Itinerant Antiferromagnetism in RuO_{2}.

Bulk rutile RuO_{2} has long been considered a Pauli paramagnet. Here we report that RuO_{2} exhibits a hitherto undetected lattice distortion below approximately 900 K. The distortion is accompanied by antiferromagnetic order up to at least 300 K with a small room temperature magnetic moment of approximately 0.05µ_{B} as evidenced by polarized neutron diffraction. Density functional theory plus U (DFT+U) calculations indicate that antiferromagnetism is favored even for small values of the Hubbard U of the order of 1 eV. The antiferromagnetism may be traced to a Fermi surface instability, lifting the band degeneracy imposed by the rutile crystal field. The combination of high Néel temperature and small itinerant moments make RuO_{2} unique among ruthenate compounds and among oxide materials in general.

Probing the Pairing Interaction and Multiple Bardasis-Schrieffer Modes Using Raman Spectroscopy.

In unconventional superconductors, understanding the form of the pairing interaction is the primary goal. In this regard, Raman spectroscopy is a very useful tool, as it identifies the ground state and also the subleading pairing channels by probing collective modes. Here, we propose a general theory for a multiband Raman response and identify new features in the spectrum that can provide a robust test for a pairing theory. We identify multiple Bardasis-Schrieffer type collective modes and connect the weights of these modes to the subleading gap structures within a microscopic pairing theory. While our conclusions are completely general, we apply our approach to interpret the specific case of B_{1g} Raman scattering in hole-doped BaFe_{2}As_{2}.

[Onychocola canadensis Sigler in onychomycosis : A new dermatophyte-like mould in Germany]. / Onychocola canadensis Sigler bei Onychomykose : Ein neuer Dermatophyten-ähnlicher Schimmelpilz in Deutschland.

Moulds or non-dermatophyte moulds (NDM) are being increasingly isolated as causative agent of onychomycoses. Known causes of a NDM-OM are Scopulariopsis brevicaulis, Fusarium, Aspergillus, Acremonium, Neoscytalidium dimidiatum, Arthrographis kalrae, and Chaetomium. In this article, 5 patients with suspected nail infection due to Onychocola canadensis are reported for the first time in Germany. Systemic antifungal agents are not considered to be effective in NDM onychomycosis. In individual cases, however, terbinafine seems to be effective in Onychocola canadensis infection of the nails. Treatment of choice represents, however, nontraumatic nail avulsion using 40 % urea ointment followed by antifungal nail lacquer with ciclopirox olamine or amorolfine.

Glide-plane symmetry and superconducting gap structure of iron-based superconductors.

We consider the effect of glide-plane symmetry of the Fe-pnictogen/chalcogen layer in Fe-based superconductors on pairing in spin fluctuation models. Recent theories have proposed that so-called η-pairing states with nonzero total momentum can be realized and possess exotic properties such as odd parity spin singlet symmetry and time-reversal symmetry breaking. Here we show that η pairing is inevitable when there is orbital weight at the Fermi level from orbitals with even and odd mirror reflection symmetry in z; however, by explicit calculation, we conclude that the gap function that appears in observable quantities is identical to that found in earlier, 1 Fe per unit cell pseudocrystal momentum calculations.

High-definition optical coherence tomography and reflectance confocal microscopy in the in vivo visualization of a reaction to permanent make-up.

BACKGROUND AND OBJECTIVES: After permanent make-up treatments, eczematous and granulomatous reactions may occur which need anti-inflammatory treatment. For the definite diagnosis oftentimes biopsies are recommended. In vivo imaging such as reflectance confocal microscopy (RCM) and high-definition optical coherence tomography (HD-OCT) has been successfully used in the non-invasive diagnosis of various dermatoses before. METHODS: Here, we report on non-invasive imaging of a reaction towards permanent make-up in a 40-year-old woman by using HD-OCT and RCM. RESULTS: Both in HD-OCT and in RCM subepidermal pigment and granulomatous changes could be visualized and correlated with the histopathological findings. Regression of the lesions in response to topical steroids and intralesional injections of steroids and 5-fluorouracil is reported and treatment options are discussed. CONCLUSION: Non-invasive imaging techniques such as HD-OCT and RCM allow the visualization and localization of exogenous pigment and help in the evaluation of adverse reactions due to permanent make-up tattooing.

A multicentre pilot study investigating high-definition optical coherence tomography in the differentiation of cutaneous melanoma and melanocytic naevi.

BACKGROUND: High-definition optical coherence tomography scanners have recently been developed. OBJECTIVES: To assess the diagnostic performance of HD-OCT in the differentiation of benign melanocytic skin lesions (MSL) and cutaneous melanoma (CM). METHODS: Patients with MSL were assessed by HD-OCT. All diagnoses were histopathologically confirmed. One blinded observer evaluated both slice and en-face HD-OCT images and diagnosed MLS on the basis of an algorithm adopted from reflectance confocal microscopy, recent HD-OCT reports, and conventional OCT. RESULTS: A total of 93 MSL were studied comprising 66 benign MSL and 27 CM. The sensitivity of HD-OCT was 74.1% [95% confidence interval (CI) 53.7-88.8%)], specificity was 92.4% (95% CI 83.2-97.5%). The positive predictive value was 80%, the negative predictive value 89.7%. The performance of HD-OCT depended on tumour thickness and the presence of borderline lesions indicated by high false negative rates in very thin melanomas and high false positive rates in dysplastic naevi. CONCLUSIONS: In the distinction of MSL, HD-OCT applied in an investigator blinded fashion has a moderate diagnostic performance. The diagnostic performance of HD-OCT of MSL should be reassessed in other clinical settings.

Accuracy of a smartphone application using fractal image analysis of pigmented moles compared to clinical diagnosis and histological result.

BACKGROUND: Lately, various smartphone applications have been introduced as diagnostic self-monitoring tools in the evaluation of pigmented moles, but most of these techniques have not been evaluated systematically. OBJECTIVES: The purpose of this study was to evaluate prospectively the sensitivity and specificity of a recently developed smartphone application using fractal image analysis for the risk evaluation algorithm in the diagnosis of malignant melanoma compared to clinical diagnosis and histopathological result. METHODS: Consecutive patients with melanocytic lesions were recruited and clinical and dermoscopical diagnosis was documented by two dermatologists independently. Imaging and analysis with the smartphone application was performed prior to excision of lesions. The findings were compared to the histological results as gold standard. RESULTS: Of 195 included lesions histopathological analysis revealed 40 melanomas, 42 dysplastic nevi and 113 benign nevi. The sensitivity of the diagnosis melanoma by fractal image analysis using smartphone images was 73%, the specificity was 83% compared to a sensitivity of 88% and specificity of 97% regarding the clinical diagnosis by the dermatologists. CONCLUSION: The smartphone application using fractal analysis might be a promising tool in the pre-evaluation of pigmented moles by laypersons, while it is to date inferior to the diagnostic evaluation by a dermatologist.

Narrow-line magneto-optical trap for dysprosium atoms.

We present our technique to create a magneto-optical trap (MOT) for dysprosium atoms using the narrow-line cooling transition at 626 nm to achieve suitable conditions for direct loading into an optical dipole trap. The MOT is loaded from an atomic beam via a Zeeman slower using the strongest atomic transition at 421 nm. With this combination of two cooling transitions we can trap up to 2.0·10(8) atoms at temperatures down to 6 µK. This cooling approach is simpler than present work with ultracold dysprosium and provides similar starting conditions for a transfer to an optical dipole trap.

Ex vivo high-definition optical coherence tomography of basal cell carcinoma compared to frozen-section histology in micrographic surgery: a pilot study.

BACKGROUND: Micrographic surgery is an established, but time-consuming operating procedure for facial basal cell carcinoma (BCC). A new high-definition (HD) optical coherence tomography (OCT) with high lateral and axial resolution in a horizontal (en-face) and vertical (slice) imaging mode allows a fast and non-invasive in vivo examination of BCC. OBJECTIVES: To compare the diagnosis of BCC in excised tissue ex vivo by high-definition optical coherence tomography (HD-OCT) with the findings of frozen-section histology in micrographic surgery. METHODS: Twenty freshly excised BCC were examined by HD-OCT in the en-face and slice imaging mode divided into four sections each in concordance with the four excision margins of histography, and subsequently processed for conventional micrographic evaluation. RESULTS: A total of 80 HD-OCT images of 20 BCCs were evaluated and in 45% (9/20) HD-OCT correlated perfectly with the histography results. The sensitivity and specificity for the 80 evaluated HD-OCT images were 74% and 64% respectively. CONCLUSIONS: High-definition optical coherence tomography allows the postoperative identification of BCC in excised tissue ex vivo, but has still limitations in the recognition of tumour margins in comparison with the micrographic evaluation of frozen sections.

[Trichophyton thuringiense H.A. Koch 1969. A rare geophilic dermatophyte--now isolated for the first time from man]. / Trichophyton thuringiense H.A. Koch 1969. Ein seltener geophiler Dermatophyt, erstmals vom Menschen isoliert.

BACKGROUND: In 1969, Kolipp and Hoffmann isolated Trichophyton (T.) thuringiense spec. nov. Koch when they performed their thesis dealing with the distribution and epidemiology of dermatophytes and keratinophilic fungi in mice and other small mammals. At that time, T. thuringiense was detected as saprophytic fungus of the skin of different mice species (e.g. Mus musculus) both in rural and urban settings in the area of Thuringia in Germany. There were no further reports on this dermatophyte species until now, neither in animals, nor in man. PATIENT, METHODS AND RESULTS: Currently, we were able to isolate this geophilic fungus for the first time from a human being. A 58 year old patient baker by trade and living in a rural setting (village) suffered from nail changes like hyperkeratosis and thickening of the nail plate of his big toe. From his nail samples grew a dermatophyte with peripheral radiating and flat colonies which were a bit cottony in the centre. On Sabouraud's 4 % dextrose agar the thallus of the fungus was white to purple stained, the reverse side showed a dark red to brown color. In a typical manner, macroconidia were cylindrical to clavate, microconidia obovoidal to short-clavate with broad base. The species identification of T. thuringiense was done and confirmed by sequence analysis of the internal transcribed spacer (ITS) region of the ribosomal DNA. Antifungal treatment has been refused from the patient. CONCLUSION: In conclusion, this is the second description of the geophilic dermatophyte T. thuringiense, which could be isolated for the first time from a human being, in particular from nail sample of the big toe under the suspicion of onychomycosis. However, it is still uncertain if this fungus should be considered either as secondary colonization of the nail plate, or as causative agent of tinea unguium or onychomycosis.

Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial.

BACKGROUND: Clinical trials have shown reduced incisional hernia rates 1 year after elective median laparotomy closure using a short-stitch technique. With hernia development continuing beyond the first postoperative year, we aimed to compare incisional hernias 3 years after midline closure using short or long stitches in patients from the ESTOIH trial. METHODS: The ESTOIH trial was a prospective, multicenter, parallel-group, double-blind, randomized-controlled study of primary elective midline closure. Patients were randomized to fascia closure using a short- or long-stitch technique with a poly-4-hydroxybutyrate-based suture. A predefined 3-year follow-up analysis was performed with the radiological imaging-verified incisional hernia rate as the primary endpoint. RESULTS: The 3-year intention-to-treat follow-up cohort consisted of 414 patients (210 short-stitch and 204 long-stitch technique) for analysis. Compared with 1 year postoperatively, incisional hernias increased from 4.83% (20/414 patients) to 9.02% (36/399 patients, p = 0.0183). The difference between the treatment groups at 3 years (short vs. long stitches, 15/198 patients (7.58%) vs. 21/201 (10.45%)) was not significant (OR, 1.4233; 95% CI [0.7112-2.8485]; p = 0.31). CONCLUSION: Hernia rates increased significantly between one and 3 years postoperatively. The short-stitch technique using a poly-4-hydroxybutyrate-based suture is safe in the long term, while no significant advantage was found at 3 years postoperatively compared with the standard long-stitch technique. TRIAL REGISTRY: NCT01965249, registered on 18 October 2013.

Spectroscopy of a narrow-line optical pumping transition in atomic dysprosium.

We present measurements of the hyperfine coefficients and isotope shifts of the Dy I 683.731 nm transition, using saturated absorption spectroscopy on an atomic beam. A King Plot is drawn resulting in an updated value for the specific mass shift δν(684,sms)(164-162)=-534±17 MHz. Using fluorescence spectroscopy, we measure the excited state lifetime τ684=1.68(5) µs, yielding a linewidth of γ684=95±3 kHz. We give an upper limit to the branching ratio between the two decay channels from the excited state showing that this transition is usable for optical pumping into a dark state and demagnetization cooling.

Actinic keratosis in the en-face and slice imaging mode of high-definition optical coherence tomography and comparison with histology.

BACKGROUND: Optical coherence tomography (OCT) allows real-time, in vivo examination of nonmelanoma skin cancer. An innovative high-definition (HD)-OCT with a horizontal (en-face) and vertical (slice) imaging mode offers additional information in the diagnosis of actinic keratosis (AK) and may potentially replace invasive diagnostic biopsies. OBJECTIVES: To define the characteristic morphological features of AK by using HD-OCT in the two imaging modes compared with histopathology as gold standard. METHODS: In total, 20 AKs were examined by HD-OCT in the en-face and slice imaging modes and characteristic features were described and evaluated in comparison with the histopathological findings. Furthermore, the HD-OCT images of a subgroup of AKs were compared with those of the clinically normal adjacent skin. RESULTS: The preoperative in vivo diagnostics showed the following features in the en-face imaging mode of HD-OCT: disruption of stratum corneum, architectural disarray, cellular/nuclear polymorphism in the stratum granulosum/stratum spinosum, and bright irregular bundles in the superficial dermis. In the vertical slice imaging mode the following characteristics were found: irregular entrance signal, destruction of layering, white streaks and dots, and grey areas. In contrast, the clinically healthy adjacent skin showed mainly a regular epidermal 'honeycomb' pattern in the en-face mode and distinct layering of the skin in the slice mode. CONCLUSIONS: HD-OCT with both the en-face and slice imaging modes offers additional information in the diagnosis of AK compared with conventional OCT and might enhance the possibility of the noninvasive diagnosis of AK prior to treatment procedures and possibly in the monitoring of noninvasive treatment strategies.

Cytodiagnosis of erosive melanoma and basal cell carcinoma of the skin using cutaneous tissue smear.

BACKGROUND: Cytomorphological assessment of erosive skin tumours offers a rapid and minimally invasive way to obtain a diagnosis. However, the studies so far conducted on this method have been relatively small. AIM: To conduct a large retrospective study on cytomorphological assessment of erosive skin tumours. METHODS: In this study, 86 cytological smears prepared from erosive cutaneous tumours clinically suspicious for melanoma were examined to test the diagnostic accuracy and practicability of cytomorphological evaluation of such tumours, and to compare the assessments of two investigators with different experience levels. In a subgroup of tumours, cytological assessment was compared with dermoscopic evaluation. RESULTS: There was agreement in the cytological and histopathological results for 68 of 86 cases (79%) assessed by the experienced investigator and in 64 of 86 cases (74%) assessed by the inexperienced investigator. The diagnosis was confirmed cytologically in 39 and 34 of 42 melanomas, and in 28 and 27 of 35 basal cell carcinomas, respectively. The sensitivity of the cytodiagnosis was not significantly different between the two investigators. The dermoscopic evaluation showed good agreement with the cytological results for melanoma (82.4%), although use of dermoscopy was only possible for 49.9% of the lesions because of difficulties with the samples. CONCLUSIONS: Cytological assessment of erosive melanoma and BCC lesions is a useful tool for gaining additional information on clinically uncertain skin tumours, and shows good agreement between different investigators.

Reflectance confocal microscopy in the diagnosis of partially and completely amelanotic melanoma: report on seven cases.

BACKGROUND: The clinical diagnosis of amelanotic melanoma is often challenging, because the classical clinical and dermoscopic features of pigmented melanoma are usually missing. The reflectance confocal microscopy (RCM) offers an additional possibility of an in vivo diagnosis of both pigmented and amelanotic melanoma lesions. OBJECTIVES: To test the value of RCM in vivo in the preoperative prediction of melanoma lesions lacking significant pigment and to compare the results with the evaluation by dermoscopy and histopathology. METHODS: We examined seven patients with the clinically uncertain differential diagnosis of partially or completely amelanotic melanoma by RCM and dermoscopy prior to surgical excision of the lesions according to the previously suggested dermoscopy algorithm and RCM score for melanoma. The following RCM features were evaluated: major criteria scored +2 (non-edged papillae, cytological atypia at the dermo-epidermal junction) and minor criteria +1 (roundish pagetoid cells, widespread pagetoid infiltration, nucleated cells within dermal papillae, cerebriform cell clusters). The dermoscopic evaluation included the following criteria: polymorphous vessels, dotted and linear irregular vessels, hairpin vessels, pink-erythematous colour, milky red areas, irregularly shaped depigmentation, blue-grey dots and subtle pigmentation. RESULTS: The preoperative in vivo RCM analysis revealed common features of melanoma also found in pigmented melanoma lesions. All lesions showed a score above three in the applied RCM algorithm which was proposed earlier as the threshold for malignancy. In dermoscopy, five of seven lesions showed characteristic vascular changes. CONCLUSION: In vivo RCM is a valuable tool in the preoperative diagnosis of partially and completely amelanotic tumours suspicious for melanoma in addition to dermoscopic evaluation.

Morphology of basal cell carcinoma in high definition optical coherence tomography: en-face and slice imaging mode, and comparison with histology.

BACKGROUND: Optical coherence tomography (OCT) allows real-time, in vivo examination of basal cell carcinoma (BCC). A new high definition OCT with high lateral and axial resolution in a horizontal (en-face) and vertical (slice) imaging mode offers additional information in the diagnosis of BCC and may potentially replace invasive diagnostic biopsies. OBJECTIVES: To define the characteristic morphologic features of BCC by using high definition optical coherence tomography (HD-OCT) compared to conventional histology. METHODS: A total of 22 BCCs were examined preoperatively by HD-OCT in the en-face and slice imaging mode and characteristic features were evaluated in comparison to the histopathological findings. RESULTS: The following features were found in the en-face mode of HD-OCT: lobulated nodules (20/22), peripheral rimming (17/22), epidermal disarray (21/22), dilated vessels (11/22) and variably refractile stroma (19/22). In the slice imaging mode the following characteristics were found: grey/dark oval structures (18/22), peripheral rimming (13/22), destruction of layering (22/22), dilated vessels (7/22) and peritumoural bright stroma (11/22). In the en-face mode the lobulated structure of the BCC was more distinct than in the slice mode compared to histology. CONCLUSION: HD-OCT with a horizontal and vertical imaging mode offers additional information in the diagnosis of BCC compared to conventional OCT imaging and enhances the feasibility of non-invasive diagnostics of BCC.

[Can nursing staff from abroad meet the growing demand for care? Analysis of labor migration in nursing professions in 2010]. / Sind Pflegekräfte aus dem Ausland ein Lösungsansatz, um den wachsenden Pflegebedarf decken zu können? Analysen zur Arbeitsmigration in Pflegeberufen im Jahr 2010.

Owing to demographic changes, there will probably not be enough nursing staff available in the future to cover the continually increasing demand for long-term care. Among other things, labor migration is seen as a means to meet shortages in care staff. This report analyzes to what extent migrant workers meet the need for nursing staff today, what the structure of their qualifications is, and from which countries they come. The results show that migrant workers in nursing professions mainly come from the eastern EU countries and the former Soviet Union. The percentage of nursing staff with a minimum qualification of 1 year of long-term care training is significantly lower in the group of migrant workers than in the group of nonmigrant workers. Given the decline of new migrant workers in nursing professions in the past decade, labor migration contributes only to a small extent toward closing this gap in the long term. In view of the increase in training rates and labor participation, it is to be regarded rather as a temporary solution.

Neoadjuvant bevacizumab persistently inactivates VEGF at the time of surgery despite preoperative cessation.

BACKGROUND: When anti-VEGF (vascular endothelial growth factor) antibody bevacizumab is applied in neoadjuvant treatment of colorectal cancer patients with liver metastasis, 5-6 weeks between last bevacizumab dose and liver resection are currently recommended to avoid complications in wound and liver regeneration. In this context, we aimed to determine whether VEGF is inactivated by bevacizumab at the time of surgery. METHODS: Fifty colorectal cancer patients with liver metastases received neoadjuvant chemotherapy ± bevacizumab supplementation. The last dose of bevacizumab was administered 6 weeks before surgery. Plasma, subcutaneous and intraabdominal wound fluid were analysed for VEGF content before and after liver resection (day 1-3). Immunoprecipitation was applied to determine the amount of bevacizumab-bound VEGF. RESULTS: Bevacizumab-treated individuals showed no increase in perioperative complications. During the entire monitoring period, plasma VEGF was inactivated by bevacizumab. In wound fluid, VEGF was also completely bound by bevacizumab and was remarkably low compared with the control chemotherapy group. CONCLUSION: These data document that following a cessation time of 6 weeks, bevacizumab is fully active and blocks circulating and local VEGF at the time of liver resection. However, despite effective VEGF inactivation no increase in perioperative morbidity is recorded suggesting that VEGF activity is not essential in the immediate postoperative recovery period.

Noninvasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy.

BACKGROUND: In many Demodex-associated skin diseases Demodex mites are present in abundance and seem to be at least partially pathogenic. So far all diagnostic approaches such as scraping or standardized superficial skin biopsy are (semi-)invasive and may cause discomfort to the patient. OBJECTIVES: To see whether confocal laser scanning microscopy (CLSM) - a noninvasive method for the visualization of superficial skin layers - is able to detect and quantify D. folliculorum in facial skin of patients with rosacea. METHODS: Twenty-five patients (34-72 years of age) with facial rosacea and 25 age- and sex-matched normal controls were examined by CLSM. Mosaics of 8 × 8 mm and 5 × 5 mm were created by scanning horizontal layers of lesional skin and quantification of mites per follicle and per area as well as follicles per area was performed. RESULTS: In all patients D. folliculorum could be detected by CLSM and presented as roundish or lengthy cone-shaped structures. CLSM allowed the quantification of Demodex mites and revealed significant differences (P < 0·0001): the mean number of mites was 165·4 per 8 × 8 mm area and 94·2 per 5 × 5 mm area in the patients compared with 34·7 and 22·4, respectively, in the controls. The corresponding mean number of mites per follicle was 0·7 and 0·8, respectively, in the patients and 0·1 and 0·2, respectively, in the controls. CONCLUSIONS: With the help of CLSM it is possible to detect, image and quantify Demodex mites noninvasively in facial skin of patients with rosacea.

High-definition optical coherence tomography for the in vivo detection of demodex mites.

BACKGROUND: Demodex mites are involved in different skin diseases and are commonly detected by skin scrape tests or superficial biopsies. A new high-definition optical coherence tomography (HD-OCT) with high lateral and axial resolution in a horizontal (en-face) and vertical (slice) imaging mode might offer the possibility of noninvasive and fast in vivo examination of demodex mites. METHODS: Twenty patients with demodex-related skin diseases and 20 age- and gender-matched healthy controls were examined by HD-OCT. Mites per follicle and follicles per field of view were counted and compared to skin scrape tests. RESULTS: HD-OCT images depicted mites in the en-face mode as bright round dots in groups of 3-5 mites per hair follicle. In the patients with demodex-related disease, a mean number of 3.4 mites per follicle were detected with a mean number of 2.9 infested follicles per area of view compared to a mean of 0.6 mites in 0.4 infested follicles in the controls. The skin scrape tests were negative in 21% of the patients. CONCLUSION: The innovative HD-OCT enables fast and noninvasive in vivo recognition of demodex mites and might become a useful tool in the diagnosis and treatment monitoring of demodex-related skin diseases.