[Quality in Revision Arthroplasty: A Comparison between Claims Data Analysis and External Quality Assurance]. / Ergebnisqualität in der Revisionsendoprothetik: Eine Analyse von Routinedaten mit dem Vergleich zur externen Qualitätssicherung.

BACKGROUND: External quality assurance for revisions of total knee arthroplasty (TKA) and total hip arthroplasty (THA) are carried out through the AQUA institute in Germany. Data are collected by the providers and are analyzed based on predefined quality indicators from the hospital stay in which the revision was performed. The present study explores the possibility to add routine data analysis to the existing external quality assurance (EQS). Differences between methods are displayed. The study aims to quantify the benefit of an additional analysis that allows patients to be followed up beyond the hospitalization itself. MATERIAL AND METHODS: All persons insured in an AOK sickness fund formed the population for analysis. Revisions were identified using the same algorithm as the existing external quality assurance. Adverse events were defined according to the AQUA indicators for the years 2008 to 2011.The hospital stay in which the revision took place and a follow-up of 30 days were included. For re-operation and dislocation we also defined a 365 days interval for additional follow-up. The results were compared to the external quality control reports. RESULTS: Almost all indicators showed higher events in claims data analysis than in external quality control. Major differences are seen for dislocation (EQS SD: 1.87 vs. claims data [cd] SD: 2.06 %, cd+30 d: 2.91 %, cd+365 d: 7.27 %) and reoperation (hip revision: EQS SD: 5.88 % vs. claims data SD: 8.79 % cd+30 d: 9.82 %, cd+365 d: 15.0 %/knee revision: EQS SD: 3.21 % vs. claims data SD: 4.07 %, cd+30 d: 4.6 %, cd+365 d: 15.43 %). Claims data could show additional adverse events for all indicators after the initial hospital stay, rising to 77 % of all events. CONCLUSIONS: The number of adverse events differs between the existing external quality control and our claims data analysis. Claims data give the opportunity to complement existing methods of quality control though a longer follow-up, when many complications become evident.

Pelvic reconstruction with compound osteosynthesis following hemipelvectomy: A clinical study.

To date, all surgical techniques used for reconstruction of the pelvic ring following supra-acetabular tumour resection produce high complication rates. We evaluated the clinical, oncological and functional outcomes of a cohort of 35 patients (15 men and 20 women), including 21 Ewing's sarcomas, six chondrosarcomas, three sarcomas not otherwise specified, one osteosarcoma, two osseous malignant fibrous histiocytomas, one synovial cell sarcoma and one metastasis. The mean age of the patients was 31 years (8 to 79) and the latest follow-up was carried out at a mean of 46 months (1.9 to 139.5) post-operatively. We undertook a functional reconstruction of the pelvic ring using polyaxial screws and titanium rods. In 31 patients (89%) the construct was encased in antibiotic-impregnated polymethylmethacrylate. Preservation of the extremities was possible for all patients. The survival rate at three years was 93.9% (95% confidence interval (CI) 77.9 to 98.4), at five years it was 82.4% (95% CI 57.6 to 93.4). For the 21 patients with Ewing's sarcoma it was 95.2% (95% CI 70.7 to 99.3) and 81.5% (95% CI 52.0 to 93.8), respectively. Wound healing problems were observed in eight patients, deep infection in five and clinically asymptomatic breakage of the screws in six. The five-year implant survival was 93.3% (95% CI 57.8 to 95.7). Patients were mobilised at a mean of 3.5 weeks (1 to 7) post-operatively. A post-operative neurological defect occurred in 12 patients. The mean Musculoskeletal Tumor Society score at last available follow-up was 21.2 (10 to 27). This reconstruction technique is characterised by simple and oncologically appropriate applicability, achieving high primary stability that allows early mobilisation, good functional results and relatively low complication rates.

[Basic principles of surgical treatment of bone metastases]. / Grundlagen der operativen Behandlung von Knochenmetastasen.

Due to an increased life expectancy and improved oncological treatment, the necessity for surgical treatment of bone metastases has increased as well. Ideally, therapy should concentrate on the improvement of the patient's quality of life while preferably being interdisciplinary. The type and extent of surgical therapy depend on the prognosis, tumor entity, localization of the tumor as well as on the patient's general condition. The main aims of surgical treatment is to reduce pain and preserve or restore function and mobility. After the contribution on spinal metastases in the last volume, this article focusses on metastases of the extremities and the pelvis. Pathologic fractures with an unclear oncological situation should be examined thoroughly before any surgical treatment is performed. In case of doubt, a biopsy should be performed. Depending on the individual prognosis, possible options for extremity surgery are (compound) osteosynthesis and implantation of a tumor endoprosthesis. The latter should be preferred for patients with a favorable prognosis and long life expectancy. To avoid revision surgery, the selected implant should outlast the patient's remaining life expectancy.

Oestrogen removal from biological pretreated wastewater within decentralised sanitation and re-use concepts.

Two parallel researches were performed; one focused on the fate of oestrogens in the biological treatment systems within decentralised sanitation and re-use concepts (DESAR), the second related to the development of a suitable specific removal method. A new affinity membrane was developed using antibodies as specific binding sites for hormone removal. It was found that, especially in anaerobic treatment, the core technology in DESAR, the removal is insufficient and therefore an additional separation method is required. The affinity membrane with antibodies was found to be a suitable additional method, though in the current system it only removes one selected compound. Future research will focus on making this method more feasible in practise.

Tailoring the properties of asymmetric cellulose acetate membranes by gas plasma etching.

Cellulose triacetate (CTA) ultrafilters and cellulose acetate blend (CAB) desalination membranes were treated with a radiofrequency gas plasma (tetrafluoromethane (CF(4)) or carbon dioxide (CO(2)), 47-49 W, 0.04-0.08 mbar). Treatment times were varied between 15 s and 120 min. The plasma-treated top layer of the membranes was characterized by scanning electron microscopy, X-ray photoelectron spectroscopy, and contact angle measurements to obtain information about surface structure, chemistry, and wettability, respectively. The membrane properties (e.g., permeability, selectivity, fouling) were studied by waterflux measurements, molecular weight cutoff measurements, and fouling experiments with bovine serum albumin. CO(2) plasma treatment resulted in gradual etching of the membrane's dense top layer. Permeation and selectivity changed significantly for treatment times of 0-15 min for CTA and 5-60 min for CAB membranes. Moreover, CTA membranes were hydrophilized during CO(2) plasma treatment whereas CF(4) plasma treatment led to hydrophobic surfaces due to strong fluorination of the top layer. This study shows that gas plasma etching can tailor the properties of asymmetric cellulose acetate membranes by simultaneously modifying the chemistry and structure of the top layer. The low fouling properties of CTA membranes were thereby largely maintained.

Point mutations throughout the GLI3 gene cause Greig cephalopolysyndactyly syndrome.

Greig cephalopolysyndactyly syndrome, characterized by craniofacial and limb anomalies (GCPS; MIM 175700), previously has been demonstrated to be associated with translocations as well as point mutations affecting one allele of the zinc finger gene GLI3. In addition to GCPS, Pallister-Hall syndrome (PHS; MIM 146510) and post-axial polydactyly type A (PAP-A; MIM 174200), two other disorders of human development, are caused by GLI3 mutations. In order to gain more insight into the mutational spectrum associated with a single phenotype, we report here the extension of the GLI3 mutation analysis to 24 new GCPS cases. We report the identification of 15 novel mutations present in one of the patient's GLI3 alleles. The mutations map throughout the coding gene regions. The majority are truncating mutations (nine of 15) that engender prematurely terminated protein products mostly but not exclusively N-terminally to or within the central region encoding the DNA-binding domain. Two missense and two splicing mutations mapping within the zinc finger motifs presumably also interfere with DNA binding. The five mutations identified within the protein regions C-terminal to the zinc fingers putatively affect additional functional properties of GLI3. In cell transfection experiments using fusions of the DNA-binding domain of yeast GAL4 to different segments of GLI3, transactivating capacity was assigned to two adjacent independent domains (TA(1)and TA(2)) in the C-terminal third of GLI3. Since these are the only functional domains affected by three C-terminally truncating mutations, we postulate that GCPS may be due either to haploinsufficiency resulting from the complete loss of one gene copy or to functional haploinsufficiency related to compromised properties of this transcription factor such as DNA binding and transactivation.