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Objective: Systematic metabolic profile tests at regular intervals provide important information to meet the increasing challenges in managing dairy herds. This study aimed at deriving long-term trends from the results of metabolic profile tests in Thuringian German Holstein dairy herds., Material and Methods: Blood and urine samples were collected from 710 fresh, high yielding, and dry cows, respectively, to monitor 13 parameters including the serum non-esterified fatty acids (NEFA), β-hydroxybutyrate (BHB), bilirubin, β-carotene and urea concentrations, the serum of aspartate aminotransferase and glutamate dehydrogenase activities, the serum concentrations of the minerals calcium, inorganic phosphate and selenium, the urine potassium and sodium concentrations, and the net acid-base excretion (NABE). A total of 17,070 group samples from 103 herds were collected during 1997-2014. Period prevalence of aberrant groups was calculated for each parameter and year accordingly. Using a linear regression model, a long-term trend of the period prevalence was determined., Results: To account for the 15 aberrancies possible for each stage of lactation, seven significant trends were found for dry, nine for fresh, and ten for lactating cows. A decrease of the period prevalence was detected for increased NEFA, for low serum β-carotene, selenium, inorganic phosphate, and urea concentrations, for low sodium and high potassium urine concentrations, and for increased NABE. In contrast, period prevalence increased significantly for cases with increased serum aspartate aminotransferase and glutamate dehydrogenase activities, increased bilirubin concentration, and low NABE., Conclusion and Clinical Relevance: Metabolic profile tests enable a description of the herd health status using objectively measured data as a basis for the implementation of measures to optimize herd management to improve the herd health status.

Background: The purpose of this study was to evaluate long-term clinical and radiological results as well as survival rates of the NexGen® CR posterior cruciate retaining prosthesis., Patients and Methods: We evaluated a consecutive series of 761 total knee replacements performed on 716 patients from 1999 to 2001 at our institution. All patients had been recorded prospectively in our in-house arthroplasty register. Follow-up data were available for 379 patients at 10 years postoperatively. Functional outcome was evaluated using the Knee Society score. An additional radiographic evaluation was performed on 224 patients at 10 years. The mean age of the patients at the time of surgery was 71 years. 75 % of the patients were female, 25 % were male. Mean BMI of the patients was 29.2 kg/m(2). The preoperative diagnosis was osteoarthritis in 91 %, rheumatoid arthritis in 5,5 % and posttraumatic osteoarthritis in 2 %. Patella resurfacing was performed in 4 %. All components were cemented., Results and Discussion: Mean Knee Society clinical score improved from 26.7 points preoperatively to 88.5 points at the time of the latest follow-up, and mean Knee Society function score improved from 48.3 to 55.2 points. Flexion improved from a mean of 106.7° preoperatively to 111.4° at 10 years. Patellofemoral pain was indicated by 66 % of the patients before surgery and 4 % at the latest follow-up. 96 % were satisfied with the result of the surgery at 10 years. Radiographic evaluation was performed on 224 patients at the time of the latest follow-up. 203 patients (91 %) had normal radiographic findings, 21 patients (9 %) showed pathological findings. Radiolucencies were seen in 18 patients on the AP view of the tibia, 1 patient had an additional femoral radiolucency. There was an osteolysis located in the lateral tibia seen in 1 patient and an occurrence of heterotopic ossification in another patient. One knee showed a patella subluxation. No patient had radiographic evidence of loosening. 17 knees had required revision surgery with exchange of at least one of the components up to 10 years after the index procedure. 5 of the patients had revision for a deep infection, 2 for periprosthetic fractures of the distal femur with loosening of the prosthesis, 1 for fracture of the proximal tibia due to osteoporosis, 4 for aseptic loosening, 3 for instability and 2 for severe pain. Kaplan-Meier survival of all components using revision for any reason as the end point was 97.8 % at 10 years., Conclusion: The good clinical and radiological long-term results as well as the satisfactory survival rate after total knee replacement with the NexGen CR® prosthesis are comparable with the results of other long-term studies using the NexGen CR® and assimilable prosthesis. Our results demonstrate that quality of life was improved by the implantation of the NexGen CR® prosthesis even a long time after the index procedure despite old age and comorbidity of the patients., (Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: To investigate the usage patterns of complementary and alternative medicines (CAMs), as well as dietary interventions, by South Australian people with multiple sclerosis (MS)., Design: Self-administered postal survey., Setting: Questionnaire mailed to recipients of the South Australian (SA) MS Society newsletter (n=1230)., Main Outcome Measures: Patterns of CAMs use and dietary interventions, reasons for using/not using CAMs in MS, sources of CAMs information and monthly expenditure on CAMs/dietary interventions., Results: A total of 428 surveys were returned (response rate 34.8%) of which 416 met the inclusion criteria for analysis. The majority of SA people with MS who responded reported using CAMs/dietary interventions (64.7%). Respondents with tertiary education and those with mild and moderate disease reported highest CAM use. The most frequently used CAM product categories were vitamins (81.8%), essential fatty acids (80.7%) and minerals (62.5%). Commonly used herbal products included Ginkgo biloba (18.2%) and valerian (16.4%). Popular diets were the low fat (39.8%), low/no sugar (23.8%) and gluten-free (16.4%) diets. The majority of those using CAMs/dietary interventions did so concurrently with conventional treatments (72.1%). Reasons for use included: general health and well-being; to alleviate 'general' as well as specific MS symptoms such as muscle weakness, urinary or memory problems and mobility. Conventional health professionals, and friends/family, were the most common sources of information. Monthly expenditure was most commonly AUD$20-49/month., Conclusion: This study reports frequent use of CAM/dietary intervention amongst SA people with MS. The majority of users did so in conjunction with conventional treatments.

