Principles of the therapy of bone infections in adult extremities: Are there any new developments?

Septic diseases of the bone and immediately surrounding soft tissues can be differentiated into osteitis or osteomyelitis. Both are a most serious diagnosis in modern traumatology and orthopaedic surgery. The basis for treatment is a highly specific, problem-adapted therapy with a defined strategy, the paramount goal being to preserve the stable weightbearing bones, maintain a good mechanical axis with correctly working muscles and joints, and avoid permanent disability. “State-of-the-art” therapy of osteitis and osteomyelitis has two priorities: (a) Eradication of the infection; (b) Reconstruction of bone and soft tissue. Surgical treatment with resection of the affected bone segments and soft tissue, followed by reconstructive methods continues to be the main basic therapy, and is supported by local and systemic antibiotics and adjuvant methods such as hyperbaric oxygen. This article provides an overview of the diagnostic features and different surgical procedures as well as the current literature in order to reach the above named goals

Preservation of the shoulder joint by the use of a hybrid-spacer after septic loosening of a reversed total shoulder joint arthroplasty: a case report

Infections of a total joint replacement (TJR) of the shoulder are rare complications. After revision surgery, the incidence rises dramatically. If infection occurs, it leads to a loss of function and may be devastating to the joint. Treatment options range from single- to multiple-staged revision programs, permanent resection arthroplasty or exarticulation. In this case, a reversed shoulder endoprosthesis, which was implanted after multiple revisions of a TJR due to a posttraumatic omarthrosis and rotator cuff insufficiency, got infected. A hybrid-spacer, made of a humeral nail and a custom-made PMMA spacer forming the humeral head, was used during the revision program. After two operations, clinical and paraclinical signs turned back to normal. The patient felt well and was satisfied with the result of the therapy. The hybrid-spacer was then left in situ as a definitive solution with a satisfying range of motion. This case report shows that a hybrid-spacer can be helpful in the treatment of an infected shoulder TJR

The use of a retrograde fixed-angle intramedullary nail for tibiocalcaneal arthrodesis after severe loss of the talus

Tibiocalcaneal arthrodesis may be the only means of obtaining a painless and stable limb when there is loss of the talus. We present the early results of a prospective study on tibiocalcaneal arthrodesis using a latest-generation retrograde intramedullary nail. In the period 2006–2007, nine patients underwent tibiocalcaneal arthrodesis with retrograde intramedullary nailing. Five of these patients had infection-related loss of the talus. SF-36, AOFAS ankle-hindfoot, and Mazur Ankle Arthrodesis scores were obtained pre-fusion, and at 6 weeks, 6 months and 1 year post-fusion. The patients were also followed up clinically and radiologically. Previous surgical procedures, chronic musculoskeletal problems and other comorbidities, and complications were recorded and analyzed. All patients were available for initial follow-up and were subjectively satisfied with their outcomes. Solid fusion was achieved and fully confirmed in nine cases. One subject died 8 weeks postoperatively of a pulmonary embolism. One patient had recurrent infection. At 1 year, only one patient still needed NSAIDs regularly for pain relief. The AOFAS score improved significantly (P = 0.012) from 32.1 pre-fusion to 71.5 points at 1 year as did the Mazur score, which rose by 31.2 to 72.5 points at 1 year (P = 0.012). The SF-36 score improved significantly in the domains physical functioning, role limitations due to physical problems, bodily pain, vitality, social functioning and mental health, as did the Physical Component Summary Score. Retrograde intramedullary nailing for tibiocalcaneal arthrodesis can produce a good outcome. However, in the presence of infection, patient selection for intramedullary procedures must be carefully considered on a case-by-case basis

Toll-like receptor 4 deficiency: Smaller infarcts, but nogain in function

<p>Abstract</p> <p>Backgound</p> <p>It has been reported that Toll-like receptor 4 (TLR4) deficiency reduces infarct size after myocardial ischemia/reperfusion (MI/R). However, measurement of MI/R injury was limited and did not include cardiac <b>function</b>. In a chronic closed-chest model we assessed whether cardiac <b>function </b>is preserved in TLR4-deficient mice (C3H/HeJ) following MI/R, and whether myocardial and systemic cytokine expression differed compared to wild type (WT).</p> <p>Results</p> <p>Infarct size (IS) in C3H/HeJ assessed by TTC staining after 60 min ischemia and 24h reperfusion was significantly smaller than in WT. Despite a smaller infarct size, echocardiography showed no functional difference between C3H/HeJ and WT. Left-ventricular developed pressure measured with a left-ventricular catheter was lower in C3H/HeJ (63.0 ± 4.2 mmHg vs. 77.9 ± 1.7 mmHg in WT, p < 0.05). Serum cytokine levels and myocardial IL-6 were higher in WT than in C3H/HeJ (p < 0.05). C3H/HeJ MI/R showed increased myocardial IL-1β and IL-6 expression compared to their respective shams (p < 0.05), indicating TLR4-independent cytokine activation due to MI/R.</p> <p>Conclusion</p> <p>These results demonstrate that, although a mutant TLR4 signaling cascade reduces myocardial IS and serum cytokine levels, it <b>does not preserve myocardial function</b>. The change in inflammatory response, secondary to a non-functional TLR-4 receptor, may contribute to the observed dichotomy between infarct size and function in the TLR-4 mutant mouse.</p

Applied system analysis and technology of designing the software

An analogy is made between the stages of applied system analysis and the stages of software Engineerin

Basics of collaborative research data management: Requirements for a Schleswig-Holstein state initiative on research data management

Das Papier "Grundlagen eines partnerschaftlichen Forschungsdatenmanagements - Anforderungen an eine schleswig-holsteinische Landesinitiative zum Forschungsdatenmanagement" umreißt die Anforderungen für eine schleswig-holsteinische Landesinitiative zum Forschungsdatenmanagement (FDM-SH). Hierfür wird zunächst das Umfeld, in dem eine solche Initiative entstehen und agieren soll, beschrieben. So beeinflussen sowohl die Eigenheiten der regionalen Forschungslandschaft wie auch die Entwicklungen im Bereich der Nationalen Forschungsdateninfrastruktur (NFDI) die Ausprägungen von Landesinitiativen. Die speziellen Anforderungen werden durch den Vergleich mit anderen Landesinitiativen, die Analyse von spezifischen Umfrageergebnissen aus Schleswig-Holstein sowie die Berücksichtigung der Anforderungen der NFDI gesammelt. Der Ansatz des partnerschaftlichen Forschungsdatenmanagements (FDM) spiegelt das Anliegen Schleswig-Holsteins wider, die Herausforderungen für ein zeitgemäßes FDM vor Ort gemeinsam zu bewältigen und dabei sowohl Know-how zu teilen als auch Ressourcen zu schonen

LivestockPlus: The sustainable intensification of forage-based agricultural systems to improve livelihoods and ecosystem services in the tropics

As global demand for livestock products (such as meat, milk, and eggs) is expected to double by 2050, necessary increases to future production must be reconciled with negative environmental impacts that livestock cause. This paper describes the LivestockPlus concept and demonstrates how the sowing of improved forages can lead to the sustainable intensification of mixed crop–forage–livestock–tree systems in the tropics by producing multiple social, economic, and environmental benefits. Sustainable intensification not only improves the productivity of tropical forage-based systems but also reduces the ecological footprint of livestock production and generates a diversity of ecosystem services (ES), such as improved soil quality and reduced erosion, sedimentation, and greenhouse gas (GHG) emissions. Integrating improved grass and legume forages into mixed production systems (crop–livestock, tree–livestock, crop–tree–livestock) can restore degraded lands and enhance system resilience to drought and waterlogging associated with climate change. When properly managed tropical forages accumulate large amounts of carbon in soil, fix atmospheric nitrogen (legumes), inhibit nitrification in soil and reduce nitrous oxide emissions (grasses), and reduce GHG emissions per unit livestock product. The LivestockPlus concept is defined as the sustainable intensification of forage-based systems, which is based on three interrelated intensification processes: genetic intensification – the development and use of superior grass and legume cultivars for increased livestock productivity; ecological intensification – the development and application of improved farm and natural resource management practices; and socio-economic intensification – the improvement of local and national institutions and policies, which enable refinements of technologies and support their enduring use. Increases in livestock productivity will require coordinated efforts to develop supportive government, non-government organization, and private sector policies that foster investments and fair market compensation for both the products and ES provided. Effective research-for-development efforts that promote agricultural and environmental benefits of forage-based systems can contribute towards implemention of LivestockPlus across a variety of geographic, political, and socio-economic contexts

Ki-67 as a prognostic marker in mantle cell lymphoma—consensus guidelines of the pathology panel of the European MCL Network

Mantle cell lymphoma (MCL) has a heterogeneous clinical course and is mainly an aggressive B cell non-Hodgkin lymphoma; however, there are some indolent cases The Ki-67 index, defined by the percentage of Ki-67-positive lymphoma cells on histopathological slides, has been shown to be a very powerful prognostic biomarker. The pathology panel of the European MCL Network evaluated methods to assess the Ki-67 index including stringent counting, digital image analysis, and estimation by eyeballing. Counting of 2 × 500 lymphoma cells is the gold standard to assess the Ki-67 index since this value has been shown to predict survival in prospective randomized trials of the European MCL Network. Estimation by eyeballing and digital image analysis showed a poor concordance with the gold standard (concordance correlation coefficients [CCC] between 0.29 and 0.61 for eyeballing and CCC of 0.24 and 0.37 for two methods of digital image analysis, respectively). Counting a reduced number of lymphoma cells (2 × 100 cells) showed high interobserver agreement (CCC = 0.74). Pitfalls of the Ki-67 index are discussed and guidelines and recommendations for assessing the Ki-67 index in MCL are given