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Volatile organic compounds (VOCs) reflect the metabolism in healthy and pathological conditions, and can be collected easily in a noninvasive manner. They are directly measured using electronical nose (eNose), and may qualify as a systemic tool to monitor biomarkers related to disease. Myeloid leukemic blasts can be transformed into leukemia-derived dendritic cells (DCleu) able to improve (anti-leukemic) immune responses. To profile immunological changes in healthy and acute myeloid leukemic (AML) patients’ ex vivo cell cultures, we correlated the cell biological data with the profiles of cell culture supernatant-derived VOCs. DC/DCleu from leukemic or healthy whole blood (WB) were generated without (Control) or with immunomodulatory Kit M (Granulocyte macrophage-colony-stimulating-factor (GM-CSF) + prostaglandin E1 (PGE1)) in dendritic cell cultures (DC culture). Kit-pretreated/not pretreated WB was used to stimulate T cell-enriched immunoreactive cells in mixed lymphocyte cultures (MLC culture). Leukemia-specific adaptive and innate immune cells were detected with a degranulation assay (Deg) and an intracellular cytokine assay (InCyt). Anti-leukemic cytotoxicity was explored with a cytotoxicity fluorolysis assay (CTX). VOCs collected from serum or DC- and MLC culture supernatants (with vs. without Kit M pretreatment and before vs. after culture) were measured using eNose. Compared to the Control (without treatment), Kit M-pretreated leukemic and healthy WB gave rise to higher frequencies of mature (leukemia-derived) DC subtypes of activated and (memory) T cells after MLC. Moreover, antigen (leukemia)-specific cells of several lines (innate and adaptive immunity cells) were induced, giving rise to blast-lysing cells. The eNose could significantly distinguish between healthy and leukemic patients’ serum, DC and MLC culture supernatant-derived volatile phases and could significantly separate several supernatant (with vs. without Kit M treatment, cultured vs. uncultured)-derived VOCs within subgroups (healthy DC or leukemic DC, or healthy MLC or leukemic MLC supernatants). Interestingly, the eNose could indicate a Kit M- and culture-associated effect. The eNose may be a prospective option for the deduction of a VOC-based profiling strategy using serum or cell culture supernatants and could be a useful diagnostic tool to recognize or qualify AML disease.

BackgroundEvidence suggests that patients with COPD struggle to maintain improved physical activity (PA) after completing pulmonary rehabilitation (PR). Smartphone applications (apps) providing a comprehensive training programme have conferred healthy benefits. This study was conducted to determine whether regular usage of an app maintains PA following PR.MethodsPatients with stage II–IV COPD were enrolled in a 6-month trial following PR. After the screening period, participants were randomised into the Kaia COPD app group (intervention group (IG)) or the control group (CG). The primary outcome was PA (daily steps), measured using an activity tracker. Secondary outcomes included the COPD Assessment Test (CAT), the Chronic Respiratory Disease Questionnaire (CRQ) and the 1 min Sit-to-Stand Test (STST).ResultsSixty participants completed the study. The median steps from baseline to 6 months were significantly different between the groups, in favour of the IG (−105.3, IQR −1970.1 to 2105.8, vs CG −1173.0, IQR −3813.1 to –93.8; p=0.007). CAT was significantly decreased in the IG (15.1±8.6 vs 19.7±6.4, p=0.02), whereas the CRQ subdomains for dyspnoea (4.5±1.7 vs 3.7±1.3, p=0.033) and fatigue (4.5±1.4 vs 3.5±1.3, p=0.028) improved significantly in the IG. The STST at 6 months was not significant. Sleep duration and sleep efficiency showed no significant differences between the two groups at any time.ConclusionsA comprehensive program by using the Kaia app following PR maintained PA and improved symptoms in patients with COPD at 6 months. The app might be an important accessory tool for enhanced COPD care.Trial registration numberDRKS00017275.

