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Evolution of polyploidy and apomixis in the pantropically distributed and species-rich genus Zanthoxylum (Rutaceae)
Get PDFThe proto-Rutaceae group includes genera with significant economic and evolutionary importance, yet their phylogenetic relationships and evolutionary mechanisms remain incompletely understood. This thesis focuses on the evolutionary history of Zanthoxylum (prickly ash, Sichuan pepper) and one of its sister genera, Tetradium, addressing knowledge gaps through modern phylogenomic methods, including hybrid capture.
For Tetradium, a genus of nine species distributed across Eastern and Southeastern Asia, hybrid capture data was used to resolve interspecific relationships and clarify taxonomic questions. Phylogenetic analyses revealed five main groups supported by molecular and morphological data, with ovule number and seed functionality emerging as key evolutionary traits. Taxonomic revisions include revising Euodia meliifolia var. celebica as Tetradium celebicum and reassigning two fossils, Euodia costata and Euodia lignata, to T. costatum and T. lignatum, respectively. A description for T. celebicum and an identification key for all species of Tetradium are provided.
For Zanthoxylum, a pantropical genus of approximately 225 species, the hybrid capture method allowed a comprehensive phylogenetic analysis involving 453 specimens. The study resolved Zanthoxylum as monophyletic, identifying four main biogeographic clades and assessing the monophyly of key species. Zanthoxylum is monophyletic only if heterochlamydeous-flowered species are merged into it. Three out of five currently accepted sections proved to be monophyletic. Furthermore, one species, Z. fagara, is found to be polyphyletic while the remaining most species are monophyletic. Potential hybridization and incomplete lineage sorting were also detected, highlighting the need for future nomenclatural revisions.
Finally, the thesis explores chromosome evolution and polyploidy within Zanthoxylum, by using flow cytometry and a bioinformatic approach - nQuire. Together, these studies provide high-resolution phylogenetic insights and evolutionary interpretations, enhancing our understanding of Tetradium and Zanthoxylum within the Rutaceae family and offering new molecular data for future evolutionary research.2025-04-2
Neurodegenerationsmarker im Verlauf eines 6-wöchigen hochfrequenten standardisierten Sportprogramms (SIWAS) in 3 Gruppen Psychiatrischer Erkrankungen
Get PDFThis study investigated the effects of a six-week, structured physical exercise program on neurodegenerative biomarkers in patients with schizophrenia, depression, or substance use disorders. A total of 61 participants were assigned to three groups and underwent blood sampling at baseline, after three weeks, and after six weeks. The study focused on blood levels of ß-amyloid, tau protein, neurofilament light chain (NfL), and neuron-specific enolase (NSE). While statistical significance was not reached in most results, trends suggested potential biological responses to physical activity. Notably, subgroups such as individuals with obesity or a disease duration of over 10 years showed changes in certain biomarkers. The findings imply that exercise may exert neuroprotective effects even in psychiatric populations. Future studies should include longer observation periods and larger sample sizes.2025-06-0
Impact of the Polymerization Method on the Biocompatibility of Denture Base Resins in a 3D Tissue Engineered Human Oral Mucosa Model
No full textDeutsche Forschungsgemeinschaft: DFGPoly(methyl methacrylate) (PMMA) is widely used in dentistry to fabricate removable dentures. As these materials come into direct contact with the oral mucosa, biocompatibility is essential to prevent adverse reactions from residual monomers and other leachable substances. Biocompatibility is typically assessed following ISO standards using in vitro cell cultures in monolayers or in vivo models such as animal experiments. This study tested different PMMA materials for toxicity to human cells using various in vitro models, including an oral mucosa model (OMM). A detailed analysis of the materials and the obtained extracts by mass spectrometry revealed that different substances, such as the new plasticizer acetyl tributyl citrate (ATBC), were present in the materials, but only the