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Background
Locked dislocations of the glenohumeral joint are disabling and often painful conditions and the treatment is challenging. This study evaluates the functional outcome and the different prosthetic treatment options for chronic locked dislocations of the glenohumeral joint and a subclassification is proposed.
Methods
In this single-center retrospective case series, all patients with a chronic locked dislocation treated surgically during a four-year period were analyzed. Constant score (CS), Quick Disabilities of Shoulder and Hand Score (DASH), patient satisfaction (subjective shoulder value (SSV)), revision rate and glenoid notching were analyzed.
Results
26 patients presented a chronic locked dislocation of the glenohumeral joint. 16 patients (62%) with a mean age of 75 [61-83] years were available for follow-up at 24 ± 18 months. CS improved significantly from 10 ± 6 points to 58 ± 21 points (p < 0.0001). At the final follow-up, the mean DASH was 27 ± 23 and the mean SSV was 58 ± 23 points. The complication rate was 19% and the revision rate was 6%; implant survival was 94%. Scapular notching occurred in 2 (13%) cases (all grade 1).
Conclusion
With good preoperative planning and by using the adequate surgical technique, good clinical short-term results with a low revision rate can be achieved. The authors suggest extending the Boileau classification for fracture sequelae type 2 and recommend using a modified classification to facilitate the choice of treatment as the suggested classification system includes locked posterior and anterior dislocations with and without glenoid bone loss.
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.
Chemical synapses are a physically and functionally varied type of cell-cell contact specialized in conducting communication between neurons. They are the smallest "computational" unit of the brain and are often classified as electrical and chemical, and they can be distinguished based on their transmission mechanism. These categories could be further broken into many kinds, each having a specific structure-function repertoire that is hypothesized to provide neural networks with distinct computational capabilities. Heterogeneity refers to the variety of structures and functions present in a particular category of synapses. Contributing factors for this heterogeneity may be the synaptic vesicles, the active zone (AZ), the synaptic cleft, the postsynaptic density, and the glial processes associated with the synaptic contacts. Each of these five structural modules has its own set of functions, and their combination determines the spectrum of functional heterogeneity at mammalian excitatory synapses. This work focused on the changes in AZ protein expression after chemical induction of plasticity with forskolin in synaptic contacts of the hippocampal mossy fibers. With the nanoscopic resolution provided by dSTORM, along with the multicolor SIM imaging capabilities, changes in expression of key presynaptic AZ components were analyzed. Using SIM imaging along with a standardized stimulation protocol in acute brain slices from male 16-week old Thy1-mEGFP (Lsi1) mice, the changes of the key AZ proteins Bassoon, Munc 13-1 and Tomosyn were investigated 30 min after stimulation with forskolin (50 μM for 30 min). Forskolin induced changes in these proteins largely in small synaptic contacts whereas no clear changes were detected in large mossy fiber boutons. However, due to the high variability it cannot be ruled out that forskolin may differentially modify AZ protein composition depending on experimental circumstances such as age and gender of mice or the time point and duration of forskolin stimulation. The dSTORM data demonstrated feasibility to perform single molecule 3D imaging of hippocampal presynaptic AZs and allowed quantitative mapping of molecular changes in AZ proteins after induction of plasticity. The findings suggest high heterogeneity in mossy fiber synaptic contacts that may have an impact on the function of neural networks. These imaging approaches may now be used to identify potential differences in functional molecular rearrangements of synaptic proteins in healthy and diseased brain (e.g. after induction of traumatic brain injury).
Methionine is the first amino acid of every newly synthesised protein. In combination with its role as precursor for the vital methyl-group donor S-adenosylmethionine, methionine is essential for every living cell. The opportunistic human pathogen Staphylococcus aureus is capable of synthesising methionine de novo, when it becomes scarce in the environment. All genes required for the de novo biosynthesis are encoded by the metICFE-mdh operon, except for metX. Expression is controlled by a hierarchical network with a methionyl-tRNA-specific T-box riboswitch (MET-TBRS) as centrepiece, that is also referred to as met leader (RNA). T-box riboswitches (TBRS) are regulatory RNA elements located in the 5’-untranslated region (5’-UTR) of genes. The effector molecule of T-box riboswitches is uncharged cognate tRNA. The prevailing mechanism of action is premature termination of transcription of the nascent RNA in the absence of the effector (i.e. uncharged cognate tRNA) due to formation of a hairpin structure, the Terminator stem. In presence of the effector, a transient stabilisation of the alternative structure, the Antiterminator, enables transcription of the downstream genes (‘read-through’). Albeit, after the read-through the thermodynamically more stable Terminator eventually forms. The Terminator and the Antiterminator are two mutually exclusive structures. Previous work of the research group showed that in staphylococci the MET-TBRS ensures strictly methionine-dependent control of met operon expression. Uncharged methionyl-tRNA that activates the system is only present in sufficient amounts under methionine-deprived conditions. In contrast to other bacterial TBRS, the staphylococcal MET-TBRS has some characteristic features regarding its length and predicted secondary structure whose relevance for the function are yet unkown.
