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Previous studies have described the structure and function of the insular cortex in terms of spatially continuous gradients. Here we assess how spatial features of insular resting state functional organization correspond to individual pain sensitivity. From a previous multicenter study, we included 107 healthy participants, who underwent resting state functional MRI scans, T1-weighted scans and quantitative sensory testing on the left forearm. Thermal and mechanical pain thresholds were determined. Connectopic mapping, a technique using non-linear representations of functional organization was employed to describe functional connectivity gradients in both insulae. Partial coefficients of determination were calculated between trend surface model parameters summarizing spatial features of gradients, modal and modality-independent pain sensitivity. The dominant connectopy captured the previously reported posteroanterior shift in connectivity profiles. Spatial features of dominant connectopies in the right insula explained significant amounts of variance in thermal (R2 = 0.076; p 2 = 0.031; p 2 = 0.072; p

Specialized centers for weaning in neurological and neurosurgical early rehabilitation can be certified by the German Society for Neurorehabilitation (DGNR) since 1 October 2021. The certification criteria are indicators for structure and process quality and for treatment results for weaning of neurological patients from mechanical ventilation. In Germany these patients are treated in departments for neurological and neurosurgical early rehabilitation in acute care hospitals as well as in specialized rehabilitation hospitals. Acknowledging this diversity of care, certification is possible for both kinds of institutions. Certification is granted by the DGNR in cooperation with TUV Rheinland as the certification authority, analogous to the certification of stroke units. Institutions apply for certification by sending all necessary documents to the TUV Rheinland. Afterwards auditors of the TUV Rheinland (lead auditor) and the DGNR (medical speciality auditor) visit the institution on site. The results of this visit are reported to the certification committee of the DGNR, which in turn recommends or declines certification. The certification of centers for weaning in neurological and neurosurgical early rehabilitation is an important step towards defining neurorespiratory care and the role of the neurologist for intensive care and weaning in Germany. Thereby, the interdisciplinary dialogue between pneumologists, anesthesiologists, and neurologists is fostered. Also, the dialogue on treatment capacities and strategies with healthcare politicians, health insurances, and patient associations is facilitated.

BackgroundInhaled corticosteroids (ICS) are commonly used to treat COPD and are associated with increased risk of pneumonia. The aim of this study was to assess if accumulated use of ICS is associated with a dose-dependent risk of a positive airway culture with Pseudomonas aeruginosa in patients with COPD.MethodsWe conducted a multiregional epidemiological cohort study including Danish COPD patients followed in outpatient clinics during 2010–2017. ICS use was categorised based on accumulated prescriptions redeemed 365 days prior to cohort entry. Cox proportional hazard regression model was used to estimate the risk of acquiring P. aeruginosa. Propensity score matched models were used as sensitivity analyses.ResultsA total of 21 408 patients were included in the study, of which 763 (3.6%) acquired P. aeruginosa during follow-up. ICS use was associated with a dose-dependent risk of P. aeruginosa (low ICS dose: HR 1.38, 95% CI 1.03 to 1.84, p=0.03; moderate ICS dose: HR 2.16, 95% CI 1.63 to 2.85, pConclusionUse of ICS in patients with COPD followed in Danish outpatient clinics was associated with a substantially increased and dose-dependent risk of acquiring P. aeruginosa. Caution should be taken when administering high doses of ICS in severely ill patients with COPD. These results should be confirmed in comparable cohorts and other settings.

Aim Osteoporosis is a major risk factor for fractures. Poor persistence with osteoporosis medication hampers outcomes. This study assessed whether encouraging the formation of patient-led follow-up cooperatives between general practitioners (GPs) and community pharmacists improved medication persistence. Methods All consecutive patients who attended an osteoporosis patient education program were invited to participate. They were given a logbook containing questionnaires they would bring to 6-monthly visits to their GP and pharmacist. The effect of this 3-year cooperative follow-up on persistence with medication and lifestyle changes was assessed. Results In total, 121 patients (average age, 67 years; 93% female) participated. Poor cooperation between GPs and pharmacists was noted. Nevertheless, medication persistence ranged from 83% to 91% over the 6 visits. However, since patient drop-out rates were high and questionnaire return rates were low, a post-study medical chart review was performed. This confirmed that persistence was high (74%-83%) at 3 years post-enrollment, even for oral bisphosphonate-treated patients (73%-76%). However, adoption of anti-osteoporosis lifestyle changes was poor throughout the study: one- to two-thirds of the patients did not alter their diet, physical activity, or surroundings to prevent falls. Conclusion One study goal, namely, to encourage GPs and pharmacists to cooperate in patient follow-up, was not achieved. However, high medication persistence was observed. This may reflect the education program, patient empowerment, personalized attention from study personnel, and being in a study. Patient-centered approaches can thus significantly increase medication persistence in osteoporosis. Ongoing education may be needed to improve patient adoption of and persistence with lifestyle changes.

The aim of this study was to evaluate the effect of exposure to manganese (Mn) on fine motor functions. A total of 48 welders and 30 unexposed workers as controls completed questionnaires, underwent blood examinations, and a motor test battery. The shift exposure of welders to respirable Mn was measured with personal samplers. For all subjects accumulations of Mn in the brain were assessed with T1-weighted magnetic resonance imaging. Welders showed normal motor functions on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson Disease Rating Scale part III. Furthermore welders performed excellent on a steadiness test, showing better results than controls. However, welders were slightly slower than controls in motor tests. There was no association between fine motor test results and the relaxation rates R1 in globus pallidus and substantia nigra as MRI-based biomarkers to quantify Mn deposition in the brain.

Most of the occupational exposure limits (OELs) are based on local irritants. However, exposure to much lower concentrations of irritant substances can also lead to health complaints from workers. Exposure to irritants is often accompanied by strong unpleasant odors, and strong odors might have distracting effects and hence pose a safety risk. The findings obtained in human exposure studies with chemically sensitive, stressed, or anxious persons suggest that their ability to direct attention away from the odorous exposure and to focus on a cognitive task is reduced. In addition, after repeated odor exposure, these persons show signs of sensitization, i.e., difficulties in ignoring or getting used to the exposure. The question arises as to whether certain health conditions are accompanied by a change in sensitivity to odors and irritants, so that these persons are potentially more distracted by odors and irritants and therefore more challenged in working memory tasks than nonsusceptible persons. In our study, susceptible persons with sensory airway hyperreactivity (“capsaicin-sensitive”) respond more strongly to mechanical skin stimuli than controls and show altered network connectivity. Capsaicin-sensitive subjects have a lower pain threshold and thus are more sensitive to mechanical skin stimuli. The intrinsic functional connectivity of their saliency network is higher, and the lower the GABAergic tone of the thalamus, the higher their pain sensitivity to mechanical stimuli. It seems that the increased communication between resting-state networks promotes a stronger perception of the sensory input signal. The results can be used to inform about actual risks (i.e., attention diversion and increased risk of accidents) and “pseudo” risks such as odor perception without a negative impact on one’s well-being. This way, uncertainties that still prevail in the health assessment of odorous and sensory irritating chemicals could be reduced.

Treatment in hospitals differs from treatment in rehabilitation centers from a legal perspective because German law mandates that in hospitals physicians and other qualified personnel must be on duty at all times. This is not required for inpatient rehabilitation centers. Since this Act was passed more than 30 years ago, more acute medical interventions are now carried out and the number of older people in the population has increased. As a result patients are nowadays older, more multimorbid and therefore have a greater risk for medical complications. This is especially true for postacute neurological care. For this reason, the original legal framework for neurological rehabilitation treatment has become questionable. Therefore, we prospectively tested how often patients in inpatient neurorehabilitation suffer from complications that require immediate attention by qualified personnel. In 759 patients observed over a period of 6 months we found 602 complications requiring immediate interventions by physicians (e.g. falls, urinary tract infections, other forms of fever, diarrhea associated with Clostridium difficile, pneumonia, respiratory insufficiency, sepsis, epileptic seizures and arrhythmia). On average at least three acute care interventions occurred per day at the facility examined. We conclude that neurological inpatient rehabilitation has outgrown its legal foundations and now incorporates hospital care.Behandlungen in einem Krankenhaus unterscheiden sich von Behandlungen in einer Rehabilitationsklinik rechtlich dadurch, dass den Patienten im Krankenhaus jederzeitige Hilfe durch Ärzte und anderes qualifiziertes Personal zur Verfügung stehen muss – in der Rehabilitationsklinik hingegen nicht. Seit der Abfassung der zugehörigen Sozialgesetze vor über 30 Jahren werden mehr akutmedizinische Interventionen durchgeführt und die Zahl der Älteren in der Bevölkerung hat zugenommen. Infolgedessen sind Patienten heute älter und multimorbider und dadurch komplikationsgefährdeter. Dies gilt insbesondere für die postakute neurologische Versorgung. Deswegen sind die ursprünglichen Rahmenkonzepte für neurologische Rehabilitationsbehandlung fragwürdig geworden. Wir untersuchten daher prospektiv, wie häufig Patienten in der neurologischen Anschlussrehabilitation akute Komplikationen entwickelten und sofortiger Hilfe durch qualifiziertes Personal bedurften. Wir fanden unter 759 innerhalb einer sechsmonatigen Beobachtungsperiode behandelten Patienten 602 krankenhausmedizinische Komplikationen (Stürze, akute Harnwegsinfekte, Fieber anderer Art, Clostridium-difficile-Diarrhöen, Pneumonien, respiratorische Insuffizienz, Septitiden, epileptische Anfälle und Herzrhythmusstörungen). Insgesamt musste so in der untersuchten Einrichtung im Mittel mehr als dreimal pro Tag akutmedizinisch interveniert werden. Wir schlussfolgern, dass neurologische Anschlussrehabilitation dem bisherigen sozialgesetzlichen Rahmen entwachsen ist und Krankenhausbehandlung umfasst.

Eine mogliche klassische Komplikation des M. Crohn ist die Ausbildung einer Stenose, die wahrend des gesamten Krankheitsverlaufs auftreten und sich in Abhangigkeit von der Lumeneinengung klinisch unterschiedlich prasentieren kann. Berichtet wird uber einen 39-jahrigen Patienten mit einer stenosierenden Ileitis terminalis, die sich letztendlich erst nach Verlegung durch einen Fremdkorper manifestierte.

A large body of research shows that biodiversity loss can reduce ecosystem functioning. However, much of the evidence for this relationship is drawn from biodiversity-ecosystem functioning experiments in which biodiversity loss is simulated by randomly assembling communities of varying species diversity, and ecosystem functions are measured. This random assembly has led some ecologists to question the relevance of biodiversity experiments to real-world ecosystems, where community assembly or disassembly may be non-random and influenced by external drivers, such as climate, soil conditions or land use. Here, we compare data from real-world grassland plant communities with data from two of the largest and longest-running grassland biodiversity experiments (the Jena Experiment in Germany and BioDIV in the United States) in terms of their taxonomic, functional and phylogenetic diversity and functional-trait composition. We found that plant communities of biodiversity experiments cover almost all of the multivariate variation of the real-world communities, while also containing community types that are not currently observed in the real world. Moreover, they have greater variance in their compositional features than their real-world counterparts. We then re-analysed a subset of experimental data that included only ecologically realistic communities (that is, those comparable to real-world communities). For 10 out of 12 biodiversity-ecosystem functioning relationships, biodiversity effects did not differ significantly between the full dataset of biodiversity experiments and the ecologically realistic subset of experimental communities. Although we do not provide direct evidence for strong or consistent biodiversity-ecosystem functioning relationships in real-world communities, our results demonstrate that the results of biodiversity experiments are largely insensitive to the exclusion of unrealistic communities and that the conclusions drawn from biodiversity experiments are generally robust. By comparing data from real-world grassland communities with data from two of the longest-running grassland biodiversity-ecosystem functioning experiments, the authors show that conclusions derived from experimental systems are robust to the removal of unrealistic experimental communities., Nature Ecology & Evolution, 4 (11), ISSN:2397-334X

ZusammenfassungNeurologisch-neurochirurgische Frührehabilitanden sind klinisch oft so schwer betroffen, dass sie neben der frührehabilitativen Behandlung auch von der mechanischen Beatmung entwöhnt werden müssen. In einer Umfrage der Deutschen Gesellschaft für Neurorehabilitation (DGNR) wurden neurologische Weaningzentren gebeten, Informationen zu Strukturmerkmalen ihrer Einrichtung, ihrer personellen und apparativen Ausstattung sowie basierend auf anonymen Daten zu Fallzahl und Behandlungsergebnis zur Verfügung zu stellen. Es nahmen 36 Weaningeinheiten aus 11 Bundesländern mit insgesamt 496 Betten teil. Von 2516 erfassten Weaningfällen im Jahr 2019 wurden 2097 (83,3 %) primär erfolgreich entwöhnt und nur 120 (4,8 %) mussten mit Heimbeatmung entlassen werden. Die Mortalität in dieser Stichprobe lag bei 11,0 % (n = 276). Die Erhebung zeigt, dass das prolongierte Weaning in der neurologisch-neurochirurgischen Frührehabilitation ein wichtiger und erfolgreicher Bestandteil der Versorgung schwerstkranker Patienten darstellt.

MRI is a helpful tool for monitoring disease progression in late-onset Pompe disease (LOPD). Our study aimed to evaluate if muscle diffusion tensor imaging (mDTI) shows alterations in muscles of LOPD patients with

Background Posttraumatic morphological changes have been described in the posterior interosseous nerve (PIN) after mild wrist trauma, and it has been suggested that posttraumatic nerve changes may contribute to wrist pain. PIN excision has shown to relieve pain in some patients with wrist osteoarthritis. However, is not known if PINs from osteoarthritic wrist have pathological features.Objective The aim of this study was to investigate whether PINs from osteoarthritic wrists show morphological changes that are not present in healthy wrists.Materials and Methods PINs resected from 15 osteoarthritic wrists were analyzed with light microscopy regarding morphological changes and compared with five asymptomatic controls without osteoarthritis.Results No significant differences in fascicular area, myelinated fiber density or myelinated fiber diameter were found. However, most patients and controls exhibited some degree of pathology, and a few samples from both groups exhibited severe pathological changes.Conclusions Our findings of morphological changes in both patients with osteoarthritis and asymptomatic controls suggest that pathological changes of unknown significance might exist in the general population in the PIN at wrist level. We believe that the observed structural nerve changes in the PIN are unlikely to contribute to the symptoms of pain. Further studies of the normal histological appearance of the terminal PIN are needed.Level of Evidence This is Level II study.

Because of the increasing volume of autonomously collected data objects, duplicate detection is an important challenge in today's data management. To evaluate the efficiency of duplicate detection algorithms with respect to big data, large test data sets are required. Existing test data generation tools, however, are either not able to produce large test data sets or are domain-dependent which limits their usefulness to a few cases. In this paper, we describe a new framework that can be used to pollute a clean, homogeneous and large data set from an arbitrary domain with duplicates, errors and inhomogeneities. To prove its concept, we implemented a prototype which is built upon the cluster computing framework Apache Spark and evaluate its performance in several experiments.

Conversion of tropical forests is among the primary causes of global environmental change. The loss of their important environmental services has prompted calls to integrate ecosystem services (ES) in addition to socio-economic objectives in decision-making. To test the effect of accounting for both ES and socio-economic objectives in land-use decisions, we develop a new dynamic approach to model deforestation scenarios for tropical mountain forests. We integrate multi-objective optimization of land allocation with an innovative approach to consider uncertainty spaces for each objective. These uncertainty spaces account for potential variability among decision-makers, who may have different expectations about the future. When optimizing only socio-economic objectives, the model continues the past trend in deforestation (1975–2015) in the projected land-use allocation (2015–2070). Based on indicators for biomass production, carbon storage, climate and water regulation, and soil quality, we show that considering multiple ES in addition to the socio-economic objectives has heterogeneous effects on land-use allocation. It saves some natural forest if the natural forest share is below 38%, and can stop deforestation once the natural forest share drops below 10%. For landscapes with high shares of forest (38%–80% in our study), accounting for multiple ES under high uncertainty of their indicators may, however, accelerate deforestation. For such multifunctional landscapes, two main effects prevail: (a) accelerated expansion of diversified non-natural areas to elevate the levels of the indicators and (b) increased landscape diversification to maintain multiple ES, reducing the proportion of natural forest. Only when accounting for vascular plant species richness as an explicit objective in the optimization, deforestation was consistently reduced. Aiming for multifunctional landscapes may therefore conflict with the aim of reducing deforestation, which we can quantify here for the first time. Our findings are relevant for identifying types of landscapes where this conflict may arise and to better align respective policies.

RationalePulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the benefits achieved through alternative approaches, such as pulmonary tele-rehabilitation (PTR).ObjectiveTo investigate whether PTR is superior to conventional PR on 6 min walk distance (6MWD) and secondarily on respiratory symptoms, quality of life, physical activity and lower limb muscle function in patients with COPD and FEV1 MethodsIn this single-blinded, multicentre, superiority randomised controlled trial, patients were assigned 1:1 to 10 weeks of groups-based PTR (60 min, three times weekly) or conventional PR (90 min, two times weekly). Assessments were performed by blinded assessors at baseline, end of intervention and at 22 weeks’ follow-up from baseline. The primary analysis was based on the intention-to-treat principle.Measurements and main resultsThe primary outcome was change in 6MWD from baseline to 10 weeks; 134 participants (74 females, mean±SD age 68±9 years, FEV1 33%±9% predicted, 6MWD 327±103 metres) were included and randomised. The analysis showed no between-group differences for changes in 6MWD after intervention (9.2 metres (95% CI: −6.6 to 24.9)) or at 22 weeks’ follow-up (−5.3 metres (95% CI: −28.9 to 18.3)). More participants completed the PTR intervention (n=57) than conventional PR (n=43) (χ2 test pConclusionPTR was not superior to conventional PR on the 6MWD and we found no differences between groups. As more participants completed PTR, supervised PTR would be relevant to compare with conventional PR in a non-inferiority design.Trial registration numberClinicalTrials.gov (NCT02667171), 28 January 2016.

ZusammenfassungDie Neurorehabilitation versorgt oft Patienten, die schwer und mehrfach erkrankt sind und häufig zuvor durch nichtneurologische Fachdisziplinen behandelt wurden. Medizinisch sind diese Patienten oft noch instabil, sodass die bisherige Diagnostik und Therapien neu bewertet und gegebenenfalls adaptiert oder ergänzt werden müssen. Bestimmte, auch die Neurologie überschreitende diagnostische und therapeutische Probleme – häufig zu antithrombotischer Therapie – tauchen dabei immer wieder auf. Diese werden in Form zu überprüfender Punkte (Checks) vorgestellt, welche Hinweise geben sollen, wann im Einzelfall bisherige Maßnahmen zu hinterfragen und anzupassen sind.

Purpose: Lunocapitate arthrodesis is a motion-preserving salvage procedure for painful wrist osteoarthritis. Because the arthrodesis is limited to the capitate and the lunate, the adaptive motion of the triquetrum is theoretically maintained. We aimed to examine whether triquetral motion is sustained in vivo after lunocapitate arthrodesis. Methods: We examined 7 patients after lunocapitate arthrodesis at least 1 year earlier, with computed tomography at 2 wrist positions: maximal radial extension and maximal ulnar flexion. Triquetral motion in vivo was analyzed using volume registration technique of the paired computed tomography scans and compared with the contralateral side. Results: The triquetrum moved in all patients, but the degree of motion was small compared with the nonsurgical wrist. A minor degree of motion of the hamate relative to the fused lunocapitate could also be demonstrated. Conclusions: Triquetral motion is limited after lunocapitate arthrodesis. Type of study/level of evidence: Therapeutic IV. Key words: lunatocapitate arthrodesis, osteoarthritis, scapholunate advanced collapse, scaphoid nonunion advanced collapse, triquetrum

Scaphoid and lunate mobility has been suggested to be minimal during the dart-throwing motion in studies based on serial computed tomography (CT) scans and cadaver studies. This study analyzes the direct motion between the scaphoid and the lunate during the dart-throwing motion

