Reconstruction of a long-term recovery process from pasture to forest

We used space-for-time substitution to obtain a directed successional sequence for subalpine meadow vegetation in the Swiss National Park. Since human impacts (e.g., domestic animal grazing) ceased in 1914, the successional processes documented are assumed to be autogenic in nature. The data consist of 59 permanent plots spanning almost 90 years, and include many spatial replications. An initial inspection of the individual time series revealed the existence of a variety of response patterns, which are described in the literature as representing different successional types. However, a closer inspection suggested that many of these series can be superimposed, as they are part of a much longer deterministic series. Linking the individual time series proved to be challenging. A heuristic approach produced results that differed depending on initial starting conditions. We therefore derived a deterministic algorithm to produce a unique solution. The resulting sequence largely confirmed the heuristic interpretation, suggesting a trend from early successional (post-grazing) grassland to pine invasion spanning about 400 years. This timespan is valid only for the climatic conditions near the treeline, and for plant species specific to the study site. Our results suggest that the various species temporal response models described in the literature may be artifactual, representing portions of underlying Gaussian responses. The data also indicate that species assemblages may persist for several decades with only minor fluctuations, only to change suddenly for no apparent reason

Was ist "evidence based" in der Adipositaschirurgie?

Zusammenfassung: Seit den 1990er Jahren gilt in den USA der Konsens, dass die bariatrische Chirurgie die beste Therapie zur Erzielung eines lang anhaltenden Gewichtsverlustes wie auch zur Behandlung der adipositasassoziierten Komorbiditäten ist. In der Folge kam es zu einem regelrechten Boom in der bariatrischen Chirurgie. Diese Entwicklung wurde zusätzlich beschleunigt durch das Aufkommen der laparoskopischen Techniken, welche die Morbidität des Eingriffes deutlich verkleinerten. Eine einheitliche Vorgehensweise und Verfahrenswahl existiert bis zum heutigen Zeitpunkt nicht. Vergleichende Studien zwischen verschiedenen Verfahren sind rar und die wissenschaftliche Evidenz zur Therapie der Fettleibigkeit ist mager. Allgemein wird anerkannt, dass die Abklärung im Vorfeld einer Operation interdisziplinär im Team erfolgt und dass die behandelnden Ärzte eine lebenslange Nachsorge der Patienten sicherstellen müssen. Der bariatrisch-chirurgische Eingriff sollte heute primär laparoskopisch durchgeführt werden, da dadurch die Folgen des offenen Zuganges wie Wundinfekt- und Narbenhernienraten massiv gesenkt werden. Die verschiedenen Verfahren beinhalten restriktive, malabsorptive und kombinierte Wirkmechanismen. Rein restriktive Verfahren wie das Magenbanding sind den kombinierten und malabsorptiven Verfahren in Bezug auf den erzielbaren Gewichtsverlust unterlegen. Ebenfalls werden Komorbiditäten wie der Diabetes mellitus und die arterielle Hypertonie durch letztere Methoden wirkungsvoller behandelt. Diese Erkenntnisse sollten daher die Grundlage zur Verfahrenswahl bei der chirurgischen Behandlung der morbiden Adipositas bilde

Disseminated Invasive Aspergillosis with Cerebral Involvement Successfully Treated with Caspofungin and Voriconazole

We describe a case of cerebral aspergillosis which was successfully treated with a combination of caspofungin and voriconazole. The patient remains in remission 18 months after stopping antifungal treatment. We discuss primary and salvage therapy of invasive aspergillosis with focus on cerebral involvement. Since historical data showed a fatal outcome in most cases, amphotericin B does not cross the blood brain barrier while voriconazole does, we chose a combination of voriconazole plus caspofungin as primary therap

Super-Nernstian Shifts of Interfacial Proton-Coupled Electron Transfers : Origin and Effect of Noncovalent Interactions

