A molecular approach towards tethered bilayer lipid membranes: synthesis and characterization of novel anchor lipids

Tethered bilayer lipid membranes (tBLMs) are a promising model system for the natural cell membrane. They consist of a lipid bilayer that is covalently coupled to a solid support via a spacer group. In this study, we developed a suitable approach to increase the submembrane space in tBLMs. The challenge is to create a membrane with a lower lipid density in order to increase the membrane fluidity, but to avoid defects that might appear due to an increase in the lateral space within the tethered monolayers. Therefore, various synthetic strategies and different monolayer preparation techniques were examined. Synthetical attempts to achieve a large ion reservoir were made in two directions: increasing the spacer length of the tether lipids and increasing the lateral distribution of the lipids in the monolayer. The first resulted in the synthesis of a small library of tether lipids (DPTT, DPHT and DPOT) characterized by 1H and 13C NMR, FD-MS, ATR, DSC and TGA. The synthetic strategy for their preparation includes synthesis of precursor with a double bond anchor that can be easily modified for different substrates (e.g. metal and metaloxide). Here, the double bond was modified into a thiol group suitable for gold surface. Another approach towards the preparation of homogeneous monolayers with decreased two-dimensional packing density was the synthesis of two novel anchor lipids: DPHDL and DDPTT. DPHDL is “self-diluted” tether lipid containing two lipoic anchor moieties. DDPTT has an extended lipophylic part that should lead to the preparation of diluted, leakage free proximal layers that will facilitate the completion of the bilayer. Our tool-box of tether lipids was completed with two fluorescent labeled lipid precursors with respectively one and two phytanyl chains in the hydrophobic region and a dansyl group as a fluorophore. The use of such fluorescently marked lipids is supposed to give additional information for the lipid distribution on the air-water interface. The Langmuir film balance was used to investigate the monolayer properties of four of the synthesized thiolated anchor lipids. The packing density and mixing behaviour were examined. The results have shown that mixing anchor with free lipids can homogeneously dilute the anchor lipid monolayers. Moreover, an increase in the hydrophylicity (PEG chain length) of the anchor lipids leads to a higher packing density. A decrease in the temperature results in a similar trend. However, increasing the number of phytanyl chains per lipid molecule is shown to decrease the packing density. LB-monolayers based on pure and mixed lipids in different ratio and transfer pressure were tested to form tBLMs with diluted inner layers. A combination of the LB-monolayer transfer with the solvent exchange method accomplished successfully the formation of tBLMs based on pure DPOT. Some preliminary investigations of the electrical sealing properties and protein incorporation of self-assembled DPOT and DDPTT-based tBLMs were conducted. The bilayer formation performed by solvent exchange resulted in membranes with high resistances and low capacitances. The appearance of space beneath the membrane is clearly visible in the impedance spectra expressed by a second RC element. The latter brings the conclusion that the longer spacer in DPOT and the bigger lateral space between the DDPTT molecules in the investigated systems essentially influence the electrical parameters of the membrane. Finally, we could show the functional incorporation of the small ion carrier valinomycin in both types of membranes.

Strukturelle, chemische und isotopische Analysen nanoskaliger präsolarer und früher solarer Kondensate

Neben astronomischen Beobachtungen mittels boden- und satellitengestützer Instrumente existiert ein weiterer experimenteller Zugang zu astrophysikalischen Fragestellungen in Form einer Auswahl extraterrestrischen Materials, das für Laboruntersuchungen zur Verfügung steht. Hierzu zählen interplanetare Staubpartikel, Proben, die von Raumfahrzeugen zur Erde zurückgebracht wurden und primitive Meteorite. Von besonderem Interesse sind sog. primitive kohlige Chondrite, eine Klasse von Meteoriten, die seit ihrer Entstehung im frühen Sonnensystem kaum verändert wurden. Sie enthalten neben frühem solarem Material präsolare Minerale, die in Sternwinden von Supernovae und roten Riesensternen kondensiert sind und die Bildung unseres Sonnensystems weitgehend unverändert überstanden haben. Strukturelle, chemische und isotopische Analysen dieser Proben besitzen demnach eine große Relevanz für eine Vielzahl astrophysikalischer Forschungsgebiete. Im Rahmen der vorliegenden Arbeit wurden Laboranalysen mittels modernster physikalischer Methoden an Bestandteilen primitiver Meteorite durchgeführt. Aufgrund der Vielfalt der zu untersuchenden Eigenschaften und der geringen Größen der analysierten Partikel zwischen wenigen Nanometern und einigen Mikrometern mussten hierbei hohe Anforderungen an Nachweiseffizienz und Ortsauflösung gestellt werden. Durch die Kombination verschiedener Methoden wurde ein neuer methodologischer Ansatz zur Analyse präsolarer Minerale (beispielsweise SiC) entwickelt. Aufgrund geringer Mengen verfügbaren Materials basiert dieses Konzept auf der parallelen nichtdestruktiven Vorcharakterisierung einer Vielzahl präsolarer Partikel im Hinblick auf ihren Gehalt diagnostischer Spurenelemente. Eine anschließende massenspektrometrische Untersuchung identifizierter Partikel mit hohen Konzentrationen interessanter Elemente ist in der Lage, Informationen zu nukleosynthetischen Bedingungen in ihren stellaren Quellen zu liefern. Weiterhin wurden Analysen meteoritischer Nanodiamanten durchgeführt, deren geringe Größen von wenigen Nanometern zu stark modifizierten Festkörpereigenschaften führen. Im Rahmen dieser Arbeit wurde eine quantitative Beschreibung von Quanteneinschluss-Effekten entwickelt, wie sie in diesen größenverteilten Halbleiter-Nanopartikeln auftreten. Die abgeleiteten Ergebnisse besitzen Relevanz für nanotechnologische Forschungen. Den Kern der vorliegenden Arbeit bilden Untersuchungen an frühen solaren Partikeln, sog. refraktären Metall Nuggets (RMN). Mit Hilfe struktureller, chemischer und isotopischer Analysen, sowie dem Vergleich der Ergebnisse mit thermodynamischen Rechnungen, konnte zum ersten Mal ein direkter Nachweis von Kondensationsprozessen im frühen solaren Nebel erbracht werden. Die analysierten RMN gehören zu den ersten Festkörperkondensaten, die im frühen Sonnensystem gebildet wurden und scheinen seit ihrer Entstehung nicht durch sekundäre Prozesse verändert worden zu sein. Weiterhin konnte erstmals die Abkühlrate des Gases des lokalen solaren Nebels, in dem die ersten Kondensationsprozesse stattfanden, zu 0.5 K/Jahr bestimmt werden, wodurch ein detaillierter Blick in die thermodynamische Geschichte des frühen Sonnensystems möglich wird. Die extrahierten Parameter haben weitreichende Auswirkungen auf die Modelle der Entstehung erster solarer Festkörper, welche die Grundbausteine der Planetenbildung darstellen.

An Input-Process-Output Approach to Interorganizational Teams: The Influence of Work Group Diversity, Trust and Shared Leadership on Communication Network and Team Outputs.

The market’s challenges bring firms to collaborate with other organizations in order to create Joint Ventures, Alliances and Consortia that are defined as “Interorganizational Networks” (IONs) (Provan, Fish and Sydow; 2007). Some of these IONs are managed through a shared partecipant governance (Provan and Kenis, 2008): a team composed by entrepreneurs and/or directors of each firm of an ION. The research is focused on these kind of management teams and it is based on an input-process-output model: some input variables (work group’s diversity, intra-team's friendship network density) have a direct influence on the process (team identification, shared leadership, interorganizational trust, team trust and intra-team's communication network density), which influence some team outputs, individual innovation behaviors and team effectiveness (team performance, work group satisfaction and ION affective commitment). Data was collected on a sample of 101 entrepreneurs grouped in 28 ION’s government teams and the research hypotheses are tested trough the path analysis and the multilevel models. As expected trust in team and shared leadership are positively and directly related to team effectiveness while team identification and interorganizational trust are indirectly related to the team outputs. The friendship network density among the team’s members has got positive effects on the trust in team and on the communication network density, and also, through the communication network density it improves the level of the teammates ION affective commitment. The shared leadership and its effects on the team effectiveness are fostered from higher level of team identification and weakened from higher level of work group diversity, specifically gender diversity. Finally, the communication network density and shared leadership at the individual level are related to the frequency of individual innovative behaviors. The dissertation’s results give a wider and more precise indication about the management of interfirm network through “shared” form of governance.

Characterization of the Caspr2 and NLGN2 ligands: a proteomic and biochemical approach

Autism Spectrum Disorder (ASD) is a range of early-onset conditions classified as neurodevelopmental disorders, characterized by deficits in social interactions and communication, as well as by restricted interest and repetitive behaviors. Among the proteins associated with this spectrum of disease there are Caspr2, α-NRXN1, NLGN1-4. Caspr2 is involved in the clustering of K+ channels at the juxtaparanodes, where it is proposed to bind TAG-1. Recent works reported a synaptic localization of Caspr2, but little is know on its role in this compartment. NRXNs and their ligand NLGNs, instead, have a well-defined role in the formation and maintenance of synapses. Among the neuroligins, NLGN2 binds NRXNs with the lowest affinity, suggesting that it could have other not yet characterized ligands. The aim of this work was to better characterize the binding of Caspr2 to TAG-1 and to identify new potential binding partner for Caspr2 and NLGN2. Unexpectedly, using Isothermal Titration Calorimetry and co-immunoprecipitation experiments the direct association of the first two proteins could not be verified and the results indicate that the first evidences reporting it were biased by false-positive artifacts. These findings, together with the uncharacterized synaptic localization of Caspr2, made the identification of new potential binding partners for this protein necessary. To find new proteins that associate with Caspr2 and NLGN2, affinity chromatography in tandem with mass spectrometry experiments were performed. Interestingly, about 25 new potential partners were found for these two proteins and NLGN1, that was originally included as a control: 5 of those, namely SFRP1, CLU, APOE, CNTN1 and TNR, were selected for further investigations. Only the association of CLU to NLGN2 was confirmed. In the future, screenings of the remaining candidates have to be carried out and the functional role for the proposed NLGN2-CLU complex has to be studied.

Bioconjugation and synthetic approach towards enantioenriched gem-difluoromethylene compounds through carbenium ions

Bioconjugation of peptides and asymmetric synthesis of gem-difluoromethylene compounds are areas of the modern organic chemistry for which mild and selective methods continue to be developed. This thesis reports new methodologies for these two areas based on the use of stabilized carbenium ions. The reaction that makes the bioconjugation of peptides possible takes place via the direct nucleophilic substitution of alcohols and is driven by the spontaneous formation of stabilized carbenium ions in water. By reacting with the thiol group of cysteine in very mild conditions and with a high selectivity, these carbenium ions allow the site-specific ligation of polypeptides containing cysteine and their covalent derivatization with functionalized probes. The ligation of the indole ring of tryptophan, an emerging target in bioconjugation, is also shown and takes place in the same conditions. The second area investigated is the challenging access to optically active gem-difluoromethylene compounds. We describe a methodology relying on the synthesis of enantioenriched 1,3-benzodithioles intermediates that are shown to be precursors of the corresponding gem-difluoromethylene analogues by oxidative desulfurization-fluorination. This synthesis takes advantage of the highly enantioselective organocatalytic α-alkylation of aldehydes with the benzodithiolylium ion and of the wide possibilities of synthetic transformations offered by the 1,3-benzodithiole group. This approach allows the asymmetric access to complex gem-difluoromethylene compounds through a late-stage fluorination step, thus avoiding the use of fluorinated building blocks.

Surface patterning with colloidal monolayers

This thesis focuses on the controlled assembly of monodisperse polymer colloids into ordered two-dimensional arrangements. These assemblies, commonly referred to as colloidal monolayers, are subsequently used as masks for the generation of arrays of complex metal nanostructures on solid substrates.rnThe motivation of the research presented here is twofold. First, monolayer crystallization methods were developed to simplify the assembly of colloids and to produce more complex arrangements of colloids in a precise way. Second, various approaches to colloidal lithography are designed with the aim to include novel features or functions to arrays of metal nanostructures.rnThe air/water interface was exploited for the crystallization of colloidal monolayer architectures as it combines a two-dimensional confinement with a high lateral mobility of the colloids that is beneficial for the creation of high long range order. A direct assembly of colloids is presented that provides a cheap, fast and conceptually simple methodology for the preparation of ordered colloidal monolayers. The produced two-dimensional crystals can be transformed into non-close-packed architectures by a plasma-induced size reduction step, thus providing valuable masks for more sophisticated lithographic processes. Finally, the controlled co-assembly of binary colloidal crystals with defined stoichiometries on a Langmuir trough is introduced and characterized with respect to accessible configurations and size ratios. rnSeveral approaches to lithography are presented that aim at introducing different features to colloidal lithography. First, using metal-complex containing latex particles, the synthesis of which is described as well, symmetric arrays of metal nanoparticles can be created by controlled combustion of the organic material of the colloids. The process does not feature an inherent limit in nanoparticle size and is able to produce complex materials as will be demonstrated for FePt alloy particles. Precise control over both size and spacing of the particle array is presented. rnSecond, two lithographic processes are introduced to create sophisticated nanoparticle dimer units consisting of two crescent shaped nanostructures in close proximity; essentially by using a single colloid as mask to generate two structures simultaneously. Strong coupling processes of the parental plasmon resonances of the two objects are observed that are accompanied by high near-field enhancements. A plasmon hybridization model is elaborated to explain all polarization dependent shifts of the resonance positions. Last, a technique to produce laterally patterned, ultra-flat substrates without surface topographies by embedding gold nanoparticles in a silicon dioxide matrix is applied to construct robust and re-usable sensing architectures and to introduce an approach for the nanoscale patterning of solid supported lipid bilayer membranes. rn

The floating mass transducer at the round window: direct transmission or bone conduction?

The round window placement of a floating mass transducer (FMT) is a new approach for coupling an implantable hearing system to the cochlea. We evaluated the vibration transfer to the cochlear fluids of an FMT placed at the round window (rwFMT) with special attention to the role of bone conduction. A posterior tympanotomy was performed on eleven ears of seven human whole head specimens. Several rwFMT setups were examined using laser Doppler vibrometry measurements at the stapes and the promontory. In three ears, the vibrations of a bone anchored hearing aid (BAHA) and an FMT fixed to the promontory (pFMT) were compared to explore the role of bone conduction. Vibration transmission to the measuring point at the stapes was best when the rwFMT was perpendicularly placed in the round window and underlayed with connective tissue. Fixation of the rwFMT to the round window exhibited significantly lower vibration transmission. Although measurable, bone conduction from the pFMT was much lower than that of the BAHA. Our results suggest that the rwFMT does not act as a small bone anchored hearing aid, but instead, acts as a direct vibratory stimulator of the round window membrane.

Single fluoroscopic image based 2D/3D reconstruction of a scaled, patient-specific vertebral model

Purpose Accurate three-dimensional (3D) models of lumbar vertebrae can enable image-based 3D kinematic analysis. The common approach to derive 3D models is by direct segmentation of CT or MRI datasets. However, these have the disadvantages that they are expensive, timeconsuming and/or induce high-radiation doses to the patient. In this study, we present a technique to automatically reconstruct a scaled 3D lumbar vertebral model from a single two-dimensional (2D) lateral fluoroscopic image. Methods Our technique is based on a hybrid 2D/3D deformable registration strategy combining a landmark-to-ray registration with a statistical shape model-based 2D/3D reconstruction scheme. Fig. 1 shows different stages of the reconstruction process. Four cadaveric lumbar spine segments (total twelve lumbar vertebrae) were used to validate the technique. To evaluate the reconstruction accuracy, the surface models reconstructed from the lateral fluoroscopic images were compared to the associated ground truth data derived from a 3D CT-scan reconstruction technique. For each case, a surface-based matching was first used to recover the scale and the rigid transformation between the reconstructed surface model Results Our technique could successfully reconstruct 3D surface models of all twelve vertebrae. After recovering the scale and the rigid transformation between the reconstructed surface models and the ground truth models, the average error of the 2D/3D surface model reconstruction over the twelve lumbar vertebrae was found to be 1.0 mm. The errors of reconstructing surface models of all twelve vertebrae are shown in Fig. 2. It was found that the mean errors of the reconstructed surface models in comparison to their associated ground truths after iterative scaled rigid registrations ranged from 0.7 mm to 1.3 mm and the rootmean squared (RMS) errors ranged from 1.0 mm to 1.7 mm. The average mean reconstruction error was found to be 1.0 mm. Conclusion An accurate, scaled 3D reconstruction of the lumbar vertebra can be obtained from a single lateral fluoroscopic image using a statistical shape model based 2D/3D reconstruction technique. Future work will focus on applying the reconstructed model for 3D kinematic analysis of lumbar vertebrae, an extension of our previously-reported imagebased kinematic analysis. The developed method also has potential applications in surgical planning and navigation.

Radiation dose optimized lateral expansion of the field of view in synchrotron radiation X-ray tomographic microscopy

Volumetric data at micrometer level resolution can be acquired within a few minutes using synchrotron-radiation-based tomographic microscopy. The field of view along the rotation axis of the sample can easily be increased by stacking several tomograms, allowing the investigation of long and thin objects at high resolution. On the contrary, an extension of the field of view in the perpendicular direction is non-trivial. This paper presents an acquisition protocol which increases the field of view of the tomographic dataset perpendicular to its rotation axis. The acquisition protocol can be tuned as a function of the reconstruction quality and scanning time. Since the scanning time is proportional to the radiation dose imparted to the sample, this method can be used to increase the field of view of tomographic microscopy instruments while optimizing the radiation dose for radiation-sensitive samples and keeping the quality of the tomographic dataset on the required level. This approach, dubbed wide-field synchrotron radiation tomographic microscopy, can increase the lateral field of view up to five times. The method has been successfully applied for the three-dimensional imaging of entire rat lung acini with a diameter of 4.1 mm at a voxel size of 1.48 microm.

Trigonal and peritrigonal lesions of the lateral ventricle-surgical considerations and outcome analysis of 20 patients

The aim of this study is to review the results and clinical outcome of patients with surgically treated lesions within the trigone of the lateral ventricle. This is a retrospective case series of 20 (eight male, 12 female) patients with lesions of the trigone of the lateral ventricle operated between 1998 and 2008. All lesions were removed via the transcortical temporal and transcortical parietal route. Surgical complications and outcome were assessed using the modified Rankin Scale (mRS). There were four children and 16 adults with a mean age of 42?±?22 years (min?=?1, max?=?74). Eight (40%) lesions grew within the trigone of the dominant hemisphere. In 17 cases, the lesion was purely intraventricular, and in three cases, a slight paraventricular extension was seen. The mean size was 4.5 cm of maximal diameter. Surgical removal was achieved via the transcortical parietal route in 13 cases (65%) and the transcortical temporal route in seven cases (35%). In all cases, complete resection was possible. According to the mRS, 13 patients improved, five remained the same, and two were lost to follow-up. One patient had an increased visual field deficit postoperatively and new hemiparesis and aphasia, but returned to the preoperative level within a few weeks. In one patient, an acute myocardial infarction occurred due to previous cardiac stent placement and in-stent stenosis. Even large trigonal lesions can be resected with low morbidity using a transcortical approach depending on the peritrigonal extension of the tumor.

SMARTDIAB: a communication and information technology approach for the intelligent monitoring, management and follow-up of type 1 diabetes patients

SMARTDIAB is a platform designed to support the monitoring, management, and treatment of patients with type 1 diabetes mellitus (T1DM), by combining state-of-the-art approaches in the fields of database (DB) technologies, communications, simulation algorithms, and data mining. SMARTDIAB consists mainly of two units: 1) the patient unit (PU); and 2) the patient management unit (PMU), which communicate with each other for data exchange. The PMU can be accessed by the PU through the internet using devices, such as PCs/laptops with direct internet access or mobile phones via a Wi-Fi/General Packet Radio Service access network. The PU consists of an insulin pump for subcutaneous insulin infusion to the patient and a continuous glucose measurement system. The aforementioned devices running a user-friendly application gather patient's related information and transmit it to the PMU. The PMU consists of a diabetes data management system (DDMS), a decision support system (DSS) that provides risk assessment for long-term diabetes complications, and an insulin infusion advisory system (IIAS), which reside on a Web server. The DDMS can be accessed from both medical personnel and patients, with appropriate security access rights and front-end interfaces. The DDMS, apart from being used for data storage/retrieval, provides also advanced tools for the intelligent processing of the patient's data, supporting the physician in decision making, regarding the patient's treatment. The IIAS is used to close the loop between the insulin pump and the continuous glucose monitoring system, by providing the pump with the appropriate insulin infusion rate in order to keep the patient's glucose levels within predefined limits. The pilot version of the SMARTDIAB has already been implemented, while the platform's evaluation in clinical environment is being in progress.

The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation

A new anterior intrapelvic approach for the surgical management of displaced acetabular fractures involving predominantly the anterior column and the quadrilateral plate is described. In order to establish five 'windows' for instrumentation, the extraperitoneal space is entered along the lateral border of the rectus abdominis muscle. This is the so-called 'Pararectus' approach. The feasibility of safe dissection and optimal instrumentation of the pelvis was assessed in five cadavers (ten hemipelves) before implementation in a series of 20 patients with a mean age of 59 years (17 to 90), of whom 17 were male. The clinical evaluation was undertaken between December 2009 and December 2010. The quality of reduction was assessed with post-operative CT scans and the occurrence of intra-operative complications was noted. In cadavers, sufficient extraperitoneal access and safe instrumentation of the pelvis were accomplished. In the patients, there was a statistically significant improvement in the reduction of the fracture (pre- versus post-operative: mean step-off 3.3 mm (sd 2.6) vs 0.1 mm (sd 0.3), p < 0.001; and mean gap 11.5 mm (sd 6.5) vs 0.8 mm (sd 1.3), p < 0.001). Lesions to the peritoneum were noted in two patients and minor vascular damage was noted in a further two patients. Multi-directional screw placement and various plate configurations were feasible in cadavers without significant retraction of soft tissues. In the treatment of acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach allowed anatomical restoration with minimal morbidity related to the surgical access.

Biochemical characterization of detergent-resistant membranes: a systematic approach

Lateral segregation of cholesterol- and sphingomyelin-rich rafts and glycerophospholipid-containing non-raft microdomains has been proposed to play a role in a variety of biological processes. The most compelling evidence for membrane segregation is based on the observation that extraction with non-ionic detergents leads to solubilization of a subset of membrane components only. However, one decade later, a large body of inconsistent detergent-extraction data is threatening the very concept of membrane segregation. We have assessed the validity of the existing paradigms and we show the following. (i) The localization of a membrane component within a particular fraction of a sucrose gradient cannot be taken as a yardstick for its solubility: a variable localization of the DRMs (detergent-resistant membranes) in sucrose gradients is the result of complex associations between the membrane skeleton and the lipid bilayer. (ii) DRMs of variable composition can be generated by using a single detergent, the increasing concentration of which gradually extracts one protein/lipid after another. Therefore any extraction pattern obtained by a single concentration experiment is bound to be 'investigator-specific'. It follows that comparison of DRMs obtained by different detergents in a single concentration experiment is prone to misinterpretations. (iii) Depletion of cholesterol has a graded effect on membrane solubility. (iv) Differences in detergent solubility of the members of the annexin protein family arise from their association with chemically different membrane compartments; however, these cannot be attributed to the 'brick-like' raft-building blocks of fixed size and chemical composition. Our findings demonstrate a need for critical re-evaluation of the accumulated detergent-extraction data.

[Medium-term results after m. vastus medialis obliquus-plasty for lateral patellar dislocation]

Progressive retropatellar arthrosis is often seen in dated rigid distal realignment (i.e. osteotomy of tuberositas) at long-term follow-ups. Therefore, operations for lateral dislocation of the patella are still discussed controversially. Dynamic, proximal realignments seem to have lower rates of arthrosis but higher rates of redislocation. Recently, in anatomic and biomechanic studies, the m. vastus medialis obliquus (vmo) was found to be one of the most important proximal restraints to lateral dislocation of the patella.A total of 28 patients (mean age 21.5 years) were treated between 1994 and 2003 with a plasty of the vmo for lateral patellar dislocation. The technique was performed for most etiologies of femoropatellar instability.For this proximal soft tissue technique, the muscle tendon is detached from its patellar insertion. Subsequently, the tendon is reinserted at the patella 10-15 mm more distally and fixed with Mitek anchors. Full weight bearing in extension is possible immediately after surgery. An active vastus medialis training is started after 6 weeks.Of the patients, 27 were evaluated clinically and radiologically in 2004 (a mean of 5 years postoperatively). A total of 83% of the patients estimated the result to be good or excellent, 10% were satisfied and 7% were discontent. The mean Lysholm-Knee-Score was 83.1 points. Two patients suffered a patella redislocation (7%). A statistically significant improvement of the congruence angle was noted in the radiographs, even in medium-term controls. In 89% of the cases no or only little retropatellar arthrosis was observed. These 5 year results are comparable to those of other techniques for distal or proximal realignments. The rate of redislocation was below average. Compared to the rate of retropatellar arthrosis in long-term results of rigid distal realignment, our patients demonstrated a relative low rate after 5 years. We attribute this to the minimal interference in physiological joint mechanics and to the restored anatomy. In terms of future long-term results, our findings are promising. The idea of a proximal dynamic stabilization and the causal operative approach at the origin of pathology using vmo-plasty was confirmed in recent anatomic and biomechanic studies. Over or under correction of soft tissues could be adapted. More rigid techniques of distal realignment do not allow an adaptation to this extent and can lead to prearthrotic hyperpression in the medial femoropatellar and femorotibial joints.

A SURVEY OF THE LIKELIHOOD APPROACH TO BIOEQUIVALENCE TRIALS

Bioequivalence trials are abbreviated clinical trials whereby a generic drug or new formulation is evaluated to determine if it is "equivalent" to a corresponding previously approved brand-name drug or formulation. In this manuscript, we survey the process of testing bioequivalence and advocate the likelihood paradigm for representing the resulting data as evidence. We emphasize the unique conflicts between hypothesis testing and confidence intervals in this area - which we believe are indicative of the existence of the systemic defects in the frequentist approach - that the likelihood paradigm avoids. We suggest the direct use of profile likelihoods for evaluating bioequivalence and examine the main properties of profile likelihoods and estimated likelihoods under simulation. This simulation study shows that profile likelihoods are a reasonable alternative to the (unknown) true likelihood for a range of parameters commensurate with bioequivalence research. Our study also shows that the standard methods in the current practice of bioequivalence trials offers only weak evidence from the evidential point of view.