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Mueller CK, Nicolaus K, Thorwarth M, Schultze-Mosgau S. Multivariate analysis of the influence of patient-, tumor-, and management-related factors on the outcome of surgical therapy for facial basal-cell carcinoma. Oral Maxillofac Surg 2010; 14:163-8. [PMID: 20349095 DOI: 10.1007/s10006-010-0215-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This retrospective, case-control study aimed at evaluating the influence of patient-, tumor-, and management-related factors on the outcome of surgical therapy for facial basal-cell carcinoma (BCC) employing a multivariate analysis. METHODS One hundred one patients who underwent ablative surgery for BCC of the face at the Department of Oral and Maxillofacial Surgery/ Plastic Surgery, University Hospital Jena, between April 2005 and January 2009, were analyzed. Patients' charts were screened for anamnestic features as well as management- and follow-up-related details. Standardized photographs were subjected to an esthetic evaluation. Logistic regression was used to identify factors associated with postsurgical wound healing disorders, recurrence, and esthetic impairment. RESULTS Following surgical BCC treatment, age and tumor location in the area of the eyes, nose, lips, and ears were independent predictors of wound healing disorders. Tumor location in the area of the eyes, nose, lips, and ears, subtype and class were independent predictors of recurrence. Female gender and location in the area of the eyes, nose, lips, and ears were independent predictors of esthetic impairment. Micrographic surgery and distant reconstruction technique were management-related predictors of wound healing disorders and esthetic outcome, respectively. CONCLUSIONS The identified negative predictors of treatment outcome should be included in the informed consent to objectify the patient's preoperative expectations.
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Affiliation(s)
- Cornelia Katharina Mueller
- Department of Oral and Maxillofacial Surgery/ Plastic Surgery, University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
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Wehrhan F, Nkenke E, Melnychenko I, Amann K, Schlegel KA, Goerlach C, Zimmermann WH, Schultze-Mosgau S. Skin repair using a porcine collagen I/III membrane--vascularization and epithelization properties. Dermatol Surg 2010; 36:919-30. [PMID: 20618373 DOI: 10.1111/j.1524-4725.2010.01569.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Collagen membranes have been developed to overcome the problem of limited availability of skin grafts. Vascularization and restricted functional epithelization limit the success of bioartificial constructs. OBJECTIVE To compare the vascularization, epithelization, and integration of a porcine collagen I/III membrane with that of split-thickness skin grafts on skin wounds. MATERIALS AND METHODS In 21 adult pigs, full-thickness skin defects on the rear side of the ear healed by split-thickness skin grafting, by covering with the membrane, or by free granulation. Skin samples on postoperative days 1, 3, 7, 14, 21, and 28 were evaluated histologically (hematoxylin-eosin, Sirius Red) and using immunohistochemistry (cytokeratin 5/6, transforming growth factor beta receptor (TGFbetaR-III) and immunoblot (TGFbeta(1,3), Smad2/3). Epithelial thickness and TGFbetaR-III-positive capillary area were quantitatively assessed. RESULTS Epithelization and vascularization in the membrane group were not significantly different from in the group treated with a split-thickness skin graft. Free granulation showed significantly slower epithelization and vascularization (p<.05). TGFbeta(1) and Smad2/3 complex expression were high during free granulation. Matrix was distinguishable until day 7. CONCLUSIONS This membrane serves as a suitable full-thickness dermal substitute, because the membrane is vascularized faster than free granulation tissue and enables early epithelization.
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Affiliation(s)
- Falk Wehrhan
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University of Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany.
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Heller M, Schmidt M, Mueller CK, Thorwarth M, Schultze-Mosgau S. Clinical-anthropometric and aesthetic analysis of nose and lip in unilateral cleft lip and palate patients. Cleft Palate Craniofac J 2010; 48:388-93. [PMID: 20572778 DOI: 10.1597/09-176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Presentation of a technique to determine objectively the degree of symmetry in the area of nose and lip in cleft patients based on analysis of photographs. To compare the objective measurements with the subjective impression. DESIGN This was a retrospective study using a predefined photo documentation standard to capture images of the area of nose and lip. SETTING Department of Oral and Maxillofacial Surgery, University of Jena, Germany. PATIENTS Unilateral cleft patients following primary lip repair (group 1; n = 36) or secondary correction (group 2; n = 23). MAIN OUTCOME MEASURES Measurements were taken on standardized photographs of three dimensions in the area of the nose and two dimensions in the upper lip region. Sign tests were used to ascertain differences between the cleft and unaffected sides separately for each group. Subjective impressions regarding symmetry were gathered and quantified by means of a visual analog scale (VAS). The Mann-Whitney U test was employed to compare the observers' impressions between the two groups. RESULTS While significant side differences were found for all distances in group 1, only the side differences in the height of the nostril remained significant in group 2. Subjective evaluation of the nostril area improved significantly following corrective surgery. However, no such change in the area of the upper lip was recognized by the observers. CONCLUSIONS We were able to demonstrate that the measurable symmetry of the nostril area, as well as the upper lip, was significantly enhanced by corrective surgery. However, only the subjective impression of the nostril was improved.
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Mueller CK, Thorwarth MW, Schultze-Mosgau S. Angiogenic Gene-Modified Fibroblasts for Induction of Localized Angiogenesis. J Surg Res 2010; 160:340-8. [DOI: 10.1016/j.jss.2008.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/23/2008] [Accepted: 12/03/2008] [Indexed: 11/17/2022]
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Kirschbaum M, Schultze-Mosgau S, Pfister W, Eick S. Mixture of periodontopathogenic bacteria influences interaction with KB cells. Anaerobe 2010; 16:461-8. [PMID: 20380884 DOI: 10.1016/j.anaerobe.2010.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 03/20/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the adhesion and invasion of periodontopathogenic bacteria in varied mixed infections and the release of interleukins from an epithelial cell line (KB cells). METHODS KB cells were co-cultured with Porphyromonas gingivalis ATCC 33277 and M5-1-2, Tannerella forsythia ATCC 43037, Treponema denticola ATCC 35405 and Fusobacterium nucleatum ATCC 25586 in single and mixed infections. The numbers of adherent and internalized bacteria were determined up to 18 h after bacterial exposure. Additionally, the mRNA expression and concentrations of released interleukin (IL)-6 and IL-8 were measured. RESULTS All periodontopathogenic bacteria adhered and internalized in different numbers to KB cells, but individually without any evidence of co-aggregation also to F. nucleatum. High levels of epithelial mRNA of IL-6 and IL-8 were detectable after all bacterial challenges. After the mixed infection of P. gingivalis ATCC 33277 and F. nucleatum ATCC 25586 the highest levels of released interleukins were found. No IL-6 and IL-8 were detectable after the mixed infection of P. gingivalis M5-1-2 and F. nucleatum ATCC 25586 and the fourfold infection of P. gingivalis ATCC 33277, T. denticola ATCC 35405, T. forsythia ATCC 43037 and F. nucleatum ATCC 25586. CONCLUSION Anaerobic periodontopathogenic bacteria promote the release of IL-6 and IL-8 by epithelial cells. Despite a continuous epithelial expression of IL-8 mRNA by all bacterial infections these effects are temporary because of the time-dependent degradation of cytokines by bacterial proteases. Mixed infections have a stronger virulence potential than single bacteria. Further research is necessary to evaluate the role of mixed infections and biofilms in the pathogenesis of periodontitis.
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Affiliation(s)
- Michael Kirschbaum
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, University Hospital of Jena, Erlanger Allee 101, Jena, Germany.
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Mueller CK, Thorwarth M, Schultze-Mosgau S. Late changes in cutaneous gene expression patterns after adjuvant treatment of oral squamous cell carcinoma (OSCC) by radiation therapy. ACTA ACUST UNITED AC 2010; 109:694-9. [PMID: 20185344 DOI: 10.1016/j.tripleo.2009.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 10/09/2009] [Accepted: 10/21/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to investigate radiation-induced late changes in cutaneous gene expression using a microarray platform and quantitative, real-time, reverse-transcriptase polymerase chain reaction (RT-PCR) validation. STUDY DESIGN Paired irradiated and nonirradiated skin biopsies were obtained from 19 patients with a history of oral squamous cell carcinoma (OSCC) treated by surgery and adjuvant radiotherapy at the time of secondary corrective surgery. Topic-defined PIQOR (Parallel Identification and Quantification of RNAs) skin microarrays were used to compare gene expression profiles between control and irradiated skin sample in 8 patients. The data were validated for matrixmetalloproteinase (MMP)-1 and tissue-inhibitor of matrixmetalloproteinase (TIMP)-1 by RT-PCR for all patients. RESULTS Irradiation markedly enhanced the expression of molecules associated with the transforming growth factor (TGF)-beta(1) signaling pathway, blood vessel development, as well as extracellular matrix constitution and turn-over. CONCLUSIONS Our data suggest that radiation-induced late changes in cutaneous gene expression mainly affect molecules related to extracellular matrix (ECM)-constitution and-remodeling.
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Affiliation(s)
- Cornelia K Mueller
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Germany.
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Mueller C, Lee SY, Schultze-Mosgau S. Characterization of interfacial reactions between connective tissue and allogenous implants used for subdermal soft tissue augmentation. Int J Oral Maxillofac Surg 2009; 38:1194-200. [DOI: 10.1016/j.ijom.2009.07.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 06/06/2009] [Accepted: 07/21/2009] [Indexed: 01/30/2023]
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Bader RD, Wolf C, Raschke G, Thorwarth M, Schultze-Mosgau S. Tauglichkeit von 2,5-mm-Rekonstruktionsplatten zur Osteosynthese bei mikrovaskulären Unterkieferrekonstruktionen. Zentralbl Chir 2009. [DOI: 10.1055/s-0029-1238111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Müller CK, Lee SY, Schultze-Mosgau S. Exogene, Fibroblasten-basierte Applikation von VEGF-Plasmid zur Stimulation der Neovaskularisation im Rahmen der Wundheilung. Zentralbl Chir 2009. [DOI: 10.1055/s-0029-1238152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bader RD, Reinhardt G, Zenk W, Schultze-Mosgau S. Planungsgenauigkeit bei Umstellungsosteotomien des Unterkiefers nach Obwegeser/DalPont. Zentralbl Chir 2009. [DOI: 10.1055/s-0029-1238112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bader RD, Wolf C, Raschke G, Thorwarth M, Schultze-Mosgau S. Rekonstruktion der Gesichtsweichteile mittels mikrovaskulär reanastomosierten Lappen. Zentralbl Chir 2009. [DOI: 10.1055/s-0029-1238110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pohlers D, Brenmoehl J, Löffler I, Müller CK, Leipner C, Schultze-Mosgau S, Stallmach A, Kinne RW, Wolf G. TGF-beta and fibrosis in different organs - molecular pathway imprints. Biochim Biophys Acta Mol Basis Dis 2009; 1792:746-56. [PMID: 19539753 DOI: 10.1016/j.bbadis.2009.06.004] [Citation(s) in RCA: 454] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 12/25/2022]
Abstract
The action of transforming-growth-factor (TGF)-beta following inflammatory responses is characterized by increased production of extracellular matrix (ECM) components, as well as mesenchymal cell proliferation, migration, and accumulation. Thus, TGF-beta is important for the induction of fibrosis often associated with chronic phases of inflammatory diseases. This common feature of TGF-related pathologies is observed in many different organs. Therefore, in addition to the description of the common TGF-beta-pathway, this review focuses on TGF-beta-related pathogenetic effects in different pathologies/organs, i. e., arthritis, diabetic nephropathy, colitis/Crohn's disease, radiation-induced fibrosis, and myocarditis (including their similarities and dissimilarities). However, TGF-beta exhibits both exacerbating and ameliorating features, depending on the phase of disease and the site of action. Due to its central role in severe fibrotic diseases, TGF-beta nevertheless remains an attractive therapeutic target, if targeted locally and during the fibrotic phase of disease.
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Affiliation(s)
- Dirk Pohlers
- Experimental Rheumatology Unit, Department of Orthopedics, Waldkrankenhaus Rudolf Elle Eisenberg, University Hospital Jena, Friedrich Schiller University, Jena, Germany
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Schmidt S, Schleußner E, Schultze-Mosgau S, Knösel T, Mentzel HJ, Hübler A. Kongenitale Epulis bei einem neugeborenen Mädchen – Solide Tumoren der Mundhöhle sind ein sehr seltenes Krankheitsbild in der Neonatalperiode. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lemm D, Muegge LO, Hoeffken K, Aklan T, Mentzel T, Thorwarth M, Schultze-Mosgau S. Remission with Imatinib mesylate treatment in a patient with initially unresectable dermatofibrosarcoma protuberans--a case report. Oral Maxillofac Surg 2008; 12:209-213. [PMID: 18751744 DOI: 10.1007/s10006-008-0130-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 08/06/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare, malignant dermal mesenchymal neoplasm characterized by a slow, infiltrative growth. These neoplasms have a high tendency to recur locally after surgical excision. However, metastasizing cases are exceedingly rare. Cytogenetically, DFSP is characterized by a t(17;22)(22;q13) aberration with fusion of the COL1A1 gene on chromosome 17 with the PDGFB gene on chromosome 22. Here, we report on a successful treatment of a patient with a targeted therapy using the tyrosine kinase inhibitor Imatinib mesylate in neoadjuvant intention. PATIENTS AND METHODS A patient with recurrent and initially unresectable but non-metastatic DFSP of the scalp received Imatinib over 3 months with increasing dosage from 400 mg/day to 800 mg/day orally. Due to the location of the DFSP in our patient, we intended to decrease tumor size preoperatively to allow complete surgical resection. Response to therapy was assessed by computed tomography. RESULTS Preoperative treatment with Imatinib resulted in decrease of tumor size by over 60% in the greatest dimension during 3 months of therapy, enabling the complete resection of the DFSP by radical surgery with achieving an acceptable cosmetic result. Surgery was followed by adjuvant Imatinib therapy over 6 months. CONCLUSIONS Imatinib mesylate is effective in neoadjuvant treatment of primary unresectable dermatofibrosarcoma protuberans and can be considered as a useful option in the therapy regimen.
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Affiliation(s)
- Doreen Lemm
- Department of Internal Medicine II (Oncology/Hematology), University of Jena, Erlanger Allee 101, 07740, Jena, Germany.
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Schleier P, Bierfreund G, Schultze-Mosgau S, Moldenhauer F, Küpper H, Freilich M. Simultaneous dental implant placement and endoscope-guided internal sinus floor elevation: 2-year post-loading outcomes. Clin Oral Implants Res 2008; 19:1163-70. [DOI: 10.1111/j.1600-0501.2008.01561.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Thorwarth M, Eulzer C, Bader R, Wolf C, Schmidt M, Schultze-Mosgau S. Free flap transfer in cranio-maxillofacial surgery: a review of the current data. Oral Maxillofac Surg 2008; 12:113-124. [PMID: 18575905 DOI: 10.1007/s10006-008-0112-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The advances of cranio-maxillofacilal surgery are considerably driven by the evolution of microsurgical techniques. At present, these methods continue to provide new therapeutic options to the field. Especially, free flap transfer has evolved to become an integral part of current treatment protocols for head and neck malignancies. It ensures uneventful wound healing even after previous radiotherapy and can often preserve form and function. For many patients, this may lead to a significant improvement in their quality of life. OBJECTIVES This review summarizes aspects of tumor therapy, the impact of radiation, and discusses different techniques of microvascular tissue transfer. DISCUSSION Specific advantages in different anatomical sites of the head and neck region are highlighted in contrast to existing alternatives. Selected cases exemplify the use of popular transplants. SUMMARY While planning reconstructions, it is important to consider both the functional and aesthetic aspects. The best individual outcome is based on a thoughtful match of available methods to a given defect and the patient's condition.
