Emotionale Auswirkungen der autonomen Deafferentierung bei Diabetes-Neuropathie

Bei 46 Typ-I-Diabetikern im Alter zwischen 15 und 44 Jahren wurden die Auswirkungen der viszeralen Deafferentierung bei autonomer Diabetesneuropathie auf körperliche Befindlichkeit und Emotionalität untersucht. Die Erfassung des Ausprägungsgrad der autonomen Neuropathie erfolgte mit vegetativen Funktionstest. Diabetiker ohne Neuropathie (N = 14), mit leichter Neuropathie (N = 23) und mit schwerer Neuropathie (N = 9) wurden miteinander verglichen. Gering ausgeprägte autonome Neuropathie führt zu vegetativen Funktionsstörungen, ist aber gleichzeitig mit einer verminderten Wahrnehmung körperlicher Beschwerden - erfaßt mit der Freiburger Beschwerdenliste - verbunden. Im Streß- und Copingverhalten (SCOPE) und in bestimmten Persönlichkeitsdimensionen (FPI) finden sich dabei Hinweise auf eine verminderte emotionale Reaktivität. Patienten mit fortgeschrittener autonomer Neuropathie haben zumeist ausgeprägte diabetische Folgekrankheiten (diabetische Retinopathie, Makro- und Mikroangiopathie etc.), scheinen aber die damit verbundenen körperlichen Beeinträchtigungen und emotionalen Belastungen nicht stärker als Diabetiker ohne Neuropathie wahrzunehmen. Die autonome Deafferentierung bei Diabetikern scheint somit sowohl zu einer gestörten Wahrnehmung körperlicher Beschwerden wie auch zu einer beeinträchtigten emotionalen Reaktionsfähigkeit zu führen.Bei 46 Typ-I-Diabetikern im Alter zwischen 15 und 44 Jahren wurden die Auswirkungen der viszeralen Deafferentierung bei autonomer Diabetesneuropathie auf körperliche Befindlichkeit und Emotionalität untersucht. Die Erfassung des Ausprägungsgrad der autonomen Neuropathie erfolgte mit vegetativen Funktionstest. Diabetiker ohne Neuropathie (N = 14), mit leichter Neuropathie (N = 23) und mit schwerer Neuropathie (N = 9) wurden miteinander verglichen. Gering ausgeprägte autonome Neuropathie führt zu vegetativen Funktionsstörungen, ist aber gleichzeitig mit einer verminderten Wahrnehmung körperlicher Beschwerden - erfaßt mit der Freiburger Beschwerdenliste - verbunden. Im Streß- und Copingverhalten (SCOPE) und in bestimmten Persönlichkeitsdimensionen (FPI) finden sich dabei Hinweise auf eine verminderte emotionale Reaktivität. Patienten mit fortgeschrittener autonomer The perception of visceral activity is impaired in diabetics with autonomie neuropathy. This should affect the perception of somatic complaints and the emotional state of these patients. The degree of auronomic neuropathy was examined with three physiological tests for autonomie functions. Differences were evaluated between diabetics without neuropathy (N = 14), with mild neuropathy (N = 23) and with severe neuropathy (N = 9). It was found that mild autonomie neuropathy is related to a small increase in somatic problems (resulting from diabetes). In spite of this, autonomie deafferentation leads to a de~rease in somatic complaints (Freiburger Beschwerden Liste (FBL» and to a reduction in emotionality (assessed with personality questionaires (SCOPE and FPI». Patients with severe autonomie neuropathy exhibit frequent somatic problems. The somatic complaints and the emotionality of these patients are comparable with diabetics without neuropathy. The results show that autonomie deafferentation in diabetics is related to a reduced perception of somatic complaints and a decrease in the emotionality of these patients

Disturbances of C-fibre-mediated sensibility in lumbosacral disc disease.

In nine patients with chronic lumbosacral disc disease and radicular symptoms clearly restricted to one leg, C-fibre-mediated sensibility was measured by determination of the thresholds for heat pain and warmth on the foot, ipsi- and contralaterally to the nerve root compression. The thresholds were compared with the values for 19 healthy subjects. In the patients the warmth threshold was increased in the ipsilateral dermatome and normal in the contralateral dermatome. In contrast, the heat pain threshold was near normal ipsilaterally but was clearly decreased contralaterally. These findings are discussed with respect to a possible pain sensitisation resulting from nerve root compression

Efficacy of rotigotine for treatment of moderate-to-severe restless legs syndrome:a randomised, double-blind, placebo-controlled trial

The air-sea gas transfer velocity k is frequently estimated as an empirical function of wind speed. However, it is widely recognized that k depends on processes other than wind speed alone. The small-eddy model, which describes periodic events of small eddies disturbing the sea surface with water from below, suggests a direct relation between k and the dissipation rate of turbulent kinetic energy E at the air-sea interface. This relation has been proven both in laboratories and in the field in various freshwater and coastal environments, but to date has not been verified in open ocean conditions. Here, concurrent North Atlantic field observations of E and eddy covariance measurements of DMS and CO2 air-sea gas flux are presented. Using E measurements, we compare the small-eddy model at various depths to previously published observations. Extrapolating the measured E profiles to the thickness of the viscous sublayer allows us to formulate a function of k that depends solely on the water side friction velocity uw, which can be inferred from direct eddy covariance measurements of the air-side friction velocity ua. These field observations are generally consistent with the theoretical small-eddy model. Utilizing a variable Schmidt number exponent in the model, rather than a constant value of 1/2 yields improved agreement between model and observations

Comparison of fingolimod with interferon beta-1a in relapsing-remitting multiple sclerosis: a randomised extension of the TRANSFORMS study

In a 12-month phase 3 study in patients with relapsing-remitting multiple sclerosis (RRMS), TRANSFORMS, fingolimod showed greater efficacy on relapse rates and MRI outcomes compared with interferon beta-1a. We had two aims in our extension: to compare year 2 with year 1 in the switched patients to assess the effect of a change from interferon beta-1a to fingolimod, and to compare over 24 months the treatment groups as originally randomised to assess the effect of delaying the start of treatment with fingolimod

Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis.

BACKGROUND: Fingolimod (FTY720), a sphingosine-1-phosphate-receptor modulator that prevents lymphocyte egress from lymph nodes, showed clinical efficacy and improvement on imaging in a phase 2 study involving patients with multiple sclerosis. METHODS: In this 12-month, double-blind, double-dummy study, we randomly assigned 1292 patients with relapsing-remitting multiple sclerosis who had a recent history of at least one relapse to receive either oral fingolimod at a daily dose of either 1.25 or 0.5 mg or intramuscular interferon beta-1a (an established therapy for multiple sclerosis) at a weekly dose of 30 microg. The primary end point was the annualized relapse rate. Key secondary end points were the number of new or enlarged lesions on T(2)-weighted magnetic resonance imaging (MRI) scans at 12 months and progression of disability that was sustained for at least 3 months. RESULTS: A total of 1153 patients (89%) completed the study. The annualized relapse rate was significantly lower in both groups receiving fingolimod--0.20 (95% confidence interval [CI], 0.16 to 0.26) in the 1.25-mg group and 0.16 (95% CI, 0.12 to 0.21) in the 0.5-mg group--than in the interferon group (0.33; 95% CI, 0.26 to 0.42; P<0.001 for both comparisons). MRI findings supported the primary results. No significant differences were seen among the study groups with respect to progression of disability. Two fatal infections occurred in the group that received the 1.25-mg dose of fingolimod: disseminated primary varicella zoster and herpes simplex encephalitis. Other adverse events among patients receiving fingolimod were nonfatal herpesvirus infections, bradycardia and atrioventricular block, hypertension, macular edema, skin cancer, and elevated liver-enzyme levels. CONCLUSIONS: This trial showed the superior efficacy of oral fingolimod with respect to relapse rates and MRI outcomes in patients with multiple sclerosis, as compared with intramuscular interferon beta-1a. Longer studies are needed to assess the safety and efficacy of treatment beyond 1 year. (ClinicalTrials.gov number, NCT00340834.