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Non-planar image-rotating OPO ring resonators necessitate polarisation compensation in contrast to their planar counterparts. This is essential for maintaining phase matching conditions for non-linear optical conversion in the resonator during each cavity round trip. In this study, we examine the polarisation compensation and its impact on the performance of two types of non-planar resonators: RISTRA with a π2 image rotation and FIRE with a fractional image rotation (π2 fraction). The RISTRA is insensitive to mirror phase shifts, while the FIRE has a more complex dependence of polarisation rotation on mirror phase shifts. There has been debate over whether a single birefringent element can provide adequate polarisation compensation for non-planar resonators beyond RISTRA-type. Our results show that under certain experimentally feasible conditions, even FIRE resonators can achieve adequate polarisation compensation with a single half-wave plate. We validate our theoretical analysis through numerical simulations and experimental studies of OPO output beam polarisation using ZnGeP2 non-linear crystals.

Study Design: Abstract consensus paper with systematic literature review. Objective: The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts. Methods: The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences. Results: As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers. Conclusion: Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.

STUDY DESIGN Retrospective cohort analysis. PURPOSE Comparison of balloon kyphoplasty (BKP) and radiofrequency kyphoplasty (RFK) with respect to height restoration of the fractured vertebral bodies and the pain relief experienced after the surgical procedure. OVERVIEW OF LITERATURE BKP and RFK both offer safe, time-saving, and potent treatment options for vertebral compression fractures, but neither of these methods demonstrated any key advantage over the other yet. METHODS We performed a retrospective analysis of a cohort of 156 patients (mean age, 73±11 years) with 252 fractured vertebral bodies treated with kyphoplasty. Pain intensity was measured using a Visual Analogue Scale. Preoperative and postoperative computed tomography images were analyzed and gauged using modified bisegmental Cobb angle, vertebral angle, as well as anterior (Ha), middle (Hm), and posterior (Hp) vertebral body heights. RESULTS The mean postoperative pain relief was 5.1±1.8, which was maintained over the entire follow-up period. There were no significant differences in the pain relief between BKP and RFK. Postoperative changes in the vertebral angle (-1.3°±3.3°, p

Study Design: Expert consensus. Objectives: To establish treatment recommendations for subaxial cervical spine injuries based on current literature and the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. Methods: This recommendation summarizes the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. Results: Therapeutic goals are a stable, painless cervical spine and protection against secondary neurologic damage while retaining maximum possible motion and spinal profile. The AOSpine classification for subaxial cervical injuries is recommended. The Canadian C-Spine Rule is recommended to decide on the need for imaging. Computed tomography is the favoured modality. Conventional x-ray is preserved for cases lacking a “dangerous mechanism of injury.” Magnetic resonance imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and to exclude disco-ligamentous injuries. Computed tomography angiography is recommended in high-grade facet joint injuries or in the presence of vertebra-basilar symptoms. A0-, A1- and A2-injuries are treated conservatively, but have to be monitored for progressive kyphosis. A3 injuries are operated in the majority of cases. A4- and B- and C-type injuries are treated surgically. Most injuries can be treated with anterior plate stabilization and interbody support; A4 fractures need vertebral body replacement. In certain cases, additive or pure posterior instrumentation is needed. Usually, lateral mass screws suffice. A navigation system is advised for pedicle screws from C3 to C6. Conclusions: These recommendations provide a framework for the treatment of subaxial cervical spine Injuries. They give advice about diagnostic measures and the therapeutic strategy.

In a consensus process with four sessions in 2017, the working group "upper cervical spine" of the German Society for Orthopaedics and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Upper Cervical Fractures", taking their own experience and the current literature into consideration. The following article describes the recommendations for axis ring fractures (traumatic spondylolysis C2). About 19 to 49% of all cervical spine injuries include the axis vertebra. Traumatic spondylolysis of C2 may include potential discoligamentous instability C2/3. The primary aim of the diagnostic process is to detect the injury and to determine potential disco-ligamentous instability C2/3. For classification purposes, the Josten classification or the modified Effendi classification may be used. The Canadian C-spine rule is recommended for clinical screening for C-spine injuries. CT is the preferred imaging modality and an MRI is needed to determine the integrity of the discoligamentous complex C2/3. Conservative treatment is appropriate in case of stable fractures with intact C2/3 motion segment (Josten type 2 and 2). Patients should be closely monitored, in order to detect secondary dislocation as early as possible. Surgical treatment is recommended in cases of primary severe fracture dislocation or discoligamentous instability C2/3 (Josten 3 and 4) and/or secondary fracture dislocation. Anterior cervical decompression and fusion (ACDF) C2/3 is the treatment of choice. However, in case of facet joint luxation C2/3 with looked facet (Josten 4), a primary posterior approach may be necessary.Im Jahr 2017 wurde die Arbeitsgruppe „obere HWS“ in der Sektion Wirbelsäulenchirurgie der DGOU etabliert. Die Mitglieder der AG erstellten in einem formalen Konsensverfahren im nominalem Gruppenprozess mit 4 Präsenzveranstaltungen, Empfehlungen zur Diagnostik und Therapie von Axisringfrakturen unter Berücksichtigung der aktuellen Literatur. Der folgende Artikel beschreibt die Empfehlung für Frakturen des Axisrings (traumatische Spondylolyse HWK II). Axisfrakturen werden mit einer Häufigkeit von 19 – 41% bei Nachweis einer HWS-Verletzung detektiert. Insbesondere besteht bei Frakturen des Axisrings eine potenzielle diskoligamentäre Instabilität. Daher zielt die Diagnostik auf die Detektion der Verletzung sowie die Beurteilung einer möglichen diskoligamentären Instabilität ab. Zur Klassifikation wird die Klassifikation nach Josten oder auch die von Levine modifizierte Effendi-Klassifikation empfohlen. Zum primären klinischen Screening hat sich die Canadian C-Spine Rule bewährt. Bildgebendes Verfahren der Wahl bei klinischem Verdacht auf eine Axisringverletzung ist die Computertomografie. Die MRT dient der Beurteilung der Integrität des diskoligamentären Komplexes HWK II/III. Stabile Axisringfrakturen können konservativ in einer Zervikalorthese behandelt werden, wobei eine engmaschige Dislokationskontrolle obligat ist. Im Falle einer sekundären Dislokation ist eine operative Stabilisierung indiziert. Eine OP-Indikation besteht bei ausgeprägter Dislokation und/oder diskoligamentärer Instabilität HWK II/III, die am häufigsten bei Josten-Typ-3- und -4-Frakturen vorliegt. Operative Standardtherapie ist die ventrale Fusion HWK II/III wobei insbesondere bei Typ-4-Frakturen ein primär dorsales Vorgehen zur Frakturreposition und ggf. Stabilisation notwendig werden kann.

Groin wound infections pose a major problem in vascular surgery. Closed-incision negative pressure therapy (ciNPT) was especially designed for the management of incisions at risk of surgical site infections. The aim of this study was to investigate whether ciNPT is able to reduce the incidence of wound infections after vascular surgery. Data on 132 consecutive patients, scheduled for vascular surgery with a longitudinal femoral cutdown, were collected prospectively. All patients were randomised either to the ciNPT group (n = 64) or the control group (n = 68) with conventional dressing. In the ciNPT group, the foam dressing was applied intraoperatively and removed after 5 days. The control group received an absorbent dressing. All wounds were evaluated after 5 and 42 days. Infections were graded according the Szilagyi classification (I-III°). There were no significant differences between both groups considering patient characteristics. Indications for surgery were peripheral arterial disease in 95% (125/132) and aneurysm in 5% (7/132). The overall infection rates were 14% (9/64) in the ciNPT group and 28% (19/68) in the control group (P = 0·055). Early infections were observed in 6% (4/64) of the ciNPT group and 15% (10/68) of the control group (P = 0·125). ciNPT did not reduce infection rates associated with different risk factors for infection. While the experiences with the ciNPT device were encouraging, the study fails to provide evidence of the efficacy of the device to reduce groin wound infections after vascular surgery. It illustrates far more that larger multicentre studies are required and appear promising to provide further evidence for the use of ciNPT.

To determine the preferred water molecule binding sites of the polybasic sulfa drugs sulfamethoxazole (SMX) and sulfisoxazole (SIX), we have studied their monomers and monohydrated complexes through laser-desorption conformer-specific UV and IR spectroscopy. Both the SMX and SIX monomer adopt a single conformer in the molecular beam. On the basis of their conformer-specific IR spectra in the NH stretch region, these conformers were assigned to the SMX and SIX global minimum structures, both exhibiting a staggered sulfonamide group and an intramolecular C-HO[double bond, length as m-dash]S hydrogen bond. The SMX-H2O and SIX-H2O complexes each adopt a single isomer in the molecular beam. Their isomeric structures were determined based on their isomer-specific IR spectra in the NH/OH stretch region. Quantum Theory of Atoms in Molecules analysis of the calculated electron densities revealed that in the SMX-H2O complex the water molecule donates an O-HN hydrogen bond to the heterocycle nitrogen atom and accepts an N-HO hydrogen bond from the sulfonamide NH group. In the SIX-H2O complex, however, the water molecule does not bind to the heterocycle but instead donates an O-HO[double bond, length as m-dash]S hydrogen bond to the sulfonamide group and accepts an N-HO hydrogen bond from the sulfonamide NH group. Both water complexes are additionally stabilized by a Cph-HOH2 hydrogen bond. Interacting Quantum Atoms analysis suggests that all intermolecular hydrogen bonds are dominated by the short-range exchange-correlation contribution.

ZusammenfassungIm Rahmen eines Konsensusprozesses der Arbeitsgruppe „subaxiale HWS-Verletzungen“ der Sektion Wirbelsäule der DGOU erfolgte in 4 Sitzungen im Jahre 2016 die Erstellung der vorliegenden Therapieempfehlungen unter Berücksichtigung der vorhandenen Literatur. Therapieziele sind eine dauerhaft stabile, schmerzfreie Halswirbelsäule und der Schutz vor sekundären neurologischen Schäden unter größtmöglicher Berücksichtigung der Beweglichkeit und des Wirbelsäulenprofils. Aufgrund der Praktikabilität und der guten Evaluation hinsichtlich Reliabilität sollte die AOSpine-Klassifikation für subaxiale HWS-Verletzungen für die Klassifikation zur Anwendung kommen. Es wird die Canadian C-Spine Rule als klinischer Algorithmus zur Entscheidung hinsichtlich der Notwendigkeit einer bildgebenden Diagnostik empfohlen. Bei gemäß dieser Regel anamnestisch oder klinisch hohem Verdacht auf eine strukturelle, instabile Verletzung ist die Spiral-CT der HWS Verfahren der Wahl. Die konventionelle Röntgendiagnostik in 2 Ebenen bleibt Fällen vorbehalten, in denen kein „gefährlicher Unfallmechanismus“ vorliegt. Die Indikation für die MRT der HWS wird vor allem bei nicht erklärbaren neurologischen Symptomen, bei geplanter geschlossener Reposition und dorsaler Stabilisierung und zum Ausschluss vermuteter diskoligamentärer Verletzungen empfohlen, wobei hier je nach Befundkonstellation eine abgestufte Dringlichkeit gilt. Die CT-Angiografie wird bei höhergradigen Facettengelenkverletzungen oder bei Vorliegen vertebrobasilärer Symptome empfohlen. Die konventionelle Funktionsdiagnostik wird ausschließlich in Form der ärztlich geführten dynamischen Bildwandlerdurchleuchtung bei persistierendem Verdacht auf eine instabile Verletzung empfohlen. Die therapeutische Strategie richtet sich primär nach der Verletzungsmorphologie, die in der AOSpine-Klassifikation beschrieben wird. A0-Frakturen sollten konservativ behandelt werden. A1- und A2-Frakturen sollten meistens konservativ behandelt werden, wobei die segmentale Kyphose in Einzelfällen eine OP-Indikation bedingen kann. A3-Frakturen stellen in den meisten Fällen eine OP-Indikation dar, in Einzelfällen ist eine konservative Behandlung möglich. A4-Frakturen sowie die B- und C-Verletzungen bedürfen einer operativen Therapie. Die ventrale Plattenspondylodese mit interkorporeller Abstützung (bei Berstungskomponente durch Korporektomie und Wirbelkörperersatz) wird für die meisten Verletzungen empfohlen, eine rein dorsale oder zusätzlich dorsale Stabilisierung kann bei besonderer Befundkonstellation möglich oder sogar notwendig sein. In diesen Fällen ist die Instrumentierung mit Massa-lateralis-Schrauben zumeist ausreichend; bei Anwendung von Pedikelschrauben in Höhe C III – C VI wird ein Navigationssystem empfohlen. Bei Vorliegen einer ankylosierenden Grunderkrankung (M3-Modifikator) wird hingegen die dorsale, langstreckige Stabilisierung favorisiert.

Activation of Gq protein-coupled receptors (GqPCRs) might induce divergent cellular responses, related to receptor-specific activation of different branches of the Gq signaling pathway. Receptor-specific desensitization provides a mechanism of effector modulation by restricting the spatiotemporal activation of signaling components downstream of Gq. We quantified signaling events downstream of GqPCR activation with FRET-based biosensors in CHO and HEK 293 cells. KCNQ1/KCNE1 channels (IKs) were measured as a functional readout of receptor-specific activation. Activation of muscarinic M1 receptors (M1-Rs) caused robust and reversible inhibition of IKs. In contrast, activation of α1B-adrenergic receptors (α1B-ARs) induced transient inhibition of IKs, which turned into delayed facilitation after agonist withdrawal. As a novel finding, we demonstrate that GqPCR-specific kinetics of IKs modulation are determined by receptor-specific desensitization, evident at the level of Gαq activation, phosphatidylinositol 4,5-bisphosphate (PIP2) depletion, and diacylglycerol production. Sustained IKs inhibition during M1-R stimulation is attributed to robust membrane PIP2 depletion, whereas the rapid desensitization of α1B-AR delimits PIP2 reduction and augments current activation by protein kinase C (PKC). Overexpression of Ca2+-independent PKCδ did not affect the time course of α1B-AR-induced diacylglycerol formation, excluding a contribution of PKCδ to α1B-AR desensitization. Pharmacological inhibition of Ca2+-dependent PKC isoforms abolished fast α1B receptor desensitization and augmented IKs reduction, but did not affect IKs facilitation. These data indicate a contribution of Ca2+-dependent PKCs to α1B-AR desensitization, whereas IKs facilitation is induced by Ca2+-independent PKC isoforms. In contrast, neither inhibition of Ca2+-dependent/Ca2+-independent isoforms nor overexpression of PKCδ induced M1 receptor desensitization, excluding a contribution of PKC to M1-R-induced IKs modulation.

