Noninstrumented Clinical Assessment of Static Postural Stability in Chronic Ankle Instability: A Systematic Review and Meta-Analysis.

CONTEXT: Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used. OBJECTIVE: To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI. EVIDENCE ACQUISITION: We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence. EVIDENCE SYNTHESIS: Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, -0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, -0.94; very low certainty evidence). CONCLUSIONS: Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI.

A Th17 cell-intrinsic glutathione/mitochondrial-IL-22 axis protects against intestinal inflammation.

The intestinal tract generates significant reactive oxygen species (ROS), but the role of T cell antioxidant mechanisms in maintaining intestinal homeostasis is poorly understood. We used T cell-specific ablation of the catalytic subunit of glutamate cysteine ligase (Gclc), which impaired glutathione (GSH) production, crucially reducing IL-22 production by Th17 cells in the lamina propria, which is critical for gut protection. Under steady-state conditions, Gclc deficiency did not alter cytokine secretion; however, C. rodentium infection induced increased ROS and disrupted mitochondrial function and TFAM-driven mitochondrial gene expression, resulting in decreased cellular ATP. These changes impaired the PI3K/AKT/mTOR pathway, reducing phosphorylation of 4E-BP1 and consequently limiting IL-22 translation. The resultant low IL-22 levels led to poor bacterial clearance, severe intestinal damage, and high mortality. Our findings highlight a previously unrecognized, essential role of Th17 cell-intrinsic GSH in promoting mitochondrial function and cellular signaling for IL-22 protein synthesis, which is critical for intestinal integrity and defense against gastrointestinal infections.

Radiomics-based prediction of nonalcoholic fatty liver disease following pancreatoduodenectomy.

PURPOSE: Predicting nonalcoholic fatty liver disease (NAFLD) following pancreaticoduodenectomy (PD) is challenging, which delays therapeutic intervention and makes its prevention difficult. We conducted this study to assess the potential application of preoperative computed tomography (CT) radiomics for predicting NAFLD. METHODS: The subjects of this retrospective study were 186 patients with PD from a single institution. We extracted the predictors of NAFLD after PD statistically from conventional clinical and radiomic features of the estimated remnant pancreas and whole liver region on preoperative nonenhanced CT images. Based on these predictors, we developed a machine-learning predictive model, which integrated clinical and radiomic features. A comparative model used only clinical features as predictors. RESULTS: The incidence of NAFLD after PD was 43.5%. The variables of the clinicoradiomic model included one shape feature of the pancreas, two texture features of the liver, and sex; the variables of the clinical model were age, sex, and chemoradiotherapy. The accuracy%, precision%, recall%, F1 score, and area under the curve of the two models were 75.0, 72.7, 66.7, 69.6, and 0.80; and 69.6, 68.4, 54.2, 60.5, and 0.69, respectively. CONCLUSIONS: Preoperative CT-derived radiomic features from the pancreatic and liver regions are promising for the prediction of NAFLD post-PD. Using these features enhances the predictive model, enabling earlier intervention for high-risk patients.

Influence of anterior talofibular ligament injury and mechanical ankle anterior displacement on symptoms in individuals with chronic ankle instability.

CONTEXT: Repeated ankle sprains can lead to injuries, including those of the anterior talofibular ligament; however, the extent to which these ligament injuries are associated with symptoms of chronic ankle instability remains unclear. OBJECTIVE: To examine the influence of anterior talofibular ligament injury and ankle anterior displacement on symptoms of chronic ankle instability. DESIGN: Case-Control Study. SETTING: A university laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 426 college students completed a questionnaire survey on the history of ankle sprain. Thirty-four (24 males, 10 females; age = 20.6 ± 0.5 years), 49 (38 males, 11 females; age = 20.2 ± 1.2 years), and 39 (24 males, 15 females; age = 20.1 ± 1.1 years) participants were enrolled in the healthy, coper, and chronic ankle instability groups, respectively. DATA COLLECTION AND ANALYSIS: One examiner measured the anterior talofibular ligament delineation using ultrasound and anterior ankle displacement using a capacitance-type sensor device. The Cumberland Ankle Instability Tool was applied to assess pain and perceived instability. RESULTS: The anterior talofibular ligament was normal significantly more frequently in healthy participants and abnormal significantly more frequently in patients with chronic ankle instability (p < 0.001). Anterior ankle displacement was significantly greater in the coper and chronic ankle instability groups than in healthy individuals (p < 0.001), but no significant difference was observed between the coper and chronic ankle instability groups. There was no significant correlation between the anterior ankle displacement and Cumberland Ankle Instability Tool scores (p = 0.709) in participants with previous ankle sprains. CONCLUSION: Observation of an abnormal anterior talofibular ligament on ultrasonography is associated with anterior displacement of the ankle joint. However, it is assumed that the influence of anterior ankle displacement due to damage to the anterior talofibular ligament on the pain and perceived instability in chronic ankle instability is small.

Differences and relationships between weightbearing and non-weightbearing dorsiflexion range of motion in foot and ankle injuries.

BACKGROUND: This study aimed to: (1) identify assessment methods that can detect greater ankle dorsiflexion range of motion (DROM) limitation in the injured limb; (2) determine whether differences in weightbearing measurements exist even in the absence of DROM limitations in the injured limb according to non-weightbearing measurements; and (3) examine associations between DROM in the weightbearing and non-weightbearing positions and compare those between a patient group with foot and ankle injuries and a healthy group. METHODS: Eighty-two patients with foot and ankle injuries (e.g., fractures, ligament and tendon injuries) and 49 healthy individuals participated in this study. Non-weightbearing DROM was measured under two different conditions: prone position with knee extended and prone position with knee flexed. Weightbearing DROM was measured as the tibia inclination angle (weightbearing angle) and distance between the big toe and wall (weightbearing distance) at maximum dorsiflexion. The effects of side (injured, uninjured) and measurement method on DROM in the patient groups were assessed using two-way repeated-measures ANOVA and t-tests. Pearson correlations between measurements were assessed. In addition, we analyzed whether patients without non-weightbearing DROM limitation (≤ 3 degrees) showed limitations in weightbearing DROM using t-tests with Bonferroni correction. RESULTS: DROM in patient groups differed significantly between legs with all measurement methods (all: P < 0.001), with the largest effect size for weightbearing angle (d = 0.95). Patients without non-weightbearing DROM limitation (n = 37) displayed significantly smaller weightbearing angle and weightbearing distance on the injured side than on the uninjured side (P < 0.001 each), with large effect sizes (d = 0.97-1.06). Correlation coefficients between DROM in non-weightbearing and weightbearing positions were very weak (R = 0.17, P = 0.123) to moderate (R = 0.26-0.49, P < 0.05) for the patient group, and moderate to strong for the healthy group (R = 0.51-0.69, P < 0.05). CONCLUSIONS: DROM limitations due to foot and ankle injuries may be overlooked if measurements are only taken in the non-weightbearing position and should also be measured in the weightbearing position. Furthermore, DROM measurements in non-weightbearing and weightbearing positions may assess different characteristics, particularly in patient group. LEVEL OF EVIDENCE: Level IV, cross-sectional study.

Morphological and mechanical characteristics of the intrinsic and extrinsic foot muscles under loading in individuals with flat feet.

BACKGROUND: The intrinsic and extrinsic foot softtissue structures that apply force and support the medial longitudinal arch (MLA) have been implicated in the development of flat feet. However, the relationship between the changes in MLA height under increasing load and the morphological and mechanical properties of individual intrinsic and extrinsic foot soft tissue structures is not fully understood. RESEARCH QUESTION: To examine the morphological and mechanical characteristics of the foot soft tissue structures in flat feet when subjected to loading. METHODS: This study consisted of two studies focusing on the extrinsic foot muscles (10 normal feet/11 flat feet) and intrinsic foot muscles (14 normal feet/13 flat feet). Images of the extrinsic and intrinsic foot muscles and plantar fascia (PF) under 10%, 50%, and 90% body weight conditions were obtained using ultrasound-based shear-wave elastography. RESULTS: The cross-sectional area (CSA) of the peroneus brevis was larger in the flat-foot group than in the normal-foot group under all loading conditions. The CSAs of the intrinsic foot muscles (abductor hallucis, flexor digitorum brevis, and quadratus plantae) and thickness of the PF in the flat-foot group decreased significantly with increasing load. As for mechanical characteristics, the stiffness of the flexor digitorum longus and abductor hallucis was higher in the flat-foot group than in the normal group under high loading conditions. In addition, flat feet with greater flexibility tended to exhibit a greater decrease in PF thickness and smaller increase in stiffness. SIGNIFICANCE: Excessive stretching of the intrinsic foot muscles and PF occurs in flat feet, and excessive contraction of the flexor digitorum longus may counteract the excessive lowering of the foot arch. Therefore, it is necessary to promote the contraction of the intrinsic foot musculature in feet with greater flexibility of the MLA during loading.

