Publications by authors named "Richard Page"

456 Publications

The association between competitor level and the physical preparation practices of amateur boxers.

PLoS One 2021 27;16(9):e0257907. Epub 2021 Sep 27.

Department of Sport & Physical Activity, Sports Injury Research Group, Edge Hill University, Ormskirk, Lancashire, United Kingdom.

Physical training, testing, and monitoring are three key constitutes of athlete physical performance; however, there is a currently a lack of information on the prevalence of such methods in amateur boxing. This study aimed to explore the physical preparation practices of senior elite (SEB) and senior development (SDB) amateur boxers, and to determine whether these practices were discriminated by competitor level. One hundred and one amateur boxers (SEB n = 59, SDB n = 42) were surveyed on their understanding, perceptions and application of physical training, monitoring, and testing practices. SEB were associated with strength/power training (SEB 78%, SDB 50%, P = 0.005), monitor of training intensities (SEB 68%, SDB 40%, P = 0.006), and performing regular fitness testing (SEB 76%, SDB 50%, P = 0.006), compared to SDB. Likewise, SEB were twice as likely (56%) to have their physical preparation managed by a strength and conditioning (S&C) coach or sport scientist, compared to SDB (26%; P = 0.005). For the first time, these data demonstrate the extent to which competitor level is associated with preparatory practices in amateur boxing. Cost was identified as the main barrier in implementing several forms of scientific support in SDB. These data serve as a framework to enhance preparatory practices across different competitor levels in amateur boxing. This might include boxer and coach education on the benefits to a more scientific approach, and the use of cost-effective methods to develop, monitor and assess amateur boxers physical performance. This may be of particular importance where boxers are not funded, such as the SDB in the current study. However, this work may also be used to emphasise the importance of strength/power training, physical fitness testing and monitoring at the elite level of amateur boxing.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257907PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475992PMC
September 2021

Mid-term outcomes of pyrocarbon humeral resurfacing hemiarthroplasty compared to metal humeral resurfacing and metal stemmed hemiarthroplasty for osteoarthritis in young patients: Analysis from the Australian Orthopaedic Association National Joint Replacement Registry.

J Shoulder Elbow Surg 2021 Sep 20. Epub 2021 Sep 20.

Gold Coast University Hospital, Southport, QLD, Australia.

Background: The optimal surgical management of glenohumeral osteoarthritis in young patients remains an unsolved problem. Humeral resurfacing hemiarthroplasty and stemmed hemiarthroplasty using metallic heads are two surgical options that avoid the complications of loosening or wear of the glenoid component seen in total shoulder arthroplasty. Despite the potential benefits, improvement in survivorship has not been demonstrated from joint registry or other studies at mid-term follow-up. This is due predominantly to glenoid erosion and pain that occurs when the metal resurfaced head articulates with the native glenoid. The use of pyrocarbon as a resurfacing material has been proposed as an alternative bearing surface thought to reduce glenoid erosion due to marked reduction in wear rates in vitro. This study aims to compare the survivorship of shoulder hemi resurfacing utilizing pyrolytic carbon to shoulder hemi resurfacing and stemmed hemiarthroplasty using metallic heads.

Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed for all patients aged <55 years who had undergone a primary shoulder replacement for osteoarthritis from 16 April 2004 to 31 December 2019. The outcome of shoulder procedures using pyrocarbon hemi resurfacing were compared to procedures using metal hemi resurfacing and metal hemi stemmed arthroplasty. Reason for revision of each arthroplasty class was analyzed. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models.

Results: There were 393 primary shoulder procedures of which 163 were pyrocarbon hemi resurfacing, 163 were metal hemi resurfacing and 67 metal stemmed hemiarthroplasties. The CPR at 6 years was 8.9% for pyrocarbon hemi resurfacing 17.1% for metal hemi resurfacing and 17.5% for metal hemi stemmed. Pyrocarbon hemi resurfacing had a statistically lower revision rate compared to other hemi resurfacing prostheses (HR=0.41 (95% CI 0.18, 0.93), p=0.032). Pain, prosthesis fracture and infection were the key reasons for revision. No pyrocarbon hemi resurfacings were revised for glenoid erosion. In male patients, pyrocarbon humeral resurfacing had a lower cumulative percent revision compared to metal stemmed hemiarthroplasty (HR=0.32 (95% CI 0.11, 0.93), p=0.037).

Conclusion: Pyrocarbon humeral resurfacing arthroplasty had statistically lower revision rates at mid-term follow-up in patients aged <55 years compared to other hemi resurfacing.
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http://dx.doi.org/10.1016/j.jse.2021.08.017DOI Listing
September 2021

Predicting fracture outcomes from clinical registry data using artificial intelligence supplemented models for evidence-informed treatment (PRAISE) study protocol.

PLoS One 2021 23;16(9):e0257361. Epub 2021 Sep 23.

Clinical Registries, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Background: Distal radius (wrist) fractures are the second most common fracture admitted to hospital. The anatomical pattern of these types of injuries is diverse, with variation in clinical management, guidelines for management remain inconclusive, and the uptake of findings from clinical trials into routine practice limited. Robust predictive modelling, which considers both the characteristics of the fracture and patient, provides the best opportunity to reduce variation in care and improve patient outcomes. This type of data is housed in unstructured data sources with no particular format or schema. The "Predicting fracture outcomes from clinical Registry data using Artificial Intelligence (AI) Supplemented models for Evidence-informed treatment (PRAISE)" study aims to use AI methods on unstructured data to describe the fracture characteristics and test if using this information improves identification of key fracture characteristics and prediction of patient-reported outcome measures and clinical outcomes following wrist fractures compared to prediction models based on standard registry data.

Methods And Design: Adult (16+ years) patients presenting to the emergency department, treated in a short stay unit, or admitted to hospital for >24h for management of a wrist fracture in four Victorian hospitals will be included in this study. The study will use routine registry data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), and electronic medical record (EMR) information (e.g. X-rays, surgical reports, radiology reports, images). A multimodal deep learning fracture reasoning system (DLFRS) will be developed that reasons on EMR information. Machine learning prediction models will test the performance with/without output from the DLFRS.

Discussion: The PRAISE study will establish the use of AI techniques to provide enhanced information about fracture characteristics in people with wrist fractures. Prediction models using AI derived characteristics are expected to provide better prediction of clinical and patient-reported outcomes following distal radius fracture.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257361PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460020PMC
September 2021

Structural Comparisons of Cefotaximase (CTX-M-ase) Sub Family 1.

Front Microbiol 2021 24;12:688509. Epub 2021 Aug 24.

Department of Chemistry and Biochemistry, Miami University, Oxford, OH, United States.

The cefotaximase or CTX-M, family of serine-β-lactamases represents a significant clinical concern due to the ability for these enzymes to confer resistance to a broad array of β-lactam antibiotics an inhibitors. This behavior lends CTX-M-ases to be classified as extended spectrum β-lactamases (ESBL). Across the family of CTX-M-ases most closely related to CTX-M-1, the structures of CTX-M-15 with a library of different ligands have been solved and serve as the basis of comparison within this review. Herein we focus on the structural changes apparent in structures of CTX-M-15 in complex with diazabicyclooctane (DABCO) and boronic acid transition state analog inhibitors. Interactions between a positive surface patch near the active site and complementary functional groups of the bound inhibitor play key roles in the dictating the conformations of active site residues. The insights provided by analyzing structures of CTX-M-15 in complex with DABCO and boronic acid transition state analog inhibitors and analyzing existing structures of CTX-M-64 offer opportunities to move closer to making predictions as to how CTX-M-ases may interact with potential drug candidates, setting the stage for the further development of new antibiotics and β-lactamase inhibitors.
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http://dx.doi.org/10.3389/fmicb.2021.688509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8421805PMC
August 2021

Do patients with well-functioning total hip arthroplasty achieve typical sagittal plane hip kinematics? A proof of concept study.

Hip Int 2021 Sep 8:11207000211044471. Epub 2021 Sep 8.

Centre for Hip Surgery, Wrightington Hospital, Wigan Wrightington and Leigh NHS Trust, Wigan, UK.

Background: Total hip arthroplasty (THA) patients have been shown to not achieve normal sagittal plane hip kinematics. However, previous studies have only conducted group level analysis and as such lack the sensitivity to highlight whether individual patients do achieve normal hip kinematics. As such this study looked to determine whether some patients with well-functioning THA achieve typical sagittal plane hip kinematics.

Methods: Sagittal plane hip kinematics were collected on 11 well-functioning THA patients (Oxford Hip Score = 46 ± 3) and 10 asymptomatic controls using a 3-dimensional motion analysis system during self-paced walking. High-functioning THA patients were identified as those who displayed sagittal plane hip kinematics that were within the variance of the control group on average, and low-functioning patients as those who did not.

Results: 5 THA patients were identified as high-functioning, displaying hip kinematics within the variance of the control group. High-functioning THA patients displayed peak hip flexion and extension values more closely aligned to asymptomatic control group than low-functioning patients. However, hip range of motion was comparable between high- and low-functioning total hip arthroplasty patients and reduced compared to controls.

Conclusion: The presence of high-functioning THA patients who display comparable sagittal plane hip kinematics to controls suggests these patients do achieve normative function and challenges the conclusions of previous group level analysis. Understanding why some patients achieve better function post-operatively will aid pre- and post-operative practices to maximise functional recovery.
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http://dx.doi.org/10.1177/11207000211044471DOI Listing
September 2021

Arthroscopic repair of inferior glenoid labrum tears (Down Under lesions) produces similar outcomes to other glenoid tears.

Knee Surg Sports Traumatol Arthrosc 2021 Aug 29. Epub 2021 Aug 29.

Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital Geelong and Barwon Health, Myers Street, Geelong, VIC, 3227, Australia.

Purpose: Inferior glenoid labral tears are an uncommon but distinct shoulder injury. Only a small number of studies have reported outcomes following arthroscopic repair. The aim of the current study was to report minimum 2-year outcomes following inferior labral repair and to compare outcomes and risk factors associated with the injury to non-inferior labral tears. Whether preoperative MRI or MRA identified inferior labral tears was also assessed.

Methods: A prospective study of 162 consecutive patients undergoing arthroscopic glenoid labral repair, excluding isolated superior labral tears, was conducted. Of the 130 patients available for follow-up, 18 (13.7%) had an inferior labral tear ("Down Under lesion"), the remainder had anterior, posterior or mixed anterior/posterior lesions that did not include the inferior pole. Mean follow-up time for the Down Under group was 44 months (SD 10, range 27-57), and 30 months (SD 14, range 4-60) for the non-Down Under group. Postoperative outcomes included the Oxford Shoulder Instability Score and recurrent instability. Associations between Down Under lesions and injury mechanism, instability at presentation, recurrent instability and family history were assessed with multivariable logistic regression. Preoperative MRI or MRA reports by radiologists were examined to determine if Down Under lesions were identified.

Results: Oxford Shoulder Instability Scores indicated that most patients in both groups had little pain or shoulder problems postoperatively (average Oxford Score 41; 48 = no symptoms). Oxford Scores were not significantly different between the Down Under and non-Down Under groups. Four patients (22.2%) in the Down Under group had recurring symptoms (pain and instability) compared to 12 (10.6%) in the non-Down Under group; this difference was not statistically significant (adjusted OR 1.09, 95% CI 0.19,4.77). Family history of shoulder instability was positively associated with a Down Under lesion (adjusted OR 5.0, 95%CI 1.51,16.7). MRI or MRA identified 52.9% of Down Under lesions.

Conclusion: Down Under lesions were an infrequent type of glenoid labral injury, yet postoperative outcomes were similar to other labral tears. Patients with Down Under lesions had a significant risk factor due to family history of shoulder instability. MRI and MRA could not reliably identify Down Under lesions.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1007/s00167-021-06702-9DOI Listing
August 2021

Two-distinct polymer ubiquitin conjugates by photochemical grafting-from.

Macromol Chem Phys 2021 Jul 29;222(14). Epub 2021 May 29.

Department of Chemistry and Biochemistry, Miami University, 651 E High St, Oxford, OH 45056, USA.

Protein-polymer bioconjugates present a way to make enzymes more efficient and robust for industrial and medicinal applications. While much work has focused on mono-functional conjugates, i.e. conjugates with one type of polymer attached such as poly(ethylene glycol) or poly(N-isopropylacrylamide), there is a practical interest in gaining additional functionality by synthesizing well-defined bifunctional conjugates in a hetero-arm star copolymer architecture with protein as the core. Using ubiquitin as a model protein, a synthetic scheme was developed to attach two different polymers (OEOMA and DMAm) directly to the protein surface, using orthogonal conjugation chemistries and grafting-from by photochemical living radical polymerization techniques. The additional complexity arising from attempts to selectively modify multiple sites led to decreased polymerization performance and indicates that ICAR-ATRP and RAFT are not well-suited to bifunctional bioconjugates applications. Nonetheless, the polymerization conditions preserve the native fold of the ubiquitin and enable production of a hetero-arm star protein-polymer bioconjugate.
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http://dx.doi.org/10.1002/macp.202100091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376180PMC
July 2021

The prevalence of pre-conditioning and recovery strategies in senior elite and non-elite amateur boxing.

Phys Sportsmed 2021 May 27:1-9. Epub 2021 May 27.

Sports Injury Research Group, Sport and Physical Activity Department, Edge Hill University, Ormskirk, Lancashire, UK.

Objectives: A variety of acute strategies around competition are used to prepare and promote physical and mental restoration in athletes. However, to date, no research exists on the prevalence of such methods in amateur boxing. Therefore, this study aimed to 1) examine the prevalence of pre-conditioning and recovery strategies in amateur boxing; 2) ascertain whether this was discriminated against at competitor level.

Methods: This study surveyed 101 senior amateur boxers (Senior Elite SEB n = 59; Senior Development SDB n = 42), on their application and perceptions of pre-conditioning and recovery strategies.

Results: The reported findings determined a significantly greater number of SEB performed resistance priming activity up to 48 hours prior to competition (11, 19% vs 2, 5%; P = 0.040), and post-activation performance enhancement (PAPE) activity in the pre-competition warm-up (18, 31% vs 1, 2%; P < 0.001), compared to SDB. Likewise, SEB reported they were also significantly more likely to utilize massage (SEB 35, 59%, SDB 11, 29%, P = 0.001) and cold-water immersion (CWI) (SEB 28, 47%, SDB 10, 29%, P = 0.016) as recovery modes, compared to their SDB counterparts.

Conclusions: This study was the first to provide data on the use of PAPE, priming and recovery methods around amateur boxing bouts. Increased access to multi-disciplinary staff could be expected in SEB, possibly explaining the greater prevalence of evidence-based methods around competition. Once athlete responsiveness to PAPEand longer-term priming methods are initially assessed, these strategies could be implemented to improve punch-specific performance, though more research is needed on their efficacy. Likewise, boxers could utilize evidence-based recovery modes where possible, with increased importance during repeat-bout scenarios, such as domestic tournaments. Coaches and practitioners may use this data to implement pre-conditioning and recovery strategies, to optimize performance and reduce the risk of injury of amateur boxers.
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http://dx.doi.org/10.1080/00913847.2021.1931525DOI Listing
May 2021

The Closing Argument for Surgical Left Atrial Appendage Occlusion.

Authors:
Richard L Page

N Engl J Med 2021 06 15;384(22):2154-2155. Epub 2021 May 15.

From the Division of Cardiovascular Medicine, Department of Medicine, Robert Larner, M.D., College of Medicine, University of Vermont, Burlington.

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http://dx.doi.org/10.1056/NEJMe2106069DOI Listing
June 2021

Spectroscopic and biochemical characterization of metallo-β-lactamase IMP-1 with dicarboxylic, sulfonyl, and thiol inhibitors.

Bioorg Med Chem 2021 06 1;40:116183. Epub 2021 May 1.

Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056, USA. Electronic address:

In an effort to probe the biophysical mechanisms of inhibition for ten previously-reported inhibitors of metallo-β-lactamases (MBL) with MBL IMP-1, equilibrium dialysis, metal analyses coupled with atomic absorption spectroscopy (AAS), native state mass spectrometry (native MS), and ultraviolet-visible spectrophotometry (UV-VIS) were used. 6-(1H-tetrazol-5-yl) picolinic acid (1T5PA), ANT431, D/l-captopril, thiorphan, and tiopronin were shown to form IMP-1/Zn(II)/inhibitor ternary complexes, while dipicolinic acid (DPA) and 4-(3-aminophenyl)pyridine-2,6-dicarboxylic acid (3AP-DPA) stripped some metal from the active site of IMP but also formed ternary complexes. DPA and 3AP-DPA stripped less metal from IMP-1 than from VIM-2 but stripped more metal from IMP-1 than from NDM-1. In contrast to a previous report, pterostilbene does not appear to bind to IMP-1 under our conditions. These results, along with previous studies, demonstrate similar mechanisms of inhibition toward different MBLs for different MBL inhibitors.
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http://dx.doi.org/10.1016/j.bmc.2021.116183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170513PMC
June 2021

Cytosolic protein quality control machinery: Interactions of Hsp70 with a network of co-chaperones and substrates.

Exp Biol Med (Maywood) 2021 Jun 17;246(12):1419-1434. Epub 2021 Mar 17.

Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056, USA.

The chaperone heat shock protein 70 (Hsp70) and its network of co-chaperones serve as a central hub of cellular protein quality control mechanisms. Domain organization in Hsp70 dictates ATPase activity, ATP dependent allosteric regulation, client/substrate binding and release, and interactions with co-chaperones. The protein quality control activities of Hsp70 are classified as foldase, holdase, and disaggregase activities. Co-chaperones directly assisting protein refolding included J domain proteins and nucleotide exchange factors. However, co-chaperones can also be grouped and explored based on which domain of Hsp70 they interact. Here we discuss how the network of cytosolic co-chaperones for Hsp70 contributes to the functions of Hsp70 while closely looking at their structural features. Comparison of domain organization and the structures of co-chaperones enables greater understanding of the interactions, mechanisms of action, and roles played in protein quality control.
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http://dx.doi.org/10.1177/1535370221999812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243209PMC
June 2021

Gender differences in female and male Australian Football injuries - A prospective observational study of emergency department presentations.

J Sci Med Sport 2021 Jul 22;24(7):670-676. Epub 2021 Feb 22.

Barwon Centre for Orthopaedic Research and Education (B-CORE), School of Medicine, Deakin University and St John of God Hospital, Australia.

Objectives: To compare injury-profiles of females and males presenting to Emergency Departments (EDs) with an Australian Football injury.

Design: Prospective observational study.

Methods: All patients presenting to one of 10 EDs in Victoria, Australia, with an Australian Football injury were included in the study. Data were prospectively collected over a 10 month period, coinciding with a complete Australian Football season, including pre-season training and practice matches. Relevant information was extracted from patient medical records regarding injury-type, body part injured, investigations and treatments required. Female and male data were compared with chi-squared and Fisher's exact tests.

Results: 1635 patients were included, of whom 242 (14.8%) were female. Females had a higher proportion of hand/finger injuries (34.3% v 23.4%), neck injuries (6.6% v 2.5%) and patella dislocations (2.9% v 0.6%). Males had a higher proportion of shoulder injuries (11.5% v 5.8%), skin lacerations (8.0% v 1.7%), and thorax/abdominal/pelvic injuries (5.7% v 2.1%). Concussion rates were similar between the genders, occurring in 14.1% of all patients. Anterior cruciate ligament injuries were infrequent (1.0%) and not significantly different between genders. Females received more imaging investigations (83.1% v 74.7%) and analgesia (62.4% v 48.5%). A higher proportion of males required admission to hospital (5.0% v 2.1%), usually for surgery.

Conclusion: Australian Football injury profiles differed between females and males. Gender-specific injury prevention and management programs would be indicated based on the study findings.
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http://dx.doi.org/10.1016/j.jsams.2021.02.011DOI Listing
July 2021

Evaluating the effects of arthroscopic Bankart repair and open Latarjet shoulder stabilisation procedures on shoulder joint neuromechanics and function: a single-centre, parallel-arm trial protocol.

BMJ Open Sport Exerc Med 2021 23;7(1):e000956. Epub 2021 Feb 23.

Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health, Geelong, Victoria, Australia.

Introduction: Shoulder instability injuries are common in sports involving collisions and overhead movements. Arthroscopic Bankart repair and the open Latarjet are two commonly used surgical stabilisation procedures. There is a lack of knowledge surrounding movement strategies, joint loading and muscle strength after each of these procedures. This study will compare: (1) shoulder joint neuromechanics during activities of daily living and an overhead sporting task; (2) shoulder range of motion; (3) shoulder strength; and (4) self-reported shoulder function and health status, between individuals who have undergone an arthroscopic Bankart repair versus open Latarjet.

Methods And Analysis: This is a prospective cohort, single-centre, non-randomised parallel arm study of surgical interventions for athletic shoulder instability injuries. Thirty participants will be recruited. Of these, 20 will have experienced one or more traumatic shoulder instability injuries requiring surgical stabilisation-and will undergo an arthroscopic Bankart repair or open Latarjet procedure. The remaining 10 participants will have no history of shoulder instability injury and act as controls. Participants will undergo baseline testing and be followed up at 3, 6 and 12 months. A two-way (group×time) analysis of variance with repeated measures on one factor (ie, time) will compare each outcome measure between groups across time points.

Ethics And Dissemination: This study was approved by the Barwon Health and Deakin University Human Research Ethics Committees. Outcomes will be disseminated through publications in peer-reviewed journals and presentations at relevant scientific conferences.

Trial Registration Number: Australian and New Zealand Clinical Trials Registry (ACTRN12620000016932).
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http://dx.doi.org/10.1136/bmjsem-2020-000956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907843PMC
February 2021

Impaired health-related quality of life, psychological distress, and productivity loss in younger people with persistent shoulder pain: a cross-sectional analysis.

Disabil Rehabil 2021 Feb 23:1-10. Epub 2021 Feb 23.

Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Barwon Health, Geelong, Australia.

Purpose: To investigate wellbeing and work impacts in younger people with persistent shoulder pain.

Materials And Methods: People aged 20-55 years with shoulder pain of >6 weeks' duration (excluding those with recent fracture or dislocation) were recruited from orthopaedic clinics at three major public hospitals. Health-related quality of life (HRQoL) and psychological distress were evaluated using the Assessment of Quality of Life (AQoL) and K10 instruments and compared to population norms. Shoulder-related absenteeism and presenteeism were quantified using the Work Productivity and Activity Impairment (WPAI) Questionnaire.

Results: Of the 81 participants (54% male), 69% had shoulder pain for over 12 months. Substantial HRQoL impairment was evident (mean reduction from population norms 0.33 AQoL units, 95% CI -0.38 to -0.27; minimal important difference 0.06 AQoL units). High or very high psychological distress was three times more prevalent among participants than the general population (relative risk 3.67, 95% CI 2.94 to 4.59). One-quarter of participants had ceased paid employment due to shoulder pain and 77% reported shoulder-related impairment at work.

Conclusions: The broader impacts of painful shoulder conditions on younger people extend well beyond pain and upper limb functional limitations. In particular, the work-related impacts should form a routine part of patient assessment and rehabilitation.Implications for rehabilitationPersistent shoulder pain in younger people (aged 20-55 years) is associated with substantially reduced health-related quality of life and greater psychological distress, compared to population norms, as well as work participation and productivity impacts.As rotator cuff conditions, shoulder capsule pathology, and glenohumeral instability are relatively common, our data suggest that persistent shoulder pain is likely to have a high community impact among people of working age.Information resources that people with painful shoulder conditions can share with their families, employers, and colleagues may assist others to better understand the broader impacts of these conditions.Work-related challenges associated with shoulder pain should be considered within routine clinical care, and may require referral to an occupational health clinician or vocational rehabilitation service.
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http://dx.doi.org/10.1080/09638288.2021.1887376DOI Listing
February 2021

Carbapenem Use Is Driving the Evolution of Imipenemase 1 Variants.

Antimicrob Agents Chemother 2021 03 18;65(4). Epub 2021 Mar 18.

Department of Chemistry and Biochemistry, Miami University, Oxford, Ohio, USA

Metallo-β-lactamases (MBLs) are a growing clinical threat because they inactivate nearly all β-lactam-containing antibiotics, and there are no clinically available inhibitors. A significant number of variants have already emerged for each MBL subfamily. To understand the evolution of imipenemase (IMP) genes ( ) and their clinical impact, 20 clinically derived IMP-1 like variants were obtained using site-directed mutagenesis and expressed in a uniform genetic background in strain DH10B. Strains of IMP-1-like variants harboring S262G or V67F substitutions exhibited increased resistance toward carbapenems and decreased resistance toward ampicillin. Strains expressing IMP-78 (S262G/V67F) exhibited the largest changes in MIC values compared to IMP-1. In order to understand the molecular mechanisms of increased resistance, biochemical, biophysical, and molecular modeling studies were conducted to compare IMP-1, IMP-6 (S262G), IMP-10 (V67F), and IMP-78 (S262G/V67F). Finally, unlike most New Delhi metallo-β-lactamase (NDM) and Verona integron-encoded metallo-β-lactamase (VIM) variants, the IMP-1-like variants do not confer any additional survival advantage if zinc availability is limited. Therefore, the evolution of MBL subfamilies (i.e., IMP-6, -10, and -78) appears to be driven by different selective pressures.
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http://dx.doi.org/10.1128/AAC.01714-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097420PMC
March 2021

Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial.

JAMA Surg 2021 Mar;156(3):229-237

Gosford and Wyong Hospitals, Gosford, Australia.

Importance: The burden of injury and costs of wrist fractures are substantial. Surgical treatment became popular without strong supporting evidence.

Objective: To assess whether current surgical treatment for displaced distal radius fractures provided better patient-reported wrist pain and function than nonsurgical treatment in patients 60 years and older.

Design, Setting, And Participants: In this multicenter randomized clinical trial and parallel observational study, 300 eligible patients were screened from 19 centers in Australia and New Zealand from December 1, 2016, until December 31, 2018. A total of 166 participants were randomized to surgical or nonsurgical treatment and followed up at 3 and 12 months by blinded assessors. Those 134 individuals who declined randomization were included in a parallel observational cohort with the same treatment options and follow-up. The primary analysis was intention to treat; sensitivity analyses included as-treated and per-protocol analyses.

Intervention: Surgical treatment was open reduction and internal fixation using a volar-locking plate (VLP). Nonsurgical treatment was closed reduction and cast immobilization (CR).

Main Outcomes And Measures: The primary outcome was the Patient-Rated Wrist Evaluation score at 12 months. Secondary outcomes were Disabilities of Arm, Shoulder, and Hand questionnaire score, health-related quality of life, pain, major complications, patient-reported treatment success, bother with appearance, and therapy use.

Results: In the 300 study participants (mean [SD] age, 71.2 [7.5] years; 269 [90%] female; 166 [81 VLP and 85 CR] in the randomized clinical trial sample and 134 [32 VLP and 102 CR] in the observational sample), no clinically important between-group difference in 12-month Patient-Rated Wrist Evaluation scores (mean [SD] score of 19.8 [21.1] for VLP and 21.5 [24.3] for CR; mean difference, 1.7 points; 95% CI -5.4 to 8.8) was observed. No clinically important differences were found in quality of life, wrist pain, or bother at 3 and 12 months. No significant difference was found in total complications between groups (12 of 84 [14%] for the CR group vs 6 of 80 [8%] for the VLP group; risk ratio [RR], 0.53; 95% CI, 0.21-1.33). Patient-reported treatment success favored the VLP group at 12 months (very successful or successful: 70 [89%] vs 57 [70%]; RR, 1.26; 95% CI, 1.07-1.48; P = .005). There was greater use of postoperative physical therapy in the VLP group (56 [72%] vs 44 [54%]; RR, 1.32; 95% CI, 1.04-1.69; P = 0.02).

Conclusions And Relevance: This randomized clinical trial found no between-group differences in improvement in wrist pain or function at 12 months from VLP fixation over CR for displaced distal radius fractures in older people.

Trial Registration: http://anzctr.org.au identifier: ACTRN12616000969460.
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http://dx.doi.org/10.1001/jamasurg.2020.5672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807386PMC
March 2021

The rate of 2nd revision for shoulder arthroplasty as analyzed by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).

Acta Orthop 2021 06 12;92(3):258-263. Epub 2021 Jan 12.

South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.

Background and purpose - The increase in shoulder arthroplasty may lead to a burden of revision surgery. This study compared the rate of (2nd) revision following aseptic 1st revision shoulder arthroplasty, considering the type of primary, and the class and type of the revision.Patients and methods - All aseptic 1st revisions of primary total reverse shoulder arthroplasty (rTSA group) and of primary total stemmed and stemless total shoulder arthroplasty (non-rTSA group) procedures reported to our national registry between April 2004 to December 2018 were included. The rate of 2nd revision was determined using Kaplan-Meier estimates and comparisons were made using Cox proportional hazards models.Results - There was an increased risk of 2nd revision in the 1st month only for the rTSA group (n = 700) compared with the non-rTSA group (n = 991); hazard ratio (HR) = 4.8 (95% CI 2.2-9). The cumulative percentage of 2nd revisions (CPR) was 24% in the rTSA group and 20% in the non-rTSA group at 8 years. There was an increased risk of 2nd revision for the type (cup vs. head) HR = 2.2 (CI 1.2-4.2), but not class of revision for the rTSA group. Minor (> 3 months) vs. major class revision, and humeral revision vs. all other revision types were second revision risk factors for the non-rTSA group.Interpretation - The CPR of revision shoulder arthroplasty was > 20% at 8 years and was influenced by the type of primary, the class, and the type of revision. The most common reasons for 2nd revision were instability/dislocation, loosening, and infection.
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http://dx.doi.org/10.1080/17453674.2020.1871559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231394PMC
June 2021

Guideline-Concordant Antiarrhythmic Drug Use in the Get With The Guidelines-Atrial Fibrillation Registry.

Circ Arrhythm Electrophysiol 2021 02 8;14(2):e008961. Epub 2021 Jan 8.

Duke Clinical Research Institute (D.N.H., R.A.M., J.P.P.), Durham, NC.

Background: Antiarrhythmic drug (AAD) therapy for atrial fibrillation (AF) can be associated with both proarrhythmic and noncardiovascular toxicities. Practice guidelines recommend tailored AAD therapy for AF based on patient-specific characteristics, such as coronary artery disease and heart failure, to minimize adverse events. However, current prescription patterns for specific AADs and the degree to which these guidelines are followed in practice are unknown.

Methods: Patients enrolled in the Get With The Guidelines-Atrial Fibrillation registry with a primary diagnosis of AF discharged on an AAD between January 2014 and November 2018 were included. We analyzed rates of prescription of each AAD in several subgroups including those without structural heart disease. We classified AAD use as guideline concordant or nonguideline concordant based on 6 criteria derived from the American Heart Association/American College of Cardiology/Heart Rhythm Society AF guidelines. Guideline concordance for amiodarone was not considered applicable, since its use is not specifically contraindicated in the guidelines for reasons such as structural heart disease or renal function. We analyzed guideline-concordant AAD use by specific patient and hospital characteristics, and regional and temporal trends.

Results: Among 21 921 patients from 123 sites, the median age was 69 years, 46% female and 51% had paroxysmal AF. The most commonly prescribed AAD was amiodarone (38%). Sotalol (23.2%) and dofetilide (19.2%) were each more commonly prescribed than either flecainide (9.8%) or propafenone (4.8%). Overall guideline-concordant AAD prescription at discharge was 84%. Guideline-concordant AAD use by drug was as follows: dofetilide 93%, sotalol 66%, flecainide 68%, propafenone 48%, and dronedarone 80%. There was variability in rate of guideline-concordant AAD use by hospital and geographic region.

Conclusions: Amiodarone remains the most commonly prescribed AAD for AF followed by sotalol and dofetilide. Rates of guideline-concordant AAD use were high, and there was significant variability by specific drugs, hospitals, and regions, highlighting opportunities for additional quality improvement.
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http://dx.doi.org/10.1161/CIRCEP.120.008961DOI Listing
February 2021

Polymer Modification of Lipases, Substrate Interactions, and Potential Inhibition.

Biomacromolecules 2021 02 8;22(2):309-318. Epub 2021 Jan 8.

Department of Chemistry and Biochemistry, Miami University, 651 E High St., Oxford, Ohio 45056, United States.

An industrially important enzyme, lipase B (CalB), was modified with a range of functional polymers including hydrophilic, hydrophobic, anionic, and cationic character using a "grafting to" approach. We determined the impact of polymer chain length on CalB activity by synthesizing biohybrids of CalB with each polymer at three different chain lengths, using reversible addition-fragmentation chain transfer (RAFT) polymerization. The activity of CalB in both aqueous and aqueous-organic media mixtures was significantly enhanced for acrylamide (Am) and ,-dimethyl acrylamide (DMAm) conjugates, with activity remaining approximately constant in 25 and 50% ethanol solvent systems. Interestingly, the activity of ,-dimethylaminopropyl-acrylamide (DMAPA) conjugates increased gradually with increasing organic solvent content in the system. Contrary to other literature reports, our study showed significantly diminished activity for hydrophobic polymer-protein conjugates. Functional thermal stability assays also displayed a considerable enhancement of retained activity of Am, DMAm, and DMAPA conjugates compared to the native CalB enzyme. Thus, this study provides an insight into possible advances in lipase production, which can lead to new improved lipase bioconjugates with increased activity and stability.
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http://dx.doi.org/10.1021/acs.biomac.0c01159DOI Listing
February 2021

Early revision in anatomic total shoulder arthroplasty in osteoarthritis: a cross-registry comparison.

Shoulder Elbow 2020 Dec 11;12(1 Suppl):81-87. Epub 2019 Apr 11.

Department of Orthopedic Surgery, Southern California Permanente Medical Group, Harbor City, CA, USA.

Background: We evaluated anatomic total shoulders undergoing early revision (less than two years) in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Kaiser Permanente Shoulder Arthroplasty Registry (KPSAR).

Methods: A cross-sectional comparison of both registries was performed between the years of 2009 and 2012. Only patients who underwent anatomic total shoulder arthroplasty for a primary diagnosis of osteoarthritis were included. Aggregate-level data of patients undergoing early revisions done within two years of index arthroplasty were evaluated, and descriptive analysis was conducted.

Results: During the study period, 4614 patients were identified in the AOANJRR compared to 2036 in the KPSAR. Rotator cuff pathology, component loosening, and prosthetic instability were among the most common reasons for revision in both registries. A higher rate of revision in the AOANJRR was found to be secondary to the failure of one specific prosthesis, which has since been discontinued.

Discussion: Comparing reasons for early revision in total shoulder arthroplasty revealed several similarities between the AOANJRR and KPSAR. Differences were also noted, and this study served to highlight the importance prosthesis selection can play in determining outcomes. Cooperation among registries may allow for earlier identification of risk factors for failure in shoulder arthroplasty.
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http://dx.doi.org/10.1177/1758573219842168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726180PMC
December 2020

Lower-Limb Muscle Excitation, Peak Torque, and External Load Responses to a 120-Minute Treadmill-Based Soccer-Specific Simulation.

Res Q Exerc Sport 2020 Dec 11:1-11. Epub 2020 Dec 11.

University of Huddersfield.

: The aim of this study was to investigate thigh musculature excitation and torque generation in response to soccer-specific exercise incorporating an extra-time (ET) period. : Twelve semiprofessional soccer players performed 120-min treadmill-based soccer-specific exercise. Surface electromyography (EMG) signals for the rectus femoris (EMG) and biceps femoris (EMG) were measured as the mean response across a pre-determined 10-second sprint bout during each 15-min block of exercise. Peak eccentric torque of the knee flexors (eccKF) and concentric torque of the knee extensors (conKE) were recorded across angular velocities of 60, 180, and 270 deg∙s immediately pre- and post-exercise. Tri-axial PlayerLoad™ (PL-T) was monitored throughout exercise and defined across vertical (PL-V), anterior-posterior (PL-AP), and medial-lateral (PL-ML) planes of motion. : A reduction in normalized EMG amplitude was evident at 105‒120 min, versus 0‒15 min (-12.5%; .037), 15‒30 min (-12.5%; .047), and 45‒60 min (-14%; .030). Peak torque of the eccKF was significantly reduced from pre- to post-exercise at 60 (-7.7%; = .018), 180 (-10.5%; = .042), and 270 deg∙s (-7.5%; = .034). A main effect for time was identified for PL-T ( < .010), PL-V ( = .033), and PL-AP ( < .010). : These findings suggest that muscle excitation of the rectus femoris is reduced during ET, accompanied with a deficit in the torque generation of the knee flexors following 120 min of soccer-specific activity. Practitioners should adequately condition players for the additional ET period by incorporating exercises into training schedules that develop fatigue-resistant eccentric hamstring strength to minimize injury risk.
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http://dx.doi.org/10.1080/02701367.2020.1844858DOI Listing
December 2020

Simulating the effect of glenohumeral capsulorrhaphy on kinematics and muscle function.

J Orthop Res 2021 04 25;39(4):880-890. Epub 2020 Nov 25.

Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health, St John of God Hospital, Deakin University, Geelong, Australia.

This study aimed to use a predictive simulation framework to examine shoulder kinematics, muscular effort, and task performance during functional upper limb movements under simulated selective glenohumeral capsulorrhaphy. A musculoskeletal model of the torso and upper limb was adapted to include passive restraints that simulated the changes in shoulder range of motion stemming from selective glenohumeral capsulorrhaphy procedures (anteroinferior, anterosuperior, posteroinferior, posterosuperior, and total anterior, inferior, posterior, and superior). Predictive muscle-driven simulations of three functional movements (upward reach, forward reach, and head touch) were generated with each model. Shoulder kinematics (elevation, elevation plane, and axial rotation), muscle cost (i.e., muscular effort), and task performance time were compared to a baseline model to assess the impact of the capsulorrhaphy procedures. Minimal differences in shoulder kinematics and task performance times were observed, suggesting that task performance could be maintained across the capsulorrhaphy conditions. Increased muscle cost was observed under the selective capsulorrhaphy conditions, however this was dependent on the task and capsulorrhaphy condition. Larger increases in muscle cost were observed under the capsulorrhaphy conditions that incurred the greatest reductions in shoulder range of motion (i.e., total inferior, total anterior, anteroinferior, and total posterior conditions) and during tasks that required shoulder kinematics closer to end range of motion (i.e., upward reach and head touch). The elevated muscle loading observed could present a risk to joint capsule repair. Appropriate rehabilitation following glenohumeral capsulorrhaphy is required to account for the elevated demands placed on muscles, particularly when a significant range of motion loss presents.
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http://dx.doi.org/10.1002/jor.24908DOI Listing
April 2021

The effects of medium chain triglyceride (MCT) supplementation using a C:C ratio of 30:70 on cognitive performance in healthy young adults.

Physiol Behav 2021 02 18;229:113252. Epub 2020 Nov 18.

School of Health Sciences, Liverpool Hope University, Liverpool, United Kingdom. Electronic address:

Purpose: The brain can utilise medium chain triglycerides (MCTs) as an alternative fuel to glucose, and research has shown that MCT ingestion improves cognitive function in diseased and/or elderly individuals. The aim of this study is to determine if these improvements can also be observed in young, healthy adults. Furthermore, we aim to establish the ideal dosage and timeframe necessary for an effect.

Methods: Participants were divided equally into three groups of 10 (Placebo (0 g), 12 g and 18 g MCT/day) and were supplemented for 4 weeks. The supplement had a C:C ratio of 30:70. Participants visited the laboratory once a week for 5 weeks (baseline, test weeks 1-4) to undergo a battery of cognitive tests; Trail Making, Digit Span, Spatial Span, Covert Shift of Attention, and Rapid Visual Information Processing.

Results: After 2-3 weeks of supplementation, MCT ingestion enhanced performance in cognitive tasks, including: Trail Making A/B and Digit Span Forwards/Backwards (ps<0.001) when compared to a placebo group taking a carbohydrate gel. In Spatial Span Backwards, there was a significant main effect of group (p = 0.002). Where significance was seen, there were main effects of time after 2-3 weeks (ps<0.05). There was minimal difference between the two MCT intervention groups in most measures (ps>0.05). There were also null results in tasks measuring attention and reaction time (ps>0.05).

Conclusions: MCT ingestion improved cognitive performance after 2-3 weeks, with minimal difference between taking 12 g and 18 g MCT/day groups, suggesting a possible dose-response threshold at 12 g MCT/day when supplementing over a short period.
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http://dx.doi.org/10.1016/j.physbeh.2020.113252DOI Listing
February 2021

Internet and Telerehabilitation-Delivered Management of Rotator Cuff-Related Shoulder Pain (INTEL Trial): Randomized Controlled Pilot and Feasibility Trial.

JMIR Mhealth Uhealth 2020 11 18;8(11):e24311. Epub 2020 Nov 18.

School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.

Background: Rotator cuff-related shoulder pain (RCRSP) is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes.

Objective: The primary aim of this pilot randomized controlled trial was to assess the feasibility of a 12-week internet-delivered intervention for RCRSP comparing advice only, recommended care, and recommended care with group-based telerehabilitation.

Methods: Reporting was in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist for pilot and feasibility trials. People with a primary complaint of RCRSP for 3 months or longer were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated (via a Zelen design) to receive (1) advice only, (2) recommended care (internet-delivered evidence-based exercise and education), or (3) recommended care and telerehabilitation (including a weekly group teleconference session). Progression criteria for a full-scale trial included (1) recruitment of 20% or greater of eligible participants, (2) acceptable adherence (two or more of the three prescribed weekly sessions) among 70% or greater of participants, (3) 80% or greater retention of participants, (4) absence of intervention-related serious adverse events, and (5) 80% or greater response rates to questionnaires. Secondary clinical and patient knowledge outcomes were collected (via email or text) at baseline, six weeks, and 12 weeks (for clinical and patient knowledge), and within-group change was reported descriptively.

Results: We enrolled 36 of 38 (95%) eligible participants and all participants were recruited within a 3-week period. Of the 36 participants, 12 participants were allocated to each of the three trial arms. The mean age of participants was between 51 and 56 years, and 83% (10/12) to 92% (11/12) were female. Retention at the 12-week endpoint was 94% (34/36) and response to email questionnaires at other time points was 83% or greater. We found acceptable adherence (defined as greater than 70% of participants performing exercise 2 or 3 times/week) in the recommended care group with telerehabilitation but not in the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms), with the exception of one instance of elective surgery (unrelated to the person's shoulder condition).

Conclusions: Our prespecified success criteria were met or exceeded, but there was a gender imbalance toward women. It is feasible to progress to a fully powered trial, but strategies to address the gender imbalance need to be implemented.

Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000248965); https://tinyurl.com/yy6eztf5.
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http://dx.doi.org/10.2196/24311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710452PMC
November 2020

Current national hand surgery registries worldwide.

J Hand Surg Eur Vol 2021 Jan 17;46(1):103-106. Epub 2020 Nov 17.

Division of Orthopedic Surgery, Geneva University Hospitals, Switzerland.

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http://dx.doi.org/10.1177/1753193420970155DOI Listing
January 2021

Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies.

Obes Rev 2021 03 9;22(3):e13146. Epub 2020 Nov 9.

The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.

This systematic review and meta-analysis investigated the association between consumption of ultraprocessed food and noncommunicable disease risk, morbidity and mortality. Forty-three observational studies were included (N = 891,723): 21 cross-sectional, 19 prospective, two case-control and one conducted both a prospective and cross-sectional analysis. Meta-analysis demonstrated consumption of ultraprocessed food was associated with increased risk of overweight (odds ratio: 1.36; 95% confidence interval [CI], 1.23-1.51; P < 0.001), obesity (odds ratio: 1.51; 95% CI, 1.34-1.70; P < 0.001), abdominal obesity (odds ratio: 1.49; 95% CI, 1.34-1.66; P < 0.0001), all-cause mortality (hazard ratio: 1.28; 95% CI, 1.11-1.48; P = 0.001), metabolic syndrome (odds ratio: 1.81; 95% CI, 1.12-2.93; P = 0.015) and depression in adults (hazard ratio: 1.22; 95% CI, 1.16-1.28, P < 0.001) as well as wheezing (odds ratio: 1.40; 95% CI, 1.27-1.55; P < 0.001) but not asthma in adolescents (odds ratio: 1.20; 95% CI, 0.99-1.46; P = 0.065). In addition, consumption of ultraprocessed food was associated with cardiometabolic diseases, frailty, irritable bowel syndrome, functional dyspepsia and cancer (breast and overall) in adults while also being associated with metabolic syndrome in adolescents and dyslipidaemia in children. Although links between ultraprocessed food consumption and some intermediate risk factors in adults were also highlighted, further studies are required to more clearly define associations in children and adolescents. STUDY REGISTRATION: Prospero ID: CRD42020176752.
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http://dx.doi.org/10.1111/obr.13146DOI Listing
March 2021

Angle-Specific Isokinetic Metrics Highlight Strength Training Needs of Elite Youth Soccer Players.

J Strength Cond Res 2020 Nov;34(11):3258-3265

Department of Sport and Physical Activity, Sports Injury Research Group, Edge Hill University, Ormskirk, United Kingdom.

Eustace, SJ, Page, RM, and Greig, M. angle specific isokinetic metrics highlight strength training needs of elite youth soccer players. J Strength Cond Res 34(11): 3258-3265, 2020-The purpose of this study was to assess traditional and angle-specific isokinetic strength of eccentric knee flexors (eccKFs) and concentric knee extensors (conKEs) between senior professional and youth soccer players. Thirty-four male soccer players (17 senior and 17 youth) were recruited for bilateral assessments at 180, 270, and 60°·s. Peak torque (PT), dynamic control ratio (DCR), angle of peak torque (APT), functional range (FR), angle-specific torque (AST), and angle-specific DCR (DCRAST) were compared. The eccentric knee flexor (eccKF) and conKE PT (p = 0.782) and DCR (p = 0.508) were not different between groups across all angular velocities. Significant differences were identified for eccKF APT (p = 0.018) and FR (p = 0.006), DCRAST at 270°·s (p = 0.031), and in AST data recorded across angular velocities for eccKF and conKE (p = 0.003). Traditional strength measures were not sensitive to playing age, with implications for misinterpretation in training prescription. By contrast, AST data did differentiate between ages. Strength deficits that highlight the muscle contraction type, angular velocity, and joint angle can be manipulated within an individualized training intervention. Given the relevance to injury etiology, this study highlights potential implications for improved assessment strategies to inform training prescription for performance and injury prevention. Given the high number of injuries in adolescent soccer players, and in line with previous recommendations, practitioners should consider using more informed and specific strength and conditioning practices at younger ages.
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http://dx.doi.org/10.1519/JSC.0000000000002612DOI Listing
November 2020

CHIP phosphorylation by protein kinase G enhances protein quality control and attenuates cardiac ischemic injury.

Nat Commun 2020 10 20;11(1):5237. Epub 2020 Oct 20.

Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA.

Proteotoxicity from insufficient clearance of misfolded/damaged proteins underlies many diseases. Carboxyl terminus of Hsc70-interacting protein (CHIP) is an important regulator of proteostasis in many cells, having E3-ligase and chaperone functions and often directing damaged proteins towards proteasome recycling. While enhancing CHIP functionality has broad therapeutic potential, prior efforts have all relied on genetic upregulation. Here we report that CHIP-mediated protein turnover is markedly post-translationally enhanced by direct protein kinase G (PKG) phosphorylation at S20 (mouse, S19 human). This increases CHIP binding affinity to Hsc70, CHIP protein half-life, and consequent clearance of stress-induced ubiquitinated-insoluble proteins. PKG-mediated CHIP-pS20 or expressing CHIP-S20E (phosphomimetic) reduces ischemic proteo- and cytotoxicity, whereas a phospho-silenced CHIP-S20A amplifies both. In vivo, depressing PKG activity lowers CHIP-S20 phosphorylation and protein, exacerbating proteotoxicity and heart dysfunction after ischemic injury. CHIP-S20E knock-in mice better clear ubiquitinated proteins and are cardio-protected. PKG activation provides post-translational enhancement of protein quality control via CHIP.
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http://dx.doi.org/10.1038/s41467-020-18980-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575552PMC
October 2020

The Effect of Fixture Congestion on Performance During Professional Male Soccer Match-Play: A Systematic Critical Review with Meta-Analysis.

Sports Med 2021 Feb;51(2):255-273

School of Human and Health Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK.

Background: Fixture congestion (defined as a minimum of two successive bouts of match-play, with an inter-match recovery period of < 96 h) is a frequent and contemporary issue in professional soccer due to increased commercialisation of the sport and a rise in the number of domestic and international cup competitions. To date, there is no published systematic review or meta-analysis on the impact of fixture congestion on performance during soccer match play.

Objective: We sought to conduct a systematic review and meta-analysis of the literature related to the effects of fixture congestion on physical, technical, and tactical performance in professional soccer match-play.

Methods: Adhering to PRISMA guidelines and following pre-registration with the Open Science Framework ( https://osf.io/fqbuj ), a comprehensive and systematic search of three research databases was conducted to identify articles related to soccer fixture congestion. For inclusion in the systematic review and meta-analysis, studies had to include male professional soccer players, a congestion period that contained two matches ≤ 96 h, and have outcome measures related to physical, technical or tactical performance. Exclusion criteria comprised non-male and/or youth players, data that only assessed impact of congestion on injury, used simulated protocols, or were grey literature, such as theses or dissertations.

Results: Out of sixteen articles included in the systematic review, only five were eligible for the meta-analysis, and the only variable that was measured consistently across studies was total distance covered. Fixture congestion had no impact on total distance covered [p = 0.134; pooled standardized mean difference; Hedge's G = 0.12 (- 0.04, 0.28)]. Between-study variance, heterogeneity, and inconsistency across studies were moderate [Cochrane's Q = 6.7, p = 0.150, I = 40.7% (CI 0.00, 93.34)]. Data from articles included in the systematic review suggest fixture congestion has equivocal effects on physical performance, with variation between studies and low quality of research design in some instances. Tactical performance may be negatively impacted by fixture congestion; however, only one article was identified that measured this element. Technical performance is unchanged during fixture congestion; however, again, research design and the sensitivity and relevance of methods and variables require improvement.

Conclusion: Total distance covered is not impacted by fixture congestion. However, some studies observed a negative effect of fixture congestion on variables such as low- and moderate-intensity distance covered, perhaps suggesting that players employ pacing strategies to maintain high-intensity actions. There is a lack of data on changes in tactical performance during fixture congestion. With ever increasing numbers of competitive matches scheduled, more research needs to be conducted using consistent measures of performance (e.g., movement thresholds) with an integration of physical, technical and tactical aspects.
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http://dx.doi.org/10.1007/s40279-020-01359-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846542PMC
February 2021
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