Search

Clinical research-characteristics: Clinical research is a key component of developed health care systems, a major driving force of medical innovation, and, of course, an integral part of the German Federal Statutory Accident Insurance System. Specific institutions and well-trained experts are needed to cope with the rapidly emerging methodological, ethical, and administrative mandates of clinical research. Quality assurance and independence: Similar to other areas of health care, clinical research must demonstrate and maintain a high degree of structural and process quality. Yet, it can be shown that this increases the internal and external validity of research findings, as well as their likelihood of publication in renowned scientific journals. Apart from content validity, the relationship between individual investigators, their institutions, as well as public and commercial sponsors must be disclosed to maintain the integrity of research. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg 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.)

Copyright of Trauma und Berufskrankheit 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.)

Based on the results of a pilot study in 2007, which found high mixing ratios of molecular iodine (I2) above the intertidal macroalgae (seaweed) beds at Mweenish Bay (Ireland), we extended the study to nine different locations in the vicinity of Mace Head Atmospheric Research Station on the west coast of Ireland during a field campaign in 2009. The mean values of I2 mixing ratio found above the macroalgae beds at nine different locations ranged from 104 to 393 ppt, implying a high source strength of I2. Such mixing ratios are sufficient to result in photochemically driven coastal newparticle formation events. Mixing ratios above the Ascophyllum nodosum and Fucus vesiculosus beds increased with exposure time: after 6 h exposure to ambient air the mixing ratios were one order of magnitude higher than those initially present. This contrasts with the emission characteristics of Laminaria digitata, where most I2 was emitted within the first half hour of exposure. Discrete in situ measurements (offline) of I2 emission from ambient air-exposed chamber experiments of L. digitata, A. nodosum and F. vesiculosus substantially supported the field observations. Further online and time-resolved measurements of the I2 emission from O3-exposed macroalgal experiments in a chamber confirmed the distinct I2 emission characteristics of A. nodosum and F. vesiculosus compared to those of L. digitata. The emission rates of A. nodosum and F. vesiculosus were comparable to or even higher than L. digitata after the initial exposure period of ~20-30 min. We suggest that A. nodosum and F. vesiculosus may provide an important source of photolabile iodine in the coastal boundary layer and that their impact on photochemistry and coastal new-particle formation should be reevaluated in light of their longer exposure at low tide and their widespread distribution. [ABSTRACT FROM AUTHOR]

Introduction: Patellar dislocation is a common knee injury with mainly lateral dislocations, leading to ruptures of the medial patellofemoral ligament in most of the cases. Even though several prognostic factors for patellofemoral instability have been identified so far, the appropriate therapy for patients with patellar dislocation remains a controversial issue. The purpose of this study was to compare the outcome after conservative or operative treatment in patients after first-time patellar dislocation. Patients and methods: This randomized controlled clinical trial was designed multicentric including patients from six German orthopaedic and trauma departments. Twenty patients with a mean age of 24.6 years with first-time traumatic patella dislocation were included and randomized into either a conservative arm or an operative arm. Plain X-ray images of the knee joint (a.p. and lateral view and tangential view of both patellae) were performed in all cases prior to therapy to exclude osteochondral fragments requiring refixation. An MRI was recommended, but not compulsory. Patients were consulted after 6, 12, and 24 months with a questionnaire including the criteria of the Kujala score, recurrent dislocation, and satisfaction. Results: The mean Kujala score of the conservative vs operative treatment group was 78.6 vs 80.3 after 6 months ( p = 0.842), 79.9 vs 88.9 after 12 months ( p = 0.165), and 81.3 vs 87.5 after 24 months ( p = 0.339). Redislocation rate after 24 months was 37.5 % in the conservative group and 16.7 % in the operative group ( p = 0.347). Due to the small number of patients that could be included, no significant difference between the groups could be detected. We see a tendency towards better results after operative treatment. Conclusion: Our multicentric prospective randomized controlled trial revealed no significant difference between conservative and operative treatment for patients after first-time traumatic patellar dislocation. However, a tendency towards a better Kujala score and lower redislocation rates for patients with operative treatment was observed. The small number of patients is a limiting factor of the study, leading to results without statistical significance. A meta-analysis including other study′s level I data is desirable for the future. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg 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.)

All existing classifications, which are based on the severity of hand injuries, are being referred to facets of variety of hand injuries in general. A clear picture of all consequences of hand injuries would be apparent, if any kind of injury mechanism and occurrence of an injury would be identified and academically captured. Predictions regarding return to the former occupation and rehabilitation time would be possible with further study; 102 patients with different hand injuries were engaged in a pilot project using a specifically designed assessment sheet to achieve this purpose in the framework of a retrospective clinical testing within 1 year. Data were summarized and demonstrated graphically. Each category showed a picture of prior localization of the injury and its morphology. All categories show specific injury patterns. The choice of categories reflects the mechanisms of injury emphasized in literature. Furthermore, the mean DASH equivalents of one category were compared to the mean Hand Injury Severity Scoring (HISS) scores in order to get an initial idea of information on the degree of severity. A first impression of the potential of this assessment sheet has been obtained with regard to the above. With further study, we could evaluate the assessment sheet and try to create a classification of the grade of severity as well as prognostic values like return to the former occupation and rehabilitation time. [ABSTRACT FROM AUTHOR]

