Rapid turnover of a pea aphid superclone mediated by thermal endurance in central Chile.

Global change drivers are imposing novel conditions on Earth's ecosystems at an unprecedented rate. Among them, biological invasions and climate change are of critical concern. It is generally thought that strictly asexual populations will be more susceptible to rapid environmental alterations due to their lack of genetic variability and, thus, of adaptive responses. In this study, we evaluated the persistence of a widely distributed asexual lineage of the alfalfa race of the pea aphid, Acyrthosiphon pisum, along a latitudinal transect of approximately 600 km in central Chile after facing environmental change for a decade. Based on microsatellite markers, we found an almost total replacement of the original aphid superclone by a new variant. Considering the unprecedented warming that this region has experienced in recent years, we experimentally evaluated the reproductive performance of these two A. pisum lineages at different thermal regimes. The new variant exhibits higher rates of population increase at warmer temperatures, and computer simulations employing a representative temperature dataset suggest that it might competitively displace the original superclone. These results support the idea of a superclone turnover mediated by differential reproductive performance under changing temperatures.

mTORC2 Puts Its Shoulder to Krebs' Wheel.

In this issue of Molecular Cell, Moloughney et al. (2016) find that mTORC2 responds to falling levels of glucose and glutamine catabolites, promoting glutaminolysis and preserving the TCA cycle and hexosamine biosynthesis.

Intravenous infusion of 5-hydroxytryptophan to mid-lactation Holstein cows transiently affects milk production and circulating amino acid concentrations.

In dairy cows, the lactating mammary glands synthesize serotonin, which acts in an autocrine-paracrine manner in the glands and is secreted into the periphery. Serotonin signaling during lactation modulates nutrient metabolism in peripheral tissues such as adipose and liver. We hypothesized that the elevation of circulating serotonin during lactation would increase nutrient partitioning to the mammary glands, thereby promoting milk production. Our objective was to elevate circulating serotonin via intravenous infusion of the serotonin precursor 5-hydroxytryptophan (5-HTP) to determine its effects on mammary supply and extraction efficiency of AA, and milk components production. Twenty-two multiparous mid-lactation Holstein cows were intravenously infused with 5-HTP (1 mg/kg body weight) or saline, in a crossover design with two 21-d periods. Treatments were infused via jugular catheters for 1 h/d, on d 1 to 3, 8 to 10, and 15 to 17 of each period, to maintain consistent elevation of peripheral serotonin throughout the period. Milk and blood samples were collected in the last 96 h of each period. Whole-blood serotonin concentration was elevated above saline control for 96 h after the last 5-HTP infusion. Dry matter intake was decreased for cows receiving 5-HTP, and on average they lost body weight over the 21-d period, in contrast to saline cows who gained body weight. Milk production and milk protein yield were lower in cows receiving 5-HTP during the 3 infusion days, but both recovered to saline cow yields in the days after. Although milk fat yield exhibited a day-by-treatment interaction, no significant difference occurred on any given day. Milk urea nitrogen concentration was lower in 5-HTP cows on the days following the end of infusions, but not different from saline cows on infusion days. Meanwhile, plasma urea nitrogen was not affected by 5-HTP infusion. Circulating concentrations of AA were overall transiently decreased by 5-HTP, with concentrations mostly returning to baseline within 7 h after the end of 5-HTP infusion. Mammary extraction efficiency of AA was unaffected by 5-HTP infusion. Overall, both lactation performance and circulating AA were transiently reduced in cows infused with 5-HTP, despite sustained elevation of circulating serotonin concentration.

Differences in gait analysis and clinical outcome after dynamic fixation or screw fixation in acute syndesmosis tear: a prospective randomized pilot study.

