[Rehabilitation after occupational accidents in professional dancers: advice with due regard to dance specific aspects]. / Rehabilitation nach Arbeitsunfällen im professionellen Bühnentanz: Empfehlungen unter Berücksichtigung tanzmedizinischer Gesichtspunkte.

The highly specialized occupation of professional dancers is a combination of sport and artistic expression. The exertion is only possible with a fully operative body. Although professional dancers may be compared with elite athletes and acute injuries frequently happen, dancers do not seem to be granted an appropriate therapy after accidents as compared with athletes. Although even minor injuries may potentially endanger the career of a professional dancer, physiotherapeutic or physical treatment methods are applied in every tenth case only. Alternative and holistic concepts such as Pilates or dance-specific re-integration that proved successful in professional dancers, are used in even fewer instances. The aim of this study is to develop a rehabilitation concept for professional dancers focusing on dance-medicine aspects. It has been taken into account that the best physical outcomes are reflected in an optimized, holistic, dance-specific therapy and rehabilitation. Intensifying and exploiting dance-specific methods of treatment can not only reduce costs in the end but can even contribute to reducing the duration of rehabilitation after injuries of dancers. Preconditions for realization of the rehabilitative model are a high qualification of all persons working in the rehabilitative field as well as a marked willingness to cooperate in the various dance fields. Both gender-specific and dance-style particularities are to be taken into account to ensure a successful rehabilitation.

Pituitary adenylate cyclase-activating peptide receptor 1 mediates anti-inflammatory effects in allergic airway inflammation in mice.

BACKGROUND: Bronchial asthma is characterized by airway inflammation and reversible obstruction. Since the gold standard of therapy, a combination of anti-inflammatory corticosteroids and bronchodilatory ß(2) agonists, has recently been discussed to be related to an increased mortality, there is a need for novel therapeutic pathways. OBJECTIVE: A new experimental concept that encompasses the vasoactive intestinal peptide/pituitary adenylate cyclase activating peptide (PACAP) family of receptors by demonstrating the anti-inflammatory effects of the PACAP receptor 1 (PAC1R) in a murine model of allergic asthma is described. METHODS: PAC1R expression was investigated in lung tissue and isolated dendritic cells (DCs) via real-time PCR. Ovalbumin (OVA)-induced asthma models were used in PAC1R-deficient mice and BALB/c mice treated with PAC1R agonist maxadilan (MAX). Bronchoalveolar lavages have been performed and investigated at the cellular and cytokine levels. Fluorescence staining of a frozen lung section has been performed to detect eosinophil granulocytes in lung tissue. Plasma IgE levels have been quantified via the ELISA technique. Lung function was determined using head-out body plethysmography or whole-body plethysmography. RESULTS: Increased PAC1R mRNA expression in lung tissue was present under inflammatory conditions. PAC1R expression was detected on DCs. In OVA-induced asthma models, which were applied to PAC1R-deficient mice (PAC1R(-/-)) and to BALB/c mice treated with the specific PAC1R agonist MAX, PAC1R deficiency resulted in inflammatory effects, while agonistic stimulation resulted in anti-inflammatory effects. No effects on lung function were detected both in the gene-depletion and in the pharmacologic studies. In summary, here, we demonstrate that anti-inflammatory effects can be achieved via PAC1R. CONCLUSION: PAC1R agonists may represent a promising target for an anti-inflammatory therapy in airway diseases such as bronchial asthma.

Glutathione peroxidase-2 protects from allergen-induced airway inflammation in mice.

The aim of the present study was to identify and validate the biological significance of new genes/proteins involved in the development of allergic airway disease in a murine asthma model. Gene microarrays were used to identify genes with at least a two-fold increase in gene expression in lungs of two separate mouse strains with high and low allergic susceptibility. Validation of mRNA data was obtained by western blotting and immunohistochemistry, followed by functional analysis of one of the identified genes in mice with targeted disruption of specific gene expression. Expression of two antioxidant enzymes, glutathione peroxidase-2 (GPX2) and glutathione S-transferase omega (GSTO) 1-1 was increased in both mouse strains after induction of allergic airway disease and localised in lung epithelial cells. Mice with targeted disruption of the Gpx-2 gene showed significantly enhanced airway inflammation compared to sensitised and challenged wild-type mice. Our data indicate that genes encoding the antioxidants GPX2 and GSTO 1-1 are common inflammatory genes expressed upon induction of allergic airway inflammation, and independently of allergic susceptibility. Furthermore, we provide evidence to illustrate the importance of a single antioxidant enzyme, GPX2, in protection from allergen-induced disease.

Lipocalin2 protects against airway inflammation and hyperresponsiveness in a murine model of allergic airway disease.

BACKGROUND: Allergen-induced bronchial asthma is a chronic airway disease that involves the interplay of various genes with environmental factors triggering different inflammatory pathways. OBJECTIVE: The aim of this study was to identify possible mediators of airway inflammation (AI) in a model of allergic AI via microarray comparisons and to analyse one of these mediators, Lipocalin2 (Lcn2), for its role in a murine model of allergic airway disease. METHODS: Gene microarrays were used to identify genes with at least a twofold increase in gene expression in the lungs of two separate mouse strains with high and low allergic susceptibility, respectively. Validation of mRNA data was obtained by Western blotting, followed by functional analysis of one of the identified genes, Lcn2, in mice with targeted disruption of specific gene expression. Epithelial cell cultures were undertaken to define induction requirements and possible mechanistic basis of the results observed in the Lcn2 knock-out mice. RESULTS: Lcn2 was up-regulated upon allergen sensitization and airway challenges in lung tissues of both mouse strains and retraced on the protein level in bronchoalveolar lavage fluids. Functional relevance was assessed in mice genetically deficient for Lcn2, which showed enhanced airway resistance and increased AI associated with decreased apoptosis of lung inflammatory cells, compared with wild-type controls. Similarly, application of Lcn2-blocking antibodies before airway challenges resulted in increased inflammation and reduced apoptosis. CONCLUSION: These data indicate a protective role for Lcn2 in allergic airway disease, suggesting a pro-apoptotic effect as the underlying mechanism.

[Scientometric analysis of the BMI]. / Eine szientometrische Betrachtung des BMI.

BACKGROUND: The connection between overweight and health risks has been known since the beginning of the 19th century. In order to define overweight, the "body mass index" (BMI) in kg/m (2) was introduced. METHODS: The present study evaluates the quantity and quality of the published literature available, and its changes over the years. Basic bibliographic methods and recent visualizing techniques were used in order to analyse and categorise research in the field of the BMI. The data were extracted from "ISI Web of Science" by Thomson Reuters beginning from 1900 to 2008 by defined search terms. RESULTS: There are 63,845 articles on the subject available. It shows, that the number of annual publications is increasing continuously, starting in 1972. The bibliometric methods and the application of density equalising maps reveal global research productivity and citation activity with emphasis on the USA. CONCLUSION: The present study supplies a first bibliometric approach to visualise research activity in the field of BMI. Furthermore, it provides data that can be used for the identification of research clusters and to locate regions where more research needs to be done. Despite the controversial discussion, the analysed data suggest that the BMI is still an important, simple, and inexpensive measure for the assessment of the nutritional status that comes to a worldwide use.

[A scientometric analysis of leukoplakia and erythroplakia]. / Eine szientometrische Analyse der Leukoplakie und Erythroplakie.

BACKGROUND: The oral leukoplakia and erythroplakia is one of the most common epithelial precursor lesions of the oral squamous cell carcinoma. Transformation rates are approximately 0.9-17% in 10 years for leukoplakia and in 14-50% for the erythroplakia. Despite the clinical relevance of these lesions, currently exists no detailed bibliometric analysis. METHODS: The present study combines classical bibliometric tools with novel scientometric and visualizing techniques in order to analyse and categorize research in the field of leukoplakia and erythroplakia. RESULTS: All studies related to leukoplakia and erythroplakia and listed in the ISI database since 1900 were identified by the use of defined search terms. The bibliometric analysis of the collected data shows a continuous increase in quantitative marker such as the number of publications and cooperation and qualitative markers, such as citations and H-index. The combination with density equalizing mapping revealed a distinct global structure of research and citing activity. Radar chart techniques were used to illustrate bi- and multilateral cooperations and institution research collaborations. DISCUSSION: The present study demonstrates the first scientometric approach that visualizes research activities in the area of leukoplakia and erythroplakia. It provides data that can be used for geografical context and research networks.

[Pulmonary hypertension--clinical aspects, pathophysiology, diagnostic and therapy]. / Pulmonale Hypertonie--Klinik, Patho- physiologie, Diagnostik und Therapie.

Pulmonary hypertension (PH) is a disease which is characterised by an increase in the mean pulmonary arterial pressure (mPAP) in the lung circulation of over 25 mmHg in rest and over 30 mmHg in movement. Due to the chronic overload of the right ventricle, the heart is always affected by a PH and often develops a so-called cor pulmonale chronicum which can lead to right-heart failure. There are five groups in the clinical WHO Venice classification which are arranged according to pathogenetical, clinical and therapeutical criteria. In addition, an adjusted NYHA classification helps to grade the significance of the disease stages. Principally, one classifies a mostly isolated form of the pulmonary arterial hypertension (PAH) and other secondary forms of the PH which develop on the grounds of existing problems such as left-heart diseases, hypoxic lung diseases, pulmonary embolism and infections. The pathophysiological reasons for a PH are just as various as the different manifestations. Yet there are generally four main alterations in the walls of the pulmonary vessels. This includes vasoconstriction, rarefaction of vessels, vascular remodelling and the occlusion of vascular lumen by a thrombus with subsequent structural remodelling of the vascular and mounted extracellular matrix. The diagnostic procedure should be algorithm-oriented and includes anamnesis, physical examination, electrocardiogram (ECG), thoracic x-ray and echocardiography. To confirm the diagnosis and for a better measuring of the prognosis, an examination with a right-heart flow-directed balloon-tipped catheter is favourable. Because of the change in the pathophysiological concepts of the PH from a vasoconstrictive to a vasoproliterative genesis, additional pharmacological targets are developed for therapeutic treatment. Today the former regime of therapy with high-dosed calcium-channel blockers such as vasodilatators only finds application after pharmacological testing at so-called responders. The current scheme of therapy is focused on the synergic effects of different drugs, such as prostacyclines, endothelial-receptor blockers and phosphodiesterase-5 inhibitors. After the failure of pharmacological treatments, the endarteriectomy remains as the last therapy option, although it is accompanied by poor survival rates.

[MRSA--current aspects of resistance, pathology, epidemiology and therapy]. / MRSA--aktuelle Aspekte der Resistenzentwicklung, Pathomechanismen, Epidemiologie und Therapie.

The Methicillin-resistant Staphylococcus aureus (MRSA) is a Staphylococcus aureus (S. aureus) resistant against all kinds of beta-lactam antibiotics. Moreover, resistances against other antibiotics have gradually started to develop. In the last decades, MRSA started as a serious problem only in hospitals, but in recent years it also rose as an alarming community pathogen. In addition to the resistances against Penicillin which emerged in the 1940s. with the use of beta-lactamase proof antibiotics in the 1960s, the resistance of S. aureus against Methicillin started to develop. According to the kind of resistance, the genotype, the time of infection and the origin of the infection, MRSA infections are classified as hospital-associated (HA-MRSA) and community-associated (cMRSA). On the one hand, this differentiation results in distinct strategies of calculated therapy against each class of MRSA. On the other hand, it is important in order to identify relevant judicious aspects of transmission.

BCG priming of dendritic cells enhances T regulatory and Th1 function and suppresses allergen-induced Th2 function in vitro and in vivo.

BACKGROUND: The inverse correlation of mycobacterial infection with asthma prevalence and the inhibitory effects of vaccination with Bacille Calmette-Guérin (BCG) on airway hyperreactivity in asthma models suggest modulation of dendritic cell (DC) and T cell functions by mycobacterial compounds. METHODS: To delineate these immunological effects, the immunogenicity of BCG Copenhagen, BCG Chicago and BCG Pasteur was compared in a mouse model. Bone marrow-derived dendritic cells (BMDCs) from BALB/c mice were stimulated with ovalbumin (OVA) with or without BCG. BMDCs were phenotypically characterized by flow cytometry, and we used ELISA to measure the cytokine production of BMDCs as well as of co-cultivated allergen-specific T cells in response to OVA-pulsed. Immunomodulatory effects of BCG were studied in a model of allergic airway inflammation by adoptive transfer of allergen-pulsed BMDCs. RESULTS: Immunomodulation with BCG induced production of IL-10 and IL-12 by BMDCs. Co-cultured allergen-specific T cells produced less IL-5, IL-13 and IFN-gamma but more IL-10. Also the number of FoxP3(+) regulatory T cells was enhanced. Strongest effects were seen with BCG Chicago and BCG Pasteur. In vivo, administration of BCG modulated OVA-pulsed BMDCs then reduced eosinophilic airway inflammation but enhanced infiltration with granulocytes. Airway hyperreactivity and mucus production were reduced and more FoxP3(+) T cells were observed. CONCLUSION: BCG-induced suppression of Th2-type allergic airway inflammation was associated with enhancement of regulatory T cell function but also of Th1-associated neutrophilic airway inflammation. These findings raise concerns regarding the safety profile of BCG as a potential tool for prevention and therapy of allergic airway disease.

Cough as a symptom and a disease entity: scientometric analysis and density-equalizing calculations.

BACKGROUND: Cough is a prominent symptom of many allergic diseases and a major health burden but there is little information available on the current state of research in this area. OBJECTIVES: To analyze long-term developments in cough research and recent trends. METHODS: We searched the Thomson Reuters Web of Science databases for cough-related items published between 1900 and 2007 and analyzed the results using scientometric methods and density-equalizing calculations. RESULTS: We found 12 960 cough-related publications from 132 countries for the period studied. The most productive country was the United States of America (USA), followed by the United Kingdom (UK), France, Japan, Canada, and Germany. These 12 960 published items were cited 165 868 times. The average number of citations per item increased from 1976 to 1992, with peaks in 1977, 1979, 1981, 1984, 1989 and 1992. Each of these years was followed by a decrease in citation numbers. Bilateral and multilateral cooperation analysis using the radar chart technique showed a progressive increase in international co-authorship starting at the beginning of the 1990s, with a leading role by the USA and the UK. CONCLUSION: We detected a marked increased in cough-related research starting in the 1990s. While the majority of data originates from the US, other countries have taken a leading position in terms of research quality (number of citations per item).

An observational real-time study to analyze junior physicians' working hours in the field of gastroenterology.

BACKGROUND: In recent years, data from questionnaires have demonstrated increasing criticism from junior physicians regarding their work conditions. Ideally, such subjective statements should be compared to accurate objective data regarding workload. However, such data is not available in the research literature. Therefore the aim of the current study is to deliver exact data about physicians' work in different gastroenterology departments to analyze and to optimize work routines. METHOD: An observational real-time study was conducted by shadowing 21 gastroenterologists individually during weekday shifts at three hospitals in urban German settings. A total of 585 hours of observations were recorded by using an ultra mobile computer. RESULTS: The observation results have shown that a gastroenterologist's working day lasted on an average 9 hours 16 min (SD = 1:11:18 h). The following amount of time was given to varying tasks within this time period: 30.21 % for meetings (SD = 8.54 %), 13.42 % for documentation duties (SD = 7.74 %), 15.53 % for indirect patient care (SD = 6.32 %), 7.98 % for hospital admissions and ward rounds (SD = 5.49 %). Doctor patient communication was restricted to 4.05 % of the working day (SD = 2.71 %). CONCLUSION: This is the first real time analysis on how hospital gastroenterologists spend their working hours. Some of the problems with work routine reported by the doctors themselves were partly confirmed. With regard to the study results a rearrangement of job tasks coupled with technological solutions may prove helpful in reducing the burden on gastroenterologists and thereby improving the quality of medical care.

[Current and future medical drugs for smoking cessation]. / Aktuelle und neue Medikamente in der Tabakentwöhnung.

Tobacco smoking is the leading cause of preventable morbidity and mortality in the world. There are nearly 1, 3 billion users of nicotine and tobacco products worldwide while approximately 4, 9 millions of them die from smoking-related disease every year. Cigarette smoking is a highly addictive behavior. Pharmacotherapy can be useful to achieve long-term abstinence. Nicotine replacement products are widely employed and recommended by the World Health Organization. There is strong evidence for the efficacy of the atypical antidepressant Bupropion as therapy for smoking cessation. The partial nicotinic receptor agonist varenicline has recently been approved as treatment for nicotine addiction in Germany. Preliminary data from clinical trials have suggested that varenicline may be an effective therapy for tobacco dependence with minimal side effects. Clonidine and nortriptyline have demonstrated some efficacy but possible side effects may limit their use. Additionally both are not approved for smoking cessation in Germany. Other promising new therapeutic drugs include Rimonabant and nicotine vaccines. They will provide smokers additional options to assist in achieving smoking cessation. Treatment of psychological dependence in addition to physiological dependence, however, is a must for long-term abstinence. For this reason a successful smoking cessation intervention requires besides pharmacological treatments motivational counseling and behavioral interventions.

[Erythropoietin - state of science]. / Erythropoietin - aktueller Stand der Wissenschaft.

After a century of research and medical use, erythropoietin (EPO) has more therapeutic approaches than ever in history. After cloning its gene in 1984, EPO obtained FDA license for clinical use in 1989. EPO and its analogues are mainly used for treatment of the anaemias of chronic renal failure and malignancies. Regarding research of the past 15 years, tremendous efforts were made for improvement of bioactivity, half-life and alternative application. Today, there are human cell-lined derived EPO, SEP, CEPO, CERA and drugs which are linked to different pathways of signaling. Due to the fact that these substances are not detectable with standardized methods of detection, it must be assumed that the abuse in sport is still possible. Moreover it was found out that the EPO receptor and EPO synthesis are also expressed by non-hematopoietic tissues, e. g. heart myocytes, ovarian and glial cells. On these tissues EPO is linked to promote cell proliferation and differentiation, angiogenesis or inhibition of apoptosis. This detection offered approaches in treatment for apoplexia and cardiac infarction and even in preventive treatment of cardiovascular diseases which led to an interest of manifold subject categories.

Neurokinin-1 receptor activation induces reactive oxygen species and epithelial damage in allergic airway inflammation.

BACKGROUND: An induction of reactive oxygen species (ROS) is characteristic for inflammation but the exact pathways have not been identified for allergic airway diseases so far. OBJECTIVE: The aim of this study was to characterize the role of the tachykinin NK-1 receptor on ROS production during allergen challenge and subsequent inflammation and remodelling. METHODS: Precision-cut lung slices of ovalbumin (OVA)-sensitized mice were cultivated and ROS-generation in response to OVA challenge (10 microg/mL) was examined by the 2',7'-dichloroflourescein-diacetate method. Long-term ROS effects on epithelial proliferation were investigated by 5-bromo-2'-deoxyuridine incorporation (72 h). In vivo, the results were validated in OVA-sensitized animals which were treated intra-nasally with either placebo, the tachykinin neurokinin 1 (NK-1) receptor antagonist SR 140333 or the anti-oxidant N-acetylcystein (NAC) before allergen challenge. Inflammatory infiltration and remodelling were assessed 48 h after allergen challenge. RESULTS: ROS generation was increased by 3.7-fold, which was inhibited by SR 140333. [Sar(9),Met(11)(O(2))]-Substance P (5 nM) caused a tachykinin NK-1 receptor-dependent fourfold increase in ROS generation. Epithelial proliferation was decreased by 68% by incubation with [Sar(9),Met(11)(O(2))]-SP over 72 h. In-vivo, treatment with SR 140333 and NAC reduced epithelial damage (91.4% and 76.8% vs. placebo, respectively, P<0.01) and goblet cell hyperplasia (67.4% and 50.1% vs. placebo, respectively, P<0.05), and decreased inflammatory cell influx (65.3% and 45.3% vs. placebo, respectively, P<0.01). CONCLUSION: Allergen challenge induces ROS in a tachykinin NK-1 receptor-dependent manner. Inhibition of the tachykinin NK-1 receptor reduces epithelial damage and subsequent remodelling in vivo. Therefore, patients may possibly benefit from treatment regime that includes radical scavengers or tachykinin NK-1 receptor antagonists.

Ethambutol in paediatric tuberculosis: aspects of ethambutol serum concentration, efficacy and toxicity in children.

SETTING: Ethambutol (EMB) is used as a fourth drug in paediatric anti-tuberculosis treatment. In current recommendations the dosage of EMB is calculated per kg body weight. OBJECTIVE: To present two studies investigating an appropriate EMB dosage in children, and observational data on its toxicity and efficacy. DESIGN: EMB serum levels in children of different age groups were determined after single oral administration of EMB alone as well as after EMB combined with rifampicin, and optimal dosages were established. The efficacy and toxicity of these EMB dosages were examined retrospectively. RESULTS: EMB serum levels were lower than those expected in adults receiving a similar oral dose, due to different pharmacokinetics and pharmacodynamics in childhood. Thereafter, children were treated with EMB doses calculated by body surface (867 mg/m2). Ocular toxicity occurred in 0.7% of cases and relapses in 0.8%. CONCLUSION: Current recommended EMB dosages in childhood tuberculosis lead to subtherapeutic serum levels. It appears to be more valid to calculate the EMB dosage on the basis of body surface rather than body weight, leading to higher dosages especially in younger children. With these dosages, therapeutic serum levels are reached in all age groups, leading to a high efficacy of anti-tuberculosis treatment without increased ocular toxicity.

Targeting transcription: a new concept of anti-inflammatory therapy of airway diseases.

Most pathological conditions that result in human diseases are associated with altered gene expression. With the advent of new technologies that might control gene expression and a broader knowledge of transcription factors and pathways, new strategies have emerged that offer promising first results for therapeutical and experimental purposes. This review will focus on different inflammatory conditions of the lung, in which targeting the transduction of involved genes have been successfully attempted.

Gene expression profiling as novel tool in experimental asthma research.

With the advances achieved in decoding of the genetic structures of species and the novel possibilities of simultaneous measurements of the regulation of all genes of a given tissue, the last 10 years have seen a massive increase of our knowledge about genetic regulation of diseases. Additionally, the possibilities to control transcriptional processes within the cells will speed up the process of disentangling the various pathways leading to disease.

A bibliometric analysis of bipolar affective disorders using density-equalizing mapping and output benchmarking.

BACKGROUND: Bipolar affective disorder (BaD) has a great impact on health systems worldwide. Although bibliometric studies have been done on this subject, these studies did not do an analysis of the contents of papers, the cooperation between countries, or of the names currently used to describe the condition. Furthermore, the number of publications since the last bibliometric study has doubled. AIM: This study was to examine the recent developments in the field, explore main topics/subject areas of the top 10 authors in this research field, and to compare diagnosis-defined data between International Classification of Diseases, 10(th) edition (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). MATERIALS AND METHODS: Using distinct search terms, the Web of Science database developed by the Thompson Reuters Institute of Scientific Information was scanned for relevant items published between 1900 and 2008. Results were analyzed using scientometric methods and density-equalizing calculations. RESULTS: We found an important increase of publications on the subject over the last decade. Most published studies came from North America and Europe, while the countries cooperating with each other were comparable to other areas of medical research. Although there has been an increase in publications on BaD (m=3.3 publications per year in the last decade), the number of works using the term bipolar disorder (BD) was considerably higher (m=141.8 publications per year in the last decade). We found that the subject areas, genetics and pharmacology were focuses of research for the 10 most prolific authors, all of whom where psychiatrists. CONCLUSION: Research interest in BaD is rising. Reflecting the two main disease classification systems, DSM and ICD, both terms BD and BaD are used in research, with a preponderance of the former. The research of the most prolific authors engages genetic and pharmacological questions.