Untersuchung zur Therapie akuter venöser Thromboembolien mit niedermolekularen Heparinen (NMH)

Über einen Zeitraum von 14 Monaten wurden Patienten mit akuter, duplexsonographisch nachgewiesener tiefer Beinvenenthrombose erfasst und im initialen Behandlungszeitraum mit niedermolekularem Heparin (Enoxaparin) sowie im weiteren Verlauf überlappend mit Marcumar® therapiert. Erhoben wurden eine ausführliche, standardisierte Eigen- sowie Familienanamnese und die Risikofaktoren für eine TVT. Desweiteren wurde eine klinische Untersuchung inklusive Duplexsonographie der Venen und eine Thrombophiliediagnostik durchgeführt. Täglich erfolgte die Bestimmung diverser Laborparameter (INR, APTT, D-Dimere, CRP, kleines Blutbild). Am ersten und fünften Tag wurden zusätzlich die Transaminasen bestimmt. Nach 30 Tagen erfolgte eine klinische Verlaufskontrolle, nach drei Monaten eine ambulante Kontrollduplexsonographie. Diskutiert werden Enoxaparin-Nebenwirkungen, Verläufe der duplexsonographisch erhobenen Befunde und klinischen Symptome, die Thrombophiliediagnostik sowie Laborverläufe der Infekt- und Gerinnungsparameter (APTT, INR, D-Dimere). Die D-Dimerverläufe und die Bedeutung der sinnvollen D-Dimerbestimmung wurden bereits auf mehreren Tagungen vorgestellt.

Geochemistry, petrogenesis and tectonic setting of ophiolites and mafic-ultramafic complexes in the Northeastern Aegean Region

In this study two ophiolites and a mafic-ultramafic complexes of the northeastern Aegean Sea, Greece, have been investigated to re-evaluate their petrogenetic evolution and tectonic setting. These complexes are: the mafic-ultramafic complex of Lesvos Island and the ophiolites of Samothraki Island and the Evros area. In order to examine these complexes in detail whole-rock major- and trace-elements as well as Sr and Nd isotopes, and minerals were analysed and U-Pb SHRIMP ages on zircons were determined. The mafic-ultramafic complex of Lesvos Island consists of mantle peridotite thrusted over a tectonic mélange containing metasediments, metabasalts and a few metagabbros. This succession had previously been interpreted as an ophiolite of Late Jurassic age. The new field and geochemical data allow a reinterpretation of this complex as representing an incipient continental rift setting that led to the subsequent formation of the Meliata-Maliac-Vardar branches of Neotethys in Upper Permian times (253 ± 6 Ma) and the term “Lesvos ophiolite” should be abandoned. With proceeding subduction and closure of the Maliac Ocean in Late Jurassic times (155 Ma) the Lesvos mafic-ultramafic complex was obducted. Zircon ages of 777, 539 and 338 Ma from a gabbro strongly suggest inheritance from the intruded basement and correspond to ages of distinct terranes recently recognized in the Hellenides (e.g. Florina terrane). Geochemical similar complexes which contain rift associations with Permo-Triassic ages can be found elsewhere in Greece and Turkey, namely the Teke Dere Thrust Sheet below the Lycian Nappes (SW Turkey), the Pindos subophiolitic mélange (W Greece), the Volcanosedimentary Complex on Central Evia Island (Greece) and the Karakaya Complex (NW Turkey). This infers that the rift-related rocks from Lesvos belong to an important Permo-Triassic rifting episode in the eastern Mediterranean. The ‘in-situ’ ophiolite of Samothraki Island comprises gabbros, sparse dykes and basalt flows as well as pillows cut by late dolerite dykes and had conventionally been interpreted as having formed in an ensialic back-arc basin. The results of this study revealed that none of the basalts and dolerites resemble mid-ocean ridge or back-arc basin basalts thus suggesting that the Samothraki ophiolite cannot represent mature back-arc basin crust. The age of the complex is regarded to be 160 ± 5 Ma (i.e. Oxfordian; early Upper Jurassic), which precludes any correlation with the Lesvos mafic-ultramafic complex further south (253 ± 6 Ma; Upper Permian). Restoration of the block configuration in NE Greece, before extensional collapse of the Hellenic hinterland and exhumation of the Rhodope Metamorphic Core Complex (mid-Eocene to mid-Miocene), results in a continuous ophiolite belt from Guevgueli in the NW to Samothraki in the SE, thus assigning the latter to the Innermost Hellenic Ophiolite Belt. In view of the data of this study, the Samothraki ophiolite represents a rift propagation of the Sithonia ophiolite spreading ridge into the Chortiatis calc-alkaline arc. The ophiolite of the Evros area consists of a plutonic sequence comprising cumulate and non-cumulate gabbros with plagiogranite veins, and an extrusive sequence of basalt dykes, massive and pillow lavas as well as pyroclastic rocks. Furthermore, in the Rhodope Massif tectonic lenses of harzburgites and dunites can be found. All rocks are spatially separated. The analytical results of this study revealed an intra-oceanic island arc setting for the Evros ophiolitic rocks. During late Middle Jurassic times (169 ± 2 Ma) an intra-oceanic arc has developed above a northwards directed intra-oceanic subduction zone of the Vardar Ocean in front of the Rhodope Massif. The boninitic, island arc tholeiitic and calc-alkaline rocks reflect the evolution of the Evros island arc. The obduction of the ophiolitic rocks onto the Rhodope basement margin took place during closure of the Vardar ocean basins. The harzburgites and dunites of the Rhodope Massif are strongly depleted and resemble harzburgites from recent oceanic island arcs. After melt extraction they underwent enrichment processes by percolating melts and fluids from the subducted slab. The relationship of the peridotites and the Evros ophiolite is still ambiguous, but the stratigraphic positions of the peridotites and the ophiolitic rocks indicate separated origin. The harzburgites and dunites most probably represent remnants of the mantle wedge of the island arc of the Rhodope terrane formed above subducted slab of the Nestos Ocean in late Middle Jurassic times. During collision of the Thracia terrane with the Rhodope terrane thrusting of the Rhodope terrane onto the Thracia terrane took place, whereas the harzburgites and dunites were pushed between the two terranes now cropping out on top of the Thracia terrane of the Rhodope Massif.

Contour integration and principles of perceptual grouping

Ziel der Arbeit ist die Analyse von Prinzipien der Konturintegration im menschlichen visuellen System. Die perzeptuelle Verbindung benachbarter Teile in einer visuellen Szene zu einem Ganzen wird durch zwei gestalttheoretisch begründete Propositionen gekennzeichnet, die komplementäre lokale Mechanismen der Konturintegration beschreiben. Das erste Prinzip der Konturintegration fordert, dass lokale Ähnlichkeit von Elementen in einem anderen Merkmal als Orientierung nicht hinreicht für die Entdeckung von Konturen, sondern ein zusätzlicher statistischer Merkmalsunterschied von Konturelementen und Umgebung vorliegen muss, um Konturentdeckung zu ermöglichen. Das zweite Prinzip der Konturintegration behauptet, dass eine kollineare Ausrichtung von Konturelementen für Konturintegration hinreicht, und es bei deren Vorliegen zu robuster Konturintegrationsleistung kommt, auch wenn die lokalen merkmalstragenden Elemente in anderen Merkmalen in hohem Maße zufällig variieren und damit keine nachbarschaftliche Ähnlichkeitsbeziehung entlang der Kontur aufweisen. Als empirische Grundlage für die beiden vorgeschlagenen Prinzipien der Konturintegration werden drei Experimente berichtet, die zunächst die untergeordnete Rolle globaler Konturmerkmale wie Geschlossenheit bei der Konturentdeckung aufweisen und daraufhin die Bedeutung lokaler Mechanismen für die Konturintegration anhand der Merkmale Kollinearität, Ortsfrequenz sowie der spezifischen Art der Interaktion zwischen beiden Merkmalen beleuchten. Im ersten Experiment wird das globale Merkmal der Geschlossenheit untersucht und gezeigt, dass geschlossene Konturen nicht effektiver entdeckt werden als offene Konturen. Das zweite Experiment zeigt die Robustheit von über Kollinearität definierten Konturen über die zufällige Variation im Merkmal Ortsfrequenz entlang der Kontur und im Hintergrund, sowie die Unmöglichkeit der Konturintegration bei nachbarschaftlicher Ähnlichkeit der Konturelemente, wenn Ähnlichkeit statt über kollineare Orientierung über gleiche Ortsfrequenzen realisiert ist. Im dritten Experiment wird gezeigt, dass eine redundante Kombination von kollinearer Orientierung mit einem statistischen Unterschied im Merkmal Ortsfrequenz zu erheblichen Sichtbarkeitsgewinnen bei der Konturentdeckung führt. Aufgrund der Stärke der Summationswirkung wird vorgeschlagen, dass durch die Kombination mehrerer Hinweisreize neue kortikale Mechanismen angesprochen werden, die die Konturentdeckung unterstützen. Die Resultate der drei Experimente werden in den Kontext aktueller Forschung zur Objektwahrnehmung gestellt und ihre Bedeutung für die postulierten allgemeinen Prinzipien visueller Gruppierung in der Konturintegration diskutiert. Anhand phänomenologischer Beispiele mit anderen Merkmalen als Orientierung und Ortsfrequenz wird gezeigt, dass die gefundenen Prinzipien Generalisierbarkeit für die Verarbeitung von Konturen im visuellen System beanspruchen können.

Time-gated fluorescence spectroscopy improves endoscopic detection of low-grade dysplasia in ulcerative colitis

Dysplasia in ulcerative colitis is frequently missed with 4-quadrant biopsies. An experimental setup recording delayed fluorescence spectra simultaneously with white light endoscopy was recently developed.

Coagulation factor XIII activation peptide and subunit levels in patients with acute ischaemic stroke: a pilot study

We have recently shown that FXIII activation peptide (AP-FXIII) can be measured in plasma. The objective of this pilot study was to investigate for the first time if AP-FXIII can be detected in plasma from patients with acute ischaemic stroke.

Emergency skill training--a randomized controlled study on the effectiveness of the 4-stage approach compared to traditional clinical teaching

The "4-stage approach" has been widely accepted for practical skill training replacing the traditional 2 stages ("see one, do one"). However, the superior effectiveness of the 4-stage approach was never proved.

Sensitive and selective detection of free FXIII activation peptide: a potential marker of acute thrombotic events

Coagulation factor XIII (FXIII) stabilizes fibrin fibers and is therefore a major player in the maintenance of hemostasis. FXIII is activated by thrombin resulting in cleavage and release of the FXIII activation peptide (AP-FXIII). The objective of this study was to characterize the released AP-FXIII and determine specific features that may be used for its specific detection. We analyzed the structure of bound AP-FXIII within the FXIII A-subunit and interactions of AP-FXIII by hydrogen bonds with both FXIII A-subunit monomers. We optimized our previously developed AP-FXIII ELISA by using 2 monoclonal antibodies. We determined high binding affinities between the antibodies and free AP-FXIII and demonstrated specific binding by epitope mapping analyses with surface plasmon resonance and enzyme-linked immunosorbent assay. Because the structure of free AP-FXIII had been characterized so far by molecular modeling only, we performed structural analysis by nuclear magnetic resonance. Recombinant AP-FXIII was largely flexible both in plasma and water, differing significantly from the rigid structure in the bound state. We suggest that the recognized epitope is either occluded in the noncleaved form or possesses a structure that does not allow binding to the antibodies. On the basis of our findings, we propose AP-FXIII as a possible new marker for acute thrombotic events.

The pharmacokinetics and safety of porfimer after repeated administration 30-45 days apart to patients undergoing photodynamic therapy

Porfimer is an intravenous (i.v.) injectable photosensitizing agent used in the photodynamic treatment of tumours and of high-grade dysplasia in Barrett's oesophagus.

Does land-based exercise reduce pain and disability associated with hip osteoarthritis? A meta-analysis of randomized controlled trials

Objective To determine if clinical guidelines recommending therapeutic exercise for people with hip osteoarthritis (OA) are supported by rigorous scientific evidence. Methods A meta-analysis of randomized controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based exercise program (as opposed to exercises conducted in the water) with a non-exercise group in terms of hip pain and/or self-reported physical function. Results Thirty-two RCTs were identified, but only five met the inclusion criteria. Only one of the five included RCTs restricted recruitment to people with hip OA, the other four RCTs also recruiting participants with knee OA. The five included studies provided data on 204 and 187 hip OA participants for pain and physical function, respectively. Combining the results of the five included RCTs using a fixed-effects model demonstrated a small treatment effect for pain (standardized mean difference (SMD) −0.38; 95% confidence interval (CI) −0.67 to −0.09). No significant benefit in terms of improved self-reported physical function was detected (SMD −0.02; 95% CI −0.31 to 0.28). Conclusion Currently there is only silver level evidence (one small RCT) supporting the benefit of land-based therapeutic exercise for people with symptomatic hip OA in terms of reduced pain and improved physical function. The limited number and small sample size of the included RCTs restricts the confidence that can be attributed to these results.

Clues on the frequency of giant planets in wide orbits

The available results of deep imaging searches for planetary companions around nearby stars provide us useful constraints on the frequencies of giant planets in very wide orbits. Here we present some preliminary results of the Monte Carlo simulation which compare the published detection limits with the generated planetary masses and orbital parameters. This allow us to consider the impications of the null detection, which comes from the direct imaging techniques, on the distributions of mass and semimajor axis derived from the results of the other search techniques and also to check the agreement of the observations with the available planetary formation models.

New laser soldering-based closures: a promising method in natural orifice transluminal endoscopic surgery

Complete closure of gastrotomy is the linchpin of safe natural orifice transgastric endoscopic surgery.