[Apps in clinical use in orthopedics and trauma surgery : The status quo in Germany]. / Klinischer Einsatz mobiler Applikationen in der Orthopädie und Unfallchirurgie in Deutschland : Eine Bestandsaufnahme.

In the course of digitalization the smartphone is penetrating more and more areas of life giving the user mobile and almost ubiquitous access to the internet and other web applications. The advantages of mHealth are an integral part in some areas of patient care but in contrast to other disciplines, routine integration of mobile devices into orthopedics and trauma surgery is still in its infancy. A survey among German orthopedists and trauma surgeons revealed which kind of apps have become established in everyday clinical practice to date. Apps published by representative institutions such as the AO Foundation demonstrated the highest usage rates. In summary, the number of regularly used apps is low; however, the causes of this lack of acceptance have not yet been conclusively clarified. The authors of this study proclaim a significant increase in the use of mHealth and mobile devices in daily clinical practice in the future.

[Digitalization and artificial intelligence in orthopedics and traumatology]. / Digitalisierung und künstliche Intelligenz in Orthopädie und Unfallchirurgie.

In the course of digitalization it is becoming increasingly rare for medical documents to be handwritten. As a result, digitalization has already become an integral part of routine patient care but in contrast to other specialist disciplines, such as radiology or laboratory medicine, orthopedics and trauma surgery are still at the beginning of new technologies. Artificial intelligence is not only used in the form of surgical robots in joint surgery or in the design of individualized implants but also provides valuable decision-making aids through appropriate algorithms for diagnosis and treatment. It can be assumed that these technologies will be further developed and used increasingly more in the coming years. Typical examples are intuitively operable and autonomously working programs and systems that support the networking and work of medical personnel and make processes inside and outside inpatient care more precise and less vulnerable to disturbances.

[Is the discharge letter still relevant? : Chances and risks of "Medical apps" in orthopedics and traumatology]. / Ist der Entlassungsbrief noch zeitgemäß? : Chancen und Risiken von "Medical Apps" in Orthopädie und Unfallchirurgie.

CURRENT SITUATION: The discharge letter currently represents the gold standard of the information and transfer document in the field of inpatient orthopedic and trauma patient care. In the age of digitization, the smartphone is penetrating more and more areas of life as an omnipresent internet access medium and is thus fundamentally influencing the awareness of our society. Whereas the use of applications on smartphones is already well established today, the range of medical apps is rudimentary. The potential of apps on smartphones as an innovative digital communication medium is undeniable, but the currently available medical apps in orthopedics and trauma surgery are available to a small patient clientele only. FORECAST: Currently, the use of medical apps is not an adequate alternative to the discharge letter. However, it is only a matter of time before the innovative potential of applications is used as a communication tool in outpatient and inpatient care. It is, therefore, essential to start creating the legal, ethical and medical framework and to establish a relevant regulatory body.

Unloader bracing in osteoarthritis of the knee - Is there a direct effect on the damaged cartilage?

BACKGROUND: Unloading knee braces represent a conservative treatment option for non-pharmalogical management of unicompartmental osteoarthritis of the knee. Though there is consensus on the clinical effectiveness of unloading, the effect mechanism of bracing remains part of a debate. Our study was designed to assess the effect of unloader bracing on damaged cartilage via MRI cartilage mappings. METHODS: Fourteen patients (7 female, 7 male, mean age 43.1 ± 9.4 years) with unicompartmental cartilage wear in knees with varus or valgus malalignment were enrolled. Clinical scores, radiographs and MR-graphic properties (T2/T2* mapping, T1 Delayed Gadolinium Enhanced MRI of the cartilage (dGEMRIC) mapping, high-resolution PDw sequences) of knee cartilage were recorded before and three months after brace use. RESULTS: Bracing the knees for a mean of 14.4 ± 2.0 weeks (range 11 to 18 weeks) resulted in significant pain reduction (VAS changed from 5.9 ± 2.0 to 2.0 ± 1.3, p < 0.001) and improvement in knee function (KOOS increased from 42.1 ± 22.7 to 64.8 ± 18.7, p < 0.001). In the affected cartilage regions T2 relaxation times significantly decreased from 56.1 ± 11.4 ms to 46.5 ± 11.2 ms (p < 0.05). No changes in T1-dGEMRIC and T2* relaxation times, thickness or the extent of the damaged cartilage area could be detected. CONCLUSIONS: Our results suggest, that unloader bracing improves the biochemical properties of the damaged cartilage by increasing collagen and proteoglycan concentration as well as decreasing the cartilage edema.

