TY - JOUR A1 - Chopra, Martin A1 - Biehl, Marlene A1 - Steinfatt, Tim A1 - Brandl, Andreas A1 - Kums, Juliane A1 - Amich, Jorge A1 - Vaeth, Martin A1 - Kuen, Janina A1 - Holtappels, Rafaela A1 - Podlech, Jürgen A1 - Mottok, Anja A1 - Kraus, Sabrina A1 - Jordán-Garotte, Ana-Laura A1 - Bäuerlein, Carina A. A1 - Brede, Christian A1 - Ribechini, Eliana A1 - Fick, Andrea A1 - Seher, Axel A1 - Polz, Johannes A1 - Ottmueller, Katja J. A1 - Baker, Jeannette A1 - Nishikii, Hidekazu A1 - Ritz, Miriam A1 - Mattenheimer, Katharina A1 - Schwinn, Stefanie A1 - Winter, Thorsten A1 - Schäfer, Viktoria A1 - Krappmann, Sven A1 - Einsele, Hermann A1 - Müller, Thomas D. A1 - Reddehase, Matthias J. A1 - Lutz, Manfred B. A1 - Männel, Daniela N. A1 - Berberich-Siebelt, Friederike A1 - Wajant, Harald A1 - Beilhack, Andreas T1 - Exogenous TNFR2 activation protects from acute GvHD via host T reg cell expansion JF - Journal of Experimental Medicine N2 - Donor CD4\(^+\)Foxp3\(^+\) regulatory T cells (T reg cells) suppress graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HCT allo-HCT]). Current clinical study protocols rely on the ex vivo expansion of donor T reg cells and their infusion in high numbers. In this study, we present a novel strategy for inhibiting GvHD that is based on the in vivo expansion of recipient T reg cells before allo-HCT, exploiting the crucial role of tumor necrosis factor receptor 2 (TNFR2) in T reg cell biology. Expanding radiation-resistant host T reg cells in recipient mice using a mouse TNFR2-selective agonist before allo-HCT significantly prolonged survival and reduced GvHD severity in a TNFR2-and T reg cell-dependent manner. The beneficial effects of transplanted T cells against leukemia cells and infectious pathogens remained unaffected. A corresponding human TNFR2-specific agonist expanded human T reg cells in vitro. These observations indicate the potential of our strategy to protect allo-HCT patients from acute GvHD by expanding T reg cells via selective TNFR2 activation in vivo. KW - Tumor-necrosis-factor KW - Regulatory-cells KW - Bone marrow transplantantation KW - Graft-versus-leukemia KW - Rheumatoid arthritis KW - Autoimmune diseases KW - Factor receptor KW - Alpha therapy KW - Expression KW - Suppression Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-187640 VL - 213 IS - 9 ER - TY - JOUR A1 - Ladwig, Karl-Heinz A1 - Lederbogen, Florian A1 - Albus, Christian A1 - Angermann, Christiane A1 - Borggrefe, Martin A1 - Fischer, Denise A1 - Fritzsche, Kurt A1 - Haass, Markus A1 - Jordan, Jochen A1 - Jünger, Jana A1 - Kindermann, Ingrid A1 - Köllner, Volker A1 - Kuhn, Bernhard A1 - Scherer, Martin A1 - Seyfarth, Melchior A1 - Völler, Heinz A1 - Waller, Christiane A1 - Herrmann-Lingen, Christoph T1 - Position paper on the importance of psychosocial factors in cardiology: Update 2013 T1 - Positionspapier zur Bedeutung psychosozialer Faktoren in der Kardiologie: Update 2013 JF - GMS German Medical Science N2 - Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered. Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine. N2 - Hintergrund: Die rasche Weiterentwicklung der psychokardiologischen Forschung, aber auch die wachsende Verankerung psychosozialer Fragestellungen im klinischen Alltag haben die Klinische Kommission der DGK bewogen, einer Aktualisierung und Weiterentwicklung des 2008 erstmals publizierten Positionspapiers zur Bedeutung psychosozialer Faktoren in der Kardiologie zuzustimmen. Methoden: Der Kreis der Autoren wurde vergrößert, allgemeine Aspekte eingefügt und das Wissen in allen Abschnitten auf den heutigen Stand gebracht. Schwerpunkte der Empfehlungen sind die koronare Herzerkrankung, Herzrhythmusstörungen und die Herzinsuffizienz, da hier der Stand der empirischen Evidenz und des klinisches Wissens zu psychosozialen Fragestellungen am weitesten entwickelt ist. Berücksichtigt wurden bei den Empfehlungen Besonderheiten von Frauen und Männern, Unterschiede bzgl. der Lebensspanne, Einflüsse auf die kognitive Leistungsfähigkeit und die interaktive synergistische Bedeutung klassischer Risikofaktoren bei affektiver Komorbidität. Ergebnisse: Eine I-A-Empfehlung (Empfehlungsgrad I, Evidenzgrad A) wurde vergeben für die Aufforderung, psychosoziale Risikofaktoren bei der Einschätzung des KHK-Risikos zu berücksichtigen, die als unabhängige ätiologische und prognostische Risikofaktoren für das Auftreten der koronaren Herzerkrankung (KHK) und für Komplikationen im Behandlungsverlauf der KHK bedeutsam sind. Ferner für die Empfehlung, Patienten mit Herzoperationen von einem interdisziplinären Team zu betreuten, in dem die Möglichkeit besteht, auf psychosoziale Aspekte einzugehen, da bei diesen Patienten komorbide psychische Störungen wie Depressivität, Angst und posttraumatische Belastungsstörung häufig und prognostisch ungünstig sind. Eine I-B-Empfehlung wurde vergeben für die Behandlung psychosozialer Risikofaktoren mit dem Ziel einer Primärprävention der KHK, wenn das Risikomerkmal an sich Krankheitswert hat (z. B. Depression) oder die Behandlung klassischer Risikofaktoren erschwert ist. Eine antidepressive Pharmakotherapie soll Patienten nach akutem Koronarsyndrom sowie in der Phase der chronischen KHK angeboten werden, die an einer mindestens mittelschweren rezidivierenden depressiven Störung leiden. Dabei sollen vorzugsweise Substanzen aus der Gruppe der selektiven Serotoninwiederaufnahmehemmer (SSRI) zum Einsatz kommen. Bei der langfristigen ärztlichen Begleitung von ICD-Patienten sollen die psychosozialen Folgen der ICD-Technologie beachtet und insbesondere relevante Affektstörungen sowie Krisen bei ICD-Patienten erkannt und fachgerecht behandelt werden. Schlussfolgerungen: Das Positionspapier formuliert konkrete Anwendungsfelder mit hoher Priorität für die Einbeziehung psychosozialer Faktoren in die kardiologische Praxis, die eine leitlinienkonforme Evidenz aufweisen. Trotz deutlicher Fortschritte seit der Erstveröffentlichung des Positionspapiers existieren weiterhin Forschungsdefizite für die Bewertung der Wirksamkeit psychotherapeutischer und psychopharmakologischer Konzepte bei kardialen Patienten. Curricula für die Vermittlung von (psycho-)diagnostischer, kommunikativer und differenzialdiagnostischer Kompetenz müssen rasch entwickelt werden, um eine Transmission des aktuellen Wissensstands in die Alltagspraxis zu ermöglichen. KW - depression KW - anxiety KW - post-traumatic stress disorder KW - psychotherapy KW - psychopharmacology KW - Depression KW - Psychopharmakologie KW - Psychotherapie KW - posttraumatische Belastungsstörung KW - Angst Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121196 VL - 12 ER - TY - JOUR A1 - Manchia, Mirko A1 - Adli, Mazda A1 - Akula, Nirmala A1 - Arda, Raffaella A1 - Aubry, Jean-Michel A1 - Backlund, Lena A1 - Banzato, Claudio E. M. A1 - Baune, Bernhard T. A1 - Bellivier, Frank A1 - Bengesser, Susanne A1 - Biernacka, Joanna M. A1 - Brichant-Petitjean, Clara A1 - Bui, Elise A1 - Calkin, Cynthia V. A1 - Cheng, Andrew Tai Ann A1 - Chillotti, Caterina A1 - Cichon, Sven A1 - Clark, Scott A1 - Czerski, Piotr M. A1 - Dantas, Clarissa A1 - Del Zompo, Maria A1 - DePaulo, J. Raymond A1 - Detera-Wadleigh, Sevilla D. A1 - Etain, Bruno A1 - Falkai, Peter A1 - Frisén, Louise A1 - Frye, Mark A. A1 - Fullerton, Jan A1 - Gard, Sébastien A1 - Garnham, Julie A1 - Goes, Fernando S. A1 - Grof, Paul A1 - Gruber, Oliver A1 - Hashimoto, Ryota A1 - Hauser, Joanna A1 - Heilbronner, Urs A1 - Hoban, Rebecca A1 - Hou, Liping A1 - Jamain, Stéphane A1 - Kahn, Jean-Pierre A1 - Kassem, Layla A1 - Kato, Tadafumi A1 - Kelsoe, John R. A1 - Kittel-Schneider, Sarah A1 - Kliwicki, Sebastian A1 - Kuo, Po-Hsiu A1 - Kusumi, Ichiro A1 - Laje, Gonzalo A1 - Lavebratt, Catharina A1 - Leboyer, Marion A1 - Leckband, Susan G. A1 - López Jaramillo, Carlos A. A1 - Maj, Mario A1 - Malafosse, Alain A1 - Martinsson, Lina A1 - Masui, Takuya A1 - Mitchell, Philip B. A1 - Mondimore, Frank A1 - Monteleone, Palmiero A1 - Nallet, Audrey A1 - Neuner, Maria A1 - Novák, Tomás A1 - O'Donovan, Claire A1 - Ösby, Urban A1 - Ozaki, Norio A1 - Perlis, Roy H. A1 - Pfennig, Andrea A1 - Potash, James B. A1 - Reich-Erkelenz, Daniela A1 - Reif, Andreas A1 - Reininghaus, Eva A1 - Richardson, Sara A1 - Rouleau, Guy A. A1 - Rybakowski, Janusz K. A1 - Schalling, Martin A1 - Schofield, Peter R. A1 - Schubert, Oliver K. A1 - Schweizer, Barbara A1 - Seemüller, Florian A1 - Grigoroiu-Serbanescu, Maria A1 - Severino, Giovanni A1 - Seymour, Lisa R. A1 - Slaney, Claire A1 - Smoller, Jordan W. A1 - Squassina, Alessio A1 - Stamm, Thomas A1 - Steele, Jo A1 - Stopkova, Pavla A1 - Tighe, Sarah K. A1 - Tortorella, Alfonso A1 - Turecki, Gustavo A1 - Wray, Naomi R. A1 - Wright, Adam A1 - Zandi, Peter P. A1 - Zilles, David A1 - Bauer, Michael A1 - Rietschel, Marcella A1 - McMahon, Francis J. A1 - Schulze, Thomas G. A1 - Alda, Martin T1 - Assessment of Response to Lithium Maintenance Treatment in Bipolar Disorder: A Consortium on Lithium Genetics (ConLiGen) Report JF - PLoS ONE N2 - Objective: The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the "Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" scale currently