Development of musculoskeletal models for the design and the pre-clinical validation of hip resurfacing prosthesis

Background. The surgical treatment of dysfunctional hips is a severe condition for the patient and a costly therapy for the public health. Hip resurfacing techniques seem to hold the promise of various advantages over traditional THR, with particular attention to young and active patients. Although the lesson provided in the past by many branches of engineering is that success in designing competitive products can be achieved only by predicting the possible scenario of failure, to date the understanding of the implant quality is poorly pre-clinically addressed. Thus revision is the only delayed and reliable end point for assessment. The aim of the present work was to model the musculoskeletal system so as to develop a protocol for predicting failure of hip resurfacing prosthesis. Methods. Preliminary studies validated the technique for the generation of subject specific finite element (FE) models of long bones from Computed Thomography data. The proposed protocol consisted in the numerical analysis of the prosthesis biomechanics by deterministic and statistic studies so as to assess the risk of biomechanical failure on the different operative conditions the implant might face in a population of interest during various activities of daily living. Physiological conditions were defined including the variability of the anatomy, bone densitometry, surgery uncertainties and published boundary conditions at the hip. The protocol was tested by analysing a successful design on the market and a new prototype of a resurfacing prosthesis. Results. The intrinsic accuracy of models on bone stress predictions (RMSE < 10%) was aligned to the current state of the art in this field. The accuracy of prediction on the bone-prosthesis contact mechanics was also excellent (< 0.001 mm). The sensitivity of models prediction to uncertainties on modelling parameter was found below 8.4%. The analysis of the successful design resulted in a very good agreement with published retrospective studies. The geometry optimisation of the new prototype lead to a final design with a low risk of failure. The statistical analysis confirmed the minimal risk of the optimised design over the entire population of interest. The performances of the optimised design showed a significant improvement with respect to the first prototype (+35%). Limitations. On the authors opinion the major limitation of this study is on boundary conditions. The muscular forces and the hip joint reaction were derived from the few data available in the literature, which can be considered significant but hardly representative of the entire variability of boundary conditions the implant might face over the patients population. This moved the focus of the research on modelling the musculoskeletal system; the ongoing activity is to develop subject-specific musculoskeletal models of the lower limb from medical images. Conclusions. The developed protocol was able to accurately predict known clinical outcomes when applied to a well-established device and, to support the design optimisation phase providing important information on critical characteristics of the patients when applied to a new prosthesis. The presented approach does have a relevant generality that would allow the extension of the protocol to a large set of orthopaedic scenarios with minor changes. Hence, a failure mode analysis criterion can be considered a suitable tool in developing new orthopaedic devices.

Costruzione di uno scaffold vascolarizzato per la chirurgia ortopedica

Specific aims The aim is to improve the treatment of the bone losses at the metacarpal bones level (both diaphysis and epiphysis) combining microsurgery, tissue engineering and biomaterials, so to minimize the donor side morbidity and optimize healing and outcomes. Methods Pre-operative controlateral X-ray or 3-D CT to allow custom-made HA scaffolds. Cement as temporary spacer in acute lesion and monitoring of infective risks. Treatment of the bone loss recurring to pre-fabricated or custom-made HA scaffolds, adding platelet gel or growth factor OP1. Stable synthesis. Control group with auto/omografts. Outcome indices: % of bone-union; finger TAM, Kapandji, DASH score; NMR and Scintigraphy at 180 days for revascularisation and bio-substitution of the scaffold. Preliminary results The authors just treated 6 patients, 4 males and 2 females, with an average age of 38.5 yrs, affected by segmental bone losses at the hand and wrist, recurring to pre-fabricated not vascularised scaffolds. In all cases the synthesis was performed with angular stability plates and a stable synthesis achieved. All patients have been controlled at a mean follow-up of 10.5 months (from 2 to 16 ). In all case but one the bone-scaffold osteo-integration was achieved at an average of 38 days at the hand, and 46 days at the wrist. The outcome studies, according to the DASH score, finger TAM, and Kapandji, were good and excellent in 5 cases, poor in one.

A new approach for the dynamic modelling of the human knee

Mathematical models of the knee joint are important tools which have both theoretical and practical applications. They are used by researchers to fully understand the stabilizing role of the components of the joint, by engineers as an aid for prosthetic design, by surgeons during the planning of an operation or during the operation itself, and by orthopedists for diagnosis and rehabilitation purposes. The principal aims of knee models are to reproduce the restraining function of each structure of the joint and to replicate the relative motion of the bones which constitute the joint itself. It is clear that the first point is functional to the second one. However, the standard procedures for the dynamic modelling of the knee tend to be more focused on the second aspect: the motion of the joint is correctly replicated, but the stabilizing role of the articular components is somehow lost. A first contribution of this dissertation is the definition of a novel approach — called sequential approach — for the dynamic modelling of the knee. The procedure makes it possible to develop more and more sophisticated models of the joint by a succession of steps, starting from a first simple model of its passive motion. The fundamental characteristic of the proposed procedure is that the results obtained at each step do not worsen those already obtained at previous steps, thus preserving the restraining function of the knee structures. The models which stem from the first two steps of the sequential approach are then presented. The result of the first step is a model of the passive motion of the knee, comprehensive of the patello-femoral joint. Kinematical and anatomical considerations lead to define a one degree of freedom rigid link mechanism, whose members represent determinate components of the joint. The result of the second step is a stiffness model of the knee. This model is obtained from the first one, by following the rules of the proposed procedure. Both models have been identified from experimental data by means of an optimization procedure. The simulated motions of the models then have been compared to the experimental ones. Both models accurately reproduce the motion of the joint under the corresponding loading conditions. Moreover, the sequential approach makes sure the results obtained at the first step are not worsened at the second step: the stiffness model can also reproduce the passive motion of the knee with the same accuracy than the previous simpler model. The procedure proved to be successful and thus promising for the definition of more complex models which could also involve the effect of muscular forces.

Las pardelas pleistocenas de Hueso del Caballo

[EN] Osseous remains of numerous shearwaters and of eggshells of the only egg laid and often undamaged appear in the sand dunes of Jandía Península and more specifically in "Hueso del Caballo" which was one of their breeding si tes. Toe bones also visible in the sandy walls of a quarry were uncovered by the present aeolian erosion and are found in a layerwith Hymmenoptera nests and terrestrial mollusc shells in a dune dated by radiocarbon as being more than 30.000 years old. This fact proves there was a halt in the aeolian processes during a humid interval, probably related to the African aterían pluvial in Upper Pleistocene and a fixation of the dunes by vegetation.

Spatial mechanisms for modelling the human ankle passive motion

Knowledge on how ligaments and articular surfaces guide passive motion at the human ankle joint complex is fundamental for the design of relevant surgical treatments. The dissertation presents a possible improvement of this knowledge by a new kinematic model of the tibiotalar articulation. In this dissertation two one-DOF spatial equivalent mechanisms are presented for the simulation of the passive motion of the human ankle joint: the 5-5 fully parallel mechanism and the fully parallel spherical wrist mechanism. These mechanisms are based on the main anatomical structures of the ankle joint, namely the talus/calcaneus and the tibio/fibula bones at their interface, and the TiCaL and CaFiL ligaments. In order to show the accuracy of the models and the efficiency of the proposed procedure, these mechanisms are synthesized from experimental data and the results are compared with those obtained both during experimental sessions and with data published in the literature. Experimental results proved the efficiency of the proposed new mechanisms to simulate the ankle passive motion and, at the same time, the potentiality of the mechanism to replicate the ankle’s main anatomical structures quite well. The new mechanisms represent a powerful tool for both pre-operation planning and new prosthesis design.

Evaluation of bone strength: microtomographic tecniques

This thesis is a part of a larger study about the characterization of mechanical and histomorphometrical properties of bone. The main objects of this study were the bone tissue properties and its resistance to mechanical loads. Moreover, the knowledge about the equipment selected to carry out the analyses, the micro-computed tomography (micro-CT), was improved. Particular attention was given to the reliability over time of the measuring instrument. In order to understand the main characteristics of bone mechanical properties a study of the skeletal, the bones of which it is composed and biological principles that drive their formation and remodelling, was necessary. This study has led to the definition of two macro-classes describing the main components responsible for the resistance to fracture of bone: quantity and quality of bone. The study of bone quantity is the current clinical standard measure for so-called bone densitometry, and research studies have amply demonstrated that the amount of tissue is correlated with its mechanical properties of elasticity and fracture. However, the models presented in the literature, including information on the mere quantity of tissue, have often been limited in describing the mechanical behaviour. Recent investigations have underlined that also the bone-structure and the tissue-mineralization play an important role in the mechanical characterization of bone tissue. For this reason in this thesis the class defined as bone quality was mainly studied, splitting it into two sub-classes of bone structure and tissue quality. A study on bone structure was designed to identify which structural parameters, among the several presented in the literature, could be integrated with the information about quantity, in order to better describe the mechanical properties of bone. In this way, it was also possible to analyse the iteration between structure and function. It has been known for long that bone tissue is capable of remodeling and changing its internal structure according to loads, but the dynamics of these changes are still being analysed. This part of the study was aimed to identify the parameters that could quantify the structural changes of bone tissue during the development of a given disease: osteoarthritis. A study on tissue quality would have to be divided into different classes, which would require a scale of analysis not suitable for the micro-CT. For this reason the study was focused only on the mineralization of the tissue, highlighting the difference between bone density and tissue density, working in a context where there is still an ongoing scientific debate.

An New Energetic Approach to the Modeling of Human Joint Kinematics: Application to the Ankle

The objective of this dissertation is to develop and test a predictive model for the passive kinematics of human joints based on the energy minimization principle. To pursue this goal, the tibio-talar joint is chosen as a reference joint, for the reduced number of bones involved and its simplicity, if compared with other sinovial joints such as the knee or the wrist. Starting from the knowledge of the articular surface shapes, the spatial trajectory of passive motion is obtained as the envelop of joint configurations that maximize the surfaces congruence. An increase in joint congruence corresponds to an improved capability of distributing an applied load, allowing the joint to attain a better strength with less material. Thus, joint congruence maximization is a simple geometric way to capture the idea of joint energy minimization. The results obtained are validated against in vitro measured trajectories. Preliminary comparison provide strong support for the predictions of the theoretical model.

Pyrolysis of peptides and proteins. Analytical study and environmental applications

Analytical pyrolysis was used to investigate the formation of diketopiperazines (DKPs) which are cyclic dipeptides formed from the thermal degradation of proteins. A quali/quantitative procedure was developed combining microscale flash pyrolysis at 500 °C with gas chromatography-mass spectrometry (GC-MS) of DKPs trapped onto an adsorbent phase. Polar DKPs were silylated prior to GC-MS. Particular attention was paid to the identification of proline (Pro) containing DKPs due to their greater facility of formation. The GC-MS characteristics of more than 80 original and silylated DKPs were collected from the pyrolysis of sixteen linear dipeptides and four model proteins (e.g. bovine serum albumin, BSA). The structure of a novel DKP, cyclo(pyroglutamic-Pro) was established by NMR and ESI-MS analysis, while the structures of other novel DKPs remained tentative. DKPs resulted rather specific markers of amino acid sequence in proteins, even though the thermal degradation of DKPs should be taken into account. Structural information of DKPs gathered from the pyrolysis of model compounds was employed to the identification of these compounds in the pyrolysate of proteinaceous samples, including intrinsecally unfolded protein (IUP). Analysis of the liquid fraction (bio-oil) obtained from the pyrolysis of microalgae Nannochloropsis gaditana, Scenedesmus spp with a bench scale reactor showed that DKPs constituted an important pool of nitrogen-containing compounds. Conversely, the level of DKPs was rather low in the bio-oil of Botryococcus braunii. The developed micropyrolysis procedure was applied in combination with thermogravimetry (TGA) and infrared spectroscopy (FT-IR) to investigate surface interaction between BSA and synthetic chrysotile. The results showed that the thermal behavior of BSA (e.g. DKPs formation) was affected by the different form of doped synthetic chrysotile. The typical DKPs evolved from collagen were quantified in the pyrolysates of archaeological bones from Vicenne Necropolis in order to evaluate their conservation status in combination with TGA, FTIR and XRD analysis.

New mechanisms for modelling the motion of the human ankle complex

The relevance of human joint models was shown in the literature. In particular, the great importance of models for the joint passive motion simulation (i.e. motion under virtually unloaded conditions) was outlined. They clarify the role played by the principal anatomical structures of the articulation, enhancing the comprehension of surgical treatments, and in particular the design of total ankle replacement and ligament reconstruction. Equivalent rigid link mechanisms proved to be an efficient tool for an accurate simulation of the joint passive motion. This thesis focuses on the ankle complex (i.e. the anatomical structure composed of the tibiotalar and the subtalar joints), which has a considerable role in human locomotion. The lack of interpreting models of this articulation and the poor results of total ankle replacement arthroplasty have strongly suggested devising new mathematical models capable of reproducing the restraining function of each structure of the joint and of replicating the relative motion of the bones which constitute the joint itself. In this contest, novel equivalent mechanisms are proposed for modelling the ankle passive motion. Their geometry is based on the joint’s anatomical structures. In particular, the role of the main ligaments of the articulation is investigated under passive conditions by means of nine 5-5 fully parallel mechanisms. Based on this investigation, a one-DOF spatial mechanism is developed for modelling the passive motion of the lower leg. The model considers many passive structures constituting the articulation, overcoming the limitations of previous models which took into account few anatomical elements of the ankle complex. All the models have been identified from experimental data by means of optimization procedure. Then, the simulated motions have been compared to the experimental one, in order to show the efficiency of the approach and thus to deduce the role of each anatomical structure in the ankle kinematic behavior.

Conditional and transgenic mouse models as tools to study the role of TGFbeta, BMP signaling in skeletal development

Die TGFbeta/BMP Signaltransduktionskaskade ist wichtig für viele Entwicklungsprozesse fast aller embryonaler sowie extraembryonaler Gewebe und sie ist ebenso essentiell bei der Aufrechterhaltung der Homöostase im adulten Organismus. In vielen Mausmodellen und Zellkulturversuchen wurde gezeigt, dass Liganden dieses Signalweges in verschiedene Stadien der Knorpel- und Knochenentwicklung involviert sind. BMPs sind beispielsweise maßgeblich an der frühen Kondensation und Bildung des Knorpels und später an Proliferation und Hypertrophie der Chondrozyten beteiligt. BMPs können ektopisch Knochenbildung auslösen und das Expressionsmuster der Liganden und spezifischen Rezeptoren in der Wachstumsfuge lässt auf eine wichtige Rolle der BMPs in der Wachstumsfuge schließen. Der gezielte knock out der BMP-Rezeptoren Bmpr1a und Bmpr1b in proliferierenden Chondrozyten führt zur Ausbildung einer generellen Chondrodysplasie. Smad1, Smad5 und Smad8 sind die Mediatoren der BMP-Signalkaskade. Im Rahmen der vorliegenden Arbeit sollte die Rolle und Funktion der Smad1- und Smad5-Proteine in der Wachstumsfuge untersucht werden. Hierzu wurden konditionale Smad1-knock out-Mäuse mit einer transgenen Mauslinie gekreuzt, die die Cre-Rekombinase spezifisch in proliferierenden Chondrozyten exprimiert. Diese Mäuse wurden mit und ohne heterozygotem Smad5-Hintergrund charakterisiert. Bei einem knock out von Smad1 allein konnte ein leichte Verkürzung der Wachstumsfuge beobachtet werden, wobei prähypertrophe und hypertrophe Zone gleichermaßen betroffen waren. Dieser Phänotyp war verstärkt in Mäusen mit zusätzlichem heterozygotem Smad5-Hintergrund. Eine Verringerung der Proliferationsrate konnte zusammen mit einer verminderten Ihh-Expression nachgewiesen werden. Zusätzlich konnte anhand von Röntgenaufnahmen eine Dysorganisation der nasalen Region und ein fehlendes nasales Septum beobachtet werden. Produktion und Mineralisation der extrazellulären Matrix waren nicht beeinträchtigt. Um die Rolle der BMP- und TGFbeta-Signalkaskaden während der endochondralen Ossifikation zu vergleichen, wurden transgene Mäuse generiert, in denen die TGFbeta-Signalkaskade spezifisch in proliferierenden Chondrozyten gestört war. Zwei Mauslinien, die ähnliche Phänotypen zeigten, wurden untersucht. Esl1 ist ein TGFbeta-bindendes Protein, von dem man annimmt, dass es die TGFbeta-Signalkaskade inhibieren kann. Esl1-knock out-Mäuse sind kleiner als Wildtypmäuse und die Überexpression von Esl1 in proliferierenden Chondrozyten führt zu einer Verlängerung der Wachstumsfuge und einer verstärkten Proliferationsrate. Knorpelmarker, wie Col2a1 und Sox9 sind in diesen Mäusen herunterreguliert, während Col10a1 und Ihh als Marker für die hypertrophe und prähypertrophe Zone herunterreguliert waren. Dies führt zu der Annahme, dass mehr Zellen in die terminale Differenzierung eintreten. Bei transgenen Mäusen, in denen ein dominant-negativer (dn) TGFbeta-Rezeptor in proliferierenden Chondrozyten überexprimiert wurde, konnte eine verlängerte prähypertrophe Zone, eine erhöhte Ihh-Expression, sowie eine verstärkte Proliferationsrate beobachtet werden. Zusätzlich konnte in homozygoten Tieren ein craniofacialer Phänotyp beschrieben werden, der zu Problemen bei der Nahrungsaufnahme und damit zu einer starken Wachstumsbeeinträchtigung führte. Die BMP- und TGFbeta-Signalkaskaden haben möglicherweise antagonistische Effekte in der Wachstumsfuge. Während der Ausfall von BMP in proliferierenden Chondrozyten aufgrund einer gesunkenen Proliferationsrate zu einer Verkürzung der Wachstumsfuge führte, kann man in Mäusen mit einer Störung der TGFbeta-Signalkaskade eine verstärkte Proliferation in einer daher verlängerten Wachstumsfuge beobachten. Ein weiteres Ziel dieser Arbeit war die Generation einer transgenen Mauslinie, die die Cre-Rekombinase spezifisch in hypertrophen Chondrozyten exprimiert. Promoterstudien mit transgenen Mäusen weisen darauf hin, dass ein putatives AP1-Element, etwa 4 kb vor dem ersten Exon des Col10a1 gelegen, wichtig für die spezifische Expression in hypertrophen Chondrozyten ist. Ein Konstrukt, dass vier Kopien dieses Elements und den basalen Promoter enthält, wurde benutzt, um die Cre-Rekombinase spezifisch zu exprimieren. Diese Mauslinie befindet sich in der Testphase und erste Daten deuten auf eine spezifische Expression der Cre-Rekombinase in hypertrophen Chondrozyten hin.

