Online optimal experimental re-design in robotic parallel fed-batch cultivation facilities.

We present an integrated framework for the online optimal experimental re-design applied to parallel nonlinear dynamic processes that aims to precisely estimate the parameter set of macro kinetic growth models with minimal experimental effort. This provides a systematic solution for rapid validation of a specific model to new strains, mutants, or products. In biosciences, this is especially important as model identification is a long and laborious process which is continuing to limit the use of mathematical modeling in this field. The strength of this approach is demonstrated by fitting a macro-kinetic differential equation model for Escherichia coli fed-batch processes after 6 h of cultivation. The system includes two fully-automated liquid handling robots; one containing eight mini-bioreactors and another used for automated at-line analyses, which allows for the immediate use of the available data in the modeling environment. As a result, the experiment can be continually re-designed while the cultivations are running using the information generated by periodical parameter estimations. The advantages of an online re-computation of the optimal experiment are proven by a 50-fold lower average coefficient of variation on the parameter estimates compared to the sequential method (4.83% instead of 235.86%). The success obtained in such a complex system is a further step towards a more efficient computer aided bioprocess development. Biotechnol. Bioeng. 2017;114: 610-619. © 2016 Wiley Periodicals, Inc.

Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

BACKGROUND: The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. METHODS: Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. RESULTS: The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable. CONCLUSIONS: This is the first detailed analysis of the hospital department's cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

A conceptual model of compensation/decompensation in lumbar segmental instability.

Lumbar spinal instability (LSI) is a common spinal disorder and can be associated with substantial disability. The concept of defining clinically relevant classifications of disease or 'target condition' is used in diagnostic research. Applying this concept to LSI we hypothesize that a set of clinical and radiological criteria can be developed to identify patients with this target condition who are at high risk of 'irreversible' decompensated LSI for whom surgery becomes the treatment of choice. In LSI, structural deterioration of the lumbar disc initiates a degenerative cascade of segmental instability. Over time, radiographic signs become visible: traction spurs, facet joint degeneration, misalignment, stenosis, olisthesis and de novo scoliosis. Ligaments, joint capsules, local and distant musculature are the functional elements of the lumbar motion segment. Influenced by non-functional factors, these functional elements allow a compensation of degeneration of the motion segment. Compensation may happen on each step of the degenerative cascade but cannot reverse it. However, compensation of LSI may lead to an alleviation or resolution of clinical symptoms. In return, the target condition of decompensation of LSI may cause the new occurrence of symptoms and pain. Functional compensation and decompensation are subject to numerous factors that can change which makes estimation of an individual's long-term prognosis difficult. Compensation and decompensation may influence radiographic signs of degeneration, e.g. the degree of misalignment and segmental angulation caused by LSI is influenced by the tonus of the local musculature. This conceptual model of compensation/decompensation may help solve the debate on functional and psychosocial factors that influence low back pain and to establish a new definition of non-specific low back pain. Individual differences of identical structural disorders could be explained by compensated or decompensated LSI leading to changes in clinical symptoms and pain. Future spine surgery will have to carefully define and measure functional aspects of LSI, e.g. to identify a point of no return where multidisciplinary interventions do not allow a re-compensation and surgery becomes the treatment of choice.

Identification of prognostic factors for chronicity in patients with low back pain: a review of screening instruments.

Low back pain (LBP) is currently the most prevalent and costly musculoskeletal problem in modern societies. Screening instruments for the identification of prognostic factors in LBP may help to identify patients with an unfavourable outcome. In this systematic review screening instruments published between 1970 and 2007 were identified by a literature search. Nine different instruments were analysed and their different items grouped into ten structures. Finally, the predictive effectiveness of these structures was examined for the dependent variables including "work status", "functional limitation", and "pain". The strongest predictors for "work status" were psychosocial and occupational structures, whereas for "functional limitation" and "pain" psychological structures were dominating. Psychological and occupational factors show a high reliability for the prognosis of patients with LBP. Screening instruments for the identification of prognostic factors in patients with LBP should include these factors as a minimum core set.

[Titanium arthroplasty toe fit plus for the hallux metatarsophalangeal joint]. / Mittelfristige Ergebnisse der ToeFit-Grosszehengrundgelenksendoprothese.

AIM: This prospective report evaluates the clinical outcome of titanium arthroplasty in the management of hallux metatarsophalangeal joints. PATIENTS AND METHODS: Eigthy joints in 78 patients were treated surgically with the titanium implant for hallux metatarsophalangeal joints between January 2000 and April 2007. There were 56 women and 22 men. The mean age was 58 (range: 34 - 80) years, and the mean follow-up was 56 (range: 6 - 87) months. The pathological indications were hallux rigidus (85.5 %), metatarsalhead necrosis (8.5 %), revision of Keller-Brandes (3.6 %) and 2 cases were done as a revision of silastic to titanium prosthesis and a revision of pseudarthrosis after arthrodesis (2.4 %). The patients were subsequently examined by means of clinical and radiological assessments. The clinical function was classified using the score of Kitaoka et al. RESULTS: The mean time taken to get back to normal activities is 35.2 (range: 21 - 76) days. The average Kitaoka score improved to 75 points (p < 0.05) at 3 months postoperatively and to 85 points (p < 0.05) at 6 months postoperatively. The mean range of motion achieved was 38.6 degrees (range ex 21.5 degrees /flex 17.1 degrees ). CONCLUSION: The clinical results of titanium arthroplasty were good. The advantages of this procedure are preservation of joint movement and good pain relief with an early mobilisation.

Control of methionine biosynthesis genes by protein kinase CK2-mediated phosphorylation of Cdc34.

Methionine and metabolites such as S-adenosylmethionine (AdoMet) are of vital importance for eukaryotes; AdoMet is the main donor of methyl groups and is involved in expression control of the methionine biosynthesis genes (MET genes). Genome-wide expression profiling of protein kinase CK2 deletion strains of the budding yeast Saccharomyces cerevisiae has indicated a function for CK2 in MET gene control. Deletion of the regulatory CK2 subunits leads to MET gene repression, presumably due to an impaired phosphorylation of the ubiquitin-conjugating enzyme Cdc34, which controls the central MET gene transcription factor Met4. We show that CK2 phosphorylates Cdc34 at two sites and one of these, Ser282, has a significant impact on MET gene expression in vivo, and that high AdoMet levels inhibit CK2. The data provide evidence for a control of MET gene expression by protein kinase CK2-mediated phosphorylation of Cdc34, and appear to suggest a feedback control loop in which high AdoMet-levels are limiting CK2 activity and thus MET gene expression.