser bastante útil na elucidação estrutural dos compostos que são formados. / Mass spectrometry, coupled or not with other techniques, is very useful for the determination of new compounds, transformation/degradation products, metabolites and quantification at trace levels in many different matrices, due to the versatility of such a technique, specially regarding to analysis modes. In the present work a methodology was systematized for the application of mass spectrometry techniques in order to identify metabolites and transformation/degradation products for human and veterinary drugs usage. Computational chemistry tools were used to assist in the elucidation of the structure of the compounds formed during the process. The methodology was employed for identification and quantification of rosuvastatin transformation/degradation products generated during the heterogeneous photocatalysis process with ZnO, for the identification of sulfamethoxazole, ciprofloxacin and norfloxacion transformation/degradation products generated during the photolysis in aqueous medium and for quantifying amoxicillin transferred to bovine milk. The feasibility of identification of amoxicillin metabolites present in bovine milk using the same sample preparation procedure exploited for the quantification analysis was also assessed. Ten main transformation/degradation products of rosuvastatin photocatalysis were identified, as well as ten main transformation/degradation products of sulfamethoxaxole photolysis in aqueous medium, fifteen main transformation/degradation products of ciprofloxacin photolysis in aqueous medium and fifteen main transformation/degradation products of norfloxacin photolysis in aqueous medium. The methodology applied for the bovine milk amoxicillin quantification was demonstrated to be adequate, but additional studies are needed to identify amoxicillin metabolites in the milk matrix. The results of ab initio calculations utilised for the study of rosuvastatin and sulfamethoxazole transformation/degradation products show that this technique can be very useful for the structural elucidation of chemical compounds which are formed.

A paracoccidioidomicose (PCM) é uma micose sistêmica e endêmica na América Latina com maior prevalência no Brasil, Colômbia e Venezuela. A doença é causada pelos fungos P. brasiliensis e P. lutzii. As células dendríticas são eficientes apresentadoras de antígenos e quando utilizadas como adjuvante podem ser de 100 a 1000 vezes mais efetiva nesta função. O peptídeo P10 corresponde a um trecho específico de 15 aminoácidos derivado da gp43, principal antígeno diagnóstico, e é reconhecido pelos linfócitos T CD4+ capaz de induzir resposta preferencialmentedo tipo Th1 e conferindo proteção no modelo experimental. Células indiferenciadas foram obtidas a partir de medula óssea de camundongos machos BALB/c B10.A, cultivadas na presença de GM-CSF e IL-4 por 9 dias, para a diferenciação de células dendríticas (DC). As células foram incubadas na presença do P10 por 2 horas, em estufa com 5% de CO2 a 37°C, e foram utilizadas nas imunizações. A maturação das células foi observada por citometria de fluxo com os marcadores CD11c, MHC-II, CD80 e CD86. Camundongos da linhagem BALB/c e B10.A foram submetidos à imunossupressão com dexametasona, por 20 dias, seguido pela infecção intratraqueal com o isolado Pb18. Após 30 dias, os grupos foram tratados com DCs ou DCs pulsadas com P10 em associação ou não com sulfametoxazol/Trimetoprim, por um período de 15 dias. O sacrifício ocorreu 45 dias após a infecção e foram retirados os pulmões, baço e fígado para quantificação de carga fúngica, análise histológica e dosagem de citocinas. Observamos diminuição significativa da carga fúngica nos pulmões dos animais que receberam DCs pulsadas com P10 associada ou não ao tratamento medicamentoso. Não foi observado crescimento fúngico em outros órgãos como fígado e baço em ambos os grupos. A análise histológica revelou redução da carga fúngica e preservação do parênquima pulmonar nos grupos tratados com Dcs pulsadas com P10. As dosagens das citocinas indicaram uma resposta imune mista Th1/Th2. Inicialmente reportamos que as DCs pulsadas com P10 reduz a carga fúngica em camundongos infectados. Neste trabalho, reportamos que as DCs pulsadas com P10 podem também reduzir a carga fúngica em animais anérgicos, mimetizando pacientes com a forma aguda/subaguda da doença / Paracoccidioidomycosis (PCM) is a systemic and endemic mycosis in South America, with higher prevalence in Brazil, Colombia and Venezuela. This disease is caused by fungi P. brasiliensis and P. lutzii. The peptide P10 matches a specific path of 15 amonoacids which is derived from gp43, main diagnostic antigen. This peptide is recognized by the T CD4+ lymphocytes and induces a response type Th1, giving protection at an experimental mode. Some dendritic cells (DC) have an efficient antigen and, when used as adjuvant, they can be 100 to 1000 times more effective. Undifferentiated cells were obtained from bone marrow of male mice type BALB/c and B10.A and cultivated in the presence of GM-CSF and IL-4 for 9 days, so that DCs would be differentiated. The cells were incubated in the presence of P10 for 2 hours in incubator at 37°C with 5% of CO2, and later utilized in the immunizations. Maturation of the cells was observed by flow cytometry with CD11c, MHC-II, CD80 and CD86 markers. Mice types BALB/c and B10.A had been submitted to an immunosuppression with dexamethasone for 20 days, before being intratracheally infected with isolate Pb18. After 30 days, the group of animals received immunizations with DCs or DCs pulsed with P10 associated or not with the treatment by Sulfametoxazol/Trimetoprim, this for a period of 15 days. The sacrifice occurred 45 day after the animals had been infected, and their lungs, spleen and liver were taken out for quantification of fungal burden, histology and cytokine assay. We observed a significant decrease of fungal burden in the lungs of animal that received DC pulsed with P10, associated or not with the drug treatment. In both groups we didn\'t observe fungal growth in organs such as liver and spleen. The histological analyses showed reduced fungal burden and preservation of lung parenchyma. The dosages of cytokines showed an immune response mixed Th1/Th2 type. At first we reported that the DCs pulsed with P10 were responsible for reducing the fungal burden in infected mice. In this paper we report that the DCs pulsed with P10 may also be responsible for reducing fungal burden in anergic animals, mimicking patients with the acute/subacute form of the disease

