Search

Dandy-Walker malformation (DWM) and Cerebellar vermis hypoplasia (CVH) are commonly recognized human cerebellar malformations diagnosed following ultrasound and antenatal or postnatal MRI. Specific radiological criteria are used to distinguish them, yet little is known about their differential developmental disease mechanisms. We acquired prenatal cases diagnosed as DWM and CVH and studied cerebellar morphobiometry followed by histological and immunohistochemical analyses. This was supplemented by laser capture microdissection and RNA-sequencing of the cerebellar rhombic lip, a transient progenitor zone, to assess the altered transcriptome of DWM vs control samples. Our radiological findings confirm that the cases studied fall within the accepted biometric range of DWM. Our histopathological analysis points to reduced foliation and inferior vermian hypoplasia as common features in all examined DWM cases. We also find that the rhombic lip, a dorsal stem cell zone that drives the growth and maintenance of the posterior vermis is specifically disrupted in DWM, with reduced proliferation and self-renewal of the progenitor pool, and altered vasculature, all confirmed by transcriptomics analysis. We propose a unified model for the developmental pathogenesis of DWM. We hypothesize that rhombic lip development is disrupted through either aberrant vascularization and/or direct insult which causes reduced proliferation and failed expansion of the rhombic lip progenitor pool leading to disproportionate hypoplasia and dysplasia of the inferior vermis. Timing of insult to the developing rhombic lip (before or after 14 PCW) dictates the extent of hypoplasia and distinguishes DWM from CVH.

It is critical to identify potential risk factors, such as a history of early life stress (ELS), that may confer specific vulnerabilities to increased drug intake. In this study, we examined whether male and female rhesus monkeys with a history of ELS (infant maltreatment; MALT) demonstrated significantly greater cocaine intake compared with controls. Monkeys were trained to self-administer cocaine during 4-h sessions at a peak dose (0.003–0.1 mg/kg/infusion; extended access, “EA peak”) and a dose of 0.1 mg/kg/infusion (EA 0.1) of cocaine. These data were compared with data obtained previously in monkeys trained during 1-h limited access (LA) sessions at the same peak dose of cocaine used here (Wakeford et al. Psychopharmacology, 236:2785-2796, 2019). Monkeys significantly increased total number of infusions earned in EA compared with LA, but total session response rates significantly decreased in EA compared with LA. There was no evidence of escalation in drug intake when we compared response rates to obtain the first 20 cocaine infusions between LA and EA peak conditions. Moreover, there was no evidence of escalation in drug intake during an additional 7 weeks of self-administration at 0.1 mg/kg/injection. The current study expands on previous reports demonstrating that rhesus macaques did not escalate cocaine intake under the experimental conditions employed and extended these findings by using a unique population of nonhuman primates with a history of infant MALT to test the hypothesis that ELS is a risk factor for escalation of cocaine intake in nonhuman primates. There was no clear evidence of escalation in cocaine intake as a consequence of ELS.

PurposeWithin a prospective, multicenter cohort study we investigated whether operative treatment of scaphoid bone fractures leads to earlier return to previous activity levels.MethodsOnly isolated, acute, complete, stable and non-displaced fractures of the mid-third of the scaphoid bone were included. A total of 94 patients with the same number of fractures were recruited. In the operative group, fractures were fixed with a cannulated screw and had postoperative splint immobilization for a maximum of 1 week. In the conservative group a short arm cast was applied until fracture union was achieved. Both groups were followed for 6 months.ResultsBy 15 weeks patients receiving surgical treatment had returned significantly earlier to their full time work and home activities and achieved significantly better results for functional status, pain, and overall satisfaction. However, after screw fixation, complication rates concerning union and secondary operative management were higher.ConclusionOperative treatment primarily facilitates earlier return to previous activity levels, as well as better functional status, less pain and higher patient satisfaction, but conservative treatment seems to be safer and associated with a lower complication rate.

