The evolution of bicontinuous polymeric nanospheres in aqueous solution

Complex polymeric nanospheres in aqueous solution are desirable for their promising potential in encapsulation and templating applications. Understanding how they evolve in solution enables better control of the final structures. By unifying insights from cryoTEM and small angle X-ray scattering (SAXS), we present a mechanism for the development of bicontinuous polymeric nanospheres (BPNs) in aqueous solution from a semi-crystalline comb-like block copolymer that possesses temperature-responsive functionality. During the initial stages of water addition to THF solutions of the copolymer the aggregates are predominantly vesicles; but above a water content of 53% irregular aggregates of phase separated material appear, often microns in diameter and of indeterminate shape. We also observe a cononsolvency regime for the copolymer in THF-water mixtures from 22 to 36%. The structured large aggregates gradually decrease in size throughout dialysis, and the BPNs only appear upon cooling the fully aqueous dispersions from 35 °C to 5 °C. Thus, the final BPNs are ultimately the result of a reversible temperature-induced morphological transition.

[Olfactory function after transsphenoidal pituitary surgery]

Pituitary surgery remains mainly performed trough a transnasal, transseptal and transsphenoidal way. This surgical approach can damage intranasal structures and, in particular, may impede olfactory function. Our study investigates olfactory function in 67 patients undergoing this type of surgery before and 3 months after surgery. Mean olfactory scores were identical pre- and postoperatively. However, on an individual bases seven percent of the patients showed a clear decrease in olfactory function. In conclusion, transnasal, transseptal and transsphenoidal surgery is relativelv safe with regards to olfactory function

Solid State and Dissolution Rate Characterization of Co-Ground Mixtures of Nifedipine and Hydrophilic Carriers

Co-ground powders of the poorly water-soluble drug nifedipine and a hydrophilic carrier, [partially hydrolyzed gelatin (PHG), polyvinylpyrrolidone (PVP), sodium dodecyl sulfate (SDS), hydroxypropyl methylcellulose (HPMC), polyethylene glycol (PEG), urea or Pluronic F108] were prepared in order to improve the dissolution rate of nifedipine. The effects of type of grinding equipment, grinding time, and type of hydrophilic carrier on the crystallinity of nifedipine (x-ray diffraction and differential scanning calorimetry) on the interaction between drug and carriers (differential scanning calorimetry), on the particle size and appearance (scanning electron microscopy), on the wettability (contact angle measurements), and on the drug release were investigated. Grinding nifedipine together with these carriers improved the dissolution rate. PHG-ground mixtures resulted in the fastest dissolution rate followed by PVP, SDS, HPMC, Pluronic, urea, and PEG. This effect was not only due to particle size reduction, which increased in the order PHG<PEG=SDS<Pluronic<drug<urea<HPMC<PVP, but also resulted from the ability of some carriers (PVP and HPMC) to prevent reaggregation of the finely divided drug particles. PVP, HPMC, and PHG formed a powder with amorphous drug. The carriers improved the wettability of the ground products in the order HPMC<drug<urea<PVP<SDS<PHG<PEG<Pluronic. Differential scanning calorimetry (DSC) measurements gave valuable information about the nature of drug crystallinity and the interactions with the carriers within the ground mixtures.

[The mallet finger in children and adolescents]