INTRODUCTION: Acute syndesmosis tears can be treated by static screw or dynamic fixation. Various studies have compared these techniques regarding postoperative outcome. However, to our knowledge, no study has used 3D-instrumented gait analysis (IGA). We hypothesized that a dynamic fixation would perform non-inferior to screw fixation in terms of biomechanical and clinical outcomes. MATERIALS AND METHODS: Patients were prospectively randomized to both groups. All patients received the same follow-up rehabilitation and consultations (6 and 12 weeks; 6 and 12 months) postoperatively. Standardized questionnaires were used to objectify pain and ankle function. At 6 months follow-up, IGA was conducted additionally to objectify the biomechanical outcome. RESULTS: Twenty-five patients in the dynamic fixation (DF) group using TightRope® and twenty-five in the screw fixation group (SF) completed gait analysis. The DF group showed significantly higher mean values for maximum moment in the affected ankle joint (DF: 1.40 ± 0.21 Nm, SF: 1.23 ± 0.30 Nm; p = 0.023) and the unaffected ankle joint (DF: 1.52 ± 0.20 Nm, SF: 1.37 ± 0.27 Nm; p = 0.035). The difference between the affected and unaffected ankle joint was significantly higher in the SF group for active plantarflexion (DF: 1.52 ± 0.20°, SF: 1.37 ± 0.27°; p = 0.035). Both dynamic and screw fixation groups exhibited significantly reduced plantarflexion during the push-off and early swing phase, with moments and powers in the ankle joint also significantly impaired. CONCLUSIONS: Our study demonstrated that dynamic fixation has better or similar biomechanical and clinical outcomes compared to screw fixation. Future research should focus on biomechanical differences during gait as well as clinical outcomes in case of earlier weight-bearing after dynamic fixation. TRIAL REGISTRATION NUMBER (TRN): DRKS00013562 Date of Registration: 07/12/2017.

Phenotypic specialization of the pea aphid in its southern limit of distribution.

The success of biological invasions ultimately relies on phenotypic traits of the invasive species. Aphids, which include many important pests worldwide, may have been successful invading new environments partly because they can maximize reproductive output by becoming parthenogenetic and losing the sexual phase of their reproductive cycle. However, invasive populations of aphids invading wide ranges can face contrasting environmental conditions and requiring different phenotypic strategies. Besides transitions in their reproductive cycle, it is only partially known which phenotypic traits might be associated to the invasion success of aphid populations in extended novel ranges. Here, we used four genotypes of the pea aphid Acyrthosiphon pisum from two localities in Chile to test for phenotypic specialization that might explain their establishment and spread in habitats exhibiting contrasting environmental conditions. We show that lineages living at a higher latitude with low temperatures show, in addition to facultative sexual reproduction, smaller body sizes, lower metabolic rates and a higher tolerance to the cold than the obligate asexual lineages living in a mild weather, at the expense of fecundity. Conversely, at higher temperatures only asexual lineages were found, which exhibit larger body sizes, higher reproductive outputs and consequently enhanced demographic ability. As a result, in conjunction with the reproductive mode, lineage specialization in physiological and life-history traits could be taken into account as an important strategy for populations of pea aphid to effectively invade extended novel ranges comprising different climatic conditions.

Hindfoot Flexibility Influences the Biomechanical Effects of Laterally Wedged Insoles and Ankle-Foot Orthoses in Medial Knee Osteoarthritis.

OBJECTIVE: To investigate the relationship of frontal plane ankle mobility with the effects of an ankle-foot orthosis (AFO) and a laterally wedged insole (LWI) on knee adduction moment (KAM) in the treatment of medial knee osteoarthritis. DESIGN: Randomized, nonblinded crossover trial. SETTING: Outpatient clinic of university hospital. PARTICIPANTS: Referred sample of 20 patients (N=20) with medial knee osteoarthritis stage 1-3 (Kellgren and Lawrence), aged 56.4±6.5 years; 58 patients were assessed, 21 were included, and 1 was a dropout. There were 14 healthy reference participants without knee osteoarthritis (convenience sample) who were matched by age. INTERVENTIONS: Patients received AFO and LWI for 6 weeks each with gait analysis after each 6-week intervention. Patients underwent additional barefoot gait analysis, walking on even ground and on a cross slope of 5° lateral elevation and standing on inclinations of 0°, 5°, 10°, and 20°. MAIN OUTCOME MEASURES: Spearman correlation between the immediate change in first peak of KAM with each aid and the change in hindfoot varus on the cross slope relative to level ground. RESULTS: The KAM reduction with AFO correlated significantly with hindfoot varus reaction to the cross slope during walking: the greater the hindfoot valgization on the cross slope, the greater the KAM reduction with AFO (Spearman ρ=0.53, P=.02). The KAM reduction with LWI correlated moderately negatively with the change in hindfoot varus: the greater the hindfoot valgization on the cross slope, the smaller the KAM reduction with LWI (r=-0.31 P=.18). CONCLUSIONS: LWI may be suitable for patients with limited to normal frontal plane ankle mobility. Patients with greater frontal plane ankle mobility benefit most from frontal plane ankle bridging with AFO. Studies with larger samples are necessary.

Extracorporeal Membrane Oxygenation for COVID-19-associated Severe Acute Respiratory Distress Syndrome in Chile: A Nationwide Incidence and Cohort Study.

Rationale: The role of and needs for extracorporeal membrane oxygenation (ECMO) at a population level during the coronavirus disease (COVID-19) pandemic have not been completely established. Objectives: To identify the cumulative incidence of ECMO use in the first pandemic wave and to describe the Nationwide Chilean cohort of ECMO-supported patients with COVID-19. Methods: We conducted a population-based study from March 3 to August 31, 2020, using linked data from national agencies. The cumulative incidence of ECMO use and mortality risk of ECMO-supported patients were calculated and age standardized. In addition, a retrospective cohort analysis was performed. Outcomes were 90-day mortality after ECMO initiation, ECMO-associated complications, and hospital length of stay. Cox regression models were used to explore risk factors for mortality in a time-to-event analysis. Measurements and Main Results: Ninety-four patients with COVID-19 were supported with ECMO (0.42 per population of 100,000, 14.89 per 100,000 positive cases, and 1.2% of intubated patients with COVID-19); 85 were included in the cohort analysis, and the median age was 48 (interquartile range [IQR], 41-55) years, 83.5% were men, and 42.4% had obesity. The median number of pre-ECMO intubation days was 4 (IQR, 2-7), the median PaO2/FiO2 ratio was 86.8 (IQR, 64-99) mm Hg, 91.8% of patients were prone positioned, and 14 patients had refractory respiratory acidosis. Main complications were infections (70.6%), bleeding (38.8%), and thromboembolism (22.4%); 52 patients were discharged home, and 33 died. The hospital length of stay was a median of 50 (IQR, 24-69) days. Lower respiratory system compliance and higher driving pressure before ECMO initiation were associated with increased mortality. A duration of pre-ECMO intubation ≥10 days was not associated with mortality. Conclusions: Documenting nationwide ECMO needs may help in planning ECMO provision for future COVID-19 pandemic waves. The 90-day mortality of the Chilean cohort of ECMO-supported patients with COVID-19 (38.8%) is comparable to that of previous reports.

Sex differences in disease progression and arrhythmic risk in patients with arrhythmogenic cardiomyopathy.

AIMS: We aimed to assess sex-specific phenotypes and disease progression, and their relation to exercise, in arrhythmogenic cardiomyopathy (AC) patients. METHODS AND RESULTS: In this longitudinal cohort study, we included consecutive patients with AC from a referral centre. We performed echocardiography at baseline and repeatedly during follow-up. Patients' exercise dose at inclusion was expressed as metabolic equivalents of task (MET)-h/week. Ventricular arrhythmia (VA) was defined as aborted cardiac arrest, sustained ventricular tachycardia, or appropriate therapy by implantable cardioverter-defibrillator. We included 190 AC patients (45% female, 51% probands, age 41 ± 17 years). Ventricular arrhythmia had occurred at inclusion or occurred during follow-up in 85 patients (33% of females vs. 55% of males, P = 0.002). Exercise doses were higher in males compared with females [25 (interquartile range, IQR 14-51) vs. 12 (IQR 7-22) MET-h/week, P < 0.001]. Male sex was a marker of proband status [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4-5.0, P = 0.003] and a marker of VA (OR 2.6, 95% CI 1.4-5.0, P = 0.003), but not when adjusted for exercise dose and age (adjusted OR 1.8, 95% CI 0.9-3.6, P = 0.12 and 1.5, 95% CI 0.7-3.1, P = 0.30, by 5 MET-h/week increments). In all, 167 (88%) patients had ≥2 echocardiographic examinations during 6.9 (IQR 4.7-9.8) years of follow-up. We observed no sex differences in deterioration of right or left ventricular dimensions and functions. CONCLUSION: Male AC patients were more often probands and had higher prevalence of VA than female patients, but not when adjusting for exercise dose. Importantly, disease progression was similar between male and female patients.

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial.

OBJECTIVE: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. DESIGN: Single-centre, block-randomized, cross-over controlled trial. SETTING: Outpatient clinic. SUBJECTS: About 39 patients with symptomatic medial knee osteoarthritis. INTERVENTIONS: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. MAIN MEASURES: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire - Osteoarthritis and knee pain. RESULTS: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% (P < 0.001). The LWI reduced both maxima by 6% (P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% (P < 0.001) and 5% (P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI (P = 0.001, P = 0.004). CONCLUSIONS: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.

Thermal effects vary predictably across levels of organization: empirical results and theoretical basis.

