The implantation of biomaterials into the human body has become an indispensable part of almost all fields of modern medicine. Accordingly, there is an increasing need for appropriate approaches, which can be used to evaluate the suitability of different biomaterials for distinct clinical indications. The dorsal skinfold chamber is a sophisticated experimental model, which has been proven to be extremely valuable for the systematic in vivo analysis of the dynamic interaction of small biomaterial implants with the surrounding host tissue in rats, hamsters and mice. By means of intravital fluorescence microscopy, this chronic model allows for repeated analyses of various cellular, molecular and microvascular mechanisms, which are involved in the early inflammatory and angiogenic host tissue response to biomaterials during the initial 2-3 weeks after implantation. Therefore, the dorsal skinfold chamber has been broadly used during the last two decades to assess the in vivo performance of prosthetic vascular grafts, metallic implants, surgical meshes, bone substitutes, scaffolds for tissue engineering, as well as for locally or systemically applied drug delivery systems. These studies have contributed to identify basic material properties determining the biocompatibility of the implants and vascular ingrowth into their surface or internal structures. Thus, the dorsal skinfold chamber model does not only provide deep insights into the complex interactions of biomaterials with the surrounding soft tissues of the host but also represents an important tool for the future development of novel biomaterials aiming at an optimisation of their biofunctionality in clinical practice.

/pdf/the-dorsal-skinfold-chamber-window-into-the-dynamic-3ia82y1xu0.pdf

The dorsal skinfold chamber: window into the dynamic interaction of biomaterials with their surrounding host tissue.

Introduction Early operative debridement of necrotising fasciitis is a major outcome determinant. Identification and diagnosis of such patients can be clinically difficult. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score first published in 2004 is based on routinely performed parameters and offers a method for identifying early cases. No literature review has yet been performed on the application of such a score. Methods A systematic review of English-language literature was performed from 2004 to 2014 to identify articles reporting use of LRINEC score and the incidence of necrotising fasciitis. We performed a critical review of PubMed, Medline and Embase in line with the PRISMA statement. A meta-analysis was performed with a random effects model and 95% confidence interval. Suitable correlation coefficient and receiver operating characteristic (ROC) curves were also calculated. Results After application of inclusion criteria, 16 studies with 846 patients were included. The mean LRINEC score in patients with necrotising fasciitis was 6.06. Two papers reported LRINEC score in patients without necrotising fasciitis with a mean 2.45. All six studies with a reported coefficient of variance were < 1; Pearson correlation coefficient was r = 0.637 (P = 0.011). An ROC curve showed an area under the curve of 0.927. Conclusions The LRINEC score is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotising fasciitis, with a statistically positive correlation between LRINEC score and a true diagnosis of necrotising fasciitis.

/pdf/laboratory-risk-indicator-for-necrotising-fasciitis-lrinec-lh6paq5py6.pdf

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature.

Purpose The purpose of this study was to evaluate the biomechanical and design characteristics of newer suture anchors under cyclic loading. Methods Suture anchors were tested in fresh porcine cortical and cancellous bone by cyclic loading (10 to 100 N for 200 cycles) followed by destructive testing parallel to the insertion axis at 12.5 mm per second. End points included ultimate failure load, displacement at 100 and 200 cycles, failure mode, and stiffness. Anchors tested included ReelX (Stryker Endoscopy, San Jose, CA); Footprint Ultra PK (4.5 and 5.5 mm) (Smith & Nephew, Andover, MA); TwinFix (4.5, 5.5, and 6.5 mm made from polyether ether ketone [PEEK], hydroxyapatite [HA], and titanium [Ti]) (Smith & Nephew Endoscopy, Andover, MA); Morphix (2.5 and 5.5 mm) (MedShape Solutions, Atlanta, GA); CrossFT BC (ConMed-Linvatec, Largo, FL); JuggerKnot (1.5 and 2.8 mm) (Biomet Sports Medicine, Warsaw, IN); Healicoil (Smith & Nephew Endoscopy, Andover, MA); Quattro (X, Link, and GL) (Cayenne Medical, Scottsdale, AZ); Healix (Biocryl Rapide [BR], PEEK, and Ti) (DePuy Mitek, Raynham, MA); Twin Loop (3.5 mm, PEEK) (Stryker Endoscopy, San Jose, CA); PressFT (2.1 and 2.6 mm) (ConMed Linvatec, Largo FL); Y-Knot (ConMed Linvatec, Largo FL); Gryphon (BR and PEEK) (DePuy Mitek, Raynham, MA); and Iconix (1, 2, and 3) (Stryker Endoscopy, San Jose, CA). Results Rotator cuff anchors showed greater failure loads than did glenoid anchors in metaphyseal bone (rotator cuff anchors 448 N v glenoid anchors 296 N) ( P  = .001) and cancellous bone (rotator cuff anchors 435 N v glenoid anchors 225 N) ( P P  = .014) and 200 cycles ( P  = .036) than did other rotator cuff anchors, although the ReelX and Morphix showed the greatest displacements. Rotator cuff anchors failed principally by eyelet breaking, whereas glenoid anchors failed more often by anchor pullout than by any other mode. No differences in stiffness were observed across the different rotator cuff and glenoid anchors tested. Conclusions Rotator cuff anchors showed higher failure strengths than did glenoid anchors, regardless of bone type. TwinFix anchors showed more cyclic displacement than did other rotator cuff anchors (except the ReelX and Morphix anchors) and the glenoid anchors tested. The failure mode was dependent on the specific anchor. Clinical Relevance Suture anchor constructs tested showed that failure load is dependent on anchor type (rotator cuff anchor or glenoid anchor) but not on anchor location (cancellous or cortical bone).

Cyclic loading biomechanical analysis of the pullout strengths of rotator cuff and glenoid anchors: 2013 update.

Cryopreservation and transplantation of ovarian tissue has proved to be a promising technique to safeguard fertility in cancer patients. However, with some types of cancer, there is a risk of transmitting malignant cells present in the cryopreserved tissue, so transplantation after disease remission is not advisable. To restore fertility in these patients, some research teams have been developing a transplantable artificial ovary, whose main goal is to mimic the natural organ. It should be composed of a matrix that encapsulates and protects follicles, as well as ovarian cells, which are necessary for follicle survival and development. This article reviews progress made in the creation of a transplantable artificial ovary and discusses future trends for its development.

The artificial ovary: current status and future perspectives

Background Necrotizing fasciitis, a relatively uncommon infection involving the skin, subcutaneous tissue, and fascia, is a rapidly progressive soft tissue infection and a medical and surgical urgency. Delayed debridement, with subsequent huge soft tissue loss is associated with loss of limb and infection and is the most common cause of mortality. The purpose of this work is to describe the epidemiology of necrotizing fasciitis and to identify the clinical characteristics that may be used to predict amputation in routine clinical practice. Methods Retrospective cohort study data were collected from three general hospitals located in the Chiang Rai, Kamphaeng Phet, and Phayao provinces in northern Thailand. Epidemiologic data for all patients with a surgically confirmed diagnosis of necrotizing fasciitis between 2009 and 2012 were collected. Medical records and reviews were retrieved from inpatient records, laboratory reports, and registers. Clinical predictors for amputation were analyzed by multivariable risk regression. Results A total of 1,507 patients with a diagnosis of necrotizing fasciitis were classified as being with amputation (n=127, 8.4%) and without amputation (n=1,380, 91.6%). The most common causative Gram-positive and Gram-negative pathogens were Streptococcus pyogenes (33.3% in the amputation group and 40.8% in the non-amputation group) and Escherichia coli (25% in the amputation group and 17.1% in the non-amputation group). Predictive factors for amputation included gangrene (risk ratio [RR] 4.77, 95% confidence interval [CI] 2.70-8.44), diabetes mellitus (RR 3.08, 95% CI 1.98-4.78), skin necrosis (RR 2.83, 95% CI 2.52-3.18), soft tissue swelling (RR 1.76, 95% CI 1.24-2.49), and serum creatinine values ≥1.6 mg/dL on admission (RR 1.71, 95% CI 1.38-2.12). All data were analyzed using the multivariable risk regression generalized linear model. Conclusion The most causative pathogens were S. pyogenes and E. coli. Clinical predictors for amputation in patients with necrotizing fasciitis included having diabetes mellitus, soft tissue swelling, skin necrosis, gangrene, and serum creatinine values ≥1.6 mg/dL on admission. Thus, patients with any of these predictors should be monitored closely for progression and receive early aggressive treatment to avoid limb loss.

/pdf/necrotizing-fasciitis-epidemiology-and-clinical-predictors-2tcz9s5dtr.pdf

Necrotizing fasciitis: epidemiology and clinical predictors for amputation.

IL-17 is a cytokine produced by a newly identified T-cell subpopulation (THl7/THIL-17). It is a central mediator in inflammatory processes that connects T-cell stimulation with neutrophil mobilization. The role of IL-17 in the immune dysfunction after polytrauma is still not clarified. In a retrospective study, the systemic concentration of IL-17 and IL-6 of 71 polytraumatized patients were analyzed daily by enzyme-linked immunosorbent assay. The patients' collective consist of 55 men and 16 women (43 +/- 16 years; injury severity score, 33 +/- 13). In only 6% of the patients, an increase in systemic IL-17 was detected. In most patients (94%), no systemic IL-17 was detectable or the IL-17 concentrations in plasma were in the range of the healthy donor group. To identify a possible role of systemic IL-17 in the posttraumatic phase, the patients were divided into two groups. Group A (47 men, 15 women) consists of patients with IL-17 concentrations in the range of normal healthy donors. Group B (8 men, 1 woman) consists of patients with elevated (>45 pg ml(-1) on at least 3 consecutive days) systemic IL-17 concentrations. Three patients in group B showed highly increased systemic IL-17 concentrations (median, >200 pg mL(-1)). These patients were male and showed all blunt chest and abdominal trauma with lung contusion and pneumohemothorax. However, there was no conformity in other injury patterns, injury severity score, age, outcome, intensive care period, or clinical complications. After a period of 4 years, we were able to obtain a new blood sample from one patient with high IL-17 level. The systemic IL-17 value of this former patient was now less than the detection limit. However, stimulation of peripheral blood mononuclear cells from thlise patient revealed elevated numbers of cells with the capacity to produce IL-17 as determined by enzyme-linked immuno spot assay and flow cytometry compared with peripheral blood mononuclear cells obtained from current polytrauma patients and healthy donors. In conclusion, IL-17 is not suitable as a pathophysiological or predictive marker after polytrauma. Whether highly increased systemic IL-17 concentrations detected in single patients are due to individually increased numbers of TH17 cells as we have demonstrated with one rerecruited patient has to be further analyzed.

Systemic IL-17 after severe injuries.

Purpose
Mesenchymal stem cells (multipotent human mesenchymal stromal cells, MSC) are currently the most promising cell type for regenerative medicine. For a clinical approach, it is necessary to develop and establish methods for expansion, differentiation, and delivery.

Osteogenic differentiation of human mesenchymal stromal cells is promoted by a leukocytes containing fibrin matrix.

The combination of transiliac screws and lumbopelvic distraction osteosynthesis is usually an appropriate procedure to treat vertical pelvic ring instabilities under the condition of full weight bearing. In this case, due to the extent of septic destruction of the dorsal portion of the iliac bone, the common triangular fixation method using conventional pedicle screws was not possible. Using the transiliac dorsoventral screw position with special long screws, we achieved high mechanical triangular stability sufficient for pelvic ring fusion despite the large bony defect.

Pelvic stabilization in cases of septic instability. Triangular osteosynthesis in case of infection related vertical pelvic ring instability

Ziel: Die haufigsten Komplikationen bei der Endoprothetik des Huftgelenks sind rezidivierende Luxation, periprothetische Frakturen, Infektionen oder Nervenschaden. Nervenlasionen sind bei diesen elektiven Operationen besonders schwerwiegend, weil der Schaden fur den Betroffenen eine deutliche Einschrankung der Lebensqualitat bedeutet. In Abhangigkeit von der Ausgangssituation ergeben sich unterschiedliche Risiken, einen Nervenschaden bei der Implantation einer Huftprothese zu erleiden. Besonders bei geplanten Beinlangenanderungen bei der chronischen hohen Luxation ist das Risiko dafur hoher und wird besonders betrachtet. Methodik: In einer Medline-Recherche wurde die Literatur zum Thema Nervenschaden in der Huftendoprothetik durchsucht und ausgewertet. Aus 126 Arbeiten wurden 18 Arbeiten genutzt, um Aussagen zur Haufigkeit von Nervenlasionen bei gleichzeitiger Beinverlangerung in Bezug auf die Ausgangssituation zu treffen. Ergebnisse: Die Wahrscheinlichkeit, bei der Implantation einer Huftgelenksendoprothese einen motorischen Nervenschaden zu erleiden, hangt von der Ausgangssituation ab. Sie ist fur die primare OP bei der einfachen Koxarthrose am geringsten (0,5 %), deutlich hoher bei der Huftdysplasie (2,3 %, wenn nur geringfugig oder nicht verlangert wird) und am hochsten bei Prothesenwechseloperationen (3,5 %). Bei kontinuierlicher Beinverlangerung vor TEP-Implantation betragt das Risiko eines Nervenschadens in der Literatur 5,9 % und korreliert linear mit der prozentualen Verlangerung bezogen auf den operierten Knochen. Schlussfolgerung: Distraktionsbedingte Nervenschaden sind bei einzeitigen Beinverlangerungen im Rahmen der Endoprothetik von mehr als 3 cm nicht wahrscheinlich. Grosere Defekte konnen ebenfalls uberwunden werden, allerdings sollte dies mehrzeitig oder mit kontinuierlichen Verfahren unter klinischem Neuromonitoring erfolgen. Aim: Repeated luxations, periprosthetic fractures, infections, and nerve palsies are the most frequent complications of hip alloarthroplasty. Paresis acquired during elective implantation entails considerable restrictions in the quality of life. The risk of sustaining a nerve injury depends upon the initial clinical situation, cases of planned leg lengthening in patients with hip dysplasia and high luxations being particularly at risk. Method: A Medline search was conducted using the query “nerve palsies during hip prosthesis implantation”, yielding 126 publications, of which 18 were used to predict the risk of nerve palsies in cases with simultaneous leg lengthening during total hip arthroplasties according to different preconditions. Results: The risk for an acquired nerve lesion during hip alloarthroplasty in arthritis was 0.5 %. In cases of hip dysplasia (with no or moderate leg lengthening during the procedure), the risk was increased to 2.3 %. An even higher risk of 3.5 % was found in cases of revision surgery. According to the literature, the risk of nerve palsies in cases of continuous leg lengthening before THA is raised to 5.9 % with a linear correlation between the amount of leg lengthening and rate of nerve palsies. Conclusion: Neural lesions during single-stage leg lengthening of less than 3 cm in hip alloarthroplasty are uncommon. More extensive lengthening can be achieved with continuous procedures, which should be conducted under clinical monitoring of the peripheral nerves to avert possible nerve injury.

Das Risiko der Nervenläsion in der Hüftendoprothetik

Die Kombination aus iliosakraler Verschraubung und lumbopelviner Distraktionsosteosynthese ist ein geeignetes Verfahren zur belastungsstabilen Osteosynthese bei vertikaler Beckenringinstabilitat. Bei unserer Patientin war die triangulare Abstutzung mit herkommlichen Pedikelschrauben aufgrund ausgedehnter septischer Destruktion des Iliums nicht moglich. Mit der hier beschriebenen transiliakalen dorsoventralen Platzierung spezieller langer Schrauben konnte trotz des grosen iliakalen Defektes durch eine suffiziente 3-Punkt-Stabilisierung des Beckenringes eine sichere Fusion erreicht werden.

Beckenstabilisierung bei septischer Instabilität

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