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In the second of two Perspectives articles regarding the use of MRI to detect inflammatory lesions in early preclinical axial spondyloarthritis, van der Heijde et al . defend the inclusion of MRI sacroiliitis in the 2009 ASAS classification criteria and acknowledge the importance of expert opinion in the diagnosis of this disease. New classification criteria for axial spondyloarthritis (SpA) have been developed and validated. MRI of the sacroiliac joints is an important feature in these criteria. This is rightfully so, as MRI can identify active lesions in the subchondral bone marrow that are thought to be related to the underlying pathophysiological process at the cartilage–bone junction. Follow-up studies using various imaging techniques, including MRI, in unselected patients with undiagnosed back pain of short symptom duration will provide more information on the differential diagnostic capacity of MRI and its predictive value for long-term outcomes. Even longer-term follow-up (>10 years) is necessary to provide reliable data; however, the validity of MRI in the diagnostic process can only be approximated, as it will never cover the entire gestalt of SpA.

Congenital absence of portal vein (CAPV) with a systemic shunt of enteric blood is a rare malformation. Twenty-seven cases have been reported to date; with the exception of 4 patients all cases had either liver anomalies or cardiac anomalies. CAPV is usually diagnosed before the age of 18 (25/27 cases). Here we present the case of a 33-year-old woman with CAPV without further anomalies. Beside suffering from circumscript scleroderma, splenomegaly and hypersplenism, the patient was otherwise healthy. Diagnosis was based on histological findings, angiography and CT scan. The liver biopsy showed portal tracts with inconspicuous arteries and bile ducts, but with severe loss of portal vein branches and minimal proliferation of bile ductules. In addition, the perivenular sinusoids were slightly dilated with focal parenchymal atrophy. Angiography showed a missing portal vein system and a missing splenic vein with drainage of the enteric blood through dilated perisplenic and perigastric collaterals to the azygos vein system. A CT scan revealed an empty liver hilus without portal vein. Here we discuss clinical aspects of this patient, show radiologic and histopathologic findings, and compare them to other cases in the literature.

Der Band befasst sich mit Stand und Perspektiven von Fachkräften der Gesundheitswirtschaft in Berlin-Brandenburg, neuen Berufsbildern und Ausbildungsgängen und der Entwicklung und Einführung neuer Gesundheitsstudiengänge. (IAB) Inhaltsverzeichnis: I. Stand und Perspektive von Fachkräften in Berlin-Brandenburg Marion Hass, Stefanie Richter: Zur Fachkräftesituation in der Gesundheitswirtschaft in Berlin-Brandenburg. Eine Feldstudie der IHK; Stephan Padberg, Thomas Winschuh: Entwicklungstrends in der Berliner Gesundheitswirtschaft und ihre Folgen für Organisations- und Personalentwicklung; Anja Walter, Carsten Kampe, Markus Höhne: Branchenspezifische Fachkräftebedarfsanalysen als Instrument einer gestaltenden Arbeitsmarktpolitik in Berlin-Brandenburg am Beispiel der Gesundheitswirtschaft; Igor Koscak, Dennis Alexander Ostwald, Anja Ranscht: Methodische Überlegungen zur Realisierung eines Fachkräftemonitorings für die Gesundheitswirtschaft; II. Neue Berufsbilder und Ausbildungsgänge Tobias Funk: Gesundheit ist mehr - Berufsausbildungen im Bereich der Gesundheitswirtschaft; Lukas Schmid, Olaf Schenk, Jochen Sieper, Parwis Fotuhi: Entwicklungsoptionen im Bereich Pflege am Beispiel der Modularen Weiterbildung der HELIOS Kliniken; Neeltje van den Berg, Claudia Meinke, Adina Dreier, Wolfgang Hoffmann: Das Konzept AGnES. Unterstützung von Hausärzten in ländlichen Regionen; Karl Hartmann, Gunter Frenzel: Der Campus Berlin-Buch - Neue Wege der Aus- und Weiterbildung in der Gesundheitswirtschaft; III. Entwicklung und Einführung neuer Gesundheitsstudiengänge Karin Gavin-Kramer: Studium Gesundheit in Berlin und Brandenburg. Wie ein transdisziplinärer Führer entstehen kann; Georg Duda, Sabine Bartosch: Interdisziplinäre Graduiertenschule für Regenerative Therapien in Berlin-Brandenburg. Von der Grundlagenforschung zu neuen Behandlungsmethoden; Eva-Maria Neumann: Innovations- und Steuerfähigkeit im demografischen Wandel: Gerontologische Leitungsqualifikation für Gesundheits- und Sozialberufe durch den Masterstudiengang Gerontologie an der Fachschule Lausitz; Karsten Schulz: Kommunikation im Zentrum der Managementausbildung: Der MBA in Health Communication Management an der FHTW Berlin.

Introduction The molecular mechanisms of syndesmophyte formation in ankylosing spondylitis (AS) are yet to be characterised. Molecules involved in bone formation such as Wnt proteins and their antagonists probably drive syndesmophyte formation in AS. Methods This study investigated sequential serum levels of functional dickkopf-1 (Dkk1), a potent Wnt antagonist involved in bone formation in arthritis, by capture ELISA with its receptor LRP6 in 65 AS patients from the German Spondyloarthritis Inception Cohort. Dkk1 levels were then related to structural progression (syndesmophyte formation) as well as sclerostin and C-reactive protein (CRP) levels. Results Functional Dkk1 levels were significantly (p=0.025) higher in patients with no syndesmophyte growth (6.78±5.48 pg/ml) compared with those with syndesmophyte growth (4.13±2.10 pg/ml). Dkk1 levels were highly correlated to serum sclerostin levels (r=0.71, 95% CI 0.53 to 0.82; p<0.001) but not to CRP (r=0.15, 95% CI −0.10 to 0.38; p=0.23). Conclusion AS patients with no syndesmophyte formation show significantly higher functional Dkk1 levels suggesting that blunted Wnt signalling suppresses new bone formation and consequently syndesmophyte growth and spinal ankylosis. Similar to serum sclerostin levels, the functional Dkk1 level thus emerges as a potential biomarker for structural progression in patients with AS