Thrombin-Receptor Antagonist Vorapaxar in Acute Coronary Syndromes

BACKGROUND Vorapaxar is a new oral protease-activated receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. METHODS In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5010 vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P=0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95% CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were similar in the two groups. CONCLUSIONS In patients with acute coronary syndromes, the addition of vorapaxar to standard therapy did not significantly reduce the primary composite end point but significantly increased the risk of major bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.)

Neural mobilization reverses behavioral and cellular changes that characterize neuropathic pain in rats

Background: The neural mobilization technique is a noninvasive method that has proved clinically effective in reducing pain sensitivity and consequently in improving quality of life after neuropathic pain. The present study examined the effects of neural mobilization (NM) on pain sensitivity induced by chronic constriction injury (CCI) in rats. The CCI was performed on adult male rats, submitted thereafter to 10 sessions of NM, each other day, starting 14 days after the CCI injury. Over the treatment period, animals were evaluated for nociception using behavioral tests, such as tests for allodynia and thermal and mechanical hyperalgesia. At the end of the sessions, the dorsal root ganglion (DRG) and spinal cord were analyzed using immunohistochemistry and Western blot assays for neural growth factor (NGF) and glial fibrillary acidic protein (GFAP). Results: The NM treatment induced an early reduction (from the second session) of the hyperalgesia and allodynia in CCI-injured rats, which persisted until the end of the treatment. On the other hand, only after the 4th session we observed a blockade of thermal sensitivity. Regarding cellular changes, we observed a decrease of GFAP and NGF expression after NM in the ipsilateral DRG (68% and 111%, respectively) and the decrease of only GFAP expression after NM in the lumbar spinal cord (L3-L6) (108%). Conclusions: These data provide evidence that NM treatment reverses pain symptoms in CCI-injured rats and suggest the involvement of glial cells and NGF in such an effect.

Miniversal deformations of matrices of bilinear forms

Arnold [V.I. Arnold, On matrices depending on parameters, Russian Math. Surveys 26 (2) (1971) 29-43] constructed miniversal deformations of square complex matrices under similarity; that is, a simple normal form to which not only a given square matrix A but all matrices B close to it can be reduced by similarity transformations that smoothly depend on the entries of B. We construct miniversal deformations of matrices under congruence. (C) 2011 Elsevier Inc. All rights reserved.

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.

Low-level laser therapy in collagenase-induced Achilles tendinitis in rats: Analyses of biochemical and biomechanical aspects

NSAIDs are widely prescribed and used over the years to treat tendon injuries despite its well-known long-term side effects. In the last years several animal and human trials have shown that low-level laser therapy (LLLT) presents modulatory effects on inflammatory markers, however the mechanisms involved are not fully understood. The aim of this study was to evaluate the short-term effects of LLLT or sodium diclofenac treatments on biochemical markers and biomechanical properties of inflamed Achilles tendons. Wistar rats Achilles tendons (n?=?6/group) were injected with saline (control) or collagenase at peritendinous area of Achilles tendons. After 1?h animals were treated with two different doses of LLLT (810?nm, 1 and 3?J) at the sites of the injections, or with intramuscular sodium diclofenac. Regarding biochemical analyses, LLLT significantly decreased (p?<?0.05) COX-2, TNF-a, MMP-3, MMP-9, and MMP-13 gene expression, as well as prostaglandin E2 (PGE2) production when compared to collagenase group. Interestingly, diclofenac treatment only decreased PGE2 levels. Biomechanical properties were preserved in the laser-treated groups when compared to collagenase and diclofenac groups. We conclude that LLLT was able to reduce tendon inflammation and to preserve tendon resistance and elasticity. (c) 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:19451951, 2012

Fog- and cloud-induced aerosol modification observed by the Aerosol Robotic Network (AERONET)

Large fine mode-dominated aerosols (submicron radius) in size distributions retrieved from the Aerosol Robotic Network (AERONET) have been observed after fog or low-altitude cloud dissipation events. These column-integrated size distributions have been obtained at several sites in many regions of the world, typically after evaporation of low-altitude cloud such as stratocumulus or fog. Retrievals with cloud-processed aerosol are sometimes bimodal in the accumulation mode with the larger-size mode often similar to 0.4-0.5 mu m radius (volume distribution); the smaller mode, typically similar to 0.12 to similar to 0.20 mu m, may be interstitial aerosol that were not modified by incorporation in droplets and/or aerosol that are less hygroscopic in nature. Bimodal accumulation mode size distributions have often been observed from in situ measurements of aerosols that have interacted with clouds, and AERONET size distribution retrievals made after dissipation of cloud or fog are in good agreement with particle sizes measured by in situ techniques for cloud-processed aerosols. Aerosols of this type and large size range (in lower concentrations) may also be formed by cloud processing in partly cloudy conditions and may contribute to the "shoulder" of larger-size particles in the accumulation mode retrievals, especially in regions where sulfate and other soluble aerosol are a significant component of the total aerosol composition. Observed trends of increasing aerosol optical depth (AOD) as fine mode radius increased suggests higher AOD in the near-cloud environment and higher overall AOD than typically obtained from remote sensing owing to bias toward sampling at low cloud fraction.

Whither lung EIT: Where are we, where do we want to go and what do we need to get there?

Breathing moves volumes of electrically insulating air into and out of the lungs, producing conductivity changes which can be seen by electrical impedance tomography (EIT). It has thus been apparent, since the early days of EIT research, that imaging of ventilation could become a key clinical application of EIT. In this paper, we review the current state and future prospects for lung EIT, by a synthesis of the presentations of the authors at the 'special lung sessions' of the annual biomedical EIT conferences in 2009-2011. We argue that lung EIT research has arrived at an important transition. It is now clear that valid and reproducible physiological information is available from EIT lung images. We must now ask the question: How can these data be used to help improve patient outcomes? To answer this question, we develop a classification of possible clinical scenarios in which EIT could play an important role, and we identify clinical and experimental research programmes and engineering developments required to turn EIT into a clinically useful tool for lung monitoring.

ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making

Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.

Self-similarities of periodic structures for a discrete model of a two-gene system

We report self-similar properties of periodic structures remarkably organized in the two-parameter space for a two-gene system, described by two-dimensional symmetric map. The map consists of difference equations derived from the chemical reactions for gene expression and regulation. We characterize the system by using Lyapunov exponents and isoperiodic diagrams identifying periodic windows, denominated Arnold tongues and shrimp-shaped structures. Period-adding sequences are observed for both periodic windows. We also identify Fibonacci-type series and Golden ratio for Arnold tongues, and period multiple-of-three windows for shrimps. (C) 2012 Elsevier B.V. All rights reserved.

Metabolic engineering of beta-oxidation in Penicillium chrysogenum for improved semi-synthetic cephalosporin biosynthesis

Industrial production of semi-synthetic cephalosporins by Penicillium chrysogenum requires supplementation of the growth media with the side-chain precursor adipic acid. In glucose-limited chemostat cultures of P. chrysogenum, up to 88% of the consumed adipic acid was not recovered in cephalosporinrelated products, but used as an additional carbon and energy source for growth. This low efficiency of side-chain precursor incorporation provides an economic incentive for studying and engineering the metabolism of adipic acid in P. cluysogenum. Chemostat-based transcriptome analysis in the presence and absence of adipic acid confirmed that adipic acid metabolism in this fungus occurs via beta-oxidation. A set of 52 adipate-responsive genes included six putative genes for acyl-CoA oxidases and dehydrogenases, enzymes responsible for the first step of beta-oxidation. Subcellular localization of the differentially expressed acyl-CoA oxidases and dehydrogenases revealed that the oxidases were exclusively targeted to peroxisomes, while the dehydrogenases were found either in peroxisomes or in mitochondria. Deletion of the genes encoding the peroxisomal acyl-CoA oxidase Pc20g01800 and the mitochondrial acyl-CoA dehydrogenase Pc20g07920 resulted in a 1.6- and 3.7-fold increase in the production of the semi-synthetic cephalosporin intermediate adipoyl-6-APA, respectively. The deletion strains also showed reduced adipate consumption compared to the reference strain, indicating that engineering of the first step of beta-oxidation successfully redirected a larger fraction of adipic acid towards cephalosporin biosynthesis. (C) 2012 Elsevier Inc. All rights reserved.

Database of diazotrophs in global ocean: abundances, biomass and nitrogen fixation rates

[EN] Marine N2 fixing microorganisms, termed diazotrophs, are a key functional group in marine pelagic ecosystems. The biological fixation of dinitrogen (N2) to bioavailable nitrogen provides an important new source of nitrogen for pelagic marine ecosystems 5 and influences primary productivity and organic matter export to the deep ocean. As one of a series of efforts to collect biomass and rates specific to different phytoplankton functional groups, we have constructed a database on diazotrophic organisms in the global pelagic upper ocean by compiling about 12 000 direct field measurements of cyanobacterial diazotroph abundances (based on microscopic cell counts or qPCR 10 assays targeting the nifH genes) and N2 fixation rates. Biomass conversion factors are estimated based on cell sizes to convert  abundance data to diazotrophic biomass. The database is limited spatially, lacking large regions of the ocean especially in the Indian Ocean. The data are approximately log-normal distributed, and large variances exist in most sub-databases with non-zero values differing 5 to 8 orders of magnitude. 15 Lower mean N2 fixation rate was found in the North Atlantic Ocean than the Pacific Ocean. Reporting the geometric mean and the range of one geometric standard error below and above the geometric mean, the pelagic N2 fixation rate in the global ocean is estimated to be 62 (53–73) TgNyr−1 and the pelagic diazotrophic biomass in the global ocean is estimated to be 4.7 (2.3–9.6) TgC from cell counts and to 89 (40–20 200) TgC from nifH-based abundances. Uncertainties related to biomass conversion factors can change the estimate of geometric mean pelagic diazotrophic biomass in the global ocean by about ±70 %. This evolving database can be used to study spatial and temporal distributions and variations of marine N2 fixation, to validate geochemical estimates and to parameterize and validate biogeochemical models. The database is 25 stored in PANGAEA (http://doi.pangaea.de/10.1594/PANGAEA.774851).

