[Spondylolisthesis]. / Spondylolisthese.

Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.

The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study.

INTRODUCTION: Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS: Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS: In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION: These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.

Exploring the most visible websites on cutaneous T-cell lymphoma-revealing limited quality of patient health information on the internet.

BACKGROUND: Patients diagnosed with cancer frequently search the Internet for health information. Yet, the quality of CTCL online information has not been investigated so far. OBJECTIVES: The aim of this study was to identify and assess the most visible websites on CTCL. METHODS: An Internet search on the top three search engines Google, Yahoo and Bing was performed for the terms 'cutaneous T-cell-lymphoma', 'mycosis fungoides' and 'Sézary syndrome'. After selecting the most frequented websites suitable for patients' information, we investigated content quality, readability and popularity. Eighty-nine websites were evaluated for HONcode quality certification, social media popularity, Alexa popularity rank, topicality and readability levels. Furthermore, the websites' content on 13 major topics according to guidelines on CTCL was assessed. RESULTS: Twenty-three (25.8%) websites were HONcode certified. Evaluated websites were difficult to read requiring at least 9 years of US school education to properly understand the information. More than half of all websites (57.3%) have not been updated for three or more years (or did not contain any update information). We found greatly varying quality and popularity of online patient information. Out of 1157 topics (equivalent to 13 different topics on 89 websites), 59.44% were mentioned on the websites. Of these, 40% contained incorrect or incomplete information. Publicly provided websites presented the different topics more thoroughly. We could further show that HONcode certified websites received better quality and readability scores. CONCLUSIONS: We found major shortcomings regarding readability, completeness and reliability of websites on CTCL. Nevertheless, highly selected websites on CTCL can serve as a valuable and reliable source of patient information. As a consequence, oncologists have an obligation to be aware of and guide their patients to available websites that contain reliable and appropriate information.

[Sepsis-associated encephalopathy : A nationwide survey on diagnostic procedures and neuromonitoring in German intensive care units]. / Sepsis-assoziierte Enzephalopathie : Eine bundesweite Umfrage zu Verfahren der Diagnostik und des Neuromonitorings auf deutschen Intensivstationen.

BACKGROUND: Sepsis-associated encephalopathy (SAE) is one of the most frequent causes of neurocognitive impairment in intensive care patients. It is associated with increased hospital mortality and poor long-term neurocognitive outcome. To date there are no evidence-based recommendations for the diagnostics and neuromonitoring of SAE. OBJECTIVE: The aim of the study was to evaluate the current clinical practice of diagnostics and neuromonitoring of SAE on intensive care units (ICU) in Germany. MATERIAL AND METHODS: Based on available literature focusing on SAE, a questionnaire consisting of 26 items was designed and forwarded to 438 members of the Scientific Working Group for Intensive Care Medicine (WAKI) and the Scientific Working Group for Neuroanesthesia (WAKNA) as an online survey. RESULTS: The total participation rate in the survey was 12.6% (55/438). A standardized diagnostic procedure of SAE was reported by 21.8% (12/55) of the participants. The majority of participants preferred delirium screening tools (50/55; 90.9%) and the clinical examination (49/55; 89.1%) to detect SAE. Brain imaging (26/55; 47.3%), laboratory/biomarker determination (15/55; 27.3%), electrophysiological techniques (14/55; 25.5%) and cerebrospinal fluid examination (12/55; 21.8%) are less frequently performed. The follow-up examination of SAE is most frequently performed by a clinical examination (45/55; 81.8%). Neuromonitoring techniques, such as continuous electroencephalography (31/55; 56.4%), transcranial doppler sonography (31/55; 56.4%) and near-infrared spectroscopy (18/55, 32.7%) are not frequently used. We observed statistically significant differences between the theoretically attributed importance and clinical practice. The great majority of respondents (48/55; 87.3%) endorse the development of guidelines containing recommendations for diagnostics and neuromonitoring in SAE. DISCUSSION: This explorative survey demonstrated a great heterogeneity in diagnostics and neuromonitoring of SAE in German ICUs. Uniform concepts have not yet been established but are desired by the majority of study participants. Innovative biomarkers of neuroaxonal injury in blood and cerebrospinal fluid as well as electrophysiological and brain imaging techniques could provide valuable prognostic information on the neurocognitive outcome of patients and would thus be a useful addition to the clinical assessment of ICU patients with SAE.

