Komplexe proximale Humerusfraktur beim alten Menschen: Winkelstabile Plattenosteosynthese vs. Hemiarthroplastik

Zusammenfassung: Hintergrund: Ziel der vorliegenden Untersuchung ist ein direkter Vergleich der Schulterhemiarthroplastik (SHA) mit der winkelstabilen Plattenosteosynthese (WSPOS) beim alten Patienten mit komplexer proximaler Humerusfraktur. Patienten und Methoden: Zwischen 2003 und 2005 wurden alle Patienten (n=52, Alter ≥70Jahre) mit 3- und 4-Segment-Frakturen des proximalen Humerus, welche mit einer WSPOS (PHILOS®) versorgt wurden, prospektiv erfasst und nach einem Jahr mittels Constant-Score (CS), Oxford Shoulder Score (OSS) und radiologisch nachkontrolliert. Verglichen wurde die WSPOS mit einem historischen Kollektiv mit identischen Einschlusskriterien, welches zwischen 1995 und 1997 an der gleichen Institution mittels SHA versorgt wurde (n=59). Ergebnisse: Beide Patientenkollektive zeigten keine Unterschiede bezüglich Alter, Geschlechterverteilung und Frakturtypen. Der CS war signifikant besser für die WSPOS (median 71 vs. 41). Bezüglich Schmerzen zeigte sich im OSS kein Unterschied zwischen den Gruppen. In der WSPOS-Gruppe mussten signifikant mehr Revisionseingriffe durchgeführt werden (25% vs. 2%). Schlussfolgerung: Die WSPOS liefert beim alten Patienten, bei komplexen proximalen Humerusfrakturen deutlich bessere funktionelle Resultate, ist jedoch mit mehr Rezidiveingriffen behaftet. Die Selbständigkeit der Patienten kann bei beiden Operationsmethoden bei guter Schmerzfreiheit meist erhalten werde

The RNA helicase RHAU (DHX36) unwinds a G4-quadruplex in human telomerase RNA and promotes the formation of the P1 helix template boundary

Human telomerase RNA (hTR) contains several guanine tracts at its 5′-end that can form a G4-quadruplex structure. Previous evidence suggests that a G4-quadruplex within this region disrupts the formation of an important structure within hTR known as the P1 helix, a critical element in defining the template boundary for reverse transcription. RNA associated with AU-rich element (RHAU) is an RNA helicase that has specificity for DNA and RNA G4-quadruplexes. Two recent studies identify a specific interaction between hTR and RHAU. Herein, we confirm this interaction and identify the minimally interacting RNA fragments. We demonstrate the existence of multiple quadruplex structures within the 5′ region of hTR and find that these regions parallel the minimal sequences capable of RHAU interaction. We confirm the importance of the RHAU-specific motif in the interaction with hTR and demonstrate that the helicase activity of RHAU is sufficient to unwind the quadruplex and promote an interaction with 25 internal nucleotides to form a stable P1 helix. Furthermore, we have found that a 5′-terminal quadruplex persists following P1 helix formation that retains affinity for RHAU. Finally, we have investigated the functional implications of this interaction and demonstrated a reduction in average telomere length following RHAU knockdown by small interfering RNA (siRNA)

Role of seminal plasma in the anti-HIV-1 activity of candidate microbicides

BACKGROUND: Evaluation of microbicides for prevention of HIV-1 infection in macaque models for vaginal infection has indicated that the concentrations of active compounds needed for protection by far exceed levels sufficient for complete inhibition of infection in vitro. These experiments were done in the absence of seminal plasma (SP), a vehicle for sexual transmission of the virus. To gain insight into the possible effect of SP on the performance of selected microbicides, their anti-HIV-1 activity in the presence, and absence of SP, was determined. METHODS: The inhibitory activity of compounds against the X4 virus, HIV-1 IIIB, and the R5 virus, HIV-1 BaL was determined using TZM-bl indicator cells and quantitated by measuring β-galactosidase induced by infection. The virucidal properties of cellulose acetate 1,2-benzene-dicarboxylate (CAP), the only microbicide provided in water insoluble, micronized form, in the presence of SP was measured. RESULTS: The HIV-1 inhibitory activity of the polymeric microbicides, poly(naphthalene sulfonate), cellulose sulfate, carrageenan, CAP (in soluble form) and polystyrene sulfonate, respectively, was considerably (range ≈ 4 to ≈ 73-fold) diminished in the presence of SP (33.3%). Formulations of micronized CAP, providing an acidic buffering system even in the presence of an SP volume excess, effectively inactivated HIV-1 infectivity. CONCLUSION: The data presented here suggest that the in vivo efficacy of polymeric microbicides, acting as HIV-1 entry inhibitors, might become at least partly compromised by the inevitable presence of SP. These possible disadvantages could be overcome by combining the respective polymers with acidic pH buffering systems (built-in for formulations of micronized CAP) or with other anti-HIV-1 compounds, the activity of which is not affected by SP, e.g. reverse transcriptase and zinc finger inhibitors

Vein Patch Closure Using Below the Knee Greater Saphenous Vein for Femoral Endarterectomy Procedures is Not Always a Safe Choice

: Background: The complication of vein patch rupture is well described after carotid patch angioplasty; however, there is a paucity of data about the safety of vein patch closure in the setting of femoral endarterectomy. Methods/results: From May 2012 to May 2015, 115 femoral endarterectomies with patch closure were performed. A patch rupture occurred in three cases (2.6%) with a mortality rate of 66% (2/3). In all cases the greater saphenous vein below the knee was used as patch material. Discussion/conclusion: Vein patches, particularly from small calibre veins, should be excluded in femoral endarterectomy procedures as they pose a substantial risk of rupture. Keywords: Angioplasty, Patch rupture, Femoral artery, Patch, Great saphenous vei

Promozione della salute per bambini, genitori e insegnanti: una sperimentazione controllata e randomizzata

Empowerment in family and school (Eifas) is a randomised controlled trial to evaluate an early intervention for young people, that combines standardized and effective programs mediated by teachers and by parents. The programs draw upon skills training and self-efficacy beliefs to enhance well-being of scholars, their parents and their teachers in the context of family and school. It therefore aims at enhancing the positive development of young people in their closest social context. Design. The effectiveness is tested by a pre-, post-test and follow up, control group design with random assignment of school. Participants. At baseline 78 school classes with 82 Teachers, 794 parents and 1423 children (Mean age: 8 years and 11 months) participated. Main outcome measures. The primary outcome measure is smoking behaviour of studentsand the attitude towards smoking. Results. The risk of being a smoker at follow up is significantly reduced in the intervention groups compared to the control group, with the largest effect in the combined intervention group. Interesting changes were found also I parents and teachers. Conclusions. Programs to empower education of young children together in family and school have been shown to be a useful strategy to promote health and wellbeing in children, their parents and their teachers. The combined interventions in the setting of school and in the family setting do work compared to untreated control groups

[Complex fracture of the proximal humerus in the elderly. Locking plate osteosynthesis vs hemiarthroplasty]

The purpose of the present study was a direct comparison of fixed-angle plate fixation (FAPF) and shoulder hemiarthroplasty (SHA) for complex fractures of the proximal humerus in the elderly