Chronic stimulation of the globus pallidus internus for treatment of non-dYT1 generalized dystonia and choreoathetosis: 2-year follow up

OBJECT: The authors studied the long-term efficacy of deep brain stimulation (DBS) of the posteroventral lateral globus pallidus internus up to 2 years postoperatively in patients with primary non-DYT1 generalized dystonia or choreoathetosis. The results are briefly compared with those reported for DBS in DYT1 dystonia (Oppenheim dystonia), which is caused by the DYT1 gene. METHODS: Enrollment in this prospective expanded pilot study was limited to adult patients with severely disabling, medically refractory non-DYT1 generalized dystonia or choreoathetosis. Six consecutive patients underwent follow-up examinations at defined intervals of 3 months, 1 year, and 2 years postsurgery. There were five women and one man, and their mean age at surgery was 45.5 years. Formal assessments included both the Burke-Fahn-Marsden dystonia scale and the recently developed Unified Dystonia Rating Scale. Two patients had primary generalized non-DYT1 dystonia, and four suffered from choreoathetosis secondary to infantile cerebral palsy. Bilateral quadripolar DBS electrodes were implanted in all instances, except in one patient with markedly asymmetrical symptoms. There were no adverse events related to surgery. The Burke-Fahn-Marsden scores in the two patients with generalized dystonia improved by 78 and 71% at 3 months, by 82 and 69% at 1 year, and by 78 and 70% at 2 years postoperatively. This was paralleled by marked amelioration of disability scores. The mean improvement in Burke-Fahn-Marsden scores in patients with choreoathetosis was 12% at 3 months, 29% at 1 year, and 23% at 2 years postoperatively, which was not significant. Two of these patients thought that they had achieved marked improvement at 2 years postoperatively, although results of objective evaluations were less impressive. In these two patients there was a minor but stable improvement in disability scores. All patients had an improvement in pain scores at the 2-year follow-up review. Medication was tapered off in both patients with generalized dystonia and reduced in two of the patients with choreoathetosis. All stimulation-induced side effects were reversible on adjustment of the DBS settings. Energy consumption of the batteries was considerably higher than in patients with Parkinson disease. CONCLUSIONS: Chronic pallidal DBS is a safe and effective procedure in generalized non-DYT1 dystonia, and it may become the procedure of choice in patients with medically refractory dystonia. Postoperative improvement of choreoathetosis is more modest and varied, and subjective ratings of outcome may exceed objective evaluations.

Soziale Dienste, Schule und zivilgesellschaftliches Klima

In an international perspective cooperation between social services and school has a long tradition. In the German speaking countries we can recognize a historical distance or gap between school and “social pedagogy”, but despite this tradition new forms of cooperation are arising since the last few years. This tendency is part of the development of European societies into “knowledge-based societies” where knowledge and cultural capital are becoming ever stricter criteria for participation in society. This puts particular pressure on those adolescents who threaten to fail in the positional competition for educational qualifications. And it tends to the reproduction and reinforcing of social inequalities due to inequalities in education. For that reason in the article the development of school related social services in different European countries is investigated and it is shown that the increasing pressure to qualification and selection in school creates various problems of integration. Social dimensions of education are pointed out delivering starting points for the cooperation of social services in school and opening opportunities for productive forms of coping with differences between family background, informal social environment and educational milieu in school. Particular attention is paid to differences in socio cultural habits, in socio economical opportunities and in collective practices of interaction. A central focus in the contribution is the orientation towards a participative civil society climate relevant for the interaction between teachers and pupils and between professionals and addressees of social services as well. It is a task of future research in school related social services to analyse their institutional structure and their practices of professional interaction and to find out by European and international comparison in which way social services can contribute to the establishing of a participative civil society climate in school.

Injunctions against Innocent Third Parties: The Case of Website Blocking

The paper discusses the phenomenon of injunctions against third parties that are innocent from the tort law perspective. One such type of injunction, website blocking, is currently appearing in the spotlight around various European jurisdictions as a consequence of the implementation of Article 8(3) of the Information Society Directive and Article 11 of the Enforcement Directive. Website-blocking injunctions are used in this paper only as a plastic and perhaps also canonical example of the paradigmatic shift we are facing: the shift from tort-law-centric injunctions to in rem injunctions. The author of this paper maintains that the theoretical framework for the latter injunctions is not in the law of civil wrongs, but in an old Roman law concept of ‘in rem actions’ (actio in rem negatoria). Thus the term ‘in rem injunctions’ is coined to describe this paradigm of injunctions. Besides the theoretical foundations, this paper explains how a system of injunctions against innocent third parties fits into the private law regulation of negative externalities of online technology and explores the expected dangers of derailing injunctions from the tracks of tort law. The author’s PhD project – the important question of the justification of an extension of the intellectual property entitlements by the in rem paradigm, along with its limits or other solutions – is left out from the paper.

Ankle dorsiflexion arthrodesis to salvage Chopart's amputation with anterior skin insufficiency

BACKGROUND In Chopart-level amputations the heel often deviates into equinus and varus when, due to the lack of healthy anterior soft tissue, rebalancing tendon transfers to the talar head are not possible. Consequently, anterior and lateral wound dehiscence and ulceration may occur requiring higher-level amputation to achieve wound closure, with considerable loss of function for the patients. METHODS Twenty-four consecutive patients (15 diabetes, 6 trauma, and 3 tumor) had Chopart's amputation and simultaneous or delayed additional ankle dorsiflexion arthrodesis to allow for tension-free wound closure or soft tissue reconstruction, or to treat secondary recurrent ulcerations. Percutaneous Achilles tendon lengthening and subtalar arthrodesis were added as needed. Wound healing problems, time to fusion and full weight-bearing in the prosthesis, complications in the prosthesis, and the ambulatory status were assessed. Satisfaction and function were evaluated by the AmpuPro score and the validated Prosthesis Evaluation Questionnaire scale. RESULTS Five patients had successful soft tissue healing and fusions but died of their underlying disease 2 to 46 months after the operation. Two diabetic patients required a transtibial amputation. The other 17 patients were followed for 27 months (range, 13-63). The average age of the 4 women and 13 men was 53.9 years (range, 16-87). Postoperative complications included minor wound healing problems in 8 patients, wound breakdown requiring revision in 4, phantom pain in 3, residual equinus in 1, and adjacent scar carcinoma in 1 patient. The time to full weight-bearing in the prosthesis ranged from 6 to 24 weeks (mean 10). The mean AmpuPro score was 107 points (of 120), and the mean Prosthesis Evaluation Questionnaire scale was 147 points (of 200). No complications occurred with the prosthesis. Twelve patients lost 1 to 2 mobility classes (mean 0.9). The arthrodeses all healed within 2.5 months (range, 1.5 to 5 months). CONCLUSION Adding an ankle arthrodesis to a Chopart's amputation either immediately or in a delayed fashion to treat anterior soft tissue complications was a successful salvage in most patients at this amputation level. It enabled the patients to preserve the advantages of a full-length limb with terminal weight-bearing. LEVEL OF EVIDENCE Level IV, retrospective case series.

Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism.

BACKGROUND In patients with acute pulmonary embolism, systemic thrombolysis improves right ventricular (RV) dilatation, is associated with major bleeding, and is withheld in many patients at risk. This multicenter randomized, controlled trial investigated whether ultrasound-assisted catheter-directed thrombolysis (USAT) is superior to anticoagulation alone in the reversal of RV dilatation in intermediate-risk patients. METHODS AND RESULTS Fifty-nine patients (63±14 years) with acute main or lower lobe pulmonary embolism and echocardiographic RV to left ventricular dimension (RV/LV) ratio ≥1.0 were randomized to receive unfractionated heparin and an USAT regimen of 10 to 20 mg recombinant tissue plasminogen activator over 15 hours (n=30; USAT group) or unfractionated heparin alone (n=29; heparin group). Primary outcome was the difference in the RV/LV ratio from baseline to 24 hours. Safety outcomes included death, major and minor bleeding, and recurrent venous thromboembolism at 90 days. In the USAT group, the mean RV/LV ratio was reduced from 1.28±0.19 at baseline to 0.99±0.17 at 24 hours (P<0.001); in the heparin group, mean RV/LV ratios were 1.20±0.14 and 1.17±0.20, respectively (P=0.31). The mean decrease in RV/LV ratio from baseline to 24 hours was 0.30±0.20 versus 0.03±0.16 (P<0.001), respectively. At 90 days, there was 1 death (in the heparin group), no major bleeding, 4 minor bleeding episodes (3 in the USAT group and 1 in the heparin group; P=0.61), and no recurrent venous thromboembolism. CONCLUSIONS In patients with pulmonary embolism at intermediate risk, a standardized USAT regimen was superior to anticoagulation with heparin alone in reversing RV dilatation at 24 hours, without an increase in bleeding complications. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01166997.

