Direct Observation of Incoherent Cherenkov Diffraction Radiation in the Visible Range.

We report on the observation of incoherent Cherenkov radiation emitted by a 5.3 GeV positron beam circulating in the Cornell electron-positron storage ring as the beam passes in the close vicinity of the surface of a fused silica radiator (i.e., at a distance larger than 0.8 mm). The shape of the radiator was designed in order to send the Cherenkov photons towards the detector, consisting of a compact optical system equipped with an intensified camera. The optical system allows both the measurements of 2D images and angular distribution including polarization study. The corresponding light intensity has been measured as a function of the distance between the beam and the surface of the radiator and has shown a good agreement with theoretical predictions. For highly relativistic particles, a large amount of incoherent radiation is produced in a wide spectral range. A light yield of 0.8×10^{-3} photon per particle per turn has been measured at a wavelength of 600±10 nm in a 2 cm long radiator and for an impact parameter of 1 mm. This will find applications in accelerators as noninvasive beam diagnostics for both leptons and hadrons.

Antitumor activity of lurbinectedin (PM01183) and doxorubicin in relapsed small-cell lung cancer: results from a phase I study.

BACKGROUND: Lurbinectedin (PM01183) has synergistic antitumor activity when combined with doxorubicin in mice with xenografted tumors. This phase I trial determined the recommended dose (RD) of doxorubicin (bolus) and PM01183 (1-h intravenous infusion) on day 1 every 3 weeks (q3wk), and obtained preliminary evidence of antitumor activity for this combination in small-cell lung cancer (SCLC). PATIENTS AND METHODS: Patients with advanced solid tumors received doxorubicin and PM01183 following a standard dose escalation design and expansion at the RD. Twenty-seven patients had relapsed SCLC: 12 with sensitive disease (platinum-free interval ≥90 days) and 15 with resistant disease (platinum-free interval <90 days). RESULTS: Doxorubicin 50 mg/m2 and PM01183 4.0 mg flat dose was the RD. In relapsed SCLC, treatment tolerance at the RD was manageable. Transient and reversible myelosuppression (including neutropenia, thrombocytopenia, and febrile neutropenia) was the main toxicity, managed with dose adjustment and colony-stimulating factors. Fatigue (79%), nausea/vomiting (58%), decreased appetite (53%), mucositis (53%), alopecia (42%), diarrhea/constipation (42%), and asymptomatic creatinine (68%) and transaminase increases (alanine aminotransferase 42%; aspartate aminotransferase 32%) were common, and mostly mild or moderate. Complete (n = 2, 8%) and partial response (n = 13, 50%) occurred in relapsed SCLC, mostly at the RD. Response rates at second line were 91.7% in sensitive disease [median progression-free survival (PFS)=5.8 months] and 33.3% in resistant disease (median PFS = 3.5 months). At third line, response rate was 20.0% (median PFS = 1.2 months), all in resistant disease. CONCLUSION: Doxorubicin 50 mg/m2 and PM01183 4.0 mg flat dose on day 1 q3wk has shown remarkable activity, mainly in second line, with manageable tolerance in relapsed SCLC, leading to further evaluation of this combination within an ongoing phase III trial.

Chiral segregation driven by a dynamical response of the adsorption footprint to the local adsorption environment: bitartrate on Cu(110).

Local or global ordering of chiral molecules at a surface is a key step in both chiral separation and heterogeneous enantioselective catalysis. Using density functional theory and scanning probe microscopy results, we find that the accepted structural model for the well known bitartrate on Cu(110) chiral system cannot account for the chiral segregation observed. Instead, we show that this strongly bound, chiral adsorbate changes its adsorption footprint in response to the local environment. The flexible adsorption geometry allows bitartrate to form stable homochiral trimer chains in which the central molecule restructures from a rectangular to an oblique footprint, breaking its internal hydrogen bonds in order to form strong intermolecular hydrogen bonds to neighbouring adsorbates. Racemic structures containing mixed enantiomers do not form strong hydrogen bonds, providing the thermodynamic driving force for the chiral separation that is observed experimentally. This result shows the importance of considering the dynamical response of molecular adsorption footprints at the surface in directing chiral assembly and segregation. The ability of strongly-chemisorbed enantiomers to change footprint depending on the local adsorption environment indicates that supramolecular assemblies at surfaces may exhibit more complex dynamical behaviour than hitherto suspected, which, ultimately, could be tailored to lead to environment and stimuli-responsive chiral surfaces.

Decision-making in a patient with cardiac arrest due to venous thromboembolism within 24 h after glioblastoma resection.

In the fulminant VTE form with cardiac arrest, systemic thrombolysis remains the most effective therapy. However, several contraindications restrict the use such as intracranial neoplasm or a recent history of intracranial surgery. Here, we report the case of a 59-year-old man who underwent glioblastoma resection and suffered from a fulminant pulmonary embolism with cardiac arrest. After CPR, continuous tPA infusion via an endovascularly placed pulmonary catheter was maintained over a period of 8 h. In this case, we report on our decision-making process and the use of local thrombolysis as a successful therapy in a patient with multiple contraindications.

Early failure with the Journey-Deuce bicompartmental knee arthroplasty.

The aim of this study was to evaluate the early functional outcome and survivorship of a bicompartmental knee arthroplasty implant (Journey-Deuce) in a cohort of patients with combined medial and patellofemoral degenerative osteoarthritis. Fifteen patients with a mean age of 57 years were followed up prospectively and evaluated with clinical examination, Oxford knee score and radiology imaging. Poor pain scores, concerns about the tibial fixation, early aseptic loosening of the tibial component and a revision rate of 60 % at a minimum follow-up of 54 months are reported. Implantation of this prosthesis was stopped at our institution well before the first revision due to an unfavourable early clinical response. This was further endorsed by an unacceptable revision rate. The outcome of the Journey-Deuce bicompartmental knee replacement was considerably worse than the published outcome of total knee replacement.

Noncollinear Polarization Gating of Attosecond Pulse Trains in the Relativistic Regime.

High order harmonics generated at relativistic intensities have long been recognized as a route to the most powerful extreme ultraviolet pulses. Reliably generating isolated attosecond pulses requires gating to only a single dominant optical cycle, but techniques developed for lower power lasers have not been readily transferable. We present a novel method to temporally gate attosecond pulse trains by combining noncollinear and polarization gating. This scheme uses a split beam configuration which allows pulse gating to be implemented at the high beam fluence typical of multi-TW to PW class laser systems. Scalings for the gate width demonstrate that isolated attosecond pulses are possible even for modest pulse durations achievable for existing and planned future ultrashort high-power laser systems. Experimental results demonstrating the spectral effects of temporal gating on harmonic spectra generated by a relativistic laser plasma interaction are shown.

Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives.

BACKGROUND: In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy in palliative care (2010 - 2015) to serve as a longitudinal monitoring instrument and as a basis for redefinition of palliative care learning objectives and curriculum planning in our country. METHODS: As in 2007, a questionnaire was sent to the deans of all five medical faculties in Switzerland in 2012. It consisted of eight sections: basic background information, current content and hours in dedicated palliative care blocks, current palliative care content in other courses, topics related to palliative care presented in other courses, recent attempts at improving palliative care content, palliative care content in examinations, challenges, and overall summary. Content analysis was performed and the results matched with recommendations from the EAPC for undergraduate training in palliative medicine as well as with recommendations from overseas countries. RESULTS: There is a considerable increase in palliative care content, academic teaching staff and hours in all medical faculties compared to 2007. No Swiss medical faculty reaches the range of 40 h dedicated specifically to palliative care as recommended by the EAPC. Topics, teaching methods, distribution throughout different years and compulsory attendance still differ widely. Based on these results, the official Swiss Catalogue of Learning Objectives (SCLO) was complemented with 12 new learning objectives for palliative and end of life care (2013), and a national basic script for palliative care was published (2015). CONCLUSION: Performing periodic surveys of palliative care teaching at national medical faculties has proven to be a useful tool to adapt the national teaching framework and to improve the recognition of palliative medicine as an integral part of medical training.

Selection of trait combinations through bee and fly visitation to flowers of Polemonium foliosissimum.

Pollinators are known to exert natural selection on floral traits, but the extent to which combinations of floral traits are subject to correlational selection (nonadditive effects of two traits on fitness) is not well understood. Over two years, we used phenotypic manipulations of plant traits to test for effects of flower colour, flower shape and their interaction on rates of pollinator visitation to Polemonium foliosissimum. We also tested for correlational selection based on weighting visitation by the amount of conspecific pollen delivered per visit by each category of insect visitor. Although bumblebees were the presumed pollinators, solitary bees and flies contributed substantially (42%) to pollination. In manipulations of one trait at a time, insects visited flowers presenting the natural colour and shape over flowers manipulated to present artificial mutants with either paler colour or a more open or more tubular flower. When both colour and shape were manipulated in combination, selection on both traits arose, with bumblebees responding mainly to colour and flies responding mainly to shape. Despite selection on both floral traits, in a year with many bumblebees, we saw no evidence for correlational selection of these traits. In a year when flies predominated, fly visitation showed a pattern of correlational selection, but not favouring the natural phenotype, and correlational selection was still not detected for expected pollen receipt. These results show that flower colour and shape are subject to pollinator-mediated selection and that correlational selection can be generated based on pollinator visitation alone, but provide no evidence for correlational selection specifically for the current phenotype.

The importance of cutaneous gas exchange during aerial and aquatic respiration in galaxiids.

The Canterbury mudfish Neochanna burrowsius was found to be a pseudo-aestivating galaxiid with a low metabolic rate and significant cutaneous oxygen uptake (c. 43%) in both air and water. Another galaxiid, inanga Galaxias maculatus, had a higher metabolic rate in both media but the proportion of oxygen uptake met by cutaneous respiration rose significantly from 38 to 63% when the fish were exposed to air. Besides its important role in oxygen uptake, the skin of both species also contributed significantly to excretion of carbon dioxide in air, indicating the critical role of the integument as a respiratory tissue. In air, G. maculatus may increase cutaneous gas exchange to meet metabolic demands owing to the reduced utility of the gills, but as emersed G. maculatus were only able to maintain metabolic rates at c. 67% of that measured in water, this strategy probably only permits short-term survival. By contrast, the low and unchanging metabolic rate in water and air in N. burrowsius is a feature that may facilitate tolerance of long periods of emersion in the desiccating environments they inhabit.

Adverse childhood experiences and alcohol related negative consequence among college student drinkers.

OBJECTIVE: Despite increasing college campus prevention efforts, and identification of effective strategies to reduce drinking, reducing alcohol related negative consequences (ARNC, e.g., regrets, blackouts, self- and other- injury, law enforcement exposure, sexual assault, and considering suicide) continues to be a challenge. While college students with a history of adverse childhood experiences (ACE) are at greater risk for alcohol misuse, research regarding the association between ACE and ARNC remains limited. METHODS: Data are responses of currently drinking students on the American College Health Association-National College Health Assessment (ACHA-NCHA II) and College Student Health Survey (CSHS), administered in 2018 to students in California and Minnesota (N = 6,667). RESULTS: On average, students reported one ARNC (SD = 1.30) although 13 % experienced three or more different types of ARNC in the past year. Every ACE was associated with a 19 % to 41 % increase in the IRR of ARNC. Students with 1-3 ACE experienced significantly more types of ARNC events (IRR 1.55, 95 % CI: 1.44-1.67) than students with no ACE and students with ≥ 4 ACE experienced statistically significantly more types of ARNC events (IRR 2.04, 95 % CI: 1.82-2.31) than their peers with 1-3 or no ACE. The ACE-ARNC relationship did not vary by drinking frequency or binge drinking. CONCLUSIONS: The consistent ACE - ARNC relationship across drinking behaviors suggests alcohol consumption does not fully explain the association between ACE and ARNC and that early adversity heightens vulnerability for ARNC. Implications for future prevention and intervention efforts are discussed.

Development and validation of a risk score (Delay-7) to predict the occurrence of a treatment delay following cycle 1 chemotherapy.

BACKGROUND: The risk of toxicity-related dose delays, with cancer treatment, should be included as part of pretreatment education and be considered by clinicians upon prescribing chemotherapy. An objective measure of individual risk could influence clinical decisions, such as escalation of standard supportive care and stratification of some patients, to receive proactive toxicity monitoring. PATIENTS AND METHODS: We developed a logistic regression prediction model (Delay-7) to assess the overall risk of a chemotherapy dose delay of 7 days for patients receiving first-line treatments for breast, colorectal and diffuse large B-cell lymphoma. Delay-7 included hospital treated, age at the start of chemotherapy, gender, ethnicity, body mass index, cancer diagnosis, chemotherapy regimen, colony stimulating factor use, first cycle dose modifications and baseline blood values. Baseline blood values included neutrophils, platelets, haemoglobin, creatinine and bilirubin. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). Net benefit was used to understand the risk thresholds where the model would perform better than the 'treat all' or 'treat none' strategies. RESULTS: A total of 4604 patients were included in our study of whom 628 (13.6%) incurred a 7-day delay to the second cycle of chemotherapy. Delay-7 showed good discrimination and calibration, with c-statistic of 0.68 (95% confidence interval 0.66-0.7), following internal validation and calibration-in-the-large of -0.006. CONCLUSIONS: Delay-7 predicts a patient's individualised risk of a treatment-related delay at cycle two of treatment. The score can be used to stratify interventions to reduce the occurrence of treatment-related toxicity.

Comparing in-person, blended and virtual training interventions; a real-world evaluation of HIV capacity building programs in 16 countries in sub-Saharan Africa.

We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% and 63.6%, p<0.001). Nursing and midwives constituted the largest learner group overall (1145 [37.9%] vs. 949 [43.3%] vs. 107 [20.5%]). Across all domains of HIV knowledge and self-perceived confidence, there was a mean increase between pre- and post-course assessments, regardless of how training was delivered. The greatest percent increase in knowledge scores was among those participating in the in-person course compared to VW or OC formats (13.6% increase vs. 6.0% and 7.6%, p<0.001). Gains in self-reported confidence were greater among learners who participated in the in-person course compared to VW or OC formats, regardless of training level (p<0.001) or professional cadre (p<0.001). In this multi-country capacity HIV training program, in-person, online synchronous, and blended synchronous/asynchronous strategies were effective means of training learners from diverse clinical settings. Online learning approaches facilitated participation from more women and more diverse cadres. However, gains in knowledge and clinical confidence were greater among those participating in in-person learning programs.

SNP-based association mapping of the polled gene in divergent cattle breeds.

Naturally, hornless cattle are called polled. Although the POLL locus could be assigned to a c. 1.36-Mb interval in the centromeric region of BTA1, the underlying genetic basis for the polled trait is still unknown. Here, an association mapping design was set up to refine the candidate region of the polled trait for subsequent high-throughput sequencing. The case group comprised 101 homozygous polled animals from nine divergent cattle breeds, the majority represented by Galloway, Angus, Fleckvieh and Holstein Friesian. Additionally, this group included some polled individuals of Blonde d'Aquitaine, Charolais, Hereford, Jersey and Limousin breeds. The control group comprised horned Belgian Blue, Fleckvieh, Holstein Friesian and Illyrian Busa cattle. A genome-wide scan using 49,163 SNPs was performed, which revealed one shared homozygous haplotype block consisting of nine neighbouring SNPs in all polled animals. This segment defines a 381-kb interval on BTA1 that we consider to be the most likely location of the POLL mutation. Our results further demonstrate that the polled-associated haplotype is also frequent in horned animals included in this study, and thus the haplotype as such cannot be used for population-wide genetic testing. The actual trait-associated haplotype may be revealed by using higher-density SNP arrays. For the final identification of the causal mutation, we suggest high-throughput sequencing of the entire candidate region, because the identification of functional candidate genes is difficult owing to the lack of a comparable model.

Genome-wide association mapping of milk production traits in Braunvieh cattle.

A whole-genome association study of milk production traits: milk yield, protein yield, fat yield, protein percentage, and fat percentage, was performed on the population of Braunvieh cattle. Five hundred and fifty-four progeny-tested bulls and 36,219 autosomal single nucleotide polymorphism (SNP) markers on 29 Bos taurus autosomes (BTA) were included in the analysis. A principal component analysis was conducted to adjust for the effect of population stratification in the analyzed data set. For the principal component analysis, genome-wide relationships between individuals were calculated. Three different criteria (Horn's test, Kaiser's criterion, and Jolliffe's criterion) were tested to determine the number of significant principal components. Estimation of putative associations between SNP and milk production traits was carried out using a linear regression model in R software (R Foundation for Statistical Computing, Vienna, Austria). Significant principal components, adjusting for population stratification separately for each criterion and family relationships and genotypes at individual SNP were included as fixed effects in the model. The inflation factor λ and quantile-quantile plots were calculated to compare how the different criteria deal with stratification in our mapping population. Based on the analyses on all of the aforementioned criteria, we can conclude that Jolliffe's criterion deals the best with population stratification. Furthermore, significance thresholds for a given genome-wide false discovery rate of 5% were estimated and used for specific traits. Three of the analyzed traits showed genome-wide significant association with SNP. Two SNP had an effect on milk yield on BTA4, 2 SNP affected fat yield on BTA14 and BTA23, and 1 SNP was associated with fat percent on BTA1. Single nucleotide polymorphisms identified in this study as associated with milk production traits will further contribute to the mapping of corresponding quantitative trait loci and investigation of the genes responsible for polymorphisms in milk production traits in dairy cattle. Described comparison of different criteria for determination of significant principal components can provide important information for similar studies in stratified populations.

Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity.

OBJECTIVE: To analyze whether two dietary weight loss interventions--the dietary approaches to stop hypertension (DASH) program and a low-fat diet program--would be cost-effective in Australia, and to assess their potential to reduce the disease burden related to excess body weight. DESIGN: We constructed a multi-state life-table-based Markov model in which the distribution of body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. The target population was the overweight and obese adult population in Australia in 2003. We used a lifetime horizon for health effects and costs, and a health sector perspective for costs. We populated the model with data identified from Medline and Cochrane searches, Australian Bureau of Statistics published catalogues, Australian Institute of Health and Welfare, and Department of Health and Ageing. OUTCOME MEASURES: Disability adjusted life years (DALYs) averted, incremental cost-effectiveness ratios (ICERs) and proportions of disease burden avoided. ICERs under AUS$50,000 per DALY are considered cost-effective. RESULTS: The DASH and low-fat diet programs have ICERs of AUS$12,000 per DALY (95% uncertainty range: Cost-saving- 68,000) and AUS$13,000 per DALY (Cost-saving--130,000), respectively. Neither intervention reduced the body weight-related disease burden at population level by more than 0.1%. The sensitivity analysis showed that when participants' costs for time and travel are included, the ICERs increase to AUS$75,000 per DALY for DASH and AUS$49,000 per DALY for the low-fat diet. Modest weight loss during the interventions, post-intervention weight regain and low participation limit the health benefits. CONCLUSION: Diet and exercise interventions to reduce obesity are potentially cost-effective but have a negligible impact on the total body weight-related disease burden.

SNP-based association mapping of Arachnomelia in Fleckvieh cattle.

Bovine arachnomelia is an inherited congenital disorder with malformation mainly of the limbs, the vertebral column and the skull, following a monogenic autosomal recessive heredity. Despite almost identical pathological findings, arachnomelia has previously been mapped to bovine chromosome 23 and 5 in Fleckvieh and Braunvieh respectively. Therefore, this disorder may be an example of locus heterogeneity in cattle. This study aimed to refine the candidate region to allow positional cloning and sequence analyses of candidate genes in Fleckvieh cattle. For that purpose, a case-control association mapping design was set up with a case group of 16 pre-selected affected individuals and a control group of 50 unrelated animals. The subset of affected animals was selected from a total of 129 pathologically confirmed cases due to the occurrence of recombination(s) within a 14.5 cM candidate interval previously mapped to chromosome 23. Six linked microsatellites currently used for indirect gene testing in Fleckvieh were analysed for this purpose. In all selected cases, a genome-wide scan using 44 473 informative SNPs revealed shared segments of homozygosity at 15 adjacent SNPs on chromosome 23. Additional haplotype analysis of 37 carrier bulls confirmed the localization of the arachnomelia locus to a region of 927 kb (13.622-14.549 Mb) containing molybdenum cofactor biosynthesis protein 1 gene, the most likely candidate gene for arachnomelia in Fleckvieh. The number of recombinant haplotypes observed in cases was more than doubled compared with the number of expected recombinations. This remarkably increased mapping resolution and thus illustrates the benefit of pre-selection in association studies.

Confocal Raman microspectroscopy for evaluating the stratum corneum removal by 3 standard methods.

BACKGROUND/AIMS: Stratum corneum (SC) removal is needed in biopharmaceutical studies or in evaluating the barrier function. The most common technique is the tape stripping method. However, it results in neither a homogeneous nor a complete removal. METHODS: The removal qualities of tape stripping, cyanoacrylate skin surface biopsy and trypsinization were estimated in vitro via histological imaging and confocal Raman microspectroscopy (CRM) and compared. In addition, the potential of the noninvasive CRM as a replacement method is discussed. RESULTS: Comparison between the 3 methods showed, as expected, that the tape stripping method did not result in a uniform removal over the whole surface even after 28 strips. The trypsinization and cyanoacrylate skin surface biopsies allowed a complete and uniform removal of the SC after defining a standard protocol (2 cyanoacrylate strips with a polymerization time of 15 min). CONCLUSION: The feasibility of CRM to control SC removal was demonstrated in vitro. Tape stripping is a simple method, but it is influenced by many extrinsic factors and axial drug quantification is difficult. With trypsinization and cyanoacrylate methods, the entire SC is removed so that quantification over the whole SC is possible but not an axial drug screening.

Analysis of genetic and cultural conservation value of three indigenous Croatian cattle breeds in a local and global context.

It is widely accepted that autochthonous cattle breeds can be important genetic resources for unforeseeable environmental conditions in the future. Apart from that, they often represent local culture and tradition and thus assist in the awareness of ethnic identity of a country. In Croatia, there are only three indigenous cattle breeds, Croatian Busa, Slavonian Syrmian Podolian and Istrian Cattle. All of them are threatened but specialized in a particular habitat and production system. We analysed 93 microsatellites in 51 animals of each breed to get thorough information about genetic diversity and population structure. We further set them within an existing frame of additional 16 breeds that have been genotyped for the same marker set and cover a geographical area from the domestication centre near Anatolia, through the Balkan and alpine regions, to the north-west of Europe. The cultural value was evaluated regarding the role in landscape, gastronomy, folklore and handicraft. The overall results recognize Croatian Busa being partly admixed but harbouring an enormous genetic diversity comparable with other traditional unselected Busa breeds in the Anatolian and Balkan areas. The Podolian cattle showed the lowest genetic diversity at the highest genetic distance to all remaining breeds but are playing an important role as part of the cultural landscape and thus contribute to the tourist industry. The genetic diversity of the Istrian cattle was found in the middle range of this study. It is already included in the tourist industry as a local food speciality. Current and future conservation strategies are discussed.

[Perioperative pain and anxiety in endoscopic sinus surgery]. / Perioperative Schmerzen und Ängste bei endoskopischen Nasennebenhöhleneingriffen mit konventioneller Nasentamponade.

BACKGROUND: Aim of this study was to evaluate the perioperative level of pain and anxiety for endoscopic sinus surgery, and to compare 3 different types of nasal packing. MATERIAL AND METHODS: Prospective, controlled, randomized study comparing different types of nasal packing in regard to perioperative anxiety and pain. Patients suffered from chronic rhinosinusitis with nasal polyps involving all paranasal sinuses. Patients daily evaluated by standardized questionnaires (FPI-R, KASA, STAI) and also visual analog scale for pain on 5 consecutive days before and after endoscopic sinus surgery of all paranasal sinuses. Nasal packings were removed on 2(nd) postoperative day. RESULTS: A total of 73 patients (polyvinyl acetate packing N = 14, glove packing N = 37, glove packing with breathing tubes N = 22) completed the study. Female gender, bad preoperative mood and absence of pain were associated with increased preoperative state anxiety based on regression analysis. Also, preoperative gathering of additional information from relatives and friends was correlated with increased preoperative anxiety. Patients had significantly minor preoperative anxiety if they could expect use of nasal packings with breathing tubes. CONCLUSION: Female patients, who gathered information about the operation from friends or relatives or patient in worse preoperative mood are at risk for increased state anxiety and should be identified prior to rhinosurgical procedures. Use of nasal packing with at least partially preserved nasal breathing is recommended in clinically anxious patients.

Melting of subducted sediments reconciles geophysical images of subduction zones.

Sediments play a key role in subduction. They help control the chemistry of arc volcanoes and the location of seismic hazards. Here, we present a new model describing the fate of subducted sediments that explains magnetotelluric models of subduction zones, which commonly show an enigmatic conductive anomaly at the trenchward side of volcanic arcs. In many subduction zones, sediments will melt trenchward of the source region for arc melts. High-pressure experiments show that these sediment melts will react with the overlying mantle wedge to produce electrically conductive phlogopite pyroxenites. Modelling of the Cascadia and Kyushu subduction zones shows that the products of sediment melting closely reproduce the magnetotelluric observations. Melting of subducted sediments can also explain K-rich volcanic rocks that are produced when the phlogopite pyroxenites melt during slab roll-back events. This process may also help constrain models for subduction zone seismicity. Since melts and phlogopite both have low frictional strength, damaging thrust earthquakes are unlikely to occur in the vicinity of the melting sediments, while increased fluid pressures may promote the occurrence of small magnitude earthquakes and episodic tremor and slip.