Immunologically restricted patients exhibit a pronounced inflammation and inadequate response to hypoxia in fracture hematomas.

For patients who are known to have an impaired immune system, bone healing is often impaired. Therefore, it has been suggested that an effectively functioning immune system will have an influence on the quality of bone healing. Here, we demonstrate that cells within the fracture hematoma of immunologically restricted patients (1) exhibit a disturbed osteogenic differentiation (normal SPP1 but diminished RUNX2 expression), (2) show a strong inflammatory reaction (high IL8 and CXCR4), and (3) react on local hypoxia (high expression of HIF1A) but with inadequate target gene responses (diminished LDHA and PGK1 expression). Thus, it is already within the early inflammatory phase of fracture healing that the local gene expression in fracture hematomas of immunologically restricted patients points toward a critical regeneration.

[How often is bronchopneumonia overlooked as the cause of death in intensive care unit patients?]. / Wie häufig wird die Bronchopneumonie als Todesursache bei Intensivpatienten übersehen?

BACKGROUND: This study addresses the issue of analyzing the relationship between pre-mortem diagnoses and post-mortem findings in an intensive care unit (ICU). MATERIALS AND METHODS: Investigating a total of 1,205 autopsy cases, pre-mortem and post-mortem diagnoses were retrospectively evaluated and compared statistically by means of established categories (i.e."complete, partial, or lacking concordance" and"clinically suspected diagnosis"). RESULTS: When comparing clinical diagnoses and autopsy findings in terms of bronchopneumonia, concordance was recorded in only 21.15% of the cases investigated. CONCLUSION: In multimorbid ICU patients, bronchopneumonia frequently fails to be clinically recognized since clinical parameters commonly used for monitoring appear to be modified due to therapeutical interventions, and thus are inappropriate to reflect the complete histomorphological equivalent of the disease. This study also emphasizes the importance of autopsy which represents a sensitive means for professional medical quality assurance, and again establishes the necessity for strengthening the request for autopsy, which is currently characterized by an unfavourable decline.