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BACKGROUND: The Achilles tendon (AT) requires optimal material and mechanical properties to function properly. Calculation of these properties depends on accurate measurement of input parameters (i.e. tendon elongation). However, the measurement of AT elongation with ultrasound during maximum voluntary isometric contraction (MVIC) is overestimated by ankle joint rotation (AJR). Methods to correct the influence of this rotation on AT elongation exist, yet their reproducibility in clinical settings is unknown. OBJECTIVE: To evaluate the test-retest reproducibility of AT elongation during MVIC after AJR correction. METHODS: Ten participants attended test and retest measurements where they performed plantar-flexion MVIC on a dynamometer. Simultaneously, ultrasound recorded AT elongation as the displacement of the medial gastrocnemius-myotendinous junction, while an electrogoniometer measured AJR. The ankle was then passively rotated to the AJR achieved during MVIC and AT elongation again determined. Elongation was corrected by subtracting this passive AT elongation from the total AT elongation during MVIC. Reproducibility was evaluated using ICC (2.1), test-retest variability (TRV, %), Bland-Altman analyses (Bias +/- LoA [1.96*SD]) and standard error of the measurement (SEM). RESULTS: Corrected AT elongation reproducibility exhibited an ICC = 0.79, SEM = 0.2 cm and TRV = 20 +/- 19%. Bias +/- LoA were determined to be 0.0 +/- 0.8 cm. CONCLUSIONS: Using this ultrasound and electrogoniometer-based method, corrected AT elongation can be assessed reproducibly.
Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation
(2017)
Purpose: New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. Results: The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. Conclusions: Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. IMPLICATIONS FOR REHABILITATION Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation
Substance-dependent individuals often lack the ability to adjust decisions flexibly in response to the changes in reward contingencies. Prediction errors (PEs) are thought to mediate flexible decision-making by updating the reward values associated with available actions. In this study, we explored whether the neurobiological correlates of PEs are altered in alcohol dependence. Behavioral, and functional magnetic resonance imaging (fMRI) data were simultaneously acquired from 34 abstinent alcohol-dependent patients (ADP) and 26 healthy controls (HC) during a probabilistic reward-guided decision-making task with dynamically changing reinforcement contingencies. A hierarchical Bayesian inference method was used to fit and compare learning models with different assumptions about the amount of task-related information subjects may have inferred during the experiment. Here, we observed that the best-fitting model was a modified Rescorla-Wagner type model, the “double-update” model, which assumes that subjects infer the knowledge that reward contingencies are anti-correlated, and integrate both actual and hypothetical outcomes into their decisions. Moreover, comparison of the best-fitting model's parameters showed that ADP were less sensitive to punishments compared to HC. Hence, decisions of ADP after punishments were loosely coupled with the expected reward values assigned to them. A correlation analysis between the model-generated PEs and the fMRI data revealed a reduced association between these PEs and the BOLD activity in the dorsolateral prefrontal cortex (DLPFC) of ADP. A hemispheric asymmetry was observed in the DLPFC when positive and negative PE signals were analyzed separately. The right DLPFC activity in ADP showed a reduced correlation with positive PEs. On the other hand, ADP, particularly the patients with high dependence severity, recruited the left DLPFC to a lesser extent than HC for processing negative PE signals. These results suggest that the DLPFC, which has been linked to adaptive control of action selection, may play an important role in cognitive inflexibility observed in alcohol dependence when reinforcement contingencies change. Particularly, the left DLPFC may contribute to this impaired behavioral adaptation, possibly by impeding the extinction of the actions that no longer lead to a reward.
Dendritic hPG-amid-C18-mPEG core-multishell nanocarriers (CMS) represent a novel class of unimolecular micelles that hold great potential as drug transporters, e. g., to facilitate topical therapy in skin diseases. Atopic dermatitis is among the most common inflammatory skin disorders with complex barrier alterations which may affect the efficacy of topical treatment. Here, we tested the penetration behavior and identified target structures of unloaded CMS after topical administration in healthy mice and in mice with oxazolone-induced atopic dermatitis. We further examined whole body distribution and possible systemic side effects after simulating high dosage dermal penetration by subcutaneous injection. Following topical administration, CMS accumulated in the stratum corneum without penetration into deeper viable epidermal layers. The same was observed in atopic dermatitis mice, indicating that barrier alterations in atopic dermatitis had no influence on the penetration of CMS. Following subcutaneous injection, CMS were deposited in the regional lymph nodes as well as in liver, spleen, lung, and kidney. However, in vitro toxicity tests, clinical data, and morphometry-assisted histopathological analyses yielded no evidence of any toxic or otherwise adverse local or systemic effects of CMS, nor did they affect the severity or course of atopic dermatitis. Taken together, CMS accumulate in the stratum corneum in both healthy and inflammatory skin and appear to be highly biocompatible in the mouse even under conditions of atopic dermatitis and thus could potentially serve to create a depot for anti-inflammatory drugs in the skin.
A particular form of social pain is invalidation. Therefore, this study (a) investigates whether patients with chronic low back pain experience invalidation, (b) if it has an influence on their pain, and (c) explores whether various social sources (e.g. partner and work) influence physical pain differentially. A total of 92 patients completed questionnaires, and for analysis, Pearson’s correlation coefficients and hierarchical linear regression analyses were conducted. They indicated a significant association between discounting and disability due to pain (respective β = .29, p > .05). Especially, discounting by partner was linked to higher disability (β = .28, p > .05).
The purpose of the present study was to examine the effects of unilateral fatigue of the knee extensors at different movement velocities on neuromuscular performance in the fatigued and non-fatigued leg. Unilateral fatigue of the knee extensors was induced in 11 healthy young men (23.7 +/- 3.8 years) at slower (60A degrees/s; FAT60) and faster movement velocities (240A degrees/s; FAT240) using an isokinetic dynamometer. A resting control (CON) condition was included. The fatigue protocols consisted of five sets of 15 maximal concentric knee extensions using the dominant leg. Before and after fatigue, peak isokinetic torque (PIT) and time to PIT (TTP) of the knee extensors as well as electromyographic (EMG) activity of vastus medialis, vastus lateralis, and biceps femoris muscles were assessed at 60 and 240A degrees/s movement velocities in the fatigued and non-fatigued leg. In the fatigued leg, significantly greater PIT decrements were observed following FAT60 and FAT240 (11-19%) compared to CON (3-4%, p = .002, d = 2.3). Further, EMG activity increased in vastus lateralis and biceps femoris muscle following FAT240 only (8-28%, 0.018 <= p <=.024, d = 1.8). In the non-fatigued leg, shorter TTP values were found after the FAT60 protocol (11-15%, p = .023, d = 2.4). No significant changes were found for EMG data in the non-fatigued leg. The present study revealed that both slower and faster velocity fatiguing contractions failed to show any evidence of cross-over fatigue on PIT. However, unilateral knee extensor fatigue protocols conducted at slower movement velocities (i.e., 60A degrees/s) appear to modulate torque production on the non-fatigued side (evident in shorter TTP values).
Methods: As part of the Potsdam Gait Study (POGS), healthy old adults completed a no-intervention control period (69.1 +/- 4A yrs, n =14) or a power training program followed by detraining (72.9 +/- 5.4 yrs, n = 15).We measured isokinetic knee extensor and plantarflexor power and measured hip, knee and ankle kinetics at habitual, fast and standardized walking speeds. Results: Power training significantly increased isokinetic knee extensor power (25%), plantarflexor power (43%), and fast gait velocity (5.9%). Gait mechanics underlying the improved fast gait velocity included increases in hip angular impulse (29%) and H1 work (37%) and no changes in positive knee (K2) and A2 work. Detraining further improved fast gait velocity (4.7%) with reductions in H1(-35%), and increases in K2 (36%) and A2 (7%). Conclusion: Power training increased fast gait velocity in healthy old adults by increasing the reliance on hip muscle function and thus further strengthened the age-related distal-to-proximal shift in muscle function. (C) 2016 Elsevier B.V. All rights reserved.
Introduction Methods A commercial Real Time Location System was adapted to meet these requirements and subsequently validated in three households by monitoring various bathroom behaviours. Results The results indicate that the system is robust, can monitor behaviours over the long-term in different households and can reliably distinguish between individuals. Precision rates were high and consistent. Recall rates were less consistent across households and behaviours, although recall rates improved considerably with practice at set-up of the system. The achieved precision and recall rates were comparable to the rates observed in more controlled environments using more valid methods of ground truthing. Conclusion These initial findings indicate that the system is a valuable, flexible and robust system for monitoring behaviour in its natural environment that would allow new research questions to be addressed.
AIM To analyze neuromuscular activity patterns of the trunk in healthy controls (H) and back pain patients (BPP) during one-handed lifting of light to heavy loads. METHODS RESULTS Seven subjects (3m/4f; 32 +/- 7 years; 171 +/- 7 cm; 65 +/- 11 kg) were assigned to BPP (pain grade >= 2) and 36 (13m/23f; 28 +/- 8 years; 174 +/- 10 cm; 71 +/- 12 kg) to H (pain grade <= 1). H and BPP did not differ significantly in anthropometrics (P > 0.05). All subjects were able to lift the light and middle loads, but 57% of BPP and 22% of H were not able to lift the heavy load (all women) chi(2) analysis revealed statistically significant differences in task failure between H vs BPP (P = 0.03). EMG-RMS ranged from 33% +/- 10%/30% +/- 9% (DL, 1 kg) to 356% +/- 148%/283% +/- 80% (VR, 20 kg) in H/BPP with no statistical difference between groups regardless of load (P > 0.05). However, the EMG-RMS of the VR was greatest in all lifting tasks for both groups and increased with heavier loads. CONCLUSION Heavier loading leads to an increase (2-to 3-fold) in trunk muscle activity with comparable patterns. Heavy loading (20 kg) leads to task failure, especially in women with back pain.
Objective:
Brain-derived neurotrophic factor (BDNF) supports neurogenesis, angiogenesis, and promotes the survival of various cell types in the brain and the coronary system. Moreover, BDNF is associated with both coronary heart disease (CHD) and depression. The current study aims to investigate whether serum BDNF levels are associated with the course of depressive symptoms in CHD patients.
Methods:
At baseline, N = 225 CHD patients were enrolled while hospitalized. Of these, N = 190 (84%) could be followed up 6 months later. Depressive symptoms were assessed both at baseline and at the 6-months follow-up using the Patient Health Questionnaire (PHQ-9). Serum BDNF concentrations were measured using fluorometric Enzyme-linked immunosorbent assays (ELISA).
Results:
Logistic regression models showed that lower BDNF levels were associated with persistent depressive symptoms, even after adjustment for age, sex, smoking and potential medical confounders. The incidence of depressive symptoms was not related to lower BDNF levels. However, somatic comorbidity (as measured by the Charlson Comorbidity Index) was significantly associated with the incidence of depressive symptoms.
Conclusions:
Our findings suggest a role of BDNF in the link between CHD and depressive symptoms. Particularly, low serum BDNF levels could be considered as a valuable biomarker for the persistence of depressive symptoms among depressed CHD patients.
The increasing prevalence of methicillin-resistant Staphylococcus aureus has become a major public health threat. While lactobacilli were recently found useful in combating various pathogens, limited data exist on their therapeutic potential for S. aureus infections. The aim of this study was to determine whether Lactobacillus salivarius was able to produce bactericidal activities against S. aureus and to determine whether the inhibition was due to a generalized reduction in pH or due to secreted Lactobacillus product(s). We found an 8.6-log10 reduction of planktonic and a 6.3-log10 reduction of biofilm S. aureus. In contrast, the previously described anti-staphylococcal effects of L. fermentum only caused a 4.0-log10 reduction in planktonic S. aureus cells, with no effect on biofilm S. aureus cells. Killing of S. aureus was partially pH dependent, but independent of nutrient depletion. Cell-free supernatant that was pH neutralized and heat inactivated or proteinase K treated had significantly reduced killing of L. salivarius than with pH-neutralized supernatant alone. Proteomic analysis of the L. salivarius secretome identified a total of five secreted proteins including a LysM-containing peptidoglycan binding protein and a protein peptidase M23B. These proteins may represent potential novel anti-staphylococcal agents that could be effective against S. aureus biofilms.
The integration of balance and plyometric training has been shown to provide significant improvements in sprint, jump, agility, and other performance measures in young athletes. It is not known if a specific within session balance and plyometric exercise sequence provides more effective training adaptations. The objective of the present study was to investigate the effects of using a sequence of alternating pairs of exercises versus a block (series) of all balance exercises followed by a block of plyometric exercises on components of physical fitness such as muscle strength, power, speed, agility, and balance. Twenty-six male adolescent soccer players ( 13.9 +/- 0.3 years) participated in an 8-week training program that either alternated individual balance (e. g., exercises on unstable surfaces) and plyometric (e. g., jumps, hops, rebounds) exercises or performed a block of balance exercises prior to a block of plyometric exercises within each training session. Pre- and post-training measures included proxies of strength, power, agility, sprint, and balance such as countermovement jumps, isometric back and knee extension strength, standing long jump, 10 and 30-m sprints, agility, standing stork, and Y-balance tests. Both groups exhibited significant, generally large magnitude (effect sizes) training improvements for all measures with mean performance increases of approximately > 30%. There were no significant differences between the training groups over time. The results demonstrate the effectiveness of combining balance and plyometric exercises within a training session on components of physical fitness with young adolescents. The improved performance outcomes were not significantly influenced by the within session exercise sequence.
A new method is proposed for tracking individual motor units (MUs) across multiple experimental sessions on different days. The technique is based on a novel decomposition approach for high-density surface electromyography and was tested with two experimental studies for reliability and sensitivity. Experiment I (reliability): ten participants performed isometric knee extensions at 10, 30, 50 and 70% of their maximum voluntary contraction (MVC) force in three sessions, each separated by 1 week. Experiment II (sensitivity): seven participants performed 2 weeks of endurance training (cycling) and were tested pre-post intervention during isometric knee extensions at 10 and 30% MVC. The reliability (Experiment I) and sensitivity (Experiment II) of the measured MU properties were compared for the MUs tracked across sessions, with respect to all MUs identified in each session. In Experiment I, on average 38.3% and 40.1% of the identified MUs could be tracked across two sessions (1 and 2 weeks apart), for the vastus medialis and vastus lateralis, respectively. Moreover, the properties of the tracked MUs were more reliable across sessions than those of the full set of identified MUs (intra-class correlation coefficients ranged between 0.63-0.99 and 0.39-0.95, respectively). In Experiment II, similar to 40% of the MUs could be tracked before and after the training intervention and training-induced changes in MU conduction velocity had an effect size of 2.1 (tracked MUs) and 1.5 (group of all identified motor units). These results show the possibility of monitoring MU properties longitudinally to document the effect of interventions or the progression of neuromuscular disorders.
Die Lifespan-Forschung untersucht die Entwicklung von Individuen über den gesamten Lebenslauf. Die medizinische Rehabilitation hat nach geltendem Sozialrecht die Aufgabe, chronische Krankheiten abzuwenden, zu beseitigen, zu mindern, auszugleichen, eine Verschlimmerung zu verhüten und Negativfolgen für die Lebensführung zu reduzieren. Dies erfordert in wissenschaftlicher wie in praxisbezogener Hinsicht die Entwicklung einer Lebensspannenperspektive als Voraussetzung für die Klassifikation und Diagnostik chronischer Erkrankungen, die Beschreibung von verlaufsbeeinflussenden Faktoren, kritischen Lebensphasen und Critical Incidents (kritische Verlaufszeitpunkte), die Durchführung von prophylaktischen Maßnahmen, die Entwicklung von Assessmentverfahren zur Erfassung und Bewertung von Verläufen oder Vorbehandlungen, die Auswahl und Priorisierung von Interventionen, eine Behandlungs- und Behandlerkoordination auf der Zeitachse, die Präzisierung der Aufgabenstellung für spezialisierte Rehabilitationsmaßnahmen, wie beispielsweise Rehabilitationskliniken, und als Grundlage für die Sozialmedizin. Aufgrund der Vielfalt der individuellen Risikokonstellationen, Krankheitsverläufe und Behandlungssituationen über die Lebensspanne hinweg, bedarf es in der medizinischen Rehabilitation in besonderer Weise einer personalisierten Medizin, die zugleich rehabilitationsförderliche und -behindernde Umweltfaktoren im Rehabilitationsverlauf berücksichtigt.
Die berufliche Wiedereingliederung von Patienten nach akutem Herzinfarkt stellt sowohl aus gesellschaftlicher wie auch aus individueller Sicht einen entscheidenden Schritt zur vollständigen Rekonvaleszenz dar. Lediglich 10% der Patienten werden durch kardiale Probleme an der Reintegration behindert. Neben medizinischen und berufsbezogenen Faktoren determinieren insbesondere psychosoziale Parameter eine erfolgreiche Wiederaufnahme der Tätigkeit. Verschiedene Programme der Rentenversicherungsträger werden dabei unterstützend angeboten.
Das prolongierte Weaning von Patienten mit neurologischen oder neurochirurgischen Erkrankungen weist Besonderheiten auf, denen die Deutsche Gesellschaft für Neurorehabilitation e. V. in einer eigenen Leitlinie Rechnung trägt.
Im Hinblick auf Definitionen (z. B. Weaningerfolg und -versagen), Weaningkategorien, Pathophysiologie des Weaningversagens und allgemeine Weaningstrategien wird ausdrücklich auf die aktuelle S2k-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. verwiesen.
In der neurologisch-neurochirurgischen Frührehabilitation werden Patienten mit zentralen Störungen der Atmungsregulation (z. B. Hirnstammläsionen), des Schluckaktes (neurogene Dysphagien), mit neuromuskulären Problemen (z. B. Critical-illness-Polyneuropathie, Guillain-Barre-Syndrom, Querschnittlähmungen, Myasthenia gravis) und/oder kognitiven Störungen (z. B. Bewusstseins- und Vigilanzstörungen, schwere Kommunikationsstörungen) versorgt, deren Betreuung bei der Entwöhnung von der Beatmung neben intensivmedizinischer Kompetenz auch neurologische bzw. neurochirurgische und neurorehabilitative Expertise erfordert. In Deutschland wird diese Kompetenz in Zentren der neurologisch-neurochirurgischen Frührehabilitation vorgehalten, und zwar als Krankenhausbehandlung.
Der Leitlinie liegt eine systematische Recherche von Leitliniendatenbanken und Medline zugrunde. Unter Moderation durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erfolgte die Konsensfindung mittels nominalen Gruppenprozesses und Delphi-Verfahren.
In der vorliegenden Leitlinie der DGNR wird auf die strukturellen und inhaltlichen Besonderheiten der neurologisch-neurochirurgischen Frührehabilitation sowie vorhandene Studien zum Weaning in Frührehabilitationseinrichtungen eingegangen.
Adressaten der Leitlinie sind Neurologen, Neurochirurgen, Anästhesisten, Palliativmediziner, Logopäden, Intensivpflegekräfte, Ergotherapeuten, Physiotherapeuten und Neuropsychologen. Ferner richtet sich diese Leitlinie zur Information an Fachärzte für Physikalische Medizin und Rehabilitation (PMR), Pneumologen, Internisten, Atmungstherapeuten, den Medizinischen Dienst der Krankenkassen (MDK) und des Spitzenverbands Bund der Krankenkassen e. V. (MDS). Das wesentliche Ziel dieser Leitlinie ist es, den aktuellen Wissensstand zum Thema „Prolongiertes Weaning in der neurologisch-neurochirurgischen Frührehabilitation“ zu vermitteln.
Ziel:
Untersucht wurden subjektive bio-psycho-soziale Auswirkungen chronischer Herz- und Gefäßerkrankungen, Bewältigungsstrategien und Formen sozialer Unterstützung bei Rehabilitanden in besonderen beruflichen Problemlagen (BBPL).
Methodik:
Für die qualitative Untersuchung wurden 17 Patienten (48,9±7,0 Jahre, 13 männl.) mit BBPL (SIMBO-C>30) in leitfadengestützten Interviews befragt. Die Auswertung erfolgte softwaregestützt nach dem inhaltsanalytischen Ansatz von Mayring.
Ergebnisse:
Im Rahmen der Krankheitsauswirkungen benannten die Patienten soziale, einschließlich beruflicher Aspekte mit 62% der Aussagen deutlich häufiger als physische oder psychische Faktoren (9 bzw. 29%). Angewandte Bewältigungsstrategien und erfahrene Unterstützungsleistungen richteten sich jedoch überwiegend auf körperliche Einschränkungen (70 bzw. 45%).
Schlussfolgerung:
Obgleich soziale Krankheitsauswirkungen für die befragten Rehabilitanden subjektiv bedeutsam waren, gelang die Entwicklung geeigneter Bewältigungsstrategien nur unzureichen
Nanoparticles can improve topical drug delivery: size, surface properties and flexibility of polymer nanoparticles are defining its interaction with the skin. Only few studies have explored skin penetration for one series of structurally related polymer particles with systematic alteration of material composition. Here, a series of rigid poly[acrylonitrile-co-(N-vinyl pyrrolidone)] model nanoparticles stably loaded with Nile Red or Rhodamin B, respectively, was comprehensively studied for biocompatibility and functionality. Surface properties were altered by varying the molar content of hydrophilic NVP from 0 to 24.1% and particle size ranged from 35 to 244 nm. Whereas irritancy and genotoxicity were not revealed, lipophilic and hydrophilic nanoparticles taken up by keratinocytes affected cell viability. Skin absorption of the particles into viable skin ex vivo was studied using Nile Red as fluorescent probe. Whilst an intact stratum corneum efficiently prevented penetration, almost complete removal of the horny layer allowed nanoparticles of smaller size and hydrophilic particles to penetrate into viable epidermis and dermis. Hence, systematic variations of nanoparticle properties allows gaining insights into critical criteria for biocompatibility and functionality of novel nanocarriers for topical drug delivery and risks associated with environmental exposure.
Background: The purpose of this study was to analyze the prevalence of long-term benzodiazepine use in older adults treated in general and neuropsychiatric practices in Germany. Methods: This study included 32,182 patients over the age of 65 years who received benzodiazepine prescriptions for the first time between January 2010 and December 2014 in general and neuropsychiatric practices in Germany. Follow up lasted until July 2016. The main outcome measure was the proportion of patients treated with benzodiazepines for >6 months. Results: The proportion of patients with benzodiazepine therapy for >6 months increased with age (65-70 years: 12.3%; 71-80 years: 15.5%; 81-90 years: 23.7%; >90 years: 31.6%) but did not differ significantly between men (15.5%) and women (17.1%). The proportion of patients who received benzodiazepines for >6 months was higher among those with sleep disorders (21.1%), depression (20.8%) and dementia (32.1%) than among those with anxiety (15.5%). By contrast, this proportion was lower among people diagnosed with adjustment disorders (7.7%) and back pain (3.8%). Conclusion: Overall, long-term use of benzodiazepines is common in older people, particularly in patients over the age of 80 and in those diagnosed with dementia, sleep disorders, or depression.
Transient receptor potential channels (TRP channels) are cation selective transmembrane receptors with diverse structures, activation mechanisms and physiological functions. TRP channels act as cellular sensors for a plethora of stimuli, including temperature, membrane voltage, oxidative stress, mechanical stimuli, pH and endogenous as well as exogenous ligands, thereby illustrating their versatility. As such, TRP channels regulate various functions in both excitable and non-excitable cells, mainly by mediating Ca2+ homeostasis. Dysregulation of TRP channels is implicated in many pathologies, including cardiovascular diseases, muscular dystrophies and hyperalgesia. However, the importance of TRP channel expression, physiological function and regulation in chondrocytes and intervertebral disc (IVD) cells is largely unexplored. Osteoarthritis (OA) and degenerative disc disease (DDD) are chronic age-related disorders that significantly affect the quality of life by causing pain, activity limitation and disability. Furthermore, currently available therapies cannot effectively slow-down or stop progression of these diseases. Both OA and DDD are characterised by reduced tissue cellularity, enhanced inflammatory responses and molecular, structural and mechanical alterations of the extracellular matrix, hence affecting load distribution and reducing joint flexibility. However, knowledge on how chondrocytes and IVD cells sense their microenvironment and respond to its changes is still limited. In this review, we introduced six families of mammalian TRP channels, their mechanisms of activation as well as activation-driven cellular consequences. We summarised the current knowledge on TRP channel expression and activity in chondrocytes and IVD cells and the significance of TRP channels as therapeutic targets for the treatment of OA and DDD.
Paclitaxel is a commonly used cytotoxic anticancer drug with potentially life-threatening toxicity at therapeutic doses and high interindividual pharmacokinetic variability. Thus, drug and effect monitoring is indicated to control dose-limiting neutropenia. Joerger et al. (2016) developed a dose individualization algorithm based on a pharmacokinetic (PK)/pharmacodynamic (PD) model describing paclitaxel and neutrophil concentrations. Furthermore, the algorithm was prospectively compared in a clinical trial against standard dosing (Central European Society for Anticancer Drug Research Study of Paclitaxel Therapeutic Drug Monitoring; 365 patients, 720 cycles) but did not substantially improve neutropenia. This might be caused by misspecifications in the PK/PD model underlying the algorithm, especially without consideration of the observed cumulative pattern of neutropenia or the platinum-based combination therapy, both impacting neutropenia. This work aimed to externally evaluate the original PK/PD model for potential misspecifications and to refine the PK/PD model while considering the cumulative neutropenia pattern and the combination therapy. An underprediction was observed for the PK (658 samples), the PK parameters, and these parameters were re-estimated using the original estimates as prior information. Neutrophil concentrations (3274 samples) were over-predicted by the PK/PD model, especially for later treatment cycles when the cumulative pattern aggravated neutropenia. Three different modeling approaches (two from the literature and one newly developed) were investigated. The newly developed model, which implemented the bone marrow hypothesis semiphysiologically, was superior. This model further included an additive effect for toxicity of carboplatin combination therapy. Overall, a physiologically plausible PK/PD model was developed that can be used for dose adaptation simulations and prospective studies to further improve paclitaxel/ carboplatin combination therapy.
Hintergrund
Patienten, die nach gescheitertem Weaning von der Intensivstation in die Frührehabilitation (FR) verlegt werden, weisen neben motorischen Einschränkungen oft auch Defizite in ihrer kognitiven Leistungsfähigkeit auf. Welche patientenseitigen Faktoren das kognitive Outcome am Ende der FR beeinflussen, ist noch unzureichend untersucht.
Zielstellung
Ermittlung von Prädiktoren auf das kognitive Leistungsvermögen initial beatmeter FR-Patienten.
Methode
Zwischen 01/2014 und 12/2015 wurden 301 Patienten (68,3 ± 11,4 Jahre, 67 % männlich) einer neurologischen Phase-B-Weaningstation konsekutiv in eine prospektive Beobachtungsstudie eingeschlossen. Zur Ermittlung möglicher Einflussfaktoren auf das kognitive Outcome (operationalisiert mittels Neuromentalindex [NMI]) wurden soziodemografische Daten, kritische Erkrankung, Komorbiditäten, Parameter zu Weaning und Dekanülierung sowie diverse Scores zur Ermittlung funktionaler Parameter erhoben und mittels ANCOVA multivariat ausgewertet.
Ergebnisse
Insgesamt 248 Patienten (82 %) konnten erfolgreich geweant werden, 155 (52 %) dekanüliert, 75 Patienten (25 %) verstarben, davon 39 (13 %) unter Palliativtherapie. Für die überlebenden Patienten (n = 226) konnten im finalen geschlechts- und altersadjustierten statistischen Modell unabhängige Prädiktoren des NMI bei Entlassung aus der FR ermittelt werden: Wachheit und erfolgreiche Dekanülierung waren positiv mit dem NMI assoziiert, während als kritische Erkrankungen hypoxische Hirnschädigungen, Hirninfarkte und Schädel-Hirn-Traumata einen negativen Einfluss auf die kognitive Leistungsfähigkeit hatten. Das berechnete Modell begründet 57 % der Varianz des NMI (R2 = 0,568) und weist damit eine hohe Erklärungsqualität auf.
Schlussfolgerung
Aufgrund des erhöhten Risikos für eine verminderte kognitive Leistungsfähigkeit zum Ende der FR sollten vor allem Patienten nach Hypoxie, Hirninfarkt und Schädel-Hirn-Trauma intensiv neuropsychologisch betreut werden. Da weiterhin eine erfolgreiche Dekanülierung mit verbesserten kognitiven Leistungen assoziiert ist, sollte – vor allem bei wachen Patienten – zudem ein zügiges Trachealkanülenmanagement im therapeutischen Fokus stehen.
Objectives: Postural control in elderly people is impaired by degradations of sensory, motor, and higher-level adaptive mechanisms. Here, we characterize the effects of a progressive balance training programon these postural control impairments using a brain network model based on system identification techniques. Methods and Material: We analyzed postural control of 35 healthy elderly subjects and compared findings to data from 35 healthy young volunteers. Eighteen elderly subjects performed a 10 week balance training conducted twice per week. Balance training was carried out in static and dynamic movement states, on support surfaces with different elastic compliances, under different visual conditions and motor tasks. Postural control was characterized by spontaneous sway and postural reactions to pseudorandom anterior-posterior tilts of the support surface. Data were interpreted using a parameter identification procedure based on a brain network model. Conclusion: Balance training reduced overactive proprioceptive feedback and restored vestibular orientation in elderly. Based on the assumption of a linear deterioration of postural control across the life span, the training effect can be extrapolated as a juvenescence of 10 years. This study points to a considerable benefit of a continuous balance training in elderly, even without any sensorimotor deficits.
The purpose of this study was to determine the intra-rater, inter-examiner and inter-observer reliability of biceps femoris long head (BFlh) tendon strain using ultrasound imaging. Nineteen patients (age: 20.4 +/- 0.35 y) were tested twice with a 1-wk interval. Each session included passive stretching from three different hip positions. Tests were performed independently by two examiners while BFlh tendon displacement (mm) and strain (%) were manually extracted from ultrasound video footages by two observers. Intra-rater comparisons revealed an intra-class correlation coefficient (ICC2,1) range of 0.87 to 0.98 and a variability less than 4.74%. Interexaminer comparisons revealed an ICC2,1 range of 0.83 to 0.99 and less than 4.69% variability. Inter-observer ICCs ranged from 0.93 to 0.97 with variability less than 4.89%. Using a well-defined scanning protocol, two experienced examiners attained high levels of intra-rater agreement, with similarly excellent results for inter-rater and inter-observer reliability for BFlh tendon displacement and strain. (E-mail: ekellis@phed-sr.auth.gr) (C) 2017 World Federation for Ultrasound in Medicine & Biology.
Sonographically detectable intratendinous blood flow (IBF) is found in 50%-88% of Achilles tendinopathy patients as well as in up to 35% of asymptomatic Achilles tendons (AT). Although IBF is frequently associated with tendon pathology, it may also represent a physiological regulation, for example, due to increased blood flow in response to exercise. Therefore, this study aimed to investigate the acute effects of a standardized running exercise protocol on IBF assessed with Doppler ultrasound (DU) Advanced dynamic flow in healthy ATs. 10 recreationally active adults (5 f, 5m; 29 +/- 3years, 1.72 +/- 0.12m, 68 +/- 16kg, physical activity 206 +/- 145minute/wk) with no history of AT pain and inconspicious tendon structure performed 3 treadmill running tasks on separate days (M1-3) with DU examinations directly before and 5, 30, 60, and 120minutes after exercise. At M1, an incremental exercise test was used to determine the individual anaerobic threshold (IAT). At M2 and M3, participants performed 30-minute submaximal constant load tests (CL1/CL2) with an intensity 5% below IAT. IBF in each tendon was quantified by counting the number of vessels. IBF increased in five ATs from no vessels at baseline to one to four vessels solely detectable 5minutes after CL1 or CL2. One AT had persisting IBF (three vessels) throughout all examinations. Fourteen ATs revealed no IBF at all. Prolonged running led to a physiological, temporary appearance of IBF in 25% of asymptomatic ATs. To avoid exercise-induced IBF in clinical practice, DU examinations should be performed after 30minutes of rest.
Background: The aim of the present study was to investigate the psychometric characteristics of the Perceived Stress Scale (PSS) in a sample of dementia patients and their spousal caregivers. Methods: We investigated the reliability and validity of the 14-item PSS in a sample of 80 couples, each including one spouse who had been diagnosed with mild to moderate dementia (mean age 75.55, SD = 5.85, 38.7% female) and one spousal caregiver (mean age 73.06, SD = 6.75, 61.3% female). We also examined the factor structure and sensitivity of the scale with regard to gender differences. Results: Exploratory factor analysis of the PSS revealed a two-factor solution for the scale; the first factor reflected general stress while the second factor consisted of items reflecting the perceived ability to cope with stressors. A confirmatory factor analysis verified that the data were a better fit for the two-factor model than a one-factor model. The two factors of the PSS showed good reliability for patients as well as for caregivers ranging between alpha = 0.73 and alpha = 0.82. Perceived stress was significantly positively correlated with depressive symptomatology in both caregivers and patients. Mean PSS scores did not significantly differ between male and female patients nor did they differ between male and female caregivers. Conclusion: The present data indicate that the PSS provides a reliable and valid measure of perceived stress in dementia patients and their caregivers.
The starting point of this contribution is the potential risk to health and performance from the combination of elite sporting careers with the pursuit of education. In European sport science and politics, structural measures to promote dual careers in elite sports have been discussed increasingly of late. In addition to organisational measures, there are calls for educational-psychological intervention programmes supporting the successful management of dual careers at the individual level. This paper presents an appropriate intervention programme and its evaluation: stress-resistance training for elite athletes (SRT-EA). It comprises 10 units, each lasting 90 minutes. It is intended for athletes and aims to improve their resistance to chronic stress. The evaluation was carried out in a quasi-experimental design, with three points of measurement (baseline, immediately after, and three months after) and two non-randomised groups: an intervention group (n=128) and an untreated control group (n=117). Participants were between 13 and 20 years of age (53.5% male) and represented various Olympic sports. Outcome variables were assessed with questionnaires. Significant short- and mid-term intervention effects were explored. The intervention increased stress-related knowledge, general self-efficacy, and stress sensitivity. Chronic stress level, stress symptoms, and stress reactivity were reduced. In line with the intention of the intervention, the results showed short- and mid-term, small to medium-sized effects. Accordingly, separate measurements at the end of the intervention and three months later showed mostly positive subjective experiences. Thus, the results reinforce the hope that educational-psychological stress-management interventions can support dual careers.
After surgical treatment of cancer of the esophagus or the esophagogastric junction we observed steatorrhea, which is so far seldom reported. We analyzed all patients treated in our rehabilitation clinic between 2011 and 2014 and focused on the impact of surgery on digestion of fat. Reported steatorrhea was anamnestic, no pancreatic function test was made. Here we show the results from 51 patients. Twenty-three (45%) of the patients reported steatorrhea. Assuming decreased pancreatic function pancreatic enzyme replacement therapy (PERT) was started or modified during the rehabilitation stay (in the following called STEA(+)). These patients were compared with the patients without steatorrhea and without PERT (STEA(-)). Maximum weight loss between surgery and rehabilitation start was 18 kg in STEA(+) patient and 15.3 kg in STEA(-) patients. STEA(+) patients gained more weight under PERT during the rehabilitation phase (3 wk) than STEA(-) patients without PERT (+1.0 kg vs. -0.3 kg, P = 0.032). We report for the first time, that patients after cancer related esophageal surgery show anamnestic signs of exocrine pancreas insufficiency and need PERT to gain body weight.
Objectives: In patients with early-stage dementia and their caregiving partners, reciprocal dyadic coping (DC) is crucial for preventing or reducing depressive symptoms in both partners. This study examines the relationships between ‘own DC’ and ‘perceived partner DC’ with depressive symptoms in couples coping with dementia on individual (actor effects) and cross-person (partner effects) levels.
Method: 164 individuals (82 patients with early-stage dementia and their 82 caregiving partners; ND = 82 dyads) participated in this prospective study with measures (DC, depressive symptoms, and dementia severity) taken at baseline and at six months. Each partner evaluated their own and the perceived partner DC. Actor–partner interdependence models were applied to the resulting four independent evaluations.
Results: Results differed substantially between patients and caregivers. DC was significantly related to patients’ but not to caregivers’ depressive symptoms, when adjustments were made for individual coping. Perceived partner DC showed a negative association with depressive symptoms in patients, whereas own DC was adversely related for actor as well as for partner effects across individuals.
Conclusion: The adverse association between the own DC of the caregiver and the patient on depressive symptoms of the patient might be due to inappropriate efforts or to the loss of autonomy as a care-receiver. DC is important in both patients and caregivers, as shown by the negative association between perceived partner DC and depressive symptoms in the patients, which might inform interventions that target the couple as a whole.
Background/Aims: The tumor suppressor p53 is rarely mutated in gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) but they frequently show a strong expression of negative regulators of p53, rendering these tumors excellent targets for a p53 recovery therapy. Therefore, we analyzed the mechanisms of a p53 recovery therapy on intestinal neuroendocrine tumors in vitro and in vivo. Methods: By Western blot and immunohistochemistry, we found that in GEP-NEN biopsy material overexpression of MDM2 was present in intestinal NEN. Therefore, we analyzed the effect of a small-molecule inhibitor, nutlin-3a, in p53 wild-type and mutant GEP-NEN cell lines by proliferation assay, flow cytometry, immunofluorescence, Western blot, and by multiplex gene expression analysis. Finally, we analyzed the antitumor effect of nutlin-3a in a xenograft mouse model in vivo. During the study, the tumor volume was determined. Results: The midgut wild-type cell line KRJ-I responded to the treatment with cell cycle arrest and apoptosis. By gene expression analysis, we could demonstrate that nutlins reactivated an antiproliferative p53 response. KRJ-I-derived xenograft tumors showed a significantly decreased tumor growth upon treatment with nutlin-3a in vivo. Furthermore, our data suggest that MDM2 also influences the expression of the oncogene FOXM1 in a p53-independent manner. Subsequently, a combined treatment of nutlin-3a and cisplatin (as chemoresistance model) resulted in synergistically enhanced antiproliferative effects. Conclusion: In summary, MDM2 overexpression is a frequent event in p53 wild-type intestinal neuroendocrine neoplasms and therefore recovery of a p53 response might be a novel personalized treatment approach in these tumors. (c) 2017 S. Karger AG, Basel
The purpose of this study was to examine the combined effects of drop-height and surface condition on drop jump (DJ) performance and knee joint kinematics. DJ performance, sagittal and frontal plane knee joint kinematics were measured in jump experienced young male and female adults during DJs on stable, unstable and highly unstable surfaces using different drop-heights (20, 40, 60 cm). Findings revealed impaired DJ performance (Δ5–16%; p<0.05; 1.43≤d≤2.82), reduced knee valgus motion (Δ33–52%; p<0.001; 2.70≤d≤3.59), and larger maximum knee flexion angles (Δ13–19%; p<0.01; 1.74≤d≤1.75) when using higher (60 cm) compared to lower drop-heights (≤40 cm). Further, lower knee flexion angles and velocity were found (Δ8-16%; p<0.01; 1.49≤d≤2.38) with increasing surface instability. When performing DJs from high (60 cm) compared to moderate drop-heights (40 cm) on highly unstable surfaces, higher knee flexion velocity and maximum knee valgus angles were found (Δ15–19%; p<0.01; 1.50≤d≤1.53). No significant main and/or interaction effects were observed for the factor sex. In conclusion, knee motion strategies were modified by the factors ‘drop-height’ and/or ‘surface instability’. The combination of high drop-heights (>40 cm) together with highly unstable surfaces should be used cautiously during plyometrics because this may increase the risk of injury due to higher knee valgus stress.
Background: Gait speed declines with increasing age, but it is unclear if gait speed preferentially correlates with leg muscle strength or mass.
Objective: We determined the relationship between gait speed and (1) leg muscle strength measured at 3 lower extremity joints and (2) leg lean tissue mass (LTM) in healthy young (age: 25 years, n = 20) and old (age: 70 years, n = 20) adults.
Methods: Subjects were tested for maximal isokinetic hip, knee, and ankle extension torque, leg LTM by bioimpedance, and gait performance (i.e., gait speed, stride length) at preferred and maximal gait speeds.
Results: We found no evidence for a preferential relationship between gait performance and leg muscle strength compared with gait performance and leg LTM in healthy young and old adults. In old adults, hip extensor strength only predicted habitual gait speed (R-2 = 0.29, p = 0.015), whereas ankle plantarflexion strength only predicted maximal gait speed and stride length (both R-2 = 0.40, p = 0.003). Conclusions: Gait speed did not preferentially correlate with leg muscle strength or leg LTM, favoring neither outcome for predicting mobility. Thus, we recommend that both leg muscle strength and leg LTM should be tested and trained complementarily. Further, hip and ankle extension torque predicted gait performance, and thus we recommend to test and train healthy old adults by functional integrated multiarticular rather than monoarticular lower extremity strength exercises.
No association of goal-directed and habitual control with alcohol consumption in young adults
(2017)
Alcohol dependence is a mental disorder that has been associated with an imbalance in behavioral control favoring model-free habitual over model-based goal-directed strategies. It is as yet unknown, however, whether such an imbalance reflects a predisposing vulnerability or results as a consequence of repeated and/or excessive alcohol exposure. We, therefore, examined the association of alcohol consumption with model-based goal-directed and model-free habitual control in 188 18-year-old social drinkers in a two-step sequential decision-making task while undergoing functional magnetic resonance imaging before prolonged alcohol misuse could have led to severe neurobiological adaptations. Behaviorally, participants showed a mixture of model-free and model-based decision-making as observed previously. Measures of impulsivity were positively related to alcohol consumption. In contrast, neither model-free nor model-based decision weights nor the trade-off between them were associated with alcohol consumption. There were also no significant associations between alcohol consumption and neural correlates of model-free or model-based decision quantities in either ventral striatum or ventromedial prefrontal cortex. Exploratory whole-brain functional magnetic resonance imaging analyses with a lenient threshold revealed early onset of drinking to be associated with an enhanced representation of model-free reward prediction errors in the posterior putamen. These results suggest that an imbalance between model-based goal-directed and model-free habitual control might rather not be a trait marker of alcohol intake per se.
Background: We sought to develop a standardized protocol for ultrasound (US) measurements of plantar fascia (PF) width and cross-sectional area (CSA), which may serve as additional outcome variables during US examinations of both healthy asymptomatic PF and in plantar fasciopathy and determine its interrater and intrarater reliability. Methods: Ten healthy individuals (20 feet) were enrolled. Participants were assessed twice by two raters each to determine intrarater and interrater reliability. For each foot, three transverse scans of the central bundle of the PF were taken at its insertion at the medial calcaneal tubercle, identified in real time on the plantar surface of the foot, using a fine wire technique. Reliability was determined using intraclass correlation coefficients (ICC), standard errors of measurement (SEM), and limits of agreement (LOA) expressed as percentages of the mean. Reliability of PF width and CSA measurements was determined using PF width and CSA measurements from one sonogram measured once and the mean of three measurements from three sonograms each measured once. Results: Ultrasound measurements of PF width and CSA showed a mean of 18.6 +/- 2.0 mm and 69.20 +/- 13.6 mm(2) respectively. Intra-reliability within both raters showed an ICC. 0.84 for width and ICC. 0.92 for CSA as well as a SEM% and LOA%, 10% for both width and CSA. Inter-rater reliability showed an ICC of 0.82 for width and 0.87 for CSA as well as a SEM% and LOA%, 10% for width and a SEM%, 10% and LOA%, 20% for CSA. Relative and absolute reliability within and between raters were higher when using the mean of three sonographs compared to one sonograph. Conclusions: Using this novel technique, PF CSA and width may be determined reliably using measurements from one sonogram or the mean of three sonograms. Measurement of PF CSA and width in addition to already established thickness and echogenicity measurements provides additional information on structural properties of the PF for clinicians and researchers in healthy and pathologic PF.
Background. Dynamic balance is often assessed in athletes using either the Star Excursion Balance Test (SEBT) or the Y Balance Test (YBT). There is evidence that the results for the three common directions are not comparable. Thus, the question is open to debate as to which instrument is better suited to measure training-induced changes over time. Objectives. The aim of this study is to compare the changes in the SEBT and the YBT, measured before and after six weeks of balance and strength exercise programmes in young and healthy athletes. Methods. A total of 30 young male athletes aged 15-17 years participated in this study and were involved in a six-week combined training, including balance and strength exercise. During pre-and post-training periods, the SEBT and YBT were conducted in random order. Results. The comparison between the changes in the SEBT and YBT with a paired sample T-test showed a significant increase in PM (p=0.001) and PL reach directions (p=0.000). No differences were observed in the A reach direction (p=0.38). Conclusion. the responsiveness levels of the SEBT and YBT are similar is valid. Also, because of higher effect size value in the anterior direction in YBT compared with SEBT, this balance test could possibly be preferred in this direction for postural control evaluation.
To investigate and compare the occurrence of inflammatory processes in the sites of disc degeneration in the lumbar and cervical spine by a gene array and subsequent qPCR and to investigate the mechanistic involvement of transient receptor potential channels TRPC6 and TRPV4. The gene expression of inflammatory cytokines and TRP channels was measured in human disc samples obtained from patients undergoing discectomy at the cervical (n = 24) or lumbar (n = 27) spine for degenerative disc disease (DDD) and disc herniation (DH) and analyzed for differences with regard to spinal level, IVD degeneration grade, Modic grade, age, sex, disc region and surgical extent. Aside from genes with known implication in DDD and DH, four previously unreported genes from the interferon and TRP families (IFNA1, IFNA8, IFNB1, TRPC6) could be detected. A correlation between gene expression and age (IL-15) and IVD degeneration grade (IFNA1, IL-6, IL-15, TRPC6), but not Modic grade, was identified. Significant differences were detected between cervical and lumbar discs (IL-15), nucleus and annulus (IL-6, TNF-alpha, TRPC6), single-level and multi-level surgery (IL-6, IL-8) as well as DDD and DH (IL-8), while sex had no effect. Multiple gene-gene pair correlations, either between different cytokines or between cytokines and TRP channels, exist in the disc. This study supports the relevance of IL-6 and IL-8 in disc diseases, but furthermore points toward a possible pathological role of IL-15 and type I interferons, as well as a mechanistic role of TRPC6. With limited differences in the inflammatory profile of cervical and lumbar discs, novel anti-inflammatory or TRP-modulatory strategies for the treatment of disc pathologies may be applicable independent of the spinal region.
There are few data demonstrating the specific extent to which surgical intervention for vocal fold nodules (VFN) improves vocal function in professional (PVU) and non-professional voice users (NVU). The objective of this study was to compare and quantify results after phonomicrosurgery for VFN in these patient groups. METHODS: In a prospective clinical study, surgery was performed via microlaryngoscopy in 37 female patients with chronic VFN manifestations (38±12 yrs, mean±SD). Pre- and postoperative evaluations of treatment efficacy comprised videolaryngostroboscopy, auditory-perceptual voice assessment, voice range profile (VRP), acoustic-aerodynamic analysis, and voice handicap index (VHI-9i). The dysphonia severity index (DSI) was compared with the vocal extent measure (VEM). RESULTS: PVU (n=24) and NVU (n=13) showed comparable laryngeal findings and levels of suffering (VHI-9i 16±7 vs 17±8), but PVU had a better pretherapeutic vocal range (26.8±7.4 vs 17.7±5.1 semitones, p<0.001) and vocal capacity (VEM 106±18 vs 74±29, p<0.01). Three months postoperatively, all patients had straight vocal fold edges, complete glottal closure, and recovered mucosal wave propagation. The mean VHI-9i score decreased by 8±6 points. DSI increased from 4.0±2.4 to 5.5±2.4, and VEM from 95±27 to 108±23 (p<0.001). Both parameters correlated significantly (rs=0.82). The average vocal range increased by 4.1±5.3 semitones, and the mean speaking pitch lowered by 0.5±1.4 semitones. CONCLUSIONS: These results confirm that phonomicrosurgery for VFN is a safe therapy for voice improvement in both PVU and NVU who do not respond to voice therapy alone. Top-level artistic capabilities in PVU were restored, but numeric changes of most vocal parameters were considerably larger in NVU.
Altered scapular muscle activity is mostly described under unloaded and submaximal loaded conditions in impingement patients. However, there is no clear evidence on muscle activity with respect to movement phases under maximum load in healthy subjects. Therefore, this study aimed to investigate scapular muscle activity under unloaded and maximum loaded isokinetic shoulder flexion and extension in regard to the movement phase. Fourteen adults performed unloaded (continuous passive motion [CPM]) as well as maximum loaded (concentric [CON], eccentric [ECC]) isokinetic shoulder flexion (Flex) and extension (Ext). Simultaneously, scapular muscle activity was measured by EMG. Root mean square was calculated for the whole ROM and four movement phases. Data were analyzed descriptively and by two-way repeated measures ANOVA. CPMFlex resulted in a linear increase of muscle activity for all muscles. Muscle activity during CONFlex and ECCFlex resulted in either constant activity levels or in an initial increase followed by a plateau in the second half of movement. CPMExt decreased with the progression of movement, whereas CONExt and ECCExt initially decreased and either levelled off or increased in the second half of movement. Scapular muscle activity of unloaded shoulder flexion and extension changed under maximum load showing increased activity levels and an altered pattern over the course of movement.
In this paper, we address the question of whether spacecraft potential depends on the ambient electron density. In Maxwellian space plasmas, the onset of spacecraft charging does not depend on the ambient electron density. The balance of electron currents causes the incoming electrons to balance with the outgoing secondary electrons. The onset is controlled by the critical or anticritical temperature of the ambient electrons, but not the electron density. Above the critical temperature, charging to negative potential occurs. If the energy of the incoming electrons increases to well beyond the second crossing point of the secondary electron yield (SEY), the value of SEY decreases to well below unity. When the secondary electron current is negligible compared with the primary electron current, the spacecraft potential is governed solely by the balance of the incoming electrons and the sum of the currents of the repelled electrons and the attracted ions. In neutral space plasma, the electron and ion charges cancel each other. But if the space plasma deviates from being neutral, then the densities can have effect on the spacecraft potential. If the ambient plasma deviates significantly from equilibrium, a non-Maxwellian electron distribution may result. For a kappa distribution, one can show that the spacecraft charging level is independent of the ambient electron density. For a double Maxwellian distribution, the spacecraft charging level depends on the electron densities. For a conducting spacecraft charging in sunlight, the charging level is low and positive. It also depends on the ambient electron density. For a dielectric spacecraft in sunlight, the high-level negative-voltage charging on the shadowed side may extend to the sunlit side and block the photoelectrons trying to escape from the sunlit side. In this case, the charging level does not depend on ambient electron density. Using coordinated environmental and spacecraft charging data obtained from the Los Alamos National Laboratory geosynchronous satellites, we showed some results confirming that spacecraft potential is indeed often independent of the ambient electron density.
Knie- und Hüftgelenksarthrose zählen zu den zehn häufigsten Einzeldiagnosen in orthopädischen Praxen. Die Wirksamkeit einer stationären Rehabilitation für Patienten nach Knie- oder Hüft-Totalendoprothese (TEP) ist in mehreren Studien belegt. Dennoch stellt die mittel- und langfristige Nachhaltigkeit zum Erhalt des Therapieerfolges eine große Herausforderung dar. Das Ziel des Projekts ReMove-It ist es, einen Wirksamkeitsnachweis für eintelemedizinisch assistiertes Interventionstraining für Patienten nach einem operativen Eingriff an den unteren Extremitäten zu erbringen.
In dem Beitrag wird anhand von Erfahrungsberichten dargestellt, wie das interaktive Übungsprogramm für Knie- und Hüft-TEP-Patienten entwickelt und das telemedizinische Assistenzsystem MeineReha® in den Behandlungsalltag von drei Rehakliniken integriert wurde. Ebenso werden der Aufbau und Ablauf der klinischen Studie dargestellt und das System aus Sicht der beteiligten Ärzte, und Therapeuten bewertet.
We investigated the efficacy of reminiscence therapy (RT) on symptoms of depression in patients with mild to moderate dementia. Out of 227 patients with mild to moderate dementia from a specialized physician’s office, 27 pairs (N = 54; mean age 79.04 ± 6.16 years) who had either received treatment as usual (TAU) or TAU combined with RT, were matched retrospectively according to age as well as cognitive and depressive symptom scores. After controlling for age and sex, symptoms of depression significantly decreased over time in the RT group compared to TAU (F1,52 = 4.36; p < .05). RT is a promising option for the treatment of depression in mild to moderate dementia. Larger randomized-controlled trials are needed.
Background: In health research, indicators of socioeconomic status (SES) are often used interchangeably and often lack theoretical foundation. This makes it difficult to compare results from different studies and to explore the relationship between SES and health outcomes. To aid researchers in choosing appropriate indicators of SES, this article proposes and tests a theory-based selection of SES indicators using chronic back pain as a health outcome. Results: Chronic back pain intensity was best predicted by the multidimensional index (beta = 0.31, p < 0.05), followed by job position (beta = 0.29, p < 0.05) and education (beta = -0.29, p < 0.05); whereas, income exerted no significant influence. Back pain disability was predicted strongest by education (beta = -0.30, p < 0.05) and job position (beta = 0. 29, p < 0.05). Here, multidimensional index and income had no significant influence. Conclusions: The choice of SES indicators influences predictive power on both back pain dimensions, suggesting SES predictors cannot be used interchangeably. Therefore, researchers should carefully consider prior to each study which SES indicator to use. The introduced framework can be valuable in supporting this decision because it allows for a stable prediction of SES indicator influence and their hierarchy on a specific health outcomes.
The research aimed to investigate back pain (BP) prevalence in a large cohort of young athletes with respect to age, gender, and sport discipline. BP (within the last 7days) was assessed with a face scale (face 1-2=no pain; face 3-5=pain) in 2116 athletes (m/f 61%/39%; 13.3 +/- 1.7years; 163.0 +/- 11.8cm; 52.6 +/- 13.9kg; 4.9 +/- 2.7 training years; 8.4 +/- 5.7 training h/week). Four different sports categories were devised (a: combat sports, b: game sports; c: explosive strength sport; d: endurance sport). Analysis was described descriptively, regarding age, gender, and sport. In addition, 95% confidence intervals (CI) were calculated. About 168 (8%) athletes were allocated into the BP group. About 9% of females and 7% of males reported BP. Athletes, 11-13years, showed a prevalence of 2-4%; while prevalence increased to 12-20% in 14- to 17-year olds. Considering sport discipline, prevalence ranged from 3% (soccer) to 14% (canoeing). Prevalences in weight lifting, judo, wrestling, rowing, and shooting were 10%; in boxing, soccer, handball, cycling, and horse riding, 6%. 95% CI ranged between 0.08-0.11. BP exists in adolescent athletes, but is uncommon and shows no gender differences. A prevalence increase after age 14 is obvious. Differentiated prevention programs in daily training routines might address sport discipline-specific BP prevalence.
Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section
(2017)
Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation. The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients. Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients.
Instrumented treadmills offer the potential to generate standardized walking perturbations, which are particularly rapid and powerful. However, technical requirements to release adequate perturbations regarding timing, duration and amplitude are demanding. This study investigated the test-retest reliability and validity of a new treadmill perturbation protocol releasing rapid and unexpected belt perturbations to provoke muscular reflex responses at lower extremities and the trunk. Fourteen healthy participants underwent two identical treadmill walking protocols, consisting of 10 superimposed one-sided belt perturbations (100 ms duration; 2 m/s amplitude), triggered by a plantar pressure insole 200 ms after heel contact. Delay, duration and amplitude of applied perturbations were recorded by 3D-motion capture. Muscular reflex responses (within 200 ms) were measured at lower extremities and the trunk (10-lead EMG). Data was analyzed descriptively (mean +/- SD). Reliability was analyzed using test-retest variability (TRV%) and limits of agreement (LoA, bias +/- 1.96*SD). Perturbation delay was 202 14 ms, duration was 102 +/- 4 ms and amplitude was 2.1 +/- 0.01 m/s. TRV for perturbation delay, duration and amplitude ranged from 5.0% to 5.7%. LoA reached 3 +/- 36 ms for delay, 2 +/- 13 ms for duration and 0.0 +/- 0.3 m/s for amplitude. EMG amplitudes following perturbations ranged between 106 +/- 97% and 909 +/- 979% of unperturbed gait and EMG latencies between 82 +/- 14 ms and 106 +/- 16 ms. Minor differences between preset and observed perturbation characteristics and results of test-retest analysis prove a high validity with excellent reliability of the setup. Therefore, the protocol tested can be recommended to provoke muscular reflex responses at lower extremities and the trunk in perturbed walking. (C) 2017 Elsevier Ltd. All rights reserved.
Objectives: Anticipated affective responses influence decision-making processes in profound ways. The present study emphasized the role of anticipated regret and assessed the additive and interactive effects of anticipated regret in predicting doping intentions among adolescent athletes. Design: Survey-based, correlational. Method: Two hundred and sixteen adolescent athletes (M age = 17.37, SD = 1.68, 79.1% males) from team sports took part in the study and completed structured and anonymous questionnaires on social cognitive variables relevant to doping use, anticipated regret from engaging in doping and doping intentions. Results: Variance-based structural equation modeling showed that anticipated regret significantly predicted doping intentions over and above the effects of past use of doping substances and nutritional supplements, and other social cognitive predictors, and the overall model predicted 72% of the variance in doping intentions. Further analysis of interaction effects showed that anticipated regret significantly interacted with past use of nutritional supplements, and subjective and descriptive social norms in predicting doping intentions. Conclusions: Anticipated regret represents a theoretically relevant and important predictor of doping intentions in sports, and can have a protective role against pro-doping use intentions among athletes with past use of nutritional supplements. Regret also appears to be relevant to social norms and expectations, thus, highlighting for the first time a normative component in the process linking anticipated affective responses with behavioural intentions. (C) 2017 Elsevier Ltd. All rights reserved.
This study aimed at examining the effects of plyometric training on stable (SPT) vs. unstable (UPT) surfaces on physical fitness in prepuberal soccer players. Male athletes were randomly assigned to SPT (n = 18; age = 12.7 +/- 0.2 years) or UPT (n = 16; age = 12.2 +/- 0.5 years). Both groups conducted 3 regular soccer training sessions per week combined with either 2 SPT or UPT sessions. Assessment of jumping ability (countermovement jump [CMJ], and standing long jump [SLJ]), speed (10-m, 20-m, 30-m sprint), agility (Illinois agility test [IAT]), and balance (stable [SSBT], unstable [USBT] stork balance test; stable [SYBT], unstable [UYBT] Y balance test) was conducted pre-and post-training. An ANCO-VA model was used to test for between-group differences (SPT vs. UPT) at post-test using baseline values as covariates. No significant differences were found for CMJ height (p > 0.05, d = 0.54), SLJ (p > 0.05; d = 0.81), 10-m, 20-m, and 30-m sprint performances (p > 0.05, d = 0.00-0.24), IAT (p > 0.05, d = 0.48), and dynamic balance (SYBT and UYBT, both p > 0.05, d = 0.39, 0.08, respectively). Statistically significant between-group differences were detected for the USBT (p < 0.01, d = 1.86) and the SSBT (p < 0.01, d = 1.75) in favor of UPT. Following 8 weeks of SPT or UPT in prepuberal athletes, similar performance levels were observed in both groups for measures of jumping ability, speed, dynamic balance, and agility. However, if the goal is to additionally enhance static balance, UPT has an advantage over SPT.
In the context of back pain, great emphasis has been placed on the importance of trunk stability, especially in situations requiring compensation of repetitive, intense loading induced during high-performance activities, e.g., jumping or landing. This study aims to evaluate trunk muscle activity during drop jump in adolescent athletes with back pain (BP) compared to athletes without back pain (NBP). Eleven adolescent athletes suffering back pain (BP: m/f: n = 4/7; 15.9 +/- 1.3 y; 176 +/- 11 cm; 68 +/- 11 kg; 12.4 +/- 10.5 h/we training) and 11 matched athletes without back pain (NBP: m/f: n = 4/7; 15.5 +/- 1.3 y; 174 +/- 7 cm; 67 +/- 8 kg; 14.9 +/- 9.5 h/we training) were evaluated. Subjects conducted 3 drop jumps onto a force plate (ground reaction force). Bilateral 12-lead SEMG (surface Electromyography) was applied to assess trunk muscle activity. Ground contact time [ms], maximum vertical jump force [N], jump time [ms] and the jump performance index [m/s] were calculated for drop jumps. SEMG amplitudes (RMS: root mean square [%]) for all 12 single muscles were normalized toMIVC (maximum isometric voluntary contraction) and analyzed in 4 time windows (100 ms pre- and 200 ms post-initial ground contact, 100 ms pre- and 200 ms post-landing) as outcome variables. In addition, muscles were grouped and analyzed in ventral and dorsal muscles, as well as straight and transverse trunk muscles. Drop jump ground reaction force variables did not differ between NBP and BP (p > 0.05). Mm obliquus externus and internus abdominis presented higher SEMG amplitudes (1.3-1.9-fold) for BP (p < 0.05). Mm rectus abdominis, erector spinae thoracic/lumbar and latissimus dorsi did not differ (p > 0.05). The muscle group analysis over the whole jumping cycle showed statistically significantly higher SEMG amplitudes for BP in the ventral (p = 0.031) and transverse muscles (p = 0.020) compared to NBP. Higher activity of transverse, but not straight, trunk muscles might indicate a specific compensation strategy to support trunk stability in athletes with back pain during drop jumps. Therefore, exercises favoring the transverse trunk muscles could be recommended for back pain treatment.
Background: In isometric muscle function, there are subjectively two different modes of performance: one can either hold isometrically - thus resist an impacting force - or push isometrically -therefore work against a stable resistance. The purpose of this study is to investigate whether or not two different isometric muscle actions - the holding vs. pushing one (HIMA vs PIMA) - can be distinguished by objective parameters. Methods: Ten subjects performed two different measuring modes at 80% of MVC realized by a special pneumatic system. During HIMA the subject had to resist the defined impacting force of the pneumatic system in an isometric position, whereby the force of the cylinder works in direction of elbow flexion against the subject. During PIMA the subject worked isometrically in direction of elbow extension against a stable position of the system. The signals of pressure, force, acceleration and mechanomyography/-tendography (MMG/MTG) of the elbow extensor (MMGtri/MTGtri) and the abdominal muscle (MMGobl) were recorded and evaluated concerning the duration of maintaining the force level (force endurance) and the characteristics of MMG-/MTG-signals. Statistical group differences comparing HIMA vs. PIMA were estimated using SPSS. Results: Significant differences between HIMA and PIMA were especially apparent regarding the force endurance: During HIMA the subjects showed a decisively shorter time of stable isometric position (19 +/- 8 s) in comparison with PIMA (41 +/- 24 s; p = .005). In addition, during PIMA the longest isometric plateau amounted to 59.4% of the overall duration time of isometric measuring, during HIMA it lasted 31.6% (p = .000). The frequency of MMG/MTG did not show significant differences. The power in the frequency ranges of 8-15 Hz and 10-29 Hz was significantly higher in the MTGtri performing HIMA compared to PIMA (but not for the MMGs). The amplitude of MMG/MTG did not show any significant difference considering the whole measurement. However, looking only at the last 10% of duration time (exhaustion), the MMGtri showed significantly higher amplitudes during PIMA. Conclusion: The results suggest that under holding isometric conditions muscles exhaust earlier. That means that there are probably two forms of isometric muscle action. We hypothesize two potential reasons for faster yielding during HIMA: (1) earlier metabolic fatigue of the muscle fibers and (2) the complexity of neural control strategies.
Repetitive overhead movements have been identified as a main risk factor to develop shoulder complaints with scapular muscle activity being altered. Reliable assessment of muscle activity is essential to differentiate between symptomatic and asymptomatic individuals. Therefore, the present study aimed to investigate the intra-and inter-session reliability of scapular muscle activity during maximal isokinetic shoulder flexion and extension. Eleven asymptomatic adults performed maximum effort isokinetic shoulder flexion and extension (concentric and eccentric at 60 degrees/s) in a test-retest design. Muscle activity of the upper and lower trapezius and serratus anterior was assessed by sEMG. Root Mean Square was calculated for whole ROM and single movement phases of absolute and normalized muscle activity. Absolute (Bland-Altman analysis (Bias, LoA), Minimal detectable change (MDC)) and relative reliability parameters (Intraclass correlation coefficient (ICC), coefficient of variation (CV)/test-retest variability (TRV)) were utilized for the evaluation of reproducibility. Intra-session reliability revealed ICCs between 0.56 and 0.98, averaged CVs of 18% and average MDCs of 81 mV. Inter-session reliability resulted in ICCs between 0.13 and 0.93, averaged TRVs of 21%, average MDCs of 15% and systematic and random error between -8 +/- 60% and 12 +/- 36%. Scapular muscle activity assessed in overhead movements can be measured reliably under maximum load conditions, though variability is dependent on the movement phase. Measurement variability does not exceed magnitudes of altered scapular muscle activities as reported in previous studies. Therefore, maximum load application is a promising approach for the evaluation of changes in scapular control related to pathologies. (C) 2017 Elsevier Ltd. All rights reserved.
Non-local or crossover (contralateral and non-stretched muscles) increases in range-of-motion (ROM) and balance have been reported following rolling of quadriceps, hamstrings and plantar flexors. Since there is limited information regarding plantar sole (foot) rolling effects, the objectives of this study were to determine if unilateral foot rolling would affect ipsilateral and contralateral measures of ROM and balance in young healthy adults. A randomized within-subject design was to examine non-local effects of unilateral foot rolling on ipsilateral and contralateral limb ankle dorsiflexion ROM and a modified sit-and-reachtest (SRT). Static balance was also tested during a 30 s single leg stance test. Twelve participants performed three bouts of 60 s unilateral plantar sole rolling using a roller on the dominant foot with 60 s rest intervals between sets. ROM and balance measures were assessed in separate sessions at pre-intervention, immediately and 10 minutes post-intervention. To evaluate repeated measures effects, two SRT pre-tests were implemented. Results demonstrated that the second pre-test SRT was 6.6% higher than the first pre-test (p = 0.009, d = 1.91). There were no statistically significant effects of foot rolling on any measures immediately or 10 min post-test. To conclude, unilateral foot rolling did not produce statistically significant increases in ipsilateral or contralateral dorsiflexion or SRT ROM nor did it affect postural sway. Our statistically non-significant findings might be attributed to a lower degree of roller-induced afferent stimulation due to the smaller volume of myofascia and muscle compared to prior studies. Furthermore, ROM results from studies utilizing a single pre-test without a sufficient warm-up should be viewed critically.
Background: The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP). Methods: This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively. Demographic data included age, gender, and type of health insurance coverage. The share of elderly people with benzodiazepine prescriptions was estimated in different age and disease groups for both GP and NP patients. The share of the six most commonly prescribed drugs was also calculated for each type of practice. Results: The share of people taking benzodiazepines prescribed by GP increased from 3.2% in patients aged between 65 and 69 years to 8.6% in patients aged between 90 and 100 years, whereas this share increased from 5.4% to 7.1% in those seen by NP. Benzodiazepines were frequently used by patients suffering from sleep disorders (GP: 33.9%; NP: 5.5%), depression (GP: 17.9%; NP: 29.8%), and anxiety disorders (GP: 14.5%; NP: 22.8%). Lorazepam (30.3%), oxazepam (24.7%), and bromazepam (24.3%) were the three most commonly prescribed drugs for GP patients. In contrast, lorazepam (60.4%), diazepam (14.8%), and oxazepam (11.2%) were those more frequently prescribed to NP patients. Conclusion: Prescription patterns of benzodiazepine in the elderly varied widely between GP and NP.
Purpose Using a novel technique of high-density surface EMG decomposition and motor unit (MU) tracking, we compared changes in the properties of vastus medialis and vastus lateralis MU after endurance (END) and high-intensity interval training (HIIT). Methods Sixteen men were assigned to the END or the HIIT group (n = 8 each) and performed six training sessions for 14 d. Each session consisted of 8-12 x 60-s intervals at 100% peak power output separated by 75 s of recovery (HIIT) or 90-120 min continuous cycling at similar to 65% VO2peak (END). Pre- and postintervention, participants performed 1) incremental cycling to determine VO2peak and peak power output and 2) maximal, submaximal (10%, 30%, 50%, and 70% maximum voluntary contraction [MVC]), and sustained (until task failure at 30% MVC) isometric knee extensions while high-density surface EMG signals were recorded from the vastus medialis and vastus lateralis. EMG signals were decomposed (submaximal contractions) into individual MU by convolutive blind source separation. Finally, MU were tracked across sessions by semiblind source separation. Results After training, END and HIIT improved VO2peak similarly (by 5.0% and 6.7%, respectively). The HIIT group showed enhanced maximal knee extension torque by similar to 7% (P = 0.02) and was accompanied by an increase in discharge rate for high-threshold MU (50% knee extension MVC) (P < 0.05). By contrast, the END group increased their time to task failure by similar to 17% but showed no change in MU discharge rates (P > 0.05). Conclusions HIIT and END induce different adjustments in MU discharge rate despite similar improvements in cardiopulmonary fitness. Moreover, the changes induced by HIIT are specific for high-threshold MU. For the first time, we show that HIIT and END induce specific neuromuscular adaptations, possibly related to differences in exercise load intensity and training volume.
Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.
Canonical finger postures, as used in counting, activate number knowledge, but the exact mechanism for this priming effect is unclear. Here we dissociated effects of visual versus motor priming of number concepts. In Experiment 1, participants were exposed either to pictures of canonical finger postures (visual priming) or actively produced the same finger postures (motor priming) and then used foot responses to rapidly classify auditory numbers (targets) as smaller or larger than 5. Classification times revealed that manually adopted but not visually perceived postures primed magnitude classifications. Experiment 2 obtained motor priming of number processing through finger postures also with vocal responses. Priming only occurred through canonical and not through non-canonical finger postures. Together, these results provide clear evidence for motor priming of number knowledge. Relative contributions of vision and action for embodied numerical cognition and the importance of canonicity of postures are discussed.
Background In patients with mild cognitive impairment (MCI), gait instability, particularly in dual-task situations, has been associated with impaired executive function and an increased fall risk. Ginkgo biloba extract (GBE) could be an effective mean to improve gait stability. Aims This study investigated the effect of GBE on spatiotemporal gait parameters of MCI patients while walking under single and dual-task conditions. Methods Fifty patients aged 50-85 years with MCI and associated dual-task-related gait impairment participated in this randomised, double-blind, placebo-controlled, exploratory phase IV drug trial. Intervention group (IG) patients received GBE (Symfona (R) forte 120 mg) twice-daily for 6 months while control group (CG) patients received placebo capsules. A 6-month open-label phase with identical GBE dosage followed. Gait was quantified at months 0, 3, 6 and 12. Results After 6 months, dual-task-related cadence increased in the IG compared to the CG (p = 0.019, d = 0.71). No significant changes, but GBE-associated numerical non-significant trends were found after 6-month treatment for dual-task-related gait velocity and stride time variability. Discussion Findings suggest that 120 mg of GBE twice-daily for at least 6 months may improve dual-task-related gait performance in patients with MCI. Conclusions The observed gait improvements add to the understanding of the self-reported unspecified improvements among MCI patients when treated with standardised GBE.
This study is intended to find more effective and robust clinical diagnostic indices to characterize muscle strength and coordination alternation following anterior cruciate ligament (ACL) rupture. To evaluate angle-specific moments and hamstring (H)/quadriceps (Q) ratios, 46 male subjects with unilateral chronic ACL-rupture performed isokinetic concentric (c), eccentric (e) quadriceps and hamstring muscle tests respectively at 60 degrees/s. Normalized moments and H/Q ratios were calculated for peak moment (PM) and 30 degrees, 40 degrees, 50 degrees, 60 degrees, 70 degrees, 80 degrees knee flexion angles. Furthermore, we introduced single-to-arithmetic-mean (SAM) and single-to-root-mean-square (SRMS) muscle co-contraction ratios, calculating them for specific angles and different contraction repetitions. Normalized PM and 40 degrees specific concentric quadriceps, concentric hamstring strength in the ACL-deficient knee were reduced significantly (P <= 0.05). Concentric angle-specific moments together with Qe/Qc ratios at 40 degrees (d = 0.766 vs. d = 0.654) identify more obvious differences than peak values in ACL ruptured limbs. Furthermore, we found SRMS-QeQc deficits at 40 degrees showed stronger effect than Qe/Qc ratios (d = 0.918 vs. d = 0.766), albeit other ratio differences remained basically the same effect size as the original H/Q ratios. All the newly defined SAM and SRMS indices could decrease variance. Overall, 40 degrees knee moments and SAM/ SRMS ratios might be new potential diagnosis indices for ACL rupture detection.
A comparison of running kinetics in children with and without genu varus: A cross sectional study
(2017)
Introduction Varus knee alignment has been identified as a risk factor for the progression of medial knee osteoarthritis. However, the underlying mechanisms have not been elucidated yet in children. Thus, the aims of the present study were to examine differences in ground reaction forces, loading rate, impulses, and free moment values during running in children with and without genu varus. Methods Thirty-six boys aged 9-14 volunteered to participate in this study. They were divided in two age-matched groups (genu varus versus healthy controls). Body weight adjusted three dimensional kinetic data (Fx, Fy, Fz) were collected during running at preferred speed using two Kistler force plates for the dominant and non-dominant limb. Results Individuals with knee genu varus produced significantly higher (p = .01; d = 1.09; 95%) body weight adjusted ground reaction forces in the lateral direction (Fx) of the dominant limb compared to controls. On the non-dominant limb, genu varus patients showed significantly higher body weight adjusted ground reaction forces values in the lateral (p = .01; d = 1.08; 86%) and medial (p < .001; d = 1.55; 102%) directions (Fx). Further, genu varus patients demonstrated 55% and 36% greater body weight adjusted loading rates in the dominant (p < .001; d = 2.09) and non-dominant (p < .001; d = 1.02) leg, respectively. No significant between-group differences were observed for adjusted free moment values (p>.05). Discussion Higher mediolateral ground reaction forces and vertical loading rate amplitudes in boys with genu varus during running at preferred running speed may accelerate the development of progressive joint degeneration in terms of the age at knee osteoarthritis onset. Therefore, practitioners and therapists are advised to conduct balance and strength training programs to improve lower limb alignment and mediolateral control during dynamic movements.
Background: Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. Methods/design: This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. Discussion: We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.
The purpose of this study was to examine whether drop height-induced changes in leg muscle activity during drop jumps (DJ) are additionally modulated by surface condition. Twenty-four healthy participants (23.7 +/- 1.8years) performed DJs on a force plate on stable, unstable, and highly unstable surfaces using different drop heights (i.e., 20cm, 40cm, 60cm). Electromyographic (EMG) activity of soleus (SOL), gastrocnemius (GM), tibialis anterior (TA) muscles and coactivation of TA/SOL and TA/GM were analyzed for time intervals 100ms prior to ground contact (preactivation) and 30-60ms after ground contact [short latency response (SLR)]. Increasing drop heights resulted in progressively increased SOL and GM activity during preactivation and SLR (P<0.01; 1.01 d 5.34) while TA/SOL coactivation decreased (P<0.05; 0.51 d 3.01). Increasing surface instability produced decreased activities during preactivation (GM) and SLR (GM, SOL) (P<0.05; 1.36 d 4.30). Coactivation increased during SLR (P<0.05; 1.50 d 2.58). A significant drop heightxsurface interaction was observed for SOL during SLR. Lower SOL activity was found on unstable compared to stable surfaces for drop heights 40cm (P<0.05; 1.25 d 2.12). Findings revealed that instability-related changes in activity of selected leg muscles are minimally affected by drop height.
Objective:Common genetic variants in the gene encoding uromodulin (UMOD) have been associated with renal function, blood pressure (BP) and hypertension. We investigated the associations between an important single nucleotide polymorphism (SNP) in UMOD, that is rs12917707-G>T, and estimated glomerular filtration rate (eGFR), BP and cardiac organ damage as determined by echocardiography in patients with arterial hypertension.Methods:A cohort of 1218 treated high-risk patients (mean age 58.5 years, 83% men) with documented cardiovascular disease (81% with coronary heart disease) was analysed.Results:The mean values for 24-h SBP and DBP were 124.714.7 and 73.9 +/- 9.4mmHg; mean eGFR was 77.5 +/- 18.3ml/min per 1.73m(2), mean left ventricular ejection fraction was 59.3 +/- 9.9% and mean left ventricular mass index in men and women was 53.9 +/- 23.2 and 54.9 +/- 23.7g/m(2.7) with 50.4% of patients having left ventricular hypertrophy. A significant association between rs12917707 and eGFR was observed with T-allele carriers showing significantly higher eGFR values (+2.6ml/min per 1.73m(2), P=0.006) than noncarriers. This SNP associated also with left atrial diameter (P=0.007); homozygous carriers of the T-allele had smaller left atrial diameter (-1.5mm) than other genotype groups (P=0.040). No significant associations between rs12917707 and other cardiac or BP phenotypes were observed.Conclusions:These findings extend the previously documented role of UMOD for renal function also to treated high-risk patients with arterial hypertension and reveal a novel association with left atrial remodelling and thus a potential cardiorenal link modulated by UMOD.
Physical activity (PA) can play an important role in improving the mental and physical health in patients with mental disorders but is not well studied in this population. The aim of this study was to assess the status of PA in outpatients with mental disorders, compare the convergence of self-rating and accelerometer measurement and examine the influence of social cognitive variables from the Motivation-Volition (MoVo) model and clinical measures on PA. Eighty-four patients were recruited from three psychiatric outpatient clinics and local psychiatrists (Distribution of ICD-10-Diagnoses: F3.x = 59.5%, F4.x = 20.2%, F2.x = 17.9%, F1.x = 2.4%). PA, Self-efficacy, Outcome-expectancies, Intention, Self-concordance, Action- and Coping-planning, Health-related Quality of Life (SF-12) and Psychiatric Symptoms (SCL-27) were assessed through questionnaires. PA was assessed objectively by accelerometers. Most of the participants did not reach PA recommendations. Subjective and objective measurement of PA showed good accordance for total PA on group level but lower accordance on individual level. Motivational and volitional determinants of health behavior change showed a similar pattern of correlations with PA as in populations without mental disorders. Outpatients with mental disorders have the ability and are willing to perform PA but a large proportion of our sample did not meet PA recommendations. To assess group levels of PA, subjective and objective measurement seem equally apt, for individual diagnostics, a combination of both should be considered. Social cognitive determinants of health behavior change seem to be as helpful for the design of PA interventions for patients with mental disorders as they are in other populations.