used in the Consortium on Lithium Genetics (ConLiGen) study. Materials and Methods: Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (\(\kappa\))] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling. Results: Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (\(\kappa\) = 0.66 and \(\kappa\) = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (\(ICC_1 = 0.71\) and \(ICC_2 = 0.75\), respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders). Conclusions: We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study. KW - age KW - observer agreement KW - prophylactic lithium KW - mapping susceptibility genes KW - mood disorders KW - onset KW - association KW - reliability KW - morality KW - illness Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-130938 VL - 8 IS - 6 ER - TY - JOUR A1 - Boelch, Sebastian P. A1 - Rueckl, Kilian A1 - Fuchs, Clara A1 - Jordan, Martin A1 - Knauer, Markus A1 - Steinert, Andre A1 - Rudert, Maximilian A1 - Luedemann, Martin T1 - Comparison of elution characteristics and compressive strength of biantibiotic-loaded PMMA bone cement for spacers: Copal\(^®\) spacem with gentamicin and vancomycin versus Palacos\(^®\) R+G with vancomycin JF - BioMed Research International N2 - Purpose. Copal\(^®\) spacem is a new PMMA bone cement for fabricating spacers. This study compares elution of gentamicin, elution of vancomycin, and compressive strength of Copal\(^®\) spacem and of Palacos\(^®\) R+G at different vancomycin loadings in the powder of the cements. We hypothesized that antibiotic elution of Copal\(^®\) spacem is superior at comparable compressive strength. Methods. Compression test specimens were fabricated using Copal\(^®\) spacem manually loaded with 0.5 g gentamicin and additionally 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (COP specimens) and using 0.5 g gentamicin premixed Palacos\(^®\) R+G manually loaded with 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (PAL specimens). These specimens were used for determination of gentamicin and vancomycin elution (in fetal calf serum, at 22°C) and for determination of compressive strength both prior and following the elution tests. Results. Cumulative gentamicin concentrations (p < 0.005) and gentamicin concentration after 28 days (p ≤ 0.043) were significantly lower for COP specimens compared to PAL specimens. Cumulative vancomycin concentrations were significantly higher (p ≤ 0.043) for COP specimens after the second day. Vancomycin concentrations after 28 days were not significantly higher for the Copal specimens loaded with 2 g and 4 g of vancomycin. Compressive strength was not significantly different between COP specimens and PAL specimens before elution tests. Compressive strength after the elution tests was significantly lower (p = 0.005) for COP specimens loaded with 2 g of vancomycin. Conclusion. We could not demonstrate consistent superior antibiotic elution from Copal\(^®\) spacem compared to Palacos\(^®\) R+G for fabricating gentamicin and vancomycin loaded spacers. The results do not favor Copal\(^®\) spacem over Palacos\(^®\) R+G for the use as a gentamicin and vancomycin biantibiotic-loaded spacer. KW - Copal\(^®\) spacem KW - PMMA bone cement KW - elution KW - compressive strength Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177435 VL - 2018 IS - 4323518 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Hoelscher-Doht, Stefanie A1 - Fehske, Kai A1 - Gilbert, Fabian A1 - Jansen, Hendrik A1 - Meffert, Rainer H. T1 - Bunnell or cross-lock Bunnell suture for tendon repair? Defining the biomechanical role of suture pretension JF - Journal of Orthopaedic Surgery and Research N2 - Background Suture pretension during tendon repair is supposed to increase the resistance to gap formation. However, its effects on the Bunnell suture technique are unknown. The purpose of this study was to determine the biomechanical effects of suture pretension on the Bunnell and cross-lock Bunnell techniques for tendon repair. Methods Eighty porcine hindlimb tendons were randomly assigned to four different tendon repair groups: those repaired with or without suture pretension using either a simple Bunnell or cross-lock Bunnell technique. Pretension was applied as a 10 % shortening of the sutured tendon. After measuring the cross-sectional diameter at the repair site, static and cyclic biomechanical tests were conducted to evaluate the initial and 5-mm gap formation forces, elongation during cyclic loading, maximum tensile strength, and mode of failure. The suture failure mechanism was also separately assessed fluoroscopically in two tendons that were repaired with steel wire. Results Suture pretension was accompanied by a 10 to 15 % increase in the tendon diameter at the repair site. Therefore, suture pretension with the Bunnell and cross-lock Bunnell repair techniques noticeably increased the resistance to initial gap formation and 5-mm gap formation. The tension-free cross-lock Bunnell repair demonstrated more resistance to initial and 5-mm gap formation, less elongation, and higher maximum tensile strength than the tension-free Bunnell repair technique. The only difference between the tensioned cross-lock Bunnell and tensioned Bunnell techniques was a larger resistance to 5-mm gap formation with the cross-lock Bunnell technique. Use of the simple instead of cross-lock suture configuration led to failure by suture cut out, as demonstrated fluoroscopically. Conclusion Based on these results, suture pretension decreases gapping and elongation after tendon repair, and those effects are stronger when using a cross-lock, rather than a regular Bunnell suture. However, pretension causes an unfavorable increase in the tendon diameter at the repair site, which may adversely affect wound healing. KW - suture KW - cross-lock KW - Bunnell KW - achilles KW - pretension KW - tendon Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126262 VL - 10 IS - 192 ER - TY - JOUR A1 - Bäuerlein, Carina A. A1 - Riedel, Simone S. A1 - Baker, Jeanette A1 - Brede, Christian A1 - Jordán Garrote, Ana-Laura A1 - Chopra, Martin A1 - Ritz, Miriam A1 - Beilhack, Georg F. A1 - Schulz, Stephan A1 - Zeiser, Robert A1 - Schlegel, Paul G. A1 - Einsele, Hermann A1 - Negrin, Robert S. A1 - Beilhack, Andreas T1 - A diagnostic window for the treatment of acute graft-versus-host disease prior to visible clinical symptoms in a murine model JF - BMC Medicine N2 - Background Acute graft-versus-host disease (aGVHD) poses a major limitation for broader therapeutic application of allogeneic hematopoietic cell transplantation (allo-HCT). Early diagnosis of aGVHD remains difficult and is based on clinical symptoms and histopathological evaluation of tissue biopsies. Thus, current aGVHD diagnosis is limited to patients with established disease manifestation. Therefore, for improved disease prevention it is important to develop predictive assays to identify patients at risk of developing aGVHD. Here we address whether insights into the timing of the aGVHD initiation and effector phases could allow for the detection of migrating alloreactive T cells before clinical aGVHD onset to permit for efficient therapeutic intervention. Methods Murine major histocompatibility complex (MHC) mismatched and minor histocompatibility antigen (miHAg) mismatched allo-HCT models were employed to assess the spatiotemporal distribution of donor T cells with flow cytometry and in vivo bioluminescence imaging (BLI). Daily flow cytometry analysis of peripheral blood mononuclear cells allowed us to identify migrating alloreactive T cells based on homing receptor expression profiles. Results We identified a time period of 2 weeks of massive alloreactive donor T cell migration in the blood after miHAg mismatch allo-HCT before clinical aGVHD symptoms appeared. Alloreactive T cells upregulated α4β7 integrin and P-selectin ligand during this migration phase. Consequently, targeted preemptive treatment with rapamycin, starting at the earliest detection time of alloreactive donor T cells in the peripheral blood, prevented lethal aGVHD. Conclusions Based on this data we propose a critical time frame prior to the onset of aGVHD symptoms to identify alloreactive T cells in the peripheral blood for timely and effective therapeutic intervention. KW - Allogeneic stem cell transplantation KW - Graft-versus-host disease KW - Minor histocompatibility antigen mismatch transplantation Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96797 UR - http://www.biomedcentral.com/1741-7015/11/134 ER - TY - JOUR A1 - Chopra, Martin A1 - Lang, Isabell A1 - Salzmann, Steffen A1 - Pachel, Christina A1 - Kraus, Sabrina A1 - Bäuerlein, Carina A. A1 - Brede, Christian A1 - Jordán Garrote, Ana-Laura A1 - Mattenheimer, Katharina A1 - Ritz, Miriam A1 - Schwinn, Stefanie A1 - Graf, Carolin A1 - Schäfer, Viktoria A1 - Frantz, Stefan A1 - Einsele, Hermann A1 - Wajant, Harald A1 - Beilhack, Andreas T1 - Tumor Necrosis Factor Induces Tumor Promoting and Anti-Tumoral Effects on Pancreatic Cancer via TNFR1 JF - PLoS ONE N2 - Multiple activities are ascribed to the cytokine tumor necrosis factor (TNF) in health