Markus Huber-Lang

Universität Ulm, Ulm, Baden-Württemberg, Germany

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Publications (176)609.47 Total impact

  • W. Öchsner · F. Josse · S. Fleischmann · M. Huber-Lang · M. Helm

    No preview · Article · Feb 2016 · Der Notarzt
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    ABSTRACT: Backgrounds and objectives: As part of the expansion of the site-specific education profile of the medical curriculum MED@ULM of the University of Ulm, a new track "trauma care and trauma research" was established in the winter semester 2012/2013. The acceptance of the track was evaluated during the winter semester 2013/2014. Material and methods: The 6-semester track extends the existing curriculum by offering subjects in trauma management and trauma research to students of human medicine. A central aim of the track is to promote medical professional competence, expertise in emergency care and competence in trauma-related scientific work and research. Central learning contents could be intensified in newly established emergency simulation training. Additionally, participating students have to perform a doctoral thesis on an obligatory trauma-related experimental subject. A first analysis study focusing on the learning style of the participating students (n = 17) and a control group consisting of members of the same semester (n = 20) was performed using the Kolb learning style inventory. In a validated evaluation in the winter semesters 2013/2014 and 2014/2015, the students were asked about their expectations and experience with the track, criticisms, suggestions and satisfaction with the study conditions. The data were analyzed using descriptive statistics. Results: The analysis of the students' preferred learning styles revealed no differences between track students and the control group. Most of the students considered the track as a form of personal further education. The students had high expectations of practical skills with relevance to the clinical daily routine, learning scientific methods and preparing their thesis. The track students were more critical with regard to the study conditions than the control group students, although the track students of the third semester still judged their studies to be more interesting than the track students of the first semester and the control group. Conclusion: With the introduction of the new trauma track into the curriculum of the medical curriculum MED@ULM of the University of Ulm, a further possibility for medical students to focus on their own individual options was established. At least half of the track students wanted to be later active in the triad of patient care, teaching and research. Further investigations are necessary to determine whether the establishment of the trauma track has a positive influence on the number of new recruits in trauma surgery and anesthesiology.
    No preview · Article · Dec 2015 · Der Unfallchirurg
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    ABSTRACT: The serum proteins factor H (FH), consisting of 20 complement control protein modules (CCPs), and its splice product FH-like protein 1 (FHL-1; consisting of CCPs 1-7) are major regulators of the alternative pathway (AP) of complement activation. The engineered version of FH, miniFH, contains only the N- and C-terminal portions of FH linked by an optimized peptide and shows ∼10-fold higher ex vivo potency. We explored the hypothesis that regulatory potency is enhanced by unmasking of a ligand-binding site in the C-terminal CCPs 19-20 that is cryptic in full-length native FH. Therefore, we produced an FH variant lacking the central domains 10-15 (FHΔ10-15). To explore how avidity affects regulatory strength, we generated a duplicated version of miniFH, termed midiFH. We compared activities of FHΔ10-15 and midiFH to miniFH, FH, and FHL-1. Relative to FH, FHΔ10-15 exhibited an altered binding profile toward C3 activation products and a 5-fold-enhanced complement regulation on a paroxysmal nocturnal hemoglobinuria patient's erythrocytes. Contrary to dogma, FHL-1 and FH exhibited equal regulatory activity, suggesting that the role of FHL-1 in AP regulation has been underestimated. Unexpectedly, a substantially increased avidity for complement opsonins, as seen in midiFH, did not potentiate the inhibitory potential on host cells. In conclusion, comparisons of engineered and native FH-based regulators have identified features that determine high AP regulatory activity on host cells. Unrestricted availability of FH CCPs 19-20 and an optimal spatial orientation between the N- and C-terminal FH regions are key.
    No preview · Article · Dec 2015 · The Journal of Immunology
