InterMiG: international differences in the therapeutic approach to migraine patients in specialized headache centers.

BACKGROUND: There is currently a wide therapeutic arsenal for migraine patients, without a single first-line preventive drug and we choose the different available alternatives taking into account comorbidities, national guidelines, previous treatments and personal experiences. Our objective was to evaluate the differences in the use of migraine treatments between neurologists from different countries. METHODS: This is a multi-centre observational study carried out by neurologists from specialized headache units in seven countries, retrospective with consecutive inclusion of all patients presenting with a migraine diagnosis, over a period of three months. RESULTS: A total of 734 patients were recruited but only 600 were considered in the analysis in order to homogenize the patient cohorts from countries: 200 Spain (ES), 100 Italy (IT), 85 Russia (RUS), 80 Germany (DE), 60 Portugal (PT), 45 Poland (PL) and 30 Australia (AU). 85.4 % of patients were women with a mean age of 42.6 ± 11.8 years. Considering previous and current preventive treatment, the order of use was: antidepressants (69.3 %), antiepileptic drugs (54.7 %), beta-blockers and antihypertensive drugs (49.7 %), OnabotulinumtoxinA (44.0 %) and others (36.2 %). Statistically significant differences were found between all pharmacological classes: antidepressants were commonly used in all countries, with the exception of Poland (AU: 76.7 %, IT: 71.0 %, DE: 60.0 %, PL: 31.1 %, PT: 71.7 %, RUS: 70.6 %, ES: 78.5 %; p < 0.0001); antiepileptic drugs were more frequently prescribed in Portugal, Australia and Spain (AU: 73.3 %, IT: 40.0 %, DE: 37.5 %, PL: 48.9 %, PT: 85.0 %, RUS: 29.4 % and ES: 69.0 %; p < 0.0001); beta-blockers and antihypertensive drugs were frequently used in all countries except Italy (AU: 60.0 %, IT: 14.0 %, DE: 53.8 %, PL: 48.9 %, PT: 68.3 %, RUS: 49.4 % and ES: 59.0 %; p < 0.0001); BTX-A were predominately used in Spain, Italy and Australia (AU:56.7 %, IT:58.0 %, DE:20.0 %, PL: 42.2 %, PT: 26.7 %, RUS: 24.7 % and ES: 58.5 %; p < 0.0001) and others were most frequently used in Poland (AU: 0.0 %, IT: 19.0 %, DE: 42.5 %, PL: 95.6 %, PT: 31.7 %, RUS: 3.5 % and ES: 49.5 %; p < 0.0001). If only patients without comorbidities are considered (200/600), statistically differences between countries persist in all preventive treatments. CONCLUSIONS: There is heterogeneity in the choice of preventive treatment between different countries. Prospective comparative studies of the different oral and subcutaneous alternatives would help to create a global therapeutic algorithm that would guarantee the best option for our patients.

Are there effects of age, gender, height, and body fat on the functional muscle-bone unit in children and adults?

The aim was to describe the effect of age, gender, height, different stages of human life, and body fat on the functional muscle-bone unit. All these factors had a significant effect on the functional muscle-bone unit and should be addressed when assessing functional muscle-bone unit in children and adults. INTRODUCTION: For the clinical evaluation of the functional muscle-bone unit, it was proposed to evaluate the adaptation of the bone to the acting forces. A frequently used parameter for this is the total body less head bone mineral content (TBLH-BMC) determined by dual-energy X-ray absorptiometry (DXA) in relation to the lean body mass (LBM by DXA). LBM correlates highly with muscle mass. Therefore, LBM is a surrogate parameter for the muscular forces acting in everyday life. The aim of the study was to describe the effect of age and gender on the TBLH-BMC for LBM and to evaluate the impact of other factors, such as height, different stages of human life, and of body fat. METHODS: As part of the National Health and Nutrition Examination Survey (NHANES) study, between the years 1999-2006 whole-body DXA scans on randomly selected Americans from 8 years of age were carried out. From all eligible DXA scans (1999-2004), three major US ethnic groups were evaluated (non-Hispanic Whites, non-Hispanic Blacks, and Mexican Americans) for further statistical analysis. RESULTS: For the statistical analysis, the DXA scans of 8190 non-Hispanic White children and adults (3903 female), of 4931 non-Hispanic Black children and adults (2250 female) and 5421 of Mexican-American children and adults (2424 female) were eligible. Age, gender, body height, and especially body fat had a significant effect on the functional muscle-bone unit. CONCLUSIONS: When assessing TBLH-BMC for LBM in children and adults, the effects of age, gender, body fat, and body height should be addressed. These effects were analyzed for the first time in such a large cohort.

