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Background: Impaired liver function and cholestasis are frequent findings in critically ill patients and are associated with poor outcomes. We tested the hypothesis that hypoxic liver injury and hypoxic cholangiocyte injury are detectable very early in patients with ARDS, may depend on the severity of hypoxemia, and may be aggravated by the use of rescue therapies (high PEEP level and prone positioning) but could be attenuated by extracorporeal membrane oxygenation (ECMO). Methods: In 70 patients with ARDS, aspartate-aminotransferase (AST), alanin-aminotransferase (ALT) and gamma glutamyltransferase (GGT) were measured on the day of the diagnosis of ARDS and three more consecutive days (day 3, day 5, day 10), total bile acids were measured on day 0, 3, and 5. Results: AST levels increased on day 0 and remained constant until day 5, then dropped to normal on day 10 (day 0: 66.5 U/l; day 3: 60.5 U/l; day 5: 63.5 U/l, day 10: 32.1 U/l), ALT levels showed the exact opposite kinetic. GGT was already elevated on day 0 (91.5 U/l) and increased further throughout (day 3: 163.5 U/l, day 5: 213 U/l, day 10: 307 U/l), total bile acids levels increased significantly from day 0 to day 3 (p = 0.019) and day 0 to day 5 (p < 0.001), but not between day 3 and day 5 (p = 0.217). Total bile acids levels were significantly correlated to GGT on day 0 (p < 0.001), day 3 (p = 0.02), and in a trend on day 5 (p = 0.055). PEEP levels were significantly correlated with plasma levels of AST (day 3), ALT (day 5) and GGT (day 10). Biomarker levels were not associated with the use of ECMO, prone position, the cause of ARDS, and paO2. Conclusions: We found no evidence of hypoxic liver injury or hypoxic damage to cholangiocytes being caused by the severity of hypoxemia in ARDS patients during the very early phase of the disease. Additionally, mean PEEP level, prone positioning, and ECMO treatment did not have an impact in this regard. Nevertheless, GGT levels were elevated from day zero and rising, this increase was not related to paO2, prone position, ECMO treatment, or mean PEEP, but correlated to total bile acid levels.

Background. Noninvasive neurally adjusted ventilatory assist (NAVA) has been shown to improve patient-ventilator interaction in many settings. There is still scarce data with regard to postoperative patients indicated for noninvasive ventilation (NIV) which this study elates. The purpose of this trial was to evaluate postoperative patients for synchrony and comfort in noninvasive pressure support ventilation (NIV-PSV) vs. NIV-NAVA. Methods. Twenty-two subjects received either NIV-NAVA or NIV-PSV in an object-blind, prospective, randomized, crossover fashion (observational trial). We evaluated blood gases and ventilator tracings throughout as well as comfort of ventilation at the end of each ventilation phase. Results. There was an effective reduction in ventilator delays (p

Objectives: Severe acute respiratory syndrome coronavirus 2 cell entry depends on angiotensin-converting enzyme 2 and transmembrane serine protease 2 and is blocked in cell culture by camostat mesylate, a clinically proven protease inhibitor. Whether camostat mesylate is able to lower disease burden in coronavirus disease 2019 sepsis is currently unknown. Design: Retrospective observational case series. Setting: Patient treated in ICU of University hospital Göttingen, Germany. Patients: Eleven critical ill coronavirus disease 2019 patients with organ failure were treated in ICU. Interventions: Compassionate use of camostat mesylate (six patients, camostat group) or hydroxychloroquine (five patients, hydroxychloroquine group). Measurements and Main Results: Clinical courses were assessed by Sepsis-related Organ Failure Assessment score at days 1, 3, and 8. Further, viral load, oxygenation, and inflammatory markers were determined. Sepsis-related Organ Failure Assessment score was comparable between camostat and hydroxychloroquine groups upon ICU admission. During observation, the Sepsis-related Organ Failure Assessment score decreased in the camostat group but remained elevated in the hydroxychloroquine group. The decline in disease severity in camostat mesylate treated patients was paralleled by a decline in inflammatory markers and improvement of oxygenation. Conclusions: The severity of coronavirus disease 2019 decreased upon camostat mesylate treatment within a period of 8 days and a similar effect was not observed in patients receiving hydroxychloroquine. Camostat mesylate thus warrants further evaluation within randomized clinical trials. Open-Access-Publikationsfonds 2020 peerReviewed

Prothesenlockerungen, insbesondere aseptische, sind ein bislang ungelöstes Problem in der modernen Endoprothetik. Die bisherige medizinisch- wissenschaftliche Forschung auf diesem Gebiet konnte eine verbesserte Osteointegration durch diverse unterschiedliche Oberflächenmodifikationen zeigen. Leider offenbaren alle bisherigen Modifikationsverfahren verschiedene Nachteile. Besonders die schwache Oberflächenstärke der Beschichtungen schränkt deren Verwendung massiv ein. Anodic-plasma-chemical (APC) Behandlung ermöglicht die Herstellung von Implantaten, bei denen Kalziumphosphat direkt in eine metallische Oberfläche inkorporiert ist. Durch diese Behandlung erhält man eine wesentlich bessere Oberflächenstärke als mit bisher verwendeten Modifikationsmethoden. Zusätzlich führt die bioaktive Metalloberfläche zu einer verbesserten Osteointegration. Da die gute Zytokompatibilität bereits durch in-vitro Versuche bestätigt worden ist wurde diese Studie mit der Zielsetzung durchgeführt, die Zytokompatibilität (wenig Osteolysen und wenig aseptische Entzündungsreaktion) in belasteter Umgebung in einem in-vivo Modell bei lumbaler Spondylodese nachzuweisen. Als Vergleichsmaterialien wurden ein herkömmliches Titanoxid- und ein mit dem Plasma-sprayed-Verfahren behandeltes Titanmaterial verwendet. Die Spondylodeseimplantate wurden in die Lendenwirbelsäulen von weiblichen Merino-Mix Schafen mit einer postoperativen Standzeit von sechs beziehungsweise zwölf Wochen implantiert (zwei Auswertungszeitpunkte). Osteoklasten als Marker für Osteolysen und Neovaskularisation als Marker für Entzündungsreaktionen wurden nach immunhistologischer Färbung quantitativ ausgewertet. Es wurden keine signifikanten Unterschiede zwischen den getesteten Oberflächen-modifikationen gefunden. Dieses Ergebnis führt zu der Schlussfolgerung, dass die APC behandelten Implantate eine mindestens ebenso gute Biokompatibilität haben, wie die verwendeten Vergleichsmaterialien. Der aktuellen Studienlage nach ermöglicht das APC-Verfahren eine bisher nicht gekannte bioaktive und dennoch starke Oberfläche in Verbindung mit einer in-vivo nachgewiesenen guten Biokompatibilität, bei vergleichsweise einfacher, schneller und kostengünstiger Herstellung. Aus diesen Gründen scheint das APC- Oberflächenmodifikationsverfahren großes Potenzial für die zukünftige Herstellung von metallischen Implantatmaterialien zu haben., Implant failure is an unsolved problem by now. By modifying the implant surface a better oteointegration could be achieved, but still there are some limitations. Especially weak surface strength limits the usage. Anodic-plasma- chemical treatment allows incorporation of calcium-phosphate directly into the metallic surface which leads to enhanced surface strength. Because cytocompatibility has been shown already in-vitro we studied it in a loaded environment in an in-vivo sheep-spine-model. We compared APC to implants made of titaniumodixe an an implant modified by plasma-sprayed treatment. After 6 respectively 12 weeks post-operationem I examined osteolytic an inflammatory immunhistologically. I found no significant differences between the tested surfaces. This leads to the conclusion that APC-treated implants have the same cytocompatibility as the compared materials. But APC-treatment enables to produce a biocompatible surface of titanium-implants by a cheap and fast production of the surface. Conclusively APC-treatment seems to have a great potential for future metallic implants.

Objectives: Severe acute respiratory syndrome coronavirus 2 cell entry depends on angiotensin-converting enzyme 2 and transmembrane serine protease 2 and is blocked in cell culture by camostat mesylate, a clinically proven protease inhibitor. Whether camostat mesylate is able to lower disease burden in coronavirus disease 2019 sepsis is currently unknown. Design: Retrospective observational case series. Setting: Patient treated in ICU of University hospital Göttingen, Germany. Patients: Eleven critical ill coronavirus disease 2019 patients with organ failure were treated in ICU. Interventions: Compassionate use of camostat mesylate (six patients, camostat group) or hydroxychloroquine (five patients, hydroxychloroquine group). Measurements and Main Results: Clinical courses were assessed by Sepsis-related Organ Failure Assessment score at days 1, 3, and 8. Further, viral load, oxygenation, and inflammatory markers were determined. Sepsis-related Organ Failure Assessment score was comparable between camostat and hydroxychloroquine groups upon ICU admission. During observation, the Sepsis-related Organ Failure Assessment score decreased in the camostat group but remained elevated in the hydroxychloroquine group. The decline in disease severity in camostat mesylate treated patients was paralleled by a decline in inflammatory markers and improvement of oxygenation. Conclusions: The severity of coronavirus disease 2019 decreased upon camostat mesylate treatment within a period of 8 days and a similar effect was not observed in patients receiving hydroxychloroquine. Camostat mesylate thus warrants further evaluation within randomized clinical trials., Critical Care Explorations, 2 (11)