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Further development of novel biomaterials and the discovery of alternative cell sources may facilitate the process of cell-based regenerative therapies for all knee structures becoming the gold standard in the future.

Overall, cell-based regenerative cartilage therapy of the knee has shown tremendous development over the last years and has become the standard of care for large and isolated chondral defects. It has shown success in the treatment of traumatic, osteochondral defects but also for degenerative cartilage lesions in the demanding condition of early OA. Future developments and alternative cell sources may help to facilitate cell-based regenerative treatment for all different structures around the knee by a whole joint approach.

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IV.The Robert Koch Institute (RKI) plays a central role in Germany in the management of health hazards of biological origin. The RKI's crisis management aims to contribute to protecting the health of the population in Germany in significant epidemic situations and to maintain the RKI's working ability over a long period of time even under high load. This article illustrates the crisis management of the RKI in general as well as during the COVID-19 pandemic. The generic RKI crisis management structures and the setup of the RKI emergency operations centre (EOC), their operationalisation in the context of the COVID-19 pandemic and the resulting challenges as of 31 October 2020 are described in this paper. The exchange between the federal and state governments during the pandemic is also described.The COVID-19 pandemic has led to extraordinary circumstances. During the epidemic situation, good communication and coordination has been essential, both within the RKI and with other federal or state authorities and expert groups. Under great pressure, the RKI produces and regularly updates recommendations, statements and assessments on various topics. To provide operational support for all COVID-19 related activities, an EOC was activated at the RKI. During the COVID-19 pandemic, there are various challenges regarding personnel and structures. It became apparent that good preparation (e.g. existing task descriptions and premises) has an important positive impact on crisis management.

One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate.

Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19.

Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital.

Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation.

Clinical and ventilation data were obtained from medical records in a retrospective manner.

A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42-87 years. All patients received open tracheostsiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.In the present study, an urban and industrial area were evaluated through a biomonitoring study employing the Tillandsia purpurea and T. latifolia species as a biomonitor. Plants were collected from a non-contaminated area and transplanted and exposed for three months into study areas to determine metal accumulation. Sixteen elements (Al, As, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, Rb, Sb, V, and Zn) were measured using ICP-MS analysis. Datasets were assessed by one-way ANOVA, exposed-to-baseline (EB) ratio, and principal component analysis. Results showed significant differences among study areas for most elements, but no differences were found between species. According to EB ratios, As, Cd, Cr, Cu, Fe, Ni, Pb, Sb, V, and Zn showed EB ratios > 1.75 for both Tillandsia species around the industrial area, indicating influence from the Smelter plant. Ba, Sb, and Zn showed EB ratios > .1.75 in the urban area for both plants, indicating the releasing of pollutants from vehicular sources. PCA showed that most elements are derived from vehicular sources, industrial activities, and dust resuspension.Osteochondral lesions (OCL) of the talus are defined as chondral damage with subchondral involvement. The traumatic etiology is important; in particular, sprains and fractures can lead to lesions of the articular surface and the subchondral plate. JNK Inhibitor VIII solubility dmso As a result, unstable lesions and subchondral cysts can trigger substantial persistent pain and functional impairments. A primary conservative treatment can be considered and is especially recommended in children and adolescents; however, return to previous sports activity and level is often not achieved. The principles of reconstructive surgical management include internal fixation of osteochondral fragments, bone marrow stimulation, autologous membrane-augmented chondrogenesis ± bone grafting, osteochondral transfer, retrograde techniques ± bone grafting, (matrix-associated) autologous chondrocyte implantation and autologous osteoperiosteal graft from the iliac crest. Additional surgical procedures for ankle stabilization and deformity correction should be considered if necessary.

Effective interprofessional teamwork and stress are important factors for quality of care and patient safety in the operating room (OR); however, there are just afew systematic investigations into the relationship of OR teamwork and occupational stress.

Determination of the relationship between interdisciplinary OR teamwork and stress in routine procedures, for the whole OR team as well as individual professions.

Multimethod study with expert observations using astandardized observation tool (OTAS-D) and systematic self-reports of the entire OR team. A total of 64 elective interventions across different surgical departments were observed. Relationships were calculated using mixed-effects regression models with control of procedural and provider characteristics.

The quality of the intraoperative teamwork was at amedium level. Reported stress during interventions was at comparatively low levels, with significant differences between the professions of surgery, nursing and anesthesiology. Members of the surgical team reported the highest stress levels. An association between teamwork and perceived stress could not be determined for the entire OR team; however, within the surgical sub-team there were significant positive correlations for the quality of teamwork and stress (as well as for the teamwork dimensions of collaboration and leadership). For the nursing sub-team, we observed significant negative correlations with overall teamwork as well as with the dimension team monitoring.

The findings suggest aprofession-specific relationship between OR teamwork and occupational stress. Further research is necessary to investigate to what extent successful OR teamwork during routine procedures contributes to intraoperative stress.

The findings suggest a profession-specific relationship between OR teamwork and occupational stress. Further research is necessary to investigate to what extent successful OR teamwork during routine procedures contributes to intraoperative stress.Chronic kidney disease is a widespread terminal illness that afflicts millions of people across the world. Hemodialysis is the predominant therapeutic management strategy for kidney failure and involves the external filtration of metabolic waste within the circulation. This process requires an arteriovenous fistula (AVF) for vascular access. However, AVF maturation failures are significant obstacles in establishing long-term vascular access for hemodialysis. Appropriate stimulation, activation, and proliferation of smooth muscle cells, proper endothelial cell orientation, adequate structural changes in the ECM, and the release of anti-inflammatory markers are associated with maturation. AVFs often fail to mature due to inadequate tissue repair and remodeling, leading to neointimal hyperplasia lesions. The transdifferentiation of myofibroblasts and sterile inflammation are possibly involved in AVF maturation failures; however, limited data is available in this regard. The present article critically reviews the interplay of various damage-associated molecular patterns (DAMPs) and the downstream sterile inflammatory signaling with a focus on the NLRP3 inflammasome. Improved knowledge concerning AVF maturation pathways can be unveiled by investigating the novel DAMPs and the mediators of sterile inflammation in vascular remodeling that would open improved therapeutic opportunities in the management of AVF maturation failures and its associated complications.

The decision for total hip arthroplasty (THA) is based on pain, loss of function, radiological changes and failed conservative therapy. These criteria are rarely based on systematic research and have not been integrated in generally accepted treatment guidelines. Aim of our study was, therefore, to analyse which decision criteria German orthopaedic and trauma surgeons use in order to recommend THA for patients with hip osteoarthritis.

From 10/2019 to 07/2020 we conducted anation-wide survey among 218 orthopaedic and trauma surgeons about their criteria for and against THA surgery, as well as their treatment objectives.

147 fully completed questionnaires were analysed. Pain (99%), limitation of movement (99%), as well as impairment of walking distance (97%), and the subjective burden (97%) were the most frequent criteria. 97% and 96% of surgeons consider prescription of analgesics and physical therapy, as well as alack of their effectiveness, as criteria for THA. 87% see radiological changes grade Kellgr seen as contraindication by all surgeons.

Obtaining informed consent is achallenging task and is part of the educational objectives in the German NKLM. Teaching formats are inconsistent and time-consuming, with little emphasis on legal aspects, although they have moved into the focus of attention since the implementation of patient rights laws and play an important role in legal proceedings.

The aim of this study was the evaluation of medical students' knowledge about the legal aspects of obtaining informed consent. Alegal analysis was performed, and the patient rights laws were reviewed with reference to implications for undergraduate medical education.

After the analysis of laws and jurisdiction, multiple-choice questions regarding the legal aspects of obtaining informed consent were created and placed in the Progress Test Medicine (PTM). A statistical analysis of the results of Berlin medical students was performed descriptively.

The answers of 2625 (winter semester 2018/19) and 2409 (summer semester 2019) medical students in Berlin were analyzed.