monomer methyl methacrylate (MMA) leached out into the supernatant. Thereby, MMA leached out from all materials independent of the manufacturing process except the PMMA material, which was manufactured by photopolymerization. The obtained extracts were tested for their cytotoxicity in various models. For this purpose, standard ISO-norm experiments with mouse fibroblasts and immortalized keratinocytes originally derived from the oral mucosa were used. Complementary, an oral mucosa model composed of multilayered keratinocytes on top of a fibroblast-containing collagen matrix was created as part of this work, closely resembling the natural structure of native oral mucosa. By employing MTT assays, TUNEL assays, qPCRs and proteomics, it was shown that the extracts, a higher concentration of the monomer MMA and the plasticizer ATBC influenced the regulation of apoptotic genes, such as TNF, NF-κB, TP53, MMP1, CRK and RAB21 in the keratinocyte model and reduced the viability of the mouse fibroblasts. In contrast, this evident effect could not be overserved using the OMM system. Therefore, the toxicity of the extracts, MMA monomer and ATBC is model-dependent, limiting the ability to make general statements. Finally, this work demonstrated that methyl methacrylate can be released from dentures independently of the manufacturing process, except for the photopolymerized PMMA. The amount of released monomer seems to affect only simple cell models but not more complex, realistic models, such as the OMM. In the future, models like the OMM should be used to allow more precise statements on the toxicity of PMMA compounds.2025-04-2
Micro-CT, Histomorphometric and Immunohistological Analysis of 3D-Printed PLLA/CaCO3 Scaffolds Supplemented with CaPO4 in the Göttinger Minipig for the Development of a Patient-Specific, Resorbable Bone Substitute Material
No full textEinleitung:
Eine der zentralen Herausforderungen in der Mund-, Kiefer- und Gesichtschirurgie ist die rekonstruktive Versorgung von Gewebedefekten nach umfangreichen Tumorresektionen im Kopf-Hals-Bereich. Der mikrovaskuläre freie Gewebetransfer spielt in diesem Bereich nach wie vor eine zentrale Rolle. Obwohl die autologe Knochentransplantation derzeit als Goldstandard gilt, erfordert sie ein zweites Operationsgebiet und birgt damit zusätzliche Morbidität und damit verbundene Risiken. Daher sind die Entwicklung und Implementierung effektiver Knochenersatzmaterialien von größter Bedeutung, um den Bedarf an autologen Transplantaten zu vermeiden.
Ziel dieser Studie war es, das Ausmaß der De-novo-Knochenbildung durch Calciumcarbonat (CaCO₃)- basierte Komposit-Scaffolds zu bewerten und den Einfluss der Scaffold-Architektur auf die Osteogenese zu untersuchen.
Materialien und Methoden:
Zehn Göttinger Minischweine wurden randomisiert zwei Gruppen entsprechend den Evaluationszeitpunkten (4 und 12 Woche) zugeteilt. Vier verschiedene Poly-Lactid (PLLA)/CaCO₃-Kompositgerüste mit unterschiedlichen Stegabmessungen, teilweise ergänzt mit Calciumphosphat (CaPO₄), wurden in 5×7 mm große, zylindrische Defekte implantiert, die mit einem Trepanbohrer erzeugt wurden. Die Ergebnismessungen umfassten eine computertomografische (CT) volumetrische Knochenanalyse in mm³ und eine histomorphometrische Untersuchung in mm², wobei drei vordefinierte Regionen und die Knochen-Gerüst-Grenzfläche im Mittelpunkt standen. Der immunhistochemische Nachweis von Osteocalcin diente der Bewertung des Mineralisationsgrads und der Ableitung der Knochenregenerationsrate.
Ergebnisse:
Die histomorphometrische Analyse mittels Smith Karagianes und Van-Gieson Färbung ergab keine statistisch signifikanten Unterschiede zwischen den Gruppen. In der Scaffold-Gruppe PK4 wurden jedoch signifikante Unterschiede in der Knochenbildung mittels CT-Bildgebung und Osteocalcin-Expression festgestellt. Die Analyse der Scaffold-Knochen-Kontaktfläche zeigte keine signifikanten Unterschiede zwischen den Gruppen. Insgesamt zeigten Scaffolds mit höherer Porosität (PK2 und PK4) eine leicht verbesserte Knochenbildung. Die CaPO4-Beschichtung führte nicht zu einer statistisch signifikanten Verbesserung der Osteogenese, verbesserte jedoch die mechanische Stabilität und die Handhabungseigenschaften. Nach 12 Wochen waren die Porenvolumina der meisten Scaffolds nahezu vollständig mit neu gebildetem Knochen ausgewachsen, was ihre Eignung als osteokonduktives Material bestätigte.
Dabei zeigte sich ein Trend in der Scaffold-Zusammensetzung, der wie folgt geordnet war: PK1 < PK3 < PK2 < PK4.
Schlussfolgerungen:
Die Calciumphosphat-Oberflächenmodifizierung verbesserte die Knochenregeneration nicht signifikant, ermöglichte aber eine verbesserte intraoperative Handhabung, insbesondere bei Scaffolds mit kleineren Porengrößen. Sowohl nach vier als auch nach zwölf Wochen orientierte sich die Knochenneubildung vorwiegend an der Gerüststruktur, was deren Rolle als effektive osteokonduktive Führung unterstreicht. Nach zwölf Wochen zeigte sich eine starke Korrelation zwischen der Gerüstporosität und dem Knocheneinwuchs. Eine höhere Porosität förderte eine schnellere und umfassendere Knochenbildung, was die Gerüststruktur als entscheidenden Faktor für den regenerativen Erfolg darstellt.Introduction:
One of the central challenges in oral and maxillofacial surgery is the reconstructive restoration of tissue defects following extensive tumor resections in the head and neck region. Microvascular free tissue transfer continues to play a central role in this field. While autologous bone grafting is currently regarded as the gold standard, it necessitates a secondary surgical site, thereby introducing additional morbidity and associated risks. Consequently, the development and implementation of effective bone substitute materials are of paramount importance to obviate the need for autologous grafts.
This study aimed to evaluate the extent of de novo bone formation facilitated by calcium carbonate (CaCO₃) -based composite scaffolds and to investigate the influence of scaffold architecture on osteogenesis.
Materials and Methods:
Ten Göttinger minipigs were randomly assigned to two groups corresponding to evaluation time points (4 and 12 weeks). Four distinct poly-L-lactide (PLLA)/CaCO₃ composite scaffolds with varying bar dimensions, partially supplemented with calcium phosphate (CaPO4), were implanted into 5×7 mm cylindrical defects created by a trephine drill. Outcome measures included computed tomography (CT)-based volumetric bone analysis in mm³ and histomorphometric assessment in mm², focusing on three predefined regions and the bone–scaffold interface. Immunohistochemical detection of osteocalcin was used to evaluate the degree of mineralization and infer the rate of bone regeneration.
Results:
Histomorphometric analysis using Smith Karagianes and Van Gieson staining did not yield statistically significant differences among groups. However, significant differences in bone formation were identified in scaffold group PK4 through CT imaging and osteocalcin expression. Scaffold-bone contact area analysis showed no significant differences across groups. Overall, scaffolds with higher porosity (PK2 and PK4) demonstrated slightly enhanced bone formation. The presence of a CaPO4 coating did not result in a statistically significant improvement in osteogenesis, although it improved mechanical stability and handling characteristics. After 12 weeks, the pore volumes of most scaffolds were nearly completely infiltrated by newly formed bone, confirming their suitability as osteoconductive matrices.
A trend in scaffold performance was observed, ordered as follows: PK1 < PK3 < PK2 < PK4.
