Influence of a single oral dose of trazodone on intradermal histamine reactivity in clinically healthy dogs.

BACKGROUND: Drug interactions are significant considerations for intradermal testing (IDT). Trazodone (TRZ) is an anxiolytic and selective histaminergic (H1 ) antagonist with no interaction in human prick tests; however, interaction in canine IDT is unknown. HYPOTHESIS/OBJECTIVES: Trazodone will not adversely affect intradermal histamine reactions in dogs. ANIMALS: Fourteen nonanxious, nonatopic, healthy client-owned dogs were enrolled in this randomised, blinded, cross-over study. MATERIALS AND METHODS: Dogs were randomised to receive low-dose TRZ (4 mg/kg) (Teva Pharmaceuticals), high-dose TRZ (8 mg/kg) or no TRZ per os two hours before intravenous sedation with dexmedetomidine (5 mcg/kg) (Dexdomitor; Zoetis). Intradermal testing was performed with five quadrupling dilutions of histamine (1:100,000 to 1:25,600,000 w/v; Greer) and 0.9% saline (Hospira), observing a minimum two weeks washout period between treatments. Two observers, who were blinded to treatment and the identity of the injections, evaluated each test using previously established subjective and objective methods. RESULTS: The mean wheal diameter of histamine 1:1,600,000 w/v was significantly smaller with low-dose TRZ (4 mg/kg) compared to the control group (p = 0.048; repeated measures ANOVA with post hoc Tukey's test). For all other histamine dilutions and saline, mean wheal diameter was not significantly different among groups. There were no significant differences in the subjective scores of all histamine dilutions and saline (p > 0.05; Friedman test). CONCLUSION AND CLINICAL RELEVANCE: A single oral dose of TRZ does not adversely affect intradermal histamine reactions in dogs.

Physical performance and perception of foot discomfort during a soccer-specific match simulation. A comparison of football boots.

Football boots are marketed with emphasis on a single key performance characteristic (e.g. speed). Little is known on how design parameters impact players' performance. This study investigated the impact of boot design on performance maintenance and perceived foot comfort during a 90-minute match simulation drill. Eleven male university football players tested two commercially available "sprint boots" known to generate significantly different plantar pressures (high=Boot H and low=Boot L) . Players completed a modified Soccer-specific Aerobic Field Test on a 3G pitch. Heart rate, rated perceived exertion and perceived foot discomfort were assessed for each 15-min interval. Power generation was assessed pre- and post-match simulation. A significantly higher mean heart rate was seen for Boot L in the 60th-75th and 75th-90th minute intervals (P = 0.017, P = 0.012 respectively). Perceived exertion did not differ between boots (P ≥ 0.302). Power generation significantly decreased in Boot H between pre- and post-match (P = 0.042). Both boots increased discomfort with significantly more plantar discomfort felt in the last 30 min in Boot H (75th min: P = 0.037; 90th min: P = 0.048). The results imply that a comfortable boot design may improve maintenance of performance during match-play.

Accentuated Eccentric Loading and Cluster Set Configurations in the Back Squat: A Kinetic and Kinematic Analysis.

ABSTRACT: Wagle, JP, Cunanan, AJ, Carroll, KM, Sams, ML, Wetmore, A, Bingham, GE, Taber, CB, DeWeese, BH, Sato, K, Stuart, CA, and Stone, MH. Accentuated eccentric loading and cluster set configurations in the back squat: a kinetic and kinematic analysis. J Strength Cond Res 35(2): 420-427, 2021-This study examined the kinetic and kinematic differences between accentuated eccentric loading (AEL) and cluster sets in trained male subjects (age = 26.1 ± 4.1 years, height = 183.5 ± 4.3 cm, body mass = 92.5 ± 10.5 kg, and back squat to body mass ratio = 1.8 ± 0.3). Four load condition sessions consisted of traditionally loaded (TL) "straight sets," TL cluster (TLC) sets, AEL cluster (AEC) sets, and AEL "straight sets" where only the first repetition had eccentric overload (AEL1). An interrepetition rest interval of 30 seconds was prescribed for both TLC and AEC. Concentric intensity for all load conditions was 80% 1 repetition maximum (1RM). Accentuated eccentric loading was applied to repetitions using weight releasers with total eccentric load equivalent to 105% of concentric 1RM. Traditionally loaded cluster had statistically greater concentric outputs than TL. Furthermore, statistically greater eccentric and concentric outputs were observed during AEC compared with TL with the exception of peak power. Statistically greater concentric characteristics were observed in TLC compared with AEL1, but statistically greater eccentric outputs were observed in AEL1. In the 2 cluster set conditions, statistically greater concentric rate of force development (RFDCON) (d = 0.470, p < 0.001) and average velocity (vavg) (d = 0.560, p < 0.001) in TLC compared with AEC were observed. However, statistically greater eccentric work (WECC) (d = 2.096, p < 0.001) and eccentric RFD (RFDECC) (d = 0.424, p < 0.001) were observed in AEC compared with TLC. Overall, eccentric overload demonstrated efficacy as a means of increasing eccentric work and RFD, but not as a means of potentiating concentric output. Finally, interrepetition rest seems to have the largest influence on concentric power output and RFD.

