[Distal femoral fractures in geriatric patients : Does time to surgery affect revision and mortality?] / Die distale Femurfraktur beim geriatrischen Patienten : Ist der Zeitpunkt der Operation relevant für Revision und Sterblichkeit?

BACKGROUND: For proximal femoral fractures the time to surgery has been reported to influence the mortality rate. To date, detailed analyses in geriatric patients with distal femoral fractures are not available. MATERIAL AND METHODS: A monocentric study with retrospective data retrieved from an electronic database was performed. The study included distal femoral fractures with surgical treatment between 2006 and 2017 in patients aged 65 years and older. A total of ten variables were evaluated and two outcome measures were investigated: revision and mortality in relation to time of surgery within 24 h or later. The minimum follow-up was 2 years. For patients who were still alive the Parker score was calculated. The null hypothesis was that time to surgery does not affect revision and mortality. RESULTS: A total of 57 consecutive patients with 60 fractures and an average age of 82.5 years (65-97 years) were included. Most of the fractures were supracondylar (n = 42). All but three fractures were treated with internal fixation. The revision rate was 17.5% (peri-implant fractures n = 4, infections n = 2, non-union n = 2, impaired wound healing n = 2 and secondary dislocation n = 1). The 1­year mortality rate was 20%. No significant effects on revision (p = 0.414) and survival rate (log rank 0.175) were observed for patients treated within 24 h or later. After a mean postoperative period of 5.5 years, the mean Parker score for 18 living patients was 5.9. CONCLUSION: Time to surgery demonstrated no significant effects with respect to revision and mortality. Multicenter studies are absolutely necessary to increase the sample size and statistical power.

Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score.

BACKGROUND: Adherence to topical corticosteroids (TCS) is essential for the effective treatment of atopic dermatitis but can be limited by concerns about their use. This study examined the feasibility of applying the validated TOPICOP score for assessing TCS phobia across different countries. METHODS: This was a prospective multicentre feasibility study conducted in 21 hospitals in 17 countries. Patients >3 months of age with atopic dermatitis or their parents or legal representatives completed a validated translation of the TOPICOP questionnaire in the country's native language. Respondents also completed questionnaires collecting opinions about the feasibility and acceptability of the TOPICOP questionnaire. RESULTS: A total of 1564 participants in 15 countries were included in the analysis. 81% of respondents considered the questions clear or very clear, and 79% reported that it took less than 5 minutes to complete. Each of the individual items in the TOPICOP questionnaire was considered to be not at all difficult to answer by 49% to 74% of participants. The mean global TOPICOP score was 44.7%±20.5. Mean TOPICOP subscores were 37.0±22.8% for knowledge and beliefs, 54.7±27.8% for fears and 50.1±29.1% for behaviours. Global scores and subscores differed between countries, although the subscores did not always vary in parallel, suggesting different levels of TCS phobia and different drivers for each country. CONCLUSIONS: The TOPICOP score can be feasibly applied across countries and may therefore be useful for obtaining qualitative and quantitative data from international studies and for adapting patient education and treatment.

[S2k-Guideline on Meniscus Diseases: from Aetiology to Scoring]. / S2k-Leitlinie Meniskuserkrankung: Von der Ätiologie bis zum Scoring.

The number of patients with meniscal injuries is increasing constantly, but the treatment algorithms are undergoing continuous change. The effects of meniscal surgery, as well as the indications for the procedure, are currently a matter of heated debate. Various German speaking associations addressing topics related to the knee have joined forces to develop guidelines for the diagnosis, evaluation and therapy of meniscal lesions. The hope is that this first of two publications will shed light on some of the ongoing issues and offer guidance to health care professionals treating these patients.

Anisotropic Polar Magneto-Optic Kerr Effect of Ultrathin Fe/GaAs(001) Layers due to Interfacial Spin-Orbit Interaction.

We report the observation of the anisotropic polar magneto-optical Kerr effect in thin layers of epitaxial Fe/GaAs(001) at room temperature. A clear twofold symmetry of the Kerr rotation angle depending on the orientation of the linear polarization of the probing laser beam with respect to the crystallographic directions of the sample is detected for ultrathin magnetic films saturated out of the film plane. The amplitude of the anisotropy decreases with increasing Fe film thickness, suggesting that the interfacial region is the origin of the anisotropy. The twofold symmetry is fully reproduced by model calculations based on an interference of interfacial Bychkov-Rashba and Dresselhaus spin-orbit coupling.

TSLP, IL-31, IL-33 and sST2 are new biomarkers in endophenotypic profiling of adult and childhood atopic dermatitis.

BACKGROUND: Recent years have seen growing interest in identifying new biomarkers in atopic dermatitis (AD) that could serve as indicators of disease severity and predictors of treatment response. OBJECTIVES: We compared serum levels of thymic stromal lymphopoietin (TSLP), interleukin(IL)-31, IL-33 and soluble(s)ST2 in AD patients and healthy controls, investigated the possible correlation with disease severity, investigated if other atopic comorbidities could play a role, and assessed their potential as biomarkers in AD. METHODS: Using standard enzyme-linked immunosorbent assay techniques, we measured target serum levels in 71 adults and 61 children with AD, and 31 adult controls. We characterized our cohort by disease severity, radioallergosorbent test status concerning both dietary and inhalant allergens, and anamnestic reports of food allergy, concomitant allergic asthma and/or allergic rhinitis. RESULTS: Serum levels of TSLP, IL-31 and IL-33, but not sST2, were significantly elevated in AD patients compared with controls. In AD patients, both IL-31 and IL-33 serum levels were higher in children than in adults, while the opposite was the case for sST2. We observed no correlation between disease severity and any of the investigated targets. While serum TSLP levels were unaffected by concomitant allergies and atopic comorbidities, serum levels of IL-31, IL-33 and sST2 were affected to a small extent. We found a positive correlation between TSLP, IL-31 and IL-33, and an inverse relationship between IL-33 and sST2. CONCLUSIONS: The studied targets hold little potential as indicators of disease severity. The serum values of our targets show robustness against atopic comorbidities, allergies and changes in disease severity. This robustness strengthens their potential use in biomarker-based stratification and could be instrumental in identifying subgroups and predicting the possible benefit of therapeutic and prevention approaches.

Childhood atopic dermatitis-Brain-derived neurotrophic factor correlates with serum eosinophil cationic protein and disease severity.

Several studies have shown that neurotrophins including brain-derived neurotrophic factor (BDNF) play a role in chronic inflammatory skin diseases such as atopic dermatitis (AD). BDNF is increased in the serum samples of adults with AD. Interestingly, eosinophils of these patients can release and produce BDNF. We analyzed BDNF serum levels with ELISA and their correlation with SCORAD score, eosinophil cationic protein (ECP), total IgE, IL-4, IL-13 and IL-31 in children with AD (n = 56) compared to nonatopic healthy children (n = 25). In addition, we analyzed FLG loss-of-function mutations in 17 children with AD and their connection to BDNF. BDNF serum levels were significantly higher in children with AD. Further, BDNF correlated with disease activity, serum ECP, and total IgE serum levels in AD. There was no difference in BDNF levels of filaggrin-positive or filaggrin-negative children with AD, and there was no correlation of BDNF with IL-31 and Th2 cytokines including IL-4 and IL-13. Together, our data add new insights into the pathophysiology of AD, suggesting that serum BDNF which correlates with disease severity contributes to the regulation of inflammation in an eosinophil-, but not Th2-dependent manner.

Observation of Atom-Wave Beats Using a Kerr Modulator for Atom Waves.

A phase modulation puts the atom in a coherent superposition of quantum states with different kinetic energies. We have detected the interference of such modulated waves at the output of our atom interferometer, and we have observed beats at the difference of the modulation frequencies and its harmonics, in good agreement with theory. The phase modulations were produced by a Kerr phase modulator, i.e., by the propagation of the atom wave in a time-dependent electric field. An extension of this technique to electron interferometry should open the way to very high temporal resolution in electron microscopy.

Real-time observation of domain fluctuations in a two-dimensional magnetic model system.

Domain patterns of perpendicularly magnetized ultra-thin ferromagnetic films are often determined by the competition of the short range but strong exchange interaction favouring ferromagnetic alignment of magnetic moments and the long range but weak antiferromagnetic dipolar interaction. Detailed phase diagrams of the resulting stripe domain patterns have been evaluated in recent years; however, the domain fluctuations in these pattern forming systems have not been studied in great detail so far. Here we show that domain fluctuations can be observed in ultra-thin two-dimensional ferromagnetic Fe/Ni/Cu(001) films with perpendicular magnetization in the stripe domain phase. Non-stroboscopic time-resolved threshold photoemission electron microscopy with high temporal resolution allows analysing the dynamic fingerprint of the topological excitations in the nematic domain phase. Furthermore, proliferation of domain ending defects in the vicinity of the spin reorientation transition is witnessed.

Note: A passively cooled heat pipe for spectroscopy.

We have developed and characterized a heat pipe for lithium spectroscopy, which is cooled only by air-convection, although its operating temperature is 330 °C: its construction is simple, of moderate cost and it is very reliable. A thermal model proves that heat-pipes without water cooling can be used up to considerably higher temperatures.

Measurement of the He-McKellar-Wilkens topological phase by atom interferometry and test of its independence with atom velocity.

In this Letter, we report a measurement of the He-McKellar-Wilkens (HMW) topological phase by atom interferometry. The experiment is done with our lithium atom interferometer, and in order to suppress the stray effects present in our first experiment, we use optical pumping of the (7)Li atoms in their F=2, m(F)=+2 (or -2) ground state sublevel. In these conditions, the measured phase shift is the sum of the HMW phase and of the Aharonov-Casher phase, which are separated due to their different m(F) dependence. The HMW phase has been measured for different lithium beam velocities and the results are in very good agreement with a phase independent of the atom velocity, as expected for a topological phase.

Dipolar-energy-activated magnetic domain pattern transformation driven by thermal fluctuations.

Two-dimensional ferromagnetic layers can serve as a playground for the study of basic physical properties of various pattern forming systems by virtue of their tuneable magnetic properties. Here we use threshold photoemission magnetic circular dichroism in combination with photoemission electron microscopy to investigate ultra-thin ferromagnetic Fe/Ni/Cu(001) films in the stripe domain phase near the spin reorientation transition as a function of film thickness, temperature and effective anisotropy. Here we report a metastable domain state with domain width larger than the thermodynamically stable one as a result of a rapid reduction of the anisotropy. The transformation into the equilibrium state takes place via the propagation of a transition front, which originates from defined steps in the film thickness.

He-McKellar-Wilkens topological phase in atom interferometry.

We report an experimental test of the topological phase predicted by He and McKellar in 1993 and by Wilkens in 1994: this phase, which appears when an electric dipole propagates in a magnetic field, is connected to the Aharonov-Casher effect by electric-magnetic duality. The He-McKellar-Wilkens phase is quite small, at most 27 mrad in our experiment, and this experiment requires the high phase sensitivity of our atom interferometer with spatially separated arms as well as symmetry reversals such as the direction of the electric and magnetic fields. The measured value of the He-McKellar-Wilkens phase differs by 31% from its theoretical value, a difference possibly due to some as yet uncontrolled systematic errors.

Spleen tyrosine kinase (Syk) is a potent target for GvHD prevention at different cellular levels.

Acute graft-versus-host disease (GvHD) limits the applicability of allogeneic hematopoietic cell transplantation for the treatment of leukemia. GvHD occurs as a consequence of multiple activating events in antigen-presenting cells (APCs) and T cells (Tcs). Spleen tyrosine kinase (Syk) is an intracellular non-receptor tyrosine kinase involved in multiple signaling events of immune cells. Therefore, we hypothesized that Syk may be a promising target to inhibit GvHD, which involves activation of different immune cell populations. In vivo expansion of luciferase(+) donor Tcs in mice developing GvHD was reduced by treatment with the Syk inhibitor Fostamatinib, which led to increased survival and reduced histologically confirmed GvHD severity. Importantly, in vivo and in vitro cytotoxicity against leukemia target cells and anti-murine cytomegalovirus immune responses were not impacted by Fostamatinib. In APCs Syk inhibition reduced the expression of costimulatory molecules and disrupted cytoskeletal organization with consecutive APC migratory defects in vitro and in vivo while phagocytic activity remained intact. On the basis of these immunomodulatory effects on different cell populations, we conclude that Syk targeting in alloantigen-activated Tcs and APCs with pharmacologic inhibitors, already applied successfully in anti-lymphoma therapy, has clinical potential to reduce GvHD, especially as anti-leukemia and anti-viral immunity were preserved.

[Diaper dermatitis]. / Windeldermatitis.

Diaper dermatitis is one of the most common skin diseases during infancy and childhood. It is a type of irritant contact eczema resulting from a complex interaction between urine and feces under occlusive conditions in combination with the hyperhydration of the stratum corneum, pressure and friction under the diaper. These conditions pave the way for Candida albicans infection, which is often associated with diaper dermatitis. The anogenital region can be involved by a variety of dermatoses, so a precise skin examination, detailed history and sometimes histologic examination are needed for a precise diagnosis. Therapeutically, frequent diaper changes and adequate skin care are most important.

Juvenile separation stress induces rapid region- and layer-specific changes in S100ss- and glial fibrillary acidic protein-immunoreactivity in astrocytes of the rodent medial prefrontal cortex.