In a consensus process with four sessions in 2017, the working group on "the upper cervical spine" of the German Society for Orthopaedic and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Fractures to the Upper Cervical Spine", incorporating their own experience and current literature. The following article describes the recommendations for the atlas vertebra. About 10% of all cervical spine injuries include the axis vertebra. The diagnostic process primarily aims to detect the injury and to determine joint incongruency and integrity of the atlas ring. For classification purposes, the Gehweiler classification and the Dickman classification are suitable. The Canadian c-spine rule is recommended for clinical screening for c-spine injuries. CT is the preferred imaging modality; MRI is needed to determine the integrity of the Lig. transversum atlantis in complete atlas ring fractures. Conservative treatment is appropriate in very many atlas fractures. Surgical treatment is recommended in existing or potential joint incongruity or instability, which are frequently seen in Gehweiler IIIB or Gehweiler IV fractures. Posterior atlanto-axial stabilisation and fusion using transarticular screws or an internal fixator are regarded as a gold standard in the majority of surgical cases. Especially in young patients, the possibility of isolated atlas osteosynthesis should be checked. A possible option for Gehweiler IV fractures is halo-fixation with mild distraction for ligamentotaxis. Secondary dislocation should be checked for frequently. Involvement of the occipito-atlantal joint complex requires stabilisation of the occiput as well.Im Jahr 2017 erstellten die Mitglieder der AG „obere HWS“ der Sektion „Wirbelsäule“ der DGOU in einem Konsensusprozess mit 4 Sitzungen Empfehlungen zur Diagnostik und Therapie oberer Halswirbelsäulenverletzungen unter Berücksichtigung der aktuellen Literatur. Der folgende Artikel beschreibt die Empfehlung für Frakturen des Atlasrings. Etwa 10% aller HWS-Verletzungen betreffen den Atlas. Die Diagnostik zielt im Wesentlichen auf die Detektion der Verletzung sowie die Beurteilung der Gelenkflächen hinsichtlich einer Lateralisationstendenz der Atlasmassive. Zur Klassifikation haben sich die Gehweiler-Klassifikation und ergänzend die Dickman-Klassifikation bewährt. Zum primären klinischen Screening hat sich die Canadian C-Spine Rule bewährt. Bildgebendes Verfahren der Wahl bei klinischem Verdacht auf eine Atlasverletzung ist die CT. Die MRT dient der Beurteilung der Integrität des Lig. transversum atlantis bei vorderer und hinterer Bogenfraktur. Die Indikation zur Gefäßdarstellung sollte großzügig gestellt werden. Viele Atlasfrakturen können konservativ in einer Zervikalorthese behandelt werden. Eine OP-Indikation ist gegeben bei bestehender oder drohender massiver Gelenkinkongruenz oder -instabilität, die am häufigsten bei Gehweiler-IIIB-Frakturen oder bei Gehweiler-IV-Frakturen vorliegt. Operative Standardtherapie ist die dorsale atlantoaxiale Fixation, entweder in transartikulärer Technik oder mittels Fixateur interne. Insbesondere bei jüngeren Patienten sollte die Möglichkeit einer isolierten Atlasosteosynthese geprüft werden. Dislozierte Gehweiler-IV-Frakturen mit sagittaler Spaltbildung können auch probatorisch im Halofixateur unter Ausnutzung der Ligamentotaxis behandelt werden; eine engmaschige Dislokationskontrolle ist obligat. Im Falle einer sekundären Dislokation ist auch hier eine operative Stabilisierung indiziert. Bei Mitbeteiligung des okzipitozervikalen Gelenks ist eine Einbeziehung des Okziputs in die Instrumentierung notwendig.

Lumbopelvic stabilization is a surgical technique used frequently to treat lumbosacral fractures; however, it can also be used in revision cases, infections, or during deformity correction. However, the related soft tissue complication rates associated with open lumbopelvic stabilization are high. Different authors have recently reported minimally invasive surgical techniques. We developed a rigid minimally invasive technique for lumbopelvic stabilization. We present our technique and also present preliminary results from 10 cases. We did not observe soft tissue-related complications in any patient. Implant removal was performed twice, to release healthy disks and because of implant prominence. One patient required revision surgery because of implant loosening due to osteoporosis, and one patient required revision surgery due to screw cap loosening. Postsurgical mobilization was good in all patients without further injuries; however, polytraumatized patients were limited by additional injuries. Thus, minimally invasive U-shaped lumbopelvic stabilization is a useful technique combining the soft tissue-related advantages of minimally invasive surgical techniques as well as a theoretically very rigid construct caused by strong implants.

Die Entscheidung zwischen Erhaltungsversuch und primarer Amputation der schwersttraumatisierten unteren Extremitat ist schwierig und folgenreich. In der Lower-Extremity-Assessment-Project(LEAP)-Studie wurden prospektiv Patienten mit schweren, den Erhalt der Extremitat bedrohenden Verletzungen ab distal des Femurs mit drittgradig offenen Frakturen, definierten Weichteilschaden und Amputationsverletzungen eingeschlossen und nachuntersucht. Die vorliegende Ubersichtsarbeit stellt die Ergebnisse der Studie, die in multiplen Teilaspekten publiziert wurde, unter Berucksichtigung der neueren Literatur dar und leitet Schlussfolgerungen fur die klinische Praxis ab. Wichtige Ergebnisse sind: Bisher ist kein Score ausreichend reliabel, den Erfolg eines Extremitatenerhalts vorherzusagen. Das Ausmas der muskularen Verletzung erscheint fur die Funktion bedeutsamer als das der knochernen Verletzung. Wesentlich fur das Ergebnis sind Begleitverletzungen, die im individuellen Therapiekonzept berucksichtigt werden mussen, sowie Vorerkrankungen und andere patientenspezifische Faktoren (Alkohol, Nikotin, Versicherungsstatus, soziale Aspekte). Psychische Beeintrachtigungen sind haufige Folgen dieser Verletzungen und sollten bei der Rehabilitation Beachtung finden.

Bei schwerstem Trauma der unteren Extremitat stellt sich nicht selten die Frage der Erfolgswahrscheinlichkeit eines Extremitatenerhalts. Objektive Kriterien sollen bei der Entscheidungsfindung helfen. Im Folgenden demonstrieren wir aus der klinischen Praxis einer universitaren unfallchirurgischen Klinik drei Fallberichte von Patienten mit schwerstem Trauma der unteren Extremitat mit jeweils unterschiedlicher Herangehensweise.

The clinical decision-making process for patients with severe trauma of the extremities for primary amputation or to initiate extensive reconstructive measures for limb salvage in the best interests of the patient can be complex and difficult. The many factors influencing the decision-making process, such as local anatomical, pathomechanical, physiological, psychosocial and general factors are demonstrated and discussed. In the past, the role of scores supporting the decision-making process for amputation or limb salvage has been overestimated. In the LEAP study it could clearly be demonstrated that none of the sometimes highly complex scores could fulfill the expectations to predict successful limb salvage or the need for amputation. In this article it is shown that initiators and authors of scores achieved much higher sensitivity and specificity in the inaugural studies compared to the standardized and controlled conditions used in the LEAP study. For a long time, a lack of feeling in the feet was considered a safe and reliable criterion for amputation but the LEAP study has made a substantial contribution to demythologizing this as a lead symptom. Patients with severe trauma of the ankle or foot requiring a free flap or ankle arthrodesis have a significantly worse outcome compared to patients with a below knee amputation. Taking all these influencing factors into consideration, a comprehensive algorithm is presented that facilitates, strengthens and standardizes decision-making for amputation or limb salvage. This algorithm consists of four modules: 1) decision-making, 2) emergency treatment, 3) definitive treatment and 4) fine tuning. In the decision-making module not only local and general injury severity are addressed but the expected result, the general condition, comorbidities, compliance and the will of the patient are also included.

