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While clear evidence exists for the direct involvement of cytolysins in the pathogenesis of Gram-positive bacteria, the significance of Gram-negative haemolysins remains unclear. This paper presents briefly data indicating a role for haemolysin production in infections caused by Escherichia coli and also experiments which have allowed an analysis of the molecular basis of the haemolysis among pathogenic and non-pathogenic strains of this species.
The 06 serogroup Escherichia coli strain 536 carries two hemolysin (hly) determinants integrated into the chromosome. The two hly determinants are not completely identical, either functionally or structurally, as demonstrated by spontaneous deletion mutants carrying only one of them and by cloning each of the two determinants separately into cosmid vectors. Each hly determinant is independently deleted at a frequency of 10-4 , leading to variants which exhibit similar levels of internal hemolysin but different amounts of secreted hemolysin. The two hly determinants were also identified in the 04 E. coli strain 519. The three E. coli strains 251, 764, and 768, which belong to the serogroup 018, and the 04 strain 367 harbor a single chromosomal hly determinant, as demonstrated by hybridization with hly-gene-specific probes. However, a hybridization probe derived from a sequence adjacent to the hlyC-proximal end of the plasmid pHlyl52-encoded hly determinant hybridizes with several additional chromosomal bands in hemolytic 018 and 06 E. coli strains and even in E. coli K-12. The size ofthe probe causing the multiple hybridization suggests a 1,500- to 1,800-base pair sequence directly flanking hlyC. Spontaneous hemolysin-negative mutants were isolated from strains 764 and 768, which had lost the entire hly determinant but retained all copies of the hlyC-associated sequence. This sequence is not identical to a previously identified (J. Hacker, S. Knapp, and W. Goebel, J. Bacteriol. 154:1145-1154, 1983) somewhat smaller (about 850 base pairs) sequence flanking the other (hlyBb-proximal) end of the plasmid pHlyl52-encoded hly determinant which, as shown here, exists also in multiple copies in these hemolytic E. coli strains and in at least two copies in E. coli K-12. In contrast to the plasmid-encoded hly determinant which is directly flanked at both ends by these two diJJerent sequences, the chromosomal hly determinants are not immediately flanked by such sequences.
Aufgrund des demographischen Wandels mit einer zunehmend älter werdenden Bevölkerung ist die Zahl der Knieprothesen und vor allem auch der Revisionsoperationen in den letzten Jahren deutlich gestiegen. Mit ebenfalls zunehmendem medizinischem Anspruch wurden die bestehenden Prothesenmodelle stetig weiter entwickelt.
Ziel der vorliegenden Studie war es, in einer prospektiv angelegten einfach verblindeten Studie zwei verschiedene Rotating-Hinge-Revisionsprothesen unterschiedlicher Hersteller miteinander zu vergleichen und sie auf ihr klinisches Outcome zu überprüfen.
Von Juni 2012 bis Mai 2013 wurden insgesamt 25 Patienten in die Studie aufgenommen und dann bis zu 12 Monate nach erfolgter Revisionsoperation nachuntersucht. Die Zuteilung der Prothesenarten erfolgte randomisiert, sodass 13 Patienten die Prothese „EnduRo“ und 12 Patienten die Prothese „Endo-Modell“ erhielten. Als Vergleichswerte wurden klinische Scores herangezogen.
In der Untersuchung zeigten beiden Vergleichsgruppen insgesamt eine deutliche Schmerzreduktion sowie eine Funktionsverbesserungen in allen erhobenen Scores. Zwar erreichten die Patienten der Gruppe „Endo-Modell“ etwas höhere Punktwerte, jedoch waren die Unterschiede im Vergleich zur Patientengruppe „EnduRo“ im durchgeführten Zweistichproben-T-Test nicht statistisch signifikant.