One T Gate Makes Distribution Learning Hard.

The task of learning a probability distribution from samples is ubiquitous across the natural sciences. The output distributions of local quantum circuits are of central importance in both quantum advantage proposals and a variety of quantum machine learning algorithms. In this work, we extensively characterize the learnability of output distributions of local quantum circuits. Firstly, we contrast learnability with simulatability by showing that Clifford circuit output distributions are efficiently learnable, while the injection of a single T gate renders the density modeling task hard for any depth d=n^{Ω(1)}. We further show that the task of generative modeling universal quantum circuits at any depth d=n^{Ω(1)} is hard for any learning algorithm, classical or quantum, and that for statistical query algorithms, even depth d=ω[log(n)] Clifford circuits are hard to learn. Our results show that one cannot use the output distributions of local quantum circuits to provide a separation between the power of quantum and classical generative modeling algorithms, and therefore provide evidence against quantum advantages for practically relevant probabilistic modeling tasks.

Antipsychotic drug-induced neutropenia: results from the AMSP drug surveillance program between 1993 and 2016.

Neutropenia and agranulocytosis (N&A) are relatively rare, but potentially fatal adverse drug reactions (ADR). This study presents cases of N&A related to one or more antipsychotic drugs (APDs) in psychiatric inpatients. Data on APD utilization and reports of N&A caused by APDs were analyzed by using data from an observational pharmacovigilance program in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP)-from 1993 to 2016. 333,175 psychiatric inpatients were treated with APDs for schizophrenia and other indications during the observation period. A total of 124 cases of APD-induced N&A were documented, 48 of which fulfilled the criteria for agranulocytosis, corresponding to a rate of 0.37, respectively, 0.14 in 1000 inpatients treated with APDs. Neutropenia was more often detected in women, whereas there was no difference regarding sex in cases of agranulocytosis. Clozapine had the highest relative risk for inducing N&A and was imputed alone as a probable cause of N&A in 60 cases (1.57‰ of all patients exposed). Perazine showed the second highest relative risk with 8 cases and an incidence 0.52‰, followed by quetiapine (15 cases resp. 0.23‰ of all patients exposed) and olanzapine (7 cases; 0.13‰ of all patients exposed). N&A most often occurred during the first 3 months of treatment. Overall N&A are severe and potentially fatal complications that can occur during treatment with APDs. The results from this study largely agree with the currently available literature, highlighting the positive effects of alertness and established appropriate monitoring.

Effects of Acacia mearnsii added to silages differing in nutrient composition and condensed tannins on ruminal and manure-derived methane emissions of dairy cows.

This study investigated the effects of acacia (extract of Acacia mearnsii) and sainfoin (Onobrychis viciifolia) as condensed tannin (CT)-rich sources on ruminal and manure methane (CH4) emissions in comparison with non-CT silages characterized by different contents of the cell wall and water-soluble carbohydrates. In a 3 × 6 incomplete Latin square design, 30 Holstein cows (63 ± 23 d in milk; mean ± SD; 33.8 ± 7.6 kg of milk per day, body weight 642 ± 81 kg) were provided with ad libitum access to 1 of 6 total mixed rations comprising 790 g of silage and 210 g of concentrate per kilogram of dry matter (DM). The silages were either rich in sainfoin [neutral detergent fiber (NDF): 349 g/kg of DM], perennial ryegrass (NDF: 420 g/kg of DM), or red clover (NDF: 357 g/kg of DM). Each silage was supplemented with 20 g/kg (of total diet DM) of acacia or straw meal. Feed intake and milk yield were recorded daily. Milk composition and ruminal fluid characteristics and microbiota were analyzed. The individual ruminal CH4 production was determined using the GreenFeed system, and CH4 emissions from the manure of cows fed the same diets were measured in a parallel experiment over 30 d at 25°C using a dynamic flux chamber. The CT sources did not reduce CH4 yield or emission intensity. Acacia reduced milk production (from 26.3 to 23.2 kg/d) and DM intake (from 19.7 to 16.7 kg/d) when supplemented with ryegrass, and both CT sources reduced the milk protein content and yield. Acacia supplementation and ryegrass silage reduced the ruminal acetate:propionate ratio. Furthermore, during acacia treatment, the abundance of Methanobrevibacter archaea tended to be lower and that of Thermoplasmata was higher. Acacia reduced the CH4 emissions from manure for the ryegrass group by 17% but not for the sainfoin and clover groups. Feeding sainfoin silage resulted in the lowest manure-derived CH4 emissions (-47% compared with ryegrass). In conclusion, acacia reduced ruminal CH4 production by 10%, but not emission intensity, and the mitigation effect of sainfoin depended on the silage to which it was compared. Because mitigation was partially associated with animal productivity losses, careful evaluation is required before the implementation of tanniferous feeds in farm practice.

Incidence of Drug-Induced Delirium During Treatment With Antidepressants or Antipsychotics: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2016.

OBJECTIVES: Successful treatment of delirium depends on the detection of the reversible contributors. Drugs with delirogenic properties are the most prevalent reversible cause of delirium. METHODS: This observational study is based on data from Arzneimittelsicherheit in der Psychiatrie, a multicenter drug surveillance program in German-speaking countries recording severe adverse drug reactions (ADRs) in psychiatric inpatients. The present study analyzes drug-induced delirium (DID) during treatment with antidepressants and antipsychotics. RESULTS: A total of 436 565 psychiatric inpatients were treated with antidepressants and/or antipsychotics during the observation period from 1993 to 2016 in the participating 110 hospitals. Overall, 254 cases (0.06% of all patients treated with antidepressants and/or antipsychotics) of DID were detected. Implicated either in combination or alone (multiple drugs were implicated in 70.1% of DID), clomipramine (0.24%), amitriptyline (0.21%), and clozapine (0.18%) showed the highest incidence rates of DID. When implicated alone (98 cases overall), clozapine (0.11%) followed by amitriptyline (0.05%) were most likely causally associated with the occurrence of DID. Drugs with strong antimuscarinic properties generally exhibited higher risk of DID. CONCLUSIONS: With an incidence rate of <0.1%, the use of antidepressants and antipsychotics was rarely associated with DID within the Arzneimittelsicherheit in der Psychiatrie program. Tricyclic antidepressants and clozapine were the most commonly implicated psychotropic drugs. These data support the specific role of antimuscarinic properties in DID.

Spectroscopic characterization of singlet-triplet doorway states of aluminum monofluoride.

Aluminum monofluoride (AlF) possesses highly favorable properties for laser cooling, both via the A1Π and a3Π states. Determining efficient pathways between the singlet and the triplet manifold of electronic states will be advantageous for future experiments at ultralow temperatures. The lowest rotational levels of the A1Π, v = 6 and b3Σ+, v = 5 states of AlF are nearly iso-energetic and interact via spin-orbit coupling. These levels thus have a strongly mixed spin-character and provide a singlet-triplet doorway. We here present a hyperfine resolved spectroscopic study of the A1Π, v = 6//b3Σ+, v = 5 perturbed system in a jet-cooled, pulsed molecular beam. From a fit to the observed energies of the hyperfine levels, the fine and hyperfine structure parameters of the coupled states and their relative energies as well as the spin-orbit interaction parameter are determined. The standard deviation of the fit is about 15 MHz. We experimentally determine the radiative lifetimes of selected hyperfine levels by time-delayed ionization, Lamb dip spectroscopy, and accurate measurements of the transition lineshapes. The measured lifetimes range between 2 and 200 ns, determined by the degree of singlet-triplet mixing for each level.

Spectroscopic characterization of the a3Π state of aluminum monofluoride.

Spectroscopic studies of aluminum monofluoride (AlF) have revealed its highly favorable properties for direct laser cooling. All Q lines of the strong A1Π â† X1Σ+ transition around 227 nm are rotationally closed and thereby suitable for the main cooling cycle. The same holds for the narrow, spin-forbidden a3Π â† X1Σ+ transition around 367 nm, which has a recoil limit in the µK range. We here report on the spectroscopic characterization of the lowest rotational levels in the a3Π state of AlF for v = 0-8 using a jet-cooled, pulsed molecular beam. An accidental AC Stark shift is observed on the a3Π0, v = 4 ← X1Σ+, v = 4 band. By using time-delayed ionization for state-selective detection of the molecules in the metastable a3Π state at different points along the molecular beam, the radiative lifetime of the a3Π1, v = 0, J = 1 level is experimentally determined as τ = 1.89 ± 0.15 ms. A laser/radio frequency multiple resonance ionization scheme is employed to determine the hyperfine splittings in the a3Π1, v = 5 level. The experimentally derived hyperfine parameters are compared to the outcome of quantum chemistry calculations. A spectral line with a width of 1.27 kHz is recorded between hyperfine levels in the a3Π, v = 0 state. These measurements benchmark the electronic potential of the a3Π state and yield accurate values for the photon scattering rate and for the elements of the Franck-Condon matrix of the a3Π-X1Σ+ system.

