Balance Performance across the Lifespan Assessed by the Leonardo Mechanograph®: A Cross-Sectional Study

Reference values of sway parameters have not been published for the Leonardo mechanograph® so far. The aim of this cross-sectional study was to determine normative values on postural control measured by the force plate Leonardo Mechanograph® and to analyze the influence of age and sex on balance performance. A set of standardized standing positions with eyes opened (Romberg, semi-tandem, tandem, unipedal standing) was carried out. Analysis of covariance (ANCOVA) was used to detect age-and sex-related differences in center of pressure (COP) parameters (path length, velocity, elliptical area, anterior-posterior, and medio-lateral directions). Measurements were available for 570 subjects aged 20–86 years. Statistical analysis showed a high effect of age group on postural control (partial n² between 0.1 and 0.4) with a U-shaped dependency between postural control and age for all area- and path-related COP parameters, with the largest sway in the youngest (aged 20–40) and the oldest age group (aged 60–86). For velocity of COP, a linear deterioration with increasing age was found. Medio-lateral components of COP are likely to indicate the extent of postural control. Significant sex differences were not clearly supported by current findings. Age- and sex-related normative values are a useful resource for diagnostic, research, and training

Sarcopenia - decline of neuromuscular functions due to age and rheumatoid arthritis

Hintergrund: Sarkopenie umfasst den altersbedingten oder mit systemischen Krankheiten assoziierten Abbau von Muskelkraft, Muskelmasse und Muskelfunktionen und geht mit einem erhöhten Risiko für Stürze einher. Ziele: Die Diagnostik von Sarkopenie erfordert Referenzwerte für Balance, die Identifikation sarkopenischer Veränderungen sowie Risikovorhersagen für Stürze. Methoden: In einer gesunden Studienkohorte wird die Balancefähigkeit mittels Posturographie auf einem Leonardo Mechanograph® erhoben und alters- und geschlechtsspezifische Referenzwerte für Variablen der posturalen Kontrolle ermittelt. In einer längsschnittlichen Beobachtung dieser Studienkohorte wird der Abbau der Muskelmasse mittels DXA, die Muskelkraft mit einem Handdynamometer und die Muskelleistung auf einem Leonardo Mechanograph® bei Zweibeinsprüngen und dem Chair Rise Test untersucht. Veränderungen werden mit gepaarten t-Tests nach Altersgruppe und Geschlecht analysiert. Varianzanalysen und Dunnett-Tests ermitteln Unterschiede zwischen den Gruppen. In einer Kohorte mit rheumatoider Arthritis werden Assoziationen von Muskelfunktionen, Sarkopenie und prospektiven Stürzen untersucht. Zusätzlich zu den oben genannten Tests werden Gehgeschwindigkeit, SPPB und FICSIT-4 erhoben. Rheumaspezifische Messwerte wie HAQ, Krankheitsdauer und DAS28(CRP) werden erfasst. Sarkopenische Veränderungen werden gemäß der EWGSOP2 und der FNIH bestimmt. Die Teilnehmenden dokumentieren über ein Jahr Stürze in einem Sturztagebuch und berichten diese quartalsweise. Zur Berechnung der Assoziationen mit Sturz finden univariate und multiple logistische Regressionen Anwendung. Ergebnisse: Referenzwerte für Variablen der posturalen Kontrolle stehen für Frauen und Männer zwischen 20 und 86 Jahren in 5-Jahres-Schritten zur Verfügung. Der Abbau von Muskelleistung während Zweibeinsprüngen beginnt in der jüngsten Altersgruppe von 20-39 Jahren (-1,22 % pro Jahr bei Frauen, -1,51 % pro Jahr bei Männern, p<0,001). Veränderungen der Muskelkraft und Muskelmasse werden ab einem Alter von 50 Jahren und weniger stark deutlich. In der Rheumakohorte lassen sich keine signifikante Assoziation zwischen Sarkopenie und prospektiven Stürzen feststellen. Alter (OR=1,04, KI 1,01-1,07), HAQ (OR=1,62, KI 1,1-2,38) und FICSIT-4 (OR=2,38, KI 1,13-5,0) zeigen eine solche Assoziation. Muskelleistung bei Zweibeinsprüngen kann Gruppenunterschiede zwischen Stürzenden und Nicht-Stürzenden identifizieren (p=0,05). Schlussfolgerung: Referenzwerte der posturalen Kontrolle sind zur Identifizierung von Risikopatienten klinisch relevant. Eine Sarkopenie-Diagnostik sollte die Erhebung von Muskelleistung beinhalten, da diese früher und stärker altersbedingt abnimmt als Muskelkraft und Muskelmasse. FICSIT-4, Alter und selbsteingeschätzte Einschränkungen im Alltag können bei Menschen mit rheumatoider Arthritis Stürze vorhersagen. Der Leonardo Mechanograph® ist ein geeignetes Instrument zur Erhebung von posturaler Kontrolle und Muskelleistung.Background: Sarcopenia refers to the loss of muscle strength, muscle mass and neuromuscular functions due to ageing or systemic diseases. Early diagnosis is important to predict risks and prevent adverse outcomes such as falls. Objectives: Sarcopenia screening requires reference values of postural control and indicators for early identification of sarcopenic changes as well as prediction models for falls. Methods: In a healthy study sample postural control is assessed by means of posturography on a Leonardo Mechanograph® and age- and sex-specific reference values for variables of postural control are determined. In a longitudinal observation of this study cohort, the loss of muscle mass is measured using DXA, muscle strength by hand dynamometer and muscle power on a Leonardo Mechanograph® during two-leg jumps (2LJ) and the chair rise test. Changes are analysed with paired t-tests by age group and sex. Differences between groups are calculated using analyses of variance and Dunnett’s tests. In a one-year prospective study of patients with rheumatoid arthritis, associations between neuromuscular variables, sarcopenia and falls are evaluated. At baseline, muscle mass, strength and power are collected. Further, physical function tests such as gait speed, SPPB and FICSIT-4 are assessed. Rheumatism-specific measures including HAQ, disease duration and DAS28CRP are evaluated. Sarcopenic changes are determined according to established definitions by the EWGSOP2 and FNIH. Falls are reported in quarterly falls diaries. Univariate and multiple logistic regression analyses are used to calculate associations with falls. Results: Reference values for variables of postural control are reported for men and women in five-year bands of age between 20 and 86 years. Muscle power measured during 2LJ shows the earliest and highest rate of decline in the youngest age group of 20-39 years in both sexes (-1.22 % per year in women, -1.51 % per year in men, p<0.001). Changes in muscle strength and muscle mass emerge from the age of 50 years and less pronounced. In the rheumatic sample, no significant association is observed between sarcopenia and prospective falls. Associations are found between age (OR=1.04, CI 1.01-1.07), HAQ (OR=1.62, CI 1.1-2.38) and low FICSIT-4 (OR=2.38, CI 1.13-5.0) with prospective falls. Muscle power during 2LJ is able to identify group differences between fallers and non-fallers (p=0.05). Conclusion: Postural control can prevent falls, so reference values are clinically relevant to early identify persons at high risk. Sarcopenia screening should include muscle power assessment, as it shows an earlier and more pronounced age-related decline than muscle strength and muscle mass. A physical function test as FICSIT-4, in combination with age and self-reported activities of daily life, can predict falls in patients with rheumatoid arthritis. The Leonardo Mechanograph® is a suitable instrument for assessing balance and muscle power in clinical practice

