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Anatomical reduction and lag screw fixation of posterior malleolar (PM) ankle fractures typically involves an open posterolateral approach. The aim of this anatomical study was to assess whether a minimally-invasive, percutaneous posterior-to-anterior lag screw fixation technique is safe to perform. Eighteen cadaveric ankle specimens were used. A transverse incision was made at the lateral border of the Tendo Achilles (TA). Windows were made lateral to and through the substance of the TA and simulated reduction and placement of a single lag screw performed. Specimens were then fully dissected to ascertain proximity and damage to anatomical structures. Lag screw fixation was placed appropriately in all ankles. No injury to the neurovascular structures, ankle joint or syndesmotic ligaments was observed. The mean distance from the soft tissue window to sural nerve was 10.0 mm (range 5–16), and 9.5 mm to short saphenous vein (4–14). Whilst the muscle belly of flexor hallucis longus (FHL) was pierced in six specimens, no injuries to the FHL tendon were observed. The mean distance from screw to syndesmosis was 9.3 mm (range 3–15) and 12.7 mm to the ankle joint (7–17). This study demonstrates that posterior percutaneous lag screw fixation is both safe and accurate. Further work is required to evaluate the precision of reduction and the biomechanical stability of this fixation technique. This novel minimally-invasive technique may be beneficial in avoiding the wound complications associated with open posterolateral ankle approaches and also offer a functional advantage due to minimal soft tissue disruption.

BackgroundHandguns and rifles are often involved in violent deaths such as homicide and suicide. Consequently, forensic investigations are important to clarify the nature of ballistic trauma.MethodsThis study investigated the differences in entrance and exit wound morphology with Bos taurus(bovine) scapulae that have two cortical layers surrounding a central cancellous bone section which are comparable with human flat bones, with a series of experiments using six different calibres (0.22 Long Rifle, 9×19 mm North Atlantic Treaty Organization, 0.40 Smith & Wesson, 0.45 Automatic Colt Pistol, 5.56×45 mm and 7.62×51 mm). B. taurus(bovine) scapulae were used for closed range 30 cm simulated executions.ResultsThe ballistic experiments presented similarities in entrance wound morphology and exit wound bevelling with that of recognised forensic cases. As muzzle velocity increased, bevelling increased. Circumferential delamination is clearly visible with full metal jacket rounds, yielding similar bone damage morphology as human crania.ConclusionBovine scapulae seem appropriate for ballistic simulations of flat bone injuries on the macroscopic level, if the correct portion of the scapulae is deployed. More research is needed to further substantiate these interpretations.

BackgroundThe prevalence of civilian 0.223 ammunition is widespread. Due to low costs and the same dimensions as a 5.56×45 mm North Atlantic Treaty Organization, this round is exceptionally popular. However, recent mass shootings have employed soft point (SP) expanding ammunition to cause grievous wounds compared with military full metal jacket (FMJ) rounds that do not rapidly expand on impact.MethodsThe aim of this given study is to compare FMJ and SP rounds to determine if there are diagnostic differences between the bullet types in the wounds inflicted to flat bones. Bos taurusscapulae were used for 25 m simulated cranial gunshot injuries. Scanning electron microscopy was employed to assess the difference in wound morphology and elemental analysis between SP and FMJ rounds.ResultsEntrance and exit wound morphology change significantly between the two different types of ammunition as seen with circumferential delamination which is indicative of FMJ rounds and is not seen with the softer SP hunting rounds. Lead staining of the entrance wound is visible on only the SP rounds.ConclusionGunshot flat bone wound morphology is distinctively different between SP and FMJ rounds. Circumferential delamination is only seen with FMJ due to the hardness of the round. Lead staining is only seen with SP rounds due to bullet composition.

