German Total Ankle Replacement Register of the German Foot and Ankle Society (D. A. F.) - presentation of design and reliability of the data as well as first results

INTRODUCTION Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. MATERIAL AND METHODS The D. A. F.'s total ankle replacement register is a nation-wide, voluntary registry. After giving written informed consent, the patients can be added to the database by participating providers. Data are collected during hospital stay for surgical treatment, during routine follow-up inspections and in the context of revision surgery. The information can be submitted in paper-based or online formats. The survey instruments are available as minimum data sets or scientific questionnaires which include patient-reported outcome measures (PROMs). The pseudonymous clinical data are collected and evaluated at the Institute for Evaluative Research in Medicine, University of Bern/Switzerland (IEFM). The patient-related data remain on the register's module server in North Rhine-Westphalia, Germany. The registry's methodology as well as the results of the revisions and patient satisfaction for 115 patients with a two year follow-up period are presented. Statistical analyses are performed with SAS™ (Version 9.4, SAS Institute, Inc., Cary, NC, USA). RESULTS About 2½ years after the register was launched there are 621 datasets on primary implantations, 1,427 on follow-ups and 121 records on re-operation available. 49 % of the patients received their implants due to post-traumatic osteoarthritis, 27 % because of a primary osteoarthritis and 15 % of patients suffered from a rheumatic disease. More than 90 % of the primary interventions proceeded without complications. Subsequent interventions were recorded for 84 patients, which corresponds to a rate of 13.5 % with respect to the primary implantations. It should be noted that these secondary procedures also include two-stage procedures not due to a complication. "True revisions" are interventions with exchange of components due to mechanical complications and/or infection and were present in 7.6 % of patients. 415 of the patients commented on their satisfaction with the operative result during the last follow-up: 89.9 % of patients evaluate their outcome as excellent or good, 9.4 % as moderate and only 0.7 % (3 patients) as poor. In these three cases a component loosening or symptomatic USG osteoarthritis was present. Two-year follow-up data using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale (AOFAS-AHS) are already available for 115 patients. The median AOFAS-AHS score increased from 33 points preoperatively to more than 80 points three to six months postoperatively. This increase remained nearly constant over the entire two-year follow-up period. CONCLUSION Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.

Biotic and abiotic controls of nitrogen and phosphorus cycling in Central European forests

The functioning and services of Central European forests are threatened by global change and a loss of biodiversity. Nutrient cycling as a key forest function is affected by biotic drivers (e.g., dominant tree species, understory plants, soil organisms) that interact with abiotic conditions (e.g., climate, soil properties). In contrast to grassland ecosystems, evidence for the relationship of nutrient cycles and biodiversity in forests is scarce because the structural complexity of forests limits experimental control of driving factors. Alternatively, observational studies along gradients in abiotic conditions and biotic properties may elucidate the role of biodiversity for forest nutrient cycles. This thesis aims to improve the understanding of the functional importance of biodiversity for nutrient cycles in forests by analyzing water-bound fluxes of nitrogen (N) and phosphorus (P) along gradients in biodiversity in three regions of Germany. The tested hypotheses included: (1) temperate forest canopies retain atmospheric N and retention increases with increasing plant diversity, (2) N release from organic layers increases with resource availability and population size of decomposers but N leaching decreases along a gradient in plant diversity, (3) P leaching from forest canopies increases with improved P supply from recalcitrant P fractions by a more diverse ectomycorrhizal fungal community. In the canopies of 27 forest stands from three regions, 16 % to 51 % of atmospheric N inputs were retained. Regional differences in N retention likely resulted from different in N availability in the soil. Canopy N retention was greater in coniferous than in beech forests, but this was not the case on loessderived soils. Nitrogen retention increased with increasing tree and shrub diversity which suggested complementary aboveground N uptake. The strength of the diversity effect on canopy N uptake differed among regions and between coniferous and deciduous forests. The N processing in the canopy directly coupled back to N leaching from organic layers in beech forests because throughfall-derived N flushed almost completely through the mull-type organic layers at the 12 studied beech sites. The N release from organic layers increased with stand basal area but was rather low (< 10 % of annual aboveground litterfall) because of a potentially high microbial N immobilization and intensive incorporation of litter into the mineral soil by bioturbation. Soil fauna biomass stimulated N mineralization through trophic interactions with primary producers and soil microorganisms. Both gross and net leaching from organic layers decreased with increasing plant diversity. Especially the diversity but not the cover of herbs increased N uptake. In contrast to N, P was leached from the canopy. Throughfall-derived P was also flushed quickly through the mull-type organic layers and leached P was predominantly immobilized in non directly plant-available P fractions in the mineral soil. Concentrations of plant-available phosphate in mineral soil solution were low and P leaching from the canopy increased with increasing concentrations of the moderately labile P fraction in soil and increasing ectomycorrhiza diversity while leaf C:P ratios decreased. This suggested that tree P supply benefited from complementary mining of diverse mycorrhizal communities for recalcitrant P. Canopy P leaching increased in years with pronounced spring drought which could lead to a deterioration of P supply by an increasing frequency of drought events. This thesis showed that N and P cycling in Central European forests is controlled by a complex interplay of abiotic site conditions with biological processes mediated by various groups of organisms, and that diverse plant communities contribute to tightening the N cycle in Central European forests and that diverse mycorrhizal communities improve the limited P availability. Maintaining forest biodiversity seems essential to ensure forest services in the light of environmental change.

Glenohumeral dislocation. Injury patterns and combination injuries

Hintergrund Begleitverletzungen können in bis zu 90 % der Fälle nach erstmaliger Schulterluxation auftreten. Auch wenn sie nicht immer einen Einfluss auf die Therapiewahl haben, so ist eine sorgfältige Diagnostik entscheidend. Einteilung In der Akutsituation ist eine konventionelle Bildgebung in mindestens 2 Ebenen (a.-p./Neer/evtl. axial) vor und nach Reposition zwingend. Luxationsfrakturen dürfen nicht übersehen bzw. durch das Manöver der geschlossenen Reposition sekundär disloziert werden. Bestehen ossäre glenoidale, humerale oder kombinierte Verletzungen, sollten sie gemäß Stabilitätskriterien versorgt werden. Dies kann umgehend, nach manifester Dezentrierung oder Instabilität entweder mittels Osteosythese oder als glenohumerale Stabilisation im Verlauf erfolgen. Bei einer Instabilität ist prinzipiell zur Bilanzierung einer ossären Ursache das Arthro-CT die Untersuchung der Wahl, welche auch eine Beurteilung der kapsulolabroligamentären Verletzung sowie einer traumatischen Rotatorenmanschettenläsion ermöglicht. Letztere ist jedoch besser mittels Arthro-MRT zu beurteilen. Diskussion Eine signifikante frische, meist größere oder massive, Rotatorenmanschettenläsion sollte rasch operativ angegangen werden. Medial reichende „off the track“ Hill-Sachs-Läsionen können mittels einer Hill-Sachs-Remplissage oder, wie auch glenoidale Defekte, mittels einer Kochenaugmentation versorgt werden. Langzeitresultate des Latarjet-Verfahrens zeigen 25 Jahre nach dem Eingriff die niedrigste Reluxationsrate < 4 %, eine gute Außenrotation, eine sehr hohe Patientenzufriedenheit und degenerative Veränderungen, welche vergleichbar mit der natürlichen Entwicklung nach erstmaliger Schulterluxation ohne Rezidiv sind.

Fossil record of foraminifera and ostracoda from the Elsterian-Saalian-Interglacial in Schleswig-Holstein, Germany

Die in den Ablagerungen des marinen Elster-Saale-Interglazials (= Holstein-See = Stör-Meer) gefundenen und als autochthon betrachteten Foraminiferen und Ostrakoden kommen alle noch rezent vor. In vielen Proben wurden daneben aus dem Tertiär und der Oberkreide aufgearbeitete Foraminiferen gefunden. In den Proben aus Muldsberg, Albersdorf und Esbjerg konnte eine gleichgerichtete Faunen-veränderung vom Liegenden zum Hangenden beobachtet werden. Die Formen der jeweils unteren Proben gehören subarktischen bis hochborealen Temperaturen, etwa vollmarinem Milieu und mindestens 30 m Wassertiefe an. Ins Hangende hinein wurde nach Foraminiferen und Ostrakoden das Meer flacher, wärmer und brackischer, bis es schließlich in den obersten Proben wattähnliche Verhältnisse mit wahrscheinlich etwas geringerer Temperatur als am heutigen südlichen Nordseerand erreichte. Diese Beobachtung stimmt überein mit den von GRAHLE (1936) an Mollusken gewonnenen Erkenntnissen und den Schlüssen, die andere Bearbeiter aus einzelnen Mikrofaunen zogen. Es wurde versucht, die Faunen der restlichen Aufschlüsse in das oben erwähnte Schema einzuordnen. Dies gelang nur in zwei Fällen nicht. In Oldenhütten ist das Versagen wahrscheinlich auf unentwirrte Lagerungsstörungen zurückzuführen, in der Austernbank Tarbek liegen abweichende fazielle Verhältnisse vor. Die restlichen Aufschlüsse zeigen, daß aus den vom Eis gestörten Sedimenten doch oft ein sinnvolles Bild rekonstruiert werden kann. Die im kälteren Teil der Holstein-See auftretende Foraminifere Elphidium subarcticum CUSHMAN scheint in den Absätzen des schleswig-holsteinischen Eem-Meeres zu fehlen.

Newer optics efficiently mix, dim, and color-tune LED light

Low-cost, plastic-injected optics mix light from different color LED dies without a significant decrease in average brightness, simplifying luminaire design both optically and electronically. In solid-state lighting, high-flux and high-color rendering index (CRI) light engines may be achieved by arraying and mixing the light from different color dies or phosphors, or a combination of the two, in the LED package. However, these nonhomogeneous sources, when combined with luminaire optics, tend to produce patterns with undesirable artifacts such as spatial and angular nonuniformities and color separation.

Isolation and characterization of mutant cell lines defective in transforming growth factor beta signaling.

To isolate and characterize effector molecules of the transforming growth factor beta (TGFbeta) signaling pathway we have used a genetic approach involving the generation of stable recessive mutants, defective in their TGFbeta signaling, which can subsequently be functionally complemented to clone the affected genes. We have generated a cell line derived from a hypoxanthine-guanine phosphoribosyltransferase negative (HPRT-) HT1080 clone that contains the selectable marker Escherichia coli guanine phosphoribosyltransferase (gpt) linked to a TGFbeta-responsive promoter. This cell line proliferates or dies in the appropriate selection medium in response to TGFbeta. We have isolated three distinct TGFbeta-unresponsive mutants following chemical mutagenesis. Somatic cell hybrids between pairs of individual TGFbeta-unresponsive clones reveal that each is in a distinct complementation group. Each mutant clone retains all three TGFbeta receptors yet fails to induce a TGFbeta-inducible luciferase reporter construct or TGFbeta-mediated plasminogen activator inhibitor-1 (PAI-1) expression. Two of the three have an attenuated TGFbeta-induced fibronectin response, whereas in the other mutant the fibronectin response is intact. These TGFbeta-unresponsive cells should allow selection and identification of signaling molecules through functional complementation.

Potential Adverse Effects of the Alaska Natural Gas Pipeline on Arctic Caribou and Proposed Mitigation

The Alaska Natural Gas Pipeline (ANGP) is proposed for construction on the North Slope in 2016. It will be aligned through Arctic caribou habitat and evidence shows that caribou are negatively affected by human development. This Capstone identifies potential adverse affects of ANGP on Arctic caribou using interviews from expert caribou biologists and the 1977 Trans-Alaska Pipeline System (TAPS) as a model. Based on a synthesis of the interviews and TAPS analysis, this capstone proposes and examines a set of seventeen conservation measures to be implemented during construction and operation of ANGP to minimize adverse impacts on caribou herds. These conservation measures can be used as a baseline for future developments on the North Slope to promote caribou herd management.

Tap:sīro [tapsīlo] : manuscript, 1884?

Local paper. Ms. imperfect, later folios missing, paper brittle in poor condition; ff. 1, 2 and 114 damaged.

Recueil des meilleures pièces dramatiques faites en France, depuis Rotrou jusqu'a nos jours; ou le théâtre francois; tragédies.

Mode of access: Internet.

Répertoire du Théâtre François, ou, Recueil des tragédies et comédies restées au théâtre depuis Rotrou pour faire suite aux éditions in-octavo de Corneille, Molière, Racine, Regnard, Crébillon, et au théâtre de Voltaire; avec des notices sur chaque auteur, et l'examen de chaque pièce,

Vols. 1-6, "tragédies"; v. 7, "drames"; v. 8-23, "comédies"

Aureum breuiarium concionatorum, siue sermones breues in dominicos et festos dies totius anni : quibus in fine accedunt conciones siue adhorationes breues nuptiales /

Mode of access: Internet.

Capitols, estatuts, e ordinacions de la... ciutat de Valencia, dits del Quitament : ordenats, y publicats en lo insigne Consell General de aquella en lo dia de 21 de Març del any... 1669 y en altres dies seguents del mateix any...

Sign.: [ ]2, A-Z2, 2A-2Y2, [ ]1.

Exercitia spiritualia ad mentem et normam D. Ignatii conscripta et adaptata usui personarum ecclesiasticarum pro sacra solitudine singulis annis ineunda et in octo vel decem dies protrahenda /

Mode of access: Internet.

Clericus instructus seu Doctrina moralis : ex epistolis et euangeliis missarum desumpta in singulos anni dies et principaliora festa distributa venerabili Clero /

Mode of access: Internet.

Quadripartitae conciones Stanislai Grodicii Societatis Iesu ... : tomus quartus, continet tres dies paschales [et] quinque dominicas sequentes.

Mode of access: Internet.