Constraints From Exhumed Rocks on the Seismic Signature of the Deep Subduction Interface.

Low Velocity Zones (LVZs) with anomalously high V p-V s ratios occur along the downdip extents of subduction megathrusts in most modern subduction zones and are collocated with complex seismic and transient deformation patterns. LVZs are attributed to high pore fluid pressures, but the spatial correlation between the LVZ and the subduction interface, as well as the rock types that define them, remain unclear. We characterize the seismic signature of a fossil subduction interface shear zone in northern California that is sourced from the same depth range as modern LVZs. Deformation was distributed across 3 km of dominantly metasedimentary rocks, with periodic strain localization to km-scale ultramafic lenses. We estimate seismic velocities accounting for mineral and fracture anisotropy, constrained by microstructural observations and field measurements, resulting in a V p/Vs of 2.0. Comparable thicknesses and velocities suggest that LVZs represent, at least in part, the subduction interface shear zone.

Effects of tranexamic acid on human nasal ciliary beat frequency.

BACKGROUND: Patients with recurrent epistaxis, particularly due to hereditary hemorrhagic telangiectasia (HHT) are recommended to apply topical tranexamic acid (TXA) to reduce bleeding events. Those patients may suffer ciliary dysfunction due to TXA's effects on ciliary beating frequency (CBF) and their consequences. METHODOLOGY/PRINCIPAL: Human nasal epithelial cells were harvested with a nasal brush in 30 healthy subjects. We investigated the CBF in RPMI medium using high-frequency video microscopy. TXA was added to the cells in various concentrations ranging from 2 to 5%, including the therapeutic concentration (2%) and a control (0%). RESULTS: CBF in the control condition was 6.1 ± 1.6 Hz. TXA reduces CBF in a time and concentration dependent manner, to, e.g. 4.3 ± 1.2 Hz with 2% TXA and 3.3 ± 0.9 Hz with 5% TXA after 16-20 min. The differences in CBF were statistically significant for all concentrations of TXA. CONCLUSIONS: TXA has the potential to significantly impair nasal epithelial function. Therefore, frequent or regular topical nasal application of TXA should be done under close monitoring of nasal function, especially in patients with co-morbidities like chronic rhinosinusitis.

The N-terminal pro-brain-type natriuretic peptide based short-term prognosis in patients with acute pulmonary embolism according to renal function.

N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is currently used for risk stratification in acute pulmonary embolism (PE). We aimed to clarify the impact of renal function on the validity of the NT-proBNP based prognosis, assuming that the biomarker is accumulated in renal insufficiency. The NT-proBNP based prediction of PE related in-hospital death was investigated according to renal function in 329 patients with acute PE. The normalized NT-proBNP ratios (NT-proBNP level divided by the age-adjusted normal upper range) were inversely correlated (r = -0.414, P < 0.001) to the estimated glomerular filtration rates (eGFR). A cut-off point of ≥ 2.5 for the normalized NT-proBNP ratio was found to be best for the prediction of mortality (AUC 0.716, 95% CI 0.626-0.805, P < 0.001) and was a significant predictor for death in univariate and multivariate analysis. A normalized NT-proBNP ratio ≥ 2.5 was a significant predictor for PE-mortality only in patients with an eGFR ≥ 60 ml/min/1.73 m². Renal insufficiency significantly predicted mortality in univariate but not in multivariate analysis. High-risk PE and cerebrovascular diseases were significantly more frequent in renal dysfunction and significantly predicted death in univariate and multivariate analysis. The validity of the NT-proBNP based short-term prognosis might be limited in renal dysfunction not only by accumulation, but also because renal insufficiency itself and concurrent conditions are contributing to PE related mortality.

Tracking Deep Sediment Underplating in a Fossil Subduction Margin: Implications for Interface Rheology and Mass and Volatile Recycling.

The architecture and mechanical properties of the subduction interface impact large-scale subduction processes, including mass and volatile recycling, upper-plate orogenesis, and seismic behavior. The nature of the deep subduction interface, where a dominantly frictional megathrust likely transitions to a distributed ductile shear zone, is poorly understood, due to a lack of constraints on rock types, strain distribution, and interface thickness in this depth range. We characterized these factors in the Condrey Mountain Schist, a Late Jurassic to Early Cretaceous subduction complex in northern California that consists of an upper and lower unit. The Lower Condrey unit is predominantly pelagic and hemipelagic metasediment with m-to km-scale metamafic and metaserpentinitic ultramafic lenses all deformed at epidote blueschist facies (0.7-1.1 GPa, 450°C). Major and trace element geochemistry suggest tectonic erosion of the overriding plate sourced all ultramafic and some mafic lenses. We identified two major ductile thrust zones responsible for Lower Condrey unit assembly, with earlier strain distributed across the structural thickness between the ductile thrusts. The Lower Condrey unit records distributed deformation across a sediment-dominated, 2+ km thick shear zone, possibly consistent with low velocity zones observed in modern subduction zones, despite subducting along a sediment poor, tectonically erosive margin. Periodic strain localization occurred when rheological heterogeneities (i.e., km-scale ultramafic lenses) entered the interface, facilitating underplating that preserved 10%-60% of the incoming sediment. Modern mass and volatile budgets do not account for erosive margin underplating, so improved quantification is crucial for predicting mass and volatile net flux to Earth's interior.

[Does multi-slice CT provide reliable attenuation values if measured with low slice thickness and low tube current? Results of a phantom study]. / Sind mit der Mehrschicht-Computertomografie Dichtemessungen auch bei geringer Schichtdicke und niedrigem Röhrenstrom verlässlich? Ergebnisse einer Phantomstudie.

PURPOSE: To test whether CT with low slice thickness and low tube current provides reliable attenuation measurements. MATERIALS AND METHODS: Using multi-slice CT and a phantom, we measured the attenuation values of thrombi with different proportions of erythrocytes, using a slice thickness of 1.25 mm, 2.5 mm, and 5 mm with tube currents of 200 mA, 300 mA, and 400 mA and a slice thickness of 0.625 mm with tube currents of 150 mA, 175 mA, and 200 mA. Differences in attenuation values and pixel noise between the three thrombi for tube current and slice thickness were statistically analyzed. RESULTS: The attenuation values of all thrombi increased (p<0.05) when the slice thickness decreased using a tube current of 200 mA or when the tube current decreased using a slice thickness of 1.25 mm. With higher tube currents and thicker slices, the CT values depended on the type of thrombus and the slice thickness. In slices with a thickness of 0.625 mm, the CT values decreased with the tube current in the mixed thrombus with a low proportion of erythrocytes and in the red thrombus (p<0.05). The maximal difference in mean attenuation values was 4.3 HU with a slice thickness of 0.625 mm and 2.2 HU with a slice thickness of 1.25 mm. The pixel noise increased as the slice thickness decreased (p<0.05) with the exception of the red thrombus, if reduced to 0.625 mm. The pixel noise also increased as the tube current decreased (p<0.05) except in mixed thrombi measured with 0.625 mm. The maximal difference in mean standard deviation was 1.8 HU with a slice thickness of 1.25 mm. CONCLUSION: The accuracy of attenuation values as determined by CT with low slice thickness and low tube current with a maximal difference of 4.3 HU suffices for the purposes of clinical routine. A reduction of slice thickness from 1.25 mm to 0.625 mm yields the greatest differences in CT values.

Tumor cell contamination of peripheral blood stem cell transplants and bone marrow in high-risk breast cancer patients.

Twenty-one high-risk patients with primary stage II/III breast cancer were treated with high-dose chemotherapy comprising etoposide, ifosfamide, carboplatin and epirubicin (VIC-E). Tumor cells of epithelial origin were analyzed using the monoclonal antibodies CK2 (IgG1) and A45-B/B3 (IgG1) against cytokeratin (CK) components in bone marrow (BM) aspirates prior to chemotherapy, and in peripheral blood stem cell transplants (PBSCT). They were separated after the first (21/21 patients) and the second cycle (16/21 patients) of induction chemotherapy with VIP-E (etoposide, ifosfamide, cisplatin, epirubicin). Preliminary results showed CK positive tumor cells in 40% (14/35) of the analyzed transplants. In 7/12 (58.3%) patients, CK positive tumor cells were detectable in BM prior to treatment. Sixteen patients were separated after the 1st and 2nd cycle of VIP-E. PBSCT of 14/16 patients were assessable for presence of CK positive tumor cells. Our preliminary results demonstrate a lower tumor cell contamination of PBSCT separated after the 2nd cycle of induction therapy (14.3%) compared to contamination after the first induction therapy (64.3%). To date, 4/21 patients have experienced a relapse, and three of these patients had tumor cell positive transplants. Due to the small patient number only a trend towards a superior relapse-free survival in the patient group with CK negative transplants can be shown by Kaplan-Meier analysis.

Rhinocerebral mucormycosis in a diabetic ketoacidotic patient.

A 51-year-old, ketoacidotic diabetic with the rare neurological complications of rhinocerebral mucormycosis is reported. The clinical presentation was characterized by initial severe frontal headache, rapid visual loss with complete external ophthalmoplegia and intracranial spread by invasive fungal growth. Its course and fungostatic therapy with amphotericin B and ketoconazole are described and the literature reviewed.

Investigations of cerebrospinal fluid in Borna disease virus seropositive psychiatric patients.

Borna disease virus (BDV) appears to cause meningoencephalitis and schizophreniform psychosis in sporadic cases according to earlier cerebrospinal fluid (CSF) inoculation experiments (Rott et al, 1991). However, CSF parameters in BDV seropositive psychiatric patients proved nearly all normal; only the most sensitive CSF/serum index I-BDV for intrathecally produced BDV specific IgG was pathologic in 10.5-29.0% (according to different methodological limits) of patients. An increase in sensitivity was attempted to detect specific IgG in CSF in a part of the cases by concentration. Concentration procedure does not significantly increase methodological bias according to a statistical analysis of the results. Our findings support the hypothesis that BDV may cause or contribute to the pathogenesis of a diagnostically broad pattern of psychiatric syndromes. The occurence of a spectrum of diagnoses is expected from non-specificity of psychiatric symptoms in other infectious diseases of the brain as well as from results in experimental Borna disease (BD) in animals, when a majority of the animals showed rather unspecific symptomatology due to slight, preferentially limbic encephalitis. Slight deficiencies from an earlier BDV infection could explain continuing symptoms in a part of the cases. Recurrences years after infection are well known in experimental and natural BD in animals. It remains open, whether this mechanism could play a more prominent role in a form of "symptomatic" cyclothymia and "symptomatic" schizophrenia, although the results of CSF investigations are more clear in BDV seropositive patients with major psychoses.

[Bedside determination of clinical-chemical quantities using dry chemistry in an emergency admission]. / Patientennahe Bestimmung klinisch-chemischer Kenngrössen mittels Trockenchemie in einer Notaufnahme.

We evaluated the clinical relevance and reliability of a solid phase chemistry apparatus (Seralyzer) installed for near-patient testing of CK, GOT, glucose and potassium in the emergency admission of our hospital. Calibrations and quality controls were done by technologists of the central laboratory, the analyses were performed by the nursing staff after appropriate training. The rapid availability of the laboratory tests shortened the diagnostic process in only 8% of the patients. Clinical chemistry test results, therefore, appear to be of minor importance in making the diagnosis in an emergency room. The coefficients of variation of the inter-operator imprecision varied between 2.1 and 8.8% (means = 5.06%), when the measurements were performed by persons with no professional laboratory training, and between 2.7 and 8.5% (means = 3.98%) for skilled laboratory personal. In order to test the accuracy we correlated the dry chemistry values measured by the nurses in the daily routine with the results of a wet chemistry system. The Spearman rank correlation coefficients ranged between 0.916 and 0.950. Thus after appropriate training non-laboratory personal is able to perform dry chemistry testing with adequate precision and accuracy provided a competent supervision is guaranteed.

Central thromboembolism is a possible predictor of right heart dysfunction in normotensive patients with acute pulmonary embolism.

