Global view of vasomotor symptoms and sleep disturbance in menopause: a systematic review.

Studies have shown racial/ethnic differences in the prevalence of vasomotor symptoms (VMS), sleep disturbance and VMS treatment in menopause. To assess the reproducibility of these differences, we systematically reviewed observational studies, published in 2000-2021, reporting the prevalence/incidence of VMS, sleep disturbance or treatment use in menopausal women stratified by race/ethnicity. We screened 3799 records from PubMed and Embase and included 27 papers (19 studies). No incidence data were found. Prevalence data varied widely, but some common patterns emerged. In all five studies comparing VMS between Black women and White, Hispanic and/or East Asian women, the prevalence was highest in Black women and lowest in East Asian women. The prevalence of sleep disturbance overall was compared among Black, White and East Asian women in two study populations, and was highest in White women in both papers. Sleep disturbance was more common than VMS in East Asian women. In all four studies comparing hormone therapy use between White women and Black and/or East Asian women, treatment use was more common in White women. These results highlight the need for individualized counseling and treatment, outreach to under-served minorities, and standardized definitions and outcome measures for VMS and sleep disturbance for future studies.

Epidemiology of uterine fibroids: a systematic review.

BACKGROUND: Uterine fibroids (UFs) are the most common neoplasm affecting women that can cause significant morbidity and may adversely impact fertility. OBJECTIVES: To examine UF epidemiology and to evaluate the relative strengths of putative risk factors. SEARCH STRATEGY: MEDLINE and Embase were searched for studies published in English between January 1995 and April 2015. SELECTION CRITERIA: Publications reporting relevant data from registries and other observational studies with over 1000 patients and single-centre studies with over 100 patients were selected. DATA COLLECTION AND ANALYSIS: Data on UF incidence, prevalence and associated risk factors were extracted from 60 publications. MAIN RESULTS: Wide ranges were reported in both UF incidence (217-3745 cases per 100 000 women-years) and prevalence (4.5-68.6%), depending on study populations and diagnostic methods. Black race was the only factor that was recurrently reported to increase UF risk, by two-threefold compared with white race. Eleven other factors affected UF risk to a magnitude similar to or greater than race. Age, premenopausal state, hypertension, family history, time since last birth, and food additive and soybean milk consumption increased UF risk; use of oral contraceptives or the injectable contraceptive depot medroxyprogesterone acetate, smoking in women with low body mass index and parity reduced UF risk. CONCLUSIONS: We identified 12 risk factors that play an important role in UF epidemiology. The UF risk factor with the strongest evidence is black race. High-quality prospective observational data are needed to improve our understanding of UF epidemiology, and thus its aetiology and optimal management. TWEETABLE ABSTRACT: Uterine fibroids occur in about 70% of women. Black race and 11 other factors affect uterine fibroid risk.

Long-Term Respiratory Support for Children and Adolescents in Austria: A National Survey.

BACKGROUND: Population-based data on pediatric patients on long-term respiratory support (LTRS) in Austria are lacking. This study aimed to record the pediatric departments active in this field, as well as number and characteristics of patients on LTRS. METHODS: A national cross-sectional study was carried out by means of questionnaires sent to all pediatric departments in Austria. RESULTS: All departments answered to the questionnaires. On June 1st, 2013, the reference day for this study, 12 of the 41 pediatric departments in Austria were active in the field. At this time, these centers were caring for 143 patients, 111 (77.6%) of them under 18 years, which corresponds to a prevalence of 7.4 per 100 000. The patients suffered from neuromuscular disorders (44%), other neurological disorders (18.9%), disorders of respiratory drive (9.1%), obstructive sleep apnea (8.4%), thoracal and spinal diseases (8.4%), pulmonary disorders (4.9%) and other diseases (6.3%). Continuous positive airway pressure was used in 6.3%, non-invasive ventilation in 60.1% and invasive ventilation in 33.6% of the patients, respectively. LTRS was performed at home in 92.3%. CONCLUSION: LTRS represents a common management strategy in children and adolescents with a variety of disorders. Census reports such as this one provide the basis for appropriate planning of resource allocation. The age distribution of our patients shows the need for structured transition into adult care.

Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients.

We investigated the effect of an extended denervation procedure in the thumb carpometacarpal (CMC) joint in patients suffering from CMC osteoarthritis. Between 2006 and 2018, 46 patients underwent the procedure in our clinic and were included in this retrospective study. Pain, strength, range of motion, DASH score, complications and overall satisfaction were determined. Assessment showed a significant decrease in pain and excellent physical function at a median 5 years' follow-up. Twelve patients needed secondary surgery due to persistent pain. Overall, 28 of the 46 patients were satisfied with the results of the denervation. Even though the results of CMC denervation are poorer than with simple trapeziectomy, considerable pain relief can be achieved in selected young, physically active patients by exclusively soft-tissue surgery, conserving the biomechanical properties of the joint. In case of failure of the procedure, all other options remain available.

