Schwan-Stabilo (Germany)

In keinem anderen Bereich der Medizin gehören molekularbiologische Testungen inzwischen so sehr zum diagnostischen Standardrepertoire wie im Bereich der Infektionsdiagnostik. Für den direkten Erregernachweis haben sich hauptsächlich zwei Methoden durchgesetzt, die Polymerasekettenreaktion und die Immunchromatographie, die häufig in Form von Teststreifen oder Testkarten angeboten wird. Vorteilhaft an der Polymerasekettenreaktion ist insbesondere die Möglichkeit, neben dem Erregernachweis die Simultananalyse von Resistenzdeterminanten oder Virulenzfaktoren einzubinden. Im Zeitalter der multiresistenten (Krankenhaus-)Keime gewinnt die schnelle und zuverlässige molekularbiologische Differenzierung vor den Hintergrund einer unmittelbaren Einleitung von möglichst frühzeitigen und damit auch effizienten Isolierungsmaßnahmen von betroffenen Patienten zunehmend an Bedeutung.

Abstract Background: The prognostic relevance of blood markers in multiple trauma is still a matter of controversial debate. Besides clinical scores new biomarkers indicating the disease severity and the prognosis during the first hours of therapy are highly needed to improve individual patient management. Methods: In prospectively collected sera of 164 patients, among them 115 with multiple trauma, the values of circulating nucleosomes, high-mobility-group-box protein 1 (HMGB1) and soluble receptor of advanced glycation end products (sRAGE) were determined at time of admission to the resuscitation room. Disease severity and clinical status were quantified by injury severity score (ISS) and Glasgow Coma Scale (GCS). As controls, 24 patients with femoral neck fractures and 25 patients with ankle fractures (AFs) were included. Results: Patients with severe multiple trauma (SMT) showed significantly higher HMGB1 and sRAGE levels than patients with moderate trauma and single fractures. Interestingly, HMGB1 and nucleosomes (R=0.56; p<0.01) as well as HMGB1 and sRAGE (R=0.44; p<0.01) correlated significantly with each other. In multiple trauma patients, high HMGB1 and sRAGE levels were significantly associated with more severe trauma according ISS (both p<0.01) and more severe traumatic brain injury (TBI) (GCS≤8; both p<0.01). Thirteen of the multiple injured patients died during the first week after trauma. Non-surviving patients showed significantly higher values of HMGB1, nucleosomes, and sRAGE than survivors (p<0.01; p=0.01; p=0.02). Best prediction of first-week mortality was obtained in receiver operating characteristic (ROC) curves for HMGB1 that yielded an area under the curve (AUC) of 90.6%. Conclusions: HMGB1, nucleosomes and sRAGE are valuable biomarkers indicating trauma severity and prognosis of trauma patients.

The prevalence and incidence of epilepsies in elderly is high. Due to demographic development, the portion of elderly patients with epilepsy will continue to rise over the next decades. In this study, we aimed to investigate seizure semiology, etiology, comorbidity, and therapy in elderly patients dependent on onset of epilepsy and in comparison with younger patients. In a prospective multicentre study, 202 epilepsy patients were included in a consecutive manner and subdivided into three groups (group A1: >65 years, onset of epilepsy after the age of 65 years; group A2: >65 years with early onset epilepsy, seizure onset before the age of 50 years; and group B: <50 years with epilepsy). Clinical data with respect to epilepsy, seizures, comorbidity, etiology, and anti-epileptic drug (AED) therapy were assessed using a questionnaire developed especially for these patient groups and filled out by the physicians. The clinical profile with regard to etiology, postictal conditions, and comorbidities clearly depends on the age of the patients and age of onset of epilepsy. Patients with an epilepsy onset after 65 years need lower doses of AEDs, gain better seizure control and have more concomitant diseases than younger patients or elderly epilepsy patients with early-onset epilepsy.

A new type of electrolytic stripper containing neutralisation products of nitric acid with amines, carboxylic acids and a small quantity of halogen is described. This electrolyte is especially deve...