Eine neue arthroskopische Klassifikation der artikularseitigen Rotatorenmanschettenpartialruptur

Zusammenfassung   Die Klassifikationen der RM-Partialrupturen nach Ellman sowie Snyder beschreiben die betroffene Sehnenfl?che sowie die L?sionstiefe ohne die ?tiopathomorphologie der Rupturentstehung an der Sehneninsertion zu berücksichtigen. Ziel unserer prospektiven Studie war eine rationelle reproduzierbare Beschreibung zur Quantifizierung der artikularseitigen Rotatorenmanschettenpartialruptur (RMPR) zu entwickeln. 56 konsekutive Patienten mit klinischer und mittels MRT nachgewiesener artikularseitiger RMPR wurden standardisiert diagnostisch arthroskopiert. Die RMPR wurde intraoperativ nach Ellman und Snyder klassifiziert. Zus?tzlich wurde das Ausma? der RMPR zweidimensional gemessen. Die londitudinale Rupturausdehnung wurde anhand der L?nge des freiliegenden kn?chernen Footprints in der paracoronaren Ebene bestimmt. Die sagittale Rupturausdehnung in der transversalen Ebene wurde definiert als Ruptur des lateralen Pulley-Systems am medialen Supraspinatussehnenrand und / oder als Ruptur im Bereich der Crescent-Zone. Arthroskopisch wiesen 71,4 % eine isolierte artikularseitige SSP-Ruptur und 28,6 % wiesen eine kombinierte artikularseitige SSP- und SCP-Ruptur auf. 62,5 % der Patienten mit artikularseitiger SSP-Ruptur hatten ein positives Cable-Sign. In der transversalen Ebene wiesen Patienten mit artikularseitiger SSP-Ruptur in 26,8 % eine Ruptur des LCH, die sich in die SSP-Sehne fortsetzte (Zone A) auf. Bei 23,2 % fand sich eine artikularseitige SSP-Ruptur in der Crescent-Zone bei intaktem Rotatorenintervall (Zone B) und 50 % wiesen eine artikularseitige SSP-Ruptur mit Ausdehnung in Zone A und B auf. In der paracoronaren Ebene fand sich bei 48,2 % eine Ausdehnung der artikularseitigen SSPRuptur in die übergangszone von Knorpel zu Knochen (Typ 1), in 37,5 % eine Rupturausdehnung bis zur Mitte des Footprints (Typ 2) und in 14,2 % bis zum Tuberculum majus (Typ 3). Statistisch wurde eine hohe Korrelation (Spearman's rho r = 0.920; p < 0.0001) zwischen der Klassifikation nach Ellman und nach Snyder beobachtet. Eine geringe Korrelation bestand (r = 0.342; p = 0.007) zwischen der Klassifikation nach Snyder und der Rupturausdehnung in der übergangszone sowie zwischen der Klassifikation nach Ellman und der Rupturausdehnung and der übergangszone (r = 0.376; p = 0.003). Zwischen SSP-Rupturausdehnung bis zur Mitte des Footprints und der Klassifikation nach Ellman (r = 0.380; p = 0.003) sowie der Klassifikation nach Snyder (r = 0.326; p = 0.011) besteht ebenfalls nur eine geringe Korrelation. Die Klasifikationen der artikularseitigen Supraspinatussehnenrupturen nach Snyder und nach Ellman reproduzieren nicht die Ausdehnung der Rotatorenmanschettenpartialruptur in der transversalen und in der coronaren Ebene ausgehend von der Sehneninsertion. * Diese Arbeit wurde mit dem Best-Paper-Preis der DVSE ausgezeichnet.     

Selective effects of upper respiratory tract infection on cognition, mood and emotion processing: a prospective study

Observational and experimentally induced infection studies show that upper respiratory tract infections (URTI) affect mood and cognition. This study tested the effects of naturally occurring URTI on cognition, mood and emotional processing, using a prospective design, with a broader array of tests than previous research, and with well matched control participants. Eighty participants (42 younger, M age 20.3 years; 38 older, M age 64.3 years) underwent neuropsychological assessment at baseline. Once a participant had URTI symptoms, s/he and a healthy, matched participant were retested. The Cognitive Drug Research computerised assessment battery was used to assess Power and Continuity of Attention, Quality of Episodic and Working Memory, Speed of Memory, and mood. Additionally, emotional processing was measured on matching of emotionally-negative faces with faces and faces with labels. Forty-two of 80 participants were matched (21 well, 21 ill). Well participants improved in Speed of Memory and face-label reaction time. Despite a lack of fever, ill participants demonstrated significantly smaller improvements. Older participants reported feeling less alert if ill, and less stressed if well, than at baseline. All ill participants reported less contentment than at baseline than well participants. Severity of URTI symptoms correlated with changes in Speed of Memory and mood. Even without fever, infectious disease produces large disturbances in speed of cognitive processing, particularly that reflecting retrieval from memory, and these effects are more marked in older participants. URTIs also affect mood. Future studies need to examine the role of inflammatory molecules and the brain regions implicated in mediating these findings.     

Ischemic-like cholangiopathy with secondary sclerosing cholangitis in critically ill patients

OBJECTIVES: Sclerosing cholangitis in critically ill patients (SC-CIP) is a newly described entity of severe biliary disease with progression to liver cirrhosis. The mechanisms leading to this form of cholangiopathy with stricture formation and complete obliteration of bile ducts are unknown. PATIENTS AND METHODS: In the last 2 yr, sclerosing cholangitis was diagnosed in 26 patients during or after their stay on the intensive care unit by ERCP and/or liver histology. Complete patient records were available for 17 patients. Histological evaluations of liver biopsies and of four explanted livers, parameters of cardiovascular and respiratory conditions, treatment modalities, and accompanying infections were analyzed to find further hints for the pathomechanisms leading to SC-CIP. RESULTS: With the beginning of cholestasis, the earliest endoscopic findings were intrahepatic biliary casts with impairment of the biliary flow and subsequent biliary infection, in most cases with Enterococcus faecium. Liver biopsy confirmed cholangitis and histology of explanted livers revealed ulcerated biliary epithelium with hemorrhagic exudates in the bile ducts. In the further course, progressive sclerosis with formation of multiple strictures of the bile ducts was observed. All patients suffered severe respiratory insufficiency with the need for mechanical ventilation (40.7+/-32.9 days). The PaO2/FiO2 ratio until beginning of cholestasis was 150.5+/-43.1. Half of the patients (9/17) were treated with high-frequency oscillatory ventilation and 12/17 patients by intermittent prone positioning. All patients required catecholamines for hemodynamic stabilization. CONCLUSIONS: SC-CIP is a severe and in most cases rapidly progressive complication of intensive care patients. Ischemic injury of the biliary tree with the formation of biliary casts and subsequent ongoing biliary infection due to multiresistant bacteria seem to be major pathogenic mechanisms in the development of this new entity of sclerosing cholangitis.     

Age-dependent distribution of Plasmodium falciparum gametocytes quantified by Pfs25 real-time QT-NASBA in a cross-sectional study in Burkina Faso

Sexual stages of Plasmodium falciparum play a key role in the transmission of malaria. Studies on gametocytes are generally based on microscopic detection, but more sensitive detection methods for P. falciparum gametocytes frequently detect sub-patent gametocytes. We used Pfs25 mRNA quantitative-nucleic acid sequence-based amplification (QT-NASBA) to quantify gametocytes in 412 samples from a cross-sectional study in Burkina Faso, covering all age groups, to determine age-related patterns in gametocyte carriage and gametocyte density. The more sensitive QT-NASBA technique gave estimates of gametocyte prevalence 3.3-fold higher than microscopy (70.1% versus 21.4%, respectively). Prevalence of gametocytes significantly decreased with age. Our data suggest that asexual parasite densities are primarily responsible for the age-related decrease of gametocyte prevalence, possibly because of developing asexual stage immunity. Gametocyte densities decrease also with age, primarily because of decreasing asexual parasite densities; only a small but significant age effect on gametocyte density may be caused by developing sexual stage-specific immunity.     

Inhibitory effect of tumor cell-derived lactic acid on human T cells

A characteristic feature of tumors is high production of lactic acid due to enhanced glycolysis. Here, we show a positive correlation between lactate serum levels and tumor burden in cancer patients and examine the influence of lactic acid on immune functions in vitro. Lactic acid suppressed the proliferation and cytokine production of human cytotoxic T lymphocytes (CTLs) up to 95% and led to a 50% decrease in cytotoxic activity. A 24-hour recovery period in lactic acid-free medium restored CTL function. CTLs infiltrating lactic acid-producing multicellular tumor spheroids showed a reduced cytokine production. Pretreatment of tumor spheroids with an inhibitor of lactic acid production prevented this effect. Activated T cells themselves use glycolysis and rely on the efficient secretion of lactic acid, as its intracellular accumulation disturbs their metabolism. Export by monocarboxylate transporter-1 (MCT-1) depends on a gradient between cytoplasmic and extracellular lactic acid concentrations and consequently, blockade of MCT-1 resulted in impaired CTL function. We conclude that high lactic acid concentrations in the tumor environment block lactic acid export in T cells, thereby disturbing their metabolism and function. These findings suggest that targeting this metabolic pathway in tumors is a promising strategy to enhance tumor immunogenicity.