TY - JOUR A1 - Kippnich, Maximilian A1 - Duempert, Maximilian A1 - Schorscher, Nora A1 - Jordan, Martin C. A1 - Kunz, Andreas S. A1 - Meybohm, Patrick A1 - Wurmb, Thomas T1 - Simultaneous treatment of trauma patients in a dual room trauma suite with integrated movable sliding gantry CT system: an observational study JF - Scientific Reports N2 - The trauma center of the University Hospital Wuerzburg has developed an advanced trauma pathway based on a dual-room trauma suite with an integrated movable sliding gantry CT-system. This enables simultaneous CT-diagnostics and treatment of two trauma patients. The focus of this study was to investigate the quality of the concept based on defined outcome criteria in this specific setting (time from arrival to initiation of CT scan: tCT; time from arrival to initiation of emergency surgery: tES). We analyzed all trauma patients admitted to the hospital’s trauma suite from 1st May 2019 through 29th April 2020. Two subgroups were defined: trauma patients, who were treated without a second trauma patient present (group 1) and patients, who were treated simultaneously with another trauma patient (group 2). Simultaneous treatment was defined as parallel arrival within a period of 20 min. Of 423 included trauma patients, 46 patients (10.9%) were treated simultaneously. Car accidents were the predominant trauma mechanism in this group (19.6% vs. 47.8%, p < 0.05). Prehospital life-saving procedures were performed with comparable frequency in both groups (intubation 43.5% vs. 39%, p = 0.572); pleural drainage 3.2% vs. 2.2%, p = 0.708; cardiopulmonary resuscitation 5% vs. 2.2%, p = 0.387). At hospital admission, patients in group 2 suffered significantly more pain (E-problem according to Advanced Trauma Life Support principles©; 29.2% vs. 45.7%, p < 0.05). There were no significant differences in the clinical treatment (emergency procedures, vasopressor and coagulant therapy, and transfusion of red blood cells). tCT was 6 (4–10) minutes (median and IQR) in group 1 and 8 (5–15.5) minutes in group 2 (p = 0.280). tES was 90 (78–106) minutes in group 1 and 99 (97–108) minutes in group 2 (p = 0.081). The simultaneous treatment of two trauma patients in a dual-room trauma suite with an integrated movable sliding gantry CT-system requires a medical, organizational, and technical concept adapted to this special setting. Despite the oftentimes serious and life-threatening injuries, optimal diagnostic and therapeutic procedures can be guaranteed for two simultaneous trauma patients at an individual medical level in consistent quality. KW - dual-room trauma suite KW - movable sliding gantry KW - CT Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299695 VL - 12 IS - 1 ER - TY - JOUR A1 - Dhaliwal, Anand A1 - Zamora, Tomas A1 - Nedopil, Alexander J. A1 - Howell, Stephen M. A1 - Hull, Maury L. T1 - Six commonly used postoperative radiographic alignment parameters do not predict clinical outcome scores after unrestricted caliper-verified kinematically aligned TKA JF - Journal of Personalized Medicine N2 - Background: Unrestricted caliper-verified kinematically aligned (KA) TKA restores patient’s prearthritic coronal and sagittal alignments, which have a wide range containing outliers that concern the surgeon practicing mechanical alignment (MA). Therefore, knowing which radiographic parameters are associated with dissatisfaction could help a surgeon decide whether to rely on them as criteria for revising an unhappy patient with a primary KA TKA using MA principles. Hence, we determined whether the femoral mechanical angle (FMA), hip–knee–ankle angle (HKAA), tibial mechanical angle (TMA), tibial slope angle (TSA), and the indicators of patellofemoral tracking, including patella tilt angle (PTA) and the lateral undercoverage of the trochlear resection (LUCTR), are associated with clinical outcome scores. Methods: Forty-three patients with a CT scan and skyline radiograph after a KA TKA with PCL retention and medial stabilized design were analyzed. Linear regression determined the strength of the association between the FMA, HKA angle, PTS, PTA, and LUCTR and the forgotten joint score (FJS), Oxford knee score (OKS), and KOOS Jr score obtained at a mean of 23 months. Results: There was no correlation between the FMA (range 2° varus to −10° valgus), HKAA (range 10° varus to −9° valgus), TMA (range 10° varus to −0° valgus), TSA (range 14° posterior to −4° anterior), PTA (range, −10° medial to 14° lateral), and the LUCTR resection (range 2 to 9 mm) and the FJS (median 83), the OKS (median 44), and the KOOS Jr (median 85) (r = 0.000 to 0.079). Conclusions: Surgeons should be cautious about using postoperative FMA, HKAA, TMA, TSA, PTA, and LUCTR values within the present study’s reported ranges to explain success and dissatisfaction after KA TKA. KW - total knee arthroplasty KW - kinematic alignment KW - reoperation KW - revision KW - phenotype Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288186 SN - 2075-4426 VL - 12 IS - 9 ER - TY - JOUR A1 - Boelch, S. P. A1 - Jansen, H. A1 - Meffert, R. H. A1 - Frey, S. P. T1 - Six Sesamoid Bones on Both Feet: Report of a Rare Case JF - Journal of Clinical and Diagnostic Research N2 - There is a variation of the total number of distinct bones in the human in the literature. This difference is mainly caused by the variable existence of sesamoid bones. Sesamoid bones at the first MTP are seen regularly. In contrast additional sesamoid bones at the divond to fifth MTP are rare. We report a case of additional sesamoid bones at every metatarsophalangeal joint (MTP) of both feet. A 22-year-old female Caucasian presented with weight-dependent pain of the divond MTP of the left foot. In the radiographs of both feet additional sesamoid bones at every MTP could be seen. This case reports a very rare variation in human anatomy. A similar case has not been displayed to the academic society and therefore should be acknowledged. KW - anatomy KW - genetics KW - variation Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126073 VL - 9 IS - 8 ER - TY - JOUR A1 - Kaltdorf, Martin A1 - Breitenbach, Tim A1 - Karl, Stefan A1 - Fuchs, Maximilian A1 - Kessie, David Komla A1 - Psota, Eric A1 - Prelog, Martina A1 - Sarukhanyan, Edita A1 - Ebert, Regina A1 - Jakob, Franz A1 - Dandekar, Gudrun A1 - Naseem, Muhammad A1 - Liang, Chunguang A1 - Dandekar, Thomas T1 - Software JimenaE allows efficient dynamic simulations of Boolean networks, centrality and system state analysis JF - Scientific Reports N2 - The signal modelling framework JimenaE simulates dynamically Boolean networks. In contrast to SQUAD, there is systematic and not just heuristic calculation of all system states. These specific features are not present in CellNetAnalyzer and BoolNet. JimenaE is an expert extension of Jimena, with new optimized code, network conversion into different formats, rapid convergence both for system state calculation as well as for all three network centralities. It allows higher accuracy in determining network states and allows to dissect networks and identification of network control type and amount for each protein with high accuracy. Biological examples demonstrate this: (i) High plasticity of mesenchymal stromal cells for differentiation into chondrocytes, osteoblasts and adipocytes and differentiation-specific network control focusses on wnt-, TGF-beta and PPAR-gamma signaling. JimenaE allows to study individual proteins, removal or adding interactions (or autocrine loops) and accurately quantifies effects as well as number of system states. (ii) Dynamical modelling of cell–cell interactions of plant Arapidopsis thaliana against Pseudomonas syringae DC3000: We analyze for the first time the pathogen perspective and its interaction with the host. We next provide a detailed analysis on how plant hormonal regulation stimulates specific proteins and who and which protein has which type and amount of network control including a detailed heatmap of the A.thaliana response distinguishing between two states of the immune response. (iii) In an immune response network of dendritic cells confronted with Aspergillus fumigatus, JimenaE calculates now accurately the specific values for centralities and protein-specific network control including chemokine and pattern recognition receptors. KW - cellular signalling networks KW - computer modelling Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313303 VL - 13 ER - TY - THES A1 - Kreische, Gunda T1 - Stabilisierung zur Verletzungsprävention am Sprunggelenk - eine Metaanalyse T1 - Prevention of ankle injuries - a metha-analysis N2 - In der vorliegenden Arbeit sollte im Rahmen einer Metaanalyse die Effektivität der verschiedenen präventiven Stabilisierungshilfen auf das Sprunggelenk bewertet werden. Dazu wurde in den medizinischen Datenbanken Medline und Pubmed nach relevanten Studien recherchiert. Nach der Literaturselektion entsprechend festgelegter Auswahlkriterien konnten 44 Studien im Zeitraum von 1962 bis 2005 in die Bewertung einfließen. Diese wurden der Evidenzhierarchie nach der Cochrane Collaboration zugeordnet. Entsprechend der Evidenzstärken und der kritischen Beurteilung der externen und internen Validität wurden die einzelnen Stabilisierungshilfen bewertet. Dabei zeigt sich, dass ältere, weit verbreitete und langzeiterprobte Maßnahmen wie der adhäsive Tape- Verband innovativeren und ausbaufähigen Methoden wie dem propriozeptiven Training weichen. In diesem sensomotorischen Bereich konnten übereinstimmend positive und größtenteils signifikante Ergebnisse ermittelt werden. Auch die Anwendung semirigider und rigider Orthesen zeigte bei der Mehrzahl der Studien einen signifikanten Supinationsschutz. Der präventive Effekt von (Schnür-) Bandagen äußerte sich vornehmlich in der Verbesserung der propriozeptiven Fähigkeiten vor allem instabiler Sprunggelenke. Beim Tape-Verband steht die initiale signifikante Supinationsrestriktion im Vordergrund, was unter anderem mit den Materialeigenschaften sowie vielfältigen und eingeschränkt reproduzierbaren Techniken begründet wird. Die Untersuchungen zu Schuhen unterschiedlicher Schafthöhen konnten keine übereinstimmend signifikanten Ergebnisse liefern. N2 - In the submitted paper, the purpose was to assess the effectivity of different external stabilizers (taping, orthesis, bandage and shoes) to prevent ankle injuriers doing a metha-analysis. From the medical databases Medline and Pubmed 44 studies werer chosen between 1962-2005 and were assessed following the evidence-criteria of the Cochrane Collaboration. This has shown that the older more common and longterm-proven methods, such as adhesive taping are now slowly being replaced by more innovative and improving methods. One of these is proprioceptive training. The preventive effect of bandages was mainly characterized by the improvement of proprioceptive abilities, above all for unstable ankles. Where semirigid and rigid braces have been used, a significant supination protection was shown in the majority of the studies as well. KW - Sprunggelenkverletzung KW - ankle KW - sprain KW - injury KW - prevention KW - shoes KW - taping KW - orthesis KW - bandage Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-25229 ER - TY - THES A1 - Ebersberger, Jeannette Elisabeth T1 - Stellenwert der dreifachen Beckenosteotomie nach Tönnis in der Behandlung der juvenilen Hüftdysplasie T1 - The meaning of Triple Pelvic Osteotomy by Tönnis in the treatment of juvenile hip dysplasia N2 - In vorliegender Studie wird der präoperative Hüftstatus mit den postoperativen klinischen, funktionellen und radiologischen Ergebnissen nach der dreifachen Beckenosteotomie nach Tönnis bei Jugendlichen und Erwachsenen verglichen. Es wurden 48 Patienten und 53 Hüften mit primärer Hüftdysplasie nachuntersucht. Das mittlere Nachuntersuchungsintervall betrug 2 Jahre, 9 Monate und das mittlere Alter zum Zeitpunkt der Operation lag bei 24 Jahren (11-43 Jahre). Klinische und funktionelle Parameter wurden mittels Harris Hip Score bewertet. 59 Prozent zeigten dabei sehr gute Ergebnisse, 9 Prozent gute und 13 Prozent zufriedenstellende Ergebnisse. Im Harris Hip Score konnte eine signifikante Verbesserung von 66 Punkten auf 83,5 Punkten im Mittel gesehen werden. Subjektiv waren 92 Prozent der Patienten mit dem Operationsergebnis sehr zufrieden oder zufrieden. In 79 Prozent wurde eine signifikante Schmerzreduktion nach der dreifachen Beckenosteotomie beobachtet. Die radiologische Auswertung erfolgte durch die Ermittlung der prä- und postoperativen CE-Winkel (Wiberg), VCA-Winkel (Lequesne, De Seze) und TF-Winkel (Bombelli). Der CE-Winkel vergrößerte sich durchschnittlich von 10,6° auf 32,3°, der VCA-Winkel wurde signifikant von 18,6° auf 33,5° verbessert und der TF-Winkel verkleinerte sich signifikant von 20,8° auf 3,8° im Mittel. In keinem Fall wurde eine Verschlechterung der Osteoarthrose gesehen. Die Autoren mußten einige Komplikationen zur Kenntnis nehmen; heterotope Ossifikation in der pelvitrochanteren Muskulatur ohne klinische Symptome bei 27 Patienten, Dysfunktion des N. cutaneus femoris lateralis bei 19 Patienten. Es zeigten sich drei Pseudarthrosen im Os pubis und zwei Pseudarthrosen im Os ischium und eine kombinierte Scham-und Sitzbeinpseudarthrose. Unsere Nachuntersuchungsergebnisse zeigen die Effizienz der dreifachen Beckenosteotomie nach Tönnis in der Verbesserung der Position des dysplastischen Acetabulums und in der Schmerzreduktion bei einer großen Prozentzahl der Patienten. N2 - In this study we compare the preoperative situation of the dysplastic hip with the postoperative clinical, functional and radiological results after Triple Pelvic Osteotomy by Tönnis in juveniles and adults. The results were evaluated for 48 patients and 53 hips with developemental hip dysplasia. The mean follow-up was 2 years, 9 months and the mean age at operation was 24 years (11-43 years). Clinical and functional criteria was scored by Harris Hip Score. 59 per cent showed very good results, 9 per cent good results and 13 per cent satisfaying results. The Harris Hip Score improved significantly from mean 66 points to 83,5 points. Subjectively 92 per cent of the patients were completely satisfied or satisfied with the operation results. In 79 per cent we saw a significant reduction in pain after Triple Pelvic Osteotomy. The radiographic evaluation included determination of pre- and postoperative center-edge-angle (Wiberg), anterior-center-edge-angle (Lequesne, De Seze) and acetabular angle of weight baring zone (Bombelli). Center-edge-angle improved significantly from mean 10,6° to 32,2°, anterior-center-edge-angle increased from mean 18,6° to 33,5° and acetabular-angle of weight baring zone decreased from mean 20,8° to 3,8° significantly. No deterioration of osteoarthrosis was seen in any case. The authors noticed following complications; heterotopic ossification in the pelvitrochanteric muscels without clinical symptoms in 27 patients, dysfunction of femoral cutaneus nerve in 19 patients. Three pseudarthrosis in Os pubis and two pseudarthrosis in Os ischium and one combined pseudarthrosis in Ischium and Pubis were seen. Our follow-up results demonstrate the efficacy of Triple Pelvic Osteotomy by Tönnis in improving the position of dysplastic acetabulum and in minimize pain in a large percentage of patients. KW - Hüftdysplasie KW - Osteoarthrose KW - Harris Hip Score KW - dreifache Beckenosteotomie KW - Tönnis KW - hip dysplasia KW - osteoarthrosis KW - Harris Hip Score KW - Triple Pelvic Osteotomy KW - Tönnis Y1 - 2001 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-585 ER - TY - JOUR A1 - Rackwitz, Lars A1 - Eden, Lars A1 - Reppenhagen, Stephan A1 - Reichert, Johannes C. A1 - Jakob, Franz A1 - Walles, Heike A1 - Pullig, Oliver A1 - Tuan, Rocky S. A1 - Rudert, Maximilian A1 - Nöth, Ulrich T1 - Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head JF - Stem Cell Research & Therapy N2 - Avascular necrosis (AVN) of the femoral head is a debilitating disease of multifactorial genesis, predominately affects young patients, and often leads to the development of secondary osteoarthritis. The evolving field of regenerative medicine offers promising treatment strategies using cells, biomaterial scaffolds, and bioactive factors, which might improve clinical outcome. Early stages of AVN with preserved structural integrity of the subchondral plate are accessible to retrograde surgical procedures, such as core decompression to reduce the intraosseous pressure and to induce bone remodeling. The additive application of concentrated bone marrow aspirates, ex vivo expanded mesenchymal stem cells, and osteogenic or angiogenic growth factors (or both) holds great potential to improve bone regeneration. In contrast, advanced stages of AVN with collapsed subchondral bone require an osteochondral reconstruction to preserve the physiological joint function. Analogously to strategies for osteochondral reconstruction in the knee, anterograde surgical techniques, such as osteochondral transplantation (mosaicplasty), matrix-based autologous chondrocyte implantation, or the use of acellular scaffolds alone, might preserve joint function and reduce the need for hip replacement. This review summarizes recent experimental accomplishments and initial clinical findings in the field of regenerative medicine which apply cells, growth factors, and matrices to address the clinical problem of AVN. KW - osteochondral allografts KW - autologous chondrocyte implantation KW - osteogenesis imperfecta KW - segmental collapse KW - mesenchymal cells KW - progenitor cells KW - stromal cells KW - sheep model KW - colony-stimulating factor KW - core depression Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-135413 VL - 3 IS - 7 ER - TY - GEN A1 - Seefried, Lothar T1 - Supplement: Impaired Physical Performance in X-linked Hypophosphatemia is not caused by depleted muscular phosphate stores T2 - Journal of Clinical Endocrinology & Metabolism N2 - Supplemental Data to "Impaired Physical Performance in X-linked Hypophosphatemia is not caused by depleted muscular phosphate stores" KW - XLH KW - Hypophosphatemia KW - Muscle Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-303647 ER - TY - JOUR A1 - Weber, Patrick A1 - Beck, Melina A1 - Klug, Michael A1 - Klug, Andreas A1 - Klug, Alexander A1 - Glowalla, Claudio A1 - Gollwitzer, Hans T1 - Survival of patient-specific unicondylar knee replacement JF - Journal of Personalized Medicine N2 - Unicompartmental knee arthroplasty (UKA) in isolated medial or lateral osteoarthritis leads to good clinical results. However, revision rates are higher in comparison to total knee arthroplasty (TKA). One reason is suboptimal fitting of conventional off-the-shelf prostheses, and major overhang of the tibial component over the bone has been reported in up to 20% of cases. In this retrospective study, a total of 537 patient-specific UKAs (507 medial prostheses and 30 lateral prostheses) that had been implanted in 3 centers over a period of 10 years were analyzed for survival, with a minimal follow-up of 1 year (range 12 to 129 months). Furthermore, fitting of the UKAs was analyzed on postoperative X-rays, and tibial overhang was quantified. A total of 512 prostheses were available for follow-up (95.3%). Overall survival rate (medial and lateral) of the prostheses after 5 years was 96%. The 30 lateral UKAs showed a survival rate of 100% at 5 years. The tibial overhang of the prosthesis was smaller than 1 mm in 99% of cases. In comparison to the reported results in the literature, our data suggest that the patient-specific implant design used in this study is associated with an excellent midterm survival rate, particularly in the lateral knee compartment, and confirms excellent fitting. KW - unicompartmental knee arthroplasty KW - osteoarthritis KW - patient-specific implant KW - partial knee arthroplasty KW - patient-specific instruments Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313650 SN - 2075-4426 VL - 13 IS - 4 ER - TY - JOUR A1 - Reichert, Johannes A1 - Schmalzl, Jonas A1 - Prager, Patrick A1 - Gilbert, Fabian A1 - Quent, Verena M. C. A1 - Steinert, Andre F. A1 - Rudert, Maximilian A1 - Nöth, Ulrich T1 - Synergistic effect of Indian hedgehog and bone morphogenetic protein-2 gene transfer to increase the osteogenic potential of human mesenchymal stem cells JF - Stem Cell Research & Therapy N2 - Introduction To stimulate healing of large bone defects research has concentrated on the application of mesenchymal stem cells (MSCs). Methods In the present study, we induced the overexpression of the growth factors bone morphogenetic protein 2 (BMP-2) and/or Indian hedgehog (IHH) in human MSCs by adenoviral transduction to increase their osteogenic potential. GFP and nontransduced MSCs served as controls. The influence of the respective genetic modification on cell metabolic activity, proliferation, alkaline phosphatase (ALP) activity, mineralization in cell culture, and osteogenic marker gene expression was investigated. Results Transduction had no negative influence on cell metabolic activity or proliferation. ALP activity showed a typical rise-and-fall pattern with a maximal activity at day 14 and 21 after osteogenic induction. Enzyme activity was significantly higher in groups cultured with osteogenic media. The overexpression of BMP-2 and especially IHH + BMP-2 resulted in a significantly higher mineralization after 28 days. This was in line with obtained quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analyses, which showed a significant increase in osteopontin and osteocalcin expression for osteogenically induced BMP-2 and IHH + BMP-2 transduced cells when compared with the other groups. Moreover, an increase in runx2 expression was observed in all osteogenic groups toward day 21. It was again more pronounced for BMP-2 and IHH + BMP-2 transduced cells cultured in osteogenic media. Conclusions In summary, viral transduction did not negatively influence cell metabolic activity and proliferation. The overexpression of BMP-2 in combination with or without IHH resulted in an increased deposition of mineralized extracellular matrix, and expression of osteogenic marker genes. Viral transduction therefore represents a promising means to increase the osteogenic potential of MSCs and the combination of different transgenes may result in synergistic effects. KW - Medizin Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-97010 UR - http://stemcellres.com/content/4/5/105 ER - TY - JOUR A1 - Boelch, Sebastian P. A1 - Roth, Magnus A1 - Arnholdt, Joerg A1 - Rudert, Maximilian A1 - Luedemann, Martin T1 - Synovial fluid aspiration should not be routinely performed during the two-stage exchange of the knee JF - BioMed Research International N2 - Purpose. Detection of infection persistence during the two-stage exchange of the knee for periprosthetic joint infection is challenging. Synovial fluid culture (SFC) and synovial white blood cell count (SWBCC) before joint reimplantation are widespread diagnostic means for this indication. The sensitivity and specificity of SFC and of SWBCC for infection persistence before planned reimplantation were evaluated. Methods. 94 two-stage exchanges of the knee with synovial fluid aspiration performed after a drug holiday of at least 14 days and before reimplantation or spacer exchange (planned reimplantation) were retrospectively analyzed. Only cases with at least 3 intraoperative samples at planned reimplantation were included. SFC and SWBCC were compared to pathogen detection (SFC\(_{(culture)}\)/SWBCC\(_{(culture)}\) and to histopathological signs of infection persistence (SFC\(_{(histo)}\)/SWBCC\(_{(histo)}\) from intraoperative samples at planned reimplantation. For SFC, the sensitivity and specificity were calculated. For SWBCC, the optimal cut-off value with its sensitivity and specificity was calculated with the Youden-Index. Results. Sensitivity and specificity of SFC\(_{(culture)}\) were 0.0% and 98.9%. Sensitivity and specificity of SFC\(_{(histo)}\) were 3.4% and 100%. The optimal cut-off value for SWBCC\(_{(culture)}\) was 4450 cells/μl with a sensitivity of 50.0% and a specificity of 86.5%. The optimal cut-off value for SWBCC\(_{(histo)}\) was 3250 cells/μl with a sensitivity of 35.7% and a specificity of 92.9%. Conclusion. The detection of infection persistence remains challenging and a consented approach is lacking. The results do not warrant the routine performance of SFC during the two-stage exchange at the knee. SWBCC can be used to confirm infection persistence at high cut-offs, but they only occur in few patients and are therefore inappropriate for the routine use. KW - knee KW - two-stage exchange KW - Synovial Fluid Aspiration Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176800 VL - 2018 IS - 6720712 ER - TY - JOUR A1 - Achenbach, Leonard A1 - Le Hanneur, Malo A1 - Camenzind, Roland S. A1 - Bouyer, Michael A1 - Pottecher, Pierre A1 - Lafosse, Thibault T1 - Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients JF - Interdisciplinary Neurosurgery N2 - To date, no consensus exists regarding the best surgical management of isolated, micro-traumatic long thoracic nerve (LTN) paresis. Our hypothesis was that a combined decompression of the LTN at two potential locations for entrapment would be effective in the management of dynamic LTN paresis. We report on twelve patients with isolated LTN parersis, with tenderness at two entrapment sites, who underwent bifocal LTN decompression after undergoing unsuccessful conservative treatment for at least 6 months; all patients had preoperative electrodiagnostic studies that confirmed the paresis and ruled out peripheral neuritis. Clinical and electrical improvements were observed in eight patients (67%) regarding shoulder flexion, shoulder abduction, and Quick-DASH scores. Four patients (33%) did not improve after surgery. The results corroborate our hypothesis that a bifocal LTN decompression can be an effective and reliable therapeutic option in more than half of a very selective patient population suffering from serratus anterior muscle deficiency. KW - entrapment, traction KW - serratus anterior KW - scapular winging KW - scapula alata KW - dyskinesia KW - peripheral nerve KW - nerve compression KW - micro-traumatic KW - neurolysis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265085 VL - 27 ER - TY - JOUR A1 - Rudert, Maximilian T1 - Taking the next step in personalised orthopaedic implantation JF - Journal of Personalized Medicine N2 - No abstract available KW - personalised orthopaedic implantation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262089 SN - 2075-4426 VL - 12 IS - 3 ER - TY - THES A1 - George, Enrico T1 - Temporäre Hemiepiphyseodese bei idiopathischen Beinachsenfehlstellungen - klinische und radiologische Gegenüberstellung der VaWiKo® EPI-PLATTE und PediatrOS™ FlexTack™ - eine retrospektive Studie T1 - Temporary hemiepiphysiodesis with idiopathic leg axis malalignment - clinical and radiological comparison of the VaWiKo® EPI-PLATTE and PediatrOS™ FlexTack™ - a retrospective study N2 - Beinachsenfehlstellungen im Kindesalter zählen zu den häufigsten Wachstums- und Entwicklungsstörungen der unteren Extremitäten. Eine daraus resultierende Prädisposition für degenerative Erkrankungen begründet die Bedeutung der operativen Korrektur bei noch geöffneten Wachstumsfugen mittels temporärer Hemiepiphyseodese. Zur Beurteilung des Therapieerfolges wurden insgesamt 140 Beinachsen mit idiopathischen Achsfehlstellungen retrospektiv betrachtet. In den Jahren 2017 bis 2021 wurden mit der VaWiKo® EPI-PLATTE und der PediatrOS™ FlexTack™ zwei unterschiedliche Implantate zur temporären Hemiepiphyseodese in der kinderorthopädischen Klinik des Marienstift Arnstadt verwendet. Entsprechend der verwendeten Implantate erfolgte die Einteilung in zwei Patientengruppen, die sowohl klinisch als auch radiologisch jeweils prä- und postoperativ gegenübergestellt wurden. Bei Patienten/-innen mit einer Beinachsenkorrektur durch die VaWiKo® EPI-PLATTE ergab sich durchschnittlich eine signifikant kürzere Explantationsdauer (EP 26,05 min; FT 35,60 min) sowie eine kürzere Durchleuchtungszeit in Winkelminuten (EP 0,03; FT 0,07) im Rahmen der Explantation. Dem gegenüber steht die signifikant kürzere stationäre Aufenthaltsdauer in Tagen bei der Im- und Explantation der PediatrOS™ FlexTack™. (EP 5,43/ 3,73; FT 4,52/ 3,35). In Bezug auf die zur Wachstumskorrektur benötigten Zeit in Tagen resultiert in der Varus-Gruppe ein signifikanter Unterschied zugunsten der PediatrOS™ FlexTack™, (EP 517; FT 299) wohingegen sich in der Valgus-Gruppe kein signifikanter Unterschied zwischen beiden Implantaten zeigte (EP 343; FT 334). Zusammenfassend traten zwei Komplikationen auf, die jeweils Kinder aus der PediatrOS™ FlexTack™-Gruppe betrafen. Sowohl die PediatrOS™ FlexTack™ als auch die VaWiKo® EPI-PLATTE konnten die gewünschte Beinachsenkorrektur erzielen. Die in der Literatur mit der PediatrOS™ FlexTack™ in Verbindung gebrachten kürzeren Implantations- und Durchleuchtungszeiten sowie die kürzeren Therapiedauern des Genu valgum konnten im Vergleich zur VaWiKo® EPI-PLATTE nicht bestätigt werden. N2 - In the study, the VaWiKo® EPI-PLATTE (EP) and PediatrOS™ FlexTack™ (FT) were opposed as implants for temporary hemiepiphysiodesis to establish a direct comparability and therefore being able to show possible therapeutic consequences. The aim of the study was to make a prospectively preoperative statement on the selection of the implant to be chosen in view of the co-factors. In the years from 2017 to 2021, a total of eighty children with idiopathic leg axis malpositions were surgically treated in the Department of Paediatric Orthopaedics at Marienstift Arnstadt. According to the implants used, the patients were divided into two groups of 40 children each. To evaluate the success of the therapy, the resulting 140 leg axes were examined retrospectively. To verify the leg axis malalignment, the intermalleolar distance was used clinically on the one hand and the MAD/mLDFW/mMPTW and aFTW were used radiologically with full length x-rays taken pre- and postoperatively on the other. Of the 80 patients, 29 (36.25%) were female and 51 (63.75%) male. A total of 140 leg axis malpositions were corrected, 12 (8.57%) were varus and 128 (91.43%) valgus axes. The average age at the time of surgery was 12.74 years. The mean preoperative intermalleolar distance of 11.83 cm in the 55 patients with bilateral valgus deformity showed no significant difference between the two groups (p=0.294). The mean MAD in the valgus group was -16.52 mm preoperatively (p=0.966) and 3.60 mm postoperatively (p=0.125). The preoperatively measured mLDFW, mMPTW and aFTW did not show any significant difference in the comparison of the VaWiKo® EPI-PLATTE and PediatrOS™ FlexTack™, so that a homogeneous patient population was there. Patients with leg axis correction using the VaWiKo® EPI-PLATTE had a significantly shorter explantation time (p=0,006) and a shorter fluoroscopy time in angular minutes (p=0,005) during explantation. These contrasts with the significantly shorter inpatient length of stay in days during implantation and explantation of the PediatrOS™ FlexTack™. (EP 5.43/ 3.73; FT 4.52/ 3.35). In relation to the time required for growth correction in days, there was a significant difference in favour of the PediatrOS™ FlexTack™ in the varus group (EP 517; FT 299), whereas there was no significant difference between the two implants in the valgus group (EP 343; FT 334). Two complications occurred, each affecting children in the PediatrOS™ FlexTack™ group. Both the PediatrOS™ FlexTack™ and the VaWiKo® EPI-PLATTE were able to achieve the desired leg axis correction. The VaWiKo® EPI-PLATTE was more convincing with shorter explantation times and fluoroscopy times an no documented complications compared to the PediatrOS™ FlexTack™. The PediatrOS™ FlexTack™ impressed with a shorter therapy duration in the correction of varus deformities. KW - Epiphyseodese KW - Temporäre Hemiepiphyseodese Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-327338 ER - TY - JOUR A1 - Schmalzl, Jonas A1 - Plumhoff, Piet A1 - Gilbert, Fabian A1 - Gohlke, Frank A1 - Konrads, Christian A1 - Brunner, Ulrich A1 - Jakob, Franz A1 - Ebert, Regina A1 - Steinert, Andre F. T1 - Tendon-derived stem cells from the long head of the biceps tendon JF - Bone & Joint Research N2 - Objectives The long head of the biceps (LHB) is often resected in shoulder surgery and could therefore serve as a cell source for tissue engineering approaches in the shoulder. However, whether it represents a suitable cell source for regenerative approaches, both in the inflamed and non-inflamed states, remains unclear. In the present study, inflamed and native human LHBs were comparatively characterized for features of regeneration. Methods In total, 22 resected LHB tendons were classified into inflamed samples (n = 11) and non-inflamed samples (n = 11). Proliferation potential and specific marker gene expression of primary LHB-derived cell cultures were analyzed. Multipotentiality, including osteogenic, adipogenic, chondrogenic, and tenogenic differentiation potential of both groups were compared under respective lineage-specific culture conditions. Results Inflammation does not seem to affect the proliferation rate of the isolated tendon-derived stem cells (TDSCs) and the tenogenic marker gene expression. Cells from both groups showed an equivalent osteogenic, adipogenic, chondrogenic and tenogenic differentiation potential in histology and real-time polymerase chain reaction (RT-PCR) analysis. Conclusion These results suggest that the LHB tendon might be a suitable cell source for regenerative approaches, both in inflamed and non-inflamed states. The LHB with and without tendinitis has been characterized as a novel source of TDSCs, which might facilitate treatment of degeneration and induction of regeneration in shoulder surgery. KW - biceps tendon KW - tendon-derived stem cell KW - mesenchymal stem cell KW - tissue engineering KW - shoulder Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200370 VL - 8 IS - 9 ER - TY - JOUR A1 - Weißenberger, Manuel A1 - Wagenbrenner, Mike A1 - Schote, Fritz A1 - Horas, Konstantin A1 - Schäfer, Thomas A1 - Rudert, Maximilian A1 - Barthel, Thomas A1 - Heinz, Tizian A1 - Reppenhagen, Stephan T1 - The 3-triangle method preserves the posterior tibial slope during high tibial valgus osteotomy: first preliminary data using a mathematical model JF - Journal of Experimental Orthopaedics N2 - Purpose Despite much improved preoperative planning techniques accurate intraoperative assessment of the high tibial valgus osteotomy (HTO) remains challenging and often results in coronal over- and under-corrections as well as unintended changes of the posterior tibial slope. Noyes et al. reported a novel method for accurate intraoperative coronal and sagittal alignment correction based on a three-dimensional mathematical model. This is the first study examining preliminary data via the proposed Noyes approach for accurate intraoperative coronal and sagittal alignment correction during HTO. Methods From 2016 to 2020 a total of 24 patients (27 knees) underwent HTO applying the proposed Noyes method (Noyes-Group). Radiographic data was analyzed retrospectively and matched to patients that underwent HTO using the conventional method, i.e., gradual medial opening using a bone spreader under fluoroscopic control (Conventional-Group). All operative procedures were performed by an experienced surgeon at a single orthopaedic university center. Results From the preoperative to the postoperative visit no statistically significant changes of the posterior tibial slope were noted in the Noyes-Group compared to a significant increase in the Conventional-Group (p = 0.01). Regarding the axial alignment no significant differences between both groups were observed pre- and postoperatively. The number of over- and under-corrections did not differ significantly between both groups. Linear regression analysis showed a significant correlation of the postoperative medial proximal tibial angle (MPTA) with the position of the weightbearing line on the tibial plateau. Conclusion The 3-triangle method by Noyes seems to be a promising approach for preservation of the posterior tibial slope during HTO. KW - knee KW - high tibial valgus osteotomy KW - axial alignment KW - posterior tibial slope KW - weight bearing line KW - cartilage KW - triangle method KW - osteoarthritis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300806 SN - 2197-1153 VL - 9 ER - TY - JOUR A1 - Heinz, Tizian A1 - Meller, Felix A1 - Luetkens, Karsten Sebastian A1 - Anderson, Philip Mark A1 - Stratos, Ioannis A1 - Horas, Konstantin A1 - Rudert, Maximilian A1 - Reppenhagen, Stephan A1 - Weißenberger, Manuel T1 - The AMADEUS score is not a sufficient predictor for functional outcome after high tibial osteotomy JF - Journal of Experimental Orthopaedics N2 - Purpose The Area Measurement And Depth Underlying Structures (AMADEUS) classification system has been proposed as a valuable tool for magnetic resonance (MR)-based grading of preoperatively encountered chondral defects of the knee joint. However, the potential relationship of this novel score with clinical data was yet to determine. It was the primary intention of this study to assess the correlative relationship of the AMADEUS with patient reported outcome scores in patients undergoing medial open-wedge high tibial valgus osteotomy (HTO). Furthermore, the arthroscopic ICRS (International Cartilage Repair Society) grade evaluation was tested for correlation with the AMADEUS classification system. Methods This retrospective, monocentric study found a total of 70 individuals that were indicated for HTO due to degenerative chondral defects of the medial compartment between 2008 and 2019. A preoperative MR image as well as a pre-osteotomy diagnostic arthroscopy for ICRS grade evaluation was mandatory for all patients. The Knee Osteoarthritis Outcome Score (KOOS) including its five subscale scores (KOOS-ADL, KOOS-QOL, KOOS-Sports, KOOS-Pain, KOOS-Symptoms) was obtained preoperatively and at a mean follow-up of 41.2 ± 26.3 months. Preoperative chondral defects were evaluated using the AMADEUS classification system and the final AMADEUS scores were correlated with the pre- and postoperative KOOS subscale sores. Furthermore, arthroscopic ICRS defect severity was correlated with the AMADEUS classification system. Results There was a statistically significant correlation between the AMADEUS BME (bone marrow edema) subscore and the KOOS Symptoms subscore at the preoperative visit (r = 0.25, p = 0.04). No statistically significant monotonic association between the AMADEUS total score and the AMADEUS grade with pre- and postoperative KOOS subscale scores were found. Intraoperatively obtained ICRS grade did reveal a moderate correlative relation with the AMADEUS total score and the AMADEUS grade (r = 0.28, p = 0.02). Conclusions The novel AMADEUS classification system largely lacks correlative capacity with patient reported outcome measures in patients undergoing HTO. The MR tomographic appearance of bone marrow edema is the only parameter predictive of the clinical outcome at the preoperative visit. KW - cartilage KW - AMADEUS KW - KOOS KW - knee KW - high tibial osteotomy KW - chondral defect KW - osteoarthritis KW - PROM KW - correlation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357765 VL - 10 ER - TY - JOUR A1 - Wagenbrenner, Mike A1 - Heinz, Tizian A1 - Horas, Konstantin A1 - Jakuscheit, Axel A1 - Arnholdt, Jörg A1 - Hermann, Marietta A1 - Rudert, Maximilian A1 - Holzapfel, Boris M. A1 - Steinert, Andre F. A1 - Weißenberger, Manuel T1 - The human arthritic hip joint is a source of mesenchymal stromal cells (MSCs) with extensive multipotent differentiation potential JF - BMC Musculoskeletal Disorders N2 - Background While multiple in vitro studies examined mesenchymal stromal cells (MSCs) derived from bone marrow or hyaline cartilage, there is little to no data about the presence of MSCs in the joint capsule or the ligamentum capitis femoris (LCF) of the hip joint. Therefore, this in vitro study examined the presence and differentiation potential of MSCs isolated from the bone marrow, arthritic hyaline cartilage, the LCF and full-thickness samples of the anterior joint capsule of the hip joint. Methods MSCs were isolated and multiplied in adherent monolayer cell cultures. Osteogenesis and adipogenesis were induced in monolayer cell cultures for 21 days using a differentiation medium containing specific growth factors, while chondrogenesis in the presence of TGF-ss1 was performed using pellet-culture for 27 days. Control cultures were maintained for comparison over the same duration of time. The differentiation process was analyzed using histological and immunohistochemical stainings as well as semiquantitative RT-PCR for measuring the mean expression levels of tissue-specific genes. Results This in vitro research showed that the isolated cells from all four donor tissues grew plastic-adherent and showed similar adipogenic and osteogenic differentiation capacity as proven by the histological detection of lipid droplets or deposits of extracellular calcium and collagen type I. After 27 days of chondrogenesis proteoglycans accumulated in the differentiated MSC-pellets from all donor tissues. Immunohistochemical staining revealed vast amounts of collagen type II in all differentiated MSC-pellets, except for those from the LCF. Interestingly, all differentiated MSCs still showed a clear increase in mean expression of adipogenic, osteogenic and chondrogenic marker genes. In addition, the examination of an exemplary selected donor sample revealed that cells from all four donor tissues were clearly positive for the surface markers CD44, CD73, CD90 and CD105 by flow cytometric analysis. Conclusions This study proved the presence of MSC-like cells in all four examined donor tissues of the hip joint. No significant differences were observed during osteogenic or adipogenic differentiation depending on the source of MSCs used. Further research is necessary to fully determine the tripotent differentiation potential of cells isolated from the LCF and capsule tissue of the hip joint. KW - Hip joint KW - Osteoarthritis KW - MSCs KW - Cartilage regeneration KW - Tissue engineering KW - Ligamentum capitis femoris KW - Joint capsule KW - Bone marrow Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229497 VL - 21 IS - 1 ER - TY - JOUR A1 - Wehrle, Esther A1 - Liedert, Astrid A1 - Heilmann, Aline A1 - Wehner, Tim A1 - Bindl, Ronny A1 - Fischer, Lena A1 - Haffner-Luntzer, Melanie A1 - Jakob, Franz A1 - Schinke, Thorsten A1 - Amling, Michael A1 - Ignatius, Anita T1 - The impact of low-magnitude high-frequency vibration on fracture healing is profoundly influenced by the oestrogen status in mice JF - Disease Models & Mechanisms N2 - Fracture healing is impaired in aged and osteoporotic individuals. Because adequate mechanical stimuli are able to increase bone formation, one therapeutical approach to treat poorly healing fractures could be the application of whole-body vibration, including low-magnitude high-frequency vibration (LMHFV). We investigated the effects of LMHFV on fracture healing in aged osteoporotic mice. Female C57BL/6NCrl mice (n=96) were either ovariectomised (OVX) or sham operated (non-OVX) at age 41 weeks. When aged to 49 weeks, all mice received a femur osteotomy that was stabilised using an external fixator. The mice received whole-body vibrations (20 minutes/day) with 0.3 g peak-to-peak acceleration and a frequency of 45 Hz. After 10 and 21 days, the osteotomised femurs and intact bones (contra-lateral femurs, lumbar spine) were evaluated using bending-testing, micro-computed tomography (mu CT), histology and gene expression analyses. LMHFV disturbed fracture healing in aged non-OVX mice, with significantly reduced flexural rigidity (-81%) and bone formation (-80%) in the callus. Gene expression analyses demonstrated increased oestrogen receptor β (ERβ, encoded by Esr2) and Sost expression in the callus of the vibrated animals, but decreased β-catenin, suggesting that ERβ might mediate these negative effects through inhibition of osteoanabolic Wnt/β-catenin signalling. In contrast, in OVX mice, LMHFV significantly improved callus properties, with increased flexural rigidity (+ 1398%) and bone formation (+637%), which could be abolished by subcutaneous oestrogen application (0.025 mg oestrogen administered in a 90-day-release pellet). On a molecular level, we found an upregulation of ER alpha in the callus of the vibrated OVX mice, whereas ERβ was unaffected, indicating that ERa might mediate the osteoanabolic response. Our results indicate a major role for oestrogen in the mechanostimulation of fracture healing and imply that LMHFV might only be safe and effective in confined target populations. KW - level mechanical vibrations KW - ovariectomized rats KW - bone formation KW - LMHFV KW - whole body vibration KW - receptor beta KW - replacement therapy KW - osteoblastic cells KW - early stage KW - alpha KW - Wnt KW - fracture healing KW - oestrogen receptor signalling KW - Wnt signalling Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144700 VL - 8 ER - TY - JOUR A1 - Wehrle, Esther A1 - Liedert, Astrid A1 - Heilmann, Aline A1 - Wehner, Tim A1 - Bindl, Ronny A1 - Fischer, Lena A1 - Haffner-Luntzer, Melanie A1 - Jakob, Franz A1 - Schinke, Thorsten A1 - Amling, Michael A1 - Ignatius, Anita T1 - The impact of low-magnitude high-frequency vibration on fracture healing is profoundly influenced by the oestrogen status in mice JF - Disease Models & Mechanisms N2 - Fracture healing is impaired in aged and osteoporotic individuals. Because adequate mechanical stimuli are able to increase bone formation, one therapeutical approach to treat poorly healing fractures could be the application of whole-body vibration, including low-magnitude high-frequency vibration (LMHFV). We investigated the effects of LMHFV on fracture healing in aged osteoporotic mice. Female C57BL/6NCrl mice (n=96) were either ovariectomised (OVX) or sham operated (non-OVX) at age 41 weeks. When aged to 49 weeks, all mice received a femur osteotomy that was stabilised using an external fixator. The mice received whole-body vibrations (20 minutes/day) with 0.3 G: peak-to-peak acceleration and a frequency of 45 Hz. After 10 and 21 days, the osteotomised femurs and intact bones (contra-lateral femurs, lumbar spine) were evaluated using bending-testing, micro-computed tomography (μCT), histology and gene expression analyses. LMHFV disturbed fracture healing in aged non-OVX mice, with significantly reduced flexural rigidity (-81%) and bone formation (-80%) in the callus. Gene expression analyses demonstrated increased oestrogen receptor β (ERβ, encoded by Esr2) and Sost expression in the callus of the vibrated animals, but decreased β-catenin, suggesting that ERβ might mediate these negative effects through inhibition of osteoanabolic Wnt/β-catenin signalling. In contrast, in OVX mice, LMHFV significantly improved callus properties, with increased flexural rigidity (+1398%) and bone formation (+637%), which could be abolished by subcutaneous oestrogen application (0.025 mg oestrogen administered in a 90-day-release pellet). On a molecular level, we found an upregulation of ERα in the callus of the vibrated OVX mice, whereas ERβ was unaffected, indicating that ERα might mediate the osteoanabolic response. Our results indicate a major role for oestrogen in the mechanostimulation of fracture healing and imply that LMHFV might only be safe and effective in confined target populations. KW - fracture healing KW - LMHFV KW - oestrogen receptor signalling KW - whole-body vibration KW - Wnt-signalling Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121109 VL - 8 ER - TY - JOUR A1 - Steinert, Andre F. A1 - Schröder, Lennart A1 - Sefrin, Lukas A1 - Janßen, Björn A1 - Arnholdt, Jörg A1 - Rudert, Maximilian T1 - The impact of total knee replacement with a customized cruciate-retaining implant design on patient-reported and functional outcomes JF - Journal of Personalized Medicine N2 - Purpose: To treat patients with tricompartimental knee osteoarthritis (OA), a customized cruciate-retaining total knee arthroplasty (CCR-TKA) system can be used, including both individualized instrumentation and implants. The objective of this monocentric cohort study was to analyze patient-reported and functional outcomes in a series of patients implanted with the second generation of this customized implant. Methods: At our arthroplasty center, we prospectively recruited a cohort of patients with tricompartmental gonarthrosis to be treated with total knee replacement (TKA) using a customized cruciate-retaining (CCR) implant design. Inclusion criteria for patients comprised the presence of intact posterior cruciate and collateral ligaments and a knee deformity that was restricted to <15° varus, valgus, or flexion contracture. Patients were assessed for their range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form (SF)-12 physical and mental scores, preoperatively, at 3 and 6 months, as well as at 1, 2, 3, and 5 years of follow-up (FU) postoperatively. Results: The average age of the patient population was 64 years (range: 40–81), the average BMI was 31 (range: 23–42), and in total, 28 female and 45 male patients were included. Implant survivorship was 97.5% (one septic loosening) at an average follow-up of 2.5 years. The KSS knee and function scores improved significantly (p < 0.001) from, respectively, 41 and 53 at the pre-operative visit, to 92 and 86, respectively, at the 5-year post-operative time point. The SF-12 Physical and Mental scores significantly (p < 0.001) improved from the pre-operative values of 28 and 50, to 50 and 53 at the 5-year FU, respectively. Patients experienced significant improvements in their overall knee range of motion, from 106° at the preoperative visit to 122°, on average, 5 years postoperatively. The total WOMAC score significantly (p < 0.001) improved from 49.1 preoperatively to 11.4 postoperatively at 5-year FU. Conclusions: Although there was no comparison to other implants within this study, patients reported high overall satisfaction and improvement in functional outcomes within the first year from surgery, which continued over the following years. These mid-term results are excellent compared with those reported in the current literature. Comparative long-term studies with this device are needed. Level of evidence 3b (individual case–control study). KW - patient-specific KW - custom-made implant KW - total knee arthroplasty KW - TKA KW - knee replacement KW - tricompartmental knee osteoarthritis KW - iTotal Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312746 SN - 2075-4426 VL - 12 IS - 2 ER - TY - JOUR A1 - Schmalzl, J. A1 - Plumhoff, P. A1 - Gilbert, F. A1 - Gohlke, F. A1 - Konrads, C. A1 - Brunner, U. A1 - Jakob, F. A1 - Ebert, R. A1 - Steinert, AF T1 - The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis JF - Journal of Orthopaedic Surgery N2 - Introduction: The long head of the biceps (LHB) is often resected in shoulder surgery. However, its contribution to inflammatory processes in the shoulder remains unclear. In the present study, inflamed and noninflamed human LHBs were comparatively characterized for features of inflammation. Materials and methods: Twenty-two resected LHB tendons were classified into inflamed (n = 11) and noninflamed (n = 11) samples. For histological examination, samples were stained with hematoxylin eosin, Azan, van Gieson, and Masson Goldner trichrome. Neuronal tissue was immunohistochemically visualized. In addition, specific inflammatory marker gene expression of primary LHB-derived cell cultures were analyzed. Results: Features of tendinopathy, such as collagen disorganization, infiltration by inflammatory cells, neovascularization, and extensive neuronal innervation were found in the tendinitis group. Compared to noninflamed samples, inflamed LHBs showed a significantly increased inflammatory marker gene expression Conclusion: Structural and biomolecular differences of both groups suggest that the LHB tendon acts as an important pain generator in the shoulder joint. These findings can, on the one hand, contribute to the understanding of the biomolecular genesis of LHB tendinitis and, on the other hand, provide possibilities for new therapeutic approaches. KW - biceps tendinitis KW - biomolecular processes KW - inflammatory gene KW - interleukin KW - long head of biceps tendon KW - pain generator KW - shoulder pain Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228611 VL - 27 IS - 1 ER - TY - JOUR A1 - Dotterweich, Julia A1 - Tower, Robert J. A1 - Brandl, Andreas A1 - Müller, Marc A1 - Hofbauer, Lorenz C. A1 - Beilhack, Andreas A1 - Ebert, Regina A1 - Glüer, Claus C. A1 - Tiwari, Sanjay A1 - Schütze, Norbert A1 - Jakob, Franz T1 - The KISS1 Receptor as an In Vivo Microenvironment Imaging Biomarker of Multiple Myeloma Bone Disease JF - PLoS One N2 - Multiple myeloma is one of the most common hematological diseases and is characterized by an aberrant proliferation of plasma cells within the bone marrow. As a result of crosstalk between cancer cells and the bone microenvironment, bone homeostasis is disrupted leading to osteolytic lesions and poor prognosis. Current diagnostic strategies for myeloma typically rely on detection of excess monoclonal immunoglobulins or light chains in the urine or serum. However, these strategies fail to localize the sites of malignancies. In this study we sought to identify novel biomarkers of myeloma bone disease which could target the malignant cells and/or the surrounding cells of the tumor microenvironment. From these studies, the KISS1 receptor (KISS1R), a G-protein-coupled receptor known to play a role in the regulation of endocrine functions, was identified as a target gene that was upregulated on mesenchymal stem cells (MSCs) and osteoprogenitor cells (OPCs) when co-cultured with myeloma cells. To determine the potential of this receptor as a biomarker, in vitro and in vivo studies were performed with the KISS1R ligand, kisspeptin, conjugated with a fluorescent dye. In vitro microscopy showed binding of fluorescently-labeled kisspeptin to both myeloma cells as well as MSCs under direct co-culture conditions. Next, conjugated kisspeptin was injected into immune-competent mice containing myeloma bone lesions. Tumor-burdened limbs showed increased peak fluorescence compared to contralateral controls. These data suggest the utility of the KISS1R as a novel biomarker for multiple myeloma, capable of targeting both tumor cells and host cells of the tumor microenvironment. KW - multiple myeloma Lesions KW - fluorescence microscopy KW - biomarkers Myelomas KW - bone imaging KW - myeloma cells KW - fluorescent dyes Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146960 VL - 11 IS - 5 ER - TY - JOUR A1 - Arnholdt, Jörg A1 - Gilbert, Fabian A1 - Blank, Marc A1 - Papazoglou, Jannis A1 - Rudert, Maximilian A1 - Nöth, Ulrich A1 - Steinert, Andre F. T1 - The Mayo conservative hip: complication analysis and management of the first 41 cases performed at a University level 1 department JF - BMC Muskoskeletal Disorders N2 - Background: To prevent bone loss in hip arthroplasty, several short stem systems have been developed, including the Mayo conservative hip system. While there is a plethora of data confirming inherent advantages of these systems, only little is known about potential complications, especially when surgeons start to use these systems. Methods: In this study, we present a retrospective analysis of the patients’ outcome, complications and the complication management of the first 41 Mayo conservative hips performed in 37 patients. For this reason, functional scores, radiographic analyses, peri- and postoperative complications were assessed at an average follow-up of 35 months. Results: The overall HHS improved from 61.2 pre-operatively to 85.6 post-operatively. The German Extra Short Musculoskeletal Function Assessment Questionnaire (XSFMA-D) improved from 30.3 pre-operatively to 12.2 post-operatively. The most common complication was an intraoperative non-displaced fracture of the proximal femur observed in 5 cases (12.1%). Diabetes, higher BMI and older ages were shown to be risk factors for these intra-operative periprosthetic fractures (p < 0.01). Radiographic analysis revealed a good offset reconstruction in all cases. Conclusion: In our series, a high complication rate with 12.1% of non-displaced proximal femoral fractures was observed using the Mayo conservative hip. This may be attributed to the flat learning curve of the system or the inherent patient characteristics of the presented cohort." KW - total hip arthroplasty KW - short hip stem KW - mayo stem KW - minimal invasive surgery Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157812 VL - 18 IS - 250 ER - TY - JOUR A1 - Rueckl, Kilian A1 - Runer, Armin A1 - Bechler, Ulrich A1 - Faschingbauer, Martin A1 - Boelch, Sebastian Philipp A1 - Keyes Sculco, Peter A1 - Boettner, Friedrich T1 - The posterior-anterior-flexed view is essential for the evaluation of valgus osteoarthritis. A prospective study on 134 valgus knees JF - BMC Muscoskeletal Disorders N2 - Background Radiographic imaging is an important tool to assess osteoarthritis (OA). Lateral compartment osteoarthritis (valgus OA) usually starts with cartilage degeneration along the posterior aspect of the lateral femoral condyle. There is evidence that the posterior-anterior (PA)-flexed view is more sensitive when diagnosing early stages of valgus OA compared to the anterior-posterior (AP) view. The current paper analyzes the value of the PA-flexed view for patients scheduled for total knee arthroplasty (TKA). Methods Radiographs of 134 valgus knees were assessed prior to TKA. The minimal joint space width (minJSW) was measured on AP and PA-flexed views. The extent of mechanical deformity was measured on hip to ankle standing films. Results 49 (36.6%) AP views showed Kellgren and Lawrence (K/L)-grade 4 osteoarthritis in the lateral compartment, 82 (63.4%) showed grade 3 or less. The PA-flexed view resulted in an increased K/L-grading to grade 4 for 53 knees (62.4%) that were considered grade 3 or less on standard AP-radiographs. There was a significant differences between lateral minJSW on AP and PA-flexed view for patients with up to 10 degrees of mechanical valgus deformity (p < 0.001), as well as 11 to 15 degrees of mechanical deformity (p = 0.021). Only knees with severe deformity of more than 15 degrees did not show a difference in minJSW between PA-flexed view and AP view (p = 0.345). Conclusions The PA-flexed view is superior to the standard AP view in quantifying the extent of valgus OA in patients with zero to fifteen degrees of valgus deformity. It is recommended for the initial assessment of patients with valgus osteoarthritis and better documents the extent of osteoarthritis prior to TKA. KW - Valgus osteoarthritis KW - Knee KW - PA-flexed view KW - View KW - Radiographs Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200536 VL - 20 ER - TY - JOUR A1 - Streck, Laura Elisa A1 - Forster, Johannes A1 - von Hertzberg-Boelch, Sebastian Philipp A1 - Reichel, Thomas A1 - Rudert, Maximilian A1 - Rueckl, Kilian T1 - The role of synovial fluid aspiration in shoulder joint infections JF - BMC Musculoskeletal Disorders N2 - Background Joint aspiration with analysis of synovial fluid white blood cell count (WBC) and microbiological culture is a widely established aspect in the diagnosis of shoulder joint infections (SJI). In case of a two stage revision for SJI, joint aspiration before re−/implantation of a total shoulder arthroplasty (TSA) was used to rule out persistent infection for years but its value is under debate. Shoulder specific data on all aspects is rare. The current study aims to answer the following research questions: Does joint aspiration have an insufficient predictive value in the diagnosis of SJI in (1) initial workup and (2) before definite arthroplasty with polymethylmethacrylate (PMMA)-Spacer in place? Methods This retrospective evaluation investigates 35 patients that were treated for SJI with a two staged implantation of a TSA after debridement and implantation of an PMMA-Spacer. Joint aspirations were performed preoperatively (PA) and before re−/implantation of the prosthesis while spacer was in place (interstage aspiration, IA). Samples were taken for microbiological culture and analysis of WBC. Sensitivity and specificity were calculated with reference to intraoperative microbiological samples. Receiver Operating Characteristic (ROC), Area-Under-Curve analysis (AUC) and calculation of the Youden index were performed to find optimum cut-off for WBC. Results The sensitivity of microbiological cultures from PA was 58.3% and the specificity was 88.9%. The mean WBC was 27,800 leucocytes/mm3 (range 400-96,300). The maximum Youden index (0.857) was a cut-off of 2600 leucocytes/mm3 with a sensitivity of 85.7% and a specificity of 100.0%. The sensitivity and specificity of IA were 0.0% and 88.5%, respectively. Conclusions Preoperative aspiration is likely to miss Cutibacteria spp. and CoNS and cannot rule out infection for sure. However, we recommend it for its advantages of targeted antibiotic therapy in case of germ identification. Empiric antibiotic therapy should cover Cutibacteria and CoNS even if aspiration showed negative microbiological cultures. In contrast, the diagnostic value of interstage aspiration does not qualify for its routine use. KW - revision arthroplasty KW - periprosthetic joint infection KW - white blood cell count KW - septic KW - microbiological culture KW - interstage aspiration Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300795 VL - 23 ER - TY - JOUR A1 - Benisch, Peggy A1 - Schilling, Tatjana A1 - Klein-Hitpass, Ludger A1 - Frey, Sönke P. A1 - Seefried, Lothar A1 - Raaijmakers, Nadja A1 - Krug, Melanie A1 - Regensburger, Martina A1 - Zeck, Sabine A1 - Schinke, Thorsten A1 - Amling, Michael A1 - Ebert, Amling A1 - Jakob, Franz T1 - The Transcriptional Profile of Mesenchymal Stem Cell Populations in Primary Osteoporosis Is Distinct and Shows Overexpression of Osteogenic Inhibitors JF - PLoS One N2 - Primary osteoporosis is an age-related disease characterized by an imbalance in bone homeostasis. While the resorptive aspect of the disease has been studied intensely, less is known about the anabolic part of the syndrome or presumptive deficiencies in bone regeneration. Multipotent mesenchymal stem cells (MSC) are the primary source of osteogenic regeneration. In the present study we aimed to unravel whether MSC biology is directly involved in the pathophysiology of the disease and therefore performed microarray analyses of hMSC of elderly patients (79-94 years old) suffering from osteoporosis (hMSC-OP). In comparison to age-matched controls we detected profound changes in the transcriptome in hMSC-OP, e.g. enhanced mRNA expression of known osteoporosis-associated genes (LRP5, RUNX2, COL1A1) and of genes involved in osteoclastogenesis (CSF1, PTH1R), but most notably of genes coding for inhibitors of WNT and BMP signaling, such as Sclerostin and MAB21L2. These candidate genes indicate intrinsic deficiencies in self-renewal and differentiation potential in osteoporotic stem cells. We also compared both hMSC-OP and non-osteoporotic hMSC-old of elderly donors to hMSC of similar to 30 years younger donors and found that the transcriptional changes acquired between the sixth and the ninth decade of life differed widely between osteoporotic and non-osteoporotic stem cells. In addition, we compared the osteoporotic transcriptome to long term-cultivated, senescent hMSC and detected some signs for pre-senescence in hMSC-OP. Our results suggest that in primary osteoporosis the transcriptomes of hMSC populations show distinct signatures and little overlap with non-osteoporotic aging, although we detected some hints for senescence-associated changes. While there are remarkable inter-individual variations as expected for polygenetic diseases, we could identify many susceptibility genes for osteoporosis known from genetic studies. We also found new candidates, e.g. MAB21L2, a novel repressor of BMP-induced transcription. Such transcriptional changes may reflect epigenetic changes, which are part of a specific osteoporosis-associated aging process. KW - alkaline-phosphatase KW - in vitro KW - bone-mineral density KW - age-related osteoporosis KW - WNT signaling pathway KW - replicative senescence KW - morphogenetic protein KW - parathyroid-hormone KW - growth factor KW - skeletal overexpression Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133379 VL - 7 IS - 9 ER - TY - JOUR A1 - Sappey-Marinier, Elliot A1 - Howell, Stephen M. A1 - Nedopil, Alexander J. A1 - Hull, Maury L. T1 - The trochlear groove of a femoral component designed for kinematic alignment is lateral to the quadriceps line of force and better laterally covers the anterior femoral resection than a mechanical alignment design JF - Journal of Personalized Medicine N2 - Background: A concern about kinematically aligned (KA) total knee arthroplasty (TKA) is that it relies on femoral components designed for mechanical alignment (MAd-FC) that could affect patellar tracking, in part, because of a trochlear groove orientation that is typically 6° from vertical. KA sets the femoral component coincident to the patient’s pre-arthritic distal and posterior femoral joint lines and restores the Q-angle, which varies widely. Relative to KA and the native knee, aligning the femoral component with MA changes most distal joint lines and Q-angles, and rotates the posterior joint line externally laterally covering the anterior femoral resection. Whether switching from a MAd- to a KAd-FC with a wider trochlear groove orientation of 20.5° from vertical results in radiographic measures known to promote patellar tracking is unknown. The primary aim was to determine whether a KAd-FC sets the trochlear groove lateral to the quadriceps line of force (QLF), better laterally covers the anterior femoral resection, and reduces lateral patella tilt relative to a MAd-FC. The secondary objective was to determine at six weeks whether the KAd-FC resulted in a higher complication rate, less knee extension and flexion, and lower clinical outcomes. Methods: Between April 2019 and July 2022, two surgeons performed sequential bilateral unrestricted caliper-verified KA TKA with manual instruments on thirty-six patients with a KAd- and MAd-FC in opposite knees. An observer measured the angle between a line best-fit to the deepest valley of the trochlea and a line representing the QLF that indicated the patient’s Q-angle. When the trochlear groove was lateral or medial relative to the QLF, the angle is denoted + or −, and the femoral component included or excluded the patient’s Q-angle, respectively. Software measured the lateral undercoverage of the anterior femoral resection on a Computed Tomography (CT) scan, and the patella tilt angle (PTA) on a skyline radiograph. Complications, knee extension and flexion measurements, Oxford Knee Score, KOOS Jr, and Forgotten Joint Score were recorded pre- and post-operatively (at 6 weeks). A paired Student’s T-test determined the difference between the KA TKAs with a KAd-FC and MAd-FC with a significance set at p < 0.05. Results: The final analysis included thirty-five patients. The 20.5° trochlear groove of the KAd-FC was lateral to the QLF in 100% (15 ± 3°) of TKAs, which was greater than the 69% (1 ± 3°) lateral to the QLF with the 6° trochlear groove of the MAd-FC (p < 0.001). The KAd-FC’s 2 ± 1.9 mm lateral undercoverage of the anterior femoral resection was less than the 4.4 ± 1.5 mm for the MAd-FC (p < 0.001). The PTA, complication rate, knee extension and flexion, and clinical outcome measures did not differ between component designs. Conclusions: The KA TKA with a KAd-FC resulted in a trochlear groove lateral to the QLF that included the Q-angle in all patients, and negligible lateral undercoverage of the anterior femoral resection. These newly described radiographic parameters could be helpful when investigating femoral components designed for KA with the intent of promoting patellofemoral kinematics. KW - total knee arthroplasty KW - lateral trochlear undercoverage KW - prosthetic design KW - kinematic alignment KW - patellofemoral relationship Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290482 SN - 2075-4426 VL - 12 IS - 10 ER - TY - JOUR A1 - Rudert, Maximilian A1 - Horas, Konstantin A1 - Hoberg, Maik A1 - Steinert, Andre A1 - Holzapfel, Dominik Emanuel A1 - Hübner, Stefan A1 - Holzapfel, Boris Michael T1 - The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint JF - BMC Musculoskeletal Disorders N2 - Background The key for successful delivery in minimally-invasive hip replacement lies in the exact knowledge about the surgical anatomy. The minimally-invasive direct anterior approach to the hip joint makes it necessary to clearly identify the tensor fasciae latae muscle in order to enter the Hueter interval without damaging the lateral femoral cutaneous nerve. However, due to the inherently restricted overview in minimally-invasive surgery, this can be difficult even for experienced surgeons. Methods and Surgical Technique In this technical note, we demonstrate for the first time how to use the tensor fasciae latae perforator as anatomical landmark to reliably identify the tensor fasciae latae muscle in orthopaedic surgery. Such perforators are used for flaps in plastic surgery as they are constant and can be found at the lateral third of the tensor fasciae latae muscle in a direct line from the anterior superior iliac spine. Conclusion As demonstrated in this article, a simple knowledge transfer between surgical disciplines can minimize the complication rate associated with minimally-invasive hip replacement. KW - anatomical landmark KW - direct anterior approach KW - Hueter interval KW - minimally-invasive KW - hip replacement KW - perforator Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146031 VL - 17 IS - 57 ER - TY - JOUR A1 - Liedtke, Daniel A1 - Hofmann, Christine A1 - Jakob, Franz A1 - Klopocki, Eva A1 - Graser, Stephanie T1 - Tissue-Nonspecific Alkaline Phosphatase—A Gatekeeper of Physiological Conditions in Health and a Modulator of Biological Environments in Disease JF - Biomolecules N2 - Tissue-nonspecific alkaline phosphatase (TNAP) is a ubiquitously expressed enzyme that is best known for its role during mineralization processes in bones and skeleton. The enzyme metabolizes phosphate compounds like inorganic pyrophosphate and pyridoxal-5′-phosphate to provide, among others, inorganic phosphate for the mineralization and transportable vitamin B6 molecules. Patients with inherited loss of function mutations in the ALPL gene and consequently altered TNAP activity are suffering from the rare metabolic disease hypophosphatasia (HPP). This systemic disease is mainly characterized by impaired bone and dental mineralization but may also be accompanied by neurological symptoms, like anxiety disorders, seizures, and depression. HPP characteristically affects all ages and shows a wide range of clinical symptoms and disease severity, which results in the classification into different clinical subtypes. This review describes the molecular function of TNAP during the mineralization of bones and teeth, further discusses the current knowledge on the enzyme’s role in the nervous system and in sensory perception. An additional focus is set on the molecular role of TNAP in health and on functional observations reported in common laboratory vertebrate disease models, like rodents and zebrafish. KW - TNAP KW - hypophosphatasia KW - HPP KW - zebrafish KW - mineralization KW - ALPL KW - craniosynostosis KW - teeth KW - nervous system Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220096 SN - 2218-273X VL - 10 IS - 12 PB - MDPI ER - TY - JOUR A1 - Graser, Stephanie A1 - Liedtke, Daniel A1 - Jakob, Franz T1 - TNAP as a new player in chronic inflammatory conditions and metabolism JF - International Journal of Molecular Sciences N2 - This review summarizes important information on the ectoenzyme tissue-nonspecific alkaline phosphatase (TNAP) and gives a brief insight into the symptoms, diagnostics, and treatment of the rare disease Hypophosphatasia (HPP), which is resulting from mutations in the TNAP encoding ALPL gene. We emphasize the role of TNAP beyond its well-known contribution to mineralization processes. Therefore, above all, the impact of the enzyme on central molecular processes in the nervous system and on inflammation is presented here. KW - TNAP KW - Hypophosphatasia KW - HPP KW - mineralization KW - nervous system KW - inflammation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258888 SN - 1422-0067 VL - 22 IS - 2 ER - TY - THES A1 - Schilling, Tatjana T1 - Transdifferentiation of Human Mesenchymal Stem Cells T1 - Transdifferenzierung humaner Mesenchymaler Stammzellen N2 - With ageing, the loss of bone mass correlates with the expansion of adipose tissue in human bone marrow thus facilitating bone-related diseases like osteopenia and osteoporosis. The molecular mechanisms underlying these events are still largely unknown. Reduced osteogenesis and concurrently enhanced adipogenesis might not only occur due to the impairment of conventional osteogenic differentiation originating from mesenchymal stem cells (MSCs). Additionally, transdifferentiation of (pre-)osteoblasts into adipocytes could contribute to the fatty conversion. Therefore, the aim of the present study was to prove the existence of transdifferentiation between the adipogenic and osteogenic lineage and to elucidate molecular mechanisms underlying this phenomenon. At first, a cell culture system of primary human MSCs was established that allowed for differentiation into the adipogenic and osteogenic lineage and proved that the MSC-derived adipocytes and pre-osteoblasts were capable of transdifferentiation (reprogramming) from one into the other lineage. Thereby, lineage-specific markers were completely reversed after reprogramming of pre-osteoblasts into adipocytes. The osteogenic transdifferentiation of adipocytes was slightly less efficient since osteogenic markers were present but the adipogenic ones partly persisted. Hence, plasticity also reached into the differentiation pathways of both lineages and the better performance of adipogenic reprogramming further supported the assumption of its occurrence in vivo. The subsequent examination of gene expression changes by microarray analyses that compared transdifferentiated cells with conventionally differentiated ones revealed high numbers of reproducibly regulated genes shortly after initiation of adipogenic and osteogenic reprogramming. Thereof, many genes were correlated with metabolism, transcription, and signal transduction as FGF, IGF, and Wnt signalling, but only few of the established adipogenesis- and none of the osteogenesis-associated marker genes were detected within 24 h after initiation of transdifferentiation. To find possible key control factors of transdifferentiation amongst the huge amount of regulated genes, a novel bioinformatic scoring scheme was developed that ranked genes due to their potential relevance for reprogramming. Besides the reproducibility and level of their regulation, also the possible reciprocity between the adipogenic and osteogenic transdifferentiation pathway was taken into account. Fibroblast growth factor 1 (FGF1) that ranked as one of the leading candidates to govern reprogramming was proven to inhibit adipogenic differentiation as well as adipogenic transdifferentiation in our cell culture system. Further examination of the FGF signalling pathway and other highly ranked genes could help to better understand the age-related fatty degeneration at the molecular level and therefore provide target molecules for therapeutic modulation of the plasticity of both lineages in order to inhibit adipogenic degeneration and to enhance osteogenesis. N2 - Der Verlust an Knochenmasse im Alter ist mit der Ausbreitung von Fettgewebe im menschlichen Knochenmark assoziiert und fördert daher auch knochenspezifische Erkrankungen wie Osteopenie und Osteoporose. Die diesen Ereignissen zu Grunde liegenden Mechanismen sind immer noch weitgehend unbekannt. Die abnehmende Osteogenese und die gleichzeitig zunehmende Adipogenese treten wahrscheinlich nicht nur wegen der Beeinträchtigung der konventionellen osteogenen Differenzierung von mesenchymalen Stammzellen (MSZ) auf. Zusätzlich könnte auch die Transdifferenzierung (Reprogrammierung) von Osteoblasten(vorläufern) zu Adipozyten zur fettigen Umwandlung beitragen. Das Ziel der vorliegenden Studie war es daher, die Existenz der Transdifferenzierung zwischen dem adipogenen und osteogenen Differenzierungsweg nachzuweisen und die molekularen Mechanismen aufzuklären, die diesem Phänomen zu Grunde liegen. Zunächst wurde ein Zellkultursystem primärer mesenchymaler Stammzellen etabliert, in dem eine Differenzierung zu Adipozyten und Osteoblasten durchgeführt werden konnte, und nachgewiesen, dass aus MSZ erhaltene Adipozyten und Osteoblastenvorläufer von einer zur anderen Zelllinie transdifferenziert (reprogrammiert) werden können. Dabei wurden die zelllinienspezifischen Marker nach der Reprogrammierung von Osteoblastenvorläufern zu Adipozyten vollständig umgekehrt. Die osteogene Transdifferenzierung von Adipozyten war etwas weniger effizient, da die osteogenen Marker zwar vorhanden waren, aber auch die adipogenen Marker weiterhin auftraten. Die Plastizität erstreckte sich also auch auf die Differenzierungswege der beiden Zellpopulationen, wobei das bessere Ergebnis bezüglich der adipogenen Reprogrammierung die Annahme ihres Auftretens in vivo weiter unterstützte. Die nachfolgende Untersuchung von Genexpressionsänderungen mittels Mikroarray-Analysen, die transdifferenzierte mit konventionell differenzierten Zellen verglichen, führte kurz nach Initiation der adipogenen und osteogenen Transdifferenzierung zum Auffinden zahlreicher, reproduzierbar regulierter Gene. Viele dieser Gene standen mit Metabolismus, Transkription und Signaltransduktion wie dem FGF-, IGF- und Wnt-Signalweg in Zusammenhang, es wurden allerdings nur einige Adipogenese- und keinerlei Osteogenese-assoziierte Markergene innerhalb 24 h nach Initiation der Transdifferenzierung detektiert. Um unter der großen Zahl an regulierten Genen mögliche Schlüsselkontrollfaktoren der Transdifferenzierung zu finden, wurde ein neuartiges, bioinformatisches Punktesystem entwickelt, das Gene entsprechend ihrer potenziellen Relevanz für die Reprogrammierung auflistete. Dabei wurde neben der Reproduzierbarkeit und dem Ausmaß ihrer Regulation auch eine mögliche Reziprozität der Regulation zwischen dem adipogenen und osteogenen Transdifferenzierungsweg berücksichtigt. Es konnte nachgewiesen werden, dass der Fibroblastenwachstumsfaktor 1 (FGF1), der als einer der Hauptkandidaten für die Steuerung der Reprogrammierung eingeordnet worden war, in unserem Zellkultursystem sowohl die adipogene Differenzierung als auch die adipogene Transdifferenzierung hemmt. Die weitere Untersuchung des FGF-Signalwegs und anderer, hoch gelisteter Gene könnte zum besseren Verständnis der altersbezogenen fettigen Degeneration auf molekularer Ebene beitragen und daher Zielmoleküle liefern, die eine therapeutische Beeinflussung der Plastizität zwischen beiden Zelllinien zur Verhinderung der fettigen Degeneration und zur Förderung der Osteogenese erlauben. KW - Zelldifferenzierung KW - Metaplasie KW - Mesenchymale Stammzellen KW - Transdifferenzierung KW - Osteoblasten KW - Adipozyten KW - Mesenchymal Stem Cells KW - transdifferentiation KW - osteoblasts KW - adipocytes Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-24299 ER - TY - JOUR A1 - Heinz, Tizian A1 - Eidmann, Annette A1 - Anderson, Philip A1 - Weißenberger, Manuel A1 - Jakuscheit, Axel A1 - Rudert, Maximilian A1 - Stratos, Ioannis T1 - Trends in computer-assisted surgery for total knee arthroplasty in Germany: an analysis based on the operative procedure classification system between 2010 to 2021 JF - Journal of Clinical Medicine N2 - Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (−3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard. KW - robotic KW - TKA KW - knee replacement KW - computer navigation KW - Germany Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304879 SN - 2077-0383 VL - 12 IS - 2 ER - TY - JOUR A1 - Luetkens, Karsten Sebastian A1 - Grunz, Jan-Peter A1 - Kunz, Andreas Steven A1 - Huflage, Henner A1 - Weißenberger, Manuel A1 - Hartung, Viktor A1 - Patzer, Theresa Sophie A1 - Gruschwitz, Philipp A1 - Ergün, Süleyman A1 - Bley, Thorsten Alexander A1 - Feldle, Philipp T1 - Ultra-high-resolution photon-counting detector CT arthrography of the ankle: a feasibility study JF - Diagnostics N2 - This study was designed to investigate the image quality of ultra-high-resolution ankle arthrography employing a photon-counting detector CT. Bilateral arthrograms were acquired in four cadaveric specimens with full-dose (10 mGy) and low-dose (3 mGy) scan protocols. Three convolution kernels with different spatial frequencies were utilized for image reconstruction (ρ\(_{50}\); Br98: 39.0, Br84: 22.6, Br76: 16.5 lp/cm). Seven radiologists subjectively assessed the image quality regarding the depiction of bone, hyaline cartilage, and ligaments. An additional quantitative assessment comprised the measurement of noise and the computation of contrast-to-noise ratios (CNR). While an optimal depiction of bone tissue was achieved with the ultra-sharp Br98 kernel (S ≤ 0.043), the visualization of cartilage improved with lower modulation transfer functions at each dose level (p ≤ 0.014). The interrater reliability ranged from good to excellent for all assessed tissues (intraclass correlation coefficient ≥ 0.805). The noise levels in subcutaneous fat decreased with reduced spatial frequency (p < 0.001). Notably, the low-dose Br76 matched the CNR of the full-dose Br84 (p 0.999) and superseded Br98 (p < 0.001) in all tissues. Based on the reported results, a photon-counting detector CT arthrography of the ankle with an ultra-high-resolution collimation offers stellar image quality and tissue assessability, improving the evaluation of miniscule anatomical structures. While bone depiction was superior in combination with an ultra-sharp convolution kernel, soft tissue evaluation benefited from employing a lower spatial frequency. KW - photon-counting CT KW - arthrography KW - ankle KW - cartilage KW - radiation dosage Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362622 SN - 2075-4418 VL - 13 IS - 13 ER - TY - JOUR A1 - Wirtz, Dieter C. A1 - Gravius, Sascha A1 - Ascherl, Rudolf A1 - Thorweihe, Miguel A1 - Forst, Raimund A1 - Noeth, Ulrich A1 - Maus, Uwe M. A1 - Wimmer, Matthias D. A1 - Zeiler, Guenther A1 - Deml, Moritz C. T1 - Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem 5-to 16-year results of 163 cases JF - Acta Orthopaedica N2 - Background and purpose - Due to the relative lack of reports on the medium- to long-term clinical and radiographic results of modular femoral cementless revision, we conducted this study to evaluate the medium- to long-term results of uncemented femoral stem revisions using the modular MRP-TITAN stem with distal diaphyseal fixation in a consecutive patient series. Patients and methods - We retrospectively analyzed 163 femoral stem revisions performed between 1993 and 2001 with a mean follow-up of 10 (5-16) years. Clinical assessment included the Harris hip score (HHS) with reference to comorbidities and femoral defect sizes classified by Charnley and Paprosky. Intraoperative and postoperative complications were analyzed and the failure rate of the MRP stem for any reason was examined. Results - Mean HHS improved up to the last follow-up (37 (SD 24) vs. 79 (SD 19); p < 0.001). 99 cases (61%) had extensive bone defects (Paprosky IIB-III). Radiographic evaluation showed stable stem anchorage in 151 cases (93%) at the last follow-up. 10 implants (6%) failed for various reasons. Neither a breakage of a stem nor loosening of the morse taper junction was recorded. Kaplan-Meier survival analysis revealed a 10-year survival probability of 97% (95% CI: 95-100). Interpretation - This is one of the largest medium- to longterm analyses of cementless modular revision stems with distal diaphyseal anchorage. The modular MRP-TITAN was reliable, with a Kaplan-Meier survival probability of 97% at 10 years. KW - follow-up KW - distal fixation KW - bone loss KW - replacement KW - register KW - junction KW - cement KW - prosthesis KW - roentgenographic assessment KW - total HIP-arthroplasty Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-114555 SN - 1745-3674 VL - 85 IS - 6 ER - TY - THES A1 - Flegler, Katharina T1 - Untersuchung der Expression von Knochensialoprotein (BSP) an Gewebe von Knochenmetastasen mittels Immunhistologie : Vergleich eines Antikörpers gegen nicht-glykosyliertes BSP mit einem Antikörper gegen glykosyliertes BSP T1 - Expression of bone sialoprotein (BSP) in bone metastases : antibodies against normal BSP compared to antibodies against BSP which bind epitopes that are incomplete in their posttranslational glycosylation N2 - Knochensialoprotein (BSP) ist ein Protein der extrazellulären Matrix im Knochen und mineralisierten Geweben, wird aber auch von verschiedenen Tumorzellen exprimiert (Bellahcene et al., 1994, 1997, 1998). Dies ist assoziiert mit einer schlechten Prognose und einem erhöhten Risiko für eine spätere Entwicklung von Knochenmetastasen. Diel et al. (1999) konnte zeigen, dass ein erhöhter Serum-BSP-Wert bei Patientinnen mit Mammakarzinom zu einem gehäuften Auftreten von Knochenmetastasen im Laufe der Erkrankung führt. BSP scheint ein Marker für die Entstehung von Knochenmetastasen zu sein. In der Literatur ist ein Antikörper beschrieben, der ein Epitop des BSP erkennt, welches im BSP aus Tumorzellen nicht glykosyliert ist, im BSP aus mineralisiertem Gewebe allerdings schon (Armbruster et al., 2009). Im Tiermodell konnte gezeigt werden, dass Knochenmetastasen verhindert werden können bei gleichzeitiger Gabe von Tumorzellen und Antikörpern gegen BSP beziehungsweise, dass bei vorhandenen Knochenmetastasen eine Behandlung der Tiere mit einem Anti-BSP-Antikörper die Metastasen zurückbildet (Bäuerle et al., 2005, 2006). In der aktuellen Arbeit wird die Expression von BSP an menschlichem Gewebe von Knochenmetastasen mit unterschiedlichen Primärtumoren mittels Immunhistochemie untersucht. Insgesamt wurden 35 Fälle von Knochenmetastasen mit Primärtumor eines Mammakarzinoms untersucht, wobei 22,9% eine BSP Expression aufweisen, davon 5,7% eine starke. Knochenmetastasen mit dem Primärtumor Prostatakarzinom sind mit 8 Fällen repräsentiert, wobei 75% positiv für BSP sind, davon 25% stark positiv. Die einzelnen Fälle zeigen eine starke BSP Expression im Stroma und eine schwache BSP Expression der Tumorzellen. Diese Ergebnisse des Antikörpers gegen normal glykosyliertes BSP wurden verglichen mit dem Antikörper gegen nicht glykosyliertes BSP. Der Nachweis von BSP in Tumorzellen zeigt dasselbe Ergebnis, BSP im Stroma wird durch den Antikörper gegen nicht- glykosyliertes BSP intensiver dargestellt. Daraus lässt sich folgern, dass der Antikörper gegen nicht- glykosyliertes BSP nicht spezifisch für die Isoform des BSP aus Tumorzellen ist, sondern gleichermaßen in der Routinediagnostik von BSP eingesetzt werden kann. Die Untersuchung könnte sogar darauf hinweisen, dass dieser Antikörper die nicht- glykosylierte Isoform im Stroma erkennt und damit bei Untersuchung des Stromas die bessere Alternative darstellt. N2 - Bone sialoprotein (BSP) is a bone matrix protein that is also expressed by breast cancer and prostate cancer cells (Bellahcene et al., 1994, 1997, 1998). The BSP expression in primary breast and prostate carcinomas is associated with a poor prognosis and an increased risk to develop bone metastases. Serum BSP was found to be a prognostic marker