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Flohé S, Matthes G, Maegele M, Huber-Wagner S, Nienaber U, Lefering R, Paffrath T. [Future perspective of the TraumaRegister DGU® : Further development, additional modules and potential limits]. Unfallchirurg 2019; 121:774-780. [PMID: 30238270 DOI: 10.1007/s00113-018-0558-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since its founding in 1993 the TraumaRegister DGU® has become one of the largest registries especially in terms of data diversity. Since the introduction of the TraumaNetzwerk DGU®, the TraumaRegister DGU® has enabled a quasi-nationwide picture of the quality of care of severely injured patients in Germany. The register is subject to constant development, under the guidance of the working groups of the German Society for Trauma Surgery (DGU). The first modular expansion of special injury entities (craniocerebral trauma and complex hand injuries) is currently taking place. The future developments will involve the extension of the register to certain injury patterns. The existing registry will also be supplemented with other recorded qualities (from the supplementary serum database up to the quality of life). This makes the TraumaRegister DGU® a tool for quality assurance and science which is well prepared for the future.
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Affiliation(s)
- S Flohé
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städt. Klinikum Solingen gGmbH, Gotenstr. 1, 42653, Solingen, Deutschland.
| | - G Matthes
- Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Deutschland
| | - M Maegele
- Orthopädie, Unfallchirurgie und Sport, Kliniken der Stadt Köln, Köln, Deutschland
| | - S Huber-Wagner
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, München, Deutschland
| | - U Nienaber
- AUC Akademie der Unfallchirurgie GmbH, München, Deutschland
| | - R Lefering
- Institut für Forschung in der operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | - T Paffrath
- Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Witten, Deutschland
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Lefering R, Nienaber U, Paffrath T. [What is a seriously injured person? : Differentiated view of the severity of the injuries in a trauma patient]. Unfallchirurg 2019; 120:898-901. [PMID: 28894909 DOI: 10.1007/s00113-017-0409-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Lefering
- Institut für Forschung in der Operativen Medizin (IFOM), Fakultät für Gesundheit, Private Universität Witten/Herdecke, Ostmerheimer Str. 200 (Haus 38), 51109, Köln, Deutschland.
| | - U Nienaber
- AUC - Akademie der Unfallchirurgie GmbH, München, Deutschland
| | - T Paffrath
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln gGmbH, und Lehrstuhl für Unfallchirurgie & Orthopädie, Klinikum der Privaten Universität Witten/Herdecke, Köln, Deutschland
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Abstract
INTRODUCTION Biological sex is considered a risk factor for adverse outcome after major trauma. We hypothesized that female sex is protective against organ failure, sepsis and mortality in patients with traumatic haemorrhage. PATIENTS AND METHODS We selected patients from TraumaRegister DGU(®) (TR-DGU) with primary admission for blunt trauma with an injury severity score ≥ 16 and an ICU stay ≥ 3 days that presented with relevant bleeding in the years 2007-2012. Relevant bleeding was defined as Abbreviated Injury Scale (AIS) ≥ 3 with an estimated blood loss exceeding 20%, any femoral shaft fracture, any pelvic clamp as surrogate for unstable pelvic fracture or the presence of at least one criteria of haemorrhagic shock: shock index of 0.8-1.4; base excess of -2.0 to -10.0 mmol/L; body temperature ≤ 34°C; transfusion of ≥ 4 units of packed red blood cells; application of recombinant activated factor VII; any embolization during trauma room phase and pre-hospital resuscitation volume ≥ 3000 ml or any catecholamine use during pre-hospital care in the absence of cardiopulmonary resuscitation. A total of 7560 males and 2774 females were selected and analyzed for sex differences. RESULTS Higher rates of multiple organ failure (24.4 vs. 21.3%, Odds ratio [OR] 1.19 (95% confidence interval [95%CI] 1.07-1.33), p=0.001*) and sepsis (16.5 vs. 11.3%, OR 1.55 (95%CI 1.35-1.77), p<0.001*) were observed in males. Organ function of lung, cardio-circulatory system, liver and kidney were better in females, however, there was no difference in mortality. Stratification by age group revealed that in particular age-group 16-44 years was related to improved organ function which may indicate effects of sex hormones in females at reproductive age. Increased rates of sepsis in males were observed throughout virtually all age groups starting at 16 years of age, except in age group 54-64 years. This may suggest suppressive effect of testosterone on immune function. CONCLUSIONS Our study supports the hypothesis that female sex is associated with improved organ function following traumatic injury and haemorrhagic shock, in particular in age groups that are at reproductive age. However, further studies are warranted before sex steroids can be deployed as therapeutic intervention in critically ill trauma patients.
