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A method for monitoring hemodialysis based on quantitative infrared spectroscopic determination of the molecules dialyzed from patient blood is reported. The measurements are reagent-free and aim at real-time and in-line monitoring of the hemodialysis patient. A flow cell using attenuated total reflection infrared spectroscopy is coupled downstream of the dialysis filter unit. A calibration model has been developed from real hemodialysis samples analyzed by chemical reference analysis and from artificially mixed dialysis samples. The infrared monitoring of hemodialysis includes quantitative determination of urea as the lead substance, as well as glucose, lactate, and creatinine, all at a precision only limited by the chemical reference analysis. The flow cell can be fitted to all standard hemodialysis systems. Preliminary tests with hemodialysis patients have demonstrated that detoxification can be clearly monitored. Furthermore, these experiments demonstrate that a wide, real-time control of the patient's physiological parameters is possible with this method, which could lead to increased patient safety. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

The prediction and experimental verification of the quantum spin Hall state marked the discovery of a new state of matter now known as topological insulators. Two-dimensional topological insulators exhibit the quantum spin-Hall effect, characterized by gapless spin-polarized counter-propagating edge channels. Whereas the helical character of these edge channels is now well established, experimental confirmation that the transport in the edge channels is spin polarized is still outstanding. We report experiments on nanostructures fabricated from HgTe quantum wells with an inverted band structure, in which a split gate technique allows us to combine both quantum spin Hall and metallic spin Hall transport in a single device. In these devices, the quantum spin Hall effect can be used as a spin current injector and detector for the metallic spin Hall effect, and vice versa, allowing for an all-electrical detection of spin polarization. [ABSTRACT FROM AUTHOR]

A comprehensive approach of bioprocess design at various levels was used to optimize microbial production of extracellular fructofuranosidase, important as biocatalyst to derive fructooligosaccharides with broad application in food or pharmaceutical industry. For production, the recombinant strain Aspergillus niger SKAn1015 was used, which expresses the fructofuranosidase encoding gene suc1 under control of a strong constitutive promoter. In a first screening towards an optimized medium, glucose, nitrate, Fe2+, and Mn2+ were identified as beneficial for production. A minimal medium with optimized concentration of these key nutrients, obtained by central composite design experiments and quadratic modelling, provided a threefold increased fructofuranosidase activity in the culture supernatant (400 U/mL) as compared to the originally described medium. Utilizing the optimized medium, the process was then transferred from shake flask into a fed-batch-operated bioreactor. Hereby, the intended addition of talc microparticles allowed engineering the morphology of A. niger into a highly active mycelial form, which strongly boosted production. Fructofuranosidase production was highly specific as confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. The secreted enzyme activity of 2,800 U/mL, corresponding to about 3 g/L of fructofuranosidase, achieved by the microparticle-enhanced fed-batch process, is tenfold higher than that of any other process reported so far, so that the presented bioprocess strategy appears as a milestone towards future industrial fructofuranosidase production. [ABSTRACT FROM AUTHOR]

A set of different integrative expression vectors for the intracellular production of recombinant proteins with or without affinity tag in Aspergillus niger was developed. Target genes can be expressed under the control of the highly efficient, constitutive pkiA promoter or the novel sucrose-inducible promoter of the β-fructofuranosidase ( sucA) gene of A. niger in the presence or absence of alternative carbon sources. All expression plasmids contain an identical multiple cloning sequence that allows parallel construction of N- or C-terminally His6- and StrepII-tagged versions of the target proteins. Production of two heterologous model proteins, the green fluorescence protein and the Thermobifida fusca hydrolase, proved the functionality of the vector system. Efficient production and easy detection of the target proteins as well as their fast purification by a one-step affinity chromatography, using the His6- or StrepII-tag sequence, was demonstrated. [ABSTRACT FROM AUTHOR]

Introduction. The incidence of early deep infection after arthroplasty of the knee is very low but could represent a serious future problem. Material and methods. The authors report on a 71-year-old woman with gonarthritis who was supplied with a total knee endoprosthesis and developed a local infection followed by septic shock. Results. The infection was evidently caused by a multiresistant Staphylococcus aureus (Staph. aureus). The primary clinical signs closely resembled a necrotizing fasciitis. Systemic and local application of vancomycin led to an improvement of the symptoms at secondary sites, but only the amputation of the primarily infected leg was lifesaving. Conclusion. In order to prevent such events, the authors recommend a number of additional presurgical measures. Firstly, a swab from the nose and throat should be taken prior to an elective surgery in patients with elevated risk of immunodeficiency, for example in patients with diabetes. The diabetes should be adequately treated before an elective operation is undertaken. Secondly, an early punction of the knee joint should be carried out if there is any doubt regarding inflammation. Isolated infectious agents should be grounds for early revision, which should always be completed with a rinsing procedure and with adequate antibiotics. Immunotherapy should be taken into consideration. Antiepidemic measures are recommended in cases with known Staph. aureus. [ABSTRACT FROM AUTHOR]

Introduction: Atraumatic necrosis of the femoral head (AFHN) is a common disease with an incidence of 5000–7000 middle-aged adults in Germany. There is no uniform consensus in the literature regarding the configuration of the bone in AFHN. The clinical picture of our patients varies from very hard bone, especially in idiopathic findings, and rather soft bone in cortisone-induced necrosis. A better understanding of the underlying process could be decisive for establishing a morphology-dependent approach. The aim of this study is the closer examination of the condition of the bone in the AFHN compared to the primary hip osteo arthritis (PHOA). Materials and methods: The preparations were obtained as part of elective endoprosthetic treatment of the hip joint. Immediately after sample collection, thin-slice CT of the preserved femoral heads was performed to determine the exact density of the bone in the necrosis zone. Reconstruction was done in 0.8–1 mm layers in two directions, coronary and axial, starting from the femoral neck axis. Density of the femoral heads was determined by grey value analysis. The value in Hounsfield units per sample head was averaged from three individual measurements to minimize fluctuations. For biomechanical and histomorphological evaluation, the samples were extracted in the load bearing zone perpendicular to the surface of the femoral head. Group-dependent statistical evaluation was performed using single factor variance analysis (ANOVA). Results: A total of 41 patients with a mean age of 64.44 years were included. The mean bone density of the AFHN samples, at 1.432 g/cm3, was about 7% higher than in the PHOA group with a mean value of 1.350 g/cm3 (p = 0.040). The biomechanical testing in the AFHN group showed a 22% higher—but not significant—mean compressive strength (20.397 MPa) than in the PHOA group (16.733 MPa). On the basis of histological analysis, no differentiation between AFHN and PHOA samples was possible. Conclusions: The present study (NCT, evidence level II) shows that AFHN has a very well detectable higher bone density compared to PHOA. However, neither biomechanical stress tests nor histomorphological evaluation did show any significant difference between the groups. The results allow the conclusion that there is no "soft" necrosis at all in the AFHN group. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the diagnostic value of simultaneous 18F-fluordeoxyglucose positron emission tomography/magnetic resonance imaging (PET/MRI) in suspected periprosthetic joint infection (PJI) of the hip and knee. Methods: Sixteen prostheses from 13 patients with suspected PJI were prospectively examined using PET/MRI. Image datasets were evaluated in consensus by a radiologist and a nuclear physician for the overall diagnosis of 'PJI' (yes/no) and its anatomical involvement, such as the periprosthetic bone margin, bone marrow, and soft tissue. The imaging results were compared with the reference standard obtained from surgical or biopsy specimens and subjected to statistical analysis. Results: Using the reference standard, ten out of the 13 prostheses (ten hips, threes knees) were diagnosed with PJI. Using PET/MRI, every patient with PJI was correctly diagnosed (sensitivity, 100%; specificity, 100%). Considering the anatomical regions, the sensitivity and specificity were 57% and 50% in the periprosthetic bone margin, 75% and 33% in the bone marrow, and 100% and 100% in the soft tissue. Conclusion: PET/MRI can be reliably used for the diagnosis of PJI. However, assessment of the periprosthetic bone remains difficult due to the presence of artefacts. Thus, currently, this modality is unlikely to be recommended in clinical practice. [ABSTRACT FROM AUTHOR]

To investigate, whether hyperspectral imaging (HSI) is able to reliably differentiate between healthy and damaged cartilage tissue. A prospective diagnostic study was performed including 21 patients undergoing open knee surgery. HSI data were acquired during surgery, and the joint surface's cartilage was assessed according to the ICRS cartilage injury score. The HSI system records light spectra from 500 to 1000 nm and generates several parameters including tissue water index (TWI) and the absorbance at 960 nm and 540 nm. Receiver operating characteristic curves were calculated to assess test parameters for threshold values of HSI. Areas with a cartilage defect ICRS grade ≥ 3 showed a significantly lower TWI (p = 0.026) and higher values for 540 nm (p < 0.001). No difference was seen for 960 nm (p = 0.244). For a threshold of 540 nm > 0.74, a cartilage defect ICRS grade ≥ 3 could be detected with a sensitivity of 0.81 and a specificity of 0.81. TWI was not suitable for cartilage defect detection. HSI can provide reliable parameters to differentiate healthy and damaged cartilage. Our data clearly suggest that the difference in absorbance at 540 nm would be the best parameter to achieve accurate identification of damaged cartilage. [ABSTRACT FROM AUTHOR]

Endoprosthetic surgery can lead to relevant blood loss resulting in red blood cell (RBC) transfusions. This study aimed to identify risk factors for blood loss and RBC transfusion that enable the prediction of an individualized transfusion probability to guide preoperative RBC provision and blood saving programs. A retrospective analysis of patients who underwent primary hip or knee arthroplasty was performed. Risk factors for blood loss and transfusions were identified and transfusion probabilities computed. The number needed to treat (NNT) of a potential correction of preoperative anemia with iron substitution for the prevention of RBC transfusion was calculated. A total of 308 patients were included, of whom 12 (3.9%) received RBC transfusions. Factors influencing the maximum hemoglobin drop were the use of drain, tranexamic acid, duration of surgery, anticoagulation, BMI, ASA status and mechanical heart valves. In multivariate analysis, the use of a drain, low preoperative Hb and mechanical heart valves were predictors for RBC transfusions. The transfusion probability of patients with a hemoglobin of 9.0–10.0 g/dL, 10.0–11.0 g/dL, 11.0–12.0 g/dL and 12.0–13.0 g/dL was 100%, 33.3%, 10% and 5.6%, and the NNT 1.5, 4.3, 22.7 and 17.3, while it was 100%, 50%, 25% and 14.3% with a NNT of 2.0, 4.0, 9.3 and 7.0 in patients with a drain, respectively. Preoperative anemia and the insertion of drains are more predictive for RBC transfusions than the use of tranexamic acid. Based on this, a personalized transfusion probability can be computed, that may help to identify patients who could benefit from blood saving programs. [ABSTRACT FROM AUTHOR]

The present paper is concerned with the investigation of the phenomenon of long-term bone remodelling on cementless hip replacements. Changes in bone density in the periprosthetic region around the stem, measured by dual X–ray absorptiometry (DXA), were used as a measure of the osseous adaptation reaction. A postoperative follow-up of the use of four different types of prostheses of varying design after on average 13.3 (11.4–14.5) years. Specifically, the prostheses assessed in this study were the CLS/Spotorno stem with the Allofit cup by Zimmer, the Vision 2000 stem with the Duraloc cup by DePuy Synthes, the AlphaFit stem with the AlphaLock cup by Corin and the Mayo stem with the Trilogy cup by Zimmer. For the DXA measurement, the femur was divided into the zones suggested by Gruen et al. On the femur, there was a significant reduction in bone mineral density (BMD) in the proximal Region Of Interest (ROI) 1 (p = 0.003) and 7 (p < 0.001), whilst there was a significant increase in ROI 4 (p = 0.03). A greater degree of bone atrophy was seen in patients aged 60 years and older and in female patients. A remarkable finding when comparing the stems was a significantly greater reduction in BMD in ROI 6 (p = 0.003) in the case of the Vision 2000 stem and a markedly, but not statistically significantly smaller reduction in BMD in ROI 7 (p = 0.18) in the case of the short-stem Mayo-type prosthesis. The best clinical results were found with the use of the latter. The investigations provide a starting point for establishing a differential indication in the choice of prosthesis types, depending on age and sex, the use of short-stem prostheses, as well as the administration of bone-effective drugs for the prevention of stress shielding. [ABSTRACT FROM AUTHOR]

Correction to: Archives of Orthopaedic and Trauma Surgery https://doi.org/10.1007/s00402-021-... The original version of this article unfortunately contained a mistake. The correct given name and family name should be: Alexander Hofmann - Benjamin Fischer - Stefan Schleifenbaum - Sascha Kurz - Melanie Edel - Gudrun Borte - Gabriele Lehmann - Andreas Roth The original article has been corrected. [Extracted from the article]

Purpose: The cementless implantation of hip replacement cups may be performed with and without the additional use of acetabular screws. If the surgeon uses screws or not depends on variable factors. In general, the use of screws is intended to increase the primary stability of the cup. Whether screws increase the initial stability of the cup construct, or even reduce it in part, is the subject of considerable debate in the literature. It is also unclear whether the additional screws lead to increased wear or increased periacetabular osteolysis over the long-term course.Methods: Two hundred eleven patients from a previous study with a minimum follow-up of 10.7 years were included. Of these, 68 patients with 82 total hip arthroplasties (THA) were given clinical and radiological follow-up examinations. Of these, 52 had been fitted without screws and 30 with screws. On the basis of radiographs, annual wear and osteolysis were quantified. The clinical results were recorded by means of VAS, HHS, and WOMAC scores.Results: Significantly more periacetabular osteolysis was found if additive acetabular screws had been used. No difference was found in relation to the volumetric wear per year. Likewise, no difference was found with regard to the clinical scores.Conclusions: The use of additive acetabular screws leads to increased osteolysis in the periacetabular bone stock. Insofar as the primary stability of the cementless cup construct allows it, no additional acetabular screws should be used. [ABSTRACT FROM AUTHOR]

KeY is a tool that provides facilities for formal specification and verification of programs within a commercial platform for UML based software development. Using the KeY tool, formal methods and object-oriented development techniques are applied in an integrated manner. Formal specification is performed using the Object Constraint Language (OCL), which is part of the UML standard. KeY provides support for the authoring and formal analysis of OCL constraints. The target language of KeY based development isJava Card DL, a proper subset ofJavafor smart card applications and embedded systems. KeY uses a dynamic logic forJava Card DLto express proof obligations, and provides a state-of-the-art theorem prover for interactive and automated verification. Apart from its integration into UML based software development, a characteristic feature of KeY is that formal specification and verification can be introduced incrementally. [ABSTRACT FROM AUTHOR]