[Treatment mapping of lower urinary tract symptoms due to benign prostatic hyperplasia-an analysis of the Governing Body of German Prostate Centers]. / Versorgungsabbild des benignen Prostatasyndroms ­ eine Analyse des Dachverbandes der Prostatazentren Deutschlands (DVPZ) e. V.

BACKGROUND: Due to the high incidence and demographic development, there is an urgent need for healthcare research data on lower urinary tract symptoms due to benign prostatic hyperplasia (LTUS/BPH). Since 2005 the Governing Body of German Prostate Centers (DVPZ) has been collecting data from 22 prostate centers in order to determine the quality and type of cross-sectoral care in particular for LUTS/BPH patients. OBJECTIVES: Presentation of the DVPZ database in general, as well as an investigation of treatment patterns for medical and instrumental therapies. MATERIALS AND METHODS: The analysis is based on UroCloud data sets from 30 November 2017. In the UroCloud data on diagnostics, therapy and course of disease are recorded in a web-based manner. RESULTS: A total of 29,555 therapies were documented for 18,299 patients (1.6/patient), divided into 48.5% instrumental, 29.2% medical treatment, and 18.0% "wait and see" (in 4.3% no assignment was possible). Patients treated with an instrumental therapy were oldest (median: 72 years, interquartile range: 66-77), had the largest prostate volumes (50 ml, 35-75 ml), and were mostly bothered by symptoms (International Prostate Symptom Score = 19/4). The majority of patients under medical treatment received alphablockers (56%); phytotherapeutics were used least frequently (3%). Instrumental therapies are dominated by transurethral resection (TUR) of the prostate (60.0%), open prostatectomy (9.4%) and laser therapy (5.0%), with laser therapy having the shortest hospital stay (5 days) and the lowest transfusion and re-intervention rates (1.0% and 4.6%, respectively). CONCLUSIONS: The DVPZ certificate covers the complete spectrum of cross-sectoral care for LUTS/BPH patients and documents the use of the various therapies as well as their application and effectiveness in the daily routine setting.

The influence of gait and speed on the dynamic navicular drop - A cross sectional study on healthy subjects.

INTRODUCTION: Variations of gait speed influence kinematic variables that may have an effect on dynamic foot deformation. The influence of gait speed on the navicular drop has not yet been investigated. METHODS: The navicular drop was evaluated in static and dynamic conditions using a 3D-motion capture system. The dynamic navicular drop was evaluated on a treadmill while walking and running at three different speeds. A repeated measures ANOVA and post-hoc tests were conducted to evaluate the differences in dynamic navicular drop, corresponding unloaded navicular height at foot strike and loaded navicular height during stance. RESULTS: Higher walking speed led to a significant decrease in navicular height at foot strike and a subsequent decrease of dynamic navicular drop (p=0.006). Across increasing running speeds, minimum navicular height was significantly decreased which in consequence led to an increased dynamic navicular drop (p=0.015). For walking and running at the same speed, there was a large effect of gait style with an increase of dynamic navicular drop by 3.5mm (p<0.001) during running. DISCUSSION: The change of gait from walking to running at the same speed had a large effect on dynamic navicular drop. The values of navicular height at foot strike and minimum navicular height during stance should be taken into account for the interpretation of dynamic navicular drop measures. Static and dynamic navicular drop measures differ substantially.

Effect of foot progression angle adjustment on the knee adduction moment and knee joint contact force in runners with and without knee osteoarthritis.

