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The purpose was to compare systematically the legibility of a font without serifs (Helvetica) and one with serifs (Times New Roman).Three paragraphs that were equal in the number of words, syllables, characters, difficulty and reading length were printed at equal size, with equal spacing between the lines and equal layout (paperback style), in either the sans serif typeface Helvetica Neue T1 55 Roman (Adobe) or the serif typeface Times New Roman PS Roman (Adobe). They were also printed in newspaper format in the serif font. The paragraphs were presented in random order (Latin square design) to 36 participants between 18 and 38 years of age (wearing their best-corrected visual acuity). Reading duration was measured with a stopwatch. Reading time, reading speed and the number of reading errors were compared.For the paperback layout, no significant difference in reading time (p = 0.50) or reading speed (p = 0.56) was found between the two fonts. The correlation between the two fonts was high for both reading time and speed (r = 0.93). The mean number of reading errors was the same (0.31 ± 0.58 errors/text) for both fonts. There was a significant difference in reading time and speed between the paperback and the newspaper layout.The legibility of Helvetica and Times New Roman is similar when investigated under equivalent conditions. Thus, these two font types can be used as interchangeable standard typefaces.

Purpose To investigate the effect of font choice on reading parameters by using the RADNER Reading Charts printed in two fonts (Helvetica vs. Times Roman) equalized in terms of x-height. Methods This is a cross-sectional study of 40 participants with healthy eyes (18 to 60 years of age; mean: 42.13 ± 12.28 years). Reading performance was evaluated binocularly with RADNER Reading Charts printed in either Helvetica Neue (T1) Roman sans serif (Adobe) or Times New Roman PS Roman serif (Adobe). The test distance was 40 cm. Reading charts were presented in random order. Reading acuity (RA), mean reading speed of all sentences read (MEAN-ALL RS), mean reading speed from 0.8 logRAD to 0.3 logRAD (MEAN-RS), maximum reading speed (MAX-RS), and critical print size (CPS) were compared. Results The RA values obtained for the Helvetica and Times Roman fonts (in full logarithmic units of 0.1 logRAD) did not differ between the two fonts (mean for both fonts: − 0.128 ± 0.064 logRAD; 95% CI for both: − 0.148; − 0.107 logRAD). The differences in all other reading parameters between the two fonts were small and not statistically significant. The analyses revealed narrow confidence intervals and good coefficients of reliability. Except for the CPS (r = 0.49) and RA (equal for Helvetica and Times Roman), the correlations for all parameters were high, ranging from r = 0.92 to r = 0.98. Conclusion The equivalent reading performance obtained with Helvetica and Times Roman (when equalized in x-height and layout) makes these font types interchangeable as standards for reading charts.

Background Navigated computer-assisted total knee arthroplasty (TKA) was introduced to expedite long-term survival based on improved postoperative implantation accuracy. However, long-term outcome data after 10 years or more are rare, even available meta-analyses show controversial study results. Methods In a prospective randomized trial, 100 conventional TKAs (group CONV) were compared with 100 computer-assisted TKAs (group NAV) after a mean follow-up of 12 years postoperatively. A long-leg weight-bearing X-ray was performed for measuring mechanical axis of the limb, lateral distal femoral angle, and medial proximal tibial angle. Tibial slope, patella alpha angle, and radiolucent lines were also observed. Clinical investigation included evaluation of 4 different scores: Insall Knee Score, Western Ontario and MacMaster University Index score, Hospital for Special Surgery Knee Score, and visual analog scale. Results Based on a follow-up rate of at least 75%, no difference in TKA survival was found 12 years postoperatively: 91.5% in group CONV vs 98.2% in group NAV (P = .181). Since 5-year follow-up, no additional TKA revision had been performed in both groups. Group CONV showed a nonsignificant higher inaccuracy of neutral lower limb axis (1.8° ± 1.4°) compared to group NAV (1.6° ± 1.7°, P = .700). All X-ray assessments were not significant different within both study groups (P ≥ .068). Clinical examination showed no differences in evaluations (P ≥ .204). All collected outcome score results were similar (P ≥ .222). Conclusion Twelve years postoperatively, no differences were found in terms of long-term survival, implantation accuracy, clinical outcome or score results.

Objective Navigated computer-assisted total knee arthroplasty (TKA) shows inconclusive mid- to long-term outcome results and is limited by increased costs, surgery-time and an additional learning curve. We introduced a treatment algorithm preserving computer-assisted TKA for patients with adipositas-per-magna, posttraumatic leg-deformities, osteosynthetic material in-situ or reduced preoperative X-ray quality. Methods 237 primary unilateral TKA were allocated based on the treatment concept described above. A retrospective pre- and postoperative radiological analysis was performed. Results 222 TKA (93.7%) were within 3° varus/valgus of mechanical-lower-limb axis (mean absolute deviation: 1.8° ± 1.3°). Conclusion This algorithm showed an excellent postoperative implantation-accuracy based on an accurate preoperative surgery-planning.

PurposeTo assess age-related differences in baseline measures of reading performance obtained from the RADNER Reading Charts in healthy eyes with best corrected (ETDRS) distance acuity.MethodsCross-sectional study of participants (n=200) aged 25–74 years (n=20 per 5 years age group). Best corrected distance visual acuity was measured monocularly with ETDRS 2000 Charts. Reading performance was evaluated binocularly with the RADNER Reading Charts. Reading acuity (RA), reading acuity score (RA score), mean reading speed (MEAN-RS), maximum reading speed, reading speed with a long paragraph, critical print size (CPS) and the logMAR/logRAD ratio were analysed.ResultsRA, RA score, CPS-1 (last logRAD with normal reading speed) and ETDRS acuity did not change significantly between age 25 and 54 years. Overall, the mean RA was −0.091±0.07 logRAD, and the RA score was −0.069±0.07 logRAD. The mean difference between the RA and best ETDRS acuity was 0.0603±0.055 logMAR (r=0.62; pConclusionBest corrected RA, reading speed and ETDRS distance acuity were constant until the age of 54 years. An age-related break point was found between the groups aged 50–54 years and 55–59 years; for reading speed, the break point can be assumed to be within the age range of 50–54 years.

