NS1-mediated enhancement of MVC transcription and replication promoted by KAT5/H4K12ac

Histone modifications function in both cellular and viral gene expression. However, the roles of acetyltransferases and histone acetylation in parvoviral infection remain poorly understood. In the current study, we found the histone deacetylase (HDAC) inhibitor, trichostatin A (TSA), promoted the replication and transcription of parvovirus minute virus of canines (MVC). Notably, the expression of host acetyltransferases KAT5, GTF3C4, and KAT2A was increased in MVC infection, as well as H4 acetylation (H4K12ac). KAT5 is not only responsible for H4K12ac but also crucial for viral replication and transcription. The viral nonstructural protein NS1 interacted with KAT5 and enhanced its expression. Further study showed that Y44 in KAT5, which may be tyrosine-phosphorylated, is indispensable for NS1-mediated enhancement of KAT5 and efficient MVC replication. The data demonstrated that NS1 interacted with KAT5, which resulted in an enhanced H4K12ac level to promote viral replication and transcription, implying the epigenetic addition of H4K12ac in viral chromatin-like structure by KAT5 is vital for MVC replication.IMPORTANCEParvoviral genomes are chromatinized with host histones. Therefore, histone acetylation and related acetyltransferases are required for the virus to modify histones and open densely packed chromatin structures. This study illustrated that histone acetylation status is important for MVC replication and transcription and revealed a novel mechanism that the viral nonstructural protein NS1 hijacks the host acetyltransferase KAT5 to enhance histone acetylation of H4K12ac, which relies on a potential tyrosine phosphorylation site, Y44 in KAT5. Other parvoviruses share a similar genome organization and coding potential and may adapt a similar strategy for efficient viral replication and transcription.

Effects of Four Weeks of Static vs. Dynamic Bodyweight Exercises with Whole-Body Electromyostimulation on Jump and Strength Performance: A Two-Armed, Randomized, Controlled Trial

The combination of strength training with complementary whole-body electromyostimulation (WB-EMS) and plyometric exercises has been shown to increase strength and jumping performance in athletes. In elite sport, however, the mesocycles of training are often organized according to block periodization. Furthermore, WB-EMS is often applied onto static strength exercises, which may hamper the transfer into more sport-specific tasks. Thus, this study aimed at investigating whether four weeks of strength training with complementary dynamic vs. static WB-EMS followed by a four-week block of plyometric training increases maximal strength and jumping performance. A total of n = 26 (13 female/13 male) trained adults (20.8 ± 2.2 years, 69.5 ± 9.5kg, 9.7 ± 6.1h of training/w) were randomly assigned to a static (STA) or volume-, load- and work-to-rest-ratio-matched dynamic training group (DYN). Before (PRE), after four weeks (three times weekly) of WB-EMS training (MID) and a subsequent four-week block (twice weekly) of plyometric training (POST), maximal voluntary contraction (MVC) at leg extension (LE), leg curl (LC) and leg press machines (LP) and jumping performance (SJ, Squat Jump; CMJ, counter-movement-jump; DJ, drop-jump) were assessed. Furthermore, perceived effort (RPE) was rated for each set and subsequently averaged for each session. MVC at LP notably increased between PRE and POST in both STA (2335 ± 539 vs. 2653 ± 659N, standardized mean difference [SMD] = 0.528) and DYN (2483 ± 714N vs. 2885 ± 843N, SMD = 0.515). Reactive strength index of DJ showed significant differences between STA and DYN at MID (162.2 ± 26.4 vs. 123.1 ± 26.5 cm·s^-1, p = 0.002, SMD = 1.478) and POST (166.1 ± 28.0 vs. 136.2 ± 31.7 cm·s^-1, p = 0.02, SMD = 0.997). Furthermore, there was a significant effect for RPE, with STA rating perceived effort higher than DYN (6.76 ± 0.32 vs. 6.33 ± 0.47 a.u., p = 0.013, SMD = 1.058). When employing a training block of high-density WB-EMS both static and dynamic exercises lead to similar adaptations.

A Dynamic Procedure to Detect Maximum Voluntary Contractions in Low Back

Surface electromyography (sEMG) is generally used to measure muscles' activity. The sEMG signal can be affected using several factors and vary among individuals and even measurement trials. Thus, to consistently evaluate data among individuals and trials, the maximum voluntary contraction (MVC) value is usually calculated and used to normalize sEMG signals. However, the sEMG amplitude collected from low back muscles can be frequently larger than that found when conventional MVC measurement procedures are used. To address this limitation, in this study, we proposed a new dynamic MVC measurement procedure for low back muscles. Inspired by weightlifting, we designed a detailed dynamic MVC procedure, and then collected data from 10 able-bodied participants and compared their performances using several conventional MVC procedures by normalizing the sEMG amplitude for the same test. The sEMG amplitude normalized by our dynamic MVC procedure showed a much lower value than those obtained using other procedures (Wilcoxon signed-rank test, with p < 0.05), indicating that the sEMG collected during dynamic MVC procedure had a larger amplitude than those of conventional MVC procedures. Therefore, our proposed dynamic MVC obtained sEMG amplitudes closer to its physiological maximum value and is thus more capable of normalizing the sEMG amplitude for low back muscles.

Diagnostic accuracy of Tensiomyography parameters for monitoring peripheral neuromuscular fatigue

The diagnostic accuracy of tensiomyography (TMG) parameters compared to the gold standard in neuromuscular fatigue evaluation using voluntary and electrically induced muscle activation is unclear. This study aimed to investigate the diagnostic accuracy of TMG parameters to detect individual changes after interventions that were designed to induce central or peripheral fatigue. Nineteen males (age: 32.2 ± 9.3 years) performed two interventions, consisting of maintaining 25% of maximal voluntary contraction (MViC_25%) and a 30 s all-out cycling test (Wingate), respectively. TMG parameters, maximum voluntary contraction (PtMViC), voluntary activation (VA%) and electrically elicited double twitches (Dtw) were assessed on the knee extensors before (PRE), one minute (POST) and seven minutes after (POST7) the intervention. The diagnostic accuracy (AUC) of TMG parameters were evaluated in comparison to two criteria measures (PtMViC and Dtw). RM ANOVA revealed a significant interaction between the effects of intervention and time on VA% (p = 0.001) and Dtw (p < 0.001) but not for PtMViC (p = 0.420). AUC showed that TMG parameters had a good ability in detecting muscular fatigue assessed by Dtw but not by PtMViC. The results of the current study suggest that TMG parameters can be used to monitor peripheral neuromuscular fatigue.

Effects of Different Isometric Training Programs on Muscle Size and Function in the Elbow Flexors

It remains unknown whether a regimen of a combination of high- and low-intensity resistance training increases muscle size and maximal voluntary isometric contraction (MVC) simultaneously. This study aimed to clarify the effect of the combination of high- and low-intensity resistance training on muscle size and neuromuscular function in the elbow flexors. Sixteen male adults participated in a 9-week isometric training regimen in elbow joint flexion of each arm. We randomly assigned two different training regimens to left and right arms: one aiming to strengthen maximal strength (ST) and the other aiming to develop muscle size as well as maximal strength, which consists of one contraction to volitional failure with 50% of MVC added to ST (COMB). Following the 3-week training to volitional failure as familiarization, the participants conducted the 6-week ST and COMB training in each arm. Before the intervention, and at the third (Mid) and ninth (Post) weeks, MVC and muscle thickness in the anterior part of the upper arm (ultrasound) were measured. Muscle cross-sectional area (mCSA) was derived from the obtained muscle thickness. From Mid to Post, the relative change in MVC was similar in both arms. The COMB regimen increased muscle size, but no significant change was found in ST. Following the 3-week isometric training to volitional failure, the 6-week training regimen for developing maximal voluntary and muscle hypertrophy increased MVC, with increasing mCSA, and the training-induced change in MVC was similar to that for developing maximal voluntary strength alone.

Evaluation of mechanism of injury criteria for field triage of occupants involved in motor vehicle collisions

OBJECTIVE

The mechanism of injury (MOI) criteria assist in determining which patients are at high risk of severe injury and would benefit from direct transport to a trauma center. The goal of this study was to determine whether the prognostic performance of the Centers for Disease Control's (CDC) MOI criteria for motor vehicle collisions (MVCs) has changed during the decade since the guidelines were approved. Secondary objectives were to evaluate the performance of these criteria for different age groups and evaluate potential criteria that are not currently in the guidelines.

METHODS

Data were obtained from NASS and Crash Investigation Sampling System (CISS) for 2000-2009 and 2010-2019. Cases missing injury severity were excluded, and all other missing data were imputed. The outcome of interest was Injury Severity Score (ISS) ≥16. The area under the receiver operator characteristic (AUROC) and 95% confidence intervals (CIs) were obtained from 1,000 bootstrapped samples using national case weights. The AUROC for the existing CDC MOI criteria were compared between the 2 decades. The performance of the criteria was also assessed for different age groups based on accuracy, sensitivity, and specificity. Potential new criteria were then evaluated when added to the current CDC MOI criteria.

