REDUCING OF STRESS IN THE HIP JOINT ARTICULAR SURFACE IN SKIING

INTRODUCTION - It was recently shown that too high contact stress in the articular surface of the hip joint can accelerate the arthrosis development in the hip joint ( Hadley et al., 1990). Increased contact stress in the hip joint articular surface can result from too small hip joint articular surface andlor from too high resultant hip joint force. Since the resultant hip joint force. Since the resultant hip -joint force is permanently increased during sport activities it is understandable that the incidence of the hip arthrosis among people with high exposure to sport is significantly higher compared to those with low exposure (Vingard et al., 1993). The acetabular dysplasia in sportsmen, i.e, small femoral head coverage, additionally increase the probability of hip arthorsis development. During skiing changes in the position of the upper body occur. They are associated with varying degrees of pelvic tilting, which influence the hip joint contact stress distribution (Iglic et al., 1994). The aim of this work was to determine how acetabular dysplasia and pelvic tilt affect the hip joint contact stress distribution after shifting of the upper part of the body towards the weight-bearing leg in slow skiing. METHODS - A three-dimensional model of the hip joint articular surface is used in order to calculate hip joint contact stress distribution (Iglic et al., 1993a). the resultant hip joint force for various body positions is calculated separately by using a static three-dimensional model of the adult hip in the one-legged stance (Iglic et at., 1993b, lglic et al., 1994). RESULTS - It is shown that the decrease of the hip joint contact stress after the shifting of the upper part of the body towards the supporting leg is more effective in the case of large inclination of the pelvis during the shifting og the of the upper part of the body towards the supporting leg hip the stress can be in the case of severe acetabular dysplasia and small inclination of the pelvis even increased in spite of the fact that the resultant hip joint force is considerably reduced. CONCLUSIONS - In accordance with the results of this study it can be concluded that the subjects with borderline acetabular dysplasia should be encouraged to turn during skiing with increased pelvic tilt on the side of the non-weight-bearing leg with simultaneously shifting of the upper part of the body towards the weight-bearing leg. In this way the dysplastic hip is unloaded to an optimum degree. consequently, the risk for arthrosis development is decreased. REFERENCES - Hadley N.A., Brown T.D., Weinstein S.L. (1990) J. Orthop. Res. 8:504-513. lglic A,, Kralj-lglic V., Antolic V., Srakar F., Stanic U. (1993a) IEEE Trans. Rehab. Engr. 1 :207-212. lglic A,, Srakar F., Antolic V. (1993b) Clin. Biomech. 8:223-224. lglic A,, Kralj- lglic V., Antolic V. (1994) Acta Chir. Orthop. Traum. Cech. 61.268- 270. Vingard E., Alfredsson L.. Goldie I., Hoghstedt C. (1 993) Am.J.Sports Med. 21.195-200

Postnatal β2 adrenergic treatment improves insulin sensitivity in lambs with IUGR but not persistent defects in pancreatic islets or skeletal muscle

Placental insufficiency causes intrauterine growth restriction (IUGR) and disturbances in glucose homeostasis with associated β adrenergic receptor (ADRβ) desensitization. Our objectives were to measure insulin-sensitive glucose metabolism in neonatal lambs with IUGR and to determine whether daily treatment with ADRβ2 agonist and ADRβ1/β3 antagonists for 1 month normalizes their glucose metabolism. Growth, glucose-stimulated insulin secretion (GSIS) and glucose utilization rates (GURs) were measured in control lambs, IUGR lambs and IUGR lambs treated with adrenergic receptor modifiers: clenbuterol atenolol and SR59230A (IUGR-AR). In IUGR lambs, islet insulin content and GSIS were less than in controls; however, insulin sensitivity and whole-bodyGUR were not different from controls.Of importance, ADRβ2 stimulation with β1/β3 inhibition increases both insulin sensitivity and whole-body glucose utilization in IUGR lambs. In IUGR and IUGR-AR lambs, hindlimb GURs were greater but fractional glucose oxidation rates and ex vivo skeletal muscle glucose oxidation rates were lower than controls. Glucose transporter 4 (GLUT4) was lower in IUGR and IUGR-AR skeletal muscle than in controls but GLUT1 was greater in IUGR-AR. ADRβ2, insulin receptor, glycogen content and citrate synthase activity were similar among groups. In IUGR and IUGR-AR lambs heart rates were greater, which was independent of cardiac ADRβ1 activation. We conclude that targeted ADRβ2 stimulation improved whole-body insulin sensitivity but minimally affected defects in GSIS and skeletal muscle glucose oxidation. We show that risk factors for developing diabetes are independent of postnatal catch-up growth in IUGR lambs as early as 1 month of age and are inherent to the islets and myocytes

Postnatal β2 adrenergic treatment improves insulin sensitivity in lambs with IUGR but not persistent defects in pancreatic islets or skeletal muscle

Placental insufficiency causes intrauterine growth restriction (IUGR) and disturbances in glucose homeostasis with associated β adrenergic receptor (ADRβ) desensitization. Our objectives were to measure insulin-sensitive glucose metabolism in neonatal lambs with IUGR and to determine whether daily treatment with ADRβ2 agonist and ADRβ1/β3 antagonists for 1 month normalizes their glucose metabolism. Growth, glucose-stimulated insulin secretion (GSIS) and glucose utilization rates (GURs) were measured in control lambs, IUGR lambs and IUGR lambs treated with adrenergic receptor modifiers: clenbuterol atenolol and SR59230A (IUGR-AR). In IUGR lambs, islet insulin content and GSIS were less than in controls; however, insulin sensitivity and whole-bodyGUR were not different from controls.Of importance, ADRβ2 stimulation with β1/β3 inhibition increases both insulin sensitivity and whole-body glucose utilization in IUGR lambs. In IUGR and IUGR-AR lambs, hindlimb GURs were greater but fractional glucose oxidation rates and ex vivo skeletal muscle glucose oxidation rates were lower than controls. Glucose transporter 4 (GLUT4) was lower in IUGR and IUGR-AR skeletal muscle than in controls but GLUT1 was greater in IUGR-AR. ADRβ2, insulin receptor, glycogen content and citrate synthase activity were similar among groups. In IUGR and IUGR-AR lambs heart rates were greater, which was independent of cardiac ADRβ1 activation. We conclude that targeted ADRβ2 stimulation improved whole-body insulin sensitivity but minimally affected defects in GSIS and skeletal muscle glucose oxidation. We show that risk factors for developing diabetes are independent of postnatal catch-up growth in IUGR lambs as early as 1 month of age and are inherent to the islets and myocytes

A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study.

AIMS Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management and outcome are sparse. METHODS AND RESULTS This international multicenter registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553,729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed at 214 centers in 35 countries. In 78 centers 138 patients (0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (p<0.0001)) were diagnosed with an oesophageal fistula. Periprocedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8%, and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) (odds ratio 7.463 (2.414, 23.072) p<0.001). CONCLUSIONS Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high

Teamwork and Management of Mistakes - a teaching approach in medical education

Background: Inadequate teamwork often causes medical errors. However, this subject is not integrated in undergraduate medical education in Germany yet. To foster a preventive error culture and to close this gap in our curriculum we piloted a new course concept for one cohort of students in the reformed medical track at Charité Universitätsmedizin Berlin in 2006. The main topic of this course within the compulsory communication skills training was "team communication and error management". Methods: Students studied different instruments for error prevention. Furthermore video material was used to analyse different aspects of error management such as team communication, fields of competency and management of fatal errors. The new concept was evaluated quantitatively and qualitatively by students and faculty. Results: Evaluation results show high acceptance of the new semester topic and the used teaching methods from both students and faculty. Conclusion: On basis of our evaluation results the course will be expanded and also integrated earlier within the curriculum.Zielsetzung: Unzureichende Teamarbeit ist eine häufige Ursache für Behandlungsfehler. Trotz der Relevanz dieses Themas für die Patientensicherheit gehört es in Deutschland noch nicht zur Pflichtlehre im Medizinstudium. Um diese Lücke im Curriculum zu schließen und schon im Studium eine präventive Fehlerkultur zu fördern, wurde für eine Studierendenkohorte im Reformstudiengang an der Charité Universitätsmedizin Berlin (N = 67) ein neues Lehrkonzept zum Thema "Teamarbeit und Fehlermanagement" entwickelt und im Sommersemester 2006 zum ersten Mal in der Pflichtveranstaltung Interaktion implementiert. Methodik: Die Studierenden lernten verschiedene Instrumente der Fehlerprävention kennen. Darüber hinaus wurden anhand von Filmsequenzen verschiedene Aspekte des Fehlerumgangs wie Team-Kommunikation, Einhalten und Übertreten von Kompetenzbereichen oder Umgang mit schwerwiegenden Fehlern diskutiert. Der Kurs wurde durch die Studierenden und die Lehrenden quantitativ sowie qualitativ evaluiert. Ergebnisse: Die Evaluationsergebnisse zeigen eine hohe Akzeptanz des neuen Semesterthemas und der didaktischen Umsetzung auf Seiten der Lehrenden und Studierenden. Schlussfolgerung: Auf dieser Basis soll der Kurs erweitert und im Sinne einer Lernspirale zusätzlich schon früher im Curriculum verankert werden

What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe

Objective To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. Design Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. Setting Twenty-five countries in the European Union and Norway. Population Women giving birth in participating countries in 2003 and 2004. Methods Application of a common collection of data by selecting specific International Classification of Disease codes from the 'Pregnancy, childbirth and the puerperium' chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. Main outcome measures Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. Results In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100 000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). Conclusions Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended. © 2012 RCOG