BACKGROUND: Addiction is supposedly characterized by a shift from goal-directed to habitual decision making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modeling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based versus model-free decision making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients. METHODS: Ninety detoxified, medication-free, alcohol-dependent patients and 96 age-and gender-matched control subjects underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire. Over a follow-up period of 48 weeks, 37 patients remained abstinent and 53 patients relapsed as indicated by the Alcohol Timeline Followback method. RESULTS: Patients who relapsed displayed reduced medial prefrontal cortex activation during model-based decision making. Furthermore, high alcohol expectancies were associated with low model-based control in relapsers, while the opposite was observed in abstainers and healthy control subjects. However, reduced model-based control per se was not associated with subsequent relapse. CONCLUSIONS: These findings suggest that poor treatment outcome in alcohol dependence does not simply result from a shift from model-based to model-free control but is instead dependent on the interaction between high drug expectancies and low model-based decision making. Reduced model-based medial prefrontal cortex signatures in those who relapse point to a neural correlate of relapse risk. These observations suggest that therapeutic interventions should target subjective alcohol expectancies.
Previous studies contrasted the effects of plyometric training (PT) conducted on stable vs. unstable surfaces on components of physical fitness in child and adolescent soccer players. Depending on the training modality (stable vs. unstable), specific performance improvements were found for jump (stable PT) and balance performances (unstable PT). In an attempt to combine the effects of both training modalities, this study examined the effects of PT on stable surfaces compared with combined PT on stable and unstable surfaces on components of physical fitness in prepuberal male soccer athletes. Thirty-three boys were randomly assigned to either a PT on stable surfaces (PTS; n = 17; age = 12.1 +/- 0.5 years; height = 151.6 +/- 5.7 cm; body mass = 39.2 +/- 6.5 kg; and maturity offset = 22.3 +/- 0.5 years) or a combined PT on stable and unstable surfaces (PTC; n = 16; age = 12.2 +/- 0.6 years; height = 154.6 +/- 8.1 cm; body mass = 38.7 +/- 5.0 kg; and maturity offset = 22.2 +/- 0.6 years). Both intervention groups conducted 4 soccer-specific training sessions per week combined with either 2 PTS or PTC sessions. Before and after 8 weeks of training, proxies of muscle power (e.g., countermovement jump [CMJ], standing long jump [SLJ]), muscle strength (e.g., reactive strength index [RSI]), speed (e.g., 20-m sprint test), agility (e.g., modified Illinois change of direction test [MICODT]), static balance (e.g., stable stork bal-ance test [SSBT]), and dynamic balance (unstable stork balance test [USBT]) were tested. An analysis of covariance model was used to test between-group differences (PTS vs. PTC) at posttest using baseline outcomes as covariates. No significant between-group differences at posttest were observed for CMJ (p > 0.05, d = 0.41), SLJ (p > 0.05, d = 0.36), RSI (p > 0.05, d = 0.57), 20-m sprint test (p > 0.05, d = 0.06), MICODT (p > 0.05, d = 0.23), and SSBT (p > 0.05, d = 0.20). However, statistically significant between-group differences at posttest were noted for the USBT (p < 0.01, d = 1.49) in favor of the PTC group. For most physical fitness tests (except RSI), significant pre-to-post improvements were observed for both groups (p < 0.01, d = 0.55-3.96). Eight weeks of PTS or PTC resulted in similar performance improvements in components of physical fitness except for dynamic balance. From a performance-enhancing perspective, PTC is recommended for pediatric strength and conditioning coaches because it produced comparable training effects as PTS on proxies of muscle power, muscle strength, speed, agility, static balance, and additional effects on dynamic balance.
Background
In health research, indicators of socioeconomic status (SES) are often used interchangeably and often lack theoretical foundation. This makes it difficult to compare results from different studies and to explore the relationship between SES and health outcomes. To aid researchers in choosing appropriate indicators of SES, this article proposes and tests a theory-based selection of SES indicators using chronic back pain as a health outcome.
Methods
Strength of relationship predictions were made using Brunner & Marmot’s model of ‘social determinants of health’. Subsequently, a longitudinal study was conducted with 66 patients receiving in-patient treatment for chronic back pain. Sociodemographic variables, four SES indicators (education, job position, income, multidimensional index) and back pain intensity and disability were obtained at baseline. Both pain dimensions were assessed again 6 months later. Using linear regression, the predictive strength of each SES indicator on pain intensity and disability was estimated and compared to the theory based prediction.
Results
Chronic back pain intensity was best predicted by the multidimensional index (beta = 0.31, p < 0.05), followed by job position (beta = 0.29, p < 0.05) and education (beta = −0.29, p < 0.05); whereas, income exerted no significant influence. Back pain disability was predicted strongest by education (beta = −0.30, p < 0.05) and job position (beta = 0.29, p < 0.05). Here, multidimensional index and income had no significant influence.
Conclusions
The choice of SES indicators influences predictive power on both back pain dimensions, suggesting SES predictors cannot be used interchangeably. Therefore, researchers should carefully consider prior to each study which SES indicator to use. The introduced framework can be valuable in supporting this decision because it allows for a stable prediction of SES indicator influence and their hierarchy on a specific health outcomes.
Background Low back pain (LBP) is a common pain syndrome in athletes, responsible for 28% of missed training days/year. Psychosocial factors contribute to chronic pain development. This study aims to investigate the transferability of psychosocial screening tools developed in the general population to athletes and to define athlete-specific thresholds.
Methods Data from a prospective multicentre study on LBP were collected at baseline and 1-year follow-up (n=52 athletes, n=289 recreational athletes and n=246 non-athletes). Pain was assessed using the Chronic Pain Grade questionnaire. The psychosocial Risk Stratification Index (RSI) was used to obtain prognostic information regarding the risk of chronic LBP (CLBP). Individual psychosocial risk profile was gained with the Risk Prevention Index – Social (RPI-S). Differences between groups were calculated using general linear models and planned contrasts. Discrimination thresholds for athletes were defined with receiver operating characteristics (ROC) curves.
Results Athletes and recreational athletes showed significantly lower psychosocial risk profiles and prognostic risk for CLBP than non-athletes. ROC curves suggested discrimination thresholds for athletes were different compared with non-athletes. Both screenings demonstrated very good sensitivity (RSI=100%; RPI-S: 75%–100%) and specificity (RSI: 76%–93%; RPI-S: 71%–93%). RSI revealed two risk classes for pain intensity (area under the curve (AUC) 0.92(95% CI 0.85 to 1.0)) and pain disability (AUC 0.88(95% CI 0.71 to 1.0)).
Conclusions Both screening tools can be used for athletes. Athlete-specific thresholds will improve physicians’ decision making and allow stratified treatment and prevention.
The general purpose of this systematic review was to summarize, structure and evaluate the findings on automatic evaluations of exercising. Studies were eligible for inclusion if they reported measuring automatic evaluations of exercising with an implicit measure and assessed some kind of exercise variable. Fourteen nonexperimental and six experimental studies (out of a total N = 1,928) were identified and rated by two independent reviewers. The main study characteristics were extracted and the grade of evidence for each study evaluated. First, results revealed a large heterogeneity in the applied measures to assess automatic evaluations of exercising and the exercise variables. Generally, small to large-sized significant relations between automatic evaluations of exercising and exercise variables were identified in the vast majority of studies. The review offers a systematization of the various examined exercise variables and prompts to differentiate more carefully between actually observed exercise behavior (proximal exercise indicator) and associated physiological or psychological variables (distal exercise indicator). Second, a lack of transparent reported reflections on the differing theoretical basis leading to the use of specific implicit measures was observed. Implicit measures should be applied purposefully, taking into consideration the individual advantages or disadvantages of the measures. Third, 12 studies were rated as providing first-grade evidence (lowest grade of evidence), five represent second-grade and three were rated as third-grade evidence. There is a dramatic lack of experimental studies, which are essential for illustrating the cause-effect relation between automatic evaluations of exercising and exercise and investigating under which conditions automatic evaluations of exercising influence behavior. Conclusions about the necessity of exercise interventions targeted at the alteration of automatic evaluations of exercising should therefore not be drawn too hastily.
Background
Back pain patients (BPP) show delayed muscle onset, increased co-contractions, and variability as response to quasi-static sudden trunk loading in comparison to healthy controls (H). However, it is unclear whether these results can validly be transferred to suddenly applied walking perturbations, an automated but more functional and complex movement pattern. There is an evident need to develop research-based strategies for the rehabilitation of back pain. Therefore, the investigation of differences in trunk stability between H and BPP in functional movements is of primary interest in order to define suitable intervention regimes. The purpose of this study was to analyse neuromuscular reflex activity as well as three-dimensional trunk kinematics between H and BPP during walking perturbations.
Methods
Eighty H (31m/49f;29±9yrs;174±10cm;71±13kg) and 14 BPP (6m/8f;30±8yrs;171±10cm;67±14kg) walked (1m/s) on a split-belt treadmill while 15 right-sided perturbations (belt decelerating, 40m/s2, 50ms duration; 200ms after heel contact) were randomly applied. Trunk muscle activity was assessed using a 12-lead EMG set-up. Trunk kinematics were measured using a 3-segment-model consisting of 12 markers (upper thoracic (UTA), lower thoracic (LTA), lumbar area (LA)). EMG-RMS ([%],0-200ms after perturbation) was calculated and normalized to the RMS of unperturbed gait. Latency (TON;ms) and time to maximum activity (TMAX;ms) were analysed. Total motion amplitude (ROM;[°]) and mean angle (Amean;[°]) for extension-flexion, lateral flexion and rotation were calculated (whole stride cycle; 0-200ms after perturbation) for each of the three segments during unperturbed and perturbed gait. For ROM only, perturbed was normalized to unperturbed step [%] for the whole stride as well as the 200ms after perturbation. Data were analysed descriptively followed by a student´s t-test to account for group differences. Co-contraction was analyzed between ventral and dorsal muscles (V:R) as well as side right:side left ratio (Sright:Sleft). The coefficient of variation (CV;%) was calculated (EMG-RMS;ROM) to evaluate variability between the 15 perturbations for all groups. With respect to unequal distribution of participants to groups, an additional matched-group analysis was conducted. Fourteen healthy controls out of group H were sex-, age- and anthropometrically matched (group Hmatched) to the BPP.
Results
No group differences were observed for EMG-RMS or CV analysis (EMG/ROM) (p>0.025). Co-contraction analysis revealed no differences for V:R and Srigth:Sleft between the groups (p>0.025). BPP showed an increased TON and TMAX, being significant for Mm. rectus abdominus (p = 0.019) and erector spinae T9/L3 (p = 0.005/p = 0.015). ROM analysis over the unperturbed stride cycle revealed no differences between groups (p>0.025). Normalization of perturbed to unperturbed step lead to significant differences for the lumbar segment (LA) in lateral flexion with BPP showing higher normalized ROM compared to Hmatched (p = 0.02). BPP showed a significant higher flexed posture (UTA (p = 0.02); LTA (p = 0.004)) during normal walking (Amean). Trunk posture (Amean) during perturbation showed higher trunk extension values in LTA segments for H/Hmatched compared to BPP (p = 0.003). Matched group (BPP vs. Hmatched) analysis did not show any systematic changes of all results between groups.
Conclusion
BPP present impaired muscle response times and trunk posture, especially in the sagittal and transversal planes, compared to H. This could indicate reduced trunk stability and higher loading during gait perturbations.