Lebensqualität nach Beckenringfrakturen und minimalinvasiver Stabilisierung

Instabile Beckenringfrakturen stellen noch immer eine Herausforderung in der Chirurgie dar. Einer niedrigen Inzidenz steht eine vergleichsweise hohe Mortalitätsrate gegenüber. Gleichzeitig stellen Beckenringfrakturen aufgrund der komplexen Kraftverhältnisse am Beckenring einen hohen Anspruch an die operative Versorgung. Durch schonende minimalinvasive Therapien besteht die Chance, das Outcome für die Patienten weiter zu verbessern. In der vorliegenden Studie wurden 105 konsekutive Patienten untersucht, die in den Jahren 2004 – 2014 Beckenringfrakturen AO/OTA Typ B oder Typ C erlitten hatten und operativ mit einem minimalinvasiven Schrauben-Stab-System (TIFI bzw. ILA) versorgt wurden. Von ihnen wurden demographische und klinische Daten erhoben und die operativen Ergebnisse erfasst. Von 60 Patienten konnte die Lebensqualität als patientenbezogenes, postoperatives Outcome ermittelt werden. Dies erfolgte mit Hilfe zweier etablierter Messinstrumente (SF-36 und EQ-5D). In weiteren Analysen wurden verschiedene Faktoren bezüglich ihres Einflusses auf die Lebensqualität untersucht. Weder die Art der Fraktur noch die Art der operativen Versorgung oder das Repositionsergebnis bzw. die Verletzungsschwere konnten als eindeutige Einflussgrößen auf das Lebensqualitätsoutcome ermittelt werden. Darüber hinaus wurden die Ergebnisse der patientenbezogenen Lebensqualität mit deutschen Normstichproben verglichen. Dabei zeigten sich deutlich reduzierte Werte gegenüber den Referenzpopulationen. Besonders ausgeprägt waren die Einschränkungen in den körperlichen Dimensionen. Der Vergleich mit den Ergebnissen in der Literatur machte deutlich, dass die beiden untersuchten minimalinvasiven Operationsmethoden (TIFI und ILA) zuverlässige und sichere Verfahren zur Versorgung von instabilen Beckenringverletzungen darstellen. Im Rahmen der Studie konnte auch festgestellt werden, dass nach einer Beckenringfraktur die Lebensqualität der Betroffenen deutlich reduziert ist. Eine weitere Verbesserung des Outcomes dieser Patientengruppe erscheint daher notwendig. Hierfür sollte die regelhafte Erhebung und Berücksichtigung der Lebensqualität als Parameter für das patientenbezogene Outcome einen noch höheren Stellenwert einnehmen

Patient-related outcome of unstable pelvic ring fractures stabilized with a minimal invasive screw-rod system

Background: Clinical and radiological outcomes of operatively treated unstable pelvic ring fractures are well documented, whereas little is known about the patient's related outcome. The purpose of this study is to evaluate the patient-reported outcome after minimal invasive treatment of pelvic ring fractures using the SF-36 and EQ-5D medical outcome scores. Methods: Patients with unstable pelvic ring fractures treated in our trauma department with a minimal invasive screw-rod system between 01/2004 and 12/2014 were included. Next to patient data (sex, age), injury related details (fracture type, additional injuries, Injury Severity Score (ISS)) as well as operation details (method, time to operation, general complications, adverse events associated with the surgical procedure, revision surgery, fracture reduction) were assessed. The patient related outcome was evaluated using the SF-36 and the EQ-5D score. Results: A total of 105 patients (57 men; 48 women; mean age 56 +/- 21 years) were identified as candidates for the study. 60 patients completed the SF-36 and EQ-5D score after a mean follow-up of five years (60.5 months (14-142 months)). Of these patients 77% were multiply injured with a mean ISS of 26 +/- 19. Within the respondent group 22% showed type B and 78% type C pelvic ring fractures. In 82% the dorsal pelvic ring fracture was stabilized using a minimally invasive transiliac internal fixator, in 18% an iliolumbar fixation was performed respectively. The mean physical component score of the SF-36 was 37.9 +/- 12.0, the mean mental component score was 49.8 +/- 12.5. The mean EQ-5D VAS reached 70.5 +/- 24.4. Conclusion: Patients being multiply injured and treated with minimal invasive treated dorsal pelvic ring fractures were suffering more especially concerning physical domains compared to the healthy reference population. Nevertheless, the overall patient-related outcome is comparable to pelvic ring fractures in general

