Cetirizine inhibits gender-specific blood cell dynamics upon allergen contact in allergic rhinitis.

IgE-mediated inflammatory responses upon allergen contact in allergic rhinitis (AR) are associated with rapid alterations of circulating blood cell numbers detectable in a complete blood count (CBC). Aim of this study was to evaluate whether intake of antihistamines may modulate allergen-induced CBC dynamics in male and female patients. A total of N = 112 specific allergen challenges were performed in otherwise healthy AR subjects. Seventy-two (n = 72) subjects received placebo and forty (n = 40) received cetirizine (H1-receptor antagonist) per os prior to allergen exposure in a randomized, double-blind trial at the Vienna Challenge Chamber (VCC); a subgroup of twenty-five (n = 25) subjects received cetirizine and placebo on different study days (parallel group). Blood samples and symptom scores were taken at baseline and immediately after 6 h of airway challenge simulating ambient allergen contact. Female sex was associated with a pronounced circulating monocyte increase (p < .01) and male sex with an eosinophil decrease (p < .05) in the placebo group, but not in cetirizine treated subjects. The significant increase in segmented neutrophils (p < .001) and decrease in circulating erythrocytes (p < .01) upon allergen challenge was less prominent after cetirizine intake in both sexes. A more prominent thrombocyte increase in female subjects (p < .05) was noted upon allergen exposure, regardless of prior cetirizine intake. Cetirizine inhibited the mobilization of neutrophils, lymphocytes and decline in erythrocyte numbers, but did not affect thrombocyte increase upon allergen challenge. It further diminished gender-specific blood cell dynamics. Overall, as reflected in a simple CBC, cetirizine critically diminished immediate and late innate immune responses subsequent to allergen exposure.

[Pain therapy for children and adolescents with hemophilia : Recommendations by an expert panel]. / Schmerztherapie bei Kindern und Jugendlichen mit Hämophilie : Handlungsempfehlungen einer Expertengruppe.

BACKGROUND: Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated. OBJECTIVES: This paper discusses how to improve pain management for children and adolescents (0-18 years) with hemophilia and which specific features in this population should influence decisions in pain management. MATERIALS AND METHODS: An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience. RESULT: Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.

Effects of resistance exercise in prostate cancer patients: a meta-analysis.

PURPOSE: The aim of the present meta-analysis was to quantify effects of resistance exercise (RE) on physical performance and function, body composition, health-related quality of life (HRQoL), and fatigue in patients with prostate cancer. METHODS: Trial data were obtained from the databases PubMed, MEDLINE, EMBASE, SCOPUS, and the Cochrane Library as of inception to 31st of December 2016. Thirty-two trials with 1199 patients were included. Results that were measured by using the same assessment method in five or more of the original studies were pooled in a meta-analysis. RESULTS: Pooled studies showed significant improvements of muscular strength in the upper and lower body (95% CI [2.52, 7.97] kg; p < 0.001 and 95% CI [10.51, 45.88] kg; p = 0.008, respectively) after RE. Furthermore, significant improvements were seen for body composition (body fat percentage 95% CI [-0.79, -0.53] %; p < 0.001; lean body mass 95% CI [0.15, 1.84] %; p = 0.028; trunk fat mass 95% CI [-0.73, -0.08] kg; p = 0.024). Additionally, the improvement of the 400-m walk time was significant (95% CI [-21.55, -14.65] s; p < 0.001). Concerning fatigue and HRQoL, there were not sufficient data for analysis. CONCLUSIONS: RE seems to be a promising approach in order to counteract loss of muscle mass, muscle strength, and physical performance in patients suffering from prostate cancer and its treatment-related side effects. RE should play part in interdisciplinary cancer rehabilitation and care of this patient group. Nevertheless, further research should investigate RE further to determine which protocols are the most pragmatic, yet yielding best patient outcomes.

Resistance exercise and secondary lymphedema in breast cancer survivors-a systematic review.

PURPOSE: The aim of the present review was to determine effects of strength exercise on secondary lymphedema in breast cancer patients. METHODS: Research was conducted by using the databases PubMed/Medline and Embase. Randomized controlled trials published from January 1966 to May 2015 investigating the effects of resistance exercise on breast cancer patients with or at risk of secondary lymphedema in accordance with the American College of Sports Medicine exercise guidelines for cancer survivors were included in the present study. RESULTS: Nine original articles with a total of 957 patients met the inclusion criteria. None of the included articles showed adverse effects of a resistance exercise intervention on lymphedema status. In all included studies, resistance exercise intensity was described as moderate to high. CONCLUSIONS: Strength exercise seems not to have negative effects on lymphedema status or might not increase risk of development of lymphedema in breast cancer patients. Further research is needed in order to investigate the effects of resistance exercise for patients suffering from lymphedema.

The effects of resistance exercise on physical performance and health-related quality of life in prostate cancer patients: a systematic review.

PURPOSE: Physical exercise has been shown to be an effective, safe, and quite inexpensive method to reduce cardiovascular and metabolic risk factors and is currently in the process of establishing its relevance for cancer specific morbidity and mortality. The aim of this systematic review was to focus on specific effects of resistance exercise (RE) in the adjuvant therapy and rehabilitation of prostate cancer patients (PCaPs) receiving or having received androgen deprivation therapy (ADT). METHODS: A systematic literature search focusing on relevant and peer-reviewed studies published between 1966 and September 2014, using PubMed, EMBASE, MEDLINE, SCOPUS, and Cochrane Library databases, was conducted. RESULTS: The majority of studies demonstrated RE as an effective and safe intervention to improve muscular strength and performance, fatigue and quality of life (QoL) in PCaPs, while there is inconclusive evidence concerning cardiovascular performance, body composition, blood lipids, bone mineral density (BMD), and immune response. CONCLUSION: Existing evidence leads to the conclusion that RE seems to be a safe intervention in PCaPs with beneficial effects on physical performance capacity and QoL. Nevertheless, further research in this field is urgently needed to increase understanding of exercise interventions in PCaPs.

Brain regulation training improves emotional competences in patients with alcohol use disorder.

Alcohol use disorder (AUD) is defined as the impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences and still represents one of the biggest challenges for society regarding health conditions, social consequences, and financial costs, including the high relapse rates after traditional alcohol rehabilitation treatment. Especially the deficient emotional competence in AUD is said to play a key role in the development of AUD and hinders to interrupt the substance compulsion, often leading in a viscous circle of relapse. Although the empirical evidence of a neurophysiological basis of alcohol use disorder is solid and increases even further, clinical interventions based on neurophysiology are still rare for individuals with AUD. This randomized, controlled trial investigates changes in emotional competences and alcohol-related cognitions and drinking behavior before and after an established alcohol rehabilitation treatment (control group, nCG = 29) compared to before and after an optimized, add-on neurofeedback training (experimental group: nEG = 27). Improvements on the clinical-psychological level, i.e., increases in emotional competences as well as life satisfaction were found after the experimental EEG-neurofeedback training. Neurophysiological measurements via resting state EEG indicate decreases in low beta frequency band, while alpha and theta band remained unaffected.

Effects of a lower extremity exercise program on gait biomechanics and clinical outcomes in children and adolescents with obesity: A randomized controlled trial.

BACKGROUND: Research highlights the detrimental effects of obesity on gait biomechanics and the accompanied risk of lower-extremity skeletal malalignments, increased joint stress, pain and discomfort. Individuals with obesity typically show increased knee valgus angles combined with an increased step width. Accompanying muscular dysfunctions impede their ability to compensate for these alterations, especially in the frontal plane. To date, no studies are available, which evaluated the potential effects of an exercise program (EP) in reducing these unfavorable biomechanical changes. RESEARCH QUESTIONS: Is a 12-week EP, which includes hip abductor and knee extensor strength exercises and fosters dynamic knee alignment, effective in positively altering gait biomechanics in children and adolescents with obesity? METHODS: This study was a randomized controlled trial having children and adolescents with obesity assigned to an EP (n = 19) or control (n = 16) group. Pain, self-rated knee function, muscle strength and 3D gait analysis during walking and stair climbing were evaluated. RESULTS: Results indicate that the EP was able to increase muscular strength especially in the hip abductors. In addition, children from the EP group walked with less maximum hip adduction and reduced pelvic drop during weight acceptance at follow-up. No changes were present in self-rated knee function, pain or discomfort. SIGNIFICANCE: Even though effects were small, results indicate that an EP is an effective short-term possibility to counteract the progressive development of biomechanical malalignments of the lower extremity. Clinical parameters indicated that the program was feasible. Nonetheless, low adherence highlights the need to develop more attractive programs. CLINICAL TRIALS REG. NO: clinicaltrials.gov (NCT02545764).

Serum levels of tumour necrosis factor-alpha and interleukin-6 and their correlation with body mass index, weight loss, appetite and survival rate--preliminary data of Viennese outpatients with metastatic cancer during palliative chemotherapy.

The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha)) of 61 advanced stage cancer patients receiving palliative chemotherapy as outpatients were determined with quantikine immunoassays. The values were correlated with body mass index (BMI), weight loss and appetite. Furthermore cytokine levels of patients who have died within one year were compared with those of patients who have survived more than a year. Serum levels of IL-6 (median: 1.93 pg/ml, range: 0.32-42.87) and of TNF-alpha (median: 2.55 pg/ml, range: 1.03-34.06) did not correlate with BMI, weight loss and appetite. Serum IL-6 levels of patients with survival time less than one year were significantly higher than the levels of patients who survived more than one year, no significant differences in TNF-alpha serum levels were evident. The data of this observation are consistent with current literature. Due to changes in serum levels of proinflammatory cytokines in response to chemotherapy and additional therapy, it is unlikely that IL-6 and TNF-alpha can be used as independent indicators for weight loss and appetite. Nevertheless, high serum levels of IL-6 correlate with short-time mortality.

A novel mechanotronic orthosis enables symmetrical gait kinematics in a patient with a femoral nerve palsy - a case study.

The usage of stance- and swing-phase control orthoses (SSCOs) is a good option in patients with neuromuscular insufficiency of the quadriceps muscle in a broad range of musculo-skeletal disorders. The subjective sensation of improved mobility in daily life and walking comfort could be objectively confirmed by the ability to walk without crutches and by harmonization of the gait patterns in hip and knee. They could also be a considered mobility device after limb salvage surgery, which may even have an impact on preoperative decision making. IMPLICATIONS FOR REHABILITATION Symmetric gate in spite of femoral nerve palsy. Early gate improvements even after hours. High patient?s motivation to use the device.

The course of quality of life and neurocognition in newly diagnosed patients with glioblastoma.

BACKGROUND: The importance of QoL and neurocognitive functions in patients with glioblastoma (GB) is above controversy by now. We followed newly diagnosed GB patients treated with radio-chemotherapy during their course of disease by continuously evaluating their quality of life (QoL) and cognitive functions. METHODS: We included consecutive patients with newly diagnosed GB from 2010 to 2013 at the Medical University of Vienna. To assess QoL the EORTC QLQ C30 and BN20 questionnaire were used. Neurocognition was measured with the NeuroCog FX. The evaluations were done 6 times every three months, beginning at the beginning of radio-chemotherapy. RESULTS: 42 patients participated in this study. We also recorded QoL and neurocognition in 23 patients after the first disease progression. Patients maintained their cognitive summary score until relapse. Patients with left-sided tumors showed significant lower scores in the subscale verbal fluency than patients with right-sided tumors. The global health score of QoL decreased after the fifth evaluation (13months after diagnosis) whereas a peak of fatigue symptoms was obtained at the third evaluation. Furthermore, fatigue symptoms increased strongly 7months after diagnosis and patients' financial difficulties were mentioned more frequently by younger patients and in patients with lower education levels. CONCLUSIONS: QoL and cognitive long-term assessments are feasible also in some patients with GB after a symptomatic progression. Our study demonstrates maintenance of QoL and cognitive summary scales before tumor progression. Moreover, it highlights subgroups according to tumor location and socioeconomic factors.

Driving in Parkinson's disease - a health hazard?

BACKGROUND: The driving safety of Parkinson's disease (PD) patients has lately been questioned after several authors reported road accidents caused by sleep attacks in PD patients on dopaminergic medication. OBJECTIVES: To determine 1) whether PD patients in general and those on dopaminergic medication in particular are especially prone to cause severe road accidents and 2) whether there are PD symptoms or dopaminergic side effects with the potential to compromise driving safety. DATA SOURCE: Relevant articles were identified by electronic search of biomedical databases (1966-2002: MEDLINE, EMBASE, PASCAL, PUBMED), the Cochrane Controlled Trials Register, and reference lists of located articles. RESULTS: Despite frequent occurrence of potentially hazardous dopaminergic side effects (2-57 %) and disabling parkinsonian non-motor and motor disabilities (16-63 %), the two existing studies on accident rates suggest that PD patients are not more prone to cause road accidents than the rest of the population. Five further reports including 1346 patients and focusing on dopaminergically induced sleep attacks provided comparably low accident figures (yearly incidence: 0%-2%). Because of low figures meta-analysis was intended but finally deemed inappropriate as the methodology of included studies varied greatly and was frequently flawed. CONCLUSION: Further prospective community-based well designed studies on accident risk in PD patients are needed to provide evidence based driving recommendations.

Validation of the STR system FXIIIB for forensic purposes in an Austrian population sample.

The short tandem repeat system FXIIIB was amplified by the polymerase chain reaction (PCR) on blood samples from 201 unrelated Austrians and analyzed by horizontal, non-denaturing polyacrylamide gel electrophoresis. The mean exclusion chance was 0.496, the discriminating power 0.883 and the heterozygosity rate 78.61%. In 50 families (100 meioses) no mutations were found. Sufficient amplification could be achieved with as little as 80 pg of high molecular weight cell line DNA, which could be reduced to 60 pg by using 32 instead of 30 cycles. By reamplifying 1 microliter for another 15 cycles, the threshold could be reduced to less than 20 pg. Nevertheless this sensitivity was only possible with cell line DNA, since reamplification of simulated stains proved to be problematical due to artifacts. In a degradation experiment. DNA extracted from bloodstains stored for up to 26 days in a moist chamber and DNA boiled for up to 18 min could be amplified. A quadruplex PCR with VWA, FES and amelogenin is proposed.

Cross-cultural adaptation of the Minnesota Living with Heart Failure Questionnaire for German-speaking patients.

We performed a cross-cultural adaptation of the "Minnesota Living with Heart Failure Questionnaire" (LHFQ) for use in German-speaking chronic heart failure patients. The instrument was translated and back translated, pre-tested and reviewed by a committee. The German version was tested in 114 patients with chronic heart failure. Reliability was assessed by a test-retest procedure and Cronbach's coefficient alpha of internal consistency (0.94). To assess concurrent validity, we compared the LHFQ sum scores with the New York Heart Association classification rating (r = 0.53; p < 0.0001), the 6-minute walk (r = -0.39; p < 0.0001), the left ventricular ejection fraction (r = -0.24; p = 0.011) and big-endothelin (r = 0.27; p = 0.004). Construct validity on the LHFQ scores in comparison with the Medical Outcomes Study SF-36 Health Survey (MOS SF-36) was significant (-0.41 to -0.74; all p < 0.0001). The reliability and validity of the German version of the LHFQ was proved; the questionnaire can be recommended for use in future clinical trials.

Physical performance and health-related quality of life in men on a liver transplantation waiting list.

Twenty-six men on a liver transplant waiting list (12 had alcoholic cirrhosis, 8 suffered from posthepatitic cirrhosis, and 6 from cirrhosis of other etiologies) were eligible for this observation. Nineteen subjects underwent exercise testing to determine oxygen uptake at anaerobic threshold. In all patients dynamometry was performed to determine isokinetic muscle strength of knee extensor muscles, and handgrip. Quality of life was evaluated in all patients with the MOS SF-36 questionnaire. Child-Pugh A patients showed 54 +/- 8%, Child-Pugh B patients 36 +/- 2%, and Child-Pugh C patients 31 +/- 4% of VO2 max predicted at the anaerobic threshold (Kruskal-Wallis ANOVA, p < 0.05). Isokinetic muscle strength of the quadriceps femoris (left/right) was 149 +/- 20/134 +/- 14 Nm in Child-Pugh A, 108 +/- 16/114 +/- 19 Nm in Child-Pugh B, and 89 +/- 10/81 +/- 11 Nm in Child-Pugh C patients (Kruskal-Wallis ANOVA, p < 0.05). MOS-SF36 revealed a Child-Pugh class dependent reduced functional status (Kruskal-Wallis ANOVA, p < 0.05). No significant differences in target parameters were found when analysed according to the etiology of cirrhosis. Patients on the liver transplant waiting list do have a stage dependent reduction in physical health. These data are the basis for longitudinal studies measuring the effects of preoperative rehabilitation programs in these patients.

HumCD4--validation of a STR system for forensic purposes in an Austrian Caucasian population sample.

The short tandem repeat system HumCD4 was amplified by the polymerase chain reaction (PCR) on blood samples from 304 unrelated Austrian Caucasians and analyzed by horizontal, non-denaturing polyacrylamide electrophoresis. The mean exclusion chance was 0.417, the discriminating power 0.850 and the heterozygosity rate 0.628. The observed phenotype distribution is in Hardy-Weinberg equilibrium. In 100 families (200 meioses) no mutations were found. Sufficient amplification could be achieved with as little as 80 pg of high molecular weight cell-line DNA. In a degradation experiment DNA extracted from bloodstains stored for up to 28 days in a moist chamber and DNA boiled for up to 18 min could be amplified. A duplex PCR with TH01 is proposed.

Health related quality of life in patients with long-standing insulin dependent (type 1) diabetes mellitus: benefits of regular physical training.

BACKGROUND AND AIMS: Regular exercise is recommended to diabetic patients in addition to dietary restrictions and drug therapy. We have studied whether health related quality of life (HRQOL) can be improved by a regular physical training program. METHODS: 23 otherwise healthy patients with history of type 1 diabetes for 20 +/- 10 years were included. 15 patients (age: 41 +/- 2 years) participated in an aerobic physical training program over 4 months and 8 patients (33 +/- 11 years) served as a control group. HRQOL was assessed by a validated questionnaire (MOS SF-36). Tests were carried out at baseline and after 4 months. RESULTS: Physical training increased peak oxygen uptake (VO2max) by 27 +/- 13% after 4 months (p = 0.04) in the training group. There was no significant change in hand or leg isometric muscle strength. All HRQOL scales improved in the training group with significantly higher (p < 0.04) Social Functioning and Vitality scores, respectively. Moreover, insulin requirements decreased during physical training program (p < 0.05). CONCLUSIONS: Our data indicate that physical exercise training in patients with type I diabetes mellitus improves metabolic control and various aspects of HRQOL. Besides enhanced cardiorespiratory capacity, this is an important subjective benefit in patients with longstanding insulin dependent (type 1) diabetes mellitus.

A systematic review on the effectiveness of medical training therapy for subacute and chronic low back pain.

Medical training therapy (MTT) to improve muscular strength and endurance follows evidence based guidelines and is increasingly recommended to patients suffering from subacute and chronic back pain (LBP). This study investigated whether MTT was effective in reducing pain and improving function in patients with subacute or chronic LBP. Data sources were MEDLINE, EMBASE, CINAHL, Pedro, Cochrane Central Register of Controlled Trials. We included RCTs that examined exercise or MTT in adult patients with LBP compared to placebo, no intervention or other interventions. Study outcomes had to include at least one of the following: pain intensity; functional status, absenteeism. Two independent reviewers performed quality assessment. Visual analogue scale ratings ranging from 0-10 MTT quantified the MTT aspects of the intervention. Studies with rating scores >7.5 were included. We identified only 2 studies that examined the effectiveness of MTT. Both trials, one was of high quality, found MTT to decrease pain and improve function significantly better than therapy of uncertain effectiveness. There is moderate evidence that would support the effectiveness of MTT in the treatment chronic LBP. Future high quality RCT will have to clarify whether MTT is effective and would be superior to other forms of therapeutic exercise.

[Postoperative rehabilitation of patients with carpal tunnel syndrome]. / Postoperative Rehabilitation von Patienten mit Karpaltunnelsyndrom.

The purpose of this study was to investigate the effect of mobilisation or splinting on symptoms after surgical Treatment of Carpal Tunnel Syndrome. Only original articles concerning the effect of mobilisation or splinting on symptoms after surgical Treatment of Carpal Tunnel Syndrome were included in this investigation. Concerning these topics only seven original articles were found. There was no significant influence of splinting for several weeks found on the symptom "pain" in the literature. Even there was a delay of returning to activities of daily living and the recovery of fist und keypinch strength through splinting. A program of physiotherapy and ergotherapy lead to a significant shorter recovery of dexterity in comparison to an home exercise program. Even the rehabilitated patients showed a shorter return-to-work interval. After carpal tunnel surgery neither physiotherapy nor splinting lead to a significant release of the symptom "pain". But physiotherapy leads to a shorter recovery of dexterity and shorter return-to-work interval. Due to the lack of knowledge about this topic further controlled clinical studies investigating the rehabilitation process after carpal tunnel surgery would be necessary.

[Aerobic physical training in a breast cancer patient with inflammatory recurrence]. / Aerobes Bewegungstraining bei einer Mammakarzinompatientin mit inflammatorischem Rezidiv.

Aerobic exercise has positive effects on physical performance and illness-related quality of life of cancer patients. However reports of advanced cancer patients who exercise are rare in medical literature. A 38-year-old female patient suffering from breast cancer performed an aerobic exercise program during adjuvant chemotherapy (cycle ergometry, 3x/w). After the diagnosis of relapsed inflammatory breast cancer, oncological treatment was changed to radiation therapy to reduce tumour mass. The patient continued the exercise program until palliative mastectomy. Her compliance was excellent. Despite the underlying progressive disease, endurance performance improved substantially. These findings were supported by a subjective score (Grimby). Evaluation of quality of life (SF-36, EORTC-QLQ-C30) revealed improvements of emotional wellbeing, emotional role, vitality and physical functioning, but increasing pain. The patient reported benefit due to increased psychological, social and physical wellbeing. This case report demonstrates feasibility and benefits of aerobic exercise for a patient with advanced breast cancer undergoing palliative treatment.