Pränatale Entwicklung der IgE-Antwort unter Einfluss des mütterlichen Milieus, Ergebnisse einer multizentrischen, prospektiven Kohortenstudie

Allergische Erkrankungen gehören zu den häufigsten chronischen Erkrankungen im Kindesalter. Ihre Inzidenz hat in den letzten Jahrzehnten dramatisch zugenommen. Die genauen Entstehungsmechanismen sind noch immer nicht geklärt. Die aktuelle Diskussion über diese Entstehungsmechanismen beschäftigt sich zunehmend mit der Entstehung von Allergien in utero. Die vorliegende Arbeit hatte folgende Fragestellungen: (1) Können allergen-spezifische IgE-Antikörper als Hinweis auf eine intrauterine Sensibilisierung in Nabelschnurblut nachgewiesen werden? (2) Besteht eine Korrelation zwischen maternalen und paternalen mit neonatalen IgE-Profilen Im Rahmen der PASTURE Studie wurden insgesamt 933 Nabelschnurblutproben auf allergen-spezifische IgE-AK untersucht. 24% der untersuchten Proben waren IgE-positiv. Weiter konnte eine Korrelationzischen mütterlichen und neonatalen IgE-AK gegen Hühnerei- udn Kuhmilchallergene nachgewiesen werden. Bereits intrauterin scheinen immunmodulatorische Mechanismen im Sinne einer allergischen Sensibilisierung stattzufinden. Mütter mit positiven allergenspezifischen IgE-AK scheinen die fetale Eigenproduktion von allergenspezifischen IgE-Antikörpern zu beeinflussen. Welche Bedeutung den Ergebnissen der vorliegenden Arbeit in Hinblick auf die Entwicklung manifester allergischer Erkrankungen zukommt, wird sich im Verlauf dieser prospektiven Studie herausstellen

The ideal site of cement application in cement augmented sacroiliac screw fixation: the biomechanical perspective.

PURPOSE To compare construct stability of cement augmented sacroiliac screws using two different cementation sites in a biomechanical fragility fracture model of the pelvis. METHODS A fracture model with an incomplete fracture of the sacral ala and complete fracture of the anterior pelvic ring mimicking a FFP IIB fragility fracture of the pelvis was established in five fresh frozen human cadaveric pelvises. Sacral fracture stabilization was achieved with bilateral 7.3 mm fully threaded sacroiliac screws. Cement augmentation was performed at the tip of the screw (body of S1; Group A) on one side, and at the midshaft of the screw (sacral ala; Group B) on the contralateral side. Biomechanical testing was conducted separately on both sides comprising cyclic loading of axial forces transferred through the tested hemipelvis from L5 to the ipsilateral acetabulum. Combined angular displacement in flexion and internal rotation ("gap angle"), angular displacement of the ilium in relation to the screw ("screw tilt ilium"), and screw tip cutout were evaluated. RESULTS Relative interfragmentary movements were associated with significantly higher values in group A versus group B for "gap angle" (2.4° vs. 1.4°; p < 0.001), and for "screw tilt ilium" (3.3° vs. 1.4°; p < 0.001), respectively. No significant difference was indicated for screw tip cutout between the two groups (0.6 mm [Group A] vs. 0.8 mm [Group B]; p = 0.376). CONCLUSION The present study demonstrated less fragment and screw displacements in a FFP IIB fracture model under physiologic cyclic loading by cement augmentation of sacroiliac screws at the level of the lateral mass compared to the center of vertebral body of S1

PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis-A Single-Center Retrospective Study of 73 Cases.

BACKGROUND Surgical treatment for erosive pyogenic spondylodiscitis of the lumbar spine is challenging as, following debridement of the intervertebral and bony abscess, a large and irregular defect is created. Sufficient defect reconstruction with conventional implants using a posterior approach is often impossible. Therefore, we developed the "Cement-PLIF", a single-stage posterior lumbar procedure, combining posterior lumbar interbody fusion (PLIF) with defect-filling using antibiotic-loaded polymethylmethacrylate (PMMA). This study first describes and evaluates the procedure's efficacy, safety, and infection eradication rate. Radiological implant stability, bone-regeneration, sagittal profile reconstruction, procedure-related complications, and pre-existing comorbidities were further analyzed. METHODS A retrospective cohort study analyzing 73 consecutive patients with a minimum of a one-year follow-up from 2000-2017. Patient-reported pain levels and improvement in infectious serological parameters evaluated the clinical outcome. Sagittal profile reconstruction, anterior bone-regeneration, and posterior fusion were analyzed in a.p. and lateral radiographs. A Kaplan-Meier analysis was used to determine the impact of pre-existing comorbidities on mortality. Pre-existing comorbidities were quantified using the Charlson-Comorbidity Index (CCI). RESULTS Mean follow-up was 3.3 (range: 1-16; ±3.2) years. There was no evidence of infection persistence in all patients at the one-year follow-up. One patient underwent revision surgery for early local infection recurrence (1.4%). Five (6.9%) patients required an early secondary intervention at the same level due to minor complications. Radiological follow-up revealed implant stability in 70/73 (95.9%) cases. Successful sagittal reconstruction was demonstrated in all patients (p < 0.001). There was a significant correlation between Kaplan-Meier survival and the number of pre-existing comorbidities (24-months-survival: CCI ≤ 3: 100%; CCI ≥ 3: 84.6%; p = 0.005). CONCLUSIONS The Cement-PLIF procedure for pyogenic erosive spondylodiscitis is an effective and safe treatment as evaluated by infection elimination, clinical outcome, restoration, and maintenance of stability and sagittal alignment

Pränatale Entwicklung der IgE-Antwort unter Einfluss des mütterlichen Milieus, Ergebnisse einer multizentrischen, prospektiven Kohortenstudie

Allergische Erkrankungen gehören zu den häufigsten chronischen Erkrankungen im Kindesalter. Ihre Inzidenz hat in den letzten Jahrzehnten dramatisch zugenommen. Die genauen Entstehungsmechanismen sind noch immer nicht geklärt. Die aktuelle Diskussion über diese Entstehungsmechanismen beschäftigt sich zunehmend mit der Entstehung von Allergien in utero. Die vorliegende Arbeit hatte folgende Fragestellungen: (1) Können allergen-spezifische IgE-Antikörper als Hinweis auf eine intrauterine Sensibilisierung in Nabelschnurblut nachgewiesen werden? (2) Besteht eine Korrelation zwischen maternalen und paternalen mit neonatalen IgE-Profilen Im Rahmen der PASTURE Studie wurden insgesamt 933 Nabelschnurblutproben auf allergen-spezifische IgE-AK untersucht. 24% der untersuchten Proben waren IgE-positiv. Weiter konnte eine Korrelationzischen mütterlichen und neonatalen IgE-AK gegen Hühnerei- udn Kuhmilchallergene nachgewiesen werden. Bereits intrauterin scheinen immunmodulatorische Mechanismen im Sinne einer allergischen Sensibilisierung stattzufinden. Mütter mit positiven allergenspezifischen IgE-AK scheinen die fetale Eigenproduktion von allergenspezifischen IgE-Antikörpern zu beeinflussen. Welche Bedeutung den Ergebnissen der vorliegenden Arbeit in Hinblick auf die Entwicklung manifester allergischer Erkrankungen zukommt, wird sich im Verlauf dieser prospektiven Studie herausstellen

Characteristics of Prehospital Death in Trauma Victims.

BACKGROUND Using Injury Severity Score (ISS) data, this study aimed to give an overview of trauma mechanisms, causes of death, injury patterns, and potential survivability in prehospital trauma victims. METHODS Age, gender, trauma mechanism, cause of death, and ISS data were recorded regarding forensic autopsies and whole-body postmortem CT. Characteristics were analyzed for injuries considered potentially survivable at cutoffs of (I) ISS ≤ 75 vs. ISS = 75, (II) ISS ≤ 49 vs. ISS ≥ 50, and (III) ISS LD50 according to Bull's probit model. RESULTS In n = 130 prehospital trauma victims (45.3 ± 19.5 years), median ISS was 66. Severity of injuries to the head/neck and chest was greater compared to other regions (p < 0.001). 52% died from central nervous system (CNS) injury. Increasing injury severity in head/neck region was associated with CNS-injury related death (odds ratio (OR) 2.7, confidence interval (CI) 1.8-4.4). Potentially survivable trauma was identified in (I) 56%, (II) 22%, and (III) 9%. Victims with ISS ≤ 75, ISS ≤ 49, and ISS < LD50 had lower injury severity across most ISS body regions compared to their respective counterparts (p < 0.05). CONCLUSION In prehospital trauma victims, injury severity is high. Lethal injuries predominate in the head/neck and chest regions and are associated with CNS-related death. The appreciable amount (9-56%) of victims dying at presumably survivable injury severity encourages perpetual efforts for improvement in the rescue of highly traumatized patients

Transiliac-Transsacral Screw Fixation is Superior to Lumbopelvic Stabilization in the Treatment of Minimally Displaced Sacral H-/U-Type Fragility Fractures.

STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To compare the outcomes and complications of transiliac-transsacral screw fixation (TIS) and lumbopelvic fixation (LPS), the 2 most common fixation methods for nondisplaced and minimally displaced H-/U- type sacral fragility fractures. METHODS Medical records of patients treated with TIS or LPS for nondisplaced and minimally displaced H-/U-type sacral fragility fractures at 2 level A trauma centers between 2012 and 2022 were analyzed. Postoperative low back pain and mobility levels were assessed as primary outcomes before discharge and at 6 weeks and 6 months postoperatively. Surgery time, blood loss, and surgical complication rates were assessed as secondary outcomes. Statistical analyses consisted of Fisher's exact tests for frequency distributions and Mann-Whitney-U tests and t-tests for group comparisons. RESULTS 52 patients undergoing TIS (mean age: 78 ± 9 years) and 36 patients undergoing LPS (74 ± 10 years) with no discrepancy in demographic parameters were identified. There were no differences in low back pain levels between the 2 groups before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). There were no differences in mobility levels before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). Duration of surgery was shorter after TIS (36 ± 13 min) compared to LPS (113 ± 31 min) (P 0.05). Median length of stay was shorter after TIS (11 days) compared to LPS (14 days) (P < 0.05). Rates of reoperations directly related to the index surgery were lower after TIS (n = 2) compared to LPS (n = 10) (P < 0.01). Implant failures were observed only after LPS (n = 1). CONCLUSION Patients with nondisplaced and minimally displaced H-/U- type sacral fragility fractures may preferably be treated using TIS, as it is equivalent to LPS in terms of low back pain reduction and restoration of mobility, but allows for shorter operative time, less blood loss and lower reoperation rates. Prospective randomized studies should be conducted to substantiate our findings and develop distinct treatment recommendations

Joint-preserving surgery improves pain, range of motion, and abductor strength after Legg-Calvé-Perthes disease

Patients after Legg-Calvé-Perthes disease (LCPD) often develop pain, impaired ROM, abductor weakness, and progression of osteoarthritis (OA) in early adulthood. Based on intraoperative observations during surgical hip dislocation, we established an algorithm for more detailed characterization of the underlying pathomorphologies with a proposed joint-preserving surgical treatment

Acetabular Cartilage Thickness Differs Among Cam, Pincer, or Mixed-Type Femoroacetabular Impingement: A Descriptive Study Using In Vivo Ultrasonic Measurements During Surgical Hip Dislocation.

OBJECTIVE To investigate acetabular cartilage thickness among (1) 8 measurement locations on the lunate surface and (2) different types of femoroacetabular impingement (FAI). DESIGN Prospective descriptive study comparing in vivo measured acetabular cartilage thickness using a validated ultrasonic device during surgical hip dislocation in 50 hips. Measurement locations included the anterior/posterior horn and 3 locations on each peripheral and central aspect of the acetabulum. The clock system was used for orientation. Thickness was compared among cam (11 hips), pincer (8 hips), and mixed-type (31 hips) of FAI. Mean age was 31 ± 8 (range, 18-49) years. Hips with no degenerative changes were included (Tönnis stage = 0). RESULTS Acetabular cartilage thickness ranged from 1.7 mm to 2.7 mm and differed among the 8 locations (P < 0.001). Thicker cartilage was found on the peripheral aspect at 11 and 1 o'clock positions (mean of 2.4 mm and 2.7 mm, respectively). At 5 out of 8 locations of measurement (anterior and posterior horn, 1 o'clock peripheral, 12 and 2 o'clock central), cartilage thickness was thinner in hips with pincer impingement compared to cam and/or mixed-type of FAI (P ranging from <0.001 to 0.031). No difference in thickness existed between cam and mixed-type of impingement (P = 0.751). CONCLUSION Acetabular cartilage thickness varied topographically and among FAI types. This study provides first baseline information about topographical cartilage thickness in FAI measured in vivo. Thinner cartilage thickness in pincer deformities could be misinterpreted as joint degeneration and could therefore have an impact on indication for hip preserving surgery

Impact of different surgical and non-surgical interventions on health-related quality of life after thoracolumbar burst fractures without neurological deficit: protocol for a comprehensive systematic review with network meta-analysis

Introduction There is no international consensus on how to treat thoracolumbar burst fractures (TLBFs) without neurological deficits. The planned systematic review with network meta-analyses (NMA) aims to compare the effects on treatment outcomes, focusing on midterm health-related quality of life (HRQoL).Methods and analysis We will conduct a comprehensive and systematic literature search, identifying studies comparing two or more treatment modalities. We will search MEDLINE, EMBASE, Google Scholar, Scopus and Web of Science from January 2000 until July 2023 for publications. We will include (randomised and non-randomised) controlled clinical trials assessing surgical and non-surgical treatment methods for adults with TLBF. Screening of references, data extraction and risk of bias (RoB) assessment will be done independently by two reviewers. We will extract relevant studies, participants and intervention characteristics. The RoB will be assessed using the revised Cochrane RoB V.2.0 tool for randomised trials and the Newcastle-Ottawa Scale for controlled trials. The OR for dichotomous data and standardised mean differences for continuous data will be presented with their respective 95% CIs. We will conduct a random-effects NMA to assess the treatments and determine the superiority of the therapeutic approaches. Our primary outcomes will be midterm (6 months to 2 years after injury) overall HRQoL and pain. Secondary outcomes will include radiological or clinical findings. We will present network graphs, forest plots and relative rankings on plotted rankograms corresponding to the treatment rank probabilities. The ranking results will be represented by the area under the cumulative ranking curve. Analyses will be performed in Stata V.16.1 and R. The quality of the evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluations framework.Ethics and dissemination Ethical approval is not required. The research will be published in a peer-reviewed journal