and disease. In particular, TNF was shown to affect carcinogenesis in multiple ways. This cytokine acts via the activation of two cell surface receptors, TNFR1, which is associated with inflammation, and TNFR2, which was shown to cause anti-inflammatory signaling. We assessed the effects of TNF and its two receptors on the progression of pancreatic cancer by in vivo bioluminescence imaging in a syngeneic orthotopic tumor mouse model with Panc02 cells. Mice deficient for TNFR1 were unable to spontaneously reject Panc02 tumors and furthermore displayed enhanced tumor progression. In contrast, a fraction of wild type (37.5%), TNF deficient (12.5%), and TNFR2 deficient mice (22.2%) were able to fully reject the tumor within two weeks. Pancreatic tumors in TNFR1 deficient mice displayed increased vascular density, enhanced infiltration of CD4+ T cells and CD4+ forkhead box P3 (FoxP3)+ regulatory T cells (Treg) but reduced numbers of CD8+ T cells. These alterations were further accompanied by transcriptional upregulation of IL4. Thus, TNF and TNFR1 are required in pancreatic ductal carcinoma to ensure optimal CD8+ T cell-mediated immunosurveillance and tumor rejection. Exogenous systemic administration of human TNF, however, which only interacts with murine TNFR1, accelerated tumor progression. This suggests that TNFR1 has basically the capability in the Panc02 model to trigger pro-and anti-tumoral effects but the spatiotemporal availability of TNF seems to determine finally the overall outcome. KW - Bioluminescence KW - cancer treatment KW - cell staining KW - cytokines KW - immune cells KW - metastasis KW - regulatory T cells KW - T cells Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-97246 ER - TY - JOUR A1 - Schmidt, Karsten A1 - Jordan, Martin C. A1 - Hölscher-Doht, Stefanie A1 - Jakubietz, Michael G. A1 - Jakubietz, Rafael G. A1 - Meffert, Rainer H. T1 - Suture material for flexor tendon repair: 3–0 V-Loc versus 3–0 Stratafix in a biomechanical comparison ex vivo N2 - Background Barbed suture material offers the possibility of knotless flexor tendon repair, as suggested in an increasing number of biomechanical studies. There are currently two different absorbable barbed suture products available, V-Loc™ and Stratafix™, and both have not been compared to each other with regard to flexor tendon repair. The purpose of this study was to evaluate both suture materials for primary stability under static and cyclic loading in a biomechanical ex vivo model. Methods Forty fresh porcine flexor digitorum profundus tendons were randomized in two groups. A four-strand modified Kessler suture technique was used to repair the tendon either with a 3–0 V-Loc™ or 3–0 Stratafix™ without a knot. Parameters of interest were mode of failure, 2-mm gap formation force, displacement, stiffness and maximum load under static and cyclic testing. Results The maximum load was 42.3 ± 7.2 for the Stratafix™ group and 50.7 ± 8.8 N for the V-Loc™ group. Thus, the ultimate tensile strength was significantly higher for V-Loc™ (p < 0.05). The 2-mm gap occurred at 24.8 ± 2.04 N in the Stratafix™ group in comparison to 26.5 ± 2.12 N in the V-Loc™ group (n.s.). Displacement was 2.65 ± 0.56 mm in the V-Loc™ group and 2.71 ± 0.59 mm in the Stratafix™ group (n.s.). Stiffness was 4.24 ± 0.68 (N/mm) in the V-Loc™ group and 3.85 ± 0.55 (N/mm) the Stratafix™ group (n.s.). Those measured differences were not significant. Conclusion V-Loc™ demonstrates a higher maximum load in tendon reconstruction. The differences in 2-mm gap formation force, displacement and stiffness were not significant. Hereby, the V-Loc™ has an advantage when used as unidirectional barbed suture for knotless flexor tendon repair. KW - Barbed suture KW - Barbed suture material KW - Flexor tendon repair KW - Knotless tendon repair KW - Stratafix KW - V-Loc Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-110419 ER - TY - THES A1 - Jordan, Martin Cornelius T1 - Biotechnologisch modifizierte Silikonimplantate in der Chirurgie - in vivo Untersuchungen zur Biokompatibilität einer Polydimethylsiloxan-Tetraethoxysilan-Halofuginon-Hybridoberfläche T1 - Modified medical silicone implants in surgery - in vivo compatibility of Polydimethylsiloxan-Tetraethoxysilan-Halofuginone-Surfaces N2 - Silikonprodukte werden erfolgreich im klinischen Alltag eingesetzt und haben sich in vielen Bereichen der Medizin als nützlich erwiesen. Trotz guter Biokompatibilität ist die Verwendung von medizinischen Materialien aus Silikon, besonders bei der dauerhaften Integration in den Körper, mit Komplikationen verbunden. Die Brustrekonstruktion mit Silikonimplantaten ist ein Beispiel für den langfristigen Gewebeersatz mit einem Fremdmaterial. Der Organismus erkennt dabei das synthetische Polymer und reagiert mit einer fibrösen Abkapselung. Dabei handelt es sich um eine physiologische Entzündungsreaktion mit Abgrenzung des Implantats durch Bestandteile der extrazellulären Matrix. Durch bisher nicht vollständig geklärte pathophysiologische Abläufe kann es jedoch zu einer verstärkten Ausprägung dieser Kapselfibrose kommen, was mit Schmerzen und einer Deformierung sowie Zerstörung des Implantats einhergehen kann. Als Konsequenz einer voll ausgeprägten Kapselfibrose, der sogenannten Kapselkontraktur, bleibt dann meist nur eine operative Revision. Das Ziel dieser Arbeit war die Modifizierung herkömmlicher Silikonimplantate, um die Biokompatibilität zu verbessern und die übermäßige Ausbildung einer periprothetischen Kapsel als häufigste revisionsbedürftige Komplikation zu vermeiden. Dafür wurde der antifibrotische Wirkstoff Halofuginon in einem nasschemischen Beschichtungsprozess auf eine Silikonoberfläche gebunden und die Implantate in einem Tiermodell der Ratte untersucht. Es zeigte sich, dass Halofuginon den TGF-beta1-Signalweg durch Beeinflussung der intrazellulären Smad-Signalkaskade hemmt, wodurch es unter anderem zu einer spezifischen Hemmung der Kollagen-Typ-I-Expression kommt. Histologische, immunhistologische und molekularbiologische Untersuchungen nach einer Implantationsdauer von drei Monaten zeigten, dass eine Halofuginonbeschichtung die Kollagendichte, die Kapseldicke und die Anzahl an Fibroblasten und Entzündungszellen im Kapselgewebe vermindert. Zusätzlich konnten weniger TGF-beta- und CD68-positive Zellen im Vergleich zur Kontrollgruppe nachgewiesen werden. Die Ergebnisse der Real-Time-PCR zeigten übereinstimmend eine erniedrigte Expression für TGF-beta1, Kollagen-Typ-I, CTGF und CD68 und bestätigten die immunhistologische Auswertung. Darüber hinaus konnte eine verminderte Expression des MMP-2-Gens nachgewiesen werden, welches für die Steuerung der EZM-Ablagerung mitverantwortlich ist. Es kann belegt werden, dass eine Halofuginon freisetzende Silikonhybridoberfläche effektiv und spezifisch die pathologische periprothetische Kapselbildung hemmt. Es sind jedoch weitere in-vivo-Studien zur Überprüfung der Nachhaltigkeit und der Pharmakodynamik erforderlich, um die gewonnenen Erkenntnisse als Schritt in der Verbesserung der Biokompatibilität von Silikonimplantaten nutzen zu können. N2 - Modified medical silicone implants in surgery - in vivo compatibility of Polydimethylsiloxan-Tetraethoxysilan-Halofuginone-Surfaces KW - Silikon KW - Polydimethylsiloxan KW - Tetraethoxysilan KW - Halofuginon KW - Hybridoberfläche KW - Polydimethylsiloxan KW - Tetraethoxysilan KW - Halofuginon KW - Silicone Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-81213 ER - TY - JOUR A1 - Dufner, Vera A1 - Kessler, Almuth Friederike A1 - Just, Larissa A1 - Hau, Peter A1 - Bumes, Elisabeth A1 - Pels, Hendrik Johannes A1 - Grauer, Oliver Martin A1 - Wiese, Bettina A1 - Löhr, Mario A1 - Jordan, Karin A1 - Strik, Herwig T1 - The emesis trial: depressive glioma patients are more affected by chemotherapy-induced nausea and vomiting JF - Frontiers in Neurology N2 - Purpose Glioma patients face a limited life expectancy and at the same time, they suffer from afflicting symptoms and undesired effects of tumor treatment. Apart from bone marrow suppression, standard chemotherapy with temozolomide causes nausea, emesis and loss of appetite. In this pilot study, we investigated how chemotherapy-induced nausea and vomiting (CINV) affects the patients' levels of depression and their quality of life. Methods In this prospective observational multicentre study (n = 87), nausea, emesis and loss of appetite were evaluated with an expanded MASCC questionnaire, covering 10 days during the first and the second cycle of chemotherapy. Quality of life was assessed with the EORTC QLQ-C30 and BN 20 questionnaire and levels of depression with the PHQ-9 inventory before and after the first and second cycle of chemotherapy. Results CINV affected a minor part of patients. If present, it reached its maximum at day 3 and decreased to baseline level not before day 8. Levels of depression increased significantly after the first cycle of chemotherapy, but decreased during the further course of treatment. Patients with higher levels of depression were more severely affected by CINV and showed a lower quality of life through all time-points. Conclusion