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Gerhardt F, Dumitrescu D, Gärtner C, Beccard R, Viethen T, Kramer T, Baldus S, Hellmich M, Schönau E, Rosenkranz S. Oscillatory whole-body vibration improves exercise capacity and physical performance in pulmonary arterial hypertension: a randomised clinical study. Heart 2017; 103:592-598. [PMID: 28100544 PMCID: PMC5529961 DOI: 10.1136/heartjnl-2016-309852] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 01/11/2023] Open
Abstract
Objective In patients with pulmonary arterial hypertension (PAH), supportive therapies may be beneficial in addition to targeted medical treatment. Here, we evaluated the effectiveness and safety of oscillatory whole-body vibration (WBV) in patients on stable PAH therapy. Methods Twenty-two patients with PAH (mean PAP≥25 mm Hg and pulmonary arterial wedge pressure (PAWP)≤15 mm Hg) who were in world health organization (WHO)-Functional Class II or III and on stable PAH therapy for≥3 months, were randomised to receive WBV (16 sessions of 1-hour duration within 4 weeks) or to a control group, that subsequently received WBV. Follow-up measures included the 6-min walking distance (6MWD), cardiopulmonary exercise testing (CPET), echocardiography, muscle-power, and health-related quality of life (HRQoL; SF-36 and LPH questionnaires). Results When compared to the control group, patients receiving WBV exhibited a significant improvement in the primary endpoint, the 6MWD (+35.4±10.9 vs −4.4±7.6 m), resulting in a net benefit of 39.7±7.8 m (p=0.004). WBV was also associated with substantial improvements in CPET variables, muscle power, and HRQoL. The combined analysis of all patients (n=22) indicated significant net improvements versus baseline in the 6MWD (+38.6 m), peakVO2 (+65.7 mL/min), anaerobic threshold (+40.9 mL VO2/min), muscle power (+4.4%), and HRQoL (SF-36 +9.7, LPH −11.5 points) (all p<0.05). WBV was well tolerated in all patients, and no procedure-related severe adverse events (SAEs) occurred. Conclusions WBV substantially improves exercise capacity, physical performance, and HRQoL in patients with PAH who are on stable targeted therapy. This methodology may be utilised in structured training programmes, and may be feasible for continuous long-term physical exercise in these patients. Trial registration number NCT01763112; Results.
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Esche J, Johner S, Shi L, Schönau E, Remer T. Urinary Citrate, an Index of Acid-Base Status, Predicts Bone Strength in Youths and Fracture Risk in Adult Females. J Clin Endocrinol Metab 2016; 101:4914-4921. [PMID: 27676395 DOI: 10.1210/jc.2016-2677] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Diet can impact on bone strength via metabolic shifts in acid-base status. In contrast to the strongly diet-dependent biomarker urinary potential renal acid load (uPRAL), the amount of renally excreted citrate integrates nutritional and systemic influences on acid-base homeostasis with high citrate indicating prevailing alkalization. OBJECTIVE To examine the association between urinary citrate excretion and bone strength as well as long-term fracture risk. DESIGN AND PARTICIPANTS Prospective cross-sectional analysis; 231 healthy children (6-18 y) of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study were included, with at least 2 urine collections available during the 4 years preceding peripheral quantitative computed tomography (pQCT) of the nondominant proximal forearm. uPRAL, urinary citrate, and urinary nitrogen excretion were quantified in 857 24-hour urine samples. Data on overall fracture incidence were collected within a 15-year follow-up after pQCT measurement. MAIN OUTCOME MEASURES Parameters of bone quality and geometry (pQCT) as well as long-term fracture incidence. RESULTS After controlling for confounders, especially forearm length, muscle area, and urinary nitrogen (biomarker of protein intake), urinary citrate excretion was positively associated with various parameters of bone quality and geometry (P < .05). Fracture risk in adult females, but not in males, was inversely associated with urinary citrate and positively with uPRAL (P < .05). CONCLUSIONS Although urinary citrate has to be confirmed as an integrated noninvasive biomarker of systemic acid-base status in further studies, our results substantiate dietary and metabolic acidity as potentially adverse for bone health in the long run from childhood onward.
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Stahl M, Müller FM, Holfelder C, Kneppo C, Kieser M, Kasperk C, Schönau E, Sommerburg O, Tönshoff B. WS12.2 Increased fracture rate in relation to macroscopic bone architecture in young patients with cystic fibrosis. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30127-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bonfig W, Roehl FW, Riedl S, Dörr HG, Bettendorf M, Brämswig J, Schönau E, Riepe F, Hauffa B, Holl RW, Mohnike K. Blood Pressure in a Large Cohort of Children and Adolescents With Classic Adrenal Hyperplasia (CAH) Due to 21-Hydroxylase Deficiency. Am J Hypertens 2016; 29:266-72. [PMID: 26071487 DOI: 10.1093/ajh/hpv087] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Data on blood pressure (BP) in children and adolescents with classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency are conflicting in the literature. PATIENTS AND METHODS BP data of n = 716 children and adolescents (aged 3-18 years) from a national CAH database were analyzed. BP data were adjusted for height and compared to contemporary national reference data. A systolic and diastolic BP above the 95th centile was defined as hypertensive. RESULTS Overall prevalence of hypertension was 12.5%. Prevalence of hypertension was higher in younger children than in adolescents (18.5% vs. 4.9%). Until 8 years of age, fludrocortisone dose/m(2)/day correlated significantly with BP in regression analysis (P < 0.0001). BP correlated significantly with body mass index standard deviation score (BMI-SDS) (P < 0.0001), but not with hydrocortisone dose. In patients with salt-wasting CAH, BMI-SDS and BP were significantly higher compared to patients with simple virilising CAH, P < 0.01. CONCLUSION Especially young CAH children seem to be at risk for-most likely transient-hypertension, since the prevalence of hypertension decreases with age. In children up to 8 years of age, the used fludrocortisone dose is a significant risk factor for hypertension. Therefore we recommend accurate measurement of BP and careful fludrocortisone dosing in children with CAH.
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Ellerbroek VL, Bonfig W, Dörr HG, Bettendorf M, Hauffa B, Fricke-Otto S, Rohrer T, Reschke F, Schönau E, Schwab KO, Kapelari K, Röhl FW, Mohnike K, Holl RW. Long-term Surveillance of Children with Congenital Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (AQUAPE "Hypo Dok"). KLINISCHE PADIATRIE 2015; 227:199-205. [PMID: 26038964 DOI: 10.1055/s-0035-1549978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The German study group for quality assurance in pediatric endocrinology and the University of Ulm have established a software ("Hypo Dok") for the documentation of longitudinal data of patients with congenital primary hypothyroidism (CH). Aim of this study was to analyse the long-term follow-up of patients with CH and to compare treatment with current guidelines. METHODS/PATIENTS Anonymised data of 1,080 patients from 46 centres were statistically analysed. RESULTS Newborn screening result was available at a mean age of 7.3 days. Confirmation of the diagnosis was established at 8.4 days and therapy was started at 11 days. The average screening TSH was 180.0 mIU/L. During the first 3 months mean levothyroxine (LT4) dose was 10.7 µg/kg/day or 186.0 µg/m²/day. Weight-, BMI- and height-SDS did not differ significantly from the normal population. Only 25% of the patients (n=262) underwent formal EQ/IQ-testing. Their average IQ was 98.8 ± 13.2 points. DISCUSSION In Germany screening, confirmation and start of treatment of CH are within the recommended time frame of 14 days. Initial LT4-doses are adequate. The auxological longterm outcome of young CH patients is normal. The implementation of standardized IQ testing has to be improved in routine patient care. CONCLUSION Longitudinal data of patients with CH was analysed and compared to current guidelines. Confirmation and start of treatment are according to the recommendations. However standardised IQ testing requires improvement.
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Eydam M, Kottoor N, Schönau E, Semler O, Hoyer-Kuhn H, Körber S, Maintz D, Körber F. Therapiemonitoring unter Bisphosponat bei Kindern mit Osteogenesis imperfecta mittels „Cologne-Osteogenesis-Imperfecta-Numeric-(COIN)-Score“: Detektion von Nicht-Respondern in Korrelation zur Genetik. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kottoor N, Eydam M, Schönau E, Semler O, Hoyer-Kuhn H, Körber S, Maintz D, Körber F. Anwendung und Modifikation einer automatisierten Wirbelkörperanalyse für die Ermittlung des „Cologne-Osteogenesis-imperfecta-Numeric-(COIN)-Scores“ – Erste Ergebnisse. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Koerber F, Schönau E, Semler O, Hoyer-Kuhn H, Körber S, Kottoor N, Eydam M, Maintz D. Anwendung des „Cologne-Osteogenesis-Imperfecta-Numeric-Score“ (COIN-Score) bei Kindern und Jugendlichen mit Osteogenesis imperfecta (OI) unter Bisphosphonat-Therapie – eine Kohortenstudie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Soucek O, Schönau E, Lebl J, Sumnik Z. Artificially low cortical bone mineral density in Turner syndrome is due to the partial volume effect. Osteoporos Int 2015; 26:1213-8. [PMID: 25288443 DOI: 10.1007/s00198-014-2901-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/09/2014] [Indexed: 12/15/2022]
Abstract
UNLABELLED We aimed to show that the decrease in the cortical bone mineral density (BMD) in the radius in Turner syndrome (TS) is artificially caused by the partial volume effect. We confirmed that the partial volume effect-corrected cortical BMD is not decreased in TS compared to in the healthy controls. Other factors are responsible for the increased fracture rate in TS. INTRODUCTION Decreased cortical bone mineral density (BMD) has been reported in Turner syndrome (TS), using peripheral quantitative computerised tomography, and it is perceived as one of the major factors leading to increased fracture risk. We tested the hypothesis that low cortical BMD in the radius is caused artificially by the partial volume effect. METHODS A cross-sectional study was conducted at the university hospital referral centre between March and October 2013. Thirty-two participants with TS who consented to the study were included (mean age 15.3 ± 3.2 years). We assessed the cortical BMD in the radius as well as the tibia, where the cortex is thicker compared with the radius. RESULTS Whereas the cortical BMD was decreased in the radius (mean ± SD Z-score -0.6 ± 1.5, p = 0.037), it was increased in the tibia (mean Z-score 0.83 ± 1.0, p < 0.001). After correcting the cortical BMD for the partial volume effect, the mean Z-score was normal in the radius in TS (0.4 ± 1.3, p = 0.064). The corrected cortical BMD values were similar in the radius and tibia (1108 ± 52 vs. 1104 ± 48, group difference p = 0.75). CONCLUSIONS The cortical BMD is not decreased in TS. The partial volume effect is responsible for previous findings of decreased cortical BMD in the radius. Altered bone geometry or other factors rather than low cortical BMD likely play a role in the increased fracture risk in TS.
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Shi L, Sánchez-Guijo A, Hartmann MF, Schönau E, Esche J, Wudy SA, Remer T. Higher glucocorticoid secretion in the physiological range is associated with lower bone strength at the proximal radius in healthy children: importance of protein intake adjustment. J Bone Miner Res 2015; 30:240-8. [PMID: 25196629 DOI: 10.1002/jbmr.2347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 08/08/2014] [Accepted: 08/25/2014] [Indexed: 01/18/2023]
Abstract
Whether higher production of glucocorticoids (GCs) within the physiological range may already be affecting bone status in healthy children is unknown. Because dietary protein intake affects both bone and GCs, we examined the association of urinary measures of glucocorticoid status and cortical bone in healthy non-obese children, after particularly controlling for protein intake. Proximal forearm bone parameters were measured by peripheral quantitative computed tomography (pQCT). Subjects studied (n = 175, 87 males, aged 6 to 18 years) had two 24-hour urine samples collected: the first sample at 1 year before bone measurement, and the second sample at the time of bone measurement. Major urinary GC metabolites were measured by mass spectrometry and summed to assess daily adrenal GC secretion (∑C21). Urinary free cortisol (UFF) and cortisone (UFE) were summed to assess potentially bioactive free GCs (UFF + UFE). After controlling for several covariates and especially urinary nitrogen (the biomarker of protein intake) cortisol secretion ∑C21 was inversely associated with all analyzed pQCT measures of bone quality. ∑C21 also predicted a higher endosteal and lower periosteal circumference, explaining both a smaller cortical area and (together with lower BMD) a lower strength-strain-index (SSI). UFF + UFE, UFE itself, and a urinary metabolite-estimate of 11beta-hydroxysteroid dehydrogenase type1 (11beta-HSD1) activity showed corresponding reciprocal associations (p < 0.05) with BMD and bone mineral content, but not with SSI and bone geometry variables. In conclusion, higher GC levels, even within the physiological range, appear to exert negative influences on bone modeling and remodeling already during growth. Our physiological data also suggest a relevant role of cortisone as the direct source for intracrine-generated cortisol by bone cell 11beta-HSD1.
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Ireland A, Rittweger J, Schönau E, Lamberg-Allardt C, Viljakainen H. Time since onset of walking predicts tibial bone strength in early childhood. Bone 2014; 68:76-84. [PMID: 25132490 DOI: 10.1016/j.bone.2014.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/01/2014] [Accepted: 08/08/2014] [Indexed: 11/25/2022]
Abstract
Bone strength in adulthood is known to be affected by health at birth and early childhood. Habitual bone loading is a primary determinant of bone strength in later childhood and adulthood. However, the effects of physical activity in early childhood (e.g. crawling, standing and walking) on bone strength are unknown. Fifty-three children (twenty-seven males) were included in a longitudinal study in their early infancy. Shortly after birth (0.3±0.3months), details of mass and height were obtained along with a pQCT scan at 20% distal-proximal tibia length. At 14.8±0.5months of age the same data were collected, along with details of age at onset of standing, crawling, supported and unsupported walking. Time since onset of walking unsupported was associated with greater bone mass, cortical bone area, pericortical circumference and polar moment of inertia of both total and cortical bone (all P<0.05). There were no significant associations between other physical activity timepoints and bone measures. Age at onset of walking was not significantly related to mass, length or bone measures at birth. The results suggest that time since attainment of independent walking - representing exposure of the tibia to the large reaction and muscular forces associated with locomotion - is a primary determinant of bone strength in early childhood. This finding raises the possible opportunity of physical activity interventions at young age in paediatric populations associated with low childhood bone strength and late walking (e.g. low birth weight, cerebral palsy and Down's Syndrome, etc.).
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Koy A, Pauls KAM, Flossdorf P, Becker J, Schönau E, Maarouf M, Liebig T, Fricke O, Fink GR, Timmermann L. Young Adults with Dyskinetic Cerebral Palsy Improve Subjectively on Pallidal Stimulation, but not in Formal Dystonia, Gait, Speech and Swallowing Testing. Eur Neurol 2014; 72:340-8. [DOI: 10.1159/000360984] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 02/26/2014] [Indexed: 11/19/2022]
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Niehoff A, Lechner P, Ratiu O, Reuter S, Hamann N, Brüggemann GP, Schönau E, Bloch W, Beccard R. Effect of whole-body vibration and insulin-like growth factor-I on muscle paralysis-induced bone degeneration after botulinum toxin injection in mice. Calcif Tissue Int 2014; 94:373-83. [PMID: 24292598 DOI: 10.1007/s00223-013-9818-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
Botulinum toxin A (BTX)-induced muscle paralysis results in pronounced bone degradation with substantial bone loss. We hypothesized that whole-body vibration (WBV) and insulin-like growth factor-I (IGF-I) treatment can counteract paralysis-induced bone degradation following BTX injections by activation of the protein kinase B (Akt) signaling pathway. Female C57BL/6 mice (n = 60, 16 weeks) were assigned into six groups (n = 10 each): SHAM, BTX, BTX+WBV, BTX+IGF-I, BTX+WBV+IGF-I, and a baseline group, which was killed at the beginning of the study. Mice received a BTX (1.0 U/0.1 mL) or saline (SHAM) injection in the right hind limb. The BTX+IGF-I and BTX+WBV+IGF-I groups obtained daily subcutaneous injections of human IGF-I (1 μg/day). The BTX+WBV and BTX+WBV+IGF-I groups underwent WBV (25 Hz, 2.1 g, 0.83 mm) for 30 min/day, 5 days/week for 4 weeks. Femora were scanned by pQCT, and mechanical properties were determined. On tibial sections TRAP staining, static histomorphometry, and immunohistochemical staining against Akt, phospho-Akt, IGF-IR (IGF-I receptor), and phospho-IGF-IR were conducted. BTX injection decreased trabecular and cortical bone mineral density. The WBV and WBV+IGF-I groups showed no difference in trabecular bone mineral density compared to the SHAM group. The phospho-IGF-IR and phospho-Akt stainings were not differentially altered in the injected hind limbs between groups. We found that high-frequency, low-magnitude WBV can counteract paralysis-induced bone loss following BTX injections, while we could not detect any effect of treatment with IGF-I.
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Tallen G, Bielack S, Henze G, Horneff G, Korinthenberg R, Lawrenz B, Niehues T, Peitz J, Placzek R, Schmittenbecher P, Schönau E, Wessel L, Wirth T, Mentzel HJ, Creutzig U. Musculoskeletal Pain: A New Algorithm for Differential Diagnosis of a Cardinal Symptom in Pediatrics. KLINISCHE PADIATRIE 2014; 226:86-98. [DOI: 10.1055/s-0034-1366989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shi L, Sánchez-Guijo A, Hartmann MF, Schönau E, Wudy SA, Remer T. Higher 24-h urinary free cortisone, but not cortisol is associated with impaired cortical bone status at the proximal radius in healthy children. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hartmann K, Ittner J, Müller-Rossberg E, Schönau E, Stephan R, Ullrich KP, Hoppe B, Ramseger R, Brämswig J. Growth hormone treatment adherence in prepubertal and pubertal children with different growth disorders. Horm Res Paediatr 2014; 80:1-5. [PMID: 23860437 DOI: 10.1159/000351800] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Treatment of children with growth disorders with recombinant human growth hormone is necessary for improved outcomes, including final height. METHODS Adherence data from the Observational Study Saizen®-online, recorded with the easypod™ device collected between October 2009 and May 2011, were analyzed in pediatric patients receiving recombinant human growth hormone treatment for a variety of growth disorders. RESULTS Data from 75 children (46 boys, 29 girls) with different growth disorders were analyzed over a period of 343 ± 201 (SD) days. Boys and girls showed similar mean ± SD adherence rates of 90.5 ± 3.1% and 92.2 ± 10.7%, respectively. Pubertal children (n = 41) had a significantly lower adherence rate (89.1 ± 13.7%) than prepubertal children (n = 29) (96.5 ± 3.9%; p < 0.005). There were nonsignificant differences in adherence rates according to diagnosis: growth hormone deficiency (n = 48) 91.4 ± 11.0%, small for gestational age (n = 18) 91.1 ± 15.3%, Turner syndrome (n = 6) 86.0 ± 14.5%, and chronic renal failure (n = 3) 99.3 ± 1.0%, although the latter two groups were small. CONCLUSION Our data indicate that only a small number of pediatric patients using the easypod device had poor adherence to treatment. Further reliable adherence data are required to identify factors affecting long-term adherence in this population.
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Vry J, Schubert IJ, Semler O, Haug V, Schönau E, Kirschner J. Whole-body vibration training in children with Duchenne muscular dystrophy and spinal muscular atrophy. Eur J Paediatr Neurol 2014; 18:140-9. [PMID: 24157400 DOI: 10.1016/j.ejpn.2013.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/14/2013] [Accepted: 09/23/2013] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Whole-body-vibration training is used to improve muscle strength and function and might therefore constitute a potential supportive therapy for neuromuscular diseases. OBJECTIVE To evaluate safety of whole-body vibration training in ambulatory children with Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA). METHODS 14 children with DMD and 8 with SMA underwent an 8-week vibration training programme on a Galileo MedM at home (3 × 3 min twice a day, 5 days a week). Primary outcome was safety of the training, assessed clinically and by measuring serum creatine kinase levels. Secondary outcome was efficacy as measured by changes in time function tests, muscle strength and angular degree of dorsiflexion of the ankles. RESULTS All children showed good clinical tolerance. In boys with DMD, creatine kinase increased by 56% after the first day of training and returned to baseline after 8 weeks of continuous whole-body vibration training. No changes in laboratory parameters were observed in children with SMA. Secondary outcomes showed mild, but not significant, improvements with the exception of the distance walked in the 6-min walking test in children with SMA, which rose from 371.3 m to 402.8 m (p < 0.01). INTERPRETATION Whole-body vibration training is clinically well tolerated in children with DMD and SMA. The relevance of the temporary increase in creatine kinase in DMD during the first days of training is unclear, but it is not related to clinical symptoms or deterioration.
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Barbe MT, Amarell M, Snijders AH, Florin E, Quatuor EL, Schönau E, Fink GR, Bloem BR, Timmermann L. Gait and upper limb variability in Parkinson’s disease patients with and without freezing of gait. J Neurol 2013; 261:330-42. [DOI: 10.1007/s00415-013-7199-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/08/2013] [Accepted: 11/20/2013] [Indexed: 12/16/2022]
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Slizewski A, Schönau E, Shaw C, Harvati K. Muscle area estimation from cortical bone. Anat Rec (Hoboken) 2013; 296:1695-707. [PMID: 24123941 DOI: 10.1002/ar.22788] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/23/2013] [Accepted: 07/02/2013] [Indexed: 11/06/2022]
Abstract
This article investigates the relationship between the cortical bone of the radius and the muscle area of the forearm. The aim of this study was to develop a method for muscle area estimation from cortical bone area at 65% of radius length where the muscle area at the forearm is largest. Muscle area and cortical area were measured directly in vivo by peripheral Quantitative Computed Tomography (pQCT). We found significant correlations between muscle area and cortical area (r = 0.881) in the forearm that are in line with previous studies. We have set up a regression model by testing relevant parameters such as age, sex, forearm length, and stature that were all highly correlated to muscle area. The influence of age and sex on the proportion of muscle area to cortical area is strong and potentially related to the effects of testosterone and estrogen on the muscle-bone-unit. Muscle area estimation from cortical bone is possible with a Percent Standard Error of Estimate (%SEE) ranging from 12.03% to 14.83%, depending on the parameters available and the age and sex of the individual. Muscle area estimation from cortical bone can provide new information for the study of skeletal and/or fossil human remains.
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Keupp K, Beleggia F, Kayserili H, Barnes A, Steiner M, Semler O, Fischer B, Yigit G, Janda C, Becker J, Breer S, Altunoglu U, Grünhagen J, Krawitz P, Hecht J, Schinke T, Makareeva E, Lausch E, Cankaya T, Caparrós-Martín J, Lapunzina P, Temtamy S, Aglan M, Zabel B, Eysel P, Koerber F, Leikin S, Garcia K, Netzer C, Schönau E, Ruiz-Perez V, Mundlos S, Amling M, Kornak U, Marini J, Wollnik B. Mutations in WNT1 cause different forms of bone fragility. Am J Hum Genet 2013; 92:565-74. [PMID: 23499309 PMCID: PMC3617378 DOI: 10.1016/j.ajhg.2013.02.010] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 12/13/2022] Open
Abstract
We report that hypofunctional alleles of WNT1 cause autosomal-recessive osteogenesis imperfecta, a congenital disorder characterized by reduced bone mass and recurrent fractures. In consanguineous families, we identified five homozygous mutations in WNT1: one frameshift mutation, two missense mutations, one splice-site mutation, and one nonsense mutation. In addition, in a family affected by dominantly inherited early-onset osteoporosis, a heterozygous WNT1 missense mutation was identified in affected individuals. Initial functional analysis revealed that altered WNT1 proteins fail to activate canonical LRP5-mediated WNT-regulated β-catenin signaling. Furthermore, osteoblasts cultured in vitro showed enhanced Wnt1 expression with advancing differentiation, indicating a role of WNT1 in osteoblast function and bone development. Our finding that homozygous and heterozygous variants in WNT1 predispose to low-bone-mass phenotypes might advance the development of more effective therapeutic strategies for congenital forms of bone fragility, as well as for common forms of age-related osteoporosis.
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Schönau E. Kindliche Adipositas – Folgen für den Bewegungsapparat und Therapieansätze. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:528-31. [DOI: 10.1007/s00103-012-1634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wirth F, Schempf G, Stein G, Wellmann K, Manthou M, Scholl C, Sidorenko M, Semler O, Eisel L, Harrach R, Angelova S, Jaminet P, Ankerne J, Ashrafi M, Ozsoy O, Ozsoy U, Schubert H, Abdulla D, Dunlop SA, Angelov DN, Irintchev A, Schönau E. Whole-Body Vibration Improves Functional Recovery in Spinal Cord Injured Rats. J Neurotrauma 2013; 30:453-68. [DOI: 10.1089/neu.2012.2653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Langensiepen S, Semler O, Sobottke R, Fricke O, Franklin J, Schönau E, Eysel P. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2360-71. [PMID: 23443679 DOI: 10.1007/s00586-013-2693-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/18/2013] [Accepted: 01/25/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Scoliosis of the vertebral column can be assessed with the Cobb angle (Cobb 1948). This examination is performed manually by measuring the angle on radiographs and is considered the gold standard. However, studies evaluating the reproducibility of this procedure have shown high variability in intra- and inter-observer agreement. Because of technical advancements, interests in new procedures to determine the Cobb angle has been renewed. This review aims to systematically investigate the reproducibility of various new techniques to determine the Cobb angle in idiopathic scoliosis and to assess whether new technical procedures are reasonable alternatives when compared to manual measurement of the Cobb angle. METHOD Systematic review. Studies examining procedures used to determine the Cobb angle were selected. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias. Statistical results of reliability and agreement were summarised and described. RESULTS Eleven studies of new measuring procedures were included, all reporting the reproducibility. The new procedures can be divided into computer-assisted procedures, automatic procedures and smartphone apps. CONCLUSIONS All investigated measuring procedures showed high degrees of reliability. In general, digital procedures tend to be slightly better than manual ones. For all other measurement procedures (automatic or smartphone), results varied. Studies implementing vertebral pre-selection and observer training achieved better agreement.
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Weber T, Beijer Å, Rosenberger A, Mulder E, Yang P, Schönau E, Bloch W, Rittweger J. Vascular adaptations induced by 6 weeks WBV resistance exercise training. Clin Physiol Funct Imaging 2012; 33:92-100. [PMID: 23383686 DOI: 10.1111/j.1475-097x.2012.01166.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/13/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of whole-body vibration (WBV) upon the cardiovascular system is receiving increasing attention. Despite numerous studies addressing the acute cardiovascular effects of WBV training, very little is known regarding long-term adaptations in healthy humans. METHODS A 6-week training study, with a 70 days follow-up was designed to compare resistive exercise with or without super-imposed whole-body vibrations. Arterial diameter, intima media thickness and flow-mediated dilation (FMD) were assessed by ultrasonography in the superficial femoral artery (SFA), the brachial (BA) and the carotid arteries (CA). RESULTS SFA resting diameter was increased from 6·22 mm (SD = 0·69 mm) at baseline to 6·52 mm (SD = 0·74 mm) at the end of the training period (P = 0·03) with no difference between groups (P = 0·48). Arterial wall thickness was significantly reduced by 4·3% (SD = 11%) in the CA only (P = 0·04). FMD was not affected by any of the interventions and in any of the investigated arteries. CONCLUSION To the best of our knowledge, this has been the first study to show that the superposition of vibration upon conventional resistance exercise does not have a specific effect upon long-term vascular adaptation in asymptomatic humans. Our findings seem to be at variance with the findings observed in a bed-rest setting. One possible explanation could be that the independently saturable effects of flow-mediated versus acceleration-related endothelial shear stresses on arterial structure and function differ between ambulatory and bed-rest conditions.
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Kühn T, Kroke A, Remer T, Schönau E, Buyken AE. Is breastfeeding related to bone properties? A longitudinal analysis of associations between breastfeeding duration and pQCT parameters in children and adolescents. MATERNAL AND CHILD NUTRITION 2012; 10:642-9. [PMID: 22909290 DOI: 10.1111/j.1740-8709.2012.00443.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nutritive and bioactive components of human milk could be involved in programming metabolic systems that affect bone growth throughout the life course. Bone properties in childhood and adolescence might differ, depending on breastfeeding duration. Thus, breastfeeding could be a relevant factor in the context of primary osteoporosis prevention. The prospective association between breastfeeding duration and bone properties was investigated using the data of 284 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Breastfeeding duration was assessed during infancy. Bone properties were measured by peripheral quantitative computed tomography (pQCT) at ages 5-23 years. Cortical volumetric bone mineral density, cortical bone mineral content, strength strain index, total cross-sectional area of the bone and cross-sectional area of the cortical bone were determined at the 65% site of the radius. Linear regression analyses were performed to check for differences in pQCT parameters of subjects who had not or shortly been breastfed (0-16 weeks) and subjects who had been breastfed for a long duration (≥17 weeks). Multivariable models adjusted for age, gender, forearm length, muscle cross-sectional area, body mass index standard deviation score (SDS), height SDS and socio-economic status did not yield associations between breastfeeding duration and pQCT parameters. These findings suggest neither protective nor adverse effects of prolonged breastfeeding on bone health in childhood and adolescence. Influences of early nutrition on bone growth might be overridden by current effects of mechanical loads on bone physiology.
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