Thermal performance curves have provided a common framework to study the impact of temperature in biological systems. However, few generalities have emerged to date. Here, we combine an experimental approach with theoretical analyses to demonstrate that performance curves are expected to vary predictably with the levels of biological organization. We measured rates of enzymatic reactions, organismal performance and population viability in Drosophila acclimated to different thermal conditions and show that performance curves become narrower with thermal optima shifting towards lower temperatures at higher levels or organization. We then explain these results on theoretical grounds, showing that this pattern reflects the cumulative impact of asymmetric thermal effects that piles up with complexity. These results and the proposed framework are important to understand how organisms, populations and ecological communities might respond to changing thermal conditions.

Clinical validation of three cardiovascular magnetic resonance techniques to measure strain and torsion in patients with suspected coronary artery disease.

BACKGROUND: Several cardiovascular magnetic resonance (CMR) techniques can measure myocardial strain and torsion with high accuracy. The purpose of this study was to compare displacement encoding with stimulated echoes (DENSE), tagging and feature tracking (FT) for measuring circumferential and radial myocardial strain and myocardial torsion in order to assess myocardial function and infarct scar burden both at a global and at a segmental level. METHOD: 116 patients with a high likelihood of coronary artery disease (European SCORE > 15%) underwent CMR examination including cine images, tagging, DENSE and late gadolinium enhancement (LGE) in the short axis direction. In total, 97 patients had signs of myocardial disease and 19 had no abnormalities in terms of left ventricular (LV) wall mass index, LV ejection fraction, wall motion, LGE or a history of myocardial infarction. Thirty-four patients had myocardial infarct scar with a transmural LGE extent (transmurality) that exceeded 50% of the wall thickness in at least one segment. Global circumferential strain (GCS) and global radial strain (GRS) was analyzed using FT of cine loops, deformation of tag lines or DENSE displacement. RESULTS: DENSE and tagging both showed high sensitivity (82% and 71%) at a specificity of 80% for the detection of segments with > 50% LGE transmurality, and receiver operating characteristics (ROC) analysis showed significantly higher area under the curve-values (AUC) for DENSE (0.87) than for tagging (0.83, p < 0.001) and FT (0.66, p = 0.003). GCS correlated with global LGE when determined with DENSE (r = 0.41), tagging (r = 0.37) and FT (r = 0.15). GRS had a low but significant negative correlation with LGE; DENSE r = - 0.10, FT r = - 0.07 and tagging r = - 0.16. Torsion from DENSE and tagging had a weak correlation (- 0.20 and - 0.22 respectively) with global LGE. CONCLUSION: Circumferential strain from DENSE detected segments with > 50% scar with a higher AUC than strain determined from tagging and FT at a segmental level. GCS and torsion computed from DENSE and tagging showed similar correlation with global scar size, while when computed from FT, the correlation was lower.

Insulin potentiates essential amino acids effects on mechanistic target of rapamycin complex 1 signaling in MAC-T cells.

Different models of lactation offer conflicting evidence as to whether insulin signaling is required for AA to stimulate mechanistic target of rapamycin complex 1 (mTORC1) activity. We hypothesized that insulin potentiates essential AA stimulation of mTORC1 activity in the MAC-T mammary epithelial cell line. Here, our objective was to assess mTORC1 signaling activity in response to insulin and individual or grouped essential AA. Insulin and essential AA concentrations in the treatment medium ranged from normo- to supraphysiological, with insulin at 0, 1, 10, or 100 nmol/L and essential AA at approximately 0, 0.01, 0.05, 0.1, 1, or 3× reference plasma levels. Effects and interaction of insulin and total essential AA were tested in a 3 × 5 factorial design (n = 3 replicates/treatment); insulin and the individual AA Leu, Met, Ile, and Arg were likewise tested in 3 × 4 factorials (n = 4). As the remaining individual AA His, Lys, Phe, Thr, Trp, and Val were expected to not affect mTORC1, these were tested only at the highest insulin level, 100 nmol/L (n = 4). For all of these, linear and quadratic effects of total and individual AA were evaluated. Essential AA were subsequently grouped by their positive (Leu, Met, Ile, Arg, and Thr; TOR-AA) or absent-to-negative effects (His, Lys, Phe, Trp, and Val; NTOR-AA), and tested for interaction in a 2 × 2 factorial design (n = 4), with each AA at its respective 1× plasma level, and insulin held at 100 nmol/L. All experiments consisted of 1 h treatment incubation, followed by Western blotting of cell lysates to measure phosphorylation and abundance of the mTORC1 pathway proteins Akt (Ser473); ribosomal protein S6 kinase p70 (S6K1, Thr389); eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1, Ser65); and ribosomal protein S6 (S6, Ser240/244). The Akt phosphorylation was overall increased by insulin, with a possible negative interaction with both total essential AA and the individual AA Leu. Total essential AA also increased S6K1 and 4E-BP1 phosphorylation in an insulin-dependent manner. The individual AA Leu, Met, Ile, and Arg increased S6K1 phosphorylation in an insulin-dependent manner. Similarly, Met and Arg increased 4E-BP1 phosphorylation in an insulin-dependent manner. Histidine, Lys, Trp, and Val did not affect S6K1 phosphorylation. However, S6K1 phosphorylation was linearly increased by Thr and quadratically decreased by Phe. Relative to the phosphorylation of S6K1 when cells were incubated with no essential AA, the NTOR-AA group had no effect, whereas the TOR-AA increased phosphorylation to the same degree observed with all 10 essential AA. Overall, we have found that insulin is required for essential AA to stimulate mTORC1 activity in MAC-T cells. In addition, the AA responsible for the bulk of mTORC1 activation in MAC-T are limited to Leu, Met, Ile, Arg, and Thr.

