Diagnosis and Treatment of Venous Malformations Consensus Document of the International Union of Phlebology (IUP): updated 2013

Venous malformations (VMs) are the most common vascular developmental anomalies (birth defects) . These defects are caused by developmental arrest of the venous system during various stages of embryogenesis. VMs remain a difficult diagnostic and therapeutic challenge due to the wide range of clinical presentations, unpredictable clinical course, erratic response to the treatment with high recurrence/persistence rates, high morbidity following non-specific conventional treatment, and confusing terminology. The Consensus Panel reviewed the recent scientific literature up to the year 2013 to update a previous IUP Consensus (2009) on the same subject. ISSVA Classification with special merits for the differentiation between the congenital vascular malformation (CVM) and vascular tumors was reinforced with an additional review on syndrome-based classification. A "modified" Hamburg classification was adopted to emphasize the importance of extratruncular vs. truncular sub-types of VMs. This incorporated the embryological origin, morphological differences, unique characteristics, prognosis and recurrence rates of VMs based on this embryological classification. The definition and classification of VMs were strengthened with the addition of angiographic data that determines the hemodynamic characteristics, the anatomical pattern of draining veins and hence the risk of complication following sclerotherapy. The hemolymphatic malformations, a combined condition incorporating LMs and other CVMs, were illustrated as a separate topic to differentiate from isolated VMs and to rectify the existing confusion with name-based eponyms such as Klippel-Trenaunay syndrome. Contemporary concepts on VMs were updated with new data including genetic findings linked to the etiology of CVMs and chronic cerebrospinal venous insufficiency. Besides, newly established information on coagulopathy including the role of D-Dimer was thoroughly reviewed to provide guidelines on investigations and anticoagulation therapy in the management of VMs. Congenital vascular bone syndrome resulting in angio-osteo-hyper/hypotrophy and (lateral) marginal vein was separately reviewed. Background data on arterio-venous malformations was included to differentiate this anomaly from syndrome-based VMs. For the treatment, a new section on laser therapy and also a practical guideline for follow up assessment were added to strengthen the management principle of the multidisciplinary approach. All other therapeutic modalities were thoroughly updated to accommodate a changing concept through the years.

Hybrid bodies in cyborg sports? The case of Oscar Pistorius

The capabilities of postmodern biotechnology inevitably lead to questioning if it is morally acceptable to use all possibilities offered by technology. In sport, this very complex issue is dealt with by drawing clear boundaries between naturalness and artificiality. Currently, new biotechnology is constantly being produced and with this, boundaries between naturalness and artificiality, between normal and abnormal, human and hybrid are constantly shifting . “Human enhancement” is a fascinating prism that reflects contemporary questions of participation, justice, equality and the autonomy of the subject in all social fields. The area of elite sports is particularly affected by “human enhancement”, according to the principle of exceeding what has come before, of aiming higher, faster and further. This paper analyses the postulated “naturalness” in the regulative and normalising function in the area of elite sports, in connection with Foucault’s theory of governmentality. The example of the South African sprinter Oscar Pistorius appears to be particularly suited to illustrate current definition difficulties in the area of disabled and non-disabled people in differentiated competitive sports. His is a vivid example of a multifaceted body-sociological analysis of current sport culture and the construction of reality or naturalness in the framework of the discourse of drafting and negotiating the accreditation for sprint competitions of non-disabled athletes, most recently in the London Olympics 2012. Using the case study of Oscar Pistorius, the negotiating processes in relation to the argumentation logic, dynamics and resistance in shifting distinctions are presented in detail using the fundamental documents of the IOC, IPC, CAS and IAAF. Represented through the inclusion and exclusion processes are hierarchies of the body that are (re)consolidated and transformed. The central question emerges as to how the worth of equal opportunity and fairness in regard to “naturalness” can be reconsolidated or transformed.

Measuring the gravitational free-fall of antihydrogen

Antihydrogen holds the promise to test, for the first time, the universality of freefall with a system composed entirely of antiparticles. The AEgIS experiment at CERN’s antiproton decelerator aims to measure the gravitational interaction between matter and antimatter by measuring the deflection of a beam of antihydrogen in the Earths gravitational field (g). The principle of the experiment is as follows: cold antihydrogen atoms are synthesized in a Penning-Malberg trap and are Stark accelerated towards a moir´e deflectometer, the classical counterpart of an atom interferometer, and annihilate on a position sensitive detector. Crucial to the success of the experiment is the spatial precision of the position sensitive detector.We propose a novel free-fall detector based on a hybrid of two technologies: emulsion detectors, which have an intrinsic spatial resolution of 50 nm but no temporal information, and a silicon strip / scintillating fiber tracker to provide timing and positional information. In 2012 we tested emulsion films in vacuum with antiprotons from CERN’s antiproton decelerator. The annihilation vertices could be observed directly on the emulsion surface using the microscope facility available at the University of Bern. The annihilation vertices were successfully reconstructed with a resolution of 1–2 μmon the impact parameter. If such a precision can be realized in the final detector, Monte Carlo simulations suggest of order 500 antihydrogen annihilations will be sufficient to determine gwith a 1 % accuracy. This paper presents current research towards the development of this technology for use in the AEgIS apparatus and prospects for the realization of the final detector.

Tracking the trajectory of shame, guilt, and pride across the life span

The authors examined age differences in shame, guilt, and 2 forms of pride (authentic and hubristic) from age 13 years to age 89 years, using cross-sectional data from 2,611 individuals. Shame decreased from adolescence into middle adulthood, reaching a nadir around age 50 years, and then increased in old age. Guilt increased from adolescence into old age, reaching a plateau at about age 70 years. Authentic pride increased from adolescence into old age, whereas hubristic pride decreased from adolescence into middle adulthood, reaching a minimum around age 65 years, and then increased in old age. On average, women reported experiencing more shame and guilt; Blacks reported experiencing less shame and Asians more hubristic pride than other ethnicities. Across the life span, shame and hubristic pride tended to be negatively related to psychological well-being, and shame-free guilt and authentic pride showed positive relations with well-being. Overall, the findings support the maturity principle of personality development and suggest that as people age they become more prone to experiencing psychologically adaptive self-conscious emotions, such as guilt and authentic pride, and less prone to experiencing psychologically maladaptive ones, such as shame and hubristic pride.

The Dialectical Relationship of Preferential and Multilateral Trade Agreements

Preferentialism and multilateralism are not two independent and succinct avenues in the pur-suit of market access and regulatory policies. They historically build upon each other in a dialectical process, closely related and linked through regulatory bridges and references. They influence and direct each other in various ways. The paper mainly focuses on the evolution of international protection of intellectual property rights and of services. The multilateral regulation of the TRIPS and others derive from years of regulatory experience and high numbers of preferential agreements across the globe. The GATS and others, on the other hand, have entered the pluri- or multilateral stage early. Once regulation has reached the mul-tilateral stage, preferentialism focuses on WTO-plus and -extra commitments. Both areas, however, show close interaction. The principle of MFN ensures that multilateralism and preferentialism do not evolve independently from each other. It produces significant spill-over effects of preferential agreements. Such effects and the need to develop uniform and coherent regulatory standards have led in parallel to a number of preferential, plurilateral and multilateral regulatory initiatives. We submit that the process will eventually encourage the return to multilateralism and negotiations in international fora, in particular the WTO while traditional market access may stay with preferential relations among Nations. Such burden-sharing between different regulatory fora should be reflected in future WTO rules providing the overall backbone of the system.

Legal Aspects of Sino-­African Tied Aid: The Art of Playing with a Legal Grey Area

Sino-African trade has seen a fifty-fold increase in the years 1999 to 2008. In some African regions, particularly in sub-Saharan Africa, China has even replaced the US as the most important trading partner today. But China holds not a single FTA on the African continent, while other major trading partners of African economies rely on an extensive framework of different trade agreements. What is, thus, the legal basis of the recent increase of Sino-African trade? Interestingly, Sino-African trade has seen a particularly strong increase in countries that have entered into tied aid agreements with China. These agreements are commonly known under the term ‘Angola-Model’ and consist of a multifaceted network of barter-trading-systems, aspects of tied aid and concessions for oil and other commodities linked with a state loan. It is likely that these agreements have an impact on the trade-flows between African countries and China. This paper discusses the legal character of this new form of economic cooperation, or modern version of tied aid. Critical legal aspects related to this form of tied aid refer to violation of the principle of most-favoured nation (MFN), illegitimate export subsidies, market access, public procurement and transparency in the international trading system. However, despite the recent outcry of the foremost Western community against the strategy of the Chinese government on the African continent, the practice of the Angola-Model based tied aid is not entirely new, and neither is it against the law. The case of tied aid is situated in a legal grey area that should be examined thoroughly in order to strengthen the international trading system and to support developing countries in their attempt to gain from tied aid arrangements.

Oligoastrocytoma: Who's afraid of the … Liger?

We agree with the authors' attitude toward fostering the principle of parsimony (also known as Ockham's razor(3) ) - whereby no unnecessary entities/labels should be posited whenever a phenomenon can be reduced to a set of less complex constituents. Nevertheless, we take issue with some of the shortcuts which we feel they engaged in along their line of reasoning. This article is protected by copyright. All rights reserved.

Humanitarian intervention and the issue of state sovereignty in the discourse of legal experts between the 1830s and the First World War

This article discusses the tensions between the principle of state sovereignty and the idea of a "humanitarian intervention" (or a intervention on humanitarian grounds) as they resulted from the debate of leading legal scholars in the 19th and early 20th century. While prominent scholars such as Johann Caspar Bluntschli, Gustave Rolin Jaequemyns or Aegidius Arntz spoke out in favour of a form of "humanitarian interventions", others such as August Wilhelm Heffter or Pasquale Fiore were much more critical and in many cases spoke out in favour of absolute state sovereignty.

Inference of evolutionary forces acting on human biological pathways

Because natural selection is likely to act on multiple genes underlying a given phenotypic trait, we study here the potential effect of ongoing and past selection on the genetic diversity of human biological pathways. We first show that genes included in gene sets are generally under stronger selective constraints than other genes and that their evolutionary response is correlated. We then introduce a new procedure to detect selection at the pathway level based on a decomposition of the classical McDonald–Kreitman test extended to multiple genes. This new test, called 2DNS, detects outlier gene sets and takes into account past demographic effects and evolutionary constraints specific to gene sets. Selective forces acting on gene sets can be easily identified by a mere visual inspection of the position of the gene sets relative to their two-dimensional null distribution. We thus find several outlier gene sets that show signals of positive, balancing, or purifying selection but also others showing an ancient relaxation of selective constraints. The principle of the 2DNS test can also be applied to other genomic contrasts. For instance, the comparison of patterns of polymorphisms private to African and non-African populations reveals that most pathways show a higher proportion of nonsynonymous mutations in non-Africans than in Africans, potentially due to different demographic histories and selective pressures.

Radiochemical determination of 129I and 36Cl in MEGAPIE, a proton irradiated lead-bismuth eutectic spallation target

The concentrations of the long-lived nuclear reaction products 129I and 36Cl have been measured in samples from the MEGAPIE liquid metal spallation target. Samples from the bulk target material (lead-bismuth eutectic, LBE), from the interface of the metal free surface with the cover gas, from LBE/steel interfaces and from noble metal absorber foils installed in the cover gas system were analysed using Accelerator Mass Spectrometry at the Laboratory of Ion beam Physics at ETH Zürich. The major part of 129I and 36Cl was found accumulated on the interfaces, particularly at the interface of LBE and the steel walls of the target container, while bulk LBE samples contain only a minor fraction of these nuclides. Both nuclides were also detected on the absorber foils to a certain extent (≪ 1% of the total amount). The latter number is negligible concerning the radio-hazard of the irradiated target material; however it indicates a certain affinity of the absorber foils for halogens, thus proving the principle of using noble metal foils for catching these volatile radionuclides. The total amounts of 129I and 36Cl in the target were estimated from the analytical data by averaging within the different groups of samples and summing up these averages over the total target. This estimation could account for about half of the amount of 129I and 36Cl predicted to be produced using nuclear physics modelling codes for both nuclides. The significance of the results and the associated uncertainties are discussed.

Palynostratigraphy of the last centuries in Switzerland based on 23 lake and mire deposits: chronostratigraphic pollen markers, regional patterns, and local histories

A total of 23 pollen diagrams [stored in the Alpine Palynological Data-Base (ALPADABA), Geobotanical Institute, Bern] cover the last 100 to over 1000 years. The sites include 15 lakes, seven mires, and one soil profile distributed in the Jura Mts (three sites), Swiss Plateau (two sites), northern Pre-Alps and Alps (six sites), central Alps (five sites), southern Alps (three sites), and southern Pre-Alps (four sites) in the western and southern part of Switzerland or just outside the national borders. The pollen diagrams have both a high taxonomic resolution and a high temporal resolution, with sampling distances of 0.5–3 cm, equivalent to 1 to 11 years for the last 100 years and 8 to 130 years for earlier periods. The chronology is based on absolute dating (14 sites: 210Pb 11 sites; 14C six sites; varve counting two sites) or on biostratigraphic correlation among pollen diagrams. The latter relies mainly on trends in Cannabis sativa, Ambrosia, Mercurialis annua, and Ostrya-type pollen. Individual pollen stratigraphies are discussed and sites are compared within each region. The principle of designating local, extra-local, and regional pollen signals and vegetation is exemplified by two pairs of sites lying close together. Trends in biostratigraphies shared by a major part of the pollen diagrams allow the following generalisations. Forest declined in phases since medieval times up to the late 19th century. Abies and Fagus declined consistently, whereas the behaviour of short-lived trees and trees of moist habitats differed among sites (Alnus glutinosa-type, Alnus viridis, Betula, Corylus avellana). In the present century, however, Picea and Pinus increased, followed by Fraxinus excelsior in the second half of this century. Grassland (traced by Gramineae and Plantago lanceolata-type pollen) increased, replacing much of the forest, and declined again in the second half of this century. Nitrate enrichment of the vegetation (traced by Urtica) took place in the first half of this century. These trends reflect the intensification of forest use and the expansion of grassland from medieval times up to the end of the last century, whereas subsequently parts of the grassland became used more intensively and the marginal parts were abandoned for forest regrowth. In most pollen diagrams human impact is the dominant factor in explaining inferred changes in vegetation, but climatic change plays a role at three sites.