The role of the posterior malleolus in the treatment of unstable upper ankle joint injuries - A biomechanical study.

BACKGROUND: This biomechanical study aimed to test if the fixation of the posterior malleolus (PM) only with screws inserted from posterior to anterior (PA) restores stability comparable with the natural condition. The extent of stability was also compared with that of anterior to posterior (AP) screw osteosynthesis (OS) with an additional syndesmotic screw (SS). METHODS: First, the stability of the upper ankle joint in seven pairs of intact lower legs were examined. Subsequently, half of the lower legs were treated with PA screw fixation of a PM fracture without SS and the other half with AP screw fixation with additional tricortical SS. RESULTS: PA OS without SS showed significantly more diastasis (p = 0.027). The AP OS with an SS revealed a diastasis that was comparable with the intact condition (p = 0.797). The use of SS led to significantly higher stability compared to OS without SS (p = 0.019). CONCLUSIONS: The Fixation of the PM alone without an additional syndesmotic screw cannot achieve intact upper ankle stability. Fixation of a PM fracture with an SS helps in nearly achieving the natural condition.

High-precision measurement of the atomic mass of the electron.

The quest for the value of the electron's atomic mass has been the subject of continuing efforts over the past few decades. Among the seemingly fundamental constants that parameterize the Standard Model of physics and which are thus responsible for its predictive power, the electron mass me is prominent, being responsible for the structure and properties of atoms and molecules. It is closely linked to other fundamental constants, such as the Rydberg constant R∞ and the fine-structure constant α (ref. 6). However, the low mass of the electron considerably complicates its precise determination. Here we combine a very precise measurement of the magnetic moment of a single electron bound to a carbon nucleus with a state-of-the-art calculation in the framework of bound-state quantum electrodynamics. The precision of the resulting value for the atomic mass of the electron surpasses the current literature value of the Committee on Data for Science and Technology (CODATA) by a factor of 13. This result lays the foundation for future fundamental physics experiments and precision tests of the Standard Model.

Initial Characterization of Transgenic Mice Overexpressing Human Histamine H2 Receptors.

In an integrative approach, we studied the role of histamine H2 receptors in the mouse heart. We noted that histamine, added cumulatively to the organ bath, failed to affect the force of contraction in left atrial preparations and did not change spontaneous heart rate in right atrial preparations from wild-type mice. By contrast, in the same preparations from mice that overexpressed the human H2 receptor in a cardiac-specific way, histamine exerted concentration- and time-dependent positive inotropic and positive chronotropic effects. Messenger RNA of the human H2 receptor was only detected in transgenic mice. Likewise, immunohistology and autoradiography only gave signals in transgenic but not in wild-type cardiac preparations. Similarly, a positive inotropic and positive chronotropic effect was observed with histamine in echocardiography of living transgenic mice and isolated perfused hearts (Langendorff preparation). Phosphorylation of phospholamban was increased in atrial and ventricular preparations from transgenic mice, but not in wild-type animals. The effects of histamine were mimicked by dimaprit and amthamine and antagonized by cimetidine. In summary, we generated a new model to study the physiologic and pathophysiologic cardiac role of the human H2 receptor.

Embracing diverse worldviews to share planet Earth.

Leading societies toward a more sustainable, equitably shared, and environmentally just future requires elevating and strengthening conversations on the nonmaterial and perhaps unquantifiable values of nonhuman nature to humanity. Debates among conservationists relating to the appropriateness of valuing ecosystems in terms of their human utility have eclipsed the more important and impactful task of expressing conservation concerns in terms that are meaningful to diverse stakeholders. We considered the wide global diversity of perspectives on the biosocial complex-the relationships and interactions between all living species on Earth-and argue that humanity's best chance for effective conservation is to take a pluralistic approach that engages seriously with the worldviews of all stakeholders. Many worldviews-particularly those in indigenous cultures-place a higher value on the spiritual and nonmaterial aspects than what is often represented by the discourse surrounding Western conservation policy. Alternative framings of the biosocial complex that recognize nature's intrinsic value can be powerful motivators for social change and for local-scale conservation efforts. At a national and international level, changing ethical framings of human relationships with nature have started influencing conceptions of human rights relating to the environment and of the rights of nature itself. This change has led to an increased role of the judiciary in promoting environmental sustainability and promoting justice for groups who are most often affected by environmental harms. We hope our essay will motivate the scientific community to change its own perception of what a sound and sustainable relationship between humanity and other species should be and will help citizens become active environmental subjects, connected to the ecosystems around them.