BACKGROUND: Knee adduction moment (KAM) is often used as a surrogate marker of knee contact force (KCF) during walking. Previous studies have reported potential benefits to reduce KAM in patients with knee osteoarthritis (OA) by foot progression angle adjustment. However, KAM is an external moment and it does not consider any muscle contribution to the joint loading, which should pose a greater influence in running than walking. RESEARCH QUESTION: This study used a computational model to compare KAM and KCF between runners with and without knee OA during running. In addition, we evaluated the KAM and KCF when runners adjusted to an out-toe running style. METHODS: Kinematic, kinetic, and lower limb EMG data were collected from 9 runners with knee OA and 10 healthy counterparts. They were asked to run at their usual speed with standard shoes on an instrumented treadmill. RESULTS: We found no significant difference in the KAM during running between OA and the healthy group (p > 0.376). However, runners with knee OA exhibited a greater total KCF than the healthy counterparts (p < 0.041). We did not observe any reduction in KAM after foot progression angle adjustment (p > 0.346). Surprisingly, an increase in the longitudinal KCF and total KCF were found with adjustment of foot progression angle (p < 0.046). SIGNIFICANCE: Unlike the findings reported by the previous walking trials, our findings do not support the notion that foot progression angle adjustment would lead to a lower joint loading during running.

[Forefoot relief with shoe inserts : Effects of different construction strategies]. / Vorfußentlastung durch Schuheinlagen : Effekte unterschiedlicher Konstruktionsprinzipien.

BACKGROUND: Shoe inserts and shoe modifications are used to reduce plantar peak pressure. The effects of different shoe inserts and shoe construction strategies for relief of the forefoot have not yet been sufficiently evaluated. PURPOSE: The aim of this study was to analyze the effects of shoe inserts and shoe construction strategies (e.g. metatarsal pad, forefoot cushioning and control) and shoe modifications (e.g. flexible or stiff) on the peak plantar pressure in the forefoot region. MATERIAL AND METHODS: In this study 15 healthy subjects were recruited. Plantar pressure distribution was measured using an in-shoe system during walking (3.5km∙h-1) on a treadmill and the average plantar peak pressure (kPa) in the forefoot was calculated. The statistics for testing the hypothesis were carried out using 2­factorial ANOVA with repeat measurements (factors: shoe, insert; α = 0.05). RESULTS: The metatarsal pad and forefoot cushioning led to a reduction of peak pressure, which was statistically significant compared to the control condition (p = 0.009). No differences were observed between both shoe inserts (p > 0.05). A comparison between stiff and flexible shoes revealed a statistically significant pressure reduction in favor of stiff shoes (p = 0.0001). The metatarsal pad led to a peak pressure increase in the midfoot of 12% and by 21% compared to control and forefoot cushioning, respectively. DISCUSSION: A peak pressure reduction in the forefoot can be achieved with a metatarsal pad or with cushioning; however, the metatarsal pad resulted in a subsequent increase in midfoot pressure. Moreover, shoe construction is crucial because a stiff shoe contributes to a better peak pressure reduction compared to a flexible shoe. Prospective clinical studies should be carried out to prove whether this results in beneficial effects for patients with metatarsalgia.

[Feasibility of balance training on mats in healthy, moderately sportive women in old age. A pilot study]. / Machbarkeit eines Gleichgewichtstrainings auf Matten bei gesunden, moderat sportlichen Frauen im Alter. Eine Pilotstudie.

PURPOSE: The aim of this pilot study was to assess the feasibility and the effect size of weekly group exercise sessions on an Airex® pad with an additional home program on the participants' balance. MATERIALS AND METHODS: Two training sessions (once a week in-group and once a week as a home program) were administered for 4 weeks. The intervention group (IG) trained on Airex® pads and the control group (CG) without the pad. This study examined the feasibility in terms of recruitment and randomization process, and compliance. Moreover, the effects were evaluated for static, dynamic, and functional balance. RESULTS: A total of 11 healthy women were recruited, and 10 women completed the 4-week training program (one drop-out was recorded). Of a total of 88 training sessions, 82 were completed. The IG showed a significant difference for one test of dynamic balance. CONCLUSION: This pilot study was feasible. However, changes regarding recruitment and compliance should be made for future studies. Sensitive measuring instruments must be used for the evaluation of balance changes.

Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes.

Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 ± 1.9 years; 160 ± 13 cm; 50 ± 14 kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P ≤ 0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P ≤ 0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy.

[Effect of continuous passive motion for cartilage regenerative surgery - a systematic literature review]. / Wirkung von passiven Motorbewegungsschienen nach knorpelregenerativen Eingriffen - eine systematische Literaturübersicht.

BACKGROUND: The aim of this systematic review was to evaluate treatment effects of continuous passive motion (CPM) after surgical cartilage repair. PATIENTS/MATERIAL AND METHODS: A literature search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, International Clinical Trials Registry Platform, MEDLINE, Trip Database and in bibliographies of included studies. Two independent researchers evaluated the quality of original investigations by the Cochrane Risk of Bias tool. Systematic reviews were checked by the CBO/Dutch Cochrane Centre Guideline. RESULTS: A total of 1541 studies was initially retrieved from the databases. After screening for inclusion criteria, one review and ten original papers could be included for further evaluation. Studies showed methodological weaknesses. Heterogeneity of outcome measures and the fact that 6 of 9 studies with an one-group pre-post design measured the combined effect of surgical treatment and CPM prevented a meta-analysis. CONCLUSION: Three studies described significant improvements with regard to subjective outcome such as pain, swelling, Quality Life Survey, Knee Society score, WOMAC score or rating Cincinnati due to the surgical treatment and the CPM intervention of cartilage defects in the knee. Six (case) studies suggested an enhanced cartilage quality of the patients after CPM. More high-quality randomised controlled trials are needed to provide high level evidence.

[Intra- and interrater variability of sonographic investigations of patella and achilles tendons]. / Intra- und interobserver Variabilität sonografischer Untersuchungen an Patella- und Achillessehnen.

BACKGROUND: Clinical examinations of tendon disorders routinely include ultrasound examinations, despite the fact that availability of data concerning validity criteria of these measurements are limited. The present study therefore aims to evaluate the reliability of measurements of Achilles- and Patella tendon diameter and in the detection of structural adaptations. MATERIALS AND METHODS: In 14 healthy, recreationally active subjects both asymptomatic Achilles (AT) and patella tendons (PT) were measured twice by two examiners in a test-retest design. Besides the detection of anteroposterior (a.p.-) and mediolateral (m.l.-) diameters, areas of hypoechogenicity and neovascularisation were registered. Data were analysed descriptively with calculation of test-retest variability (TRV), intraclass-correlation coefficient (ICC) and Bland and Altman's plots with bias and 95 % limits of agreement (LOA). RESULTS: Intra- and interrater differences of AT- and PT-a.p.-diameter varied from 0.2 - 1.2 mm, those of AT- and PT-m.l-diameter from 0.7 - 5.1 mm. Areas of hypoechogenicity were visible in 24 % of the tendons, while 15 % showed neovascularisations. Intrarater AT-a.p. -diameters showed sparse deviations (TRV 4.5 - 7.4 %; ICC 0.60 - 0.84; bias -0.05 - 0.07 mm; LOA -0.6 - 0.5 to -1.1 - 1.0 mm), while interrater AT- and PT-m.l.-diameters were highly variable (TRV 13.7 - 19.7 %; ICC 0.11 - 0.20; bias -1.4 - 4.3 mm; LOA -5.5 - 2.7 to -10.5 - 1.9 mm). CONCLUSION: Our results suggest that the measurement of AT- and PT-a.p. -diameters is a reliable parameter. In contrast, reproducibility of AT- and PT-m.l.-diameters is questionable. The study corroborates the presence of hypoechogenicity and neovascularisation in asymptomatic tendons.

Is EMG of the lower leg dependent on weekly running mileage?

Neuromuscular activity of the lower leg is dependent on the task performed, speed of movement and gender. Whether training volume influences neuromuscular activity is not known. The EMG of physically active persons differing in running mileage was analysed to investigate this. 55 volunteers were allocated to a low (LM: < 30 km), intermediate (IM: > 30 km & < 45 km) or high mileage (HM: > 45 km) group according to their weekly running volume. Neuromuscular activity of the lower leg was measured during running (3.33 m·s - 1). Mean amplitude values for preactivation, weight acceptance and push-off were calculated and normalised to the mean activity of the entire gait cycle.Higher activity in the gastrocnemius group was observed in weight acceptance in LM compared to IM (+30%) and HM (+25%) but lower activity was present in the push-off for LM compared to IM and HM. For the peroneal muscle, differences were present in the push-off where HM showed increased activity compared to IM (+24%) and LM (+60%). The tibial muscle revealed slightly lower activity during preactivation for the high mileage runners. Neuromuscular activity differs during stance between the high and intermediate group compared to low mileage runners. Slight adaptations in neuromuscular activation indicate a more target-oriented activation strategy possibly due to repetitive training in runners with higher weekly mileage.

[Acute and overuse injuries in elite paracycling - an epidemiological study]. / Verletzungen und Überlastungsbeschwerden im paralympischen Radsport - eine Fragebogenerhebung bei Nationalkaderathleten.

Although paracycling is a growing discipline in high level competitive sports as well as in posttraumatic rehabilitation, epidemiological data of resulting injuries is still missing. Therefore, 19 athletes of the German national paracycling team were asked about their injuries during the 2008 season using a standardized questionnaire. Overall, 18 (94.7 %) of 19 athletes reported overuse injuries; most commonly localized at the back (83.3 %), neck/shoulder (77.8 %), knee (50 %), groin/buttock (50 %) and hands/wrists (38.9 %). Altogether, 18 accidents were registered, corresponding to an injury rate of 0,95 acute injuries per athlete per year (0,07 / 1000 km). The most common acute injuries were abrasions (69.2 %) and contusions (61.5 %), whereas fractures were stated only twice (11.8 %). The anatomical distribution of overuse injuries in disabled cyclists confirms the results of studies in able-bodied cycling, although the incidences in low-back pain and neck/shoulder pain is clearly higher in disabled cycling, as well as the rate of traumatic injuries.

Clinical effectiveness of customised sport shoe orthoses for overuse injuries in runners: a randomised controlled study.

BACKGROUND AND OBJECTIVES: Treatment of chronic running-related overuse injuries by orthopaedic shoe orthoses is very common but not evidence-based to date. HYPOTHESIS: Polyurethane foam orthoses adapted to a participant's barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners. DESIGN: Prospective, randomised, controlled clinical trial. INTERVENTION: 51 patients with running injuries were treated with custom-made, semirigid running shoe orthoses for 8 weeks. 48 served as a randomised control group that continued regular training activity without any treatment. MAIN OUTCOME MEASURES: Evaluation was made by the validated pain questionnaire Subjective Pain Experience Scale, the pain disability index and a comfort index in the orthoses group (ICI). RESULTS: There were statistically significant differences between the orthoses and control groups at 8 weeks for the pain disability index (mean difference 3.2; 95% CI 0.9 to 5.5) and the Subjective Pain Experience Scale (6.6; 2.6 to 10.6). The patients with orthoses reported a rising wearing comfort (pre-treatment ICI 69/100; post-treatment ICI 83/100) that was most pronounced in the first 4 weeks (ICI 80.4/100). CONCLUSION: Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners.

A review of the species of Mesopolobus (Chalcidoidea: Pteromalidae) associated with Ceutorhynchus (Coleoptera: Curculionidae) host-species of European origin.

Four species of Mesopolobus Westwood were reared as parasitoids of Ceutorhynchinae hosts in Europe during surveys in 2000-2004. An illustrated key is given to differentiate the four species, M. gemellus Baur & Muller sp. n., M. incultus (Walker), M. morys (Walker) and M. trasullus (Walker), plus M. moryoides Gibson, a parasitoid of the cabbage seedpod weevil, Ceutorhynchus obstrictus (Marsham), in North America. Pteromalus clavicornis Walker is recognized as a junior synonym of M. incultus syn. n., and Pteromalus berecynthos Walker (also a junior synonym of M. incultus) is considered a correct original spelling. For Disema pallipes Förster (a junior synonym of Mesopolobus morys), a lectotype is designated. Mesopolobus morys is for the first time accurately associated with the seed weevil Ceutorhynchus turbatus (Schultze), a potential agent for classical biological control, of hoary cress, Lepidium draba L. (Brassicaceae), in North America. Mesopolobus gemellus is associated with another seed weevil, Ceutorhynchus typhae (=C. floralis) (Herbst), in pods of shepherd's purse, Capsella bursa-pastoris (L.) Medik. (Brassicaceae). Implications of the host-parasitoid associations are discussed relative to the introduction of species to North America for classical biological control of the cabbage seedpod weevil.

Reactivity, stability, and strength performance capacity in motor sports.

BACKGROUND: Racing drivers require multifaceted cognitive and physical abilities in a multitasking situation. A knowledge of their physical capacities may help to improve fitness and performance. OBJECTIVE: To compare reaction time, stability performance capacity, and strength performance capacity of élite racing drivers with those of age-matched, physically active controls. METHODS: Eight élite racing drivers and 10 physically active controls matched for age and weight were tested in a reaction and determination test requiring upper and lower extremity responses to visual and audio cues. Further tests comprised evaluation of one-leg postural stability on a two-dimensional moveable platform, measures of maximum strength performance capacity of the extensors of the leg on a leg press, and a test of force capacity of the arms in a sitting position at a steering wheel. An additional arm endurance test consisted of isometric work at the steering wheel at +30 degrees and -30 degrees where an eccentric threshold load of 30 N.m was applied. Subjects had to hold the end positions above this threshold until exhaustion. Univariate one way analysis of variance (alpha = 0.05) including a Bonferroni adjustment was used to detect group differences between the drivers and controls. RESULTS: The reaction time of the racing drivers was significantly faster than the controls (p = 0.004). The following motor reaction time and reaction times in the multiple determination test did not differ between the groups. No significant differences (p>0.05) were found for postural stability, leg extensor strength, or arm strength and endurance. CONCLUSIONS: Racing drivers have faster reaction times than age-matched physically active controls. Further development of motor sport-specific test protocols is suggested. According to the requirements of motor racing, strength and sensorimotor performance capacity can potentially be improved.

Mechanical comparison of barefoot and shod running.

In order to further compare shod versus barefoot running, 35 subjects ran two bouts of 4 minutes at 3.33 m x s(-1) on a treadmill dynamometer. Parameters were measured on about 60 consecutive steps. Barefoot showed mainly lower contact and flight time (p < 0.05), lower passive peak (1.48 versus 1.70 body weight, p < 0.05), higher braking and pushing impulses (p < 0.05), and higher pre-activation of triceps surae muscles (p < 0.05) than shod. It was concluded that when performed on a sufficient number of steps, barefoot running leads to a reduction of impact peak in order to reduce the high mechanical stress occurring during repetitive steps. This neural-mechanical adaptation could also enhance the storage and restitution of elastic energy at ankle extensors level.

[Current views on the prevention of ailments of the musculoskeletal system through muscle strengthening programs]. / Prävention von Beschwerden des Stütz- und Bewegungsapparates. Schicken Sie lhre Senioren zum Krafttraining!

Because of an increasingly older population structure and the enhanced relevance of body composition, the prevention of problems arising from the musculoskeletal system has become of central importance. Strengthening and muscle-building training have been proven to be useful even for older people. The training is focused on the types of movement and exertion that frequently occur in the "activities of daily living." In addition, a purely hypertrophic training for building muscle mass must be differentiated from a more sensorimotor oriented training with situational employment of the muscles for optimizing motor control and coordination. There are no contraindications for strength training when the program is adapted to the individual. The rate of injury is small, even for people at low performance levels.

[Shoshin beriberi provoked by the inhalation of salbutamol]. / Sjosjin-beriberi na inhalatie van salbutamol.

A 45-year-old male alcoholic with a deficient diet was given salbutamol for exertion-related dyspnoea. After inhalation, he presented with a severe dyspnoea, acrocyanosis, anuria and low blood pressure as well as a respiratory compensated lactate acidosis. Shoshin beriberi was suspected on clinical grounds. The low level of thiamine and the prompt recovery after thiamine repletion confirmed this diagnosis. Shoshin beriberi is an acute, cardiac form of beriberi, which can rapidly result in death due to cardiogenic shock and lactate acidosis. Adrenergic agents can cause a hyperdynamic circulation and thus aggravate the effects of a thiamine deficiency.

[Ototoxicity induced by clarithromycin]. / Door claritromycine geïnduceerde ototoxiciteit.

A 76-year-old man developed a progressive bilateral hearing loss 4 days after starting a high dose of clarithromycin for atypical pulmonary tuberculosis. When the clarithromycin was discontinued the hearing improved subjectively but it worsened again upon reexposure. Halving the dose resulted in both an objective and subjective improvement in hearing, yet the original level of hearing was only obtained once clarithromycin had been permanently withdrawn. It would seem that this adverse effect is dose dependent. This seems to be the first published case study that demonstrates ototoxicity as a result of clarithromycin use.

[Attempted suicide with sustained release diltiazem]. / Tentamen suicidii door diltiazem met gereguleerde afgifte.

A 15-year-old woman was admitted to the intensive care unit after intentional auto-intoxication with 10 tablets of 200 mg diltiazem sustained release. She developed hypotension and became oliguric. This was followed by metabolic acidosis. Maximum plasma lactate concentration was 10 mmol/l and the highest measured plasma diltiazem level was 500 micrograms/l. The occurrence of pulmonary oedema due to adult respiratory distress syndrome (ARDS) was striking and the patient required mechanical ventilation for a period of three days as a result of this. After five days in the intensive care unit, she was transferred to a psychiatric hospital in a good physical condition. Sustained release diltiazem intoxications have previously been described on five occasions.

[Limits and possibilities of 2D video analysis in evaluating physiological and pathological foot rolling motion in runners]. / Grenzen und Möglichkeiten der 2D-Videoanalyse in der Bewertung physiologischer und pathologischer Abrollvorgänge des Fusses bei Läufern.

Three-dimensional movements of the lower extremities in support phases are usually evaluated with the help of video analysis. This analysis is mainly done two-dimensionally in a frontal and sagittal plane. Usually, the temporal ankle of the achilles tendon respectively rear foot are analysed in the frontal plane, the knee and upper ankle angle in the sagittal plane, because their values are made responsible for different sport injuries. However, so far a correlation between different injuries and biomechanical parameters could not be proven. Often, small changes in 2D video data are discussed without considering the reliability of this method of measurement. It was the aim of this study to evaluate these parameters in 2D video analyses (2D-VA) which characterize the support phases of the foot. A second goal was to find out whether a connection between these angles and chronic achillodynia can then be sensibly proven. 32 male test persons consisting of a control group (KO, n = 14) without injuries and a group with chronic achillodynia (AD, n = 18), have been examined with the test/retest method in weekly intervals. The biomechanical running analysis was done with the help of 2D-VA in the frontal and sagittal plane on a treadmill at a speed of 80% of the individual anaerobic threshold with different shoes. The test/retest variability was for all measuring points not at all satisfying. Both groups showed big mean variations in both shoes and minimal differences in the measured angles. Because of the poor capability of reproduction of the 2D-VA for angles in the frontal plane this measuring method is only usable with restrictions for the evaluation of the support phase.