North Korea and an open account

Kim Jong Un will "settle account with the United States" I’ve read in the Rheinische Post, a German newspaper. Link: http://www.RP-online.de/Politik/ausland/Kim-will-Rechnung-mit-den-USA-begleichen-1.3290915 or look at USA today: http://www.usatoday.com/story/news/world/2013/03/29/north-korea-rocket/2030319/  

It may be the case that Kim Jong Un just tries to put North Korea better in scene. Even his father didn’t see need to appear so belligerent.

The place looked harmless as I had visited it

I’ve just tried to access the page of Rodong Sinmun, but could only get the message that the page cannot be opened. Is some kind of censorship working? If it is on the North Korean side, then they don’t even trust their own propaganda. If South Korea or the US blocked the page, North Korea has already lost the battle on the internet.


Although right now experts appease, one shouldn’t underestimate the risks, which may arise from bunker mentality. Out of North Korea could develop a scenario, that Stanley Kubrick warned against in his satirical movie "Dr. Strangelove or how I learned to love the bomb" (1964).

There's quite a lot on North Korea after a visit in fall 2011 on this blog. Please use the search function.

Carpe Diem Haiku Tanpopo (Dandelion) 蒲公英

White peaks and blue sky

Meadow with dandelions

Breathing in deeply

Yellow taxi

Yellow dandelion

Yelling out happiness

Spring has come

Painting the meadow yellow

And the air with scent

春终于来了

草地上画了黄色

空气中之味

                  若你翻译地更好请告诉我。My own Chinese translation might not be the best possible.

Sweet little lions

Stalking the grass yellowly

Happy sky above

Doesn’t taraxacum remind you of abraxas?

http://chevrefeuillescarpediem.blogspot.de/

Weather today

“Oh the weather outside is frightful”

There are lots of hints that global weather changes are already happening. Global warming means more water evaporating from oceans and therefore we have more rain and snow. Right now it’s snowing in Cologne. We didn’t have a white Christmas, but we’ll enjoy a white Easter.

The arctic sea around the North Pole has less and less ice during the summer months. That could be crucial for Europe as it means that some when the Gulf Stream might be stopped coming to Europe. Cologne is as high up on the map as Newfoundland or Sakhalin, both locations with harsh winters.

So here they are. Pictures of today’s weather.

Around 10:00 a.m. in Cologne, where I live

Around 01:45 p.m. in the yard of our hospital in Meerbusch - even the rabbits are used to the weather now and won't dash away!

This is Easter Sunday, also around 01:45 p.m. - leaving the Autobahn

Around 01:45 p.m. in the yard of our hospital in Meerbusch

雪の女　

春の風上に

兔かね　

Translation:

Snow woman　

On the spring wind　

Hare

I'm not sure that the Japanese Haiku works out, but I've written it on the occasion of the second picture.

Nord Korea und die offene Rechnung

Kim Jong Un will "Rechnung mit den USA begleichen" lese ich gerade in der Rheinischen Post. http://www.rp-online.de/politik/ausland/kim-will-rechnung-mit-den-usa-begleichen-1.3290915
Kann es sein, dass Kim Jong Un gerade versucht, sich in Nord Korea besser in Szene zu setzen. So kriegerisch hat sich selbst sein Vater nicht geben müssen.

Der Platz sah jedenfalls sehr viel harmloser aus, als ich ihn besucht hatte

Ich versuche gerade, die Seite der Rodong Sinmun aufzurufen, bekomme aber nur die Meldung, dass die Seite nicht geöffnet werden kann. Ist hier eine Zensur am Werk? Wenn es auf nordkoreanischer Seite ist, dann traut man der eigenen Propaganda nichts zu. Wenn es von südkoreanischer oder amerikanischer Seite zu einer Blockierung gekommen ist, dann hat Nordkorea die Schlacht im Internet verloren.

Auch wenn jetzt Experten beschwichtigen, sollte man nicht die Gefahr unterschätzen, die aus der Bunkermentalität entspringen kann. Aus Nordkorea könnte erwachsen, wovor Stanley Kubrick in der Satire "Dr. Seltsam oder wie ich lernte, die Bombe zu lieben" (1964) warnte.

