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Introduction In the general population, hyperuricemia is associated with increased morbidity and mortality. Data on this association in hemodialysis patients is controversial. Moreover, it remains elusive whether serum uric acid (SUA) lowering therapy is associated with mortality. Methods Retrospective analysis of 601 patients on chronic hemodialysis therapy in five outpatient centers with a maximum follow-up of 100 and a mean follow-up of 41 months. Death was defined as primary endpoint. Cumulative survival was analyzed by Kaplan–Meier analysis and Cox regressions adjusted for age. Findings Cumulative survival rates were higher for those subjects with a higher than median SUA concentration both based on mean annual and baseline measurements (p 0.05 each). Stratification for SUA lowering therapy (allopurinol/febuxostat) had no impact on cumulative survival, neither in Kaplan Meier nor in Cox regression analyses (p > 0.05 each). Furthermore, Cox regression analysis excluded an increased cardiovascular mortality in subjects with hyperuricemia. Discussion In contrast to the general population, hyperuricemia is not associated with increased mortality in patients undergoing hemodialysis. Moreover, xanthine oxidase inhibition was not associated with a survival benefit in this analysis. These data do not support the use of SUA lowering medication in hemodialysis patients with asymptomatic hyperuricemia.

This article describes the design of KommPaS, a web-based tool for the clinical assessment of communication impairment in persons with dysarthria. KommPaS (the German acronym for Communication-related Parameters in Speech Disorders) allows clinicians to recruit laypersons via crowdsourcing for the evaluation of samples of dysarthric speech with regard to communication relevant parameters, that is, intelligibility, naturalness, perceived listener effort, and efficiency (intelligible speech units per unit time). Moreover, a communication total score describing the KommPaS profile elevation, i.e., the arithmetic mean of the normalized KommPaS scores, is provided. Based on considerations regarding the theoretical underpinnings and methodological constraints of a clinical tool for the assessment of these parameters, the article describes how each theoretically and methodologically motivated feature is translated into design principles and how these principles are implemented in a web application. The paper reports efficiency data and details the data privacy and data security provisions that are essential in such an approach.

This prospective cohort study aimed to characterize the sensory profile during acute herpes zoster (AHZ) and to explore sensory signs as well as physical and psychosocial health as predictors for postherpetic neuralgia (PHN). Results of quantitative sensory testing of 74 patients with AHZ at the affected site and at the distant contralateral control site were compared to a healthy control group. Pain characteristics (Neuropathic Pain and Symptom Inventory and SES), physical functioning, and psychosocial health aspects (Pain Disability Index, SF-36, and STAI) were assessed by questionnaires. Patients with PHN (n = 13) at 6-month follow-up were compared to those without PHN (n = 45). Sensory signs at the affected site were thermal and vibratory hypesthesia, dynamic mechanical allodynia (DMA), pressure hyperalgesia, and high wind-up (18%-29%), as well as paradoxical heat sensations and pinprick hypalgesia (13.5%). The unaffected control site exhibited thermal and vibratory hypesthesia, DMA, and pressure hyperalgesia. Dynamic mechanical allodynia and pinprick hypalgesia were mutually exclusive. Postherpetic neuralgia was associated with DMA (38.5% vs 6.7%; P = 0.010) and vibratory hypesthesia (38.5% vs 11.1%; P = 0.036) at the control site, with mechanical gain and/or loss combined with normal thermal detection (affected site: 69.2% vs 31.1%; P = 0.023; control site: 53.8% vs 15.5%; P = 0.009). Pain Disability Index (P = 0.036) and SES affective pain perception scores (P = 0.031) were over 50% higher, and 6 of 8 SF-36 subscores were over 50% lower (P < 0.045) in PHN. Sensory profiles in AHZ indicate deafferentation and central but not peripheral sensitization. Sensory signs at distant body sites, strong affective pain perception, as well as reduced quality of life and physical functioning in the acute phase may reflect risk factors for the transition to PHN.

This paper describes outcomes of the 2019 Cryo-EM Model Challenge. The goals were to (1) assess the quality of models that can be produced from cryogenic electron microscopy (cryo-EM) maps using current modeling software, (2) evaluate reproducibility of modeling results from different software developers and users and (3) compare performance of current metrics used for model evaluation, particularly Fit-to-Map metrics, with focus on near-atomic resolution. Our findings demonstrate the relatively high accuracy and reproducibility of cryo-EM models derived by 13 participating teams from four benchmark maps, including three forming a resolution series (1.8 to 3.1 Å). The results permit specific recommendations to be made about validating near-atomic cryo-EM structures both in the context of individual experiments and structure data archives such as the Protein Data Bank. We recommend the adoption of multiple scoring parameters to provide full and objective annotation and assessment of the model, reflective of the observed cryo-EM map density., A multi-laboratory study in the form of a community challenge assesses the quality of models that can be produced from cryo-EM maps using different software tools, the reproducibility of models generated by different users and the performance of metrics used for model validation.

[EN] This paper gathers experiences and results from several demonstration projects in the field of grid integration of electric vehicles. The analyzed research projects are selected among research institutes and universities that are part of the European Energy Research Alliance Joint Program on Smart Grids. The paper provides an overview of recent trends in the field of electric vehicles integration issues and then dives deeper into specific aspects of each project. Twelve research projects are presented in general terms, while detailed information can be retrieved from the references and the websites. Although each project has its focus, a common element that can be devised is that the charging process can be technically controlled based on different interests and algorithms, but its role in the market is still under development. Particular focus is always given to the behavior of the user, which ultimately determines the possible level of flexibility that the electric vehicle can provide to the grid.

This paper describes outcomes of the 2019 Cryo-EM Map-based Model Metrics Challenge sponsored by EMDataResource (www.emdataresource.org). The goals of this challenge were (1) to assess the quality of models that can be produced using current modeling software, (2) to check the reproducibility of modeling results from different software developers and users, and (3) compare the performance of current metrics used for evaluation of models. The focus was on near-atomic resolution maps with an innovative twist: three of four target maps formed a resolution series (1.8 to 3.1 Å) from the same specimen and imaging experiment. Tools developed in previous challenges were expanded for managing, visualizing and analyzing the 63 submitted coordinate models, and several novel metrics were introduced. The results permit specific recommendations to be made about validating near-atomic cryo-EM structures both in the context of individual laboratory experiments and holdings of structure data archives such as the Protein Data Bank. Our findings demonstrate the relatively high accuracy and reproducibility of cryo-EM models derived from these benchmark maps by 13 participating teams, representing both widely used and novel modeling approaches. We also evaluate the pros and cons of the commonly used metrics to assess model quality and recommend the adoption of multiple scoring parameters to provide full and objective annotation and assessment of the model, reflective of the observed density in the cryo-EM map.

Although complementary medicine is frequently used in Germany, there is almost no information about complementary medicine use in competitive sports. The aim was to assess the use of complementary medicine among elite athletes in Germany.A cross-sectional study among athletes was performed between March 2012 and September 2013. Athletes of both sexes who visited a sports medical outpatient clinic in Munich, Bavaria were included. Data about the use of complementary medicine were collected by means of a standardized measurement instrument, the German version of the international complementary and alternative medicine questionnaire.Of the 334 athletes (female 25%, mean age 20.2 ± 6.6 years) who completed all 4 sections of the questionnaire, 69% reported the use of at least one type of complementary medicine within the last 12 months. 505 athletes (female 26%, mean age 20.5 ± 7.0 years) completed at least one section of the questionnaire entirely. Within 12 months, the osteopath (11%), herbal medicine (17%), vitamins/minerals (32%), and relaxation techniques (15%) were the most frequently visited/used in relation to the respective sections of the questionnaire.Complementary medicine is frequently used by athletes in Germany. The efficacy, safety, and costs of complementary medicine should be investigated in clinical trials among athletes in the future.Hintergrund: Obgleich die Komplementärmedizin in Deutschland häufig eingesetzt wird, gibt es fast keine Informationen zum Einsatz im Bereich des Leistungssports. Ziel war es daher, den Einsatz der Komplementärmedizin bei Leistungssportlern in Deutschland zu untersuchen. Patienten und Methoden: Eine Querschnittsstudie unter Leistungssportlern wurde zwischen März 2012 und September 2013 durchgeführt. Eingeschlossen wurden Leistungssportler beiderlei Geschlechts, die eine sportmedi­zinische Ambulanz in München, Bayern besuchten. An­gaben zur Nutzung von Komplementärmedizin wurden mit Hilfe eines standardisierten Messinstruments, der deutschen Version des internationalen Fragebogens für Komplementär- und Alternativmedizin, erhoben. Ergebnisse: Von den 334 Leistungssportlern (25% weiblich, Durchschnittsalter 20,2 ± 6,6 Jahre), welche alle vier Abschnitte des Fragebogens ausgefüllt hatten, gaben 69% an, innerhalb der letzten 12 Monate mindestens eine Art von Komplementärmedizin angewendet zu haben. 505 Leistungssportler (26 % weiblich, Durchschnittsalter 20,5 ± 7,0 Jahre) füllten mindestens einen Abschnitt des Fragebogens vollständig aus. Innerhalb der letzten 12 Monate wurden, in Bezug auf die jeweiligen Abschnitte des Fragebogens, der Osteopath (11%), die Phytotherapie (17%), Vitamine und Mineralien (32%) und Entspannungstechniken (15%) am häufigsten besucht/verwendet. Schlussfolge­rung: Komplementärmedizin wird von Leistungssportlern in Deutschland häufig eingesetzt. Die Wirksamkeit, Sicherheit und Kosten der Komplementärmedizin sollten in Zukunft in klinischen Studien bei Sportlern untersucht werden.

Die Zahl wissenschaftlicher Studien zur Akupunktur hat in den letzten Jahren deutlich zugenommen: Akupunktur bietet im Profifusball zunehmend evidenzbasierte Einsatzmoglichkeiten. Diese Ubersicht stellt verschiedene Akupunkturtechniken sowie deren interessante Einsatzgebiete und Indikationen im Profifusball vor. Neben Knie‑, Schulter‑, Wirbelsaulen‑, Ellbogen- und postoperativen Schmerzen gibt es deutliche Hinweise auf die Wirksamkeit von Akupunktur bei Sprunggelenkdistorsionen, Rhinoconjunctivitis allergica und Ubelkeit. „Dry needling“ stellt eine vielversprechende Option zur Behandlung myofaszialer Triggerpunkte dar und konnte bei regelmasiger Anwendung auch hinsichtlich der Verletzungspravention und der Leistungsoptimierung sinnvoll sein.

Alcohol consumption is pivotal for the subsequent development of alcohol use disorders (AUD). The Alcohol Use Disorders Identification Test (AUDIT) is a recommended AUD screening tool for prevention and primary care settings. The objectives of this study were to test how many participants with heavy drinking are unidentified by the AUDIT, if proportions of unidentified participants vary over time, and whether this unidentified risk group (URG) was clinically relevant in terms of drinking behavior reports and AUD risk factors, as well as future adverse outcomes, such as craving, dependence symptoms, or depression.Our prospective cohort study followed 164 German males aged 18-19years without an alcohol dependence diagnosis over 24months. Only men were included due to higher AUD prevalence and gender-specific differences in metabolism, drinking patterns, and progression to AUD. All participants were screened via telephone interview and answered questionnaires both in person and via internet. Heavy drinking was classified using the AUDIT consumption score (AUDIT-C≥4.50). Standardized AUD diagnoses and symptoms, as well as alcohol use-related outcome criteria were assessed via standardized Composite International Diagnostic Interview (CIDI), and self-report questionnaires.One in four participants (22-28% across all four follow-ups) reported heavy drinking but was unidentified by AUDIT total score (i.e. score8), thus qualifying for URG status. The URG status did not fluctuate considerably across follow-ups (repeated-measures ANOVA, p=0.293). URG participants identified at the six-month follow-up did not generally differ from participants without URG status in terms of AUD family history or temperament (multivariate ANOVA, p=0.114), except for anxiety sensitivity (pDespite the considerable number of heavy-drinking individuals unidentified by AUDIT total scores, an additional classification according to AUDIT-C values did not prove useful. Combining AUDIT and AUDIT-C scores might not be sufficient for identifying AUD risk groups among young adult German males. There is an urgent need for a replication of our findings among female participants.

Adaptive governance and network governance theory provide a useful conceptual framework to guide the conservation of threatened species in complex multi-actor, multijurisdictional social ecological systems. We use principles from this theory to assess strengths and weaknesses in (1) national legislation, and (2) the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) Regulations applicable to the conservation of the Cape mountain zebra (Equus zebra zebra) (CMZ) in South Africa. A legislated conservation tool, Biodiversity Management Plans for Species (BMP-S), establishes a collaborative network of role players and facilitates the important principles of collaborative learning and adaptation. Effective governance of this network is critical to success, but challenging because of a mandate gap and limited capacity in government to provide essential network-level competencies. National regulations governing human use of CMZ (Threatened or Protected Species (TOPS) Regulations) accords with the principles of (1) being developed in consultation with stakeholders and (2) open to revision and adaptation. CITES Regulations also provide adequately for adaptation. Poor alignment of regulations between different regulatory authorities in South Africa and limited capacity for implementation of regulations seriously constrain learning and adaptation.

Panaeolina foenisecii is one of the most common and widely distributed lawn mushrooms in Europe and North America, and frequently involved in accidental mushroom ingestion, mainly in children. Nevertheless, there is contradictory information regarding the toxicity profile of P. foenisecii in the literature. Objective of the study was to assess clinical effects with particular attention on psychoactive properties of P. foenisecii in case of accidental oral exposure.This observational case series is based on prospectively collected data on mushroom poisoning using a structured data collection form, and it was performed in seven poisons centres in Germany and Switzerland. Inclusion criteria were accidental ingestion of at least one cap of P. foenisecii identified by a mycologist, and a follow up of at least 4 hours.Nineteen cases met all inclusion criteria, and only children were involved with a mean age of 3 years. They ingested 1-2 mushrooms in 14 cases and 3-5 mushrooms in five cases. Three patients received a single dose of activated charcoal. Sixteen out of 19 cases did not develop any symptoms, 2/19 complained of minor abdominal discomfort. One child was temporarily mildly hyperactive, and this was the only patient observed in a hospital for 12 hours. None of the children showed signs of hallucinations.This multicentre study demonstrates that the typically small amounts of P. foenisecii ingested by children probably do not lead to clinically significant symptoms.

Cryo-electron microscopy (cryo-EM) has become a leading technology for determining protein structures. Recent advances in this field have allowed for atomic resolution. However, predicting the backbone trace of a protein has remained a challenge on all but the most pristine density maps (de-novo, MAINMAST, and a Phenix based method by producing the most complete predicted protein structures, as measured by percentage of found Cα atoms. This method accurately predicted 88.9% (mean) of the Cα atoms within 3 Å of a protein’s backbone structure surpassing the 66.8% mark achieved by the leading alternate method (Phenix based fully automatic method) on the same set of density maps. The C-CNN also achieved an average root-mean-square deviation (RMSD) of 1.24 Å on a set of 50 experimental density maps which was tested by the Phenix based fully automatic method. The source code and demo of this research has been published at https://github.com/DrDongSi/Ca-Backbone-Prediction.

Cryo-electron microscopy (cryo-EM) has become a leading technology for determining protein structures. Recent advances in this field have allowed for atomic resolution. However, predicting the backbone trace of a protein has remained a challenge on all but the most pristine density maps (< 2.5Å resolution). Here we introduce a deep learning model that uses a set of cascaded convolutional neural networks (CNNs) to predict Cα atoms along a protein’s backbone structure. The cascaded-CNN (C-CNN) is a novel deep learning architecture comprised of multiple CNNs, each predicting a specific aspect of a protein’s structure. This model predicts secondary structure elements (SSEs), backbone structure, and Cα atoms, combining the results of each to produce a complete prediction map. The cascaded-CNN is a semantic segmentation image classifier and was trained using thousands of simulated density maps. This method is largely automatic and only requires a recommended threshold value for each evaluated protein. A specialized tabu-search path walking algorithm was used to produce an initial backbone trace with Cα placements. A helix-refinement algorithm made further improvements to the α-helix SSEs of the backbone trace. Finally, a novel quality assessment-based combinatorial algorithm was used to effectively map Cα traces to obtain full-atom protein structures. This method was tested on 50 experimental maps between 2.6Å and 4.4Å resolution. It outperformed several state-of-the-art prediction methods including RosettaES, MAINMAST, and a Phenix based method by producing the most complete prediction models, as measured by percentage of found Cα atoms. This method accurately predicted 88.5% (mean) of the Cα atoms within 3Å of a protein’s backbone structure surpassing the 66.8% mark achieved by the leading alternate method (Phenix based fully automatic method) on the same set of density maps. The C-CNN also achieved an average RMSD of 1.23Å for all 50 experimental density maps which is similar to the Phenix based fully automatic method. The source code and demo of this research has been published athttps://github.com/DrDongSi/Ca-Backbone-Prediction.

Rationale & Objective Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. Study Design Prospective cohort study. Setting & Participants 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. Exposures Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. Outcomes Cardiovascular and all-cause mortality. Analytical Approach Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. Results During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, “fruit and vegetable” and “Western,” were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. Limitations Self-reported food frequency questionnaire, data-driven approach. Conclusions These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.

Password policies were originally designed to make users pick stronger passwords. However, research has shown that they often fail to achieve this goal. In a systematic audit of the top 100 web sites in Germany, we explore if diversity in current real-world password policies prevents password reuse. We found that this is not the case: we are the first to show that a single password could hypothetically fulfill 99% of the policies under consideration. This is especially problematic because password reuse exposes users to similar risks as weak passwords. We thus propose a new approach for policies that focuses on password reuse and respects other websites to determine if a password should be accepted. This re-design takes current user behavior into account and potentially boosts the usability and security of password-based authentication.

This study investigated the effects of the gamification elements of scaffolding, score and hints on the user enjoyment and motivation of people of low literacy. In a four-condition within-subjects experiment, participants per-formed mental spatial ability tests with the aforementioned elements. Quantitative results were inconclusive, but post-test interviews provided insights on the limited effectiveness of the gamification elements. Complex questionnaire wording, high task difficulty, and an improperly situated task environment all contributed to ceiling effects in the influence of scaffolding. Score was found to be ineffective without proper contextualization connecting the numerical score to clearer performance measures. Finally, the underused hints functionality has indicated the need for adequate 'mixed initiative' support.

Hintergrund: In der DFG-geforderten „ACUpuncture in Seasonal Allergic Rhinitis“- (ACUSAR-) Studie bei Patienten mit allergischer Rhinitis war Akupunktur wirksamer im Vergleich zu Sham-Akupunktur und zu einer Kontrollgruppe, die nur Bedarfsmedikation erhielt. In diesem Artikel werden die Studienintervention, die zugrunde liegenden theoretischen Uberlegungen der chinesischen Medizin und auch die Lehren fur weitere Studien und die Praxis dargestellt. Studiendesign: Dreiarmige, randomisierte, kontrollierte Multicenter-Studie mit einem Follow-up von 16 Wochen im ersten Jahr und weiteren 8 Wochen im Folgejahr. Studienzentren: 6 Kliniken bzw. Universitatsambulanzen und 32 Privatpraxen in Deutschland. Studienintervention: Insgesamt wurden 422 Patienten mit saisonaler allergischer Rhinitis und nachgewiesener Allergie gegen Birken- und Graserpollen in 3 Gruppen randomisiert: Die Akupunkturgruppe erhielt 12 semi-standardisierte Behandlungen (4 obligatorische Punkte, mindestens 3 von 8 fakultativen Basis-Punkten und mindestens 3 andere lokale Ohr- oder Fernpunkte) und bei Bedarf eine „Rescue“-Medikation (RM) (Cetirizin). Die Sham-Akupunktur-Gruppe wurde 12-mal an Nicht-Akupunktur-Punkten genadelt (genau vorgegebene Punkte, streng oberflachliche Nadelung, beidseits mindestens 5−7 Punkte) und konnte RM einnehmen, die Wartelisten-Gruppe erhielt 8 Wochen lang nur RM und wurde dann nach dem Akupunktur-Schema behandelt. Die Studienintervention wurde im Rahmen eines Delphi-Prozesses festgelegt, an dem funf Experten von zwei groseren Akupunkturgesellschaften und drei Experten in Studienmethodologie teilnahmen. Ergebnisse: Die haufigsten Syndrommuster waren „Wind-Kalte“ (algor venti, fenghan) und „Wind-Hitze“ (calor venti, fengre) im Funktionskreis (Fk) „Lunge“ (o. pulmonalis, fei) mit je 37 % der Patienten. Bei der Behandlung der Akupunkturgruppe wurden die vorgegebenen obligatorischen Basispunkte in 97 % der Behandlungen genadelt (Di4/IC4 [«Vereinte Taler», hegu], Di11/IC11 [„Gekrummter Teich“, quchi], Di20/IC20 [„Empfangen der Wohlgeruche“, yingxiang] und Ex-HN 3/Ex1 [„Siegelhalle“, yintang]). Gb20/F20 („Teich des Windes“, fengchi), H3/Le3 („Die machtige grose Strase“, taichong), S36/Ma36 („Dritter Weiler am Fus“, zusanli), Lu7/P7 („Reihe von Lucken“, lieque) und L6/Mi6 („Die Verbindung der drei Yin“, sanyinjiao) waren die am haufigsten gewahlten optionalen Akupunkturpunkte. Durchschnittlich wurden in einer Akupunkturbehandlung 15,7 (± 2,5) Nadeln gesetzt, bei der Behandlung mit Sham-Akupunktur 10,0 (± 1,6). Schlussfolgerung: Die Untersuchung der Studienintervention zeigt, dass in der Akupunkturgruppe die Studienintervention der chinesischen Syndromdiagnose entsprechend ausgerichtet war. Insgesamt wurden in der Akupunkturgruppe mehr Akupunkturnadeln als in der Sham-Akupunktur-Gruppe eingesetzt. Beides sind mogliche Grunde fur die Wirksamkeit der Akupunktur in dieser Studie.

This review summarizes current evidence for acupuncture treatment of allergies. Several randomized controlled trials have demonstrated a specific effect of acupuncture for allergic rhinitis; while a few studies have shown positive effects for atopic dermatitis, asthma and itch. Specifically for allergic rhinitis and asthma, acupuncture may be cost-effective in terms of money spent per quality-of-life gained. Acupuncture plays an increasingly important role as an evidence-based therapy for allergy relief and can be recommended as adjunct therapy for allergic rhinitis. Future randomized controlled trials need to further explore acupuncture efficacy for the treatment of itch, atopic dermatitis and asthma. More experimental research is also needed to investigate mechanisms of action underlying acupuncture for allergy relief.

BACKGROUND: Data on molecular allergy diagnostics in adults with grass pollen allergy with regard to conjunctival and nasal provocation test outcome and specific immunotherapy is lacking to date. OBJECTIVE: To assess whether molecular allergy diagnostics for grass pollen allergens could help with predicting provocation test outcomes and serve as a basis for future component resolved specific immunotherapy. METHODS: Sera of 101 adults with grass pollen allergy was analysed for IgE against timothy grass pollen (Phleum pratense), rPhl p 1, rPhl p 2, nPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11 and rPhl p12 and correlated to the individuals' outcome in the nasal and conjunctival provocation tests and investigated in regard to a potential component resolved specific immunotherapy. RESULTS: An increasing number of sensitizations to timothy grass allergens was correlated to a positive reaction in the conjunctival (4.9 vs. 3.6, p=0.003) and nasal provocation tests (4.5 vs. 2.2, p=0.0175). In molecular sensitization profiles a substantial heterogeneity was detected, with none of the patients exactly matching the allergen composition of a previously published component resolved specific immunotherapy containing Phl p 1, Phl p 2, Phl p 5a/b and Phl p 6. The results indicate that in 95% of the patients a proportion of 50% of timothy-IgE would be targeted with such a specific immunotherapy, while in 50% and 10% of patients 80% and 90% of timothy-IgE would be targeted respectively. CONCLUSION AND CLINICAL RELEVANCE: Molecular allergy diagnostics is a prerequisite for future component-resolved specific immunotherapy due to the high heterogeneity of sensitization profiles. However, of current clinical relevance is the observed correlation between the number of sensitizations and provocation test outcome.

Zusammenfassung Hintergrund In der DFG-geforderten ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) Studie bei Patienten mit allergischer Rhinitis war Akupunktur wirksamer im Vergleich zu Sham-Akupunktur und zu einer Kontrollgruppe, die nur Bedarfsmedikation erhielt. In diesem Artikel werden die Studienintervention, die zugrunde liegenden theoretischen Uberlegungen der Chinesischen Medizin und auch die Lehren fur weitere Studien und die Praxis dargestellt. Studiendesign Dreiarmige, randomisierte, kontrollierte Multicenter-Studie mit einem Follow-up von 16 Wochen im ersten Jahr und weiteren acht Wochen im Folgejahr. Studienzentren Sechs Kliniken bzw. Universitatsambulanzen und 32 Privatpraxen in Deutschland. Studienintervention Insgesamt wurden 422 Patienten mit saisonaler allergischer Rhinitis und nachgewiesener Allergie gegen Birken- und Graserpollen in drei Gruppen randomisiert: Die Akupunkturgruppe erhielt zwolf semi-standardisierte Behandlungen (vier obligatorische Punkte, mindestens drei von acht fakultativen Basis-Punkten und mindestens drei andere lokale, Ohr- oder Fernpunkte und bei Bedarf eine „Rescue“ Medikation (RM) (Cetirizin). Die Sham-Akupunkturgruppe wurde zwolfmal an Nicht-Akupunkturpunkten genadelt (genau vorgegebene Punkte, streng oberflachliche Nadelung, beidseits mindestens funf bis sieben Punkte) und konnte RM einnehmen, die Wartelistengruppe erhielt acht Wochen nur RM und wurde dann nach dem Akupunkturschema behandelt. Die Studienintervention wurde im Rahmen eines Delphi-Prozesses festgelegt, an dem funf Experten von zwei groseren Akupunkturgesellschaften und drei Experten in Studienmethodologie teilnahmen. Ergebnisse Die haufigsten Syndromdiagnosen waren „Wind-Kalte“ und „Wind-Hitze“ im Funktionskreis (FK) Lunge mit je 37 % der Patienten. Bei der Behandlung der Akupunkturgruppe wurden die vorgegebenen obligatorischen Basispunkte in 97 % der Behandlungen genadelt (Di 4, Di 11, Di 20, EX-KH 3 Yintang). Gb 20, Le 3, Ma 36, Lu 7 und Mi 6 waren die am haufigsten gewahlten optionalen Akupunkturpunkte. Durchschnittlich wurden in einer Akupunkturbehandlung 15,7 (± 2,5) Nadeln gesetzt, bei der Behandlung mit Sham-Akupunktur 10,0 (± 1,6). Schlussfolgerung In der Akupunkturgruppe entsprachen die gestellten Diagnosen sowie die Punkteauswahl den klinischen Erfahrungen in der Behandlung der SAR. In der Akupunkturgruppe wurden mehr Akupunkturnadeln als in der Sham-Akupunkturgruppe eingesetzt. Beides sind mogliche Grunde fur die hohere Wirksamkeit der Verum-Akupunktur in dieser Studie.

article i nfo Background: Dipeptidylpeptidase-4 inhibition is reported to have beneficial effects on myocardial ischemia. Mechanisms might include a reduced degradation of stromal cell-derived factor-1 alpha with subsequent increased recruitment of circulating stem cells and/or incretin receptor-dependent pathways. This study evaluated the novel xanthine-based dipeptidylpeptidase-4 inhibitors linagliptin (BI 1356) and BI 14361 in cardiac ischemia. Methods: Male Wistar rats were pretreated with linagliptin or BI 14361 and subjected to ligation of the left anterior descending coronary artery for 30 min. Results: Dipeptidylpeptidase-4 inhibition significantly reduced the infarct size after 7 days (-27.7%, pb0.05) and 8 weeks (-18.0%, pb0.05). There was a significantly improved maximum rate of left ventricular pressure decline (dP/dt min) in linagliptin-treated animals 8 weeks after ischemia/reperfusion. Apart from that, treat- ment did not improve cardiac function as determined by echocardiography and cardiac catheterization. Immunohistological staining revealed an increased number of cells positive for stromal cell-derived factor- 1 alpha, CXCR-4 and CD34 within and around the infarcted area of BI 14361-treated animals. Conclusions: Linagliptin and BI 14361 are able to reduce infarct size after myocardial ischemia. The immunohisto- logical findings support the hypothesis that dipeptidylpeptidase-4 inhibition via reduced cleavage of stromal cell-derived factor-1 alpha might lead to an enhanced recruitment of CXCR-4+ circulating progenitor cells.

Objective Complementary and alternative medicine (CAM) is a conservative and increasingly popular approach to atopic diseases for both patients and medical providers. Over the past few decades, there has been increased research activity into the use of CAM therapies for allergy. In this overview, current evidence, possible mechanisms of action and clinical approaches for treating the triad of atopic dermatitis, allergic rhinitis and asthma with CAM techniques are summarised and discussed. Methods The information for this overview was gathered from a literature search in the databases Medline and Cochrane Central Register of Controlled Trials from 1 January 1951 to 1 December 2012. Results and conclusion Promising therapies include Petasites hybridus and acupuncture for allergic rhinitis; probiotics during pregnancy; the herbal product Zemaphyte and acupuncture (to control itch) for atopic dermatitis; and physical training, weight reduction, physiotherapy, correct intake of vitamins A, C and D as well as different Chinese herbal formulas for asthma. However, further research is needed to more clearly identify the mechanisms of action of these therapies, and whether these clinical effects are above and beyond any placebo effect.

Complementary and alternative medicine (CAM) is a conservative and increasingly popular approach to treat pruritus for both patients and medical providers. CAM includes natural products, mind-body medicine, and manipulative and body-based practices. In this overview, we summarize current evidence, possible mechanisms and clinical approaches for treating pruritus with CAM techniques. We focus on pruritus associated with atopic dermatitis, herpes zoster, chronic urticaria, burns, and postoperative contexts where the evidence for CAM approaches is promising.

Increase in muscle force, endurance, and flexibility is desired in elite athletes to improve performance and to avoid injuries, but it is often hindered by the occurrence of myofascial trigger points. Dry needling (DN) has been shown effective in eliminating myofascial trigger points.This randomized controlled study in 30 elite youth soccer players of a professional soccer Bundesliga Club investigated the effects of four weekly sessions of DN plus water pressure massage on thigh muscle force and range of motion of hip flexion. A group receiving placebo laser plus water pressure massage and a group with no intervention served as controls. Data were collected at baseline (M1), treatment end (M2), and 4 wk follow-up (M3). Furthermore, a 5-month muscle injury follow-up was performed.DN showed significant improvement of muscular endurance of knee extensors at M2 (P = 0.039) and M3 (P = 0.008) compared with M1 (M1:294.6 ± 15.4 N·m·s, M2:311 ± 25 N·m·s; M3:316.0 ± 28.6 N·m·s) and knee flexors at M2 compared with M1 (M1:163.5 ± 10.9 N·m·s, M2:188.5 ± 16.3 N·m·s) as well as hip flexion (M1: 81.5° ± 3.3°, M2:89.8° ± 2.8°; M3:91.8° ± 3.8°). Compared with placebo (3.8° ± 3.8°) and control (1.4° ± 2.9°), DN (10.3° ± 3.5°) showed a significant (P = 0.01 and P = 0.0002) effect at M3 compared with M1 on hip flexion; compared with nontreatment control (-10 ± 11.9 N·m), DN (5.2 ± 10.2 N·m) also significantly (P = 0.049) improved maximum force of knee extensors at M3 compared with M1. During the rest of the season, muscle injuries were less frequent in the DN group compared with the control group.DN showed a significant effect on muscular endurance and hip flexion range of motion that persisted 4 wk posttreatment. Compared with placebo, it showed a significant effect on hip flexion that persisted 4 wk posttreatment, and compared with nonintervention control, it showed a significant effect on maximum force of knee extensors 4 wk posttreatment in elite soccer players.

Electric mobility has been an integral part of the BMW product strategy since the introduction of the BMW i models i3 and i8 and the expansion of the model variety by various plug-in-hybrid vehicles. Beside of changing insights of customers worldwide in terms of future mobility and growing importance of sustainability, all OEM are faced to huge challenges in fulfilling the CO2 emissions legislation in the main markets worldwide. For premium-OEMs as BMW this means an extra effort due to the wide model program also in the sportive and luxury segment. Therefore, BMW has identified the electric vehicle as a necessary approach for the future success of the company.

BACKGROUND: ImmunoCAP ISAC 112, is a commercially available molecular allergy IgE multiplex test. Data on the comparison of this rather novel test with extract-based as well as molecular ImmunoCAP singleplex IgE tests is missing. OBJECTIVE: To perform a comparison between the ISAC multiplex IgE assay and the ImmunoCAP singleplex test results. METHODS: Serum samples of 101 adults with grass pollen allergy were analysed for sIgE to 112 allergenic molecules represented on the ISAC test as well as to common atopy-related extract-based allergy tests with the ImmunoCAP System (house dust mite [d1], cat [e1], dog [e5], cow's milk [f2], hen's egg [f1], hazelnut [f17], celery [f85], Alternaria alternate [m6], as well as pollen from birch [t3], hazel [t4], mugwort [w6], and ragweed [w1]). Subsequently statistical analysis was performed with the Spearman rank correlation test and the Clopper-Pearson method in order to compare the ISAC multiplex results with the sIgE singleplex results. RESULTS: The positive percent agreements (PPA) and negative percent agreement (NPA) of corresponding allergens between the ISAC sIgE test and the extract-based singleplex ImmunoCAP results at cutoff 0.1 kUA/l varied between 60-100 % for PPA and 78-97 % for NPA. CONCLUSION: When taking into account corresponding allergens molecular testing with the ISAC multiplex test correlates well with ImmunoCAP singleplex results.

Background. Renal failure as a consequence of eating mushrooms has been reported repeatedly after ingestion of webcaps of the Cortinarius orellanus group. But mushrooms of the genus Amanita can also cause renal failure: Amanita smithiana (North America) andAmanita proxima (Mediterranean area). Here, we discuss poisonings caused by other white amanitas. A German and—independently—two Portuguese patients reported the ingestion of completely white mushrooms with ring. Similar to intoxications with A. smithiana orA.proxima, the clinical picture was characterized by nausea and vomiting 10–12 h after ingestion, severe acute renal failure and mild hepatitis. Renal biopsy showed acute interstitial nephritis and tubular necrosis. Two patients were given temporary haemodialysis. All have fully recovered their renal function. Poisonings caused by mushrooms containing the toxin of A. smithiana were suspected. We tested 20 Amanita species for the presence of this toxin. Methods. Thin layer chromatography was applied to detect A. smithiana nephrotoxin in herbarium specimens using authentic material of A. smithiana as reference. Results. A. smithiana toxin could be detected in Amanita boudieri, Amanita gracilior and in Amanita echinocephala. A. boudieri was collected by the Portuguese patients. A. echinocephala is the only nephrotoxic Amanita growing North of the Alps and is suspected to be the cause of renal failure in the German patient. No A. smithiana toxin was detectable in the nephrotoxic A. proxima. Conclusions. A. boudieri, A. gracilior and A. echinocephala are nephrotoxic. These intoxications are clinically similar to that of A. smithiana, with acute reversible renal failure and mild hepatitis but are different in their clinical picture from Orellanus syndrome characterized by a delayed onset of severe and often irreversible renal failure.

Objective To analyze the association between low birth weight, head-to-abdominal circumference ratio, and insulin resistance in early life. Method and results Glycated serum proteins (GSPs) were quantified at delivery in 612 Chinese mother/child pairs serving as a surrogate of maternal and fetal glycemia. Differential ultrasound examination of the fetal's body (head circumference, biparietal diameter, pectoral diameter, abdominal circumference, and femur length) was done in average 1 week prior to delivery. Multivariable regression analysis considering gestational age at delivery, the child's sex, maternal BMI, maternal age at delivery, maternal body weight, and pregnancyinduced hypertension revealed that fetal GSP was inversely associated with birth weight (R(2) = 0.416; P < 0.001). Fetal GSP was furthermore positively associated with the head-to-abdominal circumference ratio, whereas the maternal GSP was negatively correlated with the offspring's head-to-abdominal circumference ratio (R(2) = 0.285; P = 0.010 and R(2) = 0.261; P = 0.020, respectively). The increased head-to-abdominal circumference ratio in newborns with higher fetal GSP is mainly due to a reduced abdominal circumference rather than reduced growth of the brain. Conclusion The disproportional intrauterine growth is in line with the concept of so-called brain sparing, a mechanism maintaining the intrauterine growth of the brain at the expense of trunk growth. Our data suggest that the low birth weight phenotype, linked to cardiovascular diseases like hypertension in later life, might be a phenotype of disproportional intrauterine growth retardation and early life insulin resistance.

Summary Background Chronic spontaneous urticaria is triggered by many direct and indirect aggravating factors including autoreactive/autoimmune mechanisms, infections, non-allergic and pseudoallergic intolerance reactions. However, the role of neuroimmune mechanisms in chronic spontaneous urticaria so far is unclear. Objective Thus, we wanted to address the regulation of the neurotrophin brain-derived neurotrophic factor (BDNF) in serum and inflammatory skin of patients with chronic spontaneous urticaria in comparison to subjects with healthy skin. Methods Fifty adult patients with chronic spontaneous urticaria and 23 skin-healthy subjects were studied. Chronic spontaneous urticaria was defined as recurrent weals for more than 6 weeks. Autologous serum skin test was performed in all patients with chronic spontaneous urticaria and BDNF serum levels were analysed by enzyme immunoassay in all subjects. Furthermore, skin biopsies were taken from weals of eight patients with chronic spontaneous urticaria as well as from healthy skin of eight controls to evaluate the expression of BDNF and its receptors including tyrosine kinase (trk) B and pan-neurotrophin receptor p75NTR by immunohistochemistry. Results BDNF serum levels were detectable in all subjects studied. However, BDNF levels were significantly higher in patients with chronic spontaneous urticaria compared to non-atopic skin-healthy controls (P

Summary Background There is minimal data available concerning the dose–response relationship between allergen exposure and clinical reactivity for outdoor aeroallergens, such as timothy grass pollen. Timothy pollen-specific IgE (sIgE) determinations might assist in predicting the clinical reactivity in patients with allergic rhinoconjunctivitis (ARC). Methods Allergen-sIgE antibody levels of timothy grass pollen were correlated with individual threshold doses eliciting allergic reactions in skin prick test (SPT), conjunctival (CPT) and nasal (NPT) provocation tests in patients suffering from pollen-induced rhinoconjunctivitis and healthy controls. Results One hundred and four patients with ARC (median age: 27 years; range: 18–64; females: 58%) and 36 controls (25 years (22–77); females: 70%) were included in the study. Ninety-six percent of the patients showed a positive reaction in the nasal and 57% showed a positive reaction in the conjunctival provocation. With regarding to titrated SPT, 98% of the patients showed a positive skin test reaction; correlating with the level of sIgE for timothy (P

Biodiversity targets, or estimates of the quantities of biodiversity features that should be conserved in a region, are fundamental to systematic conservation planning. We propose that targets for species should be based on the quantitative thresholds developed for the Vulnerable category of the IUCN Red List system, thereby avoiding future listings of species in an IUCN Red List threat category or an increase in the extinction risk, or ultimate extinction, of species already listed as threatened. Examples of this approach are presented for case studies from South Africa, including threatened taxa listed under the IUCN Red List criteria of A to D, a species listed as Near Threatened, a species of conservation concern due to its rarity, and one species in need of recovery. The method gives rise to multiple representation targets, an improvement on the often used single representation targets that are inadequate for long term maintenance of biodiversity or the arbitrary multiple representation and percentage targets that are sometimes adopted. Through the implementation of the resulting conservation plan, these targets will ensure that the conservation status of threatened species do not worsen over time by qualifying for higher categories of threat and may actually improve their conservation status by eliminating the threat of habitat loss and stabilizing population declines. The positive attributes ascribed to the IUCN Red List system, and therefore to the species targets arising from this approach, are important when justifying decisions that limit land uses known to be detrimental to biodiversity.

Atopic eczema is one of the most pruritic skin diseases. Mediators of atopic eczema itch in the skin are still mostly unknown, but recent studies showed that the histamine 4 receptor plays an important role in itch pathophysiology; tryptase and interleukin-31 are also involved. Differences in itch perception and itch kinetics between healthy volunteers and eczema patients point towards an ongoing central nervous inhibitory activity in patients. Questionnaire studies reported comparatively higher loads in affective items chosen by patients with atopic eczema. In the concept of patient management, the therapy of clinical pruritus has to consider origin and perception of itch, namely the skin and the central nervous system, by combining topical and systemic treatment.

Malnutrition remains a severe problem in the recovery of critically ill patients and leads to increased in-hospital morbidity and in-hospital stay. Even though early enteral nutrition has been shown to improve overall patient outcomes in the intensive care unit (ICU), tubefeed administration is often complicated by delayed gastric emptying and gastroesophageal reflux. Acupuncture has been successfully used in the treatment and prevention of perioperative nausea and vomiting. In this study we evaluated whether acupuncture can improve gastric emptying in comparison with standard promotility drugs in critically ill patients receiving enteral feeding.Thirty mechanically ventilated neurosurgical ICU patients with delayed gastric emptying, defined as a gastric residual volume (GRV)500 mL for ≥ 2 days, were prospectively and randomly assigned to either the acupoint stimulation group (ASG; bilateral transcutaneous electrical acupoint stimulation at Neiguan, PC-6) or the conventional promotility drug treatment group (DTG) over a period of 6 days (metoclopramide, cisapride, erythromycin). Patients in the ASG group did not receive any conventional promotility drugs. Successful treatment (feeding tolerance) was defined as GRV200 mL per 24 hours.Demographic and hemodynamic data were similar in both groups. After 5 days of treatment, 80% of patients in the ASG group successfully developed feeding tolerance versus 60% in the DTG group. On treatment day 1, GRV decreased from 970 ± 87 mL to 346 ± 71 mL with acupoint stimulation (P = 0.003), whereas patients in the DTG group showed a significant increase in GRV from 903 ± 60 mL to 1040 ± 211 mL (P = 0.015). In addition, GRV decreased and feeding balance (defined as enteral feeding volume minus GRV) increased in more patients in the ASG group (14 of 15) than in the DTG group (7 of 15; P = 0.014). On treatment day 1, the mean feeding balance was significantly higher in the ASG group (121 ± 128 mL) than in the DTG group (-727 ± 259 mL) (P = 0.005). Overall, the feeding balance improved significantly on all days of treatment in comparison with the DTG group. Patients in the DTG group did not show an increase in feeding balance until day 6.We introduce a new protocol for acupuncture administration in the critical care setting. We demonstrated that this protocol was more effective than standard promotility medication in the treatment of delayed gastric emptying in critically ill patients. Acupoint stimulation at Neiguan (PC-6) may be a convenient and inexpensive option (with few side effects) for the prevention and treatment of malnutrition in critically ill patients.

Low birth weight is associated with an increased risk of cardiovascular events in later life. Insulin resistance is a key finding in adult patients with cardiovascular diseases. The neonatal phenotype of an individual with insulin resistance might be low birth weight, as insulin influences fetal growth. The renin-angiotensin-aldosterone system has been associated with cardiovascular disease and insulin resistance. We analyzed whether fetal polymorphisms of the angiotensinogen (AGT) and angiotensin-converting enzyme genes influence birth weight and/or fetal total glycated hemoglobin (fTGH), a surrogate parameter of fetal insulin resistance at birth.In 1132 white women delivering singletons, neonatal umbilical blood samples and clinical data of the mothers and newborns were obtained. Newborns were genotyped with respect to the AGT M235T and angiotensin-converting enzyme insertion/deletion polymorphism.The AGT M235T TT polymorphism is associated with reduced birth weight (TT: 3288 g versus TM + MM: 3435 g, P0.05). Furthermore, newborns with a high percentage of fTGH (6.5%) are more likely to have the TT genotype than those with normal fTGH (or=6.5%, P0.05). With higher cutoffs for fTGH, the significance increases to P less than 0.005. No association was seen between these parameters and the fetal angiotensin-converting enzyme insertion/deletion phenotype.The fetal AGT M235T polymorphism is associated with low birth weight and elevated fetal fTGH at birth. Previous findings show that elevated fetal fTGH correlates with low birth weight and that higher activity of the renin-angiotensin-aldosterone system is an independent risk factor for the development of diabetes mellitus and coronary artery disease. Therefore, our data are supportive of the fetal insulin hypothesis.

Background: Itch is the major symptom of many allergic diseases; yet it is still difficult to measure objectively. The aim of this study was to use an evaluated itch stimulus model in lesional (LS) and nonlesional (NLS) atopic eczema (AE) skin and to characterize cerebral responses using functional magnetic resonance imaging (fMRI). Methods: Thermal modulation was performed on a histamine stimulus in randomized order on LS or NLS in rapid alternating order from 32°C (warm) to 25°C (cold). Subjective itch ratings were recorded. Additionally, fMRI measurements were used to analyze the cerebral processing (n = 13). Healthy skin (HS) of age-matched volunteers served as control (n = 9). Results: Mean VAS itch intensity was significantly (P

To cite this article: Pfab F, Huss-Marp J, Gatti A, Fuqin J, Athanasiadis GI, Irnich D, Raap U, Schober W, Behrendt H, Ring J, Darsow U. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema – a blinded, randomized, placebo-controlled, crossover trial. Allergy 2010; 65: 903–910. Abstract Background: Itch is a major symptom of allergic skin disease. Acupuncture has been shown to exhibit a significant effect on histamine-induced itch in healthy volunteers. We investigated the effect of acupuncture on type I hypersensitivity itch and skin reaction in a double-blind, randomized, placebo-controlled, crossover trial. Methods: An allergen stimulus (house dust mite or grass pollen skin prick) was applied to 30 patients with atopic eczema before (direct effect) and after (preventive effect) two experimental approaches or control observation: acupuncture at points Quchi and Xuehai [verum acupuncture (VA), dominant side], ‘placebo-point’ acupuncture (PA, dominant side), no acupuncture (NA). Itch intensity was recorded on a visual analogue scale. After 10 min, wheal and flare size and skin perfusion (via LASER-Doppler) were measured at the stimulus site, and the validated Eppendorf Itch Questionnaire (EIQ) was answered. Results: Mean itch intensity was significantly lower in VA (35.7 ± 6.4) compared to NA (45.9 ± 7.8) and PA (40.4 ± 5.8) regarding the direct effect; and significantly lower in VA (34.3 ± 7.1) and PA (37.8 ± 5.6) compared to NA (44.6 ± 6.2) regarding the preventive effect. In the preventive approach, mean wheal and flare size were significantly smaller in VA (0.38 ± 0.12 cm2/8.1 ± 2.0 cm2) compared to PA (0.54 ± 0.13 cm2/13.5 ± 2.8 cm2) and NA (0.73 ± 0.28 cm2/15.1 ± 4.1 cm2), and mean perfusion in VA (72.4 ± 10.7) compared to NA (84.1 ± 10.7). Mean EIQ ratings were significantly lower in VA compared to NA and PA in the treatment approach; and significantly lower in VA and PA compared to NA in the preventive approach. Conclusions: Acupuncture at the correct points showed a significant reduction in type I hypersensitivity itch in patients with atopic eczema. With time the preventive point-specific effect diminished with regard to subjective itch sensation, whereas it increased in suppressing skin-prick reactions.

