A New Configurable Wireless Sensor System for Biomedical Applications with ISO 18000-3 Interface in 0.35 µm CMOS.

This article presents a new configurable wireless sensor system. The system is used to perform amperometric measurements and send the measurement data to a handheld reader using a wireless transponder interface. The two-chip sensor system was implemented in a 0.35 µm CMOS technology. The system consists of an integrated nano-potentiostat that performs the actual measurements and an ISO 18000-3 compliant frontend that enables wireless telemetric data transmission and powering of the entire sensor system. The system was manufactured in combination with a chronoamperometric glucose sensor which allows the measurement of the glucose content in tear fluid and thus a non-invasive determination of the blood sugar level. For a range of sensor currents from 0.1 µA to 10 µA, the potentiostat achieved an accuracy of better than 5 % with a total power dissipation of less than 600 µW. With the realized antenna geometry a wireless communication distance of more than 7 cm has been achieved.

Arthroscopic treatment of femoroacetabular impingement shows persistent clinical improvement in the mid-term.

INTRODUCTION: The concept of femoroacetabular impingement (FAI) and the indication for surgical intervention have been established in the last decade. Despite promising short-term results and emerging arthroscopic techniques, it remains unclear whether patients benefit from surgical correction in the mid- to long-term and whether progressive joint degeneration can be prevented. MATERIALS AND METHODS: A retrospective study of our first 50 consecutive patients who underwent arthroscopic correction for FAI was conducted. The modified Harris hip score (mHHS) was assessed preoperatively and at final follow-up. In addition, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and a subjective hip value (SHV) were added at final follow-up. Degenerative changes according to Kellgren and Lawrence scale and the α angle were analyzed preoperatively and on the most recent radiograph. RESULTS: Of a total of 50 patients, 44 (24 male, 20 female) with a mean age of 34.3 years (17-65) were available with complete follow-up. Of these 44 patients, 39 were treated with correction of the femoral offset for isolated cam deformity, 5 with additional focal pincer correction and partial labral resection. After a mean follow-up of 66.3 ± 14.5 months the mHHS had improved significantly from 67.2 ± 6.4 preoperatively to 86.4 ± 13.5 (p < 0.001). The WOMAC score (converted to 0 = best/100 = worst) resulted in mean indices for the subcategories pain, stiffness and function of 11.8 ± 16.5, 12.2 ± 17.8 and 9.1 ± 16.1. The SHV was reported with a mean of 77.7 ± 21.8 % at final follow-up. The α angle was reduced significantly from 57.2° ± 10.1° to 46.3° ± 7.4° (p < 0.001). The Kellgren and Lawrence score showed a non-significant trend from 2.0 ± 0.8 preoperatively to 2.2 ± 0.9 in the most recent radiograph (p = 0.46). 5 patients had been converted to a total hip arthroplasty a mean of 28 ± 7.1 months postoperatively. These patients were significantly (p < 0.01) older with a mean age of 49.8 ± 7.8 years and showed significantly higher present osteoarthritic changes with an average Kellgren and Lawrence score of 2.6 ± 2.5 before FAI correction (p < 0.01). CONCLUSIONS: Arthroscopic correction of femoroacetabular impingement results in a persistent clinical improvement without significant progression of degenerative changes in the majority of patients. The indication for surgery should be established cautiously when degenerative changes are present. LEVEL OF EVIDENCE: Level IV, Case series with no comparison group.

Injectable autologous chondrocyte transplantation for full thickness acetabular cartilage defects: early clinical results.

INTRODUCTION: Acetabular cartilage lesions are frequently seen in young patients with hip pain and have been identified as an important prognostic factor. New therapies have complemented abrasion and microfracture procedures. The aim of the study is to evaluate the early outcome of patients with arthroscopic injectable autologous chondrocyte transplantations (ACT) for full thickness acetabular cartilage defects. METHODS: A two-step procedure ACT was performed in patients with full thickness acetabular cartilage defects measuring ≥2 cm(2). The patients were closely followed with clinical examination, pre- and postoperative scores until the latest available follow-up of 3, 6, 12, and 24 months. RESULTS: 20 consecutive cases (4 female, 16 male, mean age 33 years) were included. No patients were lost at final follow-up. The average defect size was 5.05 (range 2-6) cm(2). The average follow-up was 12.05 (range 6-24) months. Three months postoperatively the preoperative scores improved significantly from a mean mHHS of 63-81 points (p = 0.009), iHOT33 of 44-66 % (p = 0.028) and subjective hip assessment (Subjective Hip Value, SHV) of 60-87 % (p = 0.007). After 12 months the results improved significantly to a mean mHHS of 93 points (p = 0.017), an iHOT33 of 79 % (p = 0.007) and an SHV of 82 % (p = 0.048) compared with the preoperative scores. DISCUSSION: The injectable matrix associated ACT is a reliable procedure, yielding promising early results with a significant increase of all scores evaluated in patients with full thickness acetabular cartilage defects.

Long-term functional outcome and quality of life after successful surgical treatment of tibial nonunions.

PURPOSE: Our aim was to evaluate quality of life (QoL) and functional outcome of patients with tibial nonunions after completion of surgical treatment with an average follow-up of five years. METHODS: The following data of 64 patients were retrospectively evaluated: fracture type, type and duration of surgical therapy, range of motion of the knee and ankle and American Orthopaedic Foot and Ankle Society (AOFAS) score. QoL was evaluated with the Short-Form Health Survey (SF-36) questionnaire; pain intensity, patient satisfaction and impairments of daily, professional and sport activities with a ten point visual analogue scale. RESULTS: QoL, even in cases with successfully completed treatment, was significantly reduced compared with the normal general population. Pain intensity and limited ankle dorsal extension, despite the absence of intra-articular fractures, were significantly correlated with inferior QoL. CONCLUSIONS: This study emphasises the long-term negative impact of tibial nonunions on patient QoL, even after successful surgical treatment.

Palmoplantar erythrodysesthesia-like skin symptoms in patients under various chemotherapeutics: preventive and therapeutic options.

BACKGROUND/AIMS: The palmoplantar erythrodysaesthesia (PPE) is an inflammatory cutaneous side effect in patients under chemotherapy with pegylated liposomal doxorubicin (PLD), with indications that also other chemotherapeutics induce similar side effects. Recently, it has been demonstrated that PLD escapes with the sweat onto the skin inducing radical-forming processes that damage the skin. The topical application of antioxidants with a high radical protection factor has proven to be a very efficient prevention strategy for PLD-treated patients. METHODS: 68 patients, who had been treated with 12 different chemotherapeutics and experienced side effects similar to PPE, were treated with a meanwhile commercially available ointment. RESULTS: At the beginning of the therapy, 46 patients suffered from a PPE of severity grade III, while in 22 patients a PPE of severity grade II was diagnosed. The application of the ointment resulted in a significant improvement of the clinical symptoms and the skin status in all these patients; their chemotherapies could be continued. CONCLUSION: The obtained results suggest that radical-forming processes play an essential role in a great number of chemotherapeutics which induce dermal side effects. The topical application of the antioxidant-containing ointment proved to be a good therapeutic option which needs further evaluation.

Efficient prevention strategy against the development of a palmar-plantar erythrodysesthesia during chemotherapy.

BACKGROUND: Pegylated liposomal doxorubicin (PLD) is a highly efficient chemotherapeutic; however, it induces dermal side effects such as palmar-plantar erythrodysesthesia (PPE) in up to 80% of cases, probably by being emitted with the sweat onto the skin surface. AIM: The aim of the present study was to examine whether a topically applied ointment containing antioxidants with a high radical protection factor is able to prevent the formation of PPE. METHODS: Twenty patients suffering from ovarian carcinoma and treated with PLD were observed. RESULTS: 60% of the patients tolerated the regular application of the cream and developed no PPE. The remaining 40% interrupted the application. Six of them developed PPE and resumed ointment application thereafter. In these cases the PPE disappeared or was strongly reduced. CONCLUSION: The results of the observation clearly demonstrate that topical application of the ointment is an efficient strategy against the development of PPE during chemotherapy with PLD.

Necrotizing fasciitis: is the bacterial spectrum changing?

PURPOSE: Necrotizing fasciitis (NF) is a rare, but potentially fatal pathology. The aim of the present study was to identify the population characteristics of the NF patients, the responsible bacteria, and the differences between survivors and nonsurvivors. METHODS: In this retrospective case-control study, all patients with NF from January 1, 2005, to December 31, 2010, treated in an academic level 1 trauma center, were identified, and their medical records were reviewed. RESULTS: The mortality rate of the 24 identified patients was 20.8 %. The majority of the infections (54.2 %) (13/24) were monomicrobial. Hemolytic Streptococcus of group A (25 %) and methicillin-resistant Staphylococcus aureus (20.8 %) were the commonest germs. The mean number of comorbidities was 3.62 (standard deviation (SD) 3.58). Diabetes mellitus, cardiovascular disease, and immunosuppression were the commonest. Mean number of operations was 8.1 (SD 4.7). Five patients (20.8 %) developed a disseminated intravascular coagulation (DIC); all of them died. Nonsurvivors, who presented with deteriorated coagulation factors, developed a DIC (p < 0.001) and received more often antibiotic monotherapy (ampicillin/sulbactam) as initial empirical therapy (p < 0.001). CONCLUSIONS: The present study suggests a shift of the bacterial spectrum towards monomicrobial infections with multiresistant bacteria. The early recognition of high-risk patients and the aggressive surgical treatment with at least double-schema antibiotic therapy are of outmost importance.

Are pentraxin 3 and transsignaling early markers for immunologic injury severity in polytrauma? A pilot study.

BACKGROUND: Inflammatory-related conditions and organ failure (OF) lead to late trauma mortality. Cytokine profiles can predict adverse events and mortality, potentially guiding treatment strategies (damage control surgery versus early total care). However, the specific cytokines to predict the clinical course in polytraumatized patients are not fully identified. QUESTIONS/PURPOSES: We investigated the early pentraxin 3 (PTX3), IL-6, soluble IL-6 receptor (sIL-6R), and transsignaling ratio (TSR) in polytraumatized patients to estimate immunologic injury severity and predict OF and survival. METHODS: We prospectively followed 58 patients with severe polytrauma, six patients with minor trauma, and 10 healthy volunteers. The mean Injury Severity Score (ISS) was 43 points and the mean Hannover Polytrauma Score (PTS) was 59 points, with a consequently high mortality rate (30%). Twenty-seven of the 58 polytraumatized patients (46%) developed OF, 67% systemic inflammatory response syndrome, and 38% sepsis. RESULTS: Mean sIL-6R concentrations in polytrauma initially were low. Mean PTX3 concentrations were high and peaked at 24 hours. The mean TSR peaked at 6 hours; at that time, the mean value was higher for nonsurvivors. PTX3 concentrations at admission were associated with injury severity calculated by ISS and PTS. Higher PTX3 serum concentrations 24 hours after admission correlated with lower probability for survival. CONCLUSIONS: PTX3, sIL-6R, and TSR were early markers for posttraumatic inflammatory status, OF, injury severity, and TSR for survival after polytrauma. The temporal profile of PTX3 and TSR might be used to anticipate the total injury severity and the clinical course and thereby guide decision making in polytraumatized patients.

Improvement of research quality in the fields of orthopaedics and trauma: a global perspective.

The international orthopaedic community aims to achieve the best possible outcome for patient care by constantly modifying surgical techniques and expanding the surgeon's knowledge. These efforts require proper reflection within a setting that necessitates a higher quality standard for global orthopaedic publication. Furthermore, these techniques demand that surgeons acquire information at a rapid rate while enforcing higher standards in research performance. An international consensus exists on how to perform research and what rules should be considered when publishing a scientific paper. Despite this global agreement, in today's "Cross Check Era", too many authors do not give attention to the current standards of systematic research. Thus, the purpose of this paper is to describe these performance standards, the available choices for orthopaedic surgeons and the current learning curve for seasoned teams of researchers and orthopaedic surgeons with more than three decades of experience. These lead to provide an accessible overview of all important aspects of the topics that will significantly influence the research development as we arrive at an important globalisation era in orthopaedics and trauma-related research.

Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation.

BACKGROUND: The arthroscopically assisted Double-TightRope technique has recently been reported to yield good to excellent clinical results in the treatment of acute, high-grade acromioclavicular dislocation. However, the orientation of the transclavicular-transcoracoidal drill holes remains a matter of debate. HYPOTHESIS: A V-shaped drill hole orientation leads to better clinical and radiologic results and provides a higher vertical and horizontal stability compared to parallel drill hole placement. STUDY DESIGN: This was a cohort study; level of evidence, 2b. METHODS: Two groups of patients with acute high-grade acromioclavicular joint instability (Rockwood type V) were included in this prospective, non-randomized cohort study. 15 patients (1 female/14 male) with a mean age of 37.7 (18-66) years were treated with a Double-TightRope technique using a V-shaped orientation of the drill holes (group 1). 13 patients (1 female/12 male) with a mean age of 40.9 (21-59) years were treated with a Double-TightRope technique with a parallel drill hole placement (group 2). After 2 years, the final evaluation consisted of a complete physical examination of both shoulders, evaluation of the Subjective Shoulder Value (SSV), Constant Score (CS), Taft Score (TF) and Acromioclavicular Joint Instability Score (ACJI) as well as a radiologic examination including bilateral anteroposterior stress views and bilateral Alexander views. RESULTS: After a mean follow-up of 2 years, all patients were free of shoulder pain at rest and during daily activities. Range of motion did not differ significantly between both groups (p > 0.05). Patients in group 1 reached on average 92.4 points in the CS, 96.2 % in the SSV, 10.5 points in the TF and 75.9 points in the ACJI. Patients in group 2 scored 90.5 points in the CS, 93.9 % in the SSV, 10.5 points in the TF and 84.5 points in the ACJI (p > 0.05). Radiographically, the coracoclavicular distance was found to be 13.9 mm (group 1) and 13.4 mm (group 2) on the affected side and 9.3 mm (group 1) and 9.4 mm (group 2) on the contralateral side. The distance of neither the affected side nor the contralateral side differed significantly between both groups (p > 0.05). In group 1, eight patients (53 %) and in group 2 four patients (31 %) revealed signs of dynamic posterior instability (p > 0.05). Clavicular drill hole enlargement was found to be equally distributed in group 1, whereas group 2 displayed a cone-shaped form. CONCLUSION: The Double-TightRope technique yields good to excellent clinical results in both V-shaped and parallel drill hole placement. Partial recurrent vertical and horizontal instability represents a problem in both techniques. So far, no significant differences regarding clinical or radiologic results have been found. Long-term results are needed to reveal possible advantages in terms of clinical and radiologic acromioclavicular stability.

Closed reduction of distal radius fractures: does instability mean irreducibility?

INTRODUCTION: The belief that not all distal radius fractures can be initially anatomically reduced with conservative means is rising. The aim of this study was to examine whether adequate reduction with a closed reduction technique is possible and to assess the importance of each step. MATERIALS AND METHODS: We prospectively enrolled 63 distal radius fractures (62 patients). A standardized reduction technique was implemented. Reduction was radiologically evaluated in hanging traction, after reduction, and in plaster. Subgroup analysis was performed for fracture-dependent and fracture-independent factors on their influence on reduction. RESULTS: The mean radiological values (radial inclination, dorsal tilt, ulnar variance) showed near anatomic reduction of all fractures in plaster. Fracture severity according to AO classification, initial displacement, number of instability criteria and patient age did not affect the reduction outcome. CONCLUSIONS: All types of enrolled fractures were nearly anatomically reduced. This contradicts the opinion that some "severe" fractures are too unstable to be initially reduced by closed means.

Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management?

BACKGROUND: Trauma is the leading cause of death among children, adolescents, and young adults. The latest data from the German Trauma Registry reveals a constant decrease in trauma mortality, indicating that 11.6 % of all trauma patients in 2010 died in hospital. Notably, trauma casualties dying before admission to hospital have not been systematically surveyed and analyzed in Germany. METHODS: We conducted a prospective observational study of all traumatic deaths in Berlin, recording demographic data, trauma mechanisms, and causes/localization and time of death after trauma. Inclusion criteria were all deaths following trauma from 1 January 2010 to 31 December 2010. RESULTS: A total of 440 trauma fatalities were included in this study, with a mortality rate of 13/100,000 inhabitants; 78.6 % were blunt injuries, and fall from a height >3 m (32.7 %) was the leading trauma mechanism. 32.5 % died immediately, 23.9 % died within 60 min, 7.7 % died within 1-4 h, 16.8 % died within 4-48 h, 11.1 % died <1 week later, and 8 % died >1 week after trauma. The predominant causes of death were polytrauma (45.7 %), sTBI (38 %), exsanguination (9.5 %), and thoracic trauma (3.2 %). Death occurred on-scene in 58.7 % of these cases, in the intensive care unit in 33.2 %, and in 2.7 % of the cases, in the emergency department, the operating room, and the ward, respectively. CONCLUSIONS: Polytrauma is the leading cause of death, followed by severe traumatic brain injury (sTBI). The temporal analysis of traumatic death indicates a shift from the classic "trimodal" distribution to a new "bimodal" distribution. Besides advances in road safety, prevention programs and improvement in trauma management-especially the pre-hospital phase-have the potential to significantly improve the survival rate after trauma.

