Westliche und TCM-diagnostische Kriterien der Menopause bei deutschen und chinesischen Frauen: Eine transkulturelle multizentrische Vergleichsstudie

Background

The following study follows a comparative cross-cultural multicenter trial design concerning menopausal conditions in patients from Germany and China.

Methods

Each of the 35 patients suffering from menopausal symptoms recruited out of the Institute of Complementary and Traditional Chinese Medicine, Knappschafts-Kranhenhaus, Kliniken Essen-Mitte, Germany, and from the Shugang Hospital in Shanghai, China, were examined using the Kupperman-index and a standardised TCM-questionnaire. In addition Estrogen and Testosterone parameters were collected from each patient. Means were compared using Students t-test, frequency distributions were compared using Pearson Chi-Square.

Results

The mean value of cumulative symptoms as recorded with the Kupperman-Index showed no significant difference between German and Chinese women. However, the examination of single items revealed statistically significant differences between the two groups examined. The Kupperman-Index focuses on psychological parameters in contrast to the TCM-questionnaire. On the other hand, the TCM-questionnaire examines single items and often diagnosed a “Kidney-Yin-Deficiency” (74.3 %) in Chinese women, whereas German women more often showed a “Kidney-Yang-Deficiency” (51.4 %). The Chinese exhibited significant higher levels of Testosterone, levels of Estrogen were not significantly different.

Conclusions

A combination of Western Kupperman-index and TCM-questionnaire promises a more symptom-orientated classification of menopausal women in subgroups with corresponding integrative therapeutic options. A possible classification of hormone levels with respect to ethnical or TCM-subgroups might be examined in subsequent studies by the means of larger study groups and more equally distributed group patterns.     

Erythrocyte defense mechanisms against free oxygen radicals in haemodialysed uraemic children

Changes in erythrocyte lipid peroxidation (measured as the concentration of malonyl dialdehyde), glutathione metabolism, antioxidant enzyme activities (glutathione peroxidase, catalase, and superoxide dismutase), the oxidized products of haemoglobin (Hb), and hydrogen peroxide (H₂O₂)-induced haemolysis were studied in six children with chronic renal failure treated with serial acetate and bicarbonate haemodialysis (HD). Ten age- and sex-matched children acted as controls. Malonyl dialdehyde levels were significantly higher and antioxidant enzyme activities lower in uraemic red blood cells (RBCs) compared with controls (P<0.05). Incubation of RBCs for 1 h with acetylphenylhydrazine induced a decrease in the concentration of reduced glutathione (P<0.001) and an increase in the level of oxidized products of Hb (P<0.001), but only in the uraemic patients. The H₂O₂ haemolysis test revealed a mild (n=3) to increased (n=3) haemolysis in the uraemic RBCs. Oxidative haemolysis is probably a multifactorial process in uraemic patients, and may be an important risk factor in HD therapy.     

Herbal Medicine in Children With Respiratory Tract Infection: Systematic Review and Meta-Analysis

Background

Herbal medicines are particularly regarded as an alternative or complement to conventional pharmaceuticals in the treatment and prevention of respiratory tract infections (RTIs). Therefore, the purpose of this review was to identify evidence for herbal therapy in the treatment of RTIs concerning effectiveness and safety.

Sodium transport and bone mineral density in hypercalciuria with thiazide treatment

Erythrocyte sodium-potassium (Na⁺/K⁺) -ATPase and sodium-lithium (Na⁺/Li⁺) countertransport activities were measured in 18 children (aged 9.6 years, range 6–16 years) with idiopathic hypercalciuria (IHU) to evaluate cellular Na handling. The effect of chronic thiazide administration on these parameters and on bone mineral density was also evaluated. Patients with IHU had significantly lower erythrocyte Na⁺/K⁺-ATPase activity than 23 age-matched healthy controls (mean±SEM 2,156±110 μmol P/l erythrocyte per hour vs. 3,165±175, P<0.01). Thiazide treatment significantly lowered urinary calcium excretion; this was followed by a slight suppression of intact parathyroid hormone (iPTH). The urinary calcium/creatinine ratio before and during treatment was 0.90±0.07 mmol/mmol versus 0.51±0.06 respectively, P<0.01. The corresponding iPTH levels were 5.9±0.6 pmol/l and 5.1±0.7, P<0.05. The Na ⁺ /K ⁺ -ATPase activity increased significantly (2,769±169 μmol P/l erythrocyte per hour vs. 2,156±110 in the control period, P<0.01) and the Na ⁺ /Li ⁺ countertransport decreased (268±28 μmol Li/l erythrocyte per hour vs. 328 ⁺ 26 in the control period, P<0.03). The bone mineral density Z score rose from –1.3±0.26 to –0.8±0.22 (P<0.03). We conclude that IHU is accompanied by abnormalities of erythrocyte Na ⁺ /K ⁺ -ATPase and Na ⁺ /Li ⁺ countertransport which are corrected by chronic hydrochlorothiazide administration. These changes could model alterations in renal tubular transport mechanisms still to be elucidated. Chronic thiazide treatment also has a positive effect on bone mineral density. Received March 3, 1997; received in revised form and accepted July 7, 1997     

Membrane-Bound PenA β-Lactamase of Burkholderia pseudomallei

Burkholderia pseudomallei is the etiologic agent of melioidosis, a difficult-to-treat disease with diverse clinical manifestations. β-Lactam antibiotics such as ceftazidime are crucial to the success of melioidosis therapy. Ceftazidime-resistant clinical isolates have been described, and the most common mechanism is point mutations affecting expression or critical amino acid residues of the chromosomally encoded class A PenA β-lactamase. We previously showed that PenA was exported via the twin arginine translocase system and associated with the spheroplast fraction. We now show that PenA is a membrane-bound lipoprotein. The protein and accompanying β-lactamase activity are found in the membrane fraction and can be extracted with Triton X-114. Treatment with globomycin of B. pseudomallei cells expressing PenA results in accumulation of the prolipoprotein. Mass spectrometric analysis of extracted membrane proteins reveals a protein peak whose mass is consistent with a triacylated PenA protein. Mutation of a crucial lipobox cysteine at position 23 to a serine residue results in loss of β-lactamase activity and absence of detectable PenA_C23S protein. A concomitant isoleucine-to-alanine change at position 20 in the signal peptide processing site in the PenA_C23S mutant results in a nonlipidated protein (PenA_{I20A C23S}) that is processed by signal peptidase I and exhibits β-lactamase activity. The resistance profile of a B. pseudomallei strain expressing this protein is indistinguishable from the profile of the isogenic strain expressing wild-type PenA. The data show that PenA membrane association is not required for resistance and must serve another purpose.     

Non-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery

We present the case histories of two children having respiratory failure due to bilateral diaphragm paralysis after cardiac surgery. In both children non-invasive positive pressure ventilation alleviated respiratory distress, improved gas exchange, and prevented the need for endotracheal intubation. Following unilateral recovery of diaphragmatic function both children were successfully weaned from non-invasive positive pressure ventilation.     

Disturbed in vitro adrenergic modulation of cytokine production in inflammatory bowel diseases in remission

OBJECTIVE: Psychological stress has been implicated in the pathophysiology of both inflammatory and functional gastrointestinal (GI) diseases. The goal of this study was to address neuroendocrine modulation of cytokine production by peripheral blood cells in GI diseases. METHODS: We analyzed the in vitro effects of the beta-adrenergic agonist terbutaline and the glucocorticoid agonist dexamethasone on TNF-alpha and IL-10 production by LPS-stimulated monocytes in whole cell blood cultures in patients with inflammatory bowel diseases in remission (N=10), diarrhoea-predominant irritable bowel syndrome (IBS, N=12), patients with a recent gastroenteritis (post-infectious group, N=10), and healthy controls (N=15). RESULTS: In response to terbutaline, there was a significant increase in IL-10 production (concentration effect: p<0.05), which was diminished in IBD (group effect: p<0.01), comparable in IBS and controls, but enhanced in the post-infectious group (group x concentration effect: p<0.05). In contrast, terbutaline resulted in a concentration-dependent suppression of TNF-alpha production, which was comparable in all groups. Dexamethasone suppressed TNF-alpha production in a dose-dependent manner in all groups, but this effect was significantly more pronounced in post-infectious subjects (group effect: p<0.05). CONCLUSIONS: In IBD, disturbed adrenergic regulation of IL-10 could be part of the mechanism(s) underlying the modulation of disease activity by psychological stress. Diarrhoea-predominant IBS was not associated with altered adrenergic or glucocorticoid regulation of cytokine production by peripheral blood cells, whereas a recent history of gastroenteritis was associated with disturbed neuroendocrine modulation of cytokine production, which may play role in the pathophysiology of post-infectious IBS.     

Stress-related peripheral neuroendocrine-immune interactions in women with ulcerative colitis

OBJECTIVES: The mechanisms underlying the interaction of psychological stress with the disease course in inflammatory bowel diseases remain unclear. We analyzed the neuroendocrine and cellular immune responses to public speaking stress, and the in vitro adrenergic and glucocorticoid modulation of cytokine production by peripheral blood cells (PBCs) in women with ulcerative colitis (UC) compared to healthy female controls. METHODS: In 22 female UC patients with inactive disease or mild disease activity and 24 healthy females we analyzed the neuroendocrine and cellular immune responses to public speaking stress and the vitro beta-adrenergic and glucocorticoid regulation of IL-10 and TNF-alpha production by PBCs. RESULTS: Public speaking stress-induced neuroendocrine and sympatho-adrenal activation, as well as the redistribution of circulating leukocytes were comparable in UC and controls. Significant but comparable public speaking stress-induced increases in LPS-stimulated TNF-alpha and IL-10, as well as in CD2/CD28-stimulated IFN-gamma were observed in both groups. UC demonstrated significantly reduced baseline IFN-gamma production, as well as significantly lower basal cortisol and prolactin levels. The in vitro beta-adrenergic stimulation of PBCs revealed reduced IL-10 response in UC. CONCLUSIONS: Psychosocial stress-induced activation of the neuroendocrine and sympatho-adrenal systems remain unaltered in UC, suggesting that the mechanism(s) mediating effects of psychological stress on disease activity are likely operative downstream at the level of the intestine. However, UC patients show disturbances in basal endocrine and cytokine measures. Together with our in vitro evidence of disturbed adrenergic regulation of IL-10 production by stimulated PBCs in UC, these may indicate the existence of subtle disturbance of peripheral cellular neuroendocrine-immune interactions in UC.     

A Randomized Controlled Trial of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: Effects on Patient-Reported Outcomes

Lifestyle interventions can have a positive impact on quality of life and psychological parameters in patients with metabolic syndrome (MetS). In this randomized controlled trial, 145 participants with MetS (62.8% women; 59.7 ± 9.3 years) were randomized to (1) 5-day fasting followed by 10 weeks of lifestyle modification (F + LM; modified DASH diet, exercise, mindfulness; n = 73) or (2) 10 weeks of lifestyle modification only (LM; n = 72). Outcomes were assessed at weeks 0, 1, 12, and 24, and included quality of life (Short-Form 36 Health Survey Questionnaire, SF-36), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), stress (Cohen Perceived Stress Scale, CPSS), mood (Profile of Mood States, POMS), self-efficacy (General Self-Efficacy Scale, GSE), mindfulness (Mindfulness Attention Awareness Scale, MAAS), and self-compassion (Self-Compassion Scale, SCS). At week 1, POMS depression and fatigue scores were significantly lower in F + LM compared to LM. At week 12, most self-report outcomes improved in both groups—only POMS vigor was significantly higher in F + LM than in LM. Most of the beneficial effects within the groups persisted at week 24. Fasting can induce mood-modulating effects in the short term. LM induced several positive effects on quality of life and psychological parameters in patients with MetS.