[Medical ID and emergency apps: A useful tool in emergency situations or a waste of time?] / Notfall-Apps: vergeudete Zeit oder sinnvolles Instrument in der präklinischen Versorgung von Traumapatienten?

BACKGROUND: In order to provide safe care to a patient in an emergency situation, it is useful to know something about the patient's previous medical conditions and medication. For this very reason smartphones have been equipped with so-called emergency apps (e.g. medical-ID, emergency-ID). The aim of our study was to find out whether the owners of smartphones are using the apps and whether medical professionals are trying to access this information. METHODS: We conducted a survey among patients in our outpatient clinic at a level one trauma center. We collected data over 3 months regarding the usage behavior of the aforementioned apps. We simultaneously asked emergency physicians at various hospitals about their experiences with these apps. RESULTS: We were able to interview 192 patients and 103 emergency physicians. The emergency apps were unknown to 45% (n = 79) of the respondents; only 10% (n = 19) of the respondents had the app with data stored. Furthermore, it was found that a total of 21% (n = 41) of the persons carried a note on themselves with previous illnesses and medication. Of the surveyed physicians, 42% (n = 44) stated that they had heard of the app before; however, only 6% (n = 5) routinely searched the smartphone for relevant information in the case of nonresponsive patients. Only 14% of physicians (n = 14) have successfully used the app so far. CONCLUSION: The collected data show that the emergency apps are still unknown to many patients and emergency physicians alike. Due to the low distribution it does not seem to be recommendable to search the smartphone for the apps in time-critical situations after accidents. For patients over 55 years of age, it currently seems more promising to search their wallets for information regarding their previous illnesses.

[Intramedullary injection with tethered cord : Case report of a rare complication during spinal anesthesia]. / Intramedulläre Injektion bei "tethered cord" : Fallbericht einer seltenen Komplikation bei Spinalanästhesie.

Although very rare, severe neurological complications can occur when undergoing spinal anesthesia. This report describes and analyses a case of spinal injury due to an undiagnosed tethered cord (TC) during spinal anesthesia for a cesarean section of a 31-year-old woman expecting twins. As a consequence of spinal dysraphism during embryogenesis, an atypically low conus level can occur and increase the risk of injury during neuraxial anesthesia, especially in the absence of symptoms. Injuries can be caused by mechanical trauma from direct needle injury, hematoma or neurotoxicity from local anesthetics. Special attention should therefore be paid to frequent symptoms, such as a hairy nevus on the back, deformities of the feet or bladder and bowels, voiding and micturition dysfunction in order to reduce the risk of complications.

[Anesthesiological management of elderly trauma patients]. / Anästhesiologisches Management in der Alterstraumatologie.

BACKGROUND: The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high. AIM: This article presents an overview of the perioperative management of elderly trauma patients in order to improve the perioperative outcome of these high risk patients. MATERIAL AND METHODS: A literature search was carried out focusing on the latest developments in the field of elderly trauma patients in order to present guidance on preoperative, intraoperative and postoperative anesthesiological management. RESULTS: Elderly trauma patients should undergo operative interventions as soon as possible. Many of these patients have a high risk profile. This can be estimated using risk scores in order to allow a prognosis for the outcome of patients. The informed consent needs to be discussed accordingly. The perioperative management is ideally addressed in a multidisciplinary approach. An array of questions in perioperative management, such as the mode of anesthesia, the ideal individual transfusion trigger and fluid management have not yet been adequately addressed in studies. CONCLUSION: The level of evidence in the perioperative management of elderly trauma patients is poor; therefore, there is an urgent need for large prospective studies in order to define uniform standards and guidelines.

Chemical evolution via beta decay: a case study in strontium-90.

Using (90)Sr as a representative isotope, we present a framework for understanding beta decay within the solid state. We quantify three key physical and chemical principles, namely momentum-induced recoil during the decay event, defect creation due to physical displacement, and chemical evolution over time. A fourth effect, that of electronic excitation, is also discussed, but this is difficult to quantify and is strongly material dependent. The analysis is presented for the specific cases of SrTiO(3) and SrH(2). By comparing the recoil energy with available threshold displacement data we show that in many beta-decay situations defects such as Frenkel pairs will not be created during decay as the energy transfer is too low. This observation leads to the concept of chemical evolution over time, which we quantify using density functional theory. Using a combination of Bader analysis, phonon calculations and cohesive energy calculations, we show that beta decay leads to counter-intuitive behavior that has implications for nuclear waste storage and novel materials design.

Pulse oximetry during intraaortic balloon pump application.

BACKGROUND: Pulse oximeters are multiple used devices in anaesthesiology and intensive care medicine and must provide reliable data during various conditions of signal interference, including light, motion and reduced perfusion. The aim of this study was to evaluate the reliability of different new-generation pulse oximeters during intraaortic balloon pump (IABP) therapy. METHODS: In the experimental setting, the validity of three pulse oximetry technologies (Masimo Radical 7, Nellcor N-600 and Datex Ohmeda TruSat) was evaluated in patients with IABP treatment. Arterial blood gas analysis (BGA-SaO2) data were compared with the pulse oximetric values (SpO2) during 1:1, 1:2 and 1:3 support ratio. RESULTS: The mean differences (bias) during 1:1, 1:2 and 1:3 IABP support between BGA-SaO2 and Datex-SpO2 were 3.38% [95% confidence intervals (CI):±1.39%], 1.41% (95% CI 1.14%) and 2.10% (95% CI:±0.94%), respectively. Between BGA-SaO2 and Nellcor-SpO2, a bias of 0.77% (95% CI:±0.46%), 0.85% (95% CI:±0.40%) and 0.59% (95% CI:±0.38%) was found. In the comparison of BGA-SaO2 and Masimo-SpO2, a bias of 0.58% (95% CI:±0.56%), 0.19% (95% CI:±0.40%) and -0.01% (95% CI:±0.43%) was found, respectively. CONCLUSIONS: In patients with IABP support, the pulse oximetric values of the Masimo Radical 7 are accurate in 1:2 and 1:3 support ratio compared with blood gas analysis. In these support ratios, the Masimo Radical 7 is superior to the Nellcor N-600. The Datex Ohmeda TruSat showed a significant difference between the measured pulse oximetric values and blood gas analysis in all support ratios.

An annotated mtDNA database.

We have compiled a database of mitochondrial DNA (mtDNA) control region, hypervariable regions 1 (HVR1) and 2 (HVR2) sequences of a total of 14,138 individuals compiled from 103 mtDNA publications before 1 January 2000, 13 data sets published in 2000 and 2001 and 2 unpublished data sets of Iraqi Kurds and Indians from Kerala. By contacting the authors and by other means, we have confirmed and corrected sequence errors, eliminated duplications and harmonised the sequence format. These changes affected all but 26 of the 116 publications. Furthermore, we have implemented a geographic information system ("mtradius") which searches for closest matches to a given mtDNA control region sequence and displays them on a geographic map. A potential application is to estimate a chance matching probability when a forensic stain and a suspect have an identical mtDNA sequence: we suggest that the geographic area with the highest frequency of closely related mtDNA sequence types may be used to define a reference population to give the suspect the maximum benefit of doubt in accordance with the ceiling principle.

Phylogenetic star contraction applied to Asian and Papuan mtDNA evolution.

In the past decade, mitochondrial DNA (mtDNA) of 826 representative East Asians and Papuans has been typed by high-resolution (14-enzyme) restriction fragment length polymorphism (RFLP) analysis. Compared with mtDNA control region sequencing, RFLP typing of the complete human mitochondrial DNA generally yields a cleaner phylogeny, the nodes of which can be dated assuming a molecular clock. We present here a novel star contraction algorithm which rigorously identifies starlike nodes (clusters) diagnostic of prehistoric demographic expansions. Applied to the Asian and Papuan data, we date the out-of-Africa migration of the ancestral mtDNA types that founded all Eurasian (including Papuan) lineages at 54,000 years. While the proto-Papuan mtDNA continued expanding at this time along a southern route to Papua New Guinea, the proto-Eurasian mtDNA appears to have drifted genetically and does not show any comparable demographic expansion until 30,000 years ago. By this time, the East Asian, Indian, and European mtDNA pools seem to have separated from each other, as postulated by the weak Garden of Eden model. The east Asian expansion entered America about 25,000 years ago, but was then restricted on both sides of the Pacific to more southerly latitudes during the Last Glacial Maximum around 20,000 years ago, coinciding with a chronological gap in our expansion dates. Repopulation of northern Asian latitudes occurred after the Last Glacial Maximum, obscuring the ancestral Asian gene pool of Amerinds.

An ab initio study of the influence of crystal packing on the host-guest interactions of calix[4]arene crystal structures.

We report the first quantum mechanical calculations of p-tert-butylcalix[4]arene inclusion complexes in the crystalline state with geometrical aspects demonstrating good agreement with experiment, while comparison of the configurations calculated for an isolated complex and in the crystal, illustrate that crystal packing forces contribute to the observed structure of the host-guest assembly.

A short tandem repeat-based phylogeny for the human Y chromosome.