The role of functional health literacy in long-term treatment outcomes in psychosocial care for adolescents.

Although among adolescents with psychosocial problems low health literacy may increase the risk of poor treatment outcomes, the contributing mechanisms within treatment remain unclear. A better understanding of these mechanisms could contribute to improved treatment processes and outcomes. This study aims to examine the relationship between functional health literacy, treatment processes (treatment adherence, learning processes), and treatment outcome (level of psychosocial problems) in adolescents in psychosocial care. We used data from a prospective cohort study among adolescents aged 12-18 (N = 390), collected in four successive measurements: at entry into care, and 3, 12, and 24 months thereafter. We used a mixed effect model to investigate the association between level of functional health literacy (adequate vs. inadequate) and treatment processes (treatment adherence, learning processes) and treatment outcome (level of psychosocial problems). Between adolescents with adequate and inadequate functional health literacy, we found no differences or change over time in adherence or learning processes. The level of psychosocial problems significantly declined over time (ß = - 1.70, 95% CI [- 2.72, - 0.69], p = .001) to a similar degree in both groups, though, in all measurements, the level was consistently higher for adolescents with inadequate health literacy. We conclude that health literacy levels did not affect change in treatment processes nor in outcomes of psychosocial treatment. However, the consistently higher level of psychosocial problems among adolescents with inadequate health literacy suggests an unaddressed need in psychosocial care.

[Current trends and injuries in cycling: faster, further, e-bike?] / Trends und Verletzungen im Radsport: schneller, weiter, E­Bike?

During the past decade, technical innovations (e.g., carbon as a new material, disk brakes, hydraulic shock absorbers, electric transmissions) and lifestyle changes have significantly influenced recreational and professional cycling. In contrast to the past, where ambitious leisure cyclists were primarily interested in the recreational value of nature and landscape, cyclists of all ages are nowadays increasingly focused on performance and self-optimization. Simultaneously, manufacturers have adapted to differing customer requirements: besides the traditional extremities of road and mountain bikes, many specialized models have been designed for special applications: trekking, cyclocross, gravel, full-suspension, single-track, hardtail, downhill, fatbike, etc. For biking fans who are no longer able to meet their own demands due to individual physical restrictions or defined health problems, electric-assist bikes (pedelecs or "e-bikes") were recently introduced. While these are becoming increasingly popular, they have also increased the number of accidents and injuries. The current work provides an update on relevant sport medical and orthopaedic challenges brought on by these developments in cycling.

[Handball injuries and their prevention]. / Verletzungen und deren Prävention beim Handball.

BACKGROUND: Handball is one of the most popular team sports in Germany, as well as one of the most dangerous ones. Injury rates in Germany are higher amongst handball professionals than in soccer, with the knee being the most commonly injured joint. To prevent injuries, a functional inert stability is necessary, but definitions and objective measures are lacking. OBJECTIVES: Establishing valid reference data of functional knee stability in amateur handball players with use of an established test battery giving objective measures METHODS: 261 athletes (f:130; m:131), mean age 25.1 ± 5.8 y were screened during the preseason. The test battery consisted of double and single-leg counter movement jumps, balance tests, agility, parkour, quick feet test and plyometric jumps. RESULTS: Significant differences between males and females were noted in regard to balance scores (favour for females p ≤ 0.001), as well as jump height, agility and speed tests (favour for males [p ≤ 0.002-0.001]). CONCLUSION: The noted differences once again bring focus to the interindividual presence of risk factors, because female and male handball athletes have gender-specific ground levels. These attributes have to be considered in further screening and prevention programs, as well as in the context of the return-to-sports decision after injury. The given data may serve as objective reference measures.

[Atraumatic fractures of the spine : Current strategies for diagnosis and treatment]. / Atraumatische Frakturen der Wirbelsäule : Aktuelle Strategien zur Diagnose und Therapie.

Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.

[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.

TDM-controlled ring resonator arrays for fast, fixed-wavelength optical biosensing.

A novel control concept for serial ring resonator arrays based on a time-division multiplex (TDM) approach is presented. It allows fast sampling rates in terms of biological kinetics. The novelty consists of using both thermal tuning of the effective refractive index and thermo-optical multiplexing for the silicon-on-insulator (SOI) ring resonator arrays, without the need for a tunable laser source. Using a fixed wavelength, fast read-out rates of 100 Hz are demonstrated for each ring.

[Surface modifications of implants. Part 1 : Material technical and biological principles]. / Oberflächenmodifikationen von Implantaten. Teil 1 : Werkstofftechnische und biologische Grundlagen.

The biological effects of implants in vivo are not only dependent on the implantation site and patient-specific factors but are also influenced by the physicochemical composition and the surface topography of the biomaterial. In cases of permanent implants applied to bone, primary stability, the promotion of rapid osteointegration and antimicrobial properties of the implant are strived for; however, surface modifications are also found on biomaterials which only temporarily come into contact with tissue. These include not only osteosynthesis materials, jig or implant templates but also surgical instruments. This article summarizes the relevant technical principles of materials for the assessment of implant surfaces. Besides technical material-specific and biological principles, different surface modifications for targeted clinical applications are presented. Furthermore, current developmental strategies are outlined.

[Endoprosthetic wear analysis using virtual CAD-based radiographs]. / Abriebanalyse mit virtuellen CAD-basierten Röntgenaufnahmen in der Endoprothetik.

The articulating parts of an endoprosthetic joint are subjected to constant wear, which results in loss of material. In peri-implant tissue, the wear debris particles cause aseptic inflammation with osteolysis and aseptic loosening. Due to the associated bone resorption-which can be considerable-"particle disease" represents a significant challenge for orthopedic surgeons. Continuous improvements in the material properties of polyethylene during the past decades have resulted in reduced wear and longer implant survival times. To evaluate wear properties in polyethylene liners after total hip arthroplasty in vivo, different graphics-based, semiautomatic software packages were developed to measure femoral head penetration in radiographic image series. However, the reduced wear properties of the new materials rendered their precise analysis and evaluation more difficult, and no software was able to reproduce the accuracy of the complex and expensive radiostereometric analysis first described by Selvik in 1974, which is still viewed as the gold standard. The aim of this study is to describe the validation of a novel and accurate method to analyze polyethylene wear in vivo using virtual computer-aided detection/diagnosis (CAD)-based radiographic images. Furthermore, its use is presented based on the first 5­year follow-up results of a multicenter approach evaluating the impact of vitamin E-blended polyethylene in cementless total hip replacement. Our data support the high accuracy of CAD-based virtual evaluation.

[Cell-based and future therapeutic strategies for femoral head necrosis]. / Zellbasierte und zukünftige Therapieansätze der Femurkopfnekrose.

BACKGROUND: The application of cell- and growth factor-based techniques in conjunction with conventional surgical approaches has great therapeutic potential for the treatment of avascular necrosis of the femoral head (AVNFH). OBJECTIVES: This review provides an overview of new strategies for the treatment of AVNFH, with emphasis on cell and growth factor-based approaches. MATERIALS AND METHODS: The results of a literature search are summarised, the most relevant publications are presented and discussed by the authors. RESULTS: In the focus of new strategies for treatment of AVNFH are bone marrow-derived cell concentrates and ex vivo-expanded mesenchymal stem cells. Besides local application during core decompression, the systemic administration of cells via blood vessels supplying the femoral head is an interesting approach. The application of osteogenic and angiogenic growth factor-laden scaffold materials has also been clinically tested. Initial results of randomised clinical trials using cell- and growth factor-based approaches underline the potential of these innovative therapeutic strategies. Cell-based therapies are governed by EU law and generally require a manufacturing authorization. CONCLUSION: To date, only few randomized controlled clinical trials are available which additionally display a considerable diversity concerning cell parameters, cell processing, adjuvant surgical techniques and the quality outcome parameters. Therefore, a final statement about the effectiveness of new cell and growth factor-based strategies is currently not possible.

[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.

[Big data and deep learning in preventive and rehabilitation medicine]. / Big Data und maschinelles Lernen bei Prävention und Rehabilitation.

The digitalization in medicine has led to almost universal availability of information to different healthcare professionals and accelerated clinical pathways. Fast-track concepts and short hospital stays require intelligent and practicable systems in preventive and rehabilitation medicine. This includes optimization of movement analysis by innovative tools such as detectors sensing skin movements, portable feedback systems for monitoring, robot-assisted devices, and prevention programs based on reliable data. Finally, clinical structures are needed to exploit the maximal potential of artificial intelligence (AI) and deep learning. One example is the establishment of inter- and transdisciplinary professional teams such as a RehaBoard. In contrast to other cost-intensive disciplines such as oncology, the introduction of AI into rehabilitation orthopedics and trauma surgery with the support of cross-sectoral cooperation has great potential for performing well in patient benefit-orientated competition (value-based competition).

