Injury incidence and specific injury patterns in app-based bodyweight training (Freeletics): results of an international survey with 3668 participants.

BACKGROUND: The aim of this study was to analyze incidences and sport-specific injury patterns among users of a bodyweight-based training method instructed by a smartphone app (Freeletics Bodyweight App). METHODS: An online questionnaire based on current validated epidemiological observation methods was designed using the statistic website Surveymonkey. Subscribers of the Freeletics Bodyweight App were contacted via an online link. Injury incidence, defined as an event leading to a training pause of at least 1 day, was recorded. The type of injury was reported and classified. Furthermore, all participants were asked whether they recognized any positive or negative effects on their subjective health status. The collected data were analyzed using Surveymonkey statistic services. RESULTS: A total of 4365 Freeletics users responded to the questionnaire, 3668 completed forms were subject of further investigation. The injury period prevalence reported by users of the Freeletics App was 24% in men and 21% in women. The most frequently reported site of injury was the shoulder (29%) and the knee joint (28%), with strains (28.5%) and other muscle injuries (14.4%) being the most frequently reported types of injuries. An injury incidence rate of 4.57 per 1000 h was calculated, with injuries occurring less frequently in experienced users. Most participants reported a distinct positive effect of the app-based training on their health status. CONCLUSION: In comparison to other sports activities app-based bodyweight training is associated with a comparably low injury period prevalence. The vast majority of injuries were reported to have resolved within one week.

A prospective follow-up study on the role of clinical pharmacists in sustainably optimized pain measurement and pain therapy consequences.

Appropriate analgesic therapy requires adequate pain measurement. A few studies have already demonstrated benefits of clinical pharmacists supporting physicians' prescribing. Nevertheless, there are still open questions about pharmaceutical interventions at the nursing level in order to optimise pain therapy sustainably. We performed a prospective controlled follow-up intervention study to analyse the sustainability of improved pain measurement performance (PMP) and its therapeutic consequences. Half a year after a successful guidance implementation in two study units (control and intervention unit), pharmacists performed an individual coaching for nurses only in the intervention unit. We consecutively monitored patient-nurse contacts and evaluated PMP with a 7-point scale (from 0: no pain measurement to 6: optimal pain measurement) in three 4-week periods (t1 : before guidance implementation, t2 : directly after guidance implementation, t3 : half a year after guidance implementation) on both units. Therapeutic consequences of PMP were evaluated in a post-hoc patient chart review. In the t1 period, we found a median PMP of 0 in both units which rose to 6 (control unit) vs. 5 (intervention unit) in t2 period due to guidance implementation in both units. In the t3 period, we found a decrease of PMP to 0 in controls vs. to 4 in the intervention unit (p<0.001). We also found, that improved PMP did not lead to a more individualised analgesic prescribing and administration of more on-demand analgesics. A coaching concept of clinical pharmacists improved the sustainability of nurses' PMP after a successful guidance implementation. Our results illustrate the potential of including clinical pharmacist in interprofessional pain therapy teams.

[Surgical therapy of ischiofemoral impingement by lateralizing intertrochanteric osteotomy]. / Chirurgische Therapie des ischiofemoralen Impingements mittels lateralisierender intertrochantärer Korrekturosteotomie.

OBJECTIVE: Lateralizing, derotating intertrochanteric varus osteotomy to increase the ischiofemoral space to counter painful impingement of the lesser trochanter and the os ischium with resulting entrapment of quadratus femoris muscle. INDICATIONS: Symptomatic ischiofemoral impingement (IFI) caused by Coxa valga et antetorta, Coxa valga or Coxa antetorta, or a short femoral neck. CONTRAINDICATIONS: Anatomic configuration suggestive of IFI in asymptomatic patients. Symptomatic IFI caused by another underlying pathology. Valgus deformity of the knee. SURGICAL TECHNIQUE: Measurement of femoral antetorsion. Planning of the osteotomy, lateralization, varus angle for correction, rotation and offset correction, leg length change, and osteosynthesis plate. General or spinal anesthesia in supine or lateral position. Skin incision (15 cm) beginning lateral of the greater trochanter tip, distally along the axis of the femur. Preparation onto the femur by L­shaped dissection of the vastus lateralis from the bone. A Kirschner(K-)wire is then positioned along the anterior femoral neck to designate the femoral neck antetorsion. A triangle set on the lateral femoral cortexis is used to determine the osteotomy angle. In the thus determined angle, a second K­wire is shot centrally along the femoral neck axis just inferior to its cranial cortex. About 5 mm distal to the second wire, the entry for the blade is prepared using a drill. Using the blade setting instrument, the blade is introduced into the femoral neck, then slightly pulled back. The rotation is then marked on the anterior femoral cortex proximal and distal to the planned osteotomy and the osteotomy is performed. A blade plate without displacement is impacted. The osteotomy is then reduced, the distal fragment pulled laterally onto the plate, and the screws inserted after compression of the osteotomy with a tension device. POSTOPERATIVE MANAGEMENT: Touch-toe bearing for 6 weeks, then radiological assessment of osteotomy healing before an increase in weight bearing (15 kg/week). Hip flexion limited to 90° for 6 weeks. Elective implant removal after 12-18 months. RESULTS: Studies of this lateralizing varus osteotomy have not been published. The 25-year results of the conventional derotating intertrochanteric varus osteotomy technique show good functional results and low complication rates, with non-union being the most common. Arthroscopic resection of the lesser trochanter has been reported as a surgical alternative in the treatment of IFI in case reports and small series. Advantages of the osteotomy are the restoration of biomechanics and preservation of iliopsoas tendon insertion.

[Achilles tendon rupture : Current diagnostic and therapeutic standards]. / Achillessehnenruptur : Aktuelle Standards in Diagnostik und Therapie.

A superior life expectancy and an increased activity in the population result in an increase in degenerative diseases, such as Achilles tendon ruptures. The medical history and physical examinations are the methods of choice to diagnose Achilles tendon ruptures. Ultrasound and radiography represent reasonable extended diagnostic procedures. In order to decide on the medical indications for the therapy concept, the advantages and disadvantages of conservative and surgical treatment options have to be weighed up on an indivdual basis. There are explicit contraindications for both treatment options. For the surgical treatment concept open suture techniques, minimally invasive methods and reconstructive procedures are available. The postoperative management of the patient is as important as the choice of surgical technique. With the correct medical indications and supervision of the patient it is possible to achieve extremely satisfying results for the patient with both conservative and surgical treatment options.

[Pain assessment in routine care : A prospective observational study in an orthopedic unit]. / Schmerzerfassung in der Routineversorgung : Eine prospektive Beobachtungsstudie auf einer orthopädischen Station.

INTRODUCTION: Although well-established guidelines give advice on how to use analgesics, measure pain, and organize pain treatment, many patients still suffer from avoidable severe pain. We assume one reason for this is that pain is inadequately addressed in routine patient contacts. Thus, we aimed to evaluate the extent to which pain was addressed during patient contacts in routine orthopedic care. MATERIALS AND METHODS: In a prospective observational study in an orthopedic unit of a university hospital, we invited physicians and nurses during their routine patient contacts to be observed by independent, trained monitors. The monitors systematically assessed all pain-related aspects, which were analyzed descriptively afterwards. RESULTS: The monitors documented 572 physician-patient contacts with 7 physicians and 108 patients and 578 nurse-patient contacts with 12 nurses and 102 patients. Physicians and nurses asked their patients about pain in 20 and 16 % of the patient contacts, respectively. While in physician-patient contacts, patients most frequently addressed their current pain situation (in 35 % of contacts), in nurse-patient contacts, patients most frequently addressed their need for analgesics (52 %). Patients rated their pain intensity in 16 % of physician-patient contacts vs. 17 % of nurse-patient contacts. CONCLUSIONS: Using a comprehensive external monitoring procedure, we found that systematic pain assessment was not optimally standardized and implemented for systematic, individualized pain therapy by physicians or nurses in our routine care setting.

Exercise-induced alterations of retinal vessel diameters and cardiovascular risk reduction in obesity.

BACKGROUND: The retinal microcirculation is affected early in the process of atherosclerosis and retinal vessel caliber is an emerging cardiovascular risk factor. Obesity is associated with vascular dysfunction. Here, we investigate the effect of regular exercise on retinal vessel diameters in lean and obese runners. We analyze a possible link to alterations of the nitric oxide (NO)-asymmetric dimethylarginine (ADMA) pathway. METHODS: Retinal vessel diameters were assessed by means of a static vessel analyzer (SVA-T) in 15 obese athletes (OA), 14 lean amateur athletes (AA) and 17 lean elite athletes (EA) following a 10 week training program. ADMA serum levels were detected by ELISA and dimethylarginine dimethylaminohydrolase (DDAH) -1/-2 mRNA-expression in peripheral mononuclear cells (PBMC) was analyzed by real time PCR. RESULTS: At baseline, the mean (±SD) arteriolar to venular diameter ratio (AVR) was impaired in obese (OA: 0.81±0.05) compared to lean subjects (AA: 0.87±0.07; EA: 0.94±0.05). The individual fitness levels correlated with AVR (rho=+0.66; P<0.001) and the training program improved AVR in all groups (P<0.001), normalising AVR in the obese (OA: 0.86±0.1). A training-induced arteriolar dilatation was found in OA (P=0.01), which was accompanied by a significant decrease of ADMA levels (0.56±0.12-0.46±0.12 µmoll(-1); P<0.028). DDAH-1 mRNA levels in PBMC increased in all groups (P<0.01). CONCLUSIONS: Cardiovascular fitness and body composition affect retinal vessel diameters. Regular exercise reverses the subclinical impairment of the retinal microvasculature in obesity by inducing retinal arteriolar dilatation. The NO/ADMA pathway may play a key role in the training-induced improvement of microvascular function, which has the potential to counteract progression of small vessel disease.

Motivation gains in performance groups: paradigmatic and theoretical developments on the Köhler effect.

In contrast to many demonstrations of social loafing, relatively few studies have documented group motivation gains. One such exception was O. Köhler's (1926, 1927) finding that team members working together did better at a taxing persistence task than would be expected from their individual performances, particularly when there was a moderate discrepancy in coworkers' capabilities. In Experiment 1, we developed a paradigm within which Köhler's overall motivation gain effect could be replicated, although the discrepancy in coworkers' capabilities did not moderate these motivation gains (after statistical artifacts were taken into account). Experiment 2 indicated that this motivation gain occurred under conjunctive but not under additive task demands, suggesting that the instrumentality of one's contribution to valued outcomes is a more likely explanation of the Köhler effect than social comparison processes.

Health circles for teleworkers: selective results on stress, strain and coping styles.

Telework is decentralized computer-mediated performance of work activities at a location distant from the employing organization. In order to improve well-being at such remote workplaces, we developed a health circle (HC) concept for teleworkers. Three HC sessions were conducted with a total of 17 teleworkers from diverse organizations and branches. The sessions were moderated by a professional facilitator, while the participants selected the discussion issues. Typical issues were technical problems at the home-based computer, time management, communication with supervisors, colleagues and customers, and feelings of isolation from the main company. Besides discussing these stress factors, participants developed concrete coping strategies based on the exchange of experiences and additional informational input by external experts. Process evaluation at the end of each meeting revealed that participants found the exchange of personal experiences and the informational input during the HCs very helpful, as well as the common development of coping strategies. Moreover, a questionnaire 2 months after the last HC session revealed that participants reported significantly more positive changes in typical stress factors than teleworkers in a control group. The implications of these results for preventive and corrective strategies of telework design are discussed.

In vivo and in vitro CT analysis of the occiput.

Arguments concerning the best procedure for occipito-cervical fusion have rarely been based upon occipital bone thickness or only based on in vitro studies. To close this gap and to offer an outlook on preoperative evaluation of the patient, 28 patients were analysed in vivo by means of spiral CT. Ten macerated human skulls were measured by means of CT and directly. Measurements were taken according to a matrix of 66 points following a grid with 1 cm spacing based upon McRae's line. Maximum thickness in the patient group was met 4 cm above the reference plane in the median slice (11.87 mm; SD 3.41 mm) and 5 cm above it in the skull group (15.85 mm; SD 1.81 mm). Correlation between CT and direct measurements was good (91.79%). Intra-individual discrepancies from one side to the respective point on the other side are common (difference > 1 mm in 60%). Judging areas suitable for operative fixation using the 10% percentile value (6.68 mm for the maximum value of 11.87 mm) led to the conclusion that screws should only be inserted along the occipital crest in an area extending from 1.5 cm above the posterior margin of the foramen magnum to the external occipital protuberance (EOP). At the level of the EOP screws may also be inserted up to 1 cm lateral of the midline. A reduction of screw length to 7 mm (9 mm for the EOP) is proposed. Preoperative evaluation of the patient should be carried out by spiral CT with 1 mm slicing and sagittal reconstructions.

Aspiration complicating bronchopulmonary dysplasia.

The purpose of this study was to study the relationship of aspiration with ongoing respiratory difficulties in infants with bronchopulmonary dysplasia (BPD). Twelve infants with BPD were identified out of 314 children who had flexible bronchoscopy between 1987 and 1990; 11 of 12 had bronchoalveolar lavage (BAL). The lipid index (LI) was used to quantify the degree of lipid-laden macrophages in the BAL fluid as a marker of aspiration. The age range at the time of bronchoscopy was 3 months to 5 years. The LI was considered positive in 6 of 11 subjects. A pH probe study was done on seven subjects with concordant findings in five. Other findings included dynamic or structural airway abnormalities in 10 of the 12 subjects. These data suggest that aspiration frequently is associated with BPD in addition to the previously recognized dynamic and structural airway problems. The predisposition to gastroesophageal reflux and laryngeal injury probably accounts for the increased aspiration risk in children with BPD.

Immunologic relatedness of extracellular ligninases from the actinomycetes Streptomyces viridosporus T7A and Streptomyces badius 252.

Four isoforms of the extracellular lignin peroxidase of the ligninolytic actinomycete Streptomyces viridosporus T7A (ALip-P1, P2, P3, and P4) were individually purified by ultrafiltration and ammonium sulfate precipitation, followed by electro-elution using polyacrylamide gel electrophoresis. Three of the purified peroxidases were compared for their immunologic relatedness by Western blot analysis using a polyclonal antibody preparation produced in rabbits against pure isoform P3. The anti-P3 antibody was also tested for its reactivity towards a lignin peroxidase from the white-rot fungus Phanerochaete chrysosporium and another ligninolytic actinomycete Streptomyces badius 252. Results showed that peroxidases ALip-P1 through ALip-P3 are immunologically related to one another. The peroxidases of S. badius, but not the peroxidase of P. chrysosporium, also reacted with the antibody, thus indicating that the lignin peroxidases of S. viridosporus and S. badius are immunologically related. Based upon its specific affinity, lignin peroxidase isoform ALip-P3 of S. viridosporus was readily purified using an anti-P3 antibody affinity column.

Cloning and expression of a lignin peroxidase gene from Streptomyces viridosporus in Streptomyces lividans.

A lignin peroxidase gene was cloned from Streptomyces viridosporus T7A into Streptomyces lividans TK64 in plasmid pIJ702. BglII-digested genomic DNA (4-10 kb) of S. viridosporus was shotgun-cloned into S. lividans after insertion into the melanin (mel+) gene of pIJ702. Transformants expressing pIJ702 with insert DNA were selected based upon the appearance of thiostrepton resistant (tsrr)/mel-colonies on regeneration medium. Lignin peroxidase-expressing clones were isolated from this population by screening of transformants on a tsr-poly B-411 dye agar medium. In the presence of H2O2 excreted by S. lividans, colonies of lignin peroxidase-expressing clones decolorized the dye. Among 1000 transformants screened, 2 dye-decolorizing clones were found. One, pIJ702/TK64.1 (TK64.1), was further characterized. TK64.1 expressed significant extracellular 2,4-dichlorophenol (2.4-DCP) peroxidase activity (= assay for S. viridosporus lignin peroxidase). Under the cultural conditions employed, plasmidless S. lividans TK64 had a low background level of 2.4-DCP oxidizing activity. TK64.1 excreted an extracellular peroxidase not observed in S. lividans TK64, but similar to S. viridosporus lignin peroxidase ALip-P3, as shown by activity stain assays on nondenaturing polyacrylamide gels. The gene was located on a 4 kb fragment of S. viridosporus genomic DNA. When peroxidase-encoding plasmid, pIJ702.LP, was purified and used to transform three different S. lividans strains (TK64, TK23, TK24), all transformants tested decolorized poly B-411. When grown on lignocellulose in solid state processes, genetically engineered S. lividans TK64.1 degraded the lignocellulose slightly better than did S. lividans TK64. This is the first report of the cloning of a bacterial gene coding for a lignin-degrading enzyme.

[MRT in primary and tumor-induced syringomyelia]. / MRT bei primärer und tumorbedingter Syringomyelie.

The MRI findings in 26 patients with primary syringomyelia and eight patients with a syrinx due to an intramedullary tumour were studied retrospectively. In general, the syrinx in the tumour cases resembled the appearance of primary syringomyelia. However, a specific and sensitive sign of tumour-induced syringomyelia was irregularity of the spinal cord close to the tumour (eight cases of eight), eccentric position of the lumen (seven of eight), and a diffuse increase of signal intensity on T2-weighted images (eight of eight). Primary syringomyelia also showed increased signal intensity on T2-weighted images outside the lumen, but this was closely related to the cavity. The use of Gd-DTPA improved demarcation of the tumour from the syrinx in all cases. Widening of the spinal canal and ectopia of cerebellar tonsils was a typical finding in primary syringomyelia. MRI proved a reliable method for distinguishing between a tumour-induced syrinx and primary syringomyelia.

[Anesthesia-induced changes in the preload-dependent circulatory reactions in patients with coronary heart disease]. / Anästhesiebedingte Veränderungen der vorlastabhängigen Kreislaufreaktionen bei Patienten mit koronarer Herzkrankheit.

The influence of preload changes (table tilt) on the hemodynamic regulation before and after induction of neuroleptanalgesia was studied in 31 patients with coronary heart disease. The induced preload changes are balanced in the awake patient for the maintenance of normal arterial pressure by regulation of stroke volume and peripheral vascular resistance. This regulation does not exist after induction of anaesthesia. Splitting the patients into sub-groups with good or poor left ventricular function, different ventricular function curves were obtained before and after the induction of anaesthesia. The pharmacologic and ventilatory reasons for the changed regulation of circulation are discussed. For investigations into hemodynamic changes produced by intervention in anaesthesia and intensive therapy, it is recommended to define more exactly the cardiovascular status of patients and the study conditions.

Characterization of an extracellular lignin peroxidase of the lignocellulolytic actinomycete Streptomyces viridosporus.

Previously we reported production of an extracellular lignin-inducible peroxidase by Streptomyces viridosporus (M. Ramachandra, D.L. Crawford, and A.L. Pometto III, Appl. Environ. Microbiol. 53:2754-2760, 1987). This peroxidase was shown to oxidize 3,4-dihydroxyphenylalanine, 2,4-dichlorophenol, homoprotocatechuic acid, caffeic acid, and N,N,N',N'-tetramethylphenylenediamine and was found in higher than normal levels in strains enhanced for lignocellulose degradation. In the present study, we used a pure extracellular enzyme preparation with high peroxidase isoform P3 activity to oxidize lignin substructure model compounds of both the 1,2-diaryl propane and arylglycerol-beta-aryl ether types and containing C alpha-carbonyl and C alpha-hydroxyl groups. The reactions were monitored by gas chromatography-mass spectrometry and high-pressure liquid chromatography techniques. In the presence, but not the absence, of hydrogen peroxide, the enzyme preparation catalyzed C alpha-C beta bond cleavage in the side chains of the diaryl ethers 1-(3,4-dimethoxyphenyl)-2-(2-methoxyphenoxy)propane-1,3-diol (I) and 1-(4-hydroxy-3-methoxyphenyl)-2-(2-methoxyphenoxy)propan-1-one (II) and the diaryl ethane 1-(4-methoxyphenyl)-2-(phenyl)ethan-1-one (III). Rapid hydrogen peroxide consumption was observed when the enzyme preparation was added to either milled corn lignin or lignocellulose. Additional characterizations showed that this enzyme is a heme protein (Soret band, 408 nm) and a major component of the ligninolytic system of S. viridosporus T7A. This is the first report of a lignin peroxidase in a bacterium. We have designated this new lignin peroxidase as ALiP-P3.

Double-blind crossover study comparing sodium cromoglycate, reproterol, reproterol plus sodium cromoglycate, and placebo in exercise-induced asthma.

Sixteen patients were included in the analysis of this double-blind crossover study comparing the effect of sodium cromoglycate, reproterol, sodium cromoglycate plus reproterol, and placebo in exercise-induced asthma. Both the sodium cromoglycate and the reproterol-containing treatment significantly inhibited exercise-induced asthma. The best protection is effected by the combination of sodium cromoglycate and reproterol. A synergistic effect of both medications could not be confirmed statistically so that their combined effect is simply additive.

Multiple sclerosis: diagnostic value of computerized tomography with delayed scanning after a double-dose of contrast medium in comparison with other diagnostic tests.

In 63 cases of clinical definite or suspected MS we compared the results of CSF analysis, VEP, BAEP, CT scanning without and after double dose contrast, in 17 cases also those of MRT. We found that CSF analysis had the highest rate of abnormal findings, followed by MRT. VEP and CT with double dose contrast showed similar sensitivity, while BAEP and CT without contrast had disappointing results. We think that CT with delayed scanning after double dose contrast can be a very useful investigation in early and doubtful cases of MS, until MRT will become a more widespread and less expensive investigation.