[Bone marrow edema syndrome from the perspective of appraisers and insurance clerks]. / Knochenmarködemsyndrom aus Sicht von Gutachter und Sachbearbeiter.

Various diseases or groups of diseases can trigger bone marrow edema (BME). The task of the appraiser is to work out the role of a diagnosed BME in the context of the causality based on liability; however, the inconsistent ICD 10 coding of the BME complex also poses a problem, especially for medically untrained insurance clerks. The coding of the BME as a fracture provided by the coding guidelines poses a problem when assessing reserves for damage settlement. Based on the etiology of BME an algorithm is presented that should make it easier for the expert as well as for the insurance clerk in the case of liability and also for the private accident insurance to classify the diagnosis of BME in the case.

Community-based native seed production for restoration in Brazil - the role of science and policy.

Large-scale restoration programmes in the tropics require large volumes of high quality, genetically diverse and locally adapted seeds from a large number of species. However, scarcity of native seeds is a critical restriction to achieve restoration targets. In this paper, we analyse three successful community-based networks that supply native seeds and seedlings for Brazilian Amazon and Cerrado restoration projects. In addition, we propose directions to promote local participation, legal, technical and commercialisation issues for up-scaling the market of native seeds for restoration with high quality and social justice. We argue that effective community-based restoration arrangements should follow some principles: (i) seed production must be based on real market demand; (ii) non-governmental and governmental organisations have a key role in supporting local organisation, legal requirements and selling processes; (iii) local ecological knowledge and labour should be valued, enabling local communities to promote large-scale seed production; (iv) applied research can help develop appropriate techniques and solve technical issues. The case studies from Brazil and principles presented here can be useful for the up-scaling restoration ecology efforts in many other parts of the world and especially in tropical countries where improving rural community income is a strategy for biodiversity conservation and restoration.

The association of the involvement of financial compensation with the outcome of cervicobrachial pain that is treated conservatively.

OBJECTIVES: To examine the influence of the involvement of financial compensation on the results of physiotherapeutic McKenzie treatment on cervicobrachial pain. METHODS: A prospective study was carried out with a cohort of 60 patients referred to two spine clinics after they had experienced at least 5 weeks of neck pain radiating to the arm. Follow-up was performed 1 yr later using a validated questionnaire to measure the outcomes of neck and arm pain, disability, the use of analgesics and the perceived effect of the treatment as reported by the patient. RESULTS: At follow-up, there was no improvement in the group of patients for whom financial compensation was involved, whereas the group for whom compensation was involved showed highly significant improvement. CONCLUSIONS: Despite uniform selection criteria and similarity of complaints and treatment protocols, the involvement of financial compensation seemed to be associated with an adverse effect on treatment results for patients with cervicobrachial pain who were treated conservatively.

[Significance of unresolved financial compensation for the course of cervical root compression]. / Betydningen af uafklaret økonomisk kompensation for forløbet af nerverodstryk i nakken.

The aim of this study was to examine the influence of claims for financial compensation on the results of physiotherapeutic McKenzie treatment for cervical nerve root compression. This study was based on prospectively collected data for quality assurance purpose with baseline classification and included a follow-up postal questionnaire to measure the outcomes: Neck and arm pain, disability, use of analgesics and the perceived effect of the treatment registered by the patient. At baseline, patients with or without compensation issues were identical in regard to their neurological and clinical signs. The study showed that 6-12 months later there was no improvement in six out of seven patients with claims for compensation involvement, in contrast to the 21 patients without claims for financial compensation who all showed significant improvement. The results applied to all five outcome measures. In conclusion, compensation involvement seems to act as a negative factor on treatment results for patients with cervical nerve root compression who were treated conservatively.

Leptin increases energy expenditure of a marsupial by inhibition of daily torpor.

Leptin plays an important role in regulating body fat stores of placental mammals, but the contribution of changes in energy expenditure to this adjustment remains controversial. We were interested in how recombinant murine leptin would affect metabolic rate (MR) and body temperature (Tb) of a marsupial mammal (Sminthopsis macroura, 25 g) known to display daily torpor but lacking thermogenetically active brown adipose tissue. In a group of eight animals deprived of food for 1 day at 18 degreesC, leptin treatment halved the duration of torpor bouts (time at Tb < 30 degreesC) and raised the average daily minimum Tb by 4.5 degreesC and minimum MR by 2.2-fold. Leptin treatment thus increased daily energy expenditure by 9%, although MR and Tb during the activity phase were not raised. Body mass was also not affected. These findings in a marsupial suggest that the adjustment of thermoregulatory energy expenditure during the rest phase in accordance with energy availability is a phylogenetically old function of leptin.

Leptin selectively increases energy expenditure of food-restricted lean mice.

OBJECTIVE: To find out whether leptin can attenuate hypometabolic torpor-like states of metabolic rate (MR) in adult lean animals, as it attenuates the morning suppression of thermoregulatory thermogenesis in suckling-age rat pups. DESIGN: Leptin effects on MR and food intake were studied in mice aged 4-7 months, in which a high incidence of exaggerated circadian reductions of MR had been induced by chronic food-restriction and, for comparison, in free-feeding mice. PROTOCOL: Continuous recordings of MR, for a group of seven mice maintained at an ambient temperature of 24 degrees C, while they were repeatedly-with pauses of at least six days-treated for three consecutive days with either recombinant murine leptin (20, 200 or 600 pmol x g(-1) x d[-1]) or saline. RESULTS: Leptin treatment caused dose-dependent 5-15% increases in energy expenditure by moderating the decreases in MR during the circadian minima, without affecting either the MR during the circadian maxima or food intake. Similar treatment of free-feeding mice caused dose-dependent decreases of food intake without changing MR. CONCLUSION: Leptin controls thermoregulatory energy expenditure when food supplies are scarce and changes food intake, rather than energy expenditure, when food is abundant.

Leptin reduces juvenile fat stores by altering the circadian cycle of energy expenditure.

The recently identified hormone leptin (ob protein) secreted by white adipose tissue is widely thought to provide a feedback signal limiting fat storage by decreasing food intake. By artificially rearing leptin-treated and control littermates fed identical amounts of milk, however, we show here that lean suckling-age rats treated with recombinant murine leptin can reduce fat storage solely by increasing energy expenditure. Continuous measurements of core temperature and metabolic rate show that this increase is not uniform throughout the day but is especially prominent in the morning when rat pups usually conserve energy by entering a torpor-like state. Leptin's alleviation of hypometabolic, torpor-like states is thus not restricted to cases of impaired hormone production but seems instead to be a normal biological function independent of its effects on food intake.