Contrasting terrestrial and marine ecospace dynamics after the end-Triassic mass extinction event.

Mass extinctions have fundamentally altered the structure of the biosphere throughout Earth's history. The ecological severity of mass extinctions is well studied in marine ecosystems by categorizing marine taxa into functional groups based on 'ecospace' approaches, but the ecological response of terrestrial ecosystems to mass extinctions is less well understood due to the lack of a comparable methodology. Here, we present a new terrestrial ecospace framework that categorizes fauna into functional groups as defined by tiering, motility and feeding traits. We applied the new terrestrial and traditional marine ecospace analyses to data from the Paleobiology Database across the end-Triassic mass extinction-a time of catastrophic global warming-to compare changes between the marine and terrestrial biospheres. We found that terrestrial functional groups experienced higher extinction severity, that taxonomic and functional richness are more tightly coupled in the terrestrial, and that the terrestrial realm continued to experience high ecological dissimilarity in the wake of the extinction. Although signals of extinction severity and ecological turnover are sensitive to the quality of the terrestrial fossil record, our findings suggest greater ecological pressure from the end-Triassic mass extinction on terrestrial ecosystems than marine ecosystems, contributing to more prolonged terrestrial ecological flux.

Femoral defects in revision hip arthroplasty: a therapy-oriented classification.

INTRODUCTION: The complex field of femoral defects in revision hip arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment. To address this issue, the femoral defect classification (FDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline. MATERIALS AND METHODS: The FDC is based on the integrity of the main femoral segments which determine function and structural support. It focuses on the femoral neck, the metaphysis consisting of the greater and lesser trochanter, and the femoral diaphysis. The four main categories determine the location of the defect while subcategories a, b and c are being used to classify the extent of damage in each location. In total, 218 preoperative radiographs were retrospectively graded according to FDC and compared to intraoperatively encountered bone defects. To account for inter-rater and intra-rater agreement, 5 different observers evaluated 80 randomized cases at different points in time. RESULTS: A Cohens kappa of 0.832 ± 0.028 could be evaluated, accounting for excellent agreement between preoperative radiographs and intraoperative findings. To account for inter-rater reliability, 80 patients have been evaluated by 5 different observers. Testing for inter-rater reliability, a Fleiss Kappa of 0.688 could be evaluated falling into the good agreement range. When testing for intra-rater reliability, Cohens Kappa of each of the 5 raters has been analyzed and the mean was evaluated at 0.856 accounting for excellent agreement. CONCLUSION: The FDC is a reliable and reproducible classification system. It combines intuitive use and structured design and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm has been created according to current literature and expert opinion. Due to the combination of the FDC with the recently introduced Acetabular Defect Classification (ADC) a structured approach to the entire field of hip revision arthroplasty is now available.

Making an art into a science: a mathematical "Likert tool" can change PI-RADS (v2) scores into Likert scores when reporting multiparametric MRI for prostate cancer.

BACKGROUND: When reporting multiparametric magnetic resonance imaging (mpMRI) for prostate cancer, UK national guidelines recommend allocating both Likert and PI-RAD scores. Likert scores have been shown to better predict clinically significant cancer (csPCa) but are subjective and lack standardization. PURPOSE: To compare differences in outcomes between the scoring systems and create a mathematical tool that can help to objectively allocate Likert scores. MATERIAL AND METHODS: A total of 791 patients referred with query prostate cancer between 2017 and 2019 were prospectively allocated PI-RADS and Likert scores by a single experienced reporter. Histology results were used to compare the predictive accuracy of both scoring systems. A "Likert tool" was created based on a logistic regression of features found to be predictors of csPCa in a cohort of 2018-2019 patients (n = 411). Its performance was evaluated. RESULTS: Assuming a policy whereby patients with a PI-RADS/Likert score of ≥3 are biopsied, Likert scoring (sensitivity 0.92, specificity 0.77) would have resulted in 107 fewer biopsies and 20.3% higher cancer yields than the PI-RADS score (sensitivity 0.99, specificity 0.43). Thirteen patients would have avoided over-diagnosis of clinically insignificant prostate cancer (iPCa). Similar outcomes (111 fewer biopsies, 22.3% increase in cancer yield, iPCa diagnosis avoided in 16 patients) could be seen when the "Likert tool" was applied to the same patient cohort (sensitivity 0.93, specificity 0.79) and to a separate cohort (n = 380). CONCLUSION: PI-RADS and Likert scores are different. A "Likert tool" could reduce inter-reporter variability, decrease the number of patients unnecessarily biopsied, increase csPCa yield, and decrease over-diagnosis of iPCa.

Cartilage Regeneration with a Cell-free Collagen Type 1 Matrix (Part 2 - Experimental Aspects). / Knorpelregeneration mittels zellfreier Kollagen-Typ-I-Matrix ­ Vergangenheit, Gegenwart und Zukunft (Teil 2 ­ experimentelle Aspekte).

Cartilage regeneration with cell-free matrices has developed from matrix-associated autologous cartilage cell transplantation (MACT) over ten years ago. Adjustments to the legal framework and higher hurdles for cell therapy have led to the procedures being established as an independent alternative to MACT. These procedures, which can be classified as matrix-induced autologous cartilage regeneration (MACR), all rely on the chemotactic stimulus of a cross-linked matrix, which mostly consists of collagens. Given the example of a commercially available type I collagen hydrogel, the physicochemical properties of such a matrix are explained and the available experimental data highlighted in more detail. The interaction between different cell types and the chemotactic properties of the collagen has been investigated extensively and, from a clinical point of view, today offers various reference points for a smart modification of the described method to further improve clinical outcomes. Since the origin of the cells in the ultimately formed repair tissue is still unrevealed, further investigations to clarify the exact mechanism are crucially needed.

Cartilage Regeneration with Cell-free Type 1 Collagen Matrix - Past, Present and Future (Part 1 - Clinical Aspects). / Knorpelregeneration mittels zellfreier Kollagen-Typ-I-Matrix ­ Vergangenheit, Gegenwart und Zukunft (Teil 1 ­ klinische Aspekte).

Cartilage regeneration with cell-free matrices has developed from matrix-associated autologous cartilage cell transplantation (MACT) over ten years ago. Adjustments to the legal framework and higher hurdles for cell therapy have led to the procedures being established as an independent alternative to MACT. These procedures, which can be classified as matrix-induced autologous cartilage regeneration (MACR), all rely on the chemotactic stimulus of a cross-linked matrix, which mostly consists of collagens. Given the example of a commercially available type I collagen hydrogel, the state of clinical experience with MACR shall be summarized and an outlook on the development of the method shall be provided. It has been demonstrated in the clinical case series summarized here over the past few years that the use of the matrix is not only safe but also yields good clinical-functional and MR-tomographic results for both small (~ 10 mm) and large (> 10 mm) focal cartilage lesions. Depending on the size of the defect, MACR with a collagen type I matrix plays an important role as an alternative treatment method, in direct competition with both: microfracture and MACT.

Acetabular defects in revision hip arthroplasty: a therapy-oriented classification.

INTRODUCTION: The treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects. METHODS: The proposed Acetabular Defect Classification (ADC) is based on the integrity of the acetabular rim and supporting structures. It consists of 4 main types of defects ascending in severity and subdivisions narrowing down-defect location. Type 1 presents an intact acetabular rim, type 2 includes a noncontained defect of the acetabular rim ≤ 10 mm, in type 3 the rim defect exceeds 10 mm and type 4 includes different kinds of pelvic discontinuity. A collective of 207 preoperative radiographs were graded according to ADC and correlated with intraoperative findings. Additionally, a randomized sample of 80 patients was graded according to ADC by 5 observers to account for inter- and intra-rater reliability. RESULTS: We evaluated the agreement of preoperative, radiographic grading and intraoperative findings presenting with a k value of 0.74. Interobserver agreement presented with a k value of 0.62 and intraobserver at a k value of 0.78. CONCLUSION: The ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice.

Who profits from three-dimensional optics in endoscopic surgery? Analysis of manual tasks under two-dimensional/three-dimensional optic vision using a pelvic trainer model.

Background: In endoscopic operations, direct binocular view, tissue sensation and depth perception get lost. It is still unclear whether the novel three-dimensional (3D) high-definition (HD) cameras are able to compensate the limited senses and how this affects the skill set of users with different endoscopic experience. This study aimed first to evaluate if the 3D technology improves depth perception, precision and space orientation as compared to conventional two-dimensional (2D) HD technology. The second aim was to determine the 3D influence on participants with different endoscopic experience. Methods: A total of 24 participants of different experience levels performed three different tasks on a pelvic trainer using the same thoracoscopic unit in 2D and 3D modes. Results were statistically analysed using Student's t-test and Pearson's product-moment correlation. Results: Across all the participants, we found that 3D optic vision significantly reduced the needed time to perform a defined difficult task in comparison to 2D. This difference was less pronounced in participants with higher experience level. Participants with eyeglasses performed slower in both 2D and 3D in comparison to participants with normal vision. Only participants with normal vision could significantly improve their completion times with 3D optic vision. Conclusions: By testing the novel generation of 3D HD cameras, we could demonstrate that the 3D optic of these systems improves depth perception and space orientation for novices and experienced users and especially inexperienced users benefit from 3D optic.

3-D Optics for Thoracoscopic Vertebral Body Replacement - Essential Technical Progress or Just Nice to Have? / Die dreidimensionale Optik für den thorakoskopischen ventralen Wirbelkörperersatz ­ notwendiger Fortschritt oder nur "nice to have"?

BACKGROUND: Three-dimensional (3-D) endoscopic optics use 2 cameras to simulate the different perspectives of the right and left eye, creating the illusion of spatial depth. Optimised orientation as well as improved hand-eye coordination compared to 2-D-optics could be proven in standardised test setups (black box) and in laparoscopic use. This retrospective study examines whether these results can also be applied to thoracoscopic vertebral body replacement at the thoracolumbar junction. HYPOTHESES: 1. Ventral vertebral body replacement using 3-D-thoracoscopy results in a shorter operation time than with 2-D-thoracoscopy. 2. Perioperative blood loss is less, due to better spatial orientation (faster haemostasis) and reduced tissue laceration. MATERIAL AND METHODS: 29 patients met the inclusion criteria of this retrospective study. Between 08 - 2012 and 08 - 2017, all of these received ventral thoracoscopic vertebral replacement at the thoracolumbar junction (Th11 to L2). Patients with additional anterior procedures (e.g. anterolateral plate) were excluded. Perioperative data such as blood loss, duration of surgery and length of hospital stay were analysed. Conventional 2-D-optics were used in n = 14 patients and 3-D-optics in 15 patients. Aesculap EinsteinVision® 2.0 was used as the 3-D-optics. Statistical significance was calculated using Student's t-test. RESULTS: The most common diagnosis was a L1 fracture (n = 18, 62%). Mean OR time was 24 minutes shorter in the 3-D group (149 ± 29, 107 - 198 min) than in the 2-D group (173 ± 39, 125 - 260 min), but this difference was not significant. Total perioperative blood loss in the 3-D group was significantly lower than in the 2-D group (**p = 0.043). Proportional intraoperative blood loss in the 3-D group was also lower (mean around 115 ml), but not significantly so. Significantly lower values were found for the delivery rate of the thoracic drainage in the 3-D group (248 vs. 560 ml, *p = 0.195). Inpatient stay with the 3-D group was on average 1.5 days (d) shorter (8.7 d for the 3-D group, 10.2 d for the 2-D group) but this difference was not significant (p = 0.27). CONCLUSION: Thoracoscopic-assisted vertebral body replacement at the thoracolumbar junction is a safe and reliable surgical procedure using conventional 2-D-optics or the new 3-D-optics. Both methods allow thoracoscopic vertebral body replacement in comparable operation times but in our study the 3-D group presented with significantly lower postoperative blood loss. Due to the small number of cases and because of the retrospective design, the present study is considered to be a pilot study only.