Sagittale Wirbelsaulendeformitaten gehen mit energiereichen Kompensationsmechanismen einher und resultieren regelmasig in lumbal lokalisierten Ruckenschmerzen. Das sagittale Wirbelsaulenprofil wird insbesondere durch das Verhaltnis der spinalen Lordosen und Kyphosen in Relation zur Stellung des Beckens beschrieben und ist in einer Wirbelsaulenganzaufnahme radiologisch zu beurteilen. Verschiedene radiologische Schlusselparameter beschreiben das sagittale Profil. Insbesondere die lumbale Lordose (LL) sowie die pelvine Inzidenz (PI), der pelvine Tilt (PT) und die thorakale Kyphose (TK) sind hier von besonderer Bedeutung. Die Differenz und PI−LL zeigt die hochste Korrelation zur eingeschrankten Lebensqualitat. Fur eine erste grobe Abschatzung der sagittalen Balance kann jedoch auch die SVA (Sagittal Vertical Axis) verwendet werden. Den Grad der Balance bzw. Imbalance kann man unter Verwendung der SVA sowie des PT ermitteln, die chirurgische Therapie bedarf jedoch einer genaueren Analyse, wozu insbesondere die SRS-Schwab-Klassifikation (SRS: Scoliosis Research Society) verwendet werden kann.

Study Design: Expert opinion. Objectives: Osteoporotic vertebral fractures are of increasing medical importance. For an adequate treatment strategy, an easy and reliable classification is needed. Methods: The working group “Osteoporotic Fractures” of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) has developed a classification system (OF classification) for osteoporotic thoracolumbar fractures. The consensus decision followed an established pathway including review of the current literature. Results: The OF classification consists of 5 groups: OF 1, no vertebral deformation (vertebral edema); OF 2, deformation with no or minor (1/5) of the posterior wall; OF 4, loss of integrity of the vertebral frame or vertebral body collapse or pincer-type fracture; OF 5, injuries with distraction or rotation. The interobserver reliability was substantial (κ = .63). Conclusions: The proposed OF classification is easy to use and provides superior clinical differentiation of the typical osteoporotic fracture morphologies.

We thank Dr. Prandoni and colleagues for their critical review of our paper ([1][1]). As correctly highlighted, the low observed prevalence of pulmonary embolism (PE) among patients with syncope in BASEL (Basel Syncope Evaluation) IX contrasts with the high observed prevalence of PE in the PESIT (

The following study on natural immunology in schizophrenic patients aims at elucidating differential effects of psychopathological status and neuroleptic treatment. Natural killer (NK-) cell activity and antibody dependent cellular cytotoxity (ADCC) were tested in 24 adolescent schizophrenic patients and compared to 27 adult schizophrenics and healthy controls. Twelve adolescent patients were tested before and after 2 weeks on neuroleptic treatment. Age or psychopathological status did not have a significant impact on NK-activity or ADCC. There were no significant general effects resulting from neuroleptic treatment on NK-activity detectable in patients tested before and during treatment. However, there was a significant negative correlation between the differences of NK-activity (before and during treatment) and the NK-activity before treatment.

Following lumbar fusion, adjacent segment degeneration has been frequently reported. Dynamic systems are believed to reduce main fusion drawbacks. We conducted a retrospective study on patients with degenerative lumbar disease treated with posterior dynamic stabilization with monoaxial hinged pedicular screws and lumbar decompression. VAS and ODI were used to compare clinical outcomes. As radiological outcomes, LL and SVA were used. 51 patients were included with an average follow-up of 24 months. 13 patients were revised because of postoperative radiculopathy (n=4), subcutaneous hematoma(n=2), L5 screw malposition (n=1) and adjacent segment disease (n=6). The mean ODI score 41 preoperatively compared to 36 postoperatively. The mean VAS scores for back and leg pain were 5.3 and 4.2, respectively compared to 4.5 and 4.0 post-operatively. The mean SVA was 5.3 cm pre-operatively, and 5.7 cm postoperatively. The mean LL was 47.5° preoperatively and 45.5° postoperatively. From our data, whichfail to show significant improvements andreflect a high revision rate, we cannot generally recommend dynamic stabilization as an alternative to fusion. Comparative trials with longer follow-ups are required.

Eine 78-jahrige Patientin stellt sich vier Tage nach Sturz auf der Toilette einer Belegarztklinik vor, in der sie wegen chronischer Ruckenschmerzen behandelt worden war. Auf den initial durchgefuhrten Rontgenaufnahmen sowie im Computertomogramm (CT) war keine Fraktur nachgewiesen worden.

Background Inverse dynamization has recently been proposed for the treatment of tibia non-unions. Nickel-titanium (NiTi) shape memory alloys (SMAs) may provide an opportunity for contactless non-invasive alteration of the stiffness of an implant after surgery. Objective The aim of this pilot study was to analyze the feasibility of the one way shape memory effect in a large animal as well as the feasibility of our ovine large animal fracture model. Methods A tibia osteotomy was performed in three sheep, followed by NiTi plate osteosynthesis in two cases and standard locking compression plate (LCP) osteosynthesis in one sheep. Contactless induction heating was performed after 3 weeks in order to alter the stiffness of the NiTi plates. Euthanasia was followed by biomechanical analysis after 8 weeks. Results Successful change of configuration through contactless induction heating was shown in both SMA plates by image intensifier control. Although large differences in bending and torsional stiffness were observed between the operated and contralateral tibia, the sheep ambulated almost normally at six weeks post-operative. Conclusion We were able to trigger the one way shape memory effect which non-invasively altered the stiffness of the plate osteosynthesis.

Synthetic graft materials are considered as possible substitutes for cancellous bone, but lack osteogenic and osteoinductive properties. In this study, we investigated how composite scaffolds of βTCP containing osteogenic human bone marrow mesenchymal stem cells (hBMSCs) and osteoinductive bone morphogenetic protein-2 (BMP-2) influenced the process of fracture healing. hBMSCs were loaded into βTCP scaffolds 24 h before implantation in a rat critical-sized bone defect. hBMSCs were either stimulated with rhBMP-2 or transduced with BMP-2 by gene transfer. The effect of both protein stimulation and gene transfer was compared for osteogenic outcome. X-rays were conducted at weeks 0, 1, 3, 6, 9 and 12 post-operatively. In addition, bone-labelling fluorochromes were applied at 0, 3, 6 and 9 weeks. Histological analysis was performed for the amount of callus tissue and cartilage formation. At 6 weeks, the critical-sized defect in 33% of the rats treated with the Ad-BMP-2-transduced hBMSCs/βTCP scaffolds was radiographically bridged. In contrast, in only 10% of the rats treated with rhBMP2/hBMSCs, 12 weeks post-treatment, the bone defect was closed in all treated rats of the Ad-BMP-2 group except for one. Histology showed significantly higher amounts of callus formation in both Ad-BMP-2- and rhBMP-2-treated rats. The amount of neocartilage was less pronounced in both BMP-2-related groups. In summary, scaffolds with BMP-2-transduced hBMSCs performed better than those with the rhBMP2/hBMSCs protein. These results suggest that combinations of osteoconductive biomaterials with genetically modified MSCs capable of secreting osteoinductive proteins may represent a promising alternative for bone regeneration. Copyright © 2015 John Wiley & Sons, Ltd.