Adopción de Diferentes Cosmovisiones para Compartir el Planeta Tierra Resumen Para poder llevar a las sociedades hacia un futuro sustentable, compartido equitativa y ambientalmente justo se requiere elevar y fortalecer las conversaciones sobre los valores no materiales y probablemente imposibles de cuantificar que la naturaleza no humana tiene para la humanidad. Los debates entre los conservacionistas en relación con lo apropiado que es valorar los ecosistemas en términos de utilidad para los humanos han eclipsado la labor más importante e impactante de expresar los asuntos de conservación en términos que son significativos para diferentes accionistas. Consideramos la amplia diversidad mundial de perspectivas que existen sobre el complejo biosocial - las relaciones e interacciones entre todas las especies vivientes en la Tierra - y argumentamos que la mejor oportunidad que tiene la humanidad para lograr una conservación efectiva es realizar una estrategia pluralística que se comprometa seriamente con las cosmovisiones de todos los accionistas. Muchas cosmovisiones - particularmente aquellas de las culturas indígenas - les otorgan un valor más alto a los aspectos espirituales y no materiales que lo que se suele representar en el discurso que rodea la política de conservación occidental. Los marcos alternativos del complejo biosocial que reconocen el valor intrínseco de la naturaleza pueden ser motivadores poderosos para el cambio social y para los esfuerzos de conservación a escala local. A nivel nacional e internacional, el cambio de los marcos éticos de las relaciones humanas con la naturaleza ha comenzado a influenciar las concepciones de los derechos humanos en relación con el ambiente y los derechos de la naturaleza misma. Este cambio ha resultado en un papel mucho mayor del poder judicial en la promoción de la sustentabilidad ambiental y de la justicia para grupos a los que con frecuencia les afectan los daños ambientales. Esperamos que nuestro ensayo motive a la comunidad científica a cambiar su propia percepción de lo que debe ser una relación sana y sustentable entre la humanidad y otras especies y que ayude a los ciudadanos a volverse sujetos ambientales más activos y conectados con el ecosistema.

[Telemedicine in heart failure]. / Telemedizin bei Herzinsuffizienz.

Improved outpatient care of heart failure patients is considered crucial to avoiding unplanned cardiovascular hospitalizations and reducing mortality. Making up for regional and rural differences in heart failure care poses a further challenge. Telemedical care as a supplement to outpatient point-of-care medicine by the general practitioner and medical specialist is considered relevant to implementing this goal. This article presents the technical and organizational basics of telemedical methods in outpatient heart failure care. Current evidence on the efficacy of telemedical co-management is also explained based on the results from the nine most important randomized studies on telemedicine in heart failure. Particular attention is paid to the TIM-HF2 study published in 2018, which showed the superiority of telemedical co-management in terms of mortality and morbidity following recent hospitalization for heart failure. Pre-stratified subgroup analysis revealed no significant interactions in terms of the primary endpoint between urban and rural regions. Scalability is required in order to translate the telemedical study concept from TIM-HF2 to a nationwide care program for all patients in Germany. Telemed5000 is the first project to set its goal as the development of a telemedicine center for the telemedical co-management of up to 5000 patients using artificial intelligence. It is being funded by the Federal Ministry of Economics and Technology for the period 2019-2022.

The ROARI project - Road Accident Acute Rehabilitation Initiative: a randomised clinical trial of two targeted early interventions for road-related trauma.

OBJECTIVES: To determine the effectiveness of an Early Rehabilitation Intervention (ERI ) versus a Brief Education Intervention (BEI) following road trauma. PRIMARY OBJECTIVE: return to work or usual activities at 12 weeks (for minor/moderate injury) and 24 weeks for major injury. SECONDARY OBJECTIVES: Reduction in pain, anxiety, depression, disability and incidence of Post Traumatic Stress Disorder and improved quality of life. DESIGN: A multi-site single-blinded stratified randomized clinical trial (RCT). METHODS: 184 patients (92 in each arm) were recruited over 18 months and followed for 12 weeks (minor/moderate injury) and 24 weeks (major injury). Screening questionnaires at 2-4 weeks and follow-up interviews by phone for all outcome measures were undertaken. For those in the ERI group with a positive screen for high risk of persistent symptoms, an early assessment and intervention by a Rehabilitation Physician was offered. Those in the BEI group were sent written information and advised to see their GP. RESULTS: 89.4% of injuries were mild in this cohort. At 12 weeks 73.8% and 69.1% of patients in the ERI and the BEI groups respectively had returned to work or usual activities. There were no significant differences between the two intervention groups with respect to the primary or any secondary outcome measures. CONCLUSION: This is the first RCT of an ERI following road trauma in Australia. A targeted ERI is as effective as a BEI in assisting those with mild/moderate trauma to return to work or usual activities.

[Does the hospital cost of care differ for inflammatory bowel disease patients with or without gastrointestinal infections? A case-control study]. / Unterscheiden sich die Behandlungskosten bei stationär betreuten Patienten mit einer chronisch-entzündlichen Darmerkrankung mit und ohne gastrointestinale Infektionen? Eine Fallkontrollstudie.

OBJECTIVE: Gastrointestinal Infections have been implicated as possible causes of exacerbation of inflammatory bowel disease (IBD) or risk factors for severe flares in general. The introduction of the G-DRG reimbursement system has greatly increased the pressure to provide cost effective treatment in German hospitals. Few studies have compared the costs of treating IBD patients with or without gastrointestinal infections and none of them have specifically considered the German reimbursement situation. METHODS: We performed a single center case-control retrospective chart review from 2002 to 2011 of inpatients with IBD (Department of Internal Medicine IV, University Hospital Jena) with an exacerbation of their disease. The presence of gastrointestinal infections (Salmonella, Shigella, Campylobacter, Yersinia, adeno-, rota-, norovirus and Clostridium difficile) was assessed in all inpatients with Cohn's disease (CD) and ulcerative colitis (UC). IBD patients with gastrointestinal infections (n = 79) were matched for age to IBD patients who were negative for gastrointestinal pathogens (n = 158). Patient level costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e. g., endoscopy, microbiology, pathology) calculated according to an activity-based costing approach. All costs were discounted to 2012 values. RESULTS: Gastrointestinal infections in IBD patients were not associated with an increase in mortality (0%); however, they were associated with 2.3-fold higher total hospital charges (6499.10 € vs. 2817.00 €; p = 0.001) and increased length of stay in hospital (14.5 vs. 9.4 days; p <  0.0001). Despite increased reimbursement by DRG for IBD patients with gastrointestinal infections compared to patients without infections (3833.90 € vs. 2553.50 €; p = 0.005), hospital care in these patients was substantially underfunded (deficit -2496.80 € vs. -433.10 €) because of increased length of stay with personnel costs, especially in UC. CONCLUSION: Inpatient hospital costs differ significantly for IBD patients with and without gastrointestinal infections, especially in ulcerative colitis, when care was provided in a single university hospital.

g Factor of lithiumlike silicon 28Si11+.

The g factor of lithiumlike silicon (28)Si(11+) has been measured in a triple-Penning trap with a relative uncertainty of 1.1×10(-9) to be g(exp)=2.000 889 889 9(21). The theoretical prediction for this value was calculated to be g(th)=2.000 889 909(51) improving the accuracy to 2.5×10(-8) due to the first rigorous evaluation of the two-photon exchange correction. The measured value is in excellent agreement with the theoretical prediction and yields the most stringent test of bound-state QED for the g factor of the 1s(2)2s state and the relativistic many-electron calculations in a magnetic field.

[Predictive value of positive and negative results of the Widal and Felix test for typhoid fever in general practice in Niamey]. / Valeurs prédictives positive et négative du test de Widal et Félix dans la fièvre typhoïde en médecine générale à Niamey (Niger).

INTRODUCTION: Typhoid is a common reason for seeking medical care in general practice in the developing countries, Use of the Widal and Felix test is frequent in this setting. The purpose of this study carried out in private general medicine clinics in Niamey, Niger was to determine the incidence of typhoid and the predictive value of positive and negative results of the Widal test. MATERIAL AND METHOD: We used low published values of sensitivity (67.9%) and specificity (93.8%). Estimation of the incidence of typhoid was based on reports made to the national health information system of Niger by 3 private clinics in Niamey. RESULT: A total of 1725 persons attended the clinics between 1/12/07 and 31/01/08, including 311 presenting nonspecific signs suggesting typhoid, i.e., at least fever and headache, and 172 presenting typhoid. The incidence was 9.97% in attendees overall and 55.31% in attendees with nonspecific evocative signs. The positive predictive value of the Widal and Felix test was 53.81% and the negative predictive value was 96.35% in attendees overall and 93.13% and 70.25% respectively in patients with clinical signs. CONCLUSION: Other diagnostic modalities such as PCR, coproculture, and hemoculture can be proposed, but are not available in this setting. The positive predictive value of the Widal test among patients with nonspecific signs suggesting typhoid is high. While not negligible, the negative predictive value in this high-incidence group is relatively low and should indicate monitoring.

Pedometer accuracy in patients with chronic heart failure.

This study assesses the accuracy of the Omron HJ-720ITC pedometer at low walking intensities in patients with chronic heart failure. Step accuracy was assessed by visual observation on the treadmill and during free walking at 40, 50, 60, 70, 80 m/min, as well as during self paced walking using the 6 min walk test. A total of ninety-seven patients with heart failure (mean age: 61+/-13, NYHA I, N=30; NYHA II, N=32; NYHA III, N=35) participated in the study. At predefined walking speeds, a statistically significant % error in pedometer accuracy was evident at 60 m/min (p=0.039), and% error increased markedly below this threshold. Highest% error in pedometer accuracy was seen at 40 m/min (mean bias (% error): 28.3+/-9.0%; 95% CI: 21.8-34.7; p<0.001). During self paced walking (6MWT) the absolute% error in pedometer readings was largest in patients with strongest functional limitations and 6 MWT distances <400 m (mean bias (% error): 10.7+/-13.6%; CI 5.6-15.4, p<0.001). The Omron HJ-720ITC pedometer is accurate for monitoring activity in individuals with normal walking behaviour, but seems unsuitable for chronically ill patients characterised by slow walking gaits.

On the relationship between farmland biodiversity and land-use intensity in Europe.

Worldwide agriculture is one of the main drivers of biodiversity decline. Effective conservation strategies depend on the type of relationship between biodiversity and land-use intensity, but to date the shape of this relationship is unknown. We linked plant species richness with nitrogen (N) input as an indicator of land-use intensity on 130 grasslands and 141 arable fields in six European countries. Using Poisson regression, we found that plant species richness was significantly negatively related to N input on both field types after the effects of confounding environmental factors had been accounted for. Subsequent analyses showed that exponentially declining relationships provided a better fit than linear or unimodal relationships and that this was largely the result of the response of rare species (relative cover less than 1%). Our results indicate that conservation benefits are disproportionally more costly on high-intensity than on low-intensity farmland. For example, reducing N inputs from 75 to 0 and 400 to 60kgha-1yr-1 resulted in about the same estimated species gain for arable plants. Conservation initiatives are most (cost-)effective if they are preferentially implemented in extensively farmed areas that still support high levels of biodiversity.

Administering and managing the u.s. And soviet space programs.

This raises a fundamental question about the management, in its largest sense, of the U.S. space program and the other activities undertaken in response to the Sputnik experience. Has the whole operation represented but another highly successful one-shot exercise in crisis management, or has it represented incorporation into American society of a new way to organize, systematically and purposefully, the development and use of scientific and technological resources to the furtherance of national goals? It is too early to discern the answer to this question. But how it is answered will heavily weight any final appraisal of the comparative results of the U.S. and Soviet space programs.

EBSD: a powerful microstructure analysis technique in the field of solidification.

