Predictors of colonization with Staphylococcus species among patients scheduled for cardiac and orthopedic interventions at tertiary care hospitals in north-eastern Germany-a prevalence screening study.

As methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in humans are a global challenge. In Mecklenburg and Western Pomerania (Germany) 1,517 patients who underwent surgical interventions were systematically screened for MRSA and MSSA colonization on the day of hospital admission and discharge. Demographic data, risk factors and colonization status of the (i) nose, (ii) throat, (iii) groin, and (iv) thorax or site of surgical intervention were determined. Of the 1,433 patients who were included for further evaluation, 331 (23.1%) were colonized with MSSA, while only 17 (1.2%) were MRSA carriers on the day of hospital admission. A combination of nose, throat and groin swabs returned a detection rate of 98.3% for MSSA/MRSA. Trauma patients had lower prevalence of MRSA/MSSA (OR 0.524, 95% CI: 0.37-0.75; p < 0.001) than patients with intended orthopedic interventions. Males showed significantly higher nasal S. aureus carrier rates than females (odds ratio (OR) = 1.478; 95% CI: 1.14-1.92; p = 0.003). Nasal S. aureus colonization was less frequent among male smokers as compared to non-smokers (chi2 = 16.801; phi = 0.154; p < 0.001). Age, gender and smoking had a significant influence on S. aureus colonization. Combining at least three different swabbing sites should be considered for standard screening procedure to determine S. aureus colonization at patients scheduled for cardiac or orthopedic interventions at tertiary care hospitals.

Population-based study of the incidence of congenital hip dysplasia in preterm infants from the Survey of Neonates in Pomerania (SNiP).

BACKGROUND: Some etiological factors involved in developmental dysplasia of the hip (DDH) occur in the last trimester of pregnancy, which could result in a decreased incidence of DDH in preterm infants. The aim of this study was to compare the incidence of DDH between preterm and term infants. METHODS: Ultrasound of the hip joint was performed in 2,534 term infants and 376 preterm infants within the population-based Survey of Neonates in Pomerania (SNiP) study. RESULTS: A total of 42 (1.66%) term infants had DDH (Graf type II c, 0.8%; type D, 0.3% left and 0.4% right; type III a, 0.2% left). Eighteen infants had bilateral findings. Hip dysplasia occurred more frequently in female neonates (32/1,182 vs. 10/1,302, p < 0.023; 95% CI 0.012-0.022, χ 2 test). A familial disposition for DDH was found in 169 (6.7%) term infants and 181 (7.1%) infants in the overall population. In preterm infants, dysplasia of the hip was found in only three late preterm infants with gestational age between 36 and 37 weeks (n = 97) and not in preterm infants <36 weeks gestational age (n = 279). Regression analysis revealed a narrowly significant association between gestational week of birth and DDH (relative risk = 1.17; 95% confidence interval 0.99-1.37; p = 0.065). CONCLUSION: Our study suggests that preterm infants <36 weeks gestational age have a decreased risk of DDH.

Subinternship in Radiology - A Practical Start to the Specialization?

Purpose: To identify factors influencing medical students to choose radiology in the four-month clinical elective in the final year of medical school following radiology subinternships. Materials and Methods: A subsample of medical students in a nationwide German online survey evaluated a subinternship in radiology (19 items). They were divided into four groups: Students who could imagine doing a clinical elective in radiology in the practical year based on their experiences during the subinternship ("yes, based on subinternship"), students who could not ("no, based on subinternship") and students who had made this decision prior to the subinternship ("yes, prior to subinternship" and "no, prior to subinternship"). Results: 94 medical students evaluated a radiology subinternship (54.4 % females). Based on their experiences during the subinternship, 54 students (57.4 %) intended to do a final year clinical elective in radiology, 39 of them (41.5 %) being encouraged by the subinternship. 40 (42.6 %) reported having a negative attitude towards a clinical elective in radiology, 16 of them (17.0 %) having made this decision based on their subinternship experience. Groups did not differ regarding gender (p = 0.396) and age (p = 0.853). Students motivated to do a final year clinical elective in radiology experienced excellent academic teaching (p = 0.001) and practical involvement (p = 0.003), achieved their learning goals more often (p = 0.001), were better integrated into the team (p = 0.001), and acquired more practical skills (p = 0.003). Overall satisfaction was higher in these groups (p = 0.001). Conclusion: Satisfaction with a radiology subinternship is crucial for motivating medical students to do a final year clinical elective in radiology. A structured subinternship and continuous mentoring should be targeted to keep students connected to radiology. Key Points: • Radiology subinternships influence further interest in the specialization.• The quality and structure of teaching critically influence student satisfaction.• Team integration and practical involvement positively affect the attitude towards a specialization. Citation Format: • Kasch R, Wirkner J, Hosten N et al. Subinternship in Radiology - A Practical Start to the Specialization? Fortschr Röntgenstr 2016; 188: 1024 - 1030.

