Comparison of skin and shoe marker placement on metatarsophalangeal joint kinematics and kinetics during running.

This study investigated the effects of marker placement (skin- vs shoe-mounted) on metatarsophalangeal joint (MTP) kinematics and kinetics during running. Fifteen trained men ran on a 15-m track at 10 and 13 km/h with three (low, standard and high stiffness) shoe longitudinal bending stiffnesses (LBS). Reflective markers were fixed on the shoe upper, and on the skin using holes cut in the shoe. Three-dimensional marker positions and ground reaction forces were recorded at 200 and 2000 Hz, respectively. Kinematic and kinetic parameters were analyzed using one-dimensional metrics (statistical parametric mapping). MTP joint was less dorsiflexed at midstance ([57% to 100%] of braking phase and [0% to 48%] of pushing phase), and the MTP joint plantarflexion moment was higher ([22% to 55%] of pushing phase) with the shoe markerset in comparison with the skin markerset. The effect of LBS on MTP angle was found to be significant for a larger percentage of each stride using the shoe markerset compared to the skin markerset. However, the effect of LBS on plantarflexion moment was significant with the shoe markerset only. The effect of running speed on MTP angle was significant for a larger percentage of each stride with the skin markerset. This study demonstrates that the placement of markers influences the measurement of MTP kinematics and kinetics and that these effects are mediated by other variables such as LBS or running speed. It is concluded that the shoe markerset does not fully reflect the movement of the MTP joint.

CT scan for early diagnosis of anastomotic leak after colorectal surgery: is rectal contrast useful?

BACKGROUND: Computed tomography (CT) scan with rectal contrast enema (RCE-CT) could increase the detection rate of anastomotic leaks (AL) in the early postoperative period following colorectal surgery, compared to CT scan without RCE. The aim of this study was to assess the benefit of RCE-CT for the early diagnosis of AL following colorectal surgery. METHODS: Patients who had a RCE-CT for suspected AL in the early postoperative period following colorectal surgery with anastomosis between January 2012 and July 2019 at the Dijon University Hospital were retrospectively included. All images were reviewed by two independent observers who were blinded to the original report. The reviewers reported for each patient whether an AL was present or not in each imaging modality (CT scan, then RCE-CT). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were then calculated to determine the diagnostic performance of each modality. RESULTS: One hundred and thirty-nine patients were included. RCE-CT had an increased NPV compared to CT scan (82% vs 77% (p = 0.02) and 84% vs 68% (p < 0.0001) for observers 1 and 2, respectively). RCE-CT had an increased sensitivity compared to CT scan (79% vs 48% (p < 0.0001) for observer 2). RCE-CT had a significant lower false-negative rate for both observers: 18% vs 23% (p = 0.02) and 16% vs 32% (p < 0.0001). CONCLUSIONS: RCE-CT improved the detection rates of AL in the early period following colorectal surgery. RCE-CT should be recommended when a CT scan is negative and AL is still suspected.

Managing severe traumatic abdominal-wall injuries, a monocentric experience.

PURPOSE: Abdominal wall injuries (AWI) is a clinical and radiological diagnosis of fasciomuscular and at times cutaneous defects after abdominal trauma. Their severity encompasses a spectrum of parietal defects, with the most severe being a burst abdomen with eviscerated organs. With the wide use of CT scans in trauma settings, their incidence is being more recognized. Especially in severe AWI, where associated intrabdominal lesions are highly prevalent, many questions about parietal reconstruction arise concerning the timing and type of surgery, and their final hernia recurrence rate. METHOD: A list of severe AWI injuries have been retrieved, all of which were treated in our center. Type of trauma, clinical presentation, surgical technique and follow-up have been included. RESULTS: Eight cases were found with severe abdominal injuries, with an age range of 11-85 years. Road traffic accidents, crush injuries, fall from height, stab and gunshot wounds are included. Seven out of the 8 cases had associated intrabdominal traumatic lesions. Mesh augmentation due to tissue loss was used in three cases. Recurrence rate was estimated around 25%. CONCLUSION: Prompt surgical exploration is required as associated intrabdominal traumatic lesions are highly associated with severe AWI. Even when intrabdominal lesions are ruled out, fasciomuscular defects should be managed during the same hospitalization, to prevent intestinal strangulation and occlusion. Mesh augmentation should only be used when parietal defects include extensive tissue loss preventing tension-free parietal reconstruction.

Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes.

OBJECTIVES: Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. METHODS: National, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening. RESULTS: 19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete). CONCLUSIONS: Our study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.

Inter-observer agreement in athletes ECG interpretation using the recent international recommendations for ECG interpretation in athletes among observers with different levels of expertise.

INTRODUCTION: International criteria for the interpretation of the athlete's electrocardiogram (ECG) have been proposed. We aimed to evaluate the inter-observer agreement among observers with different levels of expertise. METHODS: Consecutive ECGs of Swiss elite athletes (≥14 years), recorded during routine pre-participation screening between 2013 and 2016 at the Swiss Federal Institute of Sports were analysed. A medical student (A), a cardiology fellow (B) and an electrophysiologist (C) interpreted the ECG's independently according to the most recent criteria. The frequencies and percentages for each observer were calculated. An inter-observer reliability analysis using Cohen Kappa (κ) statistics was used to determine consistency among observers. RESULTS: A total of 287 ECGs (64.1% males) were analysed. Mean age of the athletes was 20.4±4.9 years. The prevalence of abnormal ECG findings was 1.4%. Both, normal and borderline findings in athletes showed moderate to good agreement between all observers. κ scores for abnormal findings resulted in excellent agreement (κ 0.855 in observer A vs C and B vs C to κ 1.000 in observer A vs B). Overall agreement ranged from moderate (κ 0.539; 0.419-0.685 95% CI) between observer B vs C to good agreement (κ 0.720; 0.681-0.821 95% CI) between observer A vs B. CONCLUSIONS: Our cohort of elite athletes had a low prevalence of abnormal ECGs. Agreement in abnormal ECG findings with the use of the recently published International recommendations for ECG interpretation in athletes among observers with different levels of expertise was excellent. ECG interpretation resulted in moderate to good overall agreement.

Mitochondrial glutathione uptake: characterization in isolated brain mitochondria and astrocytes in culture.

Glutathione in the mitochondria is an important determinant of cellular responses to oxidative stress. Mitochondrial glutathione is maintained by uptake from the cytosol, a process that has been little studied in brain cells. In the present study, measurements using isolated rat brain mitochondria showed a rapid uptake of [3H]-glutathione that was strongly influenced by the mitochondrial glutathione content. [3H]-glutathione incorporated into the mitochondria was not rapidly released. Uptake was inhibited by substrates and inhibitors for several known mitochondrial anion transporters. Citrate, isocitrate and benzene-1,2,3-tricarboxylate were particularly effective inhibitors, suggesting a possible role for a tricarboxylate carrier in the glutathione transport. The properties of uptake differed greatly from those reported previously for mitochondria from kidney and liver. In astrocytes in primary culture, diethylmaleate or hydrogen peroxide treatment resulted in depletion of cytosolic and mitochondrial glutathione. The pattern of restoration of glutathione content in the presence of glutathione precursors following treatment with diethylmaleate was consistent with uptake into mitochondria being controlled primarily by the glutathione gradient between the cytosol and mitochondria. However, following hydrogen peroxide treatment, recovery of glutathione in the mitochondria initially preceded comparable proportional restoration in the cytosol, suggesting the possibility of additional controls on glutathione uptake in some conditions.

Physiological correlates of musth: lipid metabolites and chemical composition of exudates.

Physiological changes related to lipid metabolism, behavior, and chemicals released in body exudates were studied during musth in the Asian elephant, Elephas maximus, as a case study. During musth, changes in serum testosterone and triglyceride concentrations followed similar patterns, with the former increasing sooner than the latter. Deviant behavior increased during changing androgen levels. The observed high concentrations of testosterone were positively and significantly correlated with increased triglycerides. Lipase activity elevated significantly immediately before and after musth. Blood pH increased significantly in alkalinity. Urine and temporal gland secretions released variable amounts of compounds, some of which may be chemical signals. During musth, temporal gland and urinary exudates demonstrated increased acetone and other ketones indicative of lipid metabolic alterations. Large quantities of nonmethane hydrocarbons, especially 2-butanone, were released from the seemingly dry orifice of the temporal gland before the start of overt musth and before maximum blood elevations were observed; isoprene release was similar. However, maximal acetone levels occurred simultaneously in blood, temporal gland secretions, and urine. Metabolically, musth is a series of interwoven, changing stages of increasing and decreasing hormones and lipid-related constituents. Released chemicals can be quantitatively related to these internal physiological events; some observed behaviors appear to result from altered chemical signals.

Occupational need in severe dementia: a descriptive study.

