Arbeitsunfähigkeit und Minderung der Erwerbsfähigkeit in Abhängigkeit der Arbeitsschwere nach der REFA-Klassifikation und dem Typ der Tibiakopffraktur

In der retrospektiven Untersuchung konnten 39 Patienten nach operativ-versorgter Tibiakopffraktur durchschnittlich 29,7 Monate nach dem Unfallereignis nachuntersucht werden. Das Durchschnittsalter der 17 untersuchten Frauen zum Unfallzeitpunkt lag bei 50,6 Jahren, das der 22 untersuchten Männer bei 42,3 Jahren. Die Arbeitsunfähigkeitsdauer lag bei Patienten mit Typ-B-Frakturen im Median deutlich höher als bei Patienten mit Typ-C-Frakturen (91 versus 140 Tage). Bei einer geringen Arbeitsschwere (REFA 0 oder 1) war die Arbeitsunfähigkeit signifikant niedriger als bei höherer Arbeitsschwere (REFA 2, 3 und 4). Die im Median längste Arbeitsunfähigkeitsdauer erreichten Patienten mit Typ-C-Frakturen und höhergradiger Arbeitsschwere. Vier Patienten mussten ihre Arbeitszeit (im Mittel um 10,5 Stunden/Woche) reduzieren. Durch Umgestaltung des Arbeitsplatzes oder einen Arbeitsplatzwechsel kam es bei insgesamt fünf Patienten zu einer Reduktion der Arbeitsschwere nach der REFA-Klassifikation um 1-2 Klassen bei vollschichtiger Arbeitsfähigkeit. Zwei Patienten wurden nach der Rehabilitation berentet. In einem Drittel der Fälle (n=13) handelte es sich um einen Arbeits-/Wegeunfall. Knapp einem Drittel dieser Patienten wurde eine Minderung der Erwerbfähigkeit in Höhe von durchschnittlich 22,5 ± 9,6% zugesprochen. Vier Patienten erhielten aufgrund einer massiven posttraumatischen Valgusfehlstellung eine varisierende Umstellungsosteotomie. Patienten mit Valgusfehlstellung (ohne (n=6) und mit Umstellungsosteotomie (n=4)) erzielten in den funktionellen Scores deutlich schlechtere Ergebnisse und hatten eine längere Arbeitsunfähigkeit und Rehabilitationsdauer als die übrigen Patienten. Der Lysholm-Gilllquist-Score sank im Median von 100 (Min 69, Max 100) auf 73 (Min 23, Max 100) Punkte. Während die Patienten mit Typ-B-Frakturen in 65% ein mäßiges/schlechtes Ergebnis erzielten, ergab sich bei Patienten mit Typ-C-Frakturen sogar in 78,9% ein mäßiges/schlechtes Ergebnis. Tibiakopffrakturen bedingen eine langwierige Rehabilitation. Die Dauer der Arbeitsunfähigkeit hängt wesentlich vom Frakturtyp und dem zuvor ausgeübten Beruf, sowie der damit verbundenen Arbeitsschwere ab. Außerdem konnten wir zeigen, dass das funktionelle Outcome abhängig vom Typ der Fraktur und der posttraumatischen Beinachsenverhältnisse ist und tendenziell bei Typ-C-Frakturen als schlechter bewertet werden kann als bei Typ-B-Frakturen ebenso wie bei Patienten mit posttraumatischer Valgusfehlstellung der betroffenen Extremität im Vergleich zu Patienten mit identischer Beinachse beider Beine

Reporter Dyes Demonstrate Functional Expression of Multidrug Resistance Proteins in the Marine Flatworm Macrostomum lignano: The Sponge-Derived Dye Ageladine A Is Not a Substrate of These Transporters

The marine plathyhelminth Macrostomum lignano was recently isolated from Adriatic shore sediments where it experiences a wide variety of environmental challenges, ranging from hypoxia and reoxygenation, feeding on toxic algae, to exposure to anthropogenic contaminants. As multidrug resistance transporters constitute the first line of defense against toxins and toxicants we have studied the presence of such transporters in M. lignano in living animals by applying optical methods and pharmacological inhibitors that had been developed for mammalian cells. Application of the MDR1 inhibitor Verapamil or of the MRP1 inhibitors MK571 or Probenecid increased the intracellular fluorescence of the reporter dyes Fura-2 am, Calcein am, Fluo-3 am in the worms, but did not affect their staining with the dyes Rhodamine B, CMFDA or Ageladine A. The marine sponge alkaloid Ageladine A remained intracellularly trapped for several days in the worms, suggesting that it does not serve as substrate of multidrug resistance exporters. In addition, Ageladine A did not affect multidrug resistance-associated protein (MRP)-mediated dye export from M. lignano or the MRP1-mediated glutathione (GSH) export from cultured rat brain astrocytes. The data obtained demonstrate that life-imaging is a useful tool to address physiological drug export from intact marine transparent flatworms by using multiphoton scanning microscopy

Duration of incapacity of work after tibial plateau fracture is affected by work intensity

Abstract Background Tibial plateau fractures requiring surgery are severe injuries of the lower extremity. Tibial plateau fractures have an impact not only on physically demanding jobs but notably on general professional life too. The aim of this study was to assess how the professional activity of patients will be affected after a tibial plateau fracture. Methods 39 consecutive patients (ages 20–61 years) were retrospectively included in the study and were clinically examined at a minimum of 14 month postoperatively. Inclusion criteria were surgical treatment of tibial plateau fractures between November 2009 and December 2012. The clinical evaluation included the Lysholm score and the Oxford Knee Score. Fractures were classified and analyzed using the AO classification. Intensity of work was classified as established by the REFA Association. The patients themselves provided postoperative duration of the incapacity of work and subjective ratings. Results 17 (43.6%) women and 22 (56.4%) men were examined with a mean follow-up of 29.7 ± 10.4 months (range 14–47). According to the AO classification there were 20 (51.3%) B-type-fractures and 19 (48.7%) C-type-fractures. The median incapacity of work was 120 days (range 10–700 days) with no significant differences between B- and C-type-fractures. Four (10.3%) patients reduced their working hours by 10.5 h per week on average. Patients with low workload (REFA 0–1, median incapacity of work 90 days, range 10–390 days) had a significant shorter incapacity of work than patients with heavy workload (REFA 2–4, median incapacity of work 180 days, range 90–700 days) (p < 0.05). The median Lysholm score decreased significantly from 100 points (range 69–100) before the injury to 73 points (range 23–100) at the time of the follow-up. All patients received postoperative physiotherapy (median 25 appointments, range 6–330), with a significant higher number of appointments for C-type-fractures than for B-type-fractures (p = 0.004). Conclusion A relationship was found between workload and the duration of incapacity of work after tibial plateau fractures. The post-injury shift to less demanding jobs and the reduction of working hours highlight the impact of a tibial plateau fracture on a patient’s subsequent physical ability to work

Prevalence of and factors associated with swellings of the ribs in tie stall housed dairy cows in Germany.

Swellings of the ribs result from severe injury and affected animals are subjected to considerable and prolonged pain and suffering. The knowledge on rib swellings in dairy cows has yet been very limited. Therefore, the present study aimed at determining the prevalence of rib swellings in tie stall housed dairy cows in Germany as well as at identifying associated factors. Mean animal-level prevalence of rib swellings for 2,134 cows was 7.54% with a mean of 7.00% on farm level (range 0.00% - 37.49%). Multivariable mixed logistic regression models including nested random effects were built and factors associated with swellings of the ribs were evaluated for 1,740 dairy cows on 96 farms in Germany. Out of the initial 22 predictors, 8 factors were selected for the final model. Managing dairy cows on a part-time basis (OR 0.49 [CI 0.25-0.98]) appeared to decrease the odds for rib swellings compared with full-time farming. Cattle breeds other than Simmental entailed lower odds for rib swellings (OR 0.29 [CI 0.14-0.59]). Lame cows (OR 2.59 [CI 1.71-3.93]) and cows with wounds and/or swellings of the hocks (OR 2.77 [CI 1.32-5.84]) had more than two times the odds for rib swellings compared with sound animals. The results of the present study can help raising awareness of rib swellings in dairy cows and contribute to the body of evidence on this condition