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Abstract: Objective: To provide normative values for sleep macroarchitecture of healthy children aged 1–18years using the AASM sleep scoring criteria, assessing the effects of gender, age, and Tanner pubertal stage. Methods: One-night polysomnography was performed at subjects’ habitual bedtimes in 16 laboratories on 209 healthy German children. Results: Normal values of sleep macrostructure show significant age dependencies (p <0.05). Increasing with age: awakening index, R latency (RL), sleep efficiency (SE) (total sleep time (TST)/sleep period time (SPT)) and SE (TST/time in bed), stage N2, mean sleep cycle duration, number of stage shifts. Decreasing with age: TST, SPT, wake after sleep onset, stage N3, stage R, movement time (MT), number of sleep cycles. The following sleep parameters show a dependency on Tanner stages as well as corresponding age (p <0.05):TST, SPT, awakening index, R latency, stage N2, stage N3, MT, number of sleep cycles, mean sleep cycle duration. No gender dependencies were found. Conclusion: The given study, considering AASM rules, shows the development of sleep in normal children ages 1–18. Subject selection criteria and other factors influencing sleep as well AASM guideline modifications including scoring arousals in N2 and scoring MT as a measure of sleep fragmentation are discussed. [Copyright &y& Elsevier]

Abstract: Objective: Laryngomalacia is the most common cause of stridor in newborns and infants. The aim of the contribution was to present objectified data of the outcome of transoral CO2 laser microsurgery in patients with laryngomalacia utilizing polysomnography (PSG). Patients and methods: This retrospective study comprised 21 patients who were diagnosed to suffer from laryngomalacia. Diagnosis was confirmed by pharyngo-laryngoscopy under spontaneous breathing. If there was evidence for laryngomalacia a transoral CO2 lasersurgical intervention and/or epiglottopexy was performed in the same session. 8 patients, on whom the following should be focused, received pre- and postoperative PSG which was performed for efficiency control of the applied treatment. Results: All 21 patients underwent invasive treatment for laryngomalacia (lasersurgical division of the aryepiglottic folds: n =13; epiglottopexy: n =5; combined procedure: n =3). All patients were successfully extubated after surgery. In 20/21 cases breathing improved clearly after one single intervention. Stridor disappeared completely in the further course of the disease. In the 8 patients who received pre- and postinterventional PSG, lasersurgical interventions were performed. Statistical analysis of pre- and postoperative PSG revealed that MOAI/h (mixed obstructive apnea index/hour) improved significantly (p =0.016, Wilcoxon-Signed-Rank Test). Also desaturation/hour improved in the postoperative course (p =0.11). Conclusion: The presented concept describes an effective and reliable approach for diagnostics and treatment for laryngomalacia. To objectify the success of supraglottoplaty in patients suffering from severe laryngomalacia a pre- and postoperative PSG seems to be useful and advisable. The present results of PSG demonstrate that children with laryngomalacia to benefit from lasersurgical division of the aryepiglottic folds and/or epiglottopexy. This fact is supported by the postoperative improved clinical aspect. [Copyright &y& Elsevier]

The soluble [NiFe]-hydrogenase (SH) of the facultative lithoautotrophic proteobacterium Ralstonia eutropha H16 has up to now been described as a heterotetrameric enzyme. The purified protein consists of two functionally distinct heterodimeric moieties. The HoxHY dimer represents the hydrogenase module, and the HoxFU dimer constitutes an NADH-dehydrogenase. In the bimodular form, the SH mediates reduction of NAD+ at the expense of H2. We have purified a new high-molecular-weight form of the SH which contains an additional subunit. This extra subunit was identified as the product of hoxI, a member of the SH gene cluster (hoxFUYHWI). Edman degradation, in combination with protein sequencing of the SH high-molecular-weight complex, established a subunit stoichiometry of HoxFUYHI2. Cross-linking experiments indicated that the two HoxI subunits are the closest neighbors. The stability of the hexameric SH depended on the pH and the ionic strength of the buffer. The tetrameric form of the SH can be instantaneously activated with small amounts of NADH but not with NADPH. The hexameric form, however, was also activated by adding small amounts of NADPH. This suggests that HoxI provides a binding domain for NADPH. A specific reaction site for NADPH adds to the list of similarities between the SH and mitochondrial NADH:ubiquinone oxidoreductase (Complex I). [ABSTRACT FROM AUTHOR]

