1
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Paulsen V, Jakob M, Gembruch U, Heep A, Bartmann P. Previable preterm premature rupture of membranes: 117 cases with neonatal outcomes in light of current research. J Neonatal Perinatal Med 2023; 16:21-31. [PMID: 36872792 DOI: 10.3233/npm-221054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND ppPROM < 24 + 0 weeks of gestation complicates < 1 % of all pregnancies but is responsible for significant maternal and neonatal morbidity. It is associated with 18-20% of perinatal deaths. OBJECTIVE To evaluate neonatal outcome after expectant management in ppPROM in order to obtain evidence-based information for purposes of future counselling. METHODS A single-centre, retrospective cohort study of 117 neonates born 1994 to 2012 after ppPROM < 24 weeks of gestation with a latency period > 24 hours and admission to the NICU of the Department of Neonatology, University of Bonn. Data of pregnancy characteristics and neonatal outcome were collected. The results were compared to those found in the literature. RESULTS The mean gestational age at ppPROM was 20.45±2,9 weeks (range 11 + 2 -22 + 6) with a mean latency period of 44.7±34.8 days (range 1-135). Mean gestational age at birth was 26.77±3.22 weeks (range 22 + 2-35 + 3). 117 newborns were admitted to the NICU, the overall survival rate at discharge was 72.6% (85/117). Non-survivors had a significantly lower gestational age and higher rates of intra-amniotic infections. The most common neonatal morbidities were RDS (76.1%), BPD (22.2%), pulmonary hypoplasia (PH) (14.5%), neonatal sepsis (37.6%), IVH (34.1% all grades, 17.9% grades III/IV), NEC (8.5%) and musculoskeletal deformities (13.7%). Mild growth restriction as a new complication of ppPROM was observed. CONCLUSIONS Neonatal morbidity after expectant management is similar to that described for infants without ppPROM, but carries a higher risk of pulmonary hypoplasia and mild growth restriction.
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Affiliation(s)
- V Paulsen
- Department of Neonatology and Paediatric Intensive Care, University of Bonn, Bonn, Germany.,University Children's Hospital of Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, Pan Clinic Neumarkt, Cologne, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Heep
- Medical Centre Oldenburg University, Children's Hospital Oldenburg, Oldenburg, Germany
| | - P Bartmann
- Department of Neonatology and Paediatric Intensive Care, University of Bonn, Bonn, Germany
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Vach W, Jakob M, Luta G. The double use of PROMs to improve patient-provider communication and to compare providers: a potential conflict? Int J Qual Health Care 2023; 35:6998177. [PMID: 36688588 DOI: 10.1093/intqhc/mzad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/26/2022] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Affiliation(s)
- Werner Vach
- Basel Academy for Quality and Research in Medicine, Steinenring 6, Basel CH-4051, Switzerland.,Department of Environmental Sciences, University of Basel, Spalenring 145, Basel CH-4055, Switzerland
| | - Marcel Jakob
- Crossklinik, Bundesstrasse 1, Basel CH-4054, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, Basel CH-4056, Switzerland
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, 4000 Reservoir Rd NW, Washington, DC 20057, USA.,The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg DK-2000, Denmark.,Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark
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3
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Eymann J, Vach W, Fischer L, Jakob M, Gösele A. Comparing a Sensor for Movement Assessment with Traditional Physiotherapeutic Assessment Methods in Patients after Knee Surgery-A Method Comparison and Reproducibility Study. Int J Environ Res Public Health 2022; 19:16581. [PMID: 36554461 PMCID: PMC9779175 DOI: 10.3390/ijerph192416581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Wearable sensors offer the opportunity for patients to perform a self-assessment of their function with respect to a variety of movement exercises. Corresponding commercial products have the potential to change the communication between patients and physiotherapists during the recovery process. Even if they turn out to be user-friendly, there remains the question to what degree the numerical results are reliable and comparable with those obtained by assessment methods traditionally used. To address this question for one specific recently developed and commercially available sensor, a method comparison study was performed. The sensor-based assessment of eight movement parameters was compared with an assessment of the same parameters based on test procedures traditionally used. Thirty-three patients recovering after arthroscopic knee surgery participated in the study. The whole assessment procedure was repeated. Reproducibility and agreement were quantified by the intra class correlation coefficient. The height of a one-leg vertical jump and the number of side hops showed high agreement between the two modalities and high reproducibility (ICC > 0.85). Due to differences in the set-up of the assessment, agreement could not be achieved for three mobility parameters, but even the correlation was only fair (r < 0.5). Knee stability showed poor agreement. Consequently, the use of the sensor can currently only be recommended for selected parameters. The variation in degree of agreement and reproducibility across different parameters clearly indicate the need for developing corresponding guidance for each new sensor put onto the market.
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Affiliation(s)
| | - Werner Vach
- Basel Academy for Quality and Research in Medicine, 4051 Basel, Switzerland
- Department of Environmental Sciences, University of Basel, 4056 Basel, Switzerland
| | | | - Marcel Jakob
- Crossklinik AG, 4054 Basel, Switzerland
- Medical Faculty, University of Basel, 4056 Basel, Switzerland
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4
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Lehoczky G, Trofin RE, Vallmajo-Martin Q, Chawla S, Pelttari K, Mumme M, Haug M, Egloff C, Jakob M, Ehrbar M, Martin I, Barbero A. In Vitro and Ectopic In Vivo Studies toward the Utilization of Rapidly Isolated Human Nasal Chondrocytes for Single-Stage Arthroscopic Cartilage Regeneration Therapy. Int J Mol Sci 2022; 23:ijms23136900. [PMID: 35805907 PMCID: PMC9267018 DOI: 10.3390/ijms23136900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 02/05/2023] Open
Abstract
Nasal chondrocytes (NCs) have a higher and more reproducible chondrogenic capacity than articular chondrocytes, and the engineered cartilage tissue they generate in vitro has been demonstrated to be safe in clinical applications. Here, we aimed at determining the feasibility for a single-stage application of NCs for cartilage regeneration under minimally invasive settings. In particular, we assessed whether NCs isolated using a short collagenase digestion protocol retain their potential to proliferate and chondro-differentiate within an injectable, swiftly cross-linked and matrix-metalloproteinase (MMP)-degradable polyethylene glycol (PEG) gel enriched with human platelet lysate (hPL). NC-hPL-PEG gels were additionally tested for their capacity to generate cartilage tissue in vivo and to integrate into cartilage/bone compartments of human osteochondral plugs upon ectopic subcutaneous implantation into nude mice. NCs isolated with a rapid protocol and embedded in PEG gels with hPL at low cell density were capable of efficiently proliferating and of generating tissue rich in glycosaminoglycans and collagen II. NC-hPL-PEG gels developed into hyaline-like cartilage tissues upon ectopic in vivo implantation and integrated with surrounding native cartilage and bone tissues. The delivery of NCs in PEG gels containing hPL is a feasible strategy for cartilage repair and now requires further validation in orthotopic in vivo models.
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Affiliation(s)
- Gyözö Lehoczky
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, 4031 Basel, Switzerland; (G.L.); (M.M.); (C.E.)
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Raluca Elena Trofin
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Queralt Vallmajo-Martin
- Department of Obstetrics, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (Q.V.-M.); (M.E.)
| | - Shikha Chawla
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Karoliina Pelttari
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
| | - Marcus Mumme
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, 4031 Basel, Switzerland; (G.L.); (M.M.); (C.E.)
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
- Department of Orthopaedic Surgery, University Children’s Hospital of Basel, 4056 Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Christian Egloff
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, 4031 Basel, Switzerland; (G.L.); (M.M.); (C.E.)
| | | | - Martin Ehrbar
- Department of Obstetrics, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (Q.V.-M.); (M.E.)
| | - Ivan Martin
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
- Correspondence: ; Tel.: +41-61-2652384; Fax: +41-61-2653990
| | - Andrea Barbero
- Department of Biomedicine, Tissue Engineering Laboratory, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.E.T.); (S.C.); (K.P.); (A.B.)
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Vach W, Wehberg S, Güntert B, Jakob M, Luta G. Healthcare provider profiling: fixing observation period or fixing sample size? BMJ Open Qual 2022; 11:bmjoq-2021-001588. [PMID: 35393290 PMCID: PMC8991056 DOI: 10.1136/bmjoq-2021-001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Werner Vach
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland .,Department of Environmental Sciences, University of Basel, Basel, Switzerland
| | - Sonja Wehberg
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Bernhard Güntert
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Marcel Jakob
- Medical Faculty, University of Basel, Basel, Switzerland.,Crossklinik, Basel, Switzerland
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA.,The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
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6
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Kumpunen S, Webb E, Permanand G, Zheleznyakov E, Edwards N, van Ginneken E, Jakob M. Primary Health Care during the COVID-19 pandemic: an analysis based on the HSRM. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The COVID-19 pandemic has had a dramatic impact on workload and responsibilities for those working at primary health care (PHC) level in the European region - much of which has gone unnoticed relative to the focus on hospitals. Based on the PHC-relevant data extracted from the HSRM, we describe PHC models of care and the political and system levers that supported them. Three key themes emerged: (1) varied forms of PHC multidisciplinary collaboration were developed to manage the emergency response - supported by the movement of staff to areas requiring support; (2) vulnerable patients were identified and prioritized for medical outreach within PHC, and were supported through financial incentives and complementary action from centralized and local governments that used much broader definitions of vulnerability; and (3) digital solutions for remote triage, medical advice and treatment enhanced the effectiveness of the PHC response and were facilitated through centralized investment in digital technologies. Based on our analysis, we raise opportunities for the future of PHC, namely that multidisciplinary approaches to PHC service delivery are essential to future infectious and non-infectious outbreaks, and the agility and rapid pace of change that took place among PHC providers should continue. PHC providers lacked visibility during the pandemic and should work together to develop a strong voice in all health systems.
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Affiliation(s)
| | - E Webb
- European Observatory on Health Systems and Policies, Technical University Berlin, Berlin, Germany
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
| | | | - E Zheleznyakov
- WHO European Centre for Primary Health Care, WHO/Europe, Almaty, Kazakhstan
| | | | - E van Ginneken
- European Observatory on Health Systems and Policies, Technical University Berlin, Berlin, Germany
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
| | - M Jakob
- WHO European Centre for Primary Health Care, WHO/Europe, Almaty, Kazakhstan
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Acevedo Rua L, Mumme M, Manferdini C, Darwiche S, Khalil A, Hilpert M, Buchner DA, Lisignoli G, Occhetta P, von Rechenberg B, Haug M, Schaefer DJ, Jakob M, Caplan A, Martin I, Barbero A, Pelttari K. Engineered nasal cartilage for the repair of osteoarthritic knee cartilage defects. Sci Transl Med 2021; 13:eaaz4499. [PMID: 34516821 DOI: 10.1126/scitranslmed.aaz4499] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Lina Acevedo Rua
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Marcus Mumme
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.,Department of Surgery, University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Cristina Manferdini
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Salim Darwiche
- Musculoskeletal Research Unit MSRU, Equine Department, University of Zurich, 8057 Zürich, Switzerland
| | - Ahmad Khalil
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106 , USA
| | - Morgane Hilpert
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - David A Buchner
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106 , USA
| | - Gina Lisignoli
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Paola Occhetta
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Brigitte von Rechenberg
- Competence Center for Applied Biotechnology and Molecular Medicine CABMM, University of Zurich, 8057 Zürich, Switzerland
| | - Martin Haug
- Department of Surgery, University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Dirk J Schaefer
- Department of Surgery, University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Marcel Jakob
- Department of Surgery, University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Arnold Caplan
- Department of Biology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14-16, 4123 Allschwil, Switzerland Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Karoliina Pelttari
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
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Lehoczky G, Mumme M, Pelttari K, Trofin R, Chawla S, Haug M, Egloff C, Jakob M, Martin I, Barbero A. New single-stage, arthroscopic cartilage regeneration therapy with nasal chondrocytes. Cytotherapy 2021. [DOI: 10.1016/s1465324921005016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Koppen T, Bartmann D, Jakob M, Bootz F, Müller A, Dresbach T, Send T. Diagnostics and therapy of bilateral choanal atresia in association with CHARGE syndrome. J Neonatal Perinatal Med 2020; 14:67-74. [PMID: 32741782 DOI: 10.3233/npm-200450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bilateral choanal atresia in patients with CHARGE syndrome becomes symptomatic immediately after birth. A prompt diagnosis, the implementation of sufficient preliminary measures, and the delivery of surgical therapy are crucial. This article is intended to assist in terms of diagnostics and a therapy recommendation. METHODS We performed a retrospective study using the medical records of all newborns in the University Hospital in Bonn, diagnosed with bilateral choanal atresia and CHARGE syndrome and underwent surgery at the Department of Otorhinolaryngology, Head and Neck Surgery. RESULTS A total of 21 patients have been treated with a unilateral or bilateral choanal atresia. 14 patients were primarily treated with transnasal endoscopy or underwent transnasal endoscopic surgery as a follow-up intervention (73.68%). Nine patients had a syndromal appearance, which was considered a definite diagnosis in six patients (five with CHARGE syndrome). All five patients with CHARGE syndrome received transnasal endoscopic treatment and a stent was inserted. DISCUSSION Bilateral choanal atresia can be a life-threatening situation requiring acute measures. The therapeutic trend goes towards transnasal endoscopic resection. Primary intervention should be: minimally invasive, one-stage surgery, functional, and associated with low complication rates. Patency can be increased by saline irrigations, topical corticosteroids, endoscopic controls, and regular dilatation. The insertion of stents is controversially discussed but can be useful in syndromal patients. However, adjuvant therapy with a stent and mitomycin C is increasingly being abandoned. A significantly higher recurrence rate must be expected in association with CHARGE syndrome. Stenting should be considered on an individual basis. Continuous training and support of the parents are obligatory.
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Affiliation(s)
- T Koppen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
| | - D Bartmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
| | - M Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Germany
| | - F Bootz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
| | - A Müller
- Neonatology and Pediatric Intensive Care, Children's Hospital, University Hospital Bonn, Germany
| | - T Dresbach
- Neonatology and Pediatric Intensive Care, Children's Hospital, University Hospital Bonn, Germany
| | - T Send
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany
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Lehoczky G, Wolf F, Mumme M, Gehmert S, Miot S, Haug M, Jakob M, Martin I, Barbero A. Intra-individual comparison of human nasal chondrocytes and debrided knee chondrocytes: Relevance for engineering autologous cartilage grafts. Clin Hemorheol Microcirc 2020; 74:67-78. [PMID: 31743993 DOI: 10.3233/ch-199236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Implantation of autologous chondrocytes for cartilage repair requires harvesting of undamaged cartilage, implying an additional joint arthroscopy surgery and further damage to the articular surface. As alternative possible cell sources, in this study we assessed the proliferation and chondrogenic capacity of debrided Knee Chondrocytes (dKC) and Nasal Chondrocytes (NC) collected from the same patients. METHODS Matched NC and dKC pairs from 13 patients enrolled in two clinical studies (NCT01605201 and NCT026739059) were expanded in monolayer and then chondro-differentiated in 3D collagenous scaffolds in medium with or without Transforming Growth Factor beta 1 (TGFβ1). Cell proliferation and amount of cartilage matrix production by these two cell types were assessed. RESULTS dKC exhibited an inferior proliferation rate than NC, and a lower capacity to chondro-differentiate. Resulting dKC-grafts contained lower amounts of cartilage specific matrix components glycosaminoglycans and type II collagen. The cartilage forming capacity of dKC did not significantly correlate with specific clinical parameters and was only partially improved by medium supplemention with TGFβ1. CONCLUSIONS dKC exhibit a reproducibly poor capacity to engineer cartilage grafts. Our in vitro data suggest that NC would be a better suitable cell source for the generation of autologous cartilage grafts.
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Affiliation(s)
- Gyözö Lehoczky
- Department of Surgery, University Hospital of Basel, Basel, Switzerland.,Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francine Wolf
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marcus Mumme
- Department of Surgery, University Hospital of Basel, Basel, Switzerland.,Department of Orthopaedics, University Children's Hospital Basel, Basel, Switzerland
| | - Sebastian Gehmert
- Department of Orthopaedics, University Children's Hospital Basel, Basel, Switzerland
| | - Sylvie Miot
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Martin Haug
- Department of Surgery, University Hospital of Basel, Basel, Switzerland
| | - Marcel Jakob
- Department of Surgery, University Hospital of Basel, Basel, Switzerland
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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11
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Hörmann J, Vach W, Jakob M, Seghers S, Saxer F. Kinesiotaping for postoperative oedema - what is the evidence? A systematic review. BMC Sports Sci Med Rehabil 2020; 12:14. [PMID: 32158546 PMCID: PMC7052984 DOI: 10.1186/s13102-020-00162-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postoperative oedema is a common condition affecting wound healing and function. Traditionally, manual lymphatic drainage is employed to reduce swelling. Kinesiotaping might be an alternative resource-sparing approach. This article explores current evidence for the effectiveness of kinesiotaping for the reduction of oedema in the postoperative setting. METHODS A systematic literature search was performed on the basis of five databases (Pubmed, CINAHL, Embase, Cochrane Library, and Clinicaltrials.gov) for studies published between January 2000 and October 2019.Only prospective controlled trials were included. Case studies, uncontrolled case series, studies on oedema caused by other etiologies than by surgery, as well as studies on malignant disease related oedema (especially breast cancer related oedema) were excluded.Articles were screened by title, abstract, and full text and the references were searched for further publications on the topic. A narrative and quantitative (using STATA) analysis was performed. RESULTS One thousand two hundred sixty-three articles were screened, twelve were included in the analysis. All studies evaluated either oedema after extremity surgery or maxillofacial interventions, and showed relevant methodological flaws. Only three studies employed an active comparator. Of the twelve included studies ten found positive evidence for kinesiotape application for the reduction of swelling and beneficial effects on secondary outcome parameters such as pain and patient satisfaction. The available trials were heterogenic in pathology and all were compromised by a high risk of bias. CONCLUSION There is some evidence for the efficacy of kinesiotaping for the treatment of postoperative oedema. This evidence is, however, not yet convincing given the limitations of the published trials. Methodologically sound comparison to standard of care or an active comparator is indispensable for an evaluation of effectiveness. In addition, assessments of patient comfort and cost-benefit analyses are necessary to evaluate the potential relevance of this novel technique in daily practice. SYSTEMATIC REVIEW REGISTRATION NUMBER International prospective register of systematic reviews (PROSPERO) ID 114129).
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Affiliation(s)
- Julie Hörmann
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Werner Vach
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Marcel Jakob
- Crossklinik AG Swiss Olympic Medical Centre, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Saskia Seghers
- Department of Physical Therapy, University Hospital Basel, Basel, Switzerland
| | - Franziska Saxer
- Crossklinik AG Swiss Olympic Medical Centre, Basel, Switzerland
- University of Basel, Basel, Switzerland
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12
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Schöpf AC, Vach W, Jakob M, Saxer F. Routine patient surveys: Patients' preferences and information gained by healthcare providers. PLoS One 2019; 14:e0220495. [PMID: 31369612 PMCID: PMC6675389 DOI: 10.1371/journal.pone.0220495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/17/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patient feedback after contact with a hospital is regarded as an important source of information for the improvement of local healthcare services. Routine patient surveys are in widespread use to obtain such feedback. While general principles for the composition of this kind of surveys have been described in the literature, it is unknown which method of contact and topics of feedback are important to patients in postcontact healthcare surveys. MATERIAL AND METHODS We invited 2931 consecutive patients who had in- or outpatient contact with the Department of Orthopaedics and Traumatology at the University Hospital Basel to an anonymous survey. They were asked whether they were generally in favor of feedback surveys. They also had the opportunity to state their preferred form of contact (text message, app, email, online or letter) and provide up to three topics that they regarded as specifically important in patient surveys. RESULTS A total of 745 patients participated in the survey (25.4%), of these 61.9% expressed the preference to be surveyed, and 69.1% selected `letter' as one of the preferred forms of contact. Favoring only `letter' contact increased substantially with age. Overall 54.6% of patients stated at least one topic that they wished to give feedback on. The most frequent topics were related to treatment and rather general aspects regarding staff and overall impression. The wish to include suggestions for improvements was rarely mentioned as specific topic. CONCLUSIONS The majority of patients seem to be rather indifferent to the existence and content of patient surveys. They mention a wide range of topics from general to specific ones, but do not express interest in the opportunity to suggest changes. There is a need to effectively engage patients in healthcare planning using new approaches to obtain valuable feedback on patients' hospital stay and contact experiences. These new approaches should ideally be more informative and cost-effective than the current practice.
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Affiliation(s)
- Andrea C. Schöpf
- Section of Healthcare Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- * E-mail:
| | - Marcel Jakob
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Franziska Saxer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
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13
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Koppen T, Schade G, Eichhorn K, Westermann S, Jakob M, Bootz F, Send T. [Progressive hoarseness-surgical treatment of a benign tumor]. HNO 2019; 67:633-637. [PMID: 31175379 DOI: 10.1007/s00106-019-0684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- T Koppen
- Klinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
| | - G Schade
- Klinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - K Eichhorn
- Klinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - S Westermann
- Klinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - M Jakob
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - F Bootz
- Klinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - T Send
- Klinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
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14
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Mumme M, Wixmerten A, Miot S, Barbero A, Kaempfen A, Saxer F, Gehmert S, Krieg A, Schaefer DJ, Jakob M, Martin I. Tissue engineering for paediatric patients. Swiss Med Wkly 2019; 149:w20032. [PMID: 30950502 DOI: 10.4414/smw.2019.20032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The effects of oncological treatment, congenital anomalies, traumatic injuries and post-infection damage critically require sufficient amounts of tissue for structural and functional surgical reconstructions. The patient’s own body is typically the gold standard source of transplant material, but in children autologous tissue is available only in small quantities and with severe morbidity at donor sites. Engineering of tissue grafts starting from a small amount of autologous material, combined with suitable surgical manipulation of the recipient site, is expected to enhance child and adolescent health, and to offer functional restoration for long-term wellbeing. Moreover, engineered tissues based on patient-derived cells represent invaluable models to investigate mechanisms of disease and to develop/test novel therapeutic approaches. In view of these great opportunities, here we introduce the currently limited successful implementation of tissue engineering in paediatric settings and discuss the open challenges in the field. A particular focus is on the specific needs and envisioned strategies in the areas of bone and osteochondral regeneration in children.
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Affiliation(s)
- Marcus Mumme
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland / Orthopaedic Unit, University Children's Hospital, Basel, Switzerland
| | - Anke Wixmerten
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Sylvie Miot
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Andrea Barbero
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Alexandre Kaempfen
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland / Paediatric Surgery Unit, University Children's Hospital, Basel, Switzerland
| | - Franziska Saxer
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Sebastian Gehmert
- Orthopaedic Unit, University Children's Hospital, Basel, Switzerland
| | - Andreas Krieg
- Orthopaedic Unit, University Children's Hospital, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Marcel Jakob
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Ivan Martin
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Switzerland
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15
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Jensen JS, Reiter-Theil S, Celio DA, Jakob M, Vach W, Saxer FJ. Handling of informed consent and patient inclusion in research with geriatric trauma patients - a matter of protection or disrespect? Clin Interv Aging 2019; 14:321-334. [PMID: 30863026 PMCID: PMC6388780 DOI: 10.2147/cia.s191751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Despite the aging of numerous societies and future health care challenges, clinical research in the elderly is underrepresented. The aim of this review was to analyze the current practice exemplary in gerontotraumatology and to discuss potential improvements. MATERIALS AND METHODS A literature review was performed in 2016 based on a PubMed search for gerontotraumatologic studies published between 2005 and 2015. Trials were evaluated for methodology and ethical and age-related aspects. RESULTS The search revealed 649 articles, 183 of which met the inclusion criteria. The age range for inclusion was heterogeneous; one-third of trials included patients <65 years and only 11% excluded very elderly. Seventy-four trials excluded patients with typical comorbidities, with 55% of these without stating scientific reasons. Frailty was assessed in 94 trials and defined as the exclusion criterion in 66 of them. Informed consent (IC) was reportedly obtained in 144 trials; descriptions of the IC process mostly remained vague. Substitute decision making was described in 19 trials; the consenting party remained unclear in 45 articles. Diagnosed dementia was a primary exclusion criterion in 31% of the trials. Seventeen trials assessed decisional capacity before inclusion, with six using specific assessments. CONCLUSION Many trials in gerontotraumatology exclude relevant subgroups of patients, and thus risk presenting biased estimates of the relevant treatment effects. Exclusion based on age, cognitive impairment, or other exhaustive exclusion criteria impedes specific scientific progress in the treatment of elderly patients. Meaningful trials could profit from a staged, transparent approach that fosters shared decision making. Rethinking current policies is indispensable to improve treatment and care of elderly trauma patients and to protect study participants and researchers alike.
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Affiliation(s)
- Jana S Jensen
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel 4031, Switzerland,
| | - Stella Reiter-Theil
- Department of Clinical Ethics, University Hospital Basel/Psychiatric Hospitals of the University Basel, Basel 4012, Switzerland
| | - Diana A Celio
- Department for Visceral, Thoracic and Vascular Surgery, Triemli Hospital, Zürich 8063, Switzerland
| | - Marcel Jakob
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel 4031, Switzerland,
| | - Werner Vach
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel 4031, Switzerland,
| | - Franziska J Saxer
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel 4031, Switzerland,
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Jakob M, Strupler N, Candinas D, Huynh-Do U, Beldi G. Externalized Percutaneous Stent Versus Internal Double J Stent: Short- and Long-term Complications After Kidney Transplantation. Transplant Proc 2018; 50:3416-3421. [PMID: 30577215 DOI: 10.1016/j.transproceed.2018.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/13/2018] [Accepted: 04/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In patients undergoing kidney transplantation, ureteral stents are an established technique to reduce major urologic complications such as leakage and stenosis of the ureter. However, the best technique for ureteral stenting remains unclear. The aim of this study was to compare the outcome of percutaneous ureteral stents (PS) with internal double J stents (JJS) after kidney transplantation. METHODS All patients undergoing kidney transplantation between 2005 and 2014 were retrospectively analyzed. After excluding patients <18 years old, patients without stenting, and patients who underwent multiorgan transplantation, a total of 308 patients were included in the study. Two consecutive cohorts of patients were compared. In the cohort transplanted between 2005 and 2010, stenting was routinely performed using PS (216 patients), and in the second cohort, those transplanted after 2011, stenting was routinely performed using JJS (92 patients). For ureteric anastomosis, the Lich-Grégoir technique was used in all patients. RESULTS There was no statistical difference in postoperative urinary tract infections (P = .239) between the 2 cohorts. In patients with PS, the incidence of major urologic complications (11.6% vs 3.3%; P = .018), vesicoureteral reflux (14.3% vs 2.2%; P < .001), and urologic reinterventions (14.4% vs 5.4%; P = .031) was significantly higher when compared with JJS patients. Multivariable logistic regression revealed increased incidence of major urologic complications (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.07-12.55, P = .039) and vesicoureteral reflux (OR 5.29, 95% CI 1.21-23.10, P = .027) in patients with PS compared with JJS. CONCLUSION Stenting of ureterovesical anastomosis using JJS is associated with reduced complications compared with PS after kidney transplantation.
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Affiliation(s)
- M Jakob
- Department of Visceral Surgery and Medicine, University Hospital, Bern, Switzerland
| | - N Strupler
- Department of Visceral Surgery and Medicine, University Hospital, Bern, Switzerland
| | - D Candinas
- Department of Visceral Surgery and Medicine, University Hospital, Bern, Switzerland
| | - U Huynh-Do
- Department of Nephrology and Hypertension, University Hospital, Bern, Switzerland
| | - G Beldi
- Department of Visceral Surgery and Medicine, University Hospital, Bern, Switzerland.
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du Fay de Lavallaz J, Puelacher C, Lurati Buse G, Bolliger D, Germanier D, Hidvegi R, Walter JE, Twerenbold R, Strebel I, Badertscher P, Sazgary L, Lampart A, Espinola J, Kindler C, Hammerer-Lercher A, Thambipillai S, Guerke L, Rentsch K, Buser A, Gualandro D, Jakob M, Mueller C. Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome. Heart 2018; 105:826-833. [DOI: 10.1136/heartjnl-2018-313876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 12/27/2022] Open
Abstract
ObjectiveRecently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.MethodsIn a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.ResultsOf 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).ConclusionsAlthough there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.Clinical trial registrationNCT02573532;Results.
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18
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Vach W, Saxer F, Holsgaard-Larsen A, Overgaard S, Farin-Glattacker E, Bless N, Bucher HC, Jakob M. Rationale and methods of an observational study to support the design of a nationwide surgical registry: the MIDAS study. Swiss Med Wkly 2018; 148:w14680. [PMID: 30449017 DOI: 10.4414/smw.2018.14680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND
Surgical registries are becoming increasingly popular. In addition, Swiss legislation requires data on therapeutic outcome quality. The Swiss Association of Surgeons (Schweizerische Gesellschaft Chirurgie, SGC-SCC) has already agreed on a first minimum data set. However, in the long run the scope and content of the registry should be evidence-based and not only accepted by professional stakeholders. The MIDAS study aims at providing such evidence for the example population of patients undergoing emergency or elective hip surgery. Five relevant aspects are considered: (1) choice of instruments for assessing health related quality of life (HRQoL); (2) optimal time-point for assessment; (3) use of proxy assessments; (4) choice of pre-surgery risk factors; and (5) assessment of peri- and postoperative variables.
METHODS
MIDAS is a longitudinal observational multicentre study. All patients suffering from a femoral neck fracture or from arthritis of the hip joint with an indication for prosthetic joint replacement surgery will be offered participation. The study is based on a combination of routine data from clinical standard practice with specifically documented data to be reported by the treating clinician and data to be collected in cooperation with the patient – in particular patient-reported outcome measures (PROMs). The latter include the Health Utility Index Mark 3 (HUI3) and Euro-Qol-5D (EQ-5D) as generic instruments, Hip Disability and Osteoarthritis Outcome Score (HOOS) as a disease specific instrument for the assessment of HRQoL, and two performance-based functional tests. Data will be collected at baseline, during hospitalisation/at discharge and at three routine follow-up visits. All patients will be asked to name a person for assessing proxy-perceived HRQoL.
DISCUSSION
To the best of our knowledge, this is the first study explicitly addressing questions about the design of a national surgical registry in an empirical manner. The study aims at providing a scientific base for decisions regarding scope and content of a potential national Swiss surgical registry. We designed a pragmatic study to envision data collection in a national registry with the option of specifying isolated research questions of interest. One focus of the study is the use of PROMs, and we hope that our study and their results will inspire also other surgical registries to take this important step forward.
Trial registration
Registered at the “Deutsches Register Klinischer Studien (DRKS)”, the German Clinical Trials Registry, since this registry meets the scope and methodology of the proposed study. Registration no.: DRKS00012991
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Affiliation(s)
- Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Switzerland
| | - Franziska Saxer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Switzerland
| | - Anders Holsgaard-Larsen
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark and Department of Orthopaedics and Traumatology, Odense University, Odense C, Denmark
| | - Soeren Overgaard
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark and Department of Orthopaedics and Traumatology, Odense University, Odense C, Denmark
| | - Erik Farin-Glattacker
- Sektion Versorgungsforschung und Rehabilitationsforschung, Medical Faculty and University Medical Centre, University of Freiburg, Germany
| | - Nicolas Bless
- Department of Orthopaedics and Traumatology, University Hospital Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and Department of Clinical Research, University of Basel, Switzerland
| | - Marcel Jakob
- Department of Orthopaedics and Traumatology, University Hospital Basel, Switzerland
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19
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Jensen J, Vach W, Reiter-Theil S, Celio D, Jakob M, Saxer F. #21 Handling of informed consent and inclusion in research on geriatric trauma patients: a matter of protection or disrespect? (poster presentation). Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Saxer F, Studer P, Jakob M, Suhm N, Rosenthal R, Dell-Kuster S, Vach W, Bless N. Minimally invasive anterior muscle-sparing versus a transgluteal approach for hemiarthroplasty in femoral neck fractures-a prospective randomised controlled trial including 190 elderly patients. BMC Geriatr 2018; 18:222. [PMID: 30241509 PMCID: PMC6151034 DOI: 10.1186/s12877-018-0898-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 08/27/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The relevance of femoral neck fractures (FNFs) increases with the ageing of numerous societies, injury-related decline is observed in many patients. Treatment strategies have evolved towards primary joint replacement, but the impact of different approaches remains a matter of debate. The aim of this trial was to evaluate the benefit of an anterior minimally-invasive (AMIS) compared to a lateral Hardinge (LAT) approach for hemiarthroplasty in these oftentimes frail patients. METHODS Four hundred thirty-nine patients were screened during the 44-months trial, aiming at the evaluation of 150 patients > 60 yrs. of age. Eligible patients were randomised using an online-tool with completely random assignment. As primary endpoint, early mobility, a predictor for long-term outcomes, was evaluated at 3 weeks via the "Timed up and go" test (TUG). Secondary endpoints included the Functional Independence Measure (FIM), pain, complications, one-year mobility and mortality. RESULTS A total of 190 patients were randomised; both groups were comparable at baseline, with a predominance for frailty-associated factors in the AMIS-group. At 3 weeks, 146 patients were assessed for the primary outcome. There was a reduction in the median duration of TUG performance of 21.5% (CI [- 41.2,4.7], p = 0.104) in the AMIS-arm (i.e., improved mobility). This reduction was more pronounced in patients with signs of frailty or cognitive impairment. FIM scores increased on average by 6.7 points (CI [0.5-12.8], p = 0.037), pain measured on a 10-point visual analogue scale decreased on average by 0.7 points (CI: [- 1.4,0.0], p = 0.064). The requirement for blood transfusion was lower in the AMIS- group, the rate of complications comparable, with a higher rate of soft tissue complications in the LAT-group. The mortality was higher in the AMIS-group. CONCLUSION These results, similar to previous reports, support the concept that in elderly patients at risk of frailty, the AMIS approach for hemiarthroplasty can be beneficial, since early mobilisation and pain reduction potentially reduce deconditioning, morbidity and loss of independence. The results are, however, influenced by a plethora of factors. Only improvements in every aspect of the therapeutic chain can lead to optimisation of treatment and improve outcomes in this growing patient population. TRIAL REGISTRATION www.clinicaltrials.gov : NCT01408693 (registered August 3rd 2011).
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Affiliation(s)
- Franziska Saxer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Patrick Studer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Clinic for Orthopaedics and Trauma Surgery Stephanshorn, Brauerstrasse 95, 9016 St. Gallen, Switzerland
| | - Marcel Jakob
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Norbert Suhm
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Rachel Rosenthal
- Faculty of Medicine, University of Basel, Klingelbergstr. 61, 4056 Basel, Switzerland
| | - Salome Dell-Kuster
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4031 Basel, Switzerland
- Department of Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Nicolas Bless
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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21
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Mujagic E, Zeindler J, Coslovsky M, Hoffmann H, Soysal SD, Mechera R, von Strauss M, Delko T, Saxer F, Glaab R, Kraus R, Mueller A, Curti G, Gurke L, Jakob M, Marti WR, Weber WP. The association of surgical drains with surgical site infections - A prospective observational study. Am J Surg 2018; 217:17-23. [PMID: 29935905 DOI: 10.1016/j.amjsurg.2018.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Surgical drains are widely used despite limited evidence in their favor. This study describes the associations between drains and surgical site infections (SSI). METHODS This prospective observational double center study was performed in Switzerland between February 2013 and August 2015. RESULTS The odds of SSI in the presence of drains were increased in general (OR 2.41, 95%CI 1.32-4.30, p = 0.004), but less in vascular and not in orthopedic trauma surgery. In addition to the surgical division, the association between drains and SSI depended significantly on the duration of surgery (p = 0.01) and wound class (p = 0.034). Furthermore, the duration of drainage (OR 1.24, 95%CI 1.15-1.35, p < 0.001), the number (OR 1.74, 95%CI 1.09-2.74, p = 0.019) and type of drains (open versus closed: OR 3.68, 95%CI 1.88, 6.89, p < 0.001) as well as their location (overall p = 0.002) were significantly associated with SSI. CONCLUSIONS The general use of drains is discouraged. However, drains may be beneficial in specific surgical procedures.
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Affiliation(s)
- Edin Mujagic
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Jasmin Zeindler
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Michael Coslovsky
- Clinical Trial Unit, University of Basel and University Hospital Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
| | - Henry Hoffmann
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Savas D Soysal
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Robert Mechera
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Marco von Strauss
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Tarik Delko
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Franziska Saxer
- Department of Orthopedic Trauma Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Richard Glaab
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Rebecca Kraus
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Alexandra Mueller
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Gaudenz Curti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Lorenz Gurke
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Marcel Jakob
- Department of Orthopedic Trauma Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Walter R Marti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Walter P Weber
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Ozcelik A, Pereira-Cameselle R, von Weber A, Paszkiewicz M, Carlotti M, Paintner T, Zhang L, Lin T, Zhang YQ, Barth JV, van den Nobelen T, Chiechi RC, Jakob M, Heiz U, Chiussi S, Kartouzian A, Klappenberger F, Alonso-Gómez JL. Device-Compatible Chiroptical Surfaces through Self-Assembly of Enantiopure Allenes. Langmuir 2018; 34:4548-4553. [PMID: 29551068 DOI: 10.1021/acs.langmuir.8b00305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Chiroptical methods have been proven to be superior compared to their achiral counterparts for the structural elucidation of many compounds. To expand the use of chiroptical systems to everyday applications, the development of functional materials exhibiting intense chiroptical responses is essential. Particularly, tailored and robust interfaces compatible with standard device operation conditions are required. Herein, we present the design and synthesis of chiral allenes and their use for the functionalization of gold surfaces. The self-assembly results in a monolayer-thin room-temperature-stable upstanding chiral architecture as ascertained by ellipsometry, X-ray photoelectron spectroscopy, and near-edge X-ray absorption fine structure. Moreover, these nanostructures anchored to device-compatible substrates feature intense chiroptical second harmonic generation. Both straightforward preparation of the device-compatible interfaces along with their chiroptical nature provide major prospects for everyday applications.
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Affiliation(s)
| | | | - A von Weber
- Department of Physical Chemistry, Catalysis Research Center , Technische Universität München , Lichtenbergstr. 4 , Garching 85748 , Germany
| | - M Paszkiewicz
- Physik-Department E20 , Technische Universität München , James-Franck-Str. 1 , Garching 85748 , Germany
| | - M Carlotti
- Stratingh Institute for Chemistry & Zernike Institute for Advanced Materials , University of Groningen , Nijenborgh 4 , Groningen 9747 AG , The Netherlands
| | - T Paintner
- Physik-Department E20 , Technische Universität München , James-Franck-Str. 1 , Garching 85748 , Germany
| | - L Zhang
- Physik-Department E20 , Technische Universität München , James-Franck-Str. 1 , Garching 85748 , Germany
| | - T Lin
- Physik-Department E20 , Technische Universität München , James-Franck-Str. 1 , Garching 85748 , Germany
| | - Y-Q Zhang
- Physik-Department E20 , Technische Universität München , James-Franck-Str. 1 , Garching 85748 , Germany
| | - J V Barth
- Physik-Department E20 , Technische Universität München , James-Franck-Str. 1 , Garching 85748 , Germany
| | | | - R C Chiechi
- Stratingh Institute for Chemistry & Zernike Institute for Advanced Materials , University of Groningen , Nijenborgh 4 , Groningen 9747 AG , The Netherlands
| | - M Jakob
- Department of Physical Chemistry, Catalysis Research Center , Technische Universität München , Lichtenbergstr. 4 , Garching 85748 , Germany
| | - U Heiz
- Department of Physical Chemistry, Catalysis Research Center , Technische Universität München , Lichtenbergstr. 4 , Garching 85748 , Germany
| | | | - A Kartouzian
- Department of Physical Chemistry, Catalysis Research Center , Technische Universität München , Lichtenbergstr. 4 , Garching 85748 , Germany
| | - F Klappenberger
- Physik-Department E20 , Technische Universität München , James-Franck-Str. 1 , Garching 85748 , Germany
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Affiliation(s)
- I Martin
- Department of Biomedicine and Department of Surgery, University Hospital Basel, University of Basel, Hebelstrasse 20, Basel 4031, Switzerland.
| | - M Jakob
- Department of Biomedicine and Department of Surgery, University Hospital Basel, University of Basel, Hebelstrasse 20, Basel 4031, Switzerland
| | - D J Schaefer
- Department of Biomedicine and Department of Surgery, University Hospital Basel, University of Basel, Hebelstrasse 20, Basel 4031, Switzerland
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Hoch AI, Duhr R, Di Maggio N, Mehrkens A, Jakob M, Wendt D. Expansion of Bone Marrow Mesenchymal Stromal Cells in Perfused 3D Ceramic Scaffolds Enhances In Vivo Bone Formation. Biotechnol J 2017; 12. [PMID: 28881093 DOI: 10.1002/biot.201700071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/31/2017] [Indexed: 01/05/2023]
Abstract
Bone marrow-derived mesenchymal stromal cells (BMSC), when expanded directly within 3D ceramic scaffolds in perfusion bioreactors, more reproducibly form bone when implanted in vivo as compared to conventional expansion on 2D polystyrene dishes/flasks. Since the bioreactor-based expansion on 3D ceramic scaffolds encompasses multiple aspects that are inherently different from expansion on 2D polystyrene, we aimed to decouple the effects of specific parameters among these two model systems. We assessed the effects of the: 1) 3D scaffold vs. 2D surface; 2) ceramic vs. polystyrene materials; and 3) BMSC niche established within the ceramic pores during in vitro culture, on subsequent in vivo bone formation. While BMSC expanded on 3D polystyrene scaffolds in the bioreactor could maintain their in vivo osteogenic potential, results were similar as BMSC expanded in monolayer on 2D polystyrene, suggesting little influence of the scaffold 3D environment. Bone formation was most reproducible when BMSC are expanded on 3D ceramic, highlighting the influence of the ceramic substrate. The presence of a pre-formed niche within the scaffold pores had negligible effects on the in vivo bone formation. The results of this study allow a greater understanding of the parameters required for perfusion bioreactor-based manufacturing of osteogenic grafts for clinical applications.
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Affiliation(s)
- Allison I Hoch
- Department of Biomedicine, University of Basel, University Hospital Basel, Hebelstrasse 20, CH-4031 Basel, Switzerland.,University of California, Davis, CA, USA
| | - Ralph Duhr
- Department of Biomedicine, University of Basel, University Hospital Basel, Hebelstrasse 20, CH-4031 Basel, Switzerland
| | - Nunzia Di Maggio
- Department of Biomedicine, University of Basel, University Hospital Basel, Hebelstrasse 20, CH-4031 Basel, Switzerland
| | - Arne Mehrkens
- Department of Biomedicine, University of Basel, University Hospital Basel, Hebelstrasse 20, CH-4031 Basel, Switzerland.,Department of Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marcel Jakob
- Department of Biomedicine, University of Basel, University Hospital Basel, Hebelstrasse 20, CH-4031 Basel, Switzerland.,Department of Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Wendt
- Department of Biomedicine, University of Basel, University Hospital Basel, Hebelstrasse 20, CH-4031 Basel, Switzerland.,Department of Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, University Hospital Basel, Basel, Switzerland
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Hoffmeyer P, Simmen H, Jakob M, Sommer C, Platz A, Ilchmann T, Grossen E, Ryf C, Christofilopoulos P, Schueler M, Lassen MR, Rimle M, Gasser UE. Rivaroxaban for Thromboprophylaxis After Nonelective Orthopedic Trauma Surgery in Switzerland. Orthopedics 2017; 40:109-116. [PMID: 27874908 DOI: 10.3928/01477447-20161116-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/03/2016] [Indexed: 02/03/2023]
Abstract
This study investigated the effectiveness and the outcomes of rivaroxaban vs the standard of care for venous thromboembolic prophylaxis in patients undergoing fracture-related surgery. A total of 413 patients undergoing fracture-related surgery from 9 Swiss orthopedic and trauma centers were enrolled. The authors selected the type of venous thromboembolic prophylaxis according to standardized medical practice at the participating centers before the inclusion of patients: 208 patients received rivaroxaban and 205 received the standard of care. Data on symptomatic thromboembolic and bleeding events, surgery-related complications, death, adverse events, time to mobilization, and hospital discharge were collected. Symptomatic thromboembolic events were reported in 1 patient (0.5%) and 2 patients (1.0%) and treatment-emergent major bleeding events were reported in 1 patient (0.5%) and 2 patients (1.0%) receiving rivaroxaban and the standard of care, respectively. The durations of hospital stay and venous thromboembolic prophylaxis were similar in the 2 groups. In both groups, adverse events related to venous thromboembolic prophylaxis were reported in 12 patients. The proportion of patients with minor and major fracture surgery was 74.3% and 25.7%, respectively. In patients undergoing minor fracture surgery receiving rivaroxaban (n=167) and the standard of care (n=140), no symptomatic thromboembolic events and no major bleeding events were reported. Outcomes of this study indicate that rivaroxaban might be an appropriate oral alternative for venous thromboembolic prophylaxis in routine medical care after fracture-related major and minor surgery. Reported results were comparable to those from other large-scale, noninterventional and randomized controlled studies. [Orthopedics. 2017; 40(2):109-116.].
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Mumme M, Steinitz A, Nuss KM, Klein K, Feliciano S, Kronen P, Jakob M, von Rechenberg B, Martin I, Barbero A, Pelttari K. Regenerative Potential of Tissue-Engineered Nasal Chondrocytes in Goat Articular Cartilage Defects. Tissue Eng Part A 2016; 22:1286-1295. [DOI: 10.1089/ten.tea.2016.0159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marcus Mumme
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
- Clinic for Traumatologic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Amir Steinitz
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
- Clinic for Traumatologic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Katja M. Nuss
- Musculoskeletal Research Unit (MSRU), Equine Department, University of Zurich, Zürich, Switzerland
| | - Karina Klein
- Musculoskeletal Research Unit (MSRU), Equine Department, University of Zurich, Zürich, Switzerland
| | - Sandra Feliciano
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Peter Kronen
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zürich, Switzerland
- Veterinary Anaesthesia Services–International (VAS), Winterthur, Switzerland
| | - Marcel Jakob
- Clinic for Traumatologic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Equine Department, University of Zurich, Zürich, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zürich, Switzerland
| | - Ivan Martin
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Karoliina Pelttari
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
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Mumme M, Barbero A, Miot S, Wixmerten A, Feliciano S, Wolf F, Asnaghi AM, Baumhoer D, Bieri O, Kretzschmar M, Pagenstert G, Haug M, Schaefer DJ, Martin I, Jakob M. Nasal chondrocyte-based engineered autologous cartilage tissue for repair of articular cartilage defects: an observational first-in-human trial. Lancet 2016; 388:1985-1994. [PMID: 27789021 DOI: 10.1016/s0140-6736(16)31658-0] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Articular cartilage injuries have poor repair capacity, leading to progressive joint damage, and cannot be restored predictably by either conventional treatments or advanced therapies based on implantation of articular chondrocytes. Compared with articular chondrocytes, chondrocytes derived from the nasal septum have superior and more reproducible capacity to generate hyaline-like cartilage tissues, with the plasticity to adapt to a joint environment. We aimed to assess whether engineered autologous nasal chondrocyte-based cartilage grafts allow safe and functional restoration of knee cartilage defects. METHODS In a first-in-human trial, ten patients with symptomatic, post-traumatic, full-thickness cartilage lesions (2-6 cm2) on the femoral condyle or trochlea were treated at University Hospital Basel in Switzerland. Chondrocytes isolated from a 6 mm nasal septum biopsy specimen were expanded and cultured onto collagen membranes to engineer cartilage grafts (30 × 40 × 2 mm). The engineered tissues were implanted into the femoral defects via mini-arthrotomy and assessed up to 24 months after surgery. Primary outcomes were feasibility and safety of the procedure. Secondary outcomes included self-assessed clinical scores and MRI-based estimation of morphological and compositional quality of the repair tissue. This study is registered with ClinicalTrials.gov, number NCT01605201. The study is ongoing, with an approved extension to 25 patients. FINDINGS For every patient, it was feasible to manufacture cartilaginous grafts with nasal chondrocytes embedded in an extracellular matrix rich in glycosaminoglycan and type II collagen. Engineered tissues were stable through handling with forceps and could be secured in the injured joints. No adverse reactions were recorded and self-assessed clinical scores for pain, knee function, and quality of life were improved significantly from before surgery to 24 months after surgery. Radiological assessments indicated variable degrees of defect filling and development of repair tissue approaching the composition of native cartilage. INTERPRETATION Hyaline-like cartilage tissues, engineered from autologous nasal chondrocytes, can be used clinically for repair of articular cartilage defects in the knee. Future studies are warranted to assess efficacy in large controlled trials and to investigate an extension of indications to early degenerative states or to other joints. FUNDING Deutsche Arthrose-Hilfe.
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Affiliation(s)
- Marcus Mumme
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea Barbero
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sylvie Miot
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Anke Wixmerten
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sandra Feliciano
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francine Wolf
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Adelaide M Asnaghi
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Baumhoer
- Department of Institute of Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Martin Kretzschmar
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Martin Haug
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivan Martin
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Marcel Jakob
- Department of Surgery and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Saxer F, Scherberich A, Todorov A, Studer P, Miot S, Schreiner S, Güven S, Tchang LAH, Haug M, Heberer M, Schaefer DJ, Rikli D, Martin I, Jakob M. Implantation of Stromal Vascular Fraction Progenitors at Bone Fracture Sites: From a Rat Model to a First-in-Man Study. Stem Cells 2016; 34:2956-2966. [PMID: 27538760 DOI: 10.1002/stem.2478] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/24/2016] [Accepted: 07/13/2016] [Indexed: 12/29/2022]
Abstract
Stromal Vascular Fraction (SVF) cells freshly isolated from adipose tissue include osteogenic- and vascular-progenitors, yet their relevance in bone fracture healing is currently unknown. Here, we investigated whether human SVF cells directly contribute to the repair of experimental fractures in nude rats, and explored the feasibility/safety of their clinical use for augmentation of upper arm fractures in elderly individuals. Human SVF cells were loaded onto ceramic granules within fibrin gel and implanted in critical nude rat femoral fractures after locking-plate osteosynthesis, with cell-free grafts as control. After 8 weeks, only SVF-treated fractures did not fail mechanically and displayed formation of ossicles at the repair site, with vascular and bone structures formed by human cells. The same materials combined with autologous SVF cells were then used to treat low-energy proximal humeral fractures in 8 patients (64-84 years old) along with standard open reduction and internal fixation. Graft manufacturing and implantation were compatible with intraoperative settings and led to no adverse reactions, thereby verifying feasibility/safety. Biopsies of the repair tissue after up to 12 months, upon plate revision or removal, demonstrated formation of bone ossicles, structurally disconnected and morphologically distinct from osteoconducted bone, suggesting the osteogenic nature of implanted SVF cells. We demonstrate that SVF cells, without expansion or exogenous priming, can spontaneously form bone tissue and vessel structures within a fracture-microenvironment. The gained clinical insights into the biological functionality of the grafts, combined with their facile, intra-operative manufacturing modality, warrant further tests of effectiveness in larger, controlled trials. Stem Cells 2016;34:2956-2966.
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Affiliation(s)
- Franziska Saxer
- Clinic of Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Arnaud Scherberich
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Atanas Todorov
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Studer
- Clinic of Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sylvie Miot
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Simone Schreiner
- Clinic of Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sinan Güven
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laurent A H Tchang
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Haug
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, Basel, Switzerland
| | - Michael Heberer
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, Basel, Switzerland
| | - Daniel Rikli
- Clinic of Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marcel Jakob
- Clinic of Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
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Müller S, Acevedo L, Wang X, Karim MZ, Matta A, Mehrkens A, Schaeren S, Feliciano S, Jakob M, Martin I, Barbero A, Erwin WM. Notochordal cell conditioned medium (NCCM) regenerates end-stage human osteoarthritic articular chondrocytes and promotes a healthy phenotype. Arthritis Res Ther 2016; 18:125. [PMID: 27255741 PMCID: PMC4890286 DOI: 10.1186/s13075-016-1026-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/19/2016] [Indexed: 01/30/2023] Open
Abstract
Background Notochordal cell conditioned medium (NCCM) derived from non-chondrodystrophic dogs has pro-anabolic and anti-catabolic effects upon nucleus pulposus (NP) cells. Here, for the first time, we assessed the ability of NCCM to influence the production of extracellular matrix and inflammatory proteins by healthy and osteoarthritic human chondrocytes within engineered cartilage tissues. We hypothesized that, similar to its action on NP cells, NCCM exerts metabolic and anti-catabolic effects on human articular chondrocytes and has the potential to significantly counteract inflammatory mediators. Methods Chondrocytes from nine non-osteoarthritic patients and from six osteoarthritic (OA) donors at the time of total knee arthroplasty were chondro-differentiated in pellets for 2 weeks. Non-OA pellets were exposed for 72 hours to IL-1β/TNF-α and then cultured up to 14 days in 2 % FBS-supplemented NCCM or 2 % FBS-supplemented medium (control (ctr)). OA pellets were cultured in NCCM or ctr medium without pro-inflammatory treatment. Tissues after each culture phase were analyzed biochemically (GAG/DNA), (immuno-) histologically (collagen I, II and GAG) and by Western blotting. Supernatants were analyzed by ELISA. Results Response to NCCM was age and disease dependent with healthy chondrocyte pellets (from donors >55 years of age) recovering their glycosaminoglycan (GAG) contents to baseline levels only with NCCM. OA pellets treated with NCCM significantly increased GAG content (1.8-fold) and levels of hyaluronic acid link protein (HAPLN), fibromodulin and SOX-9. The catabolic proteins (matrix metalloproteinase (MMP)-3 and MMP-13) and pro-inflammatory enzyme levels (cyclooxygenase-2 (COX-2)) were markedly reduced and there was significantly reduced secretion of pro-inflammatory chemokines (IL-6 and IL-8). Conclusions NCCM restores cartilage matrix production of end-stage human OA chondrocytes towards a healthy phenotype and suppresses the production of inflammatory mediators. Harnessing the necessary and sufficient factors within NCCM that confers chondroprotection and regenerative effects could lead to a minimally invasive agent for treatment of degenerative and inflammatory joint diseases. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1026-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.,Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.,Krembil Research Institute, Toronto Western Hospital, Divisions of Neurological and Orthopaedic Surgery, University of Toronto, 60 Leonard Street, KDT5-407, Toronto, ON, M5K 1K2, Canada
| | - Lina Acevedo
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Xiaomei Wang
- Krembil Research Institute, Toronto Western Hospital, Divisions of Neurological and Orthopaedic Surgery, University of Toronto, 60 Leonard Street, KDT5-407, Toronto, ON, M5K 1K2, Canada
| | - M Zia Karim
- Krembil Research Institute, Toronto Western Hospital, Divisions of Neurological and Orthopaedic Surgery, University of Toronto, 60 Leonard Street, KDT5-407, Toronto, ON, M5K 1K2, Canada
| | - Ajay Matta
- Krembil Research Institute, Toronto Western Hospital, Divisions of Neurological and Orthopaedic Surgery, University of Toronto, 60 Leonard Street, KDT5-407, Toronto, ON, M5K 1K2, Canada
| | - Arne Mehrkens
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Stefan Schaeren
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Sandra Feliciano
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Marcel Jakob
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.,Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - W Mark Erwin
- Krembil Research Institute, Toronto Western Hospital, Divisions of Neurological and Orthopaedic Surgery, University of Toronto, 60 Leonard Street, KDT5-407, Toronto, ON, M5K 1K2, Canada.
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Tschudin-Sutter S, Frei R, Dangel M, Jakob M, Balmelli C, Schaefer D, Weisser M, Elzi L, Battegay M, Widmer A. Validation of a treatment algorithm for orthopaedic implant-related infections with device-retention—results from a prospective observational cohort study. Clin Microbiol Infect 2016; 22:457.e1-9. [DOI: 10.1016/j.cmi.2016.01.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/28/2015] [Accepted: 01/03/2016] [Indexed: 11/28/2022]
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Abstract
The increasing importance of preventive measures in the field of orthopedics and trauma surgery becomes apparent because of the demographic changes and the high risk for secondary fractures following osteoporotic fractures. Within the fracture treatment chain, orthopedics and trauma surgery are in the "pole position" to initiate these measures in geriatric patients. In the past orthopedists and trauma surgeons have constantly accused of neglecting secondary fracture prevention in fragility fracture patients. There are several reasons that speak in favor of us undertaking a role in secondary fracture prevention: osteoporosis medication is highly effective in fracture prevention when correctly indicated, the positive effects of osteoporosis therapy on fracture healing and legal issues. Arguments that have been used to justify neglect of secondary fracture prevention are undesired side effects related to osteoporosis medications, such as atypical femoral fractures and osteonecrosis of the jaws, interference of some specific drugs with fracture healing and the working conditions in emergency departments. These run contrary to the consideration of chronic diseases such as osteoporosis, secondary osteoporosis and the underlying disease could be overlooked and the increasing complexity of medicinal osteoporosis therapy. In the first part of the article these arguments are weighed against each other. In the second part the concept of a fracture liaison service (FLS) is discussed. The FLS framework now allows an active role to be taken with respect to secondary fracture prevention despite the busy daily routine schedule. Implementation of an FLS is facilitated by dedicated instruction protocols and programs. Self-financing of an FLS is currently possible only in some specific healthcare systems. In healthcare systems in German-speaking areas a cross-financing must be available and the value of an FLS indirectly presented. Apart from the financial aspects, implementation of a FLS is also worthwhile because it can be looked on as the future driving force of innovation.
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Affiliation(s)
- N Suhm
- Klinik für Traumatologie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz.
- Endonet, Endokrinologische Praxis & Labor, Osteologisches Universitätsforschungszentrum DVO, Missionsstrasse 24, 4055, Basel, Schweiz.
| | - C Meier
- Endonet, Endokrinologische Praxis & Labor, Osteologisches Universitätsforschungszentrum DVO, Missionsstrasse 24, 4055, Basel, Schweiz
| | - M Kraenzlin
- Endonet, Endokrinologische Praxis & Labor, Osteologisches Universitätsforschungszentrum DVO, Missionsstrasse 24, 4055, Basel, Schweiz
| | - E Kungler
- Klinik für Traumatologie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz
| | - B Savic
- Klinik für Traumatologie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz
| | - S Mueller
- Klinik für Traumatologie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz
| | - M Jakob
- Klinik für Traumatologie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz
| | - D Rikli
- Klinik für Traumatologie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz
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Studer P, Suhm N, Wang Q, Rosenthal R, Saleh HAF, Jakob M. Displaced trochanteric fragments lead to poor functional outcome in pertrochanteric fractures treated by cephalomedullary nails. Injury 2015; 46:2384-8. [PMID: 26454629 DOI: 10.1016/j.injury.2015.06.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The importance of the greater trochanter and its attached abductor muscles for physiological gait is well accepted. However the influence of a displaced greater trochanter fracture after a pertrochanteric fracture is unknown. The aim of this study is to determine if there is an association between the greater trochanter position and the level of patient mobility following internal fixation of pertrochanteric fractures. METHODS One hundred and thirty-three consecutive elderly patients with a median age of 85 (interquartile range [IQR] 79-91) years, who were treated for pertrochanteric fractures at a level I trauma centre, were recruited. AO 31 A3.1 and A3.2 fracture types were excluded from the statistical analysis. Patient mobility was prospectively assessed before the fracture and one year following fracture treatment using the Parker mobility score. In a multivariable analysis, the influence of a displaced greater trochanter on patient mobility at one-year follow-up was assessed. The analysis was adjusted for age, gender, body mass index, Charlson comorbidity index, AO fracture classification, varus-/valgus malposition of the neck-shaft fragments, and Parker mobility score before fracture. RESULTS Post-operative X-rays were available in 125 patients, out of which 66 (53%) patients were identified with a displaced or migrated greater trochanter. One year mortality rate was 22% (n=27). In the 82 patients who had functional assessment one year post-operatively, the median Parker mobility score before fracture and at one-year follow-up was 7 (IQR 4-9) and 7 (IQR 3-9) in patients without, and 7 (IQR 4-9) and 3 (IQR 2-5) in patients with a displaced greater trochanter. In multivariable analysis, a displaced greater trochanter was significantly associated with a lower Parker mobility score (-1.74, 95% confidence interval -2.37, -1.12, p<0.01). CONCLUSION Greater trochanter displacement following internal fixation of extracapsular hip fractures with a cephalomedullary nail is associated with a poor functional outcome. Greater attention to achieve adequate reduction and stabilisation of this fragment during internal fixation of pertrochanteric hip fractures should be aimed for despite the inability of current cephalomedullary implants to do so. LEVEL OF EVIDENCE III prognostic and epidemiological study.
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Affiliation(s)
- Patrick Studer
- Department of Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Norbert Suhm
- Department of Traumatology, University Hospital Basel, Basel, Switzerland
| | - Qing Wang
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Rachel Rosenthal
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Marcel Jakob
- Department of Traumatology, University Hospital Basel, Basel, Switzerland
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Gruetter F, Rudkin G, Stavrou P, Dracopoulos G, Jakob M, Iselin LD. Use of peripheral blocks and tourniquets in foot surgery: A survey of Australian orthopaedic foot and ankle surgeons. Foot Ankle Surg 2015; 21:282-5. [PMID: 26564732 DOI: 10.1016/j.fas.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/09/2014] [Accepted: 03/04/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The most common reasons for unplanned admission to the hospital from outpatient surgery have the potential to be minimised or eliminated by peripheral nerve blocks (PNB). Tourniquets are commonly used in elective extremity surgery but it's use is mostly guided by personal preferences and does no correlate with the existing literature. Our aim was to explore the current practice of PNB and tourniquet use by foot and ankle surgeons in Australia. METHODS The Australian Orthopaedic Foot and Ankle Surgery Society (AOFAS) annual meeting was held in Adelaide in 2011. Members were asked to complete an electronic survey on their current use of peripheral nerve blocks and tourniquets. Two specific elective case scenarios were included for comment, one pertaining to forefoot pathology, the other hindfoot pathology. RESULTS Twenty-three AOFAS members replied to the survey, an overall response rate of 76.6%. Of these, only two surgeons did not use ankle blocks in elective surgery and none were prepared to operate without a tourniquet. Most Australian foot and ankle surgeons were reluctant to use local anaesthetic techniques without an accompanying GA. CONCLUSIONS While the literature suggests that GA may add to complications without any benefit for the procedure and that distally based tourniquets may add benefit, these are not the favoured techniques in Australian foot and ankle surgeons.
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Affiliation(s)
| | - Glenda Rudkin
- Specialist Anaesthetic Services, Adelaide, SA, Australia
| | - Peter Stavrou
- Adelaide Orthosports Clinic, Adelaide, SA, Australia
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Barandun M, Iselin LD, Santini F, Pansini M, Scotti C, Baumhoer D, Bieri O, Studler U, Wirz D, Haug M, Jakob M, Schaefer DJ, Martin I, Barbero A. Generation and characterization of osteochondral grafts with human nasal chondrocytes. J Orthop Res 2015; 33:1111-9. [PMID: 25994595 DOI: 10.1002/jor.22865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/08/2015] [Indexed: 02/04/2023]
Abstract
We investigated whether nasal chondrocytes (NC) can be used to generate composite constructs with properties necessary for the repair of osteochondral (OC) lesions, namely maturation, integration and capacity to recover from inflammatory burst. OC grafts were fabricated by combining engineered cartilage tissues (generated by culturing NC or articular chondrocytes - AC - onto Chondro-Gide® matrices) with devitalized spongiosa cylinders (Tutobone®). OC tissues were then exposed to IL-1β for three days and cultured for additional 2 weeks in the absence of IL-1β. Cartilage maturation extent was assessed (immune) histologically, biochemically and by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) while cartilage/bone integration was assessed using a peel-off mechanical test. The use of NC as compared to AC allowed for more efficient cartilage matrix accumulation and superior integration of the cartilage/bone layers. dGEMRIC and biochemical analyzes of the OC constructs showed a reduced glycosaminoglycan (GAG) contents upon IL-1β administration. Cartilaginous matrix contents and integration forces returned to baseline up on withdrawal of IL-1β. By having a cartilage layer well developed and strongly integrated to the subchondral layer, OC tissues generated with NC may successfully engraft in an inflammatory post-surgery joint environment.
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Affiliation(s)
- Marina Barandun
- Departments of Surgery and of Biomedicine, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Lukas Daniel Iselin
- Departments of Surgery and of Biomedicine, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Francesco Santini
- Department of Radiology, Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Michele Pansini
- Department of Radiology, Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | | | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute of Pathology, Basel University Hospital, Basel, Switzerland
| | - Oliver Bieri
- Department of Radiology, Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Ueli Studler
- Department of Radiology, Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Dieter Wirz
- Laboratory for Biomechanics and Biocalorimetry, Biozentrum- Pharmazentrum, University of Basel, Basel, Switzerland.,Orthomerian, postCode, 4054, Basel, Switzerland
| | - Martin Haug
- Departments of Surgery and of Biomedicine, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Marcel Jakob
- Departments of Surgery and of Biomedicine, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Dirk Johannes Schaefer
- Departments of Surgery and of Biomedicine, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Ivan Martin
- Departments of Surgery and of Biomedicine, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Andrea Barbero
- Departments of Surgery and of Biomedicine, Basel University Hospital, University of Basel, Basel, Switzerland
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Pelttari K, Pippenger B, Mumme M, Feliciano S, Scotti C, Mainil-Varlet P, Procino A, von Rechenberg B, Schwamborn T, Jakob M, Cillo C, Barbero A, Martin I. Adult human neural crest-derived cells for articular cartilage repair. Sci Transl Med 2015; 6:251ra119. [PMID: 25163479 DOI: 10.1126/scitranslmed.3009688] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In embryonic models and stem cell systems, mesenchymal cells derived from the neuroectoderm can be distinguished from mesoderm-derived cells by their Hox-negative profile--a phenotype associated with enhanced capacity of tissue regeneration. We investigated whether developmental origin and Hox negativity correlated with self-renewal and environmental plasticity also in differentiated cells from adults. Using hyaline cartilage as a model, we showed that adult human neuroectoderm-derived nasal chondrocytes (NCs) can be constitutively distinguished from mesoderm-derived articular chondrocytes (ACs) by lack of expression of specific HOX genes, including HOXC4 and HOXD8. In contrast to ACs, serially cloned NCs could be continuously reverted from differentiated to dedifferentiated states, conserving the ability to form cartilage tissue in vitro and in vivo. NCs could also be reprogrammed to stably express Hox genes typical of ACs upon implantation into goat articular cartilage defects, directly contributing to cartilage repair. Our findings identify previously unrecognized regenerative properties of HOX-negative differentiated neuroectoderm cells in adults, implying a role for NCs in the unmet clinical challenge of articular cartilage repair. An ongoing phase 1 clinical trial preliminarily indicated the safety and feasibility of autologous NC-based engineered tissues for the treatment of traumatic articular cartilage lesions.
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Affiliation(s)
- Karoliina Pelttari
- Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Benjamin Pippenger
- Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Marcus Mumme
- Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Sandra Feliciano
- Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Celeste Scotti
- Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milano, Italy
| | - Pierre Mainil-Varlet
- AGINKO Research AG, Route de l'ancienne Papeterie, P. O. Box 30, 1723 Marly, Switzerland
| | - Alfredo Procino
- Department of Medicine and Surgery, Federico II Medical School, Via S. Pansini 5, 80131 Napoli, Italy
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Equine Hospital, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | | | - Marcel Jakob
- Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Clemente Cillo
- Department of Medicine and Surgery, Federico II Medical School, Via S. Pansini 5, 80131 Napoli, Italy
| | - Andrea Barbero
- Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Ivan Martin
- Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland.
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Iselin LD, Mett T, Babst R, Jakob M, Rikli D. The triceps reflecting approach (Bryan-Morrey) for distal humerus fracture osteosynthesis. BMC Musculoskelet Disord 2014; 15:406. [PMID: 25471796 PMCID: PMC4289245 DOI: 10.1186/1471-2474-15-406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background “Chevron”-Olecranon osteotomies are commonly used for the approach to intraarticular distal humerus fractures but are often associated with procedure related complications. We studied the triceps reflecting approach (TRA) with preservation of the extensor apparatus as a safe alternative giving a sufficient exposure to the elbow joint and helping to achieve anatomical fracture reduction with the intact olecranon as a template. Methods We performed a retrospective review at two trauma centres and identified 31 skeletally mature distal humerus fractures treated with a TRA. 24 of the patients returned to follow-up including history recording, physical examination with functional analysis of the operated vs the normal site with the DASH and Mayo scores, measurement of range of motion, isometric elbow strength measurement and radiographic documentation. Results Mean duration of FU was 51 months (24 months-12 years) in 24 patients, 13 female, 11 male with an average age of 57.7 years (range 17-89). AO Classification showed five A2, one B2, two C1, 9 C2 and 7 C3 fractures. Radiologic control showed adequate reduction, distal humeral alignment and fracture healing in all patients. The strength analysis of flexion and extension revealed no statistically relevant loss of strength at last FU. Range of motion was excellent. Conclusion The TRA is a valuable option for ORIF in distal intraarticular humerus fractures. It preserves the normal joint anatomy of the olecranon and avoids the potential complications associated with olecranon osteotomy. The clinical outcome parameters of our series revealed excellent maintenance of strength compared to the contralateral side.
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Affiliation(s)
- Lukas Daniel Iselin
- Department of Traumatology, University Hospital Basel, Spitalstrasse 21, CH-3041 Basel, Switzerland.
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Suhm N, Kaelin R, Studer P, Wang Q, Kressig RW, Rikli D, Jakob M, Pretto M. Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch Orthop Trauma Surg 2014; 134:1261-9. [PMID: 25060921 DOI: 10.1007/s00402-014-2057-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Care pathways for elderly hip fracture patients are increasingly implemented but there has been only limited evaluation of their use. Our objective was to investigate the impact of such a care pathway on the use of healthcare resources and on patients' outcomes. MATERIALS AND METHODS The prospective survey covered 493 hip fracture patients 65 years of age or older that were treated either before "Usual Care = (UC)" or after "Co-Managed-Care = (CMC)" implementation of the care pathway. Primary outcome was length of stay (LoS). Secondary outcomes were 1-year mortality and change in residential status from prefracture baseline to 1-year after surgery. Data were analysed by descriptive and interferential statistics and adjustment for baseline differences amongst the two patient groups was done. RESULTS Patients in the CMC sample had more preexisting comorbidities (CCI 2.5 versus 2.1). Prior to the fracture, a larger proportion amongst them needed help in ADL (49 versus 26%), and they were more likely to reside in a nursing home (36 versus 29%). Prefracture mobility status was equal in both samples. In the CMC sample LoS was significantly shorter (LoS 8.6 versus 11.3 days, p < 0.01) and patients were less likely to experience a complication (59 vs 73%, p < 0.01) while being in the hospital. There was no significant difference in 1-year mortality or in change of residential status. CONCLUSIONS A care pathway for elderly hip fracture patients allowed decreased LoS without affecting mortality or change of residential status 1 year after fracture compared to prefracture baseline.
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Affiliation(s)
- N Suhm
- Traumatology, Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
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Fulco I, Miot S, Haug MD, Barbero A, Wixmerten A, Feliciano S, Wolf F, Jundt G, Marsano A, Farhadi J, Heberer M, Jakob M, Schaefer DJ, Martin I. Engineered autologous cartilage tissue for nasal reconstruction after tumour resection: an observational first-in-human trial. Lancet 2014; 384:337-46. [PMID: 24726477 DOI: 10.1016/s0140-6736(14)60544-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Autologous native cartilage from the nasal septum, ear, or rib is the standard material for surgical reconstruction of the nasal alar lobule after two-layer excision of non-melanoma skin cancer. We assessed whether engineered autologous cartilage grafts allow safe and functional alar lobule restoration. METHODS In a first-in-human trial, we recruited five patients at the University Hospital Basel (Basel, Switzerland). To be eligible, patients had to be aged at least 18 years and have a two-layer defect (≥50% size of alar subunit) after excision of non-melanoma skin cancer on the alar lobule. Chondrocytes (isolated from a 6 mm cartilage biopsy sample from the nasal septum harvested under local anaesthesia during collection of tumour biopsy sample) were expanded, seeded, and cultured with autologous serum onto collagen type I and type III membranes in the course of 4 weeks. The resulting engineered cartilage grafts (25 mm × 25 mm × 2 mm) were shaped intra-operatively and implanted after tumour excision under paramedian forehead or nasolabial flaps, as in standard reconstruction with native cartilage. During flap refinement after 6 months, we took biopsy samples of repair tissues and histologically analysed them. The primary outcomes were safety and feasibility of the procedure, assessed 12 months after reconstruction. At least 1 year after implantation, when reconstruction is typically stabilised, we assessed patient satisfaction and functional outcomes (alar cutaneous sensibility, structural stability, and respiratory flow rate). FINDINGS Between Dec 13, 2010, and Feb 6, 2012, we enrolled two women and three men aged 76-88 years. All engineered grafts contained a mixed hyaline and fibrous cartilage matrix. 6 months after implantation, reconstructed tissues displayed fibromuscular fatty structures typical of the alar lobule. After 1 year, all patients were satisfied with the aesthetic and functional outcomes and no adverse events had been recorded. Cutaneous sensibility and structural stability of the reconstructed area were clinically satisfactory, with adequate respiratory function. INTERPRETATION Autologous nasal cartilage tissues can be engineered and clinically used for functional restoration of alar lobules. Engineered cartilage should now be assessed for other challenging facial reconstructions. FUNDING Foundation of the Department of Surgery, University Hospital Basel; and Krebsliga beider Basel.
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Affiliation(s)
- Ilario Fulco
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sylvie Miot
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Martin D Haug
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Andrea Barbero
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Anke Wixmerten
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sandra Feliciano
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francine Wolf
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gernot Jundt
- Institute of Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Anna Marsano
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jian Farhadi
- Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Michael Heberer
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marcel Jakob
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivan Martin
- Department of Surgery and Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.
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Abstract
BACKGROUND Rhinoliths are rare affections of the main nasal cavity and the paranasal sinuses. Initially, as a result of their low incidence, they are often incorrectly classified as calcified tumors in clinical examination. METHODOLOGY We have identified three cases in our patient population and evaluated the clinical symptoms as well as the pathological findings and the causes of the disease. RESULTS Due to their extension and the respective clinical pattern, all masses were surgically removed under endotracheal anesthesia. The histopathological findings comprised an ectopic tooth, a vegetable (most likely a leaf from the garden) as well as a textile foreign body (probably of iatrogenic origin). CONCLUSION Undiscovered foreign bodies of the main nasal cavity are a common cause for the formation of rhinoliths. We have also displayed the respective incidence and the therapeutic options.
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Jakob M, Micklitz H, Luchner K. Observation of Pseudolocalized Vibrational Modes in the Optical Spectra of Rare Earth Atoms Isolated in Rare Gas Matrices. ACTA ACUST UNITED AC 2014. [DOI: 10.1002/bbpc.19780820120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
OBJECTIVE To evaluate the patient characteristics and natural history of pubic rami fractures in geriatric patients, with a special focus on the frequency of concomitant posterior pelvic ring lesions and the percentage of secondarily operated patients as a result of conservative treatment failure. STUDY DESIGN Retrospective cohort study. Patients were treated in a university hospital that is equivalent to a level I Trauma centre. PATIENTS AND METHODS We analysed 132 consecutive patients (113 women, 19 men), >65 years old, presenting with low energy-trauma pubic rami fractures at our emergency department from January 2009 to December 2011. RESULTS Mean age of patients was 84 years (range 66-100). Women were affected six times more frequently than men. Almost 30% of patients lost their previous independence permanently owing to the injury. Ninety eight percent of previously independent patients (community dwellers) required temporary hospital care for a median duration of 39 days (interquartile range [IQR] 28-52). One-year mortality was 18.5%. A concomitant posterior pelvic ring lesion was identified by computed tomography in 54% of patients. In 4% of the patients secondary operative fracture stabilisation was performed. DISCUSSION Pubic rami fractures are frequently associated with concomitant posterior pelvic ring injuries, making these injuries more unstable than generally assumed. Based on this fact and the long duration of hospital stay, more aggressive management of these injuries may be considered. The principle aims in this patient population are satisfying pain management, early mobilisation, conservation of independence and return to previous place of residence.
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Affiliation(s)
- Patrick Studer
- University Hospital, Spitalstrasse 21, 4031, Basel (BS), SWITZERLAND;
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Jakob M, Bruderek K, Bootz F, Lang S, Brandau S. [Trying to unravel an unresolved issue in regenerative medicine: gene expression profiling of MSCs]. Laryngorhinootologie 2013; 92:462-9. [PMID: 23592442 DOI: 10.1055/s-0033-1337982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Mesenchymal stem cells (MSCs) are adult fibroblastoid progenitor cells. Because of their immunoregulatory properties and their so-called trophic effects, MSCs play an important role in tissue regeneration, inflammation and trauma. Tissue trauma and challenge, for example during radiotherapy or infection, result in the release of so-called "danger molecules", which may be derived from dying cells or incoming pathogens. The molecular response of MSCs to this tissue stress remains largely elusive. MATERIAL AND METHODS In this study we examined the cell biological response of MSCs derived from human parotid glands (pgMSCs) and used bacterial endotoxin as a model of tissue stress and inflammation. PgMSCs from 3 donors were isolated, expanded and tested for classical tri-lineage plus myogenic differentiation. The cell biological response to the model "stressor" endotoxin was examined by low density gene expression arrays. RESULTS Through immunofluorescence and immunohistochemistry we were able to proof osteogenic, adipogenic, chondrogenic, and myogenic differentiation potential characteristic for stem cells. In vitro, gene expression analysis showed a characteristic modulation of MSCs after stimulation with endotoxin Lipopolysaccharide (LPS). Specifically, receptors and ligands typically involved in immune regulation, such as interleukins, TGF-β, tumor necrosis factors (TNF), and toll-like receptors (TLR), were regulated. CONCLUSION Our study elucidates some key functions and molecules, which are regulated in MSCs during tissue stress and inflammation. A thorough understanding of their cell biological function will aid future rationale therapeutic application of MSCs.
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Affiliation(s)
- M Jakob
- University Hospital Bonn, ENT, Bonn.
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Wolff F, Zirkel L, Betzold S, Jakob M, Maier V, Nachtrab F, Nicolat BC, Fey T, Münstedt H. Using Supercritical Carbon Dioxide for Physical Foaming of Advanced Polymer Materials. INT POLYM PROC 2013. [DOI: 10.3139/217.2469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Foams from high performance polymers find more and more interest. The processes to generate them can be difficult, however. It is shown how physical foaming with CO2 can be used as a first step to assess the potentials of such materials. For investigations of such kind an autoclave on a laboratory scale which allows pressure variations up to 300 bars and temperatures up to 300°C was set up. The samples are saturated with supercritical carbon dioxide (s.c. CO2) which acts as a foaming agent. Depending on the process and material parameters different foam characteristics and cell morphologies were obtained and characterised. The potential of this method is demonstrated for two different classes of advanced polymer materials, thermoplastic fluoropolymers (FEP), and a silicone resin. In the case of the fluoropolymer, previously prepared films were foamed and the effects of various process parameters on the foam characteristics were investigated. Besides the general potential of foams from fluoropolymers, they are candidates for polymeric piezoelectric materials with a relatively high temperature stability. Silicone polymers possess some properties superior to common organic polymers. First results on the foaming behaviour of a silicone resin are presented.
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Affiliation(s)
- F. Wolff
- Institute of Polymer Materials, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - L. Zirkel
- Institute of Polymer Materials, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - S. Betzold
- Institute of Polymer Materials, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - M. Jakob
- Institute of Polymer Materials, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - V. Maier
- Institute of General Materials Properties, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - F. Nachtrab
- Development Center X-Ray Technology (EZRT), Fraunhofer Gesellschaft, Fürth, Germany
| | - B. Ceron Nicolat
- Institute of Glass and Ceramics, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - T. Fey
- Institute of Glass and Ceramics, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - H. Münstedt
- Institute of Polymer Materials, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
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Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a rare tumor entity in Germany in contrast to endemic countries in Asia or Africa. This retrospective study investigated patient characteristics and prognostic factors with respect to different NPC treatment strategies. PATIENTS AND METHODS A total of 63 NPC patients treated during the period 1990-2009 at the University Hospital Bonn, Germany, were included. RESULTS The median age of the patients was 56.4 years, the male:female ratio was 3.2:1, 23.8% were in Union Internationale Contre le Cancer (UICC) stage I/II and 76.2% were in stage III/IV. Most of the carcinomas were WHO type III (57.1%), followed by World Health Organization (WHO) type II (33.3%) and at last WHO type I (9.6%). The 5-year overall survival rate after concomitant chemoradiotherapy (RCT) was 75% and after radiotherapy (RT) 60%. The mortality rate increased by 3.5 times with each increase in T-stage (p ≤ 0.047). The recurrence rate (RR) after RCT was 34% and after RT alone 68% (p ≤ 0.04). Tumor ablation increased the RR significantly (p ≤ 0.047). CONCLUSION Combined chemotherapy and RT is an effective treatment of NPC disease and clearly superior to RT alone. Tumor ablation before RCT/RT worsens the prognosis and is now obsolete.
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Affiliation(s)
- M Jakob
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Uniklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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46
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Jakob M, Manz M, Schröck A, Bootz F, Eichhorn K. [Analysis of quality of life outcome for nasopharyngeal carcinoma patients after treatment]. Laryngorhinootologie 2013; 92:244-50. [PMID: 23296462 DOI: 10.1055/s-0032-1330020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This retrospective study analysed patient characteristics and quality of live (QoL) for patients with nasopharyngeal carcinoma (NPC) after treatment. MATERIAL AND METHODS A cross-sectional investigation was conducted to assess the QoL of 20 NPC patients with cancer-free survival of more than one year, which were treated with radiotherapy (RT) or chemoradiotherapy (RCT) during the period 2001-2009 at the University Hospital Bonn, Germany. The QoL was assessed by the FACT-NP (functional assessment of cancer therapy-nasopharyngeal) questionnaire. RESULTS The median age of the patients was 57 ± 13 years and the male/female ratio was 2.33/1.3 (15%) patients were treated with RT and 17 (85%) with RCT. The global QoL was good in our patients. Xerostomia, chewing, decrease of gustatory sense, discontent with sexual life and ear problems were of major concern with the majority of patients and affected the QoL negatively. Pain, lost of working ability, emotional distress, or family problems were no significant factors. CONCLUSION The expected reduction of QoL after treatment must be explained in detail to the NPC patient. The integration of the family and partner, an antidepressant therapy or psycho-oncological support can be useful and necessary.
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Affiliation(s)
- M Jakob
- ENT - HNO, University Hospital Bonn, Bonn, Germany.
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Abstract
Facial impalement in childhood is very rare. In most cases, it is caused by accident. We present two young patients who suffered a facial impalement injury and were treated in the interdisciplinary emergency room of the University Hospital Bonn, Germany. The degree of injury could not be completely determined during the first examination. Serious complications could be excluded after examination via computed tomography (CT) and surgical exploration. The indication to use CT or magnetic resonance imaging in childhood has to be considered in order to obtain full and exact information about the extent of injury.
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Affiliation(s)
- U Sell
- Klinik für Hals-Nasen-Ohrenerkrankungen/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
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Mehrkens A, Saxer F, Güven S, Hoffmann W, Müller AM, Jakob M, Weber FE, Martin I, Scherberich A, Scherberich A. Intraoperative engineering of osteogenic grafts combining freshly harvested, human adipose-derived cells and physiological doses of bone morphogenetic protein-2. Eur Cell Mater 2012; 24:308-19. [PMID: 23018419 DOI: 10.22203/ecm.v024a22] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Engineered osteogenic constructs for bone repair typically involve complex and costly processes for cell expansion. Adipose tissue includes mesenchymal precursors in large amounts, in principle allowing for an intraoperative production of osteogenic grafts and their immediate implantation. However, stromal vascular fraction (SVF) cells from adipose tissue were reported to require a molecular trigger to differentiate into functional osteoblasts. The present study tested whether physiological doses of recombinant human BMP-2 (rhBMP-2) could induce freshly harvested human SVF cells to generate ectopic bone tissue. Enzymatically dissociated SVF cells from 7 healthy donors (1 x 10(6) or 4 x 10(6)) were immediately embedded in a fibrin gel with or without 250 ng rhBMP-2, mixed with porous silicated calcium-phosphate granules (Actifuse(®), Apatech) (final construct size: 0.1 cm(3)) and implanted ectopically for eight weeks in nude mice. In the presence of rhBMP-2, SVF cells not only supported but directly contributed to the formation of bone ossicles, which were not observed in control cell-free, rhBMP-2 loaded implants. In vitro analysis indicated that rhBMP-2 did not involve an increase in the percentage of SVF cells recruited to the osteogenic lineage, but rather induced a stimulation of the osteoblastic differentiation of the committed progenitors. These findings confirm the feasibility of generating fully osteogenic grafts using an easily accessible autologous cell source and low amounts of rhBMP-2, in a timing compatible with an intraoperative schedule. The study warrants further investigation at an orthotopic site of implantation, where the delivery of rhBMP-2 could be bypassed thanks to the properties of the local milieu.
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Affiliation(s)
- Arne Mehrkens
- Department of Surgery, University and University Hospital of Basel, 4031 Basel, Switzerland
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49
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Mumme M, Scotti C, Papadimitropoulos A, Todorov A, Hoffmann W, Bocelli-Tyndall C, Jakob M, Wendt D, Martin I, Barbero A. Interleukin-1β modulates endochondral ossification by human adult bone marrow stromal cells. Eur Cell Mater 2012; 24:224-36. [PMID: 23007908 DOI: 10.22203/ecm.v024a16] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Inflammatory cytokines present in the milieu of the fracture site are important modulators of bone healing. Here we investigated the effects of interleukin-1β (IL-1β) on the main events of endochondral bone formation by human bone marrow mesenchymal stromal cells (BM-MSC), namely cell proliferation, differentiation and maturation/remodelling of the resulting hypertrophic cartilage. Low doses of IL-1β (50 pg/mL) enhanced colony-forming units-fibroblastic (CFU-f) and -osteoblastic (CFU-o) number (up to 1.5-fold) and size (1.2-fold) in the absence of further supplements and glycosaminoglycan accumulation (1.4-fold) upon BM-MSC chondrogenic induction. In osteogenically cultured BM-MSC, IL-1β enhanced calcium deposition (62.2-fold) and BMP-2 mRNA expression by differential activation of NF-κB and ERK signalling. IL-1β-treatment of BM-MSC generated cartilage resulted in higher production of MMP-13 (14.0-fold) in vitro, mirrored by an increased accumulation of the cryptic cleaved fragment of aggrecan, and more efficient cartilage remodelling/resorption after 5 weeks in vivo (i.e., more TRAP positive cells and bone marrow, less cartilaginous areas), resulting in the formation of mature bone and bone marrow after 12 weeks. In conclusion, IL-1β finely modulates early and late events of the endochondral bone formation by BM-MSC. Controlling the inflammatory environment could enhance the success of therapeutic approaches for the treatment of fractures by resident MSC and as well as improve the engineering of implantable tissues.
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Affiliation(s)
- Marcus Mumme
- Department of Surgery, University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland
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Jakob M, Saxer F, Scotti C, Schreiner S, Studer P, Scherberich A, Heberer M, Martin I. Perspective on the evolution of cell-based bone tissue engineering strategies. ACTA ACUST UNITED AC 2012; 49:1-7. [PMID: 22797549 DOI: 10.1159/000338362] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 03/13/2012] [Indexed: 11/19/2022]
Abstract
Despite the compelling clinical needs in enhancing bone regeneration and the potential offered by the field of tissue engineering, the adoption of cell-based bone graft substitutes in clinical practice is limited to date. In fact, no study has yet convincingly demonstrated reproducible clinical performance of tissue-engineered implants and at least equivalent cost-effectiveness compared to the current treatment standards. Here, we propose and discuss how tissue engineering strategies could be evolved towards more efficient solutions, depicting three different experimental paradigms: (i) bioreactor-based production; (ii) intraoperative manufacturing, and (iii) developmental engineering. The described approaches reflect the need to streamline graft manufacturing processes while maintaining the potency of osteoprogenitors and recapitulating the sequence of biological steps occurring during bone development, including vascularization. The need to combine the assessment of efficacy of the different strategies with the understanding of their mechanisms of action in the target regenerative processes is highlighted. This will be crucial to identify the necessary and sufficient set of signals that need to be delivered at the injury or defect site and should thus form the basis to define release criteria for reproducibly effective engineered bone graft substitutes.
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Affiliation(s)
- M Jakob
- Department of Surgery, University Hospital Basel, Basel, Switzerland
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