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    ABSTRACT: Introduction: Sepsis is an exaggerated and dysfunctional immune response to infection. Activation of innate immunity recognition systems including complement and the Toll-like receptor family initiate this disproportionate inflammatory response. The aim of this study was to explore the effect of combined inhibition of the complement component C5 and the Toll-like receptor co-factor CD14 on survival, hemodynamic parameters and systemic inflammation including complement activation in a clinically relevant porcine model of polymicrobial sepsis. Methods: Norwegian landrace piglets (4 ± 0.5 kg) were blindly randomized to a treatment group (n = 12) receiving the C5 inhibitor coversin (OmCI) and anti-CD14 or to a positive control group (n = 12) receiving saline. Under anesthesia, sepsis was induced by a 2 cm cecal incision and the piglets were monitored in standard intensive care for 8 hours. Three sham piglets had a laparotomy without cecal incision or treatment. Complement activation was measured as sC5b-9 using enzyme immunoassay. Cytokines were measured with multiplex technology. Results: Combined C5 and CD14 inhibition significantly improved survival (p = 0.03). Nine piglets survived in the treatment group and four in the control group. The treatment group had significantly lower pulmonary artery pressure (p = 0.04) and ratio of pulmonary artery pressure to systemic artery pressure (p < 0.001). Plasma sC5b-9 levels were significantly lower in the treatment group (p < 0.001) and correlated significantly with mortality (p = 0.006). IL-8 and IL-10 were significantly (p < 0.05) lower in the treatment group. Conclusions: Combined inhibition of C5 and CD14 significantly improved survival, hemodynamic parameters and inflammation in a blinded, randomized trial of porcine polymicrobial sepsis.
    Full-text · Article · Dec 2015 · Critical Care
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    ABSTRACT: Background: Plasmacytosis (ie, an expansion of plasma cell populations to much greater than the homeostatic level) occurs in the context of various immune disorders and plasma cell neoplasia. This condition is often associated with immunodeficiency that causes increased susceptibility to severe infections. Yet a causative link between plasmacytosis and immunodeficiency has not been established. Objective: Because recent studies have identified plasma cells as a relevant source of the immunosuppressive cytokine IL-10, we sought to investigate the role of IL-10 during conditions of polyclonal and neoplastic plasmacytosis for the regulation of immunity and its effect on inflammation and immunodeficiency. Methods: We used flow cytometry, IL-10 reporter (Vert-X) and B cell-specific IL-10 knockout mice, migration assays, and antibody-mediated IL-10 receptor blockade to study plasmacytosis-associated IL-10 expression and its effect on inflammation and Streptococcus pneumoniae infection in mice. ELISA was used to quantify IL-10 levels in patients with myeloma. Results: IL-10 production was a common feature of normal and neoplastic plasma cells in mice, and IL-10 levels increased with myeloma progression in patients. IL-10 directly inhibited neutrophil migration toward the anaphylatoxin C5a and suppressed neutrophil-dependent inflammation in a murine model of autoimmune disease. MOPC.315.BM murine myeloma leads to an increased incidence of bacterial infection in the airways, which was reversed after IL-10 receptor blockade. Conclusion: We provide evidence that plasmacytosis-associated overexpression of IL-10 inhibits neutrophil migration and neutrophil-mediated inflammation but also promotes immunodeficiency.
    No preview · Article · Dec 2015 · The Journal of allergy and clinical immunology
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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: Severe tissue trauma-induced systemic inflammation is often accompanied by evident or occult blood-organ barrier dysfunctions, frequently leading to multiple organ dysfunction. However, it is unknown whether specific barrier molecules are shed into the circulation early after trauma as potential indicators of an initial barrier dysfunction. The release of the barrier molecule junctional adhesion molecule-1 (JAM-1) was investigated in plasma of C57BL/6 mice 2 h after experimental mono- and polytrauma as well as in polytrauma patients (ISS ≥ 18) during a 10-day period. Correlation analyses were performed to indicate a linkage between JAM-1 plasma concentrations and organ failure. JAM-1 was systemically detected after experimental trauma in mice with blunt chest trauma as a driving force. Accordingly, JAM-1 was reduced in lung tissue after pulmonary contusion and JAM-1 plasma levels significantly correlated with increased protein levels in the bronchoalveolar lavage as a sign for alveolocapillary barrier dysfunction. Furthermore, JAM-1 was markedly released into the plasma of polytrauma patients as early as 4 h after the trauma insult and significantly correlated with severity of disease and organ dysfunction (APACHE II and SOFA score). The data support an early injury- and time-dependent appearance of the barrier molecule JAM-1 in the circulation indicative of a commencing trauma-induced barrier dysfunction.
