bluuebunny/crossref_metadata_2025 huggingface dataset:
Mineralization of the Supraspinatus Tendon: Clinical Observations in Seven Dogs
Authors: Kriegleder H.
Published: March 2018

Mineral-like densities in the supraspinatus tendon were determined to have different clinical significance according to their location. Those identified radiographically and surgically, near the biceps tendon sheath reflecting a deep location in the supraspinatus tendon, caused chronic and acute lameness in five large breed dogs. Pain in the shoulder and biceps tendon was elicited on examination in acute cases whilst chronic cases were painfree. Systemic and local anti-inflammatory treatment failed to improve any of the cases. Surgical removal was curative with slight lameness after exercise observed in some dogs during the longterm follow-up. Recurrence of lesions were not seen radiologically. It is suggested that mineralizations, located deep in the supraspinatus tendon, cause secondary tenosynovitis of the biceps brachii through mechanical irritation.

Mineralizations found radiographically distant to the biceps tendon sheath in five cases reflecting a superficial location in the supraspinatus were determined not to be a primary cause of lameness.

Similarities in the pathomechanism, aetiopathogenesis and clinical significance of mineralizations in the supraspinatus tendon in dogs and humans were noted.

Mineralizations located deep in the supraspinatus tendon near the biceps tendon sheath caused lameness in large breed dogs. Diagnosis was established through physical examination, radiography, and surgical exploration of the lesion. Systemic steroidal and non-steroidal therapy and local steroid injection into the intertubercular groove failed to resolve any of the cases but surgical curettage of the mineralization resulted in clinical improvement. A secondary mechanical tenosynovitis of the biceps brachii as the cause of lameness, is suggested.

Mineralizations located superficially in the supraspinatus tendon were found not to be a primary cause of lameness.
Evaluation of a Method for Biopsy of the Distal Radial Physeal Growth Plate in Neonatal Foals
Authors: Firth E. C. , Hunt W. F. , Pearce S. G.
Published: March 2018

A technique was devised for taking biopsies from the distal radial physeal growth plate in neonatal foals to study cartilage morphology. The biopsy taken from the right forelimb of 21 Thoroughbred foals, four to 10 days of age, was performed under inhalation anaesthesia, using a 9 mm diameter trephine on a multi speed drill. Due to their exercise not being adequately restricted postoperatively, five foals (24%) developed excessive incisional granulation tissue at the biopsy site. Nine foals (43%) developed some flexion of the carpus (over at the knee) and 15 (71%) developed outward rotation of the left limb. There was significantly greater carpal valgus in the left limb when compared with the right limb (p <0.005), a situation which was not present in six agematched, unoperated, control foals. Abnormalities in the congruency of the antebrachiocarpal joint were not detected grossly at postmortem at five months of age. However, there were localised gross and histological abnormalities of the distal radial physeal growth plate. Postoperative morbidity, significant changes to conformation, and the unknown long term consequences of the disruption to the biopsied physeal growth plate are likely to make this procedure inappropriate for clinical usage. However, the biopsy procedure was easy to perform, and provided a suitable sample for both histological and histomorphometric examination of the physeal growth plate cartilage. Therefore this technique provides a useful research method for study of growth plate morphology in neonates.

A technique was developed for biopsy of the distal radial physeal growth plate in neonatal foals. Additionally, the effects on conformation, and on gross and histological abnormalities at five months of age, were reported. There were significant, mild conformational abnormalities, which self-corrected without intervention, and there were abnormalities detected at postmortem examination, but these abnormalities did not appear to affect the joint. The expected effects of this procedure are stated, and provided that these are accounted for, the technique is useful for harvesting and studying the physeal growth plate of neonates.
Repair of Femoral Capital Physeal Injuries in Cats -14 Cases
Authors: Black A. P. , Lorkin K. F. , Bradley W. A. , Culvenor J. A.
Published: March 2018

Femoral capital physeal fractures (CPF) are common injuries in the immature cat. Fractures of the femoral head and neck have been classified by Daly (1) as capital, physeal, subcapital and transcervical. Physeal fractures may also be classified according to Salter (2) and those covered in this paper are Salter I and II.

Perez-Aparicio and Fjeld (2) found that many cats become functional without surgical treatment although most developed malunion or non-union. Some of the untreated cats had persistent lameness.

While femoral head and neck ostectomy (3), is often recommended and will usually lead to a functional result, particularly in the cat, open reduction and internal fixation is preferred (5, 6) as is recommended in the dog (8, 21).

Fourteen femoral capital physeal fractures in 13 cats were repaired with fine pins. The surgical technique and clinical results are described. The authors feel that the ease of the technique and the clinical results make this the treatment of choice for injuries of this type in cats.
The Effect of Polysulphated Glycosaminoglycan on the Production of Proteoglycan by Equine Tendon Fibroblasts in Monolayer Culture
Authors: Rosenbusch R. F. , Booth L. C. , Dahlgren Linda
Published: March 2018

Equine tendon fibroblasts were isolated from tissue fragments of superficial digital flexor tendon, subcultured and maintained in monolayers. The cells were treated with two dosage regimes of polysulphated glycosaminoglycan (PSGAG). The high dose group received 0,25, 50 or 200 μg/ml of PSGAG and the low dose group received 0,0.3,1 or 2 μg/ml of PSGAG. Proteoglycan production was measured via liquid scintillation counting, following radiolabel with 35SO4 (40 μCi/ml). The counts were measured in both the cell associated fraction and the supernatant fraction.

The addition of PSGAG to the culture system did not adversely affect cell viability at any treatment level. The cells in all of treatment groups produced measurable amounts of proteoglycan in both the cell associated and supernatant fractions. There were not any differences between the treatment means in any of the four groups (high dose cell-associated, high dose supernatant, low dose cell-associated, low dose supernatant). A linear trend in proteoglycan production was not documented between treatment groups in either the cell-associated or the supernatant fractions for either of the two dosage regimes. The significance of the lack of effect is equivocal. PSGAG may influence tendon healing in a manner other than by increasing proteoglycan production.

The effect of polysulphated glycosaminoglycan on the production of proteoglycans by equine tendon fibroblasts was investigated. A previously described model was utilized to grow the tendon fibroblasts in monolayer cultures. Significant treatment effects were not seen at either a high or low dose of PSGAG. Addition of the PSGAG did not adversely affect cell viability at any treatment level.
Effects of Unilateral Ligamentoplasty on Spinal Development in the Growing Rabbit
Authors: Meunier A. , Breard F. , Graf H. , Moissonnier P.
Published: March 2018

Numerous models of scoliosis have been proposed, but few were characterized geometrically, easily reproductible and avalaible for testing orthopaedic procedures. Sixteen growing rabbits underwent unilateral ligamentoplasty of three lumbar vertebrae using screws in the vertebral body. Spinal modifications were evaluated at six and 12 weeks post-operatively by radiography, scannography and histology. The mean lateral deviation was found to be 21°± 3.1 at six weeks and 41.6 ± 6.6 at 12 weeks. Significant lordosis, cyphosis or vertebral rotation were not observed. Vertebral torsion was significative (p <0.005). Histological assessments of the modifications of paraspinal muscles, intervertebral discs and articular facets were performed for evaluation of consequences of surgery, spinal immobilization and deviation. We concluded that unilateral ligamentoplasty produce a reproductible model of lateral deviation of the spine in the growing rabbit.

This article analyses the spinal deformities obtained after unilateral ligamentoplasty of three lumbar vertebrae. A time-dependent lateral deviation and a vertebral torsion were found but significant lordosis, cyphosis or vertebral rotation were not observed. Paraspinal muscles, intervertebral discs and articular facets modifications are reported. Clinical relevance of these data are discussed.
Traumatic Luxation of the Elbow in 31 Dogs
Authors: Wolvekamp P. , Meij B.P. , Theijse L.F.H. , Hazewinkel H. A. W. , Schaeffer I.G.F.
Published: March 2018

The medical records of 31 dogs with traumatic luxation of the elbow joint were reviewed. The patients were referred to the Faculty of Veterinary Medicine of the Utrecht University during the period from 1984 to 1996. Nineteen dogs with an acute lateral luxation were treated by closed reduction. One dog with an acute bilateral luxation and two dogs with chronic elbow luxation were treated by open reduction. In four dogs the collateral ligaments were sutured on one side following closed reduction and in one dog following open reduction.

Five dogs had a Monteggia fracture. One was treated by closed reduction and external coaptation and 4 by open reduction with osteosynthesis. Excellent or good results were achieved in eight of the 19 dogs (47%) treated by closed reduction, in 1 of 3 (33%) treated by open reduction and in three of five (60%) treated for a Monteggia fracture. The quite disappointing results of the closed reduction appeared to be largely due to the instability remaining after the reduction in seven of the 19 elbow joints (41%).

Collateral ligament repair was performed in three dogs immediately following closed reduction and the clinical result was excellent in all three. When the elbow joint is unstable after reduction of a traumatic luxation, it should be stabilized surgically.

Traumatic cubital luxation is an emergency which occurs infrequently in dogs. The methods of treatment used in 31 dogs are reviewed and the long-term clinical results are evaluated. Good results can be expected for acute closed reduction, provided that stability is improved surgically if the elbow is unstable after reduction. Monteggia fractures should always be treated by open reduction.
Arthroscopy of the Elbow in Dogs
Authors: Bardet J. F.
Published: March 2018

The craniolateral portal of the elbow is described. The technique was applied and evaluated in 34 dogs (38 elbows). A detailed description and classification of the fragmented coronoid process (FCP) is given. All patients with FCP were treated successfully using a second craniomedial portal. Complications were not observed. The technique appears to be safe and reliable and could also be used for other procedures such as removal of loose bodies, treatment of osteochondritis dissecans of the medial condyle, reduction of selective humeral condylar fractures, excision of osteophytes and other diagnostic purposes. It also eliminates the need for exploratory arthrotomies of the elbow joint in dogs.

The cranial portals of the 38 elbows in 34 dogs allowed proper evaluation and treatment of the lesions of the medial coronoid process. A classification in 7 types of lesions of the medial coronoid process was established. All dogs were treated successfully by either removal of the FCP or by a proximal ulnar sliding osteotomy.
A Comparison of Autogenous Cortico-Cancellous Bone Graft Obtained from the Wing of the Ilium with an Acetabular Reamer to Autogenous Cancellous Bone Graft Obtained from the Proximal Humerus in Dogs
Authors: Parker R. B. , Lewis D. D. , Wronski Th. J. , Shiroma J. , Stallings J. T.
Published: March 2018

The incorporation of autogenous cortico-cancellous bone graft (CCBG) harvested from the wing of ilium using a powered acetabular reamer and autogenous cancellous bone graft (CBG), harvested from the proximal humerus by curettage, were compared in four young adult mixed breed female dogs. Five milliliters of CCBG or CBG were placed in bilateral, stable, 3.0 cm proximal diaphyseal ulnar defects. Humeral donor sites, and subsequent assignment of graft types of ulnar recipient sites, were alternated between dogs. Craniocaudal and lateral view radiographs were obtained immediately (day 0) and on days 16 and 35 after the operation. Photodensitometric and bone graft area measurements were made from these radiographs and the specific radiographic characteristics of the bone grafts were described at each time interval. Each dog received a series of intravenous fluorochrome label injections on days 23, 28 and 33. The dogs were humanely euthanatized on day 35. The bone graft recipient sites were harvested, processed and the descriptive histological and histomorphometric parameters were evaluated.

A statistically significant difference in photodensitometric measurements was not seen between the CCBG and CBG. However, there was a statistically significant increase in the graft area of the CCBG from day 0-16. Mineral apposition rate was significantly greater, (P = 0.005) for the CCBG (mean = 4.8) than for the CBG (mean = 3.7), suggesting that the CCBG appears to be in an earlier more osteogenic phase of incorporation than the CBG. There was a trend which suggested that the percentage of trabecular bone volume was greater (P = 0.11) for the CBG (mean = 43.0) than for the CCBG (mean = 32.0). Other significant differences were not found, with respect to the other morphometric parameters measured. The descriptive histology and subjective radiographic evaluation were the most effective ways of readily distinguishing between the two types of bone graft and they demonstrated that the CBG had incorporated more completely than the CCBG by day 35.

Presented at the 30th Annual Meeting of the American College of Veterinary Surgeons, Chicago, Illinois 1995 and at the 23rd Annual Meeting of the Veterinary Orthopaedic Society, Telluride, Colorado 1996
Quantitative morphology of the human and porcine mid-lumbar interspinous ligament
Authors: Dumas G. A. , Hewlett B. R. , Bednar D. A. , Dickey J. P.
Published: March 2018

Animal models are essential in spine research for evaluating implants and for studying spinal mechanics. Several studies have compared the geometrical characteristics of animal and human vertebrae, but few studies have compared the structure of the spinal ligaments. The purpose of this study was to systematically quantify the collagen fibre orientation of the porcine and human interspinous ligament and thereby allow clearer interpretation of function. Human and porcine lumbar spine segments were loaded with a 10 Nm pure-flexion moment and chemically fixed. The sagittal plane collagen fibre orientation in the mid-lumbar interspinous ligaments was quantified by examining histological sections using a plane-polarized light macroscope and custom analysis software. The specimens showed collagen fibres in a posterior-cranial orientation originating from the superior aspect of the spinous process of the inferior vertebra and merging into the supraspinous ligament. There were not any statistically significant differences in interspinous ligament collagen fibre orientation between the human and porcine specimens. The middle and ventral spaces between the spinous processes of the human specimens contained loose disorganized collagen, skeletal muscle, and voids. The main load-bearing component of porcine and human interspinous ligament at the midlumbar level appears to be the dorsal portion, which is oriented at approximately 77-79 degrees with respect to the mid-disc plane. This dorsal aspect has a long moment arm and therefore is well suited to prevent excessive flexion. The similarity of the interspinous ligament morphology suggests that the porcine lumbar spine is a good model of the human lumbar spine.
Critical size defect model on the femur in rabbits
Authors: Balligand M. , Crigel M.-H.
Published: March 2018

The study purposed to elaborate a model of non-union to test a new biomaterial enhancing bone healing in large segmental defects. The authors’ concern was to develop a model of osteosynthesis capable of maintaining the stability of a femur that sustained a segmental defect. Also, they intended to determine the length of a defect that would create a nonunion. The madel was a 20-mm segmental bone defect coupled with an appropriate osteosynthesis in the rabbit femur. Two groups of rabbits underwent a mid-shaft ostectomy. Osteosynthesis was mode by two superposed holes 2-mm cuttable plates with cerclage wires. In one group, an additional intramedullary pin was inserted. The experiment lasted 16 weeks. The rabbits of the control group suffered fracture of the plates before the end of the experiment. The rabbits of the test group showed stability of the implants and nonunion of the defect. It was concluded that a mid-shaft segmental defect of 20 mm, coupled with an osteosynthesis combining plates, wires and intramedullary pin, is a valid critical size defect model in the rabbit femur.
Modification of the triangulation technique for arthroscopy of the canine shoulder joint using a new target device
Authors: Lehmann M. , Lehmann K.
Published: March 2018

A modified triangulation technique for arthroscopy of the canine shoulder joint to insert a working cannula in the caudal joint pouch is described. This technique is compared with the triangulation technique of Van Ryssen (10). With the modified triangulation the insertion angle for the working cannula into the caudal joint pouch was provided by a target device which was attached to the arthroscopic sleeve. Both methods were carried out on 60 dog cadavers and the differences were recorded in terms of various parameters: success (SUC), time (TI), number of trials (TR), position of the working cannula (POS), damage to articular cartilage (DAM), and force to remove the working cannula (FOR). The modified triangulation technique permits simpler, faster and less traumatic insertion of the working cannula into the caudal joint pouch.
The role of negative intra-articular pressure in the maintenance of shoulder joint stability in dogs
Authors: McLaughlin R. M. , Elder S. H. , Boyle C. R. , Silverman E. B. , Sidaway B. K.
Published: March 2018

The objective of this study was to evaluate the effect of negative intra-articular pressure on shoulder joint stability in canine cadavers. Cadaver forelimbs from 12 mature dogs were used. The forelimbs were placed in a testing frame and axially preloaded with 4 kg of weight. Shoulder joint stability was tested in flexion, extension, and neutral position before and after venting of the joint capsule. Humeral translation relative to the glenoid was induced by applying a 3 kg load in three different directions (cranial, lateral, and medial) and quantitatively measured by use of an electromagnetic motion tracking system. Peak translational data were compared in each joint position before and after venting of the joint capsule. After venting the shoulder joint capsule, a significant increase in translation was observed in the cranial direction with the joint in neutral position and in the medial direction with the joint in extension. The horizontal translations measured after venting of the joint capsule were likely not clinically relevant. Negative intra-articular pressure is not a major contributor to shoulder stability in dogs during weight-bearing.
Surgery plus chondroprotection for canine cranial cruciate ligament (CCL) rupture
Authors: Lacitignola L. , Miolo A. , Fanizzi F. P. , Crovace A.
Published: March 2018

Rupture of the cranial cruciate ligament (CCL) is one of the most frequent causes of lameness of the rear limb in the dog. Regardless of the type of treatment, CCL rupture inevitably leads to knee osteoarthritis (OA). The purpose of this study was to evaluate the efficacy of associating surgical treatment of spontaneous rupture of the CCL with a chondroprotector, that is called “supraadditive” because it is formulated to counteract not only chondrodegeneration, but also the oxidative and inflammatory processes of OA. The open-label controlled study used proton NMR spectroscopy to evaluate the synovial fluid of the stifle of 10 dogs with monolateral rupture of the CCL, selected for the study based on specific inclusive criteria. The dogs were assigned randomly into two groups. Five dogs received the supra-additive chondroprotector for 60 days, starting on the day after surgery. Five dogs only underwent surgical reconstruction of the CCL. The results were analysed with the ANOVA unstructured variance matrix-covariance test. The trend overtime of the synovial concentration of four metabolites (lactate, alanine, acetyl groups of N-acety-lated sugars on glycoproteins and alpha-anomers of glucose) was found to differ to a statistically significant extent between the two groups, suggesting that the supra-additive chondroprotector produces an intra-ar-ticular metabolic rebalance. The results support the adjuvant use of the chondroprotector in the management of CCL rupture, in view of its control of the OA changes that accompany this orthopaedic disabling condition.
New Uses of Plastination in Bone Histology
Authors: Eitel F. , Waldner H. , Brunner U. , Seibold R.
Published: March 2018

The plastination techniques, originally developed for macroscopy, were modified in order to prepare plasti-nated sections for microscopy. A particularly good penetration of the specimen occurred during the preparation of the histological section when the described techniques for freeze substitution, defatting and forced impregnation with resin were employed. The different polymer mixtures were compared, in order to determine their particular advantages and disadvantages. The sectioning technique and the use of histological stains were described both for the undecalcified, as well as decalcified bones. The production of a deplastinated thin section presents a particular problem which can be addressed by this method. The modified Spalteholz technique with decalcification of sections and “Nach-Plastination” was described for the preparation of plane-parallel standardized sections for morphometric examination of the vascular structure of the bone.

The possible uses of plastination, for running histological examination procedures such as fluorescence microscopy, microangiography and microradiography, were shown. The validity of different microangiographic techniques could be determined only through the use of the further-developed Spalteholz and plastination techniques. Thus, the plastination technique appears to be an especially useful procedure for the examination of microscopy specimens. It is recommended as well for other disciplines unrelated to bone, for example in pathology and anatomy.