Dear Editor, We have read with interest the article of Alpeter et al. We appreciate the fact that they compared their reading speed determination with sentences derived from the RADNER Reading Charts [1, 2]. However, our reading charts were never designed to determine reading speed based on just a single sentence; this limited use is methodologically incorrect, and the comparison is therefore not appropriate. Further remarks regarding their analysis are provided below. The RADNER Reading Charts were designed for clinical and research use, providing a number of different reading parameters from a single examination in patients with normal to low vision [e.g., 1–3]. These reading charts offer standardized “sentence optotypes” [e.g., 1] that logarithmically progress in print size (Fig. 1). The sentence optotypes, developed in 11 different languages, have been standardized by reliability and validity analyses in 1,253 individuals involving over 42,000 measurements. The reliability of the RADNER Reading Charts has been analyzed by a test–retest protocol (interval, 3–4 weeks), interchart reliability analysis, and variant component analysis (randomized, orthogonal Latin square design) [2, 3]. Fig. 1 The RADNER Reading Charts, currently available in German, English, French, Spanish, Portuguese, Dutch, Italian, Danish, Swedish, Hungarian, and Turkish The sentences optotypes have consistently given correlations of r ≈ 0.9 with long paragraphs. Analyzing different reading parameters (such as reading acuity, mean and maximum reading speed, and critical print size, among others, has proven advantageous in evaluating specific alterations of reading performance in different eye diseases [e.g., 4–8]. The RADNER Reading Charts have been used incorrectly in the study of Alpeter et al. All RADNER Reading Charts come with clear instructions included in the booklet, informing an examiner how to use them and how to reduce inaccuracies. The unusually high number of outliers among the 30 patients (who read only three sentences each) in the paper of Alpeter et al. suggests that the readers had not been instructed correctly. It is inappropriate that the participants recruited were friends and relatives of co-workers. In addition, there was no randomization. There is incongruence between the results and our data. Using the data from a recent study (Radner et al., publication submitted) we calculated the correlations among seven sentence optotypes (font: Times Roman, 12 Pt), as measured in 60 normally sighted persons (Table ​(Table1).1). Our results offer a higher correlation (r = 0.775 to r = 0.909; p

Navigated computer-assisted total knee arthroplasty (TKA) was introduced to expedite long-term survival based on improved postoperative implantation accuracy. However, long-term outcome data after 10 years or more are rare, even available meta-analyses show controversial study results.In a prospective randomized trial, 100 conventional TKAs (group CONV) were compared with 100 computer-assisted TKAs (group NAV) after a mean follow-up of 12 years postoperatively. A long-leg weight-bearing X-ray was performed for measuring mechanical axis of the limb, lateral distal femoral angle, and medial proximal tibial angle. Tibial slope, patella alpha angle, and radiolucent lines were also observed. Clinical investigation included evaluation of 4 different scores: Insall Knee Score, Western Ontario and MacMaster University Index score, Hospital for Special Surgery Knee Score, and visual analog scale.Based on a follow-up rate of at least 75%, no difference in TKA survival was found 12 years postoperatively: 91.5% in group CONV vs 98.2% in group NAV (P = .181). Since 5-year follow-up, no additional TKA revision had been performed in both groups. Group CONV showed a nonsignificant higher inaccuracy of neutral lower limb axis (1.8° ± 1.4°) compared to group NAV (1.6° ± 1.7°, P = .700). All X-ray assessments were not significant different within both study groups (P ≥ .068). Clinical examination showed no differences in evaluations (P ≥ .204). All collected outcome score results were similar (P ≥ .222).Twelve years postoperatively, no differences were found in terms of long-term survival, implantation accuracy, clinical outcome or score results.

Background Patients with autonomic failure may experience postural dizziness, syncope, and falls. Identifying symptomatic dysautonomia in dementia is of importance to ensure appropriate management and reduce risk of falls. Objective The aim of this prospective study is to identify cardiovascular autonomic dysfunction in patients suffering from behavioral variant of frontotemporal dementia (bvFTD), compared to Alzheimer's disease (AD). Methods Patients were prospectively recruited from 2009 until 2013. Clinical autonomic function tests were carried out in an Autonomic Unit according to Ewing's cardiovascular battery. Parasympathetic tests included resting heart rate variability, deep breathing, and Valsalva. Sympathetic function tests compromised blood pressure regulation on valsalva, cutaneous cold stimulation, and 70° head up tilt including of plasma noradrenaline. Results 26 patients (17 female) with bvFTD and 18 patients (10 female) with AD were examined. Mean age of bvFTD was 69 ± 11 years, AD 74 ± 9 years. History taking was often not conclusive and did not correlate with autonomic signs. In 42% bvFTD patients and 44% AD patients, autonomic dysfunction was demonstrated. Manifest orthostatic hypotension (OH) was present in 19% of bvFTD and 33% AD patients. Frequency of autonomic dysfunction and orthostatic hypotension did not differ between bvFTD and AD, but were significantly higher than in healthy controls. Autonomic dysfunction was associated with an increased risk of falling (assessed with Tinetti Score). Conclusion This is the first prospective study to elucidate autonomic dysfunction in bvFTD patients. There is a considerable higher frequency of cardiovascular dysfunction and OH in bvFTD. History taking may be not conclusive thus cannot exclude cardiovascular dysautonomia.

Anliegen: Die Diagnose Schizophrenie ist in besonderem Ausmas mit Stigma verbunden. Vor allem internalisiertes Stigma, die Ubernahme von negativen Vorstellungen ins Selbstbild, stellt eine wesentliche Barriere im Recovery-Prozess dar. Mit der von Jennifer Boyd Ritsher und KollegInnen entwickelten Internalized Stigma of Mental Illness-Skala (ISMI) lasst sich internalisiertes Stigma valide erfassen. Ziel der Studie war es, die psychometrischen Eigenschaften der deutschen Version der ISMI bei Personen mit einer Psychose aus dem schizophrenen Formenkreis zu prufen. Methode: Die ISMI wurde ins Deutsche ubersetzt und Reliabilitat und Validitat sowie Pradiktoren fur internalisiertes Stigma wurden gepruft. Dazu fullten 157 Personen die ISMI selbststandig aus. Weiterhin wurden soziodemografische und klinische Daten sowie zur Uberprufung der Konstruktvaliditat Daten zu Devaluation-Discrimination, Depression, Selbstwert, Empowerment, Kontrolluberzeugungen und Lebensqualitat erfasst. Ergebnisse: Die deutsche Version der ISMI zeigte bei Personen mit einer Psychose aus dem schizophrenen Formenkreis gute psychometrische Eigenschaften mit einer hohen internen Konsistenz, guten Test-Retest-Reliabilitat und guten Konstruktvaliditat. Insgesamt zeigte etwa ein Drittel eine hohe Auspragung an internalisiertem Stigma. Als Pradiktoren fur ein hoheres Ausmas an internalisiertem Stigma fanden sich ein Mangel an sozialen Kontakten, eine Schulbildung unterhalb des Abiturniveaus und eine stationare bzw. tagesklinische Behandlung (versus ambulante Behandlung). Schlussfolgerungen: Die Ergebnisse sprechen fur eine Vergleichbarkeit der deutschen Version der ISMI mit der Originalversion und verweisen darauf, dass mit der deutschen Version der ISMI internalisiertes Stigma bei Personen mit einer Psychose aus dem schizophrenen Formenkreis valide und reliabel erfasst werden kann. Dies ermoglicht, die Reduktion von internalisiertem Stigma als Behandlungsziel zu definieren und zu uberprufen.

FOCUS (“Foresight Security Scenarios – Mapping Research to a Comprehensive Approach to Exogenous EU Roles”) aims namely to define the most plausible threat scenarios that affect the “borderline” between the EU’s external and internal dimensions to security. This article presents scenarios about alternative futures of security research to support a comprehensive approach of the “EU 2035” as a civil security provider. Three scenarios were selected as context scenarios for alternative futures of security research afterwards they have been lined up with drivers identified in a matrix procedure. From these three context scenarios six alternative futures for security research were evaluated using the portfolio-cluster-method. The weighting was done from a dual and interdependent perspective: a) nation/ member state vs. EU-level/international approach to civil security and b) position of the scenario on the continuum of internal/external security. Finally, the article introduces each scenario for alternative future of security research in detail.

To assess prognostic factors in epiretinal membrane (ERM) surgery using spectral-domain (SD) optical coherence tomography (OCT).Prospective, interventional case series.Forty-one patients.Patients with a diagnosis of ERM were examined with spectral-domain and time-domain (TD) OCT before and after surgery.Main outcome measures were functional results and predefined OCT patterns. Cofactors analyzed were the type of ERM, the duration and grading of subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, and age. A multivariate regression analysis was performed.Thirty-nine patients (95%) showed an improved or stable best-corrected distance visual acuity (DVA) at 3 months, whereas 36 patients (88%) showed an improved or stable best-corrected near visual acuity (NVA) at 3 months. Significant correlations (P0.4) were found between the course of central retinal thickness (CRT) assessed using SD OCT and TD OCT (P0.02). No clinically relevant correlations (P0.3) were seen between CRT and VA (P0.1). Baseline DVA and NVA were found to be significant prognostic values for the postoperative decrease in CRT in both OCT systems (P0.04) as well as for the visual outcomes (P0.007) at 3 months. In addition, the integrity of the junction between the photoreceptor inner segment and outer segment (IS/OS) significantly influenced the visual outcomes at 3 months (P0.038). The baseline profile of the internal limiting membrane (ILM) significantly influenced the NVA at 3 months (P0.009), whereas the postoperative foveal contour significantly influenced the DVA at 3 months (P0.025). The type of ERM, subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, or age had no significant influence on patient outcome (P0.05). Compared with TD OCT, SD OCT allowed for a more precise differentiation between the ERM and the retinal surface and for a better evaluation of the IS/OS line.Besides the baseline VA, the integrity of the IS/OS line, better visualized by SD OCT, can be used to predict the functional outcomes after surgery. Additionally, analyzing the ILM profile and the foveal contour may help to understand limited visual outcomes after surgery.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Background/Aims: Cinacalcet reduces serum calcium in kidney transplant recipients with hypercalcemic hyperparathyroidism. Its effect on bone, however, has not been investigated in this population. Methods: We prospectively examined bone turnover, histomorphometry and density as well as serum bone biomarkers in 10 transplant recipients before and after treatment with cinacalcet. Results: After 18–24 months of treatment with cinacalcet, bone formation decreased in 7, increased in 2, and remained zero in 1 patient (p = 0.11). Trabecular bone volume was maintained. Trabecular number decreased (p = 0.03), but trabecular thickness was unchanged (p = 0.17). Osteoid decreased (p = 0.02) and osteoblast surface increased (p = 0.02). Bone mineral density of the femur remained stable in 1 patient, decreased in 2 patients, but increased in 7 patients (p = 0.153). Serum calcium concentration (p = 0.005), iPTH (p = 0.01) and calcitonin concentration decreased (p = 0.03), while 25(OH) vitamin D3 increased (p = 0.02). No fractures were reported. Graft function remained stable. Conclusion: Whilecinacalcet might decrease bone formation rate, it did not change bone volume, and bone mineral density of the femur increased. Therefore, the use of cinacalcet in hypercalcemic hyperparathyroidism might be safe with regard to the bone disease present after kidney transplantation.

To quantify and correlate the morphological and functional effects of the recommended loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration (AMD).In a prospective, interventional clinical trial, 29 consecutive patients (29 eyes) with choroidal neovascularisation secondary to AMD received three initial monthly intravitreal injections of ranibizumab. During this loading regimen, best corrected visual acuity (BCVA) and microperimetry (MP) testing, as well as optical coherence tomography and fluorescein angiography (FA), were performed using a standardised protocol and the results correlated.Significant morphological and functional therapeutic effects were observed as early as 1 week following the first treatment. Throughout the loading-dose period, central retinal thickness, including intraretinal cysts and subretinal fluid, decreased fast and significantly (p0.01); pigment epithelial detachment resolved less rapidly. The mean leakage area by FA decreased (p0.01) and retinal function (BCVA and MP) increased significantly (both p0.01). However, the change in morphology and function was only significant between baseline and week 1. There was no significant additional morphological or functional benefit following the second and third injection.The initial administration of intravitreal ranibizumab in neovascular AMD induced a significant effect on intra- and subretinal fluid and visual function; subsequent injections had a less pronounced effect. It remains to be determined whether this loading regimen should be mandatory in all patients or if a single dose regimen would lead to a comparable functional and morphological retinal improvement.

AIMS: The influence of pre-dialysis chronic kidney disease (CKD) on bone is ill defined. Isolation of specific pathogenic mechanisms would improve the understanding and therapeutic options. We therefore investigated whether parathyroid dysfunction, altered vitamin D and hormonal status, or RANKL and OPG have an influence on bone mineral density (BMD) in patients with pre-dialysis renal failure. MATERIAL: 132 patients with chronic renal failure stage 1 - 5 (not yet on dialysis) were investigated in a cross sectional study. Osteoprotegerin (OPG), receptor activator of nuclear factor kB ligand (RANKL), parathyroid hormone (whole, intact and 7-84 fragment), bone markers, sex hormones, and vitamin D status were assessed together with femoral neck and trochanter z-score. Correlation and multivariate analyses were performed between the different parameters and BMD. RESULTS: In the multivariate analysis a significant association was found between the femoral neck z-score and sRANKL (B = -0.45; p < 0.001), and OPG (B = 0.20; p < 0.05). A significant negative association was also found between the trochanter z-score and sRANKL (B = -0.32; p < 0.001). No associations were found between the trochanter z-score and OPG or the sRANKL/OPG ratio. The body mass index was the only additional marker associated with both FN z-score (B = 0.20, p < 0.05) and TR z-score (B = 0.20, p < 0.05). Neither markers of osteoblast nor osteoclast activity, or intact PTH, whole PTH, the PTH 7-84 fragment or vitamin D status were related to bone mineral density. CONCLUSION: Our results demonstrate that the RANKL/RANK/OPG system is associated with bone mineral density in pre-dialysis chronic renal failure.

To evaluate how adding vitrectomy to cataract surgery affects the accuracy of preoperative biometry and postoperative refractive outcomes.Department of Ophthalmology, Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic, Vienna, Austria.This study comprised 40 patients with vitreoretinal pathology and coexisting significant cataract (study group) and 40 patients with significant cataract only (control group). The main outcome measure was intraocular lens (IOL) power prediction error. Secondary outcome measures were spherical equivalent, anterior chamber depth, axial length, keratometry values, and intraocular pressure. A multivariate regression analysis was performed.There was a significant difference in prediction error between the study group and control group (P.05). The addition of vitrectomy was associated with induced myopia of approximately -0.4 diopter, more so in patients who had epiretinal membrane removal than in patients with macular hole surgery (P= .04). There was no significant difference in prediction error between the 3 IOLs used (P= .2).The myopic shift was strongly dependent on the diagnosis and the need for intraocular tamponade, indicating that a slightly hyperopic IOL should be used in patients having combined surgery.

Background and Purpose— Purpose of the present study is to evaluate the clinical outcome of endovascular treatment of unruptured intracranial aneurysms and to address the question of long-term stability and protection against future subarachnoid hemorrhage. Methods— Retrospective analysis of all patients treated in a 12-year period (173 patients: age 26 to 76 yr, mean 52.2±10.8/202 aneurysms: size 3 to 50 mm, mean 10.0±8.3). Results— The mortality was 0.5%; the overall morbidity was 3.5%. The most frequent complications were thromboembolic events (10.9%). Of these, 3.0% of patients suffered a stroke, leading to severe disability in 1 patient (0.5%). In 1 patient, the aneurysm ruptured during treatment, resulting in relevant neurological disability. Another patient suffered a fatal aneurysm rupture hours after treatment. The occlusion rate depended on aneurysm and neck size. Follow-up angiography revealed a decrease of the occlusion rate over time. This trend was obvious in all size categories and was most pronounced in giant aneurysms. In 3 patients (1.5%) with partially thrombosed giant aneurysms of the posterior circulation, embolization could not prevent later aneurysm rupture. There were no ruptures of any other aneurysms in the follow-up period (3.7±3.4 yr). Conclusion— Endovascular treatment is a highly safe procedure with low intervention-related morbidity and mortality. Long-term data for nongiant aneurysms showed good protection against rupture in the observation period. In contrast, the risk of rupture for giant aneurysms of the posterior circulation was as high as expected in observational studies.

To elucidate the relationship between excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) and carotid atherosclerosis determined by ultrasonography and serum surrogate markers.One hundred and forty-seven patients (102 males) with snoring and sleep-disordered breathing were investigated. Carotid atherosclerosis was evaluated by serum analysis of high-sensitivity C-reactive protein and fibrinogen and four sonographic indices: intima media thickness (IMT) of the common carotid artery (CCA), IMT from the bulb to the internal carotid artery (ICA), combined IMT measurements from all segments and a plaque score. EDS was assessed by the Epworth Sleepiness Scale (ESS). Pearson correlation analysis, intergroup comparison (ANOVA) and two multiple regression models explored associations between confounders, surrogate markers and EDS.Forty-four patients had no OSA (apnea-hypopnea index AHI5h(-1)), 27 mild (5-15), 25 moderate (15-30) and 51 severe OSA (30). The ESS significantly distinguished severe OSA from non-OSA patients (p=0.003). It showed significant correlations with the BMI, HbA1c, systolic RR, the AHI, sleep time spent with an oxygen saturation90%, the respiratory arousal index, IMT of the CCA and combined IMT measurements, but no correlation with serum markers. The ESS was found to be an independent predictor of CCA-IMT in the pre-polysomnographic multiple regression model (p=0.008), but not in the post-polysomnographic model after including respiratory variables.EDS is associated with obesity, diabetes and all respiratory variables in OSA patients and may serve as an independent predictor of carotid atherosclerosis before polysomnography.

In a retrospective study, distance measurements of nine children with craniofacial malformation were analyzed. The accuracy of measurements was compared when measured on a workstation using a 16-slice multidetector spiral computed tomography and on a stereolithographic model. Three different methods of defining distances were investigated: 1) on the stereolithographic plastic models, 14 distances connecting landmarks were identified with a digitizer (Polaris Tracker); 2) the same distances were defined at axial, coronal, and sagittal reformats of the computed tomography data set and measured using a Philips MX View workstation; and 3) the same 14 distances were defined at three-dimensional virtual reality models of the skulls at the same workstation. All measurements were performed with all three methods by three different readers. The following conclusions could be drawn: stereolithographic models provide a highly exact reproduction of the skull in children with craniofacial malformations. They are a reliable basis for all analytic and probatory endeavors preparing complicated surgical corrections. Three-dimensional virtual reality display modes serve significantly better for exact distance measurements on the complex surface of the human skull than planar reformats of the same computed tomography data sets.

Previous reports suggest that massive hormonal changes that accompany the peripartum period may trigger perinatal depression. We investigated the relationship between magnitude of change and total level of estrogen and progesterone and grade of peripartal depression and depressive symptoms. One hundred and ninety two women were assessed in the 38th week of pregnancy (SDS scores), peripartum period (DSM-III-R diagnosis (n=105); SDS scores) and 6 months postpartum (EPDS; n=89) regarding diagnosis of depression, self-ratings of depressive symptoms and levels of estrogen and progesterone. The comparison of three diagnostic groups (lifetime major depressive disorder MDD (N=7), MDD at birth (N=12), healthy controls (N=70) showed that there were no differences in the magnitude of decline of estrogen and progesterone from day 1 to day 3 after birth . With respect to total levels of estrogen and progesterone, estrogen on day 3 was significantly higher [F(2,92)=6.6, p

Aims: Anemia is commonly observed among patients with chronic kidney disease (CKD). No such information is available for patients with a history of systemic vasculitis. Methods: We examined the prevalence of anemia, the response to therapy with erythropoiesis-stimulating agents (ESA), and the association of anemia with the kidney function in clinically stable patients with Wegener's granulomatosis in a retrospective, single-center study. Results: The mean hemoglobin concentration of 36 patients (mean age: 58 years; 15 female, 21 male; mean duration of disease: 4.6 years) was 13.0 ±2.1 g/dl, and the mean estimated glomerular filtration rate (eGFR) was 41 ± 21 ml/min/1.73 m 2 . 14 of 36 patients (38.8%) presented with anemia (hemoglobin conccntration < 12 g/dl in women, < 13 g/dl in men, or ESA therapy). In patients with a CKD Stage 3 or 4, anemia was present about twice as much as compared to the Third National Health and Nutrition Examination Survey (NHANES III) population. The hemoglobin concentration, however, was not associated with a change of kidney function (p = 0.1578). Conclusions: We found a higher prevalence of anemia in patients with Wegener's granulomatosis, as compared to the NHANES III population. The hemoglobin concentrations showed no association with changes of kidney function.

The aim of this investigation was to evaluate prognostic factors influencing the short-term prognosis of occult choroidal neovascularization (CNV). A consecutive series of 107 untreated occult CNV in 101 patients were evaluated in terms of the effect of their initial lesion characteristics, as determined with fluorescein angiography (FA), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT), on the change in distance acuity, lesion size and retinal thickness over 1–3 months. Descriptive statistics, the Pearson Correlation Coefficient and a multiple linear regression analysis were applied to treat the data. A total of 107 eyes (101 patients) were examined. The study cohort consisted of 35 males and 66 females, with a mean age of 77.6 years. During the 3-month study period the mean distance acuity decreased from 67.0 to 63.2 letters; the mean size of the lesion increased from 16.1 to 18.4 mm2; the mean maximum retinal thickness increased from 374.5 to 387.5 μm. Of the lesions, 59.8% included pigment epithelial detachments (serous or fibrovascular) and 29.9% retinal angiomatous proliferation. A better distance acuity at both visits for the entire study population correlated significantly with smaller lesions, as determined by FA and ICG-A (p

The objective of this study was to analyze the effect of single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment.Seventy-six patients (46 women, 30 men; mean age, 23.1 years) enrolled in this single-blind study were assigned to 2 groups. The patients in group 1 (G1; 38 patients, 13 men, 25 women; mean age, 25.1 years) received a single course of LLLT (Mini Laser 2075, Helbo Photodynamic Systems GmbHCo KG, Linz, Austria; wavelength 670 nm, power output 75 mW) for 30 seconds per banded tooth. The patients in group 2 (G2; 38 patients, 17 men, 21 women; mean age, 21.0 years) received placebo laser therapy without active laser irradiation. Pain perception was evaluated at 6, 30, and 54 hours after LLLT by self-rating with a standardized questionnaire.Major differences in pain perception were found between the 2 groups. The number of patients reporting pain at 6 hours was significantly lower in G1 (n = 14) than in G2 (n = 29) (P.05), and the differences persisted at 30 hours (G1, n = 22; G2, n = 33) (P.05). At 54 hours, no significant differences were seen between the number of patients reporting pain (G1, n = 20; G2, n = 25), although the women had a different prevalence between G1 (n = 11) and G2 (n = 15) (P = .079). At 6, 30, and 54 hours, more than 90% of the subjects in both groups described the pain as "tearing."LLLT immediately after multibanding reduced the prevalence of pain perception at 6 and 30 hours. LLLT might have positive effects in orthodontic patients not only immediately after multibanding, but also for preventing pain during treatment.

There is increasing evidence of a causal interaction between obstructive sleep apnea (OSA) and cerebrovascular disease. The aim of the study was to elucidate the relationship between the polysomnographically (PSG) measured severity of OSA and carotid atherosclerosis determined by ultrasonography and serum surrogate markers. 147 patients (102 males, 45 females) referred to our sleep laboratory for evaluation of snoring and sleep-disordered breathing were investigated. Carotid atherosclerosis was evaluated by serum analysis of high-sensitivity C-reactive protein (hs-CRP) and fibrinogen and four sonographic indices: intima-media thickness (IMT) of the common carotid artery (CCA), IMT from bulb to internal carotid artery (Bulb-ICA), combined IMT measurements from all segments and a plaque score (PlaS). Pearson correlation analysis, intergroup comparison (ANOVA), covariance analysis and a multiple regression were performed to assess the association between surrogate markers and respiratory variables. 44 patients had no OSA (apnea-hypopnea index AHI5/h), 27 mild (AHI 5-15), 25 moderate (AHI 15-30) and 51 severe OSA (AHI30). After adjusting for potential confounders, significant differences between the controls and all three OSA groups were observed in the CCA-IMT (p = 0.032) and in the PlaS between the controls and the severe group (p = 0.034). Multiple regression revealed the AHI as an independent predictor of CCA-IMT (p = 0.001) and combined IMT (p = 0.001), whereas the percentage of total sleep time with an oxygen saturation below 90 % was associated with Bulb-ICA IMT (p = 0.018) and hs-CRP (p = 0.015). OSA is associated with higher surrogate levels of cerebrovascular disease. Even mild OSA seems to predispose to early atherosclerosis.

Introduction: The study was undertaken to evaluate the postganglionic sympathetic sudomotor function employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer’s disease (AD) and behavioral variant of frontotemporal dementia (bvFTD). Methods: Patients were recruited in a prospective pilot study. A structured history was taken and QSART was recorded. Results: In all, 15 patients with AD (7 female) and 14 patients with bvFTD (9 female) were included. Mean age (±standard deviation) of patients with AD and bvFTD was 74 ± 9 and 71 ± 10 years, respectively. Severe sudomotor dysfunction (Composite Autonomic Severity sudomotor score 3) was present in 3 (20%) patients with AD and 0 (0%) patients with bvFTD ( P = .037). The upper extremity was only involved in 1 patient with AD and 1 patient with bvFTD. Sweat results of the 4 recording sites did not differ between both groups. Patients’ history correlated with severe autonomic symptoms as assessed with QSART. Conclusion: Postganglionic sudomotor involvement in AD and bvFTD is most likely not part of the disease.

Summary Background: Patients with gluten sensitivity, i. e. celiac disease and dermatitis herpetiformis have anti-endomysial antibodies recognizing transglutaminases, which are usually detected on appropriate tissue sections. It would be desirable to have available a reliable, tissue-independent serological diagnostic tool. We compared disease-specificity and sensitivity of tTG versus eTG-based detection systems for the diagnosis of anti-endomysial IgA-antibodies. Patients and Methods: We examined 204 serum samples in duplicates with commercial human ELISA-kits: 54 healthy blood donors, 20 celiac disease, 29 dermatitis herpetiformis and 101 with other autoimmune dermatoses. Results: The tTG-based ELISA proved to be very disease-specific (100 %) and sensitive for the diagnosis of gluten sensitivity (95 % celiac disease; 96.6 % dermatitis herpetiformis). The eTG-based ELISA was also perfectly specific (100 %), but only 15 % of celiac disease-sera and 44.8 % of dermatitis herpetiformis-sera yielded positive results. Conclusions: The human tTG-ELISA fulfills all criteria of a screening test and, because of being investigator-independent, inexpensive and highly reproducible, compares favorably with the current diagnostic gold standard (indirect immunofluorescence and biopsy) of celiac disease and dermatitis herpetiformis. The low sensitivity of the eTG-ELISA may have technical reasons, but could theoretically also be linked to disease activity or indicate the existence of an as yet undefined disease subset. Studies are currently under way to address these issues. Zusammenfassung Hintergrund: Da die sichere Diagnose der beiden glutensensitiven Erkrankungen Zoliakie und Dermatitis herpetiformis Duhring Gewebsschnitte erfordert, ist eine verlassliche Methode zur serologischen Diagnose wunschenswert. Deshalb testeten wir komparativ kommerzielle ELISA-Kits mit humanem Antigen auf ihren diagnostischen Wert bezuglich Krankheitsspezifitat und Sensitivitat zur Detektion von anti-endomysialen IgA-Autoantikorpern gegen einerseits Gewebs- bzw. andererseits epidermale Transglutaminase. Patienten und Methodik: Wir untersuchten in Doppelbestimmung Seren von 204 Personen (54 Gesunde, 20 Zoliakie, 29 Dermatitis herpetiformis, 42 Pemphigus, 38 Bulloses Pemphigoid, 17 Lupus erythematodes, 2 Lichen ruber pemphigoides, 1 Epidermolysis bullosa acquisita, 1 Pemphigoid gestationis). Ergebnisse: Der tTG-ELISA erwies sich als ideal spezifisch (100 %) sowie hoch sensitiv fur die Diagnose von Zoliakie (95 %) und Dermatitis herpetiformis (96,6 %). Auch der eTG-ELISA erreichte eine ideale Spezifitat (100 %), jedoch waren nur 15 % der Zoliakie-Seren bzw. 44,8 % der Dermatitis herpetiformis-Seren positiv. Schlussfolgerungen: Der humane Anti-tTG-ELISA erfullt alle Kriterien einer Screeningmethode. Verglichen mit dem bisherigen diagnostischen Goldstandard, der Immunfluoreszenz und der Biopsie, ist dieser Untersucher-unabhangige, preisgunstige und leicht reproduzierbare Test als eine vollig gleichwertige, wenn nicht uberlegene Methode zur hoch sensitiven Diagnostik von Zoliakie und Dermatitis herpetiformis einzustufen. Die Grunde fur die niedrige Sensitivitat des eTG-ELISA konnten technischer Natur sein, aber auch in Bezug zur Krankheitsaktivitat stehen oder auf eine noch nicht definierte Auspragungsform der Glutensensitivitat hinweisen. Untersuchungen dieser Theorien sind im Gange.

