High-dose oral colecalciferol loading in obesity: impact of body mass index and its utility prior to bariatric surgery to treat vitamin D deficiency.

Obesity is associated with lower vitamin D levels compared with normal weight subjects, and if levels are not replaced prior to bariatric surgery, this can increase fracture risk as bone density typically falls post-operatively. We analysed the effect of body mass index (BMI) on vitamin D levels in response to 300 000 IU of colecalciferol in patients with vitamin D deficiency (<30 nmol L-1 ). Patients were grouped according to their BMI as normal weight (20-24.9 kg m-2 ), overweight (25-29.9 kg m-2 ), obese class I (30-34.9 kg m-2 ) and obese class II and above (>35 kg m-2 ). The records were retrospectively analysed to investigate the effects of BMI on vitamin D (total 25-hydroxy vitamin D [25(OH)D]), serum Ca2+ and parathyroid hormone (PTH) levels at 6, 12, 26 and 52 weeks compared with baseline. Compared with normal weight subjects, overweight and obese patients achieved lower mean peak total 25(OH)D levels (6 weeks post-loading), which was most significant in the class II and above group (mean total 25(OH)D levels 96.5 ± 24.2 nmol L-1 and 72.42 ± 24.9 nmol L-1 , respectively; P = 0.003). By 26 weeks, total 25(OH)D levels fell in all groups; however, there was now a significant difference between the normal weight subjects and all other groups (mean total 25(OH)D levels 84.1 ± 23.7 nmol L-1 ; 58 ± 20 nmol L-1 , P = 0.0002; 62.65 ± 19.2 nmol L-1 , P = 0.005; 59.2 ± 21 nmol L-1 , P = 0.005, respectively). Far fewer patients in the overweight and obese groups maintained levels above the recommended level of 75 nmol L-1 52 weeks post-loading (93%; 20%, P = 0.0003; 23%, P = 0.01; and 14%, P = 0.001, respectively). Alternative regimes for the treatment of vitamin D deficiency are needed in overweight and obese patients, especially those in whom bariatric surgery is planned.

Turnover and release of P-, N-, Si-nutrients in the Mexicali Valley (Mexico): interactions between the lower Colorado River and adjacent ground- and surface water systems.

A study on dissolved nitrate, ammonium, phosphate and silicate concentrations was carried out in various water compartments (rivers, drains, channels, springs, wetland, groundwater, tidal floodplains and ocean water) in the Mexicali Valley and the Colorado River delta between 2012 and 2013, to assess modern potential nutrient sources into the marine system after river damming. While nitrate and silicate appear to have a significant input into the coastal ocean, phosphate is rapidly transformed into a particulate phase. Nitrate is, in general, rapidly bio-consumed in the surface waters rich in micro algae, but its excess (up to 2.02 mg L(-1) of N from NO3 in winter) in the Santa Clara Wetland represents a potential average annual source to the coast of 59.4×10(3)kg N-NO3. Despite such localized inputs, continuous regional groundwater flow does not appear to be a source of nitrate to the estuary and coastal ocean. Silicate is associated with groundwaters that are also geothermally influenced. A silicate receiving agricultural drain adjacent to the tidal floodplain had maximum silicate concentrations of 16.1 mg L(-1) Si-SiO2. Seepage of drain water and/or mixing with seawater during high spring tides represents a potential source of dissolved silicate and nitrate into the Gulf of California.

[Coping resources in a sample of chronic low back pain patients. Evaluation of the questionnaire for back pain]. / Fragebogen zu Bewältigungsressourcen bei Rückenschmerzen. Evaluierung an einer Stichprobe chronischer Kreuzschmerzpatienten.

BACKGROUND: The coping resources questionnaire for back pain (FBR) uses 12 items to measure the perceived helpfulness of different coping resources (CRs, social emotional support, practical help, knowledge, movement and relaxation, leisure and pleasure, spirituality and cognitive strategies). The aim of the study was to evaluate the instrument in a clinical patient sample assessed in a primary care setting. SAMPLE AND METHODS: The study was a secondary evaluation of empirical data from a large cohort study in general practices. The 58 participating primary care practices recruited patients who reported chronic back pain in the consultation. Besides the FBR and a pain sketch, the patients completed scales measuring depression, anxiety, resilience, sociodemographic factors and pain characteristics. To allow computing of retested parameters the FBR was sent to some of the original participants again after 6 months (90% response rate). We calculated consistency and retest reliability coefficients as well as correlations between the FBR subscales and depression, anxiety and resilience scores to account for validity. By means of a cluster analysis groups with different resource profiles were formed. Results. RESULTS: For the study 609 complete FBR baseline data sets could be used for statistical analysis. The internal consistency scores ranged fromα=0.58 to α=0.78 and retest reliability scores were between rTT=0.41 and rTT=0.63. Correlation with depression, fear and resilience ranged from r=-0.38 to r=0.42. The cluster analysis resulted in four groups with relatively homogenous intragroup profiles (high CRs, low spirituality, medium CRs, low CRs). The four groups differed significantly in fear and depression (the more inefficient the resources the higher the difference) as well as in resilience (the more inefficient the lower the difference). The group with low CRs also reported permanent pain with no relief. The groups did not otherwise differ. CONCLUSIONS: The FBR is an economic instrument that is suitable for practical use e.g. in primary care practices to identify strengths and deficits in the CRs of chronic pain patients that can then be specified in face to face consultation. However, due to the rather low reliability, the use of subscales for profile differentiation and follow-up measurement in individual diagnoses is limited.

Efficacy of hypnosis in adults undergoing surgery or medical procedures: a meta-analysis of randomized controlled trials.

This meta-analysis investigates the efficacy of hypnosis in adults undergoing surgical or medical procedures compared to standard care alone or an attention control. Through a comprehensive literature search N=34 eligible randomized controlled trials (RCTs) were included, comprising a total of 2597 patients. Random effects meta-analyses revealed positive treatment effects on emotional distress (g=0.53, CI 95% [0.37; 0.69]), pain (g=0.44, CI 95% [0.26; 0.61]), medication consumption (g=0.38, CI 95% [0.20; 0.56]), physiological parameters (g=0.10, CI 95% [0.02; 0.18]), recovery (g=0.25, CI 95% [0.04; 0.46]), and surgical procedure time (g=0.25, CI 95% [0.12; 0.38]). In conclusion, benefits of hypnosis on various surgically relevant outcomes were demonstrated. However, the internal validity of RCTs seems limited and further high methodological quality RCTs are needed to strengthen the promising evidence of hypnosis for adults undergoing surgery or medical procedures.

Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis.

OBJECTIVE: Group training in communication skills [communication skills training (CST)] has become partly mandatory for oncology staff. However, so far, a comprehensive meta-analysis on the efficacy is lacking. DESIGN: Included studies either compare the efficacy of a specific training with a control group or look at the additional effect of booster sessions on communication behaviour, attitudes or patient outcomes. METHODS: Four electronic databases were searched up to July 2008 without language restriction, and reference lists of earlier reviews were screened. Effect sizes (ESs) were extracted and pooled in random effects meta-analyses. RESULTS: We included 13 trials (three non-randomised), 10 with no specific intervention in the control group. Meta-analysis showed a moderate effect of CST on communication behaviour ES = 0.54. Three trials compared basic training courses with more extensive training courses and showed a small additional effect on communication skills ES = 0.37. Trials investigating participants' attitudes ES = 0.35 and patient outcomes ES = 0.13 (trend) confirmed this effect. CONCLUSIONS: Training health professionals by CST is a promising approach to change communication behaviour and attitudes. Patients might also benefit from specifically trained health professionals but strong studies are lacking. However, feasibility and economic aspects have to be kept in mind when considering providing a training of optimal length.

Jugular venous neurone specific enolase (NSE) increases following carotid endarterectomy under general, but not local, anaesthesia.

INTRODUCTION: Previous studies indicate that local (LA) rather than general anaesthesia (GA) for carotid endarterectomy (CEA) is associated with reflex hypertension and preservation of cerebral cytochrome oxidase after carotid clamping. The hypothesis that LA offers protection against ischaemic cerebral injury has been investigated by measuring ipsilateral jugular venous neurone specific enolase (NSE: neuronal glycolytic enzyme) and S-100B (glial cell protein) during and after CEA. METHODS: 27 patients with symptomatic carotid artery disease (70-99% stenosis) underwent CEA, 14 under LA and 13 under GA. Jugular venous blood samples were assayed for NSE and S-100B before carotid clamping and at 5min before and 5min, 2, 4, 6, 8, 12 and 24h after clamp release. RESULTS: No neurological complications occurred. S-100B levels were low and did not increase from baseline in either group. Pre-clamp NSE levels were similar in both groups (LA: 17.6 (15.2-20.7)microg/l, GA: 21.5 (11.3-26.2)microg/l; p=0.37) but increased significantly 2h after clamp release in GA patients (LA: 25.5 (16.6-27.8)microg/l, GA: 48.2 (31.4-61.3)microg/l, p=0.05) with a significant rise from baseline in GA patients (p=0.04). CONCLUSIONS: CEA performed under GA is associated with greater rises in jugular venous NSE, and hence cerebral injury, than CEA performed under LA.

Identification of chicken and C. elegans fibulin-1 homologs and characterization of the C. elegans fibulin-1 gene.

Fibulin-1, a member of the emerging family of fibulin proteins, is a component of elastic extracellular matrix fibers, basement membranes and blood. Homologs of fibulin-1 have been described in man, mouse and zebrafish. In this study, we describe the isolation and sequencing of chicken fibulin-1C and D cDNA variants. We also describe identification of a C. elegans cDNA encoding fibulin-1D and cosmids containing the C. elegans fibulin-1 gene. Using the cDNA, RT-PCR and computer-based analysis of genomic sequences, the exon/intron organization of the C. elegans fibulin-1 gene was determined. The C. elegans fibulin-1 gene is located on chromosome IV, is approximately 6 kb in length, contains 16 exons and encodes fibulin-1C and D variants. Comparative analysis of the deduced amino acid sequences of nematode and chicken fibulin-1 variants with other known vertebrate fibulin-1 polypeptides showed that the number and organization of structural modules are identical. The results of this study indicate that the structure of the fibulin-1 protein has remained highly conserved over a large period of evolution, suggestive of functional conservation.

Anti-CENP-B response in sera of uranium miners exposed to quartz dust and patients with possible development of systemic sclerosis (scleroderma).

OBJECTIVE: To look for anti-CENP-B antibodies and their diagnostic relevance in patients negative and positive for anticentromere antibodies (ACA) with different risk for the development of systemic sclerosis (SSc), including uranium miners exposed to quartz dust. METHODS: We studied sera of 107 patients with SSc, 121 patients with possible SSc, 202 uranium miners heavily exposed to quartz dust, 14 patients with vibration induced white fingers, and 240 control patients. Subjects were screened for ACA by indirect immunofluorescence on HEp-2 cells (IIF-ACA) and then for anti-CENP-B autoantibodies by an ELISA using eukaryotically expressed human full length recombinant CENP-B protein. RESULTS: All IIF-ACA positive sera of "idiopathic" SSc (N = 19), "idiopathic possible" SSc (N = 6) and other patients (N = 11), and 17 of 19 IIF-ACA positive sera of miners exposed to silica with (N = 13) and without (N = 6) symptoms of SSc reacted with CENP-B in this assay. Of the 622 IIF-ACA negative sera, 28 were found positive for anti-CENP-B. There was a significant increase of the prevalence of anti-CENP-B antibodies in IIF-ACA negative patients with possible SSc (11 of 109) and in miners exposed to silica (11 of 196) compared to a group of men older than 60 years with diseases or symptoms not related to SSc (1 of 138). CONCLUSION: (1) CENP-B is also the major target of the IIF-ACA response in diseases other than scleroderma and in the risk group of miners exposed to quartz dust. (2) Anti-CENP-B antibodies can be found in IIF-ACA-negative sera, particularly in those at risk for SSc. (3) The detection of anti-CENP-B antibodies in miners exposed to quartz dust may indicate a high risk group for developing SSc and reveals possibilities for the study of early pathogenetic changes as well as exogenic and endogenic factors involved in the development of this disease.

Isolation and maintenance of the human pilosebaceous duct: 13-cis retinoic acid acts directly on the duct in vitro.

The human pilosebaceous duct was isolated and maintained for 7 days in defined medium, and defined medium supplemented with 1 microM 13-cis retinoic acid. Freshly isolated ducts retained their in vivo morphology, showing a stratified squamous keratinizing epithelium. On maintenance there was a loss of basic duct architecture, and a significant reduction in the rate of [methyl-3H] thymidine uptake. The addition of 1 microM 13-cis retinoic acid resulted in an improved duct architecture and caused a further significant reduction in the rate of [methyl-3H] thymidine uptake. [Methyl-3H] thymidine autoradiography showed that freshly isolated ducts maintained their in situ pattern of cell division. It was difficult to discern the region of cell division in ducts maintained for 7 days, but the degree of graining reflected the measured rates of [methyl-3H] thymidine uptake into PCA precipitable material. The pattern of keratin synthesis of the freshly isolated duct was similar to patterns previously described for the duct in situ. This study reports the successful isolation and maintenance of the human pilosebaceous duct, and demonstrates that 13-cis retinoic acid acts directly at the level of the duct.

Transformation and degradation of leukotriene B4, 12-hydroxyeicosatetraenoic acid and 5-hydroxyeicosatetraenoic acid induced by ultraviolet radiation.

To reveal the underlying mechanisms in the therapeutic effectiveness of ultraviolet (UBV)- and psoralen plus UVA phototherapy, the photostability of leukotriene B4 (LTB4), 12-hydroxyeicosatetraenoic acid (12-HETE) and 5-HETE was investigated in the presence and absence of photosensitizers (8-methoxypsoralen and 5-methoxypsoralen). Arachidonic lipoxygenase products were irradiated with doses of narrow-band UVB (311 nm) ranging from 0.5-3.2 J/cm2, UVB and UVA (305-400 nm) ranging from 0.6-6.3 J/cm2 and UVA ranging from 5.0-60.0 J/cm2, respectively. High-performance liquid chromatography demonstrated a dose-dependent decrease of LTB4, 12-HETE, and 5-HETE. The photostability of 12-HETE was much higher than that of LTB4 and 5-HETE. Two products of transformation of LTB4 were identified as 5(S), 12(R)-dihydroxy-(6E, 8E, 10E, 14Z)-eicosatetraenoic acid [6-trans-LTB4] and 5(S), 12(R)-dihydroxy-(6E, 8Z, 10E, 14Z)-eicosatetraenoic acid [5(S), 12(R)-DiHETE]. There was no significant increase in photodegradation after addition of photosensitizing psoralens.

[Effect of acoustic stress on immunoregulatory cells in female patients with systemic lupus erythematodes (SLE), patients with sarcoidosis and normal comparative subjects]. / Einfluss von akustischem Stress auf immunregulatorische Zellen bei Patientinnen mit systemischem Lupus erythematodes (SLE), Patienten mit Sarkoidose und gesunden Vergleichspersonen.

14 patients with systemic lupus erythematosus (SLE), 12 with sarcoidosis and two age- and sex-matched groups of healthy subjects were exposed to a 10-minute acoustic stress test. Healthy subjects and patients with sarcoidosis showed significant increases in leukocyte and lymphocyte counts (p less than 0.01), relative elevations of B and Tsc lymphocytes (p less than 0.01) and a relative reduction of Th lymphocytes (p less than 0.01). Patients with SLE showed the same characteristic alterations (p less than 0.01) but the degree of this cell mobilization was significantly less pronounced as compared with the healthy subjects (p less than 0.01). No dependence was found between corticosteroid therapy or disease activity and the cellular reaction in SLE patients. In SLE patients there thus seemed to be an attenuated immune response due to stress which may play an etiopathogenetic role in this disease.

[References for the operating behavior of ultraviolet fluorescence tubes in phototherapy equipment]. / Hinweise zum Betriebsverhalten von UV-Fluoreszenzstrahlern in Phototherapiegeräten.

The working behaviour of the UV-fluorescent tubes type UVS 20-2, UVS 40-2 and UVS 65-2 (Manufacturer: VEB NARVA "Rosa Luxemburg" Leuchten- und Leuchtstoff-lampenwerk Brand-Erbisdorf) applicated in phototherapy equipments has been investigated in four commercially and two self-made devices. In the first 100 hours of the application of the fluorescent tubes an exponential decrease of the irradiation power reaching a value of 30 percent must be considered. After an exchange of old tubes (1,500 working hours) to new one a jump in the irradiation power with a factor 2.5 may be observed. The temperature of the fluorescent tube altering after the switch and daily instabilities in the supply power influence the irradiation power in a way that must not be neglected. The emission of equipments with good remove of the tube heat is constant after 5 minutes. In constructions causing and maintaining a high temperature of the tubes this time is about 20 minutes.

[The REM syndrome--alternative therapeutic possibilities]. / REM-Syndrom (REMS)--Alternative Therapiemöglichkeiten.

Chloroquine and chloroquine derivatives have proved successful in the therapy of REM syndrome (REMS). Alternative treatment schedules have not been described so far. In a female Patient, chloroquine therapy had to be discontinued because of ophthalmologic contraindication. PUVA therapy induced complete remission, whereas dapsone alone only led to incomplete improvement. Additional UV radiation--mainly UV-A--had a positive effect. Chloroquine contraindication justifies the use of these alternative therapeutic approaches to REMS.

[Pharmacokinetics and pharmacodynamics of prednisolone following extremely high dosage as prednisolone hemisuccinate]. / Zur Pharmakokinetik und Pharmakodynamik von Prednisolon nach extrem hoher Dosierung als Prednisolonhemisuccinat.

Plasma levels of prednisolone and prednisolone hemisuccinate of volunteers were measured with HPLC following i.v. injections of 1200 and 75 mg of prednisolone, given as the water-soluble hemisuccinate ester. The hemisuccinate ester is hydrolyzed relatively quickly with a plasma half-life between 18 and 25 min, and the resulting prednisolone has a plasma half-life of 3.5-3.7 h. The dose dependency of the pharmacokinetic parameters indicates a partial saturation of the metabolizing enzymes as consequence of the application of the high dose of prednisolone. In saliva no hemisuccinate could be detected. The prednisolone saliva concentration corresponds with those of non-protein-bound prednisolone in plasma measured at the same time. Only minor quantities of intact ester (1-8%) or intact prednisolone (2-4%) are excreted in urine. Following the application of 1200 mg prednisolone the endogenous cortisol level is partially suppressed only 24 h after the i.v. injection; 48 h later the difference from the basis value is not statistically significant. Leukocytosis and granulocytosis are at maximum 24 h after the injection of the high dose, and after 48 h normal values are observed. Lymphocytes and monocytes fall below normal levels for a longer time after 1200 mg compared to 75 mg, the minimum is between 4 and 8 h. Glucose levels are enhanced dose-dependently. They are normalized even after the extremely high dose at 24 h. Sodium, potassium, calcium, plasma proteins, urea, creatinine, hematocrit and hemoglobin showed no significant differences within 48 h following the injections.

Impairment to viability of neutrophils and lymphocytes by angular psoralens and UV-radiation.

The angular psoralen derivative, 4,5'-dimethylangelicin (Dm Agn), both without and with UV-radiation induces under adequate conditions a higher percentage of lethally damaged cultured human polymorphonuclear neutrophils (PMN) as compared with angelicin (Agn). In general, PMN photosensitized with Dm Agn are less resistant than similarly photosensitized lymphocytes. These results suggest that Dm Agn might be used to improve the photochemo (PUVA-)therapy of skin diseases where PMN are of pathogenic importance.