The neck-shaft angle: an update on reference values and associated factors.

Background and purpose - The neck-shaft angle (NSA) is valuable for diagnostics and therapy of the hip, but current reference values derive mostly from studies on anatomic specimens, small cohorts, or are hospital-based. Moreover, associated factors such as age, sex, or anthropometric data have rarely been considered. Therefore, we determined associated factors for NSA and reassessed the historical reference values in a general adult population.Methods - NSAs on both sides of 3,226 volunteers from the population-based Study of Health in Pomerania (SHIP) were measured with MRI. SHIP drew a representative sample of the population of Pomerania (northeastern Germany). NSAs were compared with sex, age, and anthropometric data by bivariable linear regression models. Reference values were assessed by quantile regressions for 2.5th and 97.5th percentiles.Results - The mean NSA was 127° (SD 7), while men had a lower NSA than women (95% confidence interval [CI] 0.4°-1.4°). The reference range was 114°-140°. Age was inversely associated with NSA (CI -0.2 to -0.1). Body height was positively associated with the NSA, while BMI and waist circumference showed a negative association. There was no association between body weight and NSA.Interpretation - The historical lower limit of 120° might be too high, so the radiological prevalence of hip pathology might have been overestimated. The previously reported influence of age, sex, and body height on the NSA has been confirmed.

[Frequencies of musculoskeletal symptoms and disorders in the population-based German National Cohort (GNC)]. / Häufigkeiten muskuloskelettaler Symptome und Erkrankungen in der bevölkerungsbezogenen NAKO Gesundheitsstudie.

BACKGROUND: Musculoskeletal diseases and symptoms are very common in the general population. They lead to high healthcare costs and pose a significant burden to the national economy. OBJECTIVES: Based on data from the population-based German National Cohort (GNC), frequencies of musculoskeletal symptoms and diseases are reported, including back pain, osteoporosis, osteoarthritis, and arthritis. MATERIALS AND METHODS: Data were collected from March 2014 to March 2017 in adults aged 20-75 years during the first half of the baseline survey of the GNC. The sample comprised 101,779 interviewed subjects, including 9370 subjects who underwent clinical musculoskeletal examinations. The interview included questions about specific musculoskeletal disorders. A clinical examination of the hand provided information about palpable swollen joints and pressure-sensitive joints. Resting pain of the knees and hips was also assessed by a clinical examination. Frequencies were standardized to the German standard population of the year 2011. RESULTS: Having ever been diagnosed with recurrent back pain (22.5%) or osteoarthritis (20.6%) were the most common complaints reported in the interview; osteoporosis (2.9%) and rheumatoid arthritis (1.9%) were stated more seldom. According to the hand examination, 6.0% of all participants experienced pain in at least one finger joint. Resting pain was present in at least one knee among 8.2% and in at least one hip among 5.1% of the participants as assessed during the clinical examination. Women were more likely to report musculoskeletal disorders and symptoms than men. The proportion of adults affected by musculoskeletal diseases increased strongly with age. CONCLUSION: Musculoskeletal disorders and symptoms occur frequently. The burden of complaints and diagnoses is comparable to previous population-based surveys.

[Mandatory Surgical Subinternship in the Final Year of Medical School - a Stepping Stone to Becoming a Surgeon?] / Chirurgisches Pflichttertial im Praktischen Jahr ­ das Sprungbrett in die chirurgische Weiterbildung?

BACKGROUND: The final year is an important time for a medical student as this is when medical knowledge is transformed into medical responsibilities. The field of surgery is firmly anchored in the educational structure as it is mandatory during the practical year of a medical student. The purpose of this paper is to identify factors that influence medical students to choose surgery after the final year of medical school. MATERIALS AND METHODS: An online survey conducted by the AG DGOU 2012 provided complete data sets from a total of 9079 participants. 184 of these had already completed their PJ compulsory sub-internship (tertiary) surgery. These were divided into four groups for analysis: decision to specialise in surgery prior to the PJ compulsory tertiary ("yes, before", JV), during the PJ compulsory ("yes, during", JW), decision against before the PJ compulsory ("no, before", NV) or during the compulsory ("no, during", NW). The total of 38 survey items were summarised for overall assessment, taking into account the decision on subject specialisation. RESULTS: 57.9% of the respondents were positive regarding the overall impression of the surgical internship during their final year. The respondents of the JW group were especially positive, having made the decision to become a surgeon, based on their internship experience during the final year in comparison to the NW group (decision against surgery). We find significant differences in all analysed items: integration into team JW/NW (p ≤ 0.003), acquisition of expertise (p ≤ 0.014), teachers (p ≤ 0.025), quality and structure of teaching (p ≤ 0.043) and overall satisfaction with the required tertial (p ≤ 0.037). CONCLUSION: In comparison to other specialities, in the field of surgery there is the option of recruiting directly within the framework of the compulsory internship. The results reveal unsatisfactory structures from a student perspective. The lack of medical care/support, the insufficient inclusion in therapeutic considerations, the lack of professional knowledge and lack of contact with the teachers are just a few key points that negatively impact the overall outcome of students' satisfaction with the compulsory tertiary education. The results of the present study should serve as motivation and contribute to the restructuring of the compulsory core of the Practical Year, which the Master Plan 2020 will entail.

What Are the Reference Values and Associated Factors for Center-edge Angle and Alpha Angle? A Population-based Study.

BACKGROUND: The available evidence regarding normal ranges for the center-edge angle and the alpha angle derives from a few small studies, and associated factors such as sex and anthropometric factors have not been well evaluated. Knowing more about normal values for these parameters is critical, because this can inform decisions about when to perform elective hip preservation surgery. Population-level studies would provide considerable clarity on these issues, but to our knowledge, no such studies are available. QUESTIONS/PURPOSES: The purposes of this study were (1) to use MRI in patients of a population-based study to establish normal values for the alpha and center-edge angles in the normal adult hip; and (2) to determine whether age, sex, or anthropometric variables were associated with differences in these values. METHODS: We used MRI images (1.5 T) of 3226 participants of the Study of Health in Pomerania (SHIP). SHIP is a population-based study that started with 4308 participants in 1997. Participants were recruited randomly from official inhabitant data files as a stratified cluster sample of the population from a defined region in northeastern Germany. To ensure a representative epidemiologic cohort, stratification variables were sex, age, and city of residence. Between 2008 and 2012, 1094 of these participants underwent whole-body MRI with pelvic sequences in the second followup. In parallel, the next cohort, SHIP-Trend, started with the same protocol in which 2132 participants underwent MRI examination. Reference values were calculated by quantile regressions for the 2.5 and 97.5 percentiles. Associations with the demographic features sex, age, weight, height, body mass index (BMI), and waist circumference were analyzed by bivariate linear regression models. RESULTS: The mean center-edge angle was 31° (± 7°) with a corresponding calculated normal range of 17° to 45°. The mean alpha angle was 55° (± 8°) with a corresponding calculated normal range between 39° and 71°. Men (30° ± 7°) had a lower center-edge angle than women (32° ± 8°) (p < 0.001, ß = 1.4°; 95% confidence interval [CI], 0.9°-1.9°) and a higher alpha angle (57° ± 8° versus 52° ± 7°, p < 0.001, ß = 5.7°; 95% CI, 5.2°-6.3°). Moreover, a higher center-edge angle for the left side was found (33° ± 8° versus 30° ± 8°, p < 0.001, ß =3.2°; 95% CI, 3.0°-3.4°). In addition to sex, we found that age, height, waist circumference, and BMI affected both center-edge angle and alpha angle. Weight was associated with the alpha angle as well. Because of these associations, age- and sex-adjusted reference values with belonging formulas were calculated. CONCLUSIONS: The range of normal center-edge and alpha angles is quite wide. Therefore, only markedly abnormal angles may be associated with pathology. Moreover, center-edge angle and alpha angle are associated with age, sex, and anthropometric factors, which have to be taken into account for better interpretation. CLINICAL RELEVANCE: The association of abnormal radiographic values with true clinical hip pathology is tenuous at best. Assuming that a patient with an abnormal radiograph requires treatment is unwise. The clinical picture has to be substantial for therapeutic decisions.

In vitro susceptibility of methicillin-resistant and methicillin-susceptible strains of Staphylococcus aureus to two different cold atmospheric plasma sources.

BACKGROUND: Staphylococcus aureus may be the most important wound pathogen and causative for most of surgical site infections. As many anti-staphylococcal drugs are useless because of resistance, novel antimicrobial strategies are strongly needed and may be provided by cold atmospheric plasma (CP), which is being currently investigated for antiseptic efficacy. METHODS: To test the antimicrobial properties of CP against Staphylococcus aureus, 168 methicillin-susceptible isolates (MSSA) and 50 methicillin-resistant isolates (MRSA) were treated with two technically different plasma sources [an atmospheric pressure plasma jet (APPJ) and a dielectric barrier discharge plasma (DBD)] in vitro. RESULTS: CP treatment allowed a reproducible and significant growth reduction of MRSA and MSSA. However, MRSA was significantly less susceptible to treatment with DBD than was MSSA, while no difference between MRSA and MSSA was found using APPJ. CONCLUSIONS: As the initial physical antiseptic on skin, CP may be suitable for rapid decolonization of microbial pathogens in vivo. Each device must undergo validated efficacy testing prior to clinical application, as device related differences may occur.

Plasma disc decompression compared to physiotherapy for symptomatic contained lumbar disc herniation: A prospective randomized controlled trial.

INTRODUCTION: To evaluate clinical outcomes with PDD as compared with patients who underwent to standard physiotherapy intervention. MATERIAL AND METHODS: One-hundred-seventy-seven randomly assigned patients with primarily radicular pain associated with a single-level lumbar contained disc herniation were enrolled. Participants received either PDD (89 patients) or conservative physiotherapy care (88 patients). RESULTS: Patients in the PDD group had significantly greater reduction in leg pain scores and significantly improved VAS (p<0.001), Oswestry Disability Index (p<0.05), and 36-Item Short Form, than those in the physiotherapy group at 12 months. On subset analysis, patients achieved even better outcomes after PPD who: were younger, had a shorter period of radiculopathy, of male gender, and lower BMI. Patients with subacute pain reported better outcomes than those with chronic pain in the PDD group. CONCLUSIONS: Patient selection for PDD over physiotherapy favored younger patients who presented with a shorter period of pain symptoms and who had a more favorable body habitus.

Comparison of health care costs between aseptic and two stage septic hip revision.

The number of septic and aseptic total hip arthroplasty (THA) revisions will increase, which involves a greater financial burden. We here provide a retrospective consecutive analysis of the major variable direct costs involved in revision THA for aseptic and septic failure. A total of 144 patients (30 septic, 114 aseptic) treated between January 1, 2009 and March 31, 2012 was included. The management of septic THA loosening is much more expensive than that of aseptic loosening ($14,379.8 vs. $5,487.4). This difference is mainly attributable to the two-stage exchange technique used for septic failure (hospital stay: 40.2 vs. 15.6 days) and significantly higher implant costs ($3,930.9 vs. $2,298.2). The septic implantation part is on average $3,384.6 more expensive than aseptic procedures (P < .001).

Operation of lumbar zygoapophyseal joint cysts using a full-endoscopic interlaminar and transforaminal approach: prospective 2-year results of 74 patients.

In appropriate situations, extensive decompression with laminectomy often continues to be described as the method of choice for operations involving lumbar zygoapophyseal joint (z-joint) cysts. Tissue-sparing procedures are nevertheless becoming more common. Endoscopic techniques have become the standard procedures in many areas because of the advantages they offer in terms of surgical technique and in rehabilitation. One key aspect in spinal surgery was the development of instruments for sufficient bone resection carried out under continuous visual control. This enabled endoscopes to be used when operating on z-joint cysts. The objective of this prospective study was to examine the technical possibilities for the full-endoscopic interlaminar and transforaminal technique in lumbar z-joint cysts. A total of 74 patients were followed up for 2 years. The results show that 85% of the patients no longer have any leg pain or that the pain had been almost completely eliminated, and 11 % experience occasional pain. The complication rate was low. The full-endoscopic techniques brought advantages in the following areas: operation, complications, traumatization, and rehabilitation. The recorded results show that full-endoscopic resection of a z-joint cyst using an interlaminar and transforaminal approach provides an adequate and safe supplement, and is an alternative to conventional procedures when the indication criteria are fulfilled. It also offers the advantages of a minimally invasive intervention.