Background: The German mandatory quality assurance programme collects data from all primary total hip and knee replacements. The quality of the indication is measured by clinical and radiological criteria. The results were analysed in terms of differences in establishing the indication subject to patient and hospital characteristics., Materials and Methods: Data on more than 270,000 primary total hip and knee replacements that were operated in 2006 in Germany were analysed concerning differences in the quality of the indication subject to age, gender, hospital volume and density of population and hospitals (metropolitan vs rural areas). The statistical analysis was done by exact Fisher's test., Results: The quality of the indication was statistically significantly better in men, patients 60 and older, in rural areas and in high volume hospitals (50 and more joint replacements per year)., Discussion: Data of this mandatory German quality assurance programme are useful to describe differences in medical care. The results are valid and complete. An exact analysis of the reasons for these differences is difficult though. Data focus is on quality assurance and represent only in-hospital results., Conclusion: Further analyses are necessary to ascertain whether the differences in quality of care are deficits or only variances in medical care.

In a prospective study, 93 unselected consecutive uncemented hip arthroplasties were performed in 80 patients using the titanium-coated RM acetabular component and the CLS femoral component. The mean age of the patients at operation was 52 years (28 to 81). None were lost to follow-up. In the 23 patients who had died (26 hips) only one acetabular component had been revised. In the 57 living patients (67 hips), 13 such revisions had been performed. Of the 14 revisions, seven were for osteolysis, five for loosening and two for infection. Survival analysis of this implant showed a total probability of survival of 83% (95% confidence interval 73 to 90), with all revisions as the endpoint, and a probability of 94% (95% confidence interval 87 to 98) with revision for aseptic loosening as the endpoint, indicating reliable long-term fixation of the titanium-coated RM acetabular component.

Hydrogenation reactions starting with di- or oligonuclear boron compounds featuring direct B-B bonds with the B atoms in the formal oxidation state +II are analyzed with the aid of ab initio quantum chemical (RI-MP2) calculations. The products of these reactions are B(III) hydrides which might be useful starting reagents for stoichiometric hydrogenation reactions and possibly in special cases also for hydrogen storage. Several different isomers of these B(III) hydrides featuring either terminal or bridging H atoms were considered. The results are compared to hydrogenation reactions of related molecules.

The discussion on the results of open spinal surgery, in particular, on complications as a result of open surgery, e.g., the so-called post-discotomy syndrome, has led to the development of less invasive methods, especially for treatment of lumbar disc prolapses. Percutaneous nucleotomy procedures are based on a variety of intradiscal diagnostic and therapy methods, such as discography, retroperitoneal spinal disc fenestration or chemonucleolysis. Since the 1970s, various methods such as mechanical percutaneous nucleotomy, automated percutaneous nucleotomy, intradiscal laser procedures and, in part, endoscopic intradiscal procedures have been developed and also used clinically. The clinical results vary from 30% good/very good results to almost 100% good/very good results, depending on the author and study. It is obvious that not many prospective randomized studies using either conservatively or surgically treated control groups have been conducted. The results of these studies on intradiscal therapy methods are often analyzed more critically and with lower success rates than the partially retrospective stuides of a single method, which often have large case numbers, but do not always meet the demanding criteria for scientific study design. To attain good results, percutaneous nucleotomy procedures can only be used to treat select cases of lumbar disc disorders according to strict indication criteria. At the present time it can be concluded that, in comparison to endoscopic und microsurgical methods, percutaneous nucleotomy procedures must be restricted to a small number of cases.

