Subacromial impingement syndrome: association of multiple magnetic resonance imaging parameters with shoulder function and pain.

INTRODUCTION: Shoulder pain is one of the most common complaints in orthopaedics. This study focusses on the relationship between shoulder function in subacromial impingement syndrome and imaging criteria in magnetic resonance imaging (MRI). MATERIALS AND METHODS: This prospective clinical trial included 69 patients treated for subacromial impingement syndrome. Shoulder function (Constant Score, range of abduction, abduction force) and pain were correlated with the following MRI parameters: tendinosis of the rotator cuff, "halo-sign" around the biceps tendon, subacromial distance, critical shoulder angle, size of subacromial osteophytic spurs and maximum width of subacromial and subdeltoid bursa. Statistical analyses included Pearson's and Spearman's coefficients of correlation, multiple regression analysis and Student's t-test. RESULTS: The Constant Score was correlated positively with the critical shoulder angle (r = 0.313; p = 0.009) and inversely with a "halo-sign" around the biceps tendon (rho = -0.384; p = 0.001). There was no significant correlation between spur size and shoulder function, but the size of the subacromial and subdeltoid bursae was positively correlated with the subacromial spur's size (subacromial bursa: coronal plane: r = 0.327; p = 0.006; sagittal view: r = 0.305; p = 0.011; subdeltoid bursa coronal view: r = 0.333 p = 0.005). The width of the subdeltoid bursa in coronal plane was positively correlated with shoulder pain (r = 0.248; p = 0.004) and negatively with the range of abduction (r = -0.270; p = 0.025), as well as the mean (r = -0.332; p = 0.005) and maximum (r = -0.334; p = 0.005) abduction force. CONCLUSIONS: Shoulder function and pain in subacromial impingement are best predicted by the width of the subdeltoid bursa measured in the coronal MRI plane as an indicator of bursitis as well as the presence of a "halo-sign" around the biceps tendon indicating glenohumeral joint effusion. Presence of a subacromial spur could lead to subacromial and subdeltoid bursitis, which impairs shoulder function. Shoulder function seems not to be compromised by the presence of a subacromial spur in absence of bursitis. This study was registered at the German Clinical Trials Register on 08 February 2013 (ID: DRKS00011548).

Rehabilitation of Patients with Osseointegrated Prosthesis after Transfemoral Amputation - Literature-based Recommendation for Postoperative Rehabilitative Procedure. / Rehabilitation bei Patienten mit osseointegrierten Prothesen nach transfemoraler Amputation ­ literaturbasierte Nachbehandlungsempfehlung.

BACKGROUND: Osseointegrative implantation after amputation of the lower extremity is a special treatment option. Physiotherapeutic treatment is important for the functional outcome. This study systematically evaluated existing follow-up treatment protocols to establish a literature-based recommendation for postoperative rehabilitation procedures. METHODOLOGY: A PubMed literature search was conducted on December 10, 2020, using the following search terms: (osseo-integrat* OR endo-exo OR boneanchored OR bone anchored) AND (prosthe*) AND (leg OR lower limb* OR lower extremit* OR transfem* OR transtib*) AND (rehabilitation). 113 publications were found in this context. 10 of them met inclusion criteria. The Cochrane risk of bias tool was used to determine the publications' quality. RESULTS: Three systematic rehabilitation protocols have been described: Osseointegrated Prostheses for the Rehabilitation of Amputees protocol, Osseointegration Group of Australia Accelerated protocol and Radboud Amputation: rehabilitation protocol for endo-exo femoral prosthesis. There are clear differences in the duration of the rehabilitation protocols. The quality of published studies is limited due to the high risk of bias and low evidence levels (mainly III - V). A concept for long-term rehabilitation has not been described yet. CONCLUSIONS: There are various protocols for rehabilitation after treatment with osseointegrative prosthesis. Gradually increasing axial weight bearing started shortly after surgery; step-by-step gait training, adaptation of the prosthesis to the new biomechanics and critical patient selection and pre-operative training have been proven useful for successful rehabilitation. Controlled comparative studies, standardised outcome measurements or comparative studies between different protocols are not available. Models for multi-level long-term care have not been described in the literature so far.

