Injection of Autologous Adipose Stromal Vascular Fraction in Combination with Autologous Conditioned Plasma for the Treatment of Advanced Knee Osteoarthritis Significantly Improves Clinical Symptoms.

(1) Background: Osteoarthritis (OA) is the most common joint disease in the world. It is chronic, systemic, progressive and disabling. Orthobiologics have the potential to positively alter the course of this disease. Therefore, the aim of this study is to evaluate the efficacy of SVF/ACP in the treatment of advanced osteoarthritis of the knee in an unfiltered patient population. We hypothesize that this therapy can improve the symptoms associated with osteoarthritis of the knee. We also hypothesize that there are patient-related factors that influence the efficacy of therapy. (2) Methods: Two hundred and thirteen patients with moderate to severe OA of the knee and SVF/ACP injection were recruited for this study. Patients were excluded if they did not provide informed consent or were not receiving SVF/ACP therapy. Pain, function, symptoms and quality of life were assessed using standardized scores (KOOS, WOMAC) before and after treatment. (3) Results: The VAS pain score was significantly reduced by at least 30% (p < 0.001). Knee function, as measured by the KOOS daily activity and sport scores, showed significant increases of 21% and 45%, respectively, at 6 months (p < 0.04). (4) Conclusions: Treatment of knee OA with SVF/ACP injection positively modifies the disease by significantly reducing pain and improving function.

Impact of the First and Second Wave of the SARS-CoV-2 Pandemic on Severe Trauma and the Care Structures in the German TraumaNetzwerk DGU®.

(1) Background: The aim of this study was to investigate the effects of the pandemic on transfer rates of severely injured patients within the German TraumaNetzwerk of the DGU. Furthermore, cause of accident, rescue times, and trauma cases are compared to pre-pandemic times. (2) Methods: For this investigation patients documented in the TraumaRegister DGU® from 2018 to 2020 were analyzed. The years 2018 and 2019 served as a comparison to 2020, the first COVID-19 pandemic year. All primary admissions and transfers were included if treated on an intensive care unit. (3) Results: Demographics (age, sex) and injury severity in 2020 were comparable with 2018/2019. In 2020, a significant decrease (3.7%) in car accidents was found. In contrast, a significant increase (3.2%) in bicycle accidents was seen. During the second wave, there was a significant burden of COVID-19 patients on hospitals. In this time, we found a significant increase in early transfers of trauma patients primarily from small level 3 to large level 1 centers. There was also a small but significant increase in rescue time, especially during the 2nd wave. (4) Conclusions: Our data confirm the importance of the network structures established in the TraumaNetzwerk DGU®, especially during the pandemic. The established structures allow smaller hospitals to spread their resources and prevent internal collapse. Therefore, the structures of the TraumaNetzwerk DGU® play a prominent role in stabilizing the healthcare system by helping to maintain both surgical and critical care capacity and providing adequate emergency care.

Combination of high-sensitivity C-reactive protein with logistic EuroSCORE improves risk stratification in patients undergoing TAVI.

AIMS: The aim of this study was to assess the clinical value of biomarkers to identify TAVI patients at high risk for adverse outcome, to assess whether these biomarkers provide prognostic information beyond that of established clinical risk scores, and to assess whether a combined multi-marker strategy can improve clinical decision making. METHODS AND RESULTS: In 683 TAVI patients, biomarkers reflecting various pathophysiologic systems were measured before TAVI. The primary endpoint was one-year all-cause mortality. Other outcomes were recorded according to the VARC-2 criteria. Thirty-day and one-year mortality was 2.9% and 12.0%, respectively. Non-survivors at one year had higher risk scores and increased median biomarker levels. Logistic EuroSCORE in combination with hs-CRP had the highest predictive value for 30-day (AUC 0.740 [95% CI: 0.667-0.812], p=0.1117) and one-year mortality (AUC 0.631 [95% CI: 0.569-0.693], p=0.0403). In multivariate regression analysis, logistic EuroSCORE in combination with hs-CRP showed the strongest association with one-year mortality. Combinations of increasing medians of logistic EuroSCORE results and hs-CRP levels allowed the stratification of the TAVI patients into subgroups with one-year mortality rates ranging from 6.6% up to 18.2%. CONCLUSIONS: hs-CRP alongside the logistic EuroSCORE was an independent predictor of one-year all-cause mortality in TAVI patients. A combination of both might help to predict procedural risk and outcome better.