RESUMEN
Variations of atmospheric CO2 during the Pleistocene ice-ages have been associated with changes in the drawdown of carbon into the deep-sea. Modelling studies suggest that about one third of the glacial carbon drawdown may not be associated to the deep ocean, but to the thermocline or intermediate ocean. However, the carbon storage capacity of thermocline waters is still poorly constrained. Here we present paired 230Th/U and 14C measurements on scleractinian cold-water corals retrieved from ~ 450 m water depth off the Maldives in the Indian Ocean. Based on these measurements we calculate ∆14C, ∆∆14C and Benthic-Atmosphere (Batm) ages in order to understand the ventilation dynamics of the equatorial Indian Ocean thermocline during the Last Glacial Maximum (LGM). Our results demonstrate a radiocarbon depleted thermocline as low as -250 to -345 (∆∆14C), corresponding to ~ 500-2100 years (Batm) old waters at the LGM compared to ~ 380 years today. More broadly, we show that thermocline ventilation ages are one order of magnitude more variable than previously thought. Such a radiocarbon depleted thermocline can at least partly be explained by variable abyssal upwelling of deep-water masses with elevated respired carbon concentrations. Our results therefore have implications for radiocarbon-only based age models and imply that upper thermocline waters as shallow as 400 m depth can also contribute to some of the glacial carbon drawdown.
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Respiración , Agua de Mar , Océano Índico , Carbono , AguaRESUMEN
The treatment of burn wounds is subject to a defined management which can be divided into preclinical treatment, emergency room management, and the clinical phase. A decisive factor for the care of a burn patient is correct assessment of the extent of the burn injury. At the location of the accident, vital functions, i.v. catheters, fluid management, the decision for intubation, and sufficient pain control are crucial. The admission of patients to the emergency room should be subject to a standardized protocol, which is quickly and effectively performed by an interdisciplinary team. Emergency room management consists of a mechanical cleaning and subsequent accurate assessment of the extent of the burn injury, monitoring of vital functions, diagnosis and treatment of an inhalation injury as well as associated injuries, and the appropriate care of the burn wounds.
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Vendajes , Quemaduras/diagnóstico , Quemaduras/terapia , Fluidoterapia/métodos , HumanosRESUMEN
We reviewed the natural history and assessed the SMN2 copy number of 66 patients with infantile spinal muscular atrophy (SMA) type I born between 2000 and 2005 in Germany whose diagnosis was confirmed by a homozygous SMN1 deletion in the first 6 months of life. After excluding patients who had received valproic acid, the median/mean age at disease endpoint was 6.1/7.3 months (range 0.0-34.0). Four (6.1%) patients with one SMN2 copy had severe SMA type '0' with joint contractures and respiratory distress from birth. Median/mean age at onset (months) in 57 (86.3%) patients with two SMN2 copies was 1.2/1.3, and 3.5/3.4 in 5 (7.6%) patients with three SMN2 copies. Median/mean age at disease endpoint was 6.5/7.8 months (range 0.5-30) in patients with two SMN2 copies. All patients with three SMN2 copies were still alive at 10-55 months, two of them under permanent ventilation. Our data are relevant for prognostication and genetic counselling. The observed clinical variability, especially in the group with two SMN2 copies, might be important for clinical trials in SMA I where a possible control group could be defined as follows: age at onset within 4-5 months, age at genetic diagnosis <6 months, two SMN2 copies present, head control in less than 10%, no respiratory distress from birth, disease endpoint either age at death or age at permanent ventilation.
Asunto(s)
Ensayos Clínicos como Asunto , Asesoramiento Genético , Atrofias Musculares Espinales de la Infancia/genética , Atrofias Musculares Espinales de la Infancia/patología , Edad de Inicio , Estudios de Cohortes , Dosificación de Gen/genética , Genotipo , Alemania/epidemiología , Humanos , Lactante , Fenotipo , Atrofias Musculares Espinales de la Infancia/tratamiento farmacológico , Atrofias Musculares Espinales de la Infancia/mortalidad , Tasa de Supervivencia , Proteína 2 para la Supervivencia de la Neurona Motora/genética , Ácido Valproico/uso terapéuticoRESUMEN
OBJECTIVE: Homozygous deletions/mutations of the SMN1 gene cause infantile spinal muscular atrophy (SMA). The presence of at least one SMN2 gene copy is required for normal embryogenesis. Lack of SMN protein results in degeneration of motor neurons, while extraneuronal manifestations have been regarded as a chance association with SMA. We report on heart defects in the subgroup of congenital SMA type I patients. METHODS: Data were recruited from 65 unselected SMA I patients whose diagnosis had been confirmed genetically within the first 6 months of age. SMN2 copy numbers were analysed retrospectively and correlated with clinical findings including heart malformations. RESULTS: Four (6%) patients had one copy of SMN2, 56 (86%) had two and five (8%) had three SMN2 copies. Three out of four (75%) patients with a single SMN2 copy had congenital SMA with haemodynamically relevant atrial or ventricular septal defects. CONCLUSIONS: Previous case reports of SMA I patients with congenital heart defects did not clarify whether the cardiac malformations were coincidental. Given the respective incidences of congenitally lethal SMA with a single SMN2 copy and of cardiac septal defects in humans, a chance association of both conditions would occur in less than one out of 50 million individuals. Our findings suggest that the SMN protein is relevant for normal cardiogenesis.
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Cardiopatías Congénitas/complicaciones , Proteínas del Complejo SMN/genética , Atrofias Musculares Espinales de la Infancia/complicaciones , Femenino , Dosificación de Gen , Cardiopatías Congénitas/genética , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Atrofias Musculares Espinales de la Infancia/genética , Proteína 2 para la Supervivencia de la Neurona MotoraRESUMEN
BACKGROUND: The postdoctoral lecturer thesis in medicine represents an essential success factor for the career of a physician; however, there is controversial discussion on whether this reflects academic competence or is more a career booster. In this context we conducted a survey among postdoctoral medical lecturers with the aim to evaluate the significance of this qualification. MATERIAL AND METHODS: The online survey was performed using a questionnaire requesting biographical parameters and subjective ratings of topics concerning the postdoctoral lecturer thesis. RESULTS: Overall 628 questionnaires were included in the study. The significance of the postdoctoral qualification was rated high in 68.6 % and was seen to be necessary for professional advancement in 71.0 %. The chances of obtaining a full professorship after achieving a postdoctoral qualification were rated moderate to low (68.1 %); nevertheless, 92.3 % would do it again and 86.5 % would recommend it to colleagues. Accordingly, 78.8 % were against its abolishment. Wishes for reforms included standardized federal regulations, reduced dependency on professors and more transparency. CONCLUSION: The postdoctoral lecturer qualification in medicine is highly valued and the majority of responders did not want it to be abolished. Although the chances for a full professorship were only rated low, successful graduation seems to be beneficial for the career; however, there is a need for substantial structural and international changes.
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Tesis Académicas como Asunto , Movilidad Laboral , Competencia Clínica , Educación de Postgrado en Medicina , Docentes Médicos/educación , Docentes/educación , Éxito Académico , Alemania , Humanos , Internet , Encuestas y CuestionariosRESUMEN
Papillary tumors originate from the various structures of the ampulla of Vater; therefore, these rare tumors represent a heterogeneous group of tumor entities. Intestinal differentiated adenomas are the most common benign lesions, whereas intestinal differentiated papillary carcinomas are the most common malignant tumors. Carcinomas with pancreaticobiliary differentiation have a poorer prognosis. Mesenchymal and neuroendocrine tumors are among the least frequent papillary tumors. Diagnosis is performed by side-view upper endoscopy and biopsy. In cases of suspected malignancy a complete staging with computed tomography (CT) and endoscopic ultrasound scanning is indicated to determine local tumor spread.Adenomas are removed by endoscopic snare papillectomy whereas the therapy of choice for papillary carcinomas is pancreatic head resection with systematic lymphadenectomy. Patients with papillary carcinomas are most likely to benefit from adjuvant therapy, which should be determined in an interdisciplinary consensus conference considering the histological differentiation of the tumor.
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Adenoma/cirugía , Ampolla Hepatopancreática/cirugía , Carcinoma Papilar/cirugía , Neoplasias del Conducto Colédoco/cirugía , Adenoma/diagnóstico , Adenoma/mortalidad , Adenoma/patología , Ampolla Hepatopancreática/patología , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/mortalidad , Carcinoma Papilar/patología , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/mortalidad , Neoplasias del Conducto Colédoco/patología , Conducta Cooperativa , Humanos , Comunicación Interdisciplinaria , Estadificación de Neoplasias , Páncreas/patología , Páncreas/cirugía , Pronóstico , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
Tendon injuries of the hand are common and their treatment is surgically challenging. Precise knowledge of the anatomy of the extensor and flexor tendons in the hand is necessary to be able to perform a detailed clinical examination and to estimate adequately the extent of injury. Depending on the injury pattern, various conservative and surgical treatment options must be considered. Concerning the overall concept of the supply of tendon injuries of the hand, follow-up treatment is crucial to achieve an optimal functional outcome. It should be noted, however, that the results are influenced by the following: extent of the injury, mechanism, exact anatomical location, associated injuries, and finally the participation of the patient in the follow-up treatment.
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Traumatismos de los Dedos/cirugía , Traumatismos de la Mano/cirugía , Traumatismos de los Tendones/cirugía , Pulgar/lesiones , Desbridamiento , Traumatismos de los Dedos/diagnóstico , Fijación Interna de Fracturas , Traumatismos de la Mano/diagnóstico , Humanos , Cuidados Posoperatorios , Rotura , Técnicas de Sutura , Traumatismos de los Tendones/diagnóstico , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/cirugíaRESUMEN
The Malawi Rift and Pliocene palaeofaunas, which include a hominid mandible attributed to Homo rudolfensis, provide a biogeographical link between the better known Plio-Pleistocene faunal records of East and Southern Africa. The Malawi Rift is in a latitudinal position suitable for recording any hominid and faunal dispersion towards the Equator that was brought on by increased aridity of the Late Pliocene African landscape. The evidence suggests that Pliocene hominids originated in the eastern African tropical domain and dispersed to southern Africa only during more favourable ecological circumstances.
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Fósiles , Hominidae , Mandíbula , África Oriental , África Austral , Animales , Evolución Biológica , Hominidae/clasificación , HumanosRESUMEN
A 4-year-old girl presented with recurrent infections. Immunoglobulin deficiency (serum and secretory IgA, serum IgG3) neutropenia and neutrophil dysfunction (defective spontaneous migration and chemotaxis) were found. T-lymphocyte counts were normal and they responded to phytohaemagglutinin but were not stimulated by Concanavalin A, pokeweed mitogen and microbial antigens in vitro. Delayed cutaneous hypersensitivity testing to purified protein derivative and candidin was negative. Despite bacille Calmette-Guérm vaccination and candidiasis, near normal beta-2-micro-globulin and human leucocyte antigen (HLA) class I concentrations were detected on mononuclear cells and phytohaemagglutinin-induced lymphoblasts. HLA class II antigens (HLA-DP, -DQ, -DR) were not expressed. These observations indicated a bare lymphocyte syndrome (BLS) type II. This is the first time neutrophil dysfunction has been noted in association with BLS.