Return to Sport After Turf Toe Injuries: A Systematic Review and Meta-analysis

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: The prevalence of turf toe injuries has increased in recent years. However, uncertainty remains as to how to optimally treat turf toe injuries and the implications that the severity of the injury has on outcomes, specifically return to sport (RTS). Purpose: To determine RTS based on treatment modality and to provide clinicians with additional information when comparing operative versus nonoperative treatment of turf toe injuries in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review and meta-analysis was performed using the PubMed/Ovid MEDLINE/PubMed Central databases (May 1964 to August 2018) per PRISMA-IPD (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data) guidelines. RTS, treatment, severity of injury, athletic position, and sport were recorded and analyzed. Results: Of 858 identified studies, 12 met the criteria for the final meta-analysis. The studies included 112 athletes sustaining a total of 121 turf toe injuries; 63 (52.1%) of these injuries were treated surgically, while 58 (47.9%) were treated nonoperatively, and 53.7% were classified by the grade of injury (grade I, n = 1; grade II, n = 9; grade III, n = 55). Overall, 56 (46.3%) injuries could not be classified based on the data provided and were excluded from the final analysis. The median time to RTS for patients treated nonoperatively was 5.85 weeks (range, 3.00-8.70 weeks) compared with 14.70 weeks (range, 6.00-156.43 weeks) for patients treated surgically (P < .001); however, there was variability in the grade of injury between the 2 groups. Similarly, patients who sustained grade II injuries returned to sport more quickly (8.70 weeks) than patients who had a grade I (13.04 weeks) or grade III injury (16.50 weeks) (P = .016). The amount of time required to RTS was significantly influenced by the athlete’s level of play (16.50 weeks for both high school and college levels; 14.70 weeks for professional level) (P = .018). Conclusion: The time to RTS for an athlete who suffers from a turf toe injury is significantly influenced by the severity of injury and the athlete’s level of competition. Professional athletes who suffer from turf toe injuries RTS sooner than both high school and college athletes. However, there are a limited number of high-level studies evaluating turf toe injuries in the athletic population. Further research is necessary to clearly define the appropriate treatment and RTS protocols based on sport, position, and level of play

A novel totivirus and piscine reovirus (PRV) in Atlantic salmon (Salmo salar) with cardiomyopathy syndrome (CMS)

<p>Abstract</p> <p>Background</p> <p>Cardiomyopathy syndrome (CMS) is a severe disease affecting large farmed Atlantic salmon. Mortality often appears without prior clinical signs, typically shortly prior to slaughter. We recently reported the finding and the complete genomic sequence of a novel piscine reovirus (PRV), which is associated with another cardiac disease in Atlantic salmon; heart and skeletal muscle inflammation (HSMI). In the present work we have studied whether PRV or other infectious agents may be involved in the etiology of CMS.</p> <p>Results</p> <p>Using high throughput sequencing on heart samples from natural outbreaks of CMS and from fish experimentally challenged with material from fish diagnosed with CMS a high number of sequence reads identical to the PRV genome were identified. In addition, a sequence contig from a novel totivirus could also be constructed. Using RT-qPCR, levels of PRV in tissue samples were quantified and the totivirus was detected in all samples tested from CMS fish but not in controls. <it>In situ </it>hybridization supported this pattern indicating a possible association between CMS and the novel piscine totivirus.</p> <p>Conclusions</p> <p>Although causality for CMS in Atlantic salmon could not be proven for either of the two viruses, our results are compatible with a hypothesis where, in the experimental challenge studied, PRV behaves as an opportunist whereas the totivirus might be more directly linked with the development of CMS.</p

Amplifying Signals and avoiding surprises: Potential synergies between ICOS and eLTER at the Water-Climate-Greenhouse Gas nexus

Environmental thresholds. tipping points and subsequent regime shifts associated with the water/climate/greenhouse gas nexus pose a genuine threat to sustainability. Both the ongoing forest dieback in Central Europe caused by the extreme droughts of the last years and the effect of global warming on ecosystem functioning have the potential to cause ecological surprise (sensu Lindenmayer et al. 2010) where ecosystems are pushed into new, unexpected and usually undesirable states. Formulating appropriate scientific and societal responses to such regime shifts requires breadth, depth, intensity and duration of environmental, ecological and socio-ecological monitoring. Broad geographic coverage to encompass relevant biophysical and societal gradients, consideration of all appropriate parameters, adequate measurement frequency and long-term, standardized observations are all needed to provide reliable early warnings of severe environmental change, test ecosystem models, avoid double counting in carbon accounting and to reduce the likelihood of undesirable ecological outcomes. This is especially true of events driven by simultaneous changes in climate, the water cycle and human activities. Well-supported, site-based research infrastructures (RIs; e.g., eLTER and ICOS) are essential tools with the necessary breadth, depth, intensity and duration for early detection and attribution of environmental change. Individually, the eLTER and ICOS RIs generate a wealth of data supporting the ecosystem and carbon research communities. Achieving synergies between the two RIs can add value to both communities and potentially offer meaningful insight into the European water-climate-greenhouse gas nexus. The unique insights into processes and mechanisms of ecosystem dynamics and functioning obtained from high intensity monitoring conducted by the ICOS RI greatly increase the likelihood of detecting signals of environmental change. These signals must be placed into the context of their long-term trajectory and potential societal and environmental drivers. The spatially extensive, long-term, multi-disciplinary monitoring conducted at LTER sites and LTSER platforms under the umbrella of the eLTER programme can provide this context. Here, we outline one potential roadmap for achieving synergies between the ICOS and eLTER RIs focussing on the value of co-location for improved understanding of the water/climate/greenhouse gas nexus. Based on data and experiences from intensively studied research sites, we highlight some of the possibilities for reducing the likelihood of ecological surprise that could result from such synergies.Peer reviewe

Single-nucleus RNA sequencing of pre-malignant liver reveals disease-associated hepatocyte state with HCC prognostic potential

Current approaches to staging chronic liver diseases have limited utility for predicting liver cancer risk. Here, we employed single-nucleus RNA sequencing (snRNA-seq) to characterize the cellular microenvironment of healthy and pre-malignant livers using two distinct mouse models. Downstream analyses unraveled a previously uncharacterized disease-associated hepatocyte (daHep) transcriptional state. These cells were absent in healthy livers but increasingly prevalent as chronic liver disease progressed. Copy number variation (CNV) analysis of microdissected tissue demonstrated that daHep-enriched regions are riddled with structural variants, suggesting these cells represent a pre-malignant intermediary. Integrated analysis of three recent human snRNA-seq datasets confirmed the presence of a similar phenotype in human chronic liver disease and further supported its enhanced mutational burden. Importantly, we show that high daHep levels precede carcinogenesis and predict a higher risk of hepatocellular carcinoma development. These findings may change the way chronic liver disease patients are staged, surveilled, and risk stratified

Writing in Britain and Ireland, c. 400 to c. 800

No abstract available

Identification of Novel Genetic Loci Associated with Thyroid Peroxidase Antibodies and Clinical Thyroid Disease

Peer reviewe

Assembling place : Buenos Aires in cultural production (1920-1935)

textIn works of cultural production, interpretations of the built, natural, and social environment engage a hierarchy of readings of place. Formed by a totality of interpretations—accepted/unaccepted, dominant/subordinate, normal/abnormal, and everything in between—this hierarchy of readings frames place as a social understanding. Interpretations of place, therefore, are social positionings: kinds of individual delineations of the meaning of place as a social understanding. Collectively, these social positionings compose and comprise our understanding of the meaning of a place. In this study, I examine the different ways in which the understanding of Buenos Aires as a place shapes and is shaped by the avant-garde urban criollismo of Jorge Luis Borges’ poetry of the 1920s, the five plays of Armando Discépolo’s dramatic genre of the grotesco criollo, Robert Arlt’s dark and portentous binary novel Los siete locos/ Los lanzallamas (1929/1931), and three early Argentine sound films [Tango! (Mogila Barth 1933), Los tres berretines (Equipo Lumiton 1933), and Riachuelo (Moglia Barth 1934)]. To get at the mechanisms that drive the interaction between these works of cultural production, which are social positionings, and the social understanding of Buenos Aires as a place, I draw from Manuel De Landa’s notions of assemblage theory and non-linear history. Wholes such as porteño society of the 1920s and 1930s are assemblages of an almost limitless number of parts whose functions within the greater entity are not always clear. Place, therefore, is an assemblage whose meaning is made up of indeterminable interpretations of space. It is also a non-linear social understanding in that its meaning is irreducible to its components (i.e. social positionings). The mutual interactions and feedback within assemblages such as Buenos Aires are indicative of how meaning is ever changing through processes of destratification, restratification, and stratification in its components, including Borges’ early poetry, Discépolo’s grotesco criollo, Arlt’s Los siete locos/ Los lanzallamas, and the films Tango!, Los tres berretines, and Riachuelo.Spanish and Portugues