According to previous investigations, CD14 is suggested to play a pivotal role in initiating and perpetuating the pro-inflammatory response during sepsis. A functional polymorphism within the CD14 ...gene, rs2569190, has been shown to impact the pro-inflammatory response upon stimulation with lipopolysaccharide, a central mediator of inflammation in sepsis. In this study, we hypothesized that the strong pro-inflammatory response induced by the TT genotype of CD14 rs2569190 may have a beneficial effect on survival (30-day) in patients with sepsis. A total of 417 adult patients with sepsis (and of western European descent) were enrolled into this observational study. Blood samples were collected for rs2569190 genotyping. Patients were followed over the course of their stay in the ICU, and the 30-day mortality risk was recorded as the primary outcome parameter. Sepsis-related organ failure assessment (SOFA) scores were quantified at sepsis onset and throughout the observational period to monitor organ failure as a secondary variable. Moreover, organ support-free days were evaluated as a secondary outcome parameter. TT-homozygous patients were compared to C-allele carriers. Kaplan-Meier survival analysis revealed a higher 30-day mortality risk among C-allele carriers compared with T homozygotes (p = 0.0261). To exclude the effect of potential confounders (age, gender, BMI and type of infection) and covariates that varied at baseline with a p-value < 0.2 (e.g., comorbidities), we performed multivariate Cox regression analysis to examine the survival time. The CD14 rs2569190 C allele remained a significant covariate for the 30-day mortality risk in the multivariate analysis (hazard ratio, 2.11; 95% CI, 1.08-4.12; p = 0.0282). The 30-day mortality rate among C allele carriers was 23%, whereas the T homozygotes had a mortality rate of 13%. Additionally, an analysis of organ-specific SOFA scores revealed a significantly higher SOFA-Central nervous system score among patients carrying the C allele compared with T-homozygous patients (1.9 plus or minus 1.1 and 1.6 plus or minus 1.0, respectively; p = 0.0311). In conclusion, CD14 rs2569190 may act as a prognostic variable for the short-term outcome (30-day survival) in patients with sepsis.
"Chirurgische Sofortmaßnahmen" by G. H. Willital - an established classic in a new edition - provides valuable orientation for every surgically active physician. The book covers all diseases and ...accidents which might make emergency surgical intervention necessary. The surgical procedures for each case are systematically structured and presented in a clear and concise manner for rapid consultation.
Der Unternehmenskauf ist eine hochkomplexe Angelegenheit, die eine perfekte Organisation und Struktur benötigt. Das Handbuch stellt den gesamten Ablauf eines Unternehmenskaufs dar, liefert ein ...zuverlässiges Projektmanagement und behandelt kompetent alle einschlägigen rechtlichen, steuerlichen und betriebswirtschaftlichen Aspekte. Außer den zivilrechtlichen Fragen rund um die Vertragsgestaltung werden die betriebswirtschaftlichen Bewertungs- und Finanzierungsfragen und die steuer-, arbeits- und kartellrechtlichen Voraussetzungen und Folgen behandelt, die rechtsformspezifischen Besonderheiten bei börsennotierten Aktiengesellschaften erläutert sowie die besonderen Anforderungen in bestimmten Branchen wie Immobilienunternehmen oder bei internationalen Transaktionen dargestellt.
Die Vorteile des Hölters auf einen Blick:
Alle rechtlichen und wirtschaftlichen Themen rund um den Unternehmenskauf werden eingehend behandelt
Rundum auf aktuellem Stand mit umfassender Einarbeitung der Gesetzesänderungen der letzten Jahre (z.B. Bilanzrechtsmodernisierung, 8. GWB-Novelle, Einführung des KAGB, AIFM-StAnpG, ESUG)
Das Autorenteam aus herausragenden Praktikern gibt sein Praxis-Know-how weiter und schärft die Sinne nicht nur für die rechtlichen, sondern auch für die strategischen und psychologischen Herausforderungen
Zahlreiche Vertragsmuster und Checklisten (deutsch und englisch) erleichtern die Umsetzung in der Praxis
Aus dem Inhalt
Mergers & Acquisitions
Bewertung
Finanzierung
Steuern beim Unternehmenskauf
Arbeitsrecht
Kartellrecht
Der Unternehmens- und Beteiligungskaufvertrag
Unternehmensbewertung und Post-Merger-/Acquisitions- Bilanzierung von Beteiligungen
Wertorientiertes Integrationsmanagement
Aktiengesellschaften und Unternehmensakquisition
Erwerb börsennotierter Unternehmen
Private Equity
Erwerb von Immobilienunternehmen
Unternehmenskauf in Krise und Insolvenz
Besonderheiten beim grenzüberschreitenden Unternehmenskauf
Unternehmenskaufvertrag nach anglo-amerikanischem Muster
Anhang:
Vertragsbeispiele Checklisten (deutsch-englisch)
Handbuch Unternehmenskauf Wolfgang Hölters, Jobst-Hubertus Bauer, Stefan Blum, Martin Bouchon, Jens Buchta, Tanja Drescher, Oliver Duys, Holger Franz, Heide Gröger, Kerstin Henrich, Wolfgang Hölters, Kai Lucks, Olaf Müller-Michaels, Gerrit Raupach, Friedhelm Sahner, Jochim Sedemund, Franz-Jörg Semler, Robert Steinau-Steinrüc
2010
eBook
Antiseptics in surgery Hirsch, Tobias; Seipp, Hans-Martin; Jacobsen, Frank ...
Eplasty,
2010-May-27, 20100527, Letnik:
10
Journal Article
Odprti dostop
Wound healing is a complex process, with many potential factors that can delay or complicate healing. Bacterial infection is one of the most dangerous complications once the skin barrier is ...destroyed. The search for optimal treatment of chronic and infected wounds is an ongoing challenge for healthcare professionals.
This article discusses recent findings in the field of wound antiseptics, its antibacterial efficacy, cell toxicity, and compatibility with wound dressings.
Skin antiseptics are daily used for wound cleansing to reduce the bacterial burden. However, there is little evidence concerning the antimicrobial efficacy, cytotoxicity of host cells, and compatibility with commonly used wound dressings. Recent findings show high toxicity and significant incompatibilities with wound dressings for some antiseptics.
Antiseptics are widely used in hospitals worldwide to reduce, inactivate, or eliminate potentially pathogenic microorganisms. Current studies show that widely used wound antiseptics show relevant cytotoxicity and cross-reactivity with certain wound dressings. Future research should particularly focus on cytotoxicity, mechanisms of bacterial resistance toward skin antiseptics and wound irrigants, as well as compatibility and cross-reactivity with wound dressings.
Acral manifestations of systemic sclerosis include Raynaud's phenomenon, calcinosis cutis, and sclerodactyly. In the later stages of the disease, contractures of the skin and joints as well as ...obliterative vasculopathy leading to digital ulcers and necrotic lesions may occur. Patients with acral manifestations of systemic sclerosis are ideally treated by a team that includes a rheumatologist, dermatologist, hand surgeon, physiotherapist, and, eventually, a psychologist. Calcium channel antagonists, alpha(1)-adrenergic blockade with prazosin, and prostacyclin analogs were proven to be effective in the treatment of scleroderma-related Raynaud's phenomenon. Losartan, an angiotensin II receptor inhibitor, and fluoxetine, a selective serotonin reuptake inhibitor, have been beneficial for systemic sclerosis-associated Raynaud's phenomenon in pilot studies. Parenteral prostacyclin analogs, e. g., iloprost, can be recommended as first-line treatment of ischemic digital ulcers. When prostacyclin analogs fail, the phosphodiesterase type 5 inhibitor sildenafil can be tried to improve ulcer healing. Bosentan, an endothelin receptor antagonist, may prevent new digital ulcers. At present, there are no medical agents agreed to be generally effective in the reduction of calcinotic deposits or cutaneous fibrosis, although some drugs have been identified as potentially beneficial. Surgical treatment of acral manifestations consists of excision or curettage of symptomatic calcific deposits, digital sympathectomy, arterial reconstruction, and amputation in rare cases. Flexion contractures of the proximal interphalangeal joints, with secondary hyperextension of the metacarpophalangeal joints, can be treated by arthrodesis of the proximal interphalangeal joints and resection arthroplasty or prostheses at the metacarpophalangeal joints to improve hand function.
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