Tobias Boeselt,1 Johannes Kroenig,1 Theresa-Sophie Lueders,1 Niklas Koehler,2 Bjoern Beutel,1 Olaf Hildebrandt,1 Ulrich Koehler,1 Regina Conradt1 1Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Philipps-University Marburg, Marburg, Germany; 2Thora Tech GmbH, Clinical Research Department, Gießen, GermanyCorrespondence: Tobias Boeselt, Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Philipps-University Marburg, Baldingerstrasse 1, Marburg, 35033, Germany, Email tobias.boeselt@uni-marburg.deIntroduction: In clinical practice, wheezing and coughing represent a worsening of the respiratory situation of COPD patients and should be monitored long-term during and after an Acute Exacerbation of COPD (AECOPD) to observe the therapy. We investigated if overnight monitoring of wheezing and coughing is feasible during AECOPD and whether automatic long - term monitoring enables an objective assessment during and after an AECOPD.Methods: In 14 patients (age: 56– 80 years) with pre-existing COPD (stages B-D) nighttime wheezing and coughing events were monitored for a period of three weeks. The portable LEOSound® monitor recorded three nights into AECOPD (nights 1, 3 and 6) during the hospital stay, and the 20th night post- AECOPD ambulatory. Before each recording the subjective symptom severity was assessed by a COPD Assessment Test (CAT) and a Modified British Medical Research Council (MMRC) dyspnoea index questionnaire.Results: In all 14 patients, lung sounds were recorded in good quality during each of the 4 recording nights. Wheezing ranged between 5% and 90% (79 − 539.5 minutes) of the recording time on the first night. All patients showed some coughs, in four patients coughing was particularly pronounced and largely receding over the total investigation period. As group, the percentages of wheezing and the number of coughs did not show significant differences between the four recording times. The CAT scores (p< 0.001) declined over the course of investigation period, suggesting a subjective improvement of symptoms.Conclusion: The observational study showed that standardized long-term recording can be performed in high-quality during acute COPD exacerbation as it does not require the patient’s cooperation. The good-quality data of coughs and wheezing were analyzed qualitatively and quantitatively. The long-term presentation of respiratory symptoms during an AECOPD offers the opportunity to evaluate factors that influence exacerbations and therapeutic approaches.Keywords: COPD, wheezing, cough, long term monitoring of respiratory sounds, CAT, exacerbation

Zusammenfassung. Die pneumologische Rehabilitation (PR) ist ein wirksames Verfahren der nicht-medikamentösen Therapie bei chronischen Erkrankungen der Lunge und der Atemwege. Die meisten validen Daten gibt es zur COPD. Allerdings ist der Effekt der PR nach sechs bis zwölf Monaten nicht mehr nachweisbar, es sei denn der Patient nimmt im Anschluss an eine PR an einem Erhaltungsprogramm teil. Wie ein solches Erhaltungsprogramm in Bezug auf Ort, Länge, Intensität und Inhalte aussehen soll, ist Gegenstand aktueller Forschung. Deshalb sind konkrete Empfehlungen noch nicht verfügbar und weitere Studienresultate bleiben abzuwarten. In dieser Arbeit soll ein Überblick über die vorhandenen Ergebnisse gegeben werden.

Zusammenfassung Hintergrund Pulmonale Hypertonie (PH) ist definiert als ein Anstieg des mittleren pulmonal-arteriellen Drucks auf > 20 mmHg in Ruhe, der auf Dauer zu einer Rechtsherzinsuffizienz führen kann. Bis vor einigen Jahren wurde PH-Patienten wegen der Befürchtung einer möglichen Symptomverschlechterung und dem Auftreten unerwünschter, belastungsassoziierter klinischer Ereignisse von körperlichem Training abgeraten. Methoden Drei elektronische Datenbanken wurden mit folgenden Suchbegriffen nach randomisiert, kontrollierten Studien durchsucht, in denen eine Trainingsintervention bei PH-Patienten untersucht wurde: „pulmonary hypertension ODER „pulmonary arterial hypertension“ UND „exercise“ ODER „pulmonary rehabilitation“ UND „randomized“. Ergebnisse In dieser Metaanalyse konnten Daten von 5 Studien mit insgesamt 187 PH-Patienten eingeschlossen werden, welche 3- bis 12-wöchige Trainingsprogramme (z. B. 10 – 45 Minuten Ergometertraining; 60 – 80 % der maximalen Herzfrequenz) absolvierten. Patienten in den Trainingsgruppen wiesen im Vergleich zur Kontrollgruppe signifikante (p Schlussfolgerung Ein individuell angepasstes Trainingsprogramm bei stabilen PH-Patienten kann nach zuvor optimierter medikamentöser Therapie die körperliche Belastbarkeit und Lebensqualität ohne nachweisbare klinische Gefährdung verbessern. Diese Einschätzungen basieren bisher nur auf kleinen Fallzahlen und größere, randomisierte Studien mit unterschiedlichen PH-Schweregraden sind dringend notwendig.

Background: Monitoring for physical activity becomes popular and actually many devices are available. Some physical activity monitors (PAMs) provide data about sleep quality for the user, but there are scarce data concerning validity and usability of these measurements. This study compared the data of sleep parameters generated by a PAM with the polysomnography (PSG). Methods: In 2016, data of 26 patients in two consecutive PSGs as well as in two daytime and nighttime measurements with a PAM according to physical activity and sleep quality were collected. Furthermore, sleep quality, using the Pittsburgh sleep quality index (PSQI), daytime fatigue, using the multidimensional fatigue inventory (MFI-20) and additionally data of a sleep diary were collected. Results: There were positive correlations of both methods with respect to total sleep time (TST) (r = 0.76, P < 0.01) and sleep efficiency (r = 0.71, P < 0.01). Data analysis over two nights showed that over 90% of the TST (95% confidence interval (CI) -1.59 to 0.82) and of the sleep efficiency (95% CI -8.28 to 15.51) were within the limits of agreement. The analysis of the PSQI and the sleep efficiency of the PAM showed no significant correlations. The daytime fatigue correlated negatively with the physical activity (r = -0.72, P < 0.01). Conclusion: The sleep efficiency and TST measured with the PAM sufficiently reflect the PSG sleep parameters and the subjects’ subjective feelings. At the same time, PAM results are also correlated with the subjectively perceived quality of sleep. Further investigations to assess the long-term results are pending. J Clin Med Res. 2019;11(12):825-833 doi: https://doi.org/10.14740/jocmr4026

Background: Post-stroke dysphagia leads to increased risk of aspiration and subsequent higher risk of pneumonia. It is important to not only diagnose post-stroke dysphagia early but also to evaluate the protective mechanism that counteracts aspiration, i.e., primarily cough. The aim of this study was to investigate the predictive value of cough frequency in addition to aspiration risk for pneumonia outcome. Methods: This was a single-center prospective observational study. Patients with first-ever strokes underwent clinical swallowing evaluation, fibreoptic endoscopic evaluation of swallowing (FEES), and overnight cough recording using LEOSound® (Löwenstein Medical GmbH & Co. KG, Bad Ems, Germany ). Penetration–Aspiration Scale (PAS) ratings and cough frequency measurements were correlated with incidence of pneumonia at discharge. Results: 11 women (37%) and 19 men (63%), mean age 70.3 years (SD ± 10.6), with ischemic stroke and dysphagia were enrolled. Correlation analysis showed statistically significant relationships between pneumonia and PAS (r = 0.521; p < 0.05), hourly cough frequency (r = 0,441; p < 0.05), and categories of cough severity (r = 0.428 p < 0.05), respectively. Logistic regression showed significant predictive effects of PAS (b = 0.687; p = 0.014) and cough frequency (b = 0.239; p = 0.041) for pneumonia outcome. Conclusion: Cough frequency in addition to aspiration risk was an independent predictor of pneumonia in dysphagic stroke survivors.

Background Increasing physical activity (PA) is considered to be an important factor for the efficient management of chronic obstructive pulmonary disease (COPD). Successful methods required to achieve improvements in PA following pulmonary rehabilitation (PR), however, are rarely reported. Therefore, we will conduct this trial to evaluate the effectiveness of using a COPD management program delivered to the patient via the KAIA COPD app, a mobile medical application, after the completion of PR. Methods This is the protocol for a randomized, controlled, open-label, multicentered trial that will be carried out at inpatient PR hospital centers in Germany and Switzerland. The interventions will involve the use of the KAIA COPD app program (Arm 1) or an active comparator, i.e., usual care (Arm 2). Patients completing an in-hospital PR program and consenting to participate in the study will be screened with the inclusion and exclusion criteria and enrolled in the study. After fulfilling the screening requirements, the patients will be randomized into one of the two arms with parallel group assignment in a 1:1 ratio. The training program will be delivered to the participants grouped in Arm 1 via the KAIA COPD app and to participants grouped in Arm 2 via the regular recommendations or standard of care by the PI. In total, 104 participants will be included in the trial. The treatment period will last for 24 weeks. Electronic versions of questionnaires will be used to collect patient-reported assessments remotely. The primary outcome measure is the change in physical activity of the intervention group in comparison to the control group, measured over 1 week as the mean steps per day with a Polar A 370 activity tracker, from baseline (end of PR) to the 6-month follow-up. The secondary outcome measures are functional exercise capacity, health status, sleep quality, exacerbation rate, and depression and anxiety symptoms assessed at several intervals. Discussion This study seeks to prove the effects of the KAIA COPD mobile application in COPD patients after PR. The app offers educational, exercise training plus activity monitoring and motivational programs that can be easily implemented in the patient’s home setting, enabling patients to maintain the effects that are typically elicited in the short term after pulmonary rehabilitation for the long term. Trial registration German Clinical Trials Register (DRKS00017275). Protocol version 2.0 dated 3 June 2019.

Background: Numerous studies have reported positive effects of exercise training in patients with interstitial lung disease (ILD) on physical capacity and quality of life. However, evidence is rare on the effects of specific forms of training and further pathophysiological mechanisms in these patients. Objectives: In this multicenter study we aimed to explore the clinical effects of whole-body vibration training (WBVT) in patients with ILD on various outcome measures, including proinflammatory cytokines and myostatin. Methods: We randomly assigned 26 patients with different forms of multidisciplinary confirmed fibrotic ILDs either to the WBVT group (n = 11; 55% male, 61 ± 14 years old, forced vital capacity 83.2 ± 29.3% predicted, 6-min walking distance [6MWD] 478 ± 79 m) performing 3 months of a standardized training (3 times per week), or to a control training group (CTG, n = 15; 60% male, 63 ± 9 years old, FVC 74.6 ± 20.5% predicted, 6MWD 455 ± 85 m) performing sham WBV training. Training in the two groups was performed on a GalileoTM vibration plate (6–20 vs. 5 Hz). The functional assessments before and after the intervention period included pulmonary function, 6MWD test, chair rise test, ultrasonographic measurement of quadriceps muscle thickness (cross-sectional area), quality of life questionnaires, and serum samples. Results: We observed a significant increase in 6MWD (∆Training = 30 m [12–67], p = 0.024) and a decrease of myostatin (∆Training = –465 pg/mL [–713 to –166], p = 0.008) in the WBVT group. In contrast, no significant differences were observed in the CTG. Conclusions: The present study demonstrates that WBVT is able to significantly increase 6MWD and decrease myostatin in patients with fibrotic ILDs. Therefore, WBVT seems to be a beneficial and feasible training modality in ILD patients. Clinical Trial Registry: German Clinical Trials Registry (DRKS00012930).

Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients

ZusammenfassungEntsprechend der GINA-Kriterien ist es Ziel des Asthma-Managements, eine optimale Symptomkontrolle zu erreichen und die Risiken für Exazerbationen, Verschlechterungen der Lungenfunktion, Langzeitfolgen und Nebenwirkungen der Therapie zu minimieren. Studien wie REALISE und AIRE geben uns Informationen dahingehend, ob und wie sich innerhalb von annähernd 15 Jahren Verbesserungen bei der Versorgung von Patienten mit Asthma bronchiale eingestellt haben. Obwohl es sehr wirksame Medikamente zur Behandlung des Asthma bronchiale gibt, sind die Ergebnisse der Asthmakontrolle weiterhin unbefriedigend. Bei deutlich mehr als 50 % der Patienten muss das Asthma als nicht bzw. schlecht kontrolliert angesehen werden. Eine schlechte Therapieadhärenz, die Angst vor systemischen Effekten der inhalativen Kortisontherapie, die vermehrte Inanspruchnahme der Bedarfstherapie, eine nicht ausreichende Schulung und Aufklärung der Patienten sind dafür verantwortlich. Es besteht eine Notwendigkeit zur Intensivierung der Schulungsmaßnahmen und verbesserten Patientenüberwachung.

Zusammenfassung Ziel der Studie Einen Eckpfeiler der pneumologischen Rehabilitation (PR) von Patienten mit einer chronisch obstruktiven Lungenerkrankung (COPD) stellt das körperliche Training dar. Die Komponenten eines erfolgreichen Trainings sind aber noch nicht abschließend untersucht. Es wurde eine randomisierte kontrollierte Studie durchgeführt, um die Effektivität eines sensomotorischen Trainings (SMT) im Vergleich zu einem konventionellen Krafttraining (KT) auf den Zugewinn an Leistungsfähigkeit zu untersuchen. Patienten und Methoden 43 COPD-Patienten wurden randomisiert und trainierten entweder in der Interventionsgruppe (SMT = 30 Minuten SMT pro Tag) oder in der Kontrollgruppe (KT = 30 Minuten KT pro Tag). Das SMT wurde als Zirkeltraining mit 5 Stationen durchgeführt. Der primäre Endpunkt war die Differenz zwischen T1 (Beginn der PR) und T2 (Ende der PR) im 5-Times Sit-to-Stand-Test (5-STST) im Intergruppenvergleich. Sekundäre Endpunkte waren die Intra- und Intergruppenvergleiche zu T1 und T2 im 6-Minuten-Gehtest (6-MWT), COPD-Assessmenttest (CAT), St. George Respiratory Questionnaire (SGRQ), Hospital-Anxiety-and-Depression Scale (HADS) und der Lungenfunktion. Ergebnisse Im 5-STST zeigt sich zwischen den Gruppen kein signifikanter Unterschied. Ebenso im 6-MWT, SGRQ, CAT, HADS und in der Lungenfunktion. Im Intragruppenvergleich zwischen T1 und T2 zeigten sich in beiden Gruppen signifikante Unterschiede im 5-STST, 6-MWT, SGRQ, CAT und HADS. Die Unterschiede in der Lungenfunktion waren weder im Inter- noch im Intragruppenvergleich signifikant. Schlussfolgerung Die Verbesserungen der körperlichen Leistungsfähigkeit bei COPD-Patienten im Rahmen einer PR sind mit einem SMT ebenso gut erreichbar wie mit einem konventionellen Krafttraining. Weitere Studien sind erforderlich, um den Stellenwert des SMT im Hinblick auf die posturale Kontrolle zu definieren.

Ziel der Studie Die akute Exazerbation einer COPD (AECOPD) stellt fur die Patienten ein erhebliches Risiko dar und ist fur die Prognose mitentscheidend. Bisherige Ergebnisse uber die Auswirkungen einer pneumologischen Rehabilitation (PR) auf die Exazerbationsfrequenz nach AECOPD sind uneinheitlich. Es wurde eine prospektive, fallkontrollierte Studie mit dem Ziel durchgefuhrt, den Einfluss der PR auf die Exazerbationsfrequenz nach AECOPD zu messen. Patienten und Methoden Eine PR wurde bei 57 COPD-Patienten nach AECOPD durchgefuhrt. Davon konnten 30 nach einem Jahr nachuntersucht werden und wurden mit 32 Kontrollpatienten (KG = hospitalisiert wegen AECOPD ohne PR) verglichen. Die Anzahl der Exazerbationen wurde innerhalb der Gruppen und zwischen den Gruppen analysiert. Registrierung: DRKS Nr. 00 006 847. Ergebnisse Im Intragruppenvergleich war die Exazerbationsrate in der PR-Gruppe im Jahr nach der Rehabilitation signifikant niedriger (0,97 ± 1,52 vs. 2,67±1,12; p Schlussfolgerung Es konnte gezeigt werden, dass durch die PR im Untersuchungszeitraum von einem Jahr die Exazerabationsrate nach AECOPD im Vergleich pra/post und im Intergruppenvergleich zur KG-Gruppe signifikant gesenkt werden konnte. Weitere prospektive Studien, die den Stellenwert der PR nach AECOPD untersuchen, sind erforderlich.

Background: The aim of the study was to investigate whether whole-body vibration training (WBVT) can be applied beneficially within an outpatient low frequency exercise program. Methods: In a prospective, controlled, randomized study, WBVT effectiveness and safety were investigated in COPD stage II-IV patients undergoing a 3-month training program. Participants took part in a 90-min circuit training once a week. On top patients were randomized to either perform squats with WBVT, or without (conventional training group (CTG)). Before and after the intervention, a sit-to-stand test (STST), a 6-min walk test (6-MWT), the COPD assessment test (CAT), and the chronic respiratory disease questionnaire (CRQ) were evaluated. Results: Twenty-eight out of 55 patients completed the study (n = 12 WBTV, n = 16 CTG). The STST time remained nearly constant for the CTG (Δ -0.8 ± 3.1 s) and the WBVT (Δ 1.4 ± 3.2 s; P = 0.227), respectively. Similarly, for both WBVT and CTG, the 6-min walk distance remained unchanged (Δ 7 ± 55 m vs. 9 ± 45 m, P = 0.961). In three out of four categories, the CRQ scores showed a significant improvement within WBVT, and in one category when comparing across groups. The CAT score dropped by -0.8 ± 2.9 points within CTG and by 2.4 ± 2.7 points within WBVT (P = 0.105). There were no adverse events related to WBVT. Conclusion: The implementation of WBVT in the context of an outpatient low frequency exercise program did not significantly improve the patients’ exercise capacity. An improvement in CAT and partially in CRQ was shown within WBVT. However, regarding the high dropout rate (49%), these results must be interpreted with caution. J Clin Med Res. 2017;9(5):396-402 doi: https://doi.org/10.14740/jocmr2763w

Background: Various exercise training programs are used for patients with chronic obstructive pulmonary disease (COPD) of different severity. Objectives: To investigate the impact of individualized high-intensity training on exercise capacity with COPD. Methods: A total of 49 patients agreed to participate. Of these, 31 were assigned to the training group and 18 served as controls. The training group exercised twice a week for 90 min with consecutively increasing loads. At the time of enrollment (T0), as well as after 3 (T1) and 6 (T2) months, a 6-min walk test (6-MWT) was performed and data on health-related quality of life, femoral muscle thickness, and various serum markers were obtained. Results: The training group improved in their 6-MWT results (T0 = 407 ± 152 m vs. T1 = 459 ± 127 m, p = 0.002, vs. T2 = 483.2 ± 130.1 m, p = 0.004), in their cross-sectional area of the musculus rectus femoris (T0 = 6.2 ± 1.2 cm2 vs. T1 = 6.9 ± 1.2 cm2, p = 0.003, vs. 7.5 ± 1.6 cm2, p = 0.002), and in their St. George's Respiratory Questionnaire (SGRQ) score (T0 = 43.3 ± 18.0 vs. T1 = 36.0 ± 18.4, p = 0.001, vs. T2 = 34.7 ± 18. 0, p = 0.004). Serum levels of myostatin, irisin, resistin, and α-Klotho did not change significantly within the training period. Of note, the exercise group showed an inverse relationship between serum levels of resistin and those of α-Klotho after 6 months (r = -0.608, p = 0.021). Conclusions: COPD patients undergoing an individualized, structured, high-intensity training program improved their exercise capacity, gained muscle mass, and improved their quality of life.

The objective of this study was to investigate the benefits of a low-volume out-patient whole-body vibration training (WBVT) program on exercise capacity in comparison with a calisthenics training program in subjects with COPD.In this single-center randomized controlled trial, 29 subjects with mild to severe COPD were randomized to WBVT or to calisthenics training, including relaxation and breathing retraining in combination with calisthenics exercises. Both groups equally exercised for a duration of 3 months with 2 sessions of 30 min/week. Outcome parameters were 6-min walk distance (6MWD, primary outcome), 5-repetition sit-to-stand test, leg press peak force, Berg balance scale, St George Respiratory Questionnaire, and COPD assessment test.Twenty-seven subjects completed the study (WBVT, n = 14; calisthenics training program, n = 13). Baseline characteristics between groups were comparable. Subjects in the WBVT group significantly improved median (interquartile range) 6MWD (+105 [45.5-133.5] m, P = .001), sit-to-stand test (-2.3 [-3.1 to -1.3] s, P = .001), peak force (28.7 [16.7-33.3] kg, P = .001), and Berg balance scale (1.5 [0.0-4.0] points, P = .055). Changes in 6MWD, sit-to-stand test, and leg press peak force were also found to be significantly different between groups in favor of the WBVT group. Only the between-group difference of the COPD assessment test score was in favor of the calisthenics training group (P = .02).A low-volume WBVT program resulted in significantly and clinically relevant larger improvements in exercise capacity compared with calisthenics exercises in subjects with mild to severe COPD. (ClinicalTrials.gov registration DRKS9706.).

Background: Admission to the intensive care unit is associated with sustained loss of muscle mass, reduced quality of life and increased mortality. Early rehabilitation measures may counteract this process. New approaches to rehabilitation while the patient remains in bed are whole-body vibration alone and whole-body vibration with a dumbbell. The aims of this study are to determine the safety of whole-body vibration for patients admitted to the intensive care unit, and to compare the effects of these techniques in intensive care unit patients and healthy subjects. Methods: Twelve intensive care unit patients and 12 healthy subjects using whole-body vibration for the first time were examined while lying in bed. First both groups performed whole body vibration over 3 min. In a second step whole body vibration with dumbbell was performed. In order to determine the safety of the training intensity, heart rate, oxygen saturation and blood pressure were measured. The study was approved by the Marburg ethics committee. Results: There were minor reversible and transient increases in diastolic blood pressure (p = 0.005) and heart rate (p = 0.001) in the control group with whole-body vibration with a dumbbell. In intensive care patients receiving wholebody vibration alone, there were increases in diastolic blood pressure (p = 0.011) and heart rate (p < 0.001). Conclusion: This study demonstrates the feasibility of using whole-body vibration and whole-body vibration with a dumbbell for intensive care unit in-bed patients. No clinically significant safety problems were found. Whole-body vibration and whole-body vibration with a dumbbell might therefore be alternative methods for use in early in-bed rehabilitation, not only for hospitalized patients.

BACKGROUND/AIM Cystoscopy, the standard diagnostic for bladder tumors, is uncomfortable, invasive, and expensive. The available urine-based marker systems all lack accuracy. Measuring volatile organic compounds (VOCs) from urine is a promising alternative. This pilot study evaluates the feasibility of discriminating bladder cancer patients' urine from healthy controls with an electronic nose. MATERIALS AND METHODS Headspace measurements of urine samples of 30 patients with confirmed transitional cell carcinoma (TCC) and 30 healthy controls were performed with Cyranose 320 calculating Mahalanobis distance and linear discriminant analysis. Histology reports following TUR-BT were correlated with urine findings. RESULTS After storage at -20°C, Cyranose correctly detected 28/30 already confirmed TCC samples and 26/30 healthy controls (p

Purpose Purpose of this study was to analyze the impact of a pulmonary rehabilitation (PR) program on the measured inspiratory capacity (IC) in patients with chronic obstructive pulmonary disease (COPD) while performing a 6-min walk test (6MWT). Methods Before and after PR, IC was measured by spirometry both at the beginning and at the end of the 6MWT for 15 patients with COPD in the PR group (PRG) and compared with a similar calisthenics training group (CTG; n = 15). In addition, the COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ), and other lung function tests were recorded and compared. Results Both groups were not significantly different at baseline. Compared with the CTG, the PRG achieved a significant increase in the delta of IC measured during the 6MWT (0.5 ± 0.2 L [PRG] vs -0.2 + 0.2 L [CTG], P = .001). Significant differences were found for the 6MWT walking distance (PRG: 99 ± 36 m vs CTG: 5 ± 25 m, P = .001). No significant increase in dyspnea while performing the 6MWT was found in either group. The differences in the CAT score and the SGRQ Global score were significant only for the PRG in intragroup comparisons, whereas the intergroup comparison showed no significant differences. Except for residual volume, no significant changes in all parameters of the static lung function tests were observed in either group. Conclusion Participation in a PR may lead to a significant and clinically relevant increase in IC and the walking distance. Additional research is necessary to define the effects of this increase in IC on exercise capacity.

This review article discusses various forms of sleep disorders associated with musculoskeletal diseases (MD). It presents the pathophysiology and interaction of sleep-related disorders and MD and summarizes clinical symptoms and therapies from a somnological perspective. BACKGROUND: A large number of patients suffering from MD report fragmented sleep with poor overall sleep quality. Sleep disorders often lead to increased symptoms such as daytime fatigue, depression, or increased pain intensity. In contrast, the perception of pain worsens the quality of sleep. Sleep is a complex regulation of hormonal and neuromodulatory influences to maintain regenerative processes and signal processing. Furthermore, interleukins (e.g., IL-6 and TNFα), messenger substances, or inflammatory markers (e.g., CRP) may have a regulatory influence on sleep. THERAPY: Sleep disorders in MD can often be treated with behavioral therapies or drug approaches. Another and very important influence is physical activity. In combination with training, regular physical activity can lead, for instance, to improved sleep quality, endurance performance, and reduced inflammation values. The change of lifestyle with regard to activity and nutrition is another key concept in the optimal therapy of patients with MD.

Introduction: Abstention from exercise results in reduced mobility, loss of cardiopulmonary capacity and social isolation . Aims and objectives: WBVT has been proven as a safe training method which produces benefits regarding exercise capacity, dyspnoea and health-related quality of life (Greulich, T., et al. BMC Pulm Med, 2014. 14: p. 60). We aimed to evaluate whether WBVT has an impact on lung function, physical capacity and diaphragmatic movement and strength. Methods: Between May and Dec 2015 , 22 stable patients I-IV (FEV1 (SG) 51.9 ± 22% (TG) 57.1 ± 20.8%) were randomized (1:1) to receive sham (SG) training at 5 Hz or WBVT (TG) (starting with 14Hz up to 28 Hz). Physical endurance (6 Minute Walk Test, Chair Rising Test), lung function and diaphragmatic parameters (P0.1, PImax, diaphragm ultrasound), quality of life (SF-12, PHQ-9) and symptoms (SGRQ, CAT, mMRC) were measured at the time of enrolment (T 0 ), after completing the training period (T 1 ) and 6 weeks after having completed the training (T 2 ). Results: Our preliminary data analysis showed an improvement (1.68 ± 2.34mm; p 0 : 6.3 ± 1.8; T 1 : 7.6 ± 1.3; T 2 : 5.5 ± 1.3mm/SG= T 0 : 5.1 ± 0.8; T 1 : 6.15 ± 1.9; T 2 : 6.1 ± 2.6mm). 6 weeks later, a decrease of thickness was found (-1.9 ± 2.2mm; p Conclusion: The first results after TG-WBVT showed promising effects in diaphragm muscle increase. No change in diaphragm strength was found which might be due to the short training episode. Further recruitment up to 40 patients will be done.

BACKGROUND The analysis of obstructive sleep apnoea syndrome (OSAS) is time- and cost-intensive. A number of studies demonstrated that the non-invasive analysis of exhaled breath (EB) may be suitable to distinguish between OSAS patients and healthy subjects (HS). Methods/Population: We included OSAS patients (n = 15) and HS (n = 15) in this diagnostic proof-of-concept-study. All participants underwent polygraphy to verify or exclude OSAS and performed spirometry to exclude pulmonary ventilatory diseases. The volatile organic compound profile of EB and of the headspaces over EB condensate, pharyngeal washing fluid, and serum was measured using ion mobility spectrometry (IMS) (BioScout®) and an e-nose (Cyranose® 320). For the statistical analysis, we fitted classification tree models using recursive partitioning, followed by a leave-one-out cross-validation. For the cross-validated predictions we calculated descriptive classification statistics, p-values from a [Formula: see text]-test with continuity correction, as well as ROC curves. RESULTS Using IMS, OSAS patients and HS could be distinguished with high accuracy (values ranged from 79% to 97%). The results of the e-nose-derived analyses (with the exception of EB) were less accurate. However, the cross-validated accuracy for EB was very good (0.9), reflecting a positive predictive value of 100% and a negative predictive value of 83%. For each material, we identified the best five substances that may be used for diagnostic purposes. 2-Methylfluran was found in three different biological materials to be discriminative between OSAS and HS. CONCLUSION The results strengthen the hypothesis that substances detectable in headspace measurements of different airway and blood materials may undergo a transition from blood into the alveoli (and EB) or vice versa. This means that substances from different compartments could be used to distinguish patients with airway diseases (in this case OSAS) from healthy controls.

*both authors contributed equally Einleitung: Aspergilluspneumonien stellen eine wesentliche Todesursache von Patienten mit neutropenem Fieber dar. Die zum Beweis notwendige histologische Sicherung kann oft auf Grund der Kompromittierung nicht erfolgen, sodass sich die Diagnose meist auf die bildgebende CT Diagnostik und serologische Marker wie Galactomannan stutzen muss. Oft werden neutropene Patienten unter breiter antibiotischer Therapie mit persistierendem Fieber rein empirisch antimykotisch therapiert. Es war das Ziel dieser Studie, eine nicht-invasive Methodik im Atemwegskondensat neutropener Patienten zu testen, welche PCR und Galactomannan Elisa-Nachweis von Aspergillus fumigatus erganzt. Methoden: Es wurden 33 neutropene Patienten mit persistierendem Fieber unter antibiotischer Therapie eingeschlossen. Bei allen Patienten wurde Serum, EDTA-Blut, Sputum und Atemwegskondensat (EBC) gewonnen. Die EBC-Gewinnung erfolgte mittels ECco-Screen. Fur den DNA-Nachweis des Aspergillus wurde eine nested PCR durchgefuhrt. Der Antigen-Nachweis erfolgte mittels Platelia Aspergillus Galactomannan ELISA (Biorad- Laboratories) aus Sputum und Serum. Ergebnisse: Insgesamt wurden Serum- und Sputumproben von 27 Patienten mittels ELISA analysiert. Eine nested PCR erfolgte bislang bei 9 Sputumproben. Bei 3 Patienten erfolgte die PCR aus EBC und EDTA-Blut. Hierbei war eine der EBC Proben positiv bei gleichzeitig positiver Sputumprobe und negativer PCR im Blut. Diskussion/Ausblick: Zum ersten Mal wurde im EBC mittels PCR Aspergillus nachgewiesen. Im Elisa konnte gezeigt werden, dass positive Sputumproben mit der Klinik der Patienten korrelieren, auch wenn der Erreger noch nicht in die Blutbahn ubergetreten ist. Dieser Test stellt damit eine vielversprechende Moglichkeit dar, fruhzeitig neutropene Patienten zu screenen. Zu beachten sind Kreuzreaktivitat des Antigennachweis unter Ascomyzeten sowie die Moglichkeit falsch positiver Ergebnisse unter Piperazillin/Tazobac im ELISA.

PLoS one 10(7), e0132227 (2015). doi:10.1371/journal.pone.0132227, Published by PLoS, Lawrence, Kan.

Purpose:To analyze time-domain, spectral, and fractal properties of speed regulation during half-marathon racing.Methods:In 21 male experienced runners, high-resolution data on speed (V), stride frequency (SF), and stride length (SL) were assessed during half-marathon competition (21,098 m). Performance times, timeand frequency-domain variability, spectral-scaling exponent (beta), and fractal dimension (FD) of V, SF, and SL were analyzed.Results:V of 3.65 ± 0.41 m/s, SF of 1.41 ± 0.05 Hz, and SL of 2.58 ± 0.25 m occurred with higher (P < .05) individual variability in V and SL than in SF. Beta and FD were always 1.04–1.88 and 1.56–1.99, respectively. Beta and FD differed (P < .05) in SF and SL compared with V and were correlated in V and SL (r = .91, P < .05). Spectral peaks of V, SF, and SL occurred at wavelengths of 3–35 min, and those of V and SL were interrelated (r = .56, P < .05). Mean SF and mean SL were significantly correlated with performance (r = .59 and r = .95, P < .05). SL accounted for 84% ± 6% and SF for 16% ± 6% of speed variability.Conclusions:The observed nonrandom fluctuations in V, SF, and SL correspond to nonstationary fractional Brownian motion with inherent long-range correlations. This indicates a similar complex regulation process in experienced runners that is primarily mediated via SL.