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  • 1
    Language: English
    In: Obere Extremitat, Dec, 2012, Vol.7(4), p.200(9)
    Description: Byline: Tim Logters (1), Michael Schadel-Hopfner (1), Joachim Windolf (1) Keywords: Distale Radiusfraktur; Winkelstabile Platte; Palmar; Komplikation; Kosten; Distal radius fracture; Locking plate; Volar; Complication; Costs Abstract (German): Die Einfuhrung der palmaren winkelstabilen Plattenosteosynthese hat zu einem Paradigmenwechsel in der Versorgung von distalen Radiusfrakturen gefuhrt. Sie stellt heute ein etabliertes Verfahren zu deren Behandlung dar und fuhrt bei sachgerechter Indikation zu guten klinischen und radiologischen Ergebnissen. Anhand randomisierter Studien und deren Metaanalysen konnte aber noch keine signifikante Uberlegenheit der palmaren Platte gegenuber den Alternativverfahren nachgewiesen werden. In dieser Ubersichtsarbeit wird auf der Basis der aktuellen Literatur dargestellt, welche Patientengruppen und Frakturformen von der Implantation der palmaren Plattenosteosynthese einen besonderen Nutzen haben. Wahrend fur junge Patienten die mit der palmaren Platte erzielten guten Repositionsergebnisse im Vordergrund stehen, profitieren altere Patienten insbesondere von der fruhfunktionellen Behandlung des verletzten Handgelenks. Unter Kenntnis der Anatomie und der Frakturmorphologie am distalen Radius sowie Berucksichtigung der Implantatlage kann das Risiko von Beuge- und Strecksehnenrupturen deutlich gesenkt werden. Anhand klinischer und radiologischer Indikatoren konnen zudem Patienten identifiziert werden, die nach knocherner Konsolidierung der Fraktur von einer Implantatentfernung profitieren. Die Anwendung der palmaren Platte fuhrt im Vergleich zu den Alternativimplantaten zu deutlich hoheren Personal- und Materialkosten. Innerhalb des DRG-Vergutungssystems ist mit den palmaren Platten weiterhin eine kostendeckende Versorgung moglich. Der Nachweis, dass die mit der palmaren Plattenosteosynthese erzielte Fruhfunktionalitat auch aus volkswirtschaftlicher Sicht einen Vorteil darstellt, steht jedoch noch aus. Abstract: 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. Author Affiliation: (1) Klinik fur Unfall- und Handchirurgie, Universitatsklinikum Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Deutschland Article History: Registration Date: 02/10/2012 Received Date: 21/06/2012 Accepted Date: 02/07/2012 Online Date: 30/11/2012
    Keywords: Hand Injuries -- Analysis
    ISSN: 1862-6599
    Source: Cengage Learning, Inc.
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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: Critical Care, Jan 13, 2011, Vol.15, p.R20
    Description: Introduction 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. Methods 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. Results Serum levels of sFas in patients who later developed sepsis were significantly increased at day 5 (P [less than] 0.01) and day 9 (P [less than] 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 [less than] 0.001), day 5 (r = 0.62, P [less than] 0.01) and day 9 (r = 0.58, P [less than] 0.01) and with PMNE and leukocyte counts (r = 0.49, P [less than] 0.05 for both) as well as MODS at day 5 (r = 0.56, P [less than] 0.01) after trauma. Conclusions 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 -- Physiological Aspects ; Apoptosis -- Genetic Aspects ; Apoptosis -- Research ; Injuries -- Complications And Side Effects ; Injuries -- Patient Outcomes ; Injuries -- Research ; Multiple Organ Failure -- Risk Factors ; Multiple Organ Failure -- Development And Progression ; Multiple Organ Failure -- Genetic Aspects ; Multiple Organ Failure -- Research ; Sepsis -- Risk Factors ; Sepsis -- Development And Progression ; Sepsis -- Genetic Aspects ; Sepsis -- Research
    ISSN: 1364-8535
    Source: Cengage Learning, Inc.
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  • 5
    Language: English
    In: Critical Care, Jan 13, 2011, Vol.15, p.R20
    Description: Introduction 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. Methods 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. Results Serum levels of sFas in patients who later developed sepsis were significantly increased at day 5 (P [less than] 0.01) and day 9 (P [less than] 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 [less than] 0.001), day 5 (r = 0.62, P [less than] 0.01) and day 9 (r = 0.58, P [less than] 0.01) and with PMNE and leukocyte counts (r = 0.49, P [less than] 0.05 for both) as well as MODS at day 5 (r = 0.56, P [less than] 0.01) after trauma. Conclusions 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 -- Physiological Aspects ; Apoptosis -- Genetic Aspects ; Apoptosis -- Research ; Injuries -- Complications And Side Effects ; Injuries -- Patient Outcomes ; Injuries -- Research ; Multiple Organ Failure -- Risk Factors ; Multiple Organ Failure -- Development And Progression ; Multiple Organ Failure -- Genetic Aspects ; Multiple Organ Failure -- Research ; Sepsis -- Risk Factors ; Sepsis -- Development And Progression ; Sepsis -- Genetic Aspects ; Sepsis -- Research
    ISSN: 1364-8535
    Source: Cengage Learning, Inc.
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  • 6
    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...
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 7
    Language: German
    In: OP-Journal, 2015, Vol.31(03), pp.160-166
    ISSN: 0178-1715
    E-ISSN: 1439-2496
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  • 8
    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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  • 9
    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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  • 10
    In: Journal of Orthopaedic Research, December 2013, Vol.31(12), pp.2013-2020
    Description: Byline: Ceylan D. Windolf, Wei Meng, Tim T. Logters, Colin R. MacKenzie, Joachim Windolf, Sascha Flohe ABSTRACT Staphylococcus aureus (SA) is the most common causative agent for implant-associated osteitis. The present study characterizes a novel model of a low grade acute SA osteitis with bone defect in the femur which is stabilized by a titanium locking plate. Wild-type Balb/c mice were osteotomized, fixed by a locking plate and infected with SA. Mice underwent debridement 7 and 14 days later and were sacrificed at Day 28. At Days 7, 14, and 28 after inoculation local and systemic cell populations and IL-6 were analyzed. Fracture healing was quantified by radiography. The control group underwent the same procedure without infection. The bacterial load of implant-associated osteitis with biofilm formation was quantified by counting CFU and real-time PCR. Fracture healing determined by radiography was delayed in infected compared to non-infected mice. Throughout the investigation period CFU and leukocyte counts, as well as IL-6 levels were found to be significantly elevated in infected mice at the infection site but not systemically. Our murine model allows the detailed investigation of implant associated localized osteitis with biofilm producing SA and its influence on fracture healing. The model provides a tool to analyze therapeutic or prophylactic approaches to the problem of biofilm-associated osteitis. [c] 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:2013-2020, 2013
    Keywords: Mouse ; Infection ; Osteitis ; Biofilm
    ISSN: 0736-0266
    E-ISSN: 1554-527X
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