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The Altenberg–Teplice Volcanic Complex (ATVC) is a large ~ NNW–SSE trending volcano-plutonic system in the southern part of the Eastern Erzgebirge (northern Bohemian Massif, south-eastern Germany and northern Czech Republic). This study presents high precision U–Pb CA-ID-TIMS zircon ages for the pre-caldera volcano-sedimentary Schönfeld–Altenberg Complex and various rocks of the caldera stage: the Teplice rhyolite, the microgranite ring dyke, and the Sayda-Berggießhübel dyke swarm. These data revealed a prolonged time gap of ca. 7–8 Myr between the pre-caldera stage (Schönfeld–Altenberg Complex) and the climactic caldera stage. The volcanic rocks of the Schönfeld–Altenberg Complex represent the earliest volcanic activity in the Erzgebirge and central Europe at ca. 322 Ma. The subsequent Teplice rhyolite was formed during a relatively short time interval of only 1–2 Myr (314–313 Ma). During the same time interval (314–313 Ma), the microgranite ring dyke intruded at the rim of the caldera structure. In addition, one dyke of the Sayda-Berggiesshübel dyke swarm was dated at ca. 314 Ma, while another yielded a younger age (ca. 311 Ma). These data confirm the close genetic and temporal relationship of the Teplice rhyolite, the microgranite ring dyke, and (at least part of) the Sayda-Berggießhübel dyke swarm. Remarkably, the caldera formation in the south of the Eastern Erzgebirge (caldera stage of ATVC: 314–313 Ma) and that in the north (Tharandt Forest caldera: 314–312 Ma) occurred during the same time. These data document a large ~ 60 km NNW–SSE trending magmatic system in the whole Eastern Erzgebirge. For the first time, Hf-O-isotope zircon data was acquired on the ring dyke from the ATVC rocks to better characterize its possible sources. The homogeneous Hf-O-isotope zircon data from the microgranite ring dyke require preceding homogenization of basement rocks. Some small-scale melts that were produced during Variscan amphibolite-facies metamorphism show similar Hf-O-isotope characteristics and can therefore be considered as the most probable source for the microgranite ring dyke melt. In addition, a second source with low oxygen isotope ratios (e.g. basic rocks) probably contributed to the melt and possibly triggered the climactic eruption of the Teplice rhyolite as well as the crystal-rich intrusion of the ring dyke.
More than 30% of the world's population are anemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell transfusion is the mainstay to correct anemia, but it is also 1 of the top 5 overused procedures. Patient blood management (PBM) is a proactive, patient-centered, and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss, and harness tolerance to anemia. Although the World Health Organization has endorsed PBM in 2010, many hospitals still seek guidance with the implementation of PBM in clinical routine. Given the use of proven change management principles, we propose simple, cost-effective measures enabling any hospital to reduce both anemia and red blood cell transfusions in surgical and medical patients. This article provides comprehensive bundles of PBM components encompassing 107 different PBM measures, divided into 6 bundle blocks acting as a working template to develop institutions' individual PBM practices for hospitals beginning a program or trying to improve an already existing program. A stepwise selection of the most feasible measures will facilitate the implementation of PBM. In this manner, PBM represents a new quality and safety standard.
The continental expression of global cooling during the Miocene Climate Transition in Central Asia is poorly documented, as the tectonically active setting complicates the correlation of Neogene regional and global climatic developments. This study presents new geochemical data (CaSO4 content, carbonate δ13C and δ18O) from the endorheic alluvial‐lacustrine Aktau succession (Ili Basin, south‐east Kazakhstan) combined with findings from the previously published facies evolution. Time series analysis revealed long‐eccentricity forcing of the paleohydrology throughout the entire succession, split into several facies‐dependent segments. Orbital tuning, constrained by new laser ablation U‐Pb dates and a preexisting magnetostratigraphy, places the succession in a 5.0 Ma long interval in the middle to late Miocene (15.6 to 10.6 Ma). The long‐term water accumulation in the Ili Basin followed the timing of the Miocene Climate Transition, suggesting increased precipitation in the catchment area in response to climate cooling and stronger westerly winds. This was paced by minima of the 2.4 Ma eccentricity cycle, which favored the establishment of a discharge playa (~14.3 Ma) and a perennial lake (12.6 to 11.8 Ma). Furthermore, low obliquity amplitudes (nodes) caused a transient weakening of the westerlies at ~13.7 to 13.5 Ma and at ~12.7 Ma, resulting in negative hydrological budgets and salinization. Flooding of the windward Ili Basin coeval with aridification in the leeward basins suggests that the Tian Shan was a climate boundary already in the middle Miocene. Our results emphasize the impact of climate fluctuations on the westerlies' strength and thus on Central Asian hydrology.
The aim of this clinical trial was to evaluate the impact of all-trans retinoic acid (ATRA) in combination with chemotherapy and to assess the NPM1 status as biomarker for ATRA therapy in younger adult patients (18-60 years) with acute myeloid leukemia (AML). Patients were randomized for intensive chemotherapy with or without open-label ATRA (45 mg/m2, days 6-8; 15 mg/m2, days 9-21). Two cycles of induction therapy were followed by risk-adapted consolidation with high-dose cytarabine or allogeneic hematopoietic cell transplantation. Due to the open label character of the study, analysis was performed on an intention-to-treat (ITT) and a per-protocol (PP) basis. One thousand one hundred patients were randomized (556, STANDARD; 544, ATRA) with 38 patients treated vice versa. Median follow-up for survival was 5.2 years. ITT analyses revealed no difference between ATRA and STANDARD for the total cohort and for the subset of NPM1-mutated AML with respect to event-free (EFS; p = 0.93, p = 0.17) and overall survival (OS; p = 0.24 and p = 0.32, respectively). Pre-specified PP analyses revealed better EFS in NPM1-mutated AML (p = 0.05) and better OS in the total cohort (p = 0.03). Explorative subgroup analyses on an ITT basis revealed better OS (p = 0.05) in ATRA for genetic low-risk patients according to ELN recommendations. The clinical trial is registered at clinicaltrialsregister.eu (EudraCT Number: 2004-004321-95).
A wide variety of enzymatic pathways that produce specialized metabolites in bacteria, fungi and plants are known to be encoded in biosynthetic gene clusters. Information about these clusters, pathways and metabolites is currently dispersed throughout the literature, making it difficult to exploit. To facilitate consistent and systematic deposition and retrieval of data on biosynthetic gene clusters, we propose the Minimum Information about a Biosynthetic Gene cluster (MIBiG) data standard.
Genetic generalised epilepsy (GGE) is the most common form of genetic epilepsy, accounting for 20% of all epilepsies. Genomic copy number variations (CNVs) constitute important genetic risk factors of common GGE syndromes. In our present genome-wide burden analysis, large (≥ 400 kb) and rare (< 1%) autosomal microdeletions with high calling confidence (≥ 200 markers) were assessed by the Affymetrix SNP 6.0 array in European case-control cohorts of 1,366 GGE patients and 5,234 ancestry-matched controls. We aimed to: 1) assess the microdeletion burden in common GGE syndromes, 2) estimate the relative contribution of recurrent microdeletions at genomic rearrangement hotspots and non-recurrent microdeletions, and 3) identify potential candidate genes for GGE. We found a significant excess of microdeletions in 7.3% of GGE patients compared to 4.0% in controls (P = 1.8 x 10-7; OR = 1.9). Recurrent microdeletions at seven known genomic hotspots accounted for 36.9% of all microdeletions identified in the GGE cohort and showed a 7.5-fold increased burden (P = 2.6 x 10-17) relative to controls. Microdeletions affecting either a gene previously implicated in neurodevelopmental disorders (P = 8.0 x 10-18, OR = 4.6) or an evolutionarily conserved brain-expressed gene related to autism spectrum disorder (P = 1.3 x 10-12, OR = 4.1) were significantly enriched in the GGE patients. Microdeletions found only in GGE patients harboured a high proportion of genes previously associated with epilepsy and neuropsychiatric disorders (NRXN1, RBFOX1, PCDH7, KCNA2, EPM2A, RORB, PLCB1). Our results demonstrate that the significantly increased burden of large and rare microdeletions in GGE patients is largely confined to recurrent hotspot microdeletions and microdeletions affecting neurodevelopmental genes, suggesting a strong impact of fundamental neurodevelopmental processes in the pathogenesis of common GGE syndromes.