COMPARISON OF WEARABLES FOR SELF-MONITORING OF HEART RATE IN CORONARY REHABILITATION PATIENTS.

The leading cause of morbidity and mortality in the world is ischemic heart disease. Physical activity is a major approach in prevention and therapy of cardiac diseases. Self-heart-rate-monitoring in daily life is an important point for health awareness of cardiac patients. Aim of this study was validation of measurement accuracy of seven different devices against ECG-monitoring during cardiac rehabilitation training on a bicycle ergometer. Tested devices were: Garmin Forerunner 35 (Garmin), Mio Fuse (Mio), Fitbit Charge HR (FitbitHR), Fitbit Surge (FitbitS), Withings Pulse™ Ox (Withings), Apple Watch Series 1 (Apple) and Pearl Fitness-Tracker (FBT-50.HR PRO.V4). All devices were tested on 35 participants with six timed measurements during 20 minutes constant load bicycle ergometer workout for each. Simultaneousely, ECG measurements were recorded. Pearson´s correlations were assessed. Apple, Mio, and Garmin showed excellent accuracy with close correlation to ECG for self-monitoring of heart rate (HR) during cycling. FitbitHR, Pearl and FitbitS presented reasonable results. In contrast, Withings showed poor correlation to ECG with significant differences. We found significant differences between the tested devices. Since accuracy is of major importance for cardiac patients, only Apple, Mio and Garmin could be recommended. However, further research within distinct clinical and non-clinical settings is necessary and should take different types of physical activities into account.

[Injury prevention in amateur football with FIFA 11+ : What is implemented on the football pitch?] / Verletzungsprävention im Amateurfußball mit FIFA 11+ : Was kommt auf dem Sportplatz an?

BACKGROUND: The warm-up and injury prevention program FIFA 11+ was developed to reduce injuries in recreational and amateur level football. Despite systematic education it is uncertain what amount of knowledge is passed down to the lower recreational level football players and what exercises are implemented in the daily routine. This study presents the summarized experiences of German coaches about the implementation of exercises on the football pitch. MATERIAL AND METHODS: In this study 142 coaches who participated in 1 (of 5) of the 2­day courses between 2013 and 2017 were sent a questionnaire. The questionnaire consisted of 24 questions, which were developed by the football union of Lower Saxony. Incomplete questionnaires were excluded from the study. RESULTS: A total of 121 questionnaires could be analyzed, which is a response rate of 85.2%. The mean time period between the 2­day training and answering the questionnaire was 29 months. Of the participating coaches 82.6% indicated that they use the program regularly (22% of the coaches use it twice a week or more frequently, 34% use it only once a week) and 6% of the coaches use additional programs to prevent injuries. A total of 86% of the participants believed in a reduction in the incidence of injuries induced by the FIFA 11+ concept, 89% of the participants rated the FIFA 11+ program as good ors very good, 91% rated the teaching concept as good or very good and 94% of the participants would recommend the 2­day advanced course to others. DISCUSSION: The prevention program as well as the advanced training concept were evaluated very positively. Most coaches use the program regularly. Nevertheless, many coaches use the FIFA 11+ exercises less than the recommended twice a week. Most coaches praised the good structure of the program, but also wished for the possibility of variations. CONCLUSION: The prevention program FIFA 11+ is seen by coaches in recreational and amateur football as an effective tool to prevent injury. Implementation on the football pitch is regular but not as frequent as the evidence-based recommendations in the training concept.

[Evidence-based therapy for tendinopathy of the knee joint : Which forms of therapy are scientifically proven?] / Evidenzbasierte Therapie bei Tendinopathien am Kniegelenk : Welche Therapieformen sind wissenschaftlich belegt?

Tendinopathy in the region of the knee joint is a common pathological disorder. People active in sports, in particular, have a high probability of suffering from tendinopathy. Despite its high clinical relevance, the level of evidence of therapy options for tendinopathy in the knee region differs greatly. This review gives an overview of current evidence levels for therapy options in tendinopathy of the quadriceps, patellar and pes anserinus insertion tendons as well as of the distal iliotibial tract tendon. The treatment with platelet-rich plasma showed a significantly better outcome when used correctly and treatment with shock waves, operative treatment and sclerotherapy have also shown positive effects. Treatment with corticosteroid injections and with oral non-steroidal anti-inflammatory drugs (NSAID) showed positive short-term effects (follow-up ±4 weeks). No reasonable data are available for the treatment of tendinopathy in the knee region by acupuncture, fascial therapy or cryotherapy. The use of kinesio taping showed no significant relief from complaints compared with standard conservative treatment. The use of multimodal therapy without evidence is, therefore, particularly common in elite athletes.

Eighteen-year follow-up after rotationplasty for a grade IIIC open fracture of the distal femur.

We report the 18-year follow-up of a patient who underwent rotationplasty for severe bone loss and infection after an grade IIIC open fracture of the distal femur. The patient is now 49 years old and fully satisfied with his life. During the follow-up period, he has never had significant physical or psychological problems directly concerning the rotationplasty. The analysis of quality of life using the SF36 questionnaire revealed even higher scores than the normal healthy population in seven out of eight sub-categories. Clinical examination revealed bland soft tissues without hyperkeratosis or other signs of maladaptation. Articular and cutaneous proprioception was intact all over the left leg. The active extension/flexion of the prosthetic knee was 0°-0°-100° and 10°-0°-70° of the ankle joint. Manual testing of motor strength revealed grade five of five for dorsiflexion and plantar flexion of the ankle. Gait patterns including climbing slopes and stairs were close to normal. Examination in sports physiology showed lower maximum power of hip and knee muscles compared to the healthy side, but better muscular endurance. These findings emphasize that rotationplasty can be a good alternative to arthrodesis or amputation in trauma patients providing high satisfaction and activity levels in the long-term follow-up.

Immunocytochemical characterization of the endocytic and phagolysosomal compartments in peritoneal macrophages.

We have used endocytic and phagocytic tracers in an EM immunocytochemical study to define the compartments of the phagocytic and endocytic pathways in mouse peritoneal macrophages. Endocytosed BSA-gold appeared successively in early endosomes, spherical endosomal vesicles, a late endosomal tubuloreticular compartment (TC), and terminal lysosomes. The TC appeared as an elaborate structure enriched for the lysosomal membrane glycoproteins Lamp 1 and Lamp 2, and expressing significant levels of rab7, a late endosome-specific GTP-binding protein. The cation-independent mannose-6-phosphate receptor was restricted to specialized regions of the TC that were predominantly adjacent to the Golgi complex. Both the early endosome and the TC had coated bud structures whose composition and function are presently unknown. Phagolysosomes containing latex beads expressed the same membrane antigens and received endocytic tracers simultaneously with the TC. Since the membrane surrounding both organelles was also in direct continuity, we assume that both structures form one functional compartment. Macrosialin, an antigen confined to macrophages and dendritic cells, was heavily expressed in TC and phagolysosomal membranes with low levels being detected in other endosomal compartments and on the cell surface. Treatment of cells with wheat germ agglutinin drastically altered the morphology of the TC, giving rise to sheets of tightly adherent membrane and greatly expanded vesicles, in which cell-associated wheat germ agglutinin was concentrated. The spherical endosomal carrier vesicles loaded with internalized gold tracers clustered nearby, often making contact without fusing. Since the delivery of endocytic tracer to the TC was significantly delayed these experiments suggest that the lectin is somehow preventing the endosome vesicles from fusing with the TC. Collectively, our data argue first that the PLC is equivalent to the "tubular lysosomes" commonly described in macrophages, and second that the meeting of the phagocytic and endocytic pathway occurs in this compartment.

Regulated docking of nuclear membrane vesicles to vimentin filaments during mitosis.

During mitosis, several types of intermediate-sized filaments (IFs) undergo an extensive remodelling in response to phosphorylation by cdc 2 and other protein kinases. However, unlike the nuclear lamins, the cytoplasmic IFs do not seem to follow a fixed disassembly stereotype and often retain their physical continuity without depolymerizing into soluble subunits. To investigate potential interactions between mitotically modified IFs and other cellular structures, we have examined prometaphase-arrested cells expressing the IF protein vimentin. We demonstrate here that vimentin filaments associate in situ and co-fractionate with a distinct population of mitotic vesicles. These vesicles carry on their surfaces nuclear lamin B, the inner nuclear membrane protein p58, and wheat germ agglutinin (WGA)-binding proteins. Consistent with a tight interaction between the IFs and the mitotic membranes, vimentin, nuclear lamin B, and a 180-kD WGA-binding protein are co-isolated when whole mitotic homogenates are incubated with anti-vimentin or anti-lamin B antibodies immobilized on magnetic beads. The vimentin-associated vesicles are essentially depleted of ER, Golgi and endosomal membrane proteins. The interaction of vimentin with lamin B-carrying membranes depends on phosphorylation and is weakened by dephosphorylation during nuclear reassembly in vitro. These observations reveal a novel interaction between IFs and cellular membranes and further suggest that the vimentin filaments may serve as a transient docking site for inner nuclear membrane vesicles during mitosis.

Bactenecins, defense polypeptides of bovine neutrophils, are generated from precursor molecules stored in the large granules.

Bactenecins are highly cationic polypeptides of bovine neutrophil granules and exert in vitro a potent antimicrobial activity. We have previously purified two bactenecins, designated in an abbreviated form Bac7 and Bac5 from their approximate molecular masses of 7 and 5 kD (Gennaro, R., B. Skerlavaj, and D. Romeo. 1989. Infect. Immun. 57:3142-3146). Here we have studied the biosynthesis, processing, and localization of precursors of Bac7 and Bac5 in bovine bone marrow cells of the myeloid lineage. In vitro translation directed by mRNA isolated from these cells has shown that the primary translation products are preprobactenecins of 23.5 and 21 kD, and are processed to polypeptides of 20 and 15.8 kD, respectively. The 20-kD polypeptide is the granule storage form of Bac7, or proBac7, as also demonstrated by Western blot analysis of lysates of peripheral neutrophils. Between 15 and 50 min from the beginning of its biosynthesis the 15.8-kD polypeptide is converted into the 15-kD granule storage form of Bac5, or proBac5. As shown by immunogold EM, proBac7 and proBac5 are sorted and targeted to the matrix of the so called large granules, which are the predominant organelles in the cytoplasm of bovine neutrophils and are the exclusive store of the nonoxidative antimicrobial system of these cells. Solubilization of granules with Triton X-100 with concomitant unmasking of proteases leads to cleavage of the proforms to Bac7 and Bac5. Experiments performed with protease inhibitors suggest that the proteolytic cleavage is catalyzed in detergent-solubilized neutrophils by neutral serine protease(s), very likely derived from the azurophil granules.

Filensin: a new vimentin-binding, polymerization-competent, and membrane-associated protein of the lens fiber cell.

We have studied the molecular properties of a 100-kD protein, termed filensin, which we have isolated from porcine lens membranes. Filensin represents a membrane-associated element, resistant to salt and nonionic detergent treatment, and extractable only by alkali or high concentrations of urea. By indirect immunofluorescence and immunoelectron microscopy, this protein can be localized at the periphery of the lens fiber cells. Immunochemical analysis suggests that filensin originates from a larger 110-kD component which is abundantly expressed in lens but not in other tissues. Purified filensin polymerizes in a salt-dependent fashion and forms irregular fibrils (integral of 10 nm in diameter) when reconstituted into buffers of physiological ionic strength and neutral pH. Radiolabeled filensin binds specifically to lens vimentin under isotonic conditions, as demonstrated by affinity chromatography and ligand-blotting assays. By the latter approach, filensin also reacts with a 47-kD peripheral membrane protein of the lens cells. Purified filensin binds to PI, a synthetic peptide modelled after a segment of the COOH-terminal domain of peripherin (a type III intermediate filament protein highly homologous to vimentin), but not to various other peptides including the NH2-terminal headpiece of vimentin and derivatives of its middle (rod) domain. The filensin-PI binding is inhibited by purified lamin B, which is known to interact in vitro with PI (Djabali, K., M.-M. Portier, F. Gros, G. Blobel, and S. D. Georgatos. 1991. Cell. 64:109-121). Finally, limited proteolysis indicates that the filensin-vimentin interaction involves a 30-kD segment of the filensin molecule. Based on these observations, we postulate that the lens fiber cells express a polymerization-competent protein which is tightly associated with the plasma membrane and has the potential to serve as an anchorage site for vimentin intermediate filaments.

Intracellular transport and localization of major histocompatibility complex class II molecules and associated invariant chain.

The intracellular transport and location of major histocompatibility complex (MHC) class II molecules and associated invariant chain (Ii) were investigated in a human melanoma cell line. In contrast to the class II molecules, which remain stable for greater than 4 h after synthesis, the associated Ii is proteolytically processed within 2 h. During or shortly after synthesis the NH2-terminal cytoplasmic and membrane-spanning segment is in some of the Ii molecules cleaved off; during intracellular transport, class II associated and membrane integrated Ii is processed from its COOH terminus in distinct steps in endocytic compartments. Immunocytochemical studies at the light and electron microscopic level revealed the presence of class II molecules, but not of Ii on the cell surface. Intracellularly both Ii and class II molecules were localized in three morphologically and kinetically distinct compartments, early endosomes, multivesicular bodies, and prelysosomes. This localization in several distinct endosomal compartments contrasts with the localization of class II molecules in mainly one endocytic compartment in B lymphoblastoid cell lines. As in these lymphoblastoid cell lines Ii is known to be rapidly degraded it is conceivable that the rate of proteolysis of the class II associated Ii and its dissociation from class II molecules modulates the retention of the oligomeric complex in endocytic compartments, and as a consequence the steady-state distribution of these molecules within the endosomal system.

Docked granules, the exocytic burst, and the need for ATP hydrolysis in endocrine cells.

Ca(2+)-triggered exocytosis was studied in single rat melanotrophs and bovine chromaffin cells by capacitance measurements. Sustained exocytosis required MgATP, but even in the absence of MgATP, Ca2+ could trigger exocytosis of 2700 granules in a typical melanotroph and of 840 granules in a chromaffin cell. Granules undergoing ATP-independent exocytosis were similar in number to those appearing docked to the plasmalemma in quickly frozen unfixed sections (3300 in a melanotroph and 830 in a chromaffin cell). Most exocytosis required tens of seconds, but a small pool of granules was released in tens of milliseconds. Evidently, only a small subset of docked granules is rapidly releasable. We suggest that, temporally, the last ATP-dependent step in exocytosis is closely associated with docking and that docked granules reach fusion competence only after subsequent steps.

Local Ca2+ release from internal stores controls exocytosis in pituitary gonadotrophs.

Exocytosis and the cell-averaged cytosolic [Ca2+], [Ca2+]i, were tracked in single gonadotrophs. Cells released 100 granules/s at 1 microM = [Ca2+]i when gonadotropin-releasing hormone (GnRH) activated IP3-mediated Ca2+ release from internal stores, but only 1 granule/s when [Ca2+]i was raised uniformly to 1 microM by other means. Strong exocytosis was then seen only at higher [Ca2+]i (half-maximal at 16 microM). Parallel second messengers did not contribute to GnRH-induced exocytosis, because IP3 alone was as effective as GnRH, and because even GnRH failed to trigger rapid exocytosis when the [Ca2+]i rise was blunted by EGTA. When [Ca2+]i was released from stores, exocytosis depended on [Ca2+]i rising rapidly, as if governed by Ca2+ flux into the cytosol. We suggest that IP3 releases Ca2+ selectively from subsurface cisternae, raising [Ca2+] near exocytic sites 5-fold above the cell average.

Biomechanical properties of adjustable extracortical graft fixations in ACL reconstruction.

BACKGROUND: Reliable biomechanical data about the strength of different tibial extracortical graft fixation devices is sparse. This biomechanical study compares the properties of tibial graft fixation in ACL reconstruction with either the ACL Tight Rope™ or the Rigid Loop Adjustable™ device. The hypothesis was that both fixation devices would provide comparable results concerning gap formation during cyclic loading and ultimate failure load. METHODS: Sixteen sawbone tibiae (Sawbones™) underwent extracortical fixation of porcine flexor digitorum profundus grafts for ACL reconstruction. Either the ACL Tight Rope™ (Arthrex) or the Rigid Loop Adjustable™ (DePuy Mitek) fixation device were used, resulting in 2 groups with 8 specimens per group. Biomechanical analysis included pretensioning the constructs 10 times with 0.75 Hz, then cyclic loading of 1,000 position-controlled cycles and 1,000 force-controlled cycles applied with a servohydraulic testing machine. Elongation during cyclic loading was recorded. After this, ultimate failure load and failure mode analysis were performed. RESULTS: No statistically significant difference could be noted between the groups regarding gap formation during cyclic loading (4.6 ± 2.6 mm for the Rigid Loop Adjustable™ vs. 6.6 ± 1.5 mm for the ACL Tight Rope™ (p > 0.05)), and ultimate failure loads (980 ± 101.9 N for the Rigid Loop Adjustable™ vs. 861 ± 115 N ACL Tight Rope™ (p > 0.05)). CONCLUSION: ACL Tight Rope™ and the Rigid Loop Adjustable™ fixation devices yield comparable biomechanical results for tibial extracortical graft fixation in ACL reconstruction. These findings may be of relevance for the future surgical decision-making in ACL reconstruction. Randomized controlled clinical trials comparing both fixation devices are desirable for the future.

Influence of 12(S)-hydroxyeicosatetraenoic acid (12(S)-HETE) on the localization of cathepsin B and cathepsin L in human lung tumor cells.

Cathepsins B and L are catabolic lysosomal enzymes but are likely candidates for extracellular proteolysis in normal and malignant processes. The signal mediator 12(S)-HETE selectively triggers a shot-gun release of cathepsin B. We have therefore investigated the intracellular distribution of cathepsins in unstimulated and 12(S)-HETE-stimulated tumor cells. Cathepsins B and L have only limited colocalization, which is found in the regions of synthesis and sorting (endoplasmic reticulum, Golgi, trans Golgi network). Treatment by 12(S)-HETE scatters cathepsin B but not cathepsin L and proform of cathepsin B. Colocalization with both mannose 6-phosphate receptors is very limited for both cathepsins. But extensive colocalization of cathepsin B and the endosomal/lysosomal marker CD63 (LIMP-I) documents the main fraction of the enzyme in these compartments. The supposed non-lysosomal fraction of cathepsin B is very likely the secretable material which follows a regulated secretory pathway. Storage and regulated secretion in tumor cells support extracellular proteolysis as a means in invasion which may lead to metastasis. But the mechanisms by which cells might acquire and eventually apply this means is still unknown.

Direct observation of membrane retrieval in chromaffin cells by capacitance measurements.

This study was focussed on the identification of the endocytic organelles in chromaffin cells which retrieve large, dense core vesicle (LDCV)-membrane components from the plasma membrane. For this purpose, 'on-cell' capacitance measurements and electron microscopy were employed. We found capacitance steps and capacitance flickers, corresponding to single exo- and endocytic events. The analysis revealed that the total membrane surface of completely fused LDCVs is recycled by large endocytic vesicles and smaller, most likely clathrin-coated vesicles, at approximately the same ratio. These results were confirmed by rapid-freeze immuno-electron microscopy, where an extracellular marker was rapidly internalized into endocytic vesicles that morphologically resembled LDCVs.

Age-related changes in the composition of proteins in the trabecular meshwork of the human eye.

The composition of the trabecular meshwork proteins of human eyes ranging in age from 36 days to 84 years was examined by polyacrylamide gel electrophoresis and amino acid analysis. Proteins of different molecular weights could be extracted from the tissue with acetic acid. Although their electrophoretic patterns became less distinct with increasing age, proteins of molecular weights ranging from 50 000 to 69 000 always prevailed. The amino acid compositions of the acetic acid-insoluble trabecular meshwork residues revealed the prevalence of collagenous proteins. The peptide maps produced by treatment with cyanogen bromide indicate that most of the fragments solubilized from the trabecular meshwork of younger eyes are derived from type I collagen. Beyond 40 years of age, the trabecular meshwork was resistant to cyanogen bromide and pepsin digestion. A rough estimate of the distribution of collagen types in the trabecular meshwork was based on 3-hydroxyproline/4-hydroxyproline ratios, indicating an age-related increase of type I collagen from about 55 to 70 per cent, and of type IV collagen from about 2 to 5 per cent of the total protein present. During ageing, some of the protein-bound methionine is oxidized to methionine sulfoxide, reaching about 35 per cent of the total methionine content at the age of 20 years and, with a slower rate of oxidation, a mean value of 40 per cent at 80 years of age. Electron-microscopic analysis of specimens remaining undissolved after cyanogen bromide cleavage and pepsin treatment no longer revealed regular collagenous fibrils but rather elastic-like fibers surrounded by wide sheaths consisting of fine fibrils with a regular cross-banding periodicity of 40-50 nm. In addition, clusters of so-called curly (lattice) collagen were found. The amino acid composition of this insoluble material suggests that altered collagen-like molecules prevail among the proteins of the residues.

Exercise participation after menopause.

Who should exercise? What exercises should be performed and with what frequency and duration? What benefits can be expected from such exercises? These are some of the questions frequently asked of physicians who care for elderly and post-menopausal patients. Data are conflicting, but significant conclusions can be drawn that will help provide the answers to these questions. This article is written to guide physicians' recommendations to their patients regarding postmenopausal exercise.

Treatment of cubitus varus with osteotomy and Ilizarov external fixation.

A cubitus varus deformity, secondary to a supracondylar fracture, was treated with a short oblique osteotomy and the Ilizarov external fixator. An excellent anatomic and functional outcome resulted. This method may prove to be of significant value in the treatment of this difficult deformity.

The brachioradialis for restoration of abduction and extension of spastic thumb in children.

The surgical technique is described for transfer of the brachioradialis for restoration of abduction and extension of the thumb in spastic children's hands. Long-term followup studies (average: 6.5 years) for 14 children demonstrate satisfactory functional and cosmetic results for patients carefully selected on the basis of Goldner's criteria.

Commercial software as the basis for an augmentative communication system on a personal computer.

Many severely speech-impaired individuals have a need or desire to maintain the capability for computerized speech generation while performing a variety of other computer-supported tasks such as word processing, financial analysis, or database management. Criteria are presented for augmentative communication systems that both incorporate a personal computer (PC) and provide capabilities for voice output to satisfy this requirement. Current approaches to such systems are categorized and reviewed in light of these criteria. A new method is then described in which word processing or other appropriate PC software is used for speech production, providing a natural integration of written and spoken communication. The approach separates the computer access and voice output functions to allow great flexibility in the choice of an alternative access system. This flexibility combined with appropriate exploitation of PC software features has the potential to yield a high communication rate as well as maximum compatibility with application software.

Physical capacity and quality of life in patients with multiple sclerosis.

BACKGROUND: Physical capacity (PC) and quality of life (QoL) are both reduced in multiple sclerosis (MS). OBJECTIVE: Aim of our study was to investigate limitations in PC and QoL in response to the severity of MS. METHODS: The study involved 60 patients (PG) (Expanded Disability Status Scale EDSS 0-3:38, EDSS 3.5-6:22) and 48 healthy controls (CG). Endurance capacity was assessed as peak oxygen uptake (VO2peak) and ventilatory anaerobic threshold (VAT). Maximum force was measured in isokinetic testing. QoL was assessed using the SF-36-questionnaire and HALEMS. RESULTS: Patients with MS showed reduced VO2peak and QoL in comparison with CG. Patients with an EDSS >3 showed reduced VO2peak, and maximum force, however at the VAT there was no significant difference independent of the EDSS. The MS-specific QoL HALEMS and subscales 1, 4, 6, 8 and the physical sum score of the SF-36-questionnaire were evaluated to be better in patients with an EDSS ≤3. CONCLUSIONS: There are limitations within PC in patients with MS in comparison with a healthy CG; within the PG there are notes on a similar aerobic capacity but worsened anaerobic capacity in patients with an EDSS >3. This should be taken into account in future treatment strategies for training therapy.