Showing papers by "German Red Cross published in 2022"

Stabilizing the immune system by chlorogenic acid

Abstract: It has been suggested that CGA can control glucose, amino acid, and lipid metabolism1, 2. In a mouse model of DSS-induced ulcerative colitis, CGA reduced mucosal damage, suppressed inflammation and oxidative stress, and reduced expression of components of the MAPK/ERK/JNK signaling pathways.3 Human macrophages respond to the CGA from the Nelumbo nucifera (Indian lotus) extract by the suppression of NF-κB-dependent inflammatory response and by the decreased production of TNFalpha.2 In human endothelial cells, CGA enhanced sirtuin 1 (SIRT1) deacetylase activity and reversed oxLDL-impaired SIRT1 activity, mitigated oxLDL-induced oxidative stress and dysfunction of mitochondrial biogenesis.4 Silencing SIRT1, AMPK, and PGC-1 diminished the ability of CGA to protect cells against oxidative stress, indicating that CGA inhibits oxLDL-induced endothelial apoptosis through modulating SIRT1 and AMPK/PGC-1 function in the vasculature. The study of Li et al.5 focused on the SIRT1-mediated anti-inflammatory mechanism of CGA action in the mouse model of pneumonia caused by Klebsiella pneumoniae (Kp), that belongs to the enterobacteriaceae family, and, as an opportunistic pathogen, can induce pneumonia. Bacterial infections are common complications of viral pneumonia. During COVID-19 epidemics, it was identified worldwide that patients infected by SARS-CoV2 have a dramatically increased risk of developing superinfections, in particular caused by multidrug-resistant pathogens, including carbapenemase-producing Kp (CP-Kp).6 Li et al.5 for the first time have demonstrated that CGA reversed Kp-induced repolarization of M1 macrophages toward the M2 phenotype characterized by the reduced production of iNOS, IL6, and IL-12, and increased expression of CD206, CCL22, and TGFbeta. The GCA-enhanced activity of SIRT1 that suppressed Kp-induced acetylation of the high mobility group box 1 protein (HMGB1), a driver for M1 polarization, and, consequently, inhibited HMGB1 nuclear translocation and interaction with chromatin. CGA-mediated reprogramming of alveolar macrophages toward the M2 phenotype had significant beneficial effects by reducing pathologic tissue remodeling and bacterial load in lungs of mice. The significance of the fact that CGA stimulates the activity of SIRT1 in macrophages goes far beyond the beneficial effect of CGA identified by Li et al. in opportunistic bacterial infections causing lung inflammation. Sirtuins (SIRTs, SIRT1–7) are nicotinamide adenine dinucleotide-dependent histone deacetylases. SIRTs have multiple effects on cell metabolism and mediate the reaction of various cell types to the microenvironmental signals, changes in energy availability, and cellular stress. SIRT1 and SIRT2 have been even suggested to be promising antiviral targets. Thus, the findings of Li et al.5 make CGA-mediated modulation of SIRTS an attractive approach for the suppression of inflammation in virus-induced disorders, that may also be critical not only for the acute COVID-19, but also for the long-COVID-19 disease. Long-COVID-19 syndrome is characterized by the long-lasting low-grade inflammation mixed with fibrosis caused by not yet understood molecular mechanisms. Long-COVID-19 syndrome can have a clinical manifestation as multiple organ failure. Such complex destruction of the immune balance justifies the obvious need for systemically acting anti-inflammatory substances with minimal toxicity and minimal side effects, that we can actually expect from naturally derived substances. Another highly relevant field that can benefit from the identification of anti-inflammatory mechanism of CGA action is the field of autoimmune disorders, including rheumatoid arthritis (RA), where failure in the reciprocal control of adaptive and innate immunity results in the amplification of inflammation locally and systemically. Typical pathologic manifestations of RA include persistent inflammation and synovial hyperplasia leading to the joint destruction and function loss. Remarkably, RA patients have increased incidence of metabolic disorders, where energy metabolism is critically changed in different immune cells. These changes can be linked to the activity of SIRT1. Many studies identified SIRT-1 as a mechanistic link between inflammatory and metabolic pathways. For example, the cross-talk between SIRT1 and FOXO transcription factors controls diabetic complications.7 SIRT1 also mediates renal and cardioprotective effects of sodium-glucose cotransporter 2 inhibitors in diabetes patients.8 SIRT1 regulates not only signaling pathways and transcription factors that would have rather short-term effects. SIRT1 also has a profound effect on the programming of immune status due to its histone deacetylase activity responsible for deacetylation of lysine residues in histones. This epigenetic mechanism can lead to the conservation of transcriptionally inactive heterochromatin and provide prolonged immunologic memory. Therefore, substances that can enhance SIRT1 activity are needed for therapy of not only infections and autoimmune disorders, but also for the prevention of diabetic vascular complications that are largely caused by inflammatory activity of innate immune cells. In particular, circulating monocytes and local tissue macrophages react on diabetic stimuli by metabolic and epigenetic alterations. CGA-mediated enhancement of SIRT1 can have also therapeutic perspective as a neuroprotective drug because SIRT1 was shown to suppress inflammasome signaling during stem cell therapy as tested in an animal model of ischemic stroke.9 In cancer therapy, SIRT1-mediated stabilization of chimeric antigen receptor T (CAR-T) cells seems to be a promising approach to overcome current problems caused by the limitations in the expansion and persistence of CAR-T cells once these cells are administered in vivo.10 Summing up, the effects of CGA on the stimulation of SIRT1 activity identified by Li et al.5 open a new range of options for the developing of immunomodulatory approaches that can be combined with various types of cellular therapies or with other pharmacologic substances. The pleiotropic immune stabilizing effects of CGA can be expected to provide a minimally toxic approach for instructing macrophages to protect the human organism against detrimental actions of endogenous and infectious factors, including, for example, the long-lasting pathology effects caused by SARS-CoV2. Open Access funding enabled and organized by Projekt DEAL.

Training Effectiveness and Impact on Safety, Treatment Quality, and Communication in Prehospital Emergency Care: The Prospective Longitudinal Mixed-Methods EPPTC Trial

Abstract: Emergency training is designed to improve medical care teams' knowledge, practical skills, and treatment procedures in patient care to increase patient safety. This requires effective training, but the multifactorial effects of training are difficult to measure.We assessed the impact of emergency team training on treatment procedures and quality, processes, technical skills, and nontechnical skills in simulated trauma emergencies in a longitudinal analysis, using videos that were recorded before (t0), immediately after (t1), and 1 year after the training (t2). The training was evaluated with the validated PERFECT checklist, which includes 7 scales: primary assessment, secondary assessment, procedures, technical skills, trauma communication, nontechnical skills, and a global performance scale.The primary end point was the change from before a training intervention (t0) to 1 year after training (t2), measured by a metric point score. The second end point was the impact of the intervention from before training to after and from immediately after training to 1 year later.A total of 146 trainings were evaluated. In simulated traumatological emergencies, training participants showed significantly better treatment capacity after 1 year (t0: 28.8 ± 5.6 points versus t2: 59.6 ± 6.6 points, P < 0.001), with greater improvement from t0 to t1 (28.8 ± 5.6 points versus 65.1 ± 7.9 points, P < 0.001). The most significant change from t0 to t2 was seen in the primary assessment, with a mean change of 11.1 ± 5.1, followed by the scale of the procedure (6.1 ± 3.0) and nontechnical skills (6.0 ± 3.0).Team trainings with intensive scenario training and short theoretical inputs lead to a significant improvement in simulated care of severely injured patients, especially in identifying and intervening in life-threatening symptoms, processes, and nontechnical skills, even 1 year after the course. Positive, longitudinally positive effects were also in communication and subjective safety of prehospital health care personnel.

Learning Success and Influencing Factors in Out-of-Hospital Placement of Intravenous Catheters

Abstract: Placing peripheral intravenous catheters ("IV lines") is a standard procedure for health care professionals in acute and emergency medicine. The study aimed to determine the learning curve and success rates in applying IV lines during a three-year paramedic training and the factors influencing successful placement.This was a prospective and noninterventional observational study to determine the influencing factors, learning outcomes, and performance in the placement of IV lines by trainees and experienced paramedics. Trial registration: German Clinical Trials Register, ID DRKS00024631.From February 1, 2016 through December 31, 2021, a total of 3,547 peripheral venous accesses attempts were performed: 76.5% (n = 2,712) by trainees and 23.5% (n = 835) by experienced practitioners. The trainee group had one-to-three years of training and the experienced group had 11 (SD = 11) years of work experience after training (one-to-35 years). The learning or success curve in the successful placement of peripheral venous accesses was 85.2% in the first year of training, 88.5% in the second year of training, and 92.5% in the third year (and the end of training). It was then 94.3% in the fourth year (first year of being experienced). Successful insertion of peripheral venous accesses in the experienced group was up to 97.0%. The first-attempt success rate was 90.4% across the entire trainee group versus 95.9% in the experienced group (P <.0001).Significant factors influencing successful placement of IV lines were puncture site (P = .022), catheter size (OR = 0.600; P = .002), and number of attempts (OR = 0.370; P <.001). The time of day (or night) was not influential. Work experience, patient age, or blood pressure were also not significant.

Wissen in Krisen- und Katastrophenlagen: Umgang mit Erfahrungen aus der Praxis

Abstract: Zusammenfassung Im Bevölkerungsschutz spielen Erfahrungswerte und Wissen eine große Rolle. Diese bilden u. a. die Basis für Entscheidungen in zukünftigen Einsätzen, gelingende Konzepte sowie Lösungsstrategien. Dieses Kapitel widmet sich dem Umgang mit Wissen im Rahmen von Krisen und Einsätzen und nimmt dabei eine besonders praxisnahe Perspektive ein, durch die sowohl organisationsspezifische als auch -übergreifende Erfahrungen wiedergegeben sowie Handlungsimpulse aufgezeigt werden.

Einführung digitaler Implantatepass – Schritt für Schritt

Abstract: Der Gesetzgeber fordert eine verbesserte Patientensicherheit. Daher müssen alle Krankenhäuser, die medizinische Implantate (= Medizinprodukte) einsetzen, seit Oktober 2015 den Patienten einen Implantatepass aushändigen. Gesundheitseinrichtungen, die entsprechende Medizinprodukte implantieren, sind verpflichtet, die technischen Voraussetzungen so zu schaffen, dass zum Beispiel im Falle von Produktrückrufen alle Patienten innerhalb von drei Werktagen ermittelt werden können.