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The Asian financial crisis of 1997-98 was one of the most dramatic economic events of recent times, which raised many questions regarding the appropriate policy response to financial crises. This paper reviews the experience of this crisis, focusing on the overall strategy of crisis management and the way that strategy was implemented including, with regard to official and private financing, structural reforms, and monetary and fiscal policies.
Aus der Flora-Fauna-Habitat (FFH)-Richtlinie (Europäische Kommission 1992) und aus der Vogelschutz-Richtlinie (Europäische Kommission 1979) leiten sich unabhängig von der bereits erfolgten Auswahl und Meldung der NATURA 2000-Gebiete konkrete Aufgabenstellungen (z.B. Berichtspflicht, Monitoring, Gebietsmanagement) ab. Die Erfüllung dieser Aufgaben ist obligatorisch, die Methoden sind nicht verbindlich vorgeschrieben.
Naturschutzfachlich wertvolles extensiv genutztes Feuchtgrünland der Auen ist durch Maßnahmen des Gewässerausbaus, des Hochwasserschutzes sowie durch Entwässerung und Melioration in Mitteleuropa sehr selten geworden. Renaturierungsmaßnahmen von Gewässern und Auen werden in der jüngeren Vergangenheit gezielt eingesetzt, um die gefährdeten Tier- und Pflanzenarten des offenen Feuchtgrünlandes zu fördern. Dabei werden häufig ehemals intensiv genutzte Wiesen renaturiert. Die Frage des Flächenmanagements nach der Wiedervernässung ist sowohl aus praktischer und ökonomischer als auch aus naturschutzfachlicher Sicht wichtig. Eine extensive Beweidung ist auf den wiedervernässten Auestandorten oft praktikabler als eine Mahdnutzung, aber durch die Umstellung der Nutzung aus naturschutzfachlicher Sicht oft umstritten. Im Rahmen der vorliegenden Studie werden unterschiedliche Landnutzungsregime für Feuchtgrünland in der Luxemburger Syr-Aue sechs Jahre nach der Wiedervernässung durch ein Renaturierungsprojekt vegetationsökologisch verglichen. Ziel ist es, Unterschiede in der Vegetationszusammensetzung zwischen den Nutzungsvarianten der extensiven Beweidung, der einschürigen Mahd mit Beweidung und der zweischürigen Mahd zu analysieren und Rückschlüsse für ein künftiges Management von wiedervernässtem Auengrünland zu ziehen. Entlang der Nutzungsgrenze Weide – Mahdflächen wurden anhand von gepaarten Probeflächen, die standörtlich ähnliche Verhältnisse gewährleisten sollten, Vegetationsaufnahmen durchgeführt. Neben Parametern der floristischen Diversität und Seltenheit wurden die gewonnenen Vegetationsdaten mit Hilfe von Zeigerwerten und funktionallen Arteigenschaften analysiert. Eine NMDS-Ordination unterscheidet die Vegetationszusammensetzung der Nutzungsvarianten entlang einer Dimension signifikant voneinander. Haupteinflussfaktor ist hier die unterschiedliche Nutzung. Auf den untersuchten Weideflächen konnten insgesamt im Vergleich zu den Mahdflächen mehr Arten beobachtet werden. Die durchschnittlichen Artenzahlen, Diversitätsindizes und strukturellen Vegetationsparameter pro Aufnahmeeinheit deuten auf eine größere räumliche Heterogenität der Vegetation unter den Nutzungseinflüssen der Weidetiere hin. Bei den seltenen und naturschutzrelevanten Pflanzenarten konnten keine signifikanten Unterschiede zwischen den Varianten nachgewiesen werden. Dagegen unterscheiden sich die Arteigenschaften der vorkommenden Pflanzenarten der zweischürigen Wiesen von der Standweide im Hinblick auf die Lebensformen, den Reproduktionstyp und den Blühbeginn bereits signifikant voneinander. Die Ergebnisse dieser Studie decken sich nicht mit dem beobachteten Artenrückgang durch einen Bewirtschaftungswechsel von Mahd zu Beweidung, der bei verschiedenen Vergleichsstudien auf anderen Stand orten von Mahd- und Weidenutzungen festgestellt wurde. Die extensive Mahd- und Weidenutzung im Syrtal kommt historischen Bewirtschaftungsformen im Gebiet sehr nahe, die zunehmend zur Erhaltung und Entwicklung von artenreichen Habitattypen gefordert werden. Die unterschiedlichen Nutzungsregime ergänzen sich im Syrtal auf engstem Raum und bieten Habitatnischen für Pflanzenarten mit unterschiedlichen Ansprüchen.
Objectives: To discuss optimal management of recurrent urinary tract infections (UTIs) in women. About every second woman experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life.
Methods: This is a narrative review, investigating publications dealing with recurrent UTI in women. Risk factors and options for management are discussed.
Results: The increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioural, genetic, and urological factors. However, why some women are more likely than others to develop and maintain rUTI remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli that are able to form extra- and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder, may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counselled to use non-antibiotic strategies including behavioural changes, anti-adhesive treatments, antiseptics, and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as faecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor’s faecal matter to patients using oral capsules, enemas, or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialled for UTIs.
Conclusion: Due to the limitation of available data, novel treatment options require further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.
Background. The placement of an implant in a previously infected site is an important etiologic factor contributing to implant failure. The aim of this case report is to present the management of retrograde peri-implantitis (RPI) in a first maxillary molar site, 2 years after the implant placement. The RPI was treated using an air-abrasive device, Er,Cr:YSGG laser, and guided bone regeneration (GBR).
Case Description. A 65-year-old Caucasian male presented with a draining fistula associated with an implant at tooth #3. Tooth #3 revealed periapical radiolucency two years before the implant placement. Tooth #3 was extracted, and a ridge preservation procedure was performed followed by implant rehabilitation. A periapical radiograph (PA) showed lack of bone density around the implant apex. The site was decontaminated with an air-abrasive device and Er,Cr:YSGG laser, and GBR was performed. The patient was seen every two weeks until suture removal, followed by monthly visits for 12 months. The periapical X-rays, from 6 to 13 months postoperatively, showed increased bone density around the implant apex, with no signs of residual clinical or radiographic pathology and probing depths ≤4 mm.
Conclusions. The etiology of RPI in this case was the placement of an implant in a previously infected site. The use of an air-abrasive device, Er,Cr:YSGG, and GBR was utilized to treat this case of RPI. The site was monitored for 13 months, and increased radiographic bone density was noted.
The purpose of this narrative review is to discuss and highlight recently published studies regarding the surgical management of patients suffering from prostate cancer treatment complications. Focus will be put on the recalcitrant and more complex cases which might lead to urinary diversion as a definite, last resort treatment. It is in the nature of every treatment, that complications will occur and be bothersome for both patients and physicians. A small percentage of patients following prostate cancer treatment (radical prostatectomy, radiation therapy, or other focal therapies) will suffer side effects and thus, will experience a loss of quality of life. These side effects can persist for months and even years. Often, conservative management strategies fail resulting in recalcitrant recurrences. Prostate cancer patients with “end-stage bladder,” “devastated outlet,” or a history of multiple failed interventions, are fortunately rare, but can be highly challenging for both patients and Urologists. In a state of multiple previous surgical procedures and an immense psychological strain for the patient, urinary diversion can offer a definite, last resort surgical solution for this small group of patients. Ideally, they should be transferred to centers with experience in this field and a careful patient selection is needed. As these cases are highly complex, a multidisciplinary approach is often necessary in order to guarantee an improvement of quality of life.
This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU) or the emergency department. This document is a cooperative effort between members of two European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study groups and was coordinated by Hakan Leblebicioglu and Jordi Rello for ESGITM (ESCMID Study Group for Infections in Travellers and Migrants) and ESGCIP (ESCMID Study Group for Infections in Critically Ill Patients), respectively. A relevant expert on the subject of each section prepared the first draft which was then edited and approved by additional members from both ESCMID study groups. This article summarizes considerations regarding clinical syndromes requiring ICU admission in travellers, covering immunocompromised patients.
Background: Radiotherapy dose and target volume prescriptions for anal squamous cell carcinoma (ASCC) vary considerably in daily practice and guidelines, including those from NCCN, UK, Australasian, and ESMO. We conducted a pattern-of-care survey to assess the patient management in German speaking countries.
Methods: We developed an anonymous questionnaire comprising 18 questions on diagnosis and treatment of ASCC. The survey was sent to 361 DEGRO-associated institutions, including 41 university hospitals, 118 non-university institutions, and 202 private practices.
Results: We received a total of 101 (28%) surveys, including 20 (19.8%) from university, 36 (35.6%) from non-university clinics, and 45 (44.6%) from private practices. A total of 28 (27.8%) institutions reported to treat more than 5 patients with early-stage ASCC and 42 (41.6%) institutions treat more than 5 patients with locoregionally-advanced ASCC per year. Biopsy of suspicious inguinal nodes was advocated in only 12 (11.8%) centers. Screening for human immunodeficiency virus (HIV) is done in 28 (27.7%). Intensity modulated radiotherapy or similar techniques are used in 97%. The elective lymph node dose ranged from 30.6 Gy to 52.8 Gy, whereas 87% prescribed 50.4–55. 8 Gy (range: 30.6 to 59.4 Gy) to the involved lymph nodes. The dose to gross disease of cT1 or cT2 ASCC ranged from 50 to ≥60 Gy. For cT3 or cT4 tumors the target dose ranged from 54 Gy to more than 60 Gy, with 76 (75.2%) institutions prescribing 59.4 Gy. The preferred concurrent chemotherapy regimen was 5-FU/Mitomycin C, whereas 6 (6%) prescribed Capecitabine/Mitomycin C. HIV-positive patients are treated with full-dose CRT in 87 (86.1%) institutions. First assessment for clinical response is reported to be performed at 4–6 weeks after completion of CRT in 2 (2%) institutions, at 6–8 weeks in 20 (19.8%), and 79 (78%) institutions wait up to 5 months.
Conclusions: We observed marked differences in radiotherapy doses and treatment technique in patients with ASCC, and also variable approaches for patients with HIV. These data underline the need for an consensus treatment guideline for ASCC.