A pilot study of hair and cytokine balance alteration in healthy young women under major exam stress

Mouse models show that experimental stress mimicking prolonged life-stress exposure enhances neurogenic inflammation, induces adaptive immunity cytokine- imbalance characterized by a shift to Type 1 T-helper cell cytokines and increases apoptosis of epithelial cells. This affects hair growth in otherwise healthy animals. In this study, we investigate whether a prolonged naturalistic life-stress exposure affects cytokine balance and hair parameters in healthy humans. 33 (18 exam, 15 comparison) female medical students with comparable sociobiological status were analyzed during a stressful final examination period, at three points in time (T) 12 weeks apart. T1 was before start of the learning period, T2 between the three-day written exam and an oral examination, and T3 after a 12 week rest and recovery from the stress of the examination period. Assessments included: self-reported distress and coping strategies (Perceived Stress Questionnaire [PSQ], Trier Inventory for the Assessment of Chronic Stress [TICS]), COPE), cytokines in supernatants of stimulated peripheral blood mononucleocytes (PBMCs), and trichogram (hair cycle and pigmentation analysis). Comparison between students participating in the final medical exam at T2 and non-exam students, revealed significantly higher stress perception in exam students. Time-wise comparison revealed that stress level, TH1/TH2 cytokine balance and hair parameters changed significantly from T1 to T2 in the exam group, but not the control. However, no group differences were found for cytokine balance or hair parameters at T2. The study concludes that in humans, naturalistic stress, as perceived during participation in a major medical exam, has the potential to shift the immune response to TH1 and transiently hamper hair growth, but these changes stay within a physiological range. Findings are instructive for patients suffering from hair loss in times of high stress. Replication in larger and more diverse sample populations is required, to assess suitability of trichogram analysis as biological outcome for stress studies

Unklare chronische Schwindelsyndrome – Erfahrungen mit einem interdisziplinären stationären Diagnostikkonzept

Dizziness is a common leading symptom. Especially patients with chronic vertigo syndromes experience a significant impairment in quality of life up to a limitation of their ability to work in the case of employed persons. The consequences are financial and capacitive burdens on the health system due to frequently multiple examinations and sick leave up to occupational invalidity of the affected patient. In 150 patients with chronic vertigo syndromes and an unclear outpatient diagnosis, at least one diagnosis that justified the complaint was made in over 90% of cases on the basis of a structured interdisciplinary inpatient diagnostic concept. Chronic vertigo syndromes are often multifactorial. Psychosomatic (accompanying) diagnoses were found in more than half of the patients. Targeted therapy can only be recommended after establishing a specific diagnosis. This justifies an interdisciplinary inpatient diagnostic concept for persistently unclear cases

Physical treatment of lymphedema

Der erste Beitrag zu dieser Arbeit befasst sich mit den grundlegenden Aspekten der Komorbiditäten des Lymphödems (Manuskript 1). Manuskript 2 untersucht einen Aspekt grundlegender Wirkeffekte der manuellen Lymphdrainage auf das Gewebe. Die Komplexe Physikalische Entstauungstherapie (KPE), bestehend aus Kompressionstherapie, manueller Lymphdrainage, Bewegung und Hautpflege, ist weiterhin unbestrittener Standard in der Behandlung von Lymphödemen. Die zunehmend stärker werdende Evidenz zur Therapie von Lymphödemen hat in den letzten Jahren eine Betonung der Bedeutung der Kompressionstherapie mit sich gebracht. Nichtsdestotrotz werden immer wieder adjuvante, teils auch alternative Therapieverfahren vorgeschlagen, deren Wertigkeit aber immer wissenschaftlichen Kriterien standhalten und deshalb klinisch geprüft werden muss. In diesem Kontext wurden die Tiefenoszillation, die Anwendung sogenannter Lymphtapes, sowie neue Klettverschluss-basierte Kompressionsbandagen (medizinische adaptive Kompressionssysteme) jeweils in randomisierten, kontrollierten klinischen Studien bzw. experimentell untersucht (Manuskripte 3-6). Die explorative Prävalenzstudie deckte hohe Prävalenzen von Adipositas bei sekundären Lymphödemen sowie eine überraschend hohe Hypothyreoseprävalenz bei sekundären Lymphödempatienten auf. Dahingegen scheint die Genese des Lymphödems nicht entscheiden für die Erysipelprävalenz zu sein. Der transkutan gemessene Sauerstoffpartialdruck ist an lymphödematös veränderten Extremitäten reduziert. Manuelle Lymphdrainage verbessert den Sauerstoffpartialdruck, eine Behandlungsserie als Teil einer KPE kann ihn normalisieren. Elastische Tapes können für die Therapie von Lymphödemen nicht empfohlen werden, da sie, unter der Kompression angelegt, keine signifikante Wirkung auf Volumen oder subjektive Beschwerden zeigen. Als alleinige Therapie ohne Kompression kann gar es zu gefährlichen Volumenexazerbationen kommen. Tiefenoszillation (Lymphdrainage mit niedrigfrequent wechselnden elektromagnetischen Feldern) ist, als additive Anwendung gegenüber MLD allein, vorteilhaft bei der Therapie des sekundären Brustlymphödems. Medizinische adaptive Kompressionssysteme sind maßgefertigten Flachstrick-Kompressionsstrümpfen in der Erhaltungsphase der KPE nicht unterlegen. In-vivo-Druckmessungen untermauern deren therapeutische Effektivität. Komorbiditäten des Lymphödems sollten bei diagnostischen und therapeutischen Strategien stärker berücksichtigt werden. Hierfür ist es auch notwendig, die vorhandenen Diagnostik- und Assessmentverfahren zu verbessern und zielgerichtet einzusetzen. Die Erforschung und Weiterentwicklung bestehender und etablierter Therapieverfahren muss weitergeführt, neue Therapieverfahren müssen kritisch hinterfragt werden und wissenschaftlichen Standards standhalten

Introduction of the Charité Mobility Index (CHARMI) - A Novel Clinical Mobility Assessment for Acute Care Rehabilitation.

Mobility is an essential part of a person's functioning and independence. It encompasses locomotive functions, but also the more basic functions of positioning and transferring. Despite the availability of several mobility-related assessment instruments to date, there is a need for assessment instruments with the specific capability to display the full range of mobilisation. Our aim was to develop and validate a scoring instrument with hierarchical composition where every score value stands for a defined mobility level.A previously developed and validated pilot instrument was applied to assess patients (n = 113) admitted to an acute rehabilitation programme. Mobility was assessed during admission, subsequently at weekly intervals and at discharge to acquire a detailed status of mobility at multiple time points and individual mobilisation profiles over time. The scoring instrument was then remodelled based on clinical criteria to establish an easy-to-use scoring system with hierarchical composition. Psychometric properties were calculated using an independent sample of 87 consecutive patients.Content validity could be affirmed. The psychometric tests demonstrated excellent convergent validity with the three mobility items of the Barthel Index (r = 0.93), despite an adequately lower correlation with the whole Barthel Index (r = 0.63). Adequate floor and ceiling effects (20%) and a large responsiveness to change (ǀdǀ = 1.7, p < 0.001) between admission and discharge values were demonstrated. Inter-rater reliability was excellent (κ = 0.88).The Charité Mobility Index (CHARMI) is a promising, easy-to-use hierarchical scoring instrument assessing the full individual spectrum from immobility to unlimited mobility, including positioning, transfer and locomotion items. It allows for monitoring of mobilisation

Differentiation of CHARMI items by ICF subcategories.

<p>Differentiation of CHARMI items by ICF subcategories.</p

Sample characteristics and normative data of ACR sample for CHARMI.

<p>Sample characteristics and normative data of ACR sample for CHARMI.</p

Basic requirements for the final assessment instrument.

<p>Basic requirements for the final assessment instrument.</p

Charité Mobility Index [43].

<p>Charité Mobility Index [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0169010#pone.0169010.ref043" target="_blank">43</a>].</p

The KORE-INNOVATION trial, a prospective controlled multi-site clinical study to implement and assess the effects of an innovative peri-operative care pathway for patients with ovarian cancer: rationale, methods and trial design

Inci MG, Sehouli J, Schnura E, et al. The KORE-INNOVATION trial, a prospective controlled multi-site clinical study to implement and assess the effects of an innovative peri-operative care pathway for patients with ovarian cancer: rationale, methods and trial design. International Journal of Gynecological Cancer . 2023: ijgc-2023-004531.BACKGROUND: Advanced ovarian cancer is managed by extensive surgery, which could be associated with high morbidity. A personalized pre-habilitation strategy combined with an 'enhanced recovery after surgery' (ERAS) pathway may decrease post-operative morbidity.; PRIMARY OBJECTIVE: To analyze the effects of a combined multi-modal pre-habilitation and ERAS strategy on severe post-operative morbidity for patients with ovarian cancer (primary diagnosis or first recurrence) undergoing cytoreductive surgery.; STUDY HYPOTHESIS: A personalized multi-modal pre-habilitation algorithm entailing a physical fitness intervention, nutritional and psycho-oncological support, completed by an ERAS pathway, reduces post-operative morbidity.; TRIAL DESIGN: This is a prospective, controlled, non-randomized, open, interventional two-center clinical study. Endpoints will be compared with a three-fold control: (a) historic control group (data from institutional ovarian cancer databases); (b) prospective control group (assessed before implementing the intervention); and (c) matched health insurance controls.; INCLUSION CRITERIA: Patients with ovarian, fallopian, or primary peritoneal cancer undergoing primary surgical treatment (primary ovarian cancer or first recurrence) can be included. The intervention group receives an additional multi-level study treatment: (1) standardized frailty assessment followed by (2) a personalized tri-modal pre-habilitation program and (3) peri-operative care according to an ERAS pathway.; EXCLUSION CRITERIA: Inoperable disease or neoadjuvant chemotherapy, simultaneous diagnosis of simultaneous primary tumors, in case of interference with the overall prognosis (except for breast cancer); dementia or other conditions that impair compliance or prognosis.; PRIMARY ENDPOINT: Reduction of severe post-operative complications (according to Clavien- Dindo Classification (CDC) III-V) within 30 days after surgery.; SAMPLE SIZE: Intervention group (n=414, of which approximately 20% insure with the participating health insurance); historic control group (n=198); prospective control group (n=50), health insurance controls (for those intervention patients who are members of the participating health insurance).; ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: The intervention phase started in December 2021 and will continue until June 2023. As of March 2023, 280 patients have been enrolled in the intervention group. The expected completion of the entire study is September 2024.; TRIAL REGISTRATION: NCT05256576. © IGCS and ESGO 2023. No commercial re-use. See rights and permissions. Published by BMJ