Effects of the PPAR-β/δ agonist GW0742 during resuscitated porcine septic shock.

BACKGROUND: In un-resuscitated rodent models of septic shock, the peroxisome proliferator-activated receptor-β/δ (PPAR-β/δ) agonist GW0742 improved visceral organ function. Therefore, we tested the hypothesis whether GW0742 would attenuate kidney injury during long-term, resuscitated, porcine polymicrobial septic shock. METHODS: Six, 12, and 18 h after the induction of fecal peritonitis by inoculation of autologous feces, anesthetized, mechanically ventilated, and instrumented male pigs with pre-existing atherosclerosis resulting from familial hypercholesteremia and atherogenic diet randomly received either vehicle (dimethyl sulfoxide, n = 12) or GW0742 (n = 10). Resuscitation comprised hydroxyethyl starch and norepinephrine infusion titrated to maintain mean arterial pressure at baseline values. RESULTS: Despite aggressive fluid resuscitation, fecal peritonitis was associated with arterial hypotension requiring norepinephrine infusion, ultimately resulting in progressive lactic acidosis and acute kidney injury. GW0742 did not beneficially affect any parameter of systemic and regional hemodynamics, gas exchange, metabolism, or organ function. The parameters of inflammation, oxidative and nitrosative stress, and organ injury (post-mortem analysis for histomorphology and markers of apoptosis) were not influenced either. Immunohistochemistry of pre-shock kidney biopsies from a previous study in this swine strain showed markedly lower PPAR-β/δ receptor expression than in healthy animals. CONCLUSIONS: In swine with pre-existing atherosclerosis, the PPAR-β/δ agonist GW0742 failed to attenuate septic shock-induced circulatory failure and kidney dysfunction, most likely due to reduced receptor expression coinciding with cardiovascular and metabolic co-morbidity

First metatarsophalangeal hemiarthroplasty for hallux rigidus

There is a paucity of objective information in the literature about first metatarsophalangeal (MTP) hemiarthroplasty. The authors postulate that it is a reasonable treatment option for severe hallux rigidus in selected patients. Twenty-two elective first MTP hemiarthroplasties were performed on 20 patients that met the inclusion criteria. Pre- and postoperative evaluations were done using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) pain score, range of motion (ROM) measurements, and radiographs. Average ROM and dorsiflexion improved by 15° and 8°, respectively. VAS pain scores improved from 5 to 2.5 after six weeks. Painless ambulation occurred after six weeks, with maximum improvement by six months. After 24 months, two patients had pain at the surgical site interfering with function, leading to an unsatisfactory result that required conversion to arthrodesis. First MTP hemiarthroplasty for severe hallux rigidus can be considered an alternative to fusion in properly selected patients who wish to maintain a functional range of motion

The Necessity of Self-Employment Towards Retirement: Evidence from Labor Market Dynamics and Search Requirements for Unemployment Benefits

Hervorming Sociale Regelgevin

In Search for a Credit Crunch in Germany

The purpose of this paper is to investigate whether a credit crunch occurred in Germany during the recent financial crisis and to analyze the underlying factors. In order to disentangle credit supply and demand we specify a theory-based dynamic disequilibrium model of the German credit market. To estimate this model we use a new approach based on Bayesian Inference suggested by Bauwens and Lubrano (2007). Besides the analysis of the whole banking sector we will apply the model to five groups of banks (big private banks, Landesbanken, savings banks, credit cooperatives, regional institutions of credit cooperatives) that were affected differently by the financial crisis. The results suggest that a credit crunch did not occur in Germany during the recent economic crisis as well as during the following recovery starting in 2010. Furthermore, we find that especially those banks that were more affected by the financial crisis through huge impairments restricted their credit supply more than others. Both supply and demand side factors contributed to the stabilization of credit financing. This suggests that the structure of the German banking sector as well as economic policy measures avoided a credit crunch

Kirschner wire transfixation of the femoral head in slipped capital femoral epiphysis in children.

OBJECTIVE: To stabilize the unstable capital femoral epiphysis to stop further slippage. To prevent imminent epiphyseal dislocation with subsequent articulation disorders of the hip joint and joint degeneration. To prevent additional growth disorders of the proximal femur. INDICATIONS: Epiphyseolysis capitis femoris acuta.Epiphyseolysis capitis femoris lenta. Epiphyseolysis capitis femoris incipiens (incipient epiphyseolysis). Epiphyseolysis capitis femoris imminens (imminent epiphyseolysis of the so-called healthy contralateral side). CONTRAINDICATIONS: None. The diagnosis of slipped capital femoral epiphysis is an absolute indication for surgery unless there is an internal or pediatric disorder that dictates a conservative approach. SURGICAL TECHNIQUE: Three, possibly four, Kirschner wires, at least 2 mm thick, are inserted through a short subtrochanteric approach under image intensification into the femoral neck so that they are seen to be spread uniformly over the cross section of the femoral head when viewed in both planes. The opposite side is transfixed prophylactically. POSTOPERATIVE MANAGEMENT: 3 weeks partial loading at 10 kg, then increased loading after radiologic assessment. Radiologic assessment every 6 months until the end of the growth phase so that migration of the Kirschner wiresout of the femoral head can be identified early. If necessary, renewed Kirschner wire transfixation. Implants are removed after consolidation and closure of the growth plate. RESULTS: 59 therapeutic and 48 prophylactic transfixations of slipped capital femoral epiphysis were performed from 1970 to 1995. The average follow-up period was 4 years (0.1-17.3 years). The most frequent complications were incipient secondary joint degeneration arising in most cases from femoral head necrosis, and postoperative identification of Kirschner wire malalignment. At the time of follow-up 27 patients had an excellent result on the pathologic side according to Southwick's classification, 26 a good, three a moderate, and three a poor result. In particular, a poor result ensued subsequent to femoral head necrosis

Influence of surgical experience on accuracy of acetabular cup positioning in total hip arthroplasty.

Acetabular cup positioning with respect to inclination and anteversion is important in total hip arthroplasty. Positioning affects wear, range of motion, dislocation, and aseptic loosening and is essential for the prognosis after surgery. In this study, we sought to determine the accuracy of surgeons' cup positioning and to test for any differences in accuracy among surgeons with different levels of surgical experience. Using a lateral transgluteal approach, 2 groups of surgeons with different levels of surgical experience positioned 85 cups. Fifty-nine percent of the cups were outside the safe zone of Lewinnek. There was no significant difference between the 2 groups