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Background Pompe's disease, a rare, inherited deficiency of the enzyme alpha-1,4-glucosidase (GAA), is a lysosomal storage disorder. Early-onset (infantile) Pompe's disease is associated with cardiomegaly and severe myopathy and, if left untreated, will inevitably lead to death within the first 2 years of life. In juvenile Pompe's disease, progression of the disease is generally slower and involvement of the myocardium is less likely with onset at a later age. The adult form of Pompe's disease is frequently associated with a progressive proximal myopathy which is more marked in the lower limbs. Involvement of the respiratory system is common. A new treatment with intravenous enzyme replacement (Myozyme) is now available. At present, there is only limited data available regarding its efficacy in the treatment of the adult form of Pompe's disease. Case report A 67-year-old lady with Pompe's disease and known severe respiratory compromise due to involvement of the respiratory muscles had had recurrent emergency admissions with respiratory failure. After only a few weeks of treatment with intravenous enzyme replacement with Myozyme, significant improvement in her respiratory function was noticed. Following a total length of treatment of 7 months, her arterial blood gas results on room air had almost returned to normal. Conclusion A glycogen storage disorder (type II) should be excluded in all adult patients with a slowly progressive weakness involving pelvic and thigh muscles even when respiratory involvement is not present. In addition to supportive treatment, a new enzyme replacement therapy for patients with late-onset disease has now become available which shows promising results.

BACKGROUND: Civilian victims of war suffer from disrupted lines of evacuation and medical treatment. It is therefore difficult to obtain viable outcome predictors after patient evacuation, according to which further surgical interventions and rehabilitation will be planned. METHODS: Case report. The patient was an Iraqi woman wounded by shrapnel of an exploding grenade/rocket; three were embedded in the right cerebral hemisphere. RESULTS: At release from hospital the patient was in a markedly improved neurological condition. The search for prognostic outcome factors revealed that the outcomes of the cognitive minimal screening (CMS) fitted best to the patient's situation. CONCLUSIONS: A combination of the ASA, GCS and CMS gives the most accurate outcome predictor for further intervention. The combination is necessary to evaluate the operative risk (ASA score), the acute situation at first contact with trained medical personnel (GCS) and the cognitive abilities (CMS) relevant for complete recovery.

BACKGROUND: During the last decade cluster bombs containing submunition bomblets (SB) have appeared on battlefields resulting in a new challenge to war surgery. METHODS: Thirty-two patients either wounded by antipersonnel landmines (AP) or SB were treated in a field hospital. The patterns of injuries were described by applying the scoring system of the International Committee of the Red Cross and by Gustilo's classification of open fractures. RESULTS: A total of 95 wounds were observed; 72 caused by SB, 23 by AP. Mortality rate (MR) for the SB group was 6/24 (25.0%), for the AP group 2/8 (25.0%). Three SB patients (12.5%) were "killed in action", leading to a MR of victims "died of wounds" of 3/24 (12.5%) in the SB group and a total MR of 5/32 (15.6%). CONCLUSIONS: From devastating lower limb injuries of AP, a change to multiple wounds affecting the whole body caused by SB has been observed.

Background Sarcomas infiltrating the knee joint require extraarticular resection to achieve wide margins. Opinions differ as to whether the superior tibiofibular joint (STFJ) is part of the knee joint and should be removed in the course of extraarticular resection. Thus, we investigated the frequency of communication between the tibiofemoral joint (TFJ) and the STFJ, and the reported local recurrence rates (LRR) following extraarticular knee resection. Methods A systematic literature review on STFJ and TFJ communication and local recurrence rates following extraarticular knee resections was undertaken. Results Cadaver studies detected communication between the TFJ and STFJ in 10–64 % of the cases. Direct arthrography with physical loading verified a 100 % communication rate. Regarding the extent of extraarticular knee resection, two institutions where the STFJ was resected had a LRR of 4–8 %, while studies from another three where the STFJ was not routinely resected reported a LRR of 0–21 %. Conclusions Since the literature reports about a 100 % communication rate between the TFJ and the STFJ, resection of the STFJ in patients with sarcomas involving the knee joint would seem to be indicated, although it is not clear whether resection of the STFJ reduces local recurrence rates.

The purpose of this article is to investigate the added value of second-opinion evaluation of prostate MRI by subspecialized genitourinary oncologic radiologists for the assessment of extracapsular extension (ECE) of prostate cancer.We performed a retrospective evaluation of initial and second-opinion radiology reports of 76 patients who underwent MRI of the prostate before prostatectomy for histologically proven prostate cancer. Initial outside reports and second-opinion reports were unpaired and reviewed in random order by a urologist who was blinded to patients' clinical details and histopathologic data. Histopathologic analysis of the prostatectomy specimen served as the reference standard.Among cases with diagnostic-quality images available (71/76; 93%), disagreement between the initial report and the second-opinion report was observed in 30% of cases (21/71; κ = 0.35); in 18 of these 21 cases (86%), histopathologic analysis proved that the second-opinion report was correct. The second-opinion interpretations had statistically significantly higher sensitivity (66% vs 24%; p0.0001) than did the initial reports, whereas there was no statistically significant difference in specificity (87% vs 93%; p = 0.317). On ROC curve analysis, the second-opinion reports yielded a statistically significantly higher AUC for the detection of ECE (0.80 vs 0.65; p = 0.004).The reinterpretation of prostate MRI examinations by subspecialized genitourinary oncologic radiologists improved the detection of ECE of prostate cancer.

Background The integrin α4β7 mediates the trafficking of immune cells to the gut associated lymphoid tissue (GALT) and is an attachment factor for the HIV gp120 envelope glycoprotein. We developed a viral replication inhibition assay to more clearly evaluate the role of α4β7 in HIV infection and the contribution of viral and host factors. Results Replication of 60 HIV-1 subtype C viruses collected over time from 11 individuals in the CAPRISA cohort were partially inhibited by antibodies targeting α4β7. However, dependence on α4β7 for replication varied substantially among viral isolates from different individuals as well as over time in some individuals. Among 8 transmitted/founder (T/F) viruses, α4β7 reactivity was highest for viruses having P/SDI/V tri-peptide binding motifs. Mutation of T/F viruses that had LDI/L motifs to P/SDI/V resulted in greater α4β7 reactivity, whereas mutating P/SDI/V to LDI/L motifs was associated with reduced α4β7 binding. P/SDI/V motifs were more common among South African HIV subtype C viruses (35%) compared to subtype C viruses from other regions of Africa (

Trata-se de uma interpretação dos principais aspectos da filosofia platônica como origem da Metafísica, à luz do pensamento de Martin Heidegger. Com o olhar fincado no mundo contemporâneo e na compreensão da essência da tecnologia que Heidegger pela primeira vez traz à presença, o trabalho procura esclarecer o impensado da essência onto- teo-lógica da metafísica que se origina com Platão, a saber, o retraimento da aletheia como acontecimento originário, em favor de um modo de desvelamento do ser como substância, com a correlata postulação de um ente supremo que fundamenta a adequação entre ser e pensar. Mostra-se como este acorde inicial da metafísica inicia seu declínio na modernidade, com o pensamento de Descartes, dispensando um outro modo de desvelamento: o Gestell, a essência da tecnologia. Sob esta ótica, são abordados os seguintes diálogos de Platão: Mênon, República, Banquete, Sofista e Timeu. Faz-se também uma análise dos desdobramentos do eclipse da noção de substância na modernidade, nas filosofias de Descartes e Kant, assim como uma exposição crítica das concepções contemporâneas que entendem a tecnologia como sendo de caráter essencialmente instrumental. This work is an interpretation of the main aspects of Plato`s philosophy as Metaphysic`s beginning, enlightened by Martin Heidegger`s thinking. With the regard founded in the contemporary world and the comprehension of the technology`s essence that first came to light with Martin Heidegger, it aims to enlighten the forgotten ground of metaphysic`s onto-theo-logical essence that begins with Plato, i.e., the retrial of the aletheia as original happening favoring a way of unconcealment of being as substance, with the correlate postulation of a supreme being that founds the adequacy between being an thinking. It shows how this original accord starts metaphysic`s decline in the modernity, with Cartesian thinking, giving another way of unconcealment: o Gestell, the technology`s essence. In this perspective the study analyses the next Plato`s dialogues: Meno, Republic, Symposium, Sophist and Timaeus. The work presents too an analysis of the consequences of the decline of substance notion in the modernity, in Descartes and Kant`s philosophies, as well as a critical exposition of those contemporary conceptions that understand technology as essentially having an instrumental character.

Purpose of review To provide an update on neutralizing antibody targets in the context of the recent HIV-1 envelope trimer structure, describe new antibody isolation technologies, and discuss the implications of these data for HIV-1 prevention and therapy. Recent findings Recent advances in B-cell technologies have dramatically expanded the number of antibodies isolated from HIV-infected donors with broadly neutralizing plasma activity. These, together with the first high-resolution crystal and cryo-electron microscopy (cryo-EM) structures of a cleaved, prefusion HIV-1 trimer, have defined new regions susceptible to neutralization. This year, three epitopes in the gp120-gp41 interface were structurally characterized, highlighting the importance of prefusion gp41 as a target. Similar to many other broadly neutralizing antibody epitopes, these new antibodies define a target that is also highly glycan dependent. Collectively, the epitopes for broadly neutralizing antibodies now reveal a continuum of vulnerability spanning the length of the HIV-1 envelope trimer. Summary Progress in the last year has provided support for the use of rationally stabilized whole HIV-1 trimers as immunogens for eliciting antibodies to multiple epitopes. Furthermore, the increasing number of broad and potent antibodies with the potential for synergistic/complementary combinations opens up new avenues for preventing and treating HIV-1 infection.

To aid in therapy selection for patients with spinal bone metastases (SBM), predictive models have been developed. These models consider SBM from breast cancer a positive predictive factor, but do not take phenotypes based on estrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) receptors into account. The aim of this study was to ascertain whether receptors are associated with survival, when the disease has progressed up to SBM. All patients who were treated for SBM from breast cancer between 2005 and 2012 were included in this international multi-center retrospective study (n = 111). Reports were reviewed for ER, PR and HER2 status and subsequently subdivided into one of four categories; luminal A, luminal B, HER2 and triple negative. Survival time was calculated as the difference between start of treatment for SBM and date of death. Analysis was performed using the Kaplan-Meier method and log-rank tests. Median follow-up was 3.7 years. Survival times in the luminal B and HER2 categories were not significantly different to the luminal A category and were joined into a single receptor positive category. Eighty-five patients (77 %) had a receptor positive phenotype and 25 (23 %) had a triple negative phenotype. Median survival time was 22.5 months (95 %CI 18.0-26.9) for the receptor positive category and 6.7 months (95 %CI 2.4-10.9) for the triple negative category (p < 0.001). Patients with SBM from breast cancer with a triple negative phenotype have a shorter survival time than patients with a receptor positive phenotype. Models estimating survival should be adjusted accordingly.

The impact of HIV glycans on α4β7 reactivity. (A) Correlations between the glycan density, the length of V1/V2, V3, C3/V4, V5 and dependence on α4β7 (Act-1) for replication of 60 IEC. Blocks shaded in grey are those which were significant in a linear mixed model corrected for repeated measures. Beta coefficients and p values are shown below the respective blocks. (B) Frequency of predicted N-linked glycans in the conserved regions of gp120 relative to the percentage of viruses that showed high (green, n = 33) or low (blue, n = 27) dependency on α4β7. Significance was determined by the Fisher exact test where PNG234 (**p = 0.009) and PNG334 (**p = 0.006) were more frequent in viruses with high α4β7 dependence andPNG332 was more frequent in viruses with low α4β7 dependence(*p = 0.026).

We introduce a class of strongly ��tale difference algebras, whose role in the study of difference equations is analogous to the role of ��tale algebras in the study of algebraic equations. We deduce an improved version of Babbitt's decomposition theorem and we present applications to difference algebraic groups and the compatibility problem., 22 pages, minor changes, several examples added

We describe herein the preparation of novel exfoliated graphene–phthalocyanine nanohybrids, and the investigation of their photophysical properties. Pyridyl-phthalocyanines (Pcs) 1–3 are presented as novel electron accepting building blocks of variable strengths with great potential for the exfoliation of graphite via their immobilization onto the basal plane of graphene in dimethylformamide (DMF) affording single layered and turbostratic graphene based G1–G3. G1–G3 were fully characterized (AFM, TEM, Raman, steady-state and pump probe transient absorption spectroscopy) and were studied in terms of electron donor–acceptor interactions in the ground and excited states. In this context, electron transfer upon photoexcitation from graphene to the electron accepting Pcs with dynamics, for example, in G2 of

Let \(f (Z) \in {\Bbb F}[Z]\) be a univariate, separable polynomial of degree n with roots x1,…,xn in some algebraic closure \(\bar{\Bbb F}\) of the ground field \({\Bbb F}\). It is a classical problem of Galois theory to find all the relations between the roots. It is known that the ideal of all such relations is generated by polynomials arising from G-invariant polynomials, where G is the Galois group of f(Z). Namely: The action of G on the ordered set of roots induces an action on \({\Bbb F}^n\) by permutation of the coordinates and each \(P \in {\Bbb F}[X_1, \ldots,X_n]^G\) defines a relation P − P(x1,…,xn) called a G-invariant relation. These generate the ideal of all relations. In this note we show that the ideal of relations admits an H-basis of G-invariant relations if and only if the algebra of coinvariants \({\Bbb F}[X_1,\ldots,X_n]_G\) has dimension ‖G‖ over \({\Bbb F}\). To complete the picture we then show that the coinvariant algebra of a transitive permutation representation of a finite group G has dimension ‖G‖ if and only if G = Σn acting via the tautological permutation representation.

Die Erdheim-Chester-Erkrankung ist eine seltene Non-Langerhans-Zell-Histiozytose mit Multiorganbefall unklarer Genese. Typisch ist ein osteosklerotischer Befall der langen Rohrenknochen. Klinische Symptome werden aber meist durch Befall anderer Organe wie Lunge, Herz und Retroperitoneum hervorgerufen. Ein 58-jahriger Mann stellte sich wegen Abgeschlagenheit, nachlassender Belastbarkeit, diffuser Schmerzen der unteren Extremitat, Dyspnoe und trockenen Hustens vor. Die korperliche Untersuchung war unauffallig. Im Rontgenbild des Thorax fiel eine ausgedehnte interstitielle Zeichnungsvermehrung auf. In der Computertomographie fanden sich fibrotische Lungengerustveranderungen, eine periaortale Fibrose der thorakalen Aorta und eine retroperitoneale Fibrose. Mittels chirurgischer Lungenbiopsie wurde die Diagnose einer Erdheim-Chester-Erkrankung gesichert. Eine Steroidtherapie wurde nicht toleriert. Nach einem therapiefreien Intervall von 18 Monaten kam es zu einer Progredienz der Erkrankung. Unter einer Cyclophosphamidtherapie konnte der Krankheitsverlauf stabilisiert werden. Bei ausgedehnten pulmonalen fibrotischen Veranderungen sollte man bei gleichzeitigem Nachweis anderer Organmanifestationen wie periaortaler oder retroperitonealer Fibrose und insbesondere bei osteosklerotischen symmetrischen Knochenveranderungen an die Erdheim-Chester-Erkrankung denken. Unter einer immunsuppressiven Therapie kann es zu einer Stabilisierung oder sogar Besserung der Erkrankung kommen.

Glycerol kinase deficiency is a rarely diagnosed X-linked recessive disorder which occurs as a complex form together with the adrenal hypoplasia congenita (AHC) or with Duchenne muscular dystrophy (DMD) or as an isolated form either symptomatic or asymptomatic. We report the case of a male adult who had pseudo-hypertriglyceridemia (falsely elevated triglycerides of 552 mg/dl) refractory to lipid-lowering therapy for more than 15 years. Further investigations revealed an isolated, asymptomatic glycerol kinase deficiency. Using polymerase chain reaction and direct DNA sequencing, a novel missense mutation Gly280Ala in the Xp21.3 glycerol kinase gene was found. Comparison between human and E.coli glycerol kinase showed that the mutation affects a highly conserved amino acid in an ATP-binding domain in the active centre. This mutation is assumed to destabilize a hydrogen bond between ligand and enzyme resulting in a reduced activity of glycerol kinase and therefore in hyperglycerolemia.

