We investigated the cerebral autoregulation (CA) dynamics parameter phase and gain change when exposed to a longlasting motor task. 25 healthy subjects (mean age ± SE, 38±2.6 years, 13 females) underwent simultaneous recordings of spontaneous fluctuations in blood pressure (BP), cerebral blood flow velocity (CBFV), and end-tidal CO(2) (ETCO(2)) over 5 min of rest followed by 5 min of left elbow flexion at a frequency of 1 Hz. Tansfer function gain and phase between BP and CBFV were assessed in the frequency ranges of very low frequencies (VLF, 0.02-0.07 Hz), low frequencies (LF, 0.07-0.15), and high frequencies (HF, >0.15). CBFV increased on both sides rapidly to maintain an elevated steady state until movement stopped. Cerebrovascular resistance fell on the right side (rest 1.35±0.06, movement 1.28±0.06, p<0.01), LF gain decreased from baseline (right side 0.97±0.07 %/mm Hg, left 1.01±0.09) to movement epoch (right 0.73±0.08, left 0.76±0.06, p

• MeSH
• Adult MeSH
• Blood Pressure physiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Elbow physiology   MeSH
• Cerebrovascular Circulation physiology   MeSH
• Psychomotor Performance physiology   MeSH
• Blood Flow Velocity physiology   MeSH
• Heart Rate physiology   MeSH
• Ultrasonography, Doppler, Transcranial methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

PURPOSE OF THE STUDY The postoperative outcomes of total hip replacement and hemiarthroplasty after femoral neck fractures in elderly patients were analysed to determine general and local complications as well as morbidity and mortality rates in order to detect risk profiles and assess the best individual treatment option. MATERIALS AND METHODS One hundred sixty-one femoral neck fractures among patients aged ≥ 65 years treated with cemented hemiarthroplasty (HA) or uncemented total hip arthroplasty (THA) between January 2005 and October 2013 were evaluated. In the presence of articular pathologies as well as a fracture type Garden III or IV, the indication for joint replacement was given. Criteria for performing hemiarthroplasty were previously limited mobility. Freely and fully mobilised patients and patients with manifested osteoarthritis received a cementless THA. A comparison of the observed complications was made, differentiating between general and surgery-specific hip-related complications. Furthermore, the mortality rates were analysed in relation to the respective surgical treatment. RESULTS Seventy cemented HA and ninety-one uncemented THA were performed. There was a high complication rate of approximately 19% in both surgical intervention groups. The patients were more likely to develop general complications (HA 12.8%; THA 10.8%) even though cardiopulmonary complications occurred more frequently in the cemented HA group. Four patients died after cemented hemiarthroplasty due to thromboembolic events (5.7% mortality rate), whereas no deaths occurred after total hip replacement. Surgery-specific complications rates were 7.8% in THA and 5.7% in HA patients. CONCLUSIONS THA in eldery patients with femoral neck fractures is associated with a higher complication rate, mostly of general medical entity. After cemented HA, our study reveals a high mortality rate due to thromboembolic events. For patients with multimorbidity in particular, these findings therefore suggest that uncemented THA should be considered to prevent lethal complications. Key words: femoral neck fracture; total hip arthroplasty; hemiarthroplasty; complications.

• MeSH
• Survival Analysis MeSH
• Cementation adverse effects   MeSH
• Femoral Neck Fractures surgery   MeSH
• Hemiarthroplasty adverse effects   methods   MeSH
• Bone Cements MeSH
• Humans MeSH
• Arthroplasty, Replacement, Hip adverse effects   methods   MeSH
• Postoperative Complications MeSH
• Aged MeSH
• Thromboembolism etiology   MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

