Short communication: Baroreflex function in embryonic emus (Dromiceius novaehollandiae).

The baroreflex involves cardiovascular homeostatic mechanisms that buffer the system against acute deviations in arterial blood pressure. It is comprised of the cardiac limb which involves adjustments in heart rate and the peripheral limb which involves adjustments in vascular resistance. This negative feedback loop mechanism has been investigated in numerous species of adult vertebrates, however our understanding of the maturation and functional importance of the reflex in developing animals remains poorly understood. In egglaying species, our knowledge of this mechanism is limited to the domestic chicken embryo and the embryonic alligator. While each of these species possess a cardiac baroreflex prior to hatching, they differ in the timing when it becomes functional, with the embryonic chicken possessing the reflex at 90% of incubation, while the alligator possesses the reflex at 70% of incubation. In an effort to determine if bird species might share similar patterns of active baroreflex function, we studied embryonic emus (Dromiceius novaehollandiae). However, we hypothesized that emus would possess a pattern of baroreflex function similar to that of the American alligator given the emu embryo possesses functional vagal tone at 70% of incubation, possibly indicating a more mature collection of cardiovascular control mechanism than those found in embryonic chickens. Our findings illustrate that emu embryos possess a hypotensive baroreflex at 90% of incubation. Therefore, our data fail to support our original hypothesis. While only two species of birds have been studied in this context, it could indicate that baroreflex function is not essential for cardiovascular homeostasis in birds for the majority of in ovo development.

Salivary S100 calcium-binding protein beta (S100B) and neurofilament light (NfL) after acute exposure to repeated head impacts in collegiate water polo players.

Blood-based biomarkers of brain injury may be useful for monitoring brain health in athletes at risk for concussions. Two putative biomarkers of sport-related concussion, neurofilament light (NfL), an axonal structural protein, and S100 calcium-binding protein beta (S100B), an astrocyte-derived protein, were measured in saliva, a biofluid which can be sampled in an athletic setting without the risks and burdens associated with blood sampled by venipuncture. Samples were collected from men's and women's collegiate water polo players (n = 65) before and after a competitive tournament. Head impacts were measured using sensors previously evaluated for use in water polo, and video recordings were independently reviewed for the purpose of validating impacts recorded by the sensors. Athletes sustained a total of 107 head impacts, all of which were asymptomatic (i.e., no athlete was diagnosed with a concussion or more serious). Post-tournament salivary NfL was directly associated with head impact frequency (RR = 1.151, p = 0.025) and cumulative head impact magnitude (RR = 1.008, p = 0.014), while controlling for baseline salivary NfL. Change in S100B was not associated with head impact exposure (RR < 1.001, p > 0.483). These patterns suggest that repeated head impacts may cause axonal injury, even in asymptomatic athletes.

Head impact exposure and concussion in women's collegiate club lacrosse.

This study sought to describe head impact exposure in women's collegiate club lacrosse. Eleven women's collegiate club lacrosse players wore head impact sensors during eight intercollegiate competitions. Video recordings of competitions were used to verify impact data. Athletes completed questionnaires detailing their concussion history and perceived head impact exposure. During the monitored games, no diagnosed concussions were sustained. Three athletes reported sustaining head impacts (median = 0; range: 0-3 impacts per game). Six impacts registered by the sensors were verified on video across a total of 81 athlete-game exposures. Verified impacts had a median peak linear acceleration of 21.0 g (range: 18.3 g - 48.3 g) and peak rotational acceleration of 1.1 krad/s2 (range: 0.7 krad/s2 - 5.7 krad/s2). Women competing in collegiate club lacrosse are at a low risk of sustaining head impacts, comparable to previous reports of the high school and collegiate varsity levels of play.

Co-occurrence of Blount's disease and Legg-Calvé-Perthes disease: is obesity a factor?

Legg-Calvé-Perthes disease (LCPD) and Blount's disease share a similar presenting age in addition to similar symptoms such as limp or knee pain. A little overlap is mentioned about both diseases. We sought to present cases of children having both conditions to discuss the implications of this co-occurrence on diagnosis and management. After institutional review board approval, we retrospectively reviewed records of four children who developed both Blount's disease and LCPD. Patient details and outcomes were analyzed. Radiographs were evaluated for the lateral pillar classification, Stulberg classification, tibial metaphyseal-diaphyseal angle and tibiofemoral angle. Two of the cases were initially diagnosed with Blount's disease and subsequently developed Perthes, one case presented initially with both disorders and the final case had Perthes followed by Blount's. Three children were obese and one was overweight. The common symptom to all patients was an abnormal gait, which was painless in two children and painful in two. Blount's disease required surgery in three children. Radiographs showed Lateral Pillar B, B/C border and C hips, and the final Stulberg was stage II (n = 2) or stage IV (n = 2). Obesity is associated with Blount's disease and LCPD, so obese children can be at an increased risk of developing both disorders. Therefore, a child with Blount's disease who has persistent, recurrent or worsening symptoms such as gait disturbance or thigh or knee pain might benefit from a careful physical exam of the hips to prevent a delayed or even missed LCPD diagnosis.

Safety factors as a 'design' principle of animal form and function: an historical perspective.

For well over 150 years, factors of safety (also known as safety factors) have been a fundamental engineering concept that expresses how much stronger a system is compared with the intended load. The pioneering work of Robert McNeill Alexander in the early 1980s applied this engineering concept to biomechanics. Over the next decade, evidence from comparative biomechanics supported the idea that safety factors are a fundamental principle of animal form and function. In terms of physiology, Jared Diamond related the maximal capacity of a physiological process to normal functional demands and incorporated evolutionary thinking into the concept of safety factors. It was proposed that evolutionary reasoning is required to understand the magnitudes of biological reserve capacities, an idea called 'quantitative evolutionary design'. However, the general idea of safety factors as related to organismal form and function is much older. In 1906, Samuel James Meltzer, a physiologist and physician, presented the 5th Harvey Lecture to the New York Academy of Medicine; a lecture entitled 'The Factors of Safety in Animal Structure and Animal Economy', which was later published in Science in 1907. The 1907 paper is rarely cited and has never been cited within comparative biomechanics or comparative physiology. The purpose of this Commentary is to highlight Meltzer's historical contribution to the concept of safety factors as a general principle of organismal 'design'.

COVID-19 and Acute Cervical Spinal Cord Injury-Case Report of 2 Patients: Do We Need to Rethink Our Standard Treatment Strategy?

STUDY DESIGN: This was a case series. OBJECTIVE: The authors sought to examine the high-risk population of COVID-positive patients with acute cervical spinal cord injury (SCI) in a large level 1 trauma and tertiary referral center. SUMMARY OF BACKGROUND DATA: There are limited studies regarding the surgical management of patients with acute SCI in the setting of the recent coronavirus pandemic. METHODS: The authors describe the cases of 2 patients who died from COVID-related complications after acute cervical SCI. RESULTS: Patients with SCI are at increased risk of pulmonary complications. COVID-19 infection represents a double hit in this patient population, increasing potential morbidity and mortality in the perioperative time frame. Careful consideration must be made regarding the timing of potential surgical intervention in the treatment of acute SCI. CONCLUSIONS: Nationwide database of COVID-positive patients with acute spinal cord injury should be collected and analyzed to better understand how to manage acute SCI in the COVID-19 era. The authors recommend preoperative discussion in patients with acute cervical SCI with COVID-19, specifically emphasizing the increased risk of respiratory complications and mortality.

Arterial blood gases during maximum metabolic demands: Patterns across the vertebrate spectrum.

Elevations of metabolic rate, for example during physical activity, elicit immediate and coordinated respiratory and cardiovascular responses that ensure adequate diffusive and convective fluxes of O2 from the environment (water or air) to the mitochondria where ATP is produced. The same physiological responses also provide for CO2 to be removed in the opposite direction. There is significant variation in the morphology of the cardiovascular and respiratory structures among vertebrates, and a varying reliance on aerobic versus anaerobic metabolism to power activity. However, gas exchange in all vertebrates can be decribed as diffusive and convective steps in series, and we summarise data on the diffusive step across the respiratory surface of gills and lungs in this graphical review. Based on relatively constant arterial partial pressures of O2 and CO2 from rest to near maximal levels of physical activity, we conclude that under normoxic conditions, the diffusive step within the respiratory system exert no or small limitations for either O2 or CO2 exchange at or near maximal rate of oxygen consumption (VO2max). However, there are exceptions, such as the exercise-induced arterial hypoxemia (EIAH) in racehorses, and elite human athletes. Our analysis also indicates that exercise-induced arterial hypercapnia (i.e. a rise in arterial PCO2) at or near VO2max is not common among vertebrates. Across the vertebrate spectrum, the diffusive and perfusive conductances (D/ßQ) of water and air-breathing vertebrates are well-matched to maximal rates of gas exchange, and diffusion is not a limiting factor when aerobic metabolism increases.

COVID-19 Lockdowns: Exacerbating the Silent Pandemic.

The global medical community has exalted the vaccine as the champion solution to end the violent toll inflicted by COVID-19. While the role of vaccines cannot be undervalued in wide-scale intervention, presenting them as the sole solution exonerates individuals of the importance of taking ownership over their lifestyle choices. This editorial focuses on the importance of physical activity as a crucial component of COVID-19 prevention programs and a long-term investment against chronic diseases.

Publishing Characteristics of Foot and Ankle Research Over a 15-Year Time Interval: A Review of The Journal of Bone & Joint Surgery from 2004 to 2018.

BACKGROUND: As the foot and ankle subspecialty continues to grow in orthopaedics, trends in published literature provide valuable insights to help understand and strengthen the field. The current study evaluates the changes in the characteristics of foot and ankle articles in The Journal of Bone & Joint Surgery (American Volume) (JBJS-A) from 2004 to 2018. METHODS: Foot and ankle-related articles in JBJS-A from 2004 to 2018 were identified and categorized by type of study, level of evidence, number of authors, academic degree(s) of the first and last authors, male and female authorship, number of citations, number of references, region of publication, and use of patient-reported outcomes (PROs). RESULTS: A total of 336 foot and ankle articles from 2004 to 2018 were reviewed. The type of study published has changed over time, with more clinical therapeutic evidence and less case reports. The level of evidence grades, as rated by JBJS-A and objective evaluators, have increased over the past 15 years. The total number of authors per article has increased, and female authorship has increased significantly. The number of references per article has increased, and the number of citations per year has decreased. The field of foot and ankle surgery has seen an increase in global publications. CONCLUSIONS: The results of this study suggest that the foot and ankle literature that has been published in JBJS-A has continued to increase in quality and diversity over the past 15 years.

Patterns of head impact exposure in men's and women's collegiate club water polo.

OBJECTIVES: Recent reports have demonstrated a risk of concussion and subconcussive head impacts in collegiate varsity and international elite water polo. We sought to characterize patterns of head impact exposure at the collegiate club level of water polo. DESIGN: Prospective cohort study. METHODS: Head impact sensors (SIM-G, Triax Technologies) were worn by men's (n=16) and women's (n=15) collegiate club water polo players during 11 games. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of head impacts were recorded by the sensors. Two streams of competition video were used to verify and describe the nature of head impacts. RESULTS: Men's players sustained 52 verified head impacts of magnitude 39.7±16.3g PLA and 5.2±3.2 krad/s2 PRA, and women's players sustained 43 verified head impacts of magnitude 33.7±12.6g PLA and 4.0±2.8krad/s2 PRA. Impacts sustained by men had greater PLA than those sustained by women (p=.045). Athletes were impacted most frequently at the offensive center position, to the back of the head, and by an opponent's torso or limb. CONCLUSIONS: Our cohort of male and female athletes sustained relatively infrequent head impacts during water polo competitions played at the collegiate club level. The amount of head impact exposure in our cohort was dependent on player position, with offensive centers prone to sustaining the most impacts. Head impact sensors are subject to large amounts of false positives and should be used in conjunction with video recordings to verify the validity of impact data.

A Dose Relationship Between Brain Functional Connectivity and Cumulative Head Impact Exposure in Collegiate Water Polo Players.

A growing body of evidence suggests that chronic, sport-related head impact exposure can impair brain functional integration and brain structure and function. Evidence of a robust inverse relationship between the frequency and magnitude of repeated head impacts and disturbed brain network function is needed to strengthen an argument for causality. In pursuing such a relationship, we used cap-worn inertial sensors to measure the frequency and magnitude of head impacts sustained by eighteen intercollegiate water polo athletes monitored over a single season of play. Participants were evaluated before and after the season using computerized cognitive tests of inhibitory control and resting electroencephalography. Greater head impact exposure was associated with increased phase synchrony [r (16) > 0.626, p < 0.03 corrected], global efficiency [r (16) > 0.601, p < 0.04 corrected], and mean clustering coefficient [r (16) > 0.625, p < 0.03 corrected] in the functional networks formed by slow-wave (delta, theta) oscillations. Head impact exposure was not associated with changes in performance on the inhibitory control tasks. However, those with the greatest impact exposure showed an association between changes in resting-state connectivity and a dissociation between performance on the tasks after the season [r (16) = 0.481, p = 0.043] that could also be attributed to increased slow-wave synchrony [F (4, 135) = 113.546, p < 0.001]. Collectively, our results suggest that athletes sustaining the greatest head impact exposure exhibited changes in whole-brain functional connectivity that were associated with altered information processing and inhibitory control.

Speckleplethysmographic (SPG) Estimation of Heart Rate Variability During an Orthostatic Challenge.

Heart rate variability (HRV) provides insight into cardiovascular health and autonomic function. Electrocardiography (ECG) provides gold standard HRV measurements but is inconvenient for continuous acquisition when monitored from the extremities. Optical techniques such as photoplethysmography (PPG), often found in health and wellness trackers for heart rate measurements, have been used to estimate HRV peripherally but decline in accuracy during increased physical stress. Speckleplethysmography (SPG) is a recently introduced optical technique that provides benefits over PPG, such as increased signal amplitude and reduced susceptibility to temperature-induced vasoconstriction. In this research, we compare SPG and PPG to ECG for estimation of HRV during an orthostatic challenge performed by 17 subjects. We find that SPG estimations of HRV are highly correlated to ECG HRV for both time and frequency domain parameters and provide increased accuracy over PPG estimations of HRV. The results suggest SPG measurements are a viable alternative for HRV estimation when ECG measurements are impractical.

Embryonic developmental oxygen preconditions cardiovascular functional response to acute hypoxic exposure and maximal ß-adrenergic stimulation of anesthetized juvenile American alligators (Alligator mississippiensis).

The effects of the embryonic environment on juvenile phenotypes are widely recognized. We investigated the effect of embryonic hypoxia on the cardiovascular phenotype of 4-year-old American alligators (Alligator mississippiensis). We hypothesized that embryonic 10% O2 preconditions cardiac function, decreasing the reduction in cardiac contractility associated with acute 5% O2 exposure in juvenile alligators. Our findings indicate that dobutamine injections caused a 90% increase in systolic pressure in juveniles that were incubated in 21% and 10% O2, with the 10% O2 group responding with a greater rate of ventricular relaxation and greater left ventricle output compared with the 21% O2 group. Further, our findings indicate that juvenile alligators that experienced embryonic hypoxia have a faster rate of ventricular relaxation, greater left ventricle stroke volume and greater cardiac power following ß-adrenergic stimulation, compared with juvenile alligators that did not experience embryonic hypoxia. When juveniles were exposed to 5% O2 for 20 min, normoxic-incubated juveniles had a 50% decline in left ventricle maximal rate of pressure development and maximal pressure; however, these parameters were unaffected and decreased less in the hypoxic-incubated juveniles. These data indicate that embryonic hypoxia in crocodilians alters the cardiovascular phenotype, changing the juvenile response to acute hypoxia and ß-adrenergic stimulation.

Genome of the Komodo dragon reveals adaptations in the cardiovascular and chemosensory systems of monitor lizards.

Monitor lizards are unique among ectothermic reptiles in that they have high aerobic capacity and distinctive cardiovascular physiology resembling that of endothermic mammals. Here, we sequence the genome of the Komodo dragon Varanus komodoensis, the largest extant monitor lizard, and generate a high-resolution de novo chromosome-assigned genome assembly for V. komodoensis using a hybrid approach of long-range sequencing and single-molecule optical mapping. Comparing the genome of V. komodoensis with those of related species, we find evidence of positive selection in pathways related to energy metabolism, cardiovascular homoeostasis, and haemostasis. We also show species-specific expansions of a chemoreceptor gene family related to pheromone and kairomone sensing in V. komodoensis and other lizard lineages. Together, these evolutionary signatures of adaptation reveal the genetic underpinnings of the unique Komodo dragon sensory and cardiovascular systems, and suggest that selective pressure altered haemostasis genes to help Komodo dragons evade the anticoagulant effects of their own saliva. The Komodo dragon genome is an important resource for understanding the biology of monitor lizards and reptiles worldwide.

Head impacts sustained by male collegiate water polo athletes.

Water polo is a contact sport that is gaining popularity in the United States and carries a risk of repeated head impacts and concussion. The frequency and magnitude of sport-related head impacts have not been described for water polo. We aimed to compare patterns of empirically measured head impact exposure of male collegiate water polo players to patterns previously reported by a survey of current and former water polo athletes. Participants wore water polo caps instrumented with head impact sensors during three seasons of collegiate water polo. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) were recorded for head impacts. Athlete positions were recorded by research staff at the occurrence of each head impact. Head impacts were sustained by athletes in offensive positions more frequently than in defensive and transition positions (246, 59.9% vs. 93, 22.6% vs. 72, 17.5%). 37% of all head impacts during gameplay were sustained by athletes playing the offensive center position. Impact magnitude (means ± SD: PLA = 36.1±12.3g, PRA = 5.0±2.9 krads/sec2) did not differ between position or game scenario. Among goalies, impact frequency and magnitude were similar between games (means ± SD: 0.54±.51 hits/game, PLA = 36.9±14.2g, PRA = 4.3±4.2 krads/sec2) and practices (means ± SD: 0.96±1.11 hits/practice, PLA = 43.7±14.5g, PRA = 3.9±2.5 krads/sec2). We report that collegiate water polo athletes are at risk for sport-related head impacts and impact frequency is dependent on game scenario and player position. In contrast, magnitude does not differ between scenarios or across positions.

The Effectiveness of Protective Headgear in Attenuating Ball-to-Forehead Impacts in Water Polo.

Recent reports have demonstrated that there is a serious risk of head impact and injury in water polo. The use of protective headgear in contact sports is a commonly accepted strategy for reducing the risk of head injury, but there are few available protective headgears for use in water polo. Many of those that are available are banned by the sport's governing bodies due to a lack of published data supporting the effectiveness of those headgears in reducing head impact kinematics. To address this gap in knowledge, we launched a water polo ball at the forehead of an anthropomorphic testing device fitted with either a standard water polo headgear or one of two protective headgears. We selected a range of launch speeds representative of those observed across various athlete ages. Mixed-model ANOVAs revealed that, relative to standard headgear, protective headgears reduced peak linear acceleration (by 10.8-21.6%; p < 0.001), and peak rotational acceleration (by 24.5-48.5%; p < 0.001) induced by the simulated ball-to-forehead impacts. We discuss the possibility of using protective headgears in water polo to attenuate head impact kinematics.

Simultaneously Occurring Elevated Metabolic States Expose Constraints in Maximal Levels of Oxygen Consumption in the Oviparous Snake Lamprophis fuliginosus.

African house snakes (Lamprophis fuliginosus) were used to compare the metabolic increments associated with reproduction, digestion, and activity both individually and when combined simultaneously. Rates of oxygen consumption ([Formula: see text]) and carbon dioxide production ([Formula: see text]) were measured in adult female (nonreproductive and reproductive) and adult male snakes during rest, digestion, activity while fasting, and postprandial activity. We also compared the endurance time (i.e., time to exhaustion) during activity while fasting and postprandial activity in males and females. For nonreproductive females and males, our results indicate that the metabolic increments of digestion (∼3-6-fold) and activity while fasting (∼6-10-fold) did not interact in an additive fashion; instead, the aerobic scope associated with postprandial activity was 40%-50% lower, and animals reached exhaustion up to 11 min sooner. During reproduction, there was no change in digestive [Formula: see text], but aerobic scope for activity while fasting was 30% lower than nonreproductive values. The prioritization pattern of oxygen delivery exhibited by L. fuliginosus during postprandial activity (in both males and females) and for activity while fasting (in reproductive females) was more constrained than predicted (i.e., instead of unchanged [Formula: see text], peak values were 30%-40% lower). Overall, our results indicate that L. fuliginosus's cardiopulmonary system's capacity for oxygen delivery was not sufficient to maintain the metabolic increments associated with reproduction, digestion, and activity simultaneously without limiting aerobic scope and/or activity performance.

Right-to-left shunt has modest effects on CO2 delivery to the gut during digestion, but compromises oxygen delivery.

By virtue of their cardiovascular anatomy, reptiles and amphibians can shunt blood away from the pulmonary or systemic circuits, but the functional role of this characteristic trait remains unclear. It has been suggested that right-to-left (R-L) shunt (recirculation of systemic blood within the body) fuels the gastric mucosa with acidified and CO2-rich blood to facilitate gastric acid secretion during digestion. However, in addition to elevating PCO2 , R-L shunt also reduces arterial O2 levels and would compromise O2 delivery during the increased metabolic state of digestion. Conversely, arterial PCO2  can also be elevated by lowering ventilation relative to metabolism (i.e. reducing the air convection requirement, ACR). Based on a mathematical analysis of the relative roles of ACR and R-L shunt on O2 and CO2 levels, we predict that ventilatory modifications are much more effective for gastric CO2 supply with only modest effects on O2 delivery. Conversely, elevating CO2 levels by means of R-L shunt would come at a cost of significant reductions in O2 levels. The different effects of altering ACR and R-L shunt on O2 and CO2 levels are explained by the differences in the effective blood capacitance coefficients.

Continuous arterial PO2 profiles in unrestrained, undisturbed aquatic turtles during routine behaviors.

Mammals and birds maintain high arterial partial pressure of oxygen (PO2 ) values in order to preserve near-complete hemoglobin (Hb) oxygen (O2) saturation. In diving mammals and birds, arterial O2 follows a primarily monotonic decline and then recovers quickly after dives. In laboratory studies of submerged freshwater turtles, arterial O2 depletion typically follows a similar pattern. However, in these studies, turtles were disturbed, frequently tethered to external equipment and confined either to small tanks or breathing holes. Aquatic turtles can alter cardiac shunting patterns, which will affect arterial PO2  values. Consequently, little is known about arterial O2 regulation and use in undisturbed turtles. We conducted the first study to continuously measure arterial PO2  using implanted microelectrodes and a backpack logger in undisturbed red-eared sliders during routine activities. Arterial PO2  profiles during submergences varied dramatically, with no consistent patterns. Arterial PO2  was also lower than previously reported during all activities, with values rarely above 50 mmHg (85% Hb saturation). There was no difference in mean PO2  between five different activities: submerged resting, swimming, basking, resting at the surface and when a person was present. These results suggest significant cardiac shunting occurs during routine activities as well as submergences. However, the lack of relationship between PO2  and any activity suggests that cardiac shunts are not regulated to maintain high arterial PO2  values. These data support the idea that cardiac shunting is the passive by-product of regulation of vascular resistances by the autonomic nervous system.