Cell-free repair of small cartilage defects in the Goettinger minipig: which defect size is possible?

PURPOSE: Cartilage repair of full-thickness chondral defects in the knees of Goettinger minipigs was assessed by treatment with cell-free collagen type-I gel plugs of three different sizes. METHODS: In 6 adult Goettinger minipigs, three full-thickness chondral defects were created in the trochlear groove of one knee of the hind leg. These defects were treated with a cell-free collagen type-I gel plug of 8, 10, or 12 mm diameter. All animals were allowed unlimited weight bearing. After 1 year, the animals were killed. Immediately after recovery, a non-destructive biomechanical testing was performed. The repair tissue quality was evaluated immunohistologically, collagen type-II protein was quantified, and a semiquantitative score (O'Driscoll score) was calculated. RESULTS: After 1 year, a high number of cells migrated into the initially cell-free collagen gel plugs and a hyaline-like repair tissue had been created. The O'Driscoll scores were: 8 mm, 21.2 (SD, 2.8); 10 mm, 21.5 (SD, 1.6); and 12 mm, 22.3 (SD, 1.0). The determination of the e-modulus, creep and relaxation revealed that mechanical properties of the two smaller defects were closer to unaffected hyaline cartilage. CONCLUSIONS: As cell-free collagen type-I gel plugs of all three different sizes created hyaline-like repair tissue, this system seems suitable for the treatment of even larger defects.

Case-control study on risk factors for leukaemia and brain tumours in children under 5 years in Germany.

In the context of a case control study on the cancer risk for children under five by distance to the nearest nuclear power plant, we collected information on other risk factors in a subset. We present the interview study as if it had been an independent study. Parents of 471 cases with Leukaemia, Lymphoma or CNS (Central Nervous System)-tumour from the German Childhood Cancer Registry, diagnosed at age under 5 in the years 1993-2003, and 1,457 matched controls were to be interviewed. For Leukaemia, 243 cases/604 controls, and for CNS 102 cases/246 controls participated, lymphoma cases were too few. Questions related to social status, ionizing radiation, pregnancy and birth, immune system, and selected toxins. The analysis is exploratory in nature; variables were selected by backward elimination. For leukaemia we found a significant protective effect of social contacts (OR=0.50, 95% CI [0.29;0.87]) and a risk for high birth weight (OR=1.96 95% CI [1.12;3.41] comparing >4,000 g to "normal"). We could not reproduce other associations reported in the literature such as a negative association with allergies. For CNS tumours we found a significant protective effect of social contacts (OR=0.30 95% CI [0.13;0.72]), of pesticides and herbicides (OR=0.39 95% CI [0.18;0.83]) and an increased risk for low birth weight (p=0.0232). This study on risk factors for childhood leukaemia and brain tumours is relatively small and exploratory. We could reproduce some major associations reported in the literature (leukaemia: social contacts and high birth weight) but not others. Some observations may be reporting artefacts or self selection artefacts.

In vitro interface and cement mantle analysis of different femur stem designs.

The aim of this study is to define stem design related factors causing both gaps in the metal-bone cement interface and cracks within the cement mantle. Six different stem designs (Exeter; Lubinus SP II; Ceraver Osteal; Mueller-straight stem; Centega; Spectron EF) (n=15 of each design) were cemented into artificial femur bones. Ten stems of each design were loaded, while five stems served as an unloaded control. Physiologically adapted cyclical loading (DIN ISO 7206-4) was performed with a hip simulator. After loading both interfaces and the bone cement itself were analysed regarding gaps and cracks in the cement mantle. Significant differences between the stem designs concerning gaps in the metal-bone cement interface and cracks in the cement mantle became apparent. Additionally, a high correlation between gaps in the metal-bone cement interface and cracks within the cement mantle could be proven. Gaps in the metal-bone cement interface but no cracks within the cement mantle were seen in the unloaded specimens. Differences between the unloaded control groups and the cyclical loaded stems regarding the longitudinal extension and width of gaps in the metal-bone cement interface were obvious. The designs of cemented femoral stems have an influence on both the quality of the metal-bone cement contact and the failure rate of the cement mantle. Less interface gaps and less cement defects were found with anatomically formed, collared, well-rounded stem designs without undercuttings.

A novel rat tail collagen type-I gel for the cultivation of human articular chondrocytes in low cell density.

Collagen type-I matrix systems have gained growing importance as a cartilage repair device. However, most of the established matrix systems use collagen type-I of bovine origin seeded in high cell densities. Here we present a novel collagen type-I gel system made of rat tail collagen for the cultivation of human chondrocytes in low cell densities. Rat tail collagen type-I gel (CaReS, Arthro Kinetics, Esslingen, Germany) was seeded with human passage 2 chondrocytes in different cell densities to evaluate the optimal cell number. In vitro, the proliferation factor of low density cultures was more than threefold higher compared with high density cultures. After 6 weeks of in vitro cultivation, freshly prepared chondrocytes with an initial cell density of 2x10(5) cells/mL showed a proliferation factor of 33. A cell density of 2x10(5) cells/mL was chosen for in vitro and in vivo cultivation using the common nude mouse model as an in vivo system. Chondrocytes stayed viable as a Live/Dead fluorescence assay and TUNEL staining revealed. During in vitro cultivation, passage 0 cells partly dedifferentiated morphologically. In vivo, passage 0 cells maintained the chondrocyte phenotype and demonstrated an increased synthesis of collagen type-II protein and gene expression compared to passage 2 cells. Passage 2 cells did not redifferentiate in vivo. Cultivating a cell-seeded collagen gel of bovine origin as a control (AtelocollagenTM, Koken, Tokyo, Japan) did not lead to superior results with regard to cell morphology, col-II protein production and col-II gene expression. With the CaReS collagen gel system the best quality of repair tissue was obtained by seeding freshly isolated chondrocytes.

In vivo cultivation of human articular chondrocytes in a nude mouse-based contained defect organ culture model.

The nude mouse model is an established method to cultivate and investigate tissue engineered cartilage analogues under in vivo conditions. One limitation of this common approach is the lack of appropriate surrounding articular tissues. Thus the bonding capacity of cartilage repair tissue cannot be evaluated. Widely applied surgical techniques in cartilage repair such as conventional and three-dimensional autologous chondrocyte implantation (ACI) based on a collagen gel matrix cannot be included into nude mouse studies, since their application require a contained defect. The aim of this study is to apply an organ culture defect model for the in vivo cultivation of different cell-matrix-constructs. Cartilage defects were created on osteochondral specimens which had been harvested from 10 human knee joints during total knee replacement. Autologous chondrocytes were isolated from the cartilage samples and cultivated in monolayer until passage 2. On each osteochondral block defects were treated either by conventional ACI or a collagen gel seeded with autologous chondrocytes, including a defect left empty as a control. The samples were implanted into the subcutaneous pouches of nude mice and cultivated for six weeks. After retrieval, the specimens were examined histologically, immunohistochemically and by cell morphology quantification. In both, ACI and collagen gel based defect treatment, a repair tissue was formed, which filled the defect and bonded to the adjacent tissues. The repair tissue was immature with low production of collagen type II. In both groups redifferentiation of chondrocytes remained incomplete. Different appearances of interface zones between the repair tissue and the adjacent cartilage were found. The presented contained defect organ culture model offers the possibility to directly compare different types of clinically applied biologic cartilage repair techniques using human articular tissues in a nude mouse model.

[In vivo imaging of the conjunctival epithelium using confocal laser scanning microscopy]. / In-vivo-Darstellung des Bindehautepithels. Eine vergleichende morphologische Untersuchung mittels konfokaler Laser-Scanning-Mikroskopie und Impressionszytologie.

BACKGROUND: In various ocular diseases, cytomorphological findings of the ocular surface are an essential component of clinical diagnostics. When evaluating the conjunctival epithelium, minimally invasive acquisition of biomaterial is necessary for lab and technical processing and in vitro histological examination. To examine corneal structures in vivo, confocal laser scanning microscopy is a successful standard method. Our aim was to employ in vivo confocal laser scanning microscopy also for examining the conjunctival epithelium. MATERIAL AND METHOD: Results were analyzed and compared with cytomorphological findings of impression cytology. Accordingly, the basic features of conjunctival in vivo examination using RLSM were described and defined. In vivo images were analyzed and compared with impression cytological slide preparations (n=110) of 23 healthy test persons. Examination was standardized. Finally, the confocal laser scan images were compared to the impression cytological patterns. RESULTS: Due to the distribution of reflectors (pixel brightness), diagnostic analysis of important morphological structures (cell nucleus, cytoplasm, nucleus/plasma relation) of the conjunctiva is possible. Secretory cells of the epithelium (goblet cells) can be easily recognized by their size. Highly reflective pixels depict cell walls or wide intercellular spaces with high contrast. CONCLUSIONS: The in vivo investigation of important anatomical and morphological structures of the conjunctival epithelium is possible using RLSM. The distribution pattern of goblet cell pixel brightness may correlate with various secretion contents or suggest distinct, recognizable, functional conditions (hypo- or hypersecretion).

[Liver laceration following a kick in a soccer game]. / Leberruptur nach einem Fusstritt im Fussballspiel.

Severe intraabdominal injuries in soccer are very rare. We present the case of an 18 year old soccer player who suffered from a grad IV liver laceration following a kick during a soccer game. After primary explorative laparatomy and liver packing in a hospital nearby the patient was transferred to our clinic. Following CT scan the injury was treated by suture of liver parencym lacerations, argon laser coagulation and pile duct repair. In soccer severe intraabdominal injuries should be expected following players collision at high velocity or kicking with the foot or the knee.

[The injury pattern following the introduction of the junior premier league in Germany compared to professional senior football (soccer)]. / Das Verletzungsmuster nach Einführung der A-Junioren-Fussball-Bundesliga in Deutschland im Vergleich zum Senioren-Profi-Fussball.

In 2003 the junior soccer premier league (U19) has been introduced in Germany to increase the competitive level in this group of age (16 - 18 years). It is the aim of this study to compare the injury pattern accompanying this new league of semi-professional junior soccer with a professional senior team. In a retrospective study all traumatic and overuse injuries, responsible for absence from practice or matches, which occurred in two seasons of one junior premier league team were recorded and analyzed. These data were compared to the injury pattern of a professional senior team based on a one-season survey. Overall, more traumatic than overuse injuries were seen. The lower extremity was predominantly affected by both. The ankle joint was the most injured joint. An injury rate of 2.89 per 1000 hours of soccer was calculated for the juniors and 2.35 for the seniors. Junior players missed 15.8 days and seniors 17.1 days of practice or match as result of an injury. Semi-professional junior and professional senior soccer share the same injury patterns with regard to injury rates and types of injuries. Therefore a professional medical care with special emphasis on prophylaxis is warranted in semi-professional junior soccer.

[Risk of injury in and adolescent and junior competitive karate]. / Das Verletzungsrisiko im Jugend- und Juniorenwettkampfkarate.

Increasing professionalism in competitive karate has led to a specific injury pattern. The aim of our study was to investigate the injury pattern in junior competitive karate and to evaluate the prophylactic effect of fist padding. During the 4 (th) Junior World Championships of the World Karate Confederation (WKC) 2004 235 karate fights were observed and injury-related data were recorded. Fist padding was used in 183 fights, 52 fights were carried out without. In 22 % of all fights we saw an injury. Most of them were mild injuries of the head and face: 32 bruises of the face (13 with epistaxis), 7 facial lacerations and 3 concussions (mild brain injury). 14 fights were stopped due to an injury. Only in the category male 18 - 20 years a higher rate of injuries was seen without fist padding (shobu ippon) compared to shobu sanbon (with fist padding). The injury pattern of junior competitive karate is comparable to senior karate. Fist padding does not generally reduce the incidence or severity of injuries.

Gastrointestinal complications after cardiac surgery.

From 1975 to 1985, a total of 1596 coronary artery bypasses or valve replacements resulted in 18 gastrointestinal tract complications in 16 patients at Good Samaritan Hospital in Cincinnati. Twelve patients were treated surgically (hemorrhagic duodenal ulcer, one patient; perforated duodenal ulcer, one patient; cholecystitis: acalculous, gangrenous, two patients, and calculus, one patient; perforated cecum, one patient; ischemic colitis, one patient; and perforated diverticulitis of the colon, five patients). Six patients were treated conservatively by either nasogastric intubation or nothing by mouth and intravenous therapy (ileus, three patients; acute sigmoid diverticulitis, one patient; and active peptic ulcer disease, two patients). Multisystem failure caused two deaths. The etiology of hollow viscus complications seems to be related to a low-flow state, impairing normal tissue perfusion that can initiate an ischemic change. This change can lead to acute inflammation, perforation, or both or late stricture. When evidence of an acute abdominal disorder is observed or when conservative treatment falls to alleviate symptoms, prompt surgical intervention should be performed.

Severe hemolysis after incomplete mitral valve repair.

We report 2 cases of severe intravascular hemolysis after mitral valve repair using a Duran annuloplasty ring. In both patients residual mitral regurgitation was present, hemolysis was severe enough to warrant a second operation, and hemolysis ceased immediately after the second operation. We believe that a high-velocity regurgitant jet directed toward the cloth-covered annuloplasty ring was responsible for the hemolysis in both patients.

Severity of intrathoracic injuries associated with first rib fractures.

The benign condition of isolated first rib fracture is compared with the severity of intrathoracic injuries resulting from first rib fracture associated with multiple rib injuries. Seventy-five patients with 90 first rib fractures were divided into two groups. Group 1 (n = 13) included those with isolated first rib fractures and Group 2 (n = 62), those with first-rib fractures associated with multiple rib injuries. In Group 1 patients, intrathoracic injuries were mild with no major vascular injuries. Conversely, Group 2 patients sustained severe intrathoracic injury, 58% of them with aortic injury. Stress is placed on early diagnosis, assigning of priority to associated injuries, and early operative intervention.

Effect of protracted intermittent fasting on the activities of enzymes involved in energy metabolism, and on the concentrations of glycogen, protein and DNA in skeletal muscle of obese women.

In the quadriceps femoris muscle of obese women the glycogen concentration was significantly lower than in the control group, while protein and DNA values showed no significant differences. After 37 days of intermittent fasting, which consisted of repeated 5-day fasts alternating with 3-day intervals on 500 KCal/day with 60 g protein, in a group of 21 obese women a significant decline of the hexokinase activity in skeletal muscle was found. Other enzymes: triosophosphate dehydrogenase, lactate dehydrogenase, glycerol-3-phosphate dehydrogenase, citrate synthase, malate dehydrogenase and hydroxyacyl-CoA dehydrogenase showed no significant changes. There was a significant fall in concentration of DNA and and glycogen, but the protein concentration did not change.

Cartridge cracks during foldable intraocular lens insertion.

PURPOSE: To assess the incidence of cartridge cracks during foldable intraocular lens (IOL) insertion and to determine factors that play a role in the development of these cracks. SETTING: Leesburg Regional Ambulatory Surgical Care Center, Leesburg, Florida, USA. METHODS: Small incision cataract surgery was performed in 350 consecutive cases. A foldable silicone IOL (Allergan Medical Optics SI-40) was inserted in all cases using the Unfolder cartridge and 3 viscoelastic agents: sodium hyaluronate (Healon, Vitrax) and sodium chondroitin sulfate-sodium hyaluronate (Viscoat). RESULTS: Cartridge cracks occurred in 52 eyes (14.86%). Almost all cracks (98.1%) occurred in cases in which Healon was used to load the IOL. In each case of a cracked cartridge, there was evidence of the plunger overriding the optic edge. CONCLUSIONS: We recommend the use of chondroitin-based viscoelastic agents to load the SI-40 foldable IOL to minimize the risk of cartridge cracks. Modifications in the design of the IOL inserter may eliminate the problem of cartridge cracks.

Predictors of lung function in infants at high risk of atopy: effect of allergen avoidance.

Children of atopic parents are recognised as being at higher risk of developing bronchial asthma, drawing the attention of prevention strategies towards this population. Due to recent advances, lung function abnormalities in asthmatic children may now be measured early in life. The aim ofthis investigation was to examine possible predictors of lung function development in a sub sample of high-risk infants who took part in an allergy avoidance study In 60 babies of atopic parents, measurements of upper airways inflammation were performed at 4 weeks of age, respiratory symptoms were assessed at 6 and 12 months of age, and lung function (Vmax, FRC) was measured at 18 months by the rapid thoracoabdominal compression technique. Twenty-eight babies were enrolled in an allergen avoidance program, and 32 recruited as controls. No significant differences were detected for V'max,FRC between the intervention group (mean 331 ml s(-1)) and the control group (359 ml s(-1)), P = 0.382. A multiple linear regression model could explain levels of V'max FRC by weight gain since birth (beta = -35.35 ml s(-1) kg(-1), P = 0.022) and by eosinophilic cationic protein (ECP) (beta = -0.95 ml s(-1) microl(-1), P = 0.044), but not by intervention. Lung function measured at the age of 18 months in high-risk children is associated with weight gain and nasal ECF.

Lipid peroxidation in acute falciparum malaria.

Lipid peroxidation was assessed by measuring malondialdehyde (MDA) in 30 patients with falciparum malaria and 20 controls (10 healthy adults and 10 patients of vivax malaria). Mean serum MDA was 0.96 +/- 0.38 nmol/ml, 1.1 +/- 0.17 nmol/ml and 2.9 +/- 1.1 nmol/ml in healthy controls, disease controls and falciparum malaria patients, respectively. Levels were significantly high (P less than 0.001) in patients with falciparum malaria. Higher values were associated with more number of complications and deaths.