Differential role of NK cells against Candida albicans infection in immunocompetent or immunocompromised mice

Little is known regarding the role of NK cells during primary and secondary disseminated Candida albicans infection. We assessed the role of NK cells for host defense against candidiasis in immunocompetent, as well as immunodeficient, hosts. Surprisingly, depletion of NK cells in immunocompetent WT mice did not increase susceptibility to systemic candidiasis, suggesting that NK cells are redundant for antifungal defense in otherwise immunocompetent hosts. NK‐cell‐depleted mice were found to be protected as a consequence of attenuation of systemic inflammation. In contrast, the absence of NK cells in T/B/NK‐cell‐deficient NSG (NOD SCID gamma) mice led to an increased susceptibility to both primary and secondary systemic C. albicans infections compared with T/B‐cell‐deficient SCID mice. In conclusion, this study demonstrates that NK cells are an essential and nonredundant component of anti‐C. albicans host defense in immunosuppressed hosts with defective T/B‐lymphocyte immunity, while contributing to hyperinflammation in immunocompetent hosts. The discovery of the importance of NK cells in hosts with severe defects of adaptive immunity might have important consequences for the design of adjunctive immunotherapeutic approaches in systemic C. albicans infections targeting NK‐cell function.     

New avenues to quality assurance--a model project for recording bedsore incidence

Bedsores can usually be avoided by adequate care and preventive measures. In the context of the local agenda process a local district office (Landratsamt) and inspection units initiated a variety of activities to promote sensitisation in health institutions and contribute to an increase in life quality of the persons concerned. Nearly all nursing care homes, domiciliary services and hospitals participated in a pilot study which was accompanied by the Fraunhofer IAO in Stuttgart. Objectives of the pilot study were to implement internal quality assurance to sensitise for persons the topic and to collect comparable data to achieve benchmarking. Software-tool institutions recorded data on care days, days spent with bedsores according to care level from July till September 01. Major result was that - although institutions had already a decreasing incidence in bedsores since the start of discussing the project - bedsore quotas could be further decreased from 2.15 to 1.84 %.     

Does the NexGen LPS flex mobile knee prosthesis offer advantages compared to the NexGen LPS?--a comparison of clinical and radiological results

Under experimental conditions, mobile bearing knee prostheses have several advantages. The optimized congruence of the tibio-femoral joint surface allows a knee flexion of more than 120 degrees without creating instability or increase of wear. AIM: The aim of this study is to compare the results of a prospective randomized study after implantation of the mobile bearing knee prosthesis NexGen LPS Flex with the results of the fixed bearing knee prosthesis NexGen LPS. METHODS: Sixty patients underwent a total knee replacement (30 patients with NexGen LPS Flex mobile, 30 patients with NexGen LPS) via a mid vastus approach. All implants were cemented (Palacos) including the patella resurfacing. We evaluated the Hospital for Special Surgery Score (HSS) and different radiological parameters (maximal flexion, positioning of the implants, leg axis) preoperatively as well as 3 months and 3 years (34.6 +/- 7.3 months) postoperatively. RESULTS: After 3 months the NexGen LPS Flex group showed better results in the scores for pain, range of motion (122.5 degrees vs. 107.33 degrees ) as well as the overall HSS (87.21 vs. 82.68 points) compared to the NexGen LPS group. Three years postoperatively there were no differences in all scores between the two groups. CONCLUSION: The theoretical advantages of the mobile bearing knee prostheses were reflected in the clinical results only partly and temporarily. Probably the results of long-term follow-ups will show characteristic advantages or disadvantages of mobile bearing knee prostheses.     

Osteoporosis--a neglected issue in orthopaedics? Results of a survey amongst German orthopaedic surgeons

AIM: Patients with fragility fractures have a significantly increased risk of sustaining additional fractures. Therefore one should consider avoidance of further fractures as the primary treatment principle. Since orthopaedic surgeons manage most of fragility fractures, but might not be well attuned to osteoporosis itself, it was the aim of the Bone and Joint Decade (BJD) and the International Osteoporosis Foundation (IOF) to survey orthopaedic surgeons in order to assess their knowledge of prevention, diagnosis, and treatment of osteoporosis. MATERIAL AND METHODS: The multinational survey questionnaire was developed by a working group of national project co-ordinators in France, Germany, Italy, Spain, the United Kingdom, and New Zealand and based to some extent on an American survey. Following translation into the national language it was distributed in 2002 to the members of the orthopaedic societies to assess the management of prevention, diagnosis, and therapy of osteoporosis and fragility fractures, comparing both different health-care systems and different working environments. 5 700 questionnaires were distributed in Germany with a 20 percent response rate. RESULTS: As the main result of the German survey -- independent of the working environment -- a substantial deficit concerning training and knowledge about the management of prevention, diagnosis, and treatment of osteoporosis and fragility fractures was seen. In addition, the majority of participants requested educational opportunities to become qualified for a better disease control. CONCLUSION: In order to satisfy the increasing need for adequate management of prevention, diagnosis, and therapy of osteoporosis and fragility fractures, structured educational opportunities have to be offered to the German orthopaedic community. In the mean time first steps have been initiated: training courses to qualify as "Osteologe DVO" and the "White Book Osteoporosis", which was initiated by BJD and IOF and developed by several German medical societies and patient organisations it is based on the German DVO guidelines providing an evidence-based and structured overview concerning all relevant aspects of osteoporosis and fragility fractures.     

对《伤寒论》预后诊断思想方法的研究

为提高临床诊断疾病的准确性和对治疗效果的判定,作者认真研读《伤寒论》对疾病病证的传变和预测疾病生死愈危,并对其方法进行了深入地研究,对现实临床实践具有重要的指导意义。     

The midvastus approach for total knee arthroplasty

Objective  Approach to the knee for total knee arthroplasty with the goal to avoid tendency to lateralization and extension lag. Indications  Implantation of total knee components. Revision surgery after total knee arthroplasty. Contraindications  Morbid obesity. For revision surgery: preoperative knee flexion of <60°. Surgical Technique  Anterior midline incision, blunt separation of the distal part of the obliquely running fibers of the vastus medialis over an extent of at least 5 cm. The muscle incision ends at the proximal and medial corner of the patella and is continued distally along the medial patellar border ending at the tibial tuberosity. After opening of the joint, the patella is dislocated laterally thus exposing the articular surfaces. After insertion of the components, superficial adaptation of the muscle fibers and wound closure in layers. Results  Of 297 total knee implants 276 knees (92.9%) could be followed up for an average of 36.2 (19–56) months. 153 knees were in women and 123 in men with an average age of 66.3 (33–81) years. In none of the operations a lateral release became necessary. The results were based on the score of the American Knee Society. The score showed 52.3 points preoperatively and 90.6 at follow-up. 95% of the patients had an excellent or good functional result. Tangential radiographs of the patella with the knee in 30° of flexion showed in 91% a central position in the patellar groove.