The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty.

BACKGROUND: The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°. METHODS: A total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group. RESULTS: The median (min/max) values for the 231 shoulders were 8° (- 23°/56°) for the inclination angle, - 11°(- 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders. CONCLUSION: Our findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact. LEVEL OF EVIDENCE: Level III.

The function of tcf3 in medaka embryos: efficient knockdown with pePNAs.

BACKGROUND: The application of antisense molecules, such as morpholino oligonucleotides, is an efficient method of gene inactivation in vivo. We recently introduced phosphonic ester modified peptide nucleic acids (PNA) for in vivo loss-of-function experiments in medaka embryos. Here we tested novel modifications of the PNA backbone to knockdown the medaka tcf3 gene. RESULTS: A single tcf3 gene exists in the medaka genome and its inactivation strongly affected eye development of the embryos, leading to size reduction and anophthalmia in severe cases. The function of Tcf3 strongly depends on co-repressor interactions. We found interactions with Groucho/Tle proteins to be most important for eye development. Using a dominant negative approach for combined inactivation of all groucho/tle genes also resulted in eye phenotypes, as did interference with three individual tle genes. CONCLUSIONS: Our results show that side chain modified PNAs come close to the knockdown efficiency of morpholino oligonucleotides in vivo. A single medaka tcf3 gene combines the function of the two zebrafish paralogs hdl and tcf3b. In combination with Groucho/Tle corepressor proteins Tcf3 acts in anterior development and is critical for eye formation.

The influence of humeral neck shaft angle and glenoid lateralization on range of motion in reverse shoulder arthroplasty.

BACKGROUND: Recent developments in reverse shoulder arthroplasty (RSA) have focused on changes in several design-related parameters, including humeral component design, to allow for easier convertibility. Alterations in humeral inclination and offset on shoulder kinematics may have a relevant influence on postoperative outcome. This study used a virtual computer simulation to evaluate the influence of humeral neck shaft angle and glenoid lateralization on range of motion in onlay design RSA. METHODS: Three-dimensional RSA computer templating was created from computed tomography (CT) scans in 20 patients undergoing primary total shoulder arthroplasty for concentric osteoarthritis (Walch A1). Two concurrent factors were tested for impingement-free range of motion: humeral inclination (135° vs. 145°) and glenoid lateralization (0 mm vs. 5 mm). RESULTS: Decreasing the humeral neck shaft angle demonstrated a significant increase in impingement-free range of motion. Compared to the 145° configuration, extension was increased by 42.3° (-8.5° to 73.5°), adduction by 15° (10° to 23°), and external rotation with the arm at side by 15.1° (8.5° to 26.5°); however, abduction was decreased by 6.5° (-1° to 12.5°). Glenoid lateralization led to comparable results, but an additional increase in abduction of 7.6° (-1° to 16.5°) and forward flexion of 26.6° (6.5° to 62°) was observed. CONCLUSION: Lower humeral neck shaft angle and glenoid lateralization are effective for improvement in range of motion after RSA. The use of the 135° model with 5 mm of glenoid lateralization provided the best results in impingement-free range of motion, except for abduction.

Does arm lengthening affect the functional outcome in onlay reverse shoulder arthroplasty?

BACKGROUND: The concept of onlay design reverse shoulder arthroplasty has been introduced to overcome complications observed with the traditional Grammont-type prosthesis. The aim of this study was to determine the influence of arm lengthening on the short-term clinical outcome in onlay reverse shoulder arthroplasty and investigate the effect of humeral tray offset positioning on arm lengthening and range of motion. METHODS: We retrospectively evaluated 56 patients undergoing reverse shoulder arthroplasty with the Aequalis Ascend Flex prosthesis (Tornier, Bloomington, MN, USA) at a minimum 2 years' follow-up. Arm lengthening was determined using bilateral scaled radiographs of the entire humerus. The Constant score and active range of motion were documented preoperatively and postoperatively. The relationship between arm lengthening, humeral tray offset position, and functional outcome was analyzed. RESULTS: The Constant score improved from 25.5 ± 9.5 points to 71.5 ± 13.8 points at a mean follow-up of 30.1 ± 5.2 months. Mean postoperative anterior elevation was 145.2° ± 21.1°, and external rotation was 30.7° ± 20.3°. Arm lengthening exceeding 2.5 cm was related to a decrease in anterior elevation. We found a relationship between arm lengthening averaging 2.2 ± 1.7 cm and increased Constant score values. Humeral tray positioning demonstrated no influence on the functional outcome. There was a trend toward increased arm lengthening in lateral offset positioning. CONCLUSIONS: Onlay reverse shoulder arthroplasty yields good short-term clinical results. In our population, arm lengthening averaging 1 to 2.5 cm was found to be the best compromise on postoperative range of motion.

The influence of three-dimensional planning on decision-making in total shoulder arthroplasty.

BACKGROUND: Long-term results and complication rates in shoulder arthroplasty are related to implant positioning. Current literature reports increased precision in glenoid component positioning using 3-dimensional (3D) computed tomography (CT) planning tools. This study evaluated the accuracy of glenoid version and inclination measurements using 2D CT scans compared with a validated 3D software program and its influence on decision making on implant selection. METHODS: Preoperative CT scans were obtained from 50 patients undergoing total shoulder arthroplasty. Glenoid version and inclination measurements were performed in random order by 3 independent qualified orthopedic surgeons on reformatted 2D CT scans. Indication for anatomic or reverse shoulder arthroplasty was based on glenoid deformity and on rotator cuff conditions. Results were compared with those from a validated 3D computer software program, and the final decision was made according to the 3D planning. RESULTS: Mean preoperative glenoid retroversion on reformatted 2D CT scans was 11.9° ± 9.6° and mean superior inclination was 10.7° ± 8.6°. When the 3D software was used, glenoid retroversion averaged 15.1° ± 10.6° and superior inclination averaged 8.9° ± 9.9°. The 2D CT demonstrated good interobserver and intraobserver reliability for glenoid version and inclination. Decision on the choice of implant was adjusted in 7 patients after the 3D planning. CONCLUSIONS: Our findings show that measurements of glenoid version and inclination on reformatted 2D CT scans are less accurate compared with 3D measurements. A preoperative 3D planning software allows for improvement of virtual glenoid positioning and influences the decision making process.

Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems.

BACKGROUND: Revision of failed shoulder arthroplasty is often associated with poor results and a high rate of complications. Significant humeral bone loss after removal of long stems poses a considerable surgical challenge. Therefore, the aim of our study was the evaluation of the clinical and radiologic outcome of cemented long-stem humeral components in revision reverse shoulder arthroplasty with a minimum 5 years' follow-up. METHODS: Between June 2001 and June 2009, revision reverse shoulder arthroplasty using long-stem cemented humeral components was performed in 124 patients. Mean age at time of surgery was 69.6 years (range, 42-87 years). Complete clinical and radiographic data were available in 50 patients at a mean of 7 years (range, 5-11.6 years). Postoperative radiographs were evaluated for radiolucent lines, implant migration, fracture, and glenoid notching. RESULTS: The mean Constant score improved from 11.1 points (range, 0-27 points) to 39.5 points (range, 14-73 points) at the latest follow-up. Progressive humeral radiolucency was present in 24 patients, including 6 patients demonstrating complete loosening or progressive distal migration of the humeral stem. We noted an overall of 12 additional complications in 8 patients, necessitating revision surgery in 16. CONCLUSION: The use of long-stem humeral components is a beneficial treatment in revision reverse shoulder arthroplasty. Nevertheless, the high percentage of patients with humeral loosening is concerning. Modular cementless revision stems that are adapted to the distal humeral medullary canal and additional distal screw and cable fixation might enhance durable distal fixation in case of advanced bone loss.

Are written information or counseling (WOMAN-PRO II program) able to improve patient satisfaction and the delivery of health care of women with vulvar neoplasms? Secondary outcomes of a multicenter randomized controlled trial / Können schriftliche Informationen oder eine Beratung (WOMAN-PRO II Programm) bei Frauen mit vulvären Neoplasien die Patientenzufriedenheit und den Versorgungsprozess verbessern? Sekundäre Outcomes einer multizentrischen randomisiert kontrollierten Studie

