Trimeric autotransporter adhesins: variable structure, common function.

Trimeric autotransporter adhesins (TAAs) are important virulence factors in gram-negative pathogens. Despite the variety of hosts ranging from plants to mammals and the specialized regulation of TAAs, their molecular organization follows surprisingly simple rules: they form trimeric surface structures with a head-stalk-anchor architecture. The head and stalk are composed of a small set of domains, building blocks that are frequently arranged repetitively. We propose that this repetitive arrangement facilitates recombination of domains to modulate the specificity of the common function: adhesion to the host

Prevention

Rare but regularly recurring complications are leading to ongoing regulation of the commercial, non-medical whole-body electromyostimulation (WB-EMS) market. In addition to the revised German Radiation Protection Statutes (NiSV), the Deutsche Industrie Norm (DIN) 33961-5 was recently published with safety policies for WB-EMS application, anchoring both relative and absolute contraindications for WB-EMS for the first time. The purpose of this article is to justify the rationale of contraindications in a commercial setting and to support their consistent application.While the relative contraindicationsappear plausible and uncritical, absolute contraindications for WB-EMS are much more debatable. In fact, some absolute contraindications (e.g. diabetes mellitus) could be safely addressed by WB-EMS at least after careful medical anamnesis and competent, close supervision. However, this requires sound knowledge of WB-EMS on the part of physicians and instructors, low user-trainer ratios and prompt medical care in an emergency.However, considering the multitude of different settings of commercial WB-EMS, in extreme cases with hardly supervised, only video-guided WB-EMS sessions, the necessary accurateness and expertise for safe WB-EMS is not always guaranteed. That there is no mandatory licensing of WB-EMS instructors, the key players in WB-EMS, underscores the concern. Whilst acknowledging the multitude of high-quality suppliers, it is advised thatthe commercial, non-medical WB-EMS sector as a whole to be wary of indications with significantly increased complication potential. Lastly, the mandatory acceptance of the contraindications listed in DIN 33961-5 might be considered as an inevitable step towards preventing overregulation by official authorities.KEY WORDS: Whole-Body Electromyostimulation, DIN 33961-5, Commercial Application, Guidelin