Spider prey-wrapping silk is an α-helical coiled-coil/ß-sheet hybrid nanofiber.

Solid-State NMR results on 13C-Ala/Ser and 13C-Val enriched Argiope argentata prey-wrapping silk show that native, freshly spun aciniform silk nanofibers are dominated by α-helical (∼50% total) and random-coil (∼35% total) secondary structures, with minor ß-sheet nanocrystalline domains (∼15% total). This is the most in-depth study to date characterizing the protein structural conformation of the toughest natural biopolymer: aciniform prey-wrapping silks.

[Epidemiology, injury entities and treatment practice for chest wall injuries : Current scientific knowledge and treatment recommendations]. / Epidemiologie, Verletzungsentitäten und Behandlungspraxis der Thoraxwandverletzungen : Aktuelle wissenschaftliche Erkenntnisse und Therapieempfehlungen.

BACKGROUND: Fractures of the bony chest wall are common injuries. They affect almost every second severely injured person and are gaining more and more importance even after low-energy accidents, especially among older people. Complications mainly occur due to respiratory insufficiency, secondary pulmonary complications and remaining deformities with a functional disorder of the chest wall. In addition to the important conservative therapeutic measures, such as a differentiated pain therapy and pneumonia prophylaxis, operative stabilization of fractures can be an option; however, this is still controversially discussed. OBJECTIVE: A thematically structured overview provides basic knowledge on rib and sternal fractures as well as the treatment options. MATERIAL AND METHODS: Epidemiological facts are presented based on the relevant literature and clinical experience. Anatomical principles are intended to improve understanding of the various entities of rib and sternal fractures. For this purpose, the new AO­/OTA classification system is presented and finally therapeutic options including different osteosynthesis procedures are presented and their importance discussed. RESULTS AND DISCUSSION: Multimodal therapy concepts and closely controlled follow-up examinations of fractures avoid complications or can detect them early. Bony chest wall injuries should still be evaluated for complications and typical fracture patterns identified and classified. Modern osteosynthesis procedures with high patient safety and soft tissue-preserving tissue preparation for the surgical access route to the ribs and sternum provide an excellent opportunity for successful restoration of the anatomical and physiological integrity of the bony thorax.

Predictors of colonization with Staphylococcus species among patients scheduled for cardiac and orthopedic interventions at tertiary care hospitals in north-eastern Germany-a prevalence screening study.

As methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in humans are a global challenge. In Mecklenburg and Western Pomerania (Germany) 1,517 patients who underwent surgical interventions were systematically screened for MRSA and MSSA colonization on the day of hospital admission and discharge. Demographic data, risk factors and colonization status of the (i) nose, (ii) throat, (iii) groin, and (iv) thorax or site of surgical intervention were determined. Of the 1,433 patients who were included for further evaluation, 331 (23.1%) were colonized with MSSA, while only 17 (1.2%) were MRSA carriers on the day of hospital admission. A combination of nose, throat and groin swabs returned a detection rate of 98.3% for MSSA/MRSA. Trauma patients had lower prevalence of MRSA/MSSA (OR 0.524, 95% CI: 0.37-0.75; p < 0.001) than patients with intended orthopedic interventions. Males showed significantly higher nasal S. aureus carrier rates than females (odds ratio (OR) = 1.478; 95% CI: 1.14-1.92; p = 0.003). Nasal S. aureus colonization was less frequent among male smokers as compared to non-smokers (chi2 = 16.801; phi = 0.154; p < 0.001). Age, gender and smoking had a significant influence on S. aureus colonization. Combining at least three different swabbing sites should be considered for standard screening procedure to determine S. aureus colonization at patients scheduled for cardiac or orthopedic interventions at tertiary care hospitals.

The chemical and antioxidant stability of isolated low molecular weight phlorotannins.

Due to their high anti-oxidant activity, phlorotannins represent potential natural alternatives to synthetic preservatives currently used within the food industry. However, their successful integration into food products requires research into their chemical integrity, particularly when selecting appropriate storage conditions. Subsequently, this study aims to investigate the stability of low molecular weight phlorotannin fractions from Fucus vesiculosus (L.). Powder and aqueous fractions were stored under five different conditions for 10weeks. Phlorotannin stability was determined using Q-ToF-MS and UPLC-TQD-MS/MS and a DPPH assay. After 10weeks of storage, fractions suspended in an aqueous matrix underwent oxidation when exposed to continuous atmospheric oxygen and thermal degradation when exposed to a constant temperature of 50°C, resulting in decreases in radical scavenging activity (p<0.001). Phlorotannins remained stable under all other storage conditions. This study highlights phlorotannins as highly stable polymers, under certain storage conditions, with an excellent capacity for scavenging radicals.

