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Zur operativen Rekonstruktion lateraler und posterolateraler (Rotations‑)Instabilitaten bei Verletzungen der posterolateralen Ecke, Popliteussehne (PLT), popliteofibulares Ligament (PFL), laterales Kollateralband (LCL), sind nichtanatomische und anatomische Techniken in offener und arthroskopischer Form etabliert. Exemplarisch erfolgt die Demonstration der anatomischen Rekonstruktion nach LaPrade. Insgesamt werden vier Bohrkanale benotigt (fibular, tibial, zwei femorale Kanale). Nach offener Praparation und Darstellung des N. peroneus wird zunachst der fibulare Bohrkanal, ausgehend vom Ursprungsbereich des LCL in Richtung auf den Ursprungsbereich des PFL angelegt. Anschliesend wird ein tibialer Kanal von ventral zwischen dem Tuberculum Gerdi und der Tuberositas tibiae nach dorsal in Richtung des muskulotendinosen Ubergangs des M. popliteus gebohrt. Die Bohrrichtung der femoralen Kanale verlauft von den femoralen Ansatzpunkten des LCL und PLT aus parallel nach proximal und ventral. Die Transplantate werden zunachst femoral befestigt, wovon der popliteale Schenkel im Verlauf der Popliteussehne nach dorsal ausgeleitet wird. Der LCL-Schenkel wird dagegen unterhalb des Tractus zum ventralen Eingang des fibularen Bohrkanals ausgeleitet und durch diesen hindurch eingezogen. Die fibulare Fixation des LCL-Schenkels erfolgt in strecknaher Position und unter Valgusstress. Schlieslich werden beide Transplantate gemeinsam von dorsal nach ventral durch den tibialen Bohrkanal gefuhrt und unter Zugspannung in beugenaher Position (60° Flexion) mit einer Interferenzschraube befestigt. Die fruhfunktionelle Nachbehandlung mittels Orthese und sukzessiver Steigerung des Bewegungsausmases unter Teilbelastung erfolgt in verschiedenen Phasen. Die Ruckkehr zum Sport erfolgt nach individueller Freigabe.

Introduction Injuries of the posterolateral corner (PLC) of the knee lead to chronic lateral and external rotational instability and are often associated with PCL injuries. Numerous surgical techniques for repair and reconstruction of the PLC are established. Recently, several arthroscopic techniques have been published in order to address different degrees of PLC injuries through reconstruction of one or more functional structures. The purpose of this systematic review is to give an overview about arthroscopic techniques of posterolateral corner reconstructions and to evaluate their safeness. Materials and methods A systematic review of the literature on arthroscopic reconstructions of the posterolateral corner of the knee according to the PRISMA guidelines was performed using PubMed MEDLINE and Web of Science Databases on June 15th, 2020. Inclusion criteria were descriptions of surgical techniques to reconstruct different aspects of the posterolateral corner either strictly arthroscopically or minimally-invasive with an arthroscopic assistance. Results Arthroscopic techniques differ with regard to the extent of reconstructed units (popliteus tendon, popliteofibular ligament, lateral collateral ligament), surgical approach (transseptal, lateral) and biomechanical results (anatomic vs. non-anatomic reconstruction, restoration of rotational instability and/or lateral instability). Conclusion Different approaches to arthroscopic PLC reconstruction are presented, yet clinical results are scarce. Up to now good and excellent clinical results are reported. No major complications are reported in the literature so far.

The use of smartphone apps is an essential part of everyday life. Mobile applications offer enormous opportunities for dealing with challenges in public health, and their number increases every day. This paper aims to review the existing literature on mobile applications in orthopaedic oncology and to summarize the current mobile applications for musculoskeletal tumors. A systematic literature review was conducted regarding articles on mobile applications in orthopaedic and trauma surgery. The focus was on identifying mobile applications that can be used in the treatment of patients with musculoskeletal tumors. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality. In addition, the Apple App Store and Google Play Store were searched for suitable mobile applications. Ninety-one articles describing a mobile application in orthopaedic and trauma surgery were identified. Three articles focused on a mobile application for musculoskeletal tumors. Additionally, seven mobile applications were available in the App/Play Stores dealing with bone or soft tissue tumors in orthopaedic oncology without corresponding scientific articles. Increasing numbers of mobile applications are being developed in orthopaedic and trauma surgery. Currently, only three scientific articles on mobile applications in orthopaedic oncology are present, yet several more applications are available without scientific medical evaluation. Since mobile applications can facilitate the everyday life of orthopaedic and trauma surgeons, it is worthwhile to be aware of new developments in this field. A regular scientific evaluation of the subject is important in order to classify the significance of these applications. Supplementary information The online version contains supplementary material available at 10.1007/s10916-021-01774-z.

Stress is a risk factor in safety-critical environments. It increases the probability for errors, which in turn can possibly be detrimental to human health and damaging to materials. While some industries have already turned to stress training in virtual reality (VR), the nursing profession still finds itself in the early stages of adopting the technology. In this paper, we use the already established method of VR induced acrophobia to provoke stress responses. By applying appropriate sensing technologies, the effects on physiological changes in affected vital functions are measured. The VR environment, the sensing technology and the software consist of both off-the-shelf as well as self-built solutions for the collection and evaluation of measurements. These measurements are taken from the participants while they experience a stress inducing factor (height) in two different intensities (view from sixth and 19th floor) in an artificial environment. In addition, we examine a possible correlation between the objective measurements and the subjective self-rated stress using the Short Stress State Questionnaire (SSSQ). Our focus in this work is to obtain reliable stress measurements from a sensor array. The long-term goal is the usage of the same sensors in a nursing-focused environment, with tasks taken directly from the work routines of the nursing profession. While we can’t report significant differences in our evaluations, our results indicate that the tested sensor array for measuring stress is sensitive enough to pick up differences in the stress responses to two distinct intensities of the same stress factor. Based on this knowledge we can continue using this system for VR experiments with environments that closely resemble the actual work environments of nurses. In doing so, we hope to improve the quality-of-life in the nursing profession by enabling better coping techniques with certain occupational stress factors. We further provide insights into what sensors are most suitable for our needs.

