bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition by Cellular Vacuolar ATPase Impairs Human Papillomavirus Uncoating and Infection
Authors: Müller Konstantin H. , Spoden Gilles A. , Scheffer Konstanze D. , Brunnhöfer Regina , De Brabander Jef K. , Maier Martin E. , Florin Luise , Muller Claude P.
Published: March 2014

Several viruses, including human papillomaviruses, depend on endosomal acidification for successful infection. Hence, the multisubunit enzyme vacuolar ATPase (V-ATPase), which is mainly responsible for endosome acidification in the cell, represents an attractive target for antiviral strategies. In the present study, we show that V-ATPase is required for human papillomavirus (HPV) infection and that uncoating/disassembly but not endocytosis is affected by V-ATPase inhibition. The infection inhibitory potencies of saliphenylhalamide, a proven V-ATPase inhibitor, and its derivatives, as well as those of other V-ATPase inhibitors, were analyzed on different HPV types in relevant cell lines. Variation in the selectivity indices among V-ATPase inhibitors was high, while variation for the same inhibitor against different HPV subtypes was low, indicating that broad-spectrum anti-HPV activity can be provided.
Tannin Degradation by a Novel Tannase Enzyme Present in Some Lactobacillus plantarum Strains
Authors: Jiménez Natalia , Esteban-Torres María , Mancheño José Miguel , de las Rivas Blanca , Muñoz Rosario
Published: March 2014

Lactobacillus plantarum
is frequently isolated from the fermentation of plant material where tannins are abundant.
L. plantarum
strains possess tannase activity to degrade plant tannins. An
L. plantarum
tannase (TanB
Lp
, formerly called TanLp1) was previously identified and biochemically characterized. In this study, we report the identification and characterization of a novel tannase (TanA
Lp
). While all 29
L. plantarum
strains analyzed in the study possess the

tanB
Lp

gene, the gene

tanA
Lp

was present in only four strains. Upon methyl gallate exposure, the expression of

tanB
Lp

was induced, whereas

tanA
Lp

expression was not affected. TanA
Lp
showed only 27% sequence identity to TanB
Lp
, but the residues involved in tannase activity are conserved. Optimum activity for TanA
Lp
was observed at 30°C and pH 6 in the presence of Ca
2+
ions. TanA
Lp
was able to hydrolyze gallate and protocatechuate esters with a short aliphatic alcohol substituent. Moreover, TanA
Lp
was able to fully hydrolyze complex gallotannins, such as tannic acid. The presence of the extracellular TanA
Lp
tannase in some
L. plantarum
strains provides them an advantage for the initial degradation of complex tannins present in plant environments.
Development of a Markerless Knockout Method for Actinobacillus succinogenes
Authors: Joshi Rajasi V. , Schindler Bryan D. , McPherson Nikolas R. , Tiwari Kanupriya , Vieille Claire
Published: March 2014

Actinobacillus succinogenes
is one of the best natural succinate-producing organisms, but it still needs engineering to further increase succinate yield and productivity. In this study, we developed a markerless knockout method for
A. succinogenes
using natural transformation or electroporation. The
Escherichia coli
isocitrate dehydrogenase gene with flanking flippase recognition target sites was used as the positive selection marker, making use of
A. succinogenes
's auxotrophy for glutamate to select for growth on isocitrate. The
Saccharomyces cerevisiae
flippase recombinase (Flp) was used to remove the selection marker, allowing its reuse. Finally, the plasmid expressing
flp
was cured using acridine orange. We demonstrate that at least two consecutive deletions can be introduced into the same strain using this approach, that no more than a total of 1 kb of DNA is needed on each side of the selection cassette to protect from exonuclease activity during transformation, and that no more than 200 bp of homologous DNA is needed on each side for efficient recombination. We also demonstrate that electroporation can be used as an alternative transformation method to obtain knockout mutants and that an enriched defined medium can be used for direct selection of knockout mutants on agar plates with high efficiency. Single-knockout mutants of the fumarate reductase and of the pyruvate formate lyase-encoding genes were obtained using this knockout strategy. Double-knockout mutants were also obtained by deleting the citrate lyase-, β-galactosidase-, and aconitase-encoding genes in the pyruvate formate lyase knockout mutant strain.
Fluorescent Fingerprints of Endolithic Phototrophic Cyanobacteria Living within Halite Rocks in the Atacama Desert
Authors: Roldán M. , Ascaso C. , Wierzchos J.
Published: March 2014

Halite deposits from the hyperarid zone of the Atacama Desert reveal the presence of endolithic microbial colonization dominated by cyanobacteria associated with heterotrophic bacteria and archaea. Using the λ-scan confocal laser scanning microscopy (CLSM) option, this study examines the autofluorescence emission spectra produced by single cyanobacterial cells found inside halite rocks and by their photosynthetic pigments. Photosynthetic pigments could be identified according to the shapes of the emission spectra and wavelengths of fluorescence peaks. According to their fluorescence fingerprints, three groups of cyanobacterial cells were identified within this natural extreme microhabitat: (i) cells producing a single fluorescence peak corresponding to the emission range of phycobiliproteins and chlorophyll
a
, (ii) cells producing two fluorescence peaks within the red and green signal ranges, and (iii) cells emitting only low-intensity fluorescence within the nonspecific green fluorescence signal range. Photosynthetic pigment fingerprints emerged as indicators of the preservation state or viability of the cells. These observations were supported by a cell plasma membrane integrity test based on Sytox Green DNA staining and by transmission electron microscopy ultrastructural observations of cyanobacterial cells.
Vibriophages and Their Interactions with the Fish Pathogen Vibrio anguillarum
Authors: Tan Demeng , Gram Lone , Middelboe Mathias
Published: March 2014

Vibrio anguillarumis an important pathogen in aquaculture, responsible for the disease vibriosis in many fish and invertebrate species. Disease control by antibiotics is a concern due to potential development and spread of antibiotic resistance. The use of bacteriophages to control the pathogen may offer a non-antibiotic-based approach to reduce vibriosis. A detailed understanding of the phage-host interaction is needed to evaluate the potential of phages to control the pathogen. In this study, we examined the diversity and interactions of 11 vibriophages, 24V. anguillarumