bluuebunny/crossref_metadata_2025 huggingface dataset:
Destabilization in external skeletal fixation finite element method evaluation
Authors: Evans M. D. , Lauer S. K. , Aron D. N.
Published: March 2018

Destabilization is a concept of pursuing gradual staged disassembly of external skeletal fixators (ESFs) intending to increase only axial loading of the fracture while controlling non-axial loading. The purpose of this study was to determine how destabilization alters loading at the fracture site. The destabilization of a Type III to a Type Ia and Ib ESF was analyzed with the Finite Element Method (FEM) for five callus stages (0%, 0.1%, 10%, 50%, 100% modulus of elasticity of intact bone) for axial compression, torsion, and bending. Axial gap strain (A) comprising the linear displacement along the longitudinal bone axis, the remaining degrees of gap strain (R) comprising all other rotational and linear displacements and the R/A ratio were calculated. In the presence of the callus stages 0% and 0.1%, the R/A ratio ranges between 0.1 and 0.3. Destabilization increases A by two to18 fold and R by five to 41 fold. In the presence of the callus stages 10%, 50% and 100%, the R/A ratio ranges between 1 and 3.2. Destabilization increases A by 2% -15%, and R by 15% -176%. A decrease in the ESF stiffness correlates with an increase of R, A and the R/A ratio. We proposed that the clinical benefits of destabilization might be mechanically based on optimization of the R/A ratio and not of axial strain.
Treatment of radius, ulna and humerus fractures with the aid of a bone morphogenetic protein in a giant anteater (Myrmecophaga tridactyla)
Authors: Futema F. , Fedullo D. L. , Kyan V. , Fantoni D. , Baccarin D. C. B. , Romano M. A. , Ferrigno C. R. A.
Published: March 2018

A giant anteater (Myrmecophaga tridactyla) was found with closed comminuted fractures on the right radius and ulna and left humerus the duration of which was unknown. The animal was unable to use either of the thoracic limbs. The fractures were stabilized with 3.5-mm titanium plates and a commercially available mixture of micro lyophilized bovine cortical osseous and bovine BMP (Gen-tech®, Baumer, Brazil) was implanted into the fractures sites. Postoperative radiographic evaluations were performed every 30 days and after four months. Bone healing was observed in all of the fractures. The animal was able to be reintroduced into its natural habitat. From this case we conclude that despite the low metabolic rate of the giant anteater, which is an inherent characteristic of this species, the treatment of radius, ulna and humerus fractures by means of plates and screws, associated with BMP on the Myrmecophaga tridactyla, was a success.
Prostatakarzinom: Cabazitaxel könnte Lücke in der 2nd-Line-Therapie schließen
Authors: Henning Peter
Published: March 2018

Prostatakrebs ist mit 26% mittlerweile die häufigste Krebserkrankung bei Männern (1). 2006 erkrankten in Deutschland 60 120 Männer an einem Prostatakarzinom. Das RKI erwartet für 2010 bereits 64 370 Erkrankungsfälle. Das P-Ca überbietet somit das Mammakarzinom bei Frauen (57 970 Neuerkrankungen in 2006). Mit dem neuartigen Taxan Cabazitaxel zeichnet sich erstmals eine 2nd-line-Therapie für Patienten ab, die während oder nach einer Chemotherapie mit Docetaxel in einen Erkrankungsprogress kommen.
Unerwartete Rückschläge lassen aufhorchen: Licht und Schatten in der Tumortherapie
Authors: Kretzschmar Alexander
Published: March 2018

Das Motto und Versprechen des diesjährigen ASCO-Kongresses in Chicago Advancing Quality Through Innovation” wurde nur teilweise eingelöst. Ungewohnt für die erfolgsverwöhnten Onkologen, mussten sie einige negative Studien im fortgeschrittenen Stadium der klinischen Prüfung in der neuen Trendindikation NSCLC hinnehmen. Brillieren konnte dagegen mit der Dermatologie eine Indikation, die lange vom therapeutischen Fortschritt vernachlässigt wurde. Die vielen Studien zu spezifischen Therapiemarkern markieren nachdrücklich, dass der Einsatz neuer zielgerichteter Therapien – auch unter dem Eindruck des wachsenden ökonomischen Drucks – nur bei einer guten Selektion der dafür geeigneten Patientenpopulation erfolgversprechend ist.
Mehr Lebensqualität durch Fixkombination aus retardiertem Oxycodon und retardiertem Naloxon: Schmerztherapie wichtiger Pfeiler in der Supportivtherapie
Authors: Kretzschmar Alexander
Published: March 2018

Die Effektivität einer Schmerztherapie wird vom Patienten daran gemessen, ob sie seine Lebensqualität verbessert. Gemessen an diesem Kriterium gibt es noch erhebli-chen Nachholbedarf, resümierte Dr. Stephan Schulz, Witten, auf dem 15. Münchener Fachpresse-Workshop Supportivtherapie in der Onkologie“. Von der Fixkombination aus retardiertem Oxycodon und retardiertem Naloxon (Targin®) profitieren auch viele Patienten, die vorher über unzureichende Wirksamkeit oder Unverträglichkeiten klagten. Schulz: Wir wollen Patienten, die wieder ihre Sozialkontakte pflegen können.“
Chronische myeloische Leukämie: Neue Option in der Erstlinientherapie bei der CML
Authors: Eimer Martina
Published: March 2018

