Effect of sodium lactate on the microbiological quality and shelf life of sausages

This study was performed to investigate the effects of various levels of sodium lactate on the microbiological quality and shelf life of sausages, and determine whether it can be used as a nitrite alternative. For this purpose, 0%, 0.6%, 1.2%. and 1.8% NaL and 0.125% NaNO2 were added to sausage samples. Samples were vacuum-packaged and stored at 4 degrees C for 60 days and periodically analyzed for their sensorial properties, microbial counts (aerobic plate count, lactic acid bacteria, yeast-mould, and sulphite reducing anaerobic bacteria), and pH values. Sensorial characteristics were not altered with NaL addition; the flavor of the samples was partially improved. In contrast to red-pinkish color in NaNO2 containing samples, natural meat color was preserved in the lactate containing ones. NaL delayed microbial growth depending on the concentration used. There was a significant increase in the shelf life of the samples containing NaL compared to the control group. NaL caused no change in pH values during storage that would affect the microbial quality of the samples. This study indicated that the addition of NaL to sausages improved their microbiological quality depending on the concentration used, extended their shelf life, and exhibited a better antimicrobial effect than NaNO2

Burn Guidelines—An International Comparison

Burn injuries can be life-threatening, thus standardized procedures are essential to ensure the best medical care is provided after injury. Therefore, burn care guidelines were created throughout the world. There are many similarities within the different burn guidelines, especially in basic burn care procedures. Taking a closer look, it becomes clear that there are also a lot of disparities within the guidelines. In this review the guidelines of the German Society of Burn Treatment (DGV), British Burn Association (BBA), European Burns Association (EBA), American Burn Association (ABA), Australian and New Zealand Burn Association (ANZBA), and the International Society for Burn Injuries (ISBI) are compared. The DGV-guidelines focus on pre-hospital treatment measures, intensive care treatment and acute wound therapy, whereas the BBA puts emphasis on infrastructure and staff qualification. The EBA created guidelines for medical practitioners and non-medical staff to standardize burn care in European countries with special focus on clear treatment recommendations and best infrastructural facilities. The ABA underlines the need for best qualified medical staff and ABLS- (Advanced Burn Life Support) standards. The ANZBA focuses on best treatment options including novel wound healing biotechnologies and post-burn return-to-function rehabilitation. In contrast to all other guidelines, the ISBI does not only deal with burn care in developed countries but also in resource-limited settings. Special focus lies on the discussion of ethical issues and cost-effectiveness. In this review, advantages and disadvantages of each guideline are discussed. These findings are supposed to help improving burn care procedures worldwide

E-cigarette explosions: patient profiles, injury patterns, clinical management, and outcome

Background: E-cigarette abuse, also known as vaping, is a widespread habit. Recently, there have been increasing reports of explosions of these devices resulting in serious burn injuries, especially to the groin, hand, and face. Overheating rechargeable lithium-ion batteries are supposed to be the responsible mechanism, especially in low quality fabrications. Methods: In this single-center retrospective study, data of 46 patients are presented and analyzed. In addition to information on demographics, injury patterns, and treatment options, this is the first study investigating outcome after an average of 13 months via a standardized telephone interview of 31 patients (67%). Patients were specifically asked regarding their outcome, vaping habits, technical modifications to their devices and supply source. Results: Patients were mainly male (98.2%) with a median age of 36 years. Typical injury patterns included the groin region (n = 32; 69%), hands (n = 12; 25%) and face (n = 3; 7%). All patients underwent debridement, in nine cases hydrotherapeutically. 61% (n = 28) underwent consecutive tangential necrectomy and subsequent split thickness skin graft transplantation. Wound infection was observed in 18 patients (39%), with burn depth as a significant risk factor (p < 0.001). 91% of the followed-up patients were satisfied. Surprisingly, 38% were still using e-cigarettes. 42% (n = 13) reported manual modifications of their devices to prolong battery life or increasing smoke production. Conclusions: Injuries from exploding e-cigarettes can be serious and should be treated in a specialized burn center. E-cigarette explosions lead to characteristic injury patterns and often need surgical treatment. This should be made more public to reduce their use and keep people from modifying the devices. The counterintuitive and irrational observation of a high rate of abuse even after the injury underlines their addiction potential

Schnappender Finger bei Kindern mit Hurler-Syndrom - Verteilungsmuster und Behandlungsmöglichkeiten

Introduction: Mucopolysaccharidosis is a rare and congenital autosomal recessive lysosomal storage disorder of glycosaminoglycans. An enzyme defect leads to cell, tissue and organ dysfunction. Carpal tunnel syndrome and trigger finger are the results of mucopolysaccharid deposition.Material and methods: We are treating 6 patients with mucopolysaccharide associated trigger fingers in an interdisciplinary setting with the department of pediatric hematology and oncology at Hannover Medical School, where each patient is examined inter alia for symptoms of trigger finger annually.Besides an interview of the parents about abnormalities with regard to hand function, pain and/or neurologic symptoms the children are examined by palpation and by assessment of the active and passive range of finger motion.In the case of finger locking due to an impaired excursion of the flexor tendons in the A2 and A3 pulley region, we performed a trap-door incision technique for A2 pulley widening and a simple release of the A3 pulley.Results: In 6 patients 43 fingers were affected. The average age was 10 years. Pulley thickening was palpated in 19 fingers of to the left hand and 24 fingers of the right hand. In 7 fingers the A1 pulley was affected, in 28 fingers the A2 pulley and in 25 fingers the A3 pulley. The A4 and A5 pulley were not affected in any case. Trigger symptoms were seen in 13 fingers. Five of the 6 children were given an operation indication. In these cases we performed carpal tunnel release, release of Loge de Guyon, and trigger finger release, either in combination or alone. In all cases the procedure led to pain relief and functional improvement.Conclusion: The treatment of trigger fingers in children with mucopolysaccharidosis as a rare disease is challenging with regard to diagnostics and indication.The main treatment goal is pain relief and improvement of hand function.Einleitung: Die Mukopolysaccharidose ist eine seltene und angeborene, autosomal rezessive und lysosomale Speicherkrankheit von Glykosaminoglykanen. Ein Enzymdefekt führt zu Zell-, Gewebe- und Organfunktionsstörungen. Das Karpaltunnelsyndrom und der schnappende Finger sind die Folge der Mukopolysaccharidablagerungen.Material und Methode: Wir behandeln zurzeit 6 Patienten mit Mucopolysaccharid-assoziiertem Schnappfinger in einem interdisziplinären Setting zusammen mit der Abteilung für pädiatrische Hämatologie und Onkologie an der Medizinischen Hochschule Hannover. Jeder Patient wird im Rahmen der jährlichen Kontrolluntersuchungen unter anderem im Hinblick auf die Symptome eines schnappenden Fingers hin untersucht.Neben einer detaillierten Befragung der Eltern zu bestehenden Funktionsstörungen der Hände ihrer Kinder, begleitenden Schmerzen und/ oder neurologischen Symptomen werden die Kinder eingehend klinisch durch Palpation und mit Bestimmung der aktiven und passiven Beweglichkeit der Finger untersucht.In den Fällen mit auslösbarem Schnappphänomen der betroffenen Finger und Blockade auf Höhe der A2- und A3-Ringbänder wurde die Indikation zur A2-Ringbanderweiterungsplastik und A3-Ringbandspaltung gestellt.Ergebnisse: Bei den 6 untersuchten Patienten waren insgesamt 43 Finger betroffen. Das durchschnittliche Alter der Kinder lag bei 10 Jahren. Eine Verdickung der Ringbänder fand sich bei 19 Fingern der linken Hand und bei 24 Fingern der rechten Hand. Bei 7 Fingern war das A1-Ringband betroffen, bei 28 Fingern das A2-Ringband und bei 25 Fingern das A3-Ringband. Das A4- und A5-Ringband war bei keinem der untersuchten Patienten betroffen. Ein Schnappphänomen beobachteten wir bei insgesamt 13 Fingern. Bei 5 der 6 Kinder stellten wir eine Operationsindikation. In diesen Fällen erfolgten, entweder kombiniert oder isoliert, eine Karpaldachspaltung, eine Spaltung der Loge de Guyon und eine A2-Ringbanderweiterungsplastik und A3-Ringbandspaltung. In allen Fällen führte der Eingriff zu einer Schmerzfreiheit und Funktionsverbesserung der Hände durch Ausbleiben der Fingerblockade. Fazit: Die Behandlung des schnappenden Fingers bei Hurler-Kindern betrifft v.a. das A2- und A3-Ringband und erfordert eine genaue Diagnostik und Indikationsstellung. Schmerzfreiheit und die Funktionsverbesserung der Hände sind das primäre Ziel

Botulinum Toxin Versus Placebo: A Meta-Analysis of Treatment and Quality-of-life Outcomes for Hyperhidrosis

Aims!#!This study aims at assessing the treatment effect, disease severity and quality-of-life outcomes of botulinum toxin (BTX) injections for focal hyperhidrosis.!##!Methods!#!We included randomized controlled trials of BTX injections compared with placebo for patients with primary or secondary focal hyperhidrosis. PubMed, Embase and the Cochrane Library were searched to August 2020. Gravimetric sweat rate reduction, disease severity measured by Hyperhidrosis Disease Severity Scale and quality-of-life assessment measured by Dermatology Life Quality Index were the outcomes of interest. Cochrane risk-of-bias tools were employed for quality assessment of given randomized controlled trials.!##!Results!#!Eight studies met our inclusion criteria (n=937). Overall, risk bias was mixed and mostly moderate. BTX injections showed reduced risk in comparison with placebo for the gravimetric quantitative sweat reduction of &amp;gt; 50 % from baseline (risk difference: 0.63, 95% CI 0.51 to 0.74). Additionally, improvements were seen for disease severity and quality-of-life assessments evaluated by Hyperhidrosis Disease Severity Score reduction of ≥ 2 points (risk difference: 0.56, 95% CI 0.42 to 0.69) and mean change in Dermatology Life Quality Index (mean difference: - 5.55, 95% CI - 7.11 to - 3.98). The acquired data were insufficient to assess for long-term outcomes and limited to an eight-week follow-up period.!##!Conclusions!#!In focal axillary hyperhidrosis, BTX significantly reduces sweat production and yields superior outcomes in assessments of disease severity and quality-of-life. However, the quality-of-evidence is overall moderate and included studies account for short-term trial periods only. Further studies assessing BTX in comparison with first-line treatments for hyperhidrosis are warranted.!##!Level of evidence iii!#!This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Infektion nach zahnärztlichem Eingriff. Zahnärztliche oder allgemeinmedizinische Ursache? Ein Fallbericht

Whenever a dentist is dealing with abscess formation in the oral and maxillofacial region, it is mostly from dental origins. However, sometimes uncommon (co-)factors are present and responsible for major complications. Many general conditions or medications can significantly influence the course of an inflammation. It might spread faster and wider and also be resistant to "correct" therapy. This case report should raise awareness about general conditions supporting inflammation and demonstrate the importance of interdisciplinary treatment in these situations. A 76-year-old patient was referred to the maxillofacial surgery clinic after extraction of two teeth resulted in therapy-resistant painful swelling. Her dentist already had initiated "standard" therapy including Ponstan® (mefenamic acid) and Clamoxyl® (amoxicillin) without success. Initial blood testing came back with severe agranulocytosis. Immediately all potentially myelosuppressing drugs were stopped while myelosupporting drugs were prescribed. Under close interdisciplinary treatment conditions, healing was then uneventful without the necessity of surgical intervention. The challenge in inflammation treatment is to identify patients with uncommonly severe, fast-progressing, or therapy-resistant disease as early as possible. Further examination including blood workup for several medical parameters is indispensable in those patients

Anatomic relations between the lateral collateral ligament and the radial head: implications for arthroscopic resection of the synovial fold of the elbow

The purpose of this study was to determine the anatomic relationship between the radial head and the lateral collateral ligament (LCL) and when the LCL would be at risk of iatrogenic injury during arthroscopic resection of the synovial fold. Thirty-four formalin-fixed upper extremities were dissected. A projection of the LCL onto the radial head was marked with a needle. The percentage of the posterior border of the radial head overlaid by the LCL was digitally measured. A portion of the projection of the LCL was statistically correlated with the overall diameter of the radial head. The overall diameter of the radial head was 21.2 mm +/- A 2.3. The proportionate projection of the medial border of the LCL onto the radial head was 5.3 +/- A 1.6 mm on average. The lateral 25 % of the radial head was overlaid by the LCL with a maximum value of 40 % on average. The inter- and intraobserver reliability showed very good accordance with the digital measurements (r > 0.8). Care must be taken when performing a resection in the lateral 40 % of the radial head, whereas resection in the medial 60 % of the radial head appears to be safe. The LCL is an important stabiliser of the elbow joint, a lesion of which by undeliberate arthroscopic dissection may lead to joint instability. Iatrogenic injury to the LCL presumably can be prevented when respecting the given data. Experimental study

In Vitro Differentiation of Myoblast Cell Lines on Spider Silk Scaffolds in a Rotating Bioreactor for Vascular Tissue Engineering

Functional construction of tissue-engineered vessels as an alternative to autologous vascular grafts has been shown to be feasible, however the proliferation of seeded smooth-muscle cells remains a limiting factor. We employed a rotating bioreactor system to improve myoblast cell differentiation on a spider silk scaffold for tissue-engineered vessel construction. C2C12 myofibroblast cells were seeded on the surface of spider silk scaffold constructs and cultivated in a rotating bioreactor system with a continuous rotation speed (1 rpm). Cell function, cell growth and morphological structure and expression of biomarkers were analyzed using scanning electron microscopy, the LIVE/DEAD&reg; assay, Western blot and quantitative real-time PCR analyses. A dense myofibroblast cell sheet could be developed which resembled native blood vessel muscular tissue in morphological structure and in function. Bioreactor perfusion positively affected cell morphology, and increased cell viability and cell differentiation. The expression of desmin, MYF5 and MEF2D surged as an indication of myoblast differentiation. Cell-seeded scaffolds showed a tear-down at 18 N when strained at a set speed (20 mm min&minus;1). Spider silk scaffolds appear to offer a reliable basis for engineered vascular constructs and rotating bioreactor cultivation may be considered an effective alternative to complex bioreactor setups to improve cell viability and biology