Investigation of a potential electrogenic transport-system for myo-inositol in the small intestine of laying hens.

1. Myo-inositol (MI) is an essential metabolite for cell function in animals and humans. The aim of this study was to characterise the transport mechanism of MI in the small intestine of laying hens as there is a lack of knowledge about the MI uptake mechanisms. The hypothesised secondary active, cation coupled transport of MI was assessed by electrophysiological measurements with Ussing chambers, and was compared to the electrophysiology of glucose transport.2. Twenty-six laying hens were used. The potential ion-dependent transport was tested in tissue of the small intestine. Barrier function of the tissue was shown by determining the transepithelial resistance. During the experiments, mucosal and serosal buffers were sampled to measure time-dependent changes in MI concentrations. Samples from eight hens were further used for Western blot analyses of the jejunal apical membranes.3. Active MI transport, indicated by changes in the short circuit current after MI addition, could not be demonstrated in the Ussing chambers experiments. MI was further not detectable in the serosal buffer, nor in the lysates of mucosal tissue cytoplasm nor lipids. Thus, there was no evidence for a MI transport or absorption. However, Western blot analyses of the jejunal apical membrane revealed signals indicated the expression of the MI transport proteins SMIT-1 and SMIT-2.4. In conclusion, the MI transport process in the chicken intestine is more complex than it was presumed and is probably influenced by still unknown regulations or metabolic processes.

Galactorrhea during antipsychotic treatment: results from AMSP, a drug surveillance program, between 1993 and 2015.

Galactorrhea is a well-known adverse drug reaction (ADR) of numerous antipsychotic drugs (APD) and is often distressing for those affected. Methodological problems in the existing literature make it difficult to determine the prevalence of symptomatic hyperprolactinemia in persons treated with APDs. Consequently, a large sample of patients exposed to APDs is needed for more extensive evaluation. Data on APD utilization and reports of galactorrhea caused by APDs were analyzed using data from an observational pharmacovigilance program in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP)-from 1993 to 2015. 320,383 patients (175,884 female inpatients) under surveillance were treated with APDs for schizophrenia and other indications. A total of 170 events of galactorrhea caused by APDs were identified (0.97 cases in 1000 female inpatient admissions). Most cases occurred during the reproductive age with the highest incidence among patients between 16 and 30 years (3.81 cases in 1000 inpatients). The APDs that were most frequently imputed alone for inducing galactorrhea were risperidone (52 cases and 0.19% of all exposed inpatients), amisulpride (30 resp. 0.48%), and olanzapine (13 resp. 0.05%). In three cases, quetiapine had a prominent role as a probable cause for galactorrhea. High dosages of the imputed APDs correlated with higher rates of galactorrhea. Galactorrhea is a severe and underestimated condition in psychopharmacology. While some APDs are more likely to cause galactorrhea, we identified a few unusual cases. This highlights the importance of alertness in clinical practice and of taking a patient's individual situation into consideration.

[Psychopharmacotherapy during the COVID-19 pandemic]. / Psychopharmakotherapie in Zeiten der COVID-19-Pandemie.

In view of the current coronavirus disease 2019 (COVID-19) pandemic, patient care, including that of psychiatric patients, is facing unprecedented challenges. Treatment strategies for mental illness include psychotherapy and psychopharmacological interventions. The latter are associated with a multitude of adverse drug reactions (ADR); however, they may currently represent the preferred treatment due to restrictions regarding patient care (i.e. social distancing). Direct contact to patients may have to be reduced in favor of telephone calls or video conferences, so that new techniques in diagnosing and treating patients have to be established to guarantee patient safety. Patients should be extensively informed about relevant ADRs and physicians should actively ask patients about the timely recognition of ADRs. The use of psychotropic drugs may lead to an increased risk of developing ADRs, which are considered to be particularly unfavorable if they occur simultaneously with an acute infection or may even lead to an increased risk of infection. These include respiratory depression, agranulocytosis, intoxication by inhibition of metabolizing enzymes and venous thromboembolism, each of which may be associated with potentially fatal consequences; however, physicians should simultaneously ensure adequate efficacy of treatment, since the ongoing crisis may lead to a worsening of preexisting mental illnesses and to a surge in first onset of psychiatric disorders.

Effect of cellobiose supplementation on in vitro fermentation activity and bacterial numbers of porcine inocula.

In this in vitro study, the modified Hohenheim gas test (HGT) was applied to determine fermentation activity and bacterial composition of pig's faecal microbial inoculum using different concentrations of cellobiose. Incubation procedures included normal buffered and osmotic stress conditions (elevated medium salinity). After 24 hr of fermentation, production of gas, ammonia and short-chain fatty acid (SCFA) was measured, and the gene copy numbers of total bacteria, Lactobacillus spp., Bifidobacterium spp., Roseburia spp., Clostridium Cluster IV spp. and Enterobacteriaceae were analysed using real-time polymerase chain reaction. There was a significant reduction in gas production after 24 hr when comparing osmotic stress conditions with normal buffered conditions. Under osmotic stress, increasing cellobiose concentrations linearly increased gas production (p < .001), while ammonia, acetic acid and isobutyric acid concentrations decreased (p < .001, p = .012, p = .035 respectively). Under normal buffered conditions, Roseburia spp. gene copies linearly increased with increasing cellobiose concentrations (p = .048). Lactobacillus spp. and Bifidobacterium spp. numbers were higher under osmotic stress (p < .001) compared to normal conditions. Results might point towards a positive impact of cellobiose supplementation on gut health especially under osmotic stress conditions.

Obtaining healthy offspring from PRRSV-positive pig breeding herds.

In this study, we propose a possible way of obtaining reproductive and respiratory syndrome virus (PRRSV) free offspring from genetically valuable lines of Prestice black-pied boars com- ming from PRRSV-positive pig breeding herds with the use of artificial insemination (AI). The ejaculates were collected from 4 different lines of boars. Samples of fresh semen were not detected with the virus and 12 sows were inseminated. Blood samples of sows and their offspring were repeatedly tested for the virus but the results were negative. We managed in this way to maintain the endangered population of this breed and obtain PRRSV-free offspring.

Porcine intestinal microbiota is shaped by diet composition based on rye or triticale.

AIMS: The present study aimed to compare the microbiota composition from pigs fed different cereal grain types, either rye or triticale, as sole energy source. METHODS AND RESULTS: Ileal digesta and faeces were sampled from eight pigs of each experiment. Illumina amplicon sequencing of the 16S rRNA gene was used to analyse the microbiota. Concentrations of short-chain fatty acids and ammonia were determined from faecal samples. The grain type revealed significant alterations in the overall microbiota structure. The rye-based diet was associated with an increased abundance of Lactobacillus in ileal digesta and Streptococcus in faeces and significantly higher concentrations of faecal short-chain fatty acids and ammonia compared to triticale. However, triticale significantly promoted the abundance of Streptococcus in ileal digesta and Clostridium sensu stricto in faeces. CONCLUSIONS: Diets based on rye or triticale affect varying intestinal microbiota, both of taxonomical and metabolic structure, with rye indicating an enhanced saccharolytic potential and triticale a more cellulolytic potential. SIGNIFICANCE AND IMPACT OF THE STUDY: Nutrient composition of rye and triticale are attractive for porcine nutrition. Both cereal grains show varying stimuli on the microbiota composition and microbial products of the ileum and faeces.

[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.

[Epidemiology of multidrug-resistant organisms in travellers: Results of a 2-year screening in a German level 1 trauma center]. / Epidemiologie multiresistenter Erreger bei Auslandsreisenden: Ergebnisse nach 2 Jahren Screening an einem Krankenhaus der Maximalversorgung.

INTRODUCTION: Antibiotic resistance has emerged as one of the eminent public health concerns. Infections can cause prolonged illness and are related to a high mortality. Expanding tourism and global travelling is one risk factor for spreading of "superbugs" (multidrug-resistant organisms, MDRO) from endemic countries with less hygiene conditions and an overuse of antibiotics. Persons that have had contact with foreign healthcare systems are at a high risk of being contaminated with these bacteria. Returning home they can transmit them to other patients and release nosocomial infections. MATERIAL AND METHODS: To improve the prevention of nosocomial infections at the Unfallkrankenhaus Berlin (ukb), at the beginning of 2011 the hospital hygiene commission decided to expand the existing testing for methicillin-resistant Staphylococcus aureus (MRSA) to screening of incoming patients with contact to foreign healthcare systems to identify colonization or infection with multidrug-resistant bacteria. RESULTS: In a 24-month period 155 patients were screened for MDROs, 31 patients (20%) were found to be positive, 18 showed colonization,13 patients showed infection and a multifold colonization was found in 10 patients. A total of 26 multiresistant gram-negative resistant rod-shaped bacilli resistant to 3 of the 4 classes of antibiotics (3MRGNs) were detected, 12 cases of 4MRGNs and 9 MRSAs. The average isolation time was 39 days and the calculated costs for isolation of MDRO positive patients were approximately 205,000 €. The average case mix index of MDRO positive patients was 9.54. CONCLUSION: The high percentage of patients with MDROs who had had contact with foreign healthcare systems or stayed in foreign countries shows the importance of screening to identify these persons and thus help avoid nosocomial infections of other patients as well as to protect healthcare workers. No transmissions or nosocomial infections were observed during the study period.

Effect of donor animal species and their feeding on the composition of the microbial community establishing in a rumen simulation.

AIMS: To investigate the effect of donor animal species and their feeding on the composition of the active fraction of rumen microbiota established during in vitro experiments with different forages. METHODS AND RESULTS: Rumen simulation experiments were conducted with maize silage (MS) and grass silage (GS) as substrates. Four experimental runs were performed with ruminal contents of sheep and cows fed either with hay and concentrate or with MS or GS, respectively. Liquid- and solid-associated microbes (LAM and SAM) were fixed for fluorescence in situ hybridization after 14 days of incubation. The LAM were characterized by higher proportions of Lachnospiraceae, Bacteroidetes, Deltaproteobacteria and Methanobacteriaceae at hay-concentrate-based feeding of the donor animals whereas counts of Gammaproteobacteria were lower. Similar results were found for SAM. Hay-concentrate-based feeding caused a higher ratio of Bacteria:Archaea in SAM. Incubations with GS seemed to enhance Bacteroidetes, Deltaproteobacteria and Archaea whereas numbers of Gammaproteobacteria were enhanced in MS experiments. The effect of the donor animal species was limited to the number of Archaea establishing in vitro being higher for sheep than for cows. CONCLUSIONS: The feeding of donor animals, more than the animal species itself, affects the composition of the ruminal microbial community that establishes in vitro. SIGNIFICANCE AND IMPACT OF THE STUDY: Data suggest the need of a standardized approach for studying the rumen microbiota in a rumen simulation. Moreover, this study provides fundamental data on the composition of the ruminal microbial community when different diets are fed to donor animals.

Alpine Skiing With total knee ArthroPlasty (ASWAP): symmetric loading during skiing.

The aim of this pilot study was to determine the pressure distribution, symmetry of load between operated (OP) and non-operated (NOP) leg, and pain level during alpine skiing in participants with unilateral total knee arthroplasty (TKA). The responses of the dependent variables were analyzed following a 10-week guided skiing intervention of 2-3 days of skiing per week. Ground reaction force (GRF) was recorded bilaterally and was determined for 13 participants with TKA (65 ± 4 years) at pre- and post-test. Additionally, pain perception was determined using a numeric rating scale in the OP leg at both test sessions and after each skiing day. No statistical differences were observed between OP and NOP legs for peak and average GRF as well as the asymmetry indices at pre-test. Pain perception was low and was not increased as a consequence of the skiing intervention. In conclusion, alpine skiing did not lead to increased or decreased loading of the OP leg compared with the NOP leg. Therefore, alpine skiing may be allowed for patients with skiing experience and a good clinical outcome.

Prevalence of low back pain in adolescent athletes - an epidemiological investigation.

Low back pain (LBP) is a common symptom in the populations of western countries, and adolescent athletes seem to be prone to LBP. The main objective of this study was to analyze the point (LBP within the last 48 h), 1-year (LBP within the last 12 months) and lifetime (LBP within the entire life) prevalence rates of LBP in adolescent athletes participating in various sports. We also assessed the characteristics of LBP and its association with potential risk factors. To this end, 272 competitive adolescent athletes involved in 31 different sports (158 males, 113 females, 15.4 ± 2.0 years, body mass index [BMI] 20.3 ± 2.4 kg/m(2)) were enrolled in a 10-month prospective clinical trial that included a questionnaire and physical examination. We found a point prevalence of 14%, a 1-year prevalence of 57%, and a lifetime prevalence of 66% for LBP. The mean age of first appearance of LBP was 13.1 ± 2.0 years. The lifetime prevalence was significantly higher in volleyball than in biathletes (74.3 vs. 45.7%, p = 0.015). Our findings confirm that LBP is a common symptom in adolescent athletes; LBP prevalence correlates with sports participation and individual competitive level. Adolescent athletes with LBP should receive a thorough diagnostic work-up and adapt training and technique correspondingly when indicated.

[Mild whole body hyperthermia in combination with inpatient multimodal oriented pain therapy: evaluation in patients with chronic unspecific lumbar back pain]. / Milde Ganzkörperhyperthermie in Kombination mit stationärer multimodal orientierter Schmerztherapie: Evaluation bei Patienten mit chronischem unspezifischem lumbalem Rückenschmerz.

PURPOSE: A randomized controlled clinical trial was implemented to evaluate the effectiveness of combined mild hyperthermia therapy (body core temperature 38.4 °C) and multimodal inpatient rehabilitation for patients suffering from chronic low back pain when compared to multimodal pain therapy alone. PATIENTS AND METHODS: A total of 88 patients were randomly assigned to the combined or single therapeutic schemes according to a block randomization scheme. According to the trial inclusion criteria all patients suffered from chronic low back pain and showed morphological degeneration. All patients underwent a 12-day inpatient multimodal pain therapy, which was complemented with a 6-session schedule of mild hyperthermia therapy for the intervention group (1 h at 38.6 °C). On admission and 3 months after treatment the study patients were asked to complete an interview assessment with the Oswestry low back pain disability questionnaire (Oswestry disability index). The change in the Oswestry disability index total score (%) 3 months after versus before therapy was defined as the primary clinical endpoint of the investigation. The patients in the control group and in the intervention group had a median age of 50 years. In the intervention group 70 % of the patients were female and 55 % reported having half to full time employment compared to 55 % and 43 % in the control group, respectively. RESULTS: On admission the control patients reported a median Oswestry disability index of 64 % and on recall the same of 64 %. The intervention group showed median Oswestry disability index estimates of 60 % and 66 %, respectively. The changes in the overall Oswestry disability index after 3 months differed significantly with an estimated 6 % for the intervention group versus 0 % for the control group (Wilcoxon p = 0.050). CONCLUSION: When combined with a multimodal inpatient lower back pain functional therapy in patients showing morphological degeneration, the mild hyperthermia therapy demonstrated statistically significant, although not clinically relevant benefits in comparison to the multimodal treatment alone. However, regarding the moderate overall patient-related benefits as measured in terms of the Oswestry disability index, the benefit of the underlying multimodal therapy concept implementation must be critically discussed irrespective of its combination with mild hyperthermia therapy.

[Diagnosis and management of peripheral vascular injuries]. / Diagnostik und Management peripherer Gefäßverletzungen.

Peripheral vascular injuries are the cause of high morbidity in trauma patients. Up to 5 % of all patients with injuries of the extremities present with concomitant vascular lesions. While open peripheral vascular injuries are associated with a high mortality at the scene of the accident, closed vascular injuries present the danger of developing critical tissue ischemia with a high risk of amputation and limb loss. Early diagnosis is crucial in order to rapidly restore and maintain adequate blood flow and downstream tissue perfusion. A correct diagnosis and early treatment of peripheral vascular injuries place enormous demands on interdisciplinary teams consisting of emergency physicians, orthopedic surgeons, vascular surgeons, anesthesiologists and radiologists. The top priority in the context of emergency care is hemorrhage control by applying direct pressure and dressings until definitive surgical treatment. Hypovolemic shock, reperfusion injury and compartment syndrome are complications of peripheral vascular injuries that must be recognized and treated in the early stages.

Surface structure of alanine on Cu(110) studied by fast atom diffraction.

We demonstrate that quantum scattering of fast atoms and molecules under grazing angles of incidence can be exploited to study the structure of organic molecules on metal surfaces. Making use of keV H and He atoms as well as H2 molecules, the surface structures of the chiral amino acid alanine adsorbed on a Cu(110) surface is studied. We present a detailed investigation on the (3×2) phase of a monolayer of enantiopure and racemic alanine on Cu(110), revealing the formation of an elongated surface unit cell of c(n×2) symmetry with n=3.16±0.04 for the sticking out methyl groups of the alanine molecules.