Aim of the present thesis was to experimentally determine the structure of the met leader RNA and to investigate the stability of the met operon-specific transcripts in the context of methionine biosynthesis control. Furthermore, the yet unknown function of the mdh gene within the met operon was to be determined.
In the context of this thesis, the secondary structure of the met leader was determined employing in-line probing. The structural analysis revealed the presence of almost all highly conserved T-box riboswitch structural characteristics. Furthermore, three additional stems, absent in all T-box riboswitches analysed to date, could be identified. Particularly remarkable is the above average length of the Terminator stem which renders it a potential target of the double-strand-specific endoribonuclease III (RNase III). The RNase III-dependent cleavage of the met leader could be experimentally verified by the use of suitable mutants. Moreover, the exact cleavage site within the Terminator was determined.
The unusual immediate separation of the met leader from the met operon mRNA via the RNase III cleavage within the Terminator stem induces the rapid degradation of the met leader RNA and, most likely, that of the 5’-region of the met mRNA. The met mRNA is degraded from its 5’-end by the exoribonuclease RNase J. The stability of the met mRNA was found to vary over the length of the transcript with an instable 5’-end (metI and metC) and a longer half-life towards the 3’-end (metE and mdh). The varying transcript stability is reflected by differences in the available cellular protein levels. The obtained data suggest that programmed mRNA degradation is another level of regulation in the complex network of staphylococcal de novo methionine biosynthesis control.
In addition, the MET-TBRS was studied with regard to a future use as a drug target for novel antimicrobial agents. To this end, effects of a dysregulated methionine biosynthesis on bacterial growth and survival were investigated in met leader mutants that either caused permanent transcription of the met operon (‘ON’) or prevented operon transcription (‘OFF’), irrespective of the methionine status in the cell. Methionine deprivation turned out to be a strong selection pressure, as ‘OFF’ mutants acquired adaptive mutations within the met leader to restore met operon expression that subsequently re-enabled growth.
The second part of the thesis was dedicated to the characterisation of the Mdh protein that is encoded by the last gene of the met operon and whose function is unknown yet. At first, co-transcription and -expression with the met operon could be demonstrated. Next, the Mdh protein was overexpressed and purified and the crystal structure of Mdh was solved to high resolution by the Kisker research group (Rudolf-Virchow-Zentrum Würzburg). Analysis of the structure revealed the amino acid residues crucial for catalytic activity, and zinc was identified as a co-factor of Mdh. Also, Mdh was shown to exist as a dimer. However, identification of the Mdh substrate was, in the context of this thesis, (still) unsuccessful. Nevertheless, interactions of Mdh with enzymes of the met operon could be demonstrated by employing the bacterial two-hybrid system. This fact and the high conservation of mdh/Mdh on nucleotide and amino acid level among numerous staphylococcal species suggests an important role of Mdh within the methionine metabolism that should be a worthwhile subject of future research.
In this work, we consider impulsive dynamical systems evolving on an infinite-dimensional space and subjected to external perturbations. We look for stability conditions that guarantee the input-to-state stability for such systems. Our new dwell-time conditions allow the situation, where both continuous and discrete dynamics can be unstable simultaneously. Lyapunov like methods are developed for this purpose. Illustrative finite and infinite dimensional examples are provided to demonstrate the application of the main results. These examples cannot be treated by any other published approach and demonstrate the effectiveness of our results.
A bipartite graph G=(U,V,E) is convex if the vertices in V can be linearly ordered such that for each vertex u∈U, the neighbors of u are consecutive in the ordering of V. An induced matching H of G is a matching for which no edge of E connects endpoints of two different edges of H. We show that in a convex bipartite graph with n vertices and m weighted edges, an induced matching of maximum total weight can be computed in O(n+m) time. An unweighted convex bipartite graph has a representation of size O(n) that records for each vertex u∈U the first and last neighbor in the ordering of V. Given such a compact representation, we compute an induced matching of maximum cardinality in O(n) time. In convex bipartite graphs, maximum-cardinality induced matchings are dual to minimum chain covers. A chain cover is a covering of the edge set by chain subgraphs, that is, subgraphs that do not contain induced matchings of more than one edge. Given a compact representation, we compute a representation of a minimum chain cover in O(n) time. If no compact representation is given, the cover can be computed in O(n+m) time. All of our algorithms achieve optimal linear running time for the respective problem and model, and they improve and generalize the previous results in several ways: The best algorithms for the unweighted problem versions had a running time of O(n\(^{2}\)) (Brandstädt et al. in Theor. Comput. Sci. 381(1–3):260–265, 2007. https://doi.org/10.1016/j.tcs.2007.04.006). The weighted case has not been considered before.
Usher syndrome, the most prevalent cause of combined hereditary vision and hearing impairment, is clinically and genetically heterogeneous. Moreover, several conditions with phenotypes overlapping Usher syndrome have been described. This makes the molecular diagnosis of hereditary deaf-blindness challenging. Here, we performed exome sequencing and analysis on 7 Mexican and 52 Iranian probands with combined retinal degeneration and hearing impairment (without intellectual disability). Clinical assessment involved ophthalmological examination and hearing loss questionnaire. Usher syndrome, most frequently due to biallelic variants in MYO7A (USH1B in 16 probands), USH2A (17 probands), and ADGRV1 (USH2C in 7 probands), was diagnosed in 44 of 59 (75%) unrelated probands. Almost half of the identified variants were novel. Nine of 59 (15%) probands displayed other genetic entities with dual sensory impairment, including Alström syndrome (3 patients), cone-rod dystrophy and hearing loss 1 (2 probands), and Heimler syndrome (1 patient). Unexpected findings included one proband each with Scheie syndrome, coenzyme Q10 deficiency, and pseudoxanthoma elasticum. In four probands, including three Usher cases, dual sensory impairment was either modified/aggravated or caused by variants in distinct genes associated with retinal degeneration and/or hearing loss. The overall diagnostic yield of whole exome analysis in our deaf-blind cohort was 92%. Two (3%) probands were partially solved and only 3 (5%) remained without any molecular diagnosis. In many cases, the molecular diagnosis is important to guide genetic counseling, to support prognostic outcomes and decisions with currently available and evolving treatment modalities.
Safety behavior prevents the occurrence of threat, thus it is typically considered adaptive. However, safety behavior in anxiety-related disorders is often costly, and persists even the situation does not entail realistic threat. Individuals can engage in safety behavior to varying extents, however, these behaviors are typically measured dichotomously (i.e., to execute or not). To better understand the nuances of safety behavior, this study developed a dimensional measure of safety behavior that had a negative linear relationship with the admission of an aversive outcome. In two experiments, a Reward group receiving fixed or individually calibrated incentives competing with safety behavior showed reduced safety behavior than a Control group receiving no incentives. This allowed extinction learning to a previously learnt warning signal in the Reward group (i.e., updating the belief that this stimulus no longer signals threat). Despite the Reward group exhibited extinction learning, both groups showed a similar increase in fear to the warning signal once safety behavior was no longer available. This null group difference was due to some participants in the Reward group not incentivized enough to disengage from safety behavior. Dimensional assessment revealed a dissociation between low fear but substantial safety behavior to a safety signal in the Control group. This suggests that low-cost safety behavior does not accurately reflect the fear-driven processes, but also other non-fear-driven processes, such as cost (i.e., engage in safety behavior merely because it bears little to no cost). Pinpointing both processes is important for furthering the understanding of safety behavior.
A part of the plant kingdom consists of a variety of carnivorous plants. Some trap their prey
using sticky leaves, others have pitfall traps where prey cannot escape once it has fallen inside.
A rare trap type is the snap-trap: it appears only twice in the plant kingdom, in the genera
Aldrovanda and Dionaea. Even Charles Darwin himself described Dionaea muscipula, the
Venus flytrap, with the following words “This plant, commonly called Venus' fly-trap, from the
rapidity and force of its movements, is one of the most wonderful in the world”. For a long
time now, the mechanisms of Dionaea’s prey recognition, capture and utilization are of
interest for scientists and have been studied intensively.
Dionaea presents itself with traps wide-open, ready to catch insects upon contact. For this,
the insect has to touch the trigger hairs of the opened trap twice within about 20-30 seconds.
Once the prey is trapped, the trap lobes close tight, forming a hermetically sealed “green
stomach”.
Until lately, there was only limited knowledge about the molecular and hormonal mechanisms
which lead to prey capture and excretion of digestive fluids. It is known that the digestion
process is very water-consuming; therefore, the interplay of digestion-inducing and digestion inhibiting
substances was to be analyzed in this work, to elucidate the fine-tuning of the
digestive pathway. Special attention was given to the impact of phytohormones on mRNA
transcript levels of digestion-related proteins after various stimuli as well as their effect on
Dionaea’s physiological responses.
Jasmonic acid (JA) and its isoleucine-conjugated form, JA-Ile, are an important signal in the
jasmonate pathway. In the majority of non-carnivorous plants, jasmonates are critical for the
defense against herbivory and pathogens. In Dionaea, this defense mechanism has been
restructured towards offensive prey catching. One question in this work was how the
frequency of trigger hair bendings is related to the formation of jasmonates and the induction
of the digestion process. Upon contact of a prey with the trigger hairs in the inside of the trap,
the trap closes and jasmonates are produced biosynthetically. JA-Ile interacts with the COI1-
receptor, thereby activating the digestion pathway which leads to the secretion of digestive
fluid and production of transporters needed to take up prey-derived nutrients. In this work it
could be shown that the number of trigger hair bendings is positively correlated with the level
and duration of transcriptional induction of several digestive enzymes/hydrolases.
Abscisic acid (ABA) acts, along with many other functions, as the plant “drought stress
hormone”. It is synthesized either by roots as the primary sensor for water shortage or by
guard cells in the leaves. ABA affects a network of several thousand genes whose regulation
prepares the plant for drought and initiates protective measurements. It was known from
previous work that the application of ABA for 48 hours increased the required amount of
trigger hair bendings to achieve trap closure. As the digestion process is very water-intensive,
the question arose how exactly the interplay between the jasmonate- and the ABA-pathway
is organized, and if ABA could stop the running digestion process once it had been activated.
In the present work it could be shown that the application of ABA on intact traps prior to
mechanically stimulating the trigger hairs (mechanostimulation) already significantly reduced
the transcription of digestive enzymes for an incubation time as short as 4 h, showing that
already short-term exposure to ABA counteracts the effects of jasmonates when it comes to
initiating the digestion process, but does not inhibit trap closure. Incubation for 24 and 48
hours with 100 μM active ABA had no effect on trap reopening, only very high levels of 200
μM of active ABA inhibited trap reopening but also led to tissue necrosis. As the application
of ABA could reduce the transcription of digestive hydrolases, it is likely that Dionaea can stop
the digestion process, if corresponding external stimuli are received.
Another factor, which only emerged later, was the effect of the wounding-induced systemic
jasmonate burst. As efficient as ABA was in inhibiting marker hydrolase expression after
mechanostimulation in intact plants, the application of ABA on truncated traps was not able
to inhibit mechanostimulation-induced marker hydrolase expression. One reason might be
that the ABA-signal is perceived in the roots, and therefore truncated traps were not able to
react to it. Another reason might be that the wounding desensitized the tissue for the ABAsignal.
Further research is required at this point.
Inhibitors of the jasmonate pathway were also used to assess their effect on the regulation of
Dionaea´s hunting cycle. Coronatine-O-methyloxime proved to be a potent inhibitor of
mechanostimulation-induced expression of digestive enzymes, thus confirming the key
regulatory role of jasmonates for Dionaea´s prey consumption mechanism.
In a parallel project, the generation of in vitro cultures from sterilized seeds and single plant
parts proved successful, which may be important for stock-keeping of future transgenic lines.
Protoplasts were generated from leaf blade tissue and transiently transformed, expressing the
reporter protein YFP after 24 h of incubation. In the future this might be the starting point for
the generation of transgenic lines or the functional testing of DNA constructs.