Pre-existing basement faults controlling deformation in the Jura Mountains fold-and-thrust belt: Insights from analogue models

Pre-existing faults in the mechanical basement are believed to play an important role in controlling deformation of the thin-skinned Jura Mountains fold-and-thrust belt, which constitutes the northernmost extension of the European Alps. We use brittle-viscous analogue models to investigate the influence of frontal and oblique basement steps on the subsequent evolution of structures during thin-skinned shortening. Vertical offset between two rigid baseplates (simulating the mechanical basement) causes the formation of reverse faults and grabens in the overlying brittle layers that are not reactivated during subsequent thin-skinned shortening. However, baseplate steps localise deformation, causing a temporary frontward propagation of deformation in an early stage and inhibiting propagation afterwards. Downward baseplate steps induce very strong deformation localisation and foster the formation of fault-bend folds. Models featuring upward steps develop step-controlled pop-up structures with imbricated fronts and viscous ramps that shorten dynamically with progressive contraction. We find that deformation localisation increases both with higher step-throws and lower obliquity (α) of the strike of the step (e.g. frontal step α = 0°). With increasing step-throws, α = 30° and α = 45° oblique upward-steps lead to a characteristic imbrication of the brittle cover with laterally confined thrust-slices and step-parallel oblique-thrusts, which rotate up to 15° about a vertical axis over time. Step-controlled backthrusts preceding the formation of thrust-slices do not show notable rotation and hence constitute excellent indicators for the orientation of oblique upward-steps. The topographic patterns of oblique-step models resemble individual thin-skinned structures of the Internal Jura (i.e. Pontarlier and Vuache fault zones, the nappe system SE of Oyonnax and the Chasseral anticline), strongly suggesting that pre-existing NNE-SSW and NW-SE striking oblique upward-steps in the basement controlled deformation in the overlying cover. Our model results may be applied to other thin-skinned fold-and-thrust belts worldwide that formed above pre-existing basement structures

Brain stem encephalitis is a rare complication of COVID-19

Here, we describe the clinical phenotype of SARS-CoV-2-related CNS disease and evaluate the SARS-CoV-2 antibody index as a tool to differentiate between a direct (viral) and indirect etiology. Out of >4000 hospitalized patients with COVID-19, we included 13 patients with neurological symptoms with suspicion of neuroinflammation. On clinical grounds, eight were classified as having a possible/probable relationship between neurological symptoms and COVID-19. A clinically distinctive phenotype of brainstem and cerebellar symptoms was seen in 6/8 patients. As we found a positive SARS-CoV-2 antibody index in 3/5 patients, indicating specific intrathecal SARS-CoV-2 IgG production, a direct link with SARS-CoV-2 is likely

Moderators of the effect of psychosocial interventions on fatigue in women with breast cancer and men with prostate cancer:Individual patient data meta-analyses

Objective Psychosocial interventions can reduce cancer-related fatigue effectively. However, it is still unclear if intervention effects differ across subgroups of patients. These meta-analyses aimed at evaluating moderator effects of (a) sociodemographic characteristics, (b) clinical characteristics, (c) baseline levels of fatigue and other symptoms, and (d) intervention-related characteristics on the effect of psychosocial interventions on cancer-related fatigue in patients with non-metastatic breast and prostate cancer. Methods Data were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. Potential moderators were studied with meta-analyses of pooled individual patient data from 14 randomized controlled trials through linear mixed-effects models with interaction tests. The analyses were conducted separately in patients with breast (n = 1091) and prostate cancer (n = 1008). Results Statistically significant, small overall effects of psychosocial interventions on fatigue were found (breast cancer: beta = -0.19 [95% confidence interval (95%CI) = -0.30; -0.08]; prostate cancer: beta = -0.11 [95%CI = -0.21; -0.00]). In both patient groups, intervention effects did not differ significantly by sociodemographic or clinical characteristics, nor by baseline levels of fatigue or pain. For intervention-related moderators (only tested among women with breast cancer), statistically significant larger effects were found for cognitive behavioral therapy as intervention strategy (beta = -0.27 [95%CI = -0.40; -0.15]), fatigue-specific interventions (beta = -0.48 [95%CI = -0.79; -0.18]), and interventions that only targeted patients with clinically relevant fatigue (beta = -0.85 [95%CI = -1.40; -0.30]). Conclusions Our findings did not provide evidence that any selected demographic or clinical characteristic, or baseline levels of fatigue or pain, moderated effects of psychosocial interventions on fatigue. A specific focus on decreasing fatigue seems beneficial for patients with breast cancer with clinically relevant fatigue

Two versus five days of antibiotics after appendectomy for complex acute appendicitis (APPIC): Study protocol for a randomized controlled trial

