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Das Herausgeberteam der Sportphysio hat im vergangenen Jahr eine Umfrage durchgeführt, um herauszufinden, aus welchen Gründen sich Physiotherapeut*innen entscheiden, Sportler*innen zu betreuen, was sie verdienen und wie die Rahmenbedingungen ihrer Arbeit sind. Befragt wurden die Leserinnen und Leser der Zeitschrift, aber auch über andere Kanäle wurde die Umfrage beworben. In diesem Artikel stellen wir die Ergebnisse vor.

Bis ein Sportler nach einer Verletzung wieder am Wettkampf teilnehmen kann, müssen seine motorischen Fähigkeiten abhängig von den Heilungsvorgängen spezifisch entwickelt werden – ein komplexer Prozess, bei dem viele Aspekte berücksichtigt werden müssen.

Preterm premature rupture of membranes (PPROM) occurs in up to 3% of all pregnancies. Only few comparative studies have investigated potential risks and benefits between different tocolytic substances in women with PPROM. The aim of this study was to compare the neonatal short term outcome after tocolysis with Atosiban or Hexoprenaline in women with PPROM. This is a retrospective observational cohort study of women with PPROM between 24 and 32 weeks of gestation comparing neonatal and maternal outcome after tocolysis with atosiban or hexoprenaline. Outcome parameters were short term neonatal outcome, maternal tocolytic efficacy, effectiveness and tolerability and neonatal neurodevelopmental long-term outcome. Continuous variables were compared using t-Test or Mann–Whitney U test, as appropriate. For categorical variables Chi-square after Pearson and Fisher exact-test were used to compare the two groups. 93 women were included into this study with 42 women receiving hexoprenaline and 51 women receiving atosiban as primary tocolytic treatment. Mean gestational age was 29 weeks in both groups at the time PPROM. No differences were found for any short term neonatal outcome parameters, tocolytic efficacy, effectiveness and tolerability and neonatal neurodevelopmental long-term outcome. Both hexoprenaline and atosiban do not affect the short and long term neonatal outcome in women with PPROM for the time of lung maturation.

Introduction Preterm birth is defined as a live birth before 37 weeks of gestation and is associated with increased neonatal morbidity and mortality. The aim of this study is to compare the efficacy of hexoprenaline and atosiban for short- and long-term tocolysis and their effects on neonatal and maternal outcomes. Methods This retrospective cohort study included women with threatened preterm labor between 24 + 0 and 34 + 0 weeks of gestation without premature rupture of membranes. The tocolytic efficacy of hexoprenaline and atosiban was compared in women receiving one of the two medications for short- and long-term tocolysis. Continuous variables were compared using t-test or Mann–Whitney U test, as appropriate. Comparison of categorical variables between the two groups was done with χ2 test after Pearsonʼs and Fisherʼs exact test. Results 761 women were enrolled in this study; 387 women received atosiban and 374 women received hexoprenaline as their primary tocolytic agent. Atosiban showed a higher efficacy as a primary tocolytic agent (p = 0.000) within 48 hours. As regards long-term tocolysis, there were no differences between the treatment groups (p = 0.466). Maternal side effects such as tachycardia (p = 0.018) or palpitations (p = 0.000) occurred more frequently after the administration of hexoprenaline, while there were no differences between the two drugs administered with regard to any other maternal or neonatal outcome parameter. Conclusion Our retrospective study shows a significantly higher efficacy of atosiban in the first 48 hours, especially when administered at an early gestational age. There were no significant differences in terms of neonatal outcome but significantly more maternal adverse effects during the administration of hexoprenaline.

BACKGROUND Two studies have found primary ovarian carcinomas in stage I disease to be larger than those in stage III. Thus, these stages may represent different tumor entities. MATERIALS AND METHODS The clinical data from 553 patients operated on between 1985 and 2012 for epithelial ovarian cancer were retrospectively analyzed. RESULTS Primary lesions including invasive, borderline and benign components were significantly larger in stage I compared to stage III disease (p

Introduction Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. Methods As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having low skeletal muscle mass (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity. Results Median patient age was 63 years (19–87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI]>6, 63.2%), 30-day mortality was 5.8% (n = 25). Median HUAC was 19.78 HU (IQR: 15.94–23.54) with 145 patients (34.2%) having low skeletal muscle mass. Preoperative frailty defined by low skeletal muscle mass was associated with an increased risk for postoperative complications (OR 1.55, CI 95% 0.98–2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, CI 95% 1.57–16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (CI 95% 0.78–0.91, p = 0.0001). Patients with CCI ≥6 and low skeletal muscle mass defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, CI 95% 2.98–12.2, p = 0.0001). Conclusion Low skeletal muscle mass predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients.

Zusammenfassung Auswahlverfahren fur ein Medizinstudium: Korrelation zwischen Somatisierungssymptomen und Prufungserfolg Fragestellung: Zulassungsverfahren zu Universitaten stellen ein quasi-experimentelles Setting fur die Stressforschung dar,wurden aber bislang kaum genutzt,um Somatisierungphanomene zu erforschen. Wir untersuchten in der vorliegenden Studie, wie Somatisierungssymptome und Erfolg bei einem Auswahlverfahren zum Medizinstudium miteinander assoziiert sind. Methoden: Teilnehmer an einem Auswahlverfahren zumMedizinstudium erhielten einen personlichen Link zu drei Onlinefragebogen (SOMS-7, HADS-D,WHOQOL-BREF),welche drei Wochen vor, zwei bis einen Tag vor dem Auswahlverfahren und nach Bekanntgabe der Ergebnisse beantwortet werden mussten. Ergebnisse: 43 Teilnehmer (24 weiblich) wurden eingeschlossen. Die Anzahl an Somatisierungssymptomen reduzierte sich nach dem Auswahlverfahren signifikant (p ≤ 0.004) bei allen Teilnehmern. Signifikant hohereWerte wurden bei denjenigen festgestellt, welche kei...

Objective To examine the impact of different treatment strategies - surgical treatment or watchful waiting- on sexual activity, psychosocial distress, and fear of progression in women with Human Papillomavirus (HPV)-associated premalignant genital lesions. Study design Observational cohort study of women diagnosed with HPV-associated premalignant lesions of the cervix, vagina or vulva. Patients were stratified into two groups depending on the severity of their premalignancy: surgical treatment or watchful waiting. Validated patient administered questionnaires, i.e. Fear of Progression questionnaire (FoP-Q), Cervical Dysplasia Distress Questionnaire (CDDQ), and Sexual Activity Questionnaire (SAQ) were completed after clinical evaluation (baseline), at 6- and 12-months follow-ups. Results 209 women treated with surgery (N = 125) were compared with women who were monitored in regular intervals (N = 82). During an observational period of 12 months there were no significant differences in fear of progression, psychosocial distress, and sexual activity (p > 0.05). The level of concerns and anxiety about the future, and fear of progression were present, mostly at baseline. While there was a small increase of tension from visit to visit in both groups, patients generally were able to cope with their clinical situation quite well. Conclusions Fear of progression, psychosocial distress and sexual activity in women with precancerous HPV- associated premalignant genital lesions seem to be independent from type of treatment. Both treatment strategies may be applied without major psychological sequelae, as long as adequate information is provided.

REAKTIVKRAFT - VON „LOW LOAD“ ZU „HIGH LOAD“ Die richtige Kraftentwicklung in den Beinen ist fur Athleten in Sportarten mit schnellen Richtungswechseln qualitatsentscheidend. Gut trainierte Sportler rennen schneller oder springen weiter. Diese reaktive Kraftfahigkeit kann man schulen. Mithilfe von vier Lernphasen, hilfreichen Feedbacks und einem systematischen Belastungsaufbau kommt der Sportler ans Ziel.

Accumulating evidence points toward mutual interaction between parathyroid hormone (PTH) and aldosterone as potential mechanism for increasing cardiovascular risk in primary hyperparathyroidism (pHPT).The Eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism (EPATH) trial is a single-center, randomized, double-blind, parallel-group, placebo-controlled trial. The primary aim is to evaluate the effects of the mineralocorticoid receptor antagonist eplerenone on plasma intact PTH (iPTH) concentration in patients with pHPT. Secondary end points comprised surrogate parameters of cardiovascular health [24-h ambulatory SBP and DBP and echocardiographic parameters related to systolic/diastolic function as well as to cardiac dimensions].We enrolled 110 study participants with pHPT, 25-hydroxyvitamin D at least 20 ng/ml and estimated glomerular filtration rate more than 50 ml/min per 1.73 m. Patients were 1 : 1 randomly assigned to receive either 25 mg eplerenone once daily (up-titration after 4 weeks to 50 mg/day) or matching placebo for a treatment period of 8 weeks.The study was completed by 97 participants [mean (SD) age: 67.5 ± 9.5 years; 78.4% women). The mean treatment effect (95% confidence interval) for iPTH was 1.0 (0.9-1.1; P = 0.777) pg/ml. Mean 24-h ambulatory SBP and DBP decreased significantly [mean change (95% confidence interval) -6.3 (-9.4 to -3.3) and -3.7 (-5.7 to -1.7) mmHg, respectively; P 0.001]. No differences were seen in any further secondary outcomes or frequency of adverse events.In pHPT, treatment with eplerenone compared with placebo had no effect on circulating iPTH levels. Eplerenone treatment was well tolerated and safe and followed by significant decrease of ambulatory blood pressure.

Introduction Genital human papillomavirus (HPV) infections are very common in women 18 to 30 years old and substantially affect women's sexual health. Aim To examine sexual activity, psychosexual distress, and fear of progression in women diagnosed with HPV-related precancerous genital lesions. Methods In this observational study, women diagnosed with premalignant lesions of the cervix, vagina, or vulva were recruited from a university hospital–based colposcopy clinic. Main Outcome Measures Quantitative data from three validated patient-administered questionnaires (Sexual Activity Questionnaire, German version of the Cervical Dysplasia Distress Questionnaire, and Fear of Progression Questionnaire) were compared within the study population, according to the location of the genital lesion, and with relevant reference populations. Qualitative data from two written open-ended questions about women's thoughts regarding diagnosis and information were analyzed. Results Two-hundred nine women completed the questionnaires. Seventy-eight percent of women (n = 162) were referred for evaluation of suspect lesions of the cervix, 8% (n = 17) of the vagina, and 14% (n = 30) of the vulva. There were no significant differences in questionnaire results among the three patient groups, except for sexual consequences (Cervical Dysplasia Distress Questionnaire) and recent sexual activity (Sexual Activity Questionnaire). Women with vulvar lesions were most likely to worry about sexual consequences (ie, being unable to have children, being sexually less attractive, or infecting a sexual partner; P = .04). The Sexual Activity Questionnaire subscales sexual pleasure ( P = .15) and sexual habits ( P = 1.00) were similar to those in a healthy control population, whereas sexual discomfort ( P = .51) was comparable to that in a reference population of women who survived cervical cancer. The subscale partner-specific concerns (Fear of Progression Questionnaire) was similar to that in a reference population of patients with cancer ( P = .28). Conclusion HPV-related precancerous genital lesions, especially of the vulva, are likely to cause concerns about sexual health. Effective information and communication are important to lessen negative sexual consequences and anxiety.

Background: Genetic testing is of prognostic and predictive importance in patients with ovarian cancer and breast cancer. The best explored mutations are those of the BRCA 1 and BRCA2 genes, and the result of BRCA testing impacts treatment and prophylactic options. Data on other breast-cancer-associated genes are accumulating. Methods: All patients who underwent genetic counseling and testing for BRCA 1 and BRCA 2 between 2007 and 2019 at the Medical University of Graz were reviewed. If BRCA testing was negative patients were offered panel testing for other breast and ovarian cancer associated genes including ATM, PETEN, RAD50, RAD51D, RAD51C, TP53, STK11, ATM, NBN, CDH, MSH6, MSH2, MLH1, CHEK2, PALB2, BRIP1, SMO, PETEN, SMO. Results: In total 1905 patients were counseled for genetic testing between 2007 to 2019. In 292 patients (mean age 53yrs) panel gene testing was performed. 114 (39%) of these 292 BRCA-negative patients (55 with breast cancer, 24 with ovarian cancer) had a pathogenic variant (n=32) or a mutation of unknown significance (n=82). The most common pathogenic variant occurred in the CHEK2 gene (n=15). Interpretation: In this series approximately one third of high-risk patients who tested negative for a BRCA mutation had a mutation of unknown significance and/or pathogenic mutation in gene panel testing. This indicates that genetic panel testing should be considered more frequently. Citation Format: Elisabeth Katharina Trapp, Michael Speicher, Jochen B Geigl, Vassiliki Kolovetsiou-Kreiner, Julia Reisinger, Josef Haas, Edgar Petru, Karl Tamussino, Gunda Pristauz. Multigene panel analysis in breast and ovarian cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-03-09.

BIPEDIE: In den westlichen Staaten verbucht die Sportart Laufen die meisten Aktiven. Die Zahl der jahrlich durchgefuhrten Laufveranstaltungen steigt stetig, und die Teilnehmerzahlen der grosen Marathonveranstaltungen in Boston, Rotterdam, New York oder Berlin nehmen jedes Jahr zu. Mittlerweile werden die Starterzahlen limitiert und die Startplatze teilweise verlost.

SPOT ON: Der Begriff des Funktionellen Trainings ist noch nicht eindeutig definiert. Wir haben Experten aus mehreren Bereichen des Sports befragt. Wir wollten wissen, was sie unter einem funktionellen Training verstehen und was es beinhalten muss. Welchen Stellenwert hat es in ihrer Sportart? Welche Unterschiede oder Gemeinsamkeiten zwischen athletischem und funktionellem Training gibt es? Und zu guter Letzt, was ist neu am funktionellen Training? Hier lesen Sie die Statements.

The cardiotonic steroid marinobufagenin (MBG) is increasingly suggested to be responsible for some of the cardiovascular injury that has been previously attributed to aldosterone. We examined the clinical correlates of circulating MBG concentrations in hypertensive patients and tested the hypothesis that MBG serves as a reliable diagnostic tool for detecting primary aldosteronism (PA).Plasma MBG concentrations (mean: 0.51±0.25 nmol/l) were measured in the morning fasting samples in 20 patients with PA and 20 essential hypertensive (EH) controls matched for age, sex, body mass index, renal function, urinary sodium and intake of antihypertensive medication (mean age: 51.6 years; 52.2% women).Overall, plasma MBG was directly correlated with plasma aldosterone, aldosterone to active renin ratio (AARR), diastolic blood pressure, mean carotid intima-media thickness, serum sodium, urinary protein to creatinine ratio and inversely with serum potassium levels. Plasma MBG levels were significantly higher in patients with PA compared to EH (mean: 0.68±0.12 versus 0.35±0.24 nmol/l; p0.001). ROC analysis yielded a greater AUC for plasma MBG compared to the AARR, PAC and serum potassium levels for detecting PA. Youden's Index analyses yielded the optimal plasma MBG cut-off score for diagnosing PA at 0.49 nmol/l with specificity and sensitivity values of 0.85 and 0.95, respectively, which were higher than those at the optimum AARR cut-off at 3.32 ng/dl/µU/ml.In a well-characterized cohort, values of plasma MBG were significantly related to clinical correlates of cardiovascular and renal disease. Plasma MBG emerged as a valuable alternative to the AARR for screening of PA.

Background/Definition of the Problem: In recent years, postoperative management has changed towards rapid mobilisation, early oral feeding and rapid rehabilitation (known as Fast-Track or Enhanced Recovery Concepts). This study analysed the postoperative length of stay after vaginal hysterectomy in 3 different periods of time. Material and Methods: In the period October 2011 – September 2012, 75 patients underwent vaginal hysterectomies (± adnexectomy); another 114 vaginal or laparoscopic hysterectomies with additional operations (e.g. prolapse surgery and incontinence surgery) and malignancies were not included. The time periods August 1995 – July 1996 (n = 50) and October 1996 – September 1997 (n = 96) served as a comparison. Reducing the length of stay was not an explicit goal. Results: The median postoperative stay was shortened from 7 (5–9) to 5 (3–15) or 3 (0–5) days (p

We conducted a prospective randomized controlled noninferiority trial to compare objective and subjective outcomes of retropubic tension-free vaginal tape (TVT) with those of transobturator tape (TVT-O) as primary treatment for stress urinary incontinence (SUI) in women. The study was conducted at 25 gynecology units in Austria and Germany; regional and academic hospitals participated. A total of 569 patients were randomly assigned to undergo TVT or TVT-O. A total of 480 patients (85 %) were examined at 3 months. A negative cough stress test with stable cystometry to 300 ml was seen in 87 % of patients after TVT and in 84 % after TVT-O; 64 % and 59 % of patients, respectively, reported no pad use, and 88 % of patients in both groups considered themselves much or very much better on the Patient Global Impression of Improvement (PGI-I) scale. Quality of life (QoL) as assessed with the SF-12 Health Survey, Kings’ Health Questionnaire, (KHQ), and EuroQol-5D (EQ-5D) was significantly improved in both arms, with no differences between arms. There were no significant differences in postoperative pain or complications. Results of this trial demonstrate noninferiority between TVT and TVT-O with regard to postoperative continence and QoL and suggest little difference in perioperative problems (ClinicalTrials.gov NCT 00441454).

ZusammenfassungEine physiotherapeutische Behandlungsserie führt oft dazu, dass der Patient beschließt, wieder mehr „für sich“ zu tun – z.B. laufen zu gehen. Beachtet er dabei ein paar Regeln, stehen die Chancen gut, dass aus der anfänglichen Schwärmerei eine Leidenschaft wird, die am Ende sogar von sportlichen Erfolgen gekrönt ist.

Aim As recent clinical data suggest a harmful effect of arterial hyperoxia on patients after resuscitation from cardiac arrest (CA), we aimed to investigate this association during cardiopulmonary resuscitation (CPR), the earliest and one of the most crucial phases of recirculation. Methods We analysed 1015 patients who from 2003 to 2010 underwent out-of-hospital CPR administered by emergency medical services serving 300,000 inhabitants. Inclusion criteria for further analysis were nontraumatic background of CA and patients >18 years of age. One hundred and forty-five arterial blood gas analyses including oxygen partial pressure (paO2) measurement were obtained during CPR. Results We observed a highly significant increase in hospital admission rates associated with increases in paO2 in steps of 100 mmHg (13.3 kPa). Subsequently, data were clustered according to previously described cutoffs (≤ 60 mmHg [8 kPa]], 61-300 mmHg [8.1-40 kPa], >300 mmHg [>40 kPa]). Baseline variables (age, sex, initial rhythm, rate of bystander CPR and collapse-to-CPR time) of the three compared groups did not differ significantly. Rates of hospital admission after CA were 18.8%, 50.6% and 83.3%, respectively. In a multivariate analysis, logistic regression revealed significant prognostic value for paO2 and the duration of CPR. Conclusion This study presents novel human data on the arterial paO2 during CPR in conjunction with the rate of hospital admission. We describe a significantly increased rate of hospital admission associated with increasing paO2. We found that the previously described potentially harmful effects of hyperoxia after return of spontaneous circulation were not reproduced for paO2 measured during CPR. Clinical trial registration n/a.

Eine physiotherapeutische Behandlungsserie fuhrt oft dazu, dass der Patient danach beschliest, wieder mehr „fur sich“ zu tun - beispielsweise laufen zu gehen. Beachtet er dabei ein paar Grundsatze und Regeln, sind die Chancen gut, dass aus der anfanglichen Schwarmerei eine langfristige Liebe wird, die am Ende sogar von sportlichen Erfolgen gekront ist.

Albumin is the major plasma protein with several important biological functions. Various disturbances of albumin function have been demonstrated in end-stage liver disease. These functional disturbances may be related to oxidative modifications of albumin at cysteine-34, including the irreversibly oxidized human nonmercaptalbumin-2 (HNA2). The aim of the present study was to relate oxidative modification of albumin to short-term prognosis in chronic liver failure. Patients with advanced cirrhosis (N = 39), acute-on-chronic liver failure (N = 15), and healthy controls (N = 15) were investigated. Three fractions of albumin were separated by high performance liquid chromatography according to the redox state of cysteine-34. The HNA2 fraction was markedly increased in cirrhotic patients vs. controls and correlated with the degree of chronic liver failure as well as laboratory parameters of liver dysfunction. The HNA2 level tended to be a better predictor of short-term mortality than the model for end stage liver disease with respect to both 30-day mortality (area under the receiver operating characteristic curve [AUROC] 0.87 vs. 0.81, NS) and 90-day mortality (AUROC 0.87 vs. 0.82, NS). In multivariate analysis of prognostic variables, HNA2 was the only remaining predictor of 90-day mortality. Our results suggest that HNA2, a marker of chronic oxidative stress, is related to liver dysfunction and mortality in cirrhosis and may represent a novel biomarker of chronic liver failure.

Little is known about the immunomodulation by tick saliva during a natural tick bite in human skin, the site of the tick-host interaction. We examined the expression of chemokines, cytokines and leucocyte markers on the mRNA levels and histopathologic changes in human skin biopsies of tick bites (n=37) compared to unaffected skin (n=9). Early tick-bite skin lesions (24 hours of tick attachment) were characterized by a predominance of macrophages and dendritic cells, elevated mRNA levels of macrophage chemoattractants (CCL2, CCL3, CCL4) and neutrophil chemoattractants (CXCL1, CXCL8), of the pro-inflammatory cytokine, IL-1β, and the anti-inflammatory cytokine, IL-5. In contrast, the numbers of lymphocytes and mRNA levels of lymphocyte cell markers (CD4, CD8, CD19), lymphocyte chemoattractants (CXCL9, CXCL10, CXCL11, CXCL13, CCL1, CCL22), dendritic cell chemoattractants (CCL20), and other pro- (IL-6, IL-12p40, IFN-γ, TNF-α) and anti-inflammatory cytokines (IL-4, IL-10, TGF-β) did not differ from normal skin. With longer tick attachment (24 hours), the numbers of innate immune cells and mediators (not significantly) declined, whereas the numbers of lymphocytes (not significantly) increased. Natural tick bites by Ixodes ricinus ticks initially elicit a strong local innate immune response in human skin. Beyond 24 hours of tick attachment, this response usually becomes less, perhaps because of immunomodulation by tick saliva.

Purpose An arterial blood gas analysis (ABG) yields important diagnostic information in the management of cardiac arrest. This study evaluated ABG samples obtained during out-of-hospital cardiopulmonary resuscitation (OHCPR) in the setting of a prospective multicenter trial. We aimed to clarify prospectively the ABG characteristics during OHCPR, potential prognostic parameters and the ABG dynamics after return of spontaneous circulation (ROSC). Methods ABG samples were collected and instantly processed either under ongoing OHCPR performed according to current advanced life support guidelines or immediately after ROSC and data ware entered into a case report form along with standard CPR parameters. Results During a 22-month observation period, 115 patients had an ABG analysis during OHCPR. In samples obtained under ongoing CPR, an acidosis was present in 98% of all cases, but was mostly of mixed hypercapnic and metabolic origin. Hypocapnia was present in only 6% of cases. There was a trend towards higher paO 2 values in patients who reached sustained ROSC, and a multivariate regression analysis revealed age, initial rhythm, time from collapse to CPR initiation and the arterio-alveolar CO 2 difference (AaDCO 2 ) to be associated with sustained ROSC. ABG samples drawn immediately after ROSC demonstrated higher paO 2 and unaltered pH and base excess levels compared with samples collected during ongoing CPR. Conclusions Our findings suggest that adequate ventilation and oxygenation deserve more research and clinical attention in the management of cardiac arrest and that oxygen uptake improves within minutes after ROSC. Hyperventilation resulting in arterial hypocapnia is not a major problem during OHCPR.

Objectives Oral health-related quality of life is a relatively new but rapidly growing concept in dentistry. It is an aspect of dental health addressing the patient’s perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DHS), which is a common condition of transient tooth pain associated with a variety of exogenous stimuli, may disturb the patient during eating, drinking, toothbrushing and sometimes even breathing. The resulting restrictions on everyday activities can have an important effect on the patient’s quality of life. The aims of this paper were to consider the concept of oral health-related quality of life and to review and discuss the literature on oral health-related quality of life and DHS. Material and methods A PubMed literature research was conducted using the terms (“dentin sensitivity” [MeSH Terms] OR (“dentin” [All Fields] AND “sensitivity” [All Fields]) OR “dentin sensitivity” [All Fields]) AND ((“oral health” [MeSH Terms] OR (“oral” [All Fields] AND “health” [All Fields]) OR “oral health” [All Fields]) AND related [All Fields] AND (“quality of life” [MeSH Terms] OR (“quality” [All Fields] AND “life” [All Fields]) OR “quality of life” [All Fields])). Furthermore, a manual search was carried out. Any relevant work published presenting pertinent information about the described issue was considered for inclusion in the review. Results The combination of the search terms resulted in a list of only three titles. The few published studies convincingly demonstrated that oral health-related quality of life is negatively affected in patients suffering from DHS. Conclusions Patients with sensitive teeth report substantial oral health-related quality of life (OHRQoL) impairment. Nevertheless, knowledge about the influence of DHS on oral health-related quality of life is incomplete and, therefore, needs further research. Clinical relevance Oral diseases can lead to physical, psychological and social disability. This paper shows that DHS can have a negative impact on the patients’ OHRQoL.

Background Septic episodes in preterm infants recently have been reported to be associated with periventricular leukomalacia (PVL). The role of hypocarbia as an independent risk factor for PVL in clinical studies raises many questions without conclusive answers. Aims To evaluate risk factors for cystic PVL focussing on the influence of hypocarbia. Study design Retrospective single centre case-control study. Subjects Preterm infants 24 to 35 weeks of gestational age and matched (1:2 for gender, birth year, gestational age and birth weight) controls. Outcome measures Multivariate analysis of perinatal factors being associated with cystic PVL diagnosed by serial ultrasound examinations. Results Univariate analysis of risk factors revealed lower 5 and 10 min Apgar scores, and higher rates of neonatal seizures, early-onset sepsis, neonatal steroids, respiratory distress syndrome with surfactant replacement therapy, and episodes of hypocarbia significantly being associated with PVL. Multivariate analysis using a logistic regression model revealed early-onset sepsis and hypocarbia being significantly associated with PVL (p = .022 and .024, respectively). Lowest PaCO 2 values did not differ as did not the duration of hypocarbia, but the onset of hypocarbia was significantly later in PVL cases compared to controls (mean 26 vs. 15 h, p = .033). Neurodevelopmental follow-up at a median time of 46 months was poor showing 88% of the cases having an adverse neurological outcome. Conclusion We found early-onset sepsis and episodes of hypocarbia within the first days of life being independently associated with PVL.

Objective To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic tracings and subsequent management recommendations. Design Prospective online study. Setting Seven university hospitals in five European countries. Population Forty-two intrapartum tracings from women with singleton pregnancies and uneventful antepartum courses. Methods Using an online questionnaire, 123 healthcare professionals interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the National Institute of Clinical Excellence guidelines (intrapartum care). Two months later, 93 of the 123 participants re-interpreted the same re-ordered tracings, this time with information on the newborn's umbilical artery pH. Outcome measures Comparison of the evaluation of tracing features, overall tracing classification, and management recommendations between the initial analysis and re-interpretation. Results In newborns with umbilical artery pH ≤ 7.05, knowledge of the pH value led to significant changes in the evaluation of all basic tracing features. In this group, classification of tracings as ‘normal’ decreased 76% (8.8–2.1%, P < 0.001), whereas classification as ‘pathologic’ increased 51% (44.7–67.5%, P < 0.001). In newborns with pH 7.06–7.19, classification of tracings as ‘normal’ decreased 36% (22.4–14.4%, P < 0.001), and in those with pH ≥ 7.20, classification of tracings as ‘pathologic’ decreased 40% (23.4–14.1%, P < 0.001). In the group of newborns with umbilical artery pH ≤ 7.05, the recommendations ‘no attention needed’ decreased 75% (10.2–2.6%, P < 0.001), and the number of recommendations ‘rapid reversal of hypoxic cause or immediate delivery’ increased 70.3% (42.1–71.7%, P < 0.001). Conclusions When provided with information on adverse fetal outcome, healthcare professionals provide a more pessimistic evaluation of basic tracing features, overall classification, and clinical management recommendations. Tweetable abstract Knowledge of adverse fetal outcome leads to more pessimistic CTG evaluation and management recommendations.

PURPOSE Excessive fetal fat as the hallmark of GDM pregnancy complications is one consequence of fetal hyperinsulinism. Noninvasive methods for fetal surveillance and measurement of fetal fat are needed. The purpose of this study was to test the hypothesis that measurements of the fetal anterior abdominal wall thickness (AAWT) in women with GDM will allow early detection of fetal hyperinsulinism. MATERIALS AND METHODS Amniocentesis was performed between 28 and 32 weeks of gestation (wks) in 220 women with GDM (diagnosed by 75 g oGTT at 24 to 28 wks). Amniotic fluid insulin levels (AFIL) were determined by a commercially available radioimmunoassay. Transabdominal ultrasound provided fetal biometric measurements following standard procedures and the AAWT including fetal skin and subcutaneous tissue at the time of amniocentesis. Maternal parameters (weight, BMI, oGTT blood glucose levels and mean daily blood glucose levels) were correlated with fetal biometric data and with AFIL. RESULTS There was no difference in AAWT in women with GDM and no correlation with mean AFIL. AFIL also did not correlate with any other fetal measurement or with mean oGTT blood glucose levels. AFIL only showed a correlation with maternal weight (p = 0.02) and maternal BMI (p = 0.01). The correlation was present for values both before pregnancy and at the time of amniocentesis. CONCLUSION In the early third trimester, AAWT measurements do not correlate with fetal insulin levels.

Objective: To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome.Methods: We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pHart), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II.Results: A total of 207 twin pairs were included in our study. In Group A (n= 151) there were no significant correlations between TTDT and pHartor Apgar scores at 1, 5 and 10 minutes of twin II (p= .156; 0.861; 0.151 and 0.384, respectively). In Group B (n= 56), the mean pHartof twin II was inversely correlated to TTDT, but not significantly (p= .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p= .330;p= .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p= .638).Conclusion: Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.

Das Erkennen eines suspekten oder pathologischen CTGs lasst keine sichere Aussage uber das tatsachliche Vorliegen eines „fetal distress“, bzw. das Ausmas der fetalen Blutgas-u. pHWert-Veranderungen zu. Ohne den Einsatz der Mikroblutuntersuchung muss das Auftreten von suspekten oder pathologischen CTG-Veranderungen haufig eine raschest mogliche Geburtsbeendigung mittels vaginal-operativer Masnahme oder Kaiserschnitt nach sich ziehen. Diese Studie soll prufen, wie viele Kaiserschnitte und vaginal-operative Entbindungen durch den Einsatz von Mikroblutuntersuchungen (MBU) bei suspekten oder pathologischen Geburts-CTGs in der klinischen Realitat verhindert werden konnen. Retrospektive Analyse des Geburtsmodus mittels deskriptiver Statistik an 669 Patientinnen im Zeitraum 2008–2009, bei denen bei suspektem oder pathologischem CTG eine Mikroblutuntersuchung durchgefuhrt wurde. Auserdem sollte untersucht werden, ob eine Abhangigkeit der MBU-Verteilung vom Gestationsalter besteht. Durch den Einsatz der Mikroblutuntersuchung konnte bei 6,4% der im Studienkollektiv eingeschlossene Patientinnen mit suspektem oder pathologischem CTG, durch einen oder mehrere MBU-Werte im Normbereich, eine operative Entbindung umgangen und eine Spontangeburt ermoglicht werden. Weiters zeigt sich eine Haufung der Mikroblutuntersuchungen bei Gestationsaltern jenseits des Geburtstermins. Die fetale Mikroblutuntersuchung stellt ein effektives Hilfsmittel im geburtshilflichen Management dar und kann zur Reduktion der operativen Entbindungsrate beitragen. Das Risiko der Invasivitat des Eingriffs kann im Vergleich zur Reduktion der operativen Entbindungsrate als gering angesehen werden. Die Bereitschaft zur Durchfuhrung von Mikroblutuntersuchungen steigt mit Fortschreiten des Gestationsalters offensichtlich stetig an.

Background: Indocyanine green (ICG) clearance has been proposed as a quantitative liver function test several decades ago. Interest in this method has been renewed following the development of finger pulse densitometry for noninvasive estimation of the ICG plasma disappearance rate (PDR). On the other hand, the model for end-stage liver disease (MELD), which is based on routine laboratory parameters, is widely used for estimation of short-term survival in cirrhosis, but its prognostic value in critically ill cirrhotic patients is unclear. Aims: The aim of the present study was to compare the diagnostic accuracy of ICG PDR vs. MELD for estimation of short-term prognosis in cirrhotic patients. Methods: Ninety consecutive cirrhotic patients who were admitted for decompensated disease or were being evaluated for liver transplantation were screened. Patients who underwent liver transplantation within the following 90 days and those with hepatocellular carcinoma were excluded. In the remaining 70 patients, routine laboratory parameters and ICG clearance were analysed. Following an injection of ICG 0.25 mg/kg, PDR was measured by finger pulse densitometry. The diagnostic accuracy of ICG PDR and MELD for prediction of 90-day survival was assessed by receiver–operating characteristic (ROC) curve analysis. Results: ROC curve analysis revealed superior diagnostic accuracy for MELD as compared with ICG PDR in predicting 90-day survival (area under the ROC curve 0.89 vs. 0.71). A MELD cut-off of 22 provided the best discrimination for prediction of 90-day survival. Conclusions: MELD is superior to ICG PDR for estimation of short-term survival in patients with decompensated cirrhosis.

Objective Recent prospective data support the trend towards systematic retroperitoneal lymphadenectomy in patients with high-risk endometrial cancer. Because para-aortic node involvement in the absence of pelvic node involvement is uncommon, a reliable finding of negative pelvic lymph nodes (PLN) at intraoperative frozen section examination might allow omitting para-aortic dissection. We analyzed the diagnostic accuracy of frozen section examination of PLN in patients with endometrial cancer. Methods We reviewed 131 patients with endometrial cancer who underwent surgery including systematic pelvic lymphadenectomy ( n =101) or pelvic and para-aortic lymphadenectomy ( n =27). Intraoperative frozen section examination of PLN was performed in 72 (55%) patients. Results of frozen section examination were compared with those of final histopathology and the diagnostic accuracy of frozen section examination of PLN was calculated. One pathologist measured the diameters of PLN metastases retrospectively. Results A total of 1063 and 2666 PLN were analyzed by frozen section examination and by final histopathology, respectively. PLN metastases were found in 7 cases (10%) at frozen section examination, and in 17 cases (24%) at final histopathology (false negative rate, 59%). No false positive cases were noted. The mean diameter of all PLN metastases at final histopathology was 4.3 mm, as compared to 9.0 mm for the metastases detected at frozen section analyses. The mean diameter of PLN metastases missed at frozen section examination was 2.0 mm. Conclusion In this review at a single institution, intraoperative frozen section histology missed nearly two of three endometrial cancer patients with positive nodes. These results do not support tailoring the extent of lymphadenectomy according to the results of frozen section examination.

The purpose of the study was to investigate the long-term treatment side effects on the quality of life (QoL) and sexual functioning of cervical cancer survivors undergoing different treatment regimens.QoL and sexual functioning were measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, the Cervix Cancer Module, and the Sexual Activity Questionnaire.One hundred twenty-one cervical cancer survivors (63 Surgery, 38 Surgery/CT, and 20 Surgery/RT) participated. Patients in the Surgery/RT Group reported significantly worse QoL outcomes (lower scores on physical, role, cognitive, and social functioning) compared with patients in the Surgery Group or patients in the Surgery/CT Group. The level of symptoms such as nausea/vomiting, pain, appetite loss, frequent urination (p=0.019), leaking of urine (p=0.015), and the feeling of a tight vagina (p=0.018) was significantly higher in irradiated patients. Concerning sexual functioning, patients in the Surgery/RT Group reported a significantly lower sexual activity rate compared with women in the Surgery Group or women in the Surgery/CT group (p0.05). However, there were no statistically significant differences concerning sexual pleasure and sexual discomfort among the three treatment groups (p0.05).Cervical cancer survivors treated with adjuvant radiotherapy are more likely at risk for impaired QoL. Survivors treated with surgery or adjuvant chemotherapy return to a similar level of QoL as women without a history of cancer. Although the sexual activity rate is lower in irradiated patients their sexual pleasure is similar to patients after surgery and chemotherapy.

Objective To identify obstetric risk factors and to elucidate the effect of prolonged rupture of the membranes on the development of cystic periventricular leukomalacia (PVL) in preterm infants. Methods A retrospective case–control study of 95 preterm infants with the diagnosis of PVL and 245 healthy controls matched for gestational age. A total of 52 antenatal, intrapartum and neonatal characteristics were studied by univariate methods and logistic regression. Results Preterm premature rupture of membranes (PPROM) (odds ratio 2.1 [95% CI 1.3–3.4], P =.003), gestational age at PPROM ( P =.025), prolonged rupture of membranes ( P P =.019) and antibiotics (1.9 [1.2–3.1], P =.008) were associated with PVL. The use of tocolytic agents >24 h ( P =.008), prolonged latency between the increase in maternal leukocyte count and birth ( P =.034), spontaneous onset of labor (1.8 [1.0–2.9], P =.026), vaginal delivery (1.7 [1.1–2.8], P =.029) and male gender (1.5 [1.0–2.0], P =.04) were found more frequently in PVL cases. Preeclampsia (0.4 [0.1–0.9], P =.034), hypertension at booking ( P =.009), sonographic IUGR ( P =.020), abnormal blood flow of the umbilical artery ( P =.032) and cesarean section without labor (0.5 [0.3–0.8], P =.006) were found less frequently. In logistic regression analysis, prolonged rupture of the membranes ( P =.748), preeclampsia ( P =.973), the use of antibiotics ( P =.617) and beta-sympathomimetic tocolytic agents ( P =.563) lost statistical significance, whereas birth weight ( P =.036) became significant. Conclusion PPROM and prolonged rupture of the membranes may provoke adverse effects on the neurodevelopmental outcome of the preterm fetus. These findings may have implications on the obstetric management of PPROM beyond 30 weeks of gestation. Cesarean section without labor was less likely associated with the diagnosis of PVL.

Fragestellung: Eine Analyse des geburtshilflichen und neonatalen Outcomes bei Gestationsdiabetikerinnen, die sich zur Therapieentscheidung einer Amniozentese zur Fruchtwasserinsulinbestimmung unterzogen oder Blutzuckertagesprofile mit Ermittlung der mittleren Blutglukose oder beide Methoden wählten. Material und Methodik: 408 Schwangerschaften mit Gestationsdiabetes wurden retrospektiv untersucht. 307 Schwangere wurden mit Diät behandelt (Klasse A) und 101 mit Diät und Insulin (Klasse AB). Geburtshilfliche und anthropometrische Daten wurden in Abhängigkeit der verwendeten Untersuchungsmethode innerhalb der Klassen mit Pearsons χ2 oder dem exakten Fisher-Test verglichen. Ergebnisse:Klasse A – Ältere Schwangere entschieden sich signifikant häufiger für die nichtinvasive Methode (p = 0,007). Das Gestationsalter bei der Geburt (p = 0,396) sowie der Geburtsmodus (p = 0,79) zeigten keine signifikanten Unterschiede. Dasselbe galt für das mittlere Geburtsgewicht (p = 0,348) und ein Geburtsgewicht >75. Perzentile (p = 0,473). Ein Geburtsgewicht >90. Perzentile trat signifikant häufiger bei Schwangerschaften auf, die mit beiden Methoden getestet wurden (p = 0,005). Der mittlere Ponderal-Index (PI; p = 0,434), die Nabelarterien- (p = 0,065) und Nabelvenen-pH-Werte (p = 0,052) sowie die Apgar-Werte nach 1 (p = 0,56) und 5 min (p = 0,072) erbrachten keinen Unterschied. Allerdings war ein Apgar Klasse AB – In dieser Klasse fanden sich keine signifikanten Unterschiede für die untersuchten Parameter: Alter der Mutter (p = 0,062), Gestationsalter bei der Geburt (p = 0,219), Geburtsmodus (p = 0,386), mittleres Geburtsgewicht (p = 0,59), Geburtsgewicht >75. und >90. Perzentile (p = 0,701 und p = 0,487), mittlerer PI (p = 0,156), Nabelarterien- und -venen-pH (p = 0,197 und p = 0,056), Apgar-Werte nach 1 und 5 min (p = 0,58 und p = 0,52), Nabelschnurinsulin und -glukose (p = 0,67 und p = 0,11). Schlussfolgerungen: Diese retrospektive Analyse zeigte keinen Vorteil für das geburtshilfliche und neonatale Outcome bei Gestationsdiabetikerinnen, deren Therapie aufgrund der Höhe des Fruchtwasserinsulins festgelegt wurde, weshalb diese Methode als eine von mehreren Optionen angesehen werden muss.

Objective : To assess neonatal outcome and 2-year follow-up of pregnancies complicated by second trimester preterm premature rupture of membranes (PPROM). Methods : A retrospective review of obstetric and neonatal records for 87 pregnancies (56 singletons, 6 twins, 1 triplet) with PPROM between 14 + 0 and 24 + 6 weeks of gestation. Patients received antibiotics and steroids for fetal lung maturity once they reached 24 weeks of gestation. Placentas were examined histopathologically. Surviving infants were followed-up at 2 years of age. Results : Median latency from PPROM to delivery was 4 days. Survival rate of 56 singletons was 45% (25/56); and 13 died in hospital. Survival rate of infants discharged from hospital was 23% (12/56). Chorioamnionitis was seen histologically in 42% (5/12) of surviving infants compared with 92% (12/13) of those that died in hospital. Of the 12 surviving infants, 50% had a normal neurological and developmental outcome at 2 years of age. Conclusion : Gestational age, birth weight, and histologic chorioamnionitis have prognostic importance in pregnancies complicated by PPROM. Surviving infants have a 50% chance of achieving an adequate health status at 2 years of age.

Aim: The incidence of lesions due to birth trauma can be generally regarded as a characteristic of obstetric management; since obstetric management has changed through the years, one might expect a decrease or increase of lesions due to birth trauma in mature newborn infants. Methods: In a retrospective study, the incidence of lesions due to birth trauma was recorded in the year 2000. In 1989, an identical study had already been carried out in the same department, employing the same criteria. The new findings were compared with the historical data. Results: In the year 1989 24.6% and in 2000 13.2% showed lesions due to obstetric trauma. The episiotomy rate and lesions due to birth trauma had significantly decreased. A decline regarding the traumas per se was noticed in caput succedaneum traumas, in hematomas due to birth trauma and in clavicle fracture. The cesarean section rate among the study group increased. The cesarean section rate among the traumatized newborns decreased. Conclusion: Episiotomy does not prevent newborns from traumatic lesions. Gestational age and birthweight have not significantly changed throughout the years; therefore an increase in the cesarean section rate must have contributed to the decrease of birth traumas. Even during abdominal operative delivery, obstetric traumas in newborns do occur. However, an increase in cesarean sections alone can not thoroughly explain the reduction of birth lesion among newborns. Improvement in prenatal diagnostic tools and procedures, respectively, and a goal-oriented use of labor induction might also play a major role.

Our objective was to examine the neonatal outcome of second twins depending on presentation and mode of delivery. Using a database we analyzed the short-term neonatal outcome in twin pregnancies offered a trial of labor with special emphasis on the second twin depending on presentation and mode of delivery. Neonatal outcome was evaluated by Apgar scores, umbilical cord blood pH values, and perinatal or neonatal morbidity and mortality. Overall, in 219 (78%) of 281 pregnancies successful vaginal birth (VB) of both twins (VB–VB) was possible, 48 (17%) women had to be delivered by cesarean section (CS) of both twins (CS–CS), and in 14 (5%) women the second twin had to be delivered by CS after VB of the first twin (VB–CS). Successful VB was most common for vertex-vertex (V/V; n = 171, 82%) and vertex-nonvertex (n = 48, 75%) presentation (V/NV). Twins delivered by VB–CS had the lowest values for pHart (p = .006) and pHven (p = .010). pHart less than or equal to 7.00 values occurred only in second twins delivered VB–VB or VB–CS. Lower Apgar scores of the second twin occurred more frequently in the VB–CS and in the VB–VB than in the CS–CS groups (ps < .05). Lower levels of pHart (p = .002) and frequency of pHart less than or equal to 7.00 occurred more often in nonvertex second twins than in vertex second twins (p < .022). The high CS rate in V/NV presentation and the significantly worse perinatal short-term outcome of NV second twins after VB of the first twin underline that randomized studies are necessary to evaluate the best delivery mode for V/NV twins.