Historically, standard approaches for surgical treatment of displaced acetabular fractures were the KocherLangenbeck approach, the ilioinguinal approach and the extended iliofemoral approach (12). Presently, several modifications of these approaches are accepted alternatives, especially anterior modifications based on the intrapelvic approach described by Hirvensalo (8). Single access approaches allowing visualization of one acetabular column are the posterior Kocher-Langenbeck approach and the anterior ilioinguinal approach (12) and the use of a single approach is favoured (9, 24). For more complex situations, in the 80s and 90s extended approaches (extended iliofemoral approach according to Letournel (12), its modification to Reinert (19) (Baltimore approach), and the Triradiate approach according to Mears (14)) were introduced. These approaches are presently rarely choosen due to the extensive soft tissue dissection and higher complication rates (28). Alternatively, the combination of an anterior and posterior standard approach was recommended (7, 21, 22) having the disadvantage of longer operating time and blood loss and showed no superior results compared to a single approach. The meta-analysis by Giannoudis et al. stated that 48,7% of patients were treated using the Kocher-Langenbeck approach, followed by 21,9% ilioinguinal approaches and 12,4% extended approaches (6). More recent data from the years 2005-2007, showed that anterior approaches are now predominantly used according to a higher number of acetabular fractures with anterior column involvement. Overall, more than 40% of all patients with acetabular fractures are still approached via the Kocher-Langenbeck approach (18). Therefore, the Kocher-Langenbeck approach is still a "working horse" in approaching displaced acetabular fractures. The Kocher-Langenbeck approach consists of two parts. In 1874 von Langenbeck described a longitudinal incision starting from above the greater sciatic notch to the greater trochanter, dissecting the gluteal muscles for treating hip joint infections (11). Theodor Kocher in 1911 described a curved incision starting from the posterior-inferior corner of the greater trochanter, running across the postero-superior tip of the greater trochanter passing oblique in line with the fibres of the gluteus maximus muscle in direction to the posterior superior iliac spine (10). The aim of the present analysis is the detailed anatomi - cal analysis of this standard approach, focusing on fracture indication, positioning of the patient, exposure, dissection, reduction techniques of special fracture types, approach modifications/extensions, complications and approach-specific results.

• MeSH
• Acetabuloplasty methods   MeSH
• Acetabulum injuries   surgery   MeSH
• Operative Time MeSH
• Fracture Fixation methods   MeSH
• Fractures, Bone surgery   MeSH
• Blood Loss, Surgical statistics & numerical data   MeSH
• Humans MeSH
• Patient Positioning MeSH
• Fracture Fixation, Internal methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

The ilioinguinal approach is one of the standard approaches in the treatment of displaced acetabular fractures used during the last decades (9). The meta-analysis of Giannoudis et al. showed that 21.9% of acetabular fractures were historically treated using this approach (3). One of the disadvantages of this study was, that studies focussing especially on posterior wall stabilization and studies dealing with more complex fracture types treated by extended approaches were integrated. Thus, these fracture types were overrepresented. Re-analysis excluding these data lead to an increase of the rate of anterior approaches to 25.9%. More recent data (years 2005-2007) from the German multicenter study showed that presently in almost 45% of the cases the single ilioinguinal approach was used and only 38% of patients were stabilized via the KocherLangenbeck approach (11). Historically, the Smith-Peterson approach (15, 17) and the iliofemoral approach were used to treat acetabular fractures. In the 60ies, based on the work by Letournel and Judet, the ilioinguinal approach was developed for acetabular fracture fixation (9). It is an extrapelvic approach resulting in an indirect reconstruction concept of the acetabulum without direct visualization of the articular acetabulum. The ilioinguinal approach was the standard anterior approach during the last 30-40 years. An important advantage is the reduced soft tissue detachment of periarticular muscles with only a small risk of developing heterotopic bone formation. The aim of the second part of "Standard approaches to the acetabulum" is to report on the special topics indication, positioning, exposure, incision, dissection, the anatomical basis of osteosynthesis and present results using ilioinguinal approach.

• MeSH
• Acetabulum surgery   MeSH
• Fractures, Bone surgery   MeSH
• Humans MeSH
• Multicenter Studies as Topic MeSH
• Patient Positioning MeSH
• Fracture Fixation, Internal methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Introduction The intrapelvic approach was originally described by Hirvensalo et al. from Finland in the early 90ies (8) and a further comparable description was published shortly thereafter by Cole et al. (5). Since then, various modifications have been described. Whereas the ilioinguinal approach was used until then to treat acetabular fractures with relevant anterior column involvement from an extrapelvic view, the intrapelvic approach was developed to address the often accompanied central hip dislocation in these fracture types with relevant fractures of the quadrilateral surface. With this approach a complete different view to the antero-medial acetabular pathology was possible. The view from more medial allows a better direct access to joint structures "below" the pelvic brim in the true pelvis (intrapelvic) in contrast to the extrapelvic access with the ilioinguibnal approach. Meanwhile, the surgical technique has been described in detail and some modifications and tricks have been published (5, 8, 10, 13, 19). The intrapelvic approach offers several advantages compared to the ilioinguinal approach: • lower invasiveness without substantial muscle detachment, • direct view of the superior pubic rami from superior and medial, the inferior anterior column and the quadrilateral surface up to the posterior border of the posterior column at the greater sciatic notch, • reduction and fixation of the anterior column and the quadrilateral surface under direct visualization, • reduction of antero-superior marginal impactions under direct visualization, • low risk of heterotopic ossification, • low risk of lesions to the lateral cutaneous femoral nerve. The aim of the third part of "standard approaches of the acetabulum" is to report on the special topics indication, positioning, exposure, incision, dissection, the anatomical basis of osteosynthesis and present results using the via the intrapelvic approach.

• MeSH
• Acetabuloplasty methods   MeSH
• Acetabulum injuries   MeSH
• Fractures, Bone surgery   MeSH
• Humans MeSH
• Fracture Fixation, Internal methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Abstracts MeSH

Tattooing has been shown to be very efficient at inducing immunity by vaccination with DNA vaccines. In this study, we examined the usability of tattooing for delivery of peptide vaccines. We compared tattooing with subcutaneous (s.c.) needle injection using peptides derived from human papillomavirus type 16 (HPV16) proteins. We observed that higher peptide-specific immune responses were elicited after vaccination with the simple peptides (E7(44-62) and E7(49-57)) and keyhole limpet hemocyanin-(KLH)-conjugated peptides (E7(49-57), L2(18-38) and L2(108-120)) with a tattoo device compared to s.c. inoculation. The administration of the synthetic oligonucleotide containing immunostimulatory CpG motifs (ODN1826) enhanced the immune responses developed after s.c. injection of some peptides (E7(44-62), KLH-conjugated L2(18-38) and L2(108-120)) to levels close to or even comparable to those after tattoo delivery of identical peptides with ODN1826. The highest efficacy of tattooing was observed in combination with ODN1826 for the vaccination with the less immunogenic E6(48-57) peptide and KLH-conjugated and non-conjugated E7(49-57) peptides which form the visible aggregates that could negatively influence the development of immune responses after s.c. injection but probably not after tattooing. In summary, we first evidenced that tattoo administration of peptide vaccines that might be useful in some cases efficiently induced both humoral and cell-mediated immune responses.

• MeSH
• T-Lymphocytes, Cytotoxic immunology   MeSH
• Vaccines, DNA immunology   MeSH
• Hemocyanins immunology   MeSH
• Human papillomavirus 16 immunology   MeSH
• Molecular Sequence Data MeSH
• Mice, Inbred C57BL MeSH
• Mice MeSH
• Oncogene Proteins, Viral immunology   MeSH
• Papillomavirus E7 Proteins MeSH
• Peptide Fragments MeSH
• Repressor Proteins immunology   MeSH
• Amino Acid Sequence MeSH
• Tattooing MeSH
• Vaccination MeSH
• Papillomavirus Vaccines immunology   MeSH
• Capsid Proteins immunology   MeSH
• Animals MeSH
• Check Tag
• Mice MeSH
• Female MeSH
• Animals MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH