Enhancement of awareness through feedback does not lead to interlimb transfer of obstacle crossing in virtual reality.

Locomotor skill transfer is an essential feature of motor adaptation and represents the generalization of learned skills. We previously showed that gait adaptation after crossing virtual obstacles did not transfer to the untrained limb and suggested it may be due to missing feedback of performance. This study investigated whether providing feedback and an explicit goal during training would lead to transfer of adaptive skills to the untrained limb. Thirteen young adults crossed 50 virtual obstacles with one (trained) leg. Subsequently, they performed 50 trials with their other (transfer) leg upon notice about the side change. Visual feedback about crossing performance (toe clearance) was provided using a color scale. In addition, joint angles of the ankle, knee, and hip were calculated for the crossing legs. Toe clearance decreased with repeated obstacle crossing from 7.8 ± 2.7 cm to 4.6 ± 1.7 cm for the trained leg and from 6.8 ± 3.0 cm to 4.4 ± 2.0 cm (p < 0.05) for the transfer leg with similar adaptation rates between limbs. Toe clearance was significantly higher for the first trials of the transfer leg compared to the last trials of the training leg (p < 0.05). Furthermore, statistical parametric mapping revealed similar joint kinematics for trained and transfer legs in the initial training trials but differed in knee and hip joints when comparing the last trials of the trained leg with the first trials of the transfer leg. We concluded that locomotor skills acquired during a virtual obstacle crossing task are limb-specific and that enhanced awareness does not seem to improve interlimb transfer.

Obstacle avoidance training in virtual environments leads to limb-specific locomotor adaptations but not to interlimb transfer in healthy young adults.

Obstacle avoidance is one of the skills required in coping with challenging situations encountered during walking. This study examined adaptation in gait stability and its interlimb transfer in a virtual obstacle avoidance task. Twelve young adults walked on a treadmill while wearing a virtual reality headset with their body state represented in the virtual environment. At random times, but always at foot touchdown, 50 virtual obstacles of constant size appeared 0.8 m in front of the participant requiring a step over with the right leg. Early, mid and late adaptation phases were investigated by pooling data from trials 1-3, 24-26 and 48-50. One left-leg obstacle appearing after 50 right-leg trials was used to investigate interlimb transfer. Toe clearance and the anteroposterior margin of stability (MoS) at foot touchdown were calculated for the stepping leg. Toe clearance decreased over repeated practice between early and late phases from 0.13 ± 0.05 m to 0.09 ± 0.04 m (mean ± SD, p < 0.05). MoS increased from 0.05 ± 0.02 m to 0.08 ± 0.02 m (p < 0.05) between early and late phases, with no significant differences between mid and late phases. No differences were found in toe clearance and MoS between the practiced right leg for early phase and the single trial of the left leg. Obstacle avoidance during walking in a virtual environment stimulated adaptive gait improvements that were related in a nonlinear manner to practice dose, though such gait adaptations seemed to be limited in their transferability between limbs.

Sexual cues alter working memory performance and brain processing in men with compulsive sexual behavior.

Pornography has been repeatedly at the centre of public attention and has been controversially discussed for a long time. However, little is known about the connection between pornographic stimuli and individual (neuronal) processing of attention and memory. Here, the impact and neural underpinnings of pornographic pictures on working memory processes in a sample of subjects with compulsive sexual behaviour was investigated. Therefore, whilst using functional magnetic resonance imaging (fMRI), a letter n-back task with neutral or pornographic pictures in the background was employed in 38 patients and 31 healthy controls. On the behavioural level, patients were slowed down by pornographic material depending on their pornography consumption in the last week, which was reflected by a higher activation in the lingual gyrus. In addition, the lingual gyrus showed a higher functional connectivity to the insula during processing of pornographic stimuli in the patient group. In contrast, healthy subjects showed faster responses when confronted with pornographic pictures only with high cognitive load. Also, patients showed a better memory for pornographic pictures in a surprise recognition task compared to controls, speaking for a higher relevance of pornographic material in the patient group. These findings are in line with the incentive salience theory of addiction, especially the higher functional connectivity to the salience network with the insula as a key hub and the higher lingual activity during processing of pornographic pictures depending on recent pornography consumption.

A convenient method for large-scale STM mapping of freestanding atomically thin conductive membranes.

Two-dimensional atomically flat sheets with a high flexibility are very attractive as ultrathin membranes but are also inherently challenging for microscopic investigations. We report on a method using Scanning Tunneling Microscopy (STM) under ultra-high vacuum conditions for large-scale mapping of several-micrometer-sized freestanding single and multilayer graphene membranes. This is achieved by operating the STM at unusual parameters. We found that large-scale scanning on atomically thin membranes delivers valuable results using very high tip-scan speeds combined with high feedback-loop gain and low tunneling currents. The method ultimately relies on the particular behavior of the freestanding membrane in the STM which is much different from that of a solid substrate.

Antifungal prophylaxis with posaconazole vs. fluconazole or itraconazole in pediatric patients with neutropenia.

Pediatric patients with hemato-oncological malignancies and neutropenia resulting from chemotherapy have a high risk of acquiring invasive fungal infections. Oral antifungal prophylaxis with azoles, such as fluconazole or itraconazole, is preferentially used in pediatric patients after chemotherapy. During this retrospective analysis, posaconazole was administered based on favorable results from studies in adult patients with neutropenia and after allogeneic hematopoietic stem cell transplantation. Retrospectively, safety, feasibility, and initial data on the efficacy of posaconazole were compared to fluconazole and itraconazole in pediatric and adolescent patients during neutropenia. Ninety-three pediatric patients with hemato-oncological malignancies with a median age of 12 years (range 9 months to 17.7 years) that had prolonged neutropenia (>5 days) after chemotherapy or due to their underlying disease, and who received fluconazole, itraconazole, or posaconazole as antifungal prophylaxis, were analyzed in this retrospective single-center survey. The incidence of invasive fungal infections in pediatric patients was low under each of the azoles. One case of proven aspergillosis occurred in each group. In addition, there were a few cases of possible invasive fungal infection under fluconazole (n = 1) and itraconazole (n = 2). However, no such cases were observed under posaconazole. The rates of potentially clinical drug-related adverse events were higher in the fluconazole (n = 4) and itraconazole (n = 5) groups compared to patients receiving posaconazole (n = 3). Posaconazole, fluconazole, and itraconazole are comparably effective in preventing invasive fungal infections in pediatric patients. Defining dose recommendations in these patients requires larger studies.

Overestimate of relative aerobic contribution with maximal accumulated oxygen deficit: a review.

Maximal accumulated oxygen deficit (MAOD) is widely utilized in calculating energy production during supra-maximal exercises. Since its introduction by Medbo et al. in 1988, debate on MAOD existed. The purpose of this review was to summarize the development and description of MAOD and another method of calculating energy production (Pcr-La-O2). We reviewed similar studies on relative aerobic contribution (O2%) and analyzed various results of O2% calculated using MAOD or Pcr-La-O2. An overestimate of O2% was found when using MAOD compared to Pcr-La-O2. The overestimate when using MAOD is likely due to the linear extrapolation of oxygen uptake at supra-maximal intensity, the neglect of anaerobic energy release and the reduced duration of each step in sub-maximal incremental test. Since it is unknown which method provides a more reliable estimation of O2%, an exponential regression function (y=22.404 * ex + 45.176, where y=O2% in percentage, x=duration of the supra-maximal exercise in minute) was drawn from the existing data using both methods.

Maximal lactate steady state in kayaking.

A fixed blood lactate value of 4 mM was commonly used to calculate workload at maximal lactate steady state (MLSS) in kayaking. Our purpose was to measure the actual blood lactate value at MLSS and workload at MLSS in kayaking and assess the validity of using a fixed blood lactate value to calculate the workload at MLSS. 8 junior kayakers (15.1±1.2 years; 179.9±7.3 cm; 72.3±4.9 kg) participated in an incremental workload test and 4-6 sub-maximal constant workload tests (duration of 30 min) on a kayaking ergometer. Blood lactate was measured to calculate the blood lactate value and workload at MLSS. The blood lactate value at MLSS in kayaking was 5.4±0.7 mM. The measured workload at MLSS (112±22 watts) was significantly greater than the calculated workload using a lactate value of 4 mM (104±18 watts, p=0.016). The measured MLSS workload was not significantly different from the calculated workload using a fixed lactate value of 5.4 mM (115±19 watts, p=0.16) or 5.0 mM (113±19 watts, p=0.78) in the incremental tests. A fixed blood lactate value of 5 mM instead of 4 mM might be a better estimate in kayaking given the incremental workload test used in this study.

Comparison of itraconazole, voriconazole, and posaconazole as oral antifungal prophylaxis in pediatric patients following allogeneic hematopoietic stem cell transplantation.

Oral antifungal prophylaxis with extended-spectra azoles is widely used in pediatric patients after allogeneic hematopoietic stem cell transplantation (HSCT), while controlled studies for oral antifungal prophylaxis after bone marrow transplantation in children are not available. This survey analyzed patients who had received either itraconazole, voriconazole, or posaconazole. We focused on the safety, feasibility, and initial data of efficacy in a cohort of pediatric patients and adolescents after high-dose chemotherapy and HSCT. Fifty consecutive pediatric patients received itraconazole, 50 received voriconazole, and 50 pediatric patients received posaconazole after HSCT as oral antifungal prophylaxis. The observation period lasted from the start of oral prophylactic treatment with itraconazole, voriconazole, or posaconazole until two weeks after terminating the oral antifungal prophylaxis. No incidences of proven or probable invasive mycosis were observed during itraconazole, voriconazole, or posaconazole treatment. A total of five possible invasive fungal infections occurred, two in the itraconazole group (4%) and three in the voriconazole group (6%). The percentage of patients with adverse events potentially related to clinical drugs were 14% in the voriconazole group, 12% in the itraconazole group, and 8% in the posaconazole group. Itraconazole, voriconazole, and posaconazole showed comparable efficacy as antifungal prophylaxis in pediatric patients after allogeneic HSCT.

Alterations in basement membrane immunoreactivity of the diabetic retina in three diabetic mouse models.

BACKGROUND: The mouse retina contains three kinds of basement membrane (BM) structures; the inner limiting membrane (ILM), Bruch's membrane (BrM), and the BM surrounding the capillaries. We aimed to investigate possible variations of individual BM components and to detect effects caused by diabetes in three different diabetic mouse models. METHODS: After 4 and 6 months of diabetes (defined by blood glucose > 250 mg/dl), we analyzed by immunohistochemistry the laminin, collagen IV, and nidogen-1 and nidogen-2 protein composition of the BMs obtained from diabetic and non-diabetic Leptin-receptor deficient (db/db) mice and insulin receptor (IR)/insulin receptor substrate-1 (IRS-1) double heterozygous knockout mice. In addition, C57BL/6 J mice were rendered diabetic by intraperitoneal injections of streptozotocin (STZ). RESULTS: All analyzed BM proteins were detected in all of the three BMs with the exception of collagen IV, which was not detectable in the ILM of db/db mice and IR/IRS-1 mice. We present the first analysis of nidogen expression in diabetic BM. The staining patterns did not differ between the type-1 diabetic model (STZ) or the type-2 diabetic models (db/db and IR/IRS-1) and the wild-type controls, with only one exception: both the db/db mice and the IR/IRS-1 mice but not the STZ mice showed a decreased nidogen-1 immunoreactivity in the BrM after 4 months of diabetes, but not after 6 months. CONCLUSIONS: The BMs in the three mouse strains differ with regard to protein immunoreactivity in the inner limiting membrane. Changes in BM composition may affect both the assembly and the function of the retinal BM. However, there are no marked differences in the BM composition between type-1 and type-2 diabetes. These results provide evidence for BM remodelling during diabetic retinopathy.

Prevalence of osteoporosis among cancer patients in Germany: prospective data from an oncological rehabilitation clinic.

UNLABELLED: In this prospective study, we measured bone mineral density (BMD) in 1,041 cancer patients undergoing an oncological rehabilitation program in an inpatient rehabilitation clinic. There was an osteoporosis prevalence of approximately 16%, independent of sex, which is considerably higher than in the community-dwelling population. INTRODUCTION: There is evidence that cancer patients are at risk of an increased BMD-loss following the disease and its therapy. Nevertheless, there is only little data available about the prevalence of osteoporosis in German cancer patients. Therefore, we measured BMD in 1,041 oncological inpatients undergoing rehabilitation. METHODS: From February 2006 to September 2009, BMD was measured in oncological patients with dual-energy x-ray absorptiometry (DXA; femur and spine). Statistical analysis for prevalence of osteoporosis was done in descriptive manner calculating means, standard deviation, frequencies, and 95% confidence intervals. To compare the prevalence of osteoporosis in different subgroups, χ (2) tests were done with p < 0.05. To create a risk profile, odds ratios were calculated using uni- and multivariate logistic regression. RESULTS: In 1,041 patients with a mean age of 57.1 years (11.0 years), DXA-measures were performed. Of them, 22% were male and 78% were female. The osteoporosis prevalence was about 16% (13.8, 18.2), independent of sex (p = 0.9722) or cancer type (p = 0.7174). As risk factors influencing the development of osteoporosis, age, weight, menopausal state, and hormone replacement therapy were identified in women and weight only in men. CONCLUSIONS: Compared to the general population, the rate of osteoporosis is distinctly elevated in German cancer patients independent of sex or cancer type. Hence, a general recommendation for a DXA screening in these patients appears to be justified.

[Vocational interventions integrated in inpatient rehabilitation]. / Medizinisch-berufliche Interventionen in der stationären orthopädischen Rehabilitation. Explorative Evaluation eines Pilot-projektes aus Patientensicht.

Orientation on work place associated problems is a typical assignment of medical rehabilitation in Germany. The implementation of special vocational programmes, however, may be associated with several challenges concerning staff and space required, which could be difficult to overcome.

[Nutrition patterns in German breast cancer patients]. / Wie ernähren sich Frauen mit Brustkrebs in Deutschland?

BACKGROUND: Several studies could demonstrate an association between nutrition and the risk of breast cancer. PATIENTS AND METHODS: In this study we examined the daily diet of German patients with breast cancer approximately 12 months after diagnosis. In a prospective trial nutritional habits were evaluated in 165 breast cancer patients on admittance to an inpatient medical rehabilitation program. RESULTS: The results of this survey show that patients with breast cancer report on a nutritional pattern which is characterised by a (very) low consumption of grains, vegetables, fruits und fish and a high consumption of meat and processed meat. Due to epidemiological data, it may be hypothesized that the patients' diet might have contributed to the development of their disease. CONCLUSION: Our results underscore the need for nutritional counselling of breast cancer patients, as they show a relatively unfavourable nutrition pattern which differs from currently available advice. An inpatient rehabilitation programme could be an adequate starting point for this purpose.

[Elevated liver enzymes in rheumatoid arthritis : differential diagnostic considerations based on a case report]. / Leberwerterhöhung bei rheumatoider Arthritis : Differenzialdiagnostische Uberlegungen an einem Fallbeispiel.

Elevated liver enzymes in patients with rheumatoid arthritis may have various causes. These can range from the rheumatic disease itself, the anti-rheumatic medication or be the manifestation of an associated autoimmune disease. We present the case of a 19-year-old female with known seropositive rheumatoid arthritis who developed severe liver damage after 9 months of anti-rheumatic therapy with leflunomide and adalimumab. Both drugs were stopped. In addition to the underlying disease and the specific anti-rheumatic drugs, a temporary therapy with flucloxacillin as well as an association with newly diagnosed celiac disease had to be considered as possible causes of elevated liver enzymes. Following repeated liver biopsy, autoimmune hepatitis was assumed and prednisolone and azathioprine were initiated. Elevated liver enzymes and bilirubin rapidly returned to normal values.

[Effect of propriocetiv trainings tools for the muscles in stance stability]. / Auswirkung propriozeptiver Trainingsgeräte auf beteiligte Muskulatur im Einbeinstand.

Today in each therapy and training program proprioceptive exercises are integrated. A lot of equipment you can buy. But for an more effective training exercises and equipment should be select more regarding the aim and the problem of the training. In literature is not much written about the specific way proprioction equipment stimulate different muscles. In this study 15 students of sport sciences (25.7 +/- 2.2 years, 8 male, 7 female) were tested for a period of 15 seconds in a single-leg standing position on a small rocker board, a wobble board, a gym mat and the Posturomed(c). The exercise was done just one time on each tool in a random way. The effect of the exercise was measured by EMG on six main stabilising muscles, m. tibialis ant., m. peroneus long., m. gastrocnemius med. And lat., m. semimembranosus and m. vastus med. At the end of the test series MVC of each muscle was tested. For the analysis we regarded the first, middle and last second of the test. Also the maximum peak over 0.5 sec. and the average of the whole test was integrated into the data base. The statistics was done with the Wilcoxen-Test. The experimental standard deviation was defined of 5 %. The highest EMG activity we noticed on the small rocker board. The activity was over the whole test series significant higher in the muscles m. tibialis ant., m. peroneus long. and m. gastrocnemius. The m. semimebranusus shows in all exercises the slightest EMG activity, the m. peroneus long. shows the highest activity. During the test all muscles decrease in EMG activity except m. peroneus long. on the small rocker board and the Posturomed. With these facts of EMG activity during proprioceptive exercises we are able to advice training more specifically: Because of the decreasing activity we advice doing repeated intervals not longer than 15 seconds. In the aim of ankle stabilisation use the small rocker board and the gym mat. For rehabilitation and prevention on the knee use the Posturomed, the mat or even the small rocker board. The advocacies are given looking to the tested rehab tools.

Advanced cantilevers for magnetic force microscopy and high frequency magnetic force microscopy.

In order to improve the spatial resolution achieved by magnetic force microscopy (MFM) technique and its derivatives, we employ here advanced MFM tips fabricated by means of focused ion beam (FIB) milling. The magnetic coating applied on these tips is a CoCr film of 10 nm thickness. The MFM measurements on hard disk test samples reveal the achieved high resolution, and the measurement on a garnet film demonstrates the low invasiveness. High-frequency MFM (HF-MFM) is a development of the MFM technique to observe the HF stray fields emerging from magnetic recording writer poles at their operating conditions. By means of HF-MFM, magnetic recording writer poles are characterized in the frequency range 100-1,000 MHz. Up to now, all HF-MFM experiments conducted were using standard MFM cantilevers. From the HF-MFM images obtained using the advanced MFM cantilevers, it is clearly seen that the spatial resolution is considerably improved over the images obtained using standard MFM tips. However, the 10 nm thick magnetic coating of the cantilevers is found to work properly only at frequencies of up to about 500 MHz.

Once versus twice daily formoterol via Novolizer for patients with moderate to severe COPD--a double-blind, randomised, controlled trial.

STUDY OBJECTIVES: To evaluate in patients with moderate to severe COPD whether a single morning dose of 24 microg formoterol from the Novolizer is not inferior to two divided doses of 12 microg formoterol inhaled in the morning and in the evening. DESIGN: Randomised, double blind, active-controlled, parallel-group, multi-centre study with a 2-week run-in period and a 12-week treatment phase. SETTING: Forty-seven outpatient centres in Germany, including private practices. PARTICIPANTS: N=321 symptomatic patients with moderate to severe COPD aged 40-70 years with an FEV1 of 30-80% predicted and the requirement of 3-12 actuations of salbutamol per day on 5 days during the run-in period. TREATMENT: Eligible patients were randomised to inhale formoterol either (a) as a single 24 microg dose in the morning (OD) or (b) in two divided 12 microg doses in the morning and in the evening (b.i.d.). MEASUREMENTS AND RESULTS: The mean age was 60.3 (SD 7.3) years, and mean baseline pre-dose FEV1 was 1.5l (0.5l) or 50% (12%) of predicted, respectively. After 12 weeks of treatment, pre-dose FEV(1) improved in both groups (mean: OD, +104 ml, b.i.d., +135 ml, mean difference between groups: 31 ml). The 95% CI exceeded the pre-determined margin of 100ml by 2 ml, so that the statistical hypothesis of non-inferiority of once daily dosing was not confirmed. No statistically significant differences were seen for improvements in PEF, MEF75, MEF50, and MEF25. COPD symptoms, percentage of symptom-free days and quality of life (SGRQ) improved in both groups to a similar degree. There were no relevant differences in the incidence of adverse events. CONCLUSIONS: Based on a comparable efficacy and tolerability, the dosing schedule with formoterol via Novolizer as once daily in the morning seems to be an alternative compared to twice daily treatment. The primary endpoint suggests the equivalence of both treatment schedules from a clinical perspective. This regimen can be considered as an alternative therapeutic approach for a subgroup of COPD patients and may help to improve patient compliance.

Telomere length analysis in monocytes and lymphocytes from patients with systemic lupus erythematosus using multi-color flow-FISH.

In order to analyse telomere length in subsets of human peripheral blood lymphocytes and monocytes, we modified a recently developed multicolor flow- fluorescent in situ hybridization (FISH) methodology that combines flow-FISH and antibody staining for cell surface antigens. We analysed telomere length of peripheral blood mononuclear cells in a group of 22 patients with systemic lupus erythematosus (SLE) and 20 age-matched healthy donors. We found that neither CD4+, CD8+, CD19+ cells nor CD14+ monocytes have significantly shorter telomeres compared with their healthy counterparts. On the basis of these findings, we then used monocyte telomere length as internal reference in order to control for intra-individual variability in telomere length. By using this approach, we could demonstrate significant telomere shortening in all three lymphocyte subsets (in all cases P < 0.05) compared with monocytes. However, these differences did not vary significantly between SLE patients and controls. In summary, telomere lengths in subpopulations of hematopoietic cells can be monitored in patients with SLE using multicolor flow-FISH. While confirming data by other groups on telomere length in lymphocyte subpopulations, our data argue against an increased proliferation rate of peripheral blood monocytes reflected by accelerated telomere shortening in patients with SLE.

Randomised trial comparing as-needed versus regular treatment with formoterol in patients with persistent asthma.

PURPOSE: The aim of this study was to demonstrate the equivalent efficacy of inhaled formoterol in asthmatic patients, either given as-needed or on a regular twice-daily schedule. METHODS: Randomised, open 12-week study in patients with mild to moderate asthma not adequately controlled with inhaled glucocorticosteroids alone. Patients received inhaled formoterol as needed or on a regular schedule (2x2 puffs/day with 6 microg formoterol per puff). Patients in the twice-daily formoterol group could use salbutamol as a rescue medication. The primary endpoint was the number of patients with asthma exacerbations in each group. RESULTS: Thirty-nine centres randomised 359 patients. The number of patients with asthma exacerbations showed neither a clinically relevant nor a statistically significant difference between groups: formoterol as-needed: 3.95% (7 of 177); twice daily: 3.45% (6 of 174). Patients in the formoterol as-needed group used significantly less formoterol (-1.5 puffs per day; P<0.0001). Including the saved rescue medication (up to one puff per day), total beta-2 agonist use in the formoterol as-needed group decreased by approximately 2-2.5 puffs per day. Both formoterol treatment schedules were well tolerated. Musculoskeletal pain and tremor were less frequent in the formoterol as-needed group: headaches were slightly more frequent. CONCLUSION: Formoterol given as needed and without additional beta-2 agonist, and formoterol given on a regular basis twice daily, supplemented by salbutamol as a rescue medication, appeared equally effective in this clinical study. Drug consumption was markedly lower in the former group.