Orthopedic Clinic

Skopje, Macedonia

Orthopedic Clinic

Skopje, Macedonia
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Top 10 Cyber Attack Breaches of 2016 Compromised More Than 12 Million Records SAN MATEO, CA--(Marketwired - Dec 22, 2016) -  TrapX™, a global leader in advanced cybersecurity defense, today announced the availability of its "2016 Year-End Healthcare Cyber-Breach Report." The research, which was conducted by TrapX Labs, indicates that the continued wave of cyberattacks impacting healthcare institutions in the United States increased by 63 percent year-over-year to a total of 93 major attacks. The data also shows sophisticated cyber attackers are now responsible for 31.42 percent of all major HIPAA data breaches reported in 2016, which is a 300 percent increase in the last three years. The full report can be downloaded here: https://goo.gl/3lBQ5O To give some context as to how pervasive attacks on healthcare institutions have been, in 2014 cyber attackers were responsible for 9.77 percent of the total major HIPAA data breaches, and this increased in 2015 to 21.11 percent. These sophisticated and persistent cyber attackers are a huge threat to the protection of patient healthcare data and critical healthcare operations and ultimately present a direct physical risk to the patients themselves. Medical Device Hijacks and Ransomware on the Rise "Through our ongoing research, TrapX Labs continues to uncover hijacked medical devices (MEDJACK) that attackers are using as back doors into hospital networks," said Moshe Ben-Simon, co-founder and vice president of services at TrapX Labs "Once inside the network, these attackers move laterally in search of high-profile targets from which they can ultimately exfiltrate intellectual property and patient data. Unfortunately, hospitals do not seem to be able to detect MEDJACK or remediate it. The great majority of existing cyber-defense suites do not seem able to detect attackers moving laterally from these compromised devices." The list of devices vulnerable to a MEDJACK attack is large and includes diagnostic equipment such as PET and CT scanners and MRI machines; therapeutic equipment such as infusion pumps, medical lasers and laser eye surgery machines; and life support equipment such as heart-lung machines, medical ventilators, extracorporeal membrane oxygenation machines and dialysis machines. In June, TrapX Labs issued its report "Anatomy of an Attack - Medical Device Hijack 2," which chronicles how attackers have evolved and are now increasingly targeting medical devices that use legacy operating systems that contain known vulnerabilities. By camouflaging old malware with new techniques, the attackers are able to successfully bypass traditional security mechanisms to gain entry into hospital networks and ultimately to access sensitive data. That report can be downloaded here: http://deceive.trapx.com/WPMEDJACK.2_210LandingPage.html To mitigate these attacks going forward, TrapX recommends that hospital staff review budgets and cyber-defense initiatives at the organizational board level and consider bringing in new technologies that can identify attackers that have already penetrated their networks. In addition, healthcare organizations need to implement strategies that review and remediate existing medical devices, better manage medical device end-of-life and carefully limit access to medical devices. It becomes essential to leverage technology and processes that can detect threats from within hospital networks. In addition to MEDJACK attacks, cybercriminals are increasingly turning to new strains of ransomware to extort money from healthcare institutions. In August, TrapX identified more than 2,000 variations of ransomware that employ different methods of attack on the network. Ransomware is easier to manufacture and deploy than MEDJACK and other attack methods, and organized crime is investing significantly in improving tool sets. Healthcare institutions are specifically targeted because they have the financial depth to afford the payments, and they have the incentive to make them because of the threat to critical patient care and ongoing operations. In October 2016 several hospitals in the United Kingdom experienced a ransomware attack that forced them to cancel hospital operations, including scheduled surgical procedures, for a period of several days. "Lack of new technology and associated best practices make it very difficult for hospitals to detect and remediate ransomware attacks. We expect to see an increase in the number of incidents in 2017," Ben-Simon continued. To address ransomware, TrapX introduced CryptoTrap in August this year, which was specifically designed to ensure customers are protected from all forms of ransomware. CryptoTrap is also setting an industry first by leveraging deception technology to hold ransomware attacks captive while security teams are alerted to remediate the threat. What is more, when paired with the DeceptionGrid™ Advanced