Trends in pre-hospital volume resuscitation of blunt trauma patients: a 15-year analysis of the British (TARN) and German (TraumaRegister DGU®) National Registries.

INTRODUCTION: Fluid resuscitation has long been a cornerstone of pre-hospital trauma care, yet its optimal approach remains undetermined. Although a liberal approach to fluid resuscitation has been linked with increased complications, the potential survival benefits of a restrictive approach in blunt trauma patients have not been definitively established. Consequently, equipoise persists regarding the optimal fluid resuscitation strategy in this population. METHODS: We analysed data from the two largest European trauma registries, the UK Trauma Audit and Research Network (TARN) and the German TraumaRegister DGU® (TR-DGU), between 2004 and 2018. All adult blunt trauma patients with an Injury Severity Score > 15 were included. We examined annual trends in pre-hospital fluid resuscitation, admission coagulation function, and mortality rates. RESULTS: Over the 15-year study period, data from 68,510 patients in the TARN cohort and 82,551 patients in the TR-DGU cohort were analysed. In the TARN cohort, 3.4% patients received pre-hospital crystalloid fluids, with a median volume of 25 ml (20-36 ml) administered. Conversely, in the TR-DGU cohort, 91.1% patients received pre-hospital crystalloid fluids, with a median volume of 756 ml (750-912 ml) administered. Notably, both cohorts demonstrated a consistent year-on-year decrease in the volume of pre-hospital fluid administered, accompanied by improvements in admission coagulation function and reduced mortality rates. CONCLUSION: Considerable variability exists in pre-hospital fluid resuscitation strategies for blunt trauma patients. Our data suggest a trend towards reduced pre-hospital fluid administration over time. This trend appears to be associated with improved coagulation function and decreased mortality rates. However, we acknowledge that these outcomes are influenced by multiple factors, including other improvements in pre-hospital care over time. Future research should aim to identify which trauma populations may benefit, be harmed, or remain unaffected by different pre-hospital fluid resuscitation strategies.

Identification of the novel allele, HLA-A*01:234, in the mother of a German cord blood donor.

HLA-A*01:234 was identified by next-generation sequencing and confirmed by Sanger sequencing.

Identification of the novel allele, HLA-C*01:136 in a German cord blood donor originating from Azerbaijan.

HLA-C*01:136 identified by next generation sequencing and confirmed by Sanger sequencing.

Zoomed EPI DWI of Acute Spinal Ischemia Using a Parallel Transmission System.

PURPOSE: A new method for diffusion-weighted imaging (DWI) using independent parallel transmission technique resulting in zoomed DWI was applied in four patients suffering from acute spinal cord ischemia. METHODS: Four patients with clinical symptoms of acute spinal cord ischemia were examined on a 3 T MR-system equipped with a two-channel transmit array. Scans included T2-weighted turbo spin echo, conventional DWI, and zoomed DWI. Image evaluation was performed with regard to overall image quality, anatomic delineation of the spinal cord, and the level of confidence to establish the diagnosis of spinal cord ischemia. RESULTS: Through spatially selective excitation, zoomed DWI allows for acquisition of high-resolution images with reduced scan time due to a reduced field of view in phase-encoding direction, resulting in zoomed images. In all cases the ischemia was demonstrated in conventional DWI as well as zoomed DWI. CONCLUSIONS: Compared to conventional DWI, zoomed DWI enables a faster image acquisition and allowed a more detailed analysis of the spinal lesion which may be critical to attribute the lesion to a particular vessel territory.

Influence of early irradiation on in vitro red blood cell (RBC) storage variables of leucoreduced RBCs in additive solution SAG-M.

BACKGROUND: The only accepted way to avoid transfusion-associated graft-versus-host disease is irradiation of blood components. With respect to irradiation and associated storage time, different recommendations exist. We examined early irradiated (day +3) leucoreduced red blood cell units for irradiation-associated damages during storage. STUDY DESIGN AND METHODS: We studied 80 leucoreduced units from two manufacturers. All RBCs were stored in the additive solution saline-adenine-glucose-mannitol (SAG-M) and leucoreduced on collection day. Forty components were irradiated on day +3 with 30 Gy, 40 served as non-irradiated controls. Samples were drawn and analysed from these 80 units on days +3, +7, +14, +21, +28, +35 and +42. RESULTS: From day +14, there was a significant difference in the in vitro haemolysis rate between the non-irradiated and the irradiated components. Two of the irradiated units showed a haemolysis rate over the recommended limit of 0·8% on day +42. Potassium and lactate dehydrogenase activity increased faster in irradiated groups during storage. CONCLUSIONS: Our findings show that leucoreduced RBCs which are irradiated early after collection show an obvious radiation damage over storage period. Interestingly, on days +28, +35 and +42 the quality of RBCs which were irradiated on day +3 was nearly identical to the quality of RBCs which were irradiated on day +14 in a former series. Early irradiation does not cause more damage of RBCs during subsequent storage than irradiation on day +14. The maximum storage period of irradiated RBCs should remain restricted to 28 days from collection, however independently from the day of irradiation within this period.

T-cell subsets in autologous and allogeneic peripheral blood stem cell concentrates.

BACKGROUND AND OBJECTIVES: Regulatory T cells (Tregs) and other T-cell subsets are of importance in the setting of autologous and allogeneic stem cell transplantations. We conducted a study to assess the content of peripheral blood stem cell concentrates and related apheresis parameters in the autologous and allogeneic setting. MATERIAL AND METHODS: We characterized 53 donors, patients and peripheral blood stem cell concentrates (PBSC) regarding the content of CD45(+) cells, lymphocytes, CD3(+) cells, CD3(+) CD4(+) T cells, CD3(+) CD4(+) CD25(+) T cells, CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs and CD34(+) cells and calculated cell yields, recruitment factors and collection efficiency for all cell types. We compared allogeneic data with autologous data. RESULTS: Autologous PBSC show significantly lower concentrations of T-cell subsets compared to allogeneic PBSC (17,112/µl CD4(+), 14,858/µl CD4(+) CD25(+) and 1579/µl CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs in autologous compared to 65,539/µl CD4(+), 44,208(+) /µl CD4(+) CD25(+) and 5040/µl CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs in allogeneic PBSC, respectively), in contrast to CD34(+) concentrations (5342/µl CD34(+) in autologous compared to 2367/µl CD34(+) in allogeneic PBSC, respectively). Accordantly, all T-cell yields are lower in the autologous setting compared to allogeneic PBSC. However, recruitment factor and collection efficiency of all cell types are higher in autologous compared to allogeneic PBSC, but not all parameters differ significantly when groups are compared. CONCLUSION: T-cell subsets and especially Tregs are a substantial part of PBSC transplantation, as considerable recruitment during apheresis occurs. In large volume apheresis, the collection efficiency of Treg is comparable to that of CD34(+) cells, while recruitment factors are even higher.

Correlation of the hypotonic shock response and extent of shape change with the new ThromboLUX ™.

ThromboLUX (TLX)-Score was compared with hypotonic shock response (HSR) and extent of shape change (ESC) in 99 samples from 42 platelet concentrates. Tests were performed in parallel and duplicate. Mean values for TLX Score, HSR and ESC were 30.3 ± 3.8%, 69.0 ± 12.2% and 23.2 ± 4.9%, respectively. We found no significant correlation between TLX Score and HSR or ESC (r = -0.158, P = 0.118 and r = -115, P = 0.255, respectively), whereas HSR and ESC correlated significantly (r = 0.351, P < 0.001). As TLX Score did not show significant correlation with HSR and ESC, the value of TLX for platelet quality testing remains unclear. Studies comparing these parameters with transfusion outcome are needed.

Comparison of a new microscopic system for the measurement of residual leucocytes in apheresis platelets with flow cytometry and manual counting.

BACKGROUND AND OBJECTIVES: Since 2001, all blood components in Germany must be leucocyte depleted. Recently, a new method for quality control of depletion was introduced. Our study aimed at the validation of the method for routine use in apheresis platelet concentrates. MATERIALS AND METHODS: We compared the new ADAM-rWBC device with manual counting in the Nageotte chamber and flow cytometry, two standard methods, by measuring residual leucocytes in 40 units of apheresis platelet concentrates and in six geometrical dilution series. RESULTS: Cell counts of residual leucocytes in the 40 units were below 10(6) cells per component with all methods, although mean cell counts were approximately 5 and 6 times higher in flow cytometry and ADAM-rWBC, respectively, compared to the Nageotte chamber. No unit with <10(6) leucocytes was regarded as contaminated. The dilution series showed acceptable accuracy, especially in the range around the cut-off (approximately 4·5 cells/µl in components with a volume of 220 ml) for regarding a concentrate as contaminated with leucocytes. No sample spiked with more than 4·5 cells/µl was counted as having less. CONCLUSION: In comparison with manual counting and flow cytometry, the ADAM-rWBC device performed equally. The method is suitable for routine screening of leucocyte contamination of apheresis platelets.

The novel allele, HLA-B*08:113, identified in a German cord blood donor and his mother.

The novel allele HLA-B*08:113 identified in two related individuals of Caucasian origin is described.

[Analysis and long-term observation after surgical treatment of patients with tumours of the iris]. / Analyse und Langzeitbeobachtung nach chirurgischer Therapie bei Patienten mit Iristumoren.

BACKGROUND: Uveal melanoma is the most common primary intraocular malignancy in adults. Iris melanomas are rare tumours: they account for 2-3 % of all uveal melanomas. The clinical differentiation between benign iris nevi and malignant iris melanomas can be difficult. PATIENTS AND METHODS: The aim of this study was the registration, analysis and observation of all patients with tumours of the anterior uvea who had been treated surgically between 1992 and 2011 at the ophthalmic department of the University Hospital of Jena. 40 patients were analysed and compared concerning their preoperative states, operating methods including complications, histological results, postoperative function, subjective complaints as well as the risk of metastasis and the associated dependence on mortality of the dignity of the tumours. In this time period 26 patients has been observed in a follow-up visit. Patients with a malignant tumour were offered an examination. RESULTS: The histological examination revealed for 24 patients a benign tumour and for 16 patients a malignant tumour. After an exact analysis of multiple parameters there was only a statistically significant difference in the preoperative visual acuity (p = 0.025) and in the tumour size (p = 0.011) between the two analysed groups of patients. The rate of serious postoperative complications was 11.4 %. One fourth of the patients complained of subjective problems after the surgical intervention. In the follow-up visit a visual acuity of 0.5 or better was achieved in 68 % of all interventions. CONCLUSIONS: A reliable diagnosis is only possible after histological examination. The analysed parameters can only give indications for the dignity of the tumour. The strategy of the ophthalmic department of the University Hospital of Jena to remove a tumour of uncertain dignity at an early state makes sense, because there are few postoperative complications, few patients complain about subjective problems and the chances for achieving good visual acuity are high.

[Study on the time course of macular pigment density measurement in patients with a macular hole--clinical course and impact of surgery]. / Untersuchungen zum zeitlichen Verlauf der Makulapigmentdichte bei Patienten mit idiopathischem Makulaforamen--klinischer Verlauf und Einfluss der Operation.

BACKGROUND: In a prospective clinical study we examined the course of the optical density of the macular pigment (MPOD) in patients with idiopathic macular holes before and after pars-plana vitrectomy. PATIENTS AND METHODS: Of the 26 patients four had macular holes stage 1, six patients had stage 2 or stage 4 holes and ten people had a macular hole stage 3. The surgical procedure consisted always of a standard 3-port pars plana vitrectomy (PPV) with colouring assisted peeling of the internal limiting membrane. The optical density of macular pigment was determined by the 1-wavelength reflection method before pars plana vitrectomy and after macular hole closure. RESULTS: The macular hole was completely closed in 25 of 26 eyes (96.15 %). This anatomical success is also the basis for a postoperative improvement in the retinal function. In the case of macular holes from stages 3 and 4 the surgery achieved an increase in visual acuity and an increase of the optical density of the the macular pigment. In patients with macular holes stage 2 the visual acuity and the optical density of the macular pigment were reduced after vitrectomy. In the case of stage 1 holes the visual acuity and the volume of macular pigment also were reduced after the operation. DISCUSSION: In the group of stage 4 macular holes there was a significant increase in maximum optical density and volume of macular pigment after successful surgical hole closure, so the functional profit of PPV is very high in these patients. Even in the case of macular holes of stage 3 the PPV effected a functional improvement in the sense of an increase of the optical density of macular pigment. The increase in volume proved to be significant. For macular holes stage 2 the vitrectomy as a therapy option is generally recognised but PPV does not effect positively the height of the optical density of macular pigment. In these patients both the maximum optical density as well as the volume of macular pigment were reduced in the therapeutic course. Whether surgical intervention is indicated in stage 1 is still controversial. Taking into account the development of MPOD the profit from surgery for the patients is very low. This led to a decrease in volume of macular pigment and only a slight increase in maximum optical density after pars plana vitrectomy.

Audit on the usage of plasma derived/recombinant coagulation factor concentrates at a German university hospital.

BACKGROUND: There is a lack of data on the usage of plasma derived/recombinant coagulation factor concentrates (PD/RCFC) regarding diagnostic categories. An audit of PD/RCFC and blood component usage at a tertiary care teaching hospital in northern Bavaria was conducted. STUDY DESIGN AND METHODS: All blood components and PD/RCFC transfused at a university hospital (Erlangen, Germany) during the year 2006 were analysed. Transfused blood products were listed by major diagnostic categories (MDC) formed from principal diagnoses of recipients according to the International Classification of Diseases, tenth revision and German modification. RESULTS: Blood component usage has markedly increased since last surveyed in 1994 through 1996. The diagnostic categories responsible for most transfusions have not changed since. Antithrombin is the PD/RCFC used most, whereas most money for PD/RCFC was spent on FVIII concentrates. Polytrauma patients need most fibrinogen, whereas most of FXIII is needed in patients with malignancies. Patients with prolonged artificial ventilation receive PCC most often. Altogether, three MDCs (Pre, 17, 05) accounted for 80·5% of costs created by PD/RCFC transfusion. CONCLUSION: This study provides for the first time combined data on blood component and PD/RCFC usage in a German university hospital. It shows that the MDCs responsible for most of the costs in transfusion therapy with blood components and with PD/RCFC are few, and are the same. At the same time, blood bank information software should be further improved in order to be able to identify new trends in hemotherapy in more detail.

Precise pH measuring of platelet concentrates containing additive solution--the impact of the temperature.

BACKGROUND AND OBJECTIVES: Blood gas analysers measuring pH at 37°C (pH37) are widely used for pH determination of platelet (PLT) concentrates (PCs). For reporting pH at 22°C (pH22), converting of pH37 using the correct conversion factor is mandatory. For PCs stored in PLT additive solution (PAS), such conversion factors are not yet widely available. We studied pH in samples of PCs with different PAS/plasma ratios during warming from 22 to 37°C. MATERIALS AND METHODS: We measured pH in 39 samples containing modified PAS-III (PAS-IIIM) with a plasma carryover of 20%, 30% or 40% or no PAS-IIIM. Differences between pH22 and pH37 (dpH) were compared within and between study groups. Correlation between pH22 and dpH was tested. Additional measurements in 33 samples with three different PLT counts were performed to study the influence of PLT count on dpH. RESULTS: pH22 and pH37 within each group and dpH or dpH/dT between study groups differed significantly. The dpH was 0·135 ± 0·040, 0·021 ± 0·009, 0·033 ± 0·011 and 0·048 ± 0·017 for samples containing 100%, 20%, 30% or 40% plasma, respectively. Correlation between dpH and pH22 was strong in 100% (r = 0·696, P < 0·001), weaker in 30% and 40% (r = 0·367, P = 0·022 and r = 0·345, P = 0·032, respectively) and not existing in 20% plasma (r = 0·153, P = 0·354). PLT count did not influence the dpH significantly. CONCLUSION: The dpH is dependent on different PAS-IIIM/plasma ratios and pH range. For precise reporting of pH22, the respective dpH must be used if converting is necessary. Preferably, the pH should be reported at 37°C or measured directly at 22°C.

[Influence of bodily constitution and physical activity on postural stability]. / Einfluss von Konstitution und Belastung auf die posturale Stabilität.

CONTEXT AND OBJECTIVE: In order for balance to be maintained, the postural control system must process above all visual, vestibular and proprioceptive information and translate this input into appropriate motor responses. The influence of bodily constitution and physical activity on motor responses and thus on postural stability is still unclear. To use computerized dynamic posturography (CDP) to investigate the influence of body height, body mass index (BMI), regular sporting activity and acute maximal exercise on balance. SUBJECTS AND METHODS: Eighty-four subjects completed a standardized questionnaire on their height, BMI and sporting activity. We then assessed the postural stability of the subjects. Seventeen further subjects performed a maximal exercise test on a bicycle ergometer. We used CDP and a predefined protocol to assess balance at rest, at maximal exercise and then at 5-minute intervals until recovery. RESULTS: Body height and regular physical activity did not influence balance ability. By contrast, BMI and acute physical exercise had a strong effect. Immediately after maximal exercise, postural stability deteriorated by 44 % compared to the baseline level (p < 0.017). Complete recovery occurred within only 15 minutes. CONCLUSIONS: Whereas body height and regular physical activity do not influence balance performance, a high BMI value and acute maximal exercise lead to a considerable decrease in postural stability. Our results can thus explain the increasing risk of injury after strenuous physical activity, especially in association with sports that require excellent balance.

[Monochromatic aberration in accommodation. Dynamic wavefront analysis]. / Aberrationen höherer Ordnung bei Akkommodation. Dynamische Wellenfrontmessung.