The "mallet finger" in childhood and adolescence differs from the "mallet finger" in adults because of an open or gradually closing epiphysial plate. Thus, our results of conservative and operative treatment were evaluated particularly in consideration of an open growth plate. We analysed retrospectively the data of all patients who suffered a lesion at the extensor tendon insertion between 1996 and 2005 and were treated at our hospital. The coding was done according to age, sex, localisation, typing by Doyle, therapy and functional outcome. The typing by Doyle was extended through dividing type IV A into A1 (=Aitken I) and A2 (=Aitken II). Depending on extension deficits, the results were evaluated as very good (0 degrees ), medium (<15 degrees) and bad (>15 degrees). 76 patients, 45 boys and 31 girls aged 1 to 17 years (average age: 11.3) were studied. In consideration of the modified typing by Doyle, following distribution arose: type I (n=16), type II (n=14), type III (n=0), type IV A1 (n=17), type IV A2 (n=6), type IV B (n=21) and type IV C (n=2). A total of 50 patients was treated conservatively. Out of 26 operatively treated patients, 4 could be classified as type I, 12 as type II, 1 as type IV A1, 2 as type IV A2, 5 as type IV B, and 2 as type IV C. In 81.5 % of all patients no functional extension deficit was seen at the end of treatment; in patients treated conservatively, the percentage rate was 94 %. 6 patients, who were treated primarily operatively, showed poor functional outcome. 2 of these developed a suture track infection, in 2 cases chondral and osseous damage in the joint existed additionally, in one patient there was a comminuted fracture and in one patient a technical operative problem. Even in adolescence, conservative treatment of types I, IV A1 and A2, as well as IV B injuries is promising. A prerequisite is a consequent splint treatment and strict regular lateral X-ray control of the fracture fragment. At the beginning of treatment, we favour a plaster finger splint at an intrinsic plus position with hyperextension in the DIP joint.

Autonomic Information Flow during awakeness, sleep, and multiple organ dysfunction syndrome assessed by mutual information function of heart rate fluctuations

The Autonomic Information Flow (AIF) represents the complex communication within the autonomic nervous system (ANS). It can be assessed by the mutual information function (MIF) of heart rate fluctuations (HRF). AIF represented by HRF is based on several interacting physiological mechanisms operating at different time scales. Therefore one prominent time scale for HRF complexity analysis is not given a priori. MIF reflects the information flow at different time scales. This allows a more specific characterization of the complex communication leading to dynamic stability (homeostasis) of the cardiovascular-respiratory system. Three clinically relevant examples of autonomic communication, namely AIF of normals during awake state and deep sleep, and of patients with multiple organ dysfunction syndrome (MODS) were investigated. In these states MIF clearly represents and distinguishes the different communication in dependence on the time scale of information transfer. The results confirm our systems-theoretical concept that AIF, represented by MIF, characterizes the complex communication of the ANS at different time scales.

Hidden markov models and mutual information analysis to characterize nonlinear dynamics in heart rate variability

A study of nonlinear dynamics of the heart rate variability (HRV) was performed using hidden Markov models (HMM) and Mutual Information (MI). A methodology based on HMM has been developed in the present work. Cardiac RR series were analyzed in the three frequency bands: HF (0.15-0.45Hz), high frequency band; LF (0.04-0.15Hz), low frequency band; VLF (0.003-0.04Hz), very low frequency band. These series (0, observations) were modeled using HMM. The model &#955;=(A,B,&#8719;) was selected so that P(O/&#955;) was locally maximized. Ergodic topology and N=10 states were also considered for this analysis. Different measures based on HMM were defined and obtained from RR time series of 37 Idiopathic Dilated Crdiomyopathy (IDC) patients and 46 healthy subjects (NRM), during awake and sleep stages. Two groups of IDC patients were considered: 11 high risk (HR) patients, after aborted sudden cardiac death (SCD) or who died during the follow up; 26 low risk (LR) patients, without SCD. Some HMM measures showed high percentages (up to 100%) of well classified subjects in all groups.

The Faces Symbol Test, a newly developed screening instrument to assess cognitive decline related to multiple sclerosis: first results of the Berlin Multi-Centre FST Validation Study

Reliable, language-independent, short screening instruments to test for cognitive function in patients with multiple sclerosis (MS) remain rare, despite the high number of patients affected by cognitive decline. We developed a new, short screening instrument, the Faces Symbol Test (FST), and compared its diagnostic test characteristics with a composite of the Digit Symbol Substitution Test (DSST) and the Paced Auditory Serial Addition Test (PASAT), in 108 MS patients and 33 healthy controls. An Informant-Report Questionnaire, a Self-Report Questionnaire, and a neurologist's estimation of the Every Day Life Cognitive Status were also applied to the MS patients. The statistical analyses comprised of a receiver operating characteristic analysis for test accuracy and for confounding variables. The PASAT and DSST composite score estimated that 36.5% of the MS patients had cognitive impairment. The FST estimated that 40.7% of the MS patients were cognitively impaired (sensitivity 84%; specificity 85%). The FST, DSST and PASAT results were significantly correlated with the patients' physical impairment, as measured by the Expanded Disability Status Scale (EDSS). The results suggest that the FST might be a culture-free, sensitive, and practical short screening instrument for the detection of cognitive decline in patients with MS, including those in the early stages. Multiple Sclerosis 2007; 13: 402-411. http://msj.sagepub.com

