RESUMEN
PURPOSE: Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant. METHODS: We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed. RESULTS: Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm). CONCLUSION: The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios Retrospectivos , Estudios de Seguimiento , Diseño de Prótesis , Prótesis de Cadera/efectos adversos , Reoperación , Resultado del Tratamiento , Falla de PrótesisRESUMEN
The proteinase-encoding prtB gene of Lactobacillus (Lb.) delbrueckii (d.) subsp. bulgaricus 92059 was cloned and sequenced. Two soluble, secreted, C-terminally His-tagged derivatives were constructed and expressed in Lactococcus lactis by means of the NICE® Expression System. In both obtained derivatives PrtBb and PrtB2, the C-terminal, cell wall-binding domain was deleted. In addition, in derivative PrtB2, the C-terminal part of the B domain was deleted and the signal sequence was replaced by a lactococcal export signal. The affinity-purified derivatives were both proteolytically active. Peptide hydrolysates produced from casein with each of the derivatives showed identical peptide composition, as determined by liquid chromatography-mass spectrometry. Comparison of the peptides generated to those generated with living Lb. d. subsp. bulgaricus 92059 cells (Kliche et al. Appl Microbiol Biotechnol 101:7621-7633, 2017) showed that ß-casein was the casein fraction most susceptible to hydrolysis and that some significant differences were observed between the products obtained by either the derivatives or living Lb. d. subsp. bulgaricus 92059 cells. When tested for biological activity, the hydrolysate obtained with PrtBb showed 50% inhibition of angiotensin-converting enzyme at a concentration of 0.5 mg/ml and immunomodulation/anti-inflammation in an in vitro assay of TNF-α induced NFκB activation at concentrations of 5 and 2.5 mg/ml, respectively. The enzymatically obtained hydrolysate did not show any pro-inflammatory or cytotoxic activity.
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Proteínas Bacterianas/genética , Caseínas/metabolismo , Endopeptidasas/genética , Lactobacillus delbrueckii/enzimología , Péptidos/metabolismo , Hidrolisados de Proteína/metabolismo , Inhibidores de la Enzima Convertidora de Angiotensina/aislamiento & purificación , Línea Celular , Endopeptidasas/metabolismo , Humanos , Factores Inmunológicos/aislamiento & purificación , Lactobacillus delbrueckii/genética , Lactococcus lactis/genética , Biosíntesis de Péptidos , Peptidil-Dipeptidasa A/metabolismo , Señales de Clasificación de Proteína , ProteolisisRESUMEN
Extracorporeal photopheresis (ECP) is a widely used immunomodulatory therapy for the treatment of various T cell-mediated disorders such as cutaneous T cell lymphoma (CTCL), graft-versus-host disease (GvHD) or systemic sclerosis. Although clinical benefits of ECP are already well described, the underlying mechanism of action of ECP is not yet fully understood. Knowledge on the fate of CD14+ monocytes in the context of ECP is particularly limited and controversial. Here, we investigated the immunoregulatory function of ECP treated monocytes on T cells in an in-vitro ECP model. We show that ECP-treated monocytes significantly induce proinflammatory T cell types in co-cultured T cells, while anti-inflammatory T cells remain unaffected. Furthermore, we found significantly reduced proliferation rates of T cells after co-culture with ECP-treated monocytes. Both changes in interleukin secretion and proliferation were dependent on cell-contact between monocytes and T cells. Interestingly, blocking interactions of programmed death ligand 1 (PD-L1) to programmed death 1 (PD-1) in the in-vitro model led to a significant recovery of T cell proliferation. These results set the base for further studies on the mechanism of ECP, especially the regulatory role of ECP-treated monocytes.
