[Development of the inpatient quality of care of surgically treated patients with a proximal femoral fracture in North Rhine-Westphalia : Analysis of 61,249 treatment courses based on data from external inpatient quality assurance]. / Entwicklung der stationären Versorgungsqualität operativ behandelter Patienten mit einer proximalen Femurfraktur in Nordrhein-Westfalen : Eine Analyse über 61.249 Behandlungsverläufe auf Grundlage der Daten der externen stationären Qualitätssicherung.

BACKGROUND AND OBJECTIVE: Every year in Germany over 100,000 people, mostly of older age, suffer a proximal femoral fracture. Increasing case numbers in connection with an aging population and a relatively large number of concomitant diseases requiring treatment make everyday care more difficult. It is therefore of great importance to observe the quality of care for these patients using relevant quality parameters in order to be able to derive implications for everyday treatment practice. MATERIAL AND METHODS: The data of the external inpatient quality assurance from North Rhine-Westphalia for the years 2007-2008 and 2017-2018 were analyzed and the time periods compared. In addition, based on the documented secondary diagnosis and other influencing parameters, a risk adjustment was carried out with the aid of a logistic regression model with respect to the outcomes of general and surgical complications and mortality. Both osteosynthetically and endoprosthetically treated patients were taken into account. A total of 61,249 cases were included in the study. RESULTS: Positive developments could be observed in the area of surgical complications and wound infections with decreases of 1.2% and 0.8%, respectively. Patients with cardiovascular diseases had a particularly poor outcome. Here, improvements in the subcategory of cardiovascular events were found for general complications. The mortality remained unchanged at 6%. Operative activity on the weekends increased significantly. Patients whose hospital admission was related to the weekend did not show an increased risk of complications or mortality. Although the proportion of patients who were operated on after more than 48 h was reduced from 11.4% to 8.2%, the operation (> 24 h) was still delayed in 26.8% of cases. CONCLUSION: Against the background of increasing performance demands on the healthcare system, the results document improvements in some central areas of inpatient treatment. Nevertheless, the development of strategies for the further reduction of the preoperative waiting times in a medically justifiable manner is required. Internal concomitant diseases have a decisive influence on patient outcome. Thus, an adequate treatment of the multimorbid patient collective is to be established in everyday practice on the basis of close cooperation between geriatric traumatology and geriatric internal medicine departments.

Pattern formation in the zebrafish retina.

During the past 15 years, the zebrafish has become established as a genetic model organism to study vertebrate development. It is particularly well suited for the analysis of the retina, and several genetic screens have yielded a large number of mutants affecting retinal development. Most of these mutants still await thorough analysis and molecular characterization, but work on a handful of genes has already generated interesting results that shed some light on patterning mechanisms employed in the vertebrate retina.

Patterning of the zebrafish retina by a wave of sonic hedgehog activity.

The Drosophila retina is patterned by a morphogenetic wave driven by the Hedgehog signaling protein. Hedgehog, secreted by the first neurons, induces neuronal differentiation and hedgehog expression in nearby uncommitted cells, thereby propagating the wave. Evidence is presented here that the zebrafish Hedgehog homolog, Sonic Hedgehog, is also expressed in the first retinal neurons, and that Sonic Hedgehog drives a wave of neurogenesis across the retina, strikingly similar to the wave in Drosophila. The conservation of this patterning mechanism is unexpected, given the highly divergent structures of vertebrate and invertebrate eyes, and supports a common evolutionary origin of the animal visual system.

Transient establishment of anteroposterior polarity in the zebrafish pectoral fin bud in the absence of sonic hedgehog activity.

Sonic hedgehog (Shh) is expressed in the posterior vertebrate limb bud mesenchyme and directs anteroposterior patterning and growth during limb development. Here we report an analysis of the pectoral fin phenotype of zebrafish sonic you mutants, which disrupt the shh gene. We show that Shh is required for the establishment of some aspects of anteroposterior polarity, while other aspects of anteroposterior polarity are established independently of Shh, and only later come to depend on Shh for their maintenance. We also demonstrate that Shh is required for the activation of posterior HoxD genes by retinoic acid. Finally, we show that Shh is required for normal development of the apical ectodermal fold, for growth of the fin bud, and for formation of the fin endoskeleton.

Boundary formation in Drosophila wing: Notch activity attenuated by the POU protein Nubbin.

