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[LANGUAGE= \"English\"] BACKGROUND: In more than 60 countries worldwide, laboratory testing plays a challenging and expensive role in trauma resus-citation. In 1995, the literature already suggested that routine laboratory testing may not be useful for most trauma patients. Our study hypothesized that still the need for some laboratory tests perhaps should be reconsidered. Therefore, the aim of this study was to create more insight in the distribution between normal and abnormal parameters for routine laboratory testing in trauma patient management.METHODS: This retrospective analysis was performed at Amsterdam UMC, location AMC, an academic level 1 trauma center. Data concerning age, gender, American Society of Anesthesiologists (ASA) physical state classification system (ASA), Injury Severity Scores, Glasgow Coma Scales, mechanism of injury, presence of high-energy trauma, and type of injury (blunt or penetrating) were obtained. Laboratory parameters included comprehensive hematology, coagulation, arterial blood gas, kidney, and liver blood panels. Analytical focus was paid to the patient’s vital status, the indication for an emergency intervention, and the risk of in-hospital mortality.RESULTS: A total of 1287 patients were included in the study. Patients with unstable vital signs or who required emergency inter-vention were most often dealing with abnormalities in pO2, glucose, D-dimer, creatinine, and alcohol values. Mean corpuscular volume (MCV), international normalized ratio (INR), fibrinogen, and amylase were obtained in more than 80% of the patients, but in specific patient groups only abnormal in less than 9%.CONCLUSION: Trauma patients suffer mainly from abnormal values of D-dimer, pO2, glucose, creatinine, and alcohol. By contrast, MCV, INR, amylase, fibrinogen, and thrombocytes are regularly obtained as well, but only abnormal in a small amount of trauma patients. These findings suggest reconsiderations and more accuracy in the performance of laboratory testing, especially for trauma patients with stable vital signs.[LANGUAGE= \"Turkish\"] AMAÇ: Dünya çapında 60’tan fazla ülkede, laboratuvar testlerinin travma resüsitasyonunda zorlu ve pahalı bir rolü vardır. Literatürde 1995’te, rutin laboratuvar testlerinin çoğu travma hastası için yararlı olmayabileceği zaten önerilmişti. Çalışmamız, bazı laboratuvar testlerine olan ihtiyacının yeniden gözden geçirilebileceğini varsaymaktadır. Bu çalışmanın amacı, travma hastası yönetiminde rutin laboratuvar testlerinde normal ve anormal parametreler arasındaki dağılım hakkında daha fazla bilgi oluşturmaktır.GEREÇ VE YÖNTEM: Bu geriye dönük analiz, Seviye 1 travma merkezi olan Amsterdam UMC (AMC)’de gerçekleştirildi. Yaş, cinsiyet, Fiziksel Du-rum Sınıflandırma Sistemi (ASA), Yaralanma Şiddet Skoru (ISS), Glasgow Koma Ölçeği (GCS), yaralanma mekanizması (MOI), yüksek enerjili travma varlığı (HET) ve yaralanma türü (künt veya penetran) ile ilgili veriler elde edilmiştir. Laboratuvar parametreleri kapsamlı hematoloji ve pıhtılaşma testleri, arter kan gazı, böbrek ve karaciğer kan panellerini içermekteydi. Analitik olarak hastanın hayati durumuna, acil müdahale endikasyonuna ve hastane içi ölüm riskine odaklanıldı.BULGULAR: Araştırmaya toplam 1287 hasta alındı. Stabil olmayan yaşamsal belirtileri olan veya acil müdahale gerektiren hastalarda çoğunlukla pO2, glukoz, D-dimer, kreatinin ve alkol değerlerinde anormallikler mevcuttu. Hastaların %80’inden fazlasında MCV, INR, fibrinojen ve amilaz değerleri elde edilmekle birlikte, sadece %9’dan azında ve spesifik hasta gruplarında anormal değerler görüldü.TARTIŞMA: Travma hastalarında esas olarak anormal D-dimer, pO2, glukoz, kreatinin ve alkol değerleri görülmüştür. Buna karşılık, MCV, INR, ami-laz, fibrinojen ve trombosit değerleri sadece az sayıda travma hastasında anormal olarak gözlenmiştir. Bu bulgular, özellikle stabil yaşamsal belirtileri olan travma hastaları için laboratuvar testlerinin performansında yeniden değerlendirme ve daha fazla doğrulama önermektedir.

ObjectiveTo assess the effectiveness of a prospective multifaceted quality improvement intervention on patient outcomes after total hip and knee arthroplasty (THA and TKA).DesignCluster randomised controlled trial nested in a national registry. From 1 January 2018 to 31 May 2020 routinely submitted registry data on revision and patient characteristics were used, supplemented with hospital data on readmission, complications and length of stay (LOS) for all patients.Setting20 orthopaedic departments across hospitals performing THA and TKA in The Netherlands.Participants32 923 patients underwent THA and TKA, in 10 intervention and 10 control hospitals (usual care).InterventionThe intervention period lasted 8 months and consisted of the following components: (1) monthly updated feedback on 1-year revision, 30-day readmission, 30-day complications, long (upper quartile) LOS and these four indicators combined in a composite outcome; (2) interactive education; (3) an action toolbox including evidence-based quality improvement initiatives (QIIs) to facilitate improvement of above indicators; and (4) bimonthly surveys to report on QII undertaken.Main outcome measuresThe primary outcome was textbook outcome (TO), an all-or-none composite representing the best outcome on all performance indicators (ie, the absence of revision, readmissions, complications and long LOS). The individual indicators were analysed as secondary outcomes. Changes in outcomes from pre-intervention to intervention period were compared between intervention versus control hospitals, adjusted for case-mix and clustering of patients within hospitals using random effect binary logistic regression models. The same analyses were conducted for intervention hospitals that did and did not introduce QII.Results16,314 patients were analysed in intervention hospitals (12,475 before and 3,839 during intervention) versus 16,609 in control hospitals (12,853 versus 3,756). After the intervention period, the absolute probability to achieve TO increased by 4.32% (95% confidence interval (CI) 4.30-4.34) more in intervention than control hospitals, corresponding to 21.6 (95%CI 21.5-21.8), i.e., 22 patients treated in intervention hospitals to achieve one additional patient with TO. Intervention hospitals had a larger increase in patients achieving TO (ratio of adjusted odds ratios 1.24, 95%CI 1.05-1.48) than control hospitals, a larger reduction in patients with long LOS (0.74, 95%CI 0.61-0.90) but also a larger increase in patients with reported 30-day complications (1.34, 95%CI 1.00-1.78). Intervention hospitals that introduced QII increased more in TO (1.32, 95%CI 1.10-1.57) than control hospitals, with no effect shown for hospitals not introducing QII (0.93, 95%CI 0.67-1.30).ConclusionThe multifaceted QI intervention including monthly feedback, education, and a toolbox to facilitate QII effectively improved patients achieving TO. The effect size was associated with the introduction of (evidence-based) QII, considered as the causal link to achieve better patient outcomes.Trial registration number NCT04055103.

Purpose The purpose of this study was to assess whether the vascularisation of the meniscus could be visualised intra-operatively using near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) in patients undergoing total knee arthroplasty (TKA). Methods The anterior horn (i.e., Cooper classification: zones C and D) of the meniscus that was least affected (i.e., least degenerative) was removed during TKA surgery in ten patients to obtain a cross section of the inside of the meniscus. Thereafter, 10 mg of ICG was injected intravenously, and vascularisation of the cross section of the meniscus was assessed using the Quest spectrum NIRF camera system. We calculated the percentage of patients in whom vascularisation was observed intra-operatively using NIRF imaging compared to immunohistochemistry. Results Meniscal vascularisation using NIRF imaging was observed in six out of eight (75%) patients in whom vascularisation was demonstrated with immunohistochemistry. The median extent of vascularisation was 13% (interquartile range (IQR) 3–28%) using NIRF imaging and 15% (IQR 11–23%) using immunohistochemistry. Conclusion This study shows the potential of NIRF imaging to visualise vascularisation of the meniscus, as vascularisation was observed in six out of eight patients with histologically proven meniscal vascularisation. Level of evidence IV.

