Does the use of small aids during patient handling activities lead to a decreased occurrence of musculoskeletal complaints and diseases? A systematic review.

PURPOSE: Patient handling increases the risk of musculoskeletal complaints and diseases among healthcare workers. Thus, the use of small aids for patient handling is recommended. Small aids are non-electrical and handy assistive devices that support caregivers during patient handling. To date, there is no evidence about the clinical efficacy of small aids. Hence, the objective of this systematic review was to systematically analyze whether the use of small aids during patient handling leads to a decreased occurrence of musculoskeletal disorders. METHODS: A systematic literature search was carried out. The review process was done independently by two reviewers. Methodology was assessed with the "Downs and Black checklist" and the "Risk of Bias tool." Quality of evidence was determined with the GRADE method. RESULTS: One randomized and two non-randomized trials were included. Three comparisons of intervention assessing the lumbar spine and shoulder joint were investigated. A statistically significant improvement of the 7-day prevalence of low back pain and shoulder pain was achieved within the intervention group over time of questionable clinical importance in a study with comparisons made between small aids and usual practice or mechanical aids. No comparison between the intervention group and control group at follow-up was made. Each trial showed an insufficient methodology and a high risk of bias. Quality of evidence was low for disability scores and very low for pain outcomes. CONCLUSIONS: To date, there is no convincing evidence (from low-quality studies) for the preventability of musculoskeletal complaints and diseases by the use of small aids. The literature also lacks evidence for the opposite. Generalizability of the study results is further debatable due to the different populations and settings that were investigated. Robust, high-quality intervention studies are necessary to clarify the clinical efficacy of small aids in healthcare work. PROSPERO REGISTRY NUMBER: CRD42014009767.

Systematic review: Progression of beryllium sensitization to chronic beryllium disease.

BACKGROUND: The relevance of beryllium sensitization testing for occupational health practice and prevention is unclear. AIMS: To analyse the natural course of beryllium sensitization and clarify the prognosis following cessation of exposure among sensitized workers. METHODS: An electronic literature search was conducted in PubMed, Embase, Toxline and Cochrane databases supplemented by a manual search. Data abstraction and study quality assessment with adapted guideline checklists were performed independently by three reviewers. Seven studies met the eligibility criteria and were included in the systematic review; however, six of the seven studies were of low methodological quality. RESULTS: A substantial (although not specifically quantifiable) proportion of beryllium-sensitized employees will develop chronic beryllium disease (CBD). To date, it is unknown if cessation of exposure in sensitized workers reduces the progression rate to CBD. CONCLUSIONS: To determine the utility of regular assessments for beryllium sensitization among exposed workers, there is a need for prospective studies. This should include detailed and continuous exposure monitoring, regular tests for beryllium sensitization and a thorough diagnostic evaluation of sensitized workers to confirm or exclude CBD.

uPA and PAI-1 in breast cancer: review of their clinical utility and current validation in the prospective NNBC-3 trial.

The plasminogen activator system is a complex system with multiple interactions and members participating in fibrinolysis, cell migration, angiogenesis, wound healing, embryogenesis, tumor cell dissemination, and metastasis in a variety of solid tumors. Increased levels of uPA and/or PAI-1 in primary tumor tissues of breast cancer patients correlate with tumor aggressiveness and poor clinical outcome. Patients with high tumor tissue antigen content of uPA and/or PAI-1 have a worse probability of disease-free and overall survival than patients with low levels of both of the biomarkers, serving as prognostic markers. The clinical utility of uPA and PAI-1 has been proven on the highest level of evidence (LOE-I). Next to being clinically useful prognostic factors allowing estimates of the course of disease in early breast cancer, uPA and PAI-1 may also serve as predictive factors predicting response to systemic therapy. Node-negative primary breast cancer patients with high uPA/PAI-1 levels benefit significantly from adjuvant chemotherapy. The aim of the ongoing NNBC-3 trial is to determine the benefits of a sequential anthracycline-docetaxel regimen in high-risk node-negative breast cancer patients compared to the current standard of anthracycline-based chemotherapy. At present, uPA and PAI-1 provide the unique opportunity to allow validated and clinically relevant risk assessment of breast cancer patients, over and above that provided by established risk factors. Therefore, in the evidence-based, annually updated AGO guidelines for breast cancer management, the German Working Group for Gynecological Oncology (AGO) has recommended both biomarkers as risk-group-classification markers for routine clinical decision making in node-negative breast cancer, next to established clinical and histomorphological factors.

Expression of endothelin-A-receptor predicts unfavourable response to neoadjuvant chemotherapy in locally advanced breast cancer.

Endothelin-1 (ET-1) and its receptors (ETAR and ETBR), referred to as the endothelin (ET) axis, are overexpressed in breast carcinomas and appear to influence tumour growth and progression. The objective of this study was to determine the effect of expression of the ET axis in breast carcinomas on response to cytotoxic chemotherapy. The study included 44 patients with locally advanced breast cancer participating in a prospective phase III study evaluating high-dose neoadjuvant chemotherapy of epirubicin and cyclophosphamide. Expression of ET-1, ETAR and ETBR was determined by semiquantitative immunohistochemical analysis of breast cancer tissue from prechemotherapy tru-cut biopsies. Immunohistochemical staining was positive for ET-1 in 61.5%, for ETAR in 35% and for ETBR in 35.9% of breast carcinomas. Pathological response to chemotherapy was significantly decreased in ETAR-positive patients (P=0.002). In total, 50% of ETAR-positive patients as compared to 7.7% of ETAR-negative patients attained pathologically 'no change'. Logistic regression confirmed ETAR as an independent predictive marker for pathological response (P=0.009). These data indicate that increased expression of ETAR in breast carcinomas is associated with resistance to chemotherapy. Determination of ETAR status may serve as a predictive marker for identifying patients less likely to be responsive to conventional chemotherapy.

[The death of moulages - wax figures in dermatology]. / Das "Sterben" der Moulagen - Wachsabbildungen in der Dermatologie.

Wax has been used for illustration purposes back to antiquity. Since the renaissance period human anatomy and different diseases have often been depicted in wax. During the last century the art of moulage preparation evolved to three-dimensional, realistic representations of diseased parts of the human body. Its heyday and wide spread distribution paralleled the growing independence of dermatology. Apart from few exceptions, most mouleurs did not permit access to their technique either to successors or the public. Just like other European hospitals, the Department of Dermatology at Kiel University houses a comprehensive collection of moulages dating back to a century. The 455 objects left today were collected by Professor Viktor Felix Karl Klingmüller (1870-1942) who was head of the department from 1906 to 1937. The mouleur Alfons Kröner from Breslau who died 1937 supplied most (354) of the wax models. Highly esteemed at his time, Kröner was quite secretive about his art of moulagig. 35 of his moulages bear the abbreviation "DRP" standing for Deutsches Reichspatent (German patent); Kröner was granted a patent in 1902. In his patent application both wax mixtures and technical procedure of moulaging are described in great detail. Kröner, similarly to Jules Baretta (Paris), coloured his moulages at the back of the wax layers. Applying for a patent demonstrates his effort to meet increasing commercial pressure among suppliers of teaching aids at that time. Knowledge of individual technical procedures is essential for medical history as well as proper restauration of moulages as they continually deteriorate with time. Because of their three-dimensional and realistic disease representations, moulages still compare well to modern media used today. Consequently, the "dying of moulages" concerning the wax objects themselves as well as public or medical interest has to be stopped to preserve moulages for future generations.

Inhibition by alpha- and beta-adrenoceptors of the twitch response to transmural stimulation in the guinea-pig vas deferens.

Noradrenaline as well as the indirectly acting amines tyramine and phenethylamine either enhance or inhibit the twitch response of the transmurally stimulated, isolated guine-pig vas deferens, thus partly confirming previous reports. In both cases enhancement is annulled by alpha-adrenoceptor blockers. The twitch inhibition caused by noradrenaline is abolished by alpha- + beta2-adrenoceptor blockers, but not by either blocker alone. The inhibition caused by the indirectly acting amines is largely abolished by alpha-adrenoceptor blockers. Clonidine strongly inhibits the twitch. This effect if promptly removed by phentolamine. After blockade of the neurally induced twitch by tetrodotoxin, noradrenaline and the indirectly acting amines have no effect or slightly enhance the twitch elicited by transmural stimulation of the smooth muscle. It is concluded that exogenous noradrenaline acts on postjunctional stimulatory alpha-adrenoceptors and on inhibitory alpha- and beta2-adrenoceptors, which are presumably prejunctional. In the unstimulated preparation contracted by acetylcholine, noradrenaline causes further contraction which is changed into relaxation after phentolamine. This relaxation is abolished by butoxamine, suggesting that noradrenaline may also act on inhibitory postjunctional beta2-adrenoceptors. The twitch-inhibiting effect of endogenous noradrenaline, released by nerve stimulation or by indirectly acting amines, appears to be primarily mediated by prejunctional alpha-adrenoceptors.

A tentative transmission mechanism for the twitch elicited in guinea-pig vas deferens by field stimulation.

The twitch response to nerve activity in the vas deferens does not behave as if it were adrenergic since it is enhanced by adrenoceptor blockers and often inhibited by noradrenaline and other sympathomimieic amines. Potassium (K+) ions have a strong reinforcing action on the twitch and easily restore it after blockade by lanthanum. The hypothesis is advanced that K+ ions have a transmitter function in the vas deferens and that K+ ions released in conjunction with the nerve stimulus may reach a concentration at the postsynaptic membrane sufficient to excite the muscle cell and produce a twitch.