Detecting and distinguishing infrared radiation for non-invasive medical diagnostic purposes has been attempted for basic surface temperature assessment since the middle of the 20th century.However,the long wavelength...Detecting and distinguishing infrared radiation for non-invasive medical diagnostic purposes has been attempted for basic surface temperature assessment since the middle of the 20th century.However,the long wavelength and low energy of infrared radiation impede the detection of signals from deeper tissue layers,significantly limiting its use in diagnostics.To overcome these limitations,a novel approach was developed by combining a semiconductor gallium arsenide chip and prism-based optics that enabled the detection of signals in the infrared and terahertz spectrum.Challenges related to penetration depth and thermal noises were addressed by neural network modelling.展开更多
The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies ov...The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades.The knee is a complex joint with shifting contact points,pressures and axes that are affected when a ligament is injured.The ACL,as one of the intra-articular ligaments,has a strong influence on the resulting kinematics.Often,other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes.Knowing the surgical options,anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.展开更多
AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHO...AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intraand perioperative complications increased for such patients. We evaluated all patients with body mass index(BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty(THA) or total knee arthroplasty(TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score(HHS), Hospital for Special Surgery score(HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated.RESULTS: Six thousand and seventy-eight patients with a BMI ≥ 25 were treated with a primary THA or TKA. Age decreased significantly(P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population(P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population. CONCLUSION: Higher BMI leads to endoprosthetic treatment in younger age, which is carried out at significantly lower levels of preoperative joint function.展开更多
BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is of...BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is often misdiagnosed or even missed.CASE SUMMARY The patient was a young college student.When he presented at the hospital,he had severe lactic acidosis,respiratory failure,and shock with multiple organ dysfunction syndrome(MODS).He was treated by mechanical ventilation,venoarterial extracorporeal membrane oxygenation,and other organ support.However,his condition continued to worsen.After a thorough and detailed medical and family history was taken,a mitochondrial crisis was suspected.A muscle biopsy was taken.Further genetic testing confirmed a mitochondrial gene mutation(TRNL13243A>G).The final diagnosis of mitochondrial myopathy was made.Although there is no known specific treatment,intravenous methylprednisone and intravenous immunoglobulin were started.The patient’s shock eventually improved.The further course was complicated by severe infection in multiple sites,severe muscle weakness,and recurrent MODS.After 2 mo of multidisciplinary management and intensive rehabilitation,the patient could walk with assistance 4 mo after admission and walk independently 6 mo after admission.CONCLUSION More attention should be paid to mitochondrial myopathy to avoid missed diagnosis and misdiagnosis.展开更多
Background:Limb loss has a drastic impact on a patient’s life.Severe trauma to the extremities is common in current military conflicts.Among other aspects,"life before limb"damage control surgery hinders im...Background:Limb loss has a drastic impact on a patient’s life.Severe trauma to the extremities is common in current military conflicts.Among other aspects,"life before limb"damage control surgery hinders immediate replantation within the short post-traumatic timeframe,which is limited in part by the ischemic time for successful replantation.Ex vivo limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation.Presentation of the hypothesis:The current lack of replantation possibilities in military operations with high rates of amputation can be addressed with the development of a portable ex vivo limb perfusion device,as there are several opportunities present with the introduction of this technique on the horizon.We hypothesize that ex vivo limb perfusion will enable overcoming the critical ischemic time,provide surgical opportunities such as preparation of the stump and limb,allow for spare-part surgery,enable rigorous antibiotic treatment of the limb,reduce ischemiareperfusion injuries,enable a tissue function assessment before replantation,and enable the development of large limb transplant programs.Testing the hypothesis:Data from in vivo studies in porcine models are limited by the relatively short perfusion time of 24 h.In the military setting,notably longer perfusion times need to be realized.Therefore,future animal studies must focus especially on long-term perfusion,since this represents the military setting,considering the time for stabilization of the patient until evacuation to a tertiary treatment center.Implications of the hypothesis:The development and clinical introduction of ex vivo limb perfusion in the military setting could lead to a drastic reduction in the number of limb amputations among service members.Ex vivo limb perfusion enables replantation surgery in Role 4 facilities and changes the clinical setting from a highly urgent,lifethreatening situation to a highly methodical,well-prepared starting point for optimal treatment of the wounded service member.With its introduction,the principle of"life before limb"will change to"life before limb before elective replantation/allotransplantation after ex vivo limb perfusion".展开更多
Hepatocellular carcinoma （HCC） is the fish most common cancer in the world. This case documents an unusual metastatic presentation of HCC in the humerus. Preoperative palliative arterial embolization of the tumor wa...Hepatocellular carcinoma （HCC） is the fish most common cancer in the world. This case documents an unusual metastatic presentation of HCC in the humerus. Preoperative palliative arterial embolization of the tumor was performed to arrest severe tumor bleeding caused by the biopsy. Embolization turned out to be useful also in limiting/preventing potential uncontrolled bleeding during subsequent amputation.展开更多
Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only i...Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.展开更多
We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doub...We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doubt whether applying this strategy to every patient during a mass burn event could be realistic.Of note,while there is an undisputed consensus that early burn wound excision is the gold standard of burn care,what‘early’actually means is still debated.Depending on the authors,the corresponding time limit typically varies from 24 h to a few days[2,3].展开更多
BACKGROUND Various tumors and tumor-like disorders,originating from the neural sheath,as well as other types,may affect the brachial plexus region.Due to the infrequent presentation,brachial plexus palsy caused by spo...BACKGROUND Various tumors and tumor-like disorders,originating from the neural sheath,as well as other types,may affect the brachial plexus region.Due to the infrequent presentation,brachial plexus palsy caused by spontaneous hematoma in patients with hemophilia might miss the treatment by early surgical decompression and progress to permanent nerve damage.CASE SUMMARY The case reported here was a 30-year-old man with hemophilia,as well as both sensory and motor dysfunction of the left upper extremity.A presumptive diagnosis of brachial plexus tumor was initially made,which was subsequently confirmed to be an organized chronic hematoma rather than a neoplasm.The hemophilia-induced expanding hematoma compressing the brachial plexus was considered to be the main reason for the patient’s complaints.The clinical symptoms were alleviated and the involved nerves partially recovered at a follow-up of 1 year.CONCLUSION Early surgical intervention is crucial and it seems to be an essential precondition for recovery of nerve function in brachial plexus lesions.展开更多
The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;...The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> and Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, in immediate implant-based subpectoral breast reconstruction cases. <strong>Background:</strong> The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. <strong>Methods:</strong> 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (SADM), 22 cases Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (EADM) and the remaining 35 cases Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). <strong>Results:</strong> The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed a significantly lower time of hospitalization (p < 0.001). <strong>Conclusion:</strong> No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.展开更多
Puqjose: Fractures of the humerus account for 5%—8% of all fractures. Non union is Found with an incidence of up to 15%, depending on the location of the fracture. In case of a manifest nonunion the surgeon faces a c...Puqjose: Fractures of the humerus account for 5%—8% of all fractures. Non union is Found with an incidence of up to 15%, depending on the location of the fracture. In case of a manifest nonunion the surgeon faces a challenging problem and has to conceive a therapy based on the underlying pathology. The aim of this study was to describe our treatment concepts for this entity and present our results of the last five years. Methods: Twenty-six patients were treated for nonunion of the humerus between January 2013 and December 2017. Their charts were reviewed retrospectively and demographic data, pathology, surgical treatment and outcome were assessed. Results: The most frequent location for a nonunion was the humeral shaft, with the most common trauma mechanism being multiple falls. Most often atrophic nonunion (n = 14), followed by hypertrophic and infection-caused nonunion (each n = 4), were found. Our treatment concept could be applied in 19 patients, of which in 90% of those who were available for follow-up consolidation could be achieved. Conclusion: Humeral non union is a heterogeneous entity that has to be analyzed precisely and be treated correspondingly. We therefore present a treatment concept based on the underlying pathology.展开更多