Aim: In this study, the reproducibility of a newly developed pink esthetic score (PES) for evaluating soft tissue around single-tooth implant crowns was assessed. The effect of observer specialization was another point of interest. Material and methods: Twenty observers (five prosthodontists, five oral surgeons, five orthodontists and five dental students) were given photographs of 30 single-tooth implant crowns. Seven variables were evaluated vs. a natural reference tooth: mesial papilla, distal papilla, soft-tissue level, soft-tissue contour, alveolar process deficiency, soft-tissue color and texture. Using a 0-1-2 scoring system, 0 being the lowest, 2 being the highest value, the maximum achievable PES was 14. Each observer was requested to make two assessments at an interval of 4 weeks. At the second assessment, the photographs were scored in the reverse order. Results: The mean PES of evaluations at the first assessment (n=600) was 9.46 (±3.81 SD), and 9.24 (±3.8 SD) at the second one. The difference between these two means was not significant statistically (P=0.6379). Implant-related mean PES for single-tooth implants varied from 2.28 to 13.8, with standard deviations between 0.46 and 3.51. Very poor and very esthetic restorations showed the smallest standard deviations. The mean total PES was 10.6 for the prosthodontists, 9.2 for the oral surgeons, 9.9 for the dental students and 7.6 for the orthodontists. Conclusions: The PES reproducibly evaluates peri-implant soft tissue around single-tooth implants. Thus, an objective outcome of different surgical or prosthodontic protocols can be assessed. Orthodontists were clearly more critical than the other observers.

The effect of oral anticoagulation on clotting during hemodialysis. Background Between 5% and 10% of hemodialysis patients are treated with oral anticoagulants. It is currently unknown whether additional anticoagulation with heparin or low-molecular-weight heparin (LMWH) is needed to prevent clotting during hemodialysis. Methods In this prospective, randomized, cross-over study 10 patients treated with oral anticoagulants (phenprocoumon) received either no additional anticoagulation or low dose dalteparin (bolus of 40 IU/kg body weight) before dialysis. Efficacy of hemodialysis was measured by normalized weekly Kt/V and urea reduction rate (URR). Thrombus formation was evaluated by measurement of D-dimer and inspection of air traps and dialyser. Results The median international normalized ratio (INR) did not differ between both observation periods (phenprocoumon 2.2(2 to 3) vs. dalteparin 2.1(2 to 2.9). The anti-Xa level in dalteparin patients was 0.33 (0.27 to 0.38) IU/mL after 2 hours and 0.16 (0.03 to 0.23) IU/mL after 4 hours of hemodialysis. The median increase of D-dimer was significantly higher in patients without additional dalteparin therapy during hemodialysis (ΔD-dimer 0.23 μg/mL vs. 0.03 μg/mL) ( P = 0.0004). Complete thrombosis of the dialyser membrane occurred in one patient in the phenprocoumon group but in none with combined treatment. The extent of thrombosis in the arterial and venous air trap and dialyser was significantly less in patients with additional dalteparin therapy ( P = 0.0014, P = 0.0002, and P = 0.0005, respectively). Weekly Kt/V and URR was similar in both groups. Conclusion Standard oral anticoagulation with an INR between 2 and 3 is insufficient to prevent clotting during hemodialysis. Additional low dose anticoagulation with a LMWH or heparin is necessary to facilitate treatment.

Purpose: To assess satisfaction with photocoagulation treatment in diabetes patients and to investigate how it relates to patient-related characteristics and patients' visual ability. Further, to observe the interaction between physician and patient and suggest ways to improve the patient−provider relationship and, thereby, treatment satisfaction. Methods: This open longitudinal study included 123 diabetes patients undergoing first photocoagulation treatment for diabetic maculopathy or proliferative retinopathy. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was completed by all patients. Communication, scheduling and adherence scores were defined for each physician−patient pair. Outcome measures were: the patient's overall satisfaction with laser treatment; the patient's degree of satisfaction in relation to visual results; communication, scheduling and adherence scores, and visual acuity results. Results: The level of satisfaction after initial photocoagulation treatment was high; 46.4% of patients with proliferative retinopathy and 53.1% with maculopathy scored 31 or higher. Although 69.5% of all patients reported that their expectations of treatment corresponded to their final 9-month visual results, only 8.7% of these patients reported an improvement in visual acuity after 9 months. The number of unwanted actions performed by the patients during treatment were significantly related to the number of unclear instructions given by the physician (Fisher's exact test P

Taper junctions of large diameter metal-on-metal femoral heads and femoral stems were described as metal ion generator due to accelerated wear and corrosion. However, literature about the Articular Surface Replacement (ASR) total hip arthroplasty (THA) invariably deals with stems manufactured by DePuy Orthopedics (Warsaw, IN, USA). Nothing is known whether different stems with common 12/14 mm tapers affect failure rate or ion release. 99 ASR THA (88 patients) implanted with CoxaFit or ARGE Geradschaft stems (K-Implant, Hannover, Germany) were retrospectively analyzed. After a mean follow-up of 3.5 years revision rate was 24.5%, mostly due to adverse reaction to metal debris (ARMD). CT scan revealed component loosening in 10.3% and pseudotumoral lesions in 12.6%. Elevated ion concentrations (> 7 μg/l) were found in 38.6%.

In the literature, studies of computer-assisted total knee arthroplasty (TKA) after mid-term period are not conclusive and long-term data are rare. In a prospective, randomized, comparative study 100 conventional TKAs (group REG) were compared with 100 computer-assisted TKAs (group NAV). Minimum follow-up was 5years. No difference in implant failure was found with 1.1% in group NAV versus 4.6% in group REG (P=0.368). Group NAV showed a significantly less mean deviation of mechanical limb axis (P=0.015), more TKAs (90% versus 81% in group REG) were within 3° varus/valgus and a higher tibial slope and lateral distal femoral angle (LDFA) accuracy was found (P≤0.034). Clinical investigational parameters showed no differences (P≥0.058). Insall and HSS score total were also higher in group NAV (P≤0.016).

