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Background: therapeutic dietary interventions are effective treatments for rheumatoid arthritis (RA). The mechanisms to affect inflammation and clinical outcome in rheumatoid arthritis are only partly understood. Alterations in intestinal microflora are believed to be associated with disease activity in RA., Aim: to evaluate changes in short-chain fatty acid (SCFA) profiles and clinical outcome in RA during medical fasting or mediterranean diet., Methods: Fifty consecutive in-patients from an Integrative Medicine Department were included in a prospective observational, non-randomised, clinical trial. Patients underwent a 7-day fasting (MF) therapy or a Mediterranean diet (MD) as part of a multimodal therapeutic treatment approach., Results: the mean Disease Activity Score (DAS-28) significantly decreased in both groups (p < 0.001) from 5.7 ± 0.9 to 4.1 ± 1.3 in the MF and from 5.4 ± 1.4 to 4.5 ± 1.3 in the MG group, with no significant difference between the groups (p = 0.115). VAS showed a consecutive decrease of pain in both study groups which was significantly higher in the fasting group on day 7 (p = 0.049). No significant differences between the study groups were found in the profile of total-fatty acids (p = 0.069), butyrate (p = 0.611) and propionate (p = 0.419). Measurement of acetate, however, showed significant differences (p = 0.044) with an increase from 17,4 ± 9.8 μmol/g to 21,4 ± 16.4 μmol/g in MF compared to a decrease from 15,2 ± 10.4 μmol/g to 13,8 ± 9.3 μmol/g in MD. There was no significant correlation between dietary induced changes of SCFA and changes of disease activity., Conclusion: alterations in SCFA were found in terms of significant changes to increased acetate levels in the fasting group. A correlation between changes of SCFA from intestinal microflora and disease activity in RA could not be revealed. Further studies are needed in the field of dietary inducible changes of the intestinal microflora in patients with RA.

Background: Reporting experiments in basic research in homeopathy is an important issue as comprehensive description of what exactly was done is required. So far, there is no guideline for authors available, unlike criteria catalogues common in clinical research., Methods: A Delphi Process was conducted, including a total of five rounds, three rounds of adjusting and phrasing plus two consensus conferences. European researchers who published experimental work within the last five years were involved., Results: A checklist of 23 items was obtained and supplemented with detailed examples emphasizing what each item implies. Background, objectives and possible hypotheses should be given in the part 'introduction'. Special emphasis is put on the 'materials and methods' section, where a detailed description of chosen controls, object of investigation, experimental setup, replication, parameters, intervention, allocation, blinding, and statistical methods is required. The section 'results' should present sufficient details on analysed data, descriptive as well as inferential. Authors should discuss their results and give an interpretation in the context of current evidence., Conclusion: A guideline for Reporting Experiments in Homeopathic Basic Research (REHBaR) was compiled to be applied by authors when preparing their manuscripts, and to be used by scientific journals in the reviewing process. Furthermore the guideline is a commitment to a certain minimum quality level needed in basic research, e.g. blinding and randomisation. Feedback is encouraged on applicability, strength and limitations of the list to enable future revisions.

Objective: Lumbar spinal stenosis (LSS) is a common cause of chronic lumbar pain and disability. Conventional therapy approaches include analgesics and spinal surgery. Topical cantharidin applications are used for the treatment of severe chronic lumbar pain in traditional European medicine (TEM). We tested the pain-relieving effect of lumbar cantharidin blisters in a non-randomised controlled pilot study., Patients and Methods: 28 consecutive patients with manifest LSS were included. The first 20 patients received a cantharidin blister, 8 patients served as controls (waiting list). Pain was assessed by means of a numeric visual analogue scale (VAS; 0 indicating no pain, 10 indicating strongest pain). Treatment started after a 3-day run-in phase, the blister was applied once for 12 h., Results: Patients were comparable with respect to baseline pain. In the blister group, the pain score continuously improved from 7.2 +/- 2.1 at baseline to 2.9 +/- 2.3 (VAS) at day 7, whereas the score remained unchanged in control patients. Adjusted for baseline, the difference between the blister and the control group was estimated at 4.1 (95% CI: 2.4-5.9, p < 0.0001). The use of analgesics was slightly higher in the control group. No serious adverse events were observed., Conclusion: In this first study on the efficacy of cantharidin blisters, a clinically relevant pain-relieving short-term effect on LSS was observed. As the trial was non-randomised and only included a limited number of patients, the results should be interpreted with caution., (Copyright 2009 S. Karger AG, Basel.)

The German acupuncture trials ART and GERAC have shown that acupuncture and sham or minimal acupuncture were equally effective in the reduction of chronic pain symptoms. These results have prompted an ongoing discussion as to whether acupuncture exerts its effects through a placebo response. Increasing knowledge about the neurobiology of pain and its intrinsic control suggests a combination of acupuncture-specific neurophysiologic effects combined with effects that match those of expectation-induced placebo analgesia.

Unlabelled: We investigated the effectiveness of cupping, a traditional method of treating musculoskeletal pain, in patients with carpal tunnel syndrome (CTS) in an open randomized trial. n = 52 outpatients (58.5 +/- 8.0 years) with neurologically confirmed CTS were randomly assigned to either a verum (n = 26) or a control group (n = 26). Verum patients were treated with a single application of wet cupping, and control patients with a single local application of heat within the region overlying the trapezius muscle. Patients were followed up on day 7 after treatment. The primary outcome, severity of CTS symptoms (VAS), was reduced from 61.5 +/- 20.5 to 24.6 +/- 22.7 mm at day 7 in the cupping group and from 67.1 +/- 20.2 to 51.7 +/- 23.9 mm in the control group [group difference -24.5mm (95%CI -36.1; -2.9, P < .001)]. Significant treatment effects were also found for the Levine CTS-score (-.6 pts: 95%CI -.9; -.2, P = .002), neck pain (-12.6mm; 95%CI -18.8; -6.4, P < .001), functional disability (DASH-Score) (-11.1 pts; 95%CI -17.1; -5.1, P < .001), and physical quality of life (.3; 95%CI .0; .3, P = .048). The treatment was safe and well tolerated. We conclude that cupping therapy may be effective in relieving the pain and other symptoms related to CTS. The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified., Perspective: The results of a randomized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented. Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.

Objectives: Irritable bowel syndrome (IBS) is a highly prevalent functional disorder. According to the Rome criteria, macroscopic and histological inflammation is a crucial exclusion criterion for IBS. Human defensins appear to be part of the innate immune system in the gastrointestinal tract. Human beta-defensin-2 (HBD-2) was the first inducible human antimicrobial protein discovered. The expression is induced by probiotic microorganisms and proinflammatory cytokines. Recent results imply that HBD-2 is expressed in active intestinal inflammation, especially in ulcerative colitis (UC). Our aim was to evaluate fecal measurements of HBD-2 in patients with active UC and IBS, and in healthy controls (HCs)., Methods: Fecal specimens were collected from a total of 100 participants (30 with active UC, 46 IBS, and 24 HCs). Exclusion criteria were the current use of probiotics and antibiotics. Furthermore, IBS patients with elevated C-reactive protein or leukocytes, a history of bacterial overgrowth or infectious gastrointestinal disease over the last 6 month were excluded. Disease status was addressed in all participating subjects by medical history and current symptoms. In addition, each IBS and UC patient underwent ileocolonoscopy with histopathology. Fecal inflammation markers lactoferrin (Lf) and calprotectin (Cal) were measured by enzyme-linked immunosorbent assay (ELISA) and reported as microg/g. Fecal HBD-2 was measured by ELISA and reported as ng/g feces. In addition, immunoblots were performed for fecal HBD-2. Paraffin-embedded tissue from colonic biopsies was tested for HBD-2 peptides by immunohistochemistry., Results: Lf as well as Cal was elevated in active UC (mean: 152.1+/-s.d. 374.7 microg/g; 103.5+/-87.1 microg/g), compared with IBS (8.3+/-19.4 microg/g; 18.6+/-23.3 microg/g), and HCs (0.4+/-0.5 microg/g; 7.1+/-7.9 microg/g). Scheffe post hoc tests revealed significant differences (P=0.006; P<0.001) between active UC vs. IBS and HC. In contrast, HBD-2 levels were highest in active UC (mean: 106.9+/-s.d. 91.5 ng/g), almost as high in IBS (pts 76.0+/-67.9 ng/g), and lowest for HCs (29.9+/-16.1 ng/g). Scheffe post hoc tests revealed significant differences (P<0.001) between the groups of patients (UC and IBS) vs. HCs. Immunohistochemical investigation was consistent with fecal secretion data and demonstrated the presence of beta-defensin 2 peptides in colonic epithelial enterocytes in UC as well as IBS patients with elevated fecal HBD-2., Conclusions: The results indicate significantly elevated levels of HBD-2 in patients with IBS compared with HCs and similar to those with active UC. The results support an activation of the mucosal innate defense system toward a proinflammatory response in IBS patients in the absence of macroscopic signs of inflammation.

Objective: To investigate menopause-related symptoms, traditional Chinese Medicine (TCM)-diagnosis and hormone status of two comparable urban samples of menopausal women, one in Essen (Germany) and the other in Shanghai (China)., Methods: Patients suffering from menopause-syndrome were recruited from the TCM-outpatient clinic of the University of Duisburg-Essen in Germany (35 subjects) and from the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in China (35 subjects). The Kupperman-Index for tracing menopausal symptoms was applied. The complete TCM-diagnosis was carried out by the same investigator in China as well as in Germany. Testosterone and estrogen blood samples were collected once from every woman., Results: There were significant differences in specific symptoms of the Kupperman-Index, such as a higher prevalence of formication and depression in German menopausal women; whereas Chinese menopausal women suffered significantly more from vertigo, headache and paraesthesia symptoms. Concerning TCM-diagnosis, Shen ()-yang deficiency was diagnosed in 51.43% of the German women in contrast to 5.71% of the Chinese women; 17.14% of the German women were diagnosed as having Shen-yin deficiency compared to 74.29% of the Chinese women. The German women showed significantly lower mean hormone levels for testosterone compared to the Chinese women (P

Leech therapy has been shown to be effective for symptomatic treatment of osteoarthritis of the knee. We aimed to investigate the effectiveness of leech therapy in another type of osteoarthritis, osteoarthritis of the first carpometacarpal joint (thumb saddle joint). Thirty-two women with symptomatic painful osteoarthritis of the first carpometacarpal joint and who scored>40 mm on a 100mm VAS pain scale were randomized to a single treatment with 2-3 locally applied leeches (leech group) or a 30-day course with topical diclofenac twice a day. Primary outcome measure was change of overall pain (mean of VAS for pain at rest, in motion, during grip) from baseline to day 7. Secondary outcomes were functional disability (DASH-questionnaire), quality of life (QoL, SF-36) and grip strength. Patients were examined baseline and at days 7, 30 and 60 after treatment. Overall pain score at day 7 was reduced from 59.6+/-13.8 to 27.1+/-20.6 in the leech group (n=16) and from 50.6+/-13.3 to 46.9+/-18.5 with diclofenac (n=16) (group difference -26.5, 95%CI -40.3; -12.7; p=0.0003). Group differences for pain relief favoring the leech treatment increased at days 30 and 60. Significant treatment effects were also observed for the DASH score, QoL and grip. Results were not affected by outcome expectation or consumption of analgetics. A single course of leech therapy is effective in relieving pain, improving disability and QoL for at least 2 months. The potential of leech therapy for treatment of arthritic pain and underlying mechanisms should be further investigated.

Introduction: Interdisciplinary S3 level guidelines were devised in cooperation with 8 medical, 2 psychological and 2 patient support groups. Results were elaborated in a multilevel group process., Methods: On the bases of the "Cochrane Library" (1993-2006), "Medline" (1980-2006), "PsychInfo" (2006) and "Scopus" (2006) controlled studies and meta-analyses of controlled studies were analyzed., Results: Only few controlled studies were found supporting in part the effectiveness of CAM therapies in the treatment of fibromyalgia syndrome. Due to the lack of information on long term efficacy and cost-effectiveness, only limited recommendations for CAM therapies can be given., Conclusion: Within a multicomponent therapy setting, selective CAM therapies (acupuncture, vegetarian diet, homeopathy, Tai Chi, Qi Gong, music-oriented and body-oriented therapies) can be recommended for a limited period of time.

The psychophysiology of visceral pain as it relates to gastrointestinal motility, visceral sensitivity, and putative mechanisms of the processing of visceral stimuli by the central and peripheral nervous systems are discussed. Peripheral mechanisms may include low-grade mucosal inflammation, and it is likely that central nervous mechanisms such as neuronal plasticity at the level of the spinal cord and attentional bias at the cortical level are relevant for the chronification of visceral pain. From a psychophysiological perspective, visceral pain therefore remains a complex symptom because behavioral variables, such as the way an individual deals with stress, may be as important for the etiology of visceral pain as, for example, a history of inflammation.

There is increasing clinical evidence that reflex therapies such as massage, Gua Sha, cupping, wet packs, acupuncture etc. are helpful in reducing symptoms of chronic pain. However, the neurobiological basis of these effects has rarely been investigated even though the increasing knowledge of the pathophysiology of chronic pain syndromes allows for specific hypotheses. Reflex therapies are likely able to influence chronic pain at the level of the nociceptor and the spinal cord. Moreover, it can be speculated that these therapies have a strong impact on relaxation and maybe understood as a social, comforting interaction. Since it is well accepted that the positive effect of grooming has a neurobiological basis in non-human primates, its biosocial impact on wellbeing and pain processing in humans may be underestimated. A synopsis of the neurobiological foundations of pain perception, from the nociceptor up the spinal cord to brain mechanisms provides the basis for the investigation of the 'way of action' of reflex therapies. Specific hypotheses on their neurobiological bases and methods suitable for their investigation are outlined. Further clarification of the mechanisms of action of reflex therapies will support their clinical evidence and add to our understanding of the neurobiology of complementary medicine., (Copyright 2008 S. Karger AG, Basel.)

Background: Individuals with social phobia are more likely to misinterpret ambiguous social situations as more threatening, i.e. they show an interpretive bias. This study investigated whether such a bias also exists in specific phobia., Methods: Individuals with spider phobia or social phobia, spider aficionados and non-phobic controls saw morphed stimuli that gradually transformed from a schematic picture of a flower into a schematic picture of a spider by shifting the outlines of the petals until they turned into spider legs. Participants' task was to decide whether each stimulus was more similar to a spider, a flower or to neither object while EEG was recorded., Results: An interpretive bias was found in spider phobia on a behavioral level: with the first opening of the petals of the flower anchor, spider phobics rated the stimuli as more unpleasant and arousing than the control groups and showed an elevated latent trait to classify a stimulus as a spider and a response-time advantage for spider-like stimuli. No cortical correlates on the level of ERPs of this interpretive bias could be identified. However, consistent with previous studies, social and spider phobic persons exhibited generally enhanced visual P1 amplitudes indicative of hypervigilance in phobia., Conclusion: Results suggest an interpretive bias and generalization of phobia-specific responses in specific phobia. Similar effects have been observed in other anxiety disorders, such as social phobia and posttraumatic stress disorder.

Vision is the key sensory system in humans, leading to the implicit assumption that the acquisition of spider phobia is predominantly mediated through the visual pathway. We report on a congenitally blind person with spider phobia, showing that the acquisition of spider phobia does not necessarily depend on visual cues.

Over the last several years there has been a growing interest in placebo, not only as an inert control in clinical trials, but also in the placebo effect as a group effect as well as a reaction in individual subjects. Methodological factors such as regression to the mean and natural history of the disease play a role in the evaluation of a possible placebo effect. In this report, we discuss several factors including Pavlovian conditioning, beliefs outcome, expectations, and other factors as potential mediators of the placebo response. Placebo effects are common in gastrointestinal diseases and there seems to be no clear difference between placebo effects in functional gastrointestinal diseases (functional dyspepsia and irritable bowel syndrome) and organic gastrointestinal disease (duodenal ulcer and inflammatory bowel disease).

Background: Previous studies revealed increased parietal late positive potentials (LPPs) in response to spider pictures in spider phobic individuals. This study searched for basic features of fear-relevant stimuli by investigating whether schematic spider images are sufficient to evoke differential behavioral as well as differential early and late ERP responses in spider phobic, social phobic (as a clinical control group), and non-phobic control participants., Methods: Behavioral and electrophysiological correlates of the processing of schematic spider and flower images were investigated while participants performed a color (emotional Stroop) and an object identification task. Stimuli were schematic pictures of spiders and flowers matched with respect to constituting visual elements., Results: Consistent with previous studies using photographic spider pictures, spider phobic persons showed enhanced LPPs when identifying schematic spiders compared to schematic flowers. In addition, spider phobic individuals showed generally faster responses than the control groups. This effect was interpreted as evidence for an increased general behavioral hypervigilance in this anxiety disorder group. Furthermore, both phobic groups showed enhanced P100 amplitudes compared to controls, which was interpreted as evidence for an increased (cortical) hypervigilance for incoming stimuli in phobic patients in general. Finally, all groups showed faster identification of and larger N170 amplitudes in response to schematic spider than flower pictures. This may reflect either a general advantage for fear-relevant compared to neutral stimuli, or might be due to a higher level of expertise in processing schematic spiders as compared to the more artificially looking flower stimuli., Conclusion: Results suggest that schematic spiders are sufficient to prompt differential responses in spider-fearful and spider-non-fearful persons in late ERP components. Early ERP components, on the other hand, seem to be modified by anxiety status per se, which is consistent with recent theories on general hypervigilance in the anxiety disorder spectrum.

Mind-body medicine (MBM) as a holistic approach to health and healing has been shaped by research into stress physiology and stress psychology, by psychoneuro(endocrino)immunology and by Antonovsky's salutogenetic paradigm. MBM seeks to acknowledge physical, psychological as well as social and spiritual aspects of human beings. MBM constitutes one of the traditions, which the emerging field of integrative medicine in Germany draws upon, others being mainstream medicine, traditional European naturopathy and non-European methods like traditional Chinese medicine. The article outlines historical aspects of MBM, gives a brief review of research evidence, and introduces clinical MBM institutes in Germany. Especially the Clinic and Chair of Complementary and Integrative Medicine, Alfried Krupp von Bohlen und Halbach Foundation at the University Duisburg-Essen has been integrating MBM into the concept of integrative medicine. Considering that a growing number of health issues arises due to maladaptive lifestyles, MBM is being identified as a development that supports a shift from increasingly expensive treatments to more cost-effective preventive approaches.

Purpose: Side effects of chemotherapy on cognitive functions in older patients have rarely been investigated. Addressing this lack of research, the present study evaluated cognitive functions in older cancer patients., Methods: A total of 130 younger (n=59; age<60) and older (n=71; age>or=60) cancer patients with hematological disease or cancer of the intestinal tract took part in the study. To explore short-term effects of chemotherapy, a group of patients assessed before the start of chemotherapy was compared with patients who already received their first course of chemotherapy., Results: Cognitive impairments of verbal learning, word fluency, and memory were observed following the first few days after treatment onset. Older patients showed stronger memory impairments after start of chemotherapy than younger cancer patients. Additionally, depression was neither associated with short-term effect of chemotherapy nor with age., Conclusions: The results suggest that chemotherapy has negative short-term effects on some cognitive functions. But age-dependent effects were only found for memory.

Purpose: To address the lack of research in older cancer patients, the present study prospectively evaluated their cognitive functions across the first six months following diagnosis and chemotherapy., Patients and Methods: A total of 77 younger (n=43, age < 60) and older (n=34, age > or = 60) cancer patients with hematological disease or cancer of the intestinal tract took part in the study. Medium-term effects of chemotherapy were examined in these cancer patients by means of a battery of cognitive tests during baseline and six months after start of treatment., Results: In contrast to baseline verbal learning, word fluency and memory capacity improved in all patients six months after start of treatment. A negative effect of age on cognitive functions could not be demonstrated. Additionally, depression was neither associated with medium-term effects of chemotherapy nor was it related to age., Conclusion: The results suggest that chemotherapy has no negative effects on cognitive functions after the first six months following the onset of treatment. It was demonstrated that complete recovery of cognitive functions is independent of the patient's age.

Background: In a questionnaire survey, long-distance flying staff of a charter airline reported significantly more dyspeptic symptoms than did short-haul crewmember and ground personnel (belching: 57% vs. 37%, bloating: 51% vs. 36%). To elucidate the reason for increased frequency of gastrointestinal symptoms during long-distance flights, we investigated the effects of altitude and diet on gastric emptying, cardiovascular function, and bodily complaints., Methods: In a 2 x 2 repeated measurement design we simulated an 8-h flight in a hypobaric chamber in 16 healthy men subjected to 2 meal conditions (high fiber vs. low fiber) on separate days, and assigned to either a flight altitude of 2500 m (8200 ft) or 1000 m (3280 ft). The subjects were blinded toward altitude. Heart rate and gastrointestinal symptoms were taken every hour, and gastric emptying was assessed by 13C-octanoic acid breath-test. In a separate experiment, we examined the effect of the two test meals (2 g vs. 20 g of fiber) in 30 healthy men under conventional laboratory conditions and found no significant differences., Results: At an altitude of 2500 m, heart rate was significantly increased independent of the dietary condition. Gastric emptying (T1/2) was significantly delayed at 2500 m (8200 ft) when a high-fiber meal was given (146.3 +/- 58.4 min low fiber vs. 193.9 +/- 54.3 min high fiber). The symptom score for gastric distension (mean: 1.33 +/- 0.3 vs. mean: 1.07 +/- 0.15) and bloating (mean: 1.82 +/- 0.47 vs. mean: 1.34 +/- 0.35) were also significantly increased at 2500 m for the high-fiber meal compared with the low-fiber meal., Conclusions: Flight altitude is a physiological load. In combination with a high-fiber diet, this induces significant delays in gastric emptying that may explain symptoms of cabin and cockpit crew and passengers on long-distance flights.

The electrocortical correlates of the processing of feared/fear-relevant and neutral stimuli were investigated in a pictorial emotional Stroop paradigm with spider phobic, social phobic, and nonphobic subjects. Subjects identified either the color of red or blue pictures of spiders, birds, or flowers (emotional Stroop task) or the object itself (identification task) by pressing different buttons. No emotional Stroop interference was found for spider phobic subjects when identifying the color of spiders as opposed to neutral stimuli. However, in the object identification task, spider phobic subjects identified spiders significantly faster than birds or flowers. Parietal P300 and P400 amplitudes were enhanced independent of task in spider phobic but not in nonphobic subjects when viewing pictures of spiders, which is consistent with previous studies showing that highly unpleasant and arousing pictures affect parietal late positive potentials.

This paper reviews the most important research strategies in the context of the psychophysiology of visceral pain. These are disturbed gastrointestinal motility, visceral hypersensitivity and central nervous system mechanisms such as response bias, attentional bias and affective evaluation. The most prominent research methods and results are reviewed and methodological problems are discussed. From a psychophysiological perspective, visceral pain remains a complex and heterogeneous syndrome in which stress and coping may be etiologically as important as pathophysiological mechanisms of peripheral origin and central nervous system mechanisms like attentional bias.

Unlabelled: The increased prevalence of urinary and fecal incontinence is one of the most important factors in the loss of independence and mobility in the elderly population. It is also one of the major reasons for elderly people to give up their household and move into a nursing home. Anorectal biofeedback therapy is a very effective treatment for fecal incontinence. However, due to the increased immobility of elderly people, ambulatory biofeedback training programs which require the participants to leave their homes and travel to the next available outpatient clinic on a regular basis, especially when depending on public transportation, may prove particularly difficult for elderly, incontinent subjects. Supervised home biofeedback training programs may offer an alternative for those patients, who are motivated enough and not mentally impaired. Two different age groups of women (between 49 and 63; and between 65 and 78 years old) suffering from fecal incontinence due to external anal sphincter impairment, received a supervised home biofeedback program, after extensive anorectal diagnostics including manometry. The program focused on improving voluntary sphincter contraction. After an average of 9 months, anorectal manometry was repeated, and anal resting and squeeze pressure as well as minimal rectal perception threshold were determined. There was no effect on anal resting pressure and rectal perception. However, anal maximum squeeze pressure as well as squeeze pressure over 10 s was substantially increased with no difference between the age groups., Conclusion: Supervised home biofeedback for sphincter insufficiency was effective in improving the voluntary contraction of the anorectum in both age groups. Therefore, biofeedback home training programs may offer an alternative to ambulatory programs for those individuals, who are not mobile enough to regularly attend an outpatient clinic.

Unlabelled: Interactions between visceral, intestinal stimulation and autonomic cardiovascular function have received increasing attention over the last years. The aim of the study was to investigate the effect of long-term continuous rectal distention on rectal tone and cardiovascular function at the threshold for first sensation of distention and moderate urge to defecate compared to a resting period without distention. Continuous isobaric rectal distention was performed in 13 healthy volunteers with a ten minute pressure tracking procedure at each subject's predetermined individual threshold for either moderate urge or first sensation, separated by a ten minute resting period. Rectal volume, heart rate, systolic and diastolic blood pressure were determined continuously., Results: Rectal tone decreased significantly over time at the threshold for moderate urge and first sensation. Cardiovascular measures remained stable over the distention procedures, except for a significant increase in systolic blood pressure at the threshold for moderate urge., Discussion: The previously reported rectal accommodation response to rectal distention was confirmed. The increase in systolic blood pressure is most likely mediated through sympathetic efferent pathways.

The feeding behavior of four Munich miniature pigs (29-43 kg) housed in pairs of two, was observed for two consecutive weeks. Pigs were conditioned to operate a computer-controlled recording system equipped with feeders delivering a precise food release per response and were then fed ad libitum. In addition to the descriptive analysis of feeding behavior, Walsh-Fourier Spectral Analysis was utilized to investigate the temporal patterns of food ingestion and the synchronisation of feeding patterns between the animals housed together. The pigs had up to 48% of their daily energy intake during the dark cycle and there was a substantial reduction of food intake from the first to the second week. Furthermore, pigs housed together synchronized feeding behavior from week 1 to week 2. The recording system has been shown to be highly reliable and valid and provides an excellent tool for the investigation of ingestive behaviors in miniature pigs.

Three studies were performed to investigate the effects of auditory stimuli (pure tones and environmental noise) of different intensities on surface EMG activity recorded over five facial muscle regions (M. frontalis lateralis, M. corrugator supercilii, M. orbicularis oculi, M. zygomaticus major, M. depressor anguli oris). The results show that with presentation of tones and noises of high intensity (> 85 dB) strong facial EMG reactions over muscles of the upper face (M. frontalis lateralis, M. corrugator supercilii, M. orbicularis oculi) were evoked. Among environmental noises of different valence but the same intensity, baby's crying evoked EMG reactions over facial muscles in the mouth region, possibly indicating that the subjects demonstrated expressions of dislike during this particular stimulation. It is also discussed whether facial EMG reactions to auditory stimulation of different intensities could be connected to changes in muscle tone of the middle ear muscles. The contraction of these muscles modulates sensitivity to auditory stimulation. Thus, facial EMG activity of the muscles of the upper face could serve as an indicator of sensitivity to external auditory stimuli. However, the evaluation of pleasant and unpleasant emotional reactions in response to auditory stimulation seems to be impossible.

Whether radio monitoring, task difficulty, and time of day affect driving performance was examined in a computer-controlled, simulated driving task. Driving performance was defined as the absolute deviation of the car position from road midline as displayed on the computer monitor. We found for 12 men and 8 women (i) an expected, marked deterioration of performance with increasing task difficulty, (ii) a deterioration of performance in the morning, and (iii) a deterioration of performance when subjects concurrently listened to radio programs except for the easy task conducted in the morning. The latter is supposed to be caused by a reactive increase of effort, which is induced by the concurrent radio monitoring and stimulated through a perceived impairment of attention.

Objectives: Disturbances in gastrointestinal function may result from disordered eating and may lead to increases in gastrointestinal (GI) symptoms. We compared GI symptoms in obese and non-obese binge eaters and non-binge eaters., Methods: One hundred nineteen obese and 77 normal-weight females completed a questionnaire on bowel symptoms and binge eating behaviors for the previous 3 months. Based on binge behaviors and body mass index (> 30 kg/m2), individuals were grouped as obese binge eaters (n = 73), obese non-binge eaters (n = 43), non-obese binge eaters (n = 14), and normal-weight controls (n = 61)., Results: Obese binge eaters reported more upper GI symptoms than normal controls or obese non-binge eaters (p < 0.001). Compared with normal controls, nausea, vomiting, and bloating was 2-4 times more prevalent in both binge eating groups. Indigestion was more prevalent in both obese groups. Obese binge eaters reported more lower GI symptoms than normal-weight controls (p < 0.05). Binge eating in both weight groups was associated with more frequent abdominal pain and dyschezia. Obesity was associated with more frequent constipation, diarrhea, straining, and flatus, whether or not subjects reported binge eating. Chi-square showed a significant association between obesity, binge eating, and symptoms of irritable bowel syndrome, using the Manning criteria., Conclusions: Specific GI symptoms were associated with binge eating and obesity. Overall, symptoms were more prevalent and more severe in obese binge eaters. The high prevalence of GI symptoms in obese patients who indulge in binge eating should be considered in their evaluation and treatment.

The effect of eating on defecation behaviour was investigated in four 20-30 kg pigs. Rectal distention stimulation was performed pre- and postprandially at 10 cm from the anus with a 5 cm latex balloon. Volume was increased in steps of 10 ml up to 200 ml of air or until balloon defecation. Dependent measures were volume, rectal pressure, determined with a solid state pressure transducer inside the balloon probe, rectal compliance, and an index of distention induced contractile activity. The volume and pressure required to elicit defecation was significantly lower after feeding (p less than 0.01). Distention induced contractile activity was significantly increased near defecation threshold, but pre- and postprandial conditions were not different. There was no difference in rectal compliance pre- and postprandially. These results suggest that eating lowers defecation threshold in terms of distention volume and rectal pressure, and that these changes are not dependent on altered rectal compliance or changes in distention induced motor activity.

604 out of 700 students (330 females, 274 males; mean age 23.3 [19-64] years) completed a questionnaire, which was handed out by their teachers and consisted of 26 questions concerning sexual practices and knowledge about AIDS. 285 subjects were studying natural sciences, 134 arts and 185 medicine. There were significant differences between the sexes (P less than 0.01) in drug use (alcohol, cannabis), use of condoms, promiscuity and with respect to discussion of AIDS. Fewer females than males said that they occasionally used intoxicants before sex (14% vs 25%). Women also used condoms less frequently than men (23% vs 44%), although more insisted on their use if their partner declined (68% vs 58%). 55% of the men and 72% of the women were living within a stable relationship. More women (70%) than men (56%) said they would discuss AIDS before having sex with a new partner. There were significant differences between students from individual disciplines (P less than 0.01) with regard to their knowledge, use of condoms, promiscuity, and discussion of AIDS: arts students were less well informed and changed sexual partners more frequently. The same was true of students more than 30 years old. There are important differences between students with regard to their knowledge about AIDS and sexual behaviour risk factors. Educational programmes need to take this fact into account.