[Osteoporosis-specific treatment when and how?] / Osteoporose ­ spezifische Therapie wann und wie?

Over 6 million people in Germany suffer from osteoporosis; approximately half of all women over 70 years old and approximately 1 in 5 men over 70 years old are affected. The most relevant clinical consequences of the disease are fractures leading to a clear impairment in the quality of life. Furthermore, following an osteoporotic fracture especially of the hip or vertebra there is increased mortality. Despite higher individual and socioeconomic relevance, too few patients with osteoporosis still receive adequate treatment. Based on the current guidelines of the governing body for osteology (DVO) the indications for specific medicinal treatment can be determined. Furthermore, the selection of the suitable osteoporosis medication can be carried out by considering several factors, including individual ones.

Biological Soil Crusts from Coastal Dunes at the Baltic Sea: Cyanobacterial and Algal Biodiversity and Related Soil Properties.

Biological soil crusts (BSCs) are known as "ecosystem-engineers" that have important, multifunctional ecological roles in primary production, in nutrient and hydrological cycles, and in stabilization of soils. These communities, however, are almost unstudied in coastal dunes of the temperate zone. Hence, for the first time, the biodiversity of cyanobacterial and algal dominated BSCs collected in five dunes from the southern Baltic Sea coast on the islands Rügen and Usedom (Germany) was investigated in connection with physicochemical soil parameters. The species composition of cyanobacteria and algae was identified with direct determination of crust subsamples, cultural methods, and diatom slides. To investigate the influence of soil properties on species composition, the texture, pH, electrical conductivity, carbonate content, total contents of carbon, nitrogen, phosphorus, and the bioavailable phosphorus-fraction (PO4 (3-)) were analyzed in adjacent BSC-free surface soils at each study site. The data indicate that BSCs in coastal dunes of the southern Baltic Sea represent an ecologically important vegetation form with a surprisingly high site-specific diversity of 19 cyanobacteria, 51 non-diatom algae, and 55 diatoms. All dominant species of the genera Coleofasciculus, Lyngbya, Microcoleus, Nostoc, Hydrocoryne, Leptolyngbya, Klebsormidium, and Lobochlamys are typical aero-terrestrial cyanobacteria and algae, respectively. This first study of coastal sand dunes in the Baltic region provides compelling evidence that here the BSCs were dominated by cyanobacteria, algae, or a mixture of both. Among the physicochemical soil properties, the total phosphorus content of the BSC-free sand was the only factor that significantly influenced the cyanobacterial and algal community structure of BSCs in coastal dunes.

High hydrostatic pressure treatment for advanced tissue grafts in reconstructive head and neck surgery.

The increasing importance of regenerative medicine has resulted in a growing need for advanced tissue replacement materials in head and neck surgery. Allo- and xenogenic graft processing is often time-consuming and can deteriorate the extracellular matrix (ECM). High hydrostatic pressure (HHP)-treatment could allow specific devitalization while retaining the essential properties of the ECM. Porcine connective tissue and cartilage were HHP-treated at 100-400 MPa for 10 min. Structural modifications following HHP-exposure were examined using electron microscopy, while devitalization was assessed through metabolism and cell death analyses. Furthermore, ECM alterations and decellularization were evaluated by histology, biomechanical testing, and DNA content analysis. Additionally, the inflammatory potential of HHP-treated tissue was evaluated in vivo using a dorsal skinfold chamber in a mouse model. The devitalization effects of HHP were dose-dependent, with a threshold identified at 200 MPa for fibroblasts and chondrocytes. At this pressure level, HHP induced structural alterations in cells, with a shift toward late-stage apoptosis. HHP-treatment preserved ECM structure and biomechanical properties, but did not remove cell debris from the tissue. This study observed a pressure-dependent increase of markers suggesting the occurrence of immunogenic cell death. In vivo investigations revealed an absence of inflammatory responses to HHP-treated tissue, indicating a favorable biological response to HHP. In conclusion, application of HHP devitalizes fibroblasts and chondrocytes at 200 MPa while retaining the essential properties of the ECM. Prospectively, HHP may simplify the preparation of allo- and xenogenic tissue replacement materials and increase the availability of grafts in head and neck surgery.

Decellularization of precision-cut kidney slices-application of physical and chemical methods.

The extracellular matrix (ECM) obtained by decellularization provides scaffolds with the natural complex architecture and biochemical composition of the target organ. Whole kidney decellularization by perfusion uses the vasculature to remove cells leaving a scaffold that can be recellularized with patient-specific cells. However, decellularization and recellularization are highly complex processes that require intensive optimization of various parameters. In pursuit of this, a huge number of animals must be sacrificed. Therefore, we used precision-cut kidney slices (PCKS) as a source of natural scaffolds, which were decellularized by immersion in chemical reagents allowing the examination of more parameters with less animals. However, chemical reagents have a damaging effect on the structure and components of the ECM. Therefore, this study aimed at investigating the effects of physical treatment methods on the effectiveness of PCKS decellularization by immersion in chemical reagents (CHEM). PCKS were treated physically before or during immersion in chemicals (CHEM) with high hydrostatic pressure (HHP), freezing-thawing cycles (FTC) or in an ultrasonic bath system (UBS). Biochemical and DNA quantification as well as structural evaluation with conventional histology and scanning electron microscopy (SEM) were performed. Compared to decellularization by CHEM alone, FTC treatment prior to CHEM was the most effective in reducing DNA while also preserving glycosaminoglycan (GAG) content. Moreover, while UBS resulted in a comparable reduction of DNA, it was the least effective in retaining GAGs. In contrast, despite the pretreatment with HHP with pressures up to 200 MPa, it was the least effective in DNA removal. Histological scoring showed that HHP scaffolds received the best score followed by UBS, FTC and CHEM scaffolds. However further analysis with SEM demonstrated a higher deterioration of the ultrastructure in UBS scaffolds. Altogether, pretreatment with FTC prior to CHEM resulted in a better balance between DNA removal and structural preservation.

[Personalized Therapy In Osteoporosis]. / Personalisierte Osteoporose-Therapie.

In Germany, over six million people suffer from osteoporosis. Nearly half of the women over 70 years and nearly 20 % of men at the same age are affected. The clinical and socioeconomical relevance of the disease lies in osteoporotic fractures leading to extensive bone-associated morbidity, increased mortality and health care costs. Fracture risk algorithms and guidelines for the diagnosis and treatment of osteoporosis help to assess the individual fracture risk. By calculating the individual fracture risk, the indication for specific osteoporosis treatment can objectively be determined. A consequent specific osteoporosis therapy is required for patients with a high fracture risk and is essential to prevent osteoporotic fractures and their consequences. As first-line therapy a drug with a proven fracture-reducing effect should be taken. However, for successful osteoporosis therapy, many individual factors have to be considered. A personalized treatment approach should be established according to the severity of the disease, the patient's sex and comorbidities as well as the possible additive and side effects of the drug.