Der Tyrosinkinaseinhibitor (TKI) Imatinib hat sich als Standard in der Erstlinientherapie der chronischen myeloischen Leukämie (CML) etabliert. Die neuen Daten vom diesjährigen ASCO belegen, dass der TKI Nilotinib, der bisher in der Zweitlinientherapie eingesetzt wurde, Patienten mit neu diagnostizierter CML signifikant besser vor einer Progression schützt als die bisherige Standardtherapie, so Prof. Andreas Hochhaus, Jena.
Therapietreue unter gezielter Therapie: Die Sicht von Patientinnen
Authors: Bubenzer Rainer H.
Published: March 2018

In dem Maße, wie Krebs – zum Beispiel durch gezielte Therapien oder Therapie-Individualisierung – immer öfter zu einer chronischen Krankheit mit steigender Lebenserwartung wird, rückt das Problem der Non-Compliance in den Vordergrund – und kann Therapieerfolge besonders von Langzeitüberlebenden bedrohen. Eine Krebspatientin, die diese Problematik in jahrelanger und intensiver Auseinandersetzung mit ihren behandelnden Ärzten durchlebt hat (und die anonym bleiben möchte), beantwortet Fragen zur Therapietreue unter gezielten Therapien entsprechend ihrer Erfahrungen.
How to choose PET-CT or CT in the diagnosis and staging of lung cancer
Authors: Tao X. , Liu H. , Jiang T. , Zheng X. , Liu S.
Published: March 2018

Purpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT. Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean
Prediction of lymph node metastase in NSCLC
Authors: Beyer F. , Buerke B. , Gerss J. , Scheffe K. , Puesken M. , Weckesser M. , Schober O. , Heindel W. , Wessling J.
Published: March 2018

Purpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT.

Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean
Third metacarpal bone mineral density assessment in the standing horse by dual X-ray absorptiometry
Authors: Delguste C. , Perona G. , Lebecque P. , Duboeuf F. , Lepage O. , Martin-Rosset W. , Donabedian M.
Published: March 2018

Bone mineral density (BMD) is correlated to mechanical properties of bone. In the horse, dual energy X-ray absorptiometry (DXA) has yet only been performed ex-vivo, but a new portable DXA device would be ideal for in-vivo BMD measurement. We explored field suitability, precision and accuracy of this device for in-vivo third metacarpal density assessment. Precision was analysed by calculating measurement variation under repeated measurement tests with (reproducibility) and without (repeatability) limb repositioning. Repeatability and reproducibility were tested ex-vivo, at the same time that intra- and inter-operator reproducibility were assessed in-vivo. In order to test accuracy, bone mineral content (BMC) of several bone samples determined by DXA and ashing were compared. Repeatability was 1.47% and reproducibility 1.69% ex-vivo. In-vivo reproducibility varied between 2.91 and 4.06% for intraoperator test and between 3.13 and 5.53% for interoperator test. BMC measured by DXA and ash weight were highly correlated (R2>0.99). In conclusion, under described conditions this DXA device is usable, accurate and precise. Its sensitiveness reaches 8.23% in an individual longitudinal monitoring. Using the third metacarpal bone as an example, we have shown that this device is suitable for experimental or clinical monitoring.
Biomechanical evaluation of a veterinary suture anchor in the canine cadaver pelvis and femur
Authors: Pijanowski G. , Wiley R. , Johnson A. L. , Siegel A. M. , Singer M. J.
Published: March 2018

A commercially available veterinary suture anchor was tested in the acetabula and femurs of canine cadavers. Size #2 suture anchor constructs were compared to a traditional screw and Teflon spiked washer constructs in a model of coxofemoral luxation repair. The screw/washer constructs failed at a higher maximum load than the #2 anchor constructs. In the acetabulum, significant differences in strength were also found in the position of the implant and in the direction of pull. The constructs in a more caudal position, and constructs pulled 90 degrees to the axis of insertion, failed at higher loads. The predominant mode of failure of the constructs was a suture failure. In the femur, size #5 suture anchors were used in a model of cranial cruciate ligament repair and collateral ligament repair. The anchor constructs failed predominantly by anchor pull-out in the distal femur. The constructs pulled 90 degrees to the axis of insertion were stronger than constructs pulled at 0 degrees to the axis of insertion. Varying the location of the implant in the femur did not affect the maximum load to failure.
Arthrodesis of the talocalcaneal joint for the treatment of two horses with talocalcaneal osteoarthritis
Authors: Adams S. B. , Blevins W. B. , Pauwels F. E.
Published: March 2018

Two horses with lameness due to talocalcaneal osteoarthritis that failed to respond to conservative management were treated by talocalcaneal arthrodesis using cortex screws placed in lag fashion. The affected joint of one horse was arthrodesed by compressing and stabilizing the medial facet of the joint with three screws. In the second horse, the medial and lateral facets of the affected talocalcaneal joint were each compressed and stabilized with two screws. The lameness of both horses improved markedly following surgery.
Transient benign osteopetrosis in a calf persistently infected with bovine virus diarrhoea virus
Authors: Spiess A. , Hilbe M. , Sterr K. , Reiser M. , Matis U. , Nuss K.
Published: March 2018

A two-day-old Simmental calf was admitted suffering from a fracture of the right femur. The radiographs showed striking changes in all bones, evident as alternating zones of dense and less dense tissue (bone-inbone) in the right femur and striped densities in the vertebral bodies. A stainless steel plate was used to repair the fracture, which healed well. The calf developed normally but was diagnosed as persistently infected with bovine virus diarrhoea (BVD) virus. It was kept in isolation and examined physically and radiographically during the following 13 months. The radiographic changes diminished during the first three months and at 13 months were barely visible. The animal was euthanatized, and immunohistochemistry revealed BVD virus antigen in numerous tissues. The radiographic abnormalities seen in this case are similar to those of the transient form of osteopetrosis in humans. Osteopetrosis in humans is currently thought to have a genetical cause, whereas it appears to be associated with viral disease in animals.
Performance of a composite flow moulded carbon fibre reinforced osteosynthesis plate
Authors: Wieling R. , Magerl F. , Schneider E. , Steiner A. , Rohner B.
Published: March 2018

Non-metallic implants have the advantage over metallic implants of reduction in artefact with CT and MR diagnostic imaging. In-vivo performance of a carbon fibre reinforced polyetheretherketone radiolucent plate (Snake Plate [SP]) with high stiffness, and fixed angle converging screws was compared with a seven-hole titanium Locking Compression Plate (LCP), using a sheep tibial osteotomy model (gap 0.6 mm). The sheep were divided into two groups, and the osteotomies were stabilized with a SP (n=6) or a LCP (n=6). The callus dimensions were measured radiographically at zero, two, four, six and eight weeks. The animals were euthanatized after eight weeks. Osteotomised and contralateral tibiae were tested in pairs torsion, to determine strength and stiffness. In the radii of six separate sheep, initial vascular disturbance after plate implantation was evaluated. All of the sheep of the SP and LCP groups showed maximal callus areas at six weeks. The differences between the groups, in callus dimension, were not significant at any time point. The median values for relative reduction (100 x [operated – contralateral] / contralateral) in strength of osteotomized tibiae was ™13.93% for the SP group and ™7.49% for the LCP group (p = 0.5228), and for stiffness it was ™24.44 % for the SP group and ™27.08% for the LCP group (p = 0.6481). Neither the SP nor LCP caused any notable disturbance in periosteal circulation. The SP appears to represent a valuable alternative to metallic implants for shaft fracture repair. The main advantages of the SP are radiolucency, high deformation resistance, internal fixator concept and converging screw configuration for optimal loading conditions in the bone-implant construct.
Comparison of anatomical tibial plateau angle versus observer measurement from lateral radiographs in dogs
Authors: Sanders M. , Guitan J. , Pead M. , Grierson J.
Published: March 2018

This study was conducted to compare the anatomical tibial plateau angle (TPA) with that measured by observers from a lateral radiograph of the limb, the hypothesis being that there would not be any statistically significant differences between the observer measured TPA and the true anatomical TPA. Twelve pelvic limbs from skeletally mature greyhound cadavers, without any clinical or radiographic evidence of stifle pathology, were used in this study. The radiographs were taken of each limb in a lateral position with the primary beam centered over the tibial eminences and collimated to include the stifle and tarso-crural joints. For subsequent radiographs, Kirschner wires were inserted to enable identification of the tibial plateau. The TPA was then measured, by three observers, from the plain radiographs and by one observer from the marked radiographs. The mean observer TPA was 24.4° (range 17–30°) and the mean anatomical TPA was 23.8° (range 15–31°). The mean and median discrepancy between the anatomical TPA and the observer TPA was negative and very small (− 0.64° and 0°). The magnitude of the discrepancy between individual measurements made by the observers tended to overestimate small angles and underestimate the large ones, and this trend is statistically significant. These results suggest that the measurements made by observers accurately represent the anatomical slope of the tibial plateau. Therefore, observer TPA is suitable for the planning and assessment of TPLO procedures. However, as the anatomical TPA moves away from a median angle (23.25°) the magnitude of error in the measurement increases.
In vivo axial dynamization of canine tibial fractures using the Securos external skeletal fixation system
Authors: Gorman S. C. , Kraus K. H. , Keating J. H. , Tidwell A. S. , Rand W. M. , Parkington J. D. , Boudrieau R. J.
Published: March 2018

Bilateral transverse mid-shaft tibial osteotomies, with a 4-mm gap, were performed in purpose-bred research dogs and stabilized using a Securos™ Type 2 external skeletal fixator (ESF). Full (100%) axial dynamization of one randomly selected ESF in each dog was performed at 31 days postoperatively. Caudo-cranial radiographs were obtained at weekly intervals, which were qualitatively and quantitatively evaluated (densitometry and ImageJ analysis). The dogs were euthanatized 13 weeks postoperatively, at which time dual energy x-ray absorptiometry (DEXA), peripheral quantitative computed tomography (pQCT), mechanical testing in torsion, and qualitative histological analysis were performed. A two-tailed paired Student's t-test was performed for statistical analysis of all parameters of interest, with significance set at p<0.05. Three of five dynamized bones bridged quicker, and four of five dynamized bones appeared to have greater callus formation, however, statistically significant differences could not be definitively determined. Statistically significant differences were not found with densitometry (any time frame), DEXA, pQCT, torsional stiffness or maximum torque. Despite the lack of statistically relevant data, trends were observed with larger callus size and density in the dynamized tibiae. The dynamized tibiae appeared to fracture more consistently outside of the area of the healing callus as compared to the control tibiae. Histological evaluation showed greater remodelling in four of five control limbs when compared to the dynamized limb. Dynamization at 31 days postoperatively may delay bone remodelling, despite a trend towards a larger callus size. The results of this study failed to show a definitive role for early full axial dynamization.
Use of the ComPact UniLock System for ventral stabilization procedures of the cervical spine
Authors: Steffen F. , Montavon P. M. , Voss K.
Published: March 2018

This study evaluates clinical application of the ComPact UniLock™ systema for ventral stabilization of the cervical spine. Patient material included 13 consecutive cases, 12 dogs and one cat, with cervical spinal instabilities secondary to disc-associated wobbler syndrome (six dogs), traumatic, iatrogenic, and disc-associated cervical spinal instability of small dogs (four cases), cervical spinal fractures (one dog and one cat), and congenital atlantoaxial instability (one dog). The 2.0 system was used in smaller patients and the 2.4 system was applied in large dogs. Implant failure was observed on follow-up radiographs in one dog with a healed C2 fracture and screw pullout occurred in one dog with caudal cervical spondylomyelopathy, necessitating revision surgery. Implants remained stable throughout the follow-up period in the other cases. ‘Good’ or ‘ excellent’ clinical outcome was achieved in 12 patients, including the dog with revision surgery. One dog had to be euthanatized due to postoperative deterioration of neurological status and development of pneumonia. The ComPact UniLock system was found to be a suitable implant for treating cervical instabilities of different origin in both small and large patients with lesions from C1/C2 to C6/C7. Some problems were encountered in the dogs with disc-associated Wobbler syndrome, such as lack or slow rate of vertebral fusion and partial collapse of the distracted intervertebral space on follow-up radiographs. A lack of adequate fusion was most likely related to grafting techniques used.
Outcome and prognostic factors in nonambulatory Hansen Type I intervertebral disc extrusions: 308 cases
Authors: Allen D. A. , Schertel E. R. , Barnhart M. D. , Wilson E. R. , Lineberger J. A. , Klocke N. W. , Lehenbauer T. W. , Ruddle T. L.
Published: March 2018

Thoracolumbar intervertebral disc disease is the most common cause of caudal paresis in dogs (1). Whilst the pathogenesis of the extrusion has been widely studied, treatment protocols and prognostic factors relating to outcome remain controversial. Recent studies have examined a multitude of factors relating to time to regain ambulation after decompressive surgery. Most intervertebral disc herniations occur in the thoracolumbar region, causing upper motor neuron signs in the rear limbs, which are thought to have a more favourable prognosis compared to the lower motor neuron signs created by herniation of an intervertebral disc in the caudal lumbar region. Due to the potential disruption of the lumbar intumescence, lower motor neuron signs have been reported as having a less favourable prognosis. The purpose of this study was to evaluate the intervertebral disc space as a prognostic factor relating to ambulatory outcome and time to ambulation after decompressive surgery. Hansen Type I intervertebral disc extrusions were studied in 308 non-ambulatory dogs. Preoperative and postoperative neurological status, corticosteroid use, signalment, intervertebral disc space, postoperative physical rehabilitation, previous hemilaminectomy surgery, disc fenestration, return to ambulation, and time to ambulation were reviewed.
The Role of the External Bar in a 6-Pin Type 1 External Skeletal Fixation Device
Authors: Polio F. E. , Hyman W. A. , Hulse D. A.
Published: March 2018

External skeletal fixation devices are commonly used in human and veterinary orthopedics. Although external fixators have proven useful over the years, their use is still associated with complications. The most frequently encountered complication is premature pin loosening with or without pin tract infection. Occasionally, implant failure involving the transla tion pins, pin clamps or external bar is seen. Each of these complications can contribute to patient morbidity through poor limb use, pain, loss of fracture reduction, and delayed unions or nonunions. A more thorough understanding of the biomechanics of external fixation devices may reduce the incidence of complications and associated patient morbidity. The objective of this study was to determine the role of the external connecting bar in a 6-pin type 1 external skeletal fixation device with respect to the forces transmitted to the surrounding bone for an axial load on the bone.

The methods used were finite element computer analysis and in vitro experimentation using a bone analog. The results obtained in both the FEA and in the in vitro experiments was that the middle pins on each bone segment experienced axial tension while the remainder of the pins experienced axial compression. Furthermore, increasing the stiffness of the external bar decreased the axial loads on all the pins, and more evenly distributed the end shear load and end moment on the pins.

The role of the external bar in a 6-pin type 1 ESF device was investigated using finite element computer analysis and in vitro experimentation. The results show that increasing the stiffness of the external bar decreases the axial loads and more equally distributes the end shear loads on the pins. Therefore, increasing the stiffness of the external bar may reduce the chance of complications related to excessive pin loads, such as pin loosening, pin breakage, and pin tract infection.
Fractures of the Scapula in Dogs: A Retrospective Review of 12 Cases
Authors: Dunning Dianne , Harari J.
Published: March 2018

The case records of 12 dogs with scapular fractures were reviewed; feline patients were not identified. Fractures of the scapula were treated in approximately 2.4% of the total patients with fractures. Eleven of twelve dogs sustained a scapular fracture, following vehicular trauma. The most frequent type of fracture involved the body or spine of the scapula. Open surgical repair, or conservative non-surgical therapy, yielded successful clinical outcome by three months, in most of the cases. In 60% of the patients, concurrent thoracic injuries were reported, although complications were rare.

Twelve dogs with scapular fractures were, treated surgically or by non-operative therapy. Although concurrent thoracic cavity lesions were frequent, successful clinical outcome was achieved, in most cases, by three months following injury.
The Use of Multiple Pin and Methylmethacrylate External Skeletal Fixation for the Treatment of Orthopaedic Injuries in the Dog and Cat
Authors: Matthiesen D. T. , Ross J. T.
Published: March 2018

Multiple pin and methylmethacry-late external fixation devices were applied in 74 animals to successfully treat several different types of orthopaedic injuries. The major advantages associated with use of the technique included increased versatility in the location and angle of fixation pin place-ment and greater ease in placement of the connecting bar when compared with conventional clamp and connecting bar systems, particularly with transarticular placement of a device. The major disadvantages associated with the technique included, increased difficulty compared to conventional K-E systems regarding postoperative adjustment of the device and difficulty in removing individual pins that were loose or infected. Generally, removal of the device was not a problem, provided sufficient space was left between the connecting bar and the skin surface.

Complications associated with the technique were similar to studies which have evaluated other types of external fixation and include fixation pin loosening, pin tract drainage or infection, fixation failure, osteomyelitis, angular limb deformity, mal-union, delayed union and nonunion.

The multiple pin and methylmethacrylate external fixator provides a useful and effective method of repair for a wide variety of orthopaedic injuries. The use of methylmethacrylate as a connecting bar is a helpful adjunct to standard external fixation systems.

The use of multiple pin and methylmethacrylate external fixation (MPMF) increases the versatility of the external fixation technique in small animal orthopaedic injuries. Disadvantages include difficulty in removing or replacing individual fixation pins.
Repair of a Diaphyseal Fracture of the Metatarsus by Open Reduction and Internal Fixation in an Adult Bactrian Camel
Authors: Steenhaut M. , Gasthuys F.
Published: March 2018

This paper describes the treatment of a diaphyseal fracture of the metatarsus in an adult Bactrian camel. Application of a round hole plate, on the lateral side, by means of cortical screws in lag fashion on the proximal fragment, in combination with a dor-sally placed DCP plate resulted in delayed healing. Postoperatively a synthetic cast was placed up to the tarsal region to supply external immobilization. Local postoperative infection, noted two weeks after surgery, was successfully treated by the implantation of gentamicin pearls, in combination with systemic parenteral and oral antibiotics. Although delayed callus formation was observed radiographically, an acceptable degree of fracture healing was present after six months.

This report describes the successful open reduction and internal fixation treatment of a diaphyseal fracture of the metatarsal shaft in a Bactrian camel.
Evaluation of an Instrumented Horseshoe System
Authors: Schnurr D. , Horney F. D. , Field J. R.
Published: March 2018

A commercially available instrumented horseshoe, designed to quantitate a fraction of the vertical component of the ground reaction force (Fz), underwent a series of mechanical evaluations. This followed the occurrence of considerable variability in transducer output in response to a given load.

The mechanical evaluation of this system revealed many factors that contributed to the variability in transducer output. The primary factor appeared to be the disruption to the transducer required in its calibration in the laboratory and subsequent placement in the horse-mounted system. This requirement introduced significant (P <0.05) variability into the system.

A preliminary evaluation of the system when mounted on horses only succeeded in adding to the variability in transducer output.

In view of the many contributors to transducer output variability it is concluded that as the system is currently designed it does not allow for accurate or reproducible quantitation of force transmission, in either the laboratory or when mounted on horses.

An instrumented horseshoe underwent a series of mechanical evaluations. Many factors contributed to variability in transducer output recorded. It was concluded that the system, as currently designed, does not provide accurate or reproducible quantification of the vertical force component (Fz).
Intramedullary Nailing of Experimental Femoral Midshaft Osteotomies in Cats with Biodegradable Rods of Polylactic Acid
Authors: Mero M. , Morelius M. , Rokkanen P. , Törmälä P. , Räihä J. E.
Published: March 2018

Fracture repair by intramedullary support with one or several steel implants is a cheap and quick technique, especially suitable for simple femoral, tibial and humeral fractures in small animals. These implants, however, usually have to be removed due to their excessive rigidity causing migration or osteoporosis. The biodegradable implants of polylactic and polyglycolic acid available for fracture re-pair are usually too short to be used in the medullary canals of dogs and cats. A new extrusion technique has provided essentially unlimited length rods of left isomeric polylactic acid with strength values comparable to steel, but a stiffness modulus; close to bone.

To test their use for intramedullary nailing such rods of diameter 1.1 and 2 mm were used to stack pin femoral osteotomies in four cats. Follow-up time was 24 weeks. All femurs healed, but with slight or moderate angulation or rotation and fair callus formation. Two had a bone loss defect at the lateral osteotomy line. Histology revealed minor foreign body reactions from the implants.

This technique is being developed to involve only one implant with ability to prevent rotation and a stiffness of about 40 to 60 gigapascals (between bone and steel) to provide adequate initial stiffness before biodegrading.