Heterotopic Ossification - Complication or Chance? / Heterotope Ossifikation ­ Komplikation oder Chance?

So far, there has been no clear explanation of the pathophysiological relationships in the development of HO. There is little experimental data dealing with the post-traumatic inflammatory response in terms of a balance between the repair of damaged muscle cells and the opposite response in its development. There are numerous indications regarding possible predisposing factors, such as existence of surrounding tissue hypoxia or the function of pro-angiogenic (VEGF e.g.) and osteoinductive (BMP e.g.) factors. These different scientific approaches offer the opportunity to clinically intervene. In our opinion, early intervention seems to make the most sense in terms of effectiveness and recurrence of HO. An important pathomechanism seems to be chronic inflammation. Currently, non-steroidal anti-inflammatory drugs are the most commonly prescribed prophylaxis drugs. The effectiveness and efficacy of non-steroidal anti-inflammatory drugs is limited by the time-limited release and the side effect potential. Therefore, it is interesting to focus future research towards the cross-talks between immunosuppressive downregulation of the inflammatory response and its effect on the balance between muscle regeneration and the development of HO.

Acinic cell carcinoma of the parotid gland in pregnancy: an approach to cancer in pregnancy.

A 27-year-old woman presented with an enlarging painless right preauricular mass at 28 weeks' pregnant. The mass had been stable for more than 10 years, but showed rapid growth during pregnancy. Imaging and biopsy were consistent with parotid gland malignancy, with surgical resection undertaken at 33+4 weeks' gestation. Histopathology confirmed acinic cell carcinoma. Labour was induced without complication at 36+6 weeks' gestation and adjuvant radiotherapy commenced 2 weeks postpartum. At 9 months follow-up, both mother and baby were well, with no signs of disease recurrence. Rapid progression in pregnancy, of a previously stable salivary gland mass, is a common feature among reported cases and was also observed in the current case. This suggests an aetiological link between pregnancy and salivary gland tumour progression. We demonstrate successful management of a parotid gland malignancy in pregnancy and review guiding principles for cancer management in pregnancy.

[Basic Clinical Examination of the Shoulder]. / Klinische Basisuntersuchung der Schulter.

OBJECTIVE: Successful treatment of shoulder disease requires an accurate diagnosis. In addition to differentiated history taking, clinical examination is the most important component in the diagnosis of shoulder diseases. METHOD: The present video explains the common provocation tests and functional tests that are used in the basic clinical examination of the shoulder. In addition to general inspection and palpation, the focus is on different diagnostic tests and clinical signs that improve diagnostic accuracy. CONCLUSION: The present basic clinical examination methods allow a structured approach to clinical issues and can be a good basis, if supplemented by further specific and individual tests.

[A Novel Technique for the Preparation of a 3- or 5-Stranded Hamstring Graft for Individualised Single-Bundle ACL or PCL Reconstruction]. / Neuartige Technik zur Präparation eines 3- oder 5-strängigen Hamstring-Transplantats für die individualisierte Single-Bundle-VKB- oder -HKB-Rekonstruktion.

Objective Development of a preparation technique for hamstring tendons to ensure a maximum of intraoperative flexibility during individualised cruciate ligament surgery. Indications Primary ACL- and PCL-reconstruction as well as cases of later revision. Method Three- or five-stranded grafts can be obtained with the use of semitendinosus and gracilis tendons with fiber tape enforcement and use of a conventional femoral cortical suspensory fixation device. Fibre tape and knotting style ensure free motion of the continous loop. Through its simplicity, the technique offers the highest grade of intraoperative scalability.