for the development of bone metastases (Diel et al. 1999). There are antibodies that specifically bind epitopes present in BSP produced in tumor cells, wherein the posttranslational glycosylation of BSP is incomplete in comparison with the posttranslational glycosylation of BSP produced in normal bone cells (Armbruster et al., 2009). In nude rats, incubation of breast cancer cells and anti-BSP antibodies prior to inoculation reduced the osteolytic lesion size. The treatment of bone metastases with an anti-BSP antibody resulted in a significantly smaller lesion size (Bäuerle et al., 2005, 2006). In the present study, 84 patient cases with bone metastases of different primary tumours were investigated by immunohistochemistry in order to assess the level of BSP and to compare two different anti-BSP antibodies. There are 35 cases of breast cancer bone metastases and 8 cases of prostate cancer bone metastases. BSP expression was found in 22, 9 % of all breast cancer bone metastases and 75% of all prostate cancer bone metastases. In nearly all cases a strong staining for BSP was found in stroma, a weak staining for BSP was observed in tumour cells. We compared antibodies against normal BSP with anti-BSP antibodies that bind epitopes that are incomplete in their posttranslational glycosylation. The expression of BSP in tumour cells was exactly the same, the expression of BSP in tumour stroma was different. A stronger staining was found with the antibodies that bind epitopes that are incomplete in their posttranslational glycosylation. In conclusion, these antibodies do not only stain for BSP produced by tumour cells. Both antibodies can be used for the detection of BSP. KW - Knochensialoprotein KW - Knochenmetastase KW - Mammakarzinom KW - bone sialoprotein KW - bone metastases KW - breast cancer Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-71642 ER - TY - THES A1 - Gurok, Anna T1 - Untersuchung der postoperativen Ergebnisse nach Rekonstruktion des medialen-patellofemoralen Ligamentes (MPFL) nach 5 Jahren T1 - Investigation of five-year follow-up results of medial patellofemoral ligament (MPFL) reconstruction N2 - Patellaluxationen sind eine vor allem bei jungen, aktiven Patienten häufige Verletzung komplexer Ätiologie. Die Rekonstruktion des medialen patellofemoralen Ligaments (MPFL) ist die aktuell etablierte Operationstechnik bei strecknaher patellofemoraler Instabilität, zu der in der Literatur eine Vielzahl an patellaren Fixationstechniken des autologen Sehnentransplantates beschrieben werden. In dieser Studie wurden 71 Patienten 5 Jahre nach Rekonstruktion des MPFLs mit patellarer Fixation in Weichteiltechnik nachuntersucht und die klinischen Ergebnisse der Operationsmethode und die Zufriedenheit der Patienten ermittelt. Dafür wurde die Reluxationsrate ermittelt und die Funktion der Kniegelenke im Alltag mithilfe des Kujala- und des Lysholm-Fragebogens, das Aktivitätsniveau der Patienten mit der Tegner-Aktivitätsskala erfasst. Im Rahmen einer Nachuntersuchung wurden die Beweglichkeit des Kniegelenks und die Stabilität der Kniescheibe klinisch untersucht. Die Ergebnisse wurden unter Berücksichtigung klinischer und radiologischer Risikofaktoren ausgewertet. Die Studie ergab eine Reluxationsrate von 5,6% und ist somit vergleichbar mit der Rate anderer in der Literatur beschriebener Techniken. Die Ergebnisse der klinischen Untersuchung ergaben eine stabile ligamentäre Führung der Kniescheibe bei insgesamt guter Beweglichkeit der Kniegelenke, die Auswertung der Fragebögen zeigten signifikante Verbesserungen der Funktion der operierten Kniegelenke im Alltag bei unverändertem Aktivitätsniveau. Im Ergebnis kann durch die vorliegende Studie belegt werden, dass durch die Rekonstruktion des MPFL mit weichteiliger patellarer Fixation langfristig gute Ergebnisse bei einer niedrigen Komplikationsrate erzielt werden können. Allerdings erhöht das Zusammentreffen verschiedener Pathologien wie eine Patella alta mit einer ausgeprägten Dysplasie der Trochlea das Risiko für eine persistierende Instabilität und eine erneute Luxation. N2 - Patellar luxation is an injury of young and active patients with a complex etiology. The reconstruction of the medial patellofemoral ligament (MPFL) is a well-established surgical technique for patellar instability. Lots of different patellar fixation techniques for the autologous transplant are described. This study investigated the redislocation rate and functional outcome at a minimum follow-up of five years after medial patellofemoral ligament reconstruction with soft tissue patellar fixation. 71 patients were included and the daily knee function was measured with Kujala and Lysholm questionnaires and the level of activity with Tegner Score. The knee joints were examined clinically. The results were analyzed in consideration of clinical and radiology risk factors. This study showed a redislocation rate of 5.6 % after a mean follow up of 5.8 years, the clinical examination of the knee a satisfying patellar stability and a good range of motion. The operation leads to an increased daily knee function, the activity remains on the same level. In summary, this technique of MPFL reconstruction with soft tissue patellar fixation leads to significant improvement of the knee function and has a low long term redislocation and complication rate. However, patients with high-grade trochlear dysplasia and patella alta have a higher risk for persistent patellar instability or redislocation. KW - Patella KW - MPFL KW - Patellaluxation KW - Patellofemorale Instabilität Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240585 ER - TY - THES A1 - Pawlakowitsch, Peter T1 - Untersuchung des Einflusses der Akupunktur in der frühen postoperativen Phase auf die Schmerzintensität und auf das funktionelle Ergebnis drei Monate nach Implantation einer Kniegelenks-Totalendoprothese T1 - Analysis of the influence of acupuncture in the early postoperative period on pain intensity and the functional outcome three months after total knee arthroplasty N2 - Die Implantation von Kniegelenks-Totalendoprothesen stellt heutzutage einen Routineeingriff dar, ist allerdings mit postoperativen Schmerzen und einer langwierigen Rehabilitation verbunden. In den letzten Jahren haben alternative Heilmethoden wie etwa die Traditionelle Chinesische Medizin eine zunehmende Verbreitung erfahren und speziell für die Akupunktur konnte auch eine schmerzlindernde Wirkung gezeigt werden. Inwieweit eine Akupunktur-behandlung in der postoperativen Situation das funktionelle Ergebnis verbessern kann ist unklar. Im Rahmen dieser Studie wurde deshalb der Einfluss einer Akupunktur auf das funktionelle Ergebnis zwischen dem zweiten postoperativen Tag und drei Monate nach der Operation untersucht. Dazu wurde eine randomisierte, kontrollierte und dreifach verblindete Monozenterstudie mit 60 Teilnehmern durchgeführt. Die Kontrollgruppe erhielt dabei die postoperative Standardtherapie, während die Interventionsgruppe vom 2. bis 6. Tag nach der Operation einmal täglich zusätzlich akupunktiert wurde. Im gleichen Zeitraum wurde eine dritte Studiengruppe, die Placebogruppe, scheinakupunktiert. Vom 2. bis 6. Tag nach der Operation sowie drei Monate später wurden die postoperativen Schmerzintensitäten abgefragt. Weiterhin wurden die maximal mögliche, passive Kniebeugung und die maximal mögliche Kniebelastung drei Monate nach der Operation ermittelt und das funktionelle Ergebnis der Operation mittels Fragebögen durch die Patienten bewertet. Dabei zeigten sich keine statistisch signifikanten Unterschiede zwischen den Studiengruppen. Aufgrund der Limitationen dieser sowie vergleichbarer Studien und angesichts uneinheitlicher Studienergebnisse bei insgesamt unzureichender Vergleichbarkeit der verschiedenen Akupunkturstudien ist eine abschließende Bewertung zur Wirksamkeit der Akupunktur nach Implantation einer Kniegelenks-Totalendoprothese jedoch nicht möglich. Dazu bedarf es weiterer, qualitativ hochwertiger und größerer Studien zu diesem Thema. N2 - Total knee arthroplasty is a common procedure marked by intense postoperative pain and prolonged rehabilitation. During the last years complementary medicine such as acupuncture has become increasingly popular. It has been shwon that acupuncture can alleviate pain. However, it remains unclear if acupuncture is beneficial for the outcome after surgery. This randomized, controlled, three armed study with 60 participants tried to examine the effects of scupuncture on the functional outcome three months after total knee arthroplasty. The control group received standardized postoperative care. The intervention group additionally received acupuncture on 2. - 6. day after surgery. A third study group received sham acupuncture. This study evaluated pain intensity on 2.-6. postoperative day and three months after surgery. Furthermore passive range of motion and max. load of the knee joint as well as patient reported outcome measures were evaluated. There was no statistically significant difference between the study group KW - Akupunktur KW - Kniegelenkprothese KW - Kontrollierte klinische Studie KW - TCM Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-181018 ER - TY - THES A1 - Lobmüller, Andreas T1 - Untersuchung zum Management der postoperativen Schmerztherapie nach orthopädisch-chirurgischen Eingriffen T1 - Implementation of standardized postoperative pain therapy for orthopaedic patients. Comparison between unsystematic and standardized pain therapy N2 - Hintergrund. Die „schmerzfreie Klinik" sowie die postoperative Schmerztherapie sind ein zentrales Thema in der heutigen Zeit. Im Bezug zu den ständigen Diskussionen zur Verbesserung der postoperativen Schmerztherapie und den unzähligen Forderungen nach einem Akutschmerzdienst, scheinen in Anbetracht der gegenwärtigen Kostenentwicklungen, preisgünstige oder kostenneutrale Alternativen zur schnellen und einfachen Verbesserung der Schmerztherapieversorgung ein „heiliger Gral“51 zu sein. Kliniken der Grund- und Regelversorgung, denen im Gegensatz zu Kliniken der Maximalversorgung nur beschränkte Ressourcen zur Verfügung stehen, ist die Einrichtung eines ASD oft nicht möglich2. Ziel dieser Studie war es, die Auswirkung der Implementierung einer standardisierten Schmerztherapie auf den postoperativen Schmerzverlauf nach orthopädischen Operationen zu untersuchen. Patienten und Methoden. Es wurden zwei orthopädische Patientengruppen untersucht, die sich einem operativen Eingriff unterzogen haben. Gruppe I (n = 249) erhielt eine unsystematische Schmerztherapie, die individuell und indikationsspezifisch erfolgte, Gruppe II (n = 243) erhielt eine standardisierte Schmerztherapie. Der Effekt der Schmerztherapie wurde mit einem Schmerzerfassungsprotokoll regelmäßig dokumentiert. Ergebnisse. Die Schmerzmessung ergab eindeutige Unterschiede im Schmerzerleben der beiden Gruppen. Patienten der Gruppe II gaben bis zum 9. postoperativen Tag signifikant weniger Schmerzen an. Im Gegenzug traten jedoch bei Gruppe II bis Tag 3 signifikant mehr unerwünschte Nebenwirkungen auf, insbesondere aus dem gastrointestinalen Formenkreis. Mobilität und Stimmung konnten durch die standardisierte analgetische Therapie ebenfalls signifikant verbessert werden. Schlussfolgerung. Unsere Ergebnisse zeigen, dass die Einführung eines standardisierten Schmerztherapieschemas für ein Haus mittlerer Größe (150 Betten) und einem Operationsspektrum, welches zum großen Teil sehr schmerzhafte knochenchirurgische Eingriffe beinhaltet, ein geeignetes Organisationsmodell zur Verbesserung der postoperativen Schmerztherapie darstellt. Die Implementierung einer standardisierten Schmerztherapie ist mit geringem personellem und überschaubarem zeitlichem Aufwand verbunden und ermöglicht auch ohne die Einführung eines Akutschmerzdienstes bei gleich bleibenden Ressourcen eine signifikante Verbesserung. Sie wurde vom ärztlichen Dienst und insbesondere vom Pflegepersonal positiv aufgenommen und ist im Hinblick auf die Reduzierung der postoperativen Schmerzen erfolgreich. Auch Mobilität und Stimmung der Patienten wurden positiv beeinflusst. Als Folge stieg jedoch die Inzidenz der Nebenwirkungen. N2 - Background. The painless clinic and postoperative pain therapy are currently major issues in the management of surgical procedures. The aim of this study was to evaluate the benefit of a standardized pain therapy on the postoperative pain level after orthopaedic procedures. Patients and methods. We investigated two different groups of patients who underwent an orthopaedic surgical procedure. Group 1 (n = 249) received a pain therapy which was based on an individual and surgery- dependent concept whereas group 2 (n = 243) was treated with a standardized pain therapy concept. The effect of the treatment was monitored with a VAS-based protocol. Results. Up to day 9 after surgery there was a significant difference between the two groups in regard to the postoperative pain. The patients of group 2 had less pain but had more unwanted side effects caused by the pain therapy during the first 3 days after surgery. Mobility and mental disposition were positively affected. Conclusion. The implementation of a standardized pain therapy is successful in reducing postoperative pain. Mobility and mental disposition are also influenced positively. As a consequence the incidence of unwanted side effects is rising. KW - Analgesie KW - Schmerztherapie KW - Schmerzfreie Klinik KW - Visuelle Analogskala KW - Postoperative Schmerztherapie KW - Standardisierte Schmerztherapie KW - Qualitätsmanagement KW - Painless clinic KW - Visual analogue scale KW - Postoperative pain therapy KW - Standardized pain therapy KW - Quality management Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-38506 ER - TY - THES A1 - Fensky, Florian T1 - Untersuchungen zur chondrogenen Prädifferenzierung von humanen mesenchymalen Stammzellen in Kollagen Typ I Hydrogelen unter dem Einfluss von TGF-ß1 T1 - Chondrogenic predifferentiation of human mesenchymal stem cells (MSC) in collagen type I hydrogels under the influence of TGF-ß1 N2 - Der hyaline Gelenkknorpel ist auf Grund seines sehr eingeschränkten Selbstheilungspotentiales nicht in der Lage, auf Verletzungen mit adäquaten Regenerationsmechanismen zu reagieren. So hat sich in der Orthopädischen Klinik König-Ludwig-Haus zur Behandlung von fokalen Gelenkknorpelläsionen die matrixgekoppelte autologe Chondrozytentransplantation unter Verwendung eines Kollagen Typ I Hydrogel (CaReS®, Arthro Kinetics, Esslingen) etabliert. In der Zukunft könnten möglicherweise humane mesenchymale Stammzellen (hMSZ) eine alternative Zellquelle darstellen. In der vorliegenden Arbeit wurde in Anlehnung an die im klinischen Alltag befindliche matrixgekoppelte ACT der Frage nachgegangen, ob eine ex vivo Prädifferenzierung von hMSZ mit TGF-ß1 für 10 Tage zu einer chondrogenen Differenzierung führt. Durch den Nachweis chondrogener Markergene wie Kollagen II und Aggrekan konnte gezeigt werden, dass eine chondrogene Differenzierung von hMSZ unter Zugabe von TGF-ß1 über 10 Tage induziert werden kann. Ob diese 10-tägige Prädifferenzierung zu einem ausreichend stabilen Gelenkknorpelregenerat führen kann, muss letztendlich im Tierversuch überprüft werden. N2 - Due to the very restricted self-healing potential articular cartilage is not able to react to injuries with adequate regeneration mechanisms. Concerning this problem the matrix-based autologous chondrocyte transplantation (ACT) using a collagen type I hydrogel as a three-dimensional scaffold (CaReS®, Arthro Kinetics, Esslingen) is currently established in the Orthopaedic Institute, König-Ludwig-Haus to treat focal cartilage defects. In the future human mesenchymal stem cells (MSC) can form an alternative cell source for tissue engineering. With reference to the matrix-based ACT, the objective of this study was to determine whether an ex vivo predifferentiation with TGF-ß1 over 10 days leads to a chondrogenic differentiation of MSC. The proof of the decisive chondrogenic marker genes, like collagen type II and aggrecan, demonstrated that a chondrogenic differentiation of human mesenchymal stem cells can be induced under the influence TGF-ß1 over a period of 10 days. Further animal experiments will reveal whether this 10-day ex vivo predifferentiation can lead to a sufficiently stable articular cartilage. KW - Chondrogene Differenzierung KW - Mesenchymale Stammzellen KW - Kollagen Hydrogel KW - Chondrogenic Differentiation KW - Mesenchymal Stem Cells KW - Collagen Hydrogel Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-36622 ER - TY - THES A1 - Beck, Christine T1 - Untersuchungen zur neurogenen Differenzierung von humanen mesenchymalen Stammzellen gewonnen aus dem Knochenmark und aus trabekulären Knochenfragmenten T1 - Neuronal differentiation of human bone marrow-derived and trabecular bone-derived stem cells N2 - Im ersten Teil dieser Arbeit wurden humane mesenchymale Stammzellen aus dem Knochenmark (mhMSCs) und aus trabekulären Knochenfragmenten (bhMSCs) isoliert und in einem neurogenen Prädifferenzierungsmedium mit BME gefolgt von einem Differenzierungsmedium mit BHA und DMSO kultiviert. Anschließend wurden die differenzierten hMSCs mit den jeweiligen undifferenzierten, im normalen Wachstumsmedium kultivierten, mhMSCs bzw. bhMSCs verglichen. Im Verlauf der 6-tägigen neurogenen Differenzierung zeigte sich eine deutliche Veränderung der Zellmorphologie. Die meisten differenzierten Zellen erschienen kleiner und bildeten lange, für Nervenzellen typische Zellfortsätze aus, die sich teilweise mehrfach verzweigten. Weiterhin fand sich bei den differenzierten mhMSCs und bhMSCs eine Expressionszunahme bzw. eine de novo Expression der neuronalen Marker NSE und tau auf Gen- bzw. Protein-Ebene. Es konnte jedoch keiner Expressionsänderung von NF-M auf Protein-Ebene und in mehr als der Hälfte der Fälle sogar einer Expressionsabnahme auf RNA-Ebene gefunden werden. Die Differenzierung zeigte keinen reproduzierbaren Effekt auf die Expression des Astrozyten-Markers GFAP. Diese Ergebnisse zeigten sich sowohl bei den mhMSCs als auch bei den bhMSCs und lassen vermuten, dass bhMSCs ein ähnliches Potential besitzen wie mhMSCs und nicht wie ursprünglich vermutet, auf die Differenzierung in Zellen mesenchymalen Ursprungs beschränkt sind. Die Tatsache, dass bereits undifferenzierte hMSCs neurogliale Marker (NF-M, NSE, GFAP) exprimieren konnte in dieser Arbeit für mhMSCs bestätigt und erstmals auch für bhMSC beobachtet werden. Diese Ergebnisse unterstützen die Vermutung, dass es sich bei mhMSCs und bhMSCs um Neuroglia-Vorläuferzellen handelt, die in der Lage sind in neuronale Zellen (Nerven- und Gliazellen) zu differenzieren, und dass die neurogene Differenzierung eher eine quantitative Modulation der Genexpression als ein einfaches An-/Abschalten Neuronen-spezifischer Gene bewirkt. Im zweiten Teil der Arbeit wurden zunächst Zellen vom peripheren Nerven isoliert und anschließend charakterisiert. Die aus dem peripheren Nerven herausgewachsenen spindelförmigen bzw. multipolaren Zellen bildeten mit ihren zahlreichen langen Fortsätzen ein regelrechtes Netzwerk und zeigten eine Expression der für Myelinmarker MPZ und PMP 22 sowie des Schwann-Zell-Markers S 100. Abschließend wurden mhMSCs und bhMSCs für 6 Tage in einem Schwann-Zell-Differenzierungsmedium mit Forskolin kultiviert. Die differenzierten spindelförmigen Zellen zeigten eine für Schwann-Zellen typischen fischzugartige Ausrichtung. Es fand sich eine starke Expressionszunahme der von den undifferenzierten Zellen nur schwach exprimierten Myelinmarker MPZ und PMP 22 auf RNA-Ebene sowie eine kräftige Expressionszunahme bzw. de novo Expression des Schwann-Zell-Markers S 100. Diese Ergebnisse zeigen, dass bhMSCs ebenso wie mhMSCS unter geeigneten Bedingungen in der Lage sind, eine für Schwann-Zellen typische Morphologie zu entwickeln und die Expression einzelner Schwann-Zell-Marker zu steigern. In wie weit sie auch funktionell Schwann-Zellen gleichen und damit entscheidend zur peripheren Nervenregeneration beitragen können, bleibt jedoch noch zu klären. N2 - In this study we have investigated that trabecular bone-derived human mesenchymal stem cells (bhMSCs) as well as bone marrow-derived human mesenchymal stem cells (mhMSCs), classical mesodermal cells, retain the capacity to differentiate into non-mesenchymal cells with neuronal or Schwann cell characteristics. Our results suggest that not only mhMSCs but also bhMSCs expressing different neuroglial markers can be regarded as neuroglial precursor cells able to differentiate into cells with neuronal morphology and upregulate neuronal markers including NSE and Tau in response to neuronal differentiation with ß-mercaptoethanol, dimethylsulfoxide, and butylated hydroxyanisole. Further on we investigated that mhMSCs as well as bhMSCs are Schwann cell precursor cells which can both differentiate into cells with Schwann cell-like morphology and upregulate S 100 and myelin markers including PMP 22 and MPZ in response to forskolin. These results indicate that hMSCs artificially can be induced to turn into cells with Schwann cell-like properties and therefor may constitute an abundant and accessible cellular reservoir for peripheral nerve reconstructions. KW - neuronal KW - Differenzierung KW - Stammzellen KW - neuronal KW - differentiation KW - stem cells Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-17225 ER - TY - BOOK A1 - Wang, Wen T1 - Validation of shRNA clones for gene silencing in 293FT cells N2 - ... N2 - The goal of the project was to establish knock down of mRNA in human mesenchymal stem cells. Since these cells are difficult to transfect, a viral approach is needed to achieve sufficient expression of e. g. shRNA in a high percentage of cells to allow for an efficient silencing of corresponding mRNAs. For this purpose for every gene product of interest, a number of shRNA clones have to be tested to detect an individual shRNA with sufficient efficacy. Lentiviral systems for shRNA approaches have recently become available. The principal advantage of the lentiviral system is that it allows gene silencing in nondividing cells and therefore expands the usefulness of the RNAi-based gene silencing system. Lentivirus-delivered shRNAs are capable of specific, highly stable and functional silencing of gene expression in a variety of cell types. Since the viral transfection of MSCs is a time consuming process that involves transfection of 293 FT cells plus transduction of target cells, for this thesis the following approach was chosen: genes of interest were checked for expression in 293FT cells by RT-PCR. These gene products can be silenced in 293FT cells simply by transfection of shRNA clones and efficacy was subsequently tested by RT-PCR. Beyond this thesis then the project can proceed with effective clones to transduce primary MSCs with individual shRNA clones identified as effective silencing tool in this thesis. KW - shRNA KW - RNAi KW - .................................................................... KW - shRNA KW - RNAi Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-25955 N1 - Aus rechtlichen Gründen wurde der Zugriff auf den Volltext zu diesem Dokument gesperrt. ER - TY - THES A1 - Grimm, Susann T1 - Validierung der deutschen Version der Parents' Postoperative Pain Measure PPPM-D bei Kindern im Alter zwischen 2 und 12 Jahren nach orthopädischen Operationen T1 - The german version of the parents' postoperative pain measure PPPM-D. Validation on children 2-12 years old N2 - HINTERGRUND: Eltern spielen im Rahmen der postoperativen Schmerztherapie von Kindern eine immer wichtigere Rolle. Validierte und einfach anzuwendende Instrumente zur Fremdbeobachtung durch Eltern können die Schmerzmessung verbessern. Ziel der Studie war daher die Evaluation einer deutschen Version der englischsprachigen Parents' Postoperative Pain Measure (PPPM-D). ERGEBNISSE: Die Relabilität zeigte ausreichend gute Cronbach's-alpha-Werte. Hohe Korrelationen mit den Vergleichsinstrumenten fanden sich als Ausdruck der KOntruktvalidität. Die diskriminative Validität zeigte an den ersten 3 postoperativen Tagen klinisch relevante und statistisch signifikante Unterschiede zwischen den nach Schwerefrad der Operation eingeteilten Gruppen. Zudem fanden sich Hinweise auf gute Änderungssensitivität. Die PPPM-D wurde als gut anwendbar und von der Mehrheit der Eltern als wichtig bewertet. SCHLUSSFOLGERUNG: Die PPPM-D ist ein von Eltern akzeptiertes, valides und reliables Instrument zur Fremdbeurteilung postoperativer Schmerzen bei Kindern zwischen dem 2. und 12. Lebensjahr nach orthopädischen Operationen. N2 - BACKROUND: Parents become increasingly responsible for the postoperative pain management of their children. Usefull and valis pain assessments for parents may improve pain measurement. The aim of this study was to evaluate a german version of the parents' postoperative pain measure (PPPM-D). RESULTS: The PPPM-D showed satisfactory reliability. Construct validity was demonstrated with strong correlations with the CHIPPS uns FPS-R. Discriminative validity was shown by both statistically and clinically significant differences between minor, medial and major surgeries on the first 3 days after surgery. The examination of sensitivity of change yielded promising results. The PPPM-D was well accepted by the participating parents. CONCLUSIONS: The results of the study provide evidence of the reliability, validity and high acceptance of the PPPM-D as an assessment tool of postoperative pain among children aged 2 through to 12 years og age after orthopedic surgery. KW - Schmerz KW - Kind KW - Eltern KW - postoperative Schmerzen KW - Schmerzfragebogen KW - postoperative pain KW - pain assessment KW - children KW - parents Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-83873 ER - TY - THES A1 - Schreiber, Veronika T1 - Vergleich der analgetischen Wirkung einer intravenösen Infusion von Tramadol, Metamizol und eines Antiemetikums („Würzburger Schmerztropf“) zu einer intravenösen Infusion von Paracetamol und zu einer intravenösen Infusion von Parecoxib in der postoperativen Schmerztherapie nach orthopädisch-chirurgischen Eingriffen T1 - A Randomized, Single-Blind Comparison between Parecoxib, Paracetamol and a Combined Infusion of Tramadol and Metamizol for Parenteral Postoperative Analgesia after Total Knee Arthroplasty N2 - Innerhalb der ersten zwei postoperativen Tage nach einer Knieprothesenimplantation zeigt der „Würzburger Schmerztropf“ den geringsten Verbrauch an Ausweichmedikation bei vergleichbarer Schmerzintensität und hoher Patientenzufriedenheit. Parecoxib zeichnete sich aufgrund der tendenziell selteneren unerwünschten Arzneimittelwirkungen aus und gewährleistet aufgrund der standardisierten Applikationszeit eine einfache Handhabung durch das Pflegepersonal. Andererseits benötigten die Patienten, die Parecoxib erhielten, mehr Ausweichmedikation und wiesen eine höhere Rate an Studienabbrüchen auf. Ebenso war im Vergleich der drei Studienarme der Blutverlust in der Parecoxib-Gruppe höher. Anhand unserer Studienergebnisse können wir keine eindeutige Therapieempfehlung rechtfertigen. N2 - Within the first two days after total knee arthroplasty the pain therapy with the Wuerzburg pain drip showed the fewest usage of rescue medication with a comparable pain intensity pain satisfaction. Parecoxib showed a better profile of unwanted side effects and the standardized timing of application makes its usage for the nurse stuff easier. On the other hand the parecoxib group showed a hiher consumption of rescue medication and a hiher drop out rate. The blood loss was also hiher in the parecoxib group compared to both alternative treatments. Based on our study results no tratment recommendation can be given. KW - Paracetamol KW - Comparison of Analgesia KW - Parecoxib KW - Paracetamol KW - Total Knee Arthroplasty Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-52269 ER - TY - THES A1 - Heitmann, Maximilian T1 - Vergleich der genetischen Eigenschaften von Bone Marrow derived Mesenchymal Stem Cells und Trabecular Bone derived Mesenchymal Stem Cells T1 - Comparison of the genetic character of Bone Marrow derived Mesenchymal Stem Cells and Trabecular Bone derived Mesenchymal Stem Cells N2 - Technische Neuerungen und steigende Ansprüche an die Gesundheit stellen die moderne Medizin immer wieder vor neue Herausforderungen und führen zur Entwicklung von neuen Therapiekonzepten wie dem Tissue Engineering. Vielfach kommen dabei adulte pluripotente Stammzellen zum Einsatz. Bei der Regeneration mesenchymalen Gewebes wie Knochen, Knorpel und Muskulatur leisten Mesenchymale Stammzellen (MSCs) einen entscheidenden Beitrag. Diese lassen sich aus allen mesenchymalen Geweben des Körpers gewinnen und stellen daher zwar keine homogene Zellpopulation dar, doch sie lassen sich aufgrund phänotypischer und molekularbiologischer Gemeinsamkeiten charakterisieren. In großer Zahl lassen sich MSCs aus dem Knochenmark gewinnen und werden als stromale MSCs bzw. mhMSCs (marrow-derived human MSCs) bezeichnet. Auf der Suche nach homogenen Subpopulationen von MSCs wurde in dieser Arbeit eine Zellpopulation aus Knochentrabekeln gewonnen, sogenannte bhMSCs (trabecular bone-derived MSCs), und anhand ihrer Genexpression mit mhMSCs verglichen. Dafür wurde RNA aus beiden Populationen in einem Microarray mit anschließender SAM (significance analysis of microarrays) analysiert um unterschiedliche Expressionsmuster zwischen mhMSCs und bhMSCs aufzuzeigen. Diese Ergebnisse wurden durch konventionelle Reverse Transkriptase Polymerase Kettenreaktion (RT-PCR) bestätigt, wobei das Augenmerk vor allem auf solche Gene gerichtet wurde, die differentiell exprimiert waren und zudem als Markergene ein Differenzierungspotential in bestimmte Gewebe wie Muskel und Knochen vorhersagen. Dabei konnte sowohl eine gute Übereinstimmung zwischen Microarray und RT-PCR demonstriert als auch die Hoffnung auf eine homogene (trabekuläre) MSC-Population mit anderen Differenzierungseigenschaften geweckt werden. Im Verlauf weitergehender Untersuchungen der SAM fiel eine unerklärlich hohe Expression von Immunglobulinketten in der mhMSC-Kultur (Passage 0) auf, die letztlich auf eine Kontamination der Zellkultur mit Plasmazellen schließen ließ. Da die Ergebnisse des Microarrays (Passage 0 Kultur) somit zu hinterfragen waren, wurde die Kontamination der Plasmazellen durch Passagieren der mhMSC-Zellkultur (Passage 1) beseitigt und erneut ein Microarray mit SAM durchgeführt. Dabei relativierten sich fast alle Expressionsunterschiede, die somit auf die Kontamination der Plasmazellen zurückgeführt werden mussten. Einzig drei Gene (CD24, TRIB2, AHNAK) wurden in diesem zweiten Array differentiell exprimiert, was sich bei CD24 und TRIB2 auch durch RT-PCR untermauern ließ. Es lässt sich also schlussfolgern, dass bhMSCs wahrscheinlich in der Zukunft des Tissue Engineering keinen Stellenwert haben werden, zumal ihre Gewinnung im Vergleich zu mhMSC deutlich aufwendiger ist. N2 - Technical innovations and increasing demands on health confront modern medicine constantly with new challenges and lead to the development of new therapeutic concepts such as tissue engineering. Often adult pluripotent stem cells are used thereby. In the regeneration of mesenchymal tissues such as bone, cartilage and muscle Mesenchymal stem cells (MSCs) make a significant contribution. These can be harvested from all mesenchymal tissues of the body and do not represent a homogeneous cell population, but they can be characterized due to phenotypic and molecular similarities. In large numbers MSCs can be harvested from the bone marrow and are called stromal MSCs or mhMSCs (marrow-derived human MSCs). Looking for homogeneous subpopulations of MSCs in this thesis was harvested a cell population derived from bone trabeculae, called bhMSCs (trabecular bone-derived MSCs), and was compared with mhMSCs based on their gene expression. RNA was isolated from both populations and analyzed in a microarray followed by SAM (significance analysis of microarrays) to point out different expression patterns between mhMSCs and bhMSCs. These results were confirmed by conventional reverse transcriptase polymerase chain reaction (RT-PCR). The attention was directed primarily to those genes that were differentially expressed and also predicted the differentiation potential to certain tissues such as muscle and bone as so-called marker genes. Both equivalence between microarray and RT-PCR was demonstrated and the hope of a homogeneous (trabecular) MSC population with other differentiating features was awakened. In the course of further investigations of the SAM an inexplicably high expression of immunoglobulin chains in the mhMSC culture (passage 0) was noticed, which indicated a contamination of the cell culture with plasma cells. Since the results of the microarray (passage 0 culture) were thus to question the contamination of the plasma cells was removed by passaging the mhMSC cell culture (passage 1) and a second microarray with SAM was performed. In this case, we could not find these expression differences between both populations anymore. Due to the contamination with plasma cells in the MSC culture all previous results were not valid any more. Only three genes (CD24, Trib2, AHNAK) were differentially expressed in this second array. It can be concluded, therefore, that bhMSCs likely in the future tissue engineering have no value, especially since their harvesting compared to mhMSC is much more complex. KW - Mesenchymale Stammzelle KW - Polymerase-Kettenrektion KW - Microarray KW - Differenzierung KW - Adulte Stammzelle KW - Mesenchymale Stammzelle KW - Polymerase Kettenreaktion KW - Microarray KW - Differenzierung KW - Trabekuläre Mesenchymale Stammzelle KW - mesenchymal stem cell KW - polymerase chain reaction KW - microarray KW - differentiation KW - trabecular bone-derived mesenchymal stem cell Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-108612 ER - TY - THES A1 - Rasthofer, Johanna T1 - Vergleich der plantaren Druckverteilung mit der Röntgenmorphologie des Fußskeletts T1 - Comparison of plantar pressure distribution with the x-ray morphology of the foot skeleton N2 - Hintergrund: Die Metatarsalgie ist ein sehr heterogenes Krankheitsbild mit vielfältigen Ursachen. Als zugrunde liegender Pathomechanismus wird eine übermäßige plantare Druckbelastung im Bereich der Metatarsalköpfchen beziehungsweise eine Überlastung einzelner Metatarsalköpfchen bei verändertem Vorfußalignment angenommen. Operative Techniken zielen durch entsprechende Verkürzungs- oder Umstellungsosteotomien auf einen Druckausgleich ab und liefern diesbezüglich unterschiedliche, zum Teil widersprüchliche Ergebnisse. In dieser Studie soll geklärt werden inwieweit von der Röntgenmorphologie des Fußskeletts auf die Belastungsverhältnisse im Vorfußbereich geschlossen werden kann. Insgesamt ist diese Thematik bisher selten untersucht und unzureichend geklärt. Methodik: Primär erfolgte die Einteilung in eine Patientengruppe, 46 Füße mit Metatarsalgie, und 40 asymptomatische Füße als Vergleichskollektiv. In belasteten dorsoplantaren Röntgenaufnahmen wurden der Metatarsalindex (Plus-Minus-Index und Maestroindex) und der Intermetatarsale-1/2-Winkel gemessen und dementsprechend zum Vergleich Untergruppen gebildet. Die plantare Druckverteilung wurde durch dynamische Messungen