OBJECTIVE:Mild traumatic brain injuries (mTBIs) account for approximately 90% of traumatic brain injuries and are a common cause for hospitalization. Cranial CT (CCT) is the preferred diagnostic tool, but 85%-99% of mTBI patients show no visible lesions on CCT, making its use controversial due to radiation risks and costs. To identify mTBI patients requiring CCT, serum S100B concentrations have been integrated in international guidelines. However, its short half-life and low specificity to detect intracranial hemorrhages (IHs) in mTBI are frequently discussed limitations. The aim of this study was to determine the clinical benefit of S100B in reducing unnecessary CCT studies at a high-volume trauma center. METHODS:The authors retrospectively analyzed the data of mTBI patients who were admitted to an urban level I trauma center between January 2017 and December 2022. They included all adult mTBI patients who underwent S100B measurement and had a subsequent CCT study. Patients who underwent immediate CCT on admission per the Canadian CT Head Rule or in the case of antithrombotic therapy were excluded. RESULTS:A total of 391 patients with a mean age of 46 years were included. IH was detected in 23 mTBI patients (5.9%), with 2 patients (0.51%) requiring neurosurgical intervention. The mean S100B level was 0.21 μg/L (range 0.03-2.27 μg/L), with a cutoff at 0.105 μg/L. Patients with positive CCT findings had a mean S100B level of 0.31 μg/L, compared with 0.21 μg/L for negative CCT cases (p = 0.011). IHs occurred in 6.1% of patients with elevated S100B levels and in 4.2% of patients with normal S100B values. The specificity of S100B for positive CCT findings was 12.5%, with a positive predictive value of 6.1% and a negative predictive value of 95.8%. False-positive results led to 57 unnecessary CCT studies annually. CONCLUSIONS:This study emphasizes the need for careful consideration when integrating S100B into mTBI management protocols for patients with a low risk for IHs. The low specificity in a younger population suggests that the risks of radiation from unnecessary CCT studies may outweigh the benefits. Although international guidelines were followed, integrating S100B into the mTBI protocol did not reduce CCT use as expected. In the absence of ongoing or new onset of neurological symptoms, elevated S100B values should not trigger CCT studies in a low-risk mTBI population.

Wir berichten hier von einem komplizierten Fall eines Weichteildefektes mit einer herausfordernden Weichteildeckung am rechten Unterschenkel. Ein 29-jähriger Mann entwickelte nach einer Unterschenkelfraktur und Versorgung mit einem Tibianagel ein Kompartmentsyndrom aufgrund einer massiven Nachblutung mit einer Läsion des N. peronaeus communis sowie Muskelnekrosen im Bereich der Fibularisloge. Die initiale Deckung mit Spalthaut zeigte keine Heilungstendenz, sodass der Patient mit einem Weichteildefekt von ca. 25 × 10 cm am lateralen Unterschenkel mit frei liegender Tibia über 15 cm Länge in unser Krankenhaus übernommen wurde. Es erfolgte primär der Deckungsversuch mit einer Spalthauttransplantation nach sekundärer Granulation. Aufgrund einer vorgeschädigten Gefäßversorgung zeigte sich allerdings über 8 Monate eine frustrane Wundheilung. Zudem fielen im Röntgen eine Pseudarthrose und ein daraus resultierender Schraubenbruch der beiden distalen Verriegelungsschrauben auf. Hierbei wurde die Indikation für einen Revisionseingriff zur Frakturversorgung und zum Implantatwechsel gestellt. Im gleichen Eingriff wurde der Verschluss der kutanen Restdefekte durchgeführt. Bei einem bisher komplikationsbehafteten Verlauf und der schwierigen lokalen Durchblutungssituation war die Auswahl der Rekonstruktionsverfahren begrenzt. Es wurde in einem interdisziplinären Vorgehen eine Brückenlappenplastik vom medialen Unterschenkel durchgeführt. Der Hebedefekt wurde mit Spalthaut gedeckt. Die Wunde konnte auf diese Weise nach einem Jahr schließlich suffizient gedeckt werden.

This article reports on a complicated case of a soft tissue defect with challenging soft tissue coverage on the lower leg. After a lower leg fracture and treatment with a tibial nail, a 29-year-old man developed compartment syndrome due to massive secondary bleeding with a lesion of the common peroneal nerve and muscle necrosis around the fibular muscles. The initial coverage with split skin showed no tendency to heal, so the patient was admitted to this hospital with a soft tissue defect of approximately 25 cm × 10 cm on the lateral lower leg with an exposed tibia over a length of 15 cm. The primary attempt was coverage with a split-thickness skin graft after secondary granulation; however, due to the previously damaged vascular supply, the wound demonstrated a delayed incomplete healing over 8 months. In addition, X‑ray imaging revealed a nonunion and a resulting screw fracture of the two distal locking screws. The indications for revision surgery to treat the fracture and change the implant were fulfilled. In the same procedure, the residual cutaneous defects were closed. Given the previously complication-prone course and a difficult local blood flow situation, the choice of reconstruction procedures was limited. A bridge flap of the medial lower leg was performed in an interdisciplinary approach. The lifting defect was covered with split-thickness skin. In this way, the wound was finally adequately covered after 1 year.

Background/Objectives: The aim of this study was to examine sex-related differences in the outcomes of polytraumatized patients admitted to a level I trauma center. Methods: This was a retrospective data analysis of 980 consecutive polytraumatized patients admitted to a single level I trauma center between January 1995 and December 2020. Results: Among all patients, about 30% were female, with a significantly higher age and significantly higher rates of suicidal attempts. No sex-related differences regarding injury severity or trauma mechanisms could be seen, but female patients had significantly higher overall in-hospital mortality rates compared to male patients. Even in the elderly group of patients, elderly female patients were significantly older compared to elderly male patients, with significantly increased lengths of hospital stay. In the elderly group of patients, no sex-related differences regarding injury severity, trauma mechanisms or mortality could be detected. Multivariate analysis revealed suicidal attempt, severe head injury and age > 54 years as independent prognostic factors in the survival of polytraumatized patients. Conclusions: Distinctive sex-related differences can be found, with female polytraumatized patients being significantly older and having higher overall mortality rates with significantly increased LOS. Our study suggests a strong sex-independent influence of age, suicidal attempt and severe head injury on the outcomes of polytraumatized patients.

Background: An alarming increase in domestic violence was reported during the COVID-19 pandemic worldwide. The aim of this study is to investigate changes in the frequency and the nature of domestic violence at the largest level-one trauma center in Austria. Methods: All patients admitted to our institution with domestic violence injuries 15 months before and after the beginning of the COVID-19 pandemic were included. For our analysis, we investigated the frequency of trauma patients after domestic violence in relation to all other trauma patients. Furthermore, age, sex, citizenship, injury pattern, injured body regions, injury mechanism, offender–victim relationship, and hospitalization rate were also analyzed. Results: Among all trauma patients admitted, the ratio of patients who reported domestic violence injuries increased from 0.465% to 0.548% since the start of the pandemic. In addition, out of the total count of domestic violence victims, the percentage of Austrian citizens increased significantly from 51.2% to 60.6% (p = 0.016). All other parameters showed no significant changes pre and post-pandemic. Conclusion: The COVID-19 pandemic contributed to a relative increase in patients with domestic violence injuries at the largest trauma unit in Austria, along with a significant increase among Austrian citizens. The remaining study parameters did not differ significantly, indicating that the frequency changed during the pandemic but not the underlying pattern of domestic violence.

Background: The COVID-19 pandemic has had a significant impact on the treatment protocols of orthopedic and trauma departments, but its specific effect on the mortality of hip fracture patients due to possible delays in surgery remains uncertain. This study aimed to investigate whether the COVID-19 pandemic worsened the mortality of patients with hip fractures. Materials and methods: This study included 246 prospectively enrolled patients who suffered from hip fractures during the Austrian State of Emergency period between 1 March and 30 June 2020 and 2021 and were admitted to a tertiary care trauma center. This cohort was compared with a retrospective control group of 494 patients admitted for hip fractures during the same timeframe in 2017, 2018, and 2019. These groups were compared to a prospective recruited “post-COVID-19 collective consisting of the years 2022 and 2023 including 313 patients. Results: This study found a 22% reduction in admissions during the COVID-19 period compared to the pre-COVID period (p = 0.018), as well as significant changes in gender (p = 0.013) and place of accident (p = 0.049). No other changes in demographic variables were observed. The 30-day mortality rate was 14.67% in the pre-COVID period, compared to 15.18% during the COVID-19 period (p = 0.381). No differences were observed in surgical complication rates or in the relationship between comorbidity burden and survival. Conclusion: This study did not show a higher perioperative mortality rate due to COVID-19. However, under current circumstances, with potentially reduced surgical and hospital bed capacities, it is expected that this condition might require a high degree of resources in times when resources are potentially scarce, such as during an ongoing pandemic. Level of evidence: Level III.

Optimal osseointegration of cementless total hip arthroplasty is essential for high stability and long-term survival. The purpose of this follow-up study was to evaluate the clinical and radiological outcome, the complications, and survival rates of a beta-titanium alloy stem with a specific grit-blasted-free surface. In 192 patients (mean age of 64.4 years), 202 consecutive primary total hip arthroplasties were performed using a cementless Hipstar® stem (Stryker, Duisburg, DE). The Harris Hip Score (HHS) was assessed pre-operatively and post-operatively. Radiolucent lines were evaluated and the implant survival rate was calculated using Kaplan-Meier analysis. The mean follow-up was 7.71 years (range of 5.0–14.0 years). Overall, 15 revisions were performed. Early aseptic stem loosening was observed in six cases (2.97%). Radiolucent-lines adjacent to the stem were detected in 73 cases (83.02%), especially (70.46%) in the Gruen zones 1, 7, 8, and 14. The mean postoperative HHS was 92.65 points (range 42–100). The cumulative survival probability of the stem was 94.4% (95% CI 90.3 to 98.5%). Considering aseptic failure as an endpoint, the cumulative survival rate of the stem was 95.3% (95% CI 0.914 to 0.992) at six years of follow-up. Overall, an inferior mid-term implant survival was observed in comparison to well-established cementless stem designs.

A1 Meet the needs: Important questions for ICU relatives

Alzheimer's disease (AD), a multifactorial neurodegenerative condition caused by genetic and environmental factors, is diagnosed using neuropsychological tests and brain imaging; molecular diagnostics are not routinely applied. Studies have identified AD-specific cerebrospinal fluid (CSF) biomarkers but sample collection requires invasive lumbar puncture. To identify AD-modulated proteins in easily accessible blood platelets, which share biochemical signatures with neurons, we compared platelet lysates from 62 AD, 24 amnestic mild cognitive impairment (aMCI), 13 vascular dementia (VaD), and 12 Parkinson's disease (PD) patients with those of 112 matched controls by fluorescence two-dimensional differential gel electrophoresis in independent discovery and verification sets. The optimal sum score of four mass spectrometry (MS)-identified proteins yielded a sensitivity of 94 % and a specificity of 89 % (AUC = 0.969, 95 % CI = 0.944-0.994) to differentiate AD patients from healthy controls. To bridge the gap between bench and bedside, we developed a high-throughput multiplex protein biochip with great potential for routine AD screening. For convenience and speed of application, this array combines loading control-assisted protein quantification of monoamine oxidase B and tropomyosin 1 with protein-based genotyping for single nucleotide polymorphisms (SNPs) in the apolipoprotein E and glutathione S-transferase omega 1 genes. Based on minimally invasive blood drawing, this innovative protein biochip enables identification of AD patients with an accuracy of 92 % in a single analytical step in less than 4 h.

Hand hygiene is acknowledged as the single most important measure to prevent nosocomial infections in the healthcare setting. Similarly, in non-clinical settings, hand hygiene is recognised as a key element in helping prevent the spread of infectious diseases. The aim of this study was to evaluate the efficacy of three different disinfectant hand sanitizers in reducing the burden of bacterial hand contamination in 60 healthy volunteers in a community setting, both before and after education about the correct use of hand sanitizers. The study is the first to evaluate the efficacy and ease of use of different formulations of hand rubs used by the general population. The products tested were: Sterillium (perfumed, liquid), desderman pure gel (odorless, gel) and Lavit (perfumed, spray). Sterillium and desderman are EN1500 (hygienic hand rub) certified products (available in pharmacy) and Lavit is non EN1500 certified and available in supermarkets. The two EN1500 certified products were found to be significantly superior in terms of reducing bacterial load. desderman pure gel, Sterillium and Lavit reduced the bacterial count to 6.4%, 8.2% and 28.0% respectively. After education in the correct use of each hand rub, the bacterial load was reduced even further, demonstrating the value of education in improving hand hygiene. Information about the testers' perceptions of the three sanitizers, together with their expectations of a hand sanitizer was obtained through a questionnaire. Efficacy, followed by skin compatibility were found to be the two most important attributes of a hand disinfectant in our target group.

Accurate biomarker quantification requires carefully chosen normalisation procedures. When single proteins are used as loading controls (LCs), it is crucial that their expressional stability must be known. Platelets are an important biomarker source, especially for neurological diseases. We performed a systematical analysis of the platelet proteome to identify proteins suitable as LCs, using the 2-D DIGE system. We first screened a healthy population (n = 137), aged between 18 and 104 years, to find proteins with small coefficients of total variation (CVtot), herein termed low biological variation proteins (LBVP). Thereafter, expressional stability was verified in 101 patients suffering from Alzheimer's- (AD), Parkinson's- disease, vascular dementia or schizophrenia. Interestingly, traditional LCs such as tubulin beta-1 and GAPDH, were not found amongst LBVP. The least variable protein, calculated over all 238 individuals, was 14-3-3 gamma, with a CVtot of 9.3%, showing no gender, age or disease dependency. The normalisation capability of 14-3-3 gamma was superior to traditional LC in quantifying Western blot signals of the platelet AD-biomarker Monoamine Oxidase B of patient versus controls. Similar results were obtained with HepG2 cells, treated in vitro with DNA-methyltransferase inhibitor 5-aza-2' deoxicytidine. Finally, we provide a list of alternative normalisation candidates for accurate biomarker quantification.Biological significanceThis paper suggests a considerable list of platelet proteins with a lower biological variation than well known "housekeeping" proteins like GAPDH and tubulin. Spot abundances of found proteins are middle ranged and unaffected by gender, age and certain diseases. Hence, listed proteins might be valuable normalisation candidates used additionally or alternatively. Platelet's least variable protein 14-3-3 gamma is validated as normalisation protein in platelet biomarker quantification. Furthermore 14-3-3 gamma is demonstrated to be also stable expressed by in HepG2, cells others than platelets, when treated by DNA methylation inhibitor. (C) 2013 Elsevier B.V. All rights reserved.

Monoamine oxidase-B (Mao-B) catalysing the breakdown of the neurotransmitter dopamine, is known to be involved in the pathophysiology of Parkinson's (PD) and Alzheimer's disease (AD). Increased brain Mao-B activity is associated with AD. This alteration can also be seen in platelets, albeit the cause has hitherto remained elusive. To gain a deeper understanding of the etiology of AD, the platelet proteome was characterised, (2D DIGE pH6-9, including Mao-B) from 150 individuals: 34 AD, 13 vascular dementia, 15 non-demented PD patients, 49 matched controls, 18 oldest old and 21 young individuals. One significant change was noted after applying false discovery rate with the upregulation of the Mao-B expression (30% adjusted P value < 0.001; effect size 1.31) in AD compared to age- and sex-matched controls. In contrast, Mao-B levels were unchanged in PD to matched controls. Western blot and mRNA analyses verified these findings. Moreover, Mao-B concentration correlated with age in the cognitive healthy individuals (r = 0.53; P < 0.001) and PD patients but not in those suffering from AD (r = − 0.03; P = 0.874). Mao-B activity correlated with the increased Mao-B protein expression in AD (r = 0.81; P = 0.016). We suggest that Mao-B platelet protein level may serve as a biomarker for age-related dementia, especially AD.

Studies investigating the impact of high meat intake on cognition have yielded contradictory results as some show improved cognitive performance, whereas others report an increase of risk factors for dementia. However, few studies were designed to directly assess the effect of a high protein (HP) diet on both cognitive performance and corresponding biochemical parameters. A randomised intervention study was conducted with 23 healthy males (aged 19-31 years) to investigate the effects of a usual (UP) versus a HP diet on cognitive function and on the platelet proteome a well-established model for neurons. The study individuals were assigned to either a UP diet (15% energy) or a HP diet (30% energy) for 3 weeks with controlled intake of food and beverages. Blood samples were taken along with measurements of cognitive functions at the beginning and at the end of the intervention period. Among 908 reproducibly studied platelet proteins only the level of monoamine oxidase B (MaoB), a neurotransmitter degrading enzyme, decreased by 26% significantly (adjusted P value < 0.05) due to the HP diet. In addition, we found a correlation (r = 0.477; P < 0.02) between the decrease of MaoB expression and the shortened reaction time (cognitive function) which is in accordance with reports that dementia patients show increased MaoB activity. Plasma vitamin B(12) concentration was increased by the HP diet and correlates inversely with platelet MaoB expression (r = -0.35; P < 0.02). Healthy young males on a HP diet showed improved cognitive function and counteract well-known dementia biomarkers such as platelet MaoB and components of the methylation cycle such as vitamin B(12) and homocysteine.

Objective:Oxidative stress and systemic inflammation negatively affect several protective functions of high density lipoproteins (HDL) and oxidative modification of HDL by the inflammation-derived oxidant hypochlorite converts HDL into a potent platelet agonist. Therefore it was the aim of this work to clarify if these platelet-activating effects result from specific binding of hypochlorite-oxidized HDL (hyp-OxHDL) to the platelet surface and to identify responsible receptors.Methods: Binding and functional studies were performed with hyp-OxHDL in absence and presence of (potential) competitors in normal and CD36-deficient human platelets.Platelet aggregation was quantified by light transmission aggregometry. Surface expression of CD62P, phosphatidylserine and CD40L was quantified by flow cytometry.Results: Binding studies reveal that hyp-OxHDL show specific and saturable high-affinity binding to the platelet surface. Hyp-OxHDL trigger platelet aggregation and in a dose dependent way provoke the release of significant amounts of CD40L as well as phosphatidylserine on the platelet surface. Blocking specific binding of hyp-OxHDL to the platelet surface interferes with the ability of hyp-OxHDL to stimulate human platelets.CD36-deficient human platelets show markedly reduced binding of hyp-OxHDL. Upon addition of hypochlorite-oxidized HDL, CD36-deficient platelets do not aggregate and completely fail to release CD40L or phosphatidylserine.Conclusions: From these results we conclude that specific binding of hyp-OxHDL to platelet CD36 is essential for the proinflammatory and procoagulant effects of hyp-OxHDL shown within this work. The contribution of other receptors besides CD36 to specific binding of hyp-OxHDL to the platelet membrane appears to be minimal, at best. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Hintergrund: Fleisch und tierische Produkte sind eines der beliebtesten Nahrungsmittel in der westlichen Welt. Es gibt einige Studien uber erhohten Protein Konsum die einen positiven Effekt in Bezug auf Sarkopenie, Glukose Homeostase, Knochengesundheit, Gewichtsmanagement und Sattigungsgefuhl zeigen. Es gibt jedoch nur wenige Studien, die die physiologischen Effekte einer Ernahrung mit erhohtem Proteinanteil zeigen. Weiters wurde bis jetzt noch keine Studie durchgefuhrt, die sich auf den Einfluss einer Diat mit erhohtem Proteinanteil auf Proteome konzentriert. Zielsetzung: In dieser Studie wurde der Einfluss einer Diat mit erhohtem Proteinanteil auf das Thrombozytenproteoem untersucht, wobei Thrombozyten als Modell fur Muskelzellen verwendet wurden, da diese verschiedene Ahnlichkeiten besitzen, wie zum Beispiel das kontraktile System. Weiters gibt es einige Studien die den Zusammenhang von Diaten mit verschiedenen Proteinmengen mit dem Homocysteinzyklus beschreiben. Diese sind jedoch sehr widerspruchlich. In dieser Studie wollen wir den eindeutigen Beweis fur einen Zusammenhang von Homozystein, Folat und Vitamin B12 mit einer Diat mit erhohtem Proteinanteil beweisen. Methoden: An dieser randomisierten Studie nahmen 23 junge Manner teil. In einer einwochigen Einlaufphase konsumierten alle Teilnehmer eine Diat mit einer normalen Menge an Protein (1,5 g Protein/kg Korpergewicht). In der Interventionszeit wurden sie in zwei Gruppen aufgeteilt: eine Gruppe mit erhohtem Proteinkonsum (3,0 g Protein/kg Korpergewicht) und eine Gruppe mit normalem Proteinkonsum. Bei beiden Diaten war die Proteinquelle eine tierische. Die Interventionszeit dauerte 3 Wochen. Zu Beginn und am Ende der Interventionszeit wurde den Probanden Blut abgenommen und kognitive Tests wurden durchgefuhrt. Die Thrombozyten wurden isoliert und mittels 2 D DIGE Analyse analysiert. Ergebnisse: Das Protein das den starkesten Effekt nach einer Diat mit erhohtem Proteinanteil zeigte ist Monoaminoxidase B (Mao-B), welches ein Dopamin abbauendes Enzym ist. Es war signifikant vermindert nach einer erhohten Protein Diat. Die Vitamin B12 Konzentration im Plasma war signifikant erhoht nach einer erhohten Proteindiat und korrelierte invers mit der Mao-B Konzentration in den Thrombozyten. Weiters korrelierten die Ergebnisse des Reaktionstests mit dem Abfall von Mao-B in Thrombozyten. Diskussion: Die inverse Korrelation von Vitamin B12 mit Mao-B konnte daruf hindeuten, dass Vitamin B12 Mao-B direkt reguliert. Weiters zeigt die verbesserte Reaktionszeit verbesserte kognitive Funktionen bei einer erhohten Protein Diat auf tierischer Basis. Diese verbesserten kognitiven Funktionen konnten durch die Korrelationen von Reaktionstest, Mao-B und den Komponenten des Methylierungszyklus, wie z.B.: Vitamin B12, erklart werden.

