[Reasons for proximal femoral fracture surgery delays : Analysis of the structured dialog in Rheinland-Pfalz]. / Verzögerte Versorgung hüftgelenknaher Femurfrakturen : Analyse des Strukturierten Dialogs Rheinland-Pfalz.

BACKGROUND: For the "preoperative stay" quality indicator , which is part of the external quality assurance for proximal femoral fractures (module 17/1), a tolerance range for surgery within 48 h after admission of ≤15 % is given. MATERIALS AND METHODS: The structured dialog (2014) in Rheinland-Pfalz was analyzed with respect to reasons for delaying surgery for more than 48 h after admission. RESULTS: A total of 331 cases were analyzed. In 60.7 % patient-related reasons and in 13.3 % administrative reasons were found. In 9.1 % the statements were not feasible. Due to a lack of software-related specifications in 7.3 % a wrong preoperative length of stay was generated. Wrong coding or a computer-related problem was found in 6.6 %. The most common reason for delay was the intake of an anticoagulant (25.7 %). CONCLUSION: The significance of the quality indicator "Preoperative stay" without division into whether this was administrative or patient-related must be considered critically.

Unravelling the regulatory structure of biochemical networks using stimulus response experiments and large-scale model selection.

To unravel the complex in vivo regulatory interdependences of biochemical networks, experiments with the living organism are absolutely necessary. Stimulus response experiments (SREs) have become increasingly popular in recent years. The response of metabolite concentrations from all major parts of the central metabolism is monitored over time by modem analytical methods, producing several thousand data points. SREs are applied to determine enzyme kinetic parameters and to find unknown enzyme regulatory mechanisms. Owing to the complex regulatory structure of metabolic networks and the amount of measured data, the evaluation of an SRE has to be extensively supported by modelling. If the enzyme regulatory mechanisms are part of the investigation, a large number of models with different enzyme kinetics have to be tested for their ability to reproduce the observed behaviour. In this contribution, a systematic model-building process for data-driven exploratory modelling is introduced with the aim of discovering essential features of the biological system. The process is based on data pre-processing, correlation-based hypothesis generation, automatic model family generation, large-scale model selection and statistical analysis of the best-fitting models followed by an extraction of common features. It is illustrated by the example of the aromatic amino acid synthesis pathway in Escherichia coli.

Tibial lengthening. Epiphyseal and callus distraction compared in 39 patients with 3-14 years follow-up.

We examined 32 patients with 39 lengthenings (mean 8 cm) of the lower leg 3-14 years postoperatively. 23 distraction epiphyseolyses and 16 corticotomies with callus distraction had been carried out using the llizarov system. Both procedures yielded the same healing indices and the number of problems and complications was the same in the two groups. After distraction epiphyseolysis, serious complications of the knee and greater deviations from the normal leg axis were commoner than after callus distraction, which we now prefer.

[Long-term outcome of Dega acetabulum-plasty]. / Langzeitresultate der Azetabuloplastik nach Dega.

The authors reviewed the results of Dega acetabuloplasty in developmental dysplasia of the hip performed simultaneously with intertrochanteric osteotomy (predominant derotation-varusosteotomy DVO). 74 hips in 55 patients were assessed at a follow-up of 7-17 years (mean 10 years). Measurements of the acetabulum and the head-acetabulum-relation were found to be normal or slightly pathologic in 80-93% of the hips. Values of the femoral head and neck were in the low normal percentage. Poor clinical and radiological outcome was caused by avascular necrosis of the femoral head or revalgisation after DVO. The rate of avascular necrosis after conservative treatment was 23.4%, the rate as a consequence of the operation was 5.4%. Therefore, we prefer at present the subtrochanteric osteotomy of the femur.