We show that the relation ideal of a univariate polynomial with Galois group G is generated by G-invariant relations; these relations arise from an arbitrary set of generators of the invariant ring of G in a natural way. When G is the symmetric group, the most obvious generators of this kind form an H-basis (in the sense of Macaulay) of the relation ideal. This means that there is an effective way to write any given relation in terms of these generators. We further show that such a result cannot be expected to hold for the alternating group.

The purpose of this study was to evaluate the usefulness and diagnostic performance of a 5-point standardized diagnostic certainty lexicon for reporting the likelihood of extracapsular extension (ECE) of prostate cancer on routine staging prostate MRI.This study was a retrospective analysis of routine clinical prostate MRI reports before (254 patients) and after (211 patients) the implementation of a 5-point diagnostic certainty lexicon. Whole-mount step-section pathology of the radical prostatectomy specimens served as the reference standard. The terms used to express diagnostic certainty regarding ECE on standard-of-care MRI and the presence of ECE on pathology were compared between the two periods. ROC analysis was used to evaluate the diagnostic accuracy of the 5-point certainty lexicon for detecting ECE.Before the implementation of the certainty lexicon, radiologists used 38 different terms to express the levels of certainty regarding the presence of ECE on MRI. Afterward, they adhered to the lexicon's predefined 5-point terminology in 85.3% of cases. The 5-point certainty lexicon used on MRI reports had an AUC of 0.852 for diagnosing ECE.The implementation of a lexicon of diagnostic certainty dramatically reduced the number of expressions used by radiologists to indicate their levels of diagnostic certainty. The accuracy of the certainty lexicon for diagnosing ECE on standard-of-care prostate MRI is similar to previously reported accuracy values for the diagnosis of ECE by MRI. Thus, the use of such a lexicon might prevent miscommunication and help referring clinicians reliably incorporate radiologists' assessments into clinical decision making.

Introduction Pulse transit time (PTT) is generally assumed to be a surrogate marker for blood pressure changes and arterial stiffness. The aim was to evaluate whether pulmonary PTT (pPTT) may be noninvasively measured by Doppler echocardiography and whether it might be valuable for detecting pulmonary hemodynamic and vascular alterations. Methods We defined pPTT as the interval between R-wave in the ECG and the corresponding peak late systolic pulmonary vein flow velocity measured by pw-Doppler in the pulmonary vein. Twelve consecutive patients with pulmonary hypertension (PH) and 12 subjects without any cardiovascular or respiratory disease were included in the study. All patients underwent a standard echocardiography including pPTT measurement. Results In the PH group, 5 patients had idiopathic pulmonary arterial hypertension (WHO 1), 1 patient PH associated with connective tissue disease (CTD, WHO 1) without pulmonary fibrosis (PF), and 6 patients PH associated with PF either due to CTD (WHO 1) or other etiology (WHO 3). Mean pPTT was significantly shorter in the PH group (138.0 ± 16.78 msec; P

