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Mountains, with their isolated position and altitudinal belts, are hotspots of biodiversity. Their flora and fauna have been observed worldwide since the days of Alexander von Humboldt, which has led to basic knowledge and understanding of species composition and the most important driving forces of ecosystem differentiation in such altitudinal gradients. Systematically designed analyses of changes in species composition with increasing elevation have been increasingly implemented since the 1990s. Since global climate change is one of the most important problems facing the world this century, a focus on such ecosystem studies is urgently needed. To identify the main future needs of such research we analyze the studies dealing with species changes of diverse taxonomical groups along altitudinal gradients (0 to 6,400 m a.s. l.) on all continents, published during the past one to two decades. From our study we can conclude that although mountains are powerful for climate change research most studies have to face the challenge of separating confounding effects driving species assemblages along altitudinal gradients. Our study therefore supports the view of the need of a global altitudinal concept including that (1) not only one or a few taxonomical groups should be analyzed, but rather different taxonomical groups covering all ecosystem functions simultaneously; (2) relevant site conditions should be registered to reveal direct environmental variables responsible for species distribution patterns and to resolve inconsistent effects along the altitudinal gradients; (3) transect design is appropriate for analyzing ecosystem changes in site gradients and over time; (4) both the study design and the individual methods should be standardized to compare the data collected worldwide; and (5) a long-term perspective is important to quantify the degree and direction of species changes and to validate species distribution models. (6) Finally we suggest to develop experimental altitudinal approaches to overcome the addressed problems of biodiversity surveys.
Apheresis therapies for NMOSD attacks : a retrospective study of 207 therapeutic interventions
(2018)
Objective: To analyze whether 1 of the 2 apheresis techniques, therapeutic plasma exchange (PE) or immunoadsorption (IA), is superior in treating neuromyelitis optica spectrum disorder (NMOSD) attacks and to identify predictive factors for complete remission (CR).
Methods: This retrospective cohort study was based on the registry of the German Neuromyelitis Optica Study Group, a nationwide network established in 2008. It recruited patients with neuromyelitis optica diagnosed according to the 2006 Wingerchuk criteria or with aquaporin-4 (AQP4-ab)-antibody–seropositive NMOSD treated at 6 regional hospitals and 16 tertiary referral centers until March 2013. Besides descriptive data analysis of patient and attack characteristics, generalized estimation equation (GEE) analyses were applied to compare the effectiveness of the 2 apheresis techniques. A GEE model was generated to assess predictors of outcome.
Results: Two hundred and seven attacks in 105 patients (87% AQP4-ab-antibody seropositive) were treated with at least 1 apheresis therapy. Neither PE nor IA was proven superior in the therapy of NMOSD attacks. CR was only achieved with early apheresis therapy. Strong predictors for CR were the use of apheresis therapy as first-line therapy (OR 12.27, 95% CI: 1.04–144.91, p = 0.047), time from onset of attack to start of therapy in days (OR 0.94, 95% CI: 0.89–0.99, p = 0.014), the presence of AQP4-ab-antibodies (OR 33.34, 95% CI: 1.76–631.17, p = 0.019), and monofocal attack manifestation (OR 4.71, 95% CI: 1.03–21.62, p = 0.046).
Conclusions: Our findings suggest early use of an apheresis therapy in NMOSD attacks, particularly in AQP4-ab-seropositive patients. No superiority was shown for one of the 2 apheresis techniques.
Classification of evidence: This study provides Class IV evidence that for patients with NMOSD, neither PE nor IA is superior in the treatment of attacks.
All three hitherto published novels by Dana Grigorcea do explicitly refer to Romania. Had her first novel been set in the Danube Delta and her second in Bucharest, so the plot of the recently released novel "Die nicht sterben" is located in the touristic town B. (= Buşteni) at the foot of the Carpathian Mountains. Based on Bram Stoker’s Dracula as literary pre-text, the plot of "Die nicht sterben" interweaves elements of Romanian history, Romanian contemporary events as well as elements of the family history of the first-person narrator. The present paper is focused especially on the female narrator’s bodily, erotic and flying fantasies. The social and moral revolt which manifests itself first and foremost in the vampiresses’ urge to impale, subsides in the end in uncritical idyllic and narcissistic self-reflection.
Consensus on definition and severity grading of lymphatic complications after kidney transplantation
(2020)
Background: The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy.
Methods: Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres.
