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Copyright of Datenschutz und Datensicherheit - DuD is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cellulose nanofibers (CNFs) have been widely studied for their reinforcing potential in high-performance composites. While there are numerous publications on CNF-reinforced composites in a variety of polymer matrices, few have considered the recyclability of such thermoplastic composites and whether the incorporation of CNFs deteriorates or improves their performance upon reprocessing. In this study, two thermoplastic resins, poly(lactic acid) (PLA), and glycol-modified polyethylene terephthalate (PETg), were prepared with CNF reinforcement and thermomechanically recycled to investigate the effect of CNF inclusion on the composite properties after reprocessing as well as their effect on the composites' number of useful life cycles. Changes in mechanical, thermal, rheological, molecular, and microstructural properties of the composites and/or base resins were monitored as a function of cycle numbers. As is typical, the polymers' molecular weight and mechanical performance deteriorated with continued processing. However, the addition of spray dried CNF was found to better maintain the mechanical performance of both polymers throughout multiple recycling steps as compared to neat samples. For example, the tensile strength of PETg with 20 wt% CNF after 6 processing cycles was found to exceed that of virgin neat PETg, and higher loadings of CNF were found to preserve a higher yield strength during multiple rounds of reprocessing compared to PETg composites with lower CNF loadings. Ultimately this study indicates that the addition of CNF to some thermoplastic materials can increase both their sustainability by offsetting the use of high-embodied energy resins and their circularity by enabling performance retention over more use cycles. [ABSTRACT FROM AUTHOR]

Purpose: Despite standardized treatment algorithms, patients with complex elbow fracture-dislocation frequently suffer from poor post-operative elbow function leading to reduced quality of life. Up to now, there is no valuable data regarding risk factors that lead to poor post-operative outcome after surgical reconstruction of complex elbow fracture-dislocations. Methods: From 06/2010 to 12/2020 134 patients (51.3 ± 15.1 years, 44% women) undergoing surgical treatment of complex elbow fracture-dislocations could be included in this study. Follow-up period was 4.4 years (SD 2.5). All patients were clinically evaluated for elbow movement, elbow stability and common elbow scores (MEPS, OES, DASH-Score). Potential risk factors for poor post-operative outcome were identified using bi- and multivariate analyses. Results: Overall good post-operative outcome has been achieved, mean MEPS was 88.8 ± 17.6. Post-operative complications occurred in 31.3% of the cases, while 25.4% required surgical revision. Patients with transolecranon dislocation fractures showed the significantly worst functional outcomes (p = 0.01). In addition, it has been shown that a patient's age of more than 70 years (OR = 10, p = 0.003) and a BMI of more than 35 kg/m2 (OR = 7.6, p = 0.004) are independent risk factors for a poor post-operative outcome. In contrast, gender and time to surgery showed no significant influence on post-operative outcome. Conclusion: In most cases, good post-operative functional results can be achieved using standardized treatment protocols. However, complication and revision rates remain high. Patients older than 70 years of age or with a BMI over 35 kg/m2 are at risk for an inferior outcome and require close follow-up monitoring. [ABSTRACT FROM AUTHOR]

Plastic instability, including both the discontinuous yielding and stress serrations, has been frequently observed during the tensile deformation of medium-Mn steels (MMnS) and has been intensively studied in recent years. Unfortunately, research results are controversial, and no consensus has been achieved regarding the topic. Here, we first summarize all the possible factors that affect the yielding and flow stress serrations in MMnS, including the morphology and stability of austenite, the feature of the phase interface, and the deformation parameters. Then, we propose a universal mechanism to explain the conflicting experimental results. We conclude that the discontinuous yielding can be attributed to the lack of mobile dislocation before deformation and the rapid dislocation multiplication at the beginning of plastic deformation. Meanwhile, the results show that the stress serrations are formed due to the pinning and depinning between dislocations and interstitial atoms in austenite. Strain-induced martensitic transformation, influenced by the mechanical stability of austenite grain and deformation parameters, should not be the intrinsic cause of plastic instability. However, it can intensify or weaken the discontinuous yielding and the stress serrations by affecting the mobility and density of dislocations, as well as the interaction between the interstitial atoms and dislocations in austenite grains. [ABSTRACT FROM AUTHOR]

Background: Two-tier trauma team activation (TTA)—protocols often fail to safely identify severely injured patients. A possible amendment to existing triage scores could be the measurement of serum lactate. The aim of this study was to determine the ability of the combination of serum lactate and age to predict severe injuries (ISS > 15). Methods: We conducted a retrospective cohort study in a single level one trauma center in a 20 months study-period and analyzed every trauma team activation (TTA) due to the mechanism of injury (MOI). Primary endpoint was the correlation between serum lactate (and age) and ISS and mortality. The validity of lactate (LAC) and lactate contingent on age (LAC + AGE) were assessed using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. We used a logistic regression model to predict the probability of an ISS > 15. Results: During the study period we included 325 patients, 75 met exclusion criteria. Mean age was 43 years (Min.: 11, Max.: 90, SD: 18.7) with a mean ISS of 8.4 (SD: 8.99). LAC showed a sensitivity of 0.82 with a specificity of 0.62 with an optimal cutoff at 1.72 mmol/l to predict an ISS > 15. The AUC of the ROC for LAC was 0.764 (95% CI: 0.67–0.85). The LAC + AGE model provided a significantly improved predictive value compared to LAC (0.765 vs. 0.828, p < 0.001). Conclusions: The serum lactate concentration is able to predict injury severity. The prognostic value improves significantly taking the patients age into consideration. The combination of serum lactate and age could be a suitable Ad-on to existing two-tier triage protocols to minimize undertriage. Level of evidence: Level IV, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Pretreatment of pulp is a critical step in the fibrillation process to improve the quality and efficiency for cellulose nanofibril (CNF) production. This work employed a straightforward and entirely aqueous methacrylation and subsequent grafting-through polymerization technique to modify bleached softwood kraft pulp (BSKP). Specifically, methacrylate groups, poly(acrylamide) (PAM), and poly(methyl methacrylate) (PMMA) were chemically affixed to the surface of BSKP fibers, which was confirmed using FTIR spectroscopy. Bench-scale experiments were scaled up to pilot scale to prepare the modified BSKP samples, these were subjected to fibrillation using a Supermasscolloider (SMC), and the net cumulative energy (NCE) expended was monitored during the fibrillation process. Notably, the modified BSKP samples exhibited a substantial reduction in NCE, with the methacrylate modified BSKP sample achieving a 68% reduction in NCE expenditure to attain 90% fines as compared to the fibrillation of unmodified BSKP and producing methacrylate modified cellulose nanofibrils (Met-CNFs). Furthermore, we delved into the impact of polymeric surface modifications, both pre-and post-fibrillation, on fiber and fibril behavior, including the water retention value (WRV), hard-to-remove water (HR-Water), and rheological behavior. The attached polymer's hydrophilicity and hydrophobicity influenced the physical properties of the CNFs. Additionally, we executed a post-grafting polymerization process on the produced Met-CNFs. This additional step allowed us to modify nanofibril surfaces, yielding increased surface functionalization and producing modified CNFs that could be used for composite applications. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate functional outcome and complications after primary and revision modular H-TKA using hybrid fixation with cementless stems. Methods: Between 2015 and 2018, 48 patients with 50 implants were included after hybrid implantation of a single design H-TKA system using cementless osseointegrating stems and modular components. Complications and clinical outcome were analysed using Knee Society Score (KSS), the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) and the Short-Form Health Survey 12 (SF-12) score. Results: Indications for implantation were aseptic revision (n = 29, 58%), primary TKA (n = 19, 38%) and two-stage septic revisions (n = 2, 4%). Complications were reported in 26% (n = 12), whereas complications associated with hybrid fixation occurred in 5 (10%) cases, with 2 (4%) requiring revision surgery for aseptic loosening and 3 (6%) treated with an adapted postoperative protocol for perioperative fractures. Implant survivorship was 84% after a mean follow-up of 54 months. Postoperative KSS significantly improved from 51.50 (12–100) to 78.36 (41–99; p < 0.001). The mean WOMAC score was 19.26 (0–55), SF-12 PCS was 41.56 points (22.67–57.66) and SF-12 MCS was 49.21 points (23.87–63.21). Conclusion: Hybrid modular implantation in H-TKA provides satisfactory clinical and functional results in primary and revision TKA. Clinical outcomes significantly improve with reduced pain, increased mobility, and good-to-excellent functional scores after implantation. Whilst implant survival is comparable to previous studies and complications associated with hybrid fixation are low, general complication rates are comparably high. [ABSTRACT FROM AUTHOR]

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Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Frameshift mutations in the TTN gene encoding titin are a major cause for inherited forms of dilated cardiomyopathy (DCM), a heart disease characterized by ventricular dilatation, systolic dysfunction, and progressive heart failure. To date, there are no specific treatment options for DCM patients but heart transplantation. Here, we show the beneficial potential of reframing titin transcripts by antisense oligonucleotide (AON)‐mediated exon skipping in human and murine models of DCM carrying a previously identified autosomal‐dominant frameshift mutation in titin exon 326. Correction of TTN reading frame in patient‐specific cardiomyocytes derived from induced pluripotent stem cells rescued defective myofibril assembly and stability and normalized the sarcomeric protein expression. AON treatment in Ttn knock‐in mice improved sarcomere formation and contractile performance in homozygous embryos and prevented the development of the DCM phenotype in heterozygous animals. These results demonstrate that disruption of the titin reading frame due to a truncating DCM mutation can be restored by exon skipping in both patient cardiomyocytes in vitro and mouse heart in vivo, indicating RNA‐based strategies as a potential treatment option for DCM.