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology and Toxicology Student: Veronika Ackermannová Supervisor: prof. Radomír Hrdina, MD, CSc. Title of diploma thesis: Topic and systemic treatment of acne vulgaris Acne vulgaris is a skin disease affecting the hair follicles and sebaceous glands. The disease manifests itself by increased sebum production, non-inflammatory (comedones) and inflammatory lesions (papules, pustules, nodules, cysts). It occurs predominantly in adolescents, but may persist into adulthood. It is a multifactorial disease, which is caused by several factors (internal and external stimuli). The major pathogenetic factors include increased sebum production, hyperkeratosis, P. acnes colonization and inflammation present. First, it is necessary to diagnose the type of acne in order to choose the right and effective therapy, because there is not only one type of acne. There are many types and variants of acne, and although they show similar symptoms (affecting the follicles of sebaceous glands), their cause often differs. There is no uniform classification system for acne vulgaris and it varies between authors. Some authors classify acne vulgaris according to severity into mild, moderate and severe, others into comedonic, papulopustular, nodulocystic...

Ziele dieser Dissertation sind die Aufklärung der Strömungsverhältnisse und Untersuchungen zum Verhalten von Arzneimittelrückständen im Tegeler See, die Entwicklung eines Simulationsmodells für Szenarioberechnungen sowie die Ableitung neuer Bewirtschaftungskonzepte unter Zuhilfenahme der gewonnenen Erkenntnisse und Modellergebnisse. Das zweidimensionale Strömungsmodell 2D-POM kann die Mischungsverhältnisse der beiden Zuflüsse zum Tegeler See, insbesondere den Einstrom der Oberhavel, ausreichend genau abbilden. Der Oberhaveleinstrom ist sowohl windinduziert als auch vom Abfluss der Oberhavel abhängig. Der Wind wirkt je nach Windrichtung verstärkend oder abschwächend auf den Oberhaveleinstrom. Der Tegeler See weist im Vergleich zu anderen Oberflächengewässern, die als Trinkwasserressource dienen, die höchsten bisher berichteten Gehalte an Arzneimittelrückständen auf. Die räumliche Verteilung von Carbamazepin (CBZ) und Sulfamethoxazol (SMX) wird hauptsächlich durch die Verdünnung mit Oberhavelwasser bestimmt. Nur ein geringer Teil des CBZ (40%) wird im Tegeler See eliminiert. Für SMX konnte keine Elimination festgestellt werden. Im Gegensatz dazu wird Diclofenac (DCF) im Oberflächenwasser photolytisch abgebaut (50% in den Wintermonaten, mehr als 95% im Sommer). Die Konzentrationen von DCF im Tegeler See zeigen deshalb eine hohe saisonale Variabilität. Durch Simulation von sieben Bewirtschaftungsszenarien wurde untersucht, ob mithilfe der existierenden Seeleitung und Phosphateliminierungsanlage die Konzentrationen der Arzneimittelrückstände im Tegeler See verringert werden können, ohne die erfolgreiche Seerestaurierung zu gefährden. In keinem Szenario konnten die Gehalte an Arzneimittelrückständen und Phosphor gleichzeitig auf einem akzeptablen Niveau gehalten werden. Aus diesem Grund sind ergänzende Maßnahmen notwendig, z.B. eine zusätzliche Spurenstoffentfernung im Zulauf des Sees oder eine weitere Phosphorreduzierung in der Oberhavel. / This cumulative thesis aims at (i) understanding the hydrodynamic characteristics of Lake Tegel, (ii) examining the occurrence and fate of pharmaceutical micro-pollutants in the lake, (iii) developing a modeling tool for scenario prediction, and (iv) utilizing the above findings and applying the above modeling tool to create new management strategies for Lake Tegel. The free-surface two-dimensional circulation model 2D-POM serves as an adequate tool for representing the intrusion of River Havel and the mixing intensity of both inflows, as validated by measured data. The calculations indicated that the intrusion of River Havel into Lake Tegel fluctuates with river discharge and wind, both of which can amplify or neutralize the other. Compared to other surface waters also used as drinking water resources, Lake Tegel seams to feature the highest ever reported pharmaceutical concentrations worldwide. The spatial distribution of carbamazepine (CBZ) and sulfamethoxazole (SMX) in the lake was shown to be primarily affected by dilution with water from River Havel rather than by degradation within the lake. By contrast, concentrations of diclofenac (DCL) are affected by both dilution and photodegradation. DCF showed the strongest elimination of all three pharmaceuticals and revealed significant seasonality with 50% elimination in winter and more than 95% in summer. Elimination of CBZ was 40%, while SMX did not degrade at determinable rates. Seven different management scenarios were tested to answer the question of whether the existing lake pipeline could be used to reduce the amount of pharmaceuticals in Lake Tegel without deteriorating the current phosphorus level. No scenario provided a strategy optimal for both pharmaceuticals and phosphorus. Consequently, additional efforts need to be made, such as supplementary pharmaceutical treatment of the inflow originating from the wastewater treatment plant, or phosphorus reduction in the River Havel catchment.