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Background: Rhinoviruses (RV) are the major cause of common colds in healthy individuals and are associated with acute exacerbations in patients with chronic lung diseases. Yet, no vaccines or effective treatment against RV are available. This study investigated the effect of Euphorbium compositum SN (ECSN6), a multicomponent, multitarget medication made from natural ingredients, on the mucosal barrier network during RV infection., Methods: Mucociliary-differentiated airway epithelial cell cultures were infected with RV or sham, and treated with 20% ECSN6 or placebo twice daily. Barrier integrity was assessed by measuring transepithelial resistance (TER), permeability to inulin, and expression and localization of intercellular junctions proteins (IJ). Ciliary beat frequency (CBF), expression of pro-inflammatory cytokines, antiviral interferons and mucins, and viral load were also measured. C57BL/6 mice were infected intranasally with RV or sham and treated with 40% ECSN6 or placebo twice daily. Inflammation of sinunasal mucosa, localization of E-cadherin, viral load and mucin gene expression were determined., Results: ECSN6-treated, uninfected cell cultures showed small, but significant increase in TER over placebo, which was associated with enhanced localization of E-cadherin and ZO-1 to IJ. In RV-infected cultures, treatment with ECSN6, but not placebo prevented RV-induced (1) reduction in TER, (2) dissociation of E-cadherin and ZO-1 from the IJ, (3) mucin expression, and (4) CBF attenuation. ECSN6 also decreased RV-stimulated expression of pro-inflammatory cytokines and permeability to inulin. Although ECSN6 significantly increased the expression of some antiviral type I and type III interferons, it did not alter viral load. In vivo, ECSN6 reduced RV-A1-induced moderate inflammation of nasal mucosa, beneficially affected RV-A1-induced cytokine responses and Muc5ac mRNA expression and prevented RV-caused dissociation of E-cadherin from the IJ of nasal mucosa without an effect on viral clearance., Conclusions: ECSN6 prevents RV-induced airway mucosal barrier dysfunction and improves the immunological and mucociliary barrier function. ECSN6 may maintain integrity of barrier function by promoting localization of tight and adherence junction proteins to the IJ. This in turn may lead to the observed decrease in RV-induced pro-inflammatory responses in vitro. By improving the innate defenses of the airway mucosal barrier network, ECSN6 may alleviate respiratory symptoms caused by RV infections., Competing Interests: Declarations Ethics approval and consent to participate The collection of trachea and nasal brushings and use of airway basal cells was approved by Institutional Review Board, Temple University, Philadelphia, PA (4407) and University of Michigan Ann Arbor, MI (HUM00052806). The donors had written consents to use their lungs for research if the lungs were rejected for transplantation. All the experiments with animals were approved by Institutional Animal Care and User Committee, Temple University (Protocol # 4904). Consent for publication The donors provided written consent to publish the results if the donated lungs are used in research. All authors consented to publish the results. Competing interests KW, JD and BS were employed by Heel GmbH. The funders were involved in the design of the study, in the writing of the manuscript, and in the decision to publish the results, but did not have any influence on the outcome of the study., (© 2024. The Author(s).)

Background Signals are continuously captured during the recording of motion data. Statistical analysis, however, usually uses only a few aspects of the recorded data. Functional data analysis offers the possibility to analyze the entire signal over time. Research question The review is based on the question of how functional data analysis is used in the study of lower limb movements. Methods The literature search was based on the databases EMBASE, PUBMED and OVID MEDLINE. All articles on the application of functional data analysis to motion-associated variables trajectories, ground reaction force,electromyography were included. The references were assessed independently by two reviewers. Results In total 1448 articles were found in the search. Finally, 13 articles were included in the review. All were of moderate methodological quality. The publication year of the studies ranges from 2009 to 2019. Healthy volunteers and persons with cruciate ligament injuries, knee osteoarthritis, gluteal tendinopathy, idiopathic torsional deformities, slipped capital femoral epiphysis and chronic ankle instability were examined in the studies. Movements were analyzed on basis of kinematics (3D motion analysis), ground reaction forces and electromyography. Functional Data Analysis was used in terms of landmark registration, functional principal component analysis, functional t-test and functional ANOVA. Significance Functional data analysis provides the possibility to gain detailed and in-depth insights into the analysis of motion patterns. As a result of the increase in references over the past year, the FDA is becoming more important in the analysis of continuous signals and the explorative analysis of movement data., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Early retirements make up a large portion of indirect costs of illness caused by chronic back pain., Methods: Claims data from statutory health insurance and German Pension Fund provide the basis for analysis. Cox-Regression was performed for duration to early retirement, whereby beside sociodemographic and treatment characteristics, the effect of rehabilitation was considered., Results: Early retirement started on average 7.1 month later through rehabilitation. Therefore, rehabilitants made € 8,432.60 higher payments to statutory health insurance and German Pension Fund per rehabilitant. Based on the total number of 21,262 early retirees with orthopedic indications, this can save € 180.7 million. The timing of the early retirement was also affected by age and sickness benefits in the previous month. Savings by avoiding entry into early retirement have not yet been taken into account in this model., Conclusion: Rehabilitants receive later pensions due to reduced ability, which allow for more contributions to statutory health insurance and German Pension Fund. This indicates that medical rehabilitation is an economic and effective treatment., Competing Interests: Prof. Dr. med. Gert Krischak ist an der Moor-Heilbad Buchau gGmbH beschäftigt. Dr. biol. hum. Lena Tepohl, Dr. biol. hum. Rainer Kaluscha und Dr. biol. hum. Julia Dannenmaier sind am IFR Ulm tätig. Das IFR Ulm wird von einer gemeinnützigen Stiftung getragen, die Stifter sind die Deutsche Rentenversicherung Baden-Württemberg, die Waldburg-Zeil-Kliniken GmbH & Co., das Universitätsklinikum Ulm, die RehaZentren der Rentenversicherung Baden-Württemberg, das Therapiezentrum Federsee und Nanz Medico: ZAR- Zentren für ambulante Rehabilitation. Ulrich Hartschuh ist für die Deutsche Rentenversicherung Baden-Württemberg tätig, Desiree Immel für die AOK Baden-Württemberg. Die Studie wurde von der Deutsche Rentenversicherung Baden-Württemberg und der AOK Baden-Württemberg finanziert., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Chronic back pain is the most common indication in medical rehabilitation. Numerous studies hint on positive effects of rehabilitation on health state. However, there is no evidence about the effectiveness of rehabilitation due to the lack of a valid comparison group., Methods: Based on combined secondary data from German Pension Fund and statutory health insurance, a comparison group of insured persons was identified by their typical patient career that did not apply for rehabilitation for unclear reasons. Effectiveness was measured by direct and indirect costs of back pain between rehabilitants and non-rehabilitants., Results: Costs of rehabilitation split in 2.742 € direct costs and 2.597 € indirect costs. In the 2 years following rehabilitation, rehabilitants were hospitalized less frequent and caused less indirect costs due to disability. Therefore, the benefit of rehabilitation was 727 € in the first year after rehabilitation and additional 37 € in the subsequent year., Conclusion: Rehabilitation for chronic back pain contributes to maintain the ability to work. Moreover, rehabilitation reduces duration of disability and healthcare utilization, hence direct and indirect costs of illness are lowered compared to a treatment without rehabilitation. Effects of rehabilitation by avoidance and delay of retirement are not yet recorded., Competing Interests: Prof. Dr. med. Gert Krischak ist an der Moor-Heilbad Buchau gGmbH beschäftigt. Dr. biol. hum. Lena Tepohl, Dr. biol. hum. Rainer Kaluscha und Julia Dannenmaier sind am IFR Ulm tätig. Das IFR Ulm wird von einer gemeinnützigen Stiftung getragen, die Stifter sind die Deutsche Rentenversicherung Baden-Württemberg, die Waldburg-Zeil-Kliniken GmbH & Co., das Universitätsklinikum Ulm, die RehaZentren der Rentenversicherung Baden-Württemberg, das Therapiezentrum Federsee und Nanz Medico: ZAR-Zentren für ambulante Rehabilitation. Ulrich Hartschuh ist für die Deutsche Rentenversicherung Baden-Württemberg tätig, Ramona Auer für die AOK Baden-Württemberg. Die Studie wurde von der Deutsche Rentenversicherung Baden-Württemberg und der AOK Baden-Württemberg finanziert., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The aim of this study was to examine which factors predict rehabilitation setting (inpatient vs. outpatient) after hospitalization in order to indicate the meaning of severity for access to a certain kind of rehabilitation., Methods: All patients with surgery for hip or knee (joint) endoprosthesis or disc surgery between 2005 and 2010 were selected for analysis from anonymized data from statutory health insurance (AOK Baden-Württemberg) and German Pension Fund (Bund as well as Baden-Württemberg). Logistic regression was performed for outpatient vs. inpatient rehabilitation., Results: Patients from all surgery groups utilize more often inpatient rehabilitation, if they started treatment immediately after hospitalization than patients that start treatment after a period at home. With increasing age as well as comorbidities patients use more inpatient rehabilitation. The probability for inpatient rehabilitation decreased between 2005 and 2009., Conclusion: Beneath severity also context factors seem to be issues for the choice of inpatient or outpatient rehabilitation. For a demand-orientated access to a certain kind of rehabilitation, environmental conditions like support by family or accessibility to therapeutic, nursing or medical assistance and medical parameters like severity should be weighed against each other., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: After total hip and knee arthroplasty, patients have different options of subsequent treatment: an early postoperative rehabilitation, with or without a period at home, or only outpatient services. The aim of this study was to identify factors predicting the utilization of an early postoperative rehabilitation., Methods: This cross-sectoral analysis is based on claims data of AOK Baden-Württemberg (Statutory Health Insurance), Deutsche Rentenversicherung Bund and Deutsche Rentenversicherung Baden-Württemberg (German Pension Insurance). Predictors for participation in an early postoperative rehabilitation and for an interim period were determined using logistic regression analysis., Results: 82.6% of 9 232 patients were going to an early postoperative rehabilitation after total hip arthroplasty. After total knee arthroplasty, 83.9% of 7 656 patients were utilizing postoperative rehabilitation. Moreover, there was less utilization of postoperative rehabilitation in young, male and foreign patients. The analysis shows that the utilization of post-acute rehabilitation was significantly predicted by sociodemographic variables (age, sex, nationality) as well as comorbidity, outpatient treatment and medication., Conclusion: The results provide an indication of higher severity of patients in group "postoperative rehabilitation without a period at home". Nevertheless there are some indications for under-utilization of certain patient groups., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Respiratory viruses such as respiratory syncytial virus (RSV) or rhinovirus are one of the major causes for respiratory tract infections causing common cold disease. Respiratory viral infections range from mild symptoms in adults to serious illness especially in the very young or elderly as well as patients suffering from lung diseases or being immunocompromised due to other reasons. Engystol (EGY-2) is a multicomponent, multitarget preparation consisting of Vincetoxicum hirundinaria and Sulfur in various dilutions. The study objective was to test the effect of EGY-2 on the innate immune response during the early onset of respiratory viral infection in vivo as exemplified in a mouse model of RSV-induced respiratory inflammation., Methods: Naïve BALB/c mice were infected with 1x106 infectious units RSV A2 intranasally to cause a mild respiratory infection. EGY-2 was administered daily per oral gavage starting seven days prior to RSV infection at doses of 0.4 to 5.1 tablets/kg. Control groups received placebo treatment. Animals were sacrificed 1 to 3 days post infection (p.i.) to analyse the infection and induced immune response in the lung. Viral load in bronchoalveolar lavage fluid (BALF) and lung homogenate was determined by TCID50 assay as well as immunofluorescence staining of BALF cells using anti-RSV antibody and microscopic analysis. The RSV induced immune response was assessed by evaluation of BALF differential cell count, BALF cytokine secretion and analysis of the phagocytic capacity of alveolar macrophages., Results: EGY-2 significantly reduced the RSV induced neutrophil and early lymphocyte influx on day 1 p.i. in BALF. EGY-2 treatment significantly diminished the RSV induced secretion of pro-inflammatory cytokines such as IFN-γ, IL-1β, IL-6, KC and TNF-α at day 1. EGY-2 treatment was not protective for RSV infection per se, as no alteration in the viral load in lung and BALF was detected. Enhanced numbers of phagocytic-active macrophages were observed in EGY-2 treated animals on day 1 and this macrophage population showed strongly enhanced phagocytic activity on day 1 and day 3., Conclusion: The data suggest a beneficial immunomodulatory effect of EGY-2 during early onset of respiratory viral infection in vivo, mediated by stimulation of macrophage phagocytosis, resulting in a reduced innate inflammatory response in terms of neutrophil and early lymphocyte infiltration as well as reduced inflammatory cytokine secretion.

Objective: The aim of this study was a comparison of treatment results in the year after disk surgery between the following treatment groups: rehabilitation immediately after discharge from hospital, rehabilitation with a transition time (at home) up to twenty days after rehabilitation or no rehabilitation., Methods: On basis of claims data from a statutory health insurance and the German Federal Pension Fund the comparison of treatment results was performed. Therefore, duration of disability, return to work and early retirement are considered as treatment results and are analyzed using general linear models (GLM). Furthermore utilization of occupational rehabilitation was compared between the treatment groups with logistic regression., Results: Rehabilitants showed a lower risk of unemployment. Moreover, rehabilitants utilize more often occupational rehabilitation. Both rehabilitation treatment groups had a higher duration of disability (including duration of rehabilitation) in the first quarter after surgery. Afterwards the duration of disability decreased faster. Risk of early retirement was higher in patients that started rehabilitation immediately., Conclusion: Rehabilitants tend to have better treatment results in the year following disc surgery., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The aim of this study was to identify relevant factors that influence utilization and interim period between hospitalization and postoperative rehabilitation after disk surgery. Logistic regression was performed for utilization of an early postoperative rehabilitation and for an interim period, when patients were going to a rehabilitation facility (directly after hospitalization or after a period at home) on claims data from statutory pension insurance and statutory health insurance. Increased utilization of postoperative rehabilitation was found in older and German patients. Moreover, adiposity and additional physiotherapy in hospital increased the utilization of postoperative rehabilitation, while blood transfusion during hospitalization was an inhibiting factor.Female gender, older age and additional physiotherapy in hospital decreased the probability for an interim period between hospitalization and postoperative rehabilitation. However, the probability for an interim period increased from 2005 to 2010. Utilization and interim period between hospitalization and postoperative rehabilitation meet patient's needs and seem adequate. Nevertheless, there are indications for under-utilization of certain patient groups (foreign citizens, unemployed persons, male patients)., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Effects of a combined orthopedic and psychosomatic rehabilitation (VOP) concept are evaluated in contrast to psychosomatic and orthopedic rehabilitation. Therefore both mental and physical health of rehabilitants are compared. Methods: A prospective case-control study was performed in order to gather psychic strain and bodily constitution. Covariance analysis was conducted to expose significant differences between groups. Results: An equal clinically relevant reduction of psychological distress could be achieved with psychosomatic rehabilitation (N=322) and VOP (N=511). Moreover, bodily constitution could be increased by the same amount through VOP and orthopedic rehabilitation (N=135). In conclusion the therapy concept is successful in patients with both somatic and psychic problems., (© Georg Thieme Verlag KG Stuttgart · New York.)