In a consensus process during four sessions in 2016, the working group "lower cervical spine" of the German Society for Orthopedic and Trauma Surgery (DGOU), formulated "Therapeutic Recommendations for the Lower Cervical Spine", taking into consideration the current literature. Therapeutic goals are a permanently stable, painless cervical spine and the protection against secondary neurologic damage while retaining the greatest possible amount of motion and spinal profile. Due to its ease of use and its proven good reliability, the AOSpine classification for subaxial cervical injuries should be used. The Canadian C-Spine Rule is recommended as a clinical decision rule whether to perform imaging or not. If a structural or unstable injury is suspected by patient history or clinical findings, a spiral CT scan of the cervical spine is the favoured diagnostic modality. Conventional X-ray is reserved for patients in whom there is no "dangerous mechanism of injury". MR imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and open posterior surgery and to exclude disco-ligamentous injuries. Urgency of MR imaging depends on the specific findings. CT angiography is recommended in higher-grade facet joint injuries or in the presence of vertebra-basilar symptoms. Flexion-extension imaging is recommended only as a physician-guided dynamic fluoroscopy, when an unstable lesion is still suspected. The therapeutic strategy is mainly dependent on morphologic criteria, which are described using the AOSpine classification. A0-injuries are treated conservatively. A1- and A2-injuries are treated conservatively in the majority of cases, and in single cases a gross kyphotic deformity might indicate surgical stabilisation. A3-injuries do indicate a surgical therapy in the majority of cases, but certain cases might be treated conservatively. A4-fractures as well as B- and C-type injuries are to be treated surgically. Most injuries can be treated by anterior plate stabilisation with interbody support; when a complete burst fracture is present, corpectomy and vertebral body replacement is necessary. In certain cases, an additive posterior or pure posterior instrumentation might be possible or even mandatory. In most of these cases, lateral mass screws are sufficient; when pedicle screws are applied in C3 to C6, a 3D-navigation system is recommended. Injuries in an ankylosing spine (M3-modifier) should be treated preferably from posterior with long-segment instrumentation.Im Rahmen eines Konsensusprozesses der Arbeitsgruppe „subaxiale HWS-Verletzungen“ der Sektion Wirbelsäule der DGOU erfolgte in 4 Sitzungen im Jahre 2016 die Erstellung der vorliegenden Therapieempfehlungen unter Berücksichtigung der vorhandenen Literatur. Therapieziele sind eine dauerhaft stabile, schmerzfreie Halswirbelsäule und der Schutz vor sekundären neurologischen Schäden unter größtmöglicher Berücksichtigung der Beweglichkeit und des Wirbelsäulenprofils. Aufgrund der Praktikabilität und der guten Evaluation hinsichtlich Reliabilität sollte die AOSpine-Klassifikation für subaxiale HWS-Verletzungen für die Klassifikation zur Anwendung kommen. Es wird die Canadian C-Spine Rule als klinischer Algorithmus zur Entscheidung hinsichtlich der Notwendigkeit einer bildgebenden Diagnostik empfohlen. Bei gemäß dieser Regel anamnestisch oder klinisch hohem Verdacht auf eine strukturelle, instabile Verletzung ist die Spiral-CT der HWS Verfahren der Wahl. Die konventionelle Röntgendiagnostik in 2 Ebenen bleibt Fällen vorbehalten, in denen kein „gefährlicher Unfallmechanismus“ vorliegt. Die Indikation für die MRT der HWS wird vor allem bei nicht erklärbaren neurologischen Symptomen, bei geplanter geschlossener Reposition und dorsaler Stabilisierung und zum Ausschluss vermuteter diskoligamentärer Verletzungen empfohlen, wobei hier je nach Befundkonstellation eine abgestufte Dringlichkeit gilt. Die CT-Angiografie wird bei höhergradigen Facettengelenkverletzungen oder bei Vorliegen vertebrobasilärer Symptome empfohlen. Die konventionelle Funktionsdiagnostik wird ausschließlich in Form der ärztlich geführten dynamischen Bildwandlerdurchleuchtung bei persistierendem Verdacht auf eine instabile Verletzung empfohlen. Die therapeutische Strategie richtet sich primär nach der Verletzungsmorphologie, die in der AOSpine-Klassifikation beschrieben wird. A0-Frakturen sollten konservativ behandelt werden. A1- und A2-Frakturen sollten meistens konservativ behandelt werden, wobei die segmentale Kyphose in Einzelfällen eine OP-Indikation bedingen kann. A3-Frakturen stellen in den meisten Fällen eine OP-Indikation dar, in Einzelfällen ist eine konservative Behandlung möglich. A4-Frakturen sowie die B- und C-Verletzungen bedürfen einer operativen Therapie. Die ventrale Plattenspondylodese mit interkorporeller Abstützung (bei Berstungskomponente durch Korporektomie und Wirbelkörperersatz) wird für die meisten Verletzungen empfohlen, eine rein dorsale oder zusätzlich dorsale Stabilisierung kann bei besonderer Befundkonstellation möglich oder sogar notwendig sein. In diesen Fällen ist die Instrumentierung mit Massa-lateralis-Schrauben zumeist ausreichend; bei Anwendung von Pedikelschrauben in Höhe C III – C VI wird ein Navigationssystem empfohlen. Bei Vorliegen einer ankylosierenden Grunderkrankung (M3-Modifikator) wird hingegen die dorsale, langstreckige Stabilisierung favorisiert.

We have studied the conformational preferences of the sulfonamide drug sulfanilamide, its dimer, and its monohydrated complex through laser desorption single-conformation UV and IR spectroscopy in a molecular beam. Based on potential energy curves for the inversion of the anilinic and the sulfonamide NH2 groups calculated at DFT level, we suggest that the zero-point level wave function of the sulfanilamide monomer is appreciably delocalized over all four conformer wells. The sulfanilamide dimer, and the monohydrated complex each exhibit a single isomer in the molecular beam. The isomeric structures of the sulfanilamide dimer and the monohydrated sulfanilamide complex were assigned based on their conformer-specific IR spectra in the NH and OH stretch region. Quantum Theory of Atoms in Molecules (QTAIM) analysis of the calculated electron density in the water complex suggests that the water molecule is bound side-on in a hydrogen bonding pocket, donating one O–H⋯OS hydrogen bond and accepting two hydrogen bonds, a NH⋯O and a CH⋯O hydrogen bond. QTAIM analysis of the dimer electron density suggests that the Ci symmetry dimer structure exhibits two dominating N–H⋯OS hydrogen bonds, and three weaker types of interactions: two CH⋯O bonds, two CH⋯N bonds, and a chalcogen O⋯O interaction. Most interestingly, the molecular beam dimer structure closely resembles the R22 dimer unit – the dimer unit with the greatest interaction energy – of the α, γ, and δ crystal polymorphs. Interacting Quantum Atoms analysis provides evidence that the total intermolecular interaction in the dimer is dominated by the short-range exchange–correlation contribution.

Biomechanical stimuli play a major role in fracture healing. Changing the fixation stiffness through the course of healing might accelerate bone healing and prevent healing complications. Shape memory alloy (SMA) based implants were developed to allow for non-invasive stiffness alteration during the fracture healing process. To gain a deeper understanding of the implant functionality based on the alloy characteristics and geometric design, the mechanical properties of different shape memory alloys where mechanically characterized. SMA bone plates were manufactured and the structural bending stiffness of the implants was determined at different temperatures and configurations. The temperature required for complete recovery of shape after deformation increased continuously with increasing pseudo-plastic deformation in SMA probes. Full recovery was observed at temperatures ranging from 38°C to 52°C after pseudo-plastic deformations ranging from 0.2% to 1.0% outer fibre strain, respectively. The small fragment inverse-dynamisation implants revealed bending stiffnesses ranging from 0.09Nm2 to 0.34Nm2 in the initial state and from 0.16Nm2 to 0.46Nm2 after shape alteration. Dependent on the design, a relative gain of the implant stiffness ranging from 18.8% to 115.0% could be observed. The large inverse-dynamisation implants revealed bending stiffnesses from 3.7Nm2 to 7.1Nm2 before and 4.1Nm2 to 12.6Nm2 after triggering the shape memory effect. Dependent on the design a gain in stiffness from 11.8% to 117.2% was observed. Warming the SMA implant to 40°C for a short period of time, leads to a moderate increase in implant stiffness of up to 64.5%, while triggering the implant with 50°C leads to a maximum increase in stiffness of up to 127.3%. The Nitinol shape memory bone plates have a huge potential for improving the treatment of long shaft fractures by allowing for the increase, decrease or incremental change of implant stiffness in fracture stabilization. However, the interaction between design, material properties, and manufacturing processes need to be carefully considered for each specific application to achieve optimum function of SMA-based, stiffness altering, fracture-fixation implants.

Quantitative secretome analyses are a high-performance tool for the discovery of physiological and pathophysiological changes in cellular processes. However, serum supplements in cell culture media limit secretome analyses, but serum depletion often leads to cell starvation and consequently biased results. To overcome these limiting factors, we investigated a model of T cell activation (Jurkat cells) and performed an approach for the selective enrichment of secreted proteins from conditioned medium utilizing metabolic marking of newly synthesized glycoproteins. Marked glycoproteins were labeled via bioorthogonal click chemistry and isolated by affinity purification. We assessed two labeling compounds conjugated with either biotin or desthiobiotin and the respective secretome fractions. 356 proteins were quantified using the biotin probe and 463 using desthiobiotin. 59 proteins were found differentially abundant (adjusted p-value ≤0.05, absolute fold change ≥1.5) between inactive and activated T cells using the biotin method and 86 using the desthiobiotin approach, with 31 mutual proteins cross-verified by independent experiments. Moreover, we analyzed the cellular proteome of the same model to demonstrate the benefit of secretome analyses and provide comprehensive data sets of both. 336 proteins (61.3%) were quantified exclusively in the secretome. Data are available via ProteomeXchange with identifier PXD004280.

Sell-Offs, d. h. Desinvestitionen durch den Verkauf von Unternehmensteilen, sind eine bedeutsame strategische Masnahme des Managements, um den Unternehmenswert zu steigern. Die vorliegenden zahlreichen empirischen Untersuchungen zeigen jedoch heterogene Befunde zu den durch Sell-Offs ausgelosten Wertanderungen und deren Einflussfaktoren. Insofern besteht eine hohe Relevanz fur eine umfassende Meta-Analyse der bislang vorliegenden Ergebnisse. Mit dem vorliegenden Beitrag werden deshalb erstmalig 64 Ereignisstudien zu Wertsteigerungen von Sell-Offs, die im Zeitraum von 1984–2010 publiziert wurden, anhand von vierzehn Hypothesen studienubergreifend untersucht. Dabei wird ermittelt (1) in welchem Ausmas Wertsteigerungen durch Sell-Offs realisiert und (2) durch welche Faktoren die Aktienkursreaktionen bei der Ankundigung von Sell-Offs beeinflusst wurden. Die Ergebnisse zeigen eindeutige positive Auswirkungen auf den Wert des verkaufenden Unternehmens bei der Bekanntgabe von Sell-Offs. Zudem ergeben sich signifikant positive Einflusse auf den Unternehmenswert bei der Ankundigung von Sell-Offs durch Faktoren, die (a) durch das Desinvestitionsobjekt bedingt sind (relative Transaktionsgrose, unzureichende Rentabilitat und inlandischer Sitz) und (b) das desinvestierende Unternehmen kennzeichnen (Ausschuttung des Desinvestitionserloses an die Kapitalgeber, Bekanntgabe des Verkaufspreises sowie Kaufpreiszahlung mit Aktien). Die Ergebnisse der Meta-Analyse betonen sowohl die Vorteilhaftigkeit als auch die Notwendigkeit, dass von den Unternehmen ihr Portfolio der Beteiligungen kontinuierlich uberpruft wird, um ggf. Sell-Offs wertsteigernd durchfuhren zu konnen. Die identifizierten Einflussfaktoren geben Anhaltspunkte fur das Management, um bei der Durchfuhrung von Sell-Offs moglichst positive Auswirkungen auf den Unternehmenswert zu erzielen.

This article shows an approach to change the properties of an orthopaedic shape memory implant within biological tissue, using contactless induction heating. Due to inducing the one way-memory effect, triggered by the rise of temperature within the implant, the geometry and hence the mechanical properties of the implant itself, are altered. The power uptake of the implant, depending on the induction parameters as well as on its position within the induction coil, is shown. Thermographic measurements are carried out in order to determine the surface temperature distribution of the implant. In order to simulate biological tissue, the implant was embedded in agarose gel. Suitable heating parameters, in terms of a short heating process in combination with a reduced heat impact on the surrounding environment, were determined.

The purpose of this study was to analyze the actual injury situation of bicyclists focusing on accidents involving more than one bicyclist. A medical and technical analysis was performed as a basis for preventive measures.Technical and medical data were collected at the scene, shortly after the accident. Technical analysis included speed at crash, type of collision, impact angle, environment, lane used, and relative velocity. Medical analysis included injury patterns and severity (Abbreviated Injury Scale [AIS], Injury Severity Score [ISS]).Five hundred seventy-eight injured bicyclists in 289 accidents from 1999 to 2008 were included into the study. Sixty-one percent were male (n = 350) and 39 percent were female (n = 228). Sixty-seven percent ranged between 18 and 64 years of age, 12 percent each between 13 and 17 years of age and older than 65 years, 8 percent between 6 and 12 years, and 1 percent between 2 and 5 years. Ninety-two percent of crashes took place in urban areas and 8 percent in rural areas. Ninety-seven percent of crashes occurred in dry conditions and 3 percent in wet conditions. Eighty-three percent of all accidents occurred during the daytime, 10 percent at night, and 7 percent at dawn. The helmet use rate was only 7.5 percent for all involved bicyclists. The mean Abbreviated Injury Scale (AIS) score was 1.31.The prevalence of bicycle-to-bicycle crashes is high. Most of these accidents occur in urban areas. Bicyclists should be considered as minimally or unprotected road users, with an unsatisfactorily low rate of helmet use. Though the average level and patterns of injuries is moderate, most of the severe injuries involved the head and extremities. However, there was no significant correlation between frequent helmet use and sustained injuries to the head of major AIS.

Background The effectiveness of bicycle safety helmets in preventing head injuries is well- documented. Recent studies differ regarding the effectiveness of bicycle helmets in preventing facial injuries, especially those of the mid-face and the mandible. Objectives The present study was conducted to determine the protective effect of a bicycle helmet in preventing mid-face and mandibular fractures. Patients and Methods Data from an accident research unit were analyzed to collect technical collision details (relative collision speed, type of collision, collision partner, and use of a helmet) and clinical data (type of fracture). Results Between 1999 and 2011, 5,350 bicycle crashes were included in the study. Of these, 175 (3.3%) had fractures of the mid-face or mandible. In total, 228 mid-face or mandibular fractures were identified. A significant correlation was found between age and relative collision speed, and the incidence of a fracture. While no significant correlation was found between the use of a helmet and the incidence of mid-facial fractures, the use of a helmet was correlated with a significantly increased incidence of mandibular fractures. Conclusions Higher age of cyclists and increasing speed of the accident opponent significantly increase the likelihood of sustaining facial fractures. The use of bicycle helmets does not significantly reduce the incidence of mid-facial fractures, while being correlated with an even increased incidence of mandibular fractures.

Background While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTA) involving trucks, little is known about RTA injury risk for truck drivers. Objectives The aim of this study was to analyze the injury severity in truck drivers following RTAs. Patients and Methods Our local accident research unit prospectively documented 43000 RTAs involving 582 trucks between 2000 and 2011. Injury severity, including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration. Results Thirteen percent (77/582) of truck drivers were injured. Extremities were found to be at highest risk of injury with the lower extremities (36x) being injured most severely (10x: AIS 2 and 3). Death occurred only after collisions with other trucks, and severity of injuries increased with an increased speed limit. The maximum abbreviated injury scale was higher in the crash opponents (56x MAIS ≥ 3) compared to the truck drivers (8x MAIS ≥ 3). Overall, 82% of the crash opponents were injured. Conclusions The safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.

The aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. Management consisted of analgesia, sedation, and application of a halo skull traction device. After removing halo skull traction, full reduction and recovery were achieved without instability.

We present a literature review about implant removal after operative extremity and spine fracture treatment. The indication for implant removal procedures has become less frequent in recent years, but is still more common in Europe than for example in North America. The time required to perform a implant removal can easily exceed the planned amount. Implant removal can result in significant complications like soft tissue damage, fractures, infections, and other problems. Not only because of these problems, the decision on whether or not to remove the implant should be made with great care. Therefore good communication with the patient and thorough information about risks and benefits are essential.

Objective Pedestrians, bicyclists and motorcyclists can suffer serious injury in road traffic crashes. To date, no studies examine the injury severity within this vulnerable cohort following collisions with reversing cars. Material and methods Our institution prospectively maintains a database including medical and technical information regarding traffic accidents in our area, including urban and suburban regions. In a retrospective review of this database, the authors describe the injury severity of pedestrians, bicyclists and motorcyclists following traffic crashes involving reversing cars. Injury severity was described using the abbreviated injury scale (AIS) as well as the maximum abbreviated injury scale (MAIS). Results This study included 234 crashes occurring between 1999 and 2012. The lower extremity was injured most often while also suffering more severe injuries with a median AIS of 1 compared to 0 in all other documented body regions. The upper extremity was injured second most often. AIS ranging from 4 to 6 were infrequent. AIS 3 however, was documented for the legs in 4.3% of patients. MAIS 0, 1, 2, 3, 5 and 9 were found in 1, 164, 46, 14, 1, and 8 patients in the study cohort, respectively. Pedestrians and motorcyclists were seriously injured in 9.1% and 9.6% of cases, respectively. In contrast, no bicyclists suffered serious injuries. As to the zone of impact, most collisions occurred at the rear center of the vehicle (35%) followed by rear left (26%), rear right (20%), side rear (11%), side center (4%) and side front (3%). 204 (87.2%) collisions occurred during the day, 19 (8.1%) at night and 11 (4.7%) at twilight. Speed was similar in crashes involving pedestrians, bicyclists and motorcyclists, being as high as 7.0 ± 3.6, 7.0 ± 4.0 and 7.9 ± 4.2 km/h respectively. Conclusions This is the first study that analyzes injury severity among these vulnerable road users following collisions with reversing vehicles. The majority of collisions occur at low impact speed during the day. Most injuries resulting from these collisions are not serious, however pedestrians are at greatest risk of severe injury to any body region. The lower extremities suffer the most serious and frequent injuries within this cohort.

Rotationally resolved microwave and ultraviolet spectra of jet-cooled bis-(4-hydroxyphenyl)methane (b4HPM) have been obtained using Fourier-transform microwave and UV laser/molecular beam spectrometers. A recent vibronic level study of b4HPM [Rodrigo, C. P.; Müller, C. W.; Pillsbury, N. R.; James, W. H., III; Plusquellic, D. F.; Zwier, T. S. J. Chem. Phys. 2011, 134, 164312] has assigned two conformers distinguished by the orientation of the in-plane OH groups and has identified two excitonic origins in each conformer. In the present study, the rotationally resolved bands of all four states have been well-fit to asymmetric rotor Hamiltonians. For the lower exciton (S(1)) levels, the transition dipole moment (TDM) orientations are perpendicular to the C(2) symmetry axes and consist of 41(2):59(2) and 34(2):66(2)% a:c hybrid-type character. The S(1) levels are therefore delocalized states of B symmetry and represent the antisymmetric combinations of the zero-order locally excited states of the p-cresol-like chromophores. The TDM polarizations of bands located at ≈132 cm(-1) above the S(1) origins are exclusively b-type and identify them as the upper exciton S(2) origin levels of A symmetry. The TDM orientations and the relative band strengths from the vibronic study have been analyzed within a dipole-dipole coupling model in terms of the localized TDM orientations, μ(loc), on the two chromophores. The out-of-the-ring plane angles of μ(loc) are both near 20° and are similar to results for diphenylmethane [Stearns, J. A.; Pillsbury, N. R.; Douglass, K. O.; Müller, C. W.; Zwier, T. S.; Plusquellic, D. F. J. Chem. Phys. 2008, 129, 224305]. The in-plane angles are, however, rotated by 14 and 18° relative to DPM and, in part, explain the smaller than expected exciton splittings of these two conformers.

In dieser Arbeit werden Empfehlungen zur Versorgung von Frakturen der Brust- (BWS) und der Lendenwirbelsaule (LWS) gegeben. Die Empfehlungen beruhen auf der Erfahrung der beteiligten Wirbelsaulenchirurgen der Arbeitsgemeinschaft „Wirbelsaule“ der Deutschen Gesellschaft fur Unfallchirurgie unter Berucksichtigung der aktuellen Literatur. Grundlagen der Diagnostik, der konservativen und operativen Therapie werden dargestellt. Die Frakturen werden Anhand von morphologischen Kriterien, wie der Zerstorung des Wirbelkorpers, der Fragmentdislokation, der Einengung des Spinalkanals, der Achsabweichungen und der Abweichung vom individuellen sagittalen Profil beurteilt. Die Abweichung von dem individuellen sagittalen Profil wird anhand der Anderung des monosegmentalen oder bisegmentalen Grund-Deckplatten-Winkels bestimmt. Es werden die Therapieoptionen fur den knochengesunden Patienten aufgezeigt.

While primary tumours of the spine are rare, the spine is the most common site in the skeletal system for metastases. Depending on resectability, type of tumour and existing or pending neurological deficits, surgical options are en-bloc-resection, intralesional resection, palliative decompression and stabilisation (as a rule also palliative) or vertebro- and kyphoplasties (augmentation with bone cement). Scoring systems can help to determine the life expectancy and subsequently influence the choice of options; nevertheless each decision has to be made on an individual basis and should be the result of an interdisciplinary approach together with radiotherapists and oncologists.

