Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer

Patients with upper aerodigestive tract (UAT) cancers often suffer from malnutrition and compromised functional ability. We compared clinical outcome with percutaneous endoscopic gastrostomy (PEG) tube feeding begun at two different time points. The records of 151 patients with UAT carcinomas were reviewed retrospectively. We included patients undergoing radical radiochemotherapy and PEG tube feeding. Subjects were evaluated before PEG insertion and at the end of the treatment. Patients (n=15, 100%) were divided into two groups according to the presence (group A) or absence (group B) of mucositis. Group A (51.7% of patients) received early PEG: before or within 2 wk of radiotherapy. Group B (48.3%) received delayed PEG: between 2 wk and 3 mo after the start of radiotherapy. Mean weight loss was 1.03 kg in group A vs. 4.0 kg in group B, P=0.004. Treatment interruptions were significantly (P=0.01) more common in group B. Early PEG placement at the beginning of radiochemotherapy in patients with UAT tumors maintains the patient's nutritional state and reduces treatment interruptions.

Antibiotic resistance and genetic diversity in Staphylococcus aureus from slaughter pigs in Switzerland

Nasal carriage of Staphylococcus aureus was evaluated in pigs at slaughterhouse. The nasal cavities of 304 pigs from 54 herds were screened. Eighty-nine percent of the farms harbored pigs that were colonized with S. aureus. Among them, no MRSA were found, indicating a low prevalence. However, pigs were found to harbor S. aureus, which displayed resistance to penicillin (blaZ) (62.5%), tetracycline [tet(M)] (33.3%), streptomycin (strpS194) (27%), clindamycin [erm(B)] (4.1%), erythromycin [erm(B)] (4.1%), kanamycin (4.1%), chloramphenicol (catpC194) (2%) and gentamicin [aac(6')-Ie-aph(2')-Ia] (2%). The S. aureus isolates mainly belong to Ridom spa type t034 (31.3%), t208 (14.6%) and t899 (12.5%). These pig-associated spa types have not yet been detected in hospitalized human patients in Switzerland. Surveillance programs are now necessary at both inland and import levels to rapidly detect and suppress the emergence of MRSA in pigs in Switzerland.

Expression Analysis of the Theileria parva Subtelomere-Encoded Variable Secreted Protein Gene Family

Background The intracellular protozoan parasite Theileria parva transforms bovine lymphocytes inducing uncontrolled proliferation. Proteins released from the parasite are assumed to contribute to phenotypic changes of the host cell and parasite persistence. With 85 members, genes encoding subtelomeric variable secreted proteins (SVSPs) form the largest gene family in T. parva. The majority of SVSPs contain predicted signal peptides, suggesting secretion into the host cell cytoplasm. Methodology/Principal Findings We analysed SVSP expression in T. parva-transformed cell lines established in vitro by infection of T or B lymphocytes with cloned T. parva parasites. Microarray and quantitative real-time PCR analysis revealed mRNA expression for a wide range of SVSP genes. The pattern of mRNA expression was largely defined by the parasite genotype and not by host background or cell type, and found to be relatively stable in vitro over a period of two months. Interestingly, immunofluorescence analysis carried out on cell lines established from a cloned parasite showed that expression of a single SVSP encoded by TP03_0882 is limited to only a small percentage of parasites. Epitope-tagged TP03_0882 expressed in mammalian cells was found to translocate into the nucleus, a process that could be attributed to two different nuclear localisation signals. Conclusions Our analysis reveals a complex pattern of Theileria SVSP mRNA expression, which depends on the parasite genotype. Whereas in cell lines established from a cloned parasite transcripts can be found corresponding to a wide range of SVSP genes, only a minority of parasites appear to express a particular SVSP protein. The fact that a number of SVSPs contain functional nuclear localisation signals suggests that proteins released from the parasite could contribute to phenotypic changes of the host cell. This initial characterisation will facilitate future studies on the regulation of SVSP gene expression and the potential biological role of these enigmatic proteins.

Safety climate and its association with office type and team involvement in primary care

OBJECTIVE To assess differences in safety climate perceptions between occupational groups and types of office organization in primary care. METHODS Primary care physicians and nurses working in outpatient offices were surveyed about safety climate. Explorative factor analysis was performed to determine the factorial structure. Differences in mean climate scores between staff groups and types of office were tested. Logistic regression analysis was conducted to determine predictors for a 'favorable' safety climate. RESULTS 630 individuals returned the survey (response rate, 50%). Differences between occupational groups were observed in the means of the 'team-based error prevention'-scale (physician 4.0 vs. nurse 3.8, P < 0.001). Medical centers scored higher compared with single-handed offices and joint practices on the 'team-based error prevention'-scale (4.3 vs. 3.8 vs. 3.9, P < 0.001) but less favorable on the 'rules and risks'-scale (3.5 vs. 3.9 vs. 3.7, P < 0.001). Characteristics on the individual and office level predicted favorable 'team-based error prevention'-scores. Physicians (OR = 0.4, P = 0.01) and less experienced staff (OR 0.52, P = 0.04) were less likely to provide favorable scores. Individuals working at medical centers were more likely to provide positive scores compared with single-handed offices (OR 3.33, P = 0.001). The largest positive effect was associated with at least monthly team meetings (OR 6.2, P < 0.001) and participation in quality circles (OR 4.49, P < 0.001). CONCLUSIONS Results indicate that frequent quality circle participation and team meetings involving all team members are effective ways to strengthen safety climate in terms of team-based strategies and activities in error prevention.

Epidemiology of Brucellosis and Q Fever in Linked Human and Animal Populations in Northern Togo

BACKGROUND: Although brucellosis (Brucella spp.) and Q Fever (Coxiella burnetii) are zoonoses of global importance, very little high quality data are available from West Africa. METHODS/PRINCIPAL FINDINGS: A serosurvey was conducted in Togo's main livestock-raising zone in 2011 in 25 randomly selected villages, including 683 people, 596 cattle, 465 sheep and 221 goats. Additionally, 464 transhumant cattle from Burkina Faso were sampled in 2012. The serological analyses performed were the Rose Bengal Test and ELISA for brucellosis and ELISA and the immunofluorescence assay (IFA) for Q Fever Brucellosis did not appear to pose a major human health problem in the study zone, with only 7 seropositive participants. B. abortus was isolated from 3 bovine hygroma samples, and is likely to be the predominant circulating strain. This may explain the observed seropositivity amongst village cattle (9.2%, 95%CI:4.3-18.6%) and transhumant cattle (7.3%, 95%CI:3.5-14.7%), with an absence of seropositive small ruminants. Exposure of livestock and people to C. burnetii was common, potentially influenced by cultural factors. People of Fulani ethnicity had greater livestock contact and a significantly higher seroprevalence than other ethnic groups (Fulani: 45.5%, 95%CI:37.7-53.6%; non-Fulani: 27.1%, 95%CI:20.6-34.7%). Appropriate diagnostic test cut-off values in endemic settings requires further investigation. Both brucellosis and Q Fever appeared to impact on livestock production. Seropositive cows were more likely to have aborted a foetus during the previous year than seronegative cows, when adjusted for age. This odds was 3.8 times higher (95%CI: 1.2-12.1) for brucellosis and 6.7 times higher (95%CI: 1.3-34.8) for Q Fever. CONCLUSIONS: This is the first epidemiological study of zoonoses in Togo in linked human and animal populations, providing much needed data for West Africa. Exposure to Brucella and C. burnetii is common but further research is needed into the clinical and economic impact.

Genetic characterization of antimicrobial resistance in coagulase-negative staphylococci from bovine mastitis milk

Coagulase-negative staphylococci (CNS; n=417) were isolated from bovine milk and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Nineteen different species were identified, and Staphylococcus xylosus, Staphylococcus chromogenes, Staphylococcus haemolyticus, and Staphylococcus sciuri were the most prevalent species. Resistance to oxacillin (47.0% of the isolates), fusidic acid (33.8%), tiamulin (31.9%), penicillin (23.3%), tetracycline (15.8%), streptomycin (9.6%), erythromycin (7.0%), sulfonamides (5%), trimethoprim (4.3%), clindamycin (3.4%), kanamycin (2.4%), and gentamicin (2.4%) was detected. Resistance to oxacillin was attributed to the mecA gene in 9.7% of the oxacillin-resistant isolates. The remaining oxacillin-resistant CNS did not contain the mecC gene or mecA1 promoter mutations. The mecA gene was detected in Staphylococcus fleurettii, Staphylococcus epidermidis, Staph. haemolyticus, and Staph. xylosus. Resistance to tetracycline was attributed to the presence of tet(K) and tet(L), penicillin resistance to blaZ, streptomycin resistance to str and ant(6)-Ia, and erythromycin resistance to erm(C), erm(B), and msr. Resistance to tiamulin and fusidic acid could not be attributed to an acquired resistance gene. In total, 15.1% of the CNS isolates were multidrug resistant (i.e., resistant to 2 or more antimicrobials). The remaining CNS isolates were susceptible to antimicrobials commonly used in mastitis treatment. Methicillin-resistant CNS isolates were diverse, as determined by mecA gene sequence analysis, staphylococcal cassette chromosome mec typing, and pulsed-field gel electrophoresis. Arginine catabolic mobile element types 1 and 3 were detected in both methicillin-resistant and methicillin-susceptible Staph. epidermidis and were associated with sequence types ST59 and ST111. Because this study revealed the presence of multidrug-resistant CNS in a heterogeneous CNS population, we recommend antibiogram analysis of CNS in persistent infections before treatment with antimicrobials.

Kyzylkumite, Ti2V3+O5(OH): new structure type, modularity and revised formula

The crystal structure of kyzylkumite, ideally Ti2V3+O5(OH), from the Sludyanka complex in South Baikal, Russia was solved and refined (including the hydrogen atom position) to an agreement index, R1, of 2.34 using X-ray diffraction data collected on a twinned crystal. Kyzylkumite crystallizes in space group P21/c, with a = 8.4787(1), b = 4.5624(1), c = 10.0330(1) Å, β = 93.174(1)°, V = 387.51(1) Å3 and Z = 4. Tivanite, TiV3+O3OH, and kyzylkumite have modular structures based on hexagonal close packing of oxygen, which are made up of rutile TiO2 and montroseite V3+O(OH) slices. In tivanite the rutile:montroseite ratio is 1:1, in kyzylkumite the ratio is 2:1. The montroseite module may be replaced by the isotypic paramontroseite V4+O2 module, which produces a phase with the formula Ti2V4+O6. In the metamorphic rocks of the Sludyanka complex, vanadium can be present as V4+ and V3+ within the same mineral (e.g. in batisivite, schreyerite and berdesinskiite). Kyzylkumite has a flexible composition with respect to the M4+/M3+ ratio. The relationship between kyzylkumite and a closely related Be-bearing kyzylkumite-like mineral with an orthorhombic norbergite-type structure from Byrud mine, Norway is discussed. Both minerals have similar X-ray powder diffraction patterns.

In situ dehydration behavior of veszelyite (Cu,Zn)2Zn(PO4)(OH)3·2H2O: A single-crystal X-ray study

The rare mixed copper-zinc phosphate mineral veszelyite (Cu,Zn)2Zn(PO4)(OH)3·2H2O space group P21/c, a = 7.5096(2), b = 10.2281(2), c = 9.8258(2) Å, β = 103.3040(10)°, V = 734.45(3) Å3 was investigated by in situ temperature-dependent single-crystal X-ray structure refinements. The atomic arrangement of veszelyite consists of an alternation of octahedral and tetrahedral sheets. The Jahn-Teller distorted CuO6 octahedra form sheets with eight-membered rings. The tetrahedral sheet composed of PO4 and ZnO3(OH) tetrahedra shows strong topological similarities to that of cavansite, gismondine, and kipushite.Diffraction data of a sample from Zdravo Vrelo, near Kreševo (Bosnia and Herzegovina) have been measured in steps of 25 up to 225 °C. Hydrogen positions and the hydrogen-bond system were determined experimentally from the structure refinements of data collected up to 125 °C. At 200 °C, the hydrogen-bonding scheme was inferred from bond-valence calculations and donor-acceptor distances. The hydrogen-bond system connects the tetrahedral sheet to the octahedral sheet and also braces the Cu sheet.At 150 °C, the H2O molecule at H2O2 was released and the Cu coordination (Cu1 and Cu2) decreased from originally six- to fivefold. Cu1 has a square planar coordination by four OH groups and an elongate distance to O3, whereas Cu2 has the Jahn-Teller characteristic elongate bond to H2O1. The unit-cell volume decreased 7% from originally 734.45(3) to 686.4(4) Å3 leading to a formula with 1 H2O pfu. The new phase observed above 150 °C is characterized by an increase of the c axis and a shortening of the b axis. The bending of T-O-T angles causes an increasing elliptical shape of the eight-membered rings in the tetrahedral and octahedral sheets. Moreover a rearrangement of the hydrogen-bond system was observed.At 225 °C, the structure degrades to an X-ray amorphous residual due to release of the last H2O molecule at H2O1. The stronger Jahn-Teller distortion of Cu1 relative to Cu2 suggests that Cu1 is fully occupied by Cu, whereas Cu2 bears significant Zn. H2O1 is the fifth ligand of Cu2. Zn at Cu2 is not favorable to adopt planar fourfold coordination. Thus, if the last water molecule is expelled the structure is destabilized.This study contributes to understanding the dehydration mechanism and thermal stability of supergene minerals characterized by Jahn-Teller distorted octahedra with mixed Cu, Zn occupancy.

In situ dehydration behavior of zeolite-like cavansite: A single-crystal X-ray study

To track dehydration behavior of cavansite, Ca(VO)(Si4O10)·4H2O space group Pnma, a = 9.6329(2), b = 13.6606(2), c = 9.7949(2) Å, V = 1288.92(4) Å3 single-crystal X-ray diffraction data on a crystal from Wagholi quarry, Poona district (India) were collected up to 400 °C in steps of 25 °C up to 250 °C and in steps of 50 °C between 250 and 400 °C. The structure of cavansite is characterized by layers of silicate tetrahedra connected by V4+O5 square pyramids. This way a porous framework structure is formed with Ca and H2O as extraframework occupants. At room temperature, the hydrogen bond system was analyzed. Ca is eightfold coordinated by four bonds to O of the framework structure and four bonds to H2O molecules. H2O linked to Ca is hydrogen bonded to the framework and also to adjacent H2O molecules. The dehydration in cavansite proceeds in four steps.At 75 °C, H2O at O9 was completely expelled leading to 3 H2O pfu with only minor impact on framework distortion and contraction V = 1282.73(3) Å3. The Ca coordination declined from originally eightfold to sevenfold and H2O at O7 displayed positional disorder.At 175 °C, the split O7 sites approached the former O9 position. In addition, the sum of the three split positions O7, O7a, and O7b decreased to 50% occupancy yielding 2 H2O pfu accompanied by a strong decrease in volume V = 1206.89(8) Å3. The Ca coordination was further reduced from sevenfold to sixfold.At 350 °C, H2O at O8 was released leading to a formula with 1 H2O pfu causing additional structural contraction (V = 1156(11) Å3). At this temperature, Ca adopted fivefold coordination and O7 rearranged to disordered positions closer to the original O9 H2O site.At 400 °C, cavansite lost crystallinity but the VO2+ characteristic blue color was preserved. Stepwise removal of water is discussed on the basis of literature data reporting differential thermal analyses, differential thermo-gravimetry experiments and temperature dependent IR spectra in the range of OH stretching vibrations.

A multifactorial histopathologic score for the prediction of prognosis of resected esophageal adenocarcinomas after neoadjuvant chemotherapy

BACKGROUND For esophageal adenocarcinoma treated with neoadjuvant chemotherapy, postoperative staging classifications initially developed for non-pretreated tumors may not accurately predict prognosis. We tested whether a multifactorial TNM-based histopathologic prognostic score (PRSC), which additionally applies to tumor regression, may improve estimation of prognosis compared with the current Union for International Cancer Control/American Joint Committee on Cancer (UICC) staging system. PATIENTS AND METHODS We evaluated esophageal adenocarcinoma specimens following cis/oxaliplatin-based therapy from two separate centers (center 1: n = 280; and center 2: n = 80). For the PRSC, each factor was assigned a value from 1 to 2 (ypT0-2 = 1 point; ypT3-4 = 2 points; ypN0 = 1 point; ypN1-3 = 2 points; ≤50 % residual tumor/tumor bed = 1 point; >50 % residual tumor/tumor bed = 2 points). The three-tiered PRSC was based on the sum value of these factors (group A: 3; group B: 4-5; group C: 6) and was correlated with patients' overall survival (OS). RESULTS The PRSC groups showed significant differences with respect to OS (p < 0.0001; hazard ratio [HR] 2.2 [95 % CI 1.7-2.8]), which could also be demonstrated in both cohorts separately (center 1 p < 0.0001; HR 2.48 [95 % CI 1.8-3.3] and center 2 p = 0.015; HR 1.7 [95 % CI 1.1-2.6]). Moreover, the PRSC showed a more accurate prognostic discrimination than the current UICC staging system (p < 0.0001; HR 1.15 [95 % CI 1.1-1.2]), and assessment of two goodness-of-fit criteria (Akaike Information Criterion and Schwarz Bayesian Information Criterion) clearly supported the superiority of PRSC over the UICC staging. CONCLUSION The proposed PRSC clearly identifies three subgroups with different outcomes and may be more helpful for guiding further therapeutic decisions than the UICC staging system.

Schmiede ─ Heiligtum ─ Wassermühle. Cham-Hagendorn (Kanton Zug) in römischer Zeit. Ausgrabungen 1944/45 und 2003/04

1944/1945 wurde in Cham-Hagendorn eine Wassermühle ausgegraben, die dank ihrer aussergewöhnlich guten Holzerhaltung seit langem einen prominenten Platz in der Forschung einnimmt. 2003 und 2004 konnte die Kantonsarchäologie Zug den Platz erneut archäologisch untersuchen. Dabei wurden nicht nur weitere Reste der Wassermühle, sondern auch Spuren älterer und jüngerer Anlagen geborgen: eine ältere und eine jüngere Schmiedewerkstatt (Horizont 1a/Horizont 3) sowie ein zweiphasiges Heiligtum (Horizonte 1a/1b). All diese Anlagen lassen sich nun in das in den neuen Grabungen erkannte stratigraphische Gerüst einhängen (s. Beil. 2). Dank der Holzerhaltung können die meisten Phasen dendrochronologisch datiert werden (s. Abb. 4.1/1a): Horizont 1a mit Schlagdaten zwischen 162(?)/173 und 200 n. Chr., Horizont 1b um 215/218 n. Chr. und Horizont 2 um 231 n. Chr. Ferner konnten in den neuen Grabungen Proben für mikromorphologische und archäobotanische Untersuchungen entnommen werden (Kap. 2.2; 3.11). In der vorliegenden Publikation werden der Befund und die Baustrukturen vorgelegt, (Kap. 2), desgleichen sämtliche stratifizierten Funde und eine umfassende Auswahl der 1944/1945 geborgenen Funde (Kap. 3). Dank anpassender Fragmente, sog. Passscherben, lassen sich diese zum Teil nachträglich in die Schichtenabfolge einbinden. Die mikromorphologischen und die archäobotanischen Untersuchungen (Kap. 2.2; 3.11) zeigen, dass der Fundplatz in römischer Zeit inmitten einer stark vom Wald und dem Fluss Lorze geprägten Landschaft lag. In unmittelbarer Nähe können weder eine Siedlung noch einzelne Wohnbauten gelegen haben. Die demnach nur gewerblich und sakral genutzten Anlagen standen an einem Bach, der vermutlich mit jenem Bach identisch ist, der noch heute das Groppenmoos entwässert und bei Cham-Hagendorn in die Lorze mündet (s. Abb. 2.4/1). Der antike Bach führte wiederholt Hochwasser ─ insgesamt sind fünf grössere Überschwemmungsphasen auszumachen (Kap. 2.2; 2.4). Wohl anlässlich eines Seehochstandes durch ein Überschwappen der Lorze in den Bach ausgelöst, müssen diese Überschwemmungen eine enorme Gewalt entwickelt haben, der die einzelnen Anlagen zum Opfer fielen. Wie die Untersuchung der Siedlungslandschaft römischer Zeit rund um den Zugersee wahrscheinlich macht (Kap. 6 mit Abb. 6.2/2), dürften die Anlagen von Cham-Hagendorn zu einer in Cham-Heiligkreuz vermuteten Villa gehören, einem von fünf grösseren Landgütern in diesem Gebiet. Hinweise auf Vorgängeranlagen fehlen, mit denen die vereinzelten Funde des 1. Jh. n. Chr. (Kap. 4.5) in Verbindung gebracht werden könnten. Diese dürften eher von einer der Überschwemmungen bachaufwärts weggerissen und nach Cham-Hagendorn eingeschwemmt worden sein. Die Nutzung des Fundplatzes (Horizont 1a; s. Beil. 6) setzte um 170 n. Chr. mit einer Schmiedewerkstatt ein (Kap. 2.5.1). Der Fundanfall, insbesondere die Schmiedeschlacken (Kap. 3.9) belegen, dass hier nur hin und wieder Geräte hergestellt und repariert wurden (Kap. 5.2). Diese Werkstatt war vermutlich schon aufgelassen und dem Verfall preisgegeben, als man 200 n. Chr. (Kap. 4.2.4) auf einer Insel zwischen dem Bach und einem Lorzearm ein Heiligtum errichtete (Kap. 5.3). Beleg für den sakralen Status dieser Insel ist in erster Linie mindestens ein eigens gepflanzter Pfirsichbaum, nachgewiesen mit Pollen, einem Holz und über 400 Pfirsichsteinen (Kap. 3.11). Die im Bach verlaufende Grenze zwischen dem sakralen Platz und der profanen Umgebung markierte man zusätzlich mit einer Pfahlreihe (Kap. 2.5.3). In diese war ein schmaler Langbau integriert (Kap. 2.5.2), der an die oft an Temenosmauern antiker Heiligtümer angebauten Portiken erinnert und wohl auch die gleiche Funktion wie diese gehabt hatte, nämlich das Aufbewahren von Weihegaben und Kultgerät (Kap. 5.3). Das reiche Fundmaterial, das sich in den Schichten der ersten Überschwemmung fand (s. Abb. 5./5), die um 205/210 n. Chr. dieses Heiligtum zerstört hatte, insbesondere die zahlreiche Keramik (Kap. 3.2.4), und die zum Teil auffallend wertvollen Kleinfunde (Kap. 3.3.3), dürften zum grössten Teil einst in diesem Langbau untergebracht gewesen sein. Ein als Glockenklöppel interpretiertes, stratifiziertes Objekt spricht dafür, dass die fünf grossen, 1944/1945 als Stapel aufgefundenen Eisenglocken vielleicht auch dem Heiligtum zuzuweisen sind (Kap. 3.4). In diesen Kontext passen zudem die überdurchschnittlich häufig kalzinierten Tierknochen (Kap. 3.10). Nach der Überschwemmung befestigte