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Introduction: Prognosis of survivors from cardiac arrest is generally poor. Acute kidney injury (AKI) is a common finding in these patients. In general, AKI is well characterized as a marker of adverse outcome. In-hospital cardiac arrest (IHCA) represents a special subset of cardiac arrest scenarios with differential predisposing factors and courses after the event, compared to out-of-hospital resuscitations. Data about AKI in survivors after in-hospital cardiac arrest are scarce. Methods: In this study, we retrospectively analyzed patients after IHCA for incidence and risk factors of AKI and its prognostic impact on mortality. For inclusion in the analysis, patients had to survive at least 48 h after IHCA. Results: A total of 238 IHCA events with successful resuscitation and survival beyond 48 h after the initial event were recorded. Of those, 89.9% were patients of internal medicine, and 10.1% of patients from surgery, neurology or other departments. In 120/238 patients (50.4%), AKI was diagnosed. In 28 patients (23.3%), transient or permanent renal replacement therapy had to be initiated. Male gender, preexisting chronic kidney disease and a non-shockable first ECG rhythm during resuscitation were significantly associated with a higher incidence of AKI in IHCA-survivors. In-hospital mortality in survivors from IHCA without AKI was 29.7%, and 60.8% in patients after IHCA who developed AKI (p < 0.01 between groups). By multivariate analysis, AKI after IHCA persisted as an independent predictor of in-hospital mortality (HR 3.7 (95% CI 2.14–6.33, p ≤ 0.01)). Conclusion: In this cohort of survivors from IHCA, AKI is a frequent finding, with adverse impact on outcome. Therefore, therapeutic strategies to prevent AKI in post-IHCA patients are warranted.
Matrix metalloproteinases (MMPs) play crucial roles in tissue homeostasis and pathologies by remodeling the extracellular matrix. Previous studies have demonstrated the biological activities of MMP-derived cleavage products. Furthermore, specific fragments can serve as biomarkers. Therefore, an in vitro cleavage assay to identify substrates and characterize cleavage patterns could provide important insight in disease-relevant mechanisms and the identification of novel biomarkers. In the pathogenesis of osteoarthritis (OA), MMP-2, -8, -9 and -13 are of vital importance. However, it is unclear which protease can cleave which matrix component. To address this question, we established an in vitro cleavage assay using recombinantly expressed MMPs and the two cartilage matrix components, COMP and thrombospondin-4. We found a time- and concentration-dependent degradation and an MMP-specific cleavage pattern for both proteins. Cleavage products can now be enriched and purified to investigate their biological activity. To verify the in vivo relevance, we compared the in vitro cleavage patterns with serum and synovial fluid from OA patients and could indeed detect fragments of similar size in the human samples. The cleavage assay can be adapted to other MMPs and substrates, making it a valuable tool for many research fields.
We present first data on sub-threshold production of Ks0 mesons and Λ hyperons in Au+Au collisions at sNN=2.4 GeV. We observe an universal 〈Apart〉 scaling of hadrons containing strangeness, independent of their corresponding production thresholds. Comparing the yields, their 〈Apart〉 scaling, and the shapes of the rapidity and the pt spectra to state-of-the-art transport model (UrQMD, HSD, IQMD) predictions, we find that none of them can simultaneously describe these observables with reasonable χ2 values.
In this letter we report the first multi-differential measurement of correlated pion-proton pairs from 2 billion Au+Au collisions at sNN=2.42 GeV collected with HADES. In this energy regime the population of Δ(1232) resonances plays an important role in the way energy is distributed between intrinsic excitation energy and kinetic energy of the hadrons in the fireball. The triple differential d3N/dMπ±pdpTdy distributions of correlated π±p pairs have been determined by subtracting the πp combinatorial background using an iterative method. The invariant-mass distributions in the Δ(1232) mass region show strong deviations from a Breit-Wigner function with vacuum width and mass. The yield of correlated pion-proton pairs exhibits a complex isospin, rapidity and transverse-momentum dependence. In the invariant mass range 1.1<Minv(GeV/c2)<1.4, the yield is found to be similar for π+p and π−p pairs, and to follow a power law 〈Apart〉α, where 〈Apart〉 is the mean number of participating nucleons. The exponent α depends strongly on the pair transverse momentum (pT) while its pT-integrated and charge-averaged value is α=1.5±0.08st±0.2sy.
We investigate identical pion HBT intensity interferometry in central Au+Au collisions at 1.23A GeV. High-statistics π−π− and π+π+ data are measured with HADES at SIS18/GSI. The radius parameters, derived from the correlation function depending on relative momenta in the longitudinally comoving system and parametrized as three-dimensional Gaussian distribution, are studied as function of transverse momentum. A substantial charge-sign difference of the source radii is found, particularly pronounced at low transverse momentum. The extracted source parameters agree well with a smooth extrapolation of the center-of-mass energy dependence established at higher energies, extending the corresponding excitation functions down towards a very low energy.
n this paper we report on the investigation of baryonic resonance production in proton-proton collisions at the kinetic energies of 1.25 GeV and 3.5 GeV, based on data measured with HADES. Exclusive channels npπ+ and ppπ0 as well as ppe+e− were studied simultaneously in the framework of a one-boson exchange model. The resonance cross sections were determined from the one-pion channels for Δ(1232) and N(1440) (1.25 GeV) as well as further Δ and N* resonances up to 2 GeV/c2 for the 3.5 GeV data. The data at 1.25 GeV energy were also analysed within the framework of the partial wave analysis together with the set of several other measurements at lower energies. The obtained solutions provided the evolution of resonance production with the beam energy, showing a sizeable non-resonant contribution but with still dominating contribution of Δ(1232)P33. In the case of 3.5 GeV data, the study of the ppe+e− channel gave the insight on the Dalitz decays of the baryon resonances and, in particular, on the electromagnetic transition form-factors in the time-like region. We show that the assumption of a constant electromagnetic transition form-factors leads to underestimation of the yield in the dielectron invariant mass spectrum below the vector mesons pole. On the other hand, a comparison with various transport models shows the important role of intermediate ρ production, though with a large model dependency. The exclusive channels analysis done by the HADES collaboration provides new stringent restrictions on the parameterizations used in the models.
his contribution aims to give a basic overview of the latest results regarding the production of resonances in different collision systems. The results were extracted from experimental data collected with HADES that is a multipurpose detector located at the GSI Helmholtzzentrum, Darmstadt. The main points discussed here are: the properties of the strange resonances Λ(1405) and Σ(1385), the role of Δ’s as a source of pions in the final state, the production dynamics reflected in form of differential cross sections, and the role of the ϕ meson as a source for K− particles.
We present the results of two-pion production in tagged quasi-free np collisions at a deutron incident beam energy of 1.25 GeV/c measured with the High-Acceptance Di-Electron Spectrometer (HADES) installed at GSI. The specific acceptance of HADES allowed for the first time to obtain high-precision data on π+π− and π−π0 production in np collisions in a region corresponding to large transverse momenta of the secondary particles. The obtained differential cross section data provide strong constraints on the production mechanisms and on the various baryon resonance contributions (∆∆, N(1440), N(1520), ∆(1600)). The invariant mass and angular distributions from the np → npπ+π −and np → ppπ−π0 reactions are compared with different theoretical model predictions.
In der vorliegenden Dissertation wurde untersucht, ob die endotracheale Intubation (ETI) der alternativen Atemwegssicherung mittels Larynxtubus (LT) bezüglich der Überlebenswahrscheinlichkeit bei außerklinisch reanimierten Patienten überlegen ist.
Das retrospektiv erfasste Kollektiv dieser monozentrischen Studie umfasst 222 Patienten, die in den Jahren 2006 bis 2014 nach nicht-traumatischem Herz-Kreislauf-Stillstand außerhalb der Klinik (engl.: Out-of-hospital cardiac arrest, OHCA) präklinisch primär mit Endotrachealtubus (ET) oder LT versorgt und anschließend auf die internistische Intensivstation des Universitätsklinikums Frankfurt am Main aufgenommen wurden. Endpunkte der Studie waren die innerklinische Gesamtmortalität während des Krankenhausaufenthaltes sowie die Überlebensrate nach 24 Stunden.
In die Analyse wurden 208 Patienten einbezogen, von denen präklinisch 48 Patienten mit LT (23 %) und 160 Patienten mit ET (77 %) intubiert wurden. Die innerklinische Sterblichkeitsrate lag insgesamt bei 85 % (n=176); darunter 23 % LT- und 77 % ET-versorgte Patienten. Zwischen den beiden Methoden zur Atemwegssicherung zeigten sich sowohl in einer univariaten Analyse (Hazard ratio [HR]=0,98; 95 % Konfidenzintervall [K.I.] 0,69-1,39; p=0,92) als auch in einer multivariaten Cox-Regressionsmodell (adjustierte HR=1,01; 95 % K.I. 0,76-1,56; p=0,62) keine Unterschiede. Die ersten 24 Stunden nach OHCA überlebten 38 % aller Patienten; auch hier unterschieden sich die beiden Patientenkollektive nicht signifikant voneinander (univariate HR=1,04; 95 % K.I. 0,71-1,52; p=0,83).
Ferner veranschaulichte eine Propensity-Score-Matching-Analyse (PSM) mit einer Subgruppe von 120 Patienten, zusammengestellt in einem 3:1 Verhältnis (ET:LT), sowohl mit Blick auf die Überlebensrate bis zur Krankenhausentlassung (Propensity-adjustierte HR=0,99; 95 % K.I. 0,65-1,51; p=0,97) als auch auf die Mortalität in den ersten 24 Stunden (Propensity-adjustierte HR=1,04; 95 % K.I. 0,44-2,36; p=0,96) vergleichbare Ergebnisse beim Atemwegsmanagement mit LT bzw. ET.
Die frühe Durchführung einer Herzkatheteruntersuchung (HR=0,47; 95 % K.I. 0,28-0,77; p=0,003) sowie der frühe Beginn einer systemischen empirischen antibiotischen Therapie (HR=0,28; 95% K.I. 0,17-0,45; p<0,001) konnten überdies als signifikant positive Prädiktoren für das Überleben in einer angepassten Cox-Regressionsanalyse herausgearbeitet werden.
Im Gesamten konnte somit demonstriert werden, dass die initiale präklinische Anwendung des LT nach OHCA der ETI hinsichtlich der Überlebenswahrscheinlichkeit nicht untergeordnet ist. Neuester Literatur zufolge ist sie womöglich sogar überlegen. Dies gilt es in weiteren Studien zu bestätigen.