The semiconstrained DRUJ prosthesis: blessing or curse?

PURPOSE

There are numerous operative procedures to treat osteoarthritic changes or a significant instability of the distal radioulnar joint (DRUJ). The key problem of most methods is the destabilization of the forearm leading to secondary painful impingement between the radius and ulna, as well as a significant limitation of forearm rotation. The Aptis-Prosthesis designed by Scheker represents a complete substitute for the DRUJ. It is mostly used after the failure of various treatment options to solve the primary problems (arthritis, instability). We have used this type of prosthesis mostly after multiple operative treatments for more than 25 years.

METHODS

In the following retrospective study, we analyzed the data of patients that received an Aptis-prosthesis between 2016 and 2021. We have implanted this prosthesis in 13 cases (11 female, 2 male). Routinely, we document the clinical outcome concerning range of motion (ROM), grip strength, and pain according to numeric rate scaling (NRS) after more than 12 months (month 12-24). In addition, complications, osseous changes, and the rate of loosening of the prosthesis were registered. Furthermore, DASH-Score and patients ' satisfaction were evaluated. Also-as with other implants-follow-up x-rays were performed.

RESULTS

Removal or significant revision of any of the prostheses was not needed. The ROM was 68.1° ± 19.7° for pronation and 72.3° ± 20.9° for supination, grip strength amounted to 27.7 kg ± 11.0 kg equaling 83% of the contralateral side. NRS was 0 at rest and 1.2 (0-2) under weight-bearing. A lysis margin of the radial tap was noted in the radiological examination in 2 patients but without any signs of loosening. The DASH-Score added up to 31.8 ± 13.8 (13-55). All patients were satisfied or very satisfied having this implant.

CONCLUSION

The semiconstrained Aptis-prosthesis is a safe and efficient treatment option after failed DRUJ surgeries. It is striking that of the 20 implanted prostheses no significant revision or explantations were necessary over a period of 25 years.

[Medium-term Results after percutaneous Needle Fasciotomy in Dupuytren's Disease]

BACKGROUND

Dupuytren's disease often leads to an increasing limitation in finger extension in affected patients. As the incidence rises with age, the number of cases is expected to rise in the future due to the demographic change. Therefore, an easy and patient-oriented treatment is required. In the following study, we investigated the short and medium-term results after percutaneous needle fasciotomy (PNF).

PATIENTS AND METHODS

Overall, 65 fingers of 40 patients were treated with PNF. We evaluated the total passive deficit of extension (TPED), the passive deficit of extension of the joints (PED), the Buck-Gramcko score, rate of recurrence, DASH score and patient satisfaction. The average age of the patients was 65,9 years. Most of the patients (82%) were male.

RESULTS

Directly after the PNF, extension in the treated fingers improved significantly (TPED before PNF 74,6°±41,1 SD to 32,8°±29,0 SD after the procedure). By the time of the follow-up examination (30,2±13,9 SD months), TPED had increased again (52,7°±40,2 SD). The rate of recurrence was 29,7%, and a higher Tubiana stage before the procedure correlated significantly with a higher recurrence rate. Nevertheless, patients demonstrated a very high level of satisfaction with the procedure and almost all patients would choose to undergo PNF again.

CONCLUSION

Although it is associated with a relatively high recurrence rate, PNF represents an effective and patient-oriented treatment of Dupuytren's contracture.

Local Gentamicin Fixation with Sprayed Fibrin-An In Vivo Animal Study Reveals New Options to Treat Soft Tissue Infections

For acute and chronic soft tissue infections, radical surgical debridement is required and is considered the gold standard, along with its immediate systemic antibiotic therapy. Treatment with local antibiotics and/or antibiotic-containing materials is commonly used as an additional tool in clinical practice. Spraying with fibrin and antibiotics is a newer technique that has been studied for some antibiotics. However, for gentamicin, data are not yet available on absorption, optimal application, antibiotic fate at the site and transfer of antibiotic into the blood. In an animal study involving 29 Sprague Dawley rats, 116 back wounds were sprayed with gentamicin using either gentamicin alone or one of two possible spray combinations of gentamicin and fibrin. Simultaneous application of gentamicin and fibrin via a spray system to soft tissue wounds resulted in significant antibiotic concentration over a long period of time. The technique is easy and cost-effective. The systemic crossover was significantly minimized in our study, which may have led to fewer side effects in patients. These results could lead to an improvement in local antibiotic therapy.

Various effects of 11,12 EET rescue wound healing in a combined model of diabetes and ischemia

Chronic non healing wounds in diabetic patients still impose a major problem in modern medicine. Especially additional peripheral vascular disease complicates treatment success in these patients. Thus, we analyzed the effects of 11,12 epoxyeicosatrienoic acid (EET) in a combined model of hyperglycemia and ischemia in mice. Hyperglycemia was induced by Streptozotozin 2 weeks prior to wounding. 3 days before wound creation 2 of the 3 suppling vessels of the moue ear were cautherized for ischemia. Either 11,12 EET or solvent for control was applied. Wound closure as well as TNF-α, TGF-β, SDF-1α, VEGF, CD31, and Ki67 were measured. The wounds closed on day 14.4 ± 0.4 standard deviation (SD). 11,12 EET treatment enhanced healing to 9.8 ± 0.6 SD. TNF-α level was augmented on day 9 compared to control and receded on day 18. TGF-β seemed to be elevated all days observed after 11,12 EET treatment. SDF-1α was enhanced on day 6 and 9 by 11,12 EET, and VEGF on day 6 and 18 as well as CD13 on day 3, 6, and 18. 11,12 EET did not alter Ki67. 11,12 EET are able to rescue deteriorated wound healing in a combined model of hyperglycamia and ischemia by resolution of inflammation, augmentation of neovascularization and increasing expression of TGF-β as well as SDF-1α.

Reliabilität, Validität und Akzeptanz des DIPS Open Access 1.2: Diagnostisches Interview bei psychischen Störungen in einer Gelegenheitsstichprobe aus der Allgemeinbevölkerung (Convenience Sample)

<b><i>Hintergrund:</i></b> Ziel der vorliegenden Studie war die Überprüfung der Interrater-Reliabilität, Validität und Akzeptanz des DIPS Open Access 1.2 (DIPS-OA1.2) in einer Gelegenheitsstichprobe aus der Allgemeinbevölkerung. <b><i>Methode:</i></b> Sieben DIPS-zertifizierte Psychologinnen (B.Sc.) führten 144 Interviews durch. Anschließend wurden die durch die Interviewerin gestellten Diagnosen mit denen einer Gegenko­diererin verglichen. Außerdem füllten die Proband:innen nach dem Interview eine Fragebogenbatterie aus. <b><i>Ergebnisse:</i></b> Die Ergebnisse sprechen für eine gute bis sehr gute Interrater-Reliabilität aller überprüfbaren Oberklassen und Störungskategorien mit Ausnahme der <i>früheren Diagnosen</i> der Generalisierten Angststörung und der depressiven Störung aufgrund eines anderen medizinischen Krankheitsfaktors. Außerdem deuten die Ergebnisse auf eine gute Validität der Oberklasse Angststörungen sowie eine hohe Ak­zeptanz des DIPS-OA1.2 hin. <b><i>Schlussfolgerungen:</i></b> Die Ergebnisse der vorliegenden Studie sind vergleichbar mit denen der Studien zu den Vorgängerversionen des DIPS und deuten auf eine gute Reliabilität, Validität und Akzeptanz des DIPS-OA1.2 in einer Gelegenheitsstichprobe aus der Allgemeinbevölkerung hin. Vor diesem Hintergrund lässt sich festhalten, dass sich das DIPS-OA1.2 insbesondere auch für epidemiologische Studien eignet.

Das Schülerlabor als Ort authentischer Wissenschaftsvermittlung? Entwicklung und Validierung eines Fragebogens zur Erfassung der Authentizitätswahrnehmung der Wissenschaftsvermittlung im Schülerlabor

Im vorliegenden Beitrag wird ein Fragebogen zur mehrdimensionalen Erfassung der Wahrnehmung von Authentizität in der Wissenschaftsvermittlung (FEWAW) vorgestellt. Die Entwicklung des Messinstruments mit den Authentizitätsdimensionen Vermittler, Ort, Vorgehen und Innovation erfolgte auf der Grundlage theoretischer Modelle zur Wahrnehmung von Authentizität der Wissenschaftsvermittlung. In einer Validierungsstudie mit N = 337 Schülerinnen und Schülern im Alfried Krupp-Schülerlabor der Ruhr-Universität Bochum konnte die faktorielle Struktur mittels konfirmatorischer Faktorenanalysen bestätigt werden. Die internen Konsistenzen der vier Dimensionen sind zufriedenstellend (Cronbachs α ≥ 0,81). Außerdem konnte die Messinvarianz des Instruments für das Geschlecht sowie die Klassenstufe bestätigt werden. Die Zusammenhänge der Authentizitätsdimensionen mit Außenkriterien, wie z. B. epistemologischen Überzeugungen, liefern weitere Hinweise auf die Validität des Messinstruments. Insgesamt stellt der FEWAW ein geeignetes Instrument für die mehrdimensionale Erfassung der Authentizitätswahrnehmung in der Wissenschaftsvermittlung dar.

Personalized Assessment of Anxiety and Avoidance in Children and Their Parents-Development and Evaluation of the Anxiety and Avoidance Scale for Children

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

11,12 Epoxyeicosatrienoic Acid Rescues Deteriorated Wound Healing in Diabetes

Epoxyeicosatrienoic acids (EET) facilitate regeneration in different tissues, and their benefit in dermal wound healing has been proven under normal conditions. In this study, we investigated the effect of 11,12 EET on dermal wound healing in diabetes. We induced diabetes by i.p. injection of streptozotocin 2 weeks prior to wound creation on the dorsal side of the mouse ear. 11,12 EET was applied every second day on the wound, whereas the control groups received only solvent. Epithelialization was monitored every second day intravitally up to wound closure. Wounds were stained for VEGF, CD31, TGF-β, TNF-α, SDF-1α, NF-κB, and Ki-67, and fibroblasts were counted after hematoxylin-eosin stain on days 3, 6, 9, and 16 after wounding. After induction of diabetes, wounds closed on day 13.00 ± 2.20 standard deviation (SD). Local 11,12 ETT application improved wound closure significantly to day 8.40 ± 1.39 SD. EET treatment enhanced VEGF and CD31 expression in wounds on day 3. It also seemed to raise TNF-α level on all days investigated as well as TGF-β level on days 3 and 6. A decrease in NF-κB could be observed on days 9 and 16 after EET application. The latter findings were not significant. SDF-1α expression was not influenced by EET application, and Ki-67 was significantly less in the EET group on day 9 after EET application. The number of fibroblasts was significantly increased on day 9 after the 11,12 EET application. 11,12 EET improve deteriorated wound healing in diabetes by enhancing neoangiogenesis, especially in the early phase of wound healing. Furthermore, they contribute to the dissolution of the initial inflammatory reaction, allowing the crucial transition from the inflammatory to proliferative phase in wound healing.

Rise of extremity fractures and sport accidents in children at 8-12 years and increase of admittance via the resuscitation room over a decade

Introduction

In an emergency department, the majority of pediatric trauma patients present because of minor injuries. The aim of this study was to evaluate temporal changes in age-related injury pattern, trauma mechanism, and surgeries in pediatric patients.

Methods

This retrospective study included patients < 18 years of age following trauma from 01/2009 to 12/2018 at a level I trauma center. They were divided into two groups: group A (A: 01/2009 to 12/2013) and group B (B: 01/2014 to 12/2018). Injury mechanism, injury pattern, and surgeries were analyzed. As major injuries fractures, dislocations, and organ injuries and as minor injuries contusions and superficial wounds were defined.

Results

23,582 patients were included (58% male, median age 8.2 years).

There was a slight increase in patients comparing A (n = 11,557) and B (n = 12,025) with no difference concerning demographic characteristics.

Significant more patients (A: 1.9%; B: 2.4%) were admitted to resuscitation room, though the number of multiple injured patients was not significantly different.

In A (25.5%), major injuries occurred significantly less frequently than in B (27.0%), minor injuries occurred equally. Extremity fractures were significantly more frequent in B (21.5%) than in A (20.2%), peaking at 8–12 years.

Most trauma mechanisms of both groups were constant, with a rising of sport injuries at 8–12 years.

Conclusion

Although number of patients increases only slightly over a decade, there was a clear increase in major injuries, particularly extremity fractures, peaking at 8–12 years. At this age also sport accidents significantly increased.

At least, admittance to resuscitation room rose but without an increase of multiple injured patients.

Structural Diversity of Peptoids: Tube-Like Structures of Macrocycles

Peptoids, or poly-N-substituted glycines, are characterised by broad structural diversity. Compared to peptides, they are less restricted in rotation and lack backbone-derived H bonding. Nevertheless, certain side chains force the peptoid backbone into distinct conformations. Designable secondary structures like helices or nanosheets arise from this knowledge. Herein, we report the copper-catalysed alkyne-azide cycloaddition (CuAAC) of macrocycles to form innovative tube-like tricyclic peptoids, giving access to host-guest chemistry or storage applications. Different linker systems make the single tubes tuneable in size and enable modifications within the gap. An azobenzene linker, which is reversibly switchable in conformation, was successfully incorporated and allowed for light-triggered changes of the entire tricyclic structure.

Simplified abductor pollicis longus suspension interposition arthroplasty for thumb carpometacarpal joint osteoarthritis

Purpose

The primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis.

Methods

Between 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48–79). The mean follow-up was 27.7 months (range 8–50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results

Pain averaged 0.3 (range 0–4) at rest and 1.4 (range 0–4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3–6.5) and 22 kg (range 13.3–40), respectively. The DASH score accounted for 18.5 (range 0.8–41.7).

Conclusion

The modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.

State-Dependent Memory in Infants

Why do infants remember some things and not others? Human infants frequently cycle through different states such as calm attentiveness, wakeful activity, and crying. Given that cognitive processes do not occur in isolation, such fluctuations in internal state might influence memory processing. In the present experiment, declarative memory in 9-month-old infants (N = 96) was heavily state dependent. Infants exhibited excellent retention of a deferred imitation task after a 15-min delay if their state at encoding was identical to their state at retrieval (e.g., calm). Infants failed to exhibit retention if their state at encoding was different from their state at retrieval (e.g., calm vs. animated). Infant memory processing depends on internal cues.

The role of exposure in the treatment of anxiety in children and adolescents: protocol of a systematic review and meta-analysis

BACKGROUND

In children and adolescents, anxiety disorders (ADs) are among the most prevalent mental disorders. While there is a solid empirical foundation to support CBT as an evidence-based treatment for childhood ADs, the mechanisms underlying the efficacy of CBT are not well explored. Exposure is assumed to be vital to the efficacy of CBT in ADs, but empirical evidence (e.g., dismantling studies) showing that exposure is indeed a vital element of effective treatments is relatively scarce. The proposed meta-analysis aims to investigate the role of exposure in reducing symptoms of anxiety among children and adolescents.

