Telomeraseaktivität und Telomerlänge humaner mesenchymaler Stammzellen

Zusammenfassung Humane mesenchymale Stammzellen (hMSC) haben die Fähigkeit zur Selbstreplikation sowie zur Differenzierung in verschiedene Gewebearten. Aufgrund des Selbstreplikationsvermögens wird vermutet, dass Stammzellen bzw. Zellen mit Stammzellcharakter über die Telomeraseaktivität definiert werden können. Allerdings wird der Status der Telomerase in hMSC bis heute kontrovers diskutiert. Deshalb wurden in der vorliegenden Arbeit sowohl proliferierende und hochproliferierende hMSC auf Telomeraseaktivität, als auch konfluent kultivierte bzw. osteogen differenzierende hMSC auf Telomeraseaktivität und auf Änderungen der Telomerlänge untersucht.Für klinische Anwendungen im Rahmen des tissue engineering von Knochen sollte eine Besiedlung von Leitschienen mit Zellen erfolgen, die ihre Replikationseigenschaft und ihre Differenzierungsfähigkeit durch zu lange In-vitro-Kultivierung nicht verloren haben. Die Telomeraseaktivität könnte ein Merkmal für die Charakterisierung und Isolierung dieser Zellen darstellen.     

Möglichkeiten der Heilverfahrenssteuerung

The German Statutory Accident Insurance (GUV) assumes responsibility for the recovery of health and functioning of insured persons and for their occupational and social integration. To provide the best possible recovery of health and functioning, the GUV can use different strategies to control and manage medical treatment and rehabilitation. After a brief overview of the historical development of the GUV over the last 125 years, possible options for these strategies, particularly for severely injured patients, are presented. Furthermore, this article gives an overview of research on how to optimise medical treatment and rehabilitation and how to implement and manage change. Finally, the article outlines and explains new paths within the GUV for process-oriented quality management using patient-related assessments, which will allow measurement of the quality of various therapies.     

Möglichkeiten der Schlaganfallversorgungsforschung

Background

The implementation of thrombolysis to treat acute ischemic stroke patients in Baden-Württemberg was accompanied by a comprehensive stroke treatment concept with implementation of stroke units in every local district and a stroke registry has been running for many years. The possibilities for stroke healthcare service research using data from the registry are presented and exemplified with two typical analyses.

Method

This article presents a retrospective analysis of a consecutive register containing data from all stroke patients in the federal state of Baden-Württemberg admitted to hospital less than 7 days after stroke onset. Data from the time period 2008–2012 were analyzed.

Results

The exemplified analyses for the time-dependent effect of thrombolysis showed that early thrombolysis is also associated with a better outcome in the clinical routine. The analysis of thrombolysis rates showed substantial differences depending on the treatment level of the stroke unit, especially in patients over 80 years old and with preexisting disabilities.

Conclusion

The presented analyses show the possibilities for neurological health services research by analyzing routine quality assurance data. The stroke care concept of the federal state of Baden-Württemberg not only allows a good comprehensive patient care but due to the special features of regional responsibility, also offers outstanding possibilities for vascular health services research.

     

Beeinflussungsmöglichkeiten von Kniegelenkscores

This study evaluated 96 knee joints with osteoarthritis (degree I according to Resnick). The patients were examined by three examiners with the following score systems: Larson, Lysholm, Marshall, Orthop?dische Arbeitsgemeinschaft Knie (OAK), Hospital for Special Surgery (HSS), Visual Analog Scale (VAS), Tegner activity level, and the International Knee Documentation Committee (IKDC) scoring system. The portion of subjective criteria varied in the different scores between 22 and 95 %. Nevertheless, the agreement between criteria showed high correlations among the different examiners. Depending on the scoring system used and the examiners, different values were achieved. The results were significant at the 5 % level for the numerical results (Friedmantest) and for the total results (Bowkertest). The Lysholm score showed results that were extremely dependent on the different examiners, and the evaluation was very strict. The HSS scoring system was not as strict. The Marshall and the OAK scoring system presented few differences. The Larson score results compared with the OAK, and the Marshall score results showed comparable results in the evaluation by the different examiners. The Visual Analog Scale presented difficulties when used by the patients. The results showed a tendency to the middle values, the patients did not use the whole spread. Apart from this, the correlation between these VAS values and the results of the other scoring systems were high. Since it was only used one time, the Tegner activity level could not efficiently show the limitation caused by knee-joint damage. At the level of 1-4 the Lysholm scoring system and the VSA scale resulted in high values.     

Versorgungsmöglichkeiten kindlicher Frakturen

Background

The treatment of fractures in children is part of every (trauma) surgeon’s and orthopaedist’s daily work. Nevertheless, many physicians face a huge challenge in the therapy when treating children since they lack the necessary experience and knowledge. It is a common misconception to believe that fractures in children always heal.

Treatment selection

Only after an initial decision as to whether the fracture is treated conservatively or operatively can the choice of an appropriate osteosynthesis technique be made. Various factors such as the age, weight and size of the patient as well as the fracture morphology and location have to be taken into consideration. In recent years, the operative treatment of fractures in children has become more common, as a result of the development of modern, minimally invasive osteosynthesis techniques. In many cases this has reduced the time for recovery and of hospitalisation for many patients. Even though it is well possible to acquire the skills required for carrying out osteosynthesis, avoidable complications are not uncommon. The basics of child-oriented treatment, which are essential for an optimal outcome, are described.     

Chirurgische Möglichkeiten bei Hochdruckerkrankungen

Ohne ZusammenfassungMit 8 AbbildungenVortragender:G. Heberer-Köln.     

Systemische Behandlungsmöglichkeiten der Peritonealkarzinose

Peritoneal metastases are common in metastatic disease of many tumour types and thus are determinant for prognosis and development of tumour-related symptoms that jeopardise quality of life. Systemic chemotherapy has proven efficacious in improving both prognosis and quality of life in numerous tumour types and should therefore be considered as part of the treatment strategy--although there is no large body of data from predefined cohorts with"only peritoneal" manifestation. In further clinical trials therefore, improvement of systemic chemotherapy by integration of novel agents should be implemented in multimodal treatment approaches combining systemic treatment, cytoreductive surgery, and intraperitoneal treatment strategies.     

Klinische Möglichkeiten zur Steuerung der Körpertemperatur

The constancy of body temperature (CBT) is a cornerstone of homeostatic, homothermic organisms and is essential for a regulated course of biochemical and biophysical reactions. Severe deviations from normothermia (36.8+/-0.4 degrees C) are life threatening and even a moderate perioperative reduction of the CBT is coupled with an increased morbidity and mortality especially in high-risk patients. The relevant factors are coagulation disturbances, increased infection rate and increased cardiac risk. Normothermia should be achieved by the consistent use of warmth-conserving measures. On the other hand, a deliberate reduction in temperature or induced hypothermia is a neuroprotective procedure, which offers a therapeutic option to minimize neuronal secondary damage after primary hypoxic-ischemic events as well as extending the neuronal tolerance to ischemia. Management includes the practice of cooling down to a defined temperature, rewarming as well as a differentiated control of various parameters. Furthermore, side-effects which increase in severity with decreasing temperature must be taken into consideration.     

Grenzen und Möglichkeiten der Trachealplastik

Ohne ZusammenfassungMit 12 TextabbildungenMit freundlicher Unterstützung der Deutschen Forschungsgemeinschaft.     

Möglichkeiten der Weichteilrekonstruktion bei Pseudarthrosen

Die Unfallchirurgie - Pseudarthrosen können als Komplikation einer vorhergegangenen operativen oder konservativen Frakturbehandlung oder nach elektiven Knocheneingriffen entstehen. Ihre...