[Individual aspects in eldery patients with fragility fractures]. / Individuelle Besonderheiten bei hochbetagten Patienten mit Fragilitätsfrakturen.

BACKGROUND: Due to our ageing population, the number of elderly patients who are treated in the emergency department due to low-energy trauma (e.g., tripping) continues to rise. These minor accidents often result in fragility fractures classically located in the proximal humerus, distal radius, spine, pelvis, and near the hip joint. Pre-existing conditions, polypharmacy, and general frailty increase the risk of fragility fractures in this patient population. METHODS: Geriatric trauma fractures and especially insufficiency fractures of the posterior pelvic ring are often difficult to diagnose by plain X­ray. Therefore, in geriatric trauma patients, cross-sectional imaging, e.g., computed tomography (CT), dual-energy CT (DECT), or magnetic resonance imaging (MRI), should be considered early for reliable evaluation of a suspected fracture. This also allows for the identification of older fractures. Particularly in cognitively impaired elderly patients, difficult examination conditions or an unclear fall event, cross-sectional imaging is often indicated. However, this may also involve risks, e.g., use of contrast medium in patients with impaired renal function, so that each case must be considered individually. Furthermore, the diagnosis and treatment of osteoporosis, which is an underlying disease that leads to fragility fractures, is of particular importance. In the diagnostic workup, measurement of bone density using dual energy X­ray absorptiometry (DXA) is the standard method according to guidelines. In specific situations, high-resolution peripheral quantitative CT (HR-pQCT) may also be used. CONCLUSION: Due to the special challenges of correctly detecting fragility fractures and being able to quickly initiate adequate therapy, good cooperation between radiologists and trauma surgeons is necessary.

Correction: Role of growth arrest-specific gene 6-mer axis in multiple myeloma.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

[Differential diagnoses of osteoporosis]. / Differenzialdiagnosen der Osteoporose.

The differential diagnoses of osteoporosis in geriatric and trauma patients are very important as they may induce different therapies. On average approximately 20% of women and 50% of men have secondary causes of osteoporosis. The foundation of the diagnostics is a basic osteological laboratory investigation with which the most important secondary causes can be identified. From a geriatric and traumatological point of view vitamin D deficiency with secondary hyperparathyroidism, primary hyperparathyroidism, male hypogonadism, multiple myeloma and monoclonal gammopathy of unclear significance (MGUS) are of particular importance.

Characterizing ice particles using two-dimensional reflections of a lidar beam.

We report a phenomenon manifesting itself as brief flashes of light on the snow's surface near a lidar beam. The flashes are imaged and interpreted as specular reflection patterns from individual ice particles. Such patterns have a two-dimensional structure and are similar to those previously observed in forward scattering. Patterns are easiest to capture from particles with well-defined horizontal facets, such as near-horizontally aligned plates. The patterns and their position can be used to determine properties such as ice particle shape, size, roughness, alignment, and altitude. Data obtained at Summit in Greenland show the presence of regular hexagonal and scalene plates, columns, and rounded plates of various sizes, among others.

Increased levels of sodium chloride directly increase osteoclastic differentiation and resorption in mice and men.

To better understand the association between high salt intake and osteoporosis, we investigated the effect of sodium chloride (NaCl) on mice and human osteoclastogenesis. The results suggest a direct, activating role of NaCl supplementation on bone resorption. INTRODUCTION: High NaCl intake is associated with increased urinary calcium elimination and parathyroid hormone (PTH) secretion which in turn stimulates the release of calcium from the bone, resulting in increased bone resorption. However, while calciuria after NaCl loading could be shown repeatedly, several studies failed to reveal a significant increase in PTH in response to a high-sodium diet. Another possible explanation that we investigated here could be a direct effect of high-sodium concentration on bone resorption. METHODS: Mouse bone marrow macrophage and human peripheral blood mononuclear cells (PBMC) driven towards an osteoclastogenesis pathway were cultivated under culture conditions mimicking hypernatremia environments. RESULTS: In this study, a direct effect of increased NaCl concentrations on mouse osteoclast differentiation and function was observed. Surprisingly, in a human osteoclast culture system, significant increases in the number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts, calcitonin receptor (CTR)-positive osteoclasts, nuclear factor-activated T cells c1 (NFATc1) gene expression, and areal and volumetric resorptions were observed for increasing concentrations of NaCl. This suggests a direct, activating, cell-mediated effect of increased concentrations of NaCl on osteoclasts. CONCLUSIONS: The reported that enhanced bone resorption after high-sodium diets may not only be secondary to the urinary calcium loss but may also be a direct, cell-mediated effect on osteoclastic resorption. These findings allow us to suggest an explanation for the clinical findings independent of a PTH-mediated regulation.

Spatial heterogeneity lowers rather than increases host-parasite specialization.

Abiotic environmental heterogeneity can promote the evolution of diverse resource specialists, which in turn may increase the degree of host-parasite specialization. We coevolved Pseudomonas fluorescens and lytic phage ϕ2 in spatially structured populations, each consisting of two interconnected subpopulations evolving in the same or different nutrient media (homogeneous and heterogeneous environments, respectively). Counter to the normal expectation, host-parasite specialization was significantly lower in heterogeneous compared with homogeneous environments. This result could not be explained by dispersal homogenizing populations, as this would have resulted in the heterogeneous treatments having levels of specialization equal to or greater than that of the homogeneous environments. We argue that selection for costly generalists is greatest when the coevolving species are exposed to diverse environmental conditions and that this can provide an explanation for our results. A simple coevolutionary model of this process suggests that this can be a general mechanism by which environmental heterogeneity can reduce rather than increase host-parasite specialization.

Microplastic in a macro filter feeder: Humpback whale Megaptera novaeangliae.

Marine filter feeders are exposed to microplastic because of their selection of small particles as food source. Baleen whales feed by filtering small particles from large water volumes. Macroplastic was found in baleen whales before. This study is the first to show the presence of microplastic in intestines of a baleen whale (Megaptera novaeangliae). Contents of its gastrointestinal tract were sieved, dissolved in 10% potassium hydroxide and washed. From the remaining dried material, potential synthetic polymer particles were selected based on density and appearance, and analysed by Fourier transform infrared (FTIR) spectroscopy. Several polymer types (polyethylene, polypropylene, polyvinylchloride, polyethylene terephthalate, nylon) were found, in varying particle shapes: sheets, fragments and threads with a size of 1mm to 17cm. This diversity in polymer types and particle shapes, can be interpreted as a representation of the varying characteristics of marine plastic and the unselective way of ingestion by M. novaeangliae.

Role of Growth arrest-specific gene 6-Mer axis in multiple myeloma.

Multiple myeloma is a mostly incurable malignancy characterized by the expansion of a malignant plasma cell (PC) clone in the human bone marrow (BM). Myeloma cells closely interact with the BM stroma, which secretes soluble factors that foster myeloma progression and therapy resistance. Growth arrest-specific gene 6 (Gas6) is produced by BM-derived stroma cells and can promote malignancy. However, the role of Gas6 and its receptors Axl, Tyro3 and Mer (TAM receptors) in myeloma is unknown. We therefore investigated their expression in myeloma cell lines and in the BM of myeloma patients and healthy donors. Gas6 showed increased expression in sorted BMPCs of myeloma patients compared with healthy controls. The fraction of Mer(+) BMPCs was increased in myeloma patients in comparison with healthy controls whereas Axl and Tyro3 were not expressed by BMPCs in the majority of patients. Downregulation of Gas6 and Mer inhibited the proliferation of different myeloma cell lines, whereas knocking down Axl or Tyro3 had no effect. Inhibition of the Gas6 receptor Mer or therapeutic targeting of Gas6 by warfarin reduced myeloma burden and improved survival in a systemic model of myeloma. Thus, the Gas6-Mer axis represents a novel candidate for therapeutic intervention in this incurable malignancy.

Gender differences in the use of anxiolytics and antidepressants: a population based study.

PURPOSE: In the majority of studies on determinants of use of anxiolytics and antidepressants a substantially higher consumption is observed among women than among men. We investigated gender differences in the association between the use of anxiolytics and antidepressants and mental health and explored if there are indications of gender differences in inappropriate use of these medicines. METHODS: Data were from the 2004 Belgian Health Interview Survey, a nationally representative sample of the Belgian population. The analysis was restricted to the population of 15 years and older (n = 11,220). The probability of use of anxiolytics and antidepressants was assessed through logistic regression models by gender and through models including the interaction between gender and mental health. RESULTS: The association between the use of antidepressants and mental health did not vary substantially between men and women. Among men the use of anxiolytics showed a strong association with sleeping problems, but not with depressive disorders. Among women the use of anxiolytics was significantly associated with the three mental health conditions that were investigated: depressive disorder, anxiety, and sleeping problems. CONCLUSIONS: The link between mental health and use of anxiolytics differs by gender. Some indications exist for gender differences in inappropriate use of anxiolytics, whereas this does not hold true for the use of antidepressants. Further efforts are needed to increase the awareness of prescribers, policy makers, and the general public on the appropriate use of anxiolytics, especially among women and in the older population.

[Injury situation of novice drivers in road traffic--a medical and technical analysis]. / Verletzungssituation von Fahranfängern im Strassenverkehr - eine medizinische und technische Unfallanalyse.

AIM: Novice drivers are at high risk for crash involvement. We performed an analysis of causations, injury patterns and distributions of novice drivers in cars and on motorcycles in road traffic as a basis for proper measurements. METHOD: Data of accident and hospital records of novice drivers (licence < 2 years) were analysed focusing on the following parameters: injury type, localisation and mechanism, abbreviated injury scale (AIS), maximum AIS (MAIS), delta-v, collision speed and other technical parameters and compared with those of experienced drivers. RESULTS: In 18 352 accidents in the area of Hannover (years 1985-2004), 2602 novice drivers and 18 214 experienced drivers were recorded as having an accident. Novice car drivers were more often and more severely injured whereas on motorcycles the experienced drivers were at higher risk. Novice drivers of both groups sustained more often extremity injuries. 4.5 % of the novice car drivers were not restrained by seatbelts as compared to 3.7 % of the experienced drivers and 6.1 % of the novice motorcycle drivers did not wear a proper helmet (versus 6.5 %). Severe injuries were sustained in 20 % at collision speeds below 30 km/h and in 80 % at collision speeds above 50 km/h. Novice car drivers drove significantly older cars. The risk profile of novice drivers is similar to that of drivers older than 65. CONCLUSION: Structural protection and special lectures like skidding courses could be proper measurements next to harder punishment of violations.

[Osteogenic differentiation of human bone marrow stromal cells (hBMSC) by cyclic longitudinal mechanical strain and dexamethasone]. / Osteogene Differenzierung von humanen stromalen Zellen aus dem Knochenmark (hBMSC) unter dem Einfluss von zyklischem mechanischem Dehnungsstress und Dexamethason.

AIM: The aim of the study was to investigate the effects of dexamethasone and cyclic mechanical strain on human bone marrow stromal cells (hBMSCs) in osteogenic differentiation by determing levels of mRNA of collagen I, II, III, tenascin C and Cbfa1. METHOD: hBMSCs from seven donors (32.5 +/- 6.2 years old) were cultivated with (D +) or without (D -) dexamethasone. After the second passage 2.2 x 10 (5) cells were seeded on flexible silicon dishes. A cyclic mechanical strain with an elongation of 2 % (D + 2; D - 2) or 8 % (D + 8; D - 8) was applied for three days with a stimulation time of three times for two hours each day. Cells were harvested on day 1, day 1 after stress (day 4) and day 4 after stress (day 7). mRNA expression of collagen I, II, III, tenascin C and Cbfa1 was investigated by RT-PCR. RESULTS: Cbfa1 mRNA levels were significantly different on different days (p < 0.05), and for strain on day 1: 8 %: 0.0291 +/- 0.0338 versus 0 %: 0.00 528 +/- 0.0127, p = 0.017; day 8: 8 %: 0.0411 +/- 0.116, 0 %: 0.00 103 +/- 0.00 217, p = 0.009. All other observed paramaters showed tendencies without significant differences. CONCLUSION: In the short-term over seven days, cyclic stretching is a stronger differentiation factor than dexamethasone.

Influence of perfusion and cyclic compression on proliferation and differentiation of bone marrow stromal cells in 3-dimensional culture.

Until now, there has been no in vitro model that duplicates the environment of bone marrow. The purpose of this study was to analyze proliferation and differentiation of human bone marrow stromal cells (hBMSC) under the influence of continuous perfusion and cyclic mechanical loading. hBMSC of seven individuals were harvested, grown in vitro, and combined. 10(6) hBMSC were seeded on a bovine spongiosa disc and incubated in a bioreactor system. Cell culture was continued using three different conditions: Continuous perfusion (group A), 10% cyclic compression at 0.5Hz (group B) and static controls (group C). After 24h, 1, 2, and 3 weeks, we determined cell proliferation (MTS-assay) and osteogenic differentiation (osteocalcin ELISA, Runx2 mRNA). Tenascin-C mRNA was quantified to exclude fibroblastic differentiation. In groups A and B, proliferation was enhanced after 2 weeks (48.6+/-19.6x10(3) (A) and 44.6+/-14.3 x 10(3) cells (B)) and after 3 weeks (46.6+/-15.1 x 10(3) (A) and 44.8+/-10.2 x 10(3) cells (B)) compared with controls (26.3+/-10.8 x 10(3) (2 weeks) and 17.1+/-6.5 x 10(3) cells (3 weeks), p<0.03). Runx2 mRNA was upregulated in both stimulated groups after 1, 2, and 3 weeks compared to control (group A, 1 week: 5.2+/-0.7-fold; p<0.01, 2 weeks: 4.4+/-1.9-fold; p<0.01, 3 weeks: 3.8+/-1.7-fold; p=0.013; group B, 1 week: 3.6+/-1.1-fold, p<0.01, 2 weeks: 4.2+/-2.2-fold, p<0.01; 3 weeks: 5.3+/-2.7-fold, p<0.01). hBMSC stimulated by cyclic compression expressed the highest amount of osteocalcin at all time points (1 week: 294.5+/-88.4 mg/g protein, 2 weeks: 294.4+/-73.3mg/g protein, 3 weeks: 293.1+/-83.6 mg/g protein, p0.03). The main stimulus for cell proliferation in a 3-dimensional culture of hBMSC is continuous perfusion whereas mechanical stimulation fosters osteogenic commitment of hBMSC. This study thereby contributes to the understanding of physical stimuli that influence hBMSC in a 3-dimensional cell culture system.

[(Over-)flowing bone: the rare disease of melorheostosis: clinical presentation and therapeutic concepts demonstrated by three cases]. / Knochen im (Uber-)Fluss: das seltene Krankheitsbild der Melorheostose : Klinische Präsentation und Behandlungskonzepte am Beispiel von 3 Fällen.

Melorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.

Femoral avulsion fracture of the posterior cruciate ligament in association with a rupture of the popliteal artery in a 9-year-old boy: a case report.

Ruptures of the posterior cruciate ligament (PCL) and especially proximal bony avulsion fractures in children are very rare. This in combination with a rupture of the popliteal artery is extremely rare. Thus, an exact incidence is not available from the literature. Overall, these injuries are severe and often lead to chronic knee instability. We report a case of a 9-year-old boy who suffered a traumatic displacement of the left knee with a rupture of the popliteal artery. Prior to transfer to our department, he was treated by a saphenous vein bypass graft and by a transfixation of the knee using two oblique percutaneous pins. We performed magnetic resonance imaging (MRI) scan of the knee which revealed a femoral avulsion fracture of the PCL. Other ligaments and menisci were intact. A transosseous femoral fixation using non-absorbable stitches was carried out. A 1-year follow-up after surgery demonstrates intact peripheral perfusion and sensation, straight axes of both legs and a physiological gait. Minimal differences of the length and circumference of both legs could be measured. The posterior laxity (Lachman-test) was about 5/8 mm (right/left knee) and 2/5 mm (right/left knee) in 90 degrees flexion. The range of motion (extension/flexion) was 5/0/140 degrees -/5/100 degrees (right-left knee). Intact cruciate ligaments were confirmed by MRI. Minimal experience exists in treatment of combined injuries to the PCL and the popliteal artery in children.

Oncofoetal fibronectin--a tumour-specific marker in detecting minimal residual disease in differentiated thyroid carcinoma.

Supposedly, thyrocyte-specific transcripts such as thyroglobulin (Tg) and thyroid-stimulating hormone receptor (TSH-R) were proposed to be useful for the diagnosis of circulating tumour cells in patients suffering from differentiated thyroid carcinoma (DTC). However, several research groups reported blood-borne Tg transcripts in healthy individuals. This study determines in particular the origin of Tg mRNA in nucleated blood cells and analyses whether other tumour-associated sequences are absent in leukocytes, but widely expressed in DTC. Therefore, expression analyses for Tg, TSH-R, cytokeratin 19 (CK 19), human telomerase reverse transcriptase (hTERT) and oncofoetal fibronectin (onfFN) were carried out using cDNAs derived from (1) leukocyte fractions, (2) 18 follicular thyroid carcinomas (FTCs) and 48 papillary thyroid carcinomas (PTCs), and (3) leukocytes of two thyrocyte-depleted individuals treated for C-cell carcinoma of the thyroid. Expression of onfFN was additionally analysed by semiquantitative RT-PCR and by quantitative fluorescence-based real-time PCR. Tg and TSH-R expression was demonstrated not only in both athyroid individuals, but in all leukocyte subgroups tested, while hTERT was absent in resting CD4+ cells and only weakly expressed in the CD8+ group. CK 19 was notable in each leukocyte population except for resting CD14(+), as well as for activated and resting CD19+ cells. All blood cell fractions proved negative for onfFN mRNA, whereas its presence in thyroid carcinoma was 78/98% (FTC/PTC). Threshold cycle values were calculated at: porphobilinogen deaminase (PBGD) = 25.95+/-0.73 (FTC)/24.55+/-5.43 (PTC) (P = 0.2878); onfFN = 25.48+/-3.15 (FTC)/21.44+/-3.44 (PTC) (*P = 0.0001). Finally, onfFN transcripts were detected in blood samples of six out of nine patients with known DTC metastases, demonstrating a reliable assay functionality. We propose that real-time RT-PCR of onfFN mRNA is superior to other markers in monitoring minimal residual disease in DTC with regard to both assay sensitivity and specificity.