Influence of spray drying parameters on the formation of β-phase poly(vinylidene fluoride)

A simple one-step spraying method to produce poly(vinylidene fluoride) (PVDF) in the desired conformation is presented. The content of the piezoelectric β-phase is measured at different spray drying conditions and during electrospray. The influence of a strong electrical field and charges on the droplet are investigated separately from the electrospray setup with a pneumatic atomizer. For this purpose, the electric field is integrated into a pneumatic atomization process by a plate capacitor and the charge of the droplets by corona discharge. To investigate the drying properties, the drying temperature and the flow rate of dry air are examined. The presented process offers the possibility to deposit PVDF films or to produce PVDF powders, in their piezoelectric β- and γ-phases or in the nonpolar α-phase

Longitudinal changes in muscle power compared to muscle strength and mass

Objectives: The study reports longitudinal changes in grip strength, muscle mass and muscle power of lower extremities. The aim is to identify early muscular changes to improve the diagnosis and treatment of sarcopenia. Methods: Grip strength was measured by hand dynamometer, muscle mass by dual-energy X-ray absorptiometry and muscle power by performing a chair rise test and two-leg jumps (2LJP) on the Leonardo Mechanograph®. Longitudinal changes were analysed using paired t-tests by age group and sex. Differences between groups in terms of the annual change were tested by Analysis of Variance and the Dunnett's test. Comparisons between the variables were performed using one sample t-tests. Results: Six-year changes were determined in 318 randomly selected healthy participants aged 20-90 years from Berlin. 2LJP declined significantly earlier in 20-39 years old women (-3.70 W/kg) and men (-5.97 W/kg, both p<0.001). This is an absolute annual decline of -0.46 W/kg in females and -0.75 W/kg in males. In the oldest age group, 2LJP showed the highest absolute annual loss with -0.99 W/kg in women and -0.88 W/kg in men. 2LJP was significantly different compared to all variables of muscle mass and strength (p<0.01). Conclusions: The results underline the importance of assessing muscle power using 2LJP during aging

