Language and executive functioning in young adults with Down syndrome.

BACKGROUND: This study examined the association between executive functioning and language in young adults with Down syndrome (DS). METHOD: Nineteen young adults with DS (aged 19-24 years) completed standardised measures of overall cognition, vocabulary, verbal fluency and executive function skills. RESULTS: Friedman's analysis of variance (χ2 (3) = 28.15, P < .001) and post hoc comparisons indicated that, on average, participants had a significantly lower overall non-verbal than verbal cognitive age equivalent and lower expressive than receptive vocabulary skills. Using Spearman correlations, performance on a verbal measure of cognition inhibition was significantly negatively related to receptive vocabulary (ρ = -.529, adjusted P = .036) and verbal fluency (ρ = -.608, adjusted P = .022). Attention was significantly positively correlated with receptive (ρ = .698, adjusted-p = .005) and expressive (ρ = .542, adjusted P = .027) vocabulary. Verbal working memory was significantly positively associated with receptive vocabulary (ρ = .585, adjusted P = .022) and verbal fluency (ρ = .737, adjusted P = .003). Finally, visuospatial working memory was significantly associated with receptive vocabulary (ρ = .562, adjusted P = .027). CONCLUSIONS: Verbal and non-verbal measures of executive functioning skills had important associations with language ability in young adults with DS. Future translational research is needed to investigate causal pathways underlying these relationships. Research should explore if interventions aimed at increasing executive functioning skills (e.g. attention, inhibition and working memory) have the potential to lead to increases in language for young adults with DS.

[Long-term efficacy of multimodal pain therapy for chronic back pain]. / Langfristige Wirksamkeit einer multimodalen Schmerztherapie bei chronischen Rückenschmerzen.

BACKGROUND: The day clinic for pain therapy at the Orthopedic Clinic of the University Heidelberg has been in existence since 2001. In the context of multimodal pain therapy patients with chronic and chronically recurring pain of the musculoskeletal system are treated. METHODS: The present prospective long-term study investigated the effects of therapy using the following outcome parameters: pain intensity, disability, depression, functional capacity and vitality. For this purpose patients with low back pain (n = 59) were questioned in writing at four measurement times: start of therapy (t0), completion of therapy (t1), 6 months (t2) and 10 years (t3) following therapy. Of the examined patients 78% were in chronification stages I and II, according to the Mainz pain staging system (MPSS) of Gerbershagen. AIM: The main aim of the study was to examine the effects of multimodal pain therapy in the long term. RESULTS: In the short, medium and long term significant differences were found in the outcome parameters with low to high effect sizes (d = 0.36-1.85). There was a continuous improvement of the pain intensity in the long term, and 10 years after pain therapy the effect size for the currently asked pain intensity was d = 1.28. CONCLUSION: Multimodal pain therapy is an effective method for the treatment of chronic back pain. It not only leads to short and medium-term improvements but also proves to be efficient in the long term. This form of pain therapy seems to lead to long-term success, particularly for patients with low-grade chronification.

[Chronic low back pain and psychological comorbidity : A review]. / Chronische untere Rückenschmerzen und psychische Komorbidität : Eine Übersicht.

BACKGROUND: Back pain is a common, disabling problem in Germany. Previous research has evaluated associations between low back pain (LBP), depression, and fear. OBJECTIVES: The results should provide ideas of how to optimize preventive measures, give guidelines for rehabilitation of patients with LBP, and to develop new therapies. MATERIALS AND METHODS: A systematic review of the literature including primary publications and meta-analyses using set search criteria in PubMed was performed. A meta-analysis was then done. RESULTS: In all, 34 studies met the inclusion and quality criteria, whereby 14 studies were included in the meta-analysis. In the literature, significantly different depression scores were reported for people with LBP compared to a healthy control group. The pain perception in persons with LBP is associated with depression and fear. The correlation between depression and pain perception was highly significant in 5 studies (p < 0.01) and significant in 8 studies (p < 0.05). Fear and pain perception were highly significant in 4 studies (highly significant, p < 0.01) and significant in 3 studies (p < 0.05); 5 studies had no significant results. The studies were very heterogeneous. CONCLUSIONS: The results can improve the understanding of the complexity of LBP perception and its therapy. The generalization of the results is limited. To cover the correlation of psychosocial and lifestyle factors and pain perception of LBP, further research is required. To obtain a clearer picture of pain perception in persons with LBP, standardized pain assessment would be beneficial. In addition, we recommend that future studies follow standardized procedures to allow greater comparability.

[Impact of attachment behavior on chronic and somatoform pain]. / Einfluss des Bindungsverhaltens auf chronischen und somatoformen Schmerz.

In addition to being a risk factor for the course of chronic pain, the personality characteristics of the individual attachment style are also predictors for the success of medical and psychosocial interventions and aspects of the physician-patient relationship. Insecurely attached patients seem to be less able to sustain the positive effects of pain therapy. These results are especially relevant as insecure attachment patterns are overrepresented among chronic pain patients. As a result the attachment style can be seen as a psychosocial vulnerability factor for the chronification of acute pain.

[Effect of oxytocin on human pain perception]. / Wirkung von Oxytocin auf das menschliche Schmerzerleben.

BACKGROUND: Over the years the effect of the neuropeptide oxytocin and its possible utilization for pain management has been increasingly more investigated and discussed. Initial results emphasized the effects of oxytocin with respect to labor and breastfeeding. Diverse animals studies were also able to demonstrate the effectiveness of the peptide in attachment behavior and pain perception; however, it is still unclear how oxytocin affects pain perception in humans. The potential therapeutic effectiveness of oxytocin could be particularly important for primary and secondary treatment of pain patients because chronification of pain can occur more frequently in this area. METHODS: For this review the databases PubMed, Medline und PsycINFO were searched using the terms oxytocin, pain, human and analgesic. The search resulted in a total of 89 original articles after excluding articles regarding labor pain, breastfeeding and animal studies. Only those studies were included which were carried out between 1994 and 2015. A total of 17 articles remained for inclusion in this review and included 13 studies on the exogenous application of oxytocin and 4 on measurement of oxytocin levels in plasma. CONCLUSION: This review article gives a summary of the current state of research on oxytocin and its direct and indirect association with human pain perception and emphasizes its relevance for the multimodal management of pain.

Predicting Persistent Back Symptoms by Psychosocial Risk Factors: Validity Criteria for the ÖMPSQ and the HKF-R 10 in Germany.

OBJECTIVE: 10% of all individuals in Germany develop persistent symptoms due to nonspecific back pain (NSBP) causing up to 90% of direct and indirect expenses for health care systems. Evidence indicates a strong relationship between chronic nonspecific back pain and psychosocial risk factors. The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) and the German Heidelberger Kurzfragebogen Rückenschmerz (HKF-R 10) are deemed valid in prediction of persistent pain, functional loss or amount of sick leave. This study provides and discusses validity criteria for these questionnaires using ROC-curve analyses. Quality measurements included sensitivity and specificity, likelihood-ratio related test-efficiencies and clinical utility in regard to predictive values. METHODS: 265 patients recruited from primary and secondary care units completed both questionnaires during the same timeframe. From the total, 133 patients returned a 6-month follow-up questionnaire to assess the validity criteria for outcomes of pain, function and sick leave. RESULTS: Based on heterogeneous cut-offs for the ÖMPSQ, sensitivity and specificity were moderate for outcome of pain (72%/75%). Very high sensitivity was observed for function (97%/57%) and high specificity for sick leave (63%/85%). The latter also applied to the HKF-R 10 (pain 50%/84%). Proportions between sensitivity and specificity were unbalanced except for the ÖMPSQ outcome of pain. Likelihood-ratios and positive predictive values ranged from low to moderate. CONCLUSION: Although the ÖMPSQ may be considered useful in identification of long-term functional loss or pain, over- and underestimation of patients at risk of chronic noncspecific back pain led to limited test-efficiencies and clinical utility for both questionnaires. Further studies are required to quantify the predictive validity of both questionnaires in Germany.

[Chronic knee pain and specific heat phobia. A case report]. / Chronischer Knieschmerz bei spezifischer Hitzephobie. Ein Fallbericht.

This case report presents the medical history of a patient suffering from chronic knee pain with specific heat phobia who had a long history of sick certificates. Using multimodal pain therapy and biofeedback therapy the acquired anxiety disorder could be solved. Long-term working ability could be achieved.

Mechanical properties and microstructural evolution of vacuum hot-pressed titanium and Ti-6Al-7Nb alloy.

Hot-pressing is a powder metallurgy process where loose powder is loaded into a mould, usually of graphite, and sintered by the simultaneous application of high temperature and pressure. In this study elemental titanium and Ti-6Al-7Nb alloy powders are hot-pressed under different conditions in order to study the influence of the processing parameters on the microstructure and mechanical properties. The samples are characterised in terms of relative density, microstructure, XRD, percentage of interstitials, three-point bending test and hardness. Relative densities as high as 99% are obtained, the oxygen and carbon content remains almost constant but nitrogen percentage increases. This is due to the interaction with the BN coated mould and leads to the formation of a reacted layer in the surface, composed by different titanium compounds, which greatly affect the mechanical properties. Nevertheless, the removal of this reacted layer leads to an important improvement of the ductility, especially for elemental titanium.

Characterisation of sputter deposited niobium and boron interlayer in the copper-diamond system.

In most metal matrix composites (MMCs) interfaces are decisive but hard to manipulate. Especially copper-carbon composites can exhibit excellent mechanical and thermal properties only if the Cu/C interface is modified by an optimised interlayer. Due to the excellent thermal conductivity and mechanical stability of diamond this form of carbon is preferred as reinforcement in heat sink materials (copper-diamond composite) which are often subjected to severe thermal and mechanical loads. In the present case niobium and boron interlayers of various thicknesses were deposited on diamond and vitreous carbon substrates by magnetron sputter deposition. After the coverage of all samples by a copper film, a part of the samples was subjected to heat treatment for 30 min at 800 °C under high vacuum (HV) to simulate the thermal conditions during the production of the composite material by uniaxial hot pressing. De-wetting during heat treatment leads to the formation of holes or humps in the Cu coating. This effect was investigated by scanning electron microscopy (SEM) and atomic force microscopy (AFM). A comparison of time-of-flight secondary ion mass spectroscopy (TOF SIMS) profiles of heat treated samples with those of as deposited ones showed the influence of interdiffusion during the heating process. Diffusion behaviour and chemical composition of the interface were also studied by cross sectional transmission electron microscopy (X-TEM) investigations using focused ion beam (FIB) cut samples. The thermal contact resistance (TCR) of the interface was calculated from results obtained from modulated infrared radiometry (IR). Thin interlayers suppressed de-wetting most effectively and consequently the TCR at the Cu-diamond interface was found to decrease. Therefore they are promising candidates for optimising the Cu-diamond interface.

Influence of carrier solution ionic strength and injected sample load on retention and recovery of natural nanoparticles using Flow Field-Flow Fractionation.

Natural nanoparticles, including both natural organic matter (NOM) and inorganic mineral-like phases, have been broadly characterized using Flow Field-Flow Fractionation (FlowFFF). Calibration with polystyrene sulfonate (PSS) standards was generally carried out in order to determine the molecular weight distribution of the NOM, however if the analyzed sample has a different charge density compared to the PSS standards, the resulting molecular weight distribution may become meaningless. The presented study therefore investigates and compares the influences of ionic strength and sample load on the retention time and recovery of both PSS standards and natural nanoparticles from a variety of sources. The minimum ionic strength in the carrier solution and the maximum injected sample load required for satisfactory separation depend on the molecular weight of the PSS standards and on the nature of the NOM. The degree to which results depend on conditions and parameters within the FlowFFF varies significantly between the different natural nanoparticle samples. We found that it may be necessary to calibrate the channel under different conditions from the actual sample runs. Under well controlled and documented conditions this could represent an important move away from the paradigm of "same conditions for standards and sample". From all conditions tested, the most reliable molecular weight calibrations were obtained at elevated ionic strengths in the carrier solution (>0.04 M) and low injected mass of PSS. However, even under these optimized conditions variations of up to 20% occur in the calculated molecular weights, and the recovery of NOM falls by up to 50% at high ionic strengths. Many applications aim for both correct molecular weight distribution and the measurement of low concentrations of elements bound to natural nanoparticles. We conclude, however, that finding conditions that are equally optimal for both of these analytical tasks is not always feasible.

