[New treatment methods in competitive sports : What can we learn from the medical care of top athletes?] / Neue Therapieverfahren im Wettkampfsport : Was können wir aus der Betreuung von Spitzensportlern lernen?

BACKGROUND: As elite sport becomes more professional, the medical-psychological care of athletes is an important factor in providing them with the best possible support and thus optimising their performance. Our experience in the fields of prevention, conservative and surgical treatment, and rehabilitation also provides valuable insights for the treatment of our patients in daily practice. PREVENTION: Designed to improve static and dynamic muscle strength, kinaesthetic sensitivity, and neuromuscular control, the FIFA 11+ injury prevention programme is a three-part warm-up programme that is widely used in coaching and recreational sports. CONSERVATIVE TREATMENT: Platelet-rich plasma (PRP) is probably the most widely used orthobiologic treatment modality for the conservative management of tendon, muscle and cartilage injuries. Its effectiveness depends on the underlying pathology and the affected body region. The best evidence exists for the treatment of patellar tendinitis ("jumper's knee") and epicondylitis humeri radialis ("tennis elbow"). SURGICAL TREATMENT: The treatment of ACL injuries in competitive athletes is challenging due to the high physical demands. Prompt surgical intervention, anatomical reconstruction and additional extra-articular stabilisation are associated with improved surgical outcomes. Graft selection must be individualised, adapted to the needs of the athletes and our patients. REHABILITATION: Electromyography (EMG) is a diagnostic tool to identify muscular imbalances in rehabilitation and, at the same time, to help reduce them through biofeedback training. COGNITIVE TRAINING: Training for the development of basic cognitive skills helps to optimise performance through its potentially positive influence on the executive functions of athletes.

The relationship of personality and executive functions in high-level soccer athletes: expertise-and gender-specific differences.

Background: Psycho-cognitive factors such as personality and executive functions (EFs) are influential parameters when it comes to examining expertise in high-level soccer. Therefore, the profiles of those athletes are relevant both from a practical and scientific point of view. The aim of this study was to investigate the relationship between personality traits and executive functions with age group as an influential factor in high-level male and female soccer players. Methods: Personality traits and executive functions of 138 high-level male and female soccer athletes from the U17-Pros teams were assessed using the big-five paradigm. A series of linear regressions investigated contributions of personality on EF assessments and team, respectively. Results: Linear regression models showed both negative and positive relationships between various personality traits, executive function performance and the influence of expertise and gender. Together, a maximum of 23% (R2 = 6%-23%) of the variance between EFs with personality and various teams, demonstrating that many unaccounted-for variables remain at play. Conclusion: The results of this study demonstrate the inconsistent relationship between personality traits and executive functions. The study calls for more replication studies to help strengthen the understanding of relationships between psycho-cognitive factors in high-level team sport athletes.

Validity and reliability of the Apple Health app on iPhone for measuring gait parameters in children, adults, and seniors.

This study assessed the concurrent validity and test-retest-reliability of the Apple Health app on iPhone for measuring gait parameters in different age groups. Twenty-seven children, 28 adults and 28 seniors equipped with an iPhone completed a 6-min walk test (6MWT). Gait speed (GS), step length (SL), and double support time (DST) were extracted from the gait recordings of the Health app. Gait parameters were simultaneously collected with an inertial sensors system (APDM Mobility Lab) to assess concurrent validity. Test-retest reliability was assessed via a second iPhone-instrumented 6MWT 1 week later. Agreement of the Health App with the APDM Mobility Lab was good for GS in all age groups and for SL in adults/seniors, but poor to moderate for DST in all age groups and for SL in children. Consistency between repeated measurements was good to excellent for all gait parameters in adults/seniors, and moderate to good for GS and DST but poor for SL in children. The Health app on iPhone is reliable and valid for measuring GS and SL in adults and seniors. Careful interpretation is required when using the Health app in children and when measuring DST in general, as both have shown limited validity and/or reliability.

CortexVR: Immersive analysis and training of cognitive executive functions of soccer players using virtual reality and machine learning.

Goal: This paper presents an immersive Virtual Reality (VR) system to analyze and train Executive Functions (EFs) of soccer players. EFs are important cognitive functions for athletes. They are a relevant quality that distinguishes amateurs from professionals. Method: The system is based on immersive technology, hence, the user interacts naturally and experiences a training session in a virtual world. The proposed system has a modular design supporting the extension of various so-called game modes. Game modes combine selected game mechanics with specific simulation content to target particular training aspects. The system architecture decouples selection/parameterization and analysis of training sessions via a coaching app from an Unity3D-based VR simulation core. Monitoring of user performance and progress is recorded by a database that sends the necessary feedback to the coaching app for analysis. Results: The system is tested for VR-critical performance criteria to reveal the usefulness of a new interaction paradigm in the cognitive training and analysis of EFs. Subjective ratings for overall usability show that the design as VR application enhances the user experience compared to a traditional desktop app; whereas the new, unfamiliar interaction paradigm does not negatively impact the effort for using the application. Conclusion: The system can provide immersive training of EF in a fully virtual environment, eliminating potential distraction. It further provides an easy-to-use analyzes tool to compare user but also an automatic, adaptive training mode.

Personality in Soccer: Investigation of the Five-Factor Model of Personality in High-Level Athletes.

Background: In high-level sports, rapid screening and diagnostic instruments are necessary considering limited access that researchers have to these athletes. In the area of sport psychological diagnostics, the NEO-FFI is a promising tool to gain information about an athlete's personality traits. The current study investigated the NEO-FFI's scientific quality criteria and general application to elite-level soccer. Methods: Personality traits of 378 elite-level soccer athletes were assessed using the NEO-FFI. Analysis focused on internal consistency, factor structure and gender differences. Additionally, a second measurement with a 6-week interval was conducted with a sub-sample of 86 athletes to analyse test-retest reliability. Results: Overall, the results are in line with previous findings outside high-level sports. For the total sample, alpha-levels from 0.68 to 0.84 and intraclass correlation coefficients (ICC) for test-retest measures from 0.86 to 0.91 could be found. Item-level principal component analysis using both oblimin and oblique rotation showed better stability in neuroticism (N) and conscientiousness (C) than in extraversion (E), openness (O), and agreeableness (A). Gender differences could be found in values of internal consistency, ICC and NEO-FFI traits. Conclusion: The results of this study demonstrate good transferability of the NEO-FFI from settings outside high-level sports into this specific niche of sport psychological assessment. However, the same weaknesses of the applied instrument in general populations were also replicated in the sporting population.

The Development of Executive Functions in High-Level Female Soccer Players.

Executive functions (EFs) are higher-level cognitive functions that help keep an individual's goal-oriented thoughts and actions aligned. While many studies have shown the importance of EFs in sport, a limitation in this literature is that female participants have been underrepresented. In this mixed-longitudinal study, we examined the development of EFs in a cohort of high performing female athletes. We collected data over five seasons in a large sample of 175 female soccer players (aged 12-29 years old) from the U14 - senior age groups of a professional German soccer club. Players undertook a large battery of cognitive tasks aimed at measuring higher-level cognitive functioning: a sustained attention task, a stop-signal task, a Go-No-go test, an N-Back Test, and both a 180°- and 360°-multiple-object tracking task. We used linear and non-linear mixed effect regressions to examine the relationship between age and EFs. Second order polynomial curves explained many of these relationships between age and EFs compared to their linear relationships. Negatively accelerated curves reveal that these players' cognitive abilities mainly developed before players reached early adulthood, with a performance plateau evident at around 21 years of age. Age explained low to moderate proportions of the variance in EFs (<1-50%), while cognitive development across playing positions was not a strong contributor to this variance (M = 2.1, SD = 2.1%). We concluded that age has a negatively accelerated relationship with EFs in female soccer players that does not differ between playing positions. These data support the idea that athletes require only a reasonable level of EF ability to perform at the highest level of their sport. Our research raises new questions regarding the validity of current EF measurement methods for inferring information about in-game use of these cognitive abilities.

Pharmacokinetic Engineering of OX40-Blocking Anticalin Proteins Using Monomeric Plasma Half-Life Extension Domains.

Anticalin® proteins have been proven as versatile clinical stage biotherapeutics. Due to their small size (∼20 kDa), they harbor a short intrinsic plasma half-life which can be extended, e.g., by fusion with IgG or Fc. However, for antagonism of co-immunostimulatory Tumor Necrosis Factor Receptor Superfamily (TNFRSF) members in therapy of autoimmune and inflammatory diseases, a monovalent, pharmacokinetically optimized Anticalin protein format that avoids receptor clustering and therefore potential activation is favored. We investigated the suitability of an affinity-improved streptococcal Albumin-Binding Domain (ABD) and the engineered Fab-selective Immunoglobulin-Binding Domain (IgBD) SpGC3Fab for plasma Half-Life Extension (HLE) of an OX40-specific Anticalin and bispecific Duocalin proteins, neutralizing OX40 and a second co-immunostimulatory TNFRSF member. The higher affinity of ABD fusion proteins to human serum albumin (HSA) and Mouse Serum Albumin (MSA), with a 4 to 5-order of magnitude lower KD compared with the binding affinity of IgBD fusions to human/mouse IgG, translated into longer terminal plasma half-lives (t 1/2). Hence, the anti-OX40 Anticalin-ABD protein reached t 1/2 values of ∼40 h in wild-type mice and 110 h in hSA/hFcRn double humanized mice, in contrast to ∼7 h observed for anti-OX40 Anticalin-IgBD in wild-type mice. The pharmacokinetics of an anti-OX40 Anticalin-Fc fusion protein was the longest in both models (t 1/2 of 130 h and 146 h, respectively). Protein formats composed of two ABDs or IgBDs instead of one single HLE domain clearly showed longer presence in the circulation. Importantly, Anticalin-ABD and -IgBD fusions showed OX40 receptor binding and functional competition with OX40L-induced cellular reactivity in the presence of albumin or IgG, respectively. Our results suggest that fusion to ABD or IgBD can be a versatile platform to tune the plasma half-life of Anticalin proteins in response to therapeutic needs.

The effect of stroboscopic vision on performance in a football specific assessment.

Purpose: This study aimed to investigate how restricted visual feedback affects performance in a football-specific skills assessment that incorporates the coupling of football a-specific perceptual information with football-specific motor actions. Methods: The Footbonaut is a 14x14m cage equipped with 8 ball dispensers and 64 targets measuring passing accuracy and time to complete each pass. Eighty-four amateur male participants (19.5 ± 5.4 years old; 13.1 ± 6.0 years experience) completed two sessions under two different visual conditions: stroboscopic and normal vision. Results: A linear regression revealed that performance under normal conditions was significantly associated (p < 0.001) with the performance decrement under stroboscopic vision conditions. Players were then subdivided into skilled (S; top 25%) and less-skilled (LS; bottom 25%) groups. Restricting visual feedback impacted the average time required to complete the passes in both S and LS groups equally (S: +0.18 s; LS: + 0.12 s; p = 0.385), yet S athletes' accuracy (-11.1%) was more heavily reduced under restricted visual conditions compared to their Normal condition; whereas the LS athletes' accuracy remained relatively unchanged (-1.9%). Conclusion: Therefore, stroboscopic vision may be used to induce performance errors during practice to stimulate larger training effects, particularly in more skilled players.

A Longitudinal Analysis of the Executive Functions in High-Level Soccer Players.

INTRODUCTION: Assessments of executive functions (EFs) with varying levels of perceptual information or action fidelity are common talent-diagnostic tools in soccer, yet their validity still has to be established. Therefore, a longitudinal development of EFs in high-level players to understand their relationship with increased exposure to training is required. METHODS: A total of 304 high-performing male youth soccer players (10-21 years old) in Germany were assessed across three seasons on various sport-specific and non-sport-specific cognitive functioning assessments. RESULTS: The posterior means (90% highest posterior density) of random slopes indicated that both abilities predominantly developed between 10 and 15 years of age. A plateau was apparent for domain-specific abilities during adolescence, whereas domain-generic abilities improved into young adulthood. CONCLUSION: The developmental trajectories of soccer players' EFs follow the general populations' despite long-term exposure to soccer-specific training and game play. This brings into question the relationship between high-level experience and EFs and renders including EFs in talent identification questionable.

Groin Injuries in Soccer: Investigating the Effect of Age on Adductor Muscle Forces.

PURPOSE: The sudden rise in the injury incidence during adolescence is also evident in soccer-related injuries to the groin. Submaximal passing applies high stress on the adductor muscles and pubic symphysis and is therefore likely to be connected to the occurrence of groin injuries. Therefore, the purpose of the study was to compare hip joint kinematics and adductor muscle forces of different adolescent age groups during submaximal soccer passing. METHODS: Sixty participants, in four groups, younger than 12, 15, 16. and 23 yr (U12, U15, U16, U23), were analyzed. A Footbonaut, equipped with a 3D motion capture system consisting of 16 cameras, was used to capture kinematic data of short passes. Inverse dynamic analysis was performed to calculate muscle forces of 10 passes of each subject. RESULTS: The U15 group showed reduced angular velocities. A rise in hip adductor muscle forces was evident from the youngest group up to the oldest groups. The largest increase (49%) was found between U12 and U15. Lower-limb mass was identified as the best predictor for the increasing adductor force. CONCLUSIONS: The reduced angular velocities of the U15 and the increase in muscle forces between all age groups were attributed to the increasing segment masses and length. This increases the moments of inertia of the leg segments thereby demanding higher forces to accelerate the segments. Most likely, the stress put upon the adductors apophyses increases during adolescence, as tendons are known to adapt slower than muscles, increasing the risk for overuse injuries. Coaches could use lower-limb mass as an indicator for fast increases in the force demand to identify players who would benefit from a reduced training volume.

Preclinical Development of U3-1784, a Novel FGFR4 Antibody Against Cancer, and Avoidance of Its On-target Toxicity.

The FGFR4/FGF19 signaling axis is overactivated in 20% of liver tumors and currently represents a promising targetable signaling mechanism in this cancer type. However, blocking FGFR4 or FGF19 has proven challenging due to its physiological role in suppressing bile acid synthesis which leads to increased toxic bile acid plasma levels upon FGFR4 inhibition. An FGFR4-targeting antibody, U3-1784, was generated in order to investigate its suitability as a cancer treatment without major side effects.U3-1784 is a high-affinity fully human antibody that was obtained by phage display technology and specifically binds to FGFR4. The antibody inhibits cell signaling by competing with various FGFs for their FGFR4 binding site thereby inhibiting receptor activation and downstream signaling via FRS2 and Erk. The inhibitory effect on tumor growth was investigated in 10 different liver cancer models in vivo The antibody specifically slowed tumor growth of models overexpressing FGF19 by up to 90% whereas tumor growth of models not expressing FGF19 was unaffected. In cynomolgus monkeys, intravenous injection of U3-1784 caused elevated serum bile acid and liver enzyme levels indicating potential liver damage. These effects could be completely prevented by the concomitant oral treatment with the bile acid sequestrant colestyramine, which binds and eliminates bile acids in the gut. These results offer a new biomarker-driven treatment modality in liver cancer without toxicity and they suggest a general strategy for avoiding adverse events with FGFR4 inhibitors.

Optical enhancement of a printed organic tandem solar cell using diffractive nanostructures.

Solution processable organic tandem solar cells offer a promising approach to achieve cost-effective, lightweight and flexible photovoltaics. In order to further enhance the efficiency of optimized organic tandem cells, diffractive light-management nanostructures were designed for an optimal redistribution of the light as function of both wavelength and propagation angles in both sub-cells. As the fabrication of these optical structures is compatible with roll-to-roll production techniques such as hot-embossing or UV NIL imprinting, they present an optimal cost-effective solution for printed photovoltaics. Tandem cells with power conversion efficiencies of 8-10% were fabricated in the ambient atmosphere by doctor blade coating, selected to approximate the conditions during roll-to-roll manufacturing. Application of the light management structure onto an 8.7% efficient encapsulated tandem cell boosted the conversion efficiency of the cell to 9.5%.

Enhancement of antibody-dependent cellular cytotoxicity of cetuximab by a chimeric protein encompassing interleukin-15.

Enhancement of antibody-dependent cellular cytotoxicity (ADCC) may potentiate the antitumor efficacy of tumor-targeted monoclonal antibodies. Increasing the numbers and antitumor activity of NK cells is a promising strategy to maximize the ADCC of standard-of-care tumor-targeted antibodies. For this purpose, we have preclinically tested a recombinant chimeric protein encompassing the sushi domain of the IL15Rα, IL-15, and apolipoprotein A-I (Sushi-IL15-Apo) as produced in CHO cells. The size-exclusion purified monomeric fraction of this chimeric protein was stable and retained the IL-15 and the sushi domain bioactivity as measured by CTLL-2 and Mo-7e cell proliferation and STAT5 phosphorylation in freshly isolated human NK and CD8+ T cells. On cell cultures, Sushi-IL15-Apo increases NK cell proliferation and survival as well as spontaneous and antibody-mediated cytotoxicity. Scavenger receptor class B type I (SR-B1) is the receptor for ApoA-I and is expressed on the surface of tumor cells. SR-B1 can adsorb the chimeric protein on tumor cells and can transpresent IL-15 to NK and CD8+ T cells. A transient NK-humanized murine model was developed to test the increase of ADCC attained by the chimeric protein in vivo. The EGFR+ human colon cancer cell line HT-29 was intraperitoneally inoculated in immune-deficient Rag2-/-γc-/- mice that were reconstituted with freshly isolated PBMCs and treated with the anti-EGFR mAb cetuximab. The combination of the Sushi-IL15-Apo protein and cetuximab reduced the number of remaining tumor cells in the peritoneal cavity and delayed tumor engraftment in the peritoneum. Furthermore, Sushi-IL15-Apo increased the anti-tumor effect of a murine anti-EGFR mAb in Rag1-/- mice bearing subcutaneous MC38 colon cancer transfected to express EGFR. Thus, Sushi-IL15-Apo is a potent tool to increase the number and the activation of NK cells to promote the ADCC activity of antibodies targeting tumor antigens.

Diffractive nanostructures for enhanced light-harvesting in organic photovoltaic devices.

We present in-coupling gratings for improving the performance of thin film organic solar cells. The impact of the grating on the absorption in the active layer is modeled and explained using a standard cell architecture. An increase in absorption of 14.8% is predicted and is shown to be independent from the active material. The structure is then applied on blade-coated devices and yields an efficiency improvement of 12%. The angular behavior of the structures is measured showing superior performance for two dimensional gratings. By simulating the current generation for different angles and illumination conditions, we predict a total yearly increase of the generated current of 12% using an optimized grating. The fabrication of these structures, moreover, is compatible with roll-to-roll production techniques, thus making them an optimal solution for printed photovoltaics.

Alimentary tract duplications in newborns and children: diagnostic aspects and the role of laparoscopic treatment.

Alimentary tract duplications are rare congenital lesions normally diagnosed in newborns and children that can occur anywhere from the mouth to the anus and have a reported incidence of approximately 1 in 4500 life births. Symptoms and clinical presentation vary greatly. The presentation varies according to age and location. The treatment finally is surgical; total resection when possible should be the aim of the intervention. In pediatric surgery minimally invasive surgical procedures became more and more important over the last decades. In consequence the operative procedure on alimentary tract duplications changed in this manner. We review on case reports and clinical reports on minimally invasive surgery in the treatment of alimentary tract duplications, determine the importance of minimally invasive techniques in the treatment of this rare entity and rule out that further studies in the field should be performed.

Mental practice maintains range of motion despite forearm immobilization: a pilot study in healthy persons.

OBJECTIVE: To determine whether mental practice of wrist movements during forearm immobilization maintains range of motion. DESIGN: Randomized controlled trial. PARTICIPANTS: Eighteen healthy young men aged between 20 and 30 years were assigned to either a control or a mental practice group. Both groups were immobilized with a circular forearm cast for 3 weeks to simulate a distal radial fracture. METHODS: The mental practice group received 1 × 60-min, followed by 3 × 30-min, sessions of supervised mental practice. Consecutively, they were asked to perform 15 min/day of self-guided imagery sessions, during which they mentally exercised motion sequences of the immobilized joint. The training program followed the Mental Gait Training procedure. The control group did no training. Wrist movement was measured with a goniometer before and after immobilization. RESULTS: Mental practice preserved dorsal extension and ulnar abduction. The sedentary control group showed due to this variables a significant decrease after cast removal. There was no significant change in palmar flexion and radial abduction in either group. CONCLUSION: Despite the study limitations, these results suggest that mental practice may be useful in preventing loss of hand function associated with mid-term immobilization. Because of the expected clinical benefits, the low cost and simple application of the intervention, the effects of mental practice in orthopedic rehabilitation of the upper extremity warrant further study.

Laparoscopic approach to ovarian mass in children and adolescents: already a standard in therapy.

INTRODUCTION: Functional cysts, ovarian torsion, and benign neoplasms are the most common ovarian masses among young adolescents. The laparoscopic approach to giant ovarian cysts in the pediatric population maybe difficult due the limited working space and the high risk of spillage. In this paper, we evaluate the role of laparoscopic surgery in the treatment of adnexal disease occurring in young girls. MATERIALS AND METHODS: With the approval of the institutional review board, a retrospective chart review(2007-2003) of patients with adnexal disease was conducted. RESULTS: Overall, 12 patients were evaluated with preoperative imaging, sonography, and magnetic resonance imaging (MRI) scan and laboratory values. None resulted in malignant histology. All resections of ovarian cysts were performed laparoscopically. The outcome was uneventful in all patients. CONCLUSIONS: Treatment is indicated if the diagnosis is in question, the cyst persists, in the case of ovarian torsion,or if the patient is symptomatic. Laparoscopy is becoming the favored approach by most pediatric surgeons for the treatment of ovarian cysts. All surgical procedures for ovarian cysts should spare functional ovary as much as is technically possible. Simple cysts can be fenestrated, but complex or functional cysts should be excised, with the preservation of the remaining ovary by careful dissection. The laparoscopic approach for adnexal masses can be performed in an acceptable manner, with comparable results to an open approach, plus the cosmetic advantages of minimally invasive surgery, which is an important aspect for the treated patients.

A new combined flow-cytometry-based assay reveals excellent activity against Toxoplasma gondii and low toxicity of new bisphosphonates in vitro and in vivo.

OBJECTIVES: The aim of this study was to investigate the antiparasitic activity and toxicity of bisphosphonates using a new combined flow cytometry assay. METHODS: Using Toxoplasma gondii tachyzoites carrying the green-fluorescent protein (GFP), we established a new flow cytometry assay combining testing of in vitro and in vivo activity plus toxicity of newly synthesized bisphosphonates against T. gondii. Toxicity as determined by this assay was compared with toxicity as determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test. RESULTS: In vivo, therapeutic efficacy was 100% for bisphosphonates 2F, 3B, 18A, 22A and 30B at 490, 1000, 512, 44.05 and 47.6 microM concentrations, respectively. Toxicity at 100% inhibitory concentrations was 20% for 2F and 3B, 60% for 22A and 30B, and 75% for 18A. In vitro, 6 (91A, 203A, 200C, 210A, 204A and 282A) of 15 newly synthesized bisphosphonates (12 nitrogen-containing and 3 n-alkyl) inhibited parasite replication by >50% at a concentration of 100 microM. Whereas substances 91A and 282A (high efficacy) showed moderate and low toxicity (cell viability between 70% and 100%), respectively, toxicities of 203A, 200C, 210A and 204A were 70%, 65%, 80% and 70%, respectively, as determined by flow cytometry. Compounds 290A, 218A, 214A, 266A and 219A inhibited parasite replication by between 20% and 50% at a concentration of 100 microM. CONCLUSIONS: Newly synthesized bisphosphonates 2F, 3B, 91A and 282A showed excellent therapeutic activity and low toxicity. These antiparasitic drugs may therefore be promising compounds for use in patients with acute and reactivated toxoplasmosis. The new flow cytometry assay allowed simultaneous determination of therapeutic efficacy and toxicity.