Light-independent pathway of STN7 kinase activation under low temperature stress in runner bean (Phaseolus coccineus L.).

BACKGROUND: The phosphorylation of the Light-Harvesting Complex of photosystem II (LHCII) driven by STATE TRANSITION 7 (STN7) kinase is a part of one of the crucial regulatory mechanisms of photosynthetic light reactions operating in fluctuating environmental conditions, light in particular. There are evidenced that STN7 can also be activated without light as well as in dark-chilling conditions. However, the biochemical mechanism standing behind this complex metabolic pathway has not been deciphered yet. RESULTS: In this work, we showed that dark-chilling induces light-independent LHCII phosphorylation in runner bean (Phaseolus coccineus L.). In dark-chilling conditions, we registered an increased reduction of the PQ pool which led to activation of STN7 kinase, subsequent LHCII phosphorylation, and possible LHCII relocation inside the thylakoid membrane. We also presented the formation of a complex composed of phosphorylated LHCII and photosystem I typically formed upon light-induced phosphorylation. Moreover, we indicated that the observed steps were preceded by the activation of the oxidative pentose phosphate pathway (OPPP) enzymes and starch accumulation. CONCLUSIONS: Our results suggest a direct connection between photosynthetic complexes reorganization and dark-chilling-induced activation of the thioredoxin system. The proposed possible pathway starts from the activation of OPPP enzymes and further NADPH-dependent thioredoxin reductase C (NTRC) activation. In the next steps, NTRC simultaneously activates ADP-glucose pyrophosphorylase and thylakoid membrane-located NAD(P)H dehydrogenase-like complex. These results in starch synthesis and electron transfer to the plastoquinone (PQ) pool, respectively. Reduced PQ pool activates STN7 kinase which phosphorylates LHCII. In this work, we present a new perspective on the mechanisms involving photosynthetic complexes while efficiently operating in the darkness. Although we describe the studied pathway in detail, taking into account also the time course of the following steps, the biological significance of this phenomenon remains puzzling.

The GATA factor HANABA TARANU promotes runner formation by regulating axillary bud initiation and outgrowth in cultivated strawberry.

A runner, as an elongated branch, develops from the axillary bud (AXB) in the leaf axil and is crucial for the clonal propagation of cultivated strawberry (Fragaria × ananassa Duch.). Runner formation occurs in at least two steps: AXB initiation and AXB outgrowth. HANABA TARANU (HAN ) encodes a GATA transcription factor that affects AXB initiation in Arabidopsis and promotes branching in grass species, but the underlying mechanism is largely unknown. Here, the function of a strawberry HAN homolog FaHAN in runner formation was characterized. FaHAN transcripts can be detected in the leaf axils. Overexpression (OE) of FaHAN increased the number of runners, mainly by enhancing AXB outgrowth, in strawberry. The expression of the strawberry homolog of BRANCHED1 , a key inhibitor of AXB outgrowth in many plant species, was significantly downregulated in the AXBs of FaHAN -OE lines, whereas the expression of the strawberry homolog of SHOOT MERISTEMLESS, a marker gene for AXB initiation in Arabidopsis, was upregulated. Moreover, several genes of gibberellin biosynthesis and cytokinin signaling pathways were activated, whereas the auxin response pathway genes were repressed. Further assays indicated that FaHAN could be directly activated by FaNAC2, the overexpression of which in strawberry also increased the number of runners. The silencing of FaNAC2 or FaHAN inhibited AXB initiation and led to a higher proportion of dormant AXBs, confirming their roles in the control of runner formation. Taken together, our results revealed a FaNAC2-FaHAN pathway in the control of runner formation and have provided a means to enhance the vegetative propagation of cultivated strawberry.

Smart Chemical Sensor and Biosensor Networks for Healthcare 4.0.

