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Endophytes live in partial symbiosis inside a plant and have been detected in all tested plants. They belong to the group of fungi or bacteria and their ecological function is mostly unknown. The fungal endophytes of the genus Epichloë belong to a special group of endophytes. Epichloë endophytes live symbiotically inside cool season grass species and some of them are able to produce alkaloids toxic to vertebrates and insects. Their symbiosis is seen as mutualistic for the following reasons: the fungus provides the plant herbivore resistance by producing alkaloids, and it increases the plant’s drought tolerance as well as its biomass production. In return, the grass provides the fungus shelter, nutrients and dispersal. Epichloë endophytes are host specific and the ability to produce alkaloids differs between species. In order to estimate intoxication risks in grasslands, it is necessary to detect infection rates of different grass species with Epichloë endophytes, and to determine the genotypes and chemotypes of the Epichloë species as well as the produced alkaloid concentrations. Factors like land-use intensity or season may have an influence on infection rates and alkaloid concentrations. Also, different methodological approaches may lead to different results. In this doctoral thesis my general aim was to evaluate intoxication risks in German grasslands caused by Epichloë endophytes. For that I investigated infection rates of different grass species and the genotypes and chemotypes of their Epichloë endophytes in German grasslands (Chapter II). Furthermore, I compared alkaloid concentrations detected with dry and fresh plant weight and different analytical methods. I also detected possible changes on the influence of season or land-use intensity (Chapter III). Additionally, I examined infections with Epichloë endophytes and alkaloid concentrations in commercially available grass seed mixtures and determined how that influences the intoxication risk of grazing animals in Europe (Chapter IV).
It is of agricultural interest to estimate intoxication risks for grazing livestock on German grasslands due to Epichloë infected grass species. Therefore, it is important to investigate which grasses are infected with the Epichloë endophyte, if the endophytes have the ability to produce vertebrate and invertebrate toxic alkaloids and if the alkaloids are indeed produced. I showed that Epichloë festucae var. lolii infecting agriculturally important Lolium perenne lacked the starting gene for ergovaline biosynthesis. Hence, vertebrate toxic ergovaline was not detected in the majority of the collected L. perenne plants. The detection of alkaloid concentrations is an important tool to estimate intoxication risk for vertebrates, but also invertebrates. My studies showed that the usage of dry plant material is crucial to quantify the correct alkaloid concentrations, and that alkaloid concentrations can vary depending on the detection method. Hence, the usage of validated, similar detection methods is important to be able to compare alkaloid concentrations from different studies. Nevertheless, the trends of seasonal changes and the influence of land-use intensity stayed the same, regardless if dry or fresh plant weight was used. Also, alkaloid concentrations were below toxicity thresholds on population level, regardless of the method used. Two commercially available forage grass and two commercially available turf grass seed mixtures were infected with Epichloë endopyhtes and alkaloids were detected. This might contribute to the spreading of Epichloë endopyhtes in Germany, therefore seed mixtures should be tested for Epichloë infections. My results indicate that the intoxication risk is generally low in Germany at the moment, although that might change due to climate change, an increase of monocultural land-use, or the seeding of Epichloë infected grass seeds.
Diese Dissertation liefert einen kulturhistorischen Überblick über die Darstellung der Frauenfiguren Gertrude und Ophelia in Hamlet-Verfilmungen des 20. Jahrhunderts. Die beiden weiblichen Gestalten werden dabei im Hinblick auf ihr äußeres Erscheinungsbild wie auch ihre Charakterzeichnung vor dem historischen, kulturellen, politischen und gesellschaftlichen Entstehungshintergrund der Filme beleuchtet. Die Analysen konzentrieren sich ausschließlich auf Kinofilme, da diese ein wesentlich breiteres Publikum erreichen als etwa die diversen Bühnen- oder Textfassungen des Stücks. Die erste der insgesamt zwanzig untersuchten Leinwandfassungen entstand im Jahre 1900, die letzte kam 2000 in die Kinos – die vorliegende Arbeit behandelt also eine genau 100-jährige Tradition der Hamlet-Verfilmungen.
Background
In individuals suffering from a rare disease the diagnostic process and the confirmation of a final diagnosis often extends over many years. Factors contributing to delayed diagnosis include health care professionals' limited knowledge of rare diseases and frequent (co-)occurrence of mental disorders that may complicate and delay the diagnostic process. The ZSE-DUO study aims to assess the benefits of a combination of a physician focusing on somatic aspects with a mental health expert working side by side as a tandem in the diagnostic process.
Study design
This multi-center, prospective controlled study has a two-phase cohort design.
Methods
Two cohorts of 682 patients each are sequentially recruited from 11 university-based German Centers for Rare Diseases (CRD): the standard care cohort (control, somatic expertise only) and the innovative care cohort (experimental, combined somatic and mental health expertise). Individuals aged 12 years and older presenting with symptoms and signs which are not explained by current diagnoses will be included. Data will be collected prior to the first visit to the CRD’s outpatient clinic (T0), at the first visit (T1) and 12 months thereafter (T2).
Outcomes
Primary outcome is the percentage of patients with one or more confirmed diagnoses covering the symptomatic spectrum presented. Sample size is calculated to detect a 10 percent increase from 30% in standard care to 40% in the innovative dual expert cohort. Secondary outcomes are (a) time to diagnosis/diagnoses explaining the symptomatology; (b) proportion of patients successfully referred from CRD to standard care; (c) costs of diagnosis including incremental cost effectiveness ratios; (d) predictive value of screening instruments administered at T0 to identify patients with mental disorders; (e) patients’ quality of life and evaluation of care; and f) physicians’ satisfaction with the innovative care approach.
Conclusions
This is the first multi-center study to investigate the effects of a mental health specialist working in tandem with a somatic expert physician in CRDs. If this innovative approach proves successful, it will be made available on a larger scale nationally and promoted internationally. In the best case, ZSE-DUO can significantly shorten the time to diagnosis for a suspected rare disease.
Zwischenruf aus Patmos
(2002)
No abstract available.
Obwohl der klinische Stellenwert der MRT in zahlreichen Studien für verschiedene Entitäten (AC-Komplex, coracoidale Pathologien, Rotatorenmanschette, Pathologien des Kapsel-Band-Apparates und der Bicepssehne sowie primär und reaktiv bedingte entzündliche Veränderungen) belegt ist, überrascht es, dass in der Literatur keine Arbeiten darüber existieren, inwieweit das Ergebnis der MRT-Untersuchung tatsächlich das therapeutische Procedere beeinflusst. Vorliegende Arbeit untersuchte daher den diagnostischen Impact der MRT im Setting einer hochspezialisierten Schultersprechstunde.