Sources of information influencing decision-making in orthopaedic surgery - an international online survey of 1147 orthopaedic surgeons.

BACKGROUND: Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was to evaluate the subjective usefulness and usage of different sources of information upon which orthopaedic surgeons base their decisions when acquiring new implants or techniques. METHODS: We undertook an online survey of 1174 orthopaedic surgeons worldwide (of whom n = 305 were head of their department). The questionnaire included 34 items. Sequences were randomized to reduce possible bias. Questions were closed or semi-open with single or multiple answers. The usage and relevance of different sources of information when learning about and selecting orthopaedic treatments were evaluated. Orthopaedic surgeons and trainees were targeted, and were only allowed to respond once over a period of two weeks. Baseline information included country of workplace, level of experience and orthopaedic subspecialisation. The results were statistically evaluated. RESULTS: Independent scientific proof had the highest influence on decisions for treatment while OEM (Original Equipment Manufacturer) driven activities like newsletters, white papers or workshops had the least impact. Comparison of answers from the three best-represented countries in this study (Germany, UK and USA) showed some significant differences: Scientific literature and congresses are significantly more important in the US than in the UK or Germany, although they are very important in all countries. CONCLUSIONS: Independent and peer-reviewed sources of information are preferred by surgeons when choosing between methods and implants. Manufacturers of medical devices in orthopaedics employ a considerable workforce to inform or influence hospital managers and leading doctors with marketing activities. Our results indicate that it might be far more effective to channel at least some of these funds into peer-reviewed research projects, thereby assuring significantly higher acceptance of the related products.

Comparison of Different Methods of Semiquantitative Assessment and Subjective Scores for Retropatellar Articular Cartilage Evaluation in Advancing Osteoarthritis.

BACKGROUND: cartilage layer thickness, composition of the extracellular matrix (ECM), geometry and configuration of retropatellar cartilage partially differ significantly from those found at other locations and are essential for patellofemoral biomechanics. MATERIAL AND METHODS: 119 serial medial and lateral patella facet samples of patients undergoing implantation of a total knee endoprosthesis of areas showing mild (Group A, macroscopically ICRS Grade 1b) respectively advanced (Group B, macroscopically ICRS Grade 3a/3b) (38 each) osteoarthritis according to the histological-histochemical grading system (HHGS) were compared with 22 healthy biopsies by means of immunohistochemistry and histology investigations. We quantified our results on the gene expression of collagen type I and II and aggrecan with real-time (RT)-PCR rsp using colourimetry for proteoglycan content. The digitized images of histology and immunohistochemistry staining with Safranin O, Alcian blue, PAS, Masson Goldner, immunostaining, e.g. for collagen I and II were also analyzed with Photoshop software. RESULTS: The most significant decrease in staining intensity was revealed for Safranin-O staining in Group B at the lateral patellar facet, and the most relevant increase was for Col I staining at the same site. The lateral patella site in Group B also showed the highest increase in the ratio of expression indices for the genes Col1A1 and the reference gene following the equation 2-ΔCt with a quotient of 29.6. CONCLUSIONS: 1. Comparisons of our retropatellar cartilage analysis with femoral and tibial studies utilizing similar techniques show significant differences. 2. Cartilage layer thickness, ECM composition, geometry and configuration are essential for patellofemoral biomechanics. 3. Consequently, there is a need for diversified approaches towards retropatellar surface during TKA as well as for advanced cartilage restoration techniques.

Marginal contribution of UKS- versus TKA in varus arthritis of the knee.

BACKGROUND: In recent years, decisions regarding the treatment of individual patients have increasingly been affected by economic considerations. The G-DRG system reimburses sledge endoprosthetic implantations at a much lower rate than surface replacements and at significantly different cost weights (CW). Therefore, when only G-DRG payments are considered, TKA produces higher gains. Taking only these revenues alone into consideration, however, does not provide the basis of an economically sound decision-making process. The target of this research was to present a comparison between variable costs of the two procedures. METHODS: The mean cost and performance data of 28 Endo-Modell (Link company) sledge implantations (UKS) and of 85 NexGen CR surface replacement total knee arthroplasties (TKA; Zimmer company) were compared in 2007. RESULTS: From the perspective of the hospital, UKS treatment is of greater economic advantage when the medical indication is given. In preferring UKS marginal contribution can be improved, and although the relative weighting is comparatively low, the costs are significantly lower than in a comparative analysis of TKA. Based on the length of stay required for each procedure the average daily CW for UKS can be calculated as 0.1728, while being 0.1955 for TKA. The earlier release of the first patient results in another patient being admitted 1.5 days earlier and thus an increase in case mix. Meanwhile, the case-mix index and the costs of care per case decrease ceteris paribus. CONCLUSION: Assuming the correct medical indication, the hospital seeking to maximize its marginal contribution would be wise to select sledge endoprosthesis implantation. Considering the economic perspective of gains and costs, the assumption that TKA is advantageous could not be confirmed in the present study.

The effect of the design of the orthosis on the axial load transmission of two flexion abduction orthoses used in treating congenital hip dysplasia.

Background: With an incidence of 2-4% in all newborns, developmental dysplasia of the hip, DDH, represents the most frequent congenital disorder of the skeletal system in Germany. The therapy options are deduced with the help of a sonography. The conservative therapy approach includes the application of flexion abduction orthoses, which lead to a development of the child's hip through abduction and flexion angle. The overall structure of the orthoses puts a strain on the axial skeleton of the children. The following work is intended to clarify what role the design of the orthoses plays in this respect. Methods: Inclusion criterion for the study was fully developed newborns without an indication of skeletal malformations with Type I hip joints according to Graf verified by ultrasound. A total of 19 newborns were recruited and included in the period 3/2013-01/2015. Two types of orthoses used in treating developmental dysplasia of the hip (Tübinger splint, Otto Bock; hip flexion abduction orthosis (Superior orthosis) according to Mittelmeier-Graf, AIDAMED e.K (Kreuz et al., 2012; Mittelmeier et al., 1998; Schmitz et al., 1999), constructions differ, were used. Force was measured with the help of three force sensors, which were even able to be integrated into these without changing the design of the orthosis. In this closed system, force transmission was measured for the duration of a fixed period of two minutes. Findings: The greatest axial force development (overall force) is in the Tübinger splint with an average force of 15.1 N (min. 0.59 N, max. 53.09 N, mean 15.1, SD 2.46). 4.09 N (min. 0.96 N, max. 20.99 N, mean 4.09, SD 0.65) resulted in the Superior orthosis. Significant correlations between body weight and resulting axial traction - on average during the entire measurement period and in movement - can be taken from the statistical analysis regarding the Tübinger splint. Such a correlation cannot be depicted for the Superior orthosis. Interpretation: The analysis of the load transmission of the examined flexion and abduction orthoses reveals differences between the models. The construct of the orthoses in itself appears to play a significant role. Long-term effects of orthosis therapy on a child's axial skeleton have not been studied to date. Furthermore, it seems reasonable to expand the test series to orthoses, the design of which is configured in a similar matter compared to the examined aids. Conclusion: This study proves that the orthotic design has an influence on the infant's axial load.

Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study.

STUDY DESIGN: Population-based cohort study. OBJECTIVE: We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP). SUMMARY OF BACKGROUND DATA: The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse. METHODS: Participants (n = 3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain. RESULTS: MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50-1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04-2.37), but not in those with baseline pain (-0.30; -0.99 to 0.38). CONCLUSION: Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.Level of Evidence: 3.

Internship Experience in Orthopaedics and Traumatology and its Impact on Becoming a Specialist. / Praktisches Jahr in Orthopädie und Unfallchirurgie ­ die kollegiale Staffelstabübergabe in die Weiterbildung?

