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Das humane Immundefizienz-Virus (HIV) benötigt für die Virus-Zellbindung spezifische Oberflächenrezeptoren auf den Wirtszellen (z. B. CD4, CXCR4, CCR5). Zurzeit basiert die Behandlung der chronisch persistierenden HIV-Erkrankung auf einer lebenslangen Chemotherapie (Highly Active Antiretroviral Therapy, ART) bestehend beispielsweise aus einer Kombination von 2 Nukleosidanaloga und einem Protease-Inhibitor, die das Virus nicht eradiziert, sondern nur in seiner Vermehrung hemmt. Dies birgt jedoch die Gefahr der Entwicklung von Resistenzen gegenüber der medikamentösen Therapie. Zusätzlich wird eine Veränderung der HIV-Rezeptorspezifität unter der Behandlung mit Antagonisten des HIV-Rezeptors CCR5 befürchtet. Cytarabin (Ara-C) ist ein Zytostatikum, das in der Therapie von Leukämien eingesetzt wird. Als Nukleosidanalogon gehört es strukturell zur selben Wirkstoffklasse wie die in der HIV-Therapie eingesetzten Nukleosidanaloga, jedoch sind bisher keine antiretroviralen Eigenschaften für Ara-C beschrieben worden. Die T-lymphoide Zelllinie C8166 ist permissiv für HIV. Die Adaptation von C8166-Zellen an das Wachstum in Gegenwart von Ara-C (Zellinie C8166rAra-C5μM) resultierte in einer signifikanten Verringerung der Oberflächenexpression der HIV-Rezeptoren CD4 und CXCR4 und zu einer verringerten Permissivität gegenüber HIV. In der vorliegenden Arbeit sollte untersucht werden, ob die Adaptation an Ara-C bei anderen T-lymphoiden Zelllinien ebenfalls zur Verringerung der Expression von CD4, und CXCR4 führt. Zusätzlich sollte untersucht werden, wie sich die Expression von CCR5 verhält. Es wurden die folgenden parentalen und an Ara-C adaptieten T-lymphoiden Zelllinien verwendet: H9, H9rAra-C600μM, MOLT4/8, MOLT4/8rAra-C100μM und MOLT4/8rAra-C200μM. Bei allen Ara-C resistenten Zelllinien kam es zu einer signifikant verringerten Expression von CD4 und CXCR4 auf mRNA und Proteinebene sowie zu einer signifikanten Erhöhung der CCR5-Expression. Im Gegensatz hierzu zeigten an AZT adaptierte H9-Zellen (H9rAZT3000μM) keine signifikante Veränderung in der Expression von CD4, CXCR4 oder CCR5 im Vergleich zu parentalen H9-Zellen. Die akute Behandlung der parentalen H9-Zellen mit niedrigen, untoxischen Ara-C Konzentrationen führte ebenfalls zu einem Anstieg der CCR5-Expression und zu einer Verminderung der CD4- und CXCR4-Expression. Zellzyklusmessungen ergaben, dass der Zellzyklus in mit untoxischen Ara-C-Konzentrationen behandelten H9-Zellen (Anstieg der Zellteilungsrate auf das 2-fache) und in allen an Ara-C adaptierten Zelllinien im Vergleich zu den unbehandelten bzw. parentalen Zellen stärker stimuliert war. Epigenetische Einflüsse könnten bei der veränderten Expression von CD4, CXCR4 und/oder CCR5 in Ara-C resistenten Zellen eine Rolle spielen. Dies erscheint jedoch unwahrscheinlich, da weder der DNA-Methylierungsinhibitor Aza-C noch der Histondeacetylase-Inhibitor SAHA die Expression von CD4, CXCR4 oder CCR5 beeinflussten. Weitere Untersuchungen müssen zeigen, ob eine Kombination von Ara-C, das zu einer Verringerung der CXCR4- und CD4-Expression und zu einer Erhöhung der CCR5-Expression führt, mit CCR5-Inhibitoren eine therapeutische Option darstellt. Möglicherweise wirkt die Verwendung von Ara-C auch einem CCR5/CXCR4-Shift entgegen.
This dissertation investigated the development of the complementiser that from the demonstrative pronoun in the Germanic languages; each chapter dealt with a different aspect. In the introduction, the terms ‘reanalysis’ and ‘analogy’ and their relevance for grammaticalisation were explained, and the issues of the chapters were presented. The second chapter introduced some information about the Germanic language family and the languages which were relevant for this investigation, namely Gothic, Old English, Old Icelandic, Old Saxon and Old High German. Previous assumptions about the diachrony of that were presented and discussed. One of these proposals which mainly draws on evidence from West Germanic involves the idea that the source construction contained two independent main clauses with a demonstrative pronoun (that) at the end of the first clause (cf. e.g. Paul 1962, § 248). In contrast to this, the Gothic evidence showed that the source construction of the reanalysis of ϸatei was not a proper paratactic construction (at least in Gothic) but already a complex construction which contained a complementiser (ei) in the appositional subordinate clause (cf. also e.g. Longobardi 1994 for the diachrony of ϸatei). This contradiction raised the question whether the analysis of the Gothic that-complementiser also applies to the diachrony of that in West Germanic. This issue was taken up in the third chapter which presented an overview of subordination and complementisers in Northwest Germanic. The aim was to show that the Northwest Germanic languages also show a subordinating particle, which functions like the Gothic ei, namely ϸe (OE), er/es (OI), the (OHG, OS). As a result, the subordinating particle could be observed in relative and adverbial clauses in all Northwest Germanic languages. In complement clauses, which are most crucial for the argumentation, the subordinating particle is found in Old English and Old Icelandic but not in Old Saxon. In Old High German, there are only combinations of the with a following pronoun, theih and theiz, in ‘Otfrids Evangelienbuch’ (see Wunder 1965). Consequently, the presence of a subordinating particle is confirmed in North and West Germanic. The fact that the patterns of subordination are quite similar in all Germanic languages suggested a unitary analysis of the development of that in Germanic was appropriate. In chapter four, the similarities and differences between the Germanic languages with respect to the development of that were explained. It was argued that the preconditions of the reanalysis were the same, whereas the consequences of the reanalysis are realised differently in each language. The most important precondition was that the appositional source construction (explained in more detail below) was generally available in Germanic. Since the demonstrative pronoun at the end of the matrix clause and the subordinating particle of the subordinate clause were adjacent, phonological combination might have been crucial for the subsequent reanalysis to take place. After reanalysis, however, different changes can be observed in the different languages. For instance, it appears that during the Old English period the final syllable of the form ϸætte was deleted (see chapter 4 for references), whereas the final –ei is still present in the Gothic ϸatei, and completely absent in Old High German and Old Saxon. The source structure of the reanalysis was discussed in detail in a separate subsection. The appositional source construction, which was already assumed for the reanalysis of Gothic ϸatei, was compared with analyses of clitic left dislocation which propose that two constituents with the same theta-role derive from a Big DP (see e.g. Grewendorf 2009, Belletti 2005). Based on the Big DP analysis of Grewendorf (2009), it was claimed that the appositional clause, introduced by the subordinating particle, is generated in the Spec of a DP, and adjoined to this DP on the surface. It was argued that this whole complement DP-node occurred in an extraposed position in OV-languages so that the verb, when it stays in-situ, does not appear between the demonstrative pronoun and the subordinating particle. The structure in (1) illustrates the syntactic source structure which is assumed to apply to the development of the complementiser that in Germanic. ...
Background: Many cancer patients seek homeopathy as a complementary therapy. It has rarely been studied systematically, whether homeopathic care is of benefit for cancer patients. Methods: We conducted a prospective observational study with cancer patients in two differently treated cohorts: one cohort with patients under complementary homeopathic treatment (HG; n=259), and one cohort with conventionally treated cancer patients (CG; n=380). For a direct comparison, matched pairs with patients of the same tumour entity and comparable prognosis were to be formed. Main outcome parameter: change of quality of life (FACT-G, FACIT-Sp) after 3 months. Secondary outcome parameters: change of quality of life (FACT-G, FACIT-Sp) after a year, as well as impairment by fatigue (MFI) and by anxiety and depression (HADS). Results: HG: FACT-G, or FACIT-Sp, respectively improved statistically significantly in the first three months, from 75.6 (SD 14.6) to 81.1 (SD 16.9), or from 32.1 (SD 8.2) to 34.9 (SD 8.32), respectively. After 12 months, a further increase to 84.1 (SD 15.5) or 35.2 (SD 8.6) was found. Fatigue (MFI) decreased; anxiety and depression (HADS) did not change. CG: FACT-G remained constant in the first three months: 75.3 (SD 17.3) at t0, and 76.6 (SD 16.6) at t1. After 12 months, there was a slight increase to 78.9 (SD 18.1). FACIT-Sp scores improved significantly from t0 (31.0 - SD 8.9) to t1 (32.1 - SD 8.9) and declined again after a year (31.6 - SD 9.4). For fatigue, anxiety, and depression, no relevant changes were found. 120 patients of HG and 206 patients of CG met our criteria for matched-pairs selection. Due to large differences between the two patient populations, however, only 11 matched pairs could be formed. This is not sufficient for a comparative study. Conclusion: In our prospective study, we observed an improvement of quality of life as well as a tendency of fatigue symptoms to decrease in cancer patients under complementary homeopathic treatment. It would take considerably larger samples to find matched pairs suitable for comparison in order to establish a definite causal relation between these effects and homeopathic treatment.
