Optical Traps for Sympathetic Cooling of Ions with Ultracold Neutral Atoms.

We report the trapping of ultracold neutral Rb atoms and Ba^{+} ions in a common optical potential in absence of any radio frequency (rf) fields. We prepare Ba^{+} at 370 µK and demonstrate efficient sympathetic cooling by 100 µK after one collision. Our approach is currently limited by the Rb density and related three-body losses, but it overcomes the fundamental limitation in rf traps set by rf-driven, micromotion-induced heating. It is applicable to a wide range of ion-atom species, and may enable novel ultracold chemistry experiments and complex many-body dynamics.

Serial ankle casts for patients with idiopathic toe walking: effects on functional gait parameters.

PURPOSE: The aim of the present study was to investigate the functional effects on gait parameters of serial ankle casts for patients with idiopathic toe walking (ITW), in comparison with an unremarkable control group. METHODS: A prospective trial with a pre-test-post-test control group design included ten patients with ITW and ten healthy matched children. Children with ITW underwent serial casting to stretch the plantar flexors, with two 14-day periods with walking plaster casts set at the maximum available ankle dorsiflexion. Both groups were assessed clinically and using a functional gait analysis before and after serial casting, as well as at a six-month follow-up visit. RESULTS: The normalized plantar heel force increased from 5% pre-interventionally to 79% at the follow-up. The upper ankle-joint angle and the base angle also demonstrated significant changes. Normalized compound action potentials of the medial heads of the gastrocnemius were reduced by 70%. None of these parameters demonstrated any significant differences at the follow-up examination in comparison with the healthy control group. Variations in the displacement of the knee joint on the sagittal plane and of the center of gravity in the transverse plane did not show any significant differences in comparison with the control group. CONCLUSION: The reduction of muscle tone and lengthening of the ankle plantar flexors led to persistent increased active ankle dorsiflexion with significant long-term improvement of functional kinematic parameters. No significant difference in the gait analysis was found between the ITW group and healthy children six months after treatment.Level of Evidence: Level II - Therapeutic.

CD14+ monocytes contribute to inflammation in chronic nonbacterial osteomyelitis (CNO) through increased NLRP3 inflammasome expression.

The pathophysiology of chronic nonbacterial osteomyelitis (CNO) remains incompletely understood. Increased NLRP3 inflammasome activation and IL-1ß release in monocytes from CNO patients was suggested to contribute to bone inflammation. Here, we dissect immune cell infiltrates and demonstrate the involvement of monocytes across disease stages. Differences in cell density and immune cell composition may help to discriminate between BOM and CNO. However, differences are subtle and infiltrates vary in CNO. In contrast to other cells involved, monocytes are a stable element during all stages of CNO, which makes them a promising candidate in the search for "drivers" of inflammation. Furthermore, we link increased expression of inflammasome components NLRP3 and ASC in monocytes with site-specific DNA hypomethylation around the corresponding genes NLRP3 and PYCARD. Our observations deliver further evidence for the involvement of pro-inflammatory monocytes in the pathophysiology of CNO. Cellular and molecular alterations may serve as disease biomarkers and/or therapeutic targets.

[Periacetabular osteotomy-what influence does age have on patient-relevant results? : A prospective 5­year investigation]. / Periazetabuläre Osteotomie ­ Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse? : Eine prospektive 5­Jahres-Untersuchung.

INTRODUCTION: Periacetabular osteotomy (PAO) is an effective procedure in treatment of symptomatic hip dysplasia. To achieve a good outcome a strict patient selection has to be applied. The aim of this study was to evaluate the influence of patient age at surgery on clinical outcome. METHODS: In a prospective study 86 patients (106 hips) underwent clinical and radiographic follow-up at a mean time of 5 years (2.5-8.5 years) after PAO. Patient-related outcome measurements (PROMs: EQ-5D, WOMAC, OHS, GTO) were applied preoperatively as well as postoperatively and the deformity correction as well as development of osteoarthritis were evaluated. In order to analyze the influence of patient age at surgery on clinical outcome, we subdivided the patient cohort into four different age groups (<20 years, 20-29 years, 30-39 years, >40 years). RESULTS: Of the patients 90% were very satisfied or satisfied with the results 5 years after surgery, and in all age groups PROMs significantly increased. Even though preoperative as well as postoperative algofunction declined in cohorts with increasing age, the overall benefit as measured in WOMAC and EQ-5D scores was equal in all age groups. Increasing age is associated with a progression in osteoarthritis as well as a higher conversion rate to total arthroplasty. DISCUSSION: Age is an important influencing factor on the long-term outcome after PAO. A certain age as cut off for indications could not be identified in this study. Even patients in the age groups 30-39 years and > 40 years showed PROM improvement and satisfaction with outcome at medium-term follow-up. The expected success rate has to be discussed preoperatively with the patient; however, as a higher conversion rate to hip arthroplasty as well as progressive osteoarthritis is associated with higher age, not only patient age alone but also morphological characteristics of the hip joint have to be taken into consideration.

[Corrective osteotomies for posttraumatic elbow deformities]. / Korrekturosteotomien bei posttraumatischen Fehlstellungen des Ellenbogengelenks.

OBJECTIVES: Correcion of elbow joint deformities that usually develop secondary to direct or indirect trauma of the arm or elbow with subsequent inadequate healing and consecutive axial/rotational malalignment and may be associated with cosmetic or functional deficits of the arm. INDICATIONS: Relevant malalignment of the arm axis with corresponding cosmetic or functional deficits for the patient. CONTRAINDICATIONS: Pre-existing degenerative and chronic inflammatory changes. SURGICAL TECHNIQUE: Generally, two-dimensional supracondylar open or closed wedge osteotomies are used. In the presence of a three-dimensional deformity (with rotational component), an additional derotational correction is necessary. Extra-articular deformities following extension fractures should be treated preferably with an open wedge osteotomy, extra-articular deformities of flexion fractures with a closed wedge osteotomy. Valgus/varus deformities may also require a closed/open wedge osteotomy primarily through a dorsal or alternatively radial approach. POSTOPERATIVE MANAGEMENT: The arm should be immobilized with a brachial cast splint for 2-3 weeks, with passive exercises of the elbow starting on postoperative day 7. RESULTS: In general, the results for a three-dimensional osteotomy of the distal humerus are expected to be good to very good. Only in rare cases (2.5%) is a mostly transient irritation of the ulnar nerve observed.

Long-Term Function following Periprosthetic Fractures.

PURPOSE OF THE STUDY Clinical results of long-term follow-up after traumatic periprosthetic femur fractures and different therapies (ORIF vs. revision arthroplasty) MATERIAL AND METHODS The Visual Analog Scale (VAS), Harris-Hip-Score (HHS), Oxford-Hip-Score (OHS), Oxford-Knee-Score (OKS), Knee-Society-Score (KSS), SF-36 Questionnaire and Funktionsfragebogen Hannover (FFH) were used to evaluate outcome and functionality. Radiological examinations were performed and the Vancouver (THA) and Lewis and Rorabeck (TKA) classifications used. RESULTS 70 patients suffered a periprosthetic hip fracture (29× revision prosthesis, 41x ORIF), 23 patients underwent an ORIF due to periprosthetic fracture of a TKA (total mean age 75.2 years). 47 patients (follow-up rate 51%) were examined 40 months after surgery (mean age 72 years) (THA: 16× revision, 23× ORIF, TKA: 8× ORIF). The VAS revealed significant less pain in the group that had undergone revision hip arthroplasty than in the ORIF group: 3.9±1 vs. 5.1±1.7 (p<0.05), respectively. 5/16 patients with revision arthroplasty had excellent or good results in the HSS compared to 3/23 patients after ORIF. The OHS yielded excellent or good results in 12/16 patients after revision arthroplasty vs. 10/23 after ORIF. The VAS after ORIF in patients who suffered periprosthetic knee fractures was 4.9±2.1. 3/8 patients achieved excellent or good results according to the OKS. CONCLUSION Every functional score (HSS, OHS, FFH, SF-36) of those patients who had undergone revision arthroplasty was slightly higher and their VAS significantly lower than the scores of the patients after ORIF. Key words: periprosthetic fractures, trauma, open reduction and internal fixation, revision arthroplasty.

[Adolescent idiopathic scoliosis : Guideline for practical application]. / Adoleszente idiopathische Skoliose : Leitfaden für die praktische Anwendung.

Juvenile or adolescent idiopathic scoliosis is a relatively common spinal deformity, with an incidence of more than 1 %. Early diagnosis can lead to successful therapy. In the case of pathological clinical findings, the anteroposterior X­ray of the whole spine leads the way to the correct grading, according to Cobb angle measurement. Depending on the individual risk of progression, brace treatment will be started with a Cobb angle range of 20-25°. Important predictors of therapeutic success are sufficient primary corrective power and patient compliance. COBB angles of 40-50° usually lead to the recommendation for surgery, which is performed as either anterior or posterior spinal fusion in skeletally mature adolescents, depending on the grade of the deformity according to Lenke's classification. To achieve the best possible results, it is recommended that both conservative and surgical treatments are carried out by scoliosis specialists.

Signals of the QCD phase transition in core-collapse supernovae.

We explore the implications of the QCD phase transition during the postbounce evolution of core-collapse supernovae. Using the MIT bag model for the description of quark matter, we model phase transitions that occur during the early postbounce evolution. This stage of the evolution can be simulated with general relativistic three-flavor Boltzmann neutrino transport. The phase transition produces a second shock wave that triggers a delayed supernova explosion. If such a phase transition happens in a future galactic supernova, its existence and properties should become observable as a second peak in the neutrino signal that is accompanied by significant changes in the energy of the emitted neutrinos. This second neutrino burst is dominated by the emission of antineutrinos because the electron degeneracy is reduced when the second shock passes through the previously neutronized matter.

Computer-assisted osteotomy of the lateral femoral condyle with non-constrained total knee replacement in severe valgus knees.

We describe the mid-term results of a prospective study of total knee replacement in severe valgus knees using an osteotomy of the lateral femoral condyle and computer navigation. There were 15 knees with a mean valgus deformity of 21 degrees (17 degrees to 27 degrees) and a mean follow-up of 28 months (24 to 60). A cemented, non-constrained fixed bearing, posterior-cruciate-retaining knee prosthesis of the same design was used in all cases (Columbus-B. Braun; Aesculap, Tuttlingen, Germany). All the knees were corrected to a mean of 0.5 degrees of valgus (0 degrees to 2 degrees). Flexion of the knee had been limited to a mean of 85 degrees (75 degrees to 110 degrees) pre-operatively and improved to a mean of 105 degrees (90 degrees to 130 degrees) after operation. The mean Knee Society score improved from 37 (30 to 44) to 90 points (86 to 94). Osteotomy of the lateral femoral condyle combined with computer-assisted surgery gave an excellent mid-term outcome in patients undergoing total knee replacement in the presence of severe valgus deformity.

[Combined hip-dysplasia and femuroacetabular impingement. Diagnosis and simultaneous surgical treatment]. / Koinzidenz von Hüftdysplasie und femuroazetabulärem Impingement. Klinisches Bild und simultane operative Korrektur.

Developmental dysplasia of the hip as well as femuroacetabular impingement are recognized causes of hip pain and degenerative disorders. While accepted treatment recommendations for both entities currently exist, there are no standardised approaches published for the management of combined lesions. We therefore present an algorithm of diagnosis and simultaneous surgical treatment based on a combination of periacetabular osteotomy and arthroscopically-assisted minimally invasive anterior osteochondroplasty. Short-term treatment results of 19 patients show an effective improvement of clinical symtoms and radiographic deformity.

[The natural history of developmental dysplasia of the hip. A meta-analysis of the published literature]. / Natürlicher Verlauf von Hüftreifungsstörungen und Hüftdysplasie. Eine Metaanalyse publizierter Literatur.

Assessment of the natural history of developmental dysplasia of the hip (DDH) is indispensable for age-dependent treatment of these patients. Based on a systematic meta-analysis of the published literature, this study gives an overview of the spontaneous course of DDH in different age decades. Furthermore, these results are discussed in the context of physiologic development of the hip. The data were compiled by a systematic literature search of medical databases from 1975 through 2007. For this evaluation, only papers that presented as high a level of evidence as possible were included. In early childhood, DDH with subluxation or dislocation necessitates treatment; otherwise, the spontaneous course leads invariably to osteoarthritis of the hip. However, a stable, well-centered dysplastic hip has a high potential of developing as a physiologic joint. In the analyzed data, an association between mild or moderate DDH after the end of growth and the development of osteoarthritis could not be demonstrated. The level of evidence of existing data is not sufficient to determine that persisting mild dysplasia is a relevant ethiopathological factor for osteoarthrosis of the hip. Therefore, prospective epidemiological studies are required.

[The delegation of medical services: is it a Trojan horse?]. / Delegation ärztlicher Leistungen : Ein trojanisches Pferd?

Delegation of medical treatment and responsibility from doctors to nonphysicians are being advocated more and more by public health politicians. The opinion of the German Union of Orthopaedic and Trauma Surgery is outlined. Definitions for treatment areas that cannot or may be delegated are presented. Physicians must be spared from overloading of administrative work. Delegating must not result in deterioration of patient care or destruction of the medical profession. Options and risks of delegation are discussed.

[Osteoid osteomas of the fingers: an atypical localization? Two case reports and a review of the literature]. / Osteoidosteome der Finger: eine atypische Lokalisation? Fallberichte von zwei Patienten und Literaturübersicht.

Osteoid osteomas are painful bone tumors that usually occur in childhood or adolescence. Despite the small size of the bony lesions osteoid osteomas can cause persistent pain. Pathogenesis has not been completely understood. Remission usually occurs within several months to years. Therefore surgical therapy is not indicated in all cases. Nevertheless, as a result of reduced quality of life due to pain, sufficient analgesic/antiinflammatory therapy needs to be provided. We report on two male patients, aged 10 and 14 years, who presented with arthritis of the finger joints. As a result of both patients' histories, and following radiographic imaging and magnetic resonance imaging, a diagnosis of osteoid osteoma was made. Remission could be achieved in both patients following treatment with nonsteroidal antiinflammatory drugs (NSAIDs).In addition to the typical sites at the long bones of the lower extremity, osteoid osteomas can also localize to other sites such as fingers. In the case of definitive diagnosis and under close follow-up, medical treatment with NSAIDs is an alternative to surgical strategies. The operative risk should be weighed against the risk of long-term treatment with NSAIDs.

[Hindquarter amputation - a solution for pelvic disruption]. / Hemipelvektomie - eine Lösung bei Beckenzerreissung.

Traumatic pelvic disruptions are rare and frequently these injuries are combined with other injuries and have a high lethality. Hindquarter amputation is a lifesaving option and was performed in a 21-year-old motorcyclist with closed pelvic disruption.

[Treatment of osteochondritis dissecans of the knee joint]. / Therapie der Osteochondrosis dissecans des Kniegelenks.

Osteochondritis dissecans (OD) is a lesion of the subchondral bone which can result in sequestration of the osteochondral lesion. It is categorized into 4 stages, and juvenile and adult forms depending on the distal femoral physis maturity. Prognosis and treatment depends on age and stage. Prognosis is favorable in stable lesions (stage I and II) at typical location (medial femoral condyle) in a child with open physes. Therefore non-operative treatment is indicated. If there is no response to non-operative treatment drilling to create channels for potential revascularization can be done. In unstable lesions (stage III and IV) operative treatment is necessary. Long-term results after excision of the fragment with or without drilling of the defect site are poor. Therefore refixation of an intact osteochondral fragment or biologic reconstruction should be tried.

[A novel therapeutic approach to bone replacement: vitalisation of industrial processed allogenic bone graft with autologous bone marrow]. / Das "vitalisierte" Allograft als Alternative im Knochenersatz.

AIM: Osseous defects of the human skeleton are a common problem in reconstructive orthopaedic and trauma surgery. In spite of a long-standing history of research on different organic and inorganic bone replacement materials, a clinically applicable alternative to autogenous bone transplants has not been found. METHODS: The current paper describes a novel bone replacement material, which is vitalised through injection of autologous bone marrow. Industrially processed bone allografts were used for bone replacement; the cancellous bone graft was gained from femoral heads from living human donors and processed by a French tissue bank (Banque de Tissus France, TBF). Sterile packed allogenic bone grafts can be stored at room temperature, are easy to handle and can be adapted to almost every bone defect due to their stability and versatility. RESULTS: From July 2003 to February 2006 125 patients,70 men and 55 women, underwent bone grafting with composite transplants composed of autogenous marrow cells and industrial processed bone allografts. The average age at surgery was 62 (14-84) years; the follow-up period was 11 months. The indication to use the allograft included the whole spectrum of bony defects conventionally treated with autologous cancellous bone grafts such as primary and revision surgery in THA (n = 64) and the treatment of pseudarthrosis particularly of the lower limb (n = 30). CONCLUSION: In comparison to current bone replacement materials applied in clinical use, this approach promises to replicate the biomechanical and biological properties of autogenous cancellous bone. This is an important advantage over conventional approaches to ensure successful healing and regeneration of bone defects. Hence application of vitalised bone allograft represents an important alternative to conventional autogenous cancellous bone which avoids certain complications associated with harvesting and transplantation of autogenous bone. This applies in particular in situations in which harvesting of autogenous cancellous bone is not or no longer possible.

["Trauma network Baden-Württemberg" in the Trauma Network of the German Association of Trauma Surgery. Example for the establishment of a trauma network at the State level]. / "Traumanetz Baden-Württemberg" im Traumanetzwerk der Deutschen Gesellschaft für Unfallchirurgie. Beispiel für die Einrichtung eines Traumanetzwerkes auf Landesebene.

How can regional trauma networks (RTN) be organized to best suit the local circumstances taking structural factors, "historical" conditions, relationships, and actual need into consideration while using resources wisely, in particular having different specialists on call? This article attempts to address this question and present a possible model. The creation of a RTN at the State level is described based on the preliminary work and the subsequent measures undertaken to implement the plans. Preparations at the State level are necessary to gather information on the local situation with respect to geographical and structural conditions. Regional relationships and regional allocation of resources have to be taken into account when establishing such a network. Based on these principles, after the actual quantity of patients requiring care has been determined, the establishment of regionally organized network structures can be supported. Allowance should also be made for the resources and conditions in the bordering States.

Neutrino-induced nucleosynthesis of A>64 nuclei: the nu p process.

We present a new nucleosynthesis process that we denote as the nu p process, which occurs in supernovae (and possibly gamma-ray bursts) when strong neutrino fluxes create proton-rich ejecta. In this process, antineutrino absorptions in the proton-rich environment produce neutrons that are immediately captured by neutron-deficient nuclei. This allows for the nucleosynthesis of nuclei with mass numbers A>64, , making this process a possible candidate to explain the origin of the solar abundances of (92,94)Mo and (96,98)Ru. This process also offers a natural explanation for the large abundance of Sr seen in a hyper-metal-poor star.

[Traumatic vertebral artery dissection in an 8 year old boy]. / Traumatische Vertebralisdissektion bei einem 8-Jährigen.

Dissections of extracranial brain supplying arteries are a common cause of ischemic strokes in young patients. Accidents are often accountable for that. We report the case of an 8 year old boy with traumatic vertebral dissection after he was bumped while playing football. He developed an ischemia on both sides of the thalamus which was caused by a bilateral system of the vertebral artery. He showed motor eye and progressive neuropsychological deficits. The CT and MRI scan confirmed the diagnosis. The symptoms ameliorated under anticoagulation treatment with intravenous heparin. At the end of the hospital stay, neuropsychological deficits persisted. Doppler ultrasound showed recanalization of the vertebral artery. Further treatment consisted of anticoagulation with marcumar for 6 months.

[Midterm results after treatment of liposarcoma in the extremities]. / Mittelfristige Behandlungsergebnisse nach Therapie von Liposarkomen im Extremitätenbereich.

PURPOSE: In this retrospective analysis, survival time, local recurrence and rate of metastasis were appraised in patients with primary liposarcoma of the extremities depending upon the applied primary and adjuvant therapy procedures. Furthermore, we compared the representativity of histological results of the biopsy with the final histology of the resected tumour. MATERIAL AND METHOD: Between 1990 and 1998, 27 patients were surgically treated who suffered from a primary liposarcoma of the extremities. At the mean follow-up time of 62.4 months (39-141 months) postoperative survival rate, rate of metastasis and local recurrence were determined. The results were analysed with regard to intraoperative resection distance, tumour size and localisation as well as histological classification of previous biopsy and finally resected tumour. The influence of radiotherapy on the results was also determined. RESULTS: In 5 patients (18.5%) the amputation and in 22 cases (81.5%) the limb sparing resection of the liposarcoma was performed. 6 patients underwent a marginal resection and one patient an intralesional resection. At follow-up we observed a local recurrence rate of 22.2% (n = 6) and a survival rate of 74.1%. 18.5% of the patients had metastases. After adjuvant radiotherapy three patients (50%) showed local recurrence after marginal resection. In only 8 cases (29.6%) the results of primary biopsy and final tumour classification (entity, subtype and grading) were identical. CONCLUSION: The development of metastases (often pulmonary) and local recurrences even after long tumour-free interval makes adequate follow-up investigations mandatory in liposarcoma patients. With regard to the problems in assessing liposarcoma biopsies, MRI-orientated biopsies from several tumour areas via one biopsy approach are recommended.