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Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
Biomechanische Eigenschaften eines biomaterialbasierten Kreuzbandkonstruktes in-vivo und in-vitro
(2023)
Kreuzbandrupturen stellen nach wie vor eine Herausforderung in der klinischen Praxis hinsichtlich kurz- und langfristiger unerwünschter Nebenwirkungen dar (z.B. Reruptur und Arthrosebildung).
In der vorliegenden Arbeit wird der entwickelte Ansatz eines Kollagen-I-basierten künstlichen Kreuzbandkonstruktes hinsichtlich der Reißfestigkeit, Lagerung, Verstärkungsmöglichkeit mittels Fiber-tape und langfristigen Arthroseentstehung untersucht mittels in-vitro und in-vivo Untersuchungen unter zur Hilfe nahme des Minipig Tiermodels.
Die Ergebnisse zeigen keinen Einfluss der Lagerungstemperatur sowie des Lagerungszeitraums auf die Reißfestigkeit des Konstruktes, sowie eine mögliche initiale Verstärkung mittels Fibertape im Minipig. Darüber hinaus wurde mikroskopisch wie makroskopische Arthroseentstehung nachgewiesen. Das Ausmaß der Arthroseentstehung ist diesbezüglich mit einer Abweichung der Konstruktimplantation von der ursprünglichen Kreuzbandinsertion mittels MRT bestätigt worden.
The membrane-bound proton-pumping pyrophosphatase (V-PPase), together with the V-type H+-ATPase, generates the proton motive force that drives vacuolar membrane solute transport. Transgenic plants constitutively overexpressing V-PPases were shown to have improved salinity tolerance, but the relative impact of increasing PPi hydrolysis and proton-pumping functions has yet to be dissected.
For a better understanding of the molecular processes underlying V-PPase-dependent salt tolerance, we transiently overexpressed the pyrophosphate-driven proton pump (NbVHP) in Nicotiana benthamiana leaves and studied its functional properties in relation to salt treatment by primarily using patch-clamp, impalement electrodes and pH imaging.
NbVHP overexpression led to higher vacuolar proton currents and vacuolar acidification. After 3 d in salt-untreated conditions, V-PPase-overexpressing leaves showed a drop in photosynthetic capacity, plasma membrane depolarization and eventual leaf necrosis. Salt, however, rescued NbVHP-hyperactive cells from cell death. Furthermore, a salt-induced rise in V-PPase but not of V-ATPase pump currents was detected in nontransformed plants.
The results indicate that under normal growth conditions, plants need to regulate the V-PPase pump activity to avoid hyperactivity and its negative feedback on cell viability. Nonetheless, V-PPase proton pump function becomes increasingly important under salt stress for generating the pH gradient necessary for vacuolar proton-coupled Na+ sequestration.