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The aim of this registry is to provide data on age-related clinical features of suspected myocarditis and to create a study platform allowing for deriving diagnostic criteria and, at a later stage, testing therapeutic interventions in patients with myocarditis. After an initial 6-month pilot phase, MYKKE was opened in June 2014 as a prospective multicenter registry for patients from pediatric heart centers, university hospitals, and community hospitals with pediatric cardiology wards in Germany. Inclusion criteria consisted of age<18 years and hospitalization for suspected myocarditis as leading diagnosis at the discretion of the treating physician. By December 31, 2015, fifteen centers across Germany were actively participating and had enrolled 149 patients. Baseline data reveal 2 age peaks (<2 years, >12 years), show higher proportions of males, and document a high prevalence of severe disease courses in pediatric patients with suspected myocarditis. Severe clinical courses and early adverse events were more prevalent in younger patients and were related to severely impaired leftventricular ejection fraction at initial presentation. MYKKE represents a multicenter registry and research platform for children and adolescents with suspected myocarditis that achieve steady recruitment and generate a wide range of real-world data on clinical course, diagnostic workup, and treatment of this group of patients. The baseline data reveal the presence of 2 age peaks and provide important insights into the severity of disease in children with suspected myocarditis. In the future, MYKKE might facilitate interventional substudies by providing an established collaborating network using common diagnostic approaches.

Background: The aim of this study was to evaluate the functional and radiographic outcome in patients with reverse total shoulder arthroplasty (RSA) for displaced proximal humeral fractures (PHF) with or without tenotomy of the supraspinatus tendon. Methods: Between June 2011 and June 2018, 159 patients (age >65 years) with a displaced proximal humeral fracture underwent reverse total shoulder arthroplasty (Grammont design) in a single-center study and were longitudinally followed up. In all cases, the tuberosities were attached to the prosthesis in a standardized procedure. Functional outcome, range of motion as well as tuberosity integration, resorption and displacement were assessed at final follow-up. Outcomes were compared between patients that underwent RSA in combination with tenotomy of the supraspinatus (ST) and patients that underwent RSA without supraspinatus tenotomy (NT). Results: At a mean follow up of 22.2 ± 16.4 months 76 patients (mean age 77.1 ± 7.2 years, 83% women) could be evaluated (follow-up rate 47.8%). There were no statistically significant differences between the ST (n = 29) and NT groups (n = 47) in tuberosity integration, resorption 20°: 65.5% vs. 14.9%, p < 0.05) and active abduction (>120°: 89.7% vs. 21.3%, p < 0.05). Tuberosity integration (ST and NT together: n = 34) showed better functional results than resorption or displacement (p < 0.05). Conclusions: Tenotomy of the supraspinatus tendon in RSA for displaced PHF leads to similar radiographic results regarding tuberosity integration, resorption and displacement but better functional outcome with regard to range of motion. Level of Evidence: III

Introduction This study compared the clinical and radiologic outcomes of screw-tip augmented locking plate osteosynthesis (STA) vs primary reverse total shoulder arthroplasty (RSA) in elderly patients with displaced proximal humeral fractures. Methods 60 patients (age >65 years) with a displaced proximal humeral fracture underwent open reduction and internal fixation with locking plate and fluoroscopy controlled screw-tip augmentation. Sixty matched individuals (age, gender, fracture pattern, and mean follow-up) treated by RSA for fractures were identified from the institutional database and outcomes as well as occurring complications and need for revision surgery were compared. Results At 39 months’ follow-up, 25 patients in the STA group (mean age 74.5 ± 12 years, 76.7% woman) showed a mean Constant Score (CS) of 68 ± 18.8 points. Mean %CS compared to the contralateral side was 81.6 ± 19.8%. Of 60 matched individuals in the RSA group, 22 patients (mean age 78.9 ± 8.2 years, 76.7% woman) showed a mean CS of 60.6 ± 21.2 points (P = .33), and the mean %CS compared to the contralateral side was 81.6 (74.7 ± 18.6)% (P = .14). The overall complication rate in STA group was 32% (secondary varus or valgus displacement >10°, n = 4, avascular necrosis, n = 4). In RSA group, the overall complication rate was 4.5% (P = <.05). We observed one early onset infection. Revision surgery with removal of the prosthesis and PMMA spacer implantation for two-stage revision was necessary. The follow-up rate was 41.7 vs 36.7%. Conclusions Screw-tip augmented locked plating and reverse total shoulder arthroplasty result in comparable satisfying functional outcome 3 years following a displaced proximal humeral fracture in elderly patients. However, we noted a higher complication and revision rate in the STA group. In contrast, primary reversed shoulder arthroplasty resulted in a lower rate of complications and revisions, which may be beneficial in elderly patients.

Measurements of the kinematic distributions of J / ψ mesons produced in p –C, p –Ti and p –W collisions at in the Feynman- x region −0.34< x F <0.14 and for transverse momentum up to p T =5.4 GeV/c are presented. The x F and p T dependencies of the nuclear suppression parameter, α , are also given. The results are based on 2.4×10 5 J / ψ mesons reconstructed in both the e + e − and μ + μ − decay channels. The data have been collected by the HERA-B experiment at the HERA proton ring of the DESY laboratory. The measurement explores the negative region of x F for the first time. The average value of α in the measured x F region is 0.981±0.015. The data suggest that the strong nuclear suppression of J / ψ production previously observed at high x F turns into an enhancement at negative x F .

Background Split-depression fractures to the lateral tibial plateau (AO41B3) often feature severe joint surface destructions. Precontoured locking compression plates (LCPs) are designed for optimum support of the reduced joint surface and have especially been emphasized in reduced bone quality. A lack of evidence still inhibits their broad utilization in elderly patients. Thus, aim of the present study was to investigate the implant-specific radiological outcomes of AO41B3-fractures in young versus elderly patients. Methods The hospital’s database was screened for isolated AO41B3-factures, open reduction and internal fixation (ORIF), and radiological follow-up ≥12 months. CT-scans, radiographs, and patients’ records were analyzed. Patients were attributed as young (18–49) or elderly (≥50 years). Additional subgrouping was carried out into precontoured LCP and conventional implants. The Rasmussen Radiological Score (RRS) after 12 months was set as primary outcome parameter. The RRS postoperatively and the medial proximal tibial angle (MPTA) postoperatively and after 12 months were secondary outcome parameters. Results Fifty nine consecutive patients were included (26 young, 38.2 ± 7.8 years; 33 elderly, 61.3 ± 9.4 years). There were no significant differences regarding mean size and depression depth of the lateral joint surface fragments. Prior to implant-specific subgrouping, the radiological outcome measures revealed no significant differences between young (RRS = 7.7 ± 1.7; MPTA = 90.3 ± 2.3°) and elderly (RRS = 7.2 ± 1.7; MPTA = 90.5 ± 3.3°). After implant-specific subgrouping, the radiological outcome revealed significantly impaired results in young patients with conventional implants (RRS(C) = 6.9 ± 1.6, RRS(LCP) = 8.5 ± 1.5, P = .015; MPTA(C) = 91.5 ± 1.9°, MPTA(LCP) = 89.1 ± 2.1°, P = .01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to precontoured LCP (RRS(C) = 5.7 ± 1.6, RRS(LCP) = 8.2 ± .8, P < .001; MPTA(C) = 92.6 ± 4.2°, MPTA(LCP) = 89.2 ± 1.4°, P = .002). Conclusion Utilizing precontoured LCP in the treatment of AO41B3-fractures is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered in any AO41B3-fracture, but especially in elderly patients.

A study of the angular distributions of leptons from decays of J / ψ ’s produced in p-C and p-W collisions at has been performed in the J / ψ Feynman- x region −0.34< x F <0.14 and for J / ψ transverse momenta up to 5.4 GeV/ c . The data were collected by the HERA-B experiment at the HERA proton ring of the DESY laboratory. The results, based on a clean selection of 2.3×10 5 J / ψ ’s reconstructed in both the e + e − and μ + μ − decay channels, indicate that J / ψ ’s are produced polarized. The magnitude of the effect is maximal at low  p T . For p T >1 GeV/ c a significant dependence on the reference frame is found: the polar anisotropy is more pronounced in the Collins-Soper frame and almost vanishes in the helicity frame, where, instead, a significant azimuthal anisotropy arises.

Aims and Objectives: The analysis of lower limb anatomy is mandatory in deformity surgery and total knee replacement. Standard values for joint angles and alignment are only available for 2D images using long standing and lateral radiographs. In contrast, 3D bone models realistically represent the anatomy and are independent of position and projection. Using a self-developed, standardised and validated protocol for 3D analysis of lower limb geometry, standard values for specific joint angles and axes can be obtained in a young cohort for the first time. Materials and Methods: After power and sample size analysis, 60 thin-slice CTs of the entire leg were analysed (30 patients, 13 f, 17 m; age = 33.8 [18-50 years]). After segmentation all 24 relevant bony landmarks were set using our standardised analysis method. Results of joint angles and mechanical axis deviation are calculated automatically. Mean values are stated with standard deviations to describe a possible reference range. Results: The mean neck-shaft angle (NSA) was 133±10° and the mean medial proximal femoral angle (MPFA) 85±9°. Around the knee joint, the mean mechanical lateral distal femoral angle (mLDFA) was 87±4° and the medial proximal tibial angle (MPTA) 88±5°. Medial and lateral slope averaged 12±7° and 9±8°. The deviation of the frontal mechanical leg axis from the knee joint center (MAD frontal) was 7±15mm and the mechanical femoro-tibial angle (HKA) 175±6°. Women showed a smaller mLDFA than men (86.4° vs. 87.8°, p<0.05) and a larger joint line convergence angle (JLCA 2.5° vs. 1.4°, p<0.01) representing a more valgiform anatomy. Conclusion: The standardised 3D analysis enabled reference ranges for the relevant joint angles and axes to be defined on the 3D bone model for the first time. The results redefine reference ranges for 3D measurements similar to existing 2D measurements on long standing radiographs. The systematic analysis of the complex 3D anatomy results in a multitude of new questions and possibilities in preoperative planning.

Ratios of the ψ′ over the J/ψ production cross sections in the dilepton channel for C, Ti and W targets have been measured in 920 GeV proton-nucleus interactions with the HERA-B detector at the HERA storage ring. The ψ′ and J/ψ states were reconstructed in both the μ+μ- and the e+e- decay modes. The measurements covered the kinematic range -0.35≤xF≤0.1 with transverse momentum pT≤4.5 GeV/c. The angular dependence of the ratio has been used to measure the difference of the ψ′ and J/ψ polarization. All results for the muon and electron decay channels are in good agreement: their ratio, averaged over all events, is Rψ′(μ)/Rψ′(e)=1.00±0.08±0.04. This result constitutes a new, direct experimental constraint on the double ratio of branching fractions, (B′(μ)B(e))/(B(μ)B′(e)), of ψ′ and J/ψ in the two channels. The ψ′ to J/ψ production ratio is almost constant in the covered xF range and shows a slow increase with pT.

Extended abstract of a paper presented at MC 2007, 33rd DGE Conference in Saarbrücken, Germany, September 2 – September 7, 2007