Comparison of the reliability of multifocal visual evoked cortical potentials generated by pattern reversal and pattern pulse stimulation

This study compared the effectiveness of the multifocal visual evoked cortical potentials (mfVEP) elicited by pattern pulse stimulation with that of pattern reversal in producing reliable responses (signal-to-noise ratio >1.359). Participants were 14 healthy subjects. Visual stimulation was obtained using a 60-sector dartboard display consisting of 6 concentric rings presented in either pulse or reversal mode. Each sector, consisting of 16 checks at 99% Michelson contrast and 80 cd/m² mean luminance, was controlled by a binary m-sequence in the time domain. The signal-to-noise ratio was generally larger in the pattern reversal than in the pattern pulse mode. The number of reliable responses was similar in the central sectors for the two stimulation modes. At the periphery, pattern reversal showed a larger number of reliable responses. Pattern pulse stimuli performed similarly to pattern reversal stimuli to generate reliable waveforms in R1 and R2. The advantage of using both protocols to study mfVEP responses is their complementarity: in some patients, reliable waveforms in specific sectors may be obtained with only one of the two methods. The joint analysis of pattern reversal and pattern pulse stimuli increased the rate of reliability for central sectors by 7.14% in R1, 5.35% in R2, 4.76% in R3, 3.57% in R4, 2.97% in R5, and 1.78% in R6. From R1 to R4 the reliability to generate mfVEPs was above 70% when using both protocols. Thus, for a very high reliability and thorough examination of visual performance, it is recommended to use both stimulation protocols.

Collision free region determination by modified polygonal Boolean operations

Cutting and packing problems are found in numerous industries such as garment, wood and shipbuilding. The collision free region concept is presented, as it represents all the translations possible for an item to be inserted into a container with already placed items. The often adopted nofit polygon concept and its analogous concept inner fit polygon are used to determine the collision free region. Boolean operations involving nofit polygons and inner fit polygons are used to determine the collision free region. New robust non-regularized Boolean operations algorithm is proposed to determine the collision free region. The algorithm is capable of dealing with degenerated boundaries. This capability is important because degenerated boundaries often represent local optimal placements. A parallelized version of the algorithm is also proposed and tests are performed in order to determine the execution times of both the serial and parallel versions of the algorithm.

Oral leucine supplementation is sensed by the brain but neither reduces food intake nor induces an anorectic pattern of gene expression in the hypothalamus

Leucine activates the intracellular mammalian target of the rapamycin (mTOR) pathway, and hypothalamic mTOR signaling regulates food intake. Although central infusion of leucine reduces food intake, it is still uncertain whether oral leucine supplementation is able to affect the hypothalamic circuits that control energy balance. We observed increased phosphorylation of p70s6k in the mouse hypothalamus after an acute oral gavage of leucine. We then assessed whether acute oral gavage of leucine induces the activation of neurons in several hypothalamic nuclei and in the brainstem. Leucine did not induce the expression of Fos in hypothalamic nuclei, but it increased the number of Fos-immunoreactive neurons in the area postrema. In addition, oral gavage of leucine acutely increased the 24 h food intake of mice. Nonetheless, chronic leucine supplementation in the drinking water did not change the food intake and the weight gain of ob/ob mice and of wild-type mice consuming a low- or a high-fat diet. We assessed the hypothalamic gene expression and observed that leucine supplementation increased the expression of enzymes (BCAT1, BCAT2 and BCKDK) that metabolize branched-chain amino acids. Despite these effects, leucine supplementation did not induce an anorectic pattern of gene expression in the hypothalamus. In conclusion, our data show that the brain is able to sense oral leucine intake. However, the food intake is not modified by chronic oral leucine supplementation. These results question the possible efficacy of leucine supplementation as an appetite suppressant to treat obesity

Knowledge Flows and Networks: the Interplay between Local and Global Linkages within Bangalore IT Cluster