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Affiliation(s)
- M Thorwarth
- Department of Oromaxillofacial Surgery/Plastic Surgery, University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
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Schleier P, Berndt A, Kolossa S, Zenk W, Hyckel P, Schultze-Mosgau S. Comparison of aminolevulinic acid (ALA)-thermogel-PDT with methyl-ALA-thermogel-PDT in basal cell carcinoma. Photodiagnosis Photodyn Ther 2007; 4:197-201. [DOI: 10.1016/j.pdpdt.2007.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 04/10/2007] [Accepted: 04/18/2007] [Indexed: 12/01/2022]
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Thorwarth M, Bader R, Ewald C, Reichart R, Kalff R, Schultze-Mosgau S. Functional Reconstruction of the Midface and the Temporomandibular Joint. Skull Base 2007. [DOI: 10.1055/s-2006-957281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thorwarth M, Bader R, Ewald C, Reichart R, Kalff R, Schultze-Mosgau S. Funktionelle Defektrekonstruktion im Mittelgesicht und Kiefergelenksbereich. Skull Base 2007. [DOI: 10.1055/s-2006-957282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bader R, Thorwarth M, Hochstetter A, Reichart R, Kalff R, Schultze-Mosgau S. Konzepte zur plastischen Rekonstruktion der Periorbita und Temporalisregion. Skull Base 2007. [DOI: 10.1055/s-2006-957280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bader R, Thorwarth M, Hochstetter A, Reichart R, Kalff R, Schultze-Mosgau S. Strategies for the Reconstruction of Periorbital and Temporal Tissue. Skull Base 2007. [DOI: 10.1055/s-2006-957279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Franke UFW, Bossert T, Thorwarth M, Breuer M, Bader RD, Schultze-Mosgau S, Gummert JF. Treatment of complex deep sternal wound infection by an interdisciplinary approach using two staged closure using vacuum assisted drainage and muscle flaps. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schlegel KA, Schultze-Mosgau S, Wiltfang J, Neukam FW, Rupprecht S, Thorwarth M. Changes of mineralization of free autogenous bone grafts used for sinus floor elevation. Clin Oral Implants Res 2006; 17:673-8. [PMID: 17092226 DOI: 10.1111/j.1600-0501.2006.01186.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For augmentations before implant placement in areas of minor bone quantity, autogenous bone is considered the reference to all bone substitutes used alternatively. Autogenous bone transplants originate from various donor areas and can be prepared in different ways before augmentation. They may either be used as block grafts or may be milled to granules that can be used solitarily or in combination with a bone substitute. In a prospective study, 61 patients of the Maxillofacial Surgery Department of our University receiving two-stage sinus floor elevation because of insufficient bone supply were randomly selected. At first-stage surgery, the local augmentation procedure, monocortical probes were obtained on the site of bone harvesting. At second-stage surgery, the implant insertion 6 months after the elevation procedure, bone cores were harvested in the areas of implant placement. Donor regions were the following three areas: the posterior (N=28) and anterior pelvic region (N=15) and the chin region (N=18). The implanted bone in all three groups was particulated to granules of 2-3 mm(2) using a bone mill. All biopsies were analyzed by means of microradiography. The anterior pelvic bone grafts showed a mineralized tissue grade of 35.1+/-7.6% before milling and augmentation. The posterior pelvic bone grafts exhibited a mineralization of 30.7+/-9.5% and the chin bone grafts 74.6+/-8.6%. At second-stage surgery after 6 months, the mineralization was 36.1+/-7.59% in the areas where bone grafts from the anterior pelvic crest were used. Probes harvested from sites with posterior pelvic bone augmentations showed a mineralization rate of 34.5+/-6.5%, and sites were chin bone grafts were applied expressed a mineralization of 54+/-8.6% (P=0.003 compared with the pre-operative value). The comparison of the microradiographical results demonstrated significant differences in the mineralization grades depending on the origin of the graft. The origin of the grafts and their remodeling influenced the mineralization rates found at 6 months. How these data may influence the long-term clinical outcome considering implant survival and bone resorption has to be examined in further long-term studies.
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Affiliation(s)
- Karl Andreas Schlegel
- Department of Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Dawczynski J, Thorwarth M, Koenigsdoerffer E, Schultze-Mosgau S. Interdisciplinary Treatment and Ophthalmological Findings in Parry-Romberg Syndrome. J Craniofac Surg 2006; 17:1175-6. [PMID: 17119425 DOI: 10.1097/01.scs.0000236440.20592.be] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Parry-Romberg syndrome is a rare pathologic process, characterized by progressive hemifacial atrophy. A case of Parry-Romberg syndrome with ocular involvement is reported. A 27-year-old male patient with Parry-Romberg syndrome was interdisciplinary investigated and treated. For reconstruction of hemifacial soft tissues a free vascular parascapular graft was performed. Opthalmological findings included an evident enophthalmos and an eyelid lag with keratopathy and epiphora. Furthermore pupillary disturbances and endothelial precipitates were detectable. Complete fundus examination showed a unilateral optic disc swelling, central vitreous opacities and peripheral pigmentary disturbances. In the presented case of Parry-Romberg syndrome a rare association to ophthalmological involvement could be found. Beside the enophthalmos and eyelid alterations, also a panuveitis with papillitis should be treated by steroid therapy.
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Affiliation(s)
- Jens Dawczynski
- Department of Ophthalmology, University Hospital Jena, Jena, Germany.
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Eitner S, Wichmann M, Schultze-Mosgau S, Schlegel A, Leher A, Heckmann J, Heckmann S, Holst S. Neurophysiologic and long-term effects of clinical hypnosis in oral and maxillofacial treatment--a comparative interdisciplinary clinical study. Int J Clin Exp Hypn 2006; 54:457-79. [PMID: 16950687 DOI: 10.1080/00207140600856897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This prospective comparative clinical study evaluated the effectiveness of clinical hypnosis and its long-term effect in oral and maxillofacial treatment. A total of 45 highly anxious and nonanxious subjects were evaluated by subjective experience and objective parameters. Parameters were EEG, ECG, heart rate, blood pressure, blood oxygen saturation, respiration rate, salivary cortisol concentration, and body temperature. During and subsequent to the operative treatment, hypnosis led to a significant reduction of systolic blood pressure, and respiration rate and to significant changes in the EEG. The subjective values of the parameters evaluated existing anxiety mechanisms and patterns and possible strategies to control them, whereas the objective parameters proved the effectiveness of hypnosis and its long-term effect.
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Affiliation(s)
- Stephan Eitner
- Department of Prosthodontics, Friedrich Alexander University, Erlangen-Nuremberg, Germany.
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Eitner S, Schultze-Mosgau S, Heckmann J, Wichmann M, Holst S. Changes in neurophysiologic parameters in a patient with dental anxiety by hypnosis during surgical treatment. J Oral Rehabil 2006; 33:496-500. [PMID: 16774507 DOI: 10.1111/j.1365-2842.2005.01578.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It was hypothesized that dental anxiety, which leads to neurophysiologic alterations in heart rate, respiratory rate and blood pressure prior, during and subsequent to dental treatment, can be influenced by medical hypnosis. We report the positive impact from non-invasive hypno-sedation during dental implant surgery on a 54-year-old female patient who experienced neurophysiologic reactions as a result of the psychosomatic process of dental anxiety (dental anxiety scale value = 13). The neurophysiologic changes during dental surgery performed with and without hypnosis were compared after the patient underwent the same surgical treatment protocol. This case report was part of a study designed to evaluate hypnosis as a non-invasive therapy for dental-anxious patients over six sessions using subjective experience and objective parameters, which included electroencephalogram, electrocardiogram, heart rate, blood pressure, oxygen saturation of the blood, respiration rate, salivary cortisol concentration and body temperature.
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Affiliation(s)
- S Eitner
- Department of Prosthodontics, Maxillofacial Surgery and Neurology and Psychiatry, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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77
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Thorwarth M, Wehrhan F, Srour S, Schultze-Mosgau S, Felszeghy E, Bader RD, Schlegel KA. Evaluation of substitutes for bone: comparison of microradiographic and histological assessments. Br J Oral Maxillofac Surg 2006; 45:41-7. [PMID: 16713040 DOI: 10.1016/j.bjoms.2006.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2006] [Indexed: 11/23/2022]
Abstract
We created defects of standard size in the frontal bones of adult pigs and filled them with four different materials. On six occasions (at 1, 2, 4, 8, 12, and 26 weeks), samples were harvested, and evaluated by computing microradiographic images. We examined the specimens histologically as controls. After insertion of anorganic materials, microradiographic evaluation was easy and precise, and there were no significant differences between them and the histological controls (p=0.2). A quantitative evaluation of chemically sterilised bone by computer was not possible for more than 4 weeks.
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Affiliation(s)
- M Thorwarth
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Erlanger Allee 101, D-07747 Jena, Germany.
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78
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Fenner M, Wehrhan F, Jehle M, Amann K, Radespiel-Tröger M, Grabenbauer G, Zenk J, Nkenke E, Schinhammer M, Schultze-Mosgau S. Restricted-expressed proliferation-associated protein (Repp86) expression in squamous cell carcinoma of the oral cavity. Strahlenther Onkol 2006; 181:755-61. [PMID: 16362784 DOI: 10.1007/s00066-005-1430-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 08/01/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the expression of repp86 (restricted-expressed protein of 86 kDa theoretical molecular mass), a proliferation- associated protein expressed in S-, G(2)- and M-phases of the cell cycle, in samples of normal mucosa as well as squamous cell carcinoma of the oral cavity (OSCC). PATIENTS AND METHODS The repp86 labeling index (LI) was determined imunohistochemically in ten samples of normal oral mucosa and 59 samples of OSCC. Repp86 LI was correlated with tumor stage, histopathologic grading, and the expression of Ki-67 and topoisomerase IIalpha. RESULTS Repp86 was detectable in all tissues analyzed. The mean LI was 4.7% for normal mucosa and 18.4% for squamous cell carcinoma (p < 0.0001). Repp86 expression was not related to tumor size, lymph node invasion, or histopathologic grading but was positively correlated with Ki-67 index (r = 0.48; p < 0.01) as well as with topoisomerase IIalpha (r = 0.39; p < 0.01). Ki-67 and topoisomerase IIalpha levels were also significantly correlated with each other (r = 0.34; p < 0.05). CONCLUSION These results indicate that repp86 expression can be an additional proliferation marker among Ki-67 and topoisomerase IIalpha in OSCC. Further research will be directed at the evaluation of the prognostic value of repp86 expression in OSCC as well as in leukoplakia and early-stage OSCC.
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Affiliation(s)
- Matthias Fenner
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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79
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Schultze-Mosgau S, Wehrhan F, Wichmann M, Schlegel KA, Holst S, Thorwarth M. Expression of interleukin 1-beta, transforming growth factor beta-1, and vascular endothelial growth factor in soft tissue over the implant before uncovering. ACTA ACUST UNITED AC 2006; 101:565-71. [PMID: 16632266 DOI: 10.1016/j.tripleo.2005.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 06/26/2005] [Accepted: 07/09/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Overexpression of inflammatory cytokines interleukin 1-beta (IL-1beta), transforming growth factor beta-1 (TGF-beta1), and vascular endothelial growth factor (VEGF) may cause healing impairment following implant insertion, jeopardizing success especially in patients previously irradiated. Limited data is available regarding expression pattern of inflammatory cytokines in peri-implant soft tissue caused by the surgical intervention itself. STUDY DESIGN This study examined 21 patients receiving dental implants. Biopsies of peri-implant tissue were harvested at re-entry 4 months after initial surgery. Eight patients underwent probing of untreated mucosa. Three groups were created (group 1: regular peri-implant mucosa; group 2: patients with irradiated peri-implant mucosa, radiation treatment due to oral squamous cell cancer; group 3: control). Immunohistochemical staining was performed for TGFss1, IL-1ss, and VEGF. RESULTS Following the placement of dental implants (group 1 vs group 3) a significant increase (P > .05) in TGF-beta1, IL-1beta, and VEGF expression in the peri-implant mucosa was demonstrated. No alteration of this distinct pattern was found for previously irradiated tissue (group 1 vs. group 2). CONCLUSIONS The study highlights the fundamental involvement of TGF-beta1, IL-1beta, and VEGF during the regeneration of peri-implant soft tissue structures. The use of extended interim solutions may be one clinical implication of these prolonged tissue remodeling processes.
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Affiliation(s)
- S Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Germany.
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Seyhan H, Kopp J, Schultze-Mosgau S, Horch RE. Increased Metabolic Activity of Fibroblasts Derived from Cords Compared with Nodule Fibroblasts Sampling from Patients with Dupuytren??s Contracture. Plast Reconstr Surg 2006; 117:1248-52. [PMID: 16582795 DOI: 10.1097/01.prs.0000204585.97844.7e] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pathogenesis of Dupuytren's contracture is characterized by progress in several stages. The disease process includes two structurally distinct fibrotic elements, the so-called nodule and the cord. Several hypotheses have been proposed regarding the cause. Until now, there has been ongoing discussion regarding whether cords or nodules are the primary source of the disease. METHODS Tissues from 24 patients with Dupuytren's disease were obtained during hand surgery, providing samples from nodules and cords for cell culture. Tissue from the flexor retinaculum excised from healthy patients during surgical procedures on the hand served as control. By using the explant culture technique, fibroblasts were isolated and grown in standard medium. Besides morphological analysis, XTT proliferation tests were performed at various time periods to measure the metabolic activity of the cultivated fibroblasts. RESULTS Statistical analysis revealed significant differences of nodule- and cord-derived fibroblasts after 1 hour (p = 0.0150), 8 hours (p < 0.0001), and 16 hours (p < 0.0001). CONCLUSIONS The authors suggest that distinct proliferative properties of Dupuytren-derived fibroblasts are dependent on the cells' origin. Conclusions about the cause or pathogenesis cannot yet be drawn. Further investigation concerning their apparently different fibroproliferative properties is necessary.
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Affiliation(s)
- Harun Seyhan
- Department of Plastic and Hand Surgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Petrovic L, Schlegel AK, Schultze-Mosgau S, Wiltfang J. Different substitute biomaterials as potential scaffolds in tissue engineering. Int J Oral Maxillofac Implants 2006; 21:225-31. [PMID: 16634492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
PURPOSE To find the optimal scaffold for tissue-engineered bone, one approach is to test existing biomaterials on their suitability as scaffolds. In this study, the suitability of different alloplastic and xenogenic biomaterials as scaffolds for ex vivo osteoblast cultivation was investigated. MATERIALS AND METHODS Normal human osteoblast cells were cultured on the surface of bovine collagenous materials, bovine hydroxyapatite, porcine gelatin, synthetic polymer, and collagen-containing bovine hydroxyapatite, and the investigation of proliferation was performed after 24, 72, and 120 hours. Measurement of the differentiation marker alkaline phosphatase and osteocalcin was made after 20 days of incubation. RESULTS The obtained data showed significantly higher proliferation and differentiation rates in cells cultivated on collagen-rich biomaterials in comparison to noncollagenous or collagen-poor biomaterials (P < .05). DISCUSSION In tissue engineering the scaffold should be biocompatible and serve as a proper matrix for the cells to produce the new structural environment of extracellular matrix ex vivo. Collagen supports initial cell attachment and cell proliferation, allowing immature osteogenic cells to differentiate into mature osteoblasts, but collagen may not be the only dominating factor for cell-matrix interaction during ex vivo bone formation. CONCLUSION These data suggest that a 3-dimensional collagen matrix can provide a more favorable environment for the attachment, proliferation, and differentiation of in vitro osteoblastlike cells, at least until the initial stage of differentiation, than noncollagenous biomaterials.
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Affiliation(s)
- Ljubinko Petrovic
- Oral and Maxillofacial Surgery Department, Friedrich Alexander University, Erlangen-Nuremberg, Germany.
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Thorwarth M, Schlegel KA, Wehrhan F, Srour S, Schultze-Mosgau S. Acceleration of de novo bone formation following application of autogenous bone to particulated anorganic bovine material in vivo. ACTA ACUST UNITED AC 2006; 101:309-16. [PMID: 16504863 DOI: 10.1016/j.tripleo.2005.04.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 04/04/2005] [Accepted: 04/21/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This prospective animal study examined the de novo bone formation following application of deproteinized bovine bone matrix (DBBM) with or without autogenous bone (AB) to osseous defects. STUDY DESIGN Defects of defined size were created in the frontal skull of domestic pigs and filled with DBBM alone (group A) and DBBM+25%AB (group B). De novo bone formation was analyzed qualitatively and quantitatively at 9 different times (0.5, 1, 2, 3, 4, 6, 8, 12, 26 weeks) by means of light microscopy, microradiography, and statistical analysis. RESULTS Histological analysis indicated sufficient osseointegration of DBBM in both groups. Microradiography demonstrated a significant increase of bone formation in group B after 6 weeks (P = .0159) and 8 weeks (P = .0317). CONCLUSION The addition of 25%AB to DBBM results in accelerated de novo bone formation in osseous defects. This effect is likely caused by osteoinductive properties of cellular elements transplanted with the autogenous bone.
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Affiliation(s)
- Michael Thorwarth
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Jena, Germany.
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Thorwarth M, Srour S, Felszeghy E, Kessler P, Schultze-Mosgau S, Schlegel KA. Stability of autogenous bone grafts after sinus lift procedures: a comparative study between anterior and posterior aspects of the iliac crest and an intraoral donor site. ACTA ACUST UNITED AC 2006; 100:278-84. [PMID: 16122653 DOI: 10.1016/j.tripleo.2004.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2004] [Revised: 11/26/2004] [Accepted: 12/23/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Autologous bone is the standard material used for augmentations in oral-maxillofacial surgery. Depending on the origin of the graft, subsequent bone resorption may vary. STUDY DESIGN This prospective study evaluated 57 patients receiving 2-stage sinus floor augmentations. Monocortical samples were taken at the site of bone harvesting, including the posterior (n = 28) and anterior pelvic (n = 15) and retromolar (n = 14) regions. At second-stage surgery, 6 months after the implant insertion, bone cores were harvested at the site of implant placement. All samples were analyzed by microradiography. RESULTS Mean retromolar mineralization was 68.7% +/- 8.75%; 35.1% +/- 7.6% in the anterior and 30.7% +/- 9.5% in the posterior iliac crest. Areas augmented with grafts originating from the retromolar region showed a significant decrease to 53.0% +/- 5.15% (P = .001). A stable mineralization of 36.1% +/- 7.59% was found in sites where bone grafts from the anterior pelvic crest were used. Grafts from the posterior pelvis showed a slight increase to 34.5% +/- 6.5%. CONCLUSION This prospective clinical study demonstrates the differences in mineralization depending on the origin of autogenous bone. Even after 6 months, these values could still be correlated to the transplants origin.
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Affiliation(s)
- Michael Thorwarth
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Thorwarth M, Wehrhan F, Schultze-Mosgau S, Wiltfang J, Schlegel KA. PRP modulates expression of bone matrix proteins in vivo without long-term effects on bone formation. Bone 2006; 38:30-40. [PMID: 16257592 DOI: 10.1016/j.bone.2005.06.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2004] [Revised: 06/19/2005] [Accepted: 06/22/2005] [Indexed: 11/19/2022]
Abstract
This experimental study (domestic pig) examined the bone formation after filling defined defects of the frontal skull with autogenous bone or a deproteinized bovine bone matrix (DBBM) in combination with platelet-rich plasma (PRP). Six groups, both materials with and without PRP in two different concentrations (4.1x and 6.5x referring to untreated whole blood) were evaluated at 2, 4, 12, and 26 weeks by means of immunohistochemical staining for different bone matrix proteins, microradiography, light microscopy and polychromatic fluorescence labeling. The sequential expression of bone matrix proteins reflected the specific roles these proteins fulfil in the mineralization of hard tissue. Collagen I expression at 2 weeks was enhanced in all autogenous bone groups. No specific modification of the collagen I expression was found after use of DBBM with or without PRP. Osteopontin and especially osteonectin showed a remarkable enhancement at 4 weeks in nearly all autogenous bone and DBBM groups. These increased levels closely resembled the mineralization content evaluated by microradiography at that time. For the three autogenous bone groups, an expression peak for osteocalcin was demonstrated at 12 weeks, further reflecting the way of de novo bone formation. The microradiographic evaluation demonstrated a statistically significant enhancement in bone regeneration by PRP only after use of autogenous bone plus PRP at 2 weeks (P = 0.002). After 4 weeks, mineralization values after use of autogenous bone were significantly lower if PRP was added to the autogenous bone (P = 0.002). No long-term effects of the PRP administration were found in the mineralization process. In all DBBM groups, bone formation remained unchanged, confirming the lack of any osteoinductive capacity of PRP. PRP modulated the expression of bone matrix proteins in this experimental setting. However, an enhancement of bone formation was demonstrated only at 2 weeks after application of the higher PRP concentration in combination with autogenous bone. In conjunction with an anorganic bovine bone no effects of PRP on defect mineralization were discovered, demonstrating the lack of osteoinductive capacity in PRP as well as in DBBM.
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Affiliation(s)
- Michael Thorwarth
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Erlanger Allee 101, D-07747 Jena, Germany.
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Schultze-Mosgau S, Kopp J, Thorwarth M, Rödel F, Melnychenko I, Grabenbauer GG, Amann K, Wehrhan F. Plasminogen activator inhibitor-I–related regulation of procollagen I (α1 and α2) by antitransforming growth factor-β1 treatment during radiation-impaired wound healing. Int J Radiat Oncol Biol Phys 2006; 64:280-8. [PMID: 16377416 DOI: 10.1016/j.ijrobp.2005.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Revised: 08/28/2005] [Accepted: 09/06/2005] [Indexed: 01/18/2023]
Abstract
PURPOSE Plasminogen activator inhibitor (PAI)-1 mediates transforming growth factor-beta1 (TGF-beta1)-related signaling by stimulating collagen Type I synthesis in radiation-impaired wound healing. The regulation of alpha(I)-procollagen is contradictory in fibroblasts of different fibrotic lesions. It is not known whether anti-TGF-beta1 treatment specifically inhibits alpha(I)-procollagen synthesis. We used an experimental wound healing study to address anti-TGF-beta1-associated influence on alpha(I)-procollagen synthesis. METHODS AND MATERIALS A free flap was transplanted into the preirradiated (40 Gy) or nonirradiated neck region of Wistar rats: Group 1 (n = 8) surgery alone; Group 2 (n = 14) irradiation and surgery; Group 3 (n = 8) irradiation and surgery and anti-TGF-beta1 treatment. On the 14th postoperative day, skin samples were processed for fibroblast culture, in situ hybridization for TGF-beta1, immunohistochemistry, and immunoblotting for PAI-1, alpha1/alpha2(I)-procollagen. RESULTS Anti-TGF-beta1 significantly reduced TGF-beta1 mRNA (p < 0.05) and PAI-1 expression (p < 0.05). Anti-TGF-beta1 treatment in vivo significantly reduced alpha1(I)-procollagen protein (p < 0.05) and the number of expressing cells (p < 0.05) in contrast to significantly increased (p < 0.05) alpha2(I)-procollagen expression. CONCLUSION These results emphasize anti-TGF-beta1 treatment to reduce radiation-induced fibrosis by decreasing alpha1(I)-procollagen synthesis in vivo. alpha1(I)-procollagen and alpha2(I)-procollagen might be differentially regulated by anti-TGF-beta1 treatment. Increased TGF-beta signaling in irradiated skin fibroblasts seemed to be reversible, as shown by a reduction in PAI-1 expression after anti-TGF-beta1 treatment.
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Affiliation(s)
- Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, Freidrich-Schiller-University of Jena, Jena, Germany.
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Wiltfang J, Schultze-Mosgau S, Nkenke E, Thorwarth M, Neukam FW, Schlegel KA. Onlay augmentation versus sinuslift procedure in the treatment of the severely resorbed maxilla: a 5-year comparative longitudinal study. Int J Oral Maxillofac Surg 2005; 34:885-9. [PMID: 15978775 DOI: 10.1016/j.ijom.2005.04.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Revised: 03/29/2005] [Accepted: 04/14/2005] [Indexed: 11/22/2022]
Abstract
Augmentation procedures in the severely resorbed maxilla are standard techniques in preprosthetic surgery. Aim of the present study was to compare onlay bone grafting and sinus floor elevation with autogenous bone grafts in edentulous patients in terms of bone resorption of the posterior alveolar crest and implant survival in a 5-year longitudinal study. A total of 100 patients (53 female and 47 male patients) requiring augmentation using autogenous bone due to a severely resorbed maxillae were evaluated. The degree of resorption and bone quality were preoperatively estimated in panoramic radiographs according to Lekholm and Zarb. The overall 5-year success rate of implants placed after augmentation procedures in the posterior maxilla was 93.1%. Following onlay augmentations 215 out of 235 implant insertions were successful, i.e. a success rate of 91.5% was achieved. In the sinuslift group, 330 out 349 implants remained successful, i.e. a success rate of 94.6% was found. The difference between both groups was statistically significant at the end of the evaluation period. Bone resorption, measured as loss of total bone height in panoramic radiographs, was initially more pronounced following onlay augmentations (>20% after 12 months of observation). The degree of resorption decreased in the further course of the study. Lower resorption rates and a higher overall success rate were demonstrated for the sinus lift group.
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Affiliation(s)
- J Wiltfang
- Department of Oral and Maxillofacial Surgery, University of Schleswig-Holstein/Campus Kiel, Arnold-Heller-Strasse 16, D-24105 Kiel, Germany.
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Thorwarth M, Schultze-Mosgau S, Kessler P, Wiltfang J, Schlegel KA. Bone Regeneration in Osseous Defects Using a Resorbable Nanoparticular Hydroxyapatite. J Oral Maxillofac Surg 2005; 63:1626-33. [PMID: 16243180 DOI: 10.1016/j.joms.2005.06.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE This animal study examined the de novo bone formation in bony defects following the insertion of autogenous bone alone versus an injectable nanoparticle hydroxyapatite alone and in combination with 25% autogenous bone. The regenerative potentials of the tested materials were compared with each other. MATERIALS AND METHODS A model with biological similarity to humans with regard to bone regeneration was a prerequisite for the transferability of the results to clinical practice. Therefore, the adult domestic pig was the animal of choice. A total observation period of 6 months was selected. Microradiographic and histologic evaluation of the bone specimens was completed at 8 defined times. RESULTS Microradiography indicated mineralization rates in the 2 bone substitute groups that were not significantly lower than those found in the autogenous bone group. Histologically, there was suitable osseointegration and osteoconduction of the used material. Complete resorption of the nanoparticle hydroxyapatite had taken place after 12 weeks. CONCLUSIONS It can be concluded that the evaluated nanoparticular hydroxyapatite met the clinical requirements for a bone substitute material within the limits of this experimental setting. Due to its microstructure, complete resorption took place during the course of this study.
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Affiliation(s)
- Michael Thorwarth
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Erlanger Allee 101, D-07747 Jena, Germany.
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Schultze-Mosgau S, Thorwarth M, Wehrhan F, Holter W, Stachel KD, Grabenbauer G, Amann K, Beck JD. Ewing Sarcoma of the Mandible in a Child: Interdisciplinary Treatment Concepts and Surgical Reconstruction. J Craniofac Surg 2005; 16:1140-6. [PMID: 16327573 DOI: 10.1097/01.scs.0000180005.52986.19] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ewing's sarcoma is the second most common primary bone malignancy in childhood and adolescence. We present a standardized interdisciplinary treatment protocol according to the EURO-E.W.I.N.G. 99 study, applied in the treatment of a 7-year-old patient with localized Ewing's sarcoma of the left mandible. After six blocks of VIDE (vincristine/ifosfamide/doxorubicin/etoposide) chemotherapy and stem cells rescue, intensity modulated external radiation with 48.6 Gy and subsequent high dose therapy with busulphan-melphalan were administered. Tumor resection and immediate bony reconstruction was performed using a microvascular fibula graft 10 weeks after radiation. Because of the effective neoadjuvant treatment, no extensive soft tissue resection was necessary. Healing of the osteosynthesis was uneventful. No local or systemic recurrence and no signs of significant facial deformity were found after 12 month follow-up. The presented case underlines the requirement for multidisciplinary protocols involving radiologists, pathologists, oncologists, radiation oncologists, and surgeons for accurate diagnosis and appropriate therapy. To preserve cosmetics and function within the craniofacial area after tumor resection in children, microvascular reconstructive procedures can be successfully performed with a vascularized fibular graft.
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Affiliation(s)
- Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Jena, Germany.
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Schultze-Mosgau S, Blatz MB, Wehrhan F, Schlegel KA, Thorwart M, Holst S. Principles and mechanisms of peri-implant soft tissue healing. Quintessence Int 2005; 36:759-69. [PMID: 16261792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The long-term clinical and esthetic success of implant-supported restorations is determined by osseointegration and optimal remodeling of peri-implant soft tissues. Complications of soft-tissue management are often caused by fibrotic regeneration of oral mucosa after multiple surgical procedures. Knowledge of the proliferative processes in wound healing is necessary to attain adequate soft-tissue conditions. Successful reconstruction of peri-implant soft tissues is feasible even in fibrotic conditions when appropriate surgical techniques are selected. The pleiotropic proliferative cytokine TGF-beta is involved in the regulation of all phases of wound healing and tissue remodeling. The isoform TGF-beta1 is a cytokine associated with the development of fibrotic tissue. Overexpression of TGF-beta1 causes scarring and fibrosis, and results in limited clinical success of intraoral soft-tissue management. Experimental therapeutic approaches with neutralizing antibodies to block TGF-beta1 resulted in less scarring and a reduction of fibrosis. Further molecular biologic research of cell-matrix-cytokine interactions in wound healing will provide highly specific antifibrotic therapeutic approaches in the future.
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Affiliation(s)
- Stefan Schultze-Mosgau
- Clinic and Policlinic of Oral and Maxillofacial Surgery, Friedrich-Schiller-University Jena, Germany
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90
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Rupprecht S, Tangermann-Gerk K, Schultze-Mosgau S, Neukam FW, Ellrich J. Neurophysiological monitoring of alveolar nerve function during sensor-controlled Er:YAG laser corticotomy in rabbits. Lasers Surg Med 2005; 36:186-92. [PMID: 15685602 DOI: 10.1002/lsm.20133] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The sensor-controlled Er:YAG laser system may be a potent tool for tissue specific cutting in surgery. In order to investigate the impact of the laser on neural tissues, inferior alveolar nerve (IAN) function was monitored by the jaw-opening reflex (JOR) during specific corticotomy in rabbits. STUDY DESIGN/MATERIALS AND METHODS Laser jaw corticotomy was performed in 13 anesthetized rabbits. During and after specific corticotomy the JOR was evoked by electric intraoral stimulation to monitor effects on IAN function. RESULTS The JOR permanently abolished in one case and transiently failed immediately after surgery but largely recovered within days in another rabbit. In one experiment JOR threshold increased 7 days after corticotomy. Histology did not prove any objective nerve pathology. CONCLUSIONS Monitoring IAN function by the JOR demonstrated the relatively low risk of nerve damaging during sensor-controlled laser corticotomy.
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Affiliation(s)
- Stephan Rupprecht
- Department of Oral & Cranio-Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstrasse 11, D-91054 Erlangen, Germany
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91
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Rödel F, Franz S, Sheriff A, Gaipl U, Heyder P, Hildebrandt G, Schultze-Mosgau S, Voll RE, Herrmann M. The CFSE Distribution Assay is a Powerful Technique for the Analysis of Radiation–Induced Cell Death and Survival on a Single–Cell Level. Strahlenther Onkol 2005; 181:456-62. [PMID: 15995839 DOI: 10.1007/s00066-005-1361-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 03/24/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE To analyze radiation sensitivity of cells and to monitor cellular responses to irradiation, sensitive test systems for cell death and proliferation on a single-cell level are required. Traditionally, cellular radiation survival is measured using the clonogenic assay as the gold standard. Here it is reported, that labeling of cells with 5-(and 6-)carboxyfluorescein diacetate succinimidyl ester (CFDASE) can be used as a highly sensitive assay to determine cellular response toward irradiation on a single-cell level. MATERIAL AND METHODS The human malignant cell lines U937 (myelomonocytic, nonadherent), SW48 and SW480 (colorectal, adherent) were labeled with CFDASE, irradiated with either UVB (0-540 mJ/cm(2)), or X-rays (0-16 Gy). Cell death and proliferation were monitored by cytofluorometry and compared to the clonogenic assay for adherent SW48 and SW480 cells. RESULTS Dividing nonadherent U937 cells displayed a shift in carboxyfluorescein (CF) fluorescence in parallel with an increased cell count indicating cell proliferation. By comparison, UVB-irradiated U937 cells did not show a shift in CF fluorescence and an increase in cell count indicating cell-cycle arrest. In a mixed cell culture, only the nonirradiated cells divided and concomitantly reduced their fluorescence. Calculating the number of cell divisions it was observed that the nonirradiated cells underwent approximately six cell divisions within 7 days, whereas the irradiated cells divided only once on average. The adherent SW480 colorectal cells showed a more pronounced cell-cycle arrest after irradiation with 240 mJ/cm(2) UVB as compared to cells treated with X-ray up to 16 Gy. Furthermore, the CFSE assay also discriminated colorectal cell lines of different intrinsic radiosensitivities and yielded results comparable to the standard clonogenic assay. CONCLUSION Analysis of CF distribution can be employed as a powerful add-on to the clonogenic assay to simultaneously monitor cellular responses toward irradiation on a single-cell level. It constitutes an add-on to the clonogenic assay, especially for nonadherent cells.
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Affiliation(s)
- Franz Rödel
- Department of Radiooncology, University of Erlangen-Nuremberg, Erlangen, Germany
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92
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Thorwarth M, Schultze-Mosgau S, Wehrhan F, Srour S, Wiltfang J, Neukam FW, Schlegel KA. Enhanced bone regeneration with a synthetic cell-binding peptide--in vivo results. Biochem Biophys Res Commun 2005; 329:789-95. [PMID: 15737655 DOI: 10.1016/j.bbrc.2005.01.157] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Indexed: 11/17/2022]
Abstract
This in vivo study compared the regenerative processes within defined defects of the porcine skull after delivery of a porous algae-derived hydroxyapatite (adHA), a similar, experimental adHA carrying the cell binding peptide P-15, used solely and in combination with 25% autogenous bone (AB). Particulated AB served as a control group. During an observation period of 26 weeks, microradiography and histology were performed at four specific times. Significantly higher mineralization rates (p=0.008) were found 4 weeks after application of the bioactive material in combination with AB. At 12 weeks there was a significantly higher mineralization (p=0.036) following the application of the bioactive form alone. This study showed significantly higher mineralization after use of a P-15 bioactivated material at early stages. Thus, it can be concluded that the application of the P-15 sequence to an hydroxyapatite accelerates the process of early bone formation, whereas no long-term effect was traced.
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Affiliation(s)
- Michael Thorwarth
- Department of Maxillofacial Surgery, University Erlangen-Nuremberg, Glueckstrasse 11, D-91054 Erlangen, Germany.
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93
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Langen HJ, Kranzfelder D, Köhler S, Bielmeier J, Müller J, Schultze-Mosgau S. Mikroradiographische Untersuchungen von Mikrokalzifikationen der Mamma und histologische Korrelation. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-868212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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94
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Thorwarth M, Schultze-Mosgau S, Wehrhan F, Kessler P, Srour S, Wiltfang J, Andreas Schlegel K. Bioactivation of an anorganic bone matrix by P-15 peptide for the promotion of early bone formation. Biomaterials 2005; 26:5648-57. [PMID: 15878370 DOI: 10.1016/j.biomaterials.2005.02.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 02/25/2005] [Indexed: 11/21/2022]
Abstract
This animal experiment compared the regenerative processes within defined bony defects of the porcine skull after delivery of routinely utilized bone graft materials: anorganic bone matrix (ABM) and an identical ABM carrying the cell binding peptide P-15. Particulated autogenous bone was used as a control group. The chosen porcine model guaranteed the transferability of the obtained results to clinical practice. A total observation period of 6 months was defined. The bone samples were examined microradiographically and histologically at 8 specific times. Sufficient osseointegration and osseoconduction could be demonstrated for both anorganic bone minerals. However, in the selected model significantly higher mineralization rates (p = 0.0286) were found in the microradiographic image at 12 weeks after application of the bioactive form. The histological examination confirmed this accelerating effect on bone formation starting at day 3. At the end of the study after 6 months, the mineralization values had equalized in both study groups. For the first time, the material was demonstrated to be suitable as a bone substitute material for the treatment of larger bony defects in a large animal model. The P-15 sequence accelerated the process of bone formation on the surface of the anorganic bone matrix as early as 3 days but was not traced over the whole term of the study.
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Affiliation(s)
- Michael Thorwarth
- Department of Maxillofacial and Plastic Surgery, University of Jena, Erlanger Allee 101, D-07747 Jena, Germany.
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95
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Ries J, Schultze-Mosgau S, Neukam F, Diebel E, Wiltfang J. Investigation of the expression of melanoma antigen-encoding genes (MAGE-A1 to -A6) in oral squamous cell carcinomas to determine potential targets for gene-based cancer immunotherapy. Int J Oncol 2005; 26:817-24. [PMID: 15703841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
MAGE genes are silent in normal tissues except testis but are expressed in a variety of neoplastic lesions, and therefore represent ideal targets for immunotherapy. We analysed the expression of 6 MAGE-A genes (MAGE-A1 to -A6) to determine potential implications of these antigens as targets for immunotherapy in oral squamous cell carcinoma (OSCC). Oral tumor specimens (n=21) and non-neoplastic tissue samples (n=10) of oral mucosa from healthy patients were examined by a highly sensitive reverse transcription-nested polymerase chain reaction (MAGE-1- to -6 assay) which detect any cancer cells that express at least one of six MAGE subtype genes and allows also the identification of individual MAGE isotypes (M1 to M6). MAGE expression was restricted to neoplastic specimens. No expression of MAGE was observed in the non-neoplastic normal oral mucosal tissues. Fifteen of 21 (71%) oral carcinomas expressed at least one of MAGE-A1 to -6. The expression pattern of subtypes was heterogeneous: 62% of the tumor patients were positive for MAGE-3, 57% for MAGE-4, 48% for MAGE-6, 43% for MAGE-1, 38% for MAGE-2 and 24% for MAGE-5. Also coexpression of the genes could be determined: 13 (62%) coexpressed two, 10 (48%) coexpressed three, 8 (38%) coexpressed four, 6 (29%) coexpressed five and 5 coexpressed six of the 6 subtypes tested. The high incidence of MAGE expression in oral cancer indicates that monitoring of MAGE-A subtype expression in OSCC may be of potential interest to determine new immunotherapeutic targets and may be a possibility of specific immunotherapy with polyvalent anti-genes for this disease.