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Affiliation(s)
- H Trentzsch
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital of Munich, Campus Innenstadt, Munich, Germany.
| | - U Nienaber
- Academy for Trauma Surgery (AUC), Munich, Germany
| | - M Behnke
- Department of Surgery, University Hospital of Munich, Campus Großhadern, Munich, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Campus Cologne-Merhein, Cologne, Germany
| | - S Piltz
- Department of Surgery, University Hospital of Munich, Campus Großhadern, Munich, Germany
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Mutschler M, Paffrath T, Wölfl C, Probst C, Nienaber U, Schipper IB, Bouillon B, Maegele M. The ATLS(®) classification of hypovolaemic shock: a well established teaching tool on the edge? Injury 2014; 45 Suppl 3:S35-8. [PMID: 25284231 DOI: 10.1016/j.injury.2014.08.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Uncontrolled bleeding is the leading cause of shock in trauma patients and delays in recognition and treatment have been linked to adverse outcomes. For prompt detection and management of hypovolaemic shock, ATLS(®) suggests four shock classes based upon vital signs and an estimated blood loss in percent. Although this classification has been widely implemented over the past decades, there is still no clear prospective evidence to fully support this classification. In contrast, it has recently been shown that this classification may be associated with substantial deficits. A retrospective analysis of data derived from the TraumaRegister DGU(®) indicated that only 9.3% of all trauma patients could be allocated into one of the ATLS(®) shock classes when a combination of the three vital signs heart rate, systolic blood pressure and Glasgow Coma Scale was assessed. Consequently, more than 90% of all trauma patients could not be classified according to the ATLS(®) classification of hypovolaemic shock. Further analyses including also data from the UK-based TARN registry suggested that ATLS(®) may overestimate the degree of tachycardia associated with hypotension and underestimate mental disability in the presence of hypovolaemic shock. This finding was independent from pre-hospital treatment as well as from the presence or absence of a severe traumatic brain injury. Interestingly, even the underlying trauma mechanism (blunt or penetrating) had no influence on the number of patients who could be allocated adequately. Considering these potential deficits associated with the ATLS(®) classification of hypovolaemic shock, an online survey among 383 European ATLS(®) course instructors and directors was performed to assess the actual appreciation and confidence in this tool during daily clinical trauma care. Interestingly, less than half (48%) of all respondents declared that they would assess a potential circulatory depletion within the primary survey according to the ATLS(®) classification of hypovolaemic shock. Based on these observations, a critical reappraisal of the current ATLS(®) classification of hypovolaemic seems warranted.
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Affiliation(s)
- M Mutschler
- Department of Orthopedics, Trauma and Sportsmedicine, Cologne-Merheim Medical Center (CMMC), Private University Witten-Herdecke, Cologne, Germany.