Aim: To study the changes in leiomyoma volume following uterine artery embolization (UAE) and to correlate these changes with the initial leiomyoma volume and location within the uterus and to evaluate the impact of preprocedural prediction of the best tube angle obliquity for visualization of the uterine artery origin using 3D-reconstructed contrast-enhanced MR angiography (CE-MRA) on the radiation dose, fluoroscopy time and contrast medium volume used during UAE. Materials and Methods: The study was performed in two parts. The first part was retrospectively done on 28 patients (age range: 37-57 years, mean: 48 years, SD: 4.81) in whom UAE was performed. All leiomyomas in all patients were evaluated. In total, 84 leiomyomas were evaluated. MRI studies were performed before, 3 months and 1 year after UAE. The volumes and location of each leiomyoma in each patient were evaluated in consensus by two radiologists. The second part included 40 consecutive patients (age range: 37-56 years, mean: 46 years, SD: 4.49) and was done in a controlled prospective/retrospective manner. In 20 sample patients (prospective part) pre-procedural prediction of the best tube angle obliquity was predicted using 3D-reconstructed CE-MRA and provided to the interventionalist. 3D-reconstruction was done using Inspace application. The radiation dose, fluoroscopy time and contrast medium volume for those patients were compared with the data of the last 20 procedures (control) performed by the same interventionalist (retrospective part). Results: For the first part the mean pre-embolization volume was 51.6 cm3 range:0.72-371.1cm3, SD=79.3). At 3-month follow-up 83 (98.8%) leiomyomas showed a mean volume reduction of 52.62% (range: 12.79–96.67%, SD=21.85) and 1 leiomyoma (1.2%) increased in volume. At 1-year follow-up 5 (6%) leiomyomas were not detectable, 72 (85.7%) showed a further mean of 20.5% (range: 2.52–58.72%, SD=11.92) volume reduction compared to the 3-month follow-up volume and 7 (8.3%) leiomyomas increased in volume. A statistically significant (p=0.026 at 3-month, p=0.0046 at 1-year) difference in percentage of volume change was observed based on leiomyoma location; submucous leiomyomas showed the largest volume reduction. The initial leiomyoma volume showed a weak negative correlation (Spearman's correlation-coefficient =-0.35 at 3m and -0.36 at 1y) with the leiomyoma volume change. For the second part the tube angle prediction resulted in a significant reduction of the radiation dose utilized (p<0.001), fluoroscopy time (p=0.002) and contrast medium volume (p<0.001) for the sample patients when compared with the control patients. The overall radiation dose was reduced from a mean of 11044 μGym2 to a mean of 4172.5 μGym2, fluoroscopy time was reduced from a mean of 15.45 minutes to 8.81 minutes and contrast medium volume was reduced from a mean of 135 ml to 75 ml. Conclusion: UAE results in significant leiomyoma volume reduction at 3-month and 1- year follow-up. The leiomyoma location plays an important role in volume changes while the initial leiomyoma volume plays a minor role. Pre-procedural prediction of the best tube angle obliquity for visualization of the origin of the uterine artery using 3D-reconstructed CE-MRA results in a significant reduction of the radiation dose, fluoroscopy time and contrast medium volume used during UAE.
Zielstellung: Die Untersuchung des klinischen Effekts der topischen subgingivalen Applikation eines 14%igen Doxycyclin-Gels zusätzlich zu mechanischem Debridement (DEB) während der unterstützenden Parodontitistherapie (UPT) auf die Furkationsbeteiligung mehrwurzeliger Zähne. Material und Methoden: Bei 39 UPT-Patienten mit zumindest vier Zähne mit Sondierungstiefen (ST) ≥ 5 mm und Bluten nach Sondieren (BOP) (davon mindestens eine Furkationsstelle) erfolgte ein DEB aller Stellen mit ST ≥ 4mm. Nach Randomisierung wurde bei 19 Patienten zusätzlich ein 14%iges Doxycyclin-Gel subgingival instilliert (DEB & DOXY). Die klinischen Parameter wurden vor der Therapie (Baseline) sowie 3, 6 und 12 Monate danach erhoben. Der zusätzliche Nutzen des Doxycyclin-Gels wurde bestimmt als 1) Verbesserung der Furkationsbeteiligung und 2) Einfluss auf die Häufigkeit der Reinstrumentierung während der 12 Monate. Ergebnisse: Insgesamt wurden 323 Furkationsstellen (Grad 0: 160; Grad I: 101; Grad II: 18; Grad III: 44) behandelt (DEB: 165; DEB & DOXY: 158). DEB & DOXY resultierte nach 3 Monaten in einer stärkeren Reduktion der Furkationsbeteiligung als alleiniges DEB (p = 0,041). Allerdings führte DEB & DOXY zu keiner Reduktion der Häufigkeit der Reinstrumentierung während der 12 Monate. Schlussfolgerung: Die topische subgingivale Doxycyclingabe zusätzlich zu DEB hat einen kurzzeitigen Effekt auf die Furkationsbeteiligung. Aber es reduziert nicht die Häufigkeit der Reinstrumentierung über einen Zeitraum von 12 Monaten.
