Die Chronifizierung von Rückenschmerzen

Ohne Zusammenfassung Thomas Kohlmann Institut für Community Health, Ernst-Moritz-Arndt-Universit?t Greifswald, Walter-Rathenau-Stra?e 48, 17487 Greifswald, E-Mail:Thomas.Kohlmann@uni-greifswald.de     

Psychometric properties of the EQ-5D-5L: a systematic review of the literature

Quality of Life Research - Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This...     

Genomic gains and losses influence expression levels of genes located within the affected regions: a study on acute myeloid leukemias with trisomy 8, 11, or 13, monosomy 7, or deletion 5q.

We performed microarray analyses in AML with trisomies 8 (n=12), 11 (n=7), 13 (n=7), monosomy 7 (n=9), and deletion 5q (n=7) as sole changes to investigate whether genomic gains and losses translate into altered expression levels of genes located in the affected chromosomal regions. Controls were 104 AML with normal karyotype. In subgroups with trisomy, the median expression of genes located on gained chromosomes was higher, while in AML with monosomy 7 and deletion 5q the median expression of genes located in deleted regions was lower. The 50 most differentially expressed genes, as compared to all other subtypes, were equally distributed over the genome in AML subgroups with trisomies. In contrast, 30 and 86% of the most differentially expressed genes characteristic for AML with 5q deletion and monosomy 7 are located on chromosomes 5 or 7. In conclusion, gain of whole chromosomes leads to overexpression of genes located on the respective chromosomes. Losses of larger regions of the genome translate into lower expression of the majority of genes represented by only one allele. The reduced expression of these genes is the most characteristic difference in gene expression profiles between AML with monosomy 7 and AML with deletion 5q, respectively, and other AML subtypes. Therefore, these data provide evidence that gene dosage effects gene expression in AML with unbalanced karyotype abnormalities. Losses of specific regions of the genome determine the gene expression profile more strongly than the gain of whole chromosomes.     

Effects of sibutramine on abdominal fat mass, insulin resistance and blood pressure in obese hypertensive patients

OBJECTIVE: The objective of this study is to assess the effects of sibutramine on body weight, body fat distribution, insulin resistance, plasma leptin, lipid profile and blood pressure profiles in hypertensive obese patients. METHODS: Eighty-six central obese hypertensive patients (BMI = 39 +/- 5 kg/m(2), 84% of women, 48 +/- 8.5 years old) were placed on a hypocaloric diet and placebo therapy for 4 weeks. They were then randomized to receive sibutramine (10 mg) or placebo for 24 weeks. Both, before therapy and at the end of the study, the waist and hip circumferences were measured and the waist/hip ratio (WHR) was calculated; abdominal ultrasonography was performed in order to estimate the amount of subcutaneous fat (SF) and visceral fat (VF), and the visceral/subcutaneous ratio. Beyond HOMA-r, another insulin resistance index (IRIp) was calculated by means of the formula: peak of blood glucose after oral glucose load x plasma insulin level/10(4). Fasting plasma leptin and lipid levels were also determined. RESULTS: Sibutramine induced greater weight reduction than placebo (6.7 vs. 2.5%, p < 0.001). Reductions in WHR (0.97 +/- 0.08 vs. 0.94 +/- 0.07, p < 0.01), IRIp (0.11 +/- 0.07 vs. 0.09 +/- 0.06 mmol mu/l(2)) and VF (6.4 +/- 2.4-6.0 +/- 2.4 cm, p < 0.01) were observed only with sibutramine. Plasma leptin decreased with placebo (24 +/- 15 vs. 18 +/- 10 UI/l, p < 0.01), but not with sibutramine (18.8 +/- 8.4 vs. 18.2 +/- 13.2 UI/l). No clinically significant change in lipid profile was observed in both groups. Moreover, office and 24-h blood pressure values did not change during placebo or sibutramine therapy, whereas a significant increase in office heart rate, from 78.3 +/- 7.3-82 +/- 7.9 b.p.m., p = 0.02, was observed with sibutramine. CONCLUSIONS: Sibutramine therapy induced greater body weight loss than placebo in hypertensive obese patients. This was associated with WHR reduction, decreases in VF and insulin resistance. The maintenance of leptin levels during sibutramine therapy may be important to avoid weight recovery, although this finding must be confirmed by other prospective studies.     

Perineal wound management after abdominoperineal rectal excision for carcinoma with unsatisfactory hemostasis or gross septic contamination: Primary closure vs. packing

PURPOSE: This study was designed to compare the results of two methods on the rate of postoperative perineum healing. PATIENTS AND METHODS: In this prospective, randomized, multicenter trial of 234 consecutive patients undergoing abdominoperineal rectal excision for carcinoma, 48 had unsatisfactory hemostasis or intraoperative gross septic contamination. Three patients were withdrawn because of protocol violation. Of the 45 remaining patients, 21 were randomized to undergo primary closure of the perineum with drainage while 24 underwent packing. Preoperative factors (sex, age, degree of obesity, weight loss, anemia, or presence of ascites), intraoperative findings (Dukes stage, degree of hemostasis, gross septic contamination), and postoperative oncologic courses (recurrence, mortality rate) were similar in both groups. All patients were followed for at least 12 months or until their demise. RESULTS: There was no significant difference in the number of early (one vs. zero) or late (five vs. four) deaths between primary closure and packing groups, respectively. Median duration of hospital stay was 25 and 27 days, respectively. Primary closure was associated with a significantly higher rate of healed perineums at one month (30 percent vs. 0 percent) (P = 0.01) and a shorter delay to complete cicatrization (median, 47 vs. 69 days) (P < 0.01). From three months onward, there was no difference in healing between the two groups, but two patients in the packing group had not healed at one year. Conversely, hematoma, perineal abscess, and reoperations were significantly more frequent (P < 0.01) in the primary closure group. CONCLUSION: Primary closure associated with drainage after abdominoperineal resection for carcinoma expedites perineal healing but morbidity is higher.     

Thyroid disorders in employees of a nuclear power plant.

Background: The thyroid gland is a potential target organ for radiation-related damage. The aim of this analysis was to investigate the association between occupational exposure to ionizing radiation and the risk of autoimmune thyroid disease as well as thyroid nodules and dysfunction in workers of a former nuclear power station. Methods: Seventy-one male power station workers 38 to 57 years of gae who had been exposed to a lifetime dose in the upper allowed range (accumulated lifetime dose 70 to 400 mSv) were compared to a population- based sample of 670 males who were not exposed to occupational radiation. Thyroid ultrasound was performed by the same observers. Laboratory parameters were analyzed in a central laboratory. Results: After controlling analyses for age and further relevant confounders no significant differences with respect to thyroid nodules and markers of autoimmune thyroid disease were detected between exposed and nonexposed individuals. However, nuclear power plant employees had higher odds for elevated serum thyrotropin (TSH) levels than the reference group (odds ratio 4.54; 95% confidence interval 1.43; 13.91). Conclusions: Workers of a nuclear power plant with occupational exposure to ionizing radiation within the upper allowed dose range have an increased risk of elevated serum TSH levels. Further studies are required to confirm possible effects of occupational exposure to radiation on thyroid function.     

Qualitätssicherung im ambulanten D-Arzt-Verfahren

Trauma und Berufskrankheit - Nach einem Arbeitsunfall erfolgt die ambulante medizinische Versorgung von Patienten durch spezialisierte Durchgangsärzte. Bisher existiert für diesen Sektor...     

Feasibility Study of a Sensor-Based Autonomous Load Control Exercise Training System for COPD Patients

Decision support systems (DSSs) which are able to automatically supervise and control physical exercise training of patients affected by chronic obstructive pulmonary disease (COPD) are regarded as a novel method to promote rehabilitation. The objective of our research work for this paper was to evaluate the feasibility of a rule-based DSS for autonomous bicycle ergometer training of COPD patients. Load control is based on real-time analysis of sensor parameters oxygen saturation and heart rate. Ten COPD patients have participated in a study, performing altogether 18 training sessions. On average, 7.4 rules were fired in each training session. Four sessions had to be stopped for different reasons. The average ergometer training load ranged between 31 and 47 W. The average percentage of heart rate in or lower than the intended target zone was 45.9 and 41.6 %, respectively. The average patient-perceived Borg value was 12.6?±?2.4. Patients reported a high satisfaction for the automatically controlled training. With the help of the DSS, patients may change their training place from a rehabilitation center to their own homes. More studies are needed to assess long-term clinical and motivational effects of the DSS in home environment.     

The quality of life questionnaire EQ-5D-5L: psychometric properties and normative values for the general German population

Purpose

The health state classifier EQ-5D of the EuroQoL group has been expanded to a 5-level instrument (EQ-5D-5L), but studies on psychometric properties of this new instrument, applied to the general population, are rare.

Methods

A sample of 2,469 subjects, representatively selected from the German general population, was asked to fill in the EQ-5D-5L and several other questionnaires. Crude sum scores of the EQ-5D-5L were calculated and compared with scores derived from two sets of utilities, one from a German and one from a UK sample.

Results

The mean sum score (0–100 scale) was 91.5. Males reported better health states than females, and there was a nearly linear age trend. The list of the 45 most frequent health patterns (those with at least 0.2 % of the respondents) showed that almost half of the participants (47.5 %) responded being in the optimal health state, indicating a ceiling effect. Correlations between EQ-5D-5L scores and other questionnaires were very similar for all three scoring systems of the EQ-5D-5L. Finally, normative scores are given on the basis of sum scores.

Conclusions

The applicability of the EQ-5D-5L in the general population is limited because of the skewness. Sum scores are useful because of their simplicity, international generalizability, and construct validity.