Building Phylogenetic Trees From Genome Sequences With kSNP4.

Performing phylogenetic analysis with genome sequences maximizes the information used to estimate phylogenies and the resolution of closely related taxa. The use of single-nucleotide polymorphisms (SNPs) permits estimating trees without genome alignments and permits the use of data sets of hundreds of microbial genomes. kSNP4 is a program that identifies SNPs without using a reference genome, estimates parsimony, maximum likelihood, and neighbor-joining trees, and is able to annotate the discovered SNPs. kSNP4 is a command-line program that does not require any additional programs or dependencies to install or use. kSNP4 does not require any programming experience or bioinformatics experience to install and use. It is suitable for use by students through senior investigators. It includes a detailed user guide that explains all of the many features of kSNP4. In this study, we provide a detailed step-by-step protocol for downloading, installing, and using kSNP4 to build phylogenetic trees from genome sequences.

Treatments for Morton's neuroma.

BACKGROUND: Morton's neuroma (MN) is a painful neuropathy resulting from a benign enlargement of the common plantar digital nerve that occurs commonly in the third webspace and, less often, in the second webspace of the foot. Symptoms include burning or shooting pain in the webspace that extends to the toes, or the sensation of walking on a pebble. These impact on weight-bearing activities and quality of life. OBJECTIVES: To assess the benefits and harms of interventions for MN. SEARCH METHODS: On 11 July 2022, we searched CENTRAL, CINAHL Plus EBSCOhost, ClinicalTrials.gov, Cochrane Neuromuscular Specialised Register, Embase Ovid, MEDLINE Ovid, and WHO ICTRP. We checked the bibliographies of identified randomised trials and systematic reviews and contacted trial authors as needed. SELECTION CRITERIA: We included all randomised, parallel-group trials (RCTs) of any intervention compared with placebo, control, or another intervention for MN. We included trials where allocation occurred at the level of the individual or the foot (clustered data). We included trials that confirmed MN through symptoms, a clinical test, and an ultrasound scan (USS) or magnetic resonance imaging (MRI). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. We assessed bias using Cochrane's risk of bias 2 tool (RoB 2) and assessed the certainty of the evidence using the GRADE framework. MAIN RESULTS: We included six RCTs involving 373 participants with MN. We judged risk of bias as having 'some concerns' across most outcomes. No studies had a low risk of bias across all domains. Post-intervention time points reported were: three months to less than 12 months from baseline (nonsurgical outcomes), and 12 months or longer from baseline (surgical outcomes). The primary outcome was pain, and secondary outcomes were function, satisfaction or health-related quality of life (HRQoL), and adverse events (AE). Nonsurgical treatments Corticosteroid and local anaesthetic injection (CS+LA) versus local anaesthetic injection (LA) Two RCTs compared CS+LA versus LA. At three to six months: • CS+LA may result in little to no difference in pain (mean difference (MD) -6.31 mm, 95% confidence interval (CI) -14.23 to 1.61; P = 0.12, I2 = 0%; 2 studies, 157 participants; low-certainty evidence). (Assessed via a pain visual analogue scale (VAS; 0 to 100 mm); a lower score indicated less pain.) • CS+LA may result in little to no difference in function when compared with LA (standardised mean difference (SMD) -0.30, 95% CI -0.61 to 0.02; P = 0.06, I2 = 0%; 2 studies, 157 participants; low-certainty evidence). (Function was measured using: the American Orthopaedic Foot and Ankle Society Lesser Toe Metatarsophalangeal-lnterphalangeal Scale (AOFAS; 0 to 100 points) - we transformed the scale so that a lower score indicated improved function - and the Manchester Foot Pain and Disability Schedule (MFPDS; 0 to 100 points), where a lower score indicated improved function.) • CS+LA probably results in little to no difference in HRQoL when compared to LA (MD 0.07, 95% CI -0.03 to 0.17; P = 0.19; 1 study, 122 participants; moderate-certainty evidence), and CS+LA may not increase satisfaction (risk ratio (RR) 1.08, 95% CI 0.63 to 1.85; P = 0.78; 1 study, 35 participants; low-certainty evidence). (Assessed using the EuroQol five dimension instrument (EQ-5D; 0-1 point); a higher score indicated improved HRQoL.) • The evidence is very uncertain about the effects of CS+LA on AE when compared with LA (RR 9.84, 95% CI 1.28 to 75.56; P = 0.03, I2 = 0%; 2 studies, 157 participants; very low-certainty evidence). Adverse events for CS+LA included mild skin atrophy (3.9%), hypopigmentation of the skin (3.9%) and plantar fat pad atrophy (2.6%); no adverse events were observed with LA. Ultrasound-guided (UG) CS+LA versus non-ultrasound-guided (NUG) CS+LA Two RCTs compared UG CS+LA versus NUG CS+LA. At six months: • UG CS+LA probably reduces pain when compared with NUG CS+LA (MD -15.01 mm, 95% CI -27.88 to -2.14; P = 0.02, I2 = 0%; 2 studies, 116 feet; moderate-certainty evidence). (Assessed with a pain VAS.) • UG CS+LA probably increases function when compared with NUG CS+LA (SMD -0.47, 95% CI -0.84 to -0.10; P = 0.01, I2 = 0%; 2 studies, 116 feet; moderate-certainty evidence). We do not know of any established minimum clinical important difference (MCID) for the scales that assessed function, specifically, the MFPDS and the Manchester-Oxford Foot Questionnaire (MOXFQ; 0 to 100 points; a lower score indicated improved function.) • UG CS+LA may increase satisfaction compared with NUG CS+LA (risk ratio (RR) 1.71, 95% CI 1.19 to 2.44; P = 0.003, I2 = 15%; 2 studies, 114 feet; low-certainty evidence). • HRQoL was not measured. • UG CS+LA may result in little to no difference in AE when compared with NUG CS+LA (RR 0.42, 95% CI 0.12 to 1.39; P = 0.15, I2 = 0%; 2 studies, 116 feet; low-certainty evidence). AE included depigmentation or fat atrophy for UG CS+LA (4.9%) and NUG CS+LA (12.7%). Surgical treatments Plantar incision neurectomy (PN) versus dorsal incision neurectomy (DN) One study compared PN versus DN. At 34 months (mean; range 28 to 42 months), PN may result in little to no difference for satisfaction (RR 1.06, 95% CI 0.87 to 1.28; P = 0.58; 1 study, 73 participants; low-certainty evidence), or for AE (RR 0.95, 95% CI 0.32 to 2.85; P = 0.93; 1 study, 75 participants; low-certainty evidence) compared with DN. AE for PN included hypertrophic scaring (11.4%), foreign body reaction (2.9%); AE for DN included missed nerve (2.5%), artery resected (2.5%), wound infection (2.5%), postoperative dehiscence (2.5%), deep vein thrombosis (2.5%) and reoperation with plantar incision due to intolerable pain (5%). The data reported for pain and function were not suitable for analysis. HRQoL was not measured. AUTHORS' CONCLUSIONS: Although there are many interventions for MN, few have been assessed in RCTs. There is low-certainty evidence that CS+LA may result in little to no difference in pain or function, and moderate-certainty evidence that UG CS+LA probably reduces pain and increases function for people with MN. Future trials should improve methodology to increase certainty of the evidence, and use optimal sample sizes to decrease imprecision.

Alleviation of severe chronic arthritic pain using polyvalent immunoglobulins (KMP01): Two case reports.

BACKGROUND: Treatment of arthritis is carried out using corticosteroids, methotrexate, sulfasalazine-like agents, and TNF-α-blocking agents such as infliximab and adalimumab. The disadvantages of these agents are high-cost, severe side effects including leucopenia, and in some cases the necessity of administration by injection. Polyvalent immunoglobulin formulations derived from bovine colostrum and marketed as a standardized formulation for oral application, are reported to be efficacious in chronic pain syndromes but are rarely, if ever, used as an alternative medication in such patients. AIMS: To treat arthritis in a real-world setting using polyvalent immunoglobulins in 2 patients, in one case where no alternative treatment modality was available and in another patient in whom the use of polyvalent immunoglobulins appeared to be a suitable option. MATERIALS AND METHODS: Two male subjects aged 46 and 82 years with confirmed diagnosis but not well-controlled arthritis/polyarthritis receiving either high-dose NSAIDS, corticosteroids, methotrexate injections, with previous use of, or recommendations for treatment with monoclonal antibodies (etanercept and adalimumab) were treated with oral polyvalent immunoglobulins (KMP01; dose range 10 - 20 g daily) in real-world settings, in one case during a field excursion in Peru. RESULTS: The treatment produced a rapid alleviation of pain in both patients, in one patient where the symptoms were severe and debilitating. In the second patient methotrexate SC injections could be discontinued, and there was a progressive reversal of leucopenia (leucocyte count 3.9 × 103/µL) over a period of ~ 3 months. DISCUSSION: Polyvalent immunoglobulins have been shown previously to reduce the expression of interleukin-6 and C-reactive protein in peripheral blood monocytes, events attributed to the neutralization of gut-derived endotoxin ligands lipopolysaccharides (LPS) driving the basal immune response. The mode of action of KMP01 on cytokine expression is therefore similar to the TNF-α-blocking agents etanercept and adalimumab. CONCLUSION: Findings from two case reports support the rationale for using polyvalent immunoglobulins as an effective and safe alternative in arthritis patients receiving standard treatments, in particular, methotrexate and TNF-α-blocking agents.

Effect of repeated post-resistance exercise cold or hot water immersion on in-season inflammatory responses in academy rugby players: a randomised controlled cross-over design.

PURPOSE: Uncertainty exists if post-resistance exercise hydrotherapy attenuates chronic inflammatory and hormone responses. The effects of repeated post-resistance exercise water immersion on inflammatory and hormone responses in athletes were investigated. METHODS: Male, academy Super Rugby players (n = 18, 19.9 ± 1.5 y, 1.85 ± 0.06 m, 98.3 ± 10.7 kg) participated in a 12-week programme divided into 3 × 4-week blocks of post-resistance exercise water immersion (either, no immersion control [CON]; cold [CWI]; or hot [HWI] water immersion), utilising a randomised cross-over pre-post design. Fasted, morning blood measures were collected prior to commencement of first intervention block, and every fourth week thereafter. Linear mixed-effects models were used to analyse main (treatment, time) and interaction effects. RESULTS: Repeated CWI (p = 0.025, g = 0.05) and HWI (p < 0.001, g = 0.62) reduced creatine kinase (CK), compared to CON. HWI decreased (p = 0.013, g = 0.59) interleukin (IL)-1ra, compared to CON. HWI increased (p < 0.001-0.026, g = 0.06-0.17) growth factors (PDGF-BB, IGF-1), compared to CON and CWI. CWI increased (p = 0.004, g = 0.46) heat shock protein-72 (HSP-72), compared to HWI. CONCLUSION: Post-resistance exercise CWI or HWI resulted in trivial and moderate reductions in CK, respectively, which may be partly due to hydrostatic effects of water immersion. Post-resistance exercise HWI moderately decreased IL-1ra, which may be associated with post-resistance exercise skeletal muscle inflammation influencing chronic resistance exercise adaptive responses. Following post-resistance exercise water immersion, CWI increased HSP-72 suggesting a thermoregulatory response indicating improved adaptive inflammatory responses to temperature changes, while HWI increased growth factors (PDGF-BB, IGF-1) indicating different systematic signalling pathway activation. Our data supports the continued use of post-resistance exercise water immersion recovery strategies of any temperature during in-season competition phases for improved inflammatory adaptive responses in athletes.

Primary lymphoma of bone of the little finger: a case report and review of the literature.

Primary lymphoma of bone (PLB) is a rare, malignant lymphoid proliferation within bone accounting for less than 3% of all malignant bone tumors. In this case report, a 61-year-old female with past medical history of gout presented with pain and swelling in her right little finger. Initial radiographs demonstrated periostitis and soft tissue swelling about the right little finger. She returned three months later with progressive pain. Subsequent MRI and repeat radiographs demonstrated near complete destruction of the right little finger middle phalanx and periostitis with marrow infiltration at the right long finger. Given the rapid progression of disease, the differential diagnosis consisted primarily of aggressive neoplastic processes. The little finger ray was amputated through the level of the metacarpophalangeal joint and histopathology demonstrated large neoplastic cells that stained positive with CD45, CD20, and PAX5, compatible with diffuse large B-cell lymphoma. A subsequent normal bone marrow aspiration and PET-CT demonstrated no additional sites of disease, thus excluding secondary lymphoma to bone. To the best of our knowledge, this is the first case report of polyostotic PLB involving the hand. PLB of the hands may be initially misdiagnosed due to its rarity and clinical presentation mimicking rheumatological disease. Clinical vigilance in concert with close imaging follow-up is required to make the diagnosis in a timely fashion. We also review the existing PLB hand literature which consists of five cases.

What Are Patients Told About Innovative Surgical Procedures? A Qualitative Synthesis of 7 Case Studies in the United Kingdom.

OBJECTIVES: To investigate how information about innovative surgical procedures is communicated to patients. BACKGROUND: Despite the national and international guidance that patients should be informed whether a procedure is innovative and has uncertain outcomes, little is known about current practice. METHODS: This qualitative study followed 7 "case studies" of surgical innovation in hospitals across the United Kingdom. Preoperative interviews were conducted with clinician innovators (n=9), preoperative real-time consultations between clinicians and patients were audio-recorded (n=37). Patients were interviewed postoperatively (n=30). Data were synthesized using thematic analytical methods. RESULTS: Interviews with clinicians demonstrated strong intentions to inform patients about the innovative nature of the procedure in a neutral manner, although tensions between fully informing patients and not distressing them were raised. In the consultations, only a minority of clinicians actually made explicit statements about, (1) the procedure being innovative, (2) their limited clinical experience with it, (3) the paucity of evidence, and (4) uncertainty/unknown outcomes. Discussions about risks were generalized and often did not relate to the innovative component. Instead, all clinicians optimistically presented potential benefits and many disclosed their own positive beliefs. Postoperative patient interviews revealed that many believed that the procedure was more established than it was and were unaware of the unknown risks. CONCLUSIONS: There were contradictions between clinicians' intentions to inform patients about the uncertain outcomes of innovative and their actual discussions with patients. There is a need for communication interventions and training to support clinicians to provide transparent data and shared decision-making for innovative procedures.

No effect of repeated post-resistance exercise cold or hot water immersion on in-season body composition and performance responses in academy rugby players: a randomised controlled cross-over design.

PURPOSE: Following resistance exercise, uncertainty exists as to whether the regular application of cold water immersion attenuates lean muscle mass increases in athletes. The effects of repeated post-resistance exercise cold versus hot water immersion on body composition and neuromuscular jump performance responses in athletes were investigated. METHODS: Male, academy Super Rugby players (n = 18, 19.9 ± 1.5 y, 1.85 ± 0.06 m, 98.3 ± 10.7 kg) participated in a 12-week (4-week × 3-intervention, i.e., control [CON], cold [CWI] or hot [HWI] water immersion) resistance exercise programme, utilising a randomised cross-over pre-post-design. Body composition measures were collected using dual-energy X-ray absorptiometry prior to commencement and every fourth week thereafter. Neuromuscular squat (SJ) and counter-movement jump (CMJ) performance were measured weekly. Linear mixed-effects models were used to analyse main (treatment, time) and interaction effects. RESULTS: There were no changes in lean (p = 0.960) nor fat mass (p = 0.801) between interventions. CON (p = 0.004) and CWI (p = 0.003) increased (g = 0.08-0.19) SJ height, compared to HWI. There were no changes in CMJ height (p = 0.482) between interventions. CONCLUSION: Repeated post-resistance exercise whole-body CWI or HWI does not attenuate (nor promote) increases in lean muscle mass in athletes. Post-resistance exercise CON or CWI results in trivial increases in SJ height, compared to HWI. During an in-season competition phase, our data support the continued use of post-resistance exercise whole-body CWI by athletes as a recovery strategy which does not attenuate body composition increases in lean muscle mass, while promoting trivial increases in neuromuscular concentric-only squat jump performance.

Fluoroscopic-guided procedures of the lower extremity.

This article reviews the literature and the authors' experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.

Beyond schwannomas and neurofibromas: a radiological and histopathological review of lesser-known benign lesions that arise in association with peripheral nerves.

Peripheral nerve sheath tumors comprise a significant percentage of both benign and malignant soft tissue tumors. The vast majority of these lesions are schwannomas and neurofibromas, which most radiologists are familiar with including the well-described multimodality imaging features. However, numerous additional often under-recognized benign entities associated with nerves exist. These rarer entities are becoming increasingly encountered with the proliferation of cross-sectional imaging, particularly magnetic resonance imaging (MRI). It is important for the radiologist to have a basic understanding of these entities as many have near-pathognomonic MR imaging features as well as specific clinical presentations that when interpreted in concert, often allows for a limited differential or single best diagnosis. The ability to provide a prospective, pre-intervention diagnosis based solely on imaging and clinical presentation is crucial as several of these entities are "do not touch" lesions, for which even a biopsy may have deleterious consequences. To our knowledge, the majority of these benign entities associated with nerves have only been described in scattered case reports or small case series. Therefore, the aim of this article is to provide a radiopathologic comprehensive review of these benign entities that arise in association with nerves with a focus on characteristic MRI features, unique histopathologic findings, and entity specific clinical exam findings/presentation.

Right and left ventricular mass development in early infancy: Correlation of electrocardiographic changes with echocardiographic measurements.

BACKGROUND: Right ventricular mass indexed to body surface area (RVMI) decreases and left ventricular mass index (LVMI) increases rapidly and substantially during early infancy. The relationship between these sizeable mass transformations and simultaneous electrocardiographic changes have not been previously delineated. METHODS: Normal term infants (#45 initially enrolled) were prospectively evaluated at 2 days and at 2-week, 2-month, and 4-month clinic visits. Ventricular masses were estimated with 2D echocardiographic methods. QRS voltages were measured in leads V1, V6, I and aVF. RESULTS: Mean QRS axis shifted from 135 (95%CI 124, 146) to 65 degrees (95%CI 49, 81) and correlated with both RVMI decrease and LVMI increase (R = 0.46⁎ vs. 0.25†, respectively. *p < 0.01, †p < 0.05). As RVMI decreased from mean 28.1 (95%CI 27.1, 29.1) to 23.3 g/m2 (95%CI 21.4, 25.2) so did V1R and V6S voltages. RVMI changes correlated with V1R, V6S, and V1R + V6S voltages (R = 0.29*, 0.23† and 0.35*, respectively. *p < 0.01, †p < 0.05) but not with V1R/S ratio. As LVMI increased from 44.6 (95%CI 42.9, 46.3) to 55.4 g/m2 (95%CI 52.3, 58.5) V6R and V6Q increased but V1S voltage did not. LVMI changes correlated with V6R, V6R-S, and V6(Q + R)-S voltages (R = 0.31*, 0.34*, and 0.38* respectively. *p < 0.01) but not with V1S or V6R/S (R = 0.01 and 0.18 respectively, p = NS). CONCLUSIONS: During early infancy the RVMI decrease correlates best with the QRS axis shift and V1R + V6S voltage, and the LVMI increase correlates best with V6R-S and V6(Q + R)-S voltages.

Acute Performance, Daily Well-Being, and Hormone Responses to Water Immersion After Resistance Exercise in Junior International and Subelite Male Volleyball Athletes.

ABSTRACT: Horgan, BG, Tee, N, West, NP, Drinkwater, EJ, Halson, SL, Colomer, CME, Fonda, CJ, Tatham, J, Chapman, DW, and Haff, GG. Acute performance, daily well-being and hormone responses to water immersion after resistance exercise in junior international and subelite male volleyball athletes. J Strength Cond Res 37(8): 1643-1653, 2023-Athletes use postexercise hydrotherapy strategies to improve recovery and competition performance and to enhance adaptative responses to training. Using a randomized cross-over design, the acute effects of 3 postresistance exercise water immersion strategies on perceived recovery, neuromuscular performance, and hormone concentrations in junior international and subelite male volleyball athletes ( n = 18) were investigated. After resistance exercise, subjects randomly completed either 15-minute passive control (CON), contrast water therapy (CWT), cold (CWI), or hot water immersion (HWI) interventions. A treatment effect occurred after HWI; reducing perceptions of fatigue (HWI > CWT: p = 0.05, g = 0.43); improved sleep quality, compared with CON ( p < 0.001, g = 1.15), CWI ( p = 0.017, g = 0.70), and CWT ( p = 0.018, g = 0.51); as well as increasing testosterone concentration (HWI > CWT: p = 0.038, g = 0.24). There were trivial to small ( p < 0.001-0.039, g = 0.02-0.34) improvements (treatment effect) in jump performance (i.e., squat jump and countermovement jump) after all water immersion strategies, as compared with CON, with high variability in the individual responses. There were no significant differences (interaction effect, p > 0.05) observed between the water immersion intervention strategies and CON in performance ( p = 0.153-0.99), hormone ( p = 0.207-0.938), nor perceptual ( p = 0.368-0.955) measures. To optimize recovery and performance responses, e.g., during an in-season competition phase, postresistance exercise HWI may assist with providing small-to-large improvements for up to 38 hours in perceived recovery (i.e., increased sleep quality and reduced fatigue) and increases in circulating testosterone concentration. Practitioners should consider individual athlete neuromuscular performance responses when prescribing postexercise hydrotherapy. These findings apply to athletes who aim to improve their recovery status, where postresistance exercise HWI optimizes sleep quality and next-day perceptions of fatigue.

Utilization of the Caprini Score for Risk Stratification of the Arthroplasty Patient in the Prevention of Postoperative Venous Thrombosis.

Venous thromboembolism (VTE) is a serious and predictable complication following arthroplasty. It has been recognized that a strategy utilizing individualized anticoagulation choices based on patient risk stratification results in improved patient outcomes. A 2013 version of the Caprini Risk Score has previously been validated for use in total joint arthroplasty. A Caprini score of 10 or greater assesses the patient as "high risk" while 9 or less is considered "low risk." Patients scored as "low risk" for postoperative VTE receive enteric coated aspirin 81 mg twice a day for 6 weeks. Patients scored as "high risk" for VTE are prescribed apixaban. This retrospective cohort study was conducted to assess the safety and efficacy of the thromboprophylaxis treatment prescribed based on a standardized risk assessment protocol for the calendar year 2020. Patients having total hip arthroplasty, total knee arthroplasty, revision total hip arthroplasty, revision total knee arthroplasty, or bilateral arthroplasties by 13 surgeons (N = 873) were reviewed. Patients were risk assessed using the Caprini Risk Score and thromboprophylaxis was prescribed based on the score obtained. The annual rate of VTE was 0.2%. The Caprini Risk Score is an effective approach to individualize thromboprophylaxis choices after total joint arthroplasty.

Evidence that oral immunoglobulins (KMP01) suppress pro-tumor inflammation in rectal carcinoma: Case report and treatment concept.

BACKGROUND: A female patient aged 49 years with a rectal adenocarcinoma underwent tumor resection and multiple follow-up surgical operations whilst receiving compassionate therapy with polyvalent immunoglobulins derived from bovine colostrum (KMP01), a potential modulator of the pro-tumor inflammatory response. AIMS: Assessment of safety of the treatment, effect on tumor recurrence, and effect on parameters associated with the pro-tumor inflammatory response. MATERIALS AND METHODS: The dose of KMP01 varied from 72 g daily in the perioperative period to 12 - 24 g daily thereafter. The pro-tumor inflammatory response was measured using changes in C-reactive protein (CRP) and the lymphocyte-monocyte ratio (LMR). RESULTS: Surgical intervention caused large increases in CRP (up to 400 mg/L) and decreases in the LMR (below target levels of 2.83). However, such changes rapidly returned to normal, where they remained during prolonged treatment with immunoglobulins. Despite the generally poor prognosis associated with a stenotic tumor, cachexia, and multiple surgery, there was no tumor recurrence during the 3-year follow-up. The condition of the patient is good, albeit with a reduced quality of life due to the stoma. CONCLUSION: Polyvalent immunoglobulins constitute a potential and safe prophylactic agent against the pro-tumor inflammatory response. This is the first time that polyvalent immunoglobulins have been used in a colorectal carcinoma patient. The findings can be a basis for further investigations.

Acute Inflammatory, Anthropometric, and Perceptual (Muscle Soreness) Effects of Postresistance Exercise Water Immersion in Junior International and Subelite Male Volleyball Athletes.

ABSTRACT: Horgan, BG, West, NP, Tee, N, Drinkwater, EJ, Halson, SL, Vider, J, Fonda, CJ, Haff, GG, and Chapman, DW. Acute inflammatory, anthropometric, and perceptual (muscle soreness) effects of postresistance exercise water immersion in junior international and subelite male volleyball athletes. J Strength Cond Res 36(12): 3473-3484, 2022-Athletes use water immersion strategies to recover from training and competition. This study investigated the acute effects of postexercise water immersion after resistance exercise. Eighteen elite and subelite male volleyball athletes participated in an intervention using a randomized cross-over design. On separate occasions after resistance exercise, subjects completed 1 of 4 15-minute interventions: control (CON), cold water immersion (CWI), contrast water therapy (CWT), or hot water immersion (HWI). Significance was accepted at p ≤ 0.05. Resistance exercise induced significant temporal changes (time effect) for inflammatory, anthropometric, perceptual, and performance measures. Serum creatine kinase was reduced ( g = 0.02-0.30) after CWI ( p = 0.007), CWT ( p = 0.006), or HWI ( p < 0.001) vs. CON, whereas it increased significantly ( g = 0.50) after CWI vs. HWI. Contrast water therapy resulted in significantly higher ( g = 0.56) interleukin-6 concentrations vs. HWI. Thigh girth increased ( g = 0.06-0.16) after CWI vs. CON ( p = 0.013) and HWI ( p < 0.001) and between CWT vs. HWI ( p = 0.050). Similarly, calf girth increased ( g = 0.01-0.12) after CWI vs. CON ( p = 0.039) and CWT ( p = 0.018), and HWI vs. CON ( p = 0.041) and CWT ( p = 0.018). Subject belief in a postexercise intervention strategy was associated with HSP72 ("believer">"nonbeliever," p = 0.026), muscle soreness ("believer">"nonbeliever," p = 0.002), and interleukin-4 ("nonbeliever">"believer," p = 0.002). There were no significant treatment × time (interaction effect) pairwise comparisons. Choice of postexercise water immersion strategy (i.e., cold, contrast, or hot) combined with a belief in the efficacy of that strategy to enhance recovery or performance improves biological and perceptual markers of muscle damage and soreness. On same or subsequent days where resistance exercise bouts are performed, practitioners should consider athlete beliefs when prescribing postexercise water immersion, to reduce muscle soreness.

Identification of an Amygdala-Thalamic Circuit That Acts as a Central Gain Mechanism in Taste Perceptions.

Peripheral sources of individual variation in taste intensity perception have been well described. The existence of a central source has been proposed but remains unexplored. Here we used functional magnetic resonance imaging in healthy human participants (20 women, 8 men) to evaluate the hypothesis that the amygdala exerts an inhibitory influence that affects the "gain" of the gustatory system during tasting. Consistent with the existence of a central gain mechanism (CGM), we found that central amygdala response was correlated with mean intensity ratings across multiple tastants. In addition, psychophysiological and dynamic causal modeling analyses revealed that the connection strength between inhibitory outputs from amygdala to medial dorsal and ventral posterior medial thalamus predicted individual differences in responsiveness to taste stimulation. These results imply that inhibitory inputs from the amygdala to the thalamus act as a CGM that influences taste intensity perception.SIGNIFICANCE STATEMENT Whether central circuits contribute to individual variation in taste intensity perception is unknown. Here we used functional magnetic resonance imaging in healthy human participants to identify an amygdala-thalamic circuit where network dynamics and connectivity strengths during tasting predict individual variation in taste intensity ratings. This finding implies that individual differences in taste intensity perception do not arise solely from variation in peripheral gustatory factors.

A Systematic Review of Minimally Invasive Trans-thoracic Liver Resection to Examine Intervention Description, Governance, and Outcome Reporting of an Innovative Technique.

INTRODUCTION: The number of laparoscopic liver resections undertaken has increased. However, lesions located postero-superiorly are difficult to access. This may be overcome by the novel use of trans-thoracic port(s). Methods for the safe and transparent introduction of new and modified surgical procedures are limited and a summary of these issues, for minimally invasive trans-thoracic liver resections (MITTLR), is lacking. This study aims to understand and summarize technique description, governance procedures, and reporting of outcomes for MITTLR. METHODS: A systematic literature search to identify primary studies of all designs describing MITTLR was undertaken. How patients were selected for the new technique was examined. The technical components of MITTLR were identified and summarized to understand technique development over time. Governance arrangements (eg, Institutional Review Board approval) and steps taken to mitigate harm were recorded. Finally, specific outcomes reported across studies were documented. RESULTS: Of 2067 screened articles, 16 were included reporting data from 145 patients and 6 countries. Selection criteria for patients was explicitly stated in 2 papers. No studies fully described the technique. Five papers reported ethical approval and 3 gave details of patient consent. No study reported on steps taken to mitigate harm.Technical outcomes were commonly reported, for example, blood loss (15/16 studies), operative time (15/16), and margin status (11/16). Information on patient-reported outcomes and costs were lacking. CONCLUSIONS: Technical details and governance procedures were poorly described. Outcomes focussed on short term details alone. Transparency is needed for reporting the introduction of new surgical techniques to allow their safe dissemination.

Concepts in Musculoskeletal Bone and Soft Tissue Biopsy.

Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.

COVID-19: Effect-modelling of vaccination in Germany with regard to the mutant strain B.1.1.7 and occupancy of ICU facilities.

BACKGROUND: The characteristics of the COVID-19 pandemic in Europe have changed since the initial outbreak in 2019 due to the emergence of more contagious mutant strains, notably the B.1.1.7 variant. This has resulted in the rapid implementation of vaccination programs in an effort to control the spread of the disease. AIMS: To model the effect of vaccination on the course of the pandemic in Germany taking into account observational data and the appearance of viral mutant B.1.1.7. MATERIALS AND METHODS: An effect model based on the Batman-SIZ algorithm was developed, taking into account both the parent and the B.1.1.7 mutant strains of the SARS-CoV-2 coronavirus and using input parameters obtained from observational data for January - March 2021. RESULTS: Effect-modelling using 3 different vaccination scenarios with different rates of vaccination involving 67 million persons (priority groups 1 - 5) and completed within 134 days compared to 318 days beginning February 24, 2021, showed a reduction in the number of infected persons from ca. 12.5 million to ca. 4.5 million with quantitively similar benefits regarding the occupancy and a critical burden on ICU facilities. CONCLUSION: The effect of vaccination in reducing the daily number of new infections, the total number of infections and the occupancy of intensive-care facilities in hospitals is proportional to the speed with which the target population are vaccinated.

COVID-19: Predictions for SARS-CoV-2 vaccination on the course of the pandemic and critical occupancy of intensive-care facilities in Germany.

AIMS OF THE STUDY: To obtain predictions using the Modified Bateman SIZ Model for the effects of vaccination on the course of the COVID-19 pandemic in Germany. MATERIALS AND METHODS: Start parameters for the model were obtained from observational data after data-smoothing to reduce between-day variation. Three scenarios, 1) no vaccination, 2) vaccination of 60% of the population over 12 months, 3) vaccination of 60% of the population over 7 months were examined. The effects of changes in tα (doubling-time for the spread of infection, known to be slower in the summer months) and tß (half-life of recovery from infection) on the daily number of infectious persons, the cumulative number of infected persons, and the duration of critical occupancy of intensive-care units were also determined. RESULTS: Vaccination produced a marked and rapid reduction in the number of infectious persons (up to -60%) and the total number of infected persons (up to -70%). A 7-month vaccination strategy was significantly more effective than a 12-month strategy. The summer effect came too late to have an additional effect on the spread of infection. Vaccination was predicted to reduce the duration of critical occupancy of intensive-care facilities by ~ 70%. DISCUSSION: The predictions are based on the assumptions that lockdown conditions are maintained and vaccine availability is not limiting. CONCLUSION: Predictions made using the model show that vaccination with a SARS-CoV-2 vaccine can markedly reduce the spread of the COVID-19 disease and the period of critical occupancy of intensive-care facilities in Germany.

Impaired recovery is associated with increased injury and illness: A retrospective study of 536 female netball athletes.

Sport science and medicine practitioners are interested in the relationships between training load, injury, and illness. The extent to which training preparedness is associated with workload-related injury and illness risk is debated. Therefore, this study applied multi-level mixed effect logistic regression to investigate time-dependent (±7- and ±28-day) relationships between training preparedness (fatigue, mood, motivation, soreness, stress, sleep duration, and quality), training load, injury, and illness in 536 elite and pre-elite female netball athletes. Absolute risk (AR ± 95% CI) of sustaining an injury (0.98 ± 0.06%, n = 1122 injuries, N = 254 athletes) or illness (1.09 ± 0.10%, n = 2881, N = 432 athletes) was calculated. All training preparedness variables combined resulted in an absolute risk of 0.88%-5.88% and 0.87%-20% for injury and illness, respectively. Injury and illness had significant (P < .05) bidirectional (ie, both increased and decreased) associations with physical (soreness) and physiological (sleep duration and quality), while illness also had negative (mood, motivation) and positive (stress) associations with psychological training preparedness variables. Low sleep duration in the 48-h period prior was associated (P = .005) with increased injury risk (OR = 0.91 ± 0.03; AR = 4.00%), while "very poor" sleep quality (OR = 0.59 ± 0.02; AR = 7.83%) or extremes of too little (<5 hours, OR = 1.01 ± 0.03; AR = 3.13%-14.29%) and too much (>10 hours, OR = 1.01 ± 0.03; AR = 2.61%-10.98%) sleep had bidirectional associations (P < .001) with an increased illness risk. Changes in training preparedness variables demonstrated bidirectional associations with injury and illness. These outcomes suggest that sport science and medicine practitioners should monitor sleep, physical, and psychological recovery status, to aid early detection and intervention regarding injury and illness symptomology.