Long-term follow-up after vertebroplasty - A mean 10-years follow-up control study.

Objectives: To evaluate the clinical 10 year outcome of patients treated with percutaneous vertebroplasty for vertebral compression fractures and to determine the incidence of new fractures in this time interval, as well as the mortality of the patients who underwent this procedure. Methods: All patients undergoing vertebroplasty for vertebral compression fractures between May 2007 until July 2008 were prospectively followed up at 10 years postoperatively. Patients were assessed for radiologic outcome and self-reported outcome parameters (PROs). Gathered parameters remained unmodified to the initial ones analyzing QoL improvement (EQ5D 3L and NASS score) and pain alleviation (VAS, NRS). Mortality was defined as an additional endpoint. Exclusion criteria include additional instrumentation, use of additional devices such as kyphoplasty balloons/stentoplasty, cognitive impairment, insufficient radiological documentation or absent re-consent. Results: Of 280 patients who underwent vertebroplasty, 49 (17.5%) were available for re-assessment with a mean follow-up of 10.5 years (9.9-11.1). Thirty patients (10.7%) were assessed clinically and radiologically, 16 (5.7%) in written form and three (1.1%) by phone only. A total of 186 (66.4%) died during the follow up period. Out of the remaining 45 patients, 27 patients declined participation, eight couldn't participate due to cognitive impairment, four had insufficient radiologic documentation. Six patients were lost to follow-up. At 10 years, patients reported a consistently improved quality of life (EQ-5D; p < 0.01) and global satisfaction. Vertebroplasty demonstrated a substantial and enduring effect on alleviating back pain over 10 years (p < 0.001). 26 (53%) patients experienced a new fracture since the initial procedure. Conclusion: A decade following vertebroplasty, patients continue to demonstrate a quality of life and pain level comparable to short and medium-term assessments, with a significant difference from baseline measurements. More than half (53%) of the patients participating at last follow-up experienced new fractures during this interim period. The cohort as a whole has been impacted by an elevated mortality rate over the time period.

Self-Guided Belief Propagation - A Homotopy Continuation Method.

Belief propagation (BP) is a popular method for performing probabilistic inference on graphical models. In this work, we enhance BP and propose self-guided belief propagation (SBP) that incorporates the pairwise potentials only gradually. This homotopy continuation method converges to a unique solution and increases the accuracy without increasing the computational burden. We provide a formal analysis to demonstrate that SBP finds the global optimum of the Bethe approximation for attractive models where all variables favor the same state. Moreover, we apply SBP to various graphs with random potentials and empirically show that: (i) SBP is superior in terms of accuracy whenever BP converges, and (ii) SBP obtains a unique, stable, and accurate solution whenever BP does not converge.

Owner-reported outcome measures in veterinary care for companion animal orthopedic patients: An international online survey of veterinarians' expectations and practices.

OBJECTIVE: To report veterinarians' familiarity with and perceptions of owner/observer-reported outcome measures (OROMs) and their applications in routine clinical practice. STUDY DESIGN: Cross-sectional online survey. ANIMALS OR SAMPLE POPULATION: A total of 441 veterinarians with a caseload of companion animal orthopedic patients. METHODS: Respondents answered questions regarding their familiarity with and application of OROMs. Respondents provided opinions on statements related to reasons for using or not using OROMs in routine clinical practice, prerequisites to implement OROMs in routine clinical practice, and whether they would implement OROMs in routine clinical practice if adequate tools/technologies were available. RESULTS: Most (293/441, 66.4%) respondents felt familiarity with at least one OROM. Only 17.5% (77 out of the 440 answering the question about the application of OROMs) applied OROMs in routine clinical practice. The two main reasons for not using OROMs in routine clinical practice were the lack of opportunity/feasibility and the lack sufficient information/knowledge/experiences. User-friendliness, time efficiency, and interpretability were considered the most important prerequisites for implementing OROMs in routine clinical practice. If adequate tools/technologies were available, 266/439 (60.6%) respondents indicated that they would definitely implement OROMs in routine clinical practice. CONCLUSION: Although most respondents were familiar with at least one OROM, fewer than one-fifth applied them in routine clinical practice. Most respondents were willing to implement OROMs in routine clinical practice if adequate tools/technologies were available. CLINICAL SIGNIFICANCE: Our results justify further investigations to improve the application of OROMs in routine clinical practice in veterinary care of companion animal orthopedic patients.

Traversable Wormholes in Einstein-Dirac-Maxwell Theory.

We construct a specific example of a class of traversable wormholes in Einstein-Dirac-Maxwell theory in four spacetime dimensions, without needing any form of exotic matter. Restricting to a model with two massive fermions in a singlet spinor state, we show the existence of spherically symmetric asymptotically flat configurations which are free of singularities, representing localized states. These solutions satisfy a generalized Smarr relation, being connected with the extremal Reissner-Nordström black holes. They also possess a finite mass M and electric charge Q_{e}, with Q_{e}/M>1. An exact wormhole solution with ungauged, massless fermions is also reported.

CuSO4/[Cu(NH3)4]SO4-Composite Thermochemical Energy Storage Materials.

The thermochemical energy-storage material couple CuSO4/[Cu(NH3)4]SO4 combines full reversibility, application in a medium temperature interval (<350 °C), and fast liberation of stored heat. During reaction with ammonia, a large change in the sulfate solid-state structure occurs, resulting in a 2.6-fold expansion of the bulk material due to NH3 uptake. In order to limit this volume work, as well as enhance the thermal conductivity of the solid material, several composites of anhydrous CuSO4 with inorganic inert support materials were prepared and characterized with regard to their energy storage density, reversibility of the storage reaction, thermal conductivity, and particle morphology. The best thermochemical energy storage properties were obtained for a 10:1 CuSO4-sepiolite composite, combining an attractive energy storage density with slightly improved thermal conductivity and decreased bulk volume work compared to the pure salt.

Bifunctional Fe(II) spin crossover-complexes based on ω-(1H-tetrazol-1-yl) carboxylic acids.

To increase the supramolecular cooperativity in Fe(ii) spin crossover materials based on N1-substituted tetrazoles, a series of ω-(1H-tetrazol-1-yl) carboxylic acids with chain-lengths of C2-C4 were synthesized. Structural characterization confirmed the formation of a strong hydrogen-bond network, responsible for enhanced cooperativity in the materials and thus largely complete spin-state transitions for the ligands with chain lenghts of C2 and C4. To complement the structural and magnetic investigation, electronic spectroscopy was used to investigate the spin-state transition. An initial attempt to utilize the bifunctional coordination ability of the ω-(1H-tetrazol-1-yl) carboxylic acids for preparation of mixed-metallic 3d-4f coordination polymers resulted in a novel one-dimensional gadolinium-oxo chain system with the ω-(1H-tetrazol-1-yl) carboxylic acid acting as µ2-η2:η1 chelating-bridging ligand.

Ammonium bis(salicylaldehyde thiosemicarbazonato)ferrate(III), a supramolecular material containing low-spin FeIII.

The synthesis and crystal structure (100 K) of the title compound, ammonium bis[salicylaldehyde thiosemicarbazonato(2-)-κ3O,N1,S]iron(III), NH4[Fe(C8H7N3OS)2], is reported. The asymmetric unit consists of an octahedral [FeIII(thsa)2]- fragment, where thsa2- is salicylaldehyde thiosemicarbazonate(2-), and an NH4+ cation. Each thsa2- ligand binds via the thiolate S, the imine N and the phenolate O donor atoms, resulting in an FeIIIS2N2O2 chromophore. The ligands are orientated in two perpendicular planes, with the O and S atoms in cis and the N atoms in trans positions. The FeIII ion is in the low-spin state at 100 K. The crystal structure belongs to a category I order-disorder (OD) family. It is a polytype of a maximum degree of order (MDO). Fragments of the second MDO polytype lead to systematic twinning by pseudomerohedry.

A single class of ARF GTPase activated by several pathway-specific ARF-GEFs regulates essential membrane traffic in Arabidopsis.

In eukaryotes, GTP-bound ARF GTPases promote intracellular membrane traffic by mediating the recruitment of coat proteins, which in turn sort cargo proteins into the forming membrane vesicles. Mammals employ several classes of ARF GTPases which are activated by different ARF guanine-nucleotide exchange factors (ARF-GEFs). In contrast, flowering plants only encode evolutionarily conserved ARF1 GTPases (class I) but not the other classes II and III known from mammals, as suggested by phylogenetic analysis of ARF family members across the five major clades of eukaryotes. Instead, flowering plants express plant-specific putative ARF GTPases such as ARFA and ARFB, in addition to evolutionarily conserved ARF-LIKE (ARL) proteins. Here we show that all eight ARF-GEFs of Arabidopsis interact with the same ARF1 GTPase, whereas only a subset of post-Golgi ARF-GEFs also interacts with ARFA, as assayed by immunoprecipitation. Both ARF1 and ARFA were detected at the Golgi stacks and the trans-Golgi network (TGN) by both live-imaging with the confocal microscope and nano-gold labeling followed by EM analysis. ARFB representing another plant-specific putative ARF GTPase was detected at both the plasma membrane and the TGN. The activation-impaired form (T31N) of ARF1, but neither ARFA nor ARFB, interfered with development, although ARFA-T31N interfered, like ARF1-T31N, with the GDP-GTP exchange. Mutant plants lacking both ARFA and ARFB transcripts were viable, suggesting that ARF1 is sufficient for all essential trafficking pathways under laboratory conditions. Detailed imaging of molecular markers revealed that ARF1 mediated all known trafficking pathways whereas ARFA was not essential to any major pathway. In contrast, the hydrolysis-impaired form (Q71L) of both ARF1 and ARFA, but not ARFB, had deleterious effects on development and various trafficking pathways. However, the deleterious effects of ARFA-Q71L were abolished by ARFA-T31N inhibiting cognate ARF-GEFs, both in cis (ARFA-T31N,Q71L) and in trans (ARFA-T31N + ARFA-Q71L), suggesting indirect effects of ARFA-Q71L on ARF1-mediated trafficking. The deleterious effects of ARFA-Q71L were also suppressed by strong over-expression of ARF1, which was consistent with a subset of BIG1-4 ARF-GEFs interacting with both ARF1 and ARFA. Indeed, the SEC7 domain of BIG5 activated both ARF1 and ARFA whereas the SEC7 domain of BIG3 only activated ARF1. Furthermore, ARFA-T31N impaired root growth if ARF1-specific BIG3 was knocked out and only ARF1- and ARFA-activating BIG4 was functional. Activated ARF1 recruits different coat proteins to different endomembrane compartments, depending on its activation by different ARF-GEFs. Unlike ARF GTPases, ARF-GEFs not only localize at distinct compartments but also regulate specific trafficking pathways, suggesting that ARF-GEFs might play specific roles in traffic regulation beyond the activation of ARF1 by GDP-GTP exchange.

Cycle Stability and Hydration Behavior of Magnesium Oxide and Its Dependence on the Precursor-Related Particle Morphology.

Thermochemical energy storage is considered as an auspicious method for the recycling of medium-temperature waste heat. The reaction couple Mg(OH)2⁻MgO is intensely investigated for this purpose, suffering so far from limited cycle stability. To overcome this issue, Mg(OH)2, MgCO3, and MgC2O4·2H2O were compared as precursor materials for MgO production. Depending on the precursor, the particle morphology of the resulting MgO changes, resulting in different hydration behavior and cycle stability. Agglomeration of the material during cyclization was identified as main reason for the decreased reactivity. Immersion of the spent material in liquid H2O decomposes the agglomerates restoring the initial reactivity of the material, thus serving as a regeneration step.

Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons.

OBJECTIVE: To gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs. DESIGN: Online survey. PARTICIPANTS: Surgeons who are members of the AO Foundation. MEASURES: Participants answered questions regarding demographics, their familiarity with specific and generic PROMs and the use of PROMs in clinical routine. Furthermore, reasons for/against using PROMs, why not used more often, prerequisites to implement PROMs into clinical routine and whether PROMs would be implemented if adequate tools/technologies were available, were solicited. Χ2 tests and multivariable logistic regressions were conducted to evaluate the effect of the AO Region, surgeon specialisation, current position, clinical experience, and workplace on the familiarity with disease-specific PROMs, the familiarity with generic PROMs and the current use of PROMs. Exploratory factor analysis was used to identify issues underlying the extent of PROM usage. RESULTS: 1212 surgeons completed the survey (response rate: 6.8%; margin of error: ±2.72%): 54.2% were trauma/orthopaedic surgeons, 16.6% were spine surgeons, 27.9% were craniomaxillofacial surgeons and 16 had no defined specialty. Working in a certain AO Region, surgical specialisation and current workplace were associated with a higher familiarity of disease-specific PROMs and the use of PROMs in daily clinical routine (p≤0.05). Exploratory factor analysis identified four categories important for the use of PROMs and two categories preventing the use of PROMs. In case of the availability of an adequate tool, 66.2% of surgeons would implement PROMs in clinical routine. CONCLUSIONS: Our survey results provide an understanding of the use of PROMs in clinical routine. There is consensus on the usefulness of PROMs. User-friendly and efficient tools/technologies would be a prerequisite for the daily use of PROMs. Additionally, educational efforts and/or policies might help.

Cooperativity in spin crossover materials as ligand's responsibility - investigations of the Fe(ii) - 1,3-bis((1H-tetrazol-1-yl)methyl)bicyclo[1.1.1]pentane system.

Criteria for a technologically relevant spin crossover (SCO) material include temperature and abruptness. A series of Fe(ii) - 1,3-bis((1H-tetrazol-1-yl)methyl)bicyclo[1.1.1]pentane SCO complexes with various anions (BF4-, ClO4-, and PF6-) designed using a structure-property based concept is reported. All complexes feature abrupt SCO-behavior with T1/2 between 170 K and 187 K. These materials demonstrate that without stabilizing the effects of incorporated solvents or a hydrogen bond-network, the observed cooperativity during high-spin-low-spin transition is anion independent and originates only from the rigidity and internal strain of the propellane-moiety in the ligand. Spectroscopy and structural investigations of these materials are supported by quantum chemical calculations.

Fixed Points of Belief Propagation-An Analysis via Polynomial Homotopy Continuation.

Belief propagation (BP) is an iterative method to perform approximate inference on arbitrary graphical models. Whether BP converges and if the solution is a unique fixed point depends on both the structure and the parametrization of the model. To understand this dependence it is interesting to find all fixed points. In this work, we formulate a set of polynomial equations, the solutions of which correspond to BP fixed points. To solve such a nonlinear system we present the numerical polynomial-homotopy-continuation (NPHC) method. Experiments on binary Ising models and on error-correcting codes show how our method is capable of obtaining all BP fixed points. On Ising models with fixed parameters we show how the structure influences both the number of fixed points and the convergence properties. We further asses the accuracy of the marginals and weighted combinations thereof. Weighting marginals with their respective partition function increases the accuracy in all experiments. Contrary to the conjecture that uniqueness of BP fixed points implies convergence, we find graphs for which BP fails to converge, even though a unique fixed point exists. Moreover, we show that this fixed point gives a good approximation, and the NPHC method is able to obtain this fixed point.

Halogenated Alkyltetrazoles for the Rational Design of FeII Spin-Crossover Materials: Fine-Tuning of the Ligand Size.

1-(3-Halopropyl)-1H-tetrazoles and their corresponding FeII spin-crossover complexes have been investigated in a combined experimental and theoretical study. Halogen substitution was found to positively influence the spin transition, shifting the transition temperature about 70 K towards room temperature. Halogens located at the ω position were found to be too far away from the coordinating tetrazole moiety to have an electronic impact on the spin transition. The subtle variation of the steric demand of the ligand in a highly comparable series was found to have a comparatively large impact on the spin-transition behavior, which highlights the sensitivity of the effect to subtle structural changes.

Picomolar Traces of Americium(III) Introduce Drastic Changes in the Structural Chemistry of Terbium(III): A Break in the "Gadolinium Break".

The crystallization of terbium 5,5'-azobis[1H-tetrazol-1-ide] (ZT) in the presence of trace amounts (ca. 50 Bq, ca. 1.6 pmol) of americium results in 1) the accumulation of the americium tracer in the crystalline solid and 2) a material that adopts a different crystal structure to that formed in the absence of americium. Americium-doped [Tb(Am)(H2 O)7 ZT]2 ZT⋅10 H2 O is isostructural to light lanthanide (Ce-Gd) 5,5'-azobis[1H-tetrazol-1-ide] compounds, rather than to the heavy lanthanide (Tb-Lu) 5,5'-azobis[1H-tetrazol-1-ide] (e.g., [Tb(H2 O)8 ]2 ZT3 ⋅6 H2 O) derivatives. Traces of Am seem to force the Tb compound into a structure normally preferred by the lighter lanthanides, despite a 108 -fold Tb excess. The americium-doped material was studied by single-crystal X-ray diffraction, vibrational spectroscopy, radiochemical neutron activation analysis, and scanning electron microcopy. In addition, the inclusion properties of terbium 5,5'-azobis[1H-tetrazol-1-ide] towards americium were quantified, and a model for the crystallization process is proposed.

Microwave alkylation of lithium tetrazolate.

ABSTRACT: N1-substituted tetrazoles are interesting ligands in transition metal coordination chemistry, especially in the field of spin crossover. Their synthesis is performed in most cases according to the Franke-synthesis, using a primary amine as reagent introducing the substitution pattern. To enhance flexibility in means of substrate scope, we developed a new protocol based on alkylation of lithium tetrazolate with alkyl bromides. The N1-N2 isomerism of the tetrazole during the alkylation was successfully suppressed by use of highly pure lithium tetrazolate and 30 vol.% aqueous ethanol as solvent, leading to pure N1-substituted products. The feasibility of this reaction was demonstrated by a selection of different substrates.

Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity?

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern. METHODS: Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered. RESULTS: Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate. CONCLUSIONS: The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.

Are There Gender-Specific Aspects in Obesity and Metabolic Surgery? Data Analysis from the German Bariatric Surgery Registry.

BACKGROUND: Since January 2005, the status of bariatric surgery in Germany has been examined in conjunction with a quality assurance study of the German Bariatric Surgery Registry (GBSR). All data are registered prospectively in cooperation with the Institute for Quality Assurance in Surgical Medicine at the Otto-von-Guericke University Magdeburg, Germany. METHODS: Data are registered in an online database. Data collection on obesity and metabolic surgery is voluntary, and was started in 2005. In addition, follow-up data are collected once a year. RESULTS: Since 2005, 8,293 sleeve gastrectomies, 10,330 Roux-en-Y gastric bypass procedures, and 3,741 gastric banding procedures have been performed in Germany, according to the data of the GBSR. Mean age and mean body mass index of female patients with gastric banding, sleeve gastrectomy, or Roux-en-Y gastric bypass were significantly lower than those of male patients. The incidence of relevant comorbidities was significantly higher in male than in female patients. CONCLUSION: Metabolic and obesity surgery is becoming more and more popular in Germany. Data from the GBSR study show significant differences in preoperative comorbidities and postoperative complication and mortality rates between male and female patients. There is a need for further evaluation of gender-specific aspects to optimize patient selection and reduce specific postoperative complications.

Circular Versus Linear Versus Hand-Sewn Gastrojejunostomy in Roux-en-Y-Gastric Bypass Influence on Weight Loss and Amelioration of Comorbidities: Data Analysis from a Quality Assurance Study of the Surgical Treatment of Obesity in Germany.

BACKGROUND: Since January 1 2005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg. METHODS: Data are collected in an online data bank. Data collection began in 2005 for the results of Roux-en-Y-Gastric Bypass (RYGB). In addition to primary bariatric operations, data regarding the complications and the amelioration of comorbidities have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany. RESULTS: Roux-en-Y Gastric Bypass is the most popular bariatric operation in Germany. There were 5115 operations performed from 2005 to 2010. A circular anastomosis was performed in 1587 patients, and a linear anastomosis was performed in 2734 patients. In 783 patients, the hand-sewn technique was used. The leakage rate for the linear technique is 1.6%, and the leakage rate is 1.2% for circular anastomosis, and 1.4% for hand-sewn technique. CONCLUSION: Roux-en-Y-Gastric Bypass is a popular procedure in Germany. The complication rate has decreased since 2005. The amelioration of comorbidities is not influenced by the anastomosis technique. Additional data are necessary to evaluate the long-term effect of linear versus hand-sewn and versus circular-stapled gastrojejunal anastomosis regarding pouch dilatation, small bowel dilatation, and consecutive weight loss.

Affinity purification strategies for proteomic analysis of transcription factor complexes.

Affinity purification (AP) coupled to mass spectrometry (MS) has been successful in elucidating protein molecular networks of mammalian cells. These approaches have dramatically increased the knowledge of the interconnectivity present among proteins and highlighted biological functions within different protein complexes. Despite significant technical improvements reached in the past years, it is still challenging to identify the interaction networks and the subsequent associated functions of nuclear proteins such as transcription factors (TFs). A straightforward and robust methodology is therefore required to obtain unbiased and reproducible interaction data. Here we present a new approach for TF AP-MS, exemplified with the CCAAT/enhancer binding protein alpha (C/EBPalpha). Utilizing the advantages of a double tag and three different MS strategies, we conducted a total of six independent AP-MS strategies to analyze the protein-protein interactions of C/EBPalpha. The resultant data were combined to produce a cohesive C/EBPalpha interactome. Our study describes a new methodology that robustly identifies specific molecular complexes associated with transcription factors. Moreover, it emphasizes the existence of TFs as protein complexes essential for cellular biological functions and not as single, static entities.

Proteomic analysis of seminal plasma from infertile patients with oligoasthenoteratozoospermia due to oxidative stress and comparison with fertile volunteers.

OBJECTIVE: To compare the expression protein profile of seminal plasma from infertile men with oligoasthenoteratozoospermia (OAT) due to oxidative stress with that of healthy, fertile men to determine the proteins indicative of infertility. DESIGN: Experimental study. SETTING: University hospital and research institute. PATIENT(S): Semen samples from 11 healthy, fertile (according to the 1999 World Health Organization criteria) male volunteers and 11 infertile idiopathic oligoasthenoteratozoospermia (iOAT) patients. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Proteomic analysis performed by liquid chromatography mass spectrometry on a hybrid linear trap quadrupole Orbitrap Velos mass spectrometer, carbonylation assay to determine degree of oxidative stress, semiquantitative proteomic analysis, gene ontology, and pathway analysis. RESULT(S): A total of 2,489 proteins were identified from seminal plasma, which represents the highest number of unique proteins identified to date. Twenty-four proteins were determined as ≥ 1.5-fold up-regulated in the infertile iOAT males as compared with the fertile controls; and 27 proteins from iOAT patients only were identified as common across all analyses. Only five of the proteins were shared between these two groups. CONCLUSION(S): A panel of 46 proteins were identified in patients with iOAT that are potential candidates in understanding the etiology of OAT due to oxidative stress.