Arctic marine fungi: biomass, functional genes, and putative ecological roles.

Recent molecular evidence suggests a global distribution of marine fungi; however, the ecological relevance and corresponding biological contributions of fungi to marine ecosystems remains largely unknown. We assessed fungal biomass from the open Arctic Ocean by applying novel biomass conversion factors from cultured isolates to environmental sterol and CARD-FISH data. We found an average of 16.54 nmol m-3 of ergosterol in sea ice and seawater, which corresponds to 1.74 mg C m-3 (444.56 mg C m-2 in seawater). Using Chytridiomycota-specific probes, we observed free-living and particulate-attached cells that averaged 34.07 µg C m-3 in sea ice and seawater (11.66 mg C m-2 in seawater). Summed CARD-FISH and ergosterol values approximate 1.77 mg C m-3 in sea ice and seawater (456.23 mg C m-2 in seawater), which is similar to biomass estimates of other marine taxa generally considered integral to marine food webs and ecosystem processes. Using the GeoChip microarray, we detected evidence for fungal viruses within the Partitiviridae in sediment, as well as fungal genes involved in the degradation of biomass and the assimilation of nitrate. To bridge our observations of fungi on particulate and the detection of degradative genes, we germinated fungal conidia in zooplankton fecal pellets and germinated fungal conidia after 8 months incubation in sterile seawater. Ultimately, these data suggest that fungi could be as important in oceanic ecosystems as they are in freshwater environments.

A glimpse into the biogeography, seasonality, and ecological functions of arctic marine Oomycota.

High-latitude environments are warming, leading to changes in biological diversity patterns of taxa. Oomycota are a group of fungal-like organisms that comprise a major clade of eukaryotic life and are parasites of fish, agricultural crops, and algae. The diversity, functionality, and distribution of these organisms are essentially unknown in the Arctic marine environment. Thus, it was our aim to conduct a first screening, using a functional gene assay and high-throughput sequencing of two gene regions within the 18S rRNA locus to examine the diversity, richness, and phylogeny of marine Oomycota within Arctic sediment, seawater, and sea ice. We detected Oomycota at every site sampled and identified regionally localized taxa, as well as taxa that existed in both Alaska and Svalbard. While the recently described diatom parasite Miracula helgolandica made up about 50% of the oomycete reads found, many lineages were observed that could not be assigned to known species, including several that clustered with another recently described diatom parasite, Olpidiopsis drebesii. Across the Arctic, Oomycota comprised a maximum of 6% of the entire eukaryotic microbial community in Barrow, Alaska May sediment and 10% in sea ice near the Svalbard archipelago. We found Arctic marine Oomycota encode numerous genes involved in parasitism and carbon cycling processes. Ultimately, these data suggest that Arctic marine Oomycota are a reservoir of uncharacterized biodiversity, the majority of which are probably parasites of diatoms, while others might cryptically cycle carbon or interface other unknown ecological processes. As the Arctic continues to warm, lower-latitude Oomycota might migrate into the Arctic Ocean and parasitize non-coevolved hosts, leading to incalculable shifts in the primary producer community.

Chytrids dominate arctic marine fungal communities.

Climate change is altering Arctic ecosystem structure by changing weather patterns and reducing sea ice coverage. These changes are increasing light penetration into the Arctic Ocean that are forecasted to increase primary production; however, increased light can also induce photoinhibition and cause physiological stress in algae and phytoplankton that can favour disease development. Fungi are voracious parasites in many ecosystems that can modulate the flow of carbon through food webs, yet are poorly characterized in the marine environment. We provide the first data from any marine ecosystem in which fungi in the Chytridiomycota dominate fungal communities and are linked in their occurrence to light intensities and algal stress. Increased light penetration stresses ice algae and elevates disease incidence under reduced snow cover. Our results show that chytrids dominate Arctic marine fungal communities and have the potential to rapidly change primary production patterns with increased light penetration.

