Fibroblast growth factor (FGF) 18 has been shown to increase cartilage volume when injected intra-articularly in animal models of osteoarthritis (OA) and in patients with knee OA (during clinical ...development of the recombinant human FGF18, sprifermin). However, the exact nature of this effect is still unknown. In this study, we aimed to investigate the effects of sprifermin at the cellular level.
A combination of different chondrocyte culture systems was used and the effects of sprifermin on proliferation, the phenotype and matrix production were evaluated. The involvement of MAPKs in sprifermin signalling was also studied.
In monolayer, we observed that sprifermin promoted a round cell morphology and stimulated both cellular proliferation and Sox9 expression while strongly decreasing type I collagen expression. In 3D culture, sprifermin increased the number of matrix-producing chondrocytes, improved the type II:I collagen ratio and enabled human OA chondrocytes to produce a hyaline extracellular matrix (ECM). Furthermore, we found that sprifermin displayed a ‘hit and run’ mode of action, with intermittent exposure required for the compound to fully exert its anabolic effect. Finally, sprifermin appeared to signal through activation of ERK.
Our results indicate that intermittent exposure to sprifermin leads to expansion of hyaline cartilage-producing chondrocytes. These in vitro findings are consistent with the increased cartilage volume observed in the knees of OA patients after intra-articular injection with sprifermin in clinical studies.
The purpose of this study was to investigate the clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). We reviewed a consecutive series of 248 patients (71 ...women and 177 men) with CSM who had undergone surgery at our institution between January 2000 and October 2010. Their mean age was 59.0 years (16 to 86). Medical records, office notes, and operative reports were reviewed for data collection. Special attention was focused on pre-operative duration and severity as well as post-operative persistence of myelopathic symptoms. Disease severity was graded according to the Nurick classification. Our multivariate logistic regression model indicated that Nurick grade 2 CSM patients have the highest chance of complete symptom resolution (p < 0.001) and improvement to normal gait (p = 0.004) following surgery. Patients who did not improve after surgery had longer duration of myelopathic symptoms than those who did improve post-operatively (17.85 months (1 to 101) vs 11.21 months (1 to 69); p = 0.002). More advanced Nurick grades were not associated with a longer duration of symptoms (p = 0.906). Our data suggest that patients with Nurick grade 2 CSM are most likely to improve from surgery. The duration of myelopathic symptoms does not have an association with disease severity but is an independent prognostic indicator of surgical outcome.
Despite a remarkable expansion of microsurgery, there is still no international consensus about routinely used prophylactic antithrombotic agents. Most treatment regimens still use aspirin, heparin ...(low-molecular-weight and unfractionated heparin) or colloids (hydroxyphenylacetate 6%/dextran); however, clear evidence for the clinical benefit of an ideal administration regimen or one agent over the other has not yet been established. Instead of searching for the one regime that fits all, an increasing number of reviews from different disciplines describe multistep approaches that optimize what has been shown to be most promising. This includes the use of antithrombotic agents, proper risk assessment, secondary prevention and professional training to optimize microsurgical skills. In this review, we describe factors included in traditional approaches and also emphasize the value of good surgical technique, which while recognized by all to be one of the most important factors for success, receives less emphasis in reviews describing thrombosis prophylaxis in microvascular surgery.
Vertebral body replacement after corpectomy is nowadays a standard procedure in spinal surgery.
Description of the developmental process of vertebral body replacement.
Historical description of the ...innovations in vertebral body replacement.
The first serious attempts to perform vertebral body replacement were initiated approximately 50 years ago. Over several decades spinal surgeons used bone grafts, polymethyl methacrylate, titanium and glass-ceramics containing apatite and wollastonite. Known vertebral surgeons, including Scoville, Polster, Kaneda and Harms, to name but a few, were involved in the continuous development of vertebral body replacement.
Many different expandable and non-expandable implants are now available and both types of implant can still be justified. This article describes the historical development of these implants and shows how this innovational process has significantly increased the therapy options for surgeons.
A systematic clinical examination of the shoulder joint, including a structured medical history, is essential for the diagnosis of shoulder pathologies. Complex clinical situations that are ...accompanied by pain, restriction of movement, loss of strength, or instability have to be considered in accordance with the functional interaction between the cervical spine, the shoulder girdle, and the glenohumeral joint. Only accurate diagnosis allows us to apply successful therapeutic interventions. In order to achieve this, the physician needs to use standardized clinical tests and signs combined with a profound knowledge of the anatomy and the possible underlying pathologies. To ensure a structured approach as well as a complete documentation of results, a shoulder assessment form should be used. The information obtained from the history, examination, and collected data form the basis for further diagnostic imaging.
EOS-Imaging Tarhan, T.; Froemel, D.; Meurer, A.
Der Orthopäde,
12/2015, Letnik:
44, Številka:
12
Journal Article
Zusammenfassung
Die Anwendungsmöglichkeiten des EOS-Imaging sind vielfältig und besonders für die Diagnostik und Planung von operativen Eingriffen bei komplexen orthopädischen Krankheitsbildern ...nützlich. Indiziert ist hier v. a. die Anwendung in der Beurteilung von Deformitäten oder Fehlstellungen im Bereich der Wirbelsäule, des Beckens, hier auch in der prä- und postoperativen Beurteilung und Planung der Hüft- und Knieendoprothetik, und der unteren Extremitäten. Erstmals besteht die Möglichkeit, eine haltungsbezogene Ganzkörperuntersuchung unter Belastung durchzuführen, um auch Auswirkungen einer geplanten Operation auf das „Restskelett“ und die hierdurch zu erzielende Haltungsveränderung des Patienten zu antizipieren. Im Vergleich zu etablierten radiologischen Untersuchungsmethoden wie Röntgen oder Computertomographie, wird der Patient zudem einer deutlich geringeren Strahlenbelastung ausgesetzt, was auch eine Anwendung bei kinderorthopädischen Fragestellungen sinnvoll macht.
Geschichte des Wirbelkörperersatzes Tarhan, T.; Froemel, D.; Rickert, M. ...
Der Unfallchirurg,
12/2015, Letnik:
118, Številka:
Suppl 1
Journal Article
Zusammenfassung
Hintergrund
Heutzutage stellt der operative Wirbelkörperersatz nach Korporektomie einen Standardeingriff in der Wirbelsäulenchirurgie dar.
Fragestellung
Verlauf der geschichtlichen ...Entwicklung des Wirbelkörperersatzes.
Material und Methoden
Historische Beschreibung des Innovationsprozesses in der Wirbelkörperersatzchirurgie.
Ergebnisse
Die ersten ernsthaften Versuche, einen operativen Wirbelkörperersatz durchzuführen, begannen erst vor gut 50 Jahren. Über mehrere Dekaden hinweg verwendeten Wirbelsäulenchirurgen v. a. Knochentransplantate, Polymethylmethacrylat, Apatite- und Wollastonit-beinhaltende Glaskeramik oder Titan. Bekannte Wirbelsäulenchirurgen wie Scoville, Polster, Kaneda oder Harms, um nur wenige zu nennen, waren in die kontinuierliche Entwicklung des Wirbelkörperersatzes involviert.
Schlussfolgerungen
Heute stehen diverse expandierbare und nicht expandierbare Implantate zur Verfügung, und beide Implantatarten haben unverändert ihre Berechtigung. Dieser Artikel beschreibt die geschichtliche Entwicklung dieser Implantate und zeigt, wie dieser Innovationsprozess die Therapiemöglichkeiten des Chirurgen deutlich erweitert hat.
Zusammenfassung
Eine systematische klinische Untersuchung des Schultergelenks einschließlich strukturierter Anamnese ist für die Diagnostik von Schultergelenkerkrankungen essenziell. Im Rahmen der ...klinischen Diagnostik müssen komplexe Beschwerdebilder, die durch Schmerzen, Bewegungseinschränkungen, Kraftminderung oder Instabilität gekennzeichnet sind, unter Beachtung des funktionellen Zusammenspiels zwischen Halswirbelsäule, Schultergürtel und Glenohumeralgelenk betrachtet werden. Nur mit einer präzisen Diagnosestellung ist es möglich, die am besten geeigneten Therapiemaßnahmen zu ergreifen. Hierfür sind eine standardisierte und differenzierte Anwendung von klinischen Tests und Kenntnisse der Pathomorphologie der den Beschwerden zugrunde liegenden Ursachen erforderlich. Um ein strukturiertes Vorgehen sowie eine lückenlose Dokumentation der Untersuchungsergebnisse zu gewährleisten, sollte ein Schulteruntersuchungsbogen verwendet werden. Die durch Anamnese und klinische Untersuchung gewonnenen Erkenntnisse und Daten bilden die Basis, an die sich eine gezielte bildgebende Diagnostik anschließt.
The application spectrum of the EOS imaging acquisition system is versatile. It is especially useful in the diagnostics and planning of corrective surgical procedures in complex orthopedic cases. The ...application is indicated when assessing deformities and malpositions of the spine, pelvis and lower extremities. It can also be used in the assessment and planning of hip and knee arthroplasty. For the first time physicians have the opportunity to conduct examinations of the whole body under weight-bearing conditions in order to anticipate the effects of a planned surgical procedure on the skeletal system as a whole and therefore on the posture of the patient. Compared to conventional radiographic examination techniques, such as x-ray or computed tomography, the patient is exposed to much less radiation. Therefore, the pediatric application of this technique can be described as reasonable.
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