[The chapters "Stop the bleed-prehospital" and "Coagulation management and volume therapy (emergency departement)" in the new S3 guideline "Polytrauma/severe injury treatment"]. / Die Kapitel "Stop the Bleed ­ Prähospital" sowie "Gerinnungsmanagement und Volumentherapie (Schockraum)" in der neuen S3-Leitlinie "Polytrauma/Schwerverletzten-Behandlung".

The S3 guideline on the treatment of patients with severe/multiple injuries by the German Association of the Scientific Medical Societies was updated between 2020 and 2022. This article describes the essence of the new chapter "Stop the bleed-prehospital" and the revised chapter "Coagulation management and volume therapy".

Hospital volume-outcome relationship in total knee arthroplasty: a systematic review and dose-response meta-analysis.

PURPOSE: This systematic review and dose-response meta-analysis aimed to investigate the relationship between hospital volume and outcomes for total knee arthroplasty (TKA). METHODS: MEDLINE, Embase, CENTRAL and CINAHL were searched up to February 2020 for randomised controlled trials and cohort studies that reported TKA performed in hospitals with at least two different volumes and any associated patient-relevant outcomes. The adjusted effect estimates (odds ratios, OR) were pooled using a random-effects, linear dose-response meta-analysis. Heterogeneity was quantified using the I2-statistic. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively. RESULTS: A total of 68 cohort studies with data from 1985 to 2018 were included. The risk of bias for all outcomes ranged from moderate to critical. Higher hospital volume may be associated with a lower rate of early revision ≤ 12 months (narrative synthesis of k = 7 studies, n = 301,378 patients) and is likely associated with lower mortality ≤ 3 months (OR = 0.91 per additional 50 TKAs/year, 95% confidence interval [0.87-0.95], k = 9, n = 2,638,996, I2 = 51%) and readmissions ≤ 3 months (OR = 0.98 [0.97-0.99], k = 3, n = 830,381, I2 = 44%). Hospital volume may not be associated with the rates of deep infections within 1-4 years, late revision (1-10 years) or adverse events ≤ 3 months. The confidence in the cumulative evidence was moderate for mortality and readmission rates; low for early revision rates; and very low for deep infection, late revision and adverse event rates. CONCLUSION: An inverse volume-outcome relationship probably exists for some TKA outcomes, including mortality and readmissions, and may exist for early revisions. Small reductions in unfavourable outcomes may be clinically relevant at the population level, supporting centralisation of TKA to high-volume hospitals. LEVEL OF EVIDENCE: III. REGISTRATION NUMBER: The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019131209 available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131209 ).

Evaluation of 3D printed optofluidic smart glass prototypes.

Smart glass or smart windows are an innovative technology used for thermal management, energy efficiency, and privacy applications. Notable commercially available smart glass relies on an electric stimuli to modulate the glass from a transparent to a translucent mode of operation. However, the current market technologies, such as electrochromic, polymer dispersed liquid crystal, and suspended particle devices are expensive and suffer from solar absorption, poor transmittance modulation, and in some cases, continuous power consumption. The authors of this paper present a novel optofluidic smart glass prototype capable of modulating visible light transmittance from 8% to 85%.

Network meta-analysis of topical haemostatic agents in thyroid surgery.

BACKGROUND: The objective of this study was to investigate the potential benefit of local haemostatic agents for the prevention of postoperative bleeding after thyroidectomy. METHODS: A systematic literature search was performed, and RCTs involving adult patients who underwent thyroid surgery using either active (AHA) or passive (PHA) haemostatic agents were included in the review. The main outcome was the rate of cervical haematoma that required reoperation. A Bayesian random-effects model was used for network meta-analysis with minimally informative prior distributions. RESULTS: Thirteen RCTs were included. The rate of cervical haematoma requiring reoperation ranged from 0 to 9·1 per cent, and was not reduced by haemostatic agents: AHA versus control (odds ratio (OR) 1·53, 95 per cent credibility interval 0·21 to 10·77); PHA versus control (OR 2·74, 0·41 to 16·62) and AHA versus PHA (OR 1·77, 0·12 to 25·06). No difference was observed in the time required for drain removal, duration of hospital stay, and the rate of postoperative hypocalcaemia or recurrent nerve palsy. AHA led to a significantly lower total postoperative blood loss and reduced operating time in comparison with both the control and PHA groups. CONCLUSION: The general use of local haemostatic agents has not been shown to reduce the rate of clinically relevant bleeding.

Loss analysis for a two wire optical waveguide for chip-to-chip communication.

