Slovenian health care system and possibilities for freelance medical specialists.

INTRODUCTION: The purpose of the article is to present the results of the research aimed at establishing the current situation in the health care system in Slovenia and verifying whether the possibility and support exist for the introduction of a freelance medical specialist. METHODS: We conducted a survey among physicians and health care managers. The sample framework covered the total population of physicians and health care managers in Slovenia; surveys were completed by 318 physicians and 52 health care managers. RESULTS: The results of the quantitative research analysis provided an essential basis for and feedback information about possible areas for improving the current state of the health care system. The conclusions of semistructured interviews also considerably contributed to the elaboration of the freelance medical specialist proposal. CONCLUSION: The findings of the research point out the need for changes in the Slovenian health care system and the support of the research participants in the implementation of the freelance medical specialist proposal. In the participants' opinions, the possibility of introducing freelance medical specialists would change the work organisation, particularly in terms of additional formalised possibilities for practising in the medical profession, which would further contribute to the overall improvement of the health care system.

Systematic Evaluation of a Diclofenac-Loaded Carboxymethyl Cellulose-Based Wound Dressing and Its Release Performance with Changing pH and Temperature.

Development of drug-loaded wound dressings is often performed without systematic consideration of the changing wound environment that can influence such materials' performance. Among the crucial changes are the wound pH and temperature, which have an immense effect on the drug release. Detailed release studies based on the consideration of these changing properties provide an important aspect of the in vitro performance testing of novel wound dressing materials. A sodium carboxymethyl cellulose-based wound dressing, with the incorporated non-steroidal anti-inflammatory drug diclofenac, was developed and characterised in regard to its physico-chemical, structural and morphological properties. Further, the influence of pH and temperature were studied on the drug release. Finally, the biocompatibility of the wound dressing towards human skin cells was tested. Incorporation of diclofenac did not alter important properties (water retention value, air permeability) of the host material. Changes in the pH and temperature were shown to influence the release performance and have to be accounted for in the evaluation of such dressings. Furthermore, the knowledge about the potential changes of these parameters in the wound bed could be used potentially to predict, and potentially even to control the drug release from the developed wound dressing. The prepared wound dressing was also proven biocompatible towards human skin cells, making it interesting for potential future use in the clinics.

REGENERATION OF CHRONIC WOUNDS WITH ALLOGENEIC PLATELET GEL VERSUS HYDROGEL TREATMENT: A PROSPECTIVE STUDY.

- The aim of the study was to evaluate the efficacy and safety of the new method of platelet-rich plasma activation in the form of platelet gel, used in the treatment of non-healing chronic lower leg ulcers. The study was prospectively randomized, double blind and placebo controlled. We treated 60 patients (42 males and 18 females, mean age 69.43 years, SD 14.74) with chronic lower leg ulcers of different etiologies. Thirty patients were treated with allogeneic platelet gel and 30 with hydrogel. Both groups were comparable for duration of ulcer and its size. Treatment was repeated once a week for three consecutive weeks and then the last examination was scheduled at 6 months of the first platelet gel application. The t-test was used to analyze independent samples. Healing of chronic wounds with platelet gel was statistically significantly more effective compared to the treatment with hydrogel (p<0.05). At 6 months of platelet gel application, the mean wound area in the experimental group decreased to 35.01% (SD 53.69) of the initial wound size. In the control group, the wound area decreased to 89.95% (SD 71.82) of the initial wound size (p=0.001). The circumference of the wounds diminished to 54.62% (SD 39.85) of the initial value in the experimental group, compared to 91.28% (SD 29.32) in the control group (p<0.001). Allogeneic platelet gel prepared by the new method used in this study was found to be a good treatment option for non-healing chronic wounds when other methods are ineffective.

The effect of LED on blood microcirculation during chronic wound healing in diabetic and non-diabetic patients-a prospective, double-blind randomized study.

