Systematics and biogeography of Southeast Asian Senecioneae (Asteraceae): Revision of Cissampelopsis and Gynura and hybridisation in the introduced Crassocephalum

ZUSAMMENFASSUNG Die vorgelegte Dissertation enthält zwei Teile. Der erste beinhaltet eine Einführung in die Flora Südostasiens und die Untersuchungsgruppe Asteraceae-Senecioneae Cass. mit den Gattungen Cissampelopsis (DC.) Miq., Gynura Cass. und Crassocephalum Moench (Kapitel 1). Der zweite Teil besteht aus drei Manuskripten, die auf originalen Forschungsergebnissen basieren (Kapitel 2-4). In Kapitel 2 wird eine Revision der asiatischen Gattung Cissampelopsis vorgelegt. Die folgenden zwei Sektionen mit zehn Arten und zwei Varietäten werden anerkannt: sect. Buimalia C. Jeffrey & Y. L. Chen mit C. buimalia (Buch.-Ham. ex D. Don) C. Jeffrey & Y. L. Chen, C. erythrochaeta C. Jeffrey & Y. L. Chen und C. calcadensis (Ramasw.) C. Jeffrey & Y. L. Chen sowie sect. Cissampelopsis mit C. glandulosa C. Jeffrey & Y. L. Chen, C. walkeri (Arn.) C. Jeffrey & Y. L. Chen mit var. walkeri und var. floccosa Vanijajiva & Kadereit (var. nov.), C. corifolia C. Jeffrey & Y. L. Chen, C. volubilis (Bl.) Miq, C. ansteadii (Tadul. & Jacob) C. Jeffrey & Y. L. Chen, C. spelaeicola (Van.) C. Jeffrey & Y. L. Chen und C. corymbosa (Wall. ex DC.) C. Jeffrey & Y. L. Chen. Schlüssel, Artbeschreibungen, Fotographien von Blütenmerkmalen und Verbreitungskarten werden präsentiert. Kapitel 3 beinhaltet die Revision der paläotropischen Gattung Gynura. Vierundvierzig Arten werden anerkannt, darunter die folgenden drei Neubeschreibungen: G. davisii Vanijajiva & Kadereit, G. siamensis Vanijajiva & Kadereit und G. villosus Vanijajiva & Kadereit. Gynura dissecta (F. G. Davies) Vanijajiva & Kadereit, G. annua (F. G. Davies) Vanijajiva & Kadereit und G. aurantiaca (Bl) DC. subsp. parviflora (F. G. Davies) Vanijajiva & Kadereit sind Neukombinationen. Ein Schlüssel, Artbeschreibungen und Verbreitungskarten werden vorgelegt. In Kapitel 4 wird eine Analyse von Crassocephalum in Asien, einer aus Afrika eingeschleppten Gattung, präsentiert. Diese Untersuchung basiert auf umfangreicher Feldarbeit, Herbarstudien, Analysen der Pollen- und Samenfertilität, Chromosomenzählungen sowie ITS- und trnL-F-Sequenzen. Die Studie ergab, dass Crassocephalum in Asien mit zwei Arten und deren Hybrid vertreten ist. Die zwei Arten sind C. crepidioides (Benth.) S. Moore und C. rubens (Juss. ex Jacq.) S. Moore, wobei letztere einen Neufund für Asien darstellt. Der Hybrid aus diesen beiden Arten resultiert aus einer Kreuzung von C. crepidioides (2n=40) als weiblichem und C. rubens (2n=40) als männlichem Elter.

Revision of Trogulidae Sundevall, 1833 (Arachnida: Opiliones)

The relationship and phylogeny of the western Palearctic harvestmen family Trogulidae is investigated. The traditional system of seven genera and approximately 40 species appeared to be artificially composed but a phylogenetic approach and a comprehensive revision has long been sought after. Species are poorly characterised due to their uniform morphology and species evaluation is furthermore complicated by the variability of the few characters used for species delineation. To meet these demands a molecular genetic analysis is accomplished using the nuclear 28S rRNA gene and the mitochondrial cytochrome b gene. This analysis incorporates most genera and species of Trogulidae as well as a comprehensive set of Nemastomatidae and Dicranolasmatidae as outgroup taxa. Phylogenetic results of Bayesian analysis, Maximum Parsimony, Maximum Likelihood and Neighbor Joining are compared with distributional data, morphological characters and results of canonical discriminant analysis of morphometric characters and general congruence of these data sets is shown. To demonstrate the applicability of this method the revision of two species-groups within Trogulus is set out in detail. The Trogulus hirtus species-group and the Trogulus coriziformis species-group are revised. The former is in the central and north-western Balkan Peninsula. T. tricarinatus ssp. hirtus is raised to species level and four new species are described (T. karamanorum [man.n.], T. melitensis [man.n.], T. pharensis [man.n]; T. thaleri [man.n.]). The Trogulus coriziformis species-group is confined to the western Mediterranean area. T. coriziformis, T. aquaticus are re-described, T. cristatus and T. lusitanicus are re-established and four species are described as new (T. balearicus, T. huberi, T. prietoi, T. pyrenaicus). In both species-groups two further cryptic species probably exist but were not described. The species groups are shown to represent different phylogenetic levels and this information is used for the revisional work on the genus Trogulus as well as for the generic system of Trogulidae. Family status of Dicranolasmatidae is rejected and Dicranolasma is shown to be best incorporated within Trogulidae. Calathocratus, Platybessobius and Trogulocratus appear to be polyphyletic and are best to be united within Calathocratus, the oldest name of this set. The cryptic diversity within Trogulidae, especially in Trogulus and the composed genus Calathocratus rates to 150-235% and is thereby remarkably high for a group of the generally well researched European fauna. Genetic features of the group such as heteroplasmy, the possibility of major gene rearrangements and usability of the cytochrome b gene for phylogenetic studies in Opiliones are outlined.

Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

An intraoperatively moulded PMMA prostheses like spacer for two-stage revision of infected total knee arthroplasty

We report a series of 16 consecutive total knee arthroplasty (TKA) revision procedures for deep infection, treated with a newly developed intraoperatively moulded PMMA cement-prostheses-like spacer (CPLS). The standard treatment consisted of a two-stage protocol with initial explantation of the infected components combined with radical debridement, followed by implantation of a temporary cement spacer and final reimplantation of a new TKA. A sterilizeable Teflon tapered aluminium mould was developed for production of a custom made CPLS during the intervention. Stable implantation of the CPLS was achieved with a second cementation, allowing for correct alignment and ligament balancing. The spacer remained 3.5 months on average until reimplantation of a TKA occurred. At time of reimplantation, patients had an average KSS score of 84.44 points with an average flexion capacity of 102°. There was no recurrent infection during the study period of minimum 2 years. With this new technique, a low friction articulation with good stability, high comfort and a better range of motion compared to handcrafted spacers was achieved. The use of this spacer is a time sparing, cheap and convenient option in 2-stage TKA revision.

Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm

Successful treatment of prosthetic hip joint infection (PI) means elimination of infection and restored hip function. However, functional outcome is rarely studied. We analyzed the outcome of the strict use of a treatment algorithm for PI.

International survey of primary and revision total knee replacement

Purpose Total knee arthroplasty (TKA) is currently the international standard of care for treating degenerative and rheumatologic knee joint disease, as well as certain knee joint fractures. We sought to answer the following three research questions: (1) What is the international variance in primary and revision TKA rates around the world? (2) How do patient demographics (e.g., age, gender) vary internationally? (3) How have the rates of TKA utilization changed over time? Methods The survey included 18 countries with a total population of 755 million, and an estimated 1,324,000 annual primary and revision total knee procedures. Ten national inpatient databases were queried for this study from Canada, the United States, Finland, France, Germany, Italy, the Netherlands, Portugal, Spain, and Switzerland. Inpatient data were also compared with published registry data for eight countries with operating arthroplasty registers (Denmark, England & Wales, Norway, Romania, Scotland, Sweden, Australia, and New Zealand). Results The average and median rate of primary and revision (combined) total knee replacement was 175 and 149 procedures/100,000 population, respectively, and ranged between 8.8 and 234 procedures/100,000 population. We observed that the procedure rate significantly increased over time for the countries in which historical data were available. The compound annual growth in the incidence of TKA ranged by country from 5.3% (France) to 17% (Portugal). We observed a nearly 27-fold range of TKA utilization rates between the 18 different countries included in the survey. Conclusion It is apparent from the results of this study that the demand for TKA has risen substantially over the past decade in countries around the world.

Age at hip or knee joint replacement surgery predicts likelihood of revision surgery

We compared revision and mortality rates of 4668 patients undergoing primary total hip and knee replacement between 1989 and 2007 at a University Hospital in New Zealand. The mean age at the time of surgery was 69 years (16 to 100). A total of 1175 patients (25%) had died at follow-up at a mean of ten years post-operatively. The mean age of those who died within ten years of surgery was 74.4 years (29 to 97) at time of surgery. No change in comorbidity score or age of the patients receiving joint replacement was noted during the study period. No association of revision or death could be proven with higher comorbidity scoring, grade of surgeon, or patient gender. We found that patients younger than 50 years at the time of surgery have a greater chance of requiring a revision than of dying, those around 58 years of age have a 50:50 chance of needing a revision, and in those older than 62 years the prosthesis will normally outlast the patient. Patients over 77 years old have a greater than 90% chance of dying than requiring a revision whereas those around 47 years are on average twice as likely to require a revision than die. This information can be used to rationalise the need for long-term surveillance and during the informed consent process.

Death by biscuit--exhumation, post-mortem CT, and revision of the cause of death one year after interment

We describe a case of exhumation, performed to investigate the circumstances and cause of death, one year after burial. Post mortem computed tomography (PMCT) revealed a mass in the pharynx. Imaging directed the subsequent forensic autopsy to careful retrieval of a foreign body. Histological analysis revealed a non-cellular composition. The detection of foreign material in the pharynx and its composition indicated accidental, rather than natural death, secondary to choking on food. This unusual case illustrates how post mortem imaging can significantly contribute to forensic investigation and stresses the importance of interdisciplinary collaboration between forensic pathologists and radiologists.

Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland. 2011 revision of the Swiss recommendations

Perinatal care of pregnant women at high risk for preterm delivery and of preterm infants born at the limit of viability (22-26 completed weeks of gestation) requires a multidisciplinary approach by an experienced perinatal team. Limited precision in the determination of both gestational age and foetal weight, as well as biological variability may significantly affect the course of action chosen in individual cases. The decisions that must be taken with the pregnant women and on behalf of the preterm infant in this context are complex and have far-reaching consequences. When counselling pregnant women and their partners, neonatologists and obstetricians should provide them with comprehensive information in a sensitive and supportive way to build a basis of trust. The decisions are developed in a continuing dialogue between all parties involved (physicians, midwives, nursing staff and parents) with the principal aim to find solutions that are in the infant's and pregnant woman's best interest. Knowledge of current gestational age-specific mortality and morbidity rates and how they are modified by prenatally known prognostic factors (estimated foetal weight, sex, exposure or nonexposure to antenatal corticosteroids, single or multiple births) as well as the application of accepted ethical principles form the basis for responsible decision-making. Communication between all parties involved plays a central role. The members of the interdisciplinary working group suggest that the care of preterm infants with a gestational age between 22 0/7 and 23 6/7 weeks should generally be limited to palliative care. Obstetric interventions for foetal indications such as Caesarean section delivery are usually not indicated. In selected cases, for example, after 23 weeks of pregnancy have been completed and several of the above mentioned prenatally known prognostic factors are favourable or well informed parents insist on the initiation of life-sustaining therapies, active obstetric interventions for foetal indications and provisional intensive care of the neonate may be reasonable. In preterm infants with a gestational age between 24 0/7 and 24 6/7 weeks, it can be difficult to determine whether the burden of obstetric interventions and neonatal intensive care is justified given the limited chances of success of such a therapy. In such cases, the individual constellation of prenatally known factors which impact on prognosis can be helpful in the decision making process with the parents. In preterm infants with a gestational age between 25 0/7 and 25 6/7 weeks, foetal surveillance, obstetric interventions for foetal indications and neonatal intensive care measures are generally indicated. However, if several prenatally known prognostic factors are unfavourable and the parents agree, primary non-intervention and neonatal palliative care can be considered. All pregnant women with threatening preterm delivery or premature rupture of membranes at the limit of viability must be transferred to a perinatal centre with a level III neonatal intensive care unit no later than 23 0/7 weeks of gestation, unless emergency delivery is indicated. An experienced neonatology team should be involved in all deliveries that take place after 23 0/7 weeks of gestation to help to decide together with the parents if the initiation of intensive care measures appears to be appropriate or if preference should be given to palliative care (i.e., primary non-intervention). In doubtful situations, it can be reasonable to initiate intensive care and to admit the preterm infant to a neonatal intensive care unit (i.e., provisional intensive care). The infant's clinical evolution and additional discussions with the parents will help to clarify whether the life-sustaining therapies should be continued or withdrawn. Life support is continued as long as there is reasonable hope for survival and the infant's burden of intensive care is acceptable. If, on the other hand, the health car...

Comparison of in vivo acute stent recoil between the bioresorbable everolimus-eluting coronary scaffolds (revision 1.0 and 1.1) and the metallic everolimus-eluting stent

The ABSORB cohort A trial using the bioresorbable everolimus-eluting scaffold (BVS revision 1.0, Abbott Vascular) demonstrated a slightly higher acute recoil with BVS than with metallic stents. To reinforce the mechanical strength of the scaffold, the new BVS scaffold (revision 1.1) with modified strut design was developed and tested in the ABSORB cohort B trial. This study sought to evaluate and compare the in vivo acute scaffold recoil of the BVS revision 1.0 in ABSORB cohort A and the BVS revision 1.1 in ABSORB cohort B with the historical recoil of the XIENCE V® everolimus-eluting metal stent (EES, SPIRIT I and II).