Background: Patients with vulvar neoplasms report a lack of information, missing support in self-management and a gap in delivery of health care. Aim: The aim of the study was to investigate if written information or counseling based on the WOMAN-PRO II program are able to improve patient satisfaction and the delivery of health care from the health professional's perspective of women with vulvar neoplasms. Method: Patient satisfaction and the delivery of health care have been investigated as two secondary outcomes in a multicenter randomized controlled parallel-group phase II study (Clinical Trial ID: NCT01986725). In total, 49 women, from four hospitals (CH, AUT), completed the questionnaire PACIC-S11 after written information (n = 13) and counseling (n = 36). The delivery of health care was evaluated by ten Advanced Practice Nurses (APNs) by using the G-ACIC before and after implementing counseling based on the WOMAN-PRO II program. Results: There were no significant differences between the two groups identified (p = 0.25). Only few aspects were rated highly by all women, such as the overall satisfaction (M = 80.3 %) and satisfaction with organization of care (M = 83.0 %). The evaluation of delivery of health care by APNs in women who received counseling improved significantly (p = 0.031). Conclusions: There are indications, that the practice of both interventions might have improved patient satisfaction and counseling the delivery of health care. The aspects that have been rated low in the PACIC-S11 and G-ACIC indicate possibilities to optimize the delivery of health care.

Is radiographic measurement of acromiohumeral distance on anteroposterior view after reverse shoulder arthroplasty reliable?

BACKGROUND: Reverse shoulder arthroplasty leads to arm lengthening. Different techniques have been described to determine postoperative lengthening. The purpose of this study was to evaluate the reliability of the acromiohumeral distance (AHD) in determining arm lengthening after reverse shoulder arthroplasty. METHODS: At 2 centers, 44 patients who had received an onlay design reverse shoulder arthroplasty were observed for a minimum of 6 months. Examination followed a standardized protocol including preoperative and postoperative radiographs on anteroposterior view in neutral rotation. Two orthopedic surgeons independently performed the measurements in random order. RESULTS: Mean arm lengthening averaged 2.5 cm (range, 0.3-3.9 cm) according to AHD measurement. Significant differences in interobserver and intraobserver variability for postoperative AHD measurements were found (P < .01). The mean intrapatient difference was 0.5 cm (range, 0.02-1.5 cm). CONCLUSION: According to our study, the AHD is not a reliable measurement technique to determine arm lengthening after reverse shoulder arthroplasty.

Comparison of glenoid inclination angle using different clinical imaging modalities.

BACKGROUND: The ß-angle, formed by the intersection of a line on the floor of the supraspinatus fossa and glenoid fossa line, has been described as a reliable measurement tool in the clinical setting to analyze glenoid inclination on the anteroposterior (AP) view of the shoulder. The purpose of this study was to compare the accuracy of the ß-angle measurement using different imaging modalities with a validated 3-dimensional (3D) software tool. MATERIALS AND METHODS: The ß-angle was measured on AP radiographs, unformatted 2-dimensional (2D) computed tomography (CT) scan, and reformatted 2D CT scan in the scapular plane for 51 shoulders of 49 patients undergoing primary total shoulder arthroplasty. Comparison to the glenoid inclination angle calculated by the 3D software was performed. RESULTS: The ß-angle measured on reformatted CT scan was found to be the most accurate measurement method, with a mean difference of 1° (standard deviation [SD], 0.5°) with respect to 3D measurement. On AP radiographs, the ß-angle was not as accurate, with a mean difference of 3° (SD, 0.7°; P < .006). The ß-angle on unformatted 2D CT scan was not a reliable method to measure glenoid inclination, with a mean difference of 10° (SD, 0.9°; P < .0001). CONCLUSION: The ß-angle measured with 2D CT scan formatted in the scapular plane was the most accurate method for measuring glenoid inclination. The ß-angle on the AP radiograph is less accurate and reliable. Measurement of the ß-angle on an unformatted 2D CT scan is not an acceptable method to determine glenoid inclination.

Effect of dissolved oxygen on redox potential and milk acidification by lactic acid bacteria isolated from a DL-starter culture.

Milk acidification by DL-starter cultures [cultures containing Lactococcus lactis diacetylactis (D) and Leuconostoc (L) species] depends on the oxidation-reduction (redox) potential in milk; however, the mechanisms behind this effect are not completely clear. The objective of this study was to investigate the effect of dissolved oxygen on acidification kinetics and redox potential during milk fermentation by lactic acid bacteria (LAB). Fermentations were conducted by single strains isolated from mixed DL-starter culture, including Lactococcus lactis ssp. lactis, Lactococcus lactis ssp. cremoris, and Leuconostoc mesenteroides ssp. cremoris, by the DL-starter culture, and by the type strains. High and low levels of oxygen were produced by flushing milk with oxygen or nitrogen, respectively. The kinetics of milk acidification was characterized by the maximum rate and time of acidification (Vamax and Tamax), the maximum rate and time of reduction (Vrmax and Trmax), the minimum redox potential (Eh7 final), and time of reaching Eh7 final (Trfinal). Variations in kinetic parameters were observed at both the species and strain levels. Two of the Lc. lactis ssp. lactis strains were not able to lower redox potential to negative values. Kinetic parameters of the DL-starter culture were comparable with the best acidifying and reducing strains, indicating their additive effects. Acidification curves were mostly diauxic at all oxygen levels, displaying 2 maxima of acidification rate: before (aerobic maximum) and after (anaerobic maximum) oxygen depletion. The redox potential decreased concurrently with oxygen consumption and continued to decrease at slower rate until reaching the final values, indicating involvement of both oxygen and microbiological activity in the redox state of milk. Oxygen flushing had a negative effect on reduction and acidification capacity of tested LAB. Reduction was significantly delayed at high initial oxygen, exhibiting longer Trmax, Trfinal, or both. Concurrently, anaerobic acidification rate maximum Vamax was decreased and Tamax was extended. Fermentation kinetics in nitrogen-flushed milk was not statistically different from that in untreated milk except for Lc. lactis ssp. lactis CHCC D2, which showed faster reduction time after nitrogen flushing. This study clarifies the relationship between the redox state in milk and acidification kinetics of the predominant subspecies in DL-starter cultures. This knowledge is important for dairies to ensure optimized, fast, and controlled milk fermentations, leading to greater standardization of dairy products.

Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed tomography study.

BACKGROUND: Increased critical shoulder angles consist of both the acromial cover and glenoid inclination and have been found in patients with rotator cuff pathology. The purpose of this study was to determine the correlation of the critical shoulder angle and glenoid inclination and to determine the difference in glenoid inclination between patients with osteoarthritis and massive rotator cuff tears. METHODS: The critical shoulder angle and glenoid inclination were measured on anteroposterior radiographs, and glenoid inclination was also measured on a validated 3-dimensional computer software program of 50 shoulders undergoing primary total shoulder arthroplasty. Twenty-five shoulders had osteoarthritis and A1 glenoids, as defined by the Walch classification, and were undergoing anatomic shoulder arthroplasty. The other 25 shoulders had massive rotator cuff tears and E0 glenoids, as defined by the Favard classification. The 2 groups were compared. RESULTS: Critical shoulder angle and glenoid inclination were significantly correlated (R(2) = 0.7426, P < .001). Shoulders with massive rotator cuff tears (E0) demonstrated increased glenoid inclination measurements than shoulders with osteoarthritis (A1). As measured by the 3-dimensional software, the massive rotator cuff group had a glenoid inclination of 13.6° ± 4.3° and the osteoarthritis group had a glenoid inclination of 4.7° ± 5.6°. When measured by anteroposterior radiographs, the average glenoid inclination was 13.6° ± 4.6° in the massive rotator cuff group and was 7.6° ± 5.01° in the osteoarthritic group . CONCLUSION: Glenoid inclination is linearly correlated with the critical shoulder angle and is significantly increased in patients with massive rotator cuff tears.

Evaluation of lengthening in reverse shoulder arthroplasty comparing X-rays and computerised tomography.

PURPOSE: The correct amount of arm lengthening in reverse shoulder arthroplasty is crucial to provide joint stability and good results. Determination has been proposed according to radiographs. However, radiographic measurements are error prone in regards to positioning of the arm with regard to the radiographic beam. The purpose of this study was to evaluate the precision of radiographic measurements compared to CT scans of the upper limb following reverse shoulder arthroplasty. METHODS: Thirty patients undergoing onlay reverse shoulder arthroplasty with comparative radiographs and CT scans of both humeri were included in this study. Arm length, humeral length as well as the arm and humeral lengthening were evaluated on pre- and postoperative radiographs compared to postoperative CT scans following a previously validated protocol. RESULTS: We found an excellent correlation for arm length and humeral length for radiographic and CT measurements (r > 0.90). The postoperative humeral and arm lengthening compared to the contralateral side was 0.1 (-1.2 to 1.2) cm and 2.8 (0.2 to 5.2) cm for the CT scans, and -0.6 (-4.1 to 2.0) cm and 1.9 (-2.3 to 5.0) cm for the radiographs. For arm lengthening, correlation coefficient was good (r = 0.7) even though radiographs indicated arm shortening in five cases whereas arm lengthening was observed on CT scans. CONCLUSIONS: Measurements on radiographs and CT scans are comparable in most of the cases. However, we observed some important variations that question the reliability of radiographic measurements in up to 20 % of cases. Therefore, a CT scan appears to be necessary in the event of postoperative complications (e.g., instability, neurological problems).

Glenoid bone grafting in reverse shoulder arthroplasty for long-standing anterior shoulder dislocation.

BACKGROUND: Long-standing anterior glenohumeral dislocation results in both humeral and glenoid bone loss, as well as concomitant soft tissue pathologies. Reverse shoulder arthroplasty (RSA) is an established procedure to restore both stability and function in cuff-deficient shoulders. However, fixation of the glenoid component is prone to failure in cases of advanced glenoid vault destruction and requires substantial bone graft. The purpose of this study was to evaluate the outcome of glenoid bone grafting in RSA for neglected anterior dislocation with significant glenoid bone loss. MATERIALS AND METHODS: We reviewed 21 of 32 patients after 1-staged RSA and glenoid bone grafting with resected humeral head, with a mean follow-up period of 4.9 years (range, 2-10 years). The mean age at the time of surgery was 71 years (range, 50-85 years). Glenoid bone loss averaged 45% of glenoid width according to preoperative computed tomography or magnetic resonance imaging scans. A long-pegged glenoid baseplate was used in 9 patients. RESULTS: The mean Constant score improved from 5.7 points (range, 0-22 points) preoperatively to 57.2 points (range, 26-79 points) postoperatively (P < .001). Two patients required revision because of baseplate loosening: one patient underwent conversion to a hemiarthroplasty, and the other patient underwent a 2-staged reconstruction with tricortical iliac crest bone graft. CONCLUSION: RSA in neglected anterior dislocation is a successful treatment option even in the case of advanced glenoid bone loss. To maintain stable fixation of the glenoid component, comprehensive preoperative analysis of the remaining bone stock based on 3-dimensional computed tomography scans should be included, with particular attention to ensure optimal anchorage length of the baseplate's central peg in the native glenoid bone stock.

Patient experience with bedpans in acute care: a cross-sectional study.

AIMS AND OBJECTIVES: To describe individual experiences of patients using the bedpan in an acute care setting. BACKGROUND: Patients describe the use of the bedpan often as uncomfortable and painful, and nurses mention difficulties using standard-sized bedpans for obese patients or removing a bedpan without soiling the bed. Although the bedpan is still regularly used in hospitals, there are few empirical studies that confirm these experiences. DESIGN: A descriptive quantitative research design. METHODS: A convenience sample of 78 patients was recruited, and data were collected using a standardised questionnaire (German version of the Bedpan Ongemak Schaal). Descriptive statistics were used to analyse frequency (scale A) and extent of inconvenient experiences (scale B). Internal consistency of the scales was tested using Cronbach's alpha. RESULTS: A major finding of the study was that most patients felt dependent on other persons and no autonomous movement was possible on the bedpan. Patients were frequently confronted with pain, inconvenient characteristics of the bedpan (e.g. coldness, hardness), uncomfortable positions and hygiene inconveniences (e.g. wet backside, fear that urination may miss the bedpan). CONCLUSION: As the bedpan is still regularly used in acute care hospitals, innovations in bedpan models are necessary to address the problems. But there are also several courses of action nurses should consider when caring for patients who are dependent on the bedpan. RELEVANCE FOR CLINICAL PRACTICE: The discomfort of the bedpan, the feeling of dependency and embarrassment could lead to undesirable patient reactions, such as avoidance of fluid intake or leaving the bed. If nurses know the reasons for this behaviour, they could meet these problems with empathetic understanding.

Revision to reverse shoulder arthroplasty with retention of the humeral component.

BACKGROUND: Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. METHODS: In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudoparalysis (in 13 women), revision to reverse shoulder arthroplasty was performed between October 2006 and 2010, with retention of the humeral component using modular systems. Mean age at the time of operation was 70 (56-80) years. Pre- and postoperative evaluation followed a standardized protocol including Constant score, range of motion, and radiographic analysis. Mean follow-up time was 2.5 (2-5.5) years. RESULTS: Mean Constant score improved from 9 (2-16) to 41 (17-74) points. Mean lengthening of the arm was 2.6 (0.9-4.7) cm without any neurological complications. One patient required revision due to infection. INTERPRETATION: Modular systems allow retainment of a well-fixed humeral stem with good outcome. There is a risk of excessive humeral lengthening.

Inhibition of human immunodeficiency virus replication by cell membrane-crossing oligomers.

Although rapidly becoming a valuable tool for gene silencing, regulation or editing in vitro, the direct transfer of small interfering ribonucleic acids (siRNAs) into cells is still an unsolved problem for in vivo applications. For the first time, we show that specific modifications of antisense oligomers allow autonomous passage into cell lines and primary cells without further adjuvant or coupling to a cell-penetrating peptide. For this reason, we termed the specifically modified oligonucleotides "cell membrane-crossing oligomers" (CMCOs). CMCOs targeted to various conserved regions of human immunodeficiency virus (HIV)-1 were tested and compared with nontargeting CMCOs. Analyses of uninfected and infected cells incubated with labeled CMCOs revealed that the compounds were enriched in infected cells and some of the tested CMCOs exhibited a potent antiviral effect. Finally, the CMCOs did not exert any cytotoxicity and did not inhibit proliferation of the cells. In vitro, our CMCOs are promising candidates as biologically active anti-HIV reagents for future in vivo applications.

Side chain modified peptide nucleic acids (PNA) for knock-down of six3 in medaka embryos.

BACKGROUND: Synthetic antisense molecules have an enormous potential for therapeutic applications in humans. The major aim of such strategies is to specifically interfere with gene function, thus modulating cellular pathways according to the therapeutic demands. Among the molecules which can block mRNA function in a sequence specific manner are peptide nucleic acids (PNA). They are highly stable and efficiently and selectively interact with RNA. However, some properties of non-modified aminoethyl glycine PNAs (aegPNA) hamper their in vivo applications. RESULTS: We generated new backbone modifications of PNAs, which exhibit more hydrophilic properties. When we examined the activity and specificity of these novel phosphonic ester PNAs (pePNA) molecules in medaka (Oryzias latipes) embryos, high solubility and selective binding to mRNA was observed. In particular, mixing of the novel components with aegPNA components resulted in mixed PNAs with superior properties. Injection of mixed PNAs directed against the medaka six3 gene, which is important for eye and brain development, resulted in specific six3 phenotypes. CONCLUSIONS: PNAs are well established as powerful antisense molecules. Modification of the backbone with phosphonic ester side chains further improves their properties and allows the efficient knock down of a single gene in fish embryos.

[Frequency of using the bedpan in acute care]. / Die Häufigkeit der Bettpfannenbenutzung im Akutspital.

Although the bedpan is a subject of everyday nursing practice, little research was found concerning this issue. Patients often describe that the use of the bedpan is uncomfortable and painful. Studies also underline that using a bedpan is very embarrassing and shameful for the patients. Their privacy is violated considerably. In this quantitative descriptive cross-sectional study, the frequency and duration of use of the bedpan was measured in acute care. 362 women and 367 men were included in the study, 18.2 % of them needed the bedpan for a certain time. It was used more often during the night than during the day, departmental differences were also identified. Women used the bedpan most at the orthopedic and medical wards, followed by the prenatal ward (for urine). Men from surgical wards used the bedpan most (12.3 %), followed by medical wards (8.3 %). Most patients required assistance while using the bedpan. Because of this the resulting workload for nurses should be underestimated. The introduction of alternative urine drainage systems could lead to more autonomy of patients and might reduce the workload for nurses.

A Question of Political Correctness: Translating Friendship across Time and Space.

The article explores translation processes behind diplomatic negotiations between Japan and the Spanish overseas empire in the sixteenth and seventeenth century. It applies a multi-layered approach that integrates the translations of original diplomatic documents with their re-translation as historiographical source compilations in the nineteenth and twentieth century. Analyzing the different connotations and nuances of friendship as a diplomatic concept, it highlights the impact of translation, both linguistic and cultural, as well as the strategies behind terminological choices, on intercultural encounters.

Translation in Action: Global Intellectual History and Early Modern Diplomacy.

Intellectual and diplomatic history have to a surprising degree evolved as separate historiographies, but they can be combined through a theme crucial to both: translation. Translation enabled intercultural negotiation but could also bring about inaccuracies, misunderstandings, or consciously skewed representations. This issue argues that a multitude of actors can be understood as "translators," that the power relations between types of actors, languages, and forms of communication was dramatically asymmetrical, and that gaps between representation and reality had real and dramatic political effects. On-the-ground translation practices thus illustrate how the international political system long rested on local developments and global encounters.