FreitagsGedichte

VerSterben


Zeit erStirbt
Den Ort verlassend
Was sollte überDauern?
Was überDauern sollte
VerWeht

In Schatten gePreSSt
Schweigen
Ein ÜberWurf aus Entschuldigungen

Und hämmert im Dunkel
Das Schwarz noch samtener




FeuerbachStrasse Acht

Die kalten Schatten am Morgen
In denen NachtWunden weiterBlühen

Ein Hund wird ausgeFührt
Schrippen ausgeTragen

Durch Glas und Gardine stiehlt sich
Sonne von zwischen den Häusern*

Staub tanzt im SonnenStrahl
Von den Schatten betrachtet

Wenigstens hier schmerzt es nicht
Wenigstens hier blutet es nicht

* ich gebe zu, versucht gewesen zu sein, von zwischen die Häuser zu schreiben




SphärenKlänge

In absoluter Stille
Kannst Du es hören
Das Quietschen der Sphären
AufKreischen der Shären
Vielleicht hörst Du auch Musik darin

Im Quietschen und Krachen
Des RangierBahnHofs
Entdecke ich Musik

Carpe Diem Haiku Tako (kite) 凧

 

The sunny beach

Alone with waves, sky and wind

Flying with the kite

Letting go

The string of the kite

Fly on or crash

Fresh colours

The kite gains the sky

Bested by birds

http://chevrefeuillescarpediem.blogspot.de/

Graffiti in Russia

Actually I haven’t seen much graffiti in Russia, far less in the Ukraine and none in Moldovia. But I’ll show you the hidden treasures from Arkhangelsk.

Near the little church, where wedding pictures are shot

On the kai of the beach front

At the stairs to the beach

Related links for this travel:

From Church to Swimming Hall and back again  http://rheumatologe.blogspot.de/2013/03/from-church-to-swimming-hall-and-back.html

Odessa's Opera  http://rheumatologe.blogspot.de/2013/03/odessas-opera.html

Travel and Toilets  http://rheumatologe.blogspot.de/2013/03/travel-and-toilets.html

Red Square (Красная Площадь)  http://rheumatologe.blogspot.de/2013/03/red-square.html

Cafe Pushkin and Coffee Mania  http://rheumatologe.blogspot.de/2013/02/cafe-pushkin-and-coffee-mania.html

The Monastery of Sergiev Posad  http://rheumatologe.blogspot.de/2013/02/the-monastery-of-sergiev-posad.html

Black Sea and Arkadia Beach  http://rheumatologe.blogspot.de/2013/02/black-sea-and-arkadia-beach.html

The Wooden Church of Izhma  http://rheumatologe.blogspot.de/2013/02/the-wooden-church-of-izhma.html

On Renting a Car in Arkhangelsk  http://rheumatologe.blogspot.de/2013/02/on-renting-car-in-arkhangelsk.html

Outskirts of Kiev  http://rheumatologe.blogspot.de/2013/02/outskirts-of-kiev.html

Statues of old Old Comrades or Leaders  http://rheumatologe.blogspot.de/2013/02/statues-of-old-old-comrades-or-leaders.html

New Logic or No Interest in Business  http://rheumatologe.blogspot.de/2013/02/new-logic-or-no-interest-in-business.html

The Burnt Muffin  http://rheumatologe.blogspot.de/2012/11/the-burnt-muffin.html

Love locks from the Black to the White Sea  http://rheumatologe.blogspot.de/2012/11/love-locks-from-black-to-white-sea.html

Antoniyevo-Siysky Monastery (Антониево-Сийский монастырь)  http://rheumatologe.blogspot.de/2012/10/antoniyevo-siysky-monastery.html

On changing Moldovan Lei in Odessa  http://rheumatologe.blogspot.de/2012/10/on-changing-moldovan-lei-in-odessa.html

The Very Basic Guide to Russian  http://rheumatologe.blogspot.de/2012/10/the-very-basic-guide-to-russian.html

Crime and Punishment (St. Petersburg)  http://rheumatologe.blogspot.de/2012/10/crime-and-punishment.html

Hram Ilias – the hidden silence near the Red Place in Moscow  http://rheumatologe.blogspot.de/2012/10/hram-ilias-hidden-silence-near-red.html

