Response of multicellular tumor spheroids to liposomes containing TNF-α

Summary This publication describes a new model to investigate the influence of tumor necrosis factor- (TNF-) on a three-dimensional glial cell aggregate under defined, standardized, reproducible conditions using the glioma cell line A 172.The cells are initially grown as normal monolayer culture until they reach a cell density of up to 1×10⁶. Subsequently they are grown as spheroids by the liquid overlay technique. Spheroids grown in this way were divided into ten groups of more than 50 cell aggregates. Three groups were coincubated with free TNF- in increasing dosages (100 ng/ml, 200 ng/ml and 1000 ng/ml); three groups were incubated with empty liposomes (0.2 mg/ml, 0.4 mg/ml and 2 mg/ml); three groups received liposomes which had been loaded with TNF-, and one group, which received no treatment, served as control.The diameter of the spheroids ranged from 80 m to 350 m. There was no significant difference in growth between the 3 groups treated with free TNF-. Comparing spheroids treated with TNF- with those which had been coincubated with empty liposomes, there was a significant difference (p<0.001) in growth, which correlated with the amount of liposomes. Similarly, free TNF- had a significantly (P<0.001) stronger growth-inhibiting effect as compared to liposomes loaded with TNF-. Comparing the groups treated with liposomes only to those treated with liposomes loaded with TNF-, the latter exhibited a more marked (although not significantly) growth-inhibiting effect.The preliminary conclusion is that the major growth-inhibiting effect seems to be mediated by the liposomes. This phenomenon is in agreement with results obtained in monolayer cultures.     

Acute management and outcome of multiple trauma patients with pelvic disruptions

ABSTRACT: INTRODUCTION: Data on pre-hospital and trauma room fluid management of multiple trauma patients with pelvic disruptions are rarely reported. Present trauma algorithms recommend early haemorrhage control and massive fluid resuscitation. By matching the German Pelvic Injury Register (PIR) with the TraumaRegister DGU(R) (TR) for the first time, we attempt to assess the initial fluid management for different Tile/OTA types of pelvic ring fractures. Special attention was given to the patient's post traumatic course, particularly ICU data and patient outcome. METHODS: A specific match code was applied to identify certain patients with pelvic disruptions from both PIR and TR anonymous trauma databases, admitted between 2004 and 2009. From the resulting intersection set, a retrospective analysis was done of pre-hospital and trauma room data, length of ICU stay, days of ventilation, incidence of multiple organ dysfunction syndrome (MODS), sepsis, and mortality. RESULTS: In total 402 patients were identified. Mean ISS was 25.9 points and the mean ratio of patients with ISS [greater than or equal to]16 was 85.6%. The fracture distribution was as follows: 19.7% type A, 29.4% type B, 36.6% type C, and 14.3% isolated acetabular and/or sacrum fractures. The type B/C, compared with type A fractures, were related to constantly worse vital signs that necessitated a higher volume of fluid and blood administration in the pre-hospital and/or the trauma room setting. This group of B/C fractures were also related to a significantly higher presence of concomitant injuries and related with increased ISS. This was related to increased ventilation and ICU stay, increased rate of MODS, sepsis and increased rate of mortality at least for the type C fractures. Approximately 80% of the deceased had sustained type B/C fractures. CONCLUSIONS: The present study confirms the actuality of traditional trauma algorithms with initial massive fluid resuscitation in the recent therapy of multiple trauma patients with pelvic disruptions. Low volume resuscitation seems not yet accepted in practice in managing this special patient entity. Mechanically unstable pelvic ring fractures type B/C (according Tile's/OTA classification) form a distinct entity that has to be considered notably in future trauma algorithms.     

Schockraummanagement Polytrauma

Trauma management in the emergency room is an important part of the treatment chain of the severely injured. Important decisions with respect to diagnostics and treatment must be made under time pressure. Successful trauma management in the emergency room requires a hospital tailored treatment protocol. This written protocol needs consent from all participating disciplines and must be known by all members of the resuscitation team. The ATLS® and the recently published clinical practice guidelines on multiple trauma can be of help in order to establish or update such protocols. In order to continuously evaluate and improve performance in the emergency room local quality circles are needed that truly follow that aim. Important factors are reliability of agreement between the different disciplines and continuous communication of results to the team members. In order to be successful such quality circles need people that care.     

Arthroscopy vs. MRI for a detailed assessment of cartilage disease in osteoarthritis: diagnostic value of MRI in clinical practice

Background  

In patients with osteoarthritis, a detailed assessment of degenerative cartilage disease is important to recommend adequate treatment. Using a representative sample of patients, this study investigated whether MRI is reliable for a detailed cartilage assessment in patients with osteoarthritis of the knee.     

Elektrokardiographische Zeichen der autonomen Imbalance bei S?uglingen mit angeborenen Herzfehlern

Bei S?uglingen mit angeborenen Herzfehlern finden sich h?ufig erh?hte Plasma-Katecholaminwerte, die als Zeichen einer Sympathikusaktivierung bei Herzinsuffizienz gedeutet werden. Zur Verifizierung wurden bei 64 S?uglingen die Katecholaminwerte mit dem Schweregrad der Vitien und der Herzfrequenz sowie bei 25 von ihnen mit der Herzfrequenzvariabilit?t korreliert. Das Kollektiv wurde in Abh?ngigkeit der gemessenen Noradrenalinwerte (NA) in vier Gruppen unterteilt. Bei einer Gruppe von 10 S?uglingen wurde die Herzfrequenzvariabilit?t unter Digoxin/Diuretika -Behandlung mit der unter zus?tzlicher Betablockertherapie verglichen. Zur Bewertung der Variabilit?tsindizes wurden kürzlich ver?ffentlichte Normalwerte für diese Altersgruppe herangezogen.    Die Ergebnisse zeigen keinen Zusammenhang der NA-Werte mit dem h?modynamischen Schweregrad der Vitien. Die Herzfrequenzen waren altersbezogen nicht erh?ht. Vielmehr war die mittlere Frequenz in der Gruppe niedriger NA-Werte (NA <350ng/l) signifikant erniedrigt. Als Ursache fehlender Frequenzsteigerung ist eine gest?rte Signaltransduktion der Betarezeptoren anzunehmen. Die Parameter der Frequenzvariabilit?t waren im Vergleich zu alterentsprechenden Normalwerten mehrheitlich erniedrigt. Sie fielen bei steigenden NA-Werten der 4 Gruppen ab. Die Spektralanalyse der Herzfrequenzvariabilit?t ergab in allen Gruppen, d.h. auch bei normalen NA-Werten, pathologisch erniedrigte Indizes. Urs?chlich scheint eine hohe Sensitivit?t der spektralen Indices gegenüber St?rungen in der Sympathikus/Parasympathikus-Aktivierung vorzuliegen, sodass Werte unterhalb des altersspezifischen Normbereiches auf eine autonome Imbalance hinweisen. Diese Annahme wird durch positive Effekte der Betablockerbehandlung gestützt, die in übereinstimmung mit den Ergebnissen anderer Autoren, eine weitgehende Normalisierung der spektralen Indizes erkennen lie?.     

Die vasculär und kardial dekompensierte Form der arterio-venösen Fistel traumatischer Genese

Zusammenfassung Auf Grund wesentlicher pathophysiologischer Besonderheiten wird einakutes Stadium von einemchronischen Stadium der arterio-venösen Fistel unterschieden. Für das akute Stadium ist ein relativer Volumenmangel mit seinen Folgen bezeichnend. Im chronischen Stadium treten die Auswirkungen der langfristigen Druck-und Volumenbelastung einzelner Kreislaufabschnitte in den Vordergrund. Sowohl am Herzen wie an den Gefäßen läßt sich eineerste Phase reversibler, funktioneller und struktureller Adaptationsvorgänge von einerzweiten Phase irreversibler degenerativer Schädigungen trennen, die schließlich zu der vasculären und kardialen Dekompensation führen. Die pathophysiologischen Zusammenhänge der venösen und der arteriellen Durchblutungsstörungen werden besprochen und die Voraussetzungen für die Bildung eines Kollateral-kreislaufes im Bereiche der Fistel diskutiert.Mit 6 Textabbildungen     

How reliable is MRI in diagnosing cartilaginous lesions in patients with first and recurrent lateral patellar dislocations?

Background  

Lateral dislocation of the patella (LPD) leads to cartilaginous injuries, which have been reported to be associated with retropatellar complaints and the development of patellofemoral osteoarthritis. Therefore, the purpose of this study was to determine the reliability of MRI for cartilage diagnostics after a first and recurrent LPD.