[SENDS criteria from the diversification of MAST procedures. Implementation of preoperative simulation]. / SENDS-Kriterien als Entwicklungstheorem der MAST­Prozeduren. Einführung präoperativer Simulation.

CLINICAL ISSUE: Minimal access spinal technologies (MAST) lead to a diversification of surgical procedures, which requires careful selection of the procedure and outcome monitoring. For a rational selection of the procedure simulation, endoscopy, navigation, decompression and stabilization (SENDS) criteria can be derived from the development of the MAST procedures. Preoperative simulation has diagnostic and therapeutic values. The SENDS criteria can be verified indirectly via outcome control. STANDARD TREATMENT: Biomechanically meaningful diagnostic x-rays of the spinal segment to be surgically treated are currently carried out with the patient in inclination and reclination. TREATMENT INNOVATIONS: Software-related preoperative simulation based on these x-ray images facilitates the selection and implementation of the MAST procedure. DIAGNOSTIC WORK-UP: For preoperative simulation motion shots are needed in inclination, neutral position and reclination and the dimensions can be obtained using an x-ray ball or a computed tomography (CT) scan. PERFORMANCE: The SENDS criteria are useful because established procedures based on these criteria reach a comparable outcome. Preoperative simulation appears to be a useful selection criterion. ACHIEVEMENTS: Preoperatively it is necessary to collate patient and segment information in order to provide each patient with individualized treatment. So far there is no evidence for a better outcome after preoperative simulation but a reduction of surgery time and intraoperative radiation exposure could already be demonstrated. PRACTICAL RECOMMENDATIONS: Minimally invasive methods should be preferred if there is a comparable outcome. The establishment of new procedures has to be accompanied by the maintenance of a spine register. Minimally invasive surgical procedures should be individualized for each patient and segment. Mobility X-ray images should be prepared for use with the preoperative simulation as the information content significantly increases with respect to the MAST procedure.

[Non-dislocated osteoporotic insufficiency fracture of the medial femoral neck. SPECT/CT makes the diagnostic difference]. / Undislozierte osteoporotische Insuffizienzfraktur des medialen Schenkelhalses. SPECT/CT macht den diagnostischen Unterschied.

Osteoporotic fragility fractures of the femoral neck are the most common type of fractures in the elderly and are associated with a high mortality. Most frequently these fractures are due to falls but spontaneous onset has also been described. In these patients the insufficient quantity and quality of the osteoporotic bone finally leads to the development of a fragility or insufficiency fracture. In some cases of nondisplaced insufficiency fractures the diagnosis cannot be established by conventional radiographs alone and magnetic resonance imaging (MRI), single proton emission computed tomography (SPECT) or SPECT/CT are considered as diagnostic adjuncts. We report the case of an 83-year-old patient who had complained of ongoing weight-bearing pelvic pain for over 6 months. There was no history of trauma. The clinical conventional radiographs as well as CT could not elucidate the cause of the problems. To differentiate between lumbal and hip pain a SPECT/CT was performed and the diagnosis of a medial femoral neck insufficiency fracture was established. In the delayed phase a band-like increased tracer uptake within the medial femoral neck was observed. The SPECT/CT procedure is a promising diagnostic alternative for geriatric patients and can be particularly recommended in cases of persistent unclear pelvic or lumbar spine pain in the elderly.

Edge Enhancement Optimization in Flexible Endoscopic Images to the Perception of Ear, Nose and Throat Professionals.

OBJECTIVES: Digital endoscopes are connected to a video processor that applies various operations to process the image. One of those operations is edge enhancement that sharpens the image. The purpose of this study was to (1) quantify the level of edge enhancement, (2) measure the effect on sharpness and image noise, and (3) study the influence of edge enhancement on image quality perceived by ENT professionals. METHODS: Three digital flexible endoscopic systems were included. The level of edge enhancement and the influence on sharpness and noise were measured in vitro, while systematically varying the levels of edge enhancement. In vivo images were captured at identical levels of one healthy larynx. Each series of in vivo images was presented to 39 ENT professionals according to a forced pairwise comparison test, to select the image with the best image quality for diagnostic purposes. The numbers of votes were converted to a psychometric scale of just noticeable differences (JND) according to the Thurstone V model. RESULTS: The maximum level of edge enhancement varied per endoscopic system and ranged from 0.8 to 1.2. Edge enhancement increased sharpness and noise. Images with edge enhancement were unanimously preferred to images without edge enhancement. The quality difference with respect to zero edge enhancement reaches an optimum at levels between 0.7 and 0.9. CONCLUSION: Edge enhancement has a major impact on sharpness, noise, and the resulting perceived image quality. We conclude that ENT professionals benefit from this video processing and should verify if their equipment is optimally configured. LEVEL OF EVIDENCE: NA Laryngoscope, 134:842-847, 2024.

Minimizing light exposure with the programmable array microscope.

The exposure of fluorophores to intense illumination in a microscope often results in photobleaching and phototoxicity, thus constituting a major limiting factor in time lapse live cell or single molecule imaging. Laser scanning confocal microscopes are particularly prone to this problem, inasmuch as they require high irradiances to compensate for the inherently low duty cycle of point scanning systems. In the attempt to maintain adequate speed and signal-to-noise ratios, the fluorophores are often driven into saturation, thereby generating a nonlinear response. One approach for reducing photodegradation in the laser scanning confocal microscope is represented by controlled light exposure microscopy, introduced by Manders and colleagues. The strategy is to reduce the illumination intensity in both background areas (devoid of information) as well as in bright foreground regions, for which an adequate signal-to-noise ratio can be achieved with lower excitation levels than those required for the less intense foreground pixels/voxels. Such a variable illumination scheme can also be exploited in widefield microscopes that employ lower irradiance but higher illumination duty cycles. We report here on the adaptation of the controlled light exposure microscopy principle to the programmable array microscope, which achieves optical sectioning by use of a spatial light modulator (SLM) in an image plane as a programmable mask for illumination and conjugate (and nonconjugate) detection. By incorporating the basic controlled light exposure microscopy concept for minimizing exposure, we have obtained a reduction in the rate of photobleaching of up to ~5-fold, while maintaining an image quality comparable to regular imaging with the programmable array microscope.

A toolkit for the characterization of CCD cameras for transmission electron microscopy.

Charge-coupled devices (CCD) are nowadays commonly utilized in transmission electron microscopy (TEM) for applications in life sciences. Direct access to digitized images has revolutionized the use of electron microscopy, sparking developments such as automated collection of tomographic data, focal series, random conical tilt pairs and ultralarge single-particle data sets. Nevertheless, for ultrahigh-resolution work photographic plates are often still preferred. In the ideal case, the quality of the recorded image of a vitrified biological sample would solely be determined by the counting statistics of the limited electron dose the sample can withstand before beam-induced alterations dominate. Unfortunately, the image is degraded by the non-ideal point-spread function of the detector, as a result of a scintillator coupled by fibre optics to a CCD, and the addition of several inherent noise components. Different detector manufacturers provide different types of figures of merit when advertising the quality of their detector. It is hard for most laboratories to verify whether all of the anticipated specifications are met. In this report, a set of algorithms is presented to characterize on-axis slow-scan large-area CCD-based TEM detectors. These tools have been added to a publicly available image-processing toolbox for MATLAB. Three in-house CCD cameras were carefully characterized, yielding, among others, statistics for hot and bad pixels, the modulation transfer function, the conversion factor, the effective gain and the detective quantum efficiency. These statistics will aid data-collection strategy programs and provide prior information for quantitative imaging. The relative performance of the characterized detectors is discussed and a comparison is made with similar detectors that are used in the field of X-ray crystallography.

Antibody-independent complement activation by myelin via the classical complement pathway.

Murine or rabbit whole brain homogenates were shown to activate human complement via the classical pathway by an antibody-independent reaction. This activity required Ca++ ions. Anticomplementary activity in fractionated murine brain was found to reside in the myelin fraction and in purified myelin. It was absent, however, both from highly purified myelin basic protein (MBP) and from the MBP-free residue. Because purified MBP is a monomer and this protein exists in brain tissue largely as a dimer, the ability of the cross-linked form of MBP to activate complement was investigated. MBP, dimerized with difluorodinitrobenzene, was highly anticomplementary. The murine brain, inactive when taken from the newborn mouse, was shown to first acquire the capacity to activate complement at 7 d after birth. This finding is consistent with the report that the synthesis of myelin protein has been shown to be initiated in murine brain 8 d after birth. Complement activation by MBP could play an important role in the pathological changes observed in neurological disorders.

DNA deformations near charged surfaces: electron and atomic force microscopy views.

DNA is a very important cell structural element, which determines the level of expression of genes by virtue of its interaction with regulatory proteins. We use electron (EM) and atomic force microscopy (AFM) to characterize the flexibility of double-stranded DNA ( approximately 150-950 nm long) close to a charged surface. Automated procedures for the extraction of DNA contours ( approximately 10-120 nm for EM data and approximately 10-300 nm for AFM data) combined with new statistical chain descriptors indicate a uniquely two-dimensional equilibration of the molecules on the substrate surface regardless of the procedure of molecule mounting. However, in contrast to AFM, the EM mounting leads to a noticeable decrease in DNA persistence length together with decreased kurtosis. Analysis of local bending on short length scales (down to 6 nm in the EM study) shows that DNA flexibility behaves as predicted by the wormlike chain model. We therefore argue that adhesion of DNA to a charged surface may lead to additional static bending (kinking) of approximately 5 degrees per dinucleotide step without impairing the dynamic behavior of the DNA backbone. Implications of this finding are discussed.

A hybrid total internal reflection fluorescence and optical tweezers microscope to study cell adhesion and membrane protein dynamics of single living cells.

The dynamics of cell surface membrane proteins plays an important role in cell-cell interactions. The onset of the interaction is typically not precisely controlled by current techniques, making especially difficult the visualization of early-stage dynamics. We have developed a novel method where optical tweezers are used to trap cells and precisely control in space and time the initiation of interactions between a cell and a functionalized surface. This approach is combined with total internal reflection fluorescence microscopy to monitor dynamics of membrane bound proteins. We demonstrate an accuracy of approximately 2 s in determining the onset of the interaction. Furthermore, we developed a data analysis method to determine the dynamics of cell adhesion and the organization of membrane molecules at the contact area. We demonstrate and validate this approach by studying the dynamics of the green fluorescent protein tagged membrane protein activated leukocyte cell adhesion molecule expressed in K562 cells upon interaction with its ligand CD6 immobilized on a coated substrate. The measured cell spreading is in excellent agreement with existing theoretical models. Active redistribution of activated leukocyte cell adhesion molecule is observed from a clustered to a more homogenous distribution upon contact initiation. This redistribution follows exponential decay behaviour with a characteristic time of 35 s.

Wide-gamut lasing from a single organic chromophore.

The development of wideband lasing media has deep implications for imaging, sensing, and display technologies. We show that a single chromophore can be engineered to feature wide-gamut fluorescence and lasing throughout the entire visible spectrum and beyond. This exceptional color tuning demonstrates a chemically controlled paradigm for light emission applications with precise color management. Achieving such extensive color control requires a molecular blueprint that yields a high quantum efficiency and a high solubility in a wide variety of liquids and solids while featuring a heterocyclic structure with good steric access to the lone pair electrons. With these requirements in mind, we designed a lasing chromophore that encloses a lasing color space twice as large as the sRGB benchmark. This record degree of color tuning can in principle be adapted to the solid state by incorporating the chromophore into polymer films. By appropriately engineering the base molecular structure, the widest range of lasing wavelengths observed for a conventional gain medium can be achieved, in turn establishing a possible route toward high-efficiency light emitters and lasers with near-perfect chromaticity.

Optimizing experimental parameters for the projection requirement in HAADF-STEM tomography.

Tomographic reconstruction algorithms offer a means by which a tilt-series of transmission images can be combined to yield a three dimensional model of the specimen. Conventional reconstruction algorithms assume that the measured signal is a linear projection of some property, typically the density, of the material. Here we report the use of multislice simulations to investigate the extent to which this assumption is met in HAADF-STEM imaging. The use of simulations allows for a systematic survey of a range of materials and microscope parameters to inform optimal experimental design. Using this approach it is demonstrated that the imaging of amorphous materials is in good agreement with the projection assumption in most cases. Images of crystalline specimens taken along zone-axes are found to be poorly suited for conventional linear reconstruction algorithms due to channelling effects which produce enhanced intensities compared with off-axis images, and poor compliance with the projection requirement. Off-axis images are found to be suitable for reconstruction, though they do not strictly meet the linearity requirement in most cases. It is demonstrated that microscope parameters can be selected to yield improved compliance with the projection requirement.

A Lewis acid ß-diiminato-zinc-complex as all-rounder for co- and terpolymerisation of various epoxides with carbon dioxide.

A ß-diiminato-zinc-N(SiMe3)2 complex (1) was synthesised and fully characterised, including an X-ray diffraction study. The activity of catalyst 1 towards the coupling reaction of CO2 and various epoxides, including propylene oxide (PO), cyclohexene oxide (CHO), styrene oxide (SO), limonene oxide (LO), octene oxide (OO) and epichlorohydrin (ECH), was investigated. Terpolymerisation of CO2, PO and LO, as well as CO2, CHO and PO, was successfully realised, resulting in polymers with adjustable glass transition temperatures and transparencies. Reaction conditions such as temperature, pressure and catalyst concentration were varied to find the optimal reaction values, especially regarding LO/CO2. In situ IR experiments hinted that at 60 °C and a critical LO concentration, polymerisation and depolymerisation are in an equilibrium (ceiling effect). Pressurising catalyst 1 with carbon dioxide resulted in a dimeric catalyst (2) with a OSiMe3 group as a new initiator. Homopolymerisation of different epoxides was carried out in order to explain the reactivity concerning copolymerisation reaction of CO2 and epoxides.

CO2 to methanol conversion using hydride terminated porous silicon nanoparticles.

Porous silicon nanoparticles (Si-NPs) prepared via magnesiothermic reduction were used to convert carbon dioxide (CO2) into methanol. The hydride surface of the silicon nanoparticles acted as a CO2 reducing reagent without any catalyst at temperatures above 100 °C. The Si nanoparticles were reused up to four times without significant loss in methanol yields. The reduction process was monitored using in situ FT-IR and the materials were characterized using SEM, TEM, NMR, XPS, and powder XRD techniques. The influence of reaction temperature, pressure, and Si-NP concentration on CO2 reduction were also investigated. Finally, Si particles produced directly from sand were used to convert CO2 to methanol.

Diaryliodonium salts as hydrosilylation initiators for the surface functionalization of silicon nanomaterials and their collaborative effect as ring opening polymerization initiators.

Diaryliodonium salts were found to initiate hydrosilylation reactions on the surface of silicon nanosheets as well as silicon nanocrystals of different sizes. A variety of different functional substrates can be used to stabilize the surface of the photoluminescent materials. Additionally, the combination of hydride terminated silicon nanomaterials with diaryliodonium salts was found to initiate cationic ring opening polymerization, demonstrating the potential of silicon based nanomaterials as coinitiators and enabling a mild, straightforward reaction method.

Tilt series STEM simulation of a 25×25×25nm semiconductor with characteristic X-ray emission.

The detection and quantification of fabrication defects is vital to the ongoing miniaturization of integrated circuits. The atomic resolution of HAADF-STEM combined with the chemical sensitivity of EDS could provide the means by which this is achieved for the next generation of semiconductor devices. To realize this, however, a streamlined acquisition and analysis procedure must first be developed. Here, we report the simulation of a HAADF-STEM and EDS tilt-series dataset of a PMOS finFET device which will be used as a testbed for such a development. The methods used to calculate the data and the details of the specimen model are fully described here. The dataset consists of 179 projections in 2° increments with HAADF images and characteristic X-ray maps for each projection. This unusually large calculation has been made possible through the use of a national supercomputer and will be made available for the development and assessment of reconstruction and analysis procedures for this highly significant industrial application.

[Is the Canadian CT head rule for minor head injury applicable for patients in Germany?]. / Lässt sich die Canadian CT Head Rule für das leichte Schädel-Hirn-Trauma auf Deutschland übertragen?

PURPOSE: To evaluate the applicability of the Canadian CT Head Rule (CCHR) on head trauma patients in a German university hospital. METHODS: 122 patients (m = 74; f = 48; 40 +/- 19 years) were examined with cranial CT due to minor head trauma. The need for cranial CT according to the CCHR was evaluated retrospectively. RESULTS: With a sensitivity of 98.9 % and a specificity of 46.6 % all patients with the need for neurosurgical intervention were detected by applying the major criteria of the CCHR. Also, every patient with severe brain injury was detected by the extended criteria with a sensitivity of 99.6 % and a specificity of 34.1 %. This would have led to a reduction in the rate of cranial CT examinations by 45.1 % for the major and 22.1 % for the extended criteria. No patient with severe brain injury would have been missed by application of the criteria. CONCLUSION: The Canadian CT Head Rule for patients with minor head trauma is applicable with a very high sensitivity and the potential of significantly reducing the rate of cranial CT examinations in these patients.

Synthesis and characterization of a trinuclear iridium(III) based catalyst for the photocatalytic reduction of CO2.

A trimetallic Ir(iii) based complex () was synthesized and fully characterized by spectroscopic and electrochemical methods. A detailed comparison to its mono- () and bimetallic () analogue regarding the photocatalytic reduction of CO2 is outlined. In particular, the effect of intramolecular quenching, provided by ethyl tethers, was investigated. Moreover, the relationship between the photophysical properties, the lifetime of the excited state, the quenching efficiency and the catalytic performance is presented. Notably, the covalent linkage of the Ir(iii) moieties within the three-armed ligand structure (complex ) leads to a twofold increase of the turn over number (TON) compared to its monometallic analogue . Taking in account the quantum efficiency of 10% and the TONCO = 60 (per Ir(iii) center), complex is a highly active Ir(iii) based photocatalyst.

Dinuclear zinc catalysts with unprecedented activities for the copolymerization of cyclohexene oxide and CO2.

A variety of new dinuclear zinc catalysts was developed and tested for the copolymerization of cyclohexene oxide and carbon dioxide. Electron-withdrawing groups thereby led to unprecedented activities with turnover frequencies up to 155,000 h(-1). These are by far the highest polymerization rates ever reported for the copolymerization of cyclohexene oxide and CO2.

Alignment of the cell nucleus from labeled proteins only for 4D in vivo imaging.

Studies of protein dynamics by 4D (3D + time) confocal microscopy in vivo are hampered by global cell motion. The time between the acquisitions of the 3D images is in the order of minutes. Therefore, it is not to be expected that the cell as a whole remains fixed in the water basin on the stage. This superimposes a motion on the protein dynamics that has to be removed. We present a robust registration technique to align the cell images that does not require the a priori establishment of point-to-point correspondences. Instead, it uses the distribution of the labeled proteins. After correction for the translation, the 3D rotation of the cell is estimated. A robust intrinsic body coordinate system is constructed via the inertia tensor from the intensity distribution. By combining basis transformation to this intrinsic coordinate system, we can calculated the rotation matrix in a conceptual and computational straightforward manner. We have evaluated the performance of this approach in three experiments with human osteaosarcoma cells (U-2 OS), where the nuclear proteins Histon H4 and PML were visualized. The PML is concentrated in several dozen nuclear spots. Expression of Histon H4 results in a total nuclear staining. The registration results for both channels computed independently are very similar. Practically, this means that only the labeled material needs to be observed and still registration of the cell as a whole can be achieved.

Diffusion of microspheres in sealed and open microarrays.

In several experiments, we study the diffusion of microspheres with different radii in microarrays filled with a variety of aqueous solutions of ethylene glycol. We study diffusion in open and closed (sealed) microarrays. In sealed nanoliter wells, the tracers show pure diffusion, whereas in open reactors, a radial outward-directed evaporation-induced liquid flow is superimposed onto the diffusion. In general, one of the following quantities can be calculated if the others are known: the temperature, the viscosity of the medium, the radius of the microbeads, or the diffusion constant. The estimated diffusion constants in closed microarrays are in good agreement with theoretical predictions based on the Brownian motion. We monitor the motion of the microbeads under a microscope and extract their paths in time from the digital recordings. Ambiguous paths due to the crossing of two trajectories can be detected. We show that low microsphere concentrations or high viscosities do not hamper a robust estimation of the diffusion parameters.