The effectiveness of a standardized tobacco cessation program on psychophysiological parameters in patients with addiction undergoing long-term rehabilitation: a quasi-experimental pilot study.

BACKGROUND: Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption. METHODS: The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6 weeks). RESULTS: We observed significant improvements in self-efficacy (F(1,53) = 5.86; p < .05; ηp2 = .11) and decreased CPD in the IG (ß = 1.16, ρ < .05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV. CONCLUSIONS: The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step. TRIAL REGISTRATION: ISRCTN15684371.

Therapy of aseptic nonunions with parathyroid hormone.

The absence of osseous consolidation of a fracture for 9 or more months with no potential to heal is defined as nonunion. Both for the patient and from a socioeconomic point of view, nonunions represent a major problem. Hypertrophic, vital nonunions are distinguished from atrophic avital ones. Risk factors for a delayed fracture healing are insufficient immobilisation, poor adaptation of the fracture surfaces or residual instability, interposition of soft tissue within the fracture gap, as well as circulation disturbances and infections. The incidence of nonunions after fractures of the long bones lies between 2.6 and 16% depending on the surgical technique used. In human and animal studies, a positive effect of parathyroid hormone (PTH) on fracture healing has been shown. PTH has a direct stimulatory effect on osteoblasts and osteoclasts. In addition, it appears to influence the effect of osseous growth factors. In this prospective study, 32 patients with nonunions were treated with teriparatide to investigate the effects of PTH on fracture healing. Definitive healing of the nonunions following PTH treatment could be observed in 95% of the cases.

High temperature breakdown of the Stokes-Einstein relation in a computer simulated Cu-Zr melt.

Transport properties and the Stokes-Einstein (SE) relation in liquid Cu8Zr3 are studied by molecular dynamics simulation with a modified embedded atom potential. The critical temperature Tc of mode coupling theory (MCT) is derived as 930 K from the self-diffusion coefficient D and viscosity η. The SE relation breaks down around TSE = 1900 K, which is far above Tc. At temperatures below TSE, the product of D and η fluctuates around a constant value, similar to the prediction of MCT near Tc. The influence of the microscopic atomic motion on macroscopic properties is investigated by analyzing the time dependent liquid structure and the self-hole filling process. The self-holes for the two components are preferentially filled by atoms of the same component. The self-hole filling dynamics explains the different breakdown behaviors of the SE relation in Zr-rich liquid CuZr2 compared to Cu-rich Cu8Zr3. At TSE, a kink is found in the temperature dependence of both partial and total coordination numbers for the three atomic pair combinations and of the typical time of self-hole filling. This indicates a strong correlation between liquid structure, atomic dynamics, and the breakdown of SE relation. The previously suggested usefulness of the parameter d(D1/D2)/dT to predict TSE is confirmed. Additionally we propose a viscosity criterion to predict TSE in the absence of diffusion data.

Ciprofloxacin reduces the risk of hemolytic uremic syndrome in patients with Escherichia coli O104:H4-associated diarrhea.

BACKGROUND: Whether antibiotic treatment in patients with enterohemorrhagic Escherichia coli (EHEC)-associated diarrhea influences the risk of hemolytic uremic syndrome (HUS) has still to be elucidated. PATIENTS AND METHODS: During the EHEC epidemic which occurred in northern Germany in spring 2011, 24 patients with E. coli O104:H4 infection were treated at our hospitals, 19 of whom developed HUS. The use of antibiotics before and after the onset of HUS was documented, and the outcome in patients with and without antibiotic treatment was evaluated. RESULTS: Of the 24 patients with EHEC-associated diarrhea, seven received antibiotics before any signs of HUS were present (ciprofloxacin, cefotaxime, amoxicillin and/or metronidazole). Four of these seven patients (57 %) and 15 of the 17 patients (88 %) who were treated without antibiotics developed HUS (p = 0.12). Microbiological testing showed all E. coli O104:H4 to be extended-spectrum beta lactamase producers and thus susceptible only to fluoroquinolones, aminoglycosides and carbapenems. Two of the five patients (40 %) treated with ciprofloxacin and 17 of the 19 patients (89 %) treated without ciprofloxacin developed HUS (p = 0.043). CONCLUSION: In our E. coli O104:H4-infected patients, treatment of diarrhea with antibiotics did not increase the risk of HUS. Significantly fewer patients treated with ciprofloxacin developed HUS than patients who did not receive ciprofloxacin.

Radiograph-based study of gender-specific vertebral area gain in healthy children and adolescents as a function of age, height, and weight.

This study reports gender-specific vertebral area gain data from children and adolescents. Vertebral area was measured on lateral and anteroposterior thoracic and lumbar spine radiographs from 100 female and 100 male subjects aged 7-28 yr. T9, T11, T12, L1, and L2 X-ray area calculation was based on calculation of the area of the geometric figure of a trapezoid whose 2 nonparallel sides were equal in length, taking account of the waisted shape of the vertebrae. Both the boys and girls of our study population showed statistically significant dependence (p<0.001) of vertebral area gain on chronologic age, height, and weight right through the end of puberty, and especially so up to age 15 yr. However, height and weight were clearly better predictors of lateral and anteroposterior vertebral area gain than was chronologic age. Once vertebral growth is complete by age 18 yr or so, the lateral vertebral areas of the male subjects-regardless of body weight and height-are, on average, 25% larger, and the anteroposterior areas up to 30% larger than those of their female counterparts. After adjusting for chronologic age, height, and weight however we did not find significant differences, between gender, in vertebral area of male and female subjects, neither among children younger than 11 yr nor adolescents ages of 12-14 yr and young adults older than 18 yr.

[Value of fall-risk tests for patients with rheumatoid arthritis]. / Wertigkeit von Sturzrisikotests bei Patienten mit rheumatoider Arthritis.

The aim of the study was to quickly and efficiently determine the risk of falling in patients with rheumatoid arthritis over the age of 46 with established methods, to discover parameters which influence the risk of falling and fractures. The study group consisted of 67 patients (median age 69±7.4 years, duration of disease <10 years 71%).With the help of the present data on fractures the performance of the chair-rising (CR) test, the timed up-and-go (TUG) test and the tandem stand (TS) test plus determination of the average daily and cumulative glucocorticoid (GC) dosage, it was possible to detect parameters which influence the risk of falling and fractures.Higher age (>60 years), overweight, deficits in muscle strength in the lower extremities and very low GC dosage (≤5 mg) were found to be associated with an increased risk of falling, which is accompanied by an increased risk of fractures.

[Quantitative analysis of corneal subbasal nerve plexus with in vivo confocal laser scanning microscopy]. / Quantitative Analyse des subbasalen Nervenplexus der Kornea mittels in vivo konfokaler Laser-Scanning-Mikroskopie.

BACKGROUND: An analysis of the corneal subbasal nerve plexus (SNP) allows an evaluation of the peripheral neuropathy in cases of degenerative diseases. In order to study the SNP structures quantitatively the automatically calculated morphological and topological parameters are required. METHODS: In vivo confocal laser scanning microscopy (Heidelberg Retina Tomograph II/Rostock Cornea Module) was performed in healthy volunteers as well as patients with severe diabetic neuropathy. An adapted image processing algorithm was used to preprocess, segment and evaluate quantitatively the nerve fibers of the SNP. Data sets were analysed statistically. RESULTS: The developed algorithm allows an automated detection of SNP structures. Furthermore, it allows the collection of data based on morphological and topological parameters. The main parameters that show significant differences between healthy cornea and cases of diabetic neuropathy are nerve fibre density and length, number of branching, tortuosity and number of terminal and crossing points. All parameters of the measurements can be used isolated, combined or weighted for quantification of the SNP networks. CONCLUSION: The presented fully automated preprocessing eliminates a large number of motion-induced artefacts. The quality of the resulting pictures allows an automated quantification using characteristic measurements. This represents an in vivo, non-invasive technology analysing degenerative changes of SNP especially in the course of diabetes mellitus.

Heterogeneous diffusion, viscosity, and the Stokes-Einstein relation in binary liquids.

We investigate the origin of the breakdown of the Stokes-Einstein relation (SER) between diffusivity and viscosity in undercooled melts. A binary Lennard-Jones system, as a model for a metallic melt, is studied by molecular dynamics. A weak breakdown at high temperatures can be understood from the collectivization of motion, seen in the isotope effect. The strong breakdown at lower temperatures is connected to an increase in dynamic heterogeneity. On relevant time scales some particles diffuse much faster than the average or than predicted by the SER. The van Hove self-correlation function allows one to unambiguously identify slow particles. Their diffusivity is even less than predicted by the SER. The time span of these particles being slow particles, before their first conversion to be a fast one, is larger than the decay time of the stress correlation. The contribution of the slow particles to the viscosity rises rapidly upon cooling. Not only the diffusion but also the viscosity shows a dynamically heterogeneous scenario. We can define a "slow" viscosity. The SER is recovered as the relation between slow diffusivity and slow viscosity.

Velocity autocorrelation function in supercooled liquids: Long-time tails and anomalous shear-wave propagation.

Molecular dynamic simulations are performed to reveal the long-time behavior of the velocity autocorrelation function (VAF) by utilizing the finite-size effect in a Lennard-Jones binary mixture. Whereas in normal liquids the classical positive t^{-3/2} long-time tail is observed, we find in supercooled liquids a negative tail. It is strongly influenced by the transfer of the transverse current wave across the period boundary. The t^{-5/2} decay of the negative long-time tail is confirmed in the spectrum of VAF. Modeling the long-time transverse current within a generalized Maxwell model, we reproduce the negative long-time tail of the VAF, but with a slower algebraic t^{-2} decay.

Ice XII in its second regime of metastability

We present neutron powder diffraction results which give unambiguous evidence for the formation of the recently identified new crystalline ice phase [2], labeled ice XII, in completely different conditions. Ice XII is produced here by compressing hexagonal ice I(h) at T = 77, 100, 140, and 160 K up to 1.8 GPa. It can be maintained at ambient pressure in the temperature range 1.5

Dynamics of liquid 4He in vycor

Using inelastic neutron scattering, we have observed well-defined phonon-roton ( p-r) excitations in superfluid 4He in Vycor over a wide wave-vector range, 0.3

Phonon density of states of single-wall carbon nanotubes

The vibrational density of states of single-wall carbon nanotubes (SWNT) was obtained from inelastic neutron scattering data from 0 to 225 meV. The spectrum is similar to that of graphite above 40 meV, while intratube features are clearly observed at 22 and 36 meV. An unusual energy dependence below 10 meV is assigned to contributions from intertube modes in the 2D triangular lattice of SWNT bundles, and from intertube coupling to intratube excitations. Good agreement between experiment and a calculated density of states for the SWNT lattice is found over the entire energy range.

Contribution of the cortical shell of vertebrae to mechanical behaviour of the lumbar vertebrae with implications for predicting fracture risk.

In the diagnosis of osteoporosis using single energy quantitative CT (SE-QCT) on the axial skeleton, only spongy bone mineral density (BMD) is used at present. Although the density of cortical bone is also determined by most QCT methods, it is not used for evaluation. The objective of this study was to determine the extent to which the cortical bone of the lumbar vertebral bodies accounts for their load-bearing capacity and failure behaviour, and to use this information to suggest improvements in the differential diagnosis of osteoporosis. Investigations were conducted in a clinical, theoretical-numerical and biomechanical-experimental context. Cortical (BMDC) and spongy (BMDS) bone mineral density was measured by SE-QCT/85 kV on 179 patients (68 males, 111 females). These bone densities were matched with the vertebral body fractures previously determined from conventional X-rays. A finite element model was used to study the variation in structural and material parameters of the vertebral body. 19 vertebral bodies that had been removed post-mortem were available for the biomechanical-experimental investigations. Spongy and cortical bone densities were also determined by SE-QCT on these vertebral bodies. Their failure load was then measured in the axial compression test. These investigations show that, in addition to the spongiosa, the cortical shell plays an important role in the load-bearing capacity of the vertebral body. If the spongiosa is weakened due to a loss of BMD, the residual load-bearing capacity of the vertebral bodies is increasingly shouldered by the cortical bone. The lower susceptibility to fracture in men compared with women when spongy bone mineral density is reduced can thus be attributed to the lack of a reduction in cortical bone mineral density. It is recommended that the BMDC also be evaluated in future, especially in the diagnosis of bone mass losses in women, to improve the estimation of the individual fracture risk.

Calcium rubidium nitrate: mode-coupling beta scaling without factorization.

The fast dynamics of viscous calcium rubidium nitrate is investigated by depolarized light scattering, neutron scattering, and dielectric loss. Fast beta relaxation evolves as in calcium potassium nitrate. The dynamic susceptibilities can be described by the asymptotic scaling law of mode-coupling theory with a shape parameter lambda=0.79; the temperature dependence of the amplitudes extrapolates to T(c) approximately equal 378 K. However, the frequencies of the minima of the three different spectroscopies never coincide, in conflict with the factorization prediction, indicating that the true asymptotic regime is unreachable.

The loss of stiffness as osteoporosis progresses.

The routine diagnosis of osteoporosis is based on radiological measurements of bone mineral content. An osteoporotic failure is influenced both by a loss of mineralized bone and internal bone structure. The structure cannot be estimated by bone reconstruction based on standard radiological equipment. To investigate the influence of structure on cancellous bone stiffness, a new finite element model of cancellous bone is developed. The model describes a cancellous bone unit as an open-celled structure. Trabecular length, trabecular thickness, diameter of trabecular connections, relative lattice disorder and relative bone loss determine the real architecture. Using this model, the loss of stiffness as a result of trabecular thinning and loss of trabecular connections is estimated. The volume fraction as a scalar value for a volume can not be a marker for orthotropic stiffness changes. A formula in the form Y = e(a *1 n(X) + b) can describe the correlation between cancellous bone stiffness and volume fraction. These formulas are appropriate for those cases, when the loss of bone mineral (decrease in trabecular thickness) is closely connected to a loss of structure (increasingly perforated trabecular network).

Noninvasive assessment of stiffness and failure load of human vertebrae from CT-data.

A calculational method based on noninvasively derived data for the assessment of the mechanical quality of individual vertebrae is presented. Dimensional data obtained from serial, segmented CT scans were used as the geometric input for a newly developed finite element model designed to calculate stiffness and failure load of these complex bone structures. Mechanical, structural data for cancellous bone was obtained by measurements of the compressive strength and failure load of actual vertebral specimens obtained at autopsy. The stiffness and failure load calculated by the newly developed finite element model were compared with the data obtained from mechanical measurements of vertebral specimens. A high correlation between measured and calculated failure load was found (r = 0.89, p < 0.001, n = 16). The correlation between the failure load and bone mineral density (BMD) was significant (r = 0.82, p < 0.001, n = 16). A similar correlation between calculated and measured stiffness (r = 0.81, p < 0.001, n = 15) was also found using the finite element model described herein. Thus the newly developed calculation methodology has been verified and can be used to predict the failure load and stiffness of osteoporotic vertebrae using data obtained non-invasively from CT scans.

Balloon sacroplasty as a palliative pain treatment in patients with metastasis-induced bone destruction and pathological fractures.

PURPOSE: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated. MATERIALS AND METHODS: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were. RESULTS: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6 +/- 1.78 (4 - 10) ml of PMMA cement were introduced per treated lesion. A significant (p < 0.001) reduction in pain according to the VAS occurred in all patients from 9.3 +/- 0.67 (8 - 10) pre-operatively to 2.7 +/- 1.28 (1 - 5) on the 2nd postoperative day and 2.9 +/- 0.81 (2 - 5) 6 months after the intervention. All of the patients were re-mobilized after the procedure and underwent the further therapeutic measures as planned. CONCLUSION: Balloon sacroplasty is a helpful therapeutic option in the overall palliative treatment of patients with tumor-induced destruction. It is a safe and practicable procedure that markedly reduces disabling pain.

Lattice dynamics of the icosahedral quasicrystals i-ZnMgSc and i-ZnAgSc and the cubic 1/1-approximant Zn6Sc.

A comparison of periodic approximants and their quasicrystalline counterparts offers the opportunity to better understand the structure, physical properties and stabilizing mechanisms of these complex phases. We present a combined experimental and computational study of the lattice dynamics of the icosahedral quasicrystals i-ZnMgSc and i-ZnAgSc and compare these to the lattice dynamics of the cubic 1/1-approximant Zn6Sc. The two phases, quasicrystal and approximant, are built up from the same atomic clusters, which are packed either quasiperiodically or on a body centered cubic lattice, respectively. Using inelastic neutron scattering and atomic scale simulations, we show that the vibrational spectra of these three systems are very similar, however, they contain a clear signature of the increasing structural complexity from approximant to quasicrystal.

[TSH secreting adenoma of pituitary gland (TSHom) - rare cause of hyperthyroidism in pregnancy]. / TSH-sezernierendes Hypophysenadenom (TSHom) - seltene Ursache einer Hyperthyreose in der Schwangerschaft.

HISTORY AND ADMISSION FINDINGS: A 28 year-old woman in her first pregnancy was referred to the department of obstetrics and gynecology at 24 weeks of gestation because of pregnancy-induced hypertension. INVESTIGATIONS: Thyroid stimulating hormone (TSH), free T3 and free T4 were elevated. Antibody screening did not show antithyroid peroxidase (anti-TPO) antibodies and TSH receptor antibodies. Clinical findings were suspicious of TSH secreting pituitary tumour (TSH-om) or thyroid hormone resistance (RTH). In absence of clinical sings of elevated intracranial pressure magnetic resonance imaging (MR) was discussed but not carried out and planned after delivery. A visual-field defect was ruled out by orbital field evaluation. TREATMENT AND COURSE: Treatment with 3 × 50 mg propylthiouracil daily was initiated. However, normal fT3/fT4 titers could not be achieved. Serum levels were in the high normal ranges and TSH remained increased. The clinical situation of the patient improved resulting in a normal delivery at term. The healthy newborn was breast feed and MR imaging of the mother revealed a 5×8 mm tumor of the pituitary gland. CONCLUSION: In pregnant women with pregnancy-induced hypertension thyroid diseases have to be ruled out. Rare causes of hyperthyreoidism are TSH secreting pituitary tumors or thyroid hormone resistance (RTH). Treatment of choice for hyperthyreoidism in pregnancy is propylthiouracil. Normal vaginal delivery and breast feeding are possible. Following delivery it is mandatory to determine an individual treatment strategy.