[Acne inversa: A rare disease with far-reaching consequences for those affected : Experiences and wishes of patients]. / Acne inversa: eine seltene Erkrankung mit weitreichenden Auswirkungen für Betroffene : Erfahrungen und Wünsche von Patienten.

Patients affected by acne inversa (hidradenitis suppurativa) initially notice skin changes in atypical areas of the skin. These changes can include purulent inflammation, painfully filled and red-discolored bumps or oozing and strongly smelling, small to larger openings. In order to be able to receive medical help, patients must present to the general practitioner, report their complaints and also show the lesions. This represents an enormous inhibition threshold for those affected. However, the disease is usually recognized too late. This less known skin condition is often confused with other skin diseases. Even after diagnosis, adequate treatment is not always guaranteed. On the patient side, too, fear and feelings of shame prevent the patient from visiting the doctor, long-term therapies without success create a feeling of hopelessness, and fear of losing one's job are reasons for seeking therapy too late. The quality of life is lowest compared to individuals with other dermatoses. In addition to interdisciplinary treatment, the diverse situations experienced by those who are affected need to be acknowledged in social and medical settings.

Evidence for three genetic loci involved in both anorexia nervosa risk and variation of body mass index.

The maintenance of normal body weight is disrupted in patients with anorexia nervosa (AN) for prolonged periods of time. Prior to the onset of AN, premorbid body mass index (BMI) spans the entire range from underweight to obese. After recovery, patients have reduced rates of overweight and obesity. As such, loci involved in body weight regulation may also be relevant for AN and vice versa. Our primary analysis comprised a cross-trait analysis of the 1000 single-nucleotide polymorphisms (SNPs) with the lowest P-values in a genome-wide association meta-analysis (GWAMA) of AN (GCAN) for evidence of association in the largest published GWAMA for BMI (GIANT). Subsequently we performed sex-stratified analyses for these 1000 SNPs. Functional ex vivo studies on four genes ensued. Lastly, a look-up of GWAMA-derived BMI-related loci was performed in the AN GWAMA. We detected significant associations (P-values <5 × 10-5, Bonferroni-corrected P<0.05) for nine SNP alleles at three independent loci. Interestingly, all AN susceptibility alleles were consistently associated with increased BMI. None of the genes (chr. 10: CTBP2, chr. 19: CCNE1, chr. 2: CARF and NBEAL1; the latter is a region with high linkage disequilibrium) nearest to these SNPs has previously been associated with AN or obesity. Sex-stratified analyses revealed that the strongest BMI signal originated predominantly from females (chr. 10 rs1561589; Poverall: 2.47 × 10-06/Pfemales: 3.45 × 10-07/Pmales: 0.043). Functional ex vivo studies in mice revealed reduced hypothalamic expression of Ctbp2 and Nbeal1 after fasting. Hypothalamic expression of Ctbp2 was increased in diet-induced obese (DIO) mice as compared with age-matched lean controls. We observed no evidence for associations for the look-up of BMI-related loci in the AN GWAMA. A cross-trait analysis of AN and BMI loci revealed variants at three chromosomal loci with potential joint impact. The chromosome 10 locus is particularly promising given that the association with obesity was primarily driven by females. In addition, the detected altered hypothalamic expression patterns of Ctbp2 and Nbeal1 as a result of fasting and DIO implicate these genes in weight regulation.

Microstructural Changes of Tensor Fasciae Latae and Gluteus Medius Muscles Following Total Hip Arthroplasty: A Prospective Trial.

