This study aimed to explore the epidemiological circumstances, long-term clinical outcomes, and perceived impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on elite athletes’ sports performance. A secondary objective was to determine the sports-specific (contact vs. noncontact) prevalence of SARS-CoV‑2 among 65 SARS-CoV-2-positive athletes from the Olympic Training Center Rhineland (OSP; n = 599). In all, 65 SARS-CoV-2-positive athletes from the German Olympic Training Center (OSP; 66

Background: Analysis of drug abuse is frequently performed using high-performance liquid chromatography with an MS/MS detector and electrospray ionization. In this context, matrix effects, like signal reduction by ion suppression of individual analytes, play an important role. In this study, the authors evaluated the matrix effect caused by polyethylene glycol (PEG) with chain lengths ranging from 6 to 12 repeating units in drug analysis by LC-MS/MS. Selected chain lengths were used in the Ruma urine marker system. Methods and Results: Amphetamines, opiates, opioids, antidepressants, psychotics, benzodiazepines, z-substances, and individual drugs, including THCCOOH, cocaine, LSD, and some of their metabolites were investigated. The matrix effect was investigated at PEG concentrations of 500 mcg/mL and 20 mcg/mL. The effect of each PEG molecule was determined. Furthermore, the effects of different common sample preparations on the PEG matrix effects were evaluated. There was a strong correlation between the retention time of PEG and the drug that was ion-suppressed by PEG. The matrix effect decreased to the point where it was within an acceptable range at the lower PEG concentrations investigated in this study. Conclusions: Matrix effects were observed for drugs with approximately the same retention times as the individual PEGs. The influence of the different workup methods was not as clear, which may be because of the similar solubilities of the PEGs and some analytes. At low PEG concentrations, the matrix effect was always below 60%, except for nortilidine. All the drugs were detectable. The effect on quantification was less than 15% for substances with deuterated analytes as internal standards and less than 32% for analytes without their own internal standards.

Zusammenfassung Ziel der Studie Die Kontrolle der Adhärenz gehört unabdingbar zur Therapie drogenabhängiger Patient:innen. Die dazu meistgenutzte Matrix ist der Urin, bei deren Gewinnung bis vor kurzem die Sichtkontrolle beim Urinieren oder bei der Einnahme einer Urinmarkersubstanz notwendig war, um mögliche Manipulationen aufzudecken. In den letzten Jahren wurde ein telemedizinisches Verfahren entwickelt (Ruma Digital-System (Pro), Ruma GmbH, Deutschland), bei dem der/die Patient:in während einer zweiminütigen Smartphone-Videoaufzeichnung mit offline-Kontrolle eine Urinmarker-Substanz schluckt (Polyethylenglykole) und die nachfolgende Urinprobe selbstständig an das zuständige Labor verschickt. In der vorliegenden Beobachtungsstudie wurde überprüft, ob es eine Patientengruppe mit bestimmten Merkmalen ist, die das telemetrische Verfahren akzeptiert, inwieweit das Ruma Digital-System (Pro) für Interessierte auch nach mehrmaliger Nutzung als Kontrolle der Beigebrauchsfreiheit vorstellbar ist und welche Vor- und Nachteile aus dem telemetrischen Verfahren hervorgehen. Methodik Die Gruppenzuordnung der Patient:innen erfolgte auf freiwilliger Basis. Insgesamt 133 Patient:innen (48 Frauen, 85 Männer) nahmen in einer Kontroll- (KG, n=65) und einer Interventionsgruppe (IG, n=68) teil. IG verwendete das Ruma Digital-System (Pro), bei KG wurden die Urinproben unter Sichtkontrolle genommen. Unmittelbar nach der ersten (TK1) und nach der 5. Urinkontrolle (8 bis 12 Wochen, TK5) wurde der psycho-sozial orientierte Fragebogen PARADISE 24 eingesetzt, in der Interventionsgruppe wurden zusätzlich Fragen zum Umgang und der Zufriedenheit mit dem Ruma-Digital-System (Pro) gestellt. Die Antworten dieser Fragen wurden in Quartilen der PARADISE 24 Ergebnisse zum Zeitpunkt TK5 differenziert. Ergebnisse Die Patient:innen, die sich für das Ruma Digital-System (Pro) entschieden, waren überwiegend jünger, männlich und hatten geringere psycho-soziale Schwierigkeiten. Im beobachteten Zeitraum verstärkte sich die Akzeptanz für das telemedizinische Verfahren. In dieser Gruppe kam es zu folgenden Veränderungen: Die überwiegende Mehrheit der Patient:innen hatte ein verringertes Schamgefühl bei der Urinkontrolle, konnte ihren Alltag besser bewältigen und würde das Verfahren weiterempfehlen. Bei ca. zwei Drittel der Patient:innen kam es zu einer Zeitersparnis infolge des Wegfalls von Anreise- und Wartezeiten für die Kontrolle. Schlussfolgerung Das telemedizinische Verfahren stärkt die Selbstwirksamkeit derjenigen Patient:innen, die das System akzeptieren. Es ist psychologisch gegenüber der Sichtkontrolle weniger belastend und kann auch im Falle einer pandemischen Lage für die Kontrolle der Therapietreue uneingeschränkt genutzt werden.

Purpose Monitoring adherence is an essential part of the therapy of drug-dependent patients. The most commonly used matrix for this purpose is urine, which until recently required direct supervision when urinating or when ingesting a urine marker substance in order to detect possible manipulations. In recent years, a telemedical procedure has been developed (Ruma Digital-System (Pro), Ruma GmbH, Germany), in which the patient swallows a urine marker substance (polyethylene glycols) during a two minute smartphone video recording with offline verification and then sends the subsequent urine sample to the appropriate laboratory on their own accord. In the present observational study, it was examined whether it is a patient group with certain characteristics that accepts the telemetric method, to what extent the Ruma Digital System (Pro) can be imagined for those interested after repeated use, and what advantages and disadvantages result from the telemetric procedure.Methods Assignment to two groups was executed on a voluntary basis. A total of 133 patients (48 women, 85 men) participated in a control group (CG, n=65) and an intervention group (IG, n=68). IG used Ruma Digital-System (Pro), in CG urine samples were collected under direct observation. Immediately after the first (TK1) and after the fifth urine testing (8 to 12 weeks, TK5) the psycho-socially oriented questionnaire PARADISE24 was applied with additional questions regarding handling of and content with Ruma Digital-System (Pro) for the intervention group. The answers to these questions were differentiated into quartiles of the PARADISE 24 results at time TK5.Results Patients who entered IG were predominantly younger, male and had fewer psycho-social difficulties. In the observed period, acceptance of the procedure increased. The following changes occurred in this group: The majority of the patients had a reduced feeling of shame during the urine test, were able to cope better with their everyday life and would recommend the procedure to others. About two third of patients saved time as a result of the elimination of travel and waiting times for the tests.Conclusion The telemedical procedure strengthens the self-efficacy of those patients who accept the system. It is psychologically less stressful than direct observation and can also be used without restrictions for adherence monitoring in the event of a pandemic situation.

At the end of 2020, in Germany a discussion broke out whether the past year was characterized by excess mortality. The opposite positions arose primarily from the way data was processed. In order to correct systematic trends of the last two decades, in the present study the annual death rates for Germany were calculated as the difference to those of the year 2000 and a polynomial fit of 2nd order was carried out for the total population and for the groups of people below and from 80 years of age. There were high coefficients of determination with R2 = 0.965, R2 = 0.982, and R2 = 0.991, respectively. The residuals of the individual years were interpreted as under or excess mortality. For the total population there were excess mortality rates for 2020 and 2021 with 11 500 and 10 468 deaths respectively, which in which in total is completely covered by the excess mortality of those aged 80 and over. In the age group below 80 years there was no excess mortality in the two years. For all age groups, excess mortality was most prominent in the year 2003.