Incident Response (AIR) module, which extends and automates incident response, CryptoTrap becomes the only deception-based ransomware tool on the market that can also offer deep forensics on attack details. This allows security teams to analyze the threat and tailor defenses accordingly. Top Ten Healthcare Cyberattacks of 2016 2015 witnessed some of the largest healthcare breaches in history. Three major healthcare cyberattacks compromised Excellus BlueCross® BlueShield® (10 million records), Premera Blue Cross® (11 million records), and Anthem Blue Cross (78.8 million records). In the 57 attacks documented that year, approximately 111,812,172 data records were breached. In 2016, the number of records breached decreased to approximately 12,057,759; however, the number of attacks increased by 63 percent to 93 documented data breaches. Following are the top 10 healthcare cyberattacks of 2016, based on the number of protected health information (PHI) data records breached. The dates are not necessarily based upon the date of the attack but on the date when mandatory reporting to the Department of Human Health and Services, Office of Civil Rights, was submitted. 1. Banner Health®: In August this year, this health system reported that approximately 3,620,000 patient records were breached, making this the single largest healthcare data breach reported so far in 2016. 2. Newkirk Products, Inc.: Also in August, this company, which is part of Broadridge® Financial Solutions, was attacked and approximately 3,446,120 records were potentially compromised. 3. 21st Century Oncology: In March, 21st Century Oncology was breached and approximately 2,213,597 former and current patients were affected. 4. Valley Anesthesiology Consultants, Inc.: In August, Valley Anesthesiology Consultants announced they were potentially breached during an ongoing cyberattack that occurred between March 30 and June 13, 2016. 882,590 records were affected. 5. Peachtree Orthopedic Clinic: In November, this provider of orthopedic services headquartered in Atlanta, Georgia, notified 531,000 patients of a cyberattack that had compromised their protected health information. 6. Central Ohio Urology Group, Inc.: In May, the group reported an August 2015 cyberattack that affected 300,000 patients. 7. Southeast Eye Institute, P.A. (doing business as Eye Associates of Pinellas): In May, the institute was notified by Bizmatics, a major provider of medical practice software serving over 15,000 medical practices, that it had suffered a breach that impacted 87,314 individuals. 8. Medical Colleagues of Texas, LLP: Also in May, Medical Colleagues of Texas reported a breach that affected approximately 68,631 individuals. 9. Urgent Care Clinic of Oxford: In September, the clinic reported that approximately 64,000 individuals were impacted when the organization was breached. 10. Alliance Health Networks, LLC: In February, Alliance Health Networks reported that one of its patient databases had been left accessible via the Internet; this may have resulted in the protected health information of 42,372 patients being exposed for a period of 30 months. Report Methodology The 2016 Year-End Healthcare Cyber-Breach Report shares data on all major cyberattacks in the United States reported between January 1, 2016, and December 10, 2016. Some of these breaches may have been ongoing prior to the start of 2016, but to retain consistency the report only used the official reporting dates to the HHS OCR that fall within 2016. About TrapX Labs The mission of TrapX Labs is to conduct critical cybersecurity analysis, investigation and reporting and to bring the benefits to the community at large through publications and rapid ethical compliance disclosures to manufacturers and related parties. TrapX Security™ and DeceptionGrid™ are trademarks licensed by TrapX Security, Inc. More Information  Visit the TrapX Website: www.trapx.com  Watch a 60 Second Introduction to Deception Technology: https://youtu.be/d6lzgBZ4hWQ  Learn more about DeceptionGrid: http://trapx.com/products/deceptiongrid/  Visit the TrapX blog: http://www.trapx.com/blog/  Follow TrapX on Twitter: @trapxsecurity  Follow TrapX on LinkedIn: https://www.linkedin.com/company/trapx  Like TrapX on Facebook: https://www.facebook.com/pages/TrapX/258804147648401 About TrapX TrapX Security is a leader in deception based cyber security defense. Our solutions rapidly detect, analyze, and defend against zero day and advanced attacks in real time. DeceptionGrid™ provides automated, highly accurate insight into malware and malicious activity unseen by other types of cyber defense. We create a proactive security posture, fundamentally changing the economics of cyber defense by shifting the cost to the attacker. The TrapX Security customer base includes Forbes Global 2000 commercial and government customers around the world in sectors that include defense, healthcare, finance, energy, consumer products, and other key industries. Learn more at www.trapx.com.


Ramova E.P.,Universityst Kliment Ohridski | Poposka A.,Orthopedic Clinic | Lazovic M.,Clinic for Rehabilitation
Macedonian Journal of Medical Sciences | Year: 2010

Background. The spine deformities are presented with 27.3% in the population regarding all deformities of the muscle system. The clinical examination has its limitations as a result of the subjective participation of the examiner and the lack of qualitative measurement. Aim. In our research we tested the applicability of the software program Spine Mouse in screening of the spine deformities. The software program is important for spine examination in the sagittal plane. Material and Methods. In order to evaluate the software in the screening program for bad posture, we made a score with maximum points and possible gained points regarding the parameters: number of children who participated in the examination out of the entire population, number of the examined, preserved data from the examination and cooperation during the examination. Results. A total of 986 children were examined for 15 days with 6 children examined per hour or 74%. Of the total number of children, 97.2% cooperated during the examination and the data were lost for 14.7%. Conclusion. The results showed that this software is applicable with significance for examination of spine deformities in the school population. The cost of the software and the speed of the examinationare limiting factors for its use in a large population. © 2010 Popova Ramova E.


Ui M.,Orthopedic Clinic | Ogawa K.,Eiju General Hospital
Orthopedics | Year: 2010

Lipoma is the most frequently occurring benign soft tissue tumor in the shoulder and the axillary region in middle-aged and older persons, yet few such lipoma cases have been associated with clinical symptoms. A 38-year-old right-handed man presented with an enlarged feeling and a painful back-and-forth popping in his left shoulder. Although moderate tenderness of the subacromial bursa and bicipital groove existed, an obvious impingement sign was absent. Also not evidenced were signs of neurological deficits, limited range of motion, or any physical findings suggestive of instability. Magnetic resonance imaging showed a homogenous tumor in the subdeltoid that was isointense relative to the subcutaneous fat and fluid collection in the hypertrophic subacromial bursa. As the tumor was considered from the clinical and imaging findings to be attributable to all clinical symptoms, it was resected en bloc with a satisfactory result. Histopathologically, the tumor showed typical features of a simple lipoma. To our knowledge, the present case is the first of a subdeltoid intermuscular lipoma of which mechanism developing symptoms was preoperatively surmised from imaging. The symptommimicking shoulder instability was assumed to be produced by the back-and-forth snapping of the lipoma beneath the deltoid muscle. The mechanism for developing the subacromial impingement-like symptom was surmised to derive from the middle deltoid fibers pressuring the lipoma to push up into the subacromial space. This case is presented to emphasize the careful reading of imaging in considering the pathomechanism of the attributing symptoms.


Arnoczky S.P.,Michigan State University | Cook J.L.,University of Missouri | Carter T.,Orthopedic Clinic | Turner A.S.,Colorado State University
Tissue Engineering - Part B: Reviews | Year: 2010

Advances in clinical practice often have their roots in basic science investigations that provide the proof of principle of the treatment concept in question. However, if these concepts are to become reality, they first must be tested in translational animal models to confirm both safety and efficacy. The need to identify appropriate translational models in musculoskeletal tissue engineering and regenerative repair is of critical importance. This is especially true in meniscal research, where the functional anatomy of the structure is directly related to its contribution to the complex biomechanics of the joint and its role in chondroprotection. While no one animal model has established itself as the most appropriate for all aspects of meniscal research, several species have been used to successfully test specific hypotheses. A careful and comprehensive comparison must always be done to validate the utility of a specific animal model. Therefore, it is the purpose of this article to provide an overview of the considerations involved when selecting a translational model for meniscal research. © Copyright 2010, Mary Ann Liebert, Inc.


Lange J.,University of Greifswald | Barz T.,Asklepios Klinikum Uckermark | Ekkernkamp A.,University of Greifswald | Kloting I.,University of Greifswald | Follak N.,Orthopedic Clinic
Genes and Nutrition | Year: 2013

A high-fat diet (HFD) has been recognized as a risk factor for diseases such as dyslipidemia, atherosclerosis, obesity, and osteoporosis. However, studies analyzing gene expression after HFD in bone are rare. That prompted us to analyze the expression of selected genes in bone of 4-week-old diabetes-prone B(io)B(reeding) rats. Two breeding pairs were fed a HFD (+10 % tallow) or were fed a normal diet (ND; Ssniff R-Z) before mating and afterward during pregnancy. After the birth of progeny, parents continued to be given HFD or ND until the progeny was weaned (3 weeks). Thereafter, offspring were weaned and were fed the same food as their parents up to an age of 4 weeks. Body weight was measured at an age of 4 weeks, and subsequently 13 HFD rats and 13 ND rats were killed and the tibial bone was harvested to analyze the expression of 53 genes in bone. All rats fed HFD were significantly heavier than rats fed ND after 3 and 4 weeks. The diet also influenced the expression of genes in bone. There were significant differences in 20 out of 53 genes studied between rats fed HFD compared with rats fed ND. Four out of 20 had a lower and 17 out of 20 genes a higher expression in HFD rats, but differences in gene expression showed obvious differences between males and females. There were only two genes that were similarly different between males and females: Bmp4 and Atf4. Two genes, Foxg1 and Npy, were inversely expressed in males and females. It seems that the gene expression is differently regulated by diet during pregnancy and later in life between males and females. Nevertheless, it cannot be excluded that HFD also acts as an epigenetic factor in the development of offspring in utero. © 2012 Springer-Verlag.