This project represents the first phase of a larger study, the whole of which is intended to demonstrate the occupational need of elderly persons, in hospital or residential settings, who have severe dementia and to identify those therapeutic approaches which serve to meet such need. One hundred and nine severely impaired persons in nine dementia care units were each observed over the course of a day, using the dementia care mapping instrument. Results indicate a severe dearth of occupational provision for this client group, most of whom spent the greater part of their day unoccupied. They also highlight the conditions of minimum well-being experienced by most residents for most of the time. The anomaly of those units whose dementia care mapping scores did not match the perceived quality of their social and physical environments is discussed. A hypothesis of an altered perception of environment in severely impaired persons is proposed.

A method for collection, long-term storage, and bioassay of labile volatile chemosignals.

A procedure for headspace sampling and long-term storage of organic volatiles coupled with gas chromatographic-mass spectrometric (GC-MS) analysis was used to study the volatile chemosignals in a biological secretion prior to bioassay. The approach involved collecting the volatiles in evacuated canisters from an apparatus in which 1 ml of secretion was dispersed for headspace sampling. These canisters, stainless steel, 850 ml, and 100% internally electropolished, have been demonstrated to store volatile compounds, in chemically stable form, for several weeks. The GC-MS analyses provided the quantitation and identification of compounds from C3 through C14 at concentrations as low as 0.10 parts per billion volume. The approach was used to study chemosignals of musth temporal gland secretions (TGS) from a male Asian elephant (Elephas maximus). Fresh TGS material loses its biological activity within 1 hr. TGS material stored at -20°C usually looses its activity within 30 days. The usefulness of this method for long-term storage of the volatile chemosignals was demonstrated by the retention of biologically active TGS headspace compounds, as determined through bioassays, stored in these canisters for one year.

Chemosensory responses of female Asian elephants (Elephas maximus) to cyclohexanone.

Cyclohexanone, a naturally occurring component of male Asian elephant temporal gland secretion, was tested as a candidate elicitor of bioresponses from female Asian elephants (Elephas maximus). Four female Asian elephants were presented with synthetic cyclohexanone samples during a standardized bioassay. Four types of bioresponses, some or all of which may be important in intersexual communication, were monitored: flehmen, palatal pit area contact, scrub, and check responses. Cyclohexanone evoked persistent responses of all bioresponse types by two females, moderate response by a third female, and very few responses by a relatively unresponsive female. The results suggest that cyclohexanone may provide chemical information about to females male elephants, particularly regarding their state of musth.

Longevity-determining genes in Caenorhabditis elegans: chromosomal mapping of multiple noninteractive loci.

We have used chromosome mapping with polymorphic markers to define genetic components governing life span in the nematode Caenorhabditis elegans. A complex recombinant-inbred population was derived from an interstrain cross, yielding > 1000 genotypes, each a composite of homozygous segments from the two parental strains. Genotypes were analyzed for the last-surviving 1-5% of worms in aging cohorts, and for young controls, by multiplex polymerase chain reaction using polymorphic markers to distinguish the parental alleles. We identified five regions of the genome at which one parental allele was significantly enriched in long-lived subpopulations. At four of five loci, the same alleles were selected in aging cohorts maintained under two different conditions, implying that these genes determine life span in differing environments.

Functional evaluation of total hip arthroplasty with five- to ten-year follow-up evaluation.

Forty-seven patients with unilateral hip disease had a preoperative and postoperative gait analysis of total hip arthroplasty with a follow-up period of five to ten years. The object was to correlate the levels of function with mechanical loosening. Unilateral total hip arthroplasty in uncomplicated patients restored function to 80% of normal over a two- to four-year period. Patients followed longer than five years appeared to have an accelerated decline in function unassociated with pain. No Class C patient, regardless of age or gait velocity, developed loosening or required revision of the hip prosthesis. Survivorship studies revealed an 85%-90% incidence of loosening by the seventh postoperative year in Class A patients 55 years or younger and those walking preoperatively at more than 50% of normal gait velocity. In these same two groups of patients, the probability of revision for mechanical failure by ten years is 58% for age and 66% for fast walkers. The majority of patients in this study had a technical rating not acceptable by present standards so that these results represent most likely the worst prognosis for longevity of total hip arthroplasty. In high-risk patients, protected ambulation with crutches for six months postoperation may improve their prognosis.

Electromyographic analysis of equinovarus following stroke.

The pattern of muscle activity was determined in 40 hemiplegic stroke patients with equinus, equinovarus or varus deformities. Although the exact pattern of muscle activity varied with each patient, the following general conclusions are possible. Premature firing of the triceps surae due to release of primitive locomotor control mechanisms and a hyperactive stretch response during limb loading are important causes of equinus. Prolonged firing of the tibialis anterior during stance and inactivity of the peroneus brevis are the principal factors responsible for varus.