[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.

[Hebephrenia - a viable psychopathological construct?] / Hebephrenie ­ ein brauchbares psychopathologisches Konstrukt?

Ewald Hecker was the first psychiatrist to describe the disease entity of hebephrenia in some detail, focusing mainly on disturbances of affect. Later Emil Kraepelin and Eugen Bleuler saw hebephrenia as a subtype of dementia praecox or schizophrenia. Willy Mayer-Gross and Karl Leonhard characterized hebephrenia with highly differentiated psychopathological descriptions, whereas this construct only played a minor role in the works of Klaus Conrad and Kurt Schneider. The International Classification of Diseases (ICD-10) lists hebephrenia as a subtype of schizophrenia but in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no subtypes of schizophrenia are mentioned and the concept of hebephrenia is thus lost. Hebephrenia can be seen as an ideal type describing a psychopathological course pattern. This construct can be useful to conceptualize a group of disorders of affect which otherwise escape description, especially since these psychopathological alterations of affect are difficult to operationalize. To have a viable concept of these disorders is relevant for the prognosis and therapy planning. If the concept of hebephrenia is abolished, important psychopathological knowledge might be lost for future generations of psychiatrists.

GNAQ and GNA11 mutations and downstream YAP activation in choroidal nevi.

BACKGROUND: Mutations in GNAQ/11 genes are considered an early event in the development of uveal melanoma that may derive from a pre-existing nevus. The Hippo pathway, by way of YAP activation, rather than MAP kinase, has a role in the oncogenic capacity of GNAQ/11 mutations. METHODS: We investigated 16 nevi from 13 human eyes for driver GNAQ/11 mutations using droplet digital PCR and determined whether nevi are clonal by quantifying mutant nevus cell fractions. Immunohistochemistry was performed on 15 nevi to analyse YAP activation. RESULTS: For 15 out of 16 nevi, a GNAQ/11 mutation was detected in the nevus cells albeit at a low frequency with a median of 13%. Nuclear YAP, a transcriptional co-activator in the Hippo tumour-suppressor pathway, was detected in 14/15 nevi. CONCLUSIONS: Our analysis suggests that a mutation in GNAQ/11 occurs in a subset of choroidal nevus cells. We hypothesise that GNAQ/11 mutant-driven extracellular mitogenic signalling involving YAP activation leads to accumulation of wild-type nevus cells.

Treating onychomycosis with the short-pulsed 1064-nm-Nd:YAG laser: results of a prospective randomized controlled trial.

BACKGROUND: The role of the short-pulsed 1064-nm-Nd:YAG laser in treating onychomycosis has been the subject of controversial discussion ever since it received FDA approval in 2010. Research to date provides no valid conclusions supporting its use from an evidence-based perspective. OBJECTIVE: In this prospective randomized controlled pilot study, we analysed the effect of the short-pulsed 1064-nm-Nd:YAG laser on the rate of mycological remission and clinical improvement after excluding relevant confounders with regard to our previous studies. PATIENTS AND METHODS: Twenty patients with a total of 82 mycotic toenails were randomized to the treatment group (short-pulsed 1064-nm-Nd:YAG laser) or control group (no laser treatment). We conducted four laser treatments at 4- to 6-week intervals. In both groups, a local antimycotic agent was applied to the sole of the foot, the area between the toes and the skin directly surrounding the nails. The primary endpoint was complete remission of the onychomycosis after 12 months (fungal culture and histology); secondary endpoints included clinical improvement (Onychomycosis Severity Index, OSI) and the occurrence of pain or other adverse events. RESULTS: Mycological remission was not achieved in either study group. A comparison of both groups yielded no difference in the OSI score, both at the beginning of the trial (P = 0.9873) and after 12 months (P = 0.4317). In the treatment group, the OSI score worsened by a mean 2.0 points, and in the control group, by a mean 3.5 points. On a visual analogue scale (0 = 'no pain' to 10 = 'most intense pain'), pain in the treatment group was indicated at a mean score of five. Other adverse events were not reported. CONCLUSIONS: The short-pulsed 1064-nm-Nd:YAG laser shows no long-term efficacy as a monotherapy. Its role as an adjuvant therapy should be investigated in upcoming trials.