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Purpose: Rehabilitation success is directly reflected in individual symptom reduction and indirectly in sociomedical benefits. The findings on the extension of measures to increase rehabilitation success are controversial. Treatment duration does not seem to be a sufficient predictor of rehabilitation success. Long periods of sick leave may contribute to chronification of mental illness. The study examined the relationship between the duration of sick leave before psychosomatic rehabilitation (less vs. more than 3 months) with different depression severity at the start of rehabilitation (below vs. above clinical relevance) and (un)indirect rehabilitation success. For this purpose, 1612 rehabilitants aged 18-64 years, 49% women, who completed psychosomatic rehabilitation at the Oberharz Rehabilitation Centre in 2016 were examined., Methods: Individual symptom reduction was mapped by the Reliable Change Index (consid-ered as a good estimator of true change) from pre/post test scores of the BDI-II. Periods of sick leave before rehabilitation and insurance/contribution periods one to four years after rehabilitation were taken from the accounts of Deutsche Rentenversicherung Braunschweig-Hannover. Multiple hierarchical regression, repeated measures 2-factorial ANCOVAs, planned contrasts, were calculated. Age, gender and rehabilitation duration were statistically controlled., Results: A multiple hierarchical regression showed incremental variance clarification in symptom reduction for patients who were on sick leave for less than three months before rehabilitation (4%) and for those who started rehabilitation with clinically relevant depression (9%) with medium and large effect sizes, (respectively f 2 =0,22 and 0,73). Repeated-messures 2-factorial ANCOVAs showed, more contributions/contribution periods for patients with a short period of sick leave before rehabilitation in each year after rehabilitation, with small effect size (η p 2 =0,03 and 0,02). Patients starting rehabilitation with low depression severity showed more insurance but not more contribution periods in the same period (η p 2 =0,01)., Conclusion: Duration of incapacity for work before rehabilitation appears to be an important pa-rameter for (un)direct rehabilitation success. Future studies should further differentiate and evaluate the effect of early admission within the first months of sick leave in psychosomatic rehabilitation measures., Competing Interests: Alle Autor*innen sind Mitarbeitende der Deutschen Rentenversicherung., (Thieme. All rights reserved.)

The benefits of physical activity and a reduction of sedentary behaviour in childhood and adolescence are well established.Based on a quality-assured literature review, the German recommendations were updated. Guidelines for infants, toddlers, children of kindergarten and primary school age and youth are clearly depictedIn general, a higher amount of physical activity is associated with more health benefits. Preschool age children should have 180 min of physical activity daily, and from primary school age on, at least 90 min daily are recommended. Sedentary behaviour, especially time in front of screens, is to be reduced to a minimum., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In clinical practice, oxygen saturation as measured by photoplethysmography and arterial oxygen tension as determined by blood gas analysis are the parameters used frequently to estimate the oxygen status of a patient. Additionally, the cardiac output CO and the arterial oxygen content CaO2 are critical for the delivery of oxygen ḊO2 to organs and tissues. So far, CaO2 reference values published by Mertzlufft and Zander (1984) and Siggaard-Andersen (1990) are widely used. The aim of the present study was to reevaluate previously published results using the results of a population-based study. Furthermore, the impact of smoking on CaO2 will be assessed., Patients and Methods: Data of 1018 volunteers from the Study of Health in Pomerania (SHIP) were analyzed. CaO2 was calculated from blood gas analysis of capillary blood obtained from a hyperemised ear lobe. Reference value equations controlled for sex, age and smoking were derived with quantile regression analysis and fractional polynomials., Results: Lower limits of normal (LLN) decline with age. Current smoking has no significant influence on LLN for CaO2., Conclusion: Sex, age and smoking-specific normal values can be calculated using the current equations., (© Georg Thieme Verlag KG Stuttgart · New York.)

Study Aim: This paper shows how a state-wide health-promotion intervention at primary schools can be implemented by considering the example of the programme "Join the Healthy Boat - Primary School". Additionally, it is illustrated how quality control throughout the whole process can be incorporated., Methods: To operate long-term and target-group orientated in the whole state of Baden-Württemberg, the school-based prevention programme "Join the Healthy Boat" uses a "train the trainer" model. The trainers are teachers who were instructed by the project team. In the school year 2009/10, these trainers offered quadrinominal training courses for further teachers. Every urban and rural district is covered by 1 trainer. The trainers evaluated the 6 preparatory training courses they had been given using questionnaires. The following 4 training courses the trainers offered to the teachers were reviewed by the trainers as well as the teachers using questionnaires, too. Additionally, at the end of the school year 2009/10, the teachers completed a questionnaire about their satisfaction regarding the programme itself and the work with the trainer., Results: During the school year 2009/10, 453 teachers were trained by 32 trainers. According to indications on the questionnaires about the preparatory training courses, all trainers felt themselves "very well" or "well" prepared for their task. The teachers evaluated the expertise of the respective trainer, the quality of the training courses and the satisfaction with the programme itself throughout highly., Conclusion: Based on the excellent results of the process evaluation and the programme's wide coverage, an adoption of a "train the trainer" model seems worthwhile for other school-based prevention programmes, as well., (© Georg Thieme Verlag KG Stuttgart · New York.)

Previous studies indicate that physical performance, being a relevant prognostic parameter for cardiovascular events and mortality, decreases with age. Thus, the maintenance and restoration of physical performance as part of a rehabilitation program is of great interest. In the present study, 35 physically active participants, aged 58 - 78 years, were investigated by cardiopulmonary exercise testing. In comparison to matched participants drawn from an epidemiological study, there was no significant difference in performance g between the two groups. Additionally, oxygen kineticswere incrementally measured in order to evaluate a fairly simple procedure for determining fitness under activities of daily life. Surprisingly, this method did not reveal any clinically relevant association between oxygen kinetics and physical fitness., (© Georg Thieme Verlag KG Stuttgart · New York.)

The interpretation of gas exchange measured by cardiopulmonary exercise testing (CPET) depends on reliable reference values. Within the population based Study of Health in Pomerania (SHIP) CPET was assessed in 1706 volunteers. The assessment based on symptom limited exercise tests on a bicycle in a sitting position according to a modified Jones protocol. CPET was embedded in an extensive examination program. After the exclusion of active smokers and volunteers with evidence of cardiopulmonary and musculoskeletal disorders the reference population comprised 616 healthy subjects (333 women) aged 25 to 85 years. Reference equations including upper and/or lower limits based on quantile regression were assessed. All values were corrected for the most important influencing factors.This study provides reference equations for gas exchange and exercise capacity assessed within a population in Germany., (© Georg Thieme Verlag KG Stuttgart · New York.)

Small cell carcinomas are most frequently localised within the lung, however, they also may be detected at extrapulmonary sites such as the gastrointestinal tract and the genitourinary tract. The confirmation of a small cell carcinoma outside of the lung may not necessarily indicate the presence of a metastasis, however, it also may represent the primary tumor itself. We present the case of a patient with a small cell carcinoma of the lung with metastases to the stomach. A regression of the primary lung tumor and the disappearance of the gastric metastases could be achieved by chemotherapeutic treatment with carboplatin, etoposide, and vincristine. However, death due to pneumonia occurred 3 months after initial diagnosis. This case illustrates that in rare cases a metastasis from small cell lung cancer may occur in the intestinal tract even without leading to distinctive symptoms., (Georg Thieme Verlag KG Stuttgart, New York.)

Natural history of patients with colorectal liver metastases is not significantly changed even by curative resection. The majority unfortunately relapse. The results of adjuvant treatment after resection were evaluated by analysis of 17 publications as well as by own data (60 patients). 340 patients were either treated by intraarterial (n = 201), systemic (n = 82), intraportal (n = 29) or intraperitoneal (n = 28) chemoinfusion (5-Fluorouracil or Floxuridine). An alternative approach was the treatment with specific immunotherapy using tumor vaccination (n = 35) or monoclonal antibodies (n = 20). Morbidity of adjuvant treatment includes local (chemical hepatitis, biliary sclerosis) and systemic (diarrhea, stomatitis) side effects. Technical complications could reach a level of up to 50% in case of local administration. With exception of 6 studies no comparison with a resection only group was performed. Despite postulated increase of survival and recurrence free time with historical controls the results of current ongoing studies are needed before general use of adjuvant treatment can be recommended.

The improvement of nasal air flow often requires, in addition to septoplasty, surgery of the turbinates. In order to broaden our knowledge of the influence of turbinate surgery on nasal function, the authors investigated nasal models with different lateral walls by visualisation of flow patterns and rhinoresistometry. Anterior turbinoplasty and turbinectomy reduce the nasal resistance to air flow, but the respiratory function of the nose deteriorates. As the result of these experiments, a trimming of hyperplastic turbinates must create a normal shape of lateral nasal wall, because the respiratory function is based on nearly regular narrow cavities.

The effects of adrenalectomy (Adx) and hypercorticism on the ACTH content in the anterior (AH) and the neurointermediate lobe (NIL) of the pituitary in Long Evans (+/+), heterozygous (+/DI) and homozygous (DI/DI) Brattleboro rats were determined using dispersed adrenal cells bioassay. Adx decreased the NIL-ACTH content in +/DI and DI/DI rats and left it unchanged in the +/+ rats. Adx increased the AH-ACTH content in the three groups. Hypercorticism had a delayed decreasing effect both in the AH and in the NIL in all rats, with one exception for the NIL in DI/DI rats. Conversely to what appeared in Wistar rats, in Long Evans and Brattleboro rats the corticosterone administered in drinking water was unable to reduce the increase in AH-ACTH activity. These data suggest that Brattleboro, and, to a lesser extent, Long Evans rats from which the former are derived present some particularities in the regulation of their corticotropic function at the AH and the NIL level. We also observed that NaCl (0.9%) added to drinking water and hypercorticism are two factors able to increase diabetes insipidus in homozygous rats without modifying the water intake in Long Evans and heterozygous rats.

For 10 cases in which we detected cysts in the choledochus ourselves comparing traditional radiological methods (infusion-cholegram, ERC, scintigraphy, barium meal examination, angiography) with recent imaging procedures (ultrasound, CT, NMR) the following sequence of procedures proved to be favorable: Screening methods are ultrasound and infusion-cholegram. CT and NMR furnish good presentations of the intra- and extrahepatic dilatations of the bile duct. ERC still represents the best methods for demonstration of an extrahepatic cyst of the choledochus. Hepato-biliary functional scintigraphy is performed as a supplement. Barium meal examination and coeliacography furnish a small diagnostic contribution only.

This study was aimed at investigating the influence of tissue and plasma transcortin on pituitary glucocorticoid receptor function and corticotropic activity during development. "In vivo" nuclear uptake of (3H)corticosterone was found to be increased in pituitary glands from newborn rats which, unlike that of adults, lack transcortin-like material. Immature glands incubated "in vitro" likewise showed enhanced nuclear accumulation of tracer; the magnitude of uptake being inversely related to both tissue and plasma contents of transcortin. Competition studies indicate that pituitary transcortin modulates interaction of corticosterone with receptor binding sites and, hence, may interfere with steroid translocation to the nucleus. Moreover, we found that steroid-induced inhibition of ACTH release was highest in those pituitaries which were deficient in transcortin-like molecules. We conclude that the binder plays a modulating role in pituitary glucocorticoid receptor function.