Infrared spectra of 15N-enriched preparations of the soluble cytoplasmic NAD+-reducing [NiFe]-hydrogenase from Ralstonia eutropha are presented. These spectra, together with chemical analyses, show that the Ni-Fe active site contains four cyanide groups and one carbon monoxide molecule. It is proposed that the active site is a (RS)2(CN)Ni(μ-RS)2Fe(CN)3(CO) centre (R=Cys) and that H2 activation solely takes place on nickel. One of the two FMN groups (FMN-a) in the enzyme can be reversibly released upon reduction of the enzyme. It is now reported that at longer times also one of the cyanide groups, the one proposed to be bound to the nickel atom, could be removed from the enzyme. This process was irreversible and induced the inhibition of the enzyme activity by oxygen; the enzyme remained insensitive to carbon monoxide. The Ni-Fe active site was EPR undetectable under all conditions tested. It is concluded that the Ni-bound cyanide group is responsible for the oxygen insensitivity of the enzyme. [ABSTRACT FROM AUTHOR]

Marine aggregates are densely colonized by bacteria, and inter-specific interactions such as inhibition are important for colonization by aggregate-associated bacteria and thus affect the turnover of organic matter in the sea. In order to study antagonistic activities we carried out inhibition tests with 51 isolates obtained exclusively from aggregates of the German Wadden Sea. 16S rRNA gene sequences of all isolates revealed that 35% of the isolates affiliated with the Flavobacteria/Sphingobacteria group, 24% and 16% with α- and γ-Proteobacteria, respectively, 16% with the Bacillus/Clostridium group, and 10% with Actinobacteria. The relatively high percentage of Gram-positive bacteria may be related to specific features of the Wadden Sea environment. After 11 days of incubation using Burkholder agar diffusion assays the percentage of inhibitory isolates was 54.1% and this decreased to 20.7% after 20 days of incubation but it did not decline for members of the Bacillus/Clostridium group. Inhibitory activity was expressed in strain-specific patterns even though some isolates were closely related according to their 16S rRNA gene sequences. Antagonistic activity was lowest for Flavobacteria/Sphingobacteria (35%) and highest for Actinobacteria (80%). We further examined whether growth of isolates was affected when they were placed on lawns of certain other isolates. In parallel with lowest percentage of inhibitory isolates, highest growth occurred on lawns of the Flavobacteria/Sphingobacteria group whereas it was lowest on lawns of Actinobacteria and the Bacillus/Clostridium group. The high inhibitory activity of both groups of Gram-positive bacteria fits well with data from chemical screening using matrix-assisted laser desorption ionization time of flight mass spectrometry. Hence, inhibitory activity greatly influences inter-specific interactions and may impact microbial degradation and remineralization of particulate organic matter in aquatic environments. [Copyright &y& Elsevier]

Breathing lime is used in closed circuit and semi-closed circuit rebreathers (CCR/SCR) for technical diving. Similar to the use in anesthesia systems, the lime usually contains hydroxycarbamide, which can react to caustic soda under the influence of water. The ingestion of components of the soda lime can lead to burns of the esophageal mucosa with the formation of colliquation necrosis and the danger of esophageal perforation. Early endoscopy is essential in this case to assess the consequences of ingestion. [ABSTRACT FROM AUTHOR]

Introduction of accredited Cardiac Arrest Centers. Patients after OHCA who were transferred to one of three university hospitals before and after CAC accreditation were analyzed retrospectively concerning treatment and outcome variables. Created with https://www.biorender.com/ [Display omitted] Out-of-hospital cardiac arrest (OHCA) remains a frequent medical emergency with low survival rates even after a return of spontaneous circulation (ROSC). Growing evidence supports formation of dedicated teams in scenarios like cardiogenic shock to improve prognosis. Thus, the European Resuscitation Council (ERC) recommended introduction of Cardiac Arrest Centers (CAC) in their 2015 guidelines. Here, we aimed to elucidate the effects of newly introduced CACs in Germany regarding survival rate and neurological outcome. A multicenter retrospective observational cohort study was performed at three university hospitals and outcomes after OHCA were compared before and after CAC accreditation. Primary outcomes were survival until discharge and favorable neurological status (CPC 1 or 2) at discharge. In total 784 patients (368 before and 416 after CAC accreditation) were analyzed. Rates of immediate percutaneous coronary intervention (40 vs. 52%, p = 0.01) and implementation of extracorporeal CPR (8 vs. 13%, p < 0.05) increased after CAC accreditation. Likelihood of favorable neurological status at discharge was higher after CAC accreditation (71 vs. 87%, p < 0.01), whereas overall survival remained similar (35 vs. 35%, p > 0.99). CAC accreditation is linked to higher rates of favorable neurological outcome and unchanged overall survival. [ABSTRACT FROM AUTHOR]

The basis of all metabolic processes in the human body is the production and metabolism of carriers of energy. Lactate is the end-product of anaerobic glycolysis. Lactate can serve as a substrate for gluconeogenesis and as an oxidation substrate. Hyperlactatemia can be detected as the result of a multitude of acute events (e.g. shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine deficiency, liver failure and intoxication). Hyperlactatemia can be associated with increased mortality, therefore in emergency medicine the search for the cause of hyperlactatemia is just as important as an effective causal treatment. Repetitive measurements of lactate are components of several treatment algorithms as observation of the dynamic development of blood lactate concentrations can help to make a better assessment of the acute medical condition of the patient and to evaluate the effectiveness of the measures undertaken. [ABSTRACT FROM AUTHOR]

Three Fe–C–Cr and three Fe–C–Cr–Ni-based alloys containing carbon between 0.318 and 0.410 mass%, chromium and nickel between of 0.001 and 4.990 mass% were studied. Original temperatures of solidus, liquidus and peritectic transformation were determined and clarified for all six specific alloys. Phase transition temperatures were experimentally obtained using differential thermal analysis (DTA), and the start of melting of alloys was investigated using the high-temperature laser scanning confocal microscopy. Additionally, experimental data were compared and discussed with calculation results using SW IDS and Thermo-Calc operating with commercially available thermodynamic database TCFE8. The combination of both experimental methods contributed substantially to investigate more clearly the start of melting. Determination of solidus temperatures/incipient melting point temperatures on DTA curves is often challenging, and there are significant differences when compared with the determination of liquidus and peritectic transformation temperatures. HT-LSCM method brings an improvement in that regard because it can reveal thermal events which are hardly identified on DTA curves. The relation between homogeneity/inhomogeneity of investigated alloys and the initiation of their melting was observed depending mainly on the state of alloys. [ABSTRACT FROM AUTHOR]

Background: In the acute care of trauma, some patients with a low estimated risk of death die suddenly and unexpectedly. In this study, we aim to identify predictors for early death within 24 h following hospital admission in low-risk patients. Methods: The TraumaRegister DGU® was used to collect records of patients who were primarily treated in a participating hospital between 2004 and 2013 with a RISC II score below 10%. Results: During the study period, 64,379 patients met the inclusion criteria. The mean RISC II score was 2.0%, and the mean ISS was 16 ± 9. The overall hospital mortality rate was 2.1%, and 0.5% of patients (n = 301) died within the first 24 h. A SPB of ≤ 90 mmHg was associated with an increased risk of death (p < 0.001). An AIS abdomen score of ≥ 3 was associated with increased risk of death within the first 24 h (p < 0.001). A high risk of early death was also seen in patients with an AIS score (thorax) ≥ 3; 51% of those who died died within the first 24 h (p < 0.005). Death in patients over 60 years was more common after 24 h (p < 0.001). Patients with an ASA score of ≥ 3 were more likely to die after the first 24 h (p < 0.001). Conclusions: Indicators predicting a high risk of early death in patients with a low RISC II score include a SPB ≤ 90 mmHg and severe chest and abdominal trauma. Emergency teams involved in the acute care of trauma patients should be aware of these "red flags" and treat their patients accordingly. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation METHODS: This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD ("acceptable")). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation. [ABSTRACT FROM AUTHOR]

Aim: An effective airway management is pivotal for treating hypoxia and to ensure reoxygenation during cardiopulmonary resuscitation (CPR). This matched-pair analysis from the German Resuscitation Registry (GRR) investigates the outcomes of various methods of airway management used on out-of-hospital cardiac arrest (OHCA) patients.Methods: 89,220 OHCA patients were reported between 01/01/2007 and 12/31/2017. After applying exclusion and inclusion criteria, the resulting 19,196 patient's data were analyzed. Endpoints were return of spontaneous circulation (ROSC), hospital admission, 24-h survival, hospital discharge, and discharge with cerebral performance categories 1,2 (CPC1,2). Three categories of airway management were defined: endotracheal tube ("ETT"), laryngeal tube ("LT_only"), and laryngeal to endotracheal tube exchange ("LTEX"). The groups were matched with respect to age, gender, aetiology or location of OHCA, witnessing or CPR by lay people, initial rhythm, and use of epinephrine and amiodarone.Results: "ETT" versus "LT_only" was associated with higher short- and long-term outcome rates and better neurological recovery (CPC_1.2: 7.7 vs. 5.8%, OR = 1.35, 95%-CI = 1.09-1.67, n = 5552). "LTEX" versus "LT_only" showed significantly higher ROSC- and 24-h survival rate (33.7 vs. 21.8%, OR = 1.82, 95%-CI = 1.51-2.2, n = 2302). "LTEX" versus "ETT" revealed significantly higher ROSC- and 24-h survival rate (34.6 vs. 30.4%, OR = 1.21, 95%-CI = 1.03-1.42, n = 2608).Conclusion: "ETT" was associated with higher survival rates and better neurological outcomes in comparison to "LT_only". The strategy of "LTEX" versus "LT_only" or "ETT" was only associated with better short-term outcomes. Our observational registry data suggests that endotracheal intubation by physician staffed EMS is the optimal airway strategy for OHCA in our system. [ABSTRACT FROM AUTHOR]

