The role of mast cells in neuroinflammation

Mast cells (MCs) are densely granulated perivascular resident cells of hematopoietic origin and well known for their pathogenetic role in allergic and anaphylactic reactions. In addition, they are also involved in processes of innate and adaptive immunity. MCs can be activated in response to a wide range of stimuli, resulting in the release of not only pro-inflammatory, but also anti-inflammatory mediators. The patterns of secreted mediators depend upon the given stimuli and microenvironmental conditions, accordingly MCs have the ability to promote or attenuate inflammatory processes. Their presence in the central nervous system (CNS) has been recognized for more than a century. Since then a participation of MCs in various pathological processes in the CNS has been well documented. They can aggravate CNS damage in models of brain ischemia and hemorrhage, namely through increased blood–brain barrier damage, brain edema and hemorrhage formation and promotion of inflammatory responses to such events. In contrast, recent evidence suggests that MCs may have a protective role following traumatic brain injury by degrading pro-inflammatory cytokines via specific proteases. In neuroinflammatory diseases such as multiple sclerosis, the role of MCs seems to be ambiguous. MCs have been shown to be damaging, neuroprotective, or even dispensable, depending on the experimental protocols used. The role of MCs in the formation and progression of CNS tumors such as gliomas is complex and both positive and negative relationships between MC activity and tumor progression have been reported. In summary, MCs and their secreted mediators modulate inflammatory processes in multiple CNS pathologies and can thereby either contribute to neurological damage or confer neuroprotection. This review intends to give a concise overview of the regulatory roles of MCs in brain disease.     

Große Überraschung im kleinen Becken

A 17-year-old young man presented at our clinic with asymptomatic microhematuria. Ultrasonography and computer tomography found an intraperitoneal lesion of unknown dignity located on top of the bladder. Surgical exploration and histological examination confirmed the diagnosis of a secondary pelvic spleen, a lien bipartitus.     

DVO-Leitlinie (DVO: Dachverband Osteologie) in der osteologischen Schwerpunktpraxis

Use of DVO guideline

The DVO (Dachverband Osteologie) guideline helps to detect and treat osteoporosis.

Diagnosis of osteoporosis

In the presence of typical osteoporosis-related fractures and osteoporosis habitus, osteoporosis should be considered and investigated further after surgical or conservative treatment of fractures. But even before the occurrence of fractures, risk factors should be inquired and identified. An x-ray of the lumbar and thoracic spine provides information about whether a typical osteoporosis vertebral deformity already exists. Gold standard in the measurement of bone density on the recommendations of the DVO guideline is and remains the DXA (dual-energy x-ray absorptiometry) measurement which, however, is only useful for diagnosis in the overall context of risk profile, x-rays and laboratory tests.

Therapy

Because of improved combined inpatient and outpatient care, further fractures can be prevented and the efficiency of treatment of osteoporosis patients can be increased. Compliance-supporting measures (e.g., informing the patient and regular treatment monitoring) shall ensure that the necessary treatment is also continued.