Measurement of Lumbar Multifidus Asymmetry in Amateur Cricket Pace Bowlers using Real-Time Ultrasound

International Journal of Exercise Science 11(3): 875-885, 2018. Objectives: To determine if lumbar multifidus asymmetry existed between the fifth lumbar (L5) and 1stsacral (S1) spinal level in a group of amateur cricket pace bowlers and a healthy non-cricketing group of males, and to determine if there were significant differences between groups in lumbar multifidus asymmetry at rest, on contraction, or during activation. Design: A prospective single blinded cross-sectional study. Methods: Forty healthy participants were recruited to two groups: an amateur cricket pace bowling group (n=20) and a non-cricketing group (n=20). Bilateral real-time ultrasound imaging of lumbar multifidus was conducted at the L5/S1 level in a resting and contracted state. Muscle thickness was measured and percentage activation was calculated. A force probe device was used to standardise force, inclination and roll of the ultrasound probe during real-time ultrasound imaging. Results: There was evidence of asymmetry in both groups, but differences between dominant and non-dominant sided lumbar multifidus thickness were non-significant. Between group comparisons of lumbar multifidus asymmetry indicated no significant difference for rest or activation. However, the cricket group had a significantly greater asymmetry of lumbar multifidus when contracted compared to controls (p=0.04). Conclusions: The results indicate that amateur cricket pace bowlers had significantly greater contracted lumbar multifidus asymmetry than non-cricketers. The resting lumbar multifidus asymmetries demonstrated previously in elite pace bowlers were not found in this population. Future research should investigate lumbar multifidus asymmetry in amateur pace bowlers in relation to lower back injury, and make comparisons between amateur and elite cricket pace bowlers

A dose response analysis of exercise prescription variables for lateral abdominal muscle thickness and activation: A systematic review

Background: Various exercise programs are used to treat lateral abdominal muscle (LAM) impairments in people with low back pain. Factors comprising these programs include exercise type, session time, frequency, and program duration. However, specific clinical guidance about optimal exercise prescription is lacking. Objectives: To perform a dose-response analysis on exercise prescription variables for LAM thickness and activation as measured by ultrasound imaging. Design: Systematic review Method: Databases were searched from their inception for studies examining the association between exercise interventions and LAM thickness/activation measured by ultrasound imaging in healthy individuals. Risk of bias was assessed using the Joanna Brigg's Institute critical appraisal tools. For each muscle, subgroup analyses were performed to determine the dose response of exercise prescription variables for LAM thickness and activation. Where there was insufficient data for subgroup analyses, data was narratively synthesised. Results: Fourteen studies comprising 395 participants were included. Statistical and narrative synthesis revealed specific local abdominal exercises, programs from four weeks duration, three sessions per week and sessions of ≥30 min were associated with greatest improvements to LAM thickness. Only the variables exercise type, program duration and session frequency showed a significant between groups difference for the subgroup analysis. The main limitation was inability to perform subgroup analyses for all variables across all muscles measured at rest and during contraction, due to non-reporting of data. Conclusion: This review provides preliminary guidance to practitioners on how the LAM respond to different exercise dosages. Future research should trial these findings

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Measurement of transversus abdominis activation in chronic low back pain patients using a novel standardized real-time ultrasound imaging method

Real-time ultrasound imaging (US) to measure abdominal muscle dimensions has aided low back pain rehabilitation and research. Notwithstanding, ultrasound imaging measurement of transversus abdominis muscle activation in chronic low back pain populations has been characterized by variable and generally suboptimal intra-observer reliability. Methodological deficiencies of ‘freehand’ ultrasound imaging are uncontrolled probe–skin pressure, inclination and roll of the probe. Despite previous attempts to standardize these parameters, intra-observer reliability in chronic low back pain was poor to moderate (0.32–0.62). Therefore, a standardized method that controls and records probe force, inclination and roll during ultrasound imaging may optimize measurement reliability in chronic low back pain. This pilot study investigated utility, standardization and intra-observer reliability of ultrasound imaging transversus abdominis thickness measurement in chronic low back pain patients (n = 17). Transversus abdominis imaging over two separate measurement sessions was conducted using a novel method to standardize probe parameters. Resting and contracted transversus abdominis thickness, and transversus abdominis activation measurements were obtained from duplicate paired images (n = 68). Intra-class correlation coefficients were reported with 95% confidence intervals. Transversus abdominis thickness at rest (intra-class correlation coefficient = 0.97 confidence interval: 0.93, 0.99), when contracted (intra-class correlation coefficient = 0.99 confidence interval: 0.97, 0.99) and transversus abdominis activation (intra-class correlation coefficient = 0.93 confidence interval: 0.81, 0.97) measurements were highly reliable. Ultrasound imaging of transversus abdominis using the novel standardized ultrasound imaging method produced highly reliable intra-observer transversus abdominis measurements, superior to ‘freehand’ ultrasound imaging, despite the physical limitations typically associated with a chronic low back pain population. Unique standardizing ranges for ‘probe force device’ probe parameters were obtained. This novel standardized ultrasound imaging method may optimize transversus abdominis activation assessment in chronic low back pain and other populations, aiding future research

Mechanisms for triceps surae injury in high performance front row rugby union players: a kinematic analysis of scrummaging drills

The front row of a rugby union scrum consists of three players. The loose head prop, hooker and tight head prop. The objective of this study was to determine if known biomechanical risk factors for triceps surae muscle injury are exhibited in the lower limb of front row players during contested scrummaging. Eleven high performance front row rugby union players were landmarked bilaterally at the posterior superior iliac spine (PSIS), greater trochanter, lateral femoral epicondyle, midline of the calcaneus above the plantar aspect of the heel, midline lower leg 5cm and 20cm proximal to the lateral malleolus, at the axis of subtalar joint, lateral malleolus, and head of the fifth metatarsal. Players were video recorded during a series of 2 on 1 live scrummaging drills. Biomechanical three dimensional analysis identified large angular displacements, and increased peak velocities and accelerations at the ankle joint during attacking scrummaging drill techniques when in the stance phase of gait. This places the triceps surae as increased risk of injury and provides valuable information for training staff regarding injury prevention and scrum training practices for front row players

The genomic organization of retrotransposons in Brassica oleracea

We have investigated the copy numbers and genomic organization of five representative reverse transcriptase domains from retrotransposons in Brassica oleracea. Two non-homologous Pseudoviridae (Ty1/copia-like) elements, two Metaviridae (Ty3/gypsy-like) elements (one related to the Athila family) and one Retroposinae (LINE) element were hybridized to a gridded BAC library, “BoB”. The results indicated that the individual LTR retrotransposons (copia and gypsy-like) were represented by between 90 and 320 copies in the haploid genome, with only evidence of a single location for the LINE. Sequence analysis of the same elements against genome survey sequence gave estimates of between 60 and 570, but no LINE was found. There was minimal evidence for clustering between any of these retroelements: only half the randomly expected number of BACs hybridized to both LTR-retrotransposon families. Fluorescent in situ hybridization showed that each of the retroelements had a characteristic genomic distribution. Our results suggest there are preferential sites and perhaps control mechanisms for the insertion or excision of different retrotransposon groups