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BACKGROUND: There is a lot of controversy in the recent literature with regard to the optimal treatment of anterior cruciate ligament (ACL) injuries during growth. Iatrogenic growth disturbance due to physeal damage is a potential complication, forcing many orthopaedic surgeons to treat these injuries conservatively. HYPOTHESIS: It is possible to perform a fully transphyseal ACL reconstruction in an ovine model with wide-open physes without creating growth disturbances. STUDY DESIGN: Descriptive laboratory study. MATERIALS AND METHODS: Four-month-old skeletally immature sheep underwent a transphyseal ACL reconstruction of the right knee. The surgical technique followed the criteria known to be essential to avoid growth disturbances in humans; the tibial tuberosity was spared to prevent a genu recurvatum, thermal damage to the growth plates was avoided, the physes were perforated with a small-diameter drill in the center of the growth plate, a soft tissue graft was used, graft fixation was achieved far away from the growth plates, the perforated growth plates were filled by the soft tissue graft, and the graft was moderately pretensioned before fixation. The left knee served as a control. A computer-assisted evaluation of long radiographs (frontal and sagittal plane) of the exarticulated hindlimbs was performed to exactly evaluate the limb alignment, joint orientation, and leg length. The animals were sacrificed in groups of 6 after 3, 6, 12, and 24 weeks. RESULTS: No angular deformities or leg-length discrepancies occurred after this transphyseal ACL reconstruction procedure throughout the remaining growth. CONCLUSION: This large-animal study supports the clinical observation that it is possible to perform an ACL reconstruction without creating growth disturbances as long as a number of key principles are followed. CLINICAL RELEVANCE: Previous animal studies argued against ACL reconstruction in skeletally immature patients. This large-animal study provides support for early operative treatment of ACL ruptures even in young patients with open physes. [ABSTRACT FROM AUTHOR]

Restoration of rotational and translational stability is a goal of ACL reconstruction. Intraoperative instability measurements of AP translation and rotation are not well established clinically. We compared navigated measurements of tibial AP translation and rotation with mechanical measuring devices: the KT 1000 and a modified goniometer tool. Tests were repeated with intact and dissected ACLs, and measures of translation and rotation statistically compared. There was no significant difference in AP translation between navigation, 3.2 mm (range 1–6 mm) and the KT 1000, 4.8 mm (range, 4–7 mm) in our experimental set up (p>0.05). Tibial rotation revealed no significant difference, 0.12° (range, 0°–1°) between navigation and goniometer (p>0.05). Total range of rotation was 4.2° (range, 2°–6°) in intact and 7.05° (range, 4°–9°) in dissected ACLs (p<0.05). Stability parameters in ACL navigation can be measured precisely under laboratory conditions and results are not significantly different from mechanical testing devices. [ABSTRACT FROM AUTHOR]

Abstract: In response to harmful stresses, cells induce programmed cell death (PCD) or apoptosis. Seizures can induce neural damage and activate biochemical pathways associated with PCD. Since seizures trigger intracellular calcium overload, it has been presumed that the intrinsic cell death pathway mediated by mitochondrial dysfunction would modulate cell death following seizures. However, previous work suggests that the extrinsic cell death pathway may initiate the damage program. Here we investigate intrinsic versus extrinsic cell death pathway activation using caspase cleavage as a marker for activation of these pathways in a rat in vitro model of seizures. Hippocampal cells, chronically treated with kynurenic acid, had kynurenic acid withdrawn to induce seizure-like activity for 40min. Subjecting rat hippocampal cultures to seizures increased cell death and apoptosis-like DNA fragmentation using TUNEL staining. Seizure-induced cell death was blocked by both MK801 (10μM) and CNQX (40μM), which suggests multiple glutamate receptors regulate seizure-induced cell death. Cleavage of the initiator caspases, caspase 8 and 12 were increased 4h following seizure, and cleavage of the quintessential executioner caspase, caspase 3 was increased 4h following seizure. In contrast, caspase 9 cleavage only increased 24h following seizure. Using an affinity labeling approach to trap activated caspases in situ, we show that caspase 8 is the apical caspase activated following seizures. Finally, we show that the caspase 8 inhibitor Ac-IETD-CHO was more effective at blocking seizure-induced cell death than the caspase 9 inhibitor Ac-LEHD-CHO. Taken together, our data suggests the extrinsic cell death pathway-associated caspase 8 is activated following seizures in vitro. [Copyright &y& Elsevier]

Seizure-induced neuronal death may involve engagement of the BCL-2 family of apoptosis-regulating proteins. In the present study we examined the activation of proapoptotic BAD in cultured hippocampal neurons following seizures induced by removal of chronic glutamatergic transmission blockade. Kynurenic acid withdrawal elicited an increase in seizure-like electrical activity, which was inhibited by blockers of AMPA (CNQX) and NMDA (MK801 and AP5) receptor function. However, only NMDA receptor antagonists inhibited calcium entry as assessed by fura-2, and cell death of hippocampal neurons. Seizures increased proteolysis of caspase-3 and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) of cells. Seizure-like activity induced dephosphorylation of BAD and the disruption of its constitutive interaction with 14-3-3 proteins. In turn, BAD dimerized with antiapoptotic BCL-Xl after seizures. However, the absence of neuroprotective effects of pathway intervention suggests that BAD may perform a reinforcement rather than instigator role in cell death following seizures in vitro. [ABSTRACT FROM AUTHOR]

Objectives: To present the option to use a Fascia Temporalis Superficialis pedicled flap for the implantation of a transcutaneous magnetic osseointegrated auditory implant in selected revision procedures. Background: Osseointegrated auditory implants represent a reliable option for patients. Skin intolerance and aesthetic issue are two clear limitations of percutaneous system. Magnetic transcutaneous devices have been developed to overcome such drawbacks. The current new experience of such a device shows that they are well tolerated in primary cases. However, switching from a previous percutaneous system raises the question of skin tolerance. Hence, previous implanted abutments with skin penetration and skin reduction are more likely cause to skin intolerance and complication. Methods: We described here the option to use a Fascia Temporalis Superficialis flap to cover the implanted magnet. Conclusion: When switching from percutaneous osseointegrated auditory implant to transcutaneous system in case of high risk of skin intolerance, this procedure may provide sufficient tissue coverage to prevent skin intolerance, pain and delayed extrusion. [ABSTRACT FROM AUTHOR]

Unlabelled: Despite recent advances in treatment of severe injured patients, e.g. due to damage control orthopaedics, multi organ dysfunction syndrome (MODS) and sepsis are major complications in daily practice. During one year 94 patients were prospectively collected.Inclusion Criteria: ISS 16, age 18-60 y, primary admission to our level-1 trauma center, survival > 48 hours after trauma. The development of MODS and sepsis were observed and different groups were formed (+/-). Demographic data revealed no significant differences between the subgroups. Comparing groups +MODS and -MODS significant differences on admission day were observed, when PCT showed first on day 2 after trauma differences. Regarding the development of sepsis PCT was advantageous to IL-6 showing significant higher plasma levels in group +sepsis from the first day after trauma. Serum levels of IL-6 and PCT could be useful in early identification of high risk patients to develop posttraumatic MODS. For sepsis PCT is the better prognostic factor. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate, to what extent routine preoperative MRI scans could set the indications for knee arthroscopies and reduce the number of diagnostic arthroscopies. For this retrospective cohort study, 1,000 patients who had knee arthroscopies documented in 1994/1995 were compared with 1,000 patients that were treated in 2004/2005. The preoperative diagnoses that gave indications for knee arthroscopy were compared with the intraoperative findings. The congruence of preoperative diagnosis with the intraoperative findings was evaluated comparing both study populations. The number of patients who were referred to orthopaedic trauma surgeons with MRI increased from 24% to 56%. A high congruence of preoperative diagnosis and intraoperative findings was found in 49% in 1994/1995 and 55% in 2004/2005. However, regarding the most important outcome parameter, the number of diagnostic arthroscopies, no improvement was found (3% in both periods). The presented data suggests that MRI scans are not routinely necessary as an indication for knee arthroscopy, as clinical examination and plain radiograph are sufficient. However, MRI scans do allow a more detailed characterization of the expected findings and can therefore be helpful in therapy planning. [ABSTRACT FROM AUTHOR]

Die PROFHER-Studie ist eine multizentrische randomisiert kontrollierte Studie bei der 250 von 1250 auf Eignung geprüfte Patienten mit dislozierter proximaler Humerusfraktur unter Beteiligung des chirurgischen Halses entweder der Operation oder dem konservativen Therapieregime zugeführt wurden. Zu den Ausschlusskriterien zählten neben Komorbiditäten, die eine operative Versorgung ausschließen, und einer mangelnden geistigen Leistungsfähigkeit sowohl die Luxationsfrakturen als auch für die Autoren klare Operationsindikationen. Die Ergebnisse wurden mittels standardisierter Beurteilung durch den Patienten selbst („patient reported outcome“ [PRO], „self-assessment“) u. a. durch den Oxford-Shoulder-Score (OSS) festgehalten. Die Ergebnisse zeigten sowohl nach 2 und nach 5 Jahren keinen Unterschied in den primären und sekundären Self-assessment-outcome-Scores. Obwohl sich im untersuchten Patientenkollektiv keine Unterschiede zwischen den beiden Gruppen zeigten, kann die PROFHER-Studie keine klare Aussage darüber treffen, welcher Patient von einer operativen Therapie profitieren würde. Trotzdem bietet die PROFHER-Studie eine wertvolle und wichtige Ergänzung der Literatur zu diesem stark diskutierten Thema. Ziel dieses Reviews ist die kritische Bewertung der PROFHER-Studie im Rahmen der vorhandenen Literatur u. a. in Bezug auf Patienteneinschluss, Frakturversorgung und Evaluierung der Ergebnisse. [ABSTRACT FROM AUTHOR]

Introduction: The use of reverse shoulder arthroplasty (RSA) has increased dramatically over the last two decades, with many surgeons now indicating RSA for the acute management of displaced proximal humerus fractures (PHF) in the elderly. RSA relies on adequate deltoid muscle function to obtain a good outcome, yet no literature to date exists which discusses preoperative assessment of deltoid structure prior to RSA. The purpose of this study was to assess for preoperative fatty deltoid-degeneration in patients with displaced PHF.Materials and Methods: We reviewed the axial CT scans of 100 consecutive patients with a displaced PHF. Fatty degeneration within each of the three deltoid-heads was graded at three levels, according to Goutallier and colleagues. Fractures were classified according to Neer.Results: Seventy-nine percent of the patients were female, 75% showed 3 or 4 parts fractures. The average cross-sectional area of the posterior deltoid was greatest-representing 37%, 40% and 42% of total area at each level, respectively. Severe fatty degeneration (Stages 3 and 4) was observed in the posterior deltoid only (26%). Absence of fatty degeneration (Stage 0) was observed in < 25% of cases. The Inter-Observer-Reliability for the continuous variables proved to be high.Conclusion: Preoperative deltoid fatty degeneration is common in displaced PHF in the elderly. Because CT is commonly obtained to assess fracture morphology and for preoperative planning purposes, it is an ideal tool to assess the deltoid additionally. Future studies are warranted to determine whether preoperative fatty infiltration of the deltoid correlates with mid and long term functional outcomes when RSA is used acutely to manage a PHF.Level Of Evidence: Level IV-consecutive case series. [ABSTRACT FROM AUTHOR]

