Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie

Die BEMED-Studie (BMJ 2016; 352: DOI 10.1136) war eine multizentrische, mehrarmige, placebokontrollierte Doppelblindstudie, die Patienten (zwischen 18 – 80 Jahren) mit einem ein- oder bds. M. Menière einschließen sollte, bei der eine Niedrig- (2 × 24 mg/d)- vs. Hochdosis (3 × 48 mg/d) Betahistintherapie vs. Placebo verglichen wurden. Der primäre Endpunkt sollte die „per Tagebuch dokumentierte Rate von Schwindelattacken, die länger als 20 min dauerten“ sein. Der Hauptbefund der Studie war, daß Betahistin im Vergleich zu Placebo beim M. Meniére nicht wesentlich besser in der Reduktion der Anfallshäufigkeit abschnitt. Dies soll in der vorliegenden Arbeit kritisch diskutiert werden.

Giant Magnetic Band Gap in the Rashba-Split Surface State of Vanadium-Doped BiTeI: A Combined Photoemission and Ab Initio Study

One of the most promising platforms for spintronics and topological quantum computation is the two-dimensional electron gas (2DEG) with strong spin-orbit interaction and out-of-plane ferromagnetism. In proximity to an s-wave superconductor, such 2DEG may be driven into a topologically non-trivial superconducting phase, predicted to support zero-energy Majorana fermion modes. Using angle-resolved photoemission spectroscopy and ab initio calculations, we study the 2DEG at the surface of the vanadium-doped polar semiconductor with a giant Rashba-type splitting, BiTeI. We show that the vanadium-induced magnetization in the 2DEG breaks time-reversal symmetry, lifting Kramers degeneracy of the Rashba-split surface state at the Brillouin zone center via formation of a huge gap of about 90 meV. As a result, the constant energy contour inside the gap consists of only one circle with spin-momentum locking. These findings reveal a great potential of the magnetically-doped semiconductors with a giant Rashba-type splitting for realization of novel states of matter.

[Dehiscence syndromes : Diagnosis and treatment]

BACKGROUND

Dehiscence syndromes of the semicircular canals are a relatively new group of neurotological disorders. They have a variety of symptoms with hearing/balance involvement. Younger patients have clinically relevant symptoms in only about one third of cases. In addition to etiology and pathogenesis, the present paper describes diagnostic and therapeutic possibilities using a patient series of the authors.

MATERIALS AND METHODS

This nonrandomized prospective study included 52 patients with uni-/bilateral dehiscence syndromes of the superior and/or posterior canal (SCDS/PCDS), diagnosed with high-resolution computed tomography (HR-CT) of the petrous bone. Of 41 patients undergoing surgical therapy for severe symptoms-predominantly vertigo attacks (Meniere-like) and/or falls (Tumarkin crises)-31 received single-sided hearing implants.

RESULTS

Of the 41 patients with transmastoid superior and/or posterior canal occlusion, 30 showed a significant improvement of balance in the Dizziness Handicap Inventory (DHI); the dizzy spells ceased. A positive outcome was correlated with the severity of the preoperative disorder; a poor outcome (nonsignificant increase in DHI, recurrent vertigo of various qualities/frequencies) with the comorbidities vestibular migraine, Menière's disease of the contralateral ear, and a dehiscence size exceeding 4 mm.

CONCLUSION

The more severe the vestibular symptoms, the better the outcome of surgical therapy. Auditory symptoms (nonspecific aural fullness, hyperacusis) do not generally respond well to surgical therapy. Cochlear implants have an additional beneficial effect; comorbidities should be considered as (relative) contraindications.

A novel methodology to evaluate the molecular validity of preclinical psychosis models compared to schizophrenia brain pathology

Rodent models of schizophrenia (SCZ) are indispensable when screening for novel treatments, but quantifying their translational relevance with the underlying human pathophysiology has proved difficult. A novel systems methodology (shown in Figure 1) was developed integrating and comparing proteomic data of anterior prefrontal cortex tissue from SCZ post-mortem brains and matched controls with data obtained from four established glutamatergic rodent models, with the aim of evaluating which of these models represent SCZ most closely. Liquid chromatography coupled tandem mass spectrometry (LC-MSE) proteomic profiling was applied comparing healthy and “disease state” in human post-mortem samples and rodent brain tissue samples. Protein-protein interaction networks were constructed from significant abundance changes and enrichment analyses enabled the identification of pathophysiological characteristics of the disorder, which were represented across all four rodent models. Subsequently, these functional domains were used for cross-species comparisons. Five functional domains such as “development and differentiation” represented across all four rodent models, were identified. It was quantified that the chronic phencyclidine (cPCP) model represented SCZ brain changes most closely for four of these functional domains, by using machine-learning techniques. This is the first study aiming to quantify which rodent model recapitulates the neuropathological features of SCZ most closely. The methodology and findings presented here support recent efforts to overcome translational hurdles of preclinical psychiatric research by associating behavioural endophenotypes with distinct biological processes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Temperature Dependence of Magnetic Excitations: Terahertz Magnons above the Curie Temperature