Magnetic Direct-Write Skyrmion Nanolithography.

Magnetic skyrmions are stable spin textures with quasi-particle behavior and attract significant interest in fundamental and applied physics. The metastability of magnetic skyrmions at zero magnetic field is particularly important to enable, for instance, a skyrmion racetrack memory. Here, the results of the nucleation of stable skyrmions and formation of ordered skyrmion lattices by magnetic force microscopy in (Pt/CoFeSiB/W)n multilayers, exploiting the additive effect of the interfacial Dzyaloshinskii-Moriya interaction, are presented. The appropriate conditions under which skyrmion lattices are confined with a dense two-dimensional liquid phase are identified. A crucial parameter to control the skyrmion lattice characteristics and the number of scans resulting in the complete formation of a skyrmion lattice is the distance between two adjacent scanning lines of a magnetic force microscopy probe. The creation of skyrmion patterns with complex geometry is demonstrated, and the physical mechanism of direct magnetic writing of skyrmions is comprehended by micromagnetic simulations. This study shows a potential of a direct-write (maskless) skyrmion (topological) nanolithography with sub-100 nm resolution, where each skyrmion acts as a pixel in the final topological image.

Production of polyunsaturated fatty acids by polyketide synthases in both prokaryotes and eukaryotes.

Polyunsaturated fatty acids (PUFAs) are essential membrane components in higher eukaryotes and are the precursors of many lipid-derived signaling molecules. Here, pathways for PUFA synthesis are described that do not require desaturation and elongation of saturated fatty acids. These pathways are catalyzed by polyketide synthases (PKSs) that are distinct from previously recognized PKSs in both structure and mechanism. Generation of cis double bonds probably involves position-specific isomerases; such enzymes might be useful in the production of new families of antibiotics. It is likely that PUFA synthesis in cold marine ecosystems is accomplished in part by these PKS enzymes.

Neurodevelopmental outcome and pulmonary morbidity two years after early versus late surfactant treatment: does it really differ?

AIM: To investigate whether neurodevelopmental outcome or pulmonary morbidity at age two years might be different after early versus late surfactant treatment in intubated preterm infants with severe respiratory distress syndrome (RDS). METHODS: In 185 ex-preterm infants of 27-32 completed weeks of gestation, who were enrolled in a controlled trial of early versus late surfactant treatment (31 +/- 19 min vs. 202 +/- 80 min, respectively), a standardized follow up of medical history, pulmonary morbidity and neurodevelopmental outcome using the Griffiths scales were carried out. RESULTS: Neurobehavioural and motor development was comparable in both groups, as was medical history and actual morbidity. However, in the early treatment group a delay in the subscale 'personal social' of the Griffiths test and in one 'milestone' of motor development (rolling over from supine to prone) was noticed, and the rate of increased muscular tone was significantly higher. CONCLUSION: In terms of long-term morbidity or neurological development there is no obvious advantage of an immediate surfactant administration after intubation in preterm infants with RDS. This is in line with our results published earlier on morbidity at discharge, so improvement of gas exchange after intubation can first be awaited before surfactant is indicated.

Neoplasms arising in Paget's disease of bone: a study of 82 cases.

Eighty-two cases of neoplasms arising in Paget's disease of bone from the Mid-America Bone Tumor Registry, accessioned between 1958 and 1983, were reviewed. There were 77 osteosarcomas, 3 fibrosarcomas, 1 chondrosarcoma, and 1 giant cell tumor. The male/female ratio was 2:1. The age distribution was 18%, 29%, 36%, and 17% for the groups less than 51 years, 51-60 years, 61-70 years, and greater than 70 years, respectively. The femur was involved by tumor in 22%; the humerus in 21%; the pelvis in 21%; the calvarium in 12%; the tibia in 10%; and other bones in 15% of the cases. There were 48% survivors after 1 year; 17% after two; and 5% after three and five years; two additional patients with tumor lived for more than seven and 11 years. Radiographs available for simultaneous study in 43 cases revealed predominant tumor patterns that were mixed in 69%, osteoblastic in 21%, and osteolytic in 10%. Other radiographic data and the clinical and histopathologic data are in agreement with five earlier major studies. While the prognosis of neoplasms arising in Paget's disease generally is not good, a small fraction of long-term survivors after aggressive therapy makes this complication a challenge for timely radiographic diagnosis and histopathologic confirmation.

Actions of CNTF and neurotrophins on degenerating motoneurons: preclinical studies and clinical implications.

Spinal motoneurons innervating skeletal muscle were amongst the first neurons shown to require the presence of their target cells to develop appropriately. Isolated embryonic chick and rat motoneurons have been used to identify neurotrophic factors and cytokines capable of supporting the survival of developing motoneurons. Such factors include ciliary neurotrophic factor (CNTF), which is present physiologically in high amounts in myelinating Schwann cells of peripheral nerves, and brain-derived neurotrophic factor (BDNF) which is synthesized in skeletal muscle and, after peripheral nerve lesion, in Schwann cells. These factors have been further analyzed for their physiological significance in maintaining motoneuron function in vivo, and for their potential therapeutic usefulness in degenerative motoneuron disease. Both CNTF and BDNF are capable of rescuing injured facial motoneurons in newborn rats. Furthermore, CNTF prolongs survival and improves motor function of pmn mice, an animal model for degenerative motoneuron disease, by preventing degeneration of motoneuron axons and somata. Thus treatment of human motoneuron disease with neurotrophic factors should be possible, provided that rational means for application of these factors can be established considering also the appearance of potential side effects.

[The effect of mucous excipient concentration on bioadhesion ex vivo]. / Einfluss der Schleimstoffkonzentration auf die Bioadhäsion ex vivo.

The bioadhesion of aqueous solutions of polyacrylics (1-3), hydroxyethylcellulose (4), sodium carboxymethylamylopectin (5), polyvinylalcohol (6) and tragant (7) was investigated using a tensiometer and fresh intestine of pigs. It was dependent on the concentration of the excipient as described by a quadratic equation and found in the maximum from 244 Pa (7) to 554 Pa (4). The maximum of bioadhesion corresponds to the concentration of the excipient from 0.15% (2) to 23.7% (4) and to the viscosity of the solutions from 0.11 Pa.s (3) to 3.6.10(6) Pa.s (4). There was not a correlation between the viscosity and the bioadhesion.

[Estimation of the intensity of effect of cardenolides. 2: Algorithms for the estimation of the intensity of effect]. / Abschätzung der Wirkstärke von Cardenoliden 2. Mitteilung: Algorithmus zur Abschätzung der Wirkstärke.

An algorithm worked on basis of quantitative relations between molecular-biologically defined effects and molecular-physical properties (see part 1) allows the effect estimation of concepted cardenolides before their synthesis. The empirical use of the developed equations for the estimation of molecular-biologically defined effect of compounds produces usable results and justifies therefore the proposed method, as well as it's shown by the experimental proof of estimated values of some cardenolides . An enlargement of the use of the algorithm for effect estimation seems to be successful.

[Estimation of the effects of cardenolides. 1. Relation between molecular physical parameters and parameters of action of cardenolides]. / Abschätzung der Wirkstärke von Cardenoliden. 1. Mitteilung: Zusammenhang zwischen molekülphysikalischen Parametern und dem Wirkstärkeparameter von Cardenoliden.