The main objective was to evaluate the bimodal self-rated benefits on auditory performance under real conditions and the quality of life in two groups of cochlear-implanted adults, with or without a contralateral hearing aid. The secondary objective was to investigate correlations between the use of a hearing aid and residual hearing on the non-implanted ear. This retrospective study was realized between 2000 and 2010 in two referral centers. A population of 183 postlingually deaf adults, implanted with a cochlear experience superior to 6 months, was selected. The Speech, Spatial, and other Qualities of Hearing Scale were administered to evaluate the auditory performances, and the Nijmegen Cochlear Implant Questionnaire to evaluate the quality of life. The population was divided into two groups: a group with unilateral cochlear implants (Cochlear Implant-alone, n = 54), and a bimodal group with a cochlear implant and a contralateral hearing aid ( n = 62). Both groups were similar in terms of auditory deprivation duration, duration of cochlear implant use, and pure-tone average on the implanted ear. There was a significant difference in terms of pure-tone average on low and low-to-mid frequencies on the non-implanted ear. The scores on both questionnaires showed an improvement in the basic sound perception and quality of social activities for the bimodal group. The results suggest that the bimodal stimulation (cochlear implant and contralateral hearing aid) improved auditory perception in quiet and the quality of life domain of social activities. [ABSTRACT FROM AUTHOR]

We describe the design of the Sunrise Filter Imager (SuFI) and the Image Stabilization and Light Distribution (ISLiD) unit onboard the Sunrise balloon borne solar observatory. This contribution provides the necessary information which is relevant to understand the instruments' working principles, the relevant technical data, and the necessary information about calibration issues directly related to the science data. [ABSTRACT FROM AUTHOR]

This paper describes the wave-front correction system developed for the Sunrise balloon telescope, and it provides information about its in-flight performance. For the correction of low-order aberrations, a Correlating Wave-Front Sensor (CWS) was used. It consisted of a six-element Shack - Hartmann wave-front sensor (WFS), a fast tip-tilt mirror for the compensation of image motion, and an active telescope secondary mirror for focus correction. The CWS delivered a stabilized image with a precision of 0.04 arcsec (rms), whenever the coarse pointing was better than ± 45 arcsec peak-to-peak. The automatic focus adjustment maintained a focus stability of 0.01 waves in the focal plane of the CWS. During the 5.5 day flight, good image quality and stability were achieved during 33 hours, containing 45 sequences, which lasted between 10 and 45 min. [ABSTRACT FROM AUTHOR]

The first science flight of the balloon-borne Sunrise telescope took place in June 2009 from ESRANGE (near Kiruna/Sweden) to Somerset Island in northern Canada. We describe the scientific aims and mission concept of the project and give an overview and a description of the various hardware components: the 1-m main telescope with its postfocus science instruments (the UV filter imager SuFI and the imaging vector magnetograph IMaX) and support instruments (image stabilizing and light distribution system ISLiD and correlating wavefront sensor CWS), the optomechanical support structure and the instrument mounting concept, the gondola structure and the power, pointing, and telemetry systems, and the general electronics architecture. We also explain the optimization of the structural and thermal design of the complete payload. The preparations for the science flight are described, including AIV and ground calibration of the instruments. The course of events during the science flight is outlined, up to the recovery activities. Finally, the in-flight performance of the instrumentation is discussed. [ABSTRACT FROM AUTHOR]

High tibial osteotomy is an established technique for the treatment of varus malaligned knees. This study analyses the difference between the amount of correction in the preoperative planning and the postoperative result. Furthermore, it compares the difference of the accuracy between open-wedge osteotomy and closed-wedge osteotomy. About 61 patients were either treated with open-wedge or closed-wedge high tibial osteotomy. Preoperative planning and postoperative analysis were performed with a special planning software. The influence of operative technique, aetiology, age, number of previous surgeries, amount of correction and accuracy of the correction compared to the preoperative planning were analysed. The overall postoperative mechanical axis differed form preoperative planning by 2.1° ± 1.7°. The accuracy in the open-wedge group (1.7° ± 1.6°) was significantly higher than in the closed-wedge group (2.6° ± 1.8°; P = 0.038). In patients with congenital varus deformity, the accuracy of the correction was significantly higher than in patients with post-traumatic deformity. The authors recommend open-wedge technique in combination with fixed-angle plates for high tibial osteotomy. [ABSTRACT FROM AUTHOR]

Introduction: The accuracy of preoperative planning of the size of total knee arthroplasty (TKA) in literature is only 50%. A problem of conventional radiographic planning with prothesis templates is varying enlargement of the radiographs. Digital planning and analysis of lower leg geometry revealed improved reliability compared to conventional techniques. The aim of the study was to evaluate the accuracy of digital planning of TKA with special planning software and calibrated radiographs and its interobserver reliability. Methods: In a prospective study the sizes of 30 TKA were planned with special software by a senior and a junior surgeon independently. For calibration a 30 mm reference ball on the radiographs was used. The planning was compared with the intraoperative chosen size of the TKA. Results: The correlation of the planned femoral component with the chosen size was 87% for the senior and 77% for the junior surgeon. The planning of the tibial component revealed a correlation for the senior surgeon in 90% and for the junior surgeon in 87%. Both component was planned correctly in 77% by the senior and in 63% by the junior surgeon. In 50% the planning of both surgeons matched completely the used prosthesis sizes. The linear κ coefficient of Cohen revealed a good agreement (0.65) and a high interobserver reliability. Discussion: Planning TKA with special planning software with digital, calibrated radiographs is more accurate compared to previous conventional planning. The senior surgeons planning of both component sizes matched in 77% the correct size. Clinical experience improves the accuracy of preoperative planning. [ABSTRACT FROM AUTHOR]

Despite recent advances in treatment of severe injured patients, e.g. due to damage control orthopaedics, multi organ dysfunction syndrome (MODS) and sepsis are major complications in daily practice. During one year 94 patients were prospectively collected. Inclusion criteria: ISS &ges; 16, age 18–60 y, primary admission to our level-1 trauma center, survival > 48 hours after trauma. The development of MODS and sepsis were observed and different groups were formed (+/-). Demographic data revealed no significant differences between the subgroups. Comparing groups +MODS and -MODS significant differences on admission day were observed, when PCT showed first on day 2 after trauma differences. Regarding the development of sepsis PCT was advantageous to IL-6 showing significant higher plasma levels in group +sepsis from the first day after trauma. Serum levels of IL-6 and PCT could be useful in early identification of high risk patients to develop posttraumatic MODS. For sepsis PCT is the better prognostic factor. [ABSTRACT FROM AUTHOR]

