Study protocol of a cluster-randomised controlled trial assessing a multimodal machine-based exercise training programme in senior care facilities over 6 months - the bestform study (best function of range of motion).

BACKGROUND: Physical functioning is a crucial factor for independence and quality of life in old age. The aim of the "bestform-Best function of range of motion" trial is to investigate the effects of a 6 months multimodal machine-based strength, coordination and endurance training on physical function, risk of falls and health parameters in older adults. METHODS: Bestform is a cluster-randomised trial including older adults ≥ 65 years living in senior care facilities in Southern Germany. Senior care facilities are randomly allocated to the control group with usual care (n ≥ 10 care facilities) and to the intervention group (n ≥ 10 care facilities), overall including ≥ 400 seniors. Residents belonging to the intervention group are offered a supervised machine-based exercise training programme twice weekly over 45-60 min over six months in small groups, while those in the usual care facilities will not receive active intervention. The primary outcome is the change in Short Physical Performance Battery over six months between groups. Secondary outcomes are change in risk of falling, fear of falling, number of falls and fall-related injuries, physical exercise capacity, handgrip strength, body composition, cardiac function, blood parameters, quality of life, risk of sarcopenia, activities of daily living, and cognition over three and six months. DISCUSSION: The bestform study investigates the change in physical function between seniors performing exercise intervention versus usual care over six months. The results of the study will contribute to the development of effective physical activity concepts in senior care facilities. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04207307. Registered December 2019.

Progressive machine-based resistance training for prevention and treatment of sarcopenia in the oldest old: A systematic review and meta-analysis.

The muscle disease sarcopenia, which is characterised by a loss of muscle strength, muscle quantity, and physical performance, restricts mobility and independence in an ageing society. The aim of this systematic review and meta-analysis is to analyse the effects that long-term progressive resistance training interventions performed on weight machines have on sarcopenia (European Working Group on Sarcopenia in Older People) and how the interventions are composed. In total, 779 articles published between 2000 and 2020 were scanned (PubMed, Web of Science, CINAHL) and 14 randomised controlled trials were included within the review. Populations, interventions, control groups and outcomes were analysed. Subsequent meta-analysis (10 studies, 902 participants) revealed that the time needed in a chair-stand-test, as an indicator for leg strength, was predominantly reduced, whereas grip strength remained unchanged after the interventions. Data concerning the effects of machine-based progressive resistance training on muscle quantity were insufficient for meta-analysis. Physical performance measured by undergoing the Timed-Up-and-Go-test, gait speed test, Short Physical Performance Battery and 6 min-walk-test improved significantly as well. The quality of evidence (GRADE) in the analysed studies was low or moderate. In summary, machine-based progressive resistance training has the potential to reverse sarcopenia in the oldest old, as reflected by enhanced muscle strength and physical performance. The systematic review revealed promising initial results for muscle quantity.

Frequency of extreme precipitation increases extensively with event rareness under global warming.

The intensity of the heaviest extreme precipitation events is known to increase with global warming. How often such events occur in a warmer world is however less well established, and the combined effect of changes in frequency and intensity on the total amount of rain falling as extreme precipitation is much less explored, in spite of potentially large societal impacts. Here, we employ observations and climate model simulations to document strong increases in the frequencies of extreme precipitation events occurring on decadal timescales. Based on observations we find that the total precipitation from these intense events almost doubles per degree of warming, mainly due to changes in frequency, while the intensity changes are relatively weak, in accordance to previous studies. This shift towards stronger total precipitation from extreme events is seen in observations and climate models, and increases with the strength - and hence the rareness - of the event. Based on these results, we project that if historical trends continue, the most intense precipitation events observed today are likely to almost double in occurrence for each degree of further global warming. Changes to extreme precipitation of this magnitude are dramatically stronger than the more widely communicated changes to global mean precipitation.

Impact of hindcast length on estimates of seasonal climate predictability.

It has recently been argued that single-model seasonal forecast ensembles are overdispersive, implying that the real world is more predictable than indicated by estimates of so-called perfect model predictability, particularly over the North Atlantic. However, such estimates are based on relatively short forecast data sets comprising just 20 years of seasonal predictions. Here we study longer 40 year seasonal forecast data sets from multimodel seasonal forecast ensemble projects and show that sampling uncertainty due to the length of the hindcast periods is large. The skill of forecasting the North Atlantic Oscillation during winter varies within the 40 year data sets with high levels of skill found for some subperiods. It is demonstrated that while 20 year estimates of seasonal reliability can show evidence of overdispersive behavior, the 40 year estimates are more stable and show no evidence of overdispersion. Instead, the predominant feature on these longer time scales is underdispersion, particularly in the tropics. KEY POINTS: Predictions can appear overdispersive due to hindcast length sampling errorLonger hindcasts are more robust and underdispersive, especially in the tropicsTwenty hindcasts are an inadequate sample size to assess seasonal forecast skill.

[Prevalence of the metabolic syndrome and its risk factors: results of a large work-site health assessment]. / Prävalenz des Metabolischen Syndroms und seiner Risikofaktoren: Ergebnisse einer großen betrieblichen Gesundheitsuntersuchung.

BACKGROUND: Facing the demographic change, cardiovascular risk factors have been assessed within an occupational checkup to establish health programs. PATIENTS AND METHODS: From 2006 to 2007, anthropometric and blood parameters of 27 359 employees of a large company of the German automobile industry were collected aiming to determine the prevalence of metabolic syndrome (by NCEP ATP III) and its risk factors. Data from 3048 employees (fasting state) were analyzed (age: ∅ 39,4 ± 10,3 years, 81.4% males). RESULTS: The most common risk factors were hypertension ≥ 130/85 mmHg (men [m]: 74,4%, 95%-confidence interval [CI] 73-76%, women [w]: 47,1%, 95%-CI 43-51%), elevated triglycerides (≥ 150 mg/dl; m: 32,8%, 95%-CI 31-35%, w: 13,8%, 95%-CI 11-17%) and waist-circumferences (> 102 cm for men: 15,1%, 95%-CI 14-17%; > 88 cm for women: 16,9%, 95%-CI 14-20%). The prevalence of metabolic syndrome (≥ 3 risk factors) was 11,7% (95%-CI 12-15%; m: 12,7%, 95%-CI 11-14%, w: 7,4%, 95%-CI 6-10%) increasing with physical inactivity and rising age up to 20%. The prevalence of hypertension in young (< 20 years) and elder men (≥ 50 years) was similarly high (79,1%, 95%-CI 70-86% vs. 79,9%, 95%-CI 75-82%). CONCLUSION: The prevalence of metabolic syndrome in this sample is rather low, but 75% of the men and nearly 50% of the women had hypertension. Health programs should focus on this risk factor in particular.

S100 as an immunohistochemically-detected marker with prognostic significance in endometrial carcinoma.

BACKGROUND: Several studies have indicated that dendritic cells (DC) participate in anti-tumor immunity, possibly influencing the course of malignant disease. We tested whether tumor infiltration by S100+ DC could be a prognostic marker for endometrial cancer. MATERIALS AND METHODS: A retrospective study analyzing 115 tissue samples from patients with endometrial carcinoma and known histological grading as well as hormone receptor, Ki-67, Her-2/neu and p53 expression. Sections of paraffin-embedded endometrial tissue were immunohistochemically-stained with anti S100 antibody. Tumor infiltrating S100+ DC were counted via microscopic examination and calculated as S100+ DC per mm2 of tissue. RESULTS: Samples were divided into group 1: less than 10 S100+DC/mm2 (n = 44) and group 2: 10 or more S100+ DC/mm2 (n = 71). Correlation with clinico-pathological markers was calculated by Chi-square test. Compared to group 1, the DC-rich group 2 showed a higher level of differentiation (p=0.045), a lower overexpression of p53 (p=0.021) and less proliferation (p=0.028). DC infiltration was not correlated with Her-2/neu, hormone receptor status and FIGO-stage. Although no significant correlation could be seen, the DC-poor group samples seemed to correlate with a higher FIGO-stage compared to the DC-rich group. In uni- and multivariate analysis, DC infiltration proved to be a significant prognostic marker for adjusted survival but not for overall survival. CONCLUSION: Our results indicate that the immunohistochemical determination of S100+ DC could contribute to the identification of a high-risk subgroup and, therefore, would be a favorable prognostic factor for endometrial carcinoma. Our observation that pronounced DC infiltration is associated with good prognosis points to an important role of the host's immune system response for the clinical course of endometrial cancer.

Masticatory mucosa in subjects with different periodontal phenotypes.

AIMS: The aim of the present investigation was to study thickness of masticatory mucosa and gingival width in subjects with different periodontal phenotypes. METHODS: Periodontal phenotypes were defined with the aid of cluster analysis of standardised parameters including mean gingival thickness and width as well as ratio of crown width to its length at maxillary canines, lateral and central incisors of 40 young adults with healthy periodontal conditions. RESULTS: 3 groupings could be observed. Clusters A1 and A2 comprised 75% of all subjects. They were characterised by thin gingiva and a slender tooth form. Clusters A1 and A2 were differentiated by gingival width. Cluster B comprised 11 subjects with relatively thick and wide gingiva and a quadratic tooth shape. In general, characteristics of the frontal sextant in the maxilla were also found in other parts of the dentition. Thus, mean thickness of masticatory mucosa as well as gingival width and crown form differed significantly among clusters. In addition, cluster B subjects had a significantly greater mean periodontal probing depth. Multiple linear regression analysis was employed to identify significant factors influencing palatal mucosal thickness. Women had considerably thinner palatal mucosa than men. Furthermore, cluster affiliation had a significant influence on thickness of palatal mucosa. Thickest tissue was found in the premolar region, whereas the mucosa over the root prominence of the first molar represented an anatomical barrier for graft harvesting. CONCLUSIONS: Thickness of masticatory mucosa strongly depends on gender and the periodontal phenotype.

Thickness of masticatory mucosa.

BACKGROUND: The aim of the present study was to assess thickness of all parts of the masticatory mucosa by using an ultrasonic measuring device. METHODS: A total of 40 periodontally healthy subjects, 19 to 30 years old, took part. Thickness of masticatory mucosa was measured at a maximum of 149 sites in each proband. RESULTS: Female volunteers had significantly thinner mean masticatory mucosa than males (p<0.01). Mean thickness of facial gingiva ranged between 0.7 mm at canines in the maxilla and central incisors in the mandible and 2.3 mm at 3rd molars in the mandible. In the mandible, thickness of lingual gingiva ranged between 0.9 mm at lateral incisors and 2.3 mm at 3rd molars. Interdental gingiva ranged between 1.0 mm 2.1 mm. With 3 mm or more, on average, palatal masticatory mucosa was thickest in the 3rd molar region and at 2nd premolars at more central locations. 2 regions with comparatively thin palatal mucosa of about 2 mm were identified, namely (i) at central and lateral incisors and (ii) at the prominence of the palatal roots of 1st and 2nd molars. The thickest tissue with more than 4 mm, on average, was observed in the tuberosity and retromolar regions. CONCLUSIONS: Considerable intra- as well as interindividual variation of thickness of masticatory mucosa could be observed. According to differences in thickness of facial and interdental gingiva, it appears that lining is also an important function of the gingiva in reducing and smoothing the pronounced convexities of the dentoalveolar, i.e., skeletal, complex.

Ultrasonic determination of thickness of masticatory mucosa: a methodologic study.

OBJECTIVE: The aim of the present study was to assess the reliability and validity of ultrasonic measurements of thickness of the masticatory mucosa. STUDY DESIGN: Eleven periodontally healthy subjects took part. Thickness of the buccal gingiva was assessed midbuccally and interdentally. In the maxilla, the palatal mucosa was measured at every tooth midpalatally, between the first and second molars, and between the second and third molars at each of 3 defined locations 4 mm apart. In the mandible, thickness of the lingual gingiva was measured midlingually as well as interdentally between the first and second molars and between the second and third molars. Thickness of the retromolar mucosa was also assessed. All 1,293 measurements were repeated after 24 hours. Validity of measurements was tested in a porcine model. RESULTS: Mean (+/- standard deviation) thickness of the midbuccal and midlingual gingiva was 0.99+/-0.52 mm; the measurement error was 0.26 mm. Measurements were well correlated (Pearson's r = .74, P<.001). Mean thickness of the papillary gingiva was 1.19+/-0.53 mm; the measurement error was 0.37 mm (r = .58, P<.001). A lower reliability was observed for palatal measurements of mucosal thickness; mean thickness was 2.36+/-0.87 mm, and measurement error was 0.54 mm (r = .64, P<.001). The validity of measurements was excellent in the 0.5-4.5 mm range. CONCLUSIONS: Differences in reliability of ultrasonic assessments of mucosal thickness in different parts of the oral cavity may depend on the difficulties of repeatedly measuring at the same location, on varying thickness of the tissues, and on expression of palatal rugae. These problems might be resolved by averaging multiple measurements.

Brighter near-field optical probes by means of improving the optical destruction threshold.

The optical destruction thresholds of conventionally etched and tube-etched near-field optical probes were measured. One of the main advantages of tube-etched tips is their smooth glass surface after taper formation. Presumably for this reason, a destruction limit of over 120 microJ was obtained, almost twice as large as that of the rougher, conventionally etched fibre probes. The use of additional adhesion layers (Ti. Cr, Co and Ni) between the glass surface and the aluminium coating produced, especially for tube-etched tips, a significant increase in the optical destruction threshold. With increasingly thin metal coatings, the use of a protection coating that prevents corrosion during aging is recommended. An additional increase in optical stability was achieved by applying mixed-metal coatings: alternating thin titanium and thick aluminium layers yielded fibre probes with superior properties that achieved average optical destruction thresholds of > 270 microJ. This is an increase in stability of > 400% compared with conventionally fabricated near-field optical tips.