Determining fall risk change throughout pregnancy: the accuracy of postpartum survey and relationship to fall efficacy.

All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.

Optimizing Between-Session Reliability for Quadriceps Peak Torque and Rate of Torque Development Measures.

Grindstaff, TL, Palimenio, MR, Franco, M, Anderson, D, Bagwell, JJ, and Katsavelis, D. Optimizing between-session reliability for quadriceps peak torque and rate of torque development measures. J Strength Cond Res 33(7): 1840-1847, 2019-Quadriceps peak torque and rate of torque development (RTD) have relevance for athletic performance and recovery after knee injury. The number of repetitions performed to determine RTD varies between studies, and the associated measurement error has not been established. The purpose of this study was to determine the number of repetitions necessary to optimize the between-session reliability for isometric quadriceps peak torque and RTD measures and to quantify estimates of measurement error. Twenty participants (age = 21.7 ± 1.7 years, height = 172.5 ± 16.0 cm, body mass = 76.0 ± 15.5 kg, and Tegner = 7.1 ± 1.2) volunteered for this study. Quadriceps isometric peak torque and RTD (50, 100, 150, 200, and 250 ms, and maximum torque) were obtained during 2 testing sessions. Between-session reliability was determined using intraclass correlation coefficients (ICC2,k), using the minimal detectable change (MDC) and coefficient of variation (CoV) to quantify measurement error. Between-session reliability was best maximized by using the average of the 3 repetitions with the highest peak torque. Reliability was good for quadriceps peak torque (ICC2,3 = 0.98; MDC = 51.1 N·m; CoV = 38.0%) and ranged from moderate to good for quadriceps RTD measures (ICC2,3 = 0.61 to 0.91; MDC = 264.8 to 738.3 N·m·s; CoV = 38.1-57.9%). Measures of late RTD were less variable and more reliable than early RTD and average RTD measures. These results provide confidence when measuring between-session changes for late RTD measures, but changes in early RTD may be more difficult to distinguish from measurement error. Methods should be used to minimize variability between repetitions and sessions.

Epigenetic control of intestinal barrier function and inflammation in zebrafish.

The intestinal epithelium forms a barrier protecting the organism from microbes and other proinflammatory stimuli. The integrity of this barrier and the proper response to infection requires precise regulation of powerful immune homing signals such as tumor necrosis factor (TNF). Dysregulation of TNF leads to inflammatory bowel diseases (IBD), but the mechanism controlling the expression of this potent cytokine and the events that trigger the onset of chronic inflammation are unknown. Here, we show that loss of function of the epigenetic regulator ubiquitin-like protein containing PHD and RING finger domains 1 (uhrf1) in zebrafish leads to a reduction in tnfa promoter methylation and the induction of tnfa expression in intestinal epithelial cells (IECs). The increase in IEC tnfa levels is microbe-dependent and results in IEC shedding and apoptosis, immune cell recruitment, and barrier dysfunction, consistent with chronic inflammation. Importantly, tnfa knockdown in uhrf1 mutants restores IEC morphology, reduces cell shedding, and improves barrier function. We propose that loss of epigenetic repression and TNF induction in the intestinal epithelium can lead to IBD onset.

Reliability of Hip Rotation Range of Motion in Supine and Seated Positions.

CONTEXT: Hip rotation range of motion (ROM) is commonly assessed in individuals with lower extremity or spine pathology. It remains unknown which hip rotation ROM testing position is most reliable. OBJECTIVE: To compare interrater and intrarater reliabilities between hip internal rotation (IR) and external rotation (ER) ROM in supine and seated positions. STUDY DESIGN: Controlled laboratory study. SETTING: University research laboratory. PARTICIPANTS: A total of 19 participants (11 females and 8 males; age = 23.5 [1.2] y; height = 173.2 [8.6] cm; and mass = 69.2 [13.4] kg) without hip, knee, low back, or sacroiliac pain within the preceding 3 months or history of hip or low back surgery were recruited. INTERVENTIONS: Three testers obtained measures during 2 testing sessions. Passive supine and seated hip IR and ER ROM were performed with the hip and knee flexed to 90°. MAIN OUTCOME MEASURES: The primary outcome measures were hip IR and ER ROM in supine and seated positions (in degrees). Interrater and intrarater reliabilities were calculated using intraclass correlation coefficients (ICCs). Minimal detectable change was calculated. Differences between supine and seated hip IR and ER ROM values were assessed using paired t tests (significance level was .05). RESULTS: Supine hip IR and ER ROM interrater and intrarater reliabilities were excellent (ICC = .75-.91). Seated hip IR ROM interrater and intrarater reliabilities were good (ICC = .64-.71). Seated hip ER ROM interrater reliability was good (ICC = .65), and intrarater reliabilities were good to excellent (ICC = .65-.82). Minimal detectable change values for supine and seated hip IR and ER ROM ranged from 6.1° to 8.6°. There were significant differences between supine and seated positions for hip IR and ER ROM (41.6° vs 44.5°; P < .01 and 53.0° vs 44.2°; P < .01, respectively). CONCLUSION: Supine hip rotation had higher interrater and intrarater reliabilities. Hip IR and ER ROM values differed significantly between supine and seated positions and should not be used interchangeably.

The Influence of Squat Kinematics and Cam Morphology on Acetabular Stress.

PURPOSE: To evaluate the effect of varying degrees of simulated cam morphology on acetabular stress magnitude and location using a finite element model with 1 subject that incorporates population-specific hip/pelvis kinematics during a squat task. METHODS: A reference model of the hip joint was created from magnetic resonance images obtained from 1 asymptomatic 28-year-old man without femoroacetabular impingement (FAI) morphology or hip dysplasia (alpha angle 41.9°, lateral center edge angle 34.0°, neck-shaft angle 137°, and no visible articular cartilage lesions or bone marrow edema on magnetic resonance). The femoral head/neck geometry was manipulated to mimic different cam morphology severities as reported in a previous study (minimum, moderate, and large). Peak hip and pelvis squat kinematics from healthy individuals (hip flexion 112.6°, abduction 10.5°, internal rotation 14.8°) and persons with FAI (hip flexion 106.3°, abduction 10.5°, internal rotation 8.9°) were applied to the control and cam models. Relative acetabular joint stress values and location of contact were the variables of interest. RESULTS: Average von Mises stress values for control, minimum, moderate, and large cam models were 9.64, 9.27, 11.36, and 28.43 MPa, respectively. Contact in the control and minimum cam models occurred within the acetabular cup. In the moderate and large cam models, contact shifted anterosuperiorly within the acetabular cup and to anterosuperior acetabular rim, respectively. CONCLUSIONS: Despite simulating lower degrees of hip flexion and internal rotation, increased stress and a shift in contact location were observed in the simulated models of FAI. This finding suggests that decreased hip internal rotation in this population during functional tasks may be the result of bony abutment. CLINICAL RELEVANCE: Clinicians should be cautious about prescribing deep squats for persons with cam morphology. Performing squat exercises with neutral or external hip rotation may limit bony abutment at high hip flexion angles.

Rapid identification of kidney cyst mutations by whole exome sequencing in zebrafish.

Forward genetic approaches in zebrafish have provided invaluable information about developmental processes. However, the relative difficulty of mapping and isolating mutations has limited the number of new genetic screens. Recent improvements in the annotation of the zebrafish genome coupled to a reduction in sequencing costs prompted the development of whole genome and RNA sequencing approaches for gene discovery. Here we describe a whole exome sequencing (WES) approach that allows rapid and cost-effective identification of mutations. We used our WES methodology to isolate four mutations that cause kidney cysts; we identified novel alleles in two ciliary genes as well as two novel mutants. The WES approach described here does not require specialized infrastructure or training and is therefore widely accessible. This methodology should thus help facilitate genetic screens and expedite the identification of mutants that can inform basic biological processes and the causality of genetic disorders in humans.