Knowing the modell developed by Repke and co-workers for the cardenolide-receptor-interaction the aim of this study was to find quantitative relations between molecular physical properties of cardenolides and their molecular-biologically defined effect, which are fundamentally useful to estimate the effect of still nonsynthesized cardenolide derivatives. The statistically significant relations (alpha = 0.05) between molecular physical parameters, which are derived from the dipole moment vector, and the molecular-biologically defined effect was found by means of regression analysis.

Characterisation of high-affinity and low-affinity receptors for ciliary neurotrophic factor.

Ciliary neurotrophic factor (CNTF) supports the survival of a wide variety of neuronal cells in culture. To characterise the receptor(s) mediating the biological responses of CNTF we measured the binding of radiolabelled CNTF to chick sympathetic neurons and human neuroblastoma cells. Two distinct CNTF-binding sites with high and low affinity for the ligand were identified by steady-state binding experiments. Furthermore, two low-affinity binding sites could be discriminated on the basis of the dissociation rates. Cross-linking experiments showed that CNTF interacts with two proteins, one of 80 kDa and one of 140 kDa. The identity of the 80-kDa protein was determined by transient transfection experiments with the rat CNTF-binding protein CNTFR alpha while the properties of the 140-kDa protein correspond to those of gp130. Antisense experiments confirmed that CNTFR alpha is necessary for high affinity binding of 125I-CNTF and therefore a necessary subunit of the high-affinity receptor.

Ciliary neurotrophic factor: pharmacokinetics and acute-phase response in rat.

Ciliary neurotrophic factor (CNTF) supports the survival of motoneurons in vitro and in vivo. Recombinant CNTF is an investigational drug for the treatment of amyotrophic lateral sclerosis. We determined the pharmacokinetics of radioiodinated CNTF after intravenous injection into rats. CNTF shows a biphasic clearance with an initial plasma half-life of 2.9 minutes and is removed from the circulation by the liver. No accumulation of radioactivity was detectable in nerve tissue or skeletal muscle after intravenous injection of 0.1 microgram and 0.5 microgram of CNTF. Radioactive degradation products accumulate in the skin. Liver cells express specific binding proteins for CNTF, and the incorporation and degradation of intravenously injected CNTF by the liver may occur after association of CNTF with the soluble CNTF receptor alpha in the circulation. Probably as a consequence of its binding to hepatocytes, CNTF induces acute-phase responses in liver. The short half-life and the inflammatory side effect may limit the clinical usefulness of systematically administered CNTF in the treatment of human motoneuron disorders.

"Cut and combine": an easy membrane-supported combinatorial synthesis technique.

A combinatorial synthesis process involving sequential cycles of cutting a membrane support into pieces and combining these into groups and subjecting the groups to simultaneous solid-phase chemical reactions is demonstrated by the rapid assembly of four hundred N-terminally biotinylated, soluble, octameric peptide pools. Index patterns printed onto the synthesis membrane allowed a direct identification of the compounds. These were used to study protein kinase substrate selection in a parallel microplate adapted 32P-phosphorylation assay with subsequent spotting on a biotin-capture membrane.

[Effect of phototoxic substances on simple biological systems. I. Standardizing the method with furocoumarins]. / Untersuchungen über die Wirkung phototoxischer Substanzen auf einfache biologische Systeme I. Standardisierung der Methode mit Furocumarinen.

As a basis for the investigation of new substances in respect of their photosensitization effects, we established and standardized 3 microbiological test systems, which enabled us to do without animal experiments. Using several furocumarines and various sources of light, we performed a comparative study on the eukaryotes, Chlamydomonas reinhardii (CR) and Candida albicans, and the prokaryote, Bacillus subtilis. We found that, if different light qualities were employed, our test systems also allowed a comparison of different substances by means of half-quantitative evaluation of the inhibiting areolas, which appear after exposure. With regard to the furocumarines, 8- and 5-methoxypsoralene (MOP) had the strongest photosensitizing effect under all test conditions. The remaining furocumarines showed decreasing effectiveness from psoralene to trimethylpsoralene (TMP) and imperatorine; psoralene, however, was slightly more effective in CR than 5-MOP. With the exception of CR, TMP had a stronger effect on the micro-organisms than imperatorine.