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Biomarker, ein inzwischen geradezu inflationär verwendeter Begriff! Während in den vergangenen Jahrzehnten die Bezeichnung „Marker“ vor allem mit Tumorerkrankungen und deren klinisch-chemischer Diagnostik verbunden war, hat die „-omics“-Welle der letzten Dekade eine Unmenge an neuen „Markern“ für alles und jedes in die medizinische Literatur gespült. Insbesondere der unkritische Umgang mit jenen Markern und die Unerfahrenheit derjenigen, die durch neue Techniken in vormals rein naturwissenschaftlichen Fachgebieten in die Lage versetzt wurden, diese neuen Marker zu messen, haben nicht nur zu einer großen Verunsicherung in bezug auf die Wertigkeit von Biomarkern an sich, sondern auch zu einer großen Enttäuschung in den wie Strohfeuer aufflammenden „-omics“-Disziplinen geführt. Kaum einer der oft hervorragend publizierten Biomarker hat den Weg in die Klinik gefunden, hochzitierten Wissenschaftlern konnten elementarste Fehler in (Prä-)analytik und Interpretation nachgewiesen werden und selbst die bisher als anerkannt angesehenen „klassischen“ Tumormarker sind vielfach in Misskredit geraten. Zu Unrecht! Denn mit alten wie neuen Markern hat die Labormedizin hervorragende Werkzeuge in der Hand, die, richtig angewandt, nicht nur das Potential haben, die Labordiagnostik zu revolutionieren, sondern auch das Gesicht des Faches verändern werden, weg von einer in vitro quantifizierenden Hilfsdisziplin hin zu einer integrativen und interpretativen Wissenschaft.
Background
Primary hyperventilation is defined as a state of alveolar ventilation in excess of metabolic requirements, leading to decreased arterial partial pressure of carbon dioxide. The primary aim of this study was to characterise patients diagnosed with primary hyperventilation in the ED.
Methods
Our retrospective cohort study comprised adult (≥16 years) patients admitted to our ED between 1 January 2006 and 31 December 2012 with the primary diagnosis of primary (=psychogenic) hyperventilation.
Results
A total of 616 patients were eligible for study. Participants were predominantely female (341 [55.4%] female versus 275 [44.6%] male respectively, p <0.01). The mean age was 36.5 years (SD 15.52, range 16-85). Patients in their twenties were the most common age group (181, 29.4%), followed by patients in their thirties (121, 19.6%). Most patients presented at out-of-office hours (331 [53.7%]. The most common symptom was fear (586, 95.1%), followed by paraesthesia (379, 61.5%) and dizziness (306, 49.7%). Almost a third (187, 30.4%) of our patients had previously experienced an episode of hyperventilation and half (311, 50.5%) of patients had a psychiatric co-morbidity.
Conclusion
Hyperventilation is a diagnostic chimera with a wide spectrum of symptoms. Patients predominantly are of young age, female sex and often have psychiatric comorbidities. The severity of symptoms accompanied with primary hyperventilation most often needs further work-up to rule out other diagnosis in a mostly young population. In the future, further prospective multicentre studies are needed to evaluate and establish clear diagnostic criteria for primary hyperventilation and possible screening instruments.
Background
Calcium disorders are common in both intensive care units and in patients with chronic kidney disease and are associated with increased morbidity and mortality. It is unknown whether calcium abnormalities in unselected emergency department admissions have an impact on in-hospital mortality.
Methods
This cross-sectional analysis included all admissions to the Emergency Department at the Inselspital Bern, Switzerland from 2010 to 2011. For hyper- and hypocalcaemic patients with a Mann-Whitney U-test, the differences between subgroups divided by age, length of hospital stay, creatinine, sodium, chloride, phosphate, potassium and magnesium were compared. Associations between calcium disorders and 28-day in-hospital mortality were assessed using the Cox proportional hazard regression model.
Results
8,270 patients with calcium measurements were included in our study. Overall 264 (3.2%) patients died. 150 patients (6.13%) with hypocalcaemia and 7 patients with hypercalcaemia (6.19%) died, in contrast to 104 normocalcaemic patients (1.82%). In univariate analysis, calcium serum levels were associated with sex, mortality and pre-existing diuretic therapy (all p<0.05). In multivariate Cox regression analysis, hypocalcaemia and hypercalcaemia were independent risk factors for mortality (HR 2.00 and HR 1.88, respectively; both p<0.01).
Conclusion
Both hypocalcaemia and hypercalcaemia are associated with increased 28-day in-hospital mortality in unselected emergency department admissions.
Background
Phosphate imbalances or disorders have a high risk of morbidity and mortality in patients with chronic kidney disease. It is unknown if this finding extends to mortality in patients presenting at an emergency room with or without normal kidney function.
Methods and Patients
This cross sectional analysis included all emergency room patients between 2010 and 2011 at the Inselspital Bern, Switzerland. A multivariable cox regression model was applied to assess the association between phosphate levels and in-hospital mortality up to 28 days.
Results
22,239 subjects were screened for the study. Plasma phosphate concentrations were measured in 2,390 patients on hospital admission and were included in the analysis. 3.5% of the 480 patients with hypophosphatemia and 10.7% of the 215 patients with hyperphosphatemia died. In univariate analysis, phosphate levels were associated with mortality, age, diuretic therapy and kidney function (all p<0.001). In a multivariate Cox regression model, hyperphosphatemia (OR 3.29, p<0.001) was a strong independent risk factor for mortality. Hypophosphatemia was not associated with mortality (p>0.05).
Conclusion
Hyperphosphatemia is associated with 28-day in-hospital mortality in an unselected cohort of patients presenting in an emergency room.
This paper reviews the challenges and prospects of woodland archaeology across Europe and proposes a European network to
safeguard archaeological heritage in woodlands. Woodlands and forests cover important parts of the European landmass but are often uncharted territory on the archaeological map since traditional methods of archaeological survey do not work well here. Many forests have grown on formerly open lands used for farming or settlement, and some forests have been used for charcoal burning and wood pasture. As a consequence they contain important archaeological remains that are often well preserved but little known and protected. Recent developments in the field of remote sensing have opened up new avenues for important archaeological research in woodlands. However, the legal and administrative framework to protect archaeological sites is of equal importance. While the economical, recreational, and ecological dimensions of forests are commonly known and accepted, their archaeological dimension are rarely recognized.
Vegetation history, landscape development, and archaeology of the Lower Engadine, Switzerland
(2015)
This article outlines advances in thematic progression theory in the hope they may be useful to teachers of writing, especially with non-native and non-European students. Thematic progression denotes the strategies available to writers for linking the themes and rhemes in a clause to those of surrounding clauses. It is a key factor in the structuring of information because it acts as a bridge between sentence level and discourse level, coordinating cohesion and coherence. This paper compares the use of thematic progression in essays by students on a course leading to MA studies in journalism, media and communications with that in two leading British newspapers. It considers how assignment writing could be improved generally by teaching the rudiments of progression theory. If students' assignments are to be clear in their development but also varied and interesting for the reader, additional progression skills are required. In particular, this paper recommends certain variations on Daneš' progression types, as well as the use of more breaks (non-participant themes) to mark rhetorical transitions in the text. Familiarisation with the thematic progression in tabloids and broadsheets, respectively, should provide an overview of a range of progression from formal to outspoken, which would raise awareness of what is available, even if not all elements are appropriate for all types of academic writing.
Anxiety disorder patients were repeatedly found to overestimate the association between disorder-relevant stimuli and aversive outcomes despite random contingencies. Such an illusory correlation (IC) might play an important role in the return of fear after extinction learning; yet, little is known about how this cognitive bias emerges in the brain. In a functional magnetic resonance imaging study, 18 female patients with spider phobia and 18 healthy controls were exposed to pictures of spiders, mushrooms and puppies followed randomly by either a painful electrical shock or nothing. In advance, both patients and healthy controls expected more shocks after spider pictures. Importantly, only patients with spider phobia continued to overestimate this association after the experiment. The strength of this IC was predicted by increased outcome aversiveness ratings and primary sensory motor cortex activity in response to the shock after spider pictures. Moreover, increased activation of the left dorsolateral prefrontal cortex (dlPFC) to spider pictures predicted the IC. These results support the theory that phobia-relevant stimuli amplify unpleasantness and sensory motor representations of aversive stimuli, which in turn may promote their overestimation. Hyper-activity in dlPFC possibly reflects a pre-occupation of executive resources with phobia-relevant stimuli, thus complicating the accurate monitoring of objective contingencies and the unlearning of fear.
