Is the combined auriculotherapy approach superior to magneto-auriculotherapy alone in aging males with lower urinary tract symptoms? A randomized controlled trial.

OBJECTIVES: The negative impact of lower urinary tract symptoms (LUTS) on affected males is substantial. This study aims to assess whether a combined auriculotherapy (AT) using laser AT (LAT) and magneto-AT (MAT) is more effective than using MAT alone or placebo for managing LUTS of aging males.Methods: A randomized controlled, double-blinded trial was conducted. Sixty-two aging males with moderate or severe LUTS symptoms were randomly allocated into groups: Group 1, placebo LAT plus placebo MAT (n = 20); Group 2, combined AT approach using LAT plus MAT (n = 20); and Group 3, placebo LAT followed by MAT (n = 22). Six ear acupoints assumed to be suitable for alleviating LUTS were used. The total treatment period was 4 weeks, with follow-up visits till 3 months. Generalized estimating equations model was used for the examination of the interactions among the groups over time.Results: A combined AT approach exhibited a stronger treatment effect in relieving voiding problems, improving the peak urinary flow rate, and reducing the post-void residual urine than the placebo group or MAT alone.Conclusions: This study demonstrates that the AT protocol used in this study for aging males with LUTS is feasible and can be adopted in future study of increased scale.

Epidemiological investigation on hand hygiene knowledge and behaviour: a cross-sectional study on gender disparity.

BACKGROUND: The hand hygiene (HH) behaviour of the general public and its effect on illnesses are issues of growing importance. Gender is associated with HH behaviour. HH efficiency is a combination of washing efficiency and hand drying, but information about the knowledge level and HH behaviour of the general public is relatively limited. The findings of this cross-sectional study can substantially contribute to the understanding on the knowledge gap and public behaviour towards HH, thereby providing information on gender-specific health promotion activities and campaigns to improve HH compliance. METHODS: An epidemiological investigation by using a cross-sectional study design on the general public was conducted either via an online platform (SurveyMonkey) or paper-and-pen methods. The hand-washing and -drying questionnaire was used for data collection. RESULTS: A total of 815 valid questionnaires were collected. Majority of the respondents can differentiate the diseases that can or cannot be transmitted with poor HH, but the HH knowledge of the respondents was relatively inadequate. The female respondents had a significantly better HH knowledge than male respondents. The multiple regression analysis results also indicated that females had a significantly higher knowledge score by 0.288 towards HH than males after adjusting for age and education level. Although the majority of the respondents indicated that they performed hand cleaning under different specific situations, they admitted only using water instead of washing their hands with soap. More males than females dried their hands on their own clothing, whereas more females dried their hands through air evaporation. The average time of using warm hand dryers was generally inadequate amongst the respondents. CONCLUSIONS: Being a female, middle-aged and having tertiary education level are protective factors to improve HH knowledge. Misconceptions related to the concepts associated with HH were noted amongst the public. Self-reported practice on hand drying methods indicated that additional education was needed. The findings of this study can provide information on gender-specific health promotion activities and creative campaigns to achieve sustained improvement in HH practices.

The involvement of transient receptor potential canonical type 1 in skeletal muscle regrowth after unloading-induced atrophy.

KEY POINTS: Decreased mechanical loading results in skeletal muscle atrophy. The transient receptor potential canonical type 1 (TRPC1) protein is implicated in this process. Investigation of the regulation of TRPC1 in vivo has rarely been reported. In the present study, we employ the mouse hindlimb unloading and reloading model to examine the involvement of TRPC1 in the regulation of muscle atrophy and regrowth, respectively. We establish the physiological relevance of the concept that manipulation of TRPC1 could interfere with muscle regrowth processes following an atrophy-inducing event. Specifically, we show that suppressing TRPC1 expression during reloading impairs the recovery of the muscle mass and slow myosin heavy chain profile. Calcineurin appears to be part of the signalling pathway involved in the regulation of TRPC1 expression during muscle regrowth. These results provide new insights concerning the function of TRPC1. Interventions targeting TRPC1 or its downstream or upstream pathways could be useful for promoting muscle regeneration. ABSTRACT: Decreased mechanical loading, such as bed rest, results in skeletal muscle atrophy. The functional consequences of decreased mechanical loading include a loss of muscle mass and decreased muscle strength, particularly in anti-gravity muscles. The purpose of this investigation was to clarify the regulatory role of the transient receptor potential canonical type 1 (TRPC1) protein during muscle atrophy and regrowth. Mice were subjected to 14 days of hindlimb unloading followed by 3, 7, 14 and 28 days of reloading. Weight-bearing mice were used as controls. TRPC1 expression in the soleus muscle decreased significantly and persisted at 7 days of reloading. Small interfering RNA (siRNA)-mediated downregulation of TRPC1 in weight-bearing soleus muscles resulted in a reduced muscle mass and a reduced myofibre cross-sectional area (CSA). Microinjecting siRNA into soleus muscles in vivo after 7 days of reloading provided further evidence for the role of TRPC1 in regulating muscle regrowth. Myofibre CSA, as well as the percentage of slow myosin heavy chain-positive myofibres, was significantly lower in TRPC1-siRNA-expressing muscles than in control muscles after 14 days of reloading. Additionally, inhibition of calcineurin (CaN) activity downregulated TRPC1 expression in both weight-bearing and reloaded muscles, suggesting a possible association between CaN and TRPC1 during skeletal muscle regrowth.

Using auriculotherapy for osteoarthritic knee among elders: a double-blinded randomised feasibility study.

BACKGROUND: Osteoarthritic knee (OA knee) is a common condition in the elderly. Exploration of non-invasive complementary therapies for OA knee is warranted given the limitations of pharmacologic therapies. Auriculotherapy (AT) is a therapeutic method in which specific points on the auricle are stimulated to treat various disorders of the body, and the therapeutic value and synergistic effect of laser auriculotherapy (LAT) when combined with magneto-auriculotherapy (MAT) merits further investigation. METHODS: This study adopted a double-blinded four-arm randomized placebo design. The aims of study are (1) to assess the feasibility of AT among elders with OA knee in a future large-scale study, including the use of blinding in subjects and evaluators, acceptance of treatment protocol, and estimating the effect size and attrition rate; and (2) to evaluate the preliminary effect of AT in elders with OA knee. Subjects were randomly divided into four groups with different modes of AT with/without placebo objects. A total of 43 subjects completed the 6-week intervention and post-assessment. Assessments included a numerical rating scale of pain (NRS), the timed-up-and-go test (TUGT), and standard goniometer measurements during knee flexion and extension, Kruskal-Wallis test was used to evaluate differences among groups, and Wilcoxon sign-ranked test for examining within-group comparison. RESULTS: Preliminary results indicated the absence of differences in the NRS, TUGT, and active/passive knee flexion and extension at baseline, as well as post-therapy, between the four groups. Even though the differences of these parameters between groups were not significant, the relative differences of NRS and TUGT in subjects who received combined MAT plus LAT were higher than those treated with MAT or LAT alone, or the placebo group. Four of the six parameters demonstrated significant within group differences in subjects who received MAT and/or LAT, whereas no significant differences were found in the placebo group. CONCLUSION: This study demonstrates that the AT protocol adopted in this study for elders with OA knee is feasible and could be applied in future larger-scale study. Larger sample size should be considered in a future trial to determine the causal relationship between treatment and effect. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02352636 . Registered on 23 January 2015.

Acute effects of kinesio taping on knee extensor peak torque and electromyographic activity after exhaustive isometric knee extension in healthy young adults.

OBJECTIVE: To evaluate the effect of Kinesio Tex tape and its method of application, Kinesio Taping (KT) on knee extensor performance before and after an exhaustive isometric knee extension exercise. DESIGN: Single-blinded, randomized control trial. SETTING: Centre for Sports Training and Rehabilitation at The Hong Kong Polytechnic University. PARTICIPANTS: Twenty-six healthy volunteers with no history of knee injuries. INTERVENTIONS: Subjects were randomized to either the KT or sham taping group. MAIN OUTCOME MEASURES: The effects of KT on the neuromuscular performance of the knee extensors were measured before and after KT application, and immediately and 5 and 10 minutes after an exhaustive isometric knee extension exercise. RESULTS: Within-group analyses revealed a significant effect of time on the peak torque in isometric knee extension (F2.73,65.44 = 24.5, P < 0.001), but no significant group (F2.73,65.44 = 2.13, P = 0.11) or interaction (F1,24 = 0.59, P = 0.45) effect. A significant time effect (F2.52,60.14 = 3.75, P = 0.02) and a significant time × group interaction (F1,24 = 4.59, P = 0.04) was found for the rate of peak torque development. Post hoc comparisons revealed significantly higher rates in the intervention group (F1,24 = 4.594, P = 0.04) over all 5 tests. No significant effects of time (F4,96 = 0.88, P = 0.48; F2.56,61.35 = 2.75, P = 0.06), group (F4,96 = 0.56, P = 0.69; F2.56,61.35 = 1.16, P = 0.33), or time × group interaction (F1,24 = 2.77, P = 0.11; F1,24 = 0.20, P = 0.66) were found for either the electromechanical delay or electromyographic results, respectively. CONCLUSIONS: The present study suggests that KT shortens the time required to generate peak torque during isometric knee extension, which has important implications for sports performances that require the rapid generation of peak muscular force. CLINICAL RELEVANCE: Kinesio taping is commonly seen in the sports arena. The popularity is presumably due to the general belief in its injury prevention and enhancement of muscle performance. The results of the present findings suggested that KT shortens the time to reach peak torque generation. Aside from this, there is no other significant positive effect on muscle performance. Further investigation on the effects of KT on muscle performance is warranted.

Adaptive responses of TRPC1 and TRPC3 during skeletal muscle atrophy and regrowth.

INTRODUCTION: We assessed the time-dependent changes of transient receptor potential canonical type 1 (TRPC1) and TRPC3 expression and localization associated with muscle atrophy and regrowth in vivo. METHODS: Mice were subjected to hindlimb unloading for 7 or 14 days (7U, 14U) followed by 3, 7, or 14 days of reloading (3R, 7R, 14R). RESULTS: Soleus muscle mass and tetanic force were reduced significantly at 7U and 14U and recovered by 14R. Recovery of muscle fiber cross-sectional area was observed by 28R. TRPC1 mRNA was unaltered during the unloading-reloading period. However, protein expression remained depressed through 14R. Decreased localization of TRPC1 to the sarcolemma was observed. TRPC3 mRNA and protein expression levels were decreased significantly during the early phase of reloading. CONCLUSIONS: Given the known role of these channels in muscle development, changes observed in TRPC1 and TRPC3 may relate closely to muscle atrophy and remodeling processes.

Correlates of illness severity in infectious mononucleosis.

INTRODUCTION: Understanding the spectrum and frequencies of Epstein-Barr virus (EBV) complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV-related illnesses. OBJECTIVES: To determine the clinical and laboratory correlates of illness severity among infants, children and youth with infectious mononucleosis (IM). METHODS: Study subjects with confirmed IM were prospectively enrolled. Illness severity was assessed at baseline and at six weeks using a scoring tool. Peripheral blood viral loads served as a measure of viral burden. RESULTS: Among 32 children and young adults with IM, the median age was 16 years (range two to 24 years). The predominant clinical findings were lymphadenopathy (23 of 32 [72%]), pharyngitis (16 of 32 [50%]), fever (nine of 32 [28%]) and splenomegaly (six of 32 [19%]). With respect to symptoms or signs that persisted to at least six weeks after illness onset, the predominant complaint was lymphadenopathy in 35% of subjects available for reassessment. Deranged liver function tests were present at presentation in up to 44% of subjects. Patients with the highest viral loads at presentation had significantly higher illness severity scores associated with fatigue (P=0.02). Other than the scores associated with fatigue, viral load values were not significantly correlated with the illness severity scores at baseline and at six weeks. CONCLUSION: In IM, viral loads are not necessarily correlated with illness severity, with the exception of fatigue. EBV-related hepatitis is common in IM, confirming the status of this virus as a relatively common cause of transient hepatitis in children and youth. This entity is not necessarily a marker of disease severity.

INTRODUCTION: Il faut comprendre le spectre et la fréquence des complications et des marqueurs de gravité du virus d'Epstein-Barr (VEB) chez les patients immunocompétents atteints d'une infection primaire par le VEB pour étayer la prise en charge des patients ayant une maladie liée à ce virus. OBJECTIFS: Déterminer les corrélats cliniques et de laboratoire de gravité de la maladie chez des nourrissons, des enfants et des adolescents atteints de mononucléose infectieuse (MI). MÉTHODOLOGIE: Les sujets atteints d'une MI confirmée ont été enrôlés prospectivement dans l'étude. Les chercheurs ont évalué la gravité de la maladie en début d'étude et au bout de six semaines au moyen d'un outil d'évaluation. Les charges virales du sang périphérique ont été utilisées pour mesurer le fardeau viral. RÉSULTATS: Les 32 enfants et jeunes adultes atteints de MI avaient un âge médian de 16 ans (plage de deux à 24 ans). Les principales observations cliniques étaient une lymphadénopathie (23 cas sur 32 [72 %]), une pharyngite (16 sur 32 [50 %]), de la fièvre (neuf sur 32 [28 %]) et une splénomégalie (six sur 32 [16 %]). Parmi les signes ou symptômes qui ont persisté au moins six semaines après l'apparition de la maladie, la lymphadénopathie était le principal problème chez 35 % des sujets disponibles pour être réévalués. Jusqu'à 44 % des sujets présentaient des anomalies dans les tests de fonction hépatique. Les patients dont la charge virale était la plus élevée à la présentation obtenaient des indices de gravité de la maladie associée à la fatigue considérablement plus marqués (P=0,02). À part les indices associés à la fatigue, les valeurs de la charge virale n'avaient pas de corrélation significative avec les indices de gravité de la maladie en début d'étude et au bout de six semaines. CONCLUSION: En cas de MI, les charges virales ne sont pas nécessairement corrélées avec la gravité de la maladie, à l'exception de la fatigue. L'hépatite liée au VEB est courante en présence de MI. Ainsi, ce virus est une cause relativement fréquente d'hépatite transitoire chez les enfants et les adolescents. Cette entité n'est pas nécessairement un marqueur de gravité de la maladie.

Acute Whole-Body Vibration does not Facilitate Peak Torque and Stretch Reflex in Healthy Adults.

The acute effect of whole-body vibration (WBV) training may enhance muscular performance via neural potentiation of the stretch reflex. The purpose of this study was to investigate if acute WBV exposure affects the stretch induced knee jerk reflex [onset latency and electromechanical delay (EMD)] and the isokinetic knee extensor peak torque performance. Twenty-two subjects were randomly assigned to the intervention or control group. The intervention group received WBV in a semi-squat position at 30° knee flexion with an amplitude of 0.69 mm, frequency of 45 Hz, and peak acceleration of 27.6 m/s(2) for 3 minutes. The control group underwent the same semii-squatting position statically without exposure of WBV. Two-way mixed repeated measures analysis of variance revealed no significant group effects differences on reflex latency of rectus femoris (RF) and vastus lateralis (VL; p = 0.934 and 0.935, respectively) EMD of RF and VL (p = 0.474 and 0.551, respectively) and peak torque production (p = 0.483) measured before and after the WBV. The results of this study indicate that a single session of WBV exposure has no potentiation effect on the stretch induced reflex and peak torque performance in healthy young adults. Key PointsThere is no acute potentiation of stretch reflex right after whole body vibration.Acute whole body vibration does not improve mus-cle peak torque performance in healthy young adults.

Musculoskeletal injuries in elite able-bodied and wheelchair foil fencers--a pilot study.

OBJECTIVE: To explore the incidence of musculoskeletal injuries in elite able-bodied and wheelchair foil fencers. DESIGN: A 3-year prospective cohort study of sport injuries during 2006-2009. SETTING: A sample of elite able-bodied fencers (AFs) and wheelchair fencers (WFs) from the Hong Kong National Squad. PARTICIPANTS: A total of 14 wheelchair and 10 able-bodied elite fencers completed the 3-year study. METHODS: Monthly interviews with fencers to collect data related to their injuries. MAIN OUTCOME MEASURES: The incidence rate and relative risk of injury were analyzed among able-bodied and WFs with different trunk control ability. RESULTS: Wheelchair fencers had higher overall injury incidence rate (3.9/1000 hours) than AFs (2.4/1000 hours). Wheelchair fencers with poor trunk control were more vulnerable to injuries (4.9/1000 hours) than those with good trunk control (3.0/1000 hours). Upper extremity injuries were predominant in WFs (73.8%), with elbow (32.6%) and shoulder strain (15.8%) being the most common injuries. Lower extremity injuries were predominant in AFs (69.4%), with muscle strain over knee and thigh region (22.6%), ankle sprain (14.5%), and knee sprain (11.3%) being the leading injuries. CONCLUSIONS: Results of this pilot study highlighted the distinct injury incidence between the 2 different fencer groups. Larg-scale epidemiologic and biomechanical studies are warranted to improve the understanding of fencing injuries to develop specific injury prevention/rehabilitation programs.

Expression and association of TRPC1 with TRPC3 during skeletal myogenesis.

INTRODUCTION: TRPC1 and TRPC3 proteins are widely expressed in skeletal muscles in forming calcium-permeable channels. Herein we characterize the expression pattern of TRPC transcripts during skeletal myogenesis in C2C12 myoblasts. METHODS: We used polymerase chain reaction and Western blotting to detect expression levels, immunohistochemistry for subcellular localization, and co-immunoprecipitation techniques to assess interaction. RESULTS: TRPC1 localizes to the cytoplasm and is enriched in the perinuclear region in undifferentiated myoblasts. Expression of TRPC1 increases significantly during myogenesis and resides mainly in differentiated myocytes and myotubes. TRPC3 is absent in undifferentiated myoblasts, is dramatically upregulated in differentiated culture, and is preferentially expressed in myotubes. Physical interaction of TRPC1-TRPC3 was observed, suggesting the possible existence of heteromers. CONCLUSIONS: Expression of TRPC1 and TRPC3 is tightly regulated during myogensis. Evidence of TRPC1-TRPC3 interaction was first demonstrated in a muscle cell line. The functional consequences of this interaction remain to be established.

Interventions for preventing lower limb soft-tissue running injuries.

BACKGROUND: Overuse soft-tissue injuries occur frequently in runners. Stretching exercises, modification of training schedules, and the use of protective devices such as braces and insoles are often advocated for prevention. This is an update of a review first published in 2001. OBJECTIVES: To assess the effects of interventions for preventing lower limb soft-tissue running injuries. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2011); The Cochrane Library 2010, Issue 4; MEDLINE (1966 to January 2011); EMBASE (1980 to January 2011); and international trial registries (17 January 2011). SELECTION CRITERIA: Randomised or quasi-randomised trials evaluating interventions to prevent lower limb soft-tissue running injuries. DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of bias (relating to sequence generation, allocation concealment, blinding, incomplete outcome data) and extracted data. Data were adjusted for clustering if necessary and pooled using the fixed-effect model when appropriate. MAIN RESULTS: We included 25 trials (30,252 participants). Participants were military recruits (19 trials), runners from the general population (three trials), soccer referees (one trial), and prisoners (two trials). The interventions tested in the included trials fell into four main preventive strategies: exercises, modification of training schedules, use of orthoses, and footwear and socks. All 25 included trials were judged as 'unclear' or 'high' risk of bias for at least one of the four domains listed above.We found no evidence that stretching reduces lower limb soft-tissue injuries (6 trials; 5130 participants; risk ratio [RR] 0.85, 95% confidence interval [95% CI] 0.65 to 1.12). As with all non-significant results, this is compatible with either a reduction or an increase in soft-tissue injuries. We found no evidence to support a training regimen of conditioning exercises to improve strength, flexibility and coordination (one trial; 1020 participants; RR 1.20, 95% CI 0.77 to 1.87).We found no evidence that a longer, more gradual increase in training reduces injuries in novice runners (one trial; 486 participants; RR 1.02, 95% CI 0.72 to 1.45). There was some evidence from a poor quality trial that additional training resulted in a significant increase in the number of naval recruits with shin splints (one trial; 1670 participants; RR 2.02, 95% CI 1.11 to 3.70). There was limited evidence that injuries were less frequent in prisoners when running duration (one trial; 69 participants; RR 0.41, 95% CI 0.21 to 0.79) or frequency (one trial; 58 participants; RR 0.19, 95% CI 0.06 to 0.66) were reduced.Patellofemoral braces appear to be effective for preventing anterior knee pain (two trials; 227 participants; RR 0.41, 95% CI 0.24 to 0.67).Custom-made biomechanical insoles may be more effective than no insoles for reducing shin splints (medial tibial stress syndrome) in military recruits (one trial; 146 participants; RR 0.24, 95% CI 0.08 to 0.69).We found no evidence in military recruits that wearing running shoes based on foot shape, rather than standard running shoes, significantly reduced rate of running injuries (2 trials; 5795 participants; Rate Ratio 1.03, 95% CI 0.93 to 1.14). AUTHORS' CONCLUSIONS: Overall, the evidence base for the effectiveness of interventions to reduce soft-tissue injury after intensive running is very weak, with few trials at low risk of bias. More well-designed and reported RCTs are needed that test interventions in recreational and competitive runners.

Low back pain among personal care workers in an old age home: work-related and individual factors.

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35-39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86-22.97, p = .074) and neck (OR = 0.18, CI = 0.04-0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70-3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

The effects of low frequency electrical stimulation on satellite cell activity in rat skeletal muscle during hindlimb suspension.

BACKGROUND: The ability of skeletal muscle to grow and regenerate is dependent on resident stem cells called satellite cells. It has been shown that chronic hindlimb unloading downregulates the satellite cell activity. This study investigated the role of low-frequency electrical stimulation on satellite cell activity during a 28 d hindlimb suspension in rats. RESULTS: Mechanical unloading resulted in a 44% reduction in the myofiber cross-sectional area as well as a 29% and 34% reduction in the number of myonuclei and myonuclear domains, respectively, in the soleus muscles (P < 0.001 vs the weight-bearing control). The number of quiescent (M-cadherin(+)), proliferating (BrdU(+) and myoD(+)), and differentiated (myogenin(+)) satellite cells was also reduced by 48-57% compared to the weight-bearing animals (P < 0.01 for all). Daily application of electrical stimulation (2 × 3 h at a 20 Hz frequency) partially attenuated the reduction of the fiber cross-sectional area, satellite cell activity, and myonuclear domain (P < 0.05 for all). Extensor digitorum longus muscles were not significantly altered by hindlimb unloading. CONCLUSION: This study shows that electrical stimulation partially attenuated the decrease in muscle size and satellite cells during hindlimb unloading. The causal relationship between satellite cell activation and electrical stimulation remain to be established.

The association between back pain and trunk posture of workers in a special school for the severe handicaps.

BACKGROUND: The present study aims to determine the time spent in different static trunk postures during a typical working day of workers in a special school for the severe handicaps. METHODS: Eighteen workers with low back pain (LBP) and fifteen asymptomatic workers were recruited. A cross-sectional design was employed to study the time spent in different static trunk postures which was recorded by a biaxial accelerometer attached to the T12 level of the back of the subjects. RESULTS: The results of ANCOVA revealed that subjects with LBP spent significantly longer percentage of time in static trunk posture when compared to normal (p < 0.05). It was also shown that they spent significantly longer time in trunk flexion for more than 10 degrees (p < 0.0125). CONCLUSION: An innovative method has been developed for continuous tracking of spinal posture, and this has potential for widespread applications in the workplace. The findings of the present investigation suggest that teachers in special schools are at increased risk of getting LBP. In order to minimise such risk, frequent postural change and awareness of work posture are recommended.

The public washroom - friend or foe? An observational study of washroom cleanliness combined with microbiological investigation of hand hygiene facilities.

Background: Many people use handwashing and hand-drying facilities in public washrooms under the impression that these amenities are hygienic. However, such facilities may be potential sites for the transmission of pathogenic bacteria. This study aimed to examine the hygiene facilities provided including handwashing and hand-drying facilities in public washrooms. Total bacterial counts and species identification were determined for hand-drying facilities. Antimicrobial susceptibilities were performed. Methods: The bacterial contamination levels of 55 public washrooms ranging in category from low class communities to high end establishments, were examined. The hygienic environment and facilities of the washrooms were analysed using an electronic checklist to facilitate immediate data entry. Pre-moistened sterile swabs were used to collect samples from areas around the outlet of paper towel dispensers, air outlet of air dryers, exit door handles and paper towels in the washrooms. Total bacterial counts were performed and isolates identified using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry. Antimicrobial susceptibility was determined by disk diffusion. Results: The high and middle-income categories washrooms generally had cleaner facilities and environment followed by those in low categories. Fifty-two bacterial species were identified from the 55 investigated washrooms. Over 97% of the pathogenic Staphylococcus spp. tested were resistant to at least one first-line antimicrobial therapeutic agent, including penicillin, cefoxitin, erythromycin, co-trimoxazole, clindamycin and gentamicin, and 22.6% demonstrated co-resistance to at least three antimicrobial agents, with co-resistance to penicillin, erythromycin and clindamycin being the most common. Conclusion: Our findings suggest that hand-drying facilities in public washrooms can act as reservoirs of drug-resistant bacteria. The importance of frequent cleaning and maintenance of public washrooms to promote safe hand hygiene practices for the public are emphasised.

Self-Administered Auricular Acupressure Integrated With a Smartphone App for Weight Reduction: Randomized Feasibility Trial.

BACKGROUND: Obesity is a common global health problem and increases the risk of many chronic illnesses. Given the adverse effects of antiobesity agents and bariatric surgeries, the exploration of noninvasive and nonpharmacological complementary methods for weight reduction is warranted. OBJECTIVE: The study aimed to determine whether self-administered auricular acupressure (AA) integrated with a smartphone app was more effective than using AA alone or the controls for weight reduction. METHODS: This study is a 3-arm randomized waitlist-controlled feasibility trial. A total of 59 eligible participants were randomly divided into either group 1 (AA group, n=19), group 2 (AA plus smartphone app, n=19), or group 3 (waitlist control, n=21). A total of 6 reflective zones or acupoints for weight reduction were chosen. The smartphone app could send out daily messages to the subjects to remind them to perform self-pressing on the 6 ear acupoints. A "date picker" of the 8-week treatment course was used to enable the users to input the compliance of pressing and the number of bowel movement daily instead of using the booklet for recordings. The app also served as a reminder for the subjects regarding the dates for returning to the center for acupoint changing and assessments. Treatment was delivered 2 times a week, for 8 weeks. Generalized estimating equations were used to examine the interactions among the groups before and after intervention. RESULTS: Subjects in group 2 expressed that the smartphone app was useful (7.41 out of 10). The most popular features were the daily reminders for performing self-pressing (88%), the ear diagram indicating the locations and functions of the 6 ear points (71%), and ear pressing method demonstrated in the video scripts (47%). Nearly 90% of the participants completed the 8-week intervention, with a high satisfaction toward the overall arrangement (8.37 out of 10). The subjects in group 1 and 2 achieved better therapeutic effects in terms of body weight, body mass index (BMI), waist circumference, and hip circumference and perceived more fullness before meals than the waitlist controls. Although no significant differences in the pairwise comparisons between the 2 groups were detected (P>.05), the decrease in body weight, BMI, body fat, visceral fat rating and leptin level, and increase in adiponectin level were notable in group 2 before and after the intervention. CONCLUSIONS: The high compliance rate and high satisfaction toward the trial arrangement indicate that AA can be used to achieve weight reduction and applied in future large-scale studies. AA integrated with the smartphone app has a more notable effect than using AA alone for weight reduction. Larger sample size should be considered in future trials to determine the causal relationship between treatment and effect. TRIAL REGISTRATION: ClinicalTrials.gov NCT03442712; https://clinicaltrials.gov/ct2/show/NCT03442712 (Archived by WebCite at http://www.webcitation.org/78L2tO8Ql).

Posttransplant Lymphoproliferative Disorder in Pediatric Patients: Characteristics of Disease in EBV-seropositive Recipients.

BACKGROUND: Patients at greatest risk of posttransplant lymphoproliferative disorder (PTLD) are those who acquire primary Epstein-Barr virus (EBV) infection after solid organ transplantation. The incidence of PTLD among patients who are EBV-seropositive before transplant is lower, and little is known about the differences in presentation and outcome of this population. We describe the characteristics of EBV-seropositive transplant recipients (R+) who developed PTLD and compare survival outcomes with EBV-seronegative recipients (R-). METHODS: A hospital-based registry was used to identify all patients with biopsy-proven PTLD for the period 2000-2014. Characteristics and outcomes were compared between R+ and R- patients with PTLD. RESULTS: Sixty-nine patients were included, among which 20 (29.0%) were R+ and 49 (71.0%) were R-. Multiorgan transplant patients accounted for 25% of PTLD cases in R+ patients, while accounting for only 2.1% of all transplants during the study period. There was no difference in PTLD site between R+ and R- patients. PTLD among R+ individuals occurred during the second year after transplant (median: 1.92; range: 0.35-3.09 y) compared with during the first year for R- individuals (median: 0.95; range: 0.48-2.92 y; P = 0.380). There was a trend for a higher overall mortality among R+ individuals (log rank: 0.09). PTLD-related mortality did not differ between R+ and R- individuals (log rank: 0.17). CONCLUSIONS: PTLD among R+ individuals was more likely to occur among multiorgan recipients, and there was a tendency for poorer outcomes at 1 and 5 years after the diagnosis of PTLD.

Role of the calcium-calpain pathway in cytoskeletal damage after eccentric contractions.

The mechanism(s) underlying eccentric damage to skeletal muscle cytoskeleton remain unclear. We examined the role of Ca(2+) influx and subsequent calpain activation in eccentric damage to cytoskeletal proteins. Eccentric muscle damage was induced by stretching isolated mouse muscles by 20% of the optimal length in a series of 10 tetani. Muscle force and immunostaining of the cytoskeletal proteins desmin, dystrophin, and titin were measured at 5, 15, 30, and 60 min after eccentric contractions and compared with the control group that was subjected to 10 isometric contractions. A Ca(2+)-free solution and leupeptin (100 microM), a calpain inhibitor, were applied to explore the role of Ca(2+) and calpain, respectively, in eccentric muscle damage. After eccentric contractions, decreases in desmin and dystrophin immunostaining were apparent after 5 min that accelerated over the next 60 min. Increased titin immunostaining, thought to indicate damage to titin, was evident 10 min after stretch, and fibronectin entry, indicating membrane disruption, was evident 20 min after stretch. These markers of damage also increased in a time-dependent manner. Muscle force was reduced immediately after stretch and continued to fall, reaching 56 +/- 2% after 60 min. Reducing extracellular calcium to zero or applying leupeptin minimized the changes in immunostaining of cytoskeletal proteins, reduced membrane disruption, and improved the tetanic force. These results suggest that the cytoskeletal damage and membrane disruption were mediated primarily by increased Ca(2+) influx into muscle cells and subsequent activation of calpain.

Overexpression of Mechano-Growth Factor Modulates Inflammatory Cytokine Expression and Macrophage Resolution in Skeletal Muscle Injury.

In muscle regeneration, infiltrating myeloid cells, such as macrophages mediate muscle inflammation by releasing key soluble factors. One such factor, insulin-like growth factor 1 (IGF-1), suppresses inflammatory cytokine expression and mediates macrophage polarization to anti-inflammatory phenotype during muscle injury. Previously the IGF-1Ea isoform was shown to be anti-inflammatory. Another isoform of IGF-1, mechano-growth factor (MGF), is structurally and functionally distinct from IGF-1Ea, but its role in muscle inflammation has not yet been characterized. In this study, we hypothesized that MGF expression in muscle injury modulates muscle inflammation. We first investigated changes of transcription and expression of MGF in response to skeletal muscle injury induced by cardiotoxin (CTX) in vivo. At 1-2 days post-injury, Mgf expression was significantly upregulated and positively correlated with that of inflammatory cytokines. Immunostaining revealed that infiltration of neutrophils and macrophages coincided with Mgf upregulation. Furthermore, infiltrating neutrophils and macrophages expressed Mgf, suggesting their contribution to MGF upregulation in muscle injury. Macrophages seem to be the predominant source of MGF in muscle injury, whereas neutrophil depletion did not affect muscle Mgf expression. Given the association of MGF and macrophages, we then studied whether MGF could affect macrophage infiltration and polarization. To test this, we overexpressed MGF in CTX-injured muscles and evaluated inflammatory marker expression, macrophage populations, and muscle regeneration outcomes. MGF overexpression delayed the resolution of macrophages, particularly the pro-inflammatory phenotype. This coincided with upregulation of inflammatory markers. Annexin V-based flow cytometry revealed that MGF overexpression likely delays macrophage resolution by limiting macrophage apoptosis. Although MGF overexpression did not obviously affect muscle regeneration outcomes, the findings are novel and provide insights on the physiological roles of MGF in muscle regeneration.