[Diagnosis of Patients with Painful Sacroiliac Joint Syndrome]. / Moderne Diagnostik und minimalinvasive Operationsmethoden bei Patienten mit schmerzhaftem Iliosakralgelenksyndrom.

Pain coming from the sacroiliac (SI) joints can explain up to 25% of all chronic low back pain. A careful differential diagnosis is required to avoid misdiagnosis of low back pain. In addition to historical findings, positive findings on physical examination maneuvers that stress the SI joint are a key component diagnosis. The SI joint is confirmed as a pain generator when intraarticular injection of local anaesthetics provides acute back pain relief. Minimally invasive SI joint fusion is clearly superior to invasive open surgical procedures, with decreased blood loss and tissue disruption, shorter procedure times and shorter hospital stays. Especially well documented are the results of minimally invasive SI joint fusion using iFuse Implant System®. The device's triangular profile, combined with a titanium plasma spray coating, ensures both an immediate and long-lasting joint stabilization.

An interatrial tunnel: a rare form of atrial septal defects.

Atrial septal defects (ASDs) account for approximately 6%-10% of congenital heart defects. The well-known types of atrial septal communications are the ostium secundum, ostium primum, sinus venosus types, and coronary sinus defects. A 50-year-old female was referred for TEE for better assessment of MR severity and mechanism. 2D/3D-TEE showed a rare combination of different abnormalities; bi-leaflet mitral valve prolapse, cleft P2, cor triatriatum sinister, and a tunnel-shaped IAS communication. To the best of our knowledge, this is a very rare case with a rare form of atrial septal defect that was not described before. We named this defect an interatrial tunnel.

CANHEART: Is HDL cholesterol a cardiovascular specific risk factor?

Initial observational studies have identified high-density lipoprotein cholesterol (HDL-C) as an independent predictor of cardiovascular (CV) risk, even in patients on optimal statin therapy. However, the notion that higher HDL-C is better, has been seriously challenged by the results from several recent clinical and genetic trials. Data from the CANHEART study serve to clarify the relation between HDL-C and cause-specific mortality. Individuals with lower HDL-C levels were independently associated with higher risk of CV, cancer, and non-CV/non-cancer mortality compared with individuals in the reference ranges of HDL-C levels. Given the similarities in associations between HDL-C and CV as swell as non-CV outcomes, it is likely that HDL-C level serve as a marker of risk rather than a causal CV specific risk factor.

Portal biliopathy: multidisciplinary management and outcomes of treatment.

INTRODUCTION: Portal biliopathy (PB) is a rare condition in which portal hypertension because of extrahepatic portal vein obstruction can lead to biliary abnormalities, with some patients developing obstructive jaundice. At present, there is no international consensus on the management of PB. We present the experience of an Australian tertiary referral hospital with the diagnosis and management of PB, and compare this with reported international experience. METHODS: The records of nine patients presenting with PB between June 2003 and March 2012 were reviewed and analysed. RESULTS: All patients had portal hypertension because of portal vein thrombosis, with seven patients showing cavernous transformation of the portal vein. Biliary abnormality presented with jaundice (3/9), abdominal pain (2/9) or without symptoms (3/9). All patients developed a cholestatic pattern of liver function tests (LFTs). First-line endoscopic management was employed in 7 of 8 symptomatic patients. Four patients required endoscopic management alone (sphincterotomy alone (1/9), single stent (2/9), repeated stent changes (1/9) ), while four required second-line surgical intervention (portosystemic shunt (1/9), bilioenteric anastomosis (3/9) ). All patients were well, with stable LFTs, at median 18-month follow-up, with two patients undergoing regular stent changes, and the remainder requiring no further intervention. CONCLUSION: PB can be managed successfully with endoscopic therapy as the first-line option, but a multidisciplinary approach is necessary, with second-line surgical intervention often required. We recommend a management algorithm similar to that presented in the UK PB literature, and confirm that bilioenteric anastomosis can be performed successfully without prior portal decompression.