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Duchenne muscular dystrophy (DMD) is a fatal X-linked disease caused by mutations in the DMD gene, leading to complete absence of dystrophin and progressive degeneration of skeletal muscles and heart. Animal models are essential for preclinical evaluation of novel diagnostic procedures and treatment strategies. Gene targeting/editing offers the possibility of developing tailored pig models for monogenic diseases. The first porcine DMD model was generated by deletion of DMD exon 52 (DMDΔ52) in cultured kidney cells, which were used for somatic cell nuclear transfer to produce DMDΔ52 offspring. The animals resembled clinical, biochemical, and pathological hallmarks of DMD, but died before sexual maturity, thus preventing their propagation by breeding. This limitation was overcome by the generation of female heterozygous DMDΔ52 carrier pigs, which allowed the establishment of a large breeding colony. In this overview, we summarize how porcine DMD models have been used for dissecting disease mechanisms, for validating multispectral optoacoustic tomography as an imaging modality for monitoring fibrosis, and for preclinical testing of a CRISPR/Cas9 based approach to restore an intact DMD reading frame. Particular advantages of porcine DMD models include their targeted design and the rapid disease progression with early cardiac involvement, facilitating translational studies in reasonable time frames.

The past several decades have seen alarming declines in the reproductive health of humans, animals and plants. While humans have introduced numerous pollutants that can impair reproductive systems (such as well-documented endocrine disruptors), the potential for microplastics (MPs) to be contributing to the widespread declines in fertility is particularly noteworthy. Over the same timespan that declines in fertility began to be documented, there has been a correlated shift towards a “throw-away society” that is characterised by the excessive consumption of single-use plastic products and a concomitant accumulation of MPs pollution. Studies are showing that MPs can impair fertility, but data have been limited to rodents that were force-fed hundreds of thousands of times more plastics than they would be exposed in the environment. As a first step to linkin vitrohealth effects within vivoenvironmental exposure, we quantified microplastics in the follicular fluid of women and domestic cows. We found that the concentrations of polystyrene microplastics that naturally occurred in follicular fluid were sufficient to compromise the maturation of bovine oocytesin vitro. Collectively, these findings demonstrate that microplastics may also be contributing to the widespread declines in fertility that have been occurring over recent Anthropocene decades.

There is evidence for an age-related decline in male reproductive functions, yet how the human testis may age is not understood. Human testicular peritubular cells (HTPCs) transport sperm, contribute to the spermatogonial stem cell (SSC) niche and immune surveillance, and can be isolated and studied in vitro. Consequences of replicative senescence of HTPCs were evaluated to gain partial insights into human testicular aging. To this end, early and advanced HTPC passages, in which replicative senescence was indicated by increased cell size, altered nuclear morphology, enhanced β-galactosidase activity, telomere attrition and reduced mitochondrial DNA (mtDNA), were compared. These alterations are typical for senescent cells, in general. To examine HTPC-specific changes, focused ion beam scanning electron microscopy (FIB/SEM) tomography was employed, which revealed a reduced mitochondrial network and an increased lysosome population. The results coincide with the data of a parallel proteomic analysis and indicate deranged proteostasis. The mRNA levels of typical contractility markers and growth factors, important for the SSC niche, were not significantly altered. A secretome analysis identified, however, elevated levels of macrophage migration inhibitory factor (MIF) and dipeptidyl peptidase 4 (DPP4), which may play a role in spermatogenesis. Testicular DPP4 may further represent a possible drug target.

The corpus luteum (CL) is a transient endocrine organ, yet molecular mechanisms resulting in its demise are not well known. The presence of phosphorylated mixed lineage kinase domain-like pseudokinase pMLKL(T357/S358) in human and nonhuman primate CL samples (Macaca mulatta and Callithrix jacchus) implied that necroptosis of luteal cells may be involved. In M. mulatta CL, pMLKL positive staining became detectable only from the mid-late luteal phase onwards, pointing to necroptosis during regression of the CL. Cell death, including necroptosis, was previously observed in cultures of human luteal granulosa cells (GCs), an apt model for the study of the human CL. To explore mechanisms of necroptotic cell death in GCs during culture, we performed a proteomic analysis. The levels of 50 proteins were significantly altered after 5 days of culture. Interconnectivity analysis and immunocytochemistry implicated specifically the ceramide salvage pathway to be enhanced. M. mulatta CL transcriptome analysis indicated in vivo relevance. Perturbing endogenous ceramide generation by fumonisin B1 (FB1) and addition of soluble ceramide (C2-CER) yielded opposite actions on viability of GCs and therefore supported the significance of the ceramide pathway. Morphological changes indicated necrotic cell death in the C2-CER treated group. Studies with the pan caspase blocker zVAD-fmk or the necroptosis blocker necrosulfonamid (NSA) further supported that C2-CER induced necroptosis. Our data pinpoint necroptosis in a physiological process, namely CL regression. This raises the possibility that the primate CL could be rescued by pharmacological inhibition of necroptosis or by interaction with ceramide metabolism.

