胚胎嗅鞘细胞移植治疗脑性瘫痪：4例术后4周结果报告

目的:观察胚胎嗅鞘细胞移植治疗脑性瘫痪的有效性和安全性。方法:①病例资料:4例因出生时缺血缺氧确诊为脑性瘫痪的患者,男2例,女2例,年龄分别为14岁、岁、个月、岁。嗅92817鞘细胞由北京市虹天济神经科学研究院细胞中心提供,实验经医学伦理委员会批准,4例脑性瘫痪患者均签署知情同意书。②实验方法:根据术前MRI或CT片,患者均在局麻下行微创立体定向嗅鞘细胞移植术,选取双额放射冠为注射靶点,每侧注射1.0×106个细胞。术后给予止血、抗感染、康复等常规处理。③实验评估:分别于嗅鞘细胞移植前、移植后4周采用脑瘫综合功能评定量表、脑瘫日常生活能力量表评价患者神经功能及生活质量的改善。结果:①嗅鞘细胞移植术后4周,4例患者较术前均有不同程度的神经功能改善,未出现手术并发症。②脑瘫综合功能评定总分:病例1由92.5分增至94分,病例2由55分增至56分,病例3由10.5分增至11.5分,病例4由9.5分增至13分。③脑性瘫痪日常生活能力量表总分:病例1由82.0分增至83.5分,病例2无变化,为16.5分,病例3由5.0分增至7.5分,病例4由5.0分增至8分。结论:嗅鞘细胞移植治疗脑性瘫痪患者近期评价安全可行,可部分改善神经功能与生活质量,长期效果有待进一步随访。     

Relation of homocysteine, vitamin B(12), and folate to coronary in-stent restenosis

Coronary in-stent restenosis represents a clinical problem. Because homocysteine is being discussed as a new risk factor for atherosclerosis and thrombosis, this study investigated the relations of homocysteine, folate, and vitamin B(12) to the rate of in-stent restenosis. Patients undergoing successful percutaneous transluminal coronary angioplasty of native coronary lesions with stent implantation were investigated for fasting total serum homocysteine, folic acid, and vitamin B(12). The rate of in-stent restenosis was determined angiographically after 6 months, or earlier if clinically indicated. Of 292 enrolled patients, 262 (90%) (189 men and 73 women) underwent control angiography on an average of 6.3 +/- 1.0 (SD) months after intervention. The rate of in-stent restenosis was 36%. Univariate and multivariate analyses revealed no significant differences between patients with or without restenosis with regard to total homocysteine (median [interquartile range]: 12.9 [11.2 to 14.8] and 12.4 [10.3 to 15.4] micromol/L, respectively), folate (16.1 [12.4 to 20.5] and 15.4 [12.5 to 19.5] nmol/L, respectively), or vitamin B(12) (239.0 [182.5 to 322.1] and 258.4 [205.8 to 330.5] pmol/L, respectively). These results suggest that homocysteine, folate, and vitamin B(12) are not related to the angiographically determined rate of coronary in-stent restenosis after 6 months.     

Verletzungsmuster und -ursachen in modernen Kriegen

Epidemiological analyses of injury patterns and mechanisms help to identify the expertise military surgeons need in a combat setting and accordingly help to adjust infrastructure and training requirements. Therefore, a MEDLINE search (1949–2009), World Wide Web search (keywords “combat, casualties, war, military, wounded and neurosurgery”) and an analysis of deaths among allied war casualties in Afghanistan and Iraq were performed. Up to 10th December 2009 there had been 4,688 allied military deaths in Iraq and 1,538 in Afghanistan. Of these 22% died in non-hostile action, 33% in direct combat situations and the majority of 45% in indirect combat actions. The leading causes of injury were explosive devices (70%) and gunshot wounds. Chest or abdominal injuries (40%) and traumatic brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq is approximately half that of the Vietnam War, whereas the killed-in-action rate in Afghanistan (18.7%) is similar to the Vietnam War (20%); however, the amputation rate is twice as high in modern conflicts. Approximately 8–15% of the fatal injuries seem to be potentially survivable. Military surgeons must have an excellent expertise in a wide variety of surgical specialties. Life saving emergency care, especially in the fields of thoracic, visceral and vascular surgery as well as practical skills in the fields of neurosurgery and oral and maxillofacial surgery are required. Additionally, it is of vital importance to ensure the availability of sufficient tactical and strategic medical evacuation capabilities for the wounded.     

Deutsche Militärchirurgen im Auslandseinsatz

Since 1992 the German Bundeswehr has been deployed for securing peace and peacekeeping abroad. Since then 83 German soldiers have been killed and overall 129 wounded in action as of 07.12.2009. In Northern Afghanistan the German Bundeswehr runs a combat support hospital (role 3) in Mazar-e-Sharif providing a multidisciplinary capability profile. Furthermore, there are two role 2 medical treatment facilities for primary surgical trauma care located in Kunduz and Feyzabad. In these role 2 facilities life saving procedures and damage control operations are performed in order to enable rapid evacuation to a higher level of care. Thereby military surgeons are often confronted with various medical and logistic challenges. The German Navy also has two equivalent role 2 medical treatment facilities (Naval Rescue Centers) aboard its two combat support ships (CSS) “Berlin” and “Frankfurt am Main” to support maritime task groups operating worldwide. These floating field hospitals provide an indispensable asset in the medical emergency care of naval operations with difficult space-time factors. Due to the specific operating alliance between CSS and Naval Rescue Center, special operations as well as evacuation and humanitarian missions following disasters near the coastline can be effectively accomplished.     

Risk and outcome analysis of renal replacement therapies in patients after cardiac surgery with pre-operatively normal renal function

Peri-operative acute renal failure requiring renal replacement therapy is common (5–30%) after cardiac surgery and associated with a mortality of ∼50%. Pre-operative renal impairment seems to be the most important risk factor for frank postoperative renal failure. To help evaluate the risk factors, we conducted a prospective observational trial of 1574 consecutive patients with normal pre-operative renal function (creatinine < 110 μmol.l⁻¹). Renal failure was defined as the need for renal replacement therapy. After univariate analysis of previously described risk factors, those who differed significantly between patients with or without renal failure were enrolled into a multivariate classification and regression tree (CART) statistical model that identifies the most 'predictive' risk factors and creates a ranked list of these. In patients with pre-operatively normal renal function, a serum level of lactate > 1.1 mmol.l⁻¹ in the first 24 h after the operation was the strongest predictor for the development of renal failure.     

Coordination of strength exertion during the chair-rise movement in very old people

BACKGROUND: Changes in performance of standing up from a chair have been related to measures of strength or power. However, the sit-to-stand (STS) transfer requires that the individual exerts forces with appropriate magnitude and timing. These coordinative aspects have received less attention. This study aims to analyze differences in STS performance in older people based on measures that are derived from ground reaction forces (GRFs) during STS transfer. METHODS: One hundred thirty-five participants (84.5% women; mean age 82.5 years) stood up from a chair as fast as possible. Time of stabilization after reaching an upright position, power, maximum vertical GRF, increase of vertical GRF, overshoot of vertical GRF over body weight, and left-right difference of GRF were measured by a force plate under each foot. To explain variance of total time to stand up, these variables were used as independent variables in a linear regression model. RESULTS: Eighty-one percent of variance of total time to stand up was explained by the independent variables. The strongest predictor of total time was time of stabilization (F = 459.4). Another model of linear regression explained 37% of variance of time to reach an upright position, with increase of GRF as the strongest predictor (F = 38.3). Influence of maximum vertical GRF was weak in both models. CONCLUSIONS: Variables related to coordination of strength, measured during STS transfer, were able to explain a high proportion of variance of time to rise from a chair. Stabilization after reaching an upright position seems to be a parameter worth further investigation.     

Prehospital Trauma Life Support® (PHTLS®)

Introduction

There is clinical evidence that standardized management of trauma patients in the emergency department improves outcome. Standardized prehospital management has been established for stroke patients and those suffering acute coronary syndrome. Prehospital treatment of trauma patients differs quite significantly from one system to another. The data from the German Trauma Registry show that the average time from accident until arrival in the emergency department is 72 min. This needs improvement.

Results

PHTLS® is a training course that teaches a systematic approach to the trauma patient in the preclinical setting. The aim is to rapidly and accurately assess the patient’s physiologic status, treat according to priorities, and decide whether the patient is critical and needs rapid rescue and transport. Above all, it is important for caregivers to prevent secondary injury, to realize the relevance of timing in the initial treatment, and to assure a high standard of care. PHTLS® provides the participant with knowledge, skills, and necessary behaviors. The course is open to persons in all specialties involved in the initial management of severely injured patients. The German Board of Emergency Technicians e.V. inaugurated the course concept in cooperation with the National Association of Emergency Medical Technicians (NAEMT) and the American College of Surgeons (ACS) and is authorized to organize PHTLS® courses in Germany.

Conclusion

PHTLS® teaches a standardized and established approach to the trauma patient in the emergency department. It has been established in 36 countries and the content is reviewed regularly to consider new scientific evidence. Healthcare personnel in Germany have the chance to participate in this international standard of care and to introduce their own experiences into the review process.