INTRODUCTION: The German practical year is the last clinical placement period during Medical School. However, it remains unclear how medical students evaluate the practical year in orthopaedics and traumatology (Orthopädie und Unfallchirurgie; O & U) and whether it has an impact on becoming an O & U specialist. METHOD: We analysed data of 146 medical students (46,7% female) who completed the placement in O & U. From the evaluation, 37 items were included in the analyses. Participants who could imagine becoming an O & U specialist (O & U-Ja) following graduation were statistically compared to those who could not (O & U-Nein). RESULTS: Overall 123 (83.7%) trainees indicated that they would like to become an O & U specialist (O & U-Ja), 18 (12.8%) negated (O & U-Nein) and 6 (4.1%) were undecided. Groups did not differ for sex and age (sex: Chi² = 2.50, p = 0.114; age: F [1.93] < 1, p = 0.764). Group differences were found for practical orientation, independency, acquisition of anamnesis and diagnostics skills and problem-solving expertise with students who could imagine becoming an O & U specialist (O & U-Ja) giving the highest ratings. DISCUSSION: Evaluations of the last medical year are essential in order to continuously improve the internship experience and to attract students towards a certain medical field and, moreover, to post-graduate specialist training. Clinics and institutions who already emphasize on the factors derived from this evaluation, or are continuously working on improvement, might be more able to attract young professionals, since personnel acquisition is starting early in the medical field.

Changes in content and synthesis of collagen types and proteoglycans in osteoarthritis of the knee joint and comparison of quantitative analysis with Photoshop-based image analysis.

INTRODUCTION: The different cartilage layers vary in synthesis of proteoglycan and of the distinct types of collagen with the predominant collagen Type II with its associated collagens, e.g. types IX and XI, produced by normal chondrocytes. It was demonstrated that proteoglycan decreases in degenerative tissue and a switch from collagen type II to type I occurs. The aim of this study was to evaluate the correlation of real-time (RT)-PCR and Photoshop-based image analysis in detecting such lesions and find new aspects about their distribution. PATIENTS: We performed immunohistochemistry and histology with cartilage tissue samples from 20 patients suffering from osteoarthritis compared with 20 healthy biopsies. Furthermore, we quantified our results on the gene expression of collagen type I and II and aggrecan with the help of real-time (RT)-PCR. Proteoglycan content was measured colorimetrically. Using Adobe Photoshop the digitized images of histology and immunohistochemistry stains of collagen type I and II were stored on an external data storage device. The area occupied by any specific colour range can be specified and compared in a relative manner directly from the histogram using the "magic wand tool" in the select similar menu. In the image grow menu gray levels or luminosity (colour) of all pixels within the selected area, including mean, median and standard deviation, etc. are depicted. Statistical Analysis was performed using the t test. METHOD: With the help of immunohistochemistry, RT-PCR and quantitative RT- PCR we found that not only collagen type II, but also collagen type I is synthesized by the cells of the diseased cartilage tissue, shown by increasing amounts of collagen type I mRNA especially in the later stages of osteoarthritis. RESULTS: A decrease of collagen type II is visible especially in the upper fibrillated area of the advanced osteoarthritic samples, which leads to an overall decrease. Analysis of proteoglycan showed a loss of the overall content and a quite uniform staining in the different zones compared to the healthy cartilage with a classical zonal formation. Correlation analysis of the proteoglycan Photoshop measurements with the RT-PCR using Spearman correlation analysis revealed strong correlation for Safranin O and collagen type I, medium for collagen type II and glycoprotein but weak correlation between PCR aggrecan results. CONCLUSION: Photoshop-based image analysis might become a valuable supplement for well known histopathological grading systems of lesioned articular cartilage.

Combination Drug Therapy for the Management of Low Back Pain and Sciatica: Systematic Review and Meta-Analysis.

