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The script of Caryl Churchill’s short play Hot Fudge (like several other plays by this author) contains detailed directions for overlapping conversation. At certain points in the play these may be contributing to a number of effects similar to those described for the naturally occurring ‘collaborative floor’, such as enthusiasm and mutual support. The importance of an interactive approach to constructed conversation is pointed out in the article, particularly that of analysing the overlapped speaker’s response to appreciate the discursive significance of the overlapping turn. For instance, acknowledging and/or reusing the other speaker’s overlapping formulations in a non-oppositional format can show an understanding of these contributions as collaboratively oriented. Therefore, such an interpretation of overlapping dialogue in a dramatic text will affect the reader’s understanding of the interpersonal context (e.g. dominance-seeking/mutual support/collaboration between pairs of speakers). In particular, this approach is taken to show how certain kinds of overlapping similar to those described for the naturally occurring conversation can be used dramatically to supportive rather than conflictive ends. Overall, it is shown how the dramatic characters’ interpersonal orientations become inferable from their use of certain dialogic options.
Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.
Purpose: The aim of this study was to analyze systematically the influence of the relative centrifugation force (RCF) on leukocytes, platelets and growth factor release within fluid platelet-rich fibrin matrices (PRF).
Materials and methods: Systematically using peripheral blood from six healthy volunteers, the RCF was reduced four times for each of the three experimental protocols (I–III) within the spectrum (710–44 g), while maintaining a constant centrifugation time. Flow cytometry was applied to determine the platelets and leukocyte number. The growth factor concentration was quantified 1 and 24 h after clotting using ELISA.
Results: Reducing RCF in accordance with protocol-II (177 g) led to a significantly higher platelets and leukocytes numbers compared to protocol-I (710 g). Protocol-III (44 g) showed a highly significant increase of leukocytes and platelets number in comparison to -I and -II. The growth factors’ concentration of VEGF and TGF-β1 was significantly higher in protocol-II compared to -I, whereas protocol-III exhibited significantly higher growth factor concentration compared to protocols-I and -II. These findings were observed among 1 and 24 h after clotting, as well as the accumulated growth factor concentration over 24 h.
Discussion: Based on the results, it has been demonstrated that it is possible to enrich PRF-based fluid matrices with leukocytes, platelets and growth factors by means of a single alteration of the centrifugation settings within the clinical routine.
Conclusions: We postulate that the so-called low speed centrifugation concept (LSCC) selectively enriches leukocytes, platelets and growth factors within fluid PRF-based matrices. Further studies are needed to evaluate the effect of cell and growth factor enrichment on wound healing and tissue regeneration while comparing blood concentrates gained by high and low RCF.
The etiology and pathogenesis of rheumatoid arthritis (RA) are marked by a complex interplay of various cell populations and is mediated by different signaling pathways. Traditionally, therapies have primarily focused on pain relief, reducing inflammation and the recovery of joint function. More recently, however, researchers have discussed the therapeutic efficacy of autologous platelet-rich plasma (PRP). The main objective of this work is to examine the influences of platelet-released growth factor (PRGF) on human synoviocytes under inflammatory conditions. Additionally, it is checked to which extend treatment with platelet concentrate influences the release of cytokines form synoviocytes. For this purpose, an in vitro RA model was created by stimulating the cells with the TNF-α. The release of cytokines was measured by ELISA. The cytokine gene expression was analyzed by real-time PCR. It has been observed that the stimulation concentration of 10 ng/ml TNF-α resulted in a significantly increased endogenous secretion and gene expression of IL-6 and TNF-α. The anti-inflammatory effect of PRGF could be confirmed through significant reduction of TNF-α and IL-1β. An induced inflammatory condition seems to cause PRGF to inhibit the release of proinflammatory cytokines. Further study is required to understand the exact effect mechanism of PRGF on synoviocytes.
Correction to: Nature Communications https://doi.org/10.1038/s41467-017-01045-x, published online 31 October 2017
It has come to our attention that we did not specify whether the stimulation magnitudes we report in this Article are peak amplitudes or peak-to-peak. All references to intensity given in mA in the manuscript refer to peak-to-peak amplitudes, except in Fig. 2, where the model is calibrated to 1 mA peak amplitude, as stated. In the original version of the paper we incorrectly calibrated the computational models to 1 mA peak-to-peak, rather than 1 mA peak amplitude. This means that we divided by a value twice as large as we should have. The correct estimated fields are therefore twice as large as shown in the original Fig. 2 and Supplementary Fig. 11. The corrected figures are now properly calibrated to 1mA peak amplitude. Furthermore, the sentence in the first paragraph of the Results section ‘Intensity ranged from 0.5 to 2.5 mA (current density 0.125–0.625 mA mA/cm2), which is stronger than in previous reports’, should have read ‘Intensity ranged from 0.5 to 2.5 mA peak to peak (peak current density 0.0625–0.3125 mA/cm2), which is stronger than in previous reports.’ These errors do not affect any of the Article’s conclusions. Correct versions of Fig. 2 and Supplementary Fig. 11 are presented below as Figs. 1, 2.
Transcranial electrical stimulation has widespread clinical and research applications, yet its effect on ongoing neural activity in humans is not well established. Previous reports argue that transcranial alternating current stimulation (tACS) can entrain and enhance neural rhythms related to memory, but the evidence from non-invasive recordings has remained inconclusive. Here, we measure endogenous spindle and theta activity intracranially in humans during low-frequency tACS and find no stable entrainment of spindle power during non-REM sleep, nor of theta power during resting wakefulness. As positive controls, we find robust entrainment of spindle activity to endogenous slow-wave activity in 66% of electrodes as well as entrainment to rhythmic noise-burst acoustic stimulation in 14% of electrodes. We conclude that low-frequency tACS at common stimulation intensities neither acutely modulates spindle activity during sleep nor theta activity during waking rest, likely because of the attenuated electrical fields reaching the cortical surface.
