Circulating levels of mitochondrial DNA at ICU admission predict mortality in critically ill patients. This association was in particular present in patients with elevated toll-like receptor-9 expression.

Background Patients with end-stage kidney disease (ESKD) on hemodialysis (HD) are at increased risk for bleeding. However, despite relevant clinical implications regarding dialysis modalities or anticoagulation, no bleeding risk assessment strategy has been established in this challenging population. Methods Analyses on bleeding risk assessment models were performed in the population-based Vienna InVestigation of Atrial fibrillation and thromboemboLism in patients on hemoDialysIs (VIVALDI) study including 625 patients. In this cohort study, patients were prospectively followed for a median observation period of 3.5 years for the occurrence of major bleeding. First, performances of existing bleeding risk scores (i.e., HAS-BLED, HEMORR2HAGES, ATRIA, and four others) were evaluated in terms of discrimination and calibration. Second, four machine learning-based prediction models that included clinical, dialysis-specific, and laboratory parameters were developed and tested using Monte-Carlo cross-validation. Results Of 625 patients (median age: 66 years, 38% women), 89 (14.2%) developed major bleeding, with a 1-year, 2-year, and 3-year cumulative incidence of 6.1% (95%CI 4.2-8.0), 10.3% (95%CI 8.0-12.8), and 13.5% (95%CI 10.8-16.2), respectively. C-statistics of seven contemporary bleeding risk scores ranged between 0.54 and 0.59 indicating poor discriminatory performance. The HAS-BLED score showed the highest C-statistics of 0.59 (95% 0.53-0.56). Similarly, all four machine learning-based predictions models performed poorly in internal validation (C-statistics ranging from 0.49-0.55). Conclusions Existing bleeding risk scores and a machine learning approach including common clinical parameters fail to assist in bleeding risk prediction of patients on HD. Therefore, new approaches, including novel biomarkers, to improve bleeding risk prediction in patients on HD are needed.

Fat grafting is a well‐established method in plastic surgery. Despite many technical advances, standardised recommendations for the use of prophylactic antibiotics in fat grafting are not available. This retrospective multicentre study aims to analyse the use of prophylactic antibiotics in fat grafting and to compare complication rates for different protocols. A retrospective medical chart review of 340 patients treated with fat grafting of the breast from January 2007 to March 2019 was performed in three plastic surgery centres. Complications, outcomes, and antibiotic regimes were analysed. The Clavien‐Dindo classification was applied. All patients received perioperative antibiotic prophylaxis: 33.8% (n = 115) were treated with a single shot (group 1), 66.2% (n = 225) received a prolonged antibiotic scheme (group 2). There was no significant difference in the number of sessions (P = .475). The overall complication rate was 21.6% (n = 75), including graft resorption, fat necrosis, infection, and wound healing problems. Complication rates were not significantly different between groups. Risk factors for elevated complication rates in this specific patient group are smoking, chemotherapy, and irradiation therapy. The complication rate for lipografting of the breast is low, and it is not correlated to the antibiotic protocol. The use of prolonged prophylactic antibiotics does not lower the complication rate.

ZusammenfassungBreast Implant Illness (BII) bezeichnet eine Reihe von unspezifischen, systemischen Symptomen, von denen angenommen wird, dass sie mit Brustimplantaten in Verbindung stehen. Zu den BII-Symptomen gehören unter anderem Müdigkeit, Haarausfall, Hautausschläge, oder chronische Schmerzen. Schlüssige Beweise für einen kausalen Zusammenhang zwischen Silikonimplantaten und BII fehlen jedoch nach wie vor. In Anbetracht der jüngsten Erkenntnisse, dass texturierte Implantate in seltenen Fällen zu einem Brustimplantat-assoziierten, anaplastischen Großzell-Lymphom (BIA-ALCL) führen können, ist ein möglicher Zusammenhang zwischen Brustimplantaten und BII denkbar und rechtfertigt weitere Untersuchungen. Wir beobachten eine steigende Anzahl von Patientinnen, die aufgrund systemischer Symptome im Zusammenhang mit Brustimplantaten Beratung und Behandlung ersuchen, was sich in einem zunehmenden Interesse in der Literatur und den sozialen Medien widerspiegelt. Das Ziel dieser Arbeit war es, das wachsende Interesse an BII zu untersuchen. Wir beschreiben die klinischen Merkmale einer Patientin, die unter Symptomen leidet, die mit BII vereinbar sind und kontextualisieren die klinische Präsentation mit der aktuellen Datenlage.

Summary: Soft tissue defect reconstruction at joint regions is a challenging problem due to the sparse excessive tissue and late complication of constrigent scar formation. Priorly irradiated tissue, often the case in sarcoma patients, is especially problematic. The keystone design perforator island flap is safe and reliable. We now present a new keystone flap design, which is particularly suitable for the reconstruction of large soft tissue defects at joint regions. It provides a cutaneous component without the need for a skin graft and therefore minimizes the risk of contracture. Donor site morbidity is negligible. Furthermore, it offers a favorable aesthetic result compared to other flaps, eg, a muscular flap. We propose a new keystone flap design as an extension of Behan's classification, the Keystone flap type IIIb.