Research on Precision Farming (PF) relates the adoption of PF primarily to economic incentives as well as farm attributes, whereas social factors are commonly ignored. Therefore, the present study analyses the importance of farmers’ communication and co-operation strategies in the adoption of PF and their relation to farm attributes. Forty-nine qualitative interviews with stakeholders from the agricultural sector were conducted. The survey was based in Germany where most interviews took place and reflected with findings from the Czech Republic, Denmark and Greece. It is revealed that farms differ in their communication strategies depending on farm size. Joint investment in PF was only reported from some regions. It can be assumed that agricultural contractors will be major driving forces behind the adoption of PF over the next 10 years, especially in areas with smaller-sized farms. Agricultural data processing by service providers is seen as a common issue. Concerns regarding potential data misuse, over-regulation and software compatibility were raised.

To investigate whether operative treatment leads to earlier return to previous activity level, 94 patients with the same number of isolated, acute, complete, stable and non-displaced fractures of the scaphoid mid-third were involved in a prospective, multicenter cohort study. Fractures were either fixed with a cannulated screw or immobilized with a short arm cast, and followed for 6 months. By 15 weeks, patients receiving surgical treatment returned significantly earlier to their full time work and home activities, as well as achieved significantly better results for functional status, pain, and overall satisfaction. However, complication rates concerning union and secondary operative management were higher. Operative treatment therefore primarily facilitates earlier return to previous activity level, as well as better functional status, less pain and higher patient satisfaction, yet conservative treatment seems to be safer and associated with a lower complication rate.

Das vorrangige Ziel der Behandlung von Mittelhandfrakturen ist die Wiederherstellung der Greiffunktion der Hand. Ob eine konservative Therapie moglich ist, muss sowohl anhand radiologischer Kriterien als auch anhand des Ausmases der klinischen Fehlstellung individuell entschieden werden. Fur die operative Behandlungen von Frakturen im Kopf- und Schaftbereich haben sich weichteilschonende Schrauben- und Plattenosteosynthesen bewahrt sowie insbesondere fur die Halsfrakturen der Randstrahlen die intramedullare Markraumschienung mit Drahten. Die besonders instabilen Basisfrakturen des ersten Mittelhandknochens werden mit dem Ziel der Form- und Gelenkflachenwiederherstellung in frakturadaptierter Technik regelhaft operativ behandelt. Sowohl bei der konservativen als auch nach der operativen Therapie ist eine fruhfunktionelle Weiterbehandlung zur Vermeidung von Gelenkfunktionsstorungen anzustreben.

Die Indikation zur operativen Stabilisierung von osteoporotischen Frakturen bei alteren Patienten muss der Erkrankungsschwere, dem Verletzungsmuster und den Fahigkeiten des Patienten, die rehabilitativen Masnahmen aktiv zu unterstutzen, Rechnung tragen. Intramedullare Verriegelungsnagelsysteme gehen mit einem geringeren Operationstrauma und einer fruheren Belastungsstabilitat einher als andere Verfahren und sind der „golden standard“ fur schaft- und gelenknahe Frakturen. Bei winkelstabilen Formplatten ist das Risiko einer sekundaren Frakturdislokation geringer, sie konnen haufig uber einen minimal-invasiven Zugang nach gedeckter Reposition verankert werden und bieten vor allem bei periprothetischen Frakturen—ohne Lockerung des Implantats—eine dauerhafte Stabilisierung. Die Ursachen eines Sturzes mussen abgeklart werden. Zur Pravention weiterer Spontanfrakturen und zur Behandlung des Osteoporoseschmerzes ist eine standardisierte abgestufte Therapie gemas dem Ausmas der Osteoporose Kernaufgabe der Akutbehandlung von Verletzungen im hoheren Lebensalter.

