Signalling Responses Following Varying Sequencing of Strength and Endurance Training in a Fed State.

The objective of this study was to compare anabolic signalling responses to differing sequences of concurrent strength and endurance training in a fed state.Eighteen resistance-trained males were randomly assigned to the following experimental conditions; i) strength training (ST), ii) strength followed by endurance training (ST-END) or iii) endurance followed by strength training (END-ST). Muscle tissue samples were taken from the vastus lateralis before each exercise protocol, upon cessation of exercise, and 1 h-post cessation of strength training. Tissue was analysed for total and phosphorylated (p-) signalling proteins linked to the mTOR and AMPK networks.Strength training performance was similar between ST, ST-END and END-ST. p-S6k1 was elevated from baseline 1 h post training in ST and ST-END (both p < 0.05). p-4E-BP1 was significantly lower than baseline post ST (p = 0.01), while 1 h post exercise in the ST-END condition p-4E-BP1 was significantly greater than post exercise (p = 0.04). p-ACC was elevated from baseline both post and 1 h post exercise (both p < 0.05) in the END-ST condition. AMPK, mTOR, p38, PKB, eEF2 responded similarly to the ST, ST-END and END-ST. Signalling responses to ST, ST-END and END were largely similar. As such it cannot be ascertained which sequence of concurrent strength and endurance training is most favourable in promoting anabolic signalling.These data indicate that in the case of the present study an acute bout of concurrent training of differing sequences elicited similar responses of the AMPK and mTOR networks

Comparison of outcomes after UKA in patients with and without chondrocalcinosis: a matched cohort study

Purpose: Chondrocalcinosis can be associated with an inflammatory arthritis and aggressive joint destruction. There is uncertainty as to whether chondrocalcinosis represents a contraindication to unicompartmental knee arthroplasty (UKA). This study reports the outcome of a consecutive series of patients with chondrocalcinosis and medial compartment osteoarthritis treated with UKA matched to controls. Methods: Between 1998 and 2008, 88 patients with radiological chondrocalcinosis (R-CCK) and 67 patients with histological chondrocalcinosis (H-CCK) were treated for end-stage medial compartment arthritis with Oxford UKA. One-to-two matching was performed to controls, treated with UKA, but without evidence of chondrocalcinosis. Functional outcome and implant survival were assessed in each group. Results: The mean follow-up was 10 years. The mean Oxford Knee Score (OKS) at final follow-up was 43, 41 and 41 in H-CCK, R-CCK and control groups (change from baseline OKS was 21, 18 and 15, respectively). The change was significantly higher in H-CCK than in control but was not significantly different in R-CCK. Ten-year survival was 96 % in R-CCK, 86 % in H-CCK and 98 % in controls. Although the survival in H-CCK was significantly worse than in control, only one failure was due to disease progression. Conclusion: The presence of R-CCK does not influence functional outcome or survival following UKA. Pre-operative radiological evidence of CCK should not be considered to be a contraindication to UKA. H-CCK is associated with significantly improved clinical outcomes but also a higher revision rate compared with controls. Level of evidence: Case control study, Level III

Beyond the Planar Limit in ABJM

In this article we consider gauge theories with a U(N)X U(N) gauge group. We provide, for the first time, a complete set of operators built from scalar fields that are in the bi fundamental of the two groups. Our operators diagonalize the two point function of the free field theory at all orders in 1/N. We then use this basis to investigate non-planar anomalous dimensions in the ABJM theory. We show that the dilatation operator reduces to a set of decoupled harmonic oscillators, signaling integrability in a nonplanar large N limit.Comment: v2: minor revisison

Glycosylation and immunocytochemistry of binucleate cells in pronghorn (Antilocapra americana, Antilocapridae) show features of both Giraffidae and Bovidae

Although the pronghorn (Antilocapra americana) resembles an antelope, its nearest relatives are the giraffe and okapi. In this study we have examined the placentae of 6 pronghorns using lectin- and immunocytochemistry to identify giraffid and bovid features. Binucleate cells (BNC) of the placenta exhibited features intermediate between those of the giraffe and bovine; Dolichos biflorus agglutinin binding – strong in the bovine BNC and absent in the giraffe – was evident in only a subpopulation of BNC while binding to blood vessels, as in the giraffe. Binding of Phytolacca americana agglutinin resembled that of the giraffe and okapi whereas many other glycans were found in all four clades. PAG antigens were similar to bovine and okapi but not giraffe. In summary, although the pronghorn outwardly resembles an antelope, placental BNC show giraffid features. Although each clade has its own individual characteristics, there are far more similarities than differences between them, emphasizing the common ancestry of all four clades

Correlators of Giant Gravitons from dual ABJ(M) Theory

We generalize the operators of ABJM theory, given by Schur polynomials, in ABJ theory by computing the two point functions in the free field and at finite $(N_1,N_2)$ limits. These polynomials are then identified with the states of the dual gravity theory. Further, we compute correlators among giant gravitons as well as between giant gravitons and ordinary gravitons through the corresponding correlators of ABJ(M) theory. Finally, we consider a particular non-trivial background produced by an operator with an $\cal R$-charge of $O(N^2)$ and find, in presence of this background, due to the contribution of the non-planar corrections, the large $(N_1,N_2)$ expansion is replaced by $1/(N_1+M)$ and $1/(N_2+M)$ respectively.Comment: Latex, 32+1 pages, 2 figures, journal versio

ABJM Dibaryon Spectroscopy

We extend the proposal for a detailed map between wrapped D-branes in Anti-de Sitter space and baryon-like operators in the associated dual conformal field theory provided in hep-th/0202150 to the recently formulated AdS_4 \times CP^3/ABJM correspondence. In this example, the role of the dibaryon operator of the 3-dimensional CFT is played by a D4-brane wrapping a CP^2 \subset CP^3. This topologically stable D-brane in the AdS_4 \times CP^3 is nothing but one-half of the maximal giant graviton on CP^3.Comment: 26 page

Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales

Objectives: To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR). Design: A lifetime Markov model provided the framework for the analysis. Setting: Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis. Participants: Propensity score matched patients in the NJR who received either a UKR or TKR. Interventions: UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced. Primary outcome measures: Incremental quality-adjusted life years (QALYs) and healthcare system costs. Results: The provision of UKR is expected to lead to a gain in QALYs compared with TKR for all age and gender subgroups (male: <60 years: 0.12, 60–75 years: 0.20, 75+ years: 0.19; female: <60 years: 0.10, 60–75 years: 0.28, 75+ years: 0.44) and a reduction in costs (male: <60: £−1223, 60–75 years: £−1355, 75+ years: £−2005; female: <60 years: £−601, 60–75 years: £−935, 75+ years: £−1102 per patient over the lifetime). UKR is expected to lead to a reduction in QALYs compared with TKR when performed by surgeons with low UKR utilisation but an increase among those with high utilisation (<10%, median 6%: −0.04, ≥10%, median 27%: 0.26). Regardless of surgeon usage, costs associated with UKR are expected to be lower than those of TKR (<10%: £−127, ≥10%: £−758). Conclusions: UKR can be expected to generate better health outcomes and lower lifetime costs than TKR. Surgeon usage of UKR does, however, have a significant impact on the cost-effectiveness of the procedure. To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR. Low usage surgeons may therefore need to broaden their indications for UKR

Choosing between unicompartmental and total knee replacement: what can economic evaluations tell us? A Systematic Review

Background and objective Patients with anteromedial arthritis who require a knee replacement could receive either a unicompartmental knee replacement (UKR) or a total knee replacement (TKR). This review has been undertaken to identify economic evaluations comparing UKR and TKR, evaluate the approaches that were taken in the studies, assess the quality of reporting of these evaluations, and consider what they can tell us about the relative value for money of the procedures. Methods A search of MEDLINE, EMBASE and the Centre for Reviews and Dissemination National Health Service Economic Evaluation Database was undertaken in January 2016 to identify relevant studies. Study characteristics were described, the quality of reporting and methods assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and study findings summarised. Results Twelve studies satisfied the inclusion criteria. Five were within-study analyses, while another was based on a literature review. The remaining six studies were model-based analyses. All studies were informed by observational data. While methodological approaches varied, studies generally had either limited follow-up, did not fully account for baseline differences in patient characteristics or relied on previous research that did not. The quality of reporting was generally adequate across studies, except for considerations of the settings to which evaluations applied and the generalisability of the results to other decision-making contexts. In the short-term, UKR was generally associated with better health outcomes and lower costs than TKR. Initial cost savings associated with UKR seem to persist over patients’ lifetimes even after accounting for higher rates of revision. For older patients, initial health improvements also appear to be maintained, making UKR the dominant treatment choice. However, for younger patients findings for health outcomes and overall cost effectiveness are mixed, with the difference in health outcomes depending on the lifetime risk of revision and patient outcomes following revision. Conclusions UKR appears to be less costly than TKR. For older patients, UKR is also expected to lead to better health outcomes, making it the dominant choice; however, for younger patients health outcomes are more uncertain. Future research should better account for baseline differences in patient characteristics and consider how the relative value of UKR and TKR varies depending on patient and surgical factors

Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis

Purpose For patients with medial compartment arthritis who have failed non-operative treatment, either a total knee arthroplasty (TKA) or a unicompartmental knee arthroplasty (UKA) can be undertaken. This analysis considers how the choice between UKA and TKA affects long-term patient-reported outcome measures (PROMs). Methods The Knee Arthroplasty Trial (KAT) and a cohort of patients who received a minimally invasive UKA provided data. Propensity score matching was used to identify comparable patients. Oxford Knee Score (OKS), its pain and function components, and the EuroQol 5 Domain (EQ-5D) index, estimated on the basis of OKS responses, were then compared over 10 years following surgery. Mixed-effects regressions for repeated measures were used to estimate the effect of patient characteristics and type of surgery on PROMs. Results Five-hundred and ninety UKAs were matched to the same number of TKAs. Receiving UKA rather than TKA was found to be associated with better scores for OKS, including both its pain and function components, and EQ-5D, with the differences expected to grow over time. UKA was also associated with an increased likelihood of patients achieving a successful outcome, with an increased chance of attaining minimally clinically important improvements in both OKS and EQ-5D, and an ‘excellent’ OKS. In addition, for both procedures, patients aged between 60 and 70 and better pre-operative scores were associated with better post-operative outcomes. Conclusion Minimally invasive UKAs performed on patients with the appropriate indications led to better patient-reported pain and function scores than TKAs performed on comparable patients. UKA can lead to better long-term quality of life than TKA and this should be considered alongside risk of revision when choosing between the procedures

The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: A meta-analysis

Background: Outcomes following UKA are variable and influenced by surgical caseload (UKA/year) and usage (percentage of primary knee arthroplasty that are UKA), which relates to indications. This meta-analysis assesses the relative importance of these factors. Methods: MEDLINE (Ovid), Embase (Ovid) and the Web of Science (ISI) were searched for consecutive series of minimally invasive cemented Phase 3 Oxford medial UKA. The primary outcome measure was revision-rate/100 observed component years (%pa). Series were divided into groups according to caseload and usage. Results 46studies, including 12,520 knees, were identified. The annual revision-rate varied from 0%pa to 4.35%pa, mean 1.21%pa (95%CI 0.97-1.47). In series with mean follow-up of ten-years or more the revision-rate was 0.63%pa (95%CI 0.46-0.83), which equates to a ten-year survival of 94% (95%CI 92%-95%). Aseptic loosening, lateral arthritis, bearing dislocation, and unexplained pain were the predominant failure mechanisms with revision for patello-femoral problems and polyethylene wear exceedingly rare (&lt;0.1%). Both increasing caseload (p=0.02) and usage (p&lt;0.001) were associated with decreasing revision-rate. The lowest revision-rates were achieved with a caseload &gt;24 UKA/year (0.88%pa, 95%CI 0.63-1.61) and usage &gt;30% (0.69%pa, 95%CI 0.50-0.90). Usage was more important than caseload: with high-usage (≥20%) the revision-rate was low, whether the caseload was high (&gt;12UKA/year) or low (≤12UKA/year), (0.94%pa (95%CI 0.69-1.23) and 0.85%pa (95%CI 0.65-1.08) respectively); whereas with low-usage (&lt;20%) the revision-rate was high, whether the caseload was high or low (1.58%pa, 95%CI 0.57- 3.05 and 1.76%pa, 95%CI 1.21-2.41). Conclusion: To achieve optimum results with mobile-bearing UKA surgeons, whether high or low-caseload, should adhere to the recommended indications such that ≥20%, or ideally &gt;30% of their knee replacements are UKA. If they do this then they can expect to achieve results similar to those of the long-term series, which all had high-usage (&gt;20%) and an average ten-year survival of 94%