Combining medicines may give greater pain relief and/or improved tolerability. We conducted a systematic review to investigate the effects of combination drug therapy in patients with low back pain and/or sciatica on pain, disability, and adverse events. Databases and trial registers were searched from inception to July 27, 2017, for randomized trials of (sub)acute or chronic back pain or sciatica participants that were administered combination drug therapy compared with monotherapy or placebo. Of the 27 studies included, most combinations (21 of 23) consisted of single trials. Most combinations had no or small effect on pain and disability. A clinically important difference was found in one combination, buprenorphine plus pregabalin versus buprenorphine for chronic back pain at immediate (mean difference = -23.30; 95% confidence interval = -27.68 to -18.92) and short (mean difference = -27.60; 95% confidence interval = -31.70 to -23.50) terms; however, the quality of evidence was low. There was no statistically significant increased risk of serious adverse events. When the risk of adverse events was statistically significant, it favored monotherapy or placebo. There is no clear evidence to support any combination drug therapy for the management of low back pain and sciatica due to the limited number of studies and overall low quality of evidence. Perspective: Combining medicines may give greater pain relief and/or improved tolerability compared with single-ingredient medicines. However, the lack of studies and overall low quality of evidence limit the recommendation of combination drug therapy for the management of low back pain and sciatica.

Prevalence of benign osseous lesions of the spine and association with spinal pain in the general population in whole body MRI.

BACKGROUND: Benign osseous lesions of the spine are common but precise population prevalence estimates are lacking. Our study aimed to provide the first population-based prevalence estimates and examine association with back and neck pain. MATERIALS AND METHODS: We used data from the population-based Study of Health in Pomerania (SHIP). Whole-body MRI examinations (1.5 Tesla: T1, T2, and TIRM weightings) were available from 3,259 participants. Readings of the spinal MRI images were conducted according to a standardized protocol by a single reader (JS). The intra-rater reliability was greater than Kappa values of 0.98. Pain measures included the seven-day prevalence of spine pain and neck pain, and average spine pain intensity due to spine pain during the past three months. RESULTS: We found 1,200 (36.8%) participants with at least one osseous lesion (2,080 lesions in total). Osseous lesions were less common in men than in women (35.5% vs 38.9%; P = .06). The prevalence of osseous lesions was highest at L2 in both sexes. The prevalence of osseous lesions increased with age. Up to eight osseous lesions were observed in a single subject. Hemangioma (28%), and lipoma (13%) occurred most often. Sclerosis (1.7%), aneurysmal bone cysts (0.7%), and blastoma (0.3%) were rare. Different osseous lesions occurred more often in combination with each other. The association with back or neck pain was mostly negligible. CONCLUSION: Osseous lesions are common in the general population but of no clinical relevance for spinal pain. The prevalence of osseous lesions varied strongly across different regions of the spine and was also associated with age and gender. Our population-based data offer new insights and assist in judging the relevance of osseous lesions observed on MRIs of patients.

[Quality and Satisfaction with the Surgical Medical Clerkship from a Student Perspective]. / Qualität und Zufriedenheit mit der chirurgischen Famulatur aus studentischer Sicht.

PREFACE: The surgical medical clerkship is of special importance, as the student is given the opportunity to get in touch with medical colleagues and patients for the first time, and the interest in a certain field of specialisation can be consolidated. The present study will clarify how students perceived their medical clerkship in the field of surgery. METHODS: A nationwide online survey carried out in 2012 was able to recruit 9079 participants, and contained questions about the completed curricular internships. The present evaluation contains the data of those respondents who had completed at least four weeks of internship in surgery. The following main groups were of particular interest: overall assessment, satisfaction, structure and quality of teaching, of the teachers, and the acquisition of practical skills, which were divided into 35 items. Statistical evaluation was carried out using SPSS 22.0 (IBM Corp., Armonk, USA). In addition to the descriptive statistics, the Chi² test was performed for frequencies, and univariate ANOVAs with the sub-subject factor group (satisfied, neutral, dissatisfied) were performed for the individual items. RESULTS: Overall, the data of 526 participants could be analysed. The female proportion of students was 56.7%; the average age at the time of the survey was 25 years. In all evaluated items, there were significant differences between the groups satisfied and dissatisfied. The participants of the survey who were satisfied with the overall qualification (p = 0.000), reported that they benefited with regard to the technical and didactic quality of teaching (p = 0.000), the acquisition of practical competences (p = 0.000), as well as the didactic and professional quality of teaching (p = 0.000). DISCUSSION: Little is published about the internships for students, including the medical clerkship "Famulatur". However, this information seems to be important, as the students can freely choose the subject in which the Famulatur can be completed. Thus, in this early phase of training, it is possible to recruit young academics for the department by optimising existing structures and improving the range of courses.