From: Subject: =?Windows-1252?Q?Metabool_syndroom_=A0=A0=A0=5Bwww.gezondheid.be=5D?= =?Windows-1252?Q?=A0=A0=A0?= Date: Mon, 9 Oct 2006 10:40:43 +0200 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C6EB8F.5F6CE2E0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2962 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C6EB8F.5F6CE2E0 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.gezondheid.be/index.cfm?fuseaction=art&art_id=3762 =EF=BB=BF Metabool syndroom = =C2=A0=C2=A0=C2=A0[www.gezondheid.be]=C2=A0=C2=A0=C2=A0 =
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 je bent hier : home=20 3D""=20 ziekten=20 en aandoeningen 3D""=20 hormonen=20 en stofwisseling 3D"verstuur    3D"printversie

=
dossier   =20 (overzichtslijst)=20
Metabool syndroom ( of=20 insulineresistentiesyndroom of syndroom X) =
3D""=20=20

Het = metabool=20 syndroom (of insulineresistentiesyndroom of syndroom = X) is een=20 chronisch stofwisselingsprobleem dat gekenmerkt wordt = door de=20 combinatie van
=E2=80=A2 een gestoord = bloedsuikergehalte,
=E2=80=A2=20 hoge bloeddruk,
=E2=80=A2 obesitas
=E2=80=A2 = atherogene dyslipidemie=20 (laag HDL cholesterol en hoog = triglyceridengehalte)
=E2=80=A2=20 stoornissen in de bloedstolling (protrombotische=20 toestand).
De aandoening kan op lange termijn = leiden tot=20 o.m. cardiovasculaire aandoeningen en diabetes type 2, = en=20 mogelijk sommige vormen van kanker.

Het = syndroom komt=20 meer voor bij mannen, maar het risico bij vrouwen = neemt=20 sterker toe naarmate er meer risicofactoren zijn. Het = Metabool=20 Syndroom komt voor bij ongeveer 15% van de = (ogenschijnlijk)=20 gezonde bevolking tussen 25 en 50 jaar. De aandoening = neemt=20 toe met de leeftijd: tussen 40 en 50 jaar zouden 30% = van de=20 mannen en 20% van de vrouwen het metabool syndroom = hebben.=20 Tussen 50 en 60 stijgt dat tot 40% bij de mannen en = 35% bij de=20 vrouwen. Vanaf 60 jaar steken de vrouwen de mannen = voorbij.=20

Risicofactoren     
Er zijn diverse onafhankelijke en = geassoci=C3=ABerde=20 risicofactoren in het spel.
In de definitie van de=20 International Diabetes Federation (2005) is er sprake = van=20 metabool syndroom als aan volgende criteria is = voldaan:=20
=E2=80=A2 Buikomtrek (abdominale obesitas): >94 = cm mannen,=20 >80 cm vrouwen)
plus tenminste twee van de = volgende=20 kenmerken:
=E2=80=A2 verhoogd suikergehalte = (nuchtere=20 plasmaglycemie): >100 mg/dL (5,6 mmol/L) of eerdere = diagnose van diabetes)
=E2=80=A2 verstoorde = vetzuurhuishouding=20 (triglyceriden =3D150 mg/dL (1,7 mmol/L) of een = behandeling=20 hiervoor
=E2=80=A2 HDL-cholesterol <40 mg/dL bij = mannen, < 50=20 mg/dl bij vrouwen, of een behandeling = hiervoor
=E2=80=A2 bloeddruk=20 > 130/85 mmHg of een behandeling van = hypertensie=20

De volledige = IDF-consensus=20 kan hier=20 gedownload worden  = (.pdf) =

Abdominale obesitas = (=3Dzwaarlijvige=20 buikomtrek) wordt beschouwd als een onafhankelijke = indicator=20 van (de moeilijker aan te tonen) insulineresistentie = =C3=A9n als=20 een noodzakelijke voorwaarde om over een metabool = syndroom te=20 kunnen spreken.
De nieuwe IDF-definitie van het = metabool=20 syndroom is erop gericht om een snelle diagnose en = behandeling=20 van het metabool syndroom mogelijk te maken, ook = zonder dat er=20 al sprake is van een duidelijke cardiovasculaire = pathologie.=20
Andere geassoci=C3=ABerde risicofactoren = zijn o.m.:
=E2=80=A2=20 fysieke inactiveit
=E2=80=A2 veroudering =
=E2=80=A2 verstoorde=20 hormonale balans
=E2=80=A2 genetische = voorbestemdheid (diabetes,=20 hartziekten in de familie)
=E2=80=A2 Roken wordt = niet als een=20 aparte oorzakelijke risicofactor beschouwd, maar = rookstop=20 vormt wel een dwingend onderdeel van de behandeling = van=20 pati=C3=ABnten met het metabool syndroom.
De = verschillende=20 risicofactoren tellen niet gewoon bij elkaar op, maar=20 versterken elkaar. Twee risicofactoren tellen niet = dubbel,=20 maar vier of zelfs zes keer zo zwaar. De aanwezigheid = van=20 diabetes of een hoge bloeddruk verhoogt het risico van = een=20 hartaanval 2,5 keer. Als zowel diabetes als hoge = bloeddruk=20 aanwezig
zijn, is het risico 8 keer verhoogd. = Dyslipidemie=20 verhoogt het risico 16 keer; als dyslipidemie met hoge = bloeddruk en/of diabetes aanwezig is, is het risico op = een=20 hartaanval 20 keer hoger.
Andersom geldt hetzelfde: = het=20 wegnemen van =C3=A9=C3=A9n risicofactor telt voor = meer. U moet dus=20 zoveel mogelijk risico's vermijden of verminderen.=20

Oorzaak=20     
3D""=20=20

Vooral=20 overgewicht met teveel lichaamsvet en weinig = lichaamsbeweging=20 bevorderen de ontwikkeling van het metabole syndroom. = Ook zou=20 een gestoord dag-nachtritme bijdragen tot de = ontwikkeling van=20 het metabool syndroom.
De exacte oorsprong of=20 pathofysiologie van het metabool syndroom is nog niet = bekend,=20 maar resistentie tegen door insuline gestimuleerde=20 glucoseopname die bij overgewicht en obesitas = optreedt, lijkt=20 van cruciaal belang. Meer dan 90% van de = pati=C3=ABnten die het=20 Metabool Syndroom hebben, zijn = insulineresistent.=20

Insulineresistentie     
Bij insulineresistentie zijn de cellen = minder=20 gevoelig voor het hormoon insuline. Insuline is nodig = om=20 glucose uit het bloed op te nemen in insulinegevoelige = cellen.=20 Daarbij kan insuline worden gezien als de sleutel die = op het=20 slot (receptor) past waarmee de deur van de cel voor = glucose=20 wordt geopend. In de cellen van sipieren en andere = weefsels=20 wordt glucose vervolgens opgeslagen als glycogeen = of=20 meteen omgezet in energie, die nodig is voor het=20 functioneren van cellen, weefsels en organen. Dat = cellen bij=20 insulineresistentie minder gevoelig zijn voor insuline = komt=20 door een afname van het aantal receptoren en/of een=20 verminderde werking van deze receptoren. Doordat de = glucose=20 onvoldoende in de cel wordt opgenomen, neemt het=20 glucosegehalte van het bloed toe. = Insulineresistentie=20 wordt dan ook gekarakteriseerd door hogere = bloedglucosewaarden=20 in nuchtere toestand en na de maaltijd. Het lichaam = reageert=20 hierop met een hogere productie van insuline = door de=20 pancreas.
De meeste mensen met insulineresistentie = zijn in=20 staat voldoende insuline te produceren om voldoende = lage,=20 niet-diabetische glucosebloedwaarden te handhaven. = Wanneer de=20 pancreas er niet meer in slaagt met hoge = insulinesecreties de=20 verlaagde weefselgevoeligheid voor insuline te = compenseren,=20 ontwikkelt zich diabetes type 2 .
Door=20 insulineresistentie neemt de = plasma-insulineconcentratie toe=20 en ontstaan allerlei metabole veranderingen die = leiden=20 tot een verhoogd cardiovasculair risico. = Insulineresistentie=20 leidt ook tot het ontstaan van bekende risicofactoren = zoals=20 een laag HDL-cholesterol, (milde) hypertriglyceridemie = en=20 hypertensie.
      =20 3D""=20 zie ook rubriek : = diabetes

Verband=20 insulineresistentie en obesitas     
De laatste jaren is duidelijk geworden = dat een=20 toename van de hoeveelheid vetweefsel (vooral het = viscerale=20 vetweefsel in de buikholte) leidt tot verminderde = werking van=20 insuline op het niveau van de skeletspier en lever. = Hierbij is=20 overigens niet alleen de absolute hoeveelheid = vetweefsel van=20 belang, maar ook de verdeling en lokalisatie van vet.=20
Lange tijd is gedacht dat vetweefsel alleen maar = een=20 opslagplaats is voor vet. Nu is echter duidelijk dat=20 vetweefsel een actief endocrien orgaan is, = dat=20 talrijke (poly)peptiden produceert ('adipocytokines'), = waaronder leptine, plasminogen activator-inhibitor 1 = (PAl-I),=20 adipsine, adiponectine en resitine, en verder = interleukine 6=20 (IL-6) en de cytokine tumornecrosefactor-alfa (TNF-a). = Deze=20 kunnen het functioneren van het vetweefsel zelf en van = diverse=20 andere organen be=C3=AFnvloeden. Er zijn sterke = aanwijzingen dat de=20 bij obesitas waargenomen chronisch verhoogde = concentraties van=20 tumornecrosefactor (TNF)-alfa, leptine, reistine en = andere=20 'adipocytokines' in het bloed in belangrijke mate = bijdragen=20 aan de ontwikkeling van insulineresistentie. Het=20 nettoresultaat van al deze ontregelingen door = adipocytokines=20 is de start van een vicieuze cirkel. Meer=20 adipocytokines leidt tot meer insulineresistentie en = daarmee=20 weer tot meer (vooral) visceraal vetweefsel en dat = weer tot de=20 synthese van meer adipocytokines, enz.
Daarnaast = spelen=20 o.m. leptine en TNF-alfa ook een rol bij diverse = andere=20 processen waaronder pro- pro-inflammatoire = immuunreacties en=20 oxidatieve stress, wat dan weer een rechtsreekse = invloed heeft=20 op het proces van slagaderverkalking.
Verder = speelt=20 abdominaal vetweefsel een belangrijke rol in de=20 (post-prandiale) verwerking van vrije vetzuren, wat op = zijn=20 beurt insulineresistentie in de hand werkt. =
      =20 3D""=20 zie ook rubriek : = diabetes

Behandeling     
3D""=20=20

Bij = elke=20 pati=C3=ABnt met hart- en vaatproblemen, bij = hypertensiepati=C3=ABnten=20 en zeker bij obese pati=C3=ABnten, moeten huisarts en = cardioloog=20 rekening houden met mogelijke metabole stoornissen, en = eventueel een metabole screening uitvoeren. Omgekeerd = moeten=20 pati=C3=ABnten met een metabool probleem en zeker = diabetespati=C3=ABnten=20 ook systematisch gescreend worden op cardiovasculaire=20 problemen.
Door vroegtijdig symptomen op te sporen = die=20 zouden kunnen passen bij het metabool syndroom en deze = dan ook=20 te behandelen, zijn de vooruitzichten voor mensen met = deze=20 aandoening veel gunstiger dan wanneer er pas = ingegrepen gaat=20 worden als er reeds klachten zijn ontstaan. Eens de = diagnose=20 van metabool syndroom is gesteld, moet volgens de=20 IDF-consensus een =E2=80=98agressieve en = vastberaden=E2=80=99=20 behandeling ingesteld worden om het risico op = cardiovasculair=20 lijden en diabetes type 2 te verminderen. De = behandeling moet=20 op de eerste plaats gericht zijn op vermindering van = het=20 globale cardiovasculaire risico.
Aard en = intensiteit van=20 de behandeling is afhankelijk van het cardiovasculaire = risicoprofiel op korte (- 10 jaar) en lange (+ 10 = jaar)=20 termijn. Omwille van het sterk verhoogde risico op=20 cardiovasculair lijden en diabetes type 2 op de lange = termijn=20 moeten ook pati=C3=ABnten met metabool syndroom, die = op basis van=20 de traditionele cardiovasculaire risicoscores geen = verhoogd=20 risico hebben om binnen de 10 jaar een fataal = cardiovasculair=20 accident te ontwikkelen, behandeld worden, aldus de = recente=20 Scientific Statement over =E2=80=98Diagnosis and = management of the=20 metabolic syndrome=E2=80=99 (Circulation. 2005;112: = 285-290) van de=20 American Heart Association en de National Heart, Lung, = and=20 Blood Institute (AHA/NHLBI).
Zowel de = IDF-consensus als=20 het AHA/NHLBI Scientific Statement benadrukken dat er=20 momenteel nog geen behandeling met geneesmiddelen = bestaat die=20 een directe impact heeft op de onderliggende = oorzakelijke=20 mechanismen van het metabool syndroom in zijn = globaliteit en=20 op de cardiovasculaire en metabole complicaties. In = afwachting=20 dat een dergelijke behandeling wel mogelijk wordt, = moet elke=20 component van het metabool syndroom (obesitas, = atherogene=20 dyslipidemie, hyperglycemie en insulineresistentie,=20 hypertensie) en elke onderliggende risicofactor daarom = afzonderlijk aangepakt worden. =

Leefstijlmaatregelen     
Die maatregelen worden aanbevolen bij = alle=20 pati=C3=ABnten met metabool syndroom, ongeacht hun = cardiovasculair=20 risicoprofiel over een periode van 10 jaar. =

=E2=80=A2=20 gewichtsverlies van 5 =C3=A0 10% tijdens het eerste = jaar. Wie een=20 tiende van zijn lichaamsgewicht verliest, haalt in = =C3=A9=C3=A9n klap=20 ook zijn bloeddruk naar beneden en brengt zijn = cholesterol=20 beter in balans. Er werd aangetoond dat een gemiddelde = gewichtsafname met 7% het risico op type 2 diabetes = doet dalen=20 met 58%.
=E2=80=A2 gezonde = =E2=80=98hartvriendelijke=E2=80=99 voeding (gevarieerd,=20 calorie-beperkt dieet)
=E2=80=A2 voldoende beweging = (Drie tot vier=20 keer per week een inspanning van dertig minuten = waardoor je=20 lichtjes transpireerten een beetje kortademig = wordt)
=E2=80=A2 Stop=20 met roken. Alhoewel roken geen oorzaak is van het = metabool=20 syndroom is het een belangrijke co-risicofactor in de=20 ontwikkeling van hart en vaataandoeningen en bij het=20 ontwikkelen van diabetes complicaties.
=E2=80=A2 = regelmatig dag- en=20 nachtritme
      =20 3D""=20 zie ook artikel : Cholesterolverlagende=20 voeding

Geneesmiddelen     
Bij pati=C3=ABnten met gekend = cardiovasculair lijden of=20 met een verhoogd cardiovasculair risico over een = periode van=20 10 jaar, is ook een medicamenteuze behandeling vereist = indien=20 de leefstijl-maatregelen onvoldoende effect hebben. =
=E2=80=A2=20 Bloeddrukverlagers (anti-hypertensiva)
=E2=80=A2 = normalisatie=20 lipidenprofiel (verhoging HDL, verlaging LDL en = triglyceriden)=20
=E2=80=A2 bloedsuikerverlagers (orale = glycemieverlagende=20 middelen).
=E2=80=A2 Geneesmiddelen om te = vermageren indien de=20 gewone dieetmaatregelen onvoldoende resultaat=20 geven
Mogelijk dat toekomstige medicamenteuze = behandeling=20 van abdominale obesitas bij hoogrisico pati=C3=ABnten = een=20 belangrijke therapeutische bijdrage kan leveren aan = dit=20 probleem.
In de toekomst zal ook specifieke=20 insuline-gevoeligheid-bevorderende behandeling = mogelijk een=20 rol spelen.

Het=20 verband tussen buik en hersenen     
Volgens neuro-endocrinoloog Ruud M. = Buijs van het=20 Nederlands Instituut voor Hersenonderzoek aan de Vrije = Universiteit Amsterdam en prof. Johannes A. Romijn van = de=20 afdeling endocrinologie van het Medisch Centrum van de = Rijksuniversiteit Leiden is een mutatie van het dag- = en=20 nachtritme medeoorzaak van het metabool = syndroom.
Ons dag-=20 en nachtritme is afgevlakt, gemuteerd. Doorlopende = snacks en=20 maaltijden tot laat in de avond, te weinig beweging en = te laat=20 naar bed gaan, brengen de biologische klok van slag. = Hierdoor=20 raakt het autonoom zenuwstelsel ontregeld. Gevolgen = hiervan=20 zijn o.m. centrale adipositas, een verstoorde werking = van=20 lever en pancreas en een verhoogde bloeddruk. =
Volgens de=20 Nederlandse onderzoekers heeft het
autonoom=20 zenuwstelsel een sturende rol bij zowel de = vetverdeling=20 binnen het lichaam als bij de regulering van bloeddruk = en=20 bloedglucose. Neuronen leveren hun boodschap = doelgericht af=20 aan daartoe uitgekozen weefsel. Dit = communicatienetwerk=20 co=C3=B6rdineert de overgang van het lichaam van de = actieve naar de=20 rustperiode en andersom. Bij de voorbereiding voor een = actieve=20 periode stijgen de cortisol en bloedglucosespiegels = vlak voor=20 het wakker worden. Dit wordt geco=C3=B6rdineerd door = het autonoom=20 zenuwstelsel.
Het sympathische zenuwstelsel = zorgt=20 voor de aanpassing van ons lichaam bij activiteit, = terwijl het=20 parasympathische zenuwstelsel het lichaam aanpast = tijdens=20 rust. Bij inspanning zorgt de sympathische invloed = voor een=20 versnelde hartfrequentie, hogere bloeddruk en = versterkte=20 doorbloeding van de skeletspieren. De spijsvertering = wordt dan=20 op een laag pitje gezet. In de herstelfase daarna zet = het=20 parasympathische zenuwstelsel het maag-darmkanaal dan = weer aan=20 om voedsel te verteren.
Uit de literatuur was al = bekend dat=20 sympatische activiteiten voor vetafbraak zorgen. De=20 onderzoekers toonden recent aan dat de parasympatische = activiteiten vet opbouwen. Via diverse experimenten = bewezen=20 zij dat er parasympathische zenuwvezeltjes uitkomen in = het=20 vetweefsel. Het buikvet en het onderhuidse vet bleken = vanuit=20 aparte hersengebiedjes te worden verzorgd. Dit = verklaart=20 waarom de vetopbouw per plaats aan het lichaam kan=20 verschillen. De onderzoekers konden eveneens = aantonen=20 dat het vetweefsel insulineresistent werd door = uitschakeling=20 van het parasympatisch stelsel. Niet alleen de = vetverdeling,=20 maar het totale metabool syndroom en diabetes type 2 = zouden=20 dus hun oorsprong hebben in het autonoom zenuwstelsel = binnen=20 de hypothalamus in de hersenen. =E2=80=9CDe ontdekking = dat er twee=20 gescheiden zenuwsystemen inwerken op het vetweefsel - = het=20 sympathische en het parasympathische systeem - was een = absolute doorbraak=E2=80=9D, aldus prof. = Romijn.

Dag- en nachtritme
Essentieel = bij de=20 autonome regulatie is de centrale biologische = klok in=20 de hypothalamus. Die reageert op het daglicht en zorgt = ervoor=20 dat de sympathische en parasympathische activiteit = elkaar=20 ritmisch afwisselen. Bij het aanbreken van de dag = geeft de=20 biologische klok een signaal om het lichaam via het=20 sympathische zenuwstelsel voor te bereiden op een = periode van=20 activiteit. Tegen de avond zet hij de parasympathische = invloed=20 op gang, zodat het lichaam weer kan herstellen. De = biologische=20 klok zorgt er samen met het autonoom zenuwstelsel voor = dat=20 onze energie zo effectief mogelijk gebruikt wordt, dat = wil=20 zeggen: alleen als het nodig is.
=E2=80=9CHet = probleem is dat we=20 tegenwoordig ook overdag voortdurend wisselen tussen = actieve=20 en inactieve fasen. Deze ontregeling wordt verergerd = door een=20 grotere inname van calorie=C3=ABn, ook tussendoor en = later op de=20 dag. Dat alles leidt tot tegenstrijdige informatie = naar de=20 biologische klok,=E2=80=9D aldus prof. Buijs. = =E2=80=9CDaardoor kan de=20 biologische klok je niet goed voorbereiden op de = volgende dag.=20 Hierdoor wordt misschien het hormoonritme ontregeld, = waardoor=20 de glucose, die in het bloed circuleert niet wordt = verbrand,=20 maar omgezet in vet. Bij pati=C3=ABnten met een = metabool syndroom=20 zie je bv. dat het dag-en-nachtritme verstoord is: de=20 bloeddruk daalt bij hen =E2=80=99s nachts niet meer zo = sterk en er=20 zijn minder schommelingen in de glucose-opname in de=20 weefsels.=E2=80=9DAnders dan bij gezonde mensen, waar = de activiteit=20 van het sympathische en het parasympathische = zenuwstelsel=20 elkaar afwisselen, werken bij deze pati=C3=ABnten de=20 parasympathische en de sympathische activiteit dus=20 tegelijkertijd op verschillende plaatsen in het=20 lichaam.=E2=80=9D
=E2=80=9CIndien onze hypothese = klopt, dan moeten we niet=20 meer denken in termen van vetweefselziekten, maar aan = een=20 selectieve neuropathie,=E2=80=9D meent Buijs. = =E2=80=9CCortisol en=20 geslachtshormonen hebben geen direct effect op het = vetweefsel=20 zelf, maar werken via het centraal zenuwstelsel. Het = ligt voor=20 de hand om uit te zoeken of de parasympatische = gebieden in de=20 hypothalamus specifiek receptoren voor die hormonen = tot=20 expressie brengen. Wie weet komen we tot de conclusie = dat het=20 buikvet niet het begin is van alle ellende, maar dat = de=20 associatie tussen buikvet, insulinetekort en hart- en=20 vaatziekten op een hoger niveau ligt: in het centraal=20 zenuwstelsel en in het parasympatisch = systeem.=E2=80=9D=20
      =20 3D""=20 zie ook artikel : Test je=20 bioritme

