[Treatment of fibromyalgia syndrome with gamma-hydroxybutyrate : A randomized controlled study]. / Die Behandlung des Fibromyalgiesyndroms mit Gamma-Hydroxybuttersäure : Eine randomisierte, kontrollierte Studie.

BACKGROUND: The etiology of fibromyalgia syndrome is not yet fully understood. Current hypotheses suggest a potential role of gamma-hydroxybutyrate (GHB) in influencing endocrinological abnormalities in patients with fibromyalgia. OBJECTIVE: The aim of the study was to investigate whether low dose GHB as a growth-hormone releasing substance reduces pain intensity and improves depressive mood, physical impairment and sleep quality in outpatients with fibromyalgia. Additionally, adverse events were recorded. MATERIAL AND METHODS: The pilot study was conducted in the outpatient clinic for pain at the clinic for anesthesiology and surgical intensive care of the Charité Universitätsmedizin Berlin. In the study 25 female patients with fibromyalgia according to the criteria of the American College of Rheumatology were randomized into 2 groups. Over 15 weeks patients of the intervention group received 25 mg/kg body weight oral GHB before going to bed and were compared with a placebo control group. In addition, all patients participated in operant behavioral pain treatment in a group setting. Dependent variables were pain intensity, depressive mood, physical impairment and quality of sleep. RESULTS: There were no group differences in the course of pain intensity (p = 0.61), depressive mood (p = 0.16), physical impairment (p = 0.25) and quality of sleep (p = 0.44); however, all symptoms improved across the groups from pretherapy to posttherapy. Low dose GHB did not increase growth hormone blood concentrations. The number of adverse events that were reported more than two times was similar in both groups. DISCUSSION: Administration of low dose GHB did not yield clinical improvements in female outpatients with fibromyalgia. General improvement in the course of treatment may have resulted from operant behavioral pain therapy. Future studies on GHB should control hypothetical risk factors for identification of non-responders.

[Incidence of constipation in patients with outpatient opioid therapy]. / Auftreten von Obstipation bei Patienten mit ambulanter Opioidtherapie.

BACKGROUND: Constipation is a common complication in patients with opioid therapy. Additionally, patient-related risk factors also contribute to the development of constipation and these factors have to be integrated into an individualized treatment plan. OBJECTIVE: The aim of this study was to assess the incidence of constipation in patients with opioid therapy in an outpatient setting and to analyze the risk factors that contribute to the development of constipation. MATERIAL AND METHODS: This retrospective cohort study was conducted in two university affiliated outpatient departments at the Charité hospital in Berlin. The trial included all consecutively treated patients with opioid therapy of at least 4 weeks duration. The study was conducted from January 2013 to August 2013. Constipation was defined according to the Rome III criteria. RESULTS: Out of 1166 screened patients, altogether 171 patients were included with a median duration of opioid therapy of 5 years. The most common diagnoses were back pain, musculoskeletal pain and neuropathic pain. In 14% of the treated patients symptoms of constipation were detected and another 35% needed laxatives for symptom control resulting in an overall incidence of constipation of 49%. The remaining 51% of the patients did not use any laxatives and did not experience symptoms of constipation. Age and dosing of opioid therapy significantly increased the risk of consipation but duration of opioid therapy was not related to the incidence of constipation. DISCUSSION: The incidence of constipation in this population remains high although a relevant number of patients were intermittently free of symptoms without using laxatives. An individualized therapy plan and patient education seem to be important elements to control opioid-associated constipation.

Classification characteristics of fine motor experts based on electroencephalographic and force tracking data.

The application of machine learning techniques provides a data-driven approach for a deeper understanding of the development and expressions of expertise. In extension to the common procedure of comparing experts' and novices' performances in expertise-domain-related tasks we applied conventional classification algorithms. We distinguished between tasks for each participant and between groups, i.e., experts or novices, based on electroencephalographic (EEG) activity patterns and force output variables during four different force modulation tasks. The tasks under investigation involved sinusoidal and steady force tracking tasks, which were performed with the left and right hand. Classification of tasks based on EEG patterns as well as force output was possible with high accuracy in novices and experts, whereas classification of group membership, i.e., experts or novices, was at chance level. In follow-up analyses, we found a high degree of individuality in the EEG patterns of the experts, implying the long-term development of specialized central processing during fine motor tasks in fine motor experts. Taken together, the results suggest that continuous practice in the work context leads to the development of a highly individual and task-specific central control pattern.

Classification of visuomotor tasks based on electroencephalographic data depends on age-related differences in brain activity patterns.

Classification of physiological data provides a data driven approach to study central aspects of motor control, which changes with age. To implement such results in real-life applications for elderly it is important to identify age-specific characteristics of movement classification. We compared task-classification based on EEG derived activity patterns related to brain network characteristics between older and younger adults performing force tracking with two task characteristics (sinusoidal; constant) with the right or left hand. We extracted brain network patterns with dynamic mode decomposition (DMD) and classified the tasks on an individual level using linear discriminant analysis (LDA). Next, we compared the models' performance between the groups. Studying brain activity patterns, we identified signatures of altered motor network function reflecting dedifferentiated and compensational brain activation in older adults. We found that the classification performance of the body side was lower in older adults. However, classification performance with respect to task characteristics was better in older adults. This may indicate a higher susceptibility of brain network mechanisms to task difficulty in elderly. Signatures of dedifferentiation and compensation refer to an age-related reorganization of functional brain networks, which suggests that classification of visuomotor tracking tasks is influenced by age-specific characteristics of brain activity patterns. In addition to insights into central aspects of fine motor control, the results presented here are relevant in application-oriented areas such as brain computer interfaces.

Relationship between L-alanine and sodium ion transport in isolated renal tubules.

1. Rat renal tubules were isolated by incubation with collagenase. The Na+ concentration in the tubules at 37 degrees C was increased by additions of g-strophantin and L-alanine. The increase of Na+ in the presence of both g-strophantin and L-alanine was stronger than with either alone. 2. Radioactive sodium (22-Na), which was taken up by the tubules at 0 degrees C in K+-free medium, was more slowly washed out in the buffer with added g-strophantin than in the control buffer, but L-alanine had no effect. 3. At 0 degrees C incubation without K+, g-strophantin did not affect the 22-Na transport of the tubules. But under the same conditions, L-alanine increased Na+ uptake significantly, and in conjunction with it, L-alanine uptake was also increased. 4. The relationship between L-alanine uptake and intra- extracellular Na+ concentration gradients was linear. The ration of L-alanine to Na+ uptake at 0 degrees C was about 1:2. 5. In the incubation without K+ at 0 degrees C, L-alanine could be accumulated in tubules against the chemical concentration gradient (about 1.5-fold). 6. In the incubation without K+ at 37 degrees C, the L-alanine concentration in tubules after 5 min was already steady (Ci/Ce = 2.2), but with K+ it was not stabilized after 10 min. The ration Ci/Ce with K+ WAS HIGHER THAN WITHOUT K+. 7. G-Strophantin, p-hydroxymercuribenzoate, amiloride, and 2,4-dinitrophenol inhibited L-alanine uptake in the tubules and at the same time increased Na+ concentration. The relationship between the L-alanine uptakes inhibited by g-strophantin, amiloride and dinitrophenol, and the respective intra- extracellular Na+ concentration gradients was strikingly linear. But in the case of p-hydroxymercuribenzoate there was no correlation. 8. The results indicate that L-alanine transport into the renal tubules might be regulated mainly by the intra- extracellular Na+ concentration gradient and that inhibitors such as g-strophantin, amiloride, and dinitrophenol could have a secondary effect on the L-alanine transport which follows the change of Na+ concentration in cells. p-Hydroxymercuribenzoate might have an inhibiting effect on the binding of carrier with Na+ and/or L-alanine.

Inhibition of gluconeogenesis in rat renal cortex slices by metabolites of L-tryptophan in vitro.

The inhibitory effects of metabolites of L-tryptophan on gluconeo-genesis in rat renal cortex has been established. 1. Glucose production was inhibitied by quinolinate in vitro. The inhibition is due to the decreased phosphoenolpyruvate carboxykinase activity. As suggested for purified enzyme systems, quinolinate seems to exert its action in tissue slices by chelating divalent metal ions. The minimum effective extracellular concentration of the inhibitor was 5 X 10(-5) M with pyruvate as a precursor for gluconeo-genesis. 2. The effect of 3-hydroxyanthranilate is stronger (minimal effective concentration 10(-5) M) than that of quinolinate. 3-Hydroxyanthranilate may be effective in its original form and/or as a dimer degrandation product. The compound(s) exert a second effect in addition to blocking the phosphoenolpyruvate carboxykinase. This block is attained by conversion of 3-hydroxyanthranilate to quinolinate. The non-quinolinate mediated effect may be due to a reduced ATP regeneration. 3. It is suggested that kidney cortex responds sensitively to disturbances in ATP metabolism by reduction of glucose synthesis, when it is not the result of blocked formation of phosphoenolpyruvate.

Total and free triiodothyronine in euthyroid individuals: the ambivalent influence of albumin in advanced age.

As T3 thyrotoxicosis may be difficult to be assessed in the low T3 syndrome and in advanced age, the matrix influence on different T3 parameters was evaluated in identical serum specimens of euthyroid non critically ill patients aged up to 95. The values obtained by the conventional TT3 RIA and the FT3 analog single step method with known albumin interference showed a strong relation to age (r = 0.4877 and r = 0.6929, respectively; both p < 0.001). Free T3 measurement by a labeled monoclonal antibody technique was independent of age effects (r = 0.0324, p = 0.748). Upon analyzing the binding parameters, albumin decreased with age and correlated closely with the age dependent T3 parameters (TT3: r = 0.6610, apparent FT3 by analog: r = 0.7664; both p < 0.001). In identical specimens, FT3 obtained by labeled monoclonal antibody is not influenced by albumin changes (r = 0.1986, p = 0.063). Consequently, TT3 cannot exactly predict the thyrometabolic status without corrections regarding binding protein variation including albumin, which is the underlying cause of the age dependence. The FT3 assay using labeled monoclonal antibody represents a precise and convenient technique and gives reliable results independent of changes of binding protein.

[The diagnosis of clinically silent thyroid disorders]. / Erkennung klinisch nicht vermuteter thyreoidaler Dysfunktion.

Results of tests for thyroid function are presented in two equal observation periods. Compared with the first the frequency of TSH-determinations was doubled in the second period. Data were taken from non-selected in-patients in a general hospital. In connection to clinical information TSH determination served as the first laboratory test. Prevalence data of hyperthyroid and hypothyroid dysfunction in the patients observed are given. According to controversies in health care the efficiency and efficacy of thyroid function tests are discussed. In an iodine deficient area TSH-determination uncovers many more thyroid dysfunctions in elderly patients than expected clinically. Screening of this risk group with TSH in connection with clinical information is an adequate diagnostic procedure in an area of mild iodine deficiency.

[Ultrahistochemical demonstration of blood group B substances on human erythrocytes with a lectin from Salmo gairdneri RICH]. / Ultrahistochemischer Nachweis der Blutgruppensubstanz B menschlicher Erythrocyten mit einem Lectin aus Salmo gairdneri RICH.

From the roe of Salmo gairdneri RICH., a lectin was isolated which agglutinates specifically human erythrocytes of blood group B. For cytochemical labelling of the blood group substance B on the surface of human erythrocytes, an indirect approach was chosen. By means of a polyclonal antibody from the rabbit against the B-specific fish lectin, electronmicroscopic presentation was performed with Protein A gold using a multistep method. For quantification gold labelling was partially followed by a silver technique.

High RBC labeling efficiency by controlling pretinning with the modified in vivo/in vitro labeling method.

OBJECTIVE: The image quality for gastrointestinal bleeding studies depends on the efficiency of red blood cell labeling. The in vitro technique has been used widely because of its high labeling efficiency. New data for the modified in vivo/in vitro method are lacking. This study reports on the high labeling efficiency that can be obtained with the modified in vivo/in vitro method and the pitfalls to avoid. METHODS: A consecutive series of 91 labeling studies was analyzed. Different amounts of tin, red blood cell concentrations, and infusions of interfering substances also were studied. RESULTS: A mean efficiency of red blood cell labeling of 97% (80%-99%) was obtained. Only 3 cases showed unacceptable results. Suboptimal results were obtained with amounts of tin below 10 microg SnCl2/kg body weight, a reduced hematocrit, and blood transfusion or infusion of HES solution during pretinning. CONCLUSION: The modified in vivo/in vitro red blood cell labeling technique is performed easily, is useful and is comparable to the gold standard in vitro method, provided that the pretinning period is controlled carefully.

Comparing 16 PF scores for two groups of offenders.

The 16 PF scores for 678 male offenders in a diagnostic and receiving center were compared with scores for 891 male offenders in penal institutions by t tests for independent means. Significant differences were obtained for 13 of the 16 primaries included in the 16 PF. The Penitentiary group scored significantly higher than the Reception Center group on the primaries, A, I, L, M, O, Q1, and Q4. Conversely, the Reception Center group scored significantly higher than the Penitentiary group on the primaries, B, C, F, G, N, and Q3.

L-alanine accumulation in isolated tubuli from rat kidney cortex.

Tubuli were prepared from rat renal cortex by modification of the method adopted from HOWARD and PESCH (J.Biol. Chem. 243, 3105, 1968). At 37 degrees C tubuli showed constant pyruvate consumption and glucose production for more than one hour. Intracellular electrolyte and amino acid concentrations were measured after separating the tubuli from the incubation medium by a layer of silicon oil in 5 seconds. During incubation at 37 degrees C L-alanine was accumulated 2.6 fold in the tubuli, while intracellular Na+ concentration dropped to about 50 mEq/l. At 27 degrees C, when pyruvate consumption and glucose production was reduced to less than half compared with 37 degrees C incubation, the respective gradients were higher. L-alanine accumulation was reduced by 2,4-dinitrophenol, antimycin A, ouabain and p-hydroxymercuribenzoate and was completely abolished by the reversal of the Na+ concentration gradient between extracellular and intracellular spaces. At 4 degrees C, when erergy production in tubuli ceased, L-alanine could be concentrated in the case of a Na+o/Na+i ratio greater than unity but not at a lower ratio. It is concluded that the accumulation of L-alanine is a direct function of the energy provided by the Na+ concentration gradient and is mediated by a postulated carrier, which can be injured by sulfhydryl group reagents like p-hydroxymercuribenzoate.

[Animal experimental studies on the healing of tooth fractures with conventional splinting and with endodontal tension screws]. / Tierexperimentelle Untersuchungen zur Heilung von Zahnfrakturen mit konventioneller Schienung und endodontaler Zugschraube.

Using polchromatic sequential labeling, the healing of experimentally inflicted root fractures was observed in beagle dogs. A transition through hard substances formed from vascular connective tissue of the periodontium occurred only in the fine fracture line. It was not related to the pulp, since it also appeared after endodontal fixation. A vascular mineralization occurs in the extra-fine tissue which can be reached through a tension screw into the pulp cavity. This mineralization leads to a filling of the fragments. Dislocated root fragments heal incompletely due to interposition of connective tissue.

[Facial pain--dysfunction of the neck joints]. / Gesichtsschmerz--Dysfunktion der Kopfgelenke.

The etiopathogenesis of headache (cephalalgia) is multifactorial and has not been definitely clarified yet. One of the most frequent causes of this type of pain are disorders in the area of the neck joints such as locking of joints in passive or active movements or conditions affecting the segmentally arranged muscles. Manual mobilization of the affected joint structures or, possibly, a therapeutic nerve block is the most helpful treatment measure.

[Experimental study on the effect of the model thickness and its profile on the behavior of the dimensions in cast crowns and bridge-work cast in one piece]. / Experimentelle Studie über den Einfluss der Modellationsstärke und Profilform auf das Dimensionsverhalten von Gusskronen und Einstückgussbrücken.

The dimensional response of cast objects as a function of the shape and thickness of their wax patterns was studied, the dimensions of investment patterns taken as null bodies being compared with the corresponding dimensions of cast crowns and bridges. The metal shrinkage values are discussed.