Search

Retrospective cross-sectional case series.Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ.In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint.Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values.The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29 with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative).The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.

ZusammenfassungDie folgende Kasuistik zeigt einen jungen Mann, der sich im Rahmen eines Verkehrsunfalles ein komplexes Beckentrauma mit schwerer Begleitverletzung der ableitenden Harnwege sowie ausgeprägter Begleitschädigung des Plexus lumbosacralis zuzog. Zur operativen Versorgung der Becken- und Blasenverletzung waren mehrere aufwendige Eingriffe nötig. Auf Grundlage eines Infektes kam es schließlich zur Wundheilungsstörung mit der Notwendigkeit einer Lappenplastik. Der Fall verdeutlicht die Komplexität dieser Verletzung und belegt die Notwendigkeit der interdisziplinären individualisierten Behandlung.

Background/Aim: The typical insulin deficiency in type 1 diabetes mellitus has general effects on metabolism and also affects bone quality. Materials and Methods: Two diabetic rat lines (BB/OK; BB.6KWR) and two non-diabetic rat strains (KWR and BB.14+18KWR), as control group, were included in the study. Bone mineral density, bone mineral content and body structure measurements were performed. The measurements took place before the onset of diabetes mellitus. Results: A comparison of the groups showed increased bone density values of the diabetic rats in relation to the control groups. A new finding of increased bone density in the diabetic rats occurs. Conclusion: Diabetic rats showed no osteoporotic bone metabolism before the onset of clinically relevant type 1 diabetes mellitus, but rather increased bone metabolic activity.

To determine the effect of additional mobile stroke unit (MSU) dispatch on functional outcomes among the full spectrum of stroke patients, regardless of subtype or potential contraindications to reperfusion therapies.We used data from the nonrandomized Berlin-based B_PROUD study (02/2017 to 05/2019), in which MSUs were dispatched based solely on availability, and the linked B-SPATIAL stroke registry. All patients with final stroke or transient ischemic attack (TIA) diagnoses were eligible. The intervention under study was the additional dispatch of an MSU, an emergency physician-staffed ambulance equipped to provide prehospital imaging and thrombolytic treatment, compared to conventional ambulance alone. The primary outcome was the 3-month modified Rankin Scale (mRS) score, and the co-primary outcome was a 3-tiered disability scale. We identified confounders using directed acyclic graphs and obtained adjusted effect estimates using inverse probability of treatment weighting.MSUs were dispatched to 1,125 patients (mean age: 74 years, 46.5% female), while for 1,141 patients only conventional ambulances were dispatched (75 years, 49.9% female). After confounding adjustment, MSU dispatch was associated with more favorable 3-month mRS scores (common odds ratio [cOR] = 0.82; 95% confidence interval [CI]: 0.71-0.94). No statistically significant association was found with the co-primary outcome (cOR = 0.86; 9% CI: 0.72-1.01) or 7-day mortality (OR = 0.94; 95% CI: 0.59-1.48).When considering the entire population of stroke/TIA patients, MSU dispatch improved 3-month functional outcomes without evidence of compromised safety. Our results are relevant for decision-makers since stroke subtype and treatment eligibility are unknown at time of dispatch. ANN NEUROL 2022.

Purpose To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI). Methods Ambispective cohort study (2011–2017) in n = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay (> 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression. Results The median age of the study population was 58.8 years (42.0–74.6 IQR). Older age (≥ 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2–121.3) compared to 6.6 h (4.4–47.9) in younger patients (≤ 44y). Main reasons for delayed surgery in older individuals were secondary referrals and multimorbidity. Shorter time span to surgery (≤ 12 h) was associated with higher rates of ASIA impairment scale (AIS) conversion (OR 4.22, 95%CI 1.85–9.65), as mirrored by adjusted spline curves ( 60 h Conclusion Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients.

Purpose Severe accidents are the leading cause of long-term impairment and death in children. A common diagnostic procedure for children exposed to high-injury trauma is full-body contrast-enhanced CT (fbCT). However, the number of fbCT without detected injuries is relevant. In 2007, full-body MRI (fbMRI) was implemented as a diagnostic approach for children sustaining high-energy trauma. The aim of this cross-sectional retrospective study was to analyze fbMRI as a diagnostic tool for children after high-energy trauma focusing on feasibility, radiological findings, and limitations. Methods Diagnostics using fbMRI (from apex of the head to the pelvis) was performed if a child was stable and suffered a high-energy trauma in a Level I Trauma Center in Germany. 105 fbMRIs in patients exposed to high-energy trauma aged ≤ 16 years were performed between January 2007 and December 2018. Four fbMRIs were excluded as conducted for reasons other than trauma. Time between arrival in the emergency department and fbMRI, additional diagnostic procedures, injuries, and non-trauma related pathologies were analyzed. Results Mean time between arrival in the emergency department and fbMRI was 71 min (± SD 132 min). Two scans were discontinued and changed to a faster diagnostic procedure. 45% of children had additional X-rays and 11% CT scans. The MRIs showed intracranial abnormalities in 27%, extremities injuries in 26%, spinal injuries in 18%, pelvic, and thoracic injuries in 7% of the cases. Conclusion Overall fbMRI is a diagnostic alternative for hemodynamically stable, conscious children after high-energy trauma with the advantages of a radiation-free technique. However, MRI diagnostics take longer than CT scans. Prospective studies will be needed to identify the limiting factors of fbMRIs as primary diagnostic procedure compared to CT scans. Trial registration German Clinical Trials Register (DRKS; DRKS00017015). Level of evidence Case series, level of evidence V.

