Correction to: Beta2-Agonist Doping Control and Optical Isomer Challenges

Abstract

Page 1789, table 1, 'Carmoterol' row: The cell entry in the 'Stereochemistry' column, which previously read.

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Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? A Systematic Review and Meta-Analysis

Abstract

Background

Muscle lesions account for one-third of sport-related injuries, thus representing a substantial problem for both players and their teams. The use of platelet-rich plasma (PRP) injections is rapidly growing in clinical practice, prompted by an unmet clinical need with a large commercial market. However, after early reports of positive preliminary experience, higher quality studies recently questioned the real benefit provided by PRP injections to promote muscle healing and return to sport.

Objective

To evaluate the effect of platelet-rich plasma (PRP) injections on outcomes following acute muscle injuries.

Design

Meta-analysis of randomized, controlled trials (RCTs), Level I.

Data sources

PubMed (MEDLINE), Cochrane (CENTRAL), Web of Science, clinicaltrials.gov, who.int, isrctn.com, greylit.org, opengrey.eu.

Eligibility criteria

RCTs investigating the effect of PRP for the treatment of acute muscle injuries against at least one control group including patients treated with placebo injection or physical therapy. The outcomes evaluated were time to return to sport, re-injuries, complications, pain, muscle strength, range of motion (ROM)/flexibility, muscle function, and imaging.

Results

Six studies, involving 374 patients, were included in the meta-analysis. The time to return to sport evaluated in all six studies was significantly shorter in patients treated with PRP (mean difference = − 7.17 days). However, if only the double-blind studies (n = 2) or studies including only hamstring injuries (n = 3) were considered, non-significant differences were found. Re-injuries (relative risk = − 0.03) and complications (relative risk = 0.01) were also similar between the two groups (p > 0.05), nor were any substantial differences found regarding pain, muscle strength, ROM/flexibility, muscle function, and imaging. The performance bias was high risk due to the lack of patient blinding in four studies. The quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was therefore low or very low.

Conclusions

The promising biological rationale, the positive preclinical findings, and the successful early clinical experience of PRP injections are not confirmed by the recent high-level RCTs. Therefore any benefit in terms of pain, function, return to sport, and recurrence using PRP injections for the treatment of acute muscle injuries is not supported. Due to the bias in the studies, the heterogeneity of the findings, and the limited sample size, the evidence should be considered to be of low or very low quality.

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Beyond Cut-points: Accelerometer Metrics that Capture the Physical Activity Profile

AbstractPurposeCommonly used physical activity metrics tell us little about the intensity distribution across the activity profile. The purpose of this paper is to introduce a metric, the intensity gradient, which can be used in combination with average acceleration (overall activity level) to fully describe the activity profile.Methods1669 adolescent girls (sample 1) and 295 adults with type 2 diabetes (sample 2) wore a GENEActiv accelerometer on their non-dominant wrist for up to 7-days. Body mass index and percent body fat were assessed in both samples and physical function (grip strength, Short Physical Performance Battery, sit-to-stand repetitions) in sample 2. Physical activity metrics were: average acceleration (AccelAV); the intensity gradient (IntensityGRAD from the log-log regression line: 25 mg intensity bins (x)/time accumulated in each bin (y)); total moderate-to-vigorous physical activity (MVPA); and bouted MVPA (sample 2 only).ResultsCorrelations between AccelAV and the IntensityGRAD (r=0.39-0.51) were similar to correlations between AccelAV and bouted MVPA (r=0.48), and substantially lower than between AccelAV and total MVPA (r>0.93). The IntensityGRAD was negatively associated with body fatness in sample 1 (p0.93). The IntensityGRAD was negatively associated with body fatness in sample 1 (p

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Kinetic Asymmetry during Running at Preferred and Nonpreferred Speeds

ABSTRACTPURPOSEThe aim of this study was to investigate the effect of altering preferred running speed by ±20% on kinetic asymmetry.METHODSThree-dimensional motion analysis and force data were acquired from 15 healthy males (age: 27 ± 4.6 years, height: 1.81 ± 0.09 m, mass: 80.4 ± 12.4 kg) during their preferred running speed, and at ±20% of this speed. 3T magnetic resonance images were used to measure Achilles tendon cross-sectional area and moment arm, for use in calculation of tendon stress. Kinetic and tendon stress asymmetry were subsequently calculated in each condition using the symmetry index.RESULTSAcross all joints and conditions, average asymmetry of peak moments was between ±6% but higher individual values were observed; there was no effect of speed on magnitude of asymmetry. Ground contact times, vertical ground reaction forces and support and ankle moments (maximum absolute asymmetry: 9%) were more symmetrical than hip and knee moments (up to 18%). Individual joint contribution to support moment and positive work were similar in both limbs, and ankle and hip compensatory interactions were observed with alterations in running speed. Achilles tendon stress increased with increased running speed, with higher stress in the preferred limb; asymmetry in tendon stress was not related to asymmetry in vertical ground reaction forces.CONCLUSIONResults show small effects of altering running speed on kinetic asymmetry, but responses are individual-specific with interactions occurring between joints to maintain overall movement symmetry. Further research is needed to understand the mechanical and neuromuscular mechanisms underpinning these compensations. PURPOSE The aim of this study was to investigate the effect of altering preferred running speed by ±20% on kinetic asymmetry. METHODS Three-dimensional motion analysis and force data were acquired from 15 healthy males (age: 27 ± 4.6 years, height: 1.81 ± 0.09 m, mass: 80.4 ± 12.4 kg) during their preferred running speed, and at ±20% of this speed. 3T magnetic resonance images were used to measure Achilles tendon cross-sectional area and moment arm, for use in calculation of tendon stress. Kinetic and tendon stress asymmetry were subsequently calculated in each condition using the symmetry index. RESULTS Across all joints and conditions, average asymmetry of peak moments was between ±6% but higher individual values were observed; there was no effect of speed on magnitude of asymmetry. Ground contact times, vertical ground reaction forces and support and ankle moments (maximum absolute asymmetry: 9%) were more symmetrical than hip and knee moments (up to 18%). Individual joint contribution to support moment and positive work were similar in both limbs, and ankle and hip compensatory interactions were observed with alterations in running speed. Achilles tendon stress increased with increased running speed, with higher stress in the preferred limb; asymmetry in tendon stress was not related to asymmetry in vertical ground reaction forces. CONCLUSION Results show small effects of altering running speed on kinetic asymmetry, but responses are individual-specific with interactions occurring between joints to maintain overall movement symmetry. Further research is needed to understand the mechanical and neuromuscular mechanisms underpinning these compensations. Corresponding author: Dr. Laura-Anne M Furlong, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, United Kingdom, Tel: +44 (0) 1509 223059, Fax: +44 (0) 1509 226301, Email: L.A.M.Furlong@lboro.ac.uk There are no conflicts of interest associated with this research. The results of the present unfunded study do not constitute endorsement by ACSM. Results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 11 January 2018 © 2018 American College of Sports Medicine

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Three patients with Schaaf–Yang syndrome exhibiting arthrogryposis and endocrinological abnormalities

MAGEL2 is the paternally expressed gene within Prader–Willi syndrome critical region at 15q11.2. We encountered three individuals in whom truncating mutations of MAGEL2 were identified. Patients 1 and 2, siblings born to healthy, non-consanguineous Japanese parents, showed generalized hypotonia, lethargy, severe respiratory difficulty, poor feeding, and multiple anomalies including arthrogryposis soon after birth. We carried out whole-exome sequencing, which detected a MAGEL2 mutation (c.1912C>T, p.Gln638*, heterozygous). The patients' father was heterozygous for the mutation. Patient 3 was a female infant, showed respiratory difficulty reflecting pulmonary hypoplasia, generalized hypotonia, feeding difficulty and multiple anomalies soon after birth. Targeted next-generation sequencing detected a novel heterozygous mutation in MAGEL2 (c.3131C>A, p.Ser1044*). This mutation was not found in the parents. MAGEL2 mutations, first reported to be the cause of the Prader–Willi like syndrome with autism by Schaaf et al. (2013) Nature Genetics, 45: 1405–1408 show the wide range of phenotypic spectrum from lethal arthrogryposis multiplex congenital to autism spectrum disorder (ASD) and mild intellectual disability (ID). Our results indicate that MAGEL2 mutations cause multiple congenital anomalies and intellectual disability accompanied by arthrogryposis multiplex congenita and various endocrinologic abnormalities, supporting that the view that clinical phenotypes of MAGEL2 mutations are variable.

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Previous exposure to chronic intermittent hypoxia blunts the development of one-kidney one-clip hypertension in rats

Abstract

Chronic intermittent hypoxia (CIH) and one-kidney one-clip (1K, 1C) experimental models lead to sympathetic overactivity and hypertension. We hypothesized that previous exposure to CIH potentiates the development of 1K, 1C renal hypertension. Male rats were divided into 4 groups: Control-1K, 1C, maintained under normoxia followed by 1K, 1C surgery (n = 19); Control-Sham, maintained under normoxia, followed by Sham surgery (n = 19); CIH-1K, 1C, exposed to CIH (10 days) and 1K, 1C surgery (n = 19); CIH-Sham, exposed to CIH and Sham surgery (n = 18). Animals were catheterized 8 days after 1K, 1C or Sham surgeries and cardiovascular and respiratory parameters recorded on the following day. Baseline mean arterial pressure (MAP) was higher in Control-1K, 1C than in Control-Sham rats (P < 0.05), as well as higher in CIH-1K, 1C than in CIH-Sham rats (P < 0.05). However, the increase in MAP in CIH-1K, 1C was significantly blunted in comparison to Con-1K-1C rats (P < 0.05) indicating that previous exposure to CIH attenuates the development of renal hypertension. Systemic administration of hexamethonium, a ganglionic blocker, promoted a larger hypotension response in Con-1K-1C compared to CIH-1K-1C rats (P < 0.05), suggesting that sympathetic activity was attenuated in rats previously exposed to CIH protocol. In addition, removal of the carotid bodies before 1K, 1C renal hypertension eliminated the protective effect of CIH preconditioning on the development of the 1K, 1C hypertension. We conclude that previous exposure to CIH attenuates the development of renal hypertension via a carotid body-dependent mechanism.

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Interventions at the Transition from Prison to the Community for Prisoners with Mental Illness: A Systematic Review

Abstract

Prisoners have high rates of mental illness and the transition from prison to the community is a problematic time for the provision of mental health services and a range of negative outcomes have been identified in this period. A systematic review was conducted to identify interventions for prisoners with diagnosed mental health conditions that targeted this transition period. Fourteen papers from 13 research studies were included. The interventions identified in this review were targeted at different stages of release from prison and their content differed, ranging from Medicaid enrolment schemes to assertive community treatment. It was found that insurance coverage, and contact with mental health and other services can be improved by interventions in this period but the impact on reoffending and reincarceration is complex and interventions may lead to increased return to prison. There is a developing evidence base that suggests targeting this period can improve contact with community mental health and other health services but further high quality evidence with comparable outcomes is needed to provide more definitive conclusions. The impact of programmes on return to prison should be evaluated further to establish the effect of interventions on clinical outcomes and to clarify the role of interventions on reincarceration.

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