Dieback of managed spruce stands in western Germany promotes beetle diversity

Biodiversity loss is a significant problem at a global scale and may be amplified by climate change.In recent years,coniferous forests have had substantial die-back across Europe due to drought and subsequent bark-beetle outbreaks.As many studies on the consequences of disturbance and subsequent management have focused on natural stands,management implications for managed spruce stands are not well understood,even though such stands are widespread throughout Europe.In this study,beetle taxonomy,conservation value,and community com-position are compared among spruce plantations and four post-disturbance management approaches:standing dead-wood,lying deadwood,clear cuts,and long-term succession.Diversity and community composition differed significantly among management categories,while different beetle fami-lies responded similarly.Intact spruce stands harbored the lowest beetle diversity while the highest taxonomic diver-sity and conservation value was on clear cuts and stands with lying or standing deadwood.The proportion of forest specialists was highest in successional forests.In summary,different forest management categories harbored distinct beetle communities at the family-,species-,and ecological guild levels.Therefore,post-disturbance management should consider the landscape scale and include different management types.This enhances landscape heterogeneity and thus overall biodiversity but could also mitigate negative impacts of natural disturbances on ecosystem services.

Cretaceous Large Igneous Provinces (LIPs) Affect Sedimentary Processing: Jordan, Arabian Plate;NW Germany, Central Europe

Both the NE Gondwana Platform (Jordan) and the Carpathian/NW Europe Seaway towards the N Atlantic expose comparable sequence analytical patterns as i.e. the Maximum Flooding Surface (MSF), relating to the Arabian Shelf, throughout one of the warmest Phanerozoic Epochs. Supervolcanic Large Igneous Provinces (LIPs), (explosive island arc andesitic volcanism), Mid-Oceanic Rift Basalts (MORB), (S/N Atlantic, Arctic) and kimberlitic volcanism (W Gondwana) provided striking conditions for an immense influence (tuff, degassing, T) on the sedimentary processing throughout the Cretaceous, mainly verified by K-montmorillonite , dozens of tuff beds (predominantly in NW Germany), zeolite, cristobalite, extremely high chert occurrences as well as the reconfirming of the global anoxic event around the Cenomanian/Turonian b. (94 Ma) by a positive ∂13C-maximum (~0.5%). Thus the lithofacies spectrum (carbonate rocks, chalk, chert, porcellanite, shale) was affected by pH, Eh, T, photosynthesis, and greenhouse gases—change during varying positive/negative climate forcing. While acid sturzrain events caused the transformation of arkosic/subarkosic sediments of the hinterlands to quartz arenite cycles deposited on the Jordanian Platform during early Cretaceous, the other patterns mentioned, led to a rapid change of lithofacies through Late Cretaceous. The southward directed Neotethys transgression can be reconstructed during the Early Cretaceous by glauconite-aged tidalites that give hint on transpressional tectonics during the Upper Cenomanian east of the Dead Sea. The Cretaceous/Paleogene (K-Pg) transitional zone evidences a zone of several cumulative events (island arc-volcanism) and the Chicxulub impact, indicated by at least two extinctions phases. The southward obduction of the Palmyrides, Syria and related transtensional/transpressional strike slip tectonics (partially pull-apart structures) left a fast facies change on the Jordanian Platform.

Experienced Involvement (ExIn) in Social-Psychiatric Care of Germany-Challenges and Chances

This study explores the integration of Experienced Involvement(ExIn)in social-psychiatric care in Germany,emphasizing both the challenges and opportunities it presents.The European Leonardo da Vinci Project(2005-2007)established a curriculum for ExIn,promoting participatory structures in psychiatric services.While peer support is well-established in other European countries,Germany’s experience is still developing.This research uses a mixed methods design,combining quantitative surveys and qualitative interviews,to investigate the professional experiences of ExIn recovery companions and team colleagues in German clinics and support services.The findings reveal numerous benefits:for social-psychiatric services,ExIn enhances service quality,inclusivity,and accessibility;for team colleagues,it fosters reflexivity,hope,and trust,and improves self-care;for service users,it provides empowerment,easy access to support,trust,and hope,and offers credible role models.Despite these benefits,challenges such as stigmatization,lack of recognition,and financial constraints remain and require to be addressed.The study highlights the need and provides implications for a dedicated and inclusive approach to effectively implementing ExIn,ultimately enriching psychiatric care through experiential knowledge and reducing prejudice within mental health services.

Medical Students’Views on Psychiatry in Germany and Italy:Survey

Objectives:In 2019,the Insititue for Health Metrics and Evaluation reported that 16%of life lost were attributed to mental health.As a result,global shortage of psychiatrists is a pressing issue due to the increasing burden of mental illness.In 2016,a mere 5%of US medical students chose psychiatry as a career,a trend mirrored in Germany and Italy.As the medical students of 2016 have graduated or transitioned into residency in 2023,their attitudes towards psychiatry could have contributed to today’s shortage of psychiatrists.The global mental health burden has only been exacerbated by the COVID-19 pandemic.This study explores the attitudes of German and Italian medical students towards psychiatry,their career aspirations,and the influence of factors such as personal experience and education on their interest in the field.Methods:A cross-sectional survey was conducted among 799 medical students in two European countries in 2016.Participants answered questions about their attitudes towards psychiatry,their psychiatric education,and personal experiences.Inferential analyses were performed using chi-square tests and a significance level of 0.05.Results:The number of years in medical school,personal experiences,and perceived quality of education significantly affected specialty choice and ranking of psychiatry compared to other specialties.Internships,psychiatric placements,and views on psychiatric instructors also played a significant role in choosing psychiatry as a career.Conclusions:Assessing medical students’attitudes towards psychiatry and the factors that influence their career choices,such as psychiatric education and personal experiences,can inform changes to attract students to the field.Addressing the worldwide shortage of psychiatrists is crucial to reduce the burden of mental health and substance use disorders.

Impact of COVID-19 lockdown on hospital admissions for epistaxis in Germany

BACKGROUND Reports of a decrease in hospital admissions during the coronavirus disease 2019(COVID-19)lockdown period have raised concerns about delayed or missed diagnoses and treatments for non-COVID-19-related illnesses.AIM To investigate the impact of the COVID-19 pandemic-induced lockdown and its end on hospital admissions of patients with epistaxis in Germany.METHODS A retrospective analysis based on the national database of the Hospital Remuneration System was used to compare hospital admissions during defined time periods between 2019 and 2022 with the lockdown period as the reference period.This was done on a weekly basis before,during,and after the lockdown.An Interrupted Time Series was used as the analysis method.RESULTS In our analysis,we included 26183 patients.The implementation of the lockdown led to a substantial reduction in the overall occurrence of epistaxis among patients(P<0.05).This effect was most pronounced in the age group of 0-39 years,where the decrease was highly significant(P<0.001).However,there was no change observed in patients aged 80 years and older(not significant).With the end of the lockdown period,the overall number of patients,especially in the youngest age group,increased abruptly and significantly(P<0.01).CONCLUSION During the lockdown period,there was a decrease in hospital admissions for younger patients with epistaxis,possibly due to the fear of COVID-19 exposure.We also conclude that the severity of epistaxis was not underestimated in the elderly during the pandemic.

A high frequency of GBV-C/HGV coinfection in hepatitis C patients in Germany

AIM To detect infection rate of GBV-C/HGV inhepatitis C patients,to determine the methodsof higher sensitivity and the primers of higherefficiency for GBV-C/HGV RNA detection and tostudy the dominant subtype and mutation ofGBV-C/HGV.METHODS Quantitative RT-PCR for detectionpf HCV RNA concentration in serum samples,RT-nested PCR with two sets of primers fordetection of GBV-C RNA,RT-PCR ELISA with twosets of primers for detection of HGV RNA,nucleotide sequence and putative amino acidsequence analysis.RESULTS The positive rates of GBV-C RNA atthe 5’-NCR and NS3 region in 211 serums amplesfrom the patients with HCV infection were 31.8%and 22.8% respectively.The positive rates ofHGV RNA at the 5’-NCR and NS5 region in thesame samples were 47.9% and 31.8%respectively.The total positive rate of GBV-C/HGV RNA was as high as 55.5%.HCV copynumbers in the patients without GBV-C/ HGVcoinfection were statistically higher than that inthe patients with GBV-C/ HGV coinfection(P【0.01).Frequent mutation of nucleotideresidue was present in the amplificationproducts.Frameshift mutation was found in twosamples with GBV-C NS3 region nucleotidesequences.All nucleotide sequences fromamplification products showed higher homologyto HGV genome than to GBV-C genome even though part of the sequences were amplifiedwith GBV-C primers.CONCLUSION A high frequency of GBV-C/ HGV coinfection existed in the hepatitis C patients. RT-PCR ELISA was more sensitive than RT-nested PCR for detection of GBV-C/ HGV RNA. The primers derived from the 5 -NCR was more efficient than those derived from the NS3 and NS5 regions. A reverse relationship was found to exist between HCV RNA concentration and GBV-C/ HGV infection frequency. HGV was the dominant subtype of the virus in the local area. The major mutations of GBV-C/ HGV genomes were random mutation of nucleotide residue.

Psychological preparation practices for children undergoing medical procedures in Japan and Germany

The present study aimed to clarify the current status and awareness of psychological preparation for children undergoing medical procedures in pediatric nursing in Japan as compared with that in Germany. An original questionnaire about the current status and awareness of psychological preparation for children in hospitals was distributed by mail to nurses’ working on Japanese pediatric wards in 2010. The same questionnaire, translated into German, was distributed to nurses working on German pediatric wards via the internet in 2010. A large majority of respondents strongly agreed that children have a right to informed consent. German nurses expressed a longer-term viewpoint on the effects of preparation than Japanese nurses. Japanese nurses recognized a greater need for improvement in their duties than German nurses. The results suggest that we should consider our own country’s nursing practices and need for improvement, but also learn from studies of other countries to address each culture and medical situation appropriately.

Long-term cost and efficacy analysis of latanoprost versus timolol in glaucoma patients in Germany

AIM: To evaluate 5-year effectiveness and cos between latanoprost or timolol monotherapy in a pilot trial.METHODS: A retrospective, multi-center trial performed at 6 sites in Germany of patients who had a diagnosis of primary open-angle or pigmentary glaucoma, in at least one eye, initiated on monotherapy with latanoprost or timolol maleate. Qualified consecutive charts were reviewed in which 5-year efficacy, safety and cost data was abstracted.RESULTS: Seventy-seven latanoprost and 49 timolo patients were included, at the final visit no difference existed between the two groups in disc parameters including: rim area, rim area/disc area ratio, cup volume or vertical cup/disc ratio (P 】0.05). There was no difference in intraocular pressure (IOP) between the initial latanoprost (17.4 ±2.6) and timolol (16.3 ±2.8mmHg) groups. There was less change in medicines over the follow-up period (0.1 vs 0.8) and fewer medications at the final visit (1.2 vs 1.8) with latanoprost compared to timolol. No patient treated with latanoprost discontinued therapy during follow-up, while 12% discontinued timolol mostly due to inadequate IOP control. Cost/year was less with initial timolol ($458±236) as compared to latanoprost ($552±202). CONCLUSION: Patients begun on latanoprost o timolol and followed over 5 years may have similar clinical outcomes. However, timolol patients may require more medicines and medicine changes to control IOP for long-term, but at a lower cost.

Clinical Observation on the Treatment of Insomnia in Germany with Deficiency of Heart and Spleen by the Ear Bean Therapy

Objective: To observe the effect of insomnia patients with deficiency of heart and spleen in Germany by the therapy of ear points pressing with bean. Methods: A total of 80 cases of insomnia with deficiency of heart and spleen in Germany were divided into the observation group and the control group, with 40 cases in each group. The patients in the control group were treated with oral modified Guipi Decoction(归脾汤), while the patients in the observation group were treated with oral traditional Chinese medicine(TCM) and the therapy of ear points pressing with bean. The efficacy, sleep quality, the TCM syndromes score and the incidence of adverse reactions were compared between the two groups. Results: The effective rate in the observation group was higher than that in the control group, and there was statistical difference between the two group(P<0.05). After treatment, the Pittsburgh sleep quality index scale(PSQI) score, insomnia severity index(ISI) score and the TCM syndromes score in the two groups were decreased sharply(P<0.01), and those scores in the observation group were lower than that in the control group(P<0.05). There was no adverse reaction between the two groups. Conclusion: The therapy of ear points pressing with bean is effective on insomnia in Germany, which is worth further study and promotion.

The New DIN Standards in Earth Building—The Current Situation in Germany

In the last decade the use of earth in construction has become increasingly widespread in many countries.Building with earth can contribute to sustainable development by reducing environmental impact compared with other building materials or systems.This new consciousness has given rise to a growth in the number of earth building standards in recent years although,in absolute terms,the number is very small compared with other typical building materials and systems.Forty different earth building standards coming from 20 different countries were examined.The standards provide varying degrees of technical information.With regard to their scope of application,the documents can be classified into three types,each of them dealing with a particular aspect:soil classification,earth building materials,earth construction systems.In Germany,a revival of building with earth first came about in the 1980s as an awareness of ecological criteria grew.A product of this development was the elaboration of an earth building standard,the“Lehmbau Regeln”by the Dachverband Lehm e.V.,the German national earth building association.That part of the“Lehmbau Regeln”concerning earth blocks and earth mortars was adapted to the circumstances of national DIN/European building codes and published in August 2013 as DIN 18945–47.A new DIN 18948“Earth boards”will be issued in 2019.The four DINs were elaborated for industrially produced,chemically non-stabilized earth building materials.

Prevalence of Mental Disorders and Health Service Utilization among Individuals with Turkish Migration Backgrounds in Germany: A Study Protocol for an Epidemiological Investigation

Background: There is a lack of reliable epidemiological data on prevalence and comorbidity rates of mental disorders in the migrant population in Germany. Despite existing national and international data on the extent of psychosocial burdens in migrant populations the prevalence among the study population remains unclear. The aim of this study was to collect prevalence data for the largest migrant population in Germany-individuals with Turkish migration backgrounds—using a culturally and linguistically sensitive approach. Methods: The study employs a cross-sectional design. The multi-centre study (Hamburg, Berlin) is based on a sample of individuals with Turkish migration backgrounds living in the two cities stratified by age, gender, and education. The study programme consists of three phases: 1) a qualitative focus group to collect information on how to increase the participation rate of the target population as a minority group in Germany;2) a translation phase to create culture and linguistic sensitive versions of the assessment tools (e.g., the Composite International Diagnostic Interview (CIDI) for Turkish speaking individuals;and 3) a baseline community study to assess the lifetime, 12-month and four-week prevalence and comorbidity rates of mental disorder, health care utilization and help-seeking behaviour in individuals of Turkish migration backgrounds living in Germany. Discussion: The study provides important data on the lifetime prevalence of mental disorders and health care utilization of individuals with Turkish migration backgrounds. Furthermore, the study is an important step towards gaining a better understanding of potential barriers to participation, creating resources for difficult-to- reach minorities, and understanding the need for assessing mental disorders in migrant populations. These results can offer a starting point for the initiation of the necessary structural changes for mental health care services and policies for groups with migration backgrounds.

The Research of the Localization Marketing Strategy of Amazon in Germany

Amazon Germany has formulated a series of marketing strategies based on the shopping habits of German consumers and it has achieved success.This article summarizes the current marketing strategies of Amazon in Germany,and explores the key factors for the success of this marketing strategy.By comparing with other e-commerce platforms,this article critically analyzes the innovation and deficiency of Amazon in Germany.

“Breast is best”—Infant-feeding, infant mortality and infant welfare in Germany during the late nineteenth and twentieth centuries

Breastfeeding is considered to be the key variable for infant health. Consequently, UNICEF and the World Health Organization promote the beginning of breastfeeding within the first hour after birth and recommend to exclusively breastfeed the infant during the first six months. The origins of these modern breastfeeding campaigns can be traced back to the beginning of the twentieth century. Whereas high infant mortality rates traditionally were considered to be a matter of fate and the declining birth rates towards the end of the nineteenth century raised fears about the nation’s future and led to the emergence of an increasing infant welfare movement in imperial Germany. As low breastfeeding rates were identified as a key factor behind the high infant mortality rates, the main objective of the infant care movement was to increase breastfeeding. The paper examines how the context of infant care and infant mortality was constructed and how breastfeeding campaigns in the context of infant mortality, breastfeeding rates and socio-political changes developed during the twentieth century. Thus the paper covers the period from the beginnings of social paediatrics at the beginning of the 20th century, the breastfeeding campaigns embedded into Nazi ideology during the Third Reich, until the declining breastfeeding ratios and the “feeding on demand”-movement in the 1970s as well as the ideological differences between West and East Germany during the Cold War.

Analysis of TCM Syndrome Characteristics of 122 Cases of Simple Obesity in Germany and its Correlation with Body Mass Index

Objective:To investigate the distribution of TCM syndromes,the regularity of syndrome differentiation and the correlation between syndromes and body mass index(BMI)of simple obesity in Germany.Methods:From July 2020 to May 2021,122 patients with simple obesity were collected from the Bad Koetzting hospital of Beijing University of Chinese Medicine.The basic information of age,gender,height,weight and TCM syndrome were collected.The distribution of syndrome and its correlation with BMI were analyzed by frequency analysis and single sample chi square test.Results:According to the frequency,the syndrome distribution of simple obesity was as follows:yin deficiency and internal heat type,liver stagnation and qi stagnation type,qi stagnation and blood stasis type,spleen and kidney deficiency type,spleen deficiency and dampness resistance type and stomach heat and dampness resistance type.The BMI of spleen kidney deficiency type was the highest,while that of stomach heat dampness stagnation type was the lowest.There was no significant difference in BMI between stomach heat and dampness stagnation type,liver qi stagnation type,qi stagnation and blood stasis type(P=0.110,P=0.111).There was no significant difference in BMI between yin deficiency and internal heat type and liver stagnation,qi stagnation and blood stasis type(P=0.175,P=0.437).However,there were significant differences in BMI among other TCM syndromes(P<0.01).Conclusion:The most common TCM syndrome type of simple obesity in Germany is yin deficiency and internal heat type,and the highest BMI value is spleen and kidney deficiency type,and there is a certain correlation between BMI value and different TCM syndrome types of simple obesity.

Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: Epidemiological changes in Germany

AIM:To study the epidemiologic changes of gastroenteropancreatic neuroendocrine tumors(GEP-NET)in Germany,we analyzed two time periods 1976-1988 and1998-2006.METHODS:We evaluated epidemiological data of GEP-NET from the former East German National Cancer Registry(DDR Krebsregister,1976-1988)and its successor,the Joint Cancer Registry(GKR,1998-2006),which was founded after German reunification.Due to a particularly substantial database the epidemiological data from the federal states of Mecklenburg-Western Pomerania,Saxony,Brandenburg and Thuringia,covering a population of more than 10.8 million people,were analyzed.Survival probabilities were calculated using life table analysis.In addition,GEP-NET patients were evaluated for one or more second(non-GEP-NET)primary malignancies.RESULTS:A total of 2821 GEP neuroendocrine neoplasms were identified in the two registries.The overall incidence increased significantly between 1976 and2006 from 0.31(per 100.000 inhabitants per year)to2.27 for men and from 0.57 to 2.38 for women.In the later period studied(2004-2006),the small intestine was the most common site.Neuroendocrine(NE)neoplasms of the small intestine showed the largest absolute increase in incidence,while rectal NE neoplasms exhibited the greatest relative increase.Only the incidence of appendiceal NET in women showed little change between 1976 and 2006.Overall survival of patients varied for sex,tumor site and the two periods studied but improved significantly over time.Interestingly,about 20%of the GEP-NET patients developed one or more second malignancies.Their most common location was the gastrointestinal tract.GEP-NET patients without second malignancies fared better than those with one or more of them.CONCLUSION:The number of detected GEP-NET increased about 5-fold in Germany between 1976 and2006.At the same time,their anatomic distribution changed,and the survival of GEP-NET patients improved significantly.Second malignancies are common and influence the overall survival of GEP-NET patients.Thus,GEP-NET warrant our attention as well as intensive research on their tumorigenesis.

Gender-specific associations between coronary heart disease and other chronic diseases: cross-sectional evaluation of national survey data from adult residents of Germany

Background Combinations of coronary heart disease(CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities. Methods We analyzed data from the German Health Interview and Examination Survey(DEGS1), a national survey of 8152 adults aged 18-79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions. Results The prevalence of CHD was 9%(547 participants): 34%(185) were female CHD participants and 66%(362) male. In women, CHD was associated with hypertension(OR = 3.28(1.81-5.9)), lipid disorders(OR = 2.40(1.50-3.83)), diabetes mellitus(OR = 2.08(1.24-3.50)), kidney disease(OR = 2.66(1.101-6.99)), thyroid disease(OR = 1.81(1.18-2.79)), gout/high uric acid levels(OR = 2.08(1.22-3.56)) and osteoporosis(OR = 1.69(1.01-2.84)). In men, CHD patients were more likely to have hypertension(OR = 2.80(1.94-4.04)), diabetes mellitus(OR = 1.87(1.29-2.71)), lipid disorder(OR = 1.82(1.34-2.47)), and chronic kidney disease(OR = 3.28(1.81-5.9)). Conclusion Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.

First observation of Karlodinium venef icum from the East China Sea and the coastal waters of Germany

Harmful algal blooms often occurred in the East China Sea （ECS） and the German coastal waters of the North Sea but Karlodinium veneficum had not been taxonomically reported. Two strains of Karlodinium （LAMB090611 and LAMB010601） were isolated from the two areas in 2009. The morphological characteristics and molecular phylogeny of two strains are compared on the basis of observation of a light microscope, a scanning electron microscope （SEM）, a laser scanning micro-scope （LSM） and an internal transcribed spacer （ITS） sequence data. The mean cell length of strain LAMB090611 is （14.2 ± 1.8） μm （range 11.1–18.7 μm） and mean width is （10.8 ± 1.5） μm （range 8.2– 14.7 μm）. The mean cell length of strain LAMB010601 is （15.1 ± 1.2） μm （range 12.7–17.9 μm） and the mean width is （11.4 ± 1.1） μm （range 9.1–14.7 μm）, respectively. The two strains are similar in morphological characteristics, including a straight apical groove, distinct ventral pore, sulcal extension, cingulum displacement, two or four irregular shaped chloroplasts within the cell and almost equal sized epicone and hypocone. The large and round nucleus is located at the center or at the hypocone of the cell. The sequence length of the ECS strain LAMB090611 and the German strain LAMB010601 is 640 and 646 bp, respectively. The GC content is 49%. The nucleotide similarity of the two strains is 98.1%. The sequence divergence is 0.003. Both strains are confirmed as Karlo-dinium veneficum （D. Ballantine） J. Larsen and this is the first taxonomic report from China and Germany coastal waters. The population dynamics of this toxic species in the ECS and German coastal waters needs to be investigated in the near future.

Soil Properties in Coniferous Forest Stands Along a Fly Ash Deposition Gradient in Eastern Germany

Physical, chemical, and microbial properties of forest soils subjected to long-term fly ash depositions were analyzed in spruce (Picea abies (L.) Karst.) stands of eastern Germany on three forest sites along an emission gradient of 3 (high input), 6, and 15 km (low input) downwind of a coal-fired power plant. Past emissions resulted in an atypical high mass of mineral fly ash constituents in the organic horizons at the high input site of 128 t ha-1 compared to 58 t ha-1 at the low input site. Magnetic susceptibility measurements proved that the high mineral content of the forest floor was a result of fly ash accumulation in these forest stands. Fly ash deposition in the organic horizons at Site I versus III significantly increased the pH values, effective cation exchange capacity, base saturation and, with exception of the L horizon, concentrations of mobile heavy metals Cd, Cr, and Ni, while stocks of organic C generally decreased. A principal component analysis showed that organic C content and base status mainly controlled soil microbial biomass and microbial respiration rates at these sites, while pH and mobile fractions of Cd, Cr, and Ni governed enzyme activities. Additionally, it was hypothesized that long-term fly ash emissions would eventually destabilize forest ecosystems. Therefore, the results of this study could become a useful tool for risk assessment in forest ecosystems that were subjected to past emissions from coal-fired power plants.

Perioperative chemotherapy for advanced gastric cancer - results from a tertiary-care hospital in Germany

BACKGROUND Neoadjuvant/perioperative chemotherapy is the recommended treatment for advanced stages of gastric cancer(>T2,N+)before tumour resection in many European guidelines.However,there is no consensus as to whether perioperative chemotherapy is as effective in distal as in proximal tumours,in addition to a relevant uncertainty concerning appropriate treatment modalities for elderly patients.AIM To investigate the role of perioperative chemotherapy in advanced gastric cancer in patients from a German tertiary clinic with respect to efficacy,localisation,and age.METHODS We performed a retrospective analysis of 158 patients from our clinic with adenocarcinoma of the stomach or the gastroesophageal junction who underwent resection between 2008 and 2016.The data were evaluated particularly in relation to patient age,tumour site,and perioperative therapy.RESULTS Administration of perioperative chemotherapy did not lead to a significant survival advantage in our study population.The 5-year survival rates were 40%for patients who received perioperative chemotherapy and 29%for the group without perioperative chemotherapy(P=0.125).Our patients were on average distinctly older than patients in most of the published randomised controlled trials.Patients elder than 75 years received perioperative chemotherapy far less frequently.Patients with a proximal tumour received perioperative chemotherapy much more often.CONCLUSION This analysis reconfirms our previous data concerning the effectiveness of perioperative chemotherapy for advanced gastric cancer.There is reasonable doubt that the quality of the existing randomized controlled trials is sufficient to generally justify perioperative chemotherapy in patients with advanced gastric cancer independent of tumour localization or age.

National Forest Inventories capture the multifunctionality of managed forests in Germany

Background:Forests perform various important ecosystem functions that contribute to ecosystem services.In many parts of the world,forest management has shifted from a focus on timber production to multi-purpose forestry,combining timber production with the supply of other forest ecosystem services.However,it is unclear which forest types provide which ecosystem services and to what extent forests primarily managed for timber already supply multiple ecosystem services.Based on a comprehensive dataset collected across 150 forest plots in three regions differing in management intensity and species composition,we develop models to predict the potential supply of 13 ecosystem services.We use those models to assess the level of multifunctionality of managed forests at the national level using national forest inventory data.Results:Looking at the potential supply of ecosystem services,we found trade-offs(e.g.between both bark beetle control or dung decomposition and both productivity or soil carbon stocks)as well as synergies(e.g.for temperature regulation,carbon storage and culturally interesting plants)across the 53 most dominant forest types in Germany.No single forest type provided all ecosystem services equally.Some ecosystem services showed comparable levels across forest types(e.g.decomposition or richness of saprotrophs),while others varied strongly,depending on forest structural attributes(e.g.phosphorous availability or cover of edible plants)or tree species composition(e.g.potential nitrification activity).Variability in potential supply of ecosystem services was only to a lesser extent driven by environmental conditions.However,the geographic variation in ecosystem function supply across Germany was closely linked with the distribution of main tree species.Conclusions:Our results show that forest multifunctionality is limited to subsets of ecosystem services.The importance of tree species composition highlights that a lack of multifunctionality at the stand level can be compensated by managing forests at the landscape level,when stands of complementary forest types are combined.These results imply that multi-purpose forestry should be based on a variety of forest types requiring coordinated planning across larger spatial scales.