Characteristics of the static muscle stiffness of ankle plantar flexors in individuals with chronic ankle instability.

PURPOSE: Individuals with chronic ankle instability (CAI) have deficits in closed kinetic chain dorsiflexion that may perpetuate injury. Determining the characteristics of muscle stiffness in the plantar flexors of individuals with CAI may help in developing appropriate treatments. We aimed to highlight the characteristics of static muscle stiffness in ankle plantar flexor muscles during the passive dorsiflexion of the ankle joint in individuals with CAI. METHODS: A total of 30 patients were included in the study based on the International Ankle Consortium criteria. The patients were categorized evenly into healthy, coper, and CAI groups (i.e., 10 patients in each group). After measuring the dorsiflexion range of motion (non-weight-bearing/weight-bearing) of the ankle joint, the static muscle stiffness measurements of the medial gastrocnemius, lateral gastrocnemius, soleus, and peroneus longus were obtained. The measurements were performed during the knee joint's extension and 50° flexion and passive dorsiflexion between the range of 40° plantar flexion and 20° dorsiflexion. RESULTS: The dorsiflexion range of motion of the CAI group was significantly smaller than that of the healthy and coper groups in the weight-bearing position. No interaction was observed for muscle stiffness in both the knee flexion and extension positions, and no significant differences were identified among the three groups. The shear modulus of the soleus at 20° ankle dorsiflexion with knee flexion had a significant negative correlation with the weight-bearing range of motion of the ankle. CONCLUSION: The limitation in the weight-bearing dorsiflexion range of motion in CAI was largely due to factors other than the increased elasticity of the ankle plantar flexor muscles.

Ultrasound Imaging of Subtalar Joint Instability for Chronic Ankle Instability.

The purpose of this study was to develop the assessment of subtalar joint instability with chronic ankle instability (CAI) using ultrasonography. Forty-six patients with anterior talofibular ligament (ATFL) abnormalities and a history of ankle sprain were divided into CAI (21.2 ± 5.9 y/o, 7 males and 17 females) and asymptomatic groups (21.0 ± 7.4 y/o, 9 males and 12 females) on the basis of subjective ankle instability assessed using the CAIT and the Ankle Instability Instrument Tool (AIIT). Twenty-six age-matched feet participated in a control group (18.9 ± 7.0 y/o, 9 males and 17 females). Ultrasound measurements of the width of the posterior subtalar joint facet were obtained at rest and maximum ankle inversion (subtalar joint excursion; STJE). The differences in STJE among the three groups were assessed by one-way ANOVA. The relationship between STJE and subjective ankle instability was assessed using Spearman's correlation tests. The STJE value was significantly greater in the CAI group (2.3 ± 0.8 mm) than in the asymptomatic (1.0 ±0.4 mm) and control groups (0.8 ±0.2 mm) (p < 0.001, effect size: 0.64). STJE had significant negative correlations with CAIT (r = -0.71, p < 0.01), and significant positive correlations with AIIT (r = 0.74, p < 0.01). The cut-off value to distinguish between the CAI and asymptomatic groups was 1.7 mm using the ROC curve.

A Th17 cell-intrinsic glutathione/mitochondrial-IL-22 axis protects against intestinal inflammation.

Although the intestinal tract is a major site of reactive oxygen species (ROS) generation, the mechanisms by which antioxidant defense in gut T cells contribute to intestinal homeostasis are currently unknown. Here we show, using T cell-specific ablation of the catalytic subunit of glutamate cysteine ligase (Gclc), that the ensuing loss of glutathione (GSH) impairs the production of gut-protective IL-22 by Th17 cells within the lamina propria. Although Gclc ablation does not affect T cell cytokine secretion in the gut of mice at steady-state, infection with C. rodentium increases ROS, inhibits mitochondrial gene expression and mitochondrial function in Gclc-deficient Th17 cells. These mitochondrial deficits affect the PI3K/AKT/mTOR pathway, leading to reduced phosphorylation of the translation repressor 4E-BP1. As a consequence, the initiation of translation is restricted, resulting in decreased protein synthesis of IL-22. Loss of IL-22 results in poor bacterial clearance, enhanced intestinal damage, and high mortality. ROS-scavenging, reconstitution of IL-22 expression or IL-22 supplementation in vivo prevent the appearance of these pathologies. Our results demonstrate the existence of a previously unappreciated role for Th17 cell-intrinsic GSH coupling to promote mitochondrial function, IL-22 translation and signaling. These data reveal an axis that is essential for maintaining the integrity of the intestinal barrier and protecting it from damage caused by gastrointestinal infection.

Reliability and validity of ultrasonographic automated length measurement system for assessing talofibular anterior instability in acute lateral ankle sprain.

Ankle joint instability after acute lateral ankle sprain (LAS) is an important factor for deciding treatment strategies. Nevertheless, the degree of ankle joint mechanical instability as a criterion for making clinical decisions is unclear. This study examined the reliability and validity of an Automated Length Measurement System (ALMS) in ultrasonography for assessing real-time anterior talofibular distance. Using a phantom model, we tested whether ALMS could detect two points within a landmark following movement of the ultrasonographic probe. Furthermore, we examined whether ALMS was comparable with the manual measurement method for 21 patients with an acute LAS (42 ankles) during the reverse anterior drawer test. Using the phantom model, ALMS measurements showed excellent reliability, with errors below 0.4 mm and with a small variance. The ALMS measurement was comparable to manually measured values (ICC = 0.53-0.71, p < 0.001) and detected differences in talofibular joint distances between unaffected and affected ankles of 1.41 mm (p < 0.001). ALMS shortened the measurement time by one-thirteenth for one sample compared to the manual measurement (p < 0.001). ALMS could be used to standardize and simplify ultrasonographic measurement methods for dynamic joint movements without human error in clinical applications.

Pyruvate dehydrogenase fuels a critical citrate pool that is essential for Th17 cell effector functions.

Pyruvate dehydrogenase (PDH) is the central enzyme connecting glycolysis and the tricarboxylic acid (TCA) cycle. The importance of PDH function in T helper 17 (Th17) cells still remains to be studied. Here, we show that PDH is essential for the generation of a glucose-derived citrate pool needed for Th17 cell proliferation, survival, and effector function. In vivo, mice harboring a T cell-specific deletion of PDH are less susceptible to developing experimental autoimmune encephalomyelitis. Mechanistically, the absence of PDH in Th17 cells increases glutaminolysis, glycolysis, and lipid uptake in a mammalian target of rapamycin (mTOR)-dependent manner. However, cellular citrate remains critically low in mutant Th17 cells, which interferes with oxidative phosphorylation (OXPHOS), lipid synthesis, and histone acetylation, crucial for transcription of Th17 signature genes. Increasing cellular citrate in PDH-deficient Th17 cells restores their metabolism and function, identifying a metabolic feedback loop within the central carbon metabolism that may offer possibilities for therapeutically targeting Th17 cell-driven autoimmunity.

Discriminant Feature Extraction by Generalized Difference Subspace.

In this paper, we reveal the discriminant capacity of orthogonal data projection onto the generalized difference subspace (GDS), both theoretically and experimentally. In our previous work, we demonstrated that the GDS projection works as a quasi-orthogonalization of class subspaces, which is an effective feature extraction for subspace based classifiers. Here, we further show that GDS projection also works as a discriminant feature extraction through a similar mechanism to the Fisher discriminant analysis (FDA). A direct proof of the connection between GDS projection and FDA is difficult due to the significant difference in their formulations. To circumvent the complication, we first introduce geometrical Fisher discriminant analysis (gFDA) based on a simplified Fisher criterion. It is derived from a heuristic yet practically plausible assumption: the direction of the sample mean vector of a class is largely aligned to the first principal component vector of the class, given that the principal component analysis (PCA) is applied without data centering. gFDA works stably even under few samples, bypassing the small sample size (SSS) problem of FDA. We then prove that gFDA is equivalent to GDS projection with a small correction term. This equivalence ensures GDS projection to inherit the discriminant ability from FDA via gFDA. Furthermore, we discuss two useful extensions of these methods, 1) a nonlinear extension by kernel trick, 2) a combination with CNN features. The equivalence and the effectiveness of the extensions have been verified through extensive experiments on the extended Yale B+, CMU face database, ALOI, ETH80, MNIST, and CIFAR10, mainly focusing on image recognition under small samples.

Effects of Conservative Interventions on Static and Dynamic Balance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-analysis.

OBJECTIVE: To determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI). DATA SOURCES: PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022. STUDY SELECTION: Randomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared with those of different conservative interventions or controls were included. DATA EXTRACTION: Two independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach. DATA SYNTHESIS: Forty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval [CI], 0.58-1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24-0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41-1.14; and 0.75; CI, 0.35-1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared with that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low- to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32-1.20; low-certainty evidence). Adding transcranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08-1.53; moderate-certainty evidence). The effects on balance were not significantly different among BT, ST, and WBVT (very low- to low-certainty evidence). CONCLUSIONS: The significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low.

Search for Ultralight Dark Matter from Long-Term Frequency Comparisons of Optical and Microwave Atomic Clocks.

We search for ultralight scalar dark matter candidates that induce oscillations of the fine structure constant, the electron and quark masses, and the quantum chromodynamics energy scale with frequency comparison data between a ^{171}Yb optical lattice clock and a ^{133}Cs fountain microwave clock that span 298 days with an uptime of 15.4%. New limits on the couplings of the scalar dark matter to electrons and gluons in the mass range from 10^{-22} to 10^{-20} eV/c^{2} are set, assuming that each of these couplings is the dominant source of the modulation in the frequency ratio. The absolute frequency of the ^{171}Yb clock transition is also determined as 518 295 836 590 863.69(28) Hz, which is one of the important contributions toward a redefinition of the second in the International System of Units.

Single-stage arterial switch operation conversion with dextro-transposition of the great arteries and pulmonary arterial hypertension due to baffle leak after a Senning procedure.

Patients who have undergone an atrial switch operation for dextro-transposition of the great arteries (dTGA) sometimes suffer from right ventricular dysfunction, tricuspid regurgitation, arrhythmias, or baffle leaks. We report the first case of single-stage arterial switch operation conversion in an adult patient with dTGA and pulmonary arterial hypertension (PAH) due to a baffle leak after a Senning procedure. Perioperative mechanical circulatory support was required for 3 weeks. Although chronic kidney disease persisted, her left ventricular function and pulmonary hypertension improved over the first postoperative year. This is a rare case, and we believe that the patient's PAH might have helped the left ventricle withstand systemic pumping for over two decades. Learning objective: Patients with dextro-transposition of the great arteries may face problems after an atrial switch operation because their right ventricle is responsible for systemic pumping. Staged arterial switch operation conversion is a strategy that can combat these problems but increases the risk of perioperative mortality. Pulmonary arterial hypertension allows for single-stage arterial switch operation, but the operative risk may be higher.

Protocols of rehabilitation and return to sport, and clinical outcomes after medial patellofemoral ligament reconstruction with and without tibial tuberosity osteotomy: a systematic review.

PURPOSE: No consensus exists on rehabilitation programmes after medial patellofemoral ligament reconstruction (MPFLR) with or without tibial tuberosity osteotomy (TTO). This systematic review examined the content and timeline of rehabilitation (weightbearing, range of motion [ROM] and exercise therapy) and return to sport (RTS), as well as patient-reported outcomes after MPFLR with or without TTO. METHODS: The PubMed, Cochrane Library, Web of Sciences, CINAHL and SPORTDiscus databases were searched from inception to December 2021. Studies that reported postoperative rehabilitation programmes and patient-reported outcomes for patients aged ≥ 18 years who underwent MPFLR with or without concomitant TTO were included. RESULTS: Eighty-five studies were included, 57 of which were case series and only one randomised controlled trial on rehabilitation programmes. Non-weightbearing was set within one week post-operatively in approximately 80% of weightbearing programmes for MPFLR without and with TTO. Joint immobilisation was set within one week post-operatively in 65.3% and 93.8% of programmes for MPFLR without and with TTO, respectively. Weightbearing and ROM (≤ 90°) restriction were within three weeks post-operatively for > 50% of the programmes. Quadriceps strengthening was the most cited exercise therapy (33 programmes), most often initiated within two weeks post-operatively. However, few other exercise programmes were cited (only nine programmes). RTS was mostly noted at six months post-operatively (35 programmes). The weighted mean Kujala score was 87.4 points. CONCLUSION: Regardless of TTO addition to MPFLR, most studies restricted weightbearing and ROM only in the early post-operative period, with seemingly favourable clinical results. Limited information was available on post-operative exercise therapy.

A FAsT contribution: Adipocytes rewire their metabolism to acquire immune functions.

Adipose tissue has been linked to inflammation and various physiological processes. In this issue of Cell Metabolism, Caputa et al. describe that perinodal adipocytes adapt their metabolism to actively participate in an immune response against intracellular Listeria monocytogenes.

Does the sesamoid rotation angle change differently in subjects with hallux valgus considering foot position during assumed walking? A pilot study.

Hallux valgus (HV) entails changes in the alignment of the rotating sesamoids and a shift of the abductor hallucis muscle (ABH) in the plantar direction, decreasing the abductor force. Load on the foot while walking may change the sesamoid rotation angle (SRA). Nevertheless, no study has investigated the relationship between the change in SRA during assumed walking and ABH muscle size. The aim of our study was to examine the changes in SRA at different foot postures assumed to generate skeletal alignments during walking and muscle size of the ABH in participants with HV and to discuss the association between the change in the SRA and cross-sectional area (CSA) of the ABH. Thirteen female participants were recruited and divided into the HV and non-HV groups according to the HV angle. The SRA and cross-sectional area of the ABH were measured using B-mode ultrasound. The SRA was measured under four conditions; sitting, standing, mid-stance, and pre-swing posture. The CSA was assessed in the supine position. In all postures, the SRA increased more in the HV group than in the non-HV group (p < 0.05). The change in the SRA at the pre-swing posture was greater in the HV group than in the non-HV group (p < 0.05). The change in the SRA at pre-swing posture negatively correlated with the CSA of the ABH in the HV group (r = -0.554, p < 0.05). In the HV group, increasing the load on the forefoot enhanced the sesamoid rotation. Abductor torque on the ABH decreased with ABH displacement as the sesamoids moved laterally in the pre-swing. Repeated walking increased sesamoid rotation and led to HV progression. Therefore, it may be beneficial to use an orthosis or arch pad that corrects pronation of the metatarsal with the rotation of the sesamoids.

Glutathione-dependent redox balance characterizes the distinct metabolic properties of follicular and marginal zone B cells.

The metabolic principles underlying the differences between follicular and marginal zone B cells (FoB and MZB, respectively) are not well understood. Here we show, by studying mice with B cell-specific ablation of the catalytic subunit of glutamate cysteine ligase (Gclc), that glutathione synthesis affects homeostasis and differentiation of MZB to a larger extent than FoB, while glutathione-dependent redox control contributes to the metabolic dependencies of FoB. Specifically, Gclc ablation in FoB induces metabolic features of wild-type MZB such as increased ATP levels, glucose metabolism, mTOR activation, and protein synthesis. Furthermore, Gclc-deficient FoB have a block in the mitochondrial electron transport chain (ETC) due to diminished complex I and II activity and thereby accumulate the tricarboxylic acid cycle metabolite succinate. Finally, Gclc deficiency hampers FoB activation and antibody responses in vitro and in vivo, and induces susceptibility to viral infections. Our results thus suggest that Gclc is required to ensure the development of MZB, the mitochondrial ETC integrity in FoB, and the efficacy of antiviral humoral immunity.

The Reliability and Validity of a Novel Ankle Isometric Plantar Flexion Strength Test.

CONTEXT: Strengthening of ankle plantar flexor muscles is one of the important components in the rehabilitation of many lower limb injuries and disorders. However, there are few simple methods to evaluate ankle plantar flexor strength in clinical situations without using equipment. The purpose of this study was to verify the intraexaminer and interexaminer reliability and the concurrent validity of a novel ankle isometric plantar flexion (PF) strength test (PF break test [PFBT]). DESIGN: Case-control study. METHODS: The intraexaminer and interexaminer reliabilities of the PFBT were evaluated in 57 orthopedic patients and 30 healthy adults. The range of motion of the ankle joint and the number of heel raises were compared between positive and negative PFBT cases. Then, isometric ankle PF torque (ankle PF of 0°, 15°, and 30°) was compared in knee extension and in the 50° flexion position between positive and negative PFBT cases in 30 healthy adults. RESULTS: The intraexaminer reliability (κ) of the PFBT was .81 to .94, and the interexaminer reliability (κ) was .37 to .74. The PFBT positive group had a significantly smaller range of motion in the ankle joint (P < .05) and a significantly lower number of heel raises (P < .001) than the PFBT negative group in orthopedic patients, but no significant differences in healthy adults. The PFBT positive group had less ankle PF torque than the PFBT negative group at all ankle PF angles (P < .01). The isometric PF torque in the end range of ankle PF in knee extension could predict the results of the PFBT and correctly classified 90.0% of cases (P < .001). CONCLUSION: The PFBT is considered a simple and valid method to evaluate isometric ankle PF strength in the clinical setting.