Sportmedizinische Beratung nach akuter Rhabdomyolyse bei erblicher Myopathie ­ eine herausfordernde Leistungsdiagnostik.

INTRODUCTION: Increased serum creatinine kinase after physical activity is well known and there is currently no cut-off value. We present the systematic diagnosis after rhabdomyolysis in a rare cause. HISTORY: A 36-year-old soldier developed acute kidney failure due to rhabdomyolysis after intense physical exertion. FINDINGS AND DIAGNOSIS: Sporty habitus, CK elevation and highly normal kidney values. Massive CK increase after step loading on the bicycle ergometer. We stopped further physical stress and initiated diagnostics. THERAPY AND COURSE: The genetic diagnosis found a hereditary myopathy of the lipid metabolism (VLCAD deficiency). We used individualized performance analysis to determine the safe load limit. In the ordinary athletic testing of these performance limits, no excessive CK activation could be determined. CONCLUSION: Recurrent rhabdomyolyses characterize the late onset of VLCAD, which can occur after intense physical activity, periods of fasting or dehydration. Patients can continue physical exercise safely after determining the individual tolerance.

[Continuous Passive Motion in Orthopaedic Rehabilitation of the Shoulder Girdle - A Literature Survey]. / Kontinuierliche passive Bewegungstherapie (CPM-Therapie) in der orthopädischen Rehabilitation am Schultergelenk ­ eine Literaturübersicht.

BACKGROUND: Continuous passive motion (CPM) of the shoulder is predominantly used during postoperative rehabilitation of the shoulder girdle. It is often used after rotator cuff repair (RM suture). Incapacity to work and therapy of shoulder diseases cause significant costs for the healthcare system in Germany. METHODS: In a literature analysis, studies and reviews of the CPM treatment in scientific databases were therefore identified and analysed with regard to the functional outcome particular after shoulder joint surgery. The quality of the studies was evaluated using the Cochrane Collaboration's Risk of Bias Tool. RESULTS: After rotator cuff suturing, clinical studies have predominantly shown a faster improvement in pain level and shoulder mobility when using CPM treatment compared to other forms of treatment. In the case of frozen shoulder, only studies with the scope of CPM in conservative treatment could be identified. Here predominantly faster pain reduction could be observed. Studies addressing CPM in the therapy of Impingement of the shoulder, fracture of the humeral head or arthroplasty of the glenohumeral joint could not be identified. The health economic effects of CPM use are controversially discussed. In the available studies, equipment and other costs are assessed differently. CONCLUSION: The analysed clinical studies showed overall positive effects, e. g. a faster improvement of pain level and shoulder mobility, in the postoperative therapy of the shoulder after rotator cuff repair as well as in the conservative therapy of shoulder stiffness for the CPM treatment compared to other forms of treatment. For other entities no meaningful studies are available in the literature to date. Since the health economic effects of the use of CPM have been discussed controversial so far, potential health economic benefits of the use of CPM treatment should be evaluated in future studies.

Encephalitis Associated with Sarcocystis halieti Infection in a Free-Ranging Little Owl (Athene noctua).

A juvenile Little Owl (Athene noctua) was diagnosed with granulomatous encephalitis and muscular sarcocysts. Sarcocystis halieti was identified in the brain and muscle tissue by PCR and subsequent sequencing. This is the first report of S. halieti as a potential encephalitis-causing pathogen in birds.

Independent Risk Factors for Impaired Early Outcome after Isolated Ankle Fracture - A Multivariate Analysis and Prognostic Models. / Unabhängige Risikofaktoren für komplizierte Frühverläufe nach isolierter Sprunggelenksfraktur ­ eine multivariate Analyse und prognostische Modellierung.

BACKGROUND: Ankle fractures are common operative indications in orthopedic surgery. Their incidence is increasing. OBJECTIVES: To identify independent risk factors and to develop prognostic models for the prediction of prolonged length of hospital stay (LOS) and the onset of postoperative complications. MATERIALS AND METHODS: This is a single-center, retrospective, observational study analyzing data of 154 consecutive, isolated, surgically treated ankle fractures. Multivariate binary logistic regression analysis was applied to identify significant independent risk factors. The validity and clinical applicability of the developed prognostic models was assessed with ROC-curve analysis (ROC: Receiver Operating Characteristic). Internal validation of prognostic models was performed with randomized backwards bootstrapping. RESULTS: The median LOS was 7 days. 50 patients (33%) had a longer LOS. 13% of operated patients had a postoperative complication (n = 20). Independent preoperative risk factors for prolonged length of stay were leukocytosis (p = 0.020; OR: 1.211), an increased CRP-level (p = 0.005; OR: 1.901), as well as a bi- (p = 0.002; OR: 15.197) or trimalleolar (p = 0.001; OR: 10.678) fracture type. Immediate operative therapy was an independent beneficial factor (p < 0.001; OR: 0.070). The onset of complications was associated significantly with diabetes mellitus (p = 0.004; OR: 9.903) and an elevated ASA score (p = 0,004; OR: 3.574). The developed prognostic models for the prediction of prolonged LOS (AUROC: 0.736) and postoperative complications (AUROC: 0.724) had a good clinical validity and were internally validated. CONCLUSION: The current data pronounce the importance of preoperative laboratory works. Furthermore, co-morbidities play a major role in the prognosis of outcome. The developed prognostic models are able to reliably predict the outcome and enable the preoperative identification of high-risk patients.

The Risk of Complications after Carpal Tunnel Release in Patients Taking Acetylsalicylic Acid as Platelet Inhibition: A Multicenter Propensity Score-Matched Study.

BACKGROUND: Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release. METHODS: This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed. RESULTS: Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

[Influence of Patients' Profession on Therapeutical Outcome of Patients with Primary Extrinsic Shoulder Impingement]. / Einfluss der beruflichen Tätigkeit auf den Therapieerfolg von Patienten mit primär extrinsischem Impingement der Schulter.

PURPOSE: Shoulder complaints are an important reason for inability to work. There are few considerations that link the effect of kind of therapy with ability to work in connection with kind of employment. This prospective, comparative clinical follow-up study examines the influence of occupational activity with conservative and operative therapy on the outcome of therapy in terms of function, pain and ability to work. METHODS: In this study, 97 patients (women: n=22, men: n=75, mean age: 43.1±10.1 years) with a primary extrinsic shoulder impingement syndrome were included. Patients were divided into blue and white collar workers. Further on the subgroups of conservative and operative therapy were considered. Either a sole conservative therapy or an operative therapy with physiotherapeutic follow-up treatment took place. The conservative therapy was carried out as a structured re-coordination of muscles of the shoulder girdle under supervision of a physiotherapist. In the surgical cohorts an arthroscopic subacromial decompression was performed. Follow-up examinations were passed 3, 6 and 12 months after starting the intervention. Function (Constant Score), pain (NRS) and the duration of inability to work were assessed. The statistical analysis was performed using mixed-design ANOVA to calculate main effect and interactions (therapy*kind of employment*time) adjusted with age, sex and body mass index. RESULTS: There was no statistically significant difference in terms of function and pain between blue and white collar workers. Office workers showed a significantly longer inability to work 3 months after surgical treatment compared with conservative treatment (7.3±0.8 weeks vs. 0.5±7.3 weeks; p<0.001). Further the group of white collars with operative therapy was significantly longer inable to work than the group of blue collar workers after operative therapy 3 months after surgical treatment (3.0±1.1 weeks vs. 7.3±0.8 weeks; p=0.002). CONCLUSION: On the one hand, working in an office could be seen as a negative predictor for durance of inability to work. On the other hand, surgical treatment itself was a negative predictor for the durance of inability to work. Furthermore, no difference between conservative and surgical therapy could be observed in function and pain one year after starting the treatment.

Multicentric Molecular and Pathologic Study On Canine Adenovirus Type 1 in Red Foxes (Vulpes vulpes) in Three European Countries.

Canine adenovirus type 1 (CAdV-1) is the agent of infectious canine hepatitis, a severe frequently fatal disease affecting primarily dogs (Canis lupus familiaris). The virus has been detected in many wild carnivore species. Our aim was to evaluate the prevalence and genetic and histopathologic features of CAdV-1 in wild red foxes (Vulpes vulpes). Kidney and liver samples were obtained from 86 subjects, coming from the UK (n=21), Italy (n=36), and Germany (n=29). We used PCR, targeting the viral E3 gene and flanked regions, to detect the presence of the virus; viral E3, fiber, and E4 genes were sequenced and their sequences were compared with published sequences. Kidneys and liver from foxes in Italy and Great Britain (n=57) were prepared for histologic and immunohistochemical examination for CAdV-1. Viral DNA was detected in 22% (19 of 86) kidney samples, with E3 and E4 genes showing reported and unreported single nucleotide changes. No pathologic changes or viral immunopositive signals were detected in the examined tissues. Our study suggests that red foxes could be considered potential shedders of CAdV-1, as they showed a relatively high prevalence without related pathologic changes in the organs examined.

Kramer and Chevron Osteotomy for Hallux Valgus Deformity - Retrospective Comparison of Functional and Radiological Results. / Kramer- und Chevron-Osteotomie bei Hallux valgus ­ retrospektive vergleichende Untersuchung des funktionellen und radiologischen Ergebnisses.

BACKGROUND: Hallux valgus is the most common forefoot deformity, with a prevalence of up to 23%. Surgical treatment is necessary in symptomatic patients. Prospective studies comparing different procedures are rare. Chevron osteotomy is the preferred procedure for distal osteotomy. The relevance of Kramer osteotomy is not clearly defined. The objective of this study was to compare the two procedures in terms of functional and radiological outcome. MATERIAL AND METHODS: 174 patients (42 male, 132 female, 44.0 ± 16.8 years), treated with Chevron (n = 71) or Kramer osteotomy (n = 103) between 2008 and 2015, were enrolled in this retrospective study. Time for surgery was analysed. Pre- and postoperative X-rays were evaluated to detect hallux valgus angle, intermetatarsal angle and position of sesamoids (mean ± SD). Function and quality of life were assessed using the Foot and Ankle Outcome Score (FAOS) and EuroQol5D questionnaire. Pain was rated by using the numeric rating scale (NRS). Statistical analyses were performed with mixed model ANOVA and the t test for independent samples. RESULTS: Both procedures reduce the hallux valgus angle (Kramer: 30° to 9°; Chevron 26° to 16°; p < 0.001). A significant difference was found between the two procedures (10° ± 2°; 95% CI: - 12.93; - 6.49; p < 0.001). A minimally reduced intermetatarsal angle was found in both groups (14° ± 3° to 12° ± 3°; p < 0.001). However, there was no significant difference between the two procedures (p = 0.116). The position of sesamoids was more improved by Kramer osteotomy (2/2 to 0/1; p < 0.001) according to Appel than with the Chevron osteotomy (2/2 to 2/1; p = 0.052). Time for surgery was significantly shorter when Kramer osteotomy was performed (31 ± 14 min vs. 44 ± 12 min; p < 0.001). No relevant differences in pain and function were observed (NRS postoperative Chevron: 1.3; Kramer: 1.7; p = 0.413; FAOS: no significant differences in all categories). CONCLUSION: The results of the two procedures were equal in functional outcome. Time of surgery and radiological results were significantly better in the group with Kramer osteotomy. Therefore, Kramer osteotomy is an alternative option to Chevron osteotomy. Further prospective studies are necessary to confirm these results.