Comparison of intensity distributions in tomograms from BF TEM, ADF STEM, HAADF STEM, and calculated tilt series

The three-dimensional (3D) morphology of a nanometer-sized object can be obtained using electron tomography. Variations in composition or density of the object cause variations in the reconstructed intensity. When imaging homogeneous objects, variations in reconstructed intensity are caused by the imaging technique, imaging conditions, and reconstruction. In this paper, we describe data acquisition, image processing, and 3D reconstruction to obtain and compare tomograms of magnetite crystals from bright field (BF) transmission electron microscopy (TEM), annular dark-field (ADF) scanning transmission electron microscopy (STEM), and high-angle annular dark field (HAADF) STEM tilt series. We use histograms, which plot the number of volume elements (voxels) at a given intensity vs. the intensity, to measure and quantitatively compare intensity distributions among different tomograms. In combination with numerical simulations, we determine the influence of maximum tilt angle, tilt increment, contrast changes with tilt (diffraction contrast), and the signal-to-noise ratio (SNR) as well as the choice of the reconstruction approach (weighted backprojection (WB) and sequential iterative reconstruction technique (SIRT)) on the histogram. We conclude that because ADF and HAADF STEM techniques are less affected by diffraction, and because they have a higher SNR than BF TEM, they are better suited for tomography of nanometer-sized crystals.

Quasi-monoenergetic neutron reference fields in the energy range from thermal to 200 MeV

Well-characterised neutron fields are a prerequisite for the investigation of neutron detectors. Partly in collaboration with external partners, the PTB neutron metrology group makes available for other users neutron reference fields covering the full energy range from thermal to 200 MeV. The specification of the neutron fluence in these beams is traceable to primary standard cross sections.

Die Behandlung von Beugesehnenverletzungen im Kindesalter

Full functional recovery must always be the aim of flexor tendon reconstruction. This not only applies to adults, but particularly to infants. As customary, also in a child a severed flexor tendon should be attended immediately or with only a short delay. However, we definitively reject a bandaged fist of a hand and rather recommend demobilization by a modified Kleinert plaster. At the University Clinic for Paediatric Surgery in Graz over ten years ago we established a therapeutic protocol dedicated to infants, which we evaluated recently. In this study questions addressed were whether this treatment regimen is applicable for all age groups, notably whether the dynamic post operative treatment with a modified Kleinert plaster is always advisable. A total of 211 severed flexor tendons in children from nine months to 18 years (median 7 years) were treated. 193 lesions were either reconstructed immediately or within 48 hours. As a rule we apply the Kirchmayr-Zechner suturing procedure. We believe that the desired full mobility can thus be obtained within three months. In 95% of the 173 cases followed-up we achieved this goal with good or even excellent results according to Buck-Gramcko's criteria.

[Dynamic splinting after flexor tendon injuries of the hand in childhood]

Ninety severed flexor tendons were repaired in 24 boys and 14 girls in a four-year-period at the Department of Pediatric Surgery in Graz. Mean age was 4.9 years. In 16 patients (42%) additional lesions were found. Direct repair was performed with modified techniques of Kirchmayr (23) or Kleinert (8). In four fingers, flexor tendon reconstructions were carried out. Postoperatively, the dynamic Kleinert splint was used for early nonresistive motion, beginning on average on the second postoperative day. Intensive training of motion was performed in physiotherapeutic sessions during a mean period of five months, postoperatively. In five cases tenolysis was performed; in one case a rupture of a sutured tendon had to be corrected. 27 patients (71%) with 42 injured fingers were followed-up on average 2.7 years after the operation. In accordance with the Buck-Gramcko classification, very good results were achieved in 37 cases (88%), and a poor result in one patient (2%). Atraumatic technique, dynamic splinting, consequent physiotherapeutic training by experienced physiotherapists, and well informed parents will yield excellent results after flexor tendon repair in the paediatric age group.

Analysis of the 5'-flanking regions of the MHC-linked Hsp70-2 and Hsp70-3 genes of the rat

We have analyzed the genomic interval between the MHC-linked heat shock protein 70 (Hsp70) genes Hsp70-2 and Hsp70-3 in the rat. The distance between the transcription start sites of both genes which are organized in a head-to-head orientation is 604 bp. Unlike Hsp70-2 the 5'untranslated region of Hsp70-3 is interrupted by an intron of about 3.9 kb. The Hsp70-3 promoter lacks a TATA box and heat shock elements, but contains two CRE elements, one Sp1-GC and two PuF binding sites. Analysis of the Hsp70-2 promoter by CAT assays reveals positive and negative regulatory elements extending into the Hsp70-3 gene.

Endogenous alkaloids in man. XXVI. Determination of the dopaminergic neurotoxin 1-trichloromethyl-1,2,3,4-tetrahydro-beta-carboline (TaClo) in biological samples using gas chromatography with selected ion monitoring

Highly chlorinated beta-carbolines have a potential in vivo relevance to Parkinson's disease. In this paper, a gas chromatographic method for the determination of the neurotoxic 1-trichloromethyl-1,2,3,4-tetrahydro-beta-carboline (TaClo), the condensation product of tryptamine and chloral hydrate, is described. The specific and sensitive assay involves purification of the biological samples by solid-phase extraction with C18 cartridges, derivatization with heptafluorobutyric anhydride, and chromatography on a non-polar fused-silica capillary column. Detection of TaClo was achieved by the registration of characteristic mass fragments of the TaClo heptafluorobutyric amide derivative using selected ion monitoring. The method was utilized to detect and quantify TaClo in blood, urine, bile, faeces, and brain tissue of rats treated with this alkaloid-type heterocycle. Four-fold deuterium-labelled TaClo was used as an internal standard.

[Physical complaints, stress and quality of life of oncologic patients. Effects and patient assessment in inpatient rehabilitation]

AIM

To what extent do cancer patients use an inpatient aftercare programme and how is its effect been estimated by them? How is the progress of "general physical complaints", "psychosocial stress" and "satisfaction with life" in some cases over a period of up to eight months?

PATIENTS AND METHODS

To 201 patients with breast or intestinal cancer respectively, who were going to be or had already been admitted to an inpatient aftercare, standardised and unstandardized questionnaire were presented to be filled out at 4 or 5 different dates before and during the programme as well as 3 and 6 months later.

RESULTS

Many patients tried to take part in the aftercare programme actively. Even 6 months later 95.6% estimated it as being "successful" and 70% said that there had been a lasting positive effect after the treatment. The "general physical complaints" and "psychosocial stress" grew significantly less during the inpatient aftercare programme and "satisfaction with life" improved. After the treatment these effects were declining again.

CONCLUSIONS

The results indicate that many patients, who participate in an inpatient aftercare programme, profit by it directly. As the positive effects partially get lost during the following months, the patients should be prepared more intensely for the time after dismission with its higher level of strain and should get an especially attentive ambulant care at home.

Consumer product branding strategy and the marketing of physicians' services

Hospitals have traditionally maintained physician referral programs as a means of attracting physicians to their network of affiliated providers. The advent of managed care and impending healthcare reform has altered the relationship of hospitals and physicians. An exploratory study of marketing approaches used by twelve healthcare organizations representing twenty-five hospitals in a large city was conducted. Strategies encountered in the study ranged from practice acquisition to practice promotion. This study suggests that healthcare providers might adopt consumer product branding strategies to secure market-share, build brand equity, and improve profitability.