Allylmagnesium chloride and methyl-propenyl-magnesium bromide were reacted with bulky substituted organolead and organotin halides (Ar*PbBr)2, (Ar′PbBr)2, (Ar*SnCl)2 (Ar* = 2,6-trip2C6H3-, trip = 2,4,6-triisopropylphenyl, Ar′ = 2,6-mes2C6H3-, mes = 2,4,6-trimethylphenyl). The allyl ligand coordinates in an η3-coordination mode at organoplumbylene fragments. In the solid state as well as in solution, η3-coordination was characterized by crystal structure analysis and Saunders’ isotopic perturbation technique. For the plumbylene Ar*Pb(C3H5), a solid state 207Pb magic angle spinning (MAS) NMR spectrum could be obtained. The isotropic chemical shift is −435 ppm, and the magnitude of the 207Pb chemical shift tensor of 7000(500) ppm is among the greatest observed experimentally. The methylallyl ligand coordinated at a plumbylene fragment exhibits two short and one long Pb–C interaction. In reaction with aniline, the allyl ligand reacts as a leaving group to give amidoplumbylenes.

Soft-tissue sarcomas (STS) are a rare subtype of soft-tissue mass and are frequently misinterpreted as benign lesions. Magnetic resonance imaging (MRI) is the primary recommended type of diagnostics. To assess the quality of primary radiology reports, we investigated whether recommended MRI report elements were included in compliance with European Society of Musculoskeletal Radiology (ESSR) guidelines. A total of 1107 patients were evaluated retrospectively, and 126 radiological reports on patients with malignant STS were assessed for ESSR quality criteria. One or more required sequences or planes were missing in 67% of the reports. In all 126 cases, the report recognized the mass as anomalous (100%). Sixty-eight percent of the reports mentioned signs of malignancy. The majority of reports (n = 109, 87%) articulated a suspected diagnosis, 32 of which showed a mismatch with the final diagnosis (25%). Thirty-two percent of the reports had a misinterpretation of the masses as benign. Benign misinterpretations were more common in masses smaller than 5 cm (65% vs. 27%). Thirty percent of the reports suggested tissue biopsy and 6% recommended referral to a sarcoma center. MRI reports showed frequent deviations from ESSR guidelines, and protocol guidelines were not routinely met. Deviations from standard protocol and reporting guidelines could put patients at risk for inadequate therapy.

Adaptive and innate immune responses contribute to hypertension and hypertensive end-organ damage. Here, we determined the role of anaphylatoxin C5a, a major inflammatory effector of the innate immune system that is generated in response to complement activation, in hypertensive end-organ damage. For this purpose, we assessed the phenotype of C5a receptor 1 (C5aR1)-deficient mice in ANG II-induced renal and cardiac injury. Expression of C5aR1 on infiltrating and resident renal as well as cardiac cells was determined using a green fluorescent protein (GFP)-C5aR1 reporter knockin mouse. Flow cytometric analysis of leukocytes isolated from the kidney of GFP-C5aR1 reporter mice showed that 28% of CD45-positive cells expressed C5aR1. Dendritic cells were identified as the major C5aR1-expressing population (88.5%) followed by macrophages and neutrophils. Using confocal microscopy, we detected C5aR1 in the kidney mainly on infiltrating cells. In the heart, only infiltrating cells stained C5aR1 positive. To evaluate the role of C5aR1 deficiency in hypertensive injury, an aggravated model of hypertension was used. Unilateral nephrectomy was performed followed by infusion of ANG II (1.5 ng·g−1·min−1) and salt in wild-type ( n = 34) and C5aR1-deficient mice ( n = 32). C5aR1-deficient mice exhibited less renal injury, as evidenced by significantly reduced albuminuria. In contrast, cardiac injury was accelerated with significantly increased cardiac fibrosis and heart weight in C5aR1-deficient mice after ANG II infusion. No effect was found on blood pressure. In summary, the C5a:C5aR1 axis drives end-organ damage in the kidney but protects from the development of cardiac fibrosis and hypertrophy in experimental ANG II-induced hypertension.

Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath.In this case-control-analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable sheath showed an increase in the success rate (freedom from AF) from 56% to 77% (P = 0.009) after a single procedure and 6 months of follow-up. With respect to procedural data no difference could be found for procedure time, fluoroscopy time, irradiation dose, and radiofrequency (RF) burning time. With the steerable sheath mean procedural RF power (33 +/- 9 vs 41 +/- 4 W; P0.0005) and total RF energy delivery (97,498 vs 111,864 J; P0.005) were significantly lower and the rate of complete PV isolation significantly increased from 10% to 52% (P0.0005). The complication rate was the same in both groups. Among different arrhythmia, procedure, and patient characteristics, the lack of early postinterventional arrhythmia recurrences was the only but powerful predictor for long-term ablation success.An AF mapping and ablation approach solely using a manually controlled steerable sheath for catheter navigation improved the outcome of circumferential left atrial PV ablation at similar intervention times and similar complication rates. The 6-month success rate after a single LA intervention increased from 56% to 77%.