Geriatrische Halswirbelsäulenverletzungen: Eine retrospektive monozentrische Studie

Objectives: Numbers of Geriatric patients admitted to trauma centers are dramatically increas-ing due to demographic change in Germany. These patients are particularly vulnerable for cervi-cal spine injuries. Especially numbers of upper cervical spine injuries are growing with higher age. Today, evidence for appropriate treatment, but also risk factors, outcome and complications is clearly lacking. In our current study, this circumstance should be tackled by systematic analy-sis of patient related factors, treatment methods and outcome. Design & Methods: In our retrospective analysis all patients admitted to BG Unfallklinik Murnau between 2013 and 2015 with cervical spine fractures (S12.x) and a minimum age of 65 were included (n=226 cases). Archived data of patient features, treatment, outcome and follow-up were extracted and details regarding injury patterns were obtained by archived medical imag-ing as well as medical records. Subsequently, analysis was carried out by conventional data evaluation and by regression analysis optimized in an semi-automized procedure, both with ful-ly anonymized data sets. Observations & Results: Upper and subaxial cervical spine injuries are distinct injury entities in the given data set and were therefore analyzed separately. Patient groups treated conservative-ly and operatively were differing substantially regarding their demographic data. Hence besides of conventional data analysis, regression models for delirium, postoperative delirium, death, complications, infections, fracture union and instability were established, each separate by upper and subaxial cervical spine if possible. Additionally, patient groups of special clinical interest were analyzed in order to validate regression models paradigmatically and to gain additional clinical findings. Besides age pre-existing disease, concomitant injuries, spinal cord injury and therapy were main factors predicting outcome. E.g. operative therapy and long operation time were independent risk factors negatively affecting compilation rates and delirium, respectively. Conclusions: Geriatric patients with cervical spine fractures exhibit exceptional vulnerability exposed to increased risk not only by their physical constitution and injury but also by its treat-ment. Indication of invasive treatment of the cervical spine should be strict and besides injury per-se age, patient request, concomitant injuries, pre-existing disease and therapy alternatives should be taken into account.Hintergrund und Ziele: Die Anzahl an älteren Patienten mit Traumata nimmt in Deutschland durch den demographischen Wandel immer weiter zu. Geriatrische Patienten sind besonders gefährdet, Halswirbelsäulenverletzungen zu erleiden, wobei insbesondere Verletzungen der oberen Halswirbelsäule (HWS) im Alter deutlich zunehmen. Aktuell gibt es einen deutlichen Mangel an Evidenz für adäquate Behandlung, aber auch generell für Risiken, Behandlungser-gebnisse und -komplikationen dieser Patientengruppe. In der vorliegenden Studie soll diesem Umstand durch eine systematische Aufarbeitung von Patientenfaktoren, Behandlungsarten so-wie Behandlungsergebnissen begegnet werden. Methoden: Im Rahmen einer retrospektiven Analyse wurden alle zwischen 2013 und 2015 an der BG Unfallklinik Murnau behandelten Patienten mit Halswirbelsäulenverletzungen (S12.x), die zum Zeitpunkt der Aufnahme mindestens 65 Jahre alt waren, in die retrospektive Studie eingeschlossen (n=226 Fälle). Archivierte Daten zu Patienteneigenschaften, Behandlung, The-rapieergebnissen und Follow-up wurden extrahiert und anhand von Bildmaterial und Aufzeich-nungen um Angaben zur Verletzung ergänzt sowie nachfolgend vollständig anonymisiert durch konventionelle Datenanalyse sowie durch semiautomatisiert optimierte Regressionsmodelle ausgewertet. Ergebnisse und Beobachtungen: Obere und subaxiale Halswirbelsäulenverletzungen stellen im vorliegenden Datensatz zu unterscheidende Krankheitsentitäten dar und wurden folglich ge-trennt betrachtet. Auch sind operativ und konservativ behandelte Patienten bereits hinsichtlich anthropomorphischer Daten signifikant unterschiedlich. Zur Identifikationen von potentiellen Risikofaktoren wurden deshalb neben konventioneller Datenanalyse Regressionsmodelle für Delir, postoperatives Delir, Versterben, Komplikationen, Infektionen sowie Konsolidierung und Instabilität jeweils für obere und subaxiale HWS, sofern durch die jeweiligen Fallzahlen ermög-licht, erstellt, die eine Adjustierung auf andere Einflussgrößen erlauben. Zudem erfolgte eine detaillierte Analyse von klinisch relevanten Patientengruppen, um die Ergebnisse der Regressi-onsanalysen beispielhaft zu validieren und zusätzliche klinisch relevante Informationen zu ge-winnen. Besonders bedeutsam für das Outcome der Patienten zeigten sich neben dem Alter der Patienten auch Nebenerkrankungen, Begleitverletzungen, insbesondere aus einer HWS-Fraktur resultierende Querschnittslähmungen, sowie die gewählte Therapieform. Operative Therapie bzw. lange Operationszeit stellten so unabhängige Einflussgrößen dar, die mit erhöhter Wahr-scheinlichkeit für Komplikationen bzw. Delirentstehung assoziiert waren. Schlussfolgerungen: Geriatrische Patienten mit HWS-Frakturen stellen eine besonders vul-nerable Patientengruppe dar, die ihre individuelle Konstitution und Verletzung selbst, jedoch auch durch deren Behandlung einem erhöhten Risiko ausgesetzt ist. Die Indikationsstellung für invasive Maßnahmen an der HWS sollte streng erfolgen und neben Wirbelsäulenverletzung, Alter und Patientenwunsch auch Begleitverletzungen, Vorerkrankungen sowie eventuell vorlie-gende Therapiealternativen berücksichtigen

The Fourth SeaWiFS HPLC Analysis Round-Robin Experiment (SeaHARRE-4)

Ten international laboratories specializing in the determination of marine pigment concentrations using high performance liquid chromatography (HPLC) were intercompared using in situ samples and a mixed pigment sample. Although prior Sea-viewing Wide Field-of-view Sensor (SeaWiFS) High Performance Liquid Chromatography (HPLC) Round-Robin Experiment (SeaHARRE) activities conducted in open-ocean waters covered a wide dynamic range in productivity, and some of the samples were collected in the coastal zone, none of the activities involved exclusively coastal samples. Consequently, SeaHARRE-4 was organized and executed as a strictly coastal activity and the field samples were collected from primarily eutrophic waters within the coastal zone of Denmark. The more restrictive perspective limited the dynamic range in chlorophyll concentration to approximately one and a half orders of magnitude (previous activities covered more than two orders of magnitude). The method intercomparisons were used for the following objectives: a) estimate the uncertainties in quantitating individual pigments and higher-order variables formed from sums and ratios; b) confirm if the chlorophyll a accuracy requirements for ocean color validation activities (approximately 25%, although 15% would allow for algorithm refinement) can be met in coastal waters; c) establish the reduction in uncertainties as a result of applying QA procedures; d) show the importance of establishing a properly defined referencing system in the computation of uncertainties; e) quantify the analytical benefits of performance metrics, and f) demonstrate the utility of a laboratory mix in understanding method performance. In addition, the remote sensing requirements for the in situ determination of total chlorophyll a were investigated to determine whether or not the average uncertainty for this measurement is being satisfied

Flavor in Minimal Conformal Technicolor

We construct a complete, realistic, and natural UV completion of minimal conformal technicolor that explains the origin of quark and lepton masses and mixing angles. As in "bosonic technicolor", we embed conformal technicolor in a supersymmetric theory, with supersymmetry broken at a high scale. The exchange of heavy scalar doublets generates higher-dimension interactions between technifermions and quarks and leptons that give rise to quark and lepton masses at the TeV scale. Obtaining a sufficiently large top quark mass requires strong dynamics at the supersymmetry breaking scale in both the top and technicolor sectors. This is natural if the theory above the supersymmetry breaking also has strong conformal dynamics. We present two models in which the strong top dynamics is realized in different ways. In both models, constraints from flavor-changing effects can be easily satisfied. The effective theory below the supersymmetry breaking scale is minimal conformal technicolor with an additional light technicolor gaugino. We argue that this light gaugino is a general consequence of conformal technicolor embedded into a supersymmetric theory. If the gaugino has mass below the TeV scale it will give rise to an additional pseudo Nambu-Goldstone boson that is observable at the LHC.Comment: 37 pages; references adde

A New Experimental Polytrauma Model in Rats: Molecular Characterization of the Early Inflammatory Response

Background. The molecular mechanisms of the immune response after polytrauma are highly complex and far from fully understood. In this paper, we characterize a new standardized polytrauma model in rats based on the early molecular inflammatory and apoptotic response. Methods. Male Wistar rats (250 g, 6–10/group) were anesthetized and exposed to chest trauma (ChT), closed head injury (CHI), or Tib/Fib fracture including a soft tissue trauma (Fx + STT) or to the following combination of injuries: (1) ChT; (2) ChT + Fx + STT; (3) ChT + CHI; (4) CHI; (5) polytrauma (PT = ChT + CHI + Fx + STT). Sham-operated rats served as negative controls. The inflammatory response was quantified at 2 hours and 4 hours after trauma by analysis of “key” inflammatory mediators, including selected cytokines and complement components, in serum and bronchoalveolar (BAL) fluid samples. Results. Polytraumatized (PT) rats showed a significant systemic and intrapulmonary release of cytokines, chemokines, and complement anaphylatoxins, compared to rats with isolated injuries or selected combinations of injuries. Conclusion. This new rat model appears to closely mimic the early immunological response of polytrauma observed in humans and may provide a valid basis for evaluation of the complex pathophysiology and future therapeutic immune modulatory approaches in experimental polytrauma