[Intraoperative 3D imaging : Diagnostic accuracy and therapeutic benefits]. / Intraoperative 3­D-Bildgebung : Diagnostische Genauigkeit und therapeutischer Nutzen.

Intraoperative 3D imaging has a marked impact on the surgical treatment of articular fractures. In theory, insufficient reduction of fracture fragments and malpositioning of implants can be corrected in the same session so that unnecessary secondary imaging and revision surgery can be avoided. Current evidence on the accuracy of 3D scans, however, relies on heterogeneous preclinical data and must be interpreted with caution. Every fourth 3D scan seems to lead to a repositioning of fracture fragments or implants, despite unproven sensitivity and specificity. The interaction between diagnostic accuracy and therapeutic consequences needs exploration before any conclusions on the (additional) benefits of intraoperative 3D imaging can be drawn.

[Clinical results following conservative and surgical treatment of osteoporotic distal radius fractures in the elderly : Overview of best available evidence]. / Klinische Ergebnisse nach konservativer und operativer Therapie der distalen Radiusfraktur beim älteren Patienten : Übersicht der besten verfügbaren Evidenz.

Fractures of the distal radius in elderly patients increasingly contribute to the workload in emergency departments worldwide. There is still no consensus about the best treatment option, e. g. closed reduction and cast stabilization, percutaneous pinning, external fixation or open reduction and internal fixation with volar locking plates (ORIF). In addition, the influence of pharmacological antiosteoporotic treatment (e. g. bisphosphonates) is unclear. In this overview five comparative studies were analyzed, which had been identified in a previous systematic review. The evaluation included 3 cohort studies and 2 randomized trials enrolling a total of 515 patients. A clinical or statistical advantage of ORIF over conservative treatment with respect to DASH scores 12 months after the index fracture event could not be demonstrated with a mean difference of 0.25 (95 % confidence interval CI -0.57-1.07). According to current best scientific evidence from preclinical and clinical investigations, antiosteoporotic medication does not have an unfavorable influence on fracture healing and should be continued due to its proven effectiveness in reducing subsequent osteoporotic fractures. Following distal radius fractures in elderly patients with clinical risk factors, an osteoporosis screening should be routine practice and a specific therapy should be initiated if the fracture risk is increased.

[Evidence-based trauma and orthopedic surgery : 20 years after Sackett]. / Evidenzbasierte Unfallchirurgie und Orthopädie : Zwanzig Jahre nach Sackett.

The article "Evidence based medicine: what it is and what it isn't" published in the BMJ in 1996, is regarded as the foundation of the evidence-based medicine (EbM) movement. Approximately 5 years later David L. Sackett, one of the leaders of the movement, requested all experts to voluntarily abandon their position to make way for young researchers and fresh ideas. Since the term was first coined and the establishment of organizations and platforms fostering the idea, EbM has polarized clinicians and scientists around the world. Clinical and methodological developments during recent years have, however, overtaken the original principles of EbM. This review highlights the core concepts of EbM which have remained unchanged and valid for the current practice of trauma and orthopedic surgery and where revision is needed.

[Influence of registries on the quality of care]. / Einfluss von Registern auf die Versorgungsqualität.

Registries are a topic of lively debate amongst all stakeholders in healthcare, politics and economics. In general, registries are national or international (prospective) databases documenting the current state of diagnostic, therapeutic and long-term outcome variables of subjects with a distinct condition or health problem. The access to and handling of registry information is subject to strict legal, methodological and ethical principles and regulations before these data can be scientifically utilized and reentered into the routine daily practice. Because of the representativeness and reality of data, registries are widely regarded as the backbone of health systems and budgets.Currently there is only indirect evidence that registries influence outcomes and the quality of care. Recent statistical techniques may allow quasi-experimental modelling of observational information. In orthopedic and trauma surgery, current and upcoming registries should be wisely utilized to develop and evaluate innovations and to make informed decisions relevant to care.

Standardised effect sizes in clinical research: how to compare shoulder surgeons with hip surgeons.

The Bone & Joint Journal provides the latest evidence to guide the clinical practice of orthopaedic surgeons. The benefits of one intervention compared with another are presented using outcome measures; some may be specific to a limb or joint and some are more general health-related quality of life measures. Readers will be familiar with many of these outcome measures and will be able to judge the relative benefits of different interventions when measured using the same outcome tool; for example, different treatments for pain in the knee measured using a particular knee score. But, how should readers compare outcomes between different clinical areas using different outcome measures? This article explores the use of standardised effect sizes.

Acetabular fractures with marginal impaction: mid-term results.