[Time in the OR, Outcome and Surgeons' Experience - The Use of Patient Matched Instruments in Arthroplasty of the Knee]. / OP-Zeit, Ergebnis und Ausbildungsstand des Chirurgen ­ der Einsatz patientenindividueller Instrumente bei der Implantation von Kniegelenkendoprothesen.

Background Arthrosis of the knee is a common problem in Germany that is often treated with arthroplasty. To support the orthopaedic surgeon, person-matched instruments (PMI) are available from several providers. In this study we investigated the clinical and radiological outcome of the use of the PMI Visionaire™ (Smith&Nephew). Furthermore, we investigated the influence of operative experience of the orthopaedic surgeon on the clinical and radiological results. Time in the operating room (OR) was identified as a parameter for cost effectiveness even during training to become an orthopaedic surgeon. Material und Methods 173 of 436 cases (56.6% women, 68.7 ± 0.7 years) were included in this retrospective observation. Time in the OR, Oxford Knee Score (OKS), range of motion (ROM) as well as the position of the used implant under radiological control were the parameters used to describe the results. Hereby, we compared the use and the non-use of the PMI as well as the experience of the orthopaedic surgeon (years of training and experience). Results The use of PMI led to significant decrease of time in the OR (7 minutes in mean; p = 0.004). Surgeons with more than 6 years of experience were faster than surgeons with less than 6 years of experience with and without the use of PMI (21 respectively 17 minutes). In both groups, the use of PMI led to reduced time in the OR (more experience: 6 minutes [p = 0.211]; less experience: 10 minutes [p = 0.005]). There were no relevant differences in clinical and radiological findings in the comparison of use or non-use of PMI or surgeons with more or less than 6 years of experience. Conclusion The use of PMI for knee arthroplasty is a helpful tool for reducing time in the OR. Because there were no relevant differences in the clinical and radiological results, there were no higher risks for patients. The only relevant advantage was the reduction of time in the OR. If this affects the incidence of periprosthetic infections or leads to cost effectiveness for the hospitals especially during the period of training of young surgeons are questions that should be investigated in further studies.

[Influence of Operative and Conservative Therapy on the Ability to Work of Patients With Subacromial Impingement: A Prospective Clinical Comparative Study]. / Einfluss von operativer und konservativer Therapie auf die Arbeitsfähigkeit bei Patienten mit subakromialem Impingement ­ eine prospektive klinische Vergleichsstudie.

Background Subacromial impingement is a common reason for pain in the shoulder. Treatment is difficult and patients are not able to work for a long time. An increasing number of operative treatments can be observed although conservative treatment is effective, too. There is no study that observed how operative and conservative treatment influence ability to work. Methods 86 persons were included in this prospective study. Surgery was performed with an arthroscopy of the shoulder. Conservative treatment was carried out by a physiotherapist under control of the physician. Reevaluation was conducted 3 and 6 months after the initial contact. Here we observed the time the participant was not able to work, Constant Score and pain on the numeric rating scale. Results Both therapies were able to improve pain and function. During conservative treatment, improvement was faster than under operative care. Time without ability to work was 7 ± 5 weeks longer after operative treatment than under conservative therapy (p < 0.001). No relevant influence of acromioclavicular joint arthrosis could be observed. Bursitis subacromialis detected in the MRI was a predictor of faster recovery. Conclusion Conservative and operative treatment improved pain and function significantly. Properly carried out conservative therapy enables patients to get back to work earlier.

Contribution of human osteoblasts and macrophages to bone matrix degradation and proinflammatory cytokine release after exposure to abrasive endoprosthetic wear particles.