Driven by technological advances from Industry 4.0, Healthcare 4.0 synthesizes medical sensors, artificial intelligence (AI), big data, the Internet of things (IoT), machine learning, and augmented reality (AR) to transform the healthcare sector. Healthcare 4.0 creates a smart health network by connecting patients, medical devices, hospitals, clinics, medical suppliers, and other healthcare-related components. Body chemical sensor and biosensor networks (BSNs) provide the necessary platform for Healthcare 4.0 to collect various medical data from patients. BSN is the foundation of Healthcare 4.0 in raw data detection and information collecting. This paper proposes a BSN architecture with chemical sensors and biosensors to detect and communicate physiological measurements of human bodies. These measurement data help healthcare professionals to monitor patient vital signs and other medical conditions. The collected data facilitates disease diagnosis and injury detection at an early stage. Our work further formulates the problem of sensor deployment in BSNs as a mathematical model. This model includes parameter and constraint sets to describe patient body characteristics, BSN sensor features, as well as biomedical readout requirements. The proposed model's performance is evaluated by multiple sets of simulations on different parts of the human body. Simulations are designed to represent typical BSN applications in Healthcare 4.0. Simulation results demonstrate the impact of various biofactors and measurement time on sensor selections and readout performance.

The Endocannabinoid System and Physical Exercise.

The endocannabinoid system (ECS) is involved in various processes, including brain plasticity, learning and memory, neuronal development, nociception, inflammation, appetite regulation, digestion, metabolism, energy balance, motility, and regulation of stress and emotions. Physical exercise (PE) is considered a valuable non-pharmacological therapy that is an immediately available and cost-effective method with a lot of health benefits, one of them being the activation of the endogenous cannabinoids. Endocannabinoids (eCBs) are generated as a response to high-intensity activities and can act as short-term circuit breakers, generating antinociceptive responses for a short and variable period of time. A runner's high is an ephemeral feeling some sport practitioners experience during endurance activities, such as running. The release of eCBs during sustained physical exercise appears to be involved in triggering this phenomenon. The last decades have been characterized by an increased interest in this emotional state induced by exercise, as it is believed to alleviate pain, induce mild sedation, increase euphoric levels, and have anxiolytic effects. This review provides information about the current state of knowledge about endocannabinoids and physical effort and also an overview of the studies published in the specialized literature about this subject.

Marathon shoes vs. track spikes: a crossover pilot study on metabolic demand at different speeds in experienced runners.

The aim of this study was to assess the metabolic cost (Cr) with marathon shoes (Adidas Adizero 3 [AA]) vs. track spikes (Nike Zoom Matumbo 3 [NZM]) on track. For this, five experienced runners were randomly assessed (NZM/AA) on a running track at 73% and 85% of best performance speed on 1500-m race. At first, speed (4.39 ± 0.53 m·s-1), Crs with AA and NZM resulted 3.63 ± 0.29 and 3.64 ± 0.43 J·kg-1·m-1 (+0.3% with NZM, effect size [ES] small and p = 0.951), respectively. Besides, at second speed (5.20 ± 0.18 m·s-1), Crs were 4.09 ± 0.28 and 4.07 ± 0.22 J·kg-1·m-1 (-0.5% with NZM, ES small and p = 0.919) with AA and NZM, respectively. It resulted in an increased Cr (+12.2%) between s1 and s2 with both shoe conditions (ES large and p = 0.009 and 0.011 with AA and NZM, respectively). There is a pattern yet to be confirmed for track spikes to become more beneficial at higher speeds (when duty factor becomes lower and therefore grip on track is crucial).

Age and training intensity differently affect male runners' endocrine and sexual parameters.

Physical activity is widely recognized to improve health and its inclusion in daily life at all ages is highly recommended. Gonadal hormones are known to be affected by physical activity. The exercise-induced effects on male runners of different ages were investigated by dividing 31 runners by age (Young, Y, 30-55 years; Old, O, 56-70 years) and amount of training (Light, L, <50 km/week; Heavy, H, 50 or more km/week). To test the somatic, sexual, and psychological health aspects, the Aging Male's Symptoms Scale (AMS) and the International Index of Erectile Function-6 (IIEF-6) questionnaires were administered and blood samples were drawn for adrenocorticotropic hormone, testosterone (Total-TT), free testosterone (Free-T), cortisol (C), dihydrotestosterone (DHT), estradiol, and sex hormone-binding globulin determinations. Clinical evaluations and questionnaire results showed the presence in all groups of some subclinical symptoms and "Light" dysfunctions. TT in the old-heavy (OH) group was significantly lower than in the OL group (2.38 ± 0.18 ng/mL vs. 3.36 ± 0.44 ng/ml, P = 0.05). The TT/DHT ratio was significantly higher in YH than in OH (3.64 ± 0.16 vs. 2.92 ± 0.23, P < 0.05). TT was positively correlated with AMS sexual subscale and negatively correlated with IIEF-6. Physical activity can significantly affect andrological health and testosterone levels in runners at all ages. Thus, due to the important testosterone-mediated vital functions in men, the evaluation of these parameters would be indicated in old as well as in young subjects.