Characterization of the mechanical and thermal interface of copper films on carbon substrates modified by boron based interlayers.

The manipulation of mechanical and thermal interfaces is essential for the design of modern composites. Amongst these are copper carbon composites which can exhibit excellent heat conductivities if the Cu/C interface is affected by a suitable interlayer to minimize the Thermal Contact Resistance (TCR) and to maximize the adhesion strength between Cu and C.In this paper we report on the effect of boron based interlayers on wetting, mechanical adhesion and on the TCR of Cu coatings deposited on glassy carbon substrates by magnetron sputtering. The interlayers were 5 nm thick and consisted of pure B and B with additions of the carbide forming metals Mo, Ti and Cr in the range of 5 at.% relative to B. The interlayers were deposited by RF magnetron sputtering from either a pure B target or from a composite target. The interlayer composition was checked by Auger Electron Spectroscopy and found to be homogenous within the whole film.The system C-substrate/interlayer/Cu coating was characterized in as deposited samples and samples heat treated for 30 min at 800 °C under High Vacuum (HV), which mimics typical hot pressing parameters during composite formation. Material transport during heat treatment was investigated by Secondary Ion Mass Spectroscopy (SIMS). The de-wetting and hole formation in the Cu coating upon heat treatment were studied by Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM). The adhesion of the Cu coating was evaluated by mechanical pull-off testing. The TCR was assessed by infrared photothermal radiometry (PTR). A correlation between the adhesion strength and the value of the TCR which was measured by PTR was determined for as deposited as well as for heat treated samples.

[Therapy of patients with chronic back pain. Prescriptions--contentment--outcome]. / Therapie bei Patienten mit Rückenschmerzen. Verordnungsverhalten--subjektive Zufriedenheit--Effekte.

Chronic back pain is a frequent complaint in out-patient orthopaedic practice. National (DEGAM; German Society of General Medicine and Family Medicine) and international guidelines provide recommendations for diagnostic and therapeutic procedures. Regulation of the behaviour of treating orthopaedists in the context of the therapy is so far little known.In this survey it was investigated which treatments are prescribed, whether there is a link between regulations and stage of chronification and whether the subjective effects correspond to objective results. Questionnaires relating to patient anamnesis were sent to 235 orthopaedic practices and a second questionnaire was sent to all patients who took part in the survey 6 months later. A total of 630 data sets could be evaluated.It was shown that primarily passive therapies (physiotherapy, drug therapy, injections and tablets) are mostly prescribed (physiotherapy, medications, injections) and that more therapies are used with increasing stages of chronification. The prescribed therapy achieved a high subjective patient satisfaction but an objective success could not be recognized.

[Measurement of success of treatment for chronic back pain. Can general effects in an entire sample of patients with chronic back pain be transferred to specific effects in individuals?]. / Messung von Behandlungserfolg bei chronischen Rückenschmerzen. Lassen sich generelle Effekte in einer Gesamtstichprobe von Patienten mit chronischen Rückenschmerzen auf spezifische Effekte bei Individuen übertragen?

BACKGROUND: The multimodal therapy has proved to be useful for the treatment of patients with chronic back pain. The aim of this methodical study was to test whether specific effects for the individual can be inferred from general effects of the entire sample, in order to define criteria for the success of treatment. These could be helpful when deciding to which patients the multimodal therapy can best be applied. PATIENTS AND METHODS: A total of 408 patients with chronic back pain took part in a 3-week multimodal therapy program in a day hospital. The patients were questioned regarding parameters such as pain intensity, depression, functional back capacity and quality of life before therapy as well as 6 months after therapy. RESULTS: On average, a significant improvement of all parameters could be shown after 6 months. However, scatterplots and correlations showed that general results of the entire sample should not be transferred to the individual patient CONCLUSION: Taking into account principles of classical test theory this study showed that sufficient systematic coherence of the data must be proven before changes can be calculated. As long as neither an adequate systematic nor useful criteria can be found, there seems to be no reason to exclude any patient from multimodal therapy using pre-selection criteria.

[Reduction in pain intensity after treatment for chronic back pain. When is it clinically meaningful?]. / Gutes Therapieergebnis nach Behandlung chronischer Rückenschmerzen. Wie viel Schmerzreduktion ist klinisch relevant?

