Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations.

Whole-body electromyostimulation has proven to be a highly effective alternative to conventional resistance-type exercise training. However, due to adverse effects in the past, very extensive contraindications have been put in place for the commercial, non-medical WB-EMS market. Considering recent positive innovations e.g., federal regulation, mandatory trainer education, revised guidelines, and new scientific studies on WB-EMS application, we believe that a careful revision of the very restrictive contraindications on WB-EMS is needed. This applies all the more because many cohorts with limited options for conventional exercise have so far been excluded. During a first meeting of an evidence-based consensus process, stakeholders from various backgrounds (e.g., research, education, application) set the priorities for revising the contraindications. We decided to focus on four categories of absolute contraindications: "Arteriosclerosis, arterial circulation disorders", "Diabetes mellitus" (DM), "Tumor and cancer" (TC), "Neurologic diseases, neuronal disorders, epilepsy". Based on scientific studies, quality criteria, safety aspects and benefit/risk assessment of the category, DM and TC were moved to the relative contraindication catalogue, while arteriosclerosis/arterial circulation disorders and neurologic diseases/neuronal disorders/epilepsy were still considered as absolute contraindications. While missing evidence suggests maintaining the status of neurologic diseases/neuronal disorders as an absolute contraindication, the risk/benefit-ratio does not support the application of WB-EMS in people with arteriosclerosis/arterial circulation diseases. Despite these very cautious modifications, countries with less restrictive structures for non-medical WB-EMS should consider our approach critically before implementing the present revisions. Considering further the largely increased amount of WB-EMS trials we advice regular updates of the present contraindication list.

Complex patterns of local adaptation in heat tolerance in Drosophila simulans from eastern Australia.

Latitudinal clines are considered a powerful means of investigating evolutionary responses to climatic selection in nature. However, most clinal studies of climatic adaptation in Drosophila have involved species that contain cosmopolitan inversion polymorphisms that show clinal patterns themselves, making it difficult to determine whether the traits or inversions are under selection. Further, although climatic selection is unlikely to act on only one life stage in metamorphic organisms, a few studies have examined clinal patterns across life stages. Finally, clinal patterns of heat tolerance may also depend on the assay used. To unravel these potentially confounding effects on clinal patterns of thermal tolerance, we examined adult and larval heat tolerance traits in populations of Drosophila simulans from eastern Australia using static and dynamic (ramping 0.06 °C min(-1)) assays. We also used microsatellites markers to clarify whether demographic factors or selection are responsible for population differentiation along clines. Significant cubic clinal patterns were observed for adult static basal, hardened and dynamic heat knockdown time and static basal heat survival in larvae. In contrast, static, hardened larval heat survival increased linearly with latitude whereas no clinal association was found for larval ramping survival. Significant associations between adult and larval traits and climatic variables, and low population differentiation at microsatellite loci, suggest a role for climatic selection, rather than demographic processes, in generating these clinal patterns. Our results suggest that adaptation to thermal stress may be species and life-stage specific, complicating our efforts to understand the evolutionary responses to selection for increasing thermotolerance.

Biomechanical comparisons of three minimally invasive Achilles tendon percutaneous repair suture techniques.

BACKGROUND: While no gold standard exists for the management of Achilles tendon ruptures, surgical repair is common in healthy and active patients. Minimally invasive repair methods have become increasingly popular, while biomechanical equivalency hasn't been proven yet. METHODS: A mid-substance Achilles tendon rupture was created 6 cm proximal to the calcaneal insertion in 27 fresh-frozen cadaveric ankles. Specimens were randomly allocated to 1 of 3 repair techniques: Huttunen et al. (2014) (1) PARS Achilles Jig System, Nyyssönen et al. (2008) (2) Achilles Midsubstance SpeedBridge™, Schipper and Cohen (2017) (3) Dresdner Instrument and subsequently subjected to cyclic loading with 250 cycles each at 1 Hz with 4 different loading ranges (20-100 N, 20-200 N, 20-300 N, and 20-400 N). FINDINGS: After 250 cycles no significant differences in elongation were observed between PARS and Dresdner Instrument(p = 1.0). Furthermore, SpeedBridge™ repairs elongated less than either Dresdner Instrument (p = 0.0006) or PARS (p = 0.102). Main elongation (85%) occurred within the first 10 cycles with a comparable elongation in between 10 and 100 and 100-250 cycles. While all repairs withstood the first 250 cycles of cyclic loading from 20 to 100 N, only the PARS (468 ± 175) and Midsubstance SpeedBridge™ (538 ± 208) survived more cycles. Within all 3 groups suture cut out was seen to be the most common failure mechanism. INTERPRETATION: Within all groups early repair elongation was seen. While this was least obvious within the SpeedBridge™ technique, ultimate strengths of repairs (cycles to failure) were comparable across PARS and SpeedBridge™ with a decline in the Dresdner Instrument group.

[Does osteoporosis lead to reduction the primary stability of cementless hip cups?]. / Führt Osteoporose zu einer Reduktion der Primärstabilität zementfreier Hüftpfannen?

BACKGROUND: Cementless hip cups require adequate primary stability in order to achieve osseointegration. Depending on implant design, a different biomechanical behavior in osteoporotic bone and in bone with normal bone mineral density might be expected. MATERIAL AND METHODS: The micromovement between bone and implant was determined in macerated human hip acetabula with reduced and with normal bone density for two different cementless screwed cups and two different cementless press-fit cups. The bone mineral density was assessed by means of Q-CT and 20 implantations were performed for each acetabulum with reduced and with normal bone density. RESULTS: Screwed cups showed significantly less micromovement than press-fit cups. The average micromovement of all cups, with the exception of the Monoblock cup, remained below the value of 100 µ, the upper limit for successful osseointegration. Values of over 200 µ were measured only for the Monoblock cup and only in some of the tests. There was no significant difference between the micro-movement in acetabula with reduced bone mineral density and with normal bone. CONCLUSION: Impaired osseointegration in osteoporotic bone because of increased micromovement is not to be expected in the investigated cementless hip cups as no relevant differences in micromovement were found between normal and osteoporotic bone stock. On the basis of the good clinical results with the Monoblock cup, the upper limit of 100 µ of micromotion for osseointegation in macerated bone is probably set too low.

Classical surgical resection of osteoid osteoma of the cervical spine.

Osteoid osteoma is a benign primary skeletal neoplasm occurring mainly in the cortex of long bones, but also in the spine. It occurs most often in young adult males and causes pain in the affected area. It presents as a nidus surrounded by reactive osteosclerosis or less often as a cancellous lesion with only a slight osteosclerosis. Osteoid osteoma may occur in basically any bone of the body, but the strategy of treatment has to be considered carefully, especially when it occurs in the spine. We report about a 38 year old female diagnosed with an osteoid osteoma located in the posterior element of the 5th cervical vertebra. She presented with persisting neck pain over one and a half years. An MRI and CT scan was performed. Due to the vicinity seen in the MRI imaging to neural structures and the slim rest of cortex in this area we decided to use the classical surgical excision through a minimal invasive approach to resect the lesion. Histological examination revealed the typical structures for osteoid osteoma. The patient was immediately free of symptoms and still is nine months after treatment. Surgical excision of an osteoid osteoma is still a good alternative to percutaneous radiofrequency ablation when treating osteoid osteoma located in close vicinity to neural structures.

Breeding system, colony and population structure in the weaver ant Oecophylla smaragdina.

Weaver ants (Oecophylla smaragdina) are dominant ants in open forests from India, Australia, China and Southeast Asia, whose leaf nests are held together with larval silk. The species, together with its sole congener O. longinoda, has been important in research on biological control, communication, territoriality and colony integration. Over most of the range, only one queen has been found per colony, but the occurrence of several queens per nest has been reported for the Australian Northern Territory. The number of males mating with each queen is little known. Here we report on the colony structure of O. smaragdina using published and new microsatellite markers. Worker genotype arrays reflect the occurrence of habitual polygyny (more than one queen per colony) in 18 colonies from Darwin, Northern Australia, with up to five queens inferred per colony. Monogyny (one queen per colony) with occasional polygyny was inferred for 14 colonies from Queensland, Australia, and 20 colonies from Java, Indonesia. Direct genotyping of the sperm carried by 77 Queensland queens and worker genotypic arrays of established colonies yielded similar results, indicating that less than half of the queens mate only once and some mate up to five times. Worker genotype arrays indicated that queens from Java and the Northern Territory also often mate with more than one male, but less often than those from Queensland. A strong isolation-by-distance effect was found for Queensland samples. The variation uncovered means that O. smaragdina is a more versatile study system than previously supposed.

[Prognosis-adapted surgical management of bone metastases]. / Prognoseadaptierte operative Behandlung von Knochenmetastasen.

Surgery in metastatic disease to the bone is the most common procedure in orthopaedic oncology. To assess an adequate therapeutic approach we analysed 513 surgeries performed on 453 patients between 1980 and 2005 and reviewed the literature.The most significant factor is the histology of the primary tumour. A biopsy is mandatory to confirm the diagnosis in an unknown primary tumour, especially in cases of solitary lesions. Pulmonary carcinoma has an unfavourable prognosis compared to breast and renal cell carcinoma patients. Radical resection in isolated metastatic disease in renal cell carcinoma reduces the risk of local recurrence and even may result in a long progression-free survival. In breast cancer osseous and visceral dissemination is the most decisive factor for prognosis. An interdisciplinary approach is mandatory in every patient.

Medium to long-term results with the cementless threaded Acetabular Munich II type cup.

Compared to pressfit cups, little information exists about the results of screwed cups in hip arthroplasty. 51 cementless or hybrid (cemented stem) primary total hip replacements with a cementless corundium blasted titaniumn alloy threaded Aesculap Munich II type cup were examined with a mean follow up of 7.9 years. 23 of the patients were male and 28 patients were female. From these cups 22 were implanted on the right side and 29 on the left. The results were compared to 53 patients (28 male, 25 female, 29 right side, 24 left side) with the threaded Aesculap Munich I type cup, that has a smooth surface and a direct contact of bone with the polyethylene inlay. The mean follow up ws 10.2 years. The early and medium to long-term clinical and radiographic results show an encouraging improvement of the Merle d'Aubigné Score of the type II cup compared to the type I cup. Two of the Aesculap type Munich II cups had to be revised; four showed radiologic signs of loosening. In conclusion, the threaded Aesculap cup type Munich II seems to be a decisive advance in the development of threaded acetabular hip cups. The intermediate results exceed those from smooth-surface screwed rings and compare favourably with those from cemented cups and with those from cementless press-fit metal-backed cups.

Solitary enchondromas: is radiographic follow-up sufficient in patients with asymptomatic lesions?

Enchondromas are benign cartilaginous tumours and rarely transform into chondrosarcomas. Curettage is usually performed, and a low rate of complications is assumed. We analysed retrospectively data from 73 patients with enchondromas treated by curettage with respect to symptoms, therapy, complications and recurrences. All patients were treated by curettage of the tumour, in most cases followed by cancellous bone grafting. Twenty-three percent of the patients presented a complication. There were two recurrences but no malignant transformations in the follow-up period. During the same time period 29 patients with chondrosarcomas were treated, including two secondary chondrosarcomas. One had a recurrence of a benign enchondroma of the metacarpal and developed a pulmonary metastasis from a chondrosarcoma. The other was a patient with Ollier's disease who had a secondary chondrosarcoma of the radius. Malignant transformation of a solitary enchondroma to a chondrosarcoma is rare. On the other hand the complication rate of enchondroma curettage is considerable. Regular radiological follow-up of asymptomatic enchondromas may therefore be the better option.

Influence of design and bearing material on polyethylene wear particle generation in total knee replacement.

Periprosthetic osteolysis is one of the main reasons for revision of arthroplasty. The osteolytic reaction is influenced by the dose, size and shape of the wear particles. For arthroplasty, a low number and biologically less active particles are required. This is the first study which analyzes the impact of different knee designs, combined with crosslinked polyethylenes (sequentially irradiated and annealed as well as remelted techniques), on the amount, size and shape of particles. Overall, six material combinations, four of them with crosslinked polyethylene (XPE) and two of them with ultra-high molecular weight polyethylene (UHMWPE) inserts, including fixed and mobile bearings, were tested in a knee joint simulator. After isolation nearly 100,000 particles were analyzed in size, shape and number by scanning electron microscopy and image analysis. For all the designs, the wear was predominantly smooth and granular with few fibrillar particles. The Scorpio design with the X3 insert, the Natural Knee II design with the Durasul insert and the LCS design, also combined with a crosslinked polyethylene insert, generated statistically significant (P<0.05) lower particle numbers. The particle size was independent of the radiation dose. The wear generated by the LCS knee design (XPE and UHMWPE) had a higher percentage fraction of particles >1microm in size (equivalent circle diameter). The NexGen design, tested with the Prolong insert, showed a high number of particles in the biologically active size range compared with the other crosslinked designs, which could be a predictor for higher biological reactivity.

Percutaneous cryodenervation of lumbar facet joints: a prospective clinical trial.

Facet joint pain is an important aspect of degenerative lumbar spine disease, and radiofrequency medial branch neurotomy remains an established therapy, while cryodenervation has still been poorly examined. This study was undertaken to examine the effects of medial branch cryodenervation in the treatment of lumbar facet joint pain. This was a prospective clinical case series. Patient selection was based on the history, physical examination and positive medial branch blocks. Percutaneous medial branch cryodenervation was performed using a Lloyd Neurostat 2000. Target parameters were low back pain (VAS), limitation of activity (McNab) and overall satisfaction. Fifty patients were recruited, and 46 completed the study. The follow-up time was 1 year. At 6 weeks, 33 patients (72%) were pain free or had major improvement of low back pain; 13 (28%) had no or little improvement. Including failures, mean low back pain decreased significantly from 7.7 preoperatively to 3.2 at 6 weeks, 3.3 at 3 months, 3.0 at 6 months and 4.2 at 12 months (P<0.0001). Limitation of the activities of daily living improved parallel to reduced pain. Our results suggest that medial branch cryodenervation is a safe and effective treatment for lumbar facet joint pain.

[Catamnestic examinations in a crisis intervention ward of a general hospital (author's transl)]. / Katamnestische Untersuchung in einer Kriseninterventionsstation am Allgemeinkrankenhaus.

The article reports on a catamnestic examination of patients of a crisis intervention center at a general hospital, conducted during the period from 1.5.1977 to 31.5.1978. A total of 560 admissions was recorded comprising 492 patients. Examination was carried out via an open questionnaire, plus data taken from the hospital's care index file. In 59% of the patients, the state of crisis was relieved in the course of an average hospitalisation period of 4.2 days; in 1.23% (= 6 patients), suicide occurred after hospitalisation. 2.4% only of the treated patients were re-admitted to inpatients treatment because of mental difficulties during the period of this study. Improvement of treatment is represented by the institution of facilities of transitional treatment which make it easier to transfer the patient from the crisis-intervention ward, motivating him to participate in long-term outpatient therapy.

[Patients of a crisis intervention unit 3 and 9 years after their admission]. / Patienten einer Kriseninterventionsstation drei und neun Jahre nach ihrem Aufenthalt.

369 patients of a crisis intervention center, treated in 1985, were seen in follow-up-studies 3 and 9 years after admission. The catamnesis was done by an open questionnaire and standardized inventories. The mean value of hospital stay was 3.98 days. Complete data were received from 144 resp. 138 persons. 9 persons died by suicide during the first three years after admission. During the next 6 years most of the patients were stabilized. Minimal effectivity and stability was observed for alcoholics and drug dependent patients.

[Emergency center patients from the psychiatric and psychosomatic viewpoint]. / Rettungsstellen-Patienten aus psychiatrischer und psychosomatischer Sicht.

100 patients of a surgical and internistic emergency ward of a general hospital were examined from the psychosomatic and psychiatric angle. 20 patients remained without surgical and internistic diagnosis; under this aspect, only 3% had no psychic principal sign. In 50%, psychic symptoms were seen. This leads the authors to demand inclusion of the psychosomatic-psychiatric discipline when rendering first aid, in the form of interdisciplinary co-operation.

[Comparison of the main diagnostic groups at a crisis intervention center]. / Die diagnostischen Hauptgruppen eines Kriseninterventionszentrums im Vergleich.

With the present investigation of clients (admissions in 1980) of a psychiatric crisis intervention center we intended generally a description of the population and especially a characterization of the diagnostical group "psychogenic reaction" (ICD No. 309/308). That diagnostical group differs in many signs significantly from the group of alcohol and drug addicts (ICD No. 303/304). Differences to other diagnostical groups (like neurosis, personality disorders e.g., ICD-No. 300, 301, 306) we elaborated only for some factors. Predominantly we worked with a self-made open questionnaire and an objectivated test (FAPK = Questionnaire for psychosomatic disorders). As main conflict constellations of the patients we noticed personal and social isolation and relationship disorders. Our results in crisis provoking situations are in accordance with those of the life-event-research. The therapeutical consequences are discussed.

[Multiple drug dependence]. / Mehrfachabhängigkeiten.

This study includes all inpatients of the years 1977-1988 treated for multiple drug abuse, in a psychiatric department of a general hospital in Berlin. The descriptive assessment of combined drug abuse in the last half year before admission for withdrawal treatment was the research object. 1176 persons with multiple drug abuse were admitted. The mean-value of age was 36.8 years, the duration of addictive behaviour 9.2 years and, they had 1.9 withdrawal treatments as inpatients before their admission here. On an average they took 2.91 substances simultaneously, predominantly alcohol and benzodiazepines. The third rank is occupied by combinations of analgesics, and the fourth one by heroin. Some preferred combinations with characteristic variables of their users are evaluated.

Internal hemipelvectomy and reconstruction with a megaprosthesis.

We treated nine consecutive patients by internal hemipelvectomy and reconstruction with custom-made megaprosthesis between 1990 and 1997. Four had a primary malignant bone or soft tissue tumour, one a recurrent benign giant cell tumour, three solitary metastatic bony lesions, and one a pelvic defect secondary to multiple revision procedures after total hip replacement. After a mean follow-up period of 62 (40-102) months five patients were still alive, including four of the eight patients with tumours. Three patients died as a result of the malignant disease, and one died of an infection related to the surgical treatment after 10-41 months. In two patients removal of the prosthesis was required due to infection, and six patients suffered various complications. One patient had an excellent outcome.