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Spexin (SPX) is a novel, widely expressed peptide, with anorexigenic effects demonstrated in animal models and negatively correlated with body mass index (BMI) in humans. It increases locomotor activity in rodents and is elevated in human plasma following exercise. Studies have also shown an effect of stress and anxiety on SPX's expression in different brain structures in animals. The relationships between plasma SPX and physical activity, body composition, and patient-reported outcomes such as perceived stress, depressiveness, anxiety, and eating behaviors are unknown and were examined in this study over a wide BMI range. A total of 219 female (n = 68 with anorexia nervosa; n = 79 with obesity; n = 72 with normal weight) inpatients were enrolled. Perceived stress (PSQ 20), anxiety (GAD 7), depressiveness (PHQ 9), and eating disorder pathology (EDI 2), as well as BMI, bioimpedance analysis, and accelerometry, were measured cross-sectionally at the beginning of treatment and correlated with plasma SPX levels (measured by ELISA) obtained at the same time. Plasma SPX levels were negatively associated with BMI (r = -0.149, p = 0.027) and body fat mass (r = -0.149, p = 0.04), but did not correlate with perceived stress, anxiety, depressiveness, eating behavior, energy expenditure, and physical activity (p > 0.05). The results replicate the negative correlation of SPX with BMI and fat mass, but do not support the hypothesis that peripheral SPX plays a role in the regulation of stress, depressiveness, anxiety, eating behavior, or physical activity.

Additional file 1: Supplementary Table S1: Regression models for the EORTC QLQ-C30 values in the General Population of Italy.

Mental health conditions are frequent among patients with somatic illnesses, such as cardiac diseases. They often remain undiagnosed and are related to increased utilization of outpatient services, including emergency department care. The objective of this qualitative study was to investigate the significance of the emergency department in the patients' course of treatment and from the physicians' perspective. An improved understanding of the subjective needs of this specific patient group should provide hints for targeted treatment. This study is part of the prospective EMASPOT study, which determined the prevalence of mental health conditions in emergency department patients with cardiac ambulatory care sensitive conditions. The study on hand is the qualitative part, in which 20 semi-structured interviews with patients and a focus group with six ED physicians were conducted. Data material was analyzed using the qualitative content analysis technique, a research method for systematically identifying themes or patterns. For interpretation, we used the "typical case approach". We identified five "typical patient cases" that differ in their cardiac and mental health burden of disease, frequency and significance of emergency department and outpatient care visits: (1) frequent emergency department users with cardiac diseases and mental health conditions, (2) frequent emergency department users without cardiac diseases but with mental health conditions, (3) needs-based emergency department users with cardiac diseases; (4) targeted emergency department users as an alternative to specialist care and (5) patients surprised by initial diagnose of cardiac disease in the emergency department. While patients often perceived the emergency department visit itself as a therapeutic benefit, emergency department physicians emphasized that frequent examinations of somatic complaints can worsen mental health conditions. To improve care, they proposed close cooperation with the patients' primary care providers, access to patients' medical data and early identification of mental health conditions after cardiac diagnoses, e.g., by an examination tool.

Background: The PROMIS Preference score (PROPr) is a new generic preference-based health-related quality of life (HRQoL) score that can be used as a health state utility (HSU) score for quality-adjusted life years (QALYs) in cost-utility analyses (CUAs). It is the first HSU score based on item response theory (IRT) and has favorable psychometric properties. The PROPr combines the seven PROMIS domains: cognition, depression, fatigue, pain, physical function, sleep disturbance, and ability to participate in social roles and activities. It was developed based on preferences of the US general population. We aimed to validate the PROPr in a patient sample and to compare it to the EQ-5D. Methods: We collected PROPr and EQ-5D-5L data from 141 patients treated in the rheumatology and psychosomatic departments. We evaluated the convergent validity, reliability, known-groups construct validity, and ceiling and floor effects of the PROPr and compared those characteristics to those of the EQ-5D. Results: The mean PROPr (0.26, 95% CI: 0.23; 0.29) and the mean EQ-5D (0.44, 95% CI: 0.38; 0.51) differed significantly (d = 0.18, p < 0.001). The Pearson correlation coefficient between the two scores was r = 0.72. The PROPr and EQ-5D demonstrated high reliability and similar discrimination power across sex, age, and conditions. While the PROPr showed a floor effect, the EQ-5D showed a ceiling effect. Conclusion: PROPr and EQ-5D measure HSU differently. The PROPr shows a broader definition of perfect health, with a wider range of measurements at the top end. The previous results of excellent validity and precision were confirmed.

Additional file 2. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*.

Additional file 2: Supplementary Table S2. Participants’ demographic characteristics by age group.

Additional file 1. Consent form for patients treated at Charité - Universitätsmedizin Berlin (German).

Additional file 1: Supplementary Table S1. Regression models for the EORTC QLQ-C30 values in the general population of Spain.

ObjectiveTo investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association.MethodPatients with chronic tinnitus (N = 1238) completed a questionnaire battery examining tinnitus-related distress and affective and sensory pain perceptions. A series of simple, parallel- and serial multiple mediator models examined indirect effects of psychological comorbidities as well as -process variables including depressivity, perceived stress and coping attitudes. Moderator and moderated mediation analyses examined differential relational patterns in patients with decompensated vs. compensated tinnitus.ResultsThere were significant associations between tinnitus-related distress and pain perceptions. These were partially mediated by most specified variables. Psychological comorbidities appeared to influence tinnitus-pain associations through their impact on depressivity, perceived stress, and coping attitudes. Some specific differences in affective vs. sensory pain perception pathways emerged. Patients with decompensated tinnitus yielded significantly higher symptom burden across all measured indices. Tinnitus decompensation was associated with heightened associations between [1] tinnitus-related distress and pain perceptions, depressivity and negative coping attitudes; and [2] most psychological comorbidities and sensory, but not affective pain perception. Moderated mediation analyses revealed stronger indirect effects of depressivity and anxiety in mediating affective-, and anxiety in mediating sensory pain perception in patients with decompensated tinnitus.ConclusionPsychological constructs mediate the co-occurrence of tinnitus- and pain-related symptoms across different levels of tinnitus-related distress. Psychological treatment approaches should conceptualize and address individualised interactions of common cognitive-emotional processes in addressing psychosomatic symptom clusters across syndromatic patients with varying distress levels.

Introduction: To achieve optimized blood glucose concentrations (assessed by HbA1c) and high health-related quality of life (HRQL), children and adolescents with diabetes mellitus type 1 (T1DM) must follow strict disease management strategies. This study aims to investigate HRQL of children and adolescents with T1DM and its association with HbA1c values over the course of 6 months. Methods: Patients aged 7-17 years (n = 203) with T1DM provided HRQL data on a monthly basis. HRQL was measured using the Kids-CAT, a computer-adaptive test (CAT) comprising five generic HRQL domains. HbA1c concentrations were assessed at baseline, at 3 and 6 months. We explored the trajectory of HRQL at the domain level using linear mixed effects models. Further, we investigated the association between HRQL and HbA1c concentrations over time using path analysis models. Results: Children and adolescents with T1DM reported high scores across all HRQL domains over time. However, those with an HbA1c concentrations of >9.0% reported significantly lower scores in physical well-being and parent relations compared with those with an HbA1c concentration of 9.0% reported lower scores in selected HRQL domains. Thus, special attention should be drawn to HRQL of children and adolescents with higher HbA1c concentrations. The minimal relationship between HbA1c and HRQL indicates that the two therapy goals, i.e., achievement and maintenance of glycemic targets and high HRQL, should be considered and evaluated independently in clinical routine. Trial Registration: DRKS00006326 (German Clinical Trial Register), date of registration: August 1st, 2014.

Arbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüft Abweichender Titel laut Übersetzung des Verfassers/der Verfasserin Karl-Franzens-Universität Graz, Masterarbeit, 2019

Summary of sample characteristics. (DOCX 38Â kb)

DC-NK cell interactions are thought to influence the development of maternal tolerance and de novo angiogenesis during early gestation. However, it is unclear which mechanism ensures the cooperative dialogue between DC and NK cells at the feto-maternal interface. In this article, we show that uterine NK cells are the key source of IL-10 that is required to regulate DC phenotype and pregnancy success. Upon in vivo expansion of DC during early gestation, NK cells expressed increased levels of IL-10. Exogenous administration of IL-10 was sufficient to overcome early pregnancy failure in dams treated to achieve simultaneous DC expansion and NK cell depletion. Remarkably, DC expansion in IL-10−/− dams provoked pregnancy loss, which could be abrogated by the adoptive transfer of IL-10+/+ NK cells and not by IL-10−/− NK cells. Furthermore, the IL-10 expressing NK cells markedly enhanced angiogenic responses and placental development in DC expanded IL-10−/− dams. Thus, the capacity of NK cells to secrete IL-10 plays a unique role facilitating the DC- NK cell dialogue during the establishment of a healthy gestation.

Results of confirmatory factor analyses. (DOCX 38Â kb)

Summary of sample characteristics. (DOCX 38Â kb)

Chronic tinnitus is a complex, multi-factorial symptom that requires careful assessment and management. Evidence-based therapeutic approaches involve audiological and psychological treatment components. However, not everyone benefits from treatment. The identification and characterisation of patient subgroups (or “phenotypes”) may provide clinically relevant information. Due to the large number of assessment tools, data-driven methods appear to be promising. The acceptance of these empirical results can be further strengthened by a comprehensive visualisation. In this study, we used cluster analysis to identify distinct tinnitus phenotypes based on self-report questionnaire data and implemented a visualisation tool to explore phenotype idiosyncrasies. 1228 patients with chronic tinnitus from the Charité Tinnitus Center in Berlin were included. At baseline, each participant completed 14 questionnaires measuring tinnitus distress, -loudness, frequency and location, depressivity, perceived stress, quality of life, physical and mental health, pain perception, somatic symptom expression and coping attitudes. Four distinct patient phenotypes emerged from clustering: avoidant group (56.8%), psychosomatic group (14.1%), somatic group (15.2%), and distress group (13.9%). Radial bar- and line charts allowed for visual inspection and juxtaposition of major phenotype characteristics. The phenotypes differed in terms of clinical information including psychological symptoms, quality of life, coping attitudes, stress, tinnitus-related distress and pain, as well as socio-demographics. Our findings suggest that identifiable patient subgroups and their visualisation may allow for stratified treatment strategies and research designs.