This paper presents a few examples of the application of electron back-scatter diffraction (EBSD) to solidification problems. For directionally solidified Al-Zn samples, this technique could reveal the change in dendrite growth directions from <100> to <110> as the composition of zinc increases from 5 to 90 wt%. The corresponding texture evolution and grain selection mechanisms were also examined. Twinned dendrites that form under certain solidification conditions in Al-X specimens (with X = Zn, Mg, Ni, Cu) were clearly identified as <110> dendrite trunks split in their centre by a (111) twin plane. In Zn-0.2 wt% Al hot-dip galvanized coatings on steel sheets, EBSD clearly revealed the preferential basal orientation distribution of the nuclei as well as the reinforcement of this distribution by the faster growth of <1010> dendrites. Moreover, in Al-Zn-Si coatings, misorientations as large as 10 degrees mm(-1) have been measured within individual grains. Finally, the complex band and lamellae microstructures that form in the Cu-Sn peritectic system at low growth rate could be shown to constitute a continuous network initiated from a single nucleus. EBSD also showed that the alpha and beta phases had a Kurdjumov-Sachs crystallographic relationship.

Mapping of quantitative trait loci for clinical-chemical traits in swine.

Clinical-chemical traits are diagnostic parameters essential for characterization of health and disease in veterinary practice. The traits show significant variability and are under genetic control, but little is known about the fundamental genetic architecture of this variability, especially in swine. We have identified QTL for alkaline phosphatase (ALP), lactate (LAC), bilirubin (BIL), creatinine (CRE) and ionized sodium (Na(+)), potassium (K(+)) and calcium (Ca(++)) from the serum of 139 F(2) pigs from a Meishan/Pietrain family before and after challenge with Sarcocystis miescheriana, a protozoan parasite of muscle. After infection, the pigs passed through three stages representing acute disease, subclinical disease and chronic disease. Forty-two QTL influencing clinical-chemical traits during these different stages were identified on 15 chromosomes. Eleven of the QTL were significant on a genome-wide level; 31 QTL were chromosome-wide significant. QTL showed specific health/disease patterns with respect to the baseline values of the traits as well as the values obtained through the different stages of disease. QTL influencing different traits at different times were found primarily on chromosomes 1, 3, 7 and 14. The most prominent QTL for the investigated clinical-chemical traits mapped to SSC3 and 7. Baseline traits of ALP, LAC, BIL, Ca(++) and K(+) were influenced by QTL regions on SSC3, 6, 7, 8 and 13. Single QTL explained up to 21.7% of F(2) phenotypic variance. Our analysis confirms that variation of clinical-chemical traits is associated with multiple chromosomal regions.

Heritabilities and quantitative trait loci for blood gases and blood pH in swine.

Maintaining pH and blood gases in a narrow range is essential to sustain normal biochemical reactions. Decreased oxygenation, poor tissue perfusion, disturbance to CO(2) expiration, and shortage of HCO(3)(-) can lead to metabolic acidosis. This is a common situation in swine, and originates from a broad range of medical conditions. pH and blood gases appear to be under genetic control, and populations with physiological traits closer to the pathological thresholds may be more susceptible to developing pathological conditions. However, little is known about the genetic basis of such traits. We have therefore estimated phenotypic and genetic variability and identified quantitative trait loci (QTL) for pH and blood gases in blood samples from 139 F(2) pigs from the Meishan/Pietrain family. Samples were taken before and after challenge with Sarcocystis miescheriana, a protozoan parasite of muscle. Twenty-seven QTL influencing pH and blood gases were identified on nine chromosomes. Five of the QTL were significant on a genome-wide level; 22 QTL were significant on a chromosome-wide level. QTL for pH-associated traits have been mapped to SSC3, 18 and X. QTL associated with CO(2) have been detected on SSC6, 7, 8 and 9, and QTL associated with O(2) on SSC2 and SSC8. QTL showed specific health/disease patterns that were related to the physiological state of the pigs from day 0, to acute disease (day 14), convalescence (day 28) and chronic disease (day 42). The results demonstrate that pH and blood gases are influenced by multiple chromosomal areas, each with relatively small effects.

Mapping of quantitative trait loci affecting behaviour in swine.

Behavioural indices in vertebrates are under genetic control at least to some extent. In spite of significant behavioural problems in farm animals, information on the genetic background of behaviour is sparse. The aim of this study was to map QTL for behavioural indices in swine under healthy conditions and after infection with Sarcocystis miescheriana, as behaviour can be significantly influenced by disease. This well-described parasite model subsequently leads to acute (day 14 p.i.), subclinical (day 28 p.i.) and chronic disease (day 42 p.i.), allowing the study and comparison of the behaviour of pigs under four different states of health or disease. The study was based on a well-described Pietrain/Meishan F(2) family that has recently allowed the detection of QTL for disease resistance. We have mapped six genome-wide significant and 24 chromosome-wide significant QTL for six behavioural indices in swine. Six of these QTL (i.e. 20% of total QTL) showed effects on behavioural traits of the healthy pigs (day 0). Some of them (QTL on SSC11 and 18) lost influence on behavioural activities during disease, while the effects of others (QTL on SSC5, SSC8) partly remained during the whole experiment, although with different effects on the distinct behavioural indices. The disease model has been of high relevance to detect effects of gene loci on behavioural indices. Considering the importance of segregating alleles and environmental conditions that allow the identification of the phenotype, we conclude that there are indeed QTL with interesting effects on behavioural indices in swine.

[Incidental finding of mucinous neoplasia of the appendix : Treatment strategies]. / Zufallsbefund muzinöse Neoplasie der Appendix : Therapeutische Strategien.

Tumors of the appendix are not a uniform group but differ significantly in terms of their origin/histology and metastatic behavior. Furthermore, tumors of the appendix are often diagnosed as incidental findings after appendectomy for acute appendicitis. A subgroup of these neoplasms are low-grade appendiceal mucinous neoplasms (LAMN). These are mucus-forming tumors of the appendiceal lumen, which can lead to rupture of the appendix and seeding into the abdominal cavity. Therefore LAMN are considered precursors of pseudomyxoma peritonei (PMP). It is essential to clearly differentiate the subgroups of LAMN as well as the resection status. According to this it is determined whether (radical) appendectomy is a sufficient therapy or further treatment, such as ileocecal resection with hyperthermic intraperitoneal chemotherapy (HIPEC) or cytoreductive surgery (CRS) is necessary. There is no standardized concept regarding the follow-up after resection of LAMN. Generally, it is recommended to perform a computed tomography (CT) scan of the abdomen and determination of tumor markers 6 months postoperatively and then once a year. A recommendation regarding the duration of follow-up is difficult as there are case reports in which PMP has occurred more than 15 years after removal of LAMN.

[Position paper telemonitoring : From the Nucleus Members of the AG33 Telemonitoring of the DGK and associated members]. / Positionspapier Telemonitoring : Von den Nukleusmitgliedern der AG33 Telemonitoring in der DGK und assoziierten Mitgliedern.

The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e. V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and potentials of telemonitoring in the treatment of patients with cardiac diseases. In addition to telemonitoring of acute ischaemic diseases, acute coronary syndrome and acute cardiac arrhythmias, telemonitoring of chronic cardiac diseases is discussed. Chronic diseases, such as chronic heart failure, are age-associated and present society with the great challenge of providing high-quality, yet cost-efficient care to an increasing number of patients in the future. Telemonitoring offers an opportunity to meet this challenge. However, the introduction of telemonitoring and the associated changes for patients, doctors and other service providers must be accompanied by measures to ensure the acceptance of telemonitoring and the secure handling of sensitive data as well as the quality of telemonitoring services.

[Constellations of findings and derived treatment interventions in telemedical monitoring of patients with heart failure, cardiac arrhythmia or increased risk for sudden cardiac death : Recommendations of the working group 33 telemonitoring of the German Cardiac Society]. / Befundkonstellation und abgeleitete Behandlungsinterventionen bei telemedizinisch überwachten Patienten mit Herzinsuffizienz, Herzrhythmusstörungen oder erhöhtem Risiko für den plötzlichen Herztod : Empfehlungen der Arbeitsgruppe 33 Telemonitoring der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung e. V.

The specification of standard operating procedures (SOPs) is a basic requirement for a successful implementation of telemonitoring with implanted cardiac devices and with external measuring devices in patients with heart failure, cardiac arrhytmia or increased risk of sudden cardiac death. The following article summarizes the possibilities of telemonitoring from a technical and organizational point of view and descibes basic requirements on SOPs. these basic requirements should be further specified and anchored in the organizational structure of the individual telemonitoring concept. Moreover, they should de understood as a basic guideline fpr the actions of telemonitoring center (TMC) employees.