Kishinev – the prologue of this year’s travels (2012)  http://rheumatologe.blogspot.de/2012/10/kishinev-prologue-of-this-years-travels.html

Carpe Diem Haiku Shuntoo (Spring lantern)

Spring lantern at night

Sitting wind blows out the light

But the moon shines on

Night falls slowly

And the wild geese return

Light in the lantern

Lantern dances

Shadows run and hide

Cozy on the porch

http://chevrefeuillescarpediem.blogspot.de/

Campodimele - Die Langlebigkeit seiner Einwohner

Ich sah auf meinem Blog, dass ein Interesse für Campodimele geweckt worden ist. Ich hatte früher in den Gesundheitstipps bereits auf Campodimele hingewiesen, da sich in der kleinen Ortschaft in Italien viele langlebige Menschen aufhalten. Und dann hatte ich auf das Buch von Tracey Lawson hingewiesen: „Das Geheimnis von Campodimele“, erschienen bei Bloomsbury in Berlin.

Was hat das Interesse an Campodimele, einer kleinen Gemeinde auf einem Hügel (650 m) in der Mitte zwischen Neapel und Rom, geschürt? Wahrscheinlich die Tatsache, dass die Einwohner dort durchschnittlich 10-15 Jahre länger leben als die Menschen sonst in Italien.

Man hat zunächst Umgebungsfaktoren ausfindig gemacht: die Einwohner von Campodimele leben von selbst angebauten Gemüse, Mais, Olivenöl, Früchten, der Cichercia (einer Platterbse). Sie essen Fisch (omega-3-Fettsäuren), aber nur selten und wenig Fleisch. Eine Zwiebelart, der viel Antioxidantien zugesprochen wird, kommt ebenfalls auf den Tisch. Rotwein (reich an Polyphenolen) wird mäßig getrunken, dafür kaum andere Alkoholika und auch wenig Kaffee.

Der Anbau wird mit eigenem Saatgut und ohne Insektenvertilgungsmittel oder Kunstdünger durchgeführt. Und man arbeitet in den Feldern, die am Hang liegen selbst, was für Bewegung an frischer Luft sorgt.

Die neueste Forschung fand eine Genmutation bei den Einwohnern von Campodimele; M. Arca and colleagues: „Mutations in the ANGPTL3 Gene and Familial Combined Hypolipidemia: A Clinical and Biochemical Characterization“; siehe: http://jcem.endojournals.org/content/early/2012/06/01/jc.2012-1298.abstract (auf Hinweis von: http://www.br.de/radio/bayern2/service/programm/radio-revue-campodimele-102.html). Diese Genvariante für zu erniedrigtem Blutfettspiegel und hilf deshalb vor Gefäßverkalkung.

Für mich sieht es so aus: verschiedene Faktoren kommen bei den Einwohnern von Campodimele zusammen. Sie ernähren sich mit fleischarmer Biokost, sie bewegen sich regelmäßig, sie sind an der frischen Luft, sie führen ein stressarmes Leben und haben dann noch den Vorteil, dass sie eine Genvariante vor Erhöhung der Blutfette schützt.

Daraus kann man lernen.

Links:
http://rheumatologe.blogspot.de/2012/04/gesundheitstipps-13.html
http://rheumatologe.blogspot.de/2012/07/das-geheimnis-von-campodimele.html

Carpe Diem Haiku Haru ta (Spring paddy fields) 春田

 

Cold mountain water

Gushing onto the warm fields

So green the valley

Winter’s white canvas

Is painted green by spring, now

Crickets challenge birds

 

The spring paddy fields

So tranquil without the gnats

Wind brushes though pines

http://chevrefeuillescarpediem.blogspot.de/

North Korea Women’s Dress Code No. 2

My blogpost on the dress code of women in North Korea has attracted some attention during the past weeks; link: http://rheumatologe.blogspot.de/2011/12/womens-dress-code.html.

So I’be decided to post a sequel with more pictures.

These women are looking that everyone is decently dressed and heaves well on the streets.

Office lady on the way to a commemoration point

At a refreshment stand (water and beer)

Shortly before a dance

Still waiting for the event

After haveing visited the Revolutionary Martyrs' Cemetery / Kim Jong-Suk

Quite a of women are in the army,

so they have to dress like this

These women most probably belong to the nomenklatura

From Church to Swimming Hall and back again

Do you think that's cazy? Well it is, but also it isn't. During the Chrutshev era churches were changed to swimming halls (1963). In the post Stalin era sports were pushed and churches had large halls that one could use to build a swimming hall. I'll show you one in St. Petersburg that changed back into church again.

The Lutheran Church off Nevsky Prospekt

On Nevsky Prospekt you stumble upon the Lutheran church, which has a statue of Goethe in front. The church had connections to Germany and there had been ceremonies in German, because the church served the Germans in St. Petersburg. Nowadays the church again has closer ties with Germany as you can see in the picture with our former president.

200 years of the German Evangelical-Lutheran Community St. Petri (St. Peter)

The church as a swimming hall

First Lady Mrs. Wulff, President Wulff and the Pastor

During the Stalin era the congregation has been deported to Siberia, which has been depicted in frescoes in the krypt of the church.

Deported into the Siberian forests

Down there you can also have look at the old basin. The church main hall now rests on a construction, which has been driven through the basin.

Construction through the basin under the church's main hall

You can also look at the old superintendents and construction plans of the church, which has been founded at the wish of Empress Katharina the Great.

Pictures of the superintendents on the wall

There's an exhibition on the second floor. You oversee the assembly hall, the old seats of the swimming hall, and exhibits. If the organist plays, just sit down, relax, and listen to fugues by Bach, Telemann, and others or the songs that would be sung next Sunday. Such a pity that the organ is new, but the old one, thought to be the largest an most beautiful of Russia, had been destroyed. The sound of the new one is very good, however.

Interior of the main hall with seats of the swimming hall

From the exhibition

Interior with organ

The Lutheran Church is well worth a visit, especially as it is central, but off the beaten track, so off the beaten track that even Lonely Planet doesn't mention the church.


Related links for this travel:

Odessa's Opera http://rheumatologe.blogspot.de/2013/03/odessas-opera.html  

Travel and Toilets http://rheumatologe.blogspot.de/2013/03/travel-and-toilets.html  

Red Square (Красная Площадь) http://rheumatologe.blogspot.de/2013/03/red-square.html  

Cafe Pushkin and Coffee Mania http://rheumatologe.blogspot.de/2013/02/cafe-pushkin-and-coffee-mania.html  

The Monastery of Sergiev Posad http://rheumatologe.blogspot.de/2013/02/the-monastery-of-sergiev-posad.html  

Black Sea and Arkadia Beach http://rheumatologe.blogspot.de/2013/02/black-sea-and-arkadia-beach.html  

The Wooden Church of Izhma http://rheumatologe.blogspot.de/2013/02/the-wooden-church-of-izhma.html  

On Renting a Car in Arkhangelsk http://rheumatologe.blogspot.de/2013/02/on-renting-car-in-arkhangelsk.html  

Outskirts of Kiev http://rheumatologe.blogspot.de/2013/02/outskirts-of-kiev.html 
Statues of old Old Comrades or Leaders http://rheumatologe.blogspot.de/2013/02/statues-of-old-old-comrades-or-leaders.html  

New Logic or No Interest in Business http://rheumatologe.blogspot.de/2013/02/new-logic-or-no-interest-in-business.html  

The Burnt Muffin http://rheumatologe.blogspot.de/2012/11/the-burnt-muffin.html  

Love locks from the Black to the White Sea http://rheumatologe.blogspot.de/2012/11/love-locks-from-black-to-white-sea.html  

Antoniyevo-Siysky Monastery (Антониево-Сийский монастырь) http://rheumatologe.blogspot.de/2012/10/antoniyevo-siysky-monastery.html  

On changing Moldovan Lei in Odessa http://rheumatologe.blogspot.de/2012/10/on-changing-moldovan-lei-in-odessa.html  

The Very Basic Guide to Russian http://rheumatologe.blogspot.de/2012/10/the-very-basic-guide-to-russian.html  

Crime and Punishment (St. Petersburg) http://rheumatologe.blogspot.de/2012/10/crime-and-punishment.html  

Hram Ilias – the hidden silence near the Red Place in Moscow http://rheumatologe.blogspot.de/2012/10/hram-ilias-hidden-silence-near-red.html  

Kishinev – the prologue of this year’s travels (2012) http://rheumatologe.blogspot.de/2012/10/kishinev-prologue-of-this-years-travels.html   
  

Fatigue and Rheumatoid Arthritis


During the past months it seend that nearly every patient complained about fatigue and flare or remission weren't good predictors. I've already written a blogpost on fatigue, link: http://rheumatologe.blogspot.de/2012/08/fatigue.html. And fatigue is different from morning stiffness, another common symptom.

Recently I've read the following tweet on Twitter:
AmerCollRheumatology @ACRheum The Puzzle of Fatigue in #Rheumatoid Arthritis ow.ly/jjC32 #rheumatology
http://www.the-rheumatologist.org/details/article/4460461/ACRARHP_Annual_Meeting_2012_Fatigue_for_People_With_Rheumatoid_Arthritis_Rooted_.html#src=social

Fatigue has been indexed for about 25 abstracts presented at the ACR 2012 in Washington. Quite a lot of studies can't be applied to patients with rheumatoid arthritis, but a lot of these studies are relevant. So the tweet and the article by Mary Beth Nierengarten prompted me to look again into the abstracts and fatigue in general.

R. Alten and colleagues presented: "Improved Fatigue-Related Quality of Life in CAPRA-2, a 12 Week Study of 5-Mg Modified (Delayed) Release Prednisone in Rheumatoid" (Abstract No. 367). If fatigue is associated with inflammation it isn't farfetched to expect fatigue getting better under prednisone.

J. P. Hampson and colleagues presented: "Frontal Brain Connectivity to the Default Mode Network Is Associated with Subjective Fatigue Irrespective of Pain and Depression" Abstract No. 803). They tested fibromyalgia patients, but maybe some of the results might also apply to patients with rheumatoid arthritis. They concluded: "This study suggests that connectivity of multiple brain regions to the DMN is associated with subjective reports of fatigue."

S. van Dartel and colleagues presented: "Association of Actometer Assessed Physical Activity and Fatigue in Patients with Rheumatoid Arthritis: Patients with a Lower Daily Activity Have More Fatigue" (Abstract No. 1232). They concluded: "In RA, a higher level of physical activity was associated with less fatigue."

H. Lööf and colleagues presented: "Pain and Fatigue in Adult Patients with Rheumatoid Arthritis - Associations with Demographic Factors, Disease Related Factors, Body Awareness, Emotional and Psychosocial Factors" (Abstract No. 1571). They concluded: "This study identifies that in patients with Rheumatoid arthritis fatigue and pain appears to be associated with disease related factors. Furthermore, fatigue was related to body awareness and emotional factors."

I've already quoted the study of B. I. Bremander and colleagues: "Smoking Is Associated with Worse and More Widespread Pain, Worse Fatigue, General Health and Quality of Life in a Swedish Population Based Cohort of Patients with Psoriatic Arthritis" (Abstract No. 1828). If smoking worsens fatigue in patients with psoriatic arthritis it's only a matter of time to show that smoking also worsens fatigue in patients with rheumatoid arthritis.

N. Lukkahatai and colleagues looked at: "Genomic Categories of Fatigue in Women with Fibromyalgia" (Abstract 1874). They concluded: "Within FM women with high fatigue, there appears to be two distinct patterns of gene expression. These genomic patterns correspond with differences in behavioral characteristics." Though this study is on patients with fibromyalgie, I doubt that one won't find corresponding genomic patterns in patients with rheumatoid arthritis.

P. P. Katz and colleagues presented: "Obesity Is Associated with Higher Levels of Fatigue in RA" (Abstract No. 2411). They concluded: " Obesity appears to play a role in RA fatigue, even after controlling for important covariates such as disease activity, sleep, and depression."

K. Loeppenthin and collegues presented: "Quality of Sleep, Physical Activity and Fatigue in Patients with Rheumatoid Arthritis. A Cross-Sectional Study" (Abstract No. 2689). They concluded: "A high prevalence of sleep disturbances was observed. This study indicates that PA and fatigue play a significant role in self-reported sleep quality." Very intersting, as these findings show parallels to fibromyalgia.

In her article Mary Beth Nierengarten cited R. Geenen from Utrecht University in the Netherlands: “Fatigue is much more strongly correlated with cognitive variables, such as helplessness and catastrophizing thoughts, and behavioral variables, such as pacing of activities, physical fitness, and patterns of sleep and awakening”. So it might well be that we'll reach a better understanding of what has often been called fibromyalgianess in rheumatoid arthritis patients, "the precise physiological substrate of fatigue remains largely unknown". Inflammatory parameters only show a low correlation to fatigue.

We still lack established instruments for monitoring fatigue. There are some being used in research, but they aren't in current every day practice use. So using a VAS or NRS scale concerning fatigue at every visit would already give an overview until better tools are developed. Ch. Bode from the University of Twente in the Netherlands, "reviewed a number of novel measurements of fatigue that can be useful in helping to tailor intervention strategies". There's a table of possible tools, which are interesting for research, but aren't useful in daily practice as rheumatologist won't have the time to read and evaluate diaries. For research however these tools are relevant.

S. Hewlett of the University of the West of England, looked at nonpharmacological interventions of fatigue in rheumatoid arthritis patients. Cognitive behavioral therapy, low-impact aerobic exercise, pool therapy and others showed efficacy. At our center, we use low-impact aerobic exercise and pool therapy as a routine measure. We have a clinical psychologist, who is called, when the patient agrees, though we don't initiate cognitive behavioral therapy during the short stay at our hospital, but would recommend CBT, when indicated. I found quite a lots of interventions on Saraf Hewlett's list that we use successfully in treatment of fibromyalgia patients.

I'm a bit surprised, because it's more than I had expecetd before. R. Geenen presented a chart, but I think we have to make adjustments, because we already have more information. Have a look at my chart.

To fight fatigue in rheumatoid arthritis we have to reduce inflammation and may do so with DMARDs, biologics, corticosteroids (influence on pain, morning stiffness). We can influence stuctural and functional brain changes by early and consequent therapy ("hit hard and early"), which reduce pain, morning stiffness, and stress. With graded exercise we influence the level of fitness and obesity. Reducing corticosteroids as early as possible reduces obesity. Lifestyle changes should also reduce obesity. Sleep hygine, lifestyle changes, pain controll restore sleep.

To sum it up: Fatigue needs more attention by the scientific part of rheumatology. Fatigue is complex and challenging, but it's worth the time to work on the different factors to reduce the burden of fatigue on on rheumatoid arthritis patients.

Abnehmen mit Pu-Erh Tee?

Wahrscheinlich ist es ein ganz, ganz altes Gerücht, das besagt, man könne mit Pu-Erh Tee abnehmen. Es wird ihm nachgesagt, er würde die Fettverdauung und Fettverbrennung fördern. Dies habe ich auch schon während des Studiums in Taiwan so gehört. Wenn die Fettverdauung gefördert wird, dann müsste Fett doch effektiver aufgenommen werden, so dass dies mit Abnehmen nichts zu tun haben kann. Aber ich glaube, Logik ist nicht angesagt.

Die deutsche Gesellschaft für Ernährung (DGE) hat festgestellt, dass sich diätetische und gesundheitsvorbeugende Wirkungen von Pu-Erh Tee wissenschaftlich nicht belegt lassen. Pu-Erh Tee ist wie andere chinesische Tees auch ein reines Genussmittel.

Pu-Erh Tee wird kompliziert fermentiert und dann erst getrocknet. Grüner Tee wird nicht fermentiert, Oolong (Wulong) Sorten werden kurzfristig durch Luft oxidiert, Schwarztee wird längere Zeit durch Luftsauerstoff oxidiert, um seine spezielle Farbe zu bekommen. Der englische Wikipedia-Artikel gibt über die verschiedenen Sorten von Pu-Erh Tee und die Herstellungsschritte Auskunft [http://en.wikipedia.org/wiki/Pu-erh_tea].

Es gibt eine Studie zum Abnehmen: Westerterp-Plantenga und Kollegen untersuchten "Body weight loss and weight maintenance in relation to habitual caffeine intake and green tea supplementation.“  http://www.ncbi.nlm.nih.gov/pubmed/16076989. Sie fanden heraus, dass man durch Koffein die Thermogenese verstärken kann, so dass es darüber zu etwas mehr Gewichtsverlust kommt. Das gilt dann aber für alle Getränke mit Koffein.