Antimicrobial efficacy of preoperative skin antisepsis and clonal relationship to postantiseptic skin-and-wound flora in patients undergoing clean orthopedic surgery.

Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In phase two, the clonal relationship of strains was additionally analyzed. 18.0 % of the swab samples were positive for bacterial growth in the wound base, 24.5 % in the margin, and 27.3 % in the suture. Only 65.5 % of patients showed a 100 % reduction of the skin flora after antisepsis. The microbial spectrum in all postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus (MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further studies are needed in order to understand the origin of this flora to allow further reduction of SSI.

[Infections Associated with Treatment with Hirudo medicinalis - Report of Two Cases and Review of the Literature]. / Infektionen im Zusammenhang mit der Anwendung von Hirudo medicinalis - Zwei Fallberichte und Literaturübersicht.

Medicinal leeches are well-established for promoting venous drainage in transplants/flaps and analgesia in osteoarthritis. Although medicinal leeches are bred and kept under controlled conditions, they are colonised by a genuine species-specific bacterial flora. Therapeutic application of leeches implies skin penetration carrying an a priori risk of infection. We report 2 cases with different indications for medicinal leech therapy. In both cases wound infection occurred in close temporal and spatial correlation or with evidence of a leech-associated germ that could be treated successfully. An unclarified complication rate warrants strict indications for the application of medicinal leeches. Preventive measures are currently tested.

[Diagnosis and management of peripheral vascular injuries]. / Diagnostik und Management peripherer Gefäßverletzungen.

Peripheral vascular injuries are the cause of high morbidity in trauma patients. Up to 5 % of all patients with injuries of the extremities present with concomitant vascular lesions. While open peripheral vascular injuries are associated with a high mortality at the scene of the accident, closed vascular injuries present the danger of developing critical tissue ischemia with a high risk of amputation and limb loss. Early diagnosis is crucial in order to rapidly restore and maintain adequate blood flow and downstream tissue perfusion. A correct diagnosis and early treatment of peripheral vascular injuries place enormous demands on interdisciplinary teams consisting of emergency physicians, orthopedic surgeons, vascular surgeons, anesthesiologists and radiologists. The top priority in the context of emergency care is hemorrhage control by applying direct pressure and dressings until definitive surgical treatment. Hypovolemic shock, reperfusion injury and compartment syndrome are complications of peripheral vascular injuries that must be recognized and treated in the early stages.

[Significance and prevention of post-operative wound complications]. / Bedeutung und Prävention postoperativer Wundkomplikationen.

Although surgical site infections (SSI) in dermatologic operative procedures are extremely rare, it is important to understand risks and etiological factors to initiate risk assessment and specific preventive measures. SSI commonly are associated with a complicated, long-term and expensive outcome. Typical wound pathogens of these infections include a variety of multiresistant organisms along with Staphylococcus aureus, Staphylococcus epidermidis, hemolytic streptococci and the gram-negative bacilli Escherichia coli and Pseudomonas aeruginosa. Effective hygienic measures as part of an adequate quality management system should consider the critical points in the development of SSI, particularly in the setting of an outpatient dermatologic unit, such as preparation of the operative area, preoperative skin antisepsis, hand hygiene, safe and skilled technique by surgeons, and barrier nursing to prevent spread of pathogens. The baseline infection incidence in dermatologic surgery inherently is low; nevertheless significant improvements can be achieved by implementation of risk-adapted infection control measures.

[Antibiotic prophylaxis in dermatologic and soft tissue surgery]. / Perioperative Antibiotikaprophylaxe bei Haut- und Weichteileingriffen.

In Germany, over half a million operations are done in dermatologic surgery in a hospital setting every year, as well as a less well quantified number of procedures in private offices. In spite of this large number, specific guidelines concerning the use of perioperative antibiotics in dermatologic surgery are sparse. In contrast to procedures in general, visceral or gynecological surgery, general guidelines on perioperative antibiotics issued by the Paul-Ehrlich Institutes and the AWMF do not specifically consider dermatologic operations. Several surveys indicate that familiarity with current recommendations on perioperative antibiotics is suboptimal and resulted in a considerable overuse of perioperative antibiotics in dermatologic surgery. Given the increasing antimicrobial resistance among important pathogens and the inherent risks of antibiotic administration, the decision for the use of prophylactic antibiotics should be based on the individual risk profile of the patient and of the surgical procedure. In the following, we will critically discuss the evidence for perioperative antibiotics in dermatologic surgery.

[Humeral fracture due to arm wrestling - an indirect fracture in a doped athlete]. / Oberarmschaftfraktur beim Armdrücken - ein indirekter Bruch bei einem gedopten Sportler.

BACKGROUND: Humeral shaft fractures due to recreational arm wrestling are reported from time to time. CASE REPORT: We report the case of a 19 year old, anabolic steroids up taking, recreational arm wrestler who sustained a spiral fracture of the right humeral bone and secondary radial nerve palsy. We discuss the surgical treatment and the biomechanics of this rare injury mechanism. CONCLUSION: Every professional or recreational arm wrestler has to be aware of dangerous sports injuries.

[Open dislocation of the mobile bearing in a unicondylar knee arthroplasty. A rare complication]. / Offene Luxation der mobilen Plattform einer Schlittenprothese. Eine seltene Komplikation.

Unicompartmental knee arthroplasty can be viewed as a procedure with reliable medium- to long-term success. However, complications occur. To the authors' knowledge, this is the first report on an open dislocation of the tibial component (polyethylene plate) of a mobile bearing unicondylar knee prosthesis. Twelve days after a unicompartmental knee arthroplasty a 69-year-old patient suffered an open knee trauma due to a simple fall on the ground. The clinical examination showed wound dehiscence of the former mid-line approach, ventral dislocation of the polyethylene plate and a rupture of the anterior cruciate ligament. A pragmatic surgical treatment consisting of a jet lavage with saline solution, disinfection and relocation of the polyethylene plate and application of prophylactic antibiotics was performed. No peri- or postoperative complications were observed. The 6-month follow-up revealed a range of motion of 0-0-120° for extension-flexion and an isolated anterior instability. The patient was satisfied. This case report adds an uncommon and previously unpublished complication associated with unicompartmental knee arthroplasty. Surgical management in revision knee arthroplasty is challenging, although pragmatic approaches might be successful. Open dislocation of the bearing in a unicondylar knee prosthesis demands immediate revision. The manner of treatment depends on clinical findings and the surgeon's experience with arthroplasty.

[Pathologic fracture of the distal femur in total knee arthroplasty. Polyethylene-wear-induced osteolysis? A case report]. / Pathologische Fraktur des distalen Femurs bei Knie-TEP. Polyethylenabriebinduzierte Osteolyse? - ein Fallbericht.

Malignant bone tumors and osteitis of the distal femur are common at every age. These conditions must be considered in patients with total knee arthroplasty and suspicious x-rays. A patient with gross polyethylene-wear-induced osteolysis and periprosthetic fracture is described. Neoplasm and infectious granuloma were excluded through biopsy, and the bone defect was bridged with a rotating hinged distal femoral replacement.

[Osteofibrous dysplasia campanacci of the tibia. A 12-year follow-up]. / Osteofibröse Dysplasie Campanacci der Tibia : Ein 12-Jahres-Follow-up.

Pathologic fractures and deformities are common complications of osteofibrous dysplasia. This article concerns a rare tumor-like lesion primarily in the tibial diaphysis in young patients. The case is presented of a girl with stress fracture, distinct antecurvation, relapse, and refracture. Surgical treatment is difficult and requires resection and reconstruction. Despite the controversial indication, we recommend this method due to the disorder's putative relationship with malignant adamantinoma.

[Pseudarthrosis after fracture of the distal radius: a case report]. / Pseudarthrose nach distaler Radiusfraktur: Eine Fallbeschreibung.

We report on a seventy-year-old woman who developed a non-union of the distal radius with infection of the ulnocarpal joint after having sustained a fracture. The fistula, the distal ulna and the ulnocarpal joint were resected. Two months later we removed the non-union and carried out open reduction and internal fixation of the radius with a palmar plate. Good functional and cosmetic results were achieved.

Dinuclear titanium(IV) complexes from amino acid bridged dicatechol ligands: formation, structure, and conformational analysis.

Amino acid bridged dicatechol ligands 3a-e-H4 form dinuclear double-stranded coordination compounds [(3a-e)2Ti2(OCH3)2]2- with titanium(IV) ions. Due to the directionality of the ligands, the chirality of the strand, and the chiral complex units, up to seven isomers, I-VII, can be obtained for the double-stranded complexes of ligands 3a-e-H4. The composition of the mixture of isomeric compounds in solution is strongly dependent on the conditions of complex formation. Under thermodynamic control, only a few isomers are obtained, one of which is the major component of the mixture. X-ray structure analyses were performed for K2[(3b)2Ti2(OH)2] and K2[(3d)2Ti2(OH)2] (type I), and for the meso complex Na2[(3e)(3e')Ti2(OCH3)2]. A conformational analysis that uses Ramachandrans method revealed that the conformation of the amino acids in the ligand strands can be compared with those found for amino acids in helical peptide structures. The most favored isomer of [(3)2Ti2(OCH3)2]2- appears to be of type I, with the catecholamide unit located at the N terminus of the ligand strand that binds to a lambda-configurated titanium(IV) complex unit and the dihydroxybenzyl group at the C terminus that coordinates to a delta-configurated titanium(IV) complex unit. The lambda configuration at the N terminus induces the conformation of a right-handed helix in the amino acid residue, while the delta configuration induces the less favored left-handed helix.

Tissue printing of astroglial interlaminar processes from human and non-human primate cerebral cortex.

Astroglial interlaminar processes are unique features of the cerebral cortex of adult primates, including man. The functional role of these processes in the primate cerebral cortex is largely unknown. The development and standardization of procedures that could maximize the utilization of primate brain samples is required for the experimental analysis of the individual and collective dynamic properties of interlaminar glial processes. With this aim and in order to assess the relative stability of these glial processes in ex vivo conditions, "tissue printing" procedures were applied. "Tissue printing" allows for the acute transfer of cellular elements from fresh tissue onto an artificial substrate. Human, monkey (Cebus apella), and rat brain samples were subjected to "tissue printing" procedures followed by cell culture and immunohistochemistry. For the purpose of comparing the efficiency of this procedure on the transfer of other long glial processes, "tissue prints" of radial glial processes from neonatal rats and of Bergmann glia from cerebellar samples of adult rats were included. Nitrocellulose (with and without added fibronectin or laminin) produced the best attachment results. Interlaminar processes were not modified following 24-h incubation in a cell culture medium, with the addition of agents known to modify astroglial morphotypes in vitro (cyclic adenosine monophosphate, 40 mM K(+), or fetal calf serum). It is concluded that glia with interlaminar processes can be detached from fresh tissue using "tissue printing" procedures, can be maintained for at least 24 h in standard culture conditions, and showed a stable morphological phenotype.

Heterochronous maturation of regional brain astroglia: neuronal modulation of striatal glial cells differentiation ex vivo.

Subcultured astroglial cells from striatum, cerebral cortex and ventral mesencephalon obtained from primary cultures of fetal (E14, E17 and E21) or postnatal (days 5-6) rats showed different regional, age-dependent morphological response (stellation) to cyclic AMP. While most of the cerebral cortex and ventral mesencephalic astroglial cell population was responsive at all ages tested, striatal cells at E14 and E17 were not. At age E21 striatal astroglia showed a significant shift toward a mature-like type of response to cyclic AMP. Postnatal striatal astroglia responded to cyclic AMP as the cortical and ventral mesencephalic astroglia did, with generalized stellation. Prenatal striatal astroglia was characterized immunocytochemically as A2B5+, fibronectin+, vimentin+, S-100+ and GFAP-. Failure of early prenatal (E14, E17) striatal astroglia to differentiate in response to cyclic AMP, was overcome by previous (5-7 days) co-culture with primary cell dissociates from postnatal-, but not from prenatal donors, from all brain regions tested including a non-target region for striatal cells, such as septum. This effect was duplicated when striatal astroglia was co-cultured with cell populations enriched in neurons through Percoll gradients. Only cell-to-cell contact co-cultures were able to induce a change in the studied response. Dead neuron-enriched populations obtained following various types of physical treatments were also able to change significantly striatal cell response toward cyclic AMP. Enriched astroglial populations from postnatal donors did not change striatal astroglial response toward cyclic AMP, except for ventral mesencephalic astroglia which induced a comparatively reduced but significant increase in striatal cell responsiveness. It is concluded that astroglial maturation and potential for phenotype expression during brain development proceeds with regional heterochrony. Also, that maturation of prenatal striatal astroglia responsiveness toward cyclic AMP is inducible by non-diffusible factors, probably of neuronal origin, expressed in live or dead primary cultures from various, homotopic and heterotopic, postnatal brain regions. It is further suggested that striatal afferents and/or mature local striatal neurons express membrane associated molecules that regulate responsiveness for phenotype expression of striatal glial cells, thus reinforcing the concept of a highly interactive, continuous neuron-glial developmental process that takes place during brain organization.

Aportes al conocimiento de los procesos de organización y reorganización en el sistema Nervioso Central / An attempt to the knowledge of the organizative and re-organizative processes of the Central nervous System

El conjunto de proyectos desarrollados en PRUNA se basan en la implementación de diferentes enfoques con el objetivo global de estudiar y analizar procesos de organización y reorganización en el sistema nervioso central, así como la participación de componentes no neuronales en los mismos y su posible implementación terapéutica en los procesos de reorganización luego del daño cerebral. Se ilustran tales aspectos comparando las distintas líneas experimentales desarrolladas en PRUNA: la difusión de factores tróficos que actúan modificando el fenotipo de diferentes procesos celulares y la provisión de señales para su organización; la modulación de información neural a través de procesos autocrínicos y paracrínicos; la expresión de moléculas específicas de distintas regiones corticales en función de variaciones amientales; la modulación de la respuesta astroglial ante procesos de lesión y su modulación por parte de factores tróficos; la funcionalidad de la astroglUa como prótesis biológica a transplantar; y el hallaazgo, la expresión, caracterrización citoarquitectónica y funcionamiento postlesional de componentes astrogliales específicos de la corteza cerebral de los primates. En síntesis, la naturaleza hterogénea de los componentes y funciones astrogliales implica tenerlos en consideración obligada para cualquier estudio del SNC que contemple su desarrollo en condiciones normales y patológicas

Aportes al conocimiento de los procesos de organización y reorganización en el sistema Nervioso Central / An attempt to the knowledge of the organizative and re-organizative processes of the Central nervous System

El conjunto de proyectos desarrollados en PRUNA se basan en la implementación de diferentes enfoques con el objetivo global de estudiar y analizar procesos de organización y reorganización en el sistema nervioso central, así como la participación de componentes no neuronales en los mismos y su posible implementación terapéutica en los procesos de reorganización luego del daño cerebral. Se ilustran tales aspectos comparando las distintas líneas experimentales desarrolladas en PRUNA: la difusión de factores tróficos que actúan modificando el fenotipo de diferentes procesos celulares y la provisión de señales para su organización; la modulación de información neural a través de procesos autocrínicos y paracrínicos; la expresión de moléculas específicas de distintas regiones corticales en función de variaciones amientales; la modulación de la respuesta astroglial ante procesos de lesión y su modulación por parte de factores tróficos; la funcionalidad de la astroglUa como prótesis biológica a transplantar; y el hallaazgo, la expresión, caracterrización citoarquitectónica y funcionamiento postlesional de componentes astrogliales específicos de la corteza cerebral de los primates. En síntesis, la naturaleza hterogénea de los componentes y funciones astrogliales implica tenerlos en consideración obligada para cualquier estudio del SNC que contemple su desarrollo en condiciones normales y patológicas

Cerebrospinal fluid from L-dopa-treated Parkinson's disease patients is dystrophic for various neural cell types ex vivo: effects of astroglia.

Cerebrospinal fluid from L-dopa-treated Parkinson's disease patients and subjects without neurodegenerative diseases (controls) was explored in its trophic properties as culture medium on a variety of cells from neural origin. Primary cultures of regional brain dissociates from rat and Cebus apella monkey fetuses, immature rat adrenal chromaffin cells, phaeochromocytoma (PC12), and neuroblastoma (NB69) cell lines as well as subcultured fetal rat astroglia were used as target cells for 24- to 48-h culture periods. Most cerebrospinal fluid samples from L-dopa-treated patients had a general dystrophic effect. This phenomenon was more apparent on striatum and ventral mesencephalon than on cerebral cortex cell dissociates. The deleterious effect of these samples was abolished by previous exposure to fetal astroglial cells. Neuroblastoma cells showed no differential response when exposed to samples from control and L-dopa-treated patients. Phaeochromocytoma cells did not grow processes under any of the samples assayed in the time interval explored, but neither showed evidence of dystrophy. The relevance of these findings to the transplantation of different cell types as one of the possible therapies for Parkinson's disease is discussed. The suggestion is made that CSF testing prior to transplantation may aid in anticipating its possible outcome. Cotransplantation of neuronal cells with subcultured astroglia may foster survival and growth of the former cells.