The support of the University of Aberdeen is gratefully acknowledged. C.W. acknowledges a summer studentship from the Carnegie Trust for the Universities of Scotland. E.P.M.L. acknowledges SeCYT (Universidad Nacional de Cordoba), ́ CONICET- PIP 11220110100992, Program BID (PICT 2012-2324), and PME 2006-01581 for financial support.Peer reviewedPostprin

Relevant baseline characteristics for describing patients with knee osteoarthritis: results from a Delphi survey

BACKGROUND: Inclusion/exclusion criteria and baseline characteristics are essential for assessing the applicability of trial results to a given patient and the comparability of study populations for meta-analyses. This Delphi survey aimed to generate a set of baseline characteristics for describing patients with knee osteoarthritis enrolled in clinical studies. METHODS: Survey participants comprised clinical experts (n = 23; mean age 54 y; from 4 continents) that had authored at least two randomized trials on knee osteoarthritis. First, given a prepared list of baseline patient characteristics, the experts were asked to add characteristics they considered important for assessing comparability of patient populations in different trials that evaluated the efficacy of non-surgical interventions for treating knee osteoarthritis. Next, they were asked to rate the importance of each characteristic, on a scale of 0 (not important) to 10 (highly important), according to three outcome categories: pain, function, and structure. RESULTS: Participants identified 121 baseline characteristics. A rating ≥7 points was assigned to 39 characteristics (e.g., age, depression, global knee pain, daily dose of pain killers, Kellgren-Lawrence grading); of these, 20 were related to pain, 15 to function, and 23 to structural outcomes. Global knee pain was the only baseline characteristic that fulfilled among experts the predefined consensus criteria. CONCLUSIONS: Experts identified a large number of characteristics for describing patients with knee osteoarthritis. Disagreement and uncertainty prevailed over the relevance of these characteristics. Our findings justified further efforts to define appropriate, broadly acceptable sets of baseline characteristics for describing patients with knee osteoarthritis

High secondary failure rate of rebanding after failed gastric banding

Background: Over the last decade, more than 130,000 laparoscopic adjustable gastric bandings (LAGB) have been performed for the treatment of morbid obesity. Nowadays, longer follow-up data are available in the literature and increasing numbers of late complications and treatment failures of gastric banding have been reported. The aim of the present study was the long-term evaluation of two different rescue operations after failed LAGB: conversion to laparoscopic Roux-en-Y bypass (LRYGB) versus laparoscopic gastric rebanding. Methods: Between January 1997 and November 2002, 74 consecutive patients underwent either laparoscopic gastric rebanding (n = 44) or LRYGB (n = 30) after failed LAGB. There were 14 men and 60 women, with a median age of 42 (23-60) years. The indication for reoperation was an increasing body mass index (BMI) and band-related complications such as pouch dilatation, band slippage, and penetration after LAGB. Rebandings were done by preference during the initial period of the study and LRYGB was the treatment of choice during the latter period. The success of the rescue operation was assessed by postoperative changes in the BMI, improvements of co-morbidities, and the need for further reoperations (secondary failure). The median follow-up was 36 months (range, 24-60 months). Results: Patients who underwent LRYGB had a significantly better weight loss than patients with a rebanding operation (mean −6.1 versus +1.5 BMI points). In addition, the LRYGB patients showed a significantly better control of serum cholesterol during the long term follow-up (−0.6 versus +0.1 mmol/l). Almost half of the patients (45%) in the rebanding group needed a further operative revision, whereas only 20% underwent reoperation after rescue LRYGB. Thus, the secondary failure rate in the rebanding group was significantly higher compared to the bypass group (p = 0.028). Conclusions: The present long-term study confirms our previous finding that LRYGB is a better treatment than rebanding after failed laparoscopic gastric banding regarding weight loss and treatment of co-morbidities. During the long-term follow-up the reoperation rate due to secondary failure became significantly higher in the rebanding group. We therefore recommend that LRYGB should be preferred as rescue procedure after failed laparoscopic adjustable gastric bandin