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Background In infants and young children, a wide heterogeneity of foot shape is typical. Therefore, children, who are additionally influenced by rapid growth and maturation, are a very special cohort for foot measurements and the footwear industry. The importance of foot measurements for footwear fit, design, as well as clinical applications has been sufficiently described. New measurement techniques (3D foot scanning) allow the assessment of the individual foot shape. However, the validity in comparison to conventional methods remains unclear. Therefore, the purpose of this study was to compare 3D foot scanning with two established measurement methods (2D digital scanning/manual foot measurements). Methods Two hundred seventy seven children (125 m / 152 f; mean ± SD: 8.0 ± 1.5yrs; 130.2 ± 10.7cm; 28.0 ± 7.3kg) were included into the study. After collection of basic data (sex, age (yrs), body height (cm), body weight (kg)) geometry of the right foot was measured in static condition (stance) with three different measurement systems (fixed order): manual foot measurement, 2D foot scanning (2D desk scanner) and 3D foot scanning (hand-held 3D scanner). Main outcomes were foot length, foot width (projected; anatomical; instep), heel width and anatomical foot ball breadth. Analysis of variances for dependent samples was applied to test for differences between foot measurement methods (Post-hoc analysis: Tukey-Kramer-Test; α=0.05). Results Significant differences were found for all outcome measures comparing the three methods (p Conclusions The findings suggests that when comparing foot data, it is important to consider the differences caused by new measurement methods. Differences of about 0.6cm are relevant when measuring foot length, as this is the difference of a complete shoe size (Parisian point). Hence, correction factors may be required to compare the results of different measurements appropriately. The presented results may have relevance in the field of ergonomics (shoe industry) as well as clinical practice.

Background Improving movement control might be a promising treatment goal during chronic non-specific low back pain (CLBP) rehabilitation. The objective of the study is to evaluate the effect of a single bout of game-based real-time feedback intervention on trunk movement in patients with CLBP. Methods Thirteen CLBP patients (8female;41 ± 16 years;173 ± 10 cm;78 ± 22 kg) were included in this randomized cross-over pilot trial. During one laboratory session (2 h), participants performed three identical measurements on trunk movement all including: first, maximum angle of lateral flexion was assessed. Secondly, a target trunk lateral flexion (angle: 20°) was performed. Main outcome was maximum angle ([°]; MA). Secondary outcomes were deviation [°] from the target angle (angle reproduction; AR) and MA of the secondary movement planes (rotation; extension/flexion) during lateral flexion. The outcomes were assessed by an optical 3D-motion-capture-system (2-segment-trunk-model). The measurements were separated by 12-min of intervention and/or resting (randomly). The intervention involved a sensor-based trunk exergame (guiding an avatar through virtual worlds). After carryover effect-analysis, pre-to-post intervention data were pooled between the two sequences followed by analyses of variances (paired t-test). Results No significant change from pre to post intervention for MA or AR for any segment occurred for the main movement plane, lateral flexion (p > .05). The upper trunk segment showed a significant decrease of the MA for trunk extension/flexion from pre to post intervention ((4.4° ± 4.4° (95% CI 7.06–1.75)/3.5° ± 1.29° (95% CI 6.22–0.80); p = 0.02, d = 0.20). Conclusions A single bout of game-based real-time feedback intervention lead to changes in the secondary movement planes indicating reduced evasive motion during trunk movement. Trial registration No. DRKS00029765 (date of registration 27.07.2022). Retrospectively registered in the German Clinical Trial Register.

Two new small tridactyl dinosaur tracks are found in the Middle Jurassic Bagå Formation of Bornholm and are interpreted as ornithopodian in origin. A skeletal fragment is identified as a crocodilian skull fragment. Previous finds of dinosaur tracks from the locality consist of two sizes of sauropods, a medium sized theropod and thyreophorans. The addition of tracks from ornithopod dinosaurs and skeletal evidence of crocodilians now give a broader picture of a diverse Middle Jurassic vertebrate fauna. This is an important addition to the understanding of the terres-trial Mesozoic ecosystem of Denmark, and a valuable addition to the scarce Middle Jurassic vertebrate record of Europe.

To date, there is still a lack of reliable imaging modalities to improve the quality of consultation, diagnostic and medical examinations of the oral mucosa in dentistry. Even though, optical technologies have become an important element for the detection and treatment of different diseases of soft tissue, for the case of oral screenings the evidence of the benefit in comparison to conventional histopathology is mostly still pending. One promising optical technology for oral diagnostics is optical coherence tomography (OCT). To prove the potential of OCT, even the amount of freely accessible OCT data is not sufficient to describe the variance of healthy human oral soft tissue in vivo. In order to remedy this deficiency, the present study provides in vivo OCT cross sections of the human oral mucosa of the anterior and posterior oral cavity as well as the oropharynx of 47 adult volunteers. A collection of representative OCT cross sections forms the basis for a randomized blinded image analysis by means of seven criteria to assess the main features of the superficial layers of the human oral mucosa and to determine its correlation to regional features known from hematoxylin and eosin (HE) stained histology.

The study investigated the incidence of Achilles and patellar tendinopathy in adolescent elite athletes and non-athletic controls. Furthermore, predictive and associated factors for tendinopathy development were analyzed. The prospective study consisted of two measurement days (M1/M2) with an interval of 3.2±0.9 years. 157 athletes (12.1±0.7 years) and 25 controls (13.3±0.6 years) without Achilles/patellar tendinopathy were included at M1. Clinical and ultrasound examinations of both Achilles (AT) and patellar tendons (PT) were performed. Main outcome measures were incidence tendinopathy and structural intratendinous alterations (hypo-/hyperechogenicity, vascularization) at M2 [%]. Incidence of Achilles tendinopathy was 1% in athletes and 0% in controls. Patellar tendinopathy was more frequent in athletes (13%) than in controls (4%). Incidence of intratendinous alterations in ATs was 1-2% in athletes and 0% in controls, whereas in PTs it was 4-6% in both groups (p>0.05). Intratendinous alterations at M2 were associated with patellar tendinopathy in athletes (p≤0.01). Intratendinous alterations at M1, anthropometric data, training amount, sports or sex did not predict tendinopathy development (p>0.05). Incidence of tendinopathy and intratendinous alterations in adolescent athletes is low in ATs and more common in PTs. Development of intratendinous alterations in PT is associated with tendinopathy. However, predictive factors could not be identified.

The aim of this study was to investigate the effect of a 6-week sensorimotor or resistance training on maximum trunk strength and response to sudden, high-intensity loading in athletes.Forty-three healthy, well-trained participants were randomized into sensorimotor (SMT; n=11), resistance training (RT; n=16) and control groups (CG; n=16). Treatment groups received either sensorimotor training (SMT) or resistance training (RT) for 6 weeks, 3 times a week. At baseline and after 6 weeks of intervention, participants' maximum isokinetic strength in trunk rotation and extension was tested (concentric/eccentric 30°/s). In addition, sudden, high-intensity trunk loading was assessed for eccentric extension and rotation, with additional perturbation. Peak torque [Nm] was calculated as the outcome.Interventions showed no significant difference for maximum strength in concentric and eccentric testing (p>0.05). For perturbation compensation, higher peak torque response following SMT (Extension: +24 Nm 95%CI±19 Nm; Rotation: +19 Nm 95%CI±13 Nm) and RT (Extension: +35 Nm 95%CI±16 Nm; Rotation: +5 Nm 95%CI±4 Nm) compared to CG (Extension: -4 Nm 95%CI±16 Nm; Rotation: -2 Nm 95%CI±4 Nm) was present (pThis study showed that isokinetic strength gains were small, but that significant improvements in high-intensity trunk loading response could be shown for both interventions. Therefore, depending on the individual's preference, therapists have two treatment options to enhance trunk function for back pain prevention.

The purpose was to examine gender differences in ankle stabilizing muscle activation during postural disturbances. Seventeen participants (9 females: 27 ± 2yrs., 1.69 ± 0.1 m, 63 ± 7 kg; 8 males: 29 ± 2yrs., 1.81 ± 0.1 m; 83 ± 7 kg) were included in the study. After familiarization on a split-belt-treadmill, participants walked (1 m/s) while 15 right-sided perturbations were randomly applied 200 ms after initial heel contact. Muscle activity of M. tibialis anterior (TA), peroneus longus (PL) and gastrocnemius medialis (GM) was recorded during unperturbed and perturbed walking. The root mean square (RMS; [%]) was analyzed within 200 ms after perturbation. Co-activation was quantified as ratio of antagonist (GM)/agonist (TA) EMG-RMS during unperturbed and perturbed walking. Time to onset was calculated (ms). Data were analyzed descriptively (mean ± SD) followed by three-way-ANOVA (gender/condition/muscle; α = 0.05). Perturbed walking elicited higher EMG activity compared to normal walking for TA and PL in both genders (p 0.000). RMS amplitude gender comparisons revealed an interaction between gender and condition (F = 4.6, p = 0.049) and, a triple interaction among gender, condition and muscle (F = 4.7, p = 0.02). Women presented significantly higher EMG-RMS [%] PL amplitude than men during perturbed walking (mean difference = 209.6%, 95% confidence interval = -367.0 to -52.2%, p 0.000). Co-activation showed significant lower values for perturbed compared to normal walking (p 0.000), without significant gender differences for both walking conditions. GM activated significantly earlier than TA and PL (p 0.01) without significant differences between the muscle activation onsets of men and women (p = 0.7). The results reflect that activation strategies of the ankle encompassing muscles differ between genders. In provoked stumbling, higher PL EMG activity in women compared to men is present. Future studies should aim to elucidate if this specific behavior has any relationship with ankle injury occurrence between genders.

Instrumented treadmills offer the potential to generate standardized walking perturbations, which are particularly rapid and powerful. However, technical requirements to release adequate perturbations regarding timing, duration and amplitude are demanding. This study investigated the test-retest reliability and validity of a new treadmill perturbation protocol releasing rapid and unexpected belt perturbations to provoke muscular reflex responses at lower extremities and the trunk. Fourteen healthy participants underwent two identical treadmill walking protocols, consisting of 10 superimposed one-sided belt perturbations (100 ms duration; 2 m/s amplitude), triggered by a plantar pressure insole 200 ms after heel contact. Delay, duration and amplitude of applied perturbations were recorded by 3D-motion capture. Muscular reflex responses (within 200 ms) were measured at lower extremities and the trunk (10-lead EMG). Data was analyzed descriptively (mean +/- SD). Reliability was analyzed using test-retest variability (TRV%) and limits of agreement (LoA, bias +/- 1.96*SD). Perturbation delay was 202 14 ms, duration was 102 +/- 4 ms and amplitude was 2.1 +/- 0.01 m/s. TRV for perturbation delay, duration and amplitude ranged from 5.0% to 5.7%. LoA reached 3 +/- 36 ms for delay, 2 +/- 13 ms for duration and 0.0 +/- 0.3 m/s for amplitude. EMG amplitudes following perturbations ranged between 106 +/- 97% and 909 +/- 979% of unperturbed gait and EMG latencies between 82 +/- 14 ms and 106 +/- 16 ms. Minor differences between preset and observed perturbation characteristics and results of test-retest analysis prove a high validity with excellent reliability of the setup. Therefore, the protocol tested can be recommended to provoke muscular reflex responses at lower extremities and the trunk in perturbed walking. (C) 2017 Elsevier Ltd. All rights reserved.

Persons with low back pain (LBP) exhibit delayed trunk muscle onset and increased co-contractions as a response to quasi-static and dynamic sudden trunk loading in comparison to back-healthy controls. Although LBP is more prevalent in females, sex-specific responses have not been well documented. Therefore, the purpose was to explore sex-specific neuromuscular differences, to gait perturbation, in LBP patients. Twenty-nine LBP patients (12m/17f;31 ± 10yrs; 174 ± 12 cm; 71 ± 16 kg) walked on a split-belt treadmill at 1 m/s, while 15 right-sided random perturbations (treadmill-belt decelerating, 40 m/s2, 50 ms duration; 200 ms after heel contact) were applied. Muscle activity was assessed using a 12-lead surface EMG (6 back/6 abdominal muscles; 4000 Hz). EMG-RMS [%] (0–200 ms after perturbation) was calculated and normalized to RMS of unperturbed gait for each muscle. Furthermore, muscle onsets (ms) were determined. Two-way ANOVA (factors: sex/muscle) was applied to account for sex differences in main outcomes. EMG-RMS (amplitudes; mean) ranged from 356% to 901% in males and 349% to 694% in females representing a significant interaction effect (sex * muscle: p = 0.017). Post-hoc analysis revealed significant differences for EMG-RMS analysis of rectus abdominis left (p = 0.043; f > m) as well as obliques externus right/left (p = 0.018/p = 0.005; f In this LBP population, abdominal muscle activation discriminated females from males. Specifically, females had higher activity of the rectus abdominis muscles and lower activation of the externus oblique muscles. These different activation strategies might be relevant to the development of sex-specific intervention strategies.

OBJECTIVE To evaluate trunk peak torque and muscle activation pattern during isokinetic and sudden trunk loading (STL) between adolescent athletes with/without back pain. METHODS Nine adolescent athletes with back pain (BP) (m/f 2/7; 15.6 ± 1.2 y; 177 ± 9 cm; 67 ± 13 kg; 22.5 ± 9.8 h/week) and nine matched controls (m/f 2/7; 15.7 ± 1.4 y; 177 ± 12 cm; 65 ± 9 kg; 16.5 ± 8.0 h/week training) were included. Trunk strength in rotation and flexion/extension was assessed. Sudden trunk loading was measured during eccentric extension and rotation (30∘/s) with additional perturbation. Trunk muscle activity was measured using a 12 lead-EMG (electromyography). Main outcome measures were peak torque [Nm] and MVC normalized EMG-amplitudes (RMS [%]) for each muscle. Additionally, the mean EMG-RMS for four areas of the trunk was calculated (right/left ventral, right/left dorsal). RESULTS Back pain showed lower trunk peak torque for all conditions in extension/flexion, but not for rotation. EMG amplitudes were increased for BP athletes with statistical significant differences for dorsal muscles in rotation and extension (p< 0.0042), not for ventral muscles in flexion. CONCLUSIONS The evaluation of strength and muscle activity in isokinetic and sudden trunk loading presents altered trunk function in adolescent back pain athletes. Training interventions focusing on trunk strength and muscular activation pattern appears reasonable.

The study aimed to analyse neuromuscular activity of the trunk comparing four different perturbations during gait. Thirteen subjects (28 +/- 3 yrs) walked (1 m/s) on a split-belt treadmill, while 4 (belt) perturbations (F1, F2, B1, B2) were randomly applied. Perturbations differed, related to treadmill belt translation, in direction (forward (F)/backward (B)) and amplitude (20 m/s(2) (1)/40 m/s(2) (2)). Trunk muscle activity was assessed with a 12-lead-EMG. EMG-RMS [%] (0-200 ms after perturbation; normalized to RMS of normal gait) was analyzed for muscles and four trunk areas (ventral left/right; dorsal left/right). Ratio of ventral: dorsal muscles were calculated. Muscle onset [ms] was determined. Data analysis was conducted descriptively, followed by ANOVA (post hoc Tukey-Kramer (alpha = 0.05)). All perturbations lead to an increase in EMG-RMS (428 +/- 289%). F1 showed the lowest and F2 the highest increase for the flexors. B2 showed the highest increase for the extensors. Significant differences between perturbations could be observed for 6 muscles, as well as the 4 trunk areas. Ratio analysis revealed no significant differences (range 1.25 (B1) to 1.71 (F2) between stimuli. Muscle response time (ventral: 87.0 +/- 21.7 ms; dorsal: 88.4 +/- 17.0 ms) between stimuli was only significant (p = 0.005) for the dorsal muscles. Magnitude significantly influences neuromuscular trunk response patterns in healthy adults. Regardless of direction ventral muscles always revealed higher relative increase of activity while compensating the walking perturbations. (C) 2016 Elsevier Ltd. All rights reserved.

The present case, FEMALE HUNTING INSTINCT, tells the true story of a German woman who founded a knowledge-intensive business service (in the German GmbH form, equivalent to the American LLC), after spending a few years in France. The case consists of an interview with the female founder which focuses on the establishment of her business and illustrates her occupational life. In addition, her diary account from past to present provides a closer look at the thoughts and attitudes of a mompreneur. Sabine Jotter, one of four founders of the business presented and a mother of two, wanted to push for big budgets for her company. After a few years of freelancing, her “hunting” instinct was aroused, causing her at times to feel like an uncaring mother. On most days however, she is satisfied with the flexibility, independence, and leadership role she enjoys as part of her work. Using the jigsaw approach, the teaching material below is divided into four “pieces” to help bring students and complementary data together. In doing so, different perspectives on entrepreneurial success are discussed, and light is shed on the role of the woman and mothers in France and Germany. Perceived motivational factors also play a key role.

Core-specific sensorimotor exercises are proven to enhance neuromuscular activity of the trunk. However, the influence of high-intensity perturbations on training efficiency is unclear within this context. Sixteen participants (29 +/- 2 yrs; 175 +/- 8 cm; 69 +/- 13 kg) were prepared with a 12-lead bilateral trunk EMG. Warm-up on a dynamometer was followed by maximum voluntary isometric trunk (flex/ext) contraction (MVC). Next, participants performed four conditions for a one-legged stance with hip abduction on a stable surface (HA) repeated randomly on an unstable surface (HAP), on a stable surface with perturbation (HA + P), and on an unstable surface with perturbation (HAP + P). Afterwards, bird dog (BD) was performed under the same conditions (BD, BDP, BD + P, BDP + P). A foam pad under the foot (HA) or the knee (BD) was used as an unstable surface. Exercises were conducted on a moveable platform. Perturbations (ACC 50 m/sec(2);100 ms duration;10rep.) were randomly applied in the anterior-posterior direction. The root mean square (RMS) normalized to MVC (%) was calculated (whole movement cycle). Muscles were grouped into ventral right and left (VR;VL), and dorsal right and left (DR;DL). Ventral Dorsal and right-left ratios were calculated (two way repeated-measures ANOVA;alpha = 0,05). Amplitudes of all muscle groups in bird dog were higher compared to hip abduction (p 0.05). Additional high-intensity perturbations during core-specific sensorimotor exercises lead to increased neuromuscular activity and therefore higher exercise intensities. However, the beneficial effects on trunk function remain unclear. Nevertheless, BD is more suitable to address trunk muscles.

Primary fibromyalgia syndrome (FMS) is associated with substantial psychiatric comorbidity. The aim of the present study was to investigate the interrelationship between self-reported symptoms of depression and pain in FMS compared with rheumatoid arthritis (RA).In a cross-sectional study, 100 patients with FMS and 50 patients with RA were compared with regard to depression and psychopathology using the Symptom Check List (SCL-27). Group comparisons were calculated by parametric and non-parametric tests. The association between pain intensity and depression was determined by correlation analyses and multivariate statistical procedures (CATREG).Pain intensity was significantly higher in FMS compared with RA. FMS patients also scored significantly higher on all subscales of the SCL-27 including the depression scale and the General Symptom Index (GSI) (P0.001). These group differences remained stable even after correcting for pain intensity. Correlation analyses revealed an association between pain intensity and depression in FMS but not in RA (R = 0.419, P0.001).FMS patients in tertiary referral centers suffer from higher levels of pain intensity than RA patients. Depression predicts levels of pain in FMS but not in RA and is therefore an important target of intervention.

Background: Isokinetic measurements are widely used to assess strength capacity in a clinical or research context. Nevertheless, the validity of isokinetic measures for identifying strength deficits and the evaluation of therapeutic process regard- ing different pathologies is yet to be established. Therefore, the purpose of this review is to evaluate the validity of isokinetic measures in a specific case: that of muscular capacity in low back pain (LBP). Methods: A literature search (PubMed; ISI Web of Knowledge; The Cochrane Library) covering the last 10 years was performed. Relevant papers regarding isokinetic trunk strength measures in healthy and patients with low back pain (PLBP) were searched. Peak torque values (Nm) and peak torque normalized to body weight (Nm/kg BW) were extracted for healthy and PLBP. Ranked mean values across studies were calculated for the concentric peak torque at 60 ◦ /s as well as the flexion/extension (F/E) ratio. Results: 34 publications (31 flexion/extension; 3 rotation) were suitable for reporting detailed isokinetic strength measures in healthy or LBP (untrained adults, adolescents, athletes). Adolescents and athletes were different compared to normal adults in terms of absolute trunk strength values and the F/E ratio. Furthermore, isokinetic measures evaluating therapeutic process and isokinetic rehabilitation training were infrequent in literature (8 studies). Conclusion: Isokinetic measurements are valid for measuring trunk flexion/extension strength and F/E ratio in athletes, adoles- cents and (untrained) adults with/without LBP. The validity of trunk rotation is questionable due to a very small number of pub- lications whereas no reliable source regarding lateral flexion could be traced. Therefore, isokinetic dynamometry may be utilized for identifying trunk strength deficits in healthy adults and PLBP.

Well-preserved fossil eggs and eggshell fragments from the Pliocene Apolakkia Formation of Rhodes (Greece) are described. The eggs were found in-situ in a clutch. They are sub- spherical with lengths of 53-60 mm and widths of about 40 mm. All eggs are diagenetically compressed and their original diameters are estimated at 45-50 mm. The eggshells are 0.3-0.5 mm thick, partly re-crystallized, but widely still aragonitic. They consist of needle-like crystals that form individual shell units. A few pores are preserved between these shell units. This shell-structure allows assignment to chelonian eggs in the oofamily Testudoolithidae and the oogenus Testudolithus. The external morphology, microstructure and mineralogical composition of the eggshells show close resemblance to eggs of the extant tortoise Geochelone elephantopus. Together with a small association of turtle carapace fragments from the same formation, the clutch represents the first discovery of turtle and reptilian remains from the Pliocene of the island of Rhodes. (Less)

The addition of etoposide to the CHOP protocol (CHOEP) has been shown to improve outcome in patients with aggressive non-Hodgkin's lymphoma. The intravenous administration of etoposide on three consecutive days represents a logistic problem and needs resources particular in the outpatient setting. This could be avoided by using etoposide capsules on days 2 and 3. However, the oral administration of cytotoxic agents is often affected by variable absorption and drug interactions.We investigated the pharmacokinetic equivalency of oral and intravenous etoposide in ten patients (male, n=7; female, n=3; median age 56 years) with aggressive lymphomas. Treatment consisted of standard CHOP plus etoposide 100 mg/m2 given intravenously on day 1, and 200 mg/m2 orally on days 3 and 4. Samples from blood and urine were taken on days 1 (i.v. study) and 3 (p.o. study) before and after etoposide administration. Etoposide levels were determined by high-performance liquid chromatography (HPLC), and pharmacokinetic parameters were calculated with the TOPFIT computer program.Mean peak plasma level after intravenous etoposide was significantly higher compared to oral administration (16.3+/-3.7 vs. 12.0+/-4.2 microg/ml; P=0.015). The mean bioavailability of oral etoposide was 58+/-15% with an interpatient variability of 26%. Significant differences of bioavailability of oral etoposide between the used dose levels (350, 400 and 450 mg) were not observed. Mean AUC after a 100 mg/m2 intravenous and a 200 mg/m2 oral dose of etoposide were 74.0+/-18.3 and 84.9+/-29.6 microg h/ml (P=0.481). Interpatient variability of AUC was 25% for the intravenous route and 35% after oral intake. Urinary etoposide excretion as percentage of administered dose was 39.4+/-10.6% after intravenous infusion versus 35.4+/-9.4% after oral intake (P=0.422). Renal clearance was also very similar with intravenous and oral route (18.5+/-7.4 vs. 16.7+/-6.6 ml/min; P=0.546).The equivalency of AUC after 200 mg/m2 of oral and 100 mg/m2 of intravenous etoposide support the use of the oral preparation in patients treated with the CHOEP regimen, which makes the chemotherapy more convenient for the patients and help to reduce costs.

Background Sensorimotor exercises (SE) are evident to enhance neuromuscular activity of the trunk muscles (TM). However, it is unclear if an additional unexpected perturbation leads to higher muscular activity and therefore enhances training efficacy. Objective To analyse effects of additional unexpected perturbations on trunk neuromuscular activation pattern during SE. Design Cross-sectional design. Setting University Outpatient Clinic, Sports Medicine Centre. Participants Ten healthy, normal active participants (5 m/5 f; 29±2 yrs; 177±7 cm, 74±12 kg) were included. Assessment of Risk Factors All participants were prepared with a bilateral 12-lead trunk EMG (Mm. rectus abdominis (RA), external obliquus (EO), internal obliquus (IO), latissimus dorsi (LD), thoracic (UES) and lumbar erector spinae (LES)). Warm-up on an isokinetic dynamometer (extension/flexion; 30 rep; 60°sec) was followed by maximum voluntary isometric contraction measurements (MVC, 5 sec). Next, a (right-armed) side plank on stable surface (SP; 30 sec) and 2 different instable conditions were randomly assigned (SP plus pad under the elbow (SPP), SPP plus perturbation (SPP+P)). Main Outcome Measurements Root mean square (RMS) normalized to MVC (%MVC) was calculated during the whole exercise. Muscles were grouped to ventral right/left (VR;VL=mean of RA, IO, EO), and dorsal right/left (DR;DL=mean of LD, UES, LES). Differences between conditions were calculated for muscle groups, Ventral:Dorsal (V:D) and Side-Right/Side-Left ratio (SR;SL) (repeated-measures ANOVA; α=0.05). Results SPP+P showed highest EMG-RMS (e.g,VR: 81±9%; DR: 55±12%) for all muscle groups except DL with significant differences (p 0.05). Statistically significant higher V:D ratios was found in SPP+P compared to SP (p 0.05). Conclusions The use of additional perturbations during core stability training is superior to enhance trunk neuromuscular activity and should be implemented into sensorimotor exercises addressing the trunk.

Background Prevention programs are reducing the risk of injuries. The success of these programs is dependent on a high compliance. However, it is unclear which kind of supervision lead to a high compliance in young athletes. Objective To compare the influence of different kinds of prevention-supervision during prevention training on compliance in young athletes. Design Controlled trial. Setting University Potsdam, Medical Examination Center of the German Olympic Sports Federation. Patients (or Participants) 173 young athletes (m/f: 108/68; 13.4±0.4 yrs, 164.±58.6 cm, 52.3±9.0 kg) from different sports were included. Interventions (or Assessment of Risk Factors) Athletes participated in a back pain prevention program (duration: 45 weeks; 4 exercises, 3 times/week, progression every 15 weeks). Following the initial introduction to the program, athletes were divided into 3 groups (G1: N=30; G2: N=54; G3: N=89). In G1 the coach, in G2 the coach and the athlete was responsible to execute the prevention program. In addition to G2, a therapist supervised the program once per week in G3. The number of prevention sessions was documented (paper & pencil) by coach (G1), athlete (G2) and athlete/therapist (G3). Main Outcome Measurements The number of response per athlete (documented sessions) and the training-sessions per week was analysed. Data are presented descriptively followed by analysis of group differences (ANOVA; post-hoc Tukey, α =0.05). Results All athletes in G1 responded and documented the training-session/week with a frequency of 2.0±0.4 sessions/week. In G2 53 athletes (2.5±0.7 sessions/week) and in G3 75 athletes (2.7±0.8 sessions/week) responded. Statistically significant differences could be shown between G1 and G2 (p=0.0005) and between G1 and G3 (p=0.058). There were no group differences between G2 and G3 (p=0.15). Conclusions For a targeted high compliance in prevention training, a supervised implementation seems necessary. Good teamwork between coach, athlete and therapist seems to be mandatory. A personal responsibility of the athlete is relevant.

Background Back pain (BP) is already a relevant injury site in adolescent athletes. A valid screening is essential for BP prevention. Objective To investigate whether a biomechanical screening tool (BST) is suitable to predict BP in adolescent athletes. Design Longitudinal analysis with 1.9±1.0 yrs between both measurement days. Setting Medical center of the German Olympic Sports Federation. BST was implemented in the annual (pre-participation) examination of elite athletes. Patients (or Participants) 343 athletes (195 males/148 females, 13±1 yrs, 164±12 cm, 53±13 kg, 5±3 training years, 8±6 training hours per week) out of 20 sport disciplines were included in the study. Interventions (or Assessment of Risk Factors) Subjective BP was assessed using a faces-pain-scale (FPS 1–5: 1=no pain; 2–5=slight- to maximum pain). In addition, postural control (one-legged stance), jumping performance (counter movement/drop jump), and maximum isokinetic trunk extension/flexion strength (60°/sec) was assessed for all athletes. Main Outcome Measurements Athletes were classified into 4 groups with respect to the course of back pain [(A) no BP (n=206); (B) BP-developers (n=34); (C) persisting BP (n=71); (D) diminishing BP (n=32)]. Outcomes included center of pressure displacement COP [mm], jump height [cm], peak jumping force [N], contact time [ms] and peak torque for trunk extension/flexion [Nm]. Descriptive analysis was followed by two-way ANOVA (repeated measures; α=0.05). Results Overall, the athletes enhanced trunk strength, jump performance and postural control across the evaluation period. Pain free athletes (A) showed statistically significant higher trunk strength gains (extension/flexion: +45/+37%) compared to athletes developing BP (B: +20/+9%; p 0.05). Conclusions Analysing biomechanical variables is valid to identify significantly impaired trunk strength development in athletes with BP incidence. In contrast, jump performance and postural control are of minor relevance. Therefore, poor trunk strength development could serve as back pain risk factor in athletes. Trunk strength training interventions should be recommended.

Mueller, J, Mueller, S, Stoll, J, Baur, H, and Mayer, F. Trunk extensor and flexor strength capacity in healthy young elite athletes aged 11-15 years. J Strength Cond Res 28(5): 1328-1334, 2014-Differences in trunk strength capacity because of gender and sports are well documented in adults. In contrast, data concerning young athletes are sparse. The purpose of this study was to assess the maximum trunk strength of adolescent athletes and to investigate differences between genders and age groups. A total of 520 young athletes were recruited. Finally, 377 (n = 233/144 M/F; 13 +/- 1 years; 1.62 +/- 0.11 m height; 51 +/- 12 kg mass; training: 4.5 +/- 2.6 years; training sessions/week: 4.3 +/- 3.0; various sports) young athletes were included in the final data analysis. Furthermore, 5 age groups were differentiated (age groups: 11, 12, 13, 14, and 15 years; n = 90, 150, 42, 43, and 52, respectively). Maximum strength of trunk flexors (Flex) and extensors (Ext) was assessed in all subjects during isokinetic concentric measurements (60 degrees center dot s(-1); 5 repetitions; range of motion: 55 degrees). Maximum strength was characterized by absolute peak torque (Flex(abs), Ext(abs); N center dot m), peak torque normalized to body weight (Flex(norm), Ext(norm); N center dot m center dot kg(-1) BW), and Flex(abs)/Ext(abs) ratio (RKquot). Descriptive data analysis (mean +/- SD) was completed, followed by analysis of variance (alpha = 0.05; post hoc test [Tukey-Kramer]). Mean maximum strength for all athletes was 97 +/- 34 N center dot m in Flex(abs) and 140 +/- 50 N center dot m in Ext(abs) (Flex(norm) = 1.9 +/- 0.3 N center dot m center dot kg(-1) BW, Ext(norm) = 2.8 +/- 0.6 N center dot m center dot kg(-1) BW). Males showed statistically significant higher absolute and normalized values compared with females (p < 0.001). Flex(abs) and Ext(abs) rose with increasing age almost 2-fold for males and females (Flex(abs), Ext(abs): p < 0.001). Flex(norm) and Ext(norm) increased with age for males (p < 0.001), however, not for females (Flex(norm): p = 0.26; Ext(norm): p = 0.20). RKquot (mean +/- SD: 0.71 +/- 0.16) did not reveal any differences regarding age (p = 0.87) or gender (p = 0.43). In adolescent athletes, maximum trunk strength must be discussed in a gender- and age-specific context. The Flex(abs)/Ext(abs) ratio revealed extensor dominance, which seems to be independent of age and gender. The values assessed may serve as a basis to evaluate and discuss trunk strength in athletes.

The addition of etoposide to the CHOP protocol (CHOEP) has been shown to improve outcome particularly in younger patients ( Table #1 100 mg/m2 Etoposide i.v. 200 mg/m2 Etoposide p.o. C max [μg/ml] 16.7 (10.1 – 21.1) 13.4 (5.8 – 16.8) V ss [L] 14.4 (10.7 – 18.3) 15.1 (10.6 – 25.4) CL total [ml/min] 45.9 (29.6 – 62.8) 82.5 (45.5 – 151.0) CL renal [ml/min] 17.2 (9.4 – 52.6) 16.3 (4.7 – 39.7) t 1/2 [h] 4.1 (3.8 – 5.4) 5.8 (3.2 – 8.3) AUC [μg × h/ml] 72.5 (44.3 – 93.4) 81.6 (44.0 – 147.0)