LDL-apheresis: technical and clinical aspects.

The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. There is a strong correlation between hyperlipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe hyperlipidemia therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. With respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application.

Managing floodplain-forest restoration in European river landscapes combining ecological and flood-protection issues.

Throughout Europe the demands for improved flood protection on the one hand and the requirements to maintain and enhance floodplain forests on the other are perceived as conflicting goals in river-basin management, revealing the urgent need for strategies to combine both issues. We developed an interdisciplinary approach for floodplain-forest restoration identifying sites suitable for reforestations from both an ecological and hydraulic point of view. In the ecological module, habitat-distribution models are developed providing information on ecologically suitable sites. In the hydraulic module, a two-dimensional hydrodynamic-numerical model (2D-HN model) delivers the requested hydraulic information. The output of the two models is intersected. Subsequently, in an iterative procedure, the potential of plantings without exceeding critical water levels can be identified by hydraulic evaluation using the 2D-HN-model. The approach is exemplified using two reforestation scenarios at the Elbe River, Germany, showing considerable potential for softwood forest establishment without negative hydraulic effects. The approach reported here provides a solution for a severe conflict in river-basin management that hampers the reestablishment of the strongly threatened floodplain forests in Europe. Alternative measures to enhance floodplain-forest regeneration feasible under certain preconditions are discussed in the context of the current state of European large rivers.