Ingo Marzi

Hospital Frankfurt Hoechst, Frankfurt, Hesse, Germany

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Publications (466)775.77 Total impact

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    ABSTRACT: A 79year old female patient was admitted to our emergency department with a fracture of the right medial femoral neck six days after a fall on her right side and a cemented hemiprosthesis was implanted. Five days later, she developed a hemorrhagic shock and was diagnosed with a delayed splenic rupture and the spleen was resected. Histopathological examination showed a delayed rupture of an otherwise normal spleen without signs of an underlying pathology. The outcome was fatal: In the postoperative course she developed pneumonia, three weeks later she succumbed due to multiple organ failure.
    No preview · Article · Feb 2016
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    B. Relja · J. Menke · N. Wagner · B. Auner · M. Voth · C. Nau · I. Marzi
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    ABSTRACT: The influence of alcohol on the outcome after major trauma remains controversial. In several recent studies, alcohol has been associated with neuroprotective effects in head injuries, while others reported negative or no effects on survival and/or the in-hospital stay in major trauma patients (TP). The purpose of this study was to examine the relationship of alcohol with injury characteristics and outcome as well as to analyze possible anti-inflammatory properties in major TP.
    Preview · Article · Jan 2016 · Injury
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    ABSTRACT: Purpose: Severe life-threatening injuries in Western Europe are mostly caused by blunt trauma. However, penetrating trauma might be more common in urban regions, but their characteristics have not been fully elucidated. Methods: Retrospective analysis of data from patients admitted to our urban university level I trauma center between 2008 and 2013 with suspicion of severe multiple injuries. Collection of data was performed prospectively using a PC-supported online documentation program including epidemiological, clinical and outcome parameters. Results: Out of 2095 trauma room patients admitted over the 6-year time period 194 (9.3 %) suffered from penetrating trauma. The mean Injury Severity Score (ISS) was 12.3 ± 14.1 points. In 62.4 % (n = 121) the penetrating injuries were caused by interpersonal violence or attempted suicide, 98 of these by stabbing and 23 by firearms. We observed a widespread injury pattern where mainly head, thorax and abdomen were afflicted. Subgroup analysis for self-inflicted injuries showed higher ISS (19.8 ± 21.8 points) than for blunt trauma (15.5 ± 14.6 points). In 82.5 % of all penetrating trauma a surgical treatment was performed, 43.8 % of the patients received intensive care unit treatment with mean duration of 7.4 ± 9.3 days. Immediate emergency surgical treatment had to be performed in 8.0 vs. 2.3 % in blunt trauma (p < 0.001). Infectious complications of the penetrating wounds were observed in 7.8 %. Conclusions: Specific characteristics of penetrating trauma in urban regions can be identified. Compared to nationwide data, penetrating trauma was more frequent in our collective (9.3 vs. 5.0 %), which may be due to higher crime rates in urban areas. Especially, self-inflicted penetrating trauma often results in most severe injuries.
    No preview · Article · Jan 2016 · European Journal of Trauma and Emergency Surgery
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    ABSTRACT: Limb loss is a devastating disability and while current treatments provide aesthetic and functional restoration, they are associated with complications and risks. The optimal solution would be to harness the body's regenerative capabilities to regrow new limbs. Several methods have been tried to regrow limbs in mammals, but none have succeeded. One such attempt, in the early 1970s, used electrical stimulation and demonstrated partial limb regeneration. Several researchers reproduced these findings, applying low voltage DC electrical stimulation to the stumps of amputated rat forelimbs reporting "blastema, and new bone, bone marrow, cartilage, nerve, skin, muscle and epiphyseal plate formation". In spite of these encouraging results this research was discontinued. Recently there has been renewed interest in studying electrical stimulation, primarily at a cellular and subcellular level, and studies have demonstrated changes in stem cell behavior with increased proliferation, differentiation, matrix formation and migration, all important in tissue regeneration. We applied electrical stimulation, in vivo, to the stumps of amputated rat limbs and observed significant new bone, cartilage and vessel formation and prevention of neuroma formation. These findings demonstrate that electricity stimulates tissue regeneration and form the basis for further research leading to possible new treatments for regenerating limbs.
    Full-text · Article · Dec 2015 · Scientific Reports
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    ABSTRACT: Increases in pro-inflammatory cytokine levels and tissue-infiltrating leukocytes have been closely linked to increased systemic and local inflammation, which result in organ injury. Previously, we demonstrated the beneficial and hepatoprotective anti-inflammatory effects of acute ethanol (EtOH) ingestion in an in vivo model of acute inflammation. Due to its undesirable side-effects, however, EtOH does not represent a therapeutic option for treatment of acute inflammation. Therefore, in this study, we compared the effects of acute EtOH exposure with ethyl pyruvate (EtP) as an alternative anti-inflammatory drug in an in vitro model of hepatic and pulmonary inflammation. Human hepatocellular carcinoma cells Huh7 and alveolar epithelial cells A549 were stimulated with either interleukin (IL) IL-1β (1 ng/ml, 24 h) or tumor necrosis factor (TNF) (10 ng/ml, 4 h), and then treated with EtP (2.5-10 mM), sodium pyruvate (NaP, 10 mM) or EtOH (85-170 mM) for 1 h. IL-6 or IL-8 release from Huh7 or A549 cells, respectively, was measured by an enzyme‑linked immunosorbent assay. Neutrophil adhesion to cell monolayers and CD54 expression were also analyzed. Bcl-2 and Bax gene expression was determined by RT-qPCR, and western blot analysis was performed to determine the mechanisms involved. Treating A549 cells with either EtOH or EtP significantly reduced the IL-1β- or TNF‑induced IL-8 release, whereas treating Huh7 cells did not significantly alter IL-6 release. Similarly, neutrophil adhesion to stimulated A549 cells was significantly reduced by EtOH or EtP, whereas for Huh7 cells the tendency for reduced neutrophil adhesion rates by EtOH or EtP was not significant. CD54 expression was noticeably reduced in A549 cells, but this was not the case in Huh7 cells after treatment. The Bax/Bcl-2 ratio was dose‑dependently decreased by EtOH and by high-dose EtP in A549 cells, indicating a reduction in apoptosis, whereas this effect was not observed in Huh7 cells. The underlying mechanisms involve reduced phosphorylation of Akt and nuclear factor-κB (NF-κB) p65. We noted that as with EtP, EtOH reduced the inflammatory response in lung epithelial cells under acute inflammatory conditions. However, due to the low impact which EtP and EtOH had on the hepatocellular cells, our data suggest that both substances exerted different effects depending on the cellular entity. The possible underlying mechanisms involved the downregulation of Akt and the transcription factor NF-κB, but further research on this subject is required.
    No preview · Article · Dec 2015 · International Journal of Molecular Medicine
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    ABSTRACT: Objective: This review aims to summarize current knowledge regarding the underlying patho-mechanisms of delayed fracture healing in polytraumatized patients. Data sourcesand study selection: The following search terms were used: 'fracture', 'hemorrhage', 'chest trauma', 'inflammation', 'inflammatory response', 'fracture healing', 'delayed healing', 'non-union', 'fracture stabilisation', 'intramedullary nailing', 'external fixation', 'Early Total Care' and 'Damage Control'. Medline, Embase and Cochrane Library were searched for studies published between 1.1.1990through 3.30.2014. Of 1,322 publications, 68 were included in the current summary. Conclusion: Concomitant injuries and the strategy for fracture stabilization seem to affect bone metabolism and fracture healing. Among the relevant patho-mechanisms, interactions between the local and systemic inflammatory response appear to play a role. However, the consequences of fracture fixation strategies in case of severe concomitant injuries on local inflammation and bone healing remain unknown. Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    No preview · Article · Nov 2015 · Journal of orthopaedic trauma
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    ABSTRACT: Prior to their release, interleukin (IL)-1β and IL-18 are cleaved to their bioactive forms by a multiprotein complex known as an inflammasome, which is comprised of a number of elements that are subject to nuclear factor‑κB‑dependent transcription. Catecholamines have been indicated to exert an enhancing effect on the IL‑1β release. The aim of the present study was to determine whether alterations in inflammasome gene expression may be responsible for the modified IL‑1β and IL‑18 secretion following lipopolysaccharide (LPS) and catecholamine co‑stimulation. Monocytes were isolated from the peripheral blood of 21 healthy volunteers using CD14+ microbeads. Following stimulation with LPS (2 μg/ml) and/or phenylephrine (PE; 10 μM) for 24 h, the supernatants were subjected to ELISA to evaluate the ex vivo protein expression levels of IL‑1β and IL‑18. In addition, the gene expression levels of inflammasome components associated with the cleavage of IL‑1β and IL‑18, including NLRP1, NLRP3, caspase‑1 and PYCARD were determined using polymerase chain reaction. The results indicated that LPS significantly increased IL‑1β expression compared with the unstimulated control samples. Co‑stimulation with LPS + PE significantly enhanced IL‑1β expression compared with LPS alone. Furthermore, IL‑18 expression was significantly reduced by LPS and LPS + PE co‑stimulation. The gene expression levels of IL‑18, NLRP1, caspase‑1 and PYCARD were comparable in the LPS‑ and LPS + PE‑stimulated cells. LPS significantly induced the expression levels of IL‑1β and NLRP3, and to a lesser degree, the expression of NLRP1, compared with the control. By contrast, PE markedly induced the expression levels of IL‑18 and NLRP1, while LPS reduced the gene expression of IL‑18. In conclusion, adrenergic stimulation suppressed NLRP3 expression and enhanced NLRP1 expression, indicating that NLRP3 may regulate IL‑1β secretion and NLRP1 may regulate the release of IL-18.
    No preview · Article · Nov 2015 · Experimental and therapeutic medicine
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    ABSTRACT: Background Previous studies have indicated that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients seems to be higher compared to the general population. Objective This study investigated the seroprevalence of blood-borne pathogens among patients with suspected severe multiple trauma in a German university hospital (level I trauma center). Methods Routine blood samples taken from trauma patients at the university hospital Frankfurt were tested for HBV, HCV and HIV (from 1 February 2014 to 31 January 2015). Results Overall, 275 patients with a median injury severity score (ISS) of 9 points (range 0–54) were included in the study representing 84.4 % of all trauma room admissions during this time period. Altogether 3.3 % (n = 9) of the patients were infected with blood-borne pathogens, where 7 patients were infected with HCV and 2 patients had an active HBV infection. None of the patients were tested HIV positive and only one initial diagnosis for HCV was made. A further six samples (five HCV and one HIV) showed a weak reaction in the screening assay that could not be verified by the confirmatory assay. Conclusion To the best of our knowledge this study is the first report on the prevalence of blood-borne infections among trauma patients at a level I trauma center in an urban area in Germany. Compared to the general population the prevalence of blood-borne infections was higher but considerably lower than indicated in previous international studies. Considering the broad implications of occupationally transmitted blood-borne infections occupational safety is of paramount importance.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: The Masquelet technique for the treatment of large bone defects consists of a 2-stage procedure. In the first stage, a polymethylmethacrylate (PMMA) cement spacer is inserted into the bony defect of a rat's femur and over a period of 2–4 weeks a membrane forms that encapsulates the defect/spacer. In a second operation the membrane is opened, the PMMA spacer is removed and the resulting cavity is filled with autologous bone. Different kinds of bone cements are available, with or without supplemental antibiotics. Both might influence the development and the characteristics of the induced membrane which might affect the bone healing response. Hence, this comparative study was performed to elucidate the effect of different bone cements with or without supplemental antibiotics on the development of an induced membrane in a critical size femur defect model in rats.
    No preview · Article · Nov 2015 · Injury
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    ABSTRACT: Introduction: The inflammatory response is an important part of the pathophysiology of severe injury and, in particular, of severe traumatic brain injury (TBI). This study evaluates the inflammatory course following major trauma and focuses on the effect of severe TBI on inflammatory markers. Material and methods: This was a retrospective analysis of prospectively collected data in 123 severely injured (ISS ≥16) trauma patients. The study cohort was divided into patients with isolated TBI (Head AIS ≥3, all other AIS <3), polytraumatized patients with severe TBI (Head AIS ≥3; AIS of other body area ≥3; Polytrauma+TBI) and polytraumatized patients without TBI (Head AIS <3; Polytrauma). Levels of inflammatory markers (Interleukin-6 [IL-6], C-reactive Protein [CRP], leukocytes) measured upon arrival and through hospital days 1-3 were compared between the groups. Results: On admission and through hospital day 3, IL-6 levels were significantly different between the 3 groups (admission: isolated TBI vs. Polytrauma+TBI vs. Polytrauma; 94±16 vs. 149±20 vs. 245±50pg/mL; p<0.05). Interleukin-6 levels peaked on hospital day 1 and declined thereafter. C-reactive protein and leukocyte counts were not significantly different between the cohorts on arrival and peaked on hospital day 2 and 1, respectively. In patients with severe TBI, admission IL-6 levels significantly predicted the development of septic complications (ROC analysis, AUC: 0.88, p=0.001, 95% CI: 0.79-0.97) and multiple organ dysfunction (ROC analysis, AUC: 0.83, p=0.001, 95% CI: 0.69-0.96). Conclusion: Severe TBI reduced the inflammatory response following trauma. Significant correlations between admission IL-6 values and the development of MOF, sepsis and the neurological outcome were found in patients with TBI.
    No preview · Article · Nov 2015 · Immunobiology
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    ABSTRACT: Introduction: The surgical treatment of large bone defects continues to pose a major challenge in modern trauma and orthopaedic surgery. In this study we test the effectiveness of a tissue engineering approach, using 3D β-TCP scaffolding plus bone marrow-derived mononuclear cells (BM-MNCs), combined with a vascularized periosteal flap, in a rat femur critical size defect model. Methods: Eighty rats were randomly allocated into 4 equal groups. Under general anesthetized, critical size defects were created on their femurs and were treated with: 1) Vascularized periosteal flap alone, 2) Vascularized periosteal flap + β-TCP scaffolding, 3) Vascularized periosteal flap + β-TCP scaffolding + ligated vascular pedicle, and 4) Vascularized periosteal flap + β-TCP scaffolding + BM-MNCs. After 4 and 8 weeks animals were euthanized and the bone defects were harvested for analysis of new bone formation, vascularization and strength using histology, immunohistology, micro-CT and biomechanical testing respectively. Results: Group 1: (P. flap) Increase in new bone formation and vascularization. Group 2: (P. flap + Scaffold) Increase in new bone formation and vascularization. Group 3: (P. flap + Scaffold + ligated vascular pedicle) No new bone formation and no vascularization. Group 4: (P. flap + Scaffold + BM-MNCs). A significant (p<0.05) increase was seen in new bone formation, vascularization, and strength in bones treated with flaps, scaffold and BM-MNCs, when compared to the other treatment groups. Conclusion: Combining a vascularized periosteal flap with tissue engineering approach (β-TCP scaffolding and BM-MNC) results in significantly improved bone healing in our rat femur critical size bone defect model.
    No preview · Article · Oct 2015 · Tissue Engineering Part A
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    ABSTRACT: Background: In recent years a wide variety of strategies to treat the haemodynamically unstable patient with pelvic ring fractures have been proposed. This study evaluates our institutional management of patients with severe pelvic fractures and analyses their outcomes. Methods: Retrospective review of all severely injured trauma patients with pelvic ring injuries admitted to a level I trauma centre from 2007 to 2012. Patient records were documented prospectively in a trauma database and evaluation was performed by SPSS. Results: During the study period, a total of 173 patients with pelvic ring fractures were admitted and formed the basis of this study. Overall, 46% of the patients had suffered a type A fracture, 25% a type B fracture and the remaining 29% a type C pelvic ring fracture. Surgical treatment was required in 21% of the patients (pelvic C-clamp, n = 6; supra-acetabular external fixator, n = 32; pelvic packing, n = 12; definitive plate osteosynthesis of the pubis symphysis, n = 6). Angio-embolization was performed in 16 patients (9%); in 8 patients it was the only specific treatment for the pelvic injury on day 0 and in 8 patients it was performed immediately post-operatively. The overall mortality rate was 12.7% (n = 22), with the type C pelvic fractures having the highest mortality (30.0%). Four patients died immediately after admission in the shock room. Conclusions: Angiographic embolization as a first-line treatment was only performed in haemodynamically stable patients or in patients responding to fluid resuscitation with the finding of an arterial blush in the CT scan. In haemodynamically unstable patients, pre-peritoneal pelvic packing in combination with mechanical pelvic stabilization was immediately carried out, followed by angio-embolization post-operatively if signs of persistent bleeding remained present.
    No preview · Article · Oct 2015 · Injury
  • J Menke · N Wagner · M Lehnert · I Marzi · B Relja
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    ABSTRACT: Introduction: Alcohols' influence on trauma patients (TP) remains controversial. Alcohol was associated with neuroprotective effects in TBI, while others reported negative or no effects on survival and/or in-hospital stay in TP. Here, the relationship of alcohol with injury characteristics and outcome and its possible anti-inflammatory effects in major TP were analyzed. Methods: 184 severely injured TP (ISS≥16) were enrolled. Blood alcohol concentration (BAC) and systemic interleukin (IL)-6 were determined. Patients were grouped according to their positive BAC (>0.5‰, BAC) vs. <0.5‰ alcohol (no-BAC) upon admission (ED). Injury characteristics, physiologic parameters and outcome (organ/MOF, SIRS, sepsis, pneumonia, ARDS or mortality) were assessed. Results: 49 TP had positive BAC without chronic alcohol abuse history (1.61 ± 0.1‰) and 135 patients had BAC levels below 0.5‰ (0.03 ± 0.02‰). Injury severity (ISS BAC: 23.7 ± 1.5 vs. ISS no-BAC: 27.3 ± 0.6) and age (BAC: 43.4 ± 2.3 vs. no-BAC: 43.1 ± 1.5) were comparable between groups. No-BAC TP received significantly higher amount of packed red blood cells and fresh frozen plasma compared to BAC TP. Organ failure, MOF, SIRS, sepsis, pneumonia, ARDS and in-hospital mortality were not markedly different. BAC TP had significantly decreased leukocyte cell numbers and IL-6 levels compared to no-BAC group (leukocytes: 10.8 ± 0.74 vs. 13.2 ± 0.5U/nL; IL-6: 97.2 ± 19.3 vs. 252.9 ± 65.7pg/mL, both p < 0.05). Conclusion: Positive BAC appears not to markedly influence the outcome after trauma. Alcohols' immune-suppressive effects have been observed in reduced leukocyte cell numbers and systemic IL-6 levels. The relevance of this immune-suppression for the clinical outcome remains to be elucidated in larger prospective clinical studies.
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
  • D Heftrig · R Sturm · I Marzi · B Relja
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    ABSTRACT: Introduction: Trauma patients (TP) often develop an imbalanced immune response, frequently leading to infectious post-injury complications. Monocytes, part of innate immune system, show diminished HLA-DR-expression and impaired pro-inflammatory cytokine-release upon stimulation after trauma. Monocytes recognize lipopolysaccharide (LPS) via TLR4 and CD14. Data on TLR4-expression in TP's monocytes are conflicting. Moreover, there are no studies describing TLR4-expression after secondary stimulation or TLR4- and HLA-DR-co-expression after trauma. Methods: 20 TP [ISS≥16] and ten healthy volunteers (HV) were included. Ex vivo in vitro LPS-stimulation (10 μg/mL, 24 h) of whole blood was performed daily until day 10. IL-1β-release was determined by ELISA. TLR4-expression on HLA-DR-positive and -negative monocytes prior and after their stimulation with the leukocyte-activation-cocktail (LAC) was determined by flow cytometry. Results: LPS-induced IL-1β-release was significantly diminished in TP showing a recovery after day 5 compared to HV (p < 0.05). TLR4-expression in unstimulated samples from TP was significantly reduced at ED compared to HV. LAC-stimulated monocytes from TP had continuously reduced TLR4-expression compared to HV during the whole time course. HLA-DR-expression was lowered after trauma, and even more profound after stimulation. Co-expression analysis indicated that HLA-DR- monocytes may be responsible for impaired TLR4-expression after stimulation in TP. Ratio of CD14+ monocytes to leukocytes was significantly increased in the later post-injury phase. Conclusion: Next to reduced monocyte function, TP show diminished TLR4-expression after stimulation. Here, a possible mechanism for endotoxin tolerance in monocytes after major trauma is shown. Additionally, impaired TLR4-expression on naive HLA-DR- monocytes may contribute to functional suppression of monocytes after trauma.
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
  • N Wagner · B Relja · J Menke · M Lehnert · I Marzi
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    ABSTRACT: Introduction: The influence of alcohol consumption on inflammatory state and outcome in patients suffering from traumatic brain injury (TBI) remains controversial. We analyzed effects of positive blood alcohol concentration (BAC) on inflammatory changes, in-hospital complications, and mortality in TBI-patients. Methods: Patients with an Injury Severity Score (ISS)≥16 and Abbreviated Injury Scale of head (AIS-head)≥3 were enrolled upon arrival in the emergency room. Injury severity, vital signs, complications, mortality and systemic interleukin (IL)-6 levels were prospectively taken, blood alcohol concentration was measured. Patients were grouped according to positive BAC (>0.5‰, BAC) vs. <0.5‰ alcohol (no BAC). Matched-pair analysis according to ISS, AIS-head, age and gender was conducted. Results: 101 TBI-patients were included. 74 patients were grouped to no BAC group, 27 to BAC-group. ISS was significantly higher in the no BAC-group. Positive BAC-group received significantly less packed red blood cells and fresh frozen plasma (p < 0.05). BAC-patients had shorter ICU-stay. In-hospital complications, including single/multiple-organ failure, SIRS, sepsis, pneumonia, ARDS showed no significant changes. BAC- positive patients showed significantly lower systemic IL-6 levels and leukocyte counts (IL-6: 65.0 ± 8.0 vs. 151.8 ± 22.3, leukocytes: 10.2 ± 0.9 vs. 13.2 ± 0.8, both p < 0.05). Matched-pair analysis was performed with 27 pairs. No significant differences in transfusions were observed after matching. However, lowered systemic IL-6 levels and leukocyte counts in the BAC- group were detected after matching also, indicating that this effect is ISS-independent. Conclusion: This study indicates that positive BAC influences systemic IL-6 levels and leukocyte numbers in TBI-patients, and may deliver further insights into the understanding of possible anti- inflammatory effects of alcohol.
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
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    ABSTRACT: Chronic ethanol (EtOH) abuse worsens pathophysiological derangements after hemorrhagic shock and resuscitation (H/R) that induce hepatic injury and strong inflammatory changes via JNK and NF-κB activation. Inhibiting JNK with a cell-penetrating, protease-resistant peptide D-JNKI-1 after H/R in mice with healthy livers ameliorated these effects. Here, we studied if JNK inhibition by D-JNKI-1 in chronically EtOH-fed mice after hemorrhagic shock prior to the onset of resuscitation also confers protection.
    Full-text · Article · Sep 2015 · PLoS ONE
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    ABSTRACT: After a major trauma, IL-1β-producing capacity of monocytes is reduced. Generation of IL-1β is important for appropriate immune response after trauma and requires not only synthesis and transcription of inflammasome components but also their activation. Altered IL-1β-processing due to deregulated NLRP inflammasomes assembly is associated with several inflammatory diseases. However, the precise role of NLRP1 inflammasome in monocytes after trauma is unknown. Here, we investigated if NLRP1 inflammasome components are responsible for depressed monocyte function after trauma. We found in ex vivo in vitro assays that LPS-stimulation of CD14(+)-isolated monocytes from healthy volunteers (HV) results in remarkably higher capacity of the IL-1β-release compared to trauma patients (TP). During the 10-day time course, this monocyte depression was highest immediately after admission. Inflammasome activation correlating with this inflammatory response was demonstrated by enhanced protein production of cleaved IL-1β and caspase-1. Furthermore, we found that the gene expression of IL-1β, caspase-1, and ASC was comparable in TP and HV after LPS-stimulation during the 10-day course, while NLRP1 was markedly reduced in TP. We demonstrated that transfected monocytes from TP, which expressed the lacking components, were recovered in their LPS-induced IL-1β-release and that lacking of NLRP1 is responsible for the suppressed monocyte activity after trauma. The restoration of NLRP1 inflammasome suggests new mechanistic target for the recovery of dysbalanced immune reaction after trauma. Suppression in monocyte function occurs early after a major trauma or surgery. Reduced gene expression abrogates NLRP1 inflammasome assembly after trauma. Limited availability of inflammasome components may cause reduced host defense. Restoring NLRP1 in immune-suppressed monocytes recovers NLPR1 activity after trauma. Recovered inflammasome activity may improve the immune response to PAMPs/DAMPs.
    No preview · Article · Aug 2015 · Journal of Molecular Medicine
  • A L Sander · F Ebert · I Marzi · J Frank
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    ABSTRACT: Background: To date, the Aptis distal radioulnar joint (DRUJ) prosthesis by Scheker is the only total, bipolar prosthesis available. In the literature, only few data exist concerning the prosthesis and its surgical technique. Aim of the present study was the evaluation of the medium-term clinical and radiological outcome following implantation of the Aptis DRUJ prosthesis. Methods and Patients: 5 patients (4 women and 1 man) with mean age of 40.2 (30-65) years underwent secondary implantation of the Aptisprosthesis between February 2006 and May 2013. The average date of the follow-up was after 36 (24-48) months. Besides the complications, the wrist range of motion (ROM) and the strength in grip were measured. The quality of pain was determined using a visual analogue pain scale from 0-10. In follow-up X-ray controls, bone resorption and bony abnormalities were evaluated. The DASH score as well as the postoperative subjective satisfaction of the patients were recorded. Results: No patient required removal of the prosthesis. Only 1 patient underwent secondary surgery in which debridement of the screw tip over the radius was required. The postoperative range of motion in pronation and supination was measured with 78 (70-90)° and 82 (70-90)°. The average grip strength amounted to 29 (24-32) kg. This represented 85 (76-100)% of the value of the contralateral side. Postoperative pain symptoms on the visual analogue pain scale were measured with 0 points at rest and with 1.2 (0-2) points under strain. Radiological evaluation showed bone resorption at the radial peg in 2 patients, but without evidence of implant loosening. The DASH score was recorded with 37 (13-75) points. All patients were satisfied or very satisfied after the surgical treatment. Conclusion: The Aptis prosthesis is a safe and efficient treatment option for previously failed surgery of the DRUJ. © Georg Thieme Verlag KG Stuttgart · New York.
    No preview · Article · Jun 2015 · Handchirurgie · Mikrochirurgie · Plastische Chirurgie
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    ABSTRACT: Increased local and systemic levels of interleukin (IL)‑6 are associated with inflammatory processes, including neutrophil infiltration of the alveolar space, resulting in lung injury. Our previous study demonstrated the beneficial anti‑inflammatory effects of acute exposure to ethanol (EtOH) in an acute in vivo model of inflammation. However, due to its side‑effects, EtOH is not used clinically. In the present study, the effects of EtOH and ethyl pyruvate (EtP) as an alternative anti‑inflammatory drug prior to and following application of an IL‑6 stimulus on cultured A549 lung epithelial cells were compared, and it was hypothesized that treatment with EtOH and EtP reduces the inflammatory potential of the A549 cells. Time‑ and dose‑dependent release of IL‑8 from the A549 cells was observed following stimulation with IL‑6. The release of IL‑8 from the A549 cells was assessed following treatment with EtP (2.5‑10 mM), sodium pyruvate (NaP; 10 mM) or EtOH (85‑170 mM) for 1, 24 or 72 h, prior to and following IL‑6 stimulation. The adhesion capacities of neutrophils to the treated A549 cells, and the expression levels of cluster of differentiation (CD)54 by the epithelial cells were measured. Treatment of the A549 cells with either EtOH or EtP significantly reduced the IL‑6‑induced release of IL‑8. This effect was observed in the pre‑ and post‑stimulatory conditions, which is of therapeutic importance. Similar data was revealed regarding the IL‑6‑induced neutrophil adhesion to the treated A549 cells, in which pre‑ and post‑treatment with EtOH or EtP decreased the adhesion capacity, however, the results were dependent on the duration of incubation. Incubation durations of 1 and 24 h decreased the adhesion rates of neutrophils to the stimulated A549 cells, however, the reduction was only significant at 72 h post‑treatment. The expression of CD54 was reduced only following treatment for 24 h with either EtOH or EtP, prior to IL‑6 stimulation. Therefore, EtOH and EtP reduced the inflammatory response of lung epithelial cells, and the potential of EtP to mimic EtOH was observed in the pre‑ and post‑treatment conditions.
    No preview · Article · May 2015 · Molecular Medicine Reports
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    ABSTRACT: Unlabelled: Purpose. Elderly patients are susceptible to wound healing problems due to impaired neovascularisation in tissue repair. We investigated influence of surgical wound fluid (WF) obtained from both young and aged patients after musculoskeletal surgery on in-vitro recruitment and differentiation of endothelial progenitor cells (EPCs). Further, VEGF and TGF-b1 in WF were measured and blockade experiments were performed to analyze the role of both cytokines in EPC recruitment. Methods: WF was obtained from young (28 ± 5 years, n = 14) and elderly (74 ± 8 years, n = 15) patients at 3, 8, and 24 hours after surgery. EPCs were isolated from healthy donors and incubated (72 hours) in medium substituted by WF. EPC number/differentiation was determined by fluorescence-microscopy and flow-cytometry after staining for DiLDL and lectin. CBF or ELISA was used to measure VEGF and TGF-b1 in WF. For blockade experiments, WF was mixed with antibodies against VEGF/TGF-b1 before incubation. Results: A significantly higher number and increased differentiation of EPC can be observed after incubation with WF from young compared to elderly individuals. VEGF and TGF-b1 were higher in young patients' WF, and blockade of both cytokines reduced EPC numbers significantly. Conclusion: Impaired wound healing in the elderly could be a result of dampened recruitment of EPC to site of affliction, possibly due to low VEGF/TGF-b1 levels.  .
    No preview · Article · Apr 2015 · Wounds: a compendium of clinical research and practice

Publication Stats

5k Citations
775.77 Total Impact Points


  • 2010-2015
    • Hospital Frankfurt Hoechst
      Frankfurt, Hesse, Germany
  • 2006-2015
    • University Hospital Frankfurt
      Frankfurt, Hesse, Germany
  • 2002-2015
    • Goethe-Universität Frankfurt am Main
      • • Klinik für Unfall-, Hand-, und Wiederherstellungschirurgie
      • • Center of Surgery
      • • Institut für Diagnostische und Interventionelle Radiologie
      Frankfurt, Hesse, Germany
  • 2013
    • Berufsgenossenschaftliche Unfallklinik Murnau
      Murnau, Bavaria, Germany
  • 2007-2009
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 1989-2006
    • University of North Carolina at Chapel Hill
      • • Department of Surgery
      • • Department of Pharmacology
      North Carolina, United States
  • 2004
    • Krankenhaus Barmherzige Brüder Regensburg
      Ratisbon, Bavaria, Germany
  • 1987-2004
    • Universität des Saarlandes
      • Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie
      Saarbrücken, Saarland, Germany
  • 2000
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
    • University Children's Hospital Basel
      Bâle, Basel-City, Switzerland
  • 1999-2000
    • University of Cologne
      Köln, North Rhine-Westphalia, Germany
  • 1996
    • Universitätsklinikum des Saarlandes
      Homburg, Saarland, Germany
  • 1995
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1993
    • Ludwig Boltzmann Institute for Experimental and Clinical Traumatology
      Wien, Vienna, Austria
  • 1991
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany