Feasibility of Blood Flow Restriction Exercise in Adults with a Non-surgically Treated Achilles Tendon Rupture; a Case Series.

Blood flow restriction exercise (BFRE) appears to provide a unique opportunity to preserve lower limb muscle and function in patients with an Achilles tendon rupture. The purpose of this study was to investigate the feasibility of BFRE in patients with an Achilles tendon rupture. Additionally, to evaluate muscle volume and patient-reported ankle function, symptoms, complications, and physical activity following 12 weeks of BFRE. Feasibility was measured by adherence to training sessions, drop-out rate, intervention acceptability, ankle pain exacerbation (NRS), and adverse events. At baseline and 12-weeks follow-up, patients completed the Achilles Tendon Total Rupture Score questionnaire and had their thigh and calf circumference measured. At follow-up, patients' ability to perform a single-leg heel rise was tested. Sixteen of 18 patients completed the intervention and for those, adherence to training sessions was 88% ±16%. The mean NRS following BFRE sessions was 1.1 (95%CI: 1; 1.2). Three adverse events occurred during the 12 weeks. Two re-ruptures after completion of the BFRE program and one deep venous thrombosis following cast removal. BFRE was found to be feasible in a subset of patients with an Achilles tendon rupture. However, with three adverse events in a population of 18 patients, the effectiveness and safety of BFRE warrants further investigation.

Long-term changes in the daytime growing season carbon dioxide exchange following increased temperature and snow cover in arctic tundra.

Increasing temperatures and winter precipitation can influence the carbon (C) exchange rates in arctic ecosystems. Feedbacks can be both positive and negative, but the net effects are unclear and expected to vary strongly across the Arctic. There is a lack of understanding of the combined effects of increased summer warming and winter precipitation on the C balance in these ecosystems. Here we assess the short-term (1-3 years) and long-term (5-8 years) effects of increased snow depth (snow fences) (on average + 70 cm) and warming (open top chambers; 1-3°C increase) and the combination in a factorial design on all key components of the daytime carbon dioxide (CO2 ) fluxes in a wide-spread heath tundra ecosystem in West Greenland. The warming treatment increased ecosystem respiration (ER) on a short- and long-term basis, while gross ecosystem photosynthesis (GEP) was only increased in the long term. Despite the difference in the timing of responses of ER and GEP to the warming treatment, the net ecosystem exchange (NEE) of CO2 was unaffected in the short term and in the long term. Although the structural equation model (SEM) indicates a direct relationship between seasonal accumulated snow depth and ER and GEP, there were no significant effects of the snow addition treatment on ER or GEP measured over the summer period. The combination of warming and snow addition turned the plots into net daytime CO2 sources during the growing season. Interestingly, despite no significant changes in air temperature during the snow-free time during the experiment, control plots as well as warming plots revealed significantly higher ER and GEP in the long term compared to the short term. This was in line with the satellite-derived time-integrated normalized difference vegetation index of the study area, suggesting that more factors than air temperature are drivers for changes in arctic tundra ecosystems.

Low-Load Blood-Flow-Restricted Exercise to Prevent Muscle Atrophy and Decline in Functional Performance in a Patient Recovering From a Malleolus Fracture. A Case Report.

ABSTRACT: This present case presentation offers supportive evidence that low-load blood-flow-restriction exercise (LL-BFRE) may be a feasible intervention to preserve skeletal muscle mass and, in part, lower-limb muscle function after a fracture of the lateral malleolus. A 28-year-old female patient sustained a radiographically verified stabile fracture of the lateral malleolus and was treated with a walker cast. She was allowed weight bearing on the limb within the limits of her pain threshold and to perform unloaded plantar and dorsiflexion movements of the ankle. The patient performed 12 weeks of home-based LL-BFRE 4 times per week to diminish declines in functional performance, muscle strength, and skeletal muscle atrophy. We observed that LL-BFRE was feasible with no exercise-related adverse events in the early stage of rehabilitation. The patient experienced no-or-low pain during exercise. Vastus lateralis muscle volume, and thigh and calf circumference was preserved.

Young men's perceptions and attitudes towards two fertility awareness interventions and preferences for future initiatives.

This study explored young Danish men's perceptions and attitudes towards two fertility awareness (FA) interventions (a podcast episode and an informational poster) and their preferences for how fertility awareness and prevention efforts should be targeted and communicated to young men in the future. Focus groups were held with 13 young men who were between the ages of 25-35 and in a committed relationship over Zoom in January 2021. Data were analysed using qualitative content analysis. Young men preferred FA interventions to be factual as in the informational poster and to include personal stories that could serve as conversation starters as in the podcast. According to the young men, FA interventions should communicate using positive language and humour and not be negative or shaming. They preferred intervention formats like TV-programmes, podcasts, and social media. The participants also suggested fertility information should be included in sexual education in high school and vocational education. This research suggests that future FA campaigns should be developed in cooperation with the target group together with clinicians, and concurrent studies using different intervention formats should be performed. In all probability, a mix of different interventions is necessary to attain the desired effect to ensure long-lasting fertility awareness.

Feasibility, safety, and patient-reported outcomes 90 days after same-day total knee arthroplasty: a matched cohort study.

BACKGROUND AND PURPOSE: Despite increased attention to and acceptance of fast-track procedures, there is a lack of studies concerning discharge on the day of surgery (DOS) following total knee arthroplasty (SD-TKA). We evaluated the feasibility of SD-TKA, and compared safety and patient-reported outcomes (PROs) between patients undergoing SD-TKA and patients undergoing standard TKA. PATIENTS AND METHODS: A SD-TKA group (n = 101) was matched 1:1 to a standard TKA group (n = 101) on age, sex, and ASA score. Feasibility (being discharged on DOS), safety (unplanned contacts and complications evaluated by telephone calls (2 weeks), outpatient visits (2 weeks), and readmission (90 days)) were assessed. Further, Oxford Knee Score (OKS) and Visual Analogue Scale (VAS) (pain at rest and activity) were reported (90 days). RESULTS: 89 of 101 SD-TKA patients were discharged on DOS. The number of telephone calls (≤ 83) and outpatient visits (12) were similar in the 2 groups. The number of readmissions was ≤ 3 in both groups, and only 1 of the readmissions was related to TKA surgery. No differences were found at 90-day follow-up in terms of OKS (34 in both groups) or VAS (rest: SD-TKA = 7 and standard TKA = 8; activity: SD-TKA = 17 and standard TKA = 15). INTERPRETATION: SD-TKA is feasible in a selected group of patients, and safety and PROs are comparable to patients undergoing standard TKA.

Effect of ash application on the decomposer food web and N mineralization in a Norway spruce plantation.

In the face of global climate change there is an increasing demand for biofuel, which exerts pressure on production and thus management of biofuel plantations. The intensification of whole-tree harvest from biofuel plantations increases export of nutrients. Returning ash from biofuel combustion to the forest plantations can amend the soil nutrient status and thus facilitate sustainable forest management. However, ash affects the forest floor decomposer food web, potentially changing organic matter turnover, carbon sequestration and nitrogen availability. Our aim was to examine the response of decomposer organisms, food web structure and nitrogen mineralization function after ash application. In a coniferous forest plantation amended with 0, 3, 4.5 or 6 t ash ha-1, we sampled in several depths of the forest floor for key organisms of the decomposer food web (fungal biomass, 0-12 cm; bacteria, protozoa, nematodes and enchytraeids, 0-3 cm and 3-6 cm; microarthropods and earthworms, 0-5 cm), 2, 14 and 26 months after ash application. We used structural equation modelling (SEM) to detangle the direct and indirect effects of ash application on organisms in the decomposer food web and on nitrogen availability. We found that ash increased the abundance of bacteria and protozoa, as well as the inorganic nitrogen pool at 0-3 cm depth, whereas the effect of ash was negligible at 3-6 cm depth. Earthworm abundance increased, whereas enchytraeid abundance decreased 2 years after ash application. The structural equation modelling showed that ash application stimulated the bacterial feeding pathway and increased nitrogen mineralization. Contrary, ash had a negative effect on fungal biomass at the first sampling, however, this effect subdued over time. Our results suggest that as the soil decomposer food web is resilient to ash application, this is a viable option for sustainable management of biofuel plantations.

Efficacy of periacetabular osteotomy followed by progressive resistance training compared to progressive resistance training as non-surgical treatment in patients with hip dysplasia (PreserveHip) - a protocol for a randomised controlled trial.

INTRODUCTION: Periacetabular osteotomy (PAO) is an established treatment for adolescent and adult patients with hip dysplasia. However, the efficacy of PAO has not been tested against another surgical intervention or conservative treatment in a randomised controlled trial before. We suggest that progressive resistance training (PRT) could be an alternative to PAO. The primary aim of this trial is therefore to examine the efficacy of PAO followed by 4 months of usual care followed by 8 months of PRT compared to 12 months of solely PRT in patients with hip dysplasia eligible for PAO in terms of patient-reported pain measured by The Copenhagen Hip and Groin Outcome Score (HAGOS). METHODS AND ANALYSIS: This trial is a single-blinded multicentre randomised controlled clinical trial, where patients with hip dysplasia, who are eligible for PAO, will be randomised to either PAO followed by usual care and PRT or PRT only. Primary outcome is patient-reported pain, measured on the subscale pain on the HAGOS questionnaire 12 months after initiation of PAO or PRT. The key secondary outcomes are the other subscales of the HAGOS, adverse and serious adverse events, usage of painkillers (yes/no) and type of analgesics. Based on the sample size calculation, the trial needs to include 96 patients. ETHICS AND DISSEMINATION: The trial is approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-234-18) and by the Danish Data Protection Agency (Journal No 1-16-02-120-19). The trial is also approved by The Regional Committee for Medical and Health Research Ethics, Region South-East Norway (Ref. 2018/1603). All results from this trial will be published in international peer-reviewed scientific journals regardless of whether the results are positive, negative or inconclusive. TRIAL REGISTRATION NUMBER: NCT03941171.

Progressive resistance training in patients with hip dysplasia: A feasibility study.

OBJECTIVES: To examine whether progressive resistance training is feasible in patients with symptomatic hip dysplasia scheduled for periacetabular osteotomy. A secondary objective was to investigate patient-reported outcomes, functional performance and hip muscle strength. DESIGN: Feasibility study. PATIENTS AND METHODS: Seventeen patients (median age 28 years, range 22-40 years) performed 8 weeks (20 sessions) of supervised sessions of progressive resistance training. Training-adherence, number of dropouts and adverse events, and visual analogue scale scores on pain were registered. Patients completed the Hip and Groin Outcome Score, performed 2 hop-tests, and hip peak torque was assessed by isokinetic dynamometry. RESULTS: Training-adherence was 90.3±9%. Few and minor adverse events were observed, one patient dropped out and acceptable pain levels were reported during the intervention. Scores on 4 out of 6 subscales on patient-reported outcome improved (p <0.05), as did standing distance jump (12.2%, 95% confidence interval (CI) [1.3, 23.0]), countermovement jump (25.1%, 95% CI [1.3, 48.8]). Isokinetic concentric hip flexion peak torque showed significant improvements (16.6%, 95% CI [4.6, 28.6]) on the affected side while isometric hip flexion (10.9%, 95% CI [0.3, 21.6]) improved on the non-affected side. CONCLUSION: Supervised progressive resistance training is feasible in patients with hip dysplasia. The intervention may improve pain levels, patient-reported outcomes, functional performance and hip flexion muscle strength.

Bioaccumulation of cadmium in soil organisms - With focus on wood ash application.

Harvesting whole-tree biomass for biofuel combustion intensifies removal of nutrients from the ecosystem. This can be partly amended by applying ash from the combustion back to the system and thus recycle the nutrients. However, besides being rich in inorganic nutrients, ash also contains trace amounts of heavy metals. Due to the risk of toxic effects and trophic transfer of heavy metals, especially cadmium, legislation usually restricts the use of ash as a soil amendment. In order to provide researchers and governmental agencies with a tool to assess the risk of cadmium bioaccumulation in specific soil systems after ash application, we review: 1) the properties of ash; 2) the chemical and toxic properties of cadmium; 3) the key factors affecting cadmium bioavailability, cadmium uptake-, storage- and elimination-abilities in soil organisms and the risk of cadmium accumulation and biomagnification in the soil food web; 4) how ash impact on soil can change the risk of cadmium bioaccumulation. We conclude that for assessing the risk of cadmium bioaccumulation for specific sites, it is necessary to consider both the type and composition of ash, the soil conditions and organism composition on the site. On a general basis, we conclude that granulated ashes low in cadmium content, applied to low pH soils with high organic matter content, in systems with low abundances of earthworms, isopods and gastropods, will have a low risk of cadmium accumulation.

Wood ash application increases pH but does not harm the soil mesofauna.

Application of bioash from biofuel combustion to soil supports nutrient recycling, but may have unwanted and detrimental ecotoxicological side-effects, as the ash is a complex mixture of compounds that could affect soil invertebrates directly or through changes in their food or habitat conditions. To examine this, we performed laboratory toxicity studies of the effects of wood-ash added to an agricultural soil and the organic horizon of a coniferous plantation soil with the detrivore soil collembolans Folsomia candida and Onychiurus yodai, the gamasid predaceous mite Hypoaspis aculeifer, and the enchytraeid worm Enchytraeus crypticus. We used ash concentrations spanning 0-75 g kg-1 soil. As ash increases pH we compared bioash effects with effects of calcium hydroxide, Ca(OH)2, the main liming component of ash. Only high ash concentrations above 15 g kg-1 agricultural soil or 17 t ha-1 had significant effects on the collembolans. The wood ash neither affected H. aculeifer nor E. crypticus. The estimated osmolalities of Ca(OH)2 and the wood ash were similar at the LC50 concentration level. We conclude that short-term chronic effects of wood ash differ among different soil types, and osmotic stress is the likely cause of effects while high pH and heavy metals is of minor importance.