We conclude that symptoms of depression should be perceived in advance and treated in order to avoid more severe side effects of tumor treatment. Additionally, in affected patients, delayed nausea was most prominent, pointing toward an activation of the NK1 receptor. We conclude that long acting antiemetics are necessary totreat temozolomide-induced nausea. KW - glioblastoma KW - chemotherapy KW - depression KW - nausea and emesis KW - quality of life Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262859 SN - 1664-2295 VL - 13 ER - TY - JOUR A1 - Huflage, Henner A1 - Fieber, Tabea A1 - Färber, Christian A1 - Knarr, Jonas A1 - Veldhoen, Simon A1 - Jordan, Martin C. A1 - Gilbert, Fabian A1 - Bley, Thorsten Alexander A1 - Meffert, Rainer H. A1 - Grunz, Jan-Peter A1 - Schmalzl, Jonas T1 - Interobserver reliability of scapula fracture classifications in intra- and extra-articular injury patterns JF - BMC Musculoskeletal Disorders N2 - Background Morphology and glenoid involvement determine the necessity of surgical management in scapula fractures. While being present in only a small share of patients with shoulder trauma, numerous classification systems have been in use over the years for categorization of scapula fractures. The purpose of this study was to evaluate the established AO/OTA classification in comparison to the classification system of Euler and Rüedi (ER) with regard to interobserver reliability and confidence in clinical practice. Methods Based on CT imaging, 149 patients with scapula fractures were retrospectively categorized by two trauma surgeons and two radiologists using the classification systems of ER and AO/OTA. To measure the interrater reliability, Fleiss kappa (κ) was calculated independently for both fracture classifications. Rater confidence was stated subjectively on a five-point scale and compared with Wilcoxon signed rank tests. Additionally, we computed the intraclass correlation coefficient (ICC) based on absolute agreement in a two-way random effects model to assess the diagnostic confidence agreement between observers. Results In scapula fractures involving the glenoid fossa, interrater reliability was substantial (κ = 0.722; 95% confidence interval [CI] 0.676–0.769) for the AO/OTA classification in contrast to moderate agreement (κ = 0.579; 95% CI 0.525–0.634) for the ER classification system. Diagnostic confidence for intra-articular fracture patterns was superior using the AO/OTA classification compared to ER (p < 0.001) with higher confidence agreement (ICC: 0.882 versus 0.831). For extra-articular fractures, ER (κ = 0.817; 95% CI 0.771–0.863) provided better interrater reliability compared to AO/OTA (κ = 0.734; 95% CI 0.692–0.776) with higher diagnostic confidence (p < 0.001) and superior agreement between confidence ratings (ICC: 0.881 versus 0.912). Conclusions The AO/OTA classification is most suitable to categorize intra-articular scapula fractures with glenoid involvement, whereas the classification system of Euler and Rüedi appears to be superior in extra-articular injury patterns with fractures involving only the scapula body, spine, acromion and coracoid process. KW - confidence KW - scapula KW - glenoid KW - fracture KW - classification KW - reliability Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299795 VL - 23 IS - 1 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Jäckle, Veronika A1 - Scheidt, Sebastian A1 - Gilbert, Fabian A1 - Hölscher-Doht, Stefanie A1 - Ergün, Süleyman A1 - Meffert, Rainer H. A1 - Heintel, Timo M. T1 - Trans-obturator cable fixation of open book pelvic injuries JF - Scientific Reports N2 - Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications. KW - anatomy KW - medical research Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-261212 VL - 11 IS - 1 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Jansen, Hendrik A1 - Meffert, Rainer H. A1 - Heintel, Timo M. T1 - Comparing porous tantalum fusion implants and iliac crest bone grafts for spondylodesis of thoracolumbar burst fractures: Prospectice Cohort study JF - Scientific Reports N2 - The aim of this study was to compare two different techniques of performing one-level spondylodesis for thoracolumbar burst fractures using either an autologous iliac crest bone graft (ICBG) or a porous tantalum fusion implant (PTFI). In a prospective nonrandomized study, 44 patients (20 women, 24 men; average age 43.1 +/- 13.2 years) suffering from severe thoracolumbar burst fractures were treated with combined anterior-posterior stabilization. An ICBG was used in 21 cases, and a PTFI was used in the other 23 cases. A two-year clinical and radiographic follow-up was carried out. There were no statistically significant differences in age, sex, localization/classification of the fracture, or visual analog scale (VAS) before injury between the two groups. All 44 patients were followed up for an average period of 533 days (range 173-1567). The sagittal spinal profile was restored by an average of 11.1 degrees (ICBG) vs. 14.3 degrees (PTFI) (monosegmental Cobb angle). Loss of correction until the last follow-up tended to be higher in the patients treated with ICBG than in those treated with PTFI (mean: 2.8 degrees vs. 1.6 degrees). Furthermore, significantly better restoration of the sagittal profile was obtained with the PTFI than with the iliac bone graft at the long-term follow-up (mean: ICBG 7.8 degrees, PTFI 12.3 degrees; p < 0.005). Short-segment posterior instrumentation combined with anterior one-level spondylodesis using either an ICBG or a PTFI resulted in sufficient correction of posttraumatic segmental kyphosis. PTFI might be a good alternative for autologous bone grafting and prevent donor site morbidities. KW - fracture repair KW - musculoskeletal system Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-261706 VL - 11 IS - 1 ER - TY - JOUR A1 - Schmalzl, Jonas A1 - Fenwick, Annabel A1 - Reichel, Thomas A1 - Schmitz, Benedikt A1 - Jordan, Martin A1 - Meffert, Rainer A1 - Plumhoff, Piet A1 - Boehm, Dirk A1 - Gilbert, Fabian T1 - Anterior deltoid muscle tension quantified with shear wave ultrasound elastography correlates with pain level after reverse shoulder arthroplasty JF - European Journal of Orthopaedic Surgery & Traumatology N2 - Introduction Reverse shoulder arthroplasty (RSA) leads to medialization and distalization of the centre of rotation of the shoulder joint resulting in lengthening of the deltoid muscle. Shear wave ultrasound elastography (SWE) is a reliable method for quantifying tissue stiffness. The purpose of this study was to analyse if deltoid muscle tension after RSA correlates with the patients' pain level. We hypothesized that higher deltoid muscle tension would be associated with increased pain. Material and methods Eighteen patients treated with RSA were included. Constant score (CS) and pain level on the visual analogue scale (VAS) were analysed and SWE was performed on both shoulders. All three regions of the deltoid muscle were examined in resting position and under standardized isometric loading. Results Average patient age was 76 (range 64-84) years and average follow-up was 15 months (range 4-48). The average CS was 66 points (range 35-89) and the average pain level on the VAS was 1.8 (range 0.5-4.7). SWE revealed statistically significant higher muscle tension in the anterior and middle deltoid muscle region in patients after RSA compared to the contralateral non-operated side. There was a statistically significant correlation between pain level and anterior deltoid muscle tension. Conclusion SWE revealed increased tension in the anterior and middle portion of the deltoid muscle after RSA in a clinical setting. Increased tension of the anterior deltoid muscle portion significantly correlated with an increased pain level. SWE is a powerful, cost-effective, quick, dynamic, non-invasive, and radiation-free imaging technique to evaluate tissue elasticity in the shoulder with a wide range of applications. KW - pain KW - shear wave elastography KW - strain elastography KW - shoulder KW - deltoid muscle KW - reverse shoulder arthroplasty Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-268441 SN - 1432-1068 VL - 32 IS - 2 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Bröer, David A1 - Fischer, Christian A1 - Heilig, Philipp A1 - Gilbert, Fabian A1 - Hölscher-Doht, Stefanie A1 - Kalogirou, Charis A1 - Popp, Kevin A1 - Grunz, Jan-Peter A1 - Huflage, Henner A1 - Jakubietz, Rafael G. A1 - Ergün, Süleyman A1 - Meffert, Rainer H. T1 - Development and preclinical evaluation of a cable-clamp fixation device for a disrupted pubic symphysis JF - Communications Medicine N2 - Background Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage. Methods To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility. Results We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation. Conclusion We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation. KW - pubic symphysis KW - cable-clamp implants KW - SP-fixation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299800 VL - 2 IS - 1 ER - TY - JOUR A1 - Jansen, Hendrik A1 - Heintel, Timo M. A1 - Jordan, Martin A1 - Meffert, Rainer H. A1 - Frey, Soenke P. T1 - Survived traumatic hemipelvectomy with salvage of the limb in a 14  months old toddler JF - Trauma Case Reports N2 - We report on a 14 months old toddler who sustained a traumatic hemipelvectomy by being crushed between a car and a stone wall. After stabilization in the resuscitation room he was treated operatively by laparotomy, osteosynthesis of the pelvic ring, reconstruction of the both external iliac vessels and the urethra and reposition of the testicles. After 66 days he was discharged into rehabilitation. Implants were removed after eight months. 20 months after the injury, the leg was plegic, initial radiological signs of femoral head necrosis showed up but the infant was able to walk with an orthesis and a walker. Up to our knowledge, this is the youngest patient described in the literature with a survived traumatic hemipelvectomy and salvaged limb. KW - Hemipelvectomy KW - Survival KW - Limb salvage KW - Toddler Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202207 VL - 22 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Zimmermann, Christina A1 - Gho, Sheridan A. A1 - Frey, Sönke P. A1 - Blunk, Torsten A1 - Meffert, Rainer H. A1 - Hoelscher-Doht, Stefanie T1 - Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures JF - BMC Musculoskeletal Disorders N2 - Background Tibial head depression fractures demand a high level of fracture stabilization to prevent a secondary loss of reduction after surgery. Elderly individuals are at an increased risk of developing these fractures, and biomechanical investigations of the fractures are rare. Therefore, the aim of this study was to systematically analyze different types of osteosyntheses in combination with two commonly used bone substitutes. Methods Lateral tibial head depression fractures were created in synthetic bones. After reduction, the fractures were stabilized with eight different treatment options of osteosynthesis alone or in combination with a bone substitute. Two screws, 4 screws and a lateral buttress plate were investigated. As a bone substitute, two common clinically used calcium phosphate cements, Norian® Drillable and ChronOS™ Inject, were applied. Displacement of the articular fracture fragment (mm) during cyclic loading, stiffness (N/mm) and maximum load (N) in Load-to-Failure tests were measured. Results The three different osteosyntheses (Group 1: 2 screws, group 2: 4 screws, group 3: plate) alone revealed a significantly higher displacement compared to the control group (Group 7: ChronOS™ Inject only) (Group 1, 7 [p < 0.01]; group 2, 7 [p = 0.04]; group 3, 7 [p < 0.01]). However, the osteosyntheses in combination with bone substitute exhibited no differences in displacement compared to the control group. The buttress plate demonstrated a higher normalized maximum load than the 2 and 4 screw osteosynthesis. Comparing the two different bone substitutes to each other, ChronOS™ inject had a significantly higher stiffness and lower displacement than Norian® Drillable. Conclusions The highest biomechanical stability under maximal loading was provided by a buttress plate osteosynthesis. A bone substitute, such as the biomechanically favorable ChronOS™ Inject, is essential to reduce the displacement under lower loading. KW - tibial fracture fixation KW - tibial head fracture KW - biomechanical test KW - static test KW - cyclic test Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161201 VL - 17 IS - 287 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Jovic, Sebastian A1 - Gilbert, Fabian A1 - Kunz, Andreas A1 - Ertl, Maximilian A1 - Strobl, Ute A1 - Jakubietz, Rafael G. A1 - Jakubietz, Michael G. A1 - Meffert, Rainer H. A1 - Fuchs, Konrad F. T1 - Qualitätssteigerung der Abrechnungsprüfung durch Smartphone-basierte Fotodokumentation in der Unfall-, Hand-, und Plastischen Chirurgie JF - Der Unfallchirurg N2 - Hintergrund Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat. Fragestellung Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern? Material und Methoden Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat. Ergebnisse Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt. Diskussion Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken. N2 - Background Photographic documentation of wounds, decubitus ulcers, tumors, open fractures and infections is an important part of digital patient files. It is unclear whether the photographic documentation has an effect on medical accounting with health insurance companies. Objective It was hypothesized that Smartphone-based systematic photographic documentation can improve the confirmation of proceeds-relevant diagnoses and procedures as well as the duration. Material and methods Staff in the emergency room, operating theater, outpatient clinic and on the wards were equipped with digital devices (Smartphone, tablet) including a photo-app. Medical accounting with the health insurance companies and identification of all case conferences in which the photographic documentation had effected a change in proceeds were analyzed for 2019 in a retrospective manner. Results Overall, 372 cases were discussed of which 27 cases were affected by the digital photographic documentation. Photographic documentation was used for clarification of the operative procedure (n = 5), primary diagnosis (n = 10), secondary diagnosis (n = 3), and length of hospitalization (n = 9). An average of 2119 € was negotiated and added per case affected by photographic documentation. Hereby, a level 1 trauma center gained an estimated 65,328 € in revenue. Discussion The use of Smartphone based photographic documentation can improve the overall quality of patient files and thus avoid loss of revenue. The implementation of digital devices with corresponding software is an important component of the digital structural change in hospitals. KW - Digitalisierung KW - Gesundheits-App KW - Künstliche Intelligenz KW - Plattform KW - Strukturwandel KW - artificial intelligence KW - database KW - digital transformation KW - photo app KW - surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232415 SN - 0177-5537 VL - 124 ER - TY - JOUR A1 - Heilig, Philipp A1 - Faerber, Lars-Christopher A1 - Paul, Mila M. A1 - Kupczyk, Eva A1 - Meffert, Rainer H. A1 - Jordan, Martin C. A1 - Hoelscher-Doht, Stefanie T1 - Plate osteosynthesis combined with bone cement provides the highest stability for tibial head depression fractures under high loading conditions JF - Scientific Reports N2 - Older patients sustaining tibial head depression fractures often cannot follow the post-operative rehabilitation protocols with partial weight-bearing of the affected limb, leading to osteosynthesis failure, cartilage step-off and arthritis development. Therefore, the aim of this study was to analyse the biomechanical performance of different types of osteosyntheses alone and in combination with bone cement simulating cyclically high loading conditions of tibial head depression fractures. Lateral tibial head depression fractures (AO: 41-B2.2; Schatzker type III) were created in synthetic bones and stabilized using three different osteosyntheses alone and in combination with a commonly used bone cement (chronOS™): 2 screws, 4 screws in the jail technique and a lateral angle-stable buttress plate. After fixation, the lateral tibial plateau was axially loaded in two, from each other independent testing series: In the first test protocol, 5000 cycles with 500 N and in the end load-to-failure tests were performed. In the second test protocol, the cyclic loading was increased to 1000 N. Parameters of interest were the displacement of the articular fracture fragment, the stiffness and the maximum load. The osteosyntheses revealed a higher stiffness in combination with bone cement compared to the same type of osteosynthesis alone (e.g., 500 N level: 2 screws 383 ± 43 N/mm vs. 2 screws + chronOs 520 ± 108 N/mm, increase by 36%, p < 0.01; 4 screws 368 ± 97 N/mm vs. 4 screws + chronOS 516 ± 109 N/mm, increase by 40%, p < 0.01; plate: 509 ± 73 N/mm vs. plate + chronOs 792 ± 150 N/mm, increase by 56%, p < 0.01). Bone cement reduced the displacement of the plate significantly (500 N level: plate: 8.9 ± 2.8 mm vs. plate + chronOs: 3.1 ± 1.4 mm, reduction by 65%, p < 0.01; 1000 N level: 16.9 ± 3.6 mm vs 5.6 ± 1.3 mm, reduction by 67%, p < 0.01). Thus, the highest stiffness and lowest displacement values were found when using the plate with bone cement in both loading conditions (500 N level: 2 screws + chronOs 3.7 ± 1.3 mm, 4 screws + chronOs 6.2 ± 2.4 mm; 1000 N level: 2 screws + chronOs 6.5 ± 1.2 mm, 4 screws + chronOs 5.7 ± 0.8 mm). From a biomechanical perspective, plate osteosynthesis of tibial head depression fractures should always be combined with bone cement, provides higher stability than 2-screw and 4-screw fixation and is a valid treatment option in cases where extraordinary stability is required. KW - head depression fractures KW - osteosynthesis KW - arthritis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299782 VL - 12 IS - 1 