Normative ultrasound values for Achilles tendon thickness in the general population and patients with Achilles tendinopathy:A large international cross-sectional study

The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior–posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior–posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th-97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8–6.9) mm for the midportion region and 3.7 (2.8–4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation −2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was −0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × −0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3–3.2, p &lt; 0.001) for the midportion and 1.4 mm (1.1–1.7, p &lt; 0.001) for the insertional region. Compared to the asymptomatic population 73/100 (73%) AT patients exhibited increased tendon thickening, with values exceeding the 95% RI. This study presents novel reference values for the thickness of midportion and insertional region of the Achilles tendon, which were adjusted for personal characteristics. Our novel web-based openly accessible calculator for determining normative Achilles tendon thickness (www.achillestendontool.com) will be a useful resource in the diagnostic process. Trial registration number: This trial is registered in the Netherlands Trial Register (NL9010).</p

Injuries in International Men’s Sixes Lacrosse: Injury Surveillance of the British Lacrosse Men’s National Team During a 9-Month Training Cycle Leading up to and Including The World Games 2022

OBJECTIVE: To describe the injury epidemiology of a men’s national Sixes lacrosse team across training and competition. DESIGN: Prospective observation study. METHODS: This study prospectively observed in- juries that occurred within a training and competition cycle of the British Men’s National Lacrosse team. Data were collected by the team physiotherapist, injury incidence was calculated, and data categorized into injury type, body part, and mechanism. RESULTS: Forty-three injuries occurred during Sixes competition. Injury incidence varied between practice and tournaments. Twelve percent of all injuries were time loss. Two thirds of the time, players continued playing following intervention. One in every 5 injuries was treated with self-management strate- gies. Injuries most frequently occurred in competitive matches (65%). Most injuries were sustained through a contact mechanism (49%) or an overload mechanism (37%). The most frequent injuries were contusions (26%) and muscle injuries (26%). The lower limb was the most frequently injured area (63%), with the lower leg predominantly being the most affected part of the lower limb (63%). CONCLUSIONS: To our knowledge, this is the first epidemiology study of Sixes lacrosse injuries. Further research is required to better understand the epidemiology and risk factors for injuries in Sixes lacrosse. JOSPT Open 2023;1(1):1-7. Epub: 19 June 2023. doi:10.2519/josptopen.2023.000

“It's just like a needle going into my hip, basically all of the time”. The experiences and perceptions of patients with Greater Trochanteric Pain syndrome in the UK National Health Service

Background: Greater Trochanteric Pain syndrome (GTPS) is a condition causing lateral hip pain, which can be both persistent and debilitating. Data suggests that NHS patients with GTPS often have complex presentations with greater risk of developing persistent pain. No research to date has looked to understand the lived experience of patients with GTPS. Objectives: This data may help inform a programme of intervention development for testing in a future randomised controlled trial. Hence, this qualitative study aimed to provide insight into the experiences and perceptions of patients suffering with GTPS. Design: Qualitative study using semi-structured interviews. Methods: Ten patients diagnosed with GTPS in consultant-led clinic at one NHS Hospital. Patients were identified from the physiotherapy waiting list and approached via a postal letter. Once informed consent was gained, semistructured telephone interviews were conducted, transcribed verbatim and analysed using the Framework Method. Results: Data were analysed with reference to five pre-determined themes (1) living with persistent pain; (2) understanding the problem and pain; (3) experiences of previous treatment; (4) beliefs about activity and exercise; (5) the future. Conclusion: The participants with GTPS, interviewed in this study commonly suffered from debilitating pain, affecting them during activity and at rest. They were confused about the diagnoses they were given and the meaning of their pain in relation to activity. Furthermore, participants were often either uncertain or pessimistic about their potential to recove

The VISA-A (sedentary) should be used for sedentary patients with Achilles tendinopathy: a modified version of the VISA-A developed and evaluated in accordance with the COSMIN checklist

ObjectiveTo develop and evaluate a modified version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire, for use in sedentary patients with Achilles tendinopathy, using the Consensus-based Standards for the selection of health Measurement Instruments recommendations.MethodsTwenty-two sedentary patients with Achilles tendinopathy completed the VISA-A and provided feedback regarding the relevance, comprehensiveness and comprehensibility of each item, response options and instructions. Patient and professional feedback was used to develop the VISA-A (sedentary) questionnaire. Reliability, validity and responsiveness of the VISA-A (sedentary) was evaluated in 51 sedentary patients with Achilles tendinopathy: 47.1% women, mean age 64.8 (SD 11.24).ResultsFactor analysis identified two dimensions (symptoms and activity) for the VISA-A (sedentary). Test-retest reliability was excellent for symptoms (intraclass correlation coefficient, ICC=0.991) and activity (ICC=0.999). Repeatability was 1.647 for symptoms and 0.549 for activity. There was a significant difference between the VISA-A and VISA-A (sedentary) scores both pretreatment and post-treatment. There was stronger correlation between the pretreatment to post-treatment change in the VISA-A (sedentary) scores (r=0.420 for symptoms, r=0.407 for activity) and the global rating of change than the VISA-A scores (r=0.253 for symptoms, r=0.186 for activity).ConclusionThe VISA-A (sedentary) demonstrates adequate reliability, validity and responsiveness in sedentary patients with Achilles tendinopathy. The VISA-A (sedentary) is a more appropriate measure than the VISA-A for this cohort and is recommended for clinical and research purposes

Dynamics of barred galaxies: effects of disk height

We study dynamics of bars in models of disk galaxies embeded in realistic dark matter halos. We find that disk thickness plays an important, if not dominant, role in the evolution and structure of the bars. We also make extensive numerical tests of different N-body codes used to study bar dynamics. Models with thick disks typically used in this type of modeling (height-to-length ratio hz/Rd=0.2) produce slowly rotating, and very long, bars. In contrast, more realistic thin disks with the same parameters as in our Galaxy (hz/Rd= 0.1) produce bars with normal length Rbar approx R_d, which rotate quickly with the ratio of the corotation radius to the bar radius 1.2-1.4 compatible with observations. Bars in these models do not show a tendency to slow down, and may lose as little as 2-3 percent of their angular momentum due to dynamical friction with the dark matter over cosmological time. We attribute the differences between the models to a combined effect of high phase-space density and smaller Jeans mass in the thin disk models, which result in the formation of a dense central bulge. Special attention is paid to numerical effects such as the accuracy of orbital integration, force and mass resolution. Using three N-body codes -- Gadget, ART, and Pkdgrav -- we find that numerical effects are very important and, if not carefully treated, may produce incorrect and misleading results. Once the simulations are performed with sufficiently small time-steps and with adequate force and mass resolution, all the codes produce nearly the same results: we do not find any systematic deviations between the results obtained with TREE codes (Gadget and Pkdgrav) and with the Adaptive-Mesh-Refinement (ART) code.Comment: 15 pages, 14 plots, submitted to MNRA

Chlamydia trachomatis from Australian Aboriginal people with trachoma are polyphyletic composed of multiple distinctive lineages.

Chlamydia trachomatis causes sexually transmitted infections and the blinding disease trachoma. Current data on C. trachomatis phylogeny show that there is only a single trachoma-causing clade, which is distinct from the lineages causing urogenital tract (UGT) and lymphogranuloma venerum diseases. Here we report the whole-genome sequences of ocular C. trachomatis isolates obtained from young children with clinical signs of trachoma in a trachoma endemic region of northern Australia. The isolates form two lineages that fall outside the classical trachoma lineage, instead being placed within UGT clades of the C. trachomatis phylogenetic tree. The Australian trachoma isolates appear to be recombinants with UGT C. trachomatis genome backbones, in which loci that encode immunodominant surface proteins (ompA and pmpEFGH) have been replaced by those characteristic of classical ocular isolates. This suggests that ocular tropism and association with trachoma are functionally associated with some sequence variants of ompA and pmpEFGH

Inline dynamometry provides reliable measurements of quadriceps strength in healthy and ACL-reconstructed individuals and is a valid substitute for isometric electromechanical dynamometry following ACL reconstruction.