This doctoral work gains deeper insight into the dynamics of knowledge flows within and across clusters, unfolding their features, directions and strategic implications. Alliances, networks and personnel mobility are acknowledged as the three main channels of inter-firm knowledge flows, thus offering three heterogeneous measures to analyze the phenomenon. The interplay between the three channels and the richness of available research methods, has allowed for the elaboration of three different papers and perspectives. The common empirical setting is the IT cluster in Bangalore, for its distinguished features as a high-tech cluster and for its steady yearly two-digit growth around the service-based business model. The first paper deploys both a firm-level and a tie-level analysis, exploring the cases of 4 domestic companies and of 2 MNCs active the cluster, according to a cluster-based perspective. The distinction between business-domain knowledge and technical knowledge emerges from the qualitative evidence, further confirmed by quantitative analyses at tie-level. At firm-level, the specialization degree seems to be influencing the kind of knowledge shared, while at tie-level both the frequency of interaction and the governance mode prove to determine differences in the distribution of knowledge flows. The second paper zooms out and considers the inter-firm networks; particularly focusing on the role of cluster boundary, internal and external networks are analyzed, in their size, long-term orientation and exploration degree. The research method is purely qualitative and allows for the observation of the evolving strategic role of internal network: from exploitation-based to exploration-based. Moreover, a causal pattern is emphasized, linking the evolution and features of the external network to the evolution and features of internal network. The final paper addresses the softer and more micro-level side of knowledge flows: personnel mobility. A social capital perspective is here developed, which considers both employees’ acquisition and employees’ loss as building inter-firm ties, thus enhancing company’s overall social capital. Negative binomial regression analyses at dyad-level test the significant impact of cluster affiliation (cluster firms vs non-cluster firms), industry affiliation (IT firms vs non-IT fims) and foreign affiliation (MNCs vs domestic firms) in shaping the uneven distribution of personnel mobility, and thus of knowledge flows, among companies.

The influence of petrogenetic processes on the composition of Ocean Island Basalts

Ocean Island Basalts (OIB) provide important information on the chemical and physical characteristics of their mantle sources. However, the geochemical composition of a generated magma is significantly affected by partial melting and/or subsequent fractional crystallization processes. In addition, the isotopic composition of an ascending magma may be modified during transport through the oceanic crust. The influence of these different processes on the chemical and isotopic composition of OIB from two different localities, Hawaii and Tubuai in the Pacific Ocean, are investigated here. In a first chapter, the Os-isotope variations in suites of lavas from Kohala Volcano, Hawaii, are examined to constrain the role of melt/crust interactions on the evolution of these lavas. As 187Os/188Os sensitivity to any radiogenic contaminant strongly depend on the Os content in the melt, Os and other PGE variations are investigated first. This study reveals that Os and other PGE behavior change during the Hawaiian magma differentiation. While PGE concentrations are relatively constant in lavas with relatively primitive compositions, all PGE contents strongly decrease in the melt as it evolved through ~ 8% MgO. This likely reflects the sulfur saturation of the Hawaiian magma and the onset of sulfide fractionation at around 8% MgO. Kohala tholeiites with more than 8% MgO and rich in Os have homogeneous 187Os/188Os values likely to represent the mantle signature of Kohala lavas. However, Os isotopic ratios become more radiogenic with decreasing MgO and Os contents in the lavas, which reflects assimilation of local crust material during fractional crystallization processes. Less than 8% upper oceanic crust assimilation could have produced the most radiogenic Os-isotope ratios recorded in the shield lavas. However, these small amounts of upper crust assimilation have only negligible effects on Sr and Nd isotopic ratios and therefore, are not responsible for the Sr and Nd isotopic heterogeneities observed in Kohala lavas. In a second chapter, fractional crystallization and partial melting processes are constrained using major and trace element variations in the same suites of lavas from Kohala Volcano, Hawaii. This inverse modeling approach allows the estimation of most of the trace element composition of the Hawaiian mantle source. The calculated initial trace element pattern shows slight depletion of the concentrations from LREE to the most incompatible elements, which indicates that the incompatible element enrichments described by the Hawaiian melt patterns are entirely produced by partial melting processes. The “Kea trend” signature of lavas from Kohala Volcano is also confirmed, with Kohala lavas having lower Sr/Nd and La/Th ratios than lavas from Mauna Loa Volcano. Finally, the magmatic evolution of Tubuai Island is investigated in a last chapter using the trace element and Sr, Nd, Hf isotopic variations in mafic lava suites. The Sr, Nd and Hf isotopic data are homogeneous and typical for the HIMU-type OIB and confirms the cogenetic nature of the different mafic lavas from Tubuai Island. The trace element patterns show progressive enrichment of incompatible trace elements with increasing alkali content in the lavas, which reflect progressive decrease in the degree of partial melting towards the later volcanic events. In addition, this enrichment of incompatible trace elements is associated with relative depletion of Rb, Ba, K, Nb, Ta and Ti in the lavas, which require the presence of small amount of residual phlogopite and of a Ti-bearing phase (ilmenite or rutile) during formation of the younger analcitic and nephelinitic magmas.

Biomimese biologischer Membranen: Konzeptionierung, Synthese und biophysikalische Charakterisierung einer Hierarchie festkörpergestützter Mimikry biologischer Membranen

Im Rahmen dieser Arbeit wurden drei neue Modelle zur funktionellen Mimiese biologischer Membranen im Bereich der Bionanotechnologie entwickelt. Um den Rahmen der notwendigen Faktoren und Komponenten für biomimetische Membranmodelle abzustecken, wurde das biologische Vorbild im Bezug auf Zusammensetzung, Organisation und Funktion analysiert. Die daraus abgeleiteten Erkenntnisse erlauben das Erreichen von biologisch relevanten Membranwiderständen im Bereich von mehreren MOhm cm2 und eine gute lokale Fluidität. Ein weiteres Ziel dieser Arbeit war die Entwicklung einer Hierachie unterschiedlich stark von der Festkörperoberfläche entkoppelter Membranen zur Vergrößerung des submembranen Raumes. Diese Ziele konnten realisiert werden. Das auf archaealen Etherlipiden basierende DPTL-System wurde analog dem biologischen Vorbild stereoselektiv synthetisiert und ist in der Lage die Membran bei maximaler Elongation des TEG-Spacers mit mehr als 2 nm von der Oberfläche zu entkoppeln. Die erzielten Wiederstände liegen im hohen ein- bis zweistelligen MOhm-Bereich, die Kapazität entspricht mit 0,5 µF cm-2 ebenfalls dem Wert biologischer Membranen. Die Membraneigenschaften wurden mit Hilfe von SPS, EIS, IR-Spektroskopie, QCM, AFM und Kontaktwinkelmessungen charakterisiert. Die Funktionalität und lokale Fluidität der DPTL-Membran konnte anhand des Valinomycin vermittelten K+-Transports über die Membran gezeigt werden. Fluide Elektroden oder laterale Verdünnung mit TEGL erlauben den Einbau größerer Ionenkanäle. Lipo-Glycopolymere (LGP) mit unterschiedlichen Kettenlängen wurden mit Hilfe der kontrollierten radikalischen Polymerisation mit einer PD < 1.2 synthetisiert. Es zeigte sich, daß die Vororientierung der LGPs auf dem LB-Trog, gefolgt von einem LB-Übertrag auf einen funktionalisierten Träger mit photoreaktivem SAM, nach Belichten des Systems zu einer verlässlichen kovalenten Anbindung der supramolekularen LGP-Architektur führt. Da die Lipo-Glycopolymerketten am Glycopolymerterminus nur mit oberflächennahen Repetiereinheiten an die photoaktivierte Oberfläche binden, sind sie in der Lage Oberflächenrauhigkeiten des Festkörpersubstrates auszugleichen. Die photochemische Immobilisierung von funktionell orientierten supramolekularen LGP-Architekturen auf Goldoberflächen resultiert in tBLMs mit großen vertikalen Enkopplungen der Membran von der Festkörperoberfläche (>8 nm). Der funktionelle Ionentransport von Kaliumionen durch Valinomycin zeigt eine ausreichende lokale Fluidität der Membran die mit einem guten Membranwiderstand (mehrere MOhm) kombiniert ist. Große Membran-Oberflächenentkopplungen konnten mit Hilfe plasmapolymerisierter elektrophiler Polymere erreicht werden. Filmdicken von 50 nm sind mit homogener Oberfläche und Rauhigkeiten im Bereich von Nanometern möglich. Das System zeigt interessante fluide Eigenschaften mit guten Erholungsraten bei FRAP-Experimenten (Diffusionskonstanten von etwa 17 mikro m2 s-1). Die elektrischen Eigenschaften liegen mit Widerständen von wenigen kOhm unterhalb der für gute Membranmimikrie notwendigen Werte. Erstmalig konnte gezeigt werden, daß mit Hilfe dieser Methode inerte Polymere/Plastikträger (zum Beispiel Polypropylen und TOPAS) in effizienter Weise kovalent mit reaktiven Polymeroberflächen modifiziert werden können (Anwendung als DNA-Chip ist beschrieben).

