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Background and Aims Despite relevance to pain chronicity, disease burden, and treatment, mechanisms of pain perception for different types of acute pain remain incompletely understood in patients with inflammatory bowel disease (IBD). Building on experimental research across pain modalities, we herein addressed behavioral and neural correlates of visceral versus somatic pain processing in women with quiescent ulcerative colitis (UC) compared to irritable bowel syndrome (IBS) as a patient control group, and healthy women (HC). Methods Thresholds for visceral and somatic pain were assessed with rectal distensions and cutaneous thermal pain, respectively. Using functional magnetic resonance imaging, neural and behavioral responses to individually calibrated and intensity-matched painful stimuli from both modalities were compared. Results Pain thresholds were comparable across groups, but visceral thresholds correlated with gastrointestinal symptom severity and chronic stress burden exclusively within UC. Upon experience of visceral and somatic pain, both control groups demonstrated enhanced visceral pain-induced neural activation and greater perceived pain intensity, whereas UC patients failed to differentiate between pain modalities at both behavioral and neural levels. Conclusions When confronted with acute pain from multiple bodily sites, UC patients’ responses are distinctly altered. Their failure to prioritize pain arising from the viscera may reflect a lack of adaptive behavioral flexibility possibly resulting from long-lasting central effects of repeated intestinal inflammatory insults persisting during remission. The role of psychological factors, particularly chronic stress, in visceral sensitivity and disease-specific alterations in the response to acute pain call for dedicated mechanistic research as a basis for tailoring interventions for intestinal and extraintestinal pain symptoms in IBD.

ZUSAMMENFASSUNGIngwer ist eine tropische Pflanze, welche im Wurzelstock 1,5–3% ätherisches Öl enthält. Ingwer fördert die Magenentleerung und den Magen-Darm-Transit und kann einen kurzfristigen Effekt bei der Behandlung und Prävention von Übelkeit und Erbrechen hervorrufen. Als in Pulverform anerkannte Arznei findet sie auch in der Onkologie Verwendung. Es konnte gezeigt werden, dass Ingwer bei Chemotherapie-induzierter Übelkeit/Erbrechen (CINV) behilflich sein könnte. Es gibt Hinweise, dass höhere Ingwerdosen weniger wirksam sind oder vorhandene Symptome verstärken können. Es liegen erste Ergebnisse vor, dass die Tagesdosis von 1 g nicht überschritten werden sollte. Weiterhin zeigte sich in einer Studie mit fraglicher Qualität, dass mit Ingwer behandelte Ovarialkarzinompatientinnen weniger Metastasen im Vergleich zur Kontrollgruppe aufwiesen. Studien, welche den Einfluss von Ingwer auf die Lebensqualität untersuchten, zeigen keine einheitlichen Ergebnisse. Weitere qualitative hochwertige Studien sind nötig, um die medizinische Wirksamkeit des Ingwers im onkologischen Kontext bestätigen und in der Praxis etablieren zu können.

The development of maritime transportation, in terms of the size and traffic volume of container ships, is increasingly posing technical challenges especially in crowded harbors and narrow canals. To ensure safe and efficient operation, tugboats are used for assisting large ships in such critical areas under the supervision of the responsible pilots. However, the mis-assessment of risk, especially under bad weather conditions, can lead to accidents, economic losses, and even casualties. Accordingly, the need for automated assistant systems is strong. In this paper, we investigate the maneuverability of tugboat-controlled ships under the influence of wind. We provide a characterization of the admissible set of safe wind situations for the execution of a given maneuver in terms of a constrained system of differential equations. Under some restrictions over the type of maneuvers, we prove the star-convexity of the admissible set. For this purpose, the dynamical model of the ship motion is derived, which takes tugboat and wind forces into account. The star-convexity of the sought-after set and the ship model allow for an efficient approximation of this set by optimal control methods. As an application, we propose a visual aid that allows the tugboat pilots to clearly distinguish between safe and hazardous wind situations during maneuver planning.

ZusammenfassungDie COVID-19-Pandemie ist ein weltweiter Ausbruch von neu aufgetretenen Infektionen mit dem SARS-CoV-2-Virus, von denen weltweit derzeit mehr als 10.670.000 Menschen erkrankt sind bzw. waren. In Deutschland leiden ca. 450.000 Patienten an einer chronisch entzündlichen Darmerkrankung; diese Patienten benötigen in der Regel eine kontinuierliche und kompetente Betreuung. Vor dem Hintergrund eines rasch zunehmenden Wissenszuwachses haben 68 Experten, die die derzeit gültigen Leitlinien der DGVS zum Morbus Crohn und zur Colitis ulcerosa erstellt haben, im Rahmen einer virtuellen Konferenz aktuelle und praxisnahe Empfehlungen formuliert, um die Versorgung von CED-Patienten zu verbessern. Diese adressieren das Infektionsrisiko einschließlich des Risikos für besondere Gruppen, den möglichen Verlauf der Erkrankung und die Konsequenzen für die medikamentöse und die operative Therapie der Grunderkrankung sowie allgemeine Maßnahmen zur Infektionsprävention und adjuvante Präventions- und Therapiemöglichkeiten.

The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews of randomized controlled trials of complementary and alternative therapies from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was formed by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines.Meditative movement therapies (e.g. qi gong, tai chi and yoga) are strongly recommended. Acupuncture and weight reduction in cases of obesity can be considered.

Bei der chronischen spontanen Urtikaria, den physikalischen Urtikariaformen und den Urtikariasonderformen ist ein gezieltes diagnostisches Vorgehen empfehlenswert. Dabei liegt der Schwerpunkt auf subklinischen bakteriellen und viralen Foci. Hierbei wird besonders haufig eine Infektion mit Helicobacter pylori nachgewiesen. Nicht selten kann eine Autoimmunurtikaria mittels autologem Serumtest diagnostiziert werden. Als unspezifische Werte sind bei der akuten Urtikaria die Zahl der Leukozyten im Blutbild und C-reaktives Protein manchmal hilfreich (hinweisend auf subklinische Infekte). In der Regel ist keine weitere Diagnostik indiziert. Besonders bei langjahrigen Verlaufen, ohne dass ein Triggerfaktor identifiziert werden kann, sowie bei entsprechenden anamnestischen Hinweisen bei intermittierend auftretenden Urtikariaschuben kann eine erweiterte Diagnostik mit Berucksichtigung von moglichen IgE-vermittelten Reaktionen (α-Gal und ω-5-Gliadin) wegweisend sein. Das seit einigen Jahren in unserer Sprechstunde an einer Universitats-Hautklinik erfolgreich eingesetzte Vorgehen kann aktuell individuell durch rezent identifizierte Einzelallergene bzw. Allergenkomponenten komplettiert werden. Der vorliegende Beitrag soll unser Vorgehen exemplarisch darstellen.

Psychological stress has been implicated in the pathophysiology of both inflammatory and functional gastrointestinal (GI) diseases. The goal of this study was to address neuroendocrine modulation of cytokine production by peripheral blood cells in GI diseases.We analyzed the in vitro effects of the beta-adrenergic agonist terbutaline and the glucocorticoid agonist dexamethasone on TNF-alpha and IL-10 production by LPS-stimulated monocytes in whole cell blood cultures in patients with inflammatory bowel diseases in remission (N=10), diarrhoea-predominant irritable bowel syndrome (IBS, N=12), patients with a recent gastroenteritis (post-infectious group, N=10), and healthy controls (N=15).In response to terbutaline, there was a significant increase in IL-10 production (concentration effect: p0.05), which was diminished in IBD (group effect: p0.01), comparable in IBS and controls, but enhanced in the post-infectious group (group x concentration effect: p0.05). In contrast, terbutaline resulted in a concentration-dependent suppression of TNF-alpha production, which was comparable in all groups. Dexamethasone suppressed TNF-alpha production in a dose-dependent manner in all groups, but this effect was significantly more pronounced in post-infectious subjects (group effect: p0.05).In IBD, disturbed adrenergic regulation of IL-10 could be part of the mechanism(s) underlying the modulation of disease activity by psychological stress. Diarrhoea-predominant IBS was not associated with altered adrenergic or glucocorticoid regulation of cytokine production by peripheral blood cells, whereas a recent history of gastroenteritis was associated with disturbed neuroendocrine modulation of cytokine production, which may play role in the pathophysiology of post-infectious IBS.

There are specific diagnostic recommendations for approaching chronic spontaneous urticaria, physical urticaria and special forms of urticaria. They include the detection of subclinical viral and bacterial infections, particularly with Helicobacter pylori. Frequently an autoimmune urticaria is diagnosed by using the autologous serum test. Less specific findings, such as leukocytosis and elevated CRP can sometimes be helpful in suggesting subclinical infections as the cause of acute urticaria; usually no further procedures are recommended. However, in cases with a long history of intermittent attacks, particularly with severe and generalized symptoms, it is recommended to look for IgE-mediated reactions (e.g. alpha-Gal, Omega-5-Gliadin). In our hands at the Department of Dermatology and Allergy at the Hannover Medical School a standardized set of diagnostic procedures was successfully established, and is now individually completed with selected single allergens and allergen components.

Systematic reviews have reported a wide range of prevalence rates for depressive, anxiety and posttraumatic stress disorders (PTSD) in patients with fibromyalgia syndrome (FMS) which have been partially explained by setting differences. No data are currently available on the prevalence of potential mental disorders depending on the medical specialty in Germany.All consecutive FMS patients of 8 study centres (3 rheumatology/orthopaedic surgery, 3 psychosomatic/pain medicine, 2 physical/integrative medicine) were assessed from February 1 to July 31, 2012 with standardised questionnaires. Patients with FMS diagnosed by a study physician were included. Non-German speaking and mentally retarded patients were excluded. The German version of the Patient Health Questionnaire 4 was used to screen for potential depressive and anxiety disorders. Severe life events were assessed by the trauma list of the Munich Composite International Diagnostic Interview and symptom criteria of PTSD of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) using the Posttraumatic Diagnostic Scale.Of 538 patients, 396 patients (93.9 % women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years, mean duration since FMS diagnosis 4.5 years) were analysed. In all, 65.7 % of patients met the criteria of a potential depressive disorder, 67.9 % of a potential anxiety disorder and 45.5 % of a potential PTSD. Potential depressive disorders were more frequent in the psychosomatic/pain medicine setting than in the rheumatology setting.Potential mental disorders were frequent in FMS patients regardless of the medical specialty. All FMS patients of all types of clinical settings should be screened for mental disorders.

No data were available on demographic and clinical characteristics of members of fibromyalgia syndrome (FMS) self-help groups in Germany.The study was carried out from November 2010 to April 2011. A set of questionnaires was distributed by the German League Against Rheumatism and the German Fibromyalgia Association to members and to all consecutive FMS patients at nine clinical centres of different levels of care. The set included a self-developed questionnaire on demographic and medical data and on previously and currently used therapies, the patient health questionnaire (PHQ 4) and the fibromyalgia survey questionnaire.Members of FMS self-help groups (N = 1,014) were older and reported a longer duration of chronic widespread pain, less anxiety and depression and a more frequent current use of aerobic exercise, relaxation training and complementary alternative medication than participants not affiliated with FMS self-help groups (N = 630).Membership in FMS self-help groups was associated with less psychological distress and a more frequent use of active self-management strategies.

Consumer reports provide information on benefits and harms in routine clinical care. We report the first fibromyalgia syndrome (FMS) consumer reports in Europe.The study was carried out from November 2010 to April 2011. The benefits and harms of pharmacological and non-pharmacological therapies experienced by the patient were assessed in an 11-point Likert scale (0=no, 10=very high benefit or harm) by a questionnaire. The questionnaire was distributed by the German League against Rheumatism and the German Fibromyalgia Association to their members and to all consecutive FMS patients of nine clinical centers of different levels of care.A total of 1,661 questionnaires (95% women, mean age 54 years) were analyzed. Self-management strategies (distraction, resting, aerobic exercise), physical therapies (warm and pool therapies), psychological therapies (education, psychotherapy), and inpatient multicomponent therapies were judged to be more efficacious and less harmful than all types of pharmacological therapies.The German fibromyalgia consumer reports highlight the importance of non-pharmcological therapies in the long-term management of FMS.

We report the case of a 74-year-old female with an extreme picture of melanosis coli of the whole colon after chronic use of anthraquinone laxatives for the treatment of constipation over many decades. Endoscopic work-up revealed an impressive deep black pigmentation of the whole colon mucosa which could be verified by histopathology as a widespread lipofuscin granulation. In addition, various adenomas but no colorectal carcinoma could be detected. The term melanosis coli describes a brown or black pigmentation of the colonic mucosa. Induction of melanosis coli by anthraquinone laxatives and their derivatives can be regarded as verified. The question if melanosis coli predisposes for colorectal neoplasia is discussed controversially. Based on the current literature, an association of melanosis coli between colorectal adenomas, but not colorectal carcinomas, is under discussion but the mechanisms to effect the development of colorectal neoplasia are not completely understood. Considering our case and the current scientific backround, we conclude that due to pharmaceutical side effects of anthraquinone derivatives such as electrolytic shift and water loss in addition to the risk of developing melanosis coli, anthraquinone laxatives should not be used for long-term therapy of constipation.

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).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.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; P0.001) 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 (P0.001) 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.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.

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.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.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.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.

Between 60 and 90% of patients consult their family doctor for stress-associated complaints. Not infrequently, a considerable number of these patients already have elevated blood pressure. The positive effect on high blood pressure of relaxation techniques has been confirmed in various studies. Accordingly, stress management should now have a permanent place in effective antihypertensive treatment. Appropriate relaxation techniques include, for example, autogenic training, progressive muscle relaxation, visualization and breathing exercises, chi gong and yoga. These practices are incorporated in various lifestyle programs. They act in different ways, and can be offered to the patient in accordance with his/her individual wishes.

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.

Fasting followed by vegetarian diet has shown to be an effective treatment for rheumatoid arthritis, moreover fasting is frequently used as an adjunctive treatment in chronic pain and stress/exhaustion syndromes. Data on well-being and the frequency of side effects during fasting are mostly retrospective. Mineral supplements are frequently used in order to compensate for fasting-induced tissue acidosis and to reduce side effects. There are only limited data that support this practice.To study the effects of oral mineral supplements on common side effects and well-being during short-term fasting.209 consecutive inpatients with chronic pain/exhaustion syndromes were recruited. In a controlled non-randomised study design all patients underwent fasting (250 kcal; 3 l fluid intake/day) over 7 days, in study phase 1 without (n = 103) and in study phase 2 with (n = 106) concomitant prescription of standardised oral mineral supplements (3 x 2 to 3 x 3 Bullrich's Vital). Weight, blood pressure and urinary pH were recorded daily. Well-being and mood as well as common side effects (i.e. fatigue, hunger, heart burn, headache) were assessed with standardised self-reports.Baseline characteristics of the 209 patients (mean age 54.7 +/- 10.5 years; 83.3% female) were balanced. Both groups showed a fasting-induced decrease of blood pressure, a slight decrease in mood and well-being on days 3 and 4 with consecutive increase and moderate hunger, i.e. in the evening. Side effects and general tolerability of fasting as well as well-being and mood were not different between the groups. There were no serious side effects in both groups.Short-term fasting in inpatients with pain and stress syndromes is safe and well tolerated, concomitant mineral supplements have no additive benefit.

