Ayurveda for a Type 1 Diabetes Patient with Peripheral Arterial Occlusive Disease: A Case Report

INTRODUCTION

The effect of Ayurvedic therapy in type 2 diabetes (T2D) is well documented. For people with type 1 diabetes (T1D), there is little evidence on the applicability of Ayurvedic therapy. This case illustrates the course of Ayurvedic treatment in a person with T1D accompanied by peripheral arterial occlusive disease (PAOD).

CASE PRESENTATION

The patient had insulin-dependent T1D since the age of 6 years. At 39 years of age, he developed progressive bilateral PAOD of the femoral arteries. He presented claudication symptoms at a walking distance of 150 m. Ten surgical interventions for recanalization have been performed. The PAOD put heavy psychological strains on the patient. He developed moderate depression with anxiety and complained of tinnitus and sleep disturbances. Through an initial outpatient Ayurvedic treatment mainly focused on dietary, lifestyle changes and phytotherapeutics, and a subsequent 6-week inpatient Ayurvedic treatment in India, a weight reduction of 12 kg, a reduction in insulin requirement to 65% of baseline, as well as a walking performance without restriction at a medium load could be achieved. The depression and inner tension retreated, and one-sided tinnitus and existing sleep disturbances dissolved completely. The lasting effect was still perceptible 5 months after the inpatient stay.

CONCLUSIONS

For this person with T1D with PAOD, outpatient and inpatient Ayurvedic therapy could generate a significant improvement of his situation. The case demonstrates that people with T1D can benefit from using individualized Ayurvedic therapy. This case motivates to invest in Ayurvedic research for people with T1D and complications.

Einleitung

Die Wirkung der ayurvedischen Therapie bei Typ-2-Diabetes (T2D) ist gut dokumentiert. Für Menschen mit Typ-1-Diabetes (T1D) gibt es kaum Belege für die Anwendbarkeit der ayurvedischen Therapie. Dieser Fall veranschaulicht den Verlauf einer ayurvedischen Behandlung bei einer Person mit T1D, begleitet von einer peripheren arteriellen Verschlusskrankheit (pAVK).

Fallbericht

Der Patient hatte seit seinem 6. Lebensjahr einen insulinabhängigen 'T1D'. Im Alter von 39 Jahren entwickelte er eine fortschreitende bilaterale periphere arterielle Verschlusskrankheit (pAVK) der Oberschenkelarterien. Bei einer Gehstrecke von 150 m zeigte er Claudicatio-Symptome. Es wurden 10 chirurgische Eingriffe zur Rekanalisation durchgeführt. Die pAVK stellte für den Patienten eine starke psychische Belastung dar. Er entwickelte eine mittelschwere Depression mit Angstzuständen und klagte über Tinnitus und Schlafstörungen. Durch eine erste ambulante ayurvedische Behandlung, die sich hauptsächlich auf Ernährungs-, Lebensstiländerungen und Phytotherapeutika konzentrierte, und eine anschließende 6-wöchige stationäre ayurvedische Behandlung in Indien wurde eine Gewichtsreduktion um 12 kg, eine Reduzierung des Insulinbedarfs auf 65% des Ausgangswerts sowie eine bedeutende Verbesserung der Gehstrecke erreicht. Die Depression und die innere Anspannung verschwanden, und der einseitige Tinnitus und bestehende Schlafstörungen lösten sich vollständig auf. Der nachhaltige Effekt war noch 5 Monate nach dem stationären Aufenthalt spürbar.

Schlussfolgerungen

Für diese Person mit T1D mit pAVK konnte eine ambulante und stationäre ayurvedische Therapie eine deutliche Verbesserung der Situation bewirken. Der Fall zeigt, dass Menschen mit T1D von einer individualisierten ayurvedischen Therapie profitieren können. Dieser Fall motiviert dazu, in die ayurvedische Forschung für Menschen mit T1D und Komplikationen zu investieren.

A Working TTFields Therapy Framework for Patient-Specific Segmentation-Based Treatment Planning and Dosimetry

PURPOSE/OBJECTIVE(S)

Previously reported data support the notion that patient-specific treatment planning in patients with newly diagnosed glioblastoma (GBM) could positively impact patient outcomes like overall survival and progression free survival and predictably affect imaging progression patterns (Ballo et al 2019; Glas et al 2021). These findings provide the grounds for a TTFields dosimetry and patient-specific segmentation-based treatment planning (SBTP) paradigm. This paradigm allows optimized delivery of TTFields to target regions of interest (ROIs) and ability to adjust the treatment during therapy. In this study, we describe a working framework for TTFields SBTP.

MATERIALS/METHODS

The working framework consists of the following process: First, a patient's high-resolution imaging data (MRI with or without a CT) is imported from the institution's PACS. The image is segmented to identify tissue types using a combination of automatic and semi-automatic algorithms. During this stage, the user indicates the target ROI subject to optimization. Then, a computational model of the patient is created in which typical electrical properties are allocated to each tissue type based on empirical measurements and/or literature. At this point, the user can mark avoidance zones on the skin identifying areas where the transducer arrays (TAs) should not be placed. Next, dedicated algorithms identify optimal arrangements of TAs to produce several options of TA layouts. Further, quantitative and qualitative evaluation tools such as color maps, iso-surfaces, and dose volume histogram (DVH) curves, are applied to choose the layouts that achieve the optimal distribution of TTFields therapy for each patient. Finally, each patient receives two SBTP to allow switching between the layouts in order to mitigate the risk of skin irritation.

RESULTS

Over 60 image sets from GBM patients were used to test the SBTP system. Our experience demonstrates a viable working framework that has the potential to boost TTFields delivery to target ROIs.

CONCLUSION

This working framework offers qualitative and quantitative tools for SBTP and streamlines the process of personalized treatment, allowing physicians to optimize treatment with TTFields therapy. Additionally, this system provides tools for developing an adaptive patient-specific SBTP in response to any clinical need (e.g., disease progression).

The Effect of Body Mass Index on Tumor Treating Fields (TTFields) Intensity Distribution in the Lungs

PURPOSE/OBJECTIVE(S)

Tumor Treating Fields (TTFields) therapy is a locoregional, noninvasive antimitotic cancer treatment modality. TTFields are electric fields that disrupt processes critical for cancer cell viability and tumor progression. They are generated by a portable medical device and delivered noninvasively to the tumor via two pairs of orthogonally placed transducer arrays. TTFields therapy is currently FDA-approved for recurrent and newly diagnosed glioblastoma and pleural mesothelioma, with ongoing studies in other solid tumor types including non-small cell lung cancer (NSCLC). In the phase 3 LUNAR study (NCT02973789), TTFields therapy demonstrated an improvement in overall survival when added to NSCLC standard of care. TTFields effectiveness depends upon several factors, including field intensity; thus, it is relevant to assess the impact of body mass index (BMI) on the distribution of TTFields in the lungs. This study utilized simulation-based approaches to assess the impact of BMI on electric field intensity distribution in the lungs.

MATERIALS/METHODS

Three computerized female phantom models (with BMIs of 22, 26 and 30), were used to simulate electric field intensity. Two different arrays sizes (small [13 disks] and large [20 disks]) were applied to the thoracic region of the models. An electric field intensity distribution map for each model was generated, and electric field intensity values across the entirety of the lungs were analyzed.

RESULTS

Electric field intensities were above 1 V/cm (amplitude), which is typically considered a sufficient level of TTFields dose to achieve a therapeutic effect, in all lobes in the lungs for all BMI models when large arrays were used. Therapeutic intensities were achieved in all lobes with the small arrays in all but one model (BMI 30), where intensities fell slightly below 1 V/cm in the right middle lobe.

CONCLUSION

Results from this simulation-based study demonstrate that delivery of TTFields at therapeutic intensities is feasible even in patients with a high BMI, provided the appropriately sized array is used. These findings support ongoing clinical studies of TTFields therapy in lung cancer, including the recently completed LUNAR study in advanced NSCLC, and could facilitate optimization of therapeutic TTFields delivery to individual patients, based on their BMI.

Patient-Specific Segmentation-Based Treatment Planning vs. NovoTAL for TTFields Therapy in Glioblastoma

PURPOSE/OBJECTIVE(S)

Patients treated with Tumor Treating Fields (TTFields) therapy for glioblastoma (GBM) have array layouts planned by NovoTAL. NovoTAL requires morphometric inputs and maximizes field intensity at the tumor. Patient-specific segmentation-based treatment planning (SBTP) software uses segmentation-based plans to maximize power density at defined regions of interest (ROIs). This technical analysis compared expected local minimum power density (LMiPD; mW/cm3) and local minimum field intensity (LMiFI; V/cm) delivered to ROIs with array layouts planned with SBTP vs NovoTAL. We hypothesized that SBTP has the potential to increase LMiPD and LMiFI to ROIs vs NovoTal.

MATERIALS/METHODS

37 patients from 5 sites who received TTFields therapy for GBM using NovoTAL were included. Treatment plans using the prescribed/treated NovoTAL layouts were created with SBTP. De novo SBTP layouts were also created. Three ROIs representing the original treated GBM (CTV), high risk margin around the GBM (CTV-2), and recurrent GBM (CTV-R) were created. Plans were optimized to CTV. SBTP vs NovoTAL LMiPD and LMiFI volumetrics to ROIs were evaluated. LMiPD and LMiFI were normalized with the delivered current from the treated NovoTAL layout. Layout rankings based on LMiPD and LMiFI, average LMiPD and LMiFI, D95, D5, DVHs, and voxel-by-voxel LMiPD and LMiFI for SBTP derived from NovoTAL layouts were compared to de novo SBTP layouts (paired t-tests).

RESULTS

Average LMiPD (1.551 vs 1.194) and LMiFI (1.115 vs 0.978) to CTV were significantly higher with SBTP vs NovoTAL (P < 0.0001 for each). Average LMiPD (1.445 vs 1.164) and LMiFI (1.197 vs 1.077) to CTV-2 were also higher (P < 0.0001 for each). There was a positive trend to higher average LMiPD (1.203 vs 1.157; P = 0.212) and LMiFI (1.103 vs 1.090; P = 0.311) to CTV-R. Top ranked overall layouts by LMiPD to CTV were SBTP layouts (97%; n = 36). Percent ratio ([SBTP-NovoTAL]/NovoTAL*100) D95 for LMiPD was 34% (to CTV), 24% (to CTV-2), and 5% (to CTV-R) and for LMiFI was 16%, 12%, and 2% respectively. Percent ratio D5 for LMiPD was 31%, 24%, and 3% and for LMiFI was 14%, 9%, and 0%, respectively. For a given percent CTV volume, minimum LMiPD and LMiFI were higher with SBTP (95%, n = 35; DVH curves shifted to right). SBTP yielded higher LMiPD and LMiFI to the majority of voxels within the CTV (95%, n = 35). With SBTP, LMiPD to CTV was significantly higher than to CTV-R (P < 0.001).

CONCLUSION

Overall, these data demonstrate that SBTP compared to NovoTAL yielded higher expected average LMiPD and LMiFI, D95, D5, and percent voxel LMiPD and LMiFI to defined ROIs. Higher LMiPD and LMiFI delivered to CTV vs CTV-R with SBTP suggests a benefit to re-planning if the GBM recurs. Given previous reports showing that higher LMiPD and LMiFI are positively correlated with improved overall and progression free survival, patient-specific SBTP may lead to improved clinical outcomes for GBM patients vs NovoTAL.

The Anthroposophic Artistic Movement Assessment for Eurythmy Therapy (AART-ASSESS-EuMove). A validation study

OBJECTIVE

Eurythmy Therapy (ET) is a mindfulness oriented therapy developed in the context of anthroposophic medicine. Despite commonly used in practice, it remains unclear whether active participation (Inner Correspondence) during ET can be observed in eurythmy gestures (EGest). So far, no validated peer-report instrument to evaluate EGest exists.

METHOD

To validate an 83-item ET peer-report scale, a nested study on a sample of n = 82 breast cancer survivors with cancer-related fatigue was conducted. EGest were evaluated twice, at baseline and at 10-week follow-up, by peer-reports from two separate therapists. Interrater-reliability (IRR) was estimated by Cohen's weighted kappa (κw) across all items. Additionally, reliability-(RA) and principal component analyses (PCA) were conducted. Patients completed two self-report scales: Satisfaction with ET (SET) and Inner Correspondence with the Movement Therapy (ICPH).

RESULTS

IRR was greater than or equal (κw ≥ 0.25) for 41 items (49.3%) with a mean weighted kappa of κ̅w = 0.40 (SD = 0.17, range = 0.25-0.85). RA resulted in the exclusion of 25 items with insufficient item-total correlations < 0.40. A PCA with 16 items revealed 3 subscales: 1. Mindfulness in Movement (8 items), 2. Motor Skills (5 items), 3. Walking Pattern (3items) explaining 63.86% of total variance. Internal consistency (Cronbach's alpha) was high for the sum score with α = 0.89 and for the subscales with α = 0.88, 0.86 and 0.84 respectively. Significant small to moderate subscale correlations were found ranging from r = 0.29-0.63 (all p < 0.01). Mindfulness in Movement correlated with Inner Correspondence (r = 0.32) and with Satisfaction with ET (r = - 0.25, both p < 0.05).

CONCLUSIONS

The new AART-ASSESS-EuMove is the first consistent and reliable peer-report instrument to evaluate EGest. It shows associations between peer-reported Mindful Movement and patients' self-reported ICPH and SET.

Combined Heterozygous Genetic Variations in Complement C2 and C8B: An Explanation for Multidimensional Immune Imbalance?

The complement system plays a crucial role in host defense, homeostasis, and tissue regeneration and bridges the innate and the adaptive immune systems. Although the genetic variants in complement C2 (c.839_849+17del; p.(Met280Asnfs*5)) and C8B (c.1625C>T; p.(Thr542Ile)) are known individually, here, we report on a patient carrying their combination in a heterozygous form. The patient presented with a reduced general condition and suffers from a wide variety of autoimmune diseases. While no autoimmune disease-specific autoantibodies could be detected, genetic analysis revealed abnormalities in the two complement genes C2 and C8B. Therefore, we performed a comprehensive investigation of the innate immune system on a cellular and humoral level to define the functional consequences. We found slightly impaired functionality of neutrophils and monocytes regarding phagocytosis and reactive oxygen species generation and a diminished expression of the C5aR1. An extensive complement analysis revealed a declined activation potential for the alternative and classical pathway. Reconstitution with purified C2 and C8 into patient serum failed to normalize the dysfunction, whereas the addition of C3 improved the hemolytic activity. In clinical transfer, in vitro supplementation of the patient's plasma with FFP as a complement source could fully restore full complement functionality. This study describes for the first time a combined heterozygous genetic variation in complement C2 and C8B which, however, cannot fully explain the overall dysfunctions and calls for further complement deficiency research and corresponding therapies.

High-throughput shoot phenotyping reveals temporal growth responses to nitrogen and inorganic and organic phosphorus sources in tomato

The application of nitrogen (N) and phosphorus (P) fertilizers to soils is required to maintain crop yields, so the sufficient and timely delivery of nutrients to match crop demand is important in fertilizer management. We quantified temporal growth responses of tomato plants with different rates of N and P application using high-throughput shoot phenotyping. The tomato plants were grown in soil that had organic, inorganic or a combination of sources of P incorporated. Additional N was added to each pot at low and high rates, 13 days after planting. At the same rate of total P application, the inorganic P source resulted in greater shoot growth at the early time points. Later on, the plants supplied with organic or mixed P sources grew faster than those that received the inorganic P source, resulting in comparable shoot biomass in all treatments at the time of destructive harvest. The shoot phenotyping data demonstrated that readily available soil P was important for early tomato growth while available N was more important in later stages of vegetative growth. These results suggest that a fertilizer formulation of combined inorganic and organic P sources may be able to sustain rapid and great shoot growth in tomato plants, while also reducing additional N input.

The Introspective Patient Experience of Mistletoe Therapy in Cancer: A Qualitative Study

INTRODUCTION

The introspective experience of cancer patients using mistletoe therapy has received little scientific interest, although it is crucial for a holistic understanding of this therapy. This study contributes to patient-centered research and treatment by documenting the subjective experiences of individuals undergoing mistletoe therapy.

METHODS

In this qualitative, explorative study, 20 outpatients with a history of various cancer types were recruited from Arlesheim Hospital (Arlesheim, Switzerland). All patients received subcutaneous mistletoe therapy for at least 2 years (median 7.5 years). Data was collected through 2 semi-structured, in-depth interviews per patient. Qualitative content analysis was applied to examine the data. The individual experience of mistletoe therapy was analyzed in relation to 6 predefined levels of human experience: physical, vital, emotional, mental, spiritual and social. In addition, 3 further aspects, considered as cross-dimensional perspectives, emerged out of the material: warmth, immune strengthening, and general wellbeing.

RESULTS

Data analysis revealed considerable heterogeneity among patients' experiences with mistletoe therapy. The importance of specific aspects became apparent, such as increased vitality to manage daily life, greater emotional and mental stability, warmth as a multidimensional phenomenon, feelings of safety and protection through mistletoe therapy, heightened self-awareness and improved self-care, as well as sensations of spiritual connectedness.

CONCLUSIONS

Prior to this study it had not been shown that cancer patients using mistletoe therapy do have observations on different levels of experience. These results may lead to a deeper understanding of patients receiving mistletoe therapy, enabling them to be supported in a more holistic way both during mistletoe treatment and on their life path. Further investigations into the effects of mistletoe therapy on the emotional, mental, and spiritual level are warranted.

Predictors of sustained use of mobile health applications: Content analysis of user perspectives from a fever management app

Objectives

Mobile health applications could be means of educating and changing behaviours of their users. Their features and qualities determine the sustainability of use. The FeverApp with two main features of information and documentation is a research-based app. In this observational cohort study, to evaluate the influential predictors of use, users' feedback on the FeverApp, were analyzed.

Methods

Feedback is given using a structured questionnaire, four Likert items and two open questions regarding positive and negative impressions, available via app menu. Conventional content analysis (inductive approach) on the two open questions was performed. Comments were grouped into 12 codes. These codes were grouped hierarchically in an iterative process into nine subcategories and lastly into two main categories 'format' and 'content'. Descriptive and quantitative analysis were performed.

Results

Out of 8243 users, 1804 of them answered the feedback questionnaire. The features of the app (N  =  344), followed by the information aspect (N  =  330) were most frequently mentioned. Documentation process (N  =  226), request for new features or improvement of the current ones (N  =  193), and functioning (N  =  132) were also highlighted in users' feedback. App's ease of use, design and being informative were important for the users. The first impression of the app seems important as the majority of feedback were given during the first month of using the app.

Conclusion

In-app feedback function could highlight shortcomings and strengths of mobile health apps. Taking users' feedback into consideration could increase the chance of sustained use. Besides ease of use and clear, likeable designs, users want apps that serve their needs while saving time.

[Teaching otorhinolaryngology in times of COVID-19: to what extent can digital formats replace face-to-face teaching?]

OBJECTIVE

Due to the coronavirus disease 19 (COVID-19) pandemic, postgraduate training in otorhinolaryngology in 2020 was transferred completely from face-to-face to digital teaching. This paper assesses whether this change was possible without a reduction in the quality of teaching and learning.

METHODS

Results of final written examinations were compared for the years 2016-2020, and the results of the teaching evaluation by the students for 2017-2020. The evaluation by students in 2020 included additional questions related to the switch from face-to-face to digital teaching. Additionally, the lecturers and teachers were asked for their assessments.

RESULTS

Results of the final written examination did not show any significant differences between 2016-2019 and 2020. Students were highly satisfied with the digital format, but values did not reach the level of former years with face-to-face-teaching. Especially the interaction with patients and the teaching of manual skills were rated lower in the digital format. Lecturers emphasized the additional workload for preparation of digital teaching.

CONCLUSION

The results of written examinations showed no difference between digital and face-to-face teaching. Online communication and interaction were reduced and regarded as cumbersome by students and faculty. Digital solutions providing more interaction and active participation are required. The digital format is more appropriate for teaching basic knowledge than for teaching practical skills.

Corrigendum to: Identification of salt tolerance QTL in a wheat RIL mapping population using destructive and non-destructive phenotyping

Bread wheat (Triticum aestivum L.) is one of the most important food crops, however it is only moderately tolerant to salinity stress. To improve wheat yield under saline conditions, breeding for improved salinity tolerance of wheat is needed. We have identified nine quantitative trail loci (QTL) for different salt tolerance sub-traits in a recombinant inbred line (RIL) population, derived from the bi-parental cross of Excalibur × Kukri. This population was screened for salinity tolerance subtraits using a combination of both destructive and non-destructive phenotyping. Genotyping by sequencing (GBS) was used to construct a high-density genetic linkage map, consisting of 3236 markers, and utilised for mapping QTL. Of the nine mapped QTL, six were detected under salt stress, including QTL for maintenance of shoot growth under salinity (QG ( 1-5 ) .asl -5A , QG ( 1-5 ) .asl -7B ) sodium accumulation (QNa.asl -2A ), chloride accumulation (QCl.asl -2A , QCl.asl -3A ) and potassium : sodium ratio (QK :Na.asl -2DS2 ). Potential candidate genes within these QTL intervals were shortlisted using bioinformatics tools. These findings are expected to facilitate the breeding of new salt tolerant wheat cultivars. Soil salinity causes major yield losses in bread wheat, which is moderately tolerant to salinity stress. Using high throughput genotyping and phenotyping techniques, we identified quantitative trail loci (QTL) for different salt tolerance sub-traits in bread wheat and shortlisted potential candidate genes. These QTL and candidate genes may prove useful in breeding for salt tolerant wheat cultivars.

Sensor-based phenotyping of above-ground plant-pathogen interactions

Plant pathogens cause yield losses in crops worldwide. Breeding for improved disease resistance and management by precision agriculture are two approaches to limit such yield losses. Both rely on detecting and quantifying signs and symptoms of plant disease. To achieve this, the field of plant phenotyping makes use of non-invasive sensor technology. Compared to invasive methods, this can offer improved throughput and allow for repeated measurements on living plants. Abiotic stress responses and yield components have been successfully measured with phenotyping technologies, whereas phenotyping methods for biotic stresses are less developed, despite the relevance of plant disease in crop production. The interactions between plants and pathogens can lead to a variety of signs (when the pathogen itself can be detected) and diverse symptoms (detectable responses of the plant). Here, we review the strengths and weaknesses of a broad range of sensor technologies that are being used for sensing of signs and symptoms on plant shoots, including monochrome, RGB, hyperspectral, fluorescence, chlorophyll fluorescence and thermal sensors, as well as Raman spectroscopy, X-ray computed tomography, and optical coherence tomography. We argue that choosing and combining appropriate sensors for each plant-pathosystem and measuring with sufficient spatial resolution can enable specific and accurate measurements of above-ground signs and symptoms of plant disease.

Hypericum perforatum to Improve Postoperative Pain Outcome After Monosegmental Spinal Sequestrectomy (HYPOS): Results of a Randomized, Double-Blind, Placebo-Controlled Trial

Introduction: Patients undergoing lumbar spine surgery often suffer from severe radicular postoperative pain leading to the prescription of high-dose opioids. In Integrative Medicine, Hypericum perforatum is known as a remedy to relieve pain caused by nerve damage. Objectives: This trial investigated whether homeopathic Hypericum leads to a reduction in postoperative pain and a decrease in pain medication compared with placebo. Design: Randomized double blind, monocentric, placebo controlled clinical trial. Settings/Location: Department of Neurosurgery, Community Hospital Herdecke. Subjects: Inpatients undergoing lumbar sequestrectomy surgery. Interventions: Homeopathic treatment versus placebo in addition to usual pain management. Outcomes Measures: Primary endpoint was pain relief measured with a visual analog scale. Secondary endpoints were the reduction of inpatient postoperative analgesic medication and change in sensory and affective pain perception. Results: Baseline characteristics were comparable between the groups. Pain perception between baseline and day 3 did not significantly differ between the study arms. With respect to pain medication, total morphine equivalent doses did not differ significantly. However, a statistical trend and a moderate effect (d = 0.432) in the decrease of pain medication consumption in favor of the Hypericum group was observed. Conclusion: This is the first trial of homeopathy that evaluated the efficacy of Hypericum C200 after lumbar monosegmental spinal sequestrectomy. Although no significant differences between the groups could be shown, we found that patients who took potentiated Hypericum in addition to usual pain management showed lower consumption of analgesics. Further investigations, especially with regard to pain medication, should follow to better classify the described analgesic reduction. Clinical Trial Registration Number: German Clinical Trials Register No: DRKS00007913.

Evaluation of commercial composts and potting mixes and their ability to support arbuscular mycorrhizal fungi with maize (Zea mays) as host plant

The use of composts and potting mixes in food production systems is a promising way to counteract the effects of soil degradation and allows crop growth in soilless culture systems. Arbuscular mycorrhizal fungi (AMF) are a well-studied group of beneficial plant symbionts that have been shown to provide important ecosystem services. This study analysed the properties of nine commercial Australian potting mixes and composts and investigated whether they support colonization of maize plants with AMF in a plant growth bioassay. Physicochemical analyses showed highly variable properties between the substrates, with some extreme values that limited plant growth. DNA-based analysis revealed the presence of various plant pathogens, which was linked to inhibited plant growth in one substrate. Some substrates did not meet national quality standards, due to the concentrations of plant nutrients, heavy metals, or substrate maturity. Plant growth was mostly limited due to nitrogen immobilization, which required weekly fertilizer applications. Solid state ¹³C nuclear magnetic resonance spectroscopy gave insight into the decomposition state of the substrates. Plant roots in most substrates were well colonized with AMF (>60% root length), regardless of most substrate properties. Root colonization was negatively affected in only one substrate, likely due to ammonium toxicity. Results of this study show that not all commercial substrates adhered to national quality standards. Potting mixes and composts can support high mycorrhizal root colonization when plant growth is otherwise not limited.

Identifying the genetic control of salinity tolerance in the bread wheat landrace Mocho de Espiga Branca

Salinity tolerance in bread wheat is frequently reported to be associated with low leaf sodium (Na+) concentrations. However, the Portuguese landrace, Mocho de Espiga Branca, accumulates significantly higher leaf Na+ but has comparable salinity tolerance to commercial bread wheat cultivars. To determine the genetic loci associated with the salinity tolerance of this landrace, an F2 mapping population was developed by crossing Mocho de Espiga Branca with the Australian cultivar Gladius. The population was phenotyped for 19 salinity tolerance subtraits using both non-destructive and destructive techniques. Genotyping was performed using genotyping-by-sequencing (GBS). Genomic regions associated with salinity tolerance were detected on chromosomes 1A, 1D, 4B and 5A for the subtraits of relative and absolute growth rate (RGR, AGR respectively), and on chromosome 2A, 2B, 4D and 5D for Na+, potassium (K+) and chloride (Cl-) accumulation. Candidate genes that encode proteins associated with salinity tolerance were identified within the loci including Na+/H+ antiporters, K+ channels, H+-ATPase, calcineurin B-like proteins (CBLs), CBL-interacting protein kinases (CIPKs), calcium dependent protein kinases (CDPKs) and calcium-transporting ATPase. This study provides a new insight into the genetic control of salinity tolerance in a Na+ accumulating bread wheat to assist with the future development of salt tolerant cultivars.

Yoga, Eurythmy Therapy and Standard Physiotherapy (YES-Trial) for Patients With Chronic Non-specific Low Back Pain: A Three-Armed Randomized Controlled Trial

We aimed to evaluate the effects of yoga and eurythmy therapy compared to conventional physiotherapy exercises in patients with chronic low back pain. In a three-armed, multicentre, randomized controlled trial, patients with chronic low back pain were treated for 8 weeks in group sessions (75 minutes once per week). Primary outcome was patients' physical disability (measured by RMDQ) from baseline to week 8. Secondary outcome variables were pain intensity and pain-related bothersomeness (VAS), health-related quality of life (SF-12) and life satisfaction (BMLSS). Outcomes were assessed at baseline, after the intervention at 8 weeks and at a 16-week follow up. Data of 274 participants were used for statistical analyses. There were no significant differences between the three groups for the primary and all secondary outcomes. In all groups, RMDQ decreased comparably at 8 weeks, but did not reach clinical meaningfulness. Pain intensity and pain-related bothersomeness decreased, while quality of life increased in all 3 groups. In explorative general linear models for the SF-12's mental health component participants in the eurythmy arm benefitted significantly more compared to physiotherapy and yoga. Furthermore, within-group analyses showed improvements of SF-12 mental score for yoga and eurythmy therapy only. All interventions were safe. Clinical Trials Register: DRKS-ID: DRKS00004651 Perspective: This article presents the results of a multicentre three-armed randomized controlled trial on the clinical effects of three 8-week programs in patients with chronic low back pain. Compared to the 'gold standard' of conventional physiotherapeutic exercises, eurythmy therapy and yoga therapy lead to comparable symptomatic improvements in patients with chronic low back pain. However, the within-group effect sizes were small to moderate and did not reach clinical meaningfulness on patients' physical disability (RMDQ).

Enantioselective Synthesis of Acyclic Orthogonally Functionalized Compounds Bearing a Quaternary Stereocenter Using Chiral Ammonium Salt Catalysis

We herein report an asymmetric protocol to access a series of orthogonally functionalized acyclic chiral target molecules containing a quaternary stereogenic center by carrying out the enantioselective α-alkylation of novel orthogonally functionalized dioxolane-containing cyanoacetates under chiral ammonium salt catalysis. By using just 1 mol % of Maruoka's spirocyclic ammonium salt catalysts enantioselectivities up to e.r.=97.5 : 2.5 could be achieved and further functional group manipulations of the products were carried out as well.

Genome-wide association study reveals the genetic complexity of fructan accumulation patterns in barley grain

We profiled the grain oligosaccharide content of 154 two-row spring barley genotypes and quantified 27 compounds, mainly inulin- and neoseries-type fructans, showing differential abundance. Clustering revealed two profile groups where the 'high' set contained greater amounts of sugar monomers, sucrose, and overall fructans, but lower fructosylraffinose. A genome-wide association study (GWAS) identified a significant association for the variability of two fructan types: neoseries-DP7 and inulin-DP9, which showed increased strength when applying a novel compound ratio-GWAS approach. Gene models within this region included three known fructan biosynthesis genes (fructan:fructan 1-fructosyltransferase, sucrose:sucrose 1-fructosyltransferase, and sucrose:fructan 6-fructosyltransferase). Two other genes in this region, 6(G)-fructosyltransferase and vacuolar invertase1, have not previously been linked to fructan biosynthesis and showed expression patterns distinct from those of the other three genes, including exclusive expression of 6(G)-fructosyltransferase in outer grain tissues at the storage phase. From exome capture data, several single nucleotide polymorphisms related to inulin- and neoseries-type fructan variability were identified in fructan:fructan 1-fructosyltransferase and 6(G)-fructosyltransferase genes. Co-expression analyses uncovered potential regulators of fructan biosynthesis including transcription factors. Our results provide the first scientific evidence for the distinct biosynthesis of neoseries-type fructans during barley grain maturation and reveal novel gene candidates likely to be involved in the differential biosynthesis of various types of fructan in barley.

Seven-day fasting as a multimodal complex intervention for adults with type 1 diabetes: Feasibility, benefit and safety in a controlled pilot study

OBJECTIVES

Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions such as metabolic syndrome, type 2 diabetes, and rheumatic diseases. Fasting for individuals with type 1 diabetes (T1D) is generally considered too risky. However, the ability and possibility to change from carbohydrate- to ketone-based fuel supply might be relevant for individuals with T1D. The aim of this patient-led research was to investigate the feasibility, benefit, and safety of a 7-d multimodal fasting intervention in individuals with T1D.

METHODS

This was a non-randomized controlled pilot study, with 20 participants with T1D and 10 without the disease. Data acquisition took place before, after, and 4 mo after the intervention and daily during intervention.

RESULTS

Of the individuals with T1D, 19 finished fasting. A mean β-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7; whereas average glucose remained between 4.9 (±1.5) and 7.5 (±2.3) mmol/L (89 ± 27 and 136 ± 40 mg/dL). Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54 (±4.4) to 68.8 (±15; P = 0.01) after fasting. There was a decrease from before until the follow-up 4 mo later of weight from 77.6 (±20.4) to 76.6 (±20.9) kg (P = 0.023) and for body mass index from 27.68 (±7.04) to 26.74 (±7.15) kg/m² (P = 0.008). Diastolic blood pressure increased from 69.75 (±11.41) to 75.74 (±8.42) mm Hg (P = 0.028) and stayed in a healthy range on average. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes compared with the reference group.

CONCLUSIONS

This study demonstrated the feasibility, benefits, and safety aspects of a 7-d fast in adults with T1D.

Switching from healthy to unhealthy oxidative stress - does the radical type can be used as an indicator?

Ultraviolet (UV) radiation leads to the formation of free radicals, which may cause immunological modulations, skin aging or skin cancer. Sunlight exposure in the UVA region according to CIE 85 promotes almost 46% of radical formation in skin. A critical radical concentration characterized by the inversion of the domination of primary ROS (reactive oxygen species) to an excess of secondary LOS (lipid oxygen species) is proven for the spectral regions UV and or VIS light and is intended to be a marker for an imbalance in the redox system, which can no longer compensate harmful effects. To investigate whether this transition point is also universally valid for one spectral region, the radical formation during and after targeted UVA in situ-irradiation at 365 ± 5 nm and three different irradiances (31, 94 and 244 mW/cm²) was investigated in ex vivo porcine skin using x-band electron paramagnetic resonance (EPR) spectroscopy. The quantification was performed with the spin probe 3-(carboxy)-2,2,5,5-tetramethylpyrrolidin-1-oxyl (PCA), the spin trap 5,5-Dimethyl-1-Pyrroline-N-Oxide (DMPO) was used to characterize the radical species. Furthermore, the viability of the skin cells after irradiation was controlled by an MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay, skin integrity was examined by histological analysis. A significant dose dependence in the radical formation is given at higher irradiance. The transition point was detected in the range of 0.5 MED after irradiation with the highest irradiance. From this point on the proportion of LOS increases with increasing dose and the proportion of ROS decreases. After switching off the UVA irradiation no further quantitative changes were detected, but rapid changes in the radical pattern were observed demonstrating the importance of in situ irradiation during the use of spin traps. Heat-pre-stressed skin showed more LOS than ROS already at the beginning of the irradiation, leading to the assumption that the transition point to the distress-level has already been reached. In summary, a postulated transition point could be verified for the UVA spectral region using only one spin trap combined with in-situ irradiation. A certain degree of stress is necessary to detect an inversion of the ratio of ROS to LOS. This reversal indicates an imbalance in the redox status. However, at low intensities no changes at all in radical pattern appeared over time (dose), probably it can be compensated by adaptation processes of the skin.

Identification of salt tolerance QTL in a wheat RIL mapping population using destructive and non-destructive phenotyping

Bread wheat (Triticum aestivum L.) is one of the most important food crops, however it is only moderately tolerant to salinity stress. To improve wheat yield under saline conditions, breeding for improved salinity tolerance of wheat is needed. We have identified nine quantitative trail loci (QTL) for different salt tolerance sub-traits in a recombinant inbred line (RIL) population, derived from the bi-parental cross of Excalibur × Kukri. This population was screened for salinity tolerance subtraits using a combination of both destructive and non-destructive phenotyping. Genotyping by sequencing (GBS) was used to construct a high-density genetic linkage map, consisting of 3236 markers, and utilised for mapping QTL. Of the nine mapped QTL, six were detected under salt stress, including QTL for maintenance of shoot growth under salinity (QG(1-5).asl-5A, QG(1-5).asl-7B) sodium accumulation (QNa.asl-2A), chloride accumulation (QCl.asl-2A, QCl.asl-3A) and potassium:sodium ratio (QK:Na.asl-2DS2). Potential candidate genes within these QTL intervals were shortlisted using bioinformatics tools. These findings are expected to facilitate the breeding of new salt tolerant wheat cultivars.

Correction to: Impact of a combined multimodal-aerobic and multimodal intervention compared to standard aerobic treatment in breast cancer survivors with chronic cancer-related fatigue - results of a three-armed pragmatic trial in a comprehensive cohort design

An amendment to this paper has been published and can be accessed via the original article.

High-throughput, image-based phenotyping reveals nutrient-dependent growth facilitation in a grass-legume mixture

This study used high throughput, image-based phenotyping (HTP) to distinguish growth patterns, detect facilitation and interpret variations to nutrient uptake in a model mixed-pasture system in response to factorial low and high nitrogen (N) and phosphorus (P) application. HTP has not previously been used to examine pasture species in mixture. We used red-green-blue (RGB) imaging to obtain smoothed projected shoot area (sPSA) to predict absolute growth (AG) up to 70 days after planting (sPSA, DAP 70), to identify variation in relative growth rates (RGR, DAP 35-70) and detect overyielding (an increase in yield in mixture compared with monoculture, indicating facilitation) in a grass-legume model pasture. Finally, using principal components analysis we interpreted between species changes to HTP-derived temporal growth dynamics and nutrient uptake in mixtures and monocultures. Overyielding was detected in all treatments and was driven by both grass and legume. Our data supported expectations of more rapid grass growth and augmented nutrient uptake in the presence of a legume. Legumes grew more slowly in mixture and where growth became more reliant on soil P. Relative growth rate in grass was strongly associated with shoot N concentration, whereas legume RGR was not strongly associated with shoot nutrients. High throughput, image-based phenotyping was a useful tool to quantify growth trait variation between contrasting species and to this end is highly useful in understanding nutrient-yield relationships in mixed pasture cultivations.

A single nucleotide substitution in TaHKT1;5-D controls shoot Na+ accumulation in bread wheat

Improving salinity tolerance in the most widely cultivated cereal, bread wheat (Triticum aestivum L.), is essential to increase grain yields on saline agricultural lands. A Portuguese landrace, Mocho de Espiga Branca accumulates up to sixfold greater leaf and sheath sodium (Na+ ) than two Australian cultivars, Gladius and Scout, under salt stress in hydroponics. Despite high leaf and sheath Na+ concentrations, Mocho de Espiga Branca maintained similar salinity tolerance compared to Gladius and Scout. A naturally occurring single nucleotide substitution was identified in the gene encoding a major Na+ transporter TaHKT1;5-D in Mocho de Espiga Branca, which resulted in a L190P amino acid residue variation. This variant prevents Mocho de Espiga Branca from retrieving Na+ from the root xylem leading to a high shoot Na+ concentration. The identification of the tissue-tolerant Mocho de Espiga Branca will accelerate the development of more elite salt-tolerant bread wheat cultivars.

A single nucleotide substitution in TaHKT1;5-D controls shoot Na+ accumulation in bread wheat

Improving salinity tolerance in the most widely cultivated cereal, bread wheat (Triticum aestivum L.), is essential to increase grain yields on saline agricultural lands. A Portuguese landrace, Mocho de Espiga Branca accumulates up to sixfold greater leaf and sheath sodium (Na⁺ ) than two Australian cultivars, Gladius and Scout, under salt stress in hydroponics. Despite high leaf and sheath Na⁺ concentrations, Mocho de Espiga Branca maintained similar salinity tolerance compared to Gladius and Scout. A naturally occurring single nucleotide substitution was identified in the gene encoding a major Na⁺ transporter TaHKT1;5-D in Mocho de Espiga Branca, which resulted in a L190P amino acid residue variation. This variant prevents Mocho de Espiga Branca from retrieving Na⁺ from the root xylem leading to a high shoot Na⁺ concentration. The identification of the tissue-tolerant Mocho de Espiga Branca will accelerate the development of more elite salt-tolerant bread wheat cultivars.

The Performances of Hyperspectral Sensors for Proximal Sensing of Nitrogen Levels in Wheat

The accurate and high throughput quantification of nitrogen (N) content in wheat using non-destructive methods is an important step towards identifying wheat lines with high nitrogen use efficiency and informing agronomic management practices. Among various plant phenotyping methods, hyperspectral sensing has shown promise in providing accurate measurements in a fast and non-destructive manner. Past applications have utilised non-imaging instruments, such as spectrometers, while more recent approaches have expanded to hyperspectral cameras operating in different wavelength ranges and at various spectral resolutions. However, despite the success of previous hyperspectral applications, some important research questions regarding hyperspectral sensors with different wavelength centres and bandwidths remain unanswered, limiting wide application of this technology. This study evaluated the capability of hyperspectral imaging and non-imaging sensors to estimate N content in wheat leaves by comparing three hyperspectral cameras and a non-imaging spectrometer. This study answered the following questions: (1) How do hyperspectral sensors with different system setups perform when conducting proximal sensing of N in wheat leaves and what aspects have to be considered for optimal results? (2) What types of photonic detectors are most sensitive to N in wheat leaves? (3) How do the spectral resolutions of different instruments affect N measurement in wheat leaves? (4) What are the key-wavelengths with the highest correlation to N in wheat? Our study demonstrated that hyperspectral imaging systems with satisfactory system setups can be used to conduct proximal sensing of N content in wheat with sufficient accuracy. The proposed approach could reduce the need for chemical analysis of leaf tissue and lead to high-throughput estimation of N in wheat. The methodologies here could also be validated on other plants with different characteristics. The results can provide a reference for users wishing to measure N content at either plant- or leaf-scales using hyperspectral sensors.

Dissecting new genetic components of salinity tolerance in two-row spring barley at the vegetative and reproductive stages

Soil salinity imposes an agricultural and economic burden that may be alleviated by identifying the components of salinity tolerance in barley, a major crop and the most salt tolerant cereal. To improve our understanding of these components, we evaluated a diversity panel of 377 two-row spring barley cultivars during both the vegetative, in a controlled environment, and the reproductive stages, in the field. In the controlled environment, a high-throughput phenotyping platform was used to assess the growth-related traits under both control and saline conditions. In the field, the agronomic traits were measured from plots irrigated with either fresh or saline water. Association mapping for the different components of salinity tolerance enabled us to detect previously known associations, such as HvHKT1;5. Using an "interaction model", which took into account the interaction between treatment (control and salt) and genetic markers, we identified several loci associated with yield components related to salinity tolerance. We also observed that the two developmental stages did not share genetic regions associated with the components of salinity tolerance, suggesting that different mechanisms play distinct roles throughout the barley life cycle. Our association analysis revealed that genetically defined regions containing known flowering genes (Vrn-H3, Vrn-H1, and HvNAM-1) were responsive to salt stress. We identified a salt-responsive locus (7H, 128.35 cM) that was associated with grain number per ear, and suggest a gene encoding a vacuolar H+-translocating pyrophosphatase, HVP1, as a candidate. We also found a new QTL on chromosome 3H (139.22 cM), which was significant for ear number per plant, and a locus on chromosome 2H (141.87 cM), previously identified using a nested association mapping population, which associated with a yield component and interacted with salinity stress. Our study is the first to evaluate a barley diversity panel for salinity stress under both controlled and field conditions, allowing us to identify contributions from new components of salinity tolerance which could be used for marker-assisted selection when breeding for marginal and saline regions.

Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study

Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients' satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson's correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = -0.60). Qualitative feedback confirmed patients' benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients' satisfaction and qualitative feedback they help refine treatment.

Smoothing and extraction of traits in the growth analysis of noninvasive phenotypic data

BACKGROUND

Non-destructive high-throughput plant phenotyping is becoming increasingly used and various methods for growth analysis have been proposed. Traditional longitudinal or repeated measures analyses that model growth using statistical models are common. However, often the variation in the data is inappropriately modelled, in part because the required models are complicated and difficult to fit. We provide a novel, computationally efficient technique that is based on smoothing and extraction of traits (SET), which we compare with the alternative traditional longitudinal analysis methods.

RESULTS

The SET-based and longitudinal analyses were applied to a tomato experiment to investigate the effects on plant growth of zinc (Zn) addition and growing plants in soil inoculated with arbuscular mycorrhizal fungi (AMF). Conclusions from the SET-based and longitudinal analyses are similar, although the former analysis results in more significant differences. They showed that added Zn had little effect on plants grown in inoculated soils, but that growth depended on the amount of added Zn for plants grown in uninoculated soils. The longitudinal analysis of the unsmoothed data fitted a mixed model that involved both fixed and random regression modelling with splines, as well as allowing for unequal variances and autocorrelation between time points.

CONCLUSIONS

A SET-based analysis can be used in any situation in which a traditional longitudinal analysis might be applied, especially when there are many observed time points. Two reasons for deploying the SET-based method are (i) biologically relevant growth parameters are required that parsimoniously describe growth, usually focussing on a small number of intervals, and/or (ii) a computationally efficient method is required for which a valid analysis is easier to achieve, while still capturing the essential features of the exhibited growth dynamics. Also discussed are the statistical models that need to be considered for traditional longitudinal analyses and it is demonstrated that the oft-omitted unequal variances and autocorrelation may be required for a valid longitudinal analysis. With respect to the separate issue of the subjective choice of mathematical growth functions or splines to characterize growth, it is recommended that, for both SET-based and longitudinal analyses, an evidence-based procedure is adopted.

[Validation of the German Version of Pediatric Self-Efficacy for Diabetes-Type-1 Scale]

INTRODUCTION

Since there is no suitable tool for measuring the specific, diabetes-related self-efficacy in children with type-1-diabetes in German language, this paper presents the construction and validation of Pediatric Self-Efficacy for Diabetes-Type-1 Scale (PSEDT-1). The intention was to develop a guideline-compliant, pediatric, revised self-efficacy scale on the basis of Grossman, Brink and Hauser̓s SED.

DESIGN

Children with type 1 diabetes (N=221) were included in a clinical, multi-centre validation study. To assess sensitivity to change, 85 of these children were asked to complete the PSEDT-1 before, immediately after, and 6 months after inpatient diabetes training. PSEDT-1 has been associated with scales that measure constructs that are similar and different in terms of content. The interpretation of the correlation results should provide information on validity. The PSEDT-1 was thus reviewed using the German Multidimensional Self-Assessment Scale (MSWS), the German questionnaire on health and illness-related control beliefs (KKG).

RESULTS

The reliability results showed a good internal consistency with Cronbach's α=0,87; the discriminatory power of the items was acceptable. Exploratory factor analysis identified 4 factors that account for 54% of the variance: 1) diabetes self-management skill, 2) (medical) insulin management competence, 3) (general) self-assertiveness, 4) autonomous self-regulation. The construct validity of PSEDT-1 has been evaluated by estimating its association with other variables. It was possible to verify the theoretically expected correlation patterns. In addition, the study results showed indications of sufficiently high sensitivity to change.

DISCUSSION

The results suggest that PSEDT-1 is a valid and reliable tool that, in addition to the scale values of the competence areas of diabetes self-management, medical management, and general self-assertion, also determines the scale value of autonomous self-regulation to assess diabetes-related self-efficacy.

Perceived effects of Tango Argentino on body experience in persons with Parkinson's disease (PD)-A qualitative study with affected persons and their partners

BACKGROUND

Persons with Parkinson's disease (PD) experience somatic and psycho-emotional limitations. As a neurodegenerative disease with increasing motor symptoms, PD changes the body experience. Embodied activities like dancing are beneficial to individuals with PD regarding mobility, balance and body feeling. The objective of this study was to assess the impact of Tango Argentino (TA) on body experience in individuals with PD.

METHODS

This qualitative study was conducted among 12 individuals with PD and their dance partners participating in TA courses for persons with PD and uses semi-standardized interviews. The heterogeneity of the sample was mainly based on the number of TA classes, so that participants were distinguished in participants with 10 h (beginners) and participants with more than 10 h (advanced). Further variance was due to different age groups and duration of disease.

RESULTS

Participants reported change on five categories of body experiences: body awareness, motor symptoms and movement, general feelings, body sensations and disease-related feelings. Participants cited a shift in body awareness and improved stability, walking safety, enhanced mobility and amelioration in gestures and facial expressions. In general, participants described reduced body fatigue, anxiety, shame and frustration and increase in joy, pride, curiosity as well as reinforcement of partnership. With regard to perception, positive and negative feelings, ease, relaxation and increase of inner congruence were reported. The experience of normality and health helped to generate greater acceptance of disease burdens and to develop self-confidence and self-assurance. Dance partners confirmed the perceptions of the dancers with PD.

CONCLUSION

The perceived effects of TA courses may be linked to a positive body awareness and body control which may be related improved motor symptoms, social and everyday life. These perceived effects should be controlled in relation to the long time change in embodied activity and body experience in persons with PD.

Greenhouse Spatial Effects Detected in the Barley (Hordeum vulgare L.) Epigenome Underlie Stochasticity of DNA Methylation

Environmental cues are known to alter the methylation profile of genomic DNA, and thereby change the expression of some genes. A proportion of such modifications may become adaptive by adjusting expression of stress response genes but others have been shown to be highly stochastic, even under controlled conditions. The influence of environmental flux on plants adds an additional layer of complexity that has potential to confound attempts to interpret interactions between environment, methylome, and plant form. We therefore adopt a positional and longitudinal approach to study progressive changes to barley DNA methylation patterns in response to salt exposure during development under greenhouse conditions. Methylation-sensitive amplified polymorphism (MSAP) and phenotypic analyses of nine diverse barley varieties were grown in a randomized plot design, under two salt treatments (0 and 75 mM NaCl). Combining environmental, phenotypic and epigenetic data analyses, we show that at least part of the epigenetic variability, previously described as stochastic, is linked to environmental micro-variations during plant growth. Additionally, we show that differences in methylation increase with time of exposure to micro-variations in environment. We propose that subsequent epigenetic studies take into account microclimate-induced epigenetic variability.

Effect of Rice GDP-L-Galactose Phosphorylase Constitutive Overexpression on Ascorbate Concentration, Stress Tolerance, and Iron Bioavailability in Rice

Ascorbate (vitamin C) is an essential multifunctional molecule for both plants and mammals. In plants, ascorbate is the most abundant water-soluble antioxidant that supports stress tolerance. In humans, ascorbate is an essential micronutrient and promotes iron (Fe) absorption in the gut. Engineering crops with increased ascorbate levels have the potential to improve both crop stress tolerance and human health. Here, rice (Oryza sativa L.) plants were engineered to constitutively overexpress the rice GDP-L-galactose phosphorylase coding sequence (35S-OsGGP), which encodes the rate-limiting enzymatic step of the L-galactose pathway. Ascorbate concentrations were negligible in both null segregant (NS) and 35S-OsGGP brown rice (BR, unpolished grain), but significantly increased in 35S-OsGGP germinated brown rice (GBR) relative to NS. Foliar ascorbate concentrations were significantly increased in 35S-OsGGP plants in the vegetative growth phase relative to NS, but significantly reduced at the reproductive growth phase and were associated with reduced OsGGP transcript levels. The 35S-OsGGP plants did not display altered salt tolerance at the vegetative growth phase despite having elevated ascorbate concentrations. Ascorbate concentrations were positively correlated with ferritin concentrations in Caco-2 cells - an accurate predictor of Fe bioavailability in human digestion - exposed to in vitro digests of NS and 35S-OsGGP BR and GBR samples.

The Development of Hyperspectral Distribution Maps to Predict the Content and Distribution of Nitrogen and Water in Wheat (Triticum aestivum)

Quantifying plant water content and nitrogen levels and determining water and nitrogen phenotypes is important for crop management and achieving optimal yield and quality. Hyperspectral methods have the potential to advance high throughput phenotyping efforts by providing a rapid, accurate, and nondestructive alternative for estimating biochemical and physiological plant traits. Our study (i) acquired hyperspectral images of wheat plants using a high throughput phenotyping system, (ii) developed regression models capable of predicting water and nitrogen levels of wheat plants, and (iii) applied the regression coefficients from the best-performing models to hyperspectral images in order to develop prediction maps to visualize nitrogen and water distribution within plants. Hyperspectral images were collected of four wheat (Triticum aestivum) genotypes grown in nine soil nutrient conditions and under two water treatments. Five multivariate regression methods in combination with 10 spectral preprocessing techniques were employed to find a model with strong predictive performance. Visible and near infrared wavelengths (VNIR: 400-1,000nm) alone were not sufficient to accurately predict water and nitrogen content (validation R2 = 0.56 and R2 = 0.59, respectively) but model accuracy was improved when shortwave-infrared wavelengths (SWIR: 1,000-2,500nm) were incorporated (validation R2 = 0.63 and R2 = 0.66, respectively). Wavelength reduction produced equivalent model accuracies while reducing model size and complexity (validation R2 = 0.69 and R2 = 0.66 for water and nitrogen, respectively). Developed distribution maps provided a visual representation of the concentration and distribution of water within plants while nitrogen maps seemed to suffer from noise. The findings and methods from this study demonstrate the high potential of high-throughput hyperspectral imagery for estimating and visualizing the distribution of plant chemical properties.

P2519Multiprofessional intervention for fostering self management capabilities for patients with chronic heart disease - development of a common curriculum (MIFeSCH)

Background

Chronic cardiovascular disease (CAD) still is the leading cause of death in industrialized countries in spite of substantial progress in diagnostics and therapy. Programs of lifestyle management are effective but insufficiently established in usual patient care. The authors provide multi professional educational courses to strengthen self management capabilities for cardiovascular patients in five different institutions in Europe since up to 20 years in modification of the program of Dr. Dean Ornish. Physicians, psychologists, dietitians and artistic and movement therapists work together in courses lasting from half a year to one year.

To implement their programs in daily care, an association of these five institutions will evaluate a common lifestyle management program in four phases: 1. development of a common curriculum, 2. pilot study, 3. interventional study, 4. implementation study.

Phase 1 is now completed. The evaluation will show, whether this lifestyle management program leads to improvement of health in patients and in the therapeutic team.

Purpose of phase 1: development of a common curriculum by the five active members of the association.

Methods

The five existing educational programs were assessed and differences between the programs themselves and other existing programs of patient education were defined. Distinctive and common features of the different institutions were recorded. Structured interviews with members of all institutions acquired content, methods and eductional goals of the interventions according to predefined criteria for patient education programs in the respective countries. The results were discussed, reflected and a common curriculum was consented.

Results

The consented multi professional curriculum, comprising the activities of five active heart education programs defines five different levels of competence which are key of their patient education goals: (1) reflective self-awareness (I-competence), (2) artistic competence, (3) competence of ensouled movement, (4) nutritional competence and (5) social competence.

The main difference between the already existing programs for patients with CAD and the newly developed curriculum is the emphasis on training the participants' self awareness and social competence, for example by biography work in an interdisciplinary approach.

Levels of competence

Conclusion

The process of generating a common curriculum of competence levels, educational goals and necessary methods comprising the work of five different but associated institutions was successful. A pilot study will now be performed to show the effects of this program on cardiovascular health and quality of live of study participants and the therapeutic team as well to show, whether this intervention reduces the risk of burn out for the therapists.

By this the authors hope to implement their education program according to the curriculum as an improvement of standard therapy for patients with cardiovascular disease.

Acknowledgement/Funding

Universität Witten-Herdecke

Resource allocation to growth or luxury consumption drives mycorrhizal responses

Highly variable phenotypic responses in mycorrhizal plants challenge our functional understanding of plant-fungal mutualisms. Using non-invasive high-throughput phenotyping, we observed that arbuscular mycorrhizal (AM) fungi relieved phosphorus (P) limitation and enhanced growth of Brachypodium distachyon under P-limited conditions, while photosynthetic limitation under low nitrogen (N) was exacerbated by the fungus. However, these responses were strongly dependent on host genotype: only the faster growing genotype (Bd3-1) utilised P transferred from the fungus to achieve improved growth under P-limited conditions. Under low N, the slower growing genotype (Bd21) had a carbon and N surplus that was linked to a less negative growth response compared with the faster growing genotype. These responses were linked to the regulation of N : P stoichiometry, couples resource allocation to growth or luxury consumption in diverse plant lineages. Our results attest strongly to a mechanism in plants by which plant genotype-specific resource economics drive phenotypic outcomes during AM symbioses.

Fasten für Menschen mit Typ-1-Diabetes (FaMeD1)

Typ-1-Diabetes mellitus (T1DM) ist eine fortschreitende und herausfordernde chronische Erkrankung, welche immer wieder neue emotionale Anpassungsleistungen erfordert 1. Im folgenden Studienprotokoll wird das geplante Vorgehen zur Überprüfung der Machbarkeit und Sicherheit einer Buchinger-Fastenintervention bei Menschen mit Typ-1-Diabetes mellitus in Hinblick auf diabetesbezogene Problembereiche und unerwünschte Ereignisse wie Ketoazidosen und schwere Unterzuckerungen vorgestellt.

High-throughput 3D modelling to dissect the genetic control of leaf elongation in barley (Hordeum vulgare)

To optimize shoot growth and structure of cereals, we need to understand the genetic components controlling initiation and elongation. While measuring total shoot growth at high throughput using 2D imaging has progressed, recovering the 3D shoot structure of small grain cereals at a large scale is still challenging. Here, we present a method for measuring defined individual leaves of cereals, such as wheat and barley, using few images. Plant shoot modelling over time was used to measure the initiation and elongation of leaves in a bi-parental barley mapping population under low and high soil salinity. We detected quantitative trait loci (QTL) related to shoot growth per se, using both simple 2D total shoot measurements and our approach of measuring individual leaves. In addition, we detected QTL specific to leaf elongation and not to total shoot size. Of particular importance was the detection of a QTL on chromosome 3H specific to the early responses of leaf elongation to salt stress, a locus that could not be detected without the computer vision tools developed in this study.

Genome-wide association of barley plant growth under drought stress using a nested association mapping population

BACKGROUND

Barley (Hordeum vulgare L.) is the fourth most important cereal crop worldwide. Barley production is compromised by many abiotic stresses including drought. Wild barley is a valuable source of alleles that can improve adaptation of cultivated barley to drought stress.

RESULTS

In the present study, a nested association mapping population named HEB-25, consisting of 1420 BC₁S₃ lines that were developed by crossing 25 different wild barley accessions to the elite barley cultivar 'Barke', was evaluated under both control and drought-stressed conditions in the Australian Plant Phenomics Facility, University of Adelaide. Overall, 14 traits reflecting the performance of individual plants in each treatment were calculated from non-destructive imaging over time and destructive end-of-experiment measurements. For each trait, best linear unbiased estimators (BLUEs) were calculated and used for genome-wide association study (GWAS) analysis. Among the quantitative trait loci (QTL) identified for the 14 traits, many co-localise with known inflorescence and developmental genes. We identified a QTL on chromosome 4H where, under drought and control conditions, wild barley alleles increased biomass by 10 and 17% respectively compared to the Barke allele.

CONCLUSIONS

Across all traits, QTL which increased phenotypic values were identified, providing a wider range of genetic diversity for the improvement of drought tolerance in barley.

Using High-Throughput Phenotyping to Explore Growth Responses to Mycorrhizal Fungi and Zinc in Three Plant Species

There are many reported benefits to plants of arbuscular mycorrhizal fungi (AMF), including positive plant biomass responses; however, AMF can also induce biomass depressions in plants, and this response receives little attention in the literature. High-throughput phenotyping (HTP) technology permits repeated measures of an individual plant's aboveground biomass. We examined the effect on AMF inoculation on the shoot biomass of three contrasting plant species: a vegetable crop (tomato), a cereal crop (barley), and a pasture legume (Medicago). We also considered the interaction of mycorrhizal growth responses with plant-available soil zinc (Zn) and phosphorus (P) concentrations. The appearance of a depression in shoot biomass due to inoculation with AMF occurred at different times for each plant species; depressions appeared earliest in tomato, then Medicago, and then barley. The usually positive-responding Medicago plants were not responsive at the high level of soil available P used. Mycorrhizal growth responsiveness in all three species was also highly interactive with soil Zn supply; tomato growth responded negatively to AMF inoculation in all soil Zn treatments except the toxic soil Zn treatment, where it responded positively. Our results illustrate how context-dependent mycorrhizal growth responses are and the value of HTP approaches to exploring the complexity of mycorrhizal responses.

Tracking Dark Excitons with Exciton Polaritons in Semiconductor Microcavities

Dark excitons are of fundamental importance for a wide variety of processes in semiconductors but are difficult to investigate using optical techniques due to their weak interaction with light fields. We reveal and characterize dark excitons nonresonantly injected into a semiconductor microcavity structure containing InGaAs/GaAs quantum wells by a gated train of eight 100 fs pulses separated by 13 ns by monitoring their interactions with the bright lower polariton mode. We find a surprisingly long dark exciton lifetime of more than 20 ns, which is longer than the time delay between two consecutive pulses. This creates a memory effect that we clearly observe through the variation of the time-resolved transmission signal. We propose a rate equation model that provides a quantitative agreement with the experimental data.

Reliability and first validity of the inner correspondence questionnaire for painting therapy (ICPTh) in a sample of breast cancer patients

Objectives Art therapy (ArT) such as mindfulness-oriented painting therapy is increasingly used in psychosomatic, oncological integrative and rehabilitative medicine. Though it remains unknown how ArT works, we hypothesize that an engaged participation with painting ('Inner-Correspondence') contributes to improved symptom scores. In the context of a comprehensive cohort study for breast cancer survivors with cancer-related fatigue, we developed a patient-reported outcome measure to assess 'Inner Correspondence' with painting therapy and conducted a first validation study. Design A 24-item questionnaire on 'Inner Correspondence' (ICPTh) was administered after ten weeks of intervention and at six month followup together with concurrent scales (Inner Correspondence and Peaceful Harmony, Cancer Fatigue Scale, Hospital Anxiety and Depression Scale, Internal Coherence Scale). Statistical assessment included reliability- and factor analyses. Results A total of n = 68 BC (mean age, 58.2 years, SD = 8.7) participated in the preliminary validation study. Exploratory factor analysis revealed a robust 22-item scale with an unambiguous four-factor solution explaining 78% of total variance and the following subsales: 1) therapy congruence and relaxation (11 items), 2) inner development and mood (6 items), 3) artistic skill (3 items) and 4) task congruence (2 items). The 22-item ICPTh yielded high reliability (Cronbach's alpha = .966, item-total correlation = .497 - .883, test-retest reliability = .888). Conclusions We present a reliable instrument to measure 'Inner Correspondence' with painting therapy. Due to the small sample size and sample selection further validation studies are indicated.

Salinity tolerance in Australian wild Oryza species varies widely and matches that observed in O. sativa

BACKGROUND

Soil salinity is widespread in rice-producing areas globally, restricting both vegetative growth and grain yield. Attempts to improve the salt tolerance of Asian rice, Oryza sativa-the most salt sensitive of the major cereal crops-have met with limited success, due to the complexity of the trait and finite variation in salt responses among O. sativa lines. Naturally occurring variation among the more than 20 wild species of the Oryza genus has great potential to provide breeders with novel genes to improve resistance to salt. Here, through two distinct screening experiments, we investigated variation in salinity tolerance among accessions of two wild rice species endemic to Australia, O. meridionalis and O. australiensis, with O. sativa cultivars Pokkali and IR29 providing salt-tolerant and sensitive controls, respectively.

RESULTS

Rice plants were grown on soil supplemented with field-relevant concentrations of NaCl (0, 40, 80, and 100 mM) for 30 d, a period sufficient to reveal differences in growth and physiological traits. Two complementary screening approaches were used: destructive phenotyping and high-throughput image-based phenotyping. All genotypes displayed clear responses to salt treatment. In the first experiment, both salt-tolerant Pokkali and an O. australiensis accession (Oa-VR) showed the least reduction in biomass accumulation, SES score and chlorophyll content in response to salinity. Average shoot Na+/K+ values of these plants were the lowest among the genotypes tested. In the second experiment, plant responses to different levels of salt stress were quantified over time based on projected shoot area calculated from visible red-green-blue (RGB) and fluorescence images. Pokkali grew significantly faster than the other genotypes. Pokkali and Oa-VR plants displayed the same absolute growth rate under 80 and 100 mM, while Oa-D grew significantly slower with the same treatments. Oa-VR showed substantially less inhibition of growth in response to salinity when compared with Oa-D. Senescence was seen in Oa-D after 30 d treatment with 40 mM NaCl, while the putatively salt-tolerant Oa-VR had only minor leaf damage, even at higher salt treatments, with less than a 40% increase in relative senescence at 100 mM NaCl compared to 120% for Oa-VR.

CONCLUSION

The combination of our two screening experiments uncovered striking levels of salt tolerance diversity among the Australian wild rice accessions tested and enabled analysis of their growth responses to a range of salt levels. Our results validate image-based phenotyping as a valuable tool for quantitative measurement of plant responses to abiotic stresses. They also highlight the potential of exotic germplasm to provide new genetic variation for salinity tolerance in rice.