We propose an optical interconnect system for chip-to-chip communication using gold bond wires as a two wire waveguide. Here the loss of such a waveguide is determined for near-IR wavelengths, for different wire sizes and configurations, and show that we can achieve transmission loss coefficients less than 0.4 mm(-1) (1.7 dB/mm) making chip-to-chip optical communication possible using two-wire transmission lines made of standard gold bond wires. Such an optical waveguide scheme would greatly simplify inter-chip optical communication compared with existing waveguide concepts.

Longer term safety of dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes mellitus: systematic review and meta-analysis.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral antidiabetic agents that hold the potential of slowing the progress of type 2 diabetes mellitus. Their long-term safety is still a subject of debate. A systematic review of randomized, controlled trials was undertaken to comprehensively profile the safety of chronic treatment of type 2 diabetes mellitus with DPP-4 inhibitors. We searched data sources including MEDLINE, CENTRAL, publishers' and manufacturers' databases. Eligible trials were double-blind, randomized, placebo or active-controlled trials with ≥18 weeks duration in patients with type 2 diabetes reporting safety outcomes. Meta-analysis was performed separately for trials in which the control group received placebo (44 studies), another gliptin (3 studies) and any other antidiabetic drug (20 studies). Risk ratios with 95% confidence intervals were computed using a Mantel-Haenszel fixed-effect model for general safety outcomes, hypoglycaemia and adverse events by system organ class. Of 307 publications retrieved, 67 randomized, controlled trials met the eligibility criteria and were included in this review (4 alogliptin, 8 linagliptin, 8 saxagliptin, 20 sitagliptin, and 27 vildagliptin trials). Adverse events with gliptin treatment were at placebo level (relative risk (RR) 1.02 [0.99, 1.04]). No increased risk of infections was detectable (RR 0.98 [0.93, 1.05] compared to placebo and 1.02 [0.97, 1.07] compared to other antidiabetic drugs). Asthenia (RR 1.57 [1.09, 2.27]) as well as cardiac (RR 1.37 [1.00, 1.89]) and vascular disorders (RR 1.74 [1.05, 2.86] for linagliptin) emerged as adverse events associated with DPP-4 inhibitor treatment. The risk of hypoglycaemia was low with DPP-4 inhibitor treatment (RR 0.92 [0.74, 1.15] compared to placebo, RR 0.20 [0.17, 0.24] compared to sulphonylureas) in the absence of sulphonylurea or insulin co-therapy, but significantly elevated for combination therapy of sulphonylurea or insulin with sitagliptin or linagliptin (RR 1.86 [1.46, 2.37] compared to placebo). A large body of data supports the long-term safety of gliptin treatment and refutes an increased risk of infections. Further research is needed to clarify a possible link to asthenia, cardiac and vascular events. For combination therapy with insulin or insulin secretagogues, a careful choice of the agent used may limit the risk of hypoglycaemia.

Dual-function detector-modulator smart-pixel module.

We describe a smart-pixel circuit that permits the use of a GaAs/AlGaAs multiple quantum well diode to be used both as a detector for data input and a modulator for data output. The module provides the ability to double the number of inputs or outputs to the array and is well suited to cascaded optoelectronic system architectures that require bidirectional communition.

Photonic page buffer based on GaAs multiple-quantum-well modulators bonded directly over active silicon complementary-metal-oxide-semiconductor (CMOS) circuits.

We present a 2-kbit, 50-Mpage/s, photonic first-in, first-out page buffer based on gallium arsenide/aluminium-gallium arsenide multiple-quantum-well diodes that are flip-chip bonded to submicrometer silicon complementary-metal-oxide-semiconductor circuits. This photonic chip provides nonvolatile storage (buffering), asynchronous-to-synchronous conversion, bandwidth smoothing, tolerance to jitter or skew, spatial format conversion, wavelength conversion, and independent flow control for the input and the output channels. It serves as an interface chip for parallel-accessed optical bit-plane data. It represents the first smart-pixel array that accomplishes the vertical integration of multiple-quantum-well modulators and detectors directly over active silicon VLSI circuits and provides over 340 transistors per optical input-output. Results from high-speed single-channel testing and real-time array operation of the photonic page buffer are reported.

Photonic page buffer based on GaAs multiple-quantum-well modulators bonded directly over active silicon complementary-metal-oxide-semiconductor (CMOS) circuits: errata.

Owing to printing errors, [Appl. Opt. 35, 2439 (1996)] several figures were illegible. The figures are reprinted and briefly reviewed.