Endobronchial ultrasound guided fine needle aspiration versus transcervical mediastinoscopy in nodal staging of non small cell lung cancer: a prospective comparison study

BACKGROUND: At present only few studies directly compare the diagnostic yield of endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) and transcervical video-assisted mediastinoscopy (TM) for mediastinal lymph node staging in patients with NSCLC. If and when EBUS-FNA may replace TM as Gold Standard remains controversial. METHODS: From April 2008 to December 2009, 36 patients with mediastinal lymphadenopathy underwent simultaneous EBUS-FNA/ TM at our institution. Among them were 26 patients with confirmed or suspected NSCLC. RESULTS: A total of 133 samples were obtained by EBUS-FNA and 157 samples by TM. EBUS-FNA achieved significantly less conclusive, but more indeterminate pathological results in comparison to TM (78.7% vs. 98.6%, p < 0.001; 14.9% vs. 1.4%, p = 0.007). Less paratracheal nodes were sampled by EBUS-FNA (right: 46.2% vs. 88.5%, p = 0.003; left: 23.1% vs. 65.4%, p = 0.005), while sampling rates in the subcarinal localisation were comparable (96.2% vs. 80.8%, p = NS). Among patients with confirmed NSCLC and conclusive EBUS-FNA/ TM findings (n = 18), the prevalence of N2/N3 disease was 66.7% (n = 12) according to TM findings. Diverging nodal stages were found in five patients (27.8%). Three patients who were N2 negative in EBUS-FNA were upstaged to N2 or N3 by TM, two patients with N2 status in EBUS-FNA were upstaged to N3 by TM. CONCLUSIONS: Compared to TM, EBUS-FNA had a lower diagnostic yield and resulted in systematic mediastinal nodal understaging. At this point we suggest corroborating negative EBUS-FNA results by transcervical mediastinoscopy

FAN, a Novel WD-Repeat Protein, Couples the p55 TNF-Receptor to Neutral Sphingomyelinase

AbstractThe initiation of intracellular signaling events through the 55 kDa tumor necrosis factor–receptor (TNF-R55) appears to depend on protein intermediates that interact with specific cytoplasmic domains of TNF-R55. By combined use of the yeast interaction trap system and a peptide scanning library, the novel WD-repeat protein FAN has been identified, which specifically binds to a cytoplasmic nine amino acid binding motif of TNF-R55. This region has been previously recognized as a distinct functional domain that is both required and sufficient for the activation of neutral sphingomyelinase (N-SMase). Overexpression of full-length FAN enhanced N-SMase activity in TNF–treated cells, while truncated mutants of FAN produced dominant negative effects. The data suggest that FAN regulates ceramide production by N-SMase, which is a crucial step in TNF signaling

Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study

Background: Patients with rheumatoid arthritis (RA) are at increased risk of falls and fractures. Sarcopenia occurs more frequently in RA patients due to the inflammatory processes. Early diagnosis and prevention programmes are essential to avoid serious complications. The present study aims to identify risk factors for falls related to sarcopenia and physical performance. Methods: In a 1-year prospective study, a total of 289 patients with RA, ages 24-85 years, were followed using quarterly fall diaries to report falls. At the baseline, medical data such as RA disease duration and Disease Activity Score (DAS28(CRP)) were collected. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ). Appendicular skeletal mass was determined by Dual X-ray-Absorptiometry (DXA). Physical performance was evaluated by handgrip strength, gait speed, chair rise test, Short Physical Performance Battery, and FICSIT-4. Muscle mechanography was measured with the Leonardo Mechanograph (R). Sarcopenia was assessed according to established definitions by the European Working Group on Sarcopenia in Older People (EWGSOP2) and The Foundation for the National Institutes of Health (FNIH). Univariate and multiple logistic regression analysis were used to explore associations with falling. Receiver-operating characteristics (ROC) were performed, and the area under the curve is reported. Results: A total of 238 subjects with RA completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. No association was found between sarcopenia and prospective falls. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), and low FICSIT-4 score (OR = 2.38, 1.13-5.0) showed significant associations with falls. Conclusions: In clinical practice, a fall assessment including age, self-reported activities of daily life and a physical performance measure can identify RA patients at risk of falling

FAN, a Novel WD-Repeat Protein, Couples the p55 TNF-Receptor to Neutral Sphingomyelinase

AbstractThe initiation of intracellular signaling events through the 55 kDa tumor necrosis factor–receptor (TNF-R55) appears to depend on protein intermediates that interact with specific cytoplasmic domains of TNF-R55. By combined use of the yeast interaction trap system and a peptide scanning library, the novel WD-repeat protein FAN has been identified, which specifically binds to a cytoplasmic nine amino acid binding motif of TNF-R55. This region has been previously recognized as a distinct functional domain that is both required and sufficient for the activation of neutral sphingomyelinase (N-SMase). Overexpression of full-length FAN enhanced N-SMase activity in TNF–treated cells, while truncated mutants of FAN produced dominant negative effects. The data suggest that FAN regulates ceramide production by N-SMase, which is a crucial step in TNF signaling

Development and evaluation of a patient education programme for children, adolescents, and young adults with differences of sex development (DSD) and their parents: study protocol of Empower-DSD

Background: Differences in sexual development (DSD) are rare diseases, which affect the chromosomal, anatomical or gonadal sex differentiation. Although patient education is recommended as essential in a holistic care approach, standardised programmes are still lacking. The present protocol describes the aims, study design and methods of the Empower-DSD project, which developed an age-adapted multidisciplinary education programme to improve the diagnosis-specific knowledge, skills and empowerment of patients and their parents. Methods: The new patient education programme was developed for children, adolescents and young adults with congenital adrenal hyperplasia, Turner syndrome, Klinefelter syndrome or XX-/or XY-DSD and their parents. The quantitative and qualitative evaluation methods include standardised questionnaires, semi-structured interviews, and participatory observation. The main outcomes (assessed three and six months after the end of the programme) are health-related quality of life, disease burden, coping, and diagnosis-specific knowledge. The qualitative evaluation examines individual expectations and perceptions of the programme. The results of the quantitative and qualitative evaluation will be triangulated. Discussion: The study Empower-DSD was designed to reduce knowledge gaps regarding the feasibility, acceptance and effects of standardised patient education programmes for children and youth with DSD and their parents. A modular structured patient education programme with four generic and three diagnosis-specific modules based on the ModuS concept previously established for other chronic diseases was developed. The topics, learning objectives and recommended teaching methods are summarised in the structured curricula, one for each diagnosis and age group. At five study centres, 56 trainers were qualified for the implementation of the training programmes. A total of 336 subjects have been already enrolled in the study. The recruitment will go on until August 2022, the last follow-up survey is scheduled for February 2023. The results will help improve multidisciplinary and integrated care for children and youth with DSD and their families. Trial registration: German Clinical Trials Register, DRKS00023096. Registered 8 October 2020 - Retrospectively registered

Oil saturation of the sea ice pore space

Observations have shown that oil spilled under sea ice collects in patches within the under-ice relief and is encapsulated in the growing ice sheet. Due to its lower density, compared to seawater brine, oil will migrate upwards into the sea ice pore space. During winter migration is limited to lower levels where pore sizes and porosity are larger than near the colder ice surface. Upon warming the oil may continue migration through the widening pore network. To predict when oil may reach the surface, good information about oil saturation, the fraction of the sea ice pore space that may be occupied by oil, is needed. However, at present little is known about the influence on oil saturation and its dependence on sea ice porosity and microstructure. Here we analyse a recently obtained dataset of 3-d X-ray micro-tomographic images of young sea ice to determine oil saturation. We use these images to perform numerical simulations of the immiscible displacement of brine (wetting fluid) by oil (non-wetting) and thereby determine the dependence of oil saturation on porosity and capillary pressure/oil patch thickness. Comparing the results to published observations of laboratory-grown seawater ice of similar age highlights the importance of internal convection for oil entrainment. We perform the analysis for a limited set of 3-d images of older first-year ice of similar porosity. The comparison suggests one to two order higher oil saturation and oil storage capacity in the old ice. To determine the seasonal evolution in the saturation-porosity relationship of oil in sea ice during aging, more observations are needed. This relationship is crucial to estimate the porosity-dependent storage capacity of oil in sea ice, predict oil surfacing, and will be important for planning of response scenarios to oil spills under sea ice