Prolonged seizures (status epilepticus) are associated with brain region-specific regulation of apoptosis-associated signaling pathways. Bcl-2 homology domain 3-only (BH3) members of the Bcl-2 gene family are of interest as possible initiators of mitochondrial dysfunction and release of apoptogenic molecules after seizures. Previously, we showed that expression of the BH3-only protein, Bcl-2 interacting mediator of cell death (Bim), increased in the rat hippocampus but not in the neocortex after focal-onset status epilepticus. In this study, we examined Bim expression in mice and compared seizure damage between wild-type and Bim-deficient animals. Status epilepticus induced by intra-amygdala kainic acid (KA) caused extensive neuronal death within the ipsilateral hippocampal CA3 region. Hippocampal activation of factors associated with transcriptional and posttranslational activation of Bim, such as CHOP and c-Jun NH(2)-terminal kinases, was significant within 1 h. Upregulation of bim mRNA was evident after 2 h and Bim protein increased between 4 and 24 h. Hippocampal CA3 neurodegeneration was reduced in Bim-deficient mice compared with wild-type animals after seizures in vivo, and short interfering RNA molecules targeting bim reduced cell death after KA treatment of hippocampal organotypic cultures. In contrast, neocortical Bim expression declined after status epilepticus, and neocortex damage in Bim-deficient mice was comparable with that in wild-type animals. These results show region-specific differential contributions of Bim to seizure-induced neuronal death. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate, to what extent routine preoperative MRI scans could set the indications for knee arthroscopies and reduce the number of diagnostic arthroscopies. For this retrospective cohort study, 1,000 patients who had knee arthroscopies documented in 1994/1995 were compared with 1,000 patients that were treated in 2004/2005. The preoperative diagnoses that gave indications for knee arthroscopy were compared with the intraoperative findings. The congruence of preoperative diagnosis with the intraoperative findings was evaluated comparing both study populations. The number of patients who were referred to orthopaedic trauma surgeons with MRI increased from 24% to 56%. A high congruence of preoperative diagnosis and intraoperative findings was found in 49% in 1994/1995 and 55% in 2004/2005. However, regarding the most important outcome parameter, the number of diagnostic arthroscopies, no improvement was found (3% in both periods). The presented data suggests that MRI scans are not routinely necessary as an indication for knee arthroscopy, as clinical examination and plain radiograph are sufficient. However, MRI scans do allow a more detailed characterization of the expected findings and can therefore be helpful in therapy planning. [ABSTRACT FROM AUTHOR]

Abstract: A neuroprotected state can be acquired by preconditioning brain with a stimulus that is subthreshold for damage (tolerance). Acquisition of tolerance involves coordinate, bi-directional changes to gene expression levels and the re-programmed phenotype is determined by the preconditioning stimulus. While best studied in ischemic brain there is evidence brief seizures can confer tolerance against prolonged seizures (status epilepticus). Presently, we developed a model of epileptic preconditioning in mice and used microarrays to gain insight into the transcriptional phenotype within the target hippocampus at the time tolerance had been acquired. Epileptic tolerance was induced by an episode of non-damaging seizures in adult C57Bl/6 mice using a systemic injection of kainic acid. Neuron and DNA damage-positive cell counts 24 h after status epilepticus induced by intraamygdala microinjection of kainic acid revealed preconditioning given 24 h prior reduced CA3 neuronal death by ∼45% compared with non-tolerant seizure mice. Microarray analysis of over 39,000 transcripts (Affymetrix 430 2.0 chip) from microdissected CA3 subfields was undertaken at the point at which tolerance was acquired. Results revealed a unique profile of small numbers of equivalently up- and down-regulated genes with biological functions that included transport and localization, ubiquitin metabolism, apoptosis and cell cycle control. Select microarray findings were validated post hoc by real-time polymerase chain reaction and Western blotting. The present study defines a paradigm for inducing epileptic preconditioning in mice and first insight into the global transcriptome of the seizure-damage refractory brain. [Copyright &y& Elsevier]

In this study we examine the in vivo formation of the Apaf-1/ cytochrome c complex and activation of caspase-9 following limbic seizures in the rat. Seizures were elicited by unilateral intraamygdala microinjection of kainic acid to induce death of CA3 neurons within the hippocampus of the rat. Apaf-1 was found to interact with cytochrome c within the injured hippocampus 0-24 h following seizures by co-immunoprecipitation analysis and immunohistochemistry demonstrated Apaf-1/cytochrome c co-localization. Cleavage of caspase-9 was detected ∼4 h following seizure cessation within ipsilateral hippocampus and was accompanied by increased cleavage of the substrate Leu-Glu-His-Asp-p-nitroanilide (LEHDpNA) and subsequent strong caspase-9 immunoreactivity within neurons exhibiting DNA fragmentation. Finally, intracerebral infusion of z-LEHD-fluoromethyl ketone increased numbers of surviving CA3 neurons. These data suggest seizures induce formation of the Apaf-1/cytochrome c complex prior to caspase-9 activation and caspase-9 may be a potential therapeutic target in the treatment of brain injury associated with seizures. [ABSTRACT FROM AUTHOR]