Ribosome recycling orchestrated by the ATP binding cassette (ABC) protein ABCE1 can be considered as the final—or the first—step within the cyclic process of protein synthesis, connecting translation termination and mRNA surveillance with re-initiation. An ATP-dependent tweezer-like motion of the nucleotide-binding domains in ABCE1 transfers mechanical energy to the ribosome and tears the ribosome subunits apart. The post-recycling complex (PRC) then re-initiates mRNA translation. Here, we probed the so far unknown architecture of the 1-MDa PRC (40S/30S·ABCE1) by chemical cross-linking and mass spectrometry (XL-MS). Our study reveals ABCE1 bound to the translational factor-binding (GTPase) site with multiple cross-link contacts of the helix–loop–helix motif to the S24e ribosomal protein. Cross-linking of the FeS cluster domain to the ribosomal protein S12 substantiates an extreme lever-arm movement of the FeS cluster domain during ribosome recycling. We were thus able to reconstitute and structurally analyse a key complex in the translational cycle, resembling the link between translation initiation and ribosome recycling.
The endoplasmic reticulum–mitochondria encounter structure (ERMES) connects the mitochondrial outer membrane with the ER. Multiple functions have been linked to ERMES, including maintenance of mitochondrial morphology, protein assembly and phospholipid homeostasis. Since the mitochondrial distribution and morphology protein Mdm10 is present in both ERMES and the mitochondrial sorting and assembly machinery (SAM), it is unknown how the ERMES functions are connected on a molecular level. Here we report that conserved surface areas on opposite sides of the Mdm10 β-barrel interact with SAM and ERMES, respectively. We generated point mutants to separate protein assembly (SAM) from morphology and phospholipid homeostasis (ERMES). Our study reveals that the β-barrel channel of Mdm10 serves different functions. Mdm10 promotes the biogenesis of α-helical and β-barrel proteins at SAM and functions as integral membrane anchor of ERMES, demonstrating that SAM-mediated protein assembly is distinct from ER-mitochondria contact sites.
In this paper, we study the limit of compactness which is a graph index originally introduced for measuring structural characteristics of hypermedia. Applying compactness to large scale small-world graphs (Mehler, 2008) observed its limit behaviour to be equal 1. The striking question concerning this finding was whether this limit behaviour resulted from the specifics of small-world graphs or was simply an artefact. In this paper, we determine the necessary and sufficient conditions for any sequence of connected graphs resulting in a limit value of CB = 1 which can be generalized with some consideration for the case of disconnected graph classes (Theorem 3). This result can be applied to many well-known classes of connected graphs. Here, we illustrate it by considering four examples. In fact, our proof-theoretical approach allows for quickly obtaining the limit value of compactness for many graph classes sparing computational costs.
Background: To evaluate survival data and local tumor control after transarterial chemoembolization in two groups with different embolization protocols for the treatment of HCC patients.
Methods: Ninty-nine patients (mean age: 63.6 years), 78 male (78.8%) with HCC were repeatedly treated with chemoembolization in 4-week-intervals. Eighty-eight patients had BCLC-Stage-B and in 11 patients, chemoembolization was performed for bridging (BCLC-Stage-A). In total, 667 chemoembolization treatments were performed (mean 6.7 treatments/patient). The administered chemotherapeutic agent included mitomycin. For embolization, lipiodol only (n = 51;51.5%; mean age 63.8 years; 38 male), or lipiodol plus degradable starch microspheres (DSM) (n = 48; 48.5%; mean age 63.4 years; 40 male) were used. The local tumor response was assessed by MRI using Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1). Patient survival times were evaluated using Kaplan-Meier curves and log-rank tests.
Results: The local tumor control in the lipiodol-group was: PR (partial response) in 11 (21.6%), SD (stable disease) in 32 (62.7%) and PD (progressive disease) in 8 cases (15.7%). In the lipiodol-DSM-group, PR was seen in 14 (29.2%), SD in 22 (45.8%), and PD in 12 (25.0%) individuals (p = 0.211). The median survival of patients after chemoembolization with lipiodol was 25 months and in the lipiodol-DSM-group 28 months (p = 0.845).
Conclusion: Our data suggest a slight benefit of the use of lipiodol and DSM in comparison of using lipiodol only for chemoembolization of HCC in terms of local tumor control and survival data, this trend did not reach the level of significance.
Age-related diseases, such as osteoarthritis, Alzheimer’s disease, diabetes, and cardiovascular disease, are often associated with chronic unresolved inflammation. Neutrophils play central roles in this process by releasing tissue-degenerative proteases, such as cathepsin G, as well as pro-inflammatory leukotrienes produced by the 5-lipoxygenase (5-LO) pathway. Boswellic acids (BAs) are pentacyclic triterpene acids contained in the gum resin of the anti-inflammatory remedy frankincense that target cathepsin G and 5-LO in neutrophils, and might thus represent suitable leads for intervention with age-associated diseases that have a chronic inflammatory component. Here, we investigated whether, in addition to BAs, other triterpene acids from frankincense interfere with 5-LO and cathepsin G. We provide a comprehensive analysis of 17 natural tetra- or pentacyclic triterpene acids for suppression of 5-LO product synthesis in human neutrophils. These triterpene acids were also investigated for their direct interference with 5-LO and cathepsin G in cell-free assays. Furthermore, our studies were expanded to 10 semi-synthetic BA derivatives. Our data reveal that besides BAs, several tetra- and pentacyclic triterpene acids are effective or even superior inhibitors of 5-LO product formation in human neutrophils, and in parallel, inhibit cathepsin G. Their beneficial target profile may qualify triterpene acids as anti-inflammatory natural products and pharmacological leads for intervention with diseases related to aging.
