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Economic effects of the revised VAV: The effects of the reform of the injury type procedure (VAV) are demonstrated using the example of a rural specialized care clinic (400 beds). Using a retrospective analysis of 114 inpatient VAV cases from the clinic in the year 2012, 11 patients were identified who should have been transferred to an appropriate maximum care clinic according to the new criteria for the severe injury type procedure (SAV). The cost analysis of these 11 cases resulted in a turnover volume of 113,714.97 Euros. From an economic perspective, such a decline in turnover without a reduction of the contingency costs and at the same time increased requirements of the new VAV (e.g. hygiene), must be considered a negative development. Effect of the revised VAV on expertise: The loss or transfer of interesting trauma surgery cases (as a rule multiple trauma cases) could lead to a reduction in medical expertise in the department and in addition there is the problem with future acquisition of the next generation of trauma surgeons. It is feared that the advanced training to specialist trauma surgeon in VAV hospitals will be made more difficult or take longer in the future which will be a clear disadvantage for VAV clinics for attracting the ever decreasing numbers of next generation surgeons. Conclusion: In Germany as a whole there is extensive SAV competence in VAV clinics. This is of course not true for all clinics and for all regions but to a varied extent in the different locations. That this excellent expertise in VAV clinics will be compromised by bureaucratic regulations and which will therefore be detrimental for the patients is, from the author's point of view, taking things too far. In synopsis, the expectations of the author are subdued with respect to the reform of inpatient healthcare procedures from the perspective of a senior consultant in a VAV clinic. In the sense of the best possible care of patients, it would have been desirable if more attention had been paid in the reform to the actual competence of the individual VAV clinics. [ABSTRACT FROM AUTHOR]

Intramedullary bone endoscopy (IBE) was introduced as a new endoscopic technique in the year 2002 to achieve and manipulate the medullary canal of long bone under direct visual control. We report on a patient with a proximal femur fracture, where the new technique of IBE was used for intramedullary fracture reduction under visual control for the first time. Thus, the intraoperative use of an image intensifier was reduced. [ABSTRACT FROM AUTHOR]

A delta–sigma feedforward topology is presented, which avoids the need for an analogue adder in front of the quantiser. This simplifies the implementation and saves power. Simulation results show that the proposed topology achieves as good performance as the standard feedforward topology at high input signal amplitudes even with high distortion at the outputs of the integrators. [ABSTRACT FROM AUTHOR]

Abstract: Evaluation of Singh index (SI) as a simple means for estimating bone mass on radiographs has been subject of numerous studies. All of these studies used plain film radiographs for assessment of SI. Digital radiography may improve validity and reliability of SI assessment. Aim of this study was to evaluate SI gradings assessed on digital radiographs. Digital pelvic radiographs of 100 patients were graded using SI by five independent observers (two radiologists, three traumatologists) blinded to dual energy X-ray absorptiometry (DXA) results and re-graded by all observers for assessment of intraobserver agreement. SI was correlated with DXA measurements and after grouping the patients according to World Health Organisation (WHO) criteria (osteoporosis, osteopenia, normal). Logistic regression analysis was performed in order to identify influential parameters on the SI grading process. Mean intraobserver agreement was 0.648±0.18 (Kendall''s Tau) and 0.43±0.28 (kappa). Mean interobserver agreement was 0.488±0.193 (Kendall''s Tau) and 0.199±0.248 (kappa). Mean correlation between SI and trochanteric BMD and T scores was 0.219±0.04 and 0.210±0.05 (Spearman''s coefficient). Only one observer (senior radiologist) reached the significance level after grouping the patients’ DXA results according to WHO criteria and correlating the results with SI gradings. Logistic regression analysis revealed a significant influence of trochanteric T score in two observers while other variable parameters failed to reach the significance level. Even though we found reasonable intraobserver agreement assessment of SI is highly subjective and interobserver agreement is generally poor. Moreover, using digital radiography could not improve correlation with DXA measurements. [Copyright &y& Elsevier]

