Measurement protocols and determinants of peak oxygen consumption in adults with Down syndrome: a systematic review.

This systematic review aimed to provide an overview of test protocols used to measure peak oxygen uptake (VO2peak) in adults with Down syndrome (DS) and to determine how generalisable the outcomes are for the entire population of adults with DS by describing the sample characteristics of these studies and their impact on VO2peak. A literature search (PROSPERO CRD42022309560) was performed (18 July 2023) using the following databases: PubMed, CINAHL, APA PsycINFO, Web of Science, Embase and SPORTDiscus. For articles to be included, they had to be peer-reviewed pubications, reporting VO2peak or VO2max for individuals with DS separately, with a sample of n ≥ 5 and a mean age ≥18 years. Systematic reviews and meta-analyses were excluded but their reference lists were searched for additional papers to include. Studies were evaluated for risk of bias following the guidelines of Kmet et al. The results were summarised with frequency statistics. Forty-three studies were included in this systematic review. Sample sizes of included adults with DS ranged from n = 4-226, with a total of n = 1498 adults with DS being included. Most studies (29/43) used the same standardised maximal exercise treadmill protocol to measure VO2peak in adults with DS, and 33 out of 43 studies used at least one objective criterion to determine a valid maximal effort. Participants were predominantly male, under 40 years old, and overweight or obese. Additionally, the diversity of study samples was lacking or not reported. The most widely used, standardised, maximal exercise test treadmill protocol is recommended for future use in research and practice, including objective criteria to determine valid maximal effort. The current study samples are not representative of the population of adults with DS in terms of sex, age and diverse backgrounds and therefore likely overestimate VO2peak of this population.

Comprehensive cardiopulmonary profile of individuals with Down syndrome.

BACKGROUND: Individuals with Down syndrome (DS) have low levels of cardiorespiratory fitness and previous studies have shown that these low levels of fitness have a physiological cause. During exercise, the cardiovascular, ventilatory and muscular systems are simultaneously active. While individual parameters of these systems have been investigated in DS before, the interaction between these parameters and systems have not been discussed in detail. Doing so may provide important insight regarding the aetiology of low cardiorespiratory fitness and which parameters of the cardiovascular, pulmonary and muscular systems are altered in individuals with DS compared with their peers without DS. METHODS: Cardiopulmonary exercise tests were performed in healthy adults with and without DS. Parameters related to the cardiovascular, ventilatory and muscular systems were collected until VO2peak . In total, 51 participants were included in analysis, of which 21 had DS. RESULTS: Individuals with DS showed lower peak values for all collected outcomes (P ≤ 0.001) compared with those without DS, except for ventilatory threshold as a percentage of maximal oxygen uptake and VE /VCO2 slope, which were similar. CONCLUSIONS: Our results show that individuals with DS present impairments across the cardiovascular, ventilatory and muscular aspects of the cardiopulmonary system.

Anthropometry does not fully explain low fitness among adults with Down syndrome.

BACKGROUND: Cardiorespiratory fitness, expressed as peak oxygen uptake during exercise (VO2 peak), is an important predictor of cardiovascular health and is related to anthropometry in the general population. Individuals with Down syndrome (DS) have reduced cardiorespiratory fitness and often exhibit different anthropometrics compared with the general population. Interestingly, the relation between anthropometry and cardiorespiratory fitness found in the general population is not apparent in individuals with DS. However, accurate measures with dual energy X-ray absorptiometry (DEXA) scan have not been used to investigate this relationship in this population. The purpose of this paper was to investigate the relationship between accurate measures of anthropometry and cardiorespiratory fitness in adults with DS compared with an age-matched and sex-matched control group. METHODS: Anthropometrics (height, weight, waist and hip circumference, body composition via DEXA) and cardiorespiratory fitness (VO2 peak, measured during a graded maximal exercise test) were assessed in adults with (n = 9; 25 ± 3 years; 6 male patients) and without DS (n = 10, 24 ± 4 years; 5 male patients). RESULTS: Participants with DS were shorter (P < 0.01) than without DS and had a higher body mass index (P < 0.01), waist circumference (WC) (P = 0.026) and waist/height ratio (WHtR) (P < 0.01), but similar weight, body surface area (BSA), waist/hip ratio and body composition (P > 0.05). Participants with DS had significantly lower relative VO2 peak and VO2 peak corrected for total lean mass (TLM), but similar absolute VO2 peak, compared with without DS. In participants with DS, only WC and WHtR were associated with VO2 peak, whereas in participants without DS, height, weight, BSA, TLM, leg lean mass and body fat percentage were associated with VO2 peak. CONCLUSIONS: These results suggest that the relation between anthropometry and cardiorespiratory fitness found in the general population is not the same in adults with DS and that anthropometrics do not fully explain cardiorespiratory fitness in adults with DS. Further research into potential alternative explanations is required.

The remains of the taboo: experiences, attitudes, and knowledge about menopause in the workplace.

Objectives: This study explored experiences of, attitudes to, and knowledge about menopause in the workplace among participants from the UK to assess the extent to which menopause remains a taboo in this context.Method: An online survey was distributed via Trades Union Congress, UK networks and social media, and was completed by 5399 respondents. Questions explored three key issues relating to menopause at work: respondents' own experiences of menopause transition; disclosure at work; and availability of information on menopause at work.Result: The largest group (43.4%) of respondents were perimenopausal and 16.8% were postmenopausal; 12.3% indicated that they might be experiencing menopause but were not sure. Only 45.8% had disclosed their menopause status at work. Fewer than 20% were provided with information about menopause in their workplace but the majority would like such information to be available.Conclusion: The survey findings suggest some progress has been made to raise awareness about menopause in the workplace but that substantial work remains to be done to ensure women transitioning through menopause are supported.

Factors associated with pain induced by orthodontic separators.

Pain resulting from the application of orthodontic forces varies markedly across individuals. The reasons of this variability are still largely unknown. To investigate factors that may be associated with orthodontic pain following the application of orthodontic separators. One hundred and seven participants were screened for pain response over 48 h following placement of orthodontic elastomeric separators. The highest (n = 10) and lowest (n = 10) pain responders were identified, and data collected on tooth pain sensitivity to electrical stimulation in conjunction with using the Pain Catastrophising Scale (PCS), Dental Anxiety Scale (DAS) and cold pressor test (CPT). There were statistically significant differences between high- and low-pain responders in catastrophising score (P ≤ 0.023). For every PCS magnification score of 1 unit higher, the relative risk of being a high-pain responder was 1.6 (P = 0.002); those scoring higher on helplessness had a lower risk of being so. DAS scores of high-pain responders were twice as high as those of low-pain responder (P = 0.043). During the first 2 min of CPT, the high-pain responders experienced more pain than the low-pain responders (P ≤ 0.029). Tooth pain thresholds did not differ between the two different pain responder groups. Pain catastrophising, dental anxiety and cold sensitivity appear to modify the pain experienced following placement of orthodontic separators. Further research is needed to determine the validity of screening questions to identify at-risk patients prior to commencing orthodontic treatment.

Impact of malocclusion on quality of life among New Zealand adolescents.

OBJECTIVES: To determine whether malocclusion is associated with oral-health-related quality of life (OHRQoL) in New Zealand adolescents. METHODS: Data from two cross-sectional epidemiological studies of adolescents in Taranaki and Otago were used. Each participant completed a self-administered questionnaire and underwent a clinical examination. Information collected included sociodemographic characteristics (sex, ethnicity and household deprivation), and clinical measures (caries and malocclusion, the latter measured with the Dental Aesthetic Index, or DAI). OHRQoL was measured using the validated 16-item impact short-form Child Perceptions Questionnaire (CPQ11-14). Linear regression was used to model the CPQ11-14 score. RESULTS: 783 adolescents (52.6% male) took part. One-fifth had a handicapping malocclusion and one-third had a minor malocclusion or none. The overall mean DMFS was 2.3 (SD, 3.8), with slightly more than 50% being caries-free. With the exception of the oral symptoms domain, females presented with higher mean CPQ11-14 and domain scores, while Mãori had lower scores. There was a distinct gradient in mean CPQ11-14 and domain scores across the categories of malocclusion severity, whereby those in the 'handicapping' category of the DAI had the highest CPQ11-14 score. Linear regression modeling of the CPQ11-14 score showed that, after controlling for DMFS and socio-demographic characteristics, malocclusion category and being female were positively associated with higher CPQ11-14 scores. CONCLUSION: A severe malocclusion appears to have a negative impact on the OHRQoL of New Zealand adolescents.

[Activity trails, risk of falling, and health-related quality of life. Effects of a 12-week guided intervention]. / Bewegungsparcours, Sturzrisiko und gesundheitsbezogene Lebensqualität : Effekte einer 3-monatigen Bewegungsintervention.

BACKGROUND: The purpose was to evaluate the interventional effects of activity trails (courses) on fall risk factors and health-related quality of life (hrQoL). MATERIALS AND METHODS: A total of 94 subjects (67.7 ± 5.7 years; 29 men, 65 women) completed the following measurements prior to and 12 weeks after the initiation of the activity trail intervention: maximum isometric leg extensors force (Fmax, m3 diagnoses©), gait velocity (GV), and static postural stability (STAB, Zebris FDM©), fall-associated self-efficacy (FALL, FES-I), and hrQoL (SF-36). RESULTS: During the 12-week intervention period, the participants increased Fmax (1.63 ± 0.6 vs. 1.70 ± 0.6 N•kg(-1)) and GV (1.06 ± 0.25 vs. 1.11 ± 0.18m•s(-1); p < 0.05). Neither FALL (19.44 ± 3.6 vs. 19.41 ± 4.3 points) nor STAB (84.3 ± 56.4 vs. 79.7 ± 63.1 mm(2)) changed. Additionally, significant improvements in hrQoL regarding vitality (56.3 ± 17.2 vs. 63.2 ± 18.3 points) and mental health (69.4 ± 18.7 vs. 75.5 ± 16.5 points; p < 0.05) were found. CONCLUSION: The improvements in fall-related risk factors and hrQoL may be expected to contribute to fall prevention and psychosocial quality of life.

Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies.

OBJECTIVE: Since 2003, multiple cases of bisphosphonate-induced osteonecrosis of the jaw (ONJ) were reported. The aim of this study was to describe the incidence and risk factors of ONJ in patients with breast cancer or gynecological malignancies receiving bisphosphonates (BP). METHODS: ONJ was recorded for all patients with breast cancer or gynecological malignancies treated with intravenous bisphosphonates at the Department of Gynecology and Obstetrics, University Hospital Tuebingen during April, 1999 and May, 2006. RESULTS: 10 of 345 (2.9%) patients with breast cancer or gynecological malignancies developed ONJ while receiving bisphosphonate therapy. Six patients with ONJ had a history of recent dental procedures. All patients had received zoledronic acid as part of their bisphosphonate regimen. Time of exposure to bisphosphonates and the number of treatment cycles were significant risk factors for the development of ONJ (p<0.001). In patients diagnosed with ONJ the mean number of treatment cycles was 27+/-18 cycles. However, the mean number of treatment cycles in patients without manifestation of ONJ was 12+/-12 cycles. CONCLUSION: Length of exposure to BPs and the cumulative dose of given BPs seem to be the most important risk factors for the development of ONJ followed by dental procedures.

[Management of ureteral injuries]. / Management von Harnleiterverletzungen.

Ureteral injuries account for less than 3% of genitourinary injuries. Most of them are caused iatrogenically during abdominal surgery. The symptoms are often non-specific and do not aid in diagnosis. The later the injury is detected, the more often complications occur. Therefore, in such situations it is important to consider the possibility of ureteral injury and initiate further diagnostic steps as soon as possible. A variety of diagnostic tests are available. In addition to the direct inspection of the ureters and retrograde ureteropyelography, computed tomography (CT) urography is routinely used. Based on the time of diagnosis as well as the extent and the localization of the injury, the further procedure can be determined. For minor injuries, the insertion of a ureteral splint is usually the treatment of choice. In the case of higher grade damage, operative reconstruction by one of several possible surgical procedures is indicated.

[Stricture of the vesicourethral anastomosis after radical prostatectomy]. / Die Striktur der vesikourethralen Anastomose nach radikaler Prostatektomie.

BACKGROUND: The development of a stricture of the vesicourethral anastomosis is a serious complication after radical prostatectomy. Strictures occur in 5-8% of patients after radical prostatectomy. SYMPTOMS: Usually the clinical symptoms include an irritative and obstructive component similar to benign prostatic hyperplasia. In rare cases, patients suffer from partial or complete stress incontinence as a result of the anastomotic stricture. DIAGNOSTICS: The diagnostic workup is similar to the procedure for urethral strictures. In addition to uroflowmetry, a cystourethrogram (CUG) or, if necessary, a micturating cystourethrogram (MCU) can be performed. A urethrocystoscopy can be performed to ensure the diagnosis. THERAPY: In most cases, endoscopic procedures were performed for treatment. Beside a transurethral dilation of the stricture or the Sachse urethrotomy, the most common procedure is transurethral resection to treat the stricture. However, all procedures are associated with a high recurrence rate. In recurrent strictures, open surgical procedures, usually a perineal reanastomosis, should performed early. CONCLUSION: Endourological procedures like transurethral resection are a good treatment option, but due to the high recurrence rates, open surgical procedures should be discussed and if necessary should be performed early.

[Diagnostic workup of urethral strictures]. / Diagnostischer Workup bei der Harnröhrenstriktur.

Urethral stricture is a narrowing of the urethra due to scar tissue. It causes obstructive voiding dysfunction and can lead to long-term damage of the entire urinary tract. The probability of therapeutic success is dampened by a high rate of recurrence. Therefore, a careful taking of the patient's history and further diagnostics are crucial for finding the appropriate form of therapy. This review highlights the clinical presentation and diagnostic workup of urethral strictures.

[Urethral stricture : From diagnostics to appropriate treatment]. / Urethrastriktur : Von der Diagnostik bis zur sinnvollen Therapie.

Before making a treatment decision for patients presenting with a urethral stricture, following anamnesis and general examinations, appropriate diagnostics are necessary. This includes at least uroflowmetry and cystourethrography and the use of ultrasound and cystoscopy may be of additional help. The curative treatment of a urethral stricture is always an operation. Besides endourological procedures, open surgery for urethral reconstruction is also performed. This article aims to give an overview about the necessary diagnostic measures and the pros and cons of the different operative therapies.

[Current Aspects on the Pathogenesis of Urinary Tract Infections]. / Aktuelle Aspekte zur Pathogenese der Harnwegsinfektion.

Urinary tract infections are among the most common bacterial infectious diseases worldwide. Every second woman will experience at least one urinary tract infection in her lifetime. The administration of antibiotics has been a safe and efficient treatment modality so far. However, due to the emergence of multi-resistant pathogens and the developmental void of new antimicrobial drugs, the therapy of infections mighty become more challenging in the near future. So, knowledge of the complex host-pathogen interaction is of great importance. Common phenotypes observed in clinical practice suggest basic principles, which are relevant for the development of novel antimicrobial strategies. With invading pathogens forming intracellular bacterial communities they evade host response and provide a nidus for recurrent infection. A plethora of virulence factors allow uropathogenic bacteria to colonize and to establish infections in the urinary tract. In response, host responses seem to address specific virulence mechanisms that are essential to pathogenicity. Deciphering the molecular mechanisms underlying the complex host-pathogen interaction is critical to devise novel treatment options.

Phytoestrogens derived from red clover: an alternative to estrogen replacement therapy?

The benefits of plant extracts from soy and red clover as alternatives to conventional hormone replacement therapy (HRT) have been debated in the past. Here, an attempt has been made to summarize the biochemical and pharmacological data in the light of clinical aspects. Red clover and soy extracts contain isoflavones, which have a high affinity to estrogen receptor alpha (ERalpha), estrogen receptor beta (ERbeta), progesterone receptor (PR) and androgen receptor (AR). The higher affinity to ERbeta compared to ERalpha has been used as an explanation why red clover extracts function as food additives to treat menopausal disorders and may reduce risk of breast cancer. Biochemical analysis shows that these representatives of phytoestrogens have multiple actions beside selective estrogen receptor modulator (SERM)-activity. They act as selective estrogen enzyme modulators (SEEMs), have antioxidant activity and interact with transcription factors such as NF-kappaB. Furthermore, it is indicated that they have protective effects on osteoporosis and the cardiovascular system. Currently 40-50mg of isoflavones (biochanin A, daidzein, formononetin and genistein) are recommended as daily dose. This recommendation is based on the daily intake of phytoestrogens in a traditional Japanese diet.

Interaction of PCBs with thyroid hormone levels and time of hatching in chicken embryos.

The effects of polychlorinated biphenyls (PCB 77, PCB 153, and the mixture Aroclor 1242) on circulating and intracellular thyroid hormone (TH) levels were studied during chicken embryonic development. We observed no influences of PCB 153 on TH availability. Aroclor 1242 caused a transient increase in the T(3) level in the cerebellum at day 16. Clear effects were only seen with PCB 77 around the period of hatching: a severely reduced TH peak, which normally coincides with the stage of internal pipping, and a considerable delay in the moment of hatching.

Neurotoxicity of polychlorinated biphenyls (PCBs) by disturbance of thyroid hormone-regulated genes.

PCBs are known as neurotoxic compounds. Part of this neurotoxicity could be due to an alteration of the expression of TH-regulated genes in brain. To identify such genes, brain protein extracts of hypo- and hyperthyroid as well as PCB-treated embryos were compared by fluorescent 2D-DIGE. In total, we observed 109 differentially expressed proteins, of which 17 differed with both PCB and hypo- or hyperthyroid treatment. It was found that the interaction of PCBs with the expression of TH-regulated genes is congener-specific and that both hyperthyroidism- and hypothyroidism-related effects occur.

Comparison of hormonal activity (estrogen, androgen and progestin) of standardized plant extracts for large scale use in hormone replacement therapy.

Extracts from red clover (Trifolium pratense), soybean (Glycine max.) and black cohosh (Cimicifuga racemosa) are frequently used as alternative compounds for hormone replacement therapy (HRT) to treat menopausal disorders. Fifteen commercially available products made either from red clover, soybean or black cohosh were tested in in vitro assays in this study. The main polycyclic phenolic compounds of soy and red clover products were biochanin A, genistein, daidzein, formononetin, and glycitein. In red clover products glycitein was not abundant. All the compounds showed clear estrogenic activity through estrogen receptor alpha (ERalpha) and estrogen receptor beta (ERbeta) and affinity to progesterone receptor (PR) and androgen receptor (AR), whereas the compounds from black cohosh did not. This was corroborated by synthetic isoflavones such as biochanin A, daidzein, genistein and formononetin. They exerted affinity to PR and AR in the range of 0.39-110 mM. Statistical analysis applying principal component analysis (PCA) revealed that all red clover and soy products are grouped in different clusters. Red clover products showed a higher affinity to AR and PR than soy products, which is explained by the higher amount of isoflavones present. In vitro assays and chemical analysis showed that theoretical estrogenic activity expressed as equivalent E2 concentration is in the same range as recommended for synthetic estrogens. Broader spectrum of action and hypothesized lower side effects by action through ERbeta make them suitable for alternative hormone replacement therapy.

Asymmetrical dark field detectors in the STEM.

Although the annular dark field detector in the STEM collects a large fraction of the elastically scattered electrons, it does not use all the information carried by these electrons because it ignores the distribution of electrons over its surface. This information can be obtained by dividing the detector into sections. This paper calculates the number of electrons scattered by a single atom onto each side of an annular dark field detector split in half by a line passing through its center. This scattering problem is unusual becuase the incident wave is not a plane wave in the STEM. The sum and difference signals are calculated for a single atom from its scattering amplitude for a STEM limited by primary or secondary spherical aberration operating at 10 kV, 70kV, or 100 kV. All the cases calculated show that a single thorium atom should give an observable difference signal which is very sensitive to the focal conditions of the STEM.

High resolution imaging properties of the STEM.

The effect of the finite size of the atom on the resolution of the STEM is investigated. When the probe size becomes comparable to the size of the atom, the quality of the image depends on the scattering properties of the atom as well as the distribution of electrons in the probe. A technique for calculating the image of a single atom is developed by expanding the scattering amplitude. This allows the image of an atom or its spatial frequency to be expanded into various components. The specific case of dark field contrast formed with elastically scattered electrons is considered. The coefficients of the components are evaluated for carbon and thorium using complex scattering amplitudes derived from relativistic Hartree-Fock-Slater wavefunctions. The coefficients are evaluated for a 100 keV microscope using an immersion type objective lens whose aperture is limited to 12 mrad by primary spherical aberration and a 100 keV microscope using the same objective lens in conjunction with a corrector lens for spherical aberration. Secondary spherical aberration limits the objective aperture of the corrected microscope to 30 mrad.