Symmetric Nuclear Matter from the Strong Interaction.

We study the equation of state of symmetric nuclear matter at zero temperature over a wide range of densities using two complementary theoretical approaches. At low densities, up to twice nuclear saturation density, we compute the energy per particle based on modern nucleon-nucleon and three-nucleon interactions derived within chiral effective field theory. For higher densities, we derive for the first time constraints in a Fierz-complete setting directly based on quantum chromodynamics using functional renormalization group techniques. We find remarkable consistency of the results obtained from both approaches as they come together in density and the natural emergence of a maximum in the speed of sound c_{S} at supranuclear densities. The presence of this maximum appears tightly connected to the formation of a diquark gap. Notably, this maximum is observed to exceed the asymptotic value c_{S}^{2}=1/3 while its exact position in terms of the density cannot yet be determined conclusively.

[Acupuncture for treatment of depressive disorders in pain diseases]. / Akupunktur zur Behandlung depressiver Störungen bei Schmerzerkrankungen.

Therapy with acupuncture as a part of Traditional Chinese Medicine (TCM) is increasingly being used as an alternative or complementary method. The regular diagnostic processes and conventional therapies must primarily be applied as the basic principle of a treatment concept. In addition to a qualified education and training with recognition of the further qualification in acupuncture a continued medical education is required to treat patients. In the field of regular medical care diseases with the symptoms chronic low back pain, chronic low back pain with radicular symptoms radiating to the knee and chronic osteoarthrosis of the knee can be treated: by implementation of a differentiated documentation of the treatment and the results of treatment using Likert scales for the severity of depressive symptoms. Under the aspects of a health services research approach, the results of treatment with acupuncture in practice under the prerequisite of 15 sessions for chronic low back pain including radicular symptoms reaching the knee were analyzed based on syndromes of TCM. Due to the importance of depressive symptoms in pain disorders in a second group additional special acupuncture points (Ren 12, Bl 20, Bl 21, Ma 36, Mi 6, Pe 6) in the area of the conversion phase "earth" were additionally used to influence a depressive disorder under standardized aspects. The results showed the positive influence of a therapy with acupuncture on depressive symptoms in both groups M = 7.67, M = 7.95, M = 3.29 and M = 2.29 (p < 0.001) with significant differences (p < 0.01) and an increase in the effect when using additional specific points for treatment of depression (p < 0.01). Further investigations are necessary in the future for treatment with acupuncture using standardized and reproducible selection of acupuncture point.

Dislocation rates of perineural catheters: a volunteer study.

BACKGROUND: Dislocation rates of continuous peripheral nerve block are poorly described even though this technique is frequently used in clinical practice. The present study was designed to evaluate dislocation rates over time of interscalene and femoral nerve catheters under defined experimental circumstances. Ultrasound (US) monitoring was used to detect the position of the perineural catheters. METHODS: Twenty volunteers received US-guided interscalene and femoral nerve catheters. The volunteers performed standardized physical exercises in regular intervals and the position of both catheters was examined by US confirmation of the spread of fluid. The maximal time of investigation in each volunteer was 6 h. The main outcome parameters were the overall dislocation rates and the cumulative dislocation rates at a given time point. RESULTS: We observed an overall dislocation rate of 15% (5% for interscalene catheters, 25% for femoral nerve catheters) and a significant correlation between time and rate of dislocations (r=0.99, P=0.001). US visualization of the spread of fluid was possible in all cases. CONCLUSIONS: This is the first dedicated evaluation of dislocation rates of peripheral nerve catheters (PNCs) via US investigation. Both movement and time are considerable factors for perineural catheter displacement. US is useful for the performance of PNCs and for the continuous detection of the spread of fluid relative to the nerve and adjacent anatomical structures. Translational research is required to confirm the study results in the clinical practice.

Early post-operative neurodevelopment and visual assessment in neonates with congenital heart disease undergoing cardiac surgery.