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Affiliation(s)
- Jutta Ries
- Department of Oral and Maxillofacial Surgery, University of Erlangen, D-91054 Erlangen, Germany.
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96
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Schultze-Mosgau S, Lehner B, Rödel F, Wehrhan F, Amann K, Kopp J, Thorwarth M, Nkenke E, Grabenbauer G. Expression of bone morphogenic protein 2/4, transforming growth factor-β1, and bone matrix protein expression in healing area between vascular tibia grafts and irradiated bone—experimental model of osteonecrosis. Int J Radiat Oncol Biol Phys 2005; 61:1189-96. [PMID: 15752901 DOI: 10.1016/j.ijrobp.2004.12.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 11/30/2004] [Accepted: 12/01/2004] [Indexed: 11/26/2022]
Abstract
PURPOSE For the surgical treatment of osteoradionecrosis after multimodal therapy of head-and-neck cancers, free vascular bone grafts are used to reconstruct osseous structures in the previously irradiated graft bed. Reduced, or even absent osseous healing in the transition area between the vascular graft and the irradiated graft bed represents a clinical problem. Inflammatory changes and fibrosis lead to delayed healing, triggered by bone morphogentic protein 2/4 (BMP2/4) and transforming growth factor (TGF)-beta(1). Given the well-known fibrosis-inducing activity of TGF-beta(1), an osteoinductive effect has been reported for BMP2/4. However, the influence of irradiation (RT) on this cytokine expression remains elusive. Therefore, the aim of the present in vivo study was to analyze the expression of BMP2/4, TGF-beta(1), collagen I, and osteocalcin in the transition area between the bone graft and the graft bed after RT. METHODS AND MATERIALS Twenty Wistar rats (male, weight 300-500 g) were used in this study. A free vascular tibia graft was removed in all rats and maintained pedicled in the groin region. Ten rats underwent RT with 5 x 10 Gy to the right tibia, the remainder served as controls. After 4 weeks, the previously removed tibia grafts were regrafted into the irradiated (Group 1) and nonirradiated (Group 2) graft beds. The interval between RT and grafting was 4 weeks. After a 4-week osseous healing period, the bone grafts were removed, and the transition area between the nonirradiated graft and the irradiated osseous graft bed was examined histomorphometrically (National Institutes of Health imaging program) and immunohistochemically (avidin-biotin-peroxidase complex) for the expression of BMP2/4, TGF-beta(1), collagen I, and osteocalcin. RESULTS Absent or incomplete osseous healing of the graft was found in 9 of 10 rats after RT with 50 Gy and in 1 of 10 of the rats with nonirradiated osseous grafts. Histomorphometrically, the proportion of osseous healing in the transition area was 17% in Group 1 and 48% in Group 2 (p = 0.001). Compared with the nonirradiated rats, reduced enchondral and perichondral ossification was found in the healing area after RT, with a reduction of BMP2/4 and osteocalcin expression. TGF-beta(1) and collagen I expression in the transition area to the irradiated osseous graft bed was significantly increased compared with that in the nonirradiated osseous graft bed. CONCLUSION After RT, osseous healing of vascular bone grafts is significantly reduced and may be a result of radiation-induced inhibition of BMP2/4 and osteocalcin expression. In addition, induction of TGF-beta(1) and collagen I expression occurs. Because the effects of the TGF-beta superfamily are manifold and partially unknown, additional research directions could be in the exogenous application of BMP2/4 and inhibition of TGF-beta(1) by antibody treatment to search for appropriate therapeutic approaches for improving osseous healing in the irradiated graft bed.
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Affiliation(s)
- Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, Erlangen 91054, Germany.
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97
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Ries J, Schultze-Mosgau S, Neukam F, Diebel E, Wiltfang J. Investigation of the expression of melanoma antigen-encoding genes (MAGE-A1 to -A6) in oral squamous cell carcinomas to determine potential targets for gene-based cancer immunotherapy. Int J Oncol 2005. [DOI: 10.3892/ijo.26.3.817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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98
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Kopp J, Wang GY, Kulmburg P, Schultze-Mosgau S, Huan JN, Ying K, Seyhan H, Jeschke MD, Kneser U, Bach AD, Ge SD, Dooley S, Horch RE. Accelerated wound healing by in vivo application of keratinocytes overexpressing KGF. Mol Ther 2005; 10:86-96. [PMID: 15233945 DOI: 10.1016/j.ymthe.2004.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 04/26/2004] [Indexed: 11/18/2022] Open
Abstract
Epidermal regeneration is a complex process, strongly influenced by growth factors, including keratinocyte growth factor (KGF). The objective of this study was to establish immortalized HaCaT keratinocytes and KMST-6-fibroblasts stably expressing KGF. Transfection efficiency, genomic integration, and functionality of the transgene were determined by ELISA and PCR, and KGF-expressing clones were selected using an air-liquid interface test system. HaCaT cells displayed stronger transgene expression compared to transfected fibroblasts, and the most effective HaCaT clone was incubated on a membrane carrier to form a "membrane cell graft." Twenty-one superficial second-degree burn wounds were created in each of three pigs, and wound healing capacity of the generated "polypeptide cell delivery system" after grafting was examined. Untransfected HaCaT keratinocytes and membrane-covered and untreated burn wounds served as controls. Histological and macroscopical follow-up revealed that grafting of transfected HaCaT cells resulted in complete reepithelialization within 5 days, while wounds covered with untransfected cells needed 2 days longer. At untreated sites, a thin epithelium was detectable after 10 days. The results indicate that wound healing processes can be stimulated distinctly by growth factors secreted from HaCaT cells, with a prominent role for transgenic KGF.
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Affiliation(s)
- Jürgen Kopp
- Department of Plastic and Hand Surgery, University Medical Center, Friedrich-Alexander-University, 91054 Erlangen-Nürnberg, Germany.
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99
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Affiliation(s)
- Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany.
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100
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Lehner B, Bauer J, Rödel F, Grabenbauer G, Neukam FW, Schultze-Mosgau S. Radiation-induced impairment of osseous healing with vascularized bone transfer: experimental model using a pedicled tibia flap in rat. Int J Oral Maxillofac Surg 2004; 33:486-92. [PMID: 15183413 DOI: 10.1016/j.ijom.2003.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2003] [Indexed: 11/19/2022]
Abstract
Aim of this study was to establish an appropriate animal model for investigating the healing of vascularized osseous transplants to irradiated recipient sites applying metabolic, vascular and immunologic experimental studies. In 20 Wistar rats (male, weight 300-500 g), a pedicled osseous tibia flap was raised and transferred to a subcutaneous pocket in the ipsilateral groin. The remaining tibia was stabilized with a monocortical titanium miniplate. To create a pre-irradiated transplant bed, the donor-area including the adjacent bone of the tibia was irradiated with a total dose of 50Gy (5 x 10 Gy) in 10 animals. The interval between irradiation and retransfer of the non-irradiated pedicled tibia flap was 4 weeks. Ten animals received no radiation. Evaluation of osseous healing and the success of the transferred flap were based on a clinical and quantitative histomorphometric assessment. Testing for significant differences was performed using the non-parametric Mann-Whitney U-test. The rate of complete osseous healing in the non-irradiated animals was 90%. In contrast there was no significant bone union observed in the group of the pedicled flaps grafted to the pre-irradiated (50Gy) recipient site (P = 0.001). Similarly bone formation in the transitional zone between bone graft and recipient bone was significantly lower in the preirradiated group (P < 0.001) (16.9 +/- 3%) in contrast to the non-irradiated transplant bed (47.9 +/- 6%).
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Affiliation(s)
- B Lehner
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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