Open Access

In den Jahren 2003 und 2004 gelangen Nachweise mehrerer Flachbärlapp- Arten (Diphasiastrum) im hessischen Odenwald bei Beerfelden und Olfen. Von herausragender Bedeutung ist der Fund von D. oellgaardii, welches seit rund 50 Jahren in Hessen als erloschen galt. Daneben wurden D. complanatum und D. tristachyum an je einer Lokalität neu entdeckt. Die Diphasiastrum-Arten besiedeln an den Wuchsorten bei Beerfelden und Olfen anthropogene Sekundärstandorte (Skipiste oder Straßenböschung). Syntaxonomisch lassen sich die Bestände innerhalb der Ordnung Ulicetalia minoris zum Genisto pilosae-Callunetum oder zu einer Deschampsia-flexuosa-Vaccinium-myrtillus- Gesellschaft stellen. An beiden Wuchsorten wachsen die Flachbärlappe auf stark sauren, mäßig frischen, sandigen Lehmböden. Die Wuchsorte erhalten volle Freilandhelligkeit oder sind mäßig beschattet. Neben populationsbiologischen Parametern wie Anzahl der Sprosse und Fertilität werden Daten zur Gefährdung der Bestände genannt. Eine Neueinstufung für zwei der drei beobachteten Diphasiastrum-Arten in der Roten Liste für Hessen wird vorgeschlagen.

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.