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In general, matrices for tissue engineering must maintain structural integrity during the process of tissue formation and promote vascularization of developing tissue. Therefore, collagen sponges, manufactured by an approach that offers the potential of unidirectional pore size, were seeded with human umbilical vein endothelial cells (HUVEC) to demonstrate a positive effect on cell proliferation. In addition, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) have been used to promote proliferation of HUVEC on optimized collagen sponges. Growth and viability of the cells were evaluated. Potential unidirectional pore structure demonstrated an improvement of both, endothelial cell growth and viability. Supplementation of growth factors showed an additional increase of endothelial cell growth on collagen sponges, which confirmed the high potential of combining this biomaterial with growth factors. The results suggest that a collagen sponge with a potential specific pore size could be a suitable scaffold for endothelial cells and might be a promising implantable biomaterial with enhanced angiogenic capabilities for future clinical applications.

BACKGROUND Adipose-derived stem cells are considered as candidate cells for regenerative plastic surgery. Measures to influence cellular properties and thereby direct their regenerative potential remain elusive. Hyperbaric oxygen therapy-the exposure to 100% oxygen at an increased atmospheric pressure-has been propagated as a noninvasive treatment for a multitude of indications and presents a potential option to condition cells for tissue-engineering purposes. The present study evaluates the effect of hyperbaric oxygen therapy on human adipose-derived stem cells. METHODS Human adipose-derived stem cells from healthy donors were treated with hyperbaric oxygen therapy at 2 and 3 atm. Viability before and after each hyperbaric oxygen therapy, proliferation, expression of surface markers and protein contents of transforming growth factor (TGF)-β, tumor necrosis factor-α, hepatocyte growth factor, and epithelial growth factor in the supernatants of treated adipose-derived stem cells were measured. Lastly, adipogenic, osteogenic, and chondrogenic differentiation with and without use of differentiation-inducing media (i.e., autodifferentiation) was examined. RESULTS Hyperbaric oxygen therapy with 3 atm increased viability, proliferation, and CD34 expression and reduced the CD31/CD34/CD45 adipose-derived stem cell subset and endothelial progenitor cell population. TGF-β levels were significantly decreased after two hyperbaric oxygen therapy sessions in the 2-atm group and decreased after three hyperbaric oxygen therapy sessions in the 3-atm group. Hepatocyte growth factor secretion remained unaltered in all groups. Although the osteogenic and chondrogenic differentiation were not influenced, adipogenic differentiation and autodifferentiation were significantly enhanced, with osteogenic autodifferentiation significantly alleviated by hyperbaric oxygen therapy with 3 atm. CONCLUSION Hyperbaric oxygen therapy with 3 atm increases viability and proliferation of adipose-derived stem cells, alters marker expression and subpopulations, decreases TGF-β secretion, and skews adipose-derived stem cells toward adipogenic differentiation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.

Introduction Numerous techniques have been proposed for the plastic surgical treatment of hypertrophic breasts. Challenges of the procedure include the preservation of vascular supply and sensitivity of the nipple areola complex (NAC), breast feeding, and an esthetically pleasing result. Objectives In the present preliminary report, we introduce a new technique called the three-block L -wing reduction mammaplasty that addresses the aforementioned difficulties. Materials and Methods The three-block L-wing reduction mammaplasty with a thick hemispheric superiorly based NAC pedicle and a medial as well as lateral pillar was performed in a total of 60 patients. Results Our technique increases both, vascular safety and the sensory supply to the NAC, as it conceptually decreases the need for dissection of breast tissue and skin. The incidence of fat necrosis and wound healing disorders may be reduced with this technique. Because the ducts of the breast-gland underneath the NAC are not dissected, this technique also promises a higher probability of regular breast-feeding. Finally, our technique permits a cosmetically pleasing round-shaped mound of the breast. Conclusion The three-block modification simplifies the procedure of the superior pedicle L-wing mammaplasty markedly. It may increase the esthetic as well as the functional outcome and decrease postoperative complications.

Background: The macrophage migration inhibitory factor (MIF) has been determined as a cytokine exerting a multitude of effects in inflammation and angiogenesis. Earlier studies have indicated that MIF may also be involved in wound healing and flap surgery. Methods: We investigated the effect of MIF in an excisional wound model in wildtype, Mif-/- and recombinant MIF treated mice. Wound closure rates as well as the macrophage marker Mac-3, the pro-inflammatory cytokine tumor necrosis factor α (TNFα) and the pro-angiogenic factor von Willebrand factor (vWF) were measured. Finally, we used a flap model in Mif-/- and WT mice with an established perfusion gradient to identify MIF's contribution in flap perfusion. Results: In the excision wound model, we found reduced wound healing after MIF injection, whereas Mif deletion improved wound healing. Furthermore, a reduced expression of Mac-3, TNFα and vWF in Mif-/- mice was seen when compared to WT mice. In the flap model, Mif-/- knockout mice showed mitigated flap perfusion with lower hemoglobin content and oxygen saturation as measured by O2C measurements when compared to WT mice. Conclusions: Our data suggest an inhibiting effect of MIF in wound healing with increased inflammation and perfusion. In flaps, by contrast, MIF may contribute to flap vascularization.

Rationale Skin breakdown, as in wounds, leads to an electric potential, defined as current of injury with the intent of wound closure. Burn wounds are defined by different zones of perfusion having a direct influence on further therapy (e.g. conservative management or skin grafting). We studied immediate, quantifiable effects of electric stimulation on skin perfusion in burn wounds. Method Wireless Microcurrent Stimulation (WMCS) was utilised as an adjunct therapeutic modality in 10 patients with partial thickness burn wounds. Microcirculation in the skin was quantified with a Laser Doppler (LDI) before and after WMCS treatment. We included a control group of 10 healthy individuals. Results A single application of WMCS significantly increased mean flow, velocity and subsequently, haemoglobin and oxygen saturation in partial thickness burn wounds. In healthy skin these parameters increased, but were far less pronounced than in thermally injured skin. Conclusion This study revealed, for the first time that non-contact WMCS improves blood flow in critically perfused partial thickness burn wounds without disturbing the wound or systemically affecting the patient and may represent a promising adjunct tool in burn treatment, with the potential of faster healing by enhanced perfusion of burn wounds and reduction of the zone of stasis. Level of evidence: III

Healthcare : open access journal 9(6), 616 (2021). doi:10.3390/healthcare9060616 special issue: "Special issue "Minimally invasive techniques and advanced surgical procedures" / special issue editor: Dr. Panagiotis Fikatas, guest editor", Published by MDPI, Basel

Cartilage tissue has a limited capacity for healing with the consequence that patients are often treated symptomatically until they become candidates for osteotomy or total joint replacement. Alternative biological therapies, for example, application of platelet-rich plasma and implantation of chondrocytes and mesenchymal stem cells, have emerged as a new treatment modality to repair articular cartilage. In addition, autologous fat transfer is performed for treatment of cartilage defects, example given, in osteoarthrosis, but several questions regarding basic biochemical properties of the transplant remain unanswered. Bone morphogenetic protein 4 (BMP4), matrix metalloproteinase (MMP)-8, cartilage oligomeric matrix protein (COMP), and chitinase-3-like protein 1 (CHI3L1) have been shown to be involved in chondrogenic regeneration and represent potential therapeutic agents for cartilage repair. However, no study regarding naturally occurring levels of these soluble factors in transplanted adipose tissue has yet been performed.To investigate the influence of age, body mass index, donor site, and sex on the concentration of BMP4, MMP-8, COMP, and CHI3L1 in freshly aspirated adipose tissue, their content was measured by means of enzyme-linked immunosorbent assay readings.There were significant quantities of BMP4, MMP-8, COMP, and CHI3L1 (23.6, 249.9, 298.0, and 540.6 pg/mg, respectively) in the lipoaspirate harvested for transplantation. There was no correlation between the content of soluble factors and the patients' age or body mass index. Furthermore, the sex did not affect the amount of the investigated factors. However, there were significantly lower contents of BMP4, COMP, and CHI3L1 found in lipoaspirates harvested from the abdomen compared with nonabdominal donor sites.Naturally occurring differences in the concentrations of the investigated soluble factors will favor certain donor sites for autologous fat transfer in the field of cartilage repair. Thus, increasing knowledge will enable researchers and clinicians to make autologous fat transfer procedures more reliable and efficient for treatment of articular cartilage defects.

Auch wenn der uberwiegende Teil asthetisch-plastischer Eingriffe an Frauen vorgenommen wird, stellen Manner eine relativ konstante Quote, wohingegen sich bei ihnen eine Verschiebung der durchgefuhrten Eingriffe beobachten lasst. Insbesondere die Volumentherapie mit Fillern und autologem Fett, die jeweils spezifische Eigenschaften, Vor- und Nachteile mit sich bringen, erfreuen sich zunehmender Beliebtheit.

Breast cancer is among the most commonly diagnosed cancers in the world, affecting one in eight women in their lifetimes. The disease places a substantial burden on healthcare systems in developed countries and often requires surgical correction. In spite of this, much of the breast cancer pathophysiology remains unknown, allowing for the cancer to develop to later stages prior to detection. Many women undergo reduction mammaplasties (RM) to adjust breast size, with over 500,000 operations being performed annually. Tissue samples from such procedures have drawn interest recently, with studies attempting to garner a better understanding of breast cancer’s development. A number of samples have revealed nascent cancer developments that were previously undetected and unexpected. Investigating these so-called “occult” findings of cancer in otherwise healthy patients may provide further insight regarding risk factors and countermeasures. Here, we detail occult findings of cancer in reduction mammaplasty samples provided from a cohort of over 5000 patients from 16 different institutions in Europe. Although the majority of our resected breast tissue specimens were benign, our findings indicate that there is a continued need for histopathological examination. As a result, our study suggests that preoperative imaging should be routinely performed in patients scheduled for RM, especially those with risk factors of breast cancer, to identify and enable a primary oncologic approach.

Fat grafting is as a unique regenerative filler with soluble factors and progenitor cells that may remodel scar tissue in an easy yet effective way. A combination of microfat grafting, lipococoncentrate injection, scar subcision, and platelet-rich plasma supplementation may be used to treat the majority of facial scars. The lipoconcentrate technique condenses the lipoaspirate to a progenitor cell-rich fluid of low volume by a combination of centrifugation and emulsification steps. In this article, the authors' methods for scar treatment by fat grafting are discussed. Choice of technique for facial scars, precise indications, and contraindications are introduced.

This chapter will mainly concentrate on basic principles for biopsy and excision of the primary tumour as well as lymph nodes and finally the reconstruction of malignant cutaneous tumours. Special reconstructive techniques for localized skin cancers of the respective body parts as well as the detailed surgical management of lymph nodes will be introduced in the following chapters. As the title of this chapter already suggests, cutaneous melanomas (CMs) are regarded as a special entity within the groups of malignant skin tumours due to their specific pathogenesis and treatment. They resemble the most feared malignant tumour with considerable morbidity and mortality.

Tissue expansion is based on a dynamic process of nature in which vital tissue responds to continuous mechanical stress load. The capability to gain or lose weight during pregnancy for instance demonstrates the skin ability to develop independently. Tissue expansion has a significant implication in different ethnic societies throughout the world. Enlarged lips of Ethiopian Mursi women or elongated necks of Padauang women attest the exotic aesthetics associated with tissue expansion [1]. Tissue expansion represents the medical application of this normal physiologic process for reconstructive purposes and has already provided to be a reliable principle in plastic and reconstructive surgery [2, 3].

The performance of a transparent absorbent adhesive wound dressing (TAAWD) was observed over 7 days in five plastic surgery clinics across Germany. The study included 47 diverse postoperative linear wounds and donor sites with dry or minimal exudate levels. Data on ease of application and removal, adhesive strength, skin compatibility, conformability to the body, visual wound inspection and parameters of wound assessment were collected and analysed. At the end of the observation period, 100% of wounds were recorded as healing with no reported complications. Clinicians considered that the new dressing had predominantly met clinical needs in 89% of cases. The dressing was shown to be skin friendly, easy to apply, adhere and conform to the skin while protecting the wound and allowing the patient to shower. Due to its transparency, the dressing enabled direct wound surveillance without potential disruption to the wound and healing process.

This prospective case study presents a new method for the treatment of oversized and therapy-resistant keloids of the neck and ears employing intralesional excision combined with intralesional cryosurgery. The keloids were excised in an intralesional approach, and the remaining base and lateral margins of the scar tissue were frozen using intralesional cryoneedles. After complete thawing of the frozen tissues, the margins of the scar were approximated and sutured. The follow-up period extended over 18–24 months. Over a period of 12 months, the scars gradually flattened with no hypopigmentation. No signs of recurrence of the keloids were seen. Intralesional excision of oversized and therapy-resistant keloids combined with intralesional cryosurgery could well be an additional tool to the plastic surgical armamentarium, for treating this group of patients. Level of Evidence: Level IV, therapeutic study.

To allow for a better implementation of external volume expansion to clinical applications for soft tissue regeneration, it is necessary to comprehensively understand the underlying mechanisms. As human adipose-derived stem cells (hASCs) play a crucial role in soft tissue enlargement, we investigated the impact of cyclic stretch on gene expression, proliferation rate and adipogenic differentiation of these cells. After cyclic stretching, RNA was extracted and subjected to DNA microarray analysis and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Also, the expression of FABP4 mRNA was analysed by RT-qPCR to test whether mechanical stretch affected adipogenic differentiation of hASCs. The proliferation rate was assessed using the alamarBlue assay and Ki-67 staining. A cell cycle analysis was performed with flow cytometry and Western blot. We found that cyclic stretch significantly induced the expression of CYP1B1 mRNA. Furthermore, the adipogenic differentiation of hASCs was impaired, as was the proliferation. This was partly due to a decrease in extracellular signal-regulated kinase (ERK) 1/2 and histone H3 phosphorylation, suggesting a growth arrest in the G2 /M phase of the cell cycle. Enrichment analyses demonstrated that stretch-regulated genes were over-represented in pathways and biological processes involved in extracellular matrix organization, vascular remodelling and responses to cell stress. Taken together, mechanical stress impaired both proliferation and adipogenic differentiation, but led to a tissue-remodelling phenotype of hASCs. These data suggest that extracellular matrix remodelling and neoangiogenesis may play a more important role in external volume expansion than proliferation and adipogenesis of hASCs. Copyright © 2017 John Wiley & Sons, Ltd.

Background: Although chemical antiseptics are the most basic measure to control wound infection and frequently come into contact with subcutaneous adipose tissue, no studies have evaluated their toxicity on adipose tissue and its cell fractions. In the present study, the effects of five different antiseptics on adipose-derived stem cells were evaluated. Methods: Human adipose-derived stem cells were harvested from healthy donors. Adipose-derived stem cell viability was measured after treatment with different concentrations of antiseptics over 5 days. Furthermore, the effect on the proliferation, adipogenic differentiation, and apoptosis/necrosis of adipose-derived stem cells was analyzed. Finally, the mRNA expression of the stem cell markers CD29, CD34, CD73, CD90, and CD105 was detected. Results: Octenisept and Betaisodona significantly reduced cell proliferation and differentiation and led to considerable adipose-derived stem cell necrosis. Octenisept decreased stem cell viability at the lowest concentrations tested, and all stem cell markers were down-regulated by Octeniseptr and Betaisodona. Lavasept and Prontosan both led to reduced stem cell viability, proliferation, and differentiation, and increased apoptosis/necrosis, although the effects were less pronounced compared with Octenisept and Betaisodona. Adipose-derived stem cells survived treatment with mafenide acetate even at high concentrations, and mafenide acetate showed minimal negative effects on their proliferation, adipogenic differentiation, cell death, and stem cell marker expression. Conclusions: Mafenide acetate may be regarded as a feasible antiseptic for the treatment of wounds with exposed adipose tissue because of its low adipose-derived stem cell toxicity. Lavasept and Prontosan are possible alternatives to mafenide acetate. Octenisept and Betaisodona, by contrast, may be used only in highly diluted solutions.

In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRAC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.

Progress in material development has enabled the production of nerve guides that increasingly resemble the characteristics of an autologous nerve graft. In the present study, 20 mm adult rat sciatic nerve defects were bridged with the collagen-based, two-component nerve guide 'Neuromaix', the commercially available NeuraGen® nerve tube or an autologous nerve graft. Neuromaix was able to support structural as well as functional regeneration across this gap. The majority of the axons grew across the scaffold into the distal nerve segment and retrograde tracing confirmed that these axons were of somatosensory and motor origin. Histomorphology revealed that axons regenerating through Neuromaix exhibited reduced myelin sheath thickness, whereas axon diameter and axon density were comparable to those of the autograft. Neuromaix implantation resulted in reinnervation of the gastrocnemius muscle to a level that was not significantly different from that supported by the autograft, as demonstrated by electrophysiology. Our findings show that the use of the Neuromaix scaffold not only allowed axonal regeneration across large nerve gaps, but that the regenerating axons were also able to functionally reinnervate the muscles. These data provide a promising perspective for the first in human application of the materials. Copyright © 2016 John Wiley & Sons, Ltd.

Hintergrund: Die autologe Fetttransplantation ist eine in letzter Zeit zunehmend verbreitete operative Prozedur und umfasst die Entnahme, Bearbeitung und Transplantation von Fettgewebe sowie die fachgerechte Nachsorge. Dieser operative Eingriff ist ein Verfahren, das sowohl nach traumatischem, krankheits- oder altersbedingtem Volumenverlust der Weichteile als auch zur Weichteilaugmentation eingesetzt werden kann. Aufgrund der zunehmenden Anwendung aber noch bisher wenig definierten Variablen in der Fettgewinnung, Indikationsstellung und Art der Transplantation in der rekonstruktiven und asthetischen Chirurgie besteht ein groses Interesse an der Entwicklung einer Leitlinie. Methodik: In einer Konsensuskonferenz im Rahmen eines nominalen Gruppenprozesses der anwendenden Fachgesellschaften wurden alle im Delphi-Verfahren strittigen Punkte diskutiert und mit starken Konsens (>95%) beschlossen. Die Literatur der letzten 10 Jahre in den gangigen medizinischen Informationsportalen und Datenbanken wurde abgefragt, studiert und unter Berucksichtigung auch wichtiger alterer Arbeiten entscheidende Aussagen der Leitlinie belegt. Ergebnisse: Unter Einschluss aller relevanten Fachgesellschaften wurden hinsichtlich nachfolgender Punkte konsensbasierte Empfehlungen in Form dieser Leitlinie formuliert. 1. Definition, 2. Indikation/Kontraindikation, 3. Praoperative Masnahmen, 4. Entnahmetechniken, 5. Bearbeitungstechniken, 6. Transplantation, 7. Nachsorge, 8. Aufbewahrung und Lagerung, 9. Effizienz, 10. Dokumentation, 11. Bewertung der Sicherheit. Zusammenfassung: Klare Indikationsstellung und fachliche Expertise sind Grundvoraussetzung um die autologe Fetttransplantation durchzufuhren. Der Erfolg dieses operativen Eingriffs ist abhangig vom Einsatz der richtigen Methoden sowie der speziellen Instrumente und Materialen. Aufgrund der niedrigen Rate an postoperativen Komplikationen und Spatfolgen ist die autologe Fetttransplantation als sicheres Verfahren in der rekonstruktiven und asthetischen Medizin anzusehen. Teile dieses Artikels sind wortlich aus der Leitlinie entnommen 1

Autologous adipose tissue (AT) transfer has gained widespread acceptance and is used for a broad variety of regenerative clinical indications. It is assumed that the successful outcome of AT transfer essentially depends on the amount of autocrine-generated growth factors (GF). It is supposed that several GF enhance and improve the anatomic and functional integration of the transplanted AT grafts at the site of implantation. In the present study we have investigated for the first time the correlation between the concentration of GF of freshly isolated AT and the proliferation and migration capacity of mesenchymal stroma cells (MSCs) derived from the respective AT sample. We here show that the proliferation and migration capacity of MSCs strongly depends on the GF content of the AT the cells were isolated from but in an inversely proportional manner. The lower the GF content of an AT sample was, the higher was the proliferation and migration capacity of the respective MSC population contained in the AT and vice versa. Furthermore, we found that supplementation with recombinant GFs only in the case of AT samples with low but not with higher growth factor contents led to a significant enhancement of proliferation and migration of the AT-resident MSCs. As we further show, this inefficiency of GFs to enhance MSC proliferation and migration in AT samples with high GF contents indicates a GF-mediated negative feedback mechanism leading to an impaired GF signaling in MSC obtained from those AT samples. Our results might explain why the successful use of AT grafting is frequently limited by low and unpredictable survival rates, and we suggest to use the knowledge of GF content of harvested AT as a predictive clinical parameter for risk assessment of the therapeutic outcome of autologous AT transfer.

Sepsis is a leading cause of death worldwide and recent studies have shown white adipose tissue (WAT) to be an important regulator in septic conditions. In the present study, the role of the inflammatory cytokine macrophage migration inhibitory factor (MIF) and its structural homolog D-dopachrome tautomerase (D-DT/MIF-2) were investigated in WAT in a murine endotoxemia model. Both MIF and MIF-2 levels were increased in the peritoneal fluid of LPS-challenged wildtype mice, yet in visceral WAT, the proteins were differentially regulated, with elevated MIF but down-regulated MIF-2 expression in adipocytes. Mif gene deletion polarized adipose tissue macrophages (ATM) towards an anti-inflammatory phenotype while Mif-2 gene knockout drove ATMs towards a pro-inflammatory phenotype and Mif-deficiency was found to increase fibroblast viability. Additionally, we observed the same differential regulation of these two MIF family proteins in human adipose tissue in septic vs healthy patients. Taken together, these data suggest an inverse relationship between adipocyte MIF and MIF-2 expression during systemic inflammation, with the downregulation of MIF-2 in fat tissue potentially increasing pro-inflammatory macrophage polarization to further drive adipose inflammation.

The Vectra X3 3-dimensional face scanner allows us to visualise the erythema of superficial layers of skin in addition to its regular scanning functions. The aim of our study was to find out whether changes we provoked in the circulation of the skin would be registered and displayed by the face scanner. We measured the circulation in the skin of the cheeks of 20 volunteers with a face scanner, a laser Doppler device, and a skin pigmentation analyser before and after the application of a nitric oxide cream. The results were compared in terms of grey tones, local concentrations of haemoglobin, and erythema. All methods showed significant changes (p0.001) before and after application of the cream. The study proved that the Vectra X3 recognises changes in skin circulation and displays them in a simple and evident way.

Background One increasingly important trend in plastic, reconstructive, and aesthetic surgery is the use of fat grafts to improve cutaneous wound healing. In clinical practice, lipoaspirates (adipose tissue harvested by liposuction) are re-injected in a procedure called lipofilling. Previous studies, however, mainly evaluated the regenerative effect of isolated adipocytes, adipose-derived stem cells, and excised en bloc adipose tissue on keratinocytes, whereas no study to date has examined the effect of lipoaspirates. Objectives The authors aimed to investigate differences in the regenerative property of en bloc adipose tissue and lipoaspirates on keratinocytes. Methods Human keratinocytes, lipoaspirates, and en bloc adipose tissue from 36 healthy donors were isolated. In vitro proliferation, differentiation, migration, stratification, and wound healing of keratinocyte monolayers were measured. Furthermore, secreted levels of VEGF, bFGF, IGF-1, MMP-9, and MIF were detected by ELISA. Results Migration, proliferation, and wound healing of keratinocytes were increased by lipoaspirates. Interestingly, the effect of lipoaspirates on keratinocyte proliferation was significantly higher than by en bloc adipose tissue after 5 days. The differentiation of keratinocytes was equally attenuated by lipoaspirates and en bloc adipose tissue. Stratification of keratinocyte layers was enhanced by lipoaspirates and en bloc fat when compared to controls. Lipoaspirates secrete higher levels of bFGF, whereas higher levels of VEGF and IGF-1 are released by en bloc adipose tissue. Conclusion We show that lipoaspirates and en bloc adipose tissue have a regenerative effect on keratinocytes. One reason for the higher effect of lipoaspirates on keratinocyte proliferation may be the secretion of different cytokines. [10.1093/asj/sjw076][1] [1]: /lookup/doi/10.1093/asj/sjw076

In the present observational study, we measured serum levels of the chemokine stromal cell-derived factor-1α (SDF-1α) in 100 patients undergoing cardiac surgery with cardiopulmonary bypass at seven distinct time points including preoperative values, myocardial ischemia, reperfusion, and the postoperative course. Myocardial ischemia triggered a marked increase of SDF-1α serum levels whereas cardiac reperfusion had no significant influence. Perioperative SDF-1α serum levels were influenced by patients' characteristics (e.g., age, gender, aspirin intake). In an explorative analysis, we observed an inverse association between SDF-1α serum levels and the incidence of organ dysfunction. In conclusion, time of myocardial ischemia was identified as the key stimulus for a significant upregulation of SDF-1α, indicating its role as a marker of myocardial injury. The inverse association between SDF-1α levels and organ dysfunction association encourages further studies to evaluate its organoprotective properties in cardiac surgery patients.

Haut- und Weichteilinfektionen konnen zum Teil einen fulminanten Verlauf nehmen und werden dann schnell lebensbedrohlich, wenn sie nicht rechtzeitig und radikal behandelt werden. In diesem Fall stellte sich ein 44-jahriger Patient ohne Vorerkrankungen mit einer scheinbar harmlosen Bursitis olecrani und unspezifischen Allgemeinsymptomen in unserer Notfallambulanz vor. Innerhalb kurzester Zeit entwickelte sich ein absolut lebensbedrohlicher Zustand.Wir beschreiben den Verlauf wahrend des mehrwochigen Aufenthalts auf unserer Intensivstation sowie unsere Diagnosen und Therapie-Ansatze.

An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The computational model is based on the multi-body simulation software AnyBody. Multi body dynamic musculoskeletal models capable of predicting muscle forces and joint contact pressures simultaneously would be valuable for studying clinical issues related to wrist joint degeneration and restoration. In this study, the simulation model of the wrist joint was used for investigating deeper the biomechanical function of the wrist joint. In representative physiological scenarios, the joint behavior and muscle forces were computed. Furthermore, the load transmission of the proximal wrist joint was investigated. The model was able to calculate the parameters of interest that are not easily obtainable experimentally, such as muscle forces and proximal wrist joint forces. In the case of muscle force investigation, the computational model was able to accurately predict the computational outcome for flexion and extension motion. In the case of force distribution of the proximal wrist joint, the model was able to predict accurately the computational outcome for an axial load of 140 N. The presented model and approach of using a multi-body simulation model are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient-specific planning and custom implant design. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.