BG Klinik Tübingen

Conventional 2D mono-cultures fall short in replicating the complex microenvironment of glomerular tissue, where cell-cell and cell-matrix interactions are critical. To better mimic in vivo conditions, the development of robust 3D co-culture systems is essential. Here, we systematically evaluate five hydrogel matrices-Matrigel, alginate dialdehyde-gelatin (ADA-GEL), fibrin, recombinantly produced spider silk protein eADF4(C16)-RGD, and allyl-modified gelatin (GelAGE)-for their suitability in supporting glomerular 3D co-culture. The hydrogels are assessed for handling properties, cell viability, and the support of physiological cell behavior using bright-field microscopy, live/dead assays, immunofluorescence, and multiphoton imaging. Among the tested hydrogels, GelAGE and eADF4(C16)-RGD demonstrate superior biocompatibility and structural support. Due to its ease of use and comparable biological performance, GelAGE and spider silk protein eADF(C16)-RGD are selected for further mechanical characterization, revealing favorable viscoelastic properties. These findings position both hydrogels as a promising candidate for engineering physiologically relevant 3D glomerular models and advancing kidney tissue research.

Wood ash from small-scale (<1 MW) wood-fired heating plants represents a valuable secondary resource containing essential plant nutrients such as Ca, K, and P, but may also harbor potentially hazardous elements. Its current utilization and disposal are typically based solely on total elemental composition, disregarding element mobility and environmental behavior. This study introduces element mobility as an additional criterion for assessing ash quality and suitability for recycling. Sequential extraction using a modified BCR (Community Bureau of Reference) protocol with four solvents (water, acetic acid, hydroxylamine hydrochloride, and ammonium acetate) was applied to evaluate the leachability of 26 elements. Results indicate high extractabilities for several potentially hazardous elements—Sr (54 %), B (48 %), V (44 %), Cd (38 %), and Tl (27 %)—suggesting potential environmental risks despite low total concentrations. In contrast, key plant nutrients, especially P (15 %) were less mobile but could be mobilized under oxidizing conditions. While dissolution of K (74 %) and Ca (12 %) in water and weak organic acid indicates partial plant-availability already in the untreated ash, 26 % resp. 88 % remained in the residual fraction, indicating only long-term plant availability through weathering. The findings demonstrate that both total concentrations and leaching behavior must be considered in environmental assessments. For fertilizer production, pretreatment to remove Tl and enhance P solubility is recommended. From a waste management perspective, controlled ash processing can promote nutrient recovery and support circular economy objectives. These insights contribute to optimizing wood ash management strategies and minimizing environmental risks associated with its reuse. • Element mobility as a new criterion for assessment of wood ash as fertilizer. • Sequential extraction reveals wide variation of element leachability from ash. • P becomes extractable via oxidation with hydrogen peroxide and ammonium acetate. • Only Tl exceeds limits among toxic elements but can be selectively removed.

Evidence on the outcome of aseptic exchange of rotating-hinge prosthesis is missing in the literature. This study aimed to evaluate implant survival, complication rates, and clinical outcomes following revision of a rotating-hinge prosthesis to another rotating-hinge prosthesis with anatomical axis. Between March 2014 and Juli 2023 62 cases of aseptic exchange of a rotating-hinge prosthesis were performed at a tertiary medical center in Germany. In this retrospective study, all patients were contacted for clinical follow-up and prosthesis survival. Implant survival was analyzed using the Kaplan-Meier method, and clinical outcomes were assessed using the Knee Society Score. The 5-year implant survival rate was 83.4% (73.2-93.6, 95%-CI) for revision due to any reason, 85.1% (75.3-94.9, 95%-CI) for aseptic failure and 98.0% (94.1-100.0, 95%-CI: ) for septic failure. The estimated 10-year survival rates were 73.2% (59.2-87.1%; 95%-CI), 78.0% (65.1-90.9%; 95%-CI), and 93.9% (85.3-100.0%; 95%-CI), respectively. Improvements were observed in all KSS subdomains except for the Patient Expectation Score. The exchange of a rotating-hinge prosthesis, using metaphyseal cones when indicated for bone defects, yields implant survival and complication rates comparable to those of primary rotating-hinge prosthesis implantation. However, clinical outcome scores tend to be lower than those reported for first-time implantation of rotating-hinge prostheses.

BackgroundThe hazardous triad of osteopenia, sarcopenia and obesity was recently defined as osteosarcopenic obesity (OSO). The causes for OSO appear to be multifactorial, including age and gender, as well as chronic diseases. The impact of physical inactivity has not been studied so far.PurposeThe purpose of this study was to assess the association of short-term and long-term physical inactivity over a time period of 14 years on osteosarcopenic obesity in a population-based cohort from southern Germany.MethodsSupine whole body MRI (3 T scanner, Magnetom Skyra, Siemens Healthcare) was performed in 400 subjects from the population-based observational cohort study “Kooperative Gesundheitsforschung in der Region Augsburg (KORA)” to determine bone marrow fat fraction (BMFF), skeletal muscle fat fraction (SMFF) and total adipose tissue (TAT). Based on this, phenotyping was conducted into the groups of the OSO complex. Physical inactivity was obtained via a questionnaire at three timepoints: exam 1 (1999 to 2001), exam 2 (2006 to 2008) and exam 3 (2013 and 2014).ResultsIn total, 363 subjects (56.0 ± 9.1 years, 57.6% male) were included. The OSO phenotype was fully expressed in 81 (22,3%) participants. All pathological subgroups of the OSO complex, except isolated obesity were associated with less physical activity (< 1 h/week) at exam 3. Work activity correlated with the isolated osteopenic and sarcopenic phenotypes, as well as OSO, whereas neither walking, nor cycling activity correlated significantly with any phenotypic subgroup. Similarly, long-term physical inactivity was accompanied by isolated osteopenia, sarcopenia and osteosarcopenic obesity but not with isolated obesity. Lower back pain was present in 54.5% of all participants at exam 3. No correlation was shown with the OSO complex.ConclusionPhysical inactivity was strongly correlated with an isolated osteopenic, sarcopenic and OSO phenotype, but not with an isolated obese phenotype by MRI. Although slightly over fifty percent of participants reported back pain on exam 3, the manifestation of the OSO complex had no effect on this.

BackgroundPeripheral nerve injuries may accompany traumatic extremity injuries and are associated with significant morbidity. Diagnostic options are limited in young children since compliance might be restricted. High-resolution ultrasound (HRUS) is a promising technique to close the diagnostic gap, but clear recommendations are lacking. This study evaluates clinical outcomes after conservative versus surgical management, considering HRUS findings in pediatric patients with upper extremity peripheral nerve injuries.MethodsWe retrospectively analyzed our pediatric neurosurgery database from August 2008 to December 2022 including patients < 18 years with traumatic upper extremity nerve injury and excluding obstetrical brachial plexus injury. Systematic HRUS examinations were implemented from 2016 onwards. Clinical, intraoperative, sonographic and electrophysiological findings were assessed.ResultsA total of 73 nerve injuries in 67 patients (median age = 7.0 years) were analyzed. The most frequently affected nerves were the ulnar (49.3%), radial (21.9%), and median nerve (19.2%). At initial presentation, 47.9% underwent electrophysiology and 67.1% received HRUS. Surgery was performed in 49.3% at a median of 4 months posttrauma, whereas 50.7% were managed conservatively. Patients undergoing surgery initially had more severe sensory and motor deficits (χ2 = 3.98,p = 0.046), but final outcomes showed no significant difference in nerve function (median follow-up = 6.0 months). Binary logistic regression identified age (odds ratio [OR] = 1.3,p = 0.028), HRUS (OR = 10.6,p = 0.035), and injured nerve (OR = 3.1,p = 0.022) as independent outcome predictors.InterpretationGood functional recovery in pediatric patients with peripheral nerve injury was demonstrated. HRUS-guided treatment and age < 9 years were independent predictors of favorable outcome. These findings support HRUS as a valuable, noninvasive tool for guiding pediatric nerve injury management.

The growing incidence of paediatric both bone fractures and the increased tendency for operative treatment using the titanium elastic nailing (TEN) technique has been established in the literature. We aim to evaluate the importance of titanium elastic nail pre-contouring on radiographic and clinical outcome in AO PCCF 22-D/4 and D/5 fractures.Cohort I- twelve cadaveric forearms (six pairs) were divided into 3 groups of six specimens: Group 1 – Two straight nails; Group 2 – 1 curved and 1 straight nail; Group 3 – Two curved nails. The same forearm specimen was used for group 1 and group 2 by exchange of the radial nail only. In Cohort II, 80 patients who underwent elastic nailing were followed up for a mean period of 17.9 months. Maximal radial bow (MRB), location of MRB and MRB as percentage of radial length were measured on the AP x-rays. Outcome for Cohort II was evaluated using QuickDASH and range of motion (ROM) testing at the time of implant removal.When compared between each other, instrumented groups in Cohort I showed statistically significant difference in MRB (P= .000), %MRB (P= .000) and LMRB (P= .000). Compared to the intact forearms: Group 1 showed decrease in MRB of 3.7mm (P= .003), decrease in %MRB of 1.85%, increase in LMRB of 2.64% (P=. 459); Group 2 showed increase in MRB of 1.9mm, increase in %MRB of .93%, decrease in LMRB of 1.8%; Group 3 showed increase in MRB of .73mm (P= .073), increase in %MRB of .36%, decrease in LMRB of 2.01% (P= .27). In Cohort II patients with loss of prono-supination (n=8) had a mean value of LMRB of 72.45, compared to 63.5 for those without loss in range of motion (n=72), which was statistically significant (P= .003). Mean QuickDASH score and loss of forearm rotation in the ROM impaired group were 6.75 and 11° respectively.Cadaveric experimentation shows that the use of two titanium elastic nails of identical size and bend assures the best possible reduction. Fixation via 1 curved and 1 straight implant leads to slight overcorrection of the radial bow whereas utilization of 2 straight TENs leads to the worst radiographic results. Clinical evidence correlates with cadaveric results, as all patients with loss in range of motion in our series had an increase in LMRB values, which may suggest suboptimal implant contouring.

Functional lack of knee extension is an important limitation for patients. Whereas in younger patients the limitation of activity usually dominates, in older patients there is also the risk of secondary injuries due to an increased risk of falls due to instability and unsteady gait. Depending on the cause, an improvement in quality of life can be achieved for most patients through various methods of knee extension reconstruction. There are no general restrictions for reconstruction due to comorbidities or age. The present study offers a comprehensive overview of the potential options for reconstruction, as well as a decision-making aid for operative indication, that considers the underlying lesion and patient-specific characteristics. Local reconstructions, functional tendon- and nerve-transfers and free functional muscle transfers are presented. Further information on the postoperative procedure is given, as well as an overview of the expected result. The therapeutic aim should not end with controlling a tumour disease or treating the initial trauma, rather therapy planning should also include functional reconstruction as part of an interdisciplinary therapeutic approach to improve quality of life and participation as well as preventing secondary consequences of disease or trauma.

In this article, we report a case of severe median nerve compression in the forearm caused by a large hematoma resulting from an iatrogenic pseudoaneurysm of the radial artery. Two weeks before presenting to our emergency room with neuropathic pain and persistent numbness of the palm, thumb, index, and middle fingers, as well as thumb motor deficits, the patient had undergone wrist denervation at an external outpatient clinic. Duplex ultrasound indicated a large pseudoaneurysm of the radial artery, which was confirmed by computed tomography angiography. The patient underwent emergency surgery, including evacuation of the hematoma compressing the median nerve beneath the forearm fascia, repair of the injured radial artery, and decompression of the median nerve. The procedure also included a carpal tunnel release. The patient experienced symptom improvement immediately after surgery. By the third postoperative day, when discharged, sensation in the median nerve distribution was equal bilaterally as assessed by the TEN-test, and he was able to abduct his thumb using the abductor pollicis brevis muscle. This article highlighted a relatively rare complication following wrist denervation surgery. Because this procedure involves exposure of the radial artery, there is an increased risk for iatrogenic pseudoaneurysm. This case also illustrated the diagnostic steps and microsurgical expertise required to manage such complications and to prevent severe damage to the median nerve through early decompression.

In patients undergoing total knee arthroplasty (TKA) obstructive sleep apnea (OSA) is common. Our retrospective study aimed to investigate whether perioperative outcome differ between patients with low-moderate OSA risk and patients with high OSA risk and whether the perioperative outcomes of patients with and without CPAP (continuous positive airway pressure) device differ. After excluding patients (missing STOP-Bang-Score, concomitant lung disease) 1444 TKA operated between 2016 and 2020 were included. The STOP-Bang Score was used to determine the risk for OSA (low-moderate risk: Score 0-4, high risk: Score 5-8). SpO2 drops < 90% and readmission rates were compared for low-moderate risk patients and high risk patients as well as for patients with and without CPAP. There was no difference in SpO2-drops < 90% (1% vs. 1% P = 0.612) and readmission rate (4% vs. 3%, P = 0.537) between low-moderate risk (409 TKA) and high risk patients (1035 TKA). A significant reduction in O2 Flow-Rate (P < 0.001) and no difference in SpO2 (P > 0.999) was observed from post anesthesia care unit to the morning of postoperative day one for both groups. 47% (677/1444) utilized a CPAP machine. There was no difference in the incidence of SpO2 drops < 90% (1% vs. 1%, P = 0.605) and readmission rate (3% vs. 5%, P = 0.055) between both groups. In the absence of underlying pulmonary disease perioperative outcomes did not differ between TKA patients with a low- moderate OSA risk and patients with a high OSA risk according to the STOP Bang Score regardless of the use of a CPAP machine. Outpatient TKA might be an option for optimized OSA patients (without underlying pulmonary disease) regardless of STOP Bang Score and use of a CPAP machine.