Comparing the quality of care in physician networks to usual care for elderly patients in three German regions: a quasi-experimental cohort study.

OBJECTIVES: Patients in Germany have free choice of physicians in the ambulatory care sector and can consult them as often as they wish without a referral. This can lead to inefficiencies in treatment pathways. In response, some physicians have formed networks to improve the coordination and quality of care. This study aims to investigate whether the care provided by these networks results in better health and process outcomes than usual care. STUDY DESIGN: This was a quasi-experimental cohort study. METHODS: We analysed claims data from 2017 to 2018 in Bavaria, Brandenburg, and Westphalia-Lippe. Our study population includes patients aged 65 years or older with heart failure (n = 267,256), back pain (n = 931,672), or depression (n = 483,068). We compared condition-specific and generic quality indicators between patients treated in physician networks and usual care. Ambulatory care-sensitive emergency department cases were used as a primary outcome measure. Imbalances between the groups were minimized using propensity score matching. RESULTS: Rates of ambulatory care-sensitive emergency department cases yielded insignificant differences between networks and usual care in the depression and heart failure subgroups. For back pain patients, rates were 0.17 percentage points higher (P < 0.01) in network patients compared with usual care. Among network patients, generic indicators for prevention and coordination showed significantly better performance. For instance, the rate of completed vaccination against influenza is 3.03 percentage points higher (P < 0.01), and the rate of specialist visits after referral is 1.6 percentage points higher (P < 0.01) in heart failure patients, who are treated in physician networks. This is accompanied by higher rates of polypharmacy. Furthermore, the results for condition-specific indicators suggest that for most indicators, a greater proportion of the care provided by physician networks adhered to national treatment guidelines. CONCLUSIONS: Our findings suggest that physician networks in Germany do not reduce rates of ambulatory care-sensitive emergency department cases but perform better than usual care in terms of care coordination and prevention. Further research is needed to confirm our findings and explore the implications of the potentially higher rates of polypharmacy seen in physician networks.

Relações entre aptidão cardiorrespiratória, tempo de tela e obesidade em escolares: uma revisão sistemática / Relación entre la aptitud cardiorrespiratoria, el tiempo de pantalla y la obesidad en escolares: una revisión sistemática / Relationship between cardiorrespiratory fitness, screen time and obesity in schools: a systematic review

El estudio tuvo como objetivo realizar una revisión sistemática, con el fin de mapear la asociación entre la aptitud cardiorrespiratoria, el tiempo de pantalla y el estado de peso en niños y adolescentes, así como verificar la dirección de estas relaciones. La búsqueda se realizó de acuerdo con las recomendaciones de PRISMA, en las bases de datos Web of Science, Scopus y Medline. Se incluyeron estudios completos y originales, publicados entre 2000 y marzo de 2021, que evaluaban las variables citadas en conjunto y / o asociaciones. Se identificaron 152 artículos y, después del refinamiento según los resultados, se evaluaron cualitativamente 30 documentos. Se puede observar que las variables de salud, como aptitud cardiorrespiratoria, tiempo de pantalla y estado de peso, continúan con datos negativamente alarmantes en esta población, y que están fuertemente correlacionadas, demostrando que la modificación de una de ellas puede interferir con las otras. mejorando así el estado de salud de niños y adolescentes.(AU)

O estudo teve como objetivo realizar uma revisão sistemática, com intuito de mapear as relações entre aptidão cardiorrespiratória, tempo de tela eestado nutricional em crianças e adolescentes, bem como verificar qual a direção dessas relações. A busca foi realizada de acordo com as recomendaçõesPRISMA, nas bases de dados Web of Science, Scopus, e no Medline. Foram incluídos estudos completos e originais, publicados entre 2000 e março de 2023,e que avaliassem as variáveis citadas de forma concomitante e/ou associações. Foram identificados 210 artigos, e após refinamento conforme desfechos,34 documentos avaliados de forma qualitativa. Pode-se verificar que as variáveis de saúde, como aptidão cardiorrespiratória, tempo de tela e estadonutricional, seguem com dados negativamente alarmantes nesta população, e que elas estão correlacionadas fortemente, demonstrando que amodificação de uma delas pode vir a interferir nas demais, melhorando assim o status de saúde de crianças e adolescentes.(AU)