Age-related changes in the human testis may include morphological alterations, disturbed steroidogenesis, and impaired spermatogenesis. However, the specific impact of cell age remains poorly understood and difficult to assess. Testicular peritubular cells fulfill essential functions, including sperm transport, contributions to the spermatogonial stem cell niche, and paracrine interactions within the testis. To study their role in age-associated decline of testicular functions, we performed comprehensive proteome and secretome analyses of repeatedly passaged peritubular cells from Callithrix jacchus. This nonhuman primate model better reflects the human testicular biology than rodents and further gives access to young donors unavailable from humans. Among 5095 identified proteins, 583 were differentially abundant between samples with low and high passage numbers. The alterations indicate a reduced ability of senescent peritubular cells to contract and secrete proteins, as well as disturbances in nuclear factor (NF)-&kappa, B signaling and a reduced capacity to handle reactive oxygen species. Since this in vitro model may not exactly mirror all molecular aspects of in vivo aging, we investigated the proteomes and secretomes of testicular peritubular cells from young and old donors. Even though the age-related alterations at the protein level were less pronounced, we found evidence for impaired protein secretion, altered NF-&kappa, B signaling, and reduced contractility of these in vivo aged peritubular cells.

Testicular peritubular cells (TPCs) are smooth muscle-like cells, which form a compartment surrounding the seminiferous tubules. Previous studies employing isolated human testicular peritubular cells (HTPCs) indicated that their roles in the testis go beyond sperm transport and include paracrine and immunological contributions. Peritubular cells from a non-human primate (MKTPCs), the common marmoset monkey, Callithrix jacchus, share a high degree of homology with HTPCs. However, like their human counterparts these cells age in vitro and replicative senescence limits in-depth functional or mechanistic studies. Therefore, a stable cellular model was established. MKTPCs of a young adult animal were immortalized by piggyBac transposition of human telomerase (hTERT), that is, without the expression of viral oncogenes. Immortalized MKTPCs (iMKTPCs) grew without discernable changes for more than 50 passages. An initial characterization revealed typical genes expressed by peritubular cells (androgen receptor (AR), smooth-muscle actin (ACTA2), calponin (CNN1)). A proteome analysis of the primary MKTPCs and the derived immortalized cell line confirmed that the cells almost completely retained their phenotype. To test whether they respond in a similar way as HTPCs, iMKTPCs were challenged with forskolin (FSK) and ATP. As HTPCs, they showed increased expression level of the StAR protein (StAR) after FSK stimulation, indicating steroidogenic capacity. ATP increased the expression of pro-inflammatory factors (e.g. IL1B; CCL7), as it is the case in HTPCs. Finally, we confirmed that iMKTPCs can efficiently be transfected. Therefore, they represent a highly relevant translational model, which allows mechanistic studies for further exploration of the roles of testicular peritubular cells.

Aquatic pollution is an increasing problem and requires extensive research efforts to understand associated consequences and to find suitable solutions. The crustacean Daphnia is a keystone species in lacustrine ecosystems by connecting primary producers with higher trophic levels. Therefore, Daphnia is perfectly suitable to investigate biological effects of freshwater pollution and is frequently used as an important model organism in ecotoxicology. The field of ecotoxicoproteomics has become increasingly prevalent, as proteins are important for an organism's physiology and respond rapidly to changing environmental conditions. However, one obstacle in proteome analysis of Daphnia is highly abundant proteins like vitellogenin, decreasing the analytical depth of proteome analysis. To improve proteome coverage in Daphnia, we established an easy-to-use procedure based on the LC-MS/MS of whole daphnids and the dissected Daphnia gut, which is the main tissue getting in contact with soluble and particulate pollutants, separately. Using a comprehensive spectral library, generated by gas-phase fractionation and a data-independent acquisition method, we identified 4621 and 5233 protein groups at high confidence (false discovery rate 0.01) in Daphnia and Daphnia gut samples, respectively. By combining both datasets, a proteome coverage of 6027 proteins was achieved, demonstrating the effectiveness of our approach.

Green roofs enjoy a good reputation concerning comfort in summertime, energy savings, rain water retention and durability. However, applied on moisture sensitive substrates like timber constructions, their high thermal inertia and limited drying potential may lead to failure, especially in case of insufficient design or workmanship. As the conditions below the greenery cannot be evaluated by dew point calculations, only a more detailed simulation allows for a realistic prediction of the hygrothermal performance of the components. This contribution introduces a new hygrothermal green roof model based on field and laboratory tests. In difference to previous models it focuses on the moisture and temperature conditions beneath the greenery using more simple approaches for the plant cover but more detailed approaches for the moisture balance in the drainage and growth media. Therefore material data for moisture storage, vapor diffusion and liquid transport were determined in the laboratory and adapted to the built in situation by the help of additional field tests. The model is validated by the help of measured temperature conditions beneath the green roof test fields, as well as concerning the moisture conditions in the critical layers of sensitive timber roofs! The validation shows that the performance of the green roof can be well reproduced throughout the whole year and under all climate conditions including rain water absorption and storage, evaporation and freezing influences. Thus it can be used for both, moisture and energy performance simulations of roofs with greenery under different climatic conditions.

Trotz aller positiven Entwicklungen wird postoperativen Schmerzen und ihrer Behandlung nach wie vor nicht immer die notwendige Aufmerksamkeit geschenkt. Starke Schmerzen nach chirurgischen Eingriffen betreffen einen erheblichen Anteil der Patienten. Diese Tatsache wirkt sich nicht nur auf den unmittelbaren Rekonvaleszenzprozess negativ aus, sondern kann auch die Grundlage fur eine Schmerzchronifizierung bilden. Ein adaquates und effektives Management perioperativer Schmerzen erfordert geeignete organisatorische Strukturen. Das vorliegende multidisziplinare Positionspapier, das die Osterreichische Gesellschaft fur Anasthesiologie, Reanimation und Intensivmedizin und die Osterreichische Schmerzgesellschaft initiiert und gemeinsam mit zahlreichen mit der Thematik befassten Fachgesellschaften und Berufsverbanden entwickelt haben, soll dabei unterstutzen, das perioperative Schmerzmanagement optimal zu gestalten und bewahrte Konzepte zu nutzen. Erganzende Empfehlungen beschreiben Besonderheiten der perioperativen Schmerztherapie bei ausgewahlten Eingriffsarten.

We describe the development and evaluation of a GC-MS fractionation platform that combines high-resolution fraction collection of full chromatograms with parallel MS detection. A y-split at the column divides the effluent towards the MS detector and towards an inverted y-piece where vaporized trap solvent is infused. The latter flow is directed outside the GC oven allowing subsequent condensation and stepwise collection of liquid fractions with trapped analytes on a 384-well plate. For study and optimization of the effluent split ratio, restriction capillaries of different lengths and diameters were evaluated. For a wide range of settings, local pressures were monitored during fractionation to assess the influence of MS vacuum and trap solvent infusion on the GC system stability. The platform performance was evaluated by GC-MS analysis and continuous fractionation of an n-alkane mixture followed by GC analysis of each fraction. Comparison of the on-line recorded and fraction-reconstructed chromatogram showed the GC separation is maintained during fractionation. Multiple fractionation cycles of the n-alkane sample on the same 384-well plate yielded a reconstructed chromatogram which was highly similar to that of a single analysis, demonstrating the high repeatability. The applicability of the GC-MS-fractionation platform for bioactivity screening was investigated by applying the AR-Ecoscreen reporter gene bioassay on fractions obtained after analysis of standard solutions and dust samples containing the anti-androgenic compounds vinclozolin and p,p’-DDE.

Aging of human testis and associated cellular changes is difficult to assess. Therefore, we used a translational, non-human primate model to get insights into underlying cellular and biochemical processes. Using proteomics and immunohistochemistry, we analyzed testicular tissue of young (age 2 to 3) and old (age 10 to 12) common marmosets (Callithrix jacchus). Using a mass spectrometry-based proteomics approach, we identified 63,124 peptides, which could be assigned to 5924 proteins. Among them, we found proteins specific for germ cells and somatic cells, such as Leydig and Sertoli cells. Quantitative analysis showed 31 differentially abundant proteins, of which 29 proteins were more abundant in older animals. An increased abundance of anti-proliferative proteins, among them CDKN2A, indicate reduced cell proliferation in old testes. Additionally, an increased abundance of several small leucine rich repeat proteoglycans and other extracellular matrix proteins was observed, which may be related to impaired cell migration and fibrotic events. Furthermore, an increased abundance of proteins with inhibitory roles in smooth muscle cell contraction like CNN1 indicates functional alterations in testicular peritubular cells and may mirror a reduced capacity of these cells to contract in old testes.