Results: Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention.
Conclusion: A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
TRADITIONALLY, THE COST OF DEBT IS SOLELY SEEN DEPENDENT ON FIRM OR DEBT CHARACTERISTICS. HOWEVER, INCREASED PRICE TRANSPARENCY AS CAN BE FOUND IN THE U.S. CORPORATE BOND MARKET HAS REDUCED CORPORATE BOND YIELDS. THE OBJECTIVE OF THIS WORK IS TO MEASURE THE SPILL-OVER EFFECT OF INCREASED PRICE TRANSPARENCY IN CORPORATE BONDS ON THE COST OF CORPORATE BORROWING OF SYNDICATED LOANS BY MAKING USE OF A NATURAL EXPERIMENT, I.E., THE INTRODUCTION OF THE TRACE SYSTEM FOR BONDS.
In der vorliegenden Studie wird die Gehölzentwicklung eines Eichen-Hainbuchenwald-Gebietes bei München während der letzten zwei Jahrzehnte untersucht. Eine Vorhersage der künftigen Gehölzartenzusammensetzung kann aus der Entwicklung der Verjüngung abgeleitet werden. Für die Zukunft wird ein Wechsel in der Baumartenzusammensetzung prognostiziert. So wird insbesondere der Berg-Ahorn an Bedeutung gewinnen, als Nebenbaumarten werden Esche, Ulme und Hainbuche vorhanden sein. Die für das Galio-Carpinetum charakteristische Stiel-Eiche kann sich nicht mehr erfolgreich verjüngen. Diese Arbeit gibt für den Münchener Großraum Hinweise, dass das Galio-Carpinetum seine Verbreitung der Nieder- bzw. Mittelwaldwirtschaft verdankt, also nicht in erster Linie Ausdruck der abiotischen Umweltbedingungen im Sinne des PNV-Konzepts ist. Eine syntaxonomische Neubeurteilung (insbesondere zur Abgrenzung vom Adoxo-Aceretum) dieser Pflanzengesellschaft scheint notwendig zu sein.
Two main types of sentences are traditionally distinguished in the context of semantic theories of questions and answers: declarative sentences, corresponding to statements, and interrogative sentences, corresponding to questions. The interrogative forms can be further subdivided into dialectical ones (yes-no-questions) and non-dialectical ones (constituent questions). These distinctions are made for both root and embedded sentences. The predicates that select sentential complements fall into three classes: predicates that license only declaratives, those that allow only for interrogatives, and those that embed both types of sentences. In this connection, verbs of doubt are interesting in that they allow for declaratives as well as dialectical interrogatives, while non-dialectical interrogatives do not seem to be appropriate complements.
In what follows, our main concern will be with the German verb of doubt zweifeln and its possible sentential complements. Speaker intuitions as to which constructions are grammatical or acceptable vary, particularily with respect to rare expressions like zweifeln. Therefore, interviews and corpus analysis were applied as a means to acquire reliable linguistic data. These as well as data from historical sources and from some languages other than German (esp. English and Italian) are presented and analysed. In the last section, based on the notion of ‘subjective probability’, an attempt is made at explaining the observations.
Bipolar disorder (BD) is a major psychiatric illness affecting around 1% of the global population. BD is characterized by recurrent manic and depressive episodes, and has an estimated heritability of around 70%. Research has identified the first BD susceptibility genes. However, the underlying pathways and regulatory networks remain largely unknown. Research suggests that the cumulative impact of common alleles with small effects explains only around 25–38% of the phenotypic variance for BD. A plausible hypothesis therefore is that rare, high penetrance variants may contribute to BD risk. The present study investigated the role of rare, nonsynonymous, and potentially functional variants via whole exome sequencing in 15 BD cases from two large, multiply affected families from Cuba. The high prevalence of BD in these pedigrees renders them promising in terms of the identification of genetic risk variants with large effect sizes. In addition, SNP array data were used to calculate polygenic risk scores for affected and unaffected family members. After correction for multiple testing, no significant increase in polygenic risk scores for common, BD-associated genetic variants was found in BD cases compared to healthy relatives. Exome sequencing identified a total of 17 rare and potentially damaging variants in 17 genes. The identified variants were shared by all investigated BD cases in the respective pedigree. The most promising variant was located in the gene SERPING1 (p.L349F), which has been reported previously as a genome-wide significant risk gene for schizophrenia. The present data suggest novel candidate genes for BD susceptibility, and may facilitate the discovery of disease-relevant pathways and regulatory networks.
