Respiratory virus infections in decedents in a large, urban medical examiner's office

OBJECTIVE

Most respiratory virus surveillance relies on medically attended respiratory illness, but an understanding of the true patterns of infection independent of care-seeking behaviour would enhance clinical and public health responses to respiratory virus outbreaks. We evaluated the potential of decedent surveillance by estimating the burden of respiratory virus infection in decedents in a large, urban medical examiner's office.

STUDY DESIGN

Observational.

METHODS

In 2020-2022, we tested nasopharyngeal swabs from 4121 decedents in Detroit, Michigan for 15 respiratory viruses, including SARS-CoV-2, respiratory syncytial virus, and influenza virus A and B. We analysed infection prevalence over time and by age, sex, race/ethnicity, and manner of death.

RESULTS

Of 4113 valid tests, 30.2% were positive for at least one virus, and 6.1% were positive for multiple viruses. All viruses were detected except for influenza A/H1N1 and influenza B. The most prevalent viruses were SARS-CoV-2 (15.7%), rhinovirus (11.2%), and adenovirus (4.9%), which were detected in all months. Most viruses exhibited decreasing prevalence with age, higher prevalence among Black and Hispanic than among White decedents and lower prevalence among deaths from natural causes; SARS-CoV-2 was a notable exception to the patterns by age and manner of death, instead reflecting community trends in catchment counties.

CONCLUSIONS

There was high prevalence and diversity of respiratory viruses in decedents entering a large, urban medical examiner's office. Decedent surveillance could offer a clearer picture of the true underlying burden of infection, motivating public health priorities for intervention and vaccine development, and augmenting data for real-time response to respiratory virus outbreaks.

Behavioral and physiological responses to an inspired-air supplemental cooling system for dairy cows in free-stall housing

During heat stress, dairy cows spend less time lying down to dissipate heat. Heat stress abatement strategies generally target cows outside of their resting areas. However, cooling cows while in their stalls could help alleviate heat stress without compromising lying behavior. The objective of this study was to assess the effects of an inspired-air supplemental cooling system (SCS) on respiration rate, rectal temperatures, lying behavior, rumination time, and milk production (energy-corrected milk, ECM) of lactating dairy cows. A free-stall pen was retrofitted with custom stall partitions to deliver cooled air and mist. The pen, including the stall platform, was divided into two separate sides. Twenty-eight lactating Holstein cows were randomly sorted into two groups, each housed on one side of the experimental pen. Cows experienced four treatments (control, CTRL; cooled air, AIR; mist, MIST; cooled air and mist, AIR + MIST) in a four-treatment, four-period, two-sequence crossover design, with each period lasting seven days. Cooled air was provided continuously, and mist was cycled 3 min on, 12 min off from 0900 to 2100 h. Respiration rates were observed hourly between 0900 and 1500 h, and only measurements recorded while cows were lying down were used in the analysis. Rectal temperatures of 16 focal cows were recorded at 1545 h once per day. Lying behavior and rumination were recorded continuously, and milk yields recorded twice daily were used to calculate ECM. Throughout the experimental period, the average temperature-humidity index was 66.4 ± 6.07. During the MIST treatment, the respiration rate was lower than the CTRL (45.7 vs 49.0 ± 1.92 breaths/min) and AIR (45.7 vs 48.7 ± 1.92 breaths/min). CTRL and AIR did not differ (48.7 vs 49.0 ± 1.92 breaths/min), and MIST and AIR + MIST (45.7 vs 47.1 ± 1.92 breaths/min) did not differ. All other variables were not significantly different between treatments. In conclusion, the SCS appeared to be tolerated by cows and shows the potential to assist in alleviating heat stress. The cooling capacity needs to be evaluated under more extreme environmental conditions causing heat stress than those experienced during this study. Further testing is required to determine the cooled air temperature specifications and mist delivery frequency.

Why is mock care not a good proxy for predicting hand contamination during patient care?

BACKGROUND

Healthcare worker (HCW) behaviours, such as the sequence of their contacts with surfaces and hand hygiene moments, are important for understanding disease transmission.

AIM

To propose a method for recording sequences of HCW behaviours during mock vs actual procedures, and to evaluate differences for use in infection risk modelling and staff training.

METHODS

Procedures for three types of care were observed under mock and actual settings: intravenous (IV) drip care, observational care and doctors' rounds on a respiratory ward in a university teaching hospital. Contacts and hand hygiene behaviours were recorded in real-time using either a handheld tablet or video cameras.

FINDINGS

Actual patient care demonstrated 70% more surface contacts than mock care. It was also 2.4 min longer than mock care, but equal in terms of patient contacts. On average, doctors' rounds took 7.5 min (2.5 min for mock care), whilst auxiliary nurses took 4.9 min for observational care (2.4 min for mock care). Registered nurses took 3.2 min for mock IV care and 3.8 min for actual IV care; this translated into a 44% increase in contacts. In 51% of actual care episodes and 37% of mock care episodes, hand hygiene was performed before patient contact; in comparison, 15% of staff delivering actual care performed hand hygiene after patient contact on leaving the room vs 22% for mock care. The number of overall touches in the patient room was a modest predictor of hand hygiene. Using a model to predict hand contamination from surface contacts for Staphylococcus aureus, Escherichia coli and norovirus, mock care underestimated micro-organisms on hands by approximately 30%.

Movement patterns of cheetahs (Acinonyx jubatus) in farmlands in Botswana

Botswana has the second highest population of cheetah (Acinonyx jubatus) with most living outside protected areas. As a result, many cheetahs are found in farming areas which occasionally results in human-wildlife conflict. This study aimed to look at movement patterns of cheetahs in farming environments to determine whether cheetahs have adapted their movements in these human-dominated landscapes. We fitted high-time resolution GPS collars to cheetahs in the Ghanzi farmlands of Botswana. GPS locations were used to calculate home range sizes as well as number and duration of visits to landscape features using a time-based local convex hull method. Cheetahs had medium-sized home ranges compared to previously studied cheetah in similar farming environments. Results showed that cheetahs actively visited scent marking trees and avoided visiting homesteads. A slight preference for visiting game farms over cattle farms was found, but there was no difference in duration of visits between farm types. We conclude that cheetahs selected for areas that are important for their dietary and social needs and prefer to avoid human-occupied areas. Improved knowledge of how cheetahs use farmlands can allow farmers to make informed decisions when developing management practices and can be an important tool for reducing human-wildlife conflict.

How realistic is a racehorse simulator?

Race jockey training is demanding and technical. Increased horse care costs and demands on time have led to greater availability and use of racehorse simulators during training. Little is known about the accuracy of the simulated movement and therefore how effective they are for developing the desired technique. We quantified and compared sacral rotation and displacement vectors for a racehorse simulator and a real galloping horse. A single inertial measurement unit was placed on the sacrum of six horses (horse) during a training gallop along an all-weather seven furlong gallop and on the highest speed setting 'four' on the simulator. Displacements were calculated in all three axes before being cut into cycles and analysed along with roll and pitch. Displacement and rotation amplitudes were extracted and compared for the horse and simulator. Horse sacral movement parameters were more varied than those recorded on the simulator. The real horse exhibited greater dorso-ventral, medio-lateral and roll amplitude but smaller cranio-caudal displacement amplitude and no difference in pitch amplitude. Displacement trajectory of the simulator when viewed laterally from the left side, was anticlockwise, the opposite direction to that of the real horse leaving the regular use of a simulator during jockey training under question. Use of the racehorse simulator is beneficial to develop specific fitness and to enable physical manipulation into the optimal position. Care must be taken to avoid any detrimental effects of training with the opposite movement trajectory to that experienced during a race. The programming of the simulators may benefit from adaptations to maximise their benefits.

The kinematics and kinetics of riding a racehorse: A quantitative comparison of a training simulator and real horses

Movement of a racehorse simulator differs to that of a real horse, but the effects of these differences on jockey technique have not been evaluated. We quantified and compared the kinematics and kinetics of jockeys during gallop riding on a simulator and real horses. Inertial measurement units were attached mid-shaft to the long bones of six jockeys and the sacrum of the horse or simulator. Instrumented stirrups were used to measure force. Data were collected during galloping on a synthetic gallop or while riding a racehorse simulator. Jockey kinematics varied more on a real horse compared to the simulator. Greater than double the peak stirrup force was recorded during gallop on real horses compared to the simulator. On the simulator stirrup forces were symmetrical, whereas on a real horse peak forces were higher on the opposite side to the lead limb. Asymmetric forces and lateral movement of the horse and jockey occurs away from the side of the lead leg, likely a result of horse trunk roll. Jockeys maintained a more upright trunk position on a real horse compared to simulator, with no change in pitch. The feet move in phase with the horse and simulator exhibiting similar magnitude displacements in all directions. In contrast the pelvis was in phase with the horse and simulator in the dorso-ventral and medio-lateral axes while a phase shift of 180° was seen in the cranio-caudal direction indicating an inverted pendulum action of the jockey.

Clinical utility of neuronal cells directly converted from fibroblasts of patients for neuropsychiatric disorders: studies of lysosomal storage diseases and channelopathy

Methodologies for generating functional neuronal cells directly from human fibroblasts [induced neuronal (iN) cells] have been recently developed, but the research so far has only focused on technical refinements or recapitulation of known pathological phenotypes. A critical question is whether this novel technology will contribute to elucidation of novel disease mechanisms or evaluation of therapeutic strategies. Here we have addressed this question by studying Tay-Sachs disease, a representative lysosomal storage disease, and Dravet syndrome, a form of severe myoclonic epilepsy in infancy, using human iN cells with feature of immature postmitotic glutamatergic neuronal cells. In Tay-Sachs disease, we have successfully characterized canonical neuronal pathology, massive accumulation of GM2 ganglioside, and demonstrated the suitability of this novel cell culture for future drug screening. In Dravet syndrome, we have identified a novel functional phenotype that was not suggested by studies of classical mouse models and human autopsied brains. Taken together, the present study demonstrates that human iN cells are useful for translational neuroscience research to explore novel disease mechanisms and evaluate therapeutic compounds. In the future, research using human iN cells with well-characterized genomic landscape can be integrated into multidisciplinary patient-oriented research on neuropsychiatric disorders to address novel disease mechanisms and evaluate therapeutic strategies.

Unisexual reproduction in Huntiella moniliformis

Sexual reproduction in fungi is controlled by genes present at the mating type (MAT) locus, which typically harbors transcription factors that influence the expression of many sex-related genes. The MAT locus exists as two alternative idiomorphs in ascomycetous fungi and sexual reproduction is initiated when genes from both idiomorphs are expressed. Thus, the gene content of this locus determines whether a fungus is heterothallic (self-sterile) or homothallic (self-fertile). Recently, a unique sub-class of homothallism has been described in fungi, where individuals possessing a single MAT idiomorph can reproduce sexually in the absence of a partner. Using various mycological, molecular and bioinformatic techniques, we investigated the sexual strategies and characterized the MAT loci in two tree wound-infecting fungi, Huntiella moniliformis and Huntiella omanensis. H. omanensis was shown to exhibit a typically heterothallic sexual reproductive cycle, with isolates possessing either the MAT1-1 or MAT1-2 idiomorph. This was in contrast to the homothallism via unisexual reproduction that was shown in H. moniliformis, where only the MAT1-2-1 gene was present in sexually reproducing cultures. While the evolutionary benefit and mechanisms underpinning a unisexual mating strategy remain unknown, it could have evolved to minimize the costs, while retaining the benefits, of normal sexual reproduction.

Evaluation of respiratory syncytial virus (RSV) direct antigen detection assays for use in point-of-care testing

RSV infections cause lower respiratory tract infections and result in surges in physician's office, emergency department visits and hospitalizations, especially in infants and toddlers. Point-of-care (POC) testing reduces healthcare costs and permits informed decisions on treatment, however, optimal POC assays must be sensitive, easy to perform and provide rapid results. A prospective study tested 230 patient nasopharyngeal specimens using 4 RSV direct antigen detection assays (Directigen, Quickvue, Sofia and Veritor) and RT-PCR. A RSV dilution study was also performed to evaluate sensitivity. RSV fluorescent antibody testing in 46/230 patients was also evaluated. Sensitivity values obtained for the Sofia, Veritor, Directigen and Quickvue assays (%) were 85, 72.5, 70 and 57.5, respectively. Fluorescent result interpretation may account for Sofia's enhanced sensitivity. Specificity (%) was 97-100 among assays. Sensitivity data were confirmed in the dilution studies. Fluorescent antibody testing demonstrated 64% sensitivity compared with RT-PCR. Objective result reporting, walk away testing and high sensitivity make the Sofia a valuable choice for POC testing. Veritor's sensitivity may also render it acceptable in POC. Lack of objective results by Directigen and the poor sensitivity observed by Quickvue may preclude their value in diagnostic testing.

Speed and incline during thoroughbred horse racing: racehorse speed supports a metabolic power constraint to incline running but not to decline running

We used a radio tracking system to examine the speed of 373 racehorses on different gradients on an undulating racecourse during 33 races, each lasting a few minutes. Horses show a speed detriment on inclines (0.68 m · s(-1) · 1% gradient(-1), r(2) = 0.97), the magnitude of which corresponds to trading off the metabolic cost (power) of height gain with the metabolic cost (power) of horizontal galloping. A similar relationship can be derived from published data for human runners. The horses, however, were also slower on the decline (-0.45 m · s(-1) · 1% gradient(-1), r(2) = 0.92). Human athletes run faster on a decline, which can be explained by the energy gained by the center of mass from height loss. This study has shown that horses go slower, which may be attributable to the anatomical simplicity of their front legs limiting weight support and stability when going downhill. These findings provide insight into limits to athletic performance in racehorses, which may be used to inform training regimens, as well as advancing knowledge from both veterinary and basic science perspectives.

Gene therapy for retinal ganglion cell neuroprotection in glaucoma

Glaucoma is the leading cause of irreversible blindness worldwide. The primary cause of glaucoma is not known, but several risk factors have been identified, including elevated intraocular pressure and age. Loss of vision in glaucoma is caused by the death of retinal ganglion cells (RGCs), the neurons that convey visual information from the retina to the brain. Therapeutic strategies aimed at delaying or halting RGC loss, known as neuroprotection, would be valuable to save vision in glaucoma. In this review, we discuss the significant progress that has been made in the use of gene therapy to understand mechanisms underlying RGC degeneration and to promote the survival of these neurons in experimental models of optic nerve injury.

An elevated apolipoprotein B/AI ratio is independently associated with microalbuminuria in male subjects with impaired fasting glucose

BACKGROUND AND AIMS

The ratio of apolipoprotein B/AI (apo B/AI) has been used as a marker to predict the risk of coronary artery disease. Recent studies have suggested an association between apolipoprotein B level and microalbuminuria in diabetic subjects. This study was performed to assess a possible association between the apo B/AI ratio and microalbuminuria in male subjects with impaired fasting glucose (IFG).

METHODS AND RESULTS

In 1266 patients with fasting serum glucose level in the pre-diabetic range, urine albumin-to-creatinine ratio (UACR, μg mg(-1)) was measured from single morning voided urine. The presence of microalbuminuria was defined as a UACR between 30 and 299 μg mg(-1). Participants were stratified into four groups by apo B/AI quartiles, from the lowest to the highest. Apo B/AI was higher with increasing body mass index, higher serum triglyceride and serum low-density lipoprotein cholesterol, systolic and diastolic blood pressure values, but lower with higher high-density lipoprotein cholesterol concentrations. After adjusting for these and other confounding factors, an increased apo B/AI ratio was independently associated with the presence of microalbuminuria. In receiver operating characteristic (ROC) curve analyses, apo B/AI ratio showed the highest correlation with the presence of microalbuminuria among the variables, although statistically not different.

CONCLUSION

These findings indicate that apo B/AI ratio shows significant association with microalbuminuria in Korean male subjects with IFG.

Virtual histology: a window to the heart of atherosclerosis

Intravascular ultrasound has done much to improve our understanding of atherosclerosis and the impact of percutaneous intervention on the coronary artery. However, subjectivity in interpreting the acoustic reflection of the ultrasound signal has spawned the development of other progressive technologies. Virtual histology intravascular ultrasound (VHIVUS) utilises the ultrasound backscatter signal in order to colour code plaque into four pre-specified subtypes based on their histological composition. We review the background behind traditional grey scale intravascular ultrasound (IVUS) and examine the current evidence for VHIVUS and its potential for use in clinical interventional practice.

The relationship between in vivo limb and in vitro tendon mechanics after injury: a potential novel clinical tool for monitoring tendon repair

REASONS FOR PERFORMING THE STUDY

Highly prevalent superficial digital flexor tendon (SDFT) injury results in compromised tendon function through fibrosis and high frequency of re-injury due to altered biomechanical function. This study investigated the consequences of SDF tendinopathy on limb mechanics in relation to the mechanical properties of injured tendon.

OBJECTIVES

To develop and validate a noninvasive in vivo assessment of tendon mechanics to investigate the effect of recent SDFT injury on limb stiffness index, providing an objective method to assess quality of healing.

HYPOTHESES

Limb stiffness index would reduce as a consequence of SDFT injury and progressively increase during tendon healing and correlate with in vitro mechanical properties of the respective SDFTs.

METHODS

Kinematic analysis was performed at walk in 10 horses that had sustained career-ending SDFT injury. Stiffness index was derived from limb force recorded via a series of force plates and measurement of change in metacarpophalangeal joint angle using 3D motion analysis software. Horses were subjected to euthanasia 7 months after injury, the SDFTs removed and subjected to nondestructive in vitro mechanical testing.

RESULTS

Limb stiffness index was reduced following SDFT injury in comparison with the contralateral limb and increased during the convalescent period, approximating that of the contralateral limb by 7 months post injury. There was a significant positive correlation between in vivo limb stiffness index and in vitro SDFT stiffness.

CLINICAL RELEVANCE

The ability to assess and monitor SDFT mechanical competence through limb stiffness measurement techniques in horses recovering from SDFT injury and the possibility of corroborating this with functional tendon healing may permit a more objective and accurate assessment of optimal tendon repair in the horse. This technique may be a useful method for assessing the efficacy of treatment regimens for tendinopathy and could be utilised to predict time to safe return to performance or re-injury.

Plasma glutamine concentrations in the horse following feeding and oral glutamine supplementation

REASONS FOR PERFORMING STUDY

Pharmacological benefits of glutamine supplementation have been shown in athletically and clinically stressed human subjects. In the horse, infection and intense exercise have also been shown to significantly decrease plasma glutamine concentrations, but little is known on how best to supplement.

OBJECTIVE

To evaluate whether ingestion of different foodstuffs, with or without L-glutamine (G) or a peptide (Pep) containing 31.5% w/w G in a water-stable form, could affect plasma glutamine concentrations (P-GC).

MATERIALS AND METHODS

Nine feeds (molassed sugar beet-pulp (mSB); naked oats (nO); commercial mix (CM); mSB with 30 or 60 mg/kg bwt G or the G-molar equivalent of Pep; and CM with 60 mg/kg bwt G or equivalent Pep) were offered to 6 healthy mature horses on different days following overnight food restriction. The changes in P-GC were monitored for 8 h post feeding.

RESULTS

After 1.5 h mean +/- s.d. AP-GC were -0.9 +/- 10.2% (mSB), +12.5 +/- 7.1% (nO) and +44.7 +/- 15.9% (CM; P<0.05). deltaP-GC with mSB supplemented with G was +60.9 +/- 30.0% (30 mg; P<0.05) and +156.8 +/- 34.6% (60 mg; P<0.05) at 1 h; deltaP-GC with Pep was 51.0 +/- 31.0% (30 mg equivalent, P<0.05) and +91.1 +/- 9.5% (60 mg equivalent, P<0.05) at 1 h. After 10 days of supplementation with 60 mg/kg bwt G, AP-GC following a further 60 mg/kg bwt G challenge showed a similar increase at 1 h of +154.3 +/- 37.9%; prevalues were unchanged. G and Pep added to CM, increased P-GC by 246.3 +/- 55.3 (+99.2%) and 252.3 +/- 94.2 micromol/l (96.7%) at 1.5 h with concentrations still above prevalues at 8 h (P<0.05). Apart from the CM (with or without supplement), pre P-GC was always regained by 4 h. Plasma NH3 and plasma protein concentrations were unaffected by supplementation with G or Pep.

CONCLUSION

P-GC may be modified by appropriate supplementation with no apparent adverse effects.

POTENTIAL RELEVANCE

Increasing P-GC through appropriate supplementation may be of benefit in the athletically or clinically stressed horse with lowered plasma glutamine concentrations.

A comparison of the moment arms of pelvic limb muscles in horses bred for acceleration (Quarter Horse) and endurance (Arab)

Selective breeding for performance has resulted in distinct breeds of horse, such as the Quarter Horse (bred for acceleration) and the Arab (bred for endurance). Rapid acceleration, seen during Quarter Horse racing, requires fast powerful muscular contraction and the generation of large joint torques, particularly by the hind limb muscles. This study compared hind limb moment arm lengths in the Quarter Horse and Arab. We hypothesized that Quarter Horse hind limb extensor muscles would have longer moment arms when compared to the Arab, conferring a greater potential for torque generation at the hip, stifle and tarsus during limb extension. Six Quarter Horse and six Arab hind limbs were dissected to determine muscle moment arm lengths for the following muscles: gluteus medius, biceps femoris, semitendinosus, vastus lateralis, gastrocnemius (medialis and lateralis) and tibialis cranialis. The moment arms of biceps femoris (acting at the hip) and gastrocnemius lateralis (acting at the stifle) were significantly longer in the Quarter Horse, although the length of the remaining muscle moment arms were similar in both breeds of horse. All the Quarter Horse muscles were capable of generating greater muscle moments owing to their greater physiological cross-sectional area (PCSA) and therefore greater isometric force potential, which suggests that PCSA is a better determinant of muscle torque than moment arm length in these two breeds of horse. With the exception of gastrocnemius and tibialis cranialis, the observed muscle fascicle length to moment arm ratio (MFL : MA ratio) was greater for the Arab horse muscles. It appears that the Arab muscles have the potential to operate at slower velocities of contraction and hence generate greater force outputs when compared to the Quarter Horse muscles working over a similar range of joint motion; this would indicate that Arab hind limb muscles are optimized to function at maximum economy rather than maximum power output.

Abstract 2032: MicroRNA control of tumor cell plasticity in a new tumor metastasis model

We have developed a new prostate cancer model to discover the molecular changes underlying metastasis. A series of cell lines were developed by isolating metastatic cells from lymph nodes of nude mice following orthotopic injection of DU145 human prostate cancer cells and expression changes analyzed using gene chips. We found that these DU145-LN cells exhibit a mesenchymal-epithelial transition (MET). Repeated rounds of in vivo metastatic selection progressively increased the expression of epithelial markers including E-cadherin, cytokeratin-18 and EpCAM, and decreased mesenchymal markers such as vimentin. Despite being more epithelial, DU145-LN cells are more migratory and show reduced proliferation in vitro. However, they show increased tumorigenesis when reinjected into nude mice. Interestingly, clinical metastases are frequently epithelial, despite strong evidence that EMT enhances metastasis. To explain this, current models of metastasis invoke EMT with subsequent MET at the secondary site. Our cells appear to demonstrate this plasticity making them an ideal model system for studying MET regulation.

The MET changes in the DU145-LN cells suggested a coordinated mechanism of regulation. MicroRNA arrays revealed several candidates which correlated with the epithelial phenotype. DU145-LN cells showed increased expression of the miR-200 family (a, b, c and miR-141), and treatment with synthetic miR-200 inhibitors resulted in reduced cell-cell interactions and decreased E-cadherin levels. Our data complement recent evidence showing down-regulation of miR-200 by EMT. miR-200 acts in a feedback loop with the transcription factor ZEB1 to regulate EMT. We also observed significantly reduced expression of an additional microRNA not previously linked to cell morphology in the DU145-LN cells. Transfection of precursor miRNA to this target altered the epithelial morphology and reduced E-cadherin levels, suggesting an additional pathway of MET/EMT control. We are currently determining the mechanism of action of this new microRNA target.

Our data support a role for MET in tumor metastasis, and indicate that microRNAs are an important mechanism mediating tumor cell plasticity and EMT/MET.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2032.

Reliability of conformational measurements in the horse using a three-dimensional motion analysis system

REASONS FOR PERFORMING STUDY

The importance of a reliable method for conformation studies is generally acknowledged, but there are only limited data on the accuracy and precision of current assessment methods.

OBJECTIVES

To assess (1) the accuracy and repeatability of marker placement, (2) influence of stance of the horse on conformational parameters, (3) practicality of a computerised motion analysis system and (4) to compare the computerised motion analysis system to photographic systems of assessment.

METHODS

Twenty-eight reflective markers placed over anatomical landmarks were located in 3D using a computerised motion analysis system and their coordinates used to calculate segment lengths and joint angles. Four experiments, involving a cadaver study, a series of repeated measures on a single Thoroughbred and repeat measurements on 108 racehorses were performed.

RESULTS

Identification of anatomical landmarks was found to introduce the biggest variation in the measurements for proximal conformation parameters with the interoperator being larger than intraoperator variation. Length measurements were least influenced by stance, with distal interphalangeal and metacarpo/metatarsophalangeal joint angles being the most variable. In some measurements, the variation between stances within a horse proved to be almost as large as between horses, rendering these parameters less useful as predictors of performance or orthopaedic health.

CONCLUSIONS

A computerised motion analysis system allows 3D assessment of conformation with high accuracy and precision. It eliminates 3 major sources of error associated with photography-based methods and increases accuracy of conformational assessment by allowing repeat measurements in a relatively short period.

POTENTIAL RELEVANCE

Studies on conformation should be viewed in the light of the limitations of the measurement technique used. The presented method maximises accuracy and precision and is a valuable basis for future studies investigating the effect of conformation on performance or orthopaedic health.

Relationship of foot conformation and force applied to the navicular bone of sound horses at the trot

REASONS FOR PERFORMING STUDY

Collapsed heels conformation has been implicated as causing radical biomechanical alterations, predisposing horses to navicular disease. However, the correlation between hoof conformation and the forces exerted on the navicular bone has not been documented.

HYPOTHESIS

The angle of the distal phalanx in relation to the ground is correlated to the degree of heel collapse and foot conformation is correlated to the compressive force exerted by the deep digital flexor tendon on the navicular bone.

METHODS

Thirty-one shod Irish Draught-cross type horses in routine work and farriery care were trotted over a forceplate, with 3-dimensional (3D) motion analysis system. A lateromedial radiograph of the right fore foot was obtained for each horse, and various measurements taken. Correlation coefficients were determined between hoof conformation measurements and between each of these and the force parameters at the beginning (15%) of stance phase, the middle of stance (50%) and at the beginning of breakover (86% of stance phase). Significance was defined as P<0.05.

RESULTS

The force exerted on the navicular bone was negatively correlated (P<0.05) to the angle of the distal phalanx to the ground and to the ratio between heel and toe height. This was attributed to a smaller extending moment at the distal interphalangeal joint. There was not a significant correlation between the angle of the distal phalanx and the degree of heel collapse, and heel collapse was not significantly correlated to any of the force parameters.

CONCLUSIONS

Hoof conformation has a marked correlation to the forces applied to the equine foot. Heel collapse, as defined by the change in heel angle in relation to toe angle, appears to be an inaccurate parameter. The forces applied on the foot are well correlated to the changes in the ratio of heel to toe heights and the angles of the distal phalanx.

POTENTIAL RELEVANCE

Assessment of hoof conformation should be judged based on these parameters, as they may have clinical significance, whereas parallelism of the heel and toe is of less importance.

Variation in conformation in a cohort of National Hunt racehorses

REASONS FOR PERFORMING THE STUDY

Assessment of conformation is commonly used in the selection of horses for performance purposes. Little information is available on the normal range of conformational traits within the Thoroughbred population.

OBJECTIVES

To describe variations in conformation in a cohort of racing Thoroughbreds in order to provide a set of baseline standards within which conformational traits can be considered normal.

MATERIALS AND METHODS

Ninety-eight conformational parameters were measured in a cohort of 108 National Hunt racehorses using a digital motion analysis system. The measurements consisted of segment lengths, joint angles in 2D and 3D, inclinations, deviations and circumference measurements. The differences between left and right sides were determined to obtain a measure of asymmetry. Conformational parameters were related to each horse's country of origin, preferred race distance and race type.

RESULTS

The majority of parameters followed a normal distribution with the biggest relative variation in hoof related measurements and in stifle and coxal angle. All circumference measurements and the majority of the length measurements were significantly correlated with the height of the horse at the withers. No underlying pattern of combinations of conformational parameters was identified. Twenty-five per cent of the parameters showed a significant difference between left and right-sided measurements. A significant difference in girth and intermandibular width was observed between Irish and French horses.

CONCLUSIONS

Thoroughbreds differ from other breeds, not only with regard to segment lengths but also with regard to joint angles and deviations. Variation in conformational parameters was relatively small and no distinct pattern of combinations of conformational traits identified.

CLINICAL RELEVANCE

The variation in conformational measurements in Thoroughbred racehorses establishes a set of baseline measurements of conformational range against which individual horses can be assessed.

The effect of conformation on orthopaedic health and performance in a cohort of National Hunt racehorses: preliminary results

REASONS FOR PERFORMING STUDY

There is a lack of scientific data and studies on the effect of conformation on performance or on orthopaedic health.

OBJECTIVES

To investigate the relationship between conformation, injury and performance in racehorses used for racing over fences.

METHODS

Over 2 years, 108 National Hunt racehorses were followed and their medical and performance data recorded. Conformation was measured in 3D with a computerised motion analysis system. Linear multiple regression models were used to evaluate the effect of conformation on measures of race performance and stepwise forward logistic regression models to assess the effect on risk of injury.

RESULTS

An increase in intermandibular width, flexor angle of the shoulder joint and coxal angle (the angle between the ilium and ischium) was demonstrated to have a positive effect on performance. Performance decreased with increasing girth, length of the hind digit and valgus conformation of the metacarpophalangeal joint. The risk of suffering from superficial digital flexor tendon injury increased with increasing metacarpophalangeal joint angle and with carpus valgus conformation. The risk of pelvic fracture increased with valgus conformation of the tarsus and decreased with an increasing coxal angle.

CONCLUSION

Valgus deformation was demonstrated to be detrimental to performance or increased risk of injury, perhaps resulting in higher loads on musculoskeletal structures. The coxal angle was the only parameter to have an effect on both risk of injury and performance. An alignment of the muscles with the axis of the pelvis may be beneficial for force transmission and decrease the bending moment of the muscles on the bones. The statistical power of this study is limited, however it provides preliminary data necessary for the planning of a larger scale study on the effect of conformation on performance and risk of injury.

CLINICAL RELEVANCE

Studies of the effects of conformation on performance and risk of injury may aid in identifying individuals likely to perform well on the racecourse and avoid risks of injury.

The use of MP3 recorders to log data from equine hoof mounted accelerometers

REASONS FOR PERFORMING STUDY

MP3 recorders are readily available, small, lightweight and low cost, providing the potential for logging analogue hoof mounted accelerometer signals for the characterisation of equine locomotion. These, however, require testing in practice.

OBJECTIVES

To test whether 1) multiple MP3 recorders can maintain synchronisation, giving the ability to synchronise independent recorders for the logging of multiple limbs simultaneously; and 2) features of a foot mounted accelerometer signal attributable to foot-on and foot-off can be accurately identified from horse foot mounted accelerometers logged directly into an MP3 recorder.

METHODS

Three experiments were performed: 1) Maintenance of synchronisation was assessed by counting the number of samples recorded by each of 4 MP3 recorders while mounted on a trotting horse and over 2 consecutive 30 min periods in 8 recorders on a bench. 2) Foot-on and foot-off times obtained from manual transcription of MP3 logged data and directly logged accelerometer signal were compared. 3) MP3/accelerometer acquisition units were used to log accelerometer signals from racehorses during extended training sessions.

RESULTS

Mean absolute error of synchronisation between MP3 recorders was 10 samples per million (compared to mean number of samples, range 1-32 samples per million). Error accumulation showed a linear correlation with time. Features attributable to foot on and foot off were equally identifiable from the MP3 recorded signal over a range of equine gaits.

CONCLUSIONS

Multiple MP3 recorders can be synchronised and used as a relatively cheap, robust, reliable and accurate logging system when combined with an accelerometer and external battery for the specific application of the measurement of stride timing variables across the range of equine gaits during field locomotion.

POTENTIAL RELEVANCE

Footfall timings can be used to identify intervals between the fore and hind contacts, the identification of diagonal advanced placement and to calculate stride timing variables (stance time, protraction time and stride time). These parameters are invaluable for the characterisation and assessment of equine locomotion.

Deep digital flexor tendon force and digital mechanics in normal ponies and ponies with rotation of the distal phalanx as a sequel to laminitis

REASONS FOR PERFORMING STUDY

Previous studies have implicated tension in the deep digital flexor tendon (DDFT) in the rotation of the distal phalanx (DP) after the breakdown of the dorsal laminae caused by laminitis. Howeveer, once the DP has rotated, the DDFT should become shorter, reducing the force it exerts on the DP.

OBJECTIVE

To compare DDFT force and ground reaction forces (GRFs) in normal ponies and ponies with rotation of the DP as a sequel to laminitis.

METHODS

Six normal ponies (Group 1) and 6 sound ponies with 6-13 degrees of rotation of the DP in relation to the dorsal hoof wall (Group 2) were assessed at trot using forceplate and motion analysis. The force in the DDFT was calculated by assuming that the extending moment at the distal interphalangeal (DIP) joint resulting from the GRF was equal to the flexing moment created by the force in the DDFT during the stance phase (inverse dynamics).

RESULTS

In early stance, the peak DDFT force (mean+/-s.d.) in the normal ponies was 1.92+/-1.63 N/kg. However, in Group 2, the point of zero moment was palmar to the centre of rotation of the DIP joint for the first 40% of stance and hence DDFT force was zero. Force in the DDFT reached a peak of 10.00+/-3.56 N/kg at 60.7+/-5.6% of stance in Group 1 and 6.41+/-1.37 N/kg at 79.2+/-9.6% of stance in Group 2.

CONCLUSIONS

DDFT force in Group 2 laminitic ponies was much reduced until late stance, when it neared normal values.

POTENTIAL RELEVANCE

Further studies of ponies with rotation of the DP as a sequel to laminitis should assist farriery aimed at reducing the force in the DDFT through the breakover phase of stance to protect damaged dorsal laminae.

Stromal and epithelial networks: Temporal gene expression profiling during invasive neoplasia

The interaction between tumor cells and the stromal microenvironment is a critical factor in cancer development and progression. A recent study from the Khavari group profiled the expression changes during progression to invasion in a Ras-inducible model of human epithelial neoplasia and used network modeling to analyze the molecular interactions. Human dermis was seeded with H-Ras- and IkappaBalpha-expressing keratinocytes then grafted on to immune-deficient mice. The epithelial and stromal gene expression profiles were captured during progression from quiescent epithelial tissue to in situ neoplasia to invasive neoplasia. A subset of these altered genes was compiled into a "core tumor progression signature" (CTPS), which was shown to have clinical relevance in several cancer types. Network modeling of the CTPS revealed highly interconnected "hubs", which was dominated by extracellular matrix-related genes, including beta(1) integrin. Targeting integrin beta(1) functionality reduced Ras-driven tumorigenesis in vivo and validated the network modeling strategy for predicting genes essential to neoplasia. By integrating temporal analysis of both the epithelial and stromal compartments with network modeling of molecular interactions, this work has described an effective strategy for identifying highly interconnected targets essential to tumor development.

Current molecular diagnostics of breast cancer and the potential incorporation of microRNA

Although comprehensive molecular diagnostics and personalized medicine have sparked excitement among researchers and clinicians, they have yet to be fully incorporated into today's standard of care. This is despite the discovery of disease-related oncogenes, tumor-suppressor genes and protein biomarkers, as well as other biological anomalies related to cancer. Each year, new tests are released that could potentially supplement or surpass standard methods of diagnosis, including serum, protein and gene expression analyses. All of these novel approaches have shown great promise, but initial enthusiasm has diminished as difficulties in reproducibility, expense, standardization and proof of significance beyond current protocols have emerged. This review will focus on current and novel molecular diagnostic tools applied to breast cancer with special attention to the exciting new field of microRNA analysis.

Exploring the mechanical basis for acceleration: pelvic limb locomotor function during accelerations in racing greyhounds (Canis familiaris)

Animals in their natural environments are confronted with a regular need to perform rapid accelerations (for example when escaping from predators or chasing prey). Such acceleration requires net positive mechanical work to be performed on the centre of mass by skeletal muscle. Here we determined how pelvic limb joints contribute to the mechanical work and power that are required for acceleration in galloping quadrupeds. In addition, we considered what, if any, biomechanical strategies exist to enable effective acceleration to be achieved. Simultaneous kinematic and kinetic data were collected for racing greyhounds undergoing a range of low to high accelerations. From these data, joint moments and joint powers were calculated for individual hindlimb joints. In addition, the mean effective mechanical advantage (EMA) of the limb and the ;gear ratio' of each joint throughout stance were calculated. Greatest increases in joint work and power with acceleration appeared at the hip and hock joints, particularly in the lead limb. Largest increases in absolute positive joint work occurred at the hip, consistent with the hypothesis that quadrupeds power locomotion by torque about the hip. In addition, hindlimb EMA decreased substantially with increased acceleration - a potential strategy to increase stance time and thus ground impulses for a given peak force. This mechanism may also increase the mechanical advantage for applying the horizontal forces necessary for acceleration.

Functional anatomy and muscle moment arms of the thoracic limb of an elite sprinting athlete: the racing greyhound (Canis familiaris)

We provide quantitative muscle-tendon architecture and geometry data for the racing greyhound thoracic limb. Muscle mass, belly length, fascicle lengths, pennation angles and moment arms were measured, as were tendon masses and lengths. Maximum isometric force and maximum power were estimated for muscles, and maximum stress and strain were estimated for tendons. Results are compared with other fast quadrupedal runners, and to previously published data in mixed-breed dogs. The implications of the functional adaptations of the greyhound thoracic limb for sprinting performance are discussed. The thoracic limb was found to benefit from a similar proportion of locomotor muscle mass to the pelvic limb, suggesting that it may be used to some extent in propulsion, or alternatively that stabilisation is very important in this animal. Extrinsic muscles, especially latissimus dorsi and pectoralis profundus, were predicted to be powerful and important for generating net positive work during accelerations. Proximal biarticular muscles show specialisation toward preventing collapse of the shoulder and elbow joints to enable strut-like limb function, or some form of dynamic control. Distal muscles did not appear specialised for elastic energy storage, a functional difference to pelvic limb muscles, and the equivalents in horse thoracic limbs. The greyhound thoracic limb appears to possess substantial differences from both that of more 'sub-maximal specialist' quadrupeds, and from the greyhound pelvic limb.

The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans

OBJECTIVE

Degenerative disorders of tendons present an enormous clinical challenge. They are extremely common, prone to recur and existing medical and surgical treatments are generally unsatisfactory. Recently eccentric, but not concentric, exercises have been shown to be highly effective in managing tendinopathy of the Achilles (and other) tendons. The mechanism for the efficacy of these exercises is unknown although it has been speculated that forces generated during eccentric loading are of a greater magnitude. Our objective was to determine the mechanism for the beneficial effect of eccentric exercise in Achilles tendinopathy.

METHODS

Seven healthy volunteers performed eccentric and concentric loading exercises for the Achilles tendon. Tendon force and length changes were determined using a combination of motion analysis, force plate data and real-time ultrasound.

RESULTS

There was no significant difference in peak tendon force or tendon length change when comparing eccentric with concentric exercises. However, high-frequency oscillations in tendon force occurred in all subjects during eccentric exercises but were rare in concentric exercises (P < 0.0001).

CONCLUSION

These oscillations provide a mechanism to explain the therapeutic benefit of eccentric loading in Achilles tendinopathy and parallels recent evidence from bone remodelling, where the frequency of the loading cycles is of more significance than the absolute magnitude of the force.

Functional anatomy and muscle moment arms of the pelvic limb of an elite sprinting athlete: the racing greyhound (Canis familiaris)

We provide quantitative anatomical data on the muscle-tendon architecture and geometry of the pelvic limb of an elite sprint athlete, the racing greyhound. Specifically, muscle masses, muscle lengths, fascicle lengths, pennation angles and muscle moment arms were measured. Maximum isometric force and power of muscles, the maximum muscle torque at joints and tendon stress and strain were estimated. We compare data with that published for a generalized breed of canid, and other cursorial mammals such as the horse and hare. The pelvic limb of the racing greyhound had a relatively large volume of hip extensor muscle, which is likely to be required for power production. Per unit body mass, some pelvic limb muscles were relatively larger than those in less specialized canines, and many hip extensor muscles had longer fascicle lengths. It was estimated that substantial extensor moments could be created about the tarsus and hip of the greyhound allowing high power output and potential for rapid acceleration. The racing greyhound hence possesses substantial specializations for enhanced sprint performance.

High-speed gallop locomotion in the thoroughbred racehorse. I. The effect of incline on stride parameters

During locomotion up an incline, power is required to elevate the centre of mass. This is provided when the animal's limbs are in contact with the ground. Measurements of stride timing variables from multiple limbs during high speed, over-ground locomotion would enhance our understanding of locomotor powering during changes in terrain. This study measured foot-on and foot-off times from galloping horses using a previously validated system of limb-mounted accelerometers and a global positioning system data logger. A detailed track survey provided incline information from all areas of the track. Measurements were made from six horses over a speed range of 9 to 13 m s(-1). Foot-fall timings were used to calculate variables, which included stance duration, protraction duration, stride frequency and duty factor. The relationship between track incline and measured variables was assessed. Stride variables from horses galloping on level (0-2% incline) and incline (8-12% incline) sections of the track were compared. Fore- and hindlimb protraction durations were significantly reduced across the speed range during incline galloping (P=0.001). This resulted in a mean increase in stride frequency from 2.01 to 2.08 strides s(-1) at 9.5 m s(-1) and 2.10 to 2.17 strides s(-1) at 12.5 m s(-1) during incline galloping. Duty factor was significantly greater for the hindlimbs during incline galloping (P<0.001), increasing from 0.31 to 0.32 at 9.5 m s(-1) and 0.28 to 0.29 at 12.5 m s(-1). Peak limb force was calculated from duty factor and assumed fore- to hindlimb impulse distributions. Smaller peak vertical forces were calculated in the forelimbs and increased peak vertical forces were calculated in the hindlimbs when galloping on an incline. Measured changes in stride timing variables differ from those reported in trotting horses. We propose that horses increase their stride frequency at a given speed during incline galloping to provide power for moving the centre of mass up the slope.

Comparative anatomy and muscle architecture of selected hind limb muscles in the Quarter Horse and Arab

The Quarter Horse (bred for acceleration) and the Arab (bred for endurance) are situated at either end of the equine athletic spectrum. Studies into the form and function of the leg muscles in human sprint and endurance runners have demonstrated that differences exist in their muscle architecture. It is not known whether similar differences exist in the horse. Six Quarter Horse and six Arab fresh hind limb cadavers were dissected to gain information on the muscle mass and architecture of the following muscles: gluteus medius; biceps femoris; semitendinosus; vastus lateralis; gastrocnemius; tibialis cranialis and extensor digitorum longus. Specifically, muscle mass, fascicle length and pennation angle were quantified and physiological cross-sectional area (PCSA) and maximum isometric force were estimated. The hind limb muscles of the Quarter Horse were of a significantly greater mass, but had similar fascicle lengths and pennation angles when compared with those of the Arab; this resulted in the Quarter Horse hind limb muscles having greater PCSAs and hence greater isometric force potential. This study suggests that Quarter Horses as a breed inherently possess large strong hind limb muscles, with the potential to accelerate their body mass more rapidly than those of the Arab.

Assessment of mild hindlimb lameness during over ground locomotion using linear discriminant analysis of inertial sensor data

REASONS FOR PERFORMING STUDY

Hindlimb lameness is common and can be difficult to diagnose or quantify in evaluating response to nerve blocks. An objective measure of lameness can also be used to evaluate the effectiveness of the treatment's contribution to evidence-based medicine. The inertial sensor system can be used to capture 6 degree of freedom movement during over ground locomotion and here was used to quantify tuber coxae movement in nonlame and lame horses.

HYPOTHESIS

Tuber coxae movement is useful for discriminating between nonlame and lame horses.

OBJECTIVES

To measure left and right tuber coxae movement in lame and nonlame horses during over ground locomotion and to implement a linear discriminant analysis to discriminate between lame and nonlame horses.

METHODS

Two inertial sensors were attached to the skin over left and right tuber coxae of 21 horses (9 mildly and 12 not lame). Horses were trotted on a hard surface. A total of 1021 strides were collected. For each stride 34 features were extracted from the dorsoventral and craniocaudal movement and used in 2 different classification scenarios (lame vs. nonlame or left lame, right lame and nonlame) using linear discriminant analysis.

RESULTS

Six degree of freedom inertial sensors were successfully used to collect kinematic data continuously from left and right tuber coxae in horses during over ground locomotion. These data were used for an automated classification of lameness. In the first scenario, a sensitivity of 89% was achieved with a specificity of 75%. In the second scenario, all horses could be correctly assigned to the correct class in a simple 3 class reclassification test.

POTENTIAL RELEVANCE

A mobile system that reliably detects and quantifies hindlimb lameness in horses during unconstrained locomotion could be a valuable tool to perform an evidence-based assessment of lameness in horses in a clinical setting, e.g. before and after nerve blocks or before and after surgery.

Functional specialisation of the thoracic limb of the hare (Lepus europeus)

We provide quantitative anatomical data on the muscle-tendon architecture of the hare thoracic limb (specifically muscle mass, fascicle length, pennation angle, tendon mass and length). In addition, moment arms of major thoracic limb muscles were measured. Maximum isometric force and power of muscles, the moment of force about a joint, and tendon stress and strain were estimated. Data are compared with those from other cursorial mammals. The thoracic limb of the hare consists predominantly of extrinsic musculature with long parallel fascicles, specialised for generating force over a large range. A large shoulder flexor/elbow extensor muscle mass is present, in particular Triceps brachii. The pennate nature of the long head of this muscle suggests it has an important role in stabilising the elbow joint during stance, whilst moment arm curves suggest that it may also play a role in initiating shoulder flexion. In addition, Supraspinatus and Infraspinatus are capable of generating high forces, potentially to stabilise the shoulder joint during the stance phase of locomotion. Supraspinatus may in addition play an important role in forelimb protraction. The Subscapularis muscle was capable of generating surprisingly high forces, suggesting that the hare must be able to withstand/produce high forces during activities that need medio-lateral stability, such as turning. Distally, tendons were relatively short, showing little potential for elastic energy storage when compared with both their pelvic limb counterparts and their equivalents in the horse thoracic limb. Thus, a 'stiffer' thoracic limb may be beneficial in terms of behaving like a strut, simply supporting and deflecting the body during high-speed running. This more distal/less proximal distribution of limb mass is also likely to be important in retaining the manipulative/adaptive/non-locomotor capabilities of the limb.

Muscle architecture and functional anatomy of the pelvic limb of the ostrich (Struthio camelus)

The functional anatomy of the pelvic limb of the ostrich (Struthio camelus) was investigated in order to assess musculoskeletal specialization related to locomotor performance. The pelvic limbs of ten ostriches were dissected and detailed measurements of all muscle tendon units of the pelvic limb were made, including muscle mass, muscle length, fascicle length, pennation angle, tendon mass and tendon length. From these measurements other muscle properties such as muscle volume, physiological cross-sectional area (PCSA), tendon cross-sectional area, maximum isometric muscle force and tendon stress were derived, using standard relationships and published muscle data. Larger muscles tended to be located more proximally and had longer fascicle lengths and lower pennation angles. This led to an expected proximal to distal reduction in total muscle mass. An exception to this trend was the gastrocnemius muscle, which was found to have the largest volume and PCSA and also had the highest capacity for both force and power production. Generally high-power muscles were located more proximally in the limb, while some small distal muscles (tibialis cranialis and flexor perforatus digiti III), with short fibres, were found to have very high force generation capacities. The greatest proportion of pelvic muscle volume was for the hip extensors, while the highest capacity for force generation was observed in the extensors of the ankle, many of which were also in series with long tendons and thus were functionally suited to elastic energy storage.