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Linfocitos T CD4-Positivos/inmunología , Monocitos/fisiología , Adulto , Anciano , Antígeno B7-H1/fisiología , Técnicas de Cocultivo , Femenino , Humanos , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Fotoféresis/métodos , Receptor de Muerte Celular Programada 1/fisiologíaRESUMEN
Total knee arthroplasty (TKA) is one of the most frequent surgical procedures in orthopaedic surgery. Until now there have not been any standardized indication criteria, which might contribute to the large geographical differences in the frequency of TKA. This guideline aims to consent minimal requirements (main criteria), additional important aspects (minor criteria), as well as relative and absolute contraindications for TKA. The following main criteria have been consented: knee pain, radiological confirmation of osteoarthritis or osteonecrosis, inadequate response to conservative treatment, adverse impact of knee disease on the patient's quality of life and the burden of suffering due to the knee disease. Relative contraindications have been consented as severe general disease with reduced life expectancy and a BMI ≥40; absolute contraindications are an active infection and if the patient is not able to undergo major surgery.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Humanos , Consentimiento Informado , Osteoartritis de la Rodilla/cirugía , Guías de Práctica Clínica como Asunto , Prótesis e Implantes , Calidad de VidaRESUMEN
In a screening for proteolytically active lactic acid bacteria, three strains, Lactobacillus delbrueckii ssp. lactis 92202, Lactobacillus helveticus 92201, and Lactobacillus delbrueckii ssp. bulgaricus 92059, showed the highest activities following growth in milk. All three strains degraded α- and ß-casein, but did not hydrolyse κ-casein. HPLC analysis of skim milk fermentation revealed increasing amounts of peptides after 5 and 10 h with Lb. d. ssp. bulgaricus 92059. Hydrolysates obtained with Lb. d. ssp. lactis 92202 and Lb. d. ssp. bulgaricus 92059 revealed the highest angiotensin-converting enzyme-inhibitory effect. The effect was dose dependent. Almost no effect (<10%) was seen for Lb. helveticus 92201. For Lb. d. ssp. bulgaricus 92059, maximal inhibition of approx. 65% was reached after 25 h of fermentation. In an in vitro assay measuring potential immunomodulation, hydrolysates of the three strains yielded anti-inflammatory activities in the presence of TNF-α. However, the effects were more pronounced at lower hydrolysate concentrations. In the absence of TNF-α, slight pro-inflammatory effects were observed. The hydrolysate of Lb. d. ssp. bulgaricus 92059, when purified by means of solid-phase extraction, exhibited pro-inflammatory activity. Sour whey containing Lb. d. ssp. bulgaricus 92059 cells showed pro-inflammatory activity while cell-free sour whey was clearly anti-inflammatory. In the purified hydrolysate, 20 different α- and ß-casein (CN)-derived peptides could be identified by LC-MS. Most peptides originated from the central and C-terminal regions of ß-casein. Peptide length was between 9 (ß-CN(f 59-67)) and 22 amino acids (ß-CN(f 117-138)).
Asunto(s)
Factores Biológicos/metabolismo , Lactobacillus delbrueckii/aislamiento & purificación , Lactobacillus helveticus/aislamiento & purificación , Péptido Hidrolasas/metabolismo , Péptidos/metabolismo , Proteolisis , Animales , Inhibidores Enzimáticos/aislamiento & purificación , Inhibidores Enzimáticos/metabolismo , Factores Inmunológicos/aislamiento & purificación , Factores Inmunológicos/metabolismo , Lactobacillus delbrueckii/enzimología , Lactobacillus delbrueckii/crecimiento & desarrollo , Lactobacillus delbrueckii/metabolismo , Lactobacillus helveticus/enzimología , Lactobacillus helveticus/crecimiento & desarrollo , Lactobacillus helveticus/metabolismo , Tamizaje Masivo , Leche/microbiología , Peptidil-Dipeptidasa A/metabolismo , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
BACKGROUND: Periprothetic infection after primary or revision arthroplasty is of increasing importance. The incidence of infection in primary arthroplasty is approximately 1â%. Revision arthroplasty has higher infection rates, which increase with the number of revision surgeries. Aim of this Paper: An overview of the current diagnosis of periprosthetic infection. METHODS: This selective analysis is based on a lecture by the author at the DKOU 2015. RESULTS: Periprosthetic infection is taken as having been demonstrated when either two periprosthetic cultures contain the same microorganism, or if there is a fistula communicating with a joint. If only minor criteria are met, the detection of an infection is more difficult. The medical history only provides supporting evidence, especially as regards the course of the pain. Physical examination is more helpful, especially if there is redness, swelling, heat or wound dehiscence. Radiological pathologies, such as osteolysis or bone resorption can only be found in advanced infections. Nuclear medicine scans only possess acceptable sensitivity and specificity in combination with leukocyte scintigraphy. ESR, CRP and leukocyte blood count of the blood are of poor specificity. Important and targeted diagnostic steps include joint aspiration under aseptic conditions, although this exhibits a relatively high rate of false negative results. The conditions for this must be stringently observed. This is usefully complemented by cytological examinations and biopsies for tissue culture. Sensitivity and specificity are then increased. Sonication can significantly enhance the detection of an infection. The leukocyte esterase test is inexpensive and easy to perform and is therefore very much in vogue at the moment; however it is useless if there is contamination with blood. Recent studies indicate that the alpha-defensin test possesses high sensitivity and specificity, but has the disadvantage of being expensive. CONCLUSIONS: In patients with suspected periprosthetic infection, the primary aim is either to exclude an infection, or to detect a pathogen. The essential components are careful evaluation of the medical history, accompanied by imaging and laboratory tests. A critical approach is essential. Joint aspiration has become the gold standard in detecting periprosthetic infections. This should be performed in conjunction with a cytological analysis of the synovial fluid. An improvement in sensitivity and specificity can be archived by taking tissue samples. Sonication significantly improves the results. The latter method, the leukocyte esterase test and the alpha-defensin test are optional. The essential components are a rigorous evaluation, a clear algorithm and interdisciplinary collaboration with microbiologists and possibly infectiologists.
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Artrografía/métodos , Artroplastia/efectos adversos , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Técnicas de Laboratorio Clínico/métodos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Bacterianas/etiología , Medicina Basada en la Evidencia , Rol del Médico , Infecciones Relacionadas con Prótesis/etiología , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Patellofemoral complications after total knee arthroplasty are responsible for a variety of surgical revisions. OBJECTIVE: The causes of the various types of instability of the patella are listed in a differentiated way and the importance of clinical and imaging diagnostics as well as preventive strategies are elaborated. MATERIAL AND METHODS: This article is based on a selective literature search in the PubMed database and on the long-standing experience of the author. RESULTS: Besides postoperative genu valgum with malalignment of the extensor mechanisms, other risk factors for patellar maltracking are insufficiency of the medial retinaculum, weakening of the vastus medialis muscle, contracture of the quadriceps femoris or tractus iliotibialis muscle, residual valgus deformity after total knee replacement, femoral or tibial malrotation as well as malpositioning of the patella, inappropriate design of the prosthesis and asymmetrical resection of the patella. The causes with respect to incorrect component positioning, faulty preparation of the patella, leg malalignment, inappropriate design of the prosthesis and soft tissue imbalance have to be recognized in order to address the problem in a targeted way. The preferred method of choice in the case of patellofemoral instability after total knee replacement is normally surgery; however, the cause for the instability has to be identified and consequently corrected before surgery. Without a clearly identified cause surgical measures are unrewarding and almost regularly lead to an unsatisfactory outcome. CONCLUSION: Patella maltracking after total knee arthroplasty is multifactorial and requires an accurate clarification. A surgical revision is only recommended in cases of clearly defined causes of pain or a clearly defined reason for patella malpositioning.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Rótula/lesiones , Rótula/cirugía , Diagnóstico Diferencial , Medicina Basada en la Evidencia , Humanos , Inestabilidad de la Articulación/etiología , Resultado del TratamientoRESUMEN
Limb-girdle muscular dystrophy type 2E (LGMD2E) results from mutations in the ß-sarcoglycan (SGCB) gene causing loss of functional protein and concomitant loss of dystrophin-associated proteins. The disease phenotype is characterized by muscle weakness and wasting, and dystrophic features including muscle fiber necrosis, inflammation and fibrosis. The Sgcb-null mouse recapitulates the clinical phenotype with significant endomysial fibrosis providing a relevant model to test whether gene replacement will be efficacious. We directly addressed this question using a codon optimized human ß-sarcoglycan gene (hSGCB) driven by a muscle-specific tMCK promoter (scAAVrh74.tMCK.hSGCB). Following isolated limb delivery (5 × 10(11) vector genome (vg)), 91.2% of muscle fibers in the lower limb expressed ß-sarcoglycan, restoring assembly of the sarcoglycan complex and protecting the membrane from Evans blue dye leakage. Histological outcomes were significantly improved including decreased central nucleation, normalization of muscle fiber size, decreased macrophages and inflammatory mononuclear cells, and an average of a 43% reduction in collagen deposition in treated muscle compared with untreated muscle at end point. These measures correlated with improvement of tetanic force and resistance to eccentric contraction. In 6-month-old mice, as indicated by collagen staining, scAAVrh74.tMCK.hSGCB treatment reduced fibrosis by 42%. This study demonstrates the potential for gene replacement to reverse debilitating fibrosis, typical of muscular dystrophy, thereby providing compelling evidence for movement to clinical gene replacement for LGMD2E.
