bluuebunny/crossref_metadata_2025 huggingface dataset:
Disease modifying treatment for feline rheumatoid arthritis
Authors: Hanna F. Y.
Published: March 2018

Feline erosive polyarthritis includes the more common periosteal proliferative polyarthritis (PPP) and the rarely seen rheumatoid arthritis (RA) (11). During the past three years, 12 patients with definite feline rheumatoid arthritis, which did not respond well to conventional therapy, were treated with 7.5 mg of Methotrexate and 70 mg Leflunomide, given weekly by the oral route. The average age of the cats was 5.9 years (range 2.5 to 10 years). Siamese cats were over represented. Seven of the 12 (58%) cats showed a marked improvement, usually within four weeks. Once maximum improvement was obtained the dosage was decreased. Serious toxicity was not noted and carcinogenetic effect was not seen during the course of this study.
Traumatic avulsion fracture of the lesser trochanter in a dog
Authors: Henninger W. , Lorinson D. , Mayrhofer E. , Vidoni B.
Published: March 2018

A 15-month-old 25 kg female spayed American Staffordshire Terrier was examined to determine the cause of a six month period of lameness of the left pelvic limb. Signs of severe pain were evident on hyperextension and simultaneous internal rotation or abduction of the left hip joint; crepitus or instabiltiy was not detected. The diagnosis of avulsion fracture of the lesser trochanter was based on radiographs, computed tomography (CT) and magnetic resonance imaging (MRI), supported by initial findings such as lameness and hip joint pain in extension. The dog was treated with strict confinement for eight weeks followed by a gradual increase in activity; non-steroidal anti-inflammatory drugs were given for one month. Three months later, the dog was clinically sound and unrestricted activity was resumed. Soundness was confirmed on follow-up 18 months after injury. CT and especially MRI were powerful diagnostic tools to identify chronic iliopsoas strains with an avulsion fracture of the lesser trochanter. Complete recovery ensued following conservative treatment only, despite the proximal diplacement of an avulsed segment of the lesser trochanter. Thus, traumatic injury to the iliopsoas muscle and to the lesser trochanter should be included as differential diagnosis in cases of hind leg lameness.
Examination of synovial fluid and serum following intravenous injections of hyaluronan for the treatment of osteoarthritis in dogs
Authors: Cross A. R. , Brown M. P. , Lewis D. D. , Hernandez J. , Merritt K. A. , Tran-Son-Tay R. , Canapp S. O.
Published: March 2018

A randomized, blinded, prospective clinical trial was performed to determine the effects of intravenous (IV) administration of hyaluronan sodium (HA) on serum glycosaminoglycans (GAG) concentrations, synovial fluid (SF) hyaluronan concentrations and viscosity in dogs treated for unilateral rupture of the cranial cruciate ligament. Twenty-two dogs undergoing tibial plateau leveling osteotomy were used in this study. Synovial fluid from both stifles and serum were collected prior to surgery and at 2, 4, and 8 weeks following surgery. Dogs received either 1.0 ml (10 mg) of sodium hyaluronate (treatment group 1; n = 10) or equal volume of 0.9% NaCl (treatment group 2; n = 12), IV immediately, 2 and 4 weeks following surgery. Synovial fluid viscosity was evaluated using a magnetically driven, acoustically tracked, translating-ball rheometer. Synovial fluid HA disaccharide content was measured by fluorophore-assisted carbohydrate electrophoresis. Serum GAG concentrations were measured by alcian blue spectrophotometric assay. Data were analyzed using a Wilcoxon sign rank test (p<0.05). Mean ± SD viscosity (cP) was significantly higher (p=0.011) in SF obtained from the intact stifle (450 ± 604.1) than injured (54.8 ± 60.8) prior to surgery. Mean ± SD HA concentrations (ug/ml) were significantly higher (p=0.02) in synovial fluid obtained from the injured stifles (281.4 ± 145.9) than intact stifles (141.6 ± 132.5). No significant difference was noted within or between treatment groups in SF viscosity, HA concentrations, or serum GAG concentrations at any time following surgery. Stifles with cranial cruciate ligament insufficiency had significant alterations in SF viscosity and HA concentrations.
The effect of axial and abaxial release on meniscal displacement in the dog
Authors: Kennedy S. C. , Bischoff M. G. , Kuriashkin I. V. , Pijanowski G. J. , Schaeffer D. J. , Dunning D.
Published: March 2018

The meniscal release (MR) is used to minimize meniscal pathology after Tibial Plateau Leveling Osteotomy (TPLO) surgery. The purposes of this study were: i) to describe meniscal orientation in a unaltered cadaveric canine stifle, a cruciate deficient stifle, TPLO repaired stifle with and without the MR using magnetic resonance imaging; ii) to determine if the abaxial release is equivalent to the axial release in its ability to affect caudal pole displacement in a TPLO repaired stifle and iii) to evaluate with MRI the effect of MR on the femorotibial articular cartilage contact area in a TPLO repaired stifle. Briefly, cadaver limbs were placed into a jig designed to mimic a weight-bearing stance at 140° and 90° at the stifle. The limbs were sequentially evaluated from the unaltered state; after cranial cruciate ligament transection; after TPLO stabilization; and finally after a meniscal release. No significant difference was found between the intrameniscal area (IMA) of the abaxial and axial meniscal releases although there was an increase in the IMA after the meniscal release compared to the IMA in the normal, cranial cruciate ligament deficient stifle, and TPLO stabilized stifle. In the abaxial release, a meniscal remnant remained in situ and provided a space effect between the femur and the tibial plateau. This is in contrast to the axial meniscal release, where the entire caudal pole of the medial meniscus relocated caudolaterally and consequently permitted more direct femorotibial contact. Overall, however, there was evidence of caudal pole compression of the medial meniscus throughout the MRI series which was ameliorated by either of the MR procedures.
Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy
Authors: Aiken S. W. , DiResta G. R. , Herr L. G. , Monette S. , Carey K.
Published: March 2018