BACKGROUND: Right heart dysfunction is a crucial factor in risk stratification of normotensive patients with pulmonary embolism. Apart from biomarkers, determinants of right heart dysfunction in this group of patients are not yet well established. AIM AND METHOD: In order to identify such determinants, we analysed data of 252 patients with acute pulmonary embolism admitted to our hospital in 2008. RESULTS: 69 out of 140 patients showed right heart dysfunction by echocardiography within 24 hours after diagnosis, 71 did not. Right ventricular dysfunction was significantly more frequent in patients with central clots on computed tomography (p=0.004), a history of syncope (p<0.001) and among women on oral contraceptives (p=0.003). In multiple regression analysis, only central thromboembolism (p<0.001) was identified as individual predictor of right ventricular dysfunction. Age, gender, body mass index, idiopathic or recurrent thromboembolism, duration of symptoms, preceding surgery, room air oxygen saturation, carcinoma, hypertension, diabetes, renal disease, congestive left heart failure and concomitant lung disease were equally distributed. In comparison with NT-pro brain natriuretic peptide (PPV 67%, NPV 75%, p=0.782) and troponin I (PPV 76%, NPV 62%, p=0.336), central thromboembolism has shown to have a greater statistical power in predicting right heart dysfunction in normotensive patients with pulmonary embolism (PPV 78%, NPV 88%, p<0.001). CONCLUSION: Among normotensive patients with acute pulmonary embolism, those with central clots seem to be at greater risk for echocardiographically evaluated right ventricular dysfunction.

[Impending Coumarin-necrosis in a patient with heterozygous protein C deficiency type I]. / Drohende Cumarinnekrose bei einer 24-jährigen Patientin mit stattgehabter Beinvenenthrombose.

Painful pink or magenta colored skin lesions characterized by a clear line of demarcation between the affected area and surrounding tissue appearing under therapy with coumarins may be a sign for evolving coumarin-necrosis. Immediate treatment with a protein C preparation in patients with protein C deficiency can prevent necrosis.

[Production of leukocyte-poor erythrocyte concentrates with bedside filtration. Effectiveness and practicability of a new filter system in comparison with 2 other systems]. / Herstellung leukozytenarmer Erythrozytenkonzentrate mittels Bedside-Filtration. Effektivität und Praktikabilität eines neuen Filtersystems im Vergleich zu zwei anderen Systemen.

The effectiveness and practicability of a new filter (Leucostop LT) for the production of leukocyte- and platelet-poor red cells at the bedside was evaluated and compared with two other leukocyte removal filter systems for bedside use (Erypur b and Sepacell R-500 A). As for the residual leukocytes and platelets, we found no essential differences between the tested filter systems: The mean value of the leukocyte contamination was between 11.2 (Leucostop) and 14.3 X 10(6) (Erypur b), the mean value of the platelets between 1.0 (Sepacell) and 3.0 X 10(9) (Erypur) per unit by filtering one red cell concentrate (RCC) through the filter. The red cell recovery after priming the system with 200 ml of saline was between 94.4% (Erypur) and 99.6% (Leucostop). The Leucostop LT system showed the highest flow rate; even 16-day-old RCC could be filtered within 60 min at the bedside, whereas with the Sepacell R-500 A system only 2- or 3-day-old RCC could be filtered in this time.

[Atypical course of infections with enteritis salmonellas]. / Atypische Verlaufsformen von Infektionen mit "Enteritis-Salmonellen".

During the six-year period from 1978-1983 968 so-called "enteritis Salmonellae" were isolated in our laboratory. 50 of them (= 5,2%) were primary isolations from extraintestinal specimens, first of all from blood, abscess smear and urine. The greater part of the patients with an atypical course of enteritis salmonellosis showed clinical signs of septicemia (44%) or local suppuration (24%). In atypical salmonellosis advanced age and sex distinctly prevailed compared to the distribution of age and sex of patients suffering from typical Salmonellae enteritis. 80% of the patients with atypical salmonellosis had mostly resistance lowering basic diseases, first of all diabetes mellitus, or were treated with immunosuppressive therapy. The spectrum of "enteritis Salmonellae" isolated only from feces during the same period differed significantly (p = 0,01) from the spectrum of Salmonellae types found in extraintestinal specimens. An atypical course was relatively often caused by S. enteritidis, S. panama and S. virchow.

