Wissenschaftspreise der ÖGU 2014 an Universitätsklinik für Unfallchirurgie vergeben
Die Österreichischen Gesellschaft für Unfallchirurgie (ÖGU) vergab auch heuer die neuen Wissenschaftspreise im Rahmen der 50. Jahrestagung vom 2.-4. Oktober 2014 in Salzburg. Hierbei ergingen wie im vergangenen Jahr (siehe MUW) alle Preise an Mitarbeiter der Universitätsklinik für Unfallchirurgie.
Christian Albrecht wurde für die beste experimentelle Arbeit mit dem Titel „Influence of Cell Differentiation and IL-1β Expression on Clinical Outcomes After Matrix-Associated Chondrocyte Transplantation“ ausgezeichnet. Für die beste klinische Arbeit mit dem Titel „Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule“ wurde Harald Wolf geehrt.
Influence of Cell Differentiation and IL-1β Expression on Clinical Outcomes After Matrix-Associated Chondrocyte Transplantation
C. Albrecht, B. Tichy, L. Zak, S. Aldrian, S. Nürnberger, S. Marlovits
Background: Several patient- and defect-specific factors influencing clinical outcomes after matrix-associated chondrocyte transplantation (MACT) have been identified, including the patient's age, location of the defect, or duration of symptoms before surgery. Little is known, however, about the influence of cell-specific characteristics on clinical results after transplantation.
Purpose: The aim of the present study was to investigate the influence of cell differentiation and interleukin-1 β (IL-1β) expression on clinical outcomes up to 5 years after MACT.
Study Design: Case series; Level of evidence, 4.
Methods: Twenty-seven patients who underwent MACT of the tibiofemoral joint area of the knee were included in this study. Clinical assessments were performed preoperatively as well as 6, 12, 24, and 60 months after transplantation by using the following scores: the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Noyes sports activity rating scale, the Brittberg clinical score, and a visual analog scale (VAS) for pain. The quality of repair tissue was assessed by magnetic resonance imaging using the magnetic resonance observation of cartilage repair tissue (MOCART) score at 1 and 5 years. Cell differentiation (defined as collagen type II:type I expression ratio), aggrecan, and IL-1β expression were determined by real-time polymerase chain reaction in transplant residuals and were correlated with clinical outcomes.
Results: The largest improvements in clinical scores were found during the first year. Two years postoperatively, a stable improvement was reached until 5 years after transplantation, with a mean IKDC score of 34.4± 8.6 preoperatively to 77.9 ± 16 after 24 months (P<.001). Cell differentiation showed a significant positive correlation with nearly all clinical scores at different time points, especially after 12 months (P<.05). IL-1β expression negatively influenced clinical outcomes at 24 months (Brittberg score) and 60 months (Brittberg and VAS scores) after surgery (P<.05). No correlation was found between the MOCART score
and clinical outcomes or gene expression.
Conclusion: Our data demonstrate that cell differentiation and IL-1β expression influence clinical outcomes up to 5 years after MACT.
Publiziert in Am J Sports Med. 2014 Jan;42(1):59-69.
Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule
Wolf H, Machold W, Frantal S, Kecht M, Pajenda G, Leitgeb J, Widhalm H, Hajdu S, Sarahrudi K
OBJECT: This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR).
METHODS: This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13-15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma.
RESULTS: Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (<0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%.
CONCLUSIONS: The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed.
Publiziert in J Neurosurg. 2014 Feb;120(2):447-52.
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