Controverse over het metabool syndroom=20     
Net nu de International Diabetes = Federation een=20 =E2=80=98wereldwijde definitie=E2=80=99 van het = metabool syndroom heeft=20 uitgewerkt, publiceert de American Diabetes = Association (ADA)=20 en de European Association for the Study of Diabetes = (EASD)=20 een Joint Statement waarin ernstige vragen worden = geformuleerd=20 bij het metabool syndroom.
Op basis van een = uitgebreid=20 literatuuronderzoek komt de Joint Statement van = ADA/EASD tot 8=20 bezwaren tegen het metabool syndroom:
(1) de = criteria van=20 het metabool syndroom zijn ambigu en onvolledig en de=20 gehanteerde grenswaarden zijn slecht gemotiveerd ; =
(2) het=20 heeft weinig zin om diabetes in de definitie op te = nemen;=20
(3) het is onzeker of insulineresistensie wel de=20 alomvattende oorzakelijke factor is;
(4) er = bestaat geen=20 duidelijke basis om specifieke cardiovasculaire = risicofactoren=20 al dan niet in de criteria op te nemen;
(5) het=20 cardiovasculaire risico is variabel en afhankelijk van = elk van=20 de aanwezige risicofactoren;
(6) het = cardiovasculaire=20 risico van het syndroom blijkt niet groter te zijn dan = dat van=20 de verscillende factoren afzonderlijk;
(7) de = behandeling=20 van het syndroom verschilt niet van die van elke = factor=20 afzonderlijk;
(8) het medisch belang van de = diagnose=20 metabool syndroom is onduidelijk.

Volgens prof. = Luc Van=20 Gaal, diensthoofd diabetologie, metabole ziekten en=20 nutritiepathologie aan het UZ Antwerpen draait de = discussie=20 vooral rond de pathofysiologie van het metabool = syndroom. Wat=20 is het onderliggende mechanisme, door wat wordt het=20 veroorzaakt? Men moet beseffen dat de verschillende = definities=20 van het metabool syndroom niet echt definities zijn, = maar een=20 verzameling van criteria om een cluster van = risicofactoren=20 samen te brengen. Als men het metabool syndroom = zou willen=20 defini=C3=ABren dan gaat het om een combinatie van = inflammatoire,=20 lipidemische en pro-coagulatoire factoren die in een = of andere=20 gradatie samen voorkomen en die gekoppeld zijn aan een = gemeenschappelijk kenmerk. De ene groep heeft het dan = over de=20 insulineresistentie als gemeenschappelijk kenmerk, een = andere=20 groep zegt dat het visceraal vet het centrale element = is, een=20 derde groep beweert dat het ganse inflammatoire = patroon de=20 =E2=80=98detonator=E2=80=99 is. Het is precies omdat = daarover nog geen=20 overeenstemming bestaat, dat de ADA/EASD zeggen dat = eerst nog=20 onderzoek nodig is om de exacte oorzaak te ontrafelen, = vooraleer men het metabool syndroom zo overtuigend in = de=20 dagelijkse praktijk kan gaan gebruiken als een = predictiemodel=20 voor cardiovasculair risico of als een aparte ziekte = kan=20 beschouwen.
In de Joint Statement van de ADA/EASD = wordt=20 uitdrukkelijk erkend dat het metabool syndroom wel = degelijk=20 effici=C3=ABnt is om het toekomstig risico op diabetes = te=20 voorspellen. Het gaat dus vooral om het = cardiovasculaire luik.=20 Hoewel tal van studies aantonen dat het Metabool = Syndroom=20 predictief is voor de ontwikkeling van = cardiovasculaire=20 aandoeningen, wordt in het Joint Statement = geargumenteerd dat=20 de combinatie van de verschillende componenten van het = metabool risico (met welke selectie van de 5 = componenten ook)=20 geen betere predictie biedt dan de klassieke=20 risicomodellen.
Van Gaal: =E2=80=9CZij hebben = natuurlijk een punt=20 wanneer ze zeggen dat risicotabellen zoals het=20 Framingham-model werken met continue variabelen, = waarbij dus=20 de ernst van de pathologie kan berekend worden, = terwijl het=20 metabool syndroom een gedichotomiseerd model gebruikt = met=20 alleen maar grenswaarden. Hierdoor verliest men = inderdaad een=20 stuk informatie over het risicopotentieel of over de = ernst van=20 het risico. Maar ik denk dat men het metabool syndroom = moet=20 beschouwen als een additioneel risicocluster, = met=20 minder klassieke risicofactoren naast het Framingham = model. In=20 die zin is het een heel bruikbaar instrument om op de = eerste=20 lijn op een heel eenvoudige manier een aantal = risicopati=C3=ABnten=20 op te sporen die met de klassieke cardiovasculaire=20 risico-analyses uit de boot dreigen te = vallen.=E2=80=9D
=E2=80=9CIn dat=20 verband is het zeer revelerend dat in de Joint = Statement van=20 ADA/EASD bij wijze van voorbeeld drie pati=C3=ABnten = worden=20 beschreven. 2 van de 3 zijn volgens de = Framingham-score hoog=20 risicopati=C3=ABnten, maar voldoen niet aan de = criteria voor het=20 metabool syndroom. De derde pati=C3=ABnt heeft een = laag risico,=20 maar voldoet wel aan de criteria van het metabool = syndroom.=20 Dit is mijns inziens juist een bewijs van de waarde = van het=20 metabool syndroom: pati=C3=ABnt A en B zijn evidente=20 risicopati=C3=ABnten door hun hoge bloeddruk, = diabetes, doorgemaakt=20 infarct enz. Hier zijn geen extra criteria nodig om = deze=20 pati=C3=ABnten als risicopati=C3=ABnten te beschouwen = en krachtdadig te=20 behandelen. De derde pati=C3=ABnt zal echter met de = klassieke=20 risicotabellen door de mazen van het net vallen. Er is = slechts=20 een beperkte toename van de lipiden, een lichte = hypertensie,=20 een beperkte toename van de buikomtrek, enz=E2=80=A6 = Met het metabool=20 syndroom wordt die pati=C3=ABnt w=C3=A9l gedetecteerd = zodat je hem dus=20 verder kan opvolgen en zo nodig tijdig kunt ingrijpen. = D=C3=A0t is=20 voor mij de essentie.=E2=80=9D
=E2=80=9CIk ben het = dan ook volmondig eens=20 met het Scientific Statement van de AHA/NHLBI dat = pati=C3=ABnten=20 met een cluster van metabole risicofactoren (of men = dat dan=20 metabool syndroom noemt of niet, doet er weinig toe), = die op=20 basis van de traditionele cardiovasculaire = risicoscores geen=20 verhoogd risico hebben om binnen de 10 jaar een fataal = cardiovasculair accident te ontwikkelen, toch het best = opgevolgd en behandeld moeten worden. Die behandeling = zal in=20 de eerste plaats bestaan uit gewichtsverlies, een = evenwichtig=20 dieet, meer bewegen, enz. Indien die maatregelen niet = het=20 gewenste effect hebben, of indien bepaalde = risicofactoren uit=20 de hand dreigen te lopen, zal ook een medicamenteuze=20 behandeling moeten overwogen = worden.=E2=80=9D


verschenen op = :=20 05-10-2006  |  
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uw reacties op = dit artikel=20
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in dit artikel
3D""=20 Metabool=20 syndroom ( of insulineresistentiesyndroom of syndroom=20 X)
3D""=20 Risicofactoren
3D""=20 Oorzaak
3D""=20 Insulineresistentie
3D""=20 Verband=20 insulineresistentie en obesitas
3D""=20 Behandeling
3D""=20 Leefstijlmaatregelen
3D""=20 Geneesmiddelen
3D""=20 Het=20 verband tussen buik en hersenen
3D""=20 Controverse=20 over het metabool=20 = syndroom
<= /SPAN>


ziekten=20 en aandoeningen
3D""=20 hart=20 en bloed
  =    cholesterol=20
     3D""=20 bloeddruk=20
3D""=20 eet-=20 en gewichtsproblemen
3D""=20 allergie=20
     3D""=20 voedselallergie=20
3D""=20 pijn=20
3D""=20 kanker=20
     3D""=20 borstkanker=20
     3D""=20 prostaatkanker=20
     3D""=20 darmkanker=20
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     3D""=20 huidkanker=20
3D""=20 chronisch=20 ziek en handicap
3D""=20 huid,=20 haar en nagels
3D""=20 luchtwegen=20 en longen
  =    astma=20
3D""=20 nier=20 en blaas
3D""=20 neus,=20 keel en oren
3D""=20 spieren=20 en gewrichten
  =   =20 3D"" osteoporose=20
     3D""=20 reuma=20
3D""=20 zenuwen=20 en hersenen
  =    hoofdpijn=20
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3D""=20 ogen=20
3D""=20 mond=20 en tanden
3D""=20 spijsvertering=20
     3D""=20 voedselvergiftiging=20
3D""=20 geslachtsorganen=20
     3D""=20 seksuele=20 problemen
3D""=20 hormonen=20 en stofwisseling
 =20    3D""=20 diabetes=20
     3D""=20 menopauze=20
3D""=20 infecties=20
     3D""=20 griep=20
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     3D""=20 SOA=20
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3D""=20 immuunsysteem=20
3D""=20 kinderziekten=20
3D""=20 erfelijk=20 en aangeboren
3D""=20 bindweefselziekten=20
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3D""=20 ongeval=20 en sportletsel
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  =    ADHD=20
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     3D""=20 verslaving=20
      =    roken=20
      =    drugs=20
      =    alcoholisme=20
     3D""=20 stress=20
     3D""=20 taboeklachten=20
3D""=20 psychiatrie=20 =
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All rights reserved. function AC_AddExtension(src, ext) { if (src.indexOf('?') !=3D -1) return src.replace(/\?/, ext+'?');=20 else return src + ext; } function AC_Generateobj(objAttrs, params, embedAttrs)=20 {=20 var str =3D ''; for (var i in params) str +=3D ' = '; str +=3D ''; document.write(str); } function AC_FL_RunContent(){ var ret =3D=20 AC_GetArgs ( arguments, ".swf", "movie", = "clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" , "application/x-shockwave-flash" ); AC_Generateobj(ret.objAttrs, ret.params, ret.embedAttrs); } function AC_SW_RunContent(){ var ret =3D=20 AC_GetArgs ( arguments, ".dcr", "src", = "clsid:166B1BCA-3F9C-11CF-8075-444553540000" , null ); AC_Generateobj(ret.objAttrs, ret.params, ret.embedAttrs); } function AC_GetArgs(args, ext, srcParamName, classid, mimeType){ var ret =3D new Object(); ret.embedAttrs =3D new Object(); ret.params =3D new Object(); ret.objAttrs =3D new Object(); for (var i=3D0; i < args.length; i=3Di+2){ var currArg =3D args[i].toLowerCase(); =20 switch (currArg){=09 case "classid": break; case "pluginspage": ret.embedAttrs[args[i]] =3D args[i+1]; break; case "src": case "movie":=09 args[i+1] =3D AC_AddExtension(args[i+1], ext); ret.embedAttrs["src"] =3D args[i+1]; ret.params[srcParamName] =3D args[i+1]; break; case "onafterupdate": case "onbeforeupdate": case "onblur": case "oncellchange": case "onclick": case "ondblClick": case "ondrag": case "ondragend": case "ondragenter": case "ondragleave": case "ondragover": case "ondrop": case "onfinish": case "onfocus": case "onhelp": case "onmousedown": case "onmouseup": case "onmouseover": case "onmousemove": case "onmouseout": case "onkeypress": case "onkeydown": case "onkeyup": case "onload": case "onlosecapture": case "onpropertychange": case "onreadystatechange": case "onrowsdelete": case "onrowenter": case "onrowexit": case "onrowsinserted": case "onstart": case "onscroll": case "onbeforeeditfocus": case "onactivate": case "onbeforedeactivate": case "ondeactivate": case "type": case "codebase": ret.objAttrs[args[i]] =3D args[i+1]; break; case "width": case "height": case "align": case "vspace":=20 case "hspace": case "class": case "title": case "accesskey": case "name": case "id": case "tabindex": ret.embedAttrs[args[i]] =3D ret.objAttrs[args[i]] =3D args[i+1]; break; default: ret.embedAttrs[args[i]] =3D ret.params[args[i]] =3D args[i+1]; } } ret.objAttrs["classid"] =3D classid; if (mimeType) ret.embedAttrs["type"] =3D mimeType; return ret; } ------=_NextPart_000_0000_01C6EB8F.5F6CE2E0 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://www.gezondheid.be/milonic_src.js /*=0A= =0A= Milonic DHTML Menu - A JavaScript Website Navigation System.=0A= Version 5.0 Release Candidate 17.0 Built: Tuesday October 14 2003 - 12:55=0A= Copyright 2003 (c) Milonic Solutions Limited. 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bgimage=3D"/winxp.gif"; margin=3D4; = aI("text=3Droken;url=3D/index.cfm?fuseaction=3Dartperrub&c=3D139;"); aI("text=3Ddrugs;url=3D/index.cfm?fuseaction=3Dartperrub&c=3D40;"); aI("text=3Dalcoholisme;url=3D/index.cfm?fuseaction=3Dartperrub&c=3D41;");= } drawMenus(); ------=_NextPart_000_0000_01C6EB8F.5F6CE2E0 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://a.as-eu.falkag.net/dat/dlv/aslmain.js // Falk AdSolution - Copyright (c) 2004 by Falk eSolutions AG - All = rights reserved (Build: 00000079) Ads_Build=3D'00000079';var = QQbA,QQcA,QQdA,QQeA,QQfA,QQgA,QQhA,QQiA,QQjA,QQkA,QQlA,QQmA,QQnA,QQoA,QQp= A;NUM_FARM=3D1;QQbA=3D['http://a.as-test.falkag.net' = ,'http://a.as-eu.falkag.net' ,'http://a.ads.t-online.de' = ,'http://a.as-us.falkag.net' ,'http://a.as-rh4.falkag.net' = ,'','','','',''];QQcA=3D['https://s.as-test.falkag.net' = ,'https://s.as-eu.falkag.net' ,'https://s.ads.t-online.de' = ,'https://s.as-us.falkag.net' ,'http://a.as-rh4.falkag.net' = ,'','','','',''];QQdA=3D['http://a.as-test.falkag.net' = ,'http://a.as-eu.falkag.net' ,'http://a.ads.t-online.de' = ,'http://a.as-us.falkag.net' ,'http://a.as-rh4.falkag.net' = ,'','','','',''];QQeA=3D['https://s.as-test.falkag.net' = ,'https://s.as-eu.falkag.net' ,'https://s.ads.t-online.de' = ,'https://s.as-us.falkag.net' ,'http://a.as-rh4.falkag.net' = ,'','','','',''];QQfA=3D['http://bw.as-test.falkag.net' = ,'http://bw.as-eu.falkag.net' ,'http://bw.ads.t-online.de' = ,'http://bw.as-us.falkag.net' ,'http://a.as-rh4.falkag.net' = ,'','','','',''];QQgA=3D['http://bw.as-test.falkag.net' = ,'https://s.as-eu.falkag.net' ,'https://s.ads.t-online.de' = ,'https://s.as-us.falkag.net' ,'http://a.as-rh4.falkag.net' = ,'','','','',''];QQhA=3D['http://red.as-test.falkag.net' = ,'http://red.as-eu.falkag.net' ,'http://red.ads.t-online.de' = ,'http://red.as-us.falkag.net' ,'http://red.as-rh4.falkag.net' = ,'','','','',''];QQiA=3D['https://red.as-test.falkag.net' = ,'https://red.as-eu.falkag.net' ,'https://red.ads.t-online.de' = ,'https://s.as-us.falkag.net' ,'http://red.as-rh4.falkag.net' = ,'','','','',''];QQjA=3D['http://sel.as-test.falkag.net/server/asldata.js= ','http://data.as-eu.falkag.net/server/asldata.js','http://data.ads.t-onl= ine.de/server/asldata.js' = ,'http://data.as-us.falkag.net/server/asldata.js' = ,'http://a.as-rh4.falkag.net/server/asldata.js','','','','',''];QQkA=3D['= https://sel.as-test.falkag.net/server/asldata.js','https://as1.falkag.de/= server/asldata.js' ,'https://red.ads.t-online.de/server/asldata.js' = ,'https://s.as-us.falkag.net/server/asldata.js' = ,'http://a.as-rh4.falkag.net/server/asldata.js','','','','',''];QQlA=3D['= .as-test.falkag.net' ,'.as-eu.falkag.net' ,'.ads.t-online.de' = ,'.as-us.falkag.net' ,'.as-rh4.falkag.net' = ,'','','','',''];QQmA=3D['Falk AdSolution' ,'AdSolution' ,'Adsolution' = ,'Falk AdSolution' ,'Falk AdSolution RH4' = ,'','','','',''];QQnA=3D['/dat/bgf/trpix.gif?' ,'/dat/bgf/trpix.gif?' = ,'/dat/bgf/trpix.gif?' ,'/dat/bgf/trpix.gif?' ,'/dat/bgf/trpix.gif?' = ,'','','','',''];QQoA=3D['/red?cmd=3Dred&' ,'/red?cmd=3Dred&' = ,'/red?cmd=3Dred&' ,'/red?cmd=3Dred&' ,'/red?cmd=3Dred&' = ,'','','','',''];QQpA=3D['/red?cmd=3Durl&' ,'/red?cmd=3Durl&' = ,'/red?cmd=3Durl&' ,'/red?cmd=3Durl&' ,'/red?cmd=3Durl&' = ,'','','','',''];// Falk AdSolution - Copyright (c) 2004 by Falk = eSolutions AG - All rights reserved (Build: 00000079) function QQkD(QQRc) {document.write('');}function = QQlD(QQSc) {var QQTc=3Dthis.location.hostname.toLowerCase();var QQUc=3D'';var = QQVc=3DQQTc;var QQWc=3D[];QQLc1=3DQQTc.indexOf('.');if (QQSc=3D=3D1) {if (QQLc1!=3D-1) {while (QQLc1!=3D-1) {QQLc1=3DQQVc.indexOf('.');QQWc[QQWc.length]=3D(QQLc1=3D=3D-1)?QQVc.subst= ring(QQLc1+1,QQVc.length):QQVc.substring(0,QQLc1);QQVc=3DQQVc.substring(Q= QLc1+1,QQVc.length);}if (QQWc[QQWc.length-2]=3D=3D'falkag') {for (var QQHc=3D1;QQHc=3D0)&&(QQLc1QQLc1) QQUc=3DQQTc.substring(QQLc1+1,QQTc.length);}if = ((QQUc.lastIndexOf('.')=3D=3DQQUc.indexOf('.'))&&QQUc.lastIndexOf('.')<3)= QQUc=3DQQTc;}}return QQUc;}function QQmD() {var QQUc=3DQQlD(0);if(QQUc=3D=3D'') return 'D'+this.location.hostname;else return 'D'+QQUc;}function QQnD(QQXc) {var QQUc=3DQQlD(0);if(QQXc=3D=3D-1) { if(QQUc!=3D'') QQUc=3D';domain=3D'+QQUc; return ';path=3D/;'+QQUc;}if(QQXc=3D=3D-2) { if(QQUc!=3D'') QQUc=3D';domain=3D'+QQUc return ';path=3D/;expires=3DThu,01-Jan-1970 00:00:01 GMT'+QQUc; }var = QQYc=3Dnew Date();if(QQUc!=3D'') QQUc=3D';domain=3D'+QQUc;QQYc.setTime(parseInt(QQYc.getTime(),10)+1000*60= *parseInt(QQXc,10));return = ';path=3D/;expires=3D'+QQYc.toGMTString()+QQUc;}function QQoD(QQXc) {var QQUc=3DQQlD(1);if(QQXc=3D=3D-1) { if(QQUc!=3D'') QQUc=3D' domain=3D'+QQUc; return ';path=3D/;'+QQUc;} = if(QQXc=3D=3D-2) { if(QQUc!=3D'') QQUc=3D';domain=3D'+QQUc return ';path=3D/;expires=3DThu,01-Jan-1970 00:00:01 GMT'+QQUc; }var = QQYc=3Dnew Date();if(QQUc!=3D'') QQUc=3D';domain=3D'+QQUc;QQYc.setTime(parseInt(QQYc.getTime(),10)+1000*60= *parseInt(QQXc,10));return = ';path=3D/;expires=3D'+QQYc.toGMTString()+QQUc;}function = QQpD(QQc,QQd,QQy) {if(QQsA!=3D-1) var = intBwdTyp=3DKAS[QQsA][4][27];if(typeof(intBwdTyp)=3D=3D'undefined') intBwdTyp=3D0;var QQz=3D[]; =09 QQcD( Ads_iid,QQc) =09 QQyD(1,'HAAAALLO!!!!',QQc); =09 QQz[0]=3D'&dlv=3D'+Ads_nid+','+Ads_wid+','+Ads_iid+','+QQc+','+QQd+'&kid=3D= '+QQc+QQy[0]+((QQcD( Ads_iid,QQc = )&&(QQvB>0))?QQtB:'');QQz[1]=3D'&dlv=3D'+Ads_nid+','+Ads_wid+','+Ads_iid+= ','+QQc+','+QQd+'&kid=3D'+QQc+'&chw=3D'+QQqA+'&tcs=3D'+QQrA+QQy[1]+((QQcD= ( Ads_iid,QQc )&&(QQvB>0))?QQtB:'')+QQvA;var = QQZc=3D'&sta=3D';QQz[0]+=3D'&dmn=3D'+Ads_T[5];QQz[1]+=3D'&dmn=3D'+Ads_T[5= ];if(navigator.appVersion.substring(0,1)>'3') {QQz[0]+=3D'&scx=3D'+screen.width+'&scy=3D'+screen.height+'&scc=3D'+scree= n.colorDepth;QQz[1]+=3D'&scx=3D'+screen.width+'&scy=3D'+screen.height+'&s= cc=3D'+screen.colorDepth;QQZc+=3D',,,'+(navigator.javaEnabled()?'1':'0');= if(navigator.javaEnabled()) QQz[1]+=3D'&jav=3D1';}else QQZc+=3D',,,';var QQAd=3Dnew = Date();QQZc+=3D',,,,,,';if((Ads_wrd!=3D'')&&(Ads_wrd.toLowerCase()!=3D'[k= eyword]')) {var QQDc=3D'!"%&\'()*+#-./:;<=3D>?@[\\]^{|}~=EF=BF=BD ';var = QQEc,QQBd=3D'';for(QQl=3D0;QQlStandard 1=3D>Request)',QQDd+' ('+QQa+QQb+')');if (QQDd=3D=3D0) {return ((Ads_opt&512)>0)?'':(QQcE('Ads_Count'+Ads_iid)+''+QQdE());}else if = (QQDd=3D=3D1) {return QQcE('Ads_ReqCount'+Ads_iid)+''+QQdE();}}function QQuD(QQt,QQb) {QQyD(1,'Impression = Parameters',QQb);QQt.document.write(QQtD(0,QQb));}function QQvD() {return QQwD(Math.random()*100000000,8);}function QQwD(QQEd,QQFd) {var QQGd=3D'#'+(QQEd+100000000);return = QQGd.substr(10-QQFd,QQFd);}function QQxD(QQBd,QQHd,QQId) {var QQl;while((QQl=3DQQBd.indexOf(QQHd))!=3D-1) QQBd=3DQQBd.substr(0,QQl)+QQId+QQBd.substring(QQl+QQHd.length,QQBd.length= );return QQBd;}function QQyD(QQE,QQBd,QQJd) {var QQKd=3Dnew Date();if(Ads_debug=3D=3D1) {document.write(((QQE!=3D3)?'':'
')+'[DEBUG'+((QQKd-QQwA)/1000)+'] = ');if((QQE=3D=3D0)||(QQE=3D=3D3)) document.write(''+QQBd+'
');else if(QQE=3D=3D1) document.write(''+QQBd+':  '+QQJd+'
');else document.write(''+QQBd+'
');}else = if((Ads_debug=3D=3D2)&&(QQE=3D=3D3)) document.write('[DEBUG'+((QQKd-QQwA)/1000)+'] = '+QQBd+'
');}function QQzD(QQCb) {var QQD=3D'#'+(parseInt(QQCb,10)+100000000);return = QQD.substr(2,2)+'/'+QQD.substr(4,2)+'/'+QQD.substr(6,2)+'/'+QQD.substr(8,= 2);}function QQaE(QQEd) {var QQLd=3D'0123456789ABCDEF';var QQMd=3D'';while(QQEd>0) {QQMd=3DQQLd.substr(QQEd%16,1)+QQMd;QQEd=3DparseInt(QQEd/16,10);}return = (QQMd=3D=3D'')?'0':QQMd;}function QQbE(QQMa) {var QQNd;var QQOd=3D0;if(QQaB>-1) {QQOd=3DQQaB;return QQOd;}if((QQMa=3D=3D0)&&((Ads_opt&2048)>0)) return = -1;if((navigator.userAgent.indexOf("Opera")!=3D-1)||((navigator.appName=3D= =3D"Netscape")&&(navigator.userAgent.indexOf("Mozilla")!=3D-1)&&(parseFlo= at(navigator.appVersion)>=3D4))) {if(navigator.mimeTypes&&navigator.mimeTypes["application/x-shockwave-fla= sh"]&&navigator.mimeTypes["application/x-shockwave-flash"].enabledPlugin)= {QQNd=3Dnavigator.plugins['Shockwave = Flash'].description;QQNd=3DQQNd.substring(QQNd.indexOf("."),-1);QQOd=3DQQ= Nd.substr(-1);}}else = if(navigator.userAgent&&navigator.userAgent.indexOf("MSIE")!=3D-1&&naviga= tor.userAgent.indexOf("Mac")!=3D-1&&document.all) {if(navigator.mimeTypes&&navigator.mimeTypes["application/x-shockwave-fla= sh"]&&navigator.mimeTypes["application/x-shockwave-flash"].enabledPlugin)= {QQNd=3Dnavigator.plugins['Shockwave = Flash'].description;QQNd=3DQQNd.substring(QQNd.indexOf("."),-1);QQNd=3DQQ= Nd.substring(QQNd.length-1,QQNd.length);QQOd=3DQQNd.substr(-1);}}else = if(navigator.userAgent&&navigator.userAgent.indexOf("MSIE")!=3D-1&&naviga= tor.userAgent.indexOf("Windows")!=3D-1&&navigator.userAgent.indexOf("Wind= ows 3")=3D=3D-1&&document.all) {document.write('\n = Ads_vbCV=3D10\nAds_vbMV=3D1\nDo\nOn Error Resume = Next\n');document.write('Ads_vbBF=3D(IsObject(CreateObject("ShockwaveFlas= h.ShockwaveFlash."&Ads_vbCV)))\n');document.write('If Ads_vbBF=3Dtrue = Then Exit Do\nAds_vbCV=3DAds_vbCV-1\nLoop While Ads_vbCV>=3DAds_vbMV\n = ');QQOd=3DAds_vbCV;}QQaB=3DQQOd;return QQOd;}function = QQcE(QQPd) {if(QQrB) return '
';else return '';}function QQdE() {if(QQrB) return '
';else return '';}function QQeE(QQQd) {var QQRd,QQSd;if(window.innerHeight) {QQRd=3DQQQd.x;QQSd=3DQQQd.y;}else {if(QQQd.offsetLeft) {QQQd=3DQQQd;QQRd=3DQQQd.offsetLeft;QQNk=3DQQQd.offsetParent;while(QQNk!=3D= null) {QQRd+=3DQQNk.offsetLeft;QQNk=3DQQNk.offsetParent;}QQSd=3DQQQd.offsetTop;= QQNk=3DQQQd.offsetParent;while(QQNk!=3Dnull) {QQSd+=3DQQNk.offsetTop;QQNk=3DQQNk.offsetParent;}}else return [-1000,-1000];}return [QQRd,QQSd];}function = QQfE(QQTd,QQA,QQf,QQg) {var QQUd;var QQQd=3Ddocument.images[QQA];var = QQVd=3DQQeE(QQQd);QQQd.width=3DQQf;QQQd.height=3DQQg;if(QQrB) QQUd=3Ddocument.getElementById(QQTd).style;else if(document.layers) QQUd=3Ddocument.layers[QQTd];else QQUd=3Ddocument.all[QQTd].style;QQUd.left=3DQQVd[0];QQUd.top=3DQQVd[1];if= (QQrB) QQUd.display=3D'block';else if(document.layers) = QQUd.visibility=3D'show';else QQUd.visibility=3D'visible';}// Falk = AdSolution - Copyright (c) 2004 by Falk eSolutions AG - All rights = reserved (Build: 00000079) if((typeof(Ads_debug)=3D=3D'undefined')||(Ads_debug!=3D1)) window.onerror=3DQQaD;gbolSUXX25067=3Dfalse;var = Ads_ModulMain=3Dtrue;if(typeof(Ads_ModulEffects)=3D=3D'undefined') Ads_ModulEffects=3Dfalse;var QQqA,QQrA,QQsA,QQtA,QQuA,QQvA,QQwA,QQxA;var = QQyA,QQzA,QQaB,QQbB,QQcB,QQdB;var QQeB=3Dfalse;var QQfB=3D[];var = QQgB=3D[];var QQhB=3D[];var QQiB=3D[];var QQjB=3D[];var QQkB=3D[];var = QQlB=3D[];var QQmB=3Dnavigator.userAgent.toLowerCase();var = QQnB=3D(QQmB.indexOf("msie")!=3D-1);var = QQoB=3D((QQmB.indexOf("win")!=3D-1)||(QQmB.indexOf("16bit")!=3D-1));var = QQpB=3D(QQmB.indexOf("mac")!=3D-1);var = QQqB=3D(navigator.appName.indexOf('icrosoft')!=3D-1);var = QQrB=3D(typeof(document.getElementsByTagName)!=3D'undefined'&&typeof(docu= ment.createElement)!=3D'undefined')?1:0;var QQsB=3Dtrue;var = QQtB=3D'';var QQuB=3D'';var QQvB=3D0;var QQwB=3D[];var QQxB=3D0;var = QQyB=3D0;var QQzB=3D[];var QQaC;var QQbC=3D[];var QQcC=3D[];var = QQdC=3D[];var QQeC=3D[];var QQfC=3D[];var QQgC=3D[];var QQhC=3D[];var = QQiC=3D[];var = Ads_LinkUrl,Ads_CountUrl,Ads_LinkAltUrl,Ads_CountAltUrl,Ads_CountUrl_ne,A= ds_ClickUrl,Ads_T,Ads_T_OW,iid,bid,rdm;var Ads_Data=3D[];var = Ads_status=3D[];var QQjC=3D0;if(typeof(Ads_FXPL)=3D=3D'undefined'){var = Ads_FXPL=3Dfalse;}Ads_T_OW=3D[];var QQkC=3Dfalse;var QQlC=3D0;var = QQmC=3D0;var QQnC,QQoC,Ads_gintCurVersion;var = QQpC=3D'toolbar=3Dyes,directories=3Dyes,status=3Dyes,scrollbars=3Dyes,res= izable=3Dyes,menubar=3Dyes,location=3Dyes';function = gotoSite(){window.open(QQnC,'flashwin',QQpC);}function = emosite(){window.open(QQnC,'flashwin',QQpC);}function = FlashClick(){window.open(QQnC,'flashwin',QQpC);}function = link1(){window.open(QQnC,'flashwin',QQpC);}function = gotoURL(QQa){window.open(QQoC+escape(QQa),'flashwin',QQpC);}function = QQqC() {Ads_kid=3D0;Ads_bid=3D0;Ads_cmd=3D'';}function QQrC(QQa) {QQa=3DQQxD(QQa,'[par]',escape(Ads_par));QQa=3DQQxD(QQa,'[keyword]',escap= e(Ads_wrd));QQa=3DQQxD(QQa,'[timestamp]',Ads_Timestamp);if = 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{QQvB++;QQh=3DQQvB+1;QQtB+=3D'&kid'+QQh+'=3D'+QQc;QQtB+=3D'&bid'+QQh+'=3D= '+QQd;QQtB+=3D'&iid'+QQh+'=3D'+Ads_iid;QQtB+=3D'&dlv'+QQh+'=3D'+Ads_nid+'= ,'+Ads_wid+','+Ads_iid+','+QQc+','+QQd;if(QQuA!=3D0) QQtB+=3D'&sid'+QQh+'=3D'+QQuA;QQtB+=3D'&bls3'+QQh+'=3D'+QQuB;arrIntern=3D= QQeD(QQe);Ads_iid=3DarrIntern[1];Ads_kid=3D(arrIntern.length<3||typeof(ar= rIntern[2])=3D=3D'undefined')?0:arrIntern[2];Ads_bid=3D(arrIntern.length<= 4)?0:arrIntern[3];Ads_par=3D(arrIntern.length<5)?Ads_par:unescape(arrInte= rn[4]);Ads_xp=3D(arrIntern.length<6||Ads_xp!=3D'')?Ads_xp:arrIntern[5];Ad= s_yp=3D(arrIntern.length<7||Ads_yp!=3D'')?Ads_yp:arrIntern[6];Ads_xp1=3D(= arrIntern.length<8||Ads_xp1!=3D'')?Ads_xp1:arrIntern[7];Ads_yp1=3D(arrInt= ern.length<9||Ads_yp1!=3D'')?Ads_yp1:arrIntern[8];QQxB=3DAds_iid;QQyB=3DA= ds_kid; =09 Ads_xl=3D0;Ads_yl=3D0;QQkD(QQfB[Ads_sec]+'/dat/cjf/'+QQzD(Ads_iid)+'.js')= ;}else {QQtB=3D'';QQvB=3D0;QQqC();}}function QQuC(QQi) {var QQj=3D[];var QQk=3DQQi.length;var QQl;var QQm=3D'';var = QQn=3D'';for(QQl=3D0;QQl0)) QQeF();else QQvC();}else {QQsB=3Dfalse;QQyD(1,'Waiting for asldata.','');}}function QQvC() {var QQp;if((typeof(Ads_debug)=3D=3D'undefined')||(Ads_debug!=3D1)) window.onerror=3DQQaD;if(((Ads_nid=3D=3D631)||(Ads_nid=3D=3D668))&&(NUM_F= ARM=3D=3D1)) { = QQfB[0]=3D['http://e.as-eu.falkag.net'];QQiB[0]=3DQQfB[0];}if((Ads_nid=3D= =3D80)&&(NUM_FARM=3D=3D3)) { QQfB[0]=3D['http://e.as-us.falkag.net'];QQiB[0]=3DQQfB[0];}var = QQq=3D'undefined';for (QQHc=3D0;QQHc';if(Ads_ref>0) {document.write('');}else {rdm=3DQQVk[0];if(QQSk>0) {Ads_xl=3DQQf;Ads_yl=3DQQg;QQuD(QQt,QQz[1]);if ((Ads_opt&4096)>0) {QQyD(1,'Serve AFX Out Of Frame','');var = QQWk=3D'*';for(QQZg=3D1;QQZg=3D0) {QQWk+=3D'PX'+QQaShort.substring(QQaShort.indexOf('&')+5,QQaShort.length)= +'*';}else {QQWk+=3DQQaShort+'*';}}QQyD(1,'QQWk',QQWk);QQUk=3DAds_wid+'#'+Ads_iid+'#= '+QQc+'#'+QQd+'#'+Ads_xwid+'#'+Ads_xiid+'#'+Ads_wrd+'#'+Ads_prf+'#'+Ads_p= ar+'#'+Ads_Timestamp+'#'+rdm+'#'+(QQgB[Ads_sec]+QQpA[NUM_FARM]+'flg=3D'+Q= QbD()+'&')+'#'+Ads_LinkUrl+'#'+QQWk+'#'+QQrD()+'#'+NUM_FARM+'#'+QQfB[Ads_= sec]+'#'+QQSk;var QQXk=3Ddocument.referrer;var QQYk=3D'';var = QQZk=3D'';var QQAl=3DQQXk.indexOf('://');if (QQAl>-1) {QQYk=3DQQXk.substring(0,(QQAl+3));QQZk=3DQQXk.substring((QQAl+3),QQXk.le= ngth);var QQAl=3DQQZk.indexOf('/');if (QQAl>-1) QQZk=3DQQZk.substring(0,QQAl);}QQyD(1,'Loading = ',QQYk+QQZk+'/afx_frame.html?'+ escape(QQUk));document.write('');}else {if ((typeof(Ads_FXPL)=3D=3D'undefined')||(Ads_FXPL=3D=3Dfalse)) {QQkD(QQfB[Ads_sec]+'/dat/dlv/afxplay.js');Ads_FXPL=3Dtrue;}QQkD(QQD+'.js= ');}}else QQkD(QQD+'.js');}if (QQcD(Ads_iid,QQtA)) { QQyD(1,'Reset Internal Redirect = Data','');QQtB=3D'';QQvB=3D0;}}function = QQsI(QQt,QQBa,QQz,QQK,QQL,QQHa,QQf,QQg,QQw) {QQL=3DQQrC(unescape(QQL));QQK=3DQQrC(unescape(QQK));if(QQBa) QQt.location.href=3DQQK;else {if(((QQHa||QQw)&&QQqB)||(QQL=3D=3D'')) document.write('');else QQkD(QQL);}QQuD(window,QQz[1]);if (QQcD(Ads_iid,QQtA)) { QQyD(1,'Reset Internal Redirect = Data','');QQtB=3D'';QQvB=3D0;}}function QQtI(QQt,QQF) {QQt.document.open();QQt.document.write(''+QQF+'</titl= e></head><body topmargin=3D"0" leftmargin=3D"0" rightmargin=3D"0" = marginwidth=3D"0" marginheight=3D"0"><table width=3D"100%" = height=3D"100%" border=3D"0" cellspacing=3D"0" cellpadding=3D"0" = align=3D"center"><tr><td valign=3D"middle"><center>');}function = QQuI(QQt) {QQt.document.write('</center></td></tr></table></body></html>');QQt.docu= ment.close();}function = QQvI(QQf,QQg,QQM,QQN,QQZ,QQDa,QQCa,QQR,QQEa,QQFa,QQW,QQU) {var = QQu=3D'locationbar=3Dno,directories=3Dno,statusbar=3Dno,toolbar=3Dno,loca= tion=3Dno,menubar=3Dno,personalbar=3Dno';var = QQBl=3D'Ads_Popup'+Ads_iid;var QQCl,QQDl;var QQEl=3D0;var QQFl=3D0;if = (!QQW&&QQU!