Age-Related Attenuation of Dominant Hand Superiority

The decline of motor performance of the human hand-arm system with age is well-documented. While dominant hand performance is superior to that of the non-dominant hand in young individuals, little is known of possible age-related changes in hand dominance. We investigated age-related alterations of hand dominance in 20 to 90 year old subjects. All subjects were unambiguously right-handed according to the Edinburgh Handedness Inventory. In Experiment 1, motor performance for aiming, postural tremor, precision of arm-hand movement, speed of arm-hand movement, and wrist-finger speed tasks were tested. In Experiment 2, accelerometer-sensors were used to obtain objective records of hand use in everyday activities

Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

OBJECTIVE: We investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs). METHODS: We analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021-15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19. Participants reported COVID-19 severity and symptom duration, sociodemographics and clinical characteristics. We reported the proportion experiencing prolonged symptom duration and investigated associations with baseline characteristics using logistic regression. RESULTS: We identified 441 respondents with SARDs and COVID-19 (mean age 48.2 years, 83.7% female, 39.5% rheumatoid arthritis). The median COVID-19 symptom duration was 15 days (IQR 7, 25). Overall, 107 (24.2%) respondents had prolonged symptom duration (≥28 days); 42/429 (9.8%) reported symptoms lasting ≥90 days. Factors associated with higher odds of prolonged symptom duration included: hospitalisation for COVID-19 vs not hospitalised and mild acute symptoms (age-adjusted OR (aOR) 6.49, 95% CI 3.03 to 14.1), comorbidity count (aOR 1.11 per comorbidity, 95% CI 1.02 to 1.21) and osteoarthritis (aOR 2.11, 95% CI 1.01 to 4.27). COVID-19 onset in 2021 vs June 2020 or earlier was associated with lower odds of prolonged symptom duration (aOR 0.42, 95% CI 0.21 to 0.81). CONCLUSION: Most people with SARDs had complete symptom resolution by day 15 after COVID-19 onset. However, about 1 in 4 experienced COVID-19 symptom duration 28 days or longer; 1 in 10 experienced symptoms 90 days or longer. Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs

Nekrotisierende Myositis des Oberschenkels

Infektionen des muskuloskeletalen Systems sind in der Unfallchirurgie mitunter die Krankheitsbilder, die Patienten am gravierendsten beeinträchtigen, Ärzte fachlich sowie Kliniken und das Gesundheitssystem ökonomisch herausfordern. Das systemische „Capillary-leak“-Syndrom (SCLS) ist ein seltenes idiopathisches Syndrom, welches auch bei harmlosen Infektionen fulminante lebensbedrohliche Verläufe provozieren kann. Neben einer übersichtlichen Darstellung des SCLS wird über einen betroffenen Patienten, der infolge einer instabilen Narbe eine nekrotisierende Myositis des Oberschenkels entwickelte, berichtet

Sensitivity for multimorbidity: The role of diagnostic uncertainty of physicians when evaluating multimorbid video case-based vignettes

BACKGROUND: Multimorbidity can be defined as the co-occurrence of two or more chronic medical conditions in one person. Within the diagnostic process, accurately detecting a multimorbid disease pattern still poses a major challenge for most physicians, and is known as a source of diagnostic uncertainty. OBJECTIVE: We investigated, how sensitive, confident, and accurate physicians are in diagnosing multimorbid versus monomorbid patients. METHODS: We created eight video case-based vignettes, which differed in type of morbidity (multimorbid versus monomorbid), field of medical specialization (somatic versus mental), and relatedness of underlying diseases (causally related versus unrelated). In total, 74 physicians (GPs, residents in an emergency department and psychiatrists) watched three to five randomly allocated video cases and had to generate suspected diagnoses at the end of each of three video sequences. Additionally, participating physicians rated subjective confidence for all mentioned diagnoses and for three sequences per case with the help of confidence profiles. RESULTS: Altogether, physicians made a large number of accurate diagnoses (69%). Nevertheless, the overall number of underdiagnosed multimorbid cases (misses) was significantly higher (71%) than over-diagnosed monomorbid cases (false alarms) (7%). DISCUSSION: According to Signal Detection Theory, GPs and psychiatrists both showed lower detection performance for medical cases that lay beyond their own field of specialization. Remarkably, residents show the highest sensitivity for multimorbid cases with an approximately identically detection performance d' slightly over 1 for both field of medical specialization (somatic and mental). Furthermore, higher uncertainty in diagnosing multimorbid cases is related to lower confidence especially at the beginning of a diagnostic process, as well as to unrelated and therefore probably rare disease pattern. Several limitations of the study and the video case-based vignettes are described within the discussion section. CONCLUSIONS: Physicians have to be sensitized for multimorbidity even more, and have to be taught in the prevalence of existing disease combinations. Communicating uncertainty with other specialists could be helpful when faced with a sometimes "fuzzy" pattern of symptoms

