[Hand transplantation - fiction or reality?]

Hand transplantation has been indicated in selective patients after traumatic upper extremity amputation and only performed in a few centers around the world for the last decade. In comparison to solid organ transplantation, there is a challenge to overcome the host immunological barrier due to complex antigenicity of the different included tissues, the skin being the most susceptible to rejection. Patients require lifelong immunosuppression for non life-threatening conditions. Minimization of maintenance immunosuppression represents the key step for promoting wider applicability of hand transplantation. Current research is working towards the understanding mechanisms of composite tissue allograft (CTA) rejection. Worldwide, in 51 patients 72 hands (21 double hand transplants) and once both arms have been successfully transplanted since 1998.

Language Construction of Reality in the German Tabloid Press/on Materials of BILD Newspaper/

From the moment of their birth, a person's life is determined by their sex. Goroshko wanted to find out why this difference is so striking, why society is so determined to sustain it, and how it can persist even when certain national or behavioural stereotypes are erased. She believes there are both social and biological differences between men and women, and set out to analyse these distinctions as they are manifested in language. Certain general characteristics can be identified. Males tend to write with less fluency, to refer to events in a verb phrase, to be time-oriented, to involve themselves more in their references to events, to locate events in their personal sphere of activity, and to refer less to others. Goroshko therefore concludes that the male is more active, more ego-involved in what he does and less concerned about others. Women were more fluent, referred to events in a noun-phrase, were less time-oriented, tended to be less involved in their event references, located events within their interactive community, and referred more to others. They spent much more time discussing personal and domestic subjects, relationship problems, family, health and reproductive matters, weight, food and clothing, men, and other women. Computer analysis showed that female speech was substantially more emotional, using hyperbole, metaphor, comparisons, epithets, ways of enumeration, interjections, rhetorical questions and exclamations. The level of literacy was higher in female speech, and women made fewer grammatical and spelling mistakes in written texts. Goroshko believes that her findings have relevance beyond the linguistic field. When working on anonymous texts she has been able to decide on the sex of the author and so believes that her research may even be of benefit to forensic science.

Siberian Wooden Churches: Reality and Symbolics

The preservation of Siberia's cultural heritage poses a serious problem. Many Siberian churches were destroyed or reconstructed, without their original form being carefully described. Mainicheva studied the question of Siberian wooden churches of the 17th-18th centuries, producing a complex analysis of their symbolism, phenomenology and morphology. Published and archival materials show that such unique churches as the Sophia Cathedral in Tobolesk (1621), the Trinity Church in Tomsk (1654) and the Church of Kazan Holy Mother in Ilimsk (1679) directly reflected the main features of medieval Russian culture combined with new perceptions of Man and the Universe. These Russian Orthodox churches have considerable significance for understanding the natural development of Russian architecture as a part of the Russian culture of permanently moving people. All these churches, which no longer exist in their original form, were built by unknown folk builders and represented a good example of non-professional architecture. Mainicheva developed full descriptions of the churches, including graphic reconstructions of their original plans and facades.

Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the REALITY trial: a randomized controlled trial

CONTEXT: Compared with bare metal stents, sirolimus-eluting and paclitaxel-eluting stents have been shown to markedly improve angiographic and clinical outcomes after percutaneous coronary revascularization, but their performance in the treatment of de novo coronary lesions has not been compared in a prospective multicenter study. OBJECTIVE: To compare the safety and efficacy of sirolimus-eluting vs paclitaxel-eluting coronary stents. DESIGN: Prospective, randomized comparative trial (the REALITY trial) conducted between August 2003 and February 2004, with angiographic follow-up at 8 months and clinical follow-up at 12 months. SETTING: Ninety hospitals in Europe, Latin America, and Asia. PATIENTS: A total of 1386 patients (mean age, 62.6 years; 73.1% men; 28.0% with diabetes) with angina pectoris and 1 or 2 de novo lesions (2.25-3.00 mm in diameter) in native coronary arteries. INTERVENTION: Patients were randomly assigned in a 1:1 ratio to receive a sirolimus-eluting stent (n = 701) or a paclitaxel-eluting stent (n = 685). MAIN OUTCOME MEASURES: The primary end point was in-lesion binary restenosis (presence of a more than 50% luminal-diameter stenosis) at 8 months. Secondary end points included 1-year rates of target lesion and vessel revascularization and a composite end point of cardiac death, Q-wave or non-Q-wave myocardial infarction, coronary artery bypass graft surgery, or repeat target lesion revascularization. RESULTS: In-lesion binary restenosis at 8 months occurred in 86 patients (9.6%) with a sirolimus-eluting stent vs 95 (11.1%) with a paclitaxel-eluting stent (relative risk [RR], 0.84; 95% confidence interval [CI], 0.61-1.17; P = .31). For sirolimus- vs paclitaxel-eluting stents, respectively, the mean (SD) in-stent late loss was 0.09 (0.43) mm vs 0.31 (0.44) mm (difference, -0.22 mm; 95% CI, -0.26 to -0.18 mm; P<.001), mean (SD) in-stent diameter stenosis was 23.1% (16.6%) vs 26.7% (15.8%) (difference, -3.60%; 95% CI, -5.12% to -2.08%; P<.001), and the number of major adverse cardiac events at 1 year was 73 (10.7%) vs 76 (11.4%) (RR, 0.94; 95% CI, 0.69-1.27; P = .73). CONCLUSION: In this trial comparing sirolimus- and paclitaxel-eluting coronary stents, there were no differences in the rates of binary restenosis or major adverse cardiac events. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00235092.

Multimodal augmented reality system for surgical microscopy

Image-guided, computer-assisted neurosurgery has emerged to improve localization and targeting, to provide a better anatomic definition of the surgical field, and to decrease invasiveness. Usually, in image-guided surgery, a computer displays the surgical field in a CT/MR environment, using axial, coronal or sagittal views, or even a 3D representation of the patient. Such a system forces the surgeon to look away from the surgical scene to the computer screen. Moreover, this kind of information, being pre-operative imaging, can not be modified during the operation, so it remains valid for guidance in the first stage of the surgical procedure, and mainly for rigid structures like bones. In order to solve the two constraints mentioned before, we are developing an ultrasoundguided surgical microscope. Such a system takes the advantage that surgical microscopy and ultrasound systems are already used in neurosurgery, so it does not add more complexity to the surgical procedure. We have integrated an optical tracking device in the microscope and an augmented reality overlay system with which we avoid the need to look away from the scene, providing correctly aligned surgical images with sub-millimeter accuracy. In addition to the standard CT and 3D views, we are able to track an ultrasound probe, and using a previous calibration and registration of the imaging, the image obtained is correctly projected to the overlay system, so the surgeon can always localize the target and verify the effects of the intervention. Several tests of the system have been already performed to evaluate the accuracy, and clinical experiments are currently in progress in order to validate the clinical usefulness of the system.