Impact of Anxiety During Hospitalization on the Clinical Outcome of Patients With Osteoporotic Thoracolumbar Vertebral Fracture.

STUDY DESIGN: Multicenter prospective cohort study. OBJECTIVES: Anxiety in combination with osteoporotic vertebral compression fractures (OVCFs) of the spine remains understudied. The purpose of this study was to analyze whether anxiety has an impact on the short-term functional outcome of patients with an OVCF. Furthermore, a direct impact of the fracture on the patient's anxiety during hospitalization should be recognized. METHODS: All inpatients with an OVCF of the thoracolumbar spine from 2017 to 2020 were included. Trauma mechanism, analgetic medication, anti-osteoporotic therapy, timed-up-and-go test (TuG), mobility, Barthel index, Oswestry-Disability Index (ODI) and EQ5D-5L were documented.For statistical analysis, the U test, chi-square independence test, Spearman correlation, General Linear Model for repeated measures, Bonferroni analysis and Wilcoxon test were used. The item anxiety/depression of the EQ5D-5L was analyzed to describe the patients' anxiousness. RESULTS: Data from 518 patients from 17 different hospitals were evaluated. Fracture severity showed a significant correlation (r = .087, P = .0496) with anxiety. During the hospital stay, pain medication (P < .001), anti-osteoporotic medication (P < .001), and initiation of surgical therapy (P < .001) were associated with less anxiety. The anxiety of a patient at discharge was negatively related to the functional outcomes at the individual follow-up: TuG (P < .001), Barthel index (P < .001), ODI (P < .001) and EQ5D-5L (P < .001). CONCLUSIONS: Higher anxiety is associated with lower functional outcome after OVCF. The item anxiety/depression of the EQ5D-5L provides an easily accessible, quick and simple tool that can be used to screen for poor outcomes and may also offer the opportunity for a specific anxiety intervention.

Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases.

PURPOSE: Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. METHODS: In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. RESULTS: Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:- 1 ± 3°, OS:-2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. CONCLUSION: OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment.

[Nonsurgical and surgical management of osteoporotic vertebral body fractures : Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)]. / Nichtoperative und operative Behandlung der osteoporotischen Wirbelkörperfraktur : Empfehlungen der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU).

STUDY DESIGN: Prospective clinical cohort study (data collection); expert opinion (recommendation development). OBJECTIVES: Treatment options for nonsurgical and surgical management of osteoporotic vertebral body fractures differ widely. Based on the current literature, the knowledge of the experts, and their classification for osteoporotic fractures (OF classification), the Spine Section of the German Society for Orthopaedics and Trauma has now introduced general treatment recommendations. METHODS: A total of 707 clinical cases from 16 hospitals were evaluated. An OF classification-based score was developed for guidance in the option of nonsurgical versus surgical management. For every classification type, differentiated treatment recommendations were deduced. Diagnostic prerequisites for reproducible treatment recommendations were defined: conventional X­rays with consecutive follow-up images (standing position whenever possible), magnetic resonance imaging, and computed tomography scans. OF classification allows for upgrading of fracture severity during the course of radiographic follow-up. The actual classification type is decisive for the score. RESULTS: A score of less than 6 points advocates nonsurgical management; in cases with more than 6 points, surgical management is recommended. The primary goal of treatment is fast and painless mobilization. Because of the expected comorbidities in this age group, minimally invasive procedures are preferred. As a general rule, stability is more important than motion preservation. It is mandatory to restore the physiological loading capacity of the spine. If the patient was in a compensated unbalanced state at the time of fracture, reconstruction of the individual prefracture sagittal profile is sufficient. The instrumentation technique has to account for compromised bone quality. We recommend the use of cement augmentation or high purchase screws. The particular situations of injuries with neurological impairment, the necessity to fuse, multiple level fractures, consecutive and adjacent fractures and fractures in ankylosing spondylitis are addressed separately. CONCLUSIONS: The therapeutic recommendations presented here provide a reliable and reproducible basis to decide for the treatment choices available. However, intermediate clinical situations with a score of 6 points remain, allowing for both nonsurgical and surgical options. As a result, individualized treatment decisions may still be necessary. In the subsequent step, the recommendations presented will be further evaluated in a multicentre controlled clinical trial.

[Thoracolumbar spinal fractures in the elderly : Classification and treatment]. / Thorakolumbale Wirbelsäulenfrakturen beim alten Menschen : Klassifikation und Therapie.

Thoracolumbar fractures in the elderly are frequently associated with osteoporosis. Osteoporosis can cause fractures or be a significant comorbidity in traumatic fractures. The OF classification is based on conventional X­ray, computed tomography (CT) scan and magnetic resonance imaging (MRI). It is easy to use and provides a clinically relevant classification of the fractures. Therapeutic decisions are made based on the clinical and radiological situation by using the OF score. The score takes the current clinical situation including patient-specific comorbidities into consideration. The treatment recommendations are based on an expert consensus opinion and include conservative and operative options. If surgery is indicated, vertebral body augmentation, percutaneous stabilization and even open surgery can be used.

[Course of operative treatment of a sacral insufficiency fracture : Successful or serious treatment?] / Behandlungsverlauf der operativen Versorgung einer Sakruminsuffizienzfraktur : Erfolgreiches oder folgenreiches Handeln?

A monolateral sacrum fracture was primarily diagnosed with a CT and treated with PMMA augmented SI screw fixation. The following CT showed an unexpected contralateral fracture which led to the need for a lumbopelvic stabilization. In the course of 6 months, successively occurring adjacent fractures required recurrent vertebroplasty. Most of these fractures could only be diagnosed through MRI. It remains unclear, whether initially even the contralateral sacral ala was fractured.

[The complicated course of a femoral shaft fracture in childhood]. / Komplizierter Verlauf einer Femurschaftfraktur im Kindesalter.

We report a difficult healing process after a femoral shaft fracture in childhood. We present surgical correction options of femoral shortening due to pseudarthrosis after elastic stable intramedullary nailing. First, we tried to establish distraction using an external fixator, followed by plate osteosynthesis. After material failure of plate osteosynthesis, we treated the refracture with intramedullary nailing, after which bone healing occurred.

Neuromuscular Responses to 14 Weeks of Traditional and Daily Undulating Resistance Training.

This study compared traditional (TP) and daily undulating (DUP) periodization on muscle strength, EMG-estimated neural drive and muscle architecture of the quadriceps femoris (QF). 10 non-athletic females (24.4±3.2 years) performed 14 weeks of isometric training for the QF exercising 1 leg using TP and the contralateral leg using DUP. Intensities varied from 60% to 80% of MVC and the intensity zones and training volume were equated for each leg. Knee extension MVC, maximal voluntary QF-EMG activity and vastus lateralis (VL) muscle architecture were measured in both legs before, after 6 weeks and after 14 weeks of training using dynamometry, surface EMG and ultrasonography. Isometric MVC and maximal QF-EMG remained unaltered after 6 weeks of training, but were significantly (P<0.05) enhanced after 14 weeks in both legs (MVC: TP 24%, DUP 23%; QF-EMG: TP 45%, DUP 46%). VL-architecture remained unchanged following 6 weeks of training, but VL-muscle thickness (TP 17%, DUP 16%) and fascicle length (TP 16%, DUP 17%) displayed significant (P<0.05) enlargements after 14 weeks in both legs. Importantly, these temporal neuromuscular alterations displayed no significant differences between the training legs. Therefore, periodization may not act as a key trigger for neuromuscular adaptations.

[Elbow dislocation with ipsilateral proximal radial shaft fracture and radial head dislocation]. / Ellenbogenluxation mit ipsilateraler proximaler Radiusschaftfraktur und Radiusköpfchenluxation.

Elbow dislocation with ipsilateral proximal radial shaft fracture and dislocated radial head is a rarely described injury. In this article we present the case of a 23-year-old man with this injury. After the initial diagnostics, the radial shaft fracture was osteosynthetically fixed, whereby the anatomical positions of all parts of the elbow joint were correctly aligned and the medial collateral ligament was reconstructed. After 4.5 months the radial shaft fracture was healed with nearly complete functional recovery of the upper extremity. Thus, a good outcome can be expected when all aspects of bony and ligamentous injuries are accurately addressed.

[Aggravated reduction of the posterior malleolar fracture due to incarceration of the flexor digitorum longus tendon]. / Repositionshindernis des hinteren Volkmann-Dreiecks durch Interposition der Sehne des M. flexor digitorum longus.

The indications for stabilization of the posterior malleolus (Volkmann triangle) while fixing ankle fractures are controversially discussed. Detailed descriptions of possible obstacles to reduction are scarce. The following case describes the difficulty of reduction of the posterior malleolus caused by interposition of the flexor digitorum longus tendon. The fracture line of the posterior malleolus passed in an atypical manner vertically to the posterior-medial tibial margin with direct contact to the anatomical pathway of the tendon. The impaction of the tendon was already present in the computed tomography (CT) scan taken preoperatively but the tendon hindering malleolar reduction was first realized during surgery after several unsuccessful attempts at repositioning.

Comment on 'Temperature dependent optical properties of PbS nanocrystals'.

We address erroneous statements made by Nordin et al (2012 Nanotechnology 23 275701) claiming the inadequacy of an expression we, Ullrich et al (2011 Appl. Phys. Lett. 99 081901), used to fit the temperature dependence of the photoluminescence and the absorption of PbS quantum dots. We further correct a quote by Nordin et al, who, when referring to our work, mistakenly claimed temperature invariance of the Stokes shift.

Note: Phase sensitive detection of photoluminescence with Fourier transform spectroscopy.

Although known for more than twenty years, there is limited information in the literature regarding the experimental parameters of lock-in based phase sensitive emission detection in conjunction with Fourier spectrometers. For this technique - also known as double modulation spectroscopy - we present a guideline for parameter optimization by measuring the photoluminescence of InSb:Te at cryogenic temperatures.

Altered squat jumping mechanics after specific exercise.

This study examined squat jumping (SJ) mechanics following length restricted strength training regimens of the knee extensors and flexors. SJ from a 110 degrees knee joint angle starting position and isometric moment-knee angle relations of knee extensors and flexors were analysed in 16 athletes before and directly after 8 weeks of strength training regimens that were restricted to knee joint angles corresponding to long muscle-tendon unit (MTU) length for the knee extensors and flexors. SJ mechanics were studied using a two-dimensional kinematic model with three rigid bodies (upper leg, lower leg, foot) in combination with force plates measurements of ground reaction force in the right and left lower extremity. Centre of mass jumping height significantly (p<0.05) increased post training, but this was not explained by enhanced absolute power generation in the knee joint. However, post training small but significant (p<0.05) shifts to smaller knee joint angles occurred in the normalized [% Max.] knee joint angle dependent power generation in the right and left knee joint during SJ. The isometric moment-knee angle relation of the knee extensors was also significantly (p<0.05) shifted to longer MTU lengths of knee extensors. Length restricted strength training may alter the mechanical situation during both isometric contractions and dynamic athletic movements.

Frequency-dependent deformation of liquid crystal droplets in an external electric field.

Nematic droplets suspended in the isotropic phase of the same substance were subjected to alternating electrical fields of varying frequency. To keep the system at a constant nematic/isotropic volume ratio with constant droplet size, we carefully kept the temperature in the isotropic/nematic coexistence region, which was broadened by adding small amounts of a non-mesogenic liquid. Whereas the nematic droplets remained spherical at low (in the order of 10 Hz) and high frequencies (in the order of 1 kHz), at intermediate frequencies we observed a marked flattening of the droplets in the plane perpendicular to the applied field. Droplet deformation occurred both in liquid crystals (LCs) with positive and negative dielectric anisotropy. The experimental data can be quantitatively modelled with a combination of the leaky dielectric model and screening of the applied electric field due to finite conductivity.

Moment-angle relations after specific exercise.

This study examined the amount and time-course of shifts in the moment-knee angle relation of the quadriceps (QF) and hamstring (HAM) muscles in response to different length-restricted strength training regimens. Thirty-two athletes were divided into three different training groups (G1-3): G1 performed isometric training at knee joint angles corresponding to long muscle-tendon unit (MTU) length for QF and HAM; G2 conducted concentric-eccentric contraction cycles that were restricted to a knee joint range of motion corresponding to predominantly long MTU length for QF and HAM; G3 combined the protocols of G1 and G2. Moment-knee angle and EMG-knee angle relations of QF and HAM were measured on five different occasions: two times before, after five and eight weeks of training and four weeks post training. Moments and EMG-data of each subject were normalized to the largest value produced at any knee joint position [% Max.]. Obtained by curve fitting, the optimal knee joint angle for QF moment production was significantly (P<0.05) shifted to longer MTU length in G1 and G3 after 5 weeks of training and in G2 after 8 weeks of training. Contrary, no significant shifts were detected for HAM. Our data suggest that the predominant MTU length during loading is a major trigger for human force-length adaptations.

Time-resolved X-ray microscopy of nanoparticle aggregates under oscillatory shear.

Of all the current detection techniques with nanometre resolution, only X-ray microscopy allows imaging of nanoparticles in suspension. Can it also be used to investigate structural dynamics? When studying the response to mechanical stimuli, the challenge lies in its application with a precision comparable with the spatial resolution. In the first shear experiments performed in an X-ray microscope, this has been accomplished by inserting a piezo actuator driven shear cell into the focal plane of a scanning transmission X-ray microscope. Thus shear-induced re-organization of magnetite nanoparticle aggregates could be demonstrated in suspension. As X-ray microscopy proves suitable for studying structural change, new prospects open up in physics at small length scales.

Moment-knee angle relation in well trained athletes.

The purpose of this work was to investigate whether different modes of long-term competitive physical activity cause functional differences in the moment-knee angle relation of the M. quadriceps femoris (QF). Therefore, a sample (n = 40) of young male competitive endurance runners, cyclists, triathletes and tennis players performed isometric maximal voluntary knee extensions (MVC) with their stronger leg at six different knee joint angles while keeping the hip joint angle constant. Muscle activation of QF-muscles during MVC was estimated using surface electromyography (EMG). Moments and EMG data of each subject were normalized to the largest value produced at any knee joint position [% Max.]. No significant differences in the normalized [% Max.] moment-knee angle relation of the QF were found between endurance runners, cyclists and triathletes. Despite few unsystematic exceptions, no functional differences in the normalized moment-knee angle relation of the QF occurred among tennis players and the endurance-oriented athletic groups. Obtained by curve fitting, the optimal knee joint angle for moment production was not significantly different among all athletic groups. We conclude that long-term competitive endurance running, cycling, triathlon and tennis do not provoke functional differences in the moment-knee angle relation of the whole QF.

Increased frequency of migraine in narcoleptic patients: a confirmatory study.

Previously we have reported an increased prevalence of migraine in narcoleptic patients. Because of the theoretical and clinical implications of this finding we recruited an independent new study sample of 100 patients with proven narcolepsy and conducted a structured 26-item interview based on the international diagnostic criteria for headache disorders, the Kiel Headache Questionnaire. Narcolepsy symptoms were measured by means of the Stanford Centre for Narcolepsy Sleep Inventory. Migraine prevalence was twofold to fourfold increased in the narcoleptic patients and amounted to 44.4% in women and 28.3% in men. The onset of narcolepsy symptoms was 12.3 +/- 11.4 years before the onset of migraine symptoms. The results might be regarded as indicative of a common pathophysiological pathway relevant to both of the two disorders.

Absorption and subsequent emission saturation of two-photon excited materials: theory and experiment.

The saturation of two-photon absorption and the subsequent photoluminescence of matter under ultrafast laser pulse excitation are studied. For this purpose the experimental results of using two organic conjugated polymers as model substances are discussed theoretically. One model is based on the commonly used hyperbolic approach, whereas the new theory introduced correctly describes the saturation in two-photon spectroscopy and fits the experiment closely. The new model permits microscopic analysis of the absorption saturation process and makes possible an estimate of the two-photon absorption coefficient from the saturation intensity.

Failure of AH11110A to functionally discriminate between alpha(1)-adrenoceptor subtypes A, B and D or between alpha(1)- and alpha(2)-adrenoceptors.

The potency of the putatively alpha(1B)-adrenoceptor selective drug, 1-[biphenyl-2-yloxy]-4-imino-4-piperidin-1-yl-butan-2-ol (AH11110A), to antagonize contraction upon stimulation of alpha(1A)-adrenoceptors in rat vas deferens and rat perfused kidney, alpha(1B)-adrenoceptors in guinea-pig spleen, mouse spleen and rabbit aorta, and alpha(1D)-adrenoceptors in rat aorta and pulmonary artery was evaluated and compared to that of a number of subtype-discriminating antagonists. N-[3-[4-(2-Methoxyphenyl)-1-piperazinyl]propyl]-3-methyl-4-oxo-2-phenyl-4H-1-benzopyran-8-carboxamide (Rec 15/2739) and (+/-)-1,3,5-trimethyl-6-[[3-[4-((2,3-dihydro-2-hydroxymethyl)-1,4-benzodioxin-5-yl)-1-piperazinyl]propyl]amino]-2,4(1H,3H)-pyrimidinedione (B8805-033) were confirmed as selective for alpha(1A)-adrenoceptors, 8-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-8-azaspiro[4.5]decane-7,9-dione (BMY 7378), 8-[2-(1,4-benzodioxan-2-ylmethylamino)ethyl]-8-azaspiro[4.5]decane-7,9-dione (MDL 73005EF), and cystazosin were found to be selective for alpha(1D)-adrenoceptors, whereas spiperone was weakly selective for alpha(1B)-over alpha(1A)-adrenoceptors. However, from the functional affinity profile obtained for AH11110A at alpha(1A)-adrenoceptors (pA(2)=6.41 in rat vas deferens), alpha(1B)-adrenoceptors (pA(2)=5.40-6.54) and alpha(1D)-adrenoceptors (pA(2)=5.47-5.48), the affinity and presumed selectivity previously obtained for AH11110A in radioligand binding studies at native alpha(1B)- and cloned alpha(1b)-adrenoceptors (pK(i)=7.10-7.73) could not be confirmed. Additionally, AH11110A enhanced the general contractility of rat vas deferens, produced a bell-shaped dose-response curve of vasodilation in perfused rat kidney, and its antagonism in most other tissues was not simply competitive. The affinity of AH11110A for prejunctional alpha(2)-adrenoceptors in rabbit vas deferens (pA(2)=5.44) was not much lower than that displayed for alpha(1)-adrenoceptor subtypes, revealing that AH11110A, besides alpha(1)-adrenoceptors, also interacts with alpha(2)-adrenoceptors, and thus may be unsuitable for alpha-adrenoceptor subtype characterization, at least in smooth muscle containing functional studies.