Optical Traps for Sympathetic Cooling of Ions with Ultracold Neutral Atoms.

We report the trapping of ultracold neutral Rb atoms and Ba^{+} ions in a common optical potential in absence of any radio frequency (rf) fields. We prepare Ba^{+} at 370 µK and demonstrate efficient sympathetic cooling by 100 µK after one collision. Our approach is currently limited by the Rb density and related three-body losses, but it overcomes the fundamental limitation in rf traps set by rf-driven, micromotion-induced heating. It is applicable to a wide range of ion-atom species, and may enable novel ultracold chemistry experiments and complex many-body dynamics.

CD14+ monocytes contribute to inflammation in chronic nonbacterial osteomyelitis (CNO) through increased NLRP3 inflammasome expression.

The pathophysiology of chronic nonbacterial osteomyelitis (CNO) remains incompletely understood. Increased NLRP3 inflammasome activation and IL-1ß release in monocytes from CNO patients was suggested to contribute to bone inflammation. Here, we dissect immune cell infiltrates and demonstrate the involvement of monocytes across disease stages. Differences in cell density and immune cell composition may help to discriminate between BOM and CNO. However, differences are subtle and infiltrates vary in CNO. In contrast to other cells involved, monocytes are a stable element during all stages of CNO, which makes them a promising candidate in the search for "drivers" of inflammation. Furthermore, we link increased expression of inflammasome components NLRP3 and ASC in monocytes with site-specific DNA hypomethylation around the corresponding genes NLRP3 and PYCARD. Our observations deliver further evidence for the involvement of pro-inflammatory monocytes in the pathophysiology of CNO. Cellular and molecular alterations may serve as disease biomarkers and/or therapeutic targets.

[Periacetabular osteotomy-what influence does age have on patient-relevant results? : A prospective 5­year investigation]. / Periazetabuläre Osteotomie ­ Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse? : Eine prospektive 5­Jahres-Untersuchung.

INTRODUCTION: Periacetabular osteotomy (PAO) is an effective procedure in treatment of symptomatic hip dysplasia. To achieve a good outcome a strict patient selection has to be applied. The aim of this study was to evaluate the influence of patient age at surgery on clinical outcome. METHODS: In a prospective study 86 patients (106 hips) underwent clinical and radiographic follow-up at a mean time of 5 years (2.5-8.5 years) after PAO. Patient-related outcome measurements (PROMs: EQ-5D, WOMAC, OHS, GTO) were applied preoperatively as well as postoperatively and the deformity correction as well as development of osteoarthritis were evaluated. In order to analyze the influence of patient age at surgery on clinical outcome, we subdivided the patient cohort into four different age groups (<20 years, 20-29 years, 30-39 years, >40 years). RESULTS: Of the patients 90% were very satisfied or satisfied with the results 5 years after surgery, and in all age groups PROMs significantly increased. Even though preoperative as well as postoperative algofunction declined in cohorts with increasing age, the overall benefit as measured in WOMAC and EQ-5D scores was equal in all age groups. Increasing age is associated with a progression in osteoarthritis as well as a higher conversion rate to total arthroplasty. DISCUSSION: Age is an important influencing factor on the long-term outcome after PAO. A certain age as cut off for indications could not be identified in this study. Even patients in the age groups 30-39 years and > 40 years showed PROM improvement and satisfaction with outcome at medium-term follow-up. The expected success rate has to be discussed preoperatively with the patient; however, as a higher conversion rate to hip arthroplasty as well as progressive osteoarthritis is associated with higher age, not only patient age alone but also morphological characteristics of the hip joint have to be taken into consideration.

[Adolescent idiopathic scoliosis : Guideline for practical application]. / Adoleszente idiopathische Skoliose : Leitfaden für die praktische Anwendung.