ObjectivesPostoperative delirium is a frequent complication with possible detrimental consequences in older hip fracture patients. Music interventions are promising, with positive effects on risk factors for delirium. This study aimed to assess the impact of perioperative music on postoperative delirium in older hip fracture patients.DesignProspective randomised controlled trial.SettingMulticentre study, performed in six participating hospitals in the Netherlands.ParticipantsEligibility criteria included patients aged ≥65 years with an acute hip fracture requiring surgery and documented informed consent. 449 patients were randomised, with a median age of 81 years (IQR 74–87), including 287 women (63.9%).InterventionsMusic group participants received the intervention preoperatively, intraoperatively, and postoperatively twice a day for 30 min. The control group received standard-of-care, supplemented by headphones without music intraoperatively for equal noise reduction in both groups.Primary and secondary outcome measuresThe primary outcome was delirium diagnosis (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), assessed by a geriatrician. Associations were analysed using regression models. Secondary outcomes included: Delirium Observational Score, anxiety, pain and postoperative complications.ResultsIntention-to-treat analysis showed no statistically significant decrease of delirium in the music group, compared with the control group (OR 0.685 (95% CI 0.378 to 1.242); p=0.21). However, in the modified-intention-to-treat analysis, a significant decrease in postoperative delirium was observed (OR 0.478 (95% CI 0.245 to 0.933); p=0.028), which is substantiated by a logistic regression (OR 0.43 (95 % CI 0.19 to 0.98); p=0.045). Also, more postoperative complications were observed in the control group (93 (43.3%); 66 (32.7); p=0.026) in this analysis. The intervention was associated with high patient satisfaction and no adverse events.ConclusionsThis study suggests a positive effect of music interventions on postoperative delirium, which provides additional evidence for considering the implementation of these interventions in hip fracture care.Trial registration numberInternational Clinical Trial Registry Platform, Dutch Trial Register (www.onderzoekmetmensen.nl/, ID:NTR7036).

Is it meant to be informative? I hope not, because a lot of the \"information\" is misleading if not dead wrong (I will mention a few, but there are lots more): Tulips cost \"$1 or so apiece\"! Where does Constance Casey shop? I can show her lots of places (no, not even the big-box stores) where you can buy them for 49 or 59 cents. \"... wait seven months [for the bulbs to bloom].\" Where does she live, the North Pole? I plant mine in November and they bloom in April. \"...mechanical diggers pull up the bulbs...\"! Sorry, Ms.

Background Adipose tissue is a promising source of mesenchymal stromal cells (MSCs) for the treatment of tendon disease. The goal of this study was to assess the effect of a single intralesional implantation of adipose tissue-derived mesenchymal stromal cells (AT-MSCs) on artificial lesions in equine superficial digital flexor tendons (SDFTs). Methods During this randomized, controlled, blinded experimental study, either autologous cultured AT-MSCs suspended in autologous inactivated serum (AT-MSC-serum) or autologous inactivated serum (serum) were injected intralesionally 2 weeks after surgical creation of centrally located SDFT lesions in both forelimbs of nine horses. Healing was assessed clinically and with ultrasound (standard B-mode and ultrasound tissue characterization) at regular intervals over 24 weeks. After euthanasia of the horses the SDFTs were examined histologically, biochemically and by means of biomechanical testing. Results AT-MSC implantation did not substantially influence clinical and ultrasonographic parameters. Histology, biochemical and biomechanical characteristics of the repair tissue did not differ significantly between treatment modalities after 24 weeks. Compared with macroscopically normal tendon tissue, the content of the mature collagen crosslink hydroxylysylpyridinoline did not differ after AT-MSC-serum treatment ( p  = 0.074) while it was significantly lower ( p  = 0.027) in lesions treated with serum alone. Stress at failure ( p  = 0.048) and the modulus of elasticity ( p  = 0.001) were significantly lower after AT-MSC-serum treatment than in normal tendon tissue. Conclusions The effect of a single intralesional injection of cultured AT-MSCs suspended in autologous inactivated serum was not superior to treatment of surgically created SDFT lesions with autologous inactivated serum alone in a surgical model of tendinopathy over an observation period of 22 weeks. AT-MSC treatment might have a positive influence on collagen crosslinking of remodelling scar tissue. Controlled long-term studies including naturally occurring tendinopathies are necessary to verify the effects of AT-MSCs on tendon disease.

Anxious stress compromises cognitive executive performance. This occurs, for instance, in cognitive performance anxiety (CPA), in which anxiety about one’s cognitive performance causes that performance to actually deteriorate (e.g., test anxiety). This is thought to result from a prefrontal cortically (PFC) mediated failure of top-down attentional control over stress-induced automatic processing of threat-related information. In addition, stress-induced increased catecholamine influx into the PFC may directly compromise attentional function. Previous research has suggested that the ratio between resting state electroencephalographic (EEG) low- and high-frequency power (the theta/beta ratio) is related to trait attentional control, which might moderate these effects of stress on attentional function. The goals of the present study were to test the novel prediction that theta/beta ratio moderates the deleterious effects of CPA-like anxious stress on state attentional control and to replicate a previous finding that the theta/beta ratio is related to self-reported trait attentional control. After recording of baseline frontal EEG signals, 77 participants performed a stress induction or a control procedure. Trait attentional control was assessed with the Attentional Control Scale, whereas stress-induced changes in attentional control and anxiety were measured with self-report visual analogue scales. The hypothesized moderating influence of theta/beta ratio on the effects of stress on state attentional control was confirmed. Theta/beta ratio explained 28% of the variance in stress-induced deterioration of self-reported attentional control. The negative relationship between theta/beta ratio and trait attentional control was replicated ( r = –.33). The theta/beta ratio reflects, likely prefrontally mediated, attentional control, and should be a useful biomarker for the study of CPA and other anxiety–cognition interactions.