BackgroundQuadriceps strength testing is recommended to guide rehabilitation and mitigate the risk of second injury following anterior cruciate ligament (ACL) reconstruction. Hand-held dynamometry is a practical alternative to electromechanical dynamometry but demonstrates insufficient reliability and criterion validity in healthy and ACL-reconstructed participants respectively. The purpose of this study is to investigate the reliability and concurrent validity of inline dynamometry for measuring quadriceps strength. The hypotheses are that intra-class correlation coefficient (ICC) values will be >0.90 for reliability and concurrent validity.MethodsThis was a cross sectional study using a within-participant, repeated measures design. Isometric quadriceps testing was performed at 60° knee flexion in 50 healthy and 52 ACL-reconstructed participants. Interrater reliability, intrarater reliability, and concurrent validity of inline dynamometry was investigated through calculation of ICCs, Bland-Altman analysis, linear regression, standard error of measurement (SEM) and minimal detectable change (MDC).ResultsThe lower bounds of the 95% confidence intervals were >0.90 for all reliability and validity ICCs in healthy and ACL-reconstructed participants, except for intrarater reliability in healthy participants using absolute scores (ICC = 0.936 [95% CI 0.890-0.963]). In ACL-reconstructed participants, Bland-Altman bias was 0.01 Nm/kg for absolute and average scores, limits of agreement were -11.74% to 12.59% for absolute scores, the SEM was 0.13Nm/kg (95% CI 0.10-0.17) and the MDC was 0.36Nm/kg (95% CI 0.28 - 0.47).ConclusionInline dynamometry is a reliable and economical alternative to electromechanical dynamometry for the assessment of quadriceps strength following ACL-reconstruction.Clinical trial registration numberClinicalTrials.gov (NCT05109871)

Interplay between Interferon-Mediated Innate Immunity and Porcine Reproductive and Respiratory Syndrome Virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non–structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp’s are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS

Functional and structural studies of the vaccinia virus virulence factor N1 reveal a Bcl-2-like anti-apoptotic protein

Vaccinia virus (VACV) encodes many immunomodulatory proteins, including inhibitors of apoptosis and modulators of innate immune signalling. VACV protein N1 is an intracellular homodimer that contributes to virus virulence and was reported to inhibit nuclear factor (NF)-κB signalling. However, analysis of NF-κB signalling in cells infected with recombinant viruses with or without the N1L gene showed no difference in NF-κB-dependent gene expression. Given that N1 promotes virus virulence, other possible functions of N1 were investigated and this revealed that N1 is an inhibitor of apoptosis in cells transfected with the N1L gene and in the context of VACV infection. In support of this finding virally expressed N1 co-precipitated with endogenous pro-apoptotic Bcl-2 proteins Bid, Bad and Bax as well as with Bad and Bax expressed by transfection. In addition, the crystal structure of N1 was solved to 2.9 Å resolution (0.29 nm). Remarkably, although N1 shows no sequence similarity to cellular proteins, its three-dimensional structure closely resembles Bcl-xL and other members of the Bcl-2 protein family. The structure also reveals that N1 has a constitutively open surface groove similar to the grooves of other anti-apoptotic Bcl-2 proteins, which bind the BH3 motifs of pro-apoptotic Bcl-2 family members. Molecular modelling of BH3 peptides into the N1 surface groove, together with analysis of their physico-chemical properties, suggests a mechanism for the specificity of peptide recognition. This study illustrates the importance of the evolutionary conservation of structure, rather than sequence, in protein function and reveals a novel anti-apoptotic protein from orthopoxviruses