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Purpose Iatrogenic instability of the acromioclavicular joint (ACJ) following distal clavicle excision (DCE) represents an infrequent pathology. Revision surgery to restore ACJ stability and alleviate concomitant pain is challenging due to altered anatomic relationships. The purpose of this study was to evaluate the used salvage techniques and postoperative functional and radiological outcomes in retrospectively identify patients with a painful ACJ following DCE. We hypothesized that iatrogenic instability leads to ongoing impairment of shoulder function despite secondary surgical stabilization. Methods 9 patients with a painful ACJ after DCE (6 men, 3 women, 43.3 ± 9.4 years) were followed up at a minimum of 36 months after revision surgery. Besides range of motion (ROM), strength and function were evaluated with validated evaluation tools including the Constant score and the DASH score (Disability of the Arm, Shoulder and Hand questionnaire), specific AC Score (SACS), Nottingham Clavicle Score (NCS), Taft score and Acromioclavicular Joint Instability Score (AJI). Additionally, postoperative X-rays were compared to the unaffected side, measuring the coracoclavicular (CC) and acromioclavicular (AC) distance. Results At follow-up survey (55.8 ± 18.8 months) all patients but one demonstrated clinical ACJ stability after arthroscopically assisted anatomical ACJ reconstruction with an autologous hamstring graft. Reconstruction techniques were dependent on the direction of instability. The functional results demonstrated moderate shoulder and ACJ scores with a Constant Score of 77.3 ± 15.4, DASH-score of 51.2 ± 23.4, SACS 32.6 ± 23.8, NCS 77.8 ± 14.2, AJI 75 ± 14.7 points and Taft Score 7.6 ± 3.4 points. All patients stated they would undergo the revision surgery again. Mean postoperative CC-distance (8.3 ± 2.8 mm) did not differ significantly from the contralateral side (8.5 ± 1.6 mm) (p > 0,05). However, the mean AC distance was significantly greater with 16.5 ± 5.8 mm compared to the contralateral side (3.5 ± 1.9 mm) (p = 0.012). Conclusion Symptomatic iatrogenic ACJ instability following DCE is rare. Arthroscopically assisted revision surgery with an autologous hamstring graft improved ACJ stability in eight out of nine cases (88.9%). However, the functional scores showed ongoing impairment of shoulder function and a relatively high overall complication rate (33.3%). Therefore, this study underlines the importance of precise preoperative indication and planning and, especially, the preservation of ACJ stability when performing AC joint resection procedures. Level of Evidence Case series, LEVEL IV.

Response speeds in simple decision-making tasks begin to decline from early and middle adulthood. However, response times are not pure measures of mental speed but instead represent the sum of multiple processes. Here we apply a Bayesian diffusion model to extract interpretable cognitive components from raw response time data. We apply our model to cross-sectional data from 1.2 million participants to examine age differences in cognitive parameters. To efficiently parse this large dataset, we apply a Bayesian inference method for efficient parameter estimation using specialized neural networks. Our results indicate that response time slowing begins as early as age 20, but this slowing was attributable to increases in decision caution and to slower non-decisional processes, rather than to differences in mental speed. Slowing of mental speed was observed only after approximately age 60. Our research thus challenges widespread beliefs about the relationship between age and mental speed.

Purpose Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an appropriate diagnostic and therapeutic pathway is required to avoid serious long-term consequences, eradicate the infection, and ensure good treatment outcomes. The aim of this current review article is to summarize evidence-based literature regarding diagnostic and therapeutic options of post-operative septic arthritis after arthroscopy. Methods Through a literature review, up-to-date treatment algorithms and therapies have been identified. Additionally, a supportive new algorithm is proposed for diagnosis and treatment of suspected septic arthritis following arthroscopic intervention. Results A major challenge in diagnostics is the differentiation of the post-operative status between a non-infected hyperinflammatory joint versus septic arthritis, due to clinical symptoms, (e.g., rubor, calor, or tumor) can appear identical. Therefore, joint puncture for microbiological evaluation, especially for fast leukocyte cell-count diagnostics, is advocated. A cell count of more than 20.000 leukocyte/µl with more than 70% of polymorphonuclear cells is the generally accepted threshold for septic arthritis. Conclusion The therapy is based on arthroscopic or open surgical debridement for synovectomy and irrigation of the joint, in combination with an adequate antibiotic therapy for 6–12 weeks. Removal of indwelling hardware, such as interference screws for ACL repair or anchors for rotator cuff repair, is recommended in chronic cases. Level of evidence IV.

Der digitale Fortschritt bei realistischen Bildern und Modellen ermoglicht es dank der virtuellen Simulation gefahrliche, seltene oder entfernte Situationen gefahrlos zu reproduzieren. Einige Sektoren wie die Luftfahrt und die Armee profitieren bereits von diesen Instrumenten, wenn sie riskante Situationen trainieren oder antizipieren. Die Chirurgie ist eine vertraute Tatigkeit, wenngleich auch dieselben Herausforderungen hinsichtlich Sicherheit, Schulungsbedarf und der Antizipation von Risikosituationen bestehen. Derzeit findet eine Metamorphose in der Ausbildung statt, und Operationssimulatoren verbessern einerseits die Geschicklichkeit der Chirurgen und andererseits auch die Sicherheit des Patienten. Die Geschicklichkeit und Fertigkeiten des Chirurgen konnen dank der einfachen Wiederholbarkeit und der Moglichkeit der Simulation von komplexen klinischen Situationen verbessert werden. In Bezug auf die Forschung eroffnet sich ein neues Gebiet der medizinischen Ausbildung, da der Chirurg in der Ausbildung uberwacht wird und neue metrische Parameter prazise aufgezeichnet werden konnen, um diese im Rahmen der Lernkurve zu analysieren. Letztendlich werden diese chirurgischen Simulationswerkzeuge es ermoglichen, bestimmte Teile der Terra incognita zuruckzudrangen, und der wissenschaftlichen Forschung zugutekommen, indem sie Innovationen schaffen, ohne Schaden zuzufugen. Im Folgenden soll gezeigt werden, wie Frankreich die Lehre der orthopadischen und insbesondere der arthroskopischen Chirurgie an diese neuen Instrumente angepasst hat. Auf der Grundlage strengerer Ausbildungsgesetze haben wissenschaftliche Gesellschaften und Ausbilder ein Netzwerk von Simulatoren in ganz Frankreich aufgebaut. Die jahrlichen Kongresse der Gesellschaften dienen zusatzlich der Bewertungen und Wissensuberprufungen. Seither laufen nach dem Erwerb dieser Simulatoren auch eine Reihe von Studien zur medizinischen Ausbildung. Man muss sich aber auch uber die Kosten und Grenzen dieser Ausbildung im Klaren sein. So fortschrittlich und innovativ jeder Simulator auch sein mag, er kann keinesfalls die Ratschlage eines erfahrenen Chirurgen ersetzen.