A new extrusion technique has enabled manufacturing of longer rods of totally biodegradable polylactic acid. These were tested for intramedullary use with a stack pinning technique in four cat femurs. All osteotomies healed with fair callus formation and slight or moderate deviations or rotations. Two femurs had a bone loss defect at the lateral osteotomy line. Histology revealed good tolerance to the foreign material.
Kinematic Gait Analysis of the Trot in Healthy Mixed Breed Dogs
Authors: DeCamp C. E. , Braden T. D. , Balms Michelle , Allen K.
Published: March 2018

Computer aided kinematic and synchronized force plate gait analysis were used to characterize joint movement in 14 large mixed breed dogs at a trot. A curvilinear relationship of joint angle to time was described, for three forelimb and three hindlimb joints. Two peaks of maximum extension, one preceding the onset and at the end of stance phase were observed for the femorotibial, tarsus and cubital joints. The carpus, scapulohumeral and coxofemoral joint exhibited one peak of maximum extension. The variance in joint angle measurement was calculated for repeated trials for a given dog and for differences between dogs using a 2-factor repeated measures ANOVA. The mean variance for all joints except the carpal joint for trial repetition was 12.6 (degrees)2 (range, 2.6-23.9) and for differences between dogs 6.2 (degrees)2 (range, 1.0-11.3). The carpal joint exhibited greater variation with a mean variance, attributable to trial repetition, of 42.5 (degrees)2 (range, 39.4-44.3) and a variance between dogs of 52.4 (degrees)2 (range, 18.5-89.4).

The results obtained would suggest that computer assisted kinematics is an accurate means of assessing joint angle movement in large mixed breed dogs with a low level of variance attributable to trial repetition and to differences between dogs, with the exception of the carpal joint. The sample of mixed breed dogs in this study is similar to dogs that would be seen in a clinical sample population. Our results suggest that computer assisted kinematics could be an important tool in providing objective information on gait, in clinical and research studies, using mixed breed dogs.

This study describes the trot in 14 large mixed breed dogs using computer aided kinematic and force plate gait analysis techniques. Variances in fore and hindlimb joint angle measurements were deter-mined, for a given dog, by repeated trials and for differences between dogs. The measured variances were low in all joints except the corpus, despite diverse dog conformation in the study.
Physeal Fractures of the Metacarpus and Metatarsus in Cattle
Authors: Iselin U. , Auer J. A. , Lischer C. J. , Steiner A.
Published: March 2018

This study describes the history, signalment, fracture configuration (classified according to Salter and Harris = SH), methods of treatment and outcome of 16 cattle suffering from a physeal fracture of the metacarpus or metatarsus. For the purpose of describing the accuracy of fracture reduction and progress of healing, as defined by radiographs, a grading system was developed and is described.

Thirteen animals (five SH I and eight SH II) were treated by means of a full-limb cast, one by a modified walking-cast (SH III) and two by open reduction and internal fixation (ORIF) (one open SH II and one SH III). Long-term follow-up evaluation revealed limb angulation, or shortening of the affected bone in seven animals (44%). Two or more signs of a fracture disease were found in 11 out of 13 cases (85%) treated by means of a full-limb cast. The long-term result of the SH III fracture treated by means of a modified walking-cast was satisfactory. A significant negative correlation was found between the body weight of the animals and the time that elapsed from trauma to treatment respectively, and the long-term result. However, correlation was not found between the quality of fracture reduction and the long-term result.

Sixteen physeal fractures of the metacarpus and metatarsus in cattle were evaluated retrospectively using a new radiographic scoring system. A significant negative correlation was found between the body weight of the animals and the time that elapsed from trauma to treatment respectively, and the longterm result. A correlation was not found between the quality of the fracture reduction and the long-term result.
Screw Torque and Interfragmentary Compression in Equine Cadaver Longbone Fractures
Authors: Field J. R.
Published: March 2018

The purpose of the study was to determine what contribution individual surgeon, location and bone type made to the optimal applied screw torque (Mopt) for interfragmentary compression of equine cadaver long-bone fractures. Four surgeons were required to insert 4.5 mm fully-threaded cortical bone screws at several locations in both third metacarpal and third metatarsal bones.

Consideration of individual differences was significant (P <0.05) as was location (P <0.05). There did not appear to be a contribution to variability through bone type.

Torque was also measured at point-of-failure (Mmax) showing no relationship to individual or location.

This study examines the effect of different individuals, location and bone type on the perceived optimal torque for interfragmentary compression of equine longbone fractures. It was found that individuals and location significantly effected the perceived optimal applied torque. This suggest that, for mature equine longbone fractures, the use of torque limiting devices may be a consideration to optimize interfragmental compression.
Bone Morphogenetic Proteins and Bone Derived Growth Factors
Authors: Forell Elaine , Straw R. C.
Published: March 2018

Recent studies suggest that local control of bone homeostatic and reparative mechanisms is most likely attributable to the interrelated function of a number of bone morphogenetic proteins (BMP) and bone derived growth factors. While osteogenesis is believed to be initiated by BMP, bone growth factors are thought to play a role in the promotion and maintenance of the newly induced bone and in the regulation of normal bone remodeling and repair. An overview of the current literature pertaining to BMP and the various bone derived growth factors is presented.

While osteogenesis is believed to be initiated by bone morphogenetic proteins, bone growth factors are thought to play a role in the maintenance of the newly induced bone and in the regulation of normal bone remodeling and repair. Current research suggests that, in the future, these substances may be used as systemic or locally administered adjuvant therapy in order to accelerate bone regeneration and fracture healing.
Anterior Cruciate Ligament Rupture Associated with Cardiomyopathy in Three Cats
Authors: Janssens G. O. , Janssens D. L. , Janssens L. A. A.
Published: March 2018

Over a period of 14 years, three cats with anterior cruciate ligament (ACL) rupture were seen in our practice. In all, the rupture had occurred without a history of previous trauma. All were treated surgically. All died within a period of 14 days. The reason of death was in all cases cardiomyopathy. We now suggest that cats with rupture of the anterior cruciate ligament undergo an electrocardiographic recording and eventually an thoracic radiography before surgery is considered. We also suggest that cats with ACL rupture should preferably be treated conservatively.
The Use of High-Speed Videography to Generate Angle-Time and Angle-Angle Diagrams for the Study of Equine Locomotion
Authors: Martinez-del Campo L. J. , Greer Nancy , Trent Ava , Stoner Lela June , Wickstrom L. , Loch Deborah , Kobluk C. N.
Published: March 2018

Introduction

High-speed videography was used to generate angle-time and angle-angle diagrams to provide the basis for a better subjective and objective understanding of the locomotor function of the horse. Intra- and interlimb coordination patterns were analyzed in a group of ten clinically sound racing Thoroughbreds. For lateral video recording, reflective markers were glued over the axis of rotation of the fore- and hindlimb joints of the ten horses. All horses were filmed simultaneously from both sides (right and left). Means and standard deviations were calculated for the minimum, the maximum and the range of motion values for the angle excursions of each joint. Angle-time and angle-angle diagrams were highly repeatable over the eight to nine strides videotaped for each horse and showed a very characteristic shape with minor variations between individual horses. When comparing right versus left sides, horses exhibited varying levels of significant asymmetry.
Falsch-negatives SkelettSzintigramm bei einer biparietalen Schädelfraktur beim »Battered Child«-Syndrom
Authors: Kentrup H. , Alzen G. , Skopnik H. , Büll U. , Kleinhans E.
Published: March 2018

Es wird über ein kleines Mädchen berichtet, das nach einem Schädeltrauma radiologisch zwei Frakturen der Schädelkalotte aufwies, bei dem aber eine acht Tage später durchgeführte Skelett-Szintigraphie mit 99mTc-DPD unauffällig war. Die möglichen Gründe für diese Diskordanz werden diskutiert.
Psychische Erkrankungen in Deutschland
Authors: Friede M. , Hegerl U.
Published: March 2018

Ziel dieses Positionspapiers ist es, deutlich zu machen, welche Optimierungschancen bezüglich der Versorgung psychisch Erkrankter in einer konsequenteren Nutzung vorhandener Behandlungsoptionen und einer Verbesserung der Behandlungsoptionen durch Intensivierung der Forschung liegen. Zunächst wird auf die Bedeutung, Anzahl und Heterogenität der unter dem Oberbegriff “Psychische Erkrankungen” zusammengefassten Einzelkrankheiten eingegangen. Für einige dieser Erkrankungen und für die häufigen und schweren affektiven Erkrankungen stehen gute pharmako- und psychotherapeutische Möglichkeiten zur Verfügung, mit Effektstärken, die Behandlungen in anderen Bereichen der Medizin zumindest gleichwertig sind. Da diese Behandlungsmöglichkeiten nur bei einer Minderheit konsequent genutzt werden, liegen große Optimierungsspielräume in der Gewährleistung einer leitlinienkonformen Behandlung. Dringend nötig sind Forschungsanstrengungen zum Verständnis und gezielteren und wirksameren Therapie und Prävention psychischer Erkrankungen. Gegengesteuert werden muss deshalb der in der Pharmakotherapie alarmierenden Entwicklung, dass sich innerhalb weniger Jahre Vertreter der forschenden Arzneimittelindustrie wegen der im Vergleich zu anderen medizinischen Feldern ungünstigen Gewinnaussichten aus der Entwicklung neuer Psychopharmaka zurückgezogen haben. Da hierdurch Forschungskompetenz verloren geht und von der Identifizierung eines neuen Moleküls bis zu Markteinführung Jahrzehnte vergehen, entsteht ein langfristiger Forschungshiatus, der Patienten mit psychischen Erkrankungen von zu erwartenden, segensreichen Fortschritten in der Pharmakotherapie ausschließt.
Molekulare Bildgebung in der Diagnostik von Demenzen
Authors: Kurth J. , Kilimann I. , Krause B. J. , Teipel S.
Published: March 2018

Durch die Entwicklung molekularer Marker der zerebralen Amyloidablagerung in vivo hat die Positronenemissionstomografie (PET) eine zentrale Rolle für die Definition präklinischer und prädemenzieller Stadien der Alzheimer Krankheit erlangt. Darüber hinaus haben länger etablierte nuklearmedizinische Marker eine wichtige Funktion bei der Differenzial- und Frühdiagnose demenzieller Erkrankungen. Untersuchungen mit FDG-PET zeigen typische Muster eines kortikalen Hypo metabolismus, der die Ausprägung kognitiver Defizite in klinischen Verlauf prädiziert und eine hohe diagnostische Trennschärfe zwischen Frühstadien einer Alzheimer Krankheit und einer Erkrankung aus dem Formenkreis der frontotemporalen Lobärdegenerationen aufweist. Dopamin-PET, Dopamintransporter-SPECT und Dopaminrezeptor-Tracer für PET und SPET sind frühe Indikatoren einer extrapyramidalmotorischen Beteiligung beim Parkinson-Syndrom. Der Beitrag erläutert die technischen Grundlagen der Verfahren und wesentliche klinische Befunde sowie diagnostische Anwendungen aus monozentrischen und multizentrischen Studien für die Früh und Prädemenzdiagnostik. Besonderes Gewicht legen wir auf die klinische Frage, die ein molekularer Marker beantworten kann, und die methodischen und heuristischen Grenzen der Verfahren, die insbesondere gegen einen unkritischen Einsatz der demnächst klinisch verfügbaren Amyloid-PET-Tracer für das Screenen asymptomatischer Personen außerhalb klinischer Studien sprechen.
Der Depression die Stirn bieten – mit Botulinumtoxin
Authors: Wollmer M. A. , Krüger T. H. C. , Kollewe K.
Published: March 2018

Gegenstand und Ziel: Nach Behandlung der Glabellafalte mit Botulinumtoxin A (BoNT) in einer offenen Fallserie ist es bei Patientinnen, die an einer Depression litten, zu einer Besserung oder Remission der Depression gekommen. Mit der hier vorgestellten randomisierten, kontrollierten Studie soll die Frage beantwortet werden, ob eine adjuvante BoNTBehandlung der Glabellafalte einen positiven Effekt auf die Depression zeigt.

Methodik: Es wurden je 15 Patienten in die Verum(BoNT) oder in die Placebogruppe randomisiert. Primärer Endpunkt war die Veränderung auf der 17-Item-Version der Hamilton-Depressionsskala (Ham-D17) sechs Wochen nach der BoNT-Injektion, zudem wurde der Beck-Depressionsinventar (BDI) und die Clinical Global Impression (CGI) erhoben.

Ergebnisse: Über die 16-wöchige Beobachtungszeit kam es in der Verumgruppe zu einer signifikanten Besserung der Symptome der Depression (Ham-D17, F = 5,76, p < 0,001, η2= 0,17). Sechs Wochen nach einer einmaligen Behandlung waren die Ham-D17-Werte bei den mit BoNT behandelten Studienteilnehmern im Schnitt um 47,1% und bei denen in der Placebogruppe um durchschnittlich 9,2% gesunken (F = 12,30, p = 0,002, η2 = 0,31, d = 1,28). Die klinische Verbesserung spiegelte sich in gleicher Weise im BDI und in der CGI wider.

Schlussfolgerung: Diese Studie zeigt, dass eine einmalige Behandlung der Glabellaregion mit BoNT als adjuvante Therapie bei Patienten mit Depression zu einer rasch einsetzenden, ausgeprägten und lang anhaltenden Besserung der Depression führen kann. Sie unterstützt die Facial-Feedback-Theorie, gemäß der die Mimik nicht nur Stimmung ausdrücken, sondern auch regulieren kann.
Forms that Inform
Authors: Poljak A. , Powsner S. , O’Connell R.
Published: March 2018

Objectives:
Sound medical decisions are easier for clinicians who have essential patient data in the right place at the right time. Our goal was to develop a usable form to guide clinical decisions and then test it using actual cases.

Methods:
The authors designed a form to represent data from patients with chest pain; it was revised several times. We incorporated opinions from clinician-users as well as evidence from the literature to improve usability. To test the design, we filled out forms with actual patient data derived from Emergency Department charts of patients who presented with chest pain. We then validated the design by having house officer reviewers make the decision to admit, observe in the ER for one day, or discharge subjects based entirely on a one-page form.

Results:
Thirty-three house officers reviewed our initial design and made suggestions. Our literature search yielded a number of factors discriminating ischemic from non-ischemic chest pain. Sixteen factors were included on a finalized form in the rank order assigned by reviewing physicians. Over 4 days, data from 29 subjects were used to fill out copies of the form. Based purely on the completed forms, house officers made decisions to admit, discharge, or observe all 29 subjects in less than 30 minutes.

Conclusions:
Forms have traditionally been employed to record and organize data. Here we show how principles of usability engineering can be used to create a form to meet the needs of users and even encourage evidence-based practice.
Comparison of Closed-loop and Open-loop Models in the Assessment of Cardiopulmonary and Baroreflex Gains
Authors: Takalo R. , Saul J. P. , Korhonen I.
Published: March 2018

Objectives:
Both open- and closed-loop models of beat-to-beat cardiovascular control have been suggested. We tested whether the modelling yields different results with real data while assessing cardiopulmonary and baroreflex gains.

Methods:
Two autoregressive models are described to resolve causal relationships between systolic blood pressure (SBP), RR-interval (RRI) and instantaneous lung volume (ILV): a closed-loop model which takes into account both the RRI changes induced by changes in SBP and the SBP changes mediated by changes in RRI, and an open-loop model which does not have a link from RRI to SBP. The performance of the models was compared in 14 healthy men in supine and standing positions under control conditions and under conditions of β-sympathetic and parasympathetic pharmacological blockades. Transfer function gains were computed from ILV to RRI (cardiopulmonary gain) and from SBP to RRI (baroreflex gain). The measurements were done under controlled random-interval breathing.

Results:
The gains identified by the open-loop model tended to be higher than those from the closed-loop model, but the differences did not reach statistical significance. Importantly, the two models discriminated the changes in transfer gains between different interventions equally well.

Conclusions:
Because the interactions between SBP and RRI occur physiologically in a closed-loop condition, the closed-loop model provides a theoretical advantage over the open-loop model. However, in practise, it seems to be little reason to select one over the other due to methodological errors when estimating cardiopulmonary or baroreflex transfer gains.