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Finger joint arthrosis frequently results from trauma, degenerative or inflammatory causes. When conservative treatment and joint-preserving procedures fail, arthrodesis remains a reliable surgical option to relieve pain and restore hand function. Among the various techniques, the cup and cone method has proven particularly effective due to its large cartilage-free surface area and ease of intraoperative axis correction. The aim of this study is to evaluate this based on the patient cohort of a supramaximum care provider. A retrospective analysis of 201 finger joint arthrodeses in 168 patients was conducted between 2015 and 2025. Data collected included demographics, joint location, surgical indications and postoperative complications. A subgroup analysis of arthrodesis performed for degenerative osteoarthritis included comparison of preoperative and postoperative axis deviation and flexion angles per joint type. Patients had a mean age of 60 years and 71% were male. The right hand was affected in 54% of cases. Most arthrodeses involved proximal interphalangeal (PIP) joints (104), followed by distal interphalangeal (DIP, 65) and thumb IP joints (16). The leading indication was posttraumatic arthritis (48%), followed by degeneration (20%). Complication rates were low, with infection being the most common. In degenerative osteoarthritis cases, significant postoperative reductions in axis deviation were observed (up to 25°). Arthrodesis of the finger joints is an effective measure for improving function and relieving symptoms in treatment-refractory cases. The cup and cone technique has proven to be a procedure with a high success rate and a low complication rate. Individual planning of joint positioning and careful selection of the surgical technique are crucial for the functional outcome. Future prospective studies should further investigate long-term effects and patient satisfaction. HINTERGRUND: Fingergelenkarthrosen entstehen häufig infolge von Traumata, degenerativen oder entzündlichen Prozessen. Wenn konservative Maßnahmen und gelenkerhaltende Therapien versagen, stellt die Arthrodese eine bewährte Option zu Schmerzreduktion und Funktionsverbesserung dar. Unter den verschiedenen Techniken hat sich insbesondere die Cup-and-Cone-Methode durch hohe Stabilität und intraoperative Flexibilität bei leichter Durchführbarkeit bewährt. Das Ziel der Arbeit ist es, dies anhand des Patientengutes eines Supramaximalversorgers zu eruieren. Zwischen 2015 und 2025 wurden retrospektiv 201 Fingergelenkarthrodesen bei 168 Patient*innen analysiert. Die Patient*innen waren durchschnittlich 60 Jahre alt, 71 % männlich. Die rechte Hand war bei 54 % der Eingriffe betroffen. Es erfolgte die Erfassung von demografischen Daten, Lokalisation, Ätiologie und Komplikationen. Subgruppenanalysen fokussierten sich auf arthrosebedingte Arthrodesen zur Messung prä- und postoperativer Achsabweichung sowie Gelenkstellung. Die meisten Arthrodesen erfolgten an den PIP-Gelenken (104), gefolgt von DIP- (65) und IP-Gelenken (16). Hauptursache war ein Trauma (48 %), gefolgt von degenerativen Gelenkveränderungen (20 %). Komplikationen traten selten auf; häufigste war die postoperative Infektion. In der Subgruppe degenerativer Arthrosen zeigten sich signifikante postoperative Reduktionen der Achsabweichung (bis zu 25°). Fingergelenkarthrodesen sind bei therapierefraktären Beschwerden eine effektive Maßnahme zu Funktionsverbesserung und Beschwerdelinderung. Die Cup-and-Cone-Technik erwies sich als Verfahren mit hoher Erfolgsrate und niedriger Komplikationshäufigkeit. Die individuelle Planung der Gelenkstellung und sorgfältige Technikwahl sind entscheidend für das funktionelle Ergebnis. Zukünftige prospektive Studien sollten die Langzeiteffekte und Patient*innenzufriedenheit weiter untersuchen.
Open carpal tunnel release (OCTR) is effective but results in more extensive scarring. Ultrasound-guided carpal tunnel release (USCTR) has become established as a minimally invasive alternative. This systematic review aims to compare USCTR techniques, as well as their efficacy and safety, with open techniques. The review covers the technique, functional outcomes (objective and subjective), imaging results, and electrophysiological findings. USCTR is safe when certain anatomical conditions are taken into account. Significant improvements in functional outcomes (objective and subjective) are observed. However, no difference in motor latency, sensory nerve conduction velocity, or complication rates has been reported between USCTR and OCTR. USCTR patients return to work 10-15 days earlier and resume their daily activities 21 days earlier than patients who undergo OCTR. The complication and reoperation rates for USCTR are approximately 1.6%. HINTERGRUND: Die offene Karpaltunnelentlastung (OCTR) ist zwar wirksam, geht jedoch mit stärkeren Narbenbildungen einher. Die ultraschallgesteuerte Karpaltunnelentlastung (USCTR) hat sich als minimal-invasive Alternative etabliert. ZIEL: Diese systematische Übersicht soll einerseits die USCTR sowie deren Wirksamkeit und Sicherheit mit offenen Techniken vergleichen. Die Übersichtsarbeit umfasst die Technik, die funktionellen Ergebnisse (objektiv und subjektiv), die Resultate der Bildgebung und der Elektrophysiologie. Die USCTR ist sicher, wenn gewisse anatomische Gegebenheiten berücksichtigt werden. Es zeigen sich signifikante Verbesserungen bei den funktionellen Ergebnissen (objektiv und subjektiv). Hingegen lässt sich kein Unterschied in der motorischen Latenz, der sensorischen Nervenleitgeschwindigkeit und den aufgetretenen Komplikationsraten zwischen USCTR und OCTR nachweisen. USCTR-Patienten kehren 10/15 Tage früher an ihre Arbeitsstelle zurück und beginnen 21 Tage früher mit ihren Alltagsaktivitäten als Patienten nach OCTR. Die Komplikations- und Reoperationsraten für USCTR betragen ca. 1,6 %.
Optical biopsy denotes light-based in vivo techniques that infer tissue identity in real time from image or spectral data. In a review of the literature covering the past five years, we analyze the modalities used in head and neck surgery by principle, clinical application, evidence, and technology readiness. Optical biopsy technologies include confocal laser endomicroscopy, optical coherence tomography, hyperspectral imaging, near-infrared autofluorescence (NIRAF), Raman spectroscopy, photoacoustic imaging and fluorescence lifetime imaging; these support biopsy guidance, margin mapping, and preservation of critical structures. In addition, molecular NIR tracers provide high tumor-to-background contrast and laser-induced breakdown spectroscopy identifies osseous invasion. Morphological contrast techniques (contact endoscopy; narrow-band imaging/ SPIES) sharpen the detection of superficial lesions and microvascular patterns-thus enabling optical diagnosis-yet, in the strict sense, do not constitute optical biopsy. The evidence base is promising but heterogeneous; consistent patient-level benefits remain limited to date. At present, NIRAF for parathyroid identification and morphological contrast techniques as adjuncts to white-light endoscopy are suitable for routine use. All other modalities should be implemented within structured programs with standardized endpoint ascertainment (e.g., R0 resection rate, reoperations, quality of life). In the short to medium term, multimodal fusion, AI-assisted analysis with open datasets and external validation and integration into navigation and robotic workflows are likely to increase clinical impact and generalizability. Optische Biopsie bezeichnet lichtbasierte In-vivo-Verfahren, die in Echtzeit aus Bild- oder Spektraldaten auf Gewebeidentität bzw. Dignität schließen. In einer Review der wissenschaftlichen Publikationen der letzten fünf Jahre analysieren wir die in der Kopf-Hals-Chirurgie eingesetzten Verfahren nach Prinzip, klinischem Einsatz, Evidenz und Reifegrad. Zu den optischen Biopsietechnologien zählen konfokale Laserendoskopie, optische Kohärenztomografie, Hyperspektralbildgebung, Autofluoreszenz im Nahinfrarot (NIRAF), Raman-Spektroskopie, die photoakustische Bildgebung und Fluorescence-Lifetime-Imaging; sie unterstützen Biopsiesteuerung, Margin-Mapping und die Schonung kritischer Strukturen. Ergänzend liefern molekulare NIR-Tracer hohen Tumor-zu-Hintergrund-Kontrast und die laser-induzierte Breakdown-Spektroskopie identifiziert knöcherne Infiltration. Morphologische Kontrasttechniken (Kontaktendoskopie, NBI/SPIES) schärfen die Erkennung oberflächlicher Läsionen und mikrovaskulärer Muster, ermöglichen also eine optische Diagnose, gelten im engen Wortsinn jedoch nicht als optische Biopsie. Die Studienlage ist vielversprechend, aber heterogen; konsistente Vorteile auf Patientenebene sind bislang begrenzt. Routinetauglich sind die NIRAF zur Parathyreoidea-Identifikation und morphologische Kontrasttechniken als Ergänzung zur Weißlichtendoskopie. Alle übrigen Verfahren sollten in strukturierten Programmen mit standardisierter Endpunkterfassung (z.B. R0-Rate, Re-Operationen, Lebensqualität) eingesetzt werden. Kurz- bis mittelfristig werden multimodale Fusion, KI-gestützte Auswertung mit offenen Datensätzen und externer Validierung, sowie die Integration in Navigations- und robotische Workflows die klinische Wirkung und Übertragbarkeit erhöhen.
Impression fractures of the base of the middle phalanx represent a therapeutic challenge due to central joint incongruity and a tendency towards dorsal subluxation. This study aimed to present the clinical and radiological outcomes of a larger patient cohort treated using the intramedullary tamping technique described by Hintringer and Ender. A retrospective analysis of 92 patients (2012-2024) with unstable fractures of the base of the middle phalanx base was performed. Reduction was achieved percutaneously using a pre-bent intramedullary Kirschner wire, followed by retention with additional wires. Clinical and radiological endpoints, functional outcomes according to the classification of the American Society for Surgery of the Hand (ASSH), as well as complications were recorded. Median impression depth was reduced from a median of 2.6 mm (0.6-5.5 mm) preoperatively to 0.7 mm (0-2.9 mm) postoperatively. The median total range of motion (ROM) was 210° (90°-335°). Outcome was excellent in 19 patients, good in 37 patients, fair in 32 patients, and poor in 4 patients based on the criteria of the American Society for Surgery of the Hand (ASSH). Patient age had a significant influence on ROM, whereas fracture type, timing of surgery, and residual impression did not reach statistical significance. Median operative time was 18 minutes. Three clinically relevant complications occurred. The intramedullary tamping technique according to Hintringer and Ender is a safe, time-efficient and cost-effective treatment option with low complication rates and good functional outcomes. It allows direct reduction of centrally impacted fragments and remains feasible even in cases of delayed presentation. Mittelgliedbasisimpressionsfrakturen stellen aufgrund zentraler Gelenkinkongruenzen und Subluxationstendenzen eine therapeutische Herausforderung dar. Ziel dieser Arbeit war es, die klinischen und radiologischen Ergebnisse eines größeren Patientenkollektivs nach Behandlung mit der Aufstopftechnik nach Hintringer und Ender darzustellen.Retrospektiv wurden 92 Patienten (2012–2024) mit instabilen Mittelgliedbasisfrakturen eingeschlossen. Die Reposition erfolgte perkutan über einen vorgebogenen intramedullär eingebrachten Kirschner-Draht und anschließende Retention mit weiteren Drähten. Erfasst wurden klinische und radiologische Endpunkte, funktionelle Ergebnisse gemäß der Klassifikation der American Society for Surgery of the Hand (ASSH) sowie aufgetretene Komplikationen.Die Impression konnte im Median von 2,6 mm (0,6–5,5 mm) auf 0,7 mm (0–2,9 mm) reduziert werden. Der mediane Bewegungsumfang (ROM) lag bei 210° (90°–335°). 19 Patienten erreichten ein exzellentes, 37 ein gutes, 32 ein reguläres und 4 ein schlechtes Ergebnis. Das Alter hatte einen signifikanten Einfluss auf die erzielte Beweglichkeit, während Frakturtyp, Operationszeitpunkt und verbliebene Impression keinen signifikanten Zusammenhang zeigten. Die mediane Operationsdauer lag bei 18 Minuten. Es traten drei behandlungsrelevante Komplikationen auf.Die Aufstopftechnik nach Hintringer und Ender ist ein sicheres und zeitökonomisches Verfahren mit niedriger Komplikationsrate und guten funktionellen Ergebnissen. Sie erlaubt die direkte Reposition zentral imprimierter Fragmente und bleibt auch bei verzögerter Vorstellung anwendbar.
Scapholunate ligament injuries are the most common ligamentous injuries of the wrist and typically result from high-energy trauma, most often following a fall onto the outstretched hand. This comprehensive review summarizes the current knowledge regarding scapholunate ligament injuries, including anatomy, pathophysiology, diagnostic approaches, and management strategies. Scapholunate ligament injuries primarily affect individuals aged 20-50 years, with male patients at higher risk due to participation in high-impact activities. Despite their prevalence, these injuries are challenging to diagnose due to subtle clinical presentations and limitations of imaging modalities, often leading to delayed recognition and progression to scapholunate advanced collapse, a severe form of wrist arthritis. The scapholunate ligament plays a critical role in maintaining wrist stability, with its dorsal component being biomechanically most important. Pathophysiology ranges from partial tears causing dynamic instability to complete disruptions leading to static malalignment and degenerative changes. Advances in diagnostic modalities, including high-resolution magnetic resonance imaging, wrist arthroscopy, and dynamic computed tomography or ultrasonography, have improved detection. Meanwhile, classification systems like Geissler, Mayo and Garcia-Elias help guide treatment strategies. Management is determined by injury severity and chronicity. Conservative approaches, such as immobilization and physical therapy, are effective for partial injuries, while surgical interventions, including ligament repair, reconstruction, and salvage procedures, are reserved for more severe cases. Newer arthroscopic techniques, biological augmentations, and minimally invasive approaches have improved outcomes and reduced complication rates. Rehabilitation and long-term follow-up remain essential to optimize recovery