Bioinspired fabrication of biosilica-based bone substitution materials

Until today, autogenic bone grafts from various donor regions represent the gold standard in the field of bone reconstruction, providing both osteoinductive and osteoconductive characteristics. However, due to low availability and a disequilibrium between supply and demand, the risk of disease transfer and morbidity, usually associated with autogeneic bone grafts, the development of biomimic materials with structural and chemical properties similar to those of natural bone have been extensively studied. So far,rnonly a few synthetic materials, so far, have met these criteria, displaying properties that allow an optimal bone reconstitution. Biosilica is formed enzymatically under physiological-relevant conditions (temperature and pH) via silicatein (silica protein), an enzyme that was isolated from siliceous sponges, cloned, and prepared in a recombinant way, retaining its catalytic activity. It is biocompatible, has some unique mechanical characteristics, and comprises significant osteoinductive activity.rnTo explore the application of biosilica in the fields of regenerative medicine,rnsilicatein was encapsulated, together with its substrate sodium metasilicate, into poly(D,L-lactide)/polyvinylpyrrolidone(PVP)-based microspheres, using w/o/wrnmethodology with solvent casting and termed Poly(D,L-lactide)-silicatein silicacontaining-microspheres [PLASSM]. Both silicatein encapsulation efficiency (40%) and catalytic activity retention upon polymer encapsulation were enhanced by addition of an essential pre-emulsifying step using PVP. Furthermore, the metabolic stability, cytoxicity as well as the kinetics of silicatein release from the PLASSM were studied under biomimetic conditions, using simulated body fluid. As a solid support for PLASSM, a polyvinylpyrrolidone/starch/Na2HPO4-based matrix (termed plastic-like filler matrix containing silicic acid [PMSA]) was developed and its chemical and physical properties determined. Moreover, due to the non-toxicity and bioinactivity of the PMSA, it is suggested that PMSA acts as osteoconductive material. Both components, PLASSM and PMSA, when added together, form arnbifunctional 2-component implant material, that is (i)non-toxic(biocompatible), (ii)moldable, (iii) self-hardening at a controlled and clinically suitable rate to allows a tight insertion into any bone defect (iv) biodegradable, (v)forms a porous material upon exposure to body biomimetic conditions, and (vi)displays both osteoinductive (silicatein)and osteoconductive (PMSA) properties.rnPreliminary in vivo experiments were carried out with rabbit femurs, by creatingrnartificial bone defects that were subsequently treated with the bifunctional 2-component implant material. After 9 weeks of implantation, both computed tomography (CT) and morphological analyses showed complete resorption of the implanted material, concurrent with complete bone regeneration. The given data can be considered as a significant contribution to the successful introduction of biosilica-based implants into the field of bone substitution surgery.

Forensisch-anthropologische und traumatologische Untersuchungen an den menschlichen Skeletten aus der spätmittelalterlichen Schlacht von Dornach (1499 n. Chr.)

Der Forschungsgegenstand der vorliegenden Arbeit war die Identifikation und Interpretation von Traumata an menschlichen Skeletten. Neben einer umfassenden Darstellung des aktuellen Kenntnisstandes unter verschiedenen Gesichtspunkten wurden menschliche Überreste aus der Schlacht von Dornach 1499 n. Chr. untersucht. Ergänzend wurde eine Versuchsreihe mit Replika mittelalterlicher Waffen an Kunstköpfen durchgeführt. Für die Ansprache und Kategorisierung von Traumata an Skelettfunden existiert kein einheitliches und allgemein gebräuchliches System. Die verschiedenen Herangehensweisen und ihre Vor- und Nachteile wurden benannt und diskutiert. Nachfolgend wurden die Erscheinungsformen prä-, peri- und postmortaler Traumata bzw. Defekte sowie von Verletzungen durch stumpfe und scharfe Gewalt, Schussverletzungen und anderen Verletzungsarten dargestellt. Weitere besprochene Aspekte waren die Abgrenzung von Traumata gegen pathologische Veränderungen und anatomische Varianten sowie eine Diskussion der Methodik und Problematik der Erfassung von Verletzungsfrequenzen. Neben der Bestimmung von Geschlecht, Sterbealter und Körperhöhe wurden an den zur Untersuchung zur Verfügung stehenden Schädeln (N=106) und Femora (N=33) aus der Schlacht von Dornach 1499 n. Chr. pathologische und postmortale Veränderungen sowie als Schwerpunkt prä- und perimortale Traumata identifiziert und beschrieben. Die anthropologischen Befunde zeichneten das Bild einer in Hinsicht auf Sterbealter und Körperhöhe heterogenen Gruppe von Männern mit wenigen pathologischen Veränderungen. Die Ergebnisse wurden vor dem Hintergrund des spätmittelalterlichen Söldnerwesens diskutiert. An den Schädeln wurden insgesamt 417 perimortale Traumata identifiziert, wobei Hiebverletzungen stark überwogen. Die Entstehungsweise charakteristischer Merkmale von Hiebverletzungen konnte experimentell nachvollzogen werden. Weiter stellte sich heraus, dass Hiebverletzungen durch Schwerter und Hellebarden nur in Ausnahmefällen voneinander unterschieden werden können. Verletzungen durch punktuelle Einwirkungen und stumpfe Gewalt sowie Schussverletzungen wurden in weitaus geringerer Häufigkeit festgestellt. Experimentell konnte gezeigt werden, dass die Verletzungen durch punktuelle Einwirkungen mit einer Beibringung durch Langspiesse, Stossspitzen und Reisshaken von Hellebarden sowie Armbrustbolzen vereinbar sind, wobei beträchtliche Limitationen einer genaueren Waffenzuordnung offenkundig wurden. Die Verletzungen konnten als wohl typisch für die damalige Zeit bezeichnet werden, da sie das zeitgenössische Waffenspektrum deutlich widerspiegeln. Die Lokalisation der perimortalen Traumata am Schädel liess kein Muster erkennen, mit Ausnahme der Feststellung, dass grössere Schädelknochen mehr Verletzungen aufwiesen als kleinere. Diese regellose Verteilung wurde als Hinweis darauf verstanden, dass die Kampfweise keine „ritterliche“ gewesen sein dürfte, was in Einklang mit den damals geltenden Kriegsordnungen steht. Postmortale Veränderungen unterschiedlicher Art liessen vermuten, dass die untersuchten Individuen nicht bestattet wurden und dass die vom Schlachtfeld aufgesammelten Gebeine in Beinhäusern aufbewahrt wurden. Die Resultate bestätigten damit Angaben aus Schriftquellen und erlaubten die Zuordnung der Skelettreste zu Gefallenen des Reichsheeres. Beim Vergleich der Dornacher Stichprobe mit anderen mittelalterlichen Schlachtfeldserien traten sowohl hinsichtlich der anthropologischen Befunde als auch im Hinblick auf die Verletzungen und Verletzungsmuster deutliche Ähnlichkeiten zutage. Diese ergänzten nicht nur das lückenhafte Bild spätmittelalterlicher Heere und ihrer Kampfweise, sondern beleuchteten auch Unterschiede zwischen mittelalterlicher und neuzeitlicher Kriegsführung.

In-vivo-Tumorbiologie mittels 68 Ga-PET: Beurteilung der p-Glykoprotein-Aktivität in Weichgewebe-Tumoren sowie Diagnose und Therapie von Knochenmetastasen

Krebs ist eine der häufigsten Krankheiten und stellt eine der wichtigsten medizinischen Herausforderungen des 21. Jahrhunderts dar. Eine frühzeitige Diagnose ist dabei essentiell für eine individuell angepasste Therapie zur Verbesserung der Lebensqualität und -erwartung der Patienten. Hierbei kommen der 68Ge/68Ga-Generator und das daraus resultierende PET-Nuklid 68Ga immer stärker in den Fokus von Wissenschaft und Medizin. rnrnFür eine erfolgreiche Therapie stellt die Chemoresistenz (Multi-Drug-Resistance) zahlreicher Tumore eine schwerwiegende Komplikation dar. Für das Therapieversagen ist die Aktivierung des Transportproteins p-Glykoprotein (pGP) maßgeblich mit verantwortlich. Mit Hilfe der Schiff’schen Base [68Ga]MFL6.MZ konnte die Aktivitätsänderung von pGP unter verschiedener Beeinflussung erstmals in vivo beobachtet werden. So zeigte sich, dass sich unter azidotischen Bedingungen in Tumoren die Aktivität des pGP erhöht und somit vermehrt auch Zytostatika, die pGP-Substrate sind, aus den Tumoren transportiert werden. Durch Aufklärung der Abhängigkeit der pGP-Aktivität von dessen Signalkaskade konnte gezeigt werden, dass durch eine Blockade der MAP-Kinase p38 eine Erniedrigung der pGP-Aktivität zu verzeichnen ist. Die ebenfalls in der Signalkaskade eingebundene MAP-Kinase ERK1/2 hingegen spielt hier nur eine untergeordnete Rolle.rnrnNeben dem Versagen der Chemotherapie stellt auch die Metastasierung eines Malignoms massive Einschnitte in die Lebensqualität von Erkrankten dar. Befallen die Metastasen das Skelett eines Menschen, wird dies zumeist erst spät registriert. 68Ga-markierte Bisphosphonate bieten nun die Möglichkeit, Patienten quantitativ auf Knochenmetastasen hin untersuchen zu können. So konnten zu Beginn einfache Phosphonate wie EDTMP und DOTP nicht die nötige in vivo Stabilität bzw. hohe radiochemische Ausbeuten liefern und sind damit für die Anwendung am Menschen uninteressant. Jedoch die DOTA-basierten Bisphosphonate allen voran der Ligand BPAMD zeigen ein großes Potential. In vivo-Versuche an Ratten mit Knochenmetastasen zeigten, dass sich [68Ga]BPAMD an den Metastasen anreichert und einen sehr guten Kontrast zum gesunden Knochen darstellt. Der Tracer konnte erstmals am Menschen angewendet werden und zeigte in ausgewählten Regionen eine höhere Anreicherung als eine zuvor durchgeführte PET-Aufnahme mit [18F]Fluorid. Der Ligand BPAMD bietet außerdem den Vorteil, neben 68Ga auch andere dreiwertige Radionuklide wie das therapeutische 177Lu komplexieren zu können. Durch Studien zur Komplexbildung und Stabilität konnte auch [177Lu]BPAMD in der klinischen Anwendung erprobt werden und zeigte eine Anreicherung an den Knochenmetastasen. So ist es nun möglich, Knochenmetastasen mittels 68Ga-PET zu diagnostizieren, eine entsprechende Dosisberechnung anzustellen und anschließend mit dem gleichen Liganden eine Therapie mit [177Lu]BPAMD durchzuführen.

Diversity of the proximal femur in humans: morphological variations of the head-neck junction

The proximal femur is a high-diversity region of the human skeleton, especially at the anterior junction between head and neck, where various bony morphologies have been recognized since mid nineteenth century. Classical literature on this topic is chaotic and contradictory, making almost impossible the comparison of data from different researches. Starting from an extensive bibliographic review, the first standardized method to score these traits has been created. This method allows representing both the anatomical diversity of the region already described in literature and a part of variability not considered before, giving few and univocal definitions and allowing to collect comparable data. The method has been applied to three identified and five archaeological European skeletal collections, with the aim of investigating the distribution of these features by sex, age and side, in different places and time periods. It has also been applied to 3D digital reconstructions of femurs from CT scan files of coxo-femoral joints from fresh cadavers. In addition to the osseous traits described in the standardized method, the presence and frequency of some features known as herniation pits have been scored both on bones and on CT scans. The various osseous traits of the proximal femur are present at similar frequencies in skeletal samples from different countries and different historical periods, even if with clear local differentiation. Some of the features examined show significant trends related to their distribution by gender and age. Some hypotheses are proposed about the etiology of these morphologies and their possible implication with the acquisition of bipedalism in Humans. It is therefore highlighted the possible relation of some of these traits with the development of disorders of the hip joint. Moreover, it is not recommended the use of any of these features as a specific activity-related marker.