When an ordered spin system of a given dimensionality undergoes a second order phase transition, the dependence of the order parameter, i.e., magnetization on temperature, can be well described by thermal excitations of elementary collective spin excitations (magnons). However, the behavior of magnons themselves, as a function of temperature and across the transition temperature T_{C}, is an unknown issue. Utilizing spin-polarized high resolution electron energy loss spectroscopy, we monitor the high-energy (terahertz) magnons, excited in an ultrathin ferromagnet, as a function of temperature. We show that the magnons' energy and lifetime decrease with temperature. The temperature-induced renormalization of the magnons' energy and lifetime depends on the wave vector. We provide quantitative results on the temperature-induced damping and discuss the possible mechanism, e.g., multimagnon scattering. A careful investigation of physical quantities determining the magnons' propagation indicates that terahertz magnons sustain their propagating character even at temperatures far above T_{C}.

Observation of anomalous Hall effect in a non-magnetic two-dimensional electron system

Anomalous Hall effect, a manifestation of Hall effect occurring in systems without time-reversal symmetry, has been mostly observed in ferromagnetically ordered materials. However, its realization in high-mobility two-dimensional electron system remains elusive, as the incorporation of magnetic moments deteriorates the device performance compared to non-doped structure. Here we observe systematic emergence of anomalous Hall effect in various MgZnO/ZnO heterostructures that exhibit quantum Hall effect. At low temperatures, our nominally non-magnetic heterostructures display an anomalous Hall effect response similar to that of a clean ferromagnetic metal, while keeping a large anomalous Hall effect angle θ_AHE≈20°. Such a behaviour is consistent with Giovannini-Kondo model in which the anomalous Hall effect arises from the skew scattering of electrons by localized paramagnetic centres. Our study unveils a new aspect of many-body interactions in two-dimensional electron systems and shows how the anomalous Hall effect can emerge in a non-magnetic system.

Genomic profiling of Acute lymphoblastic leukemia in ataxia telangiectasia patients reveals tight link between ATM mutations and chromothripsis

Recent developments in sequencing technologies led to the discovery of a novel form of genomic instability, termed chromothripsis. This catastrophic genomic event, involved in tumorigenesis, is characterized by tens to hundreds of simultaneously acquired locally clustered rearrangements on one chromosome. We hypothesized that leukemias developing in individuals with Ataxia Telangiectasia, who are born with two mutated copies of the ATM gene, an essential guardian of genome stability, would show a higher prevalence of chromothripsis due to the associated defect in DNA double-strand break repair. Using whole-genome sequencing, fluorescence in situ hybridization and RNA sequencing, we characterized the genomic landscape of Acute Lymphoblastic Leukemia (ALL) arising in patients with Ataxia Telangiectasia. We detected a high frequency of chromothriptic events in these tumors, specifically on acrocentric chromosomes, as compared with tumors from individuals with other types of DNA repair syndromes (27 cases total, 10 with Ataxia Telangiectasia). Our data suggest that the genomic landscape of Ataxia Telangiectasia ALL is clearly distinct from that of sporadic ALL. Mechanistically, short telomeres and compromised DNA damage response in cells of Ataxia Telangiectasia patients may be linked with frequent chromothripsis. Furthermore, we show that ATM loss is associated with increased chromothripsis prevalence in additional tumor entities.

[Routine fluoroscopic investigations after primary bariatric surgery]

BACKGROUND

Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery.

METHODS

Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated.

RESULTS

In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients.

CONCLUSION

Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.

Time-Reversal-Breaking Weyl Fermions in Magnetic Heusler Alloys

Weyl fermions have recently been observed in several time-reversal-invariant semimetals and photonics materials with broken inversion symmetry. These systems are expected to have exotic transport properties such as the chiral anomaly. However, most discovered Weyl materials possess a substantial number of Weyl nodes close to the Fermi level that give rise to complicated transport properties. Here we predict, for the first time, a new family of Weyl systems defined by broken time-reversal symmetry, namely, Co-based magnetic Heusler materials XCo_{2}Z (X=IVB or VB; Z=IVA or IIIA). To search for Weyl fermions in the centrosymmetric magnetic systems, we recall an easy and practical inversion invariant, which has been calculated to be -1, guaranteeing the existence of an odd number of pairs of Weyl fermions. These materials exhibit, when alloyed, only two Weyl nodes at the Fermi level-the minimum number possible in a condensed matter system. The Weyl nodes are protected by the rotational symmetry along the magnetic axis and separated by a large distance (of order 2π) in the Brillouin zone. The corresponding Fermi arcs have been calculated as well. This discovery provides a realistic and promising platform for manipulating and studying the magnetic Weyl physics in experiments.

De novo KAT6B Mutation Identified with Whole-Exome Sequencing in a Girl with Say-Barber/Biesecker/Young-Simpson Syndrome

Say-Barber/Biesecker/Young-Simpson syndrome (SBBYSS; OMIM 603736) is a rare syndrome with multiple congenital anomalies/malformations. The clinical diagnosis is usually based on a phenotype with a mask-like face and severe blepharophimosis and ptosis as well as other distinctive facial traits. We present a girl with dysmorphic features, an atrial septal defect, and developmental delay. Previous genetic testing (array-CGH, 22q11 deletion, PTPN11 and MLL2 mutation analysis) gave normal results. We performed whole-exome sequencing (WES) and identified a heterozygous nonsense mutation in the KAT6B gene, NM_001256468.1: c.4943C>G (p.S1648*). The mutation led to a premature stop codon and occurred de novo. KAT6B sequence variants have previously been identified in patients with SBBYSS, and the phenotype of the girl is similar to other patients diagnosed with SBBYSS. This case report provides additional evidence for the correlation between the KAT6B mutation and SBBYSS. If a patient is suspected of having a blepharophimosis syndrome or SBBYSS, we recommend sequencing the KAT6B gene. This is a further example showing that WES can assist diagnosis.

Quantitative description of short-range order and its influence on the electronic structure in Ag-Pd alloys

We investigate the effect of short-range order (SRO) on the electronic structure in alloys from the theoretical point of view using density of states (DOS) data. In particular, the interaction between the atoms at different lattice sites is affected by chemical disorder, which in turn is reflected in the fine structure of the DOS and, hence, in the outcome of spectroscopic measurements. We aim at quantifying the degree of potential SRO with a proper parameter. The theoretical modeling is done with the Korringa-Kohn-Rostoker Green's function method. Therein, the extended multi-sublattice non-local coherent potential approximation is used to include SRO. As a model system, we use the binary solid solution Ag c Pd1-c at three representative concentrations c  =  0.25, 0.5 and 0.75. The degree of SRO is varied from local ordering to local segregation through an intermediate completely uncorrelated state. We observe some pronounced features, which change over the whole energy range of the valence bands as a function of SRO in the alloy. These spectral variations should be traceable in modern photoemission experiments.

Optimisation of the round window opening in cochlear implant surgery in wet and dry conditions: impact on intracochlear pressure changes

To preserve residual hearing in cochlear implant candidates, the atraumatic insertion of the cochlea electrode has become a focus of cochlea implant research. In a previous study, intracochlear pressure changes during the opening of the round window membrane were investigated. In the current study, intracochlear pressure changes during opening of the round window membrane under dry and transfluid conditions were investigated. Round window openings were performed in an artificial cochlear model. Intracochlear pressure changes were measured using a micro-optical pressure sensor, which was placed in the apex. Openings of the round window membrane were performed under dry and wet conditions using a cannula and a diode laser. Statistically significant differences in the intracochlear pressure changes were seen between the different methods used for opening of the round window membrane. Lower pressure changes were seen by opening the round window membrane with the diode laser than with the cannula. A significant difference was seen between the dry and wet conditions. The atraumatic approach to the cochlea is assumed to be essential for the preservation of residual hearing. Opening of the round window under wet conditions produce a significant advantage on intracochlear pressure changes in comparison to dry conditions by limiting negative outward pressure.

Orbital Selectivity in Scanning Tunneling Microscopy: Distance-Dependent Tunneling Process Observed in Iron Nitride

In scanning tunneling microscopy, orbital selectivity of the tunneling process can make the topographic image dependent on a tip-surface distance. We have found reproducible dependence of the images on the distance for a monatomic layer of iron nitride formed on a Cu(001) surface. Observed atomic images systematically change between a regular dot array and a dimerized structure depending on the tip-surface distance, which turns out to be the only relevant parameter in the image variation. An accompanied change in the weight of Fe-3d local density of states to a tunneling background was detected in dI/dV spectra. These have been attributed to a shift in surface orbitals detected by the tip from the d states to the s/p states with increasing the tip-surface distance, consistent with an orbital assignment from first-principles calculations.

The low-temperature magnetostructure and magnetic field response of Pr0.9Ca0.1MnO3: the roles of Pr spins and magnetic phase separation

With the goal of elucidating the background of photoinduced ferromagnetism phenomena observed in the perovskite structured (Pr,Ca) manganites, the low-temperature magnetostructure of the material Pr0.9Ca0.1MnO3 was revised using cold neutron powder diffraction, SQUID magnetometry and ab initio calculations. Particular emphasis was placed on determining the presence of nanoscale magnetic phase separation. Previously published results of a canted A-AFM average ground state were reproduced to a good precision both experimentally and theoretically, and complemented by investigating the effects of an applied magnetic field of 2.7 T on the magnetostructure. Explicit evidence of nanoscale magnetic clusters in the material was obtained based on high-resolution neutron diffractograms. Along with several supporting arguments, we present this finding as a justification for extending the nanoscale magnetic phase separation model of manganites to the material under discussion despite its very low Ca doping level in the context of the model. In the light of the new data, we also conclude that the low temperature magnetic moment of Pr must be ca. 300% larger than previously thought in this material, close to the high spin value of 2μB per formula unit.

[Osteoradionecrosis of the sternoclavicular joint]

BACKGROUND/OBJECTIVE

Osteoradionecrosis is a rare, but feared, late complication after radiotherapy of the head and neck region. Its localization to the sternoclavicular joint has rarely been described so far.

MATERIALS AND METHODS

Data are from a retrospective study that included all patients admitted to the authors' clinic with osteoradionecrosis of the sternoclavicular joint during the last 5 years. Therapy and outcome were evaluated and compared to the established literature.

RESULTS

Over the past 5 years, 2 patients have been treated for pronounced osteoradionecrosis of the sternoclavicular joint. Both patients had received postoperative radiotherapy for tumors of the neck and chest, and presented with lesions involving the clavicle and the sternum. After eliminating the suspicion of recurrent cancer, both radiologic imaging and histopathologic evaluation confirmed an infection. Aggressive debridement with partial claviculectomy, partial sternectomy, and reconstruction using a pectoralis flap lead to the patients' recovery.

CONCLUSION

Osteoradionecrosis does not only affect bone, but also the surrounding soft tissue. Due to the changes associated with previous radiotherapy, osteoradionecrosis should always be treated with radical debridement of the infected area, followed by flap reconstruction using unaffected tissue. The prognosis for the patient is then good.

Study of electronic and magnetic properties and related x-ray absorption spectroscopy of ultrathin Co films on BaTiO3

We present a first-principles study of electronic and magnetic properties of thin Co films on a BaTiO3(0 0 1) single crystal. The crystalline structure of 1-3 monolayer thick Co films was determined and served as input for calculations of the electronic and magnetic properties of the films. The estimation of exchange constants indicates that the Co films are ferromagnetic with a high critical temperature, which depends on the film thickness and the interface geometry. In addition, we calculated x-ray absorption spectra, related magnetic circular dichroism (XMCD) and linear dichroism (XLD) of the Co L 2, 3 edges as a function of Co film thickness and ferroelectric polarization of BaTiO3. We found characteristic features, which depend strongly on the magnetic properties and the structure of the film. While there is only a weak dependence of XMCD spectra on the ferroelectric polarization, the XLD of the films is much more sensitive to the polarization switching, which could possibly be observed experimentally.

Mortality in incident dementia - results from the German Study on Aging, Cognition, and Dementia in Primary Care Patients

OBJECTIVE

Dementia is known to increase mortality, but the relative loss of life years and contributing factors are not well established. Thus, we aimed to investigate mortality in incident dementia from disease onset.

METHOD

Data were derived from the prospective longitudinal German AgeCoDe study. We used proportional hazards models to assess the impact of sociodemographic and health characteristics on mortality after dementia onset, Kaplan-Meier method for median survival times.

RESULTS

Of 3214 subjects at risk, 523 (16.3%) developed incident dementia during a 9-year follow-up period. Median survival time after onset was 3.2 years (95% CI = 2.8-3.7) at a mean age of 85.0 (SD = 4.0) years (≥2.6 life years lost compared with the general German population). Survival was shorter in older age, males other dementias than Alzheimer's, and in the absence of subjective memory complaints (SMC).

CONCLUSION

Our findings emphasize that dementia substantially shortens life expectancy. Future studies should further investigate the potential impact of SMC on mortality in dementia.

The PHF6 Mutation c.1A>G; pM1V Causes Börjeson-Forsman-Lehmann Syndrome in a Family with Four Affected Young Boys

The family presented with 4 boys, 2 sets of brothers, with unexplained intellectual disability. Numerous analyses had been conducted over more than a decade, without reaching a final clinical or molecular diagnosis. According to the pedigree, an X-linked inheritance pattern was strongly suspected. Whole-exome sequencing (WES) with targeted analysis of the coding regions of the X chromosome was carried out in the 4 boys, their mothers, and their shared grandmother. A filtering process searching for nonsynonymous variants and variants in the exon-intron boundaries revealed one variant, c.1A>G; pM1V, in the first codon of the PHF6 gene. The variant was hemizygous in the 4 boys and heterozygous in the 2 mothers and the grandmother. Mutations in the PHF6 gene are known to cause Börjeson-Forsman-Lehmann syndrome (BFLS). The boys were reexamined after the finding of the mutation, and the phenotype fitted perfectly with BFLS. The mutation found in the PHF6 gene is causative for the intellectual disability in this family. We also conclude that WES of the X chromosome is a powerful tool in families where an X-linked inheritance pattern is suspected.

Study of the negative magneto-resistance of single proton-implanted lithium-doped ZnO microwires

The magneto-transport properties of single proton-implanted ZnO and of Li(7%)-doped ZnO microwires have been studied. The as-grown microwires were highly insulating and not magnetic. After proton implantation the Li(7%) doped ZnO microwires showed a non-monotonous behavior of the negative magneto-resistance (MR) at temperature above 150 K. This is in contrast to the monotonous NMR observed below 50 K for proton-implanted ZnO. The observed difference in the transport properties of the wires is related to the amount of stable Zn vacancies created at the near surface region by the proton implantation and Li doping. The magnetic field dependence of the resistance might be explained by the formation of a magnetic/non-magnetic heterostructure in the wire after proton implantation.

ECEL1 mutation causes fetal arthrogryposis multiplex congenita

Arthrogryposis multiplex congenita (AMC) is a descriptor for the clinical finding of congenital fixation of multiple joints. We present a consanguineous healthy couple with two pregnancies described with AMC due to characteristic findings on ultrasonography of fixated knee extension and reduced fetal movement at the gestational age of 13 weeks + 2 days and 12 weeks + 4 days. Both pregnancies were terminated and postmortem examinations were performed. The postmortem examinations confirmed AMC and suggested a diagnosis of centronuclear myopathy (CNM) due to characteristic histological findings in muscle biopsies. Whole exome sequencing (WES) was performed on all four individuals and the outcome was filtered by application of multiple filtration parameters satisfying a recessive inheritance pattern. Only one gene, ECEL1, was predicted damaging and had previously been associated with neuromuscular disease or AMC. The variant found ECEL1 is a missense mutation in a highly conserved residue and was predicted pathogenic by prediction software. The finding expands the molecular basis of congenital contractures and the phenotypic spectrum of ECEL1 mutations. The histological pattern suggestive of CNM in the fetuses can expand the spectrum of genes causing CNM, as we propose that mutations in ECEL1 can cause CNM or a condition similar to this. Further investigation of this is needed and we advocate that future patients with similar clinical presentation or proven ECEL1 mutations are examined with muscle biopsy. Secondly, this study illustrates the great potential of the clinical application of WES in couples with recurrent abortions or stillborn neonates.

Low and moderate doses of ionizing radiation up to 2 Gy modulate transmigration and chemotaxis of activated macrophages, provoke an anti-inflammatory cytokine milieu, but do not impact upon viability and phagocytic function

Benign painful and inflammatory diseases have been treated for decades with low/moderate doses of ionizing radiation (LD-X-irradiation). Tissue macrophages regulate initiation and resolution of inflammation by the secretion of cytokines and by acting as professional phagocytes. Having these pivotal functions, we were interested in how activated macrophages are modulated by LD-X-irradiation, also with regard to radiation protection issues and carcinogenesis. We set up an ex-vivo model in which lipopolysaccharide pre-activated peritoneal macrophages (pMΦ) of radiosensitive BALB/c mice, mimicking activated macrophages under inflammatory conditions, were exposed to X-irradiation from 0·01 Gy up to 2 Gy. Afterwards, the viability of the pMΦ, their transmigration and chemotaxis, the phagocytic behaviour, the secretion of inflammatory cytokines and underlying signalling pathways were determined. Exposure of pMΦ up to a single dose of 2 Gy did not influence their viability and phagocytic function, an important fact regarding radiation protection. However, significantly reduced migration, but increased chemotaxis of pMΦ after exposure to 0·1 or 0·5 Gy, was detected. Both might relate to the resolution of inflammation. Cytokine analyses revealed that, in particular, the moderate dose of 0·5 Gy applied in low-dose radiotherapy for inflammatory diseases results in an anti-inflammatory cytokine microenvironment of pMΦ, as the secretion of the proinflammatory cytokine interleukin (IL)-1β was reduced and that of the anti-inflammatory cytokine transforming growth factor (TGF)-β increased. Further, the reduced secretion of IL-1β correlated with reduced nuclear translocation of nuclear factor (NF)-κB p65, starting at exposure of pMΦ to 0·5 Gy of X-irradiation. We conclude that inflammation is modulated by LD-X-irradiation via changing the inflammatory phenotype of macrophages.

Magnon dispersion in thin magnetic films

Although the dispersion of magnons has been measured in many bulk materials, few studies deal with the changes in the dispersion when the material is in the form of a thin film, a system that is of interest for applications. Here we review inelastic tunneling spectroscopy studies of magnon dispersion in Mn/Cu3Au(1 0 0) and present new studies on Co and Ni thin films on Cu(1 0 0). The dispersion in Mn and Co films closely follows the dispersion of bulk samples with negligible dependence on thickness. The lifetime of magnons depends slightly on film thickness, and decreases considerably as the magnon energy increases. In Ni/Cu(1 0 0) films the thickness dependence of dispersion is much more pronounced. The measurements indicate a considerable mode softening for thinner films. Magnon lifetimes decrease dramatically near the edge of the Brillouin zone due to a close proximity of the Stoner continuum. The experimental study is supported by first-principles calculations.

Tuning the Dirac point position in Bi(2)Se(3)(0001) via surface carbon doping

Angular resolved photoemission spectroscopy in combination with ab initio calculations show that trace amounts of carbon doping of the Bi_{2}Se_{3} surface allows the controlled shift of the Dirac point within the bulk band gap. In contrast to expectation, no Rashba-split two-dimensional electron gas states appear. This unique electronic modification is related to surface structural modification characterized by an expansion of the top Se-Bi spacing of ≈11% as evidenced by surface x-ray diffraction. Our results provide new ways to tune the surface band structure of topological insulators.

Results in using the Freiburger monosyllabic speech test in noise without and with hearing aids

The Freiburger Speech Test (FST) has been the gold standard in speech testing by word recognition score in Germany for many years. Recently, it has been demonstrated that for an amount of 104 test-persons there is no significant deviation within the lists. The objective of this study was to determine the percentiles of the distinct measuring situations in quiet and with noise (e.g. applied in hearing aid fitting) and the average benefit using hearing aids. In this prospective study, 623 patients with SNHL and equipped with hearing aids for at least 3 months have been investigated by means of the Freiburger monosyllabic test (FBE) without and with hearing aids and in quiet or with noise (CCITT noise, 65/60 dB signal-noise ratio) in free field conditions at 65 dB to determine the ratio of intelligibility. To investigate the different diagnostic conditions a linear mixed model was applied. The dependent binary variable corresponds to the number of understood syllables. The average age of all subjects was about 72.6 years. The average rate of understanding in the FBE without hearing aids and in quiet was 38.5 %, with hearing aids and in quiet 67.7 %, without hearing aids and with noise 22.4 %, and with hearing aids and with noise 39.8 %. All results were presented with the depending confidence intervals. The extent of hearing loss and the quality of hearing aid fitting can be successfully measured using the FST in quiet and with background noise (CCITT noise). In quiet, an average hearing improving gain of 29.2 % points and with noise a gain of 17.4 % points could be estimated with a successful hearing aid fitting.

[Diagnosis of otolith disorders in routine otolaryngology]

Nowadays, specific and reproducible side-separated neurotologic testing of all vestibular receptors is possible. Assessment of saccular function by measuring cervical vestibular-evoked myogenic potentials (cVEMP) is well established. Reliable screening tests exist for the isolated assessment of utricular function. These tests can be performed even in less well-equipped surroundings to generate information regarding a possible partial dysfunction of the otolith organs. Apart from assessing the functionality of the semicircular canals by caloric irrigation and the head impulse test, screening for otolith disorders should be part of a comprehensive modern vestibular examination. Neurofeedbacktraining is an effective therapy in the treatment of otholith disorders.

Apolipoprotein E epsilon 4 genotype and a physically active lifestyle in late life: analysis of gene-environment interaction for the risk of dementia and Alzheimer's disease dementia

BACKGROUND

As physical activity may modify the effect of the apolipoprotein E (APOE) ε4 allele on the risk of dementia and Alzheimer's disease (AD) dementia, we tested for such a gene-environment interaction in a sample of general practice patients aged ⩾75 years.

METHOD

Data were derived from follow-up waves I-IV of the longitudinal German study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). The Kaplan-Meier survival method was used to estimate dementia- and AD-free survival times. Multivariable Cox regression was used to assess individual associations of APOE ε4 and physical activity with risk for dementia and AD, controlling for covariates. We tested for gene-environment interaction by calculating three indices of additive interaction.

RESULTS

Among the randomly selected sample of 6619 patients, 3327 (50.3%) individuals participated in the study at baseline and 2810 (42.5%) at follow-up I. Of the 2492 patients without dementia included at follow-up I, 278 developed dementia (184 AD) over the subsequent follow-up interval of 4.5 years. The presence of the APOE ε4 allele significantly increased and higher physical activity significantly decreased risk for dementia and AD. The co-presence of APOE ε4 with low physical activity was associated with higher risk for dementia and AD and shorter dementia- and AD-free survival time than the presence of APOE ε4 or low physical activity alone. Indices of interaction indicated no significant interaction between low physical activity and the APOE ε4 allele for general dementia risk, but a possible additive interaction for AD risk.

CONCLUSIONS

Physical activity even in late life may be effective in reducing conversion to dementia and AD or in delaying the onset of clinical manifestations. APOE ε4 carriers may particularly benefit from increasing physical activity with regard to their risk for AD.

[Evaluation of the Freiburg monosyllabic speech test in background noise]

BACKGROUND

The Freiburg speech test has been the gold standard in speech audiometry in Germany for many years. Previously, however, this test had not been evaluated in assessing the effectiveness of a hearing aid in background noise. Furthermore, the validity of particular word lists used in the test has been questioned repeatedly in the past, due to a suspected higher variation within these lists as compared to the other word list used.

PATIENTS AND METHODS

In this prospective study, two groups of subjects [normal hearing control subjects and patients with SNHL (sensorineural hearing loss) that had been fitted with hearing aid] were examined. In a first group, 113 control subjects with normal age- and gender-related pure tone thresholds were assessed by means of the Freiburg monosyllabic test under free-field conditions at 65 dB. The second group comprised 104 patients that had been fitted with hearing aids at least 3 months previously to treat their SNHL. Members of the SNHL group were assessed by means of the Freiburg monosyllabic test both with and without hearing aids, and in the presence or absence of background noise (CCITT-noise; 65/60 dB signal-noise ratio, in accordance with the Comité Consultatif International Téléphonique et Télégraphique), under free-field conditions at 65 dB.

RESULTS

The first (control) group exhibited no gender-related differences in the Freiburg test results. In a few instances, inter-individual variability of responses was observed, although the reasons for this remain to be clarified. Within the second (patient) group, the Freiburg test results under the four different measurement conditions differed significantly from each other (p>0.05). This group exhibited a high degree of inter-individual variability between responses. In light of this, no significant differences in outcome could be assigned to the different word lists employed in the Freiburg speech test.

CONCLUSION

The Freiburg monosyllabic test is able to assess the extent of hearing loss, as well as the effectiveness of a fitted hearing aid, in the presence or absence of background-noise (CCITT-noise). The present study could not evidence statistically significant differences in outcome when using the different word lists in this test battery.

Band structure engineering in topological insulator based heterostructures

The ability to engineer an electronic band structure of topological insulators would allow the production of topological materials with tailor-made properties. Using ab initio calculations, we show a promising way to control the conducting surface state in topological insulator based heterostructures representing an insulator ultrathin films on the topological insulator substrates. Because of a specific relation between work functions and band gaps of the topological insulator substrate and the insulator ultrathin film overlayer, a sizable shift of the Dirac point occurs resulting in a significant increase in the number of the topological surface state charge carriers as compared to that of the substrate itself. Such an effect can also be realized by applying the external electric field that allows a gradual tuning of the topological surface state. A simultaneous use of both approaches makes it possible to obtain a topological insulator based heterostructure with a highly tunable topological surface state.

Direct probing of the exchange interaction at buried interfaces

The fundamental interactions between magnetic moments at interfaces have an important impact on the properties of layered magnetic structures. Hence, a direct probing of these interactions is highly desirable for understanding a wide range of phenomena in low-dimensional solids. Here we propose a method for probing the magnetic exchange interaction at buried interfaces using spin-polarized electrons and taking advantage of the collective nature of elementary magnetic excitations (magnons). We demonstrate that, for the case of weak coupling at the interface, the low-energy magnon mode is mainly localized at the interface. Because this mode has the longest lifetime of the modes and has a finite spectral weight across the layers on top, it can be probed by electrons. A comparison of experimental data and first-principles calculations leads to the determination of the interface exchange parameters. This method may help the development of spectroscopy of buried magnetic interfaces.

Tuning the structure of ultrathin BaTiO3 films on Me(001) (Me=Fe, Pd, Pt) surfaces

Using surface x-ray diffraction in combination with ab initio calculations, we demonstrate that the atomic structure of ultrathin BaTiO3 (BTO) films grown on Me(001) surfaces (Me=Fe, Pd, Pt) depends on subtle modifications of the interface chemical composition. A complete reversal of the surface termination from a BaO- [BTO on Fe(001)] to a TiO2-terminated film [BTO on Pt(001)] is observed which goes in parallel with the adsorption of submonolayer amounts of oxygen at metal hollow sites of the interface. Our results may suggest a new route to an overall control of both the surface and the interface geometry in BaTiO3/metal contacts.

Diabetic db/db mice exhibit central nervous system and peripheral molecular alterations as seen in neurological disorders

The db/db mouse is a widely used preclinical model in diabetes research. Recent studies have shown that these mice also display aspects of psychosis and depression-like behaviors as seen in some psychiatric disorders. Here, we have performed multiplex immunoassay and liquid chromatography mass spectrometry profiling of the plasma and brain samples from db/db and control mice to identify altered pathways, which could be related to these behavioral abnormalities. This is the first study to carry out profiling of the brain proteome in this model. Plasma from the db/db mice had increased levels of leptin and insulin, decreased levels of peptide YY, glucagon and prolactin and alterations in inflammation-related proteins, compared with control mice. Frontal cortex tissue from the db/db mice showed changes in proteins involved in energy metabolism, cellular structure and neural functioning, and the hippocampus had changes in proteins involved in the same pathways, with additional effects on cellular signalling proteins. The overlap of these findings with effects seen in type 2 diabetes, schizophrenia, major depressive disorder and Alzheimer's disease might contribute to a common endophenotype seen in metabolic and neurological disorders.

Comment on "Topological insulators in ternary compounds with a honeycomb lattice"

A Comment on the Letter by Zhang et al., Phys. Rev. Lett. 106, 156402 (2011).

Maternal cigarette smoking during pregnancy and pubertal development in sons. A follow-up study of a birth cohort

Epidemiological studies have raised concern about the reproductive consequences of prenatal cigarette smoking exposure, possibly affecting semen quality and onset of pubertal development of the offspring. The aim of this study was to further investigate pubertal development in young men exposed to cigarette smoking in foetal life. In a Danish pregnancy cohort, information on maternal smoking during pregnancy was available from questionnaires administered in 1984-1987, and information on pubertal development, assessed by age at first nocturnal emission, acne, voice break and regular shaving, was obtained from a follow-up questionnaire administered in 2005 to the young men (age: 18-21). We found no significant association between prenatal cigarette smoking exposure and earlier onset of puberty, but we did observe a tendency towards earlier age of first nocturnal emission, acne and voice break, indicating an accelerated age of pubertal development. Men exposed to ≥15 cigarettes/day had 3.1 months (95% CI: -6.4; 0.2) earlier age at acne and 2.2 months (95% CI: -7.3; 3.0) earlier age at first nocturnal emission, 1.2 months (95% CI: -4.6; 2.2) earlier age at voice break, however, 1.3 months (95% CI: -1.6; 4.3) later age at regular shaving, compared with unexposed men. Prenatal cigarette smoking exposure may induce an earlier age at onset of puberty in young men, but larger studies with prospectively collected data on pubertal development are needed to explore this hypothesis further.

Impact of atomic structure on the magnon dispersion relation: a comparison between Fe(111)/Au/W(110) and Fe(110)/W(110)

We present a combined experimental and theoretical study of the interplay between the atomic structure and the magnon excitations in low dimensional ferromagnets. Two monolayer thick Fe films on W(110) with and without a Au buffer layer are investigated. Our experiments show that adding the Au layer leads to a significant softening of the magnons. First-principles calculations confirm the experimental results revealing a strong dependency of exchange interactions on the atomic structure. It is observed that the intralayer exchange interactions increase with increasing distance between Fe layers. This unusual relationship is attributed to the complexity of the electronic structure and the contribution of different orbitals to the hybridization and exchange interaction. Our results suggest a way of tailoring magnetic excitations in low-dimensional magnetic structures.

Maternal smoking during pregnancy and reproductive health of daughters: a follow-up study spanning two decades

STUDY QUESTION

Does in utero exposure to constituents of cigarette smoke have a programming effect on daughters' age of menarche and markers of long-term reproductive health?

SUMMARY ANSWER

In utero exposure to constituents of cigarette smoke was associated with earlier age of menarche and--to a lesser extent--changes in the testosterone profile of the young women.

WHAT IS KNOWN ALREADY

Studies observe potential effects of in utero exposure to constituents of cigarette smoke on the intrauterine formation of female gonads, but the consequences on long-term reproductive health in daughters remain unclear.

STUDY DESIGN, SIZE AND DURATION

A prospective cohort study was designed using data from 965 pregnant women enrolled prior to a routine 30th-week antenatal examination at a midwifery practice in Denmark from 1988 to 1989 and a follow-up of their 19-21-year-old daughters in 2008.

PARTICIPANTS/MATERIALS, SETTING AND METHODS

The pregnant women provided information on lifestyle factors during pregnancy, including the exact number of cigarettes smoked per day during the first and the second trimesters. A total of 438 eligible daughters were asked to complete a web-based questionnaire on reproductive health and subsequently invited to participate in a clinical examination during 2008. Of the 367 daughters (84%) who answered the questionnaire, 267 (61%) agreed to further examination. Information on menstrual pattern was provided at examination, blood samples were drawn to be analyzed for serum levels of reproductive hormones [FSH, LH, estradiol (E(2)), sex hormone-binding globulin, anti-Müllerian hormone, dehydroepiandrosterone-sulphate (DHEAS), free testosterone and free E(2)] and number of follicles (2-9 mm) were examined by transvaginal ultrasound. The daughters were divided into three exposure groups according to the level of maternal smoking during first trimester [non-exposed (reference), low-exposed (mother smoking >0-9 cigarettes/day) and high-exposed (mother smoking ≥ 10 cigarettes/day)]. Data were analyzed by multiple regression analyses in which we adjusted for potential confounders. Both crude and adjusted test for trend were carried out using maternal smoking during the first trimester as a continuous variable.

MAIN RESULTS AND THE ROLE OF CHANCE

We observed an inverse association between in utero exposure to constituents of cigarette smoke and age of menarche (P = 0.001). Daughters exposed to >0-9 cigarettes/day debuted with -2.7 [95% confidence interval (CI) -5.2 to -0.1] percentage earlier age of menarche, whereas daughters exposed to ≥ 10 cigarettes/day had -4.1 (95% CI: -6.6 to -1.5) percentage earlier age of menarche corresponding to 6.5 (95% CI: -10.7 to -2.2) months. There was a non-significant tendency towards lower levels of testosterone and DHEAS with increasing in utero exposure to constituents of cigarette smoke but no associations with follicle number, cycle length or serum levels of the other reproductive hormones were observed.

LIMITATIONS AND REASONS FOR CAUTION

We collected information on age of menarche retrospectively but the recall time was relatively short (2-10 years) and the reported values were within the normal range of Caucasians. Analyses of reproductive hormones are presented only for the group of daughters who were non-users of hormonal contraceptives because users were excluded, leaving only a low number of daughters available for the analyses (n = 75), as reflected in the wide CIs. The analyses of hormones were further adjusted for menstrual phase at time of clinical examination (follicular, ovulation and luteal phase) because blood samples were not collected on a specific day of the menstrual cycle.

WIDER IMPLICATIONS OF THE FINDINGS

This study supports the limited evidence of an inverse association between maternal smoking during pregnancy and age of menarche and further addresses to what extent reproductive capacity and hormones may be programmed by maternal smoking during pregnancy. A trend toward earlier maturation of females is suggested to have implications on long-term reproductive function.

STUDY FUNDING/COMPETING INTEREST(S)

Supported by a scholarship from The Lundbeck Foundation (R93-A8476). No conflict of interest declared.