Marienhaus Klinikum Hetzelstift Neustadt

Between 1/15,000–1/50,000 passengers suffer in-flight medical emergencies (IFME) with cardiac arrest accounting for 0.3 %. Confined space can have a negative impact on quality of chest compressions during cardiopulmonary resuscitation (CPR), thus we have conducted a randomized controlled study to find the most effective approach of performing CPR in a one – vs. two-rescuer method in a simulated airliner cabin. We randomized 20 healthcare professionals to perform a set of 10 min Basic Life Support (BLS, chest compressions and bag-mask-ventilation) in a one- vs. two-rescuer scenario and in confined space vs. open space in a randomized order using a full-body manikin. The primary outcome was compression depth as sensitive marker for differences in CPR-quality. The study was registered on clinicaltrials.gov (NCT02002481). Mixed ANOVAs with post-hoc false-discovery-rate adjusted pairwise comparisons indicated that one- vs. two-rescuer method showed differences in no-flow-time (confined: 8.05 ± 0.17 vs. 24.25 ± 1.05 s/2min and open space: 7.51 ± 0.02 vs. 21.31 ± 0.43 s/2min; p < 0.001) and missing releases (confined: 27.09 ± 5.55 vs. 46.64 ± 9.66 number/10 minutes and open space: 27.09 ± 2.44 vs. 43.36 ± 6.4 number/10minutes; p < 0.001). A confined space significantly elevated no-flow-time in the two-rescuer-method vs. the one-rescuer-method (24.24 ± 1.06 s/2min vs. 21.26 ± 0.44 s/2min; p < 0.001), whereas compression frequency and compression depth were different but still within the current recommendations of ERC/AHA in both methods per condition. Limited space in an airliner cabin has significant impact on no-flow-time in a two-rescuer-method. In case of CPR and limited access to the patient, we recommend a one-rescuer-method as first approach to ensure early and high-quality CPR for experienced personnel.

The increasing use of neoadjuvant systemic therapy (NST) has led to substantial pathological complete response rates in patients with initially node-positive, early breast cancer, thereby questioning the need for axillary lymph node dissection (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce. To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND. The SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician's choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up. TAD alone vs TAD with ALND. Three-year clinical outcomes were evaluated. Of 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4% (95% CI, 71.5-89.4) in the TAD with ALND group and 91.2% (95% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4% (95% CI, 0-54.8) and 1.8% (95% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD alone was not associated with an increased risk of recurrence (hazard ratio [HR], 0.83; 95% CI, 0.34-2.05; P = .69) or death (HR, 1.07; 95% CI, 0.31-3.70; P = .91). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95% CI, 0.15-3.83; P = .74). These results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.

Liebe Leserinnen und Leser der Osteologie,Die Kenntnis seltener Knochenerkrankungen bringt osteologisch interessierten Kollegen und Kolleginnen Einsichten in die Mechanismen von Störungen des Knochenstoffwechsels und deren Behandlung. Nicht alle seltenen Knochenerkrankungen lassen sich allerdings rein konservativ und medikamentös behandeln, häufig sind operative Eingriffe und Korrekturen nötig und auch sinnvoll, um späteren Schäden vorzubeugen.