Schizophrenia is particularly associated with stigma. Especially internalized stigma, the inner subjective experience of stigma and its psychological effects resulting from applying negative stereotypes and stigmatising attitudes to oneself, is a barrier to recovery. The Internalized Stigma of Mental Illness-scale (ISMI) developed by Jennifer Boyd Ritsher and colleagues is a valid instrument for self-rated assessment of the subjective experience of stigma. The aim of the study was to examine the psychometric properties of the German Version of the ISMI among people with schizophrenia spectrum disorder.The ISMI was translated into German. Reliability and validity of the instrument were tested and predictors of internalized stigma were explored. Data of 157 people were collected on the ISMI and demographic and clinical variables. Construct validity was tested by comparing results with already established constructs such as perceived devaluation and discrimination, depression, self-esteem, empowerment, control convictions and quality of life.The German Version of the ISMI showed good psychometric properties with high internal consistency, good test-retest reliability and good construct validity among people with schizophrenia spectrum disorder. About one third had a mean above the midpoint of the scale indicating a high level of internalized stigma. Internalized stigma was predicted by insufficient social network, level of education less than high school and inpatient or day clinic treatment compared to outpatient treatment.Results suggest that the German version of the ISMI is comparable to its original version. With the German version of the ISMI internalized stigma can be measured reliably and validly among people with schizophrenia spectrum disorder. Future studies may use the ISMI to record changes in internalized stigma pertinent to the achievement of therapeutic goals.

Die Kontingenztabelle (oder Kontingenztafel) ist eine systematische Darstellung der Merkmalsauspragungskombinationen zweier kategorieller Merkmale. Eine Kontingenztabelle besteht aus den Zellen, die sich aus der Kreuzung von Zeilen und Spalten ergeben. Bei dieser Art der Tabellenkonstruktion wird auch von Kreuztabulierung gesprochen, die Tabelle wird ebenso als Kreuztabelle bezeichnet. Die Merkmalsauspragungen der beiden Merkmale werden in Zeilen beziehungsweise Spalten der Tabelle zugeordnet. Konvention ist, dass bei gerichteten Beziehungen die Merkmalsauspragung der unabhangigen Variablen (die Ursache) X den Spalten und die der abhangigen Variablen (die Folge) Y den Zeilen zugeordnet werden.

Mittels der Inferenzstatistik werden Schlussfolgerungen (Inferenzen) von den Daten einer Stichprobe auf die Verhaltnisse in der Population gezogen, aus der die Stichprobe stammt. Mittels eines statistischen Tests wird uberpruft, ob die Forschungshypothese zutrifft oder nicht. Dabei konnen Zusammenhangs- und Unterschiedshypothesen unterschieden werden. Viele Fragestellungen lassen sich sowohl als Zusammenhangs- wie auch als Unterschiedshypothese formulieren.

BACKGROUND Mechanical autotransfusion systems for washed shed blood (WSB) were introduced to reduce the need for postoperative allogenic blood transfusions (ABTs). Although some authors have postulated decreased requirements for ABT by using autologous retransfusion devices, other trials, mostly evaluating retransfusion devices for unwashed shed blood (USB), verified a small or no benefit in reducing the need for postoperative ABT. Because of these contradictory findings it is still unclear whether autologous retransfusion systems for WSB can reduce transfusion requirements. QUESTIONS/PURPOSES We therefore asked whether one such autologous transfusion system for WSB can reduce the requirements for postoperative ABT. METHODS In a prospective, randomized, controlled study, we enrolled 151 patients undergoing TKA. In Group A (n=76 patients), the autotransfusion system was used for a total of 6 hours (intraoperatively and postoperatively) and the WSB was retransfused after processing. In Control Group B (n=75 patients), a regular drain without suction was used. We used signs of anemia and/or a hemoglobin value less than 8 g/dL as indications for transfusion. If necessary, we administered one or two units of allogenic blood. RESULTS Twenty-three patients (33%) in Group A, who received an average of 283 mL (range, 160-406 mL) of salvaged blood, needed a mean of 2.1 units of allogenic blood, compared with 23 patients (33%) in Control Group B who needed a mean of 2.1 units of allogenic blood. CONCLUSIONS We found the use of an autotransfusion system did not reduce the rate of postoperative ABTs. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Grundsatzlich beginnt jeder statistische Test mit einer inhaltlichen Fragestellung, die sich in einem Hypothesenpaar formulieren lasst. Auch die Reihenfolge der Schritte, insbesondere die Formulierung der Hypothesen vor der Datenerhebung, ist einzuhalten. Nur unter diesen Bedingungen ist der p-Wert als Uberschreitungswahrscheinlichkeit zu interpretieren, die mit dem postulierten Signifikanzniveau α verglichen werden kann. Nachgeschobene Fragestellungen sind die haufigsten und schwerwiegendsten Verstose gegen dieses Prinzip. Dies passiert zumeist, wenn in den Daten etwas Auffalliges bemerkt wird, das statistisch zu sichern ist. Da aber uber die Wahrscheinlichkeit eines Ereignisses nur dann geredet werden kann, bevor es eingetreten ist, sind solche Fragen grundsatzlich sinnlos und deshalb unzulassig.

Mit Hilfe von Stichprobendaten soll beim Testen Licht in eine im Dunkel liegende Wirklichkeit (Realitat) gebracht werden. Die Wirklichkeit ist eine Grundgesamtheit, uber deren Merkmalseigenschaften Behauptungen (Hypothesen) vorliegen oder aufgestellt werden. Beim Testen wird zunachst eine statistische Hypothese uber einen interessierenden Sachverhalt formuliert. Eine geeignete Zufallsstichprobe wird gezogen; sie liefert Daten, die den interessierenden Sachverhalt betreffen und aufhellen sollen. Dies erfolgt unter Verwendung eines adaquaten wahrscheinlichkeitstheoretischen Modells. Im Rahmen dieses Modells wird die eingangs formulierte Hypothese uber den Sachverhalt durch die Anwendung einer Entscheidungsregel verworfen oder gestutzt. Der statistische Befund der Zufallsstichprobe wird somit entweder als nicht im Widerspruch zur Hypothese stehend bewertet oder als Widerlegung der Hypothese angesehen.