The discussion on the results of open spinal surgery, in particular, on complications as a result of open surgery, e. g., the so-called post-discotomy syndrome, has led to the development of less invasive methods, especially for treatment of lumbar disc prolapses. Percutaneous nucleotomy procedures are based on a variety of intradiscal diagnostic and therapy methods, such as discography, retroperitoneal spinal disc fenestration or chemonucleolysis. Since the 1970 s, various methods such as mechanical percutaneous nucleotomy, automated percutaneous nucleotomy, intradiscal laser procedures and, in part, endoscopic intradiscal procedures have been developed and also used clinically. The clinical results vary from 30 % good/very good results to almost 100 % good/very good results, depending on the author and study. It is obvious that not many prospective randomized studies using either conservatively or surgically treated control groups have been conducted. The results of these studies on intradiscal therapy methods are often analyzed more critically and with lower success rates than the partially retrospective studies of a single method, which often have large case numbers, but do not always meet the demanding criteria for scientific study design. To attain good results, percutaneous nucleotomy procedures can only be used to treat select cases of lumbar disc disorders according to strict indication criteria. At the present time it can be concluded that, in comparison to endoscopic und microsurgical methods, percutaneous nucleotomy procedures must be restricted to a small number of cases.

The Pre-Operative Evaluation Program (PEP) in the USA is a 1-week outpatient program for patients who have physical pathology which could be improved with surgical intervention. Patients are prepared for surgery and their hospital stay through an education process that includes educational groups, understanding of anatomy, pain and stress management, psychological testing and exercises to improve strength and spine techniques to improve functional abilities. The orthopedic clinic in Kassel developed a 14-days inpatient preoperative evaluation and education program (PEP) for potential surgical candidates with chronic back or neck pain.

The risks associated with blood transfusion can be minimized using autologous blood. The efficiency of preoperative blood deposit, preoperative acute-hemodilution spinal anesthesia, controlled hypotension and intra and postoperative autotransfusion in reducing homologous transfusion has been demonstrated. In a prospective study the effectivity of this concept is demonstrated. 141 patients scheduled for total hip arthroplasty were divided in three groups: group I--total hip arthroplasty without cement (n = 55); group II--total hip arthroplasty with cement (n = 52); and group III total hip revision arthroplasty (n = 34). The mean quantity of the donated blood was 900 mL. The donation was not associated with serious complications. In group I 52 patients (94.5%), in group II 40 patients (77%) and in group III 14 patients (41.2%) did not require homologous transfusion. The difference between group I and II was significant (p < 0.05). Under the conditions studied, preoperative autologous blood deposit, acute hemodilution, spinal anesthesia and controlled hypotension are effective for decreasing the application of homologous transfusions in hip arthroplasty. The efficiency of preoperative hemodilution alone is limited. Preoperative deposit of autologous blood is a simple, effective, economical, and low-risk method of reducing homologous transfusion. Autotransfusion with a cell separator can save approximately 50% of the erythrocytes lost during revision total hip arthroplasty.

Quantum-chemical methods have been employed to study the nature of stabilization in dinuclear cobalt complexes of the general formula [{(C5 H5 )Co}2 (μ-CR(1) 2 BCBR(2) R(3) )] (6) as well as the "antivan't Hoff-Le Bel" configuration of the planar tetracoordinate carbon (ptC) atom of the bridging diborylcarbene ligand 9. Extended Hückel and ab initio Hartree-Fock calculations have been carried out for the model compounds 6b (R(1) = R(2) = R(3) = H) and 6c (R(1) = R(2) = H; R(3) = C6 H5 ). Ab initio electron deformation density maps and natural population analysis calculations show that complexes 6 are stabilized through push-pull effects by which the ptC experiences π electron density delocalization and σ electron density accumulation. The calculated electronic configuration of the ptC in the free ligand 9b is σ(2.978) π(1.501) , and in 6b σ(3.944) π(1.356) . Electron density donation from one cobalt atom to an aryl group on the bridging ligand further contributes to the stabilization of the complexes 6., (Copyright © 1997 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Thirty-one patients with herniated cervical discs were treated with PLDD from 1991 to 1993. In 1990, a few of these patients were treated with the Nd:YAG laser with no complications. Since 1991 we have used the holmium:YAG laser; 28 of the 31 patients experienced pain relief in a 6-week follow-up. PLDD for the cervical discs is a viable therapy.

