TY - THES A1 - Fuchs, Matthias Sebastian T1 - Die visuelle Wahrnehmung von erwachsenen Patienten mit einer ausgeprägten Dysgnathie im Vergleich zu Erwachsenen ohne dysgnathe Anomalie: Eine Eye-Tracking Studie T1 - Visual face perception of edults with dysgnathy in comparison to controls: an Eye-Tracking Study N2 - Patienten mit einer skelettelen Klasse III Dysgnathie werden gegenüber Patienten ohne Dysgnathie als weniger attraktiv angesehen. Die Gesichter von Patienten mit einer skelettalen Klasse III werden visuell mit anderen Augenbewegungen wahrgenommen. Die unterschiedliche Wahrnehmung von Dysgnathiepatienten im Vergleich zu einer Kontrollgruppe wurde in dieser Studie zum ersten mal beschrieben.Obwohl die Unterschiede nur gering sind, ist dieses Ergebnis ein erstes Indiz für die Objektivierung, wie Gesichter wahrgenommen werden, die als weniger attrakiv, asymmetrischer und mit einem negativem Gesichtsausdruck bewertet werden. N2 - Orthognathic skeletal Class III patients were characterized as less attractive than Class I individuals. Faces of Class III orthognathic patients were visually perceived with different eye-movements. The differences in the visual perception of orthognathic skeletal Class III patients compared to Class I individuals have described in the present study for the first time. Although the differences between the two groups were small, this finding is an initial indication of an objectively measured difference in how faces are perceived which are rated subjectively as less attractive, more asymmetric and exhibiting a more negative facial expression. KW - Augenfolgebewegung KW - Dysgnathie KW - Visuelle Wahrnehmung KW - Asymmetrie KW - Dysgnathy KW - eye-tracking KW - visuell perception Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-55884 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Jovic, Sebastian A1 - Gilbert, Fabian A1 - Kunz, Andreas A1 - Ertl, Maximilian A1 - Strobl, Ute A1 - Jakubietz, Rafael G. A1 - Jakubietz, Michael G. A1 - Meffert, Rainer H. A1 - Fuchs, Konrad F. T1 - Qualitätssteigerung der Abrechnungsprüfung durch Smartphone-basierte Fotodokumentation in der Unfall-, Hand-, und Plastischen Chirurgie JF - Der Unfallchirurg N2 - Hintergrund Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat. Fragestellung Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern? Material und Methoden Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat. Ergebnisse Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt. Diskussion Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken. N2 - Background Photographic documentation of wounds, decubitus ulcers, tumors, open fractures and infections is an important part of digital patient files. It is unclear whether the photographic documentation has an effect on medical accounting with health insurance companies. Objective It was hypothesized that Smartphone-based systematic photographic documentation can improve the confirmation of proceeds-relevant diagnoses and procedures as well as the duration. Material and methods Staff in the emergency room, operating theater, outpatient clinic and on the wards were equipped with digital devices (Smartphone, tablet) including a photo-app. Medical accounting with the health insurance companies and identification of all case conferences in which the photographic documentation had effected a change in proceeds were analyzed for 2019 in a retrospective manner. Results Overall, 372 cases were discussed of which 27 cases were affected by the digital photographic documentation. Photographic documentation was used for clarification of the operative procedure (n = 5), primary diagnosis (n = 10), secondary diagnosis (n = 3), and length of hospitalization (n = 9). An average of 2119 € was negotiated and added per case affected by photographic documentation. Hereby, a level 1 trauma center gained an estimated 65,328 € in revenue. Discussion The use of Smartphone based photographic documentation can improve the overall quality of patient files and thus avoid loss of revenue. The implementation of digital devices with corresponding software is an important component of the digital structural change in hospitals. KW - Digitalisierung KW - Gesundheits-App KW - Künstliche Intelligenz KW - Plattform KW - Strukturwandel KW - artificial intelligence KW - database KW - digital transformation KW - photo app KW - surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232415 SN - 0177-5537 VL - 124 ER - TY - JOUR A1 - Fuchs, Sebastian A1 - Hertel, Dietrich A1 - Schuldt, Bernhard A1 - Leuschner, Christoph T1 - Effects of summer drought on the fine root system of five broadleaf tree species along a precipitation gradient JF - Forests N2 - While much research has addressed the aboveground response of trees to climate warming and related water shortage, not much is known about the drought sensitivity of the fine root system, in particular of mature trees. This study investigates the response of topsoil (0–10 cm) fine root biomass (FRB), necromass (FRN), and fine root morphology of five temperate broadleaf tree species (Acer platanoides L., Carpinus betulus L., Fraxinus excelsior L., Quercus petraea (Matt.) Liebl., Tilia cordata Mill.) to a reduction in water availability, combining a precipitation gradient study (nine study sites; mean annual precipitation (MAP): 920–530 mm year\(^{−1}\)) with the comparison of a moist period (average spring conditions) and an exceptionally dry period in the summer of the subsequent year. The extent of the root necromass/biomass (N/B) ratio increase was used as a measure of the species’ belowground sensitivity to water deficits. We hypothesized that the N/B ratio increases with long-term (precipitation gradient) and short-term reductions (moist vs. dry period) of water availability, while FRB changes only a little. In four of the five species (exception: A. platanoides), FRB did not change with a reduction in MAP, whereas FRN and N/B ratio increased toward the dry sites under ample water supply (exception: Q. petraea). Q. petraea was also the only species not to reduce root tip frequency after summer drought. Different slopes of the N/B ratio-MAP relation similarly point at a lower belowground drought sensitivity of Q. petraea than of the other species. After summer drought, all species lost the MAP dependence of the N/B ratio. Thus, fine root mortality increased more at the moister than the drier sites, suggesting a generally lower belowground drought sensitivity of the drier stands. We conclude that the five species differ in their belowground drought response. Q. petraea follows the most conservative soil exploration strategy with a generally smaller FRB and more drought-tolerant fine roots, as it maintains relatively constant FRB, FRN, and morphology across spatial and temporal dimensions of soil water deficits. KW - Acer platanoides KW - Carpinus betulus KW - fine root biomass KW - fine root necromass KW - Fraxinus excelsior KW - necromass/biomass ratio KW - Quercus petraea KW - root morphology KW - Tilia cordata KW - water availability Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203189 SN - 1999-4907 VL - 11 IS - 3 ER - TY - JOUR A1 - Fuchs, Konrad F. A1 - Heilig, Philipp A1 - McDonogh, Miriam A1 - Boelch, Sebastian A1 - Gbureck, Uwe A1 - Meffert, Rainer H. A1 - Hoelscher-Doht, Stefanie A1 - Jordan, Martin C. T1 - Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes JF - Journal of Orthopaedic Surgery and Research N2 - Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys (R) QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem (TM) V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients. KW - arthritis KW - bone KW - calcaneus KW - cement KW - fracture KW - fixation KW - osteoporosis KW - sanders KW - screw Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230336 VL - 15 ER - TY - JOUR A1 - Boelch, Sebastian P. A1 - Rueckl, Kilian A1 - Fuchs, Clara A1 - Jordan, Martin A1 - Knauer, Markus A1 - Steinert, Andre A1 - Rudert, Maximilian A1 - Luedemann, Martin T1 - Comparison of elution characteristics and compressive strength of biantibiotic-loaded PMMA bone cement for spacers: Copal\(^®\) spacem with gentamicin and vancomycin versus Palacos\(^®\) R+G with vancomycin JF - BioMed Research International N2 - Purpose. Copal\(^®\) spacem is a new PMMA bone cement for fabricating spacers. This study compares elution of gentamicin, elution of vancomycin, and compressive strength of Copal\(^®\) spacem and of Palacos\(^®\) R+G at different vancomycin loadings in the powder of the cements. We hypothesized that antibiotic elution of Copal\(^®\) spacem is superior at comparable compressive strength. Methods. Compression test specimens were fabricated using Copal\(^®\) spacem manually loaded with 0.5 g gentamicin and additionally 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (COP specimens) and using 0.5 g gentamicin premixed Palacos\(^®\) R+G manually loaded with 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (PAL specimens). These specimens were used for determination of gentamicin and vancomycin elution (in fetal calf serum, at 22°C) and for determination of compressive strength both prior and following the elution tests. Results. Cumulative gentamicin concentrations (p < 0.005) and gentamicin concentration after 28 days (p ≤ 0.043) were significantly lower for COP specimens compared to PAL specimens. Cumulative vancomycin concentrations were significantly higher (p ≤ 0.043) for COP specimens after the second day. Vancomycin concentrations after 28 days were not significantly higher for the Copal specimens loaded with 2 g and 4 g of vancomycin. Compressive strength was not significantly different between COP specimens and PAL specimens before elution tests. Compressive strength after the elution tests was significantly lower (p = 0.005) for COP specimens loaded with 2 g of vancomycin. Conclusion. We could not demonstrate consistent superior antibiotic elution from Copal\(^®\) spacem compared to Palacos\(^®\) R+G for fabricating gentamicin and vancomycin loaded spacers. The results do not favor Copal\(^®\) spacem over Palacos\(^®\) R+G for the use as a gentamicin and vancomycin biantibiotic-loaded spacer. KW - Copal\(^®\) spacem KW - PMMA bone cement KW - elution KW - compressive strength Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177435 VL - 2018 IS - 4323518 ER - TY - JOUR A1 - Scheer, Monika A1 - Vokuhl, Christian A1 - Blank, Bernd A1 - Hallmen, Erika A1 - von Kalle, Thekla A1 - Münter, Marc A1 - Wessalowski, Rüdiger A1 - Hartwig, Maite A1 - Sparber-Sauer, Monika A1 - Schlegel, Paul-Gerhardt A1 - Kramm, Christof M. A1 - Kontny, Udo A1 - Spriewald, Bernd A1 - Kegel, Thomas A1 - Bauer, Sebastian A1 - Kazanowska, Bernarda A1 - Niggli, Felix A1 - Ladenstein, Ruth A1 - Ljungman, Gustaf A1 - Jahnukainen, Kirsi A1 - Fuchs, Jörg A1 - Bielack, Stefan S. A1 - Klingebiel, Thomas A1 - Koscielniak, Ewa T1 - Desmoplastic small round cell tumors: Multimodality treatment and new risk factors JF - Cancer Medicine N2 - Background To evaluate optimal therapy and potential risk factors. Methods Data of DSRCT patients <40 years treated in prospective CWS trials 1997-2015 were analyzed. Results Median age of 60 patients was 14.5 years. Male:female ratio was 4:1. Tumors were abdominal/retroperitoneal in 56/60 (93%). 6/60 (10%) presented with a localized mass, 16/60 (27%) regionally disseminated nodes, and 38/60 (63%) with extraperitoneal metastases. At diagnosis, 23/60 (38%) patients had effusions, 4/60 (7%) a thrombosis, and 37/54 (69%) elevated CRP. 40/60 (67%) patients underwent tumor resection, 21/60 (35%) macroscopically complete. 37/60 (62%) received chemotherapy according to CEVAIE (ifosfamide, vincristine, actinomycin D, carboplatin, epirubicin, etoposide), 15/60 (25%) VAIA (ifosfamide, vincristine, adriamycin, actinomycin D) and, 5/60 (8%) P6 (cyclophosphamide, doxorubicin, vincristine, ifosfamide, etoposide). Nine received high-dose chemotherapy, 6 received regional hyperthermia, and 20 received radiotherapy. Among 25 patients achieving complete remission, 18 (72%) received metronomic therapies. Three-year event-free (EFS) and overall survival (OS) were 11% (±8 confidence interval [CI] 95%) and 30% (±12 CI 95%), respectively, for all patients and 26.7% (±18.0 CI 95%) and 56.9% (±20.4 CI 95%) for 25 patients achieving remission. Extra-abdominal site, localized disease, no effusion or ascites only, absence of thrombosis, normal CRP, complete tumor resection, and chemotherapy with VAIA correlated with EFS in univariate analysis. In multivariate analysis, significant factors were no thrombosis and chemotherapy with VAIA. In patients achieving complete remission, metronomic therapy with cyclophosphamide/vinblastine correlated with prolonged time to relapse. Conclusion Pleural effusions, venous thrombosis, and CRP elevation were identified as potential risk factors. The VAIA scheme showed best outcome. Maintenance therapy should be investigated further. KW - C-reactive protein KW - desmoplastic small round cell tumor KW - maintenance therapy KW - soft tissue sarcoma KW - Trousseau's syndrome Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228444 VL - 8 IS - 2 ER -