Knowledge about the extent of total variation experienced between samples from different individuals is of great importance for the design of not only proteomics but every clinical study. This variation defines the smallest statistically significant detectable signal difference when comparing two groups of individuals. We isolated platelets from 20 healthy human volunteers aged 56-100 years because this age group is most commonly encountered in the clinics. We determined the technical and total variation experienced in a proteome analysis using two-dimensional DIGE with IPGs in the pI ranges 4-7 and 6-9. Only spots that were reproducibly detectable in at least 90% of all gels (n = 908) were included in the study. All spots had a similar technical variation with a median coefficient of variation (cv) of about 7%. In contrast, spots showed a more diverse total variation between individuals with a surprisingly low median cv of only 18%. Because most known biomarkers show an effect size in a 1-2-fold range of their cv, any future clinical proteomics study with platelets will require an analytical method that is able to detect such small quantitative differences. In addition, we calculated the minimal number of samples (sample size) needed to detect given protein expression differences with statistical significance.

Since most high throughput techniques used in biomarker discovery are very time and cost intensive, highly specific and quantitative analytical alternative application methods are needed for the routine analysis. Conventional Western blotting allows detection of specific proteins to the level of single isotypes while its quantitative accuracy is rather limited. We report a novel and improved quantitative Western blotting method. The use of fluorescently labelled secondary antibodies strongly extends the dynamic range of the quantitation and improves the correlation with the protein amount (r = 0.997). By an additional fluorescent staining of all proteins immediately after their transfer to the blot membrane, it is possible to visualise simultaneously the antibody binding and the total protein profile. This allows for an accurate correction for protein load. Applying this normalisation it could be demonstrated that fluorescence-based Western blotting is able to reproduce a quantitative analysis of two specific proteins in blood platelet samples from 44 subjects with different diseases as initially conducted by 2D-DIGE. These results show that the proposed fluorescence-based Western blotting is an adequate application technique for biomarker quantitation and suggest possibilities of employment that go far beyond.