BACKGROUND AND OBJECTIVE: Liver function is one of the most important parameters for the outcome of transarterial chemoembolization (TACE). The liver maximum capacity (LiMAx) test is a bedside test that provides a real-time option for liver function testing. The objective of this pilot study was to investigate the suitability of the LiMAX test for predicting the TACE outcome. METHODS: 20 patients with intermediate-stage hepatocellular carcinoma (HCC) received a LiMAx test 24 h pre and post TACE. In addition, laboratory values were collected to determine liver function and model for endstage liver disease (MELD) scores. The success of TACE was assessed 6 weeks post intervention by morphological imaging tests using modified response evaluation criteria in solid tumors (mRECIST). RESULTS: Patients with an objective response (OR = CR + PR) according to mRECIST post TACE had significantly higher values in the pre-interventional LiMAx test than patients with a non-OR (PD or SD) post TACE (r(14) = 0.62, p = 0.01). Higher pre-interventional LiMAx values therefore indicate OR. Patients with a disease control (DC = CR + PR + SD) according to mRECIST post TACE had significantly higher values in the pre-interventional LiMAx test than patients with a non-DC (PD) post TACE (r(14) = 0.65, p = 0.01). Higher pre-interventional LiMAx values therefore indicate DC. The point biserial correlations of LiMAx values pre and post TACE with the outcome OR or DC were descriptively stronger than those of MELD with OR or DC. This suggests that the LiMAx test correlates better with the treatment response than the MELD score. CONCLUSIONS: For the first time, we were able to show in our study that patients who are scheduled for TACE could benefit from a LiMAx test to be able to estimate the benefit of TACE. The higher the pre-interventional LiMAx values, the higher the benefit of TACE. On the other hand, laboratory parameters summarized in the form of the MELD score had significantly less descriptive correlation with the TACE outcome.

Background: Due to repeated exacerbations a large group of patients with chronic obstructive pulmonary disease (COPD) are often exposed to oral corticosteroids (OCS). Corticosteroids may be thrombogenic. We evaluated the risk of venous thromboembolia and death in patients with acute exacerbation of COPD (AECOPD) according to two different dosing regimens.Method: This was a nationwide observational cohort study of outpatients with COPD with a 6 month follow up time. It was based on a linked administrative registry data between January 1st 2010 and 28th February 2018. In total 30.473 patients treated with either short course (250mg) of OCS for AECOPD were included in the study. Cox proportional hazard regression was used to estimate the risk of VTE hospitalization or all-cause mortality.Results: The incidence of VTE was low. However, long course of OCS was associated with an increased risk of VTE compared to short course, (HR 1.73, CI 1.08 to 2.79; p < 0.0001). Furthermore, we found a higher risk of all-cause mortality in the long course group, HR 1.62 (CI 1.57 to 1.62; p

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder clinically characterized by muscle atrophy and progressive paralysis. In addition to the classical ALS affecting both the upper and lower motoneurons (UMN and LMN), other subtypes with the predominant (or even exclusive) affection of the UMN or LMN have been identified. This work sought to detect specific patterns of cortical brain atrophy in the UMN and LMN phenotypes to distinguish these two forms from the healthy state. Methods: Using high-resolution structural MRI and cortical thickness analysis, 38 patients with a diagnosis of ALS and predominance of either the UMN (n = 20) or the LMN (n = 18) phenotype were investigated. Results: Significant cortical thinning in the temporal lobe was found in both the ALS groups. Additionally, UMN patients displayed a significant thinning of the cortical thickness in the pre- and postcentral gyrus, as well as the paracentral lobule. By applying multivariate analyses based on the cortical thicknesses of 34 brain regions, ALS patients with either a predominant UMN or LMN phenotype were distinguished from healthy controls with an accuracy of 94% and UMN from LMN patients with an accuracy of 75%. Conclusions: These findings support previous hypothesis that neural degeneration in ALS is not confined to the sole motor regions. In addition, the amount of cortical thinning in the temporal lobe helps to distinguish ALS patients from healthy controls, that is, to support or discourage the diagnosis of ALS, while the cortical thickness of the precentral gyrus specifically helps to distinguish the UMN from the LMN phenotype.

Due to frequent exacerbations, many patients with chronic obstructive pulmonary disease (COPD) are exposed to oral corticosteroids (OCS), which may be thrombogenic. We evaluated the risk of hospitalisation with venous thromboembolism (VTE) and death in patients with acute exacerbation of COPD (AECOPD) treated with long and short OCS regimens. In this nationwide cohort study of 30,473 COPD outpatients treated for AECOPD, we compared the risk of VTE hospitalisation and all-cause mortality within 6 months in OCS dose of &gt, 250 mg vs. ≤ 250 mg. A multivariable Cox proportional hazard regression was used to estimate the risk. The incidence of VTE hospitalisations was 0.23%. A long OCS treatment course was associated with an increased risk of VTE compared to a short course (hazard ratio (HR) 1.69, [95% confidence interval (CI) 1.05 to 2.72], p &lt, 0.031). A higher risk of all-cause mortality was seen in the group of COPD patients treated with a long OCS course (HR 1.71, [95% CI 1.63 to 1.79], p &lt, 0.0001). The risk of reported VTE hospitalisation was higher among AECOPD patients treated with long courses of OCS, but the absolute risk was low, suggesting under-reporting of the condition.

In recent years, there has been a growing interest from the digital humanities in knowledge graphs as data modelling paradigm. Already, this has led to the creation of many such knowledge graphs, many of which are now available as part of the Linked Open Data cloud. This presents new opportunities for data mining. In this work, we develop, implement, and evaluate (both data-driven and user-driven) an end-to-end pipeline for user-centric pattern mining on knowledge graphs in the humanities. This pipeline combines constrained generalized association rule mining with natural language output and facet rule browsing to allow for transparency and interpretability—two key domain requirements. Experiments in the archaeological domain show that domain experts were positively surprised by the range of patterns that were discovered and were overall optimistic about the future potential of this approach.

This article argues for an urban citizenship perspective which explores the struggle for rights and the everyday practices of illegalized migrants. Analyzing the concept of Anonymized Health Certificates as a result of such a struggle allows for examination of urban citizenship in this context. The implementation of the Anonymized Health Certificates program would facilitate access to medical care for people who live in the city of Berlin but are excluded from this right due to their lack of residency status. However, such a perspective also makes it possible to examine the limitation of the Anonymized Health Certificates, which would allow illegalized migrants in Berlin to circumvent access barriers, while at the same time the exclusion mechanisms of these barriers would remain uncontested at the national level. Whilst Anonymize Health Certificates will greatly improve access to medical care, illegalized migrants have by no means been passive subjects and have been actively rejecting their exclusion from health care: Practices include sharing health insurance cards with friends, visiting doctors who help for free as a form of solidarity, and sharing information about these doctors within their social networks. Even if they do not contest the social order visibly, they refuse to passively accept their social exclusion. Illegalized migrants perform such practices of urban citizenship in their everyday life as they actively take ownership of their rights to participate in urban life, even whilst being formally denied these rights.

Background:The usage of volar locking plate fixation for distal radial fractures has increased in older patient populations, despite the fact that surgical treatment in the elderly population has not clearly been proven to be superior to nonoperative treatment. The purpose of the present study was t

The epidemiology of scaphoid fractures has been described in limited populations, and incidence reports have been inconsistent. We investigated the nationwide incidence of scaphoid fractures by evaluating data on 34,377 patients in the Swedish National Patient Register for the years 2006–2015 regarding diagnosis, age, sex and treatment. The data were validated in 300 random patients, and incidence rates were adjusted accordingly. Forty-one per cent of the initially diagnosed fractures were false positives. The adjusted true fracture incidence rate was 22 per 100,000 person-years. During the decade studied incidence rates decreased in younger men and increased in middle-aged women. The incidence of surgical treatment vs. non-operative treatment did not change over time. Men were treated surgically more often than women (6% vs. 3%) and had a greater risk for nonunion (3% vs. 1%).

Background Combining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodulatory effects, with the latter also having in vitro antiviral properties. This may improve outcomes in patients hospitalised for COVID-19. Methods Placebo-controlled double-blind randomised multicentre trial. Patients ≥18 years, admitted to hospital for≤48 h (not intensive care) with a positive SARS-CoV-2 RT-PCR test, were recruited. The intervention was 500 mg daily azithromycin for 3 days followed by 250 mg daily azithromycin for 12 days combined with 200 mg twice daily hydroxychloroquine for all 15 days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14 days (DAOH14). Results After randomisation of 117 patients, at the first planned interim analysis, the data and safety monitoring board recommended stopping enrolment due to futility, based on pre-specified criteria. Consequently, the trial was terminated on February 1, 2021. A total of 61 patients received the combined intervention and 56 patients received placebo. In the intervention group, patients had a median of 9.0 DAOH14 (IQR, 3–11) versus. 9.0 DAOH14 (IQR, 7–10) in the placebo group (p=0.90). The primary safety outcome, death from all causes on day 30, occurred for 1 patient in the intervention group versus. 2 patients receiving placebo (p=0.52), and readmittance or death within 30 days occurred for 9 patients in the intervention group versus. 6 patients receiving placebo (p=0.57). Conclusions The combination of azithromycin and hydroxychloroquine did not improve survival or length of hospitalisation in patients with COVID-19., There are no beneficial or harmful effects from the combined intervention of hydroxychloroquine and azithromycin for hospitalised patients with confirmed coronavirus disease 2019 (COVID-19).

Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pain after trapeziectomy for trapeziometacarpal joint osteoarthritis. The aim of this study was to investigate if proximal migration after trapeziectomy is associated with a poorer long-term outcome in terms of pain and objective physical variables. We retrospectively examined 91 thumbs in 65 patients after a mean of 10 years following trapeziectomy with or without ligament reconstruction and tendon interposition. Proximal migration of the thumb metacarpal was measured on plain lateral radiographs of the thumb and correlated to visual analogue pain scale (VAS), thumb range of motion and strength. Most thumbs had a severe proximal migration of the first metacarpal, the mean scaphoid metacarpal distance was 2.7 mm. Most patients reported no or little pain, median VAS was 0 at rest and 1 after load. There were no differences in reported VAS pain at rest or after load between patients with severe (2 mm scaphoid metacarpal joint space) or less severe (≥2 mm metacarpal joint space) proximal migration. Patients that reported more pain (VAS2) did not exhibit more migration than patients reporting less or no pain. Thumbs with severe migration had weaker key pinch (3.4 vs. 4.6 kg

Graph neural networks and other machine learning models offer a promising direction for machine learning on relational and multimodal data. Until now, however, progress in this area is difficult to gauge. This is primarily due to a limited number of datasets with (a) a high enough number of labeled nodes in the test set for precise measurement of performance, and (b) a rich enough variety of multimodal information to learn from. We introduce a set of new benchmark tasks for node classification on RDF-encoded knowledge graphs. We focus primarily on node classification, since this setting cannot be solved purely by node embedding models. For each dataset, we provide test and validation sets of at least 1000 instances, with some over 10000. Each task can be performed in a purely relational manner, or with multimodal information. All datasets are packaged in a CSV format that is easily consumable in any machine learning environment, together with the original source data in RDF and pre-processing code for full provenance. We provide code for loading the data into numpy and pytorch. We compute performance for several baseline models.

Environmental factors, such as cigarette smoking or lung infections, may influence chronic obstructive pulmonary disease (COPD) progression by modifying the respiratory tract microbiome. However, whether the disease itself induces or maintains dysbiosis remains undefined. In this longitudinal study, we investigated the oropharyngeal microbiota composition and disease progression of mice (in cages of 5–10 mice per cage) before, during and up to 3 months after chronic cigarette smoke exposure or exposure to room air for 6 months. Cigarette smoke exposure induced pulmonary emphysema measurable at the end of exposure for 6 months, as well as 3 months following smoke exposure cessation. Using both classical culture methods and 16S rRNA sequencing, we observed that cigarette smoke exposure altered the relative composition of the oropharyngeal microbiota and reduced its diversity (P P Streptococcus pneumoniae on established smoke-induced emphysema and on the oropharyngeal microbiota were also evaluated. Inoculation with S. pneumoniae induced lung damage and altered the microbiota composition for a longer time compared to control groups infected but not previously exposed to smoke (P=0.01). Our data demonstrate effects of cigarette smoke and pneumococcus infection leading to altered microbiota and emphysema development. The reversal of the disordering of the microbiota composition, but not lung damage, following smoke exposure cessation and after clearance of infection suggest that changes in lung structure are not sufficient to sustain a disordered microbiota in mice. Whether changes in the airway microbiota contribute to inducing emphysema requires further investigation.

As knowledge graphs are getting increasingly adopted, the question of how to maintain the validity and accuracy of our knowledge becomes ever more relevant. We introduce context-aware constraints as a means to help preserve knowledge integrity. Context-aware constraints offer a more fine-grained control of the domain onto which we impose restrictions. We also introduce a bottom-up anytime algorithm to discover contextaware constraint directly from heterogeneous knowledge graphs-graphs made up from entities and literals of various (data) types which are linked using various relations. Our method is embarrassingly parallel and can exploit prior knowledge in the form of schemas to reduce computation time. We demonstrate our method on three different datasets and evaluate its effectiveness by letting experts on knowledge validation and management assess candidate constraints in a real-world knowledge validation use case. Our results show that overall, context-aware constraints are to an extent useful for knowledge validation tasks, and that the majority of the generated constraints are well balanced with respect to complexity.

Background Long-term treatment with corticosteroids causes loss of bone density, but the effects of using short-term high-dose systemic-corticosteroid therapy to treat acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to determine whether high-dose corticosteroid therapy affected bone turnover markers (BTMs) to a greater extent compared to low-dose corticosteroid therapy. Methods The CORTICO-COP trial (NCT02857842) showed that an eosinophil-guided corticosteroid intervention led to approximately 60% lower accumulated corticosteroid dose for hospitalized patients with AECOPD (low-dose group) compared with 5-day standard corticosteroid treatment (high-dose group). We compared the levels of BTMs C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP) in 318 participants during AECOPD and at 1- and 3-month follow-up visits. Results CTX decreased and P1NP increased significantly over time in both treatment groups. There were no significant differences between the groups at 1- or 3-months follow-up for P1NP. A significant drop in CTX was seen at 3 months (down Δ24% from the baseline, p = 0.017) for the high dose group. Conclusion Short-term, high-dose systemic corticosteroid treatment caused a rapid suppression of biomarkers of bone resorption. Corticosteroids did not suppress biomarkers of bone formation, regardless of patients receiving low or high doses of corticosteroids. This therapy was, therefore, harmless in terms of bone safety, in our prospective series of COPD patients. Trial registration ClinicalTrials.gov Identifier: NCT02857842. Submitted August 2nd, 2016.

Objective:This prospective study investigated the extent to which patients undergoing neurorehabilitation reported pain, how this pain developed during inpatient stay and whether patients were treated accordingly (using pain medication).Methods:The extent of pain, performance in daily activities, with a focus on possible impairment from pain, and pain medication were assessed at the beginning and the end of neurorehabilitation treatment. Overall 584 patients, with various neurological diagnoses, such as stroke, intracerebral hemorrhage, polyneuropathy, etc. were classified into four groups based on whether they reported having “no pain,” “mild pain,” “moderate pain,” or “severe pain.” All patients received conventional neurorehabilitation therapy in the Mauritius Hospital, Germany.Results:A total of 149 patients had clinically relevant pain at the beginning of their inpatient stay, at a group level this did not change significantly during the treatment period. At the end of inpatient stay, a slight increase was noted in patients reporting pain. Overall 164 patients suffered from moderate or severe pain, operationalized of pain scores >3 on the visual analog scale. A total of 145 patients who had pain at the end of inpatient stay, did not receive pain medication. There was a weak negative association between pain at baseline and activities of daily living at the end of the treatment period, such that, patients with higher pain levels tended to showed lower Barthel Index scores at the end.Conclusion:In our study, about one-third of patients suffered from clinically relevant pain during neurorehabilitation treatment and most of them did not receive any pain medication.

Background: Glucocorticoids (GCs) are widely used in patients with acute exacerbation of COPD. Single-nucleotide polymorphism (SNP) of the GC receptor gene (NR3C1) has been associated with individual differences in GC sensitivity and may be linked to response to GC-treatment. Objectives: i) Assess the prevalence of adrenal suppression (AS) in severe COPD patients 1 month after GCs course for exacerbation ii) Whether high GC sensitivity SNPs (BclI-G or N363S-G) is associated with increased AS and metabolic syndrome compared with SNPs associated with low GC sensitivity(ER22/23EK, 9β, wild type and mixed type). Methods: Observational prospective cohort study, we recruited 76 patients between 2017—2019 with severe COPD treated with 5 days of GCs. All patients were genotyped for all 4 SNPs. Results: AS frequency (corticotropin stimulated P-cortisol≤420 nmol/l) was 5.4% after 1-month. No difference was observed in baseline characteristics, the frequency of AS or other metabolic outcomes (figure 1) between high GC sensitivity and the low GC sensitivity genotypes. Conclusions: Carrier status of the BclI-G or N363S-G alleles was not associated with the development of AS or metabolic syndrome at 1-month after completing GC treatment, suggesting that genotyping for these SNPs can not identify COPD patients with a high risk of side effects.

Background: Pulmonary P. aeruginosa infections increase morbidity in COPD patients. While low resolution molecular typing has shown that the same clonal lineage can persist and adapt in the lungs, the prevalence of chronic infections in consistently sampled COPD cohorts remains unknown. Objective: The study aim was to determine the prevalence and genetic adaptation of persistent P. aeruginosa infections in patients with COPD. Methods: Whole-genome sequencing study of P. aeruginosa strains sampled longitudinally from sputum cultures in 23 patients enrolled in an ongoing randomized controlled trial in Denmark (clinicaltrials.gov: NCT03262142). Results: A total of 153 P. aeruginosa isolates were sequenced in 23 patients during 365 days of follow-up. Genome sequencing showed that 18 patients were infected with clonal lineages that persisted for at least 30 days (Figure 1). We identified 37 P. aeruginosa genes that were independently mutated in two or more lineages, suggesting a positive selection for adaptive mutations. Mutation in the same genes have previously been shown to be important for persistent infections in patients with genetically defined mucociliary clearance defects. Conclusion:P. aeruginosa persists and genetically adapts in patients with COPD. Thus, our results indicate parallelism to P. aeruginosa infections in patients with genetically defined mucociliary clearance defects.

BackgroundEarly pulmonary rehabilitation after exacerbation of chronic obstructive pulmonary disease (COPD) has previously been shown to reduce the risk of hospital admission and improve physical performance and quality of life. However, the impact of attendance at early rehabilitation programmes has not been established.ObjectivesTo evaluate the impact of increasing attendance to pulmonary rehabilitation on the risk of hospital admission, physical performance and quality of life in patients attending an early rehabilitation programme after an exacerbation of COPD.MethodsThis study was a secondary exploratory analysis of the randomised controlled trial COPD-EXA-REHAB study, involving patients hospitalised with an exacerbation of COPD. The COPD-EXA-REHAB study compared early pulmonary rehabilitation, starting within 2 weeks after an exacerbation, with standard treatment, that is, the same programme starting 2 months later. The present analysis included only the 70 patients allocated to early pulmonary rehabilitation.ResultsAt 1-year follow-up, we found an association between the number of sessions attended and a reduction in hospital admissions (incidence rate ratio 0.93 (95% CI 0.88 to 0.99), p=0.02), corresponding to a 7% reduction for each session attended. Similarly, at 2-month follow-up, physical performance was positively associated with sessions attended: the mean Incremental Shuttle Walk Test result improved by 8 m with each session (95% CI 2.54 to 13.56, p=0.005) and the Endurance Shuttle Walk Test result by 44 s (95% CI 18.41 to 68.95, p=0.001). Quality of life, assessed using the COPD Assessment Test, was not significantly associated with the number of attended sessions, with the average score increasing by 0.15 points with each session (95% CI −0.35 to 0.65, p=0.55).ConclusionIncreased attendance at early pulmonary rehabilitation after exacerbation of COPD was associated with reduced risk of hospital admission and improved physical performance.

An improved understanding of the historical variation in the emissions and sources (biomass burning, BB vs. fossil fuel, FF combustion) of soot and char, the two components of black carbon (BC), and polycyclic aromatic compounds (PACs) may help in assessing the environmental effects of the Atmospheric Brown Cloud (ABC) in SE Asia. We therefore determined historical variations of the fluxes of soot, char, and PACs (24 polycyclic aromatic hydrocarbons (PAHs), 12 oxygenated PAHs (OPAHs), and 4 azaarenes) in a dated sediment core (covering the past ∼150 years) of Phayao Lake in Thailand. The soot fluxes have been increasing in recent times, but at a far lower rate than previously estimated based on BC emission inventories. This may be associated with a decreasing BB contribution as indicated by the decreasing char fluxes from old to young sediments. The fluxes of high- and low-molecular-weight (HMW and LMW) PAHs, OPAHs, and azaarenes all sharply increased after ∼1980, while the ΣLMW-/ΣHMW-PAHs ratios decreased, further supporting the reduction in BB contribution at the expense of increasing FF combustion emissions. We also suggest that the separate record of char and soot, which has up to now not been done in aerosol studies, is useful to assess the environmental effects of ABC because of the different light-absorbing properties of these two BC components. Our results suggest that besides the establishment of improved FF combustion technology, BB must be further reduced in the SE Asian region in order to weaken the ABC haze.

Objectives: The role of Pseudomonas aeruginosa in the long-term prognosis of chronic obstructive pulmonary disease (COPD) is unknown. The purpose of this study was to determine whether P. aeruginosa is associated with increased risk of exacerbations or death in patients with COPD. Methods: This is a multiregional epidemiological study based on complete data on COPD outpatients between 1 January 2010 and 31 October 2017 and corresponding microbiology and national register data. Time-dependent Cox proportional hazards models and propensity matching was used to estimate hospitalization-demanding exacerbations and death after 2 years, separately and in combination. Results: A total of 22 053 COPD outpatients were followed for a median of 1082 days (interquartilerange: 427-1862). P. aeruginosa was present in 905 (4.1%) patients. During 730 days of follow-up, P. aeruginosa strongly and independently predicted an increased risk of hospitalization for exacerbation or all-cause death (HR 2.8, 95%CI 2.2-3.6; p

Background The aim of the study was to evaluate patient reported outcome measures (PROM) before and after trapeziectomy with or without ligament reconstruction and tendon interposition for trapeziometacarpal joint arthritis with special focus on possible differences due to gender, age and surgical method. Methods Data from the Swedish quality registry for hand surgery (HAKIR) was analyzed preoperatively, 3 months and 1 year postoperatively for 1850 patients (mean age 63 years, 79% women). Results One year postoperatively, mean pain at rest was reduced from 50 to 12 of maximum 100. However, pain on load and weakness had not abated to the same extent (mean 30 and 34 of 100, respectively). The mean improvement in PROM did not differ between age groups or gender. The result was similar after trapeziectomy with ligament reconstruction and tendon interposition (86% of the patients) and simple trapeziectomy but few patients were operated with the latter method. Conclusion Pain on load and weakness remains to some extent 1 year after surgery for trapeziometacarpal joint arthritis. The result is similar after trapeziectomy with or without ligament reconstruction and tendon interposition and the same improvement can be expected after surgery regardless of age and gender.

Objectives The aim of this study was to establish whether early pulmonary rehabilitation after severe exacerbation of chronic obstructive pulmonary disease (COPD) reduces mortality and hospital admissions, and increases physical performance and quality of life compared to rehabilitation initiated later in the stable phase of COPD. Methods In a randomised controlled trial of 150 patients hospitalised with an exacerbation of COPD, participants were allocated to pulmonary rehabilitation either within 2 weeks after discharge or the same rehabilitation programme but initiated 2 months after discharge. Results Early pulmonary rehabilitation did not prolong time to first hospital admission or time to death (hazard ratio 0.79, 95% CI 0.47–1.23, p=0.33) compared to rehabilitation in stable phase. However, 2 months after inclusion, pulmonary rehabilitation resulted in a significantly better improvement in the incremental shuttle walk test (33.9 m, 95% CI 4.18–63.7, p=0.02) compared to that in the stable phase. The difference in the endurance shuttle walk test was of borderline significance (140 s, 95% CI −2.03–282.76, p=0.05), but there was no significant difference concerning the COPD assessment test (−1.43 points, 95% CI −3.44–0.59, p=0.17). Conclusion Early pulmonary rehabilitation after acute exacerbation of COPD led to a faster improvement in physical performance compared to rehabilitation initiated later in the stable phase, but did not improve survival or prolong time to hospital readmission., Early pulmonary rehabilitation shortly after #AECOPD leads to a faster recovery in physical performance than initiated in the stable phase. Adherence to rehabilitation is significantly higher when initiated shortly after an exacerbation. http://bit.ly/2S7XsT9

Background Interstitial lung abnormalities (ILA) are common in participants of lung cancer screening trials and broad population-based cohorts. They are associated with increased mortality, but less is known about disease specific morbidity and healthcare utilisation in individuals with ILA. Methods We included all participants from the screening arm of the Danish Lung Cancer Screening Trial with available baseline CT scan data (n = 1990) in this cohort study. The baseline scan was scored for the presence of ILA and patients were followed for up to 12 years. Data about all hospital admissions, primary healthcare visits and medicine prescriptions were collected from the Danish National Health Registries and used to determine the participants’ disease specific morbidity and healthcare utilisation using Cox proportional hazards models. Results The 332 (16.7%) participants with ILA were more likely to be diagnosed with one of several respiratory diseases, including interstitial lung disease (HR: 4.9, 95% CI: 1.8–13.3, p = 0.008), COPD (HR: 1.7, 95% CI: 1.2–2.3, p = 0.01), pneumonia (HR: 2.0, 95% CI: 1.4–2.7, p p p = 0.03) compared with participants without ILA. These findings were confirmed by increased hospital admission rates with these diagnoses and more frequent prescriptions for inhalation medicine and antibiotics in participants with ILA. Conclusions Individuals with ILA are more likely to receive a diagnosis and treatment for several respiratory diseases, including interstitial lung disease, COPD, pneumonia, lung cancer and respiratory failure during long-term follow-up.

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1.Rapid growth of the world's human population has increased pressure on landscapes to deliver high levels of multiple ecosystem services, including food and fibre production, carbon storage, biodiversity conservation and recreation. However, we currently lack general principles describing how to achieve this landscape multifunctionality. 2.We combine theoretical simulations and empirical data on 14 ecosystem services measured across 150 grasslands in three German regions. In doing so, we investigate the circumstances under which spatial heterogeneity in a driver of ecosystem functioning (an ‘ecosystem‐driver,’ e.g. the presence of keystone species, land‐use intensification or habitat types) increases landscape‐level ecosystem multifunctionality. 3.Simulations based on theoretical data demonstrated that relationships between heterogeneity and landscape multifunctionality are highly variable and can range from non‐significant to strongly positive. Despite this variability, we could identify criteria under which heterogeneity‐landscape multifunctionality relationships were most strongly positive: this happened when multiple ecosystem services responded contrastingly (both positively and negatively) to an ecosystem‐driver. 4.These findings were confirmed using empirical data, which showed that heterogeneity in land‐use intensity promoted landscape multifunctionality in cases where functions with both positive (e.g. plant biomass) and negative (e.g. flower cover) responses to land use intensification were included. For example, the simultaneous provisioning of ecosystem functions related to forage production (generally profiting from land‐use intensification), biodiversity conservation and recreation (generally decreasing with land‐use intensification) was highest in landscapes consisting of sites varying in land‐use intensity. 5.Synthesis and applications. Our findings show that there are general principles governing landscape multifunctionality. A knowledge of these principles may support land management decisions. For example, knowledge of relationships between ecosystem services and their drivers, such as land use type, can help estimate the consequences of increasing or decreasing heterogeneity for landscape‐level ecosystem service supply, although interactions between landscape units (e.g. the movement of pollinators) must also be considered.

Despite group A streptococci being an infrequent cause of pharyngitis in adult outpatients, sore throat remains a common indication for antibiotic prescription. This prospective multicentre non-randomised study describes a community pharmacy-based antimicrobial stewardship intervention consisting in the implementation of rapid antigen testing (RAT) for the management of adults with sore throat. Trained pharmacists triaged patients presenting with symptoms of pharyngitis using the modified Centor score. Those at risk for streptococcal infection were tested with RAT. Patients with a positive RAT were invited to consult a physician, whereas others were offered a symptomatic treatment. All patients received educational leaflets and were asked to fill in a follow-up form 7 days later. Ninety-eight pharmacies in one French region participated, and 559 patients were included over 6 months. RAT was proposed in 367 (65.7%) cases, and it was positive in 28 (8.3%). The follow-up form was returned by 140 (38.5%) participants. Of these, 10/10 patients with positive RAT further consulted a physician and were prescribed an antibiotic treatment, whereas 96.5% (110/114) of patients with negative results and not having any other reason to seek for doctor's advice did not consult. All participants found the intervention useful. Pharmacists spent 6-15 min to perform the intervention, and 98.6% (73/74) of pharmacists giving a feedback declared to be ready to implement this intervention in daily practice, if endorsed and reimbursed. Our results suggest that a pharmacy-based programme for the management of sore throat is feasible and could increase adherence to guidelines.

ZusammenfassungEine erhöhte Aktivität der Kreatinkinase (CK) im Serum ist in der Regel ein Indikator für eine Muskelschädigung. Eine HyperCKämie ist häufig ein Zufallsbefund und sollte, insbesondere bei asymptomatischen Patienten, zunächst nach mehrtägiger Vermeidung körperlicher Belastung kontrolliert werden. Zudem sprechen Daten aus neueren Studien dafür, dass die aktuellen Normwerte nach oben hin korrigiert werden müssen. Diese Übersichtsarbeit enthält einen Algorithmus zur differenzialdiagnostischen Abklärung einer CK-Erhöhung bei Patienten ohne muskuläre Beschwerdesymptomatik. Auf neurologischem Fachgebiet können insbesondere Myopathien und Neuropathien mit Beteiligung des 2. Motoneurons Ursache für eine symptomatische HyperCKämie sein, wobei CK-Werte über 1000 U/L (16,7 μkat/L) eher für eine primäre Muskelerkrankung sprechen. Zu den Erkrankungen mit sehr hohen CK-Werten zählen einige Formen der Muskeldystrophien, idiopathischen Myositiden und metabolischen Myopathien. Andererseits schließt ein normaler oder nur leicht erhöhter CK-Wert eine Myopathie nicht aus. Das individuelle diagnostische Vorgehen (z. B. Bildgebung der Muskulatur, spezielle Laboruntersuchungen, Muskelbiopsie und genetische Analysen) hängt vom klinischen Phänotyp und den Ergebnissen der elektrophysiologischen Untersuchungen ab. Eine HyperCKämie kann auch als Nebenwirkung bei zahlreichen Medikamenten, einschließlich Statinen, auftreten. Bei asymptomatischen Patienten kann eine Statin-assoziierte CK-Erhöhung bis zum 5-Fachen des oberen Grenzwertes toleriert werden. Bei höheren CK-Werten und/oder assoziierten muskulären Beschwerden sollte die LDL-Cholesterin-senkende Therapie neu festgelegt werden. Eine Rhabdomyolyse ist ein potentiell lebensgefährlicher Zustand und geht mit deutlichen CK-Erhöhungen einher. Zur Therapie in der akuten Phase gehören eine Sicherstellung der Nierenfunktion und ein Ausgleich von metabolischen Störungen.

Elevated serum creatine kinase (CK) activity is usually an indicator of muscle damage. HyperCKemia is often an incidental finding and should be controlled after refraining from physical activity for some days, especially in asymptomatic patients. Furthermore, data from recent studies indicate that the upper limits of normal (ULN) need to be revised upward. This review includes an algorithm for the differential diagnosis of CK elevation in patients without muscular symptoms. In the field of neurology, in particular myopathies and neuropathies with affection of the lower motor neuron can cause symptomatic hyperCKemia, with CK values >1000 U/l (16,7 µkat/l) being indicative of a primary muscle disorder. Diseases with very high CK values include subtypes of muscular dystrophies, idiopathic inflammatory myopathies and metabolic myopathies. However, a normal or only slightly elevated CK value does not exclude the presence of a myopathy. The individual diagnostic procedure (e. g., muscle imaging, special laboratory studies, muscle biopsy and genetic testing) depends on the clinical phenotype and the results of electrophysiological studies. HyperCKemia can also be an adverse effect of several drugs including statins. In asymptomatic patients, statin-associated CK elevations

Much effort has been invested in standardizing medical terminology for representation of medical knowledge, storage in electronic medical records, retrieval, reuse for evidence-based decision making, and for efficient messaging between users. We only focus on those efforts related to the representation of clinical medical knowledge required for capturing diagnoses and findings from a wide range of general to specialty clinical perspectives (e.g., internists to pathologists). Standardized medical terminology and the usage of structured reporting have been shown to improve the usage of medical information in secondary activities, such as research, public health, and case studies. The impact of standardization and structured reporting is not limited to secondary activities; standardization has been shown to have a direct impact on patient healthcare.