A shared cis-regulatory module activates transcription in the suspensor of plant embryos.

The mechanisms controlling the transcription of gene sets in specific regions of a plant embryo shortly after fertilization remain unknown. Previously, we showed that G564 mRNA, encoding a protein of unknown function, accumulates to high levels in the giant suspensor of both Scarlet Runner Bean (SRB) and Common Bean embryos, and a cis-regulatory module containing three unique DNA sequences, designated as the 10-bp, Region 2, and Fifth motifs, is required for G564 suspensor-specific transcription [Henry KF, et al. (2015) Plant Mol Biol 88:207-217; Kawashima T, et al. (2009) Proc Natl Acad Sci USA 106:3627-3632]. We tested the hypothesis that these motifs are also required for transcription of the SRB GA 20-oxidase gene, which encodes a gibberellic acid hormone biosynthesis enzyme and is coexpressed with G564 at a high level in giant bean suspensors. We used deletion and gain-of-function experiments in transgenic tobacco embryos to show that two GA 20-oxidase DNA regions are required for suspensor-specific transcription, one in the 5' UTR (+119 to +205) and another in the 5' upstream region (-341 to -316). Mutagenesis of sequences in these two regions determined that the cis-regulatory motifs required for G564 suspensor transcription are also required for GA 20-oxidase transcription within the suspensor, although the motif arrangement differs. Our results demonstrate the flexibility of motif positioning within a cis-regulatory module that activates gene transcription within giant bean suspensors and suggest that G564 and GA 20-oxidase comprise part of a suspensor gene regulatory network.

Intensive, prolonged exercise seemingly causes gut dysbiosis in female endurance runners.

Intensive, prolonged exercise is known to induce gastrointestinal disorders such as diarrhea, with gut dysbiosis suggested as being one of the causatives. In the present study, we wanted to investigate the relationship between intensive exercise and the gut microbiota status. To that end, the microbiota, the moisture content and the bacterial metabolites (e.g., organic acids) of female endurance runners (n = 15) and those of non-athletic but healthy, age-matching female controls (n = 14) were compared. The analysis of the gut microbiota analysis showed that, unlike control subjects, female endurance runners had distinct microbiotas, with some bacteria found in higher abundances likely being involved in gut inflammation. The concentration of succinate, a gut bacterial metabolite regarded as undesirable when accumulated in the lumen, was significantly (p<0.05) higher in the female endurance runners. Faecalibacterium, that was significantly (p<0.05) abundant in female endurance runners, can produce succinate in certain environments and hence may contribute to succinate accumulation, at least partly. The present work suggested that the gut microbiotas of female endurance runners are seemingly dysbiotic when compared with those of control subjects. Further investigation of the mechanism by which intensive, prolonged exercise affects the gut microbiota is recommended.

Osseous Migration of a Perforating Gastrointestinal Foreign Body in an Indian Runner Duck (Anas platyrhynchos domesticus).

An Indian runner duck (Anas platyrhynchos domesticus) was presented for a second opinion after a linear, metallic foreign body was identified on radiographic images. The primary veterinarian performed diagnostic imaging while investigating the presenting complaint of the duck's left pelvic limb lameness. The images obtained from a computed tomography scan performed during the second-opinion visit revealed a linear, metallic foreign body with an associated migration tract originating from the ventriculus and terminating in the proximal left femur. Significant osteomyelitis was noted at the proximal left femur associated with the presence of the linear, metallic object. The foreign body and the adhesions associated with its migration were removed in 2, staged, surgical procedures. Although penetrating ventricular foreign bodies have been previously reported, migration through the cortex of a long bone is an unusual presentation. This case demonstrates that perforating, migrating, gastrointestinal foreign bodies can result in lameness refractory to analgesia and ancillary supportive care.