Pressure-controlled treadmill training in chronic stroke: a case study with AlterG.

BACKGROUND AND PURPOSE: Body-weight-supported treadmill training has been shown to be an effective intervention to improve walking characteristics for individuals who have experienced a stroke. A pressure-controlled treadmill utilizes a sealed chamber in which air pressure can be altered in a controlled manner to counteract the effects of gravity. The focus of this case study was to assess the immediate and short-term impact of a pressure-controlled treadmill to improve gait parameters, reduce fall risk, improve participation, and reduce the self-perceived negative impact of stroke in an individual with chronic stroke. CASE DESCRIPTION: The subject was an 81-year-old man (14.5 months poststroke). He had slow walking speed, poor endurance, and multiple gait deviations. INTERVENTION: The subject trained 4 times per week for 4 weeks (40 minutes per session) on a pressure-controlled treadmill (AlterG M320) to counter the influence of gravity on the lower extremities. OUTCOMES: Following training, self-selected gait speed increased from 0.50 m/s to 0.96 m/s, as measured by the 10-meter walk test. Stride length increased from 0.58 m to 0.95 m after training and to 1.00 m at 1-month follow-up. Peak hip flexion increased from 3.7° to 24.6° after training and to 19.4° at 1-month follow-up. Peak knee flexion increased from 19.4° to 34.3° after training and to 42.7° at 1-month follow-up. Measures of endurance, fall risk, and percentage of perceived recovery also were found to improve posttraining. DISCUSSION: Training with a pressure-controlled treadmill may be a viable alternative to traditional body-weight-supported treadmill training for persons poststroke. Additional studies with larger sample sizes are needed to elucidate the role of pressure-controlled treadmill training in this population. Video abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A97).

Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial.

OBJECTIVE: To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain (PFP). DESIGN: Comparative control trial. SETTING: Rehabilitation facility. PARTICIPANTS: Persons with a diagnosis of PFP (N=36; 18 men, 18 women). INTERVENTIONS: Patients were alternately assigned to a posterolateral hip muscle strengthening group (9 men and 9 women) or a quadriceps strengthening group (9 men and 9 women). The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises, whereas the quadriceps strengthening group performed quadriceps strengthening exercises (3 times a week for 8wk). MAIN OUTCOME MEASURES: Pain (visual analog scale [VAS]) and health status (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at baseline, postintervention, and 6-month follow-up. RESULTS: Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up (P<.001). Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up (P<.05). CONCLUSIONS: Although both intervention programs resulted in decreased pain and improved function in persons with PFP, outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group. The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention.

Running biomechanics differ during and after pregnancy compared to females who have never been pregnant.

BACKGROUND: Perinatal running participation has increased recently; however, pregnancy related symptoms can limit activity. Perinatal running biomechanics could inform interventions to help perinatal individuals maintain an active lifestyle. RESEARCH QUESTION: Are perinatal running biomaechanics and muscle activation different compared to nulligravida females? METHODS: Sixteen pregnant participants completed self-selected velocity running during second trimester (2 T), third trimester (3 T), and postpartum (PP) and 16 matched controls completed these procedures once in this case control study. Kinematic, kinetic, and electromyography (EMG) data were collected using a motion capture system, force plates, and EMG electrodes. Peak trunk, pelvis, hip, knee, and ankle kinematics and hip, knee, and ankle moments during stance phase, and average and peak erector spinae (ES), gluteus maximus (GMax), and gluteus medius (GMed) EMG amplitude and duration of activation during stance and swing phases were calculated. Independent t-tests were used to compare 2 T, 3 T, and PP to control participants (α < 0.05). RESULTS: Running velocity was slower during 3 T compared to control participants. At all pregnancy timepoints compared to the control group, peak trunk contralateral rotation was smaller. During 2 T and 3 T peak hip flexor moments were smaller. At 3 T pelvis contralateral rotation was smaller, ES average amplitude was greater during swing, GMax percent duration during stance and GMed percent duration during swing were smaller. At PP trunk flexion was smaller and knee abduction was greater (all p < 0.05). CONCLUSIONS: Decreased running velocity may help offset increased demand during pregnancy. During 3 T, greater ES activation, smaller trunk and pelvis motion, and altered gluteal activation could indicate trunk rigidity combined with modified hip stabilizer muscle utilization. During PP, the rigid trunk combined with greater knee abduction may indicate hip and trunk strength deficits. Altered trunk and hip motion and activation could be relevant to pathologies such as perinatal low back, pelvic girdle, or knee pain.

Notochord segmentation in zebrafish controlled by iterative mechanical signaling.

In bony fishes, patterning of the vertebral column, or spine, is guided by a metameric blueprint established in the notochord sheath. Notochord segmentation begins days after somitogenesis concludes and can occur in its absence. However, somite patterning defects lead to imprecise notochord segmentation, suggesting that these processes are linked. Here, we identify that interactions between the notochord and the axial musculature ensure precise spatiotemporal segmentation of the zebrafish spine. We demonstrate that myoseptum-notochord linkages drive notochord segment initiation by locally deforming the notochord extracellular matrix and recruiting focal adhesion machinery at these contact points. Irregular somite patterning alters this mechanical signaling, causing non-sequential and dysmorphic notochord segmentation, leading to altered spine development. Using a model that captures myoseptum-notochord interactions, we find that a fixed spatial interval is critical for driving sequential segment initiation. Thus, mechanical coupling of axial tissues facilitates spatiotemporal spine patterning.

Dynamic BMP signaling mediates notochord segmentation in zebrafish.

The vertebrate spine is a metameric structure composed of alternating vertebral bodies (centra) and intervertebral discs.1 Recent studies in zebrafish have shown that the epithelial sheath surrounding the notochord differentiates into alternating cartilage-like (col2a1/col9a2+) and mineralizing (entpd5a+) segments which serve as a blueprint for centra formation.2,3,4,5 This process also defines the trajectories of migrating sclerotomal cells that form the mature vertebral bodies.4 Previous work demonstrated that notochord segmentation is typically sequential and involves the segmented activation of Notch signaling.2 However, it is unclear how Notch is activated in an alternating and sequential fashion. Furthermore, the molecular components that define segment size, regulate segment growth, and produce sharp segment boundaries have not been identified. In this study, we uncover that a BMP signaling wave acts upstream of Notch during zebrafish notochord segmentation. Using genetically encoded reporters of BMP activity and signaling pathway components, we show that BMP signaling is dynamic as axial patterning progresses, leading to the sequential formation of mineralizing domains in the notochord sheath. Genetic manipulations reveal that type I BMP receptor activation is sufficient to ectopically trigger Notch signaling. Moreover, loss of Bmpr1ba and Bmpr1aa or Bmp3 function disrupts ordered segment formation and growth, which is recapitulated by notochord-specific overexpression of the BMP antagonist, Noggin3. Our data suggest that BMP signaling in the notochord sheath precedes Notch activation and instructs segment growth, facilitating proper spine morphogenesis.

Axial segmentation by iterative mechanical signaling.

In bony fishes, formation of the vertebral column, or spine, is guided by a metameric blueprint established in the epithelial sheath of the notochord. Generation of the notochord template begins days after somitogenesis and even occurs in the absence of somite segmentation. However, patterning defects in the somites lead to imprecise notochord segmentation, suggesting these processes are linked. Here, we reveal that spatial coordination between the notochord and the axial musculature is necessary to ensure segmentation of the zebrafish spine both in time and space. We find that the connective tissues that anchor the axial skeletal musculature, known as the myosepta in zebrafish, transmit spatial patterning cues necessary to initiate notochord segment formation, a critical pre-patterning step in spine morphogenesis. When an irregular pattern of muscle segments and myosepta interact with the notochord sheath, segments form non-sequentially, initiate at atypical locations, and eventually display altered morphology later in development. We determine that locations of myoseptum-notochord connections are hubs for mechanical signal transmission, which are characterized by localized sites of deformation of the extracellular matrix (ECM) layer encasing the notochord. The notochord sheath responds to the external mechanical changes by locally augmenting focal adhesion machinery to define the initiation site for segmentation. Using a coarse-grained mathematical model that captures the spatial patterns of myoseptum-notochord interactions, we find that a fixed-length scale of external cues is critical for driving sequential segment patterning in the notochord. Together, this work identifies a robust segmentation mechanism that hinges upon mechanical coupling of adjacent tissues to control patterning dynamics.

Parallelized computational 3D video microscopy of freely moving organisms at multiple gigapixels per second.

To study the behavior of freely moving model organisms such as zebrafish (Danio rerio) and fruit flies (Drosophila) across multiple spatial scales, it would be ideal to use a light microscope that can resolve 3D information over a wide field of view (FOV) at high speed and high spatial resolution. However, it is challenging to design an optical instrument to achieve all of these properties simultaneously. Existing techniques for large-FOV microscopic imaging and for 3D image measurement typically require many sequential image snapshots, thus compromising speed and throughput. Here, we present 3D-RAPID, a computational microscope based on a synchronized array of 54 cameras that can capture high-speed 3D topographic videos over a 135-cm^2 area, achieving up to 230 frames per second at throughputs exceeding 5 gigapixels (GPs) per second. 3D-RAPID features a 3D reconstruction algorithm that, for each synchronized temporal snapshot, simultaneously fuses all 54 images seamlessly into a globally-consistent composite that includes a coregistered 3D height map. The self-supervised 3D reconstruction algorithm itself trains a spatiotemporally-compressed convolutional neural network (CNN) that maps raw photometric images to 3D topography, using stereo overlap redundancy and ray-propagation physics as the only supervision mechanism. As a result, our end-to-end 3D reconstruction algorithm is robust to generalization errors and scales to arbitrarily long videos from arbitrarily sized camera arrays. The scalable hardware and software design of 3D-RAPID addresses a longstanding problem in the field of behavioral imaging, enabling parallelized 3D observation of large collections of freely moving organisms at high spatiotemporal throughputs, which we demonstrate in ants (Pogonomyrmex barbatus), fruit flies, and zebrafish larvae.

Parallelized computational 3D video microscopy of freely moving organisms at multiple gigapixels per second.

Wide field of view microscopy that can resolve 3D information at high speed and spatial resolution is highly desirable for studying the behaviour of freely moving model organisms. However, it is challenging to design an optical instrument that optimises all these properties simultaneously. Existing techniques typically require the acquisition of sequential image snapshots to observe large areas or measure 3D information, thus compromising on speed and throughput. Here, we present 3D-RAPID, a computational microscope based on a synchronized array of 54 cameras that can capture high-speed 3D topographic videos over an area of 135 cm2, achieving up to 230 frames per second at spatiotemporal throughputs exceeding 5 gigapixels per second. 3D-RAPID employs a 3D reconstruction algorithm that, for each synchronized snapshot, fuses all 54 images into a composite that includes a co-registered 3D height map. The self-supervised 3D reconstruction algorithm trains a neural network to map raw photometric images to 3D topography using stereo overlap redundancy and ray-propagation physics as the only supervision mechanism. The resulting reconstruction process is thus robust to generalization errors and scales to arbitrarily long videos from arbitrarily sized camera arrays. We demonstrate the broad applicability of 3D-RAPID with collections of several freely behaving organisms, including ants, fruit flies, and zebrafish larvae.

Center of pressure characteristics differ during single leg stance throughout pregnancy and compared to nulligravida individuals.