Lange J.,University of Greifswald | Barz T.,Asklepios Clinic Uckermark | Ekkernkamp A.,University of Greifswald | Wilke B.,University of Greifswald | And 2 more authors.
PLoS ONE | Year: 2012

Background: Because inbred rat strains are widely used as laboratory models, knowledge of phenotypic and genetic variations between strains will be useful to obtain insight into the relationship between different strains. Methods and Results: We studied phenotypic traits: of each strain - BN/K, DA/K and WOKW -10 male rats were studied for body weight and serum constituents at an age of 10 and 30 weeks. In addition, a total of 95 rats were studied for life expectancy. At an age of 30 weeks, these male rats were killed by an overdose of anesthetic (Sevofluran, Abbott), and the subcutaneous and visceral adipose tissue as well as bone tissue were removed to study the expression of 20 genes. There were significant differences in body weight, serum lipids and leptin at an age of 30 weeks between strains. Regarding life expectancy, BN rats lived longest (1072±228d). The highest gene expression was found in bone of BN rats. In adipose tissues, Nfkb1 is only expressed in subcutaneous adipocytes, and 5 genes, Col2a1, Mmp9, Tnfa, Ins1 and Cyp24a1, are not expressed in adipocytes. The ranking BN = DA>WOKW was observed in only one gene in subcutaneous (Fto) and visceral adipocytes (Col6a1). There were no significant differences in gene expression of one gene in subcutaneous adipocytes and of 3 genes in visceral adipocytes. Comparing the gene expression in visceral and subcutaneous adipocytes, only one gene showed a comparable behavior (Bmp1). Conclusion: From these results, it can be concluded that obvious phenotypic differences are caused by genetic differences between three rat strains, BN, DA and WOKW, as supported by gene expression studies in bone and adipose tissues. Especially BN rats can be used to study the genetic basis of long life. © 2012 Lange et al.


Mann V.,Justus Liebig University | Spitzner T.,Justus Liebig University | Schwandner T.,Justus Liebig University | Mann S.T.W.,Orthopedic Clinic | And 4 more authors.
Anaesthesia | Year: 2012

Summary For personnel inexperienced in airway management, supraglottic airway devices may be the first choice in an emergency. Changing head position is known to reduce the seal pressure of a laryngeal mask airway. The aim of this study was to investigate whether the use of a cervical collar improves the stability of airways secured with the LMA Supreme™ (The Laryngeal Mask Company Limited, Mahé, Seychelles). In this crossover trial, the primary endpoint was the difference in the seal pressure of the LMA Supreme in anaesthetised patients in maximum passive extension of the neck, with and without a cervical collar. The median (IQR [range]) seal pressure was 18 (13.8-22.1 [0-30]) cmH2O in maximum passive extension without a cervical collar. With a cervical collar in place, the seal pressure increased to 28 (22.8-30 [17-30]) cmH2O (p < 0.001). In the neutral head position, the seal pressure was 22 (17.6-24.5 [12-30]) cmH2O without and 27 (22-30 [12-30]) cmH2O with a cervical collar in place (p < 0.001). We found that a cervical collar stabilises the airway with an LMA Supreme in place and we recommend this combination for (pre-hospital) emergency cases. © Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.


Strobel U.,Universitatsspital Zurich | Tami I.,Orthopedic Clinic | Andreisek G.,Universitatsspital Zurich | Giovanoli P.,Universitatsspital Zurich | Calcagni M.,Universitatsspital Zurich
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2014

Purpose: The aim of this study was to review the outcome of transscaphoid perilunate fracture dislocations by MRI to use the advantages of MRI to show the post-traumatic degenerative changes, the examination of cartilage, the integrity of the ligaments and the vascularisation of the carpal bones. A second aim of this study is to interpret the findings in correlation to the functional results and the individual perception of hand functionality (PRWE). Patients and Methods: In this retrospective study, 20 patients (1 woman and 19 men), who were treated with open reduction and internal fixation at our institution, were reviewed at a mean of 67 (25-145) months postoperative. The mean age was 30 (12-73) years. The functional results were measured by range of motion (ROM), grip and pinch strength. The Mayo and Krimmer wrist scores were calculated and the SF-36 and the patient-rated wrist evaluation (PRWE) questionnaires were performed. Radiological findings included consolidation of the fracture and the radiological measures (revised carpal height, SL gap, SL and RL angle). An MRI, performed without a contrasting agent, was used to assess the degenerative changes of the joints, the vascularisation of the carpalia and the integrity of the SL ligament. Statistical data was calculated with SPSS. Results: Range of motion and strength were reduced by 10-20% compared to the uninjured opposite side. Although the majority of the patients (85%) achieved good to very good results in the Mayo and Krimmer wrist scores, the MRI showed osteoarthritis in 95% of the cases in at least in 1 out of 5 patients evaluated intracarpal joints. MRI showed signs of complete SL ligament tears in 5 patients and a partial tear in 2 patients. The same group also showed the strongest degenerative changes. However, there was no correlation between patient satisfaction and imaging results. Conclusion: MRI findings, as well as X-ray findings, do not correlate with the subjective and objective functional outcomes after surgical treatment of transscaphoid perilunate fracture dislocations. It can be assumed that SL ligament lesions seen in MRI play a major role over the long term course. © 2014 Georg Thieme Verlag KG Stuttgart, New York.


Bahr J.,University of Greifswald | Kloting N.,University of Greifswald | Kloting N.,University of Leipzig | Kloting I.,University of Greifswald | Follak N.,Orthopedic Clinic
Transplant Immunology | Year: 2011

B(io) B(reedding)/O(ttawa) K(alsburg) rats spontaneously develop insulin-dependent type 1 diabetes. Days before BB/OK rats become diabetic, their body seems to be flabby which may be attributed to loss of subcutaneous fat. However, the rats are normoglycemic and manifest 3-4 days later. This observation prompted us to search for possibilities to avoid the loss of adipose tissue. BB/OK rats were subcutaneously grafted with visceral adipose tissue.In total, 34 (71%) out of 48 male and 23 (49%) out of 47 female BB/OK rats grafted with adipose tissue developed type 1 diabetes so that significantly more females than males were protected from diabetes development (p= 0.03). In the control group, 17 (85%) out of 20 male and 20 (95%) out of 21 female BB/OK rats were diabetic.Adipose tissue transplantation can protect BB/OK rats from type 1 diabetes development in a sex specific manner. One could conclude that the manipulations have influenced fat accumulation and/or fat metabolism which prevent type 1 diabetes development in about 50% of BB/OK rats. This idea is supported by the finding that a mutation in the leptin receptor of NOD mice suppresses type 1 diabetes progression. © 2011 Elsevier B.V.


PubMed | Universitatsspital Zurich and Orthopedic Clinic
Type: Comparative Study | Journal: Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V... | Year: 2014

The aim of this study was to review the outcome of transscaphoid perilunate fracture dislocations by MRI to use the advantages of MRI to show the post-traumatic degenerative changes, the examination of cartilage, the integrity of the ligaments and the vascularisation of the carpal bones. A second aim of this study is to interpret the findings in correlation to the functional results and the individual perception of hand functionality (PRWE).In this retrospective study, 20 patients (1 woman and 19 men), who were treated with open reduction and internal fixation at our institution, were reviewed at a mean of 67 (25-145) months postoperative. The mean age was 30 (12-73) years. The functional results were measured by range of motion (ROM), grip and pinch strength. The Mayo and Krimmer wrist scores were calculated and the SF-36 and the patient-rated wrist evaluation (PRWE) questionnaires were performed. Radiological findings included consolidation of the fracture and the radiological measures (revised carpal height, SL gap, SL and RL angle). An MRI, performed without a contrasting agent, was used to assess the degenerative changes of the joints, the vascularisation of the carpalia and the integrity of the SL ligament. Statistical data was calculated with SPSS.Range of motion and strength were reduced by 10-20% compared to the uninjured opposite side. Although the majority of the patients (85%) achieved good to very good results in the Mayo and Krimmer wrist scores, the MRI showed osteoarthritis in 95% of the cases in at least in 1 out of 5 patients evaluated intracarpal joints. MRI showed signs of complete SL ligament tears in 5 patients and a partial tear in 2 patients. The same group also showed the strongest degenerative changes. However, there was no correlation between patient satisfaction and imaging results.MRI findings, as well as X-ray findings, do not correlate with the subjective and objective functional outcomes after surgical treatment of transscaphoid perilunate fracture dislocations. It can be assumed that SL ligament lesions seen in MRI play a major role over the long term course.

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