Purpose: In the fight against drug abuse, Polyethylene Glycol (PEG) markers have become an established method to prevent false negative results by means of donor urine or own clean urine that has been stored beforehand. Until now, little is known about the influence of meal composition, time interval between meal and PEG marker ingestion, and acute urine dilution on PEG marker detection.Aims: In the present study we investigated the detectability of monodisperse PEG markers under field conditions with variable meal compositions, caloric intakes, and drink behaviors.Methodology: 448 subjects (272 females and 176 males) took part in the study. Six study centers recruited subjects for 2 runs differing in the time interval between capsule marker intake and urine sampling (40 and 60 mins). Two different meal compositions (either carbohydrate or fat-protein rich) and three different delays between meal completion and marker intake were tested (30, 60 and 120 min.). Food and beverage intake could be made ad libitum but were protocolled. Capsules containing either a PEG 8/PEG 10 or a PEG8/PEG 12 combination with 150 mg, each served as PEG markers. PEG concentrations from PEG 8 to PEG 12 were determined by liquid chromatography mass spectrometry. Individual thresholds for positive PEG detection were used by means of the concentrations of non-administered PEGs.Main results: Both the caloric and the fluid intake significantly influenced PEG marker concentrations in urine. The 40 mins resorption phase led to a detection rate between 81% and 100%. All subjects were tested positive for PEG markers following the 60 mins resorption phase.Conclusion: The marker detection following a PEG marker containing capsule is a valid method, when individual thresholds and a marker resorption phase of 60 mins are taken into account. That holds true independently of the time interval between meal and marker intake, meal composition, and beverage volume.

The aim of this pilot study was to investigate whether there are differences in heart rate and oxygen uptake kinetics in type 2 diabetes patients, considering their cardiovascular medication. It was hypothesized that cardiovascular medication would affect heart rate and oxygen uptake kinetics and that this could be detected using a standardized exercise test. 18 subjects were tested for maximal oxygen uptake. Kinetics were measured in a single test session with standardized, randomized moderate-intensity work rate changes. Time series analysis was used to estimate kinetics. Greater maxima in cross-correlation functions indicate faster kinetics. 6 patients did not take any cardiovascular medication, 6 subjects took peripherally acting medication and 6 patients were treated with centrally acting medication. Maximum oxygen uptake was not significantly different between groups. Significant main effects were identified regarding differences in muscular oxygen uptake kinetics and heart rate kinetics. Muscular oxygen uptake kinetics were significantly faster than heart rate kinetics in the group with no cardiovascular medication (maximum in cross-correlation function of muscular oxygen uptake vs. heart rate; 0.32±0.08 vs. 0.25±0.06; p=0.001) and in the group taking peripherally acting medication (0.34±0.05 vs. 0.28±0.05; p=0.009) but not in the patients taking centrally acting medication (0.28±0.05 vs. 0.30±0.07; n.s.). It can be concluded that regulatory processes for the achievement of a similar maximal oxygen uptake are different between the groups. The used standardized test provided plausible results for heart rate and oxygen uptake kinetics in a single measurement session in this patient group.

Cardiorespiratory kinetics were analyzed in type 2 diabetes patients before and after a 12-week endurance exercise-training intervention. It was hypothesized that muscular oxygen uptake and heart rate (HR) kinetics would be faster after the training intervention and that this would be detectable using a standardized work rate protocol with pseudo-random binary sequences. The cardiorespiratory kinetics of 13 male sedentary, middle-aged, overweight type 2 diabetes patients (age, 60 ± 8 years; body mass index, 33 ± 4 kg·m-2) were tested before and after the 12-week exercise intervention. Subjects performed endurance training 3 times a week on nonconsecutive days. Pseudo-random binary sequences exercise protocols in combination with time series analysis were used to estimate kinetics. Greater maxima in cross-correlation functions (CCFmax) represent faster kinetics of the respective parameter. CCFmax of muscular oxygen uptake (pre-training: 0.31 ± 0.03; post-training: 0.37 ± 0.1, P = 0.024) and CCFmax of HR (pre-training: 0.25 ± 0.04; post-training: 0.29 ± 0.06, P = 0.007) as well as peak oxygen uptake (pre-training: 24.4 ± 4.7 mL·kg-1·min-1; post-training: 29.3 ± 6.5 mL·kg-1·min-1, P = 0.004) increased significantly over the course of the exercise intervention. In conclusion, kinetic responses to changing work rates in the moderate-intensity range are similar to metabolic demands occurring in everyday habitual activities. Moderate endurance training accelerated the kinetic responses of HR and muscular oxygen uptake. Furthermore, the applicability of the used method to detect these accelerations was demonstrated.

OBJECTIVE:Runners are prone to delayed onset muscle soreness (DOMS) during long distance training. This especially holds for unaccustomed training volumes at moderate to high intensities. We investigated the effects of a marine oil complex, PCSO-524®, derived from the New Zealand green-lipped mussel (formulated as Lyprinol® and Omega XL®) on DOMS after a 30 km training run. METHODS:Initially, peak oxygen uptake of 32 distance runners (4 female, 28 male; median age 45 years, range 28-53) was measured on a treadmill with a 1.5 km hour(-1) increase every 4 minutes starting from 8.5 km hour(-1). At least 1-week after this initial test, they participated in a 30 km road run at a speed corresponding to about 70% of their individual peak oxygen uptake on a flat terrain. Before and after (0, 24, and 48 hours) the run, blood concentration of creatine kinase (CK) were measured and pain sensation was determined (pain scale from 0 = no pain to 10 = extremely painful). Runners were then matched in pairs based on maximal CK and peak oxygen uptake, and allocated randomly into two different groups. One group was supplemented with 400 mg per day of PCSO-524® for 11 weeks, the other group with an olive oil placebo. After that period, CK and pain sensations were remeasured following a second 30 km run at the same speed and on the same terrain. RESULTS:The general pattern of soreness in the PCSO-524® supplemented group was reduced by 1.1 units (standard error 0.41) compared to the placebo (P < 0.05), the effects being greater in lesser trained runners (P < 0.05). CK levels were positively associated with pain sensation (P < 0.05), but trends toward lower CK in the PCSO-524® group, which were also more pronounced in the lesser trained runners, were not statistically significant. CONCLUSION:Pain sensations experienced by distance runners following a 30 km run were reduced by supplementation with the marine oil complex PCSO-524®, an effect which was greater in lesser trained runners.

The purpose of the present study was to compare muscular strength of knee extensors and arm flexor muscles of cardiac patients (n = 638) and healthy controls (n = 961) in different age groups. Isometric torques were measured in a sitting position with the elbow, hip, and knee flexed to 90(0). For statistical analysis, age groups were pooled in decades from the age of 30 to 90 years. Additionally, the influence of physical lifestyle prior to disease on muscular strength was obtained in the patients. For statistical analysis three-way ANOVA (factors age, gender, and physical activity level) was used.Both in patients and in controls a significant age-dependent decline in maximal torque could be observed for arm flexors and knee extensors. Maximal leg extensor muscle showed statistically significant differences between healthy controls and cardiac patients as well as between subgroups of patients: Physically inactive patients showed lowest torques (male: 148 +/- 18 Nm; female: 82 +/- 25 Nm) while highest values were measured in control subjects (male: 167 +/- 16 Nm; female: 93 +/- 17 Nm). In contrast, arm flexor muscles did not show any significant influence of health status or sports history.This qualitative difference between weight-bearing leg muscles and the muscle group of the upper extremity suggest that lower skeletal muscle strength in heart patients is mainly a consequence of selective disuse of leg muscles rather than any pathological skeletal muscle metabolism. Since a certain level of skeletal muscle strength is a prerequisite to cope with everyday activities, strength training is recommended as an important part of cardiac rehabilitation.

The excess post-exercise energy expenditure h as often been regarded as a significant contribution to weight loss. However, the immediate post-exercise oxygen consumption is also elevated through the resynthesis of creatinephosphate (CrP), which energetically should be attributed to the phase of exercise. Therefore, the energy metabolism after CrP-resynthesis is more likely to reflect the importance of post-exercise energy expenditure. In tire present study, 31 subjects (17 females, 14 males; BMI 29.7 +/- 7.4 kg/m(2)) participated in the tests. Energy expenditure was measured by means of spirometry over 20 ruin intervals before and from the 15th to the 35th min after their usual fitness training. 15 subjects performed exclusively endurance exercises and 16 subjects combined endurance with strength training The intensities corresponded to 50 % to 80% of the individual performance capacity, The main results were as follows: Energy expenditure correlated significantly with body weight (p < 0.01). Energy expenditure before and after training was nearly identical and amounted to 6.14 +/- 1.56 kJ/min and 6.30 +/- 1.48 kJ/min, respectively (not significant) and did not depend on the kind of training. After exercise, lipometabolism contributed 63 +/- 12% of the overall energy expenditure compared to 42 +/- 13% before training (p < 0.05). In conclusion, post-exercise energy expenditure after usual fitness training does not contribute significantly to weight loss.

Although it is well documented that persons suffering from diabetes type 2 profit from muscular activities, just a negligible amount of patients take advantage of physical exercises. During the last decade, vibration exercise (VE) could be established as an effective measure to prevent muscular atrophy and osteoporosis with low expenditure of overall exercise-time. Unfortunately, little is known about the metabolic effects of VE. In the present study we compared VE with the influence of strength training and a control group (flexibility training) on glycemic control in type 2 diabetes patients. Forty adult non-insulin dependent patients participated in the intervention. Fasting glucose concentration, an oral glucose tolerance test (OGTT), haemoglobin A1c (HbA1c), the isometric maximal torque of quadriceps muscles, and endurance capacity were evaluated at baseline and after 12 weeks of training with three training sessions per week. The main findings are: Fasting glucose concentrations remind unchanged after training. The area under curve and maximal glucose concentration of OGTT were reduced in the vibration and strength training group. HbA1c values tended to decrease below baseline date in the vibration training group while it increased in the two other intervention groups. Theses findings suggest that vibration exercise may be an effective and low time consuming tool to enhance glycemic control in type 2 diabetes patients.

UNLABELLED The increase in blood pressure during training is a disadvantage of strength training in the elderly. To reduce this effect it is generally recommended to apply lower levels of relative muscle strength with longer contraction durations or higher number of repetitions (continuous mode (CM), e. g. 50% of maximal strength, 10 to 15 repetitions without pauses). Alternatively, higher contraction forces could be combined with frequent periods of muscle relaxation and fewer repetitions (intermittent mode (IM), e. g. 80% of maximal strength, 8 repetitions consisting of 1.5 s concentric contraction, 1.5 s eccentric contraction and 3 s pause). We compared the blood pressure effects of both approaches during leg press exercise in two age groups (10 subjects aged 22 to 42 y, 9 subjects aged 60 to 72 y). Blood pressure was measured continuously by a non-invasive method (FINAPRES, Ohmeda 2300, Englewood USA). RESULTS 1. The age of the subjects had no significant influence on the slopes of blood pressure increase during the different exercise modes. 2. The frequent insertion of short (3 s) periods of muscle relaxation (IM) decreased the blood pressure response more effectively than a reduction in contraction strength alone (CM). Short muscle relaxations have an immediate, mechanical effect on blood pressure and they allow a metabolic recovery which attenuates the trend of blood pressure increase.

The loss of strength, coordination, endurance, and flexibility with increasing age is only partly due to the aging process itself. A major factor is physical activity, i.e. the influence of implicit or explicit training stimuli. All elements of physical performance can be improved through training even in the very old, if the intensity and frequency of training are adequate. For the elderly, strength and coordination are particularly important elements of training since they constitute a prerequisite for an independent way of living. To minimize the cardiovascular risks during strength training, we developed and tested a new method which leads to significantly smaller increases in blood pressure than conventional approaches.