SummaryThei ntravascular manifestation of Staphylococcusa ureus infection is oftena ssociated with as evere, and sometimesc atastrophic disease.Manyh ost factors contributet oe ndothelial tropism of S.aureus including subendothelialmatrix proteins,endothelialcellreceptors,and platelets thatare engagedtogether with S. aureus cell wall adhesins such as the fibronectin binding proteins.Recently, the role of secreted staphylococcalf actors that were initiallyi dentified by virtue of their binding function with hostproteins and ligands, has been reappraisedinthis regard.Among these, bacterialproteins without significant homologyamongeach other,coagulase (Coa),the extracellular fibrinogenb inding protein (Efb), the extracellular matrix binding Keywords Staphylococcusa ureus,endothelium,extracellular adhesive protein, endovascular infection protein (Emp), or thee xtracellular adhesive protein( Eap), are the mostp rominento nest ob ea ssociated with endovascular disease.Newly discoveredi nteractions withh ost components maya ccount forp rofound effects on immunmodulation and wound healing which ares ummarized in this shortr eviewa nd which ascribe an important role of these molecules in acute and chronicendo-and extravascular staphylococcal disease.Further research in the complexfunctional role of these ''secretableexpanded repertoireadhesivemolecules'' (SERAM)may not only help to increase ourunderstanding in the pathogenesis of S.aureus infection butc an specifyn ovel targets forp reventiveo r therapeutic strategies.
ObjectiveBack pain is a major problem requiring pragmatic interventions, low in costs for health care providers and feasible for individuals to perform. Our objective was to test the effectiveness of a low-dose 5-month exercise intervention with small personnel investment on low back strength and self-perceived pain.MethodsTwo hundred twenty-six employees (age: 42.7±10.2 years) from three mid-size companies were randomized to 5-month non-supervised training at home (3 times/week for 20 minutes) or wait-list-control. Health insurance professionals instructed the participants on trunk exercises at the start and then supervised participants once a month.ResultsMuscle strength for back extension increased after the 5-month intervention with a significant between-group difference (mean 27.4 Newton [95%CI 2.2; 60.3]) favoring the exercise group (p = 0.035). Low back pain was reduced more in subjects after exercise than control (mean difference –0.74 cm [95%CI –1.17; –0.27], p = 0.002). No between-group differences were observed for back pain related disability and work ability. After stratified analysis only subjects with preexisting chronic low back pain showed a between-group difference (exercise versus controls) after the intervention in their strength for back extension (mean 55.7 Newton [95%CI 2.8; 108.5], p = 0.039), self-perceived pain (mean –1.42 cm [95%CI –2.32; –0.51], p = 0.003) and work ability (mean 2.1 points [95%CI 0.2; 4.0], p = 0.032). Significant between-group differences were not observed in subjects without low back pain: strength for back extension (mean 23.4 Newton [95%CI –11.2; 58.1], p = 0.184), self-perceived pain (mean –0.48 cm [95%CI –0.99; 0.04], p = 0.067) and work ability (mean –0.1 points [95%CI –0.9; 0.9], p = 0.999). An interaction between low back pain subgroups and the study intervention (exercise versus control) was exclusively observed for the work ability index (p = 0.016).ConclusionIn middle-aged employees a low-dose, non-supervised exercise program implemented over 20 weeks improved trunk muscle strength and low back pain, and in those with preexisting chronic low back pain improved work ability.
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