Paleosecular variation of the magnetic field recorded in Pleistocene-holocene volcanics from Pantelleria (italy) and Azores archipelago (portugal): implications for local volcanic history

The primary goal of volcanological studies is to reconstruct the eruptive history of active volcanoes, by correlating and dating volcanic deposits, in order to depict a future scenario and determine the volcanic hazard of an area. However, alternative methods are necessary where the lack of outcrops, the deposit variability and discontinuity make the correlation difficult, and suitable materials for an accurate dating lack. In this thesis, paleomagnetism (a branch of Geophysics studying the remanent magnetization preserved in rocks) is used as a correlating and dating tool. The correlation is based on the assumption that coeval rocks record similar paleomagnetic directions; the dating relies upon the comparison between paleomagnetic directions recorded by rocks with the expected values from references Paleo-Secular Variation curves (PSV, the variation of the geomagnetic field along time). I first used paleomagnetism to refine the knowledge of the pre – 50 ka geologic history of the Pantelleria island (Strait of Sicily, Italy), by correlating five ignimbrites and two breccias deposits emplaced during that period. Since the use of the paleomagnetic dating is limited by the availability of PSV curves for the studied area, I firstly recovered both paleomagnetic directions and intensities (using a modified Thellier method) from radiocarbon dated lava flows in São Miguel (Azores Islands, Portugal), reconstructing the first PSV reference curve for the Atlantic Ocean for the last 3 ka. Afterwards, I applied paleomagnetism to unravel the chronology and characteristics of Holocene volcanic activity at Faial (Azores) where geochronological age constraints lack. I correlated scoria cones and lava flows yielded by the same eruption on the Capelo Peninsula and dated eruptive events (by comparing paleomagnetic directions with PSV from France and United Kingdom), finding that the volcanics exposed at the Capelo Peninsula are younger than previously believed, and entirely comprised in the last 4 ka.

Microemulsion: prediction of the phase diagram with a modified Helfrich free energy

Microemulsions are thermodynamically stable, macroscopically homogeneous but microscopically heterogeneous, mixtures of water and oil stabilised by surfactant molecules. They have unique properties like ultralow interfacial tension, large interfacial area and the ability to solubilise other immiscible liquids. Depending on the temperature and concentration, non-ionic surfactants self assemble to micelles, flat lamellar, hexagonal and sponge like bicontinuous morphologies. Microemulsions have three different macroscopic phases (a) 1phase- microemulsion (isotropic), (b) 2phase-microemulsion coexisting with either expelled water or oil and (c) 3phase- microemulsion coexisting with expelled water and oil.rnrnOne of the most important fundamental questions in this field is the relation between the properties of the surfactant monolayer at water-oil interface and those of microemulsion. This monolayer forms an extended interface whose local curvature determines the structure of the microemulsion. The main part of my thesis deals with the quantitative measurements of the temperature induced phase transitions of water-oil-nonionic microemulsions and their interpretation using the temperature dependent spontaneous curvature [c0(T)] of the surfactant monolayer. In a 1phase- region, conservation of the components determines the droplet (domain) size (R) whereas in 2phase-region, it is determined by the temperature dependence of c0(T). The Helfrich bending free energy density includes the dependence of the droplet size on c0(T) as

The applicability of non-local LCI data for LCA

This study evaluated how applicable European Life Cycle Inventory (LCI) data are to assessing the environmental impacts of the life cycle of Brazilian triple superphosphate (TSP). The LCI data used for the comparison were local Brazilian LCI data, European LCI data in its original version from the ecoinvent database and a modified version of the European LCI data, which had been adapted to better account for the Brazilian situation. We compared the three established datasets at the level of the inventory as well as for their environmental impacts, i.e. at the level of Life Cycle Environmental Assessment (LCIA). The analysis showed that the European LCIs (both the original and the modified ones) considered a broader spectrum of background processes and environmental flows (inputs and outputs). Nevertheless, TSP production had in all three cases similar values for the consumption of the main raw materials. The LCIA results obtained for the datasets showed important differences as well. Therefore we concluded that the European data in general lead to much higher environmental impacts than the Brazilian data. The differences between the LCIA results obtained with the Brazilian and the European data can be basically explained by the methodological differences underlying the data. The small differences at the LCI level for selected inputs and outputs between the Brazilian and the European LCIs from ecoinvent indicate that the latter can be regarded as applicable for characterizing the Brazilian TSP.

Inhibitory regulation of dendritic activity in vivo

The spatiotemporal control of neuronal excitability is fundamental to the inhibitory process. We now have a wealth of information about the active dendritic properties of cortical neurons including axonally generated sodium action potentials as well as local sodium spikelets generated in the dendrites, calcium plateau spikes, and NMDA spikes. All of these events have been shown to be highly modified by the spatiotemporal pattern of nearby inhibitory input which can drastically change the output firing mode of the neuron. This means that particular populations of interneurons embedded in the neocortical microcircuitry can more precisely control pyramidal cell output than has previously been thought. Furthermore, the output of any given neuron tends to feed back onto inhibitory circuits making the resultant network activity further dependent on inhibition. Network activity is therefore ultimately governed by the subcellular microcircuitry of the cortex and it is impossible to ignore the subcompartmentalization of inhibitory influence at the neuronal level in order to understand its effects at the network level. In this article, we summarize the inhibitory circuits that have been shown so far to act on specific dendritic compartments in vivo.

K(L) --> pi0 e+ e- and K(L) --> pi0 mu+ mu-: A binary star on the stage of flavor physics

A systematic analysis of New Physics impacts on the rare decays KL→π0ell+ell- is performed. Thanks to their different sensitivities to flavor-changing local effective interactions, these two modes could provide valuable information on the nature of the possible New Physics at play. In particular, a combined measurement of both modes could disentangle scalar/pseudoscalar from vector or axial-vector contributions. For the latter, model-independent bounds are derived. Finally, the KL→π0μ+μ- forward-backward CP-asymmetry is considered, and shown to give interesting complementary information.

Adjunctive local antibiotic therapy in the treatment of peri-implantitis II: clinical and radiographic outcomes

AIM: To monitor over 12 months clinical and radiographic changes occurring after adjunctive local delivery of minocycline microspheres for the treatment of peri-implantitis. MATERIAL AND METHODS: In 25 partially edentulous subjects, 31 implants diagnosed with peri-implantitis were treated. Three weeks after oral hygiene instruction, mechanical debridement and local antiseptic cleansing using 0.2% chlorhexidine gel, baseline (Day 0) parameters were recorded. Minocycline microspheres (Arestin) were locally delivered to each implant site with bone loss and a probing pocket depth (PPD) >or=5 mm. Rescue therapy with Arestin was allowed at Days 180 and 270 at any site exhibiting an increase in PPD>or=2 mm from the previous visit. The following clinical parameters were recorded at four sites/implant at Day 0, 10, 30, 60, 90, 180, 270 and 360: PPD, clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PlI). RESULTS: Six implants in six subjects were either rescued or exited because of persisting active peri-implantitis. Successful implants showed a statistically significant reduction in both PPD and percentage of sites with BOP between baseline and Day 360 (P<0.05). At mesial implant sites, the mean PPD reduction amounted to 1.6 mm (95% CI: 0.9-2.2 mm, P<0.001) and was accompanied by a statistically significant reduction of the BOP value (P<0.001). Binary regression analysis showed that the clinical parameters and smoking history could not discriminate between successfully treated and rescued or exited implants at any observation time point. CONCLUSION: Non-surgical mechanical treatment of peri-implantitis lesions with adjunctive local delivery of microencapsulated minocycline led to positive effects on clinical parameters up to 12 months.

The influence of local and systemic preconditioning on oxygenation, metabolism and survival in critically ischaemic skin flaps in pigs