AIM: The aim of this study was to evaluate how much change in pain intensity is necessary to discriminate between good, bad or no treatment outcome from the patient's point of view after therapy for chronic back pain. METHODS: A total of 153 patients with chronic back pain were admitted to a 3 week multimodal treatment program including functional restoration and cognitive behavioral support (outpatient). Pain intensity was measured at the beginning of treatment and 6 months after discharge using a visual analogue scale (VAS). At this time, patients had to evaluate their back pain compared to the beginning of treatment as of better, equal or worse (global self-assessment). RESULTS: Six months after therapy, 48% of the patients assessed their back pain as better, 28% reported no change and 14% stated that their pain was worse. Mean pain reduction among the patients who assessed themselves as better was 25 points, while those who stated that their pain was worse had an average of 9 points more (VAS). CONCLUSION: Patients' global self-assessment is a valid parameter to determine the outcome after treatment of chronic back pain. A clinically meaningful pain reduction can be assumed if there is at least a 25/100 point reduction (VAS), while a worsening of pain is already found to be important when there is a rise of 9/100 points.

[Comorbidity in patients with chronic low back pain]. / Komorbidität bei Patienten mit chronischen Rückenschmerzen.

BACKGROUND: Studies concerning comorbidity in patients with chronic low back pain and its correlation to the stage of chronification are rare. METHODS: This case-control study (matched-pair analysis) examines the number and specificity of comorbidity as well as the extent of disability due to comorbidity in 51 patients with chronic low back pain compared to age- and sex-matched control persons. Moreover, the correlation of comorbidity and the stage of chronification was analysed in these patients. RESULTS: Patients with chronic low back pain had significantly more comorbidities and a higher disability due to comorbidity compared to the control persons. The higher the stage of chronification according to the Mainz Pain Staging System (MPSS) the higher was the number of comorbidities. CONCLUSION: Comorbidity should be given due consideration when evaluating diagnosis, therapy, prognosis and therapy outcome in patients with chronic low back pain.

Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients.

OBJECTIVES: This prospective longitudinal clinical study analyses the therapy outcome of 365 patients with either chronic neck (n = 134) or low back (n = 231) pain treated with a multidisciplinary biopsychosocial therapy approach. METHODS: Patients with chronic neck pain (NP) or low back pain (LBP) for 3 months or longer, corresponding sick leave for longer than 6 weeks, and clearly defined inclusion and exclusion criteria underwent a 3-week standardized inpatient multidisciplinary biopsychosocial therapy. Baseline sociodemographic, occupational, functional, and psychological data at entry into the study (T0) were comparable in both groups. At the 6-month follow-up (T1), five different therapy outcomes were analysed in both groups: back-to-work status, generic health status (the 36-item Short Form Health Survey, SF-36), pain intensity (visual analogue scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy. RESULTS: Both treatment groups improved significantly in all outcome criteria between T0 and T1. In the total group, the back-to-work rate was 67.4%. At the final follow-up there were no significant differences between the group with chronic NP and the group with chronic LBP in the outcome criteria back-to-work status, improvement of health status and functional capacity, satisfaction with therapy, and reduction of pain. CONCLUSION: Evaluation of the main results of this study suggests that patients with chronic NP also derive significant benefit from a multidisciplinary treatment strategy, demonstrated in the literature so far mainly for patients with chronic LBP.

[Multimodal therapy patients with chronic cervical and lumbar pain. Results of a comparative prospective study]. / Multimodale Therapie bei chronischem HWS- und LWS-Schmerz. Ergebnisse einer prospektiven Vergleichsstudie.

BACKGROUND: Multimodal therapy has been established for patients with chronic low back pain, but studies reporting results in patients with chronic neck pain are rare. METHODS: This prospective clinical study compared the results in 97 patients with chronic cervical pain and 231 patients with chronic lumbar pain after three weeks of multimodal therapy. The following factors were analyzed in both groups at the beginning and after 6 months: ability to work, pain intensity and functional back capacity. RESULTS: Both groups had improved significantly after 6 months in all outcome parameters. Functional back capacity and ability to work at 6 months were not different between the two groups, but pain intensity was significantly lower in patients with low back pain compared to patients with neck pain. CONCLUSION: Multimodal therapy is also an efficient treatment strategy for patients with chronic cervical pain as has already been shown for patients with chronic lumbar pain.