Study design Monocenter case-control study. Objective Effects of spinal surgical adverse events (SSAE) on clinical and functional outcome, length of stay, and treatment costs after traumatic cervical spinal cord injury (SCI). Summary of background data Traumatic SCI is a challenge for primary care centers because of the emergency setting and complex injury patterns. SSAE rates of up to 15% are reported for spine fractures without SCI. Little is known about SSAE after traumatic SCI and their outcome relevance. Methods Acute traumatic cervical SCI patients were enrolled from 2011-2017. Cases with and without SSAE were compared regarding neurological recovery, functional outcome, secondary complications, mortality, length of stay and treatment costs. Adjusted logistic regression and generalized estimating equation models were calculated for the endpoints ASIA impairment scale (AIS)-conversion and dysphagia. All analyses were run in the total and in a propensity score matched sample. Results At least one SSAE occurred in 37 of 165 patients (22.4%). Mechanical instability and insufficient spinal decompression were the most frequent SSAE with 13 (7.9%) or 11 (6.7%) cases, respectively. The regression models adjusted for demographic, injury, and surgery characteristics demonstrated a reduced probability for AIS-conversion related to SSAE [OR (95%CI) 0.14 (0.03-0.74)] and additionally to single-sided ventral or dorsal surgical approach [0.12 (0.02-0.69)] in the matched sample. Furthermore, SSAE were associated with higher risk for dysphagia in the matched [4.77 (1.31-17.38)] and the total sample [5.96 (2.07-17.18)]. Primary care costs were higher in cases with SSAE [Median (IQR) 97,300 (78,200-112,300)] EUR compared to cases without SSAE [52,300 (26,700-91,200)] EUR. Conclusions SSAE are an important risk factor after acute traumatic cervical SCI with impact on neurological recovery, functional outcome, and healthcare costs. Reducing SSAE is a viable means to protect the limited intrinsic capacity for recovery from SCI.Level of Evidence: 4.

BackgroundThe optimal interface for the delivery of home non-invasive ventilation (NIV) to treat chronic respiratory failure has not yet been determined. The aim of this individual participant data (IPD) meta-analysis was to compare the effect of nasal and oronasal masks on treatment efficacy and adherence in patients with COPD and obesity hypoventilation syndrome (OHS).MethodsWe searched Medline and Cochrane Central Register of Controlled Trials for prospective randomised controlled trials (RCTs) of at least 1 month’s duration, published between January 1994 and April 2019, that assessed NIV efficacy in patients with OHS and COPD. The main outcomes were diurnal PaCO2, PaO2 and NIV adherence (PROSPERO CRD42019132398).FindingsOf 1576 articles identified, 34 RCTs met the inclusion criteria and IPD were obtained for 18. Ten RCTs were excluded because only one type of mask was used, or mask data were missing. Data from 8 RCTs, including 290 IPD, underwent meta-analysis. Oronasal masks were used in 86% of cases. There were no differences between oronasal and nasal masks for PaCO2 (0.61 mm Hg (95% CI −2.15 to 3.38); p=0.68), PaO2 (−0.00 mm Hg (95% CI −4.59 to 4.58); p=1) or NIV adherence (0·29 hour/day (95% CI −0.74 to 1.32); p=0.58). There was no interaction between the underlying pathology and the effect of mask type on any outcome.InterpretationOronasal masks are the most used interface for the delivery of home NIV in patients with OHS and COPD; however, there is no difference in the efficacy or tolerance of oronasal or nasal masks.

Background/aim The antiproliferative effects of cold atmospheric plasma (CAP) make it a promising application option in oncology. The aim of the present study was to examine whether short-term CAP treatment leads to an initial partial elimination of the treated cells or to long-term impairement and inhibition of cell growth. Materials and methods Cells were treated with CAP and biostatistical modelling was used to estimate growth rates over the incubation time. Four cell lines (U2-OS and MNNG osteosarcoma cells, 3T3 fibroblasts, HaCaT keratinocytes) and three CAP sources (MiniJet-R, kINPen MED, Maxium) were used. Results The antiproliferative efficacy of CAP was due to a significant reduction in cell count during treatment and the long-lasting inhibition of growth rate in the remaining cells, detectable in all cell lines and after treatment using all three CAP devices. Conclusion Induction of cell death and inhibition of cell growth are part of a general mechanism of biological CAP efficacy. However, data contradict the hypothesis that cancer cells respond more sensitively to CAP treatment compared to non-malignant cells.

Unfallverletzte im Rahmen von Arbeits- und Wegeunfallen unterliegen dem besonderen Schutz durch die Leistungen der gesetzlichen Unfallversicherung (GUV), die im Sozialgesetzbuch VII geregelt sind. Der Leistungsgrundsatz ist mit der Bezeichnung „mit allen geeigneten Mitteln“ umschrieben, um Unfallverletzte schnellstmoglich ins Arbeitsleben zuruckzubringen. Eigens fur das Rehamanagement wurden von den Tragern der GUV mit dem Verletzungsartenverfahren Steuerungsmechanismen mit strukturellen Anforderungen an Behandlungseinrichtungen und Arzte etabliert. Ziele sind die direkte Zuweisung des Unfallverletzten in eine geeignete Klinik und die in jeder Hinsicht optimierte Versorgung ohne unnotige Verlegungen. An der Unfallstelle mit Inaugenscheinnahme, initialer Befragung des Verletzten, der Polizei oder von Zeugen resultiert ein erheblicher Informationsgewinn, von dem Klinik, Durchgangsarzt und Unfallversicherungstrager (sowie letztendlich der Versicherte) profitieren konnen. Die Informationen (genauer Unfallhergang, -ort, -betrieb, Versicherungsdaten und Kontextfaktoren) sind zu dokumentieren und an die aufnehmende Klinik und den Durchgangsarzt weiterzuleiten. Die Informationserfassung sollte in die standardisierte rettungsdienstliche Dokumentation ubernommen werden.

Background Cold atmospheric plasma (CAP) has a variety of anticancer effects on different cancer cell types. In osteosarcoma (OS) cells, CAP reduces growth and motility, induces apoptosis, and alters secretion of cellular factors. The influence of CAP on membrane integrity of OS cells is unknown. Materials and methods Two different OS cell lines (U-2 OS and MNNG-HOS) were treated with CAP. Proliferation assays for cell growth after treatment was performed. Alterations in membrane permeability and the associated translocation of low molecular weight particles through the cytoplasmic membrane of OS cells after CAP treatment were shown in fluorescein diacetate (FDA) assays. Results FDA increasingly passed the membrane after CAP treatment and this effect depended on the duration of treatment. It was also shown that after CAP treatment, FDA was able to diffuse into the cells from the outside as well as out of the cell interior. These effects were observed when CAP-treated buffer was used and therefore no direct contact between cells and CAP occurred. Conclusion The observations suggest that changes in membrane permeability and function may contribute to the antiproliferative effects of CAP.

Background: Blunt high-energy trauma increase the risk of associated thoracic and accompanying abdominal organ injuries in chest trauma. A higher overall injury severity has been shown for sternovertebral injuries caused by a flexion-compression mechanism. Literature for a hyperextension-distraction mechanism equivalent to a costal arch fracture combined with a thoracic spinal fracture is sparse. Therefore, we want to show the clinical significance of this entity.Methods: A retrospective analysis of our level-one trauma center collective of severely injured patients was performed. Patients from 2013 to 2019 that involved an Injury Severity Score (ISS) ≥16 were screened for the combined thoracovertebral injury entity and analyzed concerning its accident mechanism, the injury spectrum, and the clinical course.Results: The thoracovertebral injury entity is rare. Three male patients (50–65 years old) with ISS of 57, 41, and 20 could be observed from over 1000 severely injured. All patients suffered from high-energy trauma and from tearing of the thoracic vertebrae regions 7–9. The costal arch was torn in the anterior area. All cases showed a posterolateral serial rib fracture, a traumatic intercostal pulmonary hernia, and an avulsion of the diaphragm. Two patients sustained further life-threatening injuries, such as severely bleeding avulsion to the azygos vein and a rupture of the spleen. The physicians performed exploratory thoracotomy, closure of the pulmonary hernia, re-fixation of the diaphragm and angle-stable plate osteosynthesis of the fractured ribs, including the costal arch. The spine was fixed dorsally using a screw-rod system. The patients were discharged home with independent mobility and without neurological damage. Conclusions: This thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Injuries to the costal arch can act as an indicator of severe trauma. They should be detected thorough clinical examination and assessment of the trauma CT in the soft tissue window.

Comorbidity scores are important predictors of in-hospital mortality after traumatic spinal cord injury (tSCI), but the impact of specific pre-existing diseases is unknown. This retrospective cohort study aims at identifying relevant comorbidities and explores the influence of end-of-life decisions. In-hospital mortality of all patients admitted to the study center after acute tSCI from 2011 to 2017 was assessed. A conditional inference tree analysis including baseline data, injury characteristics, and Charlson Comorbidity Index items was used to identify crucial predictors. End-of-life decisions were recorded. Three-hundred-twenty-one patients were consecutively enrolled. The median length of stay was 95.7 days (IQR 56.8–156.0). During inpatient care, 20 patients (6.2%) died. These patients were older (median: 79.0 (IQR 74.7–83.2) vs. 55.5 (IQR 41.4–72.3) years) and had a higher Charlson Comorbidity Index score (median: 4.0 (IQR 1.75–5.50) vs. 0.0 (IQR 0.00–1.00)) compared to survivors. Pre-existing kidney or liver disease were identified as relevant predictors of in-hospital mortality. End-of-life decisions were observed in 14 (70.0%) cases. The identified impairment of kidney and liver, important for drug metabolism and elimination, points to the need of careful decisions on pharmaceutical treatment regimens after tSCI. Appropriate reporting of end-of-life decisions is required for upcoming studies.

Although serious accidents remain the leading cause of pediatric mortality, protocols to orient diagnostic procedures towards a certain type of initial imaging are widely needed. Since 2007, we have performed whole-body magnetic resonance imaging (WBMR) and whole-body computed tomography (WBCT) for diagnoses of severely injured children. We retrospectively reviewed 134 WBMR and 158 WBCT in patients younger than 16 years that were performed at two trauma centers between 2007 and 2018. A higher Injury Severity Score (ISS) was found in WBCT vs. WBMR (10.6 vs. 5.8; p = 0.001), but without any significant difference in mortality. The WBMR was significantly preferred at younger ages (9.6 vs. 12.8 years; p < 0.001). The time between patient’s arrival until diagnosis was 2.5 times longer for WBCT (92.1 vs. 37.1 min; p < 0.001). More patients in the CT group received analgesic sedation and/or intubation at 37.3% vs. 21.6% in the MRI group. Of these patients, 86.4% (CT) and 27.6% (MRI) were already preclinically sedated (p < 0.001). Correspondingly, 72.4% of the patients were first sedated in-hospital for MRIs. In conclusion, WBMR is an alternative and radiation-free imaging method for high-energy-traumatized children. Although the selected diagnostics seemed appropriate, limitations regarding longer duration or additional analgesic sedation are present, and further studies are needed.

Background: The use of cold atmospheric plasma (CAP) in oncology has been intensively investigated over the past 15 years as it inhibits the growth of many tumor cells. It is known that reactive oxidative species (ROS) produced in CAP are responsible for this effect. However, to translate the use of CAP into medical practice, it is essential to know how CAP treatment affects non-malignant cells. Thus, the current in vitro study deals with the effect of CAP on human bone cancer cells and human osteoblasts. Here, identical CAP treatment regimens were applied to the malignant and non-malignant bone cells and their impact was compared. Methods: Two different human bone cancer cell types, U2-OS (osteosarcoma) and A673 (Ewing’s sarcoma), and non-malignant primary osteoblasts (HOB) were used. The CAP treatment was performed with the clinically approved kINPen MED. After CAP treatment, growth kinetics and a viability assay were performed. For detecting apoptosis, a caspase-3/7 assay and a TUNEL assay were used. Accumulated ROS was measured in cell culture medium and intracellular. To investigate the influence of CAP on cell motility, a scratch assay was carried out. Results: The CAP treatment showed strong inhibition of cell growth and viability in bone cancer cells. Apoptotic processes were enhanced in the malignant cells. Osteoblasts showed a higher potential for ROS resistance in comparison to malignant cells. There was no difference in cell motility between benign and malignant cells following CAP treatment. Conclusions: Osteoblasts show better tolerance to CAP treatment, indicated by less affected viability compared to CAP-treated bone cancer cells. This points toward the selective effect of CAP on sarcoma cells and represents a further step toward the clinical application of CAP.

Erst in den kommenden Wochen und Monaten wird sich wohl entscheiden, ob es in der deutschen Kliniklandschaft wirklich zu einer „Revolution“ kommt, wie sie Bundesgesundheitsminister Karl Lauterbach bei der Vorstellung der Reformvorschläge durch eine Expertenkommission verkündet hatte.

Introduction This study on pyogenic spinal infections with intraspinal epidural involvement (PSI +) compared the outcome of patients with spinal cord injury (SCI) to those without (noSCI) taking diagnostic algorithm, therapy, and complications into account. Methods Patients were enrolled in an ambispective study (2012–2017). Diagnostic and therapeutic algorithms, complications, and neurological outcome were analyzed descriptively. Survival was analyzed applying Kaplan–Meier method and Cox regression. Results In total, 134 patients with a median (IQR) age of 72 (61–79) years were analyzed. Baseline characteristics were similar between the SCI (n = 55) and noSCI (n = 79). A higher percentage of endocarditis (9% vs. 0%; p = 0.03) was detected in the noSCI group. The majority (81%) received combinatorial therapy including spinal surgery and antibiotic treatment. The surgery complication rate was 16%. At discharge, improvement in neurologic function was present in 27% of the SCI patients. Length of stay, duration of ventilation and the burden of disease-associated complications were significantly higher in the SCI group (e.g., urinary tract infection, pressure ulcers). Lethality risk factors were age (HR 1.09, 95% CI 1.02–1.16, p = 0.014), and empyema/abscess extension (≥ 3 infected spinal segments, HR 4.72, 95% CI 1.57–14.20, p = 0.006), dominating over additional effects of Charlson comorbidity index, SCI, and type of treatment. The overall lethality rate was 11%. Conclusion PSI + are associated with higher in-hospital mortality, particularly when multiple spinal segments are involved. However, survival is similar with (SCI) or without myelopathy (noSCI). If SCI develops, the rate of disease complications is higher and early specialized SCI care might be substantial to reduce complication rates.

BackgroundThe pandemic of COVID-19 led to exceeding restrictions especially in public life and music business. Airborne transmission of SARS-CoV-2 demands for risk assessment also in wind playing situations. Previous studies focused on short-range transmission, whereas long-range transmission has not been assessed so far.Methods and findingsWe measured resulting aerosol concentrations in a hermetically closed cabin of 20 m3in an operating theatre from 20 minutes standardized wind instrument playing (19 flute, 11 oboe, 1 clarinet, 1 trumpet players). Based on the data, we calculated total aerosol emission rates showing uniform distribution for both instrument groups (flute, oboe). Aerosol emission from wind instruments playing ranged from 7 ± 327 particles/second (P/s) up to 2583 ± 236 P/s, average rate ± standard deviation. The analysis of the aerosol particle size distribution showed that about 70 − 80% of emitted particles had a size ≤ 0.4 µm and thus being alveolar. Masking the bell with a surgical mask did not reduce aerosol emission. Aerosol emission rates were higher from wind instruments playing than from speaking and breathing. Differences between instrumental groups could not be found, but high interindividual variance as expressed by uniform distribution of aerosol emission rates.ConclusionsOur findings indicate that aerosol emission depends on physiological factors and playing techniques rather than on the type of instrument, in contrast to some previous studies. Based on our results, we present risk calculations for long-range transmission of COVID-19 for three typical woodwind playing situations.

The pandemic of COVID-19 led to restrictions in all kinds of music activities. Airborne transmission of SARS-CoV-2 requires risk assessment of wind instrument playing in various situations. Previous studies focused on short-range transmission, whereas long-range transmission risk has not been assessed. The latter requires knowledge of aerosol emission rates from wind instrument playing. We measured aerosol concentrations in a hermetically closed chamber of 20 m3 in an operating theatre as resulting from 20 min standardized wind instrument playing (19 flute, 11 oboe, 1 clarinet, 1 trumpet players). We calculated aerosol emission rates showing uniform distribution for both instrument groups. Aerosol emission from wind instrument playing ranged from 11 ± 288 particles/second (P/s) up to 2535 ± 195 P/s, expectation value ± uncertainty standard deviation. The analysis of aerosol particle size distributions shows that 70–80% of emitted particles had a size of 0.25–0.8 µm and thus are alveolar. Masking the bell with a surgical mask did not reduce aerosol emission. Aerosol emission rates were higher from wind instrument playing than from speaking or breathing. Differences between instrumental groups could not be found but high interindividual variance, as expressed by uniform distribution of aerosol emission rates. Our findings indicate that aerosol emission depends on physiological factors and playing techniques rather than on the type of instrument, in contrast to some previous studies. Based on our results, we present transmission risk calculations for long-range transmission of COVID-19 for three typical woodwind playing situations.

To test the urban myth that surplus chocolate Easter Bunnies are re-packaged as Santa Clauses for the following Christmas holiday season.Prospective radiographic cohort study of seasonal chocolate figurines, supplemented by anonymous 5-item questionnaire survey of belief in the re-wrapping myth (Generic Risk Items Noted by Chocolate consumers in Health care settings; GRINCH).Two tertiary referral trauma centres in Germany (Berlin and Duisburg).Eighteen chocolate Easter Bunnies and 15 chocolate Santa Clauses from different manufacturers purchased during 2020; 502 randomly selected people passing through the entrance halls of the two hospitals during 16 September - 12 October 2020.Whole body computed tomography (WBCT) images of chocolate Easter Bunnies and Santa Clauses assessed by four independent, board-certified radiologists using a visual contour resemblance scale (CRS); survey participants' views on statements related to the re-wrapping myth.Expert examiners clearly distinguished the WBCT images of chocolate Easter Bunnies and Santa Clauses; the mean difference in CRS was 84.2 points (95% CI, 78.5-90.0 points), with excellent inter-observer agreement (mean intra-class correlation coefficient, 0.99; 95% CI, 0.99-1.00). A total of 214 survey participants (43%) disagreed and 145 (29%) agreed with the proposition that seasonal chocolate figurines are re-packaged and re-sold the following season.Although about one-third of our survey respondents did not rule out the possibility of seasonal sweets being re-used, WBCT imaging found no similarity between chocolate foil-wrapped Easter and Christmas figurines, providing solid evidence against this urban myth. Chocolate Santa Clauses are unlikely to pose a significant threat to hospital food hygiene requirements.Current Controlled Trials, ISRCTN16847363 (prospective).

Am 1. November 2022 ist Alois G. Steidel nach kurzer schwerer Krankheit verstorben. Er wurde 62 Jahre alt.

Emergency department thoracotomy (EDT) may be the last chance for survival in some severe thoracic trauma. This study investigates a representative collective with the aim to compare the findings in Europe to the international experience. Moreover, the influence of different levels of trauma care is investigated. All emergency thoracotomies in patients with an ISS ≥ 9 from TR-DGU (2009–2014) within the first 60 min after arrival were identified. EDTs were identified separately, and mini thoracotomies and drainage systems were excluded. 99,013 patients with sufficient data were observed. 1736 (1.8%) received thoracotomy during their hospital stay. 887 patients had a thoracotomy within the first hour in the emergency department (ED). 52.5% were treated in supraregional trauma centers (STC), 36.4% in regional (RTC) and 11.0% in local trauma centers (LTC). The mortality rates were 39.4% (STC), 20.9% (RTC) and 20.8% (LTC). The overall mortality rate showed no significant differences for blunt (28.2%) and penetrating trauma (31.3%). In case of cardiac arrest in the ED, a survival rate of 4.8% for blunt trauma and 20.7% for penetrating trauma was determined if EDT was carried out. Those patients showed a higher rate in severe thoracic organ injuries due to penetrating trauma but less extrathoracic injuries. Just over half of EDTs were performed in STC. Emergency room resuscitation followed by EDT had survival rates of 4.8% and 20.7% for blunt and penetrating trauma patients, respectively.