Stress proteins represent a group of highly conserved intracellular proteins that provide adaptation against cellular stress. The present study aims to elucidate the stress protein-mediated effects of local hyperthermia and systemic administration of monophosphoryl lipid A (MPL) on oxygenation, metabolism and survival in bilateral porcine random pattern buttock flaps. Preconditioning was achieved 24h prior to surgery by applying a heating blanket on the operative site (n = 5), by intravenous administration of MPL at a dosage of 35 microg/kg body weight (n = 5) or by combining the two (n = 5). The flaps were monitored with laser Doppler flowmetry, polarographic microprobes and microdialysis until 5h postoperatively. Semiquantitative immunohistochemistry was performed for heat shock protein 70 (HSP70), heat shock protein 32 (also termed haem oxygenase-1, HO-1), and inducible nitrc oxide synthase (iNOS). The administration of MPL increased the impaired microcirculatory blood flow in the proximal part of the flap and partial oxygen tension in the the distal part by approximately 100% each (both P<0.05), whereas both variables remained virtually unaffected by local heat preconditioning. Lactate/pyruvate (L/P) ratio and glycerol concentration (representing cell membrane disintegration) in the distal part of the flap gradually increased to values of approximately 500 mmol/l and approximately 350 micromol/l, respectively (both P<0.01), which was substantially attenuated by heat application (P<0.01 for L/P ratio and P<0.05 for glycerol) and combined preconditioning (P<0.01 for both variables), whereas the effect of MPL was less marked (not significant). Flap survival was increased from 56% (untreated animals) to 65% after MPL (not significant), 71% after heat application (P<0.05) and 78% after both methods of preconditioning (P<0.01). iNOS and HO-1 were upregulated after each method of preconditioning (P<0.05), whereas augmented HSP70 staining was only observed after heat application (P<0.05). We conclude that local hyperthermia is more effective in preventing flap necrosis than systemic MPL administration because of enhancing the cellular tolerance to hypoxic stress, which is possibly mediated by HSP70, whereas some benefit may be obtained with MPL due to iNOS and HO-1-mediated improvement in tissue oxygenation.

Quality of life in stroke survivors after local intra-arterial thrombolysis

Background: We aimed to assess quality of life (QOL) and its predictors in stroke survivors after local intra-arterial thrombolysis (IAT) as well as to measure QOL according to the site of pretreatment vessel occlusion. Methods: From January 2000 to April 2004, 175 consecutive patients underwent IAT for acute ischemic stroke. Clinical and radiological data were collected prospectively. We contacted 135 stroke survivors after a mean of 923 (+/-431) days, 132 responded. QOL, assessed with EuroQol (EQ-5D), and functional abilities, measured with the modified Rankin Scale (mRS) and the Barthel Index, were compared, and predictors of QOL were analyzed. Results: Measured with EQ-5D, 56% of the patients reported a good QOL (EQ-5D Index >/=70). Low mRS and high Barthel Index scores at follow-up were associated with better overall QOL (Kendall's tau >0.5). Nevertheless, 25% of the functionally independent patients (mRS 0-2) indicated a markedly impaired QOL (EQ-5D Index <70) and 10% of disabled patients indicated good QOL. QOL was significantly lower in patients with occlusion of the internal carotid artery compared to patients with occlusion of the basilar artery or the M1, M2 or M3/4 segment of the middle cerebral artery (EQ-5D Index: p = 0.005). A high National Institute of Health Stroke Scale score on admission and occlusion of the internal carotid artery were independent predictors of impaired QOL (p < 0.05). Conclusion: More than half of the stroke survivors treated with IAT reported a good QOL, mostly survivors with mild disabilities. QOL assessment gives information that is not provided by traditional outcome scores. Our results support guidelines to measure QOL in stroke research. Copyright (c) 2008 S. Karger AG, Basel.

Transient apical ballooning syndrome--clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population

BACKGROUND: Transient apical ballooning syndrome (TABS) or Takotsubo cardiomyopathy mimics acute ST-elevation myocardial infarction, but is considered to have a good prognosis with only moderate elevation of myocardial enzymes and full recovery of left ventricular function. Although it is increasingly reported, its exact incidence, clinical presentation, and prognosis in non-Asian populations remain largely unknown. OBJECTIVE: To describe the clinical characteristics and long-term follow-up of patients who presented with TABS at our institution over a 3 year-period. METHODS: Patients were retrospectively retrieved from our local database. Patient charts were carefully reviewed and the diagnosis of TABS was based on the Mayo Clinic diagnostic criteria. Moreover, psychosocial stress or gastrointestinal disease was recorded. RESULTS: During the study period, 13,715 coronary angiographies were performed at our institution, including 2459 patients presenting with an acute coronary syndrome (ACS). Forty-one TABS were diagnosed, which represents an incidence of 1.7% of ACS-patients and 0.3% of all coronary angiographies performed, respectively. Mean age was 65 years, with 85% women. Clinical presentations included chest pain, dyspnoea, and cardiogenic shock. A preceding psychological or physical condition perceived as "stress" was reported in 61%. At a mean follow-up of 675+/-288 days, none of the patients died of cardiac causes, but two patients had a recurrence of symptoms. CONCLUSIONS: This is the largest cohort of TABS patients reported out of Europe so far. The good overall prognosis and low likelihood of recurrence were confirmed.