Longitudinal Clinical Features of Post-COVID-19 Patients-Symptoms, Fatigue and Physical Function at 3- and 6-Month Follow-Up

Post-COVID-19 syndrome (PCS) has been described as 'the pandemic after the pandemic' with more than 65 million people worldwide being affected. The enormous range of symptoms makes both diagnosis complex and treatment difficult. In a post-COVID rehabilitation outpatient clinic, 184 patients, mostly non-hospitalized, received a comprehensive, interdisciplinary diagnostic assessment with fixed follow-up appointments. At baseline, three in four patients reported more than 10 symptoms, the most frequent symptoms were fatigue (84.9%), decreased physical capacity (83.0%), tiredness (81.1%), poor concentration (73.6%), sleeping problems (66.7%) and shortness of breath (67.3%). Abnormalities were found in the mean values of scores for fatigue (FAS = 34.3), cognition (MoCA = 25.5), psychological alterations (anxiety, depression, post-traumatic stress disorder), limitation of lung function (CAT) and severity scores for PCS (PCFS, MCRS). Clinical abnormalities were found in elevated values of heart rate, breathing rate at rest, blood pressure and NT-proBNP levels. As the frequency of the described symptoms decreases only slowly but most often significantly over the course, it is important to monitor the patients over a longer period of time. Many of them suffer from an immense symptom burden, often without pre-existing clinical correlates. Our results show a clear association with objectifiable assessments and tests as well as pronounced symptoms.

Effects of Sensorimotor Training on Transversus Abdominis Activation in Chronic Low Back Pain Patients

(1) Background: The aim of this study was to investigate and compare the effect of sensorimotor training on transversus abdominis activation. (2) Methods: Seventy-five patients with chronic low back pain were randomly assigned to one of three groups (whole body vibration training using Galileo^®, coordination training using Posturomed^®, or physiotherapy (control)). Transversus abdominis activation was measured by using sonography pre- and post-intervention. Second, changes in clinical function tests and their correlation with the sonographic measurements were determined. (3) Results: All three groups showed an improvement in activation of the transversus abdominis post-intervention, with the Galileo^® demonstrating the largest improvement. There were no relevant (r > 0.5) correlations between activation of the transversus abdominis muscle and any clinical tests. (4) Conclusions: The present study provides evidence that sensorimotor training on the Galileo^® significantly improves the activation of the transversus abdominis muscle.

Effects of Different Forms of Sensorimotor Training on Postural Control and Functional Status in Patients with Chronic Low Back Pain

The aim of this study was to compare three sensorimotor training forms in patients with chronic low back pain to determine their effects on the reduction of pain-related impairment and changes in posturography. Over two weeks, during the multimodal pain therapy (MMPT) period, six sessions of sensorimotor physiotherapy or training in the Galileo® or Posturomed® (n = 25 per group) were performed. A significant reduction in pain-related impairment after the intervention phase was shown across all groups (time effect: p < 0.001; ηp2 = 0.415). There was no change in postural stability (time effect: p = 0.666; ηp2 = 0.003), but there was a significant improvement in the peripheral vestibular system (time effect: p = 0.014; ηp2 = 0.081). An interaction effect was calculated for the forefoot-hindfoot ratio (p = 0.014; ηp2 = 0.111). Only the Posturomed® group showed an improvement in anterior-posterior weight distribution (heel load: 47% vs. 49%). These findings suggest that these forms of sensorimotor training in the context of MMPT are suitable for reducing pain-related impairment. Posturography demonstrated stimulation of a subsystem, but no improvement in postural stability.

Pressure Pain Thresholds and Central Sensitization in Relation to Psychosocial Predictors of Chronicity in Low Back Pain

(1) Background: Peripheral, as well as central, sensitization have been described in chronic low back pain (cLBP). The purpose of this study is to investigate the influence of psychosocial factors on the development of central sensitization. (2) Methods: This prospective study investigated local and peripheral pressure pain thresholds and their dependence on psychosocial risk factors in patients with cLBP receiving inpatient multimodal pain therapy. Psychosocial factors were assessed using the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). (3) Results: A total of 90 patients were included in the study, 61 (75.4% women, 24.6% men) of whom had significant psychosocial risk factors. The control group consisted of 29 patients (62.1% women, 37.9% men). At baseline, patients with psychosocial risk factors showed significantly lower local and peripheral pressure pain thresholds, suggesting central sensitization, compared to the control group. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), was also correlated with altered PPTs. After multimodal therapy, all participants reported increased local pain thresholds compared to at admission, independent of psychosocial chronification factors. (4) Conclusions: Psychosocial chronicity factors measured using the ÖMPSQ have a significant influence on pain sensitization in cLBP. A 14-day multimodal pain therapy increased local, but not peripheral, pressure pain thresholds.

[Orofacial and musculoskeletal disorders of professional musicians - Frequency and therapy principles]

Playing-related musculoskeletal disorders are frequently found in the upper extremety and the spine. Moreover, orofacial pain syndromes and craniomandibular dysfunctions are important in upper string players and wind players. The treatment of musicians is based on a diagnostic process including the evaluation of specific musical aspects, a functional manual medicine examination and an evaluation of postural and movement characteristics while playing the musical instrument.

Back pain treatment: a new perspective

This article aims to provide new perspectives for the treatment of low back pain (LBP). A narrative literature review highlights the treatment strategies currently anchored in the guidelines as well as the extensive attempts to identify subgroups within the non-specific low back pain (NSLBP) classification. A variety of multimodal approaches exist for both diagnostic assessments and therapy approaches. Nonetheless, there are often gaps in the classification systems as well as in published treatment concepts with regard to the implementation of musculoskeletal functional disorders. Indeed, a growing body of evidence shows that more holistic and flexible approaches are needed to individually diagnose and target the complexity of LBP. As an example, both a diagnostic and a (independently developed) therapeutic LBP concept will be presented and discussed. Ultimately, guidelines and subgroup classification systems can only reflect the complexity of LBP, if they capture its entire multidimensional and biopsychosocial character in both the diagnostic and therapeutic processes. Furthermore, the expansion of the pain definition to include the nociplastic pain mechanism, as an important driver of LBP, has the potential to provide important impulses for further necessary research. In conclusion, the implementation of a functional musculoskeletal approach along with the emerging nociceptive pain concept in individually targeted holistic approaches seems to be the successful way to deal with the complexity of LBP.

Aerosol emission from playing wind instruments and related COVID-19 infection risk during music performance

The pandemic of COVID-19 led to restrictions in all kinds of music activities. Airborne transmission of SARS-CoV-2 requires risk assessment of wind instrument playing in various situations. Previous studies focused on short-range transmission, whereas long-range transmission risk has not been assessed. The latter requires knowledge of aerosol emission rates from wind instrument playing. We measured aerosol concentrations in a hermetically closed chamber of 20 m³ in an operating theatre as resulting from 20 min standardized wind instrument playing (19 flute, 11 oboe, 1 clarinet, 1 trumpet players). We calculated aerosol emission rates showing uniform distribution for both instrument groups. Aerosol emission from wind instrument playing ranged from 11 ± 288 particles/second (P/s) up to 2535 ± 195 P/s, expectation value ± uncertainty standard deviation. The analysis of aerosol particle size distributions shows that 70–80% of emitted particles had a size of 0.25–0.8 µm and thus are alveolar. Masking the bell with a surgical mask did not reduce aerosol emission. Aerosol emission rates were higher from wind instrument playing than from speaking or breathing. Differences between instrumental groups could not be found but high interindividual variance, as expressed by uniform distribution of aerosol emission rates. Our findings indicate that aerosol emission depends on physiological factors and playing techniques rather than on the type of instrument, in contrast to some previous studies. Based on our results, we present transmission risk calculations for long-range transmission of COVID-19 for three typical woodwind playing situations.

Neuromodulation through brain stimulation-assisted cognitive training in patients with post-COVID-19 cognitive impairment (Neuromod-COV): study protocol for a PROBE phase IIb trial

INTRODUCTION

A substantial number of patients diagnosed with COVID-19 experience long-term persistent symptoms. First evidence suggests that long-term symptoms develop largely independently of disease severity and include, among others, cognitive impairment. For these symptoms, there are currently no validated therapeutic approaches available. Cognitive training interventions are a promising approach to counteract cognitive impairment. Combining training with concurrent transcranial direct current stimulation (tDCS) may further increase and sustain behavioural training effects. Here, we aim to examine the effects of cognitive training alone or in combination with tDCS on cognitive performance, quality of life and mental health in patients with post-COVID-19 subjective or objective cognitive impairments.

METHODS AND ANALYSIS

This study protocol describes a prospective randomised open endpoint-blinded trial. Patients with post-COVID-19 cognitive impairment will either participate in a 3-week cognitive training or in a defined muscle relaxation training (open-label interventions). Irrespective of their primary intervention, half of the cognitive training group will additionally receive anodal tDCS, all other patients will receive sham tDCS (double-blinded, secondary intervention). The primary outcome will be improvement of working memory performance, operationalised by an n-back task, at the postintervention assessment. Secondary outcomes will include performance on trained and untrained tasks and measures of health-related quality of life at postassessment and follow-up assessments (1 month after the end of the trainings).

ETHICS AND DISSEMINATION

Ethical approval was granted by the Ethics Committee of the University Medicine Greifswald (number: BB 066/21). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

NCT04944147.

Safe Polycationic Dendrimers as Potent Oral In Vivo Inhibitors of Mycobacterium tuberculosis: A New Therapy to Take Down Tuberculosis

The long-term treatment of tuberculosis (TB) sometimes leads to nonadherence to treatment, resulting in multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. Inadequate bioavailability of the drug is the main factor for therapeutic failure, which leads to the development of drug-resistant cases. Therefore, there is an urgent need to design and develop novel antimycobacterial agents minimizing the period of treatment and reducing the propagation of resistance at the same time. Here, we report the development of original and noncytotoxic polycationic phosphorus dendrimers essentially of generations 0 and 1, but also of generations 2-4, with pyrrolidinium, piperidinium, and related cyclic amino groups on the surface, as new antitubercular agents active per se, meaning with intrinsic activity. The strategy is based on the phenotypic screening of a newly designed phosphorus dendrimer library (generations 0-4) against three bacterial strains: attenuated Mycobacterium tuberculosis H37Ra, virulent M. tuberculosis H37Rv, and Mangora bovis BCG. The most potent polycationic phosphorus dendrimers 1G0,_HCl and 2G0,_HCl are active against all three strains with minimum inhibitory concentrations (MICs) between 3.12 and 25.0 μg/mL. Both are irregularly shaped nanoparticles with highly mobile branches presenting a radius of gyration of 7 Å, a diameter of maximal 25 Å, and a solvent-accessible surface area of dominantly positive potential energy with very localized negative patches arising from the central N₃P₃ core, which steadily interacts with water molecules. The most interesting is 2G0,_HCl, showing relevant efficacy against single-drug-resistant (SDR) M. tuberculosis H37Rv, resistant to rifampicin, isoniaid, ethambutol, or streptomycin. Importantly, 2G0,_HCl displayed significant in vivo efficacy based on bacterial counts in lungs of infected Balb/C mice at a dose of 50 mg/kg oral administration once a day for 2 weeks and superior efficacy in comparison to ethambutol and rifampicin. This series of polycationic phosphorus dendrimers represents first-in-class drugs to treat TB infection, could fulfill the clinical candidate pipe of this high burden of infectious disease, and play a part in addressing the continuous demand for new drugs.

Datasets and analyses of molecular dynamics simulations of covalent binary and ternary complexes of MHC class I-related molecule/T-cell receptor (MR1/TCR) agonists to understand complex formation and conditions of fluorescent labelling

Data of molecular dynamics (MD) simulations were obtained for mucosal-associated invariant T (MAIT) cell ligands complexed with MR1 or MR1/TCR. Ligands included in the simulations were natural ligands 5-(2-oxoethylideneamino)-6-D-ribitylaminouracil (5-OE-RU), 5-(2-oxopropylideneamino)-6-(D-ribitylamino)uracil (5-OP-RU), their C5' ethinylated analogs in S or R configuration, as well as the corresponding fluorophore-reacted products. All-atom models of the binary and ternary complexes were constructed using PDB entry 4NQE and docked poses [1]. Missing loops, N- and C-termini were completed by homology modelling, the loop conformations optimized, and the models energy minimized prior to setup for MD simulations. A standard pre-equilibration protocol was applied before the production phase of 120 ns simulation as NPT ensemble at 300 K and 1 atm applying an explicit solvent model with OPLS3 force field parameters. Atomic coordinates and energies were recorded every 60 ps and 12 ps, respectively. The corresponding raw data files of the MD simulations are part of this dataset. All simulations were analysed with respect to root mean square deviations (rmsd) and root mean square fluctuations (rmsf) of the coordinates of protein and ligand atoms, stability of protein secondary structure, protein-ligand contacts, ligand torsion profiles, and ligand properties. More detailed statistics of non-covalent interaction counts were also collected. Radial distribution functions (rdf) were calculated when relevant. Visualization of the trajectories permits appreciation of the molecular dynamics of both, ligands and proteins and their interactions, thereby supporting drug design of MAIT cell ligands; furthermore, additional analysis of e.g. conformational changes or interactions not reported in the primary publication [1] can be performed on the data. The raw data may also be used as starting point for extension of the simulations or more sophisticated MD techniques.

Synthesis, biological evaluation and molecular modelling of new potent clickable analogues of 5-OP-RU for their use as chemical probes for the study of MAIT cell biology

MAIT cells are preset αβ T lymphocytes that recognize a series of microbial antigens exclusively derived from the riboflavin biosynthesis pathway, which is present in most bacteria. The most active known antigen is unstable 5-(2-oxopropylideneamino)-6-(d-ribitylamino)uracil (5-OP-RU) which is stabilized when bound and presented to MAIT cells by MHC-related protein 1 (MR1). Here we describe the chemical synthesis and biological evaluation of new chemical probes for the study of MAIT cell biology. The two probes were ethinyl functionalized analogues of 5-OP-RU able to react through CuAAC also called "click chemistry". The molecules up-regulated more MR1 than 5-OP-RU and they efficiently activated iVα19 Vβ8 TCR transgenic murine MAIT cells but not iVα19 TCRα transgenic MAIT cells indicating a surprisingly strong impact of the TRCβ chain. Moreover, the use of these molecules as chemical probes was validated in vitro by efficient and selective binding to MR1 revealed via fluorescence microscopy. This study was also complemented by molecular modelling investigation of the probes and the binary/ternary complexes they form with MR1 and the TCR. These new probes will be crucial to delineate the dynamics of 5-OP-RU at the cellular or whole organism level and to identify the cells presenting 5-OP-RU to MAIT cells in vivo.

Multivalent Copper(II)-Conjugated Phosphorus Dendrimers with Noteworthy In Vitro and In Vivo Antitumor Activities: A Concise Overview

Dendrimers are macromolecules with well-defined, homogeneous, and monodispersed structures that form a branch-like structure. In general, they have a symmetric core, inner shells, and an outer shell. Over the past decade, metallodendritic architectures have developed into a new area in nanomedicine. Due to their versatility and facile customization, phosphorus dendrimers represent interesting platforms for biomedical applications. Metallo-conjugated phosphorus dendrimers have been developed within the dendrimer space, an important part of the chemical space. The first investigation was made using phosphorus dendrimers bearing copper(II) groups on their surface as the original anticancer drug candidates. The aim of this minireview is to present our powerful strategy to find and develop original multivalent copper(II)-conjugated phosphorus dendrimers. The most potent of them is G3 dendrimers with N-(pyridine-2-ylmethylene)ethanamine as the chelating motif complexed with Cu(II) (1G3-Cu), showing very good in vitro and in vivo antiproliferative efficacy. On the basis of these results, 1G3-Cu is a potential clinical candidate having progressed from hit to preclinical candidate status.

Warum der rehabilitativen Versorgung auch und gerade während der COVID-19 Pandemie besondere Beachtung geschenkt werden muss: Ein Statement der Deutschen Gesellschaft für Physikalische und Rehabilitative Medizin (DGPRM)

Auch in Deutschland haben die Reaktionen auf die Pandemie mit dem SARS-Coronavirus-2 zu erheblichen Einschnitten in fast allen gesellschaftlichen Bereichen geführt und die Prioritäten der Gesundheits- und Sozialpolitik dramatisch verschoben. Dies betrifft auch die rehabilitative Versorgung in praktisch allen ihren Dimensionen. Das folgende Statement der Deutschen Gesellschaft für Physikalische und Rehabilitative Medizin (DGPRM) möchte einige Aspekte dieser Entwicklungen aufzeigen und Empfehlungen ableiten.

Tetravalent Bispecific Tandem Antibodies Improve Brain Exposure and Efficacy in an Amyloid Transgenic Mouse Model

Most antibodies display very low brain exposure due to the blood-brain barrier (BBB) preventing their entry into brain parenchyma. Transferrin receptor (TfR) has been used previously to ferry antibodies to the brain by using different formats of bispecific constructs. Tetravalent bispecific tandem immunoglobulin Gs (IgGs) (TBTIs) containing two paratopes for both TfR and protofibrillar forms of amyloid-beta (Aβ) peptide were constructed and shown to display higher brain penetration than the parent anti-Aβ antibody. Additional structure-based mutations on the TfR paratopes further increased brain exposure, with maximal enhancement up to 13-fold in wild-type mice and an additional 4–5-fold in transgenic (Tg) mice harboring amyloid plaques, the main target of our amyloid antibody. Parenchymal target engagement of extracellular amyloid plaques was demonstrated using in vivo and ex vivo fluorescence imaging as well as histological methods. The best candidates were selected for a chronic study in an amyloid precursor protein (APP) Tg mouse model showing efficacy at reducing brain amyloid load at a lower dose than the corresponding monospecific antibody. TBTIs represent a promising format for enhancing IgG brain penetration using a symmetrical construct and keeping bivalency of the payload antibody.

[Surgical treatment of a perforated cornea in a zebra]

Microsurgical procedures in zoo and wildlife animals are challenging because of the reduced perioperative sterility and postoperative care. This case report describes the positive result of the surgical treatment of a perforated corneal ulceration with prolapsed iris in an 18-year-old Grévy's zebra mare. The postoperative development and the results of the histomorphological examination 3.5 years after surgery are described.

Effect of subgroup-specific multimodal therapy on chronic spinal back pain and function-a prospective inpatient multicentre clinical trial in Germany

Treatment modalities of spinal pain patients are discussed diversely, and different multimodal therapy programs have been developed. Purpose of the present study was to evaluate therapy outcome and effectiveness of an inpatient interdisciplinary and multimodal treatment program.This prospective multicentre clinical trial has been performed with patients from orthopedic hospitals receiving a functional musculoskeletal therapy pathway. Outcome measures were pain intensity and back-specific function (Oswestry Disability Index) before (T1) and after the intervention (T2) as well as after 6 and 12 months (T3, T4). Statistical approach included parametric (t test) and nonparametric (Wilcoxon-test) tests and the calculation of effect sizes. Additionally, a statistical subgroup analysis based on selected parameters (degree of pain chronicity, gender, and age) was performed using linear mixed models.In total, 249 patients (42.6% men, 57.4% women) with spinal pain were included, 133 patients were accessible for follow-up at T3 and 106 patients at T4.Average pain (AP) reduced significantly (P <.001) from T1 to T4 with an effect size of 0.99. Back-specific function also improved (P <.001) over all measuring time points (TP) (effect size: 0.63). Furthermore, the statistical subgroup analysis demonstrated the efficacy of the treatment concept within the subgroup parameters chronicity degree and age.A functional musculoskeletal therapy pathway including treatment of musculoskeletal dysfunctions appears to be beneficial in terms of treating pain and function. Pain chronicity and age seems to be factors influencing therapy outcome. Further studies are needed to examine the superiority of these inpatient programs for back pain including control groups.

Anticancer copper(II) phosphorus dendrimers are potent proapoptotic Bax activators

A multivalent phosphorus dendrimer 1G₃ and its corresponding Cu-complex, 1G₃-Cu have been recently identified as agents retaining high antiproliferative potency. This antiproliferative capacity was preserved in cell lines overexpressing the efflux pump ABC B1, whereas cross-resistance was observed in ovarian cancer cell lines resistant to cisplatin. Theoretical 3D models were constructed: the dendrimers appear as irregularly shaped disk-like nano-objects of about 22 Å thickness and 49 Å diameter, which accumulated in cells after penetration by endocytosis. To get insight in their mode of action, cell death pathways have been examined in human cancer cell lines: early apoptosis was followed by secondary necrosis after multivalent phosphorus dendrimers exposure. The multivalent plain phosphorus dendrimer 1G₃ moderately activated caspase-3 activity, in contrast with the multivalent Cu-conjugated phosphorus dendrimer 1G₃-Cu which strikingly reduced the caspase-3 content and activity. This decrease of caspase activity is not related to the presence of copper, since inorganic copper has no or little effect on caspase-3. Conversely the potent apoptosis activation could be related to a noticeable translocation of Bax to the mitochondria, resulting in the release of AIF into the cytosol, its translocation to the nucleus and a severe DNA fragmentation, without alteration of the cell cycle. The multivalent Cu-conjugated phosphorus dendrimer is more efficient than its non-complexed analog to activate this pathway in close relationship with the higher antiproliferative potency. Therefore, this multivalent Cu-conjugated phosphorus dendrimer 1G₃-Cu can be considered as a new and promising first-in-class antiproliferative agent with a distinctive mode of action, inducing apoptosis tumor cell death through Bax activation pathway.

Diagnostic odyssey in severe neurodevelopmental disorders: toward clinical whole-exome sequencing as a first-line diagnostic test

The current standard of care for diagnosis of severe intellectual disability (ID) and epileptic encephalopathy (EE) results in a diagnostic yield of ∼50%. Affected individuals nonetheless undergo multiple clinical evaluations and low-yield laboratory tests often referred to as a 'diagnostic odyssey'. This study was aimed at assessing the utility of clinical whole-exome sequencing (WES) in individuals with undiagnosed and severe forms of ID and EE, and the feasibility of its implementation in routine practice by a small regional genetic center. We performed WES in a cohort of 43 unrelated individuals with undiagnosed ID and/or EE. All individuals had undergone multiple clinical evaluations and diagnostic tests over the years, with no definitive diagnosis. Sequencing data analysis and interpretation were carried out at the local molecular genetics laboratory. The diagnostic rate of WES reached 32.5% (14 out of 43 individuals). Genetic diagnosis had a direct impact on clinical management in four families, including a prenatal diagnostic test in one family. Our data emphasize the clinical utility and feasibility of WES in individuals with undiagnosed forms of ID and EE and highlight the necessity of close collaborations between ordering physicians, molecular geneticists, bioinformaticians and researchers for accurate data interpretation.

CODV-Ig, a universal bispecific tetravalent and multifunctional immunoglobulin format for medical applications

Bispecific immunoglobulins (Igs) typically contain at least two distinct variable domains (Fv) that bind to two different target proteins. They are conceived to facilitate clinical development of biotherapeutic agents for diseases where improved clinical outcome is obtained or expected by combination therapy compared to treatment by single agents. Almost all existing formats are linear in their concept and differ widely in drug-like and manufacture-related properties. To overcome their major limitations, we designed cross-over dual variable Ig-like proteins (CODV-Ig). Their design is akin to the design of circularly closed repeat architectures. Indeed, initial results showed that the traditional approach of utilizing (G4S)x linkers for biotherapeutics design does not identify functional CODV-Igs. Therefore, we applied an unprecedented molecular modeling strategy for linker design that consistently results in CODV-Igs with excellent biochemical and biophysical properties. CODV architecture results in a circular self-contained structure functioning as a self-supporting truss that maintains the parental antibody affinities for both antigens without positional effects. The format is universally suitable for therapeutic applications targeting both circulating and membrane-localized proteins. Due to the full functionality of the Fc domains, serum half-life extension as well as antibody- or complement-dependent cytotoxicity may support biological efficiency of CODV-Igs. We show that judicious choice in combination of epitopes and paratope orientations of bispecific biotherapeutics is anticipated to be critical for clinical outcome. Uniting the major advantages of alternative bispecific biotherapeutics, CODV-Igs are applicable in a wide range of disease areas for fast-track multi-parametric drug optimization.

Shared rhytidectomy continued to lateral canthoplasty in a Mastiff with excessive facial folding and macroblepharon

A 3.5-year-old male Neapolitan Mastiff was presented with an obstructed visual axis because of excessive facial skin folds, brow droop, macroblepharon, upper eyelid entropion and lower ectropion-entropion. To address these major defects a technique was performed which combines rhytidectomy with shortening of the palpebral fissure and stabilization of the lateral canthus. Postoperatively the dog showed an unobstructed visual axis with comfortable and symmetrical eyes.

All-fiber pulse shortening of passively Q-switched microchip laser pulses down to sub-200 fs

We present an all-fiber concept that generates ultrashort pulses using a passively Q-switched microchip seed laser. A proof-of-principle configuration combines nonlinear pulse compression applying a chirped fiber-Bragg-grating, dispersion-free pulse shortening by means of a fiber-integrated spectral filtering, and a final hollow-core-fiber compression to reach the sub-200-fs pulse-duration region. In a compact all-fiber pulse-shortening unit, initial 100 ps long microchip pulses at 1064 nm wavelength have been shortened to 174 fs and shifted to 1034 nm while preserving a high temporal quality.

[New AHA and ACC guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk : Statement of the D•A•CH Society for Prevention of Cardiovascular Diseases, the Austrian Atherosclerosis Society and the Working Group on Lipids and Atherosclerosis (AGLA) of the Swiss Society for Cardiology]

Guidelines for the reduction of cholesterol to prevent atherosclerotic vascular events were recently released by the American Heart Association and the American College of Cardiology. The authors claim to refer entirely to evidence from randomized controlled trials, thereby confining their guidelines to statins as the primary therapeutic option. The guidelines derived from these trials do not specify treatment goals, but refer to the percentage of cholesterol reduction by statin medication with low, moderate, and high intensity. However, these targets are just as little tested in randomized trials as are the cholesterol goals derived from clinical experience. The same applies to the guidelines of the four patient groups which are defined by vascular risk. No major statin trial has included patients on the basis of their global risk; thus the allocation criteria are also arbitrarily chosen. These would actually lead to a significant increase in the number of patients to be treated with high or maximum dosages of statins. Also, adhering to dosage regulations instead of cholesterol goals contradicts the principles of individualized patient care. The option of the new risk score to calculate lifetime risk up to the age of 80 years in addition to the 10-year risk can be appreciated. Unfortunately it is not considered in the therapeutic recommendations provided, despite evidence from population and genetic studies showing that even a moderate lifetime reduction of low-density lipoprotein (LDL) cholesterol or non-HDL cholesterol has a much stronger effect than an aggressive treatment at an advanced age. In respect to secondary prevention, the new American guidelines broadly match the European guidelines. Thus, the involved societies from Germany, Austria and Switzerland recommend continuing according to established standards, such as the EAS/ESC guidelines.

Smoothed spectra for enhanced dispersion-free pulse duration reduction of passively Q-switched microchip lasers

We present an enhanced technique for dispersion-free pulse shortening, which exploits the interplay of different third-order nonlinear effects in a waveguide structure. When exceeding a certain value of the pulse energy coupled into the waveguide, the typical oscillations of self-phase modulation (SPM)-broadened spectra vanish during pulse propagation. Such smoothed spectra ensure a high pulse quality of the spectrally filtered and, therefore, temporally shortened pulses independently of the filtering position. A reduction of the pulse duration from 138 to 24 ps has been achieved while preserving a high temporal quality. To the best of our knowledge, the nonlinear smoothing of SPM-broadened spectra is used in the context of dispersion-free pulse duration reduction for the first time.

Frequency, severity and predictors of playing-related musculoskeletal pain in professional orchestral musicians in Germany

Playing-related musculoskeletal disorders (PRMD) in professional musicians are common. Existing literature demonstrates that up to 86 % of musicians are affected. The aim of the study was to evaluate the frequency of musculoskeletal pain in professional orchestral musicians with regard to their instrument affiliation. Of special interest were pain intensity and its association with predictors such as gender, instrument group, age or stage fright. Professional orchestra players completed a self-report questionnaire to assess playing-related musculoskeletal pain and its frequency and intensity in various body regions on a numeric rating scale (NRS). Relative frequencies and prevalence ratios for different instrument groups were estimated. Out of 720 approached musicians, 408 were included in the sample (response rate 57 %); overall, 89.5 % had been affected by current or past playing-related musculoskeletal pain, 62.7 % reported pain in the previous 3 months, and 8.6 % reported current pain. Pain distribution and frequency varied between instrument groups. For all instrument groups, the neck was the most common pain region. About 43 % of musicians presented more than five pain regions, in particular violin players. Approximately 40 % of musicians indicated frequent or permanent pain. Average pain intensities increased from NRS 3.8 up to a range of 5.9 and 7.4 for frequent and permanent pain, respectively. Female gender and stage fright were proven to be predictors for musculoskeletal pain. Professional orchestral musicians are greatly affected by PRMD, often experiencing frequent or permanent pain, high pain levels and pain in various body regions. As PRMD might contribute considerably to performance disability, sick leave and the possibility of premature termination of a musicians' career, this study highlights the necessity for tailored therapeutic and preventive strategies in performing arts medicine.

From embouchure problems to embouchure dystonia? A survey of self-reported embouchure disorders in 585 professional orchestra brass players

OBJECTIVES

Data concerning embouchure problems in professional brass players are scarce. Embouchure problems can potentially lead to focal dystonia. The aim of this study was to investigate the frequency of distinct embouchure problems in professional brass players. Furthermore, the frequency of "cramping", a distinct symptom of embouchure dystonia, was evaluated in the context of established embouchure dystonia risk factors.

METHODS

Five hundred and eighty-five professional brass players participated in a cross-sectional study concerning embouchure problems. A self-administered questionnaire was developed to evaluate embouchure fatigue, embouchure disorders and their consequences. To study the association between risk factors and cramping (a symptom of embouchure dystonia), a log-binomial regression analysis was conducted, enabling estimation of prevalence ratios (PR) and 95 % confidence intervals (95 % CI).

RESULTS

Thirty percent (95 % CI 25.9-33.3) reported embouchure fatigue. The relative frequency of embouchure disorders was 59 % (95 % CI 54.6-63.6), with 26 % (95 % CI 22.4-29.5) reporting embouchure cramping. Embouchure disorders resulted in sick leave in 16 % (95 % CI 12.7-20.6). Female brass players (PR 2.0, 95 % CI 0.98-3.98) and musicians with a prior change in their embouchure (PR 2.4, 95 % CI 1.38-4.05) or breathing technique (PR 2.2, 95 % CI 1.25-3.72) and musicians with embouchure fatigue (PR 1.9, 95 % CI 1.18-2.93) presented more frequently with embouchure cramping than musicians with other or without risk factors.

CONCLUSION

This study shows a high relative frequency of embouchure problems in professional brass players. Given that embouchure dystonia is often preceded by embouchure problems, these findings may assist in gaining further insight into the characteristics of embouchure dystonia and the development of preventive strategies.

Symptoms of craniomandibular dysfunction in professional orchestra musicians

BACKGROUND

Up to 80% of professional musicians are affected by playing-related musculoskeletal disorders, but data regarding the frequency of craniomandibular dysfunction (CMD) in professional orchestra musicians is scarce.

AIMS

To evaluate the frequency of CMD and its relation to musculoskeletal pain in various body regions.

METHODS

A questionnaire-based survey approach assessing CMD symptoms and musculoskeletal pain in professional orchestra players was adopted. Relative prevalence rates and prevalence ratios for different instrument groups were estimated.

RESULTS

A total of 408 musicians completed the questionnaire (response rate 57%). Playing-related pain in the teeth or jaw was reported by 19-47% of musicians and TMJ pain by 15-34%, depending on the instrument group. Current pain in the face indicating a painful CMD was reported in 6-10% and related symptoms such as teeth grinding in 25-34%, jaw clenching in 33-42% and jaw locking in 11-18% of musicians. Females were 2.4 times (95% confidence intervals (CI) 1.49-3.84) more likely to report having had orofacial pain within the last month. Musicians reporting orofacial pain within the last month were 4.8 times (95% CI: 2.83-8.02) more likely to report pain in the neck and 2.5-3.8 times (P < 0.05) more likely to report pain in other body regions, including shoulders, right wrist, left fingers and the thoracic and lumbar spine.

CONCLUSIONS

Symptoms suggesting CMD were common in this study of professional orchestra musicians and were associated with pain in the neck, shoulder and hands. There is a need to enhance awareness of CMD to optimize early medical diagnosis and treatment.

Wavelength-tunable, sub-picosecond pulses from a passively Q-switched microchip laser system

We present a novel concept to generate sub-picosecond pulses from a passively Q-switched Nd:YVO4 microchip laser system with an adjustable wavelength shift up to a few tens of nanometers around the original emission wavelength of 1064 nm. This concept comprises two stages: one that carries out a nonlinear compression of fiber-amplified microchip pulses and a subsequent stage in which the compressed pulses are coupled into a further waveguide structure followed by a bandpass filter. In a proof-of-principle experiment, pedestal-free 0.62 ps long pulses have been demonstrated with a wavelength shift to 1045 nm.

Ist eine Höhenrekonstruktion mit vergleichsweise wenig Zement für die Radiofrequenz-Kyphoplastie über einen monopedikulären Zugang möglich?

Hintergrund: Perkutane Zementaugmentationssysteme haben sich in den letzten 10 Jahren als eine effektive Behandlungsmethode bei Kompressionsfrakturen durchgesetzt. Als Sonderform ist nun seit 2009 die Radiofrequenz-Kyphoplastie (RF) hinzugekommen, die durch applizierbare Energie die Viskosität des Zements erhöht. Ziel dieser Studie war es, herauszufinden, ob mit einer vergleichsweise geringen Zementmenge eine Wirbelkörpererhöhung für osteoporotische Wirbelkörperfrakturen bei der RF-Kyphoplastie zu erreichen ist. Material und Methode: Bei diesem minimalinvasiven Verfahren wurde das „StabiliT® Vertebral Augmentation System“ der Firma DFine verwendet. Im Rahmen einer retrospektiven Studie wurden von 2011 bis Januar 2012 insgesamt 35 Patienten mit 49 osteoporotischen Wirbelkörperfrakturen versorgt. Als Parameter wurden die Altersstruktur mit Geschlechtsverteilung sowie klinisch der Verlauf der Schmerzintensität anhand der visuellen Analogskala (VAS0–100) ausgewertet. Radiologisch wurde die Wirbelkörpererhöhung (Vorder-, Hinterkante, mittlere Wirbelkörperhöhe und Kyphosewinkel) erfasst und mit dem applizierten Zementvolumen verglichen. Ergebnisse: Alle Patienten hatten vor der Operation eine gescheiterte konservative Behandlung mit weiterhin bestehenden Schmerzen auf Höhe des frakturierten Wirbelkörpers. Bis zur operativen Versorgung vergingen durchschnittlich 3,0 ± 1,3 Wochen. Die durchschnittliche VAS reduzierte sich signifikant von 71 ± 9,2 präoperativ auf 35 ± 6,2 postoperativ (p < 0,001) und nach 3 Monaten weiter auf 30 ± 5,7 (p < 0,001). Mit einem durchschnittlichen Zementvolumen von 2,9 ± 0,7 ml (1,8–4,1) im Thoralbereich und einem durchschnittlichen Zementvolumen von 3,0 ± 0,7 ml (2,0–5,0) im Lumbalbereich wurde eine statistisch signifikante Wirbelkörperaufrichtung erreicht. Die Vorderkante und die mittlere Wirbelkörperhöhe wurden signifikant um 2,3 mm und 3,1 mm angehoben, der Kyphosewinkel reduzierte sich ebenfalls signifikant um 2,1° nach 3 Monaten. Bei 2 Wirbelkörpern (4,1 %) zeigte sich ein minimaler Zementaustritt in die angrenzende Bandscheibe ohne klinische Konsequenz. Bei 2 Patienten entwickelten sich Anschlussfrakturen im kranialen Segment, die erneut mit einer RF-Kyphoplastie behandelt wurden. Schlussfolgerung: Mit einem durchschnittlichen Zementvolumen von 3 ml konnte mit der RF-Kyphoplastie eine schnelle und kurzfristige Besserung der Schmerzsymptomatik erreicht werden. Zusätzlich konnte mit diesem geringen Zementvolumen eine signifikante Wirbelkörperaufrichtung erzeugt werden. Es zeigte sich keine Korrelation zwischen der Wirbelkörperaufrichtung und dem klinischen Ergebnis. Mit der ermittelten Zementleckagenrate von 4,1 % gehört die Radiofrequenz-Kyphoplastie zu den sicheren und effektiven minimalinvasiven perkutanen Zementaugmentationsverfahren. Unsere Daten bestätigen die in der Literatur angegebene höhere Sicherheit für die Kyphoplastie im Vergleich zur Vertebroplastie.

Playing-related musculoskeletal disorders in music students-associated musculoskeletal signs

BACKGROUND

Pain and overuse are common problems for musicians. Up to 80% of professional musicians suffer from playing-related musculoskeletal disorders (PRMD). The prevalence rate in music students is very high as well. Sufficient data on the underlying musculoskeletal dysfunctions however is scarce. Additionally, the self-assessment of health in musicians seems to differ compared to non-musicians, which might influence their attitudes concerning preventive strategies.

AIM

Evaluation of frequency of PRMD in music students, investigation of signs and symptoms in music students compared to non-music controls, comparison of self-reported health and well-being between the two groups.

DESIGN

Prospective, cross-sectional, case control, non-randomized.

SETTING

Other (University volunteers).

POPULATION

Music students in comparison to a non-music control group.

METHOD

Musculoskeletal examination and questionnaire of 36 volunteers of a music university and 19 volunteer students of an university of education were analyzed. The total number of musculoskeletal dysfunctions and differences between the student groups were examined. The personal pain and health self-rating were compared between music and non-music students.

RESULTS

Eighty one percent of musicians experienced PRMD. Musicians experienced 6.19 pain regions on average compared to 4.31 of non-musicians. Musicians experiencing PRMD reported significantly (P<0.05) more pain locations than musicians without. Music students presented with nearly the double amount (8.39 versus 4.37) of musculoskeletal dysfunctions per person compared to the non-music control group. Nevertheless, musicians significantly (P<0.05) rated their health more positively than the controls.

CONCLUSION

Musicians presented with more pain regions and a higher amount of musculoskeletal dysfunctions. Further studies evaluating the clinical relevance and their role in the development of PRMD are warranted.

CLINICAL REHABILITATION IMPACT

Screening of musicians for musculoskeletal dysfunction may identify those musicians at increased risk. Early treatment may prevent PRMD in musicians. Additional research is needed to confirm our hypothesis.

