Contributo dei sistemi di fusione d'immagine mediante ecografia combinata con TAC e o RMN nella diagnosi del piccolo epatocarcinoma (< 2 cm) in pazienti con epatopatia cronica

L’ecografia è la metodica diagnostica più utilizzata come screening e follow-up nei pazienti epatopatici con o senza lesioni focali e questo grazie alle sue peculiari caratteristiche, che sono date dall’essere real-time, maneggevole, priva di radiazioni ionizzanti e con bassi costi. Tuttavia tale metodica se confrontata con la TC o la RMN, può avere importanti limiti, quali l’impossibilità di visualizzare piccole lesioni localizzate in aree anatomicamente “difficili” o in pazienti obesi, che sono già state identificate con altre tecniche, come la TC o la RMN. Per superare queste limitazioni sono stati introdotti dei sistemi di “fusione d’immagine” che consentono di sincronizzare in tempo reale una metodica real time con bassa risoluzione spaziale come l’ecografia ed una statica ad alta risoluzione come la TC o la RMN. Ciò si ottiene creando attorno al paziente un piccolo campo elettromagnetico costituito da un generatore e da un rilevatore applicato al trasduttore ecografico ed introducendo in un computer abbinato all’ecografo il “volume rendering” dell’addome del paziente ottenuto mediante TC multistrato o RM. Il preciso “ appaiamento spaziale “ delle due metodiche si ottiene individuando in entrambe lo stesso piano assiale di riferimento e almeno 3-4 punti anatomici interni. Tale sistema di fusione d’immagine potrebbe essere molto utile in campo epatologico nella diagnostica non invasiva del piccolo epatocarcinoma, che secondo le ultime linee guida, nei noduli di dimensioni fra 1 e 2 cm, richiede una concordanza nel comportamento contrastografico della lesione in almeno due tecniche d’immagine. Lo scopo del nostro lavoro è stato pertanto quello di valutare, in pazienti epatopatici, il contributo che tale sistema può dare nell’identificazione e caratterizzazione di lesioni inferiori a 20 mm, che erano già state identificate alla TC o alla RMN come noduli sospetti per HCC, ma che non erano stati visualizzati in ecografia convenzionale. L’eventuale re-identificazione con l’ecografia convenzionale dei noduli sospetti per essere HCC, può permettere di evitare, alla luce dei criteri diagnostici non invasivi un’ ulteriore tecnica d’immagine ed eventualmente la biopsia. Pazienti e Metodi: 17 pazienti cirrotici (12 Maschi; 5 Femmine), con età media di 68.9 +/- 6.2 (SD) anni, in cui la TC e la RMN con mezzo di contrasto avevano identificato 20 nuove lesioni focali epatiche, inferiori a 20 mm (13,6 +/- 3,6 mm), sospette per essere epatocarcinomi (HCC), ma non identificate all’ecografia basale (eseguita in cieco rispetto alla TC o alla RMN) sono stati sottoposti ad ecografia senza e con mezzo di contrasto, focalizzata su una zona bersaglio identificata tramite il sistema di fusione d’immagini, che visualizza simultaneamente le immagini della TC e della RMN ricostruite in modalità bidimensionale ( 2D), tridimensionale ( 3 D) e real-time. La diagnosi finale era stata stabilita attraverso la presenza di una concordanza diagnostica, secondo le linee guida internazionali o attraverso un follow-up nei casi di discordanza. Risultati: Una diagnosi non invasiva di HCC è stata raggiunta in 15/20 lesioni, inizialmente sospettate di essere HCC. Il sistema di fusione ha identificato e mostrato un comportamento contrastografico tipico in 12/15 noduli di HCC ( 80%) mentre 3/15 HCC (20%) non sono stati identificati con il sistema di fusione d’immagine. Le rimanenti 5/20 lesioni non sono state visualizzate attraverso i sistemi di fusione d’immagine ed infine giudicate come falsi positivi della TC e della RMN, poiché sono scomparse nei successivi mesi di follow-up e rispettivamente dopo tre, sei, nove, dodici e quindici mesi. Conclusioni: I nostri risultati preliminari mostrano che la combinazione del sistema di fusione dell’immagine associata all’ecografia senza e con mezzo di contrasto (CEUS), migliora il potenziale dell’ecografia nell’identificazione e caratterizzazione dell’HCC su fegato cirrotico, permettendo il raggiungimento di una diagnosi, secondo criteri non invasivi e slatentizzazndo casi di falsi positivi della TC e della RMN.

Oceanic crust and island arc formation in Central Asia during late Neoproterozoic times - evidence from petrological and geochemical studies

Die vorliegende Arbeit behandelt die Entwicklung des 570 Ma alten, neoproterozoischen Agardagh - Tes-Chem Ophioliths (ATCO) in Zentralasien. Dieser Ophiolith liegt südwestlich des Baikalsees (50.5° N, 95° E) und wurde im frühen Stadium der Akkretion des Zentralasiatischen Mobilgürtels auf den nordwestlichen Rand des Tuvinisch-Mongolischen Mikrokontinentes aufgeschoben. Bei dem Zentralasiatische Mobilgürtel handelt es sich um einen riesigen Akkretions-Subduktionskomplex, der heute das größte zusammenhängende Orogen der Erde darstellt. Im Rahmen dieser Arbeit wurden eine Reihe plutonischer und vulkanischer Gesteine, sowie verschiedene Mantelgesteine des ATCO mittels mikroanalytischer und geochemischer Verfahren untersucht (Elektronenstrahlmikrosonde, Ionenstrahlmikrosonde, Spurenelement- und Isotopengeochemie). Die Auswertung dieser Daten ermöglichte die Entwicklung eines geodynamisch-petrologischen Modells zur Entstehung des ATCO. Die vulkanischen Gesteine lassen sich aufgrund ihrer Spurenelement- und Isotopenzusammensetzung in inselbogenbezogene und back-arc Becken bezogene Gesteine (IA-Gesteine und BAB-Gesteine) unterscheiden. Darüber hinaus gibt es eine weitere, nicht eindeutig zuzuordnende Gruppe, die hauptsächlich mafische Gänge umfasst. Der grösste Teil der untersuchen Vulkanite gehört zur Gruppe der IA-Gesteine. Es handelt sich um Al-reiche Basalte und basaltische Andesite, welche aus einem evolvierten Stammmagma mit Mg# 0.60, Cr ~ 180 µg/g und Ni ~ 95 µg/g hauptsächlich durch Klinopyroxenfraktionierung entstanden sind. Das Stammmagma selbst entstand durch Fraktionierung von ca. 12 % Olivin und geringen Anteilen von Cr-Spinell aus einer primären, aus dem Mantel abgeleiteten Schmelze. Die IA-Gesteine haben hohe Konzentrationen an inkompatiblen Spurenelementen (leichte-(L)- Seltenerdelement-(SEE)-Konzentrationen etwa 100-fach chondritisch, chondrit-normierte (La/Yb)c von 14.6 - 5.1), negative Nb-Anomalien (Nb/La = 0.37 - 0.62) und niedrige Zr/Nb Verhältnisse (7 - 14) relativ zu den BAB-Gesteinen. Initiale eNd Werte liegen bei etwa +5.5, initiale Bleiisotopenverhältnisse sind: 206Pb/204Pb = 17.39 - 18.45, 207Pb/204Pb = 15.49 - 15.61, 208Pb/204Pb = 37.06 - 38.05. Die Anreicherung lithophiler inkompatibler Spurenelemente (LILE) in dieser Gruppe ist signifikant (Ba/La = 11 - 130) und zeigt den Einfluss subduzierter Komponenten an. Die BAB-Gesteine repräsentieren Schmelzen, die sehr wahrscheinlich aus der gleichen Mantelquelle wie die IA-Gesteine stammen, aber durch höhere Aufschmelzgrade (8 - 15 %) und ohne den Einfluss subduzierter Komponenten entstanden sind. Sie haben niedrigere Konzentrationen an inkompatiblen Spurenelementen, flache SEE-Muster ((La/Yb)c = 0.6 - 2.4) und höhere initiale eNd Werte zwischen +7.8 und +8.5. Nb Anomalien existieren nicht und Zr/Nb Verhältnisse sind hoch (21 - 48). Um die geochemische Entwicklung der vulkanischen Gesteine des ATCO zu erklären, sind mindestens drei Komponenten erforderlich: (1) eine angereicherte, ozeaninselbasalt-ähnliche Komponente mit hoher Nb Konzentration über ~ 30 µg/g, einem niedrigen Zr/Nb Verhältnis (ca. 6.5), einem niedrigen initialen eNd Wert (um 0), aber mit radiogenen 206Pb/204Pb-, 207Pb/204Pb- und 208Pb/204Pb-Verhältnissen; (2) eine N-MORB ähnliche back-arc Becken Komponente mit flachem SEE-Muster und einem hohen initialen eNd Wert von mindestens +8.5, und (3) eine Inselbogen-Komponente aus einer verarmten Mantelquelle, welche durch die abtauchende Platte geochemisch modifiziert wurde. Die geochemische Entstehung der ATCO Vulkanite lässt sich dann am besten durch eine Kombination aus Quellenkontamination, fraktionierte Kristallisation und Magmenmischung erklären. Geodynamisch gesehen entstand der ATCO sehr wahrscheinlich in einem intraozeanischen Inselbogen - back-arc System. Bei den untersuchten Plutoniten handelt es sich um ultramafische Kumulate (Wehrlite und Pyroxenite) sowie um gabbroische Plutonite (Olivin-Gabbros bis Diorite). Die geochemischen Charakteristika der mafischen Plutonite sind deutlich unterschiedlich zu denen der vulkanischen Gesteine, weshalb sie sehr wahrscheinlich ein späteres Entwicklungsstadium des ATCO repräsentieren. Die Spurenelement-Konzentrationen in den Klinopyroxenen der ultramafischen Kumulate sind extrem niedrig, mit etwa 0.1- bis 1-fach chondritischen SEE-Konzentrationen und mit deutlich LSEE-verarmten Mustern ((La/Yb)c = 0.27 - 0.52). Berechnete Gleichgewichtsschmelzen der ultramafischen Kumulate zeigen grosse Ähnlichkeit zu primären boninitischen Schmelzen. Die primären Magmen waren daher boninitischer Zusammensetzung und entstanden in dem durch vorausgegangene Schmelzprozesse stark verarmten Mantelkeil über einer Subduktionszone. Niedrige Spurenelement-Konzentrationen zeigen einen geringen Einfluss der abtauchenden Platte an. Die Spurenelement-Konzentrationen der Gabbros sind ebenfalls niedrig, mit etwa 0.5 - 10-fach chondritischen SEE-Konzentrationen und mit variablen SEE-Mustern ((La/Yb)c = 0.25 - 2.6). Analog zu den Vulkaniten der IA-Gruppe haben alle Gabbros eine negative Nb-Anomalie mit Nb/La = 0.01 - 0.31. Die initialen eNd Werte der Gabbros variieren zwischen +4.8 und +7.1, mit einem Mittelwert von +5.9, und sind damit identisch mit denen der IA-Vulkanite. Bei den untersuchten Mantelgesteinen handelt es sich um teilweise serpentinisierte Dunite und Harzburgite, die alle durch hohe Mg/Si- und niedrige Al/Si-Verhältnisse gekennzeichnet sind. Dies zeigt einen refraktären Charakter an und steht in guter Übereinstimmung mit den hohen Cr-Zahlen (Cr#) der Spinelle (bis zu Cr# = 0.83), auf deren Basis der Aufschmelzgrad der residuellen Mantelgesteine berechnet wurde. Dieser beträgt etwa 25 %. Die geochemische Zusammensetzung und die petrologischen Daten der Ultramafite und Gabbros lassen sich am besten erklären, wenn man für die Entstehung dieser Gesteine einen zweistufigen Prozess annimmt. In einer ersten Stufe entstanden die ultramafischen Kumulate unter hohem Druck in einer Magmenkammer an der Krustenbasis, hauptsächlich durch Klinopyroxen-Fraktionierung. Bei dieser Magmenkammer handelte es sich um ein offenes System, dem von unten laufend neue Schmelze zugeführt wurde, und aus dem im oberen Bereich evolviertere Schmelzen geringerer Dichte entwichen. Diese evolvierten Schmelzen stiegen in flachere krustale Bereiche auf und bildeten dort meist isolierte Intrusionskörper. Diese Intrusionskörper erstarrten ohne Magmen-Nachschub, weshalb petrographisch sehr unterschiedliche Gesteine entstehen konnten. Eine geochemische Modifikation der abkühlenden Schmelzen erfolgte allerdings durch die Assimilation von Nebengestein. Da innerhalb der Gabbros keine signifikante Variation der initalen eNd Werte existiert, handelte es sich bei dem assimilierten Material hauptsächlich um vulkanische Gesteine des ATCO und nicht um ältere, möglicherweise kontinentale Kruste.

Stereoselektive Synthese von Stickstoffheterocyclen an Glycosylaminen als chiralen Auxiliaren

Alkaloide, im allgemeinen Stickstoffheterocyclen, sind wichtige Vorläuferverbindungen von pharmakologisch aktiven Substanzen. Die stereoselektive Synthese von Stickstoffheterocyclen ist von großem Interesse für die Entdeckung und Entwicklung von Arzneistoffen.In der Arbeit wurden Glycosylamine vom Typ des 2,3,4,6-Tetra-O-pivaloyl-?-D-galactosylamins bzw. des 2,3,4-Tri-O-pivaloyl-?-D-arabinosylamins zur diastereoselektiven Synthese mehrfach substituierter Stickstoffheterocyclen eingesetzt. In einer Tandem-Mannich-Michael-Reaktion eines Glycosylimins mit dem Danishefsky-Dien wurden die in Position 6 substituierten Dehydropiperidinone aufgebaut. In einer mehrstufigen Synthesesequenz konnte das 4a-Epimere des natürlichen Pumiliotoxin C als Hydrochlorid dargestellt werden.Mittels der Tandem-Mannich-Michael-Reaktion wurden auch 6,6`-disubstituierte Dehydropiperidinone dargestellt. Die Darstellung zweier Aza-spiro-Verbindungen gelang erstmals ausgehend von den Ketonen Cyclohexanon und 3-Methyl-cyclohexanon über die Glycosylketimine. Das in dieser Reaktion gefundene Nebenprodukt N-Glycosyl-6-(2´-oxo-propyl)-2,3 dehydropiperidin-4-on diente als Ausgangssubstanz für die Pinidinolsynthese.In der angewendeten Weise eignen sich Glycosylamine sehr gut für die stereoselektive Synthese von Stickstoffheterocyclen. Meistens werden die chirale Piperidinalkaloidvorläufer in hohen Ausbeuten und Diastereoselektivitäten erhalten.

Fattori eziologici della Sindrome del Tunnel Carpale: una revisione sistematica con meta-analisi degli studi analitici

OBIETTIVO: sintetizzare le evidenze disponibili sulla relazione tra i fattori di rischio (personali e lavorativi) e l’insorgenza della Sindrome del Tunnel Carpale (STC). METODI: è stata condotta una revisione sistematica della letteratura su database elettronici considerando gli studi caso-controllo e di coorte. Abbiamo valutato la qualità del reporting degli studi con la checklist STROBE. Le stime studio-specifiche sono state espresse come OR (IC95%) e combinate con una meta-analisi condotta con un modello a effetti casuali. La presenza di eventuali bias di pubblicazione è stata valutata osservando l’asimmetria del funnel plot e con il test di Egger. RISULTATI: Sono stati selezionati 29 studi di cui 19 inseriti nella meta-analisi: 13 studi caso-controllo e 6 di coorte. La meta-analisi ha mostrato un aumento significativo di casi di STC tra i soggetti obesi sia negli studi caso-controllo [OR 2,4 (1,9-3,1); I(2)=70,7%] che in quelli di coorte [OR 2,0 (1,6-2,7); I(2)=0%]. L'eterogeneità totale era significativa (I(2)=59,6%). Risultati simili si sono ottenuti per i diabetici e soggetti affetti da malattie della tiroide. L’esposizione al fumo non era associata alla STC sia negli studi caso-controllo [OR 0,7 (0,4-1,1); I(2)=83,2%] che di coorte [OR 0,8 (0,6-1,2); I(2)=45,8%]. A causa delle molteplici modalità di valutazione non è stato possibile calcolare una stima combinata delle esposizioni professionali con tecniche meta-analitiche. Dalla revisione, è risultato che STC è associata con: esposizione a vibrazioni, movimenti ripetitivi e posture incongrue di mano-polso. CONCLUSIONI: I risultati della revisione sistematica confermano le evidenze dell'esistenza di un'associazione tra fattori di rischio personali e STC. Nonostante la diversa qualità dei dati sull'esposizione e le differenze degli effetti dei disegni di studio, i nostri risultati indicano elementi di prova sufficienti di un legame tra fattori di rischio professionali e STC. La misurazione dell'esposizione soprattutto per i fattori di rischio professionali, è un obiettivo necessario per studi futuri.

Incident cancer burden attributable to excess body mass index in 30 European countries

Excess adiposity is associated with increased risks of developing adult malignancies. To inform public health policy and guide further research, the incident cancer burden attributable to excess body mass index (BMI >or= 25 kg/m(2)) across 30 European countries were estimated. Population attributable risks (PARs) were calculated using European- and gender-specific risk estimates from a published meta-analysis and gender-specific mean BMI estimates from a World Health Organization Global Infobase. Country-specific numbers of new cancers were derived from Globocan2002. A ten-year lag-period between risk exposure and cancer incidence was assumed and 95% confidence intervals (CI) were estimated in Monte Carlo simulations. In 2002, there were 2,171,351 new all cancer diagnoses in the 30 countries of Europe. Estimated PARs were 2.5% (95% CI 1.5-3.6%) in men and 4.1% (2.3-5.9%) in women. These collectively corresponded to 70,288 (95% CI 40,069-100,668) new cases. Sensitivity analyses revealed estimates were most influenced by the assumed shape of the BMI distribution in the population and cancer-specific risk estimates. In a scenario analysis of a plausible contemporary (2008) population, the estimated PARs increased to 3.2% (2.1-4.3%) and 8.6% (5.6-11.5%), respectively, in men and women. Endometrial, post-menopausal breast and colorectal cancers accounted for 65% of these cancers. This analysis quantifies the burden of incident cancers attributable to excess BMI in Europe. The estimates reported here provide a baseline for future modelling, and underline the need for research into interventions to control weight in the context of endometrial, breast and colorectal cancer.

Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients

PURPOSE: To describe anticipated health-related quality of life (HRQL) for different hypothetical strategies of febrile neutropenia (FN) management in adult cancer patients. METHODS: Seventy-eight adult cancer patients were enrolled. Our study considered four different hypothetical treatment strategies for FN: (1) entire inpatient management with intravenous (IV) antibiotics; (2) oral treatment at home after an initial observation in hospital with IV antibiotics; (3) entire outpatient management with IV antibiotics; and (4) entire outpatient management with oral antibiotics. Initially, patients were asked to rank the different treatment strategies for FN based on their personal preference. Subsequently, HRQL was rated using visual analog scale (VAS), time trade-off (TTO), and willingness-to-pay (WTP). RESULTS: Seventy-five percent of all respondents preferred an outpatient strategy for FN (36% oral, 21% intravenous, 18% early discharge). Further, outpatient strategies were associated with higher mean VAS scores (possible range 0-10) (oral: 6.1 (standard deviation (SD) 3.1); intravenous: 6.2 (SD 2.2); early discharge: 5.7 (SD 2.1)) as compared to inpatient care (5.3 (SD 2.9)). On the aggregate level, patients were willing to give up between 9 and 10 weeks of their life (TTO; corresponding to <1% of remaining life expectancy) and to pay between $255 and $327 Canadian dollars (WTP) to avoid treatment in hospital. CONCLUSIONS: Our study indicates that the majority of adult cancer patients would prefer an outpatient strategy for FN. However, patients' preferences vary substantially at the individual level. Implementation of outpatient strategies into routine clinical practice should consider this variability.

Biologically based strategies to augment rotator cuff tears

Lesions of the rotator cuff (RC) are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords "tendon," "rotator cuff," "augmentation," "growth factor," "platelet-rich fibrin," and "platelet-rich plasma" for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor.

Radiocarbon analysis in an Alpine ice core: Record of anthropogenic and biogenic contributions to carbonaceous Radiocarbon analysis in an Alpine ice core: Record of anthropogenic and biogenic contributions to carbonaceous aerosols in the past (1650-1940)

Long-term concentration records of carbonaceous particles (CP) are of increasing interest in climate research due to their not yet completely understood effects on climate. Nevertheless, only poor data on their concentrations and sources before the 20th century are available. We present a first long-term record of organic carbon (OC) and elemental carbon (EC) concentrations – the two main fractions of CP – along with the corresponding fraction of modern carbon (fM) derived from radiocarbon (14C) analysis in ice. This allows a distinction and quantification of natural (biogenic) and anthropogenic (fossil) sources in the past. CP were extracted from an ice archive, with resulting carbon quantities in the microgram range. Analysis of 14C by accelerator mass spectrometry (AMS) was therefore highly demanding. We analysed 33 samples of 0.4 to 1 kg ice from a 150.5 m long ice core retrieved at Fiescherhorn glacier in December 2002 (46°33'3.2" N, 08°04'0.4" E; 3900 m a.s.l.). Samples were taken from bedrock up to the firn/ice transition, covering the time period 1650–1940 and thus the transition from the pre-industrial to the industrial era. Before ~1850, OC was approaching a purely biogenic origin with a mean concentration of 24 μg kg−1 and a standard deviation of 7 μg kg−1. In 1940, OC concentration was about a factor of 3 higher than this biogenic background, almost half of it originating from anthropogenic sources, i.e. from combustion of fossil fuels. The biogenic EC concentration was nearly constant over the examined time period with 6 μg kg−1 and a standard deviation of 1 μg kg−1. In 1940, the additional anthropogenic input of atmospheric EC was about 50 μg kg−1.

Links between body mass index, total body fat, cholesterol, high-density lipoprotein, and insulin sensitivity in patients with obesity related to depression, anger, and anxiety

OBJECTIVE: Define links between psychosocial parameters and metabolic variables in obese females before and after a low-calorie diet. METHOD: Nine female obese patients (age 36.1 +/- 7.1 years, body mass index [BMI] > 30 kg/m2) were investigated before and after a 6-week low-calorie diet accompanied by behavior therapy. Blood lipids, insulin sensitivity (Bergman protocol), fat distribution (by dual-energy X-ray absorptiometry [DEXA]), as well as psychological parameters such as depression, anger, anxiety, symptom load, and well-being, were assessed before and after the dieting period. RESULTS: The females lost 9.6 +/- 2.8 kg (p < .0001) of body weight, their BMI was reduced by 3.5 +/- 0.3 kg/m2 (p < .0001), and insulin sensitivity increased from 3.0 +/- 1.8 to 4.3 +/- 1.5 mg/kg (p = .05). Their abdominal fat content decreased from 22.3 +/- 5.5 to 18.9 +/- 4.5 kg (p < .0001). In parallel, psychological parameters such as irritability (p < .05) and cognitive control (p < .0001) increased, whereas feelings of hunger (p < .05), externality (p < .05), interpersonal sensitivity (p < .01), paranoid ideation (p < .05), psychoticism (p < .01), and global severity index (p < .01) decreased. Prospectively, differences in body fat (percent) were correlated to nervousness (p < .05). Waist-to-hip ratio (WHR) differences were significantly correlated to sociability (p < .05) and inversely to emotional instability (p < .05), whereas emotional instability was inversely correlated to differences in insulin sensitivity (p < .01). DISCUSSION: Weight reduction may lead to better somatic risk factor control. Women with more nervousness and better sociability at the beginning of a diet period may lose more weight than others.

Longest available clinical outcomes after drug-eluting stent implantation for unprotected left main coronary artery disease: the DELFT (Drug Eluting stent for LeFT main) Registry

OBJECTIVES: The purpose of this study was to investigate the long-term safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for unprotected left main coronary artery (ULMCA) disease. BACKGROUND: Long-term clinical outcomes after DES implantation for ULMCA disease have not yet been ascertained. METHODS: From April 2002 to April 2004, 358 consecutive patients who underwent PCI with DES implantation for de novo lesions on ULMCA were retrospectively selected and analyzed in 7 European and U.S. tertiary care centers. No patients were excluded from the analysis, and all patients had a minimum follow-up of 3 years. RESULTS: Technical success rate was 100%. Procedural success rate was 89.6%. After 3 years, major adverse cardiovascular events (MACE)-free survival in the whole population was 73.5%. According to the Academic Research Consortium definitions, cardiac death occurred in 9.2% of patients, and reinfarction, target lesion revascularization (TLR), and target vessel revascularization (TVR) occurred in 8.6%, 5.8%, and 14.2% of patients, respectively. Definite stent thrombosis occurred in 2 patients (specifically at 0 and 439 days). In elective patients, the 3-year MACE-free survival was 74.2%, with mortality, reinfarction, TLR, and TVR rates of 6.2%, 8.3%, 6.6%, and 16%, respectively. In the emergent group the 3-year MACE-free survival was 68.2%, with mortality, reinfarction, TLR, and TVR rates of 21.4%, 10%, 2.8%, and 7.1%, respectively. CONCLUSIONS: Routine DES implantation in ULMCA disease seems encouraging, with favorable long-term clinical results.

Anti-Feminist Backlash and Violence against Women Worldwide

Although globalization, through the communications revolution and international law, brings the promise of progressive social change, the concern of this paper is with the backlash against women’s increasing emancipation, a backlash that is evidenced in the United States through making a mockery of women’s bid for equality by turning the principles against some women whose lives are troubled while rewarding others. Meanwhile across the world the victimization of women, personal and cultural, is taking place in both democratic and totalitarian regimes. Two related forms of backlash are institutional and personal. That forces from the global market and the corporate media help fuel this backlash is a major contention of this paper.

Cochrane and non-Cochrane systematic reviews in leading orthodontic journals: a quality paradigm?

The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using AMSTAR and to compare the prevalence of meta-analysis in both review types. A literature search was undertaken to identify SRs that consisted of hand-searching five major orthodontic journals [American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics and Orthodontics and Craniofacial Research (February 2002 to July 2011)] and the Cochrane Database of Systematic Reviews from January 2000 to July 2011. Methodological quality of the included reviews was gauged using the AMSTAR tool involving 11 key methodological criteria with a score of 0 or 1 given for each criterion. A cumulative grade was given for the paper overall (0-11); an overall score of 4 or less represented poor methodological quality, 5-8 was considered fair and 9 or greater was deemed to be good. In total, 109 SRs were identified in the five major journals and on the CDSR. Of these, 26 (23.9%) were in the CDSR. The mean overall AMSTAR score was 6.2 with 21.1% of reviews satisfying 9 or more of the 11 criteria; a similar prevalence of poor reviews (22%) was also noted. Multiple linear regression indicated that reviews published in the CDSR (P < 0.01); and involving meta-analysis (β = 0.50, 95% confidence interval 0.72, 2.07, P < 0.001) showed greater concordance with AMSTAR.

Hearing performance with 2 different high-power sound processors for osseointegrated auditory implants

OBJECTIVE To compare speech understanding of the BAHA BP110 and BAHA Intenso sound processors. STUDY DESIGN Prospective experimental study. SETTING Tertiary referral center. PATIENTS Twenty experienced user of osseointegrated auditory implants with conductive or mixed hearing loss. INTERVENTIONS In a first session, half of the participants were fitted with an Intenso, the other half with a BP110. After 1 month of use, aided speech understanding in quiet and in noise was measured, and the other test processor was fitted. One month later, speech understanding with the second sound processor was assessed. MAIN OUTCOME MEASURES Speech understanding in quiet and in noise, with noise arriving either from the front, the rear, or the side of the user with the osseointegrated bone conductor. RESULTS Significant improvements were found for both processors for speech understanding in quiet (+9.6 to +34.8 percent points; p = 0.02 to 0.001) and in noise (+6.2 to +13.8 dB, p < 0.001). No significant differences were found between the 2 devices for speech in quiet. For noise from the rear, subjects were able to understand speech at signal-to-noise ratios which were lower (less favorable) by -5.1 dB (p < 0.001) when compared with the Intenso. CONCLUSION Speech understanding is substantially improved by both devices, with no significant differences between the sound processors in quiet. In noise, speech understanding is significantly better with the BP110 when compared to the Intenso for noise from the rear.

Lake sediments as natural seismographs: A compiled record of Late Quaternary earthquakes in Central Switzerland and its implication for Alpine deformation

Central Switzerland lies tectonically in an intraplate area and recurrence rates of strong earthquakes exceed the time span covered by historic chronicles. However, many lakes are present in the area that act as natural seismographs: their continuous, datable and high-resolution sediment succession allows extension of the earthquake catalogue to pre-historic times. This study reviews and compiles available data sets and results from more than 10 years of lacustrine palaeoseismological research in lakes of northern and Central Switzerland. The concept of using lacustrine mass-movement event stratigraphy to identify palaeo-earthquakes is showcased by presenting new data and results from Lake Zurich. The Late Glacial to Holocene mass-movement units in this lake document a complex history of varying tectonic and environmental impacts. Results include sedimentary evidence of three major and three minor, simultaneously triggered basin-wide lateral slope failure events interpreted as the fingerprints of palaeoseismic activity. A refined earthquake catalogue, which includes results from previous lake studies, reveals a non-uniform temporal distribution of earthquakes in northern and Central Switzerland. A higher frequency of earthquakes in the Late Glacial and Late Holocene period documents two different phases of neotectonic activity; they are interpreted to be related to isostatic post-glacial rebound and relatively recent (re-)activation of seismogenic zones, respectively. Magnitudes and epicentre reconstructions for the largest identified earthquakes provide evidence for two possible earthquake sources: (i) a source area in the region of the Alpine or Sub-Alpine Front due to release of accumulated north-west/south-east compressional stress related to an active basal thrust beneath the Aar massif; and (ii) a source area beneath the Alpine foreland due to reactivation of deep-seated strike-slip faults. Such activity has been repeatedly observed instrumentally, for example, during the most recent magnitude 4.2 and 3.5 earthquakes of February 2012, near Zug. The combined lacustrine record from northern and Central Switzerland indicates that at least one of these potential sources has been capable of producing magnitude 6.2 to 6.7 events in the past.

Mid- to late Holocene Indian Ocean Monsoon variability recorded in four speleothems from Socotra Island, Yemen

Four stalagmites covering the last 7.0 ka were sampled on Socotra, an island in the northern Indian Ocean to investigate the evolution of the northeast Indian Ocean Monsoon (IOM) since the mid Holocene. On Socotra, rain is delivered at the start of the southwest IOM in May–June and at the start of the northeast IOM from September to December. The Haggeher Mountains act as a barrier forcing precipitation brought by the northeast winds to fall preferentially on the eastern side of the island, where the studied caves are located. δ18O and δ13C and Mg/Ca and Sr/Ca signals in the stalagmites reflect precipitation amounts brought by the northeast winds. For stalagmite STM6, this amount effect is amplified by kinetic effects during calcite deposition. Combined interpretation of the stalagmites' signals suggest a weakening of the northeast precipitation between 6.0 and 3.8 ka. After 3.8 ka precipitation intensities remain constant with two superimposed drier periods, between 0 and 0.6 ka and from 2.2 to 3.8 ka. No link can be established with Greenland ice cores and with the summer IOM variability. In contrast to the stable northeast rainy season suggested by the records in this study, speleothem records from western Socotra indicate a wettening of the southwest rainy season on Socotra after 4.4 ka. The local wettening of western Socotra could relate to a more southerly path (more over the Indian Ocean) taken by the southwest winds. Stalagmite STM5, sampled at the fringe between both rain areas displays intermediate δ18O values. After 6.2 ka, similar precipitation changes are seen between eastern Socotra and northern Oman indicating that both regions are affected similarly by the monsoon. Different palaeoclimatologic records from the Arabian Peninsula currently located outside the ITCZ migration pathway display an abrupt drying around 6 ka due to their disconnection from the southwest rain influence. Records that are nowadays still receiving rain by the southwest winds, suggest a more gradual drying reflecting the weakening of the southwest monsoon.