IntroductionDisplaced unstable pelvic injuries are life threatening and require rapid reduction and stabilisation, typically achieved with an external fixator. Recently, the benefits of supra-acetabular pins have been proven; however, these are usually inserted under fluoroscopic guidance. In austere environments and in extremis, this facility is limited and fixation using anatomical landmarks is required. Thus, the aim of this study is to determine the relative position of the supra-acetabular bone to the crestal plane and examine its consistency in military-aged European personnel.MethodsA radiological review of 50 randomised pelvic CT scans in European patients aged 18–30 years from a Level 1 trauma centre was performed. The CT scans were analysed using 3D rendering software. The relative position of the supra-acetabular bone to the crestal plane was determined.ResultsThe supra-acetabular bone relative to the crestal plane was approximately 28° caudal and 24° medial to the crestal plane. The mean minimum distance from the pin’s entry point to the sciatic notch was approximately 73 mm. There were no differences noted between genders or hemipelvic side.ConclusionsThe supra-acetabular bone maintains a consistent relative position to the crestal plane. Thus, with the surgeon’s thumb on the anterior superior iliac spine (ASIS) and index finger on the iliac tubercle, defining the crestal plane, a supra-acetabular pin can be inserted into the anterior inferior iliac spine, which lies 3 cm inferior and 2 cm medial to the ASIS, and advanced along the supra-acetabular bone by angling the pin 30° caudal and 25° medial to the crestal plane.

In view of a common neuroanatomy, ten basic affective states and a basic sense of selfhood/organic unity, it is likely that aesthetic creativity and appreciation only can occur when the cortically determined sense of ego-orientation has been superseded either spontaneously, by psychotropic substances, tragical catharsis, philosophical analysis, introspective techniques or by being exposed to natural stimuli. This process shifts the attention from being focused on personal egoistic concerns to a universal perspective in which the emotions are deepened and the sense of consciousness/ reality is enhanced. The resulting state of enhanced awareness, which is culture-invariant, has given rise to painting, poetry, music and other forms of aesthetics.

Aims.We present new medium-resolution high-S/N optical spectra of the ultracompact low-mass X-ray binaries 4U 0614+091 and 4U 1626-67, taken with the ESO Very Large Telescope. They are pure emission line spectra and the lines are identified as due to $\ion{C}{ii-iv}$and $\ion{O}{ii-iii}$.

A new method for in‐process measuring of cutting temperatures in turning processes is presented. Therefore, a thin‐film thermocouple is deposited at the surface of a cutting insert consisting of a nickel and nickel‐chromium conductor path. The coating technology used for the production of the pure metallic layers is performed by a PVD‐process. Turning experiments were conducted with grey cast iron GG25 in order to verify the functionality of the discussed thin layer thermocouples.

Recent UV observations of the globular cluster NGC 2808 (Brown et al. [CITE]) show a significant population of hot stars fainter than the zero-age horizontal branch (”blue hook” stars), which cannot be explained by canonical stellar evolution. Their results suggest that stars which experience unusually large mass loss on the red giant branch and which subsequently undergo the helium core flash while descending the white dwarf cooling curve could populate this region. Theory predicts that these ”late hot flashers” should show higher temperatures than the hottest canonical horizontal branch stars and should have helium- and carbon-rich atmospheres. As a test of this late hot flasher scenario, we have obtained and analysed medium resolution spectra of a sample of blue hook stars in NGC 2808 to derive their atmospheric parameters. Using the same procedures, we have also re-analyzed our earlier spectra of the blue hook stars in $\omega$ Cen (Moehler et al. [CITE]) for comparison with the present results for NGC 2808. The blue hook stars in these two clusters are both hotter ($T_{\rm eff} \ge 35\,000$ K) and more helium-rich than canonical extreme horizontal branch stars in agreement with the late hot flasher scenario. Moreover, we find indications for carbon enhancement in the three most helium-enriched stars in NGC 2808. However, the blue hook stars still show some hydrogen in their atmospheres, perhaps indicating that some residual hydrogen survives a late hot flash and then later diffuses to the surface during the horizontal branch phase. We note that the presence of blue hook stars apparently depends mostly on the total mass of the globular cluster and not so much on its horizontal branch morphology.

