Biomedical Risk Factors of Achilles Tendinopathy in Physically Active People: a Systematic Review

Abstract Background Achilles tendinopathy is the most prevalent tendon disorder in people engaged in running and jumping sports. Aetiology of Achilles tendinopathy is complex and requires comprehensive research of contributing risk factors. There is relatively little research focussing on potential biomedical risk factors for Achilles tendinopathy. The purpose of this systematic review is to identify studies and summarise current knowledge of biomedical risk factors of Achilles tendinopathy in physically active people. Methods Research databases were searched for relevant articles followed by assessment in accordance with PRISMA statement and standards of Cochrane collaboration. Levels of evidence and quality assessment designation were implemented in accordance with OCEBM levels of evidence and Newcastle-Ottawa Quality Assessment Scale, respectively. Results A systematic review of the literature identified 22 suitable articles. All included studies had moderate level of evidence (2b) with the Newcastle-Ottawa score varying between 6 and 9. The majority (17) investigated genetic polymorphisms involved in tendon structure and homeostasis and apoptosis and inflammation pathways. Overweight as a risk factor of Achilles tendinopathy was described in five included studies that investigated non-genetic factors. COL5A1 genetic variants were the most extensively studied, particularly in association with genetic variants in the genes involved in regulation of cell-matrix interaction in tendon and matrix homeostasis. It is important to investigate connections and pathways whose interactions might be disrupted and therefore alter collagen structure and lead to the development of pathology. Polymorphisms in genes involved in apoptosis and inflammation, and Achilles tendinopathy did not show strong association and, however, should be considered for further investigation. Conclusions This systematic review suggests that biomedical risk factors are an important consideration in the future study of propensity to the development of Achilles tendinopathy. The presence of certain medical comorbidities and genetic markers should be considered when contemplating the aetiology of Achilles tendinopathy. Further elucidation of biomedical risk factors will aid in the understanding of tendon pathology and patient risk, thereby informing prevention and management strategies for Achilles tendinopathy. Trial Registration PROSPERO CRD4201603655

The genetics of exercise-induced injuries involving tendon and bone

Aim of the study The aim of this research study is to identify genetic polymorphisms that contribute to increased risk of, or protection from tendon and bone injuries sustained through participation in physical activity. This knowledge will be used to develop programs for the prevention of injury in sport and physical activity. Study summary Participation in physical activity has been shown to be extremely beneficial to health however; participation in both recreational and competitive sports increases the risk of acquiring injuries of both the soft tissues and bones. The cost of sports injuries in Australia was estimated at $1.65 billion a year (Orchard & Finch, 2002). At the elite level, the occurrence of these exercise-induced injuries are common and can prevent athletes from both training and competing, limiting the progress of some athletes to top level competition (Palmer-Green, 2003). Sporting success at the international level is significantly impacted by loss of training and competition time through injury. Research that examines new approaches to reducing the number of days lost to training through injury or illness and research that examines mechanisms that have the potential to change injury or illness management are a priority for the Australian elite sport sector. Identification of factors predisposing athletes to injury will allow coaches to customise training loads for individuals, according to injury susceptibility. Clinicians will be able to administer preventative, evidence-based interventions to reduce the rate of athlete injury. This research study will focus on the role of genetics in exercise-induced injuries. Understanding genetic risk of or protection from exercise-induced injuries of the tendon and bone will allow coaches, trainers, physicians and physical therapists to develop training programs that account for such conditions. This study aims to identify genetic polymorphisms (genetic variation resulting in different biochemical characteristics) that contribute to increased risk of, or protection from tendon and bone injuries sustained through participation in physical activity. The proposed study will provide world-first evidence regarding the association between genetic polymorphisms and susceptibility to exercise-induced bony stress injuries. With advancements in molecular biology, the use of personalised medicine to prevent and treat exercise-related medical conditions will become a reality. Understanding genetic risk of or protection from exercise-induced injuries of the tendon and bone will allow coaches, trainers, physicians and physical therapists to develop training programs that account for such conditions. In addition, identification of genetic polymorphisms in relation to bone and tendon health may give rise to further research into potential causes, therapies, personalised training strategies and diagnostic tools in the field of bone and tendon injuries. All methodologies are licensed under Creative Commons CC-BY licences

The effects of multimodal prehabilitation interventions in men affected by prostate cancer on physical, clinical and patient reported outcome measures: a systematic review.

Objectives: To synthesize existing evidence on the effects of multimodal prehabilitation interventions in men affected by prostate cancer on physical, clinical, and patient-reported outcome measures. Data Sources: A systematic review was conducted according to the PRISMA 2020 Statement Guidelines. Electronic databases (ie, Medline, Embase, CINAHL and Cochrane CENTRAL, and clinicaltrials.gov) were searched using key search terms. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. The findings were integrated in a narrative synthesis. Conclusion: Of the 5863 publications screened, 118 articles were assessed in full text and 17 studies met the prescreening eligibility criteria. There were a range of study designs that included randomized controlled clinical trials (n=11), quasi experimental (n=4), cohort (n=1), and case series (n=1), covering a total of 1739 participants. The prehabilitation interventions included physical activity, peer support, pelvic floor muscle training, diet, nurse-led prehabilitation, psychological, and prehabilitation administration of phosphodiesterase-5 inhibitors. Implications for Nursing Practice: Significant heterogeneity existed in the prehabilitation intervention programs for men affected by prostate cancer in terms of the composition, duration, method of administration, and the outcomes measured to quantify their impact. This systematic review has identified that multimodal prehabilitation interventions are an emerging area for practice and research among men affected by prostate cancer. Importantly, there has been a lack of focus on the inclusion of partners as critical companions during this distressing phase of the cancer care continuum. For the moment, all members of the multidisciplinary team caring for people affected by prostate cancer are encouraged to use the findings in this review to inform holistic models of care

A missense mutation in the MLKL brace region promotes lethal neonatal inflammation and hematopoietic dysfunction

Necroptosis is a regulated form of inflammatory cell death driven by activated MLKL. Here, the authors identify a mutation in the brace region that confers constitutive activation, leading to lethal inflammation in homozygous mutant mice and providing insight into human mutations in this region