Transposition of the common carotid artery in standing cattle.

OBJECTIVE: To describe a method for permanent transposition of the common carotid artery (CCA) in standing cattle. STUDY DESIGN: Experimental study. ANIMALS: Eight healthy, adult, lactating Holstein-Friesian cows. METHODS: Cows were restrained with the head and neck extended by using halters, head catch, and squeeze chute. Surgery was performed under local anesthesia and intravenous sedation. The right CCA was approached through a skin incision dorsal and parallel to the jugular vein. The skin incision was extended through the brachiocephalicus and longus capitus muscles. When the vessel was present, ligation of accessory vessels of the CCA and internal jugular vein was performed to facilitate exposure. The artery was sharply dissected from the carotid sheath and elevated by using Penrose drains. The muscles were closed in two layers, leaving the artery in a subcutaneous position. The incision was protected with a tie-over bandage for 1 week. Sampling from the CCA was initiated approximately 6 weeks after surgery. RESULTS: The CCA was successfully transposed and used for repeated arterial blood sampling in all eight cows. No cows had intraoperative complications or evidence of surgical site infection. One cow had a postoperative suture reaction at the site of a suture used for maintaining the tie-over bandage. All arteries remained patent for use in subsequent studies. CONCLUSION: Permanent translocation of the CCA was successful in all cows in this study and consistently allowed serial arterial blood sampling. CLINICAL SIGNIFICANCE: Common carotid artery translocation is possible without general anesthesia in adult cattle and is useful in studies requiring serial sampling of arterial blood.

Long-term muscle changes after hamstring lengthening in children with bilateral cerebral palsy.

AIM: To evaluate short-term (1y postoperatively; E1) and long-term (at least 4y postoperatively; E2) changes in hamstring muscle-tendon length (MTL) and lengthening velocity after hamstring lengthening in children with bilateral cerebral palsy (CP). METHOD: Three-dimensional gait analysis was performed in 19 children (16 males, 3 females; 36 limbs; mean age at surgery 9y [SD 3y]; range 6-10y) with flexed knee gait, preoperative ankle dorsiflexion lower than 20 degrees, and CP before bilateral hamstring lengthening (E0), at E1 and E2. Hamstring MTL (normalized by leg length) and velocity were assessed via OpenSim software. RESULTS: MTL increased from E0 to E1 (p=0.004) and decreased from E1 to E2 (p<0.020). Hamstring lengthening velocity did not change. In the subgroup with short, not slow hamstrings, the increase in MTL was maintained at E2. INTERPRETATION: Hamstring lengthening is an efficient procedure to lengthen short and/or slow hamstrings short-term. The desired outcome with maintenance of the postoperative changes in hamstring MTL is only achieved for preoperatively short, not slow hamstrings. WHAT THIS PAPER ADDS: Surgical hamstring lengthening can be confirmed via musculoskeletal modelling in OpenSim software. Surgical hamstring lengthening in cerebral palsy does not change hamstring lengthening velocity. Short, not slow hamstrings present a long-lasting muscle-tendon length (MTL) increase after hamstring lengthening. Changes in MTL after hamstring lengthening cannot be maintained for slow hamstrings. MTL does not change after hamstring lengthening for neither short nor slow hamstrings.