AIM: Quads or all-terrain vehicles do not seem to play a major role either in traffic accidents or in hospital admissions in Germany. However, reports about spectacular quad crashes in the press are not that infrequent. In contrast, no scientific survey or study regarding the issue of quad crashes in Germany has been published so far. Thus, this study aims to evaluate the present incidence of quad crashes, accident circumstances and resulting injury patterns, and to discuss possible consequences. METHOD: At a level I trauma centre, data from accident and hospital records of quad drivers were analysed focusing on the following parameters: injury type, localisation and mechanism, treatment details, abbreviated injury scale (AIS) score, maximum AIS (MAIS) score, delta-v, collision speed, and other technical parameters. Comparisons to motorcycle accidents were performed. RESULT During a five-year period from 2005 to 2009, there were ten admissions of quad drivers out of around 11 000 emergency trauma patients (0.1 %). Five accidents had happened off-road, four were traffic accidents. Eight patients were male; the mean age was 30 years. The mean total hospital stay was 15 days; there was a mean of 1.5 stays per patients with 2.0 surgical procedures needed. One patient died, only two recovered fully. The accident research data bank revealed 14 cases of quad accidents out of 18 990 (0.1 %). The mean impact velocity was 35 km/h (motorcyclists 40.0 km/h). The most frequent injury mechanism was a collision with a car. The upper extremity was the predominant injured region (AIS 0.7), while it was the lower extremity for motorcyclists (AIS0.91). The maximum AIS were 1.4 in quad drivers and 1.49 in motorcyclists. CONCLUSIONS: Although the absolute incidence of quad accidents in Germany is low, they pose a relatively high risk for severe injuries. Possible reasons are the comparatively low active and passive safety of quads as well as limited experience with quad driving and the "fun" aspect which might provoke risky driving behaviour. Larger series from the US report a high incidence of drug abuse among quad casualties as well as very limited use of helmets. In Germany, helmet usage has been mandatory since 2006. Possible additional measures to prevent a rise in quad accidents could be the total prohibition of alcohol consumption for quad drivers as well as special courses or driving licenses or an increase of the legal age for driving quads. Language: en

Shape memory orthopaedic implants made from nickel–titanium (NiTi) might allow the modulation of fracture healing, changing their cross-sectional shape by employing the shape memory effect. We aimed to show the feasibility and safety of contact-free electromagnetic induction heating of NiTi implants in a rat model. A water-cooled generator–oscillator combination was used. Induction characteristics were determined by measuring the temperature increase of a test sample in correlation to generator power and time. In 53 rats, NiTi implants were introduced into the right hind leg. The animals were transferred to the inductor, and the implant was electromagnetically heated to temperatures between 40 and 60°C. Blood samples were drawn before and 4 h after the procedure. IL-1, IL-4, IL-10, TNF-α, and IFN-γ were measured. Animals were euthanized at 3 weeks. Histological specimens from the hind leg and liver were retrieved and examined for inflammatory changes, necrosis, and corrosion pits. Cytokine measurements and histological specimens showed no significant differences among the groups. We concluded that electromagnetic induction heating of orthopedic NiTi implants is feasible and safe in a rat model. This is the first step in the development of new orthopedic implants in which stiffness or rigidity can be modified after implantation to optimize bone-healing. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1671–1676, 2010

Wirbelkorperkompressionsfrakturen stellen eine der haufigsten Manifestationsformen der Osteoporose dar. Die konservative Therapie umfasst neben einer adaquaten Schmerztherapie v. a. die Sekundarprophylaxe zur Senkung des Risikos weiterer osteoporosebedingter Frakturen. Neben einer medikamentosen Osteoporosetherapie beinhaltet dies individuell auch Krankengymnastik und Orthesen. In vielen Fallen fuhren osteoporosebedingte Wirbelkorperkompressionsfrakturen jedoch zu anhaltenden Schmerzen und Einschrankungen in der Aktivitat und Lebensqualitat. In diesen Fallen konnen Kyphoplastie und Vertebroplastie effektive Behandlungsoptionen darstellen.

The excited-state dynamics of phenylvinylacetylene (1-phenyl-1-buten-3-yne, PVA) have been studied using laser-induced fluorescence spectroscopy, ultraviolet depletion spectroscopy, and the newly developed method of ultraviolet population transfer spectroscopy. Both isomers of PVA (E and Z) show a substantial loss in fluorescence intensity as a function of excitation energy. This loss in fluorescence was shown to be due to the turn-on of a nonradiative process by comparison of the laser-induced fluorescence spectrum to the ultraviolet depletion spectrum of each isomer, with a threshold 600 cm(-1) above the electronic origin in Z-PVA and 1000 cm(-1) above the electronic origin in E-PVA. Ab initio and density functional theory calculations have been used to show that the most likely source of the nonradiative process is from the interaction of the pi pi* state with a close lying pi sigma* state whose minimum energy structure is bent along the terminal CCH group. Ultraviolet population transfer spectroscopy has been used to probe the extent to which excited-state isomerization is facilitated by the interaction with the pi sigma* state. In ultraviolet population transfer spectroscopy, each isomer was selectively excited to vibronic levels in the S(1) state with energies above and below the threshold for fluorescence quenching. The ultraviolet-excited populations are then recooled to the zero point levels using a reaction tube designed to constrain the supersonic expansion and increase the collision cooling capacity of the expansion. The new isomeric distribution was detected in a downstream position using resonant-2-photon ionization spectroscopy. From these spectra, relative isomerization quantum yields were calculated as a function of excitation energy. While the fluorescence quantum yield drops by a factor of 50-100, the isomerization quantum yields remain essentially constant, implying that the nonradiative process does not directly involve isomerization. On this basis, we postulate that isomerization occurs on the ground-state potential energy surface after internal conversion. In these experiments, the isomerization to naphthalene was not observed, implying a competition between isomerization and cooling on the ground-state potential energy surface.

The fluorescence spectroscopy of Z-phenylvinylacetylene (Z-PVA) has been studied under jet-cooled conditions. The laser-induced fluorescence (LIF) spectrum shows vibronic activity up to 600 cm(-1) above the pi pi* electronic origin at 33 838 cm(-1). In contrast, the single vibronic level fluorescence spectrum of the electronic origin shows strong intensity in transitions ending in ground state levels at least 1200 cm(-1) above the ground state zero-point level. The double-resonance technique of ultraviolet depletion (UVD) spectroscopy was used to show that there are strong absorptions in Z-PVA that are not observed in the LIF spectrum due to the turn of a nonradiative process in this electronic state. The LIF and UVD spectra were compared quantitatively to calculate the relative single vibronic level fluorescence quantum yields. Upon inspection, there are some indications of state specific effects; however, the nature of these effects is unclear. Ab initio and density functional theory calculations of the ground and excited states were used to map the first two excited states of Z-PVA along the C[triple bond]CH bending coordinate, determining them to be pi pi* and pi sigma*, respectively, in character. The crossing of these two states is postulated to be the underlying reason for the observed loss in fluorescence intensity 600 cm(-1) above the pi pi* origin. The spectroscopy of Z-PVA has been compared to the previously characterized E isomer of phenylvinylacetylene [Liu, C. P., Newby, J. J., Muller, C. W., Lee, H. D. and Zwier, T. S. J. Phys. Chem. A 2008, 112 (39), 9454.].

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