The current treatment for acromioclavicular (AC) dislocation lacks a gold standard and previous literature concludes that coracoclavicular (CC) fixation with additional AC cerclage fixation adds stability and is a useful adjunct to augment these repairs.The purpose of this study was to investigate the clinical and radiological value of an additional AC cerclage. It was hypothesised that an additional AC cerclage would show better clinical results. We further expected the additional AC cerclage to result in lower radiological loss of reduction compared to the technique relying on CC-fixation only.A total of 30 male patients with acute (less than 3 weeks) AC-dislocations Rockwood grade IV and V from 2013 to 2014 underwent arthroscopic bi-cortical CC-ligament reconstruction. Patients were assigned to a surgeon depending on the day of clinical presentation. One surgeon used only bi-cortical CC-ligament reconstruction (no-PDS group); the other surgeons used an additional PDS cerclage with an 8-loop configuration over the AC joint (PDS group). Clinical data (Constant Shoulder Score, ASES Score, DASH Score, VAS pain) were assessed 24 months post-operatively, and AP shoulder radiographs used to measure the AC and CC distances.No significant differences in the Constant (Z = - 0.498, p = 0.624), ASES (Z = 0.263, p = 0.806) and DASH (Z = 1.097, p = 0.305) score as well as VAS pain (Z = 0.498, p = 0.624) were seen for both groups. Factorial ANOVA showed a significant effect of "time" [F(1,28) = 17.54, p 0.001, r = 0.62], reflecting a significant radiological increase of AC distances over time for both groups. Comparing CC and CC + AC groups, the effect of "OP technique" was significant [F(1,28) = 4.67, p = 0.039, r = 0.38], with AC distances obtained in the PDS group being statistically lower than in the No-PDS group, whereas CC distances did not significantly increase in both groups [F(1,28) = 0.07, p = 0.791]. "Time × OP technique" interaction effects were non-significant [F(1,28) = 0.38, p = 0.545], which reflects similar changes in AC distances over time in both groups. For the CC distances, neither main nor interaction effects were significant (all p 0.05).Both the isolated CC reconstruction and the CC reconstruction with an additional AC cerclage showed good clinical results at 2 years' follow-up. AC distances increased in both groups from the post-surgery measurement to the 2-year follow-up, but were generally lower with an additional AC cerclage. CC distances did not increase significantly over time in both groups. Therefore, the presented data suggest adding a fixation of the AC joint.

People are more likely to judge repeatedly perceived statements as true. A decisive explanation for this so-called truth effect is that the repeated information can be processed more fluently than new information and that this fluency experience renders the information more familiar and trustworthy. Little is known, however, regarding whether and how affective states and dispositional cognitive preferences influence the truth effect. To this end, we conducted two experiments in which we manipulated (a) processing fluency via repetition, (b) the time interval (10 min vs. 1 week) between repetitions, and (c) short-term affective states using the presentation of emotional faces (Experiment 1) or the presence of an irrelevant source for changes in affective states (Experiment 2). Additionally, we assessed the dispositional variables need for cognitive closure (NCC), preference for deliberation (PD) and preference for intuition (PI). Results of Experiment 1 showed that the truth effect was significantly reduced for statements that were followed by a negative prime, although this was the case only for the longer repetition lag. Furthermore, higher NCC and lower PD scores were associated with an increased truth effect. Results of Experiment 2 replicated the moderating role of NCC and further showed that participants, who were provided with an alternative source for changes in their affective states, showed a reduced truth effect. Together, the findings suggest that (a) fluency-related changes in affective states may be (co-)responsible for the truth effect, (b) the truth effect is decreased when the repetition interval is long rather than short, and (c) the truth effect is increased for individuals with a higher need for cognitive closure. Theoretical implications of these findings are discussed.

ZusammenfassungIn diesem Beitrag berichten die Autoren über einen Patienten mit einer Ruptur der Rotatorenmanschette, welche sich als retrahierte Komplettruptur der Supraspinatussehne und der kranialen Infraspinatussehne präsentierte. Nach 7‑monatiger Schmerzpersistenz und anhaltendem Funktionsverlust wurde im Rahmen eines arthroskopischen Eingriffs eine Rekonstruktion der superioren Kapsel durchgeführt. Die lange Bizepssehne wurde hierzu als Autograft verwendet und mit der kranialen Infraspinatussehne verknüpft. Auf diese Weise konnte ein kompletter Verschluss des posterosuperioren Gelenkraums erreicht werden.

Die Pathophysiologie des posterosuperioren Glenoid-Impingements (PSGI) wurde bereits 1992 von Walch beschrieben und ist eine haufige Ursache von Schulterschmerzen, insbesondere bei Uberkopfsportlern. Wahrend der hohen Ausenrotation (ABER-Position) besteht ein physiologischer Kontakt zwischen der Supra‑/Infraspinatussehne und dem dorsokranialen Labrumkomplex. Daruber hinaus beschrieben Verna und dann Burkhard zunachst das klinische Bild des glenohumeralen Innenrotationsdefizits (GIRD), das zu pathophysiologischen Veranderungen der Schulterbewegung beim Werfen fuhrt. Insbesondere bei Wurfsportlern kommt es zu Entzundungen mit Degeneration und Schmerzen aufgrund der wiederholten Belastung zwischen Glenoid und Sehne. Treten Weichteil- oder knocherne Veranderungen in diesem Bereich auf, kommt es zum sog. PSGI. Die Diagnose dieses pathologischen Impingements und die Abgrenzung zum physiologischen Kontakt ohne messbare strukturelle Veranderungen ist unerlasslich, da die Therapie des posterioren Impingements zunachst primar konservativ ist. Wenn dagegen konservative Ansatze versagen und strukturelle pathologische Veranderungen vorliegen (PSGI), ist ein operativer Eingriff oft sinnvoll. Der folgende Fallbericht zeigt eine klinische Darstellung des PSGI und dessen operative Behandlung.