Practical considerations when prescribing a long-acting muscarinic antagonist for patients with COPD
(2018)
COPD is characterized by persistent airflow limitation, progressive breathlessness, cough, and sputum production. Long-acting muscarinic antagonists (LAMAs) are one of the recommended first-choice therapeutic options for patients with COPD, and several new agents have been developed in recent years. A literature search identified 14 published randomized, placebo-controlled studies of the efficacy and safety of LAMAs in patients with COPD, with improvements seen in lung function, exacerbations, breathlessness, and health status. A greater weight of evidence currently exists for glycopyrronium (GLY) and tiotropium than for umeclidinium and aclidinium, especially in terms of exacerbation reductions. To date, there have been few head-to-head clinical studies of the different LAMAs. Available data indicate that GLY and aclidinium have similar efficacy to tiotropium in terms of improving lung function, dyspnea, exacerbations, and health status. Overall, evidence demonstrates that currently available LAMAs provide effective and generally well-tolerated therapy for patients with COPD. Delivery devices for the different LAMAs vary, which may affect individual patient’s adherence to and preference for treatment. Subtle differences between individual therapeutic options may be important to individual patients and the final treatment choice should involve physician’s and patient’s experiences and preferences.
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.
Fabrication of three-dimensional (3D) nanoarchitectures by focused electron beam induced deposition (FEBID) has matured to a level that highly complex and functional deposits are becoming available for nanomagnetics and plasmonics. However, the generation of suitable pattern files that control the electron beam’s movement, and thereby reliably map the desired target 3D structure from a purely geometrical description to a shape-conforming 3D deposit, is nontrivial. To address this issue we developed several writing strategies and associated algorithms implemented in C++. Our pattern file generator handles different proximity effects and corrects for height-dependent precursor coverage. Several examples of successful 3D nanoarchitectures using different precursors are presented that validate the effectiveness of the implementation.
Background: Acute critical bleeding is one of the most feared complications during treatment with oral anticoagulating agents. As more patients undergo treatment with anticoagulating agents, critically bleeding episodes in patients with vitamin K antagonists, thrombin inhibitor, or factor Xa inhibitor-inducted coagulopathy will be encountered frequently by physicians. Hence, an effective treatment capable of reversing the iatrogenic coagulopathy in the acute setting is needed. In randomised clinical trials and observational studies, prothrombin complex concentrate has been reported to be superior to other acute interventions, and many guidelines recommend prothrombin complex concentrate in treatment of critically bleeding patients. The aim of this systematic review is to synthesise the evidence of the effects of prothrombin complex concentrate compared with placebo, no intervention, or other treatment options in critically bleeding patients treated with oral anticoagulants.
Methods/design: A comprehensive search for relevant published literature will be undertaken in Cochrane Central Register of Controlled Trials, MEDLINE, Embase, WHO International Clinical Trials Registry Platform, Science Citation Index, regulatory databases, and trial registers. We will include randomised clinical trials comparing prothrombin complex concentrate versus placebo, no intervention, or other interventions in critically bleeding patients with oral anticoagulant-induced coagulopathy. Data extraction and risk of bias assessment will be handled by two independent review authors. Meta-analysis will be performed as recommended by Cochrane Handbook for Systematic Reviews of Interventions, bias will be assessed with domains, and trial sequential analysis will be conducted to control random errors. Certainty will be assessed by GRADE.
Discussion: As critical bleeding in patients treated with oral anticoagulants is an increasing problem, an up-to-date systematic review evaluating the benefits and harms of prothrombin complex concentrate is urgently needed. It is the hope that this review will be able to guide best practice in treatment and clinical research of these critically bleeding patients.
Systematic review registration: PROSPERO CRD42018084371
There are 63 known species of Thecaphora (Glomosporiaceae, Ustilaginomycotina), a third of which occur on Asteraceae. These smut fungi produce yellowish-brown to reddish-brown masses of spore balls in specific, mostly regenerative, plant organs. A species of Thecaphora was collected in the flower heads of Anthemis chia (Anthemideae, Asteraceae) on Rhodes Island, Greece, in 2015 and 2017, which represents the first smut record of a smut fungus on a host plant species in this tribe. Based on its distinctive morphology, host species and genetic divergence, this species is described as Thecaphora anthemidis sp. nov. Molecular barcodes of the ITS region are provided for this and several other species of Thecaphora. A phylogenetic and morphological comparison to closely related species showed that Th. anthemidis differed from other species of Thecaphora. Thecaphora anthemidis produced loose spore balls in the flower heads and peduncles of Anthemis chia unlike other flower-infecting species.
After initial formation, the heart tube grows by addition of second heart field progenitor cells to its poles. The transcription factor Isl1 is expressed in the entire second heart field in mouse, and Isl1-deficient mouse embryos show defects in arterial and venous pole development. The expression of Isl1 is conserved in zebrafish cardiac progenitors; however, Isl1 is required for cardiomyocyte differentiation only at the venous pole. Here we show that Isl1 homologues are expressed in specific patterns in the developing zebrafish heart and play distinct roles during cardiac morphogenesis. In zebrafish, isl2a mutants show defects in cardiac looping, whereas isl2b is required for arterial pole development. Moreover, Isl2b controls the expression of key cardiac transcription factors including mef2ca, mef2cb, hand2 and tbx20. The specific roles of individual Islet family members in the development of distinct regions of the zebrafish heart renders this system particularly well-suited for dissecting Islet-dependent gene regulatory networks controlling the behavior and function of second heart field progenitors in distinct steps of cardiac development.