Surfactin Shows Relatively Low Antimicrobial Activity against Bacillus subtilis and Other Bacterial Model Organisms in the Absence of Synergistic Metabolites

Surfactin is described as a powerful biosurfactant and is natively produced by Bacillus subtilis in notable quantities. Among other industrially relevant characteristics, antimicrobial properties have been attributed to surfactin-producing Bacillus isolates. To investigate this property, stress approaches were carried out with biotechnologically established strains of Corynebacterium glutamicum, Bacillus subtilis, Escherichia coli and Pseudomonas putida with the highest possible amounts of surfactin. Contrary to the popular opinion, the highest growth-reducing effects were detectable in B. subtilis and E. coli after surfactin treatment of 100 g/L with 35 and 33%, respectively, while P. putida showed no growth-specific response. In contrast, other antimicrobial biosurfactants, like rhamnolipids and sophorolipids, showed significantly stronger effects on bacterial growth. Since the addition of high amounts of surfactin in defined mineral salt medium reduced the cell growth of B. subtilis by about 40%, the initial stress response at the protein level was analyzed by mass spectrometry, showing induction of stress proteins under control of alternative sigma factors σB and σW as well as the activation of LiaRS two-component system. Overall, although surfactin is associated with antimicrobial properties, relatively low growth-reducing effects could be demonstrated after the surfactin addition, challenging the general claim of the antimicrobial properties of surfactin

Forschungsportal Bach

Ziel des Projekts „Forschungsportal Bach“ ist der Aufbau eines umfassenden Online-Repositoriums, das Zugang zu allen erhaltenen Dokumenten der Musikerfamilie Bach – der einflussreichsten Familiendynastie in der Musikgeschichte – vom späten 16. bis zum frühen 19. Jahrhundert bietet. Zum ersten Mal in der Geschichte der Bachforschung wird das Material, das in Bibliotheken, Archiven und Privatsammlungen erhalten ist, digital erfasst, indiziert, verarbeitet, annotiert und via Online-Portal zugänglich gemacht. Die digitalisierten Dokumente werden mittels „Transkribus“ automatisch transkribiert, mit Hilfe des TEI Publishers annotiert und schließlich als digitale Edition veröffentlicht. Dabei werden u.a. die in den Dokumenten erwähnten Werke sowie Wasserzeichen ausgewählter Archivalien mit dem Portal „Bach digital“ verknüpft

Forschungsportal Bach

Ziel des Projekts „Forschungsportal Bach“ ist der Aufbau eines umfassenden Online-Repositoriums, das Zugang zu allen erhaltenen Dokumenten der Musikerfamilie Bach – der einflussreichsten Familiendynastie in der Musikgeschichte – vom späten 16. bis zum frühen 19. Jahrhundert bietet. Zum ersten Mal in der Geschichte der Bachforschung wird das Material, das in Bibliotheken, Archiven und Privatsammlungen erhalten ist, digital erfasst, indiziert, verarbeitet, annotiert und via Online-Portal zugänglich gemacht. Die digitalisierten Dokumente werden mittels „Transkribus“ automatisch transkribiert, mit Hilfe des TEI Publishers annotiert und schließlich als digitale Edition veröffentlicht. Dabei werden u.a. die in den Dokumenten erwähnten Werke sowie Wasserzeichen ausgewählter Archivalien mit dem Portal „Bach digital“ verknüpft