One of the major reasons for failure after total joint arthroplasty is aseptic loosening of the implant. At articulating surfaces, defined as the interface between implant and surrounding bone cement, wear particles can be generated and released into the periprosthetic tissue, resulting in inflammation and osteolysis. The aim of the present study was to evaluate the extent to which osteoblasts and macrophages are responsible for the osteolytic and inflammatory reactions following contact with generated wear particles from Ti­6Al­7Nb and Co­28Cr­6Mo hip stems. To this end, human osteoblasts and THP­1 monocytic cells were incubated with the experimentally generated wear particles as well as reference particles (0.01 and 0.1 mg/ml) for 48 h under standard culture conditions. To evaluate the impact of these particles on the two cell types, the release of different bone matrix degrading matrix metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs), and relevant cytokines were determined by multiplex enzyme­linked immunosorbent assays. Following incubation with wear particles, human osteoblasts showed a significant upregulation of MMP1 and MMP8, whereas macrophages reacted with enhanced MMP3, MMP8 and MMP10 production. Moreover, the synthesis of TIMPs 1 and 2 was inhibited. The osteoblasts and macrophages also responded with modified expression of the inflammatory mediators interleukin (IL)­6, IL­8, monocyte chemoattractant protein­1 and vascular endothelial growth factor. These results demonstrate that the release of wear particles affects the release of proinflammatory cytokines and has a negative impact on bone matrix formation during the first 48 h of particle exposure. Human osteoblasts are directly involved in the proinflammatory cascade of bone matrix degradation. The simultaneous activation and recruitment of monocytes/macrophages boosted osteolytic processes in the periprosthetic tissue. By the downregulation of TIMP production and the concomitant upregulation of MMPs as a response to particle exposure, bone formation around implants may be suppressed, resulting in implant failure.

Clinical, anatomical, and technical risk factors for postoperative pacemaker or defibrillator lead perforation with particular focus on myocardial thickness.

BACKGROUND: Postoperative lead perforation is a life-threatening complication of cardiac pacing. Identification of precipitating factors for this serious complication may help to anticipate a specific risk profile and to minimize the incidence. METHODS: We conducted a retrospective tertiary referral center analysis to clarify clinical, anatomical, and technical characteristics related to pacemaker (PM) and cardioverter/defibrillator lead perforation. We examined the baseline characteristics and the symptoms. In a subgroup, we investigated the myocardial thickness on contrast-enhanced cardiac computed tomography. RESULTS: We enrolled 26 patients. Female gender appears to put patients at slightly increased risk for lead perforation. In a majority active fixation leads were used. Symptoms occurred in 72%. Pericardial effusion and tamponade were present in 38% and 19%, respectively. Sensing was compromised in 65%. A high pacing threshold or exit block occurred in 92%. Myocardial thickness did not differ between patients with or without perforation. In 96%, the perforation was treated by transvenous withdrawal. CONCLUSION: Chest pain, phrenic stimulation, bad sensing, or exit block early after PM implantation must prompt radiological and echocardiographic evaluation. A missing pericardial effusion particularly late after implantation does not rule out a perforation. Especially active fixating leads have a higher risk of perforation. With cardiac surgery in standby transvenous withdrawal is a safe way to treat lead perforation.

High-content screening data management for drug discovery in a small- to medium-size laboratory: results of a collaborative pilot study focused on user expectations as indicators of effectiveness.

High-content screening (HCS) technology provides a powerful vantage point to approach biological problems; it allows analysis of cell parameters, including changes in cell or protein movement, shape, or texture. As part of a collaborative pilot research project to improve bioscience research data integration, we identified HCS data management as an area ripe for advancement. A primary goal was to develop an integrated data management and analysis system suitable for small- to medium-size HCS programs that would improve research productivity and increase work satisfaction. A system was developed that uses Labmatrix, a Web-based research data management platform, to integrate and query data derived from a Cellomics STORE database. Focusing on user expectations, several barriers to HCS productivity were identified and reduced or eliminated. The impact of the project on HCS research productivity was tested through a series of 18 lab-requested integrated data queries, 7 of which were fully enabled, 7 partially enabled, and 4 enabled through data export to standalone data analysis tools. The results are limited to one laboratory, but this pilot suggests that through an "implementation research" approach, a network of small- to medium-size laboratories involved in HCS projects could achieve greater productivity and satisfaction in drug discovery research.

Nuclear DNA-Content in Mesenchymal Lesions in Dogs: Its Value as Marker of Malignancy and Extent of Genomic Instability.

DNA-aneuploidy may reflect the malignant nature of mesenchymal proliferations and herald gross genomic instability as a mechanistic factor in tumor genesis. DNA-ploidy and -index were determined by flow cytometry in canine inflammatory or neoplastic mesenchymal tissues and related to clinico-pathological features, biological behavior and p53 gene mutational status. Half of all sarcomas were aneuploid. Benign mesenchymal neoplasms were rarely aneuploid and inflammatory lesions not at all. The aneuploidy rate was comparable to that reported for human sarcomas with significant variation amongst subtypes. DNA-ploidy status in canines lacked a relation with histological grade of malignancy, in contrast to human sarcomas. While aneuploidy was related to the development of metastases in soft tissue sarcomas it was not in osteosarcomas. No relation amongst sarcomas was found between ploidy status and presence of P53 gene mutations. Heterogeneity of the DNA index between primary and metastatic sarcoma sites was present in half of the cases examined. Hypoploidy is more common in canine sarcomas and hyperploid cases have less deviation of the DNA index than human sarcomas. The variation in the presence and extent of aneuploidy amongst sarcoma subtypes indicates variation in genomic instability. This study strengthens the concept of interspecies variation in the evolution of gross chromosomal aberrations during cancer development.

Comparative Study of Clinical and Radiological Outcomes of Unconstrained Bicondylar Total Knee Endoprostheses with Anti-allergic Coating.

BACKGROUND: Hypersensitivity reactions to implant materials have become more important in total knee replacement (TKR). The purpose of this retrospective comparative study was to evaluate the clinical and radiological outcomes of unconstrained bicondylar total knee prostheses with and without anti-allergic titanium(niobium)nitrite (Ti(Nb)N) coating. METHODS: Twenty-four patients (25 TKRs) underwent a preoperative clinical evaluation and then a postoperative evaluation after 26.2 months in the allergy group treated with coated implants (n=13 implants) and after 24.5 months in the control group treated with uncoated implants but identical geometry (n=12) using HSS, WOMAC and SF-36 scores. Radiological evaluations were performed using standard anterior-posterior (a.p.) and lateral X-rays. RESULTS: During follow-up two patients of the allergy group had to undergo revision surgery due to non-implant-related reasons. A comparative analysis of both study groups showed a significant difference in the HSS scores at both evaluation time points (MW test p≤0.050); these findings are remarkable since the control group had a significantly lower score preoperatively (54.0 vs 65.0 points) and a significantly higher score (82.5 vs 75.0 points) postoperatively. The preoperative and postoperative WOMAC and SF-36 scores were comparable in both groups (MW test p≥0.052), although the postoperative increase in the score for the allergy group was lower. The radiological results were comparable in both groups and were unlikely to influence the results. CONCLUSIONS: This clinical study demonstrates the restricted outcome in postoperative function and quality of life in the allergy group compared to the control group.

Experimental evaluation of hyaluronidase activity in combination with specific drugs applied in clinical techniques of interventional pain management and local anaesthesia.

BACKGROUND: Hyaluronidase is an enzyme additive used in local anaesthesia and interventional pain reducing procedures such as adhesiolysis of epidural scar tissue after spinal surgery. Only a limited number of studies describe the influence of drugs on hyaluronidase activity. Postulated effects and effectiveness of hyaluronidase are only based on clinical observations. OBJECTIVE: The aim of this study is to investigate the influence of the combined drugs on the activity of hyaluronidase under standardized conditions and to verify the effectiveness of the enzyme. DESIGN: An ELISA-based microtiter-technique is used to evaluate the activity of hyaluronidase in combination with local anaesthetics, corticosteroids, NaCl 10%, and iodinated contrast media. METHODS: Microtiter plates were coated with biotinylated hyaluronate and incubated with hyaluronidase in combination with the above-mentioned drugs. The activity of hyaluronidase was determined by an avidin-peroxidase-based procedure using an ELISA reader. Incubations were carried out at room temperature as well as at 37 degrees C. RESULTS: The data show that drugs affect the activity of hyaluronidase in different ways. Iodinated contrast media, NaCl (10%), and the absence of corticosteroids reduce hyaluronidase activity. In contrast, higher activities were detected at a lower NaCl concentration (0.9%). We cannot attribute a significant influence to local anaesthetics. CONCLUSIONS: Hyaluronidase is effective in all combinations with drugs. To get the maximum effect calculated use of accompanying drugs is necessary.

Erythropoietin receptor-mediated Egr-1 activation: structural requirements and functional implications.

The transcription factor Egr-1 is encoded by an immediate early response gene and has been shown to be a key regulator in the induction of apoptosis, mitogenesis and differentiation. It is rapidly induced by different stimuli including the glycoprotein hormone erythropoietin. In this report, we analyse the role of different erythropoietin receptor substructures for the activation of Egr-1 and the functional consequences of Egr-1 overexpression in the erythroleukemic cell line ELM-I-1. The investigation of receptor variants revealed that the activity of JAK2 and the phosphorylation of receptor tyrosine residues are essential preconditions for the ability to target Egr-1. Furthermore, we observed a close correlation of the abilities of receptors to activate the Ras-MAPK pathway and Egr-1. Using mass spectrometry we identified the Ras-GTPase-activating protein-SH3-domain-binding protein 1 (G3BP-1), a component of the Ras network of proteins, as an Egr-1 interacting protein in EPO stimulated ELM-I-1 cells. The overexpression of Egr-1 in these cells resulted in an enhanced rate of spontaneous erythroid differentiation.

Stable biocompatible adjuvants--a new type of adjuvant based on solid lipid nanoparticles: a study on cytotoxicity, compatibility and efficacy in chicken.

A new type of adjuvant was tested for its ability to initiate antibody production in chickens, and its cellular and tissue compatibility were assessed. The stable biocompatible adjuvants tested are based on surface-modified solid lipid nanoparticles (SLNs), made from paraffin or biodegradable glycerides, and are simply admixed to the antigens before administration. The tissue-damaging potency of four formulations of the new adjuvants (H1, H2, H3 and H4) were first tested in vitro by using human foreskin fibroblasts and RAW 264.7 macrophages. The adjuvants were well tolerated by both cell types. Immunisation studies in chickens were performed by using a Mycoplasma bovis antigen and mouse immunoglobulin G (IgG). The resulting antibodies were non-invasively extracted from egg yolk. The use of the various adjuvant formulations resulted in a significant production of specific antibodies after the first and second booster immunisations. Freund's complete adjuvant (FCA), considered until now to be the "gold standard" among the adjuvants, revealed the highest antibody titre against mouse IgG. SLNs with a particle size of more than 100 nm exhibited a clear adjuvant activity, whereas SLNs with a particle size below 100 nm, in various concentrations, revealed a lower adjuvant activity. Immunisation of chickens with the mouse IgG alone, dissolved in phosphate-buffered saline, resulted in a slow antibody titre development. At the end of the experiment, the chickens were examined for vaccination-associated tissue damage. In contrast to FCA, the SLN formulations caused only minor tissue irritation at the injection sites. In conclusion, SLNs seem to be a promising alternative to FCA for antibody production in chickens, and potentially in other animals.