PURPOSE OF THE STUDY Although total hip arthroplasty (THA) is one of the most successful orthopedic operations, the soft tissue trauma towards the periarticular musculature during surgical approaches remains a critical concern. However, the actual microstructural proof of muscle trauma on the level of the myofiber due to the surgical approach has never been claimed. MATERIAL AND METHODS Patients undergoing THA were prospectively enrolled and either operated by a direct lateral (DL) or a anterolateral minimally invasive approach (ALMI). Intraoperatively and at 6 months follow-up a needle biopsy was taken from the gluteus medius muscle and the tensor fasciae latae. Pre- and post-operative fiber diameter and composition, of gluteal medius muscle (GMM) and the tensor fasciae latae muscle (TFLM) were compared in both surgical approaches. RESULTS A total of 19 patients (12 F; 7 M) were included in this study. The average pre-operative fiber diameter or fiber type composition did not differ significantly in the GMM and TFLM, nor did it vary among patients with different approaches. The muscle fiber diameter significantly increased post-operatively in the TFLM, in both, the DL (p = 0.043) and the ALMI (p = 0.043) approach. There was a trend towards more pronounced muscle fiber changes in the DL (TFLM: p = 0.077; GMM: p = 0.150), compared to the ALMI. DISCUSSION AND CONCLUSIONS Our results show microstructural changes to the periarticular musculature following THA by a compensatory hypertrophy of the TFLM and GMM. These adaptions directly next to the surgical trauma were observed in DL and AMLI. Key words: total hip arthroplasty, skeletal muscle, muscle biopsy, iatrogenic trauma, muscle scar.

[Periprosthetic infection after hip arthroplasty]. / Periprothetische Infektion nach Hüftendoprothetik.

BACKGROUND: Periprosthetic infections (PPI) represent one of the most complex complications in arthroplasty concerning both, diagnosis and therapy. The incidence of PPI of the hip is approximately 1 % after primary procedures and 4 % after revision surgery. About two thirds of PPIs occur via intraoperative contamination and the remaining PPIs are acquired by hematogenous seeding. AIM: This article presents an overview of up to date evidence-based diagnostics and therapy of PPI of the hip with the establishment of a clear algorithm. METHODS: A selective literature search was carried out with the inclusion of own work. RESULTS: A PPI must be actively excluded in cases of a painful prosthesis or signs of loosening within the first years after implantation. Measurement of C-reactive protein (CRP) can be normal especially in cases of chronic (low grade) PPI and cannot be used as an exclusion criterion. The standard diagnostic procedure includes preoperative joint aspiration with culture and leukocyte counts as well as culture and histology of periprosthetic tissue. Imaging techniques, such as magnetic resonance imaging (MRI) and scintigraphy are of inferior significance. Newer methods, such as sonication of removed implants have revolutionized the diagnostics and several cases which had previously been considered aseptic loosening failures have now been reclassified as PPI. Essential parameters for the treatment algorithm are maturity of the biofilm, stability of the prosthesis, the causative organism and the state of the soft tissue. Retention of the prosthesis can only be considered when the biofilm is still immature (acute PPI). In chronic (low grade) PPI eradication of the infection can only be achieved by exchanging the prosthesis. This has to be performed either as a one-stage procedure or as a two-stage exchange with a short (2-4 weeks) or a long (> 6 weeks) interval. Biofilm active antibiotics play an essential role in the treatment of PPI and have to be used as targeted therapy. DISCUSSION: Successful therapy and diagnostics of PPI require following an exact algorithm. The interdisciplinary cooperation between specialists for infectious diseases and microbiologists represents a decisive factor.

[Treatment of Mason type II radial head fractures by percutaneous reduction]. / Die Behandlung von Radiusköpfchenfrakturen Typ Mason II durch perkutane Drahtreposition.

BACKGROUND: The therapeutic algorithm for the treatment of Mason type II radial head fractures is still controversially discussed. This study describes the technique of percutaneous fracture reduction without additional internal fixation of the radial head as an alternative to open reduction and presents the results of the method. MATERIAL AND METHODS: The data from 26 out of 30 patients with a Mason type II radial head fracture who had been consecutively treated with percutaneous fracture reduction were evaluated retrospectively. The analysis comprised the disabilities of shoulder and hand (DASH) score, the Mayo elbow performance score (MEPS) and data from the radiological examinations. RESULTS: The average follow-up time was 21 months (range 6-47 months). In 22 cases (85 %) an anatomical reduction could be achieved, 2 cases (8 %) showed a complete redislocation of the fragment and 2 cases (8 %) a partial redislocation. The average DASH score was 5.6 points (range 0-56) and the average MEPS was 93.8 (range 60-100). Only 4 patients (15 %) reported persisting functional impairment with a DASH score >10. CONCLUSIONS: The method of percutaneous reduction of radial head fractures without additional internal fixation in Mason type II fractures has been demonstrated to be a good alternative to open reduction.

[More muscle mass in men: explanatory model for superior outcome after total hip arthroplasty]. / Mehr Muskelmasse bei Männern : Erklärungsmodell für bessere Ergebnisse nach Hüfttotalendoprothesenimplantation.

BACKGROUND: Men show better functional results after total hip arthroplasty (THA). The aim of this study was a patient-specific analysis of the hip joint muscles in comparison to the joint geometry. METHODS: In this study 93 computed tomography (CT) scans of the pelvis (45 men, 48 women) were analyzed to determine hip joint geometry and the volume of the gluteus medius (GMV), gluteus maximus (GXV) and tensor fasciae latae (TFL) muscles. The abduction muscle volumes were analyzed with respect to patient-specific adduction moments. RESULTS: The absolute total volume of the hip muscular system (TMV) was larger in men than in women (1913 ccm vs. 1479 ccm; p <0.0001). Men exhibited a more progressive increase of muscle volume as the adduction moment increases. CONCLUSIONS: Men have a greater abduction muscle mass in order to balance adduction moments occurring in the hip joint and therefore have more muscle mass to compensate the inevitable intraoperative muscle damage during THA. This argument supports the extraordinary importance of muscle sparing surgical techniques in women.

[Early results of gender-specific posterior stabilized total knee arthroplasty without patella resurfacing]. / Konventionelle und geschlechtsspezifische kreuzbandersetzende Knietotalendoprothesenimplantation. Vergleich frühfunktioneller Ergebnisse.

INTRODUCTION: To address anatomical gender differences in total knee arthroplasty (TKA) specific total knee prostheses have been developed for women. Potential benefits of these modified prostheses are currently under debate. The present study investigated whether the modified design features bring benefits compared to uni-sex TKA. METHODS: A total of 80 prospectively blinded and randomized patients underwent implantation of unilateral TKAs with NexGen LPS Gender Solutions (Zimmer, Warsaw, USA, group gender-specific GS prosthesis, n = 40) or NexGen LPS Flex (Zimmer, Warsaw, USA, control group standard prosthesis ST, n = 40) The follow-up was carried out 10 days and 6 weeks postoperatively. Clinical data and the subjective assessment of quality of life were evaluated using the Knee Society Clinical Rating System (KSS), the short form 36-item health survey (SF-36) and the Western Ontario and McMaster Universities OA Index (WOMAC). RESULTS: The two groups showed equal values in KSS, SF-36 and WOMAC preoperatively and ten days postoperatively the GS group reached an average KSS knee score of 62.6 ± 16.1 points (ST group 56.9 ± 14.7, p = 0.184) and a functional score of 28.5 ± 12.1 (ST group 24.3 ± 15.3, p = 0.082). In the overall score the GS group reached 91.1 ± 24.1 points (ST group 81.0 ± 27.1, p = 0.104). The GS group reached a knee score of 85.5 ± 14.4 points (ST group 77.8 ± 16.8, p = 0.03) and a functional score of 68.1 ± 20.7 points (ST group 62.3 ± 18.5, p = 0.185) 6 weeks postoperatively. In the overall score the GS group reached 153.7 ± 30.7 points (ST group 139.6 ± 32.4, p = 0.048). The analysis of SF-36 and WOMAC showed no significant differences at all time points. No evidence of loosening or migration was observed in both groups. CONCLUSIONS: Based on the data presented, gender-specific TKA type NexGen LPS Gender Solutions has advantages in terms of early functional outcome. This result is not reflected in the patient satisfaction and is not considered to be clinically relevant.

Spinal and cortical activity-dependent plasticity following learning of complex arm movements in humans.

Activity-dependent plasticity is a fundamental requirement for human motor learning, which takes place at several stages of the motor system and involves various mechanisms in neuronal circuitry. Here, we investigate parameters of cortical and spinal excitability before and immediately after a single session of locomotion-like arm training (LMT) or sequential visuo-motor learning (VMT). Both training paradigms focused especially on mainly activating the flexor carpi radialis muscle (FCR). The activity-dependent change in the excitability of FCR-associated neurons was investigated using standard transcranial magnetic stimulation, including analysis of motor-evoked potentials (MEP) amplitude, short-interval intracortical inhibition and intracortical facilitation (ICF). Furthermore, spinal plasticity was also assessed by means of homosynaptic FCR H-reflex depression (HD). LMT decreased HD and ICF. In contrast, VMT had no significant effect on cortical and spinal parameters. There was a nonsignificant tendency of an increase in MEP amplitudes after both interventions. This implies that human locomotor-related learning involves spinal mechanisms. Despite the decreasing importance of quadrupedal coordination in the course of evolution, these changes in transsynaptic plasticity may reflect a persisting locomotor memory-encoding function in the spinal circuitry of the human upper extremities. Evaluating FCR HD might be helpful for the evaluation and development of locomotor rehabilitation strategies.

The effect of non-oncology drugs on clinical and genomic risk in early luminal breast cancer.

BACKGROUND: An effect of non-oncology medications on cancer outcome has been proposed. In this study, we aimed to systematically examine the impact of commonly prescribed non-oncology drugs on clinical risk and on the genomic risk [based on the Oncotype DX recurrence score (RS)] in early breast cancer (BC). EXPERIMENTAL DESIGN: We collected data on clinical risk (stage and grade), genomic risk (Oncotype DX RS), and on non-oncology medications administered to 1423 patients with estrogen receptor-positive human epidermal growth factor receptor 2-negative BC during the month of their surgery. The influence of various medications on clinical and genomic risks was evaluated by statistical analysis. RESULTS: Out of the multiple drugs we examined, levothyroxine was significantly associated with a high Oncotype DX RS (mean 24.78; P < 0.0001) and metformin with a low Oncotype DX RS (mean 14.87; P < 0.01) compared with patients not receiving other non-oncology drugs (mean 18.7). By contrast, there were no differences in the clinical risk between patients receiving metformin, levothyroxine, or no other non-oncology drugs. Notably, there was no association between the consumption of levothyroxine and metformin and proliferation marker (Ki67) levels, but both drugs were significantly associated with progesterone-related features, suggesting that they influence genomic risk through estrogen-dependent signaling. CONCLUSIONS: The results of this study indicate a significant impact of metformin and levothyroxine on clinical decisions in luminal BC, with potential impact on the clinical course of these patients.

[Earlier postoperative mobilization with minimally invasive hip hemiarthroplasty]. / Frühere Erstmobilisation durch minimalinvasive Implantation zementierter Hüfthemiprothesen.

Treatment of medial femoral fractures in elderly patients with cemented hip hemiarthroplasty (HEP) is a widely established procedure. The main problems with this procedure are complications associated with soft tissue damage and prolonged immobilization. The aim of this study was to compare the clinical and radiological results after HEP implantation using either an anterior minimally invasive (MIS) approach or a regular transgluteal (TG) approach. In this retrospective study the results of 55 consecutive MIS and 54 consecutive TG approaches for implanted HEP after medial femoral fracture were compared. The time of successful mobilization, duration of the i.v. analgesia as well as the occurrence of any perioperative complications were recorded. The femoral offset, leg length and the femoral alignment were analyzed radiologically. The MIS group could be mobilized earlier (MIS 2. pod vs. TG 4. pod, p <0.01) but the need for i.v. applied analgesia was prolonged (MIS 4.4 pod vs. TG 3.5 pod, p=0.04). In the MIS group the number of perioperative complications was less than in the TG group (MIS 7% vs. TG 17%, p <0.05). The early functional advantages of MIS after HEP implantation for medial femoral fractures are evident also within an elderly group of patients.

A transgenic marker for mouse B lymphoid precursors.

Three lines of transgenic mice have been generated which express human CD25 under the control of the 722-base pair region located immediately 5' of the precursor (pre)-B cell-specific lambda5 gene. All three strains express human CD25 in parallel to endogenous lambda5 on pre-B cells, but not on mature B lymphocytes or other blood cell lineages. High expression of human CD25 on B lineage cells of transgenic mice has allowed the identification of a new B220+CD19-lambda5+ precursor of the B220+CD19+lambda5+ c-kit+ pre-BI cells. Both types of precursors are clonable on stromal cells in the presence of interleukin-7. The CD19- precursors have a sizeable part of their immunoglobulin heavy chain gene loci in germline configuration, while the CD19+ pre-BI cells are predominantly DJH rearranged. The results indicate that random integration of the 722-bp 5' region of the lambda5 gene into the mouse genome confers tissue and differentiation stage-specific expression of a transgene.

Precursor B cell receptor-dependent B cell proliferation and differentiation does not require the bone marrow or fetal liver environment.

The capacity of precursor B (pre-B) I cells from fetal liver and bone marrow to proliferate and differentiate into surface immunoglobulin-positive immature B cells in vitro was analyzed. Both fetal liver- and bone marrow-derived progenitors do so in a pre-B cell receptor (pre-BCR)-dependent manner in tissue culture medium alone, without addition of other cells or cytokines. Approximately 20% of the initial pre-B I cells enter more than one division. Analyses at the single-cell level show that approximately 15% divide two to five times. Coculture of pre-B I cells with stromal cells did not enhance proliferation or differentiation, whereas the presence of interleukin 7, especially in combination with stromal cells, resulted mainly in the expansion of pre-B I cells and prevented their further differentiation. Thus, the environment of fetal liver or bone marrow is not required for the pre-BCR to exert its function, which is to select and expand cells that have undergone an inframe V(H)-D(H)J(H) rearrangement that produces a pre-BCR-compatible muH chain. It appears unlikely that a ligand for the pre-BCR drives this pre-B cell proliferation.

Intrinsic B cell defects in NZB and NZW mice contribute to systemic lupus erythematosus in (NZB x NZW)F1 mice.

We have previously shown that long-term in vitro proliferating fetal liver pre-B cell lines derived from autoimmune-prone (NZB x NZW)F1 (BW) mice, but not normal (B6 x DBA2)F1 mice, can differentiate in severe combined immunodeficient (SCID) mice to produce elevated levels of serum immunoglobulin (Ig) M and IgG, and high titers of antinuclear antibodies The contribution of parental NZB and NZW strains to B cell abnormalities of BW hybrid mice was investigated here by preparing pre-B cells and transferring them into immunodeficient SCID- and RAG-2-targeted mice. We show that transfer of NZB pre-B cells led to a marked IgM hypergammaglobulinemia and to the production of limited amounts of IgG2a. On the other hand, the transfer of NZW pre-B cell lines led to moderately elevated IgM levels and marked hypergammaglobulinemia of IgG2a. High IgM and low IgG anti-DNA titers are found in the recipients of NZB pre-B cells, whereas those receiving NZW pre-B cells contained lower levels of IgM and high titers of IgG anti-DNA. In marked contrast, essentially identical titers of antibodies directed against a non-self-antigen, DNP, are found in all group of pre-B cell recipients. Thus, B-lineage cells of both NZB and NZW parental strains manifest abnormalities associated with the development of this lupus-like disease. Therefore, the present study strongly suggests a complex inheritance of B cell abnormalities in autoimmune-prone (NZB x NZW)F1 mice and emphasizes the critical importance of intrinsic B cell defects in the development of murine systemic lupus erythematosus.

Vibronic transitions and quantum dynamics in molecular oligomers: a theoretical analysis with an application to aggregates of perylene bisimides.

Vibronic absorption spectra of molecular aggregates consisting of up to N = 9 monomer units are calculated employing methods of time-dependent quantum mechanics. Taking one vibrational degree of freedom for each monomer into account and treating one-exciton excited electronic states leads to a problem with N vibrations and N electronically coupled states. The demanding quantum propagation is carried out within the multiconfiguration time-depended Hartree method (MCTDH). Spectral features of and population transfer in the aggregates are analyzed as a function of the aggregate size and the strength of the electronic coupling. With a model for oligomers of perylene bisimides, it is shown how measured temperature-dependent absorption spectra correlate with the aggregate size. Furthermore, the exciton localization and dynamics in these aggregates are investigated.

A standardized interdisciplinary algorithm for the treatment of prosthetic joint infections.

AIMS: In 2013, we introduced a specialized, centralized, and interdisciplinary team in our institution that applied a standardized diagnostic and treatment algorithm for the management of prosthetic joint infections (PJIs). The hypothesis for this study was that the outcome of treatment would be improved using this approach. PATIENTS AND METHODS: In a retrospective analysis with a standard postoperative follow-up, 95 patients with a PJI of the hip and knee who were treated with a two-stage exchange between 2013 and 2017 formed the study group. A historical cohort of 86 patients treated between 2009 and 2011 not according to the standardized protocol served as a control group. The success of treatment was defined according to the Delphi criteria in a two-year follow-up. RESULTS: Patients in the study group had a significantly higher Charlson Comorbidity Index (3.9 vs 3.1; p = 0.009) and rate of previous revisions for infection (52.6% vs 36%; p = 0.025), and tended to be older (69.0 vs 66.2 years; p = 0.075) with a broader polymicrobial spectrum (47.3% vs 33.7%; p = 0.062). The rate of recurrent infection (3.1% vs 10.4%; p = 0.048) and the mean time interval between the two stages of the procedure (66.6 vs 80.7 days; p < 0.001) were reduced significantly in the study group compared with the control group. CONCLUSION: We were able to show that the outcome following the treatment of PJIs of the hip and knee is better when managed in a separate department with an interdisciplinary team using a standard algorithm.

Prediction of thermal hydrolysis pretreatment on anaerobic digestion of waste activated sludge.

Thermal hydrolysis is known for an efficient sludge disintegration capability to enhance biogas potential--but to which extent? Obviously, residual VSS concentration in digested sludge gives not sufficient information to predict additional biogas potential. In this paper, different types of waste activated sludge (WAS) were pre-hydrolysed by a full-scale Thermo-Pressure-Hydrolysis Process (Thermo-Druck-Hydrolyse, TDH) and break-down mechanisms on specific organic compounds were investigated. The IWA Anaerobic Digestion Model No.1 (ADM1) has been used for a systematic analysis of monitoring data gained from experimental work. The TDH process combined with anaerobic digestion can be well described by a modified ADM1 model that includes an X(P)-fraction (inactivated aerobic biomass and their decay products). More rapid and more complete degradation of TDH-treated sludge is represented by calibrated disintegration rate and disintegration factors, while biokinetic parameters of acetogenesis and methanogenesis show no sensitivity. TDH process impacts mainly biomass and decay products while inerts Xi already contained in the raw wastewater are hardly converted. Final concentration of soluble inerts in digestion effluent has been increased from 2% to 9% of influent COD due to thermal hydrolysis. An increase in biogas generation (ca. +80%) and in ammonia release (ca. +75%) can be explained by complete degradation of cell mass.

The serum level of C-reactive protein alone cannot be used for the diagnosis of prosthetic joint infections, especially in those caused by organisms of low virulence.

AIMS: The aim of this study was to determine the prevalence and characteristics of C-reactive protein (CRP)-negative prosthetic joint infection (PJI) and evaluate the influence of the type of infecting organism on the CRP level. PATIENTS AND METHODS: A retrospective analysis of all PJIs affecting the hip or knee that were diagnosed in our institution between March 2013 and December 2016 was performed. A total of 215 patients were included. Their mean age was 71 years (sd 11) and there were 118 women (55%). The median serum CRP levels were calculated for various species of organism and for patients with acute postoperative, acute haematogenous, and chronic infections. These were compared using the Kruskal-Wallis test, adjusting for multiple comparisons with Dunn's test. The correlation between the number of positive cultures and serum CRP levels was estimated using Spearman correlation coefficient. RESULTS: Preoperative CRP levels were normal (< 10 mg/l) in 77 patients (35.8%) with positive cultures. Low-virulent organisms were isolated in 66 PJIs (85.7%) with normal CRP levels. When grouping organisms by species, patients with an infection caused by Propionibacterium spp., coagulase-negative staphylococci (CNS), and Enterococcus faecalis had significantly lower median serum CRP levels (5.4 mg/l, 12.2 mg/l, and 23.7 mg/l, respectively), compared with those with infections caused by Staphylococcus aureus and Streptococcus spp. (194 mg/l and 89.3 mg/l, respectively; p < 0.001). Those with a chronic PJI had statistically lower median serum CRP levels (10.6 mg/l) than those with acute postoperative and acute haematogenous infections (83.7 mg/l and 149.4 mg/l, respectively; p < 0.001). There was a significant correlation between the number of positive cultures and serum CRP levels (Spearman correlation coefficient, 0.456; p < 0.001). CONCLUSION: The CRP level alone is not accurate as a screening tool for PJI and may yield high false-negative rates, especially if the causative organism has low virulence. Aspiration of the joint should be used for the diagnosis of PJI in patients with a chronic painful arthroplasty, irrespective of CRP level. Cite this article: Bone Joint J 2018;100-B:1482-86.