im Gehen unter Verwendung des Emed-x/R Systems der Firma Novel bestimmt und hinsichtlich Spitzendruck, Druck-Zeit-Integral, Maximalkraft und Kraft-Zeit-Integral unter den Metatarsalköpfchen mit der Röntgenmorphologie verglichen. Ergebnisse: Es fand sich ein deutlicher Zusammenhang zwischen der zu MT1 relativen Länge von MT2 und der plantaren Druckverteilung im Sinne einer Belastungssteigerung unter MH2 bei verlängertem Metatarsale 2. Die übrigen Metatarsallängen schienen kaum Auswirkung auf die plantaren Druckverhältnisse zu haben. Des Weiteren bewirkte ein großer Intermetatarsalwinkel tendenziell eine Belastungssteigerung unter MH2 und Minderung unter MH1. Insgesamt fanden sich bei gesunden Füßen weniger ausgeprägte Zusammenhänge. Im Vergleich zu gesunden war bei Füßen mit Metatarsalgie die Belastung im zentralen Vorfußbereich deutlich erhöht, der Intermetatarsalwinkel vergrößert und unerwartet das erste Metatarsale länger als das zweite. Diskussion: Die Resultate zeigten übereinstimmend, dass die individuelle Struktur des Fußskeletts beziehungsweise eine Abweichung im Sinne eines auffälligen Metatarsalindex mit Überlängen einzelner Metatarsalia oder ein großer Intermetatarsalwinkel nur teilweise die Entstehung von Metatarsalgien erklärt. Sie stellt lediglich eine Komponente im Zusammenspiel von Weichgewebe, Ballenarchitektur, Kapsel-Band-Strukturen und muskulären Wechselwirkungen dar. Die durch biomechanische Hebelwirkung bei Fehlstellungen des Fußskeletts entstehenden Kräfte gewinnen erst bei vorgeschädigtem Fuß an Einfluss. Ein gesunder Fuß scheint in der Lage Besonderheiten des Fußskeletts auszugleichen. Eine große interindividuelle Variabilität der plantaren Druckverteilung suggeriert eine große Spannbreite an physiologischen Druckwerten mit der Schwierigkeit die Grenze zum Pathologischen zu definieren. N2 - Comparison of plantar pressure distribution with the x-ray morphology of the foot skeleton KW - Metatarsalgie KW - Druckverteilung KW - Fußskelett KW - Mittelfußknochen KW - plantar KW - Intermetatarsalwinkel KW - metatarsalgia KW - plantar pressure distribution KW - metatarsal lenght KW - intermetatarsalangle Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-75637 ER - TY - THES A1 - Massig, Felix T1 - Vergleich verschiedener Operationsverfahren der Patellarückfläche bei Knieprothesenwechsel T1 - Comparison of different treatments of the Patella at the time of Knee Revision Arthroplasty N2 - Die Arthrose des Kniegelenkes stellt heutzutage die häufigste Gelenkerkrankung des Menschen dar. Nachdem die konservativen Therapiemöglichkeiten ausgeschöpft sind, wird dem Patienten meist die Implantation einer Knietotalendoprothese empfohlen. Aufgrund von Schmerzen, einer Infektion, oder einer Lockerung der Prothese kann jedoch ein Wechsel des Gelenkersatzes notwendig werden. Das Femoropatellargelenk stellt bei solchen Revisionsoperationen das häufigste und bedeutendste Problem dar. Diese Studie vergleicht 5 operative Verfahren der Patella-rückflächenbearbeitung bei Revisionsoperationen. Hierzu wurden 118 Patienten anhand von 6 etablierten Scores sowie klinisch und radiologisch nach durchschnittlich ca. 2 Jahren nachuntersucht. Die Gruppe der Patienten, welche vor der Revisionsoperation eine ersetzte Patellarückfläche aufwiesen und bei welchen dieser Ersatz entnommen und somit ein knöcherner Rest hinterlassen wurde, zeigte in fast allen Scores deutliche, wenn auch nicht signifikant schlechtere Ergebnisse. Diese gliedern sich gut in die Arbeiten anderer Autoren zu diesem Thema ein. Weiterhin zeigte sich, dass der Kniescore nach Turba et al. für die Evaluation des Femoropatellargelenkes bei Knieprothesenrevisionen ungeeignet ist. Bei der Patellarückflächenbearbeitung während Revisionsoperationen sollte beim Hinweis auf eine Beschädigung der Patellakomponente diese gewechselt werden, ansonsten kann der bestehende Ersatz belassen werden. Das Entfernen eines bestehenden Ersatzes mit Hinterlassen eines knöchernen Restes sollte vermieden werden. Bei weiteren Studien zu diesem Thema wäre es wünschenswert, zusätzlich zur postoperativen Untersuchung eine präoperative Untersuchung durchzuführen. Die Ergebnisse dieser Arbeit wurden auf dem SICOT-Weltkongress der Orthopäden 2013 vorgestellt. N2 - Comparison of different treatments of the Patella at the time of Knee Revision Arthroplasty KW - Patella KW - Kniegelenkprothese KW - Revision KW - Knee KW - Resurface Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-143434 ER - TY - THES A1 - Brenner, Thomas T1 - Vergleich zweier Rekonstruktionsverfahren nach ACL - Ruptur, Semitendinosussehnentransplantat versus Ligamentum patellae Transplantat : eine prospektive randomisierte Studie T1 - A comparison of two reconstruction techniques after ruptures of the ACL, semitendinosus tendon graft versus patellar tendon graft. N2 - In dieser prospektiven randomisierten Studie wurde arthroskopisch unterstützt bei 62 Patienten über einen Zeitraum von November 1998 bis November 1999 eine Rekonstruktion des vorderen Kreuzbandes durchgeführt. Entweder mit autologem Lig. Patellae -Transplantat und Interferenzschraube oder mit Mehrfachsemitendinosussehnenersatz und femoral mit Endobuttonfixierung. In der Gruppenzusammensetzung konnte kein signifikanter Unterschied bezüglich Alter, Geschlecht und dem Aktivitätsniveau vor dem Verletzungszeitpunkt festgestellt werden. Bei allen wurde das gleiche postoperative Konzept angewendet. Dies beinhaltet eine Don-Joy Schiene (0/0/90°) und Teilbelastung bis 20 kg während der ersten sechs Wochen und außerdem externe Rehabilitation. Alle 62 Patienten wurden präoperativ zum Zeitpunkt der stationären Aufnahme und nach 6 Wochen untersucht, 60 nach 12 Wochen und noch 58 Patienten nach 6 Monaten und nach einem Jahr. Es konnte kein signifikanter Unterschied zwischen den beiden Kollektiven bezüglich der erhobenen Daten analog zum Lysholm-Score, zum IKDC, zur Tegner-Aktivitätsskala, KT-1000 Arthrometermessung und bei der Ermittlung der Schmerzintensitäten mittels Visueller Analogskala festgestellt werden. Bei der Jahresabschlussuntersuchung erreichten noch 32 Patienten (55,17%) nicht ihr Aktivitätsniveau vor der Verletzung. Der Mittelwert im Kollektiv mit Lig. Patella Ersatz (LP) lag bei 6,1 und im Kollektiv mit Semitendinosussehnentransplantat (ST) bei 5,4. Der Durchschnittswert analog zum Lysholm-Score lag in der ST-Gruppe bei 90,9 und in der LP-Gruppe bei 89,8. 20 Patienten (69%) mit Semitendinosussehnenersatz und 21 (72,4%) mit Patellarsehnentransplantat wurden entsprechend dem IKDC besser als „C“ gewertet. Beide Verfahren können nach 12 Monaten als gleichwertig angesehen werden N2 - 62 patients took part in this prospective randomized trial and underwent arthroscopically assisted reconstruction of the ACL from november 1998 till november 1999. Either with autogenous patellar tendon and interference screw or with multistrand semitendinosus tendon and femoral fixation with endobutton. No significant differences between the two groups were noted with respect to age, sex and their preinjury activity level. The same postoperative regimen was used for all patients after surgery including a Don-Joy brace (0/0/90°) , limited load of 20kg for the first six weeks and external rehabilitation. All patients were evaluated preoperatively and after 6 weeks, 60 after 12 weeks and 58 after 6 and 12 months postoperatively. No significant differences were noted between groups with respect to Lysholm-Score, IKDC, Tegner-Activity level, KT-1000 measurements and VAS pain-score. After 12 month 32 patients (55.17%) did not return to their preinjury activity level. The mean level in the patellar tendon(LP) group was 6.1 and in the semitendinousus(ST) tendon group 5.4. The mean Lysholm-Score were 90.9 in the ST group and 89.8 in the LP group. 20 patients (69%) with semitendinosus tendon and 21(72.4%) with patellar tendon reconstruction were rated better than “C” according to the IKDC. We conclude that patellar tendon and multistrand semitendinosus tendon grafts have similar outcomes in the short term. KW - ACL-Rekonstruktion KW - Patellarsehnentransplantat KW - Semitendinosussehnentransplantat KW - prospektiv KW - randomisiert KW - ACL-Reconstruction KW - patellar tendon KW - multistrand semitendinosus tendon KW - prospective KW - randomized Y1 - 2004 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-10848 ER - TY - THES A1 - Schneider, Jochen T1 - Vergleichende Analyse der patientenzentrierten Ergebnisse nach totalendoprothetischem Ersatz von Hüft- oder Kniegelenk unter Verwendung der Kurzversion des Funktionsfragebogens Bewegungsapparat XSMFA-D T1 - COMPARATIVE ANALYSIS OF PATIENT-CENTERED OUTCOME OF TOTAL HIP OR KNEE ARTHROPLASTY WITH THE HELP OF THE EXTRA SHORT MUSCULOSKELETAL FUNCTION ASSESSMENT QUESTIONAIRE XSMFA-D N2 - In dieser Studie wurden 56 Patienten mit Coxarthrose und 59 Patienten mit Gonarthrose, die sich jeweils einem totalendoprothetischen Gelenkersatz unterzogen, vor der Operation und nach einem Zeitraum von drei Monaten unter Verwendung des XSMFA-D-Fragebogens evaluiert. Bei der Auswertung der Fragebögen zeigte sich eine statistisch signifikante Verbesserung des Funktions- und des Beeinträchtigungsindex, welche jeweils bei den Coxarthrosepatienten deutlicher ausgeprägter war als bei den Gonarthrosepatienten. Bei den Patienten mit Coxarthrose und endoprothetischem Gelenkersatz verbesserte sich der Funktionsindex des XSMFA ebenso wie der Beeinträchtigungsindex. Die Funktionskapazität des FFbH-OH und auch der HHS-Gesamtscore verbesserten sich merklich. Auch die Daten des HHS zeigten im Arztteil eine Verbesserung, ebenso wie sämtliche WOMAC-Indizes sowie der WOMAC-Gesamtscore. Während sich die Gehgeschwindigkeit ebenfalls positiv entwickelte, verbesserten sich die Indizes des Arztbogens zu Gelenkschmerzen und Funktionseinschränkung merklich. Bei Patienten mit Gonarthrose waren ähnliche Änderungen nach der Operation zu verzeichnen. Auch für diese Gruppe zeigte sich in nahezu allen Parametern eine statistisch bedeutsame Verbesserung, die jedoch nicht so stark ausgeprägt war wie bei den Patienten mit Coxarthrose: Der Funktionsindex verbesserte sich ebenso wie der Beeinträchtigungsindex. Die Funktionskapazität des FFbH-OH zeigte eine deutliche Verbesserung. Deutlich rückläufige Werte im Sinne einer Verbesserung fanden sich im WOMAC-Schmerzscore. Die WOMAC-Indizes zur Steife und Funktion bildeten ebenfalls deutliche Besserungen ab. Auch der WOMAC-Gesamtscore verbesserte sich. Die Gehgeschwindigkeit reduzierte sich erwartungsgemäß. Bei der Kovarianzanalyse war der Scoreausgangswert der Parameter mit dem größten Einfluss auf das postoperative Ergebnis nach drei Monaten. Die p-Werte in Bezug zur Baseline (Scoreausgangswert) lagen bei allen Skalen der Fragebögen XSMFA-D, WOMAC und FFbH-OH durchweg in einem signifikanten Bereich. Andere Kofaktoren wie Alter, Geschlecht und Gelenk übten einen geringer ausgeprägten Einfluss aus. Für den Funktionsindex des XSMFA-D zeigte sich 3 Monate postoperativ ein tendenzieller Einfluss des Gelenkes, während für den Beeinträchtigungsindex ein signifikanter Einfluss nachgewiesen werden konnte. Auch bei der Funktionskapazität des FFbH-OH sowie beim Parameter WOMAC-Gesamtscore zeigte sich ein signifikanter Einfluss des Gelenkes. Drei Monate nach totalendoprothetischem Gelenkersatz können Patienten mit Coxarthrose eine höhere funktionelle Verbesserung erreichen als Patienten mit Gonarthrose. Analog zu anderen Studien und zur klinischen Erfahrung mit totalendoprothetisch versorgten Cox- und Gonarthrosepatienten konnte dies durch die statistische Auswertung der XSMFA-D Fragebögen bestätigt werden. Der XSMFA-D ist ein geeignetes Instrument zur Messung des patientenzentrierten Outcome. Er kann im klinischen Alltag oder als Instrument zur Qualitätssicherung uneingeschränkt empfohlen werden. N2 - This study included 56 patients with degenerativ osteoarthritis of the hip and 59 patients with degenerativ osteoarthritis of the knee, with both groups having undergone a primary total joint replacement. With the help of the XSMFA-D and other questionnaires, the postoperative course of these patients after three month was compared. The statistical analysis showed a significant improvement of both scores of the XSMFA-D. There was a greater improvement for the patients with total hip arthroplasty then for the patients with total knee arthroplasty. The greater improvement for the patients with total hip arthroplasty was also shown through the statistical analysis of the other questionnaires like WOMAC, FFbH-OH. Three month after primary total joint replacement there is a greater improvement for the patients with total hip arthroplasty then for the patients with total knee arthroplasty. Analog to other studies and the clinical experience with total hip or knee arthroplasty this could be confirmed by statistical analysis of the XSMFA-D-questionnaire. The XSMFA-D is a suitable instrument for messuring the patient-centered outcome. It can be used at the clinical routine or as an instrument of quality management. KW - XSMFA-D KW - WOMAC KW - FFbH-OH KW - Effektstärken KW - totalendoprothetischer Ersatz von Hüfte oder Knie KW - XSMFA-D KW - WOMAC KW - FFbH-OH KW - effect sizes KW - total hip or knee arthroplasty Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-17789 ER - TY - THES A1 - Arnholdt, Jörg T1 - Vergleichende Genexpressions-Analyse unterschiedlicher Populationen mesenchymaler Stammzellen T1 - Comparing microarray analysis between different populations of mesenchymal stem cells N2 - Neben den omnipotenten embryonalen Stammzellen existieren im menschlichen Körper adulte mesenchymale Stammzellen (MSZ). Diese Zellen sind in mesenchymalen Geweben über den gesamten Organismus verteilt und sorgen für die Entwicklung und Erneuerung von mesenchymalen Geweben wie Knochen, Knorpel und Bändern. Daher gelten die MSZ im Gegensatz zu den omnipotenten embryonalen Stammzellen als multipotent. Diese verschiedenen MSZ stellen keine homogene Population dar, zeigen aber sowohl in vivo und auch in vitro ein ähnliches Differenzierungsverhalten. In der vorliegenden Arbeit wurde nun eine aus den Knochentrabekeln selbst isolierte MSZ-Population, so genannte bhMSZ, mit MSZ aus dem Knochenmark, mhMSZ genannt, mittels Array-Analyse miteinander verglichen. Die technische Evaluation des Array respektive der zugehörigen SAM-Analyse (significance analysis of microarrays) mittels konventioneller oder Real-Time PCR diente dazu, die Verlässlichkeit der Aussage der Hybridisierungsverfahren zu überprüfen. Dies wurde mit einem Set an ausgewählten Genen durchgeführt, die signifikant differentiell exprimiert waren, und die im Rahmen der Stammzellbiologie relevant erschienen. Die Analyse zeigte, dass die Übereinstimmung der Aussage im Array in über 80 % mit den Ergebnissen der RT-PCR kongruent war. Auf Grund starker interindividueller Schwankungen zeigte sich aber auch, dass die Anzahl der Spender 5 nicht unterschreiten sollte. Im Rahmen der Untersuchungen ergab sich, dass offenbar bei MSZ der Passage 0 eine Kontamination der MSZ mit Plasmazellen vorliegt. Weitere Versuche zeigten, dass erst das Passagieren der MSZ kontaminierende Plasmazellen weitgehend aus der Zellkultur entfernte. Aus diesem Grund wurde in einer weiteren Array Analyse das Transkriptom von MSZ aus Knochentrabekeln mit MSZ aus dem Knochenmark in Passage 1 verglichen. Es zeigten sich in einer stringenten SAM-Analyse keine Unterschiede im Transkriptom. Für klinische Anwendungen scheinen die bhMSZ daher auf Grund der aufwendigeren Isolierung und des dennoch eher geringen Zellgewinns nicht im gleichen Maß für klinische Anwendungen geeignet wie mhMSZ. N2 - The human body contains besides omnipotent embryonal stem cells also adult mesenchymal stem cells (MSC). These cells are spread all over the organism in mesenchymal tissues and are responsible for the development and regeneration of mesenchymal tissues like bone, cartilage and ligaments. Therefore these cells are called multipotent in comparison to the omnipotent embryonal stem cells. The different types of MSC are not a homogeneous population, but show in vivo and in vitro a similar differentiation behavior. The aim of this work was to compare the population of MSC isolated from bone marrow stroma (bhMSC) with MSC isolated from bone fragments (bhMSC) via microarray analysis. The technical evaluation of this array was performed by conventional or real-time PCR to evaluate the reliability of the hybridization procedure. This was done with an assortment of genes, which were differentially expressed, and were estimated to be relevant for the biology of stem cells. The analysis showed 80% accordance between the results of the microarray analysis and the PCR. In addition, the results showed that the number of the analysed individuals shouldn’t be under 5, because of a high interindividual variability. Besides this the experiments showed, that MSC of passage 0 are obviously contaminated with plasma cells. Further tests showed that contaminating plasma cells were widely removed in cell cultures of MSC passage 1. Therefore an additional array analysis was performed comparing MSC isolated from bone marrow stroma in passage 1 with those isolated from bone fragments. No difference could be observed in terms of their transcriptomes obtained by stringent SAM analysis. For clinical purposes bhMSC seem to be less suited because of the more sophisticated isolation procedure and nevertheless the lower cell number yield. KW - Adulte Stammzelle KW - Array KW - Reverse Transkriptase-Polymerase-Kettenreaktion KW - mesenchymal stem cell KW - Array KW - RT-PCR Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-53512 ER -