BACKGROUND: Monochromatic aberrations may influence the visual acuity of the eye. They are not stable and can be affected by different factors. The subject of the following paper is the dynamic investigation of the changes in wavefront aberration with accommodation. METHOD: Dynamic measurement of higher and lower order aberrations was performed with a WASCA Wavefront Analyzer (Carl-Zeiss-Meditec) and a specially constructed target device for aligning objects in far and near distances on 25 subjects aged from 15 to 27 years old. RESULTS: Wavefront aberrations showed some significant changes in accommodation. In addition to the characteristic sphere reaction accompanying miosis and changes in horizontal prism (Z(1) (1)) in the sense of a convergence movement of the eyeball also occurred. Furthermore defocus rose (Z(2) (0)) and astigmatism (Z(2) (-2)) changed. In higher-order aberrations a decrease in coma-like Zernike polynomials (Z(3) (-1), Z(3) (1)) was found. The most obvious change appeared in spherical aberration (Z(4) (0)) which increased and changed from positive to negative. In addition the secondary astigmatism (Z(4) (-2)) and quadrafoil (Z(4) (4)) rise also increased. The total root mean square (RMS), as well as the higher-order aberrations (RMS-HO) significantly increased in accommodation which is associated with a theoretical reduction of visual acuity. An analysis of the influence of pupil size on aberrations showed significant increases in defocus, spherical aberration, quadrafoil, RMS and RMS HO by increasing pupil diameter. By accommodation-associated miosis, the growing aberrations are partially compensated by focusing on near objects. Temporal analysis of the accommodation process with dynamic wavefront analysis revealed significant delays in pupil response and changing of prism in relation to the sphere reaction. In accommodation to near objects a discrete time ahead of third order aberrations in relation to the sphere response was found. CONCLUSION: Using dynamic wavefront measurement achieved a sequential analysis of aberrations during accommodation. Significant changes in the lower and higher-order aberrations could be detected. These are additionally varied by the associated pupillary response. Moreover, the synchronicity of wave front reaction in the accommodation process was proven.

[Postpartum cardiomyopathy]. / Postpartale Kardiomyopathie.

HISTORY AND CLINICAL FINDINGS: A 27-year-old woman was admitted to the emergency room because of dyspnoea. Two months earlier she had given birth to a healthy young boy via cesarean section. IMAGING: Computed tomography showed acute embolism in both pulmonary arteries. Chest X-ray and echocardiography revealed an enlarged left ventricle, a highly reduced left ventricular function and thrombosis in the left ventricle. TREATMENT AND COURSE: The patient was treated with extensive medical heart failure therapy, and also with bromocriptine for eight weeks. Six months later, left ventricular ejection fraction had significantly improved. CONCLUSION: Peri- or postpartum cardiomyopathy (PPCM) is a rare, potentially life-threatening heart disease, which is characterized by sudden onset of heart failure between the final weeks of pregnancy and up to six months after childbirth. Early diagnosis is crucial for the patient's prognosis. Recent pilot studies on the effect of adding bromocriptine to standard heart failure therapy indicated an improvement of prognosis and myocardial function. In this case significant improvement of left ventricular function was thus achieved.

Storage induced apoptosis of peripheral blood mononuclear cells obtained from leucoreduction system chambers.

BACKGROUND AND OBJECTIVES: Recently, it was reported that leucocytes obtained from leucoreduction system chambers (LRSCs) after plateletapheresis show excellent quality due to culture of dendritic cells. This study analysed apoptosis of mononuclear cells derived from LRSCs of single platelet units (SPUs) and double platelet units (DPUs) during storage. MATERIALS AND METHODS: This randomized prospective study compared eighteen single and double platelet units produced with the Trima Accel cell separator. Buffy coat was drained from the LRSCs and analysed after 1, 6, 24, 48 and 72 h. CD45+ lymphocytes and CD14+ monocytes cells as well as Annexin-V+ and 7-AAD+ mononuclear cells were measured by flow cytometry. RESULTS: The WBC concentration of LRSCs obtained from SPUs and DPUs differed significantly (SPUs: 0·93 ± 0·32 ×10(5) per µl WBCs; DPUs: 1·71 ± 0·55 ×10(5) per µl WBCs; P<0·001). Processed blood volume (PBV) correlated significantly with WBC concentration (r(2)=0·75, P<0·001). Fifty percent of monocytes were Annexin-V-positive 1 h after production decreasing to 30% during 24 h of storage. Compared to that, the part of late apoptotic or necrotic PBMCs increased later on, after 24 h. After 24 h, Annexin-V- and 7-AAD-positive, late apoptotic and necrotic lymphocytes and monocytes doubled. CONCLUSION: PBMCs stored in autologous plasma in PVC-bags at room temperature did not show an increase of 7-AAD-positive PBMCs during 24 h prior to cell processing but increased significantly thereafter.

The novel allele, HLA-B*07:68:02, identified in a German cord blood donor and her father.

The novel allele HLA-B*07:68:02 identified in two related individuals of Caucasian origin is described.