Older adults typically show slower response times in basic cognitive tasks than younger adults. A diffusion model analysis allows the clarification of why older adults react more slowly by estimating parameters that map distinct cognitive components of decision making. The main components of the diffusion model are the speed of information uptake (drift rate), the degree of conservatism regarding the decision criterion (boundary separation), and the time taken up by non-decisional processes (i.e., encoding and motoric response execution; non-decision time). While the literature shows consistent results regarding higher boundary separation and longer non-decision time for older adults, results are more complex when it comes to age differences in drift rates. We conducted a multi-level meta-analysis to identify possible sources of this variance. As possible moderators, we included task difficulty and task type. We found that age differences in drift rate are moderated both by task type and task difficulty. Older adults were inferior in drift rate in perceptual and memory tasks, but information accumulation was even increased in lexical decision tasks for the older participants. Additionally, in perceptual and lexical decision tasks, older individuals benefitted from high task difficulty. In the memory tasks, task difficulty did not moderate the negative impact of age on drift. The finding of higher boundary separation and longer non-decision time in older than younger adults generalized over task type and task difficulty. The results of our meta-analysis are consistent with recent findings of a more pronounced age-related decline in memory than in vocabulary performance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00426-020-01371-8) contains supplementary material, which is available to authorized users.

Empirical findings predominantly support a happiness superiority effect in visual search and emotion categorization paradigms and reveal that social cues, like sex and race, moderate this advantage. A more recent study showed that the facial attribute attractiveness also influences the accuracy and speed of emotion perception. In the current study, we investigated whether the influence of attractiveness on emotion perception translates into a more general evaluation of moods when more than one emotional target is presented. In two experiments, we used the mood-of-the-crowd (MoC) task to investigate whether attractive crowds are perceived more positively compared to less attractive crowds. The task was to decide whether an array of faces included more angry or more happy faces. Furthermore, we recorded gaze movements to test the assumption that fixations on happy expressions occur more often in attractive crowds. Thirty-four participants took part in experiment 1 as well as in experiment 2. In both experiments, crowds presenting attractive faces were judged as being happy more frequently whereas the reverse pattern was found for unattractive crowds of faces. Moreover, participants were faster and more accurate when evaluating attractive crowds containing more happy faces as well as when judging unattractive crowds composed of more angry expressions. Additionally, in experiment 1, there were more fixations on happy compared to angry expressions in attractive crowds. Overall, the present findings support the assumption that attractiveness moderates emotion perception.

Die optimale Versorgung von proximalen Komplettrupturen des M. adductorlongus wird kontrovers diskutiert. Es besteht keine einheitliche Evidenz fur die Uberlegenheit einer konservativen oder operativen Therapie in Bezug auf die Zeit bis zur Ruckkehr zum vorherigen sportlichen Aktivitatslevel. Refixation einer akuten proximalen Adduktor longus Sehnenruptur mit zwei Titanfadenankern und hochreisfestem Fadenmaterial. Der Patient kehrte ohne Einschrankungen von Bewegungsumfang und Muskelkraft zu seinem vorherigen sportlichen Leistungsniveau zuruck. Die operative Therapie mit zwei Fadenankern ermoglicht die Ruckkehr zum vorherigen Leistungsniveau nach durchschnittlich 3 Monaten. Case Report Level IV

Purpose The purpose of this study was to identify modifiable factors associated with research activity among residents working in orthopedic surgery and traumatology. Methods Residents at 796 university-affiliated hospitals in Austria, Germany, and Switzerland were invited to participate. The online survey consisted of questions that ascertained 13 modifiable and 17 non-modifiable factors associated with the residents’ current research activities. Responses of 129 residents were analyzed. Univariate linear regression was used to determine the association of individual factors with the current research activity (hours per week). The impact of significant non-modifiable factors (with unadjusted p values Results The univariate analysis demonstrated six non-modifiable factors that were significantly associated with the current research activity: a University hospital setting (p p = 0.024), Swiss residents (p = 0.0012), the completion of a dedicated research year (p = 0.007), female gender (p = 0.016), and the department’s size (p = 0.048). Multivariate regression demonstrated that the number of protected research days per year (p p p Conclusions As hypothesized, more frequent and predictable protected research days were associated with higher research activity among residents in orthopedic surgery and traumatology. Level of evidence III.

Aktuell existieren weit uber 100 verschiedene Operationstechniken in der Stabilisierung des Akromioklavikulargelenks (ACG). Im letzten Jahrzehnt ist es hierbei v. a. durch technische Innovationen zu einem deutlichen Zuwachs an arthroskopisch assistierten Techniken gekommen. Nach wie vor bleibt jedoch die postoperative Komplikationsrate nach ACG-Stabilisierungen hoch. Zu den haufigsten Komplikationen gehoren Repositionsverlust, technisches Versagen, Frakturen, persistierende horizontale Instabilitat, Infektionen sowie die postoperative Schultersteife. Bei Auftreten von therapierelevanten Komplikationen ist eine detaillierte Fehleranalyse von hoher Bedeutung, um Aussagen uber Bohrkanallage, Anzahl sowie Durchmesser treffen zu konnen. Im Fall einer Revision ist eine arthroskopisch assistierte Hybridtechnik mit biologischer Augmentation zu empfehlen, um die biomechanischen Gelenkeigenschaften wiederherzustellen.

Radiuskopfchenfrakturen machen etwa 33 % aller Ellenbogenfrakturen des Erwachsenen aus und sind haufig mit Begleitverletzungen assoziiert. Sollte eine operative Therapie notwendig sein, steht eine grose Palette an Operationsmethoden zur Verfugung: Osteosynthese, Radiuskopfchenresektion, Radiuskopfchenprothese. Samtliche Methoden zeigen ein eigenes Komplikationsspektrum, welches bei der Versorgung solcher Frakturen gekannt und beherrscht werden sollte. Ziel sind die Identifikation und die Diskussion typischer Komplikationen bei der operativen Versorgung von Radiuskopfchenfrakturen. Neben einer ausgiebigen Literaturrecherche werden auch die Erfahrungen der Autoren berichtet. Im Komplikationsmanagement der operativen Versorgung von Radiuskopfchenfrakturen ist es von groster Bedeutung, Begleitverletzungen wie z. B. ligamentare Instabilitaten zu erkennen und zu adressieren. Die haufigsten Komplikationen der einzelnen Verfahren beinhalten Bewegungseinschrankungen und Pseudarthrosen im Rahmen einer Osteosynthese, Instabilitaten nach Radiuskopfchenresektion sowie radiokapitullare Arthrose und Instabilitat nach Radiuskopfchenprothese. Eine ausgiebige und vollstandige praoperative Evaluation des Patienten ist notwendig, um Begleitverletzungen zu detektieren und das geeignete operative Verfahren auszuwahlen. Viel Erfahrung und die Kenntnis uber die Risiken und Grenzen der einzelnen Techniken sind notwendig, um Komplikationen zu minimieren und, falls erforderlich, zu beherrschen.

Infektionen des Schultergelenks stellen sowohl nach arthroskopischer Operation als auch spontan auftretend eine klinische Herausforderung dar. Die Anforderungen an Diagnostik und Therapie werden vor dem Hintergrund der aktuellen Literatur diskutiert. Eine Zusammenstellung uber die aktuellen Empfehlungen zur zielfuhrenden Diagnostik sowie zur stadiengerechten Therapie wurde erarbeitet. Insbesondere die Definition des akuten vs. chronischen Infekts, die Anforderungen an den Keimnachweis sowie die konsequente chirurgische und antibiotische Therapie sind im Rahmen von Schultergelenkinfektionen zu beachten. Bei Anwendung der aktuellen Diagnose- und Therapieempfehlungen sind Infektionen des Schultergelenks gut therapierbar. Im Rahmen von periprothetischen Infektionen (PPI) oder frakturassoziierten Infektionen (FRI) des Schultergelenks sind gesonderte Vorgehensweisen zu beachten.

Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° (p p Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

Previous research suggests that feature search performance is relatively resistant to age-related decline. However, little is known regarding the neural mechanisms underlying the age-related constancy of feature search. In this experiment, we used a diffusion decision model of reaction time (RT), and event-related functional magnetic resonance imaging (fMRI) to investigate age-related differences in response-level processing during visual feature search. Participants were 80 healthy, right-handed, community-dwelling individuals, 19-79 years of age. Analyses of search performance indicated that targets accompanied by response-incompatible distractors were associated with a significant increase in the nondecision-time (t0) model parameter, possibly reflecting the additional time required for response execution. Nondecision time increased significantly with increasing age, but no age-related effects were evident in drift rate, cautiousness (boundary separation, a), or in the specific effects of response compatibility. Nondecision time was also associated with a pattern of activation and deactivation in frontoparietal regions. The relation of age to nondecision time was indirect, mediated by this pattern of frontoparietal activation and deactivation. Response-compatible and -incompatible trials were associated with specific patterns of activation in the medial and superior parietal cortex, and frontal eye field, but these activation effects did not mediate the relation between age and search performance. These findings suggest that, in the context of a highly efficient feature search task, the age-related influence of frontoparietal activation is operative at a relatively general level, which is common to the task conditions, rather than at the response level specifically.

Die Kniegelenkluxation mit Beteiligung mehrerer Ligamente ist eine seltene, aber sehr komplexe Verletzung, die mit kurz- und langfristigen Komplikationen einhergehen kann. Ziel der operativen Therapie ist es, die verletzten Strukturen anatomisch so zu rekonstruieren, dass eine fruhe postoperative Mobilisation eingeleitet werden kann. In diesem Beitrag wird der Fall eines 45-jahrigen Patienten beschrieben, der infolge eines Unfalls eine drittgradig offene Kniegelenkluxation erlitten hatte, die durch Rekonstruktion mittels „ligament bracing“ erfolgreich behandelt werden konnte. Hierbei ist die genaue Kenntnis der anatomischen Grundlagen sowie der isometrischen Insertionen und Biomechanik des Kniebandapparats essenziell. Die exakte Reposition der Rekonstruktion kann unter Bildwandlerkontrolle erfolgen. Wichtig ist eine moglichst zugige Mobilisation des Patienten, um spatere Bewegungseinschrankungen zu vermeiden.

Preventive, predictive, and personalized medicine (PPPM) has created a wealth of new opportunities but added also new complexities and challenges. The European Cancer Prevention Organization already embraced unanimously molecular biology for primary and secondary prevention. The rapidly exploding genomic language and complexity of methods face oncologists with exponentially growing knowledge they need to assess and apply. Tissue specimen quality becomes one major concern. Some new innovative medicines cost beyond any reasonable threshold of financial support from patients, health care providers, and governments and risk sustainability for the health care system. In this review, we evaluate the path for genomic guidance to become the standard for diagnostics in cancer care and formulate potential solutions to simplify its implementation. Basically, introduction of molecular biology to guide therapeutic decisions can be facilitated through supporting the oncologist, the pathologist, the molecular laboratory, and the interventionist. Oncologists need to know the exact indication, utility, and limitations of each genomic service. Minimal requirements on the label must be addressed by the service provider. The interventionist is there to bring the most optimal tissue sample to pathology where the tissue is expanded to a variety of appropriate liquid-based samples. The large body of results then should be translated into meaningful clinical guidance for the individual patient. Surveillance, with the appropriate application of health economic indicators, can make this system long lasting. For governments and health care providers, optimal cancer care must result in a cost-effective, resource-sustainable, and patient-focused outcome.

The diffusion model (Ratcliff, 1978) is a mathematical model theorized to untangle different cognitive processes involved in binary decision tasks. To test the validity of the diffusion model parameters, several experimental validation studies have been conducted. In these studies, the validity of the threshold separation parameter was tested with speed-accuracy manipulations. Typically, this manipulation not only results in the expected effect on the threshold separation parameter but it also impacts nondecision time: Nondecision time is longer in the accuracy than in the speed condition. There are two possible interpretations of the finding: On the one hand, it could indicate that speed versus accuracy instructions really have an impact on the duration of extradecisional processes. On the other hand, the effect on the measure for nondecision time could be spurious-that is, based on a problem in the parameter estimation procedures. In simulation studies-with the parameter sets based on typical values from experimental validation studies-we checked for possible biases in the parameter estimation. Our analyses strongly suggest that the observed pattern (i.e., slower nondecision processes under accuracy instructions) is attributable to a lack of discriminant validity of the manipulation rather than to trade-offs in the parameter estimations.

Background Precision treatment of cancer uses biomarker-driven therapy to individualize and optimize patient care. Objective To evaluate real-life clinical experience with biomarker-driven therapy in metastatic gastric and esophageal cancer in Israel. Patients and Methods This multicenter retrospective cohort study included patients with metastatic gastric or esophageal cancer who were treated in the participating institutions and underwent biomarker-driven therapy. Treatment was considered to have a benefit if the ratio between the longest progression-free survival (PFS) post biomarker-driven therapy and the last PFS before the biomarker-driven therapy was ≥1.3. The null hypothesis was that ≤15% of patients gain such benefit. Results The analysis included 46 patients (61% men; median age, 58 years; 57% with poorly-differentiated tumors). At least one actionable (i.e., predictive of response to a specific therapy) biomarker was identified for each patient. Immunohistochemistry was performed on all samples and identified 1–8 (median: 3) biomarkers per patient (most commonly: low TS, high TOPO1, high TOP2A). Twenty-eight patients received therapy after the biomarker analysis (1–4 lines). In the 1st line after biomarker analysis, five patients (18%) achieved a partial response and five (18%) stable disease; the median (range) PFS was 129 (12–1155) days. Twenty-four patients were evaluable for PFS ratio analysis; in seven (29.2%), the ratio was ≥1.3. In a one-sided exact binomial test vs. the null hypothesis, p = 0.019; therefore, the null hypothesis was rejected. Conclusions Our findings demonstrated that implementing biomarker-driven analysis is feasible and could provide clinical benefit for a considerable proportion (~30%) of patients with metastatic gastric or esophageal cancer.

The diffusion model (Ratcliff, Psychol Rev 85(2):59-108, 1978) is a stochastic model that is applied to response time (RT) data from binary decision tasks. The model is often used to disentangle different cognitive processes. The validity of the diffusion model parameters has, however, rarely been examined. Only few experimental paradigms have been analyzed with those being restricted to fast response time paradigms. This is attributable to a recommendation stated repeatedly in the diffusion model literature to restrict applications to fast RT paradigms (more specifically, to tasks with mean RTs below 1.5 s per trial). We conducted experimental validation studies in which we challenged the necessity of this restriction. We used a binary task that features RTs of several seconds per trial and experimentally examined the convergent and discriminant validity of the four main diffusion model parameters. More precisely, in three experiments, we selectively manipulated these parameters, using a difficulty manipulation (drift rate), speed-accuracy instructions (threshold separation), a more complex motoric task (non-decision time), and an asymmetric payoff matrix (starting point). The results were similar to the findings from experimental validation studies based on fast RT paradigms. Thus, our experiments support the validity of the parameters of the diffusion model and speak in favor of an extension of the model to paradigms based on slower RTs.

Original article has been updated.

Lateral distal femoral osteotomies (DFO) have recently been performed more frequently. In addition to realignment for varus and valgus deformity, the indication was extended with the introduction of torsional osteotomies in patellofemoral instability. The purpose of this study was to assess the general and technical risk factors for nonunion in lateral opening, closing and torsional DFO. A total of 150 lateral DFO [98 opening wedge (LOWDFO) and 52 closing wedge (LCWDFO)] were analyzed in regard to potential risk factors for nonunion until plate removal. Nonunion was defined as failure of osseous consolidation according to clinical and radiological evaluation. In LOWDFO, the nonunion rate was 2%, in LCWDFO the rate was higher with 9.6%. Nicotine abuse (p = 0.009) and a higher body mass index (p = 0.003) were significant risk factors. Patient’s age and gender, the wedge height, hinge fractures, monoplanar versus biplanar osteotomy as well as additional torsional osteotomies were not significant in regard of nonunion. Lateral DFO have a low rate of complications and nonunion. Smoking and obesity were significantly associated with the risk of nonunion. Hinge fractures, monoplanar technique or complete bone cuts of the opposite hinge in torsional osteotomies did not negatively influence the nonunion rate in DFO. Level IV.

Current techniques for anatomic repair of the dislocated acromioclavicular (AC) joint aim on reconstruction of the AC ligaments and utilize tunnels drilled through the acromion . This improves the stability of the reconstruction but might also increase the risk of fractures at the acromion. The purpose of this study was to evaluate the fracture risk for the acromion after transacromial tunnel placement for anatomic AC joint stabilization procedure. It was hypothesized that the risk of fracture of the acromion is correlated to size and orientation of bone tunnels commonly used for anatomic AC joint reconstruction. A finite element analysis was used to simulate multiple bone tunnels and incoming force vectors (lateral vs. superior). Different tunnels were analysed, horizontal meaning an anterior–posterior orientation versus a vertical inferior–superior orientation through the acromion. Two tunnel diameters were simulated (2.4 vs. 4.5 mm). Furthermore, the tunnel length and distance between tunnels were altered. Forty-five cadaveric specimens (median age: 64 years, range 33–71 years) were utilized for data acquisition. Out of these, 30 specimens were used to evaluate basic tunnel orientations and drill diameters using a MTS 858 servohydraulic test system. With regard to the tunnel orientation and drill hole size, the loads to failure were limited. The acromion is at higher fracture risk, with a superior to inferior directed incoming force. Position, size and direction of bone tunnels influenced the loads to failure. Horizontal tunnels with a higher diameter (4.5 mm) had the most impact on load to failure reduction. A long horizontal tunnel with a diameter of 4.5 mm reduced the load to failure with medial direction of force to 25% of the native acromion. The identical tunnel with a diameter of 2.4 mm reduced the load to failure to 61%. Both 2.4-mm horizontal tunnels with a medium and short length did not reduce the load to failure. Tunnels placed at the acromion did not result in an increased risk of fracture. However, descriptive data showed a tendency for an increased fracture risk if tunnels are placed at the acromion, especially in horizontal direction with diameters of 4.5 mm. In addition, the pattern of fracture was dependent on the orientation of the bone tunnels and the size. However, the results indicate a “safe zone” for the placement of bone tunnels within the anterior half of the acromion, which does not affect the loads to failure at the acromion. Therefore, current techniques for anatomic AC joint reconstruction which utilize fixation of grafts or sutures at the acromion are safe within current ranges of tunnel placement and sizes.

Recent techniques for acromioclavicular (AC) joint reconstruction focus on additional AC cerclage to coracoclavicular (CC)-reconstructions. Due to the specific slim bone morphology at the acromion, there are concerns regarding these additional bone tunnels, as they may predispose to fracture and break out. The purpose of this study was to investigate anatomic properties of the acromion which may help improve surgical techniques directed at injuries to the AC joint. It was hypothesized that via measurements of thickness and density points of increased strength and support could be identified on the acromion. Eighty-five fresh frozen cadaveric shoulders were used for this study. A standardized 3D-net was developed and thicknesses of the acromion were taken from defined points using a certified caliper. To define the acromial arch, the angle and radius of curvature between the antero-lateral, the highest point of the acromial arch and the postero-lateral aspect of the acromion were measured. Additional bone mineral density (BMD) evaluation was performed on 43 specimens in an anterio-posterior and latero-medial direction using 5-mm slices with a maximum of 10 and 6 slices, respectively. Median specimen age was 63.0 (range 36) years (55 female, and 30 male). There was no statistical significance between male (62.0, range: 35 years) and female (64.5, range 32 years) regarding age (n.s.). Thickness of acromion points of interest were ranging from 3.5 to 24.3 mm. Median radius of curvature of acromial arch for female was 48.2 (range 92.7) mm and 66.2 (range 85.6) for male (p = 0.019). The median angle for female specimens was 21.4° (range: 44.6°) and 23.3° (range 51.7°) for male (p = 0.047). The latero-medial measurements showed significant difference between the region of interest (ROI): 1 and 4, 5, 6 (p = 0.001, p = 0.001, p = 0.001), 2 and 4, 5, 6 (p = 0.007, p = 0.001, p = 0.001), 3 and 5, 6 (p = 0.001, p = 0.001), 4 and 5, 6 (p = 0.010, p = 0.001). Antero-posterior measurements showed significant difference between the ROI: 1 and 8 (p = 0.031). The posterior–medial acromion close to the AC joint revealed the highest BMD with an increasing density from lateral to medial. In combination with thickness measurements this region would support additional anatomical fixation of the AC joint using bone tunnels if necessary. To anatomically reproduce the insertions of the AC ligaments at the acromion, either bone tunnels or anchors are needed. Therefore, several techniques have been developed. This study provides the anatomical data for these techniques and confirms the reconstructive approach of techniques using anatomical points of fixation and orientation.

To investigate the biomechanical performance of four different methods used for coracoclavicular (CC) ligament reconstruction in a lateral clavicle fracture repair. Native displacement, translation, and rotation at the acromioclavicular joint of 24 fresh-frozen cadaveric shoulders were tested. A reproducible fracture in the lateral third of the clavicle was created by dissecting both CC ligaments. Each specimen was then repaired with plate fixation of the fracture and the following CC repair technique: (1) Cortical button. (2) Suture anchor and plate button. (3) Suture anchor no plate button, and (4) Suture around coracoid. All reconstructed specimens were then re-tested for displacement, translation, and load to failure, and compared to their native results. Groups 1 and 3 were investigated for rotational load. There was no difference in load to failure between the repaired groups (p: ns). Group 1 showed less superior and anterior translations (p

In 2012, the Dutch Working Party for Infection Control (WIP) issued the first Guideline for prevention of transmission of highly-resistant micro-organisms (HRMO) in Hospitals. The next step was to focus on long-term care facilities (LTCFs) both for nursing homes as for small-scale living facilities with nursing home care. These facilities providing care for residents with functional disabilities, chronical illnesses and cognitive disorders, such as dementia. The objective was to adapt the Guideline for prevention of transmission of HRMO in hospitals to LTCFs with a strong accent on living conditions and social interactions. Residents of LTCFs may be carriers of HRMO over a long period of time and most of the residents of the LTCF stay for extended periods of time. To respect individual living circumstances and to prevent unnecessary limitations in the social life of the residents due to the use of isolation measures, the WIP has chosen to describe infection control precautions per individual micro-organism instead of a ‘one size fits all’ method. The term “isolation” was therefore replaced by the term “additional” precautions. This guideline describes the screening policies for residents in LTCFs, definition and detection of HRMO carriage, standard and additional infection control precautions for HRMO positive residents, documentation and communication of HRMO carriage and discontinuation of additional infection control precautions. It also describes contact tracing of HRMO, environmental control/investigation, surveillance of HRMO and what is important when there is an outbreak.

Wie in vielen anderen Bereichen des Lebens, hat die Digitalisierung auch Einzug in die orthopadische Fort- und Weiterbildung gehalten. Der Trend geht hin zu einer digitalen und kabellosen Bereitstellung von Inhalten. Die heutigen einschlagigen Buchwerke und Zeitschriften werden zunehmend durch Operationsvideos, Online-Technik-Guides, interaktive Webseiten, mobile Apps fur das Smartphone, Online-Fort- und Weiterbildungsangebote, sowie aufgenommene Konferenzen ersetzt. Auch bieten Live-Prasentationen und Vortrage von namenhaften Chirurgen nahezu jedem die Moglichkeit, weltweit daran teilzunehmen und ggf. Fragen uber Webinterface zu stellen. Mit dieser rasanten Zunahme an online zur Verfugung gestellten Ressourcen und einer Dezentralisierung von Informationen und Wissen, stehen Weiterzubildende und Facharzte vor grosen Herausforderungen, wenn sie versuchen, sich auf dem aktuellen Stand der Wissenschaft zu halten. Die folgenden Abschnitte beschaftigen sich mit der Weiterbildung zum Facharzt fur Unfallchirurgie und Orthopadie sowie Operationshilfen und Videoplattformen. Sie sollen dabei helfen, die Suche nach verlasslichen orthopadischen und unfallchirurgischen Onlineressourcen zu erleichtern und diese abschliesend kritisch zu beurteilen.

Keeping hospitals clean is a crucial patient safety issue. The importance of the hospital environment in patient care has only recently been recognized widely in infection prevention and control (IPC). In order to create a movement for change, a group of international infection control experts teamed up with Interclean, the largest cleaning trade-show in the world to create the Healthcare Cleaning Forum. This paper is the result of this conference, which featured leaders in healthcare environmental science from across Europe. Although the available literature is limited, there is now enough evidence to demonstrate that maintaining the hygiene of the hospital environment helps prevent infections. Still, good interventional studies are rare, the quality of products and methods available is heterogeneous, and environmental hygiene personnel is often relatively untrained, unmotivated, under-paid, and under-appreciated by other actors in the hospital. Coupled with understaffed environmental hygiene service departments, this creates lasting issues in regards to patient and healthcare worker safety. The Healthcare Cleaning Forum was designed as a platform for healthcare experts, cleaning experts, hospital managers and industry to meet productively. The conference aimed to summarize the state-of-the-art knowledge in the field, create awareness and dialogue, challenge dogma and begin to shape a research agenda for developing the field of hospital hygiene and environmental control. Hospital environmental hygiene is far more complex than other types of cleaning; further evidence-based research in the field is needed. It involves the integration of current and new technologies with human elements that must work together synergistically to achieve optimal results. The education, training and career development, behavior, and work organization of environmental hygiene personnel are at the core of the proposals for the creation of a global initiative. Ultimately, what is needed is a reevaluation of how hospitals view environmental hygiene: not just as an area from which to cut costs, but one that can add value. Hospitals and key stakeholders must work together to change how we maintain the hospital environment in order to better protect patients.

Cardiac autonomic nervous dysfunction (CAND) raises the risk of mortality, but the glycaemic threshold at which it develops is unclear. We aimed to determine the prevalence of, risk factors for and impact of CAND in glucose intolerance and diabetes.Among 1,332 eligible participants aged 55-74 years in the population-based cross-sectional KORA S4 study, 130 had known diabetes mellitus (k-DM), and the remaining 1,202 underwent an OGTT. Heart rate variability (HRV) and QT variability were computed from supine 5 min ECGs.In all, 565 individuals had normal glucose tolerance (NGT), 336 had isolated impaired fasting glucose (i-IFG), 72 had isolated impaired glucose tolerance (i-IGT), 151 had combined IFG-IGT (IFG-IGT) and 78 had newly detected diabetes mellitus (n-DM). Adjusted normal HRV limits were defined in the NGT population (5th and 95th percentiles). Three HRV measures were more frequently abnormal in those with k-DM, n-DM, IFG-IGT and i-IFG than in those with NGT (p 0.05). The rates of CAND (≥2 of 4 HRV indices abnormal) were: NGT, 4.5%; i-IFG, 8.1%; i-IGT, 5.9%; IFG-IGT, 11.4%; n-DM, 11.7%; and k-DM, 17.5% (p 0.05 vs NGT, except for i-IGT). Reduced HRV was associated with cardiovascular risk factors used to construct a simple screening score for CAND. Mortality was higher in participants with reduced HRV (p 0.05 vs normal HRV).In the general population aged 55-74 years, the prevalence of CAND is increased not only in individuals with diabetes, but also in those with IFG-IGT and, to a lesser degree, in those with i-IFG. It is associated with mortality and modifiable cardiovascular risk factors which may be used to screen for diminished HRV in clinical practice.

Cardiac and respiratory rhythms are highly nonlinear and nonstationary. As a result traditional time-domain techniques are often inadequate to characterize their complex dynamics. In this article, we introduce a novel technique to investigate the interactions between R–R intervals and respiratory phases based on their joint symbolic dynamics. To evaluate the technique, electrocardiograms (ECG) and respiratory signals were recorded in 13 healthy subjects in different body postures during spontaneous and controlled breathing. Herein, the R–R time series were extracted from ECG and respiratory phases were obtained from abdomen impedance belts using the Hilbert transform. Both time series were transformed into ternary symbol vectors based on the changes between two successive R–R intervals or respiratory phases. Subsequently, words of different symbol lengths were formed and the correspondence between the two series of words was determined to quantify the interaction between cardiac and respiratory cycles. To validate our results, respiratory sinus arrhythmia (RSA) was further studied using the phase-averaged characterization of the RSA pattern. The percentage of similarity of the sequence of symbols, between the respective words of the two series determined by joint symbolic dynamics, was significantly reduced in the upright position compared to the supine position (26.4 ± 4.7 vs. 20.5 ± 5.4%, p

Chronic heart failure (CHF) is recognized as major and escalating public health problem. Approximately 69% of CHF patients suffer from cardiac death within 5 years after the initial diagnosis. Until now, no generally accepted ECG risk predictors in CHF patients are available. The objective of this study was to investigate the suitability of the new developed non-linear method segmented symbolic dynamics (SSD) for risk stratification in patients with ischemic cardiomyopathy (ICM) in comparison to other indices from time and frequency domain, non-linear dynamics, and clinical markers. Twenty-four hour Holter ECGs were recorded from 256 ICM patients. Heart rate variability (HRV) was analyzed from the filtered beat-to-beat interval time series. For calculating SSD, NN interval time series were segmented in 1 min overlapping windows with a window length of 30 min. For each window a symbol- and word-transformation was performed and probabilities of word type occurrences were calculated. Several indices from frequency domain and non-linear dynamics revealed high univariate significant differences (p < 0.01) discriminating low (n = 221) and high risk ICM patients (n = 35). For multivariate risk stratification in ICM patients the two optimal mixed parameter sets consisting of either two clinical and three non-clinical indices (two from SSD) or three clinical and two non-clinical indices (one from SSD) achieved 74 and 75% sensitivity and 79 and 76% specificity, respectively. These results suggest that the new SSD enhances considerably risk stratification in ICM patients. The multivariate analysis including SSD leads to an optimum accuracy of 81%.

Cardiogoniometry (CGM), a spatiotemporal electrocardiologic 5-lead method with automated analysis, may be useful in primary healthcare for detecting coronary artery disease (CAD) at rest. Our aim was to systematically develop a stenosis-specific parameter set for global CAD detection. In 793 consecutively admitted patients with presumed non-acute CAD, CGM data were collected prior to elective coronary angiography and analyzed retrospectively. 658 patients fulfilled the inclusion criteria, 405 had CAD verified by coronary angiography; the 253 patients with normal coronary angiograms served as the non-CAD controls. Study patients--matched for age, BMI, and gender--were angiographically assigned to 8 stenosis-specific CAD categories or to the controls. One CGM parameter possessing significance (P < .05) and the best diagnostic accuracy was matched to one CAD category. The area under the ROC curve was .80 (global CAD versus controls). A set containing 8 stenosis-specific CGM parameters described variability of R vectors and R-T angles, spatial position and potential distribution of R/T vectors, and ST/T segment alterations. Our parameter set systematically combines CAD categories into an algorithm that detects CAD globally. Prospective validation in clinical studies is ongoing.

The objective of this study was to develop an analysis method for the automatic detection of intracoronary microemboli triggered high intensity signals (HITS) during percutaneous coronary interventions (PCI). The recorded ultrasonic Doppler velocity spectra from an intracoronary ultrasonic guide-wire were decomposed into 13 wavelet scales applying the continuous wavelet transform. From 7 wavelet scales which were most suitable for a differentiation between HITS and pulsatile flow, envelopes were calculated and combined to improve the HITS-to-background noise ratio. For different intensity thresholds the resulting number of HITS was automatically counted and compared with the number estimated by experienced observers. In a first validation trial HITS were detected within a simplified in vitro model with a sensitivity of 89.2% and a positive predictive value of 87.6%. In a following clinical study 211 HITS from 18 patients during PCI were counted manually by the observers. With the developed wavelet-based method 189 HITS were correctly detected (sensitivity of 89.6%, positive predictive value of 85.5%). The introduced new method automatically detects intracoronary HITS for the first time with a reliable accuracy. This may support further studies evaluating the incidence and consequences of coronary microembolization during coronary interventions.

The Netherlands have a low prevalence of Multi drug Resistant organisms (MDRO), in part due to their national guideline concerning MDRO carriers. Apart from being flagged in Electronic Health Records, immediate isolation precautions must be taken if the last MDRO positive culture is less than 1 year ago. No clear guidance is given on duration and termination of electronic alerts and isolation precautions for MDRO positive patients.

Following an outbreak of Enterobacter cloacae complex ESBL at a neonatal intensive care unit (NICU) in a large tertiary care hospital in the Netherlands, a routine E. cloacae complex screening of all neonates was introduced. Literature on colonisation rates and risk factors for neonatal colonisation with E. cloacae are limited.

Traditional auscultation performed by general practitioners (GP) remains problematic and often gives significant results only in a late stage of the heart valve disease. Valve stenoses and insufficiencies are nowadays diagnosed with accurate but expensive ultrasonic devices. This study is aimed to develop a new heart sound analysis method for diagnosing aortic valve stenoses (AVS) based on a wavelet and correlation technique approach. Heart sounds recorded from 81 patients (43 AVS patients, 11 healthy controls-REF and 27 patients with other valve diseases-OVD) with an electronic stethoscope were wavelet filtered and envelopes were calculated. Three correlations on the basis of these envelopes were performed: (1) within AVS, (2) within mixed group AVS+REF and (3) within mixed group AVS+OVD leading to the mean correlation coefficients r/sub AVS/, T/sub AVS/REF/ and r/sub AVS/OVD/. The results show that r/sub AVS/ is significantly higher than r/sub AVS/REF/ and r/sub AVS/OVD/ (p

The human body odor plays an important role in social communication in various situations, like the olfactory identification of partners and relatives as well as in parents-child interactions. In patients with renal dysfunction the compound of sweat and volatile gases is changed because of the limited ability for removing metabolic products from the blood. The regulation of electrolyte composition and acid-base balance are also altered so that the body odor of these patients may be significantly influenced by these disorders. We show the ability of an electronic nose to detect changes in the human body odor in consequence of renal dysfunction by reducing multivariate sensor signals with principal component analysis to its first and second principal odor component (POC). All healthy subjects could clearly be distinguished from patients with renal failure using quadratic discriminant analysis, whereas a correct classification of 95.2% (98.4% using 1st-3rd POC) of patients between end stage renal failure and chronic renal failure was found. This methodology of analyzing human body odor may also provide new approaches for investigating symptoms of renal failure and for diagnosing other diseases of internal or cutaneous origin.

Item does not contain fulltext The aim of this study was to measure the rate of Staphylococcus aureus nasal colonization among attendees of the 13th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), particularly with regard to methicillin-resistant (MRSA) strains. The 31.4% rate of Staphylococcus aureus colonization detected among the participants was in line with colonization rates reported previously for healthcare workers. A statistical difference was found between the rates of Staphylococcus aureus carriage in physicians (37.4%) and non-physicians (21.7%) but not between males (35.0%) and females (28.9%). Only one participant (a Belgian physician) was found to carry MRSA. Surprisingly, the rate of methicillin-susceptible Staphylococcus aureus carriage was significantly higher among participants from countries with a low prevalence of MRSA.