Are mechanics different between male and female runners with patellofemoral pain?

INTRODUCTION: Patellofemoral pain (PFP) has often been attributed to abnormal hip and knee mechanics in females. To date, there have been few investigations of the hip and knee mechanics of males with PFP. The purpose of this study was to compare the lower extremity mechanics and alignment of male runners with PFP with healthy male runners and female runners with PFP. We hypothesized that males with PFP would move with greater varus knee mechanics compared with male controls and compared with females with PFP. Furthermore, it was hypothesized that males with PFP would demonstrate greater varus alignment. METHODS: A gait and single-leg squat analysis was conducted on each group (18 runners per group). Measurement of each runner's tibial mechanical axis was also recorded. Motion data were processed using Visual 3D (C-Motion, Bethesda, MD). ANOVAs were used to analyze the data. RESULTS: Males with PFP ran and squatted in greater peak knee adduction and demonstrated greater peak knee external adduction moment compared with healthy male controls. In addition, males with PFP ran and squatted with less peak hip adduction and greater peak knee adduction compared with females with PFP. The static measure of mechanical axis of the tibial was not different between groups. However, a post hoc analysis revealed that males with PFP ran with greater peak tibial segmental adduction. CONCLUSION: Males with PFP demonstrated different mechanics during running and during a single-leg squat compared with females with PFP and with healthy males. Based upon the results of this study, therapies for PFP may need to be sex specific. NOTE: This is a non-final version of an article published in final form in Medicine & Science in Sports & Exercise 44, no. 11 (Nov 2012): 2165-2171

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Temporal assimilations during bi-manual movements in non-impaired and Parkinsonian individuals

When bi-lateral movements of differing difficulty are performed as rapidly as possible the "easier" of the two limbs slows down and is attracted to the temporal structure of the more difficult movement. Simultaneous movements are expected to be severely compromised in Parkinson's Disease (PD). The purpose of this study was to investigate whether Parkinsonians elicit temporal assimilations in the belief that an assimilatory response may facilitate simultaneous bi-lateral control in PD.Temporal attractions were elicited by the non-impaired subjects during the bi-lateral task. The increased movement duration of the "easy" limb was the consequence of a contralateral motor command interference. The Parkinsonians failed to generate sufficient contralateral shoulder torque to interfere with the metrical structure of the "easier" task comprising the bi-lateral movements. These observations suggest that temporal assimilations elicited by this class of movements are the result of a motor command interference and not the effect of a restructuring of the movements metrics

Sex differences in soleus strength may predispose middle age women to fall

Chimera, NJ and Manal, KT. Sex differences in soleus strength may predispose middle age women to falls. J Strength Cond Res 27(9): 2596-2602, 2013-This study investigated middle age healthy adults to elucidate if plantar flexion (PF) strength differences exist because of the triceps surae or the soleus when comparing between sexes. A random population sample was stratified by sex and included 25 healthy (12 women and 13 men) subjects who volunteered for participation. Dorsiflexion range of motion was measured using a biplane goniometer. Self-reported function was assessed using the Foot and Ankle Ability Measure. Ankle PF strength was assessed using the Biodex System 3. To determine triceps surae vs. soleus strength, testing positions included (1) full ankle dorsiflexion with the knee in full extension and (2) full ankle dorsiflexion with 90° of knee flexion. Results indicated that women were significantly weaker than men in absolute PF strength for both triceps surae and soleus testing positions. Furthermore, even with normalizing PF strength to body mass PF strength deficits persisted. Additionally, when the contribution of the soleus was accounted for in the full knee extended position (triceps surae), normalized strength differences no longer existed between sexes. Therefore, these results indicate that what appeared as triceps surae complex strength deficits in middle age women compared with men was actually soleus weakness. This may suggest that middle age women are predisposed to increased falls at an early age than previously reported. Additionally, this may indicate that the soleus muscle should be a focus of strength training for women during middle age. © 2013 National Strength and Conditioning Association