Artificial prostheses for joint replacement are indispensable in orthopedic surgery.Unfortunately,the implanted surface is attractive to not only host cells but also bacteria.To enable better osteointegration,a mechan...Artificial prostheses for joint replacement are indispensable in orthopedic surgery.Unfortunately,the implanted surface is attractive to not only host cells but also bacteria.To enable better osteointegration,a mechanically stable porous structure was created on a titanium surface using laser treatment and metallic silver particles were embedded in a hydrophilic titanium oxide layer on top.The laser structuring resulted in unique amphora-shaped pores.Due to their hydrophilic surface conditions and capillary forces,the pores can be loaded preoperative with the antibiotic of choice/need,such as gentamicin.Cytotoxicity and differentiation assays with primary human osteoblast-like cells revealed no negative effect of the surface modification with or without gentamicin loading.An in vivo biocompatibility study showed significantly enhanced osteointegration as measured by push-out testing and histomorphometry 56 days after the implantation of the K-wires into rat femora.Using a S.aureus infection model,the porous,silver-coated K-wires slightly reduced the signs of bone destruction,while the wires were still colonized after 28 days.Loading the amphora-shaped pores with gentamicin significantly reduced the histopathological signs of bone destruction and no bacteria were detected on the wires.Taken together,this novel surface modification can be applied to new or established orthopedic implants.It enables preoperative loading with the antibiotic of choice/need without further equipment or post-coating,and supports osteointegration without a negative effect of the released dug,such as gentamicin.展开更多
The transcription factor Oct4(Pou5f1)is a critical regulator of pluripotency in embryonic and induced pluripotent stem cells.Therefore,Oct4 expression might identify somatic stem cell populations with inherent multipo...The transcription factor Oct4(Pou5f1)is a critical regulator of pluripotency in embryonic and induced pluripotent stem cells.Therefore,Oct4 expression might identify somatic stem cell populations with inherent multipotent potential or a propensity for facilitated reprogramming.However,analysis of Oct4 expression is confounded by Oct4 pseudogenes or non-pluripotency-related isoforms.Systematic analysis of a transgenic Oct4-EGFP reporter mouse identified testis and skin as two principle sources of Oct4^(+)cells in postnatal mice.While the prevalence of GFP^(+)cells in testis rapidly declined with age,the skin-resident GFP^(+)population expanded in a cyclical fashion.These cells were identified as epidermal stem cells dwelling in the stem cell niche of the hair follicle,which endogenously expressed all principle reprogramming factors at low levels.Interestingly,skin wounding or non-traumatic hair removal robustly expanded the GFP^(+)epidermal cell pool not only locally,but also in uninjured skin areas,demonstrating the existence of a systemic response.Thus,the epithelial stem cell niche of the hair follicle harbors an expandable pool of Oct4^(+)stem cells,which might be useful for therapeutic cell transfer or facilitated reprogramming.展开更多
Purpose: Epileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns du...Purpose: Epileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns due to seizure episode and to analyze consecutive acute medical care. Methods: This retrospective mono-center study was conducted at Frankfurt University Hospital, Frankfurt am Main, Germany between January 2007 and December 2017. Epilepsy patients with seizure-related fractures admitted to the emergency department were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G40.0—G40.9. Patients with an unclear diagnosis of epilepsy were excluded. Sociodemographic as well as disease specific aspects were analyzed. Descriptive and Kruskal—Wallis one-way analysis of variance were used for statistical analysis. Results: A total number of 62 epilepsy patients were included. The mean age was 58.1 years. Fractures concerned the upper extremity most frequently (43.5%,n= 20), and 70.0% (14/20) were humerus fractures. Admission to intensive care unit for acute trauma care was necessary in 29.0% patients (n = 18), and surgery in 45.2% patients (n = 28). Twenty-five patients (26.6%) showed clinical or radiological signs of traumatic brain injury. Provoking factors were identified in 20 patients (32.3%), i.e., acute withdrawal or excess of alcohol (n = 15), relevant sleep deprivation (n = 2), and intoxication or withdrawal of other illegal drugs or trivial infect (n = 1 for each) and non-compliance with anti-seizure drugs (n = 1). A decreased T-score (-1.04 ± 1.15) and Z-score (-0.84 ± 0.75) compared to healthy subjects were found. Conclusion: Fractures in upper extremities, trunk and craniocerebral trauma occur frequently as seizure-induced injuries. Alcohol excess and withdrawal are important provoking factors and should be targeted with preventive measurements to avoid seizure related injuries and accidents.展开更多
Aim:Breast augmentation has traditionally been performed in either the subglandular or submuscular plane.Dual plane augmentation has been described before and captures the advantages of both of these techniques but re...Aim:Breast augmentation has traditionally been performed in either the subglandular or submuscular plane.Dual plane augmentation has been described before and captures the advantages of both of these techniques but reduces the trade-offs.The biplane muscle splitting technique adopts the similar advantages seen with the dual plane method without the need for extensive costal muscle fibre release at the infra-mammary fold.Methods:Thirty-five patients underwent bilateral breast augmentation using the biplanar technique from November 2007 to December 2008.All operations were performed by the senior author and followed up prospectively.Results:Follow up ranged from 9 months to 21 months.All of the patients achieved precise and reliable implant placement with no revisions or patient dissatisfaction.There have been no cases of implant misplacement/migration;synmastia,dynamic breast deformity,capsular contracture or infections.A single case of unilateral haematoma occurred early in the series.Conclusion:Our operative cases and early follow-up supports the use of this novel biplanar technique for breast augmentation.It optimizes the advantages of subglandular and submuscular breast augmentation with simpler dissection and less complications than other submuscular techniques.It can be used in a wide variety of breast types with predictable results.展开更多
The steady progress in medical diagnosis and treatment of diseases largely hinges on the steady development and improvement of modern imaging modalities.Raman spectroscopy has attracted increasing attention for clinic...The steady progress in medical diagnosis and treatment of diseases largely hinges on the steady development and improvement of modern imaging modalities.Raman spectroscopy has attracted increasing attention for clinical applications as it is label-free,non-invasive,and delivers molecular fingerprinting information of a sample.In combination with fiber optic probes,it also allows easy access to different body parts of a patient.However,image acquisition with fiber optic probes is currently not possible.Here,we introduce a fiber optic probe-based Raman imaging system for the real-time molecular virtual reality data visualization of chemical boundaries on a computer screen and the physical world.The approach is developed around a computer vision-based positional tracking system in conjunction with photometric stereo and augmented and mixed chemical reality,enabling molecular imaging and direct visualization of molecular boundaries of three-dimensional surfaces.The proposed approach achieves a spatial resolution of 0.5 mm in the transverse plane and a topology resolution of 0.6 mm,with a spectral sampling frequency of 10 Hz,and can be used to image large tissue areas in a few minutes,making it highly suitable for clinical tissueboundary demarcation.A variety of applications on biological samples,i.e.,distribution of pharmaceutical compounds,brain-tumor phantom,and various types of sarcoma have been characterized,showing that the system enables rapid and intuitive assessment of molecular boundaries.展开更多
The clinical role and underlying mechanisms of valproic acid(VPA)on bone homeostasis remain controversial.Herein,we confirmed that VPA treatment was associated with decreased bone mass and bone mineral density(BMD)in ...The clinical role and underlying mechanisms of valproic acid(VPA)on bone homeostasis remain controversial.Herein,we confirmed that VPA treatment was associated with decreased bone mass and bone mineral density(BMD)in both patients and mice.This effect was attributed to VPA-induced elevation in osteoclast formation and activity.Through RNA-sequencing,we observed a significant rise in precursor miR-6359 expression in VPA-treated osteoclast precursors in vitro,and further,a marked upregulation of mature miR-6359(miR-6359)in vivo was demonstrated using quantitative real-time PCR(qRT-PCR)and miR-6359 fluorescent in situ hybridization(miR-6359-FISH).Specifically,the miR-6359 was predominantly increased in osteoclast precursors and macrophages but not in neutrophils,T lymphocytes,monocytes and bone marrow-derived mesenchymal stem cells(BMSCs)following VPA stimulation,which influenced osteoclast differentiation and bone-resorptive activity.Additionally,VPA-induced miR-6359 enrichment in osteoclast precursors enhanced reactive oxygen species(ROS)production by silencing the SIRT3 protein expression,followed by activation of the MAPK signaling pathway,which enhanced osteoclast formation and activity,thereby accelerating bone loss.Currently,there are no medications that can effectively treat VPA-induced bone loss.Therefore,we constructed engineered small extracellular vesicles(E-sEVs)targeting osteoclast precursors in bone and naturally carrying anti-miR-6359 by introducing of EXOmotif(CGGGAGC)in the 3’-end of the anti-miR-6359 sequence.We confirmed that the E-sEVs exhibited decent bone/osteoclast precursor targeting and exerted protective therapeutic effects on VPA-induced bone loss,but not on ovariectomy(OVX)and glucocorticoid-induced osteoporotic models,deepening our understanding of the underlying mechanism and treatment strategies for VPA-induced bone loss.展开更多
文摘Detecting and distinguishing infrared radiation for non-invasive medical diagnostic purposes has been attempted for basic surface temperature assessment since the middle of the 20th century.However,the long wavelength and low energy of infrared radiation impede the detection of signals from deeper tissue layers,significantly limiting its use in diagnostics.To overcome these limitations,a novel approach was developed by combining a semiconductor gallium arsenide chip and prism-based optics that enabled the detection of signals in the infrared and terahertz spectrum.Challenges related to penetration depth and thermal noises were addressed by neural network modelling.
基金Supported by A Research fellowship from the faculty of Medicine,Westphalian Wilhelms University Muenster to Domnick C
文摘The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades.The knee is a complex joint with shifting contact points,pressures and axes that are affected when a ligament is injured.The ACL,as one of the intra-articular ligaments,has a strong influence on the resulting kinematics.Often,other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes.Knowing the surgical options,anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.
文摘AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intraand perioperative complications increased for such patients. We evaluated all patients with body mass index(BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty(THA) or total knee arthroplasty(TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score(HHS), Hospital for Special Surgery score(HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated.RESULTS: Six thousand and seventy-eight patients with a BMI ≥ 25 were treated with a primary THA or TKA. Age decreased significantly(P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population(P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population. CONCLUSION: Higher BMI leads to endoprosthetic treatment in younger age, which is carried out at significantly lower levels of preoperative joint function.
基金The Science and Technology Department of Gansu Province,No.20JR5RA355 and No.22JR10KA009Talent Innovation and Entrepreneurship Project of Science and Technology Bureau of Chengguan District,Lanzhou,No.2020RCCX0030+1 种基金Lanzhou Science and Technology Development Guiding Plan Project,No.2019-ZD-37Fund of The First Hospital of Lanzhou University,No.Ldyyyn2020-79.
文摘BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is often misdiagnosed or even missed.CASE SUMMARY The patient was a young college student.When he presented at the hospital,he had severe lactic acidosis,respiratory failure,and shock with multiple organ dysfunction syndrome(MODS).He was treated by mechanical ventilation,venoarterial extracorporeal membrane oxygenation,and other organ support.However,his condition continued to worsen.After a thorough and detailed medical and family history was taken,a mitochondrial crisis was suspected.A muscle biopsy was taken.Further genetic testing confirmed a mitochondrial gene mutation(TRNL13243A>G).The final diagnosis of mitochondrial myopathy was made.Although there is no known specific treatment,intravenous methylprednisone and intravenous immunoglobulin were started.The patient’s shock eventually improved.The further course was complicated by severe infection in multiple sites,severe muscle weakness,and recurrent MODS.After 2 mo of multidisciplinary management and intensive rehabilitation,the patient could walk with assistance 4 mo after admission and walk independently 6 mo after admission.CONCLUSION More attention should be paid to mitochondrial myopathy to avoid missed diagnosis and misdiagnosis.
文摘Background:Limb loss has a drastic impact on a patient’s life.Severe trauma to the extremities is common in current military conflicts.Among other aspects,"life before limb"damage control surgery hinders immediate replantation within the short post-traumatic timeframe,which is limited in part by the ischemic time for successful replantation.Ex vivo limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation.Presentation of the hypothesis:The current lack of replantation possibilities in military operations with high rates of amputation can be addressed with the development of a portable ex vivo limb perfusion device,as there are several opportunities present with the introduction of this technique on the horizon.We hypothesize that ex vivo limb perfusion will enable overcoming the critical ischemic time,provide surgical opportunities such as preparation of the stump and limb,allow for spare-part surgery,enable rigorous antibiotic treatment of the limb,reduce ischemiareperfusion injuries,enable a tissue function assessment before replantation,and enable the development of large limb transplant programs.Testing the hypothesis:Data from in vivo studies in porcine models are limited by the relatively short perfusion time of 24 h.In the military setting,notably longer perfusion times need to be realized.Therefore,future animal studies must focus especially on long-term perfusion,since this represents the military setting,considering the time for stabilization of the patient until evacuation to a tertiary treatment center.Implications of the hypothesis:The development and clinical introduction of ex vivo limb perfusion in the military setting could lead to a drastic reduction in the number of limb amputations among service members.Ex vivo limb perfusion enables replantation surgery in Role 4 facilities and changes the clinical setting from a highly urgent,lifethreatening situation to a highly methodical,well-prepared starting point for optimal treatment of the wounded service member.With its introduction,the principle of"life before limb"will change to"life before limb before elective replantation/allotransplantation after ex vivo limb perfusion".
文摘Hepatocellular carcinoma （HCC） is the fish most common cancer in the world. This case documents an unusual metastatic presentation of HCC in the humerus. Preoperative palliative arterial embolization of the tumor was performed to arrest severe tumor bleeding caused by the biopsy. Embolization turned out to be useful also in limiting/preventing potential uncontrolled bleeding during subsequent amputation.
文摘Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.
文摘We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doubt whether applying this strategy to every patient during a mass burn event could be realistic.Of note,while there is an undisputed consensus that early burn wound excision is the gold standard of burn care,what‘early’actually means is still debated.Depending on the authors,the corresponding time limit typically varies from 24 h to a few days[2,3].
基金Supported by the Foundation of Science and Technology Department of Zhejiang Province,No.LGF19H060010the Foundation of Health and Family Planning Commission of Zhejiang Province,No.2021KY445.
文摘BACKGROUND Various tumors and tumor-like disorders,originating from the neural sheath,as well as other types,may affect the brachial plexus region.Due to the infrequent presentation,brachial plexus palsy caused by spontaneous hematoma in patients with hemophilia might miss the treatment by early surgical decompression and progress to permanent nerve damage.CASE SUMMARY The case reported here was a 30-year-old man with hemophilia,as well as both sensory and motor dysfunction of the left upper extremity.A presumptive diagnosis of brachial plexus tumor was initially made,which was subsequently confirmed to be an organized chronic hematoma rather than a neoplasm.The hemophilia-induced expanding hematoma compressing the brachial plexus was considered to be the main reason for the patient’s complaints.The clinical symptoms were alleviated and the involved nerves partially recovered at a follow-up of 1 year.CONCLUSION Early surgical intervention is crucial and it seems to be an essential precondition for recovery of nerve function in brachial plexus lesions.
文摘The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> and Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, in immediate implant-based subpectoral breast reconstruction cases. <strong>Background:</strong> The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. <strong>Methods:</strong> 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (SADM), 22 cases Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (EADM) and the remaining 35 cases Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). <strong>Results:</strong> The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed a significantly lower time of hospitalization (p < 0.001). <strong>Conclusion:</strong> No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.
文摘Puqjose: Fractures of the humerus account for 5%—8% of all fractures. Non union is Found with an incidence of up to 15%, depending on the location of the fracture. In case of a manifest nonunion the surgeon faces a challenging problem and has to conceive a therapy based on the underlying pathology. The aim of this study was to describe our treatment concepts for this entity and present our results of the last five years. Methods: Twenty-six patients were treated for nonunion of the humerus between January 2013 and December 2017. Their charts were reviewed retrospectively and demographic data, pathology, surgical treatment and outcome were assessed. Results: The most frequent location for a nonunion was the humeral shaft, with the most common trauma mechanism being multiple falls. Most often atrophic nonunion (n = 14), followed by hypertrophic and infection-caused nonunion (each n = 4), were found. Our treatment concept could be applied in 19 patients, of which in 90% of those who were available for follow-up consolidation could be achieved. Conclusion: Humeral non union is a heterogeneous entity that has to be analyzed precisely and be treated correspondingly. We therefore present a treatment concept based on the underlying pathology.
基金funded by the Federal Ministry of Education and Research,Germany[grant numbers 03VP03681,03VP03682].
文摘Artificial prostheses for joint replacement are indispensable in orthopedic surgery.Unfortunately,the implanted surface is attractive to not only host cells but also bacteria.To enable better osteointegration,a mechanically stable porous structure was created on a titanium surface using laser treatment and metallic silver particles were embedded in a hydrophilic titanium oxide layer on top.The laser structuring resulted in unique amphora-shaped pores.Due to their hydrophilic surface conditions and capillary forces,the pores can be loaded preoperative with the antibiotic of choice/need,such as gentamicin.Cytotoxicity and differentiation assays with primary human osteoblast-like cells revealed no negative effect of the surface modification with or without gentamicin loading.An in vivo biocompatibility study showed significantly enhanced osteointegration as measured by push-out testing and histomorphometry 56 days after the implantation of the K-wires into rat femora.Using a S.aureus infection model,the porous,silver-coated K-wires slightly reduced the signs of bone destruction,while the wires were still colonized after 28 days.Loading the amphora-shaped pores with gentamicin significantly reduced the histopathological signs of bone destruction and no bacteria were detected on the wires.Taken together,this novel surface modification can be applied to new or established orthopedic implants.It enables preoperative loading with the antibiotic of choice/need without further equipment or post-coating,and supports osteointegration without a negative effect of the released dug,such as gentamicin.
基金This work is supported by funding from the Deutsche Forschungsgemeinschaft(REBIRTH EXC 62/1,SFB738)the BMBF(IFB-Tx 01EO0802)DEBRA,E-RARE and the DAAD(scholarship and German-Chinese research group).
文摘The transcription factor Oct4(Pou5f1)is a critical regulator of pluripotency in embryonic and induced pluripotent stem cells.Therefore,Oct4 expression might identify somatic stem cell populations with inherent multipotent potential or a propensity for facilitated reprogramming.However,analysis of Oct4 expression is confounded by Oct4 pseudogenes or non-pluripotency-related isoforms.Systematic analysis of a transgenic Oct4-EGFP reporter mouse identified testis and skin as two principle sources of Oct4^(+)cells in postnatal mice.While the prevalence of GFP^(+)cells in testis rapidly declined with age,the skin-resident GFP^(+)population expanded in a cyclical fashion.These cells were identified as epidermal stem cells dwelling in the stem cell niche of the hair follicle,which endogenously expressed all principle reprogramming factors at low levels.Interestingly,skin wounding or non-traumatic hair removal robustly expanded the GFP^(+)epidermal cell pool not only locally,but also in uninjured skin areas,demonstrating the existence of a systemic response.Thus,the epithelial stem cell niche of the hair follicle harbors an expandable pool of Oct4^(+)stem cells,which might be useful for therapeutic cell transfer or facilitated reprogramming.
文摘Purpose: Epileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns due to seizure episode and to analyze consecutive acute medical care. Methods: This retrospective mono-center study was conducted at Frankfurt University Hospital, Frankfurt am Main, Germany between January 2007 and December 2017. Epilepsy patients with seizure-related fractures admitted to the emergency department were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G40.0—G40.9. Patients with an unclear diagnosis of epilepsy were excluded. Sociodemographic as well as disease specific aspects were analyzed. Descriptive and Kruskal—Wallis one-way analysis of variance were used for statistical analysis. Results: A total number of 62 epilepsy patients were included. The mean age was 58.1 years. Fractures concerned the upper extremity most frequently (43.5%,n= 20), and 70.0% (14/20) were humerus fractures. Admission to intensive care unit for acute trauma care was necessary in 29.0% patients (n = 18), and surgery in 45.2% patients (n = 28). Twenty-five patients (26.6%) showed clinical or radiological signs of traumatic brain injury. Provoking factors were identified in 20 patients (32.3%), i.e., acute withdrawal or excess of alcohol (n = 15), relevant sleep deprivation (n = 2), and intoxication or withdrawal of other illegal drugs or trivial infect (n = 1 for each) and non-compliance with anti-seizure drugs (n = 1). A decreased T-score (-1.04 ± 1.15) and Z-score (-0.84 ± 0.75) compared to healthy subjects were found. Conclusion: Fractures in upper extremities, trunk and craniocerebral trauma occur frequently as seizure-induced injuries. Alcohol excess and withdrawal are important provoking factors and should be targeted with preventive measurements to avoid seizure related injuries and accidents.