Background Regenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group ( n  = 10) or control group ( n  = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry. Results Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively. Conclusions A single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.

Background Adipose tissue-derived mesenchymal stromal cells (AT-MSCs) are frequently used to treat equine tendinopathies. Up to now, knowledge about the fate of autologous AT-MSCs after intralesional injection into equine superficial digital flexor tendons (SDFTs) is very limited. The purpose of this study was to monitor the presence of intralesionally injected autologous AT-MSCs labelled with superparamagnetic iron oxide (SPIO) nanoparticles and green fluorescent protein (GFP) over a staggered period of 3 to 9 weeks with standing magnetic resonance imaging (MRI) and histology. Methods Four adult warmblood horses received a unilateral injection of 10 × 10 6 autologous AT-MSCs into surgically created front-limb SDFT lesions. Administered AT-MSCs expressed lentivirally transduced reporter genes for GFP and were co-labelled with SPIO particles in three horses. The presence of AT-MSCs in SDFTs was evaluated by repeated examinations with standing low-field MRI in two horses and post-mortem in all horses with Prussian blue staining, fluorescence microscopy and with immunofluorescence and immunohistochemistry using anti-GFP antibodies at 3, 5, 7 and 9 weeks after treatment. Results AT-MSCs labelled with SPIO particles were detectable in treated SDFTs during each MRI in T2*- and T1-weighted sequences until the end of the observation period. Post-mortem examinations revealed that all treated tendons contained high numbers of SPIO- and GFP-labelled cells. Conclusions Standing low-field MRI has the potential to track SPIO-labelled AT-MSCs successfully. Histology, fluorescence microscopy, immunofluorescence and immunohistochemistry are efficient tools to detect labelled AT-MSCs after intralesional injection into surgically created equine SDFT lesions. Intralesional injection of 10 × 10 6 AT-MSCs leads to the presence of high numbers of AT-MSCs in and around surgically created tendon lesions for up to 9 weeks. Integration of injected AT-MSCs into healing tendon tissue is an essential pathway after intralesional administration. Injection techniques have to be chosen deliberately to avoid reflux of the cell substrate injected. In vivo low-field MRI may be used as a non-invasive tool to monitor homing and engraftment of AT-MSCs in horses with tendinopathy of the SDFT.

ObjectiveGut-residing bacteria, such as Escherichia coli, can acetylate their proteome under conditions of amine starvation. It is postulated that the (gut) microbiome is involved in the breach of immune tolerance to modified self-proteins leading to the anti-modified protein antibodies (AMPAs), hallmarking seropositive rheumatoid arthritis (RA). Our aim was to determine whether acetylated bacterial proteins can induce AMPA responses cross-reactive to modified self-proteins and be recognised by human AMPA (hAMPA).MethodsE. coli bacteria were grown under amine starvation to generate endogenously acetylated bacterial proteins. Furthermore, E. coli proteins were acetylated chemically. Recognition of these proteins by hAMPA was analysed by western blotting and ELISA; recognition by B cells carrying a modified protein-reactive B cell receptor (BCR) was analysed by pSyk (Syk phosphorylation) activation assay. C57BL/6 mice were immunised with (modified) bacterial protein fractions, and sera were analysed by ELISA.ResultsChemically modified bacterial protein fractions contained high levels of acetylated proteins and were readily recognised by hAMPA and able to activate B cells carrying modified protein-reactive BCRs. Likely due to substantially lower levels of acetylation, endogenously acetylated protein fractions were not recognised by hAMPA or hAMPA-expressing B cells. Immunising mice with chemically modified protein fractions induced a strong cross-reactive AMPA response, targeting various modified antigens including citrullinated proteins.ConclusionsAcetylated bacterial proteins are recognisable by hAMPA and are capable of inducing cross-reactive AMPA in mice. These observations provide the first conceptual evidence for a novel mechanism involving the (endogenous) acetylation of the bacterial proteome, allowing a breach of tolerance to modified proteins and the formation of cross-reactive AMPA.