The finished sequence of human chromosome 10 comprises a total of 131,666,441 base pairs. It represents 99.4% of the euchromatic DNA and includes one megabase of heterochromatic sequence within the pericentromeric region of the short and long arm of the chromosome. Sequence annotation revealed 1,357 genes, of which 816 are protein coding, and 430 are pseudogenes. We observed widespread occurrence of overlapping coding genes (either strand) and identified 67 antisense transcripts. Our analysis suggests that both inter- and intrachromosomal segmental duplications have impacted on the gene count on chromosome 10. Multispecies comparative analysis indicated that we can readily annotate the protein-coding genes with current resources. We estimate that over 95% of all coding exons were identified in this study. Assessment of single base changes between the human chromosome 10 and chimpanzee sequence revealed nonsense mutations in only 21 coding genes with respect to the human sequence.

Die vorliegende multizentrische Studie befasst sich mit der Erarbeitung optimaler Behandlungskonzepte bei Mittelhandfrakturen. Ausgangsdaten und Behandlungsoptionen von 1260 Patienten mit Mittelhandfrakturen wurden erfasst und hinsichtlich ihres Einflusses auf das klinisch-funktionelle und radiologische Ergebnis ausgewertet. 740 Patienten wurden nachuntersucht. Bei 487 der nachuntersuchten Patienten (66%) war nur ein Mittelhandknochen (MHK) der 3 haufigsten Lokalisationen (distale, metaphysare und intraartikulare Frakturen des 4. und 5. MHK, Schaftfrakturen des 2. bis 5. MHK, proximale, basisnahe Frakturen des 1. MHK) betroffen. Das klinisch-funktionelle und radiologische Ergebnis war uberwiegend sehr gut und gut. Aus der "Pfad-Analyse" der Zusammenhange zwischen Ausgangsdaten, Behandlungsoptionen und den Ergebnissen wurden Empfehlungen fur die Therapie von MHK-Frakturen abgeleitet. Die fruhfunktionelle Nachbehandlung von Mittelhandfrakturen sollte angestrebt werden. Schmerzen und Schmerzsyndrome haben einen signifikanten Einfluss auf Patientenzufriedenheit und das funktionelle Ergebnis. Sie sollten fruh erkannt und adaquat therapiert werden.

Die distale Radiusfraktur hat ihren 2. Haufigkeitsgipfel in der 2. Lebenshalfte. Durch die haufig komplexen Verletzungen sind differenzierte Behandlungsverfahren notwendig, um adaquate Ergebnisse zu erzielen. Ziel unserer Untersuchung war, die Ermittlung der Ergebnisse und Komplikationen bei Versorgung distaler Radiusfrakturen mit 2,4 mm winkelstabilen Platten bei Patienten alter als 65 Jahre mit Osteoporose und den damit verbundenen Aufwand mit anderen Behandlungsverfahren zu vergleichen. 37 Patienten sind in der prospektiven Studie eingeschlossen worden. Die Verteilung nach der AO-Klassifikation ergab: 9 A-, 1 B- und 27 C-Frakturen. Das Durchschnittsalter betrug 76 Jahre. 26 palmare Platten standen 7 dorsalen und 4 „Sandwich-Verfahren“ gegenuber. Bei einer mittleren Nachuntersuchungszeit von 11,1 Monaten (33 Patienten) ergab der funktionelle Lidstrom-Score: 13 sehr gute, 15 gute, 4 masige, 1 schlechtes Ergebnis, der radiologische Lidstrom-Score: 15 sehr gute, 13 gute, 4 masige, 1 schlechtes Ergebnis. Die Resultate zeigen, dass die winkelstabile 2,4 mm-Plattenosteosynthese bei osteoporotischen Frakturen in uber 80% zu guten und sehr guten Ergebnissen fuhren. Der Vergleich der realen Eingriffskosten mit anderen Verfahren zeigte einen erheblichen Mehraufwand fur die Versorgung mit LC-Platten.

We report a case of intestinal malrotation without any associated GI tract complications diagnosed antenatally by fetal MRI. Antenatal US revealed a midline stomach. Subsequent fetal MRI confirmed the midline stomach and, in addition, revealed all loops of small bowel to the right of the midline and all large bowel to the left. All these features were consistent with intestinal malrotation. There was no abnormal bowel wall thickening, bowel dilatation, ascites or polyhydramnios. To our knowledge, this is a unique case of intestinal malrotation without associated GI tract complications diagnosed antenatally on fetal MRI.