INTRODUCTION: There is growing evidence that exercise-induced variation in lung volumes is an important source of ventilatory limitation and is linked to exercise intolerance in COPD. The aim of this study was to compare the correlations of walk distance and lung volumes measured before and after a 6-min walk test (6MWT) in subjects with COPD. METHODS: Forty-five subjects with stable COPD (mean pre-bronchodilator FEV1: 47 ± 18% predicted) underwent a 6MWT. Body plethysmography was performed immediately pre- and post-6MWT. RESULTS: Correlations were generally stronger between 6-min walk distance and post-6MWT lung volumes than between 6-min walk distance and pre-6MWT lung volumes, except for FEV1. These differences in Pearson correlation coefficients were significant for residual volume expressed as percent of total lung capacity (−0.67 vs −0.58, P = .043), percent of predicted residual volume expressed as percent of total lung capacity (−0.68 vs −0.59, P = .026), inspiratory vital capacity (0.65 vs 0.54, P = .019), percent of predicted inspiratory vital capacity (0.49 vs 0.38, P = .037), and percent of predicted functional residual capacity (−0.62 vs −0.47, P = .023). CONCLUSIONS: In subjects with stable COPD, lung volumes measured immediately after 6MWT are more closely related to exercise limitation than baseline lung volumes measured before 6MWT, except for FEV1. Therefore, pulmonary function testing immediately after exercise should be included in future studies on COPD for the assessment of exercise-induced ventilatory constraints to physical performance that cannot be adequately assessed from baseline pulmonary function testing at rest.

Chordomas mainly arise along the axial skeleton and are characterized by their slow but destructive growth. Prognosis and quality of life are poor because treatment options are mainly limited to surgery and radiotherapy. Survivin, a member of the apoptosis inhibitor protein family, functions as a key regulator of mitosis and programmed cell death, and is overexpressed in many tumor types. The aim of this study was to determine the role of survivin in chordomas. Survivin expression was investigated in 50 chordoma samples and three chordoma cell lines using immunohistochemistry. The intensity of immunostaining was evaluated in regard to the development of recurrences. The immunohistochemical results were correlated with clinical parameters like gender, age, tumor size, and location and were performed in primary chordomas as well as in recurrent lesions. Furthermore, survivin knockdown experiments on chordoma cell lines were performed. YM155 decreased the growth behavior of chordoma cells dose- and time dependently. Transient knockdown of survivin led to a G2/M arrest, decreased proliferation, consistently induced an increase of polyploidy and morphological changes, and induced apoptosis. The resultant data from this study suggest that survivin plays a cell cycle-progressive role in chordomas. Hence, regulation of survivin by YM155 is a promising new target for the development of new therapeutic drugs.

We establish several finiteness properties of groups defined by algebraic difference equations. One of our main results is that a subgroup of the general linear group defined by possibly infinitely many algebraic difference equations in the matrix entries can indeed be defined by finitely many such equations. As an application, we show that the difference ideal of all difference algebraic relations among the solutions of a linear differential equation is finitely generated., 38 pages. This version (v2) is a major reorganization of the first version (v1). Roughly, the first four sections of v2 correspond to the first four sections of v1. The 5th section of v2 corresponds to the 6th section of v1 and the 6th section of v2 corresponds to the 9th section of v1. The 7th section of v2 is new. The sections of v1 not contained in v2 will appear elsewhere

Background Due to preferential implantation of bifurcated devices during endovascular repair of infrarenal abdominal aortic aneurysms (AAA), longer-term results following aortouni-iliac (AUI) endografting are scarce. The aim of this study was to determine the rate of endoleaks as well as frequency of secondary correction procedures after elective and emergent AUI endografting. Methods A prospectively gathered database at a tertiary care university hospital was retrospectively reviewed from January 2000 until January 2012. This interrogation identified 61 patients who had undergone AUI endografting to treat their AAA. Data retrieval obtained 47 patients with elective AAA repairs while 14 patients received emergent AUI endografting in case of rupture. Procedural outcomes, endoleaks, complications, and secondary interventions during mid-term follow-up were recorded for analysis. Results Fifty-five patients of the study cohort were male (90.2%) and mean age was 76.5 years (median: 77.2, Q1–Q3: 72.1–81.6). Patient demographics, comorbidities, procedural characteristics, as well as median follow-up length (39.8 months versus 34.9 months) were similar between groups. Endoleaks, complications, and rate of secondary correction procedures were not increased following emergent AUI endografting. The majority of these interventions comprised catheter-based or less invasive surgical procedures. All patients requiring major surgery (three open surgical conversions with endograft explantation and one open aortic banding) survived, while one patient sustained fatal myocardial infarction after a transluminal correction procedure. Conclusion Emergent AUI endografting was not associated with higher rates of adverse events or correction procedures during mid-term follow-up. Secondary interventions to maintain aneurysm exclusion could be carried out with low mortality.

Pulse transit time (PTT), the interval between ventricular electrical activity and peripheral pulse wave, is assumed to be a surrogate marker for blood pressure (BP) changes. The objective of this study was to analyze PTT and its relation to BP during cardiopulmonary exercise tests (CPET). In 20 patients (mean age 51±18.4 years), ECG and finger-photoplethysmography were continuously recorded during routine CPETs. PTT was calculated for each R-wave in the ECG and the steepest slope of the corresponding upstroke in the plethysmogram. For each subject, linear and non-linear regression models were used to assess the relation between PTT and upper-arm oscillometric BP in 9 predefined measuring points including measurements at rest, during exercise and during recovery. Mean systolic BP (sBP) and PTT at rest were 128 mm Hg and 366 ms respectively, 197 mm Hg and 289 ms under maximum exercise, and 128 mm Hg and 371 ms during recovery. Linear regression showed a significant, strong negative correlation between PTT and sBP. The correlation between PTT and diastolic BP was rather weak. Bland-Altman plots of sBP values estimated by the regression functions revealed slightly better limits of agreements for the non-linear model (–10.9 to 10.9 mm Hg) than for the linear model (−13.2 to 13.1 mm Hg). These results indicate that PTT is a good potential surrogate measure for sBP during exercise and could easily be implemented in CPET as an additional parameter of cardiovascular reactivity. A non-linear approach might be more effective in estimating BP than linear regression.

To present a single-center experience with failed EVAR requiring conversions comparing open surgery to a minimally invasive procedure modifying the existing stent-graft into an aortouni-iliac (AUI) configuration.A prospectively maintained database at our tertiary care university hospital was interrogated to identify all patients with failed EVAR who had undergone either stent-graft modification into an AUI configuration or open conversion between March 1995 and January 2012. Patients with late aneurysm ruptures were excluded. The search found 30 patients (one had initial treatment elsewhere) who required conversion among the 688 patients who had undergone EVAR in that time period. Before conversion, 16 (53%) patients had prior endovascular corrections to maintain aneurysm exclusion.An average time of 52.2 months (median 46.9, IQR 0.0-92.5) elapsed between initial EVAR and conversion. There were 11 early conversions (including 7 on-table), while 19 procedures were done30 days post EVAR. Twenty-two (73%) patients underwent AUI endografting, while open conversions were carried out in 8 (27%). Mean hospital stay after conversion was 19.5 days (median 13.0, IQR 8.0-17.0). Overall mortality after conversion was 3.3% (1 patient after on-table open conversion), but since the introduction of AUI endografting as an alternative treatment approach, 30-day mortality following conversions fell to zero.Modification of a failed stent-graft into an AUI configuration serves as a less invasive treatment option compared to open conversion and allows salvage of the failed device. With the implementation of this alternative approach, mortality after conversion parallels the mortality of elective abdominal aneurysm repair.

Fragestellung: Die Behandlung vertebraler Metastasen erfolgt im palliativen Setting, primum nihil nocere bedeutet hier Symptome lindern, ohne die Lebensqualität durch den Eingriff zu mindern. Für die Entscheidung ob chirurgische oder konservative Therapieoptionen für die PatientInnen [for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2014)

We present the canonical Gröbner Cover method for discussing parametric polynomial systems of equations. Its objective is to decompose the parameter space into subsets (segments) for which it exists a generalized reduced Gröbner basis in the whole segment with fixed set of leading power products on it. Wibmer's Theorem guarantees its existence. The Gröbner Cover is designed in a joint paper of the authors, and the Singular grobcov.lib library [15] implementing it, is developed by Montes. The algorithm is canonic and groups the solutions having the same kind of properties into different disjoint segments. Even if the algorithms involved have high complexity, we show how in practice it is effective in many applications of medium difficulty. An interesting application to automatic deduction of geometric theorems is roughly described here, and another one to provide a taxonomy for exact geometrical loci computations, that is experimentally implemented in a web based application using the dynamic geometry software Geogebra, is explained in another session.