Background: Various organizations have published definitions for periprosthetic joint infection (PJI) with significant differences in the cut-offs of white blood cell (WBC) count and polymorphonuclear (PMN) leukocyte cells. Herein, we aim to analyze optimal cut-offs in patients which are planned to undergo a prosthesis revision and compare them with the actual published thresholds of the International Consensus Meeting (ICM) and European Bone and Joint Infection Society (EBJIS). Methods: A test kit was compiled in a monocentric prospective study, according to the ICM criteria (2018) and 2021 EBJIS criteria. The kit was implemented using: blood samples (including leukocyte count and C-reactive protein); samples for examining the synovial fluid (WBC count, PMN cell differentiation, microbiological culture for incubation over 14 days, alpha-defensin ELISA laboratory test, and leukocyte-esterase test). The cut-offs for WBC and PMN counts were investigated using ROC analyses and Youden index. The ICM 2018 criteria were applied, using alpha-defensin in all cases. Patients which have to undergo a prosthesis revision were included, a pre-operative joint aspiration had been performed, and the patients had been followed up prospectively. Results: 405 patients were examined with the compiled test kit; 100% had a complete dataset with respect to alpha-defensin; 383 patients, according to WBC count; and 256, according to PMN cell differentiation The cut-off of 2478.89 cells/µl in the WBC count (sensitivity: 87.70%; specificity: 88.10%) and the cut-off of 66.99% in PMN differentiation showed the best accuracy (sensitivity: 86.00%; specificity: 88.80%). Other published cut-offs for WBC were tested in this cohort and showed the following accuracy: 3000/µl (EBJIS/ICM; sensitivity: 82.10%; specificity: 91.00%), 2000/µl (sensitivity: 89.60%; specificity: 83.40%), and 1500/µl (sensitivity: 91.50%; specificity: 75.00%). The published cut-offs for PMN had the following accuracy in this cohort: 80% (ICM; sensitivity: 66.3%; specificity: 96.50%), 70% (sensitivity: 82.6%; specificity: 90%), and 65% (EBJIS, sensitivity: 86%; specificity: 88.8%). Conclusions: This study aims to improve current cut-offs for PMN- and WB-Count, even though PJI diagnosis is based on the combination of all defined tests. The optimal diagnostic cut-off of WBC and PMN counts was found to be 2479/µL and 67%, respectively, whereas ICM cut-offs in this cohort seem too high, as they provide high specificity but very low sensitivity. On the other hand, a cut-off for WBC count of 1500/µl alone would be very low, leading to low specificity and very high suspicion of PJI. The current consensus guidelines could be actualized considering these results to significantly improve the diagnostic quality. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Introduction: The optimal treatment of terrible triad injuries of the elbow (TTI) remains topic of ongoing discussion. The aim of this study was to determine whether different treatment strategies for coronoid tip fractures in terrible triad injuries influences the clinical and radiological results in a mid-term follow-up. Methods: A total of 62 patients with surgical treatment of a TTI including a coronoid tip fracture (37 women, 25 men; mean age, 51 years) were available for follow-up assessment after an average of 4.2 years (range 24–110 months). Thirteen patients had O'Driscoll 1.1 and 49 O'Driscoll 1.2 coronoid fractures, of which 26 were treated with and 36 without fixation. Range of motion, the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score as well as grip strength were evaluated. Radiographs were analyzed for all participants. Results: No significant benefit in outcome variables could be detected between patients, whose coronoid had been fixed, compared to patients without fixation of the coronoid. In the coronoid fixation group, patients had mean outcome scores of 81.5 ± SD 19.1 (range 35–100) for MEPS, 31.0 ± SD 12.5 (range 11–48) for OES and 27.7 ± SD 23 (range 0–61) for DASH score, while in the no-fixation group, mean MEPS was 90.8 ± SD 16.5 (range 40–100), mean OES was 39.0 ± SD 10.4 (range 16–48) and mean DASH score was 14.5 ± SD 19.9 (range 0–48). Mean range of motion was 116° ± SD 21° (range 85–140°) versus 124° ± SD 24° (range 80–150°) in extension-flexion and 158° ± SD 23° (range 70–180°) versus 165° ± SD 12° (range 85–180°) in pronation-supination. Overall complication rate was 43.5% and revision rate was 24.2%, with no significant differences between both groups. Suboptimal results were more frequently seen in patients who had degenerative or heterotopic changes on their latest radiograph. Conclusions: Sufficient elbow stability and good outcomes can be achieved in most patients with TTI and coronoid tip fractures. Although some bias in treatment allocation and group heterogeneity cannot be completely omitted, our analysis detected no significant benefit in outcome when the coronoid tip fracture has been fixed compared to patients with non-fixed coronoid tip. Therefore, we would suggest a no-fixation approach for coronoid tip fractures as primary treatment in TTI of the elbow. Level of evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the role of sonication fluid cultures in detecting musculoskeletal infections in orthopedic revision surgery in patients suspected of having peri-prosthetic joint infection (PJI), fracture-related infections (FRI), or postoperative spinal implant infections (PSII). Methods: Between 2016 and 2019, 149 cases with a data set including sonication fluid cultures and tissue specimen and histological analysis were included. Accuracy of each diagnostic tool as well as the influence of antibiotic therapy was analyzed. Pathogens identified in the sonication cultures and in the associated tissue samples were compared based on the matching of the antibiograms. Therapeutic benefits were then assessed. Results: Of 149 cases, 43.6% (n = 65) were identified as PJI, 2.7% (n = 4) as FRI, 12.8% (n = 19) as PSII, 6.7% (n = 10) as aseptic non-union, and 34.2% (n = 51) as aseptic implant loosening. The sensitivity and specificity of tissue and synovial specimens showed no significant difference with respect to sonication fluid cultures (sensitivity/specificity: tissue: 68.2%/96.7%; sonication fluid cultures: 60.2%/98.4%). The administration of antibiotics over 14 days prior to microbiological sampling (n = 40) resulted in a lower sensitivity of 42.9% each. Histological analysis showed a sensitivity 86.3% and specificity of 97.4%. In 83.9% (n = 125) of the cases, the results of sonication fluid cultures and tissue specimens were identical. Different microorganisms were found in only four cases. In 17 cases, tissue samples (n = 5) or sonication (n = 12) were false-negatives. Conclusion: Sonication fluid culture showed no additional benefit compared to conventional microbiological diagnostics of tissue and synovial fluid cultures. Preoperative administration of antibiotics had a clearly negative effect on microbiologic test accuracy. In over 83.9% of the cases, sonication fluid and tissue cultures showed identical results. In the other cases, sonication fluid culture did not further contribute to the therapy decision, whereas other factors, such as fistulas, cell counts, or histological analysis, were decisive in determining therapy. [ABSTRACT FROM AUTHOR]

Purpose: The optimal strategy for surgical repair of traumatic anterior shoulder instability remains controversial. While several study groups have reported that the clinical and radiological outcomes of arthroscopic procedures performed with two anchors are not fully adequate, these conclusions are not supported by the findings published in other studies. A prospective randomized study was conducted to compare the structural and clinical outcomes of surgical procedures involving two vs. three anchors. Methods: Patients who underwent arthroscopic Bankart repair were randomly assigned to either Group I, which underwent procedures involving two double-loaded 3.5-mm knotless anchors, or Group II, which underwent procedures involving three single-loaded 2.9-mm knotless anchors. All patients underwent bilateral MRI assessments at a minimum of 12 months and clinical assessment at a minimum of 24 months postoperatively. To evaluate the reconstruction of the labral capsular ligamentous complex (LCLC), the labrum-glenoid height index (LGHI), restored labral height (LH), and labral slope (LS) were measured for both shoulders. For clinical assessment, the redislocation rate and functional outcome scores (Constant score (CS), American Shoulder and Elbow Surgeon score (ASES), Walch Duplay score (WDS), and Rowe score (RS)) were evaluated at follow-up visits. Results: Bankart repair with two knotless anchors showed lower values for anterior reconstruction of the LCLC compared to the uninjured contralateral shoulder. Likewise, significant differences were noted when comparing these measurements to those from patients who underwent reconstruction with three anchors. No differences were demonstrated with regard to the reconstruction of the inferior LCLC. Clinical assessment showed good to excellent results in both groups. In total, three patients experienced redislocation of the shoulder: two in group I and one in group II. No significant differences were found with respect to clinical outcomes and redislocation rates. Conclusion: Bankart repair with both two and three knotless anchors results in effective anatomical reconstruction of the labral capsular ligamentous complex. Although the two-anchor technique yields significantly lower values for the anterior portion compared with the contralateral side, none of these differences reach clinical relevance as per our original definition. [ABSTRACT FROM AUTHOR]

Copyright of HMD: Praxis der Wirtschaftsinformatik is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

X-ray detectors are of pivotal importance for the scientific and technological progress in a wide range of medical, industrial, and scientific applications. Here, we take advantage of the printability of perovskite-based semiconductors and achieve a high X-ray sensitivity combined with the potential of an exceptional high spatial resolution by our origami-inspired folded perovskite X-ray detector. The high performance of our device is reached solely by the folded detector architecture and does not require any photolithography. The design and fabrication of a foldable perovskite sensor array is presented and the detector is characterized as a planar and as a folded device. Exposed to 50 kVp−150 kVp X-ray radiation, the planar detector reaches X-ray sensitivities of 25−35 μC/(Gyaircm2), whereas the folded detector achieves remarkably increased X-ray sensitivities of several hundred μC/(Gyaircm2) and a record value of 1409 μC/(Gyaircm2) at 150 kVp without photoconductive gain. Finally, the potential of an exceptional high spatial resolution of the folded detector of more than 20 lp/mm under 150 kVp X-ray radiation is demonstrated. [ABSTRACT FROM AUTHOR]

A simple, fully aqueous grafting-through polymerization approach was employed to apply various polymeric surface modifications to bleached softwood kraft pulp (BSKP). Poly(acrylamide), poly(acrylic acid), poly(oligo(ethylene glycol) methyl ether methacrylate), poly(methyl methacrylate), and poly(dimethyl itaconate) were chemically attached to the BSKP fiber surface, as confirmed by Fourier transform infrared spectroscopy. The modified and unmodified BSKP samples were fibrillated and evaluated using optical fiber length analysis and scanning electron microscopy analysis. Furthermore, the effect of the polymeric surface modifications before and after fibrillation on the filtration water retention value (WRVfiltration) was studied. While the polymeric surface modifications had little effect on the percentage of fines and width distribution of nanosized fibrils, they significantly reduced the WRVfiltration after fibrillation. The polymeric surface modifications were also found to affect the morphology after drying and grinding. [ABSTRACT FROM AUTHOR]

Purpose: Non-union of the proximal ulna is a serious complication after surgical treatment of olecranon and complex elbow fractures, frequently leading to poor functional outcome. To date, there is a lack of data regarding optimal treatment strategies and functional outcome parameters after surgical revision.Methods: From 02/2010 to 12/2018, 31 patients undergoing surgical treatment of proximal ulna non-union could be included. Follow-up period was seven years (SD 2.5 years). All patients were clinically assessed using a clinical assessment tool set and standard elbow scores (MEPS, OES, DASH score). All complications and unplanned revision surgeries were recorded and all radiographic material was analyzed.Results: Initial non-union procedures were performed at an average of 6.6 months (SD 3 months) after the index procedures. Those included the use of autologous spongiosa graft in all patients and concomitant compression re-osteosynthesis in 28 patients. Radiological consolidation was achieved in all patients. Overall, patients achieved a good to fair functional outcome with Mayo elbow performance score measuring 78.5 (SD 9.1), DASH score 34.7 (SD 14.4), and Oxford elbow score 31.2 (SD 6.6) points. Initial malreduction/implant-malposition could be identified as a main reason for the occurrence of the non-union. Furthermore, inferior postoperative outcome was detected in patients > 60 years and BMI > 30 kg/m2.Conclusion: Using a standardized protocol, bony union and acceptable functional outcomes can be achieved in proximal ulna non-unions. However, surgeons should be aware of potential risk factors and proper initial fracture reduction as key to achieve sufficient bone healing. [ABSTRACT FROM AUTHOR]

Micro-scale inorganic particles (d > 1 µm) have reduced surface area and higher density, making them negatively buoyant in most dip-coating mixtures. Their controlled delivery in hard-to-reach places through entrainment is possible but challenging due to the density mismatch between them and the liquid matrix called liquid carrier system (LCS). In this work, the particle transfer mechanism from the complex density mismatching mixture was investigated. The LCS solution was prepared and optimized using a polymer binder and an evaporating solvent. The inorganic particles were dispersed in the LCS by stirring at the just suspending speed to maintain the pseudo suspension characteristics for the heterogeneous mixture. The effect of solid loading and the binder volume fraction on solid transfer has been reported at room temperature. Two coating regimes are observed (i) heterogeneous coating where particle clusters are formed at a low capillary number and (ii) effective viscous regime, where full coverage can be observed on the substrate. 'Zero' particle entrainment was not observed even at a low capillary number of the mixture, which can be attributed to the presence of the binder and hydrodynamic flow of the particles due to the stirring of the mixture. The critical film thickness for particle entrainment is h ∗ = 0.16 a for 6.5% binder and h ∗ = 0.26 a for 10.5% binder, which are smaller than previously reported in literature. Furthermore, the transferred particle matrices closely follow the analytical expression (modified LLD) of density matching suspension which demonstrate that the density mismatch effect can be neutralized with the stirring energy. The findings of this research will help to understand this high-volume solid transfer technique and develop novel manufacturing processes. [ABSTRACT FROM AUTHOR]

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Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the energy transition, there is an urgent need for decreasing overall carbon emissions. Against this background, the purposeful and verifiable tracing of emissions in the energy system is a crucial key element for promoting the deep decarbonization towards a net zero emission economy with a market-based approach. Such an effective tracing system requires end-to-end information flows that link carbon sources and sinks while keeping end consumers' and businesses' sensitive data confidential. In this paper, we illustrate how non-fungible tokens with fractional ownership can help to enable such a system, and how zero-knowledge proofs can address the related privacy issues associated with the fine-granular recording of stakeholders' emission data. Thus, we contribute to designing a carbon emission tracing system that satisfies verifiability, distinguishability, fractional ownership, and privacy requirements. We implement a proof-of-concept for our approach and discuss its advantages compared to alternative centralized or decentralized architectures that have been proposed in the past. Based on a technical, data privacy, and economic analysis, we conclude that our approach is a more suitable technical backbone for end-to-end digital carbon emission tracing than previously suggested solutions. [ABSTRACT FROM AUTHOR]

Background: The identification of risk factors for severe injury is crucial in trauma triage and trauma team activation (TTA) depends on a sufficient triage. The aim of this study was to determine whether or not elevated serum lactate levels and age are risk factors for severe injury in TTA due to trauma mechanism. Methods: We conducted a retrospective cohort study in a single level one trauma center between September 2019 and May 2021 and analysed every TTA due to trauma mechanism. Primary endpoint of interest was the association of serum lactate as well as age with injury severity assessed by the injury severity score (ISS). Results: During the study period, we included 250 patients. Mean age was 43.3 years (Min.: 11, Max.: 90, SD: 18.7) and the initial lactate level was 1.7 mmol/L (SD: 0.95) with a mean ISS of 8.4 (SD: 8.99). The adjusted odds ratio (OR) for age > 65 being associated with an ISS > 16 is 9.7 (p < 0.001; 95% CI 4.01–25.58) and for lactate > 2.2 mmol/L being associated with an ISS > 16 is 6.29 (p < 0.001; 95% CI 2.93–13.48). A lactate level of > 4 mmol/L results in a 36-fold higher risk of severe injury with an ISS > 16 (OR 36.06; 95% CI 4–324.29). Conclusion: This study identifies age (> 65) and lactate (> 2.2 mmol/L) as independent risk factors for severe injury in a TTA due to trauma mechanism. Existing triage protocols might benefit from congruous amendments. [ABSTRACT FROM AUTHOR]

Introduction: The supracondylar humerus fracture (SCHF) is one of the most common pediatric injuries. Highly displaced fractures can be very challenging. If closed reduction fails, the therapy algorithm remains controversial. Materials and methods: In total, 41 patients (21 boys and 20 girls) with irreducible Gartland type III SCHF, treated with open reduction through three different approaches and cross-pin fixation, were retrospectively evaluated. The mean follow-up was 46 months (min.: 12, max.: 83, SD: 23.9). The Mayo elbow performance score (MEPS) as well as the quick disabilities of arm, shoulder and hand (qDASH) score were used to assess the functional outcome. Baumann's angle and the anterior humeral line (AHL, Roger's line) were obtained from follow-up radiographs. Time to surgery, postoperative nerve-palsy, rate of revision surgery, and complication rate were examined. Results: Two revision surgeries were reported. One due to inadequate reduction and one due to secondary loss of reduction. In this context, the AHL was a sufficient tool to detect unsatisfactory reduction. According to the MEPS the functional outcome was excellent (> 90) in 37/41 patients and good (75–89) in 4/41 at the final visit. Fair or poor results were not documented. The qDASH score was 1.8 (min.: 0, max.: 13.6, SD: 3.4). There were no significant differences between the utilized surgical approaches. An iatrogenic injury of the ulnar nerve was not reported in any case. Overall, one heterotopic ossification without impairment of the range of motion and one preliminary affection of the radial nerve were documented. Conclusion: In the rare case of an irreducible SCHF, an anatomical reduction can be achieved by open approaches with excellent functional outcome and a high grade of patient satisfaction. All described open approaches can be utilized with a high safety-level. [ABSTRACT FROM AUTHOR]

Cellulose nanofibrils (CNFs) have attracted a great deal of research interest in recent years attributable to the low cost and abundance of lignocellulosic biomass from which they can be extracted. These materials have potential applications in a wide array of areas because of their unique properties such as ultra-high aspect ratios and specific strengths. However, the high energy required to extract CNFs from biomass through fibrillation often makes them prohibitively expensive or negates their inherent sustainability. As such, a variety of biomass treatments prior to fibrillation have been investigated by researchers to reduce the energy requirements of CNF extraction, improve the efficacy of biomass fibrillation and subsequent processes, and/or impart functionality in resulting nanofibrils. In this review, both widely used and emerging mechanical, chemical, and enzymatic pretreatments used prior to fibrillation of lignocellulosic biomass for CNF extraction are reviewed. Attention is given to the effect of these various pretreatments on the properties of the resulting CNFs. Finally, the energy consumption in fibrillation processes with and without the use of pretreatments is compared, and future perspectives on challenges and opportunities in lignocellulosic feedstock pretreatments are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The treatment of comminuted patellar fractures remains a challenge for orthopedic surgeons. The aim of this study was to assess the clinical, functional, and radiological outcome after treatment of comminuted patellar fractures using an anatomically contoured plating system. Methods: Between January 2015 and December 2019 (5 years), 29 patients with complex C3 fractures according to AO classification (18 female, 11 male; mean age: 53 years) were treated using an anatomically contoured plating system (patella SuturePlate™, Arthrex®, Naples, USA). Indication for surgery was based on instability and/or initial fragment dislocation (> 2 mm). After a minimum follow-up of 12 months, patients were examined using a standardized clinical examination and functional outcome was assessed using specific knee scores (Lysholm, WOMAC, IKDC, Kujala, and Tegner score). In addition, complications were recorded and all available radiographs were evaluated regarding osteoarthritis and reduction quality. Results: All patients returned for follow-up investigation after an average of 19 months (range: 12–48 months). A mean range of motion (ROM) of 131° (range: 100–150) was recorded. Overall good functional outcome parameters could be reported, with a mean Lysholm score of 84.7 (range: 100–45), a WOMAC of 5.1 (range: 0–19.2), a Kujala scale of 85.5 (range: 100–48), an IKDC of 76.6 (range: 100–44.8), and a Tegner score of 4.3 (range: 10–3) with a difference of 0.62 to pre-operative. Patient satisfaction was rated 8.4 (range: 4–10) using a VAS. No loss of reduction, mechanical failure, or implant complications were detected. Radiological follow-up showed no evidence of relevant post-traumatic retropatellar osteoarthritis. In 7 cases, implants were removed due to subjective mechanical irritation. Conclusion: Anatomically contoured patellar plates allow secure fixation of the fracture fragments even in comminuted cases. Especially when tension-band wiring is prone to early failure, locking plate fixation represents a viable option leading to good functional results and low complication rates. [ABSTRACT FROM AUTHOR]

Background: Sequelae of COVID-19 can be severe and longlasting. We compared frequencies of fatigue, depression and cognitive dysfunction in survivors of SARS-CoV-2-infection and sepsis. Methods: We performed a prospective cohort study of 355 symptomatic post-COVID patients who visited our out-patient clinic for post-COVID-19 care. We compared them with 272 symptomatic patients from the Mid-German Sepsis Cohort, which investigates the long-term courses of sepsis survivors. Possible predictors for frequent clinical findings (fatigue, signs of depression, cognitive dysfunction) in post-COVID were investigated with multivariable logistic regression. Results: Median age of the post-COVID patients was 51 years (range 17–86), 60.0% were female, and 31.8% required hospitalization during acute COVID-19. In the post-COVID patients (median follow-up time: 163 days) and the post-sepsis patients (180 days), fatigue was found in 93.2% and 67.8%, signs of depression were found in 81.3% and 10.9%, and cognitive dysfunction was found in 23.5% and 21.3%, respectively. In post-COVID, we did not observe an association between fatigue or depression and the severity of acute COVID-19. In contrast, cognitive dysfunction was associated with hospitalization (out-patient versus in-patient) and more frequent in post-COVID patients treated on an ICU compared to the MSC patients. Conclusion: In post-COVID patients, fatigue and signs of depression are more common than in sepsis survivors, independent from the acute SARS-CoV-2-infection. In contrast, cognitive dysfunction is associated with hospitalization. Despite the differences in frequencies, owing to the similarity of post-COVID and post-sepsis sequelae, this knowledge may help in implementing follow-up approaches after SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Therapeutic riding (THR) and HeartMath (HM) mindfulness-based interventions have promise for reducing stress in adolescents with autism spectrum disorder. In three 10-week periods, this study compared THR, HM, and control on salivary cortisol, self-reported stress, parent-reported social responsiveness, and heart-rate variability. This crossover design included 27 participants (12–21 years) randomly assigned to order of intervention. Findings suggest that HM and THR manualized protocols are equally beneficial in decreasing cortisol levels immediately following a session, but HM sessions had more impact on heart-rate variability. There was no significant effect on follow-up cortisol levels within a week after either intervention, but THR had more impact on decreasing some self-reported stressors. [ABSTRACT FROM AUTHOR]

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Purpose: Surgical treatment of end-stage posttraumatic upper ankle arthrosis is challenging. Highly variable revision rates have been reported with total ankle arthroplasty (TAA) of the upper ankle joint. The aim of this retrospective study was to compare revision rates with tibiotalar arthrodesis (TTA) and TAA with a prosthesis to determine the superior treatment approach. Methods: Data for 148 patients (96 males and 52 females) with end-stage posttraumatic upper ankle arthrosis—including 88 treated with TTA and 60 with TAA between 2008 and 2013, with a mean follow-up of 59 months—were analysed. Bone fusion was confirmed by x-ray radiography and computed tomography. Results: The overall revision rate was 28%; the rate was higher with TAA (42%) than with TTA (18%). The TAA group showed an increase in revisions from 12- to 24-month postsurgery. The most common cause of revision in the TAA group was cysts (20%), and the most frequent reason for revision was nonunion (8%). Mean American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome (FAO) scores in all patients were 55.5 and 53.1, respectively, with no significant difference between the TTA and TAA groups (p > 0.05). In nine cases (15%) the prosthesis was explanted or converted to TTA. TAA patients who underwent conversion to TTA had worse outcomes (AOFAS score = 39; FAO score = 35.29). Conclusion: TAA is associated with a high rate of revisions, especially from the 2nd year postsurgery. Therefore, TTA is the treatment of choice for end-stage posttraumatic upper ankle arthrosis. Level of evidence Level III, comparative series. [ABSTRACT FROM AUTHOR]

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Introduction: Total hip arthroplasty (THA) rates have increased dramatically in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of THA. Simultaneously, a rising number of revision procedures is expected, which will put an enormous economic burden on future health care systems. Methods: Nationwide data provided by the Federal Statistical Office of Germany were used to quantify primary and revision arthroplasty rates as a function of age and gender. Projections were performed with use of Negative Binomial and Poisson regression models on historical procedure rates in relation to population projections from 2020 to 2060. Results: A 62% increase in the incidence rate of primary THAs is projected until 2060. At the same time, the annual total number of revision procedures is forecast to rise about 40% by the year 2060. The highest numbers of revision arthroplasties were calculated around year 2043. The greatest proportions of revision surgery will be observed in women and in those aged 70 years or older. The revision burden is projected to stabilize around 15% by 2060. Conclusions: The present projections allow a quantification of the increasing economic burden that (revision) THA will place on the German health care system in the upcoming decades. This study may serve as a model for other countries with similar demographic development as the country-specific approach predicts a substantial increase in the number of these procedures. This highlights the need for appropriate financial and human resource management in the future. [ABSTRACT FROM AUTHOR]

Purpose: Total knee arthroplasty (TKA) rates have increased substantially in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of TKA. The aim of this study was to provide an overview of treatment changes during the last decade and to project the expected burden of primary and revision TKA (rTKA) for the next 30 years. Methods: Comprehensive nationwide data from Germany was used to quantify primary and revision TKA rates as a function of age and gender. Projections were performed with use of a Poisson regression models and a combination of exponential smoothing and autoregressive integrated moving average models on historical procedure rates in relation to official population projections from 2020 to 2050. Results: The incidence rate of primary TKAs is projected to increase by around 43% to 299 per 100,000 inhabitants [95% CI 231–368], leading to a projected total number of 225,957 primary TKAs in 2050 (95% CI 178,804–276,442). This increase has been related to a growing number of TKA performed in male patients, with the highest increase modelled in patients between 50 and 65 years of age. At the same time, the annual total number of revision procedures is forecast to increase even more rapidly by almost 90%, accounting for 47,313 (95% CI 15,741–78,885; IR = 62.7 per 100,000, 95% CI 20.8–104.5) procedures by 2050. Those numbers are primarily associated with a rising number of rTKAs secondary to periprosthetic joint infection (PJI). Conclusions: Using this country- specific forecast approach, a rising number of primary TKA and an even more rapidly growing number of rTKA, especially for PJI, has been projected until 2050, which will inevitably provide a huge challenge for the future health care system. As many other industrialized nations will face similar demographic and procedure-specific developments, these forecasts should be alarming for many health care systems worldwide and emphasize the tremendous need for an appropriate financial and human resource management in the future. Level of evidence: Level III, prognostic study, economic and decision analysis. [ABSTRACT FROM AUTHOR]

Introduction: Calcaneal fractures account for 60–75% of all tarsal fractures and represent surgical challenges because of their frequency and complexity. Despite standardized procedures and new implants, literature reports high revision rates and unsatisfactory results. The study aims to describe the role of the surgeon with respect to the clinical outcome. Methods: Between 2014 and 2017, 94 calcaneal fractures (all type AO C1-3) were re-examined in 86 patients (67 male and 19 female; mean age: 51 years). The treatment was always carried out by means of locking compression plate via the extensile lateral approach. A comparison was made between treatment by an experienced (ES) and less experienced surgeon (LES). Annually, the ES performed at least 30 procedures for calcaneus fracture treatment as compared to < 10 operations performed by the LES. Results: The mean AOFAS, VAS FA, and Kiel Score in the ES group were 77.0 (SD 15.9), 69.0 (SD 18.8), and 65.0 (SD 20.6), respectively. The corresponding values in the LES group were 68.1 (SD 21.0), 60.3 (SD 22.4), and 53.0 (SD 21.9) (p < 0.05). The operation time was on average 14 min shorter in the ES group than the LES group (p < 0.05). Conclusion: The significantly better scores, along with shorter operation time, shorter duration of incapacity to work, and lower complication rate prove the importance of having an experienced surgeon perform complex intra-articular calcaneal fracture repairs. The extensile lateral approach is still considered the standard method. Level of evidence: Level III, comparative series. [ABSTRACT FROM AUTHOR]

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Purpose Of Review: The training of psychiatrists and other mental health professionals requires education on a range of interpersonal, communication, and psychotherapy techniques. Classroom and workshop training must be augmented by experiential learning with feedback for skill implementation with fidelity. Virtual standardized patients (VSPs) are computerized conversational agents that can support experiential learning through standardized, consequence-free training environments at reduced costs.Recent Findings: Research on mental health VSPs is rife with feasibility and acceptability pilot studies across various training populations and settings. Users have generally reported positive reactions to training with VSPs, though frustrations with some VSP speech recognition or VSP response relevance has been reported. Several studies have demonstrated a promising transfer of clinical skills from VSP training to human standardized patients and randomized trials supporting improved skill relative to reading or academic study are encouraging. As technology improves and natural language processing and accurate computer response generation for broad ranging conversational topics emerges, the field would benefit from research on the characteristics of effective VSPs for a range of purposes and trainee populations. Well-designed randomized evaluations of VSPs relative to best practices in education are needed, particularly regarding the impact of VSPs on clinical practice among actual patients. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Achilles tendon rupture is primarily caused by degenerative processes of multifactorial origin. In addition to secondary repair (SR) with augmentation of the plantaris longus tendon, the transfer of the flexor hallucis longus tendon (FHL) to the calcaneus is a recognised reconstruction procedure. This paper aims to provide a direct comparison based on clinical scores and objectifiable strength measurements. Methods: We analysed data for 60 patients (46 males and 14 females) with chronic Achilles tendon rupture, including 34 (mean age 57 years) treated with FHL and 26 (mean age 52 years) with SR between 2016 and 2020 (mean follow-up of 49 months). The follow-up included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scoring System (AOFAS-AH) and Visual Analogue Scale Foot and Ankle (VAS FA), the 12-item Short Form Survey (SF-12) and the objectifiable strength measurement using the dynamometer BIODEX®. Pre-existing gait disorders and permanent pain therapy led to exclusion. Results: The mean AOFAS-AH was 87.8 points (FHL: 85.6, SR: 90.6), the mean VAS FA was 78.1 points (FHL: 73.7, SR: 83.6), the mean PCS was 48.2 points (FHL: 46.3, SR: 50.7) and the mean MCS was 54.1 points (FHL: 55.0, SR: 53.0). The maximum torque for plantar flexion was 56.7 Nm on average (FHL: 51.0, SR: 63.7). A total of seven (11.7%) wound infections requiring revision occurred (FHL: 4 (11.8%), SR: 3 (11.5%)). All measurements did not differ significantly between the groups (p > 0.05). Conclusion: The results of the study prove the equivalence of FHL and SR based on the clinical scores as well as on the strength measurement using BIODEX®. Nevertheless, a higher withdrawal because of morbidity with a tendency for prolonged incapacity to work in the FHL group has to be taken into account. The present work provides the basis for a prospective comparison in future studies. [ABSTRACT FROM AUTHOR]

Introduction: This study compared the outcome of knee arthrodesis versus hinged total knee arthroplasty (TKA) in patients suffering from periprosthetic joint infection (PJI). Methods: 104 patients with PJI were treated using a two-stage exchange of failed TKA. In case of non reconstructable bone loss or loss of extension mechanism, a modular intramedullary arthrodesis nail was used for reimplantation [Knee Arthrodesis Module (KAM); n = 52]. The control group was retrospectively matched treated using a hinged revision TKA [Rotating Hinge Knee (RHK); n = 52]. PJI remission rates, functional outcome (WOMAC; KSS) and quality of life (SF-12), as well as comorbidities and pain were evaluated. Results: Mean age was 72.5 years. Charlson Comorbidity Index was higher in the KAM group (3.3 vs. 2.8). PJI remission rate was 89.4% (88.5% vs. 90.4%, respectively). In case of reinfection, implant retention was mostly possible in the RHK group (7.7%), whereas amputations were mostly performed in the KAM group (9.6%). Significant pain reduction (VAS 7.9–2.8) was achieved in both groups. Walking distance was significantly reduced in the KAM groups versus the RHK group (504 vs. 1064 m). WOMAC and KSS function scores were significantly reduced in the KAM group (25 vs. 40 and 35 vs. 64). Only moderate reduction in quality of life in the KAM group was observed (SF-12 physical: 34 vs. 40; SF-12 mental: 51 vs. 56) respectively. Conclusions: Arthrodesis using a modular intramedullary nail is an alternative for limb salvage, pain reduction, and preservation of quality of life and everyday mobility, when revision TKA is not an option. This study presents the largest number of case, comparing the outcome after performing an arthrodesis versus hinged TKA after septic failed TKA. [ABSTRACT FROM AUTHOR]

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Adding pigments into waterborne barrier coatings improves barrier properties and cost-effectiveness but increases the risk of crack formation during folding. Crack formation is affected by pigment shape, aspect ratio, and concentration; however, the exact mechanism for these effects is still not well understood. In this work, a systematic model was used to understand the influence of the paper and coating thickness, the latex and pigment modulus, the pigment shape and aspect ratio, and pigment concentration on the failure of waterborne barrier coatings during folding. A finite element method-based model was solved with a commercial package to simulate the folding process. These simulations were compared to experimental results to verify the key parameters that affect coating failure. High paper and coating thickness, pigment loadings, pigment aspect ratios, and modulus differences between latex and pigment increased the likelihood of failure. Experiments and models using lower modulus spherical plastic pigments were more difficult to fail than coatings made with higher modulus kaolin. The maximum strain for coatings bent to a set curvature was the smallest when the modulus of latex and pigment were similar. The model agreed closely with experimental results for two pigment types at various pigment loadings. [ABSTRACT FROM AUTHOR]

Introduction: Comparative data to guide implant choice for radial head replacements are lacking. Here, we compared the clinical results achieved using two different types of radial head prostheses. Methods: Data from patients with comminuted radial head fractures (n = 66), who underwent radial head arthroplasty with either short-stemmed bipolar (n = 31, Group 1: rHead Small Bone Innovations/USA) or monopolar long-stemmed osseointegrated rigidly fixed (n = 35, Group 2: MoPyC Tornier/France) prostheses, were retrospectively reviewed. Patients were followed-up for an average of 42 months (16–64 months). Range of elbow motion, elbow stability, grip strength, and visual analog scale (VAS) pain were measured, and functional outcome assessed using the Mayo Elbow Performance Score, the Disability of Arm, Shoulder and Hand questionnaire, and the Broberg–Morrey Score. Complications were analyzed and revision surgeries recorded. Results: Most patients achieved good/excellent results for all assessed outcome variables, with no significant differences between the two implant groups; however, regardless of the prosthesis type, a mean extension deficit of 18.5° ± 1.7° remained at latest follow-up. Although complication and surgical revision rates were comparable (bipolar, 23%; monopolar, 18%), significantly more bipolar prostheses were explanted because of painful loosening (16% vs. 3%; p = 0.029). Conclusion: Good to excellent mid-term results for radial head arthroplasty of comminuted radial head fractures can be achieved using both a bipolar and a monopolar radial head implant; however, the monopolar implant may be preferable, as it had a lower rate of painful loosening. Extension deficit occurs regularly. Level of evidence: Level III Retrospective comparative treatment study. [ABSTRACT FROM AUTHOR]