Die Biologie der Heilung der Rotatorenmanschettenläsion: Welche Rolle spielen Wachstumsfaktoren heutzutage?

Zusammenfassung: Die Rotatorenmanschettenläsion ist eine häufige Diagnose in der orthopädischen Sprechstunde. Die Rerupturrate ist trotz Weiterentwicklung der Nahtmaterialien und -techniken im offenen und arthroskopischen Bereich nach wie vor hoch. In den letzten Jahren wurden den physiologischen Vorgängen der natürlichen Insertion wie auch den biologischen Eigenschaften der Rotatorenmanschettenheilung in der Forschung vermehrt Aufmerksamkeit geschenkt. Es hat sich gezeigt, dass die Heilung der Sehnen-Knochen-Insertion der Rotatorenmanschette ein komplexes Zusammenspiel von lokalen Zellen, Stammvorläuferzellen, extrazellulärer Matrix sowie von Wachstumsfaktoren und anderen Zytokinen ist. Dementsprechend wurden verschiedene biologische In-vitro- und In-vivo-Therapieverfahren zur potenziellen Verbesserung der Reinsertion entwickelt. Ziel dieses Artikels ist es, einen Überblick über die heutige Evidenz der Augmentation der Rotatorenmanschettenrekonstruktion mit Wachstumsfaktoren zu geben. Weiterhin werden mögliche zukünftige Therapieansätze diskutier

Rapid Detection of Pathogenic Fungi from Clinical Specimens Using LightCycler Real-Time Fluorescence PCR

In the study presented here a LightCycler real-time PCR system was used for the diagnosis of fungal infections from clinical tissue samples. Nine specimens were investigated from six patients with suspected or proven invasive fungal infections. Seven of nine samples were positive in a broad-range fungal PCR assay. In four samples, Aspergillus fumigatus was detected both by a species-specific hybridization assay as well as by sequencing of amplification products. In addition, the broad-range fungal PCR assay and PCR sequencing detected and identified, respectively, the following organisms in the specimens noted: Candida albicans in a culture-negative liver biopsy, Histoplasma capsulatum in a bone marrow sample, and Conidiobolus coronatus in a facial soft tissue specimen. Real-time PCR is a promising tool for the diagnosis of invasive fungal infections in human tissue samples and offers some advantages over culture methods, such as rapid analysis and increased sensitivit

Equine or porcine synovial fluid as a novel ex vivo model for the study of bacterial free-floating biofilms that form in human joint infections

Bacterial invasion of synovial joints, as in infectious or septic arthritis, can be difficult to treat in both veterinary and human clinical practice. Biofilms, in the form of free-floating clumps or aggregates, are involved with the pathogenesis of infectious arthritis and periprosthetic joint infection (PJI). Infection of a joint containing an orthopedic implant can additionally complicate these infections due to the presence of adherent biofilms. Because of these biofilm phenotypes, bacteria within these infected joints show increased antimicrobial tolerance even at high antibiotic concentrations. To date, animal models of PJI or infectious arthritis have been limited to small animals such as rodents or rabbits. Small animal models, however, yield limited quantities of synovial fluid making them impractical for in vitro research. Herein, we describe the use of ex vivo equine and porcine models for the study of synovial fluid induced biofilm aggregate formation and antimicrobial tolerance. We observed Staphylococcus aureus and other bacterial pathogens adapt the same biofilm aggregate phenotype with significant antimicrobial tolerance in both equine and porcine synovial fluid, analogous to human synovial fluid. We also demonstrate that enzymatic dispersal of synovial fluid aggregates restores the activity of antimicrobials. Future studies investigating the interaction of bacterial cell surface proteins with host synovial fluid proteins can be readily carried out in equine or porcine ex vivo models to identify novel drug targets for treatment of prevention of these difficult to treat infectious diseases

Holter monitoring for syncope: diagnostic yield in different patient groups and impact on device implantation

Background: Holter monitoring is routinely used in patients referred for the evaluation of syncope, but its diagnostic value in different patient groups is unclear, as is its impact on device implantation (pacemaker or cardioverter-defibrillator). Aim: To determine the diagnostic yield of Holter monitoring in the routine evaluation of syncope, and its impact on subsequent device implantation. Design: Retrospective record review. Methods: We reviewed all Holter studies in patients referred with syncope between 2000 and 2005. Strict criteria were applied to determine whether a study was diagnostic. The diagnostic value of Holter monitoring (overall and in five subgroups: age, gender, structural heart disease, ejection fraction, medication) and its impact on the implantation of devices, were determined. Results: Of 4877 Holter studies, 826 were performed in patients with syncope (age 72 ± 15 years): 71 (8.6%) were considered to explain the syncope. Structural heart disease, ejection fraction and age were significant predictors of a diagnostic study (all p < 0.01), whereas gender and cardiac medication were not. A device was implanted in 33 patients (4.4%) whose initial Holter did not explain their syncope, after mean 7 months, whereas 45 patients (5.4%) received a pacemaker based on the Holter results (p = 0.32). Discussion: The overall diagnostic yield of Holter monitoring in the evaluation of syncope was 8.6%, with dramatic differences between subgroups. Our data suggest that the impact of Holter monitoring on device implantation is generally overestimate

Characterization and financial impact of implantable cardioverter-defibrillator patients without interventions 5 years after implantation

Background: Implantable cardioverter defibrillators (ICD's) are increasingly used for primary and secondary prevention of sudden cardiac death. However, data on how many ICD patients indeed receive appropriate ICD therapy during long-term follow-up is scarce. Aim: The aim of our study was to determine the number of patients without appropriate ICD therapy 5 years after ICD implantation, to identify predicting factors, to assess the occurrence of late first ICD therapy and to quantify the financial impact of ICD therapy in a real-world setting. Design: Prospective observational study. Methods: We prospectively enrolled 322 consecutive ICD patients. Baseline data were collected at implantation and patients were followed for a median of 7.3 years (IQR 5.8-9.2 years). Time to first appropriate ICD therapy (either antitachycardia pacing or cardioversion) was documented. Results: Five years after implantation, 139 patients (43%) had not received appropriate ICD therapy. In multivariable analysis, a primary prevention indication and negative electrophysiological studies prior to ICD implantation were independent predictors of freedom from ICD therapy. Of the patients without ICD therapy, 5 years after implantation, 25% had experienced inappropriate ICD shocks. Two hundred and seven devices (1.5 devices per patient) were needed for the 139 patients without ICD intervention within 5 years, accounting for €31 784 per patient. During an additional follow-up of 3 years, 12% of the patients with unused ICD received a late first appropriate ICD therapy. Conclusions: About half of the ICD patients receive appropriate ICD therapy within 5 years after implantation. Furthermore, there is a significant proportion of patients receiving late first shocks after five initially uneventful year

Auffrischungskurse bei der Prävention von Beziehungsstörungen: Wer nimmt teil, wer profitiert?

Hintergrund: Die Wirksamkeit von verhaltenstherapeutischen Paarinterventionen ist gut dokumentiert, die erlernten Kompetenzen und die verbesserte Partnerschaftszufriedenheit sind jedoch oftmals nicht von Dauer. Durch Auffrischungssitzungen konnten erste positive Ergebnisse bei der Stabilität der Effekte gemessen werden. Allerdings ist noch unklar, ob Paare, bei denen solche Auffrischungskurse aufgrund eines hohen Trennungsrisikos indiziert wären, diese auch wirklich besuchen. Probanden und Methode: In der vorliegenden 2-Jahres-Längsschnittstudie besuchten Paare (N = 101) einen Basiskurs zur Prävention von Beziehungsstörungen (Couples Coping Enhancement Training, CCET) und konnten anschließend zu verschiedenen Zeitpunkten freiwillig an Auffrischungskursen teilnehmen. Behandlungseffekte wurden mithilfe mulitvariater Varianzanalysen und Diskriminanzanalysen ausgewertet. Ergebnisse: Paare mit und ohne Auffrischungskurse unterschieden sich bezüglich scheidungsrelevanter Variablen zu Beginn der Studie nicht wesentlich voneinander. Die Vorhersage, ob die Paare einen Auffrischungskurs besuchen würden oder nicht, erwies sich als schwierig. Paare mit Auffrischungskurs konnten allerdings die Verbesserungen nach dem Basiskurs länger aufrechterhalten. Innerhalb der Gruppe mit Auffrischungskursen zeigte sich, dass die Paare, die erst den zweiten Termin für einen Auffrischungskurs in Anspruch nahmen, höhere Werte in der Partnerschaftszufriedenheit und im dyadischen Coping aufwiesen, als die Paare, die den erstmöglichen Termin beanspruchten. Schlussfolgerung: Da viele Paare die Auffrischungssitzungen nicht besuchten, obschon dies indiziert gewesen wäre, müssen die Bemühungen verstärkt werden, diese Paare für die Teilnahme an Auffrischungssitzungen zu gewinne

Fixação biológica de nitrogênio em guandu (Cajanus cajan (L.) Millsp cv. BRS Mandarim) inoculada com estirpes de Bradyrhizobium spp. na presença ou ausência de tratamento com fungicida.

A avaliação da eficiência da fixação biológica de nitrogênio é um processo prioritário durante o melhoramento genético para obtenção de novas cultivares de leguminosas. A cultivar de guandu Mandarim foi desenvolvida para uso como recurso forrageiro e também para a rotação de culturas com a cana-de-açúcar. Destaca-se pela alta produtividade de forragem, retenção de folhas no inverno e baixo teor de taninos. Os experimentos foram conduzidos em casa-de-vegetação na Embrapa Pecuária Sudeste com o objetivo de avaliar a fixação biológica de N do guandu cv. Mandarim inoculada com três estirpes de Bradyrhizobium spp. (SEMIA 6156, SEMIA 6157 e um isolado) na presença ou ausência de tratamento de sementes com fungicida. As variáveis analisadas foram: número e massa seca de nódulos, massa seca da raiz, massa seca da parte aérea, teor de N nas folhas e relação colmo:folha de plantas. Concluiu-se que as plantas que tiveram as sementes inoculadas apresentaram boa nodulação e fixação biológica de nitrogênio em relação às não inoculadas, não houve diferença entre as estirpes. O tratamento das sementes com o fungicida captan não afetou a nodulação e teor de N na maioria das combinações