=3D'') QQBl=3DQQU;QQu=3DQQwI(QQf,QQg,QQM,QQN,QQZ,QQDa,QQCa,QQR,QQEa,QQFa,QQW,QQU= ,QQTk);if((Ads_opt&32)>0) QQBl+=3D''+Math.round(Math.random()*100000);QQt=3Dopen('',QQBl,QQu);if(QQ= Da&&(!QQnB)) QQt.moveTo(0,0);if(QQEa) QQlI(QQt,QQf,QQg);return QQt;}function = QQwI(QQf,QQg,QQM,QQN,QQZ,QQDa,QQCa,QQR,QQEa,QQFa,QQW,QQU,QQTk) {var = QQu=3D'locationbar=3Dno,directories=3Dno,statusbar=3Dno,toolbar=3Dno,loca= tion=3Dno,menubar=3Dno,personalbar=3Dno';var = QQBl=3D'Ads_Popup'+Ads_iid;var QQCl,QQDl;var QQEl=3D0;var QQFl=3D0;if = (!QQW&&QQU!=3D'') QQBl=3DQQU;if(QQDa) {if (QQoB) {QQEl=3D10;QQFl=3D30;}else if (QQpB) {QQEl=3D20;QQFl=3D35;}QQu+=3D',scrollbars=3Dno,resizable=3Dno,width=3D'+(= screen.availWidth-QQEl)+',height=3D'+(screen.availHeight-QQFl)+',screenX=3D= 0,screenY=3D0';if(QQnB) QQu=3D'fullscreen=3Dyes';}else {if(QQEa) QQu+=3D',resizable=3Dyes,width=3D90,height=3D70,innerWidth=3D90,innerHeig= ht=3D70';else QQu+=3D',resizable=3Dno,width=3D'+QQf+',height=3D'+QQg;if(QQFa) QQu+=3D',scrollbars=3Dyes';else QQu+=3D',scrollbars=3Dno';if((Ads_opt&64)>0) QQu=3D'locationbar=3Dyes,scrollbars=3Dyes,directories=3Dyes,statusbar=3Dy= es,toolbar=3Dyes,location=3Dyes,menubar=3Dyes,personalbar=3Dyes,resizable= =3Dyes,width=3D'+QQf+',height=3D'+QQg;if(QQZ=3D=3D16) {QQM=3D(screen.width-QQf-25)*QQM/100;QQN=3D(screen.height-QQg-50)*QQN/100= ;}else if(QQZ=3D=3D24) {QQM=3D(screen.width-QQf-25)*Math.random();QQN=3D(screen.height-QQg-50)*M= ath.random();}if (!QQqB) QQu+=3D",screenX=3D"+QQM+",screenY=3D"+QQN;else QQu+=3D",left=3D"+QQM+",top=3D"+QQN;}return QQu;}function = QQxI(QQtA,QQd,QQf,QQg,QQM,QQN,QQZ,QQDa,QQCa,QQR,QQEa,QQFa,QQW,QQU,QQTk,QQ= Ka) {var QQGl=3D'';QQGl=3D'<scr'+'ipt language=3D"JavaScript">'+'function = Ads_PopUp() {';if (Ads_cmd!=3D'win'&&QQTk&&(QQd>0)) {QQyD(1,'POP ON EXIT','');var QQBl=3D'Ads_Popup'+Ads_iid;if = (!QQW&&QQU!=3D'') QQBl=3DQQU;if((Ads_opt&32)>0) QQBl+=3D''+Math.round(Math.random()*100000);QQu=3DQQwI(QQf,QQg,QQM,QQN,QQ= Z,QQDa,QQCa,QQR,QQEa,QQFa,QQW,'',true);QQp=3DQQfB[Ads_sec]+'/dat/dlv/aslf= rame.html?dat=3D'+Ads_iid +'&kid=3D'+QQtA+'&wrd=3D'+escape(Ads_wrd) = +'&bid=3D'+QQd+'&prf=3D'+escape(Ads_prf) = +'&xl=3D'+QQf+'&par=3D'+escape(Ads_par) = +'&yl=3D'+QQg+'&cnturl=3D'+Ads_cnturl+'&debug=3D0' = +'&xp=3D'+QQM+'&sec=3D'+Ads_sec+'&bgc=3D'+Ads_bgc = +'&yp=3D'+QQN+'&ref=3D'+Ads_ref+'&opt=3D' +2 = +'&cmd=3Dwin';QQkB[QQkB.length]=3D'QQt=3Dopen(\''+QQp+'\',\''+QQBl+'\',\'= '+QQu+'\');';}for (var QQHc=3D0 ;QQHc<QQkB.length ;QQHc++) {QQGl+=3DQQkB[QQHc];}QQGl+=3DQQKa;QQGl+=3D'}'+'</scr'+'ipt>';document.wri= teln(QQGl);}// Falk AdSolution - Copyright (c) 2004 by Falk eSolutions = AG - All rights reserved (Build: 00000079) var QQfF=3D[];var QQgF=3D[];var QQhF;function QQiF(QQPh,QQQh,QQRh,QQOf) {if(typeof(QQPh)=3D=3D'undefined') return [];var QQl,QQk;var QQSh=3D[];var QQTh=3DQQPh.split('x');var = QQUh=3DQQTh[0];var QQVh=3DQQQh-QQUh;var = QQk=3DQQTh.length;QQgF[QQOf]=3D[];for(QQl=3D1;QQl<QQk;QQl++) {QQAj=3DQQTh[QQl].split(':');if(QQRh&&(QQAj[2]=3D=3D-1)) QQSh[QQAj[0]]=3D[QQAj[1],-1];QQAj[2]-=3DQQVh;if(QQAj[2]>0) QQSh[QQAj[0]]=3D[QQAj[1],QQAj[2]];if = (typeof(QQgF[QQOf])=3D=3D'undefined') QQgF[QQOf]=3D[];QQgF[QQOf][QQgF[QQOf].length]=3DQQAj[0];}return = QQSh;}function QQjF(QQSh,QQQh,QQOf) {var QQPd;var QQPh=3DQQQh;var QQl;if (typeof(QQgF[QQOf])!=3D'undefined') {for (var QQHc=3D0;QQHc<QQgF[QQOf].length;QQHc++) {QQl=3DQQgF[QQOf][QQHc];if (typeof(QQSh[QQl])!=3D'undefined') {QQPh+=3D'x'+QQl+':'+QQSh[QQl][0]+':'+QQSh[QQl][1];}}}return = QQPh;}function QQkF(QQWh,QQXh) {while(QQWh.length>800) QQWh=3DQQWh.substr(0,QQWh.lastIndexOf('#',QQWh.length-2)+1);QQfF[QQXh]=3D= QQWh;}function QQlF(QQXh,QQCb) {var QQYh=3D'111';var QQZh=3D'@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`';var = QQk=3D0;var QQAb=3D'#'+QQCb+':';var QQWh=3DQQfF[QQXh];var QQAi=3D'';var = QQZ=3DQQWh.indexOf(QQAb);var QQBi=3Dnew Date();var = QQCi,QQDi,QQEi,QQFi,QQEf;var QQGi,QQHi,QQIi,QQJi;if(QQWh=3D=3D'') QQWh=3D'#';if(QQZ>-1) {QQDi=3DQQWh.substr(QQZ+QQAb.length,3+QQXh);if(QQZ>0) 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QQUi=3D(QQSi?'1':'0')+(QQTi?'1':'0');if(!QQSi) QQUi+=3DQQwD(QQQi[0],4)+QQQi[1];QQkF('#'+Ads_wid+'-'+Ads_iid+'-'+QQOi+QQf= F[6],6);QQkF('#'+QQc+'-'+QQOi+QQfF[5],5);return QQUi;}function QQoF() {var QQUc=3DQQmD();var QQl,QQVi,QQPd,QQWi,QQXi,QQYi,QQZi,QQAj,QQXh;var = QQBj,QQCj;var QQPa=3Ddocument.cookie;var QQRh=3DQQkC; QQyD(1,'Session = Cookie',QQkC);var QQDj=3DQQPa.split(';');var QQk=3DQQDj.length;var = QQKd=3Dnew = Date();QQhF=3DMath.round(QQKd.getTime()/1000/60);QQfF=3D['','',[],'','','= ','',[],[],[],QQdB,'',[],'',''];QQfF=3DQQpF('',QQDj,QQk,QQRh);if(Ads_uid!= =3D'') {QQDj=3DAds_userdata.split(';');QQk=3DQQDj.length;QQfF[2]=3D[];for(QQl=3D= 1;QQl<(QQk-1);QQl++) {QQYi=3DQQDj[QQl].split(',');QQfF[2][QQYi[0]]=3D[QQYi[1],1];}}if(QQfF[3]=3D= =3D'1') QQzA=3Dtrue;=09 if (IAS[18]=3D=3D0) { QQyD(1,'VISKAM',QQfF[5]); QQyD(1,'VISWEB',QQfF[6]); }}function = QQpF(QQUc,QQDj,QQk,QQRh) {var QQl;var QQfF;var = QQPd;QQfF=3D['','',[],'','','','',[],[],[],QQdB,'',[],'',''];for(QQl=3D0;= QQl<QQk;QQl++) {QQXh=3D-1;QQYi=3DQQDj[QQl].split('=3D');QQPd=3DQQYi[0];QQXi=3DQQYi[1];if= (QQPd.charAt(0)=3D=3D' ') QQPd=3DQQPd.substr(1,QQPd.length-1);if(QQPd.substr(0,QQUc.length)=3D=3DQQ= Uc) QQWi=3DQQPd.substring(QQUc.length,QQPd.length);else QQWi=3D'';if(QQWi=3D=3D'KIDYMD') QQfF[1]=3DQQXi;else if(QQWi=3D=3D'WIDYMD') QQfF[0]=3DQQXi;else if(QQPd=3D=3D'SESTEST') QQfF[3]=3DQQXi;else if(QQPd=3D=3D'BNDLVL') QQfF[10]=3DQQXi; else if(IAS[18]=3D=3D0&&QQWi=3D=3D'VISKAM') QQfF[5]=3DQQXi;else if(IAS[18]=3D=3D0&&QQWi=3D=3D'VISWEB') QQfF[6]=3DQQXi; else if(QQWi=3D=3D'FRQSTR') {if (QQXi.indexOf("|")!=3D-1) QQYi=3DQQXi.split('|');else QQYi=3DQQXi.split(',');QQfF[2]=3DQQiF(QQYi[0],QQhF,QQRh,2);QQfF[7]=3DQQiF= (QQYi[1],QQhF,QQRh,7);QQfF[8]=3DQQiF(QQYi[2],QQhF,QQRh,8);QQfF[9]=3DQQiF(= QQYi[3],QQhF,QQRh,9);QQfF[12]=3DQQiF(QQYi[4],QQhF,QQRh,12);}if(QQWi=3D=3D= 'KIDCYMD') QQfF[14]=3DQQXi;else if(QQWi=3D=3D'WIDCYMD') QQfF[13]=3DQQXi;}return QQfF;}function QQqF(QQc,QQKe) {var QQEj,QQFj,QQZe,QQGj;var QQHj=3D'';var QQUc=3DQQmD();var = QQIj=3DKAS[QQKe][4][5];if(KAS[QQKe][4][4]>0) QQHj=3DQQnD(QQIj);else if((KAS[QQKe][5]&1)>0) {QQHj=3DQQnD(20);QQIj=3D20;}if(QQHj!=3D'') {QQZe=3DparseInt(QQsF(QQc,2)+1,10);if(Ads_uid!=3D'') {QQEj=3DAds_userdata.split(';'+QQc+',');if(QQEj.length=3D=3D2) {QQFj=3DAds_userdata.split(','+QQc+';');Ads_userdata=3DQQEj[0]+';'+QQFj[1= ];}Ads_userdata+=3DQQc+','+QQZe+','+QQIj+','+QQc+';';document.write('<img= = src=3D"http://uboot.as-eu.falkag.net/usr?cmd=3Dwrite&id=3D'+Ads_uid+'&dat= a=3D'+Ads_userdata+'&rdm=3D'+Math.random()+'" width=3D"1" = height=3D"1">');}else QQtF(QQc,2,QQZe,QQIj);}}function QQrF(QQc,QQKe,QQd,QQs,QQJj) {var QQUc=3DQQmD();var QQy=3D[];var = QQKj,QQPa,QQLj;QQqF(QQc,QQKe);if(QQd>0) {if(BAS[QQs][2][4]>0) QQtF(QQd,9,QQsF(QQd,9)+1,BAS[QQs][2][5]);}if(((KAS[QQKe][4][22]&1)>0)&&(I= AS[4]>0)) QQtF(Ads_wid,7,QQsF(Ads_wid,7)+1,IAS[5]);if(((KAS[QQKe][4][22]&2)>0)&&(IA= S[6]>0)) QQtF(Ads_nid,8,QQsF(Ads_nid,8)+1,IAS[7]);if = ((typeof(IAS[17])!=3D'undefined')&&(typeof(QQbC[Ads_wid])!=3D'undefined')= &&(typeof(KAS[QQKe][13])!