and monitor for degenerative changes. Emerging technologies, including dynamic implants and artificial intelligence for diagnostics, promise further advances. Nevertheless, early diagnosis and timely intervention remain critical to preventing chronic dysfunction and improving patient quality of life. Verletzungen des Skapholunären-Bandapparates (SLLI) sind die häufigsten Bandläsionen des Handgelenks und entstehen meist nach hochenergetischen Traumata, typischerweise nach Stürzen auf die ausgestreckte Hand. Diese Übersicht bündelt den aktuellen Stand zu Anatomie, Pathophysiologie, Diagnostik und Therapie. Betroffen sind vor allem 20- bis 50-Jährige; Männer tragen durch belastungsintensive Aktivitäten ein höheres Risiko. Trotz ihrer Häufigkeit bleiben SLLI wegen subtiler klinischer Zeichen und Grenzen der Bildgebung oft lange unentdeckt, was das Fortschreiten bis zum fortgeschrittenen skapholunären-Kollaps - einer schweren Form der Handgelenksarthrose - begünstigt. Das scapholunare Band (SLL) ist essentiell für die Handgelenksstabilität; biomechanisch ist die dorsale Komponente am bedeutendsten. Die Pathophysiologie reicht von Teilrupturen mit dynamischer Instabilität bis zu kompletten Rissen mit statischer Fehlstellung und nachfolgenden degenerativen Veränderungen. Fortschritte wie hochauflösende MRT, Handgelenksarthroskopie, dynamische CT und Sonographie verbessern die Detektion; Klassifikationen nach Geissler, Mayo und Garcia-Elias strukturieren das therapeutische Vorgehen. Die Behandlung richtet sich nach Schweregrad und Chronizität. Konservative Maßnahmen wie Ruhigstellung und Physiotherapie sind bei Teilverletzungen sinnvoll, während schwerere Fälle operative Verfahren wie Bandrekonstruktion sowie Rettungsoperationen erfordern. Neuere arthroskopische Techniken, biologische Augmentationen und minimalinvasive Methoden verbessern die Ergebnisse und senken die Komplikationsrate. Rehabilitation und langfristige Nachsorge bleiben entscheidend, um die Genesung zu optimieren und degenerative Veränderungen zu überwachen. Zukünftige Entwicklungen - etwa dynamische Implantate und KI-gestützte Diagnostik - versprechen weitere Fortschritte. Unverändert gilt: Eine frühzeitige Diagnose und rechtzeitige Intervention verhindern chronische Funktionsstörungen und verbessern die Lebensqualität.
Farmers can use automated milk feeders (AMF) to identify changes in the behavior of individual calves before they are clinically sick. However, other management factors, such as routine procedures, may affect group- and individual-level feeding behavior patterns in calves. This matched cohort study (n = 44; 22 pairs of booster-vaccinated calves matched to controls) evaluated the effects of a booster vaccination comprised of inactivated Salmonella Typhimurium and Salmonella Dublin on feeding behavior and relative changes in behavior of Angus × Holstein calves reared at one calf-rearing facility. All calves were vaccinated with Bovilis Bovivac S on d 1 after farm arrival. Booster calves received a booster vaccination at 15 d after farm arrival (d 0 of the study). Control calves did not receive the booster. We pair-matched booster-vaccinated calves to controls by sex, the first day they independently drank from the feeder, and arrival weight (±6 kg). Daily feeding behaviors (milk intake, drinking speed, and rewarded visits) were recorded by an AMF (Foerster-Technik, Engen, Germany). Calves were offered a maximum of 3.0 L of milk replacer per meal with no daily limit, using a 2-h block between meals to limit size. Mixed linear regression models assessed the effects of booster status, day (days -2 to 4), pair, and the day × booster status interaction on calf feeding behavior, with calf as a random effect and day as the repeated measure. Models also assessed effects on relative changes in feeding behavior using the same model structure. Relative change was calculated as [(day of interest behavior - baseline behavior on day -2) ÷ baseline behavior] × 100, giving the percent change at the individual calf level. Significant day × booster interactions had mean differences adjusted using the Tukey method. We observed a milk intake × day interaction: booster calves consumed more milk than controls on d 0, 2, 3, and 4. For example, on the booster day, control calves consumed 8.26 L/d (95% CI: 7.78 to 8.75; LSM) compared with 10.5 L/d (95% CI: 9.31 to 10.28) in booster calves. Booster status was also associated with greater rewarded visits and faster drinking speeds (control 0.49 L/min, 95% CI: 0.47 to 0.51 vs. booster 0.52 L/min, 95% CI: 0.50 to 0.54), but there was no day × booster interaction for these metrics. Interestingly, booster status was not associated with relative changes in milk intake, drinking speed, or rewarded visits. This suggests that although booster-vaccinated calves, as a group, consumed more milk and drank faster, the magnitude of the within-calf behavioral change after a booster shot was not significant. We suggest that calves injected with a booster vaccine for inactivated Salmonella Typhimurium and Salmonella Dublin did not experience individual changes in their behavior patterns, but group milk intake increases on the days after the booster shot.
