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Background Autosomal dominant spinocerebellar ataxia (AD SCA) and Friedreich ataxia (FRDA) are neurodegenerative and neurometabolic disorders whose characteristics include progressive impairment of balance and motor functions. The causes of these disorders vary, but both involve degeneration of the cerebellum and its connections. Until now, there has been no causative therapy for the disorders. A number of research reports point out that undamaged cerebellar tissue can be able to cope with changes and learn new or different motor skills. It is for this reason that physiotherapy and other physical activities improving balance and motor coordination are essential for all patients. It is necessary to monitor and evaluate the results of therapy/physiotherapy in order to be able to suggest the most efficient symptomatic therapy concept and thereby extend the active life of patients. The Vestibular Disorders Activities of Daily Living Scale or ADLS is used for the evaluation of the daily activities of patients suffering from vestibular disorders. There is no similar scale for patients with cerebellar or sensoric ataxia. ADLS is used for patients with vestibular ataxia and for that reason we posit that it may also help AD SCA and FRDA patients. Ataxic patients with AD SCA and FRDA are typically tested using the International Cooperative Ataxia Rating scale (ICARS); Our goal is to test AD SCA and FRDA patients using the ADLS. Posturography, a diagnostic tool for balance impairment, is then used an objective scale of measurement. Methods The observed group was created from thirty ataxic patients DL thirteen diagnosed with FRDA and seventeen with AD SCA. All were assessed using the ICARS as well as ADLS. The FOOTSCAN pressure platform was used for evaluating postural stability. The patients were examined in normal standing positions and the following parameters were evaluated: Absolute deviation in front/back direction; Absolute deviation in a left/right direction; Total travelled way of the centre of pressure COP. Results ADLS showed a correlation with the ICARS (r= 0,56) and selected parameters of postural stability. Conclusions It appears that ADLS is a reasonably effective tool for clinically monitoring the neurological state of FRDA and AD SCA patients. The correlation with the ICARS (International Cooperative Ataxia Rating Scale) scale is statistically significant. Posturographic examination as an objective diagnostic tool confirms correlations between the results of ADLS and all selected posturographic parameters. [ABSTRACT FROM AUTHOR]

Background: The physical characteristics of golfers have a strong relationship with the clubhead speed (CHS), which is the main indicator of energy produced during a golf swing. However, perennial observations of development in CHS, physical characteristics, and body composition, and their long-term effects on CHS are lacking. Therefore, this study aimed to evaluate the lower body physical characteristics and body composition parameters and their relationship with clubhead speed during one and over a two-year period in junior golfers., Methods: Nineteen skilled, male, junior golfers participated in this study., Results: A significant positive relationship (P<0.05) was found between improvement in CHS and increase in the body height (r=0.56), increase in peak power of the countermovement jump (r=0.55), and squat jump (r=0.52). A near-significant positive relationship was found between improvement in CHS and increases in the fat-free mass (r=0.42; P=0.06) and peak torque of the knee extensor at an angular velocity of 60° s -1 (r=0.44; P=0.07)., Conclusions: Thus, we recommend that golf coaches work on muscle strengthening and conditioning with their players, focusing on: 1) the increase of the active muscle mass as opposed to the total body mass in relation to the acceleration of CHS; and 2) exercises to develop the muscle power (vertical jumping) and maximum lower limb strength (knee extension).

The aim of this study was to determine the differences in golf swing execution in terms of the parameters of the pelvis and thorax movement between the sexes in junior golfers and their relation to the golf club velocity. Elite female and male players (age: 15.4 ± 1.0 and 15.8 ± 1.7 years, respectively) performed 10 golf swings with a driver under laboratory conditions. Pelvis and thorax movement parameters and golf club velocities were measured using a three-dimensional motion capture system. Statistical parametric mapping analysis of pelvis-thorax coupling revealed a significant difference ( p < 0.05) between boys and girls during backswing. Analysis of variance showed a significant effect of sex on the parameters of maximal pelvic rotation (F = 6.28, p = 0.02), X-factor (F = 5.41, p = 0.03), and golf club velocity (F = 31.98, p < 0.01). No significant relationship was found between pelvis and thorax movement parameters and golf club velocity in the girls. We found a significant negative relationship between the parameters of maximal thorax rotation and golf club velocity (r = -0.941, p < 0.01) and between X-Factor and golf club velocity (r = -0.847, p < 0.05) in the boys. We suggest that these negative relationships in males were caused by the influence of hormones during their maturation and biological development, where there is decreased flexibility (lower shoulders rotation and X-factor) and growth of muscle strength (higher club head velocity).

The treatment of chronic inflammatory and degenerative diseases by low dose radiation therapy (LDRT) is promising especially for patients who were refractory for classical therapies. LDRT aims to reduce pain of patients and to increase their mobility. Although LDRT has been applied since the late 19th century, the immunological mechanisms remain elusive. Within the prospective IMMO-LDRT01 trial (NCT02653079) the effects of LDRT on the peripheral blood immune status, as well as on pain and life quality of patients have been analyzed. Blood is taken before and after every serial irradiation with a single dose per fraction of 0.5Gy, as well as during follow-up appointments in order to determine a detailed longitudinal immune status by multicolor flow cytometry. Here, we report the results of an interim analysis of 125 patients, representing half the number of patients to be recruited. LDRT significantly improved patients' pain levels and induced distinct systemic immune modulations. While the total number of leukocytes remained unchanged in the peripheral blood, LDRT induced a slight reduction of eosinophils, basophils and plasmacytoid dendritic cells and an increase of B cells. Furthermore, activated immune cells were decreased following LDRT. Especially cells of the monocytic lineage correlated to LDRT-induced improvements of clinical symptoms, qualifying these immune cells as predictive biomarkers for the therapeutic success. We conclude that LDRT improves pain of the patients by inducing systemic immune modulations and that immune biomarkers could be defined for prediction by improved patient stratification in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer KL declared a past co-authorship with authors UG and BF to the handling editor., (Copyright © 2021 Donaubauer, Becker, Weissmann, Fröhlich, Muñoz, Gryc, Denzler, Ott, Fietkau, Gaipl and Frey.)

The purpose of our study was to investigate peak torque (PT) of knee extensors (KE) and knee flexors (KF), bilateral and unilateral strength asymmetries in isokinetic testing and vertical jump height (JH), vertical ground reaction force (VGRF), and force differences ( Δ VGRF) between legs during different jump tests in professional first-line firefighters ( n = 15) competing in fire sports disciplines. There was a significant effect of jump type on JH (F 2,44 = 7.23, p < 0.05), VGRF (F 2,44 = 16.03, p < 0.05), and Δ VGRF (F 2,44 = 3.45, p < 0.05). Professional firefighters achieved a mean JH of 50.17 cm in the countermovement jump free arms and high PT of KEs (3.15 Nm/kg). No significant differences ( p > 0.05) and small effect sizes ( d < 0.3) were found between the legs when PTs were assessed. We found a slightly higher ( d = 0.53) unilateral strength ratio in non-dominant legs (58.12 ± 10.26%) compared to dominant legs (55.31 ± 7.51%). No effect of laterality was found among limb comparisons, but a higher unilateral isokinetic strength ratio was found in non-dominant legs of firefighters. A high level of strength (PT of KEs > 3 times body weight) and vertical jump performance is comparable to the performance of elite athletic populations.

Objective: The unique foot morphology and distinctive functions facilitate complex tasks and strategies such as standing, walking, and running. In those weight-bearing activities, postural stability (PS) plays an important role. Correlations among foot type, PS, and other musculoskeletal problems that increase sport injury risk are known. However, long-term associations among the foot type, the PS, and body weight (BW) distribution are lacking. Thus, the purpose of this study was to longitudinally identify changes in foot morphology, PS, and symmetry in BW distribution during adolescence among elite male soccer players., Methods: Thirty-five Czech elite male soccer players (age, 15.49 ± 0.61 years; BW, 64.11 ± 6.16 kg; body height, 174.62 ± 5.71 cm) underwent foot type, PS, and BW distribution measurements during 3 consecutive years (T1, T2, T3). The Chippaux-Smirak index (CSI), BW distribution, and centre of pressure (COP) displacement (total traveled way [TTW]) of each player for the preferred (PL) and non-preferred leg (NL) were acquired. Repeated-measures analysis of variance (RM ANOVA), Bonferroni´s post hoc tests, and partial eta-squared (ηp2) coefficient were used for investigating the effect of time on selected variables and effect size evaluation., Results: Statistically significant effect of time on CSI values (PL: F2,68 = 5.08, p < 0.01, ηp2 = 0.13 and NL: F2,68 = 10.87, p < 0.01, ηp2 = 0.24) and COP displacement values (PL: F2,68 = 5.07, p <0.01, ηp2 = 0.13; NL: F2,68 = 3.53, p <0.05, ηp2 = 0.09) for both legs over 3-years period was identified. Furthermore, the Bonferroni´s post hoc analysis revealed a significant improvement of PS values in the PL (TTWT1 = 1617.11 ± 520.22 mm vs. TTWT2 = 1405.29 ± 462.76, p < 0.05; and between TTWT1 = 1617.11 ± 520.22 mm vs. TTWT3 = 1370.46 ± 373.94, p < 0.05). Only BW distribution parameter showed no significant differences, although slightly improved over time., Conclusions: We observed changes in foot typology, PS, and BW distribution in young elite male soccer players during 3 consecutive years. Results demonstrated that changes in PS and body weight distribution under the high-load sport conditions during adolescence may improve with aging, except for foot morphology. Therefore, foot morphology should be carefully monitored to minimize sport injury risk in professional young soccer players during adolescence. Further research is necessary to determine more clear associations between these parameters, soccer-related injuries, and sport performances., Competing Interests: The authors have declared that no competing interests exist.

Background: Recent studies have questioned the value of adding whole-brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) for brain metastasis treatment. Neurotoxicity, including radiation-induced brain volume reduction, could be one reason why not all patients benefit from the addition of WBRT. In this study, we quantified brain volume reduction after WBRT and assessed its prognostic significance., Methods: Brain volumes of 91 patients with cerebral metastases were measured during a 150-day period after commencing WBRT and were compared with their pretreatment volumes. The average daily relative change in brain volume of each patient, referred to as the "brain volume reduction rate," was calculated. Univariate and multivariate Cox regression analyses were performed to assess the prognostic significance of the brain volume reduction rate, as well as of 3 treatment-related and 9 pretreatment factors. A one-way analysis of variance was used to compare the brain volume reduction rate across recursive partitioning analysis (RPA) classes., Results: On multivariate Cox regression analysis, the brain volume reduction rate was a significant predictor of overall survival after WBRT (P < 0.001), as well as the number of brain metastases (P = 0.002) and age (P = 0.008). Patients with a relatively favorable prognosis (RPA classes 1 and 2) experienced significantly less brain volume decrease after WBRT than patients with a poor prognosis (RPA class 3) (P = 0.001). There was no significant correlation between delivered radiation dose and brain volume reduction rate (P = 0.147)., Conclusion: In this retrospective study, a smaller decrease in brain volume after WBRT was an independent predictor of longer overall survival., (© The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Golfers with disability are limited in the execution of the full golf swing, but their performance in putting may be comparable because this stroke does not demand significant strength, balance and range of motion. Therefore, the aim of this study was to compare putting performance, kinetic and kinematic consistency between golfers with different disabilities and healthy athletes. The participants consisted of three disabled athletes (perinatal cerebral palsy, multiple sclerosis, below knee lower limb amputee) and three healthy golfers (age 34 ± 4.5 years, body height 178 ± 3.3 cm, body mass 83 ± 6.2 kg). The golfers' movements were recorded by active 3D markers for kinematic analyses; the subjects performed 10 trials of a 6 m putting task while standing on separate force platforms placed under each lower limb. Putting performance was measured by the distance of the final ball position to the centre of the hole. ANOVA analyses did not show any differences in clubhead speed and total ball distance from the hole. The consistency of those two parameters expressed by the coefficient of variation (CV) was CV = 0.5% or better in both groups for clubhead speed and ranged from CV = 0.40 to 0.61% in healthy and CV = 0.21 to 0.55% in disabled athletes for total error distance. The main effect ANOVA showed differences in weight shift, hip and shoulder kinematics (p < 0.05) between healthy players and all players with disability. All disabled athletes shifted their weight toward the healthy side (towards the healthy lower limb) and alternated the end of the swing. The player with below knee amputation had the lowest range of motion in the shoulder joint during the putting stroke. The players with perinatal cerebral palsy and multiple sclerosis had the largest range of motion in the hips. Putting performance of disabled golfers was similar to healthy athletes. During training of disabled players, coaches should pay attention to the specificity of a particular disability when focused on putting performance. However, individual technique should achieve the same consistency as observed in healthy players.

Introduction: Idelalisib is approved for the treatment of relapsed chronic lymphocytic leukemia together with Rituximab and for monotherapy of follicular B-cell non-Hodgkin's lymphoma and small lymphocytic lymphoma. It is a potent and selective phosphatidylinositol 3-kinase-δ (PI3K-δ) inhibitor. PI3K-δ primarily is expressed in B-cells and prevents effectively proliferation in malignant B-cells., Methods: We provide a detailed report on treatment history and photo documentation of acute adverse effects of radiation therapy with simultaneous Idelalisib medication in one case of B-CLL. Radiosensitivity tests were performed for the index patient under Idelalisib and after the addition of Idelalisib to healthy individuals' blood. Radiosensitivity in human lymphocytes was analyzed with a three color in situ hybridization assay. Primary skin fibroblasts were studied after a treatment with Idelalisib for apoptosis, necrosis and cell cycle using flow cytometry. DNA double-strand break repair was analyzed by γH2AX immunostaining., Results: The index patient presented a strong grade 2 radiodermatitis and grade 3 mucositis after irradiation with 20 Gy and a simultaneous intake of Idelalisib. Irradiations without Idelalisib medication were well tolerated and resulted in not more than grade 1 radiodermatitis. The index patient under Idelalisib had a radiosensitivity of 0.62 B/M which is in the range of clearly radiosensitive patients. A combined treatment of lymphocytes with 2 Gy and 10 nmol/l Idelalisib showed a tendency to an increased radiosensitivity. We found a clear increase of apoptosis as a result of the combined treatment in the Idelalisib dose range of 1 to 100 nmol/l compared to solely irradiated cells or solely Idelalisib treated cells (p = 0.05)., Conclusion: A combined Idelalisib radiotherapy treatment has an increased risk of side effects. However, combined therapy seems to be feasible when patients are monitored closely.

Purpose: To analyze the efficacy of a protocol-based brachytherapy (BT) boost after external beam radiation therapy (EBRT) with simultaneous chemotherapy in patients with anal carcinoma., Methods and Materials: About 190 patients have been analyzed. Around 143 patients were identified with a good clinical response at the end of EBRT. Another 47 patients received an additional BT boost to the residual tumor at 6 weeks after end of chemoradiation., Results: The 5-year incidence of local recurrence was 24% in patients with BT boost and 19% in patients without BT boost (p = 0.238). The 5-year disease-free survival rate, overall survival rate, and colostomy-free survival rate were 64% and 75% and 76.1% in the BT group and 69% (p = 0.212), 72% (p = 0.924), and 82.7% (p = 0.488) in the non-BT group. We found no differences in late toxicity between the groups., Conclusions: For patients with anal cancer with not a good response to 50-59 Gy EBRT with simultaneous chemotherapy, the further dose escalation using the BT boost up to a mean of 67.5 Gy seems to improve the clinical outcome to the same level as observed in patients with a good response to ERBT, without an increase in late side effects., (Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

Objectives: Marital status is a well-described prognostic factor in patients with gliomas but the observed survival difference is unexplained in the available population-based studies., Methods: A series of 57 elderly glioblastoma patients (≥70 years) were analyzed retrospectively. Patients received radiotherapy or chemoradiation with temozolomide. The prognostic significance of marital status was assessed. Disease complications, toxicity, and treatment delivery were evaluated in detail., Results: Overall survival was significantly higher in married than in unmarried patients (median, 7.9 vs. 4.0 months; p = 0.006). The prognostic significance of marital status was preserved in the multivariate analysis (HR, 0.41; p = 0.011). Married patients could receive significantly higher daily temozolomide doses (mean, 53.7 mg/m² vs. 33.1 mg/m²; p = 0.020), were more likely to receive maintenance temozolomide (45.7 % vs. 11.8 %; p = 0.016), and had to be hospitalized less frequently during radiotherapy (55.0 % vs. 88.2 %; p = 0.016). Of the patients receiving temozolomide, married patients showed significantly lower rates of hematologic and liver toxicity. Most complications were infectious or neurologic in nature. Complications of any grade were more frequent in unmarried patients (58.8 % vs. 30.0 %; p = 0.041) with the incidence of grade 3-5 complications being particularly elevated (47.1 % vs. 15.0 %; p = 0.004)., Conclusion: We found poorer treatment delivery as well as an unexpected severe increase in toxicity and disease complications in elderly unmarried glioblastoma patients. Marital status may be an important predictive factor for clinical decision-making and should be addressed in further studies.

Background: Autonomic arousal-responses to emotional stimuli change with age. Age-dependent autonomic responses to music-onset are undetermined., Objective: To determine whether cardiovascular-autonomic responses to "relaxing" or "aggressive" music differ between young and older healthy listeners., Methods: In ten young (22.8±1.7 years) and 10 older volunteers (61.7±7.7 years), we monitored respiration (RESP), RR-intervals (RRI), and systolic and diastolic blood pressure (BPsys, BPdia) during silence and 180second presentations of two "relaxing" and two "aggressive" classical-music excerpts. Between both groups, we compared RESP, RRI, BPs, spectral-powers of mainly sympathetic low-frequency (LF: 0.04-0.15Hz) and parasympathetic high-frequency (HF: 0.15-0.5Hz) RRI-oscillations, RRI-LF/HF-ratios, RRI-total-powers (TP-RRI), and BP-LF-powers during 30s of silence, 30s of music-onset, and the remaining 150s of music presentation (analysis-of-variance and post-hoc analysis; significance: p<0.05)., Results: During silence, both groups had similar RRI, LF/HF-ratios and LF-BPs; RESP, LF-RRI, HF-RRI, and TP-RRI were lower, but BPs were higher in older than younger participants. During music-onset, "relaxing" music decreased RRI in older and increased BPsys in younger participants, while "aggressive" music decreased RRI and increased BPsys, LF-RRI, LF/HF-ratios, and TP-RRI in older, but increased BPsys and RESP and decreased HF-RRI and TP-RRI in younger participants. Signals did not differ between groups during the last 150s of music presentation., Conclusions: During silence, autonomic modulation was lower - but showed sympathetic predominance - in older than younger persons. Responses to music-onset, particularly "aggressive" music, reflect more of an arousal- than an emotional-response to music valence, with age-specific shifts of sympathetic-parasympathetic balance mediated by parasympathetic withdrawal in younger and by sympathetic activation in older participants., (Copyright © 2014 Elsevier B.V. All rights reserved.)