Personal view

Are our sportsmen and women getting a fair medical deal

The effect of exercise on vastus medialis oblique muscle architecture: An ultrasound investigation.

The vastus medialis oblique (VMO) is thought to be implicated in patellofemoral pain (PFP), and weakness in this portion of the vastus medialis muscle may lead to PFP. Management includes physiotherapy to strengthen the VMO. Although this intervention has been shown to be effective, the effects on the architecture of the muscle have not been investigated. This study aims to determine the changes in VMO architecture following a program of strengthening exercises. Twenty-one male participants underwent an initial ultrasound scan to measure the fiber angle and the insertion level of the VMO on the patella. Each subject then undertook a 6-week quadriceps femoris strengthening program; the scan and measurements were then repeated. A significant increase in VMO fiber angle and insertion length was observed. Average fiber angle increased by 5.24°; average insertion length increased by 2.7 mm. There was found to be a significant negative correlation between the initial values and the degree of change. Pearson's coefficient of correlation for measurements of patella length taken before and after exercise was 0.921, indicating a high degree of reliability. There was a significant positive correlation between fiber angle change and declared level of compliance (R2 = 0.796). The results reported here indicate that physiotherapy leads to a significant change in VMO morphology. Given the inverse correlation noted between initial architectural parameters and the degree of change, we suggest that patients who would benefit most from physiotherapy can be identified in clinic using a simple ultrasound technique

Solution-Based Structural Analysis of the Decaheme Cytochrome, MtrA, by Small-Angle X-ray Scattering and Analytical Ultracentrifugation

The potential exploitation of metal-reducing bacteria as a means for environmental cleanup or alternative fuel is an exciting prospect; however, the cellular processes that would allow for these applications need to be better understood. MtrA is a periplasmic decaheme c-type cytochrome from Shewanella oneidensis involved in the reduction of extracellular iron oxides and therefore is a critical element in Shewanella ability to engage in extracellular charge transfer. As a relatively small 333-residue protein, the heme content is surprisingly high. MtrA is believed to obtain electrons from the inner membrane-bound quinol oxidoreductase, CymA, and shuttle them across the outer membrane to MtrC, another decaheme cytochrome that directly interacts with insoluble metal oxides. How MtrA is able to perform this task is a question of interest. Here through the use of two solution-based techniques, small-angle X-ray scattering (SAXS) and analytical ultracentrifugation (AUC), we present the first structural analysis of MtrA. Our results establish that between 0.5 and 4 mg/mL, MtrA exists as a monomeric protein that is shaped like an extended molecular “wire” with a maximum protein dimension (D[subscript max]) of 104 Å and a rod-like aspect ratio of 2.2 to 2.5. This study contributes to a greater understanding of how MtrA fulfills its role in the redox processes that must occur before electrons reach the outside of the cell.National Science Foundation (U.S.). (0546323)National Institutes of Health (U.S.) (Grant Number F32GM904862)Howard Hughes Medical Institute. InvestigatorNational Science Foundation (U.S.) (Award DMR- 0936384

Understanding acute ankle ligamentous sprain injury in sports

This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury

The use of financial management practices by small, medium and micro enterprises: a perspective from South Africa

This paper reports on an investigation of financial management practices used by small, medium-sized and micro-enterprises (SMMEs) in South Africa. It was found that more than half the SMMEs examined use external accounting staff to prepare accounting reports and more than 60% rely on external accounting staff to interpret and use accounting information. A majority of the SMME owners were found to lack interpretation skills and an awareness of how to use information from financial statements. An implication of this study therefore is that policy makers, business support organizations, banks and academic institutions need to focus on educating SMMEs more effectively in financial management, thereby mitigating the risk of cash flow problems and business failure

Portrayals of the Holocaust in English history textbooks, 1991–2016: continuities, challenges and concerns

This study examines portrayals of the Holocaust in a sample of 21 secondary school history textbooks published in England between 1991 and 2016. Evaluated against internationally recognized criteria and guidelines, the content of most textbooks proved very problematic. Typically, textbooks failed to provide clear chronological and geographical frameworks and adopted simplistic Hitler-centric, perpetrator-oriented narratives. Furthermore, textbooks paid limited attention to pre-war Jewish life, the roots of antisemitism, the complicity of local populations and collaborationist regimes, and the impact of the Holocaust on people across Europe. Based on these critical findings, the article concludes by offering initial recommendations for textbook improvement