| | - T Paffrath
- Department of Orthopedics, Trauma and Sportsmedicine, Cologne-Merheim Medical Center (CMMC), Private University Witten-Herdecke, Cologne, Germany
| | - C Wölfl
- Department of Trauma and Orthopedic Surgery, BG Hospital Ludwigshafen, Ludwigshafen, Germany
| | - C Probst
- Department of Orthopedics, Trauma and Sportsmedicine, Cologne-Merheim Medical Center (CMMC), Private University Witten-Herdecke, Cologne, Germany
| | - U Nienaber
- Academy for Trauma Surgery (AUC), Berlin, Germany
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - B Bouillon
- Department of Orthopedics, Trauma and Sportsmedicine, Cologne-Merheim Medical Center (CMMC), Private University Witten-Herdecke, Cologne, Germany
| | - M Maegele
- Department of Orthopedics, Trauma and Sportsmedicine, Cologne-Merheim Medical Center (CMMC), Private University Witten-Herdecke, Cologne, Germany
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Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Wyen H, Peiniger S, Paffrath T, Bouillon B, Maegele M. A critical reappraisal of the ATLS classification of hypovolaemic shock: does it really reflect clinical reality? Resuscitation 2012; 84:309-13. [PMID: 22835498 DOI: 10.1016/j.resuscitation.2012.07.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/29/2012] [Accepted: 07/09/2012] [Indexed: 10/28/2022]
Abstract
AIM The aim of this study was to validate the classification of hypovolaemic shock given by the Advanced Trauma Life Support (ATLS). METHODS Patients derived from the TraumaRegister DGU(®) database between 2002 and 2010 were analyzed. First, patients were allocated into the four classes of hypovolaemic shock by matching the combination of heart rate (HR), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) according to ATLS. Second, patients were classified by only one parameter (HR, SBP or GCS) according to the ATLS classification and the corresponding changes of the remaining two parameters were assessed within these four groups. Analyses of demographic, injury and therapy characteristics were performed as well. RESULTS 36,504 patients were identified for further analysis. Only 3411 patients (9.3%) could be adequately classified according to ATLS, whereas 33,093 did not match the combination of all three criteria given by ATLS. When patients were grouped by HR, there was only a slight reduction of SBP associated with tachycardia. The median GCS declined from 12 to 3. When grouped by SBP, GCS dropped from 13 to 3 while there was no relevant tachycardia observed in any group. Patients with a GCS=15 presented normotensive and with a HR of 88/min, whereas patients with a GCS<12 showed a slight reduced SBP of 117mmHg and HR was unaltered. CONCLUSION This study indicates that the ATLS classification of hypovolaemic shock does not seem to reflect clinical reality accurately.
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Affiliation(s)
- M Mutschler
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center, Cologne, Germany.
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Nienaber U, Eichner K. Die antioxidative Wirkung von Produkten der Maillard-Reaktion in Modellsystemen und gerösteten Haselnüssen. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/lipi.2700971201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
European starlings, Sturnus vulgaris, intermingle fresh herbs, especially species rich in volatile compounds, with their otherwise dry nest material. In this field study we investigated whether these herbs reduce ectoparasites and thereby protect nestlings (the nest protection hypothesis). We also considered whether volatile compounds in herbs improve the condition of nestlings (the drug hypothesis). As measures of condition we used body mass, haematocrit levels and immunological parameters. We replaced 148 natural starling nests with artificial ones: half contained herbs and half (controls) contained grass. The ectoparasite loads (mites, lice, fleas) in herb and control nests were indistinguishable. However, nestlings in herb nests weighed more and had higher haematocrit levels at fledging than nestlings in control nests. Fledging success was similar in herb and control nests, but more yearlings from herb nests were identified in the colony the year after hatching. The response of the immune system when challenged with phytohaemagglutinin did not differ in nestlings from herb and control nests. Nestlings from herb nests had more basophils and fewer lymphocytes in their blood than those from control nests, while the eosinophil and heterophil counts did not differ. We conclude that herbs do not reduce the number of ectoparasites, but they improve the condition of nestlings, perhaps by stimulating elements of the immune system that help them to cope better with the harmful activities of ectoparasites. Copyright 2000 The Association for the Study of Animal Behaviour.
