Die Ganzkörperretention von 99mTc-Methylen-Diphosphonat bei Skeletterkrankungen

Die 24-Std.-Retentionsmessung im Ganzkörperzähler ist ein exaktes Verfahren zur Quantifizierung der Knochenaffinität eines Radiopharmazeutikums. Dieser 24-Std.-Ganzkörperretentionswert (24-Std.-GKRW) wurde bei 200 Patienten bestimmt. Für 99mTc-Methylen-Diphosphonat (MDP) war er von der Nierenfunktion unabhängig, wenn diese normal oder nur leicht eingeschränkt war. Es bestand eine diskrete Altersabhängigkeit, wobei der GKRW bei Kindern und Jugendlichen bis zum 20. Lebensjahr kontinuierlich abfiel, bei den 20- bis 25jährigen am niedrigsten war und dann mit zunehmendem Alter wieder anstieg. Als Normalbereich für den 24-Std.-GKRW wurde für die Altersgruppe der über 20jährigen 31,8 ± 5% der injizierten Radioaktivität ermittelt. Einzelne fokale Mehranreicherungen im Skelettszintigramm - wie bei Tumorpatienten mit ein bis zwei Metastasen - riefen keinen signifikanten Unterschied zum Normalkollektiv (p < 0,1) hervor. Dagegen bestand eine hochsignifikante Differenz (p < 0,001) gegenüber dem Normalkollektiv bei Patienten mit multiplen Metastasen (24-Std.-GKRW: 38,2 ± 7%), bei Patienten mit diffusen Knochenerkrankungen wie dem primären Hyperparathyreoidismus (24-Std.-GKRW: 49 ± 11,7%) (P < 0,001) und der Osteoporose (24-Std.-GKRW: 45%). Der 24-Std.-GKRW erwies sich damit als sehr empfindliches Maß für diffuse Veränderungen im Knochen. Dies zeigte sich sowohl an einzelnen Beispielen bei Verlaufskontrollen bei Tumorpatienten, wo sich der 24-Std.-GKRW neben dem Skelettszintigramm als zusätzlicher Parameter in der Erfassung einer Progredienz oder Remission bewährte, als auch an der engen Korrelation des 24-Std.-GKRW mit den bioptisch gesicherten Knochenmarksbefunden bei einer kleineren Patientengruppe mit Erkrankungen aus dem lymphatischen Formenkreis.

Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-centre study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®)

OBJECTIVES

Whole-body computed tomography (WBCT) plays an increasingly important role in the diagnostic assessment of trauma room patients. It is still unclear whether its use has led to changes of trauma room procedures and patient outcomes.

METHODS

In a retrospective multi-centric study based on the trauma registry of the German Trauma Society (TraumaRegister DGU^®), we analysed patients with an ISS ≥ 9 between 2002 and 2013. Two periods of time, i.e. up to 3 years preceding (pre-WBCT) and up to 3 years following the introduction of the WBCT (WBCT-group), were assessed separately for every hospital (TR-DGU Project ID 2014-020).

RESULTS

19,838 patients underwent treatment in 77 hospitals. Of these, 5621 were assigned to the pre-WBCT group and 11,307 to the WBCT group. Basic data did not differ relevantly. The time spent in the trauma room decreased from 77.9 min (pre-WBCT) to 63.3 min (WBCT). Following the introduction of the trauma scan, the number of diagnoses per patient increased from 4.6 to 5.1. The percentage of patients who underwent surgery immediately after the completion of trauma room procedures decreased from 44.5 to 39.1%. There was an increase in mortality from 15.7 to 15.9%.

CONCLUSIONS

Routine use of WBCT is not superior to a combination of conventional radiography, ultrasound and focused CT in terms of mortality. The entire process involving the introduction of the trauma scan and the further development of algorithms has caused changes that can be observed in the trauma room setting.

Studies on the Interaction of the Histone Demethylase KDM5B with Tricarboxylic Acid Cycle Intermediates

Methylation of lysine-4 of histone H3 (H3K4men) is an important regulatory factor in eukaryotic transcription. Removal of the transcriptionally activating H3K4 methylation is catalyzed by histone demethylases, including the Jumonji C (JmjC) KDM5 subfamily. The JmjC KDMs are Fe(II) and 2-oxoglutarate (2OG)-dependent oxygenases, some of which are associated with cancer. Altered levels of tricarboxylic acid (TCA) cycle intermediates and the associated metabolites D- and L-2-hydroxyglutarate (2HG) can cause changes in chromatin methylation status. We report comprehensive biochemical, structural and cellular studies on the interaction of TCA cycle intermediates with KDM5B, which is a current medicinal chemistry target for cancer. The tested TCA intermediates were poor or moderate KDM5B inhibitors, except for oxaloacetate and succinate, which were shown to compete for binding with 2OG. D- and L-2HG were moderate inhibitors at levels that might be relevant in cancer cells bearing isocitrate dehydrogenase mutations. Crystallographic analyses with succinate, fumarate, L-malate, oxaloacetate, pyruvate and D- and L-2HG support the kinetic studies showing competition with 2OG. An unexpected binding mode for oxaloacetate was observed in which it coordinates the active site metal via its C-4 carboxylate rather than the C-1 carboxylate/C-2 keto groups. Studies employing immunofluorescence antibody-based assays reveal no changes in H3K4me3 levels in cells ectopically overexpressing KDM5B in response to dosing with TCA cycle metabolite pro-drug esters, suggesting that the high levels of cellular 2OG may preclude inhibition. The combined results reveal the potential for KDM5B inhibition by TCA cycle intermediates, but suggest that in cells, such inhibition will normally be effectively competed by 2OG.

[Influence of Peridural Infiltration Therapy on Postural Control in Chronic Pain of the Lower Lumbar Spine - A Prospective Clinical Study]

Background: Postural control, balance stability, is reduced in patients with chronic low back pain, due to pain. Epidural injection therapy (EI) is an established treatment of low back pain. The objective of our study was to investigate whether EI-induced pain relief also leads to improvement in postural control, as detected by computerised dynamic posturography (CDP). Patients and Methods: In a prospective study, 32 patients underwent CDP during and after the EI series of three injections. The main objective was to measure changes in overall stability index (OSI) in a pre- and post-intervention comparison. Results: The pain, measured by the Visual Analog Scale (VAS), decreased by 62.8 %, from 4.3 ± 2.5 points to 1.6 ± 1.9 points (p < 0.001). Likewise, the OSI improved by 21.6 %, from 3.7 ± 1.7° to 2.9 ± 1.4° (day 5) (p = 0.019). Conclusion: Pain relief induced by EI results in improved postural control, which is of importance for supportive physiotherapy and rehabilitation.