Patellar tendon thickening (PTT) and patellar tendinosis (PTS) have been discussed in the veterinary literature as a post-operative complication of tibial plateau leveling osteotomy (TPLO). The purpose of this study was to define radiographic PTT, determine the frequency of and risk factors for PTT and PTS, and describe the clinical and histopathological findings of PTS after TPLO. We hypothesized that the location of the osteotomy alters forces placed on the patellar tendon resulting in PTT or PTS. Radiographs and medical records from 83 dogs undergoing 94 TPLO procedures were retrospectively evaluated. Two months post-operatively, 19 dogs (20.2%) had a normal patellar tendon or mild PTT, 51 (54.3%) had moderate PTT, and 24 (25.5%) had severe PTT. Seven of the 24 dogs (7.4%) with severe PTT had clinical signs consistent with PTS. Only dogs with severe PTT developed PTS (p < 0.0001). The risk factors for the development of PTT include: a cranial osteotomy, a partially intact cranial cruciate ligament (CCL) in conjunction with a cranial osteotomy, and post-operative tibial tuberosity fracture. The only risk factor identified for the development of PTS was a partially intact CCL. Four dogs with PTS improved with conservative therapy and one improved with surgical treatment. Two dogs had tendon biopsies with histopathological review that showed tendon degeneration with lack of inflammation. As only the dogs with severe PTT develop PTS, a caudal osteotomy for the prevention of PTT and subsequent PTS is recommended.
Incomplete humeral condylar fracture in two English Pointer dogs
Authors: Martini F. M. , Zanichelli S. , Volta A. , Bertoni G. , Del Bue M. , Borghetti P. , Gnudi G.
Published: March 2018

Incomplete humeral condylar fracture was diagnosed by means of radiology, CT, scintigraphy, arthroscopy and bone biopsy in two English Pointer dogs. In both cases an acute thoracic limb lameness, unrelated to a known episode of major trauma, was observed. Incomplete humeral condylar fracture, mainly described in the Spaniel breeds, has been recently diagnosed in Labrador retrievers, Rottweiler, German Wachtel and other breeds. The pathogenesis of the condition is still unknown, but incomplete ossification of the humeral condyle and mechanical stress, alone or associated, have to be considered. However, our clinical and histopathological data lead us to believe that in Pointers, high performance dogs, the mechanical stress can assume a critical ethiopathogenetic role.
Relationship between Metallic Implants and Cancer: A Case-Control Study in a Canine Population
Authors: Horn D. L. , Black J. , Stevenson Sharon , Li X. Q.
Published: March 2018

To assess the possible role of metallic implants in the development of local, systemic and remote site cancer, a case-controlled study was conducted in a canine population. The cases consisted of 222 dogs with tumours of any kind, preceded by a fracture and fixation between January 1979 and December 1990. The controls consisted of 1635 dogs who had fracture and fixation for fracture without a later development of tumour during the same time period, randomly selected from the same database. Age was found to be a strong positive predictor for the development of tumours. A significant protective effect on tumours other than bone and soft tissue tumour development was seen associated with internal fixation (P <0.05). There was not a significant increase of risk associated with metal materials for the development of bone and soft tissue tumours. Further study is needed to address the local effect of metallic implants on the development of bone and soft tissue tumours.

A case-control study was conducted to assess the relationship of metallic implants and the development of cancer in a canine population. No significant positive association was found between metal materials and the development of bone and soft tissue tumours.
The Anatomy Heresies
Authors: Shively M. J.
Published: March 2018

This essay presents incorrect, misleading, or easily misconstrued anatomical statements from a number of sources and follows each with editorial and clinically applicable commentary. The purpose of this exercise is not to degrade the sources, but only to correct the misconceptions in an attempt to avoid their perpetuation.
A Bioabsorbable Polymer for Collateral Ligament Repair in the Pig
Authors: Patton C. S. , McConnel R. F. , Ross R. , Shires G. M. H. , Korenek Nancy
Published: March 2018

A bioabsorbable internal fixation device of a poly-L-isomer of lactic acid (PLLA) was used to repair the proximal attachment of the medial femorotibial collateral ligament (MCL) in six miniature Yucatan pigs and compared with metal screw fixation in four pigs. Healing was evaluated by physical examination, gross dissection of surgical sites and histological evaluation of bone ligament interface. Chemical stress analysis of the tack was also evaluated.

The absorbable PLLA tack induced minimal tissue reaction and maintained sufficient apposition for healing of the MCL in the miniature Yucatan pigs. No postsurgical complications were noted in the experimental or control groups. All surgical implant procedures were considered successful in maintaining MCL apposition. This study suggests future potential for utilization of the PLLA tack for bioabsorbable implants in soft tissue or bone.

A bioabsorbable internal fixation device of a poly-L-isomer of lactic acid was used to repair the proximal attachment of the medial femorotibial collateral ligament in pigs, and compared with metal screw fixation. No postsurgical complications were noted in either group. All surgical implant procedures were successful. This study suggests future potential for utilization of the tack for bioabsorbable implants in soft tissue or bone.
Vertical Ground Reaction Force Redistribution During Experimentally Induced Shoulder Lameness in Dogs
Authors: McLaughlin R. M. , Roush J. K. , Griffon Dominique
Published: March 2018

The redistribution of vertical ground reaction forces after surgically induced forelimb lameness was evaluated in five Greyhounds at the walk. Vertical ground reaction forces were measured by force plate analysis before, three days, and seven days after a craniolateral approach to the shoulder was performed unilaterally in each dog.

At day # 3, peak vertical force was significantly decreased in the operated forelimbs and in the ipsilateral hindlimbs. Peak vertical force was significantly increased in the contralateral fore- and hindlimbs. The total peak vertical force applied to both forelimbs did not change, nor did the total force applied to both hindlimbs. At day # 7, peak vertical force in each of the four limbs had returned to preoperative levels. Results of this study document the redistribution of ground reaction forces (at the walk) between the four limbs in the dog after an acute, surgically induced forelimb lameness.

The redistribution of ground reaction force was evaluated in five Greyhounds before and during forelimb lameness. Lameness was induced by a craniolateral approach to one shoulder in each dog. At day # 3 after surgery, peak vertical force was decreased in the operated forelimbs and ipsilateral hindlimbs. Peak vertical force was increased in the contralateral fore- and hindlimbs. The distribution of ground reaction force in the four limbs returned to preoperative values seven days after surgery.
Avian Fracture Healing Following Stabilization with Intramedullary Polyglycolic Acid Rods and Cyanoacrylate Adhesive vs. Polypropylene Rods and Polymethylmethacrylate
Authors: Wallace L. J. , Redig P. T. , Bechtold J. E. , Pool R.R. , King V. L. , Mathews K. G.
Published: March 2018

Avian fracture healing was evaluated for twelve weeks following the repair of transverse mid-diaphyseal humeral fractures. Radiographic, histological, and biomechanical assessment of healing was used to compare a currently used method of repair - a permanent intramedullary polypropylene rod and polymethylmethacrylate bone cement, to a new biodegradable repair technique which utilized intramedullary polyglycolic acid rods and cyanoacry-late adhesive. Histological response to the biodegradable implants consisted of a granulomatous foreign body reaction that did not impair fracture healing. Fibrous encapsulation occurred around the permanent devices. Biodegradable repairs developed more periosteal callus, and early complications were more common following biodegradable repair, but there was little difference between the two groups biomechanically. Polyglycolic acid implants appear to be viable alternatives for the repair of some avian fractures. Investigation into the use of other biodegradable polymers for avian fracture fixation is warranted.

Avian fracture healing following the repair of trans-verse humeral fractures with intramedullary biodegradable polyglycolic acid (PGA) rods and cyanoacrylate adhesive was compared to healing following repair with polypropylene rods and polymethylmethacrylate (PMMA) bone cement. Foreign body reaction to the PGA/cyanoacrylate fixation occurred, but did not impair fracture healing. Biomechanical testing revealed few differences between the two fixation methods at 0-12 weeks following fracture repair.
Incidence of Canine Appendicular Musculoskeletal Disorders in 16 Veterinary Teaching Hospitals from 1980 through 1989
Authors: Johnson Justine , Austin Connie , Breur Gert
Published: March 2018

The goal of this study was to determine the incidence of musculoskeletal disorders in a large canine population. Patient information was obtained from clinical cases contributed to the Veterinary Medical Data Base (VMDB) by 16 veterinary teaching hospitals during the ten year period of 1980 through 1989. The relative contribution of bone diseases, joint diseases, and muscle-tendon-unit diseases was determined, and the incidence of each musculoskeletal disease reported.

Nearly 24% of all patients in the source population had been affected by a disorder of the musculoskeletal system, and over 70% of those diagnoses involved appendicular structures. Diseases of joints, ligaments, and related structures contributed more cases (47%) to this study than diseases of bones (39%) or muscle-tendon-units (14%). Fractures made up the largest disease category, with pelvic fractures most common, followed by femoral fractures, and fractures of the radius and/or ulna. Joint instability and degenerative joint dis-

ease were also common diagnosis categories, affecting primarily the hip and stifle joints. Common specific dis-ease entities included hip dysplasia, cruciate ligament rupture, traumatic hip luxation and patellar luxation.

In this study we provided a comprehensive analysis of the canine musculoskeletal system. The relative importance of joint disorders compared to those of bones and muscle-tendon-units was illustrated. The incidence of most of the disorders described in this report had not been well documented previously.

Patient information was obtained from the clinical cases of 16 veterinary teaching hospitals during a 10-year period. The number of dogs with musculoskeletal disorders was determined. The absolute and relative contribution of bone diseases, joint diseases, and muscle-tendon-unit diseases is reported as well as the incidence of the specific disease entities affecting the canine appendicular musculoskeletal system.
The Use of Polypropylene Mesh for Revision of Failed Repair of Superficial Digital Flexor Tendon Luxation in Three Dogs
Authors: Houlton J. E. F. , Dyce J.
Published: March 2018

Polypropylene mesh was used to reinforce the medial calcaneal retinaculum in three dogs which required revision of failed repair of superficial digital flexor tendon luxation. All three dogs were sound at follow-up examination three months after surgery.
Acute Traumatic Intracranial Haemorrhage in Dogs and Cats
Authors: Downs M.O. , Aron D.N. , Mahaffey E. A. , Dewey C.W.
Published: March 2018

Twenty-three records of dogs and cats having experienced severe craniocerebral trauma were reviewed. Case selection was restricted to those patients whose brains were examined at necropsy and/or surgery. Records of 14 dogs and nine cats were evaluated for the presence or absence of intracranial haemorrhage. The majority of patients were victims of automobile trauma (n = 16), the remainder being victims of household accidents (n = 4), malicious human behavior (n = 2), and injury inflicted by another animal (n = 1). Six of the 23 (27%) were conscious upon admission. One patient was unconscious upon admission, but regained consciousness following medical therapy. Evidence of intracranial haemorrhage was found in 100% (14/14) of the canine and 89% (8/9) of the feline cases. Four dogs and four cats exhibited two forms of intracranial haemorrhage. One cat exhibited three forms of intracranial haemorrhage. The distribution of intracranial haemorrhage was as follows: two epidural, 10 subdural, 10 subarachnoid and 10 intraparenchymal. Histopathology was available for 10 of the 23 cases. Surgical confirmation of the subdural haematomas, as typical subdural haematomas (focal intradural mass lesions), was available for four cases. Gross pathology of one other of the 10 subdural hematomas described a focal, 2 × 3 cm mass lesion. The remaining five subdural haematomas were of a more diffuse nature (more typical of subarachnoid haemorrhage), but three of these five were described as massive accumulations of blood. Four patients underwent emergency craniotomy/craniectomy; two of these patients made rapid and full recoveries, one died on the operating table, and one was euthanatized at the operation because of uncontrollable brain swelling. Ninety-three percent of the canine and 75% of the feline cases had haemorrhagic lesions that would have been potentially accessible via a lateral craniotomy/craniectomy. The results of this investigation suggest that acute intracranial haemorrhage may be a relatively frequent occurrence, following severe brain injury in dogs and cats. Prospective studies are needed to better define the incidence, anatomical distribution, and potential clinical significance of acute traumatic intracranial haemorrhage in dogs and cats. Comparative aspects of acute traumatic intracranial haemorrhage in people and small animals (dogs and cats) are discussed.

Twenty-three records of dogs (n = 14) and cats (n = 9) with severe craniocerebral trauma were evaluated for the presence or absence of intracranial haemorrhage. Evidence of intracranial haemorrhage was found in 96% (14 dogs, 8 cats) of the cases reviewed. Comparative aspects of acute traumatic intracranial haemorrhage in people and small animals (dogs and cats) are discussed.
Holding Power of Orthopaedic Screws in Bovine Femoral Heads
Authors: Ulm M. J. , Wilson D. G.
Published: March 2018

Femoral capital physeal fractures have been successfully repaired using 7.0 mm cannulated screws. The holding power of 7.0 mm cannulated screws was compared to the holding power of 5.5 mm cortical screws and 6.5 mm cancellous screws using paired bovine femoral heads. The 7.0 mm cannulated screw’s holding power was superior to the 6.5 mm cancellous screw and similar to that of the 5.5 mm cortical screw.

When placed in the bovine femoral head, 7.0 mm cannulated screws have holding power greater than 6.5 mm cancellous screws and similar to 5.5 mm cortical screws.
Small Intestinal Submucosa as an Intra-Articular Ligamentous Graft Material: A Pilot Study in Dogs
Authors: Badylak S. F. , Toombs J. P. , Shelbourne K. D. , Hiles M. C. , Lantz G. C. , Van Sickle D. , Aiken S. W.
Published: March 2018

This pilot study was performed to determine the potential for using small intestinal submucosa (SIS) xenografts for intra-articular ligament reconstruction. Porcine SIS was used to replace the excised cranial cruciate ligament (CCL) in five normal dogs. Grafts were evaluated histologically at 10, 12, 16, and 26 weeks after implantation. Two grafts were evaluated biomechanically at 26 weeks. All of the SIS neoligaments appeared macroscopically as white fibrous bands. The histological appearance progressed, with time, from disorganized immature connective tissue to large bundles of organized connective tissue, covered by a synovial membrane, that resembled the native CCL. There was no histological evidence of immune-mediated nor any foreign body reaction to the xenogeneic SIS graft material. The neoligaments 26 weeks after implantation had a maximum force to failure that was 16.2 and 21.4 times greater than the original SIS graft material and were 7.6 and 11.1 percent as strong as the contralateral control CCLs. We conclude that porcine SIS, used as an intra-articular graft material to replace the normal CCL in dogs, supported host tissue ingrowth, remodelled to form a ligamentous structure, and is worthy of further investigation.

Small intestinal submucosa was used to replace the excised cranial cruciate ligament (CCL) in five normal dogs. The histo-logical appearance of the grafts progressively changed, with time, from disorganized immature connective tissue to large bundles of organized connective tissue that resembled the native CCL. Graft strength increased between implantation and 26 weeks after the operation, however remained weaker than controls.
Osteotomy for Correction of Premature Growth Plate Closure in 24 Dogs
Authors: Miller C.W. , Morgan P.W.
Published: March 2018

Twenty-four dogs (27 limbs) were evaluated after surgery for correction of forelimb angular limb deformities. Partial ulnar ostectomies or definitive corrective osteotomies were performed depending upon the age of the dog. According to owner assessment nine of fourteen limbs were considered functionally good, or excellent, after partial ulnar ostectomies. Younger dogs appeared to have better functional results after dynamic correction with the mean age at surgery of dogs with good to excellent results being 6.5 months contrasted to the mean age at surgery of dogs with fair to poor results being 9.75 months. Ten of fourteen limbs were considered functionally good or excellent after definitive corrective osteotomy. One dog had definitive osteotomy after partial ulnar ostectomy in order to further correct a residual angular deformity. However, 58% of the limbs with radiographic follow-up had signs of degenerative joint disease (DJD). There were not significant differences between neither degree of angulation remaining after surgery and the functional result nor the degree of angulation remaining after surgery and the development of DJD. A prospective study is warranted to more objectively assess the efficacy of surgical correction of angular limb deformities in dogs.

Twenty-four dogs were evaluated after surgery for correction of forelimb angular limb deformities. The results are described.
A Mechanical and Histological Comparison of Bone Healing Using Titanium Bone Plates with Porous Surfaced Titanium Screws versus Smooth Surfaced Titanium Screws
Authors: Bruecker K. A. , Palmer J. L. , Powers Barbara , Histand M. B. , Schwarz P. D.
Published: March 2018

Bilateral midshaft femoral osteotomies were stabilized with a 3 mm fracture gap in 12 dogs using titanium bone plates and either smooth surfaced (SS) or porous surfaced (PS) titanium screws. Mechanical studies demonstrated that PS screws required a significantly greater torque to remove than the SS screws at both 8 and 16 weeks. At 16 weeks, screw removal torque increased by a factor of 1.3 over the insertion torque for PS screws and decreased by a factor of 2.9 for SS screws. Histologically, the amount of new bone formation and porosity, over the entire length of the femur, was significantly greater in the femora stabilized with PS screws; indicative of greater overall fixation rigidity. At both time periods, there was an increase in torsional stiffness in the osteotomies stabilized with SS screws. Radiographically, there was no difference in the osteotomy callus area for either screw type. From this study, there appears to be advantages to using PS bone screws instead of SS screws when subjected to dynamic loading such as gap fixation.
Stack Pinning of Long Bone Fractures: A Retrospective Study
Authors: vanEe R. T. , Gibson Karen
Published: March 2018

Long bone fractures in 20 dogs and five cats were repaired using a stack pinning (multiple intramedullary pins) technique. These cases were evaluated with long-term radiographic and physical examination. Factors including fracture location, age of animal, fracture reduction, and percent of medullary cavity filled by intramedullary pins were noted to assess their effect on postoperative complications. Specifically, distal long bone fractures had a greater tendency to develop complications than did mid-shaft or proximal fractures (p = 0.10). Other factors were not found to significantly increase the potential for fracture related complications. The overall complication rate associated with this method of fracture repair was greater than 50%. External fixators or plates were judged necessary to improve fracture stability at initial or subsequent operations in 44% of cases. Stack pinning was found to be an unreliable method of repair for long bone fractures in this clinical study.
An Experimental Study of the Healing Pattern After Bilateral Mandible Osteotomies in Sheep, Using Holographic Nondestructive Testing and a Three-Point Loading Transverse Strength Test
Authors: Paatsama J.
Published: March 2018

Holographic nondestructive testing has the advantage of displaying the stability/instability of both an osteosynthesis and a healing osteotomy. With the transverse strength test (St) it is only possible to evaluate the osteotomy healing. The results obtained from mandibles, without a plate seemed to correlate well with one another, in both methods.
Psychosoziale Interventionen
Authors: Bohlken J. , Kurz A.
Published: March 2018

Psychosoziale Interventionen verfügen über ein breites Spektrum von Wirkungen, das zur Behandlung von Demenz-Erkrankungen genutzt werden kann. Sie fördern die kognitive Leistungsfähigkeit, stützen das emotionale Wohlbefinden, mildern Verhaltenssymptome, wirken dem Verlust der Funktionsfähigkeit im Alltag entgegen und tragen zur Entlastung der pflegenden Angehörigen bei. Angesichts dieser vielfältigen Effekte erscheinen psychosoziale Interventionen dazu geeignet, die Pharmakotherapie zu verstärken und zu ergänzen. Ihr Stellenwert in der Versorgungspraxis muss aber durch Studien mit verbesserter methodischer Qualität gefestigt werden. Wichtige Fragestellungen künftiger Forschung auf diesem Gebiet betreffen die Wirksamkeit psychosozialer Interventionen im täglichen Leben, den zusätzlichen Nutzen zur pharmakologischen Therapie, die Durchführbarkeit innerhalb der bestehenden Versorgungsstrukturen und die Wirtschaftlichkeit.
Justinus Kerners therapeutische Visionen “reloaded”
Authors: Erbguth F.
Published: March 2018

In seiner zweiten großen “Wurstgift-Monographie” beschrieb Justinus Kerner 1822 mögliche Indikationen für eine Anwendung von Botulinumtoxin. Neben den mittlerweile etablierten Indikationen Bewegungsstörungen und vermehrte Drüsensekretion hielt er auch einen Einsatz zur Verbesserung der Wundheilung und bei psychiatrischen Erkrankungen für möglich. Die Übersicht soll zeigen, dass sich alle therapeutischen Visionen von Justinus Kerner erfüllt haben, wenngleich auch bei vielen der ungewöhnlichen Indikationen lediglich auf kasuistischer Basis.
Behandlung der Spastizität mit Botulinumtoxin-Typ-A-Injektionen
Authors: Müller J. , Wissel J.
Published: March 2018

Im Deutschland und Österreich sind drei Botulinumtoxin-Typ-A-Produkte (BoNT A) zur Behandlung der Spastizität der oberen Extremität nach Schlaganfall zugelassen (Abo-, Ona-, Incobotulinumtoxin A). Die Evidenzlage erlaubt die Feststellung, dass die Behandlung der fokalen und segmentalen Spastizität auch der unteren Extremität nach Schlaganfall und andere zentralnervöse Erkrankungen als Behandlung der Wahl zu empfehlen ist. Auf der Basis der klinischen Evaluation sollte gemeinsam mit dem Patienten, ggf. unter Einbeziehung eines multiprofessionellen Therapieteams, ein realistisches und objektivierbares Ziel und die Muskeln für die BoNT-A-Behandlung definiert werden. Im Anschluss kann die Injektion von BoNT A mit der notwendigen Genauigkeit (ggf. sonografische oder elektrostimulationsgestützte Injektionskontrolle) in die spastische Muskulatur (in Endplattennähe) erfolgen. Falls indiziert, sollten begleitende synergistische Behandlungen wie Lagerungen, Dehnungen und Casting zeitlich abgestimmt eingesetzt werden. Diese BoNT-A-Behandlungen sollten so häufig wie notwendig wiederholt werden, um die gesteckten realistischen Ziele zu erreichen. Falls im Verlauf kein Therapieziel für eine BoNTA-Behandlung mehr mit dem Patienten definiert werden kann, sollte die Therapie ausgesetzt und bei Indikation eine Therapieeskalation diskutiert werden.
Autonome Funktionsstörungen und Epilepsie
Authors: Kerling F.
Published: March 2018

Der plötzliche unerwartete Tod bei Epilepsie (SUDEP) ist definiert als plötzliches unerwartetes Ereignis, das nicht durch andere Ursachen erklärt werden kann und wohl im Zusammenhang mit einem Anfall – nicht jedoch mit einem Status epilepticus – steht. SUDEP ist die häufigste krankheitsbedingte Todesursache bei Patienten mit schwer behandelbarer Epilepsie. Epidemiologische Studien konnten Risikofaktoren für das Auftreten von SUDEP identifizieren. Hierzu zählen z. B. männliches Geschlecht, hohe Anfallsfrequenz, medikamentöse Polytherapie und junges Alter bei Epilepsiebeginn. Als hauptsächliche Pathomechanismen werden eine zentrale Apnoe, kardiale Arrhythmien oder Fehlregulationen im autonomen Nervensystem vermutet. Die einzige wirksam belegte Prophylaxe bei SUDEP ist eine Optimierung der Epilepsietherapie.
Wearable Systems for Health Care Applications
Authors: Kirstein T. , Tröster G. , Lukowicz P.
Published: March 2018

Objectives:
Wearable systems can be broadly defined as mobile electronic devices that can be unobtrusively embedded in the user’s outfit as part of the clothing or an accessory. In particular, unlike conventional mobile systems, they can be operational and accessed without or with very little hindrance to user activity. To this end they are able to model and recognize user activity, state, and the surrounding situation: a property, referred to as context sensitivity. Wearable systems range from micro sensors seamlessly integrated in textiles through consumer electronics embedded in fashionable clothes and computerized watches to belt worn PCs with a head mounted display. The wearable computing concept is part of a broader framework of ubiquitous computing that aims at invisibly enhancing our environment with smart electronic devices.

The goal of the paper is to provide a broad overview of wearable technology and its implications for health related applications.

Methods:
We begin by summarizing the vision behind wearable computing. We then describe a framework for wearable computing architecture and the main technological aspects. Finally we show how specific properties of wearable systems can be used in different health related application domains.

Results:
Wearable computing is an emerging concept building upon the success of today’s mobile computing and communication devices. Due to rapid technological progress it is currently making a transition from a pure research stage to practical applications. Many of those applications are in health related domains, in particular, health monitoring, mobile treatment and nursing.

Conclusions:
Within the next couple of years wearable systems and more general ubiquitous computing will introduce profound changes and new application types to health related systems. In particular they will prove useful in improving the quality and reducing the cost of caring for the aging population.
Elicitation and Representation of Expert Knowledge for Computer Aided Diagnosis in Mammography
Authors: Taylor P. , Lee R. , Alberdi E.
Published: March 2018

Objectives:
To study how professional radiologists describe, interpret and make decisions about micro-calcifications in mammograms. The purpose was to develop a model of the radiologists’ decision making for use in CADMIUM II, a computerized aid for mammogram interpretation that combines symbolic reasoning with image processing.

Methods:
In Study 1, eleven radiologists were asked to ‘think out loud’ as they interpreted 20 sets of calcifications. Participants used 159 terms to describe calcifications. We used these data to design a scheme with 50 descriptors. In Study 2, ten radiologists used the scheme to describe 40 sets of calcifications. We assessed the capacity of the terms to discriminate between benign and malignant calcifications, testing them against radiologists’ assessments of malignancy and follow-up data.

