Unfallkrankenhaus Berlin

Spinal cord injury (SCI) incidence is rising among the elderly, yet the relationship between age and recovery remains controversial. The aim of this study was to evaluate the relationship between age and neurologic and functional outcomes and to identify an age cutoff associated with a decline in recovery. We conducted a prospective cohort study using data from patients with traumatic and ischemic SCI enrolled in the European Multicenter Study about Spinal Cord Injury between 2001 and 2022. Linear regression models assessed the relationship between age and changes from baseline to 1 year after SCI in the total motor score (TMS) of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and in the Spinal Cord Independence Measure (SCIM) total score. Additional analyses examined the relationship between age and the evolution of ISNCSCI light-touch and pinprick scores, as well as ambulation parameters (6-minute walking test, 10-meter walking test, and Walking Index for Spinal Cord Injury). Models were adjusted for baseline scores, sex, year of injury, American Spinal Injury Association Impairment Scale (AIS) grade, and level of injury. The age cutoff was determined using a change-point model. A total of 2,171 patients (median age 47 years, 77.9% male, 51.9% injured at the cervical level, and 50.0% with a motor complete injury [AIS-A and AIS-B]) were included in the analysis. Increased age was not associated with changes in TMS (p = 0.896) but was significantly associated with reduced SCIM improvement (p < 0.001), with an estimated decline of 4.3 SCIM points per decade of age. Sensory outcomes were not significantly affected by age (Δlight-touch: p = 0.273; Δpinprick: p = 0.520) while ambulation recovery declined with increasing age (all outcomes p < 0.01). A noticeable reduction in functional recovery was observed in patients older than 70 years. Older age does not seem to affect neurologic recovery but is linked to poorer functional and ambulation outcomes. These findings, including the identified age cutoff, should inform future clinical trial design and guide tailored care strategies for older adults with SCI. ClinicalTrials.gov Identifier NCT01571531.

Pre-exposure prophylaxis (PrEP) has shifted the paradigm of condom use and perceived risks for HIV and sexually transmitted infections (STIs) among men who have sex with men (MSM). We identified factors associated with inconsistent condom use and reasons for non-use among German MSM, with and without HIV, from two clinics in Germany between 2018 and 2024. Participants completed a questionnaire by computer-assisted self-interview every 6 months for up to 24 months. Multivariable robust Poisson regression models were fitted to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for the associations between factors of interest and inconsistent condom use and reasons for non-use. Inconsistent condom use was reported by 81% and 66% of 122 MSM during insertive and receptive anal sex, respectively. Inconsistent condom use was associated with (aPR [95% CI]) age >30 years (insertive: 31-40, 1.34 [1.13, 1.59]; ≥41, 1.27 [1.02, 1.58]), living without HIV (insertive: 1.28 [1.11, 1.47]; receptive: 1.32 [1.17, 1.49]), sex under the influence of drugs (insertive: 1.20 [1.04, 1.38]; receptive: 1.16 [1.03, 1.31]), and not worrying about STIs (insertive: 1.20 [1.06, 1.36]). Living with HIV, preference for condomless sex, and partner's HIV suppression were the most frequent reasons for non-use among participants with HIV. Using PrEP, preference for condomless sex, and partner's HIV status were the most frequent reasons for non-use among participants without HIV. Novel interventions tailored to specific high-risk subgroups, adjusted to address reasons for non-use, and adapted to mitigate risk compensation among MSM using PrEP are needed.

Nonunions and fracture-related infections represent a significant complication in orthopedic and trauma care, with their incidence rising due to an aging, more comorbid global population and the escalating threat of multi-resistant pathogens. This narrative review highlights pivotal advancements in diagnostics and therapeutic approaches, while also providing an outlook on future directions. Diagnostic methodologies have significantly evolved from traditional cultures to sophisticated molecular techniques like metagenomic next-generation sequencing and advanced imaging. Simultaneously, therapeutic strategies have undergone substantial refinement, encompassing orthoplastic management for infected open fractures and the innovative application of antibiotic-loaded bone substitutes for local drug delivery. The effective integration of these possibilities into daily patient care critically depends on specialized centers. These institutions play an indispensable role in managing complex cases and fostering innovation. Despite considerable progress over the past 25 years, ongoing research, interdisciplinary collaboration, and a steadfast commitment to evidence-based practice remain crucial to transforming management for the future.

Abstract Background Head and neck cancers (HNCs) are the seventh most common cancers worldwide, with KRAS mutations playing a key role for developing and progression of cancer. The G12V mutation is one of the most commonly identified KRAS mutation and has been associated with tumor progression and aggressive disease. Additionally, T &gt; G alteration in the binding site of miRNA let-7 of the KRAS -3'UTR (rs61764370), let-7 complementary site 6 (LCS6), has been found to promote cancer development, metastasis, and treatment resistance. Material and Methods HEp2 laryngeal cancer cells, transfected with plasmid constructs carrying the KRAS -G12V mutation and the combined G12V + LCS6 mutations were transplanted subcutaneously (SC) or intraperitoneally (IP) into CD-1 nude mice with non-transfected control cells. The mice were euthanized on the 40th day post-transplantation and examined histopathologically. Results Primary tumor development was observed in all cell-transplanted mice. The G12V mutation significantly promoted tumor growth (p &lt; 0.01), and LCS6 alteration further accelerated progression (p &lt; 0.001). No metastases occurred in SC-injected mice, but IP-injected mice with KRAS mutations developed metastases. G12V alone led to only liver metastases (50%), whereas G12V + LCS6 resulted in metastases in the liver (100%), lung (75%), kidney (25%), and paraaortic lymph nodes (75%). No brain metastases were observed in any group. Conclusion This study shows that while the KRAS -G12V mutation enhances HNSCC tumor growth and metastasis at relatively low rates, its combination with the LCS6 alteration significantly accelerates both. These findings suggest that miRNAs and miRNAs binding site mutations in KRAS -3’UTR contribute to cancer aggressiveness and could serve as potential therapeutic targets.

ABSTRACT Although multiplex imaging allows simultaneous mapping of complex tissue architectures and cellular phenotypes, the dearth of user-friendly robust image analysis workflows remains a significant limitation to its widespread use, restricting multiplex imaging to laboratories with image analysis expertise. Here, we introduce a no-code model-based customisable suite, CellMAPS, which allows both image processing and spatial analyses by non-specialists. We also developed new tools for tissue de-arraying, image normalisation and cell segmentation to increase usability and reduce analysis subjectivity. We have also introduce new spatial analysis tools for the partition of tissue architectures and cellular microenvironments. We demonstrate the capabilities of CellMAPS in various diseases captured using different multiplex imaging platforms. Overall, CellMAPS provides a platform for inexperienced laboratories to implement multiplex imaging and complex spatial analyses, which ultimately should lead to the broader adoption of these technologies in the biomedical field.

The Osteochondral Autologous Transfer System (OATS) is a surgical technique initially developed for knee procedures to address focal articular cartilage defects. Although widely applied in the knee, elbow, shoulder, and ankle, its application in hand surgery is limited but growing. This review aims to compile evidence-based insights into OATS for hand surgery, focusing on indications, technical nuances, outcomes, and donor-site morbidity. Additionally, a demonstrative case is presented showcasing the reconstruction of a capitate using OATS. The systematic review followed PRISMA 2020 guidelines and was registered on PROSPERO. Electronic databases (PubMed, Google Scholar, Cochrane Library) and ClinicalTrials.gov were searched for studies up to August 1, 2024, using the keywords: OATS, osteochondral autologous transplantation system, hand, and wrist. Eligible studies included clinical applications of OATS in hand surgery with follow-up data. Case reports, series, and cohort studies were appraised for quality and risk of bias. Additionally, a narrative review addressed practical questions for hand surgeons. A demonstrative case involving capitate resurfacing during proximal row carpectomy was also included. Thirteen studies met the inclusion criteria, encompassing case reports and small series involving up to 11 patients. Indications for OATS in hand surgery included reconstruction of the lunate fossa, carpal bones, metacarpal heads, and interphalangeal joints. Favorable outcomes were reported, with donor sites including the lateral femoral condyle, medial femoral trochlea, and hemihamate bone. Donor-site morbidity was rare but included exertional knee pain and radiological degenerative changes. The demonstrative case highlighted capitate resurfacing with satisfactory functional and radiological outcomes. OATS shows promise in addressing osteochondral defects in the hand, with favorable outcomes across various applications. Although evidence remains limited to small case series and reports, the technique demonstrates potential as a motion-preserving option. Future research should address donor-site morbidity in healthy knees and explore the feasibility of allograft use.

s of the plenary and special interest sessions, workshops, and oral and poster presentations of the 21st EBA Congress in Berlin, Germany, from 3 to 6 September 2025.

Tendon defect reconstruction is a challenging procedure that can be complicated by tendon retraction or tendon gap increase after debridement of interposed scar tissue. Although application of tendon autografts from dispensable tendons is considered the gold standard for bridging the gap, donor-site morbidity cannot be ignored. We use a local sliding tendon autograft which can avoid distant graft harvesting and it is adaptable across all tendon zones for reconstruction of tendon defects. A reverse l-type longitudinal incision of the same length with the measured final gap is made at the midsubstance of the proximal tendon stump and the created intercalary tendon segment is transferred distally to bridge the gap, providing an "elongated" proximal stump of the required length. The Elongation Rail Technique has been applied successfully in four patients with flexor tendon defects with favorable results and functional outcome at 6 months follow-up according to Strickland and Glogovac criteria.

Autologous skin substitutes represent a promising advancement in the treatment of burn injuries, offering personalized solutions for patients with extensive skin loss. This white paper synthesizes the current knowledge on laboratory-generated autologous skin substitutes in Europe, incorporating expert opinions and legal considerations. The white paper examines the scientific principles underlying autologous skin substitute development, including cell sourcing, bioengineering techniques, and clinical applications. The regulatory framework governing the production and use of these advanced therapies in Europe is also examined, highlighting challenges in standardization, safety, and approval pathways. The text features expert insights that offer a real-world perspective on the clinical viability and translational hurdles of autologous skin substitutes. The findings highlight the potential of autologous skin substitutes to improve burn treatment outcomes while emphasizing the need for harmonized regulations to facilitate clinical implementation. Despite technological advancements, significant challenges persist, including production costs, scalability, and long-term efficacy. Another focus of this white paper are the legal changes, which have significantly impacted the production and availability of these technologies. The review concludes that while autologous skin substitutes hold great promise, further research, regulatory refinement, and interdisciplinary collaboration are essential to optimize their integration into clinical practice.