Panmixia and dispersal from the Mediterranean Basin to Macaronesian Islands of a macrolichen species
(2017)
The Mediterranean region, comprising the Mediterranean Basin and the Macaronesian Islands, represents a center of diversification for many organisms. The genetic structure and connectivity of mainland and island microbial populations has been poorly explored, in particular in the case of symbiotic fungi. Here we investigated genetic diversity and spatial structure of the obligate outcrossing lichen-forming fungus Parmelina carporrhizans in the Mediterranean region. Using eight microsatellite and mating-type markers we showed that fungal populations are highly diverse but lack spatial structure. This is likely due to high connectivity and long distance dispersal of fungal spores. Consistent with low levels of linkage disequilibrium and lack of clonality, we detected both mating-type idiomorphs in all populations. Furthermore we showed that the Macaronesian Islands are the result of colonization from the Mediterranean Basin. The unidirectional gene flow, though, seemed not to be sufficient to counterbalance the effects of drift, resulting in comparatively allelic poor peripheral populations. Our study is the first to shed light on the high connectivity and lack of population structure in natural populations of a strictly sexual lichen fungus. Our data further support the view of the Macaronesian Islands as the end of the colonization road for this symbiotic ascomycete.
Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group of 25 experts from different clinical specialties from Germany, Canada, Greece, USA and Russia discussed potential approaches to identify patients who may benefit from nutrition support, when best to initiate nutrition support, and the potential use of pharmaco-nutrition to modulate the inflammatory response to cardiopulmonary bypass. Despite conspicuous knowledge and evidence gaps, a rational nutritional support therapy is presented to benefit patients undergoing cardiac surgery.
Objectives: Sphingolipids (SLs) have been implicated as potent regulators of the hepatitis B virus (HBV) life cycle. We investigated the SL biomarker potential regarding virologic endpoints in a prospective subgroup of patients with HBeAg-negative chronic HBV infection.
Methods: From 2009–2016 98 patients with HBeAg-negative HBV infection were prospectively followed over four years. Clinical, laboratory and imaging data were evaluated annually. SLs were assessed in available serum probes via liquid chromatography coupled to tandem mass spectrometry.
Results: Of those 98 patients, 10 (10.2%) showed HBV reactivation, 13 (13.2%) lost HBsAg and 9 (9.1%) gained status of HBsAg-/HBsAb-coexistence, whereas 66 (67.3%) had no events. Within the four-year analysis sphingosine (p = 0.020), sphinganine (p<0.001), dhS1P (p<0.001), C16DHC (p<0.01) and C20Cer (p<0.001) showed a significant upregulation in patients without virologic events, C18Cer significantly decreased (p<0.001). At baseline decreased S1P-, dhS1P- and C16Cer-levels were observed in patients with upcoming status of HBsAg-/HBsAb-coexistence. S1P and dhS1P levels were elevated HBV genotype D infected patients.
Conclusions: In a prospective cohort of patients with a HBeAg-negative HBV infection, serum SLs associated with the virologic course and HBV genotype D. Further studies are required to elucidate SLs as potential novel predictors of the course of HBeAg-negative HBV infection.
Loperamide, pimozide, and STF-62247 trigger autophagy-dependent cell death in glioblastoma cells
(2018)
Autophagy is a well-described degradation mechanism that promotes cell survival upon nutrient starvation and other forms of cellular stresses. In addition, there is growing evidence showing that autophagy can exert a lethal function via autophagic cell death (ACD). As ACD has been implicated in apoptosis-resistant glioblastoma (GBM), there is a high medical need for identifying novel ACD-inducing drugs. Therefore, we screened a library containing 70 autophagy-inducing compounds to induce ATG5-dependent cell death in human MZ-54 GBM cells. Here, we identified three compounds, i.e. loperamide, pimozide, and STF-62247 that significantly induce cell death in several GBM cell lines compared to CRISPR/Cas9-generated ATG5- or ATG7-deficient cells, pointing to a death-promoting role of autophagy. Further cell death analyses conducted using pharmacological inhibitors revealed that apoptosis, ferroptosis, and necroptosis only play minor roles in loperamide-, pimozide- or STF-62247-induced cell death. Intriguingly, these three compounds induce massive lipidation of the autophagy marker protein LC3B as well as the formation of LC3B puncta, which are characteristic of autophagy. Furthermore, loperamide, pimozide, and STF-62247 enhance the autophagic flux in parental MZ-54 cells, but not in ATG5 or ATG7 knockout (KO) MZ-54 cells. In addition, loperamide- and pimozide-treated cells display a massive formation of autophagosomes and autolysosomes at the ultrastructural level. Finally, stimulation of autophagy by all three compounds is accompanied by dephosphorylation of mammalian target of rapamycin complex 1 (mTORC1), a well-known negative regulator of autophagy. In summary, our results indicate that loperamide, pimozide, and STF-62247 induce ATG5- and ATG7-dependent cell death in GBM cells, which is preceded by a massive induction of autophagy. These findings emphasize the lethal function and potential clinical relevance of hyperactivated autophagy in GBM.
Aims: Balloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress.
Methods and results: This study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU.
In total, the 51 patients underwent an average of 5 BPA procedures. The 6-month survival rate was 96.1%. The baseline (BL) meanPAP (39.5±12.1mmHg) and PVR (515.8±219.2dyn×sec×cm-5) decreased significantly within the 6-MFU (meanPAP: 32.6±12.6mmHg, P<0.001; PVR: 396.9±182.6dyn×sec×cm-5, P<0.001). At BL, the median hs-cTnT level was 11 (IQR 6–16) ng/L and the median NT-proBNP level was 820 (IQR 153–1872) ng/L. The levels of both biomarkers decreased steadily after every BPA, showing the first significant difference after the first procedure. Within the 6-MFU, hs-cTnT levels (7 [IQR 5–12] ng/L; P<0.001) and NT-proBNP levels (159 [IQR 84–464] ng/l; P<0.001) continued to decrease. The hs-cTnT levels correlated with the PVR (rrs = 0.42; p = 0.005), the meanPAP (rrs = 0.32; p = 0.029) and the NT-proBNP (rrs = 0.51; p<0.001) levels at BL.
Conclusion: Non-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.
Using the method or time-delayed embedding, a signal can be embedded into higher-dimensional space in order to study its dynamics. This requires knowledge of two parameters: The delay parameter τ, and the embedding dimension parameter D. Two standard methods to estimate these parameters in one-dimensional time series involve the inspection of the Average Mutual Information (AMI) function and the False Nearest Neighbor (FNN) function. In some contexts, however, such as phase-space reconstruction for Multidimensional Recurrence Quantification Analysis (MdRQA), the empirical time series that need to be embedded already possess a dimensionality higher than one. In the current article, we present extensions of the AMI and FNN functions for higher dimensional time series and their application to data from the Lorenz system coded in Matlab.
Imaging non-adherent cells by super-resolution far-field fluorescence microscopy is currently not possible because of their rapid movement while in suspension. Holographic optical tweezers (HOTs) enable the ability to freely control the number and position of optical traps, thus facilitating the unrestricted manipulation of cells in a volume around the focal plane. Here we show that immobilizing non-adherent cells by optical tweezers is sufficient to achieve optical resolution well below the diffraction limit using localization microscopy. Individual cells can be oriented arbitrarily but preferably either horizontally or vertically relative to the microscope’s image plane, enabling access to sample sections that are impossible to achieve with conventional sample preparation and immobilization. This opens up new opportunities to super-resolve the nanoscale organization of chromosomal DNA in individual bacterial cells.
Als Beginn der Theatermoderne gelten der Forschung gemeinhin Max Reinhardts vielgestaltige Versuche, das etablierte Modell des Repräsentationstheaters zu überwinden. Konzeptionell niedergeschlagen haben sie sich erstmals in den Überlegungen zur innenarchitektonischen Ausgestaltung des Berliner 'Kleinen Theaters', die Reinhardt in seinem Brief an den mit dem Projekt betrauten Freund Berthold Held vom 4. August 1901 anstellt: "Von der Bühne müssen meiner Ansicht nach unbedingt Stufen ins Publikum führen. Das können wir gut brauchen und erhöht die Intimität, vielleicht an jeder Seite ein paar Stufen, worauf in der Skizze gleich Rücksicht genommen werden möge." Die von Reinhardt gewünschten Stufen sollen die Einheit des den Bühnen- und Zuschauerraum umfassenden Raum-Zeit-Kontinuums markieren und so die programmatische Revision der im Laufe des 18. Jahrhunderts erfolgten Ausgliederung des Zeichenraums Bühne aus dem weltlichen Raum-Zeit-Kontinuum symbolisieren. In gleicher Weise markiert wird diese Revision der etablierten Kommunikationssituation Theater schon in Hugo von Hofmannsthals frühem lyrischen Drama 'Der Tod des Tizian' (1892), in dem dieser die Figur des Pagen ins Proszenium treten und das Publikum direkt ansprechen lässt, um die den Zuschauerraum vom Zeichenraum Bühne trennende Rampe in metaleptischer Geste zu überspielen. Bestimmt man das Repräsentationsparadigma, das durch diese Operationen überwunden werden soll, mit Jacques Derrida semiologisch als ein wesentlich durch die "Exteriorität des Signifikanten" bestimmtes Zeichenmodell, dann ist es wohl angemessen, die (im gemeinsamen Konzept der Salzburger Festspiele kulminierenden) Versuche Reinhardts und Hofmannsthals, mit dem Repräsentationsparadigma zu brechen, als ein von der Intention zur Interiorisierung des Signifikanten gesteuertes Programm zu bezeichnen.
Background: Patients with chronic kidney disease (CKD) are at high risk of myocardial infarction. Cardiac troponins are the biomarkers of choice for the diagnosis of acute myocardial infarction (AMI) without ST‐segment elevation (NSTE). In patients with CKD, troponin levels are often chronically elevated, which reduces their diagnostic utility when NSTE‐AMI is suspected. The aim of this study was to derive a diagnostic algorithm for serial troponin measurements in patients with CKD and suspected NSTE‐AMI.
Methods and Results: Two cohorts, 1494 patients from a prospective cohort study with high‐sensitivity troponin I (hs‐cTnI) measurements and 7059 cases from a clinical registry with high‐sensitivity troponin T (hs‐cTnT ) measurements, were analyzed. The prospective cohort comprised 280 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m2). The registry data set contained 1581 CKD patients. In both cohorts, CKD patients were more likely to have adjudicated NSTE‐AMI than non‐CKD patients. The specificities of hs‐cTnI and hs‐cTnT to detect NSTE‐AMI were reduced with CKD (0.82 versus 0.91 for hs‐cTnI and 0.26 versus 0.73 for hs‐cTnT) but could be restored by applying optimized cutoffs to either the first or a second measurement after 3 hours. The best diagnostic performance was achieved with an algorithm that incorporates serial measurements and rules in or out AMI in 69% (hs‐cTnI) and 55% (hs‐cTnT) of CKD patients.
Conclusions: The diagnostic performance of high‐sensitivity cardiac troponins in patients with CKD with suspected NSTE‐AMI is improved by use of an algorithm based on admission troponin and dynamic changes in troponin concentration.
Ziele: Das Ziel dieser offiziellen Leitlinie, die von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) und der Deutschen Krebsgesellschaft (DKG) publiziert und koordiniert wurde, ist es, die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms zu optimieren.
Methoden: Der Aktualisierungsprozess der S3-Leitlinie aus 2012 basierte zum einen auf der Adaptation identifizierter Quellleitlinien und zum anderen auf Evidenzübersichten, die nach Entwicklung von PICO-(Patients/Interventions/Control/Outcome-)Fragen, systematischer Recherche in Literaturdatenbanken sowie Selektion und Bewertung der gefundenen Literatur angefertigt wurden. In den interdisziplinären Arbeitsgruppen wurden auf dieser Grundlage Vorschläge für Empfehlungen und Statements erarbeitet, die im Rahmen von strukturierten Konsensusverfahren modifiziert und graduiert wurden.