Results:
The descriptors that were found to be the most discriminating in Study 2 were included in CADIMUM II’s knowledge base. They were represented as arguments for either a benign or a malignant diagnosis. These arguments are the central component of the decision support provided by the system. Other components are: image processing algorithms for the detection and measurement of calcifications and a set of rules that use the measures to decide which of the arguments apply to a given set of calcifications.

Conclusions:
Preliminary evaluations of the CADMIUM II prototype reinforce the value of representing explicitly decision making processes in computer aided mammography and of deriving these processes from image processing measurements. Decision support is presented here at a level of description that is both relevant and meaningful to the user.
Modeling Hospital Information Systems (Part 2): Using the 3LGM2 Tool for Modeling Patient Record Management
Authors: Häber A. , Brigl B. , Winter A. , Wendt T.
Published: March 2018

Objectives:
We introduce the 3LGM2 tool, a tool for modeling information systems, and describe the process of modeling parts of the hospital information system of the Leipzig University Hospital (UKLa). We modeled the sub information systems of five patient record archiving sections to support the creation of a proposal for governmental financial support for a new document management and archiving system. We explain the steps of identifying the model elements and their relations as well as the analyzing capabilities of the 3LGM2 tool to answer questions about the information system.

Methods:
The 3LGM2 tool was developed on the basis of the meta model 3LGM2 which is described in detail in [1]. 3LGM2 defines an ontological basis, divided into three layers and their relationships. In addition to usual meta CASE tools, the 3LGM2 tool meets certain requirements of information management in hospitals. The model described in this article was created on the base of on-site surveys in five archiving sections of the UKL.

Results:
A prototype of the 3LGM2 tool is available and is currently tested in some projects at the UKL and partner institutions. The model presented in this article is a structured documentation about the current state of patient record archiving at the UKL. The analyzing capabilities of the 3LGM2 tool help to use the model and to answer questions about the information system.

Conclusions:
The 3LGM2 tool can be used to model and analyze information systems. The presentation capabilities and the reliability of the prototype have to be improved. The initial modeling effort of an institution is only valuable if the model is maintained regularly and reused in other projects. Reference catalogues and reference models are needed to decrease this effort and to support the creation of comparable models.
Towards Clinical Bioinformatics: Advancing Genomic Medicine with Informatics Methods and Tools
Authors: Ammenwerth E. , Brandner R. , Brigl B. , Fischer G. , Garde S. , Lang E. , Pilgram R. , Ruderich F. , Singer R. , Wolff A. C. , Haux R. , Kulikowski C. , Knaup P.
Published: March 2018

Objectives:
To summarize the challenges facing clinical applications in the light of growing research results in genomic medicine and bioinformatics.

Methods:
Analysis of the contents of the Yearbook of Medical Informatics 2004 of the International Medical Informatics Association (IMIA).

Results:
The Yearbook of Medical Informatics 2004 includes 32 articles selected from 22 peer-reviewed scientific journals. A special section on clinical bio-informatics highlights recent developments in this field. Several guest editors review the promises and limitations of available methods and resources from biomedical informatics that are relevant to clinical medicine. Integrated data and knowledge resources are generally regarded to be central and key issues for clinical bioinformatics. Further review papers deal with public health implications of bioinformatics, knowledge management and trends in health care education. The Yearbook includes for the first time a section on the history of medical informatics, where the significant impact of the Reisensburg protocol 1973 on international health and medical informatics education is examined.

Conclusions:
Close collaboration between bio-informatics and medical informatics researchers can contribute to new insights in genomic medicine and contribute towards the more efficient and effective use of genomic data to advance clinical care.
Knowledge Logistics as an Intelligent Service for Healthcare
Authors: Pashkin M. , Chilov N. , Levashova T. , Krizhanovsky A. , Smirnov A.
Published: March 2018

Objectives:
The technology of grid services is developing fast. This paper presents an approach to the implementation of an intelligent grid service that configures a hospital taking advantage of the knowledge logistics idea.

Methods:
The presented approach is based on synergistic integration of knowledge acquired from distributed sources in order to obtain new or complement insufficient knowledge. Presented approach uses ontologies and the formalism of object-oriented constraint networks for knowledge representation and applies ILOG to constraint-based problem solving.

Results:
The application of the approach is illustrated via a decision support system for a fictitious case study of a hospital configuration in the Binni region. The system showed the ability to produce interrelated solutions for subtasks of the hospital configuration task based on the built ontology and input parameters. Besides, such preferences as cost or time minimization are also considered by the implemented fuzzy logic module that finds a feasible solution.

Conclusions:
KL would benefit from the grid, and particularly from the concept of a semantic grid. The scalable architecture of the approach enables its extension with regard to knowledge/information sources number and, thereby, with regard to factors taken into account during complex problem solving. Utilizing ontologies allows integration of the approach into existing processes and facilitates knowledge sharing with similar systems. Application of constraint networks allows rapid problem manipulation and usage of such existing efficient technologies as ILOG.
A Framework Supporting the Development of a Grid Portal for Analysis Based on ROI
Authors: Date S. , Kaishima T. , Shimojo S. , Ichikawa K.
Published: March 2018

Objectives:
In our research on brain function analysis, users require two different simultaneous types of processing: interactive processing to a specific part of data and high-performance batch processing to an entire dataset. The difference between these two types of processing is in whether or not the analysis is for data in the region of interest (ROI). In this study, we propose a Grid portal that has a mechanism to freely assign computing resources to the users on a Grid environment according to the users’ two different types of processing requirements.