Introduction: We wanted to test the hypothesis that quality changes occur in early-stage arthritic subchondral cancellous bone after acute subchondral damage. So far, not much attention has been paid to changes of the subchondral bone after traumatic subchondral lesions. Materials and methods: With an established animal model, we produced pure subchondral damage without initial affection of the articular cartilage in 12 Beagle dogs under MRI and histological control. We utilized bone histomorphometry to evaluate bone turnover, its structure and the articular cartilage 6 months after the initial damage. Results: On follow-up, bone remodelling was indicated, e.g. by a significant increase in the trabecular bone volume and thickness, osteoblast number and osteoid surface and a decrease in the trabecular number in all 12 samples. Several other parameters showed a tendency, e.g. osteoblast surface and osteoclast number. Cartilage analysis showed degenerative changes in ten of 12 samples that had not shown any evidence of damage during the initial examination. Discussion: Our investigation indicates a significant deterioration in the architecture of the cancellous bone with degenerative changes of the overlying articular cartilage after subchondral lesions, which change the mechanical properties. [ABSTRACT FROM AUTHOR]

Fecal incontinence (FI) is a major part of illness and physical discomfort in the general population. Since the 1990s, sacral nerve stimulation has been well established in the treatment of neurogenic FI. The precise placement of the electrode is crucial for the success of the procedure. Eighty percent of the patients benefit from permanent treatment, but in 10-20% of the patients tested electrode placement proves impossible due to anatomical variations of the sacral foramina. In this study, we describe the technical requirements and a new method of electrode placement with reference to the anatomical (bone) landmarks in an animal model. With a small endoscope (Verres needle), we accessed the perirectal space to identify the nervous structures. A stimulated sphincter EMG was obtained for the experimental animals and muscle action potential (MAP/M-wave), latency time [ms], and the amplitude of the motor response [μV] were recorded. Electrodes were placed, the animals killed and dissected leaving the pelvic cavity untouched. The specimens were examined in a magnetic resonance scanner and in a multi-slice computed tomography scanner to detect the electrode material and possible surgical complications. After that the specimens were dissected. In all eight cases in the four animals tested, we were able to stimulate the sacral nerve as demonstrated by the EMG findings. No major surgical complications were observed for the procedure. Endoscopic sacral nerve root stimulation is a safe and effective method for delivering stimulation material in the pelvis of the sheep. It is a promising procedure to be tested in humans. [ABSTRACT FROM AUTHOR]

Cutaneous malignant melanoma is considered one of the most deadly human cancers, based on both its penchant for metastatic spread and its typical resistance to currently available therapy. Long known to harbor oncogenic NRAS mutations, melanomas were more recently reported to be frequent bearers of activating mutations in BRAF, one of the effectors situated downstream of wild-type NRAS. NRAS and BRAF mutations are rarely found in the same melanoma, suggesting that they may possess important overlapping oncogenic activities. Here, we compare and contrast the oncogenic roles of the three major NRas downstream effectors, Raf, phosphatidylinositol 3-kinase (PI3K) and Ral guanine exchange factor (RalGEF), using genetically engineered Arf-deficient immortalized mouse melanocytes as a model system. Although no single downstream pathway could recapitulate all of the consequences of oncogenic NRas expression, our data indicate a prominent role for BRaf and PI3K in melanocyte senescence and invasiveness, respectively. More surprisingly, we discovered that constitutive RalGEF activation had a major impact on several malignant phenotypes, particularly anchorage-independent growth, indicating that this often overlooked pathway should be more carefully evaluated as a possible therapeutic target. [ABSTRACT FROM AUTHOR]

Unlabelled: Insertion of percutaneous iliosacral screws with fluoroscopic guidance is associated with a relatively high screw malposition rate and long radiation exposure. We asked whether radiation exposure was reduced and screw position improved in patients having percutaneous iliosacral screw insertion using computer-assisted navigation compared with patients having conventional fluoroscopic screw placement. We inserted 26 screws in 24 patients using the navigation system and 35 screws in 32 patients using the conventional fluoroscopic technique. Two subgroups were analyzed, one in which only one iliosacral screw was placed and another with additional use of an external fixator. We determined screw positions by computed tomography and compared operation time, radiation exposure, and screw position. We observed no difference in operative times. Radiation exposure was reduced for the patients and operating room personnel with computer assistance. The postoperative computed tomography scan showed better screw position and fewer malpositioned screws in the three-dimensional navigated groups. Computer navigation reduced malposition rate and radiation exposure.Level Of Evidence: Level II, therapeutic study. [ABSTRACT FROM AUTHOR]