The impact of juvenile stress exposure on astrocyte plasticity was assessed in the precocious rodent Octodon degus. Astrocytes expressing S100ss and glial fibrillary acidic protein (GFAP) were quantified in the limbic medial prefrontal cortex (mPFC), including the anterior cingulate (ACd), precentral medial (PrCm), infra- (IL) and prelimbic (PL) cortex and in the "non-limbic" somatosensory cortex (SSC). At the age of 21 days we compared (i) controls (C), (ii) stressed animals (SSR: separation stress/short reunion), which were exposed to 6 h separation from the family, followed by 1 h reunion with the family and (iii) stressed animals (SER: separation stress/extended reunion), which were stressed like group SSR but exposed to 48 h reunion. The observed glia response was already measurable 7 h after the onset of the stress exposure. Compared to controls SER and SSR animals showed elevated densities of S100ss-IR astrocytes in layers II/III and V-VI of the ACd, IL and PrCm, whereas no significant group differences were observed in the PL and SSC. The SSR group showed significantly decreased density of GFAP-immunoreactive astrocytes in all mPFC subregions. Only in the ACd the stress-induced changes in glia density were still evident after 48 h reunion with the family. Compared to controls, the length of GFAP-IR processes and the number of ramification points were significantly reduced in all mPFC subregions and in the SSC of the SSR group. In the SSC the stress-evoked changes in GFAP-glia density were opposite compared to the changes seen in the medial prefrontal cortical subregions, whereas the changes in GFAP-labeled processes were comparable to those observed in the mPFC. In summary, these results demonstrate that a single stress episode induces rapid and quite complex region- and cell-specific changes in glial cells, reflected by an upregulation of cytoplasmic (S100ss) and downregulation of cytoskeletal (GFAP) glial protein.

First measurements of the index of refraction of gases for lithium atomic waves.

We report the first measurements of the index of refraction of gases for lithium waves. Using an atom interferometer, we have measured the real and imaginary parts of the index of refraction n for argon, krypton, and xenon as a function of the gas density for several velocities of the lithium beam. The linear dependence of (n-1) with the gas density is well verified. The total collision cross section deduced from the imaginary part of (n-1) is in very good agreement with traditional measurements of this quantity. Finally, the real and imaginary parts of (n-1) and their ratio rho exhibit glory oscillations, in good agreement with calculations.

[Comorbidity in patients with chronic low back pain]. / Komorbidität bei Patienten mit chronischen Rückenschmerzen.

BACKGROUND: Studies concerning comorbidity in patients with chronic low back pain and its correlation to the stage of chronification are rare. METHODS: This case-control study (matched-pair analysis) examines the number and specificity of comorbidity as well as the extent of disability due to comorbidity in 51 patients with chronic low back pain compared to age- and sex-matched control persons. Moreover, the correlation of comorbidity and the stage of chronification was analysed in these patients. RESULTS: Patients with chronic low back pain had significantly more comorbidities and a higher disability due to comorbidity compared to the control persons. The higher the stage of chronification according to the Mainz Pain Staging System (MPSS) the higher was the number of comorbidities. CONCLUSION: Comorbidity should be given due consideration when evaluating diagnosis, therapy, prognosis and therapy outcome in patients with chronic low back pain.

Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients.

OBJECTIVES: This prospective longitudinal clinical study analyses the therapy outcome of 365 patients with either chronic neck (n = 134) or low back (n = 231) pain treated with a multidisciplinary biopsychosocial therapy approach. METHODS: Patients with chronic neck pain (NP) or low back pain (LBP) for 3 months or longer, corresponding sick leave for longer than 6 weeks, and clearly defined inclusion and exclusion criteria underwent a 3-week standardized inpatient multidisciplinary biopsychosocial therapy. Baseline sociodemographic, occupational, functional, and psychological data at entry into the study (T0) were comparable in both groups. At the 6-month follow-up (T1), five different therapy outcomes were analysed in both groups: back-to-work status, generic health status (the 36-item Short Form Health Survey, SF-36), pain intensity (visual analogue scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy. RESULTS: Both treatment groups improved significantly in all outcome criteria between T0 and T1. In the total group, the back-to-work rate was 67.4%. At the final follow-up there were no significant differences between the group with chronic NP and the group with chronic LBP in the outcome criteria back-to-work status, improvement of health status and functional capacity, satisfaction with therapy, and reduction of pain. CONCLUSION: Evaluation of the main results of this study suggests that patients with chronic NP also derive significant benefit from a multidisciplinary treatment strategy, demonstrated in the literature so far mainly for patients with chronic LBP.

[Multimodal therapy patients with chronic cervical and lumbar pain. Results of a comparative prospective study]. / Multimodale Therapie bei chronischem HWS- und LWS-Schmerz. Ergebnisse einer prospektiven Vergleichsstudie.

BACKGROUND: Multimodal therapy has been established for patients with chronic low back pain, but studies reporting results in patients with chronic neck pain are rare. METHODS: This prospective clinical study compared the results in 97 patients with chronic cervical pain and 231 patients with chronic lumbar pain after three weeks of multimodal therapy. The following factors were analyzed in both groups at the beginning and after 6 months: ability to work, pain intensity and functional back capacity. RESULTS: Both groups had improved significantly after 6 months in all outcome parameters. Functional back capacity and ability to work at 6 months were not different between the two groups, but pain intensity was significantly lower in patients with low back pain compared to patients with neck pain. CONCLUSION: Multimodal therapy is also an efficient treatment strategy for patients with chronic cervical pain as has already been shown for patients with chronic lumbar pain.