Human Y-chromosomal short tandem repeat (STR) data provide a potential model system for the understanding of autosomal STR mutations in humans and other species. Yet, the reconstruction of STR evolution is rarely attempted, because of the absence of an appropriate methodology. We here develop and validate a phylogenetic-network approach. We have typed 256 Y chromosomes of indigenous descent from Africa, Asia, Europe, Australia, and highland Papua New Guinea, for the STR loci DYS19, DXYS156Y, DYS389, DYS390, DYS392, and DYS393, as well as for five ancient biallelic mutation events: two poly (A) length variants associated with the YAP insertion, two independent SRY-1532 mutations, and the 92R7 mutation. We have used our previously published pedigree data from 11,000 paternity-tested autosomal STR-allele transfers to produce a two-class weighting system for the Y-STR loci that is based on locus lengths and motif lengths. Reduced-median-network analysis yields a phylogeny that is independently supported by the five biallelic mutations, with an error of 6%. We find the earliest branch in our African San (Bushmen) sample. Assuming an age of 20,000 years for the Native American DYS199 T mutation, we estimate a mutation rate of 2.6x10-4 mutations/20 years for slowly mutating Y STRs, approximately 10-fold slower than the published average pedigree rate.

Recent male-mediated gene flow over a linguistic barrier in Iberia, suggested by analysis of a Y-chromosomal DNA polymorphism.

We have examined the worldwide distribution of a Y-chromosomal base-substitution polymorphism, the T/C transition at SRY-2627, where the T allele defines haplogroup 22; sequencing of primate homologues shows that the ancestral state cannot be determined unambiguously but is probably the C allele. Of 1,191 human Y chromosomes analyzed, 33 belong to haplogroup 22. Twenty-nine come from Iberia, and the highest frequencies are in Basques (11%; n=117) and Catalans (22%; n=32). Microsatellite and minisatellite (MSY1) diversity analysis shows that non-Iberian haplogroup-22 chromosomes are not significantly different from Iberian ones. The simplest interpretation of these data is that haplogroup 22 arose in Iberia and that non-Iberian cases reflect Iberian emigrants. Several different methods were used to date the origin of the polymorphism: microsatellite data gave ages of 1,650, 2,700, 3,100, or 3,450 years, and MSY1 gave ages of 1,000, 2,300, or 2,650 years, although 95% confidence intervals on all of these figures are wide. The age of the split between Basque and Catalan haplogroup-22 chromosomes was calculated as only 20% of the age of the lineage as a whole. This study thus provides evidence for direct or indirect gene flow over the substantial linguistic barrier between the Indo-European and non-Indo-European-speaking populations of the Catalans and the Basques, during the past few thousand years.

Median-joining networks for inferring intraspecific phylogenies.

Reconstructing phylogenies from intraspecific data (such as human mitochondrial DNA variation) is often a challenging task because of large sample sizes and small genetic distances between individuals. The resulting multitude of plausible trees is best expressed by a network which displays alternative potential evolutionary paths in the form of cycles. We present a method ("median joining" [MJ]) for constructing networks from recombination-free population data that combines features of Kruskal's algorithm for finding minimum spanning trees by favoring short connections, and Farris's maximum-parsimony (MP) heuristic algorithm, which sequentially adds new vertices called "median vectors", except that our MJ method does not resolve ties. The MJ method is hence closely related to the earlier approach of Foulds, Hendy, and Penny for estimating MP trees but can be adjusted to the level of homoplasy by setting a parameter epsilon. Unlike our earlier reduced median (RM) network method, MJ is applicable to multistate characters (e.g., amino acid sequences). An additional feature is the speed of the implemented algorithm: a sample of 800 worldwide mtDNA hypervariable segment I sequences requires less than 3 h on a Pentium 120 PC. The MJ method is demonstrated on a Tibetan mitochondrial DNA RFLP data set.

[Multifactorial etiology of idiopathic Parkinson disease. A case-control study]. / Zur multifaktoriellen Atiologie der idiopathischen Parkinson-Krankheit. Eine Fall-Kontroll-Studie.

The etiology of Parkinson's disease (PD) is currently thought to be due to an interplay of genetic and environmental factors. We examined (1) familial prevalences of PD and essential tremor (ET) using a control population and personal investigation; (2) comorbidity and possible traits of a altered premorbid lifestyle in PD were also investigated. Sixty-six PD patients with disease onset after 40 and before 70 years of life and 72 age- and sex-matched hospital controls with chronic diseases underwent neurologic examination and a structured interview. Allegedly symptomatic relatives were investigated personally. For the time prior to 40 years of age, PD patients reported significantly less frequent cigarette smoking overall (Odds ratio = OR 0.37); significantly less frequently a smoking duration of more than 2 years (OR 0.42); significantly less frequently an amount of more than 10 cigarettes smoked per diem (OR 0.24); they did report, however, more frequently an onset for smoking before the age of 20 (OR 3.56). Place of residence and source of drinking water during the first 15 years of life, and number of moves and journeys outside Europe before 40th year of life were not significantly different. PD patients demonstrated an increased risk of a 1st or 2nd degree relative with PD (OR 7.14) or ET (OR 3.62) compared to the control families. Congenital or perinatal abnormalities, and comorbid diseases did not suggest greater risk for PD. Stepwise logistic regression analysis yielded three variables that separated PD patients and controls most significantly, though not completely: "smoking more than 10 cigarettes per diem", "additional family members with PD", "additional family members with ET".

The relevance of clinical subtypes for disease course, family history and epidemiological variables in Parkinson's disease.

Clinical outcome and relevance of genetic and epidemiological factors were evaluated in 161 patients with idiopathic Parkinson's disease (PD) with regard to onset symptoms [tremor (T) vs non-tremor (NT)], to clinical classification into tremor-dominant (TD), alkineto-rigid (AR), and equivalent (EQ) subtypes, and to disease onset before the 45th year of age (EO) and after age 69 (LO). Patients were investigated by questionnaire-based personal interview and clinical examination. Allegedly symptomatic first-degree relatives were examined personally or had sufficient medical documentation to allow neurological diagnosis. Disease course was more favorable in T than in NT, in TD than in AR or EQ, and in EO compared with LO. Among EO and LO patients, clinical subtypes TD, AR and EQ were not differently distributed. Frequency of first-degree relatives with PD or essential tremor and any epidemiological variable tested were not elicited differently between TD, AR and EQ patients, with the exception that TD reported more frequent premorbid travelling. EO patients reported higher frequencies of premorbid head trauma and rural living than LO patients. The more favorable disease prognosis of patients with predominant tremor at presentation and of patients with early disease onset is corroborated. Clinical subgroups do not differ in genetic and epidemiological factors.

Lead poisoning from art restoration and pottery work: unusual exposure source and household risk.

Two cases of lead poisoning following exposures in the arts and crafts environment are presented. The first illustrates the impact of an unusual exposure source experienced by a female art conservator while restoring an antique Peruvian tapestry from the Chancay Period (A.D. 1000-1500). The second demonstrates the extension to the artist's family members of a lead hazard associated with pottery work. Noted were a wide spectrum of clinical and biochemical abnormalities, ranging from severe neurological and gastrointestinal symptoms to subtle alterations in the biosynthetic pathway of heme. Marked elevation of the blood lead level (up to 130 mcg/100 mL) was found in the most severe case of lead poisoning. The cases illustrate the need for industrial hygiene measures in this type of work in order to prevent lead intoxication, both in the adult artist and children in the household. However, in some instances of increased lead absorption in persons with lead-related hobbies, sources other than those associated with arts and crafts should be investigated. This alternative is illustrated by a third case, in which firearms training was the more likely source of excessive exposure. Multiple occupational factors must occasionally be considered in evaluating increased lead absorption.

Interstitial pulmonary fibrosis in an automobile body shop worker.

Interstitial pulmonary fibrosis (IPF) is often of uncertain etiology and is therefore named 'idiopathic' pulmonary fibrosis. Some occupational exposures, however, are known to cause interstitial fibrosis, asbestos and silica being well-known examples. We present clinical and pathological findings of a case with IPF and the results of microchemical analysis of inorganic particulate matter in the lung tissue. A very high lung burden of inorganic contaminants was found, including silica and metallic compounds. Emphasis is given to the importance of obtaining detailed occupational histories and conducting microchemical analysis of lung tissue in order to clarify etiological factors in cases with 'idiopathic' pulmonary fibrosis.

Airborne fiber control in buildings during asbestos material removal by amended water methodology.

Removal of friable asbestos-containing material can cause high levels of airborne contamination. The potential efficacy of control methods recommended by the Environmental Protection Agency (EPA) was evaluated by examination of 503 air samples obtained in 40 removal projects in a number of locations. The EPA methodology with amended water for fiber emission control was utilized on all of the observed removal projects. The projects were also considered to be well controlled and the study cannot be considered representative of common work practices. The EPA amended water methodology, when effectively utilized and administered, can provide a high degree of contamination control. Mean fiber levels in the work area in this study (1.1 f/cm3) were well below those of dry removal (38.9 f/cm3) and control by application by untreated water (28.6 f/cm3). Airborne contamination was higher during bagging debris (3.8 f/cm3) than during material removal from structural surfaces. The range of fiber levels during removal was 0.0 to 37.0 f/cm3 and fibers were detected from initial barrier construction through final cleaning. Contamination was also occasionally detected outside work area containment barriers. Air sampling produced 0.0 counts in areas of obvious contamination by settled dust and debris. Control methodologies, respiratory protection, and decontamination are discussed.