Aufstieg und Fall eines Gebirges - Konvektionsmodelle zur variscischen Orogenese

Zusammenfassung der Dissertation von Gerd Jochen ArnoldThema: Aufstieg und Fall eines Gebirges - Konvektionsmodelle zur variscischen Orogenese Diese Arbeit befaßt sich mit der Entwicklung der variscischen Gebirgswurzel. Numerische Modellierung wurden mit dem Finite-Differenzen-Programm FDCON durchgeführt. Dieses berechnet auf einem Gitter die Entwicklung von Konvektion unter Berücksichtigung von Massen-, Impuls- und Energieerhaltung. Der Modellansatz eignet sich für die Untersuchung der Orogenese unter Miteinbeziehung der thermo-mechanischen Wechselwirkung von Kruste und Mantel. Kapitel 1 beschreibt wesentliche Aspekte der variscischen Gebirgsbildung. Die tektonostratigraphische Gliederung erlaubt Rückschlüsse auf das plattentektonische Szenarium während der Gebirgsbildung. Die Kollision involvierte einige Terranes, die sukzessive an Laurasia angebaut wurden und die finale Konvergenz von Gondwana mit den konsolidierten Einheiten. Diese bewirkte den maximalen Aufbau der Varisciden, der durch Hochdruck-Gesteine dokumentiert ist. Diese wurden kurz nach maximaler Krustenverdickung innerhalb weniger Millionen Jahre in geringe Tiefen angehoben. Darauf folgte eine Aufheizung der Kruste, die durch Granite dokumentiert ist. Eine zentrale Frage der Variscidenforschung ist die Ursache für die erhöhten Temperaturen in der späten orogenen Phase. Geringe und gleichförmige Krustenmächtigkeiten unter den heutigen europäischen Varisciden legen die Vermutung nahe, daß sich Teile der Mantelwurzel des Gebirges abgelöst und abgesunken sind.Kapitel 2 beschreibt physikalische Aspekte von gebirgsbildenden Prozessen, insbesondere den thermischen Zustand kontinentaler Lithosphäre und die Folgen von Krustenkonvergenz. Der Einfluß von kompositioneller Schichtung und extrinsischen Parametern auf die Rheologie und das Wechselspiel zwischen auf- und abwärts gerichteten Kräften in verschiedenen orogenen Szenarien werden diskutiert.Kapitel 3 stellt die Modelle zur variscischen Gebirgsbildung vor. Ausgehend von Kontinent-Kontinent-Kollision werden Konsequenzen von rheologischer Schichtung und tiefreichenden Schwächezonen auf das Deformationsverhalten der Kruste untersucht. Außerdem wird ein Modell zum Abriß von Mantellithosphäre während Kollision vorgestellt. Abschließend werden die thermischen Konsequenzen von Subduktion junger ozeanischer Lithosphäre diskutiert.Kapitel 4 versucht eine Synthese der Kollisionsmodelle mit Modellen zur spätorogenen variscischen Entwicklung. Die mechanischen Eigenschaften der Delaminationsmodelle sollten während der Aufbauphase des Orogens angelegt worden sein. Außerdem wird eine Fallstudie vorgestellt, bei der die Modellparameter auf die Entwicklungsgeschichte erzgebirgischer Einheiten angepaßt worden sind. Schließlich werden Modelle zur thermischen Entwicklung nach Aufstieg von Asthenosphäre an die Krustenwurzel diskutiert. Die vulkanische Aktivität während der spätorogenen variscischen Phase kann plausibel erklärt werden.Kapitel 5 faßt die Ergebnisse zusammen und interpretiert diese bezüglich des plattentektonischen Szenariums der variscischen Orogenese. Durch die sukzessive Anlegung der Suturzonen während der Konsolidierung der Terranes sind die für Delamination nötigen Schwächezonen sukzessive ins variscische Orogen eingebaut worden.

Computer simulations of charged systems in partially periodic geometries

This work presents algorithms for the calculation of the electrostatic interaction in partially periodic systems. The framework for these algorithms is provided by the simulation package ESPResSo, of which the author was one of the main developers. The prominent features of the program are listed and the internal structure is described. In the following, algorithms for the calculation of the Coulomb sum in three dimensionally periodic systems are described. These methods are the foundations for the algorithms for partially periodic systems presented in this work. Starting from the MMM2D method for systems with one non-periodic coordinate, the ELC method for these systems is developed. This method consists of a correction term which allows to use methods for three dimensional periodicity also for the case of two periodic coordinates. The computation time of this correction term is neglible for large numbers of particles. The performance of MMM2D and ELC are demonstrated by results from the implementations contained in ESPResSo. It is also discussed, how different dielectric constants inside and outside of the simulation box can be realized. For systems with one periodic coordinate, the MMM1D method is derived from the MMM2D method. This method is applied to the problem of the attraction of like-charged rods in the presence of counterions, and results of the strong coupling theory for the equilibrium distance of the rods at infinite counterion-coupling are checked against results from computer simulations. The degree of agreement between the simulations at finite coupling and the theory can be characterized by a single parameter gamma_RB. In the special case of T=0, one finds under certain circumstances flat configurations, in which all charges are located in the rod-rod plane. The energetically optimal configuration and its stability are determined analytically, which depends on only one parameter gamma_z, similar to gamma_RB. These findings are in good agreement with results from computer simulations.

Cut-first branch-and-price-second for the capacitated arc-routing problem

This paper presents the first full-fledged branch-and-price (bap) algorithm for the capacitated arc-routing problem (CARP). Prior exact solution techniques either rely on cutting planes or the transformation of the CARP into a node-routing problem. The drawbacks are either models with inherent symmetry, dense underlying networks, or a formulation where edge flows in a potential solution do not allow the reconstruction of unique CARP tours. The proposed algorithm circumvents all these drawbacks by taking the beneficial ingredients from existing CARP methods and combining them in a new way. The first step is the solution of the one-index formulation of the CARP in order to produce strong cuts and an excellent lower bound. It is known that this bound is typically stronger than relaxations of a pure set-partitioning CARP model.rnSuch a set-partitioning master program results from a Dantzig-Wolfe decomposition. In the second phase, the master program is initialized with the strong cuts, CARP tours are iteratively generated by a pricing procedure, and branching is required to produce integer solutions. This is a cut-first bap-second algorithm and its main function is, in fact, the splitting of edge flows into unique CARP tours.

From carbazole-containing and pi-expanded triangular trinuclear porphyrinoids

Zusammenfassung:rnDie vorliegende Arbeit beschreibt das Design und die Synthese neuartiger Porphyrinoide anhand der Modifikation und der π-Systemausdehnung an der Peripherie des Porphyrin-Gerüsts. Die Darstellung künstlicher Porphyrine ist von Interesse, da neue physiko-chemischen Eigenschaften erhalten und untersucht werden können. Die in dieser Arbeit vorgestellten Porphyrinoide wurden mit Hilfe von modernen Synthesemethoden wie den metallkatalysierten Kreuzkupplungen und somit durch Aryl-Aryl Verknüpfungen aufgebaut.rnDer erste Teil dieser Arbeit befasst sich mit der Modifikation des Porphyrin-Gerüsts. Porphyrine bestehen aus jeweils zwei Pyrrol- und Pyrrolenin-Einheiten, welche systematisch ausgetauscht wurden. Die Pyrrol-Einheiten wurden durch Carbazol ersetzt, das sich formal vom Pyrrol durch Anfügen von zwei Benzogruppen ableitet und deshalb besonders gut geeignet ist. Die Pyrrolenin-Einheiten wurden aus folgenden Gründen durch andere Heterozyklen wie Pyridin, Pyrrol oder Triazol ersetzt: rn* Nachbildung des stabilen Porphyrin trans-NH-Tautomers (Carbazol und Pyridin)rn* Nachbildung von (NH)4-Liganden wie Calix[4]pyrrol (Carbazol und Pyrrol)rn* Vereinigung von N-H und C-H Wasserstoffbrücken-Donor-Einheiten in einem Makrozyklus (Carbazol und Triazol)rnDie Synthese eines drei-Zentren Porphyrinoids mit ausgedehntem π-System wird im zweiten Teil der vorliegenden Arbeit beschrieben. Dieses Thema basiert auf der aktuellen Entwicklung von nicht-Edelmetall basierten Katalysatoren für die Reduktion von Sauerstoff. Hier werden derzeit N4 makrozyklische Metallkomplexe, die mehrere katalytisch aktive Stellen aufweisen, untersucht. In diesem Zusammenhang, hat die Gruppe von Prof. Müllen einen neuartigen drei-Zentren-Komplex entwickelt. Ausgehend von diesen Erkenntnissen, dient diese Arbeit zur Verbesserung der katalytischen Aktivität des drei-Zentren-Komplex durch die Variation von verschieden Substituenten. Hierbei wurden zwei wesentliche Konzepte verfolgt:rn* Vernetzung durch die Bildung von Netzwerken oder durch Pyrolyse in der Mesophasern* Verbesserung des Katalysator-Trägermaterial-KontaktsrnNeben den Synthesen wurden die Eigenschaften und möglichen Anwendungen dieser neuartigen Materialen untersucht, wie z.B. als Liganden für Übergangsmetalle, als Anionenrezeptoren oder als Elektrokatalysatoren für die Reduktion von Sauerstoff. rn