Preliminary Investigation Into the Effect of ACTN3 and ACE Polymorphisms on Muscle and Performance Characteristics.

ABSTRACT: Wagle, JP, Carroll, KM, Cunanan, AJ, Wetmore, A, Taber, CB, DeWeese, BH, Sato, K, Stuart, CA, and Stone, MH. Preliminary investigation into the effect of ACTN3 and ACE polymorphisms on muscle and performance characteristics. J Strength Cond Res 35(3): 688-694, 2021-The purpose of this investigation was to explore the phenotypic and performance outcomes associated with ACTN3 and ACE polymorphisms. Ten trained men (age = 25.8 ± 3.0 years, height = 183.3 ± 4.1 cm, body mass = 92.3 ± 9.3 kg, and back squat to body mass ratio = 1.8 ± 0.3) participated. Blood samples were analyzed to determine ACTN3 and ACE polymorphisms. Standing ultrasonography images of the vastus lateralis (VL) were collected to determine whole muscle cross-sectional area (CSA-M), and a percutaneous muscle biopsy of the VL was collected to determine type I-specific CSA (CSA-T1), type II-specific CSA (CSA-T2), and type II to type I CSA ratio (CSA-R). Isometric squats were performed on force platforms with data used to determine peak force (IPF), allometrically scaled peak force (IPFa), and rate of force development (RFD) at various timepoints. One repetition maximum back squats were performed, whereby allometrically scaled dynamic strength (DSa) was determined. Cohen's d effect sizes revealed ACTN3 RR and ACE DD tended to result in greater CSA-M but differ in how they contribute to performance. ACTN3 RR's influence seems to be in the type II fibers, altering maximal strength, and ACE DD may influence RFD capabilities through a favorable CSA-R. Although the findings of the current investigation are limited by the sample size, the findings demonstrate the potential influence of ACTN3 and ACE polymorphisms on isometric and dynamic strength testing. This study may serve as a framework to generate hypotheses regarding the effect of genetics on performance.

ß-Arrestin 2 Promotes Hepatocyte Apoptosis by Inhibiting Akt Protein.

Recent studies reveal that multifunctional protein ß-arrestin 2 (Arrb2) modulates cell apoptosis. Survival and various aspects of liver injury were investigated in WT and Arrb2 KO mice after bile duct ligation (BDL). We found that deficiency of Arrb2 enhances survival and attenuates hepatic injury and fibrosis. Following BDL, Arrb2-deficient mice as compared with WT controls displayed a significant reduction of hepatocyte apoptosis as demonstrated by the TUNEL assay. Following BDL, the levels of phospho-Akt and phospho-glycogen synthase kinase 3ß (GSK3ß) in the livers were significantly increased in Arrb2 KO compared with WT mice, although p-p38 increased in WT but not in Arrb2-deficient mice. Inhibition of GSK3ß following BDL decreases hepatic apoptosis and decreased p-p38 in WT mice but not in Arrb2 KO mice. Activation of Fas receptor with Jo2 reduces phospho-Akt and increases apoptosis in WT cells and WT mice but not in Arrb2-deficient cells and Arrb2-deficient mice. Consistent with direct interaction of Arrb2 with and regulating Akt phosphorylation, the expression of a full-length or N terminus but not the C terminus of Arrb2 reduces Akt phosphorylation and coimmunoprecipates with Akt. These results reveal that the protective effect of deficiency of Arrb2 is due to loss of negative regulation of Akt due to BDL and decreased downstream GSK3ß and p38 MAPK signaling pathways.

Chronic morphine-induced microRNA-124 promotes microglial immunosuppression by modulating P65 and TRAF6.

Opioids have been widely applied in clinics as one of the most potent pain relievers for centuries, but their abuse has deleterious physiological effects including immunosuppression. However, the mechanisms are unclear. TLRs and acetylcholine are widely expressed in the immune and nervous systems, and play critical roles in immune responses. In this article, we show that morphine suppresses the innate immunity in microglia and bone marrow-derived macrophages through differential regulation of TLRs and acetylcholinesterase. Either morphine or inhibition of acetylcholine significantly promotes upregulation of microRNA-124 (miR-124) in microglia, bone marrow-derived macrophages, and the mouse brain, where miR-124 mediates morphine inhibition of the innate immunity by directly targeting a subunit of NF-κB p65 and TNFR-associated factor 6 (TRAF6). Furthermore, transcription factors AP-1 and CREB inhibited miR-124, whereas p65 bound directly to promoters of miR-124, thereby enhancing miR-124 transcription. Moreover, acute morphine treatment transiently upregulated the expression of p65 and phospho-p65 in both nucleus and cytoplasm priming the expression of miR-124, whereas long exposure of morphine maintained miR-124 expression, which inhibited p65- and TRAF6-dependent TLR signaling. These data suggest that modulation of miRs is capable of preventing opioid-induced damage to microglia.

Pre-Training Muscle Characteristics of Subjects Who Are Obese Determine How Well Exercise Training Will Improve Their Insulin Responsiveness.

Stuart, CA, Lee, ML, South, MA, Howell, MEA, Cartwright, BM, Ramsey, MW, and Stone, MH. Pre-training muscle characteristics of subjects who are obese determine how well exercise training will improve their insulin responsiveness. J Strength Cond Res 31(3): 798-808, 2017-Only half of prediabetic subjects who are obese who underwent exercise training without weight loss increased their insulin responsiveness. We hypothesized that those who improved their insulin responsiveness might have pretraining characteristics favoring a positive response to exercise training. Thirty nondiabetic subjects who were obese volunteered for 8 weeks of either strength training or endurance training. During training, subjects increased their caloric intake to prevent weight loss. Insulin responsiveness by euglycemic clamps and muscle fiber composition, and expression of muscle key biochemical pathways were quantified. Positive responders initially had 52% higher intermediate muscle fibers (fiber type IIa) with 27% lower slow-twitch fibers (type I) and 23% lower expression of muscle insulin receptors. Whether after weight training or stationary bike training, positive responders' fiber type shifted away from type I and type IIa fibers to an increased proportion of type IIx fibers (fast twitch). Muscle insulin receptor expression and glucose transporter type 4 (GLUT4) expression increased in all trained subjects, but these moderate changes did not consistently translate to improvement in whole-body insulin responsiveness. Exercise training of previously sedentary subjects who are obese can result in muscle remodeling and increased expression of key elements of the insulin pathway, but in the absence of weight loss, insulin sensitivity improvement was modest and limited to about half of the participants. Our data suggest rather than responders being more fit, they may have been less fit, only catching up to the other half of subjects who are obese whose insulin responsiveness did not increase beyond their pretraining baseline.

Myosin content of individual human muscle fibers isolated by laser capture microdissection.

Muscle fiber composition correlates with insulin resistance, and exercise training can increase slow-twitch (type I) fibers and, thereby, mitigate diabetes risk. Human skeletal muscle is made up of three distinct fiber types, but muscle contains many more isoforms of myosin heavy and light chains, which are coded by 15 and 11 different genes, respectively. Laser capture microdissection techniques allow assessment of mRNA and protein content in individual fibers. We found that specific human fiber types contain different mixtures of myosin heavy and light chains. Fast-twitch (type IIx) fibers consistently contained myosin heavy chains 1, 2, and 4 and myosin light chain 1. Type I fibers always contained myosin heavy chains 6 and 7 (MYH6 and MYH7) and myosin light chain 3 (MYL3), whereas MYH6, MYH7, and MYL3 were nearly absent from type IIx fibers. In contrast to cardiomyocytes, where MYH6 (also known as α-myosin heavy chain) is seen solely in fast-twitch cells, only slow-twitch fibers of skeletal muscle contained MYH6. Classical fast myosin heavy chains (MHC1, MHC2, and MHC4) were present in variable proportions in all fiber types, but significant MYH6 and MYH7 expression indicated slow-twitch phenotype, and the absence of these two isoforms determined a fast-twitch phenotype. The mixed myosin heavy and light chain content of type IIa fibers was consistent with its role as a transition between fast and slow phenotypes. These new observations suggest that the presence or absence of MYH6 and MYH7 proteins dictates the slow- or fast-twitch phenotype in skeletal muscle.