Itch is the major symptom of many allergic or inflammatory skin diseases; yet it is still difficult to measure objectively. This article describes recent progress in central nervous system investigations of the itch sensation. Short-term alternating temperature modulation of histamine-induced itch has recently been introduced, allowing human neuro-imaging studies of high resolution. These studies with functional magnetic resonance imaging demonstrate that itch sensation in healthy volunteers is processed by a network of brain regions contributing to the encoding of sensory, emotional, attentional, evaluative and motivational aspects of pruritus.

Prognostic factors for severe complications in tricyclic antidepressant (TCA) overdose remain unclear. We therefore evaluated the value of clinical characteristics and electrocardiograph (ECG) parameters to predict serious events (seizures, arrhythmia, death) in severe TCA overdose of 100 patients using logistic regression models for risk assessment. The overall fatality rate was 6%, arrhythmia occurred in 21% and 31% of the patients developed seizures. Using an univariable logistic regression model, the maximal QRS interval (OR 1.22; 95% CI 1.06-1.41; p = .005), the time lag between ingestion and occurrence of first symptoms of overdose (OR 1.13; 95% CI 0.99-1.29; p = .072) and the age (OR 0.73; 95% CI 0.55-0.98; p = .038) were determined as the solely predictive parameters. In the multivariable logistic regression model, the QRS interval could not be established as independent predictor, however, the terminal 40-ms frontal plane QRS vector (T40) reached statistical significance regarding prediction of serious events (odds ration [OR] 1.70; 95% confidence interval [CI] 1.02-2.84; p = .041), along with age and time lag between ingestion and onset of symptoms of overdose with a sensitivity and specificity of 71% and 70%, respectively. Evaluation of both clinical characteristics and ECG-parameters in the early stage of TCA overdose may help to identify those patients who urgently need further aggressive medical observation and management.

Endothelin-1 (ET-1) exhibits potent proinflammatory and profibrotic properties. Moreover, inflammation is a potent stimulus for inducible NO synthase (iNOS), which has been shown to contribute to cardiac injury. We thus hypothesized that ET-1-induced cardiac injury is attenuated by concomitant lack of iNOS. We established crossbred animals of ET-1 transgenic mice (ET+/+) and iNOS knockout mice (iNOS−/−). At 13 months of age, mice were allocated according to their genotype to one of 4 study groups: wild type (WT) controls (n = 8); ET-1 transgenic (ET+/+) mice (n = 10); iNOS knockout (iNOS−/−) mice (n = 7); and crossbred (ET+/+ iNOS−/−) mice (n = 15). Left ventricular function was determined in vivo by using a tip catheter. Animals were subsequently euthanized and hearts were harvested for weight assessment and histologic evaluation. No cardiac hypertrophy was present, as evidenced by similar mean cardiac weight and myocyte diameter in all groups. Cardiac perivascular fibrosis was significantly increased in ET+/+ and iNOS−/− groups versus WT, whereas ET+/+ iNOS−/− mice did not differ from WT. Regarding left ventricular function, plasma B-type natriuretic peptide was elevated in ET+/+ and iNOS−/− mice, but again in crossbred animals this effect was blunted. Heart catheterization revealed a significantly increased stiffness constant in both ET-overexpressing groups versus WT, but this increase was significantly attenuated in the ET+/+iNOS−/− group versus the ET+/+ group. Parameters indicating systolic heart failure (EF, cardiac output), however, were not different between all study groups. Our study demonstrates that ET transgenic mice develop left ventricular stiffening with subsequent diastolic dysfunction in a slow, age-dependent manner. Additional knock out of iNOS significantly attenuates cardiac injury. We thus conclude that ET-1-induced cardiac injury is at least partially mediated by iNOS.

A genetic association study was conducted to assess whether genetically determined alterations of the nitric oxide system are associated with clinical markers of pre-eclampsia. A large number of Caucasian women were consecutively included after delivery and genotyped for the endothelial nitric oxide synthase gene (NOS3) polymorphisms G894T, T789C (n=1502) and intron 4a/b (n=2186). There are no significant differences in mean blood pressure (BP), protein excretion or new-onset peripheral oedema between any of the genotypes over the course of pregnancy. Neither particular haplotypes nor the combined presence of any two alleles is associated with those markers of pre-eclampsia. The maternal polymorphisms do not seem to influence fetal growth, birth weight or the incidence of congenital malformations. We demonstrate in a large Caucasian population that maternal polymorphisms of the NOS3 gene are not related to clinical markers of pre-eclampsia. The functional relevance of the NOS3 variants alone does not seem to be strong enough to affect BP regulation during pregnancy.

We investigated whether mortality risk factors are gender dependent in haemodialysis patients. Patients (n = 230; 118 women, 112 men) on haemodialysis were followed for 52 months to assess the incidence of death due to cardiovascular or non-cardiovascular causes. Survival was compared by Cox regression analysis using age, diabetes, pre-existing coronary disease, troponin T and C-reactive protein as covariates. In total, 120 participants (52.2%) died within the 52 months of follow-up: 57 patients died of cardiovascular disease, 35 patients died of infectious diseases. Cox regression revealed that age, pre-existing coronary heart disease and troponin T were independent all-cause mortality risk factors for both sexes. Analyzing men and women separately revealed that diabetes and C-reactive protein seemed to be a stronger risk factors for all-cause mortality in women. Cardiovascular mortality was predicted by troponin T in women (relative risk = 5.16, 95% CI: 1.67–15.88; p = 0.004), but not in men (relative risk = 1.69; 95% CI: 0.72–3.96; p = 0.23). Our study showed for the first time that the impact of risk factors in predicting death due to cardiovascular disease is clearly gender dependent.

Itch is the major symptom of many allergic or inflammatory skin diseases, yet it is still difficult to measure objectively. This article shows and updates the development and approaches of central nervous system investigation of itch.Human neuroimaging studies on the physiology and pathophysiology of itch sensation have been hampered by the lack of a reproducible ''on-off'' stimulus. Short-term alternating temperature modulation of histamine-induced itch has recently been shown to provide on-off characteristics.Recent studies with functional magnetic resonance imaging demonstrate that itch sensation in healthy volunteers is processed by a network of brain regions contributing to the encoding of sensory, emotional, attentional, evaluative, and motivational aspects of itch. Keywords: itch, cerebral processing, neuroimaging, histamine

Some studies have shown beneficial effects of needle acupuncture on physical performance. Objective: To evaluate immediate effects of a standardized acupuncture treatment on vertical jumping performance. Subjects and Methods: 12 healthy sport students participated in the study. A randomized crossover design was used to investigate specific effects of real acupuncture, sham acupuncture and a no-acupuncture waiting list condition on myoelectric activity and kinematic parameters (duration of ground contact, maximum jumping height) in one-legged drop jumps. Results: The results of the present study do not demonstrate significant treatment effects on myoelectric and kinematic parameters. However, real acupuncture tends to result in a relative decrease in the duration of ground contact accompanied by increased muscular innervation. Conclusion: Acupuncture treatment had no significant impact on muscular performance of lower leg in stretch-shortening cycle under the present conditions. As to further research, the potential efficacy of acupuncture for improving reactive strength should be investigated in terms of controlled trials with stratified randomization according to physical performance capacity.