CAMBIOS MUSCULARES A LARGO PLAZO DESPUÉS DEL ALARGAMIENTO DE LOS ISQUIOTIBIALES EN NIÑOS CON PARÁLISIS CEREBRAL BILATERAL: OBJETIVO: Evaluar los cambios a corto plazo (un año después de la operación; E1) y a largo plazo (al menos cuatro años después de la operación; E2) de la longitud del tendón muscular de los isquiotibiales (LT) y la velocidad de alargamiento después del estiramiento en niños con parálisis cerebral bilateral (PC). MÉTODO: Se realizó un análisis tridimensional de la marcha en 19 niños (16 varones, tres mujeres; 36 extremidades; edad media en la cirugía 9 años [DS 3 años]; rango 6-10 años) con la marcha en flexión de la rodilla, dorsiflexión preoperatoria del tobillo inferior a 20 grados, antes del alargamiento bilateral de los isquiotibiales (E0), en E1 y E2. El LT de los músculos isquiotibiales (normalizado por la longitud de la pierna) y la velocidad fueron evaluadas mediante el OpenSim. RESULTADOS: El LT aumentó de E0 a E1 (p = 0,004) y disminuyó de E1 a E2 (p<0,020). La velocidad de alargamiento de los isquiotibiales no cambió. En el subgrupo con isquiotibiales cortos, pero no lentos, el aumento de la LT se mantuvo en E2. INTERPRETACIÓN: El alargamiento de los isquiotibiales es un procedimiento eficiente para los isquiotibiales cortos y/o lentos a corto plazo. El resultado deseado con el mantenimiento de los cambios postoperatorios en la longitud de los isquiotibiales solo se logra para los isquiotibiales cortos no lentos antes de la operación.

ALTERAÇÕES MUSCULARES A LONGO PRAZO APÓS ALONGAMENTO DE ISQUIOTIBIAIS EM CRIANÇAS COM PARALISIA CEREBRAL BILATERAL: OBJETIVO: Avaliar a curto (um ano de pós-operatório; E1) e longo prazo (no mínimo quatro anos de pós-operatório; E2) alterações no comprimento do tendão do músculo (CTM) isquiotibial e a velocidade de estiramento após alongamento do isquiotibial em crianças com paralisia cerebral bilateral (PC). MÉTODO: Foi realizada a análise tridimensional da marcha em 19 crianças (16 meninos, três meninas; 36 membros; média de idade de cirurgia de 9 anos [DP 3 anos]; variação de 6-10 anos) com marcha com flexão de joelho, ângulo de dorsiflexão de tornozelo menor que 20o no pré-operatório, e PC antes do alongamento bilateral dos isquiotibiais (E0), em E1 e E2. CTM dos isquiotibiais (normalizado pelo comprimento da perna) e a velocidade foram avaliados pelo OpenSim. RESULTADOS: CTM aumentou de E0 para E1 (p=0,004) e diminuiu de E1 para E2 (p<0,020). A velocidade de estiramento do isquiotibial não mudou. No subgrupo com isquiotibial encurtado e não lento, o aumento no CTM foi mantido em E2. INTERPRETAÇÃO: O alongamento do músculo isquiotibial é um procedimento eficiente para alongar isquitotibiais encurtados e/ou lentos a curto prazo. O resultado desejado com a manutenção das alterações no pós-operatório no CTM do isquiotibial é atingida somente para isquiotibial curto e não lento no pré-operatório.

Supracondylar femoral rotation osteotomy affects frontal hip kinetics in children with bilateral cerebral palsy.

AIM: To evaluate the influence of supracondylar femoral derotation osteotomy (FDO) on hip abduction muscle force and frontal hip moments in children with bilateral cerebral palsy. METHOD: For this retrospective cohort study 79 children (36 females, 43 males; mean age at surgery 11y [SD 3y]; range 4-17y) with bilateral cerebral palsy and preoperatively and 1-year postoperatively documented frontal hip moments who received supracondylar FDO in 134 limbs were included. The control group consisted of eight children (two females, six males; mean age 11y [SD 4y]; range 5-17y) who received single-event multi-level surgery without FDO. RESULTS: Hip joint impulse (p<0.001) and the first peak of frontal hip moments (p=0.003) increased, whereas the second peak decreased (p<0.001) from preoperatively to postoperatively. Hip abductor strength improved (p=0.001) from preoperatively to postoperatively. INTERPRETATION: Despite the compensatory mechanism, frontal hip moments are decreased preoperatively. Supracondylar FDO results in increased frontal hip moments. Changes in anteversion directly influence hip kinetics, although no direct change of the proximal bony geometry is performed. WHAT THIS PAPER ADDS: Internal rotation gait cannot fully restore the frontal hip moment. Supracondylar femoral derotation osteotomy (FDO) influences frontal hip kinetics in children with bilateral cerebral palsy. Supracondylar FDO changes the curve progression of frontal hip moments. Supracondylar FDO restores the hip abductor moment arm. Supracondylar FDO leads to an increase in hip abductor muscle force.

Three dimensional gait analysis in patients with symptomatic component mal-rotation after total knee arthroplasty.

PURPOSE: Purpose of the present cohort study was the determination of lower body function and rotation in patients with symptomatic component mal-rotation after total knee arthroplasty using instrumented 3D gait analysis. METHODS: A consecutive series of 12 patients (61.3 years ± 11.4 years) were included suffering under remaining pain or limited range of motion at least six months after total knee arthroplasty. A CT-scan according to the protocol of Berger et al. and instrumented 3D gait analysis were carried out including clinical examination, videotaping, and kinematic analysis using a Plug-in Gait model. Outcome variables were temporospatial parameters as well as kinematics in sagittal and transversal plane. Data for reference group were collected retrospectively and matched by age and gender. RESULTS: Temporospatial parameters of the study group showed decreased velocity, cadence, and step length as well as increased step time. Single limb support was reduced for the affected limb. In sagittal plane, maximum knee flexion during swing phase was reduced for the replaced knee joint. In transverse plane, there was hardly any difference between affected and non-affected limb. Compared to the reference group, both limbs show significant increased internal ankle rotation and external hip rotation. There were significant strong linear correlations between ankle rotation and hip rotation as well as ankle rotation and radiological tibial mal-rotation. CONCLUSIONS: Patients with symptomatic component mal-rotation after total knee arthroplasty showed typically functional deficits. The affected and non-affected limb showed significant increased internal ankle rotation and external hip rotation, while only the affected, replaced knee showed reduced internal knee rotation. Identification of rotational abnormalities of hip and ankle joints seems to be mandatory in TKA to identify the patient group with external hip rotation, internal ankle rotation, and an elevated risk for symptomatic rotational TKA component mal-alignment.

Soil elemental analysis in a high conservation tropical forest in Singapore.

To understand the distribution of soil elemental concentrations and their potential sources of trace metal contamination in the high-conservation Nee Soon freshwater swamp forest in Singapore, we analyzed samples from 227 surface and 35 subsurface (auger profiles) locations. Our assessment involved distribution maps, principle component analysis, cluster analysis, and correlation analysis of element concentrations determined from a mixed acid digestion and measurement on an ICP-MS. We found a distinct zonation in the distribution of several elements (Ba, Cr, Cu, Fe, Mn, Pb, Sr, Ti, V, and Zn) between the upper and lower catchment that gives an erroneous notion of widespread contamination in the lower catchment. We believe this zonation is natural, likely related to differences in the underlying geology. However, Cu, Pb, and Sb concentrations were greatly enriched by anthropogenic activities on military training lands in the lower catchment, firing ranges in particular. Barium, Sr, and Zn also appear to be enriched in the lower part of the catchment, possibly from anthropogenic activities including military activity and roads. Although soils in the catchment are not highly contaminated, isolated areas with high concentrations of Cu, Pb and Sb may warrant management attention given the sensitive nature of the urban forest, which includes the last remaining fresh water swamp forest in Singapore.

Restoration of metabolic health by decreased consumption of branched-chain amino acids.

KEY POINTS: We recently found that feeding healthy mice a diet with reduced levels of branched-chain amino acids (BCAAs), which are associated with insulin resistance in both humans and rodents, modestly improves glucose tolerance and slows fat mass gain. In the present study, we show that a reduced BCAA diet promotes rapid fat mass loss without calorie restriction in obese mice. Selective reduction of dietary BCAAs also restores glucose tolerance and insulin sensitivity to obese mice, even as they continue to consume a high-fat, high-sugar diet. A low BCAA diet transiently induces FGF21 (fibroblast growth factor 21) and increases energy expenditure. We suggest that dietary protein quality (i.e. the precise macronutrient composition of dietary protein) may impact the effectiveness of weight loss diets. ABSTRACT: Obesity and diabetes are increasing problems around the world, and although even moderate weight loss can improve metabolic health, reduced calorie diets are notoriously difficult to sustain. Branched-chain amino acids (BCAAs; leucine, isoleucine and valine) are elevated in the blood of obese, insulin-resistant humans and rodents. We recently demonstrated that specifically reducing dietary levels of BCAAs has beneficial effects on the metabolic health of young, growing mice, improving glucose tolerance and modestly slowing fat mass gain. In the present study, we examine the hypothesis that reducing dietary BCAAs will promote weight loss, reduce adiposity, and improve blood glucose control in diet-induced obese mice with pre-existing metabolic syndrome. We find that specifically reducing dietary BCAAs rapidly reverses diet-induced obesity and improves glucoregulatory control in diet-induced obese mice. Most dramatically, mice eating an otherwise unhealthy high-calorie, high-sugar Western diet with reduced levels of BCAAs lost weight and fat mass rapidly until regaining a normal weight. Importantly, this normalization of weight was mediated not by caloric restriction or increased activity, but by increased energy expenditure, and was accompanied by a transient induction of the energy balance regulating hormone FGF21 (fibroblast growth factor 21). Consumption of a Western diet reduced in BCAAs was also accompanied by a dramatic improvement in glucose tolerance and insulin resistance. Our results link dietary BCAAs with the regulation of metabolic health and energy balance in obese animals, and suggest that specifically reducing dietary BCAAs may represent a highly translatable option for the treatment of obesity and insulin resistance.

Cardiac Troponin T Concentrations, Reversible Myocardial Ischemia, and Indices of Left Ventricular Remodeling in Patients with Suspected Stable Angina Pectoris: a DOPPLER-CIP Substudy.

BACKGROUND: Cardiac troponin T concentrations measured with high-sensitivity assays (hs-cTnT) provide important prognostic information for patients with stable coronary artery disease (CAD). However, whether hs-cTnT concentrations mainly reflect left ventricular (LV) remodeling or recurrent myocardial ischemia in this population is not known. METHODS: We measured hs-cTnT concentrations in 619 subjects with suspected stable CAD in a prospectively designed multicenter study. We identified associations with indices of LV remodeling, as assessed by cardiac MRI and echocardiography, and evidence of myocardial ischemia diagnosed by single positron emission computed tomography. RESULTS: Median hs-cTnT concentration was 7.8 ng/L (interquartile range, 4.8-11.6 ng/L), and 111 patients (18%) had hs-cTnT concentrations above the upper reference limit (>14 ng/L). Patients with hs-cTnT >14 ng/L had increased LV mass (144 ± 40 g vs 116 ± 34 g; P < 0.001) and volume (179 ± 80 mL vs 158 ± 44 mL; P = 0.006), lower LV ejection fraction (LVEF) (59 ± 14 vs 62 ± 11; P = 0.006) and global longitudinal strain (14.1 ± 3.4% vs 16.9 ± 3.2%; P < 0.001), and more reversible perfusion defects (P = 0.001) and reversible wall motion abnormalities (P = 0.008). Age (P = 0.009), estimated glomerular filtration rate (P = 0.01), LV mass (P = 0.003), LVEF (P = 0.03), and evidence of reversible myocardial ischemia (P = 0.004 for perfusion defects and P = 0.02 for LV wall motion) were all associated with increasing hs-cTnT concentrations in multivariate analysis. We found analogous results when using the revised US upper reference limit of 19 ng/L. CONCLUSIONS: hs-cTnT concentrations reflect both LV mass and reversible myocardial ischemia in patients with suspected stable CAD.

Mid-term development of hamstring tendon length and velocity after distal femoral extension osteotomy in children with bilateral cerebral palsy: a retrospective cohort study.

AIM: Flexed knee gait can be treated with distal femoral extension osteotomy (DFEO) and additional patellar tendon advancement (PTA) in children with cerebral palsy (CP). This study assesses changes in hamstring muscle tendon length (MTL) and velocity after DFEO (+PTA). METHOD: Nineteen children (mean age 13y [standard deviation 3y] at surgery) with CP and flexed knee gait who were treated with DFEO (15 limbs) or DFEO+PTA (10 limbs) were retrospectively included in this study. Gait analyses were performed preoperatively (E0), 1 year postoperatively (E1), and for 10 limbs additionally 2 to 5 years postoperatively (E2). Hamstring MTL and velocities were assessed at all examination dates using OpenSim. RESULTS: Hamstring MTL and velocity did not change significantly over time. From E0 to E1, knee flexion in stance improved for both DFEO and DFEO+PTA (p<0.05), knee flexion in swing only improved after DFEO+PTA (p<0.05). The improved knee flexion in stance and swing was maintained at E2. INTERPRETATION: DFEO led to a significant improvement in knee kinematics at E1 which was maintained at E2. DFEO seems to prevent recurrent hamstring tightness but does not lead to lengthened or fastened hamstrings. WHAT THIS PAPER ADDS: Distal femoral extension osteotomy (DFEO) does not change hamstring muscle tendon length. DFEO does not change hamstring lengthening velocity. DFEO leads to a significant improvement in knee kinematics. Changes in knee kinematics after DFEO can be maintained at mid-term. DFEO seems to prevent recurrent hamstring tightness.