Conclusions:
The calcium phosphate surface modification did not significantly enhance bone regeneration but facilitated improved intraoperative handling, particularly in scaffolds with smaller pore sizes. At both 4 and 12 weeks, new bone formation was predominantly aligned along the scaffold architecture, underscoring their role as effective osteoconductive guides. By 12 weeks, scaffold porosity showed a strong correlation with bone ingrowth, with higher porosity promoting faster and more extensive bone formation, highlighting scaffold architecture as a critical determinant in regenerative outcomes.2025-08-0
On the Consequences of Trade: Inequality, the Environment, and Aid
Get PDFThis dissertation analyzes, empirically, the consequences of international trade along three dimensions: economic inequality, the environment, and international aid. First, building upon the argument that factor endowments influence distributional outcomes, Chapter 1 examines the consequences of the “other” China shock—that is, the repercussions of the surge in Chinese demand, mostly for agricultural commodities—for economic inequality in Brazilian municipalities. It proposes a new identification strategy that exploits plausibly exogenous variation in demand for soybeans based on fluctuations in the size of the pig stock in China and shows that the proceeds of this China-driven agricultural bonanza have been rather unequally distributed. Chapter 2 turns to the environmental consequences of trade. Based on new survey data for firms in Central Asia, Eastern Europe, Middle East, and North Africa, it examines the link between global value chains (GVCs) and firms’ environmental performance. Using propensity score matching (PSM) to compare similar companies that differ in terms of GVC participation, the analysis underscores the importance of proper environmental regulation and shows that firms that join GVCs perform better across several environmental indicators. Finally, Chapter 3 investigates the effects of trade and geopolitical competition for the provision of humanitarian assistance in the aftermath of natural disasters. Based on a trilateral panel of daily humanitarian aid decisions following more than 500 fast-onset natural disasters, it shows that donor countries take faster aid decisions if they have stronger strategic interests at stake. The analysis, which relies on daily variation in donor responses, reveals a bandwagon effect, largely explained by commercial competition.2025-06-0
Eine empirisch-ethische Untersuchung
No full textThis dissertation examines the issue of equitable resource allocation in five hospitals during the initial phase of the COVID-19 pandemic, using qualitative expert interviews. The study responds to ethical and organizational challenges posed by the global health crisis, focusing on how frontline healthcare professionals perceived and managed resource scarcity in acute clinical settings.
After outlining the research questions and contextualizing the topic with relevant biomedical and ethical background, the study delves into key themes from public health ethics, including distributive justice, organizational fairness, and the allocation of scarce medical resources. A significant gap in existing literature was identified: the lack of empirical insights into the lived experiences and perspectives of healthcare workers during real-time allocation processes under pandemic conditions.
To address this gap, twenty semi-structured (telephone) interviews were conducted with staff across different professional groups. Mayring’s qualitative content analysis was applied to evaluate the collected data.
The findings are structured along the healthcare system’s multilevel framework, with a focus on the meso level (institutional decision-making). Core resources subject to allocation included personal protective equipment (PPE) and healthcare personnel. PPE shortages were managed by prioritizing high-risk areas and professions, which led to material deficits in other departments, especially those treating patients with different isolation requirements. Personnel shortages—preexisting in the nursing sector—were further intensified, leading to unequal workload distribution and ethical stress among staff.
Decision-makers varied across levels: on the macro level, early financial support via emergency legislation played a pivotal role. However, once these subsidies ended, economic incentives increasingly influenced allocation decisions, including the resumption of elective procedures despite high infection rates. On the meso level, hospital crisis committees emerged as key bodies for distribution decisions. These decisions were shaped by institutional communication practices and process quality, which varied in terms of transparency and participation across sites and hierarchical levels.
Overall, the sudden resource scarcity created substantial ethical dilemmas for health care workers. While strategies such as rationalization, prioritization, and implicit rationing were implemented to guide allocations, these did not always align with ethical principles or previously established procedural standards.
Economization emerged as a critical influencing factor. Many participants reported that economic motives either directly determined or significantly shaped allocation decisions. The resulting consequences included decreased job satisfaction, increased workloads, and potential underprovision of non-COVID-related care, particularly in elective surgery and outpatient services. These findings suggest instances of possible misallocation.
In conclusion, the study underscores the need for inclusive, ethically grounded, and interdisciplinary allocation guidelines. Future crisis preparedness should prioritize transparent, participatory decision-making processes to ensure both just resource distribution and the well-being of healthcare staff. Lessons from the pandemic offer valuable insights for optimizing allocation strategies under conditions of scarcity.2025-07-0
Exploring Transient Dialumene and Diazido-Dialane: Low Oxidation State Aluminium Chemistry based on a Hybrid Ligand
No full textThis thesis focuses on the exploration and development of the hybrid NacNac-Box-akin ligand, DippNac-Indole (DNI), and its application in stabilizing low oxidation state aluminium complexes. The study is structured to advance the understanding of the DNI ligand, starting with its design, potential to provide stability, control reactivity, and influence on the coordination chemistry of aluminium. The first part of this study focuses on the conceptual framework behind the synthesis of the DNI ligand. The design strategy is centered around combining the advantages of both bis(heterocyclo)methane (Box) ligands and β-diketiminate (BDI) ligands. This hybrid approach aims to leverage the rigid indolyl moiety of the Box ligand, which provides structural stability and limits deformation, while also incorporating the steric control provided by the Dipp substituents of the BDI ligand. Following this, the thesis will explore the synthetic methods used to integrate the DNI ligand into aluminium complexes. It will examine how DNI helps to stabilize low oxidation state aluminium complexes, which are usually highly reactive and unstable. The goal is to add to the existing body of knowledge by showcasing how DNI can effectively stabilize aluminium in oxidation states like Al(I) and Al(II), which are typically transient and challenging to handle. The thesis will investigate how the unique properties of the DNI ligand enable these aluminium complexes to engage in bond activation and explore the reactivity of these stabilized aluminium complexes, particularly their ability to activate small molecules and their possible application in catalysis. Subsequently, this thesis introduces new avenues in low-oxidation-state aluminium-azide chemistry. The alumination of azides was investigated using a DNI ligand-supported dialane platform, uncovering previously unobserved reactivity with diverse substituted organic azides (TMSN3, BnN3, 1-AdN3, DippN3). This approach reveals novel insights into the behavior and bonding in aluminium-azide interactions with the help of single-crystal X-ray diffraction and NMR spectroscopy. The final summary will also explore the prospects of DNI and DNI-based dialane ligands in the context of general aluminium chemistry, discussing their potential reactivity, ability to activate small molecules, and future applications in catalysis.2025-06-1
The role of RNA in synaptic physiology and neurodegeneration in synucleinopathies
No full textSynucleinopathies are neurodegenerative disorders characterised by the pathological accumulation and aggregation of the protein alpha-synuclein (aSyn). Parkinson’s disease (PD), Dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and pure autonomic failure (PAF) are among the widely known and studied synucleinopathies. Among these, PD is the most prevalent, affecting about 1% of the world’s population older than 60. PD can be classified into sporadic (sPD) and familial forms, with most cases being sporadic due to environmental risk factors including pesticide exposure, trauma, and chemical exposure. Familial PD, on the other hand, accounts for only 10% of the total cases. Clinically, PD is defined by motor symptoms such as bradykinesia, rigidity, resting tremors, and gait irregularities. It is now accepted that PD progression begins decades before an individual presents with these motor symptoms. This phase is known as the pre-motor phase and it can last for several years. It is marked by symptoms including REM sleep behaviour disorder (RBD), constipation, hyposmia, and depression. Currently, PD diagnosis relies on detecting the loss of dopaminergic neurons in substantia nigra Pars Compacta (SNpc) and the detection of aSyn aggregates in the brain, often confirmed post-mortem. At the onset of motor symptoms, due to the loss of more than 50% of dopaminergic neurons in SNpc, symptomatic intervention is the last resort. Hence, there is a pressing need for early diagnosing methods of PD enabling early intervention.
Firstly, we attempted to identify possible RNA-based biomarkers in a transgenic mouse model expressing human A30P aSyn (aSyn Tg). We compared exosomes from aSyn Tg primary astrocytes and neurons with wild type (Wt). Our analysis revealed four significantly upregulated miRNAs when exosomes from aSyn Tg neurons were compared with Wt – mmu-miR-185, mmu-miR-137, mmu-miR-130a, and mmu-miR-324. Interestingly, no significant differences were observed in astrocytic exosomes. Target prediction of these miRNAs revealed genes associated with epigenetic regulations, mainly methylation, prompting further investigation in the role of RNA methylation in PD.
Similarly, for our second aim, we examined isolated exosomes from human serum samples from individuals with PD and MSA and compared them with age-matched healthy controls (HCs). Our analysis revealed that 20 miRNAs were upregulated and 21 were downregulated in PD while in MSA, 30 miRNAs were upregulated and 28 were downregulated. Among the total up and downregulated miRNAs, for further analysis, we selected approximately ten from each list of miRNAs from PD and MSA vs. HCs. These miRNAs were chosen based on their expression levels and relevance based on previously published studies. Target gene prediction for the selected miRNAs in PD samples show that these genes were relevant in cancer, cell stress, autophagy, and infections. Similarly, in MSA, the target genes of the dysregulated miRNAs were largely linked to cellular inflammation, hypoxia, and cell death.
In addition to miRNAs, epitranscriptomics is also an upcoming research branch for the identification of potential biomarkers. Among the several modifications, m6A methylation is one of the most prominently studied modifications. An increase in methylation has been correlated with decreased transcriptional and translational efficiency. Therefore, our third aim involved examining m6A RNA methylation as a potential biomarker, specifically to understand the role of methylation in ageing and neurodegeneration. We used aSyn Tg mouse as the model of pathology, and 3 mo (young) mice were compared with 15 mo (old) mice. Through m6A RNA immunoprecipitation sequencing (meRIP-seq), we observed hypermethylation of synaptic genes in 3 mo aSyn Tg vs. Wt mice. This methylation decreased with ageing, with synaptic genes becoming increasingly hypomethylated in 15 mo aSyn Tg vs. Wt mice.
To further characterise the m6A landscape, we analysed the key m6A regulatory enzymes – including the writer, N6-Adenosine-Methyltransferase Complex Catalytic Subunit (METTL3); reader, YTH N6-methyladenosine RNA-binding protein (YTHDF1); and eraser, fat mass and obesity-associated protein (FTO) proteins using immunofluorescence imaging and immunoblotting. These proteins were present in different brain regions (cortex, striatum, hippocampus, and cerebellum) in Wt and aSyn Tg mice, and primary cortical neuronal cultures, however, their levels did not vary between pathological and healthy conditions. Interestingly, our findings indicated that METTL3 was not only located in the nucleus but also in the post-synaptic compartment in neuronal cultures. These findings suggest that alterations in the regulation of m6A RNA methylation may be associated with neurodegeneration and ageing and this level of epitranscriptomic regulation might play a significant role at the synapse.
Overall, our research highlights the potential of miRNA profiles in exosomes as minimally invasive biomarkers. Due to their abundance in bodily fluids, we aimed to discover biomarkers that offer promise in the diagnosis of PD in the pre-motor phase and potentially identify individuals at risk of developing the disease later in life. This might provide significant potential as a first-line diagnostic biomarker. Exosomal miRNA retrieval showed potential as a diagnostic tool, while m6A methylation patterns might enable clinicians to identify individuals at a higher risk of developing PD. Further validation of consistent miRNAs and m6A methylation levels could contribute to a novel class of biomarkers, facilitating early detection and therapeutic strategies for PD and related synucleinopathies.2026-01-0
Evaluation of the Impact of Pelvic Fractures on Clinical Parameters and the Outcome of Severely Injured Patients in a Regional Trauma Center
No full textDie Prävalenz von Beckenfrakturen ist mit 3-8% über die Jahre konstant geblieben. Trotz eines stetigen Fortschritts in der Medizin und einer allgemeinen Reduktion der Mortalität nach Trauma über die Jahre, sind Beckenringfrakturen häufig mit Polytraumata vergesellschaftet und werden in vielen Fällen mit besonders schweren und komplikationsreichen Unfällen assoziiert, die bis heute ein kritisches Risiko für das Überleben der Patienten darstellen. Die Versatilität des Beckentraumas mit sehr unterschiedlichen Schweregraden, Varianten der Dislokation und möglicher Organ- und Weichgewebsbeteiligung hat eine einheitliche Darstellung in der Literatur bis heute erschwert. Viele Autoren führen eine erhöhte Mortalität auf direkten Verblutungstod oder Multiorganversagen nach massivem retroperitonealen Blutverlust aus dem präsakralen Venenplexus, direkt aus dem Knochen oder in seltenen und besonders lebensbedrohlichen Fällen auch aus den Iliakalarterien zurück. Nichtsdestotrotz wird die Beckenfraktur häufig in der Literatur als zweitrangige Folge eines Polytraumas und als Begleitverletzung anderer primär lebensbedrohlicher Verletzungen abgetan. Die Frage, inwieweit eine Beckenringverletzung als unabhängiger Risikofaktor für die Mortalität nach Trauma verantwortlich ist, konnte bis heute nicht abschließend geklärt werden und ist Gegenstand dieser Forschungsarbeit.
Um einen isolierten Einfluss zu untersuchen, wurden alle an der UMG Göttingen behandelten, volljährigen Patienten mit einer Beckenfraktur der Jahre 2013 – 2018 aus dem TraumaRegister DGU® extrahiert. Nach Ausschluss der an Schädel-Hirn- Trauma verstorbenen und unzureichend dokumentierten Patienten, bestand die Frakturgruppe aus 198 Patienten mit Beckenfraktur. Durch Propensity Score Matching wurde anhand der Variablen Geschlecht, Altersgruppe, ISS und NISS durch ein 1:1 nearest neighbor matching eine Kontrollgruppe gleichen Umfangs aus möglichst identischen Traumapatienten ohne Beckenfraktur gebildet. Die Gegenüberstellung der gepaarten Patienten ermöglichte einen direkten Vergleich relevanter klinischer Parameter, der Mortalität und des Outcomes.
Es konnte festgestellt werden, dass Patienten nach Beckentrauma signifikant verringerte Blutdruck- und Hämoglobinwerte aufwiesen und einen erhöhten Bedarf an Bluttransfusionsvolumen zeigten. Sie verbrachten mehr Zeit auf der Intensivstation und wurden häufiger und länger mechanisch beatmet. Eine Entlassung fand seltener nach Hause, dafür signifikant häufiger in eine Rehaklinik statt. Patienten mit Beckenfraktur wiesen öfter ein mäßiges Outcome auf und verstarben mit einer Mortalität von 9% verglichen mit 4% in der Kontrollgruppe signifikant häufiger als Patienten ohne Beckenfraktur (Odds Ratio 2,6; 95% KI 1,0 – 6,3). Auch drei gängige Prognose-Scores zeigten im direkten Vergleich signifikant schlechtere Vorhersagen für Patienten mit Beckenringverletzung und wiesen auf eine höhere Sterblichkeit hin. In einer Subgruppenanalyse wurde herausgearbeitet, dass in den beobachteten Jahren nur sporadisch und ohne erkennbares Muster ein präklinischer Beckengurt angelegt wurde und die Dokumentation der gesamten Präklinik Lücken aufwies. Es fanden sich Hinweise, dass ein Beckengurt im Zeitraum dieser Studie tendenziell bei jüngeren Patienten, die häufiger bei Ankunft im Schockraum und auf der Intensivstation beatmet wurden und insgesamt schwerere Traumata erlitten, verwendet wurde. Jedoch konnte kein signifikanter Nutzen der Intervention festgestellt werden und es wurde auch kein eindeutiger Hinweis auf eine günstigere Prognose oder ein besseres Outcome beobachtet. Eine zweite Subgruppenanalyse wurde angestellt, um bei den verstorbenen Patienten mit Beckenfraktur Risikofaktoren zu evaluieren, die mit dem Versterben in Verbindung stehen. Parameter, die sich signifikant negativ auf die Prognose nach Trauma mit Beckenfraktur auswirkten, waren in dieser Population ein Alter > 65 Lebensjahren, relevante Vorerkrankungen, eine Notwendigkeit der Gabe von Katecholaminen am Unfallort, initialer Blutdruck im Schockraum von 35 und einem GCS < 9.
Die gewonnenen Ergebnisse bestätigen die Beobachtungen anderer Autoren und legen nahe, dass Beckenfrakturen einen unabhängigen Einfluss auf die aus einem Trauma resultierende Mortalität haben und Patienten mit Beckenfraktur eine besonders vulnerable Gruppe darstellen. Diesem Umstand kann man nur gerecht werden, wenn den Folgen eines Beckentraumas frühzeitig Beachtung geschenkt wird, die bekannten Risikofaktoren überwacht und korrekt interpretiert werden und der Schwere des Traumas durch eine rasche Intervention Rechnung getragen wird. Des Weiteren lässt sich der Schluss ziehen, dass der Beckengurt als Intervention am Unfallort in dieser Population nicht konsequent Verwendung fand und mit der statistischen Power dieser Studie kein Effekt nachvollziehbar war. Diese Arbeit regt eine umfänglichere Überprüfung des Nutzens im Kontext der aktuellen Literatur an. Weitere Forschungsarbeit ist nötig, um die erhöhte Mortalität nach Beckentrauma zu adressieren. Ziel sollte dabei sein, geeignete Interventionen zu ermitteln und deren Nutzen im direkten Vergleich zu überprüfen, um ein effektives und konsequent anwendbares Handlungsprotokoll für die Versorgung von Patienten mit Beckenfraktur zu definieren und Mittel und Wege zu finden, die unverändert hohe Mortalität nach Trauma mit Beckenfraktur zu senken.The prevalence of pelvic fractures has remained constant at 3–8% over the years. Despite continuous advancements in medicine and a general reduction in trauma-related mortality, pelvic ring fractures are often associated with polytrauma and severe, complication-prone injuries, posing a critical survival risk for patients. The variability of pelvic trauma, with differing severities, dislocation patterns, and potential organ and soft tissue involvement, has made consistent representation in the literature challenging. Increased mortality is often attributed to direct exsanguination or multiorgan failure due to massive retroperitoneal bleeding from the presacral venous plexus, bone, or, in rare life-threatening cases, the iliac arteries. Nevertheless, pelvic fractures are frequently regarded as secondary injuries in polytrauma, overshadowed by other life-threatening conditions. The question of whether pelvic ring injuries independently contribute to trauma-related mortality remains unresolved and forms the basis2025-04-1
Systematic Review and Evaluation of Hospital Navigators in Germany Regarding Their Comparability Based on Surgical Outcomes and Patient Satisfaction Using Radical Prostate Vesiculectomy as an Example
No full textHintergrund:
Krankenhausnavigatoren (KHN) bieten internetbasierte Informationen zur Behandlungsqualität und Patientenzufriedenheit. Ihre Aussagekraft und Vergleichbarkeit sind bislang jedoch unzureichend untersucht.
Ziel:
Ziel der Arbeit war die systematische Analyse und Bewertung ausgewählter deutscher KHN hinsichtlich der Darstellung operativer Ergebnisse und patientenzentrierter Bewertungen am Beispiel der radikalen Prostatovesikulektomie.
Methoden:
Mittels strukturierter Online-Recherche wurden relevante KHN identifiziert und anhand definierter Kriterien (z. B. QSR-Daten, PEQ-Ergebnisse, Online-Bewertungen) inhaltlich und methodisch geprüft. Statistische Analysen erfolgten zur Bewertung der Vergleichbarkeit.
Ergebnisse:
Die untersuchten KHN zeigten erhebliche Unterschiede in Datenumfang, Darstellungsform und Transparenz. Eine direkte Vergleichbarkeit operativer Qualität und Patientenzufriedenheit war nur eingeschränkt möglich. Die Korrelation zwischen systematisch erhobenen und frei zugänglichen Bewertungen war schwach bis moderat.
Schlussfolgerung:
Eine einheitliche, transparente und methodisch nachvollziehbare Darstellung von Qualitätsdaten in KHN ist erforderlich, um die informierte Entscheidungsfindung von Patient:innen zu fördern und Qualität im Gesundheitswesen vergleichbar zu machen.Background:
Hospital navigation tools provide online information about treatment quality and patient satisfaction, but their comparability and methodological robustness remain unclear.
Objective:
This study aimed to systematically assess selected German hospital navigation platforms regarding their presentation of surgical outcomes and patient-reported experiences, using radical prostatectomy as a reference procedure.
Methods:
A structured online search was conducted to identify relevant platforms, which were then evaluated based on predefined criteria (e.g., QSR data, PEQ results, online ratings). Statistical analysis was performed to assess comparability.
Results:
Substantial differences were found in data content, visualization formats, and transparency. Direct comparability of clinical outcomes and patient satisfaction was limited. Correlations between systematically collected and publicly available ratings were weak to moderate.
Conclusion:
To support informed patient decision-making and enhance quality transparency in healthcare, hospital navigation tools require standardized, consistent, and methodologically sound data presentation.2025-07-3