TY - JOUR A1 - Wiegering, Verena A1 - Andres, Oliver A1 - Schlegel, Paul G. A1 - Deinlein, Frank A1 - Eyrich, Matthias A1 - Sturm, Alexander T1 - Hyperfibrinolysis and acquired factor XIII deficiency in newly diagnosed pediatric malignancies JF - Haematologica N2 - No abstract available KW - factor XIII deficiency KW - leukemia KW - tumor KW - perioperative bleeding KW - coagulopathy KW - hyperfibrinolysis Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-130569 VL - 98 IS - 8 ER - TY - JOUR A1 - Hedrich, Christian M. A1 - Hofmann, Sigrun R. A1 - Pablik, Jessica A1 - Morbach, Henner A1 - Girschick, Hermann J. T1 - Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO) JF - Pediatric Rheumatology N2 - Sterile bone inflammation is the hallmark of autoinflammatory bone disorders, including chronic nonbacterial osteomyelitis (CNO) with its most severe form chronic recurrent multifocal osteomyelitis (CRMO). Autoinflammatory osteopathies are the result of a dysregulated innate immune system, resulting in immune cell infiltration of the bone and subsequent osteoclast differentiation and activation. Interestingly, autoinflammatory bone disorders are associated with inflammation of the skin and/or the intestine. In several monogenic autoinflammatory bone disorders mutations in disease-causing genes have been reported. However, regardless of recent developments, the molecular pathogenesis of CNO/CRMO remains unclear. Here, we discuss the clinical presentation and molecular pathophysiology of human autoinflammatory osteopathies and animal models with special focus on CNO/CRMO. Treatment options in monogenic autoinflammatory bone disorders and CRMO will be illustrated. KW - TNF-α KW - PAPA KW - DIRA KW - Majeed KW - CNO KW - CRMO KW - bone KW - inflammation KW - IL-10 KW - treatment KW - TLR4 Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-132456 VL - 11 IS - 47 ER - TY - JOUR A1 - Hedrich, Christian M. A1 - Hofmann, Sigrun R. A1 - Pablik, Jessica A1 - Morbach, Henner A1 - Girschick, Hermann J. T1 - Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO) JF - Pediatric Rheumatology N2 - Sterile bone inflammation is the hallmark of autoinflammatory bone disorders, including chronic nonbacterial osteomyelitis (CNO) with its most severe form chronic recurrent multifocal osteomyelitis (CRMO). Autoinflammatory osteopathies are the result of a dysregulated innate immune system, resulting in immune cell infiltration of the bone and subsequent osteoclast differentiation and activation. Interestingly, autoinflammatory bone disorders are associated with inflammation of the skin and/or the intestine. In several monogenic autoinflammatory bone disorders mutations in disease-causing genes have been reported. However, regardless of recent developments, the molecular pathogenesis of CNO/CRMO remains unclear. Here, we discuss the clinical presentation and molecular pathophysiology of human autoinflammatory osteopathies and animal models with special focus on CNO/CRMO. Treatment options in monogenic autoinflammatory bone disorders and CRMO will be illustrated. KW - bisphosphonate treatment KW - IL-10 expression KW - TNF-α KW - IL-10 KW - inflammation KW - bone KW - CRMO KW - CNO KW - DIRA KW - PAPA KW - Majeed-Syndrome KW - disease KW - deficiency KW - pediatric patients KW - treatment KW - TLR4 KW - PAPA syndrome KW - hypertrophic osteodystrophy KW - chronic nonbacterial osteomyelitis KW - congenital dyserythropoietic anemia Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125694 SN - 1546-0096 VL - 11 IS - 47 ER - TY - THES A1 - Seelbach, Nina T1 - Effekte eines 10-monatigen Bewegungsprogramms im Kindergarten auf kardiovaskuläre Risikofaktoren T1 - Effects of a 10 month physical activity intervention in preschool children on cardiovascular risk factors N2 - Übergewicht und Hypertonie sind die führenden Risikofaktoren für kardiovaskuläre Erkrankungen wie Herzinfarkt und Schlaganfall und erhöhen damit deutlich die Morbidität und Mortalität im Erwachsenenalter. Der Anstieg der Adipositasprävalenz in den letzten Jahrzehnten nicht nur im Erwachsenen- sondern insbesondere auch im Kindesalter erfordert die Entwicklung geeigneter Präventionsmaßnahmen. Vor diesem Hintergrund wurden in dieser Arbeit die Effekte eines 10-monatigen Bewegungsprogramms auf den systolischen und diastolischen Blutdruck sowie den BMI, die Trizepshautfaltendicke und die Summe der Dicken von vier Hautfalten (Trizeps-, Bizeps-, Subskapular- und Suprailiakalhautfalte) von vier- bis fünfjährigen Kindergartenkindern in Unterfranken untersucht. Die Daten wurden im Rahmen der Studie „PAKT“ („Prevention Through Activity in Kindergarten Trial“), einer cluster-randomisierten kontrollierten Studie, erhoben. Insgesamt wurden 709 Kinder (340 Kontroll- und 369 Interventionskinder) untersucht. Kinder der Interventionsgruppe nahmen unter Anleitung speziell geschulter ErzieherInnen fünf Mal pro Woche an einer 30-minütigen Bewegungseinheit teil und erhielten zusätzlich Bewegungshausaufgaben. Zudem fanden Elternabende unter anderem zu Themen wie „Gesunde Ernährung“ und “Bedeutung von Sport für die Entwicklung des Kindes“ statt. Kinder der Kontrollkindergärten behielten ihre gewohnten Aktivitäten, bestehend aus einer 30- bis 45-minütigen Sporteinheit pro Woche, bei. Die Ergebnisse zeigten, dass in der Interventionsgruppe eine signifikant stärkere Abnahme in der Trizepshautfalte gegenüber der Kontrollgruppe erreicht werden konnte. In der geschlechtsspezifischen Analyse war dieser Effekt nur bei den Jungen signifikant. Der erreichte Effekt war allerdings schon zwei bis vier Monate nach Beendigung der Intervention nicht mehr nachweisbar. In einer explorativen Subgruppenanalyse konnte nachgewiesen werden, dass insbesondere auch bereits von Übergewicht betroffene Kinder durch die Intervention profitierten. Trotz der geringen Stichprobengröße zeigte sich bei Kindern der Interventionsgruppe eine signifikant geringere Zunahme in der Trizepshautfalte gegenüber Kindern der Kontrollgruppe. Auf BMI und Blutdruck hatte die Intervention keinen signifikanten Einfluss. Die Ergebnisse der Arbeit zeigen, dass das im Rahmen der Studie PAKT entwickelte Bewegungsprogramm im Kindergarten bezüglich der Prävention von Übergewicht erfolgversprechend ist und auch die Körperfettmasse bereits übergewichtiger Kinder positiv beeinflusst. N2 - Adiposity and arterial hypertension are major risk factors of cadiovascular diseases. The increasing prevalence of adipositiy in the last decades not only in adults but also in children makes it necessary to develop preventive mesurements. On this background the effects of a 10 month physical activity intervention on systolic and diastolic blood pressure, triceps skinfold and skinfold thickness of four skinfolds (trizeps, bizeps, suprailiacal, subscapular) and BMI of preschool children have been evaluated. Data was drawn from the „Prevention Through Activity in Kindergarten Trial“ (PAKT), a cluster-randomised controlled trial which included 709 children (340 control group, 369 intervention group). Children of the intervention group received a daily physical education lesson of at least 30 minutes duration taught by the kindergarten teachers. Aditionally they got activity homework. The parents were invited to educational evenings and periodically received written information about topics like „healthy nutrition“ or „importance of physical activity for the childs development“. Children of the control group kept their normal physical activity of 30 to 45 minutes per week. Results showed that children of the intervention group had a greater decrease in trizepsskinfold than children of the control group. Wheras separated analysis of boys and girls did only show a significant effect in the trizepsskinfold in boys. This effect, however, was already lost two to four month after the end of the intervention period. There were no significant effects in BMI and blood pressure. A subgroup analysis showed also a significant intervention effect in the trizepsskinfold of overweight children. The results suggest that the evaluated physical activity program would be effective for the prevention of overweight. Beside that, it shows a beneficial influence on body fat in already overweight children. KW - Körperliche Aktivität KW - kardiovaskuläres Risiko KW - Bewegungsprogramm KW - Kindergarten KW - Übergewicht KW - Blutdruck Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-106381 ER - TY - JOUR A1 - Eyrich, Matthias A1 - Rachor, Johannes A1 - Schreiber, Susanne C. A1 - Wölfl, Matthias A1 - Schlegel, Paul G. T1 - Dendritic cell vaccination in pediatric gliomas: lessons learnt and future perspectives JF - Frontiers in Pediatrics N2 - Immunotherapy of malignant gliomas with autologous dendritic cells (DCs) in addition to surgery and radiochemotherapy has been a focus of intense research during the past decade. Since both children and adults are affected by this highly aggressive brain tumor, 10–15% of the several hundred vaccinated patients represent children, making pediatric glioma patients the largest uniform pediatric vaccination cohort so far. In general, DC vaccination in malignant gliomas has been shown to be safe and several studies with a non-vaccinated control group could clearly demonstrate a survival benefit for the vaccinated patients. Interestingly, children and adolescents below 21 years of age seem to benefit even more than adult patients. This review summarizes the findings of the 25 clinical trials published so far and gives a perspective how DC vaccination could be implemented as part of multimodal therapeutic strategies in the near future. KW - pediatrics KW - malignant glioma KW - DC vaccination KW - clinical trial KW - immunotherapy Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96937 ER - TY - JOUR A1 - Bäuerlein, Carina A. A1 - Riedel, Simone S. A1 - Baker, Jeanette A1 - Brede, Christian A1 - Jordán Garrote, Ana-Laura A1 - Chopra, Martin A1 - Ritz, Miriam A1 - Beilhack, Georg F. A1 - Schulz, Stephan A1 - Zeiser, Robert A1 - Schlegel, Paul G. A1 - Einsele, Hermann A1 - Negrin, Robert S. A1 - Beilhack, Andreas T1 - A diagnostic window for the treatment of acute graft-versus-host disease prior to visible clinical symptoms in a murine model JF - BMC Medicine N2 - Background Acute graft-versus-host disease (aGVHD) poses a major limitation for broader therapeutic application of allogeneic hematopoietic cell transplantation (allo-HCT). Early diagnosis of aGVHD remains difficult and is based on clinical symptoms and histopathological evaluation of tissue biopsies. Thus, current aGVHD diagnosis is limited to patients with established disease manifestation. Therefore, for improved disease prevention it is important to develop predictive assays to identify patients at risk of developing aGVHD. Here we address whether insights into the timing of the aGVHD initiation and effector phases could allow for the detection of migrating alloreactive T cells before clinical aGVHD onset to permit for efficient therapeutic intervention. Methods Murine major histocompatibility complex (MHC) mismatched and minor histocompatibility antigen (miHAg) mismatched allo-HCT models were employed to assess the spatiotemporal distribution of donor T cells with flow cytometry and in vivo bioluminescence imaging (BLI). Daily flow cytometry analysis of peripheral blood mononuclear cells allowed us to identify migrating alloreactive T cells based on homing receptor expression profiles. Results We identified a time period of 2 weeks of massive alloreactive donor T cell migration in the blood after miHAg mismatch allo-HCT before clinical aGVHD symptoms appeared. Alloreactive T cells upregulated α4β7 integrin and P-selectin ligand during this migration phase. Consequently, targeted preemptive treatment with rapamycin, starting at the earliest detection time of alloreactive donor T cells in the peripheral blood, prevented lethal aGVHD. Conclusions Based on this data we propose a critical time frame prior to the onset of aGVHD symptoms to identify alloreactive T cells in the peripheral blood for timely and effective therapeutic intervention. KW - Allogeneic stem cell transplantation KW - Graft-versus-host disease KW - Minor histocompatibility antigen mismatch transplantation Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96797 UR - http://www.biomedcentral.com/1741-7015/11/134 ER - TY - JOUR A1 - Prelog, Martina T1 - Vaccination in Patients with Rheumatoid Arthritis Receiving Immunotherapies JF - Clinical & Cellular Immunology N2 - Patients with rheumatoid arthritis (RA) are at higher risk to suffer from morbidity due to vaccine-preventable diseases and, thus, display an important target population to receive vaccines for protection from infectious complications. There have been only a few studies focusing on the administration of vaccines in RA patients with immunotherapy. Overall, antibody response rates against influenza or pneumococcal disease appeared to be only slightly lower than expected in healthy individuals. Crucial problems in the interpretation of data from studies in RA patients vaccinated against influenza and pneumococcal disease are the impaired comparability of studies due to different study designs and type of vaccines used, different health states among RA patients, heterogeneity in treatments including concomitant therapy with conventional DMARDs and glucocorticoids in addition to biological agents. Assessment of vaccination status should be performed in the initial work-up of patients with RA and should ideally be administered before initiation of immunotherapies or during stable disease. Due to differences in antibody responses and uncertainty regarding maintenance of protective antibodies, routine controls for antibody titers and specific strategies for earlier re-vaccination might be scheduled for patients with RA. KW - Immunotherapy KW - Anti-TNF-alpha agents KW - Rituximab KW - Tocilizumab KW - Abatacept KW - Pneumococcal vaccination KW - Influenza vaccination Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96446 ER - TY - JOUR A1 - Prelog, Martina A1 - Almanzar, Giovanni A1 - Eberle, Gernot A1 - Lassacher, Andrea A1 - Specht, Christian A1 - Koppelstaetter, Christian A1 - Heinz-Erian, Peter A1 - Trawöger, Rudolf A1 - Bernhard, David T1 - Maternal cigarette smoking and its effect on neonatal lymphocyte subpopulations and replication JF - BMC Pediatrics N2 - Background Significant immunomodulatory effects have been described as result of cigarette smoking in adults and pregnant women. However, the effect of cigarette smoking during pregnancy on the lymphocyte subpopulations in newborns has been discussed, controversially. Methods In a prospective birth cohort, we analyzed the peripheral lymphocyte subpopulations of smoking (SM) and non-smoking mothers (NSM) and their newborns and the replicative history of neonatal, mostly naive CD4 + CD45RA + T cells by measurements of T-cell-receptor-excision-circles (TRECs), relative telomere lengths (RTL) and the serum cytokine concentrations. Results SM had higher lymphocyte counts than NSM. Comparing SM and NSM and SM newborns with NSM newborns, no significant differences in proportions of lymphocyte subpopulations were seen. Regardless of their smoking habits, mothers had significantly lower naive T cells and higher memory and effector T cells than newborns. NSM had significantly lower percentages of CD4 + CD25++ T cells compared to their newborns, which was not significant in SM. There were no differences regarding cytokine concentrations in newborns of SM and NSM. However, NSM had significantly higher Interleukin-7 concentrations than their newborns. Regardless of smoking habits of mothers, newborns had significantly longer telomeres and higher TRECs than their mothers. Newborns of SM had significantly longer telomeres than newborns of NSM. Conclusions Apart from higher lymphocyte counts in SM, our results did not reveal differences between lymphocyte subpopulations of SM and NSM and their newborns, respectively. Our finding of significantly longer RTL in newborns of SM may reflect potential harm on lymphocytes, such as cytogenetic damage induced by smoking. KW - Cigarette smoking KW - Lymphocytes KW - T cell receptor excision circles KW - Telomeres Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96435 UR - http://www.biomedcentral.com/1471-2431/13/57 ER - TY - JOUR A1 - Prelog, Martina A1 - Schönlaub, Jörn A1 - Würzner, Reinhard A1 - Koppelstaetter, Christian A1 - Almanzar, Giovanni A1 - Brunner, Andrea A1 - Gasser, Martin A1 - Prommegger, Rupert A1 - Häusler, Gabriele A1 - Kapelari, Klaus A1 - Högler, Wolfgang T1 - Lower CD28+ T cell proportions were associated with CMV-seropositivity in patients with Hashimoto’s thyroiditis JF - BMC Endocrine Disorders N2 - Background Alterations in the naive T cell subpopulations have been demonstrated in patients with T cell mediated autoimmune disorders, reminiscent of immunological changes found in the elderly during immunosenescence, including the switch from CD45RA + to CD45RO + T cells and decreased thymic function with increased compensatory proliferative mechanisms, partly associated with latent Cytomegalovirus (CMV) infection. The present study was aimed to investigate proportions of lymphocytes, their relation to CMV-seropositivity and the replicative history of CD45RA + expressing T cells in Hashimoto’s thyroiditis (HT, n = 18) and healthy controls (HC, n = 70). Methods Proportions of peripheral T cells were investigated by flow cytometry. The replicative history was assessed by T cell receptor excision circles (TRECs) and relative telomere length (RTL). Expression of CD62L was analyzed by immunohistochemistry in thyroid sections. The role of CMV was assessed by serology, ELISPOT assay and in situ hybridization. Results Our results demonstrated a significant increase of CD28-negative T cells, associated with CMV-seropositivity in HT patients. HT showed abundant CD45RO + T cells with peripheral loss of CD62L-expressing CD8 + CD45RA + T cells, the latter mainly depending on disease duration. CD62L was expressed in thyroid lymphocyte infiltrations. The diagnosis of HT and within the HT group CMV-seropositivity were the main determinants for the loss of CD28 expression. RTL was not different between HC and HT. HT showed significantly lower TRECs in CD4 + CD45RA + T cells compared to HC. Conclusions Patients with HT display a peripheral T cell phenotype reminiscent of findings in elderly persons or other autoimmune disorders. Whether these mechanisms are primary or secondary to the immunological alterations of autoimmune conditions should be investigated in longitudinal studies which may open research on new therapeutic regimes for treatment of HT and associated autoimmune diseases. KW - Immunosenescence KW - CD62L KW - Regulatory T cells KW - TREC KW - Telomere Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96352 UR - http://www.biomedcentral.com/1472-6823/13/34 ER - TY - JOUR A1 - Almanzar, Giovanni A1 - Zlamy, Manuela A1 - Koppelstaetter, Christian A1 - Brunner, Andrea A1 - Jeller, Verena A1 - Duftner, Christina A1 - Dejaco, Christian A1 - Brunner, Juergen A1 - Prelog, Martina T1 - Increased replication of CD4+ naive T cells and changes in T cell homeostasis in a case of acute exacerbation of juvenile idiopathic arthritis: a case comparison study JF - Journal of Medical Case Reports N2 - Introduction Juvenile idiopathic arthritis is a heterogeneous T cell-mediated autoimmune disease with symptoms of premature aging of the immune system (immunosenescence). The present work is an investigation of immunosenescence parameters, such as quantity of naive and CD28- T cells, T cell receptor excision circles, relative telomere length and alterations of peripheral T cell replication, and was performed via comparison of a case of acute exacerbation of juvenile idiopathic arthritis against six patients with juvenile idiopathic arthritis with disease remission and six age-matched healthy donors over a follow-up course of 12 months. Case presentation Phenotypical T cell characterization and intracellular interferon γ, tumor necrosis factor α, and interleukin 2 production were studied in peripheral blood mononuclear cells from seven patients with juvenile idiopathic arthritis and six healthy control donors, with findings determined by flow cytometry. T cell receptor excision circles and relative telomere length quantification were performed on deoxyribonucleic acid isolated from naive (CD4+CD28+CD45RA+) T cells and investigated via reverse transcription polymerase chain reaction. Ki67 expression was studied by immunohistochemistry on naive T cells. The non-parametric Mann-Whitney U test and Wilcoxon test for two independent groups of variables were used to compare healthy donors with patients with juvenile idiopathic arthritis. During follow-up, patients with juvenile idiopathic arthritis showed lower total counts of naive and CD28-expressing T cells compared to healthy donors. Acute exacerbation led to low naive and CD28+ T cell populations and elevated proportions of Ki67-expressing CD4+ naive T cells. In conditions of exacerbation, T cell receptor excision circle numbers were in the lower range in patients with juvenile idiopathic arthritis and increased after follow-up. Healthy donors showed significantly higher relative telomere lengths compared to patients with juvenile idiopathic arthritis. Conclusions This investigation illustrates that the changes in T cell homeostasis in patients with juvenile idiopathic arthritis may be the result of several mechanisms, such as diminished thymus function and peripheral exertions to maintain the peripheral T cell pool. The results also demonstrate that hallmarks of immunosenescence such as decreased naive T cell levels and lower T cell receptor excision circle numbers can only be interpreted together with replication markers such as relative telomere length or Ki67 expression. KW - Exacerbation KW - Juvenile idiopathic arthritis KW - Naive T cells KW - T cell receptor excision circles Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96325 UR - http://www.jmedicalcasereports.com/content/7/1/135 ER - TY - JOUR A1 - Streng, Andrea A1 - Grote, Veit A1 - Carr, David A1 - Hagemann, Christine A1 - Liese, Johannes G. T1 - Varicella routine vaccination and the effects on varicella epidemiology – results from the Bavarian Varicella Surveillance Project (BaVariPro), 2006-2011 JF - BMC Infectious Diseases N2 - Background In 2004, routine varicella vaccination was recommended in Germany for children 11-14 months of age with one dose, and since 2009, with a second dose at 15-23 months of age. The effects on varicella epidemiology were investigated. Methods Data on varicella vaccinations, cases and complications were collected from annual parent surveys (2006-2011), monthly paediatric practice surveillance (Oct 2006 - Sep 2011; five varicella seasons) and paediatric hospital databases (2005-2009) in the area of Munich (about 238,000 paediatric inhabitants); annual incidences of cases and hospitalisations were estimated. Results Varicella vaccination coverage (1st dose) in children 18-36 months of age increased in two steps (38%, 51%, 53%, 53%, 66% and 68%); second-dose coverage reached 59% in the 2011 survey. A monthly mean of 82 (62%) practices participated; they applied a total of 50,059 first-dose and 40,541 second-dose varicella vaccinations, with preferential use of combined MMR-varicella vaccine after recommendation of two doses, and reported a total of 16,054 varicella cases <17 years of age. The mean number of cases decreased by 67% in two steps, from 6.6 (95%CI 6.1-7.0) per 1,000 patient contacts in season 2006/07 to 4.2 (95%CI 3.9-4.6) in 2007/08 and 4.0 (95%CI 3.6-4.3) in 2008/09, and further to 2.3 (95%CI 2.0-2.6) in 2009/10 and 2.2 (95%CI 1.9-2.5) in 2010/11. The decrease occurred in all paediatric age groups, indicating herd protection effects. Incidence of varicella was estimated as 78/1,000 children <17 years of age in 2006/07, and 19/1,000 in 2010/11. Vaccinated cases increased from 0.3 (95%0.2-0.3) per 1,000 patient contacts in 2006/07 to 0.4 (95%CI 0.3-0.5) until 2008/09 and decreased to 0.2 (95%CI 0.2-0.3) until 2010/11. The practices treated a total of 134 complicated cases, mainly with skin complications. The paediatric hospitals recorded a total of 178 varicella patients, including 40 (22.5%) with neurological complications and one (0.6%) fatality due to varicella pneumonia. Incidence of hospitalisations decreased from 7.6 per 100,000 children <17 years of age in 2005 to 4.3 in 2009, and from 21.0 to 4.7 in children <5 years of age. Conclusions Overall, the results show increasing acceptance and a strong impact of the varicella vaccination program, even with still suboptimal vaccination coverage. KW - Varicella KW - Surveillance KW - Coverage KW - Vaccination KW - Hospitalisation KW - Paediatric KW - Incidence Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96297 UR - http://www.biomedcentral.com/1471-2334/13/303 ER - TY - JOUR A1 - Kranke, Peter A1 - Girard, Thierry A1 - Lavand’homme, Patricia A1 - Melber, Andrea A1 - Jokinen, Johanna A1 - Muellenbach, Ralf M. A1 - Wirbelauer, Johannes A1 - Hönig, Arnd T1 - Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural” JF - BMC Pregnancy and Childbirth N2 - Background The epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units. Since the end of the 90ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don’t want, can’t have or don’t need epidural analgesia. Discussion In view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions. However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a “poor man’s epidural” and to safely administer remifentanil with an appropriate indication. Summary Therefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia. KW - Remifentanil KW - Epidural Analgesia KW - Labour Pain KW - Labour Analgesia KW - Patient Controlled Analgesia KW - Patient Satisfaction KW - Healthcare Cost KW - Healthcare Economics Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96262 UR - http://www.biomedcentral.com/1471-2393/13/139 ER - TY - JOUR A1 - Prelog, Martina A1 - Zlamy, Manuela A1 - Kofler, Sabine A1 - Orth, Dorothea A1 - Würzner, Reinhard A1 - Heinz-Erian, Peter A1 - Streng, Andrea T1 - The impact of Rotavirus mass vaccination on hospitalization rates, nosocomial Rotavirus gastroenteritis and secondary blood stream infections JF - BMC Infectious Diseases N2 - Background The aim of the study was to evaluate the effects of universal mass vaccination (UMV) against rotavirus (RV) on the hospitalization rates, nosocomial RV infections and RV-gastroenteritis (GE)-associated secondary blood stream infections (BSI). Methods The retrospective evaluation (2002–2009) by chart analysis included all clinically diagnosed and microbiologically confirmed RV-GE cases in a large tertiary care hospital in Austria. The pre-vaccination period (2002–2005) was compared with the recommended and early funded (2006–2007) and the funded (2008–2009) vaccination periods. Primary outcomes were RV-GE-associated hospitalizations, secondary outcomes nosocomial RV disease, secondary BSI and direct hospitalization costs for children and their accompanying persons. Results In 1,532 children with RV-GE, a significant reduction by 73.9% of hospitalized RV-GE cases per year could be observed between the pre-vaccination and the funded vaccination period, which was most pronounced in the age groups 0–11 months (by 87.8%), 6–10 years (by 84.2%) and 11–18 years (88.9%). In the funded vaccination period, a reduction by 71.9% of nosocomial RV-GE cases per year was found compared to the pre-vaccination period. Fatalities due to nosocomial RV-GE were only observed in the pre-vaccination period (3 cases). Direct costs of hospitalized, community-acquired RV-GE cases per year were reduced by 72.7% in the funded vaccination period. The reduction of direct costs for patients (by 86.9%) and accompanying persons (86.2%) was most pronounced in the age group 0–11 months. Conclusions UMV may have contributed to the significant decrease of RV-GE-associated hospitalizations, to a reduction in nosocomial RV infections and RV-associated morbidity due to secondary BSI and reduced direct hospitalization costs. The reduction in nosocomial cases is an important aspect considering severe disease courses in hospitalized patients with co-morbidities and death due to nosocomial RV-GE. KW - Rotavirus KW - Gastroenteritis KW - Blood stream infection KW - Children KW - Universal mass vaccination Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96147 UR - http://www.biomedcentral.com/1471-2334/13/112 ER - TY - THES A1 - Ruf, Katharina T1 - Effekt maximaler Belastung auf zirkulierende endotheliale und mesenchymale Progenitorzellen bei Patienten mit Mukoviszidose und gesunden Probanden T1 - Effects of maximal exertion on circulation endothelial and mesenchymal progenitor cells in patients with cystic fibrosis and healthy controls N2 - Mukoviszidose als häufigste der seltenen Erkrankungen ist trotz intensiver For-schung und Behandlungsmöglichkeiten nach wie vor mit einer deutlich verkürzten Lebenserwartung assoziiert. In den letzten Jahren hat sich gezeigt, dass körperliche Aktivität einen wichtigen Beitrag nicht nur zur Lebensqualität von Mukoviszidosepatienten leisten kann, sondern auch einen Einfluss auf den Krankheitsverlauf als solches hat. Die genauen Mechanismen des positiven Effekts von Sport auf den Krankheitsverlauf sind jedoch noch nicht hinreichend geklärt. Neben vielen anderen Mechanismen wie verbesserter Sekretelimination aus den Atemwegen, Training des Herz-Kreislaufsystems und Regulierung der überaktiven epithelialen Natriumkanäle wird zunehmend auch ein Anstoßen von Reparaturmechanismen durch Sport diskutiert. Dabei scheinen CD34+-Progenitorzellen und MSCs eine Rolle spielen zu können. In der hier vorliegenden Arbeit wurde untersucht, inwiefern eine maximale Aus-dauerbelastung die Anzahl zirkulierender CD34+-Progenitorzellen und mesen-chymaler Progenitorzellen im peripheren Blut verändert, was sekundär mit Repa-raturvorgängen im Lungengewebe assoziiert sein könnte. Hierfür wurde bei 7 Patienten mit Mukoviszidose sowie 9 gesunden Probanden eine Spiroergometrie bis zur subjektiven Erschöpfung und vor sowie zehn Minuten nach Beendigung der Aktivität eine Blutentnahme durchgeführt. Neben einer Analyse des Blutbildes inklusive Differenzierung und Bestimmung von Entzündungsparametern erfolgte mittels Durchflusszytometrie die Quantifizierung von CD34+ und mesenchymalen Progenitorzellen. Es zeigte sich ein signifikanter Anstieg der CD34+ Progenitorzellen in beiden Studiengruppen nach Belastung, während die mesenchymalen Stammzellen keine signifikante Änderung der Anzahl zeigten. Der Anstieg der CD34+-Progenitorzellen nach körperlicher Belastung ist in der Literatur mehrfach beschrieben und wird als eine Erklärung für die Prävention von Herz-Kreislauferkrankungen durch Sport genannt. Auch bei akuten wie chronischen Lungenerkrankungen scheinen hämatopoetische und endotheliale Progenitorzellen eine Rolle bei Reparaturvorgängen zu spielen. Die Rolle der mesenchymalen Stammzellen ist dagegen noch nicht hinreichend geklärt. Insgesamt erschwert die Heterogenität der Gruppe der mesenchymalen Stammzellen eine genaue Quantifizierung, ihr geringes Vorkommen im peripheren Blut stellt eine weitere Schwierigkeit bei der Charakterisierung und Quantifizierung dar. Nachdem zumindest der Nachweis von ansteigenden endothelialen Progenitorzellen auch bei Patienten mit Mukoviszidose gelingt, sollte in weiteren Studien die Rolle der mesenchymalen Stammzellen weiter untersucht werden. Insbesondere die Charakterisierung der Zellen in der Zellkultur sowie eine Untersuchung von Zytokinen, die für ein Homing von mesenchymalen Stammzellen verantwortlich sein könnten, scheint wesentlich, um den Mechanismus der Reparaturvorgänge besser zu verstehen und so mög-licherweise die Therapie der Mukoviszidose zu erweitern. N2 - Cystic fibrosis is associated with a reduced life expectancy despite many therapeutic efforts. Lately, it has been show that patients with cystic fibrosis benefit from regular exercise with regard to a higher quality of life, slowed decline in lung function and better physial fitness. The mechanism of these benefits is not fully understood yet. One possible mechanism could be an increased number of circulating progenitor cells as surrogate markers for repair mechanisms. ln this study patients with cystic fibrosis and healtyh controls underwent an incremental exercise test and blood samples were drawn before and after the exercise with regard tot he number of CD34+ and mesenchymal progenitor cells. ln both groups an signficant increase in CD34+ progenitor cells could be shown with no differente between the groups whereas no change was observed wlth regard to the mesenchymal progenitor cells. Endothelial progenitor cells seem to play a role for repair mechansims in lung disease as has been shown in patients with COPD and pneumonia. The role oft he mesenchymal progenitor cells remains unclear, especially as it is very difficult to define the exact lung specific cell in the heterogenaus group of mesenchymal progenitor cellls. Further research is needed to clarify these issues and hopefully add futher information for the treatment of cystic fibrosis. KW - Mukoviszidose KW - Stammzelle KW - Sport KW - Spiroergometrie KW - cystic fibrosis KW - exercise KW - stem cell KW - spiroergometry Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-90189 ER - TY - THES A1 - Then, Simon David T1 - Effekte einer Neugestaltung des Außengeländes im Kindergarten auf die körperliche Aktivität und die motorischen Fähigkeiten von Kindergartenkindern T1 - The effects of a preschool playground intervention on physical activity and motor skills N2 - Wenig ist bekannt über die gesundheitsrelevanten Effekte von Spielraumgestaltungen im Kindergarten. Deshalb sollten in dieser Studie die Auswirkungen der Neugestaltung des Außengeländes eines Kindergartens untersucht werden. Dazu wurde eine historisch-kontrollierte Studie konzipiert, an der 66 Kinder des Interventionskindergarten St. Jakobus in Versbach / Würzburg teilnahmen. Die Daten von 336 Kindern aus 20 Kontrollkindergärten der PAKT-Studie standen als Kontrollen zur Verfügung. Die Intervention bestand in der vollständigen Neugestaltung des Außen¬geländes des Kindergartens und der Aufstellung eines großen Klettergerätes (Playmobil-Aktivschiff). Die Messungen erfolgten 3 Monate vor und 5-7 Wochen nach der Eröffnung des neuen Außengeländes. Gemessen wurde der zeitliche Anteil an „moderate-and-vigorous physical activity“ (MVPA) mittels Bewegungsmonitoren (GT1M) an 7 Tagen, sowie folgende motorische Tests: Einbeinstand (EIN), Seitliches Hin- und Herspringen (SHH) und Standweitsprung (SW) aus dem Karlsruher Motorik-Screening, Balancieren rückwärts (RB) und Zielwurf auf eine Scheibe aus dem Motoriktest für 4-6 Jährige und das dynamische Balancieren rückwärts (DBR) aus dem Körperkoordinationstest für Kinder. Der DBR wurde nur im Interventionskindergarten durchgeführt. Aus den Z-Werten der Ergebnisse im EIN, SHH, SW wurde ein Motorikgesamtscore als Maß der allgemeinen körperlichen Leistungsfähigkeit gebildet. Größe, Gewicht, Hautfaltendicke an vier Körperstellen (über dem Bizeps und dem Trizeps, sowie subskapulär und suprailiakal) und der Blutdruck wurde gemessen (Dinamap 8100, Critikon). Aus Daten des Deutschen Wetterdienstes wurde die mittlere Tagestemperatur am Tag der zweiten Untersuchung bestimmt und bei den Analysen des Blutdrucks berücksichtigt. In zwei Fragebögen wurden Informationen zu familiären, gesundheitlichen und sozioökonomischen Gegebenheiten ermittelt sowie sportliche Aktivitäten in der Freizeit abgefragt. Die Änderungen im MVPA-Anteil an Vormittagen von Werktagen und die Änderungen im Motorikgesamtscore der motorischen Leistungsfähigkeit wurden als primäre Ergebnisvariablen definiert. Für die statistischen Berechnungen wurde PASW Statistics 18 genutzt. Um Gruppenunterschiede zu T1 zu analysieren wurde die Varianzanalyse (ANOVA) verwendet. Für die Längsschnitt¬unter-suchung bei intervallskalierten Variablen wurde die univariate Varianzanalyse genutzt (allgemeines lineares Modell) und Alter, sowie Geschlecht als feste Faktoren, das Ergebnis der Eingangsuntersuchung als Kovariate ins Modell eingeschlossen. Zur Eingangsuntersuchung bestanden folgende signifikante Unterschiede zwischen der Kontroll- und Interventionsgruppe: die Interventionsgruppe waren am Vormittag von Werktagen weniger körperlich aktiv und schnitten schlechter im SHH ab. Im Längsschnitt zeigten sich für die Interventionsgruppe gegenüber der Kontrollgruppe signifikante Verbesserungen in den beiden primären Ergebnisvariablen MVPA-Anteil am Vormittag von Werktagen (p=0,002), sowie im Motorikgesamtscore der motorischen Leistungsfähigkeit (p=0,012). Weitere positive Ergebnisse ergaben sichfür den systolischen Blutdruck (p=0,037 unter Einschluss der mittleren Tagestemperatur als Kovariate). Hingegen stiegen Gewicht (p=0,009), BMI-Perzentile (p= 0,003) und Trizeps-Hautfaltendicke (p<0,001) im Vergleich zur Kontrollgruppe an. Die attraktive Neugestaltung des Außengeländes eines Kindergartens zeigte sich also erfolgreich, das Bewegungsverhalten und die motorischen Fähigkeiten der Kinder zu fördern. Es konnte auch nachgewiesen werden, dass die mittlere Außentemperatur einen hoch signifikanten Einfluss auf den systolischen Blutdruck hat, weshalb dies in entsprechenden zukünftigen Studien berücksichtigt werden sollte. Trotz Intervention ergab sich im Beobachtungszeitraum eine Zunahme von Gewicht, BMI und subkutanem Fettgewebe. Als Ursache dafür kommen die kurze Beobachtungszeit, sowie die Einschränkungen während der Umbauphase des Außengeländes in Frage. Zukünftige Studien sollten unbedingt auch langfristige Messungen des Gewichts, BMIs und subkutanen Fettgewebes beinhalten, um hier weiter Klarheit zu schaffen. Nach den Ergebnissen dieser Studie stellt die Neugestaltung des Außengeländes in Kindergärten eine effektive Möglichkeit zur Förderung der Gesundheit von Kindern dar. N2 - Background: Low level of physical activity in preschool children, decrease in motor skills und increase in overweight. Aim: study the effects of a preschool playground intervention on physical activity and motor skills Methods: historic control trial, complete renewing of the outdoor playarea and new activity-friendly designed fixed play equipment ("pirate ship"). Tests before and 5-7 weeks after renewing of the playarea. Accelerometry during 7 days, six motor tests, weight, height, BMI, skinfold thickness at 4 locations, blood pressure and pulse. Results: data of 66 children of the intervention group, and 336 children of the "PAKT" control group. Intervention showed significant increase in physical activity and motorskill-score, but aswell significant increse in BMI und skinfold thickness. Systolic blood pressure decreased and the outside temperature showed a significant influence on blood pressure changes. Conclusion: Playground intervention increased physical activity and motor skills after 5-7 weeks. The long time of closure of the playarea, due to the construction work, could explain an increase in BMI and skinfold thickness. Longterm effects on BMI needs further investigation. Studies on blood pressure changes should take the outside temperature into account. KW - Kind KW - Bewegung KW - Motorik KW - Kindergarten KW - Spielfläche KW - Prävention KW - Übergewicht KW - Körperliche Aktivität KW - Blutdruck KW - Puls KW - Anthropometrie KW - Adipositas KW - physical activity KW - motoric skills KW - prevention KW - child KW - preschool Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-83432 ER - TY - THES A1 - Sporrer, Tobias T1 - Die Entwicklung des Verhaltens bei der Nahrungsaufnahme, der Pflege und dem Spielen bei Kindern im 2. und 3. Lebensjahr in Tageseinrichtungen T1 - The development of behaviour during food-intake, care and play of children aged 13-36 months in day-care centers N2 - Die vorliegende Arbeit beschäftigt sich mit einem Teil des Dokumentationsbogens der kindlichen Entwicklung, der im Lóczy-Institut in Budapest unter der Leitung der Kinderärztin Emmi Pikler erarbeitet wurde. Mit ihm können außerhäuslich betreute Kinder in ihrer Entwicklung beobachtet und diese dokumentiert werden. Das Ziel ist, differenzierte Aussagen zur Entwicklung der betreuten Kinder machen zu können. Die Normierung des Bogens erfolgte erstmals in den 1960er Jahren in Ungarn. Wir führen in dieser Arbeit im Rahmen einer Pilotstudie eine Re-Evaluierung der Ergebnisse und eine Bewertung des Bogens an in Kindertagesstätten betreuten Kindern im 2. und 3. Lebensjahr durch. Hierfür wurden Betreuungseinrichtungen für Kinder unter 3 Jahren per Email und Post angeschrieben sowie unter www.entwicklungsdokumentation.de eine Homepage zur Kontaktaufnahme eingerichtet. Letztlich konnte die Entwicklung von 100 Kindern im Alter von 12-36 Monaten aus 10 Einrichtungen beobachtet und dokumentiert werden. Es wurden aus den Bereichen des Verhaltens während der Nahrungsaufnahme, der Pflege und dem Spielen insgesamt 40 Items beobachtet.
 Die Ergebnisse wurden regelmäßig von den Erzieherinnen in den Einrichtungen in einen einfach auszufüllenden Bogen eingetragen. Die Arbeit hat den Charakter einer Pilotstudie und stellt keine Entwicklung eines Normalkollektives dar, hierfür ist die Anzahl der beobachteten Kinder zu gering und die Verteilung nach sozialer Herkunft nicht repräsentativ. N2 - We present developmental data of 40 items regarding behaviour during food-intake, care and play of 100 children aged 13-36 months in 10 German day-care centres. The study is based on the principles of Emmi Pikler, who founded the Lóczy orphanage in Budapest/Hungary. Starting in the 1960s, the development of several thousand children was documented there with the help of a questionnaire. The now modified questionnaire is easy to fill and evaluate, a continuous documentation is possible. It can be used in day-care centres and families to document the infants’ development and to focus the child care workers’ or parents’ view on autonomous activities, active interactions and self-confidence. Caused by the small number of children and their social background this study does not represent the development of a norm group. KW - Kindertagesstätte KW - Entwicklungsdokumentationsbogen KW - Pikler KW - Entwicklung im 2. und 3. Lebensjahr KW - day-care KW - Pikler KW - questionnaire KW - development of children aged 13-36 months Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-83749 ER -