Minarets are very slender structures with an old existence. The historical ones are made of cut-stone-block masonry assembled in peripheral cylindrical wall with an interior helicoidal stair supported on a central core and on the wall. They are spread throughout the Islamic world and constitute an important heritage not only of religious value, but also of great cultural interest. Throughout the times, these structures as part of a mosque, have suffered significant damage during the earthquakes. Istanbul presents interesting characteristics to evaluate their dynamic behavior, as they are in great number, in an area where a large event in the next 30 years has been predicted. In this paper, we performed a series of in situ ambient vibration tests to old minarets of various sizes and compared results of frequencies with numerical modeling of the same structures. For the low-amplitude motion, the frequency values of the first modes can be obtained from an empirical formulae function of the inertia of the cross-section and of the height of the main 'body.' Damping ratios for these amplitudes are of the order of 0.5-1.0%. Dynamic linear analyses of these structures indicate that for most cases very high stresses develop for PGA above 0.5 g, an input with a reasonable chance of occurring in the next 30 years. These high stresses are expected to cause the toppling of the minarets in the form that has been observed in the recent past events. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg 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.)

Fractures of the tibial plafond are rare but severe injuries which are characterized by complex fracture lines, destruction of the chondral layer and significant soft tissue damage. The key goal of staged internal fixation is anatomical reconstruction in order to minimize the risk and degree of post-traumatic osteoarthritis. There is a paucity of data on functional outcome and health-related quality of life after surgical treatment of these fractures. A retrospective study of 21 patients was conducted with follow-up for a median interval of 36 months. The range of motion (ROM) of the ankle joint, specific function, and health-related quality of life were assessed. A total of nine patients encountered local complications. At the time of follow-up the mean difference in ROM between the injured and the contra-lateral ankle joint and extremity function was clearly reduced. The mean physical component score indicated significant impairment, whereas the mental component score was only slightly below the population norm. Health-related quality of life factors were analogously assessed. Despite substantial improvement in surgical treatment the functional prognosis of fractures of the tibial plafond remains unsatisfactory. Innovative treatment approaches must target and overcome the biological damages to the joint cartilage. [ABSTRACT FROM AUTHOR]

Goals Of Work: Quality of life (Qol) represents a relevant end point in the clinical management of advanced ovarian cancer (AOC). However, there exist only a few specific instruments which have been designed for patients with ovarian cancer. The aim of this study was to develop a systematic checklist (Berlin Symptom Checklist Ovary (BSCL-O)) as an instrument of Qol for patients with AOC and to discriminate between the frequency and the importance of symptoms.Patients and Methods: The main symptoms were identified in a phase I study via free interviews of five patients with ovarian cancer (OC) as well as five medical doctors, family dependent, and care workers. In the phase II study, the capability of BSCL-O was evaluated by questionnaire-guided interviews of 200 patients with primary OC, recurrent OC, metastasized breast cancer, and benign ovarian tumors.Main Results: In phase I, 36 main symptoms were identified. In phase II, 7,200 answers from 98.5% of all patients were evaluable. Of the 36 symptoms of the BSCL-O, 23 revealed clinical relevance. There was a correlation of frequency and importance of symptoms (p < 0.05). The symptoms of the BSCL-O were deemed twice as strenuous in patients with recurrent OC.Conclusions: The BSCL-O can measure Qol of patients with OC. The BSCL-O is being validated in a phase III study. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg 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.)

BACKGROUND AND PURPOSE: Many studies have suggested that navigation-based implantation can improve cup positioning in total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to compile the best available evidence, and to overcome potential shortcomings because of small sample sizes in individual studies. METHODS: The search strategy covered the major medical databases from January 1976 through August 2007, as well as various publishers' databases. The internal validity of individual studies was evaluated independently by 3 reviewers. We used random-effects modeling to obtain mean differences in cup angulation and relative risk (RR) of cup positioning outside Lewinnek's safe zone. RESULTS: Of 363 citations originally identified, 5 trials of moderate methodology enrolling a total of 400 patients were included in the analysis. Mean cup inclination and anteversion were not statistically significantly different between the conventional groups and the navigated groups. Navigation reduced the variability in cup positioning and the risk of placing the acetabular component beyond the safe zone (RR = 0.21, CI: 0.13-0.32). INTERPRETATION: Based on the current literature, navigation is a reliable tool to optimize cup placement, and to minimize outliers. However, long-term outcomes and cost utility analyses are needed before conclusive statements can be drawn about the value of routine navigation in THA. [ABSTRACT FROM AUTHOR]

During a short period of time, surgical robots had been propagated for automated tunnel placement in anterior cruciate ligament (ACL) reconstruction. Clinical outcome data are currently unavailable. Between 2000 and 2003, 152 patients underwent ACL replacement with the assistance of the Computer Assisted Surgical Planning and Robotics system (CASPAR, OrtoMaquet, Germany) at our hospital. After minimal invasive pin placement in both the tibia and femur, computed tomography was used to register anatomical landmarks and to plan graft tunnel alignment. The robot was used to drill tibial and femoral tunnels in an outside-in fashion according to pre-operative planning. There was one procedure-specific Serious Adverse Event (i.e., an intraoperative transection of the posterior cruciate ligament). After IRB approval, all patients were invited for a follow-up examination. Data from 100 patients (35 women, 65 men, mean age 35 [SD 11] years, median follow-up 61 [range 42-77] months) form the basis of this report. Side-to-side differences in anterior laxity were measured with the KT-1000 arthrometer. Patient-centered outcomes included the Lysholm-Score, the lower extremity functional scale (LEFS), and the Short Form 36 (SF36). The mean KT-1000 side-to-side difference was 0.89 [95% confidence interval (CI) 0.52-1.26] mm. Eight and five patients had a positive Lachman and pivot shift test, respectively. The Lysholm-Score averaged 86 (95% CI 83-89) points. Excellent, good, fair, and poor outcomes were reported by 38, 32, 20, and 10 patients. The LEFS averaged 85 (95% CI 82-88) points. The mean SF36 Physical Component Score was 48.4 (95% CI 46.5-50.3), indicating residual deficits compared to the population norm. All tibial graft tunnels did not cross the Blumensaat line, but were placed slightly anterior to the optimal center of 42% reported in previous studies. Compared to literature data, robot-assisted ACL reconstruction with BTB grafts may lead to higher knee stability, but poorer functional outcomes. The immense additional efforts with the procedure did not pay off in a benefit to patients. [ABSTRACT FROM AUTHOR]

Copyright of Trauma und Berufskrankheit 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.)

Background: Typical side-effects of saphenous stripping for symptomatic varicose veins include painful thigh haematomas, which a new bipolar coagulating electric vein stripper (EVS) may reduce. Methods: In a randomized, single-blind trial at three vascular centres, 99 patients were assigned to EVS and 101 to conventional stripping. The primary outcome was postoperative pain at rest and following physical exercise (climbing stairs). Haematomas were quantified by ultrasonography. Further endpoints were duration of postoperative compression, sick leave and quality of life (measured by the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ) and Short Form 36 (SF-36®)). Results: Mean resting visual analogue scale for pain 24 h after surgery was 1.6 in the EVS group and 3.3 in the conventional stripping group (mean difference 1.7, 95 per cent confidence interval (c.i.) 1.4 to 1.9, P < 0.001). Mean ratings following exercise were 3.3 and 5.5 (mean difference 2.3, 95 per cent c.i. 2.0 to 2.6, P < 0.001) respectively. No patient in the EVS group had a measurable thigh haematoma, compared with 74 patients after conventional stripping (P < 0.001). The EVS significantly decreased the length of compression therapy and sick leave, and produced superior CIVIQ and SF-36 ratings. Conclusion: The EVS was safe and effective in avoiding painful haematomas following varicose vein surgery. [ABSTRACT FROM AUTHOR]

Background: Proponents of navigated knee arthroplasty stress its potential to increase the precision of component placement. We conducted a systematic review and meta-analysis to substantiate the validity and relevance of this contention.Methods: We searched major medical and publishers' databases for randomized trials and any other studies comparing navigated with conventional knee arthroplasty. Major periodicals were searched manually. We made no restrictions for types of studies or language. Methodological features were rated independently by two reviewers. After testing for publication bias and heterogeneity was done, the data were aggregated by random-effects modeling. We estimated the weighted mean differences of mechanical limb axes and functional scales and the risk ratios of deviations from the straight axis with 95% confidence intervals.Results: We included thirty-three studies (eleven randomized trials) of varying methodological quality involving 3423 patients with a mean age (and standard deviation) of 67.3 +/- 4.1 years (62.6% were women, and 83.7% had primary osteoarthritis). The mean preoperative deviation from the mechanical axis was 2.3 degrees +/- 5.1 degrees. There was no evidence of publication bias, but there was strong statistical heterogeneity. The alignment of the mechanical axes did not differ between the navigated and conventional surgery group (weighted mean difference, 0.2 degrees; 95% confidence interval, -0.2 degrees to 0.5 degrees). Patients managed with navigated surgery had a lower risk of malalignment at critical thresholds of >3 degrees (risk ratio, 0.79; 95% confidence interval, 0.71 to 0.87) and >2 degrees (risk ratio, 0.76; 95% confidence interval, 0.71 to 0.82). No conclusive inferences could be drawn on functional outcomes or complication rates. Navigation lengthened the mean duration of surgery by 23%.Conclusions: Navigated knee replacement provides few advantages over conventional surgery on the basis of radiographic end points. Its clinical benefits are unclear and remain to be defined on a larger scale. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Gerontologie und Geriatrie 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.)

Copyright of Trauma und Berufskrankheit 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.)

Copyright of Der Unfallchirurg 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.)

Copyright of Der Unfallchirurg 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.)

Copyright of Der Unfallchirurg 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.)

Copyright of Der Unfallchirurg 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.)