Methods:
We constructed a Grid portal which integrates interactive processing and batch processing by the following two mechanisms. First, a job steering mechanism controls job execution based on user-tagged priority among organizations with heterogeneous computing resources. Interactive jobs are processed in preference to batch jobs by this mechanism. Second, a priority-based result delivery mechanism that administrates a rank of data significance.

Results:
The portal ensures a turn-around time of interactive processing by the priority-based job controlling mechanism, and provides the users with quality of services (QoS) for interactive processing. The users can access the analysis results of interactive jobs in preference to the analysis results of batch jobs. The Grid portal has also achieved high-performance computation of MEG analysis with batch processing on the Grid environment.

Conclusion:
The priority-based job controlling mechanism has been realized to freely assign computing resources to the users’ requirements. Furthermore the achievement of high-performance computation contributes greatly to the overall progress of brain science. The portal has thus made it possible for the users to flexibly include the large computational power in what they want to analyze.
Development of Interesting Step-climbing Styles
Authors: Weng L. Y. , Peng S. M. , Tsai M. W. , Hsu M. J. , Huang C. C. , Lin S. L. , Liing R. J. , Hsien H. W. , Liao Y. H. , Chen J. J.
Published: March 2018

Objectives:
This study was to investigate the influence of stepping styles (forward, side, and cross steppings) and inclinations (25 and 45 degrees) on cardiorespiratory responses (C-R responses).

Methods:
Twenty volunteers were recruited and randomly arranged into two ten-people groups, exercising on step-climbing machines respectively of 25 and 45 degrees of inclination. C-R responses were recorded during each test which lasted for six minutes at 50 steps per minute on a step-climbing machine.

Results:
The group on 25-degree inclination had significantly lower C-R responses than the group on 45-degree inclination. Although only small differences, probably statistically insignificant, were found among the three step-climbing styles, these differences showed interesting trends independent of inclination.

Conclusions:
Climbing stairs with the three interesting step-climbing styles in this study could be considered as an exercise of moderate intensity (60-80% HRmax). Climbing on 25-degree inclination at 50 steps per minute is recommended for less fit individuals because of lower cardiovascular stress as compared with on 45-degree inclination.
Generic versus Disease-specific Instruments in Quality-of-life Assessment of Chronic Obstructive Pulmonary Disease
Authors: Vondra V. , Malý M.
Published: March 2018

Objectives:
Chronic respiratory diseases may alter a patient’s social life and well-being. Measures of health-related quality of life have been proven to bring complementary information to functional assessments. The aim of the study was to describe the questionnaires that are most frequently used to measure this subjective construct in patients with chronic obstructive pulmonary disease (COPD) and to compare the responses obtained via administering one generic (SF-36) and one disease-specific questionnaire (St. George’s Respiratory Questionnaire; SGRQ) to patients with COPD.

Methods:
One group of patients (46 individuals) was used to evaluate the questionnaire’s performance in repeated administrations under unchanged conditions (reproducibility) and to study the correlations of corresponding domains of respective questionnaires. Responsiveness of both questionnaires was tested on another group of 129 patients measured before and after the therapeutic stay at the spa. Methods of cor-relational analysis (Spearman, intraclass, and canonical correlation coefficients) as well as the Wilcoxon rank test were used for statistical analysis.

Results:
Both questionnaires seem to be comprehensive outcome measures for patients with COPD, but some particular areas may not be covered with the same intensity (e.g. emotional problems). Reproducibility of both questionnaires was good and only small non-significant shifts were seen, particularly in physical and social functioning domains. In repeated measurement, the SGRQ seemed to be slightly more responsive to change than the SF-36.

Conclusions:
The idea of using generic and disease-specific questionnaires together probably represents the best approach to this topic. It may improve our knowledge and explain better the relationship between disease-specific changes in patient status and both disease-specific treatment and general functional status.
Modeling Interdependencies between Information Processes and Communication Paths in Hospitals
Authors: Strübing A. , Wendt T. , Winter A. , Brigl B.
Published: March 2018

Objectives:
For planning hospital information systems it is important to recognize the interrelation between business processes and the communication needs between supporting application systems. We therefore present an approach to model, visualize and analyze those interdependencies.

Methods:
The approach is based on the concepts defined in 3LGM2, a meta-model to describe health information systems (HIS). An information process is defined as a sequence of functions using or updating information; a communication path as a sequence of communication links between interfaces belonging to application systems. The search for communication paths belonging to an information process is interpreted as an all-pairs shortest-paths problem. To solve this problem the Floyd-Warshall algorithm is applied.

Results:
The resulting algorithm has been implemented as function of the 3LGM2 tool, a tool to create 3LGM2 compliant models. With it, it is possible to interactively define information processes at the domain layer and to analyze step by step whether the infrastructure at the logical tool layer is sufficient to communicate necessary data between application systems.

Conclusions:
The presented approach enables the representation and analysis of dependencies between information processes and communication paths.

With it, the HIS architecture is directly associated with the business needs. This is an important condition for the systematic planning of hospital information systems.