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Affiliation(s)
- H Gwinner
- Research Unit for Ornithology of the Max-Planck-Society
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Jarén-Galán M, Nienaber U, Schwartz SJ. Paprika (Capsicum annuum) oleoresin extraction with supercritical carbon dioxide. J Agric Food Chem 1999; 47:3558-3564. [PMID: 10552685 DOI: 10.1021/jf9900985] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Paprika oleoresin was fractionated by extraction with supercritical carbon dioxide (SCF-CO(2)). Higher extraction volumes, increasing extraction pressures, and similarly, the use of cosolvents such as 1% ethanol or acetone resulted in higher pigment yields. Within the 2000-7000 psi range, total oleoresin yield always approached 100%. Pigments isolated at lower pressures consisted almost exclusively of beta-carotene, while pigments obtained at higher pressures contained a greater proportion of red carotenoids (capsorubin, capsanthin, zeaxanthin, beta-cryptoxanthin) and small amounts of beta-carotene. The varying solubility of oil and pigments in SCF-CO(2) was optimized to obtain enriched and concentrated oleoresins through a two-stage extraction at 2000 and 6000 psi. This technique removes the paprika oil and beta-carotene during the first extraction step, allowing for second-stage oleoresin extracts with a high pigment concentration (200% relative to the reference) and a red:yellow pigment ratio of 1.8 (as compared to 1.3 in the reference).
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Affiliation(s)
- M Jarén-Galán
- Department of Food Science and Technology, The Ohio State University, Columbus, Ohio 43210-1097, USA
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Martin N, Bartsch J, Scholz-B�ttcher B, Kohl-Himmelseher M, Scherbaum E, Herrmann K, Heimhuber B, Endres O, Schwerdtfeger E, Schulz H, Wegner-Hambloch S, T�ubert T, Feldheim W, Millies K, Wachtendonk DV, Nageldinger R, Bogn�r A, Kroh L, Nienaber U, Rymon Lipinski GWV, T�ufel A, Gude T, Reinders G, Scherz H, Schir�dter R, Weder J, Eichner K, Hartmeier W, Rehbein H, Jager M, Arens M, Klages U, Coors U, Kleinau HJ, Griffig J, Ehlermann D, Pfaff K, Bartsch A, Rothenb�cher L, Schmid W, Schuster B, Dillhage N, Kobelt S, Gertz C, Majerus P, Mergenthaler E, M�nnlein E, Krause E, Beljaars PR, Wittmann R, Rohrdanz A, Seulen P, Brauckhoff S, Hild J, Oeser AR, Sengl M, Bauer U, Fretzdorff B, Lehmann I, Fiebig HJ, Finger A, Meylahn K, Winter M, B�hm V, Gasser U, Karl H, Schl�ter U, Reieders G, Schneider R, Haselein I, Otteneder H, Weisshaar R, Spiegel H, Broschard T, Marx F, Reiners W, Suwelack C, Buchberger J, Hahn H, Milczewski KEV, Vogelgesang J, Burow H, Manthey M, Schreiner H, Schr�dter R, Bohnenstengel F, Meetschen U, Oehlenschl�ger J, Seiler H, Horstmann P, Siewek F, Hemming D, T�ubert T, Stumm I, Broschard T, Pabel B, M�tzel U, Rei� J, Brockmann R, Schr�der I, Reinere W, Peschla S, Stauff D, Sch�tz S. Abstracts. Eur Food Res Technol 1994. [DOI: 10.1007/bf01350310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hendrick JA, Tadokoro T, Emenhiser C, Nienaber U, Fennema OR. Various dietary fibers have different effects on lipase-catalyzed hydrolysis of tributyrin in vitro. J Nutr 1992; 122:269-77. [PMID: 1310109 DOI: 10.1093/jn/122.2.269] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The ability of various dietary fibers to impede lipase-catalyzed hydrolysis of tributyrin was studied in vitro. Conditions (temperature, kind and concentration of constituents, pH, agitation) were chosen to mimic, as closely as possible, those prevailing in the human duodenum. Lipolysis was monitored at pH 6.0 and 37 degrees C using a constant pH titrimeter. Some fibers inhibited lipolysis (red wheat bran, white wheat bran, oat bran and sugarbeet fiber), whereas most did not (psyllium seed, pectin LM 12CG, carrageenan, carboxymethylcellulose, gum arabic, and pectin slow set). Water extracts of the fibers accounted for 32-41% of the inhibitory effect of the two wheat brans on lipolysis and 100% of the inhibitory effect of oat bran.
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Affiliation(s)
- J A Hendrick
- Department of Food Science, University of Wisconsin, Madison 53706
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