Single-centre real-life observational study on mortality and outcomes: decompressive craniectomy and brain death in traumatic brain injury, haemorrhage, and other cerebral diseases.

BACKGROUND: Decompressive hemicraniectomy (DHC) is used after severe brain damages with elevated, refractory intracranial pressure (ICP). In a non age-restricted population, mortality rates and long-term outcomes following DHC are still unclear. This study's objectives were to examine both, as well as to identify predictors of unfavourable outcomes. METHODS: We undertook a retrospective observational analysis of patients aged 18 years and older who underwent DHC at the University Hospital of Bonn between 2018 and 2020, due to traumatic brain injury (TBI), haemorrhage, tumours or infections. Patient outcomes were assessed by conducting telephone interviews, utilising questionnaires for modified Rankin Scale (mRS) and extended Glasgow Outcome scale (GOSE). We evaluated the health-related quality of life using the EuroQol (EQ-5D-5L) scale. RESULTS: A total of 144 patients with a median age of 58.5 years (range: 18 to 85 years) were evaluated. The mortality rate was 67%, with patients passing away at a median of 6.0 days (IQR [1.9-37.6]) after DHC. Favourable outcomes, as assessed by the mRS and GOSE were observed in 10.4% and 6.3% of patients, respectively. Cox regression analysis revealed a 2.0% increase in the mortality risk for every year of age (HR = 1.017; 95% CI [1.01-1.03]; p = 0.004). Uni- and bilateral fixed pupils were associated with a 1.72 (95% CI [1.03-2.87]; p = 0.037) and 3.97 (95% CI [2.44-6.46]; p < 0.001) times higher mortality risk, respectively. ROC-analysis demonstrated that age and pupillary reactivity predicted 6-month mortality with an AUC of 0.77 (95% CI [0.69-0.84]). The only parameter significantly associated with a better quality of life was younger age. CONCLUSIONS: Following DHC, mortality remains substantial, and favourable outcomes occur rarely. Particularly in elderly patients and in the presence of clinical signs of herniation, mortality rates are notably elevated. Hence, the indication for DHC should be set critically.

[Interdisciplinary Acute Medical Rehabilitation after Sepsis - A Retrospective Analysis]. / Fachübergreifende Frührehabilitation nach Sepsis ­ Eine retrospektive Analyse .

BACKGROUND: Surviving sepsis may have consequences of high impact for the patients' further life regarding functioning in mobility and activities of daily living, among other fields. Patients consecutively have a great need of rehabilitation interventions beginning with early mobilization in the Intensive Care Unit ICU. Acute medical rehabilitation is a concept of early rehabilitation still in the acute care hospital, normally beginning after a direct transferal from the ICU. Its aim is to improve the patients' functioning in mobility and activities of daily living (ADL) to enable further post-acute rehabilitation interventions. METHODS: In this retrospective analysis a sample of patients who received acute medical rehabilitation after surviving a sepsis or severe sepsis was followed. The study targeted the question if basic functions of mobility and ADL could be improved by acute medical rehabilitation. Furthermore, the need for aid supply was evaluated, as well as the type of discharge or transferal after acute care. RESULTS: The increase of mobility and ADL capability before and after acute medical rehabilitation was highly significant (p<0.001 each) and showed very large effect sizes (d=1.3, 1.4 respectively). Aid supply was organized for 92% of patients. A majority of patients could receive consecutive post-acute rehabilitation after re-gaining function. DISCUSSION: The data shows the enormous gain in functioning that can be reached with an acute medical rehabilitation intervention after ICU treatment of sepsis.

Difference in quantity discrimination in dogs and wolves.

Certain aspects of social life, such as engaging in intergroup conflicts, as well as challenges posed by the physical environment, may facilitate the evolution of quantity discrimination. In lack of excessive comparative data, one can only hypothesize about its evolutionary origins, but human-raised wolves performed well when they had to choose the larger of two sets of 1-4 food items that had been sequentially placed into two opaque cans. Since in such paradigms, the animals never see the entire content of either can, their decisions are thought to rely on mental representation of the two quantities rather than on some perceptual factors such as the overall volume or surface area of the two amounts. By equaling the time that it takes to enter each quantity into the cans or the number of items entered, one can further rule out the possibility that animals simply choose based on the amount of time needed to present the two quantities. While the wolves performed well even in such a control condition, dogs failed to choose the larger one of two invisible quantities in another study using a similar paradigm. Because this disparity could be explained by procedural differences, in the current study, we set out to test dogs that were raised and kept identically as the previously tested wolves using the same set-up and procedure. Our results confirm the former finding that dogs, in comparison to wolves, have inferior skills to represent quantities mentally. This seems to be in line with Frank's (1980) hypothesis suggesting that domestication altered the information processing of dogs. However, as discussed, also alternative explanations may exist.