Die Bedeutung der Psychoonkologie in der Rehabilitation in der urologischen Onkologie

This article describes the necessities, possibilities and limits of psycho-oncological treatment during the rehabilitation of patients with uro-oncologic malignancies. Studies verify the efficacy of educational and behavioral-medicine orientated interventions: improved coping, reduced burden affects, increased quality of life and a better compliance with the medical treatment.     

Amplification of <Emphasis Type="Italic">NOTCH1</Emphasis> and <Emphasis Type="Italic">ABL1</Emphasis> gene loci is a frequent aberration in enteropathy-type T-cell lymphoma

We have shown previously that amplification of chromosomal region 9q34 is the most frequent aberration in enteropathy-type T-cell lymphoma (ETL). To determine the minimum amplified 9q34 region and identify possible candidate gene(s), we performed a detailed microsatellite screening and quantitative real-time PCR (QPCR) on 26 ETL cases. Microsatellite analysis revealed allelic imbalance in both ABL1 and NOTCH1 gene loci (microsatellites D9S290–D9S1847 and D9S158 flanking the former and latter genes, respectively) localized in the band 9q34. The results were confirmed by TaqMan-based QPCR showing amplification of ABL1 and NOTCH1 exons in 50% and 65% of cases, respectively. Amplifications of the NOTCH1 gene were more frequent than of the ABL1 gene; moreover, the analyzed NOTCH1 exon consistently displayed higher levels of amplification than ABL1 coding sequences. From 9q34 known genes, NOTCH1 could thus be the primary target of genomic DNA amplification in ETL.     

The fine specificity of the myelin oligodendrocyte glycoprotein autoantibody response in patients with multiple sclerosis and normal healthy controls

Antibodies directed against the extracellular immunoglobulin (Ig)-like domain of the myelin oligodendrocyte glycoprotein (MOG(Igd)) mediate demyelination in experimental autoimmune encephalomyelitis (EAE) and are implicated in the immunopathogenesis of multiple sclerosis (MS). In this study we investigated the epitope specificity of MOG(Igd)-specific autoantibodies immunopurified from MS patients (n=17) and normal healthy controls (HD; n=9). ELISA, using a panel of synthetic MOG(Igd) peptides, revealed that the epitope specificity of this response was heterogeneous in both groups. The most frequently recognised epitopes were located in amino acid sequences (a.a.) 1-26 (13/17) and 63-87 (15/17) in MS patients, and 14-39 (6/9) and 63-87 (6/9) in HDs, but there was no association between MS and any particular peptide specificity. We therefore investigated the ability of the immunopurified antibodies to recognise native MOG(Igd) expressed on at the membrane surface by FACS. Unexpectedly, antibodies fulfilling this essential criterion for a demyelinating antibody response were detected only in one of the MS samples. These results indicate that the epitope specificity of the human B cell response to MOG is not only heterogeneous, but may only mediate demyelination in a limited subset of MS patients.     

Postoperative morbidity in surgically treated extension fractures of the distal radius. A comparative study of dorsal and volar approach

The aim of this study was to investigate perioperative morbidity in operative interventions in distal radiusfractures, comparing the operative approach from volar and dorsal. Only problems, resulting from the operative approach towards the distal aspect of the radius, were examined. In a Case-Control-Study, we investigated patients with operative by plate-osteosynthesis treated distal radius-extensions-fractures. During 3 years we investigated 92 patients. 49 were operated with a volar approach, and after changing the operative management, consecutive 43 patients with a dorsal approach to the distal radius. Indications for operative treatment were not changed. The approach to the distal aspect of the radius corresponded to the recent guidelines. Further perioperative procedures were identical, including procedures in anesthesiology. Datas of patients have been investigated for epidemiology, kind of operations, point of time in treatment, duration of operation, X-Ray, immobilisation and time of inhospital stay as well as all documented complications. It has been shown, that in respect of all criterias, concerning length of operation (106 vs. 83 min), intraoperative X-Ray (3.0 vs. 1.65 min) as well as postoperative immobilisation (33 vs. 25 days), and documented incidences of complications like secondary wound-healing (19/49 vs. 0/43) or nerval irritations (13/49 vs. 1/43), the dorsal osteosynthesis is definitively to be favored.     

Embalmed and fresh frozen human bones in orthopedic cadaveric studies: which bone is authentic and feasible?: A mechanical study

Background and purpose

The most frequently used bones for mechanical testing of orthopedic and trauma devices are fresh frozen cadaveric bones, embalmed cadaveric bones, and artificial composite bones. Even today, the comparability of these different bone types has not been established.

Methods

We tested fresh frozen and embalmed cadaveric femora that were similar concerning age, sex, bone mineral density, and stiffness. Artificial composite femora were used as a reference group. Testing parameters were pullout forces of cortex and cancellous screws, maximum load until failure, and type of fracture generated.

Results

Stiffness and type of fracture generated (Pauwels III) were similar for all 3 bone types (fresh frozen: 969 N/mm, 95% confidence interval (CI): 897–1,039; embalmed: 999 N/mm, CI: 875–1,121; composite: 946 N/mm, CI: 852–1,040). Furthermore, no significant differences were found between fresh frozen and embalmed femora concerning pullout forces of cancellous screws (fresh frozen: 654 N, CI: 471–836; embalmed: 595 N, CI: 365–823) and cortex screws (fresh frozen: 1,152 N, CI: 894–1,408; embalmed: 1,461 N, CI: 880–2,042), and axial load until failure (fresh frozen: 3,427 N, CI: 2,564–4290; embalmed: 3,603 N, CI: 2,898–4,306). The reference group showed statistically significantly different results for pullout forces of cancellous screws (2,344 N, CI: 2,068–2,620) and cortex screws (5,536 N, CI: 5,203–5,867) and for the axial load until failure (> 7,952 N).

Interpretation

Embalmed femur bones and fresh frozen bones had similar characteristics by mechanical testing. Thus, we suggest that embalmed human cadaveric bone is a good and safe option for mechanical testing of orthopedic and trauma devices. Human cadaveric specimens are widely used in studies analyzing the mechanical properties and efficacy of orthopedic and trauadevices (Park et al. 2010). Storage of fresh human cadaveric bones at a temperature of –20°C is a commonly used and accepted method for preservation of bone. Many studies have shown that freezing does not alter the mechanical properties of human bone (Pelker et al. 1983, Goh et al. 1989, Linde and Sorensen 1993, Matter et al. 2001, van Haaren et al. 2008), although some changes have been shown compared to fresh bone (Sonstegard and Matthews 1977, Pelker et al. 1983).In Europe, there is some difficulty in obtaining a sufficient number of fresh frozen bones. Furthermore, they are expensive and need excessive storage space—and there is also the risk of transmitting pathogens to investigators (Sterling et al. 2000, van Haaren et al. 2008).Human cadaveric specimens are often obtained from anatomical institutes. The cadavers have usually been embalmed with a formaldehyde solution for at least 1 year before usage. Some studies have investigated the effects of embalming cadaveric bones regarding their mechanical properties (McElhaney et al. 1964, Pelker et al. 1983, Roe et al. 1988, Goh et al. 1989, Linde and Sorensen 1993, Currey et al. 1995).Most of the above studies used animal bones for mechanical testing, and had a maximum storage period of ≤ 100 days (McElhaney et al. 1964, Pelker et al. 1983, Roe et al. 1988, Goh et al. 1989, Currey et al. 1995). There have been few studies on long-term effects (van Haaren et al. 2008), and most of the studies using human bones have concentrated on small bone segments (Linde and Sorensen 1993, Currey et al. 1995, Burkhart et al. 2010).Another bone type that is commonly used is the artificial composite bone (Cristofolini et al. 1996, Zdero et al. 2008). Concerning the handling and mechanical properties, cadaveric specimens simulate reality best (Burkhart et al. 2010). In comparison, composite bones differ in some of their mechanical characteristics (Cristofolini et al. 1996).We compared fresh frozen human femora and long-period embalmed femora concerning stiffness, maximum axial load until fracture, type of fracture generated, and pullout strength of cortical and cancellous bone screws. Artificial femora were used as a non-osteoporotic reference group.     

Animal models of multiple sclerosis—Potentials and limitations

Experimental autoimmune encephalomyelitis (EAE) is still the most widely accepted animal model of multiple sclerosis (MS). Different types of EAE have been developed in order to investigate pathogenetic, clinical and therapeutic aspects of the heterogenic human disease. Generally, investigations in EAE are more suitable for the analysis of immunogenetic elements (major histocompatibility complex restriction and candidate risk genes) and for the study of histopathological features (inflammation, demyelination and degeneration) of the disease than for screening of new treatments. Recent studies in new EAE models, especially in transgenic ones, have in connection with new analytical techniques such as microarray assays provided a deeper insight into the pathogenic cellular and molecular mechanisms of EAE and potentially of MS. For example, it was possible to better delineate the role of soluble pro-inflammatory (tumor necrosis factor-α, interferon-γ and interleukins 1, 12 and 23), anti-inflammatory (transforming growth factor-β and interleukins 4, 10, 27 and 35) and neurotrophic factors (ciliary neurotrophic factor and brain-derived neurotrophic factor). Also, the regulatory and effector functions of distinct immune cell subpopulations such as CD4⁺ Th1, Th2, Th3 and Th17 cells, CD4⁺FoxP3⁺ Treg cells, CD8⁺ Tc1 and Tc2, B cells and γδ⁺ T cells have been disclosed in more detail. The new insights may help to identify novel targets for the treatment of MS. However, translation of the experimental results into the clinical practice requires prudence and great caution.     

Die DRGs als zukünftiges Abrechnungssystem der Krankenhausleistungen am Beispiel der Multiplen Sklerose

Die Einführung des pauschalierten Entgeltsystems auf der Basis der “Diagnosis Related Groups” (DRG) wird weitreichende Konsequenzen für die ambulante und station?re Versorgung der Patienten in Deutschland haben. Dies gilt insbesondere für die Indikationsstellung zur station?ren Therapie, aber auch für den Leistungsumfang und die Liegezeit. Auch die Multiple Sklerose als h?ufigste entzündliche Erkrankung des Nervensystems in Europa mit Jahreskosten von 2,3 Mrd. Euro allein in Deutschland wird hiervon betroffen sein. Beispielhaft soll für dieses Krankheitsbild aufgezeigt werden, wie vollst?ndiges Kodieren sich auf das Entgelt auswirkt, wobei übersichtstabellen zu praktisch relevanten Nebendiagnosen und Komplikationen bereit gestellt werden. Gleichzeitig werden das gesundheitspolitische Potenzial des neuen Entgeltsystems als Steuerungs- und Qualit?tssicherungsinstrument sowie seine Schw?chen, sogar potenzielle Risiken für die Patientenversorgung bei fehlenden Leitlinien für Diagnostik und Therapie exemplarisch diskutiert.