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Background: Attention Deficit Hyperactivity Disorder (ADHD) can be comorbid with depression, often leading to the prescription of both methylphenidate (MP) and selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (FLX). Moreover, these drugs are often misused as cognitive enhancers. This study examined the effects of chronic oral co-administration of MP and FLX on depressive- and anxiety-like behaviors. Methods: Adolescent rats received daily either water (control), MP, FLX, or the combination of MP plus FLX in their drinking water over the course of 4 weeks. Results: Data analysis shows a decrease in food consumption and body weight for rats exposed to FLX or the combination of MP and FLX. Sucrose consumption was significantly greater in FLX or MP+FLX groups compared to controls. FLX-treated rats showed no effect in the elevated plus maze (EPM; open arm time) and forced swim test (FST; latency to immobility). However, rats treated with the combination (MP+FLX) showed significant anxiolytic-like and anti-depressive-like behaviors (as measured by EPM and FST), as well as significant increases in overall activity (distance traveled in open field test). Finally, the combined MP+FLX treatment induced a decrease in anxiety and depressive- like behaviors significantly greater than the response from either of these drugs alone. Conclusion: These behavioral results characterize the long-term effects of these drugs (orally administered) that are widely co-administered and co-misused and provide important insight into the potential neurobiological and neurochemical effects. Future research will determine the potential risks of the long-term use of MP and FLX together.

In situ small-angle X-ray scattering (SAXS) was employed to identify critical parameters during thermal treatment for template removal of an ordered mesoporous carbon precursor synthesized via a direct soft-templating route. The structural parameters obtained from the SAXS data as a function of time were the lattice parameter of the 2D hexagonal structure, the diameter of the cylindrical mesostructures and a power-law exponent characterizing the interface roughness. Moreover, detailed information on contrast changes and pore lattice order was obtained from analysis of the integrated SAXS intensity of the Bragg and diffuse scattering separately. Five characteristic regions during heat treatment were identified and discussed regarding the underlying dominant processes. The influence of temperature and O2/N2 ratio on the final structure was analyzed, and parameter ranges were identified for an optimized template removal without strongly affecting the matrix. The results indicate that the final structure and controllability of the process are optimum for temperatures between 260 and 300°C with a gas flow containing 2 mol% of O2.

In the context of the so-called Long Shutdown 3 (2026–2028), the Large Hadron Collider will be upgraded to the High-Luminosity Large Hadron Collider, allowing for approximately five more instantaneous collisions. The upgrade, maintenance and decommissioning of equipment will be mainly performed in the experimental insertions of Points 1 and 5, requiring to perform multiple interventions in high-residual radiation environment. This poses complex radiological challenges that the CERN Radiation Protection group is called to address. Radiation protection studies are performed to plan and optimise (ALARA) these future interventions using the advanced Monte Carlo techniques and tools such as FLUKA, ActiWiz, SESAME and the FCC method. This paper aims to provide an overview of the studies conducted to estimate the residual radiation field in the experimental insertions, the activation levels in terms of multiple of the Swiss clearance limits/specific activity and to provide preliminary considerations on the upgrade/decommissioning of key equipment.

The upgrade of the Large Hadron Collider spare beam dumps (Target Dump External, TDE) and the autopsy of the old operational TDE required to perform several activities in a high-radiation environment posing significant radiation protection challenges due to the residual activation of the equipment. To ensure high safety standards and to respect the ALARA principle, these challenges were addressed using the advanced Monte Carlo techniques to predict the residual ambient dose equivalent rate and the radionuclide inventory at different steps of the interventions. The CERN HSE-RP group makes extensive use of the FLUKA and ActiWiz codes to produce accurate estimates. This work aims to provide an overview of the radiation protection studies to optimise the interventions (ALARA) and to reduce the radiological risk for personnel and environment.

At present, most carbon fibers are made from non-renewable polyacrylonitrile. Substantial efforts have been made to replace petroleum-based precursors for carbon fiber production. Interestingly, lignin is a carbon fiber precursor material that is cheap, highly available and sustainable. Submicron-scale lignin-based carbon nanofibers are used in numerous areas, such as electronic devices, batteries, supercapacitors and low-cost, high-performance structural composite materials. Trackspinning (TS) technology offers a way to scale up the versatile, but inefficient contact drawing technique to produce small-diameter lignin fibers from environmentally friendly aqueous solutions. In this study, the effects of TS based on probe drawing of low-concentration lignin nanofibers blended with poly(ethylene oxide) and glycerol in sodium hydroxide (NaOH) solution were investigated. The TS lignin fibers were well aligned and reached diameters as small as 500–1000 nm as the drawing length was increased. Lignin fiber macromolecular alignment was isotropic at low levels of draw, and the dichroic ratio increased from 1 to 2.25 with doubling of the drawing length. The most highly drawn trackspun lignin fibers had a mechanical strength of 3.92 MPa and a Young’s modulus of 2.15 GPa, which were similar to reported values for solvent-electrospun lignin nanofibers. These findings support the potential to utilize TS to produce small-diameter lignin fibers using a simple aqueous solvent approach.

Because animal carcasses often serve as reservoirs for pathogens, their location and removal are crucial in controlling the spread of diseases. During carcass decomposition, heat is emitted due to microbial activity and the development of maggots. Recent studies have shown that infrared sensors can be used to locate animal carcasses, but little is known about the factors influencing detection success. In this study, we investigated the potential of infrared technology to locate wild boar carcasses, as they play an important role in the spread of African swine fever. Specifically, we tested the effects of environmental and carcass conditions on the detection probability. A drone-based thermal camera was used to collect data during 379 flyovers of 42 wild boar carcasses in different stages of decomposition between September 2020 and July 2021. Generalized mixed-effect models and conditional inference trees were used to identify the environmental and carcass conditions that influenced the detection probability. Our results showed that the thermal camera accurately measured carcass temperature (R2 = 0.75, RMSE = 5.89°C). The probability of finding carcasses was higher in open habitats with air temperatures >3.0°C and thus conducive to maggot development (detection rate ≤80%). A forest canopy openness >29.3% and cloudy conditions or flights at dawn increased the detection rate. Moreover, carcasses infested with large amounts of maggots could be detected even in habitats with a more extensive canopy cover, whereas in dense forests, the detection probability was limited (6.4°C (≤62%). Our study demonstrates the utility of thermal imaging in searching for wild boar carcasses under specific environmental and carcass conditions and thus its use in supporting ground searches.

Background: Blood kallikrein-8 is supposed to be a biomarker for mild cognitive impairment (MCI) due to Alzheimer's disease (AD), a precursor of AD dementia. Little is known about the association of kallikrein-8 and non-AD type dementias. Objective: To investigate whether blood kallikrein-8 is elevated in individuals with non-amnestic MCI (naMCI), which has a higher probability to progress to a non-AD type dementia, compared with cognitively unimpaired (CU) controls. Methods: We measured blood kallikrein-8 at ten-year follow-up (T2) in 75 cases and 75 controls matched for age and sex who were participants of the population-based Heinz Nixdorf Recall study (baseline: 2000-2003). Cognitive performance was assessed in a standardized manner at five (T1) and ten-year follow-up. Cases were CU or had subjective cognitive decline (SCD) at T1 and had naMCI at T2. Controls were CU at both follow-ups. The association between kallikrein-8 (per 500 pg/ml increase) and naMCI was estimated using conditional logistic regression: odds ratios (OR) and 95% confidence intervals (95%CI) were determined, adjusted for inter-assay variability and freezing duration. Results: Valid kallikrein-8 values were measured in 121 participants (45% cases, 54.5% women, 70.5 +/- 7.1 years). In cases, the mean kallikrein-8 was higher than in controls (922 +/- 797 pg/ml versus 884 +/- 782 pg/ml). Kallikrein-8 was not associated with having naMCI compared to being CU (adjusted; OR: 1.03 [95%CI: 0.80-1.32]). Conclusion: This is the first population-based study that shows that blood kallikrein-8 tends not to be elevated in individuals with naMCI compared with CU. This adds to the evidence of the possible AD specificity of kallikrein-8. CA Schramm

Background: Variants in RYR1, the gene encoding the ryanodine receptor-1, can give rise to a wide spectrum of neuromuscular conditions. Muscle imaging abnormalities have been demonstrated in isolated cases of patients with a history of RYR1-related malignant hyperthermia (MH) susceptibility. Objective: To provide insights into the type and prevalence of muscle ultrasound abnormalities and muscle hypertrophy in patients carrying gain-of-function RYR1 variants associated with MH susceptibility and to contribute to delineating the wider phenotype, optimizing the diagnostic work-up and care for of MH susceptible patients. Methods: We performed a prospective cross-sectional observational muscle ultrasound study in patients with a history of RYR1-related MH susceptibility (n = 40). Study procedures included a standardized history of neuromuscular symptoms and a muscle ultrasound assessment. Muscle ultrasound images were analyzed using a quantitative and qualitative approach and compared to reference values and subsequently subjected to a screening protocol for neuromuscular disorders. Results: A total of 15 (38%) patients had an abnormal muscle ultrasound result, 4 (10%) had a borderline muscle ultrasound screening result, and 21 (53%) had a normal muscle ultrasound screening result. The proportion of symptomatic patients with an abnormal result (11 of 24; 46%) was not significantly higher compared to the proportion of asymptomatic patients with an abnormal ultrasound result (4 of 16; 25%) (P = 0.182). The mean z-scores of the biceps brachii (z = 1.45; P < 0.001), biceps femoris (z = 0.43; P = 0.002), deltoid (z = 0.31; P = 0.009), trapezius (z = 0.38; P = 0.010) and the sum of all muscles (z = 0.40; P < 0.001) were significantly higher compared to 0, indicating hypertrophy. Conclusions: Patients with RYR1 variants resulting in MH susceptibility often have muscle ultrasound abnormalities. Frequently observed muscle ultrasound abnormalities include muscle hypertrophy and increased echogenicity.

Anxiety disorders are a prevalent and severe problem that are often developed early in life and can disrupt the daily lives of affected individuals for many years into adulthood. Given the persistent negative aspects of anxiety, accurate and early assessment is critical for long term outcomes. Currently, the most common method for anxiety assessment is through point-in-time measures like the GAD-7. Unfortunately, this survey and others like it can be subject to recall bias and do not fully capture the variability in an individual’s day-to-day symptom experience. The current work aims to evaluate how point-in-time assessments like the GAD-7 relate to daily measurements of anxiety in a teenage population. To evaluate this relationship, we leveraged data collected at four separate three week intervals from 30 teenagers over the course of a year. The specific items of interest were a single item anxiety severity measure collected three times per day and end-of-month GAD-7 assessments. Within this sample, 40% of individuals reported clinical levels of generalized anxiety disorder symptoms at some point during the study. The first component of analysis was a visual inspection assessing how daily anxiety severity fluctuated around end-of-month reporting via the GAD-7. The second component was a between-subjects comparison assessing whether individuals with similar GAD-7 scores experienced similar symptom dynamics across the month as represented by latent features derived from a deep learning model. With this approach, similarity was operationalized by hierarchical clustering of the latent features. The aim clearly indicated that an individual’s daily experience of anxiety varied widely around what was captured by the GAD-7. Additionally, when hierarchical clustering was applied to the three latent features derived from the (LSTM) encoder (r=0.624 for feature reconstruction), it was clear that individuals with similar GAD-7 outcomes were experiencing different symptom dynamics. Upon further inspection of the latent features, the LSTM model appeared to rely as much on anxiety variability over the course of the month as it did on anxiety severity (p

Faith, as a way of how people understand God and the world and make or discover meaning in their life, is characterized by individual differences and changes over the lifetime. Our research investigates these changes over the life span in terms of hierarchically ordered types that are the elements in our developmental model, which is a critical advancement and modification of Fowler’s theory of faith development. This study is the first to investigate whether there is development in faith over the adult life span and to identify predictors of developmental change. Our mixed-method design used three-wave longitudinal data (mean lag time 10.47 years from Wave 1 to Wave 3). A sample of N = 75 participants were interviewed with the faith development interview three times and each time answered comprehensive questionnaires. Results evidenced faith development over the life span: a majority in our data moved to a higher type, while change to a lower type did occur. Openness to experience and the religious schema truth of text and teachings were potential antecedents for faith development. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

To apply a navigator-based slice tracking method to prospectively compensate the respiratory motion for kidney vessel architecture imaging (VAI).A dual gradient echo (GE)/spin echo (SE) 2D EPI sequence was developed for kidney VAI. A single gradient-echo slice selection and projection readout at the location of the diaphragm along the inferior-superior direction was applied as a navigator. Navigator acquisition and fat suppression were inserted before each transverse imaging slice. Motion information was calculated after exclusion of the signal saturation in the navigator signal caused by imaging slices. The motion information was then directly sent back to the sequence and slice positioning was adjusted in real-time. The whole sequence was applied during a contrast agent pass-through.VAI parametric maps show the structural heterogeneity of the renal vasculature. The respiratory motion from the navigator signal was precisely calculated and slice positioning was changed in real-time based on the motion information. The vibration amplitude of the signal intensity of the liver tissue at the liver-lung interface in the case of prospective motion correction (PMC) on is about 28% of the PMC off case. Compared to the case of PMC off, the coefficient of variation (CoV) was reduced 30% of the case of PMC on.This study demonstrates the feasibility of the motion-compensating technique in kidney VAI. The sequence may improve the evaluation of microvasculature in kidney diseases.

Background Classical anthropometric traits may fail to fully represent the relationship of weight, adiposity, and height with cancer risk. We investigated the associations of body shape phenotypes with the risk of overall and site-specific cancers. Methods We derived four distinct body shape phenotypes from principal component (PC) analysis on height, weight, body mass index (BMI), waist (WC) and hip circumferences (HC), and waist-to-hip ratio (WHR). The study included 340,152 men and women from 9 European countries, aged mostly 35–65 years at recruitment (1990–2000) in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results After a median follow-up of 15.3 years, 47,110 incident cancer cases were recorded. PC1 (overall adiposity) was positively associated with the risk of overall cancer, with a HR per 1 standard deviation (SD) increment equal to 1.07 (95% confidence interval 1.05 to 1.08). Positive associations were observed with 10 cancer types, with HRs (per 1 SD) ranging from 1.36 (1.30–1.42) for endometrial cancer to 1.08 (1.03–1.13) for rectal cancer. PC2 (tall stature with low WHR) was positively associated with the risk of overall cancer (1.03; 1.02–1.04) and five cancer types which were not associated with PC1. PC3 (tall stature with high WHR) was positively associated with the risk of overall cancer (1.04; 1.03–1.05) and 12 cancer types. PC4 (high BMI and weight with low WC and HC) was not associated with overall risk of cancer (1.00; 0.99–1.01). Conclusions In this multi-national study, distinct body shape phenotypes were positively associated with the incidence of 17 different cancers and overall cancer.

Background: In patients with coronary artery disease and concomitant asymptomatic severe carotid stenosis, combined simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) has been widely performed despite lack of evidence from randomized trials. We recently showed that the risk of stroke or death within 30 days was higher following CABG+CEA compared with CABG alone. Here, we report long-term outcomes following CABG with versus without CEA. Methods: The CABACS (Coronary Artery Bypass Graft Surgery in Patients With Asymptomatic Carotid Stenosis Study) is a randomized, controlled, multicenter, open trial. Patients with asymptomatic severe (≥70%) carotid stenosis undergoing CABG were allocated either CABG+CEA or CABG alone, and follow-up was 5 years. Major secondary end points included nonfatal stroke or death, any death and any nonfatal stroke. Due to low recruitment, the study was stopped prematurely after randomization of 127 patients in 17 centers. Results: By 5 years, the rate of stroke or death did not significantly differ between groups (CABG+CEA 40.6% [95% CI, 0.285–0.536], CABG alone 35.0% [95% CI, 0.231–0.484]; P =0.58). Higher albeit statistically nonsignificant rates of nonfatal strokes occurred at any time following CABG+CEA versus CABG alone (1 year: 19.3% versus 7.1%, P =0.09; 5 years: 29.4% versus 18.8%, P =0.25). All-cause mortality up to 5 years was similar in both groups (CABG+CEA: 25.4% versus CABG alone: 23.3%, hazard ratio, 1.148 [95% CI, 0.560–2.353]; P =0.71). Subgroup analyses did not reveal any significant effect of age, sex, preoperative modified Rankin Scale and center on outcome events. Conclusions: During 5-years follow-up, combined simultaneous CABG+CEA was associated with a higher albeit statistically nonsignificant rate of stroke or death compared with CABG alone. This was mainly due to a nonsignificantly higher perioperative risk following CABG+CEA. Since the power of our study was not sufficient, no significant effect of either procedure could be observed at any time during follow-up. Registration: URL: http://www.controlled-trials.com ; Unique identifier: ISRCTN13486906.

ZusammenfassungBei Einführung der Pflegeversicherung im Jahr 1994 wurden Ausgestaltungsentscheidungen getroffen, die das System bis heute prägen. In diesem Diskussionsbeitrag werden 3 dieser Entscheidungen untersucht. Jeweils wird ein Bewertungsmaßstab formuliert, um die aktuelle Situation zu beurteilen. Bei negativer Beurteilung werden Reformoptionen diskutiert.Die Ausgestaltung der Pflegeversicherung mit betraglich begrenzten Versicherungsleistungen und nach oben offenen Eigenanteilen hat zu Gesamteigenanteilen geführt, die von der Mehrheit der Heimbewohnenden nicht mehr aus dem laufenden Einkommen finanziert werden können. Um ihre ursprünglichen Ziele erfüllen zu können, müsste die Pflegeversicherung daher vom Kopf auf die Füße gestellt werden – durch eine absolute Begrenzung der Eigenanteile in Höhe und Dauer.Auch das „duale Versicherungssystem“ aus einer sozialen Pflegeversicherung und einer privaten Pflegepflichtversicherung hat sich als „Geburtsfehler“ des Systems erwiesen. Da das Kollektiv der Privatversicherten über eine wesentlich günstigere Risikostruktur und höhere Durchschnittseinkommen verfügt, ist die vom Bundesverfassungsgericht geforderte „gleichmäßige Lastenverteilung“ bei der Finanzierung nicht gegeben. Zur Behebung dieser Ungleichbehandlung ist die Überführung des dualen Systems in eine integrierte Pflegeversicherung oder zumindest ein Risikostrukturausgleich zwischen beiden Zweigen zu fordern.Dass die Pflegeversicherung als eigener Zweig der Sozialversicherung eingeführt wurde, lässt sich dagegen rechtfertigen. Allerdings wäre es zur Überwindung von Schnittstellenproblemen notwendig, die Finanzierungskompetenz für die geriatrische Rehabilitation bei der Pflegeversicherung und die für die medizinische Behandlungspflege in Pflegeheimen bei der Krankenversicherung anzusiedeln.

International audience; Aim: Land use is the most pervasive driver of biodiversity loss. Predicting its impact on species richness (SR) is often based on indicators of habitat loss. However, the degradation of habitats, especially through land-use intensification, also affects species. Here, we evaluate whether an integrative metric of land-use intensity, the human appropriation of net primary production, is correlated with the decline of SR in used landscapes across the globe. Location Global. Time period Present. Major taxa studied Birds, mammals and amphibians. Methods: Based on species range maps (spatial resolution: 20 km × 20 km) and an area-of-habitat approach, we calibrated a “species–energy model” by correlating the SR of three groups of vertebrates with net primary production and biogeographical covariables in “wilderness” areas (i.e., those where available energy is assumed to be still at pristine levels). We used this model to project the difference between pristine SR and the SR corresponding to the energy remaining in used landscapes (i.e., SR loss expected owing to human energy extraction outside wilderness areas). We validated the projected species loss by comparison with the realized and impending loss reconstructed from habitat conversion and documented by national Red Lists. Results Species–energy models largely explained landscape-scale variation of mapped SR in wilderness areas (adjusted R2-values: 0.79–0.93). Model-based projections of SR loss were lower, on average, than reconstructed and documented ones, but the spatial patterns were correlated significantly, with stronger correlation in mammals (Pearson's r = 0.68) than in amphibians (r = 0.60) and birds (r = 0.57). Main conclusions: Our results suggest that the human appropriation of net primary production is a useful indicator of heterotrophic species loss in used landscapes, hence we recommend its inclusion in models based on species–area relationships to improve predictions of land-use-driven biodiversity loss.

Photosensitizers currently used for photodynamic therapy of cancer show enhanced accumulation in tumor tissue but lack cancer cell specificity. To augment cellular uptake, the targeting of pyropheophorbide-a to carbohydrate-binding components of cancer cells was explored. Galactose was attached to pyropheophorbide-a at positions 172 and 20. Since the modification at position 172 removed a carboxylic group, which is relevant for cell specificity, this study evaluated the relative contribution of galactosyl and carboxyl groups at either position 172 or 20, with or without a (hexyloxy)ethyl at position 3, to cellular uptake by human epithelial cancer cells. The subcellular deposition was monitored using fluorescence microscopy and the photoreaction was quantified using biomarkers. The results demonstrated that any galactose addition suppresses transmembrane diffusion and promotes endocytosis and lysosomal accumulation. An anionic group at position 172 or 20 enhances lysosomal retention. Neutralization of the carboxylic group at position 172 facilitates transfer to mitochondria/endoplasmatic reticulum and promotes tumor cell-specific retention. Replacing (hexyloxy)ethyl with an ethyl group at position 3 increased both cellular uptake and egress but did not alter subcellular localization. These findings suggest that specific neutral galactosylated pheophorbides may provide an enhanced therapeutic effect for those tumor types that do not retain unmodified pyropheophorbide. However, the galactose conjugates also serve as substrates for preferential uptake by liver cells resulting in hepatic sequestration, reduced systemic distribution, and lower accumulation in tumor tissue.

For many decades, the prevailing paradigm in endocrinology was that testosterone and 5α-dihydrotestosterone are the only potent androgens in the context of human physiology. The more recent identification of adrenal derived 11-oxygenated androgens and particularly 11-ketotestosterone have challenged these established norms, prompting a revaluation of the androgen pool, particularly in women. Since being recognized as bone fide androgens in humans, numerous studies have focused their attention on understanding the role of 11-oxygenated androgens in human health and disease and have implicated them as role players in conditions such as castration resistant prostate cancer, congenital adrenal hyperplasia, polycystic ovary syndrome, Cushing's syndrome, and premature adrenarche. This review therefore provides an overview of our current knowledge on the biosynthesis and activity of 11-oxygenated androgens with a focus on their role in disease states. We also highlight important analytical considerations for measuring this unique class of steroid hormone.

Objective To assess the natural history of saphenous and non-saphenous varicose veins using the results of the Bonn Vein Studies and data published in literature. Methods We used the data of the Bonn Vein Studies (BVS) 1 and 2 to assess if preexisting non-saphenous varicose veins (NSVV) in persons who had no saphenous varicose veins (SVV) at baseline have an impact on the incidence of SVV during the follow-up of 6.6 years and vice versa. SVV where defined as tortuous or not-tortuous refluxing saphenous veins. The statistical evaluation was performed using SAS version 9.4 (SAS Institute, Cary, North Carolina). In addition, we performed a review of publications concerning the natural history of varicose veins (VV) using PubMed. Results In the BVS the overall incidence of SVV within the follow-up time of 6.6 years was 8.0 % (n = 133 of 1661; 95 % CI: 6.8–9.4). 7.2 % (n = 107 of 1492) without VV in BVS 1 and 19.8 % (n = 26) of patients with preexisting NSVV developed SVV. The relative risk for the development of SVV in patients with preexisting NSVV was 2.44 (95% CI: 1.64–3.64) adjusted for age and sex. The overall incidence of NSVV was markedly higher with 13.3 % (n = 226 of 1661; 95 % CI: 11.8–15.1). During follow-up 148 patients (9.9 %) without VV in BVS 1 developed NSVV. 48.5 % (n = 78) of patients with preexisting SVV developed NSVV during follow-up. The relative risk for the development of NSVV in patients with preexisting SVV was 4.10 (95% CI: 3.26–5.16), adjusted for age and sex.In published studies the development of VV is preceded by venous reflux. Initial VV may develop at any segment and the results from literature suggest that the location of VV and reflux at the time of the investigation depends on age. In younger individuals more distal location are reported with an ascending progression in the majority but also descending progression is possible. Conclusions Based on the results of the Bonn Vein Studies 1 and 2 we could demonstrate, that preexisting SVV increase the risk of developing NSVV and preexisting NSVV increase the risk of developing SVV in a similar way. Venous reflux may initially occur in any segment of the venous system and may progress in antegrade and/or retrograde fashion. In younger adults initial VV seem to be localized more often in distal parts of the legs with an antegrade progression over time.

ZusammenfassungIn modernen Industriegesellschaften verbringen die Menschen die aktivste Zeit ihres Lebens in beruflicher Umgebung, die damit weitgehend Alltag und Lebensqualität bestimmt. Immer mehr verschwimmen die Grenzen zwischen Privatem und Beruflichem. Neben „klassischem“ Arbeitsstress – häufig definiert als Missverhältnis von hohen Anforderungen bei gleichzeitig geringen Entscheidungsmöglichkeiten oder als Missverhältnis zwischen Arbeitseinsatz und Belohnung – gehören u. a. Überarbeitung, Mobbing und Arbeitsplatzverlust sowie negative Arbeitsplatzbedingungen zu den Belastungen, die seelische und körperliche gesundheitliche Probleme auslösen können. Evidenz aus Megastudien mit > 100000 Teilnehmern belegt die Bedeutung von Arbeitsstress als Risikofaktor (RF) für Hypertonie, Schlafstörungen und Depressionen. Unter Arbeitsstress werden häufig gesundheitsgefährdende Verhaltensweisen als Kompensationsversuche eingesetzt. Andauernder Arbeitsstress wird damit zu einem signifikanten RF für ischämische Herzerkrankungen, zerebrovaskuläre Ereignisse und Diabetes mellitus. Arbeitsstress sollte daher in der kardiologischen Praxis exploriert werden. Grundzüge einer auf Arbeitsstress fokussierten Gesprächsführung für den Alltagseinsatz werden vorgestellt.

ZusammenfassungZiele der kardiologischen Rehabilitation (kurz: KardReha) sind die Wiederherstellung der individuell bestmöglichen physischen und psychischen Gesundheit kardiovaskulär erkrankter Patienten durch die Therapie in einem multidisziplinären Team, diese nachhaltig zu stabilisieren und die berufliche und soziale Re-Integration zu ermöglichen. Auf der Basis einer S3-Leitlinie zur KardReha im deutschsprachigen Raum Europas führt die Teilnahme an einer KardReha bei Patienten nach akutem Koronarsyndrom und nach Bypass-Operation zu einer signifikanten Reduktion der Gesamtmortalität. Bei Patienten mit systolischer Herzinsuffizienz werden die körperliche Belastbarkeit und die Lebensqualität signifikant verbessert. Nach operativer oder interventioneller Herzklappenkorrektur werden die körperliche Belastbarkeit sowie die Lebensqualität gesteigert, und in ersten Studien zeigen sich Signale für eine Mortalitätsreduktion. Daher sollte die KardReha ein integraler Bestandteil einer am langfristigen Erfolg orientierten Behandlung sein.

Purpose In professional football (soccer), Achilles tendon ruptures are severe injuries. Video analysis promotes a better understanding of the underlying situational and biomechanical patterns, and provides a roadmap for future research to improve the management and prevention of Achilles tendon ruptures. The purpose of this study was to identify injury patterns contributing to acute Achilles tendon ruptures in professional male football players. Methods Professional male football players with an acute Achilles tendon rupture were identified using an online database. For every in-competition injury, the corresponding football match was detected. Video footage of the injury was accessed using Wyscout.com or publicly available video databases. Situational patterns and injury biomechanics of the injury frame were independently analysed by two reviewers using a standardised checklist and a motion analysis software. Finally, consensus was reached to describe the main injury patterns of Achilles tendon ruptures in professional male football players. Results The search identified video footage of 80 Achilles tendon ruptures in 78 players. Most injuries (94%) occurred through indirect or non-contact mechanisms. The kinematic analysis revealed characteristic joint positions at the time of injury consisting of hip extension, knee extension, ankle dorsiflexion, foot abduction, and foot pronation in most cases. The underlying direction of movement was from flexion to extension (knee) and from plantarflexion to dorsiflexion (ankle). Player actions identified as main injury patterns were stepping back (26%), landing (20%), running/sprinting (18%), jumping (13%), and starting (10%). Conclusion Most Achilles tendon ruptures in professional male football players are closed-chain indirect or non-contact injuries. Sudden loading to the plantarflexor musculotendinous unit remains to be the main component for most cases. By achieving a better understanding of underlying injury mechanisms, this study provides new strategies for the prevention of Achilles tendon ruptures. Level of evidence Level IV.