Effects of Short-Term Free-Weight and Semiblock Periodization Resistance Training on Metabolic Syndrome.

South, MA, Layne, AS, Stuart, CA, Triplett, NT, Ramsey, MW, Howell, ME, Sands, WA, Mizuguchi, S, Hornsby, WG, Kavanaugh, AA, and Stone, MH. Effects of short-term free-weight and semiblock periodization resistance training on metabolic syndrome. J Strength Cond Res 30(10): 2682-2696, 2016-The effects of short-term resistance training on performance and health variables associated with prolonged sedentary lifestyle and metabolic syndrome (MS) were investigated. Resistance training may alter a number of health-related, physiological, and performance variables. As a result, resistance training can be used as a valuable tool in ameliorating the effects of a sedentary lifestyle including those associated with MS. Nineteen previously sedentary subjects (10 with MS and 9 with nonmetabolic syndrome [NMS]) underwent 8 weeks of supervised resistance training. Maximum strength was measured using an isometric midthigh pull and resulting force-time curve. Vertical jump height (JH) and power were measured using a force plate. The muscle cross-sectional area (CSA) and type were examined using muscle biopsy and standard analysis techniques. Aerobic power was measured on a cycle ergometer using a ParvoMedics 2400 Metabolic system. Endurance was measured as time to exhaustion on a cycle ergometer. After training, maximum isometric strength, JH, jump power, and V[Combining Dot Above]O2peak increased by approximately 10% (or more) in both the metabolic and NMS groups (both male and female subjects). Over 8 weeks of training, body mass did not change statistically, but percent body fat decreased in subjects with the MS and in women, and lean body mass increased in all groups (p ≤ 0.05). Few alterations were noted in the fiber type. Men had larger CSAs compared those of with women, and there was a fiber-specific trend toward hypertrophy over time. In summary, 8 weeks of semiblock free-weight resistance training improved several performance variables and some cardiovascular factors associated with MS.

ß-Arrestin 2 negatively regulates Toll-like receptor 4 (TLR4)-triggered inflammatory signaling via targeting p38 MAPK and interleukin 10.

The control of IL-10 production in Toll-like receptor (TLR) signals remains to be elucidated. Here, we report that ß-arrestin 2 positively regulates TLR-triggered IL-10 production in a p38 mitogen-activated protein kinase (MAPK)-dependent mechanism. In vitro studies with cells including peritoneal macrophages and HEK293/TLR4 cells have demonstrated that ß-arrestin 2 forms complexes with p38 and facilitates p38 activation after lipopolysaccharide (LPS) stimulation. Deficiency of ß-arrestin 2 and inhibition of p38 MAPK activity both ameliorate TLR4-stimulated IL-10 response. Additionally, in vivo experiments show that mice lacking ß-arrestin 2 produce less amount of IL-10, and are more susceptible to LPS-induced septic shock which is further enhanced by blocking IL-10 signal. These results reveal a novel mechanism by which ß-arrestin 2 negatively regulates TLR4-mediated inflammatory reactions.

ß-arrestin2/miR-155/GSK3ß regulates transition of 5'-azacytizine-induced Sca-1-positive cells to cardiomyocytes.

Stem-cell antigen 1-positive (Sca-1+) cardiac stem cells (CSCs), a vital kind of CSCs in humans, promote cardiac repair in vivo and can differentiate to cardiomyocytes with 5'-azacytizine treatment in vitro. However, the underlying molecular mechanisms are unknown. ß-arrestin2 is an important scaffold protein and highly expressed in the heart. To explore the function of ß-arrestin2 in Sca-1+ CSC differentiation, we used ß-arrestin2-knockout mice and overexpression strategies. Real-time PCR revealed that ß-arrestin2 promoted 5'-azacytizine-induced Sca-1+ CSC differentiation in vitro. Because the microRNA 155 (miR-155) may regulate ß-arrestin2 expression, we detected its role and relationship with ß-arrestin2 and glycogen synthase kinase 3 (GSK3ß), another probable target of miR-155. Real-time PCR revealed that miR-155, inhibited by ß-arrestin2, impaired 5'-azacytizine-induced Sca-1+ CSC differentiation. On luciferase report assay, miR-155 could inhibit the activity of ß-arrestin2 and GSK3ß, which suggests a loop pathway between miR-155 and ß-arrestin2. Furthermore, ß-arrestin2-knockout inhibited the activity of GSK3ß. Akt, the upstream inhibitor of GSK3ß, was inhibited in ß-arrestin2-Knockout mice, so the activity of GSK3ß was regulated by ß-arrestin2 not Akt. We transplanted Sca-1+ CSCs from ß-arrestin2-knockout mice to mice with myocardial infarction and found similar protective functions as in wild-type mice but impaired arterial elastance. Furthermore, low level of ß-arrestin2 agreed with decreased phosphorylation of AKT and increased phophorylation of GSK3ß, similar to in vitro findings. The ß-arrestin2/miR-155/GSK3ß pathway may be a new mechanism with implications for treatment of heart disease.

Running-Related Injury Incidence: Does It Correlate with Kinematic Sub-groups of Runners? A Scoping Review.

BACKGROUND: Historically, kinematic measures have been compared across injured and non-injured groups of runners, failing to take into account variability in kinematic patterns that exist independent of injury, and resulting in false positives. Research led by gait patterns and not pre-defined injury status is called for, to better understand running-related injury (RRI) aetiology and within- and between-group variability. OBJECTIVES: Synthesise evidence for the existence of distinct kinematic sub-groups across a population of injured and healthy runners and assess between-group variability in kinematics, demographics and injury incidence. DATA SOURCES: Electronic database search: PubMed, Web of Science, Cochrane Central Register of Controlled Trials (Wiley), Embase, OVID, Scopus. ELIGIBILITY CRITERIA: Original, peer-reviewed, research articles, published from database start to August 2022 and limited to English language were searched for quantitative and mixed-methods full-text studies that clustered injured runners according to kinematic variables. RESULTS: Five studies (n = 690) were included in the review. All studies detected the presence of distinct kinematic sub-groups of runners through cluster analysis. Sub-groups were defined by multiple differences in hip, knee and foot kinematics. Sex, step rate and running speed also varied significantly between groups. Random injury dispersal across sub-groups suggests no strong evidence for an association between kinematic sub-groups and injury type or location. CONCLUSION: Sub-groups containing homogeneous gait patterns exist across healthy and injured populations of runners. It is likely that a single injury may be represented by multiple movement patterns, and therefore kinematics may not predict injury risk. Research to better understand the underlying causes of kinematic variability, and their associations with RRI, is warranted.

Neuromuscular joint function in knee osteoarthritis: A systematic review and meta-analysis.

BACKGROUND: Neuromuscular alterations are common in people with knee osteoarthritis (KOA). A comprehensive understanding of these alterations is important to enable targeted rehabilitation strategies. OBJECTIVES: This systematic review and meta-analysis aimed to comprehensively understand the neuromuscular alterations around the knee joint in people with KOA. METHODS: Moderate- and high-quality studies based on a modified version of the Downs and Black checklist, comparing neuromuscular function of peri­articular muscles between people with KOA and controls were retrieved from five databases from inception to October 2020. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and torque-related outcomes. Data were pooled according to structural KOA severity with sensitivity analysis based on sex. Evidence levels are presented in evidence gap maps. RESULTS: A total of 7 high-quality and 22 moderate-quality studies were retained (1146 people with KOA and 1353 age- and sex-matched controls). Studies demonstrated quadriceps and hamstring strength deficits and increased hamstring-to-quadriceps strength ratios across KOA severities. Women presented lower quadriceps strength at early KOA (very limited evidence) and lower voluntary activation at end stage KOA (very limited evidence) as compared with controls, whereas men did not (moderate evidence). People with KOA also demonstrated lower quadriceps force control ability with no change in rapid force production (very limited evidence). Voluntary activation deficits for quadriceps were evident (moderate evidence), with no change in quadriceps cortical excitability (very limited evidence) or soleus spinal reflexes (very limited evidence). No muscle size change was demonstrated except for the vastus medialis (limited evidence). Evidence gaps were found for neural and torque-related measures and differences in hamstring, gastrocnemius, soleus, and popliteus. CONCLUSIONS: Neuromuscular deficits are evident across different structural KOA severities and are seen in muscle strength, voluntary activation, muscle size, and force control ability. Women may exhibit these alterations to a greater extent than men. PROSPERO REGISTRATION NUMBER: CRD42019160845.

The effects of a two-week neuromuscular intervention on biopsychosocial variables in people with patellofemoral pain: an observational study.

Introduction: Patellofemoral pain (PFP) is common and predominately affects active populations. Altered biomechanics and psychosocial variables have been reported in people with PFP, but the effects of neuromuscular exercise on these variables is unknown. We aimed to investigate changes in biopsychosocial measures following a two-week neuromuscular intervention in people with PFP. Materials and Methods: We measured pain (visual analogue scale), function (Kujala), activity level (Tegner), psychological well-being (Orebro), lower-limb isometric strength (handheld dynamometry), three-dimensional (3D) lower limb kinematics, and surface electromyography (sEMG), in people with PFP. 3D lower-limb kinematics and sEMG were synchronously sampled during step-up, step-down, and overground running. All measures were repeated after participants had completed a two-week neuromuscular intervention consisting of three exercises completed once per day, five days per week. Results: 18 participants completed pre/post testing (60% females, mean age 30.6 years ±7.0, height 173.4cm ±10.4, mass 70.2kg ±12.4, symptom duration 39.0 months ±58.8), with three of 21 participants lost to follow-up. Across all clinical measures (muscle onsets, muscle activation and kinematics), the 95% bootstrapped confidence intervals (CI) of the mean difference contained the null hypothesis following the two-week neuromuscular intervention, indicating no significant differences. Conclusion: A two-week neuromuscular intervention did not change biomechanical or psychosocial measures in people with PFP. Interventions with a longer duration or greater load magnitude are required to fully evaluate the biopsychosocial mechanisms of effect for exercise in people with PFP.

2-Deoxyglucose drives plasticity via an adaptive ER stress-ATF4 pathway and elicits stroke recovery and Alzheimer's resilience.

Intermittent fasting (IF) is a diet with salutary effects on cognitive aging, Alzheimer's disease (AD), and stroke. IF restricts a number of nutrient components, including glucose. 2-deoxyglucose (2-DG), a glucose analog, can be used to mimic glucose restriction. 2-DG induced transcription of the pro-plasticity factor, Bdnf, in the brain without ketosis. Accordingly, 2-DG enhanced memory in an AD model (5xFAD) and functional recovery in an ischemic stroke model. 2-DG increased Bdnf transcription via reduced N-linked glycosylation, consequent ER stress, and activity of ATF4 at an enhancer of the Bdnf gene, as well as other regulatory regions of plasticity/regeneration (e.g., Creb5, Cdc42bpa, Ppp3cc, and Atf3) genes. These findings demonstrate an unrecognized role for N-linked glycosylation as an adaptive sensor to reduced glucose availability. They further demonstrate that ER stress induced by 2-DG can, in the absence of ketosis, lead to the transcription of genes involved in plasticity and cognitive resilience as well as proteostasis.

Self-reported bio-psycho-social factors partially distinguish rotator cuff tendinopathy from other shoulder problems and explain shoulder severity: A case-control study.