man für 215 n. Chr. (Kap. 4.2.4) das unterspülte Bachufer mit einer Uferverbauung (Kap. 2.6.1). Mit dem Bau eines weiteren, im Bach stehenden Langbaus (Kap. 2.6.2) stellte man 218 n. Chr. das Heiligtum auf der Insel in ähnlicher Form wieder her (Horizont 1b; s. Beil. 7). Von der Pfahlreihe, die wiederum die sakrale Insel von der profanen Umgebung abgrenzte, blieben indes nur wenige Pfähle erhalten. Dennoch ist der sakrale Charakter der Anlage gesichert. Ausser dem immer noch blühenden Pfirsichbaum ist es ein vor dem Langbau aufgestelltes Ensemble von mindestens 23 Terrakottafigurinen (s. Abb. 3.6/1), elf Veneres, zehn Matres, einem Jugendlichen in Kapuzenmantel und einem kindlichen Risus (Kap. 3.6; s. auch Kap. 2.6.3). In den Sedimenten der zweiten Überschwemmung, der diese Anlage um 225/230 n. Chr. zum Opfer gefallen war, fanden sich wiederum zahlreiche Keramikgefässe (Kap. 3.2.4) und zum Teil wertvolle Kleinfunde wie eine Glasperle mit Goldfolie (Kap. 3.8.2) und eine Fibel aus Silber (Kap. 3.3.3), die wohl ursprünglich im Langbau untergebracht waren (Kap. 5.3.2 mit Abb. 5/7). Weitere Funde mit sicherem oder möglichem sakralem Charakter finden sich unter den 1944/1945 geborgenen Funden (s. Abb. 5/8), etwa ein silberner Fingerring mit Merkurinschrift, ein silberner Lunula-Anhänger, eine silberne Kasserolle (Kap. 3.3.3), eine Glasflasche mit Schlangenfadenauflage (Kap. 3.8.2) und einige Bergkristalle (Kap. 3.8.4). Im Bereich der Terrakotten kamen ferner mehrere Münzen (Kap. 3.7) zum Vorschein, die vielleicht dort niedergelegt worden waren. Nach der zweiten Überschwemmung errichtete man um 231 n. Chr. am Bach eine Wassermühle (Horizont 2; Kap. 2.7; Beil. 8; Abb. 2.7/49). Ob das Heiligtum auf der Insel wieder aufgebaut oder aufgelassen wurde, muss mangels Hinweisen offen bleiben. Für den abgehobenen Zuflusskanal der Wassermühle verwendete man mehrere stehen gebliebene Pfähle der vorangegangenen Anlagen der Horizonte 1a und 1b. Obwohl die Wassermühle den 28 jährlichen Überschwemmungshorizonten (Kap. 2.2) und den Funden (Kap. 4.3.2; 4.4.4; 45) zufolge nur bis um 260 n. Chr., während gut einer Generation, bestand, musste sie mindestens zweimal erneuert werden – nachgewiesen sind drei Wasserräder, drei Mühlsteinpaare und vermutlich drei Podeste, auf denen jeweils das Mahlwerk ruhte. Grund für diese Umbauten war wohl der weiche, instabile Untergrund, der zu Verschiebungen geführt hatte, so dass das Zusammenspiel von Wellbaum bzw. Sternnabe und Übersetzungsrad nicht mehr funktionierte und das ganze System zerbrach. Die Analyse von Pollen aus dem Gehhorizont hat als Mahlgut Getreide vom Weizentyp nachgewiesen (Kap. 3.11.4). Das Abzeichen eines Benefiziariers (Kap. 3.3.2 mit Abb. 3.3/23,B71) könnte dafür sprechen, dass das verarbeitete Getreide zumindest zum Teil für das römische Militär bestimmt war (s. auch Kap. 6.2.3). Ein im Horizont 2 gefundener Schreibgriffel und weitere stili sowie eine Waage für das Wägen bis zu 35-40 kg schweren Waren aus dem Fundbestand von 1944/1945 könnten davon zeugen, dass das Getreide zu wägen und zu registrieren war (Kap. 3.4.2). Kurz nach 260 n. Chr. fiel die Wassermühle einem weiteren Hochwasser zum Opfer. Für den folgenden Horizont 3 (Beil. 9) brachte man einen Kiesboden ein und errichtete ein kleines Gebäude (Kap. 2.8). Hier war wohl wiederum eine Schmiede untergebracht, wie die zahlreichen Kalottenschlacken belegen (Kap. 3.9), die im Umfeld der kleinen Baus zum Vorschein kamen. Aufgrund der Funde (Kap. 4.4.4; 4.5) kann diese Werkstatt nur kurze Zeit bestanden haben, höchstens bis um 270 n. Chr., bevor sie einem weiteren Hochwasser zum Opfer fiel. Von der jüngsten Anlage, die wohl noch in römische Zeit datiert (Horizont 4; Beil. 10), war lediglich eine Konstruktion aus grossen Steinplatten zu fassen (Kap. 2.9.1). Wozu sie diente, muss offen bleiben. Auch der geringe Fundanfall spricht dafür, dass die Nutzung des Platzes, zumindest für die römische Zeit, allmählich ein Ende fand (Kap. 4.5). Zu den jüngsten Strukturen gehören mehrere Gruben (Kap. 2.9.2), die vielleicht der Lehmentnahme dienten. Mangels Funden bleibt ihre Datierung indes ungewiss. Insbesondere wissen wir nicht, ob sie noch in römische Zeit datieren oder jünger sind. Spätestens mit der fünften Überschwemmung, die zur endgültigen Verlandung führte und wohl schon in die frühe Neuzeit zu setzen ist, wurde der Platz aufgelassen und erst mit dem Bau der bestehenden Fensterfabrik Baumgartner wieder besetzt.

Regorafenib as second-line therapy for intermediate or advanced hepatocellular carcinoma: Multicentre, open-label, phase II safety study

PURPOSE: We assessed the safety of the multikinase inhibitor regorafenib in patients with hepatocellular carcinoma (HCC) that had progressed following first-line sorafenib. PATIENTS AND METHODS: Thirty-six patients with Barcelona Clinic Liver Cancer stage B or C HCC and preserved to mildly impaired liver function (Child-Pugh class A) received regorafenib 160 mg once daily in cycles of 3 weeks on/1 week off treatment until disease progression, unacceptable toxicity, death or patient/physician decision to discontinue. The primary end-point was safety; secondary end-points included efficacy (including time to progression and overall survival). RESULTS: The median treatment duration was 19.5 weeks (range 2-103). At data cutoff, three patients remained on treatment. Reasons for discontinuation were adverse events (n=20), disease progression (n=10), consent withdrawal (n=2) and death (n=1). Seventeen patients required dose reductions (mostly for adverse events [n=15]); 35 patients had treatment interruption (mostly for adverse events [n=32] or patient error [n=11]). The most frequent treatment-related adverse events were hand-foot skin reaction (any grade n=19; grade ≥3 n=5), diarrhoea (n=19; n=2), fatigue (n=19; n=6), hypothyroidism (n=15; n=0), anorexia (n=13; n=0), hypertension (n=13; n=1), nausea (n=12; n=0) and voice changes (n=10; n=0). Disease control was achieved in 26 patients (partial response n=1; stable disease n=25). Median time to progression was 4.3 months. Median overall survival was 13.8 months. CONCLUSION: Regorafenib had acceptable tolerability and evidence of antitumour activity in patients with intermediate or advanced HCC that progressed following first-line sorafenib.

Hellenismus und Judentum im neutestamentlichen Zeitalter

von Paul Krüger

Search for long-lived, heavy particles in final states with a muon and multi-track displaced vertex in proton–proton collisions at View the MathML sources=7 TeV with the ATLAS detector

A search for the direct production of charginos and neutralinos in final states with three electrons or muons and missing transverse momentum is presented. The analysis is based on 4.7 fb(-1) of root s = 7 TeV proton-proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with Standard Model expectations in three signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric models and in simplified models, significantly extending previous results.

Search for direct slepton and gaugino production in final states with two leptons and missing transverse momentum with the ATLAS detector in pp collisions at sqrts=7 TeV

A search for the electroweak pair production of charged sleptons and weak gauginos decaying into final states with two leptons is performed using 4.7 fb(-1) of proton-proton collision data at root s = 7 TeV recorded with the ATLAS experiment at the Large Hadron Collider. No significant excesses are observed with respect to the prediction from Standard Model processes. In the scenario of direct slepton production, if the sleptons decay directly into the lightest neutralino, left-handed slepton masses between 85 and 195 GeV are excluded at 95% confidence level for a 20 GeV neutralino. Chargino masses between 110 and 340 GeV are excluded in the scenario of direct production of wino-like chargino pairs decaying into the lightest neutralino via an intermediate on-shell charged slepton for a 10 GeV neutralino. The results are also interpreted in the framework of the phenomenological minimal supersymmetric Standard Model.