Study question Are monkey testicular peritubular cells (MKTPCs) from the common marmoset monkey (Callithrix jacchus) a suitable translational model for the study of human testicular peritubular cells (HTPCs)? Summary answer MKTPCs can be isolated and propagated in vitro, retain characteristic markers for testicular peritubular cells and their proteome strongly (correlation coefficient of 0.78) overlaps with the proteome of HTPCs. What is known already Smooth-muscle-like peritubular cells form the wall of seminiferous tubules, transport sperm, are immunologically active, secrete a plethora of factors and may contribute to the spermatogonial stem cell niche. Mechanistic studies are hampered by heterogeneity of human samples. Study design, size, duration We established a culture method for MKTPCs and characterized these cells from six young adult animals (2-3 years). To examine whether they qualify as a translational model we also examined HTPCs from seven men and compared the proteomes of both groups. Participants/materials, setting, methods We used explant cultures to obtain MKTPCs, which express smooth muscle markers (calponin (CNN1), smooth muscle actin (ACTA2)), lack FSH-receptors (FSHR) and LH-receptors (LHCGR), but possess androgen receptors (AR). MKTPCs can be passaged at least up to eight times, without discernable phenotypic changes. Mass-spectrometry-based analyses of the MKTPC and HTPC proteomes were performed. Main results and the role of chance We established a method for isolation and cultivation of MKTPCs, and provide a comprehensive analysis of their protein repertoire. The results let us conclude that MKTPCs are suitable as a non-human primate model to study peritubular cell functions. Large scale data List of identified proteins in MKTPCs by liquid chromatography-tandem mass spectrometry is accessible at the ProteomeXchange (identifier PXD009394). Limitations, reason for caution This is an in vitro cellular non-human primate model used to provide a window into the role of these cells in the human testis. Wider implications of the findings Previous studies with HTPCs from patients revealed a degree of heterogeneity, possibly due to age, lifestyle and medical history of the individual human donors. We anticipate that the new translational model, derived from young healthy non-human primates, may allow us to circumvent these issues and may lead to a better understanding of the role of peritubular cells. Study funding and competion of interest(s) This work was supported by grants from the Deutsche Forschungsgemeinschaft (MA 1080/27-1; AR 362/9-1; BE 2296/8-1). The authors declare no competing financial interests.

Despite many positive developments, postoperative pain and its treatment is still not always given the necessary attention. Severe pain after surgical procedures affects a significant proportion of patients. This very fact is not only detrimental to the immediate recovery process, but can also form the basis for the development of chronic pain conditions.An adequate and effective management of perioperative pain requires appropriate organizational structures. This multidisciplinary paper which was initiated by the Austrian Society for Anaesthesiology and Intensive Care and the Austrian Pain Society and developed together with numerous specialist and professional societies dealing with the subject aims at supporting the organization of perioperative pain management structures and to make best use of proven concepts. Additional recommendations describe specific interventions for selected types of intervention.

Malposition of the acetabular component is a risk factor for post-operative dislocation after total hip replacement (THR). We have investigated the influence of the orientation of the acetabular component on the probability of dislocation. Radiological anteversion and abduction of the component of 127 hips which dislocated post-operatively were measured by Einzel-Bild-Röentgen-Analysis and compared with those in a control group of 342 patients. In the control group, the mean value of anteversion was 15 degrees and of abduction 44 degrees. Patients with anterior dislocation after primary THR showed significant differences in the mean angle of anteversion (17 degrees), and abduction (48 degrees) as did patients with posterior dislocation (anteversion 11 degrees, abduction 42 degrees). After revision patients with posterior dislocation showed significant differences in anteversion (12 degrees) and abduction (40 degrees). Our results demonstrate the importance of accurate positioning of the acetabular component in order to reduce the frequency of subsequent dislocations. Radiological anteversion of 15 degrees and abduction of 45 degrees are the lowest at-risk values for dislocation.

In a prospective randomized study, 32 metal-on-metal prostheses and 29 ceramic-on-polyethylene prostheses of similar design were implanted in 59 patients. Radiolucency, cup migration, wear, and function were examined after a minimum of 2 years followup (followup rate, 87%). The purpose of the current study was to evaluate whether higher frictional torque of metal-on-metal will lead to a higher rate of early metal-on-metal cup loosening. A computer-assisted method was used for wear and migration measurements of the acetabular component. Metal-on-metal prostheses migrated in a craniocaudad direction significantly less than ceramic-on-polyethylene prostheses. The mean total migration for both types of prostheses exceeded 1.5 mm at 2 years. Clinically, no difference between the two prostheses regarding activity, pain, or range of motion was found at 2 years. As migration of metal-on-metal prostheses was not higher in comparison with ceramic-on-polyethylene prostheses, the expected higher frictional torque of metal-on-metal prostheses did not increase migration during short-term followup. The different debris produced by both bearings did not influence the short-term results of this study, but might cause different long-term results.

Our aim was to determine whether tantalum markers improved the accuracy and/or precision of methods for the measurement of migration in total hip replacement based on conventional measurements without mathematical correction of the data, and with Ein Bild Roentgen Analyse – Femoral Component Analysis (EBRA-FCA) which allows a computerised correction. Three observers independently analysed 13 series of roentgen-stereophotogrammetric-analysis (RSA)-compatible radiographs (88). Data were obtained from conventional measurements, EBRA-FCA and the RSA method and all the results were compared with the RSA data. Radiological evaluation was also used to quantify in how many radiographs the intraosseous position of the bone markers had been simulated. The results showed that tantalum markers improve reliability whereas they do not affect accuracy for conventional measurements and for EBRA-FCA. Because of the danger of third-body wear their implantation should be avoided unless they are an integral part of the method.

