A Randomized Controlled Trial to Evaluate the Impact of an Exercise Therapy Program Based on Sports in People with Acquired Brain Injury: Discover Study Protocol.

INTRODUCTION: Acquired brain injury (ABI) constitutes a significant and growing global public health concern. People with ABI often face a range of physical and psychosocial challenges that span the domains of "body structure and function", "activity", and "participation", as defined by the International Classification of Functioning, Disability, and Health. Multidisciplinary approaches based on exercise therapy with social leisure activities are essential to improve physical recovery and health-related quality of life after injury. METHODS: Adults with ABI, aged > 18 years, in the subacute or chronic stage (within more than one month after the injury) will be recruited through a rehabilitation center. Adults will be randomized to receive either a racket sports-based exercise therapy program combined with usual care (sET) or usual care alone (UC) using a random number sequence with a 1:1 allocation ratio. sET intervention consists of an 8-week exercise therapy program focusing on different racket sports skills, 1 h in duration, 2 days/week. It will be delivered by a physiotherapist in tailored, face-to-face, group-based sessions. Primary outcomes will be the health-related quality of life (SF-36) and upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity Scale). DISCUSSION: The study proposes an intervention that combines sports-based exercise therapy with usual care. It aims to determine whether this intervention improves the health-related quality of life and upper limb motor function in adults with ABI compared with usual care alone. The results of this study may have clinical implications for the rehabilitation of this population.

Reconstruction of the Acromioclavicular Joint Using a Double Augmentation With Hamstrings Tendon and Dermal Graft.

The purpose of this article is to describe a technique to restore both vertical and horizontal stability using an augmentation of the acromioclavicular ligament complex (ACLC) and coracoclavicular (CC) ligaments with the combination of synthetic and biological support. Our technique introduces a modification in the surgical procedure for acromioclavicular (AC) joint dislocations; it provides the use of biological supplements not only during the repair of the CC ligaments but also when the ACLC is restored due to the use of a dermal patch as an augmentation allograft after the use of a horizontal cerclage. The main purpose of this technique is to replicate the anatomy and functionality of the native ligaments that stabilize the AC joint to improve both clinical and functional results.

Effects of Exercise Programs on Functional Capacity and Quality of Life in People With Acquired Brain Injury: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aims of this systematic review and meta-analyses were to evaluate the effects of exercise on the functional capacity and quality of life (QoL) of people with acquired brain injury (ABI) and to analyze the influence of training variables. METHODS: Five electronic databases (MEDLINE, Cochrane Library, CINAHL, SportDiscus, and Web of Science) were searched until October 2021 for clinical trials or experimental studies examining the effects of exercise on the functional capacity and QoL in adults with ABI and comparing exercise interventions with non-exercise (usual care). RESULTS: Thirty-eight studies were evaluated. A total sample of 2219 people with ABI (exercise, n = 1572; control, n = 647) were included in the quantitative analysis. A greater improvement was observed in walking endurance (z score = 2.84), gait speed (z score = 2.01), QoL physical subscale (z score = 3.42), and QoL mental subscale (z score = 3.00) was observed in the experimental group than in the control group. In addition, an improvement was also observed in the experimental group in the "Timed Up and Go" Test scores and balance without differences from the control group. Significant interactions were also observed between the rehabilitation phases, type, frequency and volume of training, and overall effects. CONCLUSION: The results suggest that exercise improves functional capacity and QoL regardless of model training, highlighting the effectiveness of long-term exercise that includes short sessions with components such as strength, balance, and aerobic exercise. IMPACT: The results shown in this systematic review with meta-analysis will allow physical therapists to better understand the effects of training on people with ABI.

Distinctive mechanisms of epilepsy-causing mutants discovered by measuring S4 movement in KCNQ2 channels.

Neuronal KCNQ channels mediate the M-current, a key regulator of membrane excitability in the central and peripheral nervous systems. Mutations in KCNQ2 channels cause severe neurodevelopmental disorders, including epileptic encephalopathies. However, the impact that different mutations have on channel function remains poorly defined, largely because of our limited understanding of the voltage-sensing mechanisms that trigger channel gating. Here, we define the parameters of voltage sensor movements in wt-KCNQ2 and channels bearing epilepsy-associated mutations using cysteine accessibility and voltage clamp fluorometry (VCF). Cysteine modification reveals that a stretch of eight to nine amino acids in the S4 becomes exposed upon voltage sensing domain activation of KCNQ2 channels. VCF shows that the voltage dependence and the time course of S4 movement and channel opening/closing closely correlate. VCF reveals different mechanisms by which different epilepsy-associated mutations affect KCNQ2 channel voltage-dependent gating. This study provides insight into KCNQ2 channel function, which will aid in uncovering the mechanisms underlying channelopathies.

Molecular Probing of DOM Indicates a Key Role of Spruce-Derived Lignin in the DOM and Metal Cycles of a Headwater Catchment: Can Spruce Forest Dieback Exacerbate Future Trends in the Browning of Central European Surface Waters?

Peatlands of the Northern Hemisphere and Central European coniferous forests experience significant environmental change. The resultant browning of surface waters, that is, elevated concentrations of dissolved organic matter (DOM) and metals, is of interest in the context of the global C cycle, peatland and forest management, and water treatment. In an attempt to identify the causes of this process in the Harz Mountains (Central Germany), we studied the spatiotemporal variations in DOM molecular composition (thermally assisted hydrolysis and methylation combined with GC-MS) and metal concentrations in headwater stream samples. We found strong relationships between DOM and metals and seasonal variations in the DOM quality and tentatively DOM-metal binding mode: during summer base flow, DOM and metal concentrations are low, and all elements other than the alkali and alkaline earth metals (Ca, Mg, Sr, K, and Na) are positively correlated to DOM, whereas during spring and autumn (high discharge), only metals with strong affinity for DOM (Fe, As, Cu, Cr, Pb, and Ti), but not weakly binding ones (Al, Cd, La, Mn, Ni, Zn, and Zr), are correlated to DOM, indicative of selectivity in DOM-metal interactions. The products of polyphenols are the key ingredients of the DOM-metal complexes. We argue the importance of spruce lignin-derived vanillic acid moieties, which are involved in weak (all seasons) and strong, multidentate and/or colloidal, binding (spring and autumn) of metals. Considering the ongoing spruce forest dieback and climate change acceleration, it is tempting to conclude that spruce necromass and forest soils may release vast amounts of lignin-derived DOM and associated metals to headwater streams. This would have significant implications for forest soil C stocks and the management of connected drinking water reservoirs.

Benefits of physical exercise programs toward people with acquired brain injury: A protocol for systematic review and meta-analysis.

BACKGROUND: Exercise has proven to be a tool improving health related quality of life in people with acquired brain injury (ABI) as part of multidisciplinary team during the subacute and chronic phase. While intervention studies and revisions have been increased in recent years, there is no consensus about the type, frequency and variables of control in exercise interventions. Besides, this collective need programs that respond to different functional levels, given the heterogeneity of people with ABI, not only because of the etiology, but also because of the severity differences over their deficits. The aim of this systematic review and meta-analysis is to summarize the evidence regarding the relationship between exercise and health related quality of life in subacute and chronic phase. METHODS: A protocol of systematic review and meta-analysis will examine the benefits of physical exercise (PE) toward people with ABI will be conducted. A comprehensive search will be conducted in the following electronic databases: MEDLINE, The Cochrane Library, CINAHL, SportDiscus, and Web of Science from inception to July 2020. Independent review authors will evaluate the title and abstract for each trial and disagreements will be solved by discussion with a third author if necessary. Standard pairwise meta-analysis, including heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using the Stata software. The quality evaluation of this study will be completed using the Cochrane collaboration risk of bias tool and the risk of bias assessment will be conducted by the World Health Organization grading of recommendations, assessment, development, and evaluation. The review will be reported in accordance to the preferred reporting items for systematic reviews and meta-analyses statement. RESULTS AND CONCLUSSION: This systematic review and meta-analysis protocol will provide an overview regarding the benefits of PE on functioning, social participation and quality of life toward people with ABI. The variability of outcomes across PE from the selected studies will provide important information for future trial designs. Results of the proposed review will inform practice and the design of future clinical trials. This study will summarize all the selected trials aimed at estimating the effectiveness of applying physical activity programs to ABI users.Systematic review registration number: PROSPERO CRD42020191779.

Physical Activity and Sport for Acquired Brain Injury (PASABI): A Non-Randomized Controlled Trial.

Background and objectives: Acquired brain injury (ABI) is the first cause of disability and physical activity (PA) is a key element in functional recovery and health-related quality of life (HRQoL) during the subacute and chronic phases. However, it is necessary to develop PA programs that respond to the heterogeneity and needs of this population. The aim of this study was to assess the effectiveness of a PA program on the HRQoL in this population. Materials and Methods: With regard to recruitment, after baseline evaluations, participants were assigned to either the intervention group (IG, n = 38) or the control group (CG, n = 35). Functional capacity, mood, quality of life and depression were measured pre- and post-intervention. The IG underwent the "Physical Activity and Sport for Acquired Brain Injury" (PASABI) program, which was designed to improve HRQoL (1-h sessions, two to four sessions/week for 18 weeks). The CG underwent a standard rehabilitation program without PA. Results: Results for the IG indicated significant differences and large effect sizes for the physical and mental dimensions of quality of life, as well as mood and functional capacity, indicating an increase in HRQoL. No significant differences were found for the CG across any variables. Conclusions: The PASABI program was feasible and beneficial for improving physiological and functionality variables in the IG. The wide range of the activities of the PASABI program allow its application to a large number of people with ABI, promoting health through PA, especially in the chronic phase.

Structural equation modeling of long-term controls on mercury and bromine accumulation in Pinheiro mire (Minas Gerais, Brazil).

The application of statistical modeling is still infrequent in mercury research in peat, despite the ongoing debate on the weight of the diverse factors (climate, peat decomposition, vegetation changes, etc.) that may affect mercury accumulation. One of the few exceptions is the Hg record of Pinheiro mire (souheast Brazil). Previous studies on this mire modeled mercury using principal components regression and partial least squares. These methods assume independence between factors, which is seldom the case in natural systems, thus hampering the identification of mediating effects and interactions. To overcome these limitations, in this reserach we use structural equation modeling (PLS-SEM) to model mercury and bromine peat records - bromine has been used in some investigations to normalize mercury accumuation. The mercury model explained 83% of the variance and suggested a complex control: increased peat decomposition, dust deposition and humid climates enhanced mercury accumulation, while increased mineral fluxes resulted in a decrease in mercury accumulation. The bromine model explained 90% of the variation in concentrations: increased dust deposition and peat decomposition promoted bromine accumulation, while time (i.e. peat age) promoted bromine depletion. Thus, although mercury and bromine are both organically bound elements with relevant atmospheric cycles the weights of the factors involved in their accumulation differed significantly. Our results suggest caution when using bromine to normalize mercury accumulation. PLS-SEM results indicate a large time dependence of peat decomposition, catchment mineral fluxes, long-term climate change, and atmospheric deposition; while atmospheric dust, mineral fluxes and peat decomposition showed high to moderate climate dependency. In particular, they also point to a relevant role of autogenic processes (i.e. the build up and expansion of the mire within the catchment), which controlled local mineral fluxes; an aspect that has seldom been considered.

Human bones tell the story of atmospheric mercury and lead exposure at the edge of Roman World.

Atmospheric metal pollution is a major health concern whose roots pre-date industrialization. This study pertains the analyses of ancient human skeletons and compares them with natural archives to trace historical environmental exposure at the edge of the Roman Empire in NW Iberia. The novelty of our approach relies on the combination of mercury, lead and lead isotopes. We found over a 700-year period that rural Romans incorporated two times more mercury and lead into their bones than post-Romans inhabiting the same site, independent of sex or age. Atmospheric pollution sources contributed on average 57% (peaking at 85%) of the total lead incorporated into the bones in Roman times, which decreased to 24% after the decline of Rome. These values and accompanying changes in lead isotopic composition mirror changes in atmospheric Pb deposition recorded in local peatlands. Thus, skeletons are a time-transgressive archive reflecting contaminant exposure.

Diatom ooze-A large marine mercury sink.

The role of algae for sequestration of atmospheric mercury in the ocean is largely unknown owing to a lack of marine sediment data. We used high-resolution cores from marine Antarctica to estimate Holocene global mercury accumulation in biogenic siliceous sediments (diatom ooze). Diatom ooze exhibits the highest mercury accumulation rates ever reported for the marine environment and provides a large sink of anthropogenic mercury, surpassing existing model estimates by as much as a factor of 7. Anthropogenic pollution of the Southern Ocean began ~150 years ago, and up to 20% of anthropogenic mercury emitted to the atmosphere may have been stored in diatom ooze. These findings reveal the crucial role of diatoms as a fast vector for mercury sequestration and diatom ooze as a large marine mercury sink.

Industrial-era lead and mercury contamination in southern Greenland implicates North American sources.

To study the long-range transport of atmospheric pollutants from lower latitude industrial areas to the Arctic, we analysed a peat core spanning the last ~700cal.yr (~1300-2000CE) from southern Greenland, an area sensitive to atmospheric pollution from North American and Eurasian sources. A previous investigation conducted in the same location recorded atmospheric lead (Pb) pollution after ~1845, with peak values recorded in the 1970s, and concluded that a North American source was most likely. To confirm the origin of the lead, we present new Pb isotope data from Sandhavn, together with a high-resolution record for mercury (Hg) deposition. Results demonstrate that the mercury accumulation rate has steadily increased since the beginning of the 19th century, with maximum values of 9.3µgm-2yr-1 recorded ~1940. Lead isotopic ratios show two mixing lines: one which represents inputs from local and regional geogenic sources, and another that comprises regional geogenic and pollution sources. Detrending the Pb isotopic ratio record (thereby extracting the effect of the geogenic mixing) has enabled us to reconstruct a detailed chronology of metal pollution. The first sustained decrease in Pb isotope signals is recorded as beginning ~1740-1780 with the lowest values (indicating the highest pollution signature) dated to ~1960-1970. The 206Pb/207Pb ratio of excess Pb (measuring 1.222, and reflecting pollution-generated Pb), when compared with the Pb isotopic composition of the Sandhavn peat record since the 19th century and the timing of Pb enrichments, clearly points to the dominance of pollution sources from North America, although it did not prove possible to further differentiate the emissions sources geographically.

Solar Output Controls Periodicity in Lake Productivity and Wetness at Southernmost South America.

Cyclic changes in total solar irradiance (TSI) during the Holocene are known to affect global climatic conditions and cause cyclic climatic oscillations, e.g., Bond events and related changes of environmental conditions. However, the processes how changes in TSI affect climate and environment of the Southern Hemisphere, especially in southernmost South America, a key area for the global climate, are still poorly resolved. Here we show that highly sensitive proxies for aquatic productivity derived from sediments of a lake near the Chilean South Atlantic coast (53 °S) strongly match the cyclic changes in TSI throughout the Holocene. Intra-lake productivity variations show a periodicity of ~200-240 years coherent with the time series of TSI-controlled cosmogenic nuclide 10Be production. In addition TSI dependent periodicity of Bond events (~1500 years) appear to control wetness at the LH site indicated by mineral matter erosion from the catchment to the lake assumingly through shifts of the position of the southern westerly wind belt. Thus, both intra-lake productivity and wetness at the southernmost South America are directly or indirectly controlled by TSI.

Long-term (∼57 ka) controls on mercury accumulation in the Southern Hemisphere reconstructed using a peat record from Pinheiro mire (Minas Gerais, Brazil).

Natural archives have been used to reconstruct mercury atmospheric deposition at different spatial and temporal scales during the Holocene in the Northern Hemisphere. In this study, we present the results from a Brazilian mountain mire (Pinheiro mire, Minas Gerais, SE Brazil), extending back to ∼57 ka. The core was analyzed for mercury concentration, organic matter content, organic carbon isotopic composition, and tracers of mineral matter flux. Principal components analysis followed by principal components regression enabled us to determine the evolution of the weight of the latent processes governing the accumulation of mercury through time. We show that climate change was the main driver for the variations of mercury concentrations, either indirectly by (i) enhancing soil erosion in the mire's catchment, which led to a decrease in mercury concentration due to dilution by low mercury-containing mineral matter, (ii) increasing regional dust deposition, which resulted in increased concentrations, or directly, by long-term changes in atmospheric wet deposition (arid vs humid periods). Internal peat processes (i.e., decomposition and mass loss) had a minor influence at the time scale represented by the core.