A tailored approach for the treatment of indirect inguinal hernia in adults--an old problem revisited.

A patent processus vaginalis peritonei (PPV) presents typically as an indirect hernia with an intact inguinal canal floor during childhood. Little is known however about PPV in adults and its best treatment. A cohort study included all consecutive patients admitted for ambulatory open hernia repair. In patients with a PPV, demographics, hernia characteristics, and outcome were prospectively assessed. Annulorrhaphy was the treatment of choice in patients with an internal inguinal ring diameter of < 30 mm. Between 1998 and 2006, 92 PPVs (two bilateral) were diagnosed in 676 open hernia repairs (incidence of 14%). Eighty nine of the 90 patients were males, the median age was 34 years (range: 17-85). A PPV was right-sided in 67% and partially obliterated in 66%. Forty-one patients had an annulorrhaphy and 51 patients had a tension-free mesh repair. The median operation time was significantly shorter in the annulorrhaphy group (38 vs. 48 min, P <.0001). In a median follow-up period of 56 months (27-128), both groups did not differ concerning recurrence (1/41 vs. 2/51), chronic pain (3/41 vs. 4/51), and hypoesthesia (5/41 vs. 9/51). There was however a clear trend to less neuropathic symptoms in favor of annulorrhaphy (0/41 vs. 5/51, P < 0.066). PPV occurs in 14% of adults undergoing hernia repair. In selected patients, annulorrhaphy takes less time and is associated with equally low recurrence but less potential for neuropathic symptoms.

Discrete analysis of dividend payments in a non-life insurance portfolio

The process of free reserves in a non-life insurance portfolio as defined in the classical model of risk theory is modified by the introduction of dividend policies that set maximum levels for the accumulation of reserves. The first part of the work formulates the quantification of the dividend payments via the expectation of their current value under diferent hypotheses. The second part presents a solution based on a system of linear equations for discrete dividend payments in the case of a constant dividend barrier, illustrated by solving a specific case.

On the use of spatially discrete data to compute energy and mass balance

In many practical applications the state of field soils is monitored by recording the evolution of temperature and soil moisture at discrete depths. We theoretically investigate the systematic errors that arise when mass and energy balances are computed directly from these measurements. We show that, even with no measurement or model errors, large residuals might result when finite difference approximations are used to compute fluxes and storage term. To calculate the limits set by the use of spatially discrete measurements on the accuracy of balance closure, we derive an analytical solution to estimate the residual on the basis of the two key parameters: the penetration depth and the distance between the measurements. When the thickness of the control layer for which the balance is computed is comparable to the penetration depth of the forcing (which depends on the thermal diffusivity and on the forcing period) large residuals arise. The residual is also very sensitive to the distance between the measurements, which requires accurately controlling the position of the sensors in field experiments. We also demonstrate that, for the same experimental setup, mass residuals are sensitively larger than the energy residuals due to the nonlinearity of the moisture transport equation. Our analysis suggests that a careful assessment of the systematic mass error introduced by the use of spatially discrete data is required before using fluxes and residuals computed directly from field measurements.

Seizure semiology: an overview of the 'inverse problem'.

In clinical practice, a classification of seizures based on clinical signs and symptoms leads to an improved understanding of epilepsy-related issues and therefore strongly contributes to a better patient care. The inverse problem involves inferring the anatomical brain localization of a seizure from the scalp surface EEG, a concept we apply here to correlate seizure origin with seizure semiology. The spheres of sensorium, motor features, consciousness changes and autonomic alterations during ictal and postictal manifestations are reviewed, including several subdivisions used to better categorize particular features. Particular attention is given to behavioral features, as well as to features occurring in idiopathic generalized epileptic syndromes and psychogenic nonepileptic spells.

p53 and Ki-ras as prognostic factors for Dukes' stage B colorectal cancer.

Mutations of the TP53 and Ki-ras genes have been reported to be of prognostic importance in colorectal carcinomas. An increased intracellular concentration of the p53 protein, although not identical to, is sometimes seen in tumours with TP53 mutation and has been correlated with poor prognosis in some tumour types. Previous colorectal cancer studies, addressing the prognostic importance of Ki-ras mutation and TP53 aberrations, yielded contradictory results. The aim of this study was to determine in a clinically and therapeutically homogeneous group of 122 sporadic Dukes' B colorectal carcinomas with a median follow-up of 67 months (3-144 months) whether or not p53 protein expression, TP53 mutation and K-ras mutation correlated with prognosis. p53 staining was performed by immunohistochemistry, using the monoclonal antibody DO7 on paraffin-embedded tissue. Mutations in exons 5-8 of the TP53 gene and in codons 12 and 13 of the K-ras gene were assayed in paraffin-embedded tissue by the single-strand conformation polymorphism (SSCP) assay. Nuclear p53 staining was found in 57 (47%) tumours. Aberrant migration patterns indicating mutation of the TP53 gene were found in 39 (32%) tumours. Forty-six carcinomas (38%) showed a mutation of the Ki-ras codons 12 or 13. In a univariate analysis, patients with wild-type TP53 status showed a trend towards better survival, compared with those with mutated TP53 (log-rank test, P = 0.051). Likewise, tumours immunohistochemically positive for p53 showed a worse prognosis than p53-negative tumours (P = 0.010). The presence or absence of mutations in Ki-ras did not correlate with prognosis (P = 0.703). In multivariate analysis, only p53 immunoreactivity emerged as an independent marker for prognosis hazard ratio (HR) = 2.16, 95% confidence interval (CI) 1.12-4.11, P = 0.02). Assessment of p53 protein expression is more discriminative than TP53 mutation to predict the outcome of Dukes' stage B tumours and could be a useful tool to identify patients who might benefit from adjuvant therapy.

External dichotomous noise: The problem of the mean-first-passage time

A retarded backward equation for a non-Markovian process induced by dichotomous noise (the random telegraphic signal) is deduced. The mean-first-passage time of this process is exactly obtained. The Gaussian white noise and the white shot noise limits are studied. Explicit physical results in first approximation are evaluated.

MADAP, a flexible clustering tool for the interpretation of one-dimensional genome annotation data.

A recurring task in the analysis of mass genome annotation data from high-throughput technologies is the identification of peaks or clusters in a noisy signal profile. Examples of such applications are the definition of promoters on the basis of transcription start site profiles, the mapping of transcription factor binding sites based on ChIP-chip data and the identification of quantitative trait loci (QTL) from whole genome SNP profiles. Input to such an analysis is a set of genome coordinates associated with counts or intensities. The output consists of a discrete number of peaks with respective volumes, extensions and center positions. We have developed for this purpose a flexible one-dimensional clustering tool, called MADAP, which we make available as a web server and as standalone program. A set of parameters enables the user to customize the procedure to a specific problem. The web server, which returns results in textual and graphical form, is useful for small to medium-scale applications, as well as for evaluation and parameter tuning in view of large-scale applications, requiring a local installation. The program written in C++ can be freely downloaded from ftp://ftp.epd.unil.ch/pub/software/unix/madap. The MADAP web server can be accessed at http://www.isrec.isb-sib.ch/madap/.

Zenith angle distributions at Super-Kamiokande and SNO and the solution of the solar neutrino problem

We have performed a detailed study of the zenith angle dependence of the regeneration factor and distributions of events at SNO and SK for different solutions of the solar neutrino problem. In particular, we discuss the oscillatory behavior and the synchronization effect in the distribution for the LMA solution, the parametric peak for the LOW solution, etc. A physical interpretation of the effects is given. We suggest a new binning of events which emphasizes the distinctive features of the zenith angle distributions for the different solutions. We also find the correlations between the integrated day-night asymmetry and the rates of events in different zenith angle bins. The study of these correlations strengthens the identification power of the analysis.

Komik, Ernst und Mise en page. Zum Problem der Farblinien in Heinrich Wittenwilers "Der Ring"

Der Aufsatz nähert sich dem Interpretationsproblem des ,Ring', eines seit Forschungsbeginn ausserordentlich konträr diskutierten Textes, aus wissenschaftsanalytischer Perspektive. Er führt die Zersplitterung und die Extremisierung der Deutungsansätze, die die breite Forschung zu Wittenwilers Werk kennzeichnet, auf einen vergleichsweise simplen Befund zurück: die ungeklärte Frage nach dem Verhältnis von Komik und Didaktik und der Ernsthaftigkeit des lehrhaften Angebots im ,Ring'. Die so auf grundlegendster Ebene offen gebliebene Erfassung des Textes führt in einen interpretatorischen Leerraum, in dem die widersprüchlichsten, oft wissenschaftsideologisch begründeten Positionen Platz finden. Ihre Analyse zeigt, dass sie sich in wiederkehrende Gruppierungen ordnen. Als Schlüsselglied sowohl der Befunddaten als auch der konträren Vernetzungen von Befund und Deutung wird die wechselnd rote und grüne Initialenlinie der Münchner Handschrift identifiziert. Als im Prolog eingeführte Markierung von Ernst auf der einen und Komik auf der anderen Seite ist sie nicht nur visueller Ausdruck des Deutungsproblems des ,Ring', sondern sie hat es wegen der scheinbaren Unstimmigkeit ihrer Zuweisungen auch wesentlich bedingt. Der Aufsatz zeigt ihren bisher übersehenen Aufschluss für das Verständnis des Werks. Nimmt man die Linie als graphisches Verfahren ernst, stellt sie sich als strukturelle Markierung zum Auffinden von Text im diskontinuierlichen Zugriff dar - nicht aber, wie man sie bisher ausnahmslos verstand, als semantische Kommentierung eines laufenden, kontinuierlich zu lesenden Textes. Die strukturierende Funktion des Farbwechsels ist auf zwei Ebenen nachzuweisen: Auf Makroebene trennen seine Zuweisungen vorwiegend narrative und vorwiegend wissensvermittelnde Grosspartien des ,Ring' durch eine jeweilige Grundfarbe. Auf Mikroebene wird diese Grundfarbe durch die jeweils andere Farbe durchbrochen, um formale Einschnitte wie etwa Sprecherwechsel, Ortswechsel, Handlungsneueinsätze, Beginn und Ende eines eingeschalteten Binnentextes oder einer Sentenz anzuzeigen. Dem Benutzer der autornahen Handschrift sollte so in einem ersten Schritt (makrostrukturell) ermöglicht werden, gezielt auf gewünschte Stellen des Textes zuzugreifen und ihn in einem zweiten Schritt (mikrostrukturell) schneller zu erfassen. Nicht in seiner Umsetzung, sehr wohl aber in seiner Funktion steht dieses ungewöhnliche Layout zeitgenössischen Techniken der Buchgliederung durchaus nahe. Auch im Profil der Zusammenstellung seiner Binnentexte rückt der ,Ring' damit in die Nähe der im Spätmittelalter beliebten Sammelhandschriften mit Ziel einer Wissenssumme, die hier narrativ verbundenen wird. Es scheint, als möchte der ,Ring' in einem ungewöhnlichen Experiment beides sein: Kompilation und Werkganzes, Wissenssammlung und Erzählwerk - Texte und Text. Als Ergebnis einer Neuuntersuchung des Münchner codex unicus des ,Ring' weist der Beitrag schliesslich darauf hin, dass auch zahlreiche Markierungszeichen am Spaltenrand formale und strukturelle Texteinschnitte anzeigen und somit die gleiche Funktion haben wie der Farbwechsel auf Mikroebene. Ein kausaler, produktionstechnischer Zusammenhang zwischen diesen Zeichen und der Verteilung des Farbwechsels ist nicht auszuschliessen, zumal beide Verfahren etwa im letzten Fünftel des Textes zunehmend zusammenfallen. Möglicherweise war nur die makrostrukturelle Funktion des Farbwechsel ursprünglich indendiert und mit der Erläuterung im Prolog bezeichnet, während seine mikrostrukturelle Funktion erst Resultat des Abschreibprozesses ist.

Discrete contribution to psi ' -> J/psi plus gamma gamma

HadronPhysics2 (Grant Agreement No. 227431) (EU)