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Das Vorkommen von Kalk-Halbtrockenrasen oder Kalkmagerrasen ist im Wesentlichen auf diejenigen Regionen beschränkt, die basenreiche Ausgangsgesteine aufweisen. Es handelt sich hierbei vorrangig um die aus Sedimentgesteinen des Muschelkalks bzw. des Juras und der Kreide aufgebauten Kalkgebirge, die sich in Mitteleuropa v. a. in der Frankenalb, der Schwäbischen Alb, an den Muschelkalkhängen von Kocher, Jagst, Tauber und Main mit Nebenflüssen, in der thüringischen und bayerischen Rhön, an den Hängen des Mittleren Saaletales in Thüringen und im Dreiländereck Ostwestfalen, Südniedersachsen und Nordhessen finden. In Nordrhein-Westfalen befinden sich die größten Vorkommen der Kalkmagerrasen in den Kreisen Euskirchen (Eifel) und Höxter sowie im Raum
Marsberg (Hochsauerlandkreis).
Die Grundlage der in diesem Jahresbericht dargestellten Aktivitäten bildet ein mit den zuständigen Fachbehörden abgestimmter Arbeits- und Maßnahmenplan, in dem die Aufgaben der Landschaftsstation für das Jahr 2007 festgelegt wurden. Die detaillierten Ergebnisse dieser Arbeiten wurden den Fachbehörden in Form von umfangreichen Fachdatenblättern übermittelt. Der hier vorliegende Bericht ist für die Aufsichtsbehörden gedacht. Allen anderen interessierten Leserinnen und Lesern soll er einen knappen Einblick in die Arbeit der Landschaftsstation 2007 geben. Der Schwerpunkt der wissenschaftlichen Arbeit im Jahr 2007 lag im Monitoring der betreuten Natura 2000 (FFH-)- und Naturschutz-Gebiete (NSG) „Hannoversche Klippen“ bei Würgassen, „Desenberg“" bei Daseburg, „Kalkmagerrasen bei Ottbergen (und Bruchhausen)“, „Kiebitzteich“ bei Reelsen, „Satzer Moor“ bei Herste, „Wandelnsberg“ zwischen Beverungen und Drenke, sowie „Bleikuhlen und Wäschebachtal“ im äußersten Südwesten des Kreises bei Blankenrode. Das Team der Landschaftsstation im Kreis Höxter bittet um Verständnis, dass sich die hauptamtlichen Mitarbeiter aufgrund der oben skizzierten Entwicklung auf ihre Kernaufgaben konzentrieren müssen und somit weitere Aufgaben wie die Außendarstellung, Exkursionen und sonstige Serviceleistungen nicht immer im gewünschten Maße wahrgenommen werden können.
Species' geographical distributions are tracking latitudinal and elevational surface temperature gradients under global climate change. To evaluate the opportunities to track these gradients across space, we provide a first baseline assessment of the steepness of these gradients for the world's terrestrial birds. Within the breeding ranges of 9,014 bird species, we characterized the spatial gradients in temperature along latitude and elevation for all and a subset of bird species, respectively. We summarized these temperature gradients globally for threatened and non-threatened species and determined how their steepness varied based on species' geography (range size, shape, and orientation) and projected changes in temperature under climate change. Elevational temperature gradients were steepest for species in Africa, western North and South America, and central Asia and shallowest in Australasia, insular IndoMalaya, and the Neotropical lowlands. Latitudinal temperature gradients were steepest for extratropical species, especially in the Northern Hemisphere. Threatened species had shallower elevational gradients whereas latitudinal gradients differed little between threatened and non-threatened species. The strength of elevational gradients was positively correlated with projected changes in temperature. For latitudinal gradients, this relationship only held for extratropical species. The strength of latitudinal gradients was better predicted by species' geography, but primarily for extratropical species. Our findings suggest threatened species are associated with shallower elevational temperature gradients, whereas steep latitudinal gradients are most prevalent outside the tropics where fewer bird species occur year-round. Future modeling and mitigation efforts would benefit from the development of finer grain distributional data to ascertain how these gradients are structured within species' ranges, how and why these gradients vary among species, and the capacity of species to utilize these gradients under climate change.
Der Nationale Aktionsplan für Menschen mit Seltenen Erkrankungen (SE) enthält 52 konkrete Maßnahmen, u. a. in den Handlungsfeldern Versorgung, Forschung, Diagnose und Informationsmanagement. Mit dem Ziel, langfristig die Qualität und Interoperabilität von nationalen Registern zu erhöhen, sieht Maßnahmenvorschlag 28 die Etablierung einer Strategiegruppe „Register für Seltene Erkrankungen“ vor. Diese Strategiegruppe hat 2016 ihre Arbeit aufgenommen. Sie berichtet hier über Entwicklungen auf nationaler und internationaler Ebene, um Empfehlungen für nationale Initiativen daraus abzuleiten.