OBJECTIVE: Assessment of neurobehavior and visual function of newborns with congenital heart disease during the post-operative period to identify infants at risk of neurodevelopmental and visual impairment. STUDY DESIGN: Prospective study that included 45 newborns who underwent cardiac surgery. Newborn Behavioral Observations test (NBO) and "ML Battery of Optotypes" were used for assessment. RESULTS: The median NBO global score was 2.4 [2.1-2.6]. Total days of oral morphine [p = 0.005] and total days of sedation [p = 0.009] were strongly related to abnormal evaluations. Time of cerebral regional oxygen saturation (CrSO2) under 40% during surgery and increased lactate were related to abnormal motor evaluation. Only 14.5% of patients presented pathological results in visual evaluation. CONCLUSIONS: We have demonstrated alterations in attention, autonomic, motor, and oral motor function. Duration of sedative medication, time of CrSO2 under 40% during surgery, and increased lactate are the most important risk factors. No significant visual impairment was detected.

Impact of an intense stress on ethanol consumption in female rats characterized by their pre-stress preference: modulation by prenatal stress.

We examined the influence of prenatal stress on alcohol preference in adult female rats exposed to an intense stress. To take into account interindividual variability, the study was conducted in animals categorized as low or high alcohol preferring. After footshock, control high-preferring rats strongly reduced their alcohol consumption; in contrast, alcohol consumption was not changed in high-preferring rats that were prenatally stressed.

[Watchful waiting vs surgical repair of oligosymptomatic incisional hernias: Current status of the AWARE study]. / Beobachtung vs. Operation oligosymptomatischer Narbenhernien : Aktueller Stand der AWARE-Studie.

INTRODUCTION: Incisional hernias are one of the the most frequent complications in visceral surgery and incisional hernia repair has a relevant complication rate. Therefore, there have to be solid indications before carrying out incisional hernia repair. To date, there is a lack of evidence concerning the correct indications for surgical repair of incisional hernias. The AWARE trial compares watchful waiting to surgical repair of incisional hernias. MATERIAL AND METHODS: The AWARE trial is a prospective randomized multicenter trial. Patients with asymptomatic or oligosymptomatic incisional hernia are randomized into the watchful waiting or the surgical repair group with a follow-up of 2 years. The primary endpoint is pain during normal activities due to the hernia or the hernia repair after 2 years measured on the hernia-specific surgical pain scale (SPS). RESULTS: In this study 36 centers are participating throughout Germany, more than 1600 patients had been screened up to 31 December 2014 and 234 (14.6%) of the screened patients could be recruited. CONCLUSION: The AWARE study will provide evidence concerning the two therapeutic options of watchful waiting and surgical repair of incisional hernia.

Prenatal stress induces intrauterine growth restriction and programmes glucose intolerance and feeding behaviour disturbances in the aged rat.

There is growing evidence that prenatal adversities could be implicated in foetal programming of adult chronic diseases. Since maternal stress is known to disturb the foetal glucocorticoid environment, we examined the consequences of prenatal stress on foetal growth, on glucose-insulin metabolism and on feeding behaviour in the aged male rat. In foetuses at term, maternal stress reduced body, adrenal and pancreas weight as well as plasma corticosterone and glucose levels. In aged male rats (24 months of age), prenatal stress induced hyperglycaemia and glucose intolerance and decreased basal leptin levels. Moreover, after a fasting period, they showed an increased food intake. These data suggest that maternal stress induces a long-lasting disturbance in feeding behaviour and dysfunctions related to type 2 diabetes mellitus. This programming could be linked to the early restricted foetal growth and to the adverse glucocorticoid environment in utero.

Maternal undernutrition during late gestation-induced intrauterine growth restriction in the rat is associated with impaired placental GLUT3 expression, but does not correlate with endogenous corticosterone levels.

Fetal intrauterine growth restriction (IUGR) is a frequently occurring and serious complication of pregnancy. Infants exposed to IUGR are at risk for numerous perinatal morbidities, including hypoglycemia in the neonatal period, as well as increased risk of later physical and/or mental impairments, cardiovascular disease and non-insulin-dependent diabetes mellitus. Fetal growth restriction most often results from uteroplacental dysfunction during the later stage of pregnancy. As glucose, which is the most abundant nutrient crossing the placenta, fulfills a large portion of the fetal energy requirements during gestational development, and since impaired placental glucose transport is thought to result in growth restriction, we investigated the effects of maternal 50% food restriction (FR50) during the last week of gestation on rat placental expression of glucose transporters, GLUT1, GLUT3 and GLUT4, and on plasma glucose content in both maternal and fetal compartments. Moreover, as maternal FR50 induces fetal overexposure to glucocorticoids and since these hormones are potent regulators of placental glucose transporter expression, we investigated whether putative alterations in placental GLUT expression correlate with changes in maternal and/or fetal corticosterone levels. At term (day 21 of pregnancy), plasma glucose content was significantly reduced (P<0.05) in mothers subjected to FR50, but was not affected in fetuses. Food restriction reduced maternal body weight (P<0.001) but did not affect placental weight. Plasma corticosterone concentration, at term, was increased (P<0.05) in FR50 mothers. Fetuses from FR50 mothers showed reduced body weight (P<0.001) but higher plasma corticosterone levels (P<0.05). Adrenalectomy (ADX) followed by corticosterone supplementation of the mother prevented the FR50-induced rise in maternal plasma corticosterone at term. Food restriction performed on either sham-ADX or ADX mothers induced a similar reduction in the body weight of the pups at term (P<0.01). Moreover, plasma corticosterone levels were increased in pups from sham-ADX FR50 mothers (P<0.01) and in pups from ADX control mothers (P<0.01). Western blot analysis of placental GLUT proteins showed that maternal FR50 decreased placental GLUT3 protein levels in all experimental groups at term (P<0.05 and P<0.01), but did not affect either GLUT1 or GLUT4 protein levels. Northern blot analysis of placental GLUT expression showed that both GLUT1 and GLUT3 mRNA were not affected by the maternal feeding regimen or surgery. We concluded that prolonged maternal malnutrition during late gestation decreases maternal plasma glucose content and placental GLUT3 glucose transporter expression, but does not obviously affect fetal plasma glucose concentration. Moreover, the present results are not compatible with a role of maternal corticosterone in the development of growth-restricted rat fetuses.

Factors which predict unsuccessful mobilisation of peripheral blood progenitor cells following G-CSF alone in patients with non-Hodgkin's lymphoma.

INTRODUCTION: High-dose therapy with haematopoietic progenitor cell support has increasingly been utilised for patients with haematological malignancies. Peripheral blood is the stem cell source of choice, however, various mobilisation strategies are used by different centres. PATIENTS AND METHODS: Over a 2-year period, 52 patients with non-Hodgkin's lymphoma (median age 47 years, range 16-64 years) underwent peripheral blood progenitor cell mobilisation using G-CSF alone (16 microg/kg/day). The harvest was considered successful if > or =1 x 10(6) CD34(+) cells/kg were collected by leukapheresis. The histological subtypes of non-Hodgkin's lymphoma comprised: follicular (24 patients), diffuse large B-cell (14 patients), lymphoplasmacytoid (four patients), mantle cell (three patients), lymphoblastic lymphoma (one patient) and small lymphocytic lymphoma/chronic lymphocytic leukaemia (six patients). The median interval from diagnosis of non-Hodgkin's lymphoma to mobilisation was 27 months (range 2 months to 17 years). The median number of prior treatment episodes was 2 (range 1-5); 26 patients had received fludarabine alone or in combination. At the time of peripheral blood progenitor cell mobilisation, 20 patients were in 1st remission and 32 were in > or =2nd remission; 30 patients were in partial remission and 22 were in complete remission; the bone marrow was involved in nine patients. RESULTS: Peripheral blood progenitor cell mobilisation/harvest was unsuccessful in 19 out of 52 (37%) patients (mobilisation: 18, harvest: 1). The factors associated with unsuccessful mobilisation or harvest were: prior fludarabine therapy (P=0.002), bone marrow involvement at diagnosis (P=0.002), bone marrow involvement anytime prior to mobilisation (P=0.02), histological diagnosis of follicular, mantle cell, or lymphoplasmacytoid lymphoma, or small lymphocytic lymphoma/chronic lymphocytic leukaemia (P=0.03) and female gender (P=0.04). CONCLUSION: Although peripheral blood progenitor cells can be successfully mobilised and harvested from the majority of patients with non-Hodgkin's lymphoma after treatment with G-CSF alone, the latter is unsuccessful in approximately one-third of patients. These factors should be taken into account when patients are being considered for high-dose treatment.

Neurogenic origin of human prostate endocrine cells.

OBJECTIVES: To determine the histogenetic origin of prostate neuroendocrine cells in human embryos. METHODS: Prostatic tissue in human fetuses, ranging in gestational age from early week 10 to term, and infantile and pubertal glands were studied immunohistochemically. The distribution of neuroendocrine cells within the developing gland was semiquantitatively determined. Antibodies against the neuroendocrine markers chromogranin A (CgA) and protein gene product 9.5 (PGP), along with markers of prostatic secretion (prostate-specific antigen [PSA], prostatic acid phosphatase [PAP]), were used. They were applied either individually or in double-labeling experiments, as well as in experiments combining CgA immunohistochemical analysis with in situ hybridization or in situ end-labeling. RESULTS: In embryos of less than 65-mm crown-rump length (CRL) (ie, younger than 12 weeks of gestation), the epithelium of the urogenital sinus was free of endocrine cells. On either side of the future prostatic mesenchyme, paraganglia containing CgA-immunoreactive cells are present, which start to penetrate the urogenital mesenchyme. In the late 10th week, these CgA-immunoreactive cells are found dispersed in the urogenital mesenchyme. In embryos of 65-mm CRL, when prostatic anlagen start to sprout from the urogenital epithelium, very few (but typically shaped) neuroendocrine cells appear in the urogenital sinus epithelium. Later, after the 12th week, when solid prostatic ducts have started forming, CgA-immunoreactive neuroendocrine cells are also present in these buds. The number of neuroendocrine cells in the urethral epithelium is considerably increased, and with the continuous sprouting and lumen formation of prostatic anlagen, neuroendocrine cells are transported into the future gland. Neuroendocrine cells observed in stroma of prenatal and postnatal prostates may also contribute to the neuroendocrine cell population of the gland. CONCLUSIONS: Our results provide the first evidence that human prostate neuroendocrine cells represent a cell lineage of their own, being of neurogenic origin and therefore distinct from the urogenital sinus-derived prostate secretory and basal cells.

Effect of hydroxycitrate on food intake and body weight regain after a period of restrictive feeding in male rats.

We examined whether dietary supplementation of hydroxycitrate (HCA), a competitive inhibitor of the extramitochondrial enzyme ATP-citrate-lyase, which inhibits lipogenesis, reduces food intake and body weight regain in rats after 10-15% weight loss. In four experiments, 24 male rats were fed restrictively (10 g/day) for 10 days and then given ad lib access to one of four different diets (HI-Suc=high sucrose; HI-Glu=high glucose; Chow=grounded standard rat chow; HI-Glu+Fat=high glucose+fat) varying in the content of fat and low molecular carbohydrates for the following 10 days. For half of the rats (n=12), the ad lib diet was supplemented with 3% (w/w) HCA. HCA reduced body weight regain with all diets except Chow. HCA also reduced food intake temporarily with three of the four tested diets. The suppressive effect of HCA on food intake was particularly strong with the HI-Glu+Fat diet (fat=24% of energy). With Diet HI-Glu and HI-Glu+Fat HCA reduced the feed conversion efficiency (cumulative body weight regain (g)/cumulative food intake (MJ)) during the 10 ad lib days, suggesting that it also increased energy expenditure. This effect seemed to be positively related to the glucose content of the diet. All in all, HCA reduced body weight regain after substantial body weight loss, and the effects are presumably linked to its inhibiting effect on lipogenesis, but the exact mechanism still has to be determined.

[Dorsolateral approach to the left subphrenic area, to the bursa omentalis and to the cauda pancreatis]. / Der dorsolaterale Zugang zum linken Subphrenium, zur Bursa omentalis und zur Cauda pancreatis.

We are reporting on a dorsolateral access left to the bursa omentalis and to the left subphrenium carried out in order to relieve infectious processes in this region. The access has proved a success above all in the later postoperative period, e.g. when the protecting conglutinations towards ventral isolate the process from the abdominal cavity. At the lying patient this access allows the drainage of the exsudation over the deepest point. The results of 23 surgical interventions are being demonstrated with references to possible complications caused by the intervention.

Key strategies for risk management in acute home care.

Home care agencies face new challenges as more acute medical care shifts to the home setting. Successful risk management must address effective communication and documentation, as well as proper management of new medical technologies.

[Hermann F. Hoffmann (1891-1944)--Tübingen psychiatry on the way to national socialism]. / Hermann F. Hoffmann (1891-1944)-Die Tübinger Psychiatrie auf dem Weg in den Nationalsozialismus.

This study covers the life and scientific work of Hermann F. Hoffmann who was a disciple of Robert Gaup and in 1936 took over from him as head of the psychiatric clinic at the University of Tübinge. As a scientist, Hoffmann was especially involved in research into genetic problems in psychiatry. He introduced a new approach to some premises of the so-called Tübingen Psychiatric School. In 1933, he joined the NSDAP and became one of the most prominent members of the National Socialist party at the University of Tübingen. From then on, he saw himself as a prophet of a new "biological" philosophy of life. From the present point of view, Hoffmann is something of a contradiction. On the one hand, he was a good doctor and a serious scientist; on the other, he promoted biologistic ideology and a criminal regime. These biographical inconsistencies point to some inconsistencies in the history of psychiatry itself with its dialectics of philanthropy and discrimination.

Vitamin E content of different animal products: influence of animal nutrition.

The alpha-tocopherol content of different meat cuts was examined. Chicken thigh had the highest vitamin E content, followed by chicken breast and pork shoulder (p < 0.05). The lowest concentrations were found in longissimus dorsi muscle from pork, beef, veal and in beef shoulder. Considering the average daily lean meat consumption (105 g) in Switzerland, recommendation for daily vitamin E intake was met to 3%. Supplementation of 200 mg alpha-tocopherol acetate/kg feed to pigs and laying hens significantly increased the alpha-tocopherol content in all examined products. The alpha-tocopherol accumulation differed according to the following ranking: egg yolk > liver > adipose tissue > musculus longissimus dorsi. The alpha-tocopherol:energy ratios were 28.8, 7.3, 0.9 and 1.2 mg/MJ for egg yolk, liver, adipose tissue and longissimus dorsi muscle of the vitamin E supplemented groups, respectively. The results showed that meat, with the exception of chicken thigh, is not an important supplier of vitamin E, not even from animals fed a vitamin E enriched diet. Egg yolk became a good source of vitamin E for human nutrition by dietary modification.

Available iron and zinc in major lean meat cuts and their contribution to the recommended trace element supply in Switzerland.

The objective of the present study was to analyze iron and zinc in major lean meat cuts in order to estimate the contribution of the average lean meat consumption in Switzerland (1995) for these trace elements. Iron, heme iron and zinc contents were analyzed in following muscles: pork (longissimus dorsi muscle and shoulder), beef (longissimus dorsi muscle and shoulder), veal (longissimus dorsi muscle) and chicken (breast and thigh). Beef and pork shoulder were the best sources of iron, heme iron and zinc. Pork and veal longissimus dorsi muscle and chicken were relatively poor in these trace elements. With an average daily lean meat consumption of 105 g, iron and zinc intake were about 1.1 mg/d and 3.8 mg/d, respectively. Recommendations for daily iron intake were met to 11% (men) and 7% (women) and for zinc to 25% (men) and 32% (women). Applying a modified Monsen model, the requirements for absorbed iron were met in the range of 10-30% and 7-20% for men and women, respectively. Taking into account a zinc absorption rate from meat of about 20-36%, the daily requirements for absorbed zinc were covered to 32-56%. In conclusion, the average amount of lean meat as consumed in Switzerland was high enough to be an important source of available iron and zinc, particularly for people with low iron and zinc status.