Autologous bone marrow-derived cells enhance muscle strength following skeletal muscle crush injury in rats

Insufficient post-traumatic skeletal muscle regeneration with consecutive functional deficiency continues to be a serious problem in orthopedic and trauma surgery. Transplantation of autologous muscle precursor cells has shown encouraging results in muscle trauma treatment but is associated with significant donor site morbidity. In contrast to this, bone marrow-derived (BMD) cells can be obtained without any functional deficit by puncture. The goal of this study was to examine whether regular muscle regeneration can be improved by local application of autologous BMD cells in a rat model of blunt skeletal muscle trauma. One week after standardized open blunt crush injury to the left soleus muscle, 10(6) autologous BMD cells were injected into the traumatized muscle of male Sprague Dawley rats. Rats of the control group received saline solution as treatment. Three weeks after application, the fast twitch and tetanic contraction capacity of the soleus muscles was measured bilaterally by stimulating the sciatic nerves. Contraction forces of injured soleus muscles in control animals recovered to 39 +/- 10% (tetanic) and 59 +/- 12% (fast twitch) of the contralateral noninjured soleus muscles (p < 0.001). In contrast, autologous BMD cell injection significantly restored contractile forces to 53 +/- 8% (tetanic) and 72 +/- 13% (fast twitch) compared to those observed in contralateral noninjured soleus muscles. Thus, muscle function was significantly increased by BMD cell treatment (tetanic, p = 0.014; fast twitch, p = 0.05). In conclusion, autologous BMD cell grafting leads to an increase in contraction force, 14% in tetanic and 13% in fast twitch stimulation, demonstrating its potential to improve functional outcome after skeletal muscle crush injury.     

Fundamental approaches in molecular biology for communication sciences and disorders

PURPOSE: This contemporary tutorial will introduce general principles of molecular biology, common deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and protein assays and their relevance in the field of communication sciences and disorders. METHOD: Over the past 2 decades, knowledge of the molecular pathophysiology of human disease has increased at a remarkable pace. Most of this progress can be attributed to concomitant advances in basic molecular biology and, specifically, the development of an ever-expanding armamentarium of technologies for analysis of DNA, RNA, and protein structure and function. Details of these methodologies, their limitations, and examples from the communication sciences and disorders literature are presented. Results/Conclusions The use of molecular biology techniques in the fields of speech, language, and hearing sciences is increasing, facilitating the need for an understanding of molecular biology fundamentals and common experimental assays.     

Temporal profile of cortical perfusion and microcirculation after controlled cortical impact injury in rats

Impaired cerebral perfusion contributes to evolving posttraumatic tissue damage. Spontaneous reversibility of reduced perfusion within the first days after injury could make a persisting impact on secondary tissue damage less likely and needs to be considered for possible therapeutic approaches. The present study was designed to characterize the temporal profile and impact of trauma severity on cortical perfusion and microcirculation during the first 48 h after controlled cortical impact injury (CCI). In 10 rats, pericontusional cortical perfusion and microcirculation using laser Doppler flowmetry (LDF) and orthogonal polarization spectral (OPS) imaging were assessed before, and at 4, 24, and 48 h after CCI. Influence of trauma severity was studied by varying the penetration depth of the impactor rod (0.5 vs. 1 mm), thereby inducing a less and a more severe contusion. Mean arterial blood pressure (MABP), arterial blood gases, and blood glucose were monitored. With unchanged MABP and paCO2, cortical perfusion and microcirculation were significantly impaired during the first 48 h following CCI. Hypoperfusion observed at 4 h related to vasoconstriction and microcirculatory stasis preceded a long-lasting phase of hyperperfusion at 24 and 48 h reflected by vasodilation and increased flow velocity in arterioles and venules. Hyperperfusion was mostly pronounced in rats with a less severe contusion. Following CCI, trauma severity markedly influences changes in pericontusional cortical perfusion and microcirculation. Overall, pericontusional cortical hypoperfusion observed within the early phase preceded a long lasting phase of hyperperfusion up to 48 h after CCI.     

Operative Interdisziplinarität—Extremitäten

Interdisciplinary reconstructive surgery of the extremities involves a variety of indications ranging from IIIB/C open fractures with major segmental loss of bone and soft tissue, to arterial vessel injury necessitating vascular repair, and to biological, plastic reconstruction following resection of musculoskeletal tumors. The multidisciplinary approach involving trauma/orthopedic surgery combined with vascular, plastic, and neuro- resp. microsurgery has significantly increased the rate of limb-sparing operations and improved morbidity, function, quality of life, and long-term oncological outcome. The multidisciplinary treatment of both complex trauma and malignant bone/soft tissue sarcoma of the extremity is an integral task of surgical trauma and tumor centers. Close interactive communication between the individual surgical disciplines has decisively influenced prognosis and is the precondition for priority-adapted therapeutic strategies.     

Periprothetische Frakturen nach Knietotalendoprothetik

Periprosthetic fractures of the femur, tibia and patella are being registered with increasing frequency due to the rising numbers of total knee replacements. Depending on the site of the fracture, apart from mere traumatic mechanisms, implant specific parameters and implant loosening may represent the main causes of periprosthetic fracture. Moreover, general risk factors promote the manifestation of a periprosthetic fracture. Nowadays, valid classifications are available to categorize periprosthetic fractures of the femur, tibia and patella, and to create the basis for specific decision-making in choice of treatment. Despite a wide field of treatment options, the actual functional outcome after therapy and the high rates of complications imply that an adequate analysis of the fracture etiology and the corresponding transfer into an individualized treatment concept offer the chance of functional restoration of the patient similar to the pre-fracture state.     

In Vivo Imaging of Human Pancreatic Microcirculation and Pancreatic Tissue Injury in Clinical Pancreas Transplantation

Pancreatitis remains to be a major complication following clinical pancreas transplantation. We performed orthogonal polarized spectral (OPS) imaging for direct in vivo visualization and quantification of human pancreatic microcirculation in six healthy donors for living donor liver transplantation and 13 patients undergoing simultaneous pancreas-kidney transplantation. We further determined the impact of microvascular dysfunction during early reperfusion on pancreatic graft injury. Exocrine and endocrine pancreatic impairment was determined by analysis of serum lipase, amylase and C-peptide levels. Compared to normal pancreas in liver donors (homogeneous acinar perfusion) functional capillary density (FCD) and capillary red blood flow velocity of reperfused grafts were significantly decreased. Elevated CRP concentrations on day 2 post-transplant and serum lipase and amylase levels determined on days 4-5 significantly correlated with microvascular dysfunction during the first 30 min of graft reperfusion. Post-transplant serum C-peptide also correlated significantly with pancreatic capillary perfusion. OPS imaging allows to intra-operatively assess physiologic pancreatic microcirculation and to determine microcirculatory impairment during early graft reperfusion. This impairment correlated with the manifestation of post-transplant dysfunction of both exocrine and endocrine pancreatic tissue. OPS imaging may be used clinically to determine the efficacy of interventions, aiming at attenuating microcirculatory impairment during the acute post-transplant reperfusion phase.     

Three different stages of bone stress reactions of long bones in one patient: case report and review of the literature

Introduction The similar clinical and radiological early course of stress fractures and bone tumors can lead to diagnostic misinterpretion.Materials and methods A patient is presented who was admitted to our clinic with the diagnosis of similar bone tumors in the distal femur and the proximal tibia. We found an additional localization with high bone turnover in the contralateral proximal tibia; including this lesion, the patient presented with three different types of stress reaction of bone. The final diagnostic decision-making was based on MRI and bone scintigraphy as well as the consideration of localization, age of occurrence, and behavior of malignant bone diseases. Therefore, bone biopsy was not performed.Results After 8 weeks of partial weight-bearing, the symptoms disappeared, and the patient could return to normal activity.     

Navigation-assisted resections with image-guided surgery for primary and metastatic tumours of the spine and sacrum

Primary tumours and solitary metastases of the spine and sacrum are indications for wide/marginal en bloc excisions. Due to deranged spinal anatomy and spatial vicinity of neurovascular structures oncological sufficient resections of the spine are technically demanding. New concepts of imageguided navigation of resection planes and implant positioning have attracted major interest. This report aimed to describe the technique and oncosurgical treatment results of navigation-assisted resections of tumours/solitary metastatic lesions of the thoracolumbar spine and sacrum.Using an CT-based optoelectronic navigation system 14 patients (spinal/sacral primary tumours n=10, solitary metastatic diseases n=4) have been included. At the thoracolumbar spine, in 3 patients an anterior-posterior navigated resection was performed while an anterior-only approach was used in 1 patient. In 10 patients CT-based guidance of sacrectomy was scheduled. 6 patients received neoadjuvant polychemotherapy. Navigation was successful in 11 patients. Resections were performed at the thoracolumbar spine as hemivertebrectomies in 4 patients. In sacrectomy, segments S2-5, S3-5 and S4-5 were resected in 5, 5 and 1 patients, respectively. Resection margins were tumour-free in 11 patients and marginal with microscopic residual disease in 3 patients. Local recurrence was observed in 3 patients after free interval of 21.5 months. 11 patients have currently no evidence of disease with a mean follow up of 47.7 ± 7.0 months. Mean survival time for patients with solitary metastases was 290 ± 23 months. 1 patient with sacral Ewing sarcoma developed pulmonary metastatic disease of which he died 60 months postoperatively. The mean disease specific survival for navigated sacrectomies and hemivertebrectomies was 48.3 ± 28.5 and 32.7 ± 22.0 months.In particular in segments of the non-exposed spine navigated resections of spinal/ sacral tumours allows for a excellent intraoperative 3D-visualization of spinal anatomy, the tumour and planned resection planes. Potential problems may be caused by erroneous surface matching, insufficient exposure of landmarks and increased mobility of the resected bone segment leading to inaccuracy of navigation and reference. Tremendous gain in orientation along with decreased intraoperative radiation exposure appears to result in avoidance of unnecessarily large resection defects and improved local recurrence rates with acceptable systemic tumour control.