Over a five-year period, adult patients with marginal impaction of acetabular fractures were identified from a registry of patients who underwent acetabular reconstruction in two tertiary referral centres. Fractures were classified according to the system of Judet and Letournel. A topographic classification to describe the extent of articular impaction was used, dividing the joint surface into superior, middle and inferior thirds. Demographic information, hospitalisation and surgery-related complications, functional (EuroQol 5-D) and radiological outcome according to Matta's criteria were recorded and analysed. In all, 60 patients (57 men, three women) with a mean age of 41 years (18 to 72) were available at a mean follow-up of 48 months (24 to 206). The quality of the reduction was 'anatomical' in 44 hips (73.3%) and 'imperfect' in 16 (26.7%). The originally achieved anatomical reduction was lost in12 patients (25.8%). Radiologically, 33 hips (55%) were graded as 'excellent', 11 (18.3%) as 'good', one (1.7%) as 'fair' and 15 (25%) as 'poor'. A total of 11 further operations were required in 11 cases, of which six were total hip replacements. Univariate linear regression analysis of the functional outcome showed that factors associated with worse pain were increasing age and an inferior location of the impaction. Elevation of the articular impaction leads to joint preservation with satisfactory overall medium-term functional results, but secondary collapse is likely to occur in some patients.

[Assessment of injury severity at the accident scene by the emergency physician: utility of technical crash parameters: results of a pilot study]. / Notärztliche Einschätzung der Verletzungsschwere am Unfallort: Diagnostischer Wert technischer Parameter - Ergebnisse einer Pilotstudie.

BACKGROUND: Technical parameters of road traffic crashes are routinely documented by emergency physicians on scene. It is, however, unclear whether this information contributes to the estimation of injury severity of vehicle drivers. MATERIALS AND METHODS: In this study, three experienced emergency physicians were asked to predict the injury severity of vehicle drivers [categorized according to Injury Severity Score (ISS) values of <16 and ≥16 as moderate to severe or life-threatening] based on increasingly complex technical crash information, ranging from routine variables to photo documentation of the crash scene. A sample of 100 cases (mean ISS 23.6±26.9) was obtained from the prospective database of an in-depth technical and medical car crash research project conducted in the northeastern part of Germany. Statistical analysis comprised inter-rater agreement beyond chance (kappa values) and indicators of diagnostic test accuracy (i.e. sensitivity, specificity and so on). RESULTS: The inter-rater agreement of injury severity based on technical crash information was moderate to substantial (kappa 0.42-0.66). Amongst the three observers and various amounts of technical data, sensitivity ranged between 18 and 80%, and specificity ranged between 41 and 89% in predicting the presence of major trauma. Presentation of photographs from the crash scene increased diagnostic accuracy. Still, the presented information led to a shift from a 50% prior probability of life-threatening injuries to a maximum of 40% in the negative and 67% in the positive case. CONCLUSION: Neither basic technical parameters that are easy to obtain after a car crash nor additional technical information markedly contribute to the emergency physician's estimation of a vehicle driver's injury severity. The presented results should be supported by a subsequent study including a larger sample.

Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial.

INTRODUCTION: Patellar dislocation is a common knee injury with mainly lateral dislocations, leading to ruptures of the medial patellofemoral ligament in most of the cases. Even though several prognostic factors for patellofemoral instability have been identified so far, the appropriate therapy for patients with patellar dislocation remains a controversial issue. The purpose of this study was to compare the outcome after conservative or operative treatment in patients after first-time patellar dislocation. PATIENTS AND METHODS: This randomized controlled clinical trial was designed multicentric including patients from six German orthopaedic and trauma departments. Twenty patients with a mean age of 24.6 years with first-time traumatic patella dislocation were included and randomized into either a conservative arm or an operative arm. Plain X-ray images of the knee joint (a.p. and lateral view and tangential view of both patellae) were performed in all cases prior to therapy to exclude osteochondral fragments requiring refixation. An MRI was recommended, but not compulsory. Patients were consulted after 6, 12, and 24 months with a questionnaire including the criteria of the Kujala score, recurrent dislocation, and satisfaction. RESULTS: The mean Kujala score of the conservative vs operative treatment group was 78.6 vs 80.3 after 6 months (p = 0.842), 79.9 vs 88.9 after 12 months (p = 0.165), and 81.3 vs 87.5 after 24 months (p = 0.339). Redislocation rate after 24 months was 37.5 % in the conservative group and 16.7 % in the operative group (p = 0.347). Due to the small number of patients that could be included, no significant difference between the groups could be detected. We see a tendency towards better results after operative treatment. CONCLUSION: Our multicentric prospective randomized controlled trial revealed no significant difference between conservative and operative treatment for patients after first-time traumatic patellar dislocation. However, a tendency towards a better Kujala score and lower redislocation rates for patients with operative treatment was observed. The small number of patients is a limiting factor of the study, leading to results without statistical significance. A meta-analysis including other study's level I data is desirable for the future.