The study aimed to carry out a systematic review, with the aim of mapping the relationships between cardiorespiratory fitness, screen time andnutritional status in children and adolescents, as well as verifying the direction of these relationships. The search was carried out according to thePRISMA recommendations, in the Web of Science, Scopus, and Medline databases. Complete and original studies, published between 2000 and March2023, that evaluated the variables cited concomitantly and / or associations were included. 210 articles were identified, and after refinement accordingto outcomes, 34 documents were evaluated qualitatively. It can be seen that the health variables, such as cardiorespiratory fitness, screen time andweight status, continue with negatively alarming data in this population, and that they are strongly correlated, demonstrating that the modification of oneof them may interfere with the others , thus improving the health status of children and adolescents.(AU)

Mismatch repair deficiency, chemotherapy and survival for resectable gastric cancer: an observational study from the German staR cohort and a meta-analysis.

PURPOSE: In a post hoc analysis of the MAGIC trial, patients with curatively resected gastric cancer (GC) and mismatch repair (MMR) deficiency (MMRd) had better median overall survival (OS) when treated with surgery alone but worse median OS when treated with additional chemotherapy. Further data are required to corroborate these findings. METHODS: Between April 2013 and December 2018, 458 patients with curatively resected GC, including cancers of the esophagogastric junction Siewert type II and III, were identified in the German centers of the staR consortium. Tumor sections were assessed for expression of MLH1, MSH2, MSH6 and PMS2 by immunohistochemistry. The association between MMR status and survival was assessed. Similar studies published up to January 2021 were then identified in a MEDLINE search for a meta-analysis. RESULTS: MMR-status and survival data were available for 223 patients (median age 66 years, 62.8% male), 23 patients were MMRd (10.3%). After matching for baseline clinical characteristics, median OS was not reached in any subgroup. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd and MMRp had a HR of 0.67 (95% CI 0.13-3.37, P = 0.63) and 1.44 (95% CI 0.66-3.13, P = 0.36), respectively. The meta-analysis included pooled data from 385 patients. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd had an improved OS with a HR of 0.36 (95% CI 0.14-0.91, P = 0.03), whereas those with MMRp had a HR of 1.18 (95% CI 0.89-1.58, P = 0.26). CONCLUSION: Our data support a positive prognostic effect for MMRd in GC patients treated with surgery only and a differentially negative prognostic effect in patients treated with perioperative chemotherapy. MMR status determined by preoperative biopsies may be used as a predictive biomarker to select patients for perioperative chemotherapy in curatively resectable GC.

OR.NET: multi-perspective qualitative evaluation of an integrated operating room based on IEEE 11073 SDC.

PURPOSE: Clinical working environments have become very complex imposing many different tasks in diagnosis, medical treatment, and care procedures. During the German flagship project OR.NET, more than 50 partners developed technologies for an open integration of medical devices and IT systems in the operating room. The aim of the present work was to evaluate a large set of the proposed concepts from the perspectives of various stakeholders. METHOD: The demonstration OR is focused on interventions from the head and neck surgery and was developed in close cooperation with surgeons and numerous colleagues of the project partners. The demonstration OR was qualitatively evaluated including technical as well as clinical aspects. In the evaluation, a questionnaire was used to obtain feedback from hospital operators. The clinical implications were covered by structured interviews with surgeons, anesthesiologists and OR staff. RESULTS: In the present work, we qualitatively evaluate a subset of the proposed concepts from the perspectives of various stakeholders. The feedback of the clinicians indicates that there is a need for a flexible data and control integration. The hospital operators stress the need for tools to simplify risk management in openly integrated operating rooms. CONCLUSION: The implementation of openly integrated operating rooms will positively affect the surgeons, the anesthesiologists, the surgical nursing staff, as well as the technical personnel and the hospital operators. The evaluation demonstrated the need for OR integration technologies and identified the missing tools to support risk management and approval as the main barriers for future installments.

Inflammation, vitamin D and dendritic cell precursors in chronic kidney disease.

Decreased blood dendritic cell precursors (DCP) count is linked with atherosclerotic disease, while reduction of circulating DCP is also seen in patients with chronic kidney disease (CKD). As poor vitamin D status could be linked to a compromised innate immune response, we hypothesized that vitamin D status might be involved in the decrease in circulating DCP in CKD. Moreover, the potential role of inflammation was considered. Circulating myeloid (mDCP), plasmacytoid (pDCP) and total DCP (tDCP) were analysed using flow cytometry in 287 patients with CKD stage 3. Serum 25(OH)D and 1,25(OH)2D levels were measured using enzyme-linked immunosorbent assays (ELISA), interleukin (IL)-6, IL-10 and tumour necrosis factor (TNF)-α using cytometric bead array, C-reactive protein (CRP) using a high-sensitivity (hs) ELISA. Contrary to our hypothesis, there was no association between vitamin D levels and DCP, although their number was decreased significantly in CKD (P < 0·001). Instead, mDCP (r = -0·211) and tDCP (r = -0·188,) were associated slightly negatively with hsCRP but positively with the estimated glomerular filtration rate (eGFR, r = 0·314 for tDCP). According to multivariate linear regression, only higher hsCRP concentration and the presence of diabetes mellitus had a significant negative influence on DCP count (P < 0·03, respectively) but not vitamin D, age and eGFR. A significant impact of vitamin D on the reduction of circulating DCP in CKD 3 patients can be neglected. Instead, inflammation as a common phenomenon in CKD and diabetes mellitus had the main influence on the decrease in DCP. Thus, a potential role for DCP as a sensitive marker of inflammation and cardiovascular risk should be elucidated in future studies.

Progression and recovery of Parkinsonism in a chronic progressive MPTP-induction model in the marmoset without persistent molecular and cellular damage.

Chronic exposure to low-dose 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in marmoset monkeys was used to model the prodromal stage of Parkinson's disease (PD), and to investigate mechanisms underlying disease progression and recovery. Marmosets were subcutaneously injected with MPTP for a period of 12weeks, 0.5mg/kg once per week, and clinical signs of Parkinsonism, motor- and non-motor behaviors were recorded before, during and after exposure. In addition, postmortem immunohistochemistry and proteomics analysis were performed. MPTP-induced parkinsonian clinical symptoms increased in severity during exposure, and recovered after MPTP administration was ended. Postmortem analyses, after the recovery period, revealed no alteration of the number and sizes of tyrosine hydroxylase (TH)-positive dopamine (DA) neurons in the substantia nigra. Also levels of TH in putamen and caudate nucleus were unaltered, no differences were observed in DA, serotonin or nor-adrenalin levels in the caudate nucleus, and proteomics analysis revealed no global changes in protein expression in these brain areas between treatment groups. Our findings indicate that parkinsonian symptoms can occur without detectable damage at the cellular or molecular level. Moreover, we show that parkinsonian symptoms may be reversible when diagnosed and treated early.

Osteocalcin, adipokines and their associations with glucose metabolism in type 1 diabetes.

To determine osteocalcin (OC) and adipokines in type 1 diabetes (T1D) and healthy controls, and to explore possible associations between glucose and bone metabolism, body composition and adipokines. Serum levels of total OC, undercarboxylated (UC-OC), leptin, adiponectin, and other parameters of glucose and bone metabolism were measured in 128 patients with T1D (mean duration 21.2years) and in 77 healthy controls, matched for gender, age, and body mass index (BMI). Partial correlations (adjusted for age and gender) with parameters of body composition (BMI, fat body mass [derived from bone mineral density scans]), glycaemic control (hemoglobin A1c (HbA1c), daily insulin dose in T1D), skeletal homeostasis (osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), all measured in serum), and serum insulin-like growth factor 1 (IGF-1) were also examined. Independent predictors of total and UC-OC were then explored. Total OC was lower in males with T1D (16.3±6.4 vs. 22.2±9.9ng/ml; p=0.001), whereas UC-OC did not show group differences. Adiponectin was higher in T1D patients, both for males and females (8.9±6.6 vs. 5.7±2.5µg/ml; p=0.004 and 13.8±6.4 vs. 8.8±4.0µg/ml; p<0.001). IGF-1 was lower only in females with T1D (146.6±68.8 vs. 203.0±74.4ng/ml; p<0.001). BMI and fat body mass were similar in T1D and controls. In T1D patients, total OC was inversely correlated with BMI and HbA1c, and UC-OC inversely correlated with HbA1c. In T1D patients, leptin positively correlated with BMI, fat body mass and daily insulin dose, while adiponectin inversely correlated with BMI and daily insulin dose. Multivariate regression modelling showed that determinants of higher total OC levels were male gender (p=0.04, ß-coefficient=2.865) and lower HbA1c (p=0.04, ß-coefficient=-0.117), whereas determinants of UC-OC levels were T1D (p=0.016, ß-coefficient=2.015), higher IGF-1 (p=0.004, ß-coefficient=0.011) and lower HbA1c (p=0.011, ß-coefficient=- 0.061). Total OC and UC-OC are associated with good glycaemic control in T1D, with gender-specific differences for total-OC. The association of leptin and adiponectin with glycaemic control, as observed in controls, does not seem to be a feature in T1D, although both adipokines appear to be related to the insulin demand. This article is part of a Special Issue entitled "Bone and diabetes".

Uranium Hydridoborates: Synthesis, Magnetism, and X-ray/Neutron Diffraction Structures.

While uranium hydridoborate complexes containing the [BH4](-) moiety have been well-known in the literature for many years, species with functionalized borate centers remained considerably rare. We were now able to prepare several uranium hydridoborates (1-4) with amino-substituted borate moieties with high selectivity by smooth reaction of [Cp*2UMe2] (Cp* = C5Me5) and [Cp'2UMe2] (Cp' = 1,2,4-tBu3C5H2) with the aminoborane H2BN(SiMe3)2. A combination of nuclear magnetic resonance spectroscopy, deuteration experiments, magnetic SQUID measurements, and X-ray/neutron diffraction studies was used to verify the anticipated molecular structures and oxidation states of 1-4 and helped to establish a linear tridentate coordination mode of the borate anions.

[Anatomic reconstruction of hip joint biomechanics: conventional vs. short-stem prosthesis]. / Die anatomische Rekonstruktion des Hüftgelenks: ein Vergleich von Kurz- und Standardschaft.

BACKGROUND: Currently, short cementless femoral stems are alternative implants to treat osteoarthritis in young patients with sufficient bone quality in order to get a more proximal load transfer. The purpose of the present study was to biomechanically compare joint reconstructions resulting from implantations of a short-stemmed and a conventional hip replacement. METHODS: 100 patients (50 short-stemmed and 50 conventional) were retrospectively examined. For evaluation of biomechanical parameters standardised pre- and postoperative X-rays (pelvic AP views) were used and digitally analysed. RESULTS: The horizontal femoral off-set increased within both groups (short: 2.0 mm and conventional: 3.3 mm), with a significant increase in the conventional group. The hip centre of rotation was significantly medialised after both procedures (short: 6.0 mm and conventional: 4.2 mm). Limb length was shorter preoperatively at the arthroplasty side, but increased thereafter (short: 2.1 mm and conventional: 2.6 mm). Compared to the native contralateral side the limb length was almost equal after THA (short: 0.7 mm and conventional: 0.8 mm). CONCLUSIONS: Our study shows that an almost anatomic reconstruction of hip joint biomechanics is possible with a short-stemmed prosthesis compared to a conventional stem, regarding limb length, centre of rotation and offset.

[Mason I fracture - a simple injury?]. / Mason-I-Fraktur - eine harmlose Verletzung?

BACKGROUND: Mason I fractures of the radial head are judged to be simple injuries that can generally be treated nonoperatively. According to the current literature mainly good and excellent results can be expected. We present a case series of patients presenting to us due to complications of Mason I fractures. PATIENTS AND METHODS: We reviewed all cases of patients that were treated because of complaints following Mason I radial head fractures. In all, 16 patients (10 men and 6 women) were identified. Mean age was 37 years (range 16-59 years). Mean time between trauma and surgery was 25 months (range 1-108 months). RESULTS: Ten patients developed painful osteoarthritis with elbow stiffness and loose bodies, 4 patients suffered a posterolateral rotatory instability that had to be treated with ligament reconstruction, 1 patient presented with a combined medial and lateral instability, and 1 patient with a symptomatic hypertophic plica posterolateralis. Diagnotics and therapeutic concepts of these complications will be presented. CONCLUSION: In light of the complications, Mason I fractures must be reevaluated. They remain the domain of conservative treatment but close follow-up is recommended to recognize possible complications early in order to prevent stiffness, chronic instabilities, and osteoarthritis.

High serum pentosidine but not esRAGE is associated with prevalent fractures in type 1 diabetes independent of bone mineral density and glycaemic control.

UNLABELLED: Fracture risk in type 1 diabetes (T1D) is supposed to be underestimated by bone mineral density (BMD). Individuals with T1D had more prevalent fractures in a cross-sectional study. Serum levels of pentosidine, an advanced glycation end product, and poor glycaemic control were associated with prevalent fractures independent of BMD. INTRODUCTION: Type 1 diabetes (T1D) is associated with increased fracture risk. Bone mineral density (BMD) underestimates the risk of fractures in some individuals. The accumulation of advanced glycation end products (AGEs) impairs bone matrix and reduces bone strength. METHODS: In a cross-sectional study, 128 men and premenopausal women with T1D were evaluated. We compared traditional risk factors for fractures, BMD, parameters of bone metabolism and AGEs in individuals with and without prevalent fractures. An independent association of serum AGE levels with prevalent fractures was investigated. RESULTS: Individuals with prevalent fractures exhibited a longer duration of T1D, higher HbA1c and more diabetic-related complications. BMD at the femoral neck (z-score -0.76 ± 0.94 vs. -0.23 ± 1.02; p = 0.031) and total hip (z-score -0.54 ± 0.93 vs. 0.11 ± 1.11; p = 0.017) was lower in those with prevalent fractures. Individuals with fractures had higher pentosidine levels (164.1 ± 53.6 vs. 133.2 ± 40.4; p = 0.002). The levels of N-ε-(carboxymethyl)-lysine (CML) and endogenous secretory receptor for AGEs (esRAGE) did not significantly differ. Multivariate logistic regression analysis adjusted for age, BMI, family history of fractures, smoking, vitamin D deficiency, BMD at lumbar spine, femoral neck and total hip identified pentosidine levels and HbA1c as independent factors associated with prevalent fractures (odds ratio 1.02, 95% CI 1.00-1.03/pmol/ml increase of pentosidine; p = 0.008 and odds ratio 1.93, 95% CI 1.16-3.20 per percentage increase of HbA1c; p = 0.011). CONCLUSIONS: The pentosidine levels but not BMD are independently associated with prevalent fractures. Impaired bone quality in T1D may result from increased AGE formation.

[Anatomic reconstruction of hip joint biomechanics with the bone preserving Silent Micro Hip™ prosthesis]. / Anatomische Rekonstruktion des Hüftgelenks mit der schenkelhalserhaltenden Silent Micro Hip™.

BACKGROUND: The design and the surgical technique of the Silent Micro Hip™ are different compared to other hip stems due to a conical shape for fixation within the metaphyseal femur. The purpose of the present study was to evaluate hip joint biomechanics of the Silent Micro Hip™ in comparison to other implants. Implant-specific differences are highlighted. MATERIAL AND METHOD: 150 consecutive patients (each group 50 Silent Micro Hip™, Nanos™ and SL-Plus™ MIA) were analysed retrospectively. For evaluation of biomechanical parameters pre- and postoperative X-rays (pelvic AP views) were used. RESULTS: The horizontal femoral offset and the limb length showed no significant difference between the Silent Micro Hip™ and the Nanos™ or SL-Plus™ MIA stem at the reconstructed hip. An almost anatomic reconstruction of hip joint biomechanics was reached with all three types of implants. CONCLUSIONS: The Silent Micro Hip™ allows for almost anatomic reconstruction of hip joint biomechanics. Short-term results support the bone-preserving reconstruction with a proximal femoral load transfer. Further studies on the mid- and long-term outcomes are ongoing.

[Transosseous refixation of the common extensor muscle tendons in chronic lateral epicondylitis with and without additional reconstruction of the LUCL--a retrospective evaluation of 101 patients]. / Die transossäre Refixation der Extensoren bei chronischer radialer Epikondylopathie mit und ohne Rekonstruktion des LUCL-Komplexes--eine retrospektive Analyse von 101 Patienten.

INTRODUCTION: The chronic lateral epicondylitis (EHR) as a common pathology of the elbow is often associated with posterolateral rotatory instability of the elbow (PLRI). After evaluation of intra-articular pathology by prior diagnostic arthroscopy, we aimed to build patient groups regarding the stability of the elbow joint. In patients with a stable elbow joint, open surgery with a debridement to the origin of the common extensor tendon and transosseous refixation was performed. Patients with relevant posterolateral rotatory instability, however, underwent an additional LUCL complex stabilisation using triceps tendon graft besides debridement as mentioned above. The purpose of this study was to evaluate and compare the clinical functional outcome between these groups. MATERIAL AND METHODS: 101 patients were included in our study. Arthroscopies were first performed on all patients to identify intra-articular pathological changes. In 26 patients with stable elbows, open surgery with debridement to the origin of the common extensor tendon and transosseous refixation was performed. For the other 75 patients who were found presenting a relevant posterolateral rotatory instability, a stabilisation of the LUCL in addition to the open procedure mentioned above was performed. Examinations and questionnaires were used for retrospective evaluation at follow-up. RESULTS: Both groups of patients revealed significant improvement in pain relief and elbow function. We observed no significant difference between the two methods concerning clinical and functional outcome. CONCLUSION: We recommend diagnostic arthroscopy with assessment of stability prior to the open performance to offer a more reliable evidence for surgical technique selection and therefore to achieve a better clinical outcome.

Two-dimensional ultrasound Doppler velocimeter for flow mapping of unsteady liquid metal flows.

We present a novel pulsed-wave ultrasound Doppler system for fluid flow investigations being able to determine two-dimensional vector fields of flow velocities. Electromagnetically-driven liquid metal flows appear as an attractive application field for such a measurement system. Two linear ultrasound transducer arrays each equipped with 25 transducer elements are used to measure the flow field in a square plane of 67×67 mm(2). The application of advanced processing methods as a multi-beam operation, an interlaced echo signal acquisition and a segmental array technique enable high data acquisition rates and concurrently a high spatial resolution, which have not been obtained so far for flow measurements in liquid metals. The extended pulsing strategy and essential operation principles such as the multiplexing electronic concept will be presented within this paper. The capabilities of the measuring system make it suitable for investigations of non-transparent, turbulent flows. Here, we present measurements of liquid metal flows driven by a rotating magnetic field for demonstration purposes. The measuring setup realized here reveals details of the swirling fluid motion in a horizontal section of a cube. Frame acquisition rates up to 30 fps were achieved for a complete two-dimensional flow mapping.

[Psychosocial care in institutional neonatology in Germany: a quantitative-empirical inventory from the medical professionals' perspective]. / Die psychosoziale Versorgung in der Neonatologie in Deutschland: Eine quantitativ-empirische Bestandsaufnahme aus ärztlicher Perspektive.