Asunto(s)
Terapia Genética/métodos , Músculo Esquelético/efectos de los fármacos , Sarcoglicanopatías/terapia , Sarcoglicanos/genética , Animales , Dependovirus/genética , Modelos Animales de Enfermedad , Femenino , Fibrosis/genética , Fibrosis/terapia , Técnicas de Transferencia de Gen , Vectores Genéticos , Humanos , Masculino , Ratones , Ratones Noqueados , Músculo Esquelético/fisiopatología , Distrofias Musculares/genética , Distrofias Musculares/terapia , Mutación , Sarcoglicanopatías/genética , Sarcoglicanos/metabolismoRESUMEN
The human intestinal microbiota plays an important role in human health. While adhesion to gastrointestinal mucosa is a prerequisite for colonisation, inhibition of adhesion is a property which may prevent or reduce infections by food borne pathogens. Streptococcus thermophilus and Lactobacillus delbrueckii subsp. bulgaricus represent the two lactic bacteria constituting the yoghurt culture. These starter cultures have been claimed to be probiotic. In our study we compared two S. thermophilus strains (i.e. lysogenic strain J34 and corresponding non-lysogenic [prophage-cured] strain J34-6), with respect to (1) their in vitro adhesion properties to HT29 cells and (2) their cell surface hydrophobicities. Effects of the two strains on inhibition of adhesion of the pathogens Listeria monocytogenes Scott A, Staphylococcus aureus 6732 and Salmonella enteritidis S489 were studied in vitro with HT29 cell cultures. Lysogenic strain J34 was shown to be considerably more effective than the non-lysogenic derivative strain J34-6.
Asunto(s)
Células Epiteliales/microbiología , Intestinos/microbiología , Listeria monocytogenes/fisiología , Profagos/fisiología , Staphylococcus aureus/fisiología , Streptococcus thermophilus/fisiología , Streptococcus thermophilus/virología , Adhesión Bacteriana , Células HT29 , Humanos , Intestinos/citología , Lisogenia , Yogur/microbiologíaRESUMEN
ZEUS study was an open-label, 12-month, multicenter study in which 300 de novo kidney transplant recipients were randomized to continue receiving cyclosporine (CsA) or convert to everolimus at 4.5 months posttransplant. Five-year follow-up data were available for 245/269 patients (91.1%) who completed the core 12-month study (123 everolimus, 109 CsA). At 5 years, adjusted estimated GFR was 66.2 mL/min/1.73 m(2) with everolimus versus 60.9 mL/min/1.73 m(2) with CsA; the mean difference was 5.3 mL/min/1.73 m(2) in favor of everolimus (95% CI 2.4, 8.3; p < 0.001 [intent-to-treat population]). In a post hoc analysis of patients remaining on study drug at 5 years (everolimus 77, CsA 86), mean difference was 8.2 mL/min/1.73 m(2) (95% CI 4.3, 12.1; p < 0.001) in favor of everolimus. The cumulative incidence of biopsy-proven acute rejection postrandomization was 13.6% with everolimus versus 7.5% with CsA (p = 0.095), largely accounted for by grade I rejection (16/21 patients and 7/11 patients, respectively). Postrandomization, graft loss, mortality, serious adverse events and neoplasms were similar in both arms. In conclusion, conversion of kidney transplant patients to everolimus at 4.5 months posttransplant is associated with a significant improvement in renal function that is maintained to at least 5 years. The increase in early mild acute rejection did not affect long-term graft function.
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Ciclosporina/uso terapéutico , Rechazo de Injerto/tratamiento farmacológico , Supervivencia de Injerto/efectos de los fármacos , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Sirolimus/análogos & derivados , Adolescente , Adulto , Anciano , Everolimus , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Rechazo de Injerto/inmunología , Supervivencia de Injerto/inmunología , Humanos , Fallo Renal Crónico/complicaciones , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico , Proyectos de Investigación , Factores de Riesgo , Sirolimus/uso terapéutico , Receptores de Trasplantes , Adulto JovenRESUMEN
Infection with cytomegalovirus (CMV) shows a worldwide high prevalence with only immunocompromised individuals or newborns to become symptomatic. The host's constitution and the pathogen's virulence determine whether disease occurs after infection. Mouse CMV (MCMV) is an appreciated pathogen for in vivo investigation of host-pathogen interactions. It has recently been reported that a single base pair deletion can spontaneously occur in the open reading frame of MCMV-encoded chemokine 2 (MCK2), preventing the expression of the full-length gene product. To study the consequences of this mutation, we compared the Mck2-defective reporter virus MCMV-3D with the newly generated repaired Mck2(+) mutant MCMV-3DR. Compared with MCMV-3D, neonatal mice infected with MCMV-3DR showed severe viral disease after lung infection. Viral disease coincided with high viral activity in multiple organs and increased virus replication in previously described nodular inflammatory foci (NIF) in the lung. Notably, MCMV-3DR showed tropism for alveolar macrophages in vitro and in vivo, whereas MCMV-3D did not infect this cell type. Moreover, in vivo depletion of alveolar macrophages reduced MCMV-3DR replication in the lung. We proposed an Mck2-mediated mechanism by which MCMV exploits alveolar macrophages to increase replication upon first encounter with the host's lung mucosa.
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Quimiocinas CC/metabolismo , Infecciones por Herpesviridae/virología , Inflamación/virología , Enfermedades Pulmonares/virología , Pulmón/patología , Macrófagos Alveolares/virología , Muromegalovirus/fisiología , Nódulo Pulmonar Solitario/virología , Proteínas Virales/metabolismo , Animales , Animales Recién Nacidos , Células Cultivadas , Quimiocinas CC/genética , Macrófagos Alveolares/inmunología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Muromegalovirus/patogenicidad , Eliminación de Secuencia/genética , Proteínas Virales/genética , Tropismo Viral/genética , Virulencia/genética , Replicación Viral/genéticaRESUMEN
Duchenne muscular dystrophy is a monogenic disease potentially treatable by gene replacement. Use of recombinant adeno-associated virus (AAV) will ultimately require a vascular approach to broadly transduce muscle cells. We tested the impact of preexisting AAV antibodies on microdystrophin expression following vascular delivery to nonhuman primates. Rhesus macaques were treated by isolated limb perfusion using a fluoroscopically guided catheter. In addition to serostatus stratification, the animals were placed into one of the three immune suppression groups: no immune suppression, prednisone, and triple immune suppression (prednisone, tacrolimus, and mycophenolate mofetil). The animals were analyzed for transgene expression at 3 or 6 months. Microdystrophin expression was visualized in AAV, rhesus serotype 74 sero-negative animals (mean: 48.0 ± 20.8%) that was attenuated in sero-positive animals (19.6 ± 18.7%). Immunosuppression did not affect transgene expression. Importantly, removal of AAV binding antibodies by plasmapheresis in AAV sero-positive animals resulted in high-level transduction (60.8 ± 18.0%), which is comparable with that of AAV sero-negative animals (53.7 ± 7.6%), whereas non-pheresed sero-positive animals demonstrated significantly lower transduction levels (10.1 ± 6.0%). These data support the hypothesis that removal of AAV binding antibodies by plasmapheresis permits successful and sustained gene transfer in the presence of preexisting immunity (natural infection) to AAV.
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Dependovirus/inmunología , Distrofina/genética , Expresión Génica , Vectores Genéticos/genética , Vectores Genéticos/inmunología , Plasmaféresis , Animales , Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/inmunología , Dependovirus/genética , Genes Reporteros , Vectores Genéticos/administración & dosificación , Proteínas Fluorescentes Verdes/genética , Humanos , Macaca mulatta , Masculino , Músculo Esquelético/metabolismo , Plasmaféresis/métodos , Transducción Genética , TransgenesRESUMEN
The cytogenetic characteristics of 17 species of bushcricket belonging to eight genera of the tribe Barbitistini were examined by fluorescence in situ hybridization with 18S rDNA and (TTAGGn) telomeric as probes and by C-banding, silver, and fluorochrome staining. These markers were used to understand chromosomal organization and evolutionary relationships between genera or species within the same genus. The number of 18S rDNA clusters per haploid genome that co-localized with active nucleolus organizer regions (NORs) ranged from one to five, with the most common pattern being the presence of one NOR-bearing chromosome. This ribosomal cistron was preferentially located in the paracentromeric region of autosomes and very rarely in the sex chromosome. The results demonstrated coincidence between the localization of major ribosomal genes and active NORs and the position of C-band and GC-rich regions. The rDNA/NOR distribution and the composition of chromosome heterochromatin proved to be good cytogenetic markers for distinguishing species and phylogenetic lines and for understanding the genomic differentiation and evolution of Barbitistini. A comparison of cytogenetic and morphological or behavioral traits suggests that morphological and behavioral specialization in this group was not followed by major karyotype modification (except for Leptophyes). However, the occurrence and distribution of different repetitive DNA sites tends to vary among the taxa.
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Análisis Citogenético , Genes de Insecto , Variación Genética , Ortópteros/clasificación , Ortópteros/genética , Animales , Cromosomas de Insectos , ADN Ribosómico/genética , Evolución Molecular , Femenino , Marcadores Genéticos , Genoma de los Insectos , Hibridación Fluorescente in Situ , Región Organizadora del Nucléolo/genética , Filogenia , Telómero/genéticaRESUMEN
BACKGROUND: Intraoperative damage to the medial collateral ligament is a rather rare condition given only scant attention in the literature. Observing international medical journals (over the recent years), one finds very few case histories. What is more, these case histories vary significantly with regards to their approaches to the problem at hand. MATERIAL AND METHODS: This survey lists essential publications and case histories in question and - following their analysis and in light of the fairly low number of respective cases - attempts to create a 'treatment algorithm'. RESULTS: Approaches to treatment vary considerably throughout the medical literature. Reasons are the localisation of the actual damage, pertaining to the medial collateral ligament as well as surgeons' aptitudes and preferences with regards to hinged or constraint implants. Eventually, there are five different treatment options: (i) solely conservative treatment by means of an orthesis; (ii) primary reconstruction of the medial collateral ligament; (iii) medial collateral ligament augmentation; (iv) inlay elevation and lateral release procedure; and (v) a higher degree of coupling regarding the TKA. CONCLUSION: It is strongly advised to refrain from conducting a release at the femoral origin of the medial collateral ligament. In stages, a tibial release should be carried out strictly subperiostally. A high expenditure of energy during tension examination needs to be utterly avoided. Reconstruction of the femoral origin/insertion can be carried out rather safely, while reconstruction of the tibial origin/insertion is more complicated due to the more complex anatomic line-up/constellation. Likewise, the reconstruction of the median ligament portion is considerably more difficult; in this case, the application of a primary suture or augmentation by use of the semitendinosus or quadriceps tendon are recommended. In addition, the temporary application of an orthesis is recommended regardless. In any case, a higher degree of coupling should be considered as a fallback. Introduced is an algorithm which differentiates the ligament damage location.
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Artroplastia/efectos adversos , Artroplastia/métodos , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/terapia , Ligamento Colateral Medial de la Rodilla/lesiones , Ligamento Colateral Medial de la Rodilla/cirugía , Aparatos Ortopédicos , Modalidades de Fisioterapia , Procedimientos de Cirugía Plástica/métodos , Algoritmos , Medicina Basada en la Evidencia , Humanos , Periodo IntraoperatorioRESUMEN
BACKGROUND: One of the biggest health insurance companies in Germany (AOK, Allgemeine Ortskrankenkasse) has published new results focussing on process quality of total knee replacement in 2010. These results were published in the online portal "Weiße Liste", which is based on health insurance routine data. The German Association of Orthopeadic Surgery questions the credibility of the rating system of the "Weiße Liste". To prove the system an interdisciplinary task force was created. MATERIAL AND METHODS: The task force identified patient-specific parameters, which influence the outcome of total knee replacement based on the literature and expert opinions. Out of 907 orthopaedic departments, 4 above average and four below average were identified. The AOK was asked to provide 80 data sets for each department. These anonymised data sets could be converted into patient-specific data sets in the identified departments. Statistical analysis was performed to answer the question of whether there are differences between the below and the above average groups. RESULTS: 625 cases could be investigated. We found an increased rate of postoperative complications in the below average group. There are differences between both groups in terms of factors influencing the procedure. In the below average group an increased rate of patients with one or more comorbidities and a preoperative extension lag of over 10° was found. The above average group has a higher rate of operations before the knee replacement. CONCLUSION: The results need to be proven on a larger scale. Further, prospective investigations are planned.
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Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/normas , Interpretación Estadística de Datos , Medicina Basada en la Evidencia , Encuestas de Atención de la Salud/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Alemania/epidemiología , Complicaciones Posoperatorias/diagnóstico , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/normasRESUMEN
Three different diploid chromosome numbers (2n = 54, 56 and 58) have been reported in the lesser horseshoe bat, Rhinolophus hipposideros. Asia Minor and the Middle East are inhabited by R. hipposideros specimens with 58 chromosomes. In Europe, specimens with 56 chromosomes have been recorded from several localities in the Czech Republic, Slovakia, Italy and Greece. Up to now, specimens with 54 chromosomes have been reported only from Spain and possibly from Switzerland. With the record of 54 chromosomes in specimens from Germany presented here, the distributional area of this variant is expanded into Central Europe. According to the cytogenetic data presently available, we presume that the European R. hipposideros population is divided into a western form (from Spain to Germany) with a 2n = 54 karyotype and an eastern form (from the Czech Republic to Greece) with a 2n = 56 karyotype. This study presents banded karyotypes for the 2n = 54 and 2n = 56 variants for the first time. In addition, chromosomal arm homology to the vespertilionid bat species Myotis myotis revealed by chromosome painting is reported. Whether the variants could represent separate species is also discussed.
Asunto(s)
Quirópteros/genética , Cromosomas de los Mamíferos/genética , Variación Genética , Cariotipo , Animales , Pintura Cromosómica , Cromosomas de los Mamíferos/metabolismo , República Checa , Europa (Continente) , Evolución Molecular , Femenino , Genética de Población/métodos , Alemania , Heterocromatina/genética , Heterocromatina/metabolismo , Masculino , Metafase , Región Organizadora del Nucléolo/genética , Región Organizadora del Nucléolo/metabolismo , Homología de Secuencia de Ácido Nucleico , Tinción con Nitrato de Plata , Cromosoma X/genética , Cromosoma X/metabolismo , Cromosoma Y/genética , Cromosoma Y/metabolismoRESUMEN
The aim of this work was to investigate how production and freeze-drying conditions of Bifidobacterium animalis subsp. lactis INL1, a probiotic strain isolated from breast milk, affected its survival and resistance to simulated gastric digestion during storage in food matrices. The determination of the resistance of bifidobacteria to simulated gastric digestion was useful for unveiling differences in cell sensitivity to varying conditions during biomass production, freeze-drying and incorporation of the strain into food products. These findings show that bifidobacteria can become sensitive to technological variables (biomass production, freeze-drying and the food matrix) without this fact being evidenced by plate counts.
Asunto(s)
Bifidobacterium/metabolismo , Microbiología de Alimentos/métodos , Liofilización/métodos , Bifidobacterium/aislamiento & purificación , Reactores Biológicos , Concentración de Iones de Hidrógeno , Cinética , Microscopía Electrónica de RastreoRESUMEN
Sexual selection is thought to have led to searching as a profitable, but risky way of males obtaining mates. While there is great variation in which sex searches, previous theory has not considered search evolution when both males and females benefit from multiple mating. We present new theory and link it with data to bridge this gap. Two different search protocols exist between species in the bush-cricket genus Poecilimon (Orthoptera): females search for calling males, or males search for calling females. Poecilimon males also transfer a costly nuptial food gift to their mates during mating. We relate variations in searching protocols to variation in nuptial gift size among 32 Poecilimon taxa. As predicted, taxa where females search produce significantly larger nuptial gifts than those where males search. Our model and results show that search roles can reverse when multiple mating brings about sufficiently strong material benefits to females.
Asunto(s)
Comunicación Animal , Gryllidae/fisiología , Preferencia en el Apareamiento Animal , Caracteres Sexuales , Animales , Tamaño Corporal , Femenino , Masculino , Modelos Biológicos , Espermatogonias/fisiologíaRESUMEN
Using a set of approaches based on the use of molecular cytogenetic markers (DAPI/C-banding, estimation of the total area of DAPI-positive regions in prophase nuclei, FISH with 26S and 5S rDNA probes) and the microsatellite (SSR-PCR) assay, we studied genomic polymorphism in 15 flax (Linum usitatissimum L.) varieties from different geographic regions belonging to three directions of selection (oil, fiber, and intermediate flaxes) and in the k-37 x Viking hybrid. All individual chromosomes have been identified in the karyotypes of these varieties on the basis of the patterns of differential DAPI/C-banding and the distribution of 26S and 5S rDNA, and idiograms of the chromosomes have been generated. Unlike the oil flax varieties, the chromosomes in the karyotypes of the fiber flax varieties have, as a rule, pericentromeric and telomeric DAPI-positive bands of smaller size, but contain larger intercalary regions. Two chromosomal rearrangements (chromosome 3 inversions) were discovered in the variety Luna and in the k-37 x Viking hybrid. In both these forms, no colocalization of 26S rDNA and 5S rDNA on the satellite chromosome was detected. The SSR assay with the use of 20 polymorphic pairs of primers revealed 22 polymorphic loci. Based on the SSR data, we analyzed genetic similarity of the flax forms studied and constructed a genetic similarity dendrogram. The genotypes studied here form three clusters. The oil varieties comprise an independent cluster. The genetically related fiber flax varieties Vita and Luna, as well as the landrace Lipinska XIII belonging to the intermediate type, proved to be closer to the oil varieties than the remaining fiber flax varieties. The results of the molecular chromosomal analysis in the fiber and oil flaxes confirm their very close genetic similarity. In spite of this, the combined use of the chromosomal and molecular markers has opened up unique possibilities for describing the genotypes of flax varieties and creating their genetic passports.
Asunto(s)
Lino/genética , Cromosomas de las Plantas/genética , Lino/ultraestructura , Marcadores Genéticos , Genotipo , Cariotipificación , Repeticiones de Microsatélite , Polimorfismo GenéticoRESUMEN
The objective of the study was to isolate potential probiotic lactobacilli from Kimere, a pearl millet dough prepared in the Mbeere community of Kenya, East Africa, by fermentation for 18-24 hours. Kimere samples, collected from 11 different homesteads in Mbeere, showed average pH values of 3.63±0.29. Counts of presumptive lactobacilli were 8.52±0.02 log10 colony forming units per gram, respectively. 48 presumptive Lactobacillus isolates were characterised and identified by biochemical and molecular methods. Lactobacillus fermentum (46 isolates) was the dominant Lactobacillus species detected. Analysis of strain diversity with pulsed-field gel electrophoresis indicated relatively large biodiversity among L. fermentum isolates. All L. fermentum isolates were able to grow in MRS medium containing 0.3% ox gall. Twelve of them were able to grow in the presence of 3% ox gall, and of these 60% survived incubation at pH 3 in the presence of 2 mg pepsin per ml for three hours.