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To maintain or enhance biodiversity and sea floor integrity, mapping benthic habitats is a mandatory requirement in compliance with the Marine Strategy Framework Directive (MSFD). The EU Commission Decision distinguishes between Broad Habitat Types (BHTs) and Other Habitat Types (OHTs). At the regional level, biotopes in the Baltic Sea region are classified according to the HELCOM underwater biotope and habitat classification (HUB). In this study, the habitats and their benthic communities were mapped for the entire German Baltic Sea at a high spatial resolution of 1 km. In two nature conservation areas of the Exclusive Economic Zone (EEZ) as well as selected focus areas in the coastal waters, the resolution we provide is even more detailed at 50 × 50 m. Hydroacoustic data recording and benthological surveys (using bottom grabs, underwater towing camera technology, and diver sampling) helped identify biotopes in high resolution. Based on these data, together with additional data acquired since 2010 (a total of over 7000 stations and transect sections), we were able to spatially delineate benthic biotopes and their communities via predictive habitat modelling. The results are provided as full-coverage maps each for BHT, OHT, and HUB (9 classes of BHTs, 5 classes of OHTs, and 84 classes of HUB) with a level of spatial detail that does not yet exist for the Baltic Sea, and they form an essential basis for future monitoring, status assessments, and protection and management measures.

Long-term marine monitoring programmes have provided numerous quantitative data on the composition of North Sea benthic communities and their changes over time, including species introductions. Particularly in the German Bight, the rapid environmental and hydrographical changes are promoting the spreading (usually anthropogenically mediated) of neobiota, with more than 150 species being registered to date. During routine seafloor monitoring, grab samples taken on the subtidal sandbank of the Borkum Reef Ground revealed the presence of the polychaete Streptosyllis nunezi in different years, a species previously unreported in the southern North Sea. In this paper, these individuals are described morphologically and the population status is discussed. Our finding demonstrates the importance of intensive and regular environmental monitoring programmes for the assessment of regional biodiversity and its potential changes.

Marine sublittoral sandbanks are essential offshore feeding grounds for larger crustaceans, fish and seabirds. In the southern North Sea, sandbanks are characterized by considerable natural sediment dynamics and are subject to chronic bottom trawling. However, except for the Dogger Bank, sandbanks in the southeastern North Sea have been only poorly investigated until now. We used an extensive, multi-annual dataset covering ongoing national monitoring programmes, environmental impact assessments, and basic research studies to analyse benthic communities on sublittoral sandbanks, evaluating their ecological value against the backdrop of similar seafloor habitats in this region. The analysis revealed complex spatial structuring of sandy seafloor habitats of the southeastern North Sea. Different infauna clusters were identified and could be specified by their composition of characteristic species. The sandbanks shared common structural features in their infauna community composition although they were not necessarily characterized by particularly high biodiversity compared to other sandy habitats. A close association of one of the main bioturbators in the southern North Sea, the sea urchin Echinocardium cordatum, with sandbanks was detected, which may promote the sediment-bound biogeochemical activity in this particular seafloor habitat. This would corroborate the status of sandbanks as sites of high ecological value calling for consideration in marine conservation.

SummaryRelapse of acute leukemia is a frequent complication with uncertain outcome and poorly defined risk factors. From 1621 patients entered into two prospective clinical trials (AML02; n = 740 and AML04; n = 881), 74.2% reached complete remission (CR) 1 after induction(s) and 59 patients after additional induction ± hematopoietic cell transplantation (HCT). Of the non-refractory patients, 48.4% with a median age of 63 (range 17–85) years relapsed. Relapses occurred within 6 months after CR in 46.5%, between 7 and 18 months in 38.7%, and after 18 months in 14.8% of patients. Relapse treatment resulted in CR2 in 39% of patients depending upon age (54.5% of ≤ 60 and 28.6% of > 60 years), duration of CR1, and treatment of relapse. Overall survival (OS) was 10.9 (7.4–16.2) %, but OS after HCT ± intensive chemotherapy (ICT) was 39.3% (31.8–48.6) at 5 years and not different in younger and older patients. Donor lymphocyte infusion ± chemotherapy and ICT alone resulted only in OS of 15.4% and of 5%, respectively. Independent favorable factors for OS were long CR1 duration, and HCT, while non-monosomal disease was beneficial for OS in elderly patients. Leukemia-free survival [LFS; 24.9 (19.5–31.7) % at 10 years] was affected by similar risk factors. In a competing risk model, the relapse incidence at 5 years was 53.5 ± 3.5% and the non-relapse mortality rate 21.7 ± 2.9%. Lower relapse incidence was observed in patents with HCT, long CR1 duration, and female gender. Risk factors for non-relapse mortality were HCT in younger and type of AML in elderly patients. In conclusion, allogeneic HCT ± IC improved the results in relapsed AML in younger and elderly patients. Increasing CR2 rates and HCT frequency will be the challenge for the next years. Relapse of the disease remains the major problem.

BackgroundThe PREEMPT Studies established onabotulinumtoxinA as preventive treatment for adults with chronic migraine (CM). The purpose of the REal-life use of botulinum toxin for the symptomatic treatment of adults with chronic migraine, measuring healthcare resource utilisation, andPatient-reportedOutcomeSobserved in practice (REPOSE) Study was to observe real-life, long-term (24-month) use of onabotulinumtoxinA in adults with CM and report on the utilisation, effectiveness, safety, and tolerability.MethodsThe REPOSE Study was a European, open-label, multicentre, prospective, noninterventional study. Patients received onabotulinumtoxinA approximately every 12 weeks according to their physician’s usual practice, guided by the summary of product characteristics (SPC). Patients were observed for 24 months after initiating onabotulinumtoxinA treatment. Outcome measures were collected at baseline and all administration visits and included onabotulinumtoxinA injection practices, headache-day frequency, Migraine-Specific Quality-of-Life Questionnaire (MSQ), EuroQol 5-Dimension Questionnaire (EQ-5D), and adverse drug reactions (ADRs) to evaluate safety/tolerability.ResultsOf 641 patients enrolled, 633 received ≥1 dose of onabotulinumtoxinA for a total of 3499 treatment sessions. At baseline, mean (SD) age was 45.4 (11.7) years; patients were predominantly women (85.3%). Injection practices closely followed the SPC in mean dosage (155.1 U) and injection sites per session (31.4), with the exception of a prolongation of the recommended 12-week dosing interval, with 79.1% of patients receiving ≥1 treatment session that was > 13 weeks after the previous treatment session. Headache-day frequency was reduced from a baseline mean (SD) of 20.6 (5.4) to 7.4 (6.6) days at administration visit 8 (P < 0.001). Each MSQ domain (restrictive, preventive, and emotional) was significantly reduced from baseline through each administration visit (P < 0.001). The median EQ-5D total and health state scores were significantly improved from baseline through each administration visit (P < 0.001). Overall, 18.3% of patients reported an ADR; most were mild to moderate intensity, with only 1.3% of patients reporting a serious ADR. Eyelid ptosis (5.4%), neck pain (2.8%), and musculoskeletal stiffness (2.7%) were the most frequently reported.ConclusionsLong-term, real-world preventive treatment of CM with onabotulinumtoxinA showed effectiveness with a sustained reduction in headache-day frequency and significant improvement in quality-of-life measures. ADRs were mild to moderate, with no new safety concerns identified.Trial registrationTrial registration number: NCT01686581. Name of registry: ClinicalTrials.gov. URL of registry: https://clinicaltrials.gov/ct2/show/NCT01686581. Date of retrospective registration: September 18, 2012. Date of enrolment of first patient: July 23, 2012.

Background We evaluated the influence of comorbidity inferred risks for lymph node metastasis (pN1) and positive surgical margins (R1) after radical prostatectomy in order to optimize pretherapeutic risk classification. We analyzed 454 patients after radical prostatectomy (RP) between 2009 and 2014. Comorbidities were defined by patients’ medication from our electronic patient chart and stratified according to the ATC WHO code. Endpoints were lymph node metastasis (pN1) and positive surgical margins (R1). Results Rates for pN1 and R1 were 21.4% (97/454) and 29.3% (133/454), respectively. In addition to CAPRA and Gleason score, we identified diabetes as a significant medication inferred risk factor for pN1 (OR 2.9, p  = 0.004/OR 3.2, p  = 0.001/OR 3.5, p  = 0.001) and beta-blockers for R1 (OR 1.9, p  = 0.020/OR 2.9, p  = 0.004). Patients with diabetes showed no statistically significant difference in Gleason score, CAPRA Score, PSA, and age compared to non-diabetic patients. Conclusions We identified diabetes and beta1 adrenergic blockage as significant risk factors for lymph node metastasis and positive surgical margins in prostate cancer (PCa). Patients at risk will need intensive pretherapeutic staging for optimal therapeutic stratification.