Hemophagocytic lymphohistiocytosis in critically ill patients: diagnostic reliability of HLH-2004 criteria and HScore.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare though often fatal hyperinflammatory syndrome mimicking sepsis in the critically ill. Diagnosis relies on the HLH-2004 criteria and HScore, both of which have been developed in pediatric or adult non-critically ill patients, respectively. Therefore, we aimed to determine the sensitivity and specificity of HLH-2004 criteria and HScore in a cohort of adult critically ill patients.

Guideline-conform translation and cultural adaptation of the Addenbrooke's Cognitive Examination III into German.

Age-related disorders, such as dementia, significantly contribute to the global burden of disease. Adequate screening in the primary care setting is critical for early detection and proper management. The Addenbrooke's Cognitive Examination III (ACE-III) is an open-source neuropsychological test with superior diagnostic quality in comparison to the Mini-Mental State Examination (MMSE).

Hyperferritinemia in Critically Ill Patients.

Objective: Hyperferritinemia is frequently seen in critically ill patients. A rather rare though life-threatening condition related to severely elevated ferritin is hemophagocytic lymphohistiocytosis. We analyze ferritin levels to differentiate hemophagocytic lymphohistiocytosis from other causes of hyperferritinemia in a mixed cohort of critically ill patients.

Distal radioulnar joint instability: current concepts of treatment.

Distal radioulnar joint (DRUJ) instability is often an underestimated or missed lesion which may entail fatal consequences. The triangular fibrocartilage complex is a biomechanically very important stabilizer of the DRUJ and guarantees unrestricted range of motion of the forearm. To detect DRUJ instability a systematic examination is of uppermost importance.

Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study.

Background: Postoperative anaemia is a frequent surgical complication and in contrast to preoperative anaemia has not been validated in relation to mortality, morbidity and its associated health economic effect. Postoperative anaemia can predispose postoperative delirium through impairment of cerebral oxygenation. The aim of this secondary analysis is to investigate the association of postoperative anaemia in accordance with the sex specific World Health Organization definition of anaemia to postoperative delirium and its impact on the duration of hospital stay.

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction.

Objective: Studies of postoperative cognitive dysfunction (POCD) rely on repeat neuropsychological testing. The stability of the applied instruments, which are affected by natural variability in performance and measurement imprecision, is often unclear. We determined the stability of a neuropsychological test battery using a sample of older adults from the general population.

Presurgical cognitive impairment is associated with postoperative delirium and postoperative cognitive dysfunction.

Background: Presurgical cognitive impairment (PreCI) is frequently seen in older age, but the influence on postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) remains unclear. The present study sought to determine the association between PreCI, POD and POCD with special focus to different PreCI domains.

Methods: We analyzed 934 patients with complete baseline neurocognitive assessment.

Functional Connectivity of the Supplementary Motor Network Is Associated with Fried's Modified Frailty Score in Older Adults.

Frailty is a geriatric syndrome defined by coexistence of unintentional weight loss, low physical reserve, or activity and is associated with adverse health events. Neuroimaging studies reported structural white matter changes in frail patients. In the current study, we hypothesized that clinical frailty is associated also with functional changes in motion-related cortical areas, that is, (pre-)supplementary motor areas (SMA, pre-SMA).

Routine management of postoperative delirium outside the ICU: Results of an international survey among anaesthesiologists.

Background: Postoperative delirium (POD) is a severe brain dysfunction. Although data indicate a high relevance, no survey has investigated the routine practice to monitor delirium outside the ICU setting after surgery. Prior to publishing of the new European Society of Anaesthesiology (ESA) guidelines on POD, an international survey was conducted to assess current practice.

Innovative ICU Solutions to Prevent and Reduce Delirium and Post-Intensive Care Unit Syndrome.

Delirium, the most common form of acute brain dysfunction affecting up to 80% of intensive care unit (ICU) patients, has been shown to predict long-term cognitive impairment, one of the domains in "Post-ICU Syndrome" (PICS). The ICU environment affects several potentially modifiable risk factors for delirium, such as disorientation and disruption, of the sleep-wake cycle. Innovative solutions aim to transform standard concepts of ICU room design to limit potential stressors, and utilizing the patient care space as a treatment tool, exerting positive, therapeutic effects.

[Secondary reconstruction of flexor tendons].

The secondary reconstruction of flexor tendons is in most cases very demanding and tedious. The indications, selection of the correct surgical procedure, operative technique and further treatment have to be individually adjusted and are mostly very difficult. Due to the previous operations unpleasant surprises may occur intraoperatively, which must be recognized and treated by the surgeon.

[Perioperative Neurocognitive Disorders - Postoperative Prevention Strategies].

Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with increased morbidity and mortality as well as neurocognitive disorder and associated loss of autonomy and increased need for care. As professionals, it is our duty to treat our patients in a holistic individual concept with the aim to reintegrate our patients into their home and social environment afterwards.

[Recommendations for the Detection and Specification of Perioperative Neurocognitive Disorders].

Perioperative neurocognitive disorders (pNCD) are relevant to long term treatment outcome after elective surgery. The detection of pNCD is challenging and based on extended neuropsychological testing that often is not feasible due to economy driven time constraints during preoperative risk assessment. Only recently new recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery facilitated the transition of the former research diagnosis postoperative cognitive dysfunction (POCD) as a clinical diagnosis based on DSM-5 criteria.

Automated radial 8-arm maze: A voluntary and stress-free behavior test to assess spatial learning and memory in mice.

The radial arm maze (RAM) is a common behavioral test to assess spatial working and reference memory in mice. However, conventional RAM experiments require a substantial degree of manual handling and animals are usually subjected to prolonged periods of food or water deprivation to achieve sufficient learning motivation resulting in stress-induced confounding effects and unwanted intra- and inter-subject variation. In a proof-of-concept approach to improve reliability and repeatability of results by refining the conventional maze methodology, we developed a voluntary, fully automated 8-arm RAM and tested its feasibility and usability using both spatial working and combined working/reference memory paradigms in ten female C57BL/6J mice.

[Reconstruction of the deep fibers of the distal radioulnar ligaments facilitating a tendon graft-Adams' procedure].

Goal: Anatomical reconstruction of the deep fibers of the distal radioulnar ligaments to stabilise the distal radioulnar joint.

Indications: Multidirectional instability of the distal radioulnar joint without the possibility for anatomic refixation of the distal radioulnar ligaments.

Contraindications: General operative contraindications, infection, insufficient soft tissue coverage, osteoarthritis of the distal radioulnar joint, excessive ulna impaction syndrome, osseous deformation.

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines - a retrospective observational study.

Background: Frailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk.

Objective: This study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines.

Anticholinergic burden of long-term medication is an independent risk factor for the development of postoperative delirium: A clinical trial.

Background: Postoperative delirium (POD) is a common complication after surgery.

Objective: We sought to determine the association between preoperative anticholinergic load calculated using the anticholinergic drug scale (ADS) and POD in cancer patients over 65 years of age.

Design: A retrospective sub-investigation of a randomised controlled interventional trial.

Canker and Wood Rot Pathogens Present in Young Apple Trees and Propagation Material in the Western Cape of South Africa.

Canker and wood rot pathogens cause dieback and, in severe cases, the death of young apple trees. Recently, a higher occurrence of cankers was observed on 1-year-old apple trees in the Western Cape Province of South Africa. This study aimed to assess the phytosanitary status of nursery trees and propagation material as possible inoculum sources for canker pathogens.

Transfusion of red blood cells does not impact progression-free and overall survival after surgery for ovarian cancer.

Background: Allogeneic red blood cells (RBCs) have the potential to impact the immunosurveillance of the recipient and may therefore increase the risk of recurrence after cancer surgery. In this article the relationship between perioperative RBC transfusion and the risk of recurrence after ovarian cancer surgery is examined.

Study Design And Methods: This is a retrospective cohort analysis of a prospective database of patients who underwent surgery due to primary ovarian cancer between 2006 and 2014 and who had no residual disease after surgery.