Editor—The split hand/split foot malformation (SHFM, MIM 183600) is a central reduction defect of the hands and feet and occurs both as an isolated malformation and as part of several syndromes including the EEC syndrome (MIM 129900). We report on a 2 year old boy with SHFM associated with features of ectodermal hypoplasia, a submucous cleft palate, congenital vertical talus, malformations of the middle ear, profound sensorineural hearing loss resulting from Mondini dysplasia, and a de novo deletion of the paternal chromosome 7q21.1-q21.3. This patient with syndromic SHFM represents a case of atypical EEC syndrome, but also displays abnormalities previously not associated with SHFM or EEC syndrome. The classical features of the autosomal dominant inherited EEC syndrome are ectrodactyly, ectodermal dysplasia, and clefting of the lip/palate. In most patients, there are additional anomalies typically affecting the urogenital and lacrimal systems.1 2 Some patients also have dysmorphic facies, a tendency to infectious disease, endocrine disorders, and mental retardation. This phenotypic variability has become increasingly apparent over the last 15 years3 4 and numerous related and overlapping syndromes have been delineated by many investigators.5 In an attempt to clarify classification, major and minor criteria for the diagnosis of EEC syndrome have been elaborated.3 4 Dominant inheritance of EEC has been documented in several large multigenerational families.6 At least 15 patients have been reported to have cytogenetic abnormalities of chromosome 7q21.2-7q22.1, including nine patients with interstitial deletions.7-9 In addition, mutations in the gene encoding the transactivation factor p63 on chromosome 3q27 have been identified in familial and sporadic cases of EEC syndrome.10 A third locus was mapped to chromosome 19q,11 further delineating the genetic heterogeneity of this syndrome. The reason for the phenotypic heterogeneity in EEC syndrome patients with 7q abnormalities is unclear …

Botulinum toxin type A (BTX-A) injections induce a dose-related decrease in muscle tone and increased joint mobility in adults with spasticity and children with cerebral palsy. The aim of this study was to address the question of whether BTX-A-related improvements in joint mobility and muscle tone are associated with changes in instrumental gait analysis in children with cerebral palsy. Ten children with cerebral palsy and equinus gait were given a single dose of BTX-A (5 U BOTOX®/kg body weight per leg) into the gastrocnemius muscles. At follow-up (mean, 32.6 days post-injection), a significant (P < 0.05) increase in both passive and active ankle range of motion was observed, together with a decrease in the modified Ashworth score. Instrumental gait analysis showed improvements in ankle and knee kinematics as well as in time-distance parameters, with a significant increase in step length observed (P < 0.05). Semi-quantitative analysis of rectified electromyographic (EMG) recordings of the tibialis anterior muscle during gait showed a reduction in EMG activity during the stance phase and an increase in EMG activity during the swing phase. This study demonstrated the benefits of BTX-A treatment in improving joint mobility and ambulatory function in children with cerebral palsy, and showed that changes in tibial anterior muscle activity as a result of BTX-A injections into the gastrocnemius muscle can be measured by instrumental gait analysis.

Die Kokzygodynie geht vom sakrokokzygealen oder interkokzygealen Gelenk aus. Pseudokokzygodynie hingegen wird durch ubertragenen Schmerz aus anderen Regionen hervorgerufen.

Resection arthroplasty was performed in 62 feet, with follow-up at an average of 36 months (range, 17-68 months). All cases were performed using a combined cerclage fibreux. The mean age at operation was 61 years (range, 49-77 years). The mean score according to the hallux metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society was 81 points (range, 25-100 points). Correction of the hallux valgus angle at follow-up averaged 23 degrees (range, 0-45 degrees). The first intermetatarsal angle had been corrected an average of 3 degrees (range, 0-14 degrees). Transfer metatarsalgia was encountered in eight patients. No hallux varus or cock-up deformity was detected.

Several methods of measuring the migration of the femoral component after total hip replacement have been described, but they use different reference lines, and have differing accuracies, some unproven. Statistical comparison of different studies is rarely possible. We report a study of the EBRA-FCA method (femoral component analysis using Einzel-Bild-Röntgen-Analyse) to determine its accuracy using three independent assessments, including a direct comparison with the results of roentgen stereophotogrammetric analysis (RSA). The accuracy of EBRA-FCA was better than ±1.5 mm (95% percentile) with a Cronbach’s coefficient alpha for interobserver reliability of 0.84; a very good result. The method had a specificity of 100% and a sensitivity of 78% compared with RSA for the detection of migration of over 1 mm. This is accurate enough to assess the stability of a prosthesis within a relatively limited period. The best reference line for downward migration is between the greater trochanter and the shoulder of the stem, as confirmed by two experimental analyses and a computer-assisted design.

Between 1987 and 1993, 94 consecutive patients with painful spondylolisthesis underwent combined anterior and posterior fusion. The average age at operation was 40 years (range, 16-65 years). Posterior fusion was performed in all patients using pedicle screw systems, and anterior fusion was accomplished with autogenic or allogenic bone grafts. Patients retrospectively were assigned to two groups. In Group 1, anterior fusion was performed with autogenic bone grafts harvested from the iliac crest (n = 65; 146 segments) and in Group 2 allogenic bone grafts were taken from femoral heads (n = 39; 86 segments). The incidence of pseudarthrosis was evaluated on lateral tomograms 24 months after surgery. The mean clinical followup time was 4 years (range, 3-8 years). Pseudarthrosis was found in seven fused levels (3%) managed with autogenic bone grafts (Group 1) and in seven patients (8%) managed with allogenic bone grafts (Group 2). This incidence of pseudarthrosis was not significantly different between the two groups. Considering the possible complications associated with harvesting iliac crest bone, the use of allogenic bone appears justified.

We report the ten-year results for three designs of stem in 240 total hip replacements, for which subsidence had been measured on plain radiographs at regular intervals. Accurate migration patterns could be determined by the method of Einzel-Bild-Roentgen-Analyse-femoral component analysis (EBRA-FCA) for 158 hips (66%). Of these, 108 stems (68%) remained stable throughout, and five (3%) started to migrate after a median of 54 months. Initial migration of at least 1 mm was seen in 45 stems (29%) during the first two years, but these then became stable. We revised 17 stems for aseptic loosening, and 12 for other reasons. Revision for aseptic loosening could be predicted by EBRA-FCA with a sensitivity of 69%, a specificity of 80%, and an accuracy of 79% by the use of a threshold of subsidence of 1.5 mm during the first two years. Similar observations over a five-year period allowed the long-term outcome to be predicted with an accuracy of 91%. We discuss the importance of four different patterns of subsidence and confirm that the early measurement of migration by a reasonably accurate method can help to predict long-term outcome. Such methods should be used to evaluate new and modified designs of prosthesis.

Es wird eine Methode zur Migrationsmessung von Huftendoprothesen beschrieben. Die Migration wird anhand von Standardhuftubersichtsrontgen bestimmt. Daher kann Migration auch in retrospektiven Studien bestimmt werden. Die Messungen selbst werden am Computerbildschirm an Rontgenbildern durchgefuhrt, welche mit einem Scanner digitalisiert wurden. Knocherne Strukturen konnen durch Filter kontrastreicher dargestellt werden. Die entwickelte Software kann zusammen mit normalen Computern und Rontgenscannern verwendet werden, eine spezielle apparative Ausstattung ist nicht erforderlich. Mehrere Methoden zur Bestimmung der Genauigkeit werden beschrieben. Die Genauigkeit der beschriebenen Methode ist ungefahr 1 mm (95 % Vertrauensgrenze). Diese ist somit besser als bei anderen Methoden, jedoch schlechter als die der Rontgenstereophotogrammetrie. Von vielen auf digitaler Bildverarbeitung beruhenden Methoden wurde keine adaquate Genauigkeitsbestimmung angefuhrt. Mit der beschriebenen Methode konnen bereits 2 Jahre nach Prothesenimplantation die Revisionsraten innerhalb der ersten 10 Jahre mit einer Sensitivitat und Spezifitat von mehr als 80 % vorausgesagt werden.

Between April 1984 and December 1987 a Muller acetabular reinforcement ring was employed in 98 revision cases (94 patients). Twenty-two patients died before follow-up evaluation. Forty-seven (66%) of the remaining 72 patients (49 of 75 hips) were examined after a mean of 6.4 years (range 5–9 years). Excluding those who died, the postoperative outcome of 69 patients is known. Migration was measured according to Sutherland by means of a digitising table. Cup position was determined by a new angle (beta) between the sacroiliacal line and a reference line. The reference line connects the centre of the femoral head with the intersection between the sacroiliacal and the obturator lines. Aseptic and septic loosening required revision surgery in 2 cases each (4%). The postoperative beta angle showed a high correlation with migration (P = 0.001) as well as with radiolucencies (P = 0.001). In cases which required further revision, beta amounted to 44 deg (craniolateral position), and in stable cases up to 60 deg. A lateral and cranial position of a Muller acetabular reinforcement ring leads to high loosening rates. The beta angle accurately describes cup position, and its postoperative value is highly predictive for loosening.

We report a prospective, stratified study of 60 PCA-cups and 60 RM-polyethylene cups which have been followed for a median time of 90 months, with annual radiography. The radiological migration of cups was measured by the computer-assisted EBRA method. A number of threshold migration rates from 1 mm in the first year to 1 mm in five years have been assessed and related to clinically determined revision rates. A total of 28 cups showed a total migration of 1 mm or more within the first two years; 13 of these cups have required revision and been exchanged. The survival curves of cups which had previously shown early migration were considerably different from those without early migration. For cups with a migration of less than 1 mm within the first two years the mean survival at 96 months was 0.96 ± 0.02; for migrating cups, it was 0.63 ± 0.11 (log-rank test, p = 0.0001; chi-square value = 39.4). Early migration is a good predictor for late loosening of hip sockets.