BACKGROUND: The available studies concerning the long-term development of preterm infants emphasise the protective significance of the parents. As a consequence, concomitant psychosocial support for parents during the neonatal period aiming at moderating the adverse effects of the critical incident "premature birth" is deemed to be imperative. The aim of this study is to assess the supply of psychosocial services in neonatal care units as viewed by medical professionals in Germany. METHODS: A representative questionnaire-based survey in German neonatal care units was undertaken. A descriptive evaluation was made of frequency distributions, comparison of means between former West German and former East German states and levels of neonatal care (levels I-III). RESULTS: The time-budget available for parent consultation is considered insufficient by approximately one third (31.9%) of the medical personnel, 22.2% of the interviewees felt this task to be excessively demanding. As a standard, the option for cooperation with a qualified psychosocial consultant is available in 67.0% of the neonatal care units. 95.7% of the medical personnel consider this cooperation a desirable support; 97.9% consider interdisciplinary cooperation in neonatology a desirable option in general. CONCLUSIONS: Additional time for parent consultation is desirable and necessary. Psychosocial services should be extended and provided for in neonatal care units and appropriate financial and personnel resources should be made available. DISCUSSION: In many neonatal care units there is an awareness for the benefits of an appreciative, family-centred atmosphere as well as interdisciplinary cooperation. This is a favourable starting point for research efforts concerning further inquiries into implementation standards of family-centred, concomitant consultation.

[Psycho-oncology]. / Psychoonkologie.

Psycho-oncology addresses the psychosocial care of patients with cancer. Systematic research on the interactions between biological, psychological and social factors before, during and after cancer has only been carried out for a few decades. All cancer patients, their relatives and the treating medical team should receive low-threshold offers for psychosocial support. The demand for interdisciplinary counselling and therapy detected by clinical diagnosis and by systematic screening, is not satisfactorily covered and is continuously increasing. In collaboration between the involved professional groups, education and professional qualifications for psycho-oncologists are still being developed.

Therapeutic options for acute and chronic elbow instability.

INTRODUCTION: Acute elbow instability usually develops after injuries involving the bony or ligamentous stabilizers of the joint. It occurs frequently after dislocation and/or fracture-dislocation, but isolated valgus or varus overloading can also lead to ligament ruptures with subsequent instability. Chronic instability can result from incompletely healed acute injuries or from recurring microtrauma, for example after repetitive strain from participating in certain sports. CONCLUSION: Stable conditions of the joint are essential for early functional post-traumatic or postoperative treatment of the elbow, as permanent mobility deficits may result otherwise. The following article gives an overview of the current understanding of these injuries and concepts in treatment.

Advanced glycation end products affect growth and function of osteoblasts.

OBJECTIVES: Advanced glycation end products (AGEs) have been implicated in the pathogenesis of bone-destructive disorders. Yet reports on the influence of AGEs on human osteoblasts remain lacking. The aim of the study is to investigate the influence of AGE-modified bovine serum albumin (AGE-BSA) on cell growth and expression of osteoblastic markers associated with osteogenesis and osteoclastogenesis. METHODS: Human osteoblasts established from bone tissue specimens were stimulated with AGE-BSA and investigated in vitro. Expression of mRNA for the receptor for AGEs (RAGE), nuclear factor kappa B subunit p65 (NFκB p65), tumour necrosis factor alpha (TNF-α), matrix metallo proteinase-1 (MMP-1), receptor activator of NFκB ligand (RANKL), osteoprotegerin, collagen type I (Col1), osteocalcin (OC) and alkaline phosphatase (ALP) were measured using real-time polymerase chain reaction (PCR). Respective protein expressions were evaluated by western blot analysis or ELISA. NFκB activation was investigated by luciferase assay and electrophoretic mobility shift assay (EMSA). Cell cycle analysis, cell proliferation and markers of necrosis and early apoptosis were assessed. RESULTS: AGE-BSA was actively taken up into osteoblasts and induced cell cycle arrest and an increase in necrotic, but not apoptotic cells. The increased expression of RAGE and TNF-α together with NFκB activation indicates an AGE-mediated inflammatory response. The decreased expression of Col1, OC and ALP presumably reflects a diminished osteogenic potential, whereas upregulation of RANKL and TNF-α enhances osteoclastogenesis. CONCLUSIONS: The present study demonstrates that AGE-BSA affects the growth and function of osteoblasts. Modulation of the expression of various target genes involved in bone metabolism provides evidence that AGEs accumulated in the bone matrix have the potential to suppress osteogenic and to promote osteoclastogenic properties of osteoblasts in vivo, thereby leading to functional and structural impairment of bone.