Dexibuprofen: pharmacology, therapeutic uses and safety.

Dexibuprofen is the single pharmacologically effective enantiomer of rac-ibuprofen. Racibuprofen and dexibuprofen differ in their physico-chemical properties, in terms of their pharmacological properties and their metabolic profiles. Several clinical trials and post-marketing surveillance studies were performed to broaden the findings on dexibuprofen. In the last 5 years 4836 patients have been exposed to dexibuprofen in clinical trials and PMS trials. Only in 3.7% of patients adverse drug reactions have been reported and 3 serious adverse drug reactions (0.06%) were observed. In the dose ratio of 1 : 0.5 (rac-ibuprofen vs. dexibuprofen) at least equivalent efficacy was proven in acute mild to severe somatic and visceral pain models. Dexibuprofen has proven at least comparable efficacy to diclofenac, naproxen and celecoxib and has shown a favourable tolerability. The results suggest that dexibuprofen processed in a special crystal form is a safe and effective treatment for different pain conditions.

Disorganized infant, child, and adult attachment: collapse in behavioral and attentional strategies.

This presentation focuses on the disorganized/disoriented (Group D) categories of infant, child, and adult attachment. The infant D category is assigned on the basis of interruptions and anomalies in organization and orientation observed during Ainsworth's strange situation procedure. In neurologically normal low-risk samples, D attachment is not substantially related to descriptions of infant temperament, and usually appears with respect to only one parent. At six, former D infants are often found to be role-inverting (D-Controlling) towards the parent, while drawings and separation-related narratives (D-Fearful) suggest continuing states of fear and disorganization. In adults, marked lapses in reasoning and discourse surrounding the discussion of loss or abuse during the Adult Attachment Interview (AAI) causes a transcript to be assigned to Unresolved/disorganized (U/d) adult attachment status, which predicts infant D attachment. Bowlby's theory is extended, with the proposal that certain forms of frightening parental behavior will arouse contradictory biologically channeled propensities to approach and to take flight from the parent. Maltreated infants are therefore highly likely to be disorganized. Also identified are subtler forms of frightening parental behavior (including dissociative behavior and anomalous forms of frightened behavior) that appear to lead to infant disorganization. This suggests that infant D attachment may at times represent a second-generation effect of the parent's own continuing unresolved responses to trauma. Infant D attachment predicts disruptive/aggressive and dissociative disorders in childhood and adolescence, while U/d adult attachment appears frequently in psychiatric and criminal populations. Clinical implications are discussed.

Propensities towards absorption are related to lapses in the monitoring of reasoning or discourse during the adult attachment interview. A preliminary investigation.

Unresolved/disorganized (U) states of mind are identified in the Adult Attachment Interview (AAI) through brief lapses in the monitoring of reasoning or discourse during the discussion of potentially traumatic experiences such as loss or abuse. These lapses have been hypothesized to indicate temporary alterations in normal states of consciousness. In parents, U attachment status predicts a pattern of infant behaviour that is associated with relatively unfavourable outcomes and has been found to be a risk factor for psychopathology in middle childhood and adolescence. In the present study (N = 140), unresolved subjects were found to be significantly elevated on Tellegens' Absorption Scale (TAS) when compared with subjects classified into the remaining adult attachment categories (secure; dismissing; preoccupied; and cannot classify). Additionally, the TAS was significantly correlated with AAI scale scores for lapses in monitoring of reasoning and/or discourse during the discussion of traumatic events. This study appears to provide the first behaviorally anchored correlate of the absorption construct outside of the domain of hypnosis. Some possible developmental origins of propensities towards absorption are discussed, including early abuse experiences and infant disorganized attachment.