[What questions are appropriate for predicting the risk of chronic disease in patients suffering from acute low back pain?]. / Welche Fragen sind geeignet, ein Chronifizierungsrisiko von akuten Rückenschmerzen vorherzusagen? Eine prospektive klinische Studie.

AIM: The objective of the study was to develop a brief questionnaire to determine the risk of chronification for patients suffering from lumbar (low) back pain who are consulting a physician for the first or second time. METHOD: At the outset, and again after six months, a questionnaire with 167 valid items for chronification was distributed to patients in orthopedic offices. After six months, patients were contacted by mail to inquire whether they were still suffering from back pain. Based on outcome (persistence of back pain/absence of back pain) and by means of logistic regression analysis, those variables were determined that could predict actual chronification. RESULTS: The following items were predictive: "How strong was your back pain during the last week when it was most tolerable?" and "How much residual pain would you be willing to tolerate while still considering the therapy successful?" (Acceptance value, beta = 0.61), patient's educational level (beta = - 0.44), massage is experienced as bringing relief (beta = 0.44), 5 items of the Zung scale for depression (beta = 0.42), items of the scale for catastrophizing thoughts (beta = 0.41) and items of the scale for feelings of helplessness (beta = - 0.39) of the Kiel pain inventory; duration of the back pain for longer than 1 week (beta = 0.38), pain in other parts of the body (beta = 0.37); and female gender (beta = 0.25) CONCLUSION: Based on these questions, it was possible to predict the chronification of back pain with a probability of 78.05 %. A corresponding questionnaire and an evaluative table were developed.

Characterisation of the interface of sputter-deposited copper coatings on nitrogen plasma-treated carbon substrates.

The adhesion of copper coatings to carbon substrates is very poor, because of lack of diffusion or reaction between the constituents. Because there is technological interest in enhancing the adhesion and improving the interface between copper and carbon, plasma treatment of the carbon substrate was employed in this study. For modification of the carbon surface a nitrogen plasma was used. It was confirmed by pull-off tests that the strength of adhesion of the copper coating can be improved by a factor of more than 10 by plasma pretreatment, even after treatment for a very short time (1 min). To obtain more information about the mechanisms of the processes occurring at the interface SIMS investigations were performed on samples which had been treated for different times (between 1 and 60 min). These measurements confirmed that nitrogen is located on the interface. With increasing pretreatment time the amount of nitrogen detected on the interface increased. Besides characterisation of as-deposited samples, another focus was to study the mechanisms of diffusion of nitrogen if the samples are heat treated at 500 degrees C.

Effect of intermittent high altitude hypoxia on gene expression in rat heart and lung.

Hypoxia has been identified as an important stimulus for gene expression during embryogenesis and in various pathological situations. Its influence under physiological conditions, however, has only been studied occasionally. We therefore investigated the effect of intermittent high altitude hypoxia on the mRNA expression of different cytokines and protooncogenes, but also of other genes described to be regulated by hypoxia, in the left ventricle (LV), the right ventricle (RV), atria and the lung of adult rats after simulation of hypoxia in a barochamber (5000 m, 4 hours to 10 days). Heme oxygenase-1 as well as transforming growth factor-beta1 showed an increased expression in all regions of the heart and the lung at different periods of hypoxia. For lactate dehydrogenase-A, we found a significant up-regulation in the RV and the lung, for lactate dehydrogenase-B up-regulation in the RV, but down-regulation in the LV and the atria. Vascular endothelial growth factor was up-regulated in the RV, the LV and the lung, but down-regulated in the atria. Its receptor Flk-1 mRNA was significantly increased in the atria and RV only. Expression of c-fos was found in the LV and RV only after 4 hours of hypoxia. The level of c-jun was significantly increased in the LV but decreased in the atria. Our data clearly demonstrate that intermittent hypoxia is a modulator of gene expression under physiological conditions. It differently regulates the expression of distinct genes not only in individual organs but even within one organ, i.e. in the heart.