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BACKGROUND: In research and production, reproducibility is a key factor, to meet high quality and safety standards and maintain productivity. For microbial fermentations, complex substrates and media components are often used. The complex media components can vary in composition, depending on the lot and manufacturing process. These variations can have an immense impact on the results of biological cultivations. The aim of this work was to investigate and characterize the influence of the complex media component yeast extract on cultivations of Azotobacter vinelandii under microaerobic conditions. Under these conditions, the organism produces the biopolymer alginate. The focus of the investigation was on the respiration activity, cell growth and alginate production. RESULTS: Yeast extracts from 6 different manufacturers and 2 different lots from one manufacturer were evaluated. Significant differences on respiratory activity, growth and production were observed. Concentration variations of three different yeast extracts showed that the performance of poorly performing yeast extracts can be improved by simply increasing their concentration. On the other hand, the results with well-performing yeast extracts seem to reach a saturation, when their concentration is increased. Cultivations with poorly performing yeast extract were supplemented with grouped amino acids, single amino acids and micro elements. Beneficial results were obtained with the supplementation of copper sulphate, cysteine or a combination of both. Furthermore, a correlation between the accumulated oxygen transfer and the final viscosity (as a key performance indicator), was established. CONCLUSION: The choice of yeast extract is crucial for A. vinelandii cultivations, to maintain reproducibility and comparability between cultivations. The proper use of specific yeast extracts allows the cultivation results to be specifically optimised. In addition, supplements can be applied to modify and improve the properties of the alginate. The results only scratch the surface of the underlying mechanisms, as they are not providing explanations on a molecular level. However, the findings show the potential of optimising media containing yeast extract for alginate production with A. vinelandii, as well as the potential of targeted supplementation of the media.
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Alginatos , Aminoácidos , Alginatos/química , Reproducibilidad de los Resultados , Ácido Glucurónico/química , Ácido Glucurónico/metabolismo , Ácidos Hexurónicos/metabolismoRESUMEN
BACKGROUND: Physical examination courses are an essential part of the education of medical students. The aim of this study was to ascertain the factors influencing students' motivation and willingness to participate in a physical examination course. METHODS: Students were asked to complete a questionnaire subdivided into five domains: anthropometric data, religiousness, motivation to take part in physical examination courses, willingness to be physically examined at 11 different body regions by peers or a professional tutor and a field for free text. RESULTS: The questionnaire was completed by 142 medical students. The importance of the examination course was rated 8.7 / 10 points, the score for students' motivation was 7.8 / 10 points. Willingness to be physically examined ranged from 6 to 100% depending on body part and examiner. Female students were significantly less willing to be examined at sensitive body parts (breast, upper body, groin and the hip joint; p = .003 to < .001), depending on group composition and / or examiner. Strictly religious students showed significantly less willingness to undergo examination of any part of the body except the hand (p = .02 to < .001). Considering BMI, willingness to be examined showed comparable rates for normal weight and under- / overweight students in general (80% vs. 77%). Concerning the composition of the group for physical examination skills courses, students preferred self-assembled over mixed gender and same gender groups. CONCLUSIONS: Peer physical examination is a method to improve students' skills. While motivation to participate in and acceptance of the physical examination course appears to be high, willingness to be examined is low for certain parts of the body, e.g. breast and groin, depending on religiousness, gender and examiner. Examination by a professional medical tutor did not lead to higher acceptance. Most students would prefer to choose their team for physical examination courses themselves rather than be assigned to a group.
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Educación de Pregrado en Medicina/métodos , Grupo Paritario , Examen Físico/psicología , Estudiantes de Medicina/psicología , Adulto , Actitud del Personal de Salud , Peso Corporal , Curriculum , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Examen Físico/estadística & datos numéricos , Psicometría , Religión , Factores Sexuales , Estudiantes de Medicina/estadística & datos numéricos , Compromiso Laboral , Adulto JovenRESUMEN
OBJECTIVE: An anti-resorptive impact of the neuropeptide calcitonin gene-related peptide (CGRP) on periprosthetic osteolysis, the leading cause of early prosthesis loosening, has been shown previously. In this study, the impact of CGRP on pro-inflammatory cytokine production associated with periprosthetic osteolysis was analysed using THP-1 macrophage-like cells. METHODS: Cells were stimulated with ultra-high-molecular-weight polyethylene (UHMWPE) particles (cell-to-particle ratios of 1:100 and 1:500) and lipopolysaccharides (LPS; 1 µg/ml) to establish osteolytic conditions, and simultaneously treated with CGRP (10(-8)M). Receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL) and tumour necrosis factor (TNF)-α mRNA expression were measured by quantitative RT-PCR. RANK protein was detected by Western blot. Secreted protein levels of TNF-α as well as interleukin (IL)-1ß and IL-6 were quantified in cell culture supernatants by ELISA and Bio-Plex cytokine assay, respectively. RESULTS: Activation of macrophage-like cells failed to enhance the production of RANK but led to a dose- and time-dependent increase of TNF-α mRNA and secreted protein levels of TNF-α, IL-1ß and IL-6. Application of CGRP time-dependently suppressed TNF-α mRNA expression induced by low-particle concentrations and LPS, while both particle- and LPS-induced secretion of TNF-α was inhibited. A pronounced inhibitory effect of CGRP on LPS-induced cytokine production at 24 h of incubation was also observed with IL-1ß and IL-6. CONCLUSIONS: CGRP shows a time-dependent inhibitory effect on the secretion of osteolysis-associated pro-inflammatory cytokines, indicating an indirect anti-resorptive influence of the neuropeptide on both aseptic prosthesis loosening and bacterially induced bone resorption which might enhance the life time of total joint replacements.
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Péptido Relacionado con Gen de Calcitonina/farmacología , Citocinas/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Macrófagos/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Citocinas/genética , Relación Dosis-Respuesta a Droga , Humanos , Lipopolisacáridos/farmacología , Macrófagos/metabolismo , Monocitos/efectos de los fármacos , Monocitos/metabolismo , Polietileno/farmacología , Ligando RANK/genética , Ligando RANK/metabolismo , ARN Mensajero/metabolismo , Receptor Activador del Factor Nuclear kappa-B/genética , Receptor Activador del Factor Nuclear kappa-B/metabolismoRESUMEN
PURPOSE: Wheel gymnastics is a gymnastic discipline with a history of nearly 100 years. So far, there have been no epidemiological studies on injuries in wheel gymnastics. METHODS: The retrospective study of wheel gymnasts surveyed 151 "professionals" competing in the first national league and 352 "amateurs" by questionnaire. RESULTS: 4,898 injuries and 714 overuse syndromes were found in 988,718.9 h of training, leading to a time loss of 16,302 days. An incidence of 9.44 injuries per 1,000 h was found in wheel gymnastics. "Professionals" had a highly significant lower incidence than "amateurs" (5.23 vs. 11.24 injuries per 1,000 h; p < 0.001). The most common injuries in wheel gymnastics were found at the head (28.1 %), spine (13.75 %), ankle/foot (11.88 %), hip/thigh (11.87 %) and knee (11.61 %). 4,502 (91.9 %) injuries were classified as minor. 221 (4.5 %) injuries caused a time loss of between 1 week and 1 month. 175 (3.6 %) major injuries caused a time loss of longer than 1 month. 1.68 overuse syndromes per 1,000 h were described. CONCLUSION: Wheel gymnastics has a high incidence but low severity of injuries compared with other gymnastic sports. Physicians should be aware of the common dangers and overuse syndromes in this highly acrobatic gymnastic discipline. LEVEL OF EVIDENCE: III.
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Traumatismos en Atletas/epidemiología , Trastornos de Traumas Acumulados/epidemiología , Gimnasia/lesiones , Adolescente , Traumatismos en Atletas/prevención & control , Trastornos de Traumas Acumulados/prevención & control , Humanos , Incidencia , Masculino , Equipos de Seguridad/estadística & datos numéricos , Estudios Retrospectivos , Equipo Deportivo , Adulto JovenRESUMEN
INTRODUCTION: Previous studies reported divergent results concerning the effect of gender on patient outcome after severe injury. Results suggest that women have better outcomes because they have lower rates of sepsis and multi-organ failure. The objective of this analysis was to study gender differences in a Level 1 trauma center in Germany. METHODS: Patients who were admitted to hospital between 2002 and 2011 with an Injury Severity Score (ISS) ≥16 were included. Data were collected from the Trauma Registry of the German Society for Trauma Surgery and from hospital records. The effects of gender on a variety of parameters were investigated. To eliminate the influence of differences in ISS, an analysis of groups with similar ISS was performed. Also, a matched-pair analysis of 422 patients was performed. RESULTS: A total of 962 patients met the inclusion criteria. The mortality rate was lower in male patients (25.4% versus 36.59%). Female patients had more severe head injuries, received less fluid volume and had a lower rate of sepsis. Men were more frequently involved in motorcycle accidents and sustained more penetrating trauma. Women were more frequently involved in pedestrian accidents and sustained more falls from under 3 m. The effects of gender were reduced when the data were analyzed by matching ISS. The mortality rate was significantly different in the ISS 26 to 35 group but in mostly all groups, the mortality rate was higher in women. In the matched-pair analysis, the rate of sepsis and the length of the ICU stay were significantly lower in women and the mortality rate showed no significant difference (28.1% for male patients versus 33.01% for female patients). Women died after an average of 5.22 days, and men died after an average of 9.02 days. CONCLUSIONS: Gender-based differences in patient outcome after severe trauma were observed in this study. Women are more likely to die in the first days after trauma. Upon extended hospital stay, women had a better survival rate because they had a lower rate of sepsis. No significant differences in mortality rate could be found, but there was a trend towards a higher rate in female patients.
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Heridas y Lesiones/mortalidad , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Comorbilidad , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/etiología , Traumatismos Craneocerebrales/mortalidad , Femenino , Alemania/epidemiología , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Tiempo de Internación , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Sepsis/epidemiología , Distribución por Sexo , Tasa de Supervivencia , Centros Traumatológicos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología , Heridas Penetrantes/epidemiología , Heridas Penetrantes/etiología , Heridas Penetrantes/mortalidad , Adulto JovenRESUMEN
BACKGROUND: The actual number of accidents in escooter drivers in Germany seems to be significantly higher than the current figures from the Statistisches Bundesamt suggest. This epidemiological study examines escooter injuries and compares them with ebike and bicycle injuries. OBJECTIVE: In order to create a comparable database on the dangers of escooters, ebikes and bicycles, the typical injury patterns were analyzed and prevention options derived from them. MATERIAL AND METHODS: All accidents involving escooters, ebikes and bicycles that were presented via the university emergency room of a level 1 trauma center between 15 June 2019 and 31 October 2020 were prospectively investigated. RESULTS: In our study, 68 accidents in escooter drivers were included, of which only 11.8% (nâ¯= 8) were recorded by the police. Significantly more of them were male than female (pâ¯= 0.032) with a mean age of 31.1 (±13) years. At the same time, we registered 34 accidents in ebike riders and 356 in cyclists. In all three groups, most injuries occurred to the head, followed by injuries to the upper extremities. Significantly more escooter drivers had an ISSâ¯≥ 16 than in the group of injured cyclists (pâ¯= 0.016). Escooter riders who had an accident had a significantly longer length of stay in hospital, than ebike riders (pâ¯= 0.003) and cyclists (pâ¯= 0.001), 52.9% (nâ¯= 18) of ebike riders and 53.3% (nâ¯= 113) cyclists wore a helmet, compared to only 1.5% (nâ¯= 1) of escooter riders. The most common cause of accidents among ebike riders (17.7%; nâ¯= 6) and cyclists (10.4%; nâ¯= 37) was slipping away on tram rails, while for escooter riders it was colliding with a curb (7.4%; nâ¯= 5). CONCLUSION: The three patient collectives examined showed different causes and profiles of injuries. The reasons for an increased proportion of seriously injured people compared to cyclists are electromobility, driving under the influence of alcohol and inadequate wearing of a helmet on escooters when head injuries dominate. 73.5% (nâ¯= 50) of the escooter accidents recorded by us were not registered by the police and therefore do not appear in the current statistics of the statistisches Bundesamt. As a result, a much higher number of escooter accidents can be assumed. Preventive measures could include the introduction of compulsory helmets, a higher number of traffic controls and the expansion of bike tracks.
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Ciclismo , Traumatismos Craneocerebrales , Humanos , Masculino , Femenino , Adulto , Ciclismo/lesiones , Centros Traumatológicos , Traumatismos Craneocerebrales/epidemiología , Accidentes de Tránsito/prevención & control , PoliciaRESUMEN
Particle-induced osteolysis is a major cause of aseptic prosthetic loosening. Implant wear particles stimulate tissue macrophages inducing an aseptic inflammatory reaction, which ultimately results in bone loss. Fetuin-A is a key regulator of calcified matrix metabolism and an acute phase protein. We studied the influence of fetuin-A on particle-induced osteolysis in an established mouse model using fetuin-A-deficient mice. Ten fetuin-A-deficient (Ahsg−/−) mice and ten wild-type animals (Ahsg+/+) were assigned to test group receiving ultra-high molecular weight polyethylene (UHMWPE) particle implantation or to control group (sham surgery). After 14 days, bone metabolism parameters RANKL, osteoprotegerin (OPG), osteocalcin (OC), alkaline phosphatase (ALP), calcium, phosphate, and desoxypyridinoline (DPD) were examined. Bone volume was determined by microcomputed tomography (µCT); osteolytic regions and osteoclasts were histomorphometrically analyzed. After particle treatment, bone resorption was significantly increased in Ahsg−/− mice compared with corresponding Ahsg+/+ wild-type mice (p = 0.007). Eroded surface areas in Ahsg−/− mice were significantly increased (p = 0.002) compared with Ahsg+/+ mice, as well as the number of osteoclasts compared with control (p = 0.039). Fetuin-A deficiency revealed increased OPG (p = 0.002), and decreased levels of DPD (p = 0.038), OC (p = 0.036), ALP (p < 0.001), and Ca (p = 0.001) compared with wild-type animals. Under osteolytic conditions in Ahsg−/− mice, OPG was increased (p = 0.013), ALP (p = 0.015) and DPD (p = 0.012) were decreased compared with the Ahsg+/+ group. Osteolytic conditions lead to greater bone loss in fetuin-A-deficient mice compared with wild-type mice. Reduced fetuin-A serum levels may be a risk factor for particle-induced osteolysis while the protective effect of fetuin-A might be a future pathway for prophylaxis and treatment.
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INTRODUCTION: Severe bleeding after trauma frequently results in poor outcomes in children. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed, through a retrospective analysis of matched pairs, to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured children. METHODS: The data for 67,782 patients from the TraumaRegister DGU® of the German Trauma Society were analyzed. The following inclusion criteria were applied: injury severity score ≥16 points, primary admission, age 1 to 15 years old, systolic blood pressure ≥20 mmHg at the accident site and transfusion of at least one unit of packed red blood cells (pRBC) in the emergency trauma room prior to intensive care admission. As volume replacement therapy depends on age and body weight, especially in children, three subgroups were formed according to the mean value of the administered prehospital volume. The children were matched and enrolled into two groups according to the following criteria: intubation at the accident site (yes/no), Abbreviated Injury Scale (four body regions), accident year, systolic blood pressure and age group. RESULTS: A total of 31 patients in each group met the inclusion criteria. An increase in volume replacement was associated with an elevated need for a transfusion (≥10 pRBC: low volume, 9.7%; high volume, 25.8%; P = 0.18) and a reduction in the ability to coagulate (prothrombin time ratio: low volume, 58.7%; high volume, 55.6%; P = 0.23; prothrombin time: low volume, 42.2 seconds; high volume, 50.1 seconds; P = 0.38). With increasing volume, the mortality (low volume, 19.4%; high volume, 25.8%; P = 0.75) and multiple organ failure rates (group 1, 36.7%; group 2, 41.4%; P = 0.79) increased. With increased volume, the rescue time also increased (low volume, 62 minutes; high volume, 71.5 minutes; P = 0.21). CONCLUSION: For the first time, a tendency was shown that excessive prehospital fluid replacement in children leads to a worse clinical course with higher mortality and that excessive fluid replacement has a negative influence on the ability to coagulate.
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Servicios Médicos de Urgencia , Fluidoterapia/efectos adversos , Traumatismo Múltiple/mortalidad , Resucitación/métodos , Escala Resumida de Traumatismos , Adolescente , Catecolaminas/administración & dosificación , Niño , Preescolar , Transfusión de Eritrocitos , Femenino , Alemania/epidemiología , Hemoglobinas/análisis , Humanos , Lactante , Puntaje de Gravedad del Traumatismo , Intubación , Masculino , Análisis por Apareamiento , Insuficiencia Multiorgánica/mortalidad , Traumatismo Múltiple/terapia , Tiempo de Protrombina , Sistema de Registros , Estudios Retrospectivos , Factores de TiempoRESUMEN
PURPOSE: The correlation of cervical biomechanics and neck pain in young patients has, to date, only been described in terms of small cohorts. This study focuses on the correlation of chronic neck pain and cervical biomechanics. METHODS: Neck pain, cervical range of motion (CROM) and maximal cervical torque were recorded in 746 patients with conservatively treated chronic neck pain and 3,547 participants of physiotherapy training without chronic neck pain aged 16-32 years. RESULTS: The "neck pain" group had a highly significant (s < 0.001) higher neck disability index (44.7 vs. 10.4%), longer history of neck pain (3.47 vs. 0.59 years), higher pain intensity (VAS 5.93 vs. 0.93), higher pain frequency (VAS 6.98 vs. 1.09). No differences of CROM and maximal torque in the sagittal, frontal and transverse plane were found. CONCLUSION: This study describes the largest cohort of biomechanical data of the cervical spine in young adult recorded to date. The findings demonstrate that no correlation was found between neck pain, CROM and maximal torque in the study cohort. On this basis, we conclude that the CROM and maximal cervical torque should not be used as indicators to measure the progress of chronic neck pain in physiotherapy training and sports medicine for the young adult.
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Vértebras Cervicales/fisiopatología , Dolor Crónico/fisiopatología , Dolor de Cuello/fisiopatología , Rango del Movimiento Articular/fisiología , Adolescente , Adulto , Fenómenos Biomecánicos/fisiología , Evaluación de la Discapacidad , Humanos , Masculino , Dimensión del Dolor , TorqueRESUMEN
BACKGROUND: Osteoclasts and osteoblasts regulate bone resorption and formation to allow bone remodeling and homeostasis. The balance between bone resorption and formation is disturbed by abnormal recruitment of osteoclasts. Osteoclast differentiation is dependent on the receptor activator of nuclear factor NF-kappa B (RANK) ligand (RANKL) as well as the macrophage colony-stimulating factor (M-CSF). The RANKL/RANK system and RANK signaling induce osteoclast formation mediated by various cytokines. The RANK/RANKL pathway has been primarily implicated in metabolic, degenerative and neoplastic bone disorders or osteolysis. The central role of RANK/RANKL interaction in osteoclastogenesis makes RANK an attractive target for potential therapies in treatment of osteolysis. The purpose of this study was to assess the effect of inhibition of RANK expression in mouse bone marrow macrophages on osteoclast differentiation and bone resorption. METHODS: Three pairs of short hairpin RNAs (shRNA) targeting RANK were designed and synthesized. The optimal shRNA was selected among three pairs of shRNAs by RANK expression analyzed by Western blot and Real-time PCR. We investigated suppression of osteoclastogenesis of mouse bone marrow macrophages (BMMs) using the optimal shRNA by targeting RANK. RESULTS: Among the three shRANKs examined, shRANK-3 significantly suppressed [88.3%] the RANK expression (p < 0.01). shRANK-3 also brought about a marked inhibition of osteoclast formation and bone resorption as demonstrated by tartrate-resistant acid phosphatase (TRAP) staining and osteoclast resorption assay. The results of our study show that retrovirus-mediated shRANK-3 suppresses osteoclast differentiation and osteolysis of BMMs. CONCLUSIONS: These findings suggest that retrovirus-mediated shRNA targeting RANK inhibits osteoclast differentiation and osteolysis. It may appear an attractive target for preventing osteolysis in humans with a potential clinical application.
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Diferenciación Celular , Macrófagos/metabolismo , Osteoclastos/metabolismo , Osteólisis/prevención & control , Interferencia de ARN , ARN Interferente Pequeño/metabolismo , Receptor Activador del Factor Nuclear kappa-B/metabolismo , Fosfatasa Ácida/metabolismo , Animales , Biomarcadores/metabolismo , Western Blotting , Diferenciación Celular/genética , Células Cultivadas , Vectores Genéticos , Isoenzimas/metabolismo , Macrófagos/ultraestructura , Ratones , Ratones Endogámicos BALB C , Osteoclastos/ultraestructura , Osteólisis/genética , Osteólisis/metabolismo , Osteólisis/patología , Reacción en Cadena en Tiempo Real de la Polimerasa , Receptor Activador del Factor Nuclear kappa-B/genética , Retroviridae/genética , Fosfatasa Ácida Tartratorresistente , TransfecciónRESUMEN
BACKGROUND: This is the first study that reports on the mid-term results of 81 patients suffering from arthritis of the knee, treated with a cementless second-generation hydroxyapatite calcium phosphate (CaP)-coated tibial component. MATERIALS AND METHODS: Seventy-six knees with osteoarthritis were evaluated according to the Knee Society clinical, functional and radiological score, the Hospital for Special Surgery Rating System and the Patella Score. The clinical and radiological parameters were assessed preoperatively and after a mean follow-up of 8.7 years. RESULTS: All the three score systems revealed excellent clinical outcomes after the follow-up period. The mean preoperative Knee Society clinical Score was 124.41 ± 12.99 and the mean postoperative score was 187.07 ± 14.59 at the time of the final consultation (p = 0.0008). The survival rate was 97.5 %. Radiolucency of <1 mm around the uncemented hydroxyapatite CaP-coated tibial component without accompanying pain symptoms was seen in fewer than 6 % of cases. In two cases, a medial cyst, also without other clinical symptoms, was observed beside the tip of the tibial fixation screw. CONCLUSION: These findings indicate that the uncemented second-generation hydroxyapatite CaP-coated tibial component performed well at mid-term follow-up, and provides sufficiently stable bone ingrowth fixation.
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Fosfatos de Calcio , Materiales Biocompatibles Revestidos , Durapatita , Prótesis de la Rodilla , Osteoartritis de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Tibia , Factores de TiempoRESUMEN
This retrospective cross-sectional epidemiological study deals with sport-specific injury patterns in show jumping. A total of 363 show jumpers of all levels (S) answered a retrospective questionnaire about injuries and overuse damages which occurred in the course of their careers. Demographic data and information on injuries in various body regions were collected. In addition to descriptive analysis, significance tests were performed. For better statistical comparability with other sports, exposure time was extrapolated with total career duration and weekly training hours, and injuries per 1000 jumping hours were calculated. The study included 251 (69%) women and 112 (31%) men, who were on average 26.9 ± 10.9 years old. The injury rate for the entire collective was 3.7 per 1000 h of exposure. The most frequently affected body region was the head (31%). Overuse complaints play a subordinate role and mainly affect the upper extremities (65%). The riders of the professional lower performance levels are less likely to injure themselves per 1000 h than riders of the higher performance levels. Riders who often or always wore a helmet suffered significantly fewer head injuries (p = 0.008) and had a significantly lower total injury duration than riders who did not wear a helmet (p = 0.006). Similarly, the study showed that riders who often or always wore a safety vest suffered significantly fewer spinal injuries (p = 0.017) and had significantly fewer injuries per 1000 riding hours (p = 0.031) than riders who did not wear a safety vest. Based on the present results, there should be an extension of the general helmet requirement and a requirement to wear safety vests in show jumping in general.
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Atletas , Traumatismos en Atletas , Trastornos de Traumas Acumulados , Caballos , Deportes , Adolescente , Adulto , Animales , Atletas/estadística & datos numéricos , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/etiología , Estudios Transversales , Trastornos de Traumas Acumulados/epidemiología , Trastornos de Traumas Acumulados/etiología , Femenino , Alemania/epidemiología , Dispositivos de Protección de la Cabeza , Humanos , Masculino , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: The development of computer-aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well-characterized repository of computed tomography (CT) scans. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute (NCI), further advanced by the Foundation for the National Institutes of Health (FNIH), and accompanied by the Food and Drug Administration (FDA) through active participation, this public-private partnership demonstrates the success of a consortium founded on a consensus-based process. METHODS: Seven academic centers and eight medical imaging companies collaborated to identify, address, and resolve challenging organizational, technical, and clinical issues to provide a solid foundation for a robust database. The LIDC/IDRI Database contains 1018 cases, each of which includes images from a clinical thoracic CT scan and an associated XML file that records the results of a two-phase image annotation process performed by four experienced thoracic radiologists. In the initial blinded-read phase, each radiologist independently reviewed each CT scan and marked lesions belonging to one of three categories ("nodule > or =3 mm," "nodule <3 mm," and "non-nodule > or =3 mm"). In the subsequent unblinded-read phase, each radiologist independently reviewed their own marks along with the anonymized marks of the three other radiologists to render a final opinion. The goal of this process was to identify as completely as possible all lung nodules in each CT scan without requiring forced consensus. RESULTS: The Database contains 7371 lesions marked "nodule" by at least one radiologist. 2669 of these lesions were marked "nodule > or =3 mm" by at least one radiologist, of which 928 (34.7%) received such marks from all four radiologists. These 2669 lesions include nodule outlines and subjective nodule characteristic ratings. CONCLUSIONS: The LIDC/IDRI Database is expected to provide an essential medical imaging research resource to spur CAD development, validation, and dissemination in clinical practice.
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Bases de Datos Factuales , Neoplasias Pulmonares/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas , Diagnóstico por Computador , Humanos , Neoplasias Pulmonares/patología , Control de Calidad , Interpretación de Imagen Radiográfica Asistida por Computador , Radiografía Torácica , Estándares de Referencia , Carga TumoralRESUMEN
INTRODUCTION: Hypoxia and hypoxemia can lead to an unfavorable outcome after severe trauma, by both direct and delayed mechanisms. Prehospital intubation is meant to ensure pulmonary gas exchange. Limited evidence exists regarding indications for intubation after trauma. The aim of this study was to analyze prehospital intubation as an independent risk factor for the posttraumatic course of moderately injured patients. Therefore, only patients who, in retrospect, would not have required intubation were included in the matched-pairs analysis to evaluate the risks related to intubation. METHODS: The data of 42,248 patients taken from the trauma registry of the German Association for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie (DGU)) were analyzed. Patients who met the following criteria were included: primary admission to a hospital; Glasgow Coma Scale (GCS) of 13 to 15; age 16 years or older; maximum injury severity per body region (AIS) ≤ 3; no administration of packed red blood cell units in the emergency trauma room; admission between 2005 and 2008; and documented data regarding intubation. The intubated patients were then matched with not-intubated patients. RESULTS: The study population included 600 matched pairs that met the inclusion criteria. The results indicated that prehospital intubation was associated with a prolonged rescue time (not intubated, 64.8 minutes; intubated, 82.3 minutes; P ≤ 0.001) and a higher volume replacement (not intubated, 911.3 ml; intubated, 1,573.8 ml; P ≤ 0.001). In the intubated patients, coagulation parameters, such as the prothrombin time ratio (PT) and platelet count, declined, as did the hemoglobin value (PT not intubated: 92.3%; intubated, 85.7%; P ≤ 0.001; hemoglobin not intubated, 13.4 mg/dl; intubated, 12.2 mg/dl; P ≤ 0.001). Intubation at the scene resulted in an elevated sepsis rate (not intubated, 1.5%; intubated, 3.7%; P ≤ 0.02) and an elevated prevalence of multiorgan failure (MOF) and organ failure (OF) (OF not intubated, 9.1%; intubated, 23.4%; P ≤ 0.001). CONCLUSIONS: Prehospital intubation in trauma patients is associated with a number of risks and should be critically weighed, except in cases with clear indicators, such as posttraumatic apnea.
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Servicios Médicos de Urgencia/métodos , Intubación Intratraqueal/efectos adversos , Insuficiencia Multiorgánica/epidemiología , Sepsis/epidemiología , Heridas y Lesiones/terapia , Adulto , Femenino , Alemania/epidemiología , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Morbilidad , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Índices de Gravedad del Trauma , Adulto JovenRESUMEN
BACKGROUND: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. METHODS: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. RESULTS: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. CONCLUSIONS: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.
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The horticultural production of bell peppers generates large quantities of residual biomass. Abiotic stress stimulates the production of protective flavonoids, so the deliberate application of stress to the plants after fruit harvest could provide a strategy to valorize horticultural residuals by increasing flavonoid concentrations, facilitating their industrial extraction. Here we exposed two Capsicum cultivars, a chilli and a bell pepper, to cold and salt stress and combinations thereof to determine their valorization potential. Noninvasive image-based phenotyping and multiparametric fluorescence measurements indicated that all stress treatments inhibited plant growth and reduced the leaf chlorophyll fluorescence index, with the chilli cultivar showing greater sensitivity. The fluorescence-based FLAV index allowed the noninvasive assessment of foliar luteolin glycosides. High-performance liquid chromatography-mass spectrometry (HPLC-MS) analysis showed that moderate cold increased the levels of two foliar antioxidant luteolin glycosides in both cultivars, with bell pepper containing the highest amounts (induced to maximum 5.5 mg g-1 DW cynaroside and 37.0 mg g-1 DW graveobioside A) after combined stress treatment. These data confirm the potential of abiotic stress for the valorization of residual leaf biomass to enhance the industrial extraction of antioxidant and bioactive flavonoids.
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Capsicum , Antioxidantes , Flavonoides , Hojas de la Planta , Estrés SalinoRESUMEN
BACKGROUND: Smartphones have become an essential part of everyday life and it is undeniable that apps offer enormous opportunities for dealing with future challenges in public health. Nevertheless, the exact patient requirements for medical apps in the field of orthopedic and trauma surgery are currently unknown. OBJECTIVE: The aim of this study was to define target groups, evaluate patient requirements, and the potential and pitfalls regarding medical apps specific for patients receiving orthopedic and trauma surgical care. METHODS: A prospective multicenter study was conducted between August 2018 and December 2019 at a German trauma center and 3 trauma surgery/orthopedic practices. A paper-based survey consisting of 15 questions evaluated information regarding smartphone and medical app usage behavior. In addition, suggested app functions were rated using Likert scales. Descriptive statistics and binary log-binomial regression were performed. RESULTS: A total of 1055 questionnaires were included in our statistical analysis. Approximately 89.57% (945/1055) of the patients in this study owned a smartphone. Smartphone ownership probability decreased with every decade of life and increased with higher levels of education. Medical information was obtained via mobile web access by 62.65% (661/1055) of the patients; this correlated with smartphone ownership in regard to age and educational level. Only 11.18% (118/1055) of the patients reported previous medical app usage, and 3.50% (37/1055) of the patients received an app recommendation from a physician. More than half (594/1055, 56.30%) of the patients were unwilling to pay for a medical app. The highest rated app functions were information about medication, behavioral guidelines, and medical record archival. An improved treatment experience was reported through the suggested app features by 71.18% (751/1055) of the patients. CONCLUSIONS: Mobile devices are a widely used source of information for medical content, but only a minority of the population reported previous medical app usage. The main target group for medical apps among patients receiving orthopedic and trauma surgical care tends to be the younger population, which results in a danger of excluding fringe groups, especially the older adults. Education seems to be one of the most important pull factors to use smartphones or a mobile web connection to obtain health information. Medical apps primarily focusing on an optimized patient education and flow of information seem to have the potential to support patients in health issues, at least in their subjective perception. For future target group-oriented app developments, further evidence on the clinical application, feasibility, and acceptance of app usage are necessary in order to avoid patient endangerment and to limit socioeconomic costs.
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Aplicaciones Móviles , Telemedicina , Anciano , Humanos , Estudios Prospectivos , Teléfono Inteligente , Encuestas y CuestionariosRESUMEN
Implementation of lung screening (LS) programs is challenging even among health care organizations that have the motivation, the resources, and more importantly, the goal of providing for life-saving early detection, diagnosis, and treatment of lung cancer. We provide a case study of LS implementation in different healthcare systems, at the Mount Sinai Healthcare System (MSHS) in New York City, and at the Phoenix Veterans Affairs Health Care System (PVAHCS) in Phoenix, Arizona. This will illustrate the commonalities and differences of the LS implementation process in two very different health care systems in very different parts of the United States. Underlying the successful implementation of these LS programs was the use of a comprehensive management system, the Early Lung Cancer Action Program (ELCAP) Management SystemTM. The collaboration between MSHS and PVAHCS over the past decade led to the ELCAP Management SystemTM being gifted by the Early Diagnosis and Treatment Research Foundation to the PVAHCS, to develop a "VA-ELCAP" version. While there remain challenges and opportunities to continue improving LS and its implementation, there is an increasing realization that most patients who are diagnosed with lung cancer as a result of annual LS can be cured, and that of all the possible risks associated with LS, the greater risk of all is for heavy cigarette smokers not to be screened. We identified 10 critical components in implementing a LS program. We provided the details of each of these components for the two healthcare systems. Most importantly, is that continual re-evaluation of the screening program is needed based on the ongoing quality assurance program and database of the actual screenings. At minimum, there should be an annual review and updating. As early diagnosis of lung cancer must be followed by optimal treatment to be effective, treatment advances for small, early lung cancers diagnosed as a result of screening also need to be assessed and incorporated into the entire screening and treatment program.
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Orthopaedic and trauma research is a gateway to better health and mobility, reflecting the ever-increasing and complex burden of musculoskeletal diseases and injuries in Germany, Europe and worldwide. Basic science in orthopaedics and traumatology addresses the complete organism down to the molecule among an entire life of musculoskeletal mobility. Reflecting the complex and intertwined underlying mechanisms, cooperative research in this field has discovered important mechanisms on the molecular, cellular and organ levels, which subsequently led to innovative diagnostic and therapeutic strategies that reduced individual suffering as well as the burden on the society. However, research efforts are considerably threatened by economical pressures on clinicians and scientists, growing obstacles for urgently needed translational animal research, and insufficient funding. Although sophisticated science is feasible and realized in ever more individual research groups, a main goal of the multidisciplinary members of the Basic Science Section of the German Society for Orthopaedics and Trauma Surgery is to generate overarching structures and networks to answer to the growing clinical needs. The future of basic science in orthopaedics and traumatology can only be managed by an even more intensified exchange between basic scientists and clinicians while fuelling enthusiasm of talented junior scientists and clinicians. Prioritized future projects will master a broad range of opportunities from artificial intelligence, gene- and nano-technologies to large-scale, multi-centre clinical studies. Like Prometheus in the ancient Greek myth, transferring the elucidating knowledge from basic science to the real (clinical) world will reduce the individual suffering from orthopaedic diseases and trauma as well as their socio-economic impact.
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Inteligencia Artificial , Investigación Biomédica/organización & administración , Ortopedia/tendencias , Traumatología/tendencias , HumanosRESUMEN
A variety of metallic biomaterials is used for fracture fixation. Allergic reactions towards nickel-containing steels urge the need for alternatives. The present study investigated the suitability of the nickel-free stainless steel P2000 in comparison to titanium alloy implants for bone surgical applications in a rabbit femora defect model. Thirty-six rabbits received two different cylindrical implants press-fit inserted into the distal femoral metaphysis. At day 0, 28, and 56, implant ingrowth was monitored by radiography; implant stability was assessed by pull-out torque measurements while bone-to-implant contact (BIC) was determined histomorphometrically. Radiography revealed comparable implant ingrowth after 1 and 2 months for both implant materials. The pull-out force of P2000 tended to be higher than that for titanium at day 28 (p = .076) but the values were comparable at day 56 (p = .905). At day 56, implant fixation was significantly increased compared to the day of surgery for both, P2000 (p = .030) and for titanium alloy (p = .026). Microscopic examination revealed that both implant types appeared to be well integrated and firmly anchored in the bone. BIC ratio of titanium alloy tended to be higher at day 28 (p = .079) but they did not differ significantly at day 56 (p = .711). In the present rabbit femora defect model, the nickel-free stainless steel P2000 provides primary stability and osseointegration comparable to that of titanium alloy implants.