The plastination is a very modern technique to produce anatomical teaching specimens and to prepare tissue very naturally without artefacts. Some technical modifications allow the transfer to histologic preparations including bone histology.
Holding Power of Orthopaedic Screws in Metacarpal and Metatarsal Bones of Young Calves
Authors: Jean G. , Roush J. K. , DeBowes R. M. , Gaughan E. M. , Kirpensteijn J.
Published: March 2018

The holding power and holding power per mm bone width of 4.5 mm and 5.5 mm cortical and 6.5 mm cancellous orthopaedic screws were obtained by tensile load-to-failure studies in excised metacarpal and metatarsal bones of young female Holstein calves. Holding power and holding power per mm bone width of 6.5 mm orthopaedic screws were significantly greater than those of 4.5 and 5.5 mm orthopaedic screws in the diaphysis and metaphysis. Significant differences were not detected between holding power and holding power per mm bone width of 4.5 and 5.5 mm orthopaedic screws. The holding power was not different between metacarpi and metatarsi. The limiting factor in all tests of holding power was the shear strength of the bone. We found that 6.5 mm orthopaedic screws have the greatest holding power in the metacarpal and metatarsal bones of young calves.

This study compares the holding power of 4.5 mm and 5.5 mm cortical and 6.5 mm cancellous orthopaedic screws in excised metacarpal and metatarsal bones from young female Holstein calves. We found that 6.5 mm orthopaedic screws have the greatest holding power.
Biomechanical Properties of the Stifle Joint Lateral Collateral Ligament in Dogs
Authors: Blackketter D. , Harari J , Dupuis J.
Published: March 2018

Bone/lateral collateral ligament/bone preparations were tested and structural mechanical properties compared to properties of cranial cruciate ligament in 15 dogs. The lateral collateral ligament has sufficient stiffness to provide stifle joint stability and strength to resist acute overload following fibular head transposition.
Dynamic Strain in the Canine Tibia: an in vivo Strain Gauge Analysis
Authors: Sumner-Smith G. , Schatzker J. , Hearn T. C. , Taves C. , Hoare I. , Matushek K. J.
Published: March 2018

Electrical resistance rosette strain gauges were bonded directly to the surface of the midshaft of the tibia in four dogs. In vivo strain recording were obtained using a telemetric system allowing the dog relatively free movement. During the stance phase of walking, the cranial surface was mainly in tension while the caudal surface was mainly in compression. The pattern of strain recorded is consistent with craniocaudal bending superimposed on external torsion at the stifle.
Polymethylmethacrylate: a Review of the Implications and Complications of its Use in Orthopaedic Surgery
Authors: Anderson G. I.
Published: March 2018

Polymethylmethacrylate has application in the fixation of endoprostheses and void-filling in reconstructive and neurological surgery in both veterinary and human surgery. It also has extensive dental and ophthalmic applications. Literature detailing the nature of the bone/cement interface is reviewed along with the local effect of polymethylmethacrylate on bone and cartilage. The repercussions of the cellular effects of polymethylmethacrylate on the development of loosening are discussed. The immunosuppressive effects of polymethylmethacrylate to the patient are outlined. A review of the cardiovascular, pulmonary and hepatic toxicity problems of polymethylmethacrylate is included. Contact sensitisation of the user is briefly discussed in conclusion.
Quadriceps Contracture in Four Cats: a Complication of Internal Fixation of Femoral Fractures
Authors: Binnington A. G. , Fries Cindy L. , Cockshutt Joanne R.
Published: March 2018

In a series of twenty-two cats with femoral fractures repaired by internal fixation, four cases of quadriceps contracture (18.2%) were observed. Each case of contracture involved a midshaft fracture with extensive soft tissue injury. Repair with intramedullary pins and cerclage wires had been performed in each case. Exuberant callus production was noted in two cases, while in another quadriceps contracture followed injury to the ischiatic nerve. Contracture was evident two weeks postoperatively. Physiotherapy proved ineffective and surgical intervention was not undertaken as all cases were weightbearing on the affected limb.
Multiple Enchondromatosis in the Dog
Authors: Krauser K.
Published: March 2018

Data is presented of the post-mortem macroscopic and microscopic examination of two Toy Poodles with multiple enchondromatosis (Oilier syndrome). In both animals opening and maturation disorders of the growth plates were found in several skeletal locations. Due to the dogs’ age difference at necropsy (14 and 4 months), some variation was also present in occurrence and appearance of primary and secondary alterations, which gave rise to some conclusions regarding development and progression of the disease. Chondrodysplasia, a characteristic of several breeds, is considered to be the essential factor in the pathogenesis of multiple enchondromatosis in the described cases.
Chronischer Tinnitus
Authors: Landgrebe M. , Langguth B. , Kreuzer P. M.
Published: March 2018

Eine Geräuschwahrnehmung ohne externen akustischen Stimulus wird als Tinnitus bezeichnet. Besonders durch Begleiterkrankungen des affektiven Spektrums kann chronischer Tinnitus zur Reduktion der Lebensqualität führen. Es existiert derzeit kein “Königsweg” bei der Behandlung von Tinnitus, jedoch sollte dies keinen Anlass zur Hilflosigkeit auf Seiten des Therapeuten darstellen. Vielmehr sind allgemeine therapeutische Optionen verfügbar, welche sich mit geringem Aufwand in die tägliche Praxis integrieren lassen. Behandlungsansätze erstrecken sich vom beratenden therapeutischen Gespräch über kognitive Verhaltenstherapie, Neurofeedback-Methoden und neuromodulatorischen Techniken bis hin zur pharmakologischen Behandlung, die besonders bei tinnitusassoziierten Symptomen wie Schlafund Konzentrationsstörungen indiziert sein kann. Aufgrund der zunehmenden Evidenz für die Beteiligung zentralnervöser Strukturen an der Pathogenese von chronischem Tinnitus sowie der hohen Komorbidität mit genuin psychiatrischen Krankheitsbildern, wie Depression und Angsterkrankungen, bestehen gute Gründe für Nervenärzte, sich eingehender mit Tinnitus zu beschäftigen.
Internetbasierte psychologische Behandlungen bei Depressionen und Angststörungen
Authors: Moritz S. , Berger T. , Klein J. P.
Published: March 2018

Internetbasierte psychologische Behandlung gewinnt zunehmend an Bedeutung und wird intensiv beforscht. Vorteile dieser Form der Behandlung sind die leichte Verfügund Vervielfältigbarkeit. Grenzen werden beispielsweise in Krisensituationen der Patienten erreicht. Internetbasierte psychologische Interventionen werden eingeteilt nach der Intensität des therapeutischen Kontaktes, dem zugrunde liegenden Therapieansatz und der medialen Gestaltung der Intervention. Es liegen zahlreiche Studien und Metaanalysen zur Wirksamkeit internetbasierter psychologischer Behandlungen bei Angststörungen und Depression vor. Allerdings wurden die meisten Studien bei selbstselegierten Patientenstichproben außerhalb der Routineversorgung durchgeführt. Bei diesen Patienten haben sich insbesondere internetbasierte Interventionen, die einen therapeutischen Kontakt beinhalten (z. B. therapeutengeleitete Selbsthilfeprogramme), in vielen Studien als wirksam erwiesen. In Zukunft sollte vermehrt der Einsatz internetbasierter Interventionen in der Routineversorgung erforscht werden.
Simulation Based Analysis of Automated Classification of Medical Images
Authors: Adler W. , Hothorn T. , Lausen B.
Published: March 2018

Objectives:
The ability of various classifiers to discriminate between normal and glaucomatous eyes based on features derived from automated analysis of laser scanning images of the eye background is investigated.

Methods:
To compare the classifiers without over-optimization for a given dataset, we use a simulation model to create topography images. We designed three different simulation setups as model of extreme situations and medical subgroups.

Results:
Neither linear nor tree-based classifiers are ideal for all setups. The most robust performance is obtained by a combination of both, so-called Double-Bagging. Classification of real data from a case-control study shows best results with Double-Bagging. All results obtained with the analysis method extracting features automatically are worse than those obtained by the same classifiers but with features derived from an analysis method that requires intervention of a physician.

Conclusions:
Robust classification results for classification of laser scanning images obtained with the Heidelberg Retina Tomograph are achieved by combined classifiers. The examined automated procedure causes an increased misclassification error compared to the established clinical routine requiring an expert physician’s intervention.
Approaches and Informatics Tools to Assist in the Integration of Similar Clinical Research Questionnaires
Authors: Cohen D. B. , Shifman M. A. , Miller P. L. , Nadkarni P. M. , Frawley S. J. , Brandt C. A.
Published: March 2018

Objective:
The integration of similar clinical research questionnaires is a complex process that can benefit from informatics approaches and tools that provide a systematic structure for performing mapping and integration. This systematic approach is necessary to address complex issues in integration such as data heterogeneity, differing levels of granularity of questions and responses, and other issues involving semantic differences. Informatics tools and approaches have been successfully applied to various standard clinical vocabulary integration processes but not for questionnaire integration or mapping.

Methods:
A systematic approach to questionnaire integration was developed in the context of a collaboration of researchers using Trial/DB, a database designed to support clinical research. This approach was applied to the integration of questionnaires involving breast cancer risk factors from each of three research sites.

Results:
From 375 questions on the three original questionnaires, we identified 65 concepts that were measured by two or three of the sites. An algorithm was developed and used to formalize the process of mapping questions and answers across the questionnaires. The approach was applied to previously collected data and prospective data in disparate database systems to import and merge the data from these three sites into Trial/DB.

Conclusion:
Informatics tools that support a systematic approach to mapping questionnaires can be used throughout the research process from questionnaire integration and creation, legacy data integration to data library maintenance and curation.
Demand-driven Evolution of IT Systems in Healthcare
Authors: Buessecker F. , Herlofsen H. , Hinrichs F. , Zeiler T. , Kuhn K. A. , Lenz R.
Published: March 2018

Objectives:
To analyze and to optimize interdisciplinary clinical processes, to introduce an IT-supported model for demand-driven system evolution in healthcare, and to demonstrate the feasibility of the approach for a clinical example and to present an evaluation.

Methods:
System evolution and change management are viewed as two sides of the same coin, thus formal methods for process analysis and IT system evolution were embedded into a goal-oriented change management model. Based on a process model, a Failure Mode and Effects Analysis (FMEA) and a computer simulation were performed. A tool for rapid application development (RAD) was used to incrementally improve the healthcare information system according to newly arising needs.

Results:
Each of the formal methods used contributed to the successful reorganization of the interdisciplinary clinical process. An evaluation demonstrated significant improvements. An integrated IT application was implemented to support the optimized process.

Conclusions:
Process improvement is feasible and effective when formal methods for process analysis and requirements specification are used in a reasonable and goal-oriented way. It might be necessary to trade off costs and benefits or simplify a given method in the context of a particular project. As the same information is utilized in different tools, it is supposed that the efforts for process analysis, documentation and implementation of adapted applications could be reduced if different tools were integrated and based on a single coherent reference model for description of clinical processes.
A Methodological Framework for the Conversion of Procedure Classifications
Authors: Dahmen B. , Drösler S. , Stausberg J.
Published: March 2018

Objectives:
During the adaptation of the Australian Refined Diagnosis Related Groups for Germany mapping tables between procedure classifications were needed. The mapping between the German OPS-301 2.0 and the Australian MBS-Extended should transfer the Australian expertise by keeping a well-established terminology system.

Methods:
A methodological framework for the development of mapping tables had been developed based on the model for representation of semantics provided by the European Committee of Standardization. Two approaches were used; the concept-based approach from OPS-301 2.0 to MBS-Extended and the class-based approach the other way round. A conversion had to be identified between 23,160 classes of the OPS-301 2.0 and 6,328 classes of the MBS-Extended in two asymmetrical mapping tables.

Results:
The class-based approach leads to a low number of 6,980 conversions but misses 82.6% of the classes of the OPS-301. Because of domain incongruencies and missing domain completeness of the OPS-301 2.0 for non-operative procedures 15.7% of the MBS-Extended-classes remain without conversion. The concept-based approach leads to a slightly higher mean number of conversions per class of 1.35 in comparison to 1.31 with the class-based approach. But it was possible to find conversions for 99.5% of the OPS-301 2.0-classes. 16.3% of the DRG-relevant classes of the MBS-Extended were missed.

Conclusions:
The class-based approach was not useful, because the MBS-Extended is significantly broader than the OPS-301 2.0. An external validation study for the direction OPS-301 2.0 to MBS-Extended revealed a satisfactory quality. The empirical and the reference-based approach are important alternatives to the ones used in this project. There are clear criteria about the appropriate application area for the methodological approaches presented here.
AdaptFlow: Protocol-based Medical Treatment Using Adaptive Workflows
Authors: Mueller R. , Rahm E. , Ramsch J. , Heller B. , Loeffler M. , Greiner U.
Published: March 2018

Objectives:
In many medical domains investigator-initiated clinical trials are used to introduce new treatments and hence act as implementations of guideline-based therapies. Trial protocols contain detailed instructions to conduct the therapy and additionally specify reactions to exceptional situations (for instance an infection or a toxicity). To increase quality in health care and raise the number of patients treated according to trial protocols, a consultation system is needed that supports the handling of the complex trial therapy processes efficiently. Our objective was to design and evaluate a consultation system that should 1) observe the status of the therapies currently being applied, 2) offer automatic recognition of exceptional situations and appropriate decision support and 3) provide an automatic adaptation of affected therapy processes to handle exceptional situations.

Methods:
We applied a hybrid approach that combines process support for the timely and efficient execution of the therapy processes as offered by workflow management systems with a knowledge and rule base and a mechanism for dynamic workflow adaptation to change running therapy processes if induced by changed patient condition.

Results and Conclusions:
This approach has been implemented in the AdaptFlow prototype. We performed several evaluation studies on the practicability of the approach and the usefulness of the system. These studies show that the AdaptFlow prototype offers adequate support for the execution of real-world investigator-initiated trial protocols and is able to handle a large number of exceptions.
Genomic Profiling
Authors: Mansmann U.
Published: March 2018

Objectives:
The current literature on the use of micro-arrays to generate prognostic profiles is still a methodological wasteland. Many valid questions, such as how profiling studies should be evaluated and what conclusions can be drawn, remain unanswered. Or how can flaws in the collection, analysis and interpretation of data be detected? Undiscovered imperfections can lead to a waste of valuable resources as well as be a latent source of false conclusions.

Methods:
Three seminal papers on the prognosis of breast cancer using genomic profiling will be discussed. Six principles of good experimental design will be used for methodological guidance: defining relevant endpoints, avoiding systematic bias, generalizability of results, appropriately sized samples to achieve sufficient power, simple design to improve interpretability, and avoiding artificial assumptions.

Results:
Severe violations of at least one of the six principles of good experimental design can be found in each of the three papers. A strategy is presented to assess whether a study has achieved a high level of methodological quality. This strategy also helps to establish a suitable protocol for future profiling projects.

Conclusions:
Determining the design of a study in a protocol is a first step to avoid impending pitfalls. The protocol should deal with the problem of understanding the complex reality behind genomic profiling. There are basic guiding principles which can help handle the complex task of designing prognostic studies to find genomic signatures.
Computationally Efficient Noninvasive Cardiac Activation Time Imaging
Authors: Pfeifer B. , Seger M. , Hintermüller C. , Hanser F. , Modre R. , Tilg B. , Trieb T. , Kremser C. , Roithinger F. X. , Hintringer F. , Fischer G.
Published: March 2018

Objective:
The computer model-based computation of the cardiac activation sequence in humans has been recently subject of successful clinical validation. This method is of potential interest for guiding ablation therapy of arrhythmogenic substrates. However, computation times of almost an hour are unattractive in a clinical setting. Thus, the objective is the development of a method which performs the computation in a few minutes run time.