Chronic wounds, especially in diabetic patients, represent a challenging health issue. Since standard treatment protocols often do not provide satisfactory results, additional treatment methods-like phototherapy using low-level light therapy-are being investigated. The aim of our study was to evaluate the effect of phototherapy with light-emitting diodes on chronic wound treatment in diabetic and non-diabetic patients. Since a sufficient blood supply is mandatory for wound healing, the evaluation of microcirculation in the healthy skin at a wound's edge was the main outcome measure. Forty non-diabetic patients and 39 diabetics with lower limb chronic wounds who were referred to the University Medical Center Ljubljana between October 2012 and June 2014 were randomized to the treated and control groups. The treated group received phototherapy with LED 2.4 J/cm2 (wavelengths 625, 660, 850 nm) three times a week for 8 weeks, and the control group received phototherapy with broadband 580-900 nm and power density 0.72 J/cm2. Microcirculation was measured using laser Doppler. A significant increase in blood flow was noted in the treated group of diabetic and non-diabetic patients (p = 0.040 and p = 0.033), while there was no difference in the control groups. Additional Falanga wound bed score evaluation showed a significant improvement in both treated groups as compared to the control group. According to our results, phototherapy with LED was shown to be an effective additional treatment method for chronic wounds in diabetic and non-diabetic patients.

The influence of allogeneic platelet gel on the morphology of human long bones.

The aim of this study is to analyze the morphologic and functional change of human bone defect after its grafting with mixture of platelet gel and autologous cancellous bone. For one year, we have prospectively studied nine consecutive pa- tients, aged 25-73 y, with pseudoarthrosis of long bones, after unsuccessful initial surgeries. We have harvested can- cellous bone from patients' iliac crests and mixed with the ABO compatible allogeneic platelet rich plasma (PRP) gel. That mixture has been inserted in the bone defect, and surgically fixated. Radiologically, the defects achieved the bone morphology (the appearance of hazy callus) between 6th and 24th week. The time of functional recovery was varied, be- tween 12 and 40 weeks for partial weight bearing, and between 16 and 48 weeks for free limb mobility and full function of the limb. The overall healing of bone defect was 16 to 36 weeks. Two patients had complications of poor graft ingrowth and one with a reversible postsurgical nerve paresis. On the X-ray scans, solid and fast restoration of bone structure was notable, with excellent bone ingrowth, suitable for full weight bearing. The allogeneic platelet gel had no adverse effects. This method can be used for treating of long bone defects, because of its strong influence on restoration of normal bone morphology. Further investigation is required to establish efficiency relative to other methods.

The radiological estimation of vertebral body volumes on the thoracic and lumbal spine.

The aim of this work is to radiologicaly estimate the width, height and depth of bodies of thoracic and lumbal vertebras. Charts of one hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine, between 01.01.2008. and 31.3.2010. at the Department of Orthopedics and Traumatology - Clinical Centre Sarajevo, were retrieved, and only 14 patients, with totally 46 vetrtebras have meet including criteria (clearly visible measured structures on X-ray and CT scans, and data about implants dimensions). Digitalized anteroposterior and laterolateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height, width and depth of the vertebral body--CH, CW, CD. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and the length scale on CT scans. Enlargement of those parameters, from T1 to L5 spine level was from 60 to 100%, except the stagnation in the mid-thoracic region, and decreasing of corporal depth on the L5 vertebra (CD/L5), in comparison to the fourth vertebra (CD/L4). The clinical importance of this work is in estimation and comparison of dimensions of vertebral bodies measured on X-ray and CT scans, as the basic inputs during surgical procedures of vertebroplasty and anterior spondilodesis.

Cluster analyses of association of weather, daily factors and emergent medical conditions.

The goal of this study was to evaluate associations between the meteorological conditions and the number of emergency cases for five distinctive causes of dispatch groups reported to SOS dispatch centre in Uppsala, Sweden. Center's responsibility include alerting to 17 ambulances in whole Uppsala County, area of 8,209 km2 with around 320,000 inhabitants representing the target patient group. Source of the medical data for this study is the database of dispatch data for the year of 2009, while the metrological data have been provided from Uppsala University Department of Earth Sciences yearly weather report. Medical and meteorological data were summoned into the unified data space where each point represents a day with its weather parameters and dispatch cause group cardinality. DBSCAN data mining algorithm was implemented to five distinctive groups of dispatch causes after the data spaces have gone through the variance adjustment and the principal component analyses. As the result, several point clusters were discovered in each of the examined data spaces indicating the distinctive conditions regarding the weather and daily cardinality of the dispatch cause, as well as the associations between these two. Most interesting finding is that specific type of winter weather formed a cluster only around the days with the high count of breathing difficulties, while one of the summer weather clusters made similar association with the days with low number of cases. Findings were confirmed by confidence level estimation based on signal to noise ratio for the observed data points.

Clinical and radiological morphometry of posterior parts of thoracic and lumbal vertebras.

The aim of this work is to measure clinically important dimensions of thoracic and lumbal vertebras. Charts of one-hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine between 01.01. 2008. and 31.3.2010. at the Department for Orthopedics and Traumatology, of the Sarajevo Clinical center were retrieved, and only 14 patients, with 46 vetrtebras and 89 pedicles have had complete documentation (clearly visible measured structures on X-ray and CT scans). Digitalized antero-posterior and latero-lateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height and width of the pedicle--PH, PW, axial and vertical cortico-cortical transpedicular distances--AL, VL, and interpedicular distance--IP. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and length scale on CT scans. Enlargement of those parameters, from T1 to L5 level was from 50 to 150%. This increasing was not always linear, sometimes there was even decreasing. For instance, the IP on second and third thoracic vertebra was shorter compared to the first thoracic vertebra. Pedicles from the third to the eighth thoracic vertebra were narrower compared to the second thoracic vertebra. The importance of this work is in to analyze the mentioned dimensions by methods available to the clinician. Every other in vivo measurement is impossible because of the excessive surgical approach, while preoperative CT scanning with a great number of slices per one millimeter for this purpose is not ethical.

[Application of modern wound dressings in the treatment of chronic wounds]. / Primjena suvremenih obloga u lijecenju kronicnih rana.

Chronic and acute infected wounds can pose a major clinical problem because of associated complications and slow healing. In addition to classic preparations for wound treatment, an array of modern dressings for chronic wound care are currently available on the market. These dressings are intended for the wounds due to intralesional physiological, pathophysiological and pathological causes and which failed to heal as expected upon the use of standard procedures. Classic materials such as gauze and bandage are now considered obsolete and of just historical relevance because modern materials employed in wound treatment, such as moisture, warmth and appropriate pH are known to ensure optimal conditions for wound healing. Modern wound dressings absorb wound discharge, reduce bacterial contamination, while protecting wound surrounding from secondary infection and preventing transfer of infection from the surrounding area onto the wound surface. The use of modern wound dressings is only justified when the cause of wound development has been established or chronic wound due to the underlying disease has been diagnosed. Wound dressing is chosen according to wound characteristics and by experience. We believe that the main advantages of modern wound dressings versus classic materials include more efficient wound cleaning, simpler placement of the dressing, reduced pain to touch, decreased sticking to the wound surface, and increased capacity of absorbing wound exudate. Modern wound dressings accelerate the formation of granulation tissue, reduce the length of possible hospital stay and facilitate personnel work. Thus, the overall cost of treatment is reduced, although the price of modern wound dressings is higher than that of classic materials. All types of modern wound dressings, their characteristics and indications for use are described.

Biomechanical and clinical alterations of the hip joint following femoral neck fracture and implantation of bipolar hip endoprosthesis.

The implantation of a bipolar partial hip endoprosthesis is a treatment of choice for displaced medial femoral neck fracture. We present an experimental study which asses and compare biomechanical and clinical status through period before and after hip fracture and implantation of bipolar partial hip endoprosthesis. This study encompassed 75 patients who suffered from an acute medial femoral neck fracture and were treated with the implantation of a bipolar partial hip endoprosthesis. Their biomechanical status (stress distribution on the hip joint weight bearing area) and clinical status (Harris Hip Score) were estimated for the time prior to the injury and assessed at the follow-up examination that was, on average, carried out 40 months after the operation. Despite ageing, the observed Harris Hip Score at the follow-up examination was higher than that estimated prior to the injury (77.9 > 69.6; p = 0.006). Similarly, the hip stress distribution was reduced (2.7 MPa < 2.3 MPa; p = 0.001). While this reduction can be attributed to a loss of weight due to late ageing, the principal improvement came from the operative treatment and corresponding restoration of the biomechanical properties of the hip joint. The implantation of a bipolar partial hip endoprosthesis for patients with displaced medial femoral neck fractures improves the biomechanical and clinical features of the hip, what should have on mind during making decision about treatment.

Review of calciphylaxis and treatment of a severe case after kidney transplantation with iloprost in combination with hyperbaric oxygen and cultured autologous fibrin-based skin substitutes.

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare complication in patients with end-stage renal disease as well as in patients after renal transplantation. It should be suspected in patients with typical painful violaceous skin lesions on the extremities or on the trunk. Active multidisciplinary management approach, with intensive local wound care, is vital in these patients. Controlling parathyroid hormone, hyperbaric oxygenation, sodium thiosulphate, bisphosphonates, cinacalcet and skin grafting could be effective. In our report, we describe a case of CUA in a 43-year-old patient two years after kidney transplantation. Despite intensive standard treatment, his wounds progressed; therefore, we decided to use iloprost, in combination with hyperbaric oxygenation. The clean wounds were then covered with cultivated autologous skin cells to enhance wound epithelialization. Seven months after finishing iloprost and hyperbaric oxygen treatment and the first application of skin substitute, the wounds healed completely and remained healed during the four-yr follow-up period. We conclude that in patients with severe CUA-induced wounds, the combined treatment with iloprost, hyperbaric oxygen and autologous cultured fibrin-based skin substitutes can be effective. A combination of different treatment modalities is vital in patients with CUA.

Selective antimicrobial activity of maggots against pathogenic bacteria.

Maggot therapy, also known as biosurgery, is an ancient method for the healing of chronic infected wounds. Although clinicians have reported on the beneficial activities of the Lucilia sericata larvae that have been used for healing chronic wounds, the selectivity of this therapy against the different pathogenic micro-organisms that are found in chronic wounds has never been analysed. In the present study, we have investigated the in vitro activities of larval excreta/secreta both against selected bacterial strains that frequently occur in chronically infected wounds, and against bacteria isolated directly from the larvae and their excreta/secreta. Additionally, the antibacterial activities were investigated in in vivo studies, by comparing bacterial diversity in wounds before and after the application of L. sericata larvae. In conclusion, larval therapy is highly recommended, particularly for the treatment of wounds infected with Gram-positive bacteria, like Staphylococcus aureus, but less so for wounds infected with Gram-negative bacteria, especially Proteus spp. and Pseudomonas spp. strains. Bacteria from the genus Vagococcus were resistant to the maggot excreta/secreta.

Morphometric alteration of femoral condyles due to knee osteoarthritis.

Aim of this study was to estimate how knee osteoarthritis (OA) affects the shape of femoral condyles by comparing the radiuses of condylar curves between healthy and OA knees. Seventeen female and five male patients with established diagnosis of knee OA were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation and compared to referent values of healthy knees, after adjusting to body height. The average radiuses of condylar curves were between 52.6 +/- 6.2 and 17.6 +/- 3.5 mm medially, and between 43.3 +/- 8.4 and 15.4 +/- 3.7 mm laterally for 0 degrees and 90 degrees femoral flexion contact points, respectively The OA knees had longer curve radiuses medially and laterally at 0 degrees, 10 degrees, and 20 degrees femoral flexion contact points in comparison to the healthy sample (P < 0.001; t-test). Our results suggest that the shape of the femoral condyles in OA knees is changed. It should be aware not only in researching of OA etiology, but also in designing of knee endoprostheses, in a manner to achieve better individual sizing.

[Hip fracture--personal, family and social problem of the third age]. / Prijelom kuka--osobni, obiteljski i drustveni problem trece zivotne dobi.

AIM: The percentage of elderly people increases in societies today and so does the number of specific conditions, illnesses and injuries, with hip fracture as the most important one. The aim of the study was to point to hip fracture as a medical and social problem by objectively quantifying functional abilities of geriatric patients after hip fracture. PATIENTS AND METHODS: The study included 414 (63 male and 351 female) with femoral neck fracture and hip endoprosthesis implanted at University Department of Traumatology in Ljubljana during the 1988-2004 period. Data on sex distribution, concomitant diseases, complications, estimation of functionality before injury, and dynamic and final level of functional recovery were collected. RESULTS: The patient mean age was 77 +/- 7.3 (range 28-96) years. Excellent mobility before injury, according to personal report, was recorded in 322 (77.78%), good mobility in 78 (18.84%) and poor mobility in only 14 (3.38%) patients. The mean dynamics of functional recovery was as follows: independent sitting at 2 days, standing at 3.6 days, and walking at 7 days of the surgery. At the end of rehabilitation, an average patient felt periodic pain that did not affect his/her activities, could walk without problems at least one kilometer, limped to a certain degree, used a cane, could climb stairs holding a handrail, sat in the chair for a long time, put on shoes and socks with minor difficulties, used public transportation and had no significant deformity of the hip. With that level of functionality, our patients were independent in daily activities, able to stay socially integrated, and other people's help was reduced to the minimum. DISCUSSION: The patient's functionality before injury, the duration and quality of rehabilitation after surgery, and the patient's motivation and cooperation during rehabilitation are the key factors of patient recovery to the pre-injury state. In spite of numerous concomitant diseases, reduced psychophysical abilities of the elderly and medical difficulties in the management of these injuries, such treatment of hip fractures is necessary and human for patients and time-consuming for medical staff, yet being the most profitable option for the society. Hip fracture and consequential disablement cause a double problem. On the one hand, it entails dependence on other person, family or social institution, or society in general, and on the other hand there is mental frustration, especially if he/she is psychically instable. Quite frequently, disabled persons have psychical traumas that have unfavorable impact on their families. It is additionally complicated in societies that tend to stigmatization of disabled persons. Therefore, it is very important how the society will behave toward disabled elderly who are generally more vulnerable.

Variation of pelvic diameters due to different scanning positions--the experimental study.

The distortion of human pelvis X ray scans, due to different scanning positions, can cause huge mistakes in estimation of pelvic diameters. The aim of the study was to quantify distortion of pelvic diameters in relation to scanning inclination angles. Twenty anatomically defined spots on the pelvis of a young male cadaver, freed of soft tissues, were marked with 3 mm metal balls. The digitalized X-ray scans were made with seven different but similar inclination angles, and marked spots were recognized by computer software. Obstetrical-gynecological (Ob-Gyn), horizontal and vertical diameters were measured between marked spots, and percentages of distortion were calculated for each new scanning position. Twenty seven distances on human pelvis from seven X-ray scans varied from -35.9% to 28.3%, on average 0.47%. This study has pointed to a high variation of vertical pelvic dimensions (4.94 +/- 5.73%), consequently making them unreliable in the estimation of general pelvic shape, and low variation of horizontal dimensions (0.92 +/- 0.61%). Generally, the percentage of variation of pelvic dimensions highly increases with inclination angle, in frontal and sagittal plane. Alteration of scanning distance by 4 cm has a weak influence on pelvic diameters. The most reliable Ob-Gyn pelvic diameter was conjugata diagonalis, then diameters obliqua prima and secunda, with an average length deviations of 3.4, 4.0, and 6.0% respectively. The conjugata anatomica was the most unreliable with an average variation of 11.5%.

Guided tissue regeneration with heterologous materials in primary subtalar arthrodesis: a case report.

BACKGROUND: Calcaneal fractures are relatively rare and difficult to treat. Treatment options vary based on the type of fracture and the surgeon's experiences. In recent years, surgical procedures have increasingly been used due to the better long-term results. We present a case where guided tissue regeneration was performed in a calcaneal fracture that needed primary subtalar arthrodesis. We used the principles of guided tissue regeneration from oral surgery to perform primary subtalar arthrodesis and minimize the risk of non-union. We used a heterologous collagen membrane, which acts as a mechanical barrier and protects the bone graft from the invasion of unwanted cells that could lead to non-union. The collagenous membrane also has osteoconductive properties and is therefore able to increase the osteoblast proliferation rate. CASE PRESENTATION: A 62-year-old Caucasian woman sustained multiple fractures of her lower limbs and spine after a fall from a ladder. Her left calcaneus had a comminuted multifragmental fracture (Sanders type IV) with severe destruction of the cartilage of her subtalar joint and depression of the Böhler's angle. Therefore, we performed primary arthrodesis of her subtalar joint with elevation of the Böhler's angle using a 7.3 mm titanium screw, a heterologous cortico-cancellous collagenated pre-hydrated bone mix, a heterologous cancellous collagenated bone wedge, and a heterologous collagen membrane (Tecnoss®, Italy). The graft was fully incorporated 12 weeks after the procedure and a year and a half later our patient walks without limping. We present a new use of guided tissue regeneration with heterologous materials that can be used to treat extensive bone defects after bone injuries. CONCLUSIONS: We believe that guided tissue regeneration using heterologous materials, including a heterologous collagen membrane that presents a mechanical barrier between soft tissues and bone as well as a stimulative component that enhances bone formation, could be more often used in bone surgery.

Molecular characterization of Staphylococcus aureus isolates from skin and soft tissue infections samples and healthy carriers in the Central Slovenia region.

Staphylococcus aureus is among the most important human pathogens. It is associated with different infections and is a major cause of skin and soft tissue infections (SSTIs). The aim of our study was to compare S. aureus isolates associated with SSTIs with isolates obtained from healthy carriers in the Central Slovenia region in terms of antimicrobial susceptibility, genetic diversity by clonal complex (CC)/sequence type, spa type, and by toxin gene profiling. In total, 274 S. aureus isolates were collected prospectively by culturing wound samples from 461 SSTI patients and nasal samples from 451 healthy carriers. We have demonstrated high heterogeneity in terms of CCs and spa type in both groups of isolates. The main clone among SSTI strains was Panton-Valentine leukocidin gene (pvl) positive CC121, whereas the main clone among carrier strains was CC45 carrying a large range of toxin genes. The main spa type in both groups was t091. Pvl was more frequently present in SSTI strains (31.2% SSTI vs 3.6% carrier strains) and staphylococcal enterotoxin C was more frequently present in carrier strains (1.6% SSTI vs 17.0% carrier strains). We have also demonstrated that methicillin-resistant S. aureus was a rare cause (2.8%) of SSTIs in our region.

Variations of femoral condyle shape.

The aim of this study is to mathematically approximate the shape of the femoral articulating line and compare radiuses of condylar curves within and between males and females. Ten male and ten female participants were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation. Average radiuses of condylar curves were between 4.5 and 1.7 cm medially, and between 3.2 and 1.8 cm laterally, for 0 degrees and 90 degrees flexion contact point respectively. Males had longer curve radiuses of both condyles (p < 0.05). Differences turned out to be statistically insignificant after adjusting to body height. Even small changes in the joint geometry during lifetime could make a joint susceptible to osteoarthritis or injuries. Approximation of the radiuses of femoral condyle curves is a useful method in anthropometric, radiological and virtual calculations of the knee geometry, and other ellipsoidal structures in human body, like wrist, scull segments, dental arches, etc.

Structural differences between hip endoprostheses, and implications on a hip kinetics.

We compared kinetic characteristic of unipolar, bipolar and total hip endoprostheses, implanted after dislocated femoral neck fracture. Ninety patients were divided into three groups (30 patients in each group); a group with unipolar partial hip endoprosthesis (UPEP), a group with bipolar partial hip endoprosthesis (BPEP) and a group with total hip endoprosthesis (TEP). The patients from different groups were paired by parameters which could influence the long term functional result: follow up period, comorbidities, functional capabilities before injury, etc. After the average follow up 3.8 +/- 1.9 years, a measuring of range of hip motions (ROM) was conducted. The largest mean amplitudes in flexion (104 degrees), extension (13 degrees), abduction (35 degrees) and external rotation (38 degrees) was achieved BPEP, the largest adduction (14 degrees) was achieved UPEP, and internal rotation (34 degrees) TEP. Differences in ROMs are partially related to the clinical parameters such as: level of the hip pain, gait pattern, age and rehabilitation period (P < 0.05). Measuring of ROMs is the most reliable part of the clinical exam and it does not depend on subjectivity of patient, as opposed to other clinical parameters (level of pain, walking distance, aids usage, etc). The results obtained are favorable for the bipolar hip endoprosthesis, and they can be related to the biomechanical differences between the three types of hip endoprostheses. Kinetic advantages of the BPEP as compared to the UPEP, can be explained by the BPEP's structure: two-level mobility and a thinner neck which delays impingement in the late motion phase. In comparison to the TEP, clinical advantages of the BPEP can be attributed to less extensive surgery and scarring.

Advanced therapies of skin injuries.

The loss of tissue is still one of the most challenging problems in healthcare. Efficient laboratory expansion of skin tissue to reproduce the skins barrier function can make the difference between life and death for patients with extensive full-thickness burns, chronic wounds, or genetic disorders such as bullous conditions. This engineering has been initiated based on the acute need in the 1980s and today, tissue-engineered skin is the reality. The human skin equivalents are available not only as models for permeation and toxicity screening, but are frequently applied in vivo as clinical skin substitutes. This review aims to introduce the most important recent development in the extensive field of tissue engineering and to describe already approved, commercially available skin substitutes in clinical use.