=3D'undefined')) {if(((KAS[QQKe][4][22]&4)>0)&&(KAS[QQKe][13]>0)&&(QQbC[Ads_wid].length>0)= &&(typeof(QQbC[Ads_wid][KAS[QQKe][13]])!=3D'undefined')) {arrFamily=3DQQbC[Ads_wid][KAS[QQKe][13]];QQtF(arrFamily[0],12,QQsF(arrFa= mily[0],12)+1,arrFamily[2]);}}QQPa=3DQQjF(QQfF[2],QQhF,2)+'|' = +QQjF(QQfF[7],QQhF,7)+'|' +QQjF(QQfF[8],QQhF,8)+'|' = +QQjF(QQfF[9],QQhF,9)+'|' = +QQjF(QQfF[12],QQhF,12);QQKj=3DQQlF(1,QQc);QQLj=3DQQKj.substr(0,3)+QQlF(0= ,Ads_wid)+QQKj.substr(3,1);QQy[1]=3D'&bls3=3D'+QQLj;QQuB=3DQQLj; if = (IAS[18]=3D=3D0) = QQy[1]+=3D'&bls4=3D'+QQnF(QQc);QQAmAuswertung=3DQQlF(14,QQc);QQy[0]=3D'&u= cl=3D'+QQAmAuswertung.substr(0,3)+QQlF(13,Ads_wid)+QQAmAuswertung.substr(= 3,1);if(QQzA) QQy[1]+=3D'&uid=3D1';QQyD(1,'SETTING TOP-LEVEL = DOMAIN',QQPa);QQfD('FRQSTR=3D'+QQPa+QQoD(60*24*365));QQfD('WIDYMD=3D'+QQf= F[0]+QQoD(60*24*30));QQfD('KIDYMD=3D'+QQfF[1]+QQoD(60*24*30)); if = (IAS[18]=3D=3D0) { QQfD('VISKAM=3D'+QQfF[5]+QQoD(20)); = QQfD('VISWEB=3D'+QQfF[6]+QQoD(20)); }QQyD(1,'Cookie Auswertung = [Click/Impression]',QQy[0]+'/'+QQy[1]);return QQy;}function = QQsF(QQCb,QQOf) {if(typeof(QQfF[QQOf][''+QQCb+''])!=3D'undefined') return parseInt(QQfF[QQOf][''+QQCb+''],10);else return 0;}function QQtF(QQCb,QQOf,QQZe,QQIj) {if(typeof(QQfF[QQOf][''+QQCb+''])!=3D'undefined') QQfF[QQOf][''+QQCb+''][0]=3DQQZe;else {if (typeof(QQgF[QQOf])=3D=3D'undefined') QQgF[QQOf]=3D[];QQgF[QQOf][QQgF[QQOf].length]=3DQQCb;QQfF[QQOf][''+QQCb+'= ']=3D[QQZe,QQIj];}}// Falk AdSolution - Copyright (c) 2004 by Falk = eSolutions AG - All rights reserved (Build: 00000079) function QQgE(QQWd,QQXd) {var QQl=3D0;var QQk=3DQQWd.length;if(QQk=3D=3D0) return -1;while((QQl<QQk-1)&&(QQXd>QQWd[QQl][1])) {QQXd-=3DQQWd[QQl][1];QQl++;}return QQWd[QQl][0];}function = QQhE(QQYd,QQZd,QQAe) {var QQl,QQBe,QQCe,QQDe;if(QQYd>QQAe) {QQBe=3DQQAe/QQYd;for(QQl=3DQQZd;QQl<QQlB.length;QQl++) 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{QQFe=3D((QQGe[0]=3D=3D0)&&!((QQGe[2]=3D=3D0)&&(QQGe[3]=3D=3D1439)));QQEe= =3D(!QQFe||QQyE(QQGe[2],QQGe[3]));if(QQFe) QQDe=3DQQDe*100/KAS[QQKe][9];if(QQDb&&!QQEe&&!QQHe) {QQqA+=3D'9'+KAS[QQKe][0]+'-';}QQDb=3D(QQDb&&QQEe);}if((KAS[QQKe][5]&8)>0= ) QQDe=3DKAS[QQKe][1];if(QQHe&&QQDb) {QQc=3DKAS[QQKe][0];QQrA+=3DQQc+'-';QQqF(QQc,QQKe);}else if(QQDb) {QQlB[QQlB.length]=3D[QQKe,QQDe,QQFe,QQDe];QQYd+=3DQQDe;}else {}}QQAe=3DQQhE(QQYd,QQZd,QQAe);}function QQjE() {QQiE();var QQTe,QQKe,QQl,QQDe;var QQJe=3DQQlB.length;var QQUe=3D0;for = (QQKe=3D0;QQKe<QQJe;QQKe++) {QQl=3DQQlB[QQKe][0];QQDe=3DQQlB[QQKe][1];QQTe=3DMath.round(QQDe/QQlB[QQK= e][3]*10)-1;if(QQTe>9) QQTe=3D9;if((QQTe>=3D0)&&(KAS[QQl][0]>0)) QQqA+=3DQQTe+''+KAS[QQl][0]+'-';QQUe+=3DQQDe;}return = QQgE(QQlB,QQUe*Math.random());}function QQkE(QQKe,QQc) {var QQVe=3D[];var QQWe=3DBAS.length;var QQXe=3D((KAS[QQKe][5]&1)>0);var = QQUe=3D0;var QQs,QQDe,QQYe,QQZe,QQAf,QQBf;var QQCf=3Dtrue;for = (QQs=3D0;QQs<QQWe;QQs++) {strInhalt=3DBAS[QQs][21];QQBf=3D((strInhalt.length<3)||(strInhalt.indexO= f('#'+Ads_iid+'#')>-1));if(((Ads_xl>1)||(Ads_yl>1))&&((BAS[QQs][13]>1)||(= BAS[QQs][14]>1))) {QQCf=3D((Ads_xl=3D=3DBAS[QQs][13])&&(Ads_yl=3D=3DBAS[QQs][14]));}if(QQCf= &&QQBf&&QQaF(BAS[QQs][2],1,BAS[QQs][0],true,QQs)) {QQDe=3DBAS[QQs][1];QQVe[QQVe.length]=3D[QQs,QQDe];QQUe+=3DQQDe;}else {}}QQWe=3DQQVe.length;if(QQXe) {QQZe=3DQQsF(QQc,2);if(QQWe>0) QQs=3DQQVe[QQZe%QQWe][0];else QQs=3D-1;}else QQs=3DQQgE(QQVe,QQUe*Math.random());return QQs;}// Falk AdSolution - = Copyright (c) 2004 by Falk eSolutions AG - All rights reserved (Build: = 00000079) var QQlE=3Dfalse;var QQmE;var QQnE;var QQoE = =3D(typeof(QQoE)=3D=3D'undefined')? 0:QQoE;function QQpE(QQDf) {return = QQwD(QQDf.getHours(),2)+':'+QQwD(QQDf.getMinutes(),2)+':'+QQwD(QQDf.getSe= conds(),2);}function QQqE(QQDf) {var QQEf=3DQQDf.getYear();if(QQEf<1900) QQEf+=3D1900;return = QQwD(QQEf,4)+'-'+QQwD(QQDf.getMonth()+1,2)+'-'+QQwD(QQDf.getDate(),2);}fu= nction QQrE() {if(QQlE) return;var QQFf,QQGf,QQHf,QQl,QQIf;var QQJf=3Dnew Date();var QQKf=3Dnew = Date();QQKf.setTime(QQJf-0+parseInt(Ads_T[9],10));QQFf=3DQQfF[1].split('#= ');QQGf=3DQQFf.length-1;QQHf=3D',';for(QQl=3D1;QQl<QQGf;QQl++) {QQIf=3DQQFf[QQl].split(':');QQHf+=3DQQIf[0]+',';}QQlE=3Dtrue;QQmE=3D';ke= yword=3D'+escape(Ads_wrd) +';user-domain=3D'+Ads_T[5] = +';user-ip=3D'+Ads_T[6] +';url=3D'+escape(window.location.href) = +';referrer=3D'+escape(document.referrer) = +';accept-language=3D'+escape(Ads_T[7]) = +';accept-charset=3D'+escape(Ads_T[8]) = +';user-agent=3D'+escape(navigator.userAgent) = +';browser-name=3D'+escape(navigator.appName) = +';browser-version=3D'+escape(navigator.appVersion) = +';flash-version=3D'+QQbE(0) = +';user-day=3D'+(QQJf.getDay()=3D=3D0?7:QQJf.getDay()) = +';user-time=3D'+QQpE(QQJf) +';user-date=3D'+QQqE(QQJf) = +';server-day=3D'+(QQKf.getDay()=3D=3D0?7:QQKf.getDay()) = +';server-time=3D'+QQpE(QQKf) +';server-date=3D'+QQqE(QQKf) = +';campaigns=3D'+QQHf +';';if(navigator.appVersion.substring(0,1)>'3') {var QQLf=3D0;var QQMf=3D0;if = (typeof(window.innerWidth)=3D=3D'undefined'&&document.body!=3Dnull) {QQLf=3Ddocument.body.clientWidth;QQMf=3Ddocument.body.clientHeight;}else= {QQLf=3Dwindow.innerWidth;QQMf=3Dwindow.innerHeight;}QQmE+=3D'java=3D'+(n= avigator.javaEnabled()?'1':'0') +';screen-width=3D'+screen.width = +';screen-height=3D'+screen.height +';window-width=3D'+QQLf = +';window-height=3D'+QQMf +';color-depth=3D'+screen.colorDepth = +';';}QQyD(1,'Environment values',QQmE);}function = QQsE(QQNf,QQk,QQCb,QQOf,QQPf,QQQf,QQRf) {var QQSf;if((QQk>0)&&(QQNf>0)) {QQSf=3D((QQsF(QQCb,QQOf)<QQk)&&(QQzA||QQRf));if((QQSf?1:0)=3D=3DQQPf) return QQPf;QQnE[QQQf]=3DQQSf;}return 2;}function = QQtE(QQTf,QQUf,QQVf,QQPf,QQQf) {var QQSf;if(QQTf.length>1) {QQSf=3D(QQTf.indexOf('#'+QQUf+'#')!=3D-1);QQSf=3DQQVf>0?!QQSf:QQSf;QQnE[= QQQf]=3DQQSf;if((QQSf?1:0)=3D=3DQQPf) return QQPf;}return 2;}function QQuE(QQNf,QQWf,QQCb,QQOf,QQPf,QQQf,QQRf) {var QQSf=3Dtrue;if (typeof(QQWf)=3D=3D'undefined') QQWf=3D[];if (typeof(QQbC[Ads_wid])=3D=3D'undefined') QQbC[Ads_wid]=3D[];if(QQNf>0&&QQCb>0) {if ((QQWf.length>0)&&(QQbC[Ads_wid].length=3D=3D0)) {for (QQHc=3D0 ;QQHc<QQWf.length ;QQHc++) {QQbC[Ads_wid][QQWf[QQHc][0]]=3D[QQWf[QQHc][1],QQWf[QQHc][2],QQWf[QQHc][3= ]];if (QQWf[QQHc][0]=3D=3DQQCb) {QQvIndex=3DQQHc;}}if (typeof(QQvIndex)=3D=3D'undefined') return = 2;intReturn=3DQQsE(QQNf,QQWf[QQvIndex][2],QQWf[QQvIndex][1],QQOf,QQPf,QQQ= f,QQRf);return intReturn;}else if (QQbC[Ads_wid].length>0) {if (typeof(QQbC[Ads_wid][QQCb])=3D=3D'undefined') return = 2;intReturn=3DQQsE(QQNf,QQbC[Ads_wid][QQCb][1],QQbC[Ads_wid][QQCb][0],QQO= f,QQPf,QQQf,QQRf);return intReturn;}}return 2;}function = QQvE(QQTf,QQVf,QQPf,QQXf,QQQf) {if(QQTf=3D=3D'') return 2;var QQl,QQBd,QQYf,QQZf,QQEc,QQAg,QQBg,QQCg,QQDg;var = QQDc=3D'!"%&\'()*+,-./:;<=3D>?@[\\]^{|}~=A7 ';var = QQSf=3Dfalse;QQTf=3DQQTf.substr(1,QQTf.length-2);var = QQGe=3DQQTf.split('#');var 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