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Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs.
Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel.
Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1–25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0–88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%—subcutaneous; 29%—intravenous; 1%—unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy.
Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment.
Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.
In der Stratosphäre finden eine Reihe von dynamischen und chemischen Prozessen statt, die u.a. den Abbau von Ozon beeinflussen. Um die langfristigen Veränderungen in der Stratosphäre untersuchen zu können müssen die Abhängigkeit dieser Prozesse von Raum und Zeit bekannt sein. In dieser Arbeit wird eine Untersuchung zur Variabilität der Stratosphäre auf der Grundlage der Varianz von Tracern, die in Form der „Equivalent Displacement Height“, kurz: EDH, dargestellt wird, vorgestellt. Die EDH ist tue mit Hilfe des lokalen vertikalen Gradienten normierte lokale Standardabweichung des Mischungsverhältnisses eines Tracers und besitzt die Dimension einer Länge. Durch die Normierung kann die Varianz verschiedener Tracer miteinander verglichen werden. Mit dem Konzept ist allerdings nur die Diagnose der Variabilität möglich und keine Quantifizierung der dafür verantwortlichen Prozesse. Für die Fragestellung werden drei Datensätze ausgewertet. Ein Datensatz ist mit Hilfe eines kryogenen Luftprobensammlers entstanden. Die Berechnungen iii dieser Arbeit zeigen, dass die zeitliche und räumliche Abdeckung dieses Datensatzes zu niedrig ist, um mit ihm eine repräsentative Aussage über die Varianz von Spurengasen in der Stratosphäre treffen zu können. Eine bessere zeitliche und räumliche Abdeckung besitzt der Datensatz des Satellitenexperimentes HA-LOE. Dieser wird dazu verwendet die monatlichen Verteilungen der mittleren EDH von CH4 und O3 in einem Höhenbereich zwischen 19 und 50 km für einen Zeitraum von 1993 bis 2000 zu berechnen. Die mittlere EDH von OH4 besitzt über den Hemisphären jeweils einen unterschiedlichen Jahresgang. Die Diskussion zeigt, dass dieser hemisphärische Unterschied auf die verschiedenen dynamischen Bedingung in der Stratosphäre über den Hemisphären zurückgeführt werden kann, vor allem auf die Existenz eines stabileren und langlebigeren Polarwirbels in der Südhemisphäre. Im Gegensatz dazu zeigt die mittlere EDH von O3 über beiden Hemisphären einen vergleichbaren Jahresgang, mit minimalen Werten der Varianz während der Sommermonate, wenn die Ausbreitung planetarer Wellen in die Stratosphäre durch die vorherrschende Ostwindzirkulation behindert wird. Dieser Jahresgang steht in Verbindung mit den chemischen und dynamischen Prozessen bzw. der Kombination, welche die Verteilung und Varianz von O3 in der Stratosphäre kontrollieren. Eine eindeutige Trennung der einzelnen Effekte ist dabei allerdings nicht möglich. Der Datensatz des Simulationsmodell KASIMA enthält die Verteilung von CH4 und O3 mit der höchsten zeitlichen und räumliche Abdeckung aller drei Datensätze. Ein Vergleich zwischen den daraus berechneten Verteilungen der mittleren EDH beider Spurengase mit den HALOE-Daten soll helfen, die Varianz welche durch das Modell simuliert wird, mit der gemessenen zu vergleichen. Für das O3 wird eine gute Übereinstimmung zwischen der modellierten und gemessenen Varianz gefunden. Diese guten Übereinstimmungen ergeben sich für CH4 nicht. Aufgrund der unterschiedlichen chemischen Eigenschaften der beiden Tracer wird aus den Ergebnissen geschlossen, dass das Modell die chemischen Prozesse besser simuliert als den atmosphärischen Transport. Mit Hilfe von drei Fallstudien werden weitere Möglichkeiten aufgezeigt. die mit dem Konzept und den Datensätze von HALOE und KASIMA noch bestehen. In der ersten Fallstudie werden anhand der Verteilungen der EDH von CH4 aus dem März 1996 und 1997 die Auswirkungen vorm zwei unterschiedlichen meteorologischen Situation diskutiert, wobei ein eindeutiger Zusammenhang festgestellt wird. In einer zweiten Fallstudie wird der Frage nachgegangen, ob die Normierung auf den vertikalen Gradienten bei der Berechnung der EDH sinnvoll ist, da horizontale Transportprozesse in der Stratosphäre dominieren. Es wird daher zum Vergleich die „Equivalent Displacement Length (EDL)“ von CH4 berechnet, bei der eine Normierung der Varianz auf den horizontalen Gradienten erfolgt. In der dritten Fallstudie wird die Verteilung der mittleren EDH von N20, welche ebenfalls mit dem Datensatz von KASIMA berechnet worden ist, mit der von CH4 verglichen.
Introduction: Acute kidney injury (AKI) can evolve quickly and clinical measures of function often fail to detect AKI at a time when interventions are likely to provide benefit. Identifying early markers of kidney damage has been difficult due to the complex nature of human AKI, in which multiple etiologies exist. The objective of this study was to identify and validate novel biomarkers of AKI.
Methods: We performed two multicenter observational studies in critically ill patients at risk for AKI - discovery and validation. The top two markers from discovery were validated in a second study (Sapphire) and compared to a number of previously described biomarkers. In the discovery phase, we enrolled 522 adults in three distinct cohorts including patients with sepsis, shock, major surgery, and trauma and examined over 300 markers. In the Sapphire validation study, we enrolled 744 adult subjects with critical illness and without evidence of AKI at enrollment; the final analysis cohort was a heterogeneous sample of 728 critically ill patients. The primary endpoint was moderate to severe AKI (KDIGO stage 2 to 3) within 12 hours of sample collection.
Results: Moderate to severe AKI occurred in 14% of Sapphire subjects. The two top biomarkers from discovery were validated. Urine insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2), both inducers of G1 cell cycle arrest, a key mechanism implicated in AKI, together demonstrated an AUC of 0.80 (0.76 and 0.79 alone). Urine [TIMP-2].[IGFBP7] was significantly superior to all previously described markers of AKI (P <0.002), none of which achieved an AUC >0.72. Furthermore, [TIMP-2].[IGFBP7] significantly improved risk stratification when added to a nine-variable clinical model when analyzed using Cox proportional hazards model, generalized estimating equation, integrated discrimination improvement or net reclassification improvement. Finally, in sensitivity analyses [TIMP-2].[IGFBP7] remained significant and superior to all other markers regardless of changes in reference creatinine method.
Conclusions: Two novel markers for AKI have been identified and validated in independent multicenter cohorts. Both markers are superior to existing markers, provide additional information over clinical variables and add mechanistic insight into AKI. Trial registration: ClinicalTrials.gov number NCT01209169.
Global change effects on biodiversity and human wellbeing call for improved long-term environmental data as a basis for science, policy and decision making, including increased interoperability, multifunctionality, and harmonization. Based on the example of two global initiatives, the International Long-Term Ecological Research (ILTER) network and the Group on Earth Observations Biodiversity Observation Network (GEO BON), we propose merging the frameworks behind these initiatives, namely ecosystem integrity and essential biodiversity variables, to serve as an improved guideline for future site-based long-term research and monitoring in terrestrial, freshwater and coastal ecosystems. We derive a list of specific recommendations of what and how to measure at a monitoring site and call for an integration of sites into co-located site networks across individual monitoring initiatives, and centered on ecosystems. This facilitates the generation of linked comprehensive ecosystem monitoring data, supports synergies in the use of costly infrastructures, fosters cross-initiative research and provides a template for collaboration beyond the ILTER and GEO BON communities.
The aim of this study was to assess the invasion risk of freshwater habitats and determine the environmental variables that are most favorable for the establishment of alien amphipods, isopods, gastropods, and bivalves. A total of 981 sites located in streams and rivers in Germany. Therefore we analyzed presence-absence data of alien and indigenous amphipods, isopods, gastropods, and bivalves from 981 sites located in small to large rivers in Germany with regard to eight environmental variables: chloride, ammonium, nitrate, oxygen, orthophosphate, distance to the next navigable waterway, and maximum and minimum temperature. Degraded sites close to navigable waters were exposed to an increased invasion risk by all major groups of alien species. Moreover, invaded sites by all four groups of alien species were similar, whereas the sites where indigenous members of the four groups occurred were more variable. Increased temperature and chloride concentration as well as decreased oxygen concentration were identified as major factors for the invasibility of a site. Species-specific analyses showed that chloride was among the three most predictive environmental variables determining species assemblage in all four taxonomic groups. Also distance to the next navigable waterways was similarly important. Additionally, the minimum temperature was among the most important variables for amphipods, isopods, and bivalves. The bias in the occurrence patterns of alien species toward similarly degraded habitats suggests that the members of all four major groups of freshwater alien species are a non-random, more tolerant set of species. Their common tolerance to salinity, high temperature, and oxygen depletion may reflect that most alien species were spread in ballast water tanks, where strong selective pressures, particularly temperature fluctuations, oxygen depletion, and increased salinity may create a bottleneck for successful invasion. Knowledge on the major factors that influence the invasion risk of a habitat is needed to develop strategies to limit the spread of invasive species.
Vögel
(1995)
Die untere Havelniederung ist ein bedeutendes Brut-, Rast- und Überwinterungsgebiet für eine arten- und individuenreiche Vogelwelt. Die im Jahre 1978 erfolgte Ausweisung des Deichvorlandes der Havel als Feuchtgebiet von internationaler Bedeutung (FIB) und, einschließlich des Schollener Sees, als Europäisches Vogelschutzgebiet (IBA, seit 1993 als EU SPA bestätigt) unterstreicht die Bedeutung für den Vogelschutz. Gegenwärtig werden 135 bis 140 Brutvogel- und 80 Gastvogelarten zur Avifauna der unteren Havelniederung Sachsen-Anhalts gezählt.
Background: Dispersal rates, i.e. the effective number of dispersing individuals per unit time, are the product of dispersal capacity, i.e. a species physiological potential for dispersal, dispersal behaviour, i.e. the decision to leave a habitat patch in favour of another, and connectivity of occupied habitat. Dispersal of species that are highly specialised to a certain habitat is thus strongly limited by habitat availability. Additionally, species inhabiting very stable environments may adopt a sedentary life-style. Both factors should lead to strong genetic differentiation in highly specialised species inhabiting stable environments. These two factors apply to our model species Rhyacophila pubescens a highly specialised freshwater insect that occurs in tufa springs, a very stable habitat. Results: We examined the genetic population structure and phylogeography using range-wide mtCOI sequence and AFLP data from 333 individuals of R. pubescens. We inferred the location of Pleistocene refugia and postglacial colonisation routes of R. pubescens, and examined ongoing local differentiation. Our results indicate intraregional differentiation with a high number of locally endemic haplotypes, that we attributed to habitat specificity and low dispersal rates of R. pubescens. We observed high levels of genetic diversity south of the Alps and genetic impoverishment north of the Alps. Estimates of migrants placed the refugium and the source of the colonisation in the Dauphine Alps (SW Alps). Conclusions: This is the first example of an aquatic insect with a colonisation route along the western margin of the Alps to the Central European highlands. The study also shows that specialisation to a stable environment may have promoted a behavioural shift to decreased dispersal rates, leading to stronger local population differentiation than in less specialised aquatic insects. Alternatively, the occurrence of highly specialised tufa spring habitats may have been more widespread in the past, leading to range regression and fragmentation among present day R. pubescens populations.
The ongoing biodiversity crisis becomes evident in the widely observed decline in abundance and diversity of species, profound changes in community structure, and shifts in species’ phenology. Insects are among the most affected groups, with documented decreases in abundance up to 76% in the last 25–30 years in some terrestrial ecosystems. Identifying the underlying drivers is a major obstacle as most ecosystems are affected by multiple stressors simultaneously and in situ measurements of environmental variables are often missing. In our study, we investigated a headwater stream belonging to the most common stream type in Germany located in a nature reserve with no major anthropogenic impacts except climate change. We used the most comprehensive quantitative long‐term data set on aquatic insects available, which includes weekly measurements of species‐level insect abundance, daily water temperature and stream discharge as well as measurements of additional physicochemical variables for a 42‐year period (1969–2010). Overall, water temperature increased by 1.88 °C and discharge patterns changed significantly. These changes were accompanied by an 81.6% decline in insect abundance, but an increase in richness (+8.5%), Shannon diversity (+22.7%), evenness (+22.4%), and interannual turnover (+34%). Moreover, the community's trophic structure and phenology changed: the duration of emergence increased by 15.2 days, whereas the peak of emergence moved 13.4 days earlier. Additionally, we observed short‐term fluctuations (<5 years) in almost all metrics as well as complex and nonlinear responses of the community toward climate change that would have been missed by simply using snapshot data or shorter time series. Our results indicate that climate change has already altered biotic communities severely even in protected areas, where no other interacting stressors (pollution, habitat fragmentation, etc.) are present. This is a striking example of the scientific value of comprehensive long‐term data in capturing the complex responses of communities toward climate change.
It is commonly assumed that the colonization of restored river reaches by fish depends on the regional species pools; however, quantifications of the relationship between the composition of the regional species pool and restoration outcome are lacking. We analyzed data from 18 German river restoration projects and adjacent river reaches constituting the regional species pools of the restored reaches. We found that the ability of statistical models to describe the fish assemblages established in the restored reaches was greater when these models were based on ‘biotic’ variables relating to the regional species pool and the ecological traits of species rather than on ‘abiotic’ variables relating to the hydromorphological habitat structure of the restored habitats and descriptors of the restoration projects. For species presence in restored reaches, ‘biotic’ variables explained 34% of variability, with the occurrence rate of a species in the regional species pool being the most important variable, while ’abiotic’ variables explained only the negligible amount of 2% of variability. For fish density in restored reaches, about twice the amount of variability was explained by ‘biotic’ (38%) compared to ‘abiotic’ (21%) variables, with species density in the regional species pool being most important. These results indicate that the colonization of restored river reaches by fish is largely determined by the assemblages in the surrounding species pool. Knowledge of species presence and abundance in the regional species pool can be used to estimate the likelihood of fish species becoming established in restored reaches.