BackgroundThe standardized maritime pine bark extract (Pycnogenol®) has previously shown symptom alleviating effects in patients suffering from moderate forms of knee osteoarthritis (OA). The cellular mechanisms for this positive impact are so far unknown. The purpose of the present randomized pilot controlled study was to span the knowledge gap between the reported clinical effects of Pycnogenol® and its in vivo mechanism of action in OA patients.MethodsThirty three patients with severe OA scheduled for a knee arthroplasty either received 100 mg of Pycnogenol® twice daily or no treatment (control group) three weeks before surgery. Cartilage, synovial fluid and serum samples were collected during surgical intervention. Relative gene expression of cartilage homeostasis markers were analyzed in the patients’ chondrocytes. Inflammatory and cartilage metabolism mediators were investigated in serum and synovial fluid samples.ResultsThe oral intake of Pycnogenol® downregulated the gene expression of various cartilage degradation markers in the patients’ chondrocytes, the decrease of MMP3, MMP13 and the pro-inflammatory cytokine IL1B were statistically significant (p ≤ 0.05). Additionally, protein concentrations of ADAMTS-5 in serum were reduced significantly (p ≤ 0.05) after three weeks intake of the pine bark extract.ConclusionsThis is the first report about positive cellular effects of a dietary supplement on key catabolic and inflammatory markers in patients with severe OA. The results provide a rational basis for understanding previously reported clinical effects of Pycnogenol® on symptom scores of patients suffering from OA.Trial registration ISRCTN10754119. Retrospectively registered 08/10/2015.

A few studies have demonstrated positive effects of Advanced Parking As-sists (APA) on driver comfort and parking performance. Learning effects while handling the APA system and possible transfer effects on manual parking have not been discussed yet. In this study, N = 18 subjects parked parallel in a test area (26 manoeuvres) and in real traffic (9 manoeuvres). One half of the manoeuvres was done without the parking assist, one half with a semi-autonomous APA system which utilized automatic steering. The APA system did not control speed by accelerating or braking. Consistent with earlier studies, the APA system facilitates parking. Learning effects particularly ap-pear in glance behaviour and maximum velocity during the first parking motion. Using the APA over a large number of manoeuvres might influence parking without assistant: The more manoeuvres are done with the APA, the more often the drivers look into the display during manual parking.

Fractures of the femoral head occur during displacement injuries of the hip joint (Pipkin-type fractures). Reasons are high-energy traumas, usually dash-board injuries. Typical complications are posttraumatic necrosis of the femoral head (prevalence according to the literature: 15-66 %), and arthritis of the hip joint. It is yet uncertain, however, whether the type of surgical approach can influence the rate of necrosis. From June 1982 to December 2000, a total of 30 patients underwent surgery for Pipkin-type fractures, with 28 of them being posterior displacements, and 2 being anterior ones. Average age was 35.8 years, 2/3 were male, and 1/3 female. Total hip prosthesis was implanted primarily in 4 cases. 26 underwent osteosynthesis. Anterior displacements were stabilized via a lateral approach, whereas posterior ones were managed via a posterior approach. Reason for this procedure was the intention to use the one side of the joint-capsule for approach, that had been torn already by the displacement-injury. 21 of 26 operatively stabilized patients were followed-up between 6 and 54 months postoperatively. With this regimen of treatment, we had to face no case of necrosis of the femoral head. For fracture displacement of the femoral head we therefore suggest a posterior approach in posterior displacement, as well as an anterior approach for anterior displacement. Using this principle, rate of necrosis of the femoral head may clearly diminish (in our series 0 out of 21).

Der Chirurg ist häufig mit dem embolischen Verschluß der unteren Extremität konfrontiert. In der Mehrzahl der Fälle hat er die sofortige chirurgische Intervention zur Folge. In der Regel wird die Extraktion des Blutgerinnsels über einen inguinalen Zugang durchgeführt. Die Komplikationsrate wird in der Literatur mit 10-15% angegeben; in etwa 5-10% der Fälle kommt es jedoch zur Amputation der betroffenen Gliedmaße. Zur Optimierung des Operationsergebnisses wurde daher eine Strategic entwickelt, die abhängig von der Verschlußlokalisation zwischen femoralem, trunkalem und pedalem Zugangsweg unterscheidet. Nach trunkaler und pedaler Embolektomie verschließen wir die Arteriotomie immer mit einer Venenpatch-Plastik. Dieses sogenannte modifizierte direkte Embolektomieverfahren wurde in den Jahren 1993-1996 an 102 Patienten mit embolischen Verschlüssen der unteren Extremität in unserer Klinik durchgeführt. Es zeigte sich eine Amputationsrate von 4,9%, worin drei infolge verspäteter Operation realisierte Amputationen nicht mitgerechnet sind.