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  • 1
    Language: German
    In: OP-Journal, 2015, Vol.31(03), pp.160-166
    ISSN: 0178-1715
    E-ISSN: 1439-2496
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  • 2
    In: PLoS ONE, 2014, Vol.9(12)
    Description: The increasing incidence of implant-associated infections induced by Staphylococcus aureus (SA) in combination with growing resistance to conventional antibiotics requires novel therapeutic strategies. In the current study we present the first application of the biofilm-penetrating antimicrobial peptide lysostaphin in the context of bone infections. In a standardized implant-associated bone infection model in mice beta-irradiated lysostaphin-coated titanium plates were compared with uncoated plates. Coating of the implant was established with a poly(D,L)-lactide matrix (PDLLA) comprising lysostaphin formulated in a stabilizing and protecting solution (SPS). All mice were osteotomized and infected with a defined count of SA. Fractures were fixed with lysostaphin-coated locking plates. Plates uncoated or PDLLA-coated served as controls. All mice underwent debridement and lavage on Days 7, 14, 28 to determine the bacterial load and local immune reaction. Fracture healing was quantified by conventional radiography. On Day 7 bacterial growth in the lavages of mice with lysostaphin-coated plates showed a significantly lower count to the control groups. Moreover, in the lysostaphin-coated plate groups complete fracture healing were observed on Day 28. The fracture consolidation was accompanied by a diminished local immune reaction. However, control groups developed an osteitis with lysis or destruction of the bone and an evident local immune response. The presented approach of terminally sterilized lysostaphin-coated implants appears to be a promising therapeutic approach for low grade infection or as prophylactic strategy in high risk fracture care e.g. after severe open fractures.
    Keywords: Research Article ; Medicine And Health Sciences ; Physical Sciences ; Research And Analysis Methods
    E-ISSN: 1932-6203
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  • 3
    Language: German
    In: Obere Extremität, 2017, Vol.12(4), pp.199-200
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s11678-017-0431-3 Byline: Tim Logters (1), Kilian Wegmann (2) Author Affiliation: (1) Abteilung fur Unfalla, Hand und Orthopadische Chirurgie, St. Antonius Krankenhaus, Schillerstra[sz]e 23, 50968, Koln, Deutschland (2) Spezielle Unfallchirurgie, Klinik und Poliklinik fur Orthopadie und Unfallchirurgie, Universitatsklinikum Koln (AoR), Kerpenerstra[sz]e 62, 50937, Koln, Deutschland Article History: Registration Date: 05/10/2017 Online Date: 27/11/2017
    Keywords: Medicine & Public Health ; Orthopedics ; Surgical Orthopedics ; Medicine/Public Health, General;
    ISSN: 1862-6599
    E-ISSN: 1862-6602
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  • 4
    Language: English
    In: PLoS ONE, 01 January 2018, Vol.13(1), p.e0191594
    Description: Hyperbaric oxygen therapy (HBO) is applied very successfully in treatment of various diseases such as chronic wounds. It has been already suggested as adjunctive treatment option for osteitis by immune- and fracture modulating effects. This study evaluates the importance of HBO in an early implant-associated localized osteitis caused by Staphylococcus aureus (SA) compared to the standard therapy. In a standardized murine model the left femur of 120 BALB/c mice were osteotomized and fixed by a titanium locking plate. Osteitis has been induced with a defined amount of SA into the fracture gap. Debridément and lavages were progressed on day 7, 14, 28 and 56 to determine the local bacterial growth and the immune reaction. Hyperbaric oxygen (2 ATA, 90%) was applied for 90 minutes on day 7 to 21 for those mice allocated to HBO therapy. To evaluate the effect of HBO therapy the following groups were analyzed: Two sham-groups (12 mice / group) with and without HBO therapy, two osteotomy groups (24 mice / group) with plate osteosynthesis of the femur with and without HBO therapy, and two osteotomy SA infection groups (24 mice / group) with and without HBO therapy. Fracture healing was also quantified on day 7, 14, 28 and 56 by a.p. x-ray and bone healing markers from blood samples. Progression of infection was assessed by estimation of colony-forming units (CFU) and immune response was analyzed by determination of polymorphonuclear neutrophils (PMN), Interleukin (IL) - 6, and the circulating free DNA (cfDNA) in lavage samples. Osteitis induced significantly higher IL-6, cfDNA- and PMN-levels in the lavage samples (on day 7 and 14, each p 〈 0.05). HBO-therapy did not have a significant influence on the CFU and immune response compared to the standard therapy (each p 〉 0.05). At the same time HBO-therapy was associated with a delayed bone healing assessed by x-ray radiography and a higher rate of non-union until day 28. In conclusion, osteitis led to significantly higher bacterial count and infection parameters. HBO-therapy neither had a beneficial influence on local infection nor on immune response or fracture healing compared to the standard therapy in an osteitis mouse model.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 5
    Language: German
    In: OP-JOURNAL, 03/05/2013, Vol.28(03), pp.262-267
    ISSN: 0178-1715
    E-ISSN: 1439-2496
    Source: Thieme Publishing Group (via CrossRef)
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  • 6
    Language: English
    In: Critical care (London, England), 2011, Vol.15(1), pp.R20
    Description: Deregulated apoptosis and overshooting neutrophil functions contribute to immune and organ dysfunction in sepsis and multiple organ failure (MOF). In the present study, we determined the role of soluble Fas (sFas) in the regulation of posttraumatic neutrophil extrinsic apoptosis and the development of sepsis. Forty-seven major trauma patients, 18 with and 29 without sepsis development during the first 10 days after trauma, were enrolled in this prospective study. Seventeen healthy volunteers served as controls. Blood samples from severely injured patients were analyzed at day 1, day 5 and day 9 after major trauma. sFas levels, plasma levels of neutrophil elastase (PMNE) and levels of interleukin (IL)-6 were quantified by enzyme-linked immunosorbent assay and related to patients' Sequential Organ Failure Assessment (SOFA) score and Multiple Organ Dysfunction Score (MODS). Neutrophil apoptosis was determined by propidium iodide staining of fragmented DNA and flow cytometry. sFas-mediated effects on neutrophil apoptosis were investigated in cells cultured with agonistic anti-Fas antibodies in the presence of recombinant sFas, sFas-depleted serum or untreated serum from septic patients. Serum levels of sFas in patients who later developed sepsis were significantly increased at day 5 (P 〈 0.01) and day 9 (P 〈 0.05) after trauma compared with patients with uneventful recovery. Apoptosis of patient neutrophils was significantly decreased during the observation period compared with control cells. Moreover, Fas-mediated apoptosis of control neutrophils was efficiently inhibited by recombinant sFas and serum from septic patients. Depletion of sFas from septic patient sera diminished the antiapoptotic effects. In septic patients, sFas levels were positively correlated with SOFA at day 1 (r = 0.7, P 〈 0.001), day 5 (r = 0.62, P 〈 0.01) and day 9 (r = 0.58, P 〈 0.01) and with PMNE and leukocyte counts (r = 0.49, P 〈 0.05 for both) as well as MODS at day 5 (r = 0.56, P 〈 0.01) after trauma. Increased sFas in patients with sepsis development impairs neutrophil extrinsic apoptosis and shows a positive correlation with the organ dysfunction scores and PMNE. Therefore, sFas might be a therapeutic target to prevent posttrauma hyperinflammation and sepsis.
    Keywords: Apoptosis -- Physiology ; Fas Ligand Protein -- Blood ; Neutrophils -- Physiology ; Sepsis -- Etiology ; Wounds and Injuries -- Blood
    ISSN: 13648535
    E-ISSN: 1466-609X
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  • 7
    Language: German
    In: Obere Extremität, 2012, Vol.7(4), pp.200-208
    Description: Die Einführung der palmaren winkelstabilen Plattenosteosynthese hat zu einem Paradigmenwechsel in der Versorgung von distalen Radiusfrakturen geführt. Sie stellt heute ein etabliertes Verfahren zu deren Behandlung dar und führt bei sachgerechter Indikation zu guten klinischen und radiologischen Ergebnissen. Anhand randomisierter Studien und deren Metaanalysen konnte aber noch keine signifikante Überlegenheit der palmaren Platte gegenüber den Alternativverfahren nachgewiesen werden. In dieser Übersichtsarbeit wird auf der Basis der aktuellen Literatur dargestellt, welche Patientengruppen und Frakturformen von der Implantation der palmaren Plattenosteosynthese einen besonderen Nutzen haben. Während für junge Patienten die mit der palmaren Platte erzielten guten Repositionsergebnisse im Vordergrund stehen, profitieren ältere Patienten insbesondere von der frühfunktionellen Behandlung des verletzten Handgelenks. Unter Kenntnis der Anatomie und der Frakturmorphologie am distalen Radius sowie Berücksichtigung der Implantatlage kann das Risiko von Beuge- und Strecksehnenrupturen deutlich gesenkt werden. Anhand klinischer und radiologischer Indikatoren können zudem Patienten identifiziert werden, die nach knöcherner Konsolidierung der Fraktur von einer Implantatentfernung profitieren. Die Anwendung der palmaren Platte führt im Vergleich zu den Alternativimplantaten zu deutlich höheren Personal- und Materialkosten. Innerhalb des DRG-Vergütungssystems ist mit den palmaren Platten weiterhin eine kostendeckende Versorgung möglich. Der Nachweis, dass die mit der palmaren Plattenosteosynthese erzielte Frühfunktionalität auch aus volkswirtschaftlicher Sicht einen Vorteil darstellt, steht jedoch noch aus. The introduction of volar locking plate fixation has led to a paradigm shift and it now represents an established procedure for the treatment of distal radius fracturesresulting in good clinical and radiological outcomes. However, no randomized trials and meta-analyses could show any significant superiority for volar locking plates compared to the alternative methods. This review article based on the current literature presents which patient groups and types of fractures have a special advantage from locking plates. While for younger patients the good reduction results by locking plates are of high relevance, elderly patients in particular benefit from early functional treatment of injured wrists after surgery. Knowing the anatomy and morphology of fractures of the distal radius as well astaking plate position into consideration significantly decreases the risk of flexor and extensor tendon injuries. There are clinical and radiological indicators that can identify patients who will benefit from implant removal after fracture consolidation. The application of volar locking plates results in significantly higher labor and material costs compared to alternative implants. In the German diagnosis-related groups (DRG) payment system, cost-effective treatment with palmar plates remains possible. Evidence that the early functionality after surgery attained with volar plate fixation is an advantage from an economic perspective is still pending.
    Keywords: Distal radius fracture ; Locking plate ; Volar ; Complication ; Costs
    ISSN: 1862-6599
    E-ISSN: 1862-6602
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  • 8
    In: Orthopädie und Unfallchirurgie up2date, 2017, Vol.12(03)
    In: Orthopädie und Unfallchirurgie up2date, 2017, Vol.12(03), pp.275-290
    Keywords: Sehnenruptur ; Weichteilverletzung ; Handverletzung ; Fingerverletzung ; Handchirurgie
    ISSN: 1611-7859
    E-ISSN: 1861-1982
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  • 9
    Language: German
    In: Handchirurgie Scan, 09/05/2013, Vol.02(03), pp.233-249
    ISSN: 2194-8976
    E-ISSN: 2194-8984
    Source: Thieme Publishing Group (via CrossRef)
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  • 10
    In: Orthopädie und Unfallchirurgie up2date, 2017, Vol.12(02), pp.159-174
    ISSN: 1611-7859
    E-ISSN: 1861-1982
    Source: Thieme Publishing Group
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