Increased neural responses to empathy for pain might explain how acute stress increases prosociality.

Recent behavioral investigations suggest that acute stress can increase prosocial behavior. Here, we investigated whether increased empathy represents a potential mechanism for this finding. Using functional magnetic resonance imaging, we assessed the effects of acute stress on neural responses related to automatic and regulatory components of empathy for pain as well as subsequent prosocial behavior. Stress increased activation in brain areas associated with the automatic sharing of others' pain, such as the anterior insula, the anterior midcingulate cortex, and the primary somatosensory cortex. In addition, we found increased prosocial behavior under stress. Furthermore, activation in the anterior midcingulate cortex mediated the effects of stress on prosocial behavior. However, stressed participants also displayed stronger and inappropriate other-related responses in situations which required them to take the perspective of another person, and to regulate their automatic affective responses. Thus, while acute stress may increase prosocial behavior by intensifying the sharing of others' emotions, this comes at the cost of reduced cognitive appraisal abilities. Depending on the contextual constraints, stress may therefore affect empathy in ways that are either beneficial or detrimental.

[The regional network ADAPTHERA : Rheumatology care through coordinated cooperation: comprehensive, trans-sectoral, covering all health insurance. Initial results]. / Das landesweite Netzwerk ADAPTHERA : Erste Ergebnisse einer flächendeckenden, krankenkassenübergreifenden und transsektoralen rheumatologischen Versorgung.

The aim of the rheumatology network ADAPTHERA ("risk-adapted rheumatology therapy") is to achieve a comprehensive improvement in rheumatology care by coordinating treatment in a regional, trans-sectoral network. Accompanying biomedical research projects, training concepts, and the construction of a rheumatology register (gathering data and biomaterials) should furthermore ensure the stable and sustainable optimisation of care. In the pilot phase (2012-2015) the focus of the ADAPTHERA network, required as a "regional key project" within the framework of the Initiative on Health Economy of Rheinland-Palatinate (RL-P), Germany, was placed on the optimisation of the early diagnosis of rheumatoid arthritis, where it is well-known that there is a significant care deficit.Through the intensive, stable, and coordinated cooperation of all health care partners in the field of rheumatology (registered general practitioners and orthopaedic specialists, registered core rheumatologists as well as the Association of Rheumatology of RL-P) a unique regional, comprehensive offer with verifiable care optimisation has been established in RL-P. The network is supported by outstanding collaboration with the Association of Statutory Health Insurance Physicians and the self-help organisation Rheumatology League.The aims that were established at the start of the project will be achieved by the end of the pilot phase:- significant improvement in the early diagnosis of rheumatoid arthritis (an average of 23.7 days until diagnosis by rheumatologists)- access covering all health insurance (regardless of the particular scheme the patients belong to)- comprehensive (verifiable participation of general practitioners from all over RL-P)- data and biomaterials collection, established as a basis for biomarker research, and a rheumatology register for RL-P.

[Diagnosis of cavernomatous transformation of the portal vein]. / Diagnostik der kavernomatösen Pfortadertransformation.

In 10 patients at the age of 17 to 59 years the diagnosis of a cavernomatous transformation of the portal vein primarily was made by sonography and was confirmed by computer tomography and angiography, respectively. These findings were seen by chance when an abdominal ultrasound was performed in order to clarify splenomegaly or esophageal varices. The characteristics of the disease are the positive proof of a convoluted agglomeration of racemose venous structures that have replaced the normal single portal vein and signs of portal hypertension. The sonographic figures are so typical that ultrasound is the decisive procedure in its diagnosis and that direct or indirect splenoportography is not necessary. The present results show that clinical manifestations of cavernomatous transformation of the portal vein are delayed sometimes in to adolescence and that invasive diagnostic methods are only necessary when shunt operation is planned.

Hypokalemic rhabdomyolysis associated with Bartter's syndrome.

Severe potassium deficiency is an uncommon cause of rhabdomyolysis. We recently treated a 45-year-old patient with myalgia, serious generalized weakness, increased serum creatine kinase and myoglobin level as well as excessive hypokalemia. Histological examination of deltoid muscle biopsy showed rhabdomyolysis. After complete recovery of muscle damage by potassium substitution Bartter's syndrome proved to be the cause of initial and persistent hypokalemia.

Successful treatment of paraquat poisoning: activated charcoal per os and "continuous hemoperfusion".

Ingestion of paraquat results in an extremely dangerous poisoning. The first aim is to clear the gastrointestinal tract by inducing emesis and performing gastric/gut lavage; as much activated charcoal as possible should be administered per os and as quickly as possible. The best measure to eliminate paraquat from blood and tissue is hemoperfusion with coated activated charcoal; it has to be performed in the sense of "continuous hemoperfusion" about 8 h/d over a period of 2-3 weeks. These measures give a chance to lower the lethality of paraquat poisoning.

[Early PEEP for improvement of prognosis in patients with acute respiratory insufficiency (author's transl)]. / Verbesserung der Prognose bei Langzeitbeatmung durch frühzeitigen Einsatz von PEEP.

One hundred twenty-seven artificially ventilated patients with acute respiratory insufficiency (ARI) were investigated. In 61 patients positive endexpiratory pressure (PEEP) was used when ventilation with ZEEP proved to be insufficient for one or more of the following reasons: increasing I-aDO2m PaO3 below 60 Torr at FiO2 greater than or equal to 0.5, deterioration of clinical status (group = secondary PEEP). The time elapse between beginning of artificial ventilation and institution of PEEP was 46 +/- 47 h (median 33 h). In 66 patients PEEP was used from the beginning of artificial ventilation (group II = primary PEEP). The distribution of underlying diseases (severe poisoning, pancreatitis, polytrauma or major surgery, pneumonia, cardiovascular failure, sepsis) as well as the frequency of additional vital function failure (circulatory shock, acute renal failure) were comparable in both groups (p greater than 0.05). At the beginning of artificial ventilation both groups were comparable in respect to respiratory insufficiency. PaO2 was 75 +/- 26 Torr in group I and 70 +/- 29 Torr in group II at comparable levels of FiO2 (p greater than 0.05). PaCO2 was 34.7 +/- 8.2 Torr in group I and 37.4 +/- 10.5 Torr in group II. Significantly more patients in group II received corticosteroids (greater than 1 gr/die). Mortality was 48/61 (79%) in group I and 37/66 (56%) in group II (p less than 0.01). End-inspiratory pressure exceeding 35 cm H2O was necessary in 42/61 patients in group I and 28/66 patients in group II (p less than 0.01) and FiO2 greater than 0.5 was necessary to keep PaO2 above 60 Torr in 39/61 patients in group I and 27/66 patients in group II (p less than 0.01). It is concluded that early institution of PEEP improves the course and outcome of patients with ARI.