Muscle moment arms of pelvic limb muscles of the ostrich (Struthio camelus)

Muscle moment arms were measured for major muscles of the pelvic limb of the ostrich (Struthio camelus) in order to assess specific functional behaviour and to apply this to locomotor performance. Pelvic limbs of six juvenile ostriches were used for this study. The tendon travel technique was used to measure moment arms of 21 muscles at the hip, knee, ankle and metatarsophalangeal joints throughout the ranges of motion observed during level running. Six of the 21 muscles measured were found to have moment arms that did not change with joint angle, whilst the remainder all demonstrated angle-dependent changes for at least one of the joints crossed. Moment arm lengths tended to be longest for the large proximal muscles, whilst the largest relative changes were found for the moment arms of the distal muscles. For muscles where moment arm varied with joint angle: all hip muscles were found to have increasing moment arms with extension of the joint, knee flexors were found to have moment arms that increased with extension, knee extensor moment arms were found to increase with flexion and ankle extensor moment arms increased with extension. The greatest relative changes were observed in the flexors of the metatarsophalangeal joint, for which a three-fold increase in moment arm was observed from flexion to full extension. Changes in muscle moment arm through the range of motion studied appear to optimize muscle function during stance phase, increasing the effective mechanical advantage of these muscles.

Muscle architecture of biceps brachii, triceps brachii and supraspinatus in the horse

Three muscles from the proximal equine forelimb were dissected in order to investigate their potential to contribute to proximal limb mechanics. Muscle mass, fibre length, tendon mass and tendon length were measured from biceps brachii, triceps brachii, supraspinatus and lacertus fibrosus (biceps lateral head mass 171-343.4 g and fibre length 0.5-0.8 cm; biceps medial head mass 283-500 g and fibre length 2.2-4 cm; biceps tendon mass 121.8-260 g and tendon length 35-44 cm; triceps long head mass 3200-6663 g and fibre length 19-26.3 cm; triceps lateral head mass 513.8-1240 g and fibre length 17.5-24 cm; triceps medial head mass 85.2-270.6 g and fibre length 9-16.8 cm; supraspinatus mass 793-1546 g and fibre length 4.7-12.4 cm; lacertus fibrosus mass 4.6-12.4 g and length 10-16 cm). Physiological cross-sectional area (PCSA) and maximum isometric force were estimated for each muscle, and moment arm measurements were taken at the shoulder and elbow joints. Biceps has a greater isometric force-generating capacity than supraspinatus. It also appears to have a larger shoulder moment arm, so could therefore have the potential to make a greater contribution to the shoulder moment than supraspinatus. Supraspinatus is likely to function primarily as a shoulder stabilizer rather than a shoulder extensor. Biceps also functions as an elbow flexor and data here indicate that it has a greater PCSA and isometric force-generating capacity than its antagonist triceps brachii. Calculation of tendon forces showed that the biceps tendon can withstand much greater forces than lacertus fibrosus. This study will enable further investigation into the interaction between energy recycling in elastic tissues and the generation and absorption of mechanical work by adjacent muscle groups in the equine forelimb.

Completing the Audit Cycle: Comparison of Cardiac Risk Factor Management in Patients with Intermittent Claudication in Two Time Periods

AIM

The first line treatment of patients with intermittent claudication (IC) is to prolong life via cardiac risk factor management. We aimed to compare current standards of secondary prevention with those in a previously published audit.

METHODS

Risk factor data was prospectively collated on 304 consecutive new referrals attending the claudication clinic over a 1-year period (2004/2005) and compared to the 104 patients assessed in 2000.

RESULTS

In 2004/5 30%, (n=91) of patients did not have a diagnosis of IC confirmed (p<0.01). The use of antiplatelet therapy remained static at 73%. Statin therapy increased in 2004/5 (62% versus 38%, p<0.01) but blood pressure control remained poor with 65% failing to achieve the target levels. Smoking cessation therapy continues to be offered to a minority of patients and 17% of patients have previously undiagnosed diabetes in 2004/2005 (p-value 0.353). The number of patients who have been advised to increase physical activity significantly has fallen from 15% to 2% in the 2004/5 (p<0.01).

CONCLUSIONS

Difficulties exist in diagnosing intermittent claudication in primary care and cardiac risk factor management continues to be sub-optimally managed.

Functional specialisation of the pelvic limb of the hare (Lepus europeus)

We provide quantitative anatomical data on the muscle-tendon architecture of the hare pelvic limb (specifically muscle mass, fascicle length, pennation angle, tendon mass and length). In addition, moment arms of major pelvic limb muscles were measured. Maximum isometric force and power of muscles, the moment of force about a joint, and tendon stress and strain were estimated. Data are compared with published data for other cursorial mammals such as the horse and dog, and a non-specialised Lagamorph, the rabbit. The pelvic limb of the hare was found to contain substantial amounts of hip extensor and adductor/abductor muscle volume, which is likely to be required for power production and stability during rapid turning. A proximal to distal reduction in muscle volume and fascicle length was also observed, as is the case in other cursorial quadrupeds, along with a reduction in distal limb mass via the replacement of muscle volume by long distal limb tendons, capable of storing large amounts of elastic energy. The majority of hare pelvic limb muscle moment arms varied with joint position, giving the hare the capacity to vary muscle function with limb posture and presumably different locomotor activities.

Widespread vascular production of C-reactive protein (CRP) and a relationship between serum CRP, plaque CRP and intimal hypertrophy

OBJECTIVES

Evidence of local vascular production and a relationship between serum hsCRP levels and tissue expression of CRP in subjects with vascular disease would support a direct role for CRP in atherosclerosis.

METHODS AND RESULTS

Vascular tissue from subjects undergoing coronary artery bypass grafting surgery (CABGS) (n=28) and carotid endarterectomy (CEA) (n=25) were studied. Histological samples were assessed for intima-media ratio (IMR) and CRP by immunohistochemistry. CRP mRNA was quantified by real-time polymerase chain reaction. CRP mRNA was seen in all plaques, non-atherosclerotic artery and atrium but no difference in mRNA expression was seen between plaque and non-atherosclerotic tissue. Serum hsCRP correlated with IMR (r=0.64, p=0.001) in non-atherosclerotic arteries and with plaque CRP staining (r=0.57, p=0.009) independent of age, BMI, lipids, diabetes and blood pressure. In a separate patient series, serum hsCRP was measured in aortic and coronary sinus blood from subjects undergoing CABGS or angiography (n=54). There was a coronary circulation hsCRP gradient ([mean+/-S.E.M.] aortic CRP 4.3mg/l+/-0.8 versus coronary sinus 5.8+/-1.2mg/l, p<0.05).

CONCLUSIONS

Widespread vascular CRP mRNA expression, a correlation between serum hsCRP, intimal hypertrophy and plaque CRP, and a coronary hsCRP gradient suggest vascular secretion may contribute to serum CRP levels.