Using Ultrasound Measurement of the Achilles Tendon in Asymptomatic Runners to Assist in Predicting Tendinopathy.

OBJECTIVES: The Achilles tendon is the strongest tendon in the human body, and Achilles tendinopathy is common in athletes due to the stress imparted by repetitive forces. The prevalence of Achilles tendon abnormalities in asymptomatic elite runners is unknown. Since there is a substantial risk of developing symptomatic tendinopathy in those with abnormal tendons, identifying those asymptomatic athletes with abnormal tendons and characterizing baseline characteristics of elite runners using ultrasound (US) are valuable injury prevention tools. METHODS: This study used US to evaluate the Achilles tendons of 27 asymptomatic National Collegiate Athletic Association Division I cross-country athletes and performed correlations between dominant and nondominant side tendon size (cross-sectional area [CSA] and thickness) and athlete characteristics. Tendons were also assessed for signs of abnormalities that were suggestive of Achilles tendinopathy. RESULTS: The prevalence of tendon abnormalities in asymptomatic collegiate runners was 11%. Among the participants included in this study, dominant and nondominant Achilles tendons did not vary significantly in thickness or CSA (P > .05). The CSA was found to correlate with height, weight, sex, body mass index, and miles run per week (P < .05). Thickness was found to correlate best with miles run per week (P < .05). CONCLUSIONS: A US evaluation of the Achilles tendon has potential to identify changes in tendon size in addition to abnormalities consistent with tendinopathy. As more normative values are identified among various populations, tendon size may have prognostic value for collegiate athletes in the evaluation of Achilles tendinopathy.

An Indirect Measurement Methodology to Identify Load Fluctuations on Axial Turbine Runner Blades.

Smooth integration of intermittent energy sources, such as solar and wind power, into the electrical grid induces new operating conditions of the hydraulic turbine by increasing the off-design operations, start/stops, and load variations. Therefore, hydraulic turbines are subject to unstable flow conditions and unfavorable load fluctuations. Predicting load fluctuations on the runner using indirect measurements can allow for optimized operations of the turbine units, increase turbine refurbishment time intervals, and avoid structural failures in extreme cases. This paper investigates an experimental methodology to assess and predict the flow condition and load fluctuations on a Kaplan turbine runner at several steady-state operations by performing measurements on the shaft in the rotating and stationary frame of references. This unit is instrumented with several transducers such as miniature pressure transducers, strain gages, and proximity probes. The results show that for any propeller curve of a Kaplan turbine, the guide vane opening corresponding to the minimum pressure and strain fluctuations on the runner blade can be obtained by axial, torsion, and bending measurements on the shaft. Torsion measurements on the shaft could support index-testing in Kaplan turbines particularly for updating the cam-curve during the unit operation. Furthermore, a signature of every phenomenon observed on the runner blade signals, e.g., runner frequency, rotating vortex rope components, and rotor-stator interaction, is found in the data obtained from the shaft.

Auxin and cytokinin coordinate the dormancy and outgrowth of axillary bud in strawberry runner.

BACKGROUND: Axillary buds allow the production of either vegetative or reproductive shoots, which display a plastic developmental potential of the plant to suit the prevailing environmental changes. Strawberry represents one of many plant species which displays horizontal above-ground growth of shoot development for asexual reproduction. Two distinct runner growth patterns exist in different strawberry species: one is called sympodial type such as Fragaria vesca, and the other one is called monopodial type such as Fragaria pentaphylla. Despite the runner growth morphology of these strawberry species have been well known, the mechanisms that determine the distinct patterns have rarely been reported. RESULTS: In this study, we used Fragaria vesca Hawaii-4 and Fragaria pentaphylla as model species, and captured the initiated dormant bud and non-dormant bud as materials to compare their transcriptome profiles and phytohormone content. Comparisons revealed that relatively higher auxin activity is present in the dormant bud and relatively higher cytokinin activity is in the non-dormant bud. Decapitation and pharmacological experiments on dormant buds showed that the reduction of auxin accumulation triggers the regeneration of vegetative shoots in dormant buds, and exogenous cytokinin application triggers cell fate turnover and generation of reproductive shoots. CONCLUSION: Here, we uncover a mechanism by which auxin and cytokinin coordinate the dormancy and outgrowth of axillary bud in strawberry runner. Our results suggest a contrasting behavior of auxin and cytokinin in control of axillary bud development, facilitating a preliminary understanding of shoot architecture formation in strawberry.

A complete posterior tibial stress fracture that occurred during a middle-distance running race: a case report.

Posterior tibial stress fractures are more frequent than anterior tibial stress fractures, and they are considered to have a good prognosis for returning to sports; cases leading to a complete fracture are rare. A 17-year-old male involved in high school athletics middle-distance running had a 3-week history of pain with training. He was running up to 300 km/week on streets and cross-country in an even distribution. He had posterior tibial stress fractures, but despite the lower leg pain, he continued running. One year later, he was brought to the emergency department after having sustained an injury to the right lower leg while running in a middle-distance race; bilateral tibial stress fractures, with one side complete and the opposite side incomplete, had developed simultaneously. This relatively rare case of bilateral posterior stress fractures, with one side a complete fracture and the opposite side an incomplete fracture, that was treated surgically via exchange intramedullary nailing is reported. The patient could begin light jogging from 3 months after surgery and was without symptoms at 5 months after surgery. He could resume middle-distance racing after 1 year. Posterior tibial cortical fractures are more common and respond better to conservative treatment than anterior tibial stress fractures, and they are a common fracture type in runners. We believe that close, careful follow-up is necessary if patients continue excessive training.

Modified Valenti Arthroplasty in Running and Jumping Athletes With Hallux Limitus/Rigidus: Analysis of One Hundred Procedures.

Despite hallux limitus/rigidus being a common condition, results of surgical procedures specifically pertaining to athletes are scarce. The results of 100 modified Valenti procedures, prospectively studied from January 2000 to June 2016 with an average 49.17 months of follow-up, are presented evaluating demographics, sport, time and ability to return to activity (RTA), decreased desired activity level, and need for additional surgery. Inclusion criteria included athletes who have exhausted conservative care without relief of daily pain, dorsiflexion <20°, and grade ≥2. Seventeen had grade 2, 79 had grade 3, and 4 had grade 4 disease. RTA for the 89 procedures where exact time could be determined was 9.25 weeks; however, 100% were confirmed to RTA to some degree. The RTA of dancers and runners (the largest portion of the cohort at 76) was around 8 weeks, whereas soccer players were the slowest at >16 weeks, which was significant. There was no other significant difference in RTA between sport, sex, or grade of hallux limitus/rigidus except for between runners and soccer players. Six patients (6%) stated a decreased desire to activity, although this was not a significant finding. The modified Valenti procedure is a safe and highly effective treatment for running and jumping athletes limited by hallux limitus/rigidus because 94% of patients were able to return to their desired level of activity.

Living High-Training Low for 21 Days Enhances Exercise Economy, Hemodynamic Function, and Exercise Performance of Competitive Runners.

Living high-training low (LHTL) is performed by competitive athletes expecting to improve their performance in competitions at sea level. However, the beneficial effects of LHTL remain controversial. We sought to investigate whether 21 days of LHTL performed at a 3,000 m simulated altitude (fraction of inspired oxygen [FIO2]=14.5%) and at sea level can improve hematological parameters, exercise economy and metabolism, hemodynamic function, and exercise performance compared with living low-training low (LLTL) among competitive athletes. All participants (age = 23.5 ± 2.1 years, maximal oxygen consumption [VO2max] = 55.6 ± 2.5 mL·kg-1·min-1, 3,000 m time trial performance=583.7 ± 22.9 seconds) were randomly assigned to undergo LHTL (n = 12) or LLTL (n = 12) and evaluated before and after the 21 days of intervention. During the 21-day intervention period, the weekly routine for all athletes included 6-day training and 1-day rest. The daily training programs consisted of >4 hours of various exercise programs (i.e., jogging, high-speed running, interval running, and 3,000 m or 5,000-m time trial). The LHTL group resided in a simulated environmental chamber (FIO2 = 14.5%) for >12 hours per day and the LLTL group at sea level under comfortable conditions. The hematological parameters showed no significant interaction. However, LHTL yielded more improved exercise economy, metabolic parameters (oxygen consumption=-152.7 vs 32.4 mL·kg-1·30min-1, η2 = 0.457, p = 0.000; tissue oxygenation index=6.18 vs .66%, η2 = 0.250, p = 0.013), and hemodynamic function (heart rate = -234.5 vs -49.7 beats·30min-1, η2 = 0.172, p = 0.044; stroke volume = 136.4 vs -120.5 mL/30 min, η2 = 0.191, p = 0.033) during 30 minutes of submaximal cycle ergometer exercise corresponding to 80% maximal heart rate before training than did LLTL. Regarding exercise performance, LHTL also yielded more improved VO2max (5.40 vs 2.35 mL·kg-1·min-1, η2 = 0.527, p = 0.000) and 3,000 m time trial performance (-34.0 vs -19.5 seconds, η2 = 0.527, p = 0.000) than did LLTL. These results indicate that compared with LLTL, LHTL can have favorable effects on exercise performance by improving exercise economy and hemodynamic function in competitive runners.

FveRGA1, encoding a DELLA protein, negatively regulates runner production in Fragaria vesca.

MAIN CONCLUSION: FveRGA1 was highly expressed in tender tissues such as young leaves and stem apices and was localized in the nucleus. RNAi silencing of FveRGA1 in non-runnering woodland strawberry produced many runners. FveRGA1 is thus a key gene controlling strawberry runner formation. The propagation of strawberry is mainly based on runners, while the genes controlling runner production have not been well characterized. Exogenous applications of optimum concentration gibberellins (GAs) promote runner formation in strawberry cultivation and GA can accelerate the degradation of DELLA proteins. To investigate whether DELLA proteins are responsible for runner production, we analyzed all the DELLA genes in Fragaria vesca and cloned a DELLA protein-encoding gene FveRGA1 in woodland strawberry using RT-PCR. Subcellular localization analysis indicated that FveRGA1 was localized in the nucleus. A transcription analysis suggested that FveRGA1 was expressed ubiquitously in all examined strawberry organs, especially in young leaves, petioles, and stem apices. RNA interference (RNAi) technology was carried out to investigate the function of FveRGA1 in woodland strawberry 'Yellow Wonder' (YW) and 'Ruegen' (RG) via an Agrobacterium-mediated transformation. Interestingly, the RNAi silencing transgenic plants in the naturally non-runnering YW and RG strains produced many runners, suggesting FveRGA1 as a key gene controlling strawberry runner formation. Our study lays a solid basis for unraveling the detailed molecular mechanism of runner formation in strawberry.

Fragaria vesca CONSTANS controls photoperiodic flowering and vegetative development.

According to the external coincidence model, photoperiodic flowering occurs when CONSTANS (CO) mRNA expression coincides with light in the afternoon of long days (LDs), leading to the activation of FLOWERING LOCUS T (FT). CO has evolved in Brassicaceae from other Group Ia CO-like (COL) proteins which do not control photoperiodic flowering in Arabidopsis. COLs in other species have evolved different functions as floral activators or even as repressors. To understand photoperiodic development in the perennial rosaceous model species woodland strawberry, we functionally characterized FvCO, the only Group Ia COL in its genome. We demonstrate that FvCO has a major role in the photoperiodic control of flowering and vegetative reproduction through runners. FvCO is needed to generate a bimodal rhythm of FvFT1 which encodes a floral activator in the LD accession Hawaii-4: a sharp FvCO expression peak at dawn is followed by the FvFT1 morning peak in LDs indicating possible direct regulation, but additional factors that may include FvGI and FvFKF1 are probably needed to schedule the second FvFT1 peak around dusk. These results demonstrate that although FvCO and FvFT1 play major roles in photoperiodic development, the CO-based external coincidence around dusk is not fully applicable to the woodland strawberry.

Peritenolysis and Debridement for Main Body (Mid-Portion) Achilles Tendinopathy in Athletic Patients: Results of 107 Procedures.

Achilles tendinopathy in the main body (mid-portion) of the tendon is a common pathologic finding among active and athletic populations and can be debilitating without proper and adequate treatment. Numerous surgical approaches for this common pathologic finding have been reported, with variable outcomes. We evaluated the surgical outcomes of peritenolysis and debridement of main body Achilles tendinopathy among athletic populations using the return to activity (RTA) and decreased desired activity (DDA) as our primary outcome measures. A total of 100 patients underwent 107 procedures by the senior author (A.S.) from January 2001 through December 2015 met the inclusion criteria, 65 (65%) of whom were runners. The mean follow-up duration was 106.6 ± 55.5 months from the index procedure, and the mean interval necessary to RTA for the entire group was 10.9 ± 5.3 weeks. The average RTA after debridement was 14.1 ± 5.2 weeks and after peritenolysis was 7.3 ± 2.0 weeks (p = .00001). Of the 100 patients, 3 (3%) had experienced a DDA at the last follow-up visit. With >97% of the patients able to return to their desired activities, we have concluded that peritenolysis and debridement are favorable surgical techniques for main body Achilles tendinopathy.

Navicular Stress Fracture Outcomes in Athletes: Analysis of 62 Injuries.

The optimal treatment modalities for navicular stress fractures in athletes is currently unknown for this season-ending injury. The present study evaluated factors that might be significant and affect healing outcomes, specifically focusing on the return to activity (RTA) time and a decreased desired activity (DDA) after treatment in athletes. Such considerations included previous navicular stress fractures, patient demographic data and type of sport, and initiation time of treatment. The data from 59 patients with 62 fractures were prospectively analyzed from May 2005 through July 2016. The results showed a significant correlation between a previous navicular stress fracture and decreased desired activity. The average duration of symptoms before receiving definitive treatment was 8.8 months. Computed tomography as the initial imaging modality correlated positively with a correct diagnosis (1.00). In contrast, magnetic resonance imaging, when used initially, was only 71% accurate. Runners constituted most of the cohort at 38 (61.3%). Ten other athletes were involved in jumping sports. Of the 62 injuries, 21 (33.9%) were in elite or professional athletes, all of whom were able to RTA, with 1 patient, a 38-year-old world record holding runner, having a DDA. Seven refractures (11.2%) occurred an average >5 years after the initial injury, predominantly in those aged <21 years, none with previous surgery. Eight patients (12.9%) developed postinjury arthrosis, including 1 with DDA. Patients who underwent open reduction and internal fixation had a RTA of 4.56 months compared with those who had undergone nonoperative treatment, who had an average RTA of 3.97 months. Seven patients (11.2%) underwent screw removal and required a longer RTA. Overall, of the 62 injuries, the patients with 57 of the injuries (91.9%) were able to RTA at their preinjury level.

The Effectiveness of Compression Socks for Athletic Performance and Recovery.

Clinical Scenario: The popularity of compression socks has increased substantially among athletes, particularly those participating in endurance events such as running and triathlon. Companies are increasingly marketing compression stockings to runners, triathletes, and other endurance athletes for the benefits of improved performance and/or decreased recovery time. Originally developed for the treatment of deep-vein thrombosis, compression socks are now marketed as a tool to improve venous return, thus believed to improve both performance and recovery in athletes. The use of compression socks during training aims to help the skeletal-muscle pump, increase deep venous velocity, and/or decrease blood pooling in the calf veins and alleviate delayed-onset muscle soreness. The scenario is a 28-y-old recreational triathlete seeking your advice while training for her first half-Ironman. She occasionally complains of tightness in the calves both during and after running. She wants your opinion on the effectiveness of using compression socks to help her performance and recovery. Focused Clinical Question: What is the effectiveness of using graduated compression socks for improving athletic performance and decreasing recovery time in healthy endurance athletes?