Zusätzlich werden die Konsentierung und Implementierung sowie mit der Zeit ggf. die Anpassung eines Minimaldatensatzes zur Verwendung in Registern für Seltene Erkrankungen erläutert. Zusätzlich werden die verwendeten Datenelemente bzw. -schemata in einem sog. Metadata Repository abgebildet. Dieses Positionspapier wurde durch die Strategiegruppe sowie weitere Autoren erarbeitet und innerhalb der Gruppe konsentiert. Es wird als Konzeptpapier zum Aufbau und Betrieb von Registern der Strategiegruppe „Register“ veröffentlicht.
Improving long-term patient and graft survival after liver transplantation (LT) remains a major challenge. Compared to the early phase after LT, long-term morbidity and mortality of the recipients not only depends on complications immediately related to the graft function, infections, or rejection, but also on medical factors such as de novo malignancies, metabolic disorders (e.g., new-onset diabetes, osteoporosis), psychiatric conditions (e.g., anxiety, depression), renal failure, and cardiovascular diseases. While a comprehensive post-transplant care at the LT center and the connected regional networks may improve outcome, there is currently no generally accepted standard to the post-transplant management of LT recipients in Germany. We therefore described the structure and standards of post-LT care by conducting a survey at 12 German LT centers including transplant hepatologists and surgeons. Aftercare structures and form of cost reimbursement considerably varied between LT centers across Germany. Further discussions and studies are required to define optimal structure and content of post-LT care systems, aiming at improving the long-term outcomes of LT recipients.
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD is caused by chronic exposure to cigarette smoke and/or other environmental pollutants that are believed to induce reactive oxygen species (ROS) that gradually disrupt signalling pathways responsible for maintaining lung integrity. Here we identify the antioxidant protein sestrin-2 (SESN2) as a repressor of PDGFRβ signalling, and PDGFRβ signalling as an upstream regulator of alveolar maintenance programmes. In mice, the mutational inactivation of Sesn2 prevents the development of cigarette-smoke-induced pulmonary emphysema by upregulating PDGFRβ expression via a selective accumulation of intracellular superoxide anions (O2−). We also show that SESN2 is overexpressed and PDGFRβ downregulated in the emphysematous lungs of individuals with COPD and to a lesser extent in human lungs of habitual smokers without COPD, implicating a negative SESN2-PDGFRβ interrelationship in the pathogenesis of COPD. Taken together, our results imply that SESN2 could serve as both a biomarker and as a drug target in the clinical management of COPD.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD is caused by chronic exposure to cigarette smoke and/or other environmental pollutants that are believed to induce reactive oxygen species (ROS) that gradually disrupt signalling pathways responsible for maintaining lung integrity. Here we identify the antioxidant protein Sestrin 2 (Sesn2) as a repressor of PDGFRβ signalling and PDGFRβ signalling as an upstream regulator of alveolar maintenance programs. In mice, the mutational inactivation of Sesn2 prevents the development of cigarette-smoke induced pulmonary emphysema by upregulating PDGFRβ expression via a selective accumulation of intracellular superoxide anions (O2-). We also show that SESN2 is overexpressed and PDGFRβ downregulated in the emphysematous lungs of patients with COPD and to a lesser extent in human lungs of habitual smokers without COPD, implicating a negative SESN2/PDGFRβ interrelationship in the pathogenesis of COPD. Taken together, our results imply that SESN2 could serve as both a biomarker and as a drug target in the clinical management of COPD.
Background: Critical organ shortage results in the utilization of extended donor criteria (EDC) liver grafts. These marginal liver grafts are prone to increased ischemia reperfusion injury (IRI) which may contribute to deteriorated graft function and survival. Experimental data have shown that the calcineurin inhibitor tacrolimus exerts protective effects on hepatic IRI when applied intravenously or directly as a hepatic rinse. Therefore, the aim of the present study is to examine the effects of an ex vivo tacrolimus perfusion on IRI in transplantation of EDC liver grafts.
Methods/Design: The TOP-Study (tacrolimus organ perfusion) is a randomized multicenter trial comparing the ex vivo tacrolimus perfusion of marginal liver grafts with placebo. We hypothesize that a tacrolimus rinse reduces IRI, potentially improving organ survival following transplantation of EDC livers. The study includes livers with two or more EDC, according to Eurotransplant International Foundation’s definition of EDC livers. Prior to implantation, livers randomized to the treatment group are rinsed with tacrolimus at a concentration of 20 ng/ml in 1000 ml Custodiol solution and in the placebo group with Custodiol alone. The primary endpoint is the maximum serum alanine transamninase (ALT) level within the first 48 hours after surgery; however, the study design also includes a 1-year observation period following transplantation. The TOP-Study is an investigator-initiated trial sponsored by the University of Munich Hospital. Seven other German transplant centers are participating (Berlin, Frankfurt, Heidelberg, Mainz, Münster, Regensburg, Tübingen) and aim to include a total of 86 patients.
Discussion: Tacrolimus organ perfusion represents a promising strategy to reduce hepatic IRI following the transplantation of marginal liver grafts. This treatment may help to improve the function of EDC grafts and therefore safely expand the donor pool in light of critical organ shortage.
Trial register: EudraCT number: 2010-021333-31, ClinicalTrials.gov identifier: NCT01564095
Background & Aims: In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients.
Methods: In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort.
Results: Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p < .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly.
Conclusions: This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.