BACKGROUND: Falls are common during pregnancy and present potential for injury to the pregnant individual and the baby. RESEARCH QUESTION: Do center of pressure characteristics during single leg stance differ between participants during and after pregnancy and nulligravida participants in the presence and absence of visual input? METHODS: Nineteen pregnant participants completed testing during the second trimester, the third trimester, and 4-6 months post-partum. Matched, nulligravida females completed testing once. All participants performed single leg stance on a force platform on each limb for up to 20 s with eyes open and with eyes closed. Center of pressure characteristics were compared between pregnant and nulligravida females using three separate 2 × 2 mixed way ANOVAs, one for each pregnancy time point (second trimester, third trimester, and post-partum) with Bonferroni correction. RESULTS: Pregnant females demonstrated smaller single leg stance time with eyes closed during the third trimester. During the second and third trimester, pregnant participants demonstrated smaller sway and sway velocity across eyes open and eyes closed conditions. During the third trimester and post-partum, pregnant participants demonstrated greater median frequency of the center of pressure data. Pregnant participants also demonstrated smaller sample entropy in the anteroposterior direction during the second and third trimesters and in the mediolateral direction during the second trimester. SIGNIFICANCE: The decreased total sway and sway velocity observed during pregnancy may reflect rigidity or a protective strategy during single limb stance. Additionally, center of pressure data were less smooth and more repetitive during pregnancy indicating robust differences in postural control strategies and potentially increased fall risk. Because single limb stance is a component of many activities of daily living, the single limb stance task may have clinical utility for testing or training balance in this population with a goal of decreasing falls.

Do people with low back pain walk differently? A systematic review and meta-analysis.

BACKGROUND: The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls. METHODS: A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between back pain and back-healthy control groups. RESULTS: Ninety-seven studies were included and reviewed. Two studies investigated acute pain and the rest investigated persistent pain. Nine studies investigated running gait. Of the studies, 20% had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent LBP walked slower (SMD = -0.59, 95% confidence interval (95%CI): -0.77 to -0.42)) and with shorter stride length (SMD = -0.38, 95%CI: -0.60 to -0.16). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups (SMD = -0.60, 95%CI: -0.90 to -0.30), and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles (SMD = 0.52, 95%CI: 0.23-0.80). There were no consistent differences in running biomechanics between groups. CONCLUSION: There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.

Limb preference impacts single-leg forward hop limb symmetry index values following ACL reconstruction.

Following anterior cruciate ligament (ACL) reconstruction limb dominance for performing tasks is not considered when making rehabilitation progression decisions. The purpose of this study was to determine if strength and functional outcomes differ between individuals who injured their preferred or nonpreferred jumping limb and to determine if these same outcomes differ between individuals who injured their preferred or nonpreferred limb used to kick a ball. A secondary purpose was to determine the association of quadriceps strength and single-leg forward hop performance with patient self-reported function. Forty individuals with ACL reconstruction (age = 20.0 ± 4.6 years, height = 174.2 ± 12.7 cm, mass = 71.2 ± 12.7 kg, time since surgery = 5.3 ± 0.8 months) were included in the study. Primary outcome measures included, International Knee Documentation Committee Subjective Knee Form (IKDC) scores, quadriceps limb symmetry index (LSI) values, and single-leg forward hop LSI values. Limb preference was defined two ways, kicking a ball and performing a unilateral jump. There were no significant differences between groups based on injury to the preferred limb to kick a ball for any of the outcome variables. Individuals who injured their nonpreferred jumping limb demonstrated significantly (p = 0.05, d = 0.77) lower single-leg forward hop LSI values (81.1% ± 19.5%) compared to individuals who injured their preferred jumping limb (94.1% ± 12.6%), but demonstrated no differences in IKDC scores or quadriceps LSI values. Quadriceps LSI and single-leg forward hop LSI explained 73% of the variance in IKDC scores, but quadriceps LSI had the strongest association (r = 0.790). These findings suggests that limb preference influences single forward hop LSI values and should be considered following ACL reconstruction.

An exploratory analysis of gait biomechanics and muscle activation in pregnant females with high and low scores for low back or pelvic girdle pain during and after pregnancy.

