[Characteristics of Hospitalized Mentally ill Spanish Migrants in Germany - Results of a Statistical Reanalysis]. / Stationär behandelte psychisch kranke spanische Migranten der ersten Generation in Deutschland - Ergebnisse einer Reanalyse.

OBJECTIVE: To draft a clinical profile of mentally ill first-generation Spanish immigrants in Germany treated in a special setting in their native language and to identify possible correlations between time of onset of a mental disorder and migration and also between degree of utilization and clinical as well as care variables. METHOD: Statistical reanalysis of individual data (n = 100) of a previously published descriptive study with aggregated data corresponding to 15 variables. Correlations are calculated using chi-square as well as Fisher's exact test. Multivariate regression and logistic models were conducted. In addition to the explained variance of the models (R(2)), analyses of residuals as well as post-hoc power analyses (1-ß) were performed. RESULTS: A quarter of the sample (26 %) was mentally ill before migration; most of the patients received treatment very late (about 10 years after onset) and became chronically ill. Half of the sample shows a relevant somatic comorbidity and large average lengths of inpatient stays (54 days). In 16 % of treated cases, repatriation had to be organized. The degree of chronicity correlates with mental illness prior to migration. Severe mood disorders and psychoses occur late after having migrated, addictions and neurotic disorders are equally distributed over time. DISCUSSION: Migration can not be set in a causal relationship with the development of mental disorders, although there is a positive correlation between affective disorders and the duration of the migration status. Chronicity is related to an outbreak of the disease before migration. The sample is relatively homogeneous (one nationality, first generation), but loses epidemiological representativeness (not related to a catchment area).

Raman spectroscopy and microspectrophotometry of reactive dyes on cotton fibres: analysis and detection limits.

A collaborative study on Raman spectroscopy and microspectrophotometry (MSP) was carried out by members of the ENFSI (European Network of Forensic Science Institutes) European Fibres Group (EFG) on different dyed cotton fabrics. The detection limits of the two methods were tested on two cotton sets with a dye concentration ranging from 0.5 to 0.005% (w/w). This survey shows that it is possible to detect the presence of dye in fibres with concentrations below that detectable by the traditional methods of light microscopy and microspectrophotometry (MSP). The MSP detection limit for the dyes used in this study was found to be a concentration of 0.5% (w/w). At this concentration, the fibres appear colourless with light microscopy. Raman spectroscopy clearly shows a higher potential to detect concentrations of dyes as low as 0.05% for the yellow dye RY145 and 0.005% for the blue dye RB221. This detection limit was found to depend both on the chemical composition of the dye itself and on the analytical conditions, particularly the laser wavelength. Furthermore, analysis of binary mixtures of dyes showed that while the minor dye was detected at 1.5% (w/w) (30% of the total dye concentration) using microspectrophotometry, it was detected at a level as low as 0.05% (w/w) (10% of the total dye concentration) using Raman spectroscopy. This work also highlights the importance of a flexible Raman instrument equipped with several lasers at different wavelengths for the analysis of dyed fibres. The operator and the set up of the analytical conditions are also of prime importance in order to obtain high quality spectra. Changing the laser wavelength is important to detect different dyes in a mixture.

Vertebral body bone strength: the contribution of individual trabecular element morphology.

SUMMARY: Although the amount of bone explains the largest amount of variability in bone strength, there is still a significant proportion unaccounted for. The morphology of individual bone trabeculae explains a further proportion of the variability in bone strength and bone elements that contribute to bone strength depending on the direction of loading. INTRODUCTION: Micro-CT imaging enables measurement of bone microarchitecture and subsequently mechanical strength of the same sample. It is possible using micro-CT data to perform morphometric analysis on individual rod and plate bone trabeculae using a volumetric spatial decomposition algorithm and hence determine their contribution to bone strength. METHODS: Twelve pairs of vertebral bodies (T12/L1 or L4/L5) were harvested from human cadavers, and bone cubes (10 × 10 × 10 mm) were obtained. After micro-CT imaging, a volumetric spatial decomposition algorithm was applied, and measures of individual trabecular elements were obtained. Bone strength was measured in compression, where one bone specimen from each vertebral segment was tested supero-inferiorly (SI) and the paired specimen was tested antero-posteriorly (AP). RESULTS: Bone volume fraction was the strongest individual determinant of SI strength (r(2) = 0.77, p < 0.0001) and AP (r(2) = 0.54, p < 0.0001). The determination of SI strength was improved to r(2) = 0.87 with the addition of mean rod length and relative plate bone volume fraction. The determination of AP strength was improved to r(2) = 0.85 with the addition of mean rod volume and relative rod bone volume fraction. CONCLUSIONS: Microarchitectural measures of individual trabeculae that contribute to bone strength have been identified. In addition to the contribution of BV/TV, trabecular rod morphology increased the determination of AP strength by 57%, whereas measures of trabecular plate and rod morphology increased determination of SI strength by 13%. Decomposing vertebral body bone architecture into its constituent morphological elements shows that trabecular element morphology has specific functional roles to assist in maintaining skeletal integrity.

The importance of murine cortical bone microstructure for microcrack initiation and propagation.

In order to better understand bone postyield behavior and consequently bone failure behavior, this study aimed first to investigate cortical bone microstructure and second, to relate cortical bone microstructure to microdamage initiation and propagation in C57BL/6 (B6) and C3H/He (C3H) mice; two murine inbred strains known for their differences in bone phenotype. Murine femora of B6 and C3H were loaded axially under compression in a stepwise manner. For each loading step, 3D data sets at a nominal resolution of 700 nm were acquired by means of synchrotron radiation-based computed tomography. Cortical bone microstructure was divided into three phases: the canal network, the osteocyte lacunar system, and microdamage. Canal volume density and canal unit volume both correlated highly to crack number density (canal volume density: R(2)=0.64, p<0.005 and canal unit volume: R(2)=0.75, p<0.001). Moreover, the large canal units in C3H bone were responsible for more microdamage accumulation compared to B6 bones. This more pronounced microdamage accumulation due to large intracortical bone voids, which eventually leads to a fatal macrocrack (fracture), represents a potential contributing factor to the higher incidence of bone fractures in the elderly.

Time-lapsed assessment of microcrack initiation and propagation in murine cortical bone at submicrometer resolution.

The strength of bone tissue is not only determined by its mass, but also by other properties usually referred to as bone quality, such as microarchitecture, distribution of bone cells, or microcracks and damage. It has been hypothesized that the bone ultrastructure affects microcrack initiation and propagation. Due to its high resolution, bone assessment by means of synchrotron radiation (SR)-based computed tomography (CT) allows unprecedented three-dimensional (3D) and non-invasive insights into ultrastructural bone phenotypes, such as the canal network and the osteocyte lacunar system. The aims of this study were to describe the initiation and propagation of microcracks and their relation with these ultrastructural phenotypes. To this end, femora from the two genetically distinct inbred mouse strains C3H/He (C3H) and C57BL/6 (B6) were loaded axially under compression, from 0% strain to failure, with 1% strain steps. Between each step, a high-resolution 3D image (700 nm nominal resolution) was acquired at the mid-diaphysis using SR CT for characterization and quantitative analysis of the intracortical porosity, namely the bone canal network, the osteocyte lacunar system and the emerging microcracks. For C3H mice, the canal, lacunar, and microcrack volume densities accounted typically for 1.91%, 2.11%, and 0.27% of the cortical total volume at 2% apparent strain, respectively. Due to its 3D nature, SR CT allowed to visualize and quantify also the volumetric extent of microcracks. At 2% apparent strain, the average microcrack thickness for both mouse strains was 2.0 microm for example. Microcracks initiated at canal and at bone surfaces, whereas osteocyte lacunae provided guidance to the microcracks. Moreover, we observed that microcracks could appear as linear cracks in one plane, but as diffuse cracks in a perpendicular plane. Finally, SR CT images permitted visualization of uncracked ligament bridging, which is thought to be of importance in bone toughening mechanisms. In conclusion, this study showed the power of SR CT for 3D visualization and quantification of the different ultrastructural phases of the intracortical bone porosity. We particularly postulate the necessity of 3D imaging techniques to unravel microcrack initiation and propagation and their effects on bone mechanics. We believe that this new investigation tool will be very useful to further enhance our understanding of bone failure mechanisms.

Specimen-specific beam models for fast and accurate prediction of human trabecular bone mechanical properties.

Direct assessment of bone competence in vivo is not possible, hence, it is inevitable to predict it using appropriate simulation techniques. Although accurate estimates of bone competence can be obtained from micro-finite element models (muFE), it is at the expense of large computer efforts. In this study, we investigated the application of structural idealizations to represent individual trabeculae by single elements. The objective was to implement and validate this technique. We scanned 42 human vertebral bone samples (10 mm height, 8 mm diameter) with micro-computed tomography using a 20 microm resolution. After scanning, direct mechanical testing was performed. Topological classification and dilation-based algorithms were used to identify individual rods and plates. Two FE models were created for each specimen. In the first one, each rod-like trabecula was modeled with one thickness-matched beam; each plate-like trabecula was modeled with several beams. From a simulated compression test, assuming one isotropic tissue modulus for all elements, the apparent stiffness was calculated. After reducing the voxel size to 40 microm, a second FE model was created using a standard voxel conversion technique. Again, one tissue modulus was assumed for all elements in all models, and a compression test was simulated. Bone volume fraction ranged from 3.7% to 19.5%; Young's moduli from 43 MPa to 649 MPa. Both models predicted measured apparent moduli equally well (R2 = 0.85), and were in excellent agreement with each other (R2 = 0.97). Tissue modulus was estimated at 9.0 GPa and 10.7 GPa for the beam FE and voxel FE models, respectively. On average, the beam models were solved in 219 s, reducing CPU usage up to 1150-fold as compared to 40 microm voxel FE models. Relative to 20 microm voxel models 10,000-fold reductions can be expected. The presented beam FE model is an abstraction of the intricate real trabecular structure using simple cylindrical beam elements. Nevertheless, it enabled an accurate prediction of global mechanical properties of microstructural bone. The strong reduction in CPU time provides the means to increase throughput, to analyze multiple loading configuration and to increase sample size, without increasing computational costs. With upcoming in vivo high-resolution imaging systems, this model has the potential to become a standard for mechanical characterization of bone.

Improved anchorage in osteoporotic vertebrae with new implant designs.

The goal of our study was to evaluate two newly developed implant designs and their behavior in terms of subsidence in lumbar vertebral bodies under cyclic loading. The new implants were evaluated in two different configurations (two small prototypes vs. one large prototype with similar load-bearing area) in comparison to a conventional screw-based implant (MACS TL). A pool of 13 spines with a total of 65 vertebrae was used to establish five testing groups of similar bone mineral density (BMD) distribution with eight lumbar vertebrae each. In additional to BMD assessment via dual-energy X-ray absorptiometry, cancellous BMD and structural parameters were determined using a new generation in vivo 3D-pQCT. The specimens were loaded sinusoidally in force control at 1 Hz for 1000 cycles at three load levels (100, 200, and 400 N). A survival analysis using the number of cycles until failure (Cox regression with covariates) was applied to reveal differences between implant groups. All new prototype configurations except the large cylinder survived significantly longer than the control group. The number of cycles until failure was significantly correlated with the structural parameter Tb.Sp. and similarly with the cancellous BMD for three of five implants. In both large prototypes the cycle number until failure significantly correlated with the preoperative distance to the upper endplates. Although the direct relationship between bone structure or density and mechanical breakage behavior cannot be conclusively proven, all the prototypes adapted for poor bone structure performed better than the comparable conventional implant.

Time-lapsed investigation of three-dimensional failure and damage accumulation in trabecular bone using synchrotron light.

Synchrotron radiation micro-computed tomography (SRmicroCT) is a very useful technique when it comes to three-dimensional (3D) imaging of complex internal and external geometries. Being a fully non-destructive technique, SRmicroCT can be combined with other experiments in situ for functional imaging. We are especially interested in the combination of SRmicroCT with mechanical testing in order to gain new insights in the failure mechanism of trabecular bone. This interest is motivated by the immense costs in health care due to patients suffering from osteoporosis, a systemic skeletal disease resulting in decreased bone stability and increased fracture risk. To better investigate the different failure mechanisms on the microlevel, we have developed a novel in situ mechanical compression device, capable of exerting both static and dynamic displacements on experimental samples. The device was calibrated for mechanical testing using solid aluminum and bovine trabecular bone samples. To study different failure mechanisms in trabecular bone, we compared a fatigued and a non-fatigued bovine bone sample with respect to failure initiation and propagation. The fatigued sample failed in a burst-like fashion in contrast to the non-fatigued sample, which exhibited a distinct localized failure band. Moreover, microscopic cracks - microcracks and microfractures - were uncovered in a 3D fashion illustrating the failure process in great detail. The majority of these cracks were connected to a bone surface. The data also showed that the classification of microcracks and -fractures from 2D section can sometimes be ambiguous, which is also true for the distinction of diffuse and distinct microdamage. Detailed investigation of the failure mechanism in these samples illustrated that trabecular bone often fails in delamination, providing a mechanism for energy dissipation while conserving trabecular bone architecture. In the future, this will allow an even better understanding of bone mechanics related to its hierarchical structural organization.

Age-related changes in trabecular bone microstructures: global and local morphometry.

INTRODUCTION: A recently developed method allows investigating trabecular bone on an elemental (rod/plate) level. With this method, it is possible to measure local morphometric parameters such as thickness or orientation directly on the extracted rods and plates. Age-related changes of trabecular microarchitecture can thus be investigated on an elemental level, which may help to improve the understanding of age-related bone failure mechanism as well as the effect of pharmaceutical intervention in the prevention of such fractures. METHODS: Autopsies from femoral heads (FH) and lumbar spine (LS) were analyzed by global morphometry. Additionally, the trabecular structures were decomposed into rods and plates for the analysis with local morphometry. These morphometric indices were related to age using an analysis of covariance to test for gender differences and linearity with age. RESULTS: In this study, age-related changes showed no gender but site differences. In LS, rods were thinned in aging and finally vanish from the structure, causing a transformation of the trabecular bone structure to longer and, on average, thicker rods. In FH, changes were expressed by a simultaneous thinning and loss of interconnecting trabeculae and perforation of plates leading to new plates and rods. Results were mostly in agreement with earlier findings using descriptive analysis of the aging process. CONCLUSION: Here we present for the first time preliminary quantitative evidence of changes in the local microstructure, i.e., individual rods and plates. Nevertheless, the number of samples was too small to make for ready conclusions. We conclude that the combination of local and global morphometry is a useful method for a detailed and quantitative description of age-related changes in bone microstructure.

Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients.

BACKGROUND: The impact of various medical and demographic factors on the quality of life (QoL) of breast cancer patients has been discussed controversially. We investigated the influence of six different factors on long-term QoL and body image of women with primary breast cancer. PATIENTS AND METHODS: Two-hundred and seventy-four breast cancer patients were administered the QoL questionnaire following a mean interval of 4.2 years after primary diagnosis. All women had been primarily treated for stage I to III breast cancer without evidence of distant metastases. QoL was evaluated by using the QLQ-C30 questionnaire Version 2.0. Supplementary scales included body image, satisfaction with surgical treatment, cosmetic result and fear of recurrence. We analyzed the impact of tumor stage, surgical treatment, adjuvant radiotherapy, adjuvant cytotoxic therapy, age and length of follow-up period on the examined outcome parameters. RESULTS: At the time of the follow-up examination, patients showed minor impairment of QoL (mean 67.8) and body image (mean 24.8), but more fear of recurrence (mean 60.7). None of the studied factors had a significant impact on overall QoL (P >0.05) according to the QLQ-C30 questionnaire. In contrast, with the exception of the factors 'cytotoxic therapy' and 'radiotherapy' all investigated variables influenced at least one of the additional psychological scales (P <0.05). The primary surgical treatment modality had the strongest impact and affected all four scales. Patients treated with breast conservation reported a more favorable body image, compared to those treated with mastectomy (17.2 versus 37.5, P <0.01), more satisfaction with surgical treatment (4.0 versus 10.7, P = 0.01), rated a better cosmetic result (75.5 versus 57.1, P <0.01), but presented more fear of recurrence (63.9 versus 55.3, P = 0.04). CONCLUSION: Current QoL questionnaires do not sufficiently cover all relevant aspects of QoL, but might be complemented by breast cancer specific aspects such as body image and fear.

[Specific concepts of care for pregnant women with drug addiction or HIV infection]. / Spezifische Betreuungskonzepte für schwangere Frauen mit Sucht- bzw. HIV-Konflikten.

In the last 10 years about 130 women with a drug addiction and more than 100 HIV-positive pregnant women were treated at the 1. University Hospital of Obstetrics and Gynaecology in Munich. Besides a specialized medical treatment both groups required intensive psychosocial care. HIV-infected people are still isolated and suffer from the social stigmata. Their essential needs for sexuality and children of their own are often ignored or even condemned because of irrational fears about HIV, which continue despite rapid medical improvements. The life-expectancy for example has increased since the inauguration of protease inhibitors. Vertical transmission of HIV is below 2% through medical treatment in pregnancy, elective cesarean section and renunciation of breastfeeding. Drug addicted pregnant women are given the opportunity to change their life in order to care for their children appropriately. The basis for this is a substitution with levomethadone and elimination of the use of other drugs. The addicted women often can reduce the dosage of levomethadone during the course of their pregnancy and sometimes can cease totally. Normally they are highly motivated and thus can ease the withdrawal symptoms of their newborns following delivery. By establishing a reliable social net during pregnancy mothers learn to recognize the demands of their children after birth and thus emotional and cognitive deficits can be prevented.

Function of bicoid and hunchback homologs in the basal cyclorrhaphan fly Megaselia (Phoridae).

The Drosophila gene bicoid functions at the beginning of a gene cascade that specifies anterior structures in the embryo. Its transcripts are localized at the anterior pole of the oocyte, giving rise to a Bicoid protein gradient, which regulates the spatially restricted expression of target genes along the anterior-posterior axis of the embryo in a concentration-dependent manner. The morphogen function of Bicoid requires the coactivity of the zinc finger transcription factor Hunchback, which is expressed in a Bicoid-dependent fashion in the anterior half of the embryo. Whereas hunchback is conserved throughout insects, bicoid homologs are known only from cyclorrhaphan flies. Thus far, identification of hunchback and bicoid homologs rests only on sequence comparison. In this study, we used double-stranded RNA interference (RNAi) to address the function of bicoid and hunchback homologs in embryos of the lower cyclorrhaphan fly Megaselia abdita (Phoridae). Megaselia-hunchback RNAi causes hunchback-like phenotypes as observed in Drosophila, but Megaselia-bicoid RNAi causes phenotypes different from corresponding RNAi experiments in Drosophila and bicoid mutant embryos. Megaselia-bicoid is required not only for the head and thorax but also for the development of four abdominal segments. This difference between Megaselia and Drosophila suggests that the range of functional bicoid activity has been reduced in higher flies.

The anterior determinant bicoid of Drosophila is a derived Hox class 3 gene.

The Drosophila gene bicoid functions as the anterior body pattern organizer of Drosophila. Embryos lacking maternally expressed bicoid fail to develop anterior segments including head and thorax. In wild-type eggs, bicoid mRNA is localized in the anterior pole region and the bicoid protein forms an anterior-to-posterior concentration gradient. bicoid activity is required for transcriptional activation of zygotic segmentation genes and the translational suppression of uniformly distributed maternal caudal mRNA in the anterior region of the embryo. caudal genes as well as other homeobox genes or members of the Drosophila segmentation gene cascade have been found to be conserved in animal evolution. In contrast, bicoid homologs have been identified only in close relatives of the schizophoran fly Drosophila. This poses the question of how the bicoid gene evolved and adopted its unique function in organizing anterior-posterior polarity. We have cloned bicoid from a basal cyclorrhaphan fly, Megaselia abdita (Phoridae, Aschiza), and show that the gene originated from a recent duplication of the direct homolog of the vertebrate gene Hox3, termed zerknüllt, which specifies extraembryonic tissues in insects.

[Psychological coping with stillbirth. Course of grief response, influential factors, treatment satisfaction, patient management needs]. / Die psychische Verarbeitung einer Totgeburt. Verlauf der Trauerreaktion, Einflussfaktoren, Behandlungszufriedenheit, Betreuungswünsche.

Course of Grief Response, influencing Factors, Satisfaction with treatment, Need for Psychotherapeutic Support: The emotional response to a late miscarriage or a stillbirth was examined retrospectively in a systematic study involving 51 patients. The women had lost a child either by stillbirth (beyond the 20th week of gestation) or shortly after delivery. We assessed the long-term course of possible determinants of grief, a complicated grief response, as well as the patients' satisfaction with the treatment and their need for further psychotherapeutic support. The mourning response was complicated by a depressive reaction in 22%. Major risk factors were individual disposition, lack of partner and professional support. The findings reveal that the course of the grief response is positively influenced by: 1. open discussion (thematisation) with the skilled personnel and the patients' families, 2. direct or indirect contact with the deceased child (concretisation) and 3. the patients concerned being extensively informed as to place and circumstances of the funeral (whereabouts of the child).

[Coping with fetal death: complications, risk factors and potential physician support]. / Verarbeitung einer Totgeburt: Komplikationen, Risikomerkmale und Möglichkeiten ärztlicher Hilfen.

Only recently a stillbirth has been recognized as a major loss for the majority of women. Based on psychotherapeutic experience and clinical investigations, symptoms and risk factors of normal and pathological courses of grief are delineated and illustrated by a case vignette. Risk factors for complicated grief refer to quality of inpatient care, partner support, previous depression, anxiety or unresolved strain. Recommendations for inpatient care include validating the loss, making it real, enabling the bereaved parents to make informed decisions. Ambulatory after care should provide for monitoring and supporting the grief process.