Osteosynthesematerialien aus resorbierbaren Materialien finden aufgrund ihrer zunehmenden biomechanischen Stabilität eine immer höhere Akzeptanz. Die vorgelegte Untersuchung vergleicht die knöcherne und okklusale Stabilität von solchen Osteosynthesesystemen aus resorbierbaren Materialien im Vergleich mit konventionellen Titanminiplatten in der orthognathen Chirurgie. Untersucht wurden 100 Patienten in einem Nachsorgezeitraum von bis zu 4 Jahren. Die Beurteilung erfolgte klinisch und röntgenologisch anhand von Fernröntgen-Seiten-Aufnahmen. In die Studie gingen ein fünfzig Patienten, die mit resorbierbaren Platten versorgt worden waren, 16 davon mit Polylactid-Polyglycolid Copolymer Platten und 34 Patienten mit 70:30 Poly-L/DL-Lactid Copolymer Platten; fünfzig weitere Patienten, versorgt mit einem Titanminiplattensystem wurden als Kontrollgruppe gewertet. Zunächst konnte gezeigt werden, dass die Gruppen zueinander homogen waren, es unterschieden sich die effektiven intraoperativen Bewegungen von Studien und Kontrollgruppe statistisch nicht signifikant, gleiches galt im Vergleich der resorbierbaren Platten untereinander. Bei der Datenauswertung konnte nachgewiesen werden, dass die absolute und relative Instabilität weder zwischen den Studiengruppen noch der Kontrollgruppe noch zwischen den resorbierbaren Plattensystemen untereinander signifikant unterschiedlich war. Die postoperative 1-Jahres Stabilität unterschied sich dabei ebenfalls nicht signifikant von der 4-Jahres Stabilität. Alle untersuchten Osteosynthesesysteme zeigten im Oberkiefer eine höhere Stabilität als im Unterkiefer und gleichzeitig eine größere Stabilität in der anterior-posterioren Richtung als in der inferior-superioren Richtung. Es wurden keine signifikanten Unterschiede zwischen der klinischen Stabilität von PLGA oder P(L/DL)LA-Miniplatten gefunden. Allerdings konnte auch belegt werden, dass der Einsatz resorbierbarer Unterkieferosteosynthesen eine sehr gute Compliance des Patienten bezüglich geführter Okklusion und Nachsorge voraussetzte. Als nachteilig bei den resorbierbaren Systemen konnte sowohl für den Oberkiefer als auch für den Unterkiefer eine leicht erhöhte Mobilität bis zu 6 Wochen nach der Operation festgestellt werden, die jedoch in keinem Fall das operative Ergebnis beeinflusste. Vielmehr ermöglichten resorbierbare Osteosynthesen eine bessere postoperative okklusale Einstellung. Weiteren Nachteil der resorbierbaren Osteosynthesesysteme bedeuten die hohen Kosten, die heute noch weit über denen von Titanminiplatten liegen. Zukünftige Entwicklungen gehen dahin, das Plattendesign weiter zu optimieren, wie z.B. neuartige pinbasierte Fixationssysteme einzusetzen, wie sie in der Extremitätenchirurgie teils bereits benutzt werden. Fernziel für die Zukunft ist die Entwicklung eines resorbierbaren Osteosynthesesystems, das sich bei geringen Herstellungskosten und miniaturisiertem Plattendesign auch minimalinvasiv einbringen lässt.
The documentation of life on Earth, that is, the inventorization of nature and the naming and classification of organisms found therein, is a major task for biologists today and a fundamental precondition for nature conservation efforts. This study aimed at contributing to the inventory of amphibians and reptiles in selected, previously understudied ecoregions of Bolivia. I strove to document diversity patterns and seek possible ecological and historical reasons for these patterns. Special attention was paid to the Chiquitano Region situated in the eastern lowlands of Bolivia in a climatic transition zone between the humid evergreen Amazon Forests and the deciduous thorn-scrub vegetation of the Gran Chaco. In congruence with its location in the transition zone, the Chiquitano Region displays a mosaic of habitats: The vegetation is dominated by the endemic Chiquitano Dry Forest, which is probably the largest extant patch of Seasonal Dry Tropical Forest, with enclaves of savanna, the western outliers of the Cerrado biome of central Brazil. Taxonomic revisions: The taxonomic data in this study are used as a tool to measure biodiversity, to assess biogeographic relationships, and to evaluate conservation needs. Since all is predicated on the taxonomic decisions made, an adequate taxonomy is essential, and taxonomy can be regarded as the foundation of this study. The methodology encompassed a variety of herpetological field techniques, such as different survey methods, preparation and documentation of voucher specimens, recording of frog calls, and herpetological laboratory techniques, such as morphology, molecular procedures with mtDNA, phylogenetic analyses, and bioacoustic analysis and descriptions of frog calls. A total of 1251 specimens belonging to 200 species were obtained during this study, including 87 amphibian and 123 reptile species. This constitutes about 36% of the herpetofauna currently known for Bolivia, about 34% of the amphibians currently known for Bolivia and about 40% of the reptiles, respectively. In the course of this study, a new species of frog was described from the study site Caparu in the eastern lowlands of Bolivia; this species, Hydrolaetare caparu Jansen, Gonzales & G. Köhler 2007, differs from the other two congeners in external morphology (e.g., lateral fringes and relative length of fingers, size of palmar tubercle, webbing of toes, and colouration) and advertisement call. Two new colubrid snake species were also described from the study site San Sebastián. Thus far, both are known only from the Chiquitano Region, Provincia Ñuflo de Chávez. Phalotris sansebastiani Jansen & G. Köhler 2008 differs from all the other species in the genus in having a triangular projection of the red snout colouration reaching onto the parietals. Xenopholis werdingorum Jansen, Gonzales & G. Köhler 2009 can be identified as a member of the genus Xenopholis by its vertebral morphology. It differs from the other two species of Xenopholis in having a unique uniform dorsal colour pattern, and from X. scalaris in having two prefrontals and a narrow septum within the neural spine and perpendicular to its long axis as evident in the x-ray images. A review of a small collection of pitvipers from different lowland localities and from the Inter-Andean dry valleys of the region of Pampagrande revealed one new species of Bothrops and one of Bothrocophias (both to be formally described elsewhere). The two pitviper species differ morphologically and genetically from their congeners. The results of a brief review of a small collection of frogs of the genus Scinax (Anura: Hylidae) from different localities in the lowlands, together with analyses of their bioacoustics, suggest an unknown cryptic diversity in Bolivian species of Scinax cf. fuscomarginatus and allies. However, further studies are necessary to clarify the taxonomic status of these populations. In addition, this study provides new data on the morphology (e.g., pholidosis) of snakes, many of them previously known only from few museum specimens. Keys to the Bolivian lizard species of Cercosaura and the Bolivian snake species of Chironius, Clelia, Liophis, Lystrophis, Phalotris, and Xenodon are presented here for the first time. New information on distribution includes many range extensions of amphibian and reptile species, such as five new country records (one frog species, four snake species) and six new departmental records (two frog species, four snake species). Observations on ecology and natural history: Several observations on ecology and natural history were made during field work. Visual signaling, an aspect of territorial behavior that was already known for several species of the genus Phyllomedusa, could be described for the first time for Phyllomedusa boliviana (Jansen & J. Köhler 2007). Furthermore, during audio surveys of an anuran community at the study site San Sebastián from 2005 to 2007, a decline of certain amphibian populations was observed in the rainy season 2006/2007 (Jansen et al., in press). This is possibly related to an extreme drought in the dry season of 2006 where 158 consecutive days without rainfall were recorded. In addition, a new method for measuring intensity of anuran choruses by means of a continuous sound pressure metre was developed (Jansen 2009). The method was suitable to detect calling phenology (during one night), as well as differences in calling activity (between two nights). Biodiversity and biogeographical relationships: Species lists were compiled at the six study sites Pampagrande, Los Volcanes, San Sebastián, Caparú, El Espinal und El Corbalan. The total amphibian and reptile species numbers observed ranged from 37 to 101 with the highest species numbers in San Sebastián (101) and Caparú (89) and the lowest in Los Volcanes (37) and El Espinal (41). A preliminary species list of the herpetofauna of the Chiquitano Region was presented, including 60 amphibian and 84 reptile species. The majority of the amphibians of the Chiquitano Region are classified predominantly as inhabitants of open formations (41 species, 68.3%). Interestingly, even the majority of species recorded from the Chiquitano Dry Forest (32 species) are usually associated with open formations (22 species, 66.7%), followed by the number of species associated with open and forest formations (8 species, 24.4%). Only two of the observed species (6.0%) are predominant forest dwellers. The amphibian assemblage of the Chiquitano Region is most similar in composition to that of the Cerrado biome: 46 species (76.7%) occur in the Cerrado as well, and three species are regarded as Cerrado endemics (5.0%). The Chiquitano Region shares considerably fewer amphibian species with the other biomes (Amazon: 22 species, 36.7%; Gran Chaco: 13 species, 21.7%; Caatinga: 16 species, 26.7%). The reptile assemblage also has significant affinities to the Cerrado, which can be seen in the high proportion of reptile species distributed in that biome (68 species; 81.0%). Affinities to the other biomes are as follows: Amazon (48 species, 57.1%), Chaco (37 species, 40.1%), and Caatinga (30 species, 35.7%). When arranged in mutually exclusive biome categories, reptiles and amphibians showed similar patterns so that the majority of both amphibians and reptiles of the Chiquitano Region can be regarded as widespread. The high proportion of reptile species probably endemic to this region (5 species, 6.0%) is remarkable (i.e. Tropidurus xanthochilus, Apostolepis phillipsi, Phalotris sansebastiani, Xenopholis werdingorum, and Micrurus diana). In an analysis of the biodiversity patterns and biogeographical relationships of the herpetofauna of the study sites, these sites were compared with literature data from 37 localities and included in a presence/absence matrix with a total of 657 amphibian and reptile species in the surrounding South American biomes Amazon, Cerrado and Gran Chaco. The biogeographic relationships between these sites were evaluated using the Coefficient of Biogeographic Resemblance (CBR), cluster analysis, and multidimensional scaling (MDS) of sites. The analyses were first conducted on amphibians and reptiles combined, and than group-specific each for amphibians, reptiles, lizards, and snakes, separately. A “bias-reduced analysis” was developed for a better understanding of the affinities of the amphibians. In this analysis, e.g., the distinct habitat types of the Chiquitano Region, the Chiquitano Dry Forest and the Cerrado were taken into account. Analyses of the biodiversity patterns revealed that the sites in the Amazon comprise highest species numbers, as expected, followed successively by the sites in the Cerrado biome and sites in-between the two biomes. Within the eastern lowlands of Bolivia, the Chiquitano Region is the most rich in species. Comparing it with the other South American sites, the Chiquitano Region has a surprisingly high alpha diversity, especially in amphibians. The microgeographic variation in species composition (beta diversity) in the Chiquitano Region is also remarkably high and obviously related to the mosaic character of the vegetation and habitats. However, the bias-reduced analysis revealed that the amphibian fauna of the open areas and savannas at Hacienda San Sebastián (with 36 species in the Cerrado and pastureland) was one of the most species-rich savanna sites known for amphibians in South America. Considering that the Hacienda San Sebastián site is only ca. 3300 ha (= 1.29 amphibian species per km2), this outcome is particularly suprising. The results of the analyses of the biogeographical relationships suggest that the herpetofauna of Bolivia’s lowlands, including the Beni, the Pantanal and the Chiquitano Region, is as distinct from the herpetofauna of the Gran Chaco, Amazon, and Cerrado as these biomes are from each other. The Chiquitano herpetofauna in particular represents a unique and well-defined herpetofaunal assemblage when compared to all surrounding localities and biomes. This is supported by high CBR-values, findings from the cluster analysis, as well as a clear separation of the Chiquitano sites in the MDS. Biogeographic relations exist in all the surrounding biomes, but are strongest to Cerrado, followed by the Amazon. This study strongly suggests that the Chiquitano herpetofauna is composite and has multiple affinities. This is congruent with a well-defined Chiquitano flora, avifauna and mammalian fauna, suggesting a similar history. The bias-reduced analysis revealed a more detailed picture of the biogeographic relations of the Chiquitano Region, especially the Chiquitano Dry Forest. I argue here that the Chiquitano Dry Forest herpetofauna is a “young”, and “former savanna herpetofauna”. Whereas the Chiquitano Dry Forest is rather poor in amphibian and reptile species, and endemics are lacking from this forest type, the isolated Cerrado enclaves are especially diverse in species and probably contain locally endemic species, such as Phalotris sansebastiani and Xenopholis werdingorum. The colonization of the young Chiquitano Dry Forest may have taken place from savannas by mainly open area species, and only briefly through the Amazon. The results emphasise the importance of bias-reduction in studies of biogeography, e.g., by using group-specific analyses or by taking into account criterias as area size and heterogeneity of compared sites. The different biogeographic patterns of reptiles and amphibians of the Andean valleys indicate a different history of these two groups. In regard to reptiles, dispersals and withdrawals into the valleys in warm humid and dry cool periods in the Pleistocene seem likely, supported by a relation between the valleys and the dry lowland (e.g., Chaco). However, it is more plausible that, during these climatic fluctuations, amphibians migrated to adjacent, more humid regions, such as Yungas. The study verified the known patterns of sister-species pairs in the Inter-Andean Dry Forest and the lowlands. Additionally, pairs of populations with slight differences in morphology were found in the valleys and in the lowlands (Cercosaura parkeri and Xenodon rhapdocephalus). Further studies must test the taxonomic status of these populations. The discovery of new species of Bothrops and Bothrocophias from the Andean valleys has several implications, and possible reasons for the high endemism in the dry valleys are discussed. Conservation and outlook: The high local alpha and beta diversity of the Chiquitano herpetofauna shows that this is a region of complex faunal interaction, which reflects the present heterogeneity of the region, but which is possibly also related to a complex geological and environmental history. The Chiquitano Region can be assessed as a region of distinct regional herpetofaunal diversity charaterised by small scale diversity patterns. It therefore merits recognition as a unique ecoregion, and conservation effort should be increased. Further research is necessary to solve the taxonomic problems addressed in this study. Moreover, future work should be directed towards the development and institution of longterm monitoring programs to evaluate the effects of climate change and changes in land-use on biodiversity, especially that of the Chiquitano Region.
Orthopoxviruses are large DNA viruses that replicate within the cytoplasm of infected cells encoding over a hundred different proteins. The orthopoxviral 68k ankyrin‐like protein (68k‐ank) is highly conserved among orthopoxviruses, and this study aimed at elucidating the function of 68k‐ank. The 68k‐ank protein is composed of four ankyrin repeats (ANK) and an F‐box‐like domain; both motifs are known proteinprotein interaction domains. The F‐box is found in cellular F‐box proteins (FBP), crucial components of cellular E3 ubiquitin (Ub) ligases. With yeast‐two‐hybrid screens and subsequent co‐immunoprecipitation analyses, it was possible to identify S‐phase kinase‐associated protein 1a (Skp1a) as a cellular counterpart of 68k‐ank via binding to the F‐box‐like domain. Additionally, Cullin‐1 was co‐precipitated, suggesting the formation of a viral‐cellular SCF E3 Ub ligase complex. Modified Vaccinia virus Ankara (MVA) ‐ being attenuated and unable to replicate in most mammalian cell lines due to a block in morphogenesis – nevertheless, expresses its complete genetic information attributing to its properties as promising vector vaccine. Conservation of 68k‐ank as the only ANK protein encoded by MVA implied a substantial role of this viral factor. Hence, its function in the viral life cycle was assessed by studying a 68k‐ank knock‐out MVA. A mutant phenotype manifested in nonpermissive mammalian cells characterized by a block succeeding viral early gene expression and by a reduced ability of the virus to shutoff host protein synthesis. Studies with MVA encoding a 68k‐ank F‐box‐like domain truncated protein revealed that viral‐cellular SCF complex formation and maintenance of viral gene expression are two distinct, unrelated functions fulfilled by 68k‐ank. Moreover, K1, a well‐described VACV host range factor of the ANK protein family, is able to complement 68k‐ank function. This suggests that gene expression of MVA putatively depends on the ANKs encoded in 68k‐ank. In addition to the important findings in vitro, first virulence studies with the mouse pox agent, ectromelia virus (ECTV) deleted of the 68k‐ank ortholog (C11) suggested that this factor contributes to ECTV virulence in vivo.
Ziel der vorliegenden Arbeit war es, Qualität und Struktur der notärztlichen Versorgung von Patienten mit akutem Koronarsyndrom im Rahmen des „Netzwerks Herzinfarkt“ im Zeitraum vom 01.04. – 31.12. 2003 zu beurteilen. Hierzu wurden aus den von der Rettungsleitstelle zur Verfügung gestellten Daten 1588 Notarzteinsätze ausgewählt, die dem Notruf nach einem akuten Koronarsyndrom entsprechen könnten. Aus diesen 1588 Einsatzprotokollen wurden 506 herausgefiltert, bei denen die notärztliche Diagnose tatsächlich einem akuten Koronarsyndrom entsprach; diese wurden der definitiven Bearbeitung zugeführt. Zunächst wurde die gesamte Dokumentation im DIVI-Einsatzprotokoll auf Vollständigkeit und Schlüssigkeit überprüft, in einem zweiten Schritt dann die Qualität der medikamentösen und Basisversorgung der Patienten beurteilt. In diesen Bereichen waren die wesentlichen Ergebnisse die ausgesprochen ungenaue Dokumentation der Einsatzzeiten sowie der Anamnese und die in 37,5% aller Fälle fehlende Anfertigung eines 12-Ableitungs-EKG´s. Bei der Therapie fiel ein allgemein sehr zurückhaltender Einsatz von Betablockern, ASS und Heparin auf. Ein Vergleich der präklinisch als akuter Myokardinfarkt diagnostizierten Patientengruppe mit der restlichen Stichprobe erbrachte keine signifikanten Unterschiede bezüglich der untersuchten Parameter. Die Sensitivität der notärztlichen Infarktdiagnostik betrug 98,4%, die Spezifität 78,6%. Die benötigten prästationären und innerklinischen Zeiten (Arztkontakt bis zur Einlieferung, contact-balloon, door-balloon-Zeit) blieben im Rahmen bzw. deutlich unter den von den Leitlinien der Deutschen Gesellschaft für Kardiologie geforderten Zeiten. Im Follow-Up-Beobachtungszeitraum (6 Monate) wiesen 97,6% der Rettungsdienstpatienten ein komplikationsloses Überleben auf. Signifikante Ergebnisse konnten bei der Evaluation der Bedeutung der notärztlichen Fachrichtung für die Behandlungsqualität gezeigt werden. So schnitten die Einsatzprotokolle von Chirurgen und Allgemeinmedizinern in der durchgeführten allgemeinen Beurteilung deutlich schlechter ab als die der Internisten und Anästhesisten. Dieser Trend