Background: Management of critically ill non-trauma patients in the resuscitation room of an emergency department (ED) is very challenging, and it is difficult to identify patients with a higher risk of death. Previous studies have shown that lactate indices can predict survival for selected diseases and syndromes.Objective: As reported for other patient populations, we set out to determine whether admission lactate or lactate dynamics (LD) within 24 h can predict 30-day mortality in unselected critically ill non-traumatic patients.Methods: In this retrospective study over a 1-year period, admission lactate, time weighted average lactate (LacTW) and LD of all critically ill adult patients admitted from ED to intensive care unit were analyzed. A linear regression model was implemented to estimate lactate data 1 h after admission.Results: The admission lactate, LacTW, and LD within 24 h were analyzed from 392 critically ill patients. The overall 30-day mortality rate was around 29%. Admission lactate (4.1 ± 4.0 mmol/L vs. 6.6 ± 6.1 mmol/L; p < 0.01) and LacTW (1.8 ± 1.7 mmol/L vs. 4.1 ± 4.8 mmol/L; p < 0.01) were different between survivors and non-survivors. LD between survivors and non-survivors did not differ at 1 h, 6 h, 12 h, or 24 h. After excluding patients with out-of-hospital or in-hospital cardiac arrest during resuscitation room management, admission lactate and LD between survivors and non-survivors did not differ at 1 h, 12 h, and 24 h. LD at 6 h (44% ± 42% vs. 33% ± 58%; p = 0.042) and LacTW (1.7 ± 1.6 mmol/L vs. 2.6 ± 3.0 mmol/L; p < 0.01) did differ.Conclusions: In critically ill ED patients initially requiring treatment in a resuscitation room setting, LD at 6 h and LacTW may predict their survival beyond 30 days. These findings need to be confirmed in a prospective study design. [ABSTRACT FROM AUTHOR]

The aim of this autopsy study was to investigate chest-compression associated injuries to the trunk in out-of-hospital and in-hospital non-traumatic cardiac arrest patients treated with automated external chest compression devices (ACCD; all with LUCAS II devices) versus exclusive manual chest compressions (mCC). In this retrospective single-center study, all forensic autopsies between 2011 and 2017 were included. Injuries following cardiopulmonary resuscitation (CPR) in patients treated with mCC or ACCD were investigated and statistically compared using a bivariate logistic regression. In the seven-year period with 4433 autopsies, 614 were analyzed following CPR (mCC vs. ACCD: n = 501 vs. n = 113). The presence of any type of trunk injury was correlated with longer resuscitation intervals (30 ± 15 vs. 44 ± 25 min, p < 0.05). In comparison with mCC, treatment with ACCD led to more frequent skin emphysema (5 vs 0%, p = 0.012), pneumothorax (6 vs. 1%, p = 0.008), lung lesions (19 vs. 4%, p = 0.008), hemopericardium (3 vs 1%, p = 0.025) and liver lesions (10 vs. 1%, p = 0.001), all irrespective of confounding aspects. Higher age and longer CPR durations statistically influenced frequency of sternal and rib fractures (p < 0.001). The mean number of fractured ribs did not vary significantly between the groups (6 ± 3 vs. 7 ± 2, p = 0.09). In this cohort with unsuccessful CPR, chest compression-related injuries were more frequent following ACCD application than in the mCC group, but with only minutely increased odds ratios. The severity of injuries did not differ between the groups, and no iatrogenic injury was declared by the forensic pathologist as being fatal. In the clinical routine after successful return of spontaneous circulation a computed tomography scan for CPR-associated injuries is recommended as soon as possible. [ABSTRACT FROM AUTHOR]

Successive multiparty elections in sub-Saharan Africa are associated with incremental democratization. Yet tests in other regions are less than encouraging. Non-significant findings on Latin America and post-communist Eurasia, as well as conceptual criticism regarding the theory’s application in the contemporary Middle East, suggest that this may be a case of African exceptionalism. This article moves these debates forward by posing a comprehensive, global set of tests on the democratizing effect of elections. We seek to establish the scope conditions of the argument geographically, temporally, and substantively. Although we find a correlation between reiterated multiparty elections and improvements in the liberal-democratic components of electoral regimes globally since 1900, the relationship is only substantial in the period since the onset of the third wave of democracy. Experiences with iterated multiparty elections have substantive importance for democratization in sub-Saharan Africa, the post-communist region, Latin America and the Caribbean, and Asia. For the Middle East and North Africa, the relationship is weaker and less robust. Finally, the results suggest that reiterated sequences of multiparty elections are associated with improvements to liberal and deliberative components of democracy more so than egalitarian components. [ABSTRACT FROM PUBLISHER]

Background: Sudden cardiac arrest is a relevant problem with a significant number of deaths in Europe.Aim: Using data from the German Resuscitation Register (GRR), we examined changes in epidemiology and therapeutic interventions over a 15-year period in order to identify key factors contributing to favourable outcome in out-of-hospital cardiac arrest (OHCA) patients.Methods: GRR data were analysed in 5-year periods (2006-2010 vs 2011-2015 vs 2016-2020) representing changes in the European Resuscitation Council (ERC) guidelines. Group comparison of OHCA patients was made for epidemiological and resuscitation-associated factors. Endpoints included 30-day survival and hospital discharge with a good neurological outcome (CPC 1,2). Matched-pair analysis compared outcomes, and multivariate binary logistic regression analysis identified variables with effects on survival.Results: A total of 42,997 GRR patients were studied (2006-2010: n = 3,471, 2011-2015: n = 16,122, 2016-2020: n = 23,404). Proportion of patients over 80 years, use of intraosseous (IO) access and supraglottic airway devices, rate of bystander CPR, and the proportion of telephone CPR increased over the study period. The 30-day survival, and hospital discharge rates with CPC1/2 were unchanged. After adjusting cohorts using matched pairs, a higher CPC1,2 rate was observed (8.8 vs 10.2%, p < 0.03). Logistic regression analysis showed that IO and SAD had an unfavourable impact on outcome.Conclusion: Despite a significant increase in bystander and telephone CPR rates, no improvement in 30-day survival and hospital discharge rate with CPC1,2 was observed. Initial rhythm (VF/VT), cardiac and hypoxic cause of CA, bystander CPR and IV access were identified as factors associated with a favourable neurological outcome. [ABSTRACT FROM AUTHOR]

The article discusses the clinical care of a 30-year-old woman who was diagnosed with Dunbar syndrome. The patient complained of postprandial and sports related spasmodic pain in her upper abdomen. Duplexsonography and magnetic resonance imaging on the patient revealed a hooked shaped stenosis of the coeliac trunk caused by the median arcuate ligament. She refused to undergo surgical treatment and preferred gymnastic exercises.

Introduction: Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™). Methods: Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion. Results: The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW±SD) did not show significant differences with 17±7 (EZ-IO tibia) vs. 29±42 (EZ-IO humerus) vs. 33±21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27±5 to 69±54 ml/min (EZ-IO tibia), 16±3 to 60±44 ml/min (EZ-IO humerus) and 53±2 to 112±47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107–0.366; p≤0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63–0.80; p≤0.007). Post-hoc statistical power was 0.62 with the given sample size. Conclusions: The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings. [ABSTRACT FROM AUTHOR]

This single-centre retrospective cohort study evaluated the incidence and outcome of mycoses in critical ill patients ( n = 283) with sepsis due to peritonitis. Overall mortality was 41.3%, and the 28-day mortality was 29.3%. Fungal pathogens were found in 51.9%. The common first location was the respiratory tract (66.6%), followed by the abdominal site (19.7%). Candida colonisation was found in 64.6%, and invasive Candida infection in 34.0%. Identified fungi were Candida spp. in 98.6% and Aspergillus spp. in 6.1%. Patients with fungal pathogens showed a higher rate of postoperative peritonitis, APACHE II and tracheotomy. In comparison to patients without fungal pathogens, these patients showed a longer duration on mechanical ventilation, and a higher overall mortality. Patients with Candida-positive swabs from abdominal sites had more fascia dehiscence and anastomosis leakage. Seventy-two patients (48.9%) received antifungal therapy, 26 patients were treated empirically. Antifungal therapy was not associated with a decrease in mortality. Age and renal replacement therapy were associated with mortality. In conclusion, fungi are common pathogens in critically ill patients with peritonitis, and detection of fungi is associated with an increase in overall mortality. Particularly, Candida-positive abdominal swabs are associated with an increase in morbidity. However, we were not able to demonstrate a survival benefit for antifungal therapy in peritonitis patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Stable bearing devices are often utilized by prehospital first responders in modern management of severely injured patients. It is not known whether these devices influence radiation exposure or image quality in whole-body computed tomography (WBCT). Additionally, manufacturers currently provide no specifications concerning these criteria. This investigation analyzed the influence of nine different bearing devices on these specified criteria. Methods: The influence of nine different bearing devices on radiation exposure and image quality in WBCT was investigated. The dose-length-product (DLP100) was obtained through use of a CT-ionisation chamber placed in the centre of a 32cm CT-phantom and compared with a reference value. Moreover, the results were calculated as effective dose data E (mSv). The image quality was assessed by three expert radiologists using the following scoring scale (0=no artefacts; 1=minor artefacts; 2=clearly artefacts; 3=massive artefacts). Results: Out of nine bearing devices examined, four showed significantly higher (2.5–4.5%, p <0.05) DLP100 and five showed no significant difference between DLP100 and the reference value. The image quality was classified in the categories “0”, “1”, “2” and “3” in 4, 3, 1 and 1 case, respectively. Conclusions: In diagnostic producers using WBCT, bearing devices may be associated with relevant increases in radiation dose and can affect the image assessability. Some bearing devices are associated with no significant influence on radiation dose and reduction of image quality. Considering all results to get the best balance between image quality and radiation dose, aluminium and metal-free devices should be preferred. [Copyright &y& Elsevier]

The article describes the development and components of the Heidelberg Personal Digital Assistant (PDA)-based Clinical Documentation Suite. Topics covered include the advantages of a consequent electronic documentation approach, the time restraints faced by various fields of medicine and the main components of the suite such as data entry, post-processing and data editing.

Abstract: Background: Whole-body computed tomography (WBCT) plays an important role in the management of severely injured patients. We evaluated the radiation exposure of WBCT scans using different positioning boards and arm positions. Methods: In this retrospective study, the radiation exposure of WBCT using a 16-slice multislice computed tomography scanner was evaluated. Individual effective doses (E, mSV) was calculated. Patients were assigned to two groups according to placement on a plastic transfer mat (PTM, group 1) or on the Trauma Transfer™-Board (TTB, group 2). Data were collected for each group with arm placement on the abdomen (a) or in raising position (b), respectively. The maximum ventro-dorsal diameter [VDD] at the trunk was measured. Results: 100 patients with potentially life-threatening injuries were analysed. Patient demographics and VDD did not differ in the two groups. Radiation exposure in term of E did not reveal any significant differences between the two positioning boards using same arm position [group 1a (n =26) vs. 2a (n =24) (mSV): 16.7±4.7 vs. 17.1±4.4, group 1b (n =26) vs. 2b (n =24) (mSV): 13.1±3.9 vs. 14.3±1.5]. The arm raising positioning showed a significant reduction in E in comparison to the placement on abdomen position [group 1b vs. 1a (mSV): 13.1±3.9 vs. 16.7±4.7, p <0.05, group 2b vs. 2a (mSV): 14.3±1.5 vs. 17.1±4.4, p <0.05]. Conclusions: Patient arm positioning for WBCT has an important influence on radiation exposure. Effective dose was 16–22% lower when arms were raised. An individual placement algorithm may lead to a relevant reduction of radiation exposure of severely injured patients. [Copyright &y& Elsevier]

Purpose: The management of trauma patients suffering from active bleeding has improved with a better understanding of trauma-induced coagulopathy. The aim of this manuscript is to give recommendations for coagulation management. Methods: A systematic literature search in the PubMed database was performed for articles published between January 2000 and August 2009. A total of 230 articles were included in the present systematic review. Conclusions: The 'coagulopathy of trauma' is a discrete disease which has a decisive influence on survival. Diagnosis and therapy of deranged coagulation should start immediately after admission to the emergency department. A specific protocol for massive transfusion should be introduced and continued. Loss of body temperature should be prevented and treated. Acidaemia should be prevented and treated by appropriate shock therapy. If massive transfusion is performed using fresh frozen plasma (FFP), a ratio of FFP to pRBC (packed red blood cells) of 1:2-1:1 should be achieved. Fibrinogen should be substituted at levels of <1.5 g/L. For patients suffering from active bleeding, permissive hypotension (i.e. mean arterial pressure ~65 mmHg) may be aimed for until surgical cessation of bleeding. This option is contraindicated in injuries of the central nervous system and in patients with coronary heart disease, or with known hypertension. Thrombelastography or -metry may be performed to guide coagulation diagnosis and substitution. Hypocalcaemia <0.9 mmol/L should be avoided and may be treated. For actively bleeding patients, pRBC may be given at haemoglobin <10 g/L (6.2 mmol/L) and haematocrit may be targeted at 30%. [ABSTRACT FROM AUTHOR]

Purpose: We tested whether the chromosomal radiosensitivity of in vitro irradiated lymphocytes could be used to predict the risk of acute reactions after radiotherapy. Methods and Materials: Two prospective studies were performed: study A with 51 patients included different tumor sites and study B included 87 breast cancer patients. Acute reaction was assessed using the Radiation Therapy Oncology Group score. In both studies, patients were treated with curative radiotherapy, and the mean tumor dose applied was 55 Gy (40–65) ± boost with 11 Gy (6–31) in study A and 50.4 Gy ± boost with 10 Gy in study B. Individual radiosensitivity was determined with lymphocytes irradiated in vitro with X-ray doses of either 3 or 6 Gy and scoring the number of chromosomal deletions. Results: Acute reactions displayed a typical spectrum with 57% in study A and 53% in study B showing an acute reaction of Grade 2–3. Individual radiosensitivity in both studies was characterized by a substantial variation and the fraction of patients with Grade 2–3 reaction was found to increase with increasing individual radiosensitivity measured at 6 Gy (study A, p = 0.238; study B, p = 0.023). For study B, this fraction increased with breast volume, and the impact of individual radiosensitivity on acute reaction was especially pronounced (p = 0.00025) for lower breast volume. No such clear association with acute reaction was observed when individual radiosensitivity was assessed at 3 Gy. Conclusion: Individual radiosensitivity determined at 6 Gy seems to be a good predictor for risk of acute effects after curative radiotherapy. [Copyright &y& Elsevier]

Abstract: Objective: Superior patency of internal thoracic artery (ITA) grafting to saphenous veins is conclusive. The aim of the present study was to compare the early outcome of patients receiving either bilateral ITA (BITA) or single ITA (SITA) grafts and to identify risk factors for perioperative complications, such as obesity, diabetes mellitus, or advanced age. Methods: All 8666 patients with isolated coronary artery bypass grafting (CABG, including emergent cases or redos) operated between January 1994 and June 2004 receiving either BITA (n =4462) or SITA (n =4204) grafting were analyzed retrospectively. Demographic data were comparable for both groups concerning mean age (65.3±9.4 years vs 64.9±9.3 years), range (35–89 years (p =0.05)), diabetes incidence (29.3% vs 2.6% (p =0.08)), dialysis-dependent renal failure (0.7% vs 0.6% (p =0.4)), preoperative ejection fraction (EF) mean (61.8% vs 61.2% (p =0.07)) but not for gender (80.4% vs 76.7% males (p =0.00)), body mass index (BMI) mean (27.2±3.6 vs 26.9±3.5 (p =0.00)), COPD (7.0% vs 8.5% (p =0.00)), and hyperlipidemia (78.3% vs 74.3% (p =0.00)). In the BITA group, right ITA (RITA) was directed preferentially to the left anterior descending artery (LAD), left ITA (LITA) to the lateral wall. In the SITA group, the LAD was revascularized with the left ITA. Additional bypasses were performed with saphenous vein grafts (SVG). Results: The number of anastomoses was higher in the BITA group (3.8±0.9 vs 3.1±0.9 (p =0.00)); therefore, duration of surgery (mean: 189±46.3min vs 164±46.2min) and cross-clamp time (62.0±17.9min vs 51.0±18.0min) significantly prolonged (p =0.00). Incidence of rethoracotomy due to bleeding (2.9% vs 0.6%; p =0.00) or sternal refixation with (0.7% vs 0.2%; p =0.00) or without infection (1.4% vs 0.6%; p =0.00) was higher in the BITA group, strongly associated with diabetes mellitus and duration of surgery but not with BMI>27. Thirty-day mortality revealed 2.6% versus 3.2% (p =0.1) but was significantly lower for diabetic patients in the BITA group (3.1% vs 4.7%; p =0.00). Conclusions: CABG using both ITAs can be performed routinely with good clinical results and low mortality. Compared with single ITA grafting, sternal and bleeding complications were slightly increased. Diabetes mellitus, BITA grafting, duration of surgery but not obesity or COPD could be identified as independent risk factors for sternal complications. Dialysis-dependent renal failure, EF<30%, emergent cases, and the absence of BITA grafting were predictors for increased perioperative mortality. [Copyright &y& Elsevier]

The paper outlines the long-term space robotics projects as well as recent results in DLR's robotics laboratory. The driving force behind all the efforts made in hardware and software development is to design highly integrated robot systems which can be utilized in space, especially for extravehicular activities. Our envisaged field of application reaches from servicing satellites in low Earth and geostationary orbit to space stations as well as planetary exploration robots, all of them fully ground controlled from Earth. The ground control concept is based on the MARCO architecture, which was verified in a few space robotics projects over recent years. It includes taskoriented programming capabilities for autonomous robot control at the remote site as well as methods for direct telemanipulation by means of virtual reality and telepresence techniques, which allows a realistic feeling for the ground operator via visual and haptic feedback devices. In addition to the control techniques, a new generation of ultra-lightweight robot arms with articulated hands is required to give the space robot systems the necessary dexterity. A number of experiments will verify and consolidate the usage of space robots. First, the ROKVISS experiment aims at the verification of DLR's lightweight robotics components under realistic mission conditions. Second, the TECSAS experiment will show the feasibility of autonomous as well as telepresence methods for further satellite servicing tasks. Third, a strong cooperation with industry will create the first business case in on-orbit-servicing: by attaching a tugboat to a satellite, whose propellant is declining, the lifetime of valuable telecommunication satellites could be prolonged for several years. [ABSTRACT FROM AUTHOR]

The soluble, cytoplasmic NAD+-reducing [NiFe]-hydrogenase from Ralstonia eutropha is a heterotetrameric enzyme (HoxFUYH) and contains two FMN groups. The purified oxidized enzyme is inactive in the H2-NAD+ reaction, but can be activated by catalytic amounts of NADH. It was discovered that one of the FMN groups (FMN-a) is selectively released upon prolonged reduction of the enzyme with NADH. During this process, the enzyme maintained its tetrameric form, with one FMN group (FMN-b) firmly bound, but it lost its physiological activity – the reduction of NAD+ by H2. This activity could be reconstituted by the addition of excess FMN to the reduced enzyme. The rate of reduction of benzyl viologen by H2 was not dependent on the presence of FMN-a. Enzyme devoid of FMN-a could not be activated by NADH. As NADH-dehydrogenase activity was not dependent on the presence of FMN-a, and because FMN-b did not dissociate from the reduced enzyme, we conclude that FMN-b is functional in the NADH-dehydrogenase activity catalyzed by the HoxFU dimer. The possible function of FMN-a as a hydride acceptor in the hydrogenase reaction catalyzed by the HoxHY dimer is discussed. [ABSTRACT FROM AUTHOR]

Ein Erratum zu dieser Publikation wurde veröffentlicht: https://doi.org/10.1007/s00101-021-00920-z [ABSTRACT FROM AUTHOR]

The formation of hydroxyectoine in the industrial ectoine producer Halomonas elongata was improved by the heterologous expression of the ectoine hydroxylase gene, thpD, from Streptomyces chrysomallus. The efficient conversion of ectoine to hydroxyectoine was achieved by the concerted regulation of thpD by the H. elongata ectA promoter. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the efficacy and safety of synthetic colloid resuscitation among severely injured patients. Fluid resuscitation of trauma patients of a nationwide trauma registry was analysed between 2002 and 2015. Effects of synthetic colloid resuscitation in the pre-hospital setting and emergency department on renal failure, renal replacement therapy and multiple organ failure were analysed among patients with ≥2 days intensive care unit stay, and in-hospital mortality was analysed among all patients. 48,484 patients with mean age of 49 years and mean injury severity score of 23 points were included; 72.3% were male and 95.5% had blunt trauma. Risk-adjusted analyses revealed that patients receiving >1,000 ml synthetic colloids experienced an increase of renal failure and renal replacement therapy rates (OR 1.42 and 1.32, respectively, both p ≤ 0.006). Any synthetic colloid use was associated with an increased risk of multiple organ failure (p < 0.001), but there was no effect on hospital mortality (p = 0.594). Between 2002 and 2015 usage of synthetic colloids dropped, likewise did total fluid intake and usage of blood products. The data from this analysis suggests that synthetic colloid resuscitation provides no beneficial effects and might be harmful in patients with severe trauma. [ABSTRACT FROM AUTHOR]