Methods:
The computationally most expensive part is the product of the lead field matrix with a matrix containing the source pattern on the cardiac surface. The particular biophysical properties of both matrices are used for speeding up this operation by more than an order of magnitude. A conjugate gradient optimizer was developed using C++ for computing the activation map.

Results:
The software was tested on synthetic and clinical data. The increase in speed with respect to the previously used Fortran 77 implementation was a factor of 30 at a comparable quality of the results. As an additional finding the coupled regularization strategy, originally introduced for saving computation time, also reduced the sensitivity of the method to the choice of the regularization parameter.

Conclusions:
As it was shown for data from a WPW-patient the developed software can deliver diagnostically valuable information at a much shorter span of time than current clinical routine methods. Its main application could be the localization of focal arrhythmogenic substrates.
Improving Model Robustness with Bootstrapping
Authors: Le Teuff G. , Venot A. , Walter E. , Coste J. , Quantin C.
Published: March 2018

Objective:
Recent results published by Coste et al. in discriminant analysis with ordinal responses showed the superiority of optimal discriminating analysis for ordinal responses (ODAO) both in terms of classification and simplicity of implementation compared to classic methods (Fisher’s discrimination, logistic regression) applied to medical data (prognostics of burns) and to simulated data. Nevertheless, the solutions obtained by ODAO may be sensitive to re-sampling (i.e the estimated coefficients by ODAO may show excessive sensitivity to the training sample). This study proposes some solutions to control the fluctuations of sampling and to ensure model stability.

Methods:
We used intensive computational methods and bootstrapping, at the outset of model building in order to reduce the sampling variability of estimated coefficients. Thus, the estimation of the coefficients was not based on the minimization of a classification criterion of the training sample, but on the minimization of an aggregate criterion of bootstrapped replications of a classification criterion. Five aggregate criteria were studied.

Results:
The improvement in terms of robustness appeared in 30% of the test cases with moderate training sample size and 55% of those with small training sample size.

Conclusion:
Simulated test cases showed that bootstrapping can help construct more robust models in difficult classification situations and small training samples which are particularly frequent.
Putting the Pieces Together: Using “Off-The-Shelf” Software to Safely Transfer Medical Data
Authors: Göttler M. , Zinnhobler K. , Hasford J. , Swoboda W. J.
Published: March 2018

We describe a new computer-based, network-driven system for administering, transferring, and evaluating reports of spontaneous adverse drug reactions and serious adverse events. The system consists of three regional centers, one coordinating center, and a central database at the national drug regulatory authority. In view of its high level of data security, reliability, easy expandability, and inexpensiveness due to the use of standard shareware products, the system can serve as a model for a clinical health information network.
Toward a Framework for Computer-Mediated Collaborative Design in Medical Informatics
Authors: Kaufman D.R. , Allen V.G. , Shortliffe E.H. , Cimino J.J. , Greenes R.A. , Patel V.L.
Published: March 2018

The development and implementation of enabling tools and methods that provide ready access to knowledge and information are among the central goals of medical informatics. The need for multi-institutional collaboration in the development of such tools and methods is increasingly being recognized. Collaboration involves communication, which typically involves individuals who work together at the same location. With the evolution of electronic modalities for communication, we seek to understand the role that such technologies can play in supporting collaboration, especially when the participants are geographically separated. Using the InterMed Collaboratory as a subject of study, we have analyzed their activities as an exercise in computer- and network-mediated collaborative design. We report on the cognitive, sociocultural, and logistical issues encountered when scientists from diverse organizations and backgrounds use communications technologies while designing and implementing shared products. Results demonstrate that it is important to match carefully the content with the mode of communication, identifying, for example, suitable uses of E-mail, conference calls, and face-to-face meetings. The special role of leaders in guiding and facilitating the group activities can also be seen, regardless of the communication setting in which the interactions occur. Most important is the proper use of technology to support the evolution of a shared vision of group goals and methods, an element that is clearly necessary before successful collaborative designs can proceed.
Rescuing the Emergency – Multiple Expertise and IT in the Emergency Field
Authors: Darcy S. , Dardelet B.
Published: March 2018

Objectives: The rapid growth, both in technical and social approaches to the innovation phenomenon in health care suggests that profound changes are occurring. The focus of the project was to evaluate these changes through the case study of the French emergency field.

Methods: The consequences of information technology implementations in the Emergency Services are presented as models to investigate the importance of technical expertise, with both the involvement of all the stakeholders from the beginning of the design and the test of the new tool in real settings.

Results and Conclusion: A new form of work resulted for the management of the crisis, which questioned the status of the actors and their actions, and the characteristics of the protocols of rescue. The outcome of this project was a new model built for the rescue of the emergency field which encompasses alternative forms of expertise.