    Full-text · Article · Nov 2015 · Mediators of Inflammation
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    ABSTRACT: Background: The activated forms of the complement lectin pathway (LP) proteases MASP-1 and -2 are able to cleave the coagulation factors prothrombin, fibrinogen, factor XIII and TAFI in vitro. In vivo studies also show that MASP-1 is involved in thrombogenesis, OBJECTIVES: To clarify the not yet identified mechanisms involved in triggering activation of the LP during thrombotic reactions. Methods: Novel sandwich-ELISAs for detection of complexes between MASP-1 or MASP-2 and the serpins C1 inhibitor (C1-INH) or antithrombin (AT), were used to specifically detect and quantify the activated forms of MASP-1 and MASP-2 RESULTS: Activated platelets were shown by flow cytometry to bind Ficolin-1, -2, and -3 but not MBL, which was associated with activation of MASP-1 and MASP-2. We also demonstrated that fibrin and the plasmin-generated fibrin fragment DD in plasma, bind and activate MASP-1 and MASP-2. As demonstrated by the ELISA and SDS-PAGE/western blotting, the fibrin-associated activation was reflected in a specific inactivation by AT during clotting without the assistance of heparin. In all other cases the MASPs were as previously reported inactivated by C1-INH. In SLE patients with thrombotic disease and in polytrauma patients, the levels of activated MASP-1 and MASP-2 in complex with both AT and C1INH were associated with markers of thrombotic disease and contact/coagulation system activation. Conclusions: MASP-1 and MASP-2 are activated during blood clotting. This activation is triggered by activated platelets and by the generation of fibrin during thrombotic reactions in vitro and in vivo, and may represent a novel activation/amplification mechanism in thromboinflammation. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2015 · Journal of Thrombosis and Haemostasis
  • R Wiegner · S Denk · M Kalbitz · M Weiss · F Gebhard · M Huber-Lang
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    ABSTRACT: Introduction: Severe tissue trauma leads to an early excessive activation of the complement and the coagulation system which is associated with a poor outcome. Besides extensive interactions between the two cascades on a fluid-phase level, studies suggest that key molecules in coagulation are expressed on leukocytes. Therefore, we examined the potential crosstalk between complement and coagulation on the leukocyte surface, and aimed to identify the involved molecular mechanisms especially after polytrauma. Methods: A prospective clinical study was conducted in patients after severe trauma (ISS≥32) and healthy volunteers. The study was approved by the Independent Local Ethics Committee of the University of Ulm. Blood was obtained upon admission to the ER and 4 h, 12 h, 24 h, 48 h, 120 h and 240 h after trauma. Key players of complement and coagulation on the leukocyte cell surface were analyzed by flow cytometry in comparison to expression profiles in healthy volunteers. Results: All leukocytes showed significantly increased expression of PAI-1 during later time points after trauma, possibly accounting for decreased fibrinolysis and enhanced risk of thrombosis. TCC was significantly incorporated in monocyte membranes at increased amounts early after trauma, returning to base line levels on days 5 and 10. A similar expression pattern was observed for thrombomodulin, an essential regulator of protein C activation. TCC levels on monocytes positively correlated with thrombomodulin expression and negatively with platelet counts. Conclusion: The data are indicative of so far unknown interactions between complement and coagulation on a cellular level and the potential role of leukocyte surface molecules in the development of coagulopathy after trauma.
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
  • M Kalbitz · M Huber-Lang · F Gebhard · P Ward
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    ABSTRACT: Introduction: In sepsis myocardial dysfunction is correlated with high mortality rates. Damage associated molecular patterns are released from cells during sepsis. Furthermore, the complement activation product C5a resulted in murine cardiomyocyte in defective contractility and relaxation, suggesting that interaction of C5a with its receptors is involved in the development of septic cardiomyopathy. We hypothesized that during sepsis interaction of C5a with its receptors contribute to cardiac dysfunction. Methods: Sepsis was induced by cecal ligation and puncture (CLP) procedure. The isolation of adult rat or mouse cardiomyocytes was performed using a Langendorff perfusion system. Intracellular calcium ([Ca2+]i) and reactive oxygen species (ROS) were measured by flow cytometry using cell permeable dyes. Cardiac hemodynamic function in mice was determined with echocardiograms. Results: Absence of C5a receptors resulted in a significant decrease in plasma histone levels during sepsis, indicating a linkage between complement and histone appearance. In isolated rodent cardiomyocytes presence of C5a or histones resulted in time- and dose-dependent increases in [Ca2+]i and ROS. After infusion of FITC-labeled histones intravenously in wild type mice heart homogenates contained histones. Echocardiographic parameters showed improved cardiac function after CLP in absence of C5a receptors or in presence of histone neutralizing antibody. Conclusion: The current studies indicate that addition of C5a or extracellular histones to CMs are associated with buildup of [Ca2+]i and ROS. Cardiac dysfunction during sepsis was correlated with presence of both C5a receptors and extracellular histones. Collectively, these alterations may explain at least in part, the cardiomyopathy in sepsis.
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
  • S Denk · M Neher · R Wiegner · M Kalbitz · M Weiss · M Huber-Lang
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    ABSTRACT: Introduction: During systemic inflammatory conditions, such as sepsis, the immune system is uniquely challenged. Studies indicate that excessive complement activation is associated with impaired neutrophil function although the mechanism is marginally characterised. As a balanced cytosolic pH regulation is essential for cellular function, the effect of complement activation on neutrophil pH and resulting functional changes was investigated. Methods: Isolated human neutrophils were incubated with C5a and analyzed for intracellular pHi by flow cytometry. For evaluation of sepsis-induced changes, neutrophil pHi was determined in experimental cecal-ligation and puncture- (CLP) induced murine sepsis and in patients with septic shock (ethical approval 163/2003). Results were analyzed using one-way ANOVA followed by Student Newman-Keuls-test. Results: C5a significantly increased pHi in neutrophils in a dose- and time-dependent manner, whereas C3a failed to alter pHi. C5a was found to induce the sodium-hydrogen exchanger-1 (NHE-1) by C5a-receptor interaction with subsequent intracellular Ca2+ release and activation of PKC and calmodulin. This C5a-induced alkalinisation resulted in exocytosis of lactoferrin and myeloperoxidase from healthy human neutrophils and was almost normalised by inhibition of NHE-1. In vivo, CLP-induced sepsis also increased neutrophil pHi, which could be mitigated by pretreatment with a C5a-receptor antagonist. Similarly, pHi was significantly elevated in neutrophils from patients with sepsis (n = 10) compared to healthy volunteers (n = 10). Conclusion: These results suggest that excessive complement activation via C5a leads to a NHE-1-mediated shift of pHi and subsequent neutrophil functions during septic shock. Therefore, targeted inhibition of the C5a-C5aR interaction may balance the pHi homeostasis of neutrophils regulating crucial cellular functions during sepsis.
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
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    ABSTRACT: Introduction: Acute and chronic lung disease up-regulate purinergic receptor (P2XR4, P2XR7) expression. P2XR7 deletion or blockade attenuated pulmonary hyper-inflammation, but P2XR4 up-regulation compensated for P2XR7 deletion. Therefore, we tested the hypotheses that P2XR4 deletion may attenuate post-traumatic acute lung injury (ALI) after cigarette smoke (CS) exposure-induced COPD. Methods: After 3-4 weeks of CS exposure, anesthetized wild type or P2XR4-ko mice (n = 8 each) underwent pressure wave-induced blunt chest trauma followed by 4 hours of lung-protective mechanical ventilation, fluid resuscitation and noradrenaline to maintain blood pressure > 55mmHg. Lung mechanics, gas exchange, hemodynamics, metabolism and acid-base status were measured together with lung histology,immune-histochemistry, and western blotting. Results: P2XR4-ko mice showed higher lung compliance and lower PaO2/FiO2 ratios, which coincided with higher P2XR7 expression, aggravated histological damage and immune-cell infiltration and HO-1 expression. In contrast, P2XR4 deletion was associated with less impairment of systemic hemodynamics, glucose homeostasis and acid-base status. Conclusion: After CS exposure, genetic P2XR4 deletion aggravated post-traumatic ALI and hyper-inflammation, but attenuated impairment of systemic hemodynamics and metabolism, possibly due to preserved liver metabolic capacity resulting from less alveolar hypoxia-induced right ventricular re-modelling. Acknowledgements: Supported by Ministry of Science, Research and the Arts of Baden-Württemberg (Az:32-729.55-0/239-5/32-7533.-6-10/15/1) (Boehringer Ingelheim Ulm University BioCenter).
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)

  • No preview · Conference Paper · Sep 2015

  • No preview · Conference Paper · Sep 2015

  • No preview · Conference Paper · Sep 2015
  • Markus Huber-Lang · Anita Ignatius · Rolf E Brenner
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    ABSTRACT: Activation of both the complement and coagulation cascade after trauma and subsequent local and systemic inflammatory response represent a major scientific and clinical problem. After severe tissue injury and bone fracture, exposure of innate immunity to damaged cells and molecular debris is considered a main trigger of the posttraumatic danger response. However, the effects of cellular fragments (e.g., histones) on complement activation remain enigmatic. Furthermore, direct effects of “broken” bone and cartilage surfaces on the fluid phase response of complement and its interaction with key cells of connective tissues are still unknown. Here, we summarize data suggesting direct and indirect complement activation by extracellular and cellular danger associated molecular patterns. In addition, key complement components and the corresponding receptors (such as C3aR, C5aR) have been detected on “exposed surfaces” of the damaged regions. On a cellular level, multiple effects of complement activation products on osteoblasts, osteoclasts, chondrocytes and mesenchymal stem cells have been found. In conclusion, the complement system may be activated by trauma-altered surfaces and is crucially involved in connective tissue healing and posttraumatic systemic inflammatory response.
    No preview · Article · Aug 2015 · Advances in Experimental Medicine and Biology
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    ABSTRACT: After severe blunt chest trauma, the development of an acute lung injury (ALI) is often associated with severe or even lethal complications. Especially in multiple injured patients after blunt chest trauma ALI/ARDS [acute respiratory distress syndrome (ARDS)] is frequent. However, in the initial posttraumatic phase, inflammatory clinical signs are often not apparent and underlying changes in gene-expression profile are unknown. Therefore, inflammation in lung tissue following blunt chest trauma was characterized in a well-defined bilateral lung injury model. Using DNA microarrays representing 9240 genes, the temporal sequence of blunt chest trauma-induced gene-expression patterns in lung tissue was examined. The results suggest an activation of a highly complex transcriptional program in response to chest trauma. Chest trauma led to elevated expression levels of inflammatory and coagulatory proteins (such as TNFα receptor, IL-1α, IL-1β, C3, NF-κB and plasminogen activator). However, upregulation of proteins was found, usually incoherent of exerting effects in blunt thoracic trauma (pendrin, resistin, metallothionein and glucocorticoid-induced leucine zipper). Furthermore, significant downregulation was observed as early as 10 min after trauma for cytokines and complement factors (LCR-1, C4) as well as for intracellular signaling molecules (inhibitory protein phosphatase) and ion-channels (voltage-dependent Ca(2+) channel). Taken together, the provided global perspective of the inflammatory response following blunt chest trauma could provide a molecular framework for future research in trauma pathophysiology.
    Full-text · Article · Aug 2015
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    ABSTRACT: Cigarette smoking (CS) aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1) CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2) hyperoxia may attenuate this effect. Immediately after blast wave-induced blunt chest trauma, mice (n=32) with or without 3-4 weeks of CS exposure underwent 4 hours of pressure-controlled, thoraco-pulmonary compliance-titrated, lung-protective mechanical ventilation with air or 100 % O2. Hemodynamics, lung mechanics, gas exchange, and acid-base status were measured together with blood and tissue cytokine and chemokine concentrations, heme oxygenase-1 (HO-1), activated caspase-3, and hypoxia-inducible factor 1-α (HIF-1α) expression, nuclear factor-κB (NF-κB) activation, nitrotyrosine formation, purinergic receptor 2X4 (P2XR4) and 2X7 (P2XR7) expression, and histological scoring. CS exposure prior to chest trauma lead to higher pulmonary compliance and lower PaO2 and Horovitz-index, associated with increased tissue IL-18 and blood MCP-1 concentrations, a 2-4-fold higher inflammatory cell infiltration, and more pronounced alveolar membrane thickening. This effect coincided with increased activated caspase-3, nitrotyrosine, P2XR4, and P2XR7 expression, NF-κB activation, and reduced HIF-1α expression. Hyperoxia did not further affect lung mechanics, gas exchange, pulmonary and systemic cytokine and chemokine concentrations, or histological scoring, except for some patchy alveolar edema in CS exposed mice. However, hyperoxia attenuated tissue HIF-1α, nitrotyrosine, P2XR7, and P2XR4 expression, while it increased HO-1 formation in CS exposed mice. Overall, CS exposure aggravated post-traumatic inflammation, nitrosative stress and thereby organ dysfunction and injury; short-term, lung-protective, hyperoxic mechanical ventilation have no major beneficial effect despite attenuation of nitrosative stress, possibly due to compensation of by regional alveolar hypoxia and/or consecutive hypoxemia, resulting in down-regulation of HIF-1α expression.
    Full-text · Article · Aug 2015 · PLoS ONE
  • A. Palmer · U. Niesler · M. Eichner · F. Gebhard · M. Huber-Lang

    No preview · Conference Paper · Jun 2015

  • No preview · Article · Apr 2015 · Shock

Publication Stats

4k Citations
609.47 Total Impact Points


  • 2004-2015
    • Universität Ulm
      • • Centre of Surgery
      • • Clinic of Trauma, Hand, Plastic and Reconstructive Surgery
      Ulm, Baden-Württemberg, Germany
  • 2012
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany
  • 2005
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 1999-2002
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2000
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany