Repeatability and Safety of the Functional Capacity Evaluation-One-Handed for Individuals with Upper Limb Reduction Deficiency and Amputation.

Purpose To assess repeatability and safety of the functional capacity evaluation-one-handed (FCE-OH), a FCE-OH individuals, consisting of eight items. Method The FCE-OH protocol was administered twice to 23 individuals with upper limb absence (87% male; median age 46 years; median 2 days between sessions). To examine repeatability, test-retest reliability and agreement were assessed with the intraclass correlations coefficient (ICC) and limits of agreement (LoA), respectively. Reliability was considered acceptable when ICC-values were ≥0.75. Widths of LoA of four tests were compared with those of healthy adults. Safety and pain response were assessed with a questionnaire. Results After controlling for stability of construct, ICC-values ranged between 0.23 and 0.96, and widths of LoA ranged between 16 and 79%. Intertrial (learning) effects were present in three test items. No serious adverse reactions were reported. A pain response was reported by 30% of the participants. Conclusion Good or excellent reliability was observed in five tests, while three items showed poor or moderate test-retest reliability. Interpretation of agreement was possible for four tests, of which three showed widths of LoA similar to those reported in healthy adults. Learning effects were present; therefore, interpretation at the individual level should be performed with care. As the CI of several items were wide, confirmation of results in a larger sample is warranted. Safety was confirmed.

Functional Capacity Evaluation in Upper Limb Reduction Deficiency and Amputation: Development and Pilot Testing.

Purpose To develop and pilot test a functional capacity evaluation (FCE) for individuals with upper limb absence (ULA) due to reduction deficiency or amputation, and to examine the relationship between FCE results and presence of musculoskeletal complaints (MSC). Method Five tests (overhead lifting, overhead working, repetitive reaching, fingertip dexterity, and handgrip strength) were selected and adapted if necessary. The newly developed FCE, called FCE-One-Handed (FCE-OH), was pilot tested in 20 adults individuals with ULA, and 20 matched controls. MSC were assessed via a questionnaire. Results Adaptations were considered necessary for all tests, except the handgrip strength test. The repetitive overhead lifting test of the non-affected limb was added. On the overhead lifting test, individuals with above-elbow ULA (ten males), performed similar to controls using one hand. When lifting bimanually using the prosthesis, a trend for lower lifting capacity of individuals with below-elbow ULA (seven males, three females) was observed compared to controls. On the overhead working test, individuals with above-elbow ULA performed worse compared to controls. Other tests showed no significant differences between groups. Relationships between FCE results and presence of MSC were non-significant. Conclusion The FCE-OH can be used to test functional capacity of one-handed individuals. Individuals with ULA generally showed similar functional capacity as two-handed individuals. FCE results were not related to MSC. It was discussed that a higher physical load on the non-affected limb might reflect a relative deficit of functional capacity.

Flexible and static wrist units in upper limb prosthesis users: functionality scores, user satisfaction and compensatory movements.

BACKGROUND: The current study examines the relevance of prosthetic wrist movement to facilitate activities of daily living or to prevent overuse complaints. Prosthesis hands with wrist flexion/extension capabilities are commercially available, but research on the users' experiences with flexible wrists is limited. METHODS: In this study, eight transradial amputees using a myoelectric prosthesis tested two prosthesis wrists with flexion/extension capabilities, the Flex-wrist (Otto Bock) and Multi-flex wrist (Motion Control), in their flexible and static conditions. Differences between the wrists were assessed on the levels of functionality, user satisfaction and compensatory movements after two weeks use. RESULTS: No significant differences between flexible and static wrist conditions were found on activity performance tests and standardized questionnaires on satisfaction. Inter-individual variation was remarkably large. Participants' satisfaction tended to be in favour of flexible wrists. All participants but one indicated that they would choose a prosthesis hand with wrist flexion/extension capabilities if allowed a new prosthesis. Shoulder joint angles, reflecting compensatory movements, showed no clear differences between wrist conditions. CONCLUSIONS: Overall, positive effects of flexible wrists are hard to objectify. Users seem to be more satisfied with flexible wrists. A person's needs, work and prosthesis skills should be taken into account when prescribing a prosthesis wrist. TRIAL REGISTRATION: Nederlands Trial Register NTR3984 .

The effect of the height to which the hand is lifted on horizontal curvature in horizontal point-to-point movements.

In point-to-point reaching movements, the trajectory of the fingertip along the horizontal plane is not completely straight but slightly curved sideward. The current paper examines whether this horizontal curvature is related to the height to which the finger is lifted. Previous research suggested that the height to which the hand is lifted might be a determinant of horizontal curvature. We asked participants to make point-to-point movements in three conditions: constrained movements (i.e., fingertip keeps contact with table top) over vertically curved surfaces that differed in height, constrained movements over a flat surface, and unconstrained movements (i.e., fingertip lifted from table top). In constrained movements, we found a strong relation between horizontal curvature and lifted height of the finger. Interestingly, for unconstrained movements, the relation between horizontal curvature and height to which the finger was lifted was weak. This demonstrates that the height to which the finger was lifted relates to horizontal curvature in some, but not in all conditions. This suggests that the height to which the hand is lifted should be included, in particular for constrained movements, when giving a full account of horizontal curvature in point-to-point movements.

Enhanced stress resistance of Bifidobacterium breve NRBB57 by induction of stress proteins at near-zero growth rates.

Bifidobacterium breve is a common habitant of the human gut and is used as probiotic in functional foods. B. breve has to cope with multiple stress conditions encountered during processing and passage through the human gut, including high temperature, low pH and exposure to oxygen. Additionally, during industrial processing and in the gut, B. breve could encounter nutrient limitation resulting in reduced growth rates that can trigger adaptive stress responses. For this reason, it is important to develop culture methods that elicit resistance to multiple stresses (robustness) encountered by the bacteria. To investigate the impact of caloric restriction on robustness of the probiotic B. breve NRBB57, this strain was grown in lactose-limited chemostat cultures and in retentostat for 21 days, at growth rates ranging from 0.4 h-1 to 0.00081 h-1. Proteomes of cells harvested at different growth rates were correlated to acid, hydrogen peroxide and heat stress survival capacity. Comparative proteome analysis showed that retentostat-grown cells had significantly increased abundance of a variety of stress proteins involved in protein quality maintenance and DNA repair (DnaJ, Hsp90, FtsH, ClpB, ClpP1, ClpC, GroES, RuvB, RecA), as well as proteins involved in oxidative stress defence (peroxiredoxin, ferredoxin, thioredoxin peroxidase, glutaredoxin and thioredoxin reductase). Exposure to three different stress conditions, 45 °C, pH 3, and 10 mM H2O2, showed highest stress resistance of retentostat cells sampled at week 2 and week 3 grown at 0.0018 and 0.00081 h-1. Our findings show that cultivation at near-zero growth rates induces higher abundance of stress defence proteins contributing to the robustness of B. breve NRBB57, thereby offering an approach that may support its production and functionality.

Training prosthesis users to switch between modes of a multi-articulating prosthetic hand.

PURPOSE: Producing triggers to switch between modes of myoelectric prosthetic hands has proven to be difficult. We evaluated whether digital training methods were feasible in individuals with an upper limb defect (ULD), whether myosignals in these individuals differ from those of non-impaired individuals and whether acquired skills transfer to prosthesis use. MATERIALS AND METHODS: Two groups participated in a 9-day pre-test-post-test design study with seven 45-minute training sessions. One group trained using a serious game, the other with their myosignals digitally displayed. Both groups also trained using a prosthesis. The pre- and post-tests consisted of an adapted Clothespin Relocation Test and the spherical subset of the Southampton Hand Assessment Procedure. After the post-test, the System Usability Scale (SUS) was administered. Clinically relevant performance measures and myosignal features were analysed. RESULTS: Four individuals with a ULD participated. SUS-scores deemed both training methods feasible. Three participants produced only a few correct triggers. Myosignals features indicated larger variability for individuals with a ULD compared to non-impaired individuals (previously published data [1]). Three participants indicated transfer of skill. CONCLUSIONS: Even though both training methods were deemed feasible and most participants showed transfer, seven training sessions were insufficient to learn reliable switching behaviour.Trial registration: The study was approved by the medical ethics committee of the University Medical Center Groningen (METc 2018.268).Implications for rehabilitationSwitching between pre-programmed modes of a myoelectric prosthetic hand can be learned, however it does require training.Serious games can be considered useful training tools for trigger production in early phases of myoelectric prosthesis control training.In order to evoke transfer of skill from training to daily life both task-specificity and focus of attention during training should be taken into account.

Cross-feeding between Bifidobacterium infantis and Anaerostipes caccae on lactose and human milk oligosaccharides.

The establishment of the gut microbiota immediately after birth is a dynamic process that may impact lifelong health. At this important developmental stage in early life, human milk oligosaccharides (HMOs) serve as specific substrates to shape the gut microbiota of the nursling. The well-orchestrated transition is important as an aberrant microbial composition and bacterial-derived metabolites are associated with colicky symptoms and atopic diseases in infants. Here, we study the trophic interactions between an HMO-degrader, Bifidobacterium infantis and the butyrogenic Anaerostipes caccae using carbohydrate substrates that are relevant in the early life period including lactose and total human milk carbohydrates. Mono- and co-cultures of these bacterial species were grown at pH 6.5 in anaerobic bioreactors supplemented with lactose or total human milk carbohydrates. A. caccae was not able to grow on these substrates except when grown in co-culture with B. infantis, leading to growth and concomitant butyrate production. Two levels of cross-feeding were observed, in which A. caccae utilised the liberated monosaccharides as well as lactate and acetate produced by B. infantis. This microbial cross-feeding points towards the key ecological role of bifidobacteria in providing substrates for other important species that will colonise the infant gut. The progressive shift of the gut microbiota composition that contributes to the gradual production of butyrate could be important for host-microbial crosstalk and gut maturation.

Dynamics of competitive population abundance of Lactobacillus plantarum ivi gene mutants in faecal samples after passage through the gastrointestinal tract of mice.

AIM: This study aims to evaluate the impact of mutation of previously identified in vivo-induced (ivi) genes on the persistence and survival of Lactobacillus plantarum WCFS1 in the gastrointestinal (GI) tract of mice. METHODS AND RESULTS: Nine Lact. plantarum ivi gene replacement mutants were constructed, focussing on ivi genes that encode proteins with a predicted role in cell envelope functionality, stress response and regulation. The in vitro growth characteristics of the mutants appeared identical to those observed for the wild-type strain, which agrees with the recombination-based in vivo expression technology suggestion that these genes are not transcribed in the laboratory. Quantitative PCR experiments demonstrated differences in the relative population dynamics of the Lact. plantarum ivi mutants in faecal samples after passage through the GI tract of mice. CONCLUSIONS: The in situ competition experiments revealed a 100- to 1000-fold reduction of the relative abundance of three of the ivi gene mutants, harbouring deletions of genes predicted to encode a copper transporter, an orphan IIC cellobiose PTS and a cell wall anchored extracellular protein. SIGNIFICANCE AND IMPACT OF THE STUDY: These experiments clearly establish that the proteins encoded by these three genes play a key role in Lact. plantarum performance during passage of the GI tract.

Growth stimulation of Brevibacterium sp. by siderophores.

AIMS: To assess which types of siderophores are typically produced by Brevibacterium and how siderophore production and utilization traits are distributed within this genus. METHODS AND RESULTS: During co-cultivation experiments it was found that growth of B. linens Br5 was stimulated by B. linens NIZO B1410 by two orders of magnitude. The stimulation was caused by the production of hydroxamate siderophores by B. linens NIZO B1410 that enabled the siderophore-auxotrophic strain Br5 to grow faster under the applied iron-limited growth conditions. Different patterns of siderophore production and utilization were observed within the genus Brevibacterium. These patterns did not reflect the phylogenetic relations within the group as determined by partial 16S rDNA sequencing. Most Brevibacterium strains were found to utilize hydroxamate siderophores. CONCLUSIONS: Brevibacteria can produce and utilize siderophores although certain strains within this genus are siderophore-auxotrophic. SIGNIFICANCE AND IMPACT OF THE STUDY: It is reported for the first time that brevibacteria produce and utilize siderophores. This knowledge can be utilized to stimulate growth of auxotrophic strains under certain conditions. Enhancing the growth rate of Brevibacterium is of importance for the application of this species, for example, for cheese manufacturing or for industrial production of enzymes or metabolites.

[Absorption and oxidation rate of arginine and malate (author's transl)]. / Untersuchungen zur Resorption und Oxidationsrate von Arginin und Malat.

Six normal volunteers received L-Arginin and DL-Malat p.o. in order to test absorption and utilisation of these compounds. Both compounds are almost completely reabsorbed from the intestine and then metabolized. Only about 2% of the arginine applied are recovered in the urine. 15% of arginine and 45% of malate applied are metabolized within 8 hours. If absorption is unimpaired oral therapy of hyperammoniemia would require application of the malate-arginine solution for every 3 hours, if constant plasma levels are to be achieved.

Improving obstacle detection by redesign of walking canes for blind persons.

This paper describes an experiment in which the performance of cane walkers with the traditional straight long cane and a redesigned cane, the curved cane, was compared. The curved cane has a curve where the tip touches the ground. Participants were 18 experienced cane walkers who were totally blind. The aspects of cane walking that were investigated included obstacle detection, drop-off (slope) detection and walking speed. The performance with both canes was investigated in two different ways: (1) by means of constructed courses in which objective measures of cane walking were derived; and (2) by means of more qualitative measures based on the participants' experiences with the curved cane during a 3-week try-out period. Results showed that obstacle-detection was significantly better with the curved cane, whereas drop-off detection and walking speed were comparable for the two canes. The participants' experiences mirrored these results.

Engineering a disulfide bond and free thiols in the lantibiotic nisin Z.

The antimicrobial peptide nisin contains the uncommon amino acid residues lanthionine and methyl-lanthionine, which are post-translationally formed from Ser, Thr and Cys residues. To investigate the importance of these uncommon residues for nisin activity, a mutant was designed in which Thr13 was replaced by a Cys residue, which prevents the formation of the thioether bond of ring C. Instead, Cys13 couples with Cys19 via an intramolecular disulfide bridge, a bond that is very unusual in lantibiotics. NMR analysis of this mutant showed a structure very similar to that of wild-type nisin, except for the configuration of ring C. The modification was accompanied by a dramatic reduction in antimicrobial activity to less than 1% of wild-type activity, indicating that the lanthionine of ring C is very important for this activity. The nisin Z mutants S5C and M17C were also isolated and characterized; they are the first lantibiotics known that contain an additional Cys residue that is not involved in bridge formation but is present as a free thiol. Secretion of these peptides by the lactococcal producer cells, as well as their antimicrobial activity, was found to be strongly dependent on a reducing environment. Their ability to permeabilize lipid vesicles was not thiol-dependent. Labeling of M17C nisin Z with iodoacetamide abolished the thiol-dependence of the peptide. These results show that the presence of a reactive Cys residue in nisin has a strong effect on the antimicrobial properties of the peptide, which is probably the result of interaction of these residues with thiol groups on the outside of bacterial cells.

Protein engineering of lantibiotics.

Whereas protein engineering of enzymes and structural proteins nowadays is an established research tool for studying structure-function relationships of polypeptides and for improving their properties, the engineering of posttranslationally modified peptides, such as the lantibiotics, is just coming of age. The engineering of lantibiotics is less straightforward than that of unmodified proteins, since expression systems should be developed not only for the structural genes but also for the genes encoding the biosynthetic enzymes, immunity protein and regulatory proteins. Moreover, correct posttranslational modification of specific residues could in many cases be a prerequisite for production and secretion of the active lantibiotic, which limits the number of successful mutations one can apply. This paper describes the development of expression systems for the structural lantibiotic genes for nisin A, nisin Z, gallidermin, epidermin and Pep5, and gives examples of recently produced site-directed mutants of these lantibiotics. Characterization of the mutants yielded valuable information on biosynthetic requirements for production. Moreover, regions in the lantibiotics were identified that are of crucial importance for antimicrobial activity. Eventually, this knowledge will lead to the rational design of lantibiotics optimally suited for fighting specific undesirable microorganisms. The mutants are of additional value for studies directed towards the elucidation of the mode of action of lantibiotics.