Konzeption und Entwicklung einer universellen, kosteneffizienten und unbemannten Flugrettungsplattform

To this day, charities have not been able to provide individual help for people in need. The aim of the thesis was to develop and construct a universal aerial transporter which could be used to support charities in disaster scenarios. The focus was on the technical development based on the results of a feasibility study. The main requirements for the development were in particular: the lowest possible cost for acquisition and maintenance, providing an easy way of reproduction and the ability to control the system using mobile devices. The legal aspects and the collision avoidance were given less priority or were not considered. In order to identify the current capabilities of charities and their actual problems, a survey among different organisations was done. The results suggested the need for a transport solution. As suitable transport solutions already exist for goods of a mass of at least 50 kg and a transport distance of not less than 100 km, this thesis focuses on the development of a solution below that range and mass. Various other research works were considered, and it became obvious that most of the research was not concerned with the individual support in rescue operations. These findings were used to gather the requirements for the solution. Subsequently, a market research was carried out and possible solutions were compared. As it became apparent that there was no suitable solution available, it was decided to develop a new aerial vehicle. To this end every part that was needed and suitable was individually compared and selected. After the transport vehicle had been developed, the system was built. Parts which were not available, especially for the frame and the universal mounting system, were also developed and produced. In order to increase the flight time of the vehicle, materials of a very low mass were used. During the project a prototype of a universal and unmanned aerial vehicle was successfully developed and constructed. For the transport of different types of goods two different types of universal payload mounting systems were designed. The latter was capable of holding goods with a mass of up to 5 kg. The system allows control of the vehicle in a very convenient way using a mobile device like a smartphone or a tablet. No regular remote control was needed, though still being supported by the system. By means of an android application missions could be created and transmitted wirelessly to the vehicle. After the transmission the system performed the mission autonomously. Due to an insufficient stiffness of the frame, a longer flight test is still outstanding. The automatic release of the payload at the destination required an adjustment of the used application or at least a regular radio control in range. The servo motors used for the mounting system tended to yaw their arms and also required a permanent power supply. Further developments should review the use of alternative motors for the mounting system.Hilfsorganisationen waren bisher nicht in der Lage, Menschen in Notsituationen individuell zu helfen. Das Ziel der Arbeit war daher, die Entwicklung und den Bau eines universellen Flugsystems zum Transport von Lasten, welches in der Lage ist, Hilfsorganisationen in Katastrophenszenarien zu unterstützen. Der Fokus lag dabei auf der Entwicklung einer technischen Lösung in Anlehnung an eine Machbarkeitsstudie. Bei der Entwicklung wurde vor allen Dingen auf möglichst niedrige Anschaffungs- und Wartungskosten, eine leichte Reproduzierbarkeit und die Möglichkeit einer sehr einfachen Steuerung geachtet. Rechtliche und Zulassungsaspekte wurden nur am Rande berücksichtigt. Ein System zur Kollisionsverhütung war nicht Bestandteil der Arbeit. Um herauszufinden, was die aktuellen Möglichkeiten und Probleme von Hilfsorganisationen sind, wurde eine Umfrage unter vielen großen Hilfsorganisationen durchgeführt. Diese sorgte dafür, dass sich die Notwendigkeit einer Transportlösung herauskristallisierte. Da die aktuelle Versorgung mit Gütern ab 50 kg und über eine Distanz von 100 km bereits sehr gut funktioniert, wurde der Fokus auf die Entwicklung einer Transportlösung unterhalb dieses Bereichs konzentriert. Viele sehr interessante Forschungsarbeiten wurden im Rahmen der Arbeit studiert, führten jedoch zu der Erkenntnis, dass sich die meisten Forschungsarbeiten nicht mit der individuellen Versorgung von Personen in Not beschäftigen. Anschließend wurden aus den gewonnenen Erkenntnissen die Anforderungen für die zu entwickelnde Lösung zusammengetragen. Um die Möglichkeit zur Nutzung einer bestehenden Lösung zu überprüfen, wurde eine Marktrecherche durchgeführt und mögliche Systeme miteinander verglichen. Dies führte zu der Erkenntnis, dass aktuell keine fertige und geeignete Lösung existiert und eine neue entwickelt und gebaut werden musste. Dafür wurden alle benötigten Teile mit aktuell verfügbaren und geeignet scheinenden Teilen verglichen und daraus ein System entwickelt. Teile, welche nicht beschaffbar waren, wurden ebenfalls neu entwickelt und selbst hergestellt. Um eine möglichst lange Flugzeit des Fluggeräts zu erreichen, wurde bei der Entwicklung ein Fokus auf die Verwendung von Leichtbaumaterialien gelegt

Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature

INTRODUCTION: Systemic inflammatory response syndrome is common after surgery, and it can be difficult to discriminate between infection and inflammation. We performed a review of the literature with the aims of describing the evolution of serum procalcitonin (PCT) levels after uncomplicated cardiac surgery, characterising the role of PCT as a tool in discriminating infection, identifying the relation between PCT, organ failure, and severity of sepsis syndromes, and assessing the possible role of PCT in detection of postoperative complications and mortality. METHODS: We performed a search on MEDLINE using the keyword 'procalcitonin' crossed with 'cardiac surgery,' 'heart,' 'postoperative,' and 'transplantation.' Our search was limited to human studies published between January 1990 and June 2006. RESULTS: Uncomplicated cardiac surgery induces a postoperative increase in serum PCT levels. Peak PCT levels are reached within 24 hours postoperatively and return to normal levels within the first week. This increase seems to be dependent on the surgical procedure and on intraoperative events. Although PCT values reported in infected patients are generally higher than in non-infected patients after cardiac surgery, the cutoff point for discriminating infection ranges from 1 to 5 ng/ml, and the dynamics of PCT levels over time may be more important than absolute values. PCT is superior to C-reactive protein in discriminating infections in this setting. PCT levels are higher with increased severity of sepsis and the presence of organ dysfunction/failure and in patients with a poor outcome or in those who develop postoperative complications. PCT levels typically remain unchanged after acute rejection but increase markedly after bacterial and fungal infections. Systemic infections are associated with greater PCT elevation than is local infection. Viral infections are difficult to identify based on PCT measurements. CONCLUSION: The dynamics of PCT levels, rather than absolute values, could be important in identifying patients with infectious complications after cardiac surgery. PCT is useful in differentiating acute graft rejection after heart and/or lung transplantation from bacterial and fungal infections. Further studies are needed to define cutoff points and to incorporate PCT levels in useful prediction models

Importance of endothelial nitric oxide synthase for the hypothermic protection of lungs against ischemia-reperfusion injury

ObjectivesThe hypothesis that the protective effects of mild hypothermia against the pulmonary ischemia-reperfusion injury are mediated by endothelial nitric oxide synthase was tested.MethodsEndothelial nitric oxide synthase knock-out and wild-type mice were sham operated or underwent a 1-hour occlusion of the left pulmonary hilum, followed by 5 hours of reperfusion. Temperature in the left pleural cavity during ischemia was maintained at either 36°C (normothermia) or 32°C (hypothermia). Inflammatory response (myeloperoxidase activity), endothelial barrier function (extravasation of Evans blue–labeled albumin), and endothelial nitric oxide synthase expression and phosphorylation were determined at the end of reperfusion.ResultsAfter normothermic ischemia both strains had a similar mortality (wild-type, 22.9%; knock-out, 15.4%), which was completely abolished by hypothermia. Endothelial barrier function was disturbed after normothermic ischemia in both wild-type and knock-out mice. Mild hypothermia significantly reduced pulmonary Evans blue extravasation in wild-type mice, but not in knock-out mice. Myeloperoxidase activity increased after normothermic ischemia to the same degree in both strains. This response was significantly attenuated by hypothermia in wild-type mice, but not in knock-out mice. In wild-type mice, endothelial nitric oxide synthase expression and phosphorylation were higher after hypothermic ischemia than after normothermic ischemia. No effect of ischemia on expression of inducible nitric oxide synthase was found in wild-type or knock-out mice.ConclusionHypothermic protection against pulmonary ischemia-reperfusion injury is dependent on endothelial nitric oxide synthase and is associated with increased expression and phosphorylation of endothelial nitric oxide synthase

Impact of an in-hospital endocarditis team and a state-wide endocarditis network on perioperative outcomes

Background: Infective endocarditis (IE) requires multidisciplinary management. We established an endocarditis team within our hospital in 2011 and a state-wide endocarditis network with referring hospitals in 2015. We aimed to investigate their impact on perioperative outcomes. Methods: We retrospectively analyzed data from patients operated on for IE in our center between 01/2007 and 03/2018. To investigate the impact of the endocarditis network on referral latency and pre-operative complications we divided patients into two eras: before ( n = 409) and after ( n = 221) 01/2015. To investigate the impact of the endocarditis team on post-operative outcomes we conducted multivariate binary logistic regression analyses for the whole population. Kaplan–Meier estimates of 5-year survival were reported. Results: In the second era, after establishing the endocarditis network, the median time from symptoms to referral was halved (7 days (interquartile range: 2–19) vs. 15 days (interquartile range: 6–35)), and pre-operative endocarditis-related complications were reduced, i.e., stroke (14% vs. 27%, p < 0.001), heart failure (45% vs. 69%, p < 0.001), cardiac abscesses (24% vs. 34%, p = 0.018), and acute requirement of hemodialysis (8% vs. 14%, p = 0.026). In both eras, a lack of recommendations from the endocarditis team was an independent predictor for in-hospital mortality (adjusted odds ratio: 2.12, 95% CI: 1.27–3.53, p = 0.004) and post-operative stroke (adjusted odds ratio: 2.23, 95% CI: 1.12–4.39, p = 0.02), and was associated with worse 5-year survival (59% vs. 40%, log-rank < 0.001). Conclusion: The establishment of an endocarditis network led to the earlier referral of patients with fewer pre-operative endocarditis-related complications. Adhering to endocarditis team recommendations was an independent predictor for lower post-operative stroke and in-hospital mortality, and was associated with better 5-year survival