Cell interactions mediated by Notch-family receptors have been implicated in the specification of tissue boundaries in vertebrate and insect development. Although Notch ligands are often widely expressed, tightly localized activation of Notch is critical for the formation of sharp boundaries. Evidence is presented here that the POU domain protein Nubbin contributes to the formation of a sharp dorsoventral boundary in the Drosophila wing. Nubbin represses Notch-dependent target genes and sets a threshold for Notch activity that defines the spatial domain of boundary-specific gene expression.

Long-range action of Wingless organizes the dorsal-ventral axis of the Drosophila wing.

Short-range interaction between dorsal and ventral (D and V) cells establishes an organizing center at the DV compartment boundary that controls growth and specifies cell fate along the dorsal-ventral axis of the Drosophila wing. The secreted signaling molecule Wingless (Wg) is expressed by cells at the DV compartment boundary and has been implicated in mediating its long-range patterning activities. Here we show that Wg acts directly, at long range, to define the expression domains of its target genes, Distal-less and vestigial. Expression of the Achaete-scute genes, Distal-less and vestigial at different distances from the DV boundary is controlled by Wg in a concentration-dependent manner. We propose that Wg acts as a morphogen in patterning the D/V axis of the wing.

A hierarchy of cross-regulation involving Notch, wingless, vestigial and cut organizes the dorsal/ventral axis of the Drosophila wing.

Short-range interaction between dorsal and ventral cells establishes an organizing center at the dorsal/ventral compartment boundary that controls growth and patterning of the wing. We report here that the dorsal/ventral organiser is built though a hierarchy of regulatory interactions involving the Notch and wingless signal transduction pathways and the vestigial gene. wingless and vestigial are activated in cells adjacent to the dorsal/ventral boundary by a Notch-dependent signal. vestigial is initially expressed under control of an early dorsal/ventral boundary enhancer that does not depend on wingless activity. Similarly, activation of wingless does not require vestigial function, showing that wingless and vestigial are parallel targets of the Notch pathway. Subsequently, vestigial is expressed in a broad domain that fills the wing pouch. This second phase of vestigial expression depends on Wingless function in cells at the dorsal/ventral boundary. In addition, the Notch and Wingless pathways act synergistically to regulate expression of cut in cells at the dorsal/ventral boundary. Thus Wingless can act locally, in combination with Notch, to specify cell fates, as well as at a distance to control vestigial expression. These results suggest that secreted Wingless protein mediates both long-range and short-range patterning activities of the dorsal/ventral boundary.

Distinct mitogenic and cell fate specification functions of wingless in different regions of the wing.

Patterning and proliferation are coordinately controlled in the development of Drosophila imaginal discs. Localized expression of decapentaplegic (dpp) at the anterior-posterior and wingless (wg) at the dorsal-ventral compartment boundaries controls growth of the wing with respect to the A/P and D/V axes. The growth-promoting effects of these organizers are thought to be indirect, since growth is dispersed throughout the disc, and is not localized near the sources of wg or dpp. wg has also been implicated in proximal-distal patterning of the wing hinge. In this report, we present evidence that wg is principally required for local cell proliferation in the hinge. Loss of wg expression leads to a local reduction in cell division, resulting in the deletion of a distinct set of wing hinge structures. Ectopic activation of the wg pathway in cells of the wing hinge leads to overproliferation without repatterning, indicating that wg acts as a mitogen in this part of the disc. By contrast, overexpression of wg in the wing blade leads to repatterning and only secondarily to proliferation. These results suggest that the Wg signal elicits very different responses in different regions of the wing imaginal disc.

Sternopleural is a regulatory mutation of wingless with both dominant and recessive effects on larval development of Drosophila melanogaster.

The Drosophila wingless (wg) gene encodes a secreted signaling protein that is required for many separate patterning events in both embryonic and larval development. wg functions in the development of the adult structures have been studied using the conditional mutant wgts and also using regulatory mutations of wg that reduce larval functions. Here we present evidence that Sternopleural (Sp) is another regulatory allele of wg that affects a subset of larval functions. Sp has both a recessive loss-of-function component and a gain-of-function component. The loss-of-function component reflects a reduction of wg activity in the notum and in the antenna. The gain-of-function component apparently leads to ectopic wg activity in the dorsal first and second leg disc and thereby generates the dominant Sp phenotype. Sp and other wg alleles show a complex pattern of complementation. We present evidence that these genetic properties are due to transvection. These results have implications for the genetic definition of a null allele at loci subject to transvection.