Surface uplift and climate change - the geomorphic evolution of the western escarpment of the Andes of northern Chile between the Miocene and present

The Western Escarpment of the Andes at 18.30°S (Arica area, northern Chile) is a classical example for a transient state in landscape evolution. This part of the Andes is characterized by the presence of >10,000 km2 plains that formed between the Miocene and the present, and >1500 m deeply incised valleys. Although processes in these valleys scale the rates of landscape evolution, determinations of ages of incision, and more importantly, interpretations of possible controls on valley formation have been controversial. This paper uses morphometric data and observations, stratigraphic information, and estimates of sediment yields for the time interval between ca. 7.5 Ma and present to illustrate that the formation of these valleys was driven by two probably unrelated components. The first component is a phase of base-level lowering with magnitudes of∼300–500 m in the Coastal Cordillera. This period of base-level change in the Arica area, that started at ca. 7.5 Ma according to stratigraphic data, caused the trunk streams to dissect headward into the plains. The headward erosion interpretation is based on the presence of well-defined knickzones in stream profiles and the decrease in valley widths from the coast toward these knickzones. The second component is a change in paleoclimate. This interpretation is based on (1) the increase in the size of the largest alluvial boulders (from dm to m scale) with distal sources during the last 7.5 m.y., and (2) the calculated increase in minimum fluvial incision rates of ∼0.2 mm/yr between ca. 7.5 Ma and 3 Ma to ∼0.3 mm/yr subsequently. These trends suggest an increase in effective water discharge for systems sourced in the Western Cordillera (distal source). During the same time, however, valleys with headwaters in the coastal region (local source) lack any evidence of fluvial incision. This implies that the Coastal Cordillera became hyperarid sometime after 7.5 Ma. Furthermore, between 7.5 Ma and present, the sediment yields have been consistently higher in the catchments with distal sources (∼15 m/m.y.) than in the headwaters of rivers with local sources (<7 m/m.y.). The positive correlation between sediment yields and the altitude of the headwaters (distal versus local sources) seems to reflect the effect of orographic precipitation on surface erosion. It appears that base-level change in the coastal region, in combination with an increase in the orographic effect of precipitation, has controlled the topographic evolution of the northern Chilean Andes.

Incident malignancies among older long-term breast cancer survivors and an age-matched and site-matched nonbreast cancer comparison group over 10 years of follow-up

BACKGROUND Of the approximately 2.4 million American women with a history of breast cancer, 43% are aged ≥ 65 years and are at risk for developing subsequent malignancies. METHODS Women from 6 geographically diverse sites included 5-year breast cancer survivors (N = 1361) who were diagnosed between 1990 and 1994 at age ≥ 65 years with stage I or II disease and a comparison group of women without breast cancer (N = 1361). Women in the comparison group were age-matched and site-matched to breast cancer survivors on the date of breast cancer diagnosis. Follow-up began 5 years after the index date (survivor diagnosis date or comparison enrollment date) until death, disenrollment, or through 15 years after the index date. Data were collected from medical records and electronic sources (cancer registry, administrative, clinical, National Death Index). Analyses included descriptive statistics, crude incidence rates, and Cox proportional hazards regression models for estimating the risk of incident malignancy and were adjusted for death as a competing risk. RESULTS Survivors and women in the comparison group were similar: >82% were white, 55% had a Charlson Comorbidity Index of 0, and ≥ 73% had a body mass index ≤ 30 kg/m(2) . Of all 306 women (N = 160 in the survivor group, N = 146 in the comparison group) who developed a first incident malignancy during follow-up, the mean time to malignancy was similar (4.37 ± 2.81 years vs 4.03 ± 2.76 years, respectively; P = .28), whereas unadjusted incidence rates were slightly higher in survivors (1882 vs 1620 per 100,000 person years). The adjusted hazard of developing a first incident malignancy was slightly elevated in survivors in relation to women in the comparison group, but it was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.94-1.47). CONCLUSIONS Older women who survived 5 years after an early stage breast cancer diagnosis were not at an elevated risk for developing subsequent incident malignancies up to 15 years after their breast cancer diagnosis.

Radiofrequency catheter ablation of idiopathic ventricular tachycardia originating in the main stem of the pulmonary artery.

We report the case of a patient in whom successful radiofrequency catheter ablation of an idiopathic ventricular tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an idiopathic right ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences.

German Total Ankle Replacement Register of the German Foot and Ankle Society (D. A. F.) - presentation of design and reliability of the data as well as first results

INTRODUCTION Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. MATERIAL AND METHODS The D. A. F.'s total ankle replacement register is a nation-wide, voluntary registry. After giving written informed consent, the patients can be added to the database by participating providers. Data are collected during hospital stay for surgical treatment, during routine follow-up inspections and in the context of revision surgery. The information can be submitted in paper-based or online formats. The survey instruments are available as minimum data sets or scientific questionnaires which include patient-reported outcome measures (PROMs). The pseudonymous clinical data are collected and evaluated at the Institute for Evaluative Research in Medicine, University of Bern/Switzerland (IEFM). The patient-related data remain on the register's module server in North Rhine-Westphalia, Germany. The registry's methodology as well as the results of the revisions and patient satisfaction for 115 patients with a two year follow-up period are presented. Statistical analyses are performed with SAS™ (Version 9.4, SAS Institute, Inc., Cary, NC, USA). RESULTS About 2½ years after the register was launched there are 621 datasets on primary implantations, 1,427 on follow-ups and 121 records on re-operation available. 49 % of the patients received their implants due to post-traumatic osteoarthritis, 27 % because of a primary osteoarthritis and 15 % of patients suffered from a rheumatic disease. More than 90 % of the primary interventions proceeded without complications. Subsequent interventions were recorded for 84 patients, which corresponds to a rate of 13.5 % with respect to the primary implantations. It should be noted that these secondary procedures also include two-stage procedures not due to a complication. "True revisions" are interventions with exchange of components due to mechanical complications and/or infection and were present in 7.6 % of patients. 415 of the patients commented on their satisfaction with the operative result during the last follow-up: 89.9 % of patients evaluate their outcome as excellent or good, 9.4 % as moderate and only 0.7 % (3 patients) as poor. In these three cases a component loosening or symptomatic USG osteoarthritis was present. Two-year follow-up data using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale (AOFAS-AHS) are already available for 115 patients. The median AOFAS-AHS score increased from 33 points preoperatively to more than 80 points three to six months postoperatively. This increase remained nearly constant over the entire two-year follow-up period. CONCLUSION Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.

The late Miocene to Holocene erosion pattern of the Alpine foreland basin reflects Eurasian slab unloading beneath the western Alps rather than global climate change

We synthesized published data on the erosion of the Alpine foreland basin and apatite fission-track ages from the Alps to infer the erosional sediment budget history for the past 5 m.y. The data reveal that erosion of the Alpine foreland basin is highest in front of the western Alps (between 2 and 0.6 km) and decreases eastward over a distance of 700 km to the Austrian foreland basin (similar to 200 m). For the western Alps, erosion rates are >0.6 km/m.y., while erosion rates for the eastern foreland basin and the adjacent eastern Alps are <0.1 km/m.y., except for a small-scale signal in the Tauern Window. The results yield a large ellipsoidal, orogen-crossing pattern of erosion, centered along the western Alps. We suggest that accelerated erosion of the western Alps and their foreland basin occurred in response to regional-scale surface uplift, related to lithospheric unloading of the Eurasian slab along the Eurasian-Adriatic plate boundary. While we cannot rule out recent views that global climate change led to substantial erosion of the European Alps since 5 Ma, we postulate that regional-scale tectonic processes have driven erosion during this time, modulated by an increased erosional flux in response to Quaternary glaciations.

Grain coarsening maps: A new tool to predict microfabric evolution of polymineralic rocks

Polymineralic rocks undergo grain coarsening with increasing temperature in both static and deformational environments, as long as no mineral reactions occur. The grain coarsening in such rocks is complex because the different phases influence each other, and it is this interaction that controls the rate of grain coarsening of the entire aggregate. We present a mathematical approach to investigate coupled grain coarsening using a set of microstructural parameters, including grain size and volume fraction of both second phases and matrix mineral in combination with temperature information. Based on samples from polymineralic carbonate mylonites that were deformed at different temperatures, we demonstrate how the mathematical relation can be calibrated for this natural system. Using such data sets for other lithologies, grain coarsening maps can be generated, which allow the prediction of microstructural evolution in polymineralic rocks. Such predictions are crucial for all subdisciplines in the earth sciences that require fundamental knowledge about microstructural changes and rheology of an orogen at different depths, such as structural geology, geophysics, geodynamics, and metamorphic petrology.