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Hufnagel, Lukas A1 - McDonogh, Miriam A1 - Paul, Mila M. A1 - Schmalzl, Jonas A1 - Kupczyk, Eva A1 - Jansen, Hendrik A1 - Heilig, Philipp A1 - Meffert, Rainer H. A1 - Hoelscher-Doht, Stefanie T1 - Surgical fixation of calcaneal beak fractures — biomechanical analysis of different osteosynthesis techniques JF - Frontiers in Bioengineering and Biotechnology N2 - The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Treatment usually requires osteosynthesis. However, lack of biomechanical understanding of the ideal fixation technique persists. A beak fracture was simulated in synthetic bones and assigned to five different groups of fixation: A) 6.5-mm partial threaded cannulated screws, B) 4.0-mm partial threaded cannulated screws, C) 5.0-mm headless cannulated compression screws, D) 2.3-mm locking plate, and E) 2.8-mm locking plate. Different traction force levels were applied through an Achilles tendon surrogate in a material-testing machine on all stabilized synthetic bones. Outcome measures were peak-to-peak displacement, total displacement, plastic deformation, stiffness, visual-fracture-line displacement, and mode of implant failure. The 2.3- and 2.8-mm plating groups showed a high drop-out rate at 100 N tension force and failed under higher tension levels of 200 N. The fracture fixation using 4.0-mm partial threaded screws showed a significantly higher repair strength and was able to withhold cyclic loading up to 300 N. The lowest peak-to-peak displacement and the highest load-to-failure and stiffness were provided by fracture fixation using 6.5-mm partial threaded cannulated screws or 5.0-mm headless cannulated compression screws. As anticipated, large 6.5-mm screw diameters provide the best biomechanical fixation. Surprisingly, the 5.0-mm headless cannulated compression screws yield reliable stability despite the absent screw head and washer. When such large screws cannot be applied, 4.0-mm screws also allow reasonable fixation strength. Plate fixation should be implemented with precaution and in combination with a restrictive postoperative motion protocol. Finally, clinical cases about the surgical application and recovery are included. KW - foot KW - ankle KW - Achilles KW - tendon KW - fracture Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-282792 SN - 2296-4185 VL - 10 ER - TY - JOUR A1 - Heilig, Philipp A1 - Sandner, Phoebe A1 - Jordan, Martin Cornelius A1 - Jakubietz, Rafael Gregor A1 - Meffert, Rainer Heribert A1 - Gbureck, Uwe A1 - Hoelscher-Doht, Stefanie T1 - Experimental drillable magnesium phosphate cement is a promising alternative to conventional bone cements JF - Materials N2 - Clinically used mineral bone cements lack high strength values, absorbability and drillability. Therefore, magnesium phosphate cements have recently received increasing attention as they unify a high mechanical performance with presumed degradation in vivo. To obtain a drillable cement formulation, farringtonite (Mg\(_3\)(PO\(_4\))\(_2\)) and magnesium oxide (MgO) were modified with the setting retardant phytic acid (C\(_6\)H\(_{18}\)O\(_{24}\)P\(_6\)). In a pre-testing series, 13 different compositions of magnesium phosphate cements were analyzed concentrating on the clinical demands for application. Of these 13 composites, two cement formulations with different phytic acid content (22.5 wt% and 25 wt%) were identified to meet clinical demands. Both formulations were evaluated in terms of setting time, injectability, compressive strength, screw pullout tests and biomechanical tests in a clinically relevant fracture model. The cements were used as bone filler of a metaphyseal bone defect alone, and in combination with screws drilled through the cement. Both formulations achieved a setting time of 5 min 30 s and an injectability of 100%. Compressive strength was shown to be ~12–13 MPa and the overall displacement of the reduced fracture was <2 mm with and without screws. Maximum load until reduced fracture failure was ~2600 N for the cements only and ~3800 N for the combination with screws. Two new compositions of magnesium phosphate cements revealed high strength in clinically relevant biomechanical test set-ups and add clinically desired characteristics to its strength such as injectability and drillability. KW - magnesium phosphate cement KW - phytic acid KW - inositol hexaphosphate KW - drillable bone cement KW - tibial head depression fracture KW - synbones KW - artificial bones KW - biomechanical evaluation KW - cyclic testing KW - load to failure testing Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236633 SN - 1996-1944 VL - 14 IS - 8 ER - TY - JOUR A1 - Fuchs, Konrad F. A1 - Heilig, Philipp A1 - McDonogh, Miriam A1 - Boelch, Sebastian A1 - Gbureck, Uwe A1 - Meffert, Rainer H. A1 - Hoelscher-Doht, Stefanie A1 - Jordan, Martin C. T1 - Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes JF - Journal of Orthopaedic Surgery and Research N2 - Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys (R) QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem (TM) V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients. KW - arthritis KW - bone KW - calcaneus KW - cement KW - fracture KW - fixation KW - osteoporosis KW - sanders KW - screw Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230336 VL - 15 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Bittrich, Leonie A. A1 - Fehske, Kai A1 - Meffert, Rainer H. A1 - Jansen, Hendrik T1 - A rare case of Hoffa fracture combined with lateral patellar dislocation JF - Trauma Case Reports N2 - The coronal unicondylar fracture of the distal femur (AO 33-B3) is a rare intraarticular injury within the weight bearing area of the knee, initially described by Albert Hoffa in 1904. We report an unusual combination of a Hoffa fracture with lateral patellar dislocation in a young adult. Our patient sustained the injury by a sudden twist of his leg during sports. He presented clinically with knee swelling, dislocation of the patella, and localized tenderness; unable to bare weight. After plane radiograph confirmed the injury, manual reduction of the patella was done by hyperextension of the knee and medialward pressure. Afterwards, a CT scan and MRI were conducted. The injury was surgically treated with lag-screws, locking-plate and MPFL-reconstruction. KW - dislocation KW - femur KW - fracture KW - Hoffa KW - MPFL KW - patella Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158315 VL - 9 ER - TY - JOUR A1 - Fuchs, Konrad F. A1 - Eden, Lars A1 - Gilbert, Fabian A1 - Bernuth, Silvia A1 - Wurmb, Thomas A1 - Meffert, Rainer H. A1 - Jordan, Martin C. T1 - Führt eine COVID-19-bedingte Ausgangsbeschränkung zu einer Reduktion schwer verletzter Patienten an einem überregionalen Traumazentrum? JF - Der Unfallchirurg N2 - Hintergrund Intensiv- und Beatmungskapazitäten sind für die Behandlung COVID-19-erkrankter Patienten essenziell. Unabhängig davon beanspruchen auch schwer verletzte Patienten häufig Intensiv- und Beatmungskapazitäten. Daraus ergibt sich folgende Fragestellung: Führt eine Ausgangsbeschränkung zu einer Reduktion schwer verletzter Patienten, und kann hierdurch mit frei werdenden Intensivkapazitäten gerechnet werden? Material und Methoden Es erfolgte eine retrospektive Auswertung schwer verletzter Patienten mit einem Injury Severity Score (ISS) ≥16 zwischen dem 17.03.2020 und 30.04.2020 (landesweiter Shutdown) an einem überregionalen Traumazentrum. Erfasst wurden der Unfallmechanismus, ISS, Versicherungsträger (BG vs. GKV/PKV), ob es sich um einen dokumentierten Suizidversuch handelte, und ob eine operative Intervention innerhalb der ersten 24 h erforderlich war. Als Kontrollgruppe wurden die Daten des gleichen Zeitraums der Jahre 2018 und 2019 ausgewertet. Ergebnisse Es konnte keine wesentliche Veränderung bezüglich der Anzahl an schwer verletzten Patienten festgestellt werden (2018 n = 30, 2019 n = 23, 2020 n = 27). Es zeigten sich insgesamt keine deutlichen Veränderungen der absoluten Zahlen bezüglich der Intensivpflichtigkeit in den ersten 24 h und der Beatmungspflichtigkeit beim Verlassen des Schockraums. Die Anzahl an Patienten, die eine Operation innerhalb der ersten 24 h nach Eintreffen im Schockraum benötigten, war 2020 sogar leicht erhöht, jedoch nicht statistisch signifikant. Der durchschnittliche ISS blieb konstant. Bezüglich der Unfallursache zeigte sich 2020 kein Motorradfahrer, der einen nicht berufsgenossenschaftlich versicherten Unfall erlitt (2018 n = 5, 2019 n = 4, 2020 n = 0). Es wurde 2020 ein erhöhter Anteil an Arbeitsunfällen mit einem ISS ≥16 festgestellt (2018: 10 %, 2019: 26,1 %, 2020: 44,4 %). Diskussion Eine Ausgangsbeschränkung führte zu keiner Reduktion verletzter- und intensivpflichtiger Patienten am untersuchten Zentrum. Auch unter einer landesweiten Ausgangsbeschränkung muss für dieses Patientenkollektiv eine ausreichende Menge an Intensiv- und OP-Kapazitäten vorgehalten werden. Die Bestätigung dieser Ergebnisse durch Auswertung nationaler Register steht noch aus. KW - Pandemie KW - Intensivkapazitäten KW - Coronavirus KW - Injury Severity Score KW - Polytrauma Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265268 VL - 124 IS - 5 ER - TY - JOUR A1 - Bäuerlein, Carina A. A1 - Qureischi, Musga A1 - Mokhtari, Zeinab A1 - Tabares, Paula A1 - Brede, Christian A1 - Jordán Garrote, Ana-Laura A1 - Riedel, Simone S. A1 - Chopra, Martin A1 - Reu, Simone A1 - Mottok, Anja A1 - Arellano-Viera, Estibaliz A1 - Graf, Carolin A1 - Kurzwart, Miriam A1 - Schmiedgen, Katharina A1 - Einsele, Hermann A1 - Wölfl, Matthias A1 - Schlegel, Paul-Gerhardt A1 - Beilhack, Andreas T1 - A T-Cell Surface Marker Panel Predicts Murine Acute Graft-Versus-Host Disease JF - Frontiers in Immunology N2 - Acute graft-versus-host disease (aGvHD) is a severe and often life-threatening complication of allogeneic hematopoietic cell transplantation (allo-HCT). AGvHD is mediated by alloreactive donor T-cells targeting predominantly the gastrointestinal tract, liver, and skin. Recent work in mice and patients undergoing allo-HCT showed that alloreactive T-cells can be identified by the expression of α4β7 integrin on T-cells even before manifestation of an aGvHD. Here, we investigated whether the detection of a combination of the expression of T-cell surface markers on peripheral blood (PB) CD8\(^+\) T-cells would improve the ability to predict aGvHD. To this end, we employed two independent preclinical models of minor histocompatibility antigen mismatched allo-HCT following myeloablative conditioning. Expression profiles of integrins, selectins, chemokine receptors, and activation markers of PB donor T-cells were measured with multiparameter flow cytometry at multiple time points before the onset of clinical aGvHD symptoms. In both allo-HCT models, we demonstrated a significant upregulation of α4β7 integrin, CD162E, CD162P, and conversely, a downregulation of CD62L on donor T-cells, which could be correlated with the development of aGvHD. Other surface markers, such as CD25, CD69, and CC-chemokine receptors were not found to be predictive markers. Based on these preclinical data from mouse models, we propose a surface marker panel on peripheral blood T-cells after allo-HCT combining α4β7 integrin with CD62L, CD162E, and CD162P (cutaneous lymphocyte antigens, CLA, in humans) to identify patients at risk for developing aGvHD early after allo-HCT. KW - acute graft-versus-host disease KW - alloreactive T cells KW - transplantation KW - prediction KW - mouse models Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-224290 SN - 1664-3224 VL - 11 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Jäckle, Veronika A1 - Scheidt, Sebastian A1 - Eden, Lars A1 - Gilbert, Fabian A1 - Heintel, Timo M. A1 - Jansen, Hendrik A1 - Meffert, Rainer H. T1 - Ergebnisse nach Plattenstabilisierung der Symphysensprengung JF - Der Unfallchirurg N2 - Hintergrund Die Symphysensprengung mit entsprechender Diastase kann durch eine Symphysenplatte stabilisiert werden. Fragestellung Welche Beckenverletzungen werden mit einer Symphysenplatte stabilisiert und wie ist das Outcome? Material und Methoden Retrospektive Auswertung von 64 Patienten über einen Untersuchungszeitraum von 24 Monaten. Ergebnisse Es waren 56 Patienten männlich, 8 weiblich und das mittlere Alter betrug 44 Jahre (SD ± 17). Unfälle im Straßenverkehr waren der führende Grund für die Beckenverletzung. Die Verteilung nach AO-Klassifikation zeigte sich wie folgt: 14-mal B1-, 10-mal B2-, 5‑mal B3-, 23-mal C1-, 9‑mal C2- und 3‑mal C3-Verletzungen. Die Verteilung nach Young und Burgess ergab: 9‑mal APC-I-, 18-mal APC-II-, 13-mal APC-III-, 9‑mal LC-I-, 3‑mal LC-II-, 2‑mal LC-III- und 10-mal VS-Verletzungen. Der mittlere Injury Severity Score (ISS) betrug 32 und die mittlere stationäre Verweildauer 29 Tage (pos. Korrelation p ≤ 0,001). Im Verlauf war eine radiologische Implantatlockerung bei 52 Patienten nachweisbar. Therapierelevante Komplikationen gab es in 14 Fällen. Hierbei war das Implantatversagen (n = 8) der Hauptgrund für eine operative Revision. Diskussion Obwohl die radiologische Implantatlockerung häufig beobachtet wird, ist sie nur selten Grund für einen Revisionseingriff. Kommt es hingegen zum vollständigen Implantatversagen, tritt dies meist innerhalb der ersten postoperativen Wochen auf und ist revisionsbedürftig. Eine frühzeitige Abklärung durch Röntgenbildgebung sollte bei Verdacht erfolgen. N2 - Background Separation of the pubic symphysis with corresponding diastasis can be stabilized by symphyseal plating. Objective Which pelvic injuries are stabilized with symphyseal plating and what is their outcome? Material and methods A retrospective evaluation of 64 patients who underwent symphyseal plating over a period of 24 months was conducted. Results Of the patients 56 were male and 8 female with a mean age of 44 years (SD ± 17 years). The main cause of the pelvic injuries were traffic accidents. The distribution according to the AO fracture classification was 14 × B1, 10 × B2, 5 × B3, 23 × C1, 9 × C2 and 3 × C3 injuries. The distribution according to the Young and Burgess classification showed 9 × APC I, 18 × APC II, 13 × APC III, 9 × LC I, 3 × LC II, 2 × LC III and 10 × VS injuries. The mean Injury Severity Score (ISS) was 32 (SD ± 17) and the mean inpatient stay was 29 days (SD ± 16 days; positive correlation p ≤ 0.001). Radiological implant loosening occurred in 52 patients. 14 patients required treatment for severe complications. The leading reason for revision surgery was implant failure (n = 8). Conclusion These observations suggest that radiological signs of implant loosening are commonly observed but rarely the reason for revision surgery. Complete implant failures, however; occur mainly within the first postoperative weeks and require early revision. A timely clarification by additional X-ray imaging should be carried out if this is suspected. KW - Beckenring KW - Beckenfraktur KW - AO KW - Fixation KW - Trauma KW - pelvic ring KW - pelciv fracture KW - AO KW - fixation KW - trauma Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232447 SN - 0177-5537 VL - 123 ER - TY - JOUR A1 - Fuchs, Konrad F. A1 - Eden, Lars A1 - Gilbert, Fabian A1 - Bernuth, Silvia A1 - Wurmb, Thomas A1 - Meffert, Rainer H. A1 - Jordan, Martin C. T1 - Führt eine COVID-19 bedingte Ausgangsbeschränkung zu einer Reduktion schwerverletzter Patienten an einem überregionalen Traumazentrum? T1 - Do COVID-19 restrictions lead to a decrease in severely injured patients at a level 1 trauma center in Germany? JF - Der Unfallchirurg N2 - Hintergrund Intensiv- und Beatmungskapazitäten sind für die Behandlung COVID-19-erkrankter Patienten essenziell. Unabhängig davon beanspruchen auch schwer verletzte Patienten häufig Intensiv- und Beatmungskapazitäten. Daraus ergibt sich folgende Fragestellung: Führt eine Ausgangsbeschränkung zu einer Reduktion schwer verletzter Patienten, und kann hierdurch mit frei werdenden Intensivkapazitäten gerechnet werden? Material und Methoden Es erfolgte eine retrospektive Auswertung schwer verletzter Patienten mit einem Injury Severity Score (ISS) ≥16 zwischen dem 17.03.2020 und 30.04.2020 (landesweiter Shutdown) an einem überregionalen Traumazentrum. Erfasst wurden der Unfallmechanismus, ISS, Versicherungsträger (BG vs. GKV/PKV), ob es sich um einen dokumentierten Suizidversuch handelte, und ob eine operative Intervention innerhalb der ersten 24 h erforderlich war. Als Kontrollgruppe wurden die Daten des gleichen Zeitraums der Jahre 2018 und 2019 ausgewertet. Ergebnisse Es konnte keine wesentliche Veränderung bezüglich der Anzahl an schwer verletzten Patienten festgestellt werden (2018 n = 30, 2019 n = 23, 2020 n = 27). Es zeigten sich insgesamt keine deutlichen Veränderungen der absoluten Zahlen bezüglich der Intensivpflichtigkeit in den ersten 24 h und der Beatmungspflichtigkeit beim Verlassen des Schockraums. Die Anzahl an Patienten, die eine Operation innerhalb der ersten 24 h nach Eintreffen im Schockraum benötigten, war 2020 sogar leicht erhöht, jedoch nicht statistisch signifikant. Der durchschnittliche ISS blieb konstant. Bezüglich der Unfallursache zeigte sich 2020 kein Motorradfahrer, der einen nicht berufsgenossenschaftlich versicherten Unfall erlitt (2018 n = 5, 2019 n = 4, 2020 n = 0). Es wurde 2020 ein erhöhter Anteil an Arbeitsunfällen mit einem ISS ≥16 festgestellt (2018: 10 %, 2019: 26,1 %, 2020: 44,4 %). Diskussion Eine Ausgangsbeschränkung führte zu keiner Reduktion verletzter- und intensivpflichtiger Patienten am untersuchten Zentrum. Auch unter einer landesweiten Ausgangsbeschränkung muss für dieses Patientenkollektiv eine ausreichende Menge an Intensiv- und OP-Kapazitäten vorgehalten werden. Die Bestätigung dieser Ergebnisse durch Auswertung nationaler Register steht noch aus. N2 - Background Intensive care and ventilator capacities are essential for treatment of COVID-19 patients. Severely injured patients are often in continuous need of intensive care and ventilator treatment. The question arises, whether restrictions related to COVID-19 have led to a decrease in severely injured patients and thus to an increase in intensive care unit (ICU) capacity. Material and methods A retrospective analysis of all seriously injured patients with an injury severity score (ISS) ≥16 was performed between 17 March and 30 April 2020 at a level 1 trauma center in Germany. The mechanism of injury and the ISS were recorded. Further data were collected as to whether it was a work-related accident, a documented suicide attempt and if surgery was necessary in the first 24 h after arrival in hospital. Data from 2018 and 2019 served as a control group. Results There was no substantial difference in the total number of seriously injured patients (2018 n = 30, 2019 n = 23, 2020 n = 27). Furthermore, there was no relevant difference in the number of patients needing intensive care or ventilator treatment when leaving the shock room. The number of patients needing an operative intervention within the first 24 h after arriving at hospital was slightly higher in 2020. The mean ISS was at a constant level during all 3 years. In 2020 there was no polytraumatized motorbike rider, who did not have a work-related accident (2018 n = 5, 2019 n = 4, 2020 n = 0). A noticeable increase in work-related accidents was observed (2018: 10%, 2019: 26.1%, 2020 44.4%). Discussion Restrictions related to COVID-19 did not lead to a reduction in seriously injured patients needing ICU care. Due to the monocentric data analysis there is room for misinterpretation. In general, intensive care and operating capacities should be managed with adequate consideration for seriously injured patients even in times of crisis, such as the COVID-19 pandemic. Confirmation through the German Trauma Register is pending. KW - Intensivkapazitäten KW - Coronavirus KW - Injury Severity Score KW - Polytrauma KW - Pandemie KW - ICU capacities KW - Corona virus KW - injury severity score KW - polytrauma KW - pandemic Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232547 SN - 0177-5537 VL - 124 ER - 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 - Habarta, Johanna A1 - Jordan, Martin A1 - Meffert, Rainer A1 - Huflage, Henner A1 - Schmalzl, Jonas T1 - Surgical management of a traumatic elbow dislocation with disruption of the brachial artery. Case report JF - Obere Extremität N2 - Background Dislocations of the elbow are the second most common dislocations of humeral joints following the shoulder. Besides numerous possible concomitant injuries of the collateral ligaments or the extensor or flexor apparatus, an accompanying disruption of the brachial artery is a rare occurrence. In the following, such a case is presented and discussed. Method A 70-year-old woman sustained a closed posterior elbow dislocation with accompanying disruption of the brachial artery due to a fall in a domestic environment. Pulselessness of the radial artery led to a computed tomography angiography being performed, which confirmed the diagnosis. Direct operative vascular reconstruction with a vein insert was carried out. Due to strong swelling of the soft tissue, other examinations of the elbow could not be performed initially. A redislocation a few days later led to an operative stabilization of the elbow joint. Results The final consultation 4 months postoperatively showed a stable, centered elbow joint and a normal perfusion of the affected arm. The elbow function was good with a range of motion of 0/0/110° of extension/flexion. Conclusion An elbow dislocation is a complex injury. An accurate clinical examination of possible concomitant injuries is important and should be repeated in the first few days after the occurrence. Vascular reconstruction should be performed immediately. In the case of persistent joint instability, an operative stabilization is indicated and may be supported by a hinged external fixator. N2 - Hintergrund Eine Luxation des Ellenbogens stellt die zweithäufigste Luxation des menschlichen Körpers dar. Neben verschiedenen möglichen Begleitverletzungen im Bereich des Kapsel-Band-Apparats und der Sehnenansätze ist eine Abrissverletzung der A. brachialis eine Seltenheit. Im Folgenden wird ein solcher Fall präsentiert und diskutiert. Methoden Eine 70 Jahre alte Frau stürzte im häuslichen Umfeld und erlitt eine geschlossene Luxation des linken Ellenbogens mit begleitendem Abriss der A. brachialis. Fehlende Pulse der A. radialis führten zur Zuverlegung und zur Anfertigung einer computertomographiegesteuerten Angiographie, welche die Diagnose bestätigte. Die operative Gefäßrekonstruktion mittels Veneninterponat erfolgte sofort. Aufgrund stark geschwollener Weichteilverhältnisse waren weitere Untersuchungen des Ellenbogengelenks zunächst nicht möglich. Ein Reluxationsereignis einige Tage nach dem Unfall veranlasste zu weiterführender Diagnostik und operativer Stabilisierung des Ellenbogens. Ergebnisse Die Nachuntersuchung 4 Monate postoperativ zeigte ein stabiles, zentriertes Ellenbogengelenk, eine regelrechte Durchblutung des betroffenen Arms sowie eine gute Ellenbogenfunktion mit einem Bewegungsausmaß von 0/0/110° Extension/Flexion. Schlussfolgerung Eine Luxation des Ellenbogens ist eine komplexe Verletzung. Eine sorgfältige klinische Untersuchung aller möglichen Begleitverletzungen ist wichtig und sollte in den ersten Tagen mehrmals wiederholt werden. Gefäßverletzungen sollten sofort operativ behandelt werden. Bei persistierenden Gelenkinstabilitäten und Reluxationstendenzen ist eine operative Stabilisierung des Gelenks durchzuführen, welche durch die Anlage eines Bewegungsfixateurs unterstützt werden kann. T2 - Chirurgische Versorgung einer traumatisch bedingten Ellenbogenluxation mit Riss der A. brachialis. Fallbericht KW - elbow joint KW - vascular reconstruction KW - orthopedic surgery KW - joint instability KW - hinged external fixator KW - Ellenbogengelenk KW - Vaskuläre Rekonstruktion KW - Orthopädische Chirurgie KW - Gelenkinstabilität KW - Bewegungsfixateur Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323972 SN - 1862-6599 VL - 17 IS - 4 ER - TY - JOUR A1 - Lüke, Florian A1 - Haller, Florian A1 - Utpatel, Kirsten A1 - Krebs, Markus A1 - Meidenbauer, Norbert A1 - Scheiter, Alexander A1 - Spoerl, Silvia A1 - Heudobler, Daniel A1 - Sparrer, Daniela A1 - Kaiser, Ulrich A1 - Keil, Felix A1 - Schubart, Christoph A1 - Tögel, Lars A1 - Einhell, Sabine A1 - Dietmaier, Wolfgang A1 - Huss, Ralf A1 - Dintner, Sebastian A1 - Sommer, Sebastian A1 - Jordan, Frank A1 - Goebeler, Maria-Elisabeth A1 - Metz, Michaela A1 - Haake, Diana A1 - Scheytt, Mithun A1 - Gerhard-Hartmann, Elena A1 - Maurus, Katja A1 - Brändlein, Stephanie A1 - Rosenwald, Andreas A1 - Hartmann, Arndt A1 - Märkl, Bruno A1 - Einsele, Hermann A1 - Mackensen, Andreas A1 - Herr, Wolfgang A1 - Kunzmann, Volker A1 - Bargou, Ralf A1 - Beckmann, Matthias W. A1 - Pukrop, Tobias A1 - Trepel, Martin A1 - Evert, Matthias A1 - Claus, Rainer A1 - Kerscher, Alexander T1 - Identification of disparities in personalized cancer care — a joint approach of the German WERA consortium JF - Cancers N2 - (1) Background: molecular tumor boards (MTBs) are crucial instruments for discussing and allocating targeted therapies to suitable cancer patients based on genetic findings. Currently, limited evidence is available regarding the regional impact and the outreach component of MTBs; (2) Methods: we analyzed MTB patient data from four neighboring Bavarian tertiary care oncology centers in Würzburg, Erlangen, Regensburg, and Augsburg, together constituting the WERA Alliance. Absolute patient numbers and regional distribution across the WERA-wide catchment area were weighted with local population densities; (3) Results: the highest MTB patient numbers were found close to the four cancer centers. However, peaks in absolute patient numbers were also detected in more distant and rural areas. Moreover, weighting absolute numbers with local population density allowed for identifying so-called white spots—regions within our catchment that were relatively underrepresented in WERA MTBs; (4) Conclusions: investigating patient data from four neighboring cancer centers, we comprehensively assessed the regional impact of our MTBs. The results confirmed the success of existing collaborative structures with our regional partners. Additionally, our results help identifying potential white spots in providing precision oncology and help establishing a joint WERA-wide outreach strategy. KW - precision oncology KW - MTB KW - patient access KW - cancer care KW - outreach KW - real world data KW - outcomes research Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290311 SN - 2072-6694 VL - 14 IS - 20 ER - TY - JOUR A1 - Paul, Mila M. A1 - Mieden, Hannah J. A1 - Lefering, Rolf A1 - Kupczyk, Eva K. A1 - Jordan, Martin C. A1 - Gilbert, Fabian A1 - Meffert, Rainer H. A1 - Sirén, Anna-Leena A1 - Hoelscher-Doht, Stefanie T1 - Impact of a femoral fracture on outcome after traumatic brain injury — a matched-pair analysis of the TraumaRegister DGU\(^®\) JF - Journal of Clinical Medicine N2 - Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU\(^®\) to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI. KW - traumatic brain injury KW - femoral fracture KW - damage control orthopedics KW - mortality Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319363 SN - 2077-0383 VL - 12 IS - 11 ER -