[Trauma surgery 2020. Past developments - future demands and perspectives. III: Ideas on future care]. / Unfallchirurgie 2020. Entwicklungen der Vergangenheit - Forderungen und Perspektiven der Zukunft. Teil III. Thesenpapier zur künftigen Versorgung.

A growing number of casualties and the increasing restrictions of funding will lead as a consequence to changes within the field of trauma surgery. Despite these developments trauma surgery must maintain its major responsibility towards the victims of accidents. Therefore the German Society for Trauma Surgery (DGU) has to face the future economic and social challenges to influence the coming changes. This role compromises the engagement in a continuous struggle for the high and global standard of injury care in Germany, for quality assessment, education and training, research and adequate public relations. This paper outlines the aspects and visions of future trauma surgery and the means which may continue to guarantee international acknowledged standard of trauma care in Germany.

Stage-dependent spontaneous frog dorsal root ganglion neuritogenesis on polylysine in vitro.

Dorsal root ganglia of larval frog extended elaborate neuritic arrays in vitro under minimal culture conditions in the absence of medium-supplemented stimulatory factors. The highly adhesive attachment substratum polylysine provided the necessary condition for exuberant outgrowth, the extent of which was dependent on the developmental stage of the animal from which the neural tissue was derived, as was the capability for long-term survival. It appears that an appropriate substratum can substitute for added growth factors in eliciting robust and long-lived sensory neurites in vitro.

Developmental competency in spinal nerve fiber extension on a reconstituted basement-membrane-like matrix.

Nerve fibers readily extend from larval frog spinal cord explants when cultured on a commercially available reconstituted basement-membrane-like matrix derived from the EHS mouse sarcoma. This superior, naturally derived substratum enables the in vitro development of complex neuritic arrays with long survival times in a defined medium, thus permitting the detailed analysis of spontaneous and target-mediated neuritogenesis.

Neurotropic influence of mesenchymal limb target tissue on spinal cord neurite growth in vitro.

Peripheral nerve fiber outgrowth from developing spinal cord is proposed to be under the influence of the limb bud target which, at the time of nerve fiber invasion, is in an essentially premuscular, mesenchymal condition. Thus, the true target for elongating spinal nerve fibers in early development is mesenchyme rather than differentiated skeletal muscle. Spinal cord explants derived from stage V larval Rana pipiens were cultured in a defined medium in the presence or absence of mesenchymal limb tissue or limb-conditioned medium (LCM). Analysis of quantified neuritic outgrowth under these conditions demonstrated a dependency on the target tissue for enhanced nerve fiber density and oriented growth. The characteristics of neuritic growth in the presence of limb mesenchyme or LCM changed from the relatively sparse and straight outgrowth of control cords to dense, wavy arborizations. Areas of the cord explants nearest the limb tissue exhibited the greatest increases in nerve fiber density and morphologic complexity. Additionally, an inverse relationship existed between growth enhancement and the cord-to-target distance. Regulation of directed nerve growth in vitro is suggested to result from a diffusible, target-originated growth factor that binds to the attachment substratum as a concentration gradient guidance pathway with implications for mechanisms of in vivo nerve growth.