Differences in Hip and Knee Running Moments across Female Pubertal Development

Purpose This study aimed to investigate whether knee and hip running moments differ across stages of female pubertal development. Methods This was a cross-sectional study comparing the barefoot running moments of 91 prepubertal (n = 31, Tanner stage I), early/midpubertal (n = 30, Tanner stages II and III), and late/postpubertal (n = 30, Tanner stages IV and V) girls. External peak moments for knee abduction (KAbM), knee adduction (KAM), knee flexion (KFM), and knee internal rotation (KIRM) were analyzed. Secondary measures of hip adduction moment at the time of peak KAbM and hip flexion moment at the time of peak KFM were also derived. Between-group differences were analyzed using a series of one-way ANOVAs and ANCOVAs. Results At the knee, the late/postpubertal girls displayed a higher peak KFM and KAM compared with the prepubertal group (P 0.05). At the hip, both the late/postpubertal (P = 0.03) and early/midpubertal girls (P = 0.039) ran with a lower hip adduction moment at the time of peak KAbM than the prepubertal girls. The hip flexion moment at the time of peak KFM in late/postpubertal girls was also significantly lower than both the early/mid- and prepubertal girls (P

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Protocol for Objective Measurement of Infants’ Physical Activity using Accelerometry

Purpose This study aimed to evaluate methods for infants' physical activity measurement based on accelerometry, including the minimum number of measurement days and placement of a wrist or ankle device. We also evaluated the acceptability of the device among infants and mothers. Methods A cross-sectional mixed-methods study was conducted on a convenience sample of 90 infants. Physical activity was measured using the Actigraph GT3X+ accelerometer placed on the wrist and/or ankle for 7 consecutive days (worn for 24 h), and a qualitative interview was performed to verify acceptability. The intraclass correlation coefficient (ICC) method and the Bland and Altman's dispersion diagram were used to verify the minimum number of measurement days. All analyses were stratified by walking status. Results The mean (SD) age was 12.9 (1.70) months; the mean acceleration varied between 25.8 mg (95% confidence interval (CI), 14.3–52.7) and 27.3 mg (95% CI, 17.9–44.5) using the wrist placement, and between 24.9 mg (95% CI, 10.6–48.4) and 26.2 mg (95% CI, 11.7–65.6) using the ankle placement. The ICC results showed a lower acceleration variability between days among infants incapable of walking; they achieved an ICC of 0.80 with 1 d of measurement in both placements. Among those capable of walking, the minimum number of days to achieve an ICC of 0.80 was 2 d measured at the wrist (0.85; 95% CI, 0.71–0.93) and 3 d measured at the ankle (0.92; 95% CI, 0.84–0.96). The qualitative results pointed to the wrist placement as the preferred placement among the overall sample. Conclusions Two and three measurement days with the accelerometer placed on the wrist and ankle, respectively, seemed to adequately represent a week of measurement. The accelerometer placed on the wrist had better acceptance by the infants and mothers.

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Effect of Beta-blocker Treatment on V˙O2peak in Patients with Heart Failure

Purpose In addition to prolonged life and reduced hospitalization rates, it is currently unclear whether beta-blocker (BB) treatment modulates peak oxygen consumption (V˙O2peak), a hallmark of exercise capacity, in patients with heart failure (HF). The main aim of this study is to determine the effect of BB treatment on V˙O2peak in HF patients. Methods We conducted a systematic search of MEDLINE, Scopus, and Web of Science since their inceptions until March 2017 for randomized controlled trials (RCT) assessing the effect of BB treatment on V˙O2peak in chronic HF patients. A meta-analysis was performed to ascertain the standardized mean difference (SMD) between the effects of BB and placebo treatment on V˙O2peak. Secondary outcomes included peak exercise performance and New York Health Association functional class. Subgroup and meta-regression analyses assessed potential moderating factors. Results Fourteen RCT met the inclusion criteria (overall n = 616). Interventions comprised BB (n = 324) or placebo (n = 292) administration lasting 3 to 24 months. Concomitant reported medication did not differ between HF patients assigned to BB and placebo groups. After data pooling, V˙O2peak was preserved with BB compared with placebo treatment (SMD, −0.04; 95% confidence interval (CI), −0.20 to 0.12; P = 0.61); heterogeneity among studies was not detected (I2 = 0%, P = 0.88). Peak exercise performance was not altered (SMD, 0.02; 95% CI, −0.16 to 0.20; P = 0.85), whereas New York Health Association functional class was reduced with BB compared with placebo (SMD, −0.54; 95% CI, −0.90 to −0.18; P = 0.003). Conclusions According to evidence from RCT, prolonged BB (B1-selective or nonselective) treatment does not affect V˙O2peak but improves functional status in HF patients.

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Synchronizing Gait with Cardiac Cycle Phase Alters Heart Rate Response during Running

Timing foot strike to occur in synchrony with cardiac diastole may reduce left ventricular afterload and promote coronary and skeletal muscle perfusion. Purpose This study aimed to assess heart rate (HR) and metabolic responses to running when foot strikes are timed to occur exclusively during 1) the systolic phase of the cardiac cycle or 2) the diastolic phase. Methods Ten elite male distance runners performed a testing session on a treadmill at 4.72 m·s−1 while matching their steps to an auditory tone and wearing a chest strap that transmitted accelerometer and ECG signals. Testing comprised eight prompted 3-min stages, where a real-time adaptive auditory tone guided subjects to step with each ECG R-wave (systolic stepping) or alternatively, at 45% of each R-R interval (diastolic stepping), followed by a 3-min unprompted control stage. Metabolic variables were measured continuously. Results HR (P

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Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis

Purpose Evaluate the effects of a low-intensity resistance training (LI-RT) program associated with partial blood flow restriction on selected clinical outcomes in patients with knee osteoarthritis (OA). Methods Forty-eight women with knee OA were randomized into one of the three groups: LI-RT (30% one repetition maximum [1-RM]) associated (blood flow restriction training [BFRT]) or not (LI-RT) with partial blood flow restriction, and high-intensity resistance training (HI-RT, 80% 1-RM). Patients underwent a 12-wk supervised training program and were assessed for lower-limb 1-RM, quadriceps cross-sectional area, functionality (timed-stands test and timed-up-and-go test), and disease-specific inventory (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) before (PRE) and after (POST) the protocol. Results Similar within-group increases were observed in leg press (26% and 33%, all P

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Monitoring Training and Performance in Athletes

No abstract available

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Predictive Modeling of Hamstring Strain Injuries in Elite Australian Footballers

Purpose Three of the most commonly identified hamstring strain injury (HSI) risk factors are age, previous HSI, and low levels of eccentric hamstring strength. However, no study has investigated the ability of these risk factors to predict the incidence of HSI in elite Australian footballers. Accordingly, the purpose of this prospective cohort study was to investigate the predictive ability of HSI risk factors using machine learning techniques. Methods Eccentric hamstring strength, demographic and injury history data were collected at the start of preseason for 186 and 176 elite Australian footballers in 2013 and 2015, respectively. Any prospectively occurring HSI were reported to the research team. Using various machine learning techniques, predictive models were built for 2013 and 2015 within-year HSI prediction and between-year HSI prediction (2013 to 2015). The calculated probabilities of HSI were compared with the injury outcomes and area under the curve (AUC) was determined and used to assess the predictive performance of each model. Results The minimum, maximum, and median AUC values for the 2013 models were 0.26, 0.91, and 0.58, respectively. For the 2015 models, the minimum, maximum and median AUC values were, correspondingly, 0.24, 0.92, and 0.57. For the between-year predictive models the minimum, maximum, and median AUC values were 0.37, 0.73, and 0.52, respectively. Conclusions Although some iterations of the models achieved near perfect prediction, the large ranges in AUC highlight the fragility of the data. The 2013 models performed slightly better than the 2015 models. The predictive performance of between-year HSI models was poor however. In conclusion, risk factor data cannot be used to identify athletes at an increased risk of HSI with any consistency.

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Effect of Carbohydrate Mouth Rinse on Performance after Prolonged Submaximal Cycling

Previous studies have shown improved shorter duration (∼1 h) performance with carbohydrate (CHO) mouth rinsing (WASH), especially in overnight fasted/non-fuelled subjects. Purpose To determine the effect of WASH on cycling time trial (TT) performance and muscle activity (EMG) after 2 h of submaximal cycling while receiving CHO (FED). Methods In a double-blind, placebo-controlled crossover design, 10 well-trained males cyclists (V˙O2max: 65 mL·kg−1·min−1) completed two experimental trials. Each trial consisted of a standardized pretrial snack (2 h prior) followed by 120 min of steady-state (SS) cycling (∼60% V˙O2max) followed by an approximately 30-min TT, randomized as follows: 1) 30 g CHO·h−1 during SS + WASH during TT (every 20% of TT) (FEDWASH); 2) 30 g CHO·h−1 during SS + placebo (PLA) wash during TT (FEDPLA). Results Although FEDWASH was not significantly different than FEDPLA (P = 0.51), there was a 1.7% (90% confidence interval, +6.4% to −3.2%; ES, 0.21) decrease in TT time (35 s) for FEDWASH compared with FEDPLA, with qualitative probabilities of a 60% positive and 23% trivial outcome. For EMG, soleus showed significant increase, whereas medial gastrocnemius showed significant decrease in muscle recruitment from the beginning 20% TT segment to the last 20% only in the FEDPLA condition, which coincided with a slower (P = 0.01) last 20% of the TT in FEDPLA versus FEDWASH. Conclusions Contrary to previous studies, this investigation utilized conditions of high ecological validity including a pretrial snack and CHO during SS. Significant changes in muscle recruitment and time over the last 20% of the TT, along with an average 1.7% improvement in TT time, suggest CHO mouth rinse helps maintain power output late in TT compared with placebo. Although marginal gains were achieved with a CHO mouth rinse (35 s), small performance effects can have significant outcomes in real-world competitions.

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A Preventive Model for Muscle Injuries: A Novel Approach based on Learning Algorithms

Introduction The application of contemporary statistical approaches coming from Machine Learning and Data Mining environments to build more robust predictive models to identify athletes at high risk for injury might support injury prevention strategies of the future. Purpose The purpose was to analyze and compare the behavior of numerous machine learning methods to select the best-performing injury risk factor model to identify athlete at risk for lower extremity muscle injuries (MUSINJ). Methods A total of 132 male professional soccer and handball players underwent a preseason screening evaluation that included personal, psychological, and neuromuscular measures. Furthermore, injury surveillance was used to capture all the MUSINJ occurring in the 2013/2014 seasons. The predictive ability of several models built by applying a range of learning techniques were analyzed and compared. Results There were 32 MUSINJ over the follow-up period, 21 (65.6%) of which corresponded to the hamstrings, 3 to the quadriceps (9.3%), 4 to the adductors (12.5%), and 4 to the triceps surae (12.5%). A total of 13 injures occurred during training and 19 during competition. Three players were injured twice during the observation period so the first injury was used, leaving 29 MUSINJ that were used to develop the predictive models. The model generated by the SmooteBoost technique with a cost-sensitive ADTree as the base classifier reported the best evaluation criteria (area under the receiver operating characteristic curve score, 0.747; true positive rate, 65.9%; true negative rate, 79.1) and hence was considered the best for predicting MUSINJ. Conclusions The prediction model showed moderate accuracy for identifying professional soccer and handball players at risk for MUSINJ. Therefore, the model developed might help in the decision-making process for injury prevention.

