Schoolwalker – eine Initiative zur gesundheits- und umweltbewussten Mobilität bei Kindern

Background and research question

Walking, as a form of exercise, promotes health and can contribute to a reduction of traffic as well as reduced environmental pollution. The promotion of physical activity in early childhood has been shown to be an important instrument in improving levels of health and overall wellbeing. The aim of this study was to show the influence of walking to school on kinesic behaviour of children and to determine the impact of walking on CO₂ emission levels.

Research method

A quantitative survey was carried out in seven primary schools. Data was collected via a standardised questionnaire.

Results

In addition to promoting social behaviour and increasing the number of children walking to school to 50?%, we determined a reduction of 3.9 kg CO₂ per child per year. This corresponds to a total reduction of 1.4 t (among 370 children).

Conclusion

Projects aimed at promoting physical activity, such as Schoolwalker, can lead to reductions in CO₂ hence promoting protection of the climate and environment. Schoolwalker is an example for a successful implementation of the “Health in all Policies” approach.     

Multiple endothelial biomarkers and noninvasive vascular function in the general population: the Gutenberg Health Study

Vascular reactivity is reflected by blood biomarkers and noninvasive vascular function measurement. The relation of biomarkers to flow-mediated dilation and peripheral arterial tonometry in the general population is little understood. In 5000 individuals (mean age, 56±11 years; age range, 35-74 years; 49% women) of the population-based Gutenberg Health Study we simultaneously assessed 6 biomarkers of cardiovascular function (midregional proadrenomedullin [MR-proADM], midregional pro atrial natriuretic peptide [MR-proANP], N-terminal pro B-type natriuretic peptide, copeptin, C-terminal proendothelin 1, and neopterin) in relation to flow-mediated dilation and peripheral arterial tonometry. Strongest partial correlations (adjusted for age and sex) were observed for baseline pulse amplitude with MR-proADM (r=0.13) and MR-proANP (r=-0.13); hyperemic response variables showed the highest correlation for MR-proADM and peripheral arterial tonometry ratio (r=-0.14). In multivariable linear regression models, strongest associations with baseline vascular function were observed for MR-proANP with baseline pulse amplitude (β per SD increase [99.17%], -0.080 [-0.115 to -0.044]; P<0.0001 after Bonferroni correction for multiple testing) and MR-proADM (-0.044 [-0.070 to -0.017]; P<0.0001), as well as MR-proANP (-0.033 [-0.057 to -0.009]; P=0.0017) and N-terminal pro B-type natriuretic peptide (-0.027 [-0.051 to -0.003]; P=0.015) with brachial artery diameter. For hyperemic response variables, highest associations were seen for peripheral arterial tonometry ratio with MR-proADM (-0.022 [-0.043 to -0.004]; P=0.043), MR-proANP (0.016 [-0.0034 to 0.035]; P=0.18), and C-terminal proendothelin 1 (-0.025 [-0.043 to -0.008]; P=0.00094]. In our large, population-based study, we identified MR-proADM and MR-proANP as circulating biomarkers of vascular function most strongly related to noninvasive measures of conduit artery and peripheral arterial performance. Whether determination of blood biomarkers helps to better understand vascular pathology and may provide prognostic information needs to be investigated in future studies.     

使用替罗非班时泮托拉唑对非ST段抬高型急性冠脉综合征患者消化道保护作用的评

目的:盐酸替罗非班、阿司匹林、氯吡格雷、低分子肝素（四联）联合使用治疗急性冠脉综合征(ACS)患者时,评价静脉注射泮托拉唑对消化道保护的疗效和安全性。方法: 选择住院ACS患者296例,随机分为试药组184例,对照组112例,所有患者均服用阿司匹林、氯吡格雷、低分子肝素和使用2～3 d盐酸替罗非班。在此基础上试药组患者静脉输注泮托拉唑40 mg/d,4~5 d,再服用泮托拉唑片剂40 mg/次,2次/d,连服8 d。结果: 试药组8 d内全因死亡、顽固性心绞痛、再次心肌梗死、急诊经皮冠状动脉介入治疗(PCI)数较对照组显著减少（P<0.05）;试药组与对照组比较消化道出血发生率（2.2% vs. 12.5%）、TIMI小出血发生率(1.6% vs. 6.2%)和TIMI较小出血发生率(0.5% vs. 5.4%)明显降低（P<0.05）。结论: 在四联抗栓治疗ACS患者时,静脉注射和口服泮托拉唑可以减少8 d内消化道出血发生率,从而减少了8 d内患者死亡、顽固性心绞痛、再次心肌梗死、急诊PCI数,具有良好的消化道保护作用和安全性。     

静脉盐酸地尔硫卓对起搏阈值及心内电信号振幅的影响

目的探讨静脉盐酸地尔硫卓对起搏阈值及心内电信号振幅的影响。方法植入心脏起搏器术后1～3天的患者133例,静脉注射盐酸地尔硫卓注射液10 mg,间隔10 min后重复给药10 mg,采取体外程控仪,测定用药前及用药后30,60,120,240 min时的心房、心室起搏阈值及P波、R波振幅。结果用药前及用药后不同时段的心房、心室起搏阈值及P波、R波振幅均无明显变化(P>0.05)。结论静脉注射盐酸地尔硫卓对急性期起搏阈值及心内电信号振幅均无影响。     

Significance and causes of abnormal preoperative coagulation test results in children

To prevent bleeding related to adenoidectomy and tonsillectomy, coagulation screening tests were, until recently, performed routinely in the Czech Republic for all paediatric patients. The aim of this study was to evaluate benefit of preoperative coagulation screening tests in children. We retrospectively analysed laboratory and clinical data of children referred for abnormal preoperative coagulation test results (aPTT, PT) to the outpatient haematology clinic. A total of 274 paediatric patients were retrospectively evaluated due to abnormal preoperative coagulation tests results. In 140 of 274 patients (51.1%), coagulation tests were normal on repeated testing in a specialized haematology clinic. Ten patients had decreased factor XII. Five patients had a suspected bleeding disorder which was confirmed in two of them. One patient had low levels of von Willebrand factor, and one patient had mild factor VII deficiency. Both these patients had positive personal and/or family history of bleeding. Each case history was taken individually, without use of standardized questionnaires. Bleeding complications were not observed, and coagulation factor replacement was not needed perioperatively in our cohort. The majority of abnormal findings in aPTT and PT appeared only transiently. All the bleeding disorders found in our cohort of patients were mild in nature. Our findings provide supportive evidence for the current national Czech recommendation: laboratory coagulation screening should be performed only in patients with positive family and/or personal bleeding history.     

The Role for Sentinel Lymph Node Dissection after Neoadjuvant Chemotherapy in Patients who Present with Node-Positive Breast Cancer

Background

Sentinel lymph node (SLN) dissection has been investigated after neoadjuvant chemotherapy and has shown mixed results. Our objective was to evaluate SLN dissection in node-positive patients and to determine whether postchemotherapy ultrasound could select patients for this technique.

Methods

Between 1994 and 2010, 150 patients with biopsy proven axillary metastasis underwent SLN dissection after chemotherapy and 121 underwent axillary lymph node dissection (ALND). Clinicopathologic characteristics were analyzed before and after chemotherapy. Statistical analyses included Fisher??s exact test for nodal response and multivariate logistic regression for factors associated with false-negative events.

Results

Median age was 52?years. Median tumor size at presentation was 2?cm. The SLN was identified in 93?% (139/150). In 111 patients in whom a SLN was identified and ALND performed, 15 patients had a false-negative SLN (20.8?%). In the 52 patients with normalized nodes on ultrasound, the false-negative rate decreased to 16.1?%. Multivariate analysis revealed smaller initial tumor size and fewer SLNs removed (<2) were associated with a false-negative SLN. There were 63 (42?%) patients with a pathologic complete response (pCR) in the nodes. Of those with normalized nodes on ultrasound, 38 (51?%) of 75 had a pCR. Only 25 (33?%) of 75 with persistent suspicious/malignant-appearing nodes had a pCR (p?=?0.047).

Conclusions

Approximately 42?% of patients have a pCR in the nodes after chemotherapy. Normalized morphology on ultrasound correlates with a higher pCR rate. SLN dissection in these patients is associated with a false-negative rate of 20.8?%. Removing fewer than two SLNs is associated with a higher false-negative rate.     

Functional asplenia in hemoglobin SC disease

The incidence of functional asplenia in sickle-hemoglobin C (SC) disease has not been defined, and the use of prophylactic penicillin to prevent life-threatening septicemia in this disorder is controversial. The percentage of red blood cells with pits (pit count) is a reliable assay of splenic function in other disorders but has not been validated in hemoglobin SC disease. To address these issues, we conducted a prospective, multicenter study of splenic function in persons with hemoglobin SC disease. Baseline clinical data were recorded, and red blood cell pit counts were performed on 201 subjects, aged 6 months to 90 years, with hemoglobin SC; 43 subjects underwent radionuclide liver- spleen scanning. Pit counts greater than 20% were associated with functional asplenia as assessed by liver-spleen scan, whereas pit counts less than 20% were found in subjects with preserved splenic function. Pit counts greater than 20% were present in 0 of 59 subjects (0%) less than 4 years of age, in 19 of 86 subjects (22%) 4 to 12 years of age, and in 25 of 56 subjects (45%) greater than 12 years of age. Other subjects with hemoglobin SC, who had previously undergone surgical splenectomy, had higher pit counts (59.7% +/- 9.5%) than splenectomized subjects without hemoglobinopathy (38.5% +/- 8.8%) or with sickle cell anemia (20.5% +/- 1.9%; P < .001). Two subjects with hemoglobin SC disease (not splenectomized), ages 14 and 15 years, with pit counts of 40.3% and 41.7% died from pneumococcal septicemia. These data indicate that functional asplenia occurs in many patients with hemoglobin SC disease, but its development is usually delayed until after 4 years of age. The pit count is a reliable measure of splenic function in hemoglobin SC disease, but values indicative of functional asplenia (> 20% in our laboratory) are higher than in other disorders. The routine administration of prophylactic penicillin to infants and young children with hemoglobin SC disease may not be necessary.     

Situational awareness – what it means for clinicians,its recognition and importance in patient safety

A thorough understanding of the role of human factors in error in health care for improving patient safely is paramount. One area particularly crucial for optimising clinical performance is the recognising the importance of situational awareness. Loss of situation awareness can occur in many different settings, particularly during stressful and unexpected situations. Tunnel vision is a classic example where clinicians focus on one aspect of care, often to the detriment of overall patient management. Loss of situational awareness can result in serious compromise to patient safety if it is not recognised by either the individual or clinical team. We provide an introduction to situational awareness for those not familiar with it, including some important theory which explains how awareness can be lost, and discuss the important approaches we use in our day‐to‐day practice to safeguard both patients and clinicians in the workplace environment.     

Alloimmunization prevents the migration of transfused indium-111- labeled granulocytes to sites of infection

111In-labeled granulocytes were used to study the effects of histocompatibility factors on the migration of transfused granulocytes to infected sites. Fourteen alloimmunized and 20 nonalloimmunized patients received approximately 10(8) 111In-labeled granulocytes from ABO-compatible, non-HLA-matched donors, and scans were performed over known infected sites. All 14 alloimmunized patients had lymphocytotoxic antibody (LCTAb) and required HLA-matched platelet transfusions. Of the nonalloimmunized patients, 20/20 had positive scans at sites of infection. None of the 20 had LCTAb, 0/17 had a positive lymphocytotoxic crossmatch (LCTXM) with the donor, and 3/18 had a positive leukoagglutinin crossmatch (LAXM). Thus, histocompatibility testing was not found to be important in nonalloimmunized patients. In contrast, only 3/14 alloimmunized patients had positive scans at sites of infection (p = 0.00001 compared to nonalloimmunized patients). One of 3 had a positive LCTXM and 2/3 had a positive LAXM. Of the alloimmunized patients, 10/11 with negative scans had a positive LCTXM and 8/11 had a positive LAXM. Labeled granulocytes failed to reach sites of infection in 11/14 (78%) alloimmunized patients, demonstrating that histocompatibility factors can be of major importance in affecting the outcome of granulocyte transfusions. Granulocytes from random donors are unlikely to be effective in alloimmunized patients. The lack of an adequate crossmatching technique is a major problem limiting the ability to provide granulocyte transfusions for alloimmunized patients.