Das Arbeitszeitgesetz, ein zunehmender Fachkräftemangel sowie wirtschaftlicher Druck im Sinne von Strukturvorgaben (OP-Zahlen, OP-Auslastung etc.) machen es für viele Kliniken im Alltag schwierig, eine gute Weiterbildung zu gewährleisten. Die BG Kliniken haben mit dem weltweit ersten Fraktursimulationskurs die „Weiterbildung 3.0“ eingeleitet.

Energiekrise, Klimakrise, wachsender Fachkräftemangel, Corona-Wellen, Ukraine-Krieg – wir werden in diesen Tagen nahezu überflutet von Nachrichten, die unsere Überzeugung, dass stetiger Fortschritt in einer prosperierenden Gesellschaft nicht aufzuhalten ist und ökonomische Verwerfungen eigentlich immer nur von kurzer Dauer sind, nachhaltig erschüttern.

Purpose Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax. Methods A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF. Results 73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF. Conclusion Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.

Background The project “ARMIHN” (Adaptive Resiliency Management in Port) focuses on strengthening the capability to act in a mass casualty incident (MCI) due to an outbreak of infectious diseases (MCI-ID). In addition to the current threat from the COVID-19 pandemic and associated outbreaks on cruise ships, previous MCI-ID were especially caused by pathogens such as Influenza virus or Norovirus. The first step was, to get an overview of processes and resources using the example of the Port of Hamburg, and to show the associated interaction of involved parties. This will serve as a basis for developing an operational strategy and offers the opportunity to optimize current work processes. Methods A selective literature research using specified key words was performed and existing MCI concepts were received from local authorities. Identified structures and processes were analyzed in a multiple step process and also brought together through discussions in workshops with involved organizations and other experts. Additionally, the distances between the nearest rescue stations and selected hospitals from the Port of Hamburg were analyzed. Results The current available concepts are proven, but an adaptation to an MCI-ID shows opportunities for a further cross-organizational development. The organizational structure of an MCI-ID in the Port of Hamburg was described, including a large number of involved organizations (n = 18). There are 17 involved fire and rescue stations and the port can be reached from these locations within 6 to 35 min. Based on their specialist expertise, 14 of the 31 listed clinics were selected. Conclusion The purpose of the study was to provide an analysis of the current situation and show how involved parties would cope an MCI. A description of processes and resources at the Port of Hamburg will be used when designing a management plan for responding to an MCI-ID.

To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI).Ambispective cohort study (2011-2017) in n = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay ( 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression.The median age of the study population was 58.8 years (42.0-74.6 IQR). Older age (≥ 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2-121.3) compared to 6.6 h (4.4-47.9) in younger patients (≤ 44y). Main reasons for delayed surgery in older individuals were secondary referrals and multimorbidity. Shorter time span to surgery (≤ 12 h) was associated with higher rates of ASIA impairment scale (AIS) conversion (OR 4.22, 95%CI 1.85-9.65), as mirrored by adjusted spline curves ( 20 h 20-25%, 20-60 h 10-20%, 60 h 10% probability of AIS conversion). In incomplete SCI, the probability of AIS conversion was lower in older patients [e.g., OR 0.09 (0.02-0.44) for'45-59y' vs.' ≤ 44y'], as confirmed by spline curves ( 40y 20-80%, ≥ 40y 5-20% probability).Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients.

Knapp 300 Seiten stark ist das aktuelle Gutachten des IGES-Instituts zur Ambulantisierung von OP-Leistungen. In Auftrag gegeben von Kassenärztlicher Bundesvereinigung, GKV-Spitzenverband und der Deutschen Krankenhausgesellschaft, sollte dieser Bericht zur Pflichtlektüre für alle Klinik-Manager werden, denn er kann erhebliche Auswirkungen auf das Erlösgeschäft haben.

Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

Osteosarcoma and Ewing&rsquo, s sarcoma are the most common malignant bone tumors. Conventional therapies such as polychemotherapy, local surgery, and radiotherapy improve the clinical outcome for patients. However, they are accompanied by acute and chronic side effects that affect the quality of life of patients, motivating novel research lines on therapeutic options for the treatment of sarcomas. Previous experimental work with physical plasma operated at body temperature (cold atmospheric plasma, CAP) demonstrated anti-oncogenic effects on different cancer cell types. This study investigated the anti-cancer effect of CAP on two bone sarcoma entities, osteosarcoma and Ewing&rsquo, s sarcoma, which were represented by four cell lines (U2-OS, MNNG/HOS, A673, and RD-ES). A time-dependent anti-proliferative effect of CAP on all cell lines was observed. CAP-induced alterations in cell membrane functionality were detected by performing a fluorescein diacetate (FDA) release assay and an ATP release assay. Additionally, modifications of the cell membrane and modifications in the actin cytoskeleton composition were examined using fluorescence microscopy monitoring dextran-uptake assay and G-/F-actin distribution. Furthermore, the CAP-induced induction of apoptosis was determined by TUNEL and active caspases assays. The observations suggest that a single CAP treatment of bone sarcoma cells may have significant anti-oncogenic effects and thus may be a promising extension to existing applications.

The antiproliferative effects of cold atmospheric plasma (CAP) make it a promising application option in oncology. The aim of the present study was to examine whether short-term CAP treatment leads to an initial partial elimination of the treated cells or to long-term impairement and inhibition of cell growth.Cells were treated with CAP and biostatistical modelling was used to estimate growth rates over the incubation time. Four cell lines (U2-OS and MNNG osteosarcoma cells, 3T3 fibroblasts, HaCaT keratinocytes) and three CAP sources (MiniJet-R, kINPen MED, Maxium) were used.The antiproliferative efficacy of CAP was due to a significant reduction in cell count during treatment and the long-lasting inhibition of growth rate in the remaining cells, detectable in all cell lines and after treatment using all three CAP devices.Induction of cell death and inhibition of cell growth are part of a general mechanism of biological CAP efficacy. However, data contradict the hypothesis that cancer cells respond more sensitively to CAP treatment compared to non-malignant cells.

Chondrosarcoma is the second most common malign bone tumor in adults. Surgical resection of the tumor is recommended because of its resistance to clinical treatment such as chemotherapy and radiation therapy. Thus, the prognosis for patients mainly depends on sufficient surgical resection. Due to this, research on alternative therapies is needed. Cold atmospheric plasma (CAP) is an ionized gas that contains various reactive species. Previous studies have shown an anti-oncogenic potential of CAP on different cancer cell types. The current study examined the effects of treatment with CAP on two chondrosarcoma cell lines (CAL-78, SW1353). Through proliferation assay, the cell growth after CAP-treatment was determined. A strong antiproliferative effect for both cell lines was detected. By fluorescein diacetate (FDA) assay and ATP release assay, alterations in the cell membrane and associated translocation of low molecular weight particles through the cytoplasmic membrane were observed. In supernatant, the non-membrane-permeable FDA and endogenously synthesized ATP detected suggest an increased membrane permeability after CAP treatment. Similar results were shown by the dextran-uptake assay. Furthermore, fluorescence microscopic G-/F-actin assay was performed. G-and F-actin were selectively dyed, and the ratio was measured. The presented results indicate CAP-induced changes in cell membrane function and possible alterations in actin-cytoskeleton, which may contribute to the antiproliferative effects of CAP. �� 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Massenanfalle von Erkrankten oder Verletzten im maritimen Umfeld stellen Rettungskrafte vor besondere Herausforderungen, da zum einen personell limitierte Ressourcen vorliegen, zum anderen lange Eingriffszeiten zu uberbrucken sind und haufig nur unzureichendes Material auf Schiffen vorgehalten wird. Das vom Bundesministerium fur Bildung und Forschung geforderte Verbundprojekt KOMPASS (Kompetenz und Organisation fur den Massenanfall von Patienten in der Seeschifffahrt, Forderkennzeichen 13N13255 bis 13N13260) liefert wissenschaftlich fundierte Empfehlungen fur Erstmasnahmen an Bord. Der nautischen Crew kommt hierbei eine besondere Bedeutung sowohl fur organisatorische Aufgaben als auch die medizinische Erstversorgung zu. Es wurden Empfehlungen ausgesprochen, wie an Bord befindliches medizinisches Fach- und Laienpersonal strukturiert in das Schadensmanagement integriert werden kann. Neben der fruhzeitigen Kommunikation zu landseitigen Hilfestellen sollen Patienten an dafur vorbereiteten Ablagen gesammelt und dokumentiert werden, eine Priorisierung der Behandlung und schlieslich die Ordnung des Raumes fur therapeutische Bemuhungen erfolgen. Durch elektronisch gestutzte Triage und ein vernetztes autarkes Tablet‑/Laptop-System kann die Effektivitat der An-Bord-Versorgung erheblich gesteigert und gleichzeitig die Kommunikation zur professionellen landseitigen Hilfe zeitnah sichergestellt werden. Die Ubernahme des Managements durch den leitenden Notarzt See und ein Verletztenversorgungsteam wird hierdurch gewahrleistet.

Frakturen der anterioren Brustwand sind in der Gesamtheit aller Frakturen eher selten. Sie schliesen Sternumfrakturen (SF) und die angrenzenden knorpeligen Rippenanteile ein. Der Unfallmechanismus kann Ruckschlusse daruber geben, welche Begleitverletzungen vorliegen konnen, z. B. Rippen- und Wirbelsaulenfrakturen. Die vorliegende Arbeit gibt einen Uberblick uber Verletzungen der vorderen Brustwand. Dieser umfasst klinische Aspekte ebenso wie bildgebende Untersuchungsbefunde und Ergebnisse der gangigen Literatur. Einbezogen wurden Verletzungskonstellation der anterolateralen Brustwand, insbesondere des Sternums in Kombination mit Schaden an der Wirbelsaule im Sinne einer sternovertebralen Verletzung (SVV). Mogliche Versorgungsstrategien wurden gesichtet; entsprechende Vor- und Nachteile werden dargestellt. Bei symptomatischen Frakturen der vorderen Brustwand sollte deren operative Stabilisierung erwogen werden, um die Stabilitat des Rumpfes wiederherzustellen. Zusatzlich sind haufig Rippenfrakturen bei direktem Trauma und Wirbelsaulenverletzungen bei indirektem Trauma mitzuversorgen. Bei Verletzungen im Bereich des thorakalen Rumpfes muss dieser immer als Einheit betrachtet und somit dessen Zustand im Rahmen der klinischen Untersuchung und der apparativen Diagnostik abgeklart werden. Die Feststellung des Unfallmechanismus kann Ruckschlusse uber mogliche Verletzungsmuster zulassen, z. B. im Sinne einer SVV.

Instabile Brustwandverletzungen (FCI) ereignen sich bei jungeren Patienten haufig durch Hochrasanztraumen, im zunehmenden Patientenalter durch „Low-energy-Traumen“ oder „low falls“. Sie weisen eine hohe Inzidenz an Begleitverletzungen auf und sind mit einer hohen Morbiditat und Mortalitat verbunden. Kommt es gleichzeitig zu einer ipsilateralen Klavikulafraktur (CF), verschlechtert sich das Outcome deutlich. Das Gerust aus Schulter und Brustkorb verliert seine Stabilitat; dies kann zu einem Funktionsverlust der Schulter und einer ausgepragten Deformierung der Brustwand fuhren. Die vorliegende Arbeit zeigt die Entstehung und die klinische Relevanz von FCI. Welche Bedeutung hat eine zusatzliche ipsilaterale CF, und wie konnen diese kostoklavikularen Verletzungen („costoclavicular injury“, CCI) konservativ und operativ behandelt werden? Nach primarer Notfallversorgung der Patienten mit entsprechender Diagnostik wurde bei vorliegender CCI eine operative Stabilisierung mithilfe einer winkelstabilen Plattenosteosynthese der Klavikula und der betroffenen Rippen uber minimalinvasive Zugange in Vollnarkose durchgefuhrt. Die Patienten wurden postoperativ nachuntersucht. Verschiedene minimalinvasive dorsolaterale Zugange zur Brustwand waren zuvor im Rahmen einer Leichenstudie durchgefuhrt und anschliesend in der Praxis umgesetzt worden. Die vorliegende Arbeit bietet anhand gangiger Literatur und klinischer Beispiele Therapievorschlage zur Rekonstruktion der Brustwand. Eine ipsilaterale Klavikulafraktur, kombiniert mit einer Fraktur der 2. bis 4. Rippe, kann uber einen innovativen klavipektoralen Zugang versorgt werden. Fur die anderen Frakturen werden Standardzugange zur anterolateralen und zur posterolateralen Brustwand genutzt, die im klinischen Alltag mit gutem Outcome assoziiert sind. Spatestens, wenn FCI oder CCI dislozierende Frakturen und eine deutliche Deformierung der Thoraxwand zeigen, sollte eine operative Stabilisierung durchgefuhrt werden. Verbleibende Fehlstellungen sind mit dem gleichzeitigen Funktionsverlust von Brustwand und Schulter assoziiert.

Blutungen stellen unverandert eine der Haupttodesursachen nach schwerem Trauma bzw. Polytrauma dar. Die Kompression, chirurgische Unterbindung oder Embolisation sichtbarer Blutungsquellen ist vorrangiges Behandlungsziel. Die traumainduzierte Koagulopathie (TIC) wird als eigenstandige Entitat verstanden und durch eine Gewebeverletzung, Hypoperfusion und immunologische Vorgange ausgelost. Die Trias Hamodilution, Hypothermie und Azidose ist essenziell, erklart jedoch nicht vollstandig die Uberlebenswahrscheinlichkeit in diesem besonderen Setting. Die Therapie einer massiven traumatischen Hamorrhagie beruht einerseits auf einer verhaltnisorientierten Gabe von Blut- und Gerinnungsprodukten, andererseits auf einer spezifischen Faktorengabe anhand der Point-of-Care-Diagnostik via viskoelastischer Testverfahren. Fuhrend bleibt der Ausschluss einer Hyperfibrinolyse. Damage-Control-Resuscitation, permissive Hypotension, der Ausgleich von Azidose, Hypokalzamie und Hypothermie sowie die Transfusion von Blutprodukten und Gerinnungsfaktoren sind entscheidend, um die Uberlebensprognose der Betroffenen zu verbessern.

Sechs Milliarden Euro! Das ist der Investitionsrückstand in deutschen Kliniken im Sommer 2021, wie gesetzliche und private Krankenversicherungen in seltener Einmütigkeit zusammen mit der DKG ermittelt haben. Ganz gleich, wer die schwere Aufgabe übernimmt, das Gesundheitsministerium zu führen – der erforderliche Kassensturz wird in jedem Fall ein erschreckendes Ergebnis liefern. Denn neben den Defiziten in der Infrastruktur wird endlich auch Klarheit darüber herrschen, dass kaum oder zumindest zu wenig Geld da ist für die Therapie einer großen Anzahl von Post-Covid-Patienten und dass es keine Reserven mehr zur Finanzierung von Pflegepersonal gibt.