Training calves to drink milk independently from an automated milk feeder (AMF) requires substantial labor, with calves taking several days to learn; however, it is unknown if feeding behavior can predict successfully trained calves. The objectives of this retrospective cohort study were to (1) evaluate the association between AMF feeding behaviors (milk intake, drinking speed, and rewarded visits) and their relative changes with training success. (2) Determine which feeding behaviors were useful for classifying calves as successfully trained to use AMF by d 4 in Angus × Holstein calves fed near ad libitum milk. Angus × Holstein calves (n = 461; 129 training success, 332 unsuccessful calves) were raised by one commercial calf raiser that offered near ad libitum milk replacer with an AMF (Foerster-Technik, Engen, Germany). Calves were classified as successfully trained when they independently visited the AMF > 2 times/d and consumed > 6 L/d of milk within 4 d. Day 4 was selected as the training success threshold (d 0) because the average training day was 3.5 ± 3.6 d (mean ± SD). Mixed linear regression models were used for the association of feeding behavior, and relative changes in each behavior with training success for d - 3 to d 7 adjusting for the fixed effects of day, training success status, pen, the training status × day interaction, repeating by day, with calf nested within source farm as a random effect. Logistic regression models were used to identify the optimal feeding behaviors required to classify calf training success using AUC, Youden's index, sensitivity, specificity, accuracy, and precision as performance indicators and the random effect of source farm. There was a training success status × day interaction for milk intake and relative changes in milk intake. Successfully trained calves had greater milk intake from d -2 to 7 and greater relative changes in milk intake from d 2 to 7 compared with unsuccessful calves. Moreover, there was a training success status × day interaction for rewarded visits and relative changes in rewarded visits. Successfully trained calves had greater rewarded visits from d -1 to d 7, and greater relative changes in rewarded visits on d -3 compared with unsuccessful calves. There was no association of training success status with drinking speed or relative changes in drinking speed. The best performing prediction model used milk intake, rewarded visits, relative changes in milk intake, and relative changes in rewarded visits (AUC = 0.86, Youden's index = 0.63, sensitivity = 0.87, specificity = 0.76, accuracy = 0.79, and precision = 0.59). These findings suggest that farmers can monitor average milk intakes and rewarded visits, and relative changes in rewarded visits to identify which calves drink independently from an automated milk feeder.
The implementation of textile electrodes offers the possibility of improving comfort and reducing the risk of allergic reactions of the measured subject, while also opening the door to non-medical devices for everyday life. The main objective of the experiment is to test and compare five conductive fabrics manufactured by Shieldex in terms of the quality of the measured electrocardiography (ECG) signals. For this experiment, 3 electrodes of each conductive material were made and tested on a sample of 20 volunteers. The electrodes were attached by an elastic band at the locations of selected standardized ECG leads, and Ag/AgCl electrodes were used as reference. Correlation coefficient (R), signal-to-noice ratio (SNR) and percentage root-mean-square deviation (PRD) applied to representative cardiac periods were used to evaluate the quality of the acquired data. Differences in the results of the evaluation parameters between the different positions were noted, and when the distribution of positions was neglected, it was discovered that the best results were obtained with Shieldex Silitex material and, on the contrary, the worst results were recorded with Shieldex Technik-tex P130 + B material. It was also found that the results were not significant between the materials and after visual inspection it can be concluded that all materials are suitable for ECG measurements.
Anterior knee pain (AKP) remains one of the most common complaints following total knee arthroplasty (TKA), with an incidence ranging from 4% to 60%. Robot-assisted TKA (RA-TKA) has shown enhanced precision in component positioning and alignment, yet its influence on postoperative AKP remains insufficiently explored. This study compared the mid-term and long-term effects of RA-TKA and conventional manual TKA (CM-TKA) on AKP severity, knee function, and joint mobility. A retrospective cohort of obese patients undergoing primary TKA for advanced (Kellgren-Lawrence grade 4) osteoarthritis between 2020 and 2023 was analyzed. Propensity score matching (PSM) was applied to minimize baseline bias, yielding 88 well-balanced pairs of RA-TKA and CM-TKA patients. Outcomes included AKP intensity measured by the numeric rating scale (NRS), Knee Society Score (KSS) and active knee range of motion (ROM) at 3, 6, 9, and 12 months postoperatively. At 3 months, RA-TKA patients reported lower AKP scores compared to CM-TKA (17.5 ± 8.1 vs. 24.6 ± 10.7, p = 0.034), although this difference disappeared in later follow-ups. By 12 months, RA-TKA yielded higher KSS (37.5 ± 6.2 vs. 34.4 ± 5.6, p = 0.042), greater flexion (110.3 ± 11.8° vs. 107.5 ± 12.5°, p = 0.044), and better extension (3.6 ± 1.4° vs. 4.1 ± 1.5°, p = 0.020). Both groups exhibited peak AKP at 3 months, with gradual recovery thereafter. The RA-TKA provided superior short-term improvement in AKP and functional recovery compared to conventional TKA, particularly within the early postoperative phase when AKP is most pronounced. Although long-term outcomes were comparable, the robotic technique offered measurable benefits in early pain reduction and joint mobility, highlighting its clinical value in obese patients undergoing TKA. HINTERGRUND UND ZIEL: Vordere Knieschmerzen („anterior knee pain“, AKP) gehören nach wie vor zu den häufigsten Beschwerden nach einer Knietotalendoprothese (Knie-TEP) mit einer Inzidenz zwischen 4 und 60 %. Die robotergestützte Knie-TEP (RA-TEP) hat eine verbesserte Präzision bei der Positionierung und Ausrichtung der Komponenten gezeigt, doch ihr Einfluss auf postoperative AKP ist noch nicht ausreichend erforscht. In dieser Studie wurden die mittel- und langfristigen Auswirkungen der RA-TEP und der konventionellen manuellen TEP (KM-TEP) hinsichtlich AKP-Schweregrad, Kniefunktion und Gelenkbeweglichkeit verglichen. Es wurde eine retrospektive Kohorte von adipösen Patienten analysiert, die sich zwischen 2020 und 2023 wegen fortgeschrittener Gonarthrose (Kellgren-Lawrence-Grad 4) einer primären Knie-TEP unterzogen. Um die Verzerrung der Ausgangswerte zu minimieren, wurde ein Propensity-Score-Matching (PSM) durchgeführt, wodurch 88 gut ausgewogene Paare von Patienten mit RA-TEP und KM-TEP ermittelt wurden. Zu den Ergebnissen gehörten die anhand der numerischen Ratingskala (NRS) gemessene AKP-Intensität, der Knee Society Score (KSS) und der aktive Bewegungsumfang (ROM) des Knies 3, 6, 9 und 12 Monate postoperativ. Nach 3 Monaten berichteten Patienten mit RA-TEP niedrigere AKP-Werte als Patienten mit KM-TEP (17,5 ± 8,1 vs. 24,6 ± 10,7; p = 0,034), obwohl dieser Unterschied in späteren Nachuntersuchungen verschwand. Nach 12 Monaten erzielte RA-TEP höhere KSS-Werte (37,5 ± 6,2 vs. 34,4 ± 5,6; p = 0,042), eine größere Beugung (110,3 ± 11,8° vs. 107,5 ± 12,5°; p = 0,044) und eine bessere Streckung (3,6 ± 1,4° vs. 4,1 ± 1,5°; p = 0,020). Beide Gruppen zeigten nach 3 Monaten einen AKP-Spitzenwert, gefolgt von einer allmählichen Erholung. Die RA-TEP führte im Vergleich zur herkömmlichen TEP zu einer überlegenen kurzfristigen Verbesserung der AKP und der funktionellen Erholung, insbesondere in der frühen postoperativen Phase, in der AKP am ausgeprägtesten sind. Obwohl die Langzeitergebnisse vergleichbar waren, bot die robotergestützte Technik messbare Vorteile hinsichtlich der frühen Schmerzreduktion und Gelenkbeweglichkeit, was ihren klinischen Wert bei adipösen Patienten, die sich einer TEP unterziehen, unterstreicht.
Microtubules are ubiquitous yet diverse cytoskeleton filaments. However, tubulin conservation presents challenges in understanding the origins of diverse microtubule architectures. The mechanisms by which microtubule architecture varies through the life cycle of the malaria-causing parasite Plasmodium are not understood and provide a valuable framework for exploring how intrinsic properties of tubulin contribute to architectural variety. Using parasite-purified tubulin, we determine P. falciparum microtubule structures by cryo-electron microscopy. Parasite-specific sequences change the tubulin dimer structure, suggesting how drug susceptibility and polymer properties are modified. Within the P. falciparum microtubule, lateral contacts are smaller but stronger, and the lattice is stiffer than in brain microtubules. Non-canonical microtubule architectures found in parasites are highly similar to those observed in vitro, validating the physiological relevance of these properties. Our findings show how evolutionary adaptation of tubulin modulates the material properties of the microtubule cytoskeleton.
Despite a growing number of systematic reviews on digital health interventions, many do not sufficiently support the recognition of conclusive evidence. Methodological shortcomings may impede the identification and communication of robust findings. Abstracts are the basis for study selection in systematic reviews and are increasingly used in automated screening processes and rapid assessments. This meta-research study examines to what extent systematic reviews apply methodological standards-particularly the specification of PICO (population or problem, intervention, comparison, and outcome) elements-and how this relates to the likelihood of conclusive evidence recognition. It is based on a random sample and focuses on the assessment at the abstract level, as abstracts are used independently of the specific review choice to screen and select studies for evidence synthesis, making them critical for evidence recognition. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a comprehensive database search (2011-2023). From 2528 eligible systematic reviews, a random sample of 250 abstracts was analyzed descriptively. Abstracts were assessed for PICO specification and evidence conclusiveness in the context of further study characteristics. In total, 48% (119/250) of reviews showed low or very low PICO specification, and 64% (159/250) reported inconclusive or weak evidence. Higher specification of outcomes and problems was moderately associated with conclusive evidence. Beside the formulation of the research question along the PICO scheme, we identified recurring issues in search and screening strategy design (eg, limited database use, vague search terms, and long search periods), restrictive eligibility criteria (eg, exclusive reliance on randomized controlled trials), inconsistent use of quality appraisal tools, and underusage of alternative synthesis methods to hinder evidence recognition. Our findings suggest that methodological coherence across all review stages is a necessary condition to ensure conclusions and evidence-informed decisions in the digitalization of health care are both valid and meaningful. A structured PICO-based framework, which is aligned with current research, builds on well-established categories and provides clear and differentiated definitions that may enhance the focus and evidentiary strength of future reviews.
