Twenty-Four-Hour Movement Behaviors in Adults and Older Adults before Total Knee Arthroplasty: a Study Based on Compositional Data Analysis.

PURPOSE OF THE STUDY This study aims to describe and analyze the age differences in the 24-hour movement behavior patterns among a sample of adults and older adults with end-stage knee osteoarthritis referred for total knee arthroplasty (TKA). MATERIAL AND METHODS A total of 86 patients referred for TKA were included in this study. Sleep duration, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed using multi-day 24-hour raw data from wrist-worn accelerometers. Compositional data analysis was used to analyze the differences between the age categories. RESULTS On average (SD), the adults were 59.0 (± 4.9) years; 63% female. The older adults were 72.4 (± 5.5) years; 58% female. The adults reached 23.9 milli-gravitational units (mg) as a mean acceleration over the whole day; 34% (8.1 h/day) of the time was classified as sleep, 48.9% (11.7 h/day) as SB, 12.1% (2.9 h/day) as LPA, and 5.1% (72.9 min/day) as MVPA. The older adults reached 21.3 mg; 35.2% (8.4 h/day) of the time was classified as sleep, 50.4% (12.1 h/day) as SB, 11.3% (2.7 h/day) as LPA, and 3.1% (44.9 min/day) as MVPA. Compared with the older adults, the proportion of time spent in total MVPA (P = 0.008) and MVPA bouts of ≥1 min were greater (P ≤ 0.028) in the adult group, while the proportion of time spent in total SB was lower (P = 0.045). No age difference was found for the proportion of time spent asleep. DISCUSSION Sleep, SB, and PA are exclusive and exhaustive parts of the overall 24-h day. Using accelerometer-based measures of 24-hour movement behavior to describe these behaviors more accurately is crucial for a better understanding of patients with end-stage KOA. CONCLUSIONS Our findings suggest that the adults and older adults referred for TKA are physically active despite suffering from severe knee osteoarthritis. Such a high level of physical activity may be difficult to increase by TKA postoperatively. If replicated by other studies, 24-hour movement behaviors should be implemented among the examinations required before TKA. Key words: knee osteoarthritis, accelerometer, sedentary behaviour, physical activity, sleep, 24-hour lifestyle behaviour.

Commentary on a combined approach to the problem of developing biomarkers for the prediction of spontaneous preterm labor that leads to preterm birth.

INTRODUCTION: Globally, preterm birth has replaced congenital malformation as the major cause of perinatal mortality and morbidity. The reduced rate of congenital malformation was not achieved through a single biophysical or biochemical marker at a specific gestational age, but rather through a combination of clinical, biophysical and biochemical markers at different gestational ages. Since the aetiology of spontaneous preterm birth is also multifactorial, it is unlikely that a single biomarker test, at a specific gestational age will emerge as the definitive predictive test. METHODS: The Biomarkers Group of PREBIC, comprising clinicians, basic scientists and other experts in the field, with a particular interest in preterm birth have produced this commentary with short, medium and long-term aims: i) to alert clinicians to the advances that are being made in the prediction of spontaneous preterm birth; ii) to encourage clinicians and scientists to continue their efforts in this field, and not to be disheartened or nihilistic because of a perceived lack of progress and iii) to enable development of novel interventions that can reduce the mortality and morbidity associated with preterm birth. RESULTS: Using language that we hope is clear to practising clinicians, we have identified 11 Sections in which there exists the potential, feasibility and capability of technologies for candidate biomarkers in the prediction of spontaneous preterm birth and how current limitations to this research might be circumvented. DISCUSSION: The combination of biophysical, biochemical, immunological, microbiological, fetal cell, exosomal, or cell free RNA at different gestational ages, integrated as part of a multivariable predictor model may be necessary to advance our attempts to predict sPTL and PTB. This will require systems biological data using "omics" data and artificial intelligence/machine learning to manage the data appropriately. The ultimate goal is to reduce the mortality and morbidity associated with preterm birth.

Diagnostic performance of body mass index to identify adiposity in women.

BACKGROUND/OBJECTIVES: The aim of this study was to determine the diagnostic performance of body mass index (BMI) and to detect the optimal BMI cutoff points to define adiposity in women of various ages. SUBJECTS/METHODS: A total of 2409 women participated. Fat mass was measured using a multifrequency bioelectrical impedance analysis. The diagnostic performance of BMI to identify adiposity was evaluated using a fat mass percentage cutoff point of ⩾35%. RESULTS: Although 40% of women were overfat, the BMI-based obesity prevalence was 21%. In the total sample, BMI had low overall performance, which resulted in a sensitivity of 51.9% (95% confidence interval (CI): 48.7-55.2%) and a specificity of 99.2% (95% CI: 98.7-99.6%). BMI failed to identify overfat women with intermediate BMI ranges. An analysis of the receiver operating characteristic curves of all of the subjects demonstrated that optimal cutoff point corresponded to a BMI value of 26.4 kg/m(2). The diagnostic performance of BMI did not differ as age increased. CONCLUSIONS: BMI has a high specificity but a low sensitivity to detect adiposity, and it fails to identify nearly half of women with excess fat mass. We provide evidence that a commonly used BMI cutoff value to diagnose obesity is too high among women.

Comparison of multi- and single-frequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of body composition in post-menopausal women: effects of body mass index and accelerometer-determined physical activity.

BACKGROUND: Bioelectric impedance analysis (BIA) is commonly used in research to assess body composition. However, studies that validate the accuracy of BIA exclusively in post-menopausal women are lacking. The main purpose of the present study was to evaluate the agreement of multi-frequency (MF)-BIA and single-frequency (SF)-BIA with dual-energy X-ray absorptiometry (DXA) in the estimation of fat mass (FM) and fat-free mass (FFM) among post-menopausal women with variation in body mass index (BMI) and physical activity (PA). METHODS: FM and FFM were estimated by BIA and DXA in 146 post-menopausal women with a mean (SD) age of 62.8 (5.2) years. PA was determined by an accelerometer. RESULTS: The mean (SD) difference between MF-BIA and DXA was -1.8 (1.8) kg (P = 0.08) and 1.3 (1.8) kg (P = 0.01) for FM and FFM, respectively. SF-BIA provided a significantly lower estimate of FM [-2.0 (2.2) kg; P = 0.04] and a higher estimate of FFM [1.8 (2.4) kg; P < 0.01] compared to DXA. MF-BIA provided significantly better estimates of FM and FFM with narrower limits of agreement than SF-BIA in obese and insufficiently active subjects. In other BMI and PA groups, both BIA devices showed a similar deviation from DXA. CONCLUSIONS: BIA tends to underestimate FM and overestimate FFM relative to DXA. MF-BIA appears to be a more appropriate method for the assessment of body composition than SF-BIA in post-menopausal woman with BMI >30 kg/m(2) and in those who are insufficiently active.

Change in performance in response to training load adjustment based on autonomic activity.

The primary aim of this study was to assess performance (Perf) changes in response to a new training strategy. Specifically, based on spectral analysis of heart rate variability (SA HRV) to determine autonomic nervous system (ANS) activity, training doses were adjusted to maintain vagal activity at a high and relatively stable level during training preparation. Trained athletes (5 male and 5 female) aged 23.2±4.2 years voluntarily participated in the study. ANS activity was assessed during an orthoclinostatic test, and was represented by calculating HRV variables and a total score index. Over 17 weeks, improvement (1.4-8.5%) and deterioration (0.1-8.8%) in Perf were detected in 7 and 3 athletes, respectively. A relationship (rs=0.684; P<0.05) between the change in Perf (ΔPerf) and supine PHF during season was found. Supine HRV indices (PHF, PT, and MSSD) for the last 3 weeks of the HRV-adjusting period correlated (rs=0.636; 0.648; 0.648, P<0.05) with ΔPerf. Based on the results, a high and relative stable vagal activity during preparation may indicate a readiness to train or appropriate recovery that positively affects Perf. In conclusion, daily quantification of ANS activity by SA HRV seems to be a promising tool for the enhancement of Perf.

Vagal threshold determination. Effect of age and gender.

Progressive increases in exercise intensity cause significant decreases in vagal activity (VA) until a critical point called the vagal threshold (TVA) is reached. This is where further increases in exercise intensity cause negligible change in VA. This study was designed to develop the algorithm for the TVA determination and to assess the effects of age and gender on its level. The sample consisted of 40 subjects who were divided according to age and gender into 4 groups with 10 subjects each: G1-Men age 25-31, G2-Men age 40-57, G3-Women age 24-28, and G4-Women age 43-56. The vagal responses were assessed by spectral analysis of the heart rate variability method while walking on a treadmill in a steady-state at intensities of 20-70% of the maximal heart rate reserve (MHRR). The mean intensity of 45% MHRR was suggested as the TVA level which is related neither to age nor gender. Heart rate related to TVA (TVA-HR) was affected by gender. High frequency power at TVA was influenced by age. The TVA-HR was considered to be a promising tool for the prescription of a safe level of physical activity for subjects with higher risks of health complications involving elevated sympathoadrenal activity during exercise.

Physical evidence for distinct mechanisms of translational control by upstream open reading frames.

The Saccharomyces cerevisiae GCN4 mRNA 5'-leader contains four upstream open reading frames (uORFs) and the CPA1 leader contains a single uORF. To determine how these uORFs control translation, we examined mRNAs containing these leaders in cell-free translation extracts to determine where ribosomes were loaded first and where they were loaded during steady-state translation. Ribosomes predominantly loaded first at GCN4 uORF1. Following its translation, but not the translation of uORF4, they efficiently reinitiated protein synthesis at Gcn4p. Adding purified eIF2 increased reinitiation at uORFs 3 or 4 and reduced reinitiation at Gcn4p. This indicates that eIF2 affects the site of reinitiation following translation of GCN4 uORF1 in vitro. In contrast, for mRNA containing the CPA1 uORF, ribosomes reached the downstream start codon by scanning past the uORF. Addition of arginine caused ribosomes that had synthesized the uORF polypeptide to stall at its termination codon, reducing loading at the downstream start codon, apparently by blocking scanning ribosomes, and not by affecting reinitiation. The GCN4 and CPA1 uORFs thus control translation in fundamentally different ways.

A highly conserved mechanism of regulated ribosome stalling mediated by fungal arginine attenuator peptides that appears independent of the charging status of arginyl-tRNAs.

The Arg attenuator peptide (AAP) is an evolutionarily conserved peptide involved in Arg-specific negative translational control. It is encoded as an upstream open reading frame (uORF) in fungal mRNAs specifying the small subunit of Arg-specific carbamoyl phosphate synthetase. We examined the functions of the Saccharomyces cerevisiae CPA1 and Neurospora crassa arg-2 AAPs using translation extracts from S. cerevisiae, N. crassa, and wheat germ. Synthetic RNA containing AAP and firefly luciferase (LUC) sequences were used to program translation; analyses of LUC activity indicated that the AAPs conferred Arg-specific negative regulation in each system. The AAPs functioned either as uORFs or fused in-frame at the N terminus of LUC. Mutant AAPs lacking function in vivo did not function in vitro. Therefore, trans-acting factors conferring AAP-mediated regulation are in both fungal and plant systems. Analyses of ribosome stalling in the fungal extracts by primer extension inhibition (toeprint) assays showed that these AAPs acted similarly to stall ribosomes in the region immediately distal to the AAP coding region in response to Arg. The regulatory effect increased as the Arg concentration increased; all of the arginyl-tRNAs examined appeared maximally charged at low Arg concentrations. Therefore, AAP-mediated Arg-specific regulation appeared independent of the charging status of arginyl-tRNA.

Odontogenic ghost cell tumor: a case report with cytologic findings.

Odontogenic ghost cell tumor is a rare, neoplastic form of calcifying odontogenic cyst (Gorlin cyst) whose cytologic features have not been previously reported. We present a case of odontogenic ghost cell tumor diagnosed by fine-needle aspiration biopsy (FNAB). The aspirate was characterized by (1) tissue fragments with basaloid epithelial cells, (2) "ghost" cells, (3) scattered multinucleated giant cells, (4) rare, eosinophilic, densely hyalinized "dentinoid" material in close association with the basaloid cells, and (5) calcific debris. The aspirate was diagnosed as "consistent with odontogenic ghost cell tumor." The cytologic features of odontogenic ghost cell tumor, as described, closely parallel the major histologic findings in this rare tumor. The differential diagnoses include other odontogenic tumors, squamous cell carcinoma, basaloid cell tumors of the salivary gland, and pilomatrixoma.

Fine-needle aspiration cytologic study of myofibroblastoma of the breast. Immunohistochemical and ultrastructural findings.

Myofibroblastoma of the breast is a recently recognized benign stromal tumor arising from the breast mesenchyma. Myofibroblastomas are grossly circumscribed, unencapsulated tumors that are most commonly found in males. Histologically, myofibroblastomas comprise predominantly bipolar spindle cells arranged either haphazardly or in fascicles that traverse a collagenous background. Their ultrastructural and immunohistochemical profiles are consistent with myofibroblastic differentiation. Myofibroblastoma of the breast was discovered in a 64-year-old man. For the first time the fine-needle aspiration findings are reported, as are the histologic, immunohistochemical, and ultrastructural findings.

Prognostic significance of DNA quantitation in stage D1 prostate carcinoma with the use of image analysis.

BACKGROUND: A characteristic feature of prostatic adenocarcinoma is its great variation in biologic behavior. This variation and the observation that most carcinomas are of intermediate grade make standard histologic grading of limited value in determining the prognosis of a patient. METHODS: DNA quantitation with the use of computer-assisted image analysis on Feulgen-stained nuclei was performed on the metastatic lymph nodes from patients with Stage D1 prostate carcinoma to determine whether ploidy was a useful predictor of survival or progression. The Gleason histologic score of the primary tumor, the number and extent of lymph node metastases, and the progression and survival intervals were documented. Treatment modalities included pelvic lymph node dissection, radical prostatectomy, external beam radiation therapy, and iodine 125 implantation. RESULTS: DNA ploidy quantitation showed that 65% (33 of 51) of cases were aneuploid, 2% (1 of 51) were tetraploid, and 33% (17 of 51) were in the diploid range. Progression to Stage D2 disease occurred in 76% of the patients with aneuploid cases and 53% of those with cases in the diploid range. CONCLUSION: There was a significant difference in progression between the two ploidy groups (Cox regression analysis, P less than 0.05).

Primary tumors of the foot: MR imaging.

The findings at magnetic resonance (MR) imaging of eight patients with primary tumors of the foot were compared with those at gross pathologic examination. In all cases, there was excellent correlation between the two studies. When compared with computed tomography (CT), MR imaging was superior in defining the presence and extent of local disease. While the appearances of various foot neoplasms are nonspecific, the ease of multiplanar imaging, the superior contrast resolution, and the sensitivity to marrow abnormalities are major advantages of MR imaging over CT in staging foot neoplasms. These advantages are crucial when foot-sparing curative resection of a malignancy is contemplated. The combination of plain radiography and MR imaging may be all that is necessary for optimal preoperative detection and local staging of tumors of the foot.

Dysgenetic male pseudohermaphroditism in a 45,X/46,X,del(Y)(q11.1) mosaic infant.

We describe an infant with dysgenetic male pseudohermaphroditism and the karyotype 45,X/46,X,del(Y)(q11.1). Histologic examination of the resected gonads showed cortical dysplasia indicative of incipient gonadoblastoma.

Malignant angioendothelioma. Cytologic, histologic and ultrastructural findings.

Cells of a malignant angioendothelioma in pleural fluid were studied by light and electron microscopy. They occurred singly and clustered, with peripheral, pleomorphic nuclei containing finely particulate chromatin and one or two nucleoli. The cytoplasm was pale and finely vacuolated. Ultrastructural findings were those of endothelial cells: cytoplasmic pseudopodia, tight junctional complexes, cytoplasmic filaments and pinocytotic vesicles.

Multicentric giant lymph node hyperplasia.

A patient with retroperitoneal and axillary lymphadenopathy and splenomegaly was demonstrated histologically to have the hyaline vascular type of giant lymph node hyperplasia, with plasma cell infiltrates in each region. The abdominal lesions were not surgically resectable and did not respond to radiotherapy. The clinical findings included polyclonal gammopathy, high cold agglutinin titers, neuropathy, and bilateral papilledema. All of these abnormalities have persisted three years since the initial diagnosis.