Immunologic findings in patients with an atypical course of an infection with non-typhoid salmonellae.

We investigated the state of humoral and cellular immunity of 16 patients (eight women, eight men, aged 16 to 80 years), who had suffered from extraintestinal manifestations of infections with enteritis salmonellae. Four patients were examined during the acute state of the disease, the others one to three years thereafter. These patients were in good clinical condition. In all cases we could exclude an antibody deficiency syndrome. In the peripheral blood of 11 patients, we found a diminished number of T-helper lymphocytes, mostly together with a decrease in total T lymphocytes. Because the microbicidal activity of macrophages may be impaired by a general or localized decrease in T-helper cells, we suggest that the phagocytized enteritis salmonellae survive in this way and cause the atypical course of the infection in these patients.

Quantification of bone alkaline phosphatase in serum by precipitation with wheat-germ lectin: a simplified method and its clinical plausibility.

We report an easy, rapid method for quantifying bone isoenzyme of alkaline phosphatase (EC 3.1.3.1., ALP) in serum. The original method described by Rosalki and Ying Foo (Clin Chem 1984;30:1182-6) was somewhat simplified. In contrast to their results, we found that bone ALP is precipitated quantitatively by wheat-germ lectin. To check the clinical plausibility of the method, we used samples from several comparison groups (blood donors, children, pregnant women, patients with neoplasms but without skeletal involvement) and a large number of patients suffering from bone diseases and diseases of the liver and biliary tree. Measured activities of bone ALP nearly always correlated with the clinical diagnosis. Only patients with hepatitis often had pathological bone activities not in accord with the other findings. Possible reasons for this observation are discussed.

Adult celiac disease and primary biliary cirrhosis.

The association of primary biliary cirrhosis and adult celiac disease was observed in a female patient. Because of their clinical overlap the diagnosis of both conditions may be difficult especially in the early stage of their coexistence. The hypotheses regarding a common etiological link between celiac disease and primary biliary cirrhosis are discussed.

[Effect of storage duration and irradiation dose on in vitro aggregation of thrombocytes]. / Einfluss von Lagerungsdauer und Bestrahlungsdosis auf das In-vitro-Aggregationsverhalten von Thrombozyten.

We studied the influence of storage (1-5 days) and gamma irradiation (0, 25, 50, 100 Gy) on the in vitro aggregability of stored platelets. Platelet aggregation was measured using the method of Born and Breddin and the aggregating agents ADP, collagen, ristocetin and arachidonic acid. With increasing time of storage the ADP-, collagen- and ristocetin-induced platelet aggregation was significantly diminished. On the other hand, the irradiation even with 100 Gy had no additional effect.

[Diagnostic problems in neurosyphilis]. / Diagnostische Probleme bei der Neurosyphilis.

In two patients admitted to hospital-one with signs of cerebral infarction, the other with headaches, vertigo and paraesthesias-the TPHA test was "reactive", while the 19S(IgM)-FTA-ABS test was not. There was no cerebrospinal fluid (CSF) pleocytosis. Further CSF analyses and serological tests for syphilis (including CSF protein profile, demonstration of oligoclonal IgG, quantitative determination of Treponema-specific antibodies in serum and CSF) confirmed the diagnosis of neurosyphilis requiring treatment. In both patients the biologically false-negative 19S(IgM)-FTA-ABS test at first became transiently reactive after treatment. This unusual finding was probably due to antigen, liberated by treatment, again stimulating previously blocked IgM antibody synthesis. The listed additional tests should be performed in all patients with a reactive TPHA test and neurological or psychiatric signs and symptoms.

An amphotericin B-resistant case of rhinocerebral mucor mycosis.

A 51-year-old male patient with diabetes mellitus complicated by ketoacidotic imbalance developed a rhinocerebral mucor mycosis that advanced despite early amphotericin B therapy and extensive surgical intervention. The MIC of amphotericin B for the isolated mucor species was 64 mg/l, meaning that in vitro resistance also existed. Only long-term treatment with ketoconazole (600 mg/day, perorally) was successful in curing the disease.