Non-coding RNAs in exercise immunology:A systematic review

Regular physical exercise has been recognized as a potent modulator of immune function,with its effects including enhanced immune surveillance,reduced inflammation,and improved overall health.While strong evidence exists that physical exercise affects the specific expression and activity of non-coding RNAs(ncRNAs)also involved in immune system regulation,heterogeneity in individual study designs and analyzed exercise protocols exists,and a condensed list of functional,exercise-dependent ncRNAs with known targets in the immune system is missing from the literature.A systematic review and qualitative analysis was used to identify and categorize ncRNAs participating in immune modulation by physical exercise.Two combined approaches were used:(a)a systematic literature search for“ncRNA and exercise immunology”,(b)and a database search for microRNAs(miRNAs)(miRTarBase and DIANA-Tarbase v8)aligned with known target genes in the immune system based on the Reactome database,combined with a systematic literature search for“ncRNA and exercise”.Literature searches were based on PubMed,Web of Science,and SPORTDiscus;and miRNA databases were filtered for targets validated by in vitro experimental data.Studies were eligible if they reported on exercise-based interventions in healthy humans.After duplicate removal,95 studies were included reporting on 164 miRNAs,which were used for the qualitative synthesis.Six studies reporting on long-noncoding RNAs(lncRNAs)or circular RNAs were also identified.Results were analyzed using ordering tables that included exercise modality(endurance/resistance exercise),acute or chronic interventions,as well as the consistency in reported change between studies.Evaluation criteria were defined as“validated”with 100%of≥3 independent studies showing identical direction of regulation,“plausible”(≥80%),or“suggestive”(≥70%).For resistance exercise,upregulation of miR-206 was validated while downregulation of miR-133a appeared plausible.For endurance exercise,15 miRNAs were categorized as validated,with 12 miRNAs being consistently elevated and 3 miRNAs being downregulated,most of them after acute exercise training.In conclusion,our approach provides evidence that miRNAs play a major role in exercise-induced effects on the innate and adaptive immune system by targeting different pathways affecting immune cell distribution,function,and trafficking as well as production of(anti-)inflammatory cytokines.miRNAs miR-15,miR-29c,miR-30a,miR-142/3,miR-181a,and miR-338 emerged as key players in mediating the immunomodulatory effects of exercise predominantly after acute bouts of endurance exercise.

Empowerment in chronic wound care——exploring the scope for patient contribution

Objective:In this study,we investigated the concept of empowerment in chronic wound care and propose to facilitate patient control by making use of degrees of freedom(DOF):that is,shaping of everyday wound care tasks initiated by patients and based on their wishes,mostly in terms of patients executing treatment steps,requesting or directing health care professionals to under take changes,or modifications of internal states.Methods:As a first step,we conducted a systematic literature search,followed by an inductive form of qualitative content analysis,which resulted in the identification of 5 dimensions as main elements of empowerment:education and shared decision making,adherence to self-care behaviors,responsibility and control,general call for empowerment,and DOF.However,the latter are noticeably absent in the literature.To investigate patients'freedom in shaping the wound care process,we conducted a second literature search.Results:A number of possibilities for patients to influence the wound care process could be identified,but experimental or clinical evidence about their effects is missing,their variety is limited,and they are only inadequately described.Conclusions:However,DOF should be an indispensable aspect of genuine empowerment,since they allow patients to occupy the role of the agent in the treatment process and give rise to the subjective experience of feeling empowered.Thus,in the third part,we develop a research proposal on how to investigate and include DOF in the clinical practice of wound care.Finally,limitations about implementations are discussed(e.g.,patients being reluctant to overcome their passive role,resulting in frustration for health care professionals).

Cartilage repair techniques of the talus: An update

Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients.Although their pathomechanism is well understood,it is well known that different aetiologic factors play a role in their origin.Additionally,it is well recognised that the talar articular cartilage strongly differs from that in the knee.Despite this fact,many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee.Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans.However,depending on the size of the lesions,surgical approaches are necessary to treat many of these defects.Bone marrow stimulation techniques may achieve good results in small lesions.Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation.Autologous chondrocyte transplantation,as a restorative procedure,is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor.The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.

用SpREUK-SF10问卷快速测评慢性病患者的精神追求和宗教信仰(英文)

背景:越来越多的证据表明精神因素对健康有一定影响。测评精神状况的方法要适合所研究的人群。SpREUK问卷的设计便是为了更好地研究世俗社会中的慢性病患者如何看待精神因素对其健康的影响及其如何对待疾病。目的:本文描述可能适用于生活在世俗社会中的病人的SpREUK问卷这一评价工具的产生背景及其心理测量功能,并总结在德国病人中的验证结果。设计和受试者:采用横断面研究,对496位平均年龄(53.5±14.4)岁的慢性病患者(84%为慢性疼痛,6%为癌症,10%为其他疾病)进行问卷调查,问卷由受试者自行完成。结局指标:我们旨在设计一种SpREUK问卷的缩减版(SpREUK-SF10),并检测其因子结构及概念效度,同时使用该问卷测评患者的精神实践参与度(SpREUK-P)、生活满意度(BMLSS)及对疾病的理解(IIQ)。结果:这一问卷具有良好的心理测量功能,区分了3个心理因素,分别是:(1)信仰;(2)寻求精神/宗教支持;(3)对疾病的积极理解。其中,对疾病的积极理解与信仰和寻求支持有一定关联,揭示了其在精神层面的内涵。结论:SpREUK-SF10问卷对于不单一信仰或反对某一宗教的世俗社会中人们的精神因素有较好的测评作用。适合其他文化背景的问卷还有待进一步研究开发。

Acute traumatic coagulopathy：Incidence, risk stratification and therapeutic options

Uncontrolled hemorrhage is responsible for over 50% of all trauma-related deaths within the first 48 hours after admission. Clinical observations together with recent research resulted in an appreciation of the central role of coagulopathy in acute trauma care. A synopsis is presented of different retrospective analyses based upon datasets from severe multiply injured patients derived from the TR-DGU database （Trauma Registry of the Deutsche Gesellschaft for Unfallchirurgie （DGU）/German Society of Trauma Surgery） with respect to frequency, risk stratification and therapeutic options of acute traumatic coagulopathy （ATC）. The synopsis of different analyses based upon the datasets from severe multiply injured patients derived from the TR-DGU database and development/validation of a scoring system （TASH-score = Trauma Associated Severe Hemorrhage） that allows an early and reliable estimation for the probability of massive transfusion as a surrogate for life-threatening hemorrhage after severe multiple injuries. The high frequency of ATC upon emergency room admission is associated with significant morbidity and mortality in multiply injured patients. The TASH-score is recognized as an easy-to-calculate and valid scoring system to predict the individual＇s probability for massive transfusion and thus ongoing life-threatening hemorrhage at a very early stage after severe multiple injuries. An early aggressive management of ATC including a more balanced administration of blood products to improve outcome is advocated.

德国老年人对替代医学疗法、针刺、顺势疗法及人智学疗法的使用情况(英文)

目的:很多有关补充替代医学(complementary and alternative medicine,CAM)的研究表明,CAM的使用情况与患者的社会文化背景、性别、年龄及基础疾病等因素有关。本研究旨在调查分析拥有医疗保险的德国老年人对特定的CAM疗法的使用情况。方法:在一次匿名的德国保险受益人的横断面调查中,对5 830名老年人过去5年里通过医生或非医疗工作者使用CAM的情况的调查数据进行分析。结果:德国老年人最广泛使用的CAM疗法分别为针刺/中医(21%)、顺势疗法(21%)、运动疗法/锻炼(19%)、整骨疗法/脊椎指压疗法(12%)、草药/植物疗法(7%)、节食/特殊食谱(6%)及足底反射疗法(5%)。人智学疗法只被很少数的人使用。针刺与顺势疗法的使用者倾向于同时使用多种CAM疗法,特别是同时使用针刺与顺势疗法。男性患者与女性患者在CAM疗法的使用上有显著的不同。结论:针刺与顺势疗法的使用人数近似,而顺势疗法是源于西欧的一种CAM疗法,这说明针刺这一来自东方的疗法在德国也有其立足之地。很多患者同时使用多种CAM疗法,特别是针刺与顺势疗法同时使用者居多。此外,对于一些将并非CAM疗法的治疗方法纳入其研究之中而得出的结论,应该持谨慎态度。

Deepening trochleoplasty combined with balanced medial patellofemoral ligament reconstruction for an adequate graft tensioning

AIM To evaluate our modified deepening trochleoplasty com-bined with a balanced medial patellofemoral ligament(MPFL) reconstruction for soft tissue alignement. METHODS Thirty-three knees with with recurrent patellar dislocations and a trochlear dysplasia in 30 patients(m/f = 12/21, mean age 24 ± 9 years) underwent a combination of a modified deepening trochleoplasty and a balanced MPFL reconstruction for a medial soft tissue alignement. After a mean follow-up period of 29 ± 23 mo, patients' return to sports, possible complications as well as the clinical outcomes using the Kujala, International Knee Documentation Committee(IKDC) and Lysholm scoring were evaluated. Moreover, patients' satisfaction with the general outcome, the cosmetic outcome, the pre-and postoperative pain and a potential avoidance behaviour were assessed with additional standardized questionnaires which also included different visual analog scales. RESULTS There were no signs of a persistent instability. The Kujala score improved from a mean of 64 ± 16 points to 94 ± 9 points, the Lysholm score improved from a mean of 63 ± 17 to 95 ± 6 points and the IKDC score from 58 ± 11 to 85 ± 12 points, P < 0.0001, respectively. The assessment of pain using a visual analog scale showed a significant pain reduction from a mean of 4.8 ± 2.0 to 1.3 ± 3.4 points(P < 0.0001). Two of 26 cases(92%) who were engaged in regular physical activity before surgery did not return to full sporting activities. One patient felt that his sport was too risky for his knee and reported an ongoing avoidance behaviour. The other patient preferred to wait for surgery of her contralateral knee. Of the eight patients who were not engaged in sporting activities before surgery, three started regular sporting activities after surgery. In 31 of the 33 cases(94%), the patients were very satisfied with the clinical outcome of the surgery. Regarding the cosmetic results, no patients felt impaired in their self-confidence and in their clothing decisions. CONCLUSION Our technique shows a good clinical outcome in terms of the common scorings as well as in terms of pain, return to sports and patient satisfaction.

Long-term results of an anatomically implanted hip arthroplasty with a short stem prosthesis (MiniHip^(TM))

AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHip^(TM) system. METHODS In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem(MiniHip^(TM), Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years(range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score(OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score(HOOS) was assessed pre-and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.RESULTS The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P < 0.001 respectively. There were no differences regarding age, etiology, friction pairings, etc.,(P > 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected. CONCLUSION Regarding these first long-term results on the MiniHip^(TM), the implant performed exceedingly well with a high rate of survivorship for aseptic loosening. Our radiological results within the Gruen zones support the design rationale of the Minihip to provide a reliable metaphyseal anchoring with the expected proximal, more physiological load transfer. This might minimize or exclude a stress shielding which might be associated with thigh pain, proximal bone loss and an increased risk of aseptic loosening. The MiniHip^(TM) is a reliable partial-neck retaining prosthesis with good a clinical long-term outcome in younger as well as elderly patients.

Peritonitis and pneumoperitoneum after successful emergency pericardiocentesis in the case of a Chilaiditi syndrome

Pericardiocentesis is a common therapeutic procedure for pericardial tamponade due to pericardial effusion as well as a diagnostic procedure to obtain fluid for cytopathologic examination.Standard methods include ultrasound or fluoroscopic guidance,which generally result in high success rates(over 95%).[1,2].The complication rate of pericardiocentesis is low with reported incidences of l%-2%.[3]In the past,the most common indications for pericardiocentesis include uremia,tuberculous pericarditis or malignant pericardial effusions.However,with the increasing number of catheter-based interventional cardiac procedures,iatrogenic pericardial effusions are becoming more frequent[4-6].

Globalised world, globalised diseases: A case report on an amoebiasis-associated colon perforation

In 2010 the World Health Organisation estimated the number of infections with Entamoeba histolytica at about 50 million cases including 100000 fatal courses. In most cases this infection is a subclinical event with few or none symptoms noticeable for the patient. Courses of this disease and incidence of this parasite in industrialised nations are not yet fully investigated. Our case reports about a 68-year-old male patient from Turkey who lives for more than 30 years in Germany and had not been abroad during the past 2 years. Resistant asymptomatic amoebic dormant bodies caused an emergency-laparoscopy and revealed the seldom complication of a colon perforation. In the age of globalisation all providers in the health care systems are urged to acquaint themselves also with non-typical syndromes for the countries they work in order to reduce preventable morbidity respectively mortality rates.

Polypropylene versus Polyester Mesh for Laparoscopic Inguinal Hernia Repair: Short-Term Results of a Comparative Study

Background: Polypropylene meshes are commonly used in laparoscopic inguinal hernia repair, although they may cause complications. In this prospective study, a polyester mesh was compared to a polypropylene mesh. Methods: Transabdominal preperitoneal (TAPP) laparoscopic repair was performed in 160 consecutive male patients suffering from unilateral inguinal hernia. The first 80 cases received a polypropylene mesh (Parietene, Covidien, France), and a polyester mesh (Parietex, Covidien, France) was implanted in the second half of patients. Both groups were comparable with respect to clinical and demographic variables. Patients rated their pain using the visual analogue scale (VAS), and ultrasonography was performed on postoperative days 1 and 3 to measure seroma formation. Results: The duration of surgery and the length of stay were similar in both groups. Postoperative pain, measured on day 1 and 3, was significantly less in patients who had received a polyester mesh as compared to the polypropylene group. The size of local seroma was also significantly reduced in the polyester group. Complication rates were 10% in the polypropylene and 9% in the polyester group and included one early recurrence in each group. Conclusions: Polyester meshes may be useful in TAPP, as this mesh material produces less foreign body reaction with less seroma formation and lower pain levels than conventional polypropylene.

针灸对于体外受精和卵母细胞单精子显微注射结局的影响:一项前瞻性的随机对照临床研究

Objective: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). Design: Randomized, prospective, controlled clinical study. Setting: University IVF center. Patient(s): Two hundred twenty-five infertile patients undergoing IVF/ICSI. Intervention( s): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture. Main Outcome Measure(s): Clinical and ongoing pregnancy rates. Result(s): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4% , respectively) were significantly higher than in group II (15.6% and 13.8% ). Conclusion(s): Luteal-phase acupuncture has a positive effect on the outcome of 5 IVF/ICSI. .

Stapled Trans-Anal Rectal Resection (STARR) for Obstructive Defecation Syndrome—Functional Outcome and Quality of Life after Two Years

Background: Stapled transanal rectal resection (STARR) has been shown to improve patients’ functional and quality of life outcomes in several studies. Although it is a safe and effective treatment for obstructive defecation syndrome, still data on long-term follow-up are missing. Methods: From January 2010 to July 2014, 46 consecutive patients undergoing STARR using the CONTOUR&reg TRANSTAR&#8482 device, shortly named TRANSTAR (transanal stapler assisted resection), were prospectively followed. Recurrence rate, quality of life (Patient Assessment of Constipation-Quality of Life (PAC-Qol)) and complication were documented at baseline, 12 and 24 months after operation. Two subgroups of patients were compared to assess the impact of resection length on outcome. Results: We included 46 patients (89% female) in the study. The mean age was 65 ± 16 years and the duration of the operation was 48 ± 4 min. Total PAC-QoL score improved from 2.0 (SD 0.3) to 0.9 (1.4) after 12 months, but deteriorated to 1.2 (0.3) after 24 months (p < 0.001 for both comparisons). Complications were noted in 7% of the patients: Urinary retention (2 patients), postoperative bleeding (1 patient). No major complications or mortality were seen. After one year, we had one prolapse recurrence and after 24 month we had another. There was no significant relation between the length of the specimen and the improvement of life quality. Conclusions: The STARR procedure seems to be a safe and fast therapeutic option for patients with ODS and/or rectal prolapse. It is a tailored transanal full-thickness rectal resection improving the patients’ quality of life still two years after the operation.

Risk factors for impaired glucose tolerance in obese children and adolescents

AIM:To investigate which obese children have an increased risk for impaired glucose tolerance(IGT),a risk factor for later diabetes.METHODS:We studied 169 European untreated obese children and adolescents with normal glucose tolerance at baseline.Waist circumference,fasting glucose,lipids,blood pressure,pubertal stage,2 h glucose in oral glucose tolerance test(oGTT),and HbA1c were deter mined at baseline and 1 year later.RESULTS:One year after baseline,19(11.2) children demonstrated IGT,4(2.4) children had impaired fas ting glucose,no(0) child suffered from diabetes,and 146(86) children still showed normal glucose tolerance.At baseline,the children with IGT and with normal glucose tolerance in a one-year follow-up did not differ significantly in respect of any analyzed parameter,apart from pubertal stage.The children developing IGT entered puberty significantly more frequently(37 vs 3,P < 0.001).One year after baseline,the childr en with IGT demonstrated significantly increased waist circumference,blood pressure values,insulin and triglyceride concentrations,and insulin resistance index HOMA.The children remaining in the normal glucose tolerance status 1 year after baseline did not demonstrate any significant changes.CONCLUSION:During the study period of 1 year,more than 10 of the obese children with normal glucose tolerance converted to IGT.Repeated screening with oGTT seems meaningful in obese children entering puberty or demonstrating increased insulin resistance,waist circumference,blood pressure,or triglyceride concen trations.

Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation(CoR) was assessed and compared to the CoR of the prosthesis by using the MediC AD~? software. Additionally, the pre-and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score. RESULTS Both, the Constant and DASH scores improved signifi-cantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc.(P > 0.05). The pre-and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neckshaft angle showed no significant changes(P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.

The association between critical life events, sociodemographic data and physical activity in the development of myocardial infarction in smokers and ex-smokers

Background: Psychosocial factors attract interest in investigating the occurrence of cardiovascular disease. Design This study aimed to examine the impact of critical life events on the development of myocardial infarction in smokers and ex-smokers. We hypothesized that critical life events increase the risk of the disease. Methods: Data were taken from the Cologne Smoking Study (CoSmoS), a retrospective multicentre case-control study that examines which psychosocial factors may lead to a higher risk for smokers and ex-smokers of suffering from a myocardial infarction. Our sample consisted of n = 278 myocardial infarction participants and control participants. Both groups had a history of smoking. Logistic regression was used in the analysis. Results: The study results of the smoking and ex-smoking participants showed that sociodemographic data like gender and age have an effect on the development of myocardial infarction. Physical activity seems to offer protection aganist myocardial infarction. Final, the unexpected result that the experience of at least one critical life event seems to have a positive effect on health and so lowers the risk of myocardial infarction. Conclusions: Socio-demographic data and physical activity have an effect on the development of myocardial infarction. Participants with experience of critical life events appear to be strengthened after the events and possess adequate resources to protect their health.

Cerebrospinal Fluid Magnesium Level in Different Neurological Disorders

Magnesium (Mg) is an essential cofactor for many enzymatic reactions, especially those involved in energy metabolism. The aim of the present study was to determine the CSF concentration of Mg in various neurological disorders (n = 72) and in healthy subjects (n = 75). The control group included 35 males and 40 females, aged 16-89 years (mean age 53 years) who were subjected to a lumbar puncture for diagnostic reasons. The CSF examination was normal mainly as concerns the macroscopically examination, the leukocyte count and the protein level. The determination of Mg was performed with xylidyl-blue photometry. Our normal CSF Mg mean value was 0.97 ± 0.08 mmol/l (range 0.6-1.4 mmol/l). In the group of patients (n = 11) with convulsive seizures a slightly but significantly lower Mg were revealed (0.92 ± 0.03 mmol/l;p = 0.001;paired two-tailed Student’s t-tests). No statistically significant change of CSF Mg levels was noted in patients suffering from alcohol withdrawal syndrome, multiple sclerosis or Bell’s palsy. Our results indi-cate that magnesium deficiency may play a role for seizure manifestation even in patients with a moderate low Mg without neurological signs. Low CSF magnesium is associated with epilepsy, further studies may determine the influ-ence of anti-epileptic drug therapy on CSF magnesium levels.

用一种新的混合香料做斑贴试验检测出用目前使用的混合香料未检测出的香料敏感者

The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations-28%FM II contained 5%hydroxyisohexyl 3cyclohexene carboxaldehyde (Lyral.), 2%citral, 5%farnesol, 5%coumarin, 1%citronellol and 10%α-hexyl-cinnamic aldehyde; in 14%FM II, the single constituents’concentration was lowered to 50%and in 2.8%FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances:certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5%of the patients. Positive reactions to FMII were dose-dependent and increased from 1.3%(2.8%FM II), through 2.9%(14%FM II) to 4.1%(28%FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2%for FM I and means ranging from 1.8%to 10.6%for FM II. 8.7%of the tested patients had a certain fragrance history. Of these, 25.2%were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1%to 17.6%in this subgroup. Comparing 2 groups of history-certain and none-values for sensitivity and specificity were calculated:sensitivity:FM I, 25.2%; 2.8%FM II, 8.1%; 14%FM II, 13.5%; 28%FM II, 17.6%; specificity:FM I, 96.5%; 2.8%FM II, 99.5%; 14%FM II, 98.8%; 28%FM II, 98.1%. 31/70 patients (44.3%) positive to 28%FMII were negative to FM I, with 14%FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FMI; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14%FM II, seems to be the most appropriate diagnostic screening tool.

用一种新的混合香料做斑贴试验:各组分的反应性和相关化妆品中的化学检测

A new fragrance mix (FM II), with 6 frequently used chemicals not present in the currently used fragrance mix (FM I), was evaluated in 6 dermatological centres in Europe, as previously reported. In this publication, test results with the individual constituents and after repeated open application test (ROAT) of FM II are described. Furthermore, cosmetic products which had caused a contact dermatitis in patients were analysed for the presence of the individual constituents. In 1701 patients, the individual constituents of the medium (14%) and the highest (28%) concentration of FM II were simultaneously applied with the new mix at 3 concentrations (break-down testing for the lowest concentration of FM II (2.8%) was performed only if the mix was positive). ROAT was performed with the concentration of the FM II which had produced a positive or doubtful (+or ?+) patch test reaction. Patients’products were ana-lysed for the 6 target compounds by gas chromatography-mass spectrometry (GC-MS). Results:50 patients (2.9%) showed a positive reaction to 14%FM II and 70 patients (4.1%) to 28%FM II. 24/50 (48%) produced a positive reaction to 1 or more of the individual constituents of 14%FM II and 38/70 (54.3%) to 28%FM II, respectively. If doubtful reactions to individual constituents are included, the break-down testing was positive in 74%and 70%, respectively. Patients with a positive reaction to 14%FM II showed a higher rate of reactions to the individual constituent of the 28%FM II:36/50 (72%). Positive reactions to individual constituents in pa-tients negative to FM II were exceedingly rare. If doubtful reactions are regarded as negative, the sensitivity, specificity, positive predictive value and negative predictive value for the medium concentration of FM II towards at least 1 individual constituent was 92.3%(exact 95%confidence interval 74.9-99.1%), 98.4%(97.7-99.0%), 48%(33.7-62.6%) and 99.9%(99.6-100.0%), respectively. For the high concentration, the figures were very similar. The frequency of positive reactions to the individual constituents in descending order was the same for both FM II concentrations:hydroxyisohexyl 3-cyclohexene carboxaldehyde(Lyral.)>citral>farnesol>citronellol >αhexyl-cinnamic aldehyde (AHCA). No unequivocally positive reaction to coumarin was observed. Lyralwas the dominant individualconstituent,with positive reactions in 36%of patients reacting to 14%FM II and 37.1%to 28%FM II. 5/11 patients developed a positive ROAT after a median of 7 days (range 2-10). The 5 patients with a doubtful or negative reaction to 28%FM II were all ROAT negative except 1. There were 7 patients with a certain fragrance history and a positive reaction to either 28%or 14%FM II but a negative reaction to FM I. Analysis with GC-MS in a total of 24 products obtained from 12 patients showed at least 1-5 individual constituents per product:Lyral. (79.2%), citronellol (87.5%), AHCA (58.3%), citral (50%) and coumarin (50%). The patients were patch test positive to Lyral., citral and AHCA. In conclusion, patients with a certain fragrance history and a negative reaction to FMI can be identified by FM II. Testing with individual constituents is positive in about 50%of cases reacting to either 14%or 28%FM II.

Alpha1B adrenoceptor expression is a marker of reduced survival and increased tumor recurrence in patients with endometrioid ovarian cancer

AIM: To investigate the expression patterns of different adrenoceptor isoforms in ovarian cancer and their association with survival and tumor recurrence. METHODS: The protein expression levels of a1 B, a2 C and b2 adrenoceptor were assessed in unselected ovarian cancer using immunohistochemistry on microarrayed archival tissue samples. A database containing clinical and pathology parameters and follow-up was usedto investigate the association between adrenoceptor isoform expression with ovarian specific survival and tumor recurrence, using univariate and multivariate statistical analysis. RESULTS: Expression of a1 B showed an association with reduced ovarian specific survival(P = 0.05; CI: 1.00-1.49) and increased tumor recurrence(P = 0.021, CI: 1.04-1.69) in the whole patient group. On subanalysis the expression of a1 B in endometrioid cancers(χ2 = 5.867, P = 0.015) was found to predict reduced ovarian specific survival and increased tumor recurrence independently of tumor grade, clinical stage and chemotherapy. An association with clinical outcome was not seen for a2 C or b2 AR.CONCLUSION: Alpha1 B adrenoceptor protein was found to predict increased risk of tumor recurrence and reduced mortality in patients with endometrioid type ovarian cancer and should be investigated as a biomarker for identifying patients at increased risk of disease progression. Furthermore, a adrenergic receptor antagonists with a1 B selectivity should be investigated as a possible adjuvant therapy for treating patients with endometrioid cancer. Proof of principle could be tested in a retrospective population study.