The molecular fingerprint of lung inflammation after blunt chest trauma

Abstract Background After severe blunt chest trauma, the development of an acute lung injury (ALI) is often associated with severe or even lethal complications. Especially in multiple injured patients after blunt chest trauma ALI/ARDS [acute respiratory distress syndrome (ARDS)] is frequent. However, in the initial posttraumatic phase, inflammatory clinical signs are often not apparent and underlying changes in gene-expression profile are unknown. Methods Therefore, inflammation in lung tissue following blunt chest trauma was characterized in a well-defined bilateral lung injury model. Using DNA microarrays representing 9240 genes, the temporal sequence of blunt chest trauma-induced gene-expression patterns in lung tissue was examined. Results The results suggest an activation of a highly complex transcriptional program in response to chest trauma. Chest trauma led to elevated expression levels of inflammatory and coagulatory proteins (such as TNFα receptor, IL-1α, IL-1β, C3, NF-κB and plasminogen activator). However, upregulation of proteins was found, usually incoherent of exerting effects in blunt thoracic trauma (pendrin, resistin, metallothionein and glucocorticoid-induced leucine zipper). Furthermore, significant downregulation was observed as early as 10 min after trauma for cytokines and complement factors (LCR-1, C4) as well as for intracellular signaling molecules (inhibitory protein phosphatase) and ion-channels (voltage-dependent Ca2+ channel). Conclusions Taken together, the provided global perspective of the inflammatory response following blunt chest trauma could provide a molecular framework for future research in trauma pathophysiology.http://deepblue.lib.umich.edu/bitstream/2027.42/113091/1/40001_2015_Article_164.pd

From standard therapies to monoclonal antibodies and immune checkpoint inhibitors - an update for reconstructive surgeons on common oncological cases.

Malignancies represent a persisting worldwide health burden. Tumor treatment is commonly based on surgical and/or non-surgical therapies. In the recent decade, novel non-surgical treatment strategies involving monoclonal antibodies (mAB) and immune checkpoint inhibitors (ICI) have been successfully incorporated into standard treatment algorithms. Such emerging therapy concepts have demonstrated improved complete remission rates and prolonged progression-free survival compared to conventional chemotherapies. However, the in-toto surgical tumor resection followed by reconstructive surgery oftentimes remains the only curative therapy. Breast cancer (BC), skin cancer (SC), head and neck cancer (HNC), and sarcoma amongst other cancer entities commonly require reconstructive surgery to restore form, aesthetics, and functionality. Understanding the basic principles, strengths, and limitations of mAB and ICI as (neo-) adjuvant therapies and treatment alternatives for resectable or unresectable tumors is paramount for optimized surgical therapy planning. Yet, there is a scarcity of studies that condense the current body of literature on mAB and ICI for BC, SC, HNC, and sarcoma. This knowledge gap may result in suboptimal treatment planning, ultimately impairing patient outcomes. Herein, we aim to summarize the current translational endeavors focusing on mAB and ICI. This line of research may serve as an evidence-based fundament to guide targeted therapy and optimize interdisciplinary anti-cancer strategies

Microbiota-derived metabolites: Key modulators of cancer immunotherapies

The human gut microbiome shapes local and systemic immune responses and influences cancer immunotherapy outcomes. Microbial metabolites, including short-chain and branched-chain fatty acids, bile acids, tryptophan derivatives, and others, influence anti-tumor immunity by modulating immune cells, tumor growth, and the tumor microenvironment. These metabolites impact the efficacy of immune checkpoint inhibitors, allogeneic stem cell transplantation, chimeric antigen receptor T cell therapies, and immune-related adverse events. However, interindividual microbiome variability, antibiotic exposure, and the context-dependent pro- and anti-inflammatory effects of metabolites present significant challenges for clinical translation. Microbiome-based therapies, including live biotherapeutic products, dietary modifications (such as prebiotics), and synthetic metabolite compounds (postbiotics), are being developed for use in combination with immunotherapy. This review outlines how metabolites influence immunotherapy outcomes and discusses translational approaches to harness them for clinical practice. Future research should focus on validating metabolite-based biomarkers and tailoring metabolite-based interventions to enhance efficacy and reduce toxicity across different immunotherapies

Thinking like a lawyer — human rights and their association with the plastic surgeon of today

Plastic surgeons are trained to perform a wide repertoire of surgeries—ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR)

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk