Search

Packed red blood cells (PRBCs), stored for prolonged intervals, might contribute to adverse clinical outcomes in critically ill patients. In this study, short-term outcome after transfusion of PRBCs of two storage duration periods was analyzed in patients with Acute Respiratory Distress Syndrome (ARDS). Patients who received transfusions of PRBCs were identified from a cohort of 1044 ARDS patients. Patients were grouped according to the mean storage age of all transfused units. Patients transfused with PRBCs of a mean storage age ≤ 28 days were compared to patients transfused with PRBCs of a mean storage age > 28 days. The primary endpoint was 28-day mortality. Secondary endpoints included failure-free days composites. Two hundred and eighty-three patients were eligible for analysis. Patients in the short-term storage group had similar baseline characteristics and received a similar amount of PRBC units compared with patients in the long-term storage group (five units (IQR, 3-10) vs. four units (2-8), p = 0.14). The mean storage age in the short-term storage group was 20 (±5.4) days compared with 32 (±3.1) days in the long-term storage group (mean difference 12 days (95%-CI, 11-13)). There was no difference in 28-day mortality between the short-term storage group compared with the long-term storage group (hazard ratio, 1.36 (95%-CI, 0.84-2.21), p = 0.21). While there were no differences in ventilator-free, sedation-free, and vasopressor-free days composites, patients in the long-term storage group compared with patients in the short-term storage group had a 75% lower chance for successful weaning from renal replacement therapy (RRT) within 28 days after ARDS onset (subdistribution hazard ratio, 0.24 (95%-CI, 0.1-0.55), p < 0.001). Further analysis indicated that even a single PRBC unit stored for more than 28 days decreased the chance for successful weaning from RRT. Prolonged storage of PRBCs was not associated with a higher mortality in adults with ARDS. However, transfusion of long-term stored PRBCs was associated with prolonged dependence of RRT in critically ill patients with an ARDS.

Introduction: Laypersons with symptoms indicative of COVID-19 infection, commonly seek guidance on whether and where to seek medical care, and whether self-isolation is required of them. Numerous web-based decision support tools (DSTs) have been developed to assist in decision-making. Few studies already [for full text, please go to the a.m. URL]

Introduction Acute kidney injury (AKI) is an important complication in COVID-19, but its precise etiology has not fully been elucidated. Insights into AKI mechanisms may be provided by analyzing the temporal associations of clinical parameters reflecting disease processes and AKI development. Methods We performed an observational cohort study of 223 consecutive COVID-19 patients treated at 3 sites of a tertiary care referral center to describe the evolvement of severe AKI (Kidney Disease: Improving Global Outcomes stage 3) and identify conditions promoting its development. Descriptive statistics and explanatory multivariable Cox regression modeling with clinical parameters as time-varying covariates were used to identify risk factors of severe AKI. Results Severe AKI developed in 70 of 223 patients (31%) with COVID-19, of which 95.7% required kidney replacement therapy. Patients with severe AKI were older, predominantly male, had more comorbidities, and displayed excess mortality. Severe AKI occurred exclusively in intensive care unit patients, and 97.3% of the patients developing severe AKI had respiratory failure. Mechanical ventilation, vasopressor therapy, and inflammatory markers (serum procalcitonin levels and leucocyte count) were independent time-varying risk factors of severe AKI. Increasing inflammatory markers displayed a close temporal association with the development of severe AKI. Sensitivity analysis on risk factors of AKI stage 2 and 3 combined confirmed these findings. Conclusion Severe AKI in COVID-19 was tightly coupled with critical illness and systemic inflammation and was not observed in milder disease courses. These findings suggest that traditional systemic AKI mechanisms rather than kidney-specific processes contribute to severe AKI in COVID-19., Graphical abstract

Background Efficacy and safety of different hemoglobin thresholds for transfusion of red blood cells (RBCs) in adults with an acute respiratory distress syndrome (ARDS) are unknown. We therefore assessed the effect of two transfusion thresholds on short-term outcome in patients with ARDS. Methods Patients who received transfusions of RBCs were identified from a cohort of 1044 ARDS patients. After propensity score matching, patients transfused at a hemoglobin concentration of 8 g/dl or less (lower-threshold) were compared to patients transfused at a hemoglobin concentration of 10 g/dl or less (higher-threshold). The primary endpoint was 28-day mortality. Secondary endpoints included ECMO-free, ventilator-free, sedation-free, and organ dysfunction-free composites. Measurements and main results One hundred ninety-two patients were eligible for analysis of the matched cohort. Patients in the lower-threshold group had similar baseline characteristics and hemoglobin levels at ARDS onset but received fewer RBC units and had lower hemoglobin levels compared with the higher-threshold group during the course on the ICU (9.1 [IQR, 8.7–9.7] vs. 10.4 [10–11] g/dl, P

Additional file 1. Supplemental material including supplemental Methods, Table, and Figures.

Objective: Perspectively, we intend to develop an artificial photoreceptor based on organic materials for retinal prosthetic devices. Currently, we aim to elucidate the stimulation mechanism on a cellular model system. Materials and Methods: We conduct electrophysiological patch clamp recordings [for full text, please go to the a.m. URL], Artificial Vision 2017

Fragestellung/Einleitung: Die Module des Modellstudiengangs Medizin der Charité umfassen jeweils 100-140 Lernziele, die von Lehrverantwortlichen verschiedenster Disziplinen interdisziplinär erstellt wurden. Hierzu wurde eine online zugängliche Lehrveranstaltungs- und Lernzielplattform[for full text, please go to the a.m. URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Background: Delirium is seen in 11 to 87% of the ICU patients. It is associated with a threefold risk of dying within 6 months after ICU discharge and a worse cognitive outcome. Objectives: The primary aim of the study was to investigate the implementation rate of delirium monitoring in ICU [for full text, please go to the a.m. URL], G-I-N Conference 2012

Fragestellung: An der Charité – Universitätsmedizin Berlin wurden im WiSe 2010 erstmals alle Studienanfänger in den modular aufgebauten Modellstudiengang Medizin (MSM) eingeschrieben Es soll untersucht werden, ob eine webbasierte Lehrveranstaltungs- und Lernzielplattform (LLP) [for full text, please go to the a.m. URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Die Domäne der Medizinischen Ausbildung verbindet in ihren Lernzielen kognitive Funktionen, affektive oder motorische Fähigkeiten oder Kompetenzdefinitionen mit den Inhalten aus der klinischen und wissenschaftlichen Medizin, wie Strukturen von Organismen, Funktionen und Störungen, genauso[for full text, please go to the a.m. URL], 14. Workshop der gmds-Arbeitsgruppe "Computerunterstützte Lehr- und Lernsysteme in der Medizin (CBT)" und des GMA-Ausschusses "Neue Medien"

Die reversible Phosphorylierung ist ein verbreiteter Mechanismus der Regulation zellulärer Prozesse. Der Grad der Phosphorylierung reflektiert die relative Aktivität phosphorylierender Proteinkinasen und dephosphorylierender Proteinphosphatasen (PP). Bei der Kontraktion der glatten Muskulatur der Gefäße ist die PP1 von zentraler Bedeutung, da sie den Phosphorylierungsgrad der regulatorischen leichten Kette des Myosins (MLC20) mitbestimmt. Ziel der Untersuchungen war es, durch eine Erhöhung bzw. Erniedrigung der zellulären PP-Aktivität den Phosphorylierungsgrad der MLC20 zu variieren. Hierzu wurde die PP-Aktivität einerseits in intakten und gehäuteten Gefäßpräparationen durch den Einsatz exogener PP-Hemmstoffe erniedrigt und andererseits die PP1alpha mittels des Baculovirussystems als rekombinantes Protein hergestellt. Des weiteren konnte ein rekombinanter Adenovirus generiert werden, der die Expression des endogenen Inhibitors 2 der PP1 in intakten Zellen und Geweben ermöglichte.

Udgivelsesdato: 2002

The association of depression and hospital length of stay (LOS) has rarely been examined in surgical patients outside of cardiovascular surgery. This study investigates whether clinically significant preoperative depression shows an independent association with LOS in patients from various surgical fields after adjusting for age, gender and important somatic factors.A total of 2624 surgical patients were included in this prospective observational study. Data were collected before the preoperative anesthesiological examination within a computer-assisted psychosocial self-assessment including screening for depression (Center for Epidemiologic Studies Depression Scale, CES-D). Data on peri- and postoperative somatic parameters were obtained from the electronic patient management system of the hospital six months after the preoperative assessment.LOS of patients with clinically significant depression (N.=296; median: 5 days, interquartile range: 3-8 days) was longer than LOS of patients without depression (N.=2328; median: 4 days, interquartile range: 2-6 days) (P0.001). A multivariate logistic regression model with the binary dependent variable 'above versus below or equal to the median LOS' revealed that the significant association between depression and LOS persisted (OR: 1.822 [95% CI 1.360-2.441], P0.001) when simultaneously including the covariates age, gender, ASA classification, Charlson Comorbidity Index, surgical field and POSSUM operative severity rating.Data suggest that the association of depression and LOS is independent of the impact of age, gender, surgical field, preoperative physical health, severity of medical comorbidity and extent of surgical procedure. Integration of depression therapy into routine care of surgical patients might be an option to improve outcomes.

Solution-processed and thermally annealed thin films from a series of nalkyl terminated anilino squaraines are systematically investigated regarding their structural and optical properties by means of X-ray diffraction (XRD) and spectroscopic ellipsometry (SE). Their characteristic intense double-hump-shaped absorbance spectra consisting of coupled H-aggregate and intermolecular charge transfer (ICT) resonance bands make them appealing for fundamental light−matter interaction studies, and their environmental sustainability invites for consumer optoelectronic applications. Now, the single-crystal structure of the n-pentyl anilino squaraine (nPSQ) provides a missing link to identify potential odd−even effects with respect to the terminal alkyl chain for bulk crystals. While all single crystals adopt a triclinic unit cell with biaxial dielectric properties, the thin films condense into effectively uniaxial anisotropic thin films. Here, the inherently low sensitivity to the ut-ofplane complex refractive index of SE in reflection is reasonably compensated by adding transmission SE and transmission intensity data. With that, a general picture of the structural and dielectric properties of n-alkyl anilino squaraine thin films is launched, revealing that the terminal alkyl chain length affects the structural and optical properties in a twofold way: we observe a steady change which is superimposed by an anisotropic odd−even effect.

The impact on chiral aggregation in solution processed and thermally annealed thin films of two indolenine and one anilino squaraines with chiral (S)-citronellyl functionalization at the nitrogen of the squaraine backbone is investigated. A pseudo polymorphic crystal structure is obtained for one of the indolenine squaraines, but thin films of both compounds are basically non-aggregated and truly isotropic as evidenced by spectroscopic ellipsometry. The anilino squaraine coalesces and readily aggregates to circular dichroic but discontinuous thin films. The extent of circular dichroism correlates with the morphology of the samples, which is quantified by Mueller matrix polarimetry in combination with atomic force microscopy. The shape of the CD spectra reinforces the hybrid Frenkel and charge-transfer excitonic nature of the characteristic double hump signatures within unpolarized absorbance spectra of previously investigated non-chiral anilino squaraines with linear alkyl chain functionalization. Such excitonic CD offers an additional design parameter for next-generation opto-electronic devices.

Standardised coloured drug labels may increase patient safety in the intensive care unit (ICU). The rates of adherence to standardised drug syringe labelling (DSL) in European and non-European ICUs, and the standards applied are not known. The aim of this survey among ESICM members was to assess if and what standardised drug syringe labelling is used, if the standards for drug syringe labelling are similar internationally and if intensivists expect that standardised DSL should be delivered by the pharmaceutical industry. A structured, web-based, anonymised survey on standardised DSL, performed among ESICM members (March-May 2011; Clinicaltrials.gov NCT01232088). Descriptive data analysis was performed and Fisher's exact test was applied where applicable. Four hundred eighty-two submissions were analysed (20 % non-European). Thirty-five percent of the respondents reported that standardised drug labelling was used hospital-wide, and 39 % reported that standardised DSL was used in their ICU (Europe: Northern 53 %, Western 52 %, Eastern 17 %, Southern 22 %). The International Organization of Standardization (ISO) 26825 norm in its original form was used by 30 %, an adapted version by 19 % and local versions by 45 %; 6 % used labels that were included in the drug's packaging. Eighty percent wished that the pharmaceutical industry supplied ISO 26825 norm labelling together with the drugs. Standardised DSL is not widely applied in European and non-European ICUs and mostly does not adhere strictly to the ISO norm. The frequency and quality of DSL differs to a great extent among European regions. This leaves much room for improvement