Animal Guts as Ideal Chemical Reactors: Maximizing Absorption Rates

I solved equations that describe coupled hydrolysis in and absorption from a continuously stirred tank reactor (CSTR), a plug flow reactor (PFR), and a batch reactor (BR) for the rate of ingestion and/or the throughput time that maximizes the rate of absorption (=gross rate of gain from digestion). Predictions are that foods requiring a single hydrolytic step (e.g., disaccharides) yield ingestion rates that vary inversely with the concentration of food substrate ingested, whereas foods that require multiple hydrolytic and absorptive reactions proceeding in parallel (e.g., proteins) yield maximal ingestion rates at intermediate substrate concentrations. Counterintuitively, then, animals acting to maximize their absorption rates should show compensatory ingestion (more rapid feeding on food of lower concentration), except for the lower range of diet quality fur complex diets and except for animals that show purely linear (passive) uptake. At their respective maxima in absorption rates, the PFR and BR yield only modestly higher rates of gain than the CSTR but do so at substantially lower rates of ingestion. All three ideal reactors show milder than linear reduction in rate of absorption when throughput or holding time in the gut is increased (e.g., by scarcity or predation hazard); higher efficiency of hydrolysis and extraction offset lower intake. Hence adding feeding costs and hazards of predation is likely to slow ingestion rates and raise absorption efficiencies substantially over the cost-free optima found here.

Consecutive series of 226 journey bicruciate substituting total knee replacements: early complication and revision rates

BACKGROUND The Journey bicruciate substituting (BCS) total knee replacement (TKR) is intended to improve knee kinematics by more closely approximating the surfaces of a normal knee. The purpose of this analysis was to address the safety of Journey BCS knees by studying early complication and revision rates in a consecutive case series. METHODS Between December 2006 and May 2011, a single surgeon implanted 226 Journey BCS total knee prostheses in 191 patients (124 women, 67 men) who were eligible for study. Mean age at surgery was 68 years (41-85 years).Outcome measures were early complications and minor and major revision rates. All complications were considered, irrespective of whether conservative treatment or revision was required. RESULTS The average implantation time was 3.5 years (range 1.3-5.8 years). Thirty-three complications (14.6% of 226 knees) required minor or major revision surgery in 25 patients. The remaining eight patients were treated conservatively. Sixteen minor revisions were performed in 12 patients. Thirteen major revisions were required in 13 patients, which results in a rate of 1.65 major revisions per 100 component years. The linear trend of the early complication rate by treatment year was not significant (p = .22).Multivariate logistic regression showed no significant predictors for the occurrence of a complication or for revision surgery. A tendency towards higher complication rates was observed in female patients, although it was not significant (p = .066). CONCLUSIONS The complication and revision rates of the Journey BCS knee implant are high in comparison with those reported for other established total knee systems. Caution is advised when using this implant, particularly for less experienced knee surgeons.

Stability and kinetics of nucleic acid triplexes with chimaeric DNA/RNA third strands

A series of chimaeric DNA/RNA triplex-forming oligonucleotides (TFOs) with identical base-sequence but varying sequential composition of the sugar residues were prepared. The structural, kinetic and thermodynamic properties of triplex formation with their corresponding double-helical DNA target were investigated by spectroscopic methods. Kinetic and thermodynamic data were obtained from analysis of non-equilibrium UV-melting- and annealing curves in the range of pH 5.1 to 6.7 in a 10 mM citrate/phosphate buffer containing 0.1M NaCl and 1 mM EDTA. It was found that already single substitutions of ribo- for deoxyribonucleotides in the TFOs greatly affect stability and kinetics of triplex formation in a strongly sequence dependent manner. Within the sequence context investigated, triplex stability was found to increase when deoxyribonucleotides were present at the 5'-side and ribonucleotides in the center of the TFO. Especially the substitution of thymidines for uridines in the TFO was found to accelerate both, the association and dissociation process, in a strongly position-dependent way. Differential structural information on triplexes and TFO single-strands was obtained from CD-spectroscopy and gel mobility experiments. Only minor changes were observed in the CD spectra of the triplexes at all pH values investigated, and the electrophoretic mobility was nearly identical in all cases, indicating a high degree of structural similarity. In contrast, the single-stranded TFOs showed high structural variability as determined in the same way. The results are discussed in the context of the design of TFOs for therapeutic or biochemical applications.

Evaluation of cell responses toward adhesives with different photoinitiating systems

OBJECTIVES The photoinitiator diphenyl-(2,4,6-trimethylbenzoyl)phosphine oxide (TPO) is more reactive than a camphorquinone/amine (CQ) system, and TPO-based adhesives obtained a higher degree of conversion (DC) with fewer leached monomers. The hypothesis tested here is that a TPO-based adhesive is less toxic than a CQ-based adhesive. METHODS A CQ-based adhesive (SBU-CQ) (Scotchbond Universal, 3M ESPE) and its experimental counterpart with TPO (SBU-TPO) were tested for cytotoxicity in human pulp-derived cells (tHPC). Oxidative stress was analyzed by the generation of reactive oxygen species (ROS) and by the expression of antioxidant enzymes. A dentin barrier test (DBT) was used to evaluate cell viability in simulated clinical circumstances. RESULTS Unpolymerized SBU-TPO was significantly more toxic than SBU-CQ after a 24h exposure, and TPO alone (EC50=0.06mM) was more cytotoxic than CQ (EC50=0.88mM), EDMAB (EC50=0.68mM) or CQ/EDMAB (EC50=0.50mM). Cultures preincubated with BSO (l-buthionine sulfoximine), an inhibitor of glutathione synthesis, indicated a minor role of glutathione in cytotoxic responses toward the adhesives. Although the generation of ROS was not detected, a differential expression of enzymatic antioxidants revealed that cells exposed to unpolymerized SBU-TPO or SBU-CQ are subject to oxidative stress. Polymerized SBU-TPO was more cytotoxic than SBU-CQ under specific experimental conditions only, but no cytotoxicity was detected in a DBT with a 200μm dentin barrier. SIGNIFICANCE Not only DC and monomer-release determine the biocompatibility of adhesives, but also the cytotoxicity of the (photo-)initiator should be taken into account. Addition of TPO rendered a universal adhesive more toxic compared to CQ; however, this effect could be annulled by a thin dentin barrier.

Rapid temperature-dependent wound closure following adipose fin clipping of Atlantic salmon Salmo salar L.

Three groups of Atlantic salmon were kept at a constant temperature of 4, 10 and 14 °C. The adipose fins were removed; six fish/group were sampled at 11 subsequent time points post-clipping. Samples were prepared for histopathological examination to study the course of re-epithelization. A score sheet was developed to assess the regeneration of epidermal and dermal cell types. Wounds were covered by a thin epidermal layer between 4 and 6 h post-clipping at 10 and 14 °C. In contrast, wound closure was completed between 6 and 12 h in fish held at a constant temperature of 4 °C. By 18 h post-clipping, superficial cells, cuboidal cells, prismatic basal cells and mucous cells were discernible in all temperature groups, rapidly progressing towards normal epidermal structure and thickness. Within the observation period, only minor regeneration was found in the dermal layers. A positive correlation between water temperature and healing rates was established for the epidermis. The rapid wound closure rate, epidermal normalization and the absence of inflammatory reaction signs suggest that adipose fin clipping under anaesthesia constitutes a minimally invasive method that may be used to mark large numbers of salmon presmolts without compromising fish welfare.

Sedimentology of ODP Leg 119 samples

Cretaceous to Quaternary sediments recovered at Leg 119 Sites 738 and 744 on the southern tip of the Kerguelen Plateau were studied in order to determine the depositional environment and the paleoceanography of the southern Indian Ocean and especially the long-term glacial history of East Antarctica. Emphasis is given to bulk-sediment composition, grain-size data, and clay mineralogy. The sediment sequence at the two sites is generally of a highly pelagic character, with nannofossil oozes, chalks, and limestones dominant from the Turanian to upper Miocene and diatom oozes dominant within the uppermost Miocene to Holocene interval. The first indication of glaciation at sea level is the occurrence of isolated gravel and terrigenous sand grains, which indicate ice rafting in the middle Eocene interval of 45.0-42.3 Ma. A major intensification of glaciation, probably the onset of continental East Antarctic glaciation, is recorded in sediments of early Oligocene age (36.0 Ma). All major sediment parameters document this event. The clay mineralogy changes from smectite-dominated assemblages, typical of moderately warm and humid climatic conditions in which chemical weathering processes are prevalent, to illite- and chlorite-dominated assemblages, indicative of cooler climates and physical weathering. Ice-rafted debris of both gravel and sand size occurs in large quantities in that interval and coincides with a change in the mode of carbonate deposition. Carbonate contents are relatively high and uniform (90%-95%) in strata younger than early Oligocene; in Oligocene to upper Miocene strata they fluctuate between 65% and 95%. Oligocene and Neogene hiatuses reflect an intensification of oceanic circulation and the increased erosional force of Circumpolar Deep Water. The long-term Cenozoic cooling trend was interrupted by a phase of early Miocene warming indicated by maximum Neogene smectite concentrations. Although ice-rafted debris is present only in minor amounts and mainly in the silt fraction of early Oligocene to late Miocene age, it shows that glaciers advanced to the East Antarctic shoreline throughout that time. Ice-rafting activity drastically increased in latest Miocene time, when carbonate deposition decreased and diatom ooze sedimentation started. This suggests a pronounced intensification of Antarctic glaciation combined with a northward migration of the Polar Front.

Voces y miradas. Agentes sociales indígenas en el entramado judicial : Ciudad y campaña de Buenos Aires en el período tardocolonial

Este trabajo se ocupa de examinar el accionar de los agentes sociales indígenas atrapados en el entramado judicial, ya sea en calidad de damnificados o sospechados de un delito, en la campaña y a ciudad de Buenos Aires hacia fines del período colonial. El objetivo es indagar en la configuración y resolución de los conflictos que involucren a indígenas, observando tanto su posicionamiento como el de los agentes judiciales, eclesiásticos o particulares con cierto poder en el ámbito local que se encuentren involucrados en estas causas. Este análisis nos facilitará la entrada al entretejido social de la época, proporcionándonos claves para comprenderlo, a la vez que develará una diversidad de voces y miradas implicadas en el proceso de configuración y judicialización de los delitos

"Como a señor natural" : Interpretaciones políticas del Cantar de Mio Cid

El artículo replantea bajo otra luz la proximidad del Cantar de mio Cid a ciertos hechos históricos de su tiempo, tomando en consideración un concepto político central en el texto que, de alguna forma, aflora en relación con las revueltas burguesas del siglo xii: el concepto de señor natural, que aparece cinco veces a lo largo del poema. Lo que sugiere la aparición del término, en documentos a comienzos del siglo XII, es que el concepto de señor natural se desarrolló en el marco de las revueltas burguesas (con las que Molho y Catalán ligan el espacio del Cantar, aunque justamente representa una posición política contraria a la de los burgueses y caballeros pardos), como un mecanismo para defender la legitimidad del rey y desposeer las aspiraciones de los sublevados. En el Cantar, la función de la idea de señor natural apunta a la sustitución de un orden previo, dominado exclusivamente por el vasallaje, por uno nuevo en el que tal idea se nivela con la de naturaleza, y propicia una mayor justicia social. La naturaleza, vista ahora como fundamento de la organización política, permite al Cid recuperar su posición en la corte y evita que sea meramente un príncipe independiente.

Voces y miradas. Agentes sociales indígenas en el entramado judicial : Ciudad y campaña de Buenos Aires en el período tardocolonial

Este trabajo se ocupa de examinar el accionar de los agentes sociales indígenas atrapados en el entramado judicial, ya sea en calidad de damnificados o sospechados de un delito, en la campaña y a ciudad de Buenos Aires hacia fines del período colonial. El objetivo es indagar en la configuración y resolución de los conflictos que involucren a indígenas, observando tanto su posicionamiento como el de los agentes judiciales, eclesiásticos o particulares con cierto poder en el ámbito local que se encuentren involucrados en estas causas. Este análisis nos facilitará la entrada al entretejido social de la época, proporcionándonos claves para comprenderlo, a la vez que develará una diversidad de voces y miradas implicadas en el proceso de configuración y judicialización de los delitos

"Como a señor natural" : Interpretaciones políticas del Cantar de Mio Cid

El artículo replantea bajo otra luz la proximidad del Cantar de mio Cid a ciertos hechos históricos de su tiempo, tomando en consideración un concepto político central en el texto que, de alguna forma, aflora en relación con las revueltas burguesas del siglo xii: el concepto de señor natural, que aparece cinco veces a lo largo del poema. Lo que sugiere la aparición del término, en documentos a comienzos del siglo XII, es que el concepto de señor natural se desarrolló en el marco de las revueltas burguesas (con las que Molho y Catalán ligan el espacio del Cantar, aunque justamente representa una posición política contraria a la de los burgueses y caballeros pardos), como un mecanismo para defender la legitimidad del rey y desposeer las aspiraciones de los sublevados. En el Cantar, la función de la idea de señor natural apunta a la sustitución de un orden previo, dominado exclusivamente por el vasallaje, por uno nuevo en el que tal idea se nivela con la de naturaleza, y propicia una mayor justicia social. La naturaleza, vista ahora como fundamento de la organización política, permite al Cid recuperar su posición en la corte y evita que sea meramente un príncipe independiente.