Several studies have demonstrated the presence of opioid inducible receptors on peripheral nerves and peripheral antinociceptive effects of opioids. However, the effects of peripheral opioid administration in man are controversial. Our study used a randomized, double-blind, placebo-controlled, three-way crossover design in a human model of acute inflammatory pain (heat injury). We studied 18 healthy volunteers who each received morphine locally (2 mg), morphine systemically (2 mg), or placebo on three separate study days. The subjects received morphine infiltration subcutaneously (s.c.). 1 h before heat injury (47 degrees C, 7 min) and naloxone infiltration s.c. (0.2 mg) 2.5 h after the heat injury. Hyperalgesia to mechanical and heat stimuli were examined using von Frey hairs and thermodes, and pain was rated using a visual analogue scale. The burns produced significant hyperalgesia, but local morphine infiltration neither reduced pain during the burn, nor primary or secondary hyperalgesia to mechanical and heat stimuli after the burn. In conclusion, peripherally applied morphine had no acute antinociceptive effects in this human model of acute inflammatory pain.

Riluzole modulates several transmitter systems which may be involved in nociception. Antinociceptive effects have been shown in animal studies, but there are no human data. Therefore, we have examined the acute analgesic effect of riluzole in a human model of inflammatory pain induced by a thermal injury on the distal leg (47 degrees C, 7 min, 12.5 cm2) in 20 healthy volunteers. Hyperalgesia to mechanical and heat stimuli were examined by von Frey hairs and thermodes. We used a randomized, double-blind, placebo-controlled design, and subjects received riluzole 100 mg or placebo for 2 days with a 14-day interval. The burns produced significant hyperalgesia, but riluzole had no acute analgesic effects in normal or hyperalgesic skin.

Zusammenfassung: Es wurde eine Bewertung des thermisch hygrischen Befindens eines Menschen sowohl mit einem Energiebilanzmodell als auch mit den herkömmlichen Komplexgroßen Äquivalent-temperatur, Effektivtemperatur und Abkühlungsgrüße vorgenommen. Ziel der Untersuchung war es festzustellen, ob eine Behaglichkeitsbeurteilung anhand der genannten Komplexgrüßen noch gerechtfertigt ist.

The removal of well-fixed acetabular components following total hip arthroplasty (THA) is a difficult operation and could be accompanied by the loss of acetabular bone stock. The optimal method for fixation is still under debate. The aim of this pilot study was to compare the tear-out resistance and failure behavior between osseo-integrated and non-integrated screw cups. Furthermore, we examined examined whether there are differences in the properties mentioned between screw sockets and cemented polyethylene cups.

Without Abstract:

Aims. Three dimensional explicit hydrodynamic codes based on spherical polar coordinates using a single spherical polar grid suffer from a severe restriction of the time step size due to the convergence of grid lines near the poles of the coordinate system. More importantly, numerical artifacts are encountered at the symmetry axis of the grid where boundary conditions have to be imposed that flaw the flow near the axis. The first problem can be eased and the second one avoided by applying an overlapping grid technique. Methods. A type of overlapping grid in spherical coordinates is adopted. This so called “Yin-Yang” grid is a two-patch overset grid proposed by Kageyama and Sato for geophysical simulations. Its two grid patches contain only the low-latitude regions of the usual spherical polar grid and are combined together in a simple manner. This property of the Yin-Yang grid greatly simplifies its implementation into a 3D code already employing spherical polar coordinates. It further allows for a much larger time step in 3D simulations using high angular resolution ($\la$1°) than that required in 3D simulations using a regular spherical grid with the same angular resolution. Results. The Yin-Yang grid is successfully implemented into a 3D version of the explicit Eulerian grid-based code PROMETHEUS including self-gravity. The modified code successfully passed several standard hydrodynamic tests producing results which are in very good agreement with analytic solutions. Moreover, the solutions obtained with the Yin-Yang grid exhibit no peculiar behaviour at the boundary between the two grid patches. The code has also been successfully used to model astrophysically relevant situations, namely equilibrium polytropes, a Taylor-Sedov explosion, and Rayleigh-Taylor instabilities. According to our results, the usage of the Yin-Yang grid greatly enhances the suitability and efficiency of 3D explicit Eulerian codes based on spherical polar coordinates for astrophysical flows.

Aims. Three dimensional explicit hydrodynamic codes based on spherical polar coordinates using a single spherical polar grid suffer from a severe restriction of the time step size due to the convergence of grid lines near the poles of the coordinate system. More importantly, numerical artifacts are encountered at the symmetry axis of the grid where boundary conditions have to be imposed that flaw the flow near the axis. The first problem can be eased and the second one avoided by applying an overlapping grid technique.

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