[Partial pelvic resection (internal hemipelvectomy) and endoprosthetic replacement in periacetabular tumors]. / Beckenteilresektion (innere Hemipelvektomie) und endoprothetischer Ersatz bei hüftgelenksnahen Tumoren.

OBJECTIVE: Treatment of tumors of the pelvic girdle by resection of part or all of the innominate bone with preservation of the extremity. Implantation and stable fixation using a custom-made megaprosthesis to restore painless joint function and loading capacity. The surgical goal is to obtain a wide surgical margin and local tumor control. INDICATIONS: Primary bone and soft tissue sarcomas, benign or semi-malignant aggressive lesions, metastatic disease (radiation resistance and/or good prognosis). CONTRAINDICATIONS: Limited life expectancy and poor physical status, extensive metastatic disease, persistent deep infection or recalcitrant osteomyelitis, poor therapeutic compliance, local recurrence following a previous limb-sparing resection, extensive infiltration of the neurovascular structures and the intra- and extrapelvic soft tissues. SURGICAL TECHNIQUE: Levels of osteotomy are defined preoperatively by a CT-controlled manufactured three-dimensional 1:1 model of the pelvis. Using these data, the custom-made prosthesis and osteotomy templates are then constructed by the manufacturer. The anterior (internal, retroperitoneal) and posterior (extrapelvic, retrogluteal) aspects of the pelvis are exposed using the utilitarian incision surgical approach. The external iliac and femoral vessels are mobilized as they cross the superior pubic ramus. The adductor muscles, the rectus femoris and sartorius muscle are released from their insertions on the pelvis and the obturator vessels and nerve are transected. If the tumor extends to the hip joint, the femur is transected at a level distal to the intertrochanteric line to ensure hip joint integrity and to prevent tumor contamination. A large myocutaneous flap with the gluteus maximus muscle is retracted posteriorly. The pelvitrochanteric and small gluteal muscles are divided near their insertion in the upper border of the femur. To release the hamstrings and the attachment of the sacrotuberous ligament, the ischial tuberosity is exposed. After osteotomy using the prefabricated templates, the pelvis is released and the specimen is removed en bloc. The custom made prosthesis can either be fixed to the remaining iliac bone or to the massa lateralis of the sacrum. The released muscles are refixated on the remaining bone or the implant. POSTOPERATIVE MANAGEMENT: Time of mobilization and degree of weight-bearing depends on the extent of muscle resection. Usually partial loading of the operated limb with 10 kg for a period of 6-12 weeks, then increased loading with 10 kg per week. Thrombosis prophylaxis until full weight bearing. Physiotherapy and gait training. At follow-up, patients are monitored for local recurrence and metastases using history, physical examination, and radiographic studies. RESULTS: Between 1994 and 2008, 38 consecutive patients with periacetabular tumors were treated by resection and reconstruction with a custom-made pelvic megaprosthesis. The overall survival of the patients was 58% at 5 years and 30% at 10 years. One or more operative revisions were performed in 52.6% of the patients. The rate of local recurrence was 15.8%. Deep infection (21%) was the most common reason for revision. In two of these cases (5.3%), a secondary external hemipelvectomy had to be performed. There were four cases of aseptic loosening (10.5%) in which the prosthesis had to be revised. Six patients had recurrent hip dislocation (15.8%). In four of them a modification of the inserted inlay and an implantation of a trevira tube had to be performed respectively. Peroneal palsy occurred in 6 patients (15.8%) with recovery in only two. There were 4 operative interventions because of postoperative bleeding (10.5%). The mean MSTS score for 12 of the 18 living patients was 43.7%. In particular, gait was classified as poor and almost all patients were reliant on walking aids. However, most patients showed good emotional acceptance.

Irreversible muscle damage in bodybuilding due to long-term intramuscular oil injection.