OBJECTIVE: Examine how rotator cuff (RC) tendinopathy differed from other shoulder problems (OSP) by measuring a variety of self-reported bio-psycho-social factors, and establish which explain severity. METHODS: A validated online survey battery was used to collect self-reported biopsychosocial variables in an international population. Diagnostic group and severity were the dependent variables. Multiple logistic and linear regression analyses were utilised to generate explanatory models for group differences and severity after group comparison and univariate regression analysis. RESULTS: 82 people with RC tendinopathy (50 female, 42.8 ± 13.9 years) and 54 with OSP (33 female, 40.2 ± 14.1 years) were recruited. Both groups had comparable severity results (Shoulder Pain and Disability Index = 37.3 ± 24.5 vs. 33.7 ± 22.5). Seven factors individually differentiated RC tendinopathy from OSP. The multivariable model included 4 factors: activity effect on pain (OR(95%CI) = 2.24(1.02-4.90)), previous injury in the shoulder (OR(95% CI) = 0.30(0.13-0.69)), activity level (moderate OR(95% CI) = 3.97(1.29-12.18), high OR(95% CI) = 3.66(1.41-9.48)) and self-efficacy (OR(95%CI) = 1.12(1.02-1.22)) demonstrating acceptable accuracy. The second multivariable model for RC tendinopathy severity included one demographic, three psychological and two biomedical variables (ß(range) = 0.19-0.38) and explained 68% of the variance. CONCLUSION: Self-reported bio-psycho-social variables may be beneficial for further detailed clinical assessment as they partially distinguish RC tendinopathy from OSP, even when the groups have comparable overall pain and functional problems. Moreover, these variables were shown to be substantially associated with RC tendinopathy severity variance, implying that the clinical evaluation might be improved, perhaps by pre-consultation online data collection. The models should be validated in the future and considered alongside data from physical and imaging examinations.

Predicting the outcome of plantar heel pain in adults: a systematic review of prognostic factors.

BACKGROUND: Plantar Heel Pain (PHP) is a common disorder with many treatment pathways and is not self-limiting, hence prognostic information concerning recovery or recalcitrance is needed to guide practice. In this systematic review, we investigate which prognostic factors are associated with favourable or unfavourable PHP outcomes. METHODS: MEDLINE, Web of Science, EMBASE, Scopus and PubMed electronic bibliographic databases were searched for studies evaluating baseline patient characteristics associated with outcomes in prospective longitudinal cohorts or after specific interventions. Cohort, clinical prediction rule derivation and single arms of randomised controlled trials were included. Risk of bias was evaluated with method-specific tools and evidence certainty with GRADE. RESULTS: The review included five studies which evaluated 98 variables in 811 participants. Prognostic factors could be categorised as demographics, pain, physical and activity-related. Three factors including sex and bilateral symptoms (HR: 0.49[0.30-0.80], 0.33[0.15-0.72], respectively) were associated with a poor outcome in a single cohort study. The remaining four studies reported twenty factors associated with a favourable outcome following shockwave therapy, anti-pronation taping and orthoses. Heel spur (AUC = 0.88[0.82-0.93]), ankle plantar-flexor strength (Likelihood ratio (LR): 2.17[1.20-3.95]) and response to taping (LR = 2.17[1.19-3.90]) were the strongest factors predicting medium-term improvement. Overall, the study quality was low. A gap map analysis revealed an absence of research that included psychosocial factors. CONCLUSIONS: A limited number of biomedical factors predict favourable or unfavourable PHP outcomes. High quality, adequately powered, prospective studies are required to better understand PHP recovery and should evaluate the prognostic value of a wide range of variables, including psychosocial factors.

Self-reported bio-psycho-social factors partially distinguish patellar tendinopathy from other knee problems and explain patellar tendinopathy severity in jumping athletes: A case-control study.

OBJECTIVE: To determine what combinations of self-reported factors distinguish patellar tendinopathy (PT) from other knee problems, and explain PT severity variance. DESIGN: Case-control study. SETTING: Social media, private practice and National Health Service. PARTICIPANTS: An international sample of jumping athletes diagnosed with either PT (n = 132; 30.7 ± 8.9 years; 80 males; VISA-P = 61.6 ± 16.0) or another musculoskeletal knee condition (n = 89; 31.8 ± 9.9 years; 47 males; VISA-P = 62.9 ± 21.2) by a clinician in the last 6 months. MAIN OUTCOME MEASURES: We considered clinical diagnosis (case = having PT vs control = having other knee problems) as the dependent variable. Severity and sporting impact were defined by VISA-P and availability, respectively. RESULTS: A model comprising seven factors distinguished PT from other knee problems; training duration (OR = 1.10), sport type (OR = 2.31), injured side (OR = 2.28), pain onset (OR = 1.97), morning pain (OR = 1.89), condition acceptability (OR = 0.39) and swelling (OR = 0.37). Sports-specific function (OR = 1.02) and player level (OR = 4.11) explained sporting availability. 44% of PT severity variance was explained by quality of life (ß = 0.32), sports-specific function (ß = 0.38) and age (ß = -0.17). CONCLUSION: Sports-specific, biomedical and psychological factors partially distinguish PT from other knee problems. Availability is mainly explained by sports-specific factors, while psychosocial factors impact on severity. Adding sports-specific and bio-psycho-social factors into assessments could help better identification and management of jumping athletes with PT.

Getting Recovery Right After Neck Dissection (GRRAND-F): Mixed-methods feasibility study to design a pragmatic randomised controlled trial.

Objective: To determine the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention following neck dissection (ND) after head and neck cancer (HNC). Design: Two-arm, open, pragmatic, parallel, multicentre, randomised controlled feasibility trial. Setting: Two UK NHS hospitals. Participants: People who had HNC in whom a ND was part of their care. We excluded those with a life expectancy of six months or less, pre-existing, long-term neurological disease affecting the shoulder and cognitive impairment. Intervention: Usual care (standard care supplemented with a booklet on postoperative self-management) was received by all participants. The GRRAND intervention programme consisted of usual care plus up to six individual physiotherapy sessions including neck and shoulder range of motion and progressive resistance exercises, advice and education. Between sessions, participants were advised to complete a home exercise programme. Randomisation: 1:1 randomisation. Allocation was based on minimisation, stratified by hospital site and spinal accessory nerve sacrifice. It was not possible to mask treatment received. Main outcome measures: Primary: Participant recruitment, retention and fidelity to the study protocol and interventions from study participants and staff at six months post-randomisation (and 12 months for those reaching that time-point). Secondary: clinical measures of pain, function, physical performance, health-related quality of life, health utilisation and adverse events. Results: 36 participants were recruited and enrolled. The study achieved five of its six feasibility targets. These included consent - 70% of eligible participants were consented; intervention fidelity - 78% participants discharged completed the intervention sessions; contamination - none - no participants in the control arm received the GRRAND-F intervention and retention - 8% of participants were lost to follow-up. The only feasibility target that was not achieved was the recruitment target where only 36 of the planned 60 participants were recruited over 18 months. This was principally due to the COVID-19 pandemic which caused all research activity to be paused or reduced, with a subsequent reduction in. Conclusions: Based on the findings a full-trial can now be designed to better understand whether this proposed intervention is effective. Clinical Trial Registration: https://www.isrctn.com/ISRCTN1197999, identifier ISRCTN11979997.

Variables associated with successful outcome after anterior cruciate ligament reconstruction in recreational athletes: A prospective cohort study.

BACKGROUND: Anterior cruciate ligament (ACL) injury and subsequent reconstruction is common and has a profound effect on health-related quality of life. There is currently limited understanding as to which variables are associated with a successful outcome post-ACL reconstruction (ACLR) in recreational athletes. PURPOSE: Explore the association between both patient-reported and performance-based measures, and successful outcome, post-ACLR in recreational athletes. PROCEDURES: We sought to recruit recreational athletes within one month of a primary-ACLR for a prospective cohort study. A dichotomised patient specific functional scale of ≥9 points determined a successful outcome at nine-months post-operative. Secondary patient-reported and performance-based data were collected at baseline, three-, six-, and nine-months post-operative. The association between secondary data and the primary outcome was determined using binomial logistic regression, expressed using odds ratio (OR) and 95% confidence intervals (CI). MAIN RESULTS: 90 participants were recruited (males: 58, females: 32, mean age 32.8 years [±7.9], mean height 173.5 [±10.0], mean body mass 74.0 kg [±15.8]), 87 consented to baseline measures. 47 participants completed full data collection and 21 (45%) reported a successful outcome. Higher knee osteoarthritis outcome score (OR range 1.07-1.12) and anterior cruciate ligament quality of life (ACL-QoL) scores (OR range 1.06-1.10) were associated with a successful outcome post-ACLR at various timepoints. CONCLUSIONS: Patient-reported, rather than performance-based, measures were associated with successful outcome nine-months post-ACLR in recreational athletes. Both patient-reported and performance-based characteristics are advocated to guide optimal return to function in clinical practice.