Anhand der Ergebnisse operativ versorgter 27 basisnaher Metakarpale-I-Frakturen (zwolf intraartikular, 15 extraartikular) werden Indikation und Technik der ubungsstabilen Versorgung durch das Mini- und Kleinfragment-instrumentarium der AO besprochen. Durch die Verwendung verschieden dimensionierter Implantate, die weit gestellte Indikation zur zusatzlichen autologen Spongiosaplastik und die temporare Verwendung des gelenk-uberbruckenden Mini-Fixateur externe in all den Fallen, in denen durch interne Osteosynthese keine ausreichende Ubungsstabilitat erzielt werden kann, sowie bei Weichteilschaden in Kombination mit interner Osteosynthese, kann eine den Grundsatzen der AO entsprechende aktive, funktionelle Weiterbehandlung durchgefuhrt werden. Damit konnen Komplikationen und Folgen einer immobilisierenden Behandlung vermieden werden.

Die neue Weiterbildungsordnung fur Chirurgie weist eine erhebliche Flexibilitat und die Einbindung aller chirurgischen Spezialgebiete auf und bietet verschiedene Schwerpunktqualifizierungsmoglichkeiten. Die Weiterbildungsstrukturen sind durch gesetzliche Regelungen, den technischen Fortschritt und die Entwicklung neuer Methoden der Wissensvermittlung in ihrer Durchfuhrungsmoglichkeit stark beeinflusst. Es wird zu einer Leistungsangebotregulierung, zu einer Verlangerung der Weiterbildungszeit und zur Notwendigkeit einer kontinuierlichen Fortbildung kommen. Die Attraktivitat der Unfallchirurgie wird zwar m. E. durch den neuen Facharzt gestarkt, muss jedoch durch das positive Beispiel einer effizienteren Klinikstruktur mit flacheren hierarchischen Strukturen optimiert werden. Die durch die neue Ordnung geschaffene Option, sich zukunftig auch zu einem spateren Zeitpunkt im beruflichen Werdegang fur bestimmte Gebiete entscheiden zu konnen, ist ein wesentlicher Fortschritt. Fur den Erfolg der neuen Weiterbildungsordnung und der damit verbundenen strukturellen Veranderungen sind die Fahigkeit zur Zusammenarbeit, zur Entwicklung neuer Strukturen in der Patientenversorgung, zur Weiterbildung sowie zur klinischen und Grundlagenforschung erforderlich.

The dental arches of the major genera of Old World monkeys (superfamily Cercopithecoidea) were studied by morphometric techniques. Bicanine and bimolar breadths and arch lengths were ascertained for maxillary and mandibular arches. This data was then subjected to a variety of statistical tests. Corresponding arch dimensions of the upper and lower dentition showed the highest correlations, while the lowest correlations were generally observed between comparisons of arch dimensions and body size. A new expression was developed, relative male palate size (RMPS), which quantified the degree of sexual dimorphism while correcting for body size. The four hierarchies examined using RMPS values were sexual dimorphism, modes of sexual selection and predator defense and diet. Maxillary bicanine breadth was the only parameter that exhibited sexual dimorphism consistently in each of the four hierarchies, although differences in arch size were identified for diet and predator defense. Species grouped by predator defense showed the most sexual dimorphism in arch parameters.

A strong enhancement at the (Σ Open image in new window )+ threshold is observed in missing mass spectra of the reaction pp→K+X experiment performed at the French Saturn National Lab (LNS). This effect is related to the coupling of the (Σ Open image in new window )+ and Λp channels. It could be the signature of a strangeS=−1 resonance the H1* (2130),SU(3) analog partner of the deuteron.

Die Behandlung der Brust- und Lendenwirbelbruche wird bestimmt durch die (primare) Stabilitat oder Instabilitat der Verletzung. Definitionsgemas ist die Tragfahigkeit der Wirbelsaule bei den “stabilen” Wirbelverletzungen nicht oder nur geringfugig vermindert, so das in der Regel eine fruhzeitige Mobilisation ohne wesentlichen Form- und Funktionsverlust moglich ist. Die von Magnus entwickelte und spater mehrfach modifizierte funktionell-dynamische Behandlung der Wirbelbruche und ein krankengymnastisches “13-Punkte-Konzept” haben sich bei der Behandlung der “stabilen” Brust- und Lendenwirbelbruche auserordentlich bewahrt.

A relapse-free condition and/or healing of chronic posttraumatic osteomyelitis is obtained by 1. radical excision of the infected tissue, 2. absolute mechanical immobility in the area of the fracture, 3. optimized blood supply of soft tissues. The perfusion of soft tissues around the osteomyelitic focus is often disturbed due to large scar fields caused by injuries or repeated surgical interventions. It can be improved by means of plastic surgery with local muscle flaps or by transplantation of a free muscle flap with microsurgical connection of vessels. All muscles in which the axial vessels are predominant can be used for plastic surgery with local muscle flaps. In the leg, these are above all the musculi gastrocnemii and the musculus soleus. After having applied this method in six patients, we noticed that infection control could be achieved by this procedure after six to twelve months. When a free muscle flap (musculus latissimus dorsi) is used, the local soft tissue perfusion can be considerably ameliorated by these rather large muscle flaps, irrespective of the local blood flow after epicentric microsurgical connection of vessels. This is the precondition for the healing of the infection. Based on our own results, we discuss the difficulty to indicate exactly the duration and extent of the increased perfusion of transplanted muscles. As is shown by the clinical results available up to now, these two procedures make possible a considerably reduced recurrence rate in chronic posttraumatic osteomyelitis.

Die Befunde von 510 intraoperativ, am Ende der Operation entnommenen Wundabstrichen nach Eingriffen am proximalen Femur (n=226), Tibiamarknagelung (n=40), offene Unterschenkelfrakturen (n=32) and obere Sprunggelenkfrakturen (n=226) korrelierten in unterschiedlichem Mase zum klinischen Verlauf was lokale, entzundliche Wundheilungsstorungen betraf. Die Korrelation lag bei den Femurfrakturen, Tibiamarknagelungen and oberen Sprunggelenkfrakturen bei 0,82, bei den offenen Unterschenkelfrakturen bei 0,5. Insgesamt hatten negative Wundabstriche in 92% eine richtige Vorhersage uber den weiteren klinischen Verlauf, wahrend die positiven nur in 12% den klinischen Befund bestatigten. Alter and Zeitpunkt der Operation beeinflussen die lokale Komplikationsrate je nach Lokalisation des Eingriffes in unterschiedlichem Mase.

Defects in CHARGE association may include choanal atresia, coloboma, cardiac anomalies, growth and mental deficiency, genital hypoplasia, and ear anomalies, as well as other facial defects such as cleft palate, micrognathia, facial palsy and velopharyngeal problems. Previous studies have demonstrated that cephalic neural crest plays a major role in facial morphogenesis. Recent studies using quail/chick chimeras have shown that mesenchyme of the aorticopulmonary septum is also derived from cells of the cephalic neural crest. There is overlap between CHARGE association and DiGeorge Syndrome, and when tissue from cephalic neural crest is ablated, conotruncal septation defects and thymic deficiency may result. We hypothesized that abnormalities in the formation, proliferation, or migration of cephalic neural crest cells might result in an association between craniofacial and conotruncal anomalies in CHARGE association. We tested this hypothesis by examining the types of cardiac defects among 34 previously published and 17 new CHARGE association patients with congenital heart disease. Conotruncal defects were present in 35% of these patients, versus an expected prevalence of 16-22% in large series of patients with congenital heart disease. These data suggest a possible pathogenetic link between certain craniofacial and cardiac defects that may involve the cephalic neural crest.