Temporary Kirschner Wire Ankle Transfixation and Delayed ORIF: A Staged Operative Treatment for Closed Ankle Fractures with Tibiotalar Dislocations and Soft-Tissue Damage

Abstract : Background and Purpose: : Immediate ORIF (open reduction and internal fixation) is the treatment of choice for displaced ankle fractures. However, definitive treatment may have to be delayed due to compromised soft tissues. The value of temporary Kirschner wire ankle transfixation with staged ORIF for closed displaced ankle fractures with tibiotalar dislocations was determined. Patients and Methods: : In this retrospective case series (1997-2001), 92 patients (mean age 54 years, range 20-86 years) who underwent a staged procedure for isolated and closed displaced ankle fractures with tibiotalar dislocations were studied. Patients were primarily treated by means of immediate closed reduction. For stable fractures and adequate soft tissues a split plaster cast was applied (n = 50). K-wire transfixation was performed for unstable fracture-dislocations and/or critical soft tissues (n = 42). All patients underwent delayed ORIF after recovery of the soft tissues. Results: : In the K-wire group (KWG), local complication rate was 7%. Mean operating time was 30 min (5-65 min). In the plaster cast group (PCG), local complication rate was 10% (p = 0.72, not significant). Three redislocated ankles (6%) had to be transfixed secondarily. A higher grade of soft-tissue injuries in the KWG (p < 0.05) resulted in a longer time interval between primary treatment and staged ORIF (7 vs. 5 days; p < 0.05) and a longer hospital stay (19 vs. 17 days; p < 0.05) for the KWG. Conclusion: : Temporary K-wire ankle transfixation is an effective method for initial treatment of closed displaced ankle fractures with tibiotalar dislocation, if ORIF has to be delayed and immobilization in a split plaster cast is not suitable. Retention is reliable with a low complication rat

Prophylactic Insertion of Optional Vena Cava Filters in High-Risk Trauma Patients

Background:: Vena cava interruption is a form of pulmonary embolism prophylaxis that is being used in high-risk patients who do not tolerate pharmacologic prophylaxis. Retrievable prophylactic vena cava filters (VCFs) are of particular interest for severely injured patients where the necessity for VCF is often only temporary. Methods:: In a single-institution case series of consecutive patients who received prophylactic VCFs after polytrauma, between 04/1998 and 07/2004, the demographic data, injury pattern and complications were analysed. Results:: Ninety-five prophylactic VCFs were placed in polytrauma patients (median ISS of 38). Median age was 38 years (range 16-80 years). Median delay between trauma and filter placement was 1 day (range 0-31 days). No complication was seen related to filter insertion or retrieval. Sixty-five VCFs (68.4%) were retrieved after 4-25 days (median 13 days). One filter migration (1.1%) was observed. Retrieval failed in two patients (3.0%). A total of 30 VCFs (31.6%) were left permanently. One non-fatal PE (1.1%) occurred 21 days after filter retrieval despite prophylaxis with LMWH. DVT developed in two patients (2.1%) including one vena caval occlusion (1.1%). Overall mortality was 7.4%. Conclusions:: Early prophylactic placement of VCF in a high-risk trauma patient should be considered when anticoagulation is contraindicated. Filter insertion and retrieval is safe with a low complication rat

Primary Hemiarthroplasty for Proximal Humeral Fractures in the Elderly: Long-Term Functional Outcome and Social Implications

Background:: Primary shoulder hemiarthroplasty is an established treatment modality for complex fractures of the proximal humerus. Long-term functional outcome is often disappointing. However, little is known about social implications particularly in the elderly. Methods:: A single-institution case series of consecutive geriatric patients (age > 70 years) treated with shoulder hemiarthroplasty for complex fractures of the proximal humerus between 1994 and 1997 was analysed. Postoperative morbidity, long-term function, radiological outcome and social implications were evaluated. Results:: Seventy-seven patients fulfilled the study criteria. Median age at the time of operation was 80 years (range 70-93 years). Systemic and local postoperative complications were observed in 8% including 2 patients (3%) with revision surgery. Postoperative mortality was 1%. Forty-eight patients (62%) were available for follow-up (median 49 months, range 25-80 months), 22 (29%) died from causes unrelated to hemiarthroplasty before follow-up and 7 patients (9%) did not attend follow-up examination. Median Constant-Murley score was 41 points (range 17-77 points). Long-term results concerning pain were satisfying. The Oxford shoulder score ranged from 14 to 40 (median 30). Forty-one patients (85%) still lived in their original environment and managed their daily life independently despite poor shoulder function. Four patients (8%) lived in a retirement home and 3 (6%) in a nursery home. Eighty percent of our patients were still able to use public transportation, do the daily shopping and wash their whole body by themselves. Conclusion:: Most patients managed their daily life independently despite poor shoulder functio

Potential Risk Factors for, and Clinical Implications of, Delirium during Inpatient Rehabilitation: A Matched Case-Control Study

To investigate the association between a wide set of baseline characteristics (age, sex, rehabilitation discipline), functional scores [Functional Independence Measure (FIM), cumulative Illness Rating Scale (CIRS)], diseases, and administered drugs and incident delirium in rehabilitation inpatients and, furthermore, to assess clinical implications of developing delirium during rehabilitation.; Matched case-control study based on electronic health record data.; We studied rehabilitation stays of inpatients admitted between January 1, 2015, and December 31, 2018, to ZURZACH Care, Rehaklinik Bad Zurzach, an inpatient rehabilitation clinic in Switzerland.; We conducted unconditional logistic regression analyses to estimate adjusted odds ratios (AORs) with 95% CIs of exposures that were recorded in ≥5 cases and controls.; Among a total of 10,503 rehabilitation stays, we identified 125 validated cases. Older age, undergoing neurologic rehabilitation, a low FIM, and a high CIRS were associated with an increased risk of incident delirium. Being diagnosed with a bacterial infection (AOR 2.62, 95% CI 1.06-6.49), a disorder of fluid, electrolyte, or acid-base balance (AOR 2.76, 95% CI 1.19-6.38), Parkinson's disease (AOR 5.68, 95% CI 2.54-12.68), and administration of antipsychotic drugs (AOR 8.06, 95% CI 4.26-15.22), antiparkinson drugs (AOR 2.86, 95% CI 1.42-5.77), drugs for constipation (AOR 2.11, 95% CI 1.25-3.58), heparins (AOR 2.04, 95% CI 1.29-3.24), or antidepressant drugs (AOR 1.88, 95% CI 1.14-3.10) during rehabilitation, or an increased anticholinergic burden (ACB ≥ 3) (AOR 2.59, 95% CI 1.41-4.73) were also associated with an increased risk of incident delirium.; We identified a set of factors associated with an increased risk of incident delirium during inpatient rehabilitation. Our findings contribute to detect patients at risk of delirium during inpatient rehabilitation

Atmospheric controls on hydrogen and oxygen isotope composition of meteoric and surface waters in Patagonia

The southern tip of South America, commonly referred to as Patagonia, is a key area to understand SouthernHemisphere Westerlies (SHW) dynamics and orographic isotope effects in precipitation. However, only few studies haveaddressed these topics. We evaluated the stable isotope (2H, 18O) compositions of precipitation, lentic waters, and lotic waters in that area to characterize and understand isotope fractionation processes associated with orographic rainout, moisture 20 recycling and moisture sources. Observational data were interpreted with the help of backward trajectory modelling of moisturesources using reanalysis climate data. While the Pacific serves as the exclusive moisture source for sites upwind of the Andes and on the immediate downwind area of the Andes, recycled moisture from the continent seems to be the main humidity source at the Patagonian Atlantic coast. In contrast, the Pampean Atlantic coast north of Patagonia obtains moisture from the Atlantic Ocean. In the core zone of the SHW at a latitude of 50° S, a depletion in the heavy isotopes of 10 ? and 85 ?, for 18O and 25 2H, respectively, occurs due to orographic rainout corresponding to a drying ratio of 0.45.Fil: Mayr, Christoph. Universitat Erlangen-Nuremberg; Alemania. Universitat Technical Zu Munich; AlemaniaFil: Langhamer, Lukas. Universidad de Innsbruck; AustriaFil: Wissel, Holger. Universitat Erlangen-Nuremberg; AlemaniaFil: Meier, Wolfgang. Universitat Erlangen-Nuremberg; AlemaniaFil: Sauter, Tobias. Universitat Erlangen-Nuremberg; AlemaniaFil: Laprida, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; ArgentinaFil: Massaferro, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Administración de Parques Nacionales. Delegación Regional Patagonia; ArgentinaFil: Försterra, Günter. Pontificia Universidad Católica de Valparaíso; ChileFil: Lücke, Andreas. Universitat Erlangen-Nuremberg; Alemani

Detecting Incident Delirium within Routinely Collected Inpatient Rehabilitation Data: Validation of a Chart-Based Method

Delirium is a brain condition associated with poor outcomes in rehabilitation. It is therefore important to assess delirium incidence in rehabilitation.; To develop and validate a chart-based method to identify incident delirium episodes within the electronic database of a Swiss rehabilitation clinic, and to identify a study population of validated incident delirium episodes for further research purposes.; Retrospective validation study.; Routinely collected inpatient clinical data from ZURZACH Care.; All patients undergoing rehabilitation at ZURZACH Care, Rehaklinik Bad Zurzach between 2015 and 2018 were included.; Within the study population, we identified all rehabilitation stays for which ≥2 delirium-predictive key words (common terms used to describe delirious patients) were recorded in the medical charts. We excluded all prevalent delirium episodes and defined the remaining episodes to be potentially incident. At least two physicians independently confirmed or refuted each potential incident delirium episode by reviewing the patient charts. We calculated the positive predictive value (PPV) with 95% confidence interval (95% CI) for all potential incident delirium episodes and for specific subgroups.; Within 10,515 rehabilitation stays we identified 554 potential incident delirium episodes. Overall, 125 potential incident delirium episodes were confirmed by expert review. The PPV of the chart-based method varied from 0.23 (95% CI 0.19-0.26) overall to 0.69 (95% CI 0.56-0.79) in specific subgroups.; Our chart-based method was able to capture incident delirium episodes with low to moderate accuracy. By conducting an additional expert review of the medical charts, we identified a study population of validated incident delirium episodes. Our chart-based method contributes towards an automated detection of potential incident delirium episodes that, supplemented with expert review, efficiently yields a validated population of incident delirium episodes for research purposes

Accelerated physical emulation of Bayesian inference in spiking neural networks

The massively parallel nature of biological information processing plays an important role for its superiority to human-engineered computing devices. In particular, it may hold the key to overcoming the von Neumann bottleneck that limits contemporary computer architectures. Physical-model neuromorphic devices seek to replicate not only this inherent parallelism, but also aspects of its microscopic dynamics in analog circuits emulating neurons and synapses. However, these machines require network models that are not only adept at solving particular tasks, but that can also cope with the inherent imperfections of analog substrates. We present a spiking network model that performs Bayesian inference through sampling on the BrainScaleS neuromorphic platform, where we use it for generative and discriminative computations on visual data. By illustrating its functionality on this platform, we implicitly demonstrate its robustness to various substrate-specific distortive effects, as well as its accelerated capability for computation. These results showcase the advantages of brain-inspired physical computation and provide important building blocks for large-scale neuromorphic applications.Comment: This preprint has been published 2019 November 14. Please cite as: Kungl A. F. et al. (2019) Accelerated Physical Emulation of Bayesian Inference in Spiking Neural Networks. Front. Neurosci. 13:1201. doi: 10.3389/fnins.2019.0120

Prophylactic Insertion of Optional Vena Cava Filters in High-Risk Trauma Patients

Background:: Vena cava interruption is a form of pulmonary embolism prophylaxis that is being used in high-risk patients who do not tolerate pharmacologic prophylaxis. Retrievable prophylactic vena cava filters (VCFs) are of particular interest for severely injured patients where the necessity for VCF is often only temporary. Methods:: In a single-institution case series of consecutive patients who received prophylactic VCFs after polytrauma, between 04/1998 and 07/2004, the demographic data, injury pattern and complications were analysed. Results:: Ninety-five prophylactic VCFs were placed in polytrauma patients (median ISS of 38). Median age was 38 years (range 16-80 years). Median delay between trauma and filter placement was 1 day (range 0-31 days). No complication was seen related to filter insertion or retrieval. Sixty-five VCFs (68.4%) were retrieved after 4-25 days (median 13 days). One filter migration (1.1%) was observed. Retrieval failed in two patients (3.0%). A total of 30 VCFs (31.6%) were left permanently. One non-fatal PE (1.1%) occurred 21 days after filter retrieval despite prophylaxis with LMWH. DVT developed in two patients (2.1%) including one vena caval occlusion (1.1%). Overall mortality was 7.4%. Conclusions:: Early prophylactic placement of VCF in a high-risk trauma patient should be considered when anticoagulation is contraindicated. Filter insertion and retrieval is safe with a low complication rat

Towards Additively Manufactured Metamaterials with Powder Inclusions for Controllable Dissipation: The Critical Influence of Packing Density

Particle dampers represent a simple yet effective means to reduce unwanted oscillations when attached to structural components. Powder bed fusion additive manufacturing of metals allows to integrate particle inclusions of arbitrary shape, size and spatial distribution directly into bulk material, giving rise to novel metamaterials with controllable dissipation without the need for additional external damping devices. At present, however, it is not well understood how the degree of dissipation is influenced by the properties of the enclosed powder packing. In the present work, a two-way coupled discrete element - finite element model is proposed allowing for the first time to consistently describe the interaction between oscillating deformable structures and enclosed powder packings. As fundamental test case, the free oscillations of a hollow cantilever beam filled with various powder packings differing in packing density, particle size, and surface properties are considered to systematically study these factors of influence. Critically, it is found that the damping characteristics strongly depend on the packing density of the enclosed powder and that an optimal packing density exists at which the dissipation is maximized. Moreover, it is found that the influence of (absolute) particle size on dissipation is rather small. First-order analytical models for different deformation modes of such powder cavities are derived to shed light on this observation