Background and Objective: As the Ho:YAG laser gained increasing importance in recent experimental and clinical investigations, this study was performed to investigate the effect of power on ablation rates and temperature during disc ablation with a high power Ho:Yag laser under simulated clinical conditions., Study Design/materials and Methods: A high power Ho:YAG laser was used to investigate the influence of increasing power from 10 to 32 Watt on ablation rate (mg) and temperature (degree C). Ablation weight was measured by a precision scale calculating the difference of the pre- and postlasing weight of the specimen after application of total energies of 1,000, 1,500, and 2,000 J. Temperatures were measured by thermoprobes, which were connected via a thermomodule to an amplifier and the signal was plotted by a computer with appropriate software., Results: Whereas ablation rate rose almost linearly with total energy, increasing power above 20 W did not essentially improve ablation rate. Temperatures reached their highest values after application of a total energy of 500 J and did not rise further, whereas increasing power did not induce a rise in temperature., Conclusions: Regarding the chosen experimental setting, maximum temperatures are reached after application of 500 J, and increasing power does not induce a rise in temperature.

The primary stability of four common meniscus suture techniques was tested on human cadaver menisci. The test series was carried out under standard conditions (25 degrees C, 100% air humidity) using the Instron 1122 Tensometer. The tearing stress of different sutures was reproducible in different specimens dependent only on the suture technique. Knot-end techniques gave inferior results (tearing stress, 24 +/- 9 N) compared with arthroscopic techniques using a loop placed on the meniscus surface (tearing stress, 89 +/- 4 N). When an open meniscus repair is performed, a vertical stitching technique (tearing stress, 105 +/- 4 N) should be the preferred method. Horizontal sutures are weaker (tearing stress, 44 +/- 18 N).

A controlled trial of antepartum glucocorticoid treatment for prevention of respiratory distress syndrome in premature infants was carried out. 37 mothers, in whom premature delivery threatened between 28 and 37 weeks of gestation, were given intramuscular injections 8-12 mg of betamethasone as well as medication inhibiting uterine activity and strict bedrest to delay premature delivery for at least 24 to 48 hours. In comparison with a control group of 16 mothers, who received tocolytic and sedative medication and were on strict bedrest and another control group of 42 untreated patients, there was no difference in the 3 groups concerning the incidence of respiratory distress syndrome in premature infants, but there was a lower perinatal mortality rate of respiratory distress syndrome in the betamethasone treated group, than in the controls, possibly due to a milder course of respiratory distress syndrome disease by accelerating functional maturation of the fetal lung with betamethasone.

A controlled trial of antepartum glucocorticoid treatment for prevention of Respiratory Distress Syndrome (RDS) or Hyaline Membrane Syndrome (HMS) was carried out. 91 mothers, in whom premature delivery threatened between 27 and 37 weeks of gestation, were given intramuscular injections of 8-12 mg of betamethasone as well as medication inhibiting uterine activity (tocolytica and sedation) and strict bedrest to delay premature delivery for at least 24 to 48 hours. A control group of 118 mothers, who were hospitalized late and premature delivery could not be delayed, had no betamethasone treatment. There was no significant differerence in the incidence of Respiratory Distress Syndrome in premature infants in both groups, but there was a 50% lower mortality rate of Respiratory Distress Syndrome in the betamethasone treated group, due to a milder course of Respiratory Distress Syndrome Disease. Harmful effects from corticosteroids given to pregnant women prior to premature delivery were not observed in our group. The prophylactic treatment with betamethasone to diminish the mortality rate of Respiratory Distress Syndrome is therefore considered encouraging and profitable.

The efficacy of "athermic" lasers (HeNe lambda = 632.8 nm and IR diode lambda = 904 nm) in the treatment of tendinopathies was investigated in a randomized double-blind study. On 10 consecutive days, 64 patients (32 therapy, 32 placebo) were treated for 15 minutes each with a switched-on or switched-off laser under otherwise identical conditions. The extent of movement in involved joints (neutral 0 method) and rating on a pain scale for resting pain, movement pain, and pressure pain before treatment, after treatment, and 2 weeks after conclusion of therapy, as well as infrared thermography, served to check therapy. After the end of therapy, a significant reduction (P = less than 0.001) of 50% was shown for resting pain as well as reductions of 30% for movement and 30% for pressure pain. This result was identical in the therapy group and in the placebo group. There was also no indication of a different result of therapy between the therapy and placebo groups with regard to the thermographic control and the extent of movement. The breakdown of the data in terms of age, sex, and duration of disease did not provide any indications of different results for placebo or therapy. It was striking that the patients who reported sensations during or after the treatment (irrespective of whether pleasant or unpleasant) had a greater reduction of pain than the patients without sensations. This laser therapy thus did not show any effect above and beyond that in the untreated group in our double-blind clinical study.