Eight weeks of high-intensity interval training versus stretching do not change the psychoneuroendocrine response to a social stress test in emotionally impulsive humans.

PURPOSE: Research supports physical activity as a method to heighten stress resistance and resilience through positive metabolic alterations mostly affecting the neuroendocrine system. High-intensity interval training (HIIT) has been proposed as a highly effective time-saving method to induce those changes. However, existing literature relies heavily on cross-sectional analyses, with few randomised controlled trials highlighting the necessity for more exercise interventions. Thus, this study aims to investigate the effects of HIIT versus an active control group on the stress response to an acute psychosocial stressor in emotionally impulsive humans (suggested as being strong stress responders). METHODS: The study protocol was registered online (DRKS00016589) before data collection. Sedentary, emotionally impulsive adults (30.69 ± 8.20 y) were recruited for a supervised intervention of 8 weeks and randomly allocated to either a HIIT (n = 25) or a stretching group (n = 19, acting as active controls). Participants were submitted to a test battery, including saliva samples, questionnaires (self-efficacy- and perceived stress-related), visual analogue scales (physical exercise- and stress-related), and resting electroencephalography and electrocardiography assessing their reaction to an acute psychological stressor (Trier Social Stress Test) before and after the exercise intervention. RESULTS: HIIT increased aerobic fitness in all participants, whereas stretching did not. Participants from the HIIT group reported perceiving exercising more intensively than those from the active control group (ƞp2 = 0.108, p = 0.038). No further group differences were detected. Both interventions largely increased levels of joy post-TSST (ƞp2 = 0.209, p = 0.003) whilst decreasing tension (ƞp2 = 0.262, p < 0.001) and worries (ƞp2 = 0.113, p = 0.037). Finally, both interventions largely increased perceived levels of general self-efficacy (ƞp2 = 0.120, p = 0.029). CONCLUSION: This study suggests that 8 weeks of HIIT does not change the psychoneuroendocrine response to an acute psychological stress test compared to an active control group in emotionally impulsive humans. Further replications of supervised exercise studies highly powered with active and passive controls are warranted.

The MoxFo initiative-Mechanisms of action: Biomarkers in multiple sclerosis exercise studies.

BACKGROUND: As exercise exerts neurobiological and immunomodulatory effects, it might also act as a disease-modifying intervention in MS. However, a clear mechanistic link between exercise and disease-modifying effects in MS has yet to be established. OBJECTIVE: Establish recommendations for future mechanistic exercise studies in MS. METHODS: In regular meetings, members of the mechanisms of action group within the MoXFo (Moving eXercise research Forward in MS) initiative evaluated gaps of knowledge and discussed unmet needs in mechanistic MS research. RESULTS: We concluded that biomarkers assessed in translational studies in humans and animals are essential to decipher the underlying mechanisms of exercise in MS. Consequently, we defined clear definitions of different types of biomarkers examined in MS exercise studies and operationalized their use to align with the research question and optimal testing time points. Furthermore, we provide key considerations to improve the rigor of translational studies and defined minimal reporting criteria for animal studies. CONCLUSION: The resulting recommendations are intended to improve the quality of future mechanistic exercise studies in MS and consequently lead to a better understanding of therapeutic approaches.

Different endurance exercises modulate NK cell cytotoxic and inhibiting receptors.

PURPOSE: Induction of IDO depends on the activation of AhR forming the AhR/IDO axis. Activated AhR can transcribe various target genes including cytotoxic and inhibiting receptors of NK cells. We investigated whether AhR and IDO levels as well as activating (NKG2D) and inhibiting (KIR2DL1) NK cell receptors are influenced by acute exercise and different chronic endurance exercise programs. METHODS: 21 adult breast and prostate cancer patients of the TOP study (NCT02883699) were randomized to intervention programs of 12 weeks of (1) endurance standard training or (2) endurance polarized training after a cardiopulmonary exercise test (CPET). Serum was collected pre-CPET, immediately post-CPET, 1 h post-CPET and after 12 weeks post-intervention. Flow cytometry analysis was performed on autologous serum incubated NK-92 cells for: AhR, IDO, KIR2DL1 and NKG2D. Differences were investigated using analysis-of-variance for acute and analysis-of-covariance for chronic effects. RESULTS: Acute exercise: IDO levels changed over time with a significant increase from post-CPET to 1 h post-CPET (p = 0.03). KIR2DL1 levels significantly decreased over time (p < 0.01). NKG2D levels remained constant (p = 0.31). Chronic exercise: for both IDO and NKG2D a significant group × time interaction, a significant time effect and a significant difference after 12 weeks of intervention were observed (IDO: all p < 0.01, NKG2D: all p > 0.05). CONCLUSION: Both acute and chronic endurance training may regulate NK cell function via the AhR/IDO axis. This is clinically relevant, as exercise emerges to be a key player in immune regulation.

The German Three Factor Impulsivity Index: Confirmatory factor analysis and ties to demographic and health-related variables.

A growing body of research has focused on the differentiation of emotion-related versus non-emotion-related impulsivity, assessed by the Three-Factor Impulsivity (TFI) index. The goal of this study is to develop a German TFI index, and to validate the emotion-related impulsivity subscales against indices of substance abuse, physical or psychological disorder, physical exercise, BMI, and hours of sleep. 395 native-German speakers completed the German TFI index and questions on validity indicators online. Factor analyses supported the three-factor structure, including Pervasive Influence of Feelings, Lack of Follow Through, and Feelings Trigger Action. Correlations between factors were higher than in the original work. Both emotion-related impulsivity subscales correlated significantly with psychological disorder, engagement in and minutes of physical exercise per week. When included in multivariate regression models, the three factors explained 3.1%, and 29.2% of variance in amount of exercise per week and psychological disorder, respectively. In sum, findings indicated that the German TFI index has a robust three-factor structure that showed expected links to validity indicators, and novel effects in relation to physical exercise.

Effects of exercise training on multiple sclerosis biomarkers of central nervous system and disease status: a systematic review of intervention studies.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS) that can be tracked through biomarkers of disease status. We investigated the effects of exercise on MS biomarkers associated with CNS status including imaging, blood-brain barrier (BBB) function and neurotrophic factors. METHODS: We conducted open-dated searches of Scopus, Medline, EMBASE and the Cochrane Library. We included studies written in English describing interventions of exercise that measured one or more of the biomarkers associated with MS published up to October 2018. RESULTS: We located a total of 3012 citations through searches in electronic databases. Of these, 16 studies were eligible for review; six studies focused on magnetic resonance imaging (MRI) markers, nine studies focused on neurotrophic factors and three studies focused on BBB function markers. It is of note that two studies included both neurotrophic factor and BBB function markers and are therefore included across categories of biomarkers in this review. The existing evidence from MRI studies confirmed that exercise training can improve CNS integrity and function. There is evidence of a positive effect of exercise training on modulation of BBB permeability markers and brain-derived neurotrophic factor. CONCLUSIONS: Exercise successfully improves MRI outcomes and peripheral biomarkers (i.e. brain-derived neurotrophic factor) in people with MS. This suggests that exercise can be recommended as an adjuvant therapy for MS treatment. This conclusion is tempered by some methodological limitations including small sample sizes and high drop-out rates in the reviewed studies.

Proposed attributes of national wildlife health programmes.

Wildlife health is important for conservation, healthy ecosystems, sustainable development and biosecurity. It presents unique challenges for national programme governance and delivery because wildlife health not only crosses jurisdictional responsibilities and authorities but also inherently spans multiple sectors of expertise. The World Organisation for Animal Health (OIE) encourages its Members to have wildlife disease monitoring and notification systems. Where national wildlife health surveillance programmes do exist, they vary in scope and size. Evidence-based guidance is lacking on the critical functions and roles needed to meet the OIE's recommendations and other expectations of a national programme. A literature review and consultation with national wildlife health programme leaders identified five key attributes of national programmes: 1) being knowledge and science based; 2) fostering cross-nation equivalence and harmonisation; 3) developing partnerships and national coordination; 4) providing leadership and administration of national efforts; and 5) capacity development. Proposed core purposes include: 1) establishment and communication of the national wildlife health status; 2) leading national planning; 3) centralising information and expertise; 4) developing national networks leading to harmonisation and collaborations; 5) developing wildlife health workforces; and 6) centralising administration and management of national programmes. A national wildlife health programme should aim to identify, effectively communicate and manage the risk to or from a country's wildlife populations. It should generate the appropriate knowledge required to improve the effectiveness of wildlife policies and systems, including identifying and assessing emerging priorities, thus facilitating early warning, preparedness and preventive actions.

La santé de la faune sauvage a un impact important sur la préservation des espèces et d'écosystèmes sains, sur le développement durable et sur la biosécurité. Les défis sont nombreux et complexes pour les programmes nationaux de gouvernance et de mise en oeuvre car les responsabilités et les compétences juridictionnelles sont croisées et les secteurs d'expertise sont multiples. L'Organisation mondiale de la santé animale (OIE) encourage ses Membres à mettre en place des systèmes de notification et de surveillance des maladies de la faune sauvage. Les programmes existants sont de tailles et de compétences variables et les orientations prises concernant les fonctions indispensables pour répondre aux recommandations de l'OIE et à ce qui est attendu d'un programme national ne sont pas toujours déterminées sur une base scientifique. Une revue de la littérature et des consultations auprès de responsables des programmes nationaux de santé de la faune sauvage ont permis d'identifier cinq attributs à proposer pour ces programmes nationaux. Ces programmes doivent :1) fonctionner sur la base de données scientifiques ; 2) favoriser l'équivalence et l'harmonisation transnationales ; 3) développer des partenariats et une coordination à l'échelle nationale ; 4) encadrer et administrer les efforts nationaux ; et 5) assurer le renforcement des capacités. Les missions essentielles sont : 1) déterminer et rendre publique la situation sanitaire de la faune sauvage dans le pays ; 2) encadrer le plan national ; 3) centraliser l'information et l'expertise ; 4) développer les réseaux nationaux d'harmonisation et de collaboration ; 5) former des personnels compétents dans le domaine de la faune sauvage ; et 6) centraliser l'administration et la gestion des programmes nationaux. Les objectifs d'un programme national de santé de la faune sauvage sont d'identifier, de rendre publics et de gérer les risques pour les populations d'animaux sauvages ainsi que les risques générés par ces mêmes populations. Ces programmes doivent promouvoir les connaissances nécessaires pour améliorer l'efficacité des politiques et des systèmes applicables à la faune sauvage, en particulier l'identification et l'évaluation des nouvelles priorités afin de faciliter la mise en oeuvre de systèmes d'alerte précoce, de préparation aux urgences et d'action préventive.

La salud de los animales silvestres, tan importante para la conservación del medio, el buen funcionamiento de los ecosistemas, el desarrollo sostenible y la seguridad biológica, presenta singulares dificultades desde el punto de vista de la gobernanza y aplicación de programas nacionales, dado que la fauna silvestre no solo toca a múltiples responsabilidades y atribuciones jurisdiccionales sino que, por su propia naturaleza, convoca a una plétora de especialidades técnicas. La Organización Mundial de Sanidad Animal (OIE) alienta a sus Miembros a que se doten de sistemas de vigilancia y notificación de enfermedades de la fauna silvestre. Allí donde existen, los programas nacionales en la materia son muy variopintos en cuanto a sus dimensiones y alcance. Faltan pautas científicamente sólidas sobre las funciones y atribuciones básicas que se requieren para cumplir las recomendaciones de la OIE y otras expectativas a las que pueda responder un programa nacional. Tras efectuar un estudio bibliográfico y consultar a los directivos de programas nacionales en la materia, los autores determinaron cinco atributos clave que debe reunir todo programa nacional: 1) estar basado en el saber y la ciencia; 2) favorecer la equivalencia y la armonización entre naciones; 3) crear alianzas y mecanismos de coordinación nacional; 4) encabezar y administrar las actividades a escala nacional; y 5) desarrollar los medios de acción del país. Los objetivos básicos propuestos son: 1) determinar y dar a conocer la situación sanitaria de la fauna silvestre del país; 2) dirigir las labores de planificación a escala nacional; 3) centralizar la información y las competencias especializadas; 4) instituir redes nacionales que propicien la armonización y las iniciativas de colaboración; 5) desarrollar los recursos humanos dedicados a la sanidad de la fauna silvestre; y 6) centralizar la gestión y administración de los programas nacionales. Todo programa nacional de sanidad de la fauna silvestre debe responder a la finalidad de detectar, comunicar eficazmente y gestionar los riesgos que amenacen a las poblaciones de animales silvestres del país o que provengan de ellas. A tal efecto debe generar el conocimiento adecuado y necesario para conferir más eficacia a las políticas y sistemas tocantes a la fauna silvestre, lo que supone, entre otras cosas, determinar y evaluar las nuevas prioridades, facilitando con ello la alerta anticipada y las labores de preparación y prevención.

Physical exercise and epigenetic adaptations of the cardiovascular system.

During the last decade, epigenetics became one of the fastest growing research fields in numerous clinical and basic science disciplines. Evidence suggests that chromatin modifications (e.g., histone modifications and DNA methylation) as well as the expression of micro-RNA molecules play a crucial role in the pathogenesis of several cardiovascular diseases. On the one hand, they are involved in the development of general risk factors like chronic inflammation, but on the other hand, epigenetic modifications are conducive to smooth muscle cell, cardiomyocyte, and endothelial progenitor cell proliferation/differentiation as well as to extracellular matrix processing and endothelial function (e.g., endothelial nitric oxide synthase regulation). Therefore, epigenetic medical drugs have gained increased attention and provided the first promising results in the context of cardiovascular malignancies. Beside other lifestyle factors, physical activity and sports essentially contribute to cardiovascular health and regeneration. In this review we focus on recent research proposing physical activity as a potent epigenetic regulator that has the potential to counteract pathophysiological alterations in almost all the aforementioned cardiovascular cells and tissues. As with epigenetic medical drugs, more knowledge about the molecular mechanisms and dose-response relationships of exercise is needed to optimize the outcome of preventive and rehabilitative exercise programs and recommendations.

Exercise-induced Natural Killer Cell Activation is Driven by Epigenetic Modifications.

Exercise has been proven to reduce the risk and progression of various diseases, such as cancer, diabetes and neurodegenerative disorders. Increasing evidence suggests that exercise affects the cytokine profile and changes distribution and function of tumor-competitive immune cells. Initial studies have shown that different exercise interventions are associated with epigenetic modifications in different tissues and cell types, such as muscle, fat, brain and blood. The present investigation examines the effect of an intense endurance run (half marathon) on global epigenetic modifications in natural killer (NK) cells in 14 cancer patients compared to 14 healthy controls. We were able to show that histone acetylation and NKG2D expression, a functional NK cell marker, were elevated for at least 24 h after the run. Thus, this is the first study to present a potential mechanism of how exercise may impact NK cell activity on the subcellular level. Further studies should focus on epigenetic mechanisms and dose-dependent effects of exercise.

[Chemotherapy-induced Peripheral Neuropathy]. / Chemotherapie-induzierte Polyneuropathie.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and relevant side effect of antineoplastic agents such as cisplatin, paclitaxel, vincristine and bortezomib. Over the last years, significant progress has been achieved in elucidating the underlying pathomechanisms of CIPN using both in vivo and in vitro models. These studies suggest that mitochondrial toxicity, disturbed axonal transport, toxic effects on Schwann cells and activation of the immune system contribute to the pathogenesis of CIPN. This review provides an overview of the current pathogenetic concepts of CIPN. In addition, experimental approaches that aim at preventing or ameliorating neurotoxic effects of antineoplastic agents are discussed.

