Chronisches Schmerzsyndrom des Beckens: Neurostimulation, Neuromodulation und Akupunktur

Zusammenfassung: Das chronische Schmerzsyndrom des Beckens ("chronic pelvic pain syndrome", CPPS) ist gemäß den Richtlinien der "European Association of Urology" charakterisiert als ein nicht-maligner Schmerz, der in Bezug auf die Strukturen des weiblichen oder männlichen Beckens über einen Zeitraum von mindestens 6Monaten wahrgenommen wird, ohne dass eine Infektion oder offensichtliche anderweitige Pathologie vorliegt. Das CPPS beeinträchtigt die Lebensqualität von Millionen von Menschen weltweit und hat einen ähnlich großen Einfluss wie andere chronische Krankheiten, z.B. Diabetes mellitus, Morbus Crohn oder kongestive Herzinsuffizienz. Trotz mehrerer etablierter Erstlinientherapien stellt die Behandlung des CPPS eine große Herausforderung dar, da viele Patienten therapierefraktär bleiben. Unkonventionelle Behandlungsmethoden wie Neurostimulation, Neuromodulation und Akupunktur können beim CPPS eine ausgezeichnete Wirkung zeigen und haben ein vorteilhaftes Nebenwirkungsprofil. So sollten diese vielversprechenden Therapieverfahren im klinischen Alltag vermehrt eingesetzt werde

Sakrale Neuromodulation bei neurogenen Blasenfunktionsstörungen

Zusammenfassung: Die sakrale Neuromodulation (SNM) stellt bei therapierefraktären neurogenen Blasenfunktionsstörungen eine vielversprechende Therapieoption dar. Es bleibt allerdings zu zeigen, welche Typen der neurogenen Blasenfunktionsstörungen und welche zugrunde liegenden neurologischen Erkrankungen am besten auf die SNM ansprechen. Die SNM wurde ständig weiterentwickelt und ist heute ein minimal-invasives, in Lokalanästhesie durchführbares Therapieverfahren, das vor größeren rekonstruktiven Eingriffen zumindest erwogen werden sollte. Es wird eine Elektrodenimplantation ins Sakralforamen S3 oder S4 durchgeführt und in einer Testphase über Tage bis Wochen unter Führen eines Blasentagebuches geprüft, ob die SNM dem Patienten einen relevanten Nutzen bringt. Wenn sich eine positive Testphase zeigt, wird der Neuromodulator gluteal (oder seltener in die Bauchdecke) implantiert. Der Wirkmechanismus der SNM ist nicht gänzlich geklärt, doch Afferenzen dürften eine Schlüsselrolle spielen. So scheint die SNM via periphere Afferenzen eine Modulation von Rückenmarkreflexen und Gehirnzentren zu bewirken. Das implantierte Neuromodulationssystem führt zu keiner Einschränkung der Aktivitäten der Patienten. Allerdings gilt es zu beachten, dass bei Neuromodulatorträgern Hochfrequenzwärmetherapie und unipolare Elektrokauterisation kontraindiziert sind, dass bei einer extrakorporellen Stoßwellenlithotripsie der Brennpunkt nicht in unmittelbarer Nähe des Neuromodulators oder der Elektrode liegen darf, dass Ultrasonographie und Strahlentherapie im Bereich der Implantatkomponenten vermieden werden sollten, dass bei Schwangerschaft der Neuromodulator auszuschalten ist und dass MR-Untersuchungen nur bei zwingender Indikation und bei ausgeschaltetem Neuromodulator durchgeführt werden solle

Probing the cosmic acceleration from combinations of different data sets

We examine in some detail the influence of the systematics in different data sets including type Ia supernova sample, baryon acoustic oscillation data and the cosmic microwave background information on the fitting results of the Chevallier-Polarski-Linder parametrization. We find that the systematics in the data sets does influence the fitting results and leads to different evolutional behavior of dark energy. To check the versatility of Chevallier-Polarski-Linder parametrization, we also perform the analysis on the Wetterich parametrization of dark energy. The results show that both the parametrization of dark energy and the systematics in data sets influence the evolutional behavior of dark energy.Comment: 15 pages, 5 figures and 1 table, major revision, delete bao a data, main results unchanged. jcap in press

Unified Dark Matter models with fast transition

We investigate the general properties of Unified Dark Matter (UDM) fluid models where the pressure and the energy density are linked by a barotropic equation of state (EoS) $p = p(\rho)$ and the perturbations are adiabatic. The EoS is assumed to admit a future attractor that acts as an effective cosmological constant, while asymptotically in the past the pressure is negligible. UDM models of the dark sector are appealing because they evade the so-called "coincidence problem" and "predict" what can be interpreted as $w_{\rm DE} \approx -1$, but in general suffer the effects of a non-negligible Jeans scale that wreak havoc in the evolution of perturbations, causing a large Integrated Sachs-Wolfe effect and/or changing structure formation at small scales. Typically, observational constraints are violated, unless the parameters of the UDM model are tuned to make it indistinguishable from $\Lambda$CDM. Here we show how this problem can be avoided, studying in detail the functional form of the Jeans scale in adiabatic UDM perturbations and introducing a class of models with a fast transition between an early Einstein-de Sitter CDM-like era and a later $\Lambda$CDM-like phase. If the transition is fast enough, these models may exhibit satisfactory structure formation and CMB fluctuations. To consider a concrete case, we introduce a toy UDM model and show that it can predict CMB and matter power spectra that are in agreement with observations for a wide range of parameter values.Comment: 30 pages, 15 figures, JHEP3 style, typos corrected; it matches the published versio

Time-Varying Dark Energy Constraints From the Latest SN Ia, BAO and SGL

Based on the latest SNe Ia data provided by Hicken et al. (2009) with using MLCS17 light curve fitter, together with the Baryon Acoustic Oscillation(BAO) and strong gravitational lenses(SGL), we investigate the constraints on the dark energy equation-of-state parameter $w$ in the flat universe, especially for the time-varying case $w(z)=w_0+w_zz/(1+z)$. The constraints from SNe data alone are found to be: (a) $(\Omega_M, w)=(0.358, -1.09)$ as the best-fit results; (b) $(w_0, w_z)=(-0.73^{+0.23}_{-0.97}, 0.84^{+1.66}_{-10.34})$ for the two parameters in the time-varying case after marginalizing the parameter $\Omega_M$; (c) the likelihood of parameter $w_z$ has a high non-Gaussian distribution; (d) an extra restriction on $\Omega_M$ is necessary to improve the constraint of the SNe Ia data on the parameters ($w_0$, $w_z$). A joint analysis of SNe Ia data and BAO is made to break the degeneracy between $w$ and $\Omega_M$, and leads to the interesting maximum likelihoods $w_0 = -0.94$ and $w_z = 0$. When marginalizing the parameter $\Omega_M$, the fitting results are found to be $(w_0, w_z)=(-0.95^{+0.45}_{-0.18}, 0.41^{+0.79}_{-0.96})$. After adding the splitting angle statistic of SGL data, a consistent constraint is obtained $(\Omega_M, w)=(0.298, -0.907)$ and the constraints on time-varying dark energy are further improved to be $(w_0, w_z) = (-0.92^{+0.14}_{-0.10}, 0.35^{+0.47}_{-0.54})$, which indicates that the phantom type models are disfavored.Comment: 24 pages, 9 figures, to be published in JCA

Comparison of Recent SnIa datasets

We rank the six latest Type Ia supernova (SnIa) datasets (Constitution (C), Union (U), ESSENCE (Davis) (E), Gold06 (G), SNLS 1yr (S) and SDSS-II (D)) in the context of the Chevalier-Polarski-Linder (CPL) parametrization $w(a)=w_0+w_1 (1-a)$, according to their Figure of Merit (FoM), their consistency with the cosmological constant ($\Lambda$CDM), their consistency with standard rulers (Cosmic Microwave Background (CMB) and Baryon Acoustic Oscillations (BAO)) and their mutual consistency. We find a significant improvement of the FoM (defined as the inverse area of the 95.4% parameter contour) with the number of SnIa of these datasets ((C) highest FoM, (U), (G), (D), (E), (S) lowest FoM). Standard rulers (CMB+BAO) have a better FoM by about a factor of 3, compared to the highest FoM SnIa dataset (C). We also find that the ranking sequence based on consistency with $\Lambda$CDM is identical with the corresponding ranking based on consistency with standard rulers ((S) most consistent, (D), (C), (E), (U), (G) least consistent). The ranking sequence of the datasets however changes when we consider the consistency with an expansion history corresponding to evolving dark energy $(w_0,w_1)=(-1.4,2)$ crossing the phantom divide line $w=-1$ (it is practically reversed to (G), (U), (E), (S), (D), (C)). The SALT2 and MLCS2k2 fitters are also compared and some peculiar features of the SDSS-II dataset when standardized with the MLCS2k2 fitter are pointed out. Finally, we construct a statistic to estimate the internal consistency of a collection of SnIa datasets. We find that even though there is good consistency among most samples taken from the above datasets, this consistency decreases significantly when the Gold06 (G) dataset is included in the sample.Comment: 13 pages, 9 figures. Included recently released SDSS-II dataset. Improved presentation. Main results unchanged. The mathematica files and datasets used for the production of the figures may be downloaded from http://leandros.physics.uoi.gr/datacomp

Heterogeneity in reporting on urinary outcome and cure after surgical interventions for stress urinary incontinence in adult neuro-urological patients: A systematic review

Aims: To describe all outcome parameters and definitions of cure used to report on outcome of surgical interventions for stress urinary incontinence (SUI) in neuro-urological (NU) patients. Methods: This systematic review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The study protocol was registered and published (CRD42016033303; http://www.crd.york.ac.uk/PROSPERO). Medline, Embase, Cochrane controlled trials databases, and clinicaltrial.gov were systematically searched for relevant publications until February 2017. Result

The kk-essence scalar field in the context of Supernova Ia Observations

A $k$-essence scalar field model having (non canonical) Lagrangian of the form $L=-V(\phi)F(X)$ where $X=1/2g^{\mu\nu}\nabla_{\mu}\phi\nabla_{\nu}\phi$ with constant $V(\phi)$ is shown to be consistent with luminosity distance-redshift data observed for type Ia Supernova. For constant $V(\phi)$, $F(X)$ satisfies a scaling relation which is used to set up a differential equation involving the Hubble parameter $H$, the scale factor $a$ and the $k$-essence field $\phi$. $H$ and $a$ are extracted from SNe Ia data and using the differential equation the time dependence of the field $\phi$ is found to be: $\phi(t) \sim \lambda_0 + \lambda_1 t + \lambda_2 t^2$. The constants $\lambda_i$ have been determined. The time dependence is similar to that of the quintessence scalar field (having canonical kinetic energy) responsible for homogeneous inflation. Furthermore, the scaling relation and the obtained time dependence of the field $\phi$ is used to determine the $X$-dependence of the function $F(X)$.Comment: 8 pages, 5 figures, Late

Access to infertility consultations: what women tell us about it?

The main objective of the present paper is to evaluate the perception of women concerning the barriers and access to infertility consultations. Socio cultural and economic access to infertility consultations is detached and three municipalities of the northwest of Portugal were chosen as an example of a peripheral country. A quantitative/qualitative study was done with 60 women. Three dimensions were evaluated: geographic and structural and functional access; economic access; and sociocultural access. The main barriers were mainly identified in the last two dimensions. The economic access was the less well evaluated by women being the cost of treatment (medication, and concentration of costs in a short period) difficult to bear. This can justify a greater involvement of the Portuguese Government, by developing policies for the reimbursement of part of the costs. Also, some changes in structural and functional access must be done with special regard to the separation of the infertility consultations from the reproductive medicine section. The setting of the teams, with a follow-up by the same team of health professionals is also needed