Juvenile or adolescent idiopathic scoliosis is a relatively common spinal deformity, with an incidence of more than 1 %. Early diagnosis can lead to successful therapy. In the case of pathological clinical findings, the anteroposterior X­ray of the whole spine leads the way to the correct grading, according to Cobb angle measurement. Depending on the individual risk of progression, brace treatment will be started with a Cobb angle range of 20-25°. Important predictors of therapeutic success are sufficient primary corrective power and patient compliance. COBB angles of 40-50° usually lead to the recommendation for surgery, which is performed as either anterior or posterior spinal fusion in skeletally mature adolescents, depending on the grade of the deformity according to Lenke's classification. To achieve the best possible results, it is recommended that both conservative and surgical treatments are carried out by scoliosis specialists.

Long-Term Function following Periprosthetic Fractures.

PURPOSE OF THE STUDY Clinical results of long-term follow-up after traumatic periprosthetic femur fractures and different therapies (ORIF vs. revision arthroplasty) MATERIAL AND METHODS The Visual Analog Scale (VAS), Harris-Hip-Score (HHS), Oxford-Hip-Score (OHS), Oxford-Knee-Score (OKS), Knee-Society-Score (KSS), SF-36 Questionnaire and Funktionsfragebogen Hannover (FFH) were used to evaluate outcome and functionality. Radiological examinations were performed and the Vancouver (THA) and Lewis and Rorabeck (TKA) classifications used. RESULTS 70 patients suffered a periprosthetic hip fracture (29× revision prosthesis, 41x ORIF), 23 patients underwent an ORIF due to periprosthetic fracture of a TKA (total mean age 75.2 years). 47 patients (follow-up rate 51%) were examined 40 months after surgery (mean age 72 years) (THA: 16× revision, 23× ORIF, TKA: 8× ORIF). The VAS revealed significant less pain in the group that had undergone revision hip arthroplasty than in the ORIF group: 3.9±1 vs. 5.1±1.7 (p<0.05), respectively. 5/16 patients with revision arthroplasty had excellent or good results in the HSS compared to 3/23 patients after ORIF. The OHS yielded excellent or good results in 12/16 patients after revision arthroplasty vs. 10/23 after ORIF. The VAS after ORIF in patients who suffered periprosthetic knee fractures was 4.9±2.1. 3/8 patients achieved excellent or good results according to the OKS. CONCLUSION Every functional score (HSS, OHS, FFH, SF-36) of those patients who had undergone revision arthroplasty was slightly higher and their VAS significantly lower than the scores of the patients after ORIF. Key words: periprosthetic fractures, trauma, open reduction and internal fixation, revision arthroplasty.

Serial ankle casts for patients with idiopathic toe walking: effects on functional gait parameters.

PURPOSE: The aim of the present study was to investigate the functional effects on gait parameters of serial ankle casts for patients with idiopathic toe walking (ITW), in comparison with an unremarkable control group. METHODS: A prospective trial with a pre-test-post-test control group design included ten patients with ITW and ten healthy matched children. Children with ITW underwent serial casting to stretch the plantar flexors, with two 14-day periods with walking plaster casts set at the maximum available ankle dorsiflexion. Both groups were assessed clinically and using a functional gait analysis before and after serial casting, as well as at a six-month follow-up visit. RESULTS: The normalized plantar heel force increased from 5% pre-interventionally to 79% at the follow-up. The upper ankle-joint angle and the base angle also demonstrated significant changes. Normalized compound action potentials of the medial heads of the gastrocnemius were reduced by 70%. None of these parameters demonstrated any significant differences at the follow-up examination in comparison with the healthy control group. Variations in the displacement of the knee joint on the sagittal plane and of the center of gravity in the transverse plane did not show any significant differences in comparison with the control group. CONCLUSION: The reduction of muscle tone and lengthening of the ankle plantar flexors led to persistent increased active ankle dorsiflexion with significant long-term improvement of functional kinematic parameters. No significant difference in the gait analysis was found between the ITW group and healthy children six months after treatment.Level of Evidence: Level II - Therapeutic.

[Corrective osteotomies for posttraumatic elbow deformities]. / Korrekturosteotomien bei posttraumatischen Fehlstellungen des Ellenbogengelenks.

