Kinematics of oblique collision and ramping inferred from microstructures and strain in middle crustal rocks, central Southern Alps, New Zealand

The hanging wall of the Alpine Fault near Franz Josef Glacier has been exhumed during the past similar to2-3 m.y. providing a sample of the ductilely deformed middle crust of a modem obliquely convergent orogen. Presently exposed rocks of the Pacific Plate are inferred to have undergone several phases of ductile deformation as they moved westward above a mid-crustal detachment. Initially they were transpressed across the outboard part of the orogen, resulting in oblate fabrics with a down-dip stretch. Later, they encountered the Alpine Fault, experiencing an oblique-slip backshearing on vertical planes. This escalator-like deformation tilted and thinned the incoming crust onto that crustal-scale oblique ramp. This style of hanging wall deformation may affect only the most rapidly uplifting, central part of the Southern Alps because of the low flexural rigidity of the crust in that region and its displacement over a relatively sharp ramp-angle at depth. A 3D transpressive flow affected mylonites locally near the fault, but their shear direction remained parallel to plate motion, ruling out ductile 'extrusion' as an important process in this orogen. Outside the mylonite zone, late Cenozoic shortening is inferred to be modest (30-40%), as measured from deformation of younger biotite grains. Oblique collision is dominated by translation on the Alpine Fault, and rocks migrate rapidly through the deforming zone, preventing the accumulation of large finite strains. Transpression may play a minor role in oblique collision. (C) 2001 Elsevier Science Ltd. All rights reserved.

Appropriateness of therapy for active Crohn's disease: results of a multidisciplinary International Expert Panel (EPACT II)

Introduction: The development of novel therapies and the increasing number of trials testing management strategies for luminal Crohn's disease (CD) have not filled all the gaps in our knowledge. Thus, in clinical practice, many decisions for CD patients need to be taken without high quality evidence. For this reason, a multidisciplinary European expert panel followed the RAND method to develop explicit criteria for the management of individual patients with active, steroid-dependent (ST-D) and steroid-refractory (ST-R) CD. Methods: Twelve international experts convened in Geneva, Switzerland in December 2007, to rate explicit clinical scenarios, corresponding to real daily practice, on a 9-point scale according to the literature evidence and their own expertise. Median ratings were stratified into three categories: appropriate (7-9), uncertain (4-6) and inappropriate (1-3). Results: Overall, panelists rated 296 indications pertaining to mild-to-moderate, severe, ST-D, and ST-R CD. In anti-TNF naïve patients, budesonide and prednisone were found appropriate for mildmoderate CD, and infliximab (IFX) when those had previously failed or had not been tolerated. In patients with prior success with IFX, this drug with or without co-administration of a thiopurine analog was favored. Other anti-TNFs were appropriate in case of intolerance or resistance to IFX. High doses steroids, IFX or adalimumab were appropriate in severe active CD. Among 105 indications for ST-D or ST-R disease, the panel considered appropriate the thiopurine analogs, methotrexate, IFX, adalimumab and surgery for limited resection, depending on the outcome of prior therapies. Anti-TNFs were generally considered appropriate in ST-R. Conclusion: Steroids, including budesonide for mild-to-moderate CD, remain first-line therapies in active luminal CD. Anti-TNFs, in particular IFX with respect to the amount of available evidence, remain second-line for most indications. Thiopurine analogs are preferred to anti-TNFs when steroids are not appropriate, except when anti-TNFs were previously successful. These recommendations are available online (www.epact.ch). A prospective evaluation of these criteria in a large database in Switzerland in underway to validate these criteria.

Appropriateness of therapy for active Crohn's disease: results of a multidisciplinary international expert panel-EPACT II

The increasing number of trials testing management strategies for luminal Crohn's disease (CD) has not fitted all the gaps in our knowledge and thus, in clinical. practice, many decisions for CD patients have to be taken without the benefit of high-quality evidence. Methods: A multidisciplinary European expert panel used the RAND Appropriateness Method to develop and rate explicit criteria for the management of individual patients with active, steroid-dependent (ST-D) and steroid-refractory (ST-R) CD. Results: Overall., 296 indications pertaining to mild-to-moderate, severe, ST-D, and ST-R CD were rated. In anti-TNF naive patients, budesonide and prednisone were found to be appropriate for mild-moderate CD, and infliximab (IFX) was appropriate when these had previously failed or had not been tolerated. In patients with a prior successful treatment by IFX, this drug, with or without co-administration of a thiopurine analog, was favoured. Other anti-TNFs were appropriate in the presence of intolerance or resistance to IFX. High-dose steroids, IFX or adlimumab were appropriate in severe active CD. For the 105 indications for ST-D or ST-R disease, the panel considered the thiopurine analogs, methotrexate, IFX, adalimumab, and surgery for limited resection, to be appropriate, depending on the outcome of prior therapies. Anti-TNFs were generally considered appropriate in ST-R. Conclusion: Steroids, including budesonide for mild-to-moderate CD, remain the first-line therapy for active luminal CD. Anti-TNFs, in particular IFX as shown by the amount of available evidence, remain the second-line therapy for most indications. Thiopurine analogs, methotrexate and anti-TNFs are favoured in ST-D patients and ST-R patients. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Siderurgia e carvoejamento na Amazônia: drenagem energético-material e pauperização regional

O trabalho analisa a implantação, no último quartel do século XX, na Amazônia oriental brasileira, de indústria voltada à produção de ferro-gusa destinado ao mercado internacional de insumos siderúrgicos. Demonstra que, nos anos 1980, o discurso estatal anunciou as plantas industriais deste segmento como elemento estratégico de modernização econômica da região. Tal postura justificou a concessão de benefícios fiscais, creditícios e de infraestrutura a 22 empresas de siderurgia e metalurgia. No âmbito da dimensão ambiental, o estudo demonstra que a produção de ferro-gusa recorre a processos marcados por baixa eficiência energética e que deles resultou o acesso, sem prudência ecológica, a estoque de biomassa da floresta amazônica, com ampliação da pressão antrópica sobre ela. O estudo evidencia que o plantio de grandes áreas de floresta para produzir carvão vegetal não se concretizou, manteve-se tão-somente como retórica desprovida de base realista. Quanto à dimensão econômica, o estudo indica que as limitações de a indústria de ferro-gusa impulsionar processos de modernização vinculam-se, dentre outros aspectos, ao fato de ela ter na demanda de carvão vegetal o principal elo de articulação com a sociedade e com a economia da região. Tal demanda é suprida por centenas de fornecedores e, por meio dela, a indústria controla a margem de lucro e comprime os custos de produção transferindo custos privados para a sociedade. O estudo demonstra, ainda, que o padrão de atuação deste segmento empresarial vincula-se a condicionamentos econômicos e institucionais: a implantação de florestas energéticas exige investimentos de longo prazo, somados às grandes oscilações no preço do ferro-gusa e a dinâmicas institucionais que abrem possibilidade de se acessar, ilegalmente, biomassa de florestas primárias. Isso levou o segmento a recorrer, historicamente, ao suprimento de carvão vegetal produzido, sobretudo, a partir da biomassa de florestas primárias e não da silvicultura. Com base em tais evidências, o trabalho conclui que a predição estatal de impulso regional modernizante não se materializou. A causa principal foi a inexistência de competências sociais para regular a transformação de matéria e energia em mercadorias, e esta produção teve seus fundamentos marcados pela degradação social e ambiental. Assim, atuou em sentido contrário ao discurso estatal: acelerou a transferência energética, material e de valores para outras regiões. Drenagem energético-material que não foi compensada, nem pela capacidade de a região equilibrar as perdas com importações de produtos, nem pela implementação de dinâmicas eficazes para a industrialização da região.

Autobiografia e Ficção: análise do narrador em Extinção - Uma Derrocada, de Thomas Bernhard

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Dotierte Nanographenstreifen mit definierten Randstrukturen

Die in der vorliegenden Dissertation entwickelten organochemischen Protokolle und Konzepte erweitern die Bottom-Up-Synthese von atompräzisen Nanographenstreifen (GNR) um zwei fundamentale Bereiche. Zum einen die Dotierung der halbleitenden GNR mit Schwefel oder Stickstoffatomen und zum anderen ein Protokoll für eine lösungsbasierte Synthese von stickstoffdotierten Zickzack-Streifen.rnDie Dotierung von GNR beinhaltet die Synthese von monomeren Bausteinen bei denen, im Gegensatz zu ihren reinen Kohlenstoffhomologen, definierte Positionen am Rand mit zwei oder vier Stickstoff- beziehungsweise zwei Schwefelatomen ersetzt wurden. Die Synthese atompräziser GNR konnte mit verschiedenen experimentellen Methoden analysiert und anschaulich über STM visualisiert werden. Neben einer n-Dotierung gelang so auch erstmals eine Bottom-Up-Synthese von schwefeldotierten GNR. Eine mögliche Anwendung in der Nanoelektronik aufbauend auf dotierten GNR wurde bestätigt, indem durch Co-Polymerisation von stickstoffhaltigen mit reinen Kohlenstoffmonomeren Heteroschnittstellen zwischen dotierten und undotierten Bereichen hergestellt werden konnten. Solche Heteroschnittstellen sind fundamentale Grundlage von Dioden und damit Basis einer Vielzahl elektronischer Elemente wie Solarzellen oder Leuchtdioden.rnWährend für halbleitende GNR mit einer Armlehnen-Form ein breites Spektrum an organischen Syntheseprotokollen zur Verfügung stand, existierte zu Beginn dieser Arbeit keines für GNR mit Zickzack-Struktur. Innerhalb dieser Arbeit konnte eine Bottom-Up-Synthese zur Erschließung stickstoffdotierter GNR mit Zickzack-Randstruktur erarbeitet werden. Durch die Verwendung eines (2-Hydroxymethyl)phenylboronsäureesters werden Hydroxymethylsubsituenten entlang eines Polyphenylenrückgrats eingebaut, die nach Kondensation mit dem Stickstoffatom eine Zickzack-Kante ergeben. Innerhalb der synthetisierten Zielstrukturen kann das 9a-Azaphenalen als letztes, bislang nicht erschlossenes Isomer der Azaphenalene, als wiederkehrende Struktur, gefunden werden. Die Reaktivität der Zickzackkante konnte zudem zum Aufbau einer Vielzahl bislang unzugänglicher, polycyclischer Heteroaromaten über 1,3-dipolare Addition dieses polycyclischen Azomethin Ylides (PAMY) genutzt werden.rn

Microsurgical management of large intra-and extracranial calvarial meningiomas

Objective: Based on the largest series reported of giant intra- and extracranial calvarial meningiomas (GIECM) the purpose of the present study was to characterize the treatment and outcome data associated with patients operated on GIECM and to describe our experience in the management of this rare and therapeutically demanding tumour entity. Methods: The data of 12 patients (7/12 males, 5/12 females) with surgically treated GIECM at the University Hospitals Aachen and Bern between 1994 and 2011 were retrospectively analyzed. The mean patient age was 58 years (range, 22 to 78 years). Symptom distribution included extracranial swelling (12/12), seizures (5/12), headache (4/12), gait disturbance (3/12), dizziness (2/12), and impaired vision (1/12). GIECM were located frontal (6/12), temporal (3/12), parietal, fronto-parietal, and parieto-occipital (1/12 each). Microsurgical resection with acrylic-augmented cranioplasty was performed in all patients and 11/12 patients received dural repair with synthetic (7/11) or autologous (4/11) patch grafts. Surgical excision in two stages with primary removal of the extracranial meningioma component was undertaken in 2/12 patients, whereas preoperative embolization and postoperative radiotherapy were applied in 1/12 patient each. Results: In contrast to intradural meningiomas GIECM mainly affect male patients at a comparatively younger age. GIECM could be completely (9/12) or subtotally (3/12) resected. Surgical-associated complications included minor CSF leak (6/12), wound healing disturbance (3/12), venous engorgement, and haemorrhage (2/12 each), requiring reoperation in 3/12 cases. Histopathological examination revealed meningothelial (6/12), atypical (4/12), and transitional (1/12) GIECM. 10/12 patients exhibited excellent postoperative clinical outcome, 1/12 patient each deteriorated or died of pulmonary embolism. Conclusions: The operative management of GIECM is challenging, carries a substantial risk, and demands special strategies because of the large tumour size, anatomical involvement of scalp, calvaria, meninges, brain or vascular structures, and more frequent atypical histology. Although microsurgical resection with cranioplasty and mostly dural grafting usually results in a good clinical outcome, the potential complication rate is markedly higher when compared to smaller meningiomas without extracranial component. Preoperative embolization and staging of surgical resection are possible additional therapeutic options.

Experience with a gravitational valve in the management of symptomatic overdrainage in children with shunts

Symptomatic overdrainage in children with shunt-treated hydrocephalus represents one of the more difficult shunt-related diseases and may require repeated surgery. Gravity-assisted valve design has become a standard device to avoid overdrainage in many European pediatric hydrocephalus centers. However, the use of a gravitational valve for relieving symptoms associated with overdrainage has not yet been addressed. The goal of this study was to evaluate the effectiveness of a gravitational valve in the treatment of symptomatic overdrainage in children with shunts.

Stent placement versus balloon angioplasty for the treatment of obstructive lesions of the popliteal artery: a prospective, multicenter, randomized trial

Stenting has been shown to improve patency after femoral artery revascularization compared with balloon angioplasty. Limited data are available evaluating endovascular treatment for obstructive lesions of the popliteal artery.

Bivalirudin versus unfractionated heparin during percutaneous coronary intervention

BACKGROUND: Whether bivalirudin is superior to unfractionated heparin in patients with stable or unstable angina who undergo percutaneous coronary intervention (PCI) after pretreatment with clopidogrel is unknown. METHODS: We enrolled 4570 patients with stable or unstable angina (with normal levels of troponin T and creatine kinase MB) who were undergoing PCI after pretreatment with a 600-mg dose of clopidogrel at least 2 hours before the procedure; 2289 patients were randomly assigned in a double-blind manner to receive bivalirudin, and 2281 to receive unfractionated heparin. The primary end point was the composite of death, myocardial infarction, urgent target-vessel revascularization due to myocardial ischemia within 30 days after randomization, or major bleeding during the index hospitalization (with a net clinical benefit defined as a reduction in the incidence of the end point). The secondary end point was the composite of death, myocardial infarction, or urgent target-vessel revascularization. RESULTS: The incidence of the primary end point was 8.3% (190 patients) in the bivalirudin group as compared with 8.7% (199 patients) in the unfractionated-heparin group (relative risk, 0.94; 95% confidence interval [CI], 0.77 to 1.15; P=0.57). The secondary end point occurred in 134 patients (5.9%) in the bivalirudin group and 115 patients (5.0%) in the unfractionated-heparin group (relative risk, 1.16; 95% CI, 0.91 to 1.49; P=0.23). The incidence of major bleeding was 3.1% (70 patients) in the bivalirudin group and 4.6% (104 patients) in the unfractionated-heparin group (relative risk, 0.66; 95% CI, 0.49 to 0.90; P=0.008). CONCLUSIONS: In patients with stable and unstable angina who underwent PCI after pretreatment with clopidogrel, bivalirudin did not provide a net clinical benefit (i.e., it did not reduce the incidence of the composite end point of death, myocardial infarction, urgent target-vessel revascularization, or major bleeding) as compared with unfractionated heparin, but it did significantly reduce the incidence of major bleeding. (ClinicalTrials.gov number, NCT00262054.)

Sirolimus-eluting stent treatment at high-volume centers confers lower mortality at 6-month follow-up: results from the prospective multicenter German Cypher Registry

BACKGROUND: Studies continue to identify percutaneous coronary intervention procedural volume both at the institutional level and at the operator level as being strongly correlated with outcome. High-volume centers have been defined as those that perform >400 percutaneous coronary intervention procedures per year. The relationship between drug-eluting stent procedural volume and outcome is unknown. We investigated this relationship in the German Cypher Registry. METHODS AND RESULTS: The present analysis included 8201 patients treated with sirolimus-eluting stents between April 2002 and September 2005 in 51 centers. Centers that recruited >400 sirolimus-eluting stent patients in this time period were considered high-volume centers; those with 150 to 400 patients were considered intermediate-volume centers; and those with <150 patients were designated as low-volume centers. The primary end point was all death, myocardial infarction, and target-vessel revascularization at 6 months. This end point occurred in 11.3%, 12.1%, and 9.0% of patients in the low-, intermediate-, and high-volume center groups, respectively (P=0.0001). There was no difference between groups in the rate of target-vessel revascularization (P=0.2) or cerebrovascular accidents (P=0.5). The difference in death/myocardial infarction remained significant after adjustment for baseline factors (odds ratio 1.85, 95% confidence interval 1.31 to 2.59, P<0.001 for low-volume centers; odds ratio 1.69, 95% confidence interval 1.29 to 2.21, P<0.001 for intermediate-volume centers). Patient and lesion selection, procedural features, and postprocedural medications differed significantly between groups. CONCLUSIONS: The volume of sirolimus-eluting stent procedures performed on an institutional level was inversely related to death and myocardial infarction but not to target-vessel revascularization at 6-month follow-up. Safety issues are better considered in high-volume centers. These findings have important public health policy implications.