[Colonization-outbreak of two clonally different strains of Serratia marcescens in a neonatal intensive care unit]. / Kolonisationsausbruch mit zwei klonal unterschiedlichen Stämmen von Serratia marcescens auf einer neonatologischen Intensivstation.

We describe an outbreak of two clonally different strains of Serratia marcescens in a neonatal intensive care unit. Three colonization cases in the first outbreak phase were related to contact transmission from an index patient during emergency respiratory treatment while eight colonizations in the second phase were caused by contaminated bathing lotion. All transmissions resulted in colonization only and no infections were recorded. Based on our experience and the literature review sufficient staffing levels, basic hygiene and a goal-directed investigation of the environment are the cornerstones of a rapid outbreak termination. The epidemiological search for parallels in cases should be assisted by sophisticated electronic records.

Structural changes under low evolutionary constraint may decrease the affinity of dibenzoylhydrazine insecticides for the ecdysone receptor in non-lepidopteran insects.

Understanding how variations in genetic sequences are conveyed into structural and biochemical properties is of increasing interest in the field of molecular evolution. In order to gain insight into this process, we studied the ecdysone receptor (EcR), a transcription factor that controls moulting and metamorphosis in arthropods. Using an in silico homology model, we identified a region in the lepidopteran EcR that has no direct interaction with the natural hormone but is under strong evolutionary constraint. This region causes a small indentation in the three-dimensional structure of the protein which facilitates the binding of tebufenozide. Non-Mecopterida are considered much older, evolutionarily, than Lepidoptera and they do not have this extended cavity. This location shows differences in evolutionary constraint between Lepidoptera and other insects, where a much lower constraint is observed compared with the Lepidoptera. It is possible that the higher flexibility seen in the EcR of Lepidoptera is an entirely new trait and the higher constraint could then be an indication that this region does have another important function. Finally, we suggest that Try123, which is evolutionarily constrained and is up to now exclusively present in Lepidoptera EcRs, could play a critical role in discriminating between steroidal and non-steroidal ligands.

[Molecular mechanisms of exercise-induced cardiovascular adaptations. Influence of epigenetics, mechanotransduction and free radicals]. / Molekulare Mechanismen der Herz- und Gefäßanpassung durch Sport. Einfluss von Epigenetik, Mechanotransduktion und freien Radikalen.

The description of mechanisms underlying exercise-induced heart and vascular bed adaptations reveals and highlights the significance of different mechanical and metabolic stimuli that possibly evoke various short-term and long-term regulations and adaptations of these tissues. In this brief review the molecular mechanisms mediated by free radicals and/or mechanical stimulation and, are therefore involved in the modulation of the extracellular matrix and epigenetics-based regulation of the functional genome will be discussed. In the heart and the vascular bed free radicals play important roles in physiological and pathophysiological processes. Exercise leads on the one hand to increased free radicals but on the other hand improves the antioxidative capacity. This phenomenon shifts the cellular oxidative stress balance and also a variety of signal cascades that mediate physiological and pathophysiological heart and vascular bed adaptations. A similar great significance can be attributed to mechanical stimulation which directly or indirectly influences a variety of signaling cascades. It was demonstrated that exercise alters the molecular composition and architecture of the extracellular matrix which in turn plays an important role in the regulation of different mechanical stimuli-mediating signaling cascades. These alterations in the molecular composition and architecture of the extracellular matrix are of high significance for cellular adaptation processes, possibly also in the sense of epigenetic modulations that are actually only indirectly linked to exercise in cardiovascular tissues. However, there is growing evidence that epigenetic modulations mediated by exercise and physical activity can provoke modifications of the functional genome in heart and vascular beds, comparable to already well-described phenomena, e.g. diet or inflammation.

Anomalous percolation features in molecular evolution.

Self-replication underlies every species of living beings and simple physical intuition dictates that some sort of autocatalysis invariably constitutes a necessary ingredient for the emergence of molecular life. This led Worst et al. [E. G. Worst, P. Zimmer, E. Wollrab, K. Kruse, and A. Ott, New J. Phys. 18, 103003 (2016)NJOPFM1367-263010.1088/1367-2630/18/10/103003] to study a model of molecular evolution of self-replicating molecules where spontaneous ligation and simple autocatalysis are in competition for their building blocks. We revisit this model, where irreversible aggregation leads to a transition from a regime of small molecules to macromolecules, and find an array of anomalous percolation features, some of them predicted for very specific percolation processes [R. M. D'Souza and J. Nagler, Nat. Phys. 11, 531 (2015)1745-247310.1038/nphys3378].

The effects of exercise intensity and post-exercise recovery time on cortical activation as revealed by EEG alpha peak frequency.

Acute physical exercise (APE) induces an increase in the individual alpha peak frequency (iAPF), a cortical parameter associated with neural information processing speed. The aim of this study was to further scrutinize the influence of different APE intensities on post-exercise iAPF as well as its time course after exercise cessation. 95 healthy young (18-35 years) subjects participated in two randomized controlled experiments (EX1 and EX2). In EX1, all participants completed a graded exercise test (GXT) until exhaustion and were randomly allocated into different delay groups (immediately 0, 30, 60 and 90 min after GXT). The iAPF was determined before, immediately after as well as after the group-specific delay following the GXT. In EX2, participants exercised for 35 min at either 45-50%, 65-70% or 85-90% of their maximum heart rate (HRmax). The iAPF was determined before, immediately after as well as 20 min after exercise cessation. In EX1, the iAPF was significantly increased immediately after the GXT in all groups. This effect was not any more detectable after 30 min following exercise cessation. In EX2, a significant increase of the iAPF was found only after high-intensity (85-90% HRmax) exercise. The results indicate intense or exhaustive physical exercise is required to induce a transient increase in the iAPF that persists about 30 min following exercise cessation. Based on these findings, further research will have to scrutinize the behavioral implications associated with iAPF modulations following exercise.

Impact of aerobic exercise training during chemotherapy on cancer related cognitive impairments in patients suffering from acute myeloid leukemia or myelodysplastic syndrome - Study protocol of a randomized placebo-controlled trial.

Cancer related cognitive impairments (CRCI) are frequently reported by patients prior to, during and after medical treatment. Although this cognitive decline severely affects patients' quality of life, little is known about effective treatments. Exercise programs represent a promising supportive strategy in this field. However, evidence is sparse and existing studies display methodological limitations. In the planned study, 83 men and women newly diagnosed with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) will be randomized into one of three treatment groups. During 4weeks of induction chemotherapy with Anthracycline and Cytarabin patients allocated to exercise group will cycle 3×/week for 30min at moderate to vigorous intensity on an ergometer. Patients allocated to placebo group will receive a supervised myofascial release training (3×/week, approx. 30min) and patients at control group will get usual care. As primary endpoints a cognitive test battery will be conducted measuring performances depending on verbal/spatial memory and executive functioning. Secondary endpoints will be self-perceived cognitive functioning, as well as neurotrophic and inflammatory serum markers. All assessments will be conducted immediately after hospitalization and before chemotherapy is commenced, immediately before discharge of hospital after 4-5weeks as well as before continuing medical treatment 3-4weeks after discharge. This will be the first study investigating the impact of an aerobic exercise training on CRCI in AML/MDS patients. We hope that the study design and the state-of-the-art assessments will help to increase knowledge about CRCI in general and exercise as potential treatment option in this under investigated population.

Carbohydrate-deficient glycoprotein syndrome (CDGS)--glycosylation, folding and intracellular transport of newly synthesized glycoproteins.

Carbohydrate-deficient glycoprotein syndrome (CDGS) is a hereditary glycosylation disorder of unknown origin. In this study we used skin fibroblasts from patients with CDGS to study the glycosylation of three well characterized glycoproteins using gel mobility analysis, endoglycosidase treatments and protein folding studies. We show that glycoprotein transport along the secretory pathway was delayed. Dilation of the rough endoplasmic reticulum indicated a retention phenomenon for selected glycoproteins. However, for all examined glycoproteins cotranslational glycosylation in CDGS fibroblasts was normal.

B cell development in mice.

The development and establishment of the B Cell Repertoire is the net result of both genetic and environmental forces. The primary event at the genetic level is Ig gene rearrangement resulting in numerous possible combination of genes which can be further modified by somatic events such as N segment addition and somatic mutation. Environmental forces in the form of self and exogenous Ags also shape the repertoire by positively or negatively selecting B cells according to the specificity of their Ig receptors. These are dynamic processes beginning with the earliest expression of immunoglobulins in fetal life and continuing throughout life. In this review we discuss the genetic and selective mechanisms responsible for differences in the early immune system compared to that of the adult.

Prospective randomized trial of talc slurry vs bleomycin in pleurodesis for symptomatic malignant pleural effusions.

OBJECTIVE: Symptomatic malignant pleural effusions are common sequelae in patients with certain malignancies. Pleurodesis via bedside thoracostomy is the current treatment option most commonly used. To our knowledge, this is the first prospective randomized trial to examine which agent, bleomycin or talc slurry, is superior in terms of effectiveness, safety, and cost. PATIENTS AND METHODS: Between July 1992 and March 1995, 35 patients presenting to our medical center with symptomatic malignant pleural effusions were prospectively randomized to undergo chemical pleurodesis with either bleomycin or talc slurry via bedside thoracostomy. The conditions of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs. RESULTS: Twenty-nine patients who underwent 33 treatments (14 with bleomycin and 19 with talc) were available for follow-up. Follow-up ranged from 2 weeks to 8 months (mean, 1.7 months). Both groups demonstrated notable improvement in both pain and dyspnea following treatment, but there were no statistically significant differences between groups in the amount of improvement (two-tailed Student's t test). Permanent control of effusions, defined objectively on chest radiograph, was achieved with 11 bleomycin treatments (79%) and 17 talc treatments (90%) (p=0.388). The procedures were well tolerated and no significant adverse effects were observed. Talc is a much less costly agent than bleomycin ($12.36 cost to our medical center per treatment for talc vs $955.83 for bleomycin). CONCLUSION: Given the similar efficacy and significant cost advantage, we conclude that talc is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions.

[Differential diagnosis of chronic peripancreatic pseudocysts on the computerized tomogram. Possibility of error and pitfalls]. / Differentialdiagnose der chronischen peripankreatischen Pseudozyste im Computertomogramm. Fehlermöglichkeiten und Fallgruben.

Cystic masses within the pancreas and in its neighbourhood are often really pseudocysts. In most cases, centrally necrotic solid tumours or genuine cystic neoplasms are easy to differentiate from such pseudocysts. They are in fact rare pathologic conditions. The exclusion of a pseudocyst is sometimes more difficult, especially in peripancreatic cystic masses. Computed tomography has significantly improved the diagnostics of the upper abdomen. Nevertheless, it sometimes creates new problems. This study is a selection of cases pointing to differential diagnostic difficulties that may become pitfalls for the examiner. An image-imminent approximative diagnosis is attempted. The importance of the localisation of these lesions and of the topographical anatomy of the upper abdomen are pointed out.

Experience with silastic gel sheeting in pediatric scarring.

Silicone gel sheeting was applied to five hypertrophic scars on five pediatric outpatients at an acute care pediatric hospital. After silicone gel application, three of the five scars showed initial positive results including reduction in the scar size, reduction in the scar thickness, softening of the scar, a decrease in vascularity of the scar, and more uniform pigmentation. Many negative results including rash, skin breakdown, cessation of scar responsiveness, problems with the gel sheet application, and poor durability were documented. Preliminary results indicate that topical silicone gel application is not a viable treatment option for the control of hypertrophic scarring with a pediatric population.