Orthohantaviruses are emerging zoonotic pathogens that can cause life-threatening diseases in humans. Their tripartite, negative-sense RNA genome is encapsidated by the viral nucleoprotein, but the subcellular localization and dynamics of these viral RNAs and proteins remain poorly characterized. Here, we present a comprehensive microscopy-based analysis of Puumala virus, the most prevalent orthohantavirus in northern and western Europe. Using fluorescence in situ hybridization (FISH) and Multiple Sequential FISH, we mapped the distribution of viral mRNAs, viral genomic RNAs (vRNAs), nucleoproteins and associated host cell factors, quantifying their intracellular abundance, co-localization and subcellular positioning. We observed distinct clustering of vRNAs with varying degrees of nucleoprotein association, a progressive increase in nucleoprotein expression levels during infection and a concomitant rise in the abundance of P-bodies. Moreover, we report a marked spatial reorganization of actin, microtubules and P-bodies, indicating substantial structural remodelling of host cells during orthohantavirus infections. Using a novel end-specific FISH assay, we observed a preferential 5'-end degradation of vRNAs in P-bodies, shedding new light on orthohantavirus RNA turnover within host RNA-processing compartments. Finally, co-localization analyses revealed the formation of potential 'viral factories' composed of nucleoprotein, vRNAs and viral mRNAs, indicating an intricate assembly hierarchy. Collectively, these findings improve our understanding of orthohantavirus replication and highlight the dynamic interplay between virus and host cell components.
Autonomous artificial intelligence (AI) systems are finding their way into ophthalmological care, particularly in imaging diagnostics (fundus photographs, OCT) and screening set-ups; however, the term "autonomous" is used inconsistently in routine clinical practice: in addition to fully automated systems (AI only decisions), care services are emerging in which doctors make the diagnosis but there is no direct doctor-patient contact (asynchronous diagnosis). These forms are ethically relevant because responsibilities, duties of disclosure, trust and the consequences of errors are different from those in a traditional consultation. This article categorizes autonomous care concepts, outlines potential clinical benefits and discusses key ethical and regulatory issues. Autonome KI-Systeme halten Einzug in die ophthalmologische Versorgung – besonders in der Bilddiagnostik (Fundusfotos, OCT) und in Screening-Set-ups. „Autonom“ wird im klinischen Alltag jedoch uneinheitlich verwendet: Neben vollständig automatisierten Systemen („AI-only“-Entscheidung) entstehen Versorgungsangebote, in denen zwar Ärzte die Befundung übernehmen, aber kein direkter Arzt-Patienten-Kontakt stattfindet (asynchrone Befundung). Diese Formen sind ethisch relevant, weil sich Verantwortlichkeiten, Aufklärungspflichten, Vertrauen und Fehlerfolgen anders darstellen als in der klassischen Sprechstunde. Der Beitrag ordnet autonome Versorgungskonzepte begrifflich, skizziert klinische Nutzenpotenziale und diskutiert zentrale ethische und regulatorische Fragen.
The homeostatic skin represents a tissue niche promoting the survival of several immune cell types. Mast cells (MCs) are resident immune cells distributed throughout the dermal compartment. Their differentiation and survival depend on KIT ligand (KITLG), also known as stem cell factor, and signaling through the KIT receptor expressed by MCs. Although several cutaneous cell types can express KITLG, their specific roles in maintaining MC homeostasis in vivo are still under debate. In this study, we used immunofluorescence analysis of KitlGFP mice and single-cell RNA sequencing to identify KITLG-expressing cells in mouse ear skin. On the basis of these findings, we studied MC homeostasis using 6 mouse models with conditional Kitl deletion in epidermal and stromal populations. Our results indicate that keratinocyte-derived KITLG is dispensable for MC survival in unchallenged mouse skin. Instead, we identify dermal fibroblasts and perivascular cells as critical KITLG sources for maintaining MCs in the dermis. Overall, our study provides a detailed characterization of KITLG-expressing cells across skin regions and reveals how stromal cell types shape local KITLG availability and MC homeostasis in unchallenged mouse skin.
Clinical practice guidelines support healthcare professionals in making evidence-based decisions, yet guideline adherence among physical therapists remains inconsistent. To address this gap, a prototype digital knowledge translation tool powered by a large language model (LLM) was developed, with content based on two exemplary high-quality German national guidelines. To (1) explore the experiences of German physical therapists using the tool, (2) assess their perspectives on its utilization in clinical practice, and (3) compare perceptions between outpatient and inpatient settings. Six focus group interviews were conducted: three in a university hospital inpatient setting and three in outpatient physical therapy practices. Discussions were analyzed using qualitative content analysis with inductive and deductive coding. Twenty physical therapists (11 inpatient, 9 outpatient) participated. Overall experiences were positive, though prolonged response times were criticized. Utilization was thought to depend on time availability and workplace digitization. The tool's potential assisting with clinical questions was highlighted. No considerable differences in experiences across settings were noted. Inpatient therapists envisioned using the tool between sessions for personal knowledge enhancement, whereas outpatient therapists anticipated utilization during sessions for patient education. LLM-based knowledge translation tools may contribute to improving guideline adherence among physical therapists. Successful implementation requires assessment of digital infrastructure, relevance to clinical needs, and users' digital literacy. Further research should evaluate the quality of LLM-generated summaries to ensure validity and trustworthiness, and optimize the tools' usability regarding speed and content. Development should also prompt ethical considerations about their role in clinical decision-making and patient care.
Machine Learning (ML) research in healthcare remains challenging as large, privacy-preserving open datasets are lacking. Synthetic data could offer a solution, but the value of synthetic data depends on diverse and conflicting criteria such as utility, fidelity, and privacy, which are rarely evaluated comprehensively. To close this gap, we explore the trade-off between these metrics in an empirical evaluation across a broad spectrum of generative models, datasets and metrics. In order to include as many metrics and models as possible and to ensure both applicability and comparability with other studies, we focus on the most widely available data modality and task setting: tabular data associated with a classification task. Extending prior work our results demonstrate that no single generative model excels across all metrics and datasets. Across 9 datasets and 11 generative models, the first principal variance direction of all metrics captures the dominant trade-off between fidelity and utility metrics on one side and the privacy metrics on the other side. Sensitivity analyses indicate that the privacy-fidelity/utility trade-off captured by the first principal variance direction remains consistent across several datasets and may support model selection. These insights highlight the potential of synthetic data for responsible data sharing in health care as well as the need for better tooling in synthetic data generation with a higher degree of automation when optimizing for metrics capturing fidelity, utility and privacy.
Type IV secretion systems (T4SS) are found in both monoderm and diderm bacteria. The broad-host-range conjugative plasmid pIP501 from Enterococcus faecalis harbors a T4SS encoding 15 tra genes responsible for the spread of antimicrobial resistance genes among diverse G+ pathogens. Eight Tra proteins (TraB, TraCB3, TraF, TraHB8, TraI, TraK, TraLB6, and TraMB8) are postulated to form the mating pair formation (MPF) complex representing the central DNA translocation pore. One of these proteins is TraF, a 52.8 kDa transmembrane protein, which lacks any homologs in other well described T4SSs. In this study, TraF was proven to be an essential conjugative transfer protein. The TraF pulldown co-eluted all Tra proteins except TraGB1 and TraN. Bacterial-two-hybrid assay showed a strong interaction between TraF and TraMB8. We present a 1.25 Å resolution crystal structure of the N-terminal domain of TraF, which adopts a pseudokinase fold. AlphaFold predictions of full-length TraF with membrane mimetics show a transmembrane protein with two distinct soluble domains. FoldSeek revealed a strong similarity to YukC (EssB), a transmembrane pseudokinase from type VII secretion system (T7SS). YukC was shown to function as an interaction hub by mediating contacts between its pseudokinase domain and other T7SS proteins as part of the central membrane core complex. We postulate that TraF might play an important role in T4SS complex formation.
We studied potential pathways of PCB transport from source countries that may have caused contamination of marine fish in the Northeast Atlantic and the Baltic Sea. Using the relative fractions of ICES-7-PCB concentrations as profiles, we matched observed profiles from fish caught between 1982 and 2020 with predicted profiles, referred to as 'shadow profiles', reflecting potential contamination pathways from PCB consuming and emitting countries into marine fish. While shadow profiles directly associated with emissions from major European industrial nations showed the closest match to contamination profiles of marine fish, modelling a transient degradation of PCB in soils and a subsequent remobilisation revealed an additional plausible pathway of contamination. Shadow profiles from this plausible pathway matched published median soil profiles from selected European countries and significantly improved the explanation of congener profiles observed in marine fish. For PCB in fish, both emissions from Germany and degraded but remobilised contamination of soils in former USSR appeared to be particularly important. Unexplained observed fish profiles may be related to a mix of contamination pathways from different source countries. Overall, our results highlight the important role of soils as secondary sources of PCB contamination for marine fish.