BACKGROUND: The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy. METHODS: Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS <15) based on third trimester scores. Two-way mixed model ANOVAs were used to compare high and low pain groups over time. FINDINGS: Nine participants met the high pain group criteria and 11 were low pain. During second trimester the high pain group compared to the low pain group demonstrated smaller peak hip flexor moments, total hip work, percent hip contribution to work, and larger percent ankle contribution to work. Pregnant females demonstrated greater hip, knee, and ankle moments, ankle work, and gluteus maximus muscle activation third trimester than second trimester. INTERPRETATION: Reduced hip and greater ankle contribution to work in the high pain group during second trimester could indicate decreased hip utilization early in pregnancy and may contribute to disability as pregnancy progresses. It is also possible kinetic differences during second trimester reflect an early strategy to reduce pain by avoiding hip joint loading. Increased moments and work during third trimester indicate a clinical imperative to better prepare pregnant females to accommodate increased joint loading and muscular demand.

Quadriceps Strength Influences Patient Function More Than Single Leg Forward Hop During Late-Stage ACL Rehabilitation.

BACKGROUND: A comprehensive battery of tests are used to inform return to play decisions following anterior cruciate ligament (ACL) reconstruction. Performance measures contribute to patient function, but it is not clear if achieving symmetrical performance on strength and hop tests is sufficient or if a patient also needs to meet minimum unilateral thresholds. HYPOTHESIS/PURPOSE: To determine the association of quadriceps strength and single-leg forward hop performance with patient-reported function, as measured by the IKDC Subjective Knee Form (IKDC), during late-stage ACL rehabilitation. A secondary purpose was to determine which clinical tests were the most difficult for participants to pass. STUDY DESIGN: Descriptive Laboratory Study. METHODS: Forty-eight individuals with a history of ACL-R (32 female, 16 male; mean±SD age=18.0±2.7 y; height=172.4±7.6 cm; mass=69.6±11.4 kg; time since surgery=7.7±1.8 months; IKDC=86.8±10.6) completed the IKDC survey, quadriceps isometric strength, and single-leg forward hop performance. The relationship between IKDC scores and performance measures (LSI and involved limb) was determined using stepwise linear regression. Frequency counts were used to determine whether participants met clinical thresholds (IKDC ≥ 90%, quadriceps and single-leg forward hop LSI ≥ 90%, quadriceps peak torque ≥ 3.0 Nm/kg, and single-leg forward hop ≥ 80% height for females and ≥ 90% height for males). RESULTS: Quadriceps LSI and involved limb peak torque explained 39% of the variance in IKDC scores while measures of single-leg forward hop performance did not add to the predictive model. Nearly 90% of participants could not meet established clinical thresholds on all five tests and quadriceps strength (LSI and peak torque) was the most common unmet criteria (71% of participants). CONCLUSIONS: During late-stage ACL rehabilitation deficits in quadriceps strength contribute more to patient function and are greater in magnitude compared to hop test performance. LEVEL OF EVIDENCE: Cross-Sectional Study, Level 3.

Distinct roles for luminal acidification in apical protein sorting and trafficking in zebrafish.

Epithelial cell physiology critically depends on the asymmetric distribution of channels and transporters. However, the mechanisms targeting membrane proteins to the apical surface are still poorly understood. Here, we performed a visual forward genetic screen in the zebrafish intestine and identified mutants with defective apical targeting of membrane proteins. One of these mutants, affecting the vacuolar H+-ATPase gene atp6ap1b, revealed specific requirements for luminal acidification in apical, but not basolateral, membrane protein sorting and transport. Using a low temperature block assay combined with genetic and pharmacologic perturbation of luminal pH, we monitored transport of newly synthesized membrane proteins from the TGN to apical membrane in live zebrafish. We show that vacuolar H+-ATPase activity regulates sorting of O-glycosylated proteins at the TGN, as well as Rab8-dependent post-Golgi trafficking of different classes of apical membrane proteins. Thus, luminal acidification plays distinct and specific roles in apical membrane biogenesis.