Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures

STUDY DESIGN Technical note and case series. OBJECTIVE To introduce an innovative minimal-invasive surgical procedure reducing surgery time and blood loss in management of U-shaped sacrum fractures. SUMMARY OF BACKGROUND Despite their seldom appearance, U-shaped fractures can cause severe neurological deficits and surgical management difficulties. According to the nature of the injury normally occurring in multi-injured patients after a fall from height, a jump, or road traffic accident, U-shaped fractures create a spinopelvic dissociation and hence are highly unstable. In the past, time-consuming open procedures like large posterior constructs or shortening osteotomies with or without decompression were the method of choice, sacrificing spinal mobility. Insufficient restoration of sacrococcygeal angle and pelvic incidence with conventional techniques may have adverse long-term effects in these patients. METHODS In a consecutive series of 3 patients, percutaneous reduction of the fracture with Schanz pins inserted in either the pedicles of L5 or the S1 body and the posterior superior iliac crest was achieved. The Schanz pins act as lever, allowing a good manipulation of the fracture. The reduction is secured by a temporary external fixator to permit optimal restoration of pelvic incidence and sacral kyphosis. Insertion of 2 transsacral screws allow fixation of the restored spinopelvic alignment. RESULTS Anatomic alignment of the sacrum was possible in each case. Surgery time ranged from 90 to 155 minutes and the blood loss was <50 mL in all 3 cases. Two patients had very good results in the long term regarding maintenance of pelvic incidence and sacrococcygeal angle. One patient with previous cauda equina decompression had loss of correction after 6 months. CONCLUSIONS Percutaneous reduction and transsacral screw fixation offers a less invasive method for treating U-shaped fractures. This can be advantageous in treatment of patients with multiple injuries.

MiR-205 is progressively down-regulated in lymph node metastasis but fails as a prognostic biomarker in high-risk prostate cancer

The treatment of high-risk prostate cancer (HRPCa) is a tremendous challenge for uro-oncologists. The identification of predictive moleculobiological markers allowing risk assessment of lymph node metastasis and systemic progression is essential in establishing effective treatment. In the current study, we investigate the prognostic potential of miR-205 in HRPCa study and validation cohorts, setting defined clinical endpoints for both. We demonstrate miR-205 to be significantly down-regulated in over 70% of the HRPCa samples analysed and that reconstitution of miR-205 causes inhibition of proliferation and invasiveness in prostate cancer (PCa) cell lines. Additionally, miR-205 is increasingly down-regulated in lymph node metastases compared to the primary tumour indicating that miR-205 plays a role in migration of PCa cells from the original location into extraprostatic tissue. Nevertheless, down-regulation of miR-205 in primary PCa was not correlated to the synchronous presence of metastasis and failed to predict the outcome for HRPCa patients. Moreover, we found a tendency for miR-205 up-regulation to correlate with an adverse outcome of PCa patients suggesting a pivotal role of miR-205 in tumourigenesis. Overall, we showed that miR-205 is involved in the development and metastasis of PCa, but failed to work as a useful clinical biomarker in HRPCa. These findings might have implications for the use of miR-205 as a prognostic or therapeutic target in HRPCa.

In vitro fabrication of autologous living tissue-engineered vascular grafts based on prenatally harvested ovine amniotic fluid-derived stem cells

Amniotic fluid cells (AFCs) have been proposed as a valuable source for tissue engineering and regenerative medicine. However, before clinical implementation, rigorous evaluation of this cell source in clinically relevant animal models accepted by regulatory authorities is indispensable. Today, the ovine model represents one of the most accepted preclinical animal models, in particular for cardiovascular applications. Here, we investigate the isolation and use of autologous ovine AFCs as cell source for cardiovascular tissue engineering applications. Fetal fluids were aspirated in vivo from pregnant ewes (n = 9) and from explanted uteri post mortem at different gestational ages (n = 91). Amniotic non-allantoic fluid nature was evaluated biochemically and in vivo samples were compared with post mortem reference samples. Isolated cells revealed an immunohistochemical phenotype similar to ovine bone marrow-derived mesenchymal stem cells (MSCs) and showed expression of stem cell factors described for embryonic stem cells, such as NANOG and STAT-3. Isolated ovine amniotic fluid-derived MSCs were screened for numeric chromosomal aberrations and successfully differentiated into several mesodermal phenotypes. Myofibroblastic ovine AFC lineages were then successfully used for the in vitro fabrication of small- and large-diameter tissue-engineered vascular grafts (n = 10) and cardiovascular patches (n = 34), laying the foundation for the use of this relevant pre-clinical in vivo assessment model for future amniotic fluid cell-based therapeutic applications. Copyright © 2013 John Wiley & Sons, Ltd.

Kantönligeist bei politischen Rechten

Kantone sind unterschiedlich restriktiv, was die Gültigkeit von abgegebenen Stimmen zu nationalen Abstimmungsvorlagen betrifft. Der Anteil ungültiger Stimmen bei ein und derselben Abstimmung variiert in der Regel stark zwischen den Kantonen, was aus demokratietheoretischer Sicht bedenklich ist.

Landesverteidigung

In mehreren Vorstössen wurde der Bundesrat beauftragt, das Nebeneinander von Rekrutenschule und Studium, beziehungsweise zwischen Arbeitsleben und Armee besser zu koordinieren. – Die Schweizerische Botschaft in Tripolis (Libyen) musste durch Armeeangehörige geschützt werden. – Für 407 Mio. CHF sollen Armeeimmobilien saniert werden. – Mit der Umsetzung des Übereinkommens über Streumunition setzte das Parlament den eingeschlagenen Weg der Friedensförderung fort. – Mit dem Rüstungsprogramm 2012 beantragte der Bundesrat den Kauf von 22 Kampfflugzeugen des Typs Gripen vom Schwedischen Hersteller Saab. Das Geschäft Tiger Teilersatz beschäftigte zahlreiche Akteure und sorgte für viel Unmut. – Die Anfang Jahr eingereichte Volksinitiative „Ja zur Aufhebung der Wehrpflicht“ wurde vom Nationalrat zur Ablehnung empfohlen. – Der Bundesrat skizzierte in einem Bericht die Zukunft des Zivilschutzes nach 2015.

Gesundheit, Sozialhilfe, Sport

Die Räte verabschiedeten verschiedene Geschäfte zu Patientenrechten und Patientensicherheit. – Das Epidemiengesetz wurde erneuert und besser auf zukünftige Szenarien ausgelegt. – Im Bereich Pflege sollen Aus- und Weiterbildungsmöglichkeiten gefördert und pflegende Personen besser entschädigt werden können. – Die Ausbildung angehender Ärztinnen und Ärzte soll durch Zulassungsmassnahmen und Bereitstellung von genügend Weiterbildungsplätzen sichergestellt werden. – Auf Initiative des Nationalrates wurden 70 Mio. CHF zum Ausbau von bedeutenden Sportanlagen bewilligt. – Die Bündner Regierung und der Bundesrat gaben grünes Licht für eine Kandidatur für Olympische Winterspiele 2022 in der Schweiz.