The functional muscle-bone unit in children with cerebral palsy.

Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using only age- and height-adjusted bone mineral content (BMC) and areal bone mineral density (aBMD). When applying the functional muscle-bone unit diagnostic algorithm (FMBU-A), the prevalence of positive results decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP. INTRODUCTION: The prevalence of bone health deficits in children with cerebral palsy (CP) might be overestimated because age- and height-adjusted reference percentiles for bone mineral content (BMC) and areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry (DXA) do not consider reduced muscle activity. The aim of this study was to compare the prevalence of positive DXA-based indicators for bone health deficits in children with CP to the prevalence of positive findings after applying a functional muscle-bone unit diagnostic algorithm (FMBU-A) considering reduced muscle activity. METHODS: The present study was a monocentric retrospective analysis of 297 whole body DXA scans of children with CP. The prevalence of positive results of age- and height-adjusted BMC and aBMD defined as BMC and aBMD below the P3 percentile and of the FMBU-A was calculated. RESULTS: In children with CP, the prevalence of positive results of age-adjusted BMC were 33.3% and of aBMD 50.8%. Height-adjusted results for BMC and aBMD were positive in 16.8 and 36.0% of cases. The prevalence of positive results applying the FMBU-A regarding BMC and aBMD were significantly (p < 0.001) lower than using age- and height-adjusted BMC and aBMD (8.8 and 14.8%). CONCLUSIONS: Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using age- and height-adjusted BMC and aBMD. When applying the FMBU-A, the prevalence decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP.

Experience with jumping mechanography in children with cerebral palsy.

OBJECTIVES: Jumping mechanography provides robust motor function indicators among healthy children. The aim of the study was to assess the reproducibility and validity of jumping mechanography conducted as single two-legged jump (S2LJ) in children with cerebral palsy (CP). METHODS: 215 S2LJ investigations from a sample of 75 children with CP were eligible for evaluation. For the estimation of the reproducibility, only the baseline set of data per patient were used. Gross motor function was evaluated by the Gross Motor Function Measure (GMFM-66). In 135 S2LJ investigations, GMFM-66 was assessed within a week in the same child. This data was used for validity assessment. RESULTS: Coefficients of variation for the main outcome parameters ranged between 6.15-9.71%, except for jump height (CV%=27.3%). The intraclass correlation coefficients for peak velocity (Vmax) and peak power relative to body weight (Pmax/mass) was 0.927 and 0.931. Vmax and Pmax/mass were also the test parameters with the strongest correlation to the GMFM-66 score (⟩0.7). CONCLUSIONS: S2LJ assessed in the present study provided reproducible outcome measures particularly for Vmax and Pmax/mass in children with CP. Further, Vmax and Pmax/mass showed the strongest correlation with the GMFM-66 score and seem to be the most relevant evaluation criteria.

Home-based vibration assisted exercise as a new treatment option for scoliosis - A randomised controlled trial.

OBJECTIVES: The aim of this study was to evaluate the effect of scoliosis specific exercises (SSE) on a side-alternating whole body vibration platform (sWBV) as a home-training program in girls with adolescent idiopathic scoliosis (AIS). METHODS: 40 female AIS patients (10-17 years) wearing a brace were randomly assigned to two groups. The intervention was a six months, home-based, SSE program on a sWBV platform five times per week. Exercises included standing, sitting and kneeling. The control group received regular SSE (treatment as usual). The Cobb angle was measured at start and after six months. Onset of menarche was documented for sub-group analysis. RESULTS: The major curve in the sWBV group decreased significantly by -2.3° (SD±3.8) (95% CI -4.1 to -0.5; P=0.014) compared to the difference in the control group of 0.3° (SD±3.7) (95% CI -1.5 to 2.2; P=0.682) (P=0.035). In the sWBV group 20% (n=4) improved, 75% (n=15) stabilized and 5% (n=1) deteriorated by ≥5°. In the control group 0% (n=0) improved, 89% (n=16) stabilized and 11% (n=2) deteriorated. The clinically largest change was observed in the 'before-menarche' sub-group. CONCLUSIONS: Home-based SSE combined with sWBV for six months counteracts the progression of scoliosis in girls with AIS; the results were more obvious before the onset of the menarche.

Early vibration assisted physiotherapy in toddlers with cerebral palsy - a randomized controlled pilot trial.

OBJECTIVES: to investigate feasibility, safety and efficacy of home-based side-alternating whole body vibration (sWBV) to improve motor function in toddlers with cerebral palsy (CP). METHODS: Randomized controlled trial including 24 toddlers with CP (mean age 19 months (SD±3.1); 13 boys). INTERVENTION: 14 weeks sWBV with ten 9-minute sessions weekly (non-individualized). Group A started with sWBV, followed by 14 weeks without; in group B this order was reversed. Feasibility (≥70% adherence) and adverse events were recorded; efficacy evaluated with the Gross Motor Function Measure (GMFM-66), Pediatric Evaluation of Disability Inventory (PEDI), at baseline (T0), 14 (T1) and 28 weeks (T2). RESULTS: Developmental change between T0 and T1 was similar in both groups; change scores in group A and B: GMFM-66 2.4 (SD±2.1) and 3.3 (SD±2.9) (p=0.412); PEDI mobility 8.4 (SD±6.6) and 3.5 (SD±9.2) (p=0.148), respectively. In two children muscle tone increased post-sWBV. 24 children received between 67 and 140 sWBV sessions, rate of completed sessions ranged from 48 to 100% and no dropouts were observed. CONCLUSION: A 14-week home-based sWBV intervention was feasible and safe in toddlers with CP, but was not associated with improvement in gross motor function.

5 year retrospective follow-up of new cases of Charcot neuroarthropathy-A single centre experience.

BACKGROUND: Few data describe the natural history of Charcot neuroarthropathy treated with a total contact plaster cast (TCC). METHODS: A 5 year retrospective analysis of 50 patients presenting with an acute CN, Assessing time to clinical resolution into appropriate footwear and assessing if initial immobilisation device influenced resolution time. RESULTS: During the study period 42 patients (84%) of patients went into remission, 2 died during their treatment, 4 had major amputations, in 2 patients treatment was ongoing. 36 patients were treated with combination offloading devices, 6 were treated with one modality only. Median time to resolution for patients initially treated with a TCC was not significantly shorter than for those treated with a removable below knee boot. 34.9% required re-casting due to clinical deterioration in the removable device. CONCLUSIONS: More precise measures of resolution of CN are needed to assess the impact of initial treatment modality on time to resolution.

Neuromuscular training based on whole body vibration in children with spina bifida: a retrospective analysis of a new physiotherapy treatment program.

INTRODUCTION: Spina bifida is the most common congenital cause of spinal cord lesions resulting in paralysis and secondary conditions like osteoporosis due to immobilization. Physiotherapy is performed for optimizing muscle function and prevention of secondary conditions. Therefore, training of the musculoskeletal system is one of the major aims in the rehabilitation of children with spinal cord lesions. INTERVENTION AND METHODS: The neuromuscular physiotherapy treatment program Auf die Beine combines 6 months of home-based whole body vibration (WBV) with interval blocks at the rehabilitation center: 13 days of intensive therapy at the beginning and 6 days after 3 months. Measurements are taken at the beginning (M0), after 6 months of training (M6), and after a 6-month follow-up period (M12). Gait parameters are assessed by ground reaction force and motor function by the Gross Motor Function Measurement (GMFM-66). Sixty children (mean age 8.71 ± 4.7 years) who participated in the program until February 2014 were retrospectively analyzed. RESULTS: Walking velocity improved significantly by 0.11 m/s (p = 0.0026) and mobility (GMFM-66) by 2.54 points (p = 0.001) after the training. All changes at follow-up were not significant, but significant changes were observed after the training period. Decreased contractures were observed with increased muscle function. CONCLUSION: Significant improvements in motor function were observed after the active training period of the new neuromuscular training concept. This first analysis of the new neuromuscular rehabilitation concept Auf die Beine showed encouraging results for a safe and efficient physiotherapy treatment program which increases motor function in children with spina bifida.

Effects of feed form and dietary coarse ground corn on broiler live performance, body weight uniformity, relative gizzard weight, excreta nitrogen, and particle size preference behaviors.

In this 14-d cage study, the effects of feed form (mash and crumble) and 6 coarse ground corn ( CC: ) inclusions [0, 10, 20, 30, 40, and 50% CC that replaced fine corn ( FC: )] on broiler live performance, BW uniformity, gizzard weight, excreta nitrogen, and particle size preference were investigated. The geometric mean diameter by mass ( DGW: ) of mash diets increased from 422 µm to 431, 471, 509, 542, and 640 µm, respectively, as the percentage of CC increased. Feed intake and BW were decreased by CC and mash at 7 d. Interactions between feed form and CC were observed for feed conversion ratio ( FCR: ) at 7 d of age (P < 0.01), and feed intake (P < 0.05), BW (P < 0.01), and gizzard weight (P < 0.01) at 14 d of age. Feed intake for all CC inclusions in crumble diets was similar and exceeded (P < 0.01) that of mash diets at 14 d. Among mash diets, the 10 and 30% CC feed intake was greater (P < 0.05) than 40 and 50% CC with 0 and 20% CC intermediate. Crumble diets produced a similar BW but greater 14-d BW than mash diets (P < 0.01). Within mash diets, 40 and 50% CC produced a smaller BW (P < 0.01). The FCR at 7 d of CC inclusions in crumble diets was improved (P < 0.01) versus the same CC in mash diets. Within mash diets, 40% CC performed poorer than 0, 10, 20, and 30% CC diets with 50% CC diet intermediate (P < 0.01). Crumble diets improved FCR at 14 d, but CC worsened FCR. Gizzard weight at 14 d was not affected by CC in crumble diets, while it increased with CC in mash diets (P < 0.01). Excreta nitrogen was increased (P < 0.01) by crumble diets. These data demonstrated that pelleting and crumbling reduced the impact of CC, produced a more consistent feed intake, and reduced selective feeding, and that CC stimulated gizzard weight in a linear manner in mash diets.

Effects of dietary coarsely ground corn and litter type on broiler live performance, litter characteristics, gastrointestinal tract development, apparent ileal digestibility of energy and nitrogen, and intestinal morphology.

The objectives of this study were to evaluate the effects of the dietary inclusion of 2 coarsely ground corn (CC) levels (0 or 50%) in diets of broilers reared on 2 litter types (new wood shavings or used litter) on live performance, litter characteristics, gastrointestinal tract (GIT) development, apparent ileal digestibility (AID) of energy and nitrogen (N), and intestinal morphology. No interaction effects between CC level and litter type were observed on live performance. No litter effect was observed on live performance. Dietary inclusion of 50% CC increased BW at 35 d (P<0.01) and improved cumulative feed conversion ratio (FCR) at 35 and 49 d of age (P<0.01). The 50% CC treatment increased absolute and relative gizzard weight (P<0.01) and decreased jejunum unit weight (g/cm) (P<0.01). The new litter treatment (litter N) increased absolute and relative proventriculus weight (P<0.05) but did not affect gizzard weight. An interaction effect between CC level and litter type was observed for litter N, where the 50% CC treatment reduced litter N regardless of litter type (P<0.01), but litter N was reduced by new litter only among birds fed 0% CC (P<0.05). The 50% CC inclusion increased litter pH (P<0.05) and improved the AID of energy and N by 6.8% (P<0.01) and 3.5% (P<0.05), respectively. The 50% CC treatment increased jejunum villi tip width (P<0.05) and villi surface area (P<0.01), and decreased the muscularis layer thickness (P<0.01), whereas new litter increased jejunum villi and ileum villi height (P<0.05), jejunum villi surface area (P<0.01), and the ratio of jejunum villi height to crypt depth (P<0.01). This study showed that birds fed pelleted and screened diets containing 50% CC exhibited improved BW, FCR, and AID of energy and N, in conjunction with altered morphology of the GIT and intestinal mucosa. Litter type affected some GIT traits and functions but did not affect live performance.

Evaluation of litter type and dietary coarse ground corn inclusion on broiler live performance, gastrointestinal tract development, and litter characteristics.

Two 49 d floor pen studies were conducted to evaluate the effects of litter type and dietary coarse ground corn (CC) inclusion on broiler live performance, gastrointestinal tract (GIT) development, and litter characteristics. Experiment 1 was a 2×2 factorial arrangement of 2 genders (male or female) and 2 CC levels (0 or 50%). From 15 to 35 d, the addition of CC decreased feed intake (P<0.01) and BW gain (P<0.05) of males but not females. The inclusion of CC decreased feed intake (P<0.01) and BW gain (P<0.01) from 0 to 49 d but improved adjusted feed conversion ratio (AdjFCR) from 35 to 49 d (P<0.05). Male broilers exhibited better live performance than females during the study as evidenced by greater feed intake (P<0.01) and BW gain (P<0.01), and improved FCR (P<0.01), but with increased mortality (P<0.05). The inclusion of CC increased relative gizzard weight (P<0.01) and decreased relative proventriculus weight (P<0.01) at 49 d. Experiment 2 was a 2×2 factorial arrangement of 2 CC levels (0 or 50%) and 2 litter types (ground old litter or new wood shavings litter). The inclusion of CC decreased feed intake throughout the experiment without affecting final BW when only males were used and improved FCR after 25 d (P<0.01). New litter improved FCR from 1 to 14 d (P<0.01). At 49 d, the birds fed the CC diet had reduced excreta nitrogen (P<0.05) and litter moisture (P<0.05). In conclusion, 50% CC inclusion initially produced negative effects on live performance that became positive as BW increased. The effects of CC became evident at an earlier age for males. New litter had only a marginal benefit on broiler live performance.

Effect of dietary coarsely ground corn on broiler live performance, gastrointestinal tract development, apparent ileal digestibility of energy and nitrogen, and digesta particle size distribution and retention time.

Dietary structural material has been reported to improve broiler live performance and gastrointestinal tract (GIT) function. In this 50 d cage study, the effects of coarsely ground corn (CC) inclusion on broiler live performance, GIT development, apparent ileal digestibility (AID) of energy and nitrogen (N), and digesta particle size distribution and retention time were investigated. This study included 3 CC inclusions (0, 25, and 50% fine corn [FC] replaced by CC), with 6 replicate cages of 10 birds per treatment. The feed conversion ratio (FCR) at 35 and 42 d was improved (P<0.01) as the dietary inclusion of CC increased without effect on feed intake. The 50% CC diet increased absolute and relative gizzard weight at 42 d of age as compared to diets with 0 and 25% CC (P<0.01). Dietary CC increased absolute proventriculus weight at 28 d of age (P<0.05). A numerically lower gizzard digesta pH (P<0.08) was observed at 28 d but not 42 d of age, and there was no difference in proventriculus, jejunum, or ileum digesta pH at 28 or 42 d of age. The 25 and 50% CC treatments increased the digesta retention time at 30 and 45 d of age (P<0.05 and P<0.01, respectively). The 25 and 50% CC treatments improved AID of energy by 7.1 and 8.2%, respectively, when compared with the 0% CC treatment, and they improved AID of N by 12.2 and 12.4%, respectively (P<0.01). The digesta particles in the jejunum exhibited a similar distribution, with a dgw (geometric mean diameter by mass) of 218, 204, and 181 µm when 0, 25, of 50% CC diets were consumed, respectively. In conclusion, birds fed pelleted and screened diets that contained 25 and 50% CC exhibited increased BW, improved FCR, and increased AID of energy and N, which was probably due to enhanced gizzard development and greater digesta retention time.

Parental attitudes, values, and beliefs toward the return of results from exome sequencing in children.

Exome sequencing is being offered for children with undiagnosed conditions to identify a primary (causative) variant. Parental preferences for learning secondary (incidental) variants are largely unexplored. Our objective was to characterize values and beliefs that shape parents' preferences for learning their children's sequencing results. We conducted semi-structured interviews with 25 parents of 13 minor probands with a variety of rare genetic conditions. Parents were asked to discuss their preferences to receive four types of results from exome sequencing. Many parents preferred to receive all types of results. Parents had the most positive attitudes toward learning about variants that predispose to disorders treatable or preventable in childhood. They had reservations about learning about predispositions for untreatable adult-onset conditions and carrier status for recessive conditions. Parents described their success in coping with their child's condition as evidence for an ability to manage any additional negative health information. They felt responsible for learning about secondary variants, desiring a gain in control over their child's health. Our findings suggest that investigators should incorporate parents' perceptions of the value in receiving secondary variant information about their children when designing studies employing exome sequencing.

A specialized rehabilitation approach improves mobility in children with osteogenesis imperfecta.

OBJECTIVE: Osteogenesis imperfecta (OI) is a rare disease leading to recurrent fractures, hyperlaxicity of ligaments, short stature and muscular weakness. Physiotherapy is one important treatment approach. The objective of our analysis was to evaluate the effect of a new physiotherapy approach including side alternating whole body vibration on motor function in children with OI. METHODS: In a retrospective analysis data of 53 children were analyzed. The 12 months approach included 6 months of side alternating whole body vibration training, concomitant physiotherapy, resistance training, treadmill training and 6 months follow up. Primary outcome parameter was the Gross Motor Function Measure after 12 months (M12). RESULTS: 53 children (male: 32; age (mean±SEM): 9.1±0.61, range 2.54-24.81 years) participated in the treatment approach. A significant increase of motor function (GMFM-66 score 55.47±2.45 to 58.67±2.83; p=0.001) and walking distance (47.04 m±6.52 to 63.36±8.25 m (p<0.01) between M0 and M12 was seen. Total body without head bone mineral density increased significantly at M12 (p=0.0189). CONCLUSIONS: In the cohort of OI children which participated in the specialized treatment approach improvements of motor function were observed. Therefore this program should be considered as additional therapeutic approach for children with severe OI.

Effects of trypsin inhibitor and particle size of expeller-extracted soybean meal on broiler live performance and weight of gizzard and pancreas.

Soybean meal (SBM) is a co-product that remains after the oil is removed from whole soybeans by either solvent extraction or mechanically pressing soybeans using an expeller. Expeller-extracted soybean meal (ESBM) contains more fat and less protein than solvent-extracted soybean meal (SSBM), but has higher trypsin inhibitors (TI) that limit its inclusion in poultry diets. We hypothesized that increasing the particle size of ESBM could enhance chick tolerance to dietary TI. The experiment consisted of a 2 × 6 factorial arrangement of 2 ESBM particle sizes (coarse, 1,300 µm, and fine, 530 µm) and 6 TI levels (6, 9, 12, 15, 18, and 21 TIU/mg). A total of 672 male broiler chicks was randomly assigned among the 12 treatment combinations with 8 replicates per combination. The birds were provided with 1 kg/bird of starter diet in a crumble form. The pancreas and gizzard were excised and weighed at 16 d of age and organ weights relative to BW calculated. Feed consumption, BW, and feed conversion ratio (FCR) were determined at 7 and 14 d of age. Increasing TI level produced a quadratic effect (P < 0.01) on BW and FCR at 14 d of age. The best performance was obtained when chicks were fed diets containing ESBM at intermediate TI levels. Increasing the particle size of the ESBM from 530 to 1,300 µm improved BW and feed intake (P < 0.01) without affecting FCR. The relative weight of the pancreas increased linearly as TI level increased (P < 0.001). The results of this study indicated that chicks performed better when fed coarse ESBM at an intermediate TI level.

[Secondary forms of osteoporosis. Special features of diagnostics in childhood and adolescence]. / Sekundäre Formen der Osteoporose. Besonderheiten der Diagnostik im Kindes- und Jugendalter.

Rheumatic diseases in childhood and adolescence can lead to secondary osteoporosis based on various pathophysiologies. The underlying disease, medication and immobility resulting in a reduced osteoanabolic stimulus contribute to the development of a fragile skeletal system. For diagnostic purposes dual-energy X-ray absorptiometry (DXA) is the most frequently used technology. For interpretation of the areal bone mineral density, age and gender matched reference data have to be used. Particularly in the pediatric field, body height must additionally be taken into consideration. Further techniques which can provide detailed information are peripheral quantitative computed tomography and high resolution magnetic resonance imaging. Nowadays, skeletal assessments have to be interpreted in the context of the muscular system. The concept of the functional muscle-bone unit is widely accepted and uses the muscles as the dominating factor. In a second step the adaptation of the skeletal system to the applied muscle force is evaluated. This allows a differentiation between primary and secondary skeletal diseases depending on the ratio of muscles to bone. Therapeutic options for secondary osteoporosis include reduction of the causative medication, treatment of the underlying disease, antiresorptive treatment with bisphosphonates and different programs to activate the muscles. A multimodal interval rehabilitation program including alternating side vibration shows positive effects on mobility, muscle function and bone mass in children and adolescents.

Validation of [18F]fluorodeoxyglucose and positron emission tomography (PET) for the measurement of intestinal metabolism in pigs, and evidence of intestinal insulin resistance in patients with morbid obesity.

AIMS/HYPOTHESIS: The role of the intestine in the pathogenesis of metabolic diseases is gaining much attention. We therefore sought to validate, using an animal model, the use of positron emission tomography (PET) in the estimation of intestinal glucose uptake (GU), and thereafter to test whether intestinal insulin-stimulated GU is altered in morbidly obese compared with healthy human participants. METHODS: In the validation study, pigs were imaged using [(18)F]fluorodeoxyglucose ([(18)F]FDG) and the image-derived data were compared with corresponding ex vivo measurements in tissue samples and with arterial-venous differences in glucose and [(18)F]FDG levels. In the clinical study, GU was measured in different regions of the intestine in lean (n = 8) and morbidly obese (n = 8) humans at baseline and during euglycaemic hyperinsulinaemia. RESULTS: PET- and ex vivo-derived intestinal values were strongly correlated and most of the fluorine-18-derived radioactivity was accumulated in the mucosal layer of the gut wall. In the gut wall of pigs, insulin promoted GU as determined by PET, the arterial-venous balance or autoradiography. In lean human participants, insulin increased GU from the circulation in the duodenum (from 1.3 ± 0.6 to 3.1 ± 1.1 µmol [100 g](-1) min(-1), p < 0.05) and in the jejunum (from 1.1 ± 0.7 to 3.0 ± 1.5 µmol [100 g](-1) min(-1), p < 0.05). Obese participants failed to show any increase in insulin-stimulated GU compared with fasting values (NS). CONCLUSIONS/INTERPRETATION: Intestinal GU can be quantified in vivo by [(18)F]FDG PET. Intestinal insulin resistance occurs in obesity before the deterioration of systemic glucose tolerance.

Charge-induced distortion and stabilization of surface transfer doped porphyrin films.

The interaction between zinc-tetraphenylporphyrin (ZnTPP) and fullerenes (C60 and C60F48) are studied using ultraviolet photoelectron spectroscopy (UPS) and scanning tunneling microscopy (STM). Low temperature STM reveals highly ordered ZnTPP monolayers on Au(111). In contrast to C60, a submonolayer coverage of C60F48 results in long-range disorder of the underlying single ZnTPP layer and distortion of individual ZnTPP molecules. This is induced by substantial charge transfer at the organic-organic interface, revealed by the interface energetics from UPS. However, a second layer of ZnTPP prevents C60F48 guests from breaking the self-assembled porphyrin template. This finding is important for understanding the growth behaviour of "bottom-up" functional nanostructures involving strong donor-acceptor heterojunctions in molecular electronics.

Evaluation of soybean meal source and particle size on broiler performance, nutrient digestibility, and gizzard development.

Although there have been several reports concerning the effects of particle size of cereal grains on productive performance of poultry, there is limited information about the effects of soybean meal (SBM) particle size on broiler performance. The objective of the present experiments was to evaluate the effects of SBM source and particle size on broiler performance, gizzard weight, and nutrient digestibility. The first experiment was a 2 × 2 factorial arrangement of 2 SBM sources: expeller-extracted (ESBM) and solvent-extracted (SSBM), and 2 particle sizes: coarse grind, 971 µm, and fine grind, 465 µm. The second experiment was a 2 × 2 factorial arrangement of 2 ESBM particle sizes: coarse grind, 1,290 µm, and fine grind, 470 µm, and 2 corn particle sizes: coarse grind, 1,330 µm, and fine grind, 520 µm. In the first experiment, there was an interaction (P < 0.05) between SBM source and particle size on BW at 49 d of age. No differences in BW were observed when birds were fed coarse SSBM or ESBM, whereas birds fed diets containing fine ESBM exhibited lower BW than birds fed diets containing fine SSBM. In the second experiment, fine-grind ESBM (P < 0.05) and corn (P < 0.01) produced greater 19-d BW than did coarse grind. A significant interaction (P < 0.01) between ingredient type and particle size revealed that chicks fed coarse particles of corn or ESBM exhibited higher protein digestibility compared with chicks fed only fine particles. Corn particle size had a greater effect on gizzard weight than ESBM particle size. Birds fed diets that contained coarse corn had larger gizzards than birds fed fine corn (P < 0.01), but differences in gizzard weight were not observed when birds were fed coarse or fine ESBM. Particles greater than 1,300 µm depressed BW but improved protein digestibility.

Dementia knowledge transfer project in a rural area.

INTRODUCTION: Rural Scotland has an ageing population. There has been an increase in the number of people with dementia and as the proportion of people aged over 75 years continues to rise, this will increase still further. The Scottish Government has produced a dementia strategy and implementing this will be a challenge for rural Scotland. METHODS: Transferring academic knowledge into practice is challenging. A Knowledge Transfer Partnership was formed between NHS Highland and the University of Stirling. A literature review was undertaken of the rural dementia literature; local services were surveyed and described; and interviews were undertaken with people with dementia and carers. Work was conducted on training, diagnostic service provision and local policy. Throughout the project, a collaborative approach was used, which aimed at the joint production of knowledge. RESULTS: Involving University staff in local service development had a substantial impact. Reviewing existing research knowledge and setting it in the context of local services, and of experience of service use, allowed the relevant priorities to be identified. As well as identifying training needs and providing training, the work influenced local decisions on diagnostic service design and standards, and on policy. CONCLUSION: This embedded engagement model appeared to produce more rapid change than traditional models of use of academic knowledge.