Wirksamkeit, Zweckmäßigkeit und Wirtschaftlichkeit des multimodalen Behandlungsansatzes bei chronisch lumbalen Rückenschmerzen

Zusammenfassung: Hintergrund: Der Nachweis der Behandlungskriterien Wirksamkeit, Zweckmäßigkeit und Wirtschaftlichkeit ist bei chronisch lumbalen Rückenschmerzen ["chronic low back pain" (CLBP)] notwendig, da Kostenträger die Übernahme von Behandlungskosten hiervon abhängig machen. Material und Methoden: Eine systematische Literatursuche zu den Behandlungskriterien der interdisziplinären, multimodalen Schmerztherapie ["multidisciplinary treatment" (MDT)] bietet einen Überblick über die aktuelle Literatur zur Behandlung von CLBP. Ergebnisse: Auf die moderate Wirksamkeit von MDT weisen 8Übersichtsarbeiten hin, wenn auch mit einigen Einschränkungen. Die Ergebnisse von 6 bisher in keine Übersichtsarbeit eingeschlossenen Originalarbeiten stützen die Ergebnisse der Übersichtsarbeiten. Die Langzeitergebnisse von MDT und operativen Behandlungen sind, bei höheren Kosten und Risiken für operative Behandlungen, vergleichbar. Die Wirtschaftlichkeit von MDT erreicht in 3Originalarbeiten eine moderate bis hohe Evidenz. Schlussfolgerungen: MDT sind sowohl moderat wirksam als auch wirtschaftlich. Daher sind sie eine kostengünstigere Behandlungsalternative zu operativen Verfahre

Next to leading order eta production at hadron colliders

Inclusive eta production at hadron colliders is considered,based on evaluation of eta fragmentation functions at next to leading order. Absolute predictions at LHC and SSC are presented, including the ratio $\eta/\pi^0$, together with the estimate of the theoretical uncertainty, as a possible neutral background to the $H\to \gamma\gamma$ detection.Comment: 8 pages, latex, FNT/T-93/13,14 figures avilable upon reques

AMPK alpha 1-induced RhoA phosphorylation mediates vasoprotective effect of estradiol

OBJECTIVE: Estradiol (E2) mediates numerous beneficial effects assigned to estrogens, but whereas mechanisms have been described at the endothelial level, direct effects on vascular smooth muscle cells (VSMC) are poorly documented. As evidence accumulates regarding the role of RhoA in vascular pathophysiology and the benefit of RhoA-Rho associated protein kinase (Rock) pathway inhibition, we analyzed if E2 could inhibit it in VSMC. METHODS AND RESULTS: We show that in VSMC, E2 inhibits the RhoA-Rock pathway in a time- and concentration-dependent manner. The inhibition of RhoA-Rock pathway results from E2-induced phosphorylation of the Ser188 of RhoA. Using pharmacological, transfection, and in vitro phosphorylation experiments, we demonstrate that AMP-activated protein kinase subunit alpha 1 (AMPKalpha1) is activated by estrogen receptor stimulation and catalyzes RhoA phosphorylation induced by E2. Ex vivo, ovariectomy leads to an increase in the amplitude of phenylephrine- or serotonine-induced contractions of aortic rings in wild-type mice but not in AMPKalpha1-knock-out mice or E2-supplemented animals. These functional effects were correlated with a reduced level of RhoA phosphorylation in the aorta of ovariectomized female, male, and AMPKalpha1 knock-out mice. CONCLUSION: Our work thus defines AMPKalpha1 as (1) a new kinase for RhoA and (2) a new mediator of the vasoprotective effects of estrogen

New insights into microstructure of irradiated beryllium based on experiments and computer simulations

The microstructural response of beryllium after neutron irradiation at various temperatures (643–923 K) was systematically studied using analytical transmission electron microscope that together with outcomes from advanced atomistic modelling provides new insights in the mechanisms of microstructural changes in this material. The most prominent feature of microstructural modification is the formation of gas bubbles, which is revealed at all studied irradiation temperatures. Except for the lowest irradiation temperature, gas bubbles have the shape of thin hexagonal prisms with average height and diameter increasing with temperature. A high number density of small bubbles is observed within grains, while significantly larger bubbles are formed along high-angle grain boundaries (GB). Denuded zones (DZ) nearly free from bubbles are found along both high- and low-angle grain boundaries. Precipitations of secondary phases (mainly intermetallic Al-Fe-Be) were observed inside grains, along dislocation lines and at GBs. EDX analysis has revealed homogeneous segregation of chromium and iron along GBs. The observed features are discussed with respect to the available atomistic modelling results. In particular, we present a plausible reasoning for the abundant formation of gas bubbles on intermetallic precipitates, observation of various thickness of zones denuded in gas bubbles and precipitates, and their relation to the atomic scale diffusion mechanisms of solute-vacancy clusters

Index matching between passive and active tellurite glasses for use in microstructured fiber lasers: Erbium doped lanthanum-tellurite glass

Active and passive variants of La-containing tellurite glasses have been developed with matched refractive indices. The consequences of adding lanthanum to the glass was studied through measurements of the crystallization stability, glass viscosity and the loss of unstructured fibers. Doping the glass with erbium allowed for any spectroscopic changes to be observed through measurements of the absorption and energy level lifetimes. The fluorescence emission spectra were measured at 1.5 microm and, to the best of our knowledge, for the first time in tellurite glass at 2.7 microm.Michael R. Oermann, Heike Ebendorff-Heidepriem, Yahua Li, Tze-Cheung Foo, and Tanya M. Monrohttp://www.opticsinfobase.org/abstract.cfm?URI=oe-17-18-1557

Resources for preventing sickness absence due to low back pain

Background After an episode of non-specific low back pain (LBP) some individuals fail to return to work. The factors leading to such LBP-related sickness absence are not yet fully understood. Aims To identify individual resources, over and above the already established predictors, for preventing LBP-related sickness absence in a population-based sample of workers experiencing an episode of LBP. Methods Cohort study with 1-year follow-up. Participants were from a working population who reported an episode of acute or subacute LBP at baseline. Four potential resources—life satisfaction, doing sports, job satisfaction and social support at work—were examined for their incremental value in predicting sickness absence over and above baseline sickness absence and fear-avoidance beliefs about work. Results In all, 279 workers participated in the study. All four resources showed an inverse relationship with regard to sickness absence. A multiple regression analysis revealed that life satisfaction as a resource protected against sickness absence, when controlling for established risk factors. Job satisfaction and social support at work minimized the influence of sickness absence at baseline and at 1-year follow-up. Conclusions In a non-clinical working sample of individuals experiencing an acute/subacute episode of LBP, life satisfaction was a unique predictor of sickness absence after 1 year. Prevention in the occupational setting should not only address common risk factors but also occupational and individual resources that keep workers satisfied with life despite having LB

Patient-reported outcome measures (PROMs) after elective hip, knee and shoulder arthroplasty: Protocol for a prospective cohort study

Background The number of hip, knee and shoulder arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched an initiative (called PaRIS Initiative) for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the launch of the Initiative in Italy given that IOR hosts the Registry of Orthopedic Prosthetic Implants (RIPO), a region-wide registry which collects joint implant data from all the hospitals in the Emilia-Romagna Region. In this specific geographic area information related to PROMs after joint replacement is unknown. This paper describes the protocol of a study (PaRIS-IOR) that aims to implement the collection of a set of PROMs within an existing implant registry in Italy. The study will also investigate the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. Methods The PaRIS-IOR study is a prospective, single site, cohort study that consists of the administration of PROMs questionnaires to patients on the list for elective arthroplasty. The questionnaires will be administered to the study population within 30 days before surgery, and then at 6 and 12 months following surgery. The study population will consist of consecutive adult patients undergoing either hip, knee or shoulder arthroplasty. The collected data will be linked with those routinely collected by the RIPO in order to assess the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. Discussion The PaRIS-IOR study could have important implications in targeting the factors influencing functional outcomes and quality of life reported by patients after hip, knee and shoulder arthroplasty, and will also represent the first systematic collection of PROMs related to arthroplasty in Italy

Trimester-specific reference intervals for thyroid function parameters in pregnant Caucasian women using Roche platforms: a prospective study

Background: Standard thyroid function parameters reference intervals (RI) are unsuitable during pregnancy, potentially resulting in incongruous treatments that may cause adverse effects on pregnancy outcomes. We aimed at defining trimester-specific TSH, FT4 and FT3 RI, using samples longitudinally collected from healthy Caucasian women. Materials and methods: Blood samples from 150 healthy Caucasian women, who had a physiological gestation and a healthy newborn at term, were collected in each trimester and at around six months post-partum. They showed mild iodine deficiency. After excluding women with overt TSH abnormalities (> 10 mU/L) and/or TPO antibodies, data from 139 pregnant women were analyzed by means of widely used Roche platforms, and TSH, FT4 and FT3 trimester-specific RI were calculated. Post-partum data were available for 55 subjects. Results: Serum TSH RI were 0.34-3.81 mU/L in the first trimester, and changed slightly to 0.68-4.07 U/L and 0.63-4.00 mU/L in the second and third trimester, respectively. Conversely, both FT4 and FT3 concentrations progressively decreased during pregnancy, the median values in the third trimester being 14.8% and 13.2% lower, respectively, than in the first trimester. Thyroid function parameters in the first trimester were similar to those measured after the end of pregnancy. Conclusions: This study calculates trimester-specific RI for thyroid function parameters in pregnancy, and proposes the reference limits that should be adopted when using Roche platforms in Caucasian women

Identification of prognostic factors for chronicity in patients with low back pain: a review of screening instruments

Low back pain (LBP) is currently the most prevalent and costly musculoskeletal problem in modern societies. Screening instruments for the identification of prognostic factors in LBP may help to identify patients with an unfavourable outcome. In this systematic review screening instruments published between 1970 and 2007 were identified by a literature search. Nine different instruments were analysed and their different items grouped into ten structures. Finally, the predictive effectiveness of these structures was examined for the dependent variables including "work status", "functional limitation”, and "pain". The strongest predictors for "work status” were psychosocial and occupational structures, whereas for "functional limitation” and "pain” psychological structures were dominating. Psychological and occupational factors show a high reliability for the prognosis of patients with LBP. Screening instruments for the identification of prognostic factors in patients with LBP should include these factors as a minimum core se