Search Results (7)

Serum prostate-specific antigen (PSA), its derivatives, and magnetic resonance tomography (MRI) lack sufficient specificity and sensitivity for the prediction of risk reclassification of prostate cancer (PCa) patients on active surveillance (AS). We investigated selected transcripts in urinary extracellular vesicles (uEV) from PCa patients on AS to predict PCa risk reclassification (defined by ISUP 1 with PSA > 10 ng/mL or ISUP 2-5 with any PSA level) in control biopsy. Before the control biopsy, urine samples were prospectively collected from 72 patients, of whom 43% were reclassified during AS. Following RNA isolation from uEV, multiplexed reverse transcription, and pre-amplification, 29 PCa-associated transcripts were quantified by quantitative PCR. The predictive ability of the transcripts to indicate PCa risk reclassification was assessed by receiver operating characteristic (ROC) curve analyses via calculation of the area under the curve (AUC) and was then compared to clinical parameters followed by multivariate regression analysis. ROC curve analyses revealed a predictive potential for AMACR, HPN, MALAT1, PCA3, and PCAT29 (AUC = 0.614–0.655, p < 0.1). PSA, PSA density, PSA velocity, and MRI maxPI-RADS showed AUC values of 0.681–0.747 (p < 0.05), with accuracies for indicating a PCa risk reclassification of 64–68%. A model including AMACR, MALAT1, PCAT29, PSA density, and MRI maxPI-RADS resulted in an AUC of 0.867 (p < 0.001) with a sensitivity, specificity, and accuracy of 87%, 83%, and 85%, respectively, thus surpassing the predictive power of the individual markers. These findings highlight the potential of uEV transcripts in combination with clinical parameters as monitoring markers during the AS of PCa. Full article

Background: Managing bone defects in non-union surgery remains challenging, especially in cases of large defects exceeding 5 cm in size. Historically, amputation and compound osteosynthesis with a remaining PMMA spacer have been viable and commonly used options. The risk of non-union after fractures varies between 2% and 30% and is dependent on various factors. Autologous bone grafts from the iliac crest are still considered the gold standard but are limited in availability, prompting consideration of artificial grafts. Objectives: The aims and objectives of the study are as follows: 1. To evaluate the radiological outcome of e.g., the consolidation and thus the stability of the bone (three out of four consolidated cortices/Lane-Sandhu-score of at least 3) by using S53P4-type bioactive glass (BaG) as a substitute material for large-sized bone defects in combination with autologous bone using the RIA technique. 2. To determine noticeable data-points as a base for future studies. Methods: In our clinic, 13 patients received bioactive glass (BaG) as a substitute in non-union therapy to promote osteoconductive aspects. BaG is a synthetic material composed of sodium, silicate, calcium, and phosphate. The primary endpoint of our study was to evaluate the radiological consolidation of bone after one and two years. To assess bone stabilization, we used a modified Lane-Sandhu score, considering only radiological criteria. A bone was considered stabilized if it achieved a minimum score of 3. For full consolidation (all four cortices consolidated), a minimum score of 4 was required. Each bone defect exceeded 5 cm in length, with an average size of 6.69 ± 1.92 cm. Results: The mean follow-up period for patients without final bone consolidation was 34.25 months, with a standard deviation of 14.57 months, a median of 32.00 months and a range of 33 months. In contrast, patients with a fully consolidated non-union had an average follow-up of 20.11 ± 15.69 months and a range of 45 months. Overall, the mean time from non-union surgery to consolidation for patients who achieved final union was 14.91 ± 6.70 months. After one year, six patients (46.2%) achieved complete bone consolidation according to the Lane-Sandhu score. Three patients (23.1%) displayed evident callus formation with expected stability, while three patients (23.1%) did not develop any callus, and one patient only formed a minimal callus with no expected stability. After two years, 9 out of 13 patients (69.2%) had a score of 4. The remaining four patients (30.8%) without expected stability either did not heal within two years or required a revision during that time. Conclusions: Bioactive glass (BaG) in combination with autologous bone (RIA) appears to be a suitable filler material for treating extensive non-unions of the femur and tibia. This approach seems to show non-inferiority to treatment with Tricalcium Phosphate (TCP). To ensure the success of this treatment, it is crucial to validate the procedure through a randomized controlled trial (RCT) with a control group using TCP, which would provide higher statistical power and more reliable results. Full article

Vascular access in severely injured pediatric trauma patients is associated with time-critical circumstances and low incidences, whereas only scarce literature on procedure performance is available. The purpose of this study was to analyze the performance of different vascular access procedures from the first contact at the scene until three hours after admission. Intubated pediatric trauma patients admitted from the scene to a single Level I trauma center between 2008 and 2019 were analyzed regarding intravenous (IV) and intraosseous (IO) accesses, central venous catheterization (CVC) and arterial line placement. Sixty-five children with a median age of 14 years and median injury severity score of 29 points were included, of which 62 (96.6%) underwent successful prehospital IV or IO access by emergency medical service (EMS) physicians, while it failed in two children (3.1%). On emergency department (ED) admission, IV cannulas of prehospital EMS had malfunctions or were dislodged in seven of 55 children (12.7%). IO access was performed in 17 children without complications, and was associated with younger age, higher injury severity and higher mortality. Fifty-two CVC placements (58 attempts) and 55 arterial line placements (59 attempts) were performed in 45 and 52 children, respectively. All CVC and arterial line placements were performed in the ED, operating room (OR) and intensive care unit (ICU). Ten mechanical complications related to CVC placement (17.8%) and seven related to arterial line placement (10.2%) were observed, none of which had outcome-relevant consequences. This case series suggests that mechanical issues of vascular access may frequently occur, underlining the need for special preparedness in prehospital, ED, ICU and OR environments. Full article

With the advent of modern synchrotron sources, X-ray microscopy was developed as a vigorous tool for imaging material structures with element-specific, structural, chemical and magnetic sensitivity at resolutions down to 25 nm and below. Moreover, the X-ray time structure emitted from the synchrotron source (short bunches of less than 100 ps width) provides a unique possibility to combine high spatial resolution with high temporal resolution for periodic processes by means of pump-and-probe measurements. To that end, TimeMaxyne was developed as a time-resolved acquisition setup for the scanning X-ray microscope MAXYMUS at the BESSY II synchrotron in order to perform high precision, high throughput pump-and-probe imaging. The setup combines a highly sensitive single photon detector, a real time photon sorting system and a dedicated synchronization scheme for aligning various types of sample excitations of up to 50 GHz bandwidth to the photon probe. Hence, TimeMaxyne has been demonstrated to be capable of shot-noise limited, time-resolved imaging, at time resolutions of 50 ps and below, only limited by the X-ray pulse widths of the synchrotron. Full article

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management. Full article

Sustainable forest management activities, such as future crop tree (FCT) release treatments, became part of the REDD+ strategy to avoid carbon emissions from forests. FCT release treatments are intended to achieve increased growth of FCTs by removing competitor trees. This initially leads to a reduction of the forest carbon pool and represents a carbon debt. We estimated that the time it takes for FCTs to offset the carbon debt through increased growth on experimental sites of 10 km² in Belize, Guyana, Suriname, and Trinidad and Tobago. We further investigated whether the costs of treatment can be compensated by the generated financial carbon benefits. An average of 2.3 FCT per hectare were released through the removal of an average of 3.3 competitors per hectare. This corresponds to an average above ground biomass (AGB) deficit of 2.3 Mg FCT⁻¹. Assuming a 30% increase in growth, the FCT would need on average 130 years to offset the carbon loss. For carbon prices from US$ 5 to 100 Mg CO₂e⁻¹ an additional increment between 0.6 and 22.7 Mg tree⁻¹ would be required to cover the treatment costs of US$ 4.2 to 8.4 FCT⁻¹. Assuming a carbon price of US$ 10 Mg CO₂e⁻¹, the additional increment required would be between 5.8 and 11.4 Mg tree⁻¹, thus exceeding the biological growth potential of most individual trees. The release of FCTs does not ensure an increase in forest carbon stocks, and refinancing of treatment costs is problematic. Full article

Despite the widespread use and strong promotion of the sustainable forest management approach, there are still uncertainties about the actual contribution of current forest management practices to sustainability. We studied the problem of sustainable timber production in four tropical countries (Belize, Guyana, Suriname, and Trinidad and Tobago). Data assessed on experimental plots covering 10 km² were used to compare management practices of four forest tenure types that commonly exist in the study countries: large scale concessions (LSC), private forests (PR), periodic block system forests (PBS), and community managed forests (CM). As an indicator of sustainable timber production, we calculated the recovery times expected under the initial condition of the stands and compared them with currently practiced cutting cycles. Three growth scenarios were simulated using diameter growth rates (1.6/2.7/4.5 mm year⁻¹) from empirical data from studies in the region. Initial volumes were determined for all commercial trees as well as for commercial trees with a DBH-threshold ≥45 cm. Highest initial volumes were found in LSC and PBS managed forests. Lowest volumes were found in CM and PR forests. Assuming the lowest growth rate for all commercial trees, none of the stands studied reached the initial pre-harvest volumes within the currently practiced cutting cycles. Assuming the highest growth rate for all trees, LSC, PBS, and PR forests reach the initial pre-harvest volume. Looking at the subset of commercial trees with a DBH ≥45 cm, all stands will reach the initial volume within 30 years only if the highest growth rate is assumed. We show that general harvest codes do not guarantee sustainable forest management in the tropics. Local stand conditions must always be one of the guiding principles of sustainable timber utilization. Applying the rigid rules, which do not take into account the current conditions of the stands, entails long-term risk of forest degradation. Full article