文摘Aim:Breast augmentation has traditionally been performed in either the subglandular or submuscular plane.Dual plane augmentation has been described before and captures the advantages of both of these techniques but reduces the trade-offs.The biplane muscle splitting technique adopts the similar advantages seen with the dual plane method without the need for extensive costal muscle fibre release at the infra-mammary fold.Methods:Thirty-five patients underwent bilateral breast augmentation using the biplanar technique from November 2007 to December 2008.All operations were performed by the senior author and followed up prospectively.Results:Follow up ranged from 9 months to 21 months.All of the patients achieved precise and reliable implant placement with no revisions or patient dissatisfaction.There have been no cases of implant misplacement/migration;synmastia,dynamic breast deformity,capsular contracture or infections.A single case of unilateral haematoma occurred early in the series.Conclusion:Our operative cases and early follow-up supports the use of this novel biplanar technique for breast augmentation.It optimizes the advantages of subglandular and submuscular breast augmentation with simpler dissection and less complications than other submuscular techniques.It can be used in a wide variety of breast types with predictable results.
基金funded by the ERA-CVD project MultiFib(01KL1904)support from the China Scholarship Council.
文摘The steady progress in medical diagnosis and treatment of diseases largely hinges on the steady development and improvement of modern imaging modalities.Raman spectroscopy has attracted increasing attention for clinical applications as it is label-free,non-invasive,and delivers molecular fingerprinting information of a sample.In combination with fiber optic probes,it also allows easy access to different body parts of a patient.However,image acquisition with fiber optic probes is currently not possible.Here,we introduce a fiber optic probe-based Raman imaging system for the real-time molecular virtual reality data visualization of chemical boundaries on a computer screen and the physical world.The approach is developed around a computer vision-based positional tracking system in conjunction with photometric stereo and augmented and mixed chemical reality,enabling molecular imaging and direct visualization of molecular boundaries of three-dimensional surfaces.The proposed approach achieves a spatial resolution of 0.5 mm in the transverse plane and a topology resolution of 0.6 mm,with a spectral sampling frequency of 10 Hz,and can be used to image large tissue areas in a few minutes,making it highly suitable for clinical tissueboundary demarcation.A variety of applications on biological samples,i.e.,distribution of pharmaceutical compounds,brain-tumor phantom,and various types of sarcoma have been characterized,showing that the system enables rapid and intuitive assessment of molecular boundaries.
基金supported by the National Key Research&Development Program of China(2021YFA1101500)National Science Foundation of China(No.82002313,No.82072444)+1 种基金Department of Science and Technology of Hubei Province(2021CFB425)Wuhan Science and Technology Bureau(2022020801020464)。
文摘The clinical role and underlying mechanisms of valproic acid(VPA)on bone homeostasis remain controversial.Herein,we confirmed that VPA treatment was associated with decreased bone mass and bone mineral density(BMD)in both patients and mice.This effect was attributed to VPA-induced elevation in osteoclast formation and activity.Through RNA-sequencing,we observed a significant rise in precursor miR-6359 expression in VPA-treated osteoclast precursors in vitro,and further,a marked upregulation of mature miR-6359(miR-6359)in vivo was demonstrated using quantitative real-time PCR(qRT-PCR)and miR-6359 fluorescent in situ hybridization(miR-6359-FISH).Specifically,the miR-6359 was predominantly increased in osteoclast precursors and macrophages but not in neutrophils,T lymphocytes,monocytes and bone marrow-derived mesenchymal stem cells(BMSCs)following VPA stimulation,which influenced osteoclast differentiation and bone-resorptive activity.Additionally,VPA-induced miR-6359 enrichment in osteoclast precursors enhanced reactive oxygen species(ROS)production by silencing the SIRT3 protein expression,followed by activation of the MAPK signaling pathway,which enhanced osteoclast formation and activity,thereby accelerating bone loss.Currently,there are no medications that can effectively treat VPA-induced bone loss.Therefore,we constructed engineered small extracellular vesicles(E-sEVs)targeting osteoclast precursors in bone and naturally carrying anti-miR-6359 by introducing of EXOmotif(CGGGAGC)in the 3’-end of the anti-miR-6359 sequence.We confirmed that the E-sEVs exhibited decent bone/osteoclast precursor targeting and exerted protective therapeutic effects on VPA-induced bone loss,but not on ovariectomy(OVX)and glucocorticoid-induced osteoporotic models,deepening our understanding of the underlying mechanism and treatment strategies for VPA-induced bone loss.