Intramuscular oil injections generating slowly degrading oil-based depots represent a controversial subject in bodybuilding and fitness. However they seem to be commonly reported in a large number of non-medical reports, movies and application protocols for 'site-injections'. Surprisingly the impact of long-term (ab)use on the musculature as well as potential side-effects compromising health and sports ability are lacking in the medical literature. We present the case of a 40 year old male semi-professional bodybuilder with systemic infection and painful reddened swellings of the right upper arm forcing him to discontinue weightlifting. Over the last 8 years he daily self-injected sterilized sesame seed oil at numerous intramuscular locations for the purpose of massive muscle building. Whole body MRI showed more than 100 intramuscular rather than subcutaneous oil cysts and loss of normal muscle anatomy. 2-step septic surgery of the right upper arm revealed pus-filled cystic scar tissue with the near-complete absence of normal muscle. MRI 1 year later revealed the absence of relevant muscle regeneration. Persistent pain and inability to perform normal weight training were evident for at least 3 years post-surgery. This alarming finding indicating irreversible muscle mutilation may hopefully discourage people interested in bodybuilding and fitness from oil-injections. The impact of such chronic tissue stress on other diseases like malignancy remains to be determined.

[Evidence-based update in hip arthroplasty]. / Evidenzbasiertes Update aus der Hüftendoprothetik.

The present manuscript provides an overview of current evidence-based data and new clinically relevant developments in the field of hip arthroplasty. A multitude of current clinical trials have focussed on tribology with special interest on metal-on-metal implants. Large trials from implant registries have defined specific risk factors for early implant failure and pseudotumors in surface replacement. Furthermore, new ceramic liners and femoral head implants have been investigated in randomized trials. Apart from other very interesting studies, the results of large meta-analyses are now available for laboratory values in periprosthetic infection, antibiotic prophylaxis, regional anesthesia, prevention of thromboembolism, implant fixation, navigation and clinical pathways to prevent complications.

[Mega cups and partial pelvic replacement]. / Megapfannen und Beckenteilersatz.

Extensive bone loss, as encountered in both revision arthroplasty of the hip and after resection of malignant tumors of the pelvis, is a major challenge for the surgeon as well as for the revision implant. The aims are, despite extensive acetabular defects, to achieve a primary and load-stable fixation of the revision prosthesis in the pelvic bone as well as restoring the physiological joint biomechanics. At present, a large number of different alloarthroplastic revision implants and complex techniques are available for reconstruction of acetabular deficiencies. According to D'Antonio's classification of acetabular defects, particularly high-grade defects with loss of the posterior column or a pelvic discontinuity require special attention regarding implant selection and surgical planning. The object of this paper is to highlight the most important tools and techniques of endoprosthetic reconstruction for grade III and IV defects (D'Antonio) of the acetabulum by means of a classification-oriented therapeutic concept and to discuss the pros and cons of the particular implant.

[Individual and function-dependent therapeutic concept for the ruptured anterior cruciate ligament]. / Individuelles und funktionsabhängiges Therapiekonzept nach vorderer Kreuzbandruptur.

The knee joint is a ligament guided and muscular stabilized joint. Therefore the rupture of the anterior cruciate ligament (ACL) causes a functional deficit with change of the knee kinematics and the dynamic muscle stabilization. The muscular dysfunction can be the result of inadequate muscle strength, a neuro-muscular control defizit, a propriozeptive dysfunction or often the combination of these causes. Due to the complex anatomy of the ACL an exact, patient specific operative anatomical reconstruction is not possible. Therefore we suggest primarily a conservative therapeutic approach. If this approach fails the reconstruction will be performed after the first rehabilitation phase. Independently from the conservative or surgical approach, the rehabilitation program consists of four function-based phases and the overall therapy goal is to achieve the same or even higher activity level than before the lesion.

[Prospective study on injuries of the German national ice hockey teams in more than 1000 games]. / Prospektive Studie über Verletzungsmuster der Deutschen Eishockeynationalmannschaften bei über 1000 Länderspielen.

Due to the fast and physical nature of the game, prevention of injuries is an important issue in ice hockey. The injuries of the German male senior and junior (U16, U17, U18, U19, U20) national ice hockey teams were documented and analyzed in 1006 games between 1986 and 2006. This unique long observation period over 20 years, as well as the standardized protocol of documentation provides reliable data concerning injury pattern in German international ice hockey. Overall 277 injuries were recorded. Comparing the first and the last ten years of observation, the number did not decline over the time, despite various national and international efforts of injury prevention. The majority of the injuries, almost 60%, were caused by body contact with increasing tendency. Remarkably, the injuries with no body or puck/stick contact more than doubled in the last ten years compared to the first ten years of observation. Most injuries happened to the extremities with decreasing tendency to lower body and increasing tendency to upper body injuries. The number of head injuries did not change significantly. More injuries occurred in the second and third period compared to the first period of the game. The data of this study indicate that many injuries might be due to insufficient physical condition with consecutive lack of concentration and coordination. Players do not seem to meet the increasing technical and athletic requirements of international ice-hockey. The increasing speed and physical energy in international ice-hockey make the game unique and fascinating. Therefore, the aim must be to decrease the number and above all the severity of injuries by further development and adjustment of the player's equipment. Also, a better cooperation of players, coaches, sports medicine and referees seems to be necessary for injury prevention in the future.

[Periprosthetic fractures after total hip arthroplasty : classification, diagnosis and therapy strategies]. / Periprothetische Frakturen bei Hüftendoprothese : Klassifikation, Diagnostik und Therapiestrategien.

The number of periprosthetic fractures following hip replacement is increasing due to longer life expectancy and the rising number of joint replacements. The main causes of periprosthetic fractures include trauma, implant specific factors or loosening of the endoprosthesis. When planning therapy, surgeons should consider specific and general implant- and patient-related risk factors to ensure the best possible treatment. Established classification systems can facilitate preoperative planning. At present, the Vancouver classification system probably comes closest to the ideal, as it considers fracture configuration, stability of the implant and quality of the bone stock. Depending on these factors, therapeutic options include conservative treatment, fracture stabilisation or replacement of the endoprosthesis. The problems associated with periprosthetic fractures of varying etiology and the available treatment options are discussed against the background of the established classification systems.

[Revision arthroplasty of the hip: acetabular component]. / Revisionsendoprothetik: Hüftpfannenwechsel.

Approximately 18,000 hip revision procedures of the acetabular component are performed annually in Germany with rising incidence. The aims of acetabular revision are reconstruction of the anatomic hip center, reconstruction of bone stock, cement-free primary stability of the revision implant in autochthonous bone and permanent secondary integration.Precise planning of the revision surgery is necessary with analysis and classification of the bone defects and reconstruction following a concise therapeutic concept. Cup loosening without bone loss as well as segmental bone defects can usually be reconstructed with standard implants. Cavity defects, especially the common craniolateral defects, require the implantation of oval cups or augments to achieve anatomic reconstruction of the hip center. Combined segmental and cavity defects can be reconstructed using oval cups with craniolateral plates, whereas acetabular discontinuity requires stable fixation within the iliac wing by means of an intramedullary stem combined with an extramedullary plate. Middle and long term survival greater than 90% can be realized with the use of this therapeutic concept.

[Replacement of femoral hip prostheses]. / Femoraler Hüftprothesenwechsel.

Femoral revision of total hip arthroplasty is a technically demanding procedure. Therefore, accurate preoperative planning is essential for good clinical results. With many reconstruction methods available, the decision-making process can be complex. Well established classification systems can facilitate preoperative planning. At the time of revision surgery appropriate implants and instruments have to be available ensuring the possibility of managing operative complications. Primary goals of revision arthroplasty are restoration of the physiological joint biomechanics and primary stable fixation of the revision implant. In consideration of possible repeat revision surgery, cementless stem fixation should be preferred. Modular stems provide significant flexibility in restoring the center of rotation. Depending on the pre-existing femoral defect, osseous grafts can be necessary.The scope and classification systems of femoral osseous defects in revision arthroplasty will be discussed and different treatment options will be outlined, which guide the surgeon in selecting an appropriate method of reconstruction.

[Drug-induced osteopathies. Drugs, pathogenesis, forms, diagnosis, prevention and therapy]. / Medikamenteninduzierte Osteopathien. Medikamente, Pathogenese, Formen, Diagnostik, Prävention und Therapie.

A number of drugs can have "side effects" on bone metabolism and formation, causing bone atrophy, impaired mineralisation, as well as osteonecrosis. In both clinical and general practitioner settings, these forms of bone damage have been hitherto considered as adverse drug side effects and have received insufficient attention; moreover, they have not been the subject of patient information. Preventive measures are not instigated prior to initiation of medication and even after onset of bone damage, therapeutic strategies are poorly implemented. Even fracture healing with its complex, staged course can be both positively and negatively influenced by a number of drugs and these effects require monitoring. Recommendations regarding practical screening and therapy of drug-induced osteopathies are presented.

[Drug-induced osteopathies. Drugs, pathogenesis, forms, diagnosis, prevention and therapy]. / Medikamenteninduzierte Osteopathien: Medikamente, Pathogenese, Formen, Diagnostik, Prävention und Therapie.

A number of drugs can have "side effects" on bone metabolism and formation, causing bone atrophy, impaired mineralisation, as well as osteonecrosis. In both clinical and general practitioner settings, these forms of bone damage have been hitherto considered as adverse drug side effects and have received insufficient attention; moreover, they have not been the subject of patient information. Preventive measures are not instigated prior to initiation of medication and even after onset of bone damage, therapeutic strategies are poorly implemented. Even fracture healing with its complex, staged course can be both positively and negatively influenced by a number of drugs and these effects require monitoring. Recommendations regarding practical screening and therapy of drug-induced osteopathies are presented.

[Current diagnosis and therapy of osteoporosis on the basis of "European guidance 2008"]. / Aktuelle Diagnostik und Therapie der Osteoporose auf der Basis der "European Guidance 2008".

Osteoporosis is one of the 10 most important and widespread global diseases. In Germany alone the cost of osteoporosis runs into many billions of Euros. However, it should be noted that in the past 15 years great progress has been made both in diagnosis and in the development of new medications, and this has changed the general perception of and attitude to osteoporosis. It is now taken very seriously and recognised as a national and global disorder which is both preventable and treatable. In spite of this progress, in Europe and especially in Germany, osteoporosis remains an underdiagnosed and undertreated disease. In Germany, only about 10%-15% of patients with manifest osteoporosis are properly treated. However, in addition to national guidelines, there is now a new edition of the "European Position Paper for the Diagnosis and Management of Osteoporosis". This provides physicians treating osteoporosis patients with additional information and therefore more confidence.

[Surgical treatment of musculoskeletal soft tissue sarcomas]. / Chirurgie der Weichteilsarkome im Bereich der Extremitäten.

Treatment of soft tissue sarcomas requires an individual plan which considers interdisciplinary recommendations and the various clinical situations. Anatomical region, histological grading and typing, and tumor size necessitate adjusted methods of reconstruction. The biopsy should be performed at the institution where the patient is treated. In general surgical resection of the tumor will be the treatment of choice. Adjuvant therapies are applied according to anatomical region and size and grading of the tumor. Surgery alone is recommended only in small (<5 cm), superficial, low-grade sarcomas. Sarcomas larger than 5 cm in diameter should be treated by surgery and radiotherapy, achieving excellent results, although in high-grade sarcomas more than 50% of patients still will experience metastatic disease. In case of locally recurrent disease, surgical revision with tumor-free resection margins followed by radiotherapy should be the aim. This applies even for patients who had had radiotherapy after the first excision. In this case brachytherapy is a good modality of tissue-sparing treatment.