Molekulare Signalwege der aseptischen Endoprothesenlockerung

Die Behandlung von immobilisierenden degenerativen und entzündlichen Gelenkerkrankungen mit der Implantation von Endoprothesen ist ein großer Erfolg und Fortschritt in der Medizin und hat stark zur Verbesserung der Lebensqualität der betroffenen Patienten beigetragen. Jährlich werden weltweit ca. 1,3 Mio. Endoprothesen implantiert, davon allein 500.000 in den USA. Dennoch sind die einmal implantierten Prothesen nicht von lebenslanger Dauer und unterliegen multiplen Einflüssen. Trotz immer neuer Entwicklungen müssen innerhalb der ersten 15 Jahre bis zu 10% der Implantate aufgrund vorzeitiger Prothesenlockerung gewechselt werden. Bei vorzeitiger Lockerung ohne Infekt oder Trauma spricht man von aseptischer Lockerung. Es ist allgemein bekannt, dass durch Abrieb entstandene Kleinstpartikel und aktivierte Makrophagen die Hauptrolle im Prozess der aseptischen Lockerung spielen. Die Pathophysiologie ist jedoch noch nicht vollständig erklärt. Die vorliegende Arbeit gibt eine Übersicht über die anerkannten molekularen Mechanismen und die Signalwege, die zur aseptischen Prothesenlockerung führen. Außerdem werden neue Therapieoptionen zur Vermeidung der aseptischen Lockerung diskutier

Productivity of Telemedical Services: A State of the Art Analysis of Input and Output Factors

Peters C, Drees A, Leppert F, et al. Productivity of Telemedical Services: A State of the Art Analysis of Input and Output Factors. In: Ganz W, Kicherer F, Schletz A, eds. Productivity of services NextGen : beyond output/input ; RESER 2011, conference proceedings, September 8th - 9th 2011, Hamburg, Germany. Stuttgart: Fraunhofer-Verl.; 2011

Visualization of interindividual differences in spinal dynamics in the presence of intraindividual variabilities

Surface topography systems enable the capture of spinal dynamic movement. A visualization of possible unique movement patterns appears to be difficult due to large intraclass and small inter-class variabilities. Therefore, we investigated a visualization approach using Siamese neural networks (SNN) and checked, if the identification of individuals is possible based on dynamic spinal data. The presented visualization approach seems promising in visualizing subjects in the presence of intraindividual variability between different gait cycles as well as day-to-day variability. Overall, the results indicate a possible existence of a personal spinal ‘fingerprint’. The work forms the basis for an objective comparison of subjects and the transfer of the method to clinical use cases

Exposure to radial extracorporeal shock waves modulates viability and gene expression of human skeletal muscle cells: a controlled in vitro study

Background: Recent clinical and animal studies have shown that extracorporeal shock wave therapy has a promoting influence on the healing process of musculoskeletal disorders. However, the underlying biological effects of extracorporeal shock wave therapy on human skeletal muscle cells have not yet been investigated. Methods: In this study, we investigated human skeletal muscle cells after exposure to radial extracorporeal shock waves in a standardized in vitro setup. Cells were isolated from muscle specimens taken from adult patients undergoing spine surgery. Primary muscle cells were exposed once or twice to radial extracorporeal shock waves in vitro with different energy flux densities. Cell viability and gene expression of the paired box protein 7 (Pax7), neural cell adhesion molecule (NCAM), and myogenic factor 5 (Myf5) and MyoD as muscle cell markers were compared to non-treated muscle cells that served as controls. Results: Isolated muscle cells were positive for the hallmark protein of satellite cells, Pax7, as well as for the muscle cell markers NCAM, MyoD, and Myf5. Exposure to radial extracorporeal shock waves at low energy flux densities enhanced cell viability, whereas higher energy flux densities had no further significant impact. Gene expression analyses of muscle specific genes (Pax7, NCAM, Myf5, and MyoD) demonstrated a significant increase after single exposure to the highest EFD (4 bar, 0.19 mJ/mm(2)) and after double exposure with the medium EFDs (2 and 3 bar;0.09 and 0.14 mJ/mm(2), respectively). Double exposure of the highest EFD, however, results in a significant down-regulation when compared to single exposure with this EFD. Conclusions: This is the first study demonstrating that radial extracorporal shock wave therapy has the potential to modulate the biological function of human skeletal muscle cells. Based on our experimental findings, we hypothesize that radial extracorporal shock wave therapy could be a promising therapeutic modality to improve the healing process of sports-related structural muscle injuries

Diagnostik und Therapie der postmenopausalen Osteopathie

Alle 30 Sekunden ereignet sich in Deutschland eine osteoporotische Fraktur eines Wirbelkörpers, eines Schenkelhalses oder des Unterarmes. Über 7 Millionen Frauen und ca. 2 Millionen Männer sind von der Erkrankung betroffen. Ein Drittel unserer Patienten versterben in den ersten 100 Tagen nach einer Schenkelhalsfraktur, ein Drittel bleibt pflegebedürftig und nur ein Drittel erreicht die alte körperliche Fitness. Aufgrund dieser dramatischen Ereignisse hat die WHO die Osteoporose in die Liste der 10 wichtigsten Erkrankungen weltweit aufgenommen. Osteoporose ist aber kein Schicksal, sondern eine behandelbare Erkrankung. In dem Vortrag wird die 3-Säulen-Therapie, bestehend aus Ernährung, Physiotherapie und medikamentöser Therapie vorgestellt und kurze Hinweise auf die besondere chirurgische Therapie gegeben. Praktische Tipps bilden den Abschluss des Vortrages. Der Referent, Dr. Philipp Drees, ist Klinikdirektor und Chefarzt am Zentrum für Unfallchirurige und Orthopädie des Stiftungsklinikums Mittelrhein in Koblenz

Dexamethasone Inhibits the Pro-Angiogenic Potential of Primary Human Myoblasts

Tissue regeneration depends on the complex processes of angiogenesis, inflammation and wound healing. Regarding muscle tissue, glucocorticoids (GCs) inhibit pro-inflammatory signalling and angiogenesis and lead to muscle atrophy. Our hypothesis is that the synthetic GC dexamethasone (dex) impairs angiogenesis leading to muscle atrophy or inhibited muscle regeneration. Therefore, this study aims to elucidate the effect of dexamethasone on HUVECs under different conditions in mono- and co-culture with myoblasts to evaluate growth behavior and dex impact with regard to muscle atrophy and muscle regeneration. Viability assays, qPCR, immunofluorescence as well as ELISAs were performed on HUVECs, and human primary myoblasts seeded under different culture conditions. Our results show that dex had a higher impact on the tube formation when HUVECs were maintained with VEGF. Gene expression was not influenced by dex and was independent of cells growing in a 2D or 3D matrix. In co-culture CD31 expression was suppressed after incubation with dex and gene expression analysis revealed that dex enhanced expression of myogenic transcription factors, but repressed angiogenic factors. Moreover, dex inhibited the VEGF mediated pro angiogenic effect of myoblasts and inhibited expression of angiogenic inducers in the co-culture model. This is the first study describing a co-culture of human primary myoblast and HUVECs maintained under different conditions. Our results indicate that dex affects angiogenesis via inhibition of VEGF release at least in myoblasts, which could be responsible not only for the development of muscle atrophy after dex administration, but also for inhibition of muscle regeneration after vascular damage

Venous thromboembolism in patients hospitalized for knee joint replacement surgery

Patients undergoing knee joint replacement (KJR) are at high risk of postoperative venous thromboembolism (VTE), but data on the time trends of VTE rate in this population are sparse. In this analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary KJR in Germany 2005-2016. Overall, 1,804,496 hospitalized patients with elective primary KJR (65.1% women, 70.0 years [IQR 63.0-76.0]) were included in the analysis. During hospitalization, VTE was documented in 23,297 (1.3%) patients. Total numbers of primary KJR increased from 129,832 in 2005 to 167,881 in 2016 (β-(slope)-estimate 1,978 [95% CI 1,951 to 2,004], P < 0.001). In-hospital VTE decreased from 2,429 (1.9% of all hospitalizations for KJR) to 1,548 (0.9%) cases (β-estimate - 0.77 [95% CI - 0.81 to - 0.72], P < 0.001), and in-hospital death rate from 0.14% (184 deaths) to 0.09% (146 deaths) (β-estimate - 0.44 deaths per year [95% CI - 0.59 to - 0.30], P < 0.001). Infections during hospitalization were associated with a higher VTE risk. VTE events were independently associated with in-hospital death (OR 20.86 [95% CI 18.78-23.15], P < 0.001). Annual number of KJR performed in Germany increased by almost 30% between 2005 and 2016. In parallel, in-hospital VTE rates decreased from 1.9 to 0.9%. Perioperative infections were associated with higher risk for VTE. Patients who developed VTE had a 21-fold increased risk of in-hospital death

AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome

Disorders of swallowing often lead to pneumonia when material enters the airways (aspiration). Flexible Endoscopic Evaluation of Swallowing (FEES) plays a key role in the diagnostics of aspiration but is prone to human errors. An AI-based tool could facilitate this process. Recent non-endoscopic/non-radiologic attempts to detect aspiration using machine-learning approaches have led to unsatisfying accuracy and show black-box characteristics. Hence, for clinical users it is difficult to trust in these model decisions. Our aim is to introduce an explainable artificial intelligence (XAI) approach to detect aspiration in FEES. Our approach is to teach the AI about the relevant anatomical structures, such as the vocal cords and the glottis, based on 92 annotated FEES videos. Simultaneously, it is trained to detect boluses that pass the glottis and become aspirated. During testing, the AI successfully recognized the glottis and the vocal cords but could not yet achieve satisfying aspiration detection quality. While detection performance must be optimized, our architecture results in a final model that explains its assessment by locating meaningful frames with relevant aspiration events and by highlighting suspected boluses. In contrast to comparable AI tools, our framework is verifiable and interpretable and, therefore, accountable for clinical users

Dynamic surface topography data for assessing intra- and interindividual variation of vertebral motion

Spinal function is substantially related to the motion of the particular vertebrae and the spine as a whole. For systematic assessment of individual motion, data sets are required which cover the kinematics comprehensively. Additionally, the data should enable a comparison of inter- and intraindividual variation of vertebral orientation in dedicated motion tasks like gait. For this purpose, this article provides surface topography (ST) data which were acquired while the individual test persons were walking on a treadmill at three different speed levels (2 km/h, 3 km/h, 4 km/h). In each recording, ten full walking cycles were included per test case to enable a detailed analysis of motion patterns. The provided data reflects asymptomatic and pain-free volunteers. Each data set contains the vertebral orientation in all three motion directions for the vertebra prominens down to L4 as well as the pelvis. Additionally, spinal parameters like balance, slope, and lordosis / kyphosis parameters as well as an assignment of the motion data to single gait cycles are included. The complete raw data set without any preprocessing is provided. This allows to apply a broad range of further signal processing and evaluation steps in order to identify characteristic motion patterns as well as intra- and inter-individual variation of vertebral motion