Stiffness after knee arthrotomy: evaluation of prevalence and results after manipulation under anaesthesia

The aim of the present study was to determine the prevalence and the effect of manipulation under anaesthesia in patients with Total Knee Arthroplasty (TKA), "revision-knee" and all forms of other intra-articular surgical procedures. We aimed to determine differences in the outcome according to the number of previous surgeries and according to time of manipulation under anaesthesia (MUA).

PATIENTS AND METHODS

One thousand three hundred and forty-four elective intra-articular surgeries (no trauma cases) were performed at our institution between 2004 and 2009. Fifty-two of them underwent MUA because of postoperative knee stiffness with a flexion less than 90°. The prevalence for stiffness after primary TKA was 4.54%, for revision-knee procedures 5.11%, and for other forms of intra-articular surgery 1.29%.

RESULTS

Flexion was statistically significantly improved directly after MUA in the group after primary TKA with a mean gain of 35.13°±17.03°, in the group with revision procedures of 41.31°±9.08° and in the group with other forms of intra-articular surgery of 24.37°±5.21°. Patients with more than two previous operations showed significantly worse results (P=0.039). No statistically significant difference (P=0.307) was seen according to time (>/<30 days) of MUA.

DISCUSSION

MUA is a valuable technique to increase ROM after TKA in patients with stiff knees, for "revision-knees" and all other patients with reduced flexion after different forms of intra-articular knee surgical procedures (excluding trauma cases). The results were similar for early and delayed MUA relative to the last surgery. The patients can therefore undergo conservative treatment (e.g. physiotherapy) before the MUA without the risk of poorer outcome. The results after MUA in patients with many previous operations were significantly worse and so an open/arthroscopic arthrolysis should be discussed earlier for this subgroup.

Towards the identification of a quantum critical line in the (p, B) phase diagram of CeCoIn5 with thermal-expansion measurements

The low-temperature thermal expansion of CeCoIn(5) single crystals measured parallel and perpendicular to magnetic fields B oriented along the c axis yields the volume thermal-expansion coefficient β. Considerable deviations of β(T) from Fermi-liquid behavior occur already within the superconducting region of the (B, T) phase diagram and become maximal at the upper critical field B(c2)(0). However, β(T) and the Grüneisen parameter Γ are incompatible with a quantum critical point at B(c2)(0), but allow for a quantum criticality shielded by superconductivity and extending to negative pressures for B<B(c2)(0). We construct a tentative (p, B, T) phase diagram of CeCoIn(5) suggesting a quantum critical line in the (p, B) plane.

PSMB7 is associated with anthracycline resistance and is a prognostic biomarker in breast cancer

BACKGROUND

To date individual markers have failed to correctly predict resistance against anticancer agents in breast cancer. We used gene expression patterns attributable to chemotherapy-resistant cells to detect potential new biomarkers related to anthracycline resistance. One of the genes, PSMB7, was selected for further functional studies and clinical validation.

METHODS

We contrasted the expression profiles of four pairs of different human tumour cell lines and of their counterparts resistant to doxorubicin. Observed overexpression of PSMB7 in resistant cell lines was validated by immunohistochemistry. To examine its function in chemoresistance, we silenced the gene by RNA interference (RNAi) in doxorubicin-resistant MCF-7 breast cancer cells, then cell vitality was measured after doxorubicin treatment. Microarray gene expression from GEO raw microarray samples with available progression-free survival data was downloaded, and expression of PSMB7 was used for grouping samples.

RESULTS

After doxorubicin treatment, 79.8+/-13.3% of resistant cells survived. Silencing of PSMB7 in resistant cells decreased survival to 31.8+/-6.4% (P>0.001). A similar effect was observed after paclitaxel treatment. In 1592 microarray samples, the patients with high PSMB7 expression had a significantly shorter survival than the patients with low expression (P<0.001).

CONCLUSION

Our findings suggest that high PSMB7 expression is an unfavourable prognostic marker in breast cancer.

