Blood Flow Restriction Training After Patellar INStability (BRAINS Trial)

Background Patellar instability is a common and understudied condition that disproportionally affects athletes and military personnel. The rate of post-traumatic osteoarthritis that develops following a patellar dislocation can be up to 50% of individuals 5–15 years after injury. Conservative treatment is the standard of care for patellar instability however, there are no evidence-informed rehabilitation guidelines in the scientific literature. The purpose of this study is to assess the effectiveness of blood-flow restriction training (BFRT) for patellar instability. Our hypotheses are that this strategy will improve patient-reported outcomes and accelerate restoration of symmetric strength and knee biomechanics necessary to safely return to activity. Methods/Design This is a parallel-group, superiority, randomized, double-blinded, placebo-controlled clinical trial at the University of Kentucky, sports medicine clinic that aims to recruit 78 patients with acute patellar dislocations randomly allocated into two groups: (1) sham BFRT and (2) BFRT. Both groups will receive the current standard of care physical therapy 3 times per week for up to 9 weeks. Physical therapy sessions will consist of typical standard of care treatment followed by BFRT or sham BFRT. Primary outcomes include the Norwich Patellar Instability Scale, quadriceps strength, and imaging and biochemical biomarkers of cartilage degradation. Discussion The current standard of care for non-operative treatment of patellar instability is highly variable does not adequately address the mechanisms necessary to restore lower extremity function and protect the long-term health of articular cartilage following injury. This proposed novel intervention strategy uses an easily implementable therapy to evaluate if BFRT significantly improves patient-reported outcomes, function, and joint health over the first year of recovery. Trial Registration Blood Flow Restriction Training, Aspiration, and Intraarticular Normal Saline (BRAINS) NCT04554212. Registered on 18 September 2020

The Family Campylobacteraceae

The Campylobacteraceae is the largest and most diverse family in the phylogenetically distinct Epsilonproteobacteria, presently comprising the genera Campylobacter (30 taxa), Arcobacter (17 taxa), and Sulfurospirillum (7 taxa). Individual species may be able to grow in microaerobic, anaerobic, and/or aerobic conditions, in temperatures from 25°C to 42°C; free-living, commensal, or pathogenic; motile or aflagellate; and able to colonize the oral cavity, intestine, stomach, or reproductive tracts of humans, large production animals (such as sheep, cattle, and deer), birds, and reptiles. Some species are known to be among the most frequent causes of human gastroenteritis, others are significant threats to bovine and ovine fertility, and many pose an as-yet unknown, or no, role in human or animal diseases. The taxonomy of the Campylobacteraceae has evolved extensively since its beginnings in 1963. This chapter outlines key events in the family's taxonomic history; reviews general phenotypic traits of each genus, including their isolation; outlines the clinical (including pathogenicity studies and antimicrobial resistance traits) and/or ecological significance of constituent species; and describes current approaches and challenges for species identification and epidemiological subtyping