Bundeswehrkrankenhaus

We herein present the development and application of a forensic mass spectrometry-based procedure simultaneously targeting hard keratins from human hair adducted with sulfur mustard (SM) and its structural analogues sesquimustard (Q) and O-lost (T). These alkylating chemicals represent blister agents banned by the Chemical Weapons Convention (CWC). The procedure was applied to an authentic hair sample of an SM-poisoned patient and thus allowed for the first time the proof of exposure to SM based on keratin adducts in a real case of poisoning. Whereas adducts of SM were detected, those of Q and T were not found. Contact of SM, Q and T with hair induced the alkylation of side chains of glutamic acid (E*) residues in diverse hard keratins (adduct formation). For analysis hair proteins were subjected to lysis to make them soluble and subsequently to proteolysis with pepsin to generate adducted peptides. Micro liquid chromatography-electrospray ionization high-resolution tandem-mass spectrometry (µLC-ESI MS/HR MS) allowed the detection of the three biomarker peptides AE*IRSDL, FKTIE*EL and LE*TKLQF. The characteristic alkyl-chain hydroxyethylthioethyl (HETE) was attached by SM, hydroxyethylthioethylthioethyl (HETETE) derived from Q and the hydroxyethylthioethyloxyethylthioethyl (HETEOETE)-moiety originated from exposure to T. Accordingly, we herein present an extended and improved forensic method for the biomedical verification of hair exposure to blister agents. Due to the currently growing threat by chemical warfare agents we also included some general toxicological and bioanalytical remarks of SM poisoning helpful not only for physicians and toxicologists.

Abstract Background Despite growing insights into the pathophysiology of non-union formation, failed fracture healing remains a major complication in trauma and orthopedic surgery. The transplantation of cancellous bone grafts represents the gold standard for the treatment of atrophic non-unions and large-scaled bone defects. Depending on the type of procedure and the available personnel, the bone grafts may be exposed to a significant period of intraoperative ischemia before the transplantation to the defect site. This ischemia may have detrimental effects on the quality and functionality of the grafts. Methods Therefore, we analyzed in this study the effects of different periods of ischemia (0, 30, 60 and 90 minutes) on oxidative stress, gene expression and viability of autologous bone grafts, to determine a critical ischemia time window for cancellous bone graft transplantation. Graft samples were harvested from 24 patients undergoing revision surgery due to bone healing failure. The samples were analyzed by mRNA profiler arrays, reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry. Results An ischemia of 60 minutes or longer induced the expression of pro-inflammatory and stress-induced genes, such as CXCL8 , JUN and DUSP1 . This was associated with early cell stress within the grafts, as indicated by the presence of hypoxia-inducible factor (HIF)-1α-positive cells and an increased number of senescent p16-positive cells. Additional immunohistochemical analyses revealed a significantly higher number of apoptotic cleaved caspase-3-positive cells at 60 and 90 minutes of ischemia, demonstrating a compromised viability of the grafts. RT-PCR analyses revealed a shift from a pro-osteogenic towards a pro-chondrogenic extracellular matrix (ECM) gene expression profile, along with evidence for potentially compromised angiogenesis and hematoma formation at the later transplantation site. Conclusion Taken together, these findings indicate that periods of ischemia of 60 minutes or longer should be avoided during cancellous bone graft transplantation to preserve graft function and regenerative capacity.

BackgroundThe potential aetiological relevance of Blastocystis spp. and Dientamoeba fragilis in the human intestine, and their possible associations with Campylobacter spp. and Giardia duodenalis, remain unclear. By incorporating Bayesian priors to account for diagnostic test accuracy, we statistically analysed the interactions among these microorganisms.MethodsDiagnostic test accuracy data were derived from multiple PCR assays and incorporated as priors to adjust for non-differential misclassification. Bayesian odds ratios and relationships based on DNA quantity were assessed for a dataset of 1,065 stool samples containing at least one of the four target microorganisms.ResultsAccounting for diagnostic test accuracy resulted in wide credibility intervals. Blastocystis spp. were negatively associated with G. duodenalis. G. duodenalis was most often detected in the absence of Blastocystis spp. and D. fragilis, whereas detection of Blastocystis spp. was associated with lower Campylobacter spp. DNA abundance. A negative association between Blastocystis spp. and Campylobacter spp. was observed only in the absence of D. fragilis.ConclusionThe assumed variation in detection rates of Campylobacter spp. and G. duodenalis based on the presence of Blastocystis spp. and/or D. fragilis was confirmed. Future epidemiological studies should explore interactions among multiple microorganisms using robust statistical approaches.

BackgroundHaemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome characterised by uncontrolled immune activation and multi-organ dysfunction. Whilst initially described in paediatric populations, HLH is increasingly recognised in critically ill adults, often triggered by malignancies, infections, or autoimmune diseases.MethodsThis single-centre retrospective study analysed 43 adult patients with HLH admitted to the ICU between 2008 and 2024. Clinical characteristics, laboratory parameters, organ support requirements, and outcomes were assessed. Temporal trends in routine parameters surrounding HLH diagnosis were also evaluated.ResultsThe median age was 45 years (IQR: 33–60), and 65% were male. Respiratory failure (62.8%) and sepsis (41.9%) were the leading causes of ICU admission. Disease severity was high, with a median SOFA score of 14 (IQR: 11–17), and ICU mortality reached 65.1%. Invasive mechanical ventilation was required in 83.7% of patients, and continuous renal replacement therapy in 72.1%. Ferritin levels were markedly elevated, with a median peak of 25,045 μg/l (IQR: 12,771–94,586), with 93% of patients exceeding 6,000 μg/l. The median HScore was 245 (IQR: 210–273) and did not differ significantly between survivors and non-survivors (p = 0.64).ConclusionHLH in adult ICUs carries high mortality and demands extensive organ support. Existing diagnostic scores provide limited bedside guidance, highlighting the need for ICU-specific validation and improved prognostic markers.

BackgroundWater vapour resistance of thermal insulating protective clothing impedes sweat evaporation, the most substantial pathway of heat dissipation for working humans. Consequently, metabolic heat can increase body core temperature rapidly, which can result in life-threatening heat illnesses. The evaporative microclimate cooling method Dry Air Comfort (DAC) has been shown to be very effective for reducing the risk of heat induced illnesses. Aim of this study was to determine whether DAC can also prevent heat stress when used in intervals.MethodsUsing a balanced within-subject design twelve men in protective overalls were randomly assigned (max. 205 min, 25 °C, 50% relative humidity/RH, 0.2 m/s wind speed) to a work-rest schedule (5 × 20 min work respectively rest each; work: treadmill, 3 km/h, 5% incline; handling of loads) without cooling and with insufflating conditioned air (30 °C, < 3% RH, 600 l/min) into an air-diffusing undergarment during rest periods (interval cooling).ResultsWith interval cooling, all participants tolerated the whole exposure time never exceeding a mean core temperature of 38.0 °C. In contrast, without cooling eight subjects had to terminate work because of high core temperatures (39 °C, n = 5), subjective exhaustion or reaching 90% of the maximum individual heart rate (HR; n = 3). All parameters indicated lower heat stress and distinctive heat dissipation with interval cooling: e.g., HR between both conditions differed significantly (p ≤ 0.05; p ≤ 0.01), as were the skin temperatures (p ≤ 0.001). HR decline was more pronounced during rest periods during interval cooling, indicating significant recovery: e.g., 105.1 ± 17.0 b/min vs. 149.7 ± 15.5 b/min (rest 4, 165. min vs. work 4, 145. min, n = 12). Without cooling HR showed only minor recovery: e.g., 138.4 ± 15.0 b/min vs. 158.7 ± 12.3 b/min (rest 4, 165. min vs. work 4, 145. min, n = 8) and exceeded the level of HR in rest periods of interval cooling.ConclusionsInterval heat evaporation during rests periods with the microclimate cooling method DAC was shown to be effective in preventing body heat accumulation during alternating work-rest cycles. The method can improve occupational health and safety of men working in thermal protective clothing.

Due to the burdens of critical operations, firefighters are at occupational risk of developing mental health problems such as post-traumatic stress symptoms (PTSS) or anger. In this study, we assessed the impact of a firefighting operation with two fatalities and eleven injuries among colleagues on the mental health of those involved. Aims: The study hypothesizes that firefighters who were acquainted with the wounded or deceased show more PTSS and score higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to those who were not. The second hypothesis assumes that the deployed group shows more PTSS and scores higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to the grouping of non-deployed colleagues. Methods: A total of N = 138 firefighters were included, of which n = 32 were deployed and n = 106 were not (n = 26 acquainted with wounded or injured; n = 107 not acquainted with wounded or injured; n = 5 not specified). Both groups completed a standardized questionnaire voluntarily and after providing written informed consent ten months after the incident. The questionnaire consisted of the Posttraumatic Stress Checklist for DSM-5 (PCL-5) and the State-Trait Anger Inventory (STAXI-2) questionnaire. Results: Firefighters who knew the injured or deceased colleagues had significantly higher PTSS [T(23.7) = −2.5; p = 0.019; d = 0.67; 95% CI = (−10.8, −1.0)], state anger [T(74.2) = 2.4; p = 0.021; d = 0.41; 95% CI = (0.2, 2.0)], and anger control scores [T(124) = −2.7; p = 0.008; d = 0.71; 95% CI = (−5.9, −0.9)]. In addition, the deployed group showed higher anger control [T(134) = 2.0; p = 0.046; d = 0.42; 95% CI = (0.0, 4.2)] and outward anger expression [T(73.5) = −2.2; p = 0.032; d = 0.40; 95% CI = (−2.3, −0.1)] scores compared to their non-deployed colleagues. Discussion: Future psychological pre- and post-deployment interventions should place more focus on the increased vulnerability of those acquainted with wounded or deceased colleagues.

Abstract Introduction: For the treatment of sudden cardiac death, the prompt deployment of an automated external defibrillator (AED) has been shown to significantly improve survival rates (1). Since 2007, the availability of AEDs on seagoing vessels flying the German flag has been legally mandated. This study aims to assess the availability of AEDs on such vessels and their utilization in emergency situations on board. Subjects and Methods: A monocentric retrospective analysis was conducted to evaluate the utilization of AEDs on board. A total of 43 nautical officers completed a questionnaire covering an observational period of the past 10 years. The ship officers were interviewed on board vessels in the Port of Hamburg between August and December 2018, corresponding to an observation period of 8600 seafarer-years. Results: An AED was present on 100% of German-flagged seagoing vessels and 52.2% of non-German-flagged seagoing vessels. Of the 43 health officers surveyed, 38 did not use an AED. Among living patients, four officers used the AED once to deliver a shock, while one respondent used it twice. The five early defibrillations performed occurred following observed cardiovascular arrests and correspond to an annual prevalence of sudden cardiac death of 6 per 100,000 seafarers. Three patients (60%) were successfully defibrillated. Conclusions: The medical requirements for German-flagged ships are playing a pioneering role internationally in the equipping of seagoing vessels with AEDs. Given the unique conditions at sea and the lack of timely on-site emergency medical care – both of great importance – the availability of an AED on board appears to be highly beneficial.