Mass spectrometry and beam deflection studies of tin-lead nanoalloy clusters

Photo-ionization mass spectrometry and electric beam deflection experiments were used to study isolated Sn(M)Pb(N) clusters (7 <or=N + M<or= 13 for tin-rich clusters, 7 <or=N + M<or= 15 for lead-rich clusters) in a molecular beam apparatus. The observed mass spectra reveal a broad abundance distribution of the bimetallic clusters in which all possible cluster compositions can be identified within the investigated size ranges. Comparison of the relative cluster intensities between pure tin or lead clusters (Sn(N+M) and Pb(N+M)) and mixed Sn(M)Pb(N) clusters indicate quite similar relative abundance distributions which can be smoothly shifted from one to the other extreme by changing the composition. The mass spectroscopic findings could be explained by assuming a substitution "alloy" formation in the Sn(M)Pb(N) cluster system. In combination, the dielectric properties were determined by passing the bimetallic clusters through an inhomogeneous electric field. The observed polarizabilities are significantly increased for most of the bimetallic clusters. This can be explained in an adiabatic polarization model by the presence of permanent electric dipole moments. These observations demonstrate how the electronic properties are not only crucially influenced by the cluster size but also by the composition of this nanoalloy model system. In addition to the enhanced polarizability, most of the measured beam profiles for tin-rich clusters show detectable beam broadenings due to the permanent dipole moments, in contrast to lead-rich clusters which possess considerable smaller dipole moments. Molecular dynamic simulations of the measured beam profile for Sn(6)Pb(1) taking theoretically calculated isomeric structures and dipole moments into account yields no completely satisfying outcome. Therefore we discuss possible reasons for the discrepancy between experimental and theoretical results.

Basic research and clinical applications of non-hematopoietic stem cells, 4-5 April 2008, Tubingen, Germany

From 4 to 5 April 2008, international experts met for the second time in Tubingen, Germany, to present and discuss the latest proceedings in research on non-hematopoietic stem cells (NHSC). This report presents issues of basic research including characterization, isolation, good manufacturing practice (GMP)-like production and imaging as well as clinical applications focusing on the regenerative and immunomodulatory capacities of NHSC.

Hypoxia reduces the inhibitory effect of IL-1beta on chondrogenic differentiation of FCS-free expanded MSC

OBJECTIVE

Mesenchymal stromal cells (MSC) are a promising tool for tissue engineering of the intervertebral disc (ID). The IDs are characterized by hypoxia and, after degeneration, by an inflammatory environment as well. We therefore investigated the effects of inflammation induced with interleukin (IL)-1beta and of hypoxia (2% O(2)) on the chondrogenic differentiation of MSC.

METHODS

Bone-marrow-derived MSC (bmMSC) were cultured in a fetal-calf-serum-free medium and characterized according to the minimal criteria for multipotent MSC. Chondrogenic differentiation of MSC was induced following standard protocols, under hypoxic conditions, with or without IL-1beta supplementation. After 28 days of differentiation, micromasses were analyzed by histochemical staining and immunohistochemistry and by determining the mRNA level of chondrogenic marker genes utilizing quantitative RT-PCR.

RESULTS

Micromasses differentiated under IL-1beta supplementation are smaller and express less extracellular matrix (ECM) protein. Micromasses differentiated under hypoxia appear larger in size, display a denser ECM and express marker genes comparable to controls. The combination of hypoxia and IL-1beta supplementation improved chondrogenesis compared to IL-1beta supplementation alone. Micromasses differentiated under standard conditions served as controls.

CONCLUSION

Inflammatory processes inhibit the chondrogenic differentiation of MSC. This may lessen the regenerative potential of MSC in situ. Thus, for the cell therapy of IDs using MSC to be effective it will be necessary to manage the inflammatory conditions in situ. In contrast, hypoxic conditions exert beneficial effects on chondrogenesis and phenotype stability of transplanted MSC, and may improve the quality of the generated ECM.

Surface-Induced Dissociation as a Probe for the Energetics and Structure of Lead Clusters

Fragmentation of lead cluster ions (Pb N +: N = 2–20) in low-energy collisions with a highly oriented pyrolytic graphite surface has been investigated by means of a tandem time-of-flight mass spectrometer. At low incident energies, all clusters fragment dominantly by an atom loss process. This behavior is characteristic for clusters of metallic elements, but in contrast to Si N +, Ge N + and Sn N + clusters. The results therefore demonstrate differences in the electronic and geometric structure between lead clusters and the lighter group-14 element clusters. The low energy dissociation patterns were compared successfully with a recent theoretical study on lead cluster fragmentation, supporting the idea, that lead clusters cations already show signatures of metallic behavior unlike Si N +, Ge N + and Sn N + clusters of the same size.

Survival, neuron-like differentiation and functionality of mesenchymal stem cells in neurotoxic environment: the critical role of erythropoietin

Mesenchymal stem cells (MSCs) can ameliorate symptoms in several neurodegenerative diseases. However, the toxic environment of a degenerating central nervous system (CNS) characterized by hypoxia, glutamate (Glu) excess and amyloid beta (Abeta) pathology may hamper the survival and regenerative/replacing capacities of engrafted stem cells. Indeed, human MSC (hMSC) exposed to hypoxia were disabled in (i) the capacity of their muscarinic receptors (mAChRs) to respond to acetylcholine (ACh) with a transient increase in intracellular [Ca(2+)], (ii) their capacity to metabolize Glu, reflected by a strong decrease in glutamine synthetase activity, and (iii) their survival on exposure to Glu. Cocultivation of MSC with PC12 cells expressing the amyloid precursor protein gene (APPsw-PC12) increased the release of IL-6 from MSC. HMSC exposed to erythropoietin (EPO) showed a cholinergic neuron-like phenotype reflected by increased cellular levels of choline acetyltransferase, ACh and mAChR. All their functional deficits observed under hypoxia, Glu exposure and APPsw-PC12 cocultivation were reversed by the application of EPO, which increased the expression of Wnt3a. EPO also enhanced the metabolism of Abeta in MSC by increasing their neprilysin content. Our data show that cholinergic neuron-like differentiation of MSC, their functionality and resistance to a neurotoxic environment is regulated and can be improved by EPO, highlighting its potential for optimizing cellular therapies of the CNS.

Serum matrix metalloprotease-1 and vascular endothelial growth factor--a predict cardiac allograft rejection

Cardiac allograft rejection is currently diagnosed from endomyocardial biopsies (EMB) that are invasive and impractical to repeat. A serological marker could facilitate rejection monitoring and minimize EMB-associated risks. We investigated the relation of serum matrix metalloprotease (MMP)-1 and vascular endothelial growth factor (VEGF)-A concentrations to cardiac allograft rejection, using 1176 EMBs and serum samples obtained from 208 recipients. Acute cellular rejection was diagnosed in 186 EMBs. Mean week 1 and week 2 serum MMP-1 concentrations predicted rejection (p = 0.001, AUC = 0.80). At the optimal cut-off level of >or=7.5 ng/mL, MMP-1 predicted rejection with 82% sensitivity and 72% specificity. Initial serum MMP-1 <5.3 ng/mL (lowest quartile) was associated with rejection-free outcome in 80% of patients. Both MMP-1 (p < 0.001, AUC = 0.67-0.75) and VEGF-A (p < 0.01, AUC = 0.62-0.67) predicted rejection on the next EMB, while rejection at EMB was identified only by VEGF-A (p < 0.02, AUC = 0.70-0.77). Patients receiving combined cyclosporine-A and everolimus had the lowest serum MMP-1 concentrations. While serum MMP-1 predicts rejection-free outcome and VEGF-A identifies rejection on EMB, both markers predict rejection in follow-up of cardiac transplant recipients. Combination of serum MMP-1 and VEGF-A concentration may be a noninvasive prognostic marker of cardiac allograft rejection, and could have important implications for choice of surveillance and immunosuppression protocols.

Neutron decoherence imaging for visualizing bulk magnetic domain structures

Here we introduce a novel neutron imaging method, which is based on the effect that the spatial coherence of the neutron wave front can be changed through small-angle scattering of neutrons at magnetic domain walls in the specimen. We show that the technique can be used to visualize internal bulk magnetic domain structures that are difficult to access by other techniques. The method is transferable to a wide variety of specimens, extendable to three dimensions, and well suited for investigating materials under the influence of external parameters, as, e.g., external magnetic field, temperature, or pressure.

Cardioprotection and cardiac regeneration by mesenchymal stem cells

Mesenchymal stem cells (MSC) are promising candidates in the emerging field of regenerative medicine. MSC have been applied in numerous experimental and preclinical studies evaluating their therapeutical potential in various models of diseases. For cardiac applications, especially myocardial ischemia, MSC have been shown to provide an interesting therapeutical potential. However, to date the mechanisms of their beneficial effects on the cardiac tissue are only faintly elucidated. On the one hand we do not completely understand the biology of the MSC, on the other hand their interactions with the complex in vivo situation e. g. after myocardial infarction and the following remodeling processes are difficult to study. Initially, with respect to their in vitro differentiation capacity, it has been assumed that transplanted MSC may, promoted by the local microenvironment, differentiate in vivo into cells of cardiomyogenic phenotype or even cardiomyocytes, integrate themselves into the myocardium and help to regenerate the damaged tissue. The finding that after transplantation only a minor percentage of the MSC showed long term survival and persistent lack of evidence for in vivo differentiation make the original mechanistic concept of in vivo cardiomyogenic differentiation questionable. More recent studies suggest that the transplanted MSC may interact with the local tissue releasing paracrine factors and may hereby support the regenerative process. In this article, referring to experimental and preclinical studies, characteristics, sources, differentiation and paracrine activity of MSC contributing to cardioprotection and cardiac regeneration will be discussed.

An improved time-of-flight method for cluster deposition and ion-scattering experiments

A molecular beam apparatus has been developed for deposition and scattering experiments of size-selected clusters. The new setup combines a bimetallic laser ablation cluster source with a collinear time-of-flight mass spectrometer. Mass selection is achieved with a pulsed electrostatic mirror. A significantly improved transmission in combination with a reduction of the kinetic energy distribution of the mass selected clusters has been obtained. Without further modification of the apparatus, surface-induced dissociation of mass selected tin clusters has been investigated, demonstrating the possibility to combine cluster beam deposition and scattering experiments.