Empfehlungen: Der Teil 1 dieser Kurzversion der Leitlinie zeigt Empfehlungen zur Früherkennung, Diagnostik und Nachsorge des Mammakarzinoms: Der Stellenwert des Mammografie-Screenings wird in der aktualisierten Leitlinienversion bestätigt und bildet damit die Grundlage der Früherkennung. Neben den konventionellen Methoden der Karzinomdiagnostik wird die Computertomografie (CT) zum Staging bei höherem Rückfallrisiko empfohlen. Die Nachsorgekonzepte beinhalten Untersuchungsintervalle für die körperliche Untersuchung, Ultraschall und Mammografie, während weiterführende Gerätediagnostik und Tumormarkerbestimmungen bei der metastasierten Erkrankung Anwendung finden.
Schriftenschau
(2011)
Fremdländische Gräser (Poaceae) in Deutschland Beitrag zur Diskussion biologischer Invasionen
(2011)
Gegenwärtig sind 42 etablierte fremdländische Arten und Unterarten der Gräser, Neophyten, aus Deutschland bekannt (Liste 1). Sie sind weder außergewöhnlich häufig und invasiv noch bedrohen sie die Existenz einheimischer Arten, reduzieren die Biodiversität und schädigen die natürliche/halbnatürliche Vegetation, selbstverständlich auch nicht die seltenen, nach dem 2. Weltkrieg beobachteten unbeständigen Gräser (Liste 2). Auch sind bis heute in Deutschland keine abträglichen Wirkungen durch Kreuzungen von fremdländischen mit einheimischen Gräsern bekannt. Besondere Aufmerksamkeit wird den Anökophyten, d. h. cultigenen Taxa s. l. gewidmet (Liste 3): ausländische Getreidegräser können aus Kulturen verwildern und sind dann unbeständig, andere Arten und Unterarten entstanden als Ruderalia oder Segetalia auf Kulturland (Wiesen, Weiden, Felder etc.). — der hier vorliegende Text und die Listen enthalten mehrere kritische Bemerkungen zu DAISIE („Delivering Alien Invasive Species Inventories for Europe“), betreffend z. B. falsch klassifizierte und fehlende Taxa.
Im Rahmen stadtfloristischer Untersuchungen des Ruhrgebietes wurden in Brunnen- und Kellerlichtschächten Vorkommen von Pteris cretica var. albolineata (Pteridaceae) und Adiantum raddianum (Adiantaceae) nachgewiesen, beide taxonomisch im weiteren Sinne zu verstehen. Die Wuchsorte, Populationsgrößen und Begleitvegetation werden beschrieben, Status und Ausbreitungstendenzen der Taxa diskutiert.
Dryopteris lacunosa – eine neue Art des Dryopteris-affinis-Aggregats (Dryopteridaceae, Pteridophyta)
(2011)
Eine weitere Sippe des Dryopteris-affinis-Aggregats wird als Art, D. lacunosa S. JESS., ZENNER, CH. STARK & BUJNOCH beschrieben. Sie lässt sich morphologisch von den anderen bisher beschriebenen Taxa des Aggregats unterscheiden, ist triploid und zeigt spezifische Phloroglucid- und RAPD- Bandenmuster. Bisher sind Funde aus Norditalien, Österreich, der Schweiz, Frankreich, Deutschland, Großbritannien und Irland belegt.
Fünf neue Arten aus dem Ranunculus-auricomus-Komplex in Deutschland werden beschrieben und abgebildet. R. pleiophyllus ist weiter verbreitet und bislang aus Rheinland-Pfalz, Baden-Württemberg, Bayern, Saarland und Mecklenburg-Vorpommern nachgewiesen. Die übrigen neuen Arten besitzen – soweit bis jetzt bekannt – kleine Areale: R. excisus in Rheinland-Pfalz, R. vertumnaliformis in Mecklenburg-Vorpommern, R. biclaterae in Nordbayern und R. ferocior in Mecklenburg- Vorpommern und Nordbayern.
Angegeben wird jeweils das Sammeldatum des für die Chromosomenzählung verwendeten Materials (Lebendpflanze, Samen) zuzüglich eines eventuell gesammelten Beleges sowie – getrennt durch einen Schrägstrich – Sammeldatum und Aufbewahrungsort eines Beleges der gezählten Pflanze. Wird nur ein Datum angegeben, ist allein die Wildaufsammlung dokumentiert. Die Abkürzungen der Herbarien richten sich nach HOLMGREN & al. (1990, sowie Online- Nachträge, für die neuerdings B. Thiers verantwortlich zeichnet). Taxonomie und Nomenklatur richten sich nach der aktuellen deutschen Standardliste (BUTTLER & HAND 2008). Die Abbildungen zeigen Metaphasen, die an Quetschpräparaten von Wurzelspitzen gewonnen wurden (zur Methodik siehe VOGT & APARICIO 2000). Ralf Hand dankt Michael Meyer und seinem Gärtnerteam sowie Monika Lüchow und Marion Cubr (alle Botanischer Garten und Botanisches Museum Berlin-Dahlem) für Kultur, Dokumentation und Hilfe bei der Zählung von Material.
Alchemilla pseudo - decumbens wird als Art neu beschrieben. Im Gegensatz zur weit verbreiteten A. decumbens bleibt ihr Areal auf den Jura beschränkt. In Abbildungen, Merkmals- und Bestimmungstabellen wird A. pseudodecumbens mit ähnlichen Arten verglichen (A. decumbens, A. demissa, A. frigens, A. lunaria, A. semisecta, A. subcrenata, A. undulata, A. versipila).
Pilosella aurantiaca – tetraploid, fakultativ apomiktisch und eingebürgert – und P. officinarum – tetraploid, sexuell und einheimisch – bilden bei Hagen, Nordrhein- Westfalen, einen Hybridschwarm aus tetraund hexaploiden Pflanzen. Der Hybridschwarm wurde 1990 auf einer inzwischen brach gefallenen Wiese gefunden. Seit 20 Jahren kommt hier fast unverändert ein breites Spektrum von Hybriden vor: P. aurantiaca angenäherte Morphotypen (entsprechen P. rubra), intermediäre Morphotypen (P. stoloniflora) und verschiedene P. officinarum angenäherte Morphotypen. Diese Population wurde hinsichtlich Ploidiegrad, Genomgröße, Fortpflanzungssystem, Chloroplasten- Haplotypen und Isoenzym-Phänotypen untersucht. Der zu P. rubra korrespondierende Morphotyp ist hexaploid mit variabler Fortpflanzung. Er produziert neben apomiktischen einen erheblichen Anteil sexueller und polyha - ploider Nachkommen. Die Struktur des Genotyps und der DNA-Gehalt macht eine wiederholte Entstehung aus unreduzierten Eizellen von P. aurantiaca und reduziertem Pollen von P. officinarum (2n + n-Hybridisierung) wahrscheinlich. Die damit koexistierenden Hybriden (P. stoloniflora) sind tetraploid und sexuell. Bei P. officinarum wurden zwei Chloroplasten-Haplotypen gefunden, wovon einer auch bei P. aurantiaca vorkommt. Das Vorkommen eines Chloroplasten-Haplotypen bei P. officinarum, der typisch für P. aurantiaca ist, macht Rückkreuzungen wahrscheinlich. Die unterschiedlichen Genomgrößen der wahrscheinlichen Elternarten spiegeln sich in den Genomgrößen der homoploiden (tetraploiden) Hybriden wider. Eine mehrfache Rückkreuzung mit P. officinarum, wie sie durch die Morphologie wahrscheinlich gemacht wird, wird durch Genomgröße und Chloroplasten-Haplotypen gestützt.
Schriftenschau
(2012)
Bromus secalinus, früher sehr häufig in Getreidefeldern, aber im letzten Jahrhundert durch Bekämpfungsmaßnahmen immer seltener geworden, ist derzeit mit geänderter Landbaupraxis wieder in Ausbreitung begriffen und umfasst heute zwei morphologisch definierte Unterarten. B. secalinus subsp. infestus wird als neu für die Wissenschaft beschrieben und ist vermutlich ein Neo-Endemit der Flora Mitteldeutschlands. Seine Herkunft und Evolution wird diskutiert (a) nach der neodarwinistischen Selektionstheorie und (b) nach der neogoldschmidtschen Saltationstheorie.
Panicum riparium wurde 2002 als neoindigene Art aus Deutschland neu beschrieben. Die Merkmale der Art werden kritisch untersucht und mit denen von P. capillare verglichen. Eine Karte zeigt erstmals die bislang bekannte Verbreitung von P. riparium in Europa. Es wurden historische Herbarbelege gefunden, die bis in das 18. Jahrhundert zurückreichen. Ein Merkmalsvergleich bestätigt die weitgehende Übereinstimmung mit amerikanischen Pflanzen. Eine taxonomische Klärung der amerikanischen Sippen des P.-capillare-Aggregats lässt keine Zweifel: die Merkmale des P. riparium sind weitgehend identisch mit denen des P. barbipulvinatum NASH. P. riparium ist somit in die Synonymie dieser Art zu stellen.
Erstnachweis von Dryopteris affinis s. str. (Dryopteridaceae, Pteridophyta) für Nordrhein-Westfalen
(2013)
Neuerdings werden fünf Sippen des Dryopteris-affinis-Komplexes in Mitteleuropa als eigenständige Arten bewertet, wovon vier auch in Nordrhein-Westfalen (NRW) vorkommen. Dazu gehören die triploide D. bor - reri, die offenbar die mit Abstand häufigste Art repräsentiert, und zwei weitere triploide Arten, D. pseudodisjuncta und D. lacunosa. Letztere wurde erst vor kurzem neu beschrieben und ist in NRW bislang nur von einem Fundpunkt bekannt. Mit Hilfe der Flow-Cytometrie gelang es nun, eine auf Grund der kleinen Sporen verdächtig erscheinende Pflanze aus dem Schwalm- Nette-Gebiet als diploide D. affinis s. str. zu identifizieren. Die anfängliche Vermutung, diese Art sei auf Tiefland-Vorkommen im deutlich atlantisch getönten äußersten Nordwesten von NRW beschränkt, haben sich als unzutreffend erwiesen; die Art konnte nachfolgend auch mehrfach im Süderbergland gefunden werden. Ebenfalls mit Hilfe der Flow-Cytometrie wurden eine Reihe von Vorkommen von D. borreri bestätigt sowie tetra- und pentaploide Hybriden (D. ×complexa und D. ×critica) nachgewiesen, die durch Bastardbildung mit D. filix-mas entstehen. Während Vorkommen der pentaploiden D. ×critica bereits seit längerer Zeit aus NRW bekannt sind, handelt es sich bei denjenigen von D. ×complexa ebenfalls um Erstnachweise. Das nordrhein-westfälische Areal dieser Sippen wird in drei Fundortkarten dargestellt (für den D.-affinis-Komplex insgesamt sowie für cytologisch bzw. flow-cytometrisch bestätigte Vorkommen der beiden Arten D. affinis s. str. und D. borreri sowie der beiden Hybriden D. ×complexa und D. ×critica). Aus einer mit der räumlichen Verteilung der Jahresniederschläge kombinierten Verbreitungskarte wird die enge Bindung an niederschlagreichere Lagen (zumeist mehr als 800mm) deutlich. Dies und weitere standortökologische Besonderheiten weisen darauf hin, dass die Sippen des D.-affinis-Komplexes in größerem Maße von der Wasserversorgung abhängig sind als D. filix-mas. Zwar repräsentieren die D.-affinis-Sippen offenbar typische Waldfarne und zeigen eine Präferenz für bodensaure Buchenwald-Gesellschaften, vor allem D. affinis s. str. kommt aber auffallend häufig an anthropogen überformten Sekundärstandorten vor, so an Weg- und Grabenböschungen, in Abgrabungen sowie an einem künstlichen Steilhang und in einem Steinbruch.
An einem Beispiel wird demonstriert, dass es oft vom Erfassungsaufwand abhängt, ob ein Merkmal als qualitativ oder quantitativ (zähl- bzw. messbar) einzustufen ist. Es folgt ein Überblick über quantitative Merkmale, die von 1820 bis heute in der Literatur über mitteleuropäische Wildrosenarten (Rosaceae: Rosa) behandelt werden. Bei vielen dieser Merkmale erscheint eine Erfassung in Ordinalskalen sinnvoller als eine metrische. Zu 8 Merkmalen, bei denen das Sammeln von Messwerten und ihre statistische Aufbereitung Erfolg verheißt, werden eigene Beobachtungen und Untersuchungen mitgeteilt. Bei ihrer Erfassung gilt es, eine Reihe von Fehlerquellen zu beachten, die meist in den Objekten, in einem Fall im Beobachter liegen. Bei der Erfassung von Hagebuttenmerkmalen muss ein Dimorphismus zwischen End- und Seitenblüten der Blütenstände berücksichtigt werden. Die Beschränkung von Messungen auf solitäre Blüten verringert die Streuung der Messwerte ebenso wie die Ermittlung der Standardabweichung anstelle der von älteren Autoren verwendeten Variationsbreite. Aufgrund einer optischen Täuschung wird die relative Länge des Fruchtstiels in Bezug zur Hagebuttenlänge meist zu hoch eingeschätzt. Merkmale, deren quantitative Erfassung diagnostisch brauchbare Daten liefern kann, sind in erster Linie die relative Fruchtstiellänge und der Griffelkanaldurchmesser, in zweiter Linie die Endfiederlänge, der Längen-Breiten index der Endfiedern und die Kronblattlänge.
Nur wenige Differentialmerkmale erlauben eine sichere Unterscheidung der diploiden Stellaria pallida von der allotetraploiden S. media: die fehlenden oder rudimentären Kronblätter, die Staubblattanzahl sowie Größe und Masse der Samen. Nicht bewährt haben sich dagegen die Farbe der Laubblätter und der Samen sowie die Länge und die Behaarungsverhältnisse der Kelchblätter. Bestimmungsschwierigkeiten und die Tatsache, dass S. pallida oft übersehen wird, sind die Gründe, weshalb über Standort und Vergesellschaftung immer noch wenig bekannt ist. S. pallida bleibt nicht auf Sandgebiete und Tieflagen beschränkt, auch ist sie nicht in erster Linie eine Ruderalart (häufiger in Rasen-, Tritt- und Saumgesellschaften). Die Verbreitung ist überall erst unvollständig erfasst, sowohl innerhalb des als ursprünglich angesehenen Areals (Europa, Nordafrika, Westasien), als auch in Nord- und Südamerika, Südafrika, Ostasien und Australien, wo S. pallida als Neophyt angesehen wird. Fundierte Aussagen über eine Bestandsentwicklung sind bis jetzt nicht möglich. Ausbreitungsmöglichkeiten und Indigenat werden diskutiert. Strittig ist, ob der Name S. pallida (DUMORT.) PIRÉ 1863 als gültig veröffentlicht angesehen werden darf oder durch S. pallida (DUMORT.) CRÉPIN 1866 zu ersetzen ist. Der ältere Name S. apetala UCRIA 1793 hat Priorität vor S. pallida; ein Neotypus wird festgelegt.
Die Intention der hiermit fortgesetzten Reihe sowie die Kriterien zur Aufnahme der besprochenen Literatur und der nomenklatorischen Neuigkeiten sind in der Einführung zur ersten Folge in Kochia 1 erläutert. Uwe Amarell (Offenburg), Bernhard Dickore (München), Gerwin Kasperek (Frankfurt am Main) und Peter A. Schmidt (Tharandt) danken wir für Hinweise auf wichtige Neuerscheinungen.
Purpose: The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer.
Methods: The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure.
Recommendations: Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.
Als Fortschreibung zu der in dieser Zeitschrift im Jahr 2006 erschienenen Zusammenstellung von Florenwerken und Verbreitungsatlanten der Gefäßpflanzen Deutschlands aus dem Zeitraum 1945 bis 2005 werden hier Ergänzungen aus den Jahren 2006 bis 2010 aufgeführt und mit Schlüsselinformationen versehen. Dabei handelt es sich um 29 neue Publikationen und zusätzlich 22 Neuauflagen, Ergänzungen oder Nachträge bereits in der ersten Zusammenstellung berücksichtigter Florenwerke.
Zwei neue Arten aus dem Ranunculus-auricomus-Komplex in Deutschland werden beschrieben und abgebildet: R. reichertii und R. mosellanus. Ihre bislang bekannte Verbreitung beschränkt sich auf Rheinland-Pfalz, dort im Saar-Nahe-Bergland (R. reichertii) und im Moseltal und Umgebung (R. mosellanus). R. reichertii zeichnet sich durch seine Größe und eine flache Basalbucht der Grundblätter aus, R. mosellanus weicht durch eine starke Blattspreitenteilung der Grundblätter mit überlappenden Seitenabschnitten morphologisch von allen bislang bekannten Arten ab.