Bibliometric analysis of the top 50 highly cited articles on platelet-rich plasma in osteoarthritis and tendinopathy.

The primary goal of this study was to compile the top 50 most cited articles on the use of platelet-rich plasma (PRP). A search of relevant studies was performed in accordance with the PRISMA guidelines in Web of Science. The top 25 most cited articles in osteoarthritis and tendinopathy were then compiled and evaluated. Level 1 evidence articles constituted the majority of the studies (64%) and were more likely to have a higher citation density. Altmetric data was highest for level 1 systematic reviews. Of the articles that report a positive outcome for PRP, 13% (2/16) had low risk of bias. This study defines the most cited and influential publications regarding PRP to further research in this area.

Osteoarthritis, which is degeneration of joints from overuse and/or injuries, and tendinopathy, which is usually a chronic injury of the tendons attached to muscles and bones, are big issues in sports medicine. Platelet-rich plasma (PRP), which is a concentrated mixture of platelets from the patient's own blood, could be an effective treatment for these conditions, but the literature on PRP is limited. This article lists the top 25 most cited articles on the use of PRP in osteoarthritis and in tendinopathy, and it also analyzes how much these articles have been used in research and in public discord. This article is useful as a reading list for physicians, trainees, patients and researchers to know the evidence for PRP.

Combining wearable sensor signals, machine learning and biomechanics to estimate tibial bone force and damage during running.

There are tremendous opportunities to advance science, clinical care, sports performance, and societal health if we are able to develop tools for monitoring musculoskeletal loading (e.g., forces on bones or muscles) outside the lab. While wearable sensors enable non-invasive monitoring of human movement in applied situations, current commercial wearables do not estimate tissue-level loading on structures inside the body. Here we explore the feasibility of using wearable sensors to estimate tibial bone force during running. First, we used lab-based data and musculoskeletal modeling to estimate tibial force for ten participants running across a range of speeds and slopes. Next, we converted lab-based data to signals feasibly measured with wearables (inertial measurement units on the foot and shank, and pressure-sensing insoles) and used these data to develop two multi-sensor algorithms for estimating peak tibial force: one physics-based and one machine learning. Additionally, to reflect current running wearables that utilize running impact metrics to infer musculoskeletal loading or injury risk, we estimated tibial force using a commonly measured impact metric, the ground reaction force vertical average loading rate (VALR). Using VALR to estimate peak tibial force resulted in a mean absolute percent error of 9.9%, which was no more accurate than a theoretical step counter that assumed the same peak force for every running stride. Our physics-based algorithm reduced error to 5.2%, and our machine learning algorithm reduced error to 2.6%. Further, to gain insights into how force estimation accuracy relates to overuse injury risk, we computed bone damage expected due to a given loading cycle. We found that modest errors in tibial force translated into large errors in bone damage estimates. For example, a 9.9% error in tibial force using VALR translated into 104% error in estimated bone damage. Encouragingly, the physics-based and machine learning algorithms reduced damage errors to 41% and 18%, respectively. This study highlights the exciting potential to combine wearables, musculoskeletal biomechanics and machine learning to develop more accurate tools for monitoring musculoskeletal loading in applied situations.

Ground reaction force metrics are not strongly correlated with tibial bone load when running across speeds and slopes: Implications for science, sport and wearable tech.

INTRODUCTION: Tibial stress fractures are a common overuse injury resulting from the accumulation of bone microdamage due to repeated loading. Researchers and wearable device developers have sought to understand or predict stress fracture risks, and other injury risks, by monitoring the ground reaction force (GRF, the force between the foot and ground), or GRF correlates (e.g., tibial shock) captured via wearable sensors. Increases in GRF metrics are typically assumed to reflect increases in loading on internal biological structures (e.g., bones). The purpose of this study was to evaluate this assumption for running by testing if increases in GRF metrics were strongly correlated with increases in tibial compression force over a range of speeds and slopes. METHODS: Ten healthy individuals performed running trials while we collected GRFs and kinematics. We assessed if commonly-used vertical GRF metrics (impact peak, loading rate, active peak, impulse) were strongly correlated with tibial load metrics (peak force, impulse). RESULTS: On average, increases in GRF metrics were not strongly correlated with increases in tibial load metrics. For instance, correlating GRF impact peak and loading rate with peak tibial load resulted in r = -0.29±0.37 and r = -0.20±0.35 (inter-subject mean and standard deviation), respectively. We observed high inter-subject variability in correlations, though most coefficients were negligible, weak or moderate. Seventy-six of the 80 subject-specific correlation coefficients computed indicated that higher GRF metrics were not strongly correlated with higher tibial forces. CONCLUSIONS: These results demonstrate that commonly-used GRF metrics can mislead our understanding of loading on internal structures, such as the tibia. Increases in GRF metrics should not be assumed to be an indicator of increases in tibial bone load or overuse injury risk during running. This has important implications for sports, wearable devices, and research on running-related injuries, affecting >50 scientific publications per year from 2015-2017.

Aldosterone-to-renin ratio and the relationship between urinary salt excretion and blood pressure in a community of African ancestry.

BACKGROUND: Although aldosterone influences the effect of salt intake on blood pressure (BP), the extent to which this occurs at a population level is uncertain. We therefore aimed to determine, at a community level in a group of African descent, whether in the absence of primary aldosteronism, the relationship between salt intake and BP is modified by circulating aldosterone, and the extent to which this occurs. METHODS: In 575 participants of African ancestry (age >16 years), we assessed whether aldosterone-to-renin ratio (ARR) is associated with the relationship between urinary sodium (Na(+))-to-potassium (K(+)) ratio (urinary Na(+)/K(+)) (from 24-h urine samples), an index of salt intake, and BP. RESULTS: With adjustments for confounders, interactions between ARR and urinary Na(+)/K(+) were independently associated with systolic BP (SBP) (P < 0.0001), an effect that was accounted for by interactions between serum aldosterone concentrations and urinary Na(+)/K(+) (P < 0.0001), but not between plasma renin concentrations and urinary Na(+)/K(+) (P = 0.52). The interaction between ARR and urinary Na(+)/K(+) translated into a marked difference in the relationship between urinary Na(+)/K(+) and SBP in participants above compared to below the median for ARR (effect of 1 s.d. increase in urinary Na(+)/K(+) on SBP: ARR > median = 4.2 ± 0.6 mm Hg; ARR < median = 1.2 ± 0.4 mm Hg, P < 0.0001). In addition, participants with urinary Na(+)/K(+) above the median had higher multivariate-adjusted SBP (P < 0.001) only if ARR was also above the median. CONCLUSIONS: In groups of African descent, in the absence of primary aldosteronism, an increased aldosterone concentration relative to renin modifies a substantial proportion of the relationship between urinary Na(+)/K(+) and BP at a community level.

Relationship of predominantly mild current smoking to out-of-office blood pressure in a community sample in Africa.

OBJECTIVES: As the impact of mild smoking on blood pressure (BP) is uncertain, we assessed the relationship between predominantly mild current smoking and out-of-office BP and the effect of angiotensin-converting enzyme (ACE) genotype on this relationship in a community sample of black African ancestry. METHODS: In 689 participants randomly recruited from an urban, developing community of black African descent, we assessed smoking habits, out-of-office (24-h), and in-office conventional and central (applanation tonometry) BP, and ACE insertion (I)/deletion (D) variant genotype. RESULTS: A total of 14.5% (n=100) were current smokers, the majority being mild (72%, 7.4 ± 4.6 cigarettes/day). Despite current smokers having only modest increases in in-office (P<0.05) and similar central aortic BP values as nonsmokers, current smokers had higher unadjusted (P<0.005-P<0.0005) and multivariate adjusted 24-h SBP/DBP (mmHg; smokers=123 ± 15/76 ± 10; nonsmokers=118 ± 14/72 ± 9; P<0.005-P<0.0005) than nonsmokers, effects that were DD genotype-dependent (P<0.005 for interaction) and replicated in sex-specific groups, nondrinkers, and in overweight and obese. Current smoking was second only to age in the quantitative impact on 24-h DBP. Smoking 4.6 cigarettes per day (one standard deviation) translated into increases in 24-h SBP (mmHg) of 2.12 [confidence interval (CI)=1.77-2.47] in all participants and 3.62 (CI=3.13-4.12) in participants with the DD genotype. The risk of uncontrolled 24-h BP was increased in smokers as compared to nonsmokers (adjusted odds ratio=1.87, CI=1.02-3.41, P<0.05), an effect that was enhanced in participants with the DD genotype (adjusted odds ratio=4.01, CI=1.59-10.09, P<0.005). CONCLUSION: Mild current smoking is independently associated with an appreciable proportion of out-of-office BP in a black African community, an effect that is ACE genotype-dependent.

Relationship between urinary salt excretion and pulse pressure and central aortic hemodynamics independent of steady state pressure in the general population.

Although central pulse pressure (PPc) is strongly related to central mean arterial pressure (MAPc), PPc predicts cardiovascular outcomes beyond MAPc. Whether modifiable risk factors for hypertension contribute to PPc and its determinants, independent of MAPc, is uncertain. In 635 randomly recruited participants, we assessed the independent relationship between 24-hour urinary sodium (Na(+)) or potassium (K(+)) excretion and brachial artery PP (in office or 24-hour; n = 487), PPc, the forward (P1) and augmented (Paug) pressure wave components of PPc, central augmentation index, and determinants of central pressure waves, including aortic pulse wave velocity, effective reflecting distance, and reflective wave transit time. Central dynamics were determined using applanation tonometry of the carotid, femoral, and radial arteries. With adjustments for potential confounders, urinary Na(+)/K(+) was independently associated with in-office, central, and 24-hour PP, as well as Paug, P1, and central augmentation index (P<0.05 to P<0.005). With further adjustments for MAPc (or diastolic BP), urinary Na(+)/K(+) was independently associated with PPc, 24-hour PP, Paug, P1, and central augmentation index (P<0.05 to P = 0.005) but not with in-office PP, pulse wave velocity, effective reflecting distance, or reflective wave transit time. In conclusion, in a population of African ancestry, urinary salt excretion is independently related to central and 24-hour PP independent of MAPc or diastolic BP, effects that are attributed to increases in both P1 and Paug but not to pulse wave velocity. Hence, modifying salt intake could influence cardiovascular risk through effects on 24-hour and central PPs, as well as P1 and Paug, independent of steady-state pressure (MAP or diastolic BP) or pulse wave velocity.

Population dynamics and gene flow of Helicoverpa armigera (Lepidoptera: Noctuidae) on cotton and grain crops in the Murrumbidgee Valley, Australia.

The population dynamics of Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) in the Murrumbidgee Valley, Australia, has been characterized using five highly variable microsatellite loci. In the 2001-2002 growing season, there were very high levels of migration into the Murrumbidgee Valley with no detectable genetic structuring, consistent with previous analyses on a national scale. By contrast, there was significant genetic structuring over the 2002-2003 growing season, with three distinct genetic types detected. The first type corresponded to the first two generations and was derived from local individuals emerging from diapause and their progeny. The second genetic type corresponded to generation 3 and resulted from substantial immigration into the region. There was another genetic shift in generation 4, which accounts for the third genetic type of the season. This genetic shift occurred despite low levels of immigration. During the third generation of the 2002-2003 growing season, different population dynamics was characterized for H. armigera on maize, Zea mays L., and cotton Gossipium hirsutum L. Populations on cotton tended to cycle independently with very little immigration from outside the region or from maize within the region. Maize acted as a major sink for immigrants from cotton and from outside the region. If resistance were to develop on cotton under these circumstances, susceptible individuals from maize or from other regions would not dilute this resistance. In addition, resistance is likely to be transferred to maize and be perpetuated until diapause, from where it may reemerge next season. If low levels of immigration were to occur on transgenic cotton, this may undermine the effectiveness of refugia, especially noncotton refugia.

Assessing moth migration and population structuring in Helicoverpa armigera (Lepidoptera: Noctuidae) at the regional scale: example from the Darling Downs, Australia.

Analysis of gene flow and migration of Helicoverpa armigera (Hübner) in a major cropping region of Australia identified substantial genetic structuring, migration events, and significant population genotype changes over the 38-mo sample period from November 1999 to January 2003. Five highly variable microsatellite markers were used to analyze 916 individuals from 77 collections across 10 localities in the Darling Downs. The molecular data indicate that in some years (e.g., April 2002-March 2003), low levels of H. armigera migration and high differentiation between populations occurred, whereas in other years (e.g., April 2001-March 2002), there were higher levels of adult moth movement resulting in little local structuring of populations. Analysis of populations in other Australian cropping regions provided insight into the quantity and direction of immigration of H. armigera adults into the Darling Downs growing region of Australia. These data provide evidence adult moth movement differs from season to season, highlighting the importance of studies in groups such as the Lepidoptera extending over consecutive years, because short-term sampling may be misleading when population dynamics and migration change so significantly. This research demonstrates the importance of maintaining a coordinated insecticide resistance management strategy, because in some years H. armigera populations may be independent within a region and thus significantly influenced by local management practices; however, periods with high migration will occur and resistance may rapidly spread.

Comparative genetic study confirms exceptionally low genetic variation in the ancient and endangered relictual conifer, Wollemia nobilis (Araucariaceae).

The Wollemi pine, Wollemia nobilis (Araucariaceae), was discovered in 1994 as the only extant member of the genus, previously known only from the fossil record. With fewer than 100 trees known from an inaccessible canyon in southeastern Australia, it is one of the most endangered tree species in the world. We conducted a comparative population genetic survey at allozyme, amplified fragment length polymorphism (AFLP) and simple sequence repeat (SSR) loci in W. nobilis, Araucaria cunninghamii and Agathis robusta - representatives of the two sister genera. No polymorphism was detected at 13 allozyme loci, more than 800 AFLP loci or the 20 SSR loci screened in W. nobilis. In Ag. robusta only one of 12 allozyme loci, five of 800 AFLP loci and none of the 15 SSR loci were variable. For A. cunninghamii, 10 of > 800 AFLP loci and five of 20 SSR loci were variable. Thus low genetic diversity characterizes all three species. While not ruling out the existence of genetic variation, we conclude that genetic diversity is exceptionally low in the Wollemi pine. To our knowledge this is the most extreme case known in plants. We conclude that the combination of small population effects, clonality and below-average genetic variation in the family are probable contributing factors to the low diversity. The exceptionally low genetic diversity of the Wollemi pine, combined with its known susceptibility to exotic fungal pathogens, reinforces current management policies of strict control of access to the pines and secrecy of the pine locations.