Novel Measurement Technique of the Tibial Slope on Conventional MRI

The posterior inclination of the tibial plateau, which is referred to as posterior tibial slope, is determined routinely on lateral radiographs. However, radiographically, it is not always possible to reliably recognize the lateral plateau, making a separate assessment of the medial and lateral plateaus difficult. We propose a technique to measure the plateaus separately by defining a tibial longitudinal axis on a conventional MRI. The medial plateau posterior tibial slope obtained from radiographs was compared with MR images in 100 consecutive patients with knee pain when ligament or meniscal injury was assumed. The posterior tibial slope on MRI correlated with those on radiographs. The mean posterior tibial slope was 3.4° smaller on MRI compared with radiographs (4.8°±2.4° versus 8.2°±2.8°, respectively). The reproducibility was slightly better on radiographs than MRI (±0.9° versus±1.4°). Twenty-one of the 100 cases had more than a 5° difference (range, −8.7° to 8.9°) between the medial and lateral plateaus. The proposed technique allows measurement of the posterior tibial slope of the medial and lateral plateaus on a standard knee MRI. By using this novel measurement technique, a reliable assessment of the medial and lateral tibial plateaus is possible. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidenc

Investigation into the Hybrid Production of a Superelastic Shape Memory Alloy with Additively Manufactured Structures for Medical Implants

The demographic change in and the higher incidence of degenerative bone disease have resulted in an increase in the number of patients with osteoporotic bone tissue causing. amongst other issues, implant loosening. Revision surgery to treat and correct the loosenings should be avoided, because of the additional patient stress and high treatment costs. Shape memory alloys (SMA) can help to increase the anchorage stability of implants due to their superelastic behavior. The present study investigates the potential of hybridizing NiTi SMA sheets with additively manufactured Ti6Al4V anchoring structures using laser powder bed fusion (LPBF) technology to functionalize a pedicle screw. Different scanning strategies are evaluated, aiming for minimized warpage of the NiTi SMA sheet. For biomechanical tests, functional samples were manufactured. A good connection between the additively manufactured Ti6Al4V anchoring structures and NiTi SMA substrate could be observed though crack formation occurring at the transition area between the two materials. These cracks do not propagate during biomechanical testing, nor do they lead to flaking structures. In summary, the hybrid manufacturing of a NiTi SMA substrate with additively manufactured Ti6Al4V structures is suitable for medical implants

Optische Untersuchung der Zündeigenschaften einer Vorkammerzündkerze in einem HD-Gasmotor

Vorkammer-Zündkerzen sind ein etabliertes Bauteil im Gasmotor. Ihr Entflammungsverhalten erfolgt in engem Zusammenspiel mit den Konditionen des Brennraumes und dem Strömungsverhältnissen. In vielen Einsätzen ist die Auswahl der für den jeweiligen Motor optimalen Vorkammerkzündkerze das Ergebnis vergleichender Versuche. Eine Visualisierung der Entflammung kann hier helfen, schnell zu relevanten Aussagen zu kommen. Die Visualisierung mit Hilfe von Endoskopen (Hügel et.al. Dessau 2013) leidet darunter, dass einer der Fackelstrahlen meist direkt in Richtung der Optik gezeigt hat und deswegen verschlossen werden musste. Eine Betrachtung von Asymetrien oder grundlegenden Effekten benötigt deswegen einen speziellen optischen Zugang durch den Zylinderkopf, der ein Blickfeld mit Fackelstrahl bis zum Kolben erlaubt. Nach einer Darstellung der Konstruktion des optischen Zuganges werden auch dessen Nebeneffekte - beispielsweise auf die Temperaturverteilung - an einem Forschungs-Einzylindermotor betrachtet. Die Aufnahmen zeigen die Fackelstrahlen einer symmetrischen Vorkammerkerze und die Auswirkungen der lokalen Brennraum-Konditionen auf die Fackelausbreitung und deren Gleichverteilung. Die Highspeed-Visualisierung mit Bildverstärker-Kamera zeigt im Allgemeinen die Chemilumineszenz mehrerer Spezies, die im Akkumulationszeitraum und der Betrachtungsachse kumulieren. Zusätzliche Informationen über die Mechanismen der Entflammung bietet hier eine zeitlich und räumlich aufgelöste Darstellung der Fackelstrahlen und der von Ihnen produzierten Chemilumineszenzsignale für beispielsweise CH* und C2* (s.a.Toedter et.al. 3rd int Ignition Conf. Berlin 2016). In der hier vorgestellten Arbeit wird mit dieser Methodik das Entflammungsverhalten und auch der Zündverzug beim Einsatz der Vorkammer-Zündkerze in einem Gasmotor analysiert. Die gewonnenen Erkenntnisse dienen als Basis für das Design an den Motor angepasster Vorkammerzündkerzen und als Ausgangspunkt für weitere Forschungen

Systemic Conception of the Data Acquisition of Digital Twin Solutions for Use Case-Oriented Development and Its Application to a Gearbox

Digital Twins are being used more and more frequently and provide information from the Real Twin for different applications. Measurements on the Real Twin are required to obtain information, which in many cases requires the installation of supplementary sensors. For their conception and design, it is particularly important that the measuring principles are selected purposefully and the appropriate sensors are integrated at the goal-oriented measuring positions without impairing the functions and other properties of the Real Twin by the integration of these sensors. In this article, a “Design for Digital Twin” approach is discussed for the systematic procedure and demonstrated using a multi-staged gearbox as a concrete example. The approach focuses on the mechanical and hardware side of the Real Twin. For the systematic conception and design of the Digital Twin solution, an understanding of the stakeholder demands and the expected use cases is necessary. Based on the stakeholder demands and use cases, the relevant product properties can be determined. Using the relevant properties, an iterative process of conception, design, and analysis takes place. The conception is carried out by means of target-oriented cause–effect analyses, taking into account systemic interrelations of the Real Twin components and systematics for the selection of measurement principles. Systemic considerations, combined with an effect graph, allow for the analysis and evaluation of disturbing factors

Sex-specific associations of comorbidome and pulmorbidome with mortality in chronic obstructive pulmonary disease : results from COSYCONET

In patients with COPD, it has not been comprehensively assessed whether the predictive value of comorbidities for mortality difers between men and women. We therefore aimed to examine sex diferences of COPD comorbidities in regard with prognosis by classifying comorbidities into a comorbidome related to extrapulmonary disorders and a pulmorbidome, referring to pulmonary disorders. The study population comprised 1044 women and 1531 men with the diagnosis of COPD from COSYCONET, among them 2175 of GOLD grades 1–4 and 400 at risk. Associations of comorbidities with mortality were studied using Cox regression analysis for men and women separately. During the follow-up (median 3.7 years) 59 women and 159 men died. In men, obesity, hypertension, coronary artery disease, liver cirrhosis, osteoporosis, kidney disease, anaemia and increased heart rate (HR) predict mortality, in women heart failure, hyperuricemia, mental disorders, kidney disease and increased HR (p< 0.05 each). Regarding the pulmorbidome, signifcant predictors in men were impairment in difusion capacity and hyperinfation, in women asthma and hyperinfation. Similar results were obtained when repeating the analyses in GOLD 1–4 patients only. Gender diferences should be considered in COPD risk assessment for a tailored approach towards the treatment of COPD

Partial Anterior Cruciate Ligament Ruptures: Advantages by Intraligament Autologous Conditioned Plasma Injection and Healing Response Technique—Midterm Outcome Evaluation

The historical treatment options for partial anterior cruciate ligament (ACL) ruptures were conservative therapy or ACL reconstruction by injured bundle or entire ACL replacement. In awareness of the regenerative potential of biologic agents such as mesenchymal stem cells or platelet rich plasma (PRP), the healing response technique was developed to preserve the injured ACL with belter outcomes lhan ihe conservative therapy. Further improvement of this technique seems to be obtained by the additional application of PRP products. Thus, the aim of this study was to evaluate the midterm outcome after intraligament autologous conditioned plasma (ACP) by a clinical, scoring, and functional performance assessment. 42 patients were evaluated in this study. The failure rate was 9.5%. Outcome evaluation showed good to excellent results. The scores were IKDC subjective 83.2 (SD 14.5), Lysholm 85.5 (SD 15.5), Tegner 4.7 (SD 1.7), and Cincinnati 85.4 (SD 15.5) afler a mean follow-up of 33 months. Clinical examination showed stable Lachman tesl, negative pivot shift phenomenon, and a significant reduction in AP-laxity compared to preoperative status (rolimeter preoperative: 1.9 (SD1.4); postoperative 0.6 (SD1.8), p=0.001) in all patients. Functional performance testing showed no significant differences between the injured and healthy side. Return to sport was achieved after a mean of 5.8 months (SD 3.6) in 71.1% of the included patients. In summary, this new treatment option revealed in midterm follow-up promising results to treat partial ACL lesions with a reduced need for conversion to ACL reconstruction and with a high percentage of return to preinjury sport activity

TERT promoter mutation and chromosome 6 loss define a high-risk subtype of ependymoma evolving from posterior fossa subependymoma

Subependymomas are benign tumors characteristically encountered in the posterior fossa of adults that show distinct epigenetic profiles assigned to the molecular group "subependymoma, posterior fossa" (PFSE) of the recently established DNA methylation-based classification of central nervous system tumors. In contrast, most posterior fossa ependymomas exhibit a more aggressive biological behavior and are allocated to the molecular subgroups PFA or PFB. A subset of ependymomas shows epigenetic similarities with subependymomas, but the precise biology of these tumors and their potential relationships remain unknown. We therefore set out to characterize epigenetic traits, mutational profiles, and clinical outcomes of 50 posterior fossa ependymal tumors of the PFSE group. On histo-morphology, these tumors comprised 12 ependymomas, 14 subependymomas and 24 tumors with mixed ependymoma-subependymoma morphology. Mixed ependymoma-subependymoma tumors varied in their extent of ependymoma differentiation (2-95%) but consistently exhibited global epigenetic profiles of the PFSE group. Selective methylome analysis of microdissected tumor components revealed CpG signatures in mixed tumors that coalesce with their pure counterparts. Loss of chr6 (20/50 cases), as well as TERT mutations (21/50 cases), were frequent events enriched in tumors with pure ependymoma morphology (p < 0.001) and confined to areas with ependymoma differentiation in mixed tumors. Clinically, pure ependymoma phenotype, chr6 loss, and TERT mutations were associated with shorter progression-free survival (each p < 0.001). In conclusion, our results suggest that subependymomas may acquire genetic and epigenetic changes throughout tumor evolution giving rise to subclones with ependymoma morphology (resulting in mixed tumors) that eventually overpopulate the subependymoma component (pure PFSE ependymomas)

A randomized controlled trial to investigate the influence of low dose radiotherapy on immune stimulatory effects in liver metastases of colorectal cancer

<p>Abstract</p> <p>Background</p> <p>Insufficient migration and activation of tumor specific effector T cells in the tumor is one of the main reasons for inadequate host anti-tumor immune response. External radiation seems to induce inflammation and activate the immune response. This phase I/II clinical trial aims to evaluate whether low dose single fraction radiotherapy can improve T cell associated antitumor immune response in patients with colorectal liver metastases.</p> <p>Methods/Design</p> <p>This is an investigator-initiated, prospective randomised, 4-armed, controlled Phase I/II trial. Patients undergoing elective hepatic resection due to colorectal cancer liver metastasis will be enrolled in the study. Patients will receive 0 Gy, 0.5 Gy, 2 Gy or 5 Gy radiation targeted to their liver metastasis. Radiation will be applied by external beam radiotherapy using a 6 MV linear accelerator (Linac) with intensity modulated radiotherapy (IMRT) technique two days prior to surgical resection. All patients admitted to the Department of General-, Visceral-, and Transplantion Surgery, University of Heidelberg for elective hepatic resection are consecutively screened for eligibility into this trial, and written informed consent is obtained before inclusion. The primary objective is to assess the effect of active local external beam radiation dose on, tumor infiltrating T cells as a surrogate parameter for antitumor activity. Secondary objectives include radiogenic treatment toxicity, postoperative morbidity and mortality, local tumor control and recurrence patterns, survival and quality of life. Furthermore, frequencies of systemic tumor reactive T cells in blood and bone marrow will be correlated with clinical outcome.</p> <p>Discussion</p> <p>This is a randomized controlled patient blinded trial to assess the safety and efficiency of low dose radiotherapy on metastasis infiltrating T cells and thus potentially enhance the antitumor immune response.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01191632">NCT01191632</a></p