RESULTS

There were 150,683 (weighted 73,423,189) cases identified for analysis. There was a small but statistically significant improvement in the AUROC of the MOI criteria in the later decade (2010-2019; AUROC = 0.77, 95% CI [0.76-0.78]) compared to the earlier decade (2000-2009; AUROC = 0.75, 95% CI [0.74-0.76]). The accuracy and specificity did not vary with age, but the sensitivity dropped significantly for older adults (0-18 years: 0.62, 19-54 years: 0.59, ≥55 years: 0.37, and ≥65 years: 0.36). The addition of entrapment improved the sensitivity of the existing criteria and was the only potential new criterion to maintain a sensitivity above 0.95.

CONCLUSIONS

The MOI criteria for MVCs in the current CDC guidelines still perform well even as vehicle design has changed. However, the sensitivity of these criteria for older adults is much lower than for younger occupants. The addition of entrapment improved sensitivity while maintaining high specificity and could be considered as a potential modification to current MOI criteria.

The prevalence of long-term rehabilitation following motor-vehicle crashes in Saudi Arabia: a multicenter study

Introduction

In Saudi Arabia, motor-vehicle crashes (MVC) are the leading cause of disability-adjusted life years (DALYs). There is limited information locally on the magnitude and need for rehabilitation following MVC. This study examined the prevalence of MVC patients requiring long-term rehabilitation and the epidemiology of associated injuries.

Methods

A retrospective study was conducted at four hospitals of the National Guard Hospitals Affairs from January 2016 to March 2019. The study used data from an institutional trauma registry of all MVC admissions. Chi-square tests, bivariate and multivariate analyses were conducted to compare patients requiring long-term and short-term rehabilitation.

Results

The study included 506 patients. The study population was relatively young, with an average age was 32.8 ± 15.5 years, and the majority were males. Over two-thirds (71.3%) of patients required long-term rehabilitation. Half the patients sustained multiple fractures, and 17.0% sustained traumatic brain injuries. Overall, 53.1 and 61.8% of patients required occupational and physiotherapy, respectively. Those admitted to the intensive care unit were four times more likely to need long-term rehabilitation.

Conclusions

We found a significant burden of long-term rehabilitation following MVC. Patients were relatively young, thus posing a significant burden on future healthcare utilization. Policymakers should use these findings to guide primary, secondary, and tertiary prevention to improve health outcomes.

Improper Restraint Use in Pediatric Patients Involved in Motor Vehicle Collisions

BACKGROUND

Motor vehicle collisions (MVCs) are the leading cause of unintentional death among children and adolescents; however, public awareness and use of appropriate restraint recommendations are perceived as deficient. We aimed to investigate the use of child safety restraints and examine outcomes in our community.

METHODS

We retrospectively queried a level 1 trauma registry for pediatric (0-18 y) MVC patients from October 2013 to December 2018. Demographic and clinical variables were recorded. Data regarding appropriate restraint use by age group were examined.

RESULTS

Four hundred thirty-four cases of pediatric MVC were identified. Overall, 53% were improperly restrained or unrestrained. Sixty-two percent of car seat age and 51% of booster age children were improperly restrained or unrestrained altogether. Fifty-nine percent of back seat riding, seatbelt age were improperly restrained/unrestrained, with 26% riding in the front. Fifty-one percent of seatbelt-only adolescents were not belted. Black, non-Hispanic children were more often improperly restrained/unrestrained compared to Hispanics (63% versus 48%, P = 0.001). Improperly restrained/unrestrained children had higher injury severity (10% versus 4% Injury Severity Score > 25, P = 0.021), require operative/interventional radiology (33% versus 19%, P = 0.001), and be discharged to rehabilitation or skilled nursing facility (5.2% versus 1.5%, P = 0.033). Mortality in adolescents was higher among those unrestrained (5.2% versus 0.8%, P = 0.034).

CONCLUSIONS

Although efforts to improve adherence to restraint regulations have greatly increased in the last decade, more than half of children in MVC are still improperly restrained. Injury prevention services and community outreach is essential to educate the most vulnerable populations, especially those with infants and toddlers, on adequate motor vehicle safety measures in our community.

Increased Ipsilateral M1 Activation after Incomplete Spinal Cord Injury Facilitates Motor Performance

Incomplete spinal cord injury (SCI) may result in muscle weakness and difficulties with force gradation. Although these impairments arise from the injury and subsequent changes at spinal levels, changes have also been demonstrated in the brain. Blood-oxygen-level dependent (BOLD) imaging was used to investigate these changes in brain activation in the context of unimanual contractions with the first dorsal interosseous muscle. BOLD- and force data were obtained in 19 individuals with SCI (AISA Impairment Scale [AIS] C/D, level C4-C8) and 24 able-bodied controls during maximal voluntary contractions (MVCs). To assess force modulation, participants performed 12 submaximal contractions with each hand (at 10, 30, 50, and 70% MVC) by matching their force level to a visual target. MVCs were weaker in the SCI group (both hands p < 0.001), but BOLD activation did not differ between SCI and control groups. For the submaximal contractions, force (as %MVC) was similar across groups. However, SCI participants showed increased activity of the ipsilateral motor cortex and contralateral cerebellum across all contractions, with no differential effect of force level. Activity of ipsilateral M1 was best explained by force of the target hand (vs. the non-target hand). In conclusion, the data suggest that after incomplete cervical SCI, individuals remain capable of producing maximal supraspinal drive and are able to modulate this drive adequately. Activity of the ipsilateral motor network appears to be task related, although it remains uncertain how this activity contributes to task performance and whether this effect could potentially be harnessed to improve motor functioning.

Development of a concise injury severity prediction model for pediatric patients involved in a motor vehicle collision

OBJECTIVE

Transporting severely injured pediatric patients to a trauma center has been shown to decrease mortality. A decision support tool to assist emergency medical services (EMS) providers with trauma triage would be both as parsimonious as possible and highly accurate. The objective of this study was to determine the minimum set of predictors required to accurately predict severe injury in pediatric patients.

METHODS

Crash data and patient injuries were obtained from the NASS and CISS databases. A baseline multivariable logistic model was developed to predict severe injury in pediatric patients using the following predictors: age, sex, seat row, restraint use, ejection, entrapment, posted speed limit, any airbag deployment, principal direction of force (PDOF), change in velocity (delta-V), single vs. multiple collisions, and non-rollover vs. rollover. The outcomes of interest were injury severity score (ISS) ≥16 and the Target Injury List (TIL). Accuracy was measured by the cross-validation mean of the receiver operator curve (ROC) area under the curve (AUC). We used Bayesian Model Averaging (BMA) based on all subsets regression to determine the importance of each variable separately for each outcome. The AUC of the highest performing model for each number of variables was compared to the baseline model to assess for a statistically significant difference (p < 0.05). A reduced variable set model was derived using this information.

RESULTS

The baseline models performed well (ISS ≥ 16: AUC 0.91 [95% CI: 0.86-0.95], TIL: AUC 0.90 [95% CI: 0.86-0.94]). Using BMA, the rank of the importance of the predictors was identical for both ISS ≥ 16 and TIL. There was no statistically significant decrease in accuracy until the models were reduced to fewer than five and six variables for predicting ISS ≥ 16 and TIL, respectively. A reduced variable set model developed using the top five variables (delta-V, entrapment, ejection, restraint use, and near-side collision) to predict ISS ≥ 16 had an AUC 0.90 [95% CI: 0.84-0.96]. Among the models that did not include delta-V, the highest AUC was 0.82 [95% CI: 0.77-0.87].

CONCLUSIONS

A succinct logistic regression model can accurately predict severely injured pediatric patients, which could be used for prehospital trauma triage. However, there remains a critical need to obtain delta-V in real-time.

Dynamics of forearm muscle activity in slanted computer mice use

BACKGROUND

Static muscular activity of muscles activated in the use of the conventional PC mouse is believed to represent a higher risk for the musculoskeletal health of the user than dynamic muscular activity.

OBJECTIVE

This paper presents a compounded muscular activity dynamics indicator (akin to percent relative range), enabling comparison between computer handheld pointing devices.

METHODS

This muscular dynamism approach considers baseline muscular activity (APL, ECR, ECU and ED) relative to the Maximum Voluntary Contraction as well as the dynamics of muscular activation. The latter is computed as the ratio of the difference between APDF90 and APDF10 divided by APDF50 (APDF-Amplitude Probability Distribution Function for the 90th, 50th and 10th percentiles). The paper demonstrates the approach with results of comparative evaluation of a horizontal, a slanted and a vertical PC mouse, through surface EMG monitoring of 20 participants performing standardized graphical task with the devices.

RESULTS

Hand size impacts muscular activity dynamics in these four muscles, which supersedes differences in device geometry, across the range of devices tested.

CONCLUSION

Smaller devices relative to hand size foster more dynamic muscular activity.

Flexion-extension strength of the index-thumb system in Italian population. A cross-sectional study to gather normative data

STUDY DESIGN

Cross-sectional study.

INTRODUCTION

Flexion (Palmar Pinch, PP-MVC and Tip Pinch, TP-MVC) and extension (E-MVC) maximal voluntary contraction (MVC) of the index-thumb system offers a quick way to estimate the level of hands' impairment in several musculoskeletal and neurologic conditions.

PURPOSE OF THE STUDY

This study established normative data of PP-MVC, TP-MVC, E-MVC in the Italian population and evaluated their correlation with hand dominance, anthropometric factors, dexterity and workload level.

METHODS

In our study, 303 healthy people (150F, 153M) were recruited. Participants performed PP-MVC, TP-MVC and E-MVC tests per hand, conducted by using a pinch-gauge. T-test was used to analyze MVC means between sexes and between hands. One-way ANOVA was conducted to compare MVC means in male and female samples stratified by age (18-29, 30-44, 45-59, 60-74, +75). Spearman's correlation analysis was performed to determine anthropometric variables, dexterity and workload level effects on MVCs.

RESULTS

Medium-to-large effect sizes of age were shown in the majority of tasks. The 30 to 44 years and then +75 years age groups showed the highest and the lowest values, respectively, for both sex and both hands. Men were meanly 50% stronger, and the dominant hand showed higher values (6-10%). MVC-tests correlated moderately with weight and height weakly with dexterity and workload level.

CONCLUSIONS

After 30 to 44 years, hand strength declines in line with the normal process of aging that also entails muscle fibers and the reduction of daily activities in older adults. In relative terms, E-MVC showed the highest strength loss in the over 75 seconds. The difference between sexes was higher in E-MVC than in flexion MVCs. E-MVC seems to depend more on musculoskeletal architecture that differs from women to men, according to the highest correlation between E-MVC and anthropometric variables. Only high workload levels impacted hand strength. In heaviest occupations, no PP-MVCs differences were observed between hands.

Pair-Matching Digital 3D Models of Temporomandibular Fragments Using Mesh-To-Mesh Value Comparison and Implications for Commingled Human Remain Assemblages

The mesh-to-mesh value comparison (MVC) method developed by Karell et al. (Int J Legal Med 130(5):1315-1322, 2016) facilitates the digital comparison of three-dimensional mesh geometries obtained from laser-scanned or computed tomography data of osteological materials. This method has been employed with great success to pair-matching geometries of intact skeletal antimeres, that is, left and right sides. However, as is frequently the case for archaeological materials, there are few circumstances which proffer complete skeletal remains and fewer still when considering contexts of commingling. Prior to the present research, there existed a paucity of sorting techniques for the diverse taphonomic conditions of skeletal materials found within commingled assemblages, especially regarding fragmentary remains. The present chapter details a study in which the MVC method was adapted to encompass comparisons of isolated components of bone in lieu of entire bone geometries in order to address this dearth. Using post-mortem computed tomography data from 35 individuals, three-dimensional models of 70 mandibular fossae and 69 mandibular condyles were created and then compared using Viewbox 4, to produce numerical mesh-to-mesh values which indicate the geometrical and spatial relationship between any two given models. An all-to-all comparison was used to determine if the MVC method, using an automated Trimmed Iterative Closest Point (TrICP) algorithm, could be utilized to (1) match corresponding bilateral pairs of condyles and fossae and (2) match same-sided articular correlates. The pair-matching of both the condyles and the fossae generally produced high sensitivity and specificity rates. However, the articulation results were much poorer and are not currently recommended.

Electromyographic Assessment of the Lower Leg Muscles during Concentric and Eccentric Phases of Standing Heel Raise

Only a small number of muscle activation patterns from lower limbs have been reported and simultaneous muscle activation from several lower limb muscles have not yet been investigated. The purpose of this study was to examine any gender differences in surface electromyography (EMG) activity from six recorded lower limb muscles of the dominant limb at baseline (i.e., with the foot placed flat on the floor and in the neutral position), and during concentric and eccentric phases when performing a heel raise task. In total, 10 females and 10 males performed a standing heel raise task comprising of three continuous phases: baseline, unloading (concentric muscle action), and loading (eccentric muscle action) phases. Muscle activation from six muscles (gastrocnemius medialis, gastrocnemius lateralis, soleus, tibialis anterior, peroneus longus, and peroneus brevis) were measured using the Myon 320 EMG System. Root mean squared values of each muscle were calculated for each phase. Descriptive and inferential statistics were incorporated into the study. Statistically significant p values were set at 0.05. The results showed no significant differences between baseline, concentric, and eccentric phases with respect to each of the muscles investigated. Except for the gastrocnemius medialis at baseline and concentric phases, no significant differences were observed between genders or contractions. The data suggests that gender does not significantly influence the eccentric phase during the standing heel raise task.

Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial

The aim of this multicenter trial was to compare the effects of whole-body electromyostimulation (WB-EMS) and whole-body vibration (WBV) with conventional back-strengthening training (CT) on changes in mean back pain intensity (MPI) and trunk strength in patients suffering from chronic non-specific low back pain (CNLBP). Two-hundred and forty CNLBP patients (40–70 years; 62% female) were randomly assigned to three intervention arms (WB-EMS: n = 80 vs. WBV: n = 80 vs. CT: n = 80). All training intervention programs were performed for 12 weeks in their usual commercial training setting. Before and during the last 4 weeks of the intervention, MPI was recorded using a 4-week pain diary. Additionally, maximal isometric trunk extension and -flexion strength was assessed on the BackCheck® machine. A moderate but significant decrease of MPI was observed in all groups (WB-EMS: 29.7 ± 39.1% (SMD 0.50) vs. WBV: 30.3 ± 39.3% (SMD 0.57) vs. CT: 30.5 ± 39.6% (SMD 0.59); p < 0.001). Similar findings were observed for maximal isometric strength parameters with a significant increase in all groups (extension: WB-EMS: 17.1 ± 25.5% vs. WBV: 16.2 ± 23.6% vs. CT: 21.6 ± 27.5%; p < 0.001; flexion: WB-EMS: 13.3 ± 25.6% vs. WBV: 13.9 ± 24.0% vs. CT: 13.9 ± 25.4%; p < 0.001). No significant interaction effects for MPI (p = 0.920) and strength parameters (extension: p = 0.436; flexion: p = 0.937) were observed. WB-EMS, WBV, and CT are comparably effective in improving MPI and trunk strength. However, training volume of WB-EMS was 43 or 62% lower, compared with CT and WBV.

The surgical history of head injury in motor vehicle collision

Motor vehicle collisions (MVCs) are a significant cause of head injuries today, but efforts to manage and prevent these injuries extend as far back as the beginning of modern neurosurgery itself. Head trauma in MVCs occurred as far back as 1899, and the surgical literature of the time mentions several cases of children being struck by passing automobiles. By the 1930s, Dr. Claire L. Straith, a Detroit plastic surgeon, recommended changes to automobile design after seeing facial injuries and depressed skull fractures that resulted from automobile accidents. During World War II, Sir Hugh Cairns, a British neurosurgeon, demonstrated the efficacy of motorcycle helmets in preventing serious head injury. In the 1950s, Dr. Frank H. Mayfield, a Cincinnati neurosurgeon on the trauma committee of the American College of Surgeons, made several recommendations, such as adding padded dashboards and seatbelts, to make automobiles safer. Ford implemented the recommendations from Dr. Mayfield and others into a safety package for the 1956 models. Significant work has also been done to prevent head injury in motorsports. Efforts by surgeons, especially neurosurgeons, to prevent head injury in MVCs have saved countless lives, although it is a less frequently celebrated achievement.

Factors associated with EMS transport decisions for pediatric patients after motor vehicle collisions

OBJECTIVE

Prehospital non-transport events occur when emergency medicine service (EMS) providers respond to a scene, but the patient is ultimately not transported to a hospital for evaluation. The objective of this study was to determine the rate of non-transport of pediatric patients who were involved in a motor vehicle collision (MVC) and the factors associated with non-transport decisions.

METHODS

We searched the National Emergency Medical Services Information System (NEMSIS) database using ICD-10 mechanism of injury codes to identify cases in which EMS responded to a pediatric occupant (age < 18 years) who had been involved in an MVC. We excluded interfacility transports, scene assists, deaths at the scene, and collisions that occurred outside the US. The outcome of interest was if pediatric patients were not transported to a hospital for evaluation. We performed univariate and multivariate analysis to identify which risk factors were associated with non-transport. We also analyzed regional variation and the reasons recorded for not transporting patients.

RESULTS

We identified 92,254 pediatric patients who were evaluated by EMS after an MVC, of which 31,404 (34.0%) were not transported to a hospital for evaluation. In our adjusted analysis, the factors associated with non-transport were age <1 year or >16 years, male sex, normal Glasgow Coma Scale (GCS = 15), level of training of EMS providers, response time later than 6 a.m., and region of the country. GCS was the most important factor, with only 3.0% (108/3,616) of patients not transported who had abnormal GCS (< 15). In cases of non-transport, 32.7% (10257) were due to patient or caregiver refusal, and 33.3% (10,442) were due to patients being discharged against medical advice. Only 11.5% (3,627) pediatric patients who were not transported were discharged based on an established protocol.

CONCLUSIONS

Pediatric patients were not transported after EMS responded to an MVC in approximately one-third of cases, and there was considerable variation in the rate of non-transports based on geographic region, provider level, and time of day. The majority of non-transports occurred because patients were discharged against medical advice or the patient/caregiver refused transport, which may indicate conflicting priorities between EMS providers and patients.

Bilateral deficit in strength but not rapid force during maximal handgrip contractions

The purpose of this experiment was to evaluate the bilateral index in force and electromyographic (EMG) responses for the dominant and non-dominant hands during maximal handgrip contractions in males and females. Thirty-two right-handed participants (16 females) performed maximal unilateral and bilateral handgrip contractions on two separate visits. Bilateral indices were computed for maximal force, rate of force development (RFD₁₀₀), EMG amplitude, and the rate of EMG rise (RER). There was a bilateral deficit for maximal force in the dominant (-4.98 ± 7.39%, p < 0.001; d = 0.674) but not the non-dominant hand (-1.57 ± 9.10%, p = 0.334; d = 0.173). No deficits were observed for rapid force. The non-dominant flexor carpi radialis showed a bilateral facilitation in EMG amplitude (+12.32 ± 19.29%, p < 0.001; d = 0.638), yet a bilateral deficit for RER (-22.10 ± 27.80%, p < 0.001; d = 0.795). No sex differences were observed for any of the bilateral indices. These data suggest that maximal but not rapid force is susceptible to a bilateral deficit during contractions of the hands. The EMG responses did not parallel the force data. We show sex does not influence the magnitude or direction of the bilateral index in this muscle group.

MFsim-an open Java all-in-one rich-client simulation environment for mesoscopic simulation

MFsim is an open Java all-in-one rich-client computing environment for mesoscopic simulation with Jdpd as its default simulation kernel for Molecular Fragment (Dissipative Particle) Dynamics. The new environment comprises the complete preparation-simulation-evaluation triad of a mesoscopic simulation task and especially enables biomolecular simulation tasks with peptides and proteins. Productive highlights are a SPICES molecular structure editor, a PDB-to-SPICES parser for particle-based peptide/protein representations, a support of polymer definitions, a compartment editor for complex simulation box start configurations, interactive and flexible simulation box views including analytics, simulation movie generation or animated diagrams. As an open project, MFsim allows for customized extensions for different fields of research.

Impact of Polarized Versus Threshold Training on Fat Metabolism and Neuromuscular Variables in Ultrarunners

PURPOSE

To compare the effects of 2 different intensity distribution training programs (threshold [THR] and polarized [POL]) on fat metabolism and neuromuscular variables.

METHODS

Twenty ultrarunners were allocated to POL (n = 11; age 40.6 [9.7] y, weight 73.5 [10.8] kg, VO2max 55.8 [4.9] mL·kg-1·min-1) or THR group (n = 9; age 36.8 [9.2] y, weight 75.5 [10.4] kg, VO2max 57.1 [5.2] mL·kg-1·min-1) and performed a 12-week training program that consisted of 5 running sessions, 2 strength sessions, and 1 day of full rest per week. Both groups performed similar total training duration and load but with different intensity distribution during running sessions. Resting metabolic rate, fat metabolism, isometric rate of force development (RFD; N·s-1) and maximal voluntary contraction in the knee extensor, and electromyographic amplitude were measured before and after each program.

RESULTS

A significant decrease in RFD0-100 ms (Δ -13.4%; P ≤ .001; effect size [ES] = 1.00), RFD0-200 ms (Δ -11.7%; P ≤ .001; ES = 1.4), and RFDpeak (Δ -18%; P ≤ .001; ES = 1.4) were observed in the POL group. In THR group, a significant increase in mean electromyographic amplitude (Δ 24.4%; P = .02; ES = 1.4) was observed. There were no significant differences between groups in any of the variables.

CONCLUSIONS

Similar adaptations in fat metabolism and neuromuscular performance can be achieved after 12 weeks of POL or THR intensity distribution. However, THR distribution appears to better maintain strength (RFD) and improve mean electromyographic amplitude. Nevertheless, the combination of both running and maximum strength training could influence on results because of the residual fatigue thus inducing suboptimal adaptations in the POL group.

Finger pressing task data collected with and without post-trial performance feedback

The dataset presented in the article consists of finger forces of participants during a finger pressing task. The finger pressing task involves the production of fingertip forces using Index, Middle, Ring, and Little (I, M, R&L) fingers of the right hand. The participant performed two types of task, namely MVC task and visual occlusion task. The participants completed the Maximum Voluntary Contraction (MVC) task first, where they were instructed to produce maximum possible force from each finger individually and all fingers together. The visually occluded finger pressing task followed the MVC task. In this task, the participant's visual feedback was removed after 8s. There were two conditions in this task, one with post-trial performance feedback (referred to as "epilogue" condition in this manuscript) and another that does not have this post-trial performance feedback (referred to as "no epilogue" condition in this manuscript). The epilogue condition is a particular case of post-trial visual feedback where, at the end of each trial, the performance in that trial is shown to the participant. This was followed by the next trial. Normalization of force levels for visual occlusion tasks was performed for the forces with the participants produced in the MVC task. Fourteen healthy participants were recruited for performing the experiments. For the experiments, they were instructed to produce fingertip forces using four fingers of the right hand with the target line at 15% MVC (15% of the force that they produced in the MVC task). The two visual occlusion conditions had 30 trials each. In both conditions, a single trial lasted 16 s. For the initial 8 s, there is visual feedback, which follows an eight-second visual occlusion period where there is no visual feedback. The dataset consists of three files; the first file has the data of Maximum Voluntary Contraction (MVC) data, the second file has the data for the "without epilogue" condition, and the third file has the data of "epilogue" case.

Acute effects of bi-hemispheric transcranial direct current stimulation on the neuromuscular function of patients with chronic stroke: A randomized controlled study

BACKGROUND

Muscle weakness in patients with chronic stroke is due to neuromuscular disorders such as muscle atrophy, loss of voluntary activation or weak muscle contractile properties which are majored by the imbalance of interhemispheric inhibition following stroke. In patients with chronic stroke, unilateral transcranial direct current stimulation improved the maximal isometric strength of paretic knee extensors, but bilateral transcranial direct current stimulation failed to improve concentric strength. This study aimed to assess if a bilateral current stimulation improves isometric maximal strength, voluntary activation and contractile properties of knee extensors in patients with chronic stroke.

METHODS

Thirteen patients with chronic stroke and eight young healthy individuals participated in this randomized, simple-blinded, crossover study that included two experimental sessions: one with sham bilateral transcranial direct current stimulation and another with effective bilateral transcranial direct current stimulation (20 min, 2 mA). In the stroke patients, the anode was placed over the primary motor cortex of the affected hemisphere and the cathode over the contralateral primary motor cortex. In healthy participants, the brain side targeted by the anode and the cathode was randomly assigned. In each session, participants performed three assessments of strength, voluntary activation and contractile properties: before, during and after effective/sham bilateral transcranial direct current stimulation.

FINDINGS

Bilateral transcranial direct current stimulation had no effect on any neuromuscular assessments in both groups (All P values > 0.05, partial eta-squares varied from 0.02 to 0.06).

INTERPRETATION

A single session of bilateral transcranial direct current stimulation did not compensate muscular weakness of knee extensors in patients with chronic stroke.

Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair

Background

Weakness in end-range plantarflexion has been demonstrated after Achilles tendon repair and may be because of excessive tendon elongation. The mean frequency (MNF) of surface electromyogram (EMG) data during isometric maximum voluntary contraction (MVC) increases with muscle fiber shortening.

Hypothesis

During isometric plantarflexion, MNF during MVCs will be higher on the involved side compared with the uninvolved side after Achilles tendon repair because of excessive tendon elongation and greater muscle fiber shortening.

Study Design

Case series; Level of evidence, 4.

Methods

Isometric plantarflexion MVC torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantarflexion in 17 patients (15 men, 2 women; mean age, 39 ± 9 years) at a mean 43 ± 26 months after surgery. Surface EMG signals were recorded during strength tests. MNF was calculated from fast Fourier transforms of medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) EMG signals.

Results

Patients had marked weakness on the involved side versus the uninvolved side in 20° plantarflexion (deficit, 28% ± 18%; P < .001) but no significant weakness in 20° dorsiflexion (deficit, 8% ± 15%; P = .195). MNF increased when moving from dorsiflexion to plantarflexion (P < .001), but overall, it was not different between the involved and uninvolved sides (P = .195). However, differences in MNF between the involved and uninvolved sides were apparent in patients with marked weakness. At 10° plantarflexion, 8 of 17 patients had marked weakness (>20% deficit). MNF at 10° plantarflexion was significantly higher on the involved side versus the uninvolved side in patients with weakness, but this was not apparent in patients with no weakness (side by group, P = .012). Mean MNF at 10° plantarflexion across the 3 muscles was 13% higher on the involved side versus the uninvolved side in patients with weakness (P = .012) versus 3% lower in patients with no weakness (P = .522).

Conclusion

Higher MNF on the involved side versus the uninvolved side in patients with significant plantarflexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily because of excessive lengthening of the repaired Achilles tendon. If weakness was simply because of atrophy, a lower MNF would have been expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantarflexion after Achilles repair.

Effects of Whole-Body Electromyostimulation on Strength-, Sprint-, and Jump Performance in Moderately Trained Young Adults: A Mini-Meta-Analysis of Five Homogenous RCTs of Our Work Group

Background: Whole-body electromyostimulation (WB-EMS) gained increasing interest in sports within recent years. However, few intervention studies have examined the effects of WB-EMS on trained subjects in comparison to conventional strength training. Objective: The aim of the present mini-meta-analysis of 5 recently conducted and published randomized controlled WB-EMS trails of our work group was to evaluate potentially favorable effects of WB-EMS in comparison to conventional strength training. Methods: We included parameter of selected leg muscle's strength and power as well as sprint and jump performance. All subjects were moderately trained athletes [>2 training sessions/week, >2 years of experience in strength training; experimental group (n = 58): 21.5 ± 3.3 y; 178 ± 8 cm; 74.0 ± 11 kg; control group (n = 54): 21.0 ± 2.3 y; 179.0 ± 9 cm; 72.6 ± 10 kg]. The following WB-EMS protocols were applied to the experimental group (EG): 2 WB-EMS sessions/week, bipolar current superimposed to dynamic exercises, 85 Hz, 350 μs, 70% of the individual pain threshold amperage. The control groups (CG) underwent the same training protocols without WB-EMS, but with external resistance. Results: Five extremely homogenous studies (all studies revealed an I ² = 0%) with 112 subjects in total were analyzed with respect to lower limb strength and power in leg curl, leg extension and leg press machines, sprint-and jump performance. Negligible effects in favor of WB-EMS were found for F_max of leg muscle groups [SMD: 0.11 (90% CI: -0.08, 0.33), p = 0.73, I ² = 0%] and for CMJ [SMD: 0.01 (90% CI: -0.34, 0.33), p = 0.81, I ² = 0%]. Small effects, were found for linear sprint [SMD: 0.22 (90% CI: -0.15, 0.60), p = 0.77, I ² = 0%] in favor of the EMS-group compared to CON. Conclusion: We conclude that WB-EMS is a feasible complementary training stimulus for performance enhancement. However, additional effects on strength and power indices seem to be limited and sprint and jump-performance appear to be benefiting only slightly. Longer training periods and more frequent application times and a slightly larger stimulus could be investigated in larger samples to further elucidate beneficial effects of WB-EMS on performance parameters in athletes.

Can Heart Rate Variability Determine Recovery Following Distinct Strength Loadings? A Randomized Cross-Over Trial

This study aimed to compare the acute effects of hypertrophic (HYP) and maximum strength (MAX) loadings on heart rate variability (HRV) and to compare possible loading-specific alterations with other markers of recovery. Ten young men with strength training experience performed two leg press loadings (HYP: five times 10 repetitions at 70% of one repetition maximum (1RM) with 2 minutes inter-set rest; MAX: 15 times one repetition at 100% of 1RM with 3 minutes inter-set rest) in a randomized order. The root mean square of successive differences statistically decreased after both protocols (HYP: 65.7 ± 26.6 ms to 23.9 ± 18.7 ms, p = 0.026; MAX: 77.7 ± 37.0 ms to 55.3 ± 22.3 ms, p = 0.049), while the frequency domains of HRV remained statistically unaltered. The low frequency (LF) band statistically increased at 48h post-MAX only (p = 0.033). Maximal isometric voluntary contraction (MVC) statistically decreased after HYP (p = 0.026) and returned to baseline after 24h of recovery. Creatine kinase (CK) statistically increased above baseline at 1h post-loadings (HYP p = 0.028; MAX p = 0.020), returning to baseline at 24h post. Our findings indicate no distinct associations between changes in HRV and MVC or CK.

Risk Factors and Outcomes From All-Terrain Vehicle Injuries Compared With Motor Vehicle Collisions in Children

We compared risk factors and outcomes of children injured from all-terrain vehicle (ATV) injuries to those injured from motor vehicle collisions (MVC). We reviewed records of patients ≤18 years of age admitted to a trauma center with ATV- or MVC-related injuries between January 1, 2000, and December 31, 2015. Demographics were compared using logistic regression. Rates of injuries were compared using χ² tests. Of 6293 patients, 1140 (18%) ATV and 5153 (82%) MVC events were identified. In multivariable analysis (adjusted odds ratio [aOR], 95% confidence interval [CI]), patients with ATV-related injuries occurred more at older age (≥12 years; aOR = 4.29, 95% CI = 3.20-5.77), in rural counties (aOR = 3.72, 95% CI = 2.62-5.28), in regions with lower median household income (aOR = 1.37, 95% CI = 1.03-1.83), and in the spring (aOR = 2.44, 95% CI = 1.87-3.18), and summer (aOR = 2.50, 95% CI = 1.93-3.25) compared with winter. ATV-related injuries occurred less frequently among females (aOR = 0.76, 95% CI = 0.65-0.89). Upper extremity injuries were associated with ATV-related injuries (P ≤ .001). Findings may facilitate identification of at-risk groups for targeted interventions.

Higher variability in cervical force perception in people with neck pain

BACKGROUND

A reduced capacity to generate and sustain cervical muscle force over a range of contraction intensities is a feature of some participants with neck pain. To date there have been no studies comparing the accuracy of force perception in participants with and without neck pain.

DESIGN

Cross-sectional observational study.

METHODS

Participants with (n = 25) and without (n = 25) neck pain performed isometric muscle contractions at three progressive self-perceived (no feedback provided) intensities (10, 25, 50) % of their maximal voluntary contraction (MVC) in cervical: flexion, extension, right and left lateral flexion. Absolute error (AE), constant error (CE), and variable error (VE) between actual and targeted force values were calculated.

RESULTS

The neck pain group had: (1) AE-combined direction -significantly higher at 10% and lower at 50% (p < 0.05); (2) significantly lower CE in most measures (p < 0.05); (3) higher mean VE in all measures, with 10, 25, and 50% combined direction and overall combined % extension significantly higher (p < 0.05).

CONCLUSIONS

Findings indicate higher variability in force generation perception across all directions and intensities in participants with neck pain compared to healthy controls. Potentially this greater variability might suggest impaired force sense, a construct of proprioception in participants with neck pain. Reduced force sense may have implications for participants with neck pain during functional activities requiring precision and may need to be trained. Further research is required.

MC159 of Molluscum Contagiosum Virus Suppresses Autophagy by Recruiting Cellular SH3BP4 via an SH3 Domain-Mediated Interaction

MC159 is a viral FLIP (FLICE inhibitory protein) encoded by the molluscum contagiosum virus (MCV) enabling MCV to evade antiviral immunity and to establish persistent infections in humans. Here, we show that MC159 contains a functional SH3 binding motif, which mediates avid and selective binding to SH3BP4, a signaling protein known to regulate endocytic trafficking and suppress cellular autophagy. The capacity to bind SH3BP4 was dispensable for regulation of NF-κB-mediated transcription and suppression of proapoptotic caspase activation but contributed to inhibition of amino acid starvation-induced autophagy by MC159. These results provide new insights into the cellular functions of MC159 and reveal SH3BP4 as a novel host cell factor targeted by a viral immune evasion protein.IMPORTANCE After the eradication of smallpox, molluscum contagiosum virus (MCV) is the only poxvirus restricted to infecting humans. MCV infection is common and causes benign skin lesions that usually resolve spontaneously but may persist for years and grow large, especially in immunocompromised individuals. While not life threatening, MCV infections pose a significant global health burden. No vaccine or specific anti-MCV therapy is available. MCV encodes several proteins that enable it to evade antiviral immunity, a notable example of which is the MC159 protein. In this study, we describe a novel mechanism of action for MC159 involving hijacking of a host cell protein called SH3BP4 to suppress autophagy, a cellular recycling mechanism important for antiviral immunity. This study contributes to our understanding of the host cell interactions of MCV and the molecular function of MC159.

Reliability and Validity of a Novel Trunk-Strength Assessment for High-Performance Sprint Flat-Water Kayakers

PURPOSE

To determine the reliability and validity of a novel trunk maximal isometric force assessment involving 7 different tasks with 200-m times for elite sprint flat-water kayakers.

METHODS

Ten elite sprint flat-water kayakers performed a series of maximal isometric voluntary contractions (MVCs) on 2 separate days to assess reliability. MVC force was assessed as the participants sat on a modified kayak ergometer and applied their maximal isometric force to a uniaxial load cell during 7 different tasks. The 7 tasks of interest were a seated trunk-forward flexion, bilateral (left and right) rotational pulls, bilateral rotational pushes, and a sport-specific bilateral kayak-stroke simulation. Twenty elite flat-water kayak athletes (10 male and 10 female) participated in the validity portion by completing the series of tasks in conjunction with a 200-m race.

RESULTS

MVC force values ranged from 84 to 800 N across all participants and all tasks. The average coefficient of variation of the 7 tasks ranged from 2.4% to 7.7%. Regression analysis showed Pearson correlations ranging from -.84 to -.22 for both absolute and relative values with 200-m performance times.

CONCLUSIONS

MVC force measured in each task was considered reliable as a small degree of variance between trials was found. The summation of the 7 trunk scores showed very strong correlations with on-water performance, indicating that this assessment is valid for elite sprint kayakers.

The effects of time of day-specific resistance training on adaptations in skeletal muscle hypertrophy and muscle strength: A systematic review and meta-analysis

The present paper endeavored to elucidate the topic on the effects of morning versus evening resistance training on muscle strength and hypertrophy by conducting a systematic review and a meta-analysis of studies that examined time of day-specific resistance training. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with searches conducted through PubMed/MEDLINE, Scopus, and SPORTDiscus databases. The Downs and Black checklist was used for the assessment of the methodological quality of the included studies. Studies that examined the effects of time of day-specific resistance training (while equating all other training variables, such as training frequency and volume, between the groups) on muscle strength and/or muscle size were included in the present review. The random effects model was used for the meta-analysis. Meta-analyses explored (1) the differences in strength expression between morning and evening hours at baseline; (2) the differences in strength within the groups training in the morning and evening by using their post-intervention strength data from the morning and evening strength assessments; (3) the overall differences between the effects of morning and evening resistance training (with subgroup analyses conducted for studies that assessed strength in the morning hours and for the studies that assessed strength in the evening hours). Finally, a meta-analysis was also conducted for studies that assessed muscle hypertrophy. Eleven studies of moderate and good methodological quality were included in the present review. The primary findings of the review are as follows: (1) at baseline, a significant difference in strength between morning and evening is evident, with greater strength observed in the evening hours; (2) resistance training in the morning hours may increase strength assessed in the morning to similar levels as strength assessed in the evening; (3) training in the evening hours, however, maintains the general difference in strength across the day, with greater strength observed in the evening hours; (4) when comparing the effects between the groups training in the morning versus in the evening hours, increases in strength are similar in both groups, regardless of the time of day at which strength assessment is conducted; and (5) increases in muscle size are similar irrespective of the time of day at which the training is performed.

The Bottom-Up Rise Strength Transfer in Elderly After Endurance and Resistance Training: The BURST

The phenomenon of strength gain is highly relevant for sarcopenia and clinical aspect linked to aging. Recent advancements drive the interest toward the exercise-related cross-talk between distant tissues. We demonstrated the cross-talk between lower and upper limbs, we named the Bottom-Up Rise Strength Transfer (BURST), mainly linked to endurance training. In our opinion, this effect can be mainly related to systemic factors, likely circulating myokines and extracellular vesicles (recently defined in terms of “exerkines” and “exersomes”) whit an eventual concomitant reduction of a sub-clinical chronic inflammation. The neuronal mechanisms, even if to our sight less likely involved in this adaptation, need to be deeply investigated. Further studies are needed to better characterize the exercise-related BURST, concerning the specificity of different protocols and the underlying physiological mechanisms.

Effects of an Eight-Week Superimposed Submaximal Dynamic Whole-Body Electromyostimulation Training on Strength and Power Parameters of the Leg Muscles: A Randomized Controlled Intervention Study

The purpose of this study was to assess the effects of dynamic superimposed submaximal whole-body electromyostimulation (WB-EMS) training on maximal strength and power parameters of the leg muscles compared with a similar dynamic training without WB-EMS. Eighteen male sport students were randomly assigned either to a WB-EMS intervention (INT; n = 9; age: 28.8 (SD: 3.0) years; body mass: 80.2 (6.6) kg; strength training experience: 4.6 (2.8) years) or a traditional strength training group (CON; n = 9; age: 22.8 (2.5) years; body mass: 77.6 (9.0) kg; strength training experience: 4.5 (2.9) years). Both training intervention programs were performed twice a week over a period of 8 weeks with the only difference that INT performed all dynamic exercises (e.g., split squats, glute-ham raises, jumps, and tappings) with superimposed WB-EMS. WB-EMS intensity was adjusted to 70% of the individual maximal tolerable pain to ensure dynamic movement. Before (PRE), after (POST) and 2 weeks after the intervention (FU), performance indices were assessed by maximal strength (Fmax) and maximal power (Pmax) testing on the leg extension (LE), leg curl (LC), and leg press (LP) machine as primary endpoints. Additionally, vertical and horizontal jumps and 30 m sprint tests were conducted as secondary endpoints at PRE, POST and FU testing. Significant time effects were observed for strength and power parameters on LE and LC (LE Fmax +5.0%; LC Pmax +13.5%). A significant time × group interaction effect was merely observed for Fmax on the LE where follow-up post hoc testing showed significantly higher improvements in the INT group from PRE to POST and PRE to FU (INT: +7.7%, p < 0.01; CON: +2.1%). These findings indicate that the combination of dynamic exercises and superimposed submaximal WB-EMS seems to be effective in order to improve leg strength and power. However, in young healthy adults the effects of superimposed WB-EMS were similar to the effects of dynamic resistance training without EMS, with the only exception of a significantly greater increase in leg extension Fmax in the WB-EMS group.

Paeoniflorin in experimental BALB/c mansoniasis: A novel anti-angiogenic therapy

Chronic hepatic schistosomiasis causes portal hypertension, fibrosis and lethal hepatosplenic complications. Previous studies focused mainly on schistosomicidal drugs and neglected the therapeutic approaches against the vascular complications after portal hypertension. Investigating a novel anti-angiogenic therapy is an urgent. The current study is to evaluate the performance of Paeoniflorin (PAE) as an anti-angiogenic therapy, being a powerful anti-fibrotic, compared to artemether (ART) and praziqantel (PZQ) in schistosomiasis mansoni BALB/c mice. Thirty two laboratory bred male BALB/c Swiss albino mice. The mice were classified into four groups (8 mice each), control infected (CI), PZQ (300 mg/kg/12 h), ART (0.1 ml/mg/d) and PAE (50 mg/kg/d) treated groups for one month. All mice groups were sacrificed 15 weeks post infection for assessment of the drugs' efficacy by parasitological, histopathological and immunohistochemical studies. Our results in PAE group showed marked reduction in the mean egg count/gram stool, worm burden, egg count/gram liver tissue, granuloma diameter and pro-angiogenic factors as vascular endothelial growth factor (VEGF), Proliferating cell nuclear antigen (PCNA), alpha-smooth muscle actin (α-SMA) and CD34; conversely, there was an augmentation of the tissue inhibitor metalloproteinases-2 (TIMP-2) as an anti-angiogenic expression that was exceeded ART and PZQ treated groups compared to CI group (p˂0.001). Conclusively, PAE has an anti-angiogenic impact with no vascular proliferative activity or recanalization, no micro-vessel density (MVD) changes, granuloma resolution and fibrosis regression. PAE is predicted to be a potential therapy for chronic hepatic diseases associated with fibrosis and angiogenesis, hopeful in protecting from advanced serious complications; cancer and metastasis.

The polytrauma clinical triad in patients with chronic pain after motor vehicle collision

Background

The polytrauma clinical triad (PCT) is a complex disorder composed of three comorbid diagnoses of chronic pain, post-traumatic stress disorder (PTSD), and postconcussion syndrome (PCS). PCT has been documented in veterans returning from deployment, but this is the first report on PCT prevalence in nonmilitary personnel after a motor vehicle collision (MVC).

Methods

Data were drawn from routine intake assessments completed by 71 patients referred to a community-based clinic for chronic pain management. All patients completed the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PCL-5), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) during a standardized intake assessment. An additional modified RPQ score was derived to address previously reported symptom overlap between PCS and chronic pain.

Results

Standard and modified RPQ scores yielded PCS prevalence rates of 100% and 54.9% in our sample, respectively. Results suggest that a modified RPQ score, limited to visual and vestibular symptoms, may be more useful PCS screening criteria in patients with chronic pain. PTSD screening criteria on the PCL-5 were met by 85.9% of the patients. More than half of the patients referred for chronic pain after MVC met criteria for PCT (52.1%). Patients who met PCT criteria reported worse headache, overall pain, and sleep quality outcomes.

Conclusion

Among patients in our sample with chronic pain after MVC, more than half met criteria for PCT. A modified approach to RPQ scoring limited to visual and vestibular symptoms may be required to screen for PCS in these patients.

Reliability of surface electromyography activity of gluteal and hamstring muscles during sub-maximal and maximal voluntary isometric contractions

BACKGROUND

Normalizing to a reference signal is essential when analysing and comparing electromyography signals across or within individuals. However, studies have shown that MVC testing may not be as reliable in persons with acute and chronic pain.

OBJECTIVES

The purpose of this study was to compare the test-retest reliability of the muscle activity in the biceps femoris and gluteus maximus between a novel sub-MVC and standard MVC protocols.

METHODS

This study utilized a single individual repeated measures design with 12 participants performing multiple trials of both the sub-MVC and MVC tasks on two separate days. The participant position in the prone leg raise task was standardised with an ultrasonic sensor to improve task precession between trials/days. Day-to-day and trial-to-trial reliability of the maximal muscle activity was examined using ICC and SEM.

FINDINGS

Day-to-day and trial-to-trial reliability of the EMG activity in the BF and GM were high (0.70-0.89) to very high (≥0.90) for both test procedures. %SEM was <5-10% for both tests on a given day but higher in the day-to-day comparisons. The lower amplitude of the sub-MVC is a likely contributor to increased %SEM (8-13%) in the day-to-day comparison.

CONCLUSIONS

The findings show that the sub-MVC modified prone double leg raise results in GM and BF EMG measures similar in reliability and precision to the standard MVC tasks. Therefore, the modified prone double leg raise may be a useful substitute for traditional MVC testing for normalizing EMG signals of the BF and GM.

Increased rate of force development during periodized maximum strength and power training is highly individual

Maximum strength training induces various improvements in the rate of force development (RFD) on a group level, but no study has investigated inter-individual adaptations in RFD. Fourteen men (28 ± 6 years old) performed the same 10-week maximum strength and then a 10-week power training program. Maximal force and RFD were recorded during maximal isometric leg extension voluntary contractions repeatedly before every 7th training session (2 sessions/week). After the intervention, subjects were retrospectively divided into three groups based on their RFD improvements: (1) improved only during the maximum strength period (MS-responders, + 100 ± 35%), (2) improved only during the power period (P-responders, + 53 ± 27%) or (3) no improvement at all (non-responders, + 3 ± 9%). All groups increased dynamic 1RM equally, but baseline 1RM was greater (p < 0.05) in responder vs non-responder groups. MS-responders had higher electrical stimulation-induced torque at baseline and they improved (+ 35 ± 28%) power production at 50% 1RM load more than P- (- 7 ± 20%, p = 0.052) and non-responders (+ 3 ± 6%, p = 0.066) during the maximum strength training period. MS-responders increased vastus lateralis cross-sectional area (+ 12 ± 9%, p < 0.01) as did P-responders (+ 10 ± 7%, p = 0.07), whereas non-responders were unchanged. Free androgen index (FAI) in responders was higher (+ 34%, p < 0.05) compared to non-responders at baseline. The maximum strength period decreased testosterone (- 17 ± 12; 17 ± 22%), FAI ratio (- 12 ± 14; - 21 ± 23%) and testosterone/cortisol ratio (- 17 ± 25; - 31 ± 20%) in MS and P-responders, respectively. During the P-period hormonal levels plateaued. To conclude, periodized strength training induced different inter-individual physiological responses, and thus RFD development may vary between individuals. Therefore, RFD seems to be a useful tool for planning and monitoring strength training programs for individual neuromuscular performance needs.

Low Cost Efficient Deliverying Video Surveillance Service to Moving Guard for Smart Home

Low-cost video surveillance systems are attractive for Smart Home applications (especially in emerging economies). Those systems use the flexibility of the Internet of Things to operate the video camera only when an intrusion is detected. We are the only ones that focus on the design of protocols based on intelligent agents to communicate the video of an intrusion in real time to the guards by wireless or mobile networks. The goal is to communicate, in real time, the video to the guards who can be moving towards the smart home. However, this communication suffers from sporadic disruptions that difficults the control and drastically reduces user satisfaction and operativity of the system. In a novel way, we have designed a generic software architecture based on design patterns that can be adapted to any hardware in a simple way. The implanted hardware is of very low economic cost; the software frameworks are free. In the experimental tests we have shown that it is possible to communicate to the moving guard, intrusion notifications (by e-mail and by instant messaging), and the first video frames in less than 20 s. In addition, we automatically recovered the frames of video lost in the disruptions in a transparent way to the user, we supported vertical handover processes and we could save energy of the smartphone's battery. However, the most important thing was that the high satisfaction of the people who have used the system.

Prevalence and psychometric screening for the detection of major depressive disorder and post-traumatic stress disorder in adults injured in a motor vehicle crash who are engaged in compensation

BACKGROUND

Physical injury and psychological disorder following a motor vehicle crash (MVC) is a public health concern. The objective of this research was to determine rates of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) in adults with MVC-related injury engaged in compensation, and to determine the capacity (e.g. sensitivity and specificity) of two psychometric scales for estimating the presence of MDD and PTSD.

METHODS

Participants included 109 adults with MVC-related injury engaged in compensation during 2015 to 2017, in Sydney, Australia. The mean time from MVC to baseline assessment was 11 weeks. Comprehensive assessment was conducted at baseline, and the Depression Anxiety Stress Scales (DASS-21) and the Impact of Event Scale-Revised (IES-R) were administered to determine probable MDD and PTSD. An online psychiatric interview, based on Diagnostic and Statistical Manual for Mental Disorders (DSM-5), was used to diagnose actual MDD and PTSD, acknowledged as gold standard diagnostic criteria. One-way multivariate analyses of variance established criterion validity of the DASS-21 and IES-R, and sensitivity and specificity analyses were conducted to determine the most sensitive cut-off points for detecting probable MDD and PTSD.

RESULTS

Substantial rates of MDD (53.2%) and PTSD (19.3%) were found. The DASS-21 and IES-R were shown to have excellent criterion validity for detecting MDD and PTSD in injured participants. A range of cut-off points were investigated and shown to have acceptable sensitivity and specificity for detecting MDD and PTSD in an injured population engaged in compensation. The preferred cut-off points based on this study are: to detect MDD, a DASS-21 total score of 30 and/or a DASS-21 depression score of 10; to detect PTSD, IES-R scores of 33-40 and/or a DASS-21 anxiety score of 7-8.

CONCLUSIONS

Major psychological disorder is prevalent following a MVC. Results suggest the DASS-21 and IES-R are suitable for use in clinical/compensation settings to detect probable MDD and PTSD soon after a MVC in physically injured people engaged in compensation. These results provide positive direction in the public health arena for improving mental health outcomes.

TRIAL REGISTRATION

Clinical Trials registration number: ANZCTR - ACTRN12615000326594 (9th April 2015).

The effects of a single session of spinal manipulation on strength and cortical drive in athletes

Purpose

The primary purpose of this study was to investigate whether a single session of spinal manipulation (SM) increases strength and cortical drive in the lower limb (soleus muscle) of elite Taekwondo athletes.

Methods

Soleus-evoked V-waves, H-reflex and maximum voluntary contraction (MVC) of the plantar flexors were recorded from 11 elite Taekwondo athletes using a randomized controlled crossover design. Interventions were either SM or passive movement control. Outcomes were assessed at pre-intervention and at three post-intervention time periods (immediate post, post 30 min and post 60 min). A multifactorial repeated measures ANOVA was conducted to assess within and between group differences. Time and session were used as factors. A post hoc analysis was carried out, when an interactive effect was present. Significance was set at p ≤ 0.05.

Results

SM increased MVC force [F(3,30) = 5.95, p < 0.01], and V-waves [F(3,30) = 4.25, p = 0.01] over time compared to the control intervention. Between group differences were significant for all time periods (p < 0.05) except for the post60 force measurements (p = 0.07).

Conclusion

A single session of SM increased muscle strength and corticospinal excitability to ankle plantar flexor muscles in elite Taekwondo athletes. The increased MVC force lasted for 30 min and the corticospinal excitability increase persisted for at least 60 min.

Reduced firing rates of high threshold motor units in response to eccentric overload

Acute responses of motor units were investigated during submaximal voluntary isometric tasks following eccentric overload (EO) and constant load (CL) knee extension resistance exercise. Ten healthy resistance-trained participants performed four experimental test sessions separated by 5 days over a 20 day period. Two sessions involved constant load and the other two used eccentric overload. EO and CL used both sessions for different target knee eccentric extension phases; one at 2 sec and the other at 4 sec. Maximal voluntary contractions (MVC) and isometric trapezoid efforts for 10 sec at 70% MVC were completed before and after each intervention and decomposed electromyography was used to measure motor unit firing rate. The firing rate of later recruited, high-threshold motor units declined following the 2-sec EO but was maintained following 2sec CL (P < 0.05), whereas MUFR for all motor units were maintained for both loading types following 4-sec extension phases. MVC and rate of force development where maintained following both EO and CL and 2 and 4 sec phases. This study demonstrates a slower firing rate of high-threshold motor units following fast eccentric overload while MVC was maintained. This suggests that there was a neuromuscular stimulus without cost to the force-generating capacity of the knee extensors.

Results of the first international HIV-1 coreceptor proficiency panel test

BACKGROUND

Quality Assurance (QA) programs are essential to evaluate performance in diagnostics laboratories.

OBJECTIVES

We present the results from the first QA for HIV-1 genotypic tropism testing, organized and coordinated by the Institute of Virology at the University of Cologne.

STUDY DESIGN

12 cell culture-derived viral strains of different HIV-1 clades from the NIH AIDS Reagent Program were sent to the participants to be processed with their standard diagnostic methods Fasta files containing the V3 region sequence were centrally analyzed at the Institute of Virology, Cologne. All samples were sent in parallel for phenotypic testing.

RESULTS

36 laboratories from 16 countries reported genotypic results. The sequence-generation efficacy was 95.1%, while the phenotypic assays ESTA^® and PhenXR only achieved results for 58.3% of the samples. All four X4 samples were identified by 31/36 laboratories, two laboratories amplified 3/4×4 samples, and three detected 2/4×4 samples. There was high concordance among the genotypic and phenotypic results, although differences in FPR values were detected. Most deficiencies in sequence editing did not result in wrong classification of X4 viruses as R5, with the exception of sample NRZ05 by laboratory 38, but in an overestimation of CXCR4 use.

CONCLUSIONS

This demonstrates that genotypic tropism prediction is a safe procedure for clinical purposes. As we used homogeneous cell culture samples and all sequence fasta files were centrally analyzed, variations in FPR values can only be attributed to sample preparation, RT-PCR or sequence editing protocols.

Electromyographic analyses of the erector spinae muscles during golf swings using four different clubs

The purpose of this study was to compare the electromyography (EMG) patterns of the thoracic and lumbar regions of the erector spinae (ES) muscle during the golf swing whilst using four different golf clubs. Fifteen right-handed male golfers performed a total of twenty swings in random order using the driver, 4-iron, 7-iron and pitching-wedge. Surface EMG was recorded from the lead and trail sides of the thoracic and lumbar regions of the ES muscle (T8, L1 and L5 lateral to the spinous-process). Three-dimensional high-speed video analysis was used to identify the backswing, forward swing, acceleration, early and late follow-through phases of the golf swing. No significant differences in muscle-activation levels from the lead and trail sides of the thoracic and lumbar regions of the ES muscle were displayed between the driver, 4-iron, 7-iron and pitching-wedge (P > 0.05). The highest mean thoracic and lumbar ES muscle-activation levels were displayed in the forward swing (67-99% MVC) and acceleration (83-106% MVC) phases of the swing for all clubs tested. The findings from this study show that there were no significant statistical differences between the driver, 4-iron, 7-iron and pitching-wedge when examining muscle activity from the thoracic and lumbar regions of the ES muscle.

Cold-Water Immersion and Contrast Water Therapy: No Improvement of Short-Term Recovery After Resistance Training

CONTEXT

An athlete's ability to recover quickly is important when there is limited time between training and competition. As such, recovery strategies are commonly used to expedite the recovery process.

PURPOSE

To determine the effectiveness of both cold-water immersion (CWI) and contrast water therapy (CWT) compared with control on short-term recovery (<4 h) after a single full-body resistance-training session.

METHODS

Thirteen men (age 26 ± 5 y, weight 79 ± 7 kg, height 177 ± 5 cm) were assessed for perceptual (fatigue and soreness) and performance measures (maximal voluntary isometric contraction [MVC] of the knee extensors, weighted and unweighted countermovement jumps) before and immediately after the training session. Subjects then completed 1 of three 14-min recovery strategies (CWI, CWT, or passive sitting [CON]), with the perceptual and performance measures reassessed immediately, 2 h, and 4 h postrecovery.

RESULTS

Peak torque during MVC and jump performance were significantly decreased (P < .05) after the resistance-training session and remained depressed for at least 4 h postrecovery in all conditions. Neither CWI nor CWT had any effect on perceptual or performance measures over the 4-h recovery period.

CONCLUSIONS

CWI and CWT did not improve short-term (<4-h) recovery after a conventional resistance-training session.

Psychological distress following a motor vehicle crash: A systematic review of preventative interventions

INTRODUCTION

Psychological distress following a motor vehicle crash (MVC) is prevalent, especially when the person sustains an associated physical injury. Psychological distress can exhibit as elevated anxiety and depressive mood, as well as presenting as mental disorders such as Post Traumatic Stress Disorder (PTSD) or Major Depressive Disorder (MDD). If unmanaged, psychological distress can contribute to, or exacerbate negative outcomes such as social disengagement (e.g., loss of employment) and poor health-related quality of life, as well as contribute to higher costs to insurers. This systematic review summarises current research concerning early psychological intervention strategies aimed at preventing elevated psychological distress occurring following a MVC.

METHOD

A systematic review of psychological preventative intervention studies was performed. Searches of Medline, Embase, PsychINFO, Web of Science and Cochrane Library were used to locate relevant studies published between 1985 and September 2015. Included studies were those investigating MVC survivors who had received an early psychological intervention aimed at preventing psychological distress, and which had employed pre- and post- measures of constructs such as depression, anxiety and disorders such as PTSD.

RESULTS

Searches resulted in 2608 records. Only six studies investigated a psychological preventative intervention post-MVC. Interventions such as injury health education, physical activity and health promotion, and therapist-assisted problem solving did not result in significant treatment effects. Another six studies investigated psychological interventions given to MVC survivors who were assessed as sub-clinically psychologically distressed prior to their randomisation. Efficacy was varied, however three studies employing cognitive behaviour therapy (CBT) found significant reductions in psychological distress compared to wait-list controls.

CONCLUSION

Psychological interventions aimed at preventing psychological distress post-MVC are limited, often involving small samples, with subsequent poor statistical power and subsequent high risk of bias. These factors make it difficult to draw conclusions, however CBT appears encouraging and therefore worthy of consideration as a preventative intervention.

Assessment and Management of Whiplash From the Emergency and Acute Care Setting: Care, Questions, and Future Global Research Needs

The primary goal of this editorial is to discuss the care patients typically receive in the immediate post-motor vehicle collision setting and the questions patients typically ask with respect to their symptoms and prognosis. Commentary and guidance are provided from the perspective of an acute care physician on what we should be able to tell patients and providers going forward. J Orthop Sports Phys Ther 2016;46(10):822-825. doi:10.2519/jospt.2016.0114.

Preventable Injuries/Fatalities Due to Distracted Driving: A Call for a Coordinated Action

In the past decade, distracted driving has emerged as one of the most prominent global road safety concerns. The singular and combined efforts of many organizations, such as Drop It And Drive (DIAD) and the Traffic Injury Research Foundation (TIRF), have identified the need for partnerships, shared information, and access to interpretable research findings to guide decision making and to identify effective strategies to reduce, if not eliminate, preventable injuries/fatalities from distracted driving, including whiplash-associated disorders. This editorial describes activities in 5 target areas identified in our environmental scan in Canada: (1) provincial/territorial government strategies, (2) enforcement, (3) data collection and measurement, (4) awareness campaigns, and (5) legislation. We will also reinforce the potential benefits of seeking and establishing meaningful interdisciplinary partnerships to reduce distracted driving across the globe. Finally, this editorial provides an example of how these interdisciplinary partnerships can help reduce preventable, life-altering injuries/deaths caused by distracted driving. J Orthop Sports Phys Ther 2016;46(10):818-821. doi:10.2519/jospt.2016.0113.

Whiplash Continues Its Challenge

There have been many advances in the management of neck pain disorders, but a personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened. The commentaries in this special issue reflect the multifaceted nature of whiplash-associated disorders and the wide-ranging research in the field. While management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved, the picture is becoming clearer. This should give great confidence and some hope to individuals with whiplash-associated disorders who have long-term pain and functional disability that after the next decade of research and clinical development, the outcomes following whiplash are likely to be vastly improved. J Orthop Sports Phys Ther 2016;46(10):815-817. doi:10.2519/jospt.2016.0112.

Effects of acute static, ballistic, and PNF stretching exercise on the muscle and tendon tissue properties

The purpose of this study was to investigate the influence of a single static, ballistic, or proprioceptive neuromuscular facilitation (PNF) stretching exercise on the various muscle‐tendon parameters of the lower leg and to detect possible differences in the effects between the methods. Volunteers (n = 122) were randomly divided into static, ballistic, and PNF stretching groups and a control group. Before and after the 4 × 30 s stretching intervention, we determined the maximum dorsiflexion range of motion (RoM) with the corresponding fascicle length and pennation angle of the gastrocnemius medialis. Passive resistive torque (PRT) and maximum voluntary contraction (MVC) were measured with a dynamometer. Observation of muscle‐tendon junction (MTJ) displacement with ultrasound allowed us to determine the length changes in the tendon and muscle, respectively, and hence to calculate stiffness. Although RoM increased (static: +4.3%, ballistic: +4.5%, PNF: +3.5%), PRT (static: −11.4%, ballistic: −11.5%, PNF: −13,7%), muscle stiffness (static: −13.1%, ballistic: −20.3%, PNF: −20.2%), and muscle‐tendon stiffness (static: −11.3%, ballistic: −10.5%, PNF: −13.7%) decreased significantly in all the stretching groups. Only in the PNF stretching group, the pennation angle in the stretched position (−4.2%) and plantar flexor MVC (−4.6%) decreased significantly. Multivariate analysis showed no clinically relevant difference between the stretching groups. The increase in RoM and the decrease in PRT and muscle‐tendon stiffness could be explained by more compliant muscle tissue following a single static, ballistic, or PNF stretching exercise.

Effects of Loaded Squat Exercise with and without Application of Superimposed EMS on Physical Performance

The aim of the present study was to investigate the effects of a multiple set squat exercise training intervention with superimposed electromyostimulation (EMS) on strength and power, sprint and jump performance. Twenty athletes from different disciplines participated and were divided into two groups: strength training (S) or strength training with superimposed EMS (S+E). Both groups completed the same training program twice a week over a six week period consisting of four sets of the 10 repetition maximum of back squats. Additionally, the S+E group had EMS superimposed to the squat exercise with simultaneous stimulation of leg and trunk muscles. EMS intensity was adjusted to 70% of individual pain threshold to ensure dynamic movement. Strength and power of different muscle groups, sprint, and vertical jump performance were assessed one week before (pre), one week after (post) and three weeks (re) following the training period. Both groups showed improvements in leg press strength and power, countermovement and squat jump performance and pendulum sprint (p < 0.05), with no changes for linear sprint. Differences between groups were only evident at the leg curl machine with greater improvements for the S+E group (p < 0.05). Common squat exercise training and squat exercise with superimposed EMS improves maximum strength and power, as well as jumping abilities in athletes from different disciplines. The greater improvements in strength performance of leg curl muscles caused by superimposed EMS with improvements in strength of antagonistic hamstrings in the S+E group are suggesting the potential of EMS to unloaded (antagonistic) muscle groups. Key pointsSimilar strength adaptations occurred after a 6 week 10 RM back squat exercise program with superimposed EMS (S+E) and 10 RM back squat exercise (S) alone.Specific adaptations for S+E at the leg curl muscles were evident.S and S+E improved SJ, CMJ and pendulum sprint performance.No improvement occurred in linear sprint performance.