In Search of Benchmarking for Mortality Following Multiple Trauma: A Swiss Trauma Center Experience

Background: The manifestations associated with non-survival after multiple trauma may vary importantly between countries and institutions. The aim of the present study was to assess the quality of performance by comparing actual mortality rates to the literature. Methods: The study involved evaluation of a prospective consecutive multiple trauma cohort (injury severity score, ISS>16) primarily admitted to a university hospital. Univariate and multivariate testing of routine parameters and scores, such as the Trauma and Injury Severity Score (TRISS), was used to determine their predictive powers for mortality. Results: The 30-day mortality of 22.8% (n=54) exactly matched predicted TRISS versions of Champion or the Major Trauma Outcome Study for our 237 multiple trauma patients (42.8±20.9years; ISS 29.5±11.5). Univariate analysis revealed significant differences between survivors and non-survivors when compared for age, ISS, Glasgow coma scale (GCS), pulse oximeter saturation (SapO2), hemoglobin, prothrombin time, and lactate. In multivariate analysis, age, ISS, and GCS (P<0.001 each) functioned as major independent prognostic parameters of both 24h and 30-day mortality. Various TRISS versions hardly differed in their precision (area under the curve [AUC] 0.83-0.84), but they did differ considerably in their level of requirement, with the TRISS using newer National Trauma Data Bank coefficients (NTDB-TRISS) offering the highest target benchmark (predicted mortality 13%, Z value -5.7) in the prediction of 30-day mortality. Conclusions: Because of the current lack of a single, internationally accepted scoring system for the prediction of mortality after multiple trauma, the comparison of outcomes between medical centers remains unreliable. To achieve effective quality control, a practical benchmarking model, such as the TRISS-NTDB, should be used worldwid

BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2 – a multi-centre randomized patient and observer blind non-inferiority trial

Background: Roux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation. A systematic review revealed a similar excess weight loss (EWL) 2 years postoperatively between SG and RYGB. However, there is a lack of randomized controlled multi-centre trials comparing SG and RYGB, not only concerning EWL, but also in terms of remission of obesity-related co-morbidities, gastroesophageal reflux disease (GERD) and quality of life (QoL) in the mid- and long-term. Methods: The BariSurg trial was designed as a multi-centre, randomized controlled patient and observer blind trial. The trial protocol was approved by the corresponding ethics committees of the centres. To demonstrate EWL non-inferiority of SG compared to RYGB, power calculation was performed according to a non-inferiority study design. Morbidity, mortality, remission of obesity-related co-morbidities, GERD course and QoL are major secondary endpoints. 248 patients between 18 and 70 years, with a body mass index (BMI) between 35–60 kg/m2 and indication for bariatric surgery according to the most recent German S3-guidelines will be randomized. The primary and secondary endpoints will be assessed prior to surgery and afterwards at discharge and at the time points 3–6, 12, 24, 36, 48 and 60 months postoperatively. Discussion: With its five year follow-up, the BariSurg-trial will provide further evidence based data concerning the impact of SG and RYGB on EWL, remission of obesity-related co-morbidities, the course of GERD and QoL. Trial registration: The trial protocol has been registered in the German Clinical Trials Register DRKS0000476

Epigenetic dynamics of monocyte-to-macrophage differentiation

Background Monocyte-to-macrophage differentiation involves major biochemical and structural changes. In order to elucidate the role of gene regulatory changes during this process, we used high-throughput sequencing to analyze the complete transcriptome and epigenome of human monocytes that were differentiated in vitro by addition of colony-stimulating factor 1 in serum-free medium. Results Numerous mRNAs and miRNAs were significantly up- or down-regulated. More than 100 discrete DNA regions, most often far away from transcription start sites, were rapidly demethylated by the ten eleven translocation enzymes, became nucleosome-free and gained histone marks indicative of active enhancers. These regions were unique for macrophages and associated with genes involved in the regulation of the actin cytoskeleton, phagocytosis and innate immune response. Conclusions In summary, we have discovered a phagocytic gene network that is repressed by DNA methylation in monocytes and rapidly de-repressed after the onset of macrophage differentiation

Factors associated with reduced longer-term capacity to work in patients after polytrauma : a Swiss trauma center experience

Knowledge of the factors associated with longer-term reduced capacity to work (RCW) is lacking in patients after polytrauma

In search of benchmarking for mortality following multiple trauma : a Swiss trauma center experience

BACKGROUND: The manifestations associated with non-survival after multiple trauma may vary importantly between countries and institutions. The aim of the present study was to assess the quality of performance by comparing actual mortality rates to the literature. METHODS: The study involved evaluation of a prospective consecutive multiple trauma cohort (injury severity score, ISS 0.001 each) functioned as major independent prognostic parameters of both 24 h and 30-day mortality. Various TRISS versions hardly differed in their precision (area under the curve [AUC] 0.83-0.84), but they did differ considerably in their level of requirement, with the TRISS using newer National Trauma Data Bank coefficients (NTDB-TRISS) offering the highest target benchmark (predicted mortality 13%, Z value -5.7) in the prediction of 30-day mortality. CONCLUSIONS: Because of the current lack of a single, internationally accepted scoring system for the prediction of mortality after multiple trauma, the comparison of outcomes between medical centers remains unreliable. To achieve effective quality control, a practical benchmarking model, such as the TRISS-NTDB, should be used worldwide

Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II Score compared with trauma scores in the outcome of multiple-trauma patients

Prospective data regarding the prognostic value of the Sequential Organ Failure Assessment (SOFA) score in comparison with the Simplified Acute Physiology Score (SAPS II) and trauma scores on the outcome of multiple-trauma patients are lacking

Hibiscus rosa-sinensis L.

原著和名: ブッサウゲ科名: アオイ科 = Malvaceae採集地: 鹿児島県 肝属郡 佐多町 (大隅 肝属郡 佐多町)採集日: 1961/8/18採集者: 萩庭丈壽整理番号: JH026717国立科学博物館整理番号: TNS-VS-97671