bestätigte sich auch in der konkreten Analyse der medikamentösen Therapie, jeweils gemessen an den gültigen Leitlinien. Insgesamt war die Qualität der notärztlichen Behandlung der Patienten mit akutem Koronarsyndrom als in den genannten Punkten verbesserungsbedürftig, in den übrigen Parametern jedoch als gut anzusehen. Insbesondere im Hinblick auf die notärztliche Fachrichtung scheint eine strukturiertere Weiterbildung zum Erwerb der Zusatzbezeichnung „Notfallmedizin“ empfehlenswert. Die niedrige Komplikationsrate der präklinisch als akuter Myokardinfarkt diagnostizierten und direkt ins Interventionszentrum verbrachten Patienten im Follow-Up-Zeitraum und der deutliche Unterschied zu den Transferpatienten illustriert den Behandlungsbenefit, der aus einer verzögerungsfreien interventionellen Therapie des akuten Myokardinfarkts resultiert.
Clinical application of transcranial Doppler for detection of cerebral emboli during cardiac surgery
(2010)
Objective: Neurologic injury is one of the most damaging complications for cardiac surgery. How to decrease neurologic impairment by improving perioperative monitoring remains a challenge for both cardiac surgeons and anesthetists. For this reason, transcranial doppler (TCD) has been widely used in cerebral monitoring during cardiac surgery. In this study, two experiments of clinical application of TCD for detection of cerebral emboli during cardiac surgery were to be done. One was “Solid and gaseous cerebral emboli during valvular surgery are significantly reduced with axillary artery cannulation”. The other was “Do intraoperative cerebral embolic signals differ between valvular surgery (VS) and CABG”. Methods: In experiment one, 20 valve and combined procedures with aortic cannulation (AoC group) were compared to 18 procedures with axillary cannulation (AxC group) in a prospective non-randomized study. In experiment two, 18 VS patients and 18 CABG patients were matched by extracorporeal circulation (ECC) time retrospectively. Intraoperative monitoring of both middle cerebral arteries was performed with TCD discriminating between solid and gaseous embolic signals (ES). Results: In experiment one, the AxC group had less solid ES than the AoC group (38±22 vs 55±25, P<0.05), but no significant difference was found in gaseous (501±271 vs 538±333, P>0.05) and total (539 ± 279 vs 593 ± 350, P>0.05) ES. The AxC group had less solid ES during arterial cannulation (2.1±1.5 vs 6.6±3.6, P<0.05) and during aortic cross-clamp time (4.4 ±3.1 vs 10.2 ± 5.1, P<0.05) than the AoC group. During ECC, gaseous ES was not significantly different between groups (398±210 vs 448±291, P>0.05). However, AxC showed less gaseous ES (85±68 vs 187±148, P<0.05) and less gaseous ES per minute (1.8±1.5 vs 4.5±3.2, P<0.05) during weaning off extracorporeal circulation than the AoC group. No significant difference in gaseous ES (313±163 vs 261±189, P>0.05) and gaseous ES per minute (3.1±2.2 vs 2.8±2.2, P>0.05) was found between groups from bypass start to aortic declamping. No neurologic complications occurred. In experiment two, no significant difference was found in solid (38±20 vs 40±26, P>0.05) or gaseous (457±263 vs 412±157, P>0.05) ES between the VS and CABG group during the whole recording time. During ECC, solid ES (20±10 vs 24±19, P>0.05) and gaseous ES (368±230 vs 317±157, P>0.05) were comparable between groups. Specifically, during weaning off ECC, the VS group had more gaseous ES/min (5.6±3.6 vs 3.1±1.2, P<0.05) than the CABG group. But this difference in gaseous ES/min was not significant during the period from bypass start to aortic declamping (2.5±1.8 vs 3.0±1.8, P>0.05). Conclusion: Cerebral embolization does occur during cardiac surgery. Through these two experiments, we demonstrated the feasibility and importance of clinical application of transcranial doppler for detection of cerebral emboli during cardiac surgery. Due to the diversity in clinical application of TCD, it is impossible to compare the number of ES between different research centers. More unified standards should be drawn in order to make wider clinical application possible. Up till now, no robust evidence shows the correlation between intraoperative ES and postoperative neurological impairment. The research on intraoperative ES and postoperative neurological impairment should rely on a complete concept.