Background: Since sorafenib has shown activity in different tumour types and gemcitabine regimens improved the outcome for biliary tract cancer (BTC) patients, we evaluated first-line gemcitabine plus sorafenib in a double-blind phase II study.
Patients and methods: 102 unresectable or metastatic BTC patients with histologically proven adenocarcinoma of gallbladder or intrahepatic bile ducts, Eastern Cooperative Oncology Group (ECOG) 0–2 were randomised to gemcitabine (1000 mg/m2 once weekly, first 7-weeks + 1-week rest followed by once 3-weeks + 1-week rest) plus sorafenib (400 mg twice daily) or placebo. Treatment continued until progression or unacceptable toxicity. Tumour samples were prospectively stained for sorafenib targets and potential biomarkers. Serum samples (first two cycles) were measured for vascular endothelial growth factors (VEGFs), vascular endothelial growth factor receptor 2 (VEGFR-2) and stromal cell-derived factor 1 (SDF1)α by enzyme-linked immunosorbent assay (ELISA).
Results: Gemcitabine plus sorafenib was generally well tolerated. Four and three patients achieved partial responses in the sorafenib and placebo groups, respectively. There was no difference in the primary end-point, median progression-free survival (PFS) for gemcitabine plus sorafenib versus gemcitabine plus placebo (3.0 versus 4.9 months, P = 0.859), and no difference for median overall survival (OS) (8.4 versus 11.2 months, P = 0.775). Patients with liver metastasis after resection of primary BTC survived longer with sorafenib (P = 0.019) compared to placebo. Patients who developed hand-foot syndrome (HFS) showed longer PFS and OS than patients without HFS. Two sorafenib targets, VEGFR-2 and c-kit, were not expressed in BTC samples. VEGFR-3 and Hif1α were associated with lymph node metastases and T stage. Absence of PDGFRβ expression correlated with longer PFS.
Conclusion: The addition of sorafenib to gemcitabine did not demonstrate improved efficacy in advanced BTC patients. Biomarker subgroup analysis suggested that some patients might benefit from combined treatment.
The vast majority of European grasslands strongly depend on the regular removal of aboveground biomass by agricultural land use, mostly grazing or mowing or a combination of both. These specific management schemes have strong influence on plant diversity and vegetation composition, depending on their particular characteristics and their intensity. For example, the presence or absence of fertilization will favour some species over others, changing plant communities accordingly. Additionally, the farmer’s choice of a specific management scheme will also depend on the abiotic site conditions. This leads to a complex set of associated factors potentially affecting the structure and diversity of grasslands.
In this study, we compiled a unique dataset of 169 differently managed grasslands (in total 202 plots), which were sampled in five regions across Germany. For each plot, we documented management characteristics, measured plant diversity and functional group composition, recorded endangered species according to red lists, and calculated Ellenberg indicator values. We assessed patterns in vegetation composition and diversity in relation to the particular management scheme, which was categorized as meadow, meadow with autumn or winter grazing (with mowing as predominant management), mown pasture (where mowing and grazing are used at roughly equal intensity), seasonal pasture (with grazing as predominant management) and year-round pasture.
Our study showed that grasslands of different management schemes significantly differed in diversity, structure and functional composition. However, it also became obvious that vegetation composition was not strictly distinguished by management alone. Local and regional characteristics such as soil conditions, size of the grassland species pool or land-use history, often played a more prominent role than land use alone. Assumingly, the interplay of those local and regional characteristics with the proportion of grazing and mowing at a particular site inhibit clear differences among our predefined management schemes. Nevertheless, species richness was the lowest in year-round pastures, moderate in meadows and highest in seasonal pastures. In contrast, year-round pastures harboured the highest mean numbers of endangered species. The dependency of a certain management scheme on site-specific environmental factors such as soil fertility, further complicated the clear separation of management effects from those of the environmental background. In summary, modern grassland management strongly shaped grassland vegetation, but today’s combination of different management practices complicated the assessment of specific land-use effects on plant diversity. Thus, neither mowing nor grazing turned out to be “the one and only” management for nature conservation. Although our results challenge long-term prognoses for future vegetation development under modern grassland management, we clearly showed that low-intensity management and the absence of fertilization promoted plant diversity, with higher values in pastures compared to meadows and mown pastures.