Inspiratorisches Muskeltraining bei Herzinsuffizienz : welchen Einfluss hat die Integration eines inspiratorischen Muskeltrainings in der Rehabilitation von Herzinsuffizienzpatientinnen und -patienten in Bezug auf die Lebensqualität?

Schweizweit sind Herzkreislauferkrankungen seit 100 Jahren die häufigsten Sterbeursachen. Bei der Bevölkerungsgruppe der über 65- jährigen ist die Herzinsuffizienz der häufigste Hospitalisationsgrund. Erste Studienergebnisse zeigen, dass ein inspiratorisches Muskeltraining die Lebensqualität von Herzinsuffizienzpatientinnen und -patienten positiv beeinflusst. Diese Arbeit hat das Ziel, zu evaluieren, wie sich die Lebensqualität von Herzinsuffizienzpatientinnen und -patienten verändert, wenn ein inspiratorisches Muskeltraining in die Rehabilitation integriert wird. Zur Literaturrecherche wurden die gesundheitsspezifischen Datenbanken CINAHL Complete, PubMed sowie MEDLINE verwendet. Daraus resultierten vier quantitative Studien, welche anhand der AICA-Hilfstabelle und PEDro-Skala kritisch beurteilt und anschliessend diskutiert wurden. Drei von vier integrierten Studien zeigten eine Verbesserung der Lebensqualität, gemessen anhand des MLHFQ. Signifikante Ergebnisse erreichten jedoch nur zwei Studien. Das inspiratorische Muskeltraining beeinflusst vielfältige Faktoren günstig, ohne dabei negative Effekte zu bewirken. Insbesondere kann dadurch die Lebensqualität verbessert werden. Die Ergebnisse zeigen, dass die Integration des inspiratorischen Muskeltrainings in die kardiale Rehabilitation durchaus indiziert ist, nicht aber andere Rehabilitationsmassnahmen ersetzt

Dietary Supplement Use in Young Elite Athletes and School Children Aged 11 to 13 Years: A Cross-Sectional Study Design

Objective: Information about dietary supplement (DS) use in young German athletes beginning their sporting career is scarce and possible differences to their non-athlete counterparts are unknown. Therefore, the purpose of this study was to analyze DS use in young elite German athletes (A) and non-athlete (NA) controls. Method: During pre-participation examinations, 562 athletes (323m/239f, 11.7±0.6 years) and 69 non-athletes (12m/57f; 12.5±0.5 years) answered a standardized questionnaire analyzing the prevalence of DS use, reasons for intake, and sources of information. Group differences were analyzed with Chi² test (α=0.05). Results: 14% of A and 20% of NA used DS, with no statistically significant differences between groups (p=0.231). Magnesium (A: 35%; NA: 36%) and calcium (A: 28%; NA: 7%) were the most frequently used minerals. Vitamin C (A: 37%; NA: 36%) and multi-vitamin supplements (A: 40%; NA: 29%) were the most often used vitamins. The main reason for DS intake was for health improvement (A: 77%; NA: 71%). The main information source was cited as their parents (A: 66%, NA: 71%). Discussion: Young German athletes beginning their sporting career show similar supplementation habits astheir non-athletic counterparts. Compared to the literature, prevalence of DS use amongst the observed athletes is low. This is likely to increase with age and growing performance level. Keeping that and possible doping infractions or overdoses in mind, nutritional education should start early in ones sporting career and should include the parents

An Overview of Attitudes and Opinions On the Role of Government: A Cross-national Comparison Covering the Period of 1985 to 2016

This contribution presents descriptive findings on individual attitudes and public opinion based on the International Social Survey Program Role of Government module. It covers the period from 1985 to 2016 and is guided by the idea that attitudes and opinions are aligned with the international divisions in different welfare regimes. The analysis includes all countries that fielded this ISSP survey continuously from 1985 (Australia, Germany, United Kingdom, and the United States) or 1990 (Hungary, Israel, and Norway). Our results show that attitudes and opinions remain rather stable over time and parallel the different welfare regimes. There is no clear evidence of a growing support for liberalization and deregulation across all countries despite the increasing market orientation in many countries

Reliability of a Fully Automated Interpretation of

Background: Analysis of γ-H2AX foci is a promising approach to evaluate exercise-induced DNA damage. However, baseline levels and day-to-day variability of γ-H2AX foci have not been investigated in healthy subjects at rest. Methods: Blood was taken from eight moderately trained healthy males (29 ± 3 yrs, 1.84 ± 0.03 m, and 85 ± 6 kg) at two separate days (M1/M2) after 24-hour exercise cessation. Number of γ-H2AX foci per 100 lymphocytes (N), number of foci per affected lymphocyte (NAL), percentage of affected lymphocytes (PAL), and diameter (D) of γ-H2AX foci were analyzed (mean ± SD). Differences between M1 and M2 were analyzed using paired t-tests (α = 0.05). Day-to-day variability was evaluated by calculating the coefficients of variation (CV%), bias, and limits of agreement (LoA). Results: There were no statistically significant differences between M1 (N: 7.6 ± 4.4, NAL: 1.2 ± 0.2, PAL: 5.9 ± 2.6%, and D: 0.63 ± 0.07) and M2 (N: 8.4 ± 4.6, NAL: 1.3 ± 0.1, PAL: 6.9 ± 4.2%, and D: 0.66 ± 0.06). CV was calculated to be 98.5% (N), 88.9% (PAL), 11.3% (NAL), and 8.0% (D). Bias (LoA) was 0.75 (-15.2/13.7), -0.02 (-0.36/0.33), -1.0 (-11.9/9.9), and -0.04 (-0.16/0.09), respectively. Conclusions: Background level in healthy subjects is approximately 0.07 to 0.09 γ-H2AX foci/cell. NAL and D are reliable measures

Basale Immunmechanismen des Atemwegsepithels

Bronchiale Epithelzellen bilden die erste Barriere gegen luftgetragene Infektionserreger. Sie tragen maßgeblich zur mukosalen Immunität bei. Aufgrund des Luftstroms kommen mukosale Oberflächen regelmäßig mit pathogenen sowie auch apathogenen Mikroben in Kontakt. Daher muss die Erkennung von Erregern strikt reguliert werden, um permanente, überschießende Aktivierung zu vermeiden. Toll-like Rezeptoren (TLRs) erkennen konservierte mikrobielle Strukturen und aktivieren Zellen des angeborenen Immunsystems. In dieser Arbeit wird gezeigt, dass bronchiale Epithelzellen ebenfalls TLR1-6 und TLR9 exprimieren und sich damit eines bekannten Prinzips des angeborenen Immunsystems bedienen, um Infektionserreger zu eliminierten. Es wurde allerdings beobachtet, dass die Stimulation von TLR2 durch den Liganden Lipoteichonsäure nur marginal war. Zudem wurde beobachtet, dass bronchiale Epithelzellen nur sehr schwach mit gram-positiven Bakterien stimuliert werden konnten, wohingegen gram-negative Bakterien aktivierend wirkten. Als zugrunde liegender Mechanismus für die Hyporesponsivität konnte die niedrige Expression von TLR2 und die fehlende Expression des Korezeptors CD36 identifiziert werden. Die Transfektion mit beiden Rezeptoren stellte die Responsivität gegenüber allen TLR2 Liganden und Staphylococcus aureus wieder her. Eine genomweite Expressionsanalyse bestätigte die Hyporesponsivität gegenüber Staphylococcus aureus, wohingegen Pseudomonas aeruginosa und Respiratory-Syncytial-Virus (RSV) sowohl eine gemeinsame Antwort, als auch eine Pathogen-spezifische Antwort induzieren konnten. Diese Daten zeigen, dass die Regulation des Expressionsniveaus von TLR2 eine wichtige Stellgröße darstellt, um in nicht-sterilen Kompartimenten eine unkontrollierte Entzündungsreaktion und epitheliale Dysfunktion zu vermeiden. Im Weiteren wurde das Zusammenspiel zwischen Epithelzellen und professionellen Immunzellen untersucht, um die Hypothese zu testen, dass ein organspezifisches Mikromilieu Immunantworten reguliert. Dabei konnte gezeigt werden, dass die Kokultur von Dendritischen Zellen (DCs) oder Monozyten mit BEAS-2B Zellen, einer bronchialen Epithelzelllinie, in einer reduzierten IL-12 und TNF Freisetzung resultierte. Die Stimulation von DCs oder Monozyten in Anwesenheit von Epithelzellkonditioniertem Überstand oder in einem Transwellansatz führte ebenfalls zur Inhibition der Zytokinfreisetzung. Die Befunde zeigen, dass bronchiale Epithelzellen lösliche Faktoren sezernieren, welche DCs und Monozyten hemmen. Diese Beobachtungen konnten mit murinen primären, trachealen Epithelzellen und knochenmarksgenerierten DCs (BMDDCs) verifiziert werden. Weiterhin hatte der lösliche Faktor, der konstitutiv von Epithelzellen sezerniert wird, Einfluss auf die Expression kostimulatorischer Oberflächenmoleküle auf BMDDCs. Es konnte beobachtet werden, dass die Expression von CD40 und CD86 inhibiert wurde, wohingegen der Überstand CD80 leicht induzierte. Außerdem war die DC-vermittelte T-Zellproliferation in Anwesenheit von Epithelzell-Überstand reduziert. Zusätzlich konnte ein direkter Einfluss des Epithelzell-konditionierten Überstandes auf TLymphozyten beobachtet werden. Ein inhibitorisch wirkenden Faktor im epithelialen Überstand wurde als TGF-B identifiziert. Die Inhibition der Zytokinfreisetzung in Monozyten war mittels blockierender Antikörper nicht auf die Wirkung von TGF-B zurückzuführen, jedoch spielte TGF-B bei der reduzierten T-Zellproliferation eine Rolle. Die hier vorgelegten Daten zeigen, dass bronchiale Epithelzellen als basale Immunzellen betrachtet werden können, die aktiv in die Erkennung mikrobieller Erreger involviert sind. Zusätzlich bilden bronchiale Epithelzellen ein Mikromilieu, welches professionelle Immunzellen so verändert, dass unkontrollierte Aktivierung verhindert und Homöostase in der Lunge gewährleistet wird

IL-2 Therapy Diminishes Renal Inflammation and the Activity of Kidney-Infiltrating CD4+ T Cells in Murine Lupus Nephritis

An acquired deficiency of interleukin-2 (IL-2) and related disturbances in regulatory T cell (Treg) homeostasis play an important role in the pathogenesis of systemic lupus erythematosus (SLE). Low-dose IL-2 therapy was shown to restore Treg homeostasis in patients with active SLE and its clinical efficacy is currently evaluated in clinical trials. Lupus nephritis (LN), a challenging organ manifestation in SLE, is characterized by the infiltration of pathogenic CD4+ T cells into the inflamed kidney. However, the role of the Treg-IL-2 axis in the pathogenesis of LN and the mode of action of IL-2 therapy in the inflamed kidneys are still poorly understood. Using the (NZB × NZW) F1 mouse model of SLE we studied whether intrarenal Treg are affected by a shortage of IL-2 in comparison with lymphatic organs and whether and how intrarenal T cells and renal inflammation can be influenced by IL-2 therapy. We found that intrarenal Treg show phenotypic signs that are reminiscent of IL-2 deprivation in parallel to a progressive hyperactivity of intrarenal conventional CD4+ T cells (Tcon). Short-term IL-2 treatment of mice with active LN induced an expansion the intrarenal Treg population whereas long-term IL-2 treatment reduced the activity and proliferation of intrarenal Tcon, which was accompanied by a clinical and histological amelioration of LN. The association of these immune pathologies with IL-2 deficiency and their reversibility by IL-2 therapy provides important rationales for an IL-2-based immunotherapy of LN.DFG, SFB 650, Zelluläre Ansätze zur Suppression unerwünschter Immunreaktionen - From Bench to Bedsid

Exercise Increases the Plasma Antioxidant Capacity of Adolescent Athletes

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.Background: The reactive oxygen species produced as a result of exercise might exceed an individual’s antioxidant defence system. Various endogenous antioxidants are elevated in adult athletes, resulting in an improved antioxidant capacity. However, little is known about antioxidant defence in adolescents. The purpose of this study was to examine presumed adaptations of antioxidant capacity in exercising adolescents. Methods: Trolox-equivalent antioxidant capacity (TEAC), uric acid and nutritional antioxidants were measured in the plasma of 91 male and 98 female athletes (mean age 15.9 ± 2.0 years) and compared to those of 18 male and 22 female sedentary controls (mean age 16.3 ± 2.1 years). Antioxidant intake was calculated using 4-day dietary records. Results: Neither male nor female athletes showed differences in α-tocopherol, β-carotene or ascorbate intake compared to controls. Plasma levels of α-tocopherol and carotenoids in athletes and controls did not differ either. Nevertheless, athletes of both sexes had higher TEAC values than their respective controls (male athletes 1.48 ± 0.22 mmol/l vs. male controls 1.23 ± 0.19 mmol/l, female athletes 1.47 ± 0.20 mmol/l vs. female controls 1.15 ± 0.04 mmol/l, p < 0.05). Conclusions: Regular exercise enhances antioxidant capacity in adolescent athletes, independently of their dietary antioxidant intake, which indicates activity-related adaptations

Systematic review of the clinical effectiveness of biomarkers as cancer screening test offered as self-pay service in Austria and Germany [Abstract]

Background: Individual health services (IGeL) are medical self-pay services that are not under the liability of the German statutory health insurance. Up to 14% of IGeL are blood or laboratory and cancer screening tests, which are offered to asymptomatic individuals [1]. The aim was to investigate the clinical effectiveness of eleven biomarkers that are the most often offered biomarkers for cancer screening by physicians and laboratories on the internet in Germany (i.e., AFP, CA125, CA15-3, CA19-9, CEA, Cyfra21-1, β-HCG, NMP22, M2-PK, NSE and PCA3). Research Question: What is the benefit-harm-balance regarding patient relevant outcomes (mortality, morbidity, quality of life) for using these biomarkers as cancer screening test in comparison to usual care? Methods: Firstly, searches for Health Technology Assessment (HTA) reports and systematic reviews (SR) were performed in three different databases in spring 2012. Secondly, randomized controlled trials (RCT) that were published after the end of the research period of the most recent included secondary study were searched. We included publications in English or German which compared cancer screening with one of these biomarkers in asymptomatic persons to unscreened controls. References were independently screened by two reviewers. One reviewer extracted relevant characteristics from full text and evaluated the quality of included studies. Results: Five HTA or SR dealing with CA125 (4) or NMP22 (1) and 2 RCTs (CA125) were included. For ten biomarkers, incl. NMP22, no direct evidence on patient relevant outcomes was available. One RCT combining CA125 and vaginal ultrasound for ovarian cancer screening provided results of interest [2]. Screening compared with usual care did not reduce ovarian cancer mortality (RR, 1.18; 95% CI, 0.82-1.71) [2]. Harms occurred through overdiagnosis and false-positive results, e.g., 20.6 complications occurred per 100 surgical procedures in women who underwent surgery after a false-positive result [2]. About 4.5 surgeries were performed per one case of invasive cancer identified through CA125 screening [3]. Conclusion: While ovarian cancer screening with CA125 showed no survival benefit, false-positive tests, overdiagnosis and -treatment resulted in harm. For ten biomarkers no sufficient evidence was available. When IGeL are offered, patients should get comprehensive information about the lack of evidence on patient-relevant outcomes and potential harm caused by biomarker screening