Reconstruction of the pelvic ring using an autologous free non-vascularized fibula graft in a patient with benign fibrous histiocytoma

BACKGROUND: Benign fibrous histiocytomas (BFH) usually presents as a small benign lesion that predominantly occurs in the skin. Only few cases of BFH arising from bone have been reported, its occurrence in pelvic bones is even rarer. CASE PRESENTATION: A 34-year-old female presented with BFH at a rare anatomical location on both sides of the os ilium which was larger than earlier reported BFH of the bone. Surgical resection was performed successfully including resection of the inner pelvic ring and reconstruction of the linea terminalis using a non-vascularized fibular autograft. At 18 months after tumor resection and reconstruction of the pelvic ring, with interposition of a free vascularized fibula graft patient has an excellent clinical oncological and functional outcome. CONCLUSION: Non vascularized fibular autograft is a useful reconstructive procedure in select patients

MoRe – Mobile Research: App-basierte Studien nach dem Baukastenprinzip

Die Erfassung der Effektivität von Behandlungsmethoden sowie von Therapieergebnissen steht in einer ergebnisorientierten medizinischen Versorgung immer mehr im Vordergrund klinischen und wissenschaftlichen Interesses. Daher erwarten Experten von mobilen Gesundheitslösungen (mHealth) unter anderem Verbesserungen in der Gesundheitsvorsorge und Krankheitsfrüherkennung, Kosteneinsparungen und/oder Qualitätsverbesserungen in der Leistungserbringung. Ziel des Projektes ist die Etablierung einer universellen Applikation, die es dem Anwender ermöglicht - entsprechend aktueller Standards in Bezug auf Patientensicherheit und Datenschutz und guter klinischer Praxis - ohne individuelle Programmierkenntnisse ein eigenes Forschungsprojekt zur systematischen und hochwertigen Datenerfassung von Patienten mit unterschiedlichsten Pathologien zusammenzustellen. Dabei werden, gemäß der immer wichtiger werdenden Versorgungsforschung, Patient-reported Outcome Parameter als wertvolles und zunehmend etabliertes Instrument zur Untersuchung von Therapieergebnissen eingesetzt. Lebensqualität als wichtiger messbarer Parameter bei nicht-vitalen Indikationen sei hier nur als Beispiel genannt. Zusammengestellte Studien werden über eine Smartphone-App für den Patienten zugänglich. Die hierdurch erfassten Daten kann der Wissenschaftler über eine webbasierte Oberfläche analysieren und zur weiteren Auswertung herunterladen. Öffentliche Studien können weltweit innerhalb der App gesucht werden. Geschlossene Studien sind privat

Quadriceps Strength in Patients With Isolated Cartilage Defects of the Knee : Results of Isokinetic Strength Measurements and Their Correlation With Clinical and Functional Results.

Background: Recent studies have found a significant deficit of maximum quadriceps strength after autologous chondrocyte implantation (ACI) of the knee. However, it is unclear whether muscular strength deficits in patients with cartilage damage exist prior to operative treatment. Purpose: To isokinetically test maximum quadriceps muscle strength and quantify the impact of possible strength deficits on functional and clinical test results. Study Design: Cross-sectional study; Level of evidence, 3. Methods: To identify clinically relevant muscular strength deficits, 24 patients (5 females, 19 males; mean age, 34.5 years; body mass index, 25.9 kg/m2) with isolated cartilage defects (mean onset, 5.05 years; SD, 7.8 years) in the knee joint underwent isokinetic strength measurements. Maximal quadriceps strength was recorded in 3 different testing modes: pure concentric contraction (flexors and extensors alternating work; con1), concentric-eccentric (only the extensors work concentrically and eccentrically; con2), and eccentric contraction in the alternating mode (ecc). Results were compared for functional performance (single-leg hop test), pain scales (visual analog scale [VAS], numeric rating scale [NRS]), self-reported questionnaires (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Scale [KOOS]), and defect size (cm2). Results: Compared with the uninjured leg, significantly lower quadriceps strength was detected in the injured leg in all isokinetic working modes (con1 difference, 27.76 N·m [SD 17.47; P = .003]; con2 difference, 21.45 N·m [SD, 18.45; P =.025]; ecc difference, 29.48 N·m [SD, 21.51; P = .001]), with the largest deficits found for eccentric muscle performance. Moderate negative correlations were observed for the subjective pain scales NRS and VAS. The results of the IKDC and KOOS questionnaires showed low, nonsignificant correlations with findings in the isokinetic measurement. Moreover, defect sizes (mean, 3.13 cm2) were of no importance regarding the prediction of the strength deficit. The quadriceps strength deficit between the injured and the uninjured leg was best predicted by the results of the single-leg hop test. Conclusion: Patients with isolated cartilage defects of the knee joint have significant deficits in quadriceps muscle strength of the injured leg compared with the uninjured leg. The single-leg hop test may be used to predict quadriceps strength deficits. Future research should address whether preoperative strength training in patients with cartilage defects of the knee could be effective and should be taken into consideration in addition to surgical treatment. Keywords muscle strength, isokinetic, cartilage defect, cartilage repair, knee joint, rehabilitatio

Parameters affecting baseline hip function in patients with cam-derived femoroacetabular impingement syndrome: data analysis from the German Cartilage Registry

Background Using the database of the German Cartilage Registry (KnorpelRegister DGOU), this study aims to present patient- and joint-related baseline data in a large cohort of patients with cam-derived femoroacetabular impingement syndrome (FAI) and to detect symptom-determining factors. Materials and methods Requiring cam morphology as the primary pathology, 362 patients were found to be eligible for inclusion in the study. The assessment of preoperative baseline data was performed using the patient-reported outcome measure—International Hip Outcome Tool (iHOT-33). Descriptive statistics were performed to present baseline data. Univariate and multiple regression with post hoc testing were used to identify patient- and joint-related factors that might affect the preoperative iHOT-33 and its subscores, respectively. Results The study collective’s mean age was 36.71 ± 10.89 years, with 246 (68%) of them being male. The preoperative mean iHOT-33 total was 46.31 ± 20.33 with the subsection “sports and recreational activities” presenting the strongest decline (26.49 ± 20.68). The parameters “age,” “sex,” “body mass index” (BMI), and the confirmation of “previous surgery on the affected hip” were identified to statistically affect the preoperative iHOT-33. In fact, a significantly lower mean baseline score was found in patients aged > 40 years (p < 0.001), female sex (p < 0.001), BMI ≥ 25 kg/m2 (p = 0.002) and in patients with previous surgery on the affected hip (p = 0.022). In contrast, the parameters defect grade and size, labral tears, and symptom duration delivered no significant results. Conclusions A distinct reduction in the baseline iHOT-33, with mean total scores being more than halved, was revealed. The parameters “age > 40 years,” “female sex,” “BMI ≥ 25,” and confirmation of “previous surgery on the affected hip” were detected as significantly associated with decreased preoperative iHOT-33 scores. These results help to identify symptom-defining baseline characteristics of cam-derived FAI syndrome. Trial registration: The German Cartilage Registry is conducted in accordance with the Declaration of Helsinki and registered at germanctr.de (DRKS00005617). Registered 3 January 2014—retrospectively registered. The registration of data was approved by the local ethics committees of every participating institution. Primary approval was given by the ethics committee at the University of Freiburg (No. 105/13). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS0000561

Outcome-Affecting Parameters of Hip Arthroscopy for Femoroacetabular Impingement with Concomitant Cartilage Damage—Data Analysis from the German Cartilage Registry

This study aims to report on a prospectively collected, multicenter database of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) and concomitant cartilage damage (according to the International Cartilage Repair Society) and to assess the outcomeaffecting parameters. In the study, 353 hips with up to 24 months’ follow-up were assessed by iHOT-33 scoring and achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) levels. Multiple and binary regression analyses were performed to identify factors related to (un-) favorable outcomes and to assess their clinical relevance with regard to achieving the MCID and PASS. Multiple regression yielded the parameters of male sex (p = 0.022) and lower body mass index (BMI) (p = 0.019) at 6 months, lower BMI (p = 0.022) and younger age (p = 0.022) at 12 months, and younger age at 24 months (p = 0.039) to be significantly associated with higher iHOT scoring. Male sex (p = 0.019) and lower BMI (p = 0.018) were significantly correlated with achievement of the PASS in binary regression at 6 months, whereas at 12 (p = 0.010) and at 24 (p = 0.003) only younger age was shown to be significantly correlated. None of the parameters was statistically associated with achievement of the MCID. As the parameters of younger age, male sex, and lower BMI were identified as temporarily correlated with a preferable outcome in general and with achievement of the PASS in particular, these findings help to preoperatively identify factors associated with (un-) favorable therapy results

Microstructure Refinement of EB-PVD Gadolinium Zirconate Thermal Barrier Coatings to Improve Their CMAS Resistance

Rare-earth zirconates are proven to be very effective in restricting the CMAS attack against thermal barrier coatings (TBCs) by forming quick crystalline reaction products that seal the porosity against infiltration. The microstructural effects on the efficacy of Electron Beam-Physical Vapor Deposition gadolinium zirconate (EB-PVD GZO) against CMAS attack are explored in this study. Four distinct GZO microstructures were manufactured and the response of two selected GZO variants to different CMAS and volcanic ash melts was studied for annealing times between 10 min and 50 h at 1250°C. A significant variation in the microstructural characteristics was achieved by altering substrate temperature and rotation speed. A refined microstructure with smaller intercolumnar gaps and long feather arms lowered the CMAS infiltration by 56%-72%. Garnet phase, which formed as a continuous layer on top of apatite and fluorite, is identified as a beneficial reaction product that improves the CMAS resistance

Challenges in the Up-scaling of Resorcinol-Formaldehyde Aerogel Micro-beads Production by Jet-Cutting Method

Carbon aerogels (CAs) are excellent materials with high surface area and unique micro-structures consisting nano-particles and nano-pores. CAs find potential applications in catalysis, chromatography, energy, adsorbents, desalination, etc. In recent times, research-ers focused on the development of CAs in the form of micro-spheres and/or micro-beads due to the reduction in process time and equipment costs for various applications. Car-bon micro-beads are produced from coal or petroleum pitch by carbonizing at 350-500 °C to achieve mesophase spheres in pitch. The carbonization is quenched before an exten-sive growth and aggregation of the spheres and separated as solids from soluble pitch by extraction with a solvent. Carbon aerogel micro-beads of 1 m to 3 mm are also fabricat-ed by using an inverse emulsion gelation of resorcinol-formaldehyde (RF) solution at ele-vated temperatures followed by freeze drying or super-critical drying and subsequent carbonization. The freeze drying or super-critical drying techniques consume large amount of solvents, energy and time for the large scale production. Herein, we report the development of RF aerogel micro-beads through dropping method. The shaping of RF sol solution into a micro-beads is quite challenging because of its low apparent viscosity ( 0.5 Pa.s) and faster sol-gel transition. Hence, we aimed to improve the viscosity of the RF sol solution using a sustainable polysaccharide based thickener to achieve suitable viscosity (1 - 10 Pa.s) in-order to shape them into a micro-beads. The pre-gelled RF sol solution with various concentrations of thickener is dropped into an acid bath to form micro-beads followed by curing, washing and ambient pressure drying and carbonization. The ambient pressure drying of the micro-beads is one of the greatest advantages of the process in-terms of low-cost. The overview of the RF and Carbon aerogel micro-beads production at the laboratory and large scale is depicted in Fig. 1. However, large scale production of RF aerogel micro-beads by Jet-Cutting method poses several challenges viz., handling of enormous amounts of RF sol and acid bath, process parameter optimization, waste disposal, etc. Hence, we adopted low to high viscous alginate solution (0.5 - 3wt.%) with a viscosity ranging from 0.08 to 10 Pa.s, as a model system to optimize the Jet-Cutting parameters. The diameter of the beads (dbead) can be described in eq. 1. d_bead= 3√(3/2 D^(2 ) (u_fluid/(n.Z)-d_wire ) ) -------(1) Where, D - diameter of the nozzle, ufluid - fluid velocity, n - number of cutting wires, Z - number of cutting tool rotation, dwire - diameter of the wire. The operation of Jet-Cutter for the production of micro-beads with low-viscous fluid is no means of complicated. However, the fluid velocity, diameter of the nozzle and number of cutting tool rotation need to be understood. In the next step, large scale production of the RF micro-beads using Jet-Cutting method will be optimized and demonstrated

Biological Reconstruction of Localized Full-Thickness Cartilage Defects of the Knee: A Systematic Review of Level 1 Studies with a Minimum Follow-Up of 5 Years

Objective The objective of this study was to evaluate the best available mid- to long-term evidence of surgical procedures for the treatment of localized full-thickness cartilage defects of the knee. Design Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of Level 1 randomized clinical trials (RCTs), meta-analyses of RCTs and systematic reviews with a minimum follow-up of 5 years. Data extracted included patient demographics, defect characteristics, clinical and radiological outcomes, as well as treatment failures. Results Six RCTs and 3 Level 1 systematic reviews were included. Two RCTs compared microfracture (MFx) to periosteum-covered autologous chondrocyte implantation (ACI-P), 1 to matrix-associated ACI (M-ACI) and 2 to osteochondral autograft transplantation (OAT). One study compared OAT to collagen membrane covered ACI (ACI-C). The 3 Level 1 systematic reviews/meta-analyses assessed the outcome of MFx, OAT, and various ACI methods in RCTs. OAT showed significantly better outcomes compared with MFx. In the 2 RCTs comparing ACI-P and MFx, no significant differences in clinical outcomes were seen, whereas significantly better outcomes were reported for M-ACI versus MFx in 1 study including patients with larger defects (5 cm2), and for ACI-C versus OAT in terms of Cincinnati Score. Higher failure rates were reported for MFx compared with OAT and for OAT compared with ACI-C, while no significant differences in failure rates were observed for ACI-P compared to MFx. Conclusion Restorative cartilage procedures (ACI-C or M-ACI and OAT) are associated with better long-term clinical outcomes including lower complication and failure rates when compared with reparative techniques (MFx). Among the restorative procedures, OAT seems to be inferior to ACI especially in larger defects after longer follow-up periods. Level of evidence: Level I: Systematic review of Level I studie

Articular Cartilage Repair of the Knee in Children and Adolescents

Articular cartilage predominantly serves a biomechanical function, which begins in utero and further develops during growth and locomotion. With regard to its 2-tissue structure (chondrocytes and matrix), the regenerative potential of hyaline cartilage defects is limited. Children and adolescents are increasingly suffering from articular cartilage and osteochondral deficiencies. Traumatic incidents often result in damage to the joint surfaces, while repetitive microtrauma may cause osteochondritis dissecans. When compared with their adult counterparts, children and adolescents have a greater capacity to regenerate articular cartilage defects. Even so, articular cartilage injuries in this age group may predispose them to premature osteoarthritis. Consequently, surgery is indicated in young patients when conservative measures fail. The operative techniques for articular cartilage injuries traditionally performed in adults may be performed in children, although an individualized approach must be tailored according to patient and defect characteristics. Clear guidelines for defect dimension–associated techniques have not been reported. Knee joint dimensions must be considered and correlated with respect to the cartilage defect size. Particular attention must be given to the subchondral bone, which is frequently affected in children and adolescents. Articular cartilage repair techniques appear to be safe in this cohort of patients, and no differences in complication rates have been reported when compared with adult patients. Particularly, autologous chondrocyte implantation has good biological potential, especially for large-diameter joint surface defects

A seed-like proteome in oil-rich tubers

There are numerous examples of plant organs or developmental stages that are desiccation-tolerant and can withstand extended periods of severe water loss. One prime example are seeds and pollen of many spermatophytes. However, in some plants, also vegetative organs can be desiccation-tolerant. One example are the tubers of yellow nutsedge (Cyperus esculentus), which also store large amounts of lipids similar to seeds. Interestingly, the closest known relative, purple nutsedge (Cyperus rotundus), generates tubers that do not accumulate oil and are not desiccation-tolerant. We generated nanoLC-MS/MS-based proteomes of yellow nutsedge in five replicates of four stages of tuber development and compared them to the proteomes of roots and leaves, yielding 2257 distinct protein groups. Our data reveal a striking upregulation of hallmark proteins of seeds in the tubers. A deeper comparison to the tuber proteome of the close relative purple nutsedge (C. rotundus) and a previously published proteome of Arabidopsis seeds and seedlings indicates that indeed a seed-like proteome was found in yellow but not purple nutsedge. This was further supported by an analysis of the proteome of a lipid droplet-enriched fraction of yellow nutsedge, which also displayed seed-like characteristics. One reason for the differences between the two nutsedge species might be the expression of certain transcription factors homologous to ABSCISIC ACID INSENSITIVE3, WRINKLED1, and LEAFY COTYLEDON1 that drive gene expression in Arabidopsis seed embryos