Background: Acute appendicitis is one of the most common indications for emergency surgery. In patients with a complex appendicitis, prolonged antibiotic prophylaxis is recommended after appendectomy. There is no consensus regarding the optimum duration of antibiotics. Guidelines propose 3 to 7 days of treatment, but shorter courses may be as effective in the prevention of infectious complications. At the same time, the global issue of increasing antimicrobial resistance urges for optimization of antibiotic strategies. The aim of this study is to determine whether a short course (48 h) of postoperative antibiotics is non-inferior to current standard practice of 5 days. Methods: Patients of 8 years and older undergoing appendectomy for acute complex appendicitis - defined as a gangrenous and/or perforated appendicitis or appendicitis in presence of an abscess - are eligible for inclusion. Immunocompromised or pregnant patients are excluded, as well as patients with a contraindication to the study antibiotics. In total, 1066 patients will be randomly allocated in a 1:1 ratio to the experimental treatment arm (48 h of postoperative intravenously administered (IV) antibiotics) or the control arm (5 days of postoperative IV antibiotics). After discharge from the hospital, patients participate in a productivity-cost-questionnaire at 4 weeks and a standardized telephone follow-up at 90 days after appendectomy. The primary outcome is a composite endpoint of infectious complications, including intra-abdominal abscess (IAA) and surgical site infection (SSI), and mortality within 90 days after appendectomy. Secondary outcomes include IAA, SSI, restart of antibiotics, length of hospital stay (LOS), reoperation, percutaneous drainage, readmission rate, and cost-effectiveness. The non-inferiority margin for the difference in the primary endpoint rate is set at 7.5% (one-sided test at α 0.025). Both per-protocol and intention-to-treat analyses will be performed. Discussion: This trial will provide evidence on whether 48 h of postoperative antibiotics is non-inferior to a standard course of 5 days of antibiotics. If non-inferiority is established, longer intravenous administration following appendectomy for complex appendicitis can be abandoned, and guidelines need to be adjusted accordingly

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Multiple detachments during thin-skinned deformation of the Swiss Central Jura: a kinematic model across the Chasseral

Combining field observations, cross-section area balancing techniques and kinematic forward modelling, we present new insights into the evolution of the Jura fold-and-thrust belt in the Chasseral area between Lake Biel and the Vallon de St-Imier, in the Canton of Bern, Switzerland. Our results show that the structures of the Chasseral area and the associated regional uplift can be explained by thin-skinned deformation of the Mesozoic cover, without the need to involve highs in the pre-Triassic basement or invoking detachment folding with thickening of anticlinal cores by flow of Triassic evaporites. According to our thin-skinned model, the overall structure of the Chasseral initiated as a large-scale fault-bend fold, with initial detachment of the Mesozoic cover and NNW-directed movement of material along a basal décollement in Middle Triassic evaporites and important displacement along an upper detachment in the Middle Jurassic Opalinus-Ton Formation. This upper detachment extends from the Seekette to the Vallon de St-Imier (at least 11 km) and further to the north. Deformation above the upper detachment occurs to the north of the Chasseral area and steps back later to form a series of forward-stepping fault-propagation folds at the northern Chasseral mountainside, with associated thrusts that show a typical stair-step geometry due to low-angle breakthroughs. The Seekette anticline on the southern Chasseral mountainside formed due to a late back-stepping backthrust. A total displacement of 11.3 km is inferred that considerably exceeds a displacement estimation of 5.1 km deduced from shortening of the upper boundary of the Jurassic sequence. Forward modelling suggests that material was transported 6.2 km along the Opalinus-Ton detachment resulting in complex deformation to the north of the Vallon de St-Imier because there, folds and thrusts formed above both, the upper detachment and the basal décollement and interacted together

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Multiple detachments during thin-skinned deformation of the Swiss Central Jura: a kinematic model across the Chasseral

Combining field observations, cross-section area balancing techniques and kinematic forward modelling, we present new insights into the evolution of the Jura fold-and-thrust belt in the Chasseral area between Lake Biel and the Vallon de St-Imier, in the Canton of Bern, Switzerland. Our results show that the structures of the Chasseral area and the associated regional uplift can be explained by thin-skinned deformation of the Mesozoic cover, without the need to involve highs in the pre-Triassic basement or invoking detachment folding with thickening of anticlinal cores by flow of Triassic evaporites. According to our thin-skinned model, the overall structure of the Chasseral initiated as a large-scale fault-bend fold, with initial detachment of the Mesozoic cover and NNW-directed movement of material along a basal décollement in Middle Triassic evaporites and important displacement along an upper detachment in the Middle Jurassic Opalinus-Ton Formation. This upper detachment extends from the Seekette to the Vallon de St-Imier (at least 11km) and further to the north. Deformation above the upper detachment occurs to the north of the Chasseral area and steps back later to form a series of forward-stepping fault-propagation folds at the northern Chasseral mountainside, with associated thrusts that show a typical stair-step geometry due to low-angle breakthroughs. The Seekette anticline on the southern Chasseral mountainside formed due to a late back-stepping backthrust. A total displacement of 11.3km is inferred that considerably exceeds a displacement estimation of 5.1km deduced from shortening of the upper boundary of the Jurassic sequence. Forward modelling suggests that material was transported 6.2km along the Opalinus-Ton detachment resulting in complex deformation to the north of the Vallon de St-Imier because there, folds and thrusts formed above both, the upper detachment and the basal décollement and interacted together