Renal elimination of the paramagnetic contrast agent Gadolinium-DTPA (Gd-DTPA) was analyzed in 24 patients with impaired renal function and 3 normal controls. Dynamic magnetic resonance studies were performed using fast gradient-echo sequences with single images during suspended respiration and a temporal resolution of 10s per image. The time between appearance of the contrast agent in the renal cortex and signal intensity drop mL/min the medulla, due to a high concentration of Gd-DTPA and predominant T2-shortening, was an indicator of glomerular filtration rate and correlated well with creatinine clearance values (r=0.81). Fractionate urine collections and serum analysis up to 120h following administration showed a prolonged but complete elimination of Gd-DTPA mL/min patients with creatinine clearance above 20 mL/min. Renal functional parameters did not change after administration of Gd-DTPA and no nephrotoxic effects were observed.

We carried out 71 primary total hip arthroplasties using porous-coated, hemispherical press-fit Duraloc ‘100 Series’ cups in 68 consecutive patients; 61 were combined with the cementless Spotorno stem and ten with the cemented Lubinus SP II stem. Under-reaming of 2 mm achieved a press-fit. Of the 71 hips, 69 (97.1%) were followed up after a mean of 2.4 years. Migration analysis was performed by the Ein Bild Röntgen Analyse method, with an accuracy of 1 mm. The mean total migration after 24 months was 1.13 mm. Using the definition of loosening as a total migration of 1 mm, it follows that 30 out of 63 cups (48%) were loose at 24 months.

Successful total knee arthroplasty is dependent on the correct alignment of implanted prostheses. Major clinical problems can be related to poor femoral component positioning, including sagittal plane and rotational malalignment. A prospective randomized study was designed to test whether an optical navigation system for total knee arthroplasty achieved greater implantation precision than a nonnavigated technique. The primary variable was rotation of the femoral component in the transverse plane, measured from postoperative radiographs and computed tomography images. Sixty-four patients were included in the study. All patients received the Duracon total knee prosthesis. The patients were randomly divided into two groups: Group C patients had conventional total knee arthroplasty without navigation; Group N patients had total knee arthroplasty using a computer-assisted knee navigation system. Analysis showed that patients in Group N had significantly better rotational alignment and flexion angle of the femoral component than patients in Group C. In addition, superior postoperative alignment of the mechanical axis, posterior tibial slope, and rotational alignment was achieved for patients in Group N. The use of a navigation system provides improved alignment accuracy, and can help to avoid femoral malrotation and errors in axial alignment.

Infektiose Wirbelkorperdestruktionen konnten bereits bei agyptischen Mumien nachgewiesen werden. Hier fand man ca. 1000 v. Chr. eine Mumie mit Zerstorung des XI. und X. Brustwirbels bei einem Psoasabszess.

The abnormal bony feature found most consistently in clubfeet is talar distortion. The significance of the talar distortion for mobility of the tibiotalar joint was investigated. Twenty-seven congenital clubfeet in 19 patients were examined at a minimal followup of 20 years. In all patients Turco's posteromedial release was done because of idiopathic clubfoot. Radiographic assessment of the feet included measurement of the talocalcaneal angle and index, and the tibiocalcaneal angle. The degree of talar flattening was estimated by the ratio of the curvature of the talar dome to the length of the talar bone (radius to length ratio). Three-dimensional gait analysis was done to assess the dynamic range of ankle motion. The static range of motion was measured with a goniometer. The degree of talar flattening correlated significantly with the dynamic range of ankle motion but not with the static mobility. For assessment of idiopathic clubfoot, evaluation of talar flattening should be done because of its significance for dynamic ankle mobility.

Spina bifida is generally accompanied by a high incidence of foot deformities. The goal of management is to achieve a plantigrade foot. Deformities are related to the level of the lesion. With thoracic lesions, the most frequent deformity is an equinus lesion (55%), a club foot with mid-lumbar lesion (87%) and a calcaneal foot with sacral lesions (34%). No deformity was present in 56% of feet in sacral lesion children. Club foot surgery before the age of 2 years entails a high rate of recurrence (78%), necessitating redo surgery. A calcaneo-valgus deformity developed in 45% of ambulating patients with sacral lesions requiring operative stabilization of the foot. Patients with sacral lesions were almost the only ones who remained ambulators. Ambulation was not seen to be related to foot deformities in adolescents and young adults.

BACKGROUND: Allogeneic blood transfusions have been reported to increase susceptibility to postoperative infection, but the findings were inconclusive. This study was designed to investigate the effect of buffy coat-depleted allogeneic and autologous transfusion on postoperative infection in patients undergoing orthopedic surgery. STUDY DESIGN AND METHODS: Patients (n = 385) undergoing elective orthopedic surgery (primary and revision joint replacement, spinal, or pelvic surgery) were included in a prospective observational study of the incidence of postoperative infection between April and December 1996. Infection rates in patients who received allogeneic buffy coat-depleted blood transfusions were compared with those in patients who received no transfusion or only autologous (buffy coat-depleted) blood. RESULTS: Patients without exposure to allogeneic blood (no blood or only autologous blood) had an infection rate of 3.9 percent, as compared to a rate of 12.2 percent for those with exposure to allogeneic blood (allogeneic blood, autologous plus allogeneic blood) (odds ratio 3.442; 95% CI, 1.349-10.40; p = 0.006). Of the 385 study patients, 309 underwent primary hip or knee replacement surgery. In this homogeneous subgroup, the postoperative infection rate was 4.6 percent after no transfusion or autologous transfusion and 11.9 percent after allogeneic transfusion (odds ratio 2.827; 95% CI 1.059-8.799; p = 0.036). Multivariate regression analysis confirmed buffy coat-depleted allogeneic blood transfusion as an independent variable associated with high risk for postoperative infection. CONCLUSION: Buffy coat-depleted allogeneic blood transfusion increases the incidence of postoperative infection in patients undergoing uncontaminated orthopedic surgery.

Several methods of measuring the migration of the femoral component after total hip replacement have been described, but they use different reference lines, and have differing accuracies, some unproven. Statistical comparison of different studies is rarely possible. We report a study of the EBRA-FCA method (femoral component analysis using Einzel-Bild-Röntgen-Analyse) to determine its accuracy using three independent assessments, including a direct comparison with the results of roentgen stereophotogrammetric analysis (RSA). The accuracy of EBRA-FCA was better than +/- 1.5 mm (95% percentile) with a Cronbach's coefficient alpha for interobserver reliability of 0.84; a very good result. The method had a specificity of 100% and a sensitivity of 78% compared with RSA for the detection of migration of over 1 mm. This is accurate enough to assess the stability of a prosthesis within a relatively limited period. The best reference line for downward migration is between the greater trochanter and the shoulder of the stem, as confirmed by two experimental analyses and a computer-assisted design.

A method to determine migration of hip endoprostheses is described. Migration is measured by means of standard AP radiographs and therefore can also be evaluated in retrospective studies. Measurement is conducted in X-ray studies displayed on a computer screen. Enhancement of bony structures by application of filters is available. The developed software can be used with common commercially available computers and X-ray scanners, and does not require special hardware. Several methods to determine accuracy are described. The accuracy of the described method is about 1 mm (95% confidence limit), which compares favourably with other methods, but is less accurate than roentgen stereophotogrammetry. For other methods, accuracy was not determined adequately. Two years after implantation, revision within the first 10 years of follow-up can be predicted with a sensitivity and specificity of more than 80%.

We report a prospective, stratified study of 60 PCA-cups and 60 RM-polyethylene cups which have been followed for a median time of 90 months, with annual radiography. The radiological migration of cups was measured by the computer-assisted EBRA method. A number of threshold migration rates from 1 mm in the first year to 1 mm in five years have been assessed and related to clinically determined revision rates. A total of 28 cups showed a total migration of 1 mm or more within the first two years; 13 of these cups have required revision and been exchanged. The survival curves of cups which had previously shown early migration were considerably different from those without early migration. For cups with a migration of less than 1 mm within the first two years the mean survival at 96 months was 0.96 +/- 0.02; for migrating cups, it was 0.63 +/- 0.11 (log-rank test, p=0.0001; chi-square value=39.4). Early migration is a good predictor for late loosening of hip sockets.

Fifty-nine PCA cups and 61 hydroxyapatite-coated RM cups were included in a prospective randomised study with a mean follow up of 5.2 years. Clinical evaluation revealed better results with the RM cup. Radiological criteria of loosening could be applied only with considerable restrictions as different parameters were assessed: progressively loosened beads in PCA cups and faded contour in RM cups. Migration was measured by a computer assisted method (EBRA). PCA cups showed significantly more longitudinal migration 2 years after operation and subsequently. High migration values correlated with a limp. Loosening as defined by migration was of clinical relevance, could be measured early and predicted the survival rate.

A retrospective study of 88 of 117 kinematic total knee prostheses was carried out at the Department of Orthopaedics, University Clinic, Innsbruck. In 71 cases the clinical and functional score of the knee Society was applied. Radiographs were taken under fluoroscopic control. In 3 cases, the need for revision surgery was already obvious. A slight varus angle of 2.1 degrees became apparent. Flexion contracture showed a correlation with the inclination of the femoral component. Radiolucencies of the tibial component showed up in cases with a reduced tibial angle. Radiolucencies of the patella component correlated with lateral subluxation.

A method to determine migration of hip endoprostheses is described. Migration is measured by means of standard AP radiographs and therefore can also be evaluated in retrospective studies. Measurement is conducted in X-ray studies displayed on a computer screen. Enhancement of bony structures by application of filters is available. The developed software can be used with common commercially available computers and X-ray scanners, and does not require special hardware. Several methods to determine accuracy are described. The accuracy of the described method is about 1 mm (95% confidence limit), which compares favourably with other methods, but is less accurate than roentgen stereophotogrammetry. For other methods, accuracy was not determined adequately. Two years after implantation, revision within the first 10 years of follow-up can be predicted with a sensitivity and specificity of more than 80%.