Sports injuries in adults: overview of clinical examination and management

A wide variety of anatomical structures can be involved in a sports injury. To return to play as soon as possible is of utmost importance to an athlete, and in order to achieve this, a correct, all-inclusive diagnosis, a well-focused treatment plan, and a management plan that strives to offer protection are essential. This article aims to give an overview of acute and overuse (chronic) sports injuries in adults, the approach to an accurate diagnosis and the management strategies that are available. A literature review was conducted of scientific journals, text and internet material, including a Medline and PubMed search. Literature was selected for its in-depth data and well-researched information. Key search terms included "acute and overuse injuries", as well as "sports injuries diagnosis and management" to address current and relevant scientific data on the examination and management of sports injuries in adults. The literature review indicated that sports injuries (both acute and overuse) are increasing in number due to the growing interest in physical activity and sport, as well as the enhanced intensity of training programmes. Adults are vulnerable to both types of sports injuries, and the age of occurrence of overuse injuries varies in competitive and non-competitive athletes. The importance of making an accurate diagnosis cannot be overemphasised. To assist the clinician in making an accurate diagnosis, a comprehensive history, physical examination and appropriate special investigations are mandatory. Familiarity with the demands of the athlete's sport may also prove useful. The approach to the management of acute and overuse injuries differs, with the emphasis in acute injuries being on treating the effect (torn, broken, displaced) and in chronic injuries on treating the cause (intrinsic or extrinsic). There have been numerous advances in the management of sports injuries, however further research is still warranted in this area. Follow-up articles will focus more in-depth on specifics with regard to clinical examination, special investigations and management options

Phylostratigraphic tracking of cancer genes suggests a link to the emergence of multicellularity in metazoa

Background: Phylostratigraphy is a method used to correlate the evolutionary origin of founder genes (that is, functional founder protein domains) of gene families with particular macroevolutionary transitions. It is based on a model of genome evolution that suggests that the origin of complex phenotypic innovations will be accompanied by the emergence of such founder genes, the descendants of which can still be traced in extant organisms. The origin of multicellularity can be considered to be a macroevolutionary transition, for which new gene functions would have been required. Cancer should be tightly connected to multicellular life since it can be viewed as a malfunction of interaction between cells in a multicellular organism. A phylostratigraphic tracking of the origin of cancer genes should, therefore, also provide insights into the origin of multicellularity. Results: We find two strong peaks of the emergence of cancer related protein domains, one at the time of the origin of the first cell and the other around the time of the evolution of the multicellular metazoan organisms. These peaks correlate with two major classes of cancer genes, the 'caretakers', which are involved in general functions that support genome stability and the 'gatekeepers', which are involved in cellular signalling and growth processes. Interestingly, this phylogenetic succession mirrors the ontogenetic succession of tumour progression, where mutations in caretakers are thought to precede mutations in gatekeepers. Conclusions: A link between multicellularity and formation of cancer has often been predicted. However, this has not so far been explicitly tested. Although we find that a significant number of protein domains involved in cancer predate the origin of multicellularity, the second peak of cancer protein domain emergence is, indeed, connected to a phylogenetic level where multicellular animals have emerged. The fact that we can find a strong and consistent signal for this second peak in the phylostratigraphic map implies that a complex multi-level selection process has driven the transition to multicellularity

Engineering of Insulin Receptor Isoform-Selective Insulin Analogues

BACKGROUND: The insulin receptor (IR) exists in two isoforms, A and B, and the isoform expression pattern is tissue-specific. The C-terminus of the insulin B chain is important for receptor binding and has been shown to contact the IR just adjacent to the region where the A and B isoforms differ. The aim of this study was to investigate the importance of the C-terminus of the B chain in IR isoform binding in order to explore the possibility of engineering tissue-specific/liver-specific insulin analogues. METHODOLOGY/PRINCIPAL FINDINGS: Insulin analogue libraries were constructed by total amino acid scanning mutagenesis. The relative binding affinities for the A and B isoform of the IR were determined by competition assays using scintillation proximity assay technology. Structural information was obtained by X-ray crystallography. Introduction of B25A or B25N mutations resulted in analogues with a 2-fold preference for the B compared to the A isoform, whereas the opposite was observed with a B25Y substitution. An acidic amino acid residue at position B27 caused an additional 2-fold selective increase in affinity for the receptor B isoform for analogues bearing a B25N mutation. Furthermore, the combination of B25H with either B27D or B27E also resulted in B isoform-preferential analogues (2-fold preference) even though the corresponding single mutation analogues displayed no differences in relative isoform binding affinity. CONCLUSIONS/SIGNIFICANCE: We have discovered a new class of IR isoform-selective insulin analogues with 2-4-fold differences in relative binding affinities for either the A or the B isoform of the IR compared to human insulin. Our results demonstrate that a mutation at position B25 alone or in combination with a mutation at position B27 in the insulin molecule confers IR isoform selectivity. Isoform-preferential analogues may provide new opportunities for developing insulin analogues with improved clinical benefits

Advanced Instrumentation of Frequency Modulation AFM for Subnanometer-Scale 2D/3D Measurements at Solid-Liquid Interfaces

Since the first demonstration of true atomic-resolution imaging by frequency modulation atomic force microscopy (FM-AFM) in liquid, the method has been used for imaging subnanometer-scale structures of various materials including minerals, biological systems and other organic molecules. Rencetly, there have been further advancements in theFM-AFMinstrumentation. Three-dimensional (3D) force measurement techniques are proposed for visualizing 3D hydration structures formed at a solid-liquid interface. Thesemethods further enabled to visualize 3D distributions of flexible surface structures at interfaces between soft materials andwater. Furthermore, the fundamental performance such as force sensitivity and operation speed have been significantly improved using a small cantilever and high-speed phase detector. These technical advancements enabled direct visualization of atomic-scale interfacial phenomena at 1 frame/s. In this chapter, these recent advancements in the FM-AFM instrumentation and their applications to the studies on various interfacial phenomena are presented. © Springer International Publishing Switzerland 201

Effect of maternal smoking on stress physiology in healthy neonates

OBJECTIVE: To assess the impact of maternal smoking during pregnancy (MSDP) on the neonatal hypothalamic-pituitary-adrenal axis. STUDY DESIGN: In a prospective observational study, salivary cortisol and cortisone levels were measured at the fourth day of life during resting conditions and in response to a pain-induced stress event in healthy neonates whose mothers smoked cigarettes during each stage of pregnancy and compared with controls. RESULTS: Neonates in the control group (n=70) exhibited a physiologic stress response with a significant increase in cortisol (1.3 to 2.1 ng ml-1; P<0.05) and cortisone (11.8 to 17.8 ng ml-1; P<0.05) from baseline levels, whereas in neonates from mothers who smoked (n=33), cortisol (0.9 to 0.8 ng ml-1; P=0.77) and cortisone (11.5 to 13.0; P=0.19) stress response was not significantly different from baseline levels. A two-way analysis of variance confirmed these findings in both groups. CONCLUSIONS: Healthy neonates whose mothers smoked during pregnancy show a blunted stress response on the fourth day of life. Thus, MSDP leads to a dysregulation of the HPA axis with continued effects in neonatal life. This might explain long-term consequences of MSDP such as overweight, diabetes mellitus and modification of blood pressure control mechanisms in adult life.Journal of Perinatology advance online publication, 9 November 2017; doi:10.1038/jp.2017.17