Gait Training Interventions for Individuals with Chronic Ankle Instability: A Systematic Review & Meta-Analysis.

OBJECTIVE: This review aimed to determine if gait training interventions influence lower extremity biomechanics during walking in individuals with chronic ankle instability (CAI). METHODS: A literature search was conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE to identify English-language studies from inception through September 2022. Eligible studies included randomized control trials, repeated measures design, and descriptive laboratory studies measuring the effects during or following a gait training intervention on biomechanical outcomes (kinematics, kinetics, electromyography) during walking in individuals with CAI. Gait training interventions were broadly categorized into devices (destabilization devices, novel gait training device) and biofeedback (visual, auditory, and haptic delivery modes). Meta-analyses were conducted when appropriate using random-effects to compare pre-and post- gait training intervention mean differences and standard deviations. RESULTS: Thirteen studies were included. Meta-analyses were conducted for single session gait training studies only. Eleven studies reported kinetic outcomes. Our meta-analyses showed location of center of pressure (COP) was shifted medially from 0-90% (Effect Size [ES] range=0.35-0.82) of stance, contact time was decreased in medial forefoot (ES=0.43), peak pressure was decreased for lateral midfoot (ES=1.18) and increased for hallux (ES=0.59), pressure time integral was decreased for lateral heel (ES=0.33) and lateral midfoot (ES=1.22) and increased for hallux (ES=0.63). Three studies reported kinematic outcomes. Seven studies reported electromyography outcomes. Our meta-analyses revealed increased activity following initial contact (IC) for fibularis longus (ES=0.83). CONCLUSIONS: Gait training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar pressure outcome measures seem to be most impacted by gait training programs with improvements in decreasing lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased EMG activity post-IC for the fibularis longus. Few studies have assessed the impact of multi-session gait training on biomechanical outcome measures. Targeted gait trainning should be considered when treating patients with CAI.

Functionalized Gold Nanoparticles and Halogen Bonding Interactions Involving Fentanyl and Fentanyl Derivatives.

Fentanyl (FTN) and synthetic analogs of FTN continue to ravage populations across the globe, including in the United States where opioids are increasingly being used and abused and are causing a staggering and growing number of overdose deaths each year. This growing pandemic is worsened by the ease with which FTN can be derivatized into numerous derivatives. Understanding the chemical properties/behaviors of the FTN class of compounds is critical for developing effective chemical detection schemes using nanoparticles (NPs) to optimize important chemical interactions. Halogen bonding (XB) is an intermolecular interaction between a polarized halogen atom on a molecule and e--rich sites on another molecule, the latter of which is present at two or more sites on most fentanyl-type structures. Density functional theory (DFT) is used to identify these XB acceptor sites on different FTN derivatives. The high toxicity of these compounds necessitated a "fragmentation" strategy where smaller, non-toxic molecules resembling parts of the opioids acted as mimics of XB acceptor sites present on intact FTN and its derivatives. DFT of the fragments' interactions informed solution measurements of XB using 19F NMR titrations as well as electrochemical measurements of XB at self-assembled monolayer (SAM)-modified electrodes featuring XB donor ligands. Gold NPs, known as monolayer-protected clusters (MPCs), were also functionalized with strong XB donor ligands and assembled into films, and their interactions with FTN "fragments" were studied using voltammetry. Ultimately, spectroscopy and TEM analysis were combined to study whole-molecule FTN interactions with the functionalized MPCs in solution. The results suggested that the strongest XB interaction site on FTN, while common to most of the drug's derivatives, is not strong enough to induce NP-aggregation detection but may be better exploited in sensing schemes involving films.

Genome-wide association identifies a BAHD acyltransferase activity that assembles an ester of glucuronosylglycerol and phenylacetic acid.

Genome-wide association studies (GWAS) are an effective approach to identify new specialized metabolites and the genes involved in their biosynthesis and regulation. In this study, GWAS of Arabidopsis thaliana soluble leaf and stem metabolites identified alleles of an uncharacterized BAHD-family acyltransferase (AT5G57840) associated with natural variation in three structurally related metabolites. These metabolites were esters of glucuronosylglycerol, with one metabolite containing phenylacetic acid as the acyl component of the ester. Knockout and overexpression of AT5G57840 in Arabidopsis and heterologous overexpression in Nicotiana benthamiana and Escherichia coli demonstrated that it is capable of utilizing phenylacetyl-CoA as an acyl donor and glucuronosylglycerol as an acyl acceptor. We, thus, named the protein Glucuronosylglycerol Ester Synthase (GGES). Additionally, phenylacetyl glucuronosylglycerol increased in Arabidopsis CYP79A2 mutants that overproduce phenylacetic acid and was lost in knockout mutants of UDP-sulfoquinovosyl: diacylglycerol sulfoquinovosyl transferase, an enzyme required for glucuronosylglycerol biosynthesis and associated with glycerolipid metabolism under phosphate-starvation stress. GGES is a member of a well-supported clade of BAHD family acyltransferases that arose by duplication and neofunctionalized during the evolution of the Brassicales within a larger clade that includes HCT as well as enzymes that synthesize other plant-specialized metabolites. Together, this work extends our understanding of the catalytic diversity of BAHD acyltransferases and uncovers a pathway that involves contributions from both phenylalanine and lipid metabolism.

Endoscopic Olecranon Bursectomy in the Treatment of Recalcitrant Olecranon Bursitis: Patient Selection and Operative Technique.

Olecranon bursitis is the most common form of bursitis. While it can commonly be treated using noninvasive measures, a surgical approach is indicated for cases of recalcitrant olecranon bursitis, which fail such treatment options. Traditionally, recalcitrant olecranon bursitis has been treated with an open bursectomy. Recently, arthroscopy has been proposed as an alternative method. Contraindications for this approach are cases where the bursa is massively enlarged and contains copious amounts of gouty tophi. While a unanimous consensus regarding which surgical approach is optimal has yet to be made, the endoscopic approach could potentially reduce issues inherent to open bursectomies such as improper wound healing and recurrence. This would reduce patient discomfort and allow them to return to activity sooner. We present a technique for treating recalcitrant olecranon bursitis using endoscopic resection.

No Wound Healing Complications or Recurrences Were Seen and a High Level of Satisfaction Was Reported in Patients Who Underwent Endoscopic Olecranon Bursectomy for Recalcitrant Olecranon Bursitis.

Purpose: To determine the outcomes of endoscopic olecranon bursectomy for the treatment of recalcitrant olecranon bursitis in one surgeon's practice. Methods: A retrospective analysis was conducted on all patients who underwent an endoscopic olecranon bursectomy for the treatment of recalcitrant olecranon bursitis between January 2018 and May 2021 at one surgeon's practice. Demographic variables as well as causes for olecranon bursitis such as aseptic, septic, and gouty tophi were recorded. In addition, any complications such as infection, recurrence, wound failure, or hospitalizations were documented, with wound dehiscence, recurrence of bursitis, and return to the operating room being the primary outcome measures. During the final phone encounter before finalizing this project, patients were queried to obtain the patient-reported form of the American Shoulder and Elbow Surgeons Elbow Questionnaire, quick Disabilities of the Arm Shoulder and Hand score, and the Single Assessment Numeric Evaluation score. Results: Our study included 28 patients (23 male and 5 female) with an average age of 68 years (ranging from 33-86 years), all of whom had follow-up. The average follow-up was 24.7 months (range 3-42 months). There were 15 cases (54%) of aseptic bursitis, 13 cases (46%) of septic bursitis, and 7 cases (25%) that contained gouty tophi (5 aseptic and 2 septic). Of the 28 patients, 4 experienced complications. These all occurred within 3 months of surgery. One necessitated hospitalization and intravenous antibiotics, 2 were minor infections treated with oral antibiotics, and one was swelling treated successfully with in-office aspiration. Overall, 24 (86%) patients reported no issues at all related to the surgery. There were no instances of recurrence, wound failure, or secondary operations. Of the 20 (71.4%) patients who were reached for patient-reported form of the American Shoulder and Elbow Surgeons Elbow Questionnaire, quick Disabilities of the Arm Shoulder and Hand score, and Single Assessment Numeric Evaluation scores, all 20 patients reported no residual pain or difficulties with daily tasks. Average satisfaction with the procedure was 9.9 of 10 and, on average, patients reported that their elbow functionality was 96% with 100% representing completely normal. Conclusions: In this population, patients who underwent endoscopic olecranon bursectomy experienced no recurrences or wound-healing complications necessitating return to the operating room. In addition, patients reported high function and satisfaction after the procedure. Level of Evidence: Level IV, therapeutic case series.

Changes in injury type among NBA athletes in response to the COVID-19 pandemic.

CONTEXT: The 2019-2020 NBA season was altered significantly by the COVID-19 pandemic with a midseason suspension of games, the NBA 'bubble' tournament, and a shortened offseason. Concerns were raised regarding player conditioning and the potential increased risk of injury due to the schedule changes. The purpose of this study was to determine the impact of the COVID-19 pandemic and associated schedule changes on NBA injuries. It was hypothesized that injury rates would be higher in the year following the pandemic and teams who participated in the bubble would have higher injury rates in the following season than non-bubble teams. Furthermore, the types of injuries would shift toward more severe injuries in the condensed 2019-20 season and the following 2020-21 season. DESIGN: Retrospective Cohort Study. METHODS: The NBA's public injury reports were queried to identify players listed on an injury report. Standardized injury events were calculated for four pre-COVID-19 seasons (2015-2019), the COVID-19 season (2019-2020), and the post-COVID-19 season (2020-2021). Injury characteristics including type and location were extracted for each year and differences within each period were calculated. RESULTS: When excluding injury events related to COVID-19 health and safety protocols, the overall injury events per 1000 exposures were not significantly different between time periods of pre-COVID-19, COVID-19, and post-COVID-19 seasons; (p = 0.199), and no difference was found in the rates of teams who participated in the bubble. Injuries, including soreness and strains, significantly decreased while fracture injuries significantly increased in the COVID-19 year. CONCLUSIONS: The COVID-19 pandemic led to an increased number of games missed, but no increase in injury rates when accounting for health and safety protocols. Additionally, bubble participation had no impact on injury rates. However, despite no changes in injury rates, the types of injuries changed with an increased proportion of severe injuries and decreased proportion of minor injuries.

Closed-Loop Reflex Responses of the Lateral Ankle Musculature From Various Thresholds During a Lateral Ankle Sprain Perturbation.

CONTEXT: Latency is a reliable temporal metric used to evaluate sensorimotor integration of the fibularis longus (FL) and fibularis brevis (FB) during lateral ankle sprain perturbations. Currently, no clinical recommendations exist to select appropriate thresholds to evaluate the closed-loop reflex response of the lateral ankle musculature. The purpose of this study was to assess threshold value on latency of the FL and FB during an unanticipated inversion perturbation that simulates the mechanism of a lateral ankle sprain. DESIGN: Descriptive laboratory study. METHODS: Twenty healthy adults with no history of lateral ankle sprain injury completed an unanticipated single-leg drop landing onto a 25° laterally inclined force platform from a height of 30 cm. Surface electromyography recorded muscle activity data from the FL and FB during the inversion perturbation. Latency was identified at points where muscle activity exceeded 2, 5, and 10 SD above the average muscle activity 200 milliseconds prior to foot contact, and compared across threshold value using a 1-way analysis of variance (P < .05). RESULTS: The 2 SD threshold was significantly shorter than both 5 SD and 10 SD thresholds for the FL (P < .01) and FB (P < .01). Likewise, the 5 SD threshold was significantly shorter than the 10 SD thresholds for FL (P = .004) and FB (P = .003). CONCLUSIONS: More sensitive thresholds results in a shorter closed-loop reflexive response compared to the more rigorous thresholds. We recommend that selection of the appropriate threshold to identify latency of the lateral ankle musculature should be based on the device used to simulate a lateral ankle sprain and the ankle inversion velocity produced during the ankle inversion perturbation.

On-Site Detection of Neonicotinoid Pesticides Using Functionalized Gold Nanoparticles and Halogen Bonding.

Neonicotinoid (NN) pesticides have emerged globally as one of the most widely used agricultural tools for protecting crops from pest damage and boosting food production. Unfortunately, some NN compounds, such as extensively employed imidacloprid-based pesticides, have also been identified as likely endangering critical pollinating insects like honey bees. To this end, NN pesticides pose a potential threat to world food supplies. As more countries restrict or prohibit the use of NN pesticides, tools are needed to effectively and quickly identify the presence of NN compounds like imidacloprid on site (e.g., in storage areas on farms or pesticide distribution warehouses). This study represents a proof-of-concept where the colloidal properties of specifically modified gold nanoparticles (Au-NPs) able to engage in the rare intermolecular interaction of halogen bonding (XB) can result in the detection of certain NN compounds. Density functional theory and diffusion-ordered NMR spectroscopy (DOSY NMR) are used to explore the fundamental XB interactions between strong XB-donor structures and NN compounds, with the latter found to possess multiple XB-acceptor binding sites. A fundamental understanding of these XB interactions allows for the functionalization of alkanethiolate-stabilized Au-NPs, known as monolayer-protected gold clusters (MPCs), with XB-donor capability (f-MPCs). In the presence of certain NN compounds such as imidacloprid, the f-MPCs subsequently exhibit visual XB-induced aggregation that is also measured with absorption (UV-vis) spectroscopy and verified with transmission electron microscopy (TEM) imaging. The demonstrated f-MPC-aggregation detection scheme has a number of favorable attributes, including quickly reporting the presence of the NN target, requiring only micrograms of suspect material, and being highly selective for imidacloprid, the most prevalent and most important NN insecticide compound. Requiring no instrumentation, the presented methodology can be envisioned as a simple screening test in which dipping a cotton swab of an unknown powder from a surface in a f-MPC solution causes f-MPCs to aggregate and yield a preliminary indication of imidacloprid presence.

Reported Beliefs About COVID-19 Vaccines Among Unvaccinated Hispanic Adults Utilizing a Free Clinic in Orlando, Florida.

BACKGROUND: Subgroups of the general population including Hispanic/Latinx individuals report higher rates of COVID-19 vaccine hesitancy than non-Hispanic White individuals. The purpose of this study was to identify factors that influence attitudes toward COVID-19 vaccines among unvaccinated Hispanic adults utilizing a free community clinic in Orlando, Florida, USA. METHODS: From May 2021 to July 2021, we used convenience sampling to recruit 20 self-identified Hispanic adults who were unvaccinated to complete an individual, semi-structured interview. Interview questions were derived from constructs from the Health Belief Model. Interviews were audio-recorded, transcribed, translated (when necessary), and qualitatively analyzed using inductive content analysis to identify recurring themes. RESULTS: Of the 20 participants in this study, 65% were female (n=13) and they ranged from 21 to 73 years of age (median age =42.5). We identified three primary themes in participant responses regarding their beliefs about COVID-19 vaccines. Primary theme 1: trust and clarity of COVID-19 vaccine information, with subthemes (1a) source trustworthiness, and (1b) clarity of COVID-19 vaccine information. Primary theme 2: personal contextual factors, with subthemes (2a) underlying health conditions, (2b) personal experiences with COVID-19, and (2c) immigration. Primary theme 3: lack of confidence, yet willingness to be vaccinated, with subthemes (3a) fear and distrust and (3b) willingness to be vaccinated. In summary, participants felt hesitant, although not completely opposed, to receiving COVID-19 vaccinations due to the information they gathered on vaccines from various sources received in the context of important personal factors (e.g., immigration, underlying health concerns, etc.). CONCLUSIONS: Overcoming vaccine hesitancy in vulnerable populations such as the Hispanic communities may require addressing issues of message clarity through trusted sources while considering personal contextual factors. Healthcare professionals can begin by initiating discussions with patients to understand individual circumstances and concerns and provide information on COVID-19 vaccines that clarify areas of confusion.

Four Weeks of Hericium erinaceus Supplementation Does Not Impact Markers of Metabolic Flexibility or Cognition.

Hericium erinaceus (HE), also known as Lion's Mane mushroom, has been found to enhance cognition and metabolic flexibility in various animal models. To date however, only four studies exist in humans and none have evaluated the effects of HE on markers of metabolic flexibility or cognitive performance. A single-blind, placebo controlled, parallel-longitudinal study was used to determine the effects of HE on markers of metabolic flexibility and cognition. Twenty-four participants completed a graded exercise test on a cycle ergometer to analyze substrate oxidation rates and markers of cardiorespiratory fitness. Additionally, two dual-task challenges consisting of a Stroop Word Challenge interspersed with a Mental Arithmetic Challenge were performed, pre-post the graded exercise test, to evaluate markers of cognition in a pre-post fatigued state. Participants were stratified into two groups, receiving either 10 g of HE per day or placebo for 4-weeks in the form of two muffins identical in taste and appearance. Repeated-measures analysis of variance were conducted to evaluate potential interactions or main effects. Although group differences were noted at baseline, there were no significant interactions or main effects observed from HE ingestion for any dependent variable (all p > 0.05). Our data suggest that ingesting 10 g of HE per day for 4-weeks had no impact on metabolic flexibility and cognition in a college-age cohort. Due to the limited research on HE supplementation, future research is needed to establish an effective supplement dose and duration for potential physiological changes to be observed in humans.

Tag you're it: Application of stable isotope labeling and LC-MS to identify the precursors of specialized metabolites in plants.

Untargeted liquid chromatography/mass spectrometry (LC-MS) can contribute a comprehensive and unbiased picture of the metabolic space of plants. These data can be used to quantify natural metabolite variation for genome wide association studies, to compare global metabolic responses from environmental or genetic perturbations, and to identify previously undescribed metabolites in Nature. A major limitation with untargeted metabolomics is the classification and identification of the thousands of metabolite features that can be detected in a single analytical run. Isotopic labeling improves the informational value of these datasets by categorizing metabolites as being derived from specific upstream precursors and/or to known metabolic pathways. When a 13C-labeled precursor is fed to either a plant or tissue, the downstream metabolites produced from it have a higher m/z value than the molecules in the pre-existing pool, generating an m/z peak pair that can be specifically identified within the MS data. This paper outlines methods and principles to consider when supplementing untargeted MS data with isotopic labeling, including how to choose the appropriate isotopic label, grow and feed plant tissues to maximize label uptake and incorporation into derivatives, optimize LC-MS methods, and interpret the resulting labeling data. Although the focus here is on annotation of amino acid-derived metabolites using LC-MS, we anticipate that the methods are generally adaptable to other precursors, plant species, and chromatographic approaches.

Does altitude increase the risk of traumatic aortic injuries? A retrospective cohort study among six level I trauma centers in the United States.

BACKGROUND: Traumatic aortic injuries (TAIs) are rare but are associated with a high mortality. Prior studies have shown skiers and pilots, whose injuries occur at high altitudes, are at an increased risk for a TAI. The purpose of this study was to examine the effect of altitude on the incidence of TAIs across all causes of injury. METHODS: This retrospective cohort study at six Level I trauma centers (8/1/2016-1/1/2020) included adult blunt trauma patients with a chest or abdomen injury. High altitude injuries (> 5000 ft.) were compared to low altitude injuries (≤ 5000 ft.). The primary outcome was incidence of TAI. RESULTS: There were 8562 patients, 37% were at high altitude and 63% at low altitude. High altitude patients were older (p < 0.01), more often Caucasian (p < 0.01) and had a higher ISS (p < 0.01). There was a significantly greater incidence of TAI at high altitude than low altitude (1.5% vs. 1.1%, p = 0.01). The median altitude was significantly higher for patients with a TAI than for patients without a TAI (5100 ft. vs. 1400 ft., p = 0.01). After adjustment, high altitude patients had 2-fold [OR: 2.4 (1.6, 3.7)] greater odds of having a TAI than low altitude patients. CONCLUSION: TAIs were more prevalent among high altitude injuries. Providers should be aware of the increased incidence of TAIs at high altitudes particularly when there is a delay in diagnosis and transfer to a trauma center with appropriate resources to manage these critical injuries. TAI screening at high altitude trauma centers may improve survival rates.

Impact of Sub-Clinical and Clinical Compression Socks on Postural Stability Tasks among Individuals with Ankle Instability.

Compression socks are used by a very diverse group of individuals and may potentially have a greater impact on physically diminished or impaired individuals as opposed to healthy individuals. The purpose of this study was to compare the effects of sub-clinical (SC) and clinical (CL) compression socks among healthy (CON), copers (COP), and individuals with chronic ankle instability (CAI). Postural stability was evaluated in 20 participants (11 males and 9 females) using Balance Tracking System Balance platform (BTrackS™) during the modified clinical test of sensory integration in balance (mCTSIB) and limits of stability (LOS) tests. Postural sway parameters were analyzed using a mixed model repeated measures analysis of variance 3 (group: CON, COP, and CAI) by 3 (compression condition: BF, SC, and CL) × 4 (balance condition: EO, EC, EOF, and ECF) for mCTSIB and a 3 (group: CON, COP, and CAI) by 3 (compression condition: BF, SC, CL) × 4 (balance condition: FL, BL, BR, FR) for LOS. Results revealed significantly greater postural stability with both SC and CL compression socks when compared to barefoot conditions. However, no significant differences were observed among groups for compression socks grades. Both SC and CL compression socks may be effective in increasing postural stability.

Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft.

BACKGROUND: Comparable short-term outcomes have been obtained using hamstring allografts versus autografts after primary segmental labral reconstruction (SLR). Midterm results have not yet been determined. PURPOSE: (1) To evaluate minimum 5-year patient-reported outcome (PRO) scores in patients who underwent primary SLR with hamstring grafts in the setting of femoroacetabular impingement syndrome (FAIS) and irreparable labral tears and (2) to compare the outcomes of hamstring autografts versus allografts in a subanalysis using propensity-matched groups. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Prospectively collected data were retrospectively reviewed for patients who underwent primary hip arthroscopy between September 2010 and November 2015. Patients were included if they underwent SLR using hamstring autografts or allografts and had preoperative and minimum 5-year PROs. The exclusion criteria were previous ipsilateral hip surgery or conditions, dysplasia, or Tönnis grade >1. Patients with autograft SLR were propensity matched 1 to 1 based on age, sex, and body mass index (BMI) to patients who underwent SLR using hamstring allografts. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) were calculated. RESULTS: Overall, 48 patients (N = hips 48) were eligible to be included in this study, and 41 patients (n = 41 hips [85.4%]) had a minimum 5-year follow-up reporting significant improvements in all PROs. Within the entire cohort, 9.8% required a secondary arthroscopy, with a mean time of 19 ± 1.8 months, and survivorship was 82.9%. Of the 41 included patients, 15 underwent an SLR with a hamstring autograft and were matched to 15 patients with labral reconstruction using a hamstring allograft. Groups were similar for sex (P > .999), age (P = .775), and BMI (P = .486). The mean follow-up times were 80.8 ± 25.5 and 66.1 ± 8.3 months (P = .223) for the autograft and allograft groups, respectively. Baseline PROs, preoperative radiographic measurements, surgical findings, and intraoperative procedures were similar. The groups achieved significant and comparable improvements for all PROs (P < .0001), satisfaction (P = .187), and the rate of achieving the MCID and the PASS. However, a tendency for higher postoperative PROs favoring allograft reconstruction was found. CONCLUSION: At a minimum 5-year follow-up, patients who underwent primary arthroscopic SLR in the context of FAIS and irreparable labra, with either autograft or allograft hamstring tendons, reported significant improvements and comparable postoperative scores for all PROs, patient satisfaction, MCID, and PASS.

Endurance exercise-mediated metabolic reshuffle attenuates high-caloric diet-induced non-alcoholic fatty liver disease.

INTRODUCTION AND AIM: Non-alcoholic fatty liver disease (NAFLD) is one of the most common diseases in the United States. Metabolic distress (obese diabetes) is the main causative element of NAFLD. While there is no cure for NAFLD, endurance exercise (EEx) has emerged as a therapeutic strategy against NAFLD. However, mechanisms of EXE-induced hepatic protection especially in female subjects remain unidentified. Thus, the aim of the study is to examine molecular mechanisms of EXE-induced hepatic protection against diet-induced NAFLD in female mice. MATERIAL AND METHODS: Nine-week-old female C57BL/6J mice were randomly divided into three groups: normal-diet control group (CON, n=11); high-fat diet/high-fructose group (HFD/HF, n=11); and HFD/HF+EEx group (HFD/HF+EEx, n=11). The mice assigned to HFD/HF and HFD/HF+EEx groups were fed with HFD/HF for 12 weeks, after which the mice assigned to the EEx group began treadmill exercise for 12 weeks, with HFD/HF continued. RESULTS: EEx attenuated hepatic steatosis, reduced de novo lipogenesis (reduction in ATP-Citrate- Lyase and diacylglycerol-O-acyltransferase 1), and enhanced mitochondrial biogenesis and fatty-acid activation (oxidative phosphorylation enzymes and Acyl-CoA synthetase1). Also, EEx prevented upregulation of gluconeogenic proteins (glyceraldehyde-3-phosphate dehydrogenase, glucose-6-phosphatase, and phosphoenolpyruvate-carboxykinase1), premature senescence (suppression of p53, p22, and p16, tumor-necrosis-factor-α, and interleukin-1ß, and oxidative stress), and autophagy deficiency. Furthermore, EXE reversed apoptosis arrest (cleaved cysteine-dependent-aspartate-directed protease3 and Poly-(ADP-ribose)-polymerase1). CONCLUSION: EEx-mediated reparations of metabolic and redox imbalance (utilization of pentose phosphate pathway), and autophagy deficiency caused by metabolic distress critically contribute to preventing/delaying severe progression of NAFLD. Also, EEx-induced anti-senescence and cell turnover are crucial protective mechanisms against NAFLD.

Utility of Gait Biofeedback Training to Improve Walking Biomechanics in Patients With Chronic Ankle Instability: A Critically Appraised Topic.

CLINICAL SCENARIO: Chronic ankle instability (CAI) is a condition that involves feelings of the ankle "giving way," pain, and decreased self-reported function. Individuals with CAI often demonstrate persistent biomechanical impairments during gait that are associated with repetitive lateral ankle sprains (LAS) and the development of early onset ankle posttraumatic osteoarthritis (OA). Traditional rehabilitation strategies have not successfully improved these reported aberrant gait biomechanics; thus, traditional rehabilitation may not effectively reduce the risk of recurrent LAS and ankle OA among individuals with CAI. Conversely, targeted gait training with biofeedback may be effective at decreasing the risk of recurring LAS and ankle OA if these rehabilitation strategies can promote individuals with CAI to develop a gait strategy that protects against subsequent LAS and ankle OA. CLINICAL QUESTION: Can targeted gait biofeedback interventions cause individuals with CAI to implement a walking gait pattern that is not associated with recurrent LAS and ankle OA? SUMMARY OF FINDINGS: Five studies assessed gait biofeedback interventions targeting plantar pressure and/or ankle kinematics involving visual biofeedback (n = 3), auditory biofeedback (n = 1), and haptic biofeedback (n = 1). Plantar pressure was medially shifted during a single session while receiving biofeedback (n = 2), immediately after biofeedback (n = 1), and 5 minutes after receiving biofeedback (n = 1) in 3 studies. One study demonstrated reduced ankle inversion after 8 sessions of biofeedback training. One study did not substantially improve plantar pressure while receiving visual feedback. CLINICAL BOTTOM LINE: Targeted gait training strategies appear effective in acutely altering gait biomechanics in individuals with CAI while receiving, and immediately after, biofeedback has been removed. Long-term outcomes are not currently established for gait training strategies in those with CAI. STRENGTH OF RECOMMENDATION: Limited evidence (grade B) suggests that targeted gait biofeedback strategies can alter specific CAI gait biomechanics to a strategy not associated with recurrent LAS, and ankle OA immediately, and after, multiple sessions of gait training.

Monolayer-Protected Gold Nanoparticles Functionalized with Halogen Bonding Capability─An Avenue for Molecular Detection Schemes.

The use of functionalized nanoparticles (NPs) and their aggregation in the presence of a targeted analyte is a well-established molecular detection strategy predicated on harnessing specific molecular interactions to the NP periphery. Molecules able to specifically interact with the functionalized NPs alter the unique optical and electrochemical properties of the NPs as a function of interparticle spacing. While many intermolecular interactions have been successfully exploited in this manner in conjunction with aqueous NP systems, the use of non-aqueous NPs in the same capacity is significantly less explored. A fundamental interaction that has not been previously investigated in NP schemes is halogen bonding (XB). XB is an orthogonal, electrostatic interaction between a region of positive electrostatic potential (δ+) on a halogen atom (i.e., XB donor) and a negative (δ-) Lewis base (XB acceptor) molecule. To couple XB with NP systems, ligands featuring a molecular structure that promotes XB interactions need to be identified, optimized, and synthesized for subsequent attachment to NPs. Herein, density functional theory (DFT) and NMR techniques are used to identify a strong XB-donor moiety (-C6F4I) and a synthetic scheme for a thiolate ligand featuring that functionality is devised and executed with high purity/yield (78%). Ligand-exchange reactions allow functionalization of non-aqueous alkanethiolate-protected gold NPs or monolayer-protected clusters (MPCs) with the XB-donor ligands. Functionalized MPCs (f-MPCs), within both assembled films and in solution, are shown to engage in XB interactions with target XB-acceptor molecules. Molecular recognition events, including induced aggregation of the f-MPCs, are characterized with UV-vis spectroscopy, cyclic voltammetry, TEM imaging, and diffusion-ordered spectroscopy NMR with limits of detection of 50-100 nM for strong XB acceptors. While fundamental exploration of XB interactions is ongoing, this study represents a step toward utilizing XB within molecular detection schemes, an application with implications for supramolecular chemistry, forensic, and environmental chemical sensing.

Efficacy of antimicrobial washes before shoulder surgery against Cutibacterium: a systematic review and meta-analysis.

Background: Cutibacterium acnes is a commensal intradermal microorganism that is commonly isolated at revision shoulder arthroplasty. Standard practice chlorhexidine gluconate (CHG) skin preparation agents have limited effectiveness at eradicating C. acnes in the dermis. Benzoyl peroxide (BPO) has demonstrated effectiveness against C. acnes. This meta-analysis compares the efficacy of at-home shoulder decolonization before surgery using CHG vs. BPO to reduce shoulder C. acnes burden. Methods: This was a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review. PubMed and MEDLINE databases were searched for studies evaluating the effects of CHG and BPO in reducing C. acnes at the shoulder. Trial results were extracted and pooled using a random effects model, separating data from randomized controlled trials (RCTs) and non-RCTs. Methodologic quality of studies was assessed using the Cochrane Risk of Bias Assessment Tools. Results: Ten studies (589 patients) were included. RCTs showed that both BPO and CHG led to significant reductions in culture positivity compared with negative controls (risk ratio [RR] with 95% confidence interval [CI] = 0.20 [0.13, 0.30], P < .0001 and 0.46 [0.37, 0.57], P < .0001, respectively). Non-RCT data demonstrated similar results comparing BPO and CHG to the control (RR with 95% CI = 0.34 [0.21, 0.57], P < .0001 and 0.31 [0.20, 0.49], P < .0001, respectively). Comparing BPO and CHG, RCT data showed a significant reduction in culture positivity with BPO (RR with 95% CI = 0.46 [0.27, 0.77], P < .009). Of RCTs, 5 were low and one was of moderate risk of bias. Of non-RCTs, 3 had low risk of bias, whereas one had moderate risk of bias. Conclusion: This review demonstrated that preoperative CHG and BPO can reduce C. acnes at the shoulder. However, BPO exhibits greater efficacy than CHG, potentially because of the compound's ability to penetrate the dermis. BPO is a simple and economical agent that may reduce joint exposure to C. acnes in shoulder surgery.

Lower extremity joint kinematics of a simulated lateral ankle sprain after drop landings in participants with chronic ankle instability.

This study examined lower extremity joint kinematics in individuals with chronic ankle instability (CAI) and controls during unanticipated and anticipated single-leg drop landings onto a laterally inclined platform. Physically active adults with CAI 15 (n = 15) and controls (n = 15) performed an unanticipated and anticipated 30 cm single-leg drop landing onto a 20° laterally inclined platform. Three-dimensional ankle, knee and hip-joint kinematics were recorded 200 ms pre- to 200 post-landing and analysed with a 2 (group) × 2 (landing condition) SPM ANOVA (p < 0.05). Results revealed individuals with CAI displayed significantly greater ankle internal rotation post-landing across both landing conditions. Anticipated landings elicited significantly greater pre-landing ankle inversion and external rotation, knee abduction and hip adduction. Additionally, significantly less ankle inversion, knee and hip flexion, and knee adduction and hip abduction were present during post-landing of the anticipated landing. Greater ankle internal rotation during landing may contribute to the ankle 'giving way' in individuals with CAI. However, preparatory and reactive proximal-joint kinematics were similar in both groups during landing. This highlights the possible role of the knee and hip joints in assisting with ankle-joint stability during anticipated inversion perturbations.

Identification of the Tyrosine- and Phenylalanine-Derived Soluble Metabolomes of Sorghum.

The synthesis of small organic molecules, known as specialized or secondary metabolites, is one mechanism by which plants resist and tolerate biotic and abiotic stress. Many specialized metabolites are derived from the aromatic amino acids phenylalanine (Phe) and tyrosine (Tyr). In addition, the improved characterization of compounds derived from these amino acids could inform strategies for developing crops with greater resilience and improved traits for the biorefinery. Sorghum and other grasses possess phenylalanine ammonia-lyase (PAL) enzymes that generate cinnamic acid from Phe and bifunctional phenylalanine/tyrosine ammonia-lyase (PTAL) enzymes that generate cinnamic acid and p-coumaric acid from Phe and Tyr, respectively. Cinnamic acid can, in turn, be converted into p-coumaric acid by cinnamate 4-hydroxylase. Thus, Phe and Tyr are both precursors of common downstream products. Not all derivatives of Phe and Tyr are shared, however, and each can act as a precursor for unique metabolites. In this study, 13C isotopic-labeled precursors and the recently developed Precursor of Origin Determination in Untargeted Metabolomics (PODIUM) mass spectrometry (MS) analytical pipeline were used to identify over 600 MS features derived from Phe and Tyr in sorghum. These features comprised 20% of the MS signal collected by reverse-phase chromatography and detected through negative-ionization. Ninety percent of the labeled mass features were derived from both Phe and Tyr, although the proportional contribution of each precursor varied. In addition, the relative incorporation of Phe and Tyr varied between metabolites and tissues, suggesting the existence of multiple pools of p-coumaric acid that are fed by the two amino acids. Furthermore, Phe incorporation was greater for many known hydroxycinnamate esters and flavonoid glycosides. In contrast, mass features derived exclusively from Tyr were the most abundant in every tissue. The Phe- and Tyr-derived metabolite library was also utilized to retrospectively annotate soluble MS features in two brown midrib mutants (bmr6 and bmr12) identifying several MS features that change significantly in each mutant.