Asklepios Kliniken Bad Abbach

Osteoarthritis (OA), the most common joint disease, is marked by cartilage degradation and chronic inflammation. While 45S5-bioactive glass (45S5-BG) is well-established in bone regeneration and has been suggested to exert immunomodulatory effects, its impact on OA chondrocytes remains largely unexplored. Therefore, this in vitro study investigated the effects of 45S5-BG microparticles (0.125 mg/mL) on chondrocytes derived from OA patients, evaluating its therapeutic potential in OA. Chondrocytes were cultured with or without 45S5-BG for 1 and 7 days. Gene expression of cartilage markers, cytokines, matrix metalloproteinases (MMPs), and toll-like receptors (TLRs) was analyzed by qPCR. Protein levels were assessed by ELISA. 45S5-BG stimulation significantly altered chondrocyte activity, inducing upregulation of IL-6, IL-1β, TNF-α, MMP-1/-3/-13, and TLR4. Expression of ACAN and COL2A1 was reduced, while COL10A1—a marker of chondrocyte hypertrophy—was significantly increased at day 1. These findings show a catabolic and pro-inflammatory shift in chondrocyte phenotype upon 45S5-BG exposure, showing no therapeutic benefit of 45S5-BG on OA chondrocytes. However, considering the pronounced effects on chondrocyte activity and the well-established bioactivity and biocompatibility of 45S5-BG, our findings suggest that modified BG formulations could be developed to enhance chondroprotective and anti-inflammatory properties, warranting further investigation in co-culture and in vivo models.

Cervical spinal cord injuries (CSCIs) present challenges with potential severe neurological complications. Despite advances in care, in-hospital mortality remains a concern. This study explores the impact of patient-related factors and therapeutic strategies on in-hospital mortality in individuals with CSCIs. Retrospective cross-sectional study. Admissions with CSCIs recruited between January 2019 and December 2023. Data from the German Diagnosis Related Groups (DRG) system were used to analyze main diagnoses, patient demographics, concomitant diagnoses (ICD-10), and procedures (OPS). Specific data were extracted from the database of the German Institute for the Hospital Remuneration System (InEK GmbH). Differences in comorbidities and injuries were analyzed using the Chi-square test. Odds ratios (OR) were calculated to analyze potential risk factors for in-hospital mortality. In the analysis of 3.847 hospital admission cases, an in-hospital mortality rate of 11.7% (n=451) was observed. The patient cohort demonstrated a male predominance at 72.9%. The overall incidence of CSCI in Germany is 9.2 per million annually, with a significant increase in incidence rate observed with age, particularly after 60 years. The majority of admissions were aged over 65 years and this age group (>65 years) was identified as a significant risk factor for increased in-hospital mortality (n=2.064; OR 1.83; p<.001). Vertebral fractures at the levels C4 (n=364; 9.5%), C5 (n=582; 15.1%), and C6 (n=598; 15.5%) were the most common spinal injuries, while concomitant fractures at atlas (C1), axis (C2) and C7 fractures were associated with an elevated significant risk for in-hospital mortality (OR 2.40, OR=2.67, OR=2.21; p<.001). The need for blood transfusion was associated with a high in-hospital mortality rate of 31.3%. Amongst others, hypothermia, acute kidney failure, pleural effusion, and atrial fibrillation were significantly associated with in-hospital mortality (all p<.001). Additionally, aspiration pneumonia and hospital-acquired pneumonia were linked to increased in-hospital mortality risk (OR 2.21, OR 1.52; p<.001). Concomitant injuries and comorbidities indicating frailty and medical complications increase in-hospital mortality risk. The study highlights the need for thorough health assessments in patients with CSCIs, encouraging personalized and optimized treatment strategies.

ObjectiveTo test the reliability of the Outcome Measures in Rheumatology Giant cell arteritis (GCA) Ultrasonography Score (OGUS) and other composite scores in a patient-based exercise involving experts and non-experts in vascular ultrasonography.MethodsSix GCA patients were scanned twice (two rounds separated ≥3 hours) by 12 experts and 12 non-experts. Non-experts received 90 min of theoretical and 240 min of practical training between rounds 1 and 2. Ultrasonography was conducted on temporal arteries (common superficial, frontal and parietal branches) and axillary arteries bilaterally to calculate the OGUS, the Southend score and the Halo count. Inter-reader and intra-reader reliability were assessed by intraclass correlation coefficient (ICC).ResultsMean age of GCA patients was 78±5.1 years, 2 (33.3%) were women, and all were in clinical remission. Expert inter-reader ICC of the OGUS was 0.60 in both rounds, 0.40 in round 1 and 0.51 in round 2 for the Southend score and 0.45 and 0.52, respectively, for the Halo count. Median ICCs for intra-reader reliability were 0.86, 0.73 and 0.65 for the OGUS, Southend score and Halo count, respectively.For non-experts, inter-reader ICCs in round 1 were 0.20 for the OGUS, 0.20 for a normalised Southend score (=score divided by available segments) and 0.35 for a normalised Halo count. After training, inter-reader reliability ICCs improved to 0.52, 0.29 and 0.54, respectively.ConclusionInter-reader reliability was fair to moderate, and intra-reader reliability was good for OGUS, Southend score and Halo count among experts. Inter-reader reliability of non-experts in vascular ultrasonography improved after the training.

Background:In giant cell arteritis (GCA), various ultrasound composite scores, including the provisional OMERACT GCA ultrasonography score (OGUS), the Southend Halo score and the Halo count, have recently been introduced as a monitoring tool for clinical trials [1,2]. Patient-based reliability of these ultrasonography (US) composite scores remain elusive so far.Objectives:To test the reliability of the OGUS and the other US scores in a patient-based reliability exercise involving experts and non-experts in vascular ultrasonography.Methods:Twelve experts and 12 non-experts were asked to evaluate 6 GCA patients. Each patient was scanned twice (2 rounds separated by ≥3 hours) by each participant.Experts had a half-day meeting ahead to align on US settings and procedures. Non-experts received a training module (90 minutes of theoretical and 240 minutes of practical instructions) after round 1. US examinations were conducted at bilateral common superficial temporal arteries, frontal and parietal branches as well as the axillary arteries. The Intima-media complex was measured at the thickest site of the deep wall of individual arteries, preferentially in longitudinal scan to calculate the OGUS, the Southend score and the Halo count. In case of missing values, a normalized score was calculated by considering the available segments. Inter- and intra-reader reliability were tested by Intraclass correlation coefficient (ICC).Results:Mean age of GCA patients was 78±5.1 years, 2 (33%) were female. All had established disease and were in clinical remission, median disease duration was 22.5 (IQR 16.3-28.3) months. Experts and non-experts had a median of 16.5 years (IQR 9.8-20.0) and 1.8 years (IQR 0-3.3) of experience with vascular US, respectively. According to experts, all patients had at least one pathological vessel, mean OGUS was 0.83 (±0.07), mean Southend score was 19.0 (±4.6) and mean Halo count was 2.8 (±1.4). As depicted in Table 1, expert inter-rater ICC of the OGUS was moderate in both rounds, fair for the Southend score and the Halo count in round 1 and moderate in round 2. Expert intra-rater reliability was good for all scores.For non-experts, inter-rater reliability was poor in round 1 for all scores as well as for individual measurements. In round 2, a moderate reliability was found for the OGUS, the normalized Halo count and individual IMT measurements, while reliability remained poor for the normalized Southend score (detailed in Table 1).Conclusion:We demonstrate fair to moderate inter-rater reliability and good intra-rater reliability of the OGUS, the Southend score and the Halo count among experts. A short training program for non-experts improved their inter-rater reliability.REFERENCES:[1] Dejaco C, Ponte C, Monti S, et al. The provisional OMERACT ultrasonography score for giant cell arteritis. Ann Rheum Dis 2023;82:556-64.[2] van der Geest KSM, Borg F, Kayani A, et al. Novel ultrasonographic halo score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia. Ann Rheum Dis 2020;79:393–9.Table 1.Inter-rater (experts and non-experts in vascular ultrasonography) as well as intra-rater reliability (experts) on ultrasonography scores in GCA.Inter-raterRound 1Inter-raterRound 2Intra-raterScorenICC95% CInICC95% CIMedian ICCIQRExperts in vascular ultrasonographyOGUS60.600.33-0.9060.600.33-0.910.860.65-0.92Southend Score60.400.17-0.8260.510.24-0.870.810.61-0.87Halo Count60.450.20-0.8460.520.25-0.870.650.40-0.84Individual IMT measurements480.790.72-0.86480.840.78-0.900.880.80-0.95Non-experts in vascular ultrasonographyOGUS60.200.05-0.6560.520.25-0.88Southend Score200-0.961n.d.Normalized Southend Score60.220.06-0.6660.350.13-0.78Halo Count200-0.981n.d.Normalized Halo Count60.350.14-0.7860.570.31-0.90Individual IMT measurements4500-0.34400.630.52-0.75CI, confidence interval; ICC, intra-class correlation coefficient; IMT, intima media thickness; IQR, interquartile range; n, number; n.d., not determined; OGUS, OMERACT ultrasonography score for GCA; normalized Southend Score and Halo count, calculated in case of missing values.Acknowledgements:We thank the Austrian team of Canon for providing the Ultrasound machines, used in the reliability exercise.Disclosure of Interests:None declared.

An expert committee recommends defining fast-track clinics (FTC) for the acute diagnostics of giant cell arteritis (GCA) as follows: low-threshold, easy and prompt reachability at least on weekdays, scheduling appointments ideally within 24 h, examination by aspecialist with GCA expertise, ≥ 2experts per FTC, ≥ 50patients with suspected GCA per year, sonologists with ≥ 300 (≥ 50) temporal and axillary artery examinations, adherence to standard operating procedures, availability of an ≥ 18 (≥ 15) MHz and alower frequency linear ultrasound probe and collaboration with partners for fast performance of neurological and ophthalmological examinations, magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT, possibly CT) and for temporal artery biopsy.

EinleitungSowohl Navigationssysteme als auch die Robotik ermöglichen eine höhere Präzision bei der Implantation eines künstlichen Kniegelenkes. Eine Verbesserung der klinischen Ergebnisse kann dadurch aber nicht erreicht werden. Wir stellten die Hypothese auf, dass es im Rahmen der Implantation einer Knietotalendoprothese zwar zur Rekonstruktion des Alignments in der Koronarebene kommt, durch die variable rotatorische Tibia- sowie variable translatorische Femur- und Tibiakomponentenpositionierung zu einer Veränderung der restlichen Alignmentparameter der unteren Extremität kommt. Diese Parameter könnten jedoch mittels Navigationssystem oder Roboter bestimmt werden und könnten zukünftige Implikationen für diese Systeme darstellen.MethodenIn 9 gesunden Kniegelenken von fixierten Ganzkörperleichen nach Thiel erfolgte die Bestimmung der Kinematik (Rollback bzw. tibiale Innenrotation sowie tibiale Ab‑/Adduktion) und der Stellung zwischen Femur bzw. Epikondylen und Tibia vor und nach Implantation einer Knietotalendoprothese zwischen 0 und 90° Beugung mithilfe eines Navigationssystems (Knee 2.6, Fa. Brainlab, München, Deutschland).ErgebnisseNach endoprothetischer Versorgung kam es zu keiner Veränderung des natürlichen koronaren Alignment. In Streckung und den frühen Beugegraden zeigte sich die Rotationsstellung des Femurs gegenüber der Tibia verändert. Dies führte auch zu einer veränderten Positionierung des Epicondylus medialis und lateralis in Relation zur Tibia: Während beide Epikondylen nach endoprothetischer Versorgung in Relation zur Tibia lateraler positioniert waren, war der Epicondylus lateralis bis 20° Beugung signifikant dorsaler gelegen.DiskussionNach endoprothetischer Versorgung eines Kniegelenkes in etablierter Technik kam es zu einer guten Rekonstruktion des koronaren Alignments bei gleichzeitiger Veränderung des Alignments sowohl in rotatorischer als auch translatorischer Richtung zwischen Femur und Tibia. Mittels Navigation aber auch Robotik wären wir in der Lage, sämtliche Alignmentparameter zu quantifizieren und könnten eine Ausrichtung der Komponenten bzw. eine Rekonstruktion des Gesamtalignments in allen sechs Freiheitsgraden erzielen. Womöglich wären wir dadurch in der Lage, auch einen klinischen Vorteil zu erzielen bzw. es könnten die Standzeiten noch weiter erhöht werden.Graphic abstract

Minimally invasive injection treatment is indicated particularly in cases of treatment-resistant, painful degenerative alterations of the cervical and lumbar spine, intervertebral disc displacement and radicular syndrome. Through the injections and the supplementation with further conservative, e.g., physical therapy and activating measures, the vicious circle of neural irritation and muscle tension and sympathetic nerve reactions can be interrupted.

IntroductionEnhanced recovery after surgery (ERAS) leads to less morbidity, faster recovery, and, therefore, shorter hospital stays. The expected increment of primary total hip arthroplasty (THA) in the U.S. highlights the need for sufficient pain management. The favorable use of short-lasting spinal anesthesia enables early mobilization but may lead to increased opioid consumption the first 24 h (h) postoperatively.MethodsIn a retrospective study design, we compared conventional THA with postoperative immobilization for two days (non-ERAS) and enhanced recovery THA with early mobilization (ERAS group). Data assessment took place as part of the “Quality Improvement in Postoperative Pain Treatment project” (QUIPS). Initially, 2161 patients were enrolled, resulting in 630 after performing a matched pair analysis for sex, age, ASA score (American-Society-of-Anesthesiology) and preoperative pain score. Patient-reported pain scores, objectified by a numerical rating scale (NRS), opioid consumption and side effects were evaluated 24 h postoperatively.ResultsThe ERAS group revealed higher activity-related pain (p = 0.002), accompanied by significantly higher opioid consumption (p < 0.001). Maximum and minimum pain as well as side effects did not show significant differences (p > 0.05).ConclusionThis study is the first to analyze pain scores, opioid consumption, and side effects in a matched pair analyses at this early stage and supports the implementation of an ERAS concept for THA. Taking into consideration the early postoperative mobilization, we were not able to detect a difference regarding postoperative pain. Although opioid consumption appeared to be higher in ERAS group, occurrence of side effects ranged among comparable percentages.