Effects of yoga in inflammatory bowel diseases and on frequent IBD-associated extraintestinal symptoms like fatigue and depression.

Quality of life (QoL) of persons with inflammatory bowel diseases (IBD) is often impaired by symptoms that do not primarily relate to intestinal inflammation. Among the most challenging extraintestinal symptoms are depression and fatigue, which are also frequent in other chronic diseases like multiple sclerosis, rheumatoid arthritis and cancer. Yoga as an ancient Indian tradition containing postures, breathing exercises and meditation may positively influence those symptoms. This review evaluates the current literature with regard to the effect of yoga-based interventions in persons with IBD and with regard to QoL, depression and fatigue in other somatic disorders. A systematic literature search yielded three trials examining the effects of yoga in patients with IBD and 37 trials addressing depressive syndromes or fatigue in somatic disorders. In summary, both in-person and video-based yoga classes are feasible, acceptable and safe as complementary treatment in patients with IBD and significantly improve anxiety and impaired quality of life. Current literature does not provide information on the effect of yoga on depression and fatigue in patients with IBD, but research from other somatic disorders or patients with depressive disorders implies the potential of yoga in this regard for persons with IBD. This should be specifically addressed in interventional trials with standardized yoga modules including patients with IBD suffering from fatigue, depression and/or impaired QoL.

Long-term ecosystem monitoring and assessment of the Detroit River and Western Lake Erie.

Over 35 years of US and Canadian pollution prevention and control efforts have led to substantial improvements in environmental quality of the Detroit River and western Lake Erie. However, the available information also shows that much remains to be done. Improvements in environmental quality have resulted in significant ecological recovery, including increasing populations of bald eagles (Haliaeetus leucocephalus), peregrine falcons (Falco columbarius), lake sturgeon (Acipenser fulvescens), lake whitefish (Coregonus clupeaformis), walleye (Sander vitreus), and burrowing mayflies (Hexagenia spp.). Although this recovery is remarkable, many challenges remain, including population growth, transportation expansion, and land use changes; nonpoint source pollution; toxic substances contamination; habitat loss and degradation; introduction of exotic species; and greenhouse gases and global warming. Research/monitoring must be sustained for effective management. Priority research and monitoring needs include: demonstrating and quantifying cause-effect relationships; establishing quantitative endpoints and desired future states; determining cumulative impacts and how indicators relate; improving modeling and prediction; prioritizing geographic areas for protection and restoration; and fostering long-term monitoring for adaptive management. Key management agencies, universities, and environmental and conservation organizations should pool resources and undertake comprehensive and integrative assessments of the health of the Detroit River and western Lake Erie at least every 5 years to practice adaptive management for long-term sustainability.

Engineering craniofacial scaffolds.

OBJECTIVE: To develop an integrated approach for engineering craniofacial scaffolds and to demonstrate that these engineered scaffolds would have mechanical properties in the range of craniofacial tissue and support bone regeneration for craniofacial reconstruction. EXPERIMENTAL VARIABLE: Scaffold architecture designed to achieve desired elasticity and permeability. Scaffold external shape designed to match craniofacial anatomy. OUTCOME MEASURE: Final fabricated biomaterial scaffolds. Compressive mechanical modulus and strength. Bone regeneration as measured by micro-CT scanning, mechanical testing and histology. SETTING: Departments of Biomedical Engineering, Oral/Maxillofacial Surgery, and Oral Medicine, Pathology and Oncology at the University of Michigan. RESULTS: Results showed that the design/fabrication approach could create scaffolds with designed porous architecture to match craniofacial anatomy. These scaffolds could be fabricated from a wide range of biomaterials, including titanium, degradable polymers, and degradable calcium phosphate ceramics. Mechanical tests showed that fabricated scaffolds had compressive modulus ranging 50 to 2900 MPa and compressive strength ranging from 2 to over 56 MPa, within the range of human craniofacial trabecular bone. In vivo testing of designed scaffolds showed that they could support bone regeneration via delivery of BMP-7 transduced human gingival fibroblasts in a mouse model. Designed hydroxyapatite scaffolds with pore diameters ranging from 400 to 1200 microns were implanted in minipig mandibular defects for 6 and 18 weeks. Results showed substantial bone ingrowth (between 40 and 50% at 6 weeks, between 70 and 80% at 18 weeks) for all scaffolds, with no significant difference based on pore diameter. CONCLUSION: Integrated image-based design and solid free-form fabrication can create scaffolds that attain desired elasticity and permeability while fitting any 3D craniofacial defect. The scaffolds could be manufactured from degradable polymers, calcium phosphate ceramics and titanium. The designed scaffolds supported significant bone regeneration for all pore sizes ranging from 300 to 1200 microns. These results suggest that designed scaffolds are clinically applicable for complex craniofacial reconstruction.

Combination of Goldman risk and initial cardiac troponin I for emergency department chest pain patient risk stratification.

BACKGROUND: Accurate identification of low-risk emergency department (ED) chest pain patients who may be safe for discharge has not been well defined. Goldman criteria have reliably risk-stratified patients but have not identified any subset safe for ED release. Cardiac troponin I (cTnI) values have also been shown to risk-stratify patients but have not identified a subset safe for ED release. OBJECTIVE: To test the hypothesis that ED chest pain patients with a Goldman risk of < or =4% and a single negative cTnI (< or =0.3 ng/mL) at the time of ED presentation would be safe for discharge [<1% risk for death, acute myocardial infarction (AMI), revascularization]. METHODS: A prospective cohort study was performed in which consecutive ED chest pain patients were enrolled from July 1999 to November 2000. Data collected included patient demographics, medical and cardiac history, electrocardiogram, and creatine kinase-MB and cTnI. Goldman risk stratification score was calculated while patients were still in the ED. Hospital course was followed daily. Telephone follow-up occurred at 30 days. The main outcome was death, AMI, or revascularization (percutaneous transluminal coronary angioplasty/stents/coronary artery bypass grafting) within 30 days. RESULTS: Of 2,322 patients evaluated, 998 had both a Goldman risk < or =4% and a cTnI < or =0.3 ng/mL. During the initial hospitalization, 37 patients met the composite endpoint (3.7%): 6 deaths (0.7%), 17 AMIs (1.7%), 18 revascularizations (1.8%). Between the time of hospital discharge and 30-day follow-up, 15 patients met the composite endpoint: 4 deaths (0.4%), 6 AMIs (0.6%), and 5 revascularizations (0.5%). Overall, 49 patients met the composite endpoint (4.9%; 95% CI = 3.6% to 6.2%): 10 deaths (1.0%; 95% CI = 0.4% to 1.6%); 23 AMIs (2.3%; 95% CI = 1.4% to 3.2%), and 23 revascularizations (2.3%; 95% CI = 1.4% to 3.2%) within 30 days of presentation. CONCLUSIONS: The combination of two risk stratification modalities for ED chest pain patients (Goldman risk < or =4% and cTnI < or =0.3 ng/mL) did not identify a subgroup of chest pain patients at <1% risk for death, AMI, or revascularization within 30 days.

[Social integration of patients with anorexia nervosa and bulimia]. / Die soziale Integration von Patientinnen mit Anorexia nervosa und Bulimie.

The current study investigated the psychological and social problems of 46 patients with anorexia nervosa and 34 patients with bulimia who met the DSM III-criteria. Data were compared with 50 normal controls, using the "Fragebogen zur Sozialen Integration" (FSI, a German translation of the social adjustment scale-self report) and the Freiburger Persönlichkeitsinventar (FPI, a German personality questionnaire). Women with anorexia nervosa as well as patients with bulimia demonstrated a significant impairment in all areas of social relationships, while there were no differences between these patient groups. On the FPI, both groups reported significantly more depressed, feelings of being nervous, neuroticism and femininity, less sociable and calm than the controls.

[Social integration of Crohn disease and ulcerative colitis patients. Study of the relations of somatic, psychological and social factors]. / Soziale Integration von Morbus Crohn- und Colitis ulcerosa-Patienten. Studie zur Wechselwirkung somatischer, psychischer und sozialer Faktoren.

63 patients with Crohn's disease and 58 patients with ulcerative colitis were tested with the "Fragebogen zur sozialen Integration" (FSI, questionnaire of social adjustment), the "Freiburger Persönlichkeitsinventar" (FPI) and a semistandardized interview and were compared with surgical controls. Activity, course and symptoms of the disease were registered. We found significant restrictions in working and lesiure activities, partnership and sexual life in patients with inflammatory bowel disease. Social adjustment of patients with Crohn's disease was more dependent on disease activity than in patients with ulcerative colitis. Social impairment in patients with Crohn's disease correlated with higher stool frequency and abdominal pain, in patients with ulcerative colitis with reduced general state of health, tiredness and limpness. In the "Freiburger Persönlichkeitsinventar" (FPI) the patients with chronic inflammatory bowel disease described themselves significantly more nervous, inhibited, reserved and less aggressive, sociable and composed. The FPI scores in patients with Crohn's disease depended more on disease activity and on somatic symptoms than in patients with ulcerative colitis.

[Effect of compliance on treatment with autogenic training]. / Der Einfluss der Compliance auf die Behandlung mit autogenem Training.

Autogenic therapy courses for patient with psychosomatic psychoneurotic disorders show a high dropout rate. A study among 38 ambulant patients analysed factors of the patients have influence on their compliance. Generally the dropout group, independent of the diagnosis, shows less striking deviations. Under autogenic therapy the compliance-positive group achieves a constructive change towards normality. Realisation of autogenic therapy is achieved by patients with more intensive psychoneurotic disorders. They experience a more distinct physical answer by the basic training. It is shown that it is easier for the compliant patient to learn the autogenic therapy, which is understood as conditional response. With reference to the experience in drug compliance the results recommend that autogenic therapy should be accompanied by a compliance therapy.

[Comparative psychodiagnostic test study in acute and chronic asthma patients]. / Vergleichende psychodiagnostische Testuntersuchung bei akuten und chronisch Asthmakranken.

The psychic characteristics of patients suffering from asthma bronchiale have mostly been investigated without considering the duration of the illness. So the question was if and in which way the duration of the disease influences the patient's psychic state. 61 asthmatics were examined by the FPI and by a structured interview. Two parallel groups with a duration of illness of less than two years respectively more than five years were compared with each other. Obviously frankness and self-criticism were to be found more frequently in the chronic group than among the patients of the short continuance of the disease. The lower frankness and willingness to self-criticism of this group of patients is also symptomatic of the first reaction to the sudden onset of the illness. The patients' first reactions are denial and repression, especially concerning the psychic parts in the multifactorial pathogenesis of the disease and its social consequences. In the course of the illness self-criticism and the capability of perceiving psychosocial factors increase. These results lead to the conclusion that the chronification of asthma bronchiale is a stimulus for confrontation with conflicts in the own biography and thus with the illness itself. It seems important to use different forms of psychotherapy depending on the duration of the illness.

[Personality structure of patients with ulcerative colitis and Crohn disease, a psychological test study in disease remission]. / Zur Persönlichkeitsstruktur von Patienten mit Colitis ulcerosa und Morbus Crohn, eine testpsychologische Untersuchung während der Krankheitsremission.

30 patients with ulcerative colitis and 30 patients with Crohn's disease during remission were tested with the Freiburger Persönlichkeitsinventar (FPI) and standardized interview. There was no difference between both groups in the FPI, both were significantly less aggressive than controls. The patients with ulcerative colitis were more reserved and introverted, patients with Crohn's disease more self-confident, obliging and emotionally stable. Apart from two exceptions the answers in the standardized interview were similar in both groups. The patients with ulcerative colitis had a significantly better relationship with their mothers, the patients with Crohn's disease often called themselves "peacemaker". We couldn't confirm the clinical impression that there are important differences between patients with ulcerative colitis and Crohn's disease. A remarkable result, however, is that our study of patients during the remission didn't show any characteristics as nervousness, depression, emotional restraint and instability as it is described to be for the acute phase.