METHODS

A systematic search of several electronic databases including PubMed/MEDLINE, PsycINFO, Psyndex plus, Web of Science, Scopus, and EMBASE will be conducted (from inception onwards). We will include randomized and non-randomized clinical trials examining exposure and anxiety among children and adolescents. If feasible, we will also include experimental, quasi-experimental, and observational studies. The primary outcome will be improvement in anxiety levels (recovery or change in anxiety rating scale) after exposure. Three reviewers will independently screen all citations, abstract data, and full-text articles. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. If feasible, we will conduct mixed effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., dose of exposure, age group, methodological quality).

DISCUSSION

This systematic review and meta-analysis will examine the role of exposure in reducing symptoms of anxiety among youth. The review will provide information on the working mechanisms underlying the efficacy of CBT. Our findings will be of interest to mental health professionals, researchers, and policy makers who wish to support children and adolescents with anxiety disorders by guiding well-informed treatment decisions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42019128667).

Cognitive Vulnerability in the Context of Panic: Assessment of Panic-Related Associations and Interpretations in Individuals with Varying Levels of Anxiety Sensitivity

Background

Cognitive models of panic disorder (PD) highlight the role of panic-related associations and interpretations. However, results are mixed and rely on specific measures. This study examined panic-related associations and interpretations using established and new paradigms in individuals varying on anxiety sensitivity (AS).

Methods

Associations were measured using a priming task and a novel Single Target Implicit Association Test (STIAT); interpretations were assessed using the Interpretation Bias Questionnaire (IBQ) and a novel Scrambled Sentences Task (SST). Symptoms were assessed via a provocation task (Straw Breathing Task, SBT).

Results

Panic-related interpretations correlated with AS and other PD-related measures. Of the association tasks, only the priming task correlated with one of the other PD-related measures. Panic-related interpretations assessed via the SST, but not priming, STIAT, and IBQ, predicted SBT reactivity. The relationship between AS and SBT reactivity was mediated by panic-related interpretations.

Conclusions

Our data provide support for panic-related interpretations as an important cognitive mechanism.

Correction of Motion Artifacts Using a Multiscale Fully Convolutional Neural Network

BACKGROUND AND PURPOSE

Motion artifacts are a frequent source of image degradation in the clinical application of MR imaging (MRI). Here we implement and validate an MRI motion-artifact correction method using a multiscale fully convolutional neural network.

MATERIALS AND METHODS

The network was trained to identify motion artifacts in axial T2-weighted spin-echo images of the brain. Using an extensive data augmentation scheme and a motion artifact simulation pipeline, we created a synthetic training dataset of 93,600 images based on only 16 artifact-free clinical MRI cases. A blinded reader study using a unique test dataset of 28 additional clinical MRI cases with real patient motion was conducted to evaluate the performance of the network.

RESULTS

Application of the network resulted in notably improved image quality without the loss of morphologic information. For synthetic test data, the average reduction in mean squared error was 41.84%. The blinded reader study on the real-world test data resulted in significant reduction in mean artifact scores across all cases (P < .03).

CONCLUSIONS

Retrospective correction of motion artifacts using a multiscale fully convolutional network is promising and may mitigate the substantial motion-related problems in the clinical MRI workflow.

Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint

Purpose

Triangular fibrocartilage complex (TFCC) lesions have high clinical relevance. Although multiple studies have been done in the past, there is a lack of data after conservative treatment and controversy remains regarding management. The purpose of this study was to compare the outcome of symptomatic TFCC lesions after conservative treatment and arthroscopic debridement.

Methods

Between 2012 and 2017, 33 patients were included. 16 patients were treated conservatively and 17 patients with arthroscopic debridement. The average age was 41 years (range 18–63). The mean follow-up was 22.2 months (range 6–74). Evaluation included pain, range of motion (ROM), grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Modified Mayo Wrist Score (MMWS), and Purdue Pegboard test.

Results

Pain averaged 0.1 (range 0–1) in the conservative group compared to 1.3 (range 0–6) in the arthroscopic group. The mean ROM was 99% for wrist extension, and 100% for flexion and pro-/supination in the conservative group, and 96% for extension and flexion, and 100% for pro-/supination in the arthoscopic group compared to the contralateral side. Grip strength was 88% (range 63–100) in the conservative group versus 89% (range 33–100) in the arthroscopic group. The conservative group reached a DASH score of 16.8 and MMWS of 94.3 compared to 22.1 and 87.2 in the arthroscopic group. The differences were not statistically significant.

Conclusions

Our study demonstrated similar results of conservative compared to arthroscopic treatment. Because conservative treatment was a sufficient and reliable option, we propose it as first-line treatment for TFCC lesions with stable distal radioulnar joint.

Die Handchirurgie im 2. Staatsexamen

Hintergrund Im Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie (NKLC) wurden den 230 Lernzielen Kompetenzebenen zugeordnet, die von „Kompetenzebene 1: Faktenwissen“ bis „Kompetenzebene 3: selbstständiges Handeln“ reichen. Allerdings basiert die Konzeption des 2. Saatsexamens nicht auf dem NKLC, obwohl der Einfluss von summativen Prüfungen auf das Lernverhalten von Studierenden als erwiesen gilt.

Die durchgeführte Studie analysiert den Anteil an handchirurgischen Lernzielen im NKLC und vergleicht die Ergebnisse mit den gestellten handchirurgischen Prüfungsfragen im schriftlichen 2. Staatsexamen.

Material und Methoden Retrospektiv wurden die Examensfragen von Herbst 2009 bis Herbst 2014 (n = 11) analysiert. Es wurden Lernziele mit Bezug zur Handchirurgie durch 5 Fachärzte mit Zusatzweiterbildung Handchirurgie und/oder dem „European Board of Hand Surgery“-Diplom identifiziert. Anschließend wurden in den untersuchten Staatsexamina diejenigen Fragen identifiziert, die sich auf handchirurgische Lernziele bezogen. Die Analyse umfasste die Gesamtzahl der Fragen, die Anzahl der Fragen pro Examen sowie pro Lernziel und Kompetenzebene.

Ergebnisse 47 Lernziele des NKLC (20,4 % aller Lernziele des NKLC) wurden dem Fach Handchirurgie zugeordnet. 9 dieser 47 Lernziele (3,9 % aller Lernziele des NKLC) wurden ausschließlich von der Handchirurgie abgedeckt.

220 Fragen (6,3 % aller 3480 gestellten Fragen) adressierten diese 47 Lernziele. Dabei wurden pro Examen durchschnittlich 20 ± 8,2 Fragen (Min. 9; Max. 37) mit Bezug zur Handchirurgie gestellt. Pro Examen wurden 0,5 ± 0,7 Fragen (Min. 0; Max. 2) gestellt, die nur von der Handchirurgie abgedeckt werden.

Im Studienzeitraum wurden 16 Lernziele mit Bezug zur Handchirurgie gar nicht geprüft (13,7 % aller Lernziele des NKLC), darunter 6 Lernziele, die nur durch das Fach Handchirurgie adressiert werden. Unter den nicht-geprüften Lernzielen finden sich 5 LZ der Kompetenzebene 1 (10,6 % aller handchirurgischen Lernziele der Kompetenzebene 1), 6 Lernziele der Kompetenzebene 2 (12,8 % aller handchirurgischen Lernziele der Kompetenzebene 2) und 5 Lernziele der Kompetenzebene 3 (10,6 % aller handchirurgischen Lernziele der Kompetenzebene 3).

Schlussfolgerung Die Anzahl der Lernziele im NKLC, die nur von der Handchirurgie abgedeckt wird, erscheint hoch. Allerdings werden viele dieser Lernziele im 2. Staatsexamen nicht abgebildet. Eine bessere Anpassung der Staatsprüfung an den Lernzielkatalog ist wünschenswert.

11,12 and 14,15 epoxyeicosatrienoic acid rescue deteriorated wound healing in ischemia

Introduction

Epoxyeicosatrienoic acids (EETs) are able to enhance angiogenesis and regulate inflammation that is especially important in wound healing under ischemic conditions. Thus, we evaluated the effect of local EET application on ischemic wounds in mice.

Methods

Ischemia was induced by cautherization of two of the three supplying vessels to the mouse ear. Wounding was performed on the ear three days later. Wounds were treated either with 11,12 or 14,15 EET and compared to untreated control and normal wounds. Epithelialization was measured every second day. VEGF, TNF-α, TGF-β, matrix metalloproteinases (MMP), tissue inhibitors of metalloproteinases (TIMP), Ki67, and SDF-1α were evaluated immunohistochemically in wounds on day 3, 6, and 9.

Results

Ischemia delayed wound closure (12.8 days ± 1.9 standard deviation (SD) for ischemia and 8.0 days ± 0.94 SD for control). 11,12 and14,15 EET application ameliorated deteriorated wound healing on ischemic ears (7.6 ± 1.3 SD for 11,12 EET and 9.2 ± 1.4 SD for 14,15 EET). Ischemia did not change VEGF, TNF-α, TGF-β, SDF-1α, TIMP, MMP7 or MMP9 level significantly compared to control. Local application of 11,12 as well as 14,15 EET induced a significant elevation of VEGF, TGF-β, and SDF-1α expression as well as proliferation during the whole phase of wound healing compared to control and ischemia alone.

Conclusion

In summary, EET improve impaired wound healing caused by ischemia as they enhance neovascularization and alter inflammatory response in wounds. Thus elevating lipid mediator level as 11,12 and 14,15 EET in wounds might be a successful strategy for amelioration of deranged wound healing under ischemia.

Epidemiology and treatment of distal radius fractures: current concept based on fracture severity and not on age

PURPOSE

A shift towards surgical treatment of distal radius fractures seems to be apparent. The purpose of the present study was to assess current epidemiological data, the fracture severity according to the AO classification and the changing trend in the treatment.

METHODS

This study presents a retrospective review of 268 patients ≥ 18 years of age admitted to our level I trauma center with distal radius fractures between 2013 and 2015. The data were obtained from the hospital inpatient enquiry system and review of the radiological examinations.

RESULTS

The ratio between males and females was 87:181. The average age of the patients was 56.9 (18-99) years. A fall from standing position was the most common mechanism of injury. According to the AO classification, 43.3% were type A fractures, 13.1% type B, and 43.7% type C. As the intensity of the injury mechanism increased, the percentage of type C fractures also increased. A total of 61.9% of patients underwent surgery with open reduction and internal fixation with volar locking plates used as the preferred surgical treatment. Fracture severity correlated well with surgical decision. Elderly patients were just as likely to get surgical treatment as adult patients.

CONCLUSIONS

Our findings confirmed the increasing popularity of surgical intervention with open reduction and internal fixation. Contrary to previous studies, the fracture type profile showed an equal proportion of type A and C fractures and the indication for surgical treatment correlated with fracture severity and not age.

A simulation platform using 3D printed neurovascular phantoms for clinical utility evaluation of new imaging technologies

Modern 3D printing technology allows rapid prototyping of vascular phantoms based on an actual human patient with a high degree of precision. Using this technology, we present a platform to accurately simulate clinical views of neuro-endovascular interventions and devices. The neuro-endovascular interventional phantom has a 3D printed cerebrovasculature model derived from a patient CT angiogram and embedded inside a human skull providing bone attenuation. Acrylic layers were placed underneath and on top of the skull, simulating entrance and exit tissue attenuation and also simulating forward scatter. The 3D model was connected to a pulsatile flow loop for simulating interventions using clinical devices such as catheters and stents. To validate the x-ray attenuation and establish clinical accuracy, the automatic exposure selection by a clinical c-arm system for the phantom was compared with that for a commercial anthropomorphic head phantom (SK-150, Phantom Labs). The percentage difference between automatic exposure selection for the neuro-intervention phantom and the SK-150 phantom was under 10%. By changing 3D printed models, various patient diseased anatomies can be simulated accurately with the necessary x-ray attenuation. Using this platform various interventional procedures were performed using new imaging technologies such as a high-resolution x-ray fluoroscope and a dose-reduced region-of-interest attenuator and differential temporally filtered display for enhanced interventional imaging. Simulated clinical views from such phantom-based procedures were used to evaluate the potential clinical performance of such new technologies.

High energy probe for detecting lymph node metastases with 18F-FDG in patients with head and neck cancer

Aim of this study was to validate a newly developed high energy probe (positron emission probe, PEP) optimised for localising PET tracers in vivo. Patients and methods: Physical investigations included determination of full width at half maximum (FWHM) values at a distance of 1 cm and angular resolution using different point sources. Values obtained with the new probe were compared to those of a conventional gamma probe (CGP). Additionally, PET studies were performed in 36 patients (6 women, 30 men) with proven head and neck cancer and suspected lymph node metastases (Axis, Marconi/Philips) after administering 250–320 MBq 18F-FDG. Subsequent to PET investigations 18F-FDG uptake in cervical regions was measured using the PEP. PEP investigations were carried out bilaterally in 5 lymph node (LN) levels (Robbins’ classification of the neck). Results of probe studies were correlated with visual and semiquantitative PET evaluations, US and histological findings. Results: FWHM of the new probe was 7 mm (CGP 22 mm) at 662 keV (137Cs) and angular resolution resulted in 8° (CGP 60°). In 29 out of 36 patients LN metastases were suspected due to ultrasound investigations. After neck dissection, histology confirmed LN metastases in 21 patients. Sensitivity (sens.) of US amounted to 95% and specificity to 40%. In 18/21 patients LN metastases were detected by PET (sens. 86%). PET scans failed to diagnose the LN status correctly in 6/36 patients (accuracy 83%). Employing the PEP probe in 20/21 patients LN metastases were identified (sens. 95%), and LN status was determined accurately in 29/36 patients (accuracy 81%). Tumour/ background ratios of PEP measurement and results of semiquantitative PET analyses were comparable. Conclusions: PEP measurement is a promising method for preoperative planning of the extent of neck dissection in patients with head and neck cancer and further for radioguided localising PET tracer accumulation during surgery.

Towards predicting the encoding capability of MR fingerprinting sequences

Sequence optimization and appropriate sequence selection is still an unmet need in magnetic resonance fingerprinting (MRF). The main challenge in MRF sequence design is the lack of an appropriate measure of the sequence's encoding capability. To find such a measure, three different candidates for judging the encoding capability have been investigated: local and global dot-product-based measures judging dictionary entry similarity as well as a Monte Carlo method that evaluates the noise propagation properties of an MRF sequence. Consistency of these measures for different sequence lengths as well as the capability to predict actual sequence performance in both phantom and in vivo measurements was analyzed. While the dot-product-based measures yielded inconsistent results for different sequence lengths, the Monte Carlo method was in a good agreement with phantom experiments. In particular, the Monte Carlo method could accurately predict the performance of different flip angle patterns in actual measurements. The proposed Monte Carlo method provides an appropriate measure of MRF sequence encoding capability and may be used for sequence optimization.

Clinical outcome after alternative treatment of scaphoid fractures and nonunions

PURPOSE

Achieving stable fixation of scaphoid fractures and nonunions continues to be a challenge. Compression screw fixation has been the current standard surgical procedure. However, in some cases, bone healing cannot be achieved and requires further revision. Recent series reintroduced volar plating as valid option for stable fixation. The aim of the study was to review clinical outcome of alternative scaphoid treatment.

METHODS

From 2011 to 2014, nine patients with scaphoid fracture were treated by Headless Compression Screw (HCS) and seven patients with scaphoid nonunion by HCS or volar mini condylar plate with bone graft. The average age was 34.4 years and the average time to follow-up was 19.3 months. From 1996 to 1998, 38 patients with scaphoid nonunion were treated using compression screw (S-group) or volar mini condylar plate (P-group) with bone graft. The average age was 39.6 years and the average time to follow-up was 26.2 months.

RESULTS

The union rate was 100%. For scaphoid fractures, the mean Modified Mayo Wrist Score (MMWS) was 94.1 and the DASH score 7.4. From 2011 to 2014, the MMWS was 87.9 and the DASH score 7 in scaphoid nonunions. In the period between 1996 and 1998, the MMWS was 67.2 in the P-group and 58.6 in the S-group, and the DASH score 16.8 and 28.2.

CONCLUSIONS

Our study demonstrated that appropriate application of the HCS was able to produce very satisfactory results in scaphoid fractures and nonunions. In our opinion, however, the method of scaphoid plate osteosynthesis can achieve a higher degree of stability, particularly rotational stability, in case of multifragmentary avascular scaphoid nonunions.

Acute adrenal insufficiency: an aide-memoire of the critical importance of its recognition and prevention

Adrenal crisis is a life-threatening emergency that causes significant excess mortality in patients with adrenal insufficiency. Delayed recognition by medical staff of an impending adrenal crisis and failure to give timely hydrocortisone therapy within the emergency department continue to be commonly encountered, even in metropolitan teaching hospitals. Within the authors' institutions, several cases of poorly handled adrenal crises have occurred over the last 2 years. Anecdotal accounts from members of the Addison's support group suggest that these issues are common in Australia. This manuscript is a timely reminder for clinical staff on the critical importance of the recognition, treatment and prevention of adrenal crisis. The manuscript: (i) outlines a case and the clinical outcome of sub-optimally managed adrenal crisis, (ii) summarises the clinical features and acute management of adrenal crisis, (iii) provides recommendations on the prevention of adrenal crisis and (iv) provides guidance on the management of 'sick days' in patients with adrenal insufficiency.

U Can Touch This: How Tablets Can Be Used to Study Cognitive Development

New technological devices, particularly those with touch screens, have become virtually omnipresent over the last decade. Practically from birth, children are now surrounded by smart phones and tablets. Despite being our constant companions, little is known about whether these tools can be used not only for entertainment, but also to collect reliable scientific data. Tablets may prove particularly useful for collecting behavioral data from those children (1-10 years), who are, for the most part, too old for studies based on looking times and too young for classical psychophysical testing. Here, we analyzed data from six studies that utilized touch screen tablets to deliver experimental paradigms in developmental psychology. In studies 1 and 2, we employed a simple sorting and recall task with children from the ages of 2-8. Study 3 (ages 9 and 10) extended these tasks by increasing the difficulty of the stimuli and adding a staircase-based perception task. A visual search paradigm was used in study 4 (ages 2-5), while 1- to 3-year-olds were presented with an extinction learning task in study 5. In study 6, we used a simple visuo-spatial paradigm to obtain more details about the distribution of reaction times on touch screens over all ages. We collected data from adult participants in each study as well, for comparison purposes. We analyzed these data sets in regard to four metrics: self-reported tablet usage, completeness of data, accuracy of responses and response times. In sum, we found that children from the age of two onwards are very capable of interacting with tablets, are able to understand the respective tasks and are able to use tablets to register their answers accordingly. Results from all studies reiterated the advantages of data collection through tablets: ease of use, high portability, low-cost, and high levels of engagement for children. We illustrate the great potential of conducting psychological studies in young children using tablets, and also discuss both methodological challenges and their potential solutions.

Targeting irradiation-induced mitogen-activated protein kinase activation in vitro and in an ex vivo model for human head and neck cancer

BACKGROUND

Despite new radiotherapeutic strategies, radioresistance in head and neck squamous cell carcinoma (HNSCC) remains a major problem. Preclinical model systems are needed to identify resistance mechanisms in this heterogeneous entity.

METHODS

We elucidated the interplay among mitogen-activated protein kinase (MAPK)-inhibition, radiation, and p53 mutations in vitro and in a novel ex vivo model derived from vital human HNSCC samples. HNSCC cell lines (p53WT/mut) were treated with the mitogen-activated protein kinase (MEK)-inhibitor PD-0325901 and subsequently irradiated. Radiosensitization was functionally assessed and evaluated in the ex vivo model.

RESULTS

We observed a pronounced irradiation-induced extracellular signal-regulated kinase (ERK) phosphorylation in 2 cell lines, which was independent of their p53 mutation status and associated with PD-0325901-related radiosensitization in a clonogenic assay. Heterogeneity in irradiation-induced ERK phosphorylation and in radiosensitization after MEK-inhibition was also reflected in the ex vivo model.

CONCLUSION

We provide experimental evidence for radiosensitizing effects of PD-0325901 in HNSCC. The ex vivo culture technology might offer a promising tool for individualized drug efficacy testing. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2049-E2061, 2016.

Delayed wound repair in sepsis is associated with reduced local pro-inflammatory cytokine expression

Sepsis is one of the main causes for morbidity and mortality in hospitalized patients. Moreover, sepsis associated complications involving impaired wound healing are common. Septic patients often require surgical interventions that in-turn may lead to further complications caused by impaired wound healing. We established a mouse model to the study delayed wound healing during sepsis distant to the septic focus point. For this reason cecal ligation and puncture (CLP) was combined with the creation of a superficial wound on the mouse ear. Control animals received the same procedure without CPL. Epithelialization was measured every second day by direct microscopic visualization up to complete closure of the wound. As interplay of TNF-α, TGF-β, matrix metalloproteinases (MMP), and tissue inhibitors of metalloproteinases (TIMP) is important in wound healing in general, TNF-α, TGF-β, MMP7, and TIMP1 were assessed immunohistochemical in samples of wounded ears harvested on days 2, 6, 10 and 16 after wounding. After induction of sepsis, animals showed a significant delay in wound epithelialization from day 2 to 12 compared to control animals. Complete wound healing was attained after mean 12.2± standard deviation (SD) 3.0 days in septic animals compared to 8.7± SD 1.7 days in the control group. Septic animals showed a significant reduction in local pro-inflammatory cytokine level of TNF-α on day 2 and day 6 as well as a reduced expression of TGF-β on day 2 in wounds. A significant lower expression of MMP7 as well as TIMP1 was also observed on day 2 after wounding. The induction of sepsis impairs wound healing distant to the septic focus point. We could demonstrate that expression of important cytokines for wound repair is deregulated after induction of sepsis. Thus restoring normal cytokine response locally in wounds could be a good strategy to enhance wound repair in sepsis.

Local hyperthermia, hyperfractionated radiation, and cisplatin in preirradiated recurrent lymph node metastases of recurrent head and neck cancer

Large tumor size is a negative prognostic variable for attaining complete regression (CR) with local hyperthermia (HT) and radiotherapy (RT). Such poor prognosis lesions (i.e., >7 cm(2) or >14 cm(3)) have an expected CR rate of similar to 30+/-8%. To improve on this result we added cisplatin to HT and RT with standard fractionation (std Fx) in an earlier study, and observed a 19% CR rate in head and neck (H&N) patients. We now report the results of a second generation trial combining HT, cisplatin (40 mg/m(2)) and hyperfractionated RT in a series of 13 pretreated poor prognosis H&N patients. Therapy encompassed 44 triple modality sessions and was well tolerated: toxicity included one episode of grade-3 skin reaction and one grade 1 leukopenia. Although the overall remission rate was 92%, the CR rate was only 8%; this resulted in early closure of this trial concluding that hyperfractionated RT had no (over std Fx RT) benefit in this combined modality approach.

Heparin disrupts the CXCR4/SDF-1 axis and impairs the functional capacity of bone marrow-derived mononuclear cells used for cardiovascular repair

RATIONALE

Cell therapy is a promising option for the treatment of acute or chronic myocardial ischemia. The intracoronary infusion of cells imposes the potential risk of cell clotting, which may be prevented by the addition of anticoagulants. However, a comprehensive analysis of the effects of anticoagulants on the function of the cells is missing.

OBJECTIVE

Here, we investigated the effects of heparin and the thrombin inhibitor bivalirudin on bone marrow-derived mononuclear cell (BMC) functional activity and homing capacity.

METHODS AND RESULTS

Heparin, but not bivalirudin profoundly and dose-dependently inhibited basal and stromal cell-derived factor 1 (SDF-1)-induced BMC migration. Incubation of BMCs with 20 U/mL heparin for 30 minutes abrogated SDF-1-induced BMC invasion (16±8% of control; P<0.01), whereas no effects on apoptosis or colony formation were observed (80±33% and 100±44% of control, respectively). Pretreatment of BMCs with heparin significantly reduced the homing of the injected cells in a mouse ear-wound model (69±10% of control; P<0.05). In contrast, bivalirudin did not inhibit in vivo homing of BMCs. Mechanistically, heparin binds to both, the chemoattractant SDF-1 and its receptor, chemokine receptor 4 (CXCR4), blocking CXCR4 internalization as well as SDF-1/CXCR4 signaling after SDF-1 stimulation.

CONCLUSIONS

Heparin blocks SDF-1/CXCR4 signaling by binding to the ligand as well as the receptor, thereby interfering with migration and homing of BMCs. In contrast, the thrombin inhibitor bivalirudin did not interfere with BMC homing or SDF-1/CXCR4 signaling. These findings suggest that bivalirudin but not heparin might be recommended as an anticoagulant for intracoronary infusion of BMCs for cell therapy after cardiac ischemia.