Pathomechanismen des Organversagens

Proinflammatory mediators as well as increased formation of reactive oxygen and nitrogen species impair cellular respiration during sepsis. In particular, the highly reactive peroxynitrite irreversibly damages lipids, proteins and nucleic acids and also inhibits enzyme complexes of the respiratory chain. In this way cellular metabolic functions and subsequently organ functions are also impaired. Repair of DNA by poly(ADP-ribose)polymerase consumes large amounts of nicotinamide adenine dinucleotide (NAD⁺) which leads to cellular NAD⁺ depletion further promoting inflammation. This article summarizes central aspects of the pathophysiology of mitochondrial dysfunction during sepsis and gives an overview about newly developed strategies which proved effective in experimental studies and may have a potential clinical application in the future.     

Regional Health Care (RHC)

The effects of demographic change are particularly perceptible in sparsely populated and structurally weak regions where a significant lack of medical staff (physicians, nursing staff) will demand new strategic concepts. Solutions might be found in the strategic concept of Regional Health Care (RHC) which is a patient-centered network of health-related services (medical, psychological, social, etc.) and offers a great potential both in terms of health care and economical benefits. Key to RHC is the central coordination of the services via a dispatch center and the integration of patient-centered IT solutions. The hospital of the future has to open up itself and interact more and more with the region as vice versa the region with the hospital. The hospital obtains a new ambulatory structure for providing (emergency) medical care with telemedicine as a key element.     

Meta-Analysis of the Clamp-Crushing Technique for Transection of the Parenchyma in Elective Hepatic Resection: Back to Where We Started?

Background  After introduction of the clamp-crushing technique in the 1970s, various devices have been developed for transection of the liver with the aim of further reducing blood loss and improving the outcome of patients who undergo hepatic resection. We performed a meta-analysis to quantitatively compare the clamp-crushing technique to any subsequently introduced transection technique with respect to patients’ perioperative outcome. Methods  A systematic literature search was conducted to identify randomized controlled trials comparing the clamp-crushing technique to any alternative method of hepatic transection. Relative risks (RR) were calculated for each outcome and reported along with their 95% confidence intervals (95% CI). Meta-analyses were stratified for the various types of transection techniques compared with the clamp-crushing technique and were carried out by a random effects model. Results  Seven randomized controlled trials with a total of 554 patients were included in final analyses. Analyses of overall morbidity (RR .89; 95% CI, .63–1.25), biliary leakage (RR 1.03; 95% CI, .50–2.13), transfusion rates (RR .69; 95% CI, .31–1.51), and mortality RR (.20; 95% CI, .02–1.65) revealed no difference between the clamp-crushing and alternative transection techniques. None of the identified studies demonstrated a clinically important benefit of an alternative transection method in terms of blood loss, parenchymal injury, transection time, and hospital stay. Conclusions  This meta-analysis does not indicate a benefit of any alternative transection technique on patients’ perioperative outcome compared with the clamp-crushing technique. The clamp-crushing technique remains the reference technique for transection of the parenchyma in elective hepatic resection. Nuh N. Rahbari, Moritz Koch authors contributed equally to this article.     

Validation of Prognostic Scoring Systems for Patients Undergoing Resection of Colorectal Cancer Liver Metastases

Background  

Several prognostic scoring systems have been established for patients undergoing resection of colorectal cancer (CRC) liver metastases; however, comparative analyses of their prognostic relevance is still lacking in the literature. The aim of the present study was to assess the predictive value of five published scoring systems in an independent patient cohort for the purpose of external validation.     

Does smoking influence outcome after intravenous thrombolysis for acute ischaemic stroke?

Background and purpose:  It remains uncertain whether current smoking influences outcome in patients with acute ischaemic stroke.
Objectives:  To evaluate the effect of current smoking in routinely tissue plasminogen activator (tPA)-treated stroke patients on the 3-month functional outcome and the occurrence of symptomatic intracerebral hemorrhage (ICH).
Methods:  We analyzed data from a single stroke care unit registry of 345 consecutive patients with ischaemic stroke, treated with tPA. Logistic regression models were used to assess if smoking was independently associated with 3-months good outcome defined as a modified Rankin Scale score of ≤2, and the occurrence of symptomatic ICH.
Results:  In the multivariable models, smoking was not associated with a good outcome or a decreased risk of symptomatic ICH.
Conclusion:  Current smoking did not affect functional outcome at 3 months or the risk of symptomatic ICH in patients routinely treated with tPA for ischaemic stroke.     

Computational and noncomputational systems in brain and cognition: can one mask the other?

A theory is developed based on the premise that nonneural processes occur in the brain exemplified as spatial working memory, and is the seat of consciousness. Additionally, wave storage of spatial information, a Bose condensate to support the waves, and the location of wave storage are provided as illustrative, "existence proofs" that a coherent theory can be built along these lines in agreement with the data. The theory can be built argues on functional grounds that a nonneural spatial memory may serve a vital biological function. This article demonstrate how this same non-neural memory can bridge the explanatory gap to consciousness, in agreement with the facts. The article proposes a possible mechanism and location for the nonneural component.     

Acute prefrontal rTMS increases striatal dopamine to a similar degree as D-amphetamine

Prefrontal repetitive transcranial magnetic stimulation (rTMS) has been shown to increase striatal dopaminergic activity. Here we investigated dopaminergic neurotransmission using single photon emission computed tomography (SPECT) and [(123)I]IBZM to indirectly assess the change in endogenous striatal dopamine concentration upon rTMS as compared with d-amphetamine challenge. SPECT imaging was performed twice each in five patients during rTMS, and in two patients who received 0.3 mg/kg D-amphetamine. Administration of rTMS led to a mean relative decrease in striatal IBZM binding by 9.6+/-6.2%, and d-amphetamine challenge (n=4) induced a mean relative reduction by 8+/-2.95% (difference not statistically significant). Acute rTMS challenge showed similar striatal dopaminergic effects to those associated with the administration of d-amphetamine, a substance known to increase synaptic dopamine.