Intracellular immune sensing promotes inflammation via gasdermin D–driven release of a lectin alarmin

Inflammatory caspase sensing of cytosolic lipopolysaccharide (LPS) triggers pyroptosis and the concurrent release of damage-associated molecular patterns (DAMPs). Collectively, DAMPs are key determinants that shape the aftermath of inflammatory cell death. However, the identity and function of the individual DAMPs released are poorly defined. Our proteomics study revealed that cytosolic LPS sensing triggered the release of galectin-1, a β-galactoside-binding lectin. Galectin-1 release is a common feature of inflammatory cell death, including necroptosis. In vivo studies using galectin-1-deficient mice, recombinant galectin-1 and galectin-1-neutralizing antibody showed that galectin-1 promotes inflammation and plays a detrimental role in LPS-induced lethality. Mechanistically, galectin-1 inhibition of CD45 (Ptprc) underlies its unfavorable role in endotoxin shock. Finally, we found increased galectin-1 in sera from human patients with sepsis. Overall, we uncovered galectin-1 as a bona fide DAMP released as a consequence of cytosolic LPS sensing, identifying a new outcome of inflammatory cell death.Fil: Russo, Ashley J.. UConn Health School of Medicine; Estados UnidosFil: Vasudevan, Swathy O.. UConn Health School of Medicine; Estados UnidosFil: Mendez Huergo, Santiago Patricio. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Kumari, Puja. UConn Health School of Medicine; Estados UnidosFil: Menoret, Antoine. UConn Health School of Medicine; Estados UnidosFil: Duduskar, Shivalee. Jena University Hospital; AlemaniaFil: Wang, Chengliang. UConn Health School of Medicine; Estados UnidosFil: Pérez Sáez, Juan Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Fettis, Margaret M.. University of Florida; Estados UnidosFil: Li, Chuan. UConn Health School of Medicine; Estados UnidosFil: Liu, Renjie. University of Florida; Estados UnidosFil: Wanchoo, Arun. University of Florida; Estados UnidosFil: Chandiran, Karthik. UConn Health School of Medicine; Estados UnidosFil: Ruan, Jianbin. UConn Health School of Medicine; Estados UnidosFil: Vanaja, Sivapriya Kailasan. UConn Health School of Medicine; Estados UnidosFil: Bauer, Michael. Jena University Hospital; AlemaniaFil: Sponholz, Christoph. Jena University Hospital; AlemaniaFil: Hudalla, Gregory A.. University of Florida; Estados UnidosFil: Vella, Anthony T.. UConn Health School of Medicine; Estados UnidosFil: Zhou, Beiyan. UConn Health School of Medicine; Estados UnidosFil: Deshmukh, Sachin D.. Jena University Hospital; AlemaniaFil: Rabinovich, Gabriel Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Rathinam, Vijay A.. UConn Health School of Medicine; Estados Unido

Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

<div><p>Background</p><p>Management of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy.</p><p>Methods</p><p>Between April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy.</p><p>Results</p><p>51 (63%) questionnaires were completed and returned. All participating centers used basic hemodynamic monitoring (i.e. invasive arterial blood pressure and central venous pressure), supplemented by transesophageal echocardiography. Pulmonary arterial catheter and calibrated trend monitoring devices were also routinely available. In contrast, non-calibrated trend monitoring and esophageal doppler ultrasound devices were not commonly in use. Cerebral oximetry is increasingly emerging, but lacks clear indications. The majority of patients undergoing cardiac surgery, especially in university hospitals, required catecholamines during perioperative care, In case of low cardiac output syndrome, dobutamine (32%), epinephrine (30%) or phosphodiesterase inhibitors (8%) were first choice. In case of hypotension following vasoplegia, norepinephrine (96%) represented the most common catecholamine. 88% of the participating centers reported regular use of colloid fluids, with hydroxyethyl starches (HES) being first choice (64%).</p><p>Conclusions</p><p>Choice of hemodynamic monitoring is homogenous throughout German centers treating cardiac surgery patients. Norepinephrine is the first line catecholamine in cases of decrease in peripheral vascular resistance. However, catecholamine choice for low cardiac output syndrome varies considerably. HES was the primary colloid used for fluid resuscitation. After conduct of this survey, HES use was restricted by European regulatory authorities in critically ill patients and should only be considered as second-line fluid in surgical patients without renal impairment or severe coagulopathy. Large clinical studies addressing catecholamine and fluid therapy in cardiac surgery patients are lacking.</p></div

First line catecholamine therapy for low cardiac output (in percent).

<p>First line catecholamine therapy for low cardiac output (in percent).</p

Overview of the departments responsible for postoperative intensive care of cardiac surgery patients (in percent) A (left).

<p>Number of operations performed in the respective cardiac surgery departments per year <b>B (right)</b>.</p