Influence of statins locally applied from orthopedic implants on osseous integration.

BACKGROUND: Simvastatin increases the expression of bone morphogenetic protein 2 (BMP-2) in osteoblasts, therefore it is important to investigate the influence of statins on bone formation, fracture healing and implant integration. The aim of the present study was to investigate the effect of simvastatin, locally applied from intramedullary coated and bioactive implants, on bone integration using biomechanical and histomorphometrical analyses. METHODS: Eighty rats received retrograde nailing of the femur with titanium implants: uncoated vs. polymer-only (poly(D,L-lactide)) vs. polymer plus drug coated (either simvastatin low- or high dosed; "SIM low/ high"). Femurs were harvested after 56 days for radiographic and histomorphometric or biomechanical analysis (push-out). RESULTS: Radiographic analysis revealed no pathological findings for animals of the control and SIM low dose group. However, n=2/10 animals of the SIM high group showed osteolysis next to the implant without evidence of bacterial infection determined by microbiological analysis. Biomechanical results showed a significant decrease in fixation strength for SIM high coated implants vs. the control groups (uncoated and PDLLA). Histomorphometry revealed a significantly reduced total as well as direct bone/implant contact for SIM high- implants vs. controls (uncoated and PDLLA-groups). Total contact was reduced for SIM low vs. uncoated controls. Significantly reduced new bone formation was measured around SIM high coated implants vs. both control groups. CONCLUSIONS: This animal study suggests impaired implant integration with local application of simvastatin from intramedullary titanium implants after 8 weeks when compared to uncoated or carrier-only coated controls.

Effect of local zoledronate on implant osseointegration in a rat model.

BACKGROUND: An implant coating with poly(D, L-lactide) (PDLLA) releasing incorporated zoledronic acid (ZOL) has already proven to positively effect osteoblasts, to inhibit osteoclasts and to accelerate fracture healing. Aim of this study was to investigate the release kinetics of the chosen coating and the effect of different concentrations of ZOL locally released from this coating on the osseointegration of implants. METHODS: For release kinetics the release of C14-labled ZOL out of the coating was monitored over a period of six weeks in vitro. For testing the osseointegration, titanium Kirschner wires were implanted into the medullary canal of right femurs of 100 Sprague Dawley rats. The animals were divided into five groups receiving implants either uncoated or coated with PDLLA, PDLLA/ZOL low (1.2% w/w) or PDLLA/ZOL high (2% w/w). Additionally, a group with uncoated implants received ZOL intravenously (i.v.). After 56 days animals were sacrificed, femurs dissected and either strength of fixation or histological bone/implant contacts and newly formed bone around the implants were determined. RESULTS: Release kinetics revealed an initial peak in the release of C14-ZOL with a slight further progression over the following weeks. There was no significant enhancement of osseointegration for both groups who received ZOL-coated implants or ZOL i.v. compared to the controls in biomechanical or histological analyses, except for a significant raise in strength of fixation of ZOL i.v. versus PDLLA. CONCLUSIONS: Even though the investigated local ZOL application did not enhance the osseointegration of the implant, the findings might support its application in fracture treatment, since fracture stabilization devices are often explanted after consolidation.

Surgical intensive care unit--the trauma surgery perspective.

PURPOSE: This review addresses and summarizes the key issues and unique specific intensive care treatment of adult patients from the trauma surgery perspective. MATERIALS AND METHODS: The cornerstones of successful surgical intensive care management are fluid resuscitation, transfusion protocol and extracorporeal organ replacement therapies. The injury-type specific complications and unique pathophysiologic regulatory mechanisms of the traumatized patients influencing the critical care treatment are discussed. CONCLUSIONS: Furthermore, the fundamental knowledge of the injury severity, understanding of the trauma mechanism, surgical treatment strategies and specific techniques of surgical intensive care are pointed out as essentials for a successful intensive care therapy.

Founding of the julius wolff institut charité - universitätsmedizin berlin: editorial comment.

This Editorial on Julius Wolff corresponds to a translation of the historic text, Zur Lehre von der Fracturenheilung, available at DOI 10.1007/s11999-010-1240-9 ; and a translation and abridgement of the historic text, Ueber die Innere Architectur der Knochen und ihre Bedeutung für die Frage vom Knochenwachstum, available at DOI 10.1007/s11999-010-1239-2 . (Supplemental materials are available with the online version of CORR.) An accompanying biographical sketch is available at DOI 10.1007/s11999-010-1258-z .

Diagnostic values of clinical tests for subscapularis lesions.

Subscapularis (SSC) lesions are often underdiagnosed in the clinical routine. This study establishes and compares the diagnostic values of various clinical signs and diagnostic tests for lesions of the SSC tendon. Fifty consecutive patients who were scheduled for an arthroscopic subacromial or rotator cuff procedure were clinically evaluated using the lift-off test (LOT), the internal rotation lag sign (IRLS), the modified belly-press test (BPT) and the belly-off sign (BOS) preoperatively. A modified classification system according to Fox et al. (Type I-IV) was used to classify the SSC lesion during diagnostic arthroscopy. SSC tendon tears occurred with a prevalence of 30% (15 of 50). Five type I, six type II, three type IIIa and one type IIIb tears according to the modified classification system were found. Fifteen percent of the SSC tears were not predicted preoperatively by using all of the tests. In six cases (12%), the LOT and the IRLS could not be performed due to a painful restricted range of motion. The modified BPT and the BOS showed the greatest sensitivity (88 and 87%) followed by the IRLS (71%) and the LOT (40%). The BOS had the greatest specificity (91%) followed by the LOT (79%), mod. BPT (68%) and IRLS (45%). The BOS had the highest overall accuracy (90%). With the BOS and the modified BPT in particular, upper SSC lesions (type I and II) could be diagnosed preoperatively. A detailed physical exam using the currently available SSC tests allows diagnosing SSC lesions in the majority of cases preoperatively. However, some tears could not be predicted by preoperative assessment using all the tests.

Socioeconomic factors, hazardous alcohol consumption, and smoking in patients with minor trauma in an inner-city emergency department.

Emergency Department (ED) patients show a high prevalence of hazardous alcohol consumption and smoking. The objective of this study was to determine if socioeconomic factors and smoking status help to optimize screening for hazardous alcohol consumption (HAC) in patients with minor trauma. A survey was conducted in an ED in an inner-city university hospital. A total of 2562 patients with minor trauma were screened for HAC (≥ 8 points in men and ≥ 5 points in women on the Alcohol Use Disorders Identification Test), smoking status, and socioeconomic factors. The median age of participants was 32 years, with 62.1% being male. A total of 84.2% of patients had an Injury Severity Score of 1, indicating minor trauma. Overall, 23.5% of patients showed a pattern of HAC, whereas 46.2% were current smokers. Compared to patients without HAC, those with HAC were characterized by lower incomes, no partnership, living in a single-household, and being unemployed. The strongest discriminative variable for HAC for patients aged ≤ 53 years was smoking status. Gender differences played a role only in patients older than 53 years. Although socioeconomic factors showed a non-equal distribution in patients with respectively without HAC, solely age, gender, and smoking status may provide a successful stratification for alcohol screening and intervention in these patients.

A Contemporary View on Felix Pinkus' Concept of the Vitreous Membrane.

INTRODUCTION: Felix Pinkus' concept of the vitreous membrane (VM) published in 1927 describes circular folds protruding into the outer root sheath (ORS), which, in his opinion, serve as interdigitations between the outer root sheath (ORS) and the VM. This concept currently seems to have fallen into oblivion. OBJECTIVE: To determine the origin and possible function of the VM in the proliferation and vascularization of the hair follicle (HF). METHODS: Serial investigation of healthy skin probes with histological (hematoxylin & eosin and periodic acid-Schiff) and immunohistochemical examination (Ki67, CD56, CD8, and collagen IV) were performed. RESULTS: Morphological variations of the VM in various HFs such as protrusions and folds, the latter unilateral, bilateral or circular, some acute-angled, were found. Similarly, protrusions of the VM into the ORS were observed, that consisted of capillary tissue together with perifollicular tissue and VM mimicking minimal variants of the dermal papilla. CONCLUSIONS: Pinkus' concept of the VM is revisited, reproduced and possible functions are proposed. Since these structures are found in a HF region with a high metabolic dynamism, they may be involved in differentiation or nutrition, or else be formed as a result of pressure arising from outgrowing hair shafts.

Screening trauma patients with the alcohol use disorders identification test and biomarkers of alcohol use.

BACKGROUND: Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients. METHODS: The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake >420 g in males, >280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves. RESULTS: There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity >0.80, sensitivity for all biomarkers was <0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone. CONCLUSIONS: Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers.