Aortic biological valve prosthesis in patients younger than 65 years of age: transition to a flexible age limit?

OBJECTIVES Guidelines proposed bioprosthesis implantation for aortic valve disease if the patients were at least 65 years old at the time of surgery, with a trend towards even younger patients in recent years. Considering the adverse effects of lifetime anticoagulation, new biological valves (less prone to degeneration) and new technologies may lead patients and surgeons to different choices. Therefore, it is interesting to analyse the results of aortic bioprosthetic valve replacement in patients aged <65 years at the time of surgery. METHODS From January 2000 to December 2010, 84 patients aged <65 years at the time of surgery had undergone an aortic bio-prosthetic valve replacement. A mid-term follow-up [(FU) mean FU time: 54.4 ± 39.2 months] was done in August 2011 in all patients (FU completeness: 100%). Results were compared with patients who had a mechanical prosthetic aortic valve replacement during the same period. RESULTS The reoperation rate for structural valve degeneration (SVD) of bioprostheses was 6% and occurred exclusively among patients <56 years. Contraindications for anticoagulation determined the choice of a bioprosthesis among 83% of these patients. The personal preference to avoid anticoagulation was the leading cause in 68% of the older patients (56-65 years). Neurological complications occurred more frequently in the mechanical control group. CONCLUSIONS Reoperations for SVD after bioprosthesis implantation occurred exclusively among younger patients (<56 years), not suitable for systemic anticoagulation. Previous studies, together with our experience, are in favour of an age limit between 56 and 60 years, taking into consideration alternative transcatheter approaches to SVD treatment.

Forecasting coal resources and reserves in heterogeneous coal zones using 3D facies models (As Pontes Basin, NW Spain)

Forecasting coal resources and reserves is critical for coal mine development. Thickness maps are commonly used for assessing coal resources and reserves; however they are limited for capturing coal splitting effects in thick and heterogeneous coal zones. As an alternative, three-dimensional geostatistical methods are used to populate facies distributionwithin a densely drilled heterogeneous coal zone in the As Pontes Basin (NWSpain). Coal distribution in this zone is mainly characterized by coal-dominated areas in the central parts of the basin interfingering with terrigenous-dominated alluvial fan zones at the margins. The three-dimensional models obtained are applied to forecast coal resources and reserves. Predictions using subsets of the entire dataset are also generated to understand the performance of methods under limited data constraints. Three-dimensional facies interpolation methods tend to overestimate coal resources and reserves due to interpolation smoothing. Facies simulation methods yield similar resource predictions than conventional thickness map approximations. Reserves predicted by facies simulation methods are mainly influenced by: a) the specific coal proportion threshold used to determine if a block can be recovered or not, and b) the capability of the modelling strategy to reproduce areal trends in coal proportions and splitting between coal-dominated and terrigenousdominated areas of the basin. Reserves predictions differ between the simulation methods, even with dense conditioning datasets. Simulation methods can be ranked according to the correlation of their outputs with predictions from the directly interpolated coal proportion maps: a) with low-density datasets sequential indicator simulation with trends yields the best correlation, b) with high-density datasets sequential indicator simulation with post-processing yields the best correlation, because the areal trends are provided implicitly by the dense conditioning data.

Cenomanian-Turonian transition in a shallow water sequence of the Sinai, Egypt

Environmental and depositional changes across the Late Cenomanian oceanic anoxic event (OAE2) in the Sinai, Egypt, are examined based on biostratigraphy, mineralogy, delta(13)C values and phosphorus analyses. Comparison with the Pueblo, Colorado, stratotype section reveals the Whadi El Ghaib section as stratigraphically complete across the late Cenomanian-early Turonian. Foraminifera are dominated by high-stress planktic and benthic assemblages characterized by low diversity, low-oxygen and low-salinity tolerant species, which mark shallow-water oceanic dysoxic conditions during OAE2. Oyster biostromes suggest deposition occurred in less than 50 m depths in low-oxygen, brackish, and nutrient-rich waters. Their demise prior to the peak delta(13)C excursion is likely due to a rising sea-level. Characteristic OAE2 anoxic conditions reached this coastal region only at the end of the delta(13)C plateau in deeper waters near the end of the Cenomanian. Increased phosphorus accumulations before and after the delta(13)C excursion suggest higher oxic conditions and increased detrital input. Bulk-rock and clay mineralogy indicate humid climate conditions, increased continental runoff and a rising sea up to the first delta(13)C peak. Above this interval, a dryer and seasonally well-contrasted climate with intermittently dry conditions prevailed. These results reveal the globally synchronous delta(13)C shift, but delayed effects of OAE2 dependent on water depth.

Challenge of transition in the socio-professional insertion of youngsters with neurodisabilities.

Objective: To evaluate the activities of patients with neurodisabilities and assess their insertion problems in the professional world. Methods: It is based on medical records of 267 patients (224 with neurodevelopmental diseases and 43 with neuromuscular diseases), aged 16-25 years, followed in the transition clinic of young adults in the neurorehabilitation services of a tertiary center. Results: Nearly half of them (46.8%) were in a protected environment, 37.08% studied and only 3.4% worked. Their studies are much longer and they are less in university than Swiss people of same age. The competitiveness criteria are no mental retardation and to be completely independent. Finally, 29.2% reported work problems, the foremost being the lack of adaptation in the workplace. Conclusion: These results highlight the need to increase the integration of young adults with neuromotor disorders in the labor market.

[Magnificentiores selectioresque Urbis Venetiarum prospectus quos olim Michael Marieschi, Venetus pictor et architectus in plerisque tabulis depinxit, nunc vero ab ipsomet acurate delineante, incidente, tyspisque mandante, iterum in sexdecim aereis tabulis in lucem aeduntur]. [18], AEdis Divi Rocchi facies rudis adhuc ex cocto latere, nec sectis marmoribus obducta : ad laevam magnum sodalitium eidem Sancto dicatum, et studio Sebastiani Serlii constructum. : [estampe] / Mich.l Marieschi del.t et inci.t

Référence bibliographique : Toledano, Marieschi, 26

Epithelial-to-mesenchymal transition mediates docetaxel resistance and high risk of relapse in prostate cancer

Molecular characterization of radical prostatectomy specimens after systemic therapy may identify a gene expression profile for resistance to therapy. This study assessed tumor cells from patients with prostate cancer participating in a phase II neoadjuvant docetaxel and androgen deprivation trial to identify mediators of resistance. Transcriptional level of 93 genes from a docetaxel-resistant prostate cancer cell lines microarray study was analyzed by TaqMan low-density arrays in tumors from patients with high-risk localized prostate cancer (36 surgically treated, 28 with neoadjuvant docetaxel þ androgen deprivation). Gene expression was compared between groups and correlated with clinical outcome. VIM, AR and RELA were validated by immunohistochemistry. CD44 and ZEB1 expression was tested by immunofluorescence in cells and tumor samples. Parental and docetaxel-resistant castration-resistant prostate cancer cell lines were tested for epithelial-to-mesenchymal transition (EMT) markers before and after docetaxel exposure. Reversion of EMT phenotype was investigated as a docetaxel resistance reversion strategy. Expression of 63 (67.7%) genes differed between groups (P < 0.05), including genes related to androgen receptor, NF-k B transcription factor, and EMT. Increased expression of EMT markers correlated with radiologic relapse. Docetaxel-resistant cells had increased EMT and stem-like cell markers expression. ZEB1 siRNA transfection reverted docetaxel resistance and reduced CD44 expression in DU-145R and PC-3R. Before docetaxel exposure, a selected CD44 þ subpopulation of PC-3 cells exhibited EMT phenotype and intrinsic docetaxel resistance; ZEB1/CD44 þ subpopulations were found in tumor cell lines and primary tumors; this correlated with aggressive clinical behavior. This study identifies genes potentially related to chemotherapy resistance and supports evi-dence of the EMT role in docetaxel resistance and adverse clinical behavior in early prostate cancer.

Russian transition in the early 21st century

Tässä tutkimuksessa käsitellään Venäjän talouden kehitystä uudella vuosituhannella. Kylmän sodan aikaan Neuvostoliitto oli suurvalta, jonka asema perustui sotilasmahtiin. Sotateollisuuden konversio palvelemaan nykytarpeita ei ole ollut helppo tehtävä. Vuoden 1998 talouskriisin jälkeen elintaso on toipunut verraten nopeasti, mikä on nähtävissä tarkastellessa kotitalouksien kulutusrakenteita, joita käsitellään tarkemmin luvussa 2. Siirtymätalouksissa vaihtotaseen vajeet ovat yleisiä, mutta luonnonrikkauksiensa ansiosta Venäjän vaihtotaseet ovat olleet huomattavan ylijäämäisiä, mitä pohditaan luvussa 3. Vaihtotaseen ylijäämien heijatusvaikutus on ollut Venäjän rooli pääomien nettoviejänä. Venäjän investointikertymä onedelleen erittäin vaatimaton suhteutettuna maan kehitysvaiheeseen. Jokaisessa menestyksekkäässä taloudessa investoinnit ovat pitkän aikavälintaloudellisen menestyksen avaintekijä. Venäjän erityispiirteitä tähän liittyen on kuvattu luvussa 4. Raportti päättyy talouden nykytilanteen analyysiin (luvut 5 ja 6).

Événements et déformations tardi-métamorphiques dans le segment Ossola-Ticino (Val Vigezzo-Centovalli, Italie-Suisse)

RESUME: Une zone tectonique large et complexe, connue sous le nom de ligne des Centovalli, traverse le secteur des Alpes Centrales compris entre Domodossola et Locarno. Cette région, formée par le Val Vigezzo et la vallée des Centovalli, constitue la terminaison méridionale du dôme Lepontin et représente une portion de la zone des racines des nappes alpines. Elle fait partie d’une grande et complexe zone de cisaillement, en partie associée à des phénomènes hydrothermaux d’âge alpin (<20 Ma), qui comprend le système tectonique Insubrien et celui du Simplon. Le Val Vigezzo et les Centovalli constituent un vrai carrefour entre les principaux accidents tectoniques des Alpes ainsi qu'une zone de juxtaposition du socle Sudalpin avec la zone des racines de l’Austroalpin et du Pennique. Les phases de déformation et les structures géologiques qui peuvent être étudiées s'étalent sur une période comprise entre environ 35 Ma et l'actuel. L’étude détaillée de terrain a mis en évidence la présence de nombreuses roches et structures de déformation de type ductile et cassant tels que des mylonites, des cataclasites, des pseudotachylites, des kakirites, des failles minéralisées, des gouges de faille et des plis. Sur le terrain on a pu distinguer au moins quatre générations de plis liés aux différentes phases de déformation. Le nombre et la complexité de ces structures indiquent une histoire très compliquée, selon plusieurs étapes distinctes, parfois liées, voire même superposées. Une partie de ces structures de déformation affectent aussi les dépôts sédimentaires d’âge quaternaire, notamment des limons et des sables lacustres. Ces sédiments constituent les restes d'un bassin lacustre attribué à l'époque interglaciaire Riss/Würm (éemien, 67.000-120.000 ans) et ils affleurent dans la partie centrale de la zone étudiée, à l'Est de la plaine de Santa Maria Maggiore. Ces sédiments montrent en leur sein toute une série de structures de déformation tels que des plans de faille inverses, des structures conjuguées de raccourcissement et des véritables plis. Ces failles et ces plis représenteraient les évidences de surface d’une déformation probablement active en époque quaternaire. Une autre formation rocheuse a retenu tout notre attention; il s'agit d'un corps de brèches péridotitiques monogéniques qui affleure en discontinuité le long du versant méridional et le long du fond de la vallée Vigezzo sur environ 20 km. Ces brèches se posent indifféremment sur le socle (unités Finero, Orselina) ou sur les sédiments lacustres. Elles sont traversées par des plans de failles qui développent des véritables stries de faille et des gouges de faille; l’orientation de ces plans est la même que celle affectant les failles à gouges du socle. La genèse de cette brèche est liée à l'altération et au modelage glacier (rock-glaciers) d'une brèche tectonique originelle qui borde la partie externe du Corps de Finero. Les structures de déformation de cette brèche, pareillement à celles des sédiments lacustres, ont été considérées comme les évidences de surface d'une tectonique quaternaire active dans la région. La dernière phase de déformation cassante qui affecte cette région peut donc être considérée comme active en époque quaternaire. Une vue d’ensemble de la région étudiée nous permet de reconnaître à l’échelle régionale une zone de cisaillement complexe orientée E-W, parallèlement à l’axe de la vallée Centovalli-Val Vigezzo. Les données de terrain, indiquent que cette zone de cisaillement débute sous conditions ductiles et évolue en plusieurs étapes jusqu’à des conditions de failles cassantes de surface. La reconstruction de l'évolution géodynamique de la région a permis de définir trois étapes distinctes qui marquent le passage, de ce secteur de socle cristallin, de conditions P-T profondes à des conditions de surface. Dans ce contexte, on a reconnu trois phases principales de déformation à l’échelle régionale qui caractérisent ces trois étapes. La phase la plus ancienne est constituée par des mylonites en faciès amphibolite, associées à des mouvements de cisaillement dextre, qui sont ensuite remplacés par des mylonites en faciès schistes verts et des plis rétrovergentes liés au rétrocharriage des nappes alpines. Une deuxième étape est identifiée par le développement d’une phase hydrothermale liée à un système de failles extensives et décrochantes dextres à direction principale E-W, NE-SW et NW-SE. Leur caractérisation minéralogique a permis la mise en évidence des phases cristallines de néoformation liées à cet événement constituées par : K-feldspath (microcline), chlorites (Fe+Mg), épidotes, prehnite, zéolites (laumontite), sphène, calcite. Dans ce contexte, pour obtenir une meilleure caractérisation de cet événement hydrothermal on a utilisé des géothermomètres sur chlorites, sensible aussi à la pression et a la a(H2O), qui ont donné des valeurs descendantes comprises entre 450-200°C. Les derniers mouvements sont mis en évidence par le développement d’une série de plans majeurs de failles à gouge, qui forment une structure en sigmoïdes d’épaisseur kilométrique reconnaissable à l’échelle de la vallée et caractérisée par des mouvements transpressifs avec une composante décrochante dextre toujours importante. Cette phase de déformation forme un système conjugué de failles avec direction moyenne E-W qui coupent la zone des racines des nappes alpines, la zone du Canavese et le corps ultramafique de Finero. Ce système se déroule de manière subparallèle à l'axe de la vallée le long de plusieurs dizaines de kilomètres. Une analyse complète et détaillée des gouges de faille par XRD a montré que la fraction argileuse (<2 µm) de ces gouges contient une partie de néoformation très importante constituée par, des illites, des chlorites et des interstratifiés de type illite/smectite ou chlorite/smectite. Des datations avec méthode K-Ar sur ces illites ont donné des valeurs comprises entre 12 et 4 Ma qui représentent l'âge de cette dernière déformation cassante. L'application de la méthode de la cristallinité de l'illite (C.I.) a permis d'évaluer les conditions thermiques qui caractérisent le déroulement de cette dernière phase tectonique qui se produit sous conditions de température caractéristiques de l'anchizone et de la diagenèse. L'ensemble des structures de déformation qu'on vient de décrire s'insère parfaitement dans le contexte de convergence oblique entre la plaque adriatique et celle européenne qui à produit l'orogène alpin. On peut considérer les structures tectoniques du Val Vigezzo-Centovalli comme l'expression d'une zone majeure de cisaillement "Simplo-Insubrienne". L'empilement structural et les structures tectoniques affleurantes dans la région sont le résultat de l'interaction entre un régime tectonique transpressif et un régime transtensif. Ces deux champs de tension sont antagonistes entre eux mais sont reliés, de toute façon, à une seule phase décrochante dextre principale, due à une convergence oblique entre deux plaques. À l'échelle de l'évolution géodynamique on peut distinguer différentes étapes au cours desquelles les structures de ces deux régimes tectoniques interagissent en manière différente. En accord avec les données géophysiques et les reconstructions paléodynamiques prises dans la littérature on considère que la ligne Rhône-Simplon-Centovalli représente l'évidence de surface de la suture majeure profonde entre la plaque Adriatique et celle Européenne. Les vitesses de soulèvement qui ont été calculées dans cette étude pour cette région des Alpes donnent une valeur moyenne de 0.8 mm/a qui est tout à fait comparable avec les données proposées par la littérature sur cette zone. La zone Val Vigezzo-Centovalli peut être donc considérée comme un carrefour géologique où se croisent différentes phases tectoniques qui représentent les évidences de surface d'une suture profonde majeure entre deux plaques dans un contexte de collision continentale. ABSTRACT: A wide and complex tectonic zone known as Centovalli line, crosses the Central Alps sector between Domodossola and Locarno. This area, formed by the Vigezzo Valley and Centovalli valley, constitutes the southernmost termination of the Lepontin dome and represents a portion of the alpine nappes root zone. It belongs to a large and complex shear-zone, partly associated with hydrothermal phenomena of alpine age (<20 My), which includes the Insubric Line and the Simplon fault zone. Vigezzo Valley and Centovalli constitute a real crossroads between the mains alpines tectonics lines as well as a zone of juxtaposition of the Southalpine basement with the Austroalpin and Pennique root zone. The deformation phases and the geological structures that can be studied between approximately 35 My and the present. The detailed field study showed the presence of many brittle and ductile deformation structures and fault rocks such as mylonites, cataclasites, pseudotachylites, kakirites, mineralized faults, fault gouges and folds. In the field we could distinguish at least four folds generations related to the various deformation phases. The number and the complexity of these structures indicate a very complicated history, comprising several different stages, that sometimes are related and even superimposed. Part of these deformation structures affect also the sedimentary deposits of quaternary age, in particular the silts and sands lake deposit. These sediments constitute the remainders of a lake basin ascribed to the interglacial Riss/Würm (Eemien, 67.000-120.000 years) and outcroping in the central part of the studied area, in the Eastern part of Santa Maria Maggiore plain. These sediments show a whole series of deformation structures such as inverse fault planes, combined shortening structures and true folds. These faults and folds would represent the surface evidence of a probably active tectonic deformation in quaternary time. Another rock formation attracted all our attention. It is a body of monogenic peridotite breccia which outcrops in discontinuity along the southernmost slope and the bottom of the Vigezzo valley on approximately 20 km. This breccia lies indifferently on the basement (Finero and Orselina units) or on the lake sediments. They are crossed by fault planes which developed slikenside and fault gouges whose orientation is the same of the faults gouges in the alpine basement. This breccia results from the weathering and the surface modelling of an original tectonic breccia which borders the external part of Finero peridotite body. This breccia deformation structures, like those of the lake sediments, were regarded as the surface interaction of active quaternary tectonics in the area. So the last brittle deformation phases which affects this area seems to be actives in quaternary time. Theoverall picture of the studied area on a regional scale enables us to point out a complex shear-zone directed E-W, parallel to the axis of the Centovalli and Vigezzo Valley. The field analysis indicates that this shear-zone began under ductile conditions and evolved in several stages to brittle faulting under surface conditions. The analysis of the geodynamic evolution of the area allows to define three different stages which mark the transition of this alpine basement root zone, from deep P-T conditions to P-T surface conditions. In this context on regional scale three principal deformation phases, which characterize these three stages can be distinguished. The oldest phase consisted of the amphibolitie facies mylonites, associated to dextral strikeslip movements. They are then replaced by green-schists facies mylonites and backfolds related to the backthrusting of the alpines nappes. A second episode is caracterized by the development of an hydrothermal phase bound to an extensive fault and dextral strike-slip fault system, with E-W, NW-SE and SE-NW principal directionsThe principal neoformed mineral phases related to this event are: K-feldspar (microcline), chlorites (Fe+Mg), epidotes prehnite, zéolites (laumontite), sphene and calcite. In this context, to obtain a better characterization of this hydrothermal event, we have used an chlorite geothermometer, sensitive also to the pressure and has the a(H2O), which gave downward values ranging between 450-200°C. The last movements are caracterized by the development of important gouge fault plans, which form a sigmoid structure of kilometric thickness which is recognizable at the valley scale, and is characterized by transpressive movements always with a significant dextral strike-slip component. This deformation phase forms a combined faults system with an average E-W direction, which cuts trough the alpine root zone, the Canavese zone and the Finero ultramafic body. This fault system takes place subparallel to the axis of the valley over several tens of kilometers. A complete and detailed XRD analysis of the gouges fault showed that the clay fraction (<2µm) contains a very significant neo-formation of illite, chlorites and mixed layered clays such as illite/smectite or chlorite/smectite. The K-Ar datings of the illite fraction <2µm gave values ranging between 12 and 4 My and the illite fraction <0.2µm gave more recents values until to 2,4-0 My.This values represent the age of this last brittle deformation. The application of the illite crystallinity method (C.I.) allowed evaluating the thermal conditions which characterize this tectonic phase that occured under temperature conditions of the anchizone and diagenesis. The whole set of deformation structures which we just described, perfectly fit the context of oblique convergence between the Adriatic and the European plate that produced the alpine orogen. We can regard the Vigezzo valley and Centovalli tectonic structures as the expression of a major "Simplo-Insubric" shear-zone. Structural stacking and tectonic structures that outcrop in the studied area, are the result of the interaction between a transpressive and a transtensve tectonic phases. These two tension fields are antagonistic but they are also connected, in any event, with only one principal dextral strike-slip movement, caused by an oblique convergence between two plates. On the geodynamic evolution scale we can distinguish various stages during which these two tectonic structures fields interact in various ways. In agreement with the geophysical data and the paleodynamic recostructions taken in the literature we considers that the Rhone-Simplon-Centovalli line are the surface feature of the major collision between the Adriatique and the European plate at depth. The uplift speeds we calculated in this study for this Alpine area give an average value of 0.8 mm/a, which is in good agreement with the data suggested by the literature on this zone. TheVigezzo Valley and Centovalli zone can therefore be regarded as a geological crossroad where various tectonic phases are superimposed. They represent the evidences of a major and deeper suture between two plates in a continental collision context.

Financial convergence in transition economies: EU enlargement

This paper analyses the financial impact of the enlargement of the European Union (EU) to include 10 new Central and Eastern European Nations (CEEN) on firms’ business and financial structures. To this end, we employ quantitative analytic techniques and financial ratios. In this context, we hope to discover whether firms in the new EU member States tend to converge with business in the Europe of the 15 in terms of the structure of firms’ financial statements. We examine the extent to which the increasing integration of the former may foster the convergence of productive structures. The methodology followed consists of an analysis of the evolution of 12 financial ratios in a sample of firms obtained from the AMADEUS data base. To that end, we perform a Dynamic Factor Analysis that identifies the determining factors of the joint evolution of deviations in the financial ratios with respect to the average value of firms in the EU-15. This analysis allows us to analyse the convergence in each of the CEEN nations with respect to the EU-15.