Background Infection with H pylori is very common and may cause chronic gastritis, predisposes to gastric and duodenal ulcers, leads in some cases to gastric lymphoma and has been recognised as a class I gastric carcinogen. Rapid, inexpensive, reliable tests are needed to facilitate the diagnosis. Methods This prospective clinical study was undertaken to evaluate a new whole blood antibody test (helicoCare) in correlation to three tests for diagnosis of H pylori infection (histology, ELISA and rapid urease test). 304 patients (mean age 56.5 years, range of 11-93 years) referred for esophagogastroduodenoscopy were included in this uni-centric study over a nine-month period. According to the guidelines for clinical trials in H pylori infection, patients with at least two positive tests were classified as positive for H pylori. Results 132 patients (43.4 %) were positive for H pylori, of which helicoCare identified 118 missing one gastric and one duodenal ulcer. 172 patients (56.6 %) were H pylori negative, of which helicoCare identified 163. Sensitivity was proven to be 89.4 % and specificity 94.8 %. In a special subgroup of 75 patients younger or equal to 45 years, 28 patients were positive for H pylori (37.3 %). In this group a sensitivity of 85.7 % and a specificity of 97.9 % was found for the helicoCare. Conclusions The helicoCare test showed sufficient sensitivity and satisfying specificity for H pylori diagnosis similar to or better than those of rapid urease test or ELISA. The helicoCare whole blood test may be useful for in-office H pylori diagnosis especially in patients under 45 years.

Short-Term Therapeutic Fasting in the Treatment for Chronic Pain and Stress Syndromes. Effects of Mineral Supplements on Side Effects and Well-Being Background: Fasting followed by vegetarian diet has shown to be an effective treatment for rheumatoid arthritis, moreover fasting is frequently used as an adjunctive treatment in chronic pain and stress/exhaustion syndromes. Data on well-being and the frequency of side effects during fasting are mostly retrospective. Mineral supplements are frequently used in order to compensate for fasting-induced tissue acidosis and to reduce side effects. There are only limited data that support this practice. Objective: To study the effects of oral mineral supplements on common side effects and well-being during short-term fasting. Patients and Methods: 209 consecutive inpatients with chronic pain/exhaustion syndromes were recruited. In a controlled non-randomised study design all patients underwent fasting (250 kcal; 3 l fluid intake/day) over 7 days, in study phase 1 without (n = 103) and in study phase 2 with (n = 106) concomitant prescription of standardised oral mineral supplements (3 ×?2 to 3 × 3 Bullrich’s Vital). Weight, blood pressure and urinary pH were recorded daily. Well-being and mood as well as common side effects (i.e. fatigue, hunger, heart burn, headache) were assessed with standardised self-reports. Results: Baseline characteristics of the 209 patients (mean age 54.7 ??10.5 years; 83.3% female) were balanced. Both groups showed a fasting-induced decrease of blood pressure, a slight decrease in mood and well-being on days 3 and 4 with consecutive increase and moderate hunger, i.e. in the evening. Side effects and general tolerability of fasting as well as well-being and mood were not different between the groups. There were no serious side effects in both groups. Conclusions: Short-term fasting in inpatients with pain and stress syndromes is safe and well tolerated, concomitant mineral supplements have no additive benefit.

Methods A total of 96 patients (51 female) with UC in remission (not longer than 12 months) were included in a randomized, double-blind, double-dummy, multicenter, non inferiority study comparing mesalazine 500 mg (3x1/d) to 100mg myrrh, 70mg chamomile extract and 50mg coffee charcoal (3 x 4/d) over a time period of 12 months. As primary outcome criterion, non-inferiority of the herbal preparation was defined and accepted, if the difference in the colitis activity index (Colitis Activity Index CAI Rachmilewitz) (calculated at six time points during the 12 month interval) averaged over all visits was ≤ 1 point. Furthermore, relapse rates, relapse-free times, safety, a comprehensive activity index (CAI, CRP and fecal Lactoferrin, Calprotectin and PMN-Elastasis), an endoscopic activity index and Health-related Quality of life (HrQoL) were assessed. Peripheral CD4+CD25+ reg T-cells were investigated in a subgroup at each time point and during a flare.

Methods Eighteen patients with chronic non-specific neck pain participated in a 9-week Iyengar yoga-program. Before and after the program, patients were asked to complete a drawing of their neck and shoulder region in a way that reflects their subjective body perception. Semi-standardized interviews were used to retrieve more information on body perception, emotional status, everyday life and coping, and changes in these dimensions after attendance in the program. An interdisciplinary interpretation group analyzed the interviews using the content analysis approach according to Mayring.

Methods A computerized search of databases (Cochrane Library, Medline, PsychINFO, and Scopus) through June 2011 was performed. We screened the reference sections of original studies and systematic reviews in the English language for CAM in IBD, CD and UC. Randomized controlled trials (RCT) and controlled trials (CT) were included. RCTs comparing treatment to controls were assessed by a methodological quality score.

Background Therapeutic dietary interventions were often shown as effective treatment for rheumatoid arthritis (RA). Evidence 1a could be established for medical Fasting. The mechanisms to affect inflammation and clinical outcome are unknown. Alterations in intestinal microflora, especially the profile of short-chain-fatty-acids (SCFA) are believed to be associated with disease activity in patients with RA. Aim To evaluate changes in intestinal microflora and clinical outcome in RA during Fasting or a Mediterranean diet. We expect a greater influence of Fasting versus Mediterranean diet and a correlation between fasting response and alterations in SCFA. Methods In total, 50 consecutive patients from an Integrative Medicine Hospital were included in a prospective observational study. Patients received a 7-day Fasting therapy or a Mediterranean diet. Stool samples for gas-chromatographical analysis were taken at the beginning and at the end of a 2-week hospital stay. Disease activity of RA was assessed with DAS-28 and CRP was measured. Patients health assessment, self facility, pain and food consumption were evaluated with HAQ, SF-36, VAS and FFQ. Results DAS-28 decreased from 5.7±0.9 to 4.1±1.3 mean value in the fasting group and from 5.4±1.4 to 4.5±1.3 in non-fasters ( p =0.115). Pain on VAS significantly decreased from 4.1±2.3 at day 1 to 2.6±2.2 at day 7 in the fasting group versus 3.5±2.7 to 3.5±2.7 in the Mediterranean diet group ( p =0.049). CRP showed no significant difference ( p =0.759). No statistical differences between both groups were found in the profile of total-fatty-acids ( p =0.069), butyrate ( p =0.611) and propionate ( p =0.419), but measurement of acetate shows significant decrease from 17.4 μmol/g±9.8 to 21.4 μmol/g±16.4 in the fasting group compared to increasing values from 15.2 μmol/g±10.4 to 13.8 μmol/g±9.3 in the Mediterranean diet group ( p =0.044) (mean values). Conclusion Improvement of disease activity was comparable in both study groups. Pain decreased significantly on day 7 after Fasting therapy compared to Mediterranean diet and suggests a potential benefit of Fasting. Alterations in SCFA showed no significant differences except for the measurement of acetate. An association between anti-inflammatory properties of SCFA and disease activity in RA could not be shown.

A mutant condition characterized by absence of shanks is invariably present in chickens that are homokaryotypic for an X-ray-induced pericentric inversion to chromosome 2. The mutation was studied in 260 embryos at 19 days of incubation. Embryos produced from matings of parents with and without the inversion were karyotyped and their skeletons observed and measured. The mutant phenotype, which was seen in all birds homokaryotypic for the inversion, is characterized by malformed and reduced metacarpals, absence of tarsometatarsal shanks, increased tibia length, extra bones in digits two, three, and four, and fusion of proximal phalanges. Heterokaryotypic and homokaryotypic normal embryos had normal phenotypes, but the length of metacarpals was slightly reduced in heterokaryotypes. The primary effect of the mutation is to cause misplacement, malformation, and underdevelopment of metatarsals II, III, and IV. The recessive mutation, located in the proximal region of chromosome 2, has been designated shankless (shl).