OBJECTIVES: Correcion of elbow joint deformities that usually develop secondary to direct or indirect trauma of the arm or elbow with subsequent inadequate healing and consecutive axial/rotational malalignment and may be associated with cosmetic or functional deficits of the arm. INDICATIONS: Relevant malalignment of the arm axis with corresponding cosmetic or functional deficits for the patient. CONTRAINDICATIONS: Pre-existing degenerative and chronic inflammatory changes. SURGICAL TECHNIQUE: Generally, two-dimensional supracondylar open or closed wedge osteotomies are used. In the presence of a three-dimensional deformity (with rotational component), an additional derotational correction is necessary. Extra-articular deformities following extension fractures should be treated preferably with an open wedge osteotomy, extra-articular deformities of flexion fractures with a closed wedge osteotomy. Valgus/varus deformities may also require a closed/open wedge osteotomy primarily through a dorsal or alternatively radial approach. POSTOPERATIVE MANAGEMENT: The arm should be immobilized with a brachial cast splint for 2-3 weeks, with passive exercises of the elbow starting on postoperative day 7. RESULTS: In general, the results for a three-dimensional osteotomy of the distal humerus are expected to be good to very good. Only in rare cases (2.5%) is a mostly transient irritation of the ulnar nerve observed.

Locked posterior dislocation of the shoulder: treatment using rotational osteotomy of the humerus.

This study reports the use of rotational osteotomy in 10 patients with locked posterior dislocation of the shoulder. The average interval between injury and diagnosis was 155 days (range, 21-400 days). Patients were aged 40-78 years old, with an average age of 53 years. Articular impaction fracture of the humeral head involved 20-40% of the articular surface as determined by CT analysis. There were no postoperative complications except a transient axillary nerve palsy. Patients were started on immediate passive motion followed by an active program at 2-3 weeks. Using the Rowe/Zarins scale, six patients had good-excellent results, two fair results, and two poor results. The poor results were seen in cases where articular cartilage damage was advanced. Rotational osteotomy is an effective procedure at restoring glenohumeral congruity and early functional activity in the patient with locked posterior shoulder dislocation given the following criteria: (a) healthy articular cartilage, (b) a humeral head defect involving less than 40% of the articular surface, and (c) a patient who is able to participate in an active rehabilitation program.

[Heparin-associated thrombocytopenia (HAT) type II. An underestimated complication in prevention of thromboembolism with heparin]. / Heparinassoziierte Thrombocytopenie (HAT) Typ II. Eine unterschätzte Komplikation der Thromboembolieprophylaxe mit Heparin.

We report four patients who developed heparin-associated thrombocytopenia (HAT) under heparin prophylaxis. One patient showed no clinical signs, but three had severe complications (white-clot syndrome, acute adrenal failure and loss of limb because of thromboembolic complication), leading to death in two cases.

[Isolated injury of the subscapular muscle tendon]. / Die isolierte Verletzung der Sehne des M. subscapularis.

Avulsion of the subscapularis tendon is caused by a combined abduction and external rotation trauma of the upper limb. Weakness of internal rotation and a positive apprehension test are clinical signs of the injury. A fracture of the lesser tuberosity in the x-ray film or a disruption of the subscapularis tendon documented in dynamic sonography of the shoulder clarify the diagnosis. Operative treatment is indicated of prevent weakness of internal rotation as well as anterior instability. This recommendation is supported by four cases with full range of motion and good anterior stability after surgery.

[Differential diagnosis of shoulder dislocation with special reference to posterior dislocation]. / Die differenzierte Diagnostik der Schulterluxation mit besonderer Berücksichtigung der hinteren Luxation.

Evaluation of a dislocated shoulder must classify the direction of dislocation and describe additional injuries as well as the recurrence rate. This is required in all types of dislocations by recording the case history in detail, and by examining the shoulder clinically as well as radiographically in two planes. Ultrasound and arthro-computer tomography are valid methods to demonstrate injuries of bony and ligamentous structures. They may therefore influence surgical treatment. In posterior dislocation of the shoulder quite often early diagnosis is missed. If this injury is suspected, careful clinical and radiographical evaluation is most important.

[Modified transpeduncular spongiosa-plasty with osteotomy of the transverse process]. / Die modifizierte transpedunkuläre Spongiosaplastik mit Querfortsatzosteotomie.

Bone grafting of the vertebral body is an essential part in stabilisation of the spine. A modified transpeduncular approach to the vertebral body is described. Using this approach a bone graft can be placed more exactly in a shorter time.

[New aspects of the treatment of larger bone defects]. / Neue Aspekte in der Behandlung grösserer Knochendefekte.

A characterisation of mainly used implant materials into bone defects is performed. The materials are classified in two groups; their biological effects are described in detail. Using OCG as a typical osteoinductive implant histological and radiological findings are described which take place in animals after heterotopic and orthotopic implantation.

[Primary valgisation osteotomy in femoral neck fractures]. / Die primäre Valgisationsosteotomie bei Schenkelhalsfrakturen.

Technique and results after primary valgisation osteotomy in 41 patients with femoral neck fractures are described. 2 non unions and 9 avascular femoral head necroses were observed. The primary valgisation most probably does not influence the rate of necrosis. When performed by accurate technique it lowers the incidence of non union of the femoral neck. Postoperative leg lengthening is always evident. The most current avoidable mistake is an external rotational deformity. The procedure requires proper preoperative planning.

Signals of the QCD phase transition in core-collapse supernovae.

We explore the implications of the QCD phase transition during the postbounce evolution of core-collapse supernovae. Using the MIT bag model for the description of quark matter, we model phase transitions that occur during the early postbounce evolution. This stage of the evolution can be simulated with general relativistic three-flavor Boltzmann neutrino transport. The phase transition produces a second shock wave that triggers a delayed supernova explosion. If such a phase transition happens in a future galactic supernova, its existence and properties should become observable as a second peak in the neutrino signal that is accompanied by significant changes in the energy of the emitted neutrinos. This second neutrino burst is dominated by the emission of antineutrinos because the electron degeneracy is reduced when the second shock passes through the previously neutronized matter.

[The natural history of developmental dysplasia of the hip. A meta-analysis of the published literature]. / Natürlicher Verlauf von Hüftreifungsstörungen und Hüftdysplasie. Eine Metaanalyse publizierter Literatur.

Assessment of the natural history of developmental dysplasia of the hip (DDH) is indispensable for age-dependent treatment of these patients. Based on a systematic meta-analysis of the published literature, this study gives an overview of the spontaneous course of DDH in different age decades. Furthermore, these results are discussed in the context of physiologic development of the hip. The data were compiled by a systematic literature search of medical databases from 1975 through 2007. For this evaluation, only papers that presented as high a level of evidence as possible were included. In early childhood, DDH with subluxation or dislocation necessitates treatment; otherwise, the spontaneous course leads invariably to osteoarthritis of the hip. However, a stable, well-centered dysplastic hip has a high potential of developing as a physiologic joint. In the analyzed data, an association between mild or moderate DDH after the end of growth and the development of osteoarthritis could not be demonstrated. The level of evidence of existing data is not sufficient to determine that persisting mild dysplasia is a relevant ethiopathological factor for osteoarthrosis of the hip. Therefore, prospective epidemiological studies are required.

[Combined hip-dysplasia and femuroacetabular impingement. Diagnosis and simultaneous surgical treatment]. / Koinzidenz von Hüftdysplasie und femuroazetabulärem Impingement. Klinisches Bild und simultane operative Korrektur.

Developmental dysplasia of the hip as well as femuroacetabular impingement are recognized causes of hip pain and degenerative disorders. While accepted treatment recommendations for both entities currently exist, there are no standardised approaches published for the management of combined lesions. We therefore present an algorithm of diagnosis and simultaneous surgical treatment based on a combination of periacetabular osteotomy and arthroscopically-assisted minimally invasive anterior osteochondroplasty. Short-term treatment results of 19 patients show an effective improvement of clinical symtoms and radiographic deformity.