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Untersuchungen zur Rhizommorphologie und Wachstumsstrategie von Geophyten des Göttinger Waldes
(1996)
Das Rhizomwachstum von sieben Pflanzenarten des Göttinger Waldes wurde untersucht. Dabei wurden Wachstumszeiten, Wuchsformen und phänologische Entwicklung festgestellt. Aus den Daten wurde auf die Wachstumsstrategien der Arten geschlossen und die oberirdische Entwicklung mit dem Rhizomwachstum verglichen. Es konnte festgestellt werden, daß das Rhizomwachstum kurz nach Beginn der Blattentfaltung einsetzt. Ab diesem Zeitpunkt liefert die Photosynthese der Blätter genügend Kohlenhydrate zum Aufbau neuer Rhizomabschnitte. Bei den sieben untersuchten Arten konnten drei verschiedene Wachstumsstrategien festgestellt werden. Früh blühende Arten folgen der Dominanzstrategie, um Licht monopolisieren zu können. Arten fleckenhafter Habitate folgen der Explorationsstrategie, die flexibel auf veränderte Umweltbedingungen reagieren kann. Spät blühende Arten folgen der unspezialisierten pragmatischen Strategie.
Background & Aims: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis.
Methods: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint.
Results: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02–2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA.
Conclusion: This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis.
Lay summary: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.