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The Effects of Sex and Motoneuron Pool on Central Fatigue

Purpose It is uncertain if sex influences central fatigue because the reduction in voluntary activation (VA) has been reported as not different between the sexes for elbow flexors (EF) but greater in males compared with females for knee extensors. This disparity could result from the facilitatory and inhibitory effects of group III/IV muscle afferents on flexor versus extensor motoneurons, respectively. The purpose of this study was to examine central fatigue and motoneuron responsiveness of EF and elbow extensors (EE) in males and females. Methods Twenty-two participants (11 females) performed a 2-min isometric maximal voluntary contraction of EF and EE (on separate days) followed by 2 min of recovery. EMG potentials were recorded from biceps or triceps brachii in response to the stimulation of the brachial plexus (Mmax), corticospinal tract (cervicomedullary motor evoked potential [CMEP]), and motor cortex (motor evoked potential [MEP]). Superimposed and resting doublets (for determining VA) were evoked via muscle belly stimulation of biceps or triceps brachii. Only CMEP and superimposed doublets were recorded during fatigue. Results There was no effect of sex on CMEP area for either muscle group during fatigue or recovery. During the 2 min after EE fatigue, mean normalized CMEP and MEP area were ∼85% and ∼141% of control, indicating inhibition and facilitation of the motoneurons and motor cortex, respectively. VA during recovery was significantly reduced in males but not females for the EF, and unchanged in either sex for the EE. Conclusion The findings do not support the concept that equivocal findings regarding sex differences in central fatigue are related to augmented effects of group III/IV afferent feedback in males compared with females.

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Three Weeks of Overload Training Increases Resting Muscle Sympathetic Activity

Purpose Overload training is hypothesized to alter autonomic regulation, although interpretations using indirect measures of heart rate variability are conflicting. The aim of the present study was to examine the effects of overload training on muscle sympathetic nerve activity (MSNA), a direct measure of central sympathetic outflow, in recreational endurance athletes. Methods Measurements of heart rate variability, cardiac baroreflex sensitivity (BRS), MSNA (microneurography), and sympathetic BRS were obtained in 17 healthy triathletes and cyclists after 1 wk of reduced training (baseline) and again after 3 wk of either regular (n = 7) or overload (n = 10) training. Results After training, the changes (Δ) in peak power output (10 ± 10 vs −12 ± 9 W, P 0.05). Conclusions Overload training increased MSNA and attenuated increases in cardiac BRS and heart rate variability observed with regular training. These results support neural adaptations after overload training and suggest that increased central sympathetic outflow may be linked with decreased exercise performance.

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Raw and Count Data Comparability of Hip-Worn ActiGraph GT3X+ and Link Accelerometers

To enable inter- and intrastudy comparisons it is important to ascertain comparability among accelerometer models. Purpose The purpose of this study was to compare raw and count data between hip-worn ActiGraph GT3X+ and GT9X Link accelerometers. Methods Adults (n = 26 (n = 15 women); age, 49.1 ± 20.0 yr) wore GT3X+ and Link accelerometers over the right hip for an 80-min protocol involving 12–21 sedentary, household, and ambulatory/exercise activities lasting 2–15 min each. For each accelerometer, mean and variance of the raw (60 Hz) data for each axis and vector magnitude (VM) were extracted in 30-s epochs. A machine learning model (Montoye 2015) was used to predict energy expenditure in METs from the raw data. Raw data were also processed into activity counts in 30-s epochs for each axis and VM, with Freedson 1998 and 2011 count-based regression models used to predict METs. Time spent in sedentary, light, moderate, and vigorous intensities was derived from predicted METs from each model. Correlations were calculated to compare raw and count data between accelerometers, and percent agreement was used to compare epoch-by-epoch activity intensity. Results For raw data, correlations for mean acceleration were 0.96 ± 0.05, 0.89 ± 0.16, 0.71 ± 0.33, and 0.80 ± 0.28, and those for variance were 0.98 ± 0.02, 0.98 ± 0.03, 0.91 ± 0.06, and 1.00 ± 0.00 in the X, Y, and Z axes and VM, respectively. For count data, corresponding correlations were 1.00 ± 0.01, 0.98 ± 0.02, 0.96 ± 0.04, and 1.00 ± 0.00, respectively. Freedson 1998 and 2011 count-based models had significantly higher percent agreement for activity intensity (95.1% ± 5.6% and 95.5% ± 4.0%) compared with the Montoye 2015 raw data model (61.5% ± 27.6%; P

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Exercise Increases Glucose Transporter-4 Levels on Peripheral Blood Mononuclear Cells

Purpose Glucose transporter 4 (GLUT4) plays a key role in the pathophysiology of type 2 diabetes. Glucose transporter 4 is upregulated in response to exercise, enhancing cellular glucose transport in skeletal muscle tissue. This mechanism appears to remain intact in individuals with insulin resistance. Details of the mechanism are poorly understood and are challenging to study due to the invasive nature of muscle biopsy. Peripheral blood mononuclear cells (PBMC) have documented insulin-sensitive GLUT4 activity and may serve as a proxy tissue for studying skeletal muscle GLUT4. The purpose of this study was to investigate whether GLUT4 in PBMC is affected by conditioning. Methods We recruited 16 student athletes from the cross-country running and skiing teams and fifteen sedentary students matched for age and sex from the University of Alaska Fairbanks. Peripheral blood mononuclear cells were collected with mononuclear cell separation tubes. The GLUT4 concentrations were measured using a commercially available enzyme linked immunosorbent assay. Additionally, correlations between PBMC GLUT4 and common indicators of insulin resistance were examined. Results Results indicate significantly higher PBMC GLUT4 levels in conditioned athletes than in their sedentary counterparts, similar to what has been documented in myocytes. Females were observed to have higher PBMC GLUT4 levels than males. Correlations were not detected between PBMC GLUT4 and hemoglobin A1c, glucose, insulin, homeostatic model assessment of insulin resistance, body mass index, or body fat. Conclusions This study provides evidence to support exploration of PBMC as a proxy tissue for studying GLUT4 response to exercise or other noninsulin factors.

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The Effectiveness of Progressive Aerobic Interval Training in Cardiac Rehabilitation

Introduction Aerobic interval training (AIT) has recently emerged as a more effective strategy than moderate-intensity continuous exercise (MICE) for improving peak oxygen consumption (V˙O2peak) in coronary artery disease (CAD) patients. The primary purpose of this retrospective study was to describe the change in V˙O2peak, and cardiovascular (CV) risk profile characteristics (secondary outcomes) after progressive AIT practiced in the largest, outpatient cardiac rehabilitation (CR) program in North America compared with usual care CR involving MICE. Methods Electronic database records were retrieved from consecutively enrolled patients with CAD who attended the Toronto Rehabilitation Institute, between January 1, 2005, and December 31, 2015. Patients were then separated into two, age and sex propensity score-matched groups: 772 patients were prescribed 26 wk of MICE (60%–80% of V˙O2peak, five times per week) as per usual care CR (56.0 ± 9.2 yr; 12% female/88% male; V˙O2peak: 20.8 ± 5.9 mL·kg−1·min−1), and 772 patients were prescribed 26 wk of progressive walk/jog intervals (15 min·mile−1 walking pace, 12 min·mile−1 jogging pace, five times per week) (55.9 ± 9.3 yr; 12% female/88% male; V˙O2peak: 24.8 ± 5.7 mL·kg−1 ·min−1). Treatment effect analysis of AIT on V˙O2peak and CV risk profile characteristics was performed using multiple regression with baseline values as covariates. Results Treatment effect analysis revealed a 3.84-mL·kg−1·min−1 superior improvement in V˙O2peak in the AIT group compared to usual care MICE group (P

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Beneficial Effects of Exercise Pretreatment in a Sporadic Alzheimer’s Rat Model

Purpose This study aimed to examine the effects of swimming exercise pretreatment on a streptozotocin (STZ)-induced sporadic Alzheimer's disease (AD) rat model and provide an initial understanding of related molecular mechanisms. Methods Male 2.5-month-old Sprague–Dawley rats were divided into the following four groups: (a) control, (b) swim + vehicle, (c) STZ without swim, and (d) swim + STZ. The Barnes maze task and novel object recognition test were used to measure hippocampus-dependent spatial learning and working memory, respectively. Immunofluorescence staining, Western blot analysis, enzyme-linked immunosorbent assay (ELISA) analysis, and related assay kits were used to assess synaptic proteins, inflammatory cytokines, total antioxidant capacity, antioxidant enzymes, amyloid-beta production, and tau hyperphosphorylation. Results Behavioral tests revealed that exercise pretreatment could significantly inhibit STZ-induced cognitive dysfunction (P

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Perceptual Responses to High- and Moderate-Intensity Interval Exercise in Adolescents

Purpose Continuous high-intensity exercise is proposed to evoke unpleasant sensations as predicted by the dual-mode theory and may negatively impact on future exercise adherence. Previous studies support unpleasant sensations in affective responses during continuous high-intensity exercise, but the affect experience during high-intensity interval exercise (HIIE) involving brief bursts of high-intensity exercise separated by low-intensity activity is poorly understood in adolescents. We examined the acute affective, enjoyment, and perceived exertion responses to HIIE compared with moderate-intensity interval exercise (MIIE) in adolescents. Methods Thirteen adolescent boys (mean ± SD: age, 14.0 ± 0.5 yr) performed two counterbalanced exercise conditions: 1) HIIE: 8 × 1-min work intervals at 90% maximal aerobic speed; and 2) MIIE: between 9 and 12 × 1-min work intervals at 90% ventilatory threshold where the number of intervals performed were distance-matched to HIIE. HIIE and MIIE work intervals were interspersed with 75 s active recovery at 4 km·h−1. Affect, enjoyment, and RPE were recorded before, during, and after exercise. Results Affect responses declined in both conditions but the fall was greater in HIIE than MIIE (P 0.64). Conclusions Despite elevated RPE, HIIE did not elicit prominent unpleasant feelings as predicted by the dual-mode theory and was associated with greater postexercise enjoyment responses than MIIE. This study demonstrates the feasibility of the application of HIIE as an alternative form of physical activity in adolescents.

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Role of Chronic Stress and Exercise on Microvascular Function in Metabolic Syndrome

Purpose The present study examined the effect of unpredictable chronic mild stress (UCMS) on peripheral microvessel function in healthy and metabolic syndrome (MetS) rodents and whether exercise training could prevent the vascular dysfunction associated with UCMS. Methods Lean and obese (model of MetS) Zucker rats (LZR and OZR) were exposed to 8 wk of UCMS, exercise (Ex), UCMS + Ex, or control conditions. At the end of the intervention, gracilis arterioles (GA) were isolated and hung in a pressurized myobath to assess endothelium-dependent (EDD) and endothelium-independent (EID) dilation. Levels of nitric oxide (NO) and reactive oxygen species (ROS) were measured through 4-amino-5-methylamino-2′,7′-difluorofluorescein diacetate and dihydroethidium staining, respectively. Results Compared with LZR controls, EDD and EID were lower (P = 0.0001) in LZR-UCMS. The OZR-Ex group had a higher EDD (P = 0.0001) and EID (P = 0.003) compared with OZR controls, whereas only a difference in EDD (P = 0.01) was noted between the LZR-control and LZR-Ex groups. Importantly, EDD and EID were higher in the LZR (P = 0.0001; P = 0.02) and OZR (P = 0.0001; P = 0.02) UCMS + Ex groups compared with UCMS alone. Lower NO bioavailability and higher ROS were noted in the LZR-UCMS group (P = 0.0001), but not OZR-UCMS, compared with controls. The Ex and UCMS-Ex groups had higher NO bioavailability (P = 0.0001) compared with the control and UCMS groups, but ROS levels remained high. Conclusions The comorbidity between UCMS and MetS does not exacerbate the effects of one another on GA EDD responses, but does lead to the development of other vasculopathy adaptations, which can be partially explained by alterations in NO and ROS production. Importantly, exercise training alleviates most of the negative effects of UCMS on GA function.

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Postexercise Fructose–Maltodextrin Ingestion Enhances Subsequent Endurance Capacity

Purpose Restoring skeletal muscle and hepatic glycogen content during short-term (

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Replacement of Sedentary Time with Physical Activity: Effect on Lipoproteins

Purpose Limited data on the relationship between physical activity and lipoprotein particle profiles exist. Our objective was to investigate associations between objectively measured physical activity and lipoprotein particle size and number, and specifically whether substituting daily sedentary behavior with light activity or moderate-to-vigorous physical activity (MVPA) is associated with beneficial alterations to the lipoprotein profile among adults and those at increased cardiometabolic risk (obese and insulin-resistant subjects). Methods Sedentary behavior and physical activity intensity and duration were measured for 7 consecutive days using the GENEActiv accelerometer in a cross-sectional adult cohort (n = 396; mean age, 59.6 ± 5.5 yr). Lipoprotein particle size and subclass concentrations were determined using nuclear magnetic resonance spectroscopy. Isotemporal substitution regression modeling quantified the associations between replacing 30 min·d−1 of sedentary behavior with equal amounts of light activity and MVPA on lipoprotein profiles. Results Daily duration of MVPA was inversely associated with large VLDL particles and lipoprotein insulin resistance scores (P

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Lower-Limb Dominance, Performance, and Fiber Type in Resistance-trained Men

Introduction Large imbalances between limbs are common and potentially dangerous, yet few studies have simultaneously examined performance and physiological asymmetries. The current study examined the associations between lower-limb dominance, drop-jumping kinematics, maximal strength, and myosin heavy-chain (MHC) fiber type in the vastus lateralis. Methods Thirteen resistance-trained men (age, 24.3 ± 2.7 yr; height, 181.4 ± 6.6 cm; mass, 87.7 ± 11.3 kg) identified their dominant (DOM) and nondominant (ND) limb, performed drop jumps (30 cm) and maximal knee extensions (1-repetition maximum, or 1RM), and provided biopsies from both vastus lateralis muscles for single-fiber (109 ± 36 per limb per person) MHC fiber-type identification (FT%). Results All participants selected "right" as the "preferred kicking limb" (DOM). DOM displayed a trend for a greater eccentric knee angular velocity (EKV; P = 0.083) and a significantly greater concentric knee angular velocity (CKVl P = 0.002) during drop jump. DOM also tended to be stronger than ND (64.3 ± 11.3 vs 61.0 ± 8.8 kg, P = 0.063). Slow-twitch (MHC I) fibers were more prevalent in DOM (P 5% were present in 6 of 12 participants for EKV, 2 of 12 for CKV, 6 of 13 for 1RM, 12 of 13 for MHC I, and 11 of 13 for MHC IIa. However, only a single participant expressed asymmetries of >5% in all dependent variables (EKV, CKV, 1RM, MHC I, and MHC IIa). Conclusions Several statistically and clinically relevant asymmetries were identified. The FT% differences between lower limbs were large and common. The findings also seem to conclude that DOM was stronger, moved faster, and contained more MHC I. However, only 23% of participants actually displayed that result. This highlights the need to analyze and report both group and individual data, particularly when interpreting findings across multiple related, but not necessarily causal, measurements.

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To Train or Not to Train: Admission of Pediatricians into Pediatric Rehabilitation Medicine Fellowships

For both scenarios, Dr Louise Spierre will argue for admitting pediatricians into PRM fellowship training programs, and Dr Robert Rinaldi will argue against admitting pediatricians into PRM fellowship training programs.

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Copyright Page

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Information for Authors

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Academy News – April PM&R Journal

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:

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Table of Contents

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The Role of Physiatrists in Natural Disasters

After Hurricane Katrina hit New Orleans in 2005, the images and stories of the role of health care providers caused alarm. Questions of misconduct, extreme duress, and unimaginable choices emerged. In a recent article entitled, "The Duty of Mind: Ethical Capacity in a Time of Crisis [1]," the authors argue that "the physician is obliged to always make life-and-death decisions under conditions of maximal ethical clarity." (pg. 1) and that the stresses and chaos of a disaster can impact decision-making.

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Spanish Translated Abstracts

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Editorial Board

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BmSUC1 is essential for glycometabolism modulation in the silkworm, Bombyx mori

Publication date: Available online 14 April 2018
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Quan Gan, Xinwei Zhang, Daobo Zhang, Liang Shi, Yue Zhou, Tongtong Sun, Song Jiang, Junshan Gao, Yan Meng
Sucrose is the most commonly transported sugar in plants and is easily assimilated by insects to fulfill the requirement of physiological metabolism. BmSuc1 is a novel animal β-fructofuranosidase (β-FFase, EC 3.2.1.26)-encoding gene that was firstly cloned and identified in silkworm, Bombyx mori. BmSUC1 was presumed to play an important role in the silkworm-mulberry enzymatic adaptation system by effectively hydrolyzing sucrose absorbed from mulberry leaves. However, this has not been proved with direct evidence thus far. In this study, we investigated sucrose hydrolysis activity in the larval midgut of B. mori by inhibition tests and found that sucrase activity mainly stemmed from β-FFase, not α-glucosidase. Next, we performed shRNA-mediated transgenic RNAi to analyze the growth characteristics of silkworm larvae and variations in glycometabolism in vivo in transgenic silkworms. The results showed that in the RNAi-BmSuc1 transgenic line, larval development was delayed, and their body size was markedly reduced. Finally, the activity of several disaccharidases alone in the midgut and the sugar distribution, total sugar and glycogen in the midgut, hemolymph and fat body were then determined and compared. Our results demonstrated that silencing BmSuc1 significantly reduced glucose and apparently activated maltase and trehalase in the midgut. Together with a clear decrease in both glycogen and trehalose in the fat body, we conclude that BmSUC1 acts as an essential sucrase by directly modulating the degree of sucrose hydrolysis in the silkworm larval midgut, and insufficient sugar storage in the fat body may be responsible for larval malnutrition and abnormal petite phenotypes.

Graphical abstract

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The Atypical Rho GTPase CHW-1 Works with SAX-3/Robo To Mediate Axon Guidance in Caenorhabditis elegans

During development, neuronal cells extend an axon towards their target destination in response to a cue to form a properly functioning nervous system. Rho proteins, Ras-related small GTPases that regulate cytoskeletal organization and dynamics, cell adhesion, and motility, are known to regulate axon guidance. Despite extensive knowledge about canonical Rho proteins (RhoA/Rac1/Cdc42), little is known about the Caenorhabditis elegans (C. elegans) atypical Cdc42-like family members CHW-1 and CRP-1 in regards to axon pathfinding and neuronal migration. chw-1 (Chp/Wrch) encodes a protein that resembles human Chp (Wrch-2/RhoV) and Wrch-1 (RhoU), and crp-1 encodes for a protein that resembles TC10 and TCL. Here, we show that chw-1 works redundantly with crp-1 and cdc-42 in axon guidance. Furthermore, proper levels of chw-1 expression and activity are required for proper axon guidance. When examining CHW-1 GTPase mutants, we found that the native CHW-1 protein is likely partially activated, and mutations at a conserved residue (position 12 using Ras numbering, position 18 in CHW-1) alter axon guidance and neural migration. Additionally, we showed that chw-1 genetically interacts with the guidance receptor sax-3 in PDE neurons. Finally, in VD/DD motor neurons, chw-1 works downstream of sax-3 to control axon guidance. In summary, this is the first study implicating the atypical Rho GTPases chw-1 and crp-1 in axon guidance. Furthermore, this is the first evidence of genetic interaction between chw-1 and the guidance receptor sax-3. These data suggest that chw-1 is likely acting downstream and/or in parallel to sax-3 in axon guidance.

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Severe perineal lacerations after vaginal delivery: are they an anesthesiologist's problem?

Purpose of review Perineal tears or lacerations are common occurrences after vaginal delivery. Understanding the degree of severity of these tears and the immediate and long-term complications of severe perineal lacerations can assist anesthesiologists with the management of these patients in the immediate postpartum period. Recent findings Severe perineal lacerations have a high degree of association with postpartum depression. The presence of neuraxial labor analgesia decreases the odds of severe perineal lacerations. Summary Neuraxial labor analgesia does not directly predispose parturients to the development of perineal lacerations, and may even be protective against these injuries. Correspondence to Feyce Peralta, MD, 251 E. Huron St. F5-704, Chicago, IL 60611, USA. Tel: +1 312 472 3585; e-mail: feyce.peralta@northwestern.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Clinical pearls part 3: anaesthetic management of abnormally invasive placentation

Purpose of review Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. Recent findings Advances in pharmacological management of bleeding with recent publications of large multicentre trials in addition to new technologies in the management of massive obstetric haemorrhage (MOH) have revolutionized the management of abnormal placentation. These include the use of tranexamic acid, interventional radiology, cell saver technology, and point-of-care coagulation tests. The role of maternal critical care for the optimization of postoperative complications and physiological derangements has not been considered widely in the literature. This article summarizes the current evidence for interventions and suggests a protocol for the management of these high-risk patients. Summary A robust protocol outlining the key elements of the management of placenta accreta, including optimizing postoperative care, should be in place to promote desired outcomes. Correspondence to Dr Vinod Patil, Consultant Obstetric Anaesthetist, Department of Anesthesiology, Queens Hospital, BHR University Hospital NHS Trust Romford, Romford RM7 0AG, UK. Tel: 44 1708503727; e-mail: Vinodpatiluk@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Impact of intra-operative fluid and noradrenaline administration on early postoperative renal function after cystectomy and urinary diversion: A retrospective observational cohort study

BACKGROUND The use of noradrenaline to enable a restrictive approach to intra-operative fluid therapy to avoid salt and water overload has gained increasing acceptance. However, concerns have been raised about the impact of this approach on renal function. OBJECTIVES To identify risk factors for acute kidney injury (AKI) in patients undergoing cystectomy with urinary diversion and determine whether administration of noradrenaline and intra-operative hydration regimens affect early postoperative renal function. DESIGN Retrospective observational cohort study. SETTING University hospital, from 2007 to 2016. PATIENTS A total of 769 consecutive patients scheduled for cystectomy and urinary diversion. Those with incomplete data and having pre-operative haemodialysis were excluded. MAIN OUTCOME MEASURES AKI was defined as a serum creatinine increase of more than 50% over 72 postoperative hours. Multiple logistic regression analysis was performed to model the association between risk factors and AKI. RESULTS Postoperative AKI was diagnosed in 86/769 patients (11.1%). Independent predictors for AKI were the amount of crystalloid administered (odds ratio (OR) 0.79 [95% confidence interval (CI), 0.68 to 0.91], P = 0.002), antihypertensive medication (OR 2.07 [95% CI, 1.25 to 3.43], P = 0.005), pre-operative haemoglobin value (OR 1.02 [95% CI, 1.01 to 1.03], P = 0.010), duration of surgery (OR 1.01 [95% CI, 1.00 to 1.01], P = 0.002), age (OR 1.32 [95% CI, 1.44 to 1.79], P = 0.002) but not the administration of noradrenaline (OR 1.09 [95% CI, 0.94 to 1.21], P = 0.097). Postoperative AKI was associated with longer hospital stay (18 [15 to 22] vs. 16 [15 to 19] days; P = 0.035) and a higher 90-day major postoperative complication rate (41.9 vs. 27.5%; P = 0.002). CONCLUSION Noradrenaline administration did not increase the risk for AKI. A too restrictive approach to administration of crystalloids was associated with an increased risk for AKI, particularly in older patients, those receiving antihypertensive medication, and those whose surgery was prolonged. As AKI was associated with longer hospital stay and increased postoperative morbidity, these observations should be taken into account to improve outcome when addressing peri-operative fluid management. TRIAL REGISTRATION Not applicable. Correspondence to Patrick Y. Wuethrich, MD, Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland Tel: +41 316322725; fax: +41 316320554; e-mail: patrick.wuethrich@insel.ch © 2018 European Society of Anaesthesiology

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DNA methylation-mediated repression of miR-181a/135a/302c expression promotes the microsatellite-unstable colorectal cancer development and 5-FU resistance via targeting PLAG1

Publication date: Available online 13 April 2018
Source:Journal of Genetics and Genomics
Author(s): Lu Shi, Xiang Li, Zhiqiang Wu, Xiaolei Li, Jing Nie, Mingzhou Guo, Qian Mei, Weidong Han
Microsatellite instability (MSI) defines a subtype of colorectal cancer (CRC) with typical clinicopathologic characteristics. CRCs with MSI (MSI CRCs) frequently acquire accelerated carcinogenesis and 5-FU resistance, and the exact underlying mechanism remains incompletely understood. Our previous study has identified the microRNA (miRNA) expression profile in MSI CRCs. Three miRNAs (miR-181a, miR-135a and miR-302c) were validated by qRT-PCR to be dramatically decreased in 67 CRC samples. Proliferation and apoptosis assays demonstrated that miR-181a/135a/302c function as tumor suppressors via repressing PLAG1/IGF2 signaling. Moreover, we present compelling evidence that restoration of miR-181a/135a/302c expression promoted sensitivity of MSI CRC cells to 5-FU treatment. miR-181a/135a/302c exert their effect on chemoresistance through attenuating PLAG1 expression. Notably, the hypermethylation status of MSI CRC accounts for the decrements of miR-181a/135a/302c. Our results contribute to a better understanding of the mechanism of chemoresistance in MSI CRCs, and provid a clue for digging the biomarkers and therapeutic targets for CRC patients.



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WocEA: The visualization of functional enrichment results in word clouds

Publication date: Available online 13 April 2018
Source:Journal of Genetics and Genomics
Author(s): Wanshan Ning, Shaofeng Lin, Jiaqi Zhou, Yaping Guo, Ying Zhang, Di Peng, Wankun Deng, Yu Xue




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Massive GGAAs in genomic repetitive sequences serve as a nuclear reservoir of NF-κB

Publication date: Available online 13 April 2018
Source:Journal of Genetics and Genomics
Author(s): Jian Wu, Qiao Wang, Wei Dai, Wei Wang, Ming Yue, Jinke Wang
Nuclear factor κB (NF-κB) is a DNA-binding transcription factor. Characterizing its genomic binding sites is crucial for understanding its gene regulatory function and mechanism in cells. This study characterized the binding sites of NF-κB RelA/p65 in the tumor neurosis factor-α (TNFα) stimulated HeLa cells by a precise chromatin immunoprecipitation-sequencing (ChIP-seq). The results revealed that NF-κB binds nontraditional motifs (nt-motifs) containing conserved GGAA quadruplet. Moreover, nt-motifs mainly distribute in the peaks nearby centromeres that contain a larger number of repetitive elements such as satellite, simple repeats and SINEs (short interspersed nuclear elements). This intracellular binding pattern was then confirmed by the in vitro detection, indicating that NF-κB dimers can bind the nontraditional κB (nt-κB) sites with low affinity. However, this binding hardly activates transcription. This study thus deduced that NF-κB binding nt-motifs may realize functions other than gene regulation as NF-κB binding traditional motifs (t-motifs). To testify the deduction, this study then analyzed many ChIP-seq data of other cell lines. The results indicate that NF-κB binding nt-motifs is also widely present in other cells. The ChIP-seq data analysis also revealed that nt-motifs more widely distribute in the peaks with low-fold enrichment. Importantly, it was also found that NF-κB binding nt-motifs is mainly present in the resting cells, whereas NF-κB binding t-motifs is mainly present in the stimulated cells. Astonishingly, no known function was enriched by the gene annotation of nt-motif peaks. Based on these results, this study proposed that the nt-κB sites that extensively distribute in larger numbers of repeat elements function as a nuclear reservoir of NF-κB. The nuclear NF-κB proteins stored at nt-κB sites in the resting cells may be recruited to the t-κB sites for regulating its target genes upon stimulation.



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Tephrochronology of Bed II, Olduvai Gorge, Tanzania, and placement of the Oldowan–Acheulean transition

Publication date: Available online 12 April 2018
Source:Journal of Human Evolution
Author(s): Lindsay J. McHenry, Ian G. Stanistreet
Tuffaceous marker beds, derived from volcanic products from the Ngorongoro Volcanic Highlands, help define a stratigraphic framework for the world-renowned fossil and stone tool record exposed at Olduvai Gorge, Tanzania. However, previous efforts to constrain this tuff record, especially for Olduvai Bed II, have been limited because of erosion, contamination, reworking, and the alteration of volcanic glass under saline-alkaline conditions. This paper applies previously defined geochemical and mineralogical "fingerprints" for several major Bed II marker tuffs, based on glass (where available) and phenocrysts more resistant to alteration (feldspar, hornblende, augite, and titanomagnetite), to tuffs from stratigraphic sections in the Olduvai Junction Area, including previously and recently excavated Acheulean and Oldowan sites (HWK EE (Locality (Loc) 42), EF-HR (Loc 12a), FLK (Loc 45), and MNK (Loc 88)). The Middle Bed II Bird Print Tuff (BPT) is found to be more compositionally variable than previously reported but is still valuable as a stratigraphic marker over short distances. The confirmation of blocks of Tuff IID in conglomerate helps constrain Upper Bed II stratigraphy at sites where in-situ tuffs are absent. This paper also compiles the results of published geochronological research, providing stratigraphic context and updating previously reported dates using a consistent ⁴⁰Ar/³⁹Ar reference standard age. The results of this work support the following paleoanthropologically relevant conclusions: 1) the early Acheulean site EF-HR (Loc 12a) is situated above the level of Hay's Tuff IIC, and thus sits in Upper rather than Middle Bed II, (2) the HWK EE (Loc 42) Oldowan site is constrained between Tuff IIA and Tuff IIB, just above the boundary between Lower and Middle Bed II, and 3) the Acheulean site at FLK W most likely lies within the Middle Augitic Sandstone, above Tuff IIB, similar to the placements by Leakey and Hay for the earliest Acheulean at Olduvai.



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Distribution of environmental tritium in rivers, groundwater, mine water and precipitation in Goa, India

Publication date: September 2018
Source:Journal of Environmental Radioactivity, Volume 189
Author(s): Md. Arzoo Ansari, H.V. Mohokar, Archana Deodhar, Noble Jacob, U.K. Sinha
Tritium concentration in rivers, groundwater, precipitation and mine pits water, all over Goa state was characterized to find out spatial and temporal variability of tritium. Twenty four water samples were collected during pre-monsoon and post-monsoon and analyzed for their tritium concentration. The mean tritium concentration in surface and sub-surface hydrosphere is 2.5 (±0.6) TU. The mean concentration of tritium in rivers, groundwater, mines pits water and rain water are 2.9 (±0.5) TU, 1.95 (±0.5) TU, 2.5(±0.3) TU and 3.1(±0.1) TU respectively. The tritium distribution in all the samples shows modern precipitation (post-1950) component in surface and sub-surface hydrosphere of Goa. The HYSPLIT4.0 air mass trajectory model and atmospheric circulation pattern suggest that the moisture origin was from the Arabian Sea and this low tritium moisture is diluting the tritium concentration of surface hydrosphere near the coastal area. The tritium concentration in surface hydrosphere shows more and more enrichment as one move inland (i.e. away from the coast). Significant seasonal change is observed in the surface hydrosphere. The pre-monsoon samples showed higher tritium concentration than post-monsoon samples. This may be due to high rate of re-evaporation of water and a reduction in the supply of oceanic moisture during the summer (pre-monsoon).



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Quantitative electroencephalography as a marker of cognitive fluctuations in dementia with Lewy bodies and an aid to differential diagnosis

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Myrto Stylianou, Nicholas Murphy, Luis R. Peraza, Sara Graziadio, Ruth Cromarty, Alison Killen, John T. O' Brien, Alan J. Thomas, Fiona E.N. LeBeau, John-Paul Taylor
ObjectiveWe investigated for quantitative EEG (QEEG) differences between Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) patients and healthy controls, and for QEEG signatures of cognitive fluctuations (CFs) in DLB.MethodsWe analysed eyes-closed, resting state EEGs from 18 AD, 17 DLB and 17 PDD patients with mild dementia, and 21 age-matched controls. Measures included spectral power, dominant frequency (DF), frequency prevalence (FP), and temporal DF variability (DFV), within defined EEG frequency bands and cortical regions.ResultsDLB and PDD patients showed a leftward shift in the power spectrum and DF. AD patients showed greater DFV compared to the other groups. In DLB patients only, greater DFV and EEG slowing were correlated with CFs, measured by the clinician assessment of fluctuations (CAF) scale. The diagnostic accuracy of the QEEG measures was 94% (90.4–97.9%), with 92.26% (80.4–100%) sensitivity and 83.3% (73.6–93%) specificity.ConclusionAlthough greater DFV was only shown in the AD group, within the DLB group a positive DFV – CF correlation was found. QEEG measures could classify DLB and AD patients with high sensitivity and specificity.SignificanceThe findings add to an expanding literature suggesting that EEG is a viable diagnostic and symptom biomarker in dementia, particularly DLB.



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Transcriptomics: Finding structure in gene expression

Transcriptomics: Finding structure in gene expression

Transcriptomics: Finding structure in gene expression, Published online: 13 April 2018; doi:10.1038/nrg.2018.19

Transcriptomics: Finding structure in gene expression

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Editorial Board

Publication date: June 2018
Source:Gene Expression Patterns, Volume 28





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