Dispersion-free pulse duration reduction of passively Q-switched microchip lasers

We present a dispersion-free method for the pulse duration reduction of passively Q-switched microchip laser (MCL) seed sources. This technique comprises two stages: one that carries out the self-phase modulation induced spectral broadening in a waveguide structure and a subsequent spectral filtering stage in order to shorten the pulses in time domain. The setup of a proof-of-principle experiment consists of a fiber-amplified passively Q-switched MCL, a passive single-mode fiber used as nonlinear element in which the spectrum is broadened, and a reflective volume-Bragg-grating acting as bandpass filter. A reduction of the pulse duration from 118 to 32 ps with high temporal quality has been achieved with this setup.

Sub-5-ps, multimegawatt peak-power pulses from a fiber-amplified and optically compressed passively Q-switched microchip laser

We report on high-energy picosecond pulse generation from a passively Q-switched and fiber-amplified microchip laser system. Initially, the utilized microchip lasers produce pulses with durations of around 100 ps at 1064 nm central wavelength. These pulses are amplified to energies exceeding 100 μJ, simultaneously chirped and spectrally broadened by self-phase modulation using a double stage amplifier based on single-mode LMA photonic crystal fibers at repetition rates of up to 1 MHz. Subsequently, the pulse duration of chirped pulses is reduced by means of nonlinear pulse compression to durations of 2.7 ps employing a conventional grating compressor and 4.7 ps using a compact compressor based on a chirped volume Bragg grating.

[Magnetic resonance imaging and ultrasonography in dogs and cats with ocular and orbital diseases. Part 1: Ocular diseases]

OBJECTIVE

This two-part study describes the clinical usefulness and value of ultrasound and magnetic resonance imaging (MRI) in dogs and cats with ocular (n=30) and orbital diseases (n=31). MRI and ultrasonography characteristics are described in single cases with ocular and orbital disease.

MATERIAL AND METHODS

Ultrasonography and MRI were performed in 15 dogs and 15 cats with intraocular neoplasia or intraocular inflammatory disease.

RESULTS

In all patients with intraocular neoplasia, sonography revealed masses with increased echogenicity and fairly uniform echotexture, thus allowing the tentative diagnosis of an intraocular tumour. In these cases, MRI often proved to be a valuable diagnostic tool in showing the complete extent of intraocular lesion. An additional benefit of MRI was seen in the tissue characterization of tumours based on MRI signal characteristics and pattern of contrast enhancement. Discreet intraocular inflammatory alterations, in particular to the anterior and posterior segment of the eyeball, were more clearly shown by ultrasound than by MRI. Neoplasia could be excluded and inflammatory disease was successfully diagnosed using MRI due to the different image sequences with or without contrast medium administration. Traumatic ruptures of the lens capsule and the globe after trauma were depicted more clearly with MRI.

CONCLUSIONS AND CLINICAL RELEVANCE

When opacity of the anterior eye segment is present, various intraocular changes can be quickly diagnosed by ultrasound with high accuracy, without requiring anaesthesia of the patient. MRI of the globe allows differentiation of diverse pathologies, gives detailed information of infiltration in orbital structures and the exact degree of ocular lesions after trauma. This additional evidence often makes it easier to predict the correct prognosis and choose the best therapy.

454 EST analysis detects genes putatively involved in ginsenoside biosynthesis in Panax ginseng

Panax ginseng C.A. Meyer is one of the most highly valued medicinal plants in the world. To analyze the transcriptome of P. ginseng and discover the genes involved in ginsenoside biosynthesis, cDNAs derived from the total RNA of 11-year-old, wood-grown P. ginseng roots were analyzed by 454 sequencing. A total of 217,529 high quality reads (expressed sequence tags, ESTs), with an average length of 409 bases, were generated from a one-quarter run to yield 31,741 unique sequences. The majority (20,198; 63.6%) of the unique sequences were annotated using BLAST similarity searches. A total of 16,810 and 16,577 unique sequences were assigned to functional classifications and biochemical pathways based on Gene Ontology analysis and the Kyoto Encyclopedia of Genes and Genomes assignment, respectively. Nine genes involved in the biosynthesis of ginsenoside skeletons and many candidate genes putatively responsible for modification of the skeletons, including 133 cytochrome P450s and 235 glycosyltransferases, were identified. From these candidates, six transcripts encoding UDP-glycosyltransferases that were most likely to be involved in ginsenoside biosynthesis were selected. These results open a new avenue by which to explore and exploit biosynthetic and biochemical properties that may lead to drug improvement. These 454 ESTs will provide the foundation for further functional genomic research into the traditional herb P. ginseng or its closely related species.

Professional musicians with craniomandibular dysfunctions treated with oral splints

Craniomandibular dysfunction (CMD) symptoms occur frequently in violin/viola and wind players and can be associated with pain in the neck, shoulders and arm. In the current study, the effect of oral splint treatment of CMD on reducing pain and symptoms especially in these areas was investigated. Thirty (30) musicians undergoing CMD treatment with oral splints participated in this study. They completed a questionnaire that addressed CMD symptoms, localization of pain, and subjective changes in symptoms. Pain in the shoulder and/or upper extremity was the most frequent symptom reported by 83% of subjects, followed by neck pain (80%) and pain in the teeth/TMJ regions (63%). Treatment with oral splints contributed to a significant decrease in neck pain in 91%, teeth/TMJ pain in 83%, and shoulder and upper extremity pain in 76% of the musicians. Eighty percent (80%) of the patients reported improvement of their predominant symptoms. CMD can be a potential cause for pain in the neck, shoulders, and upper extremities of musicians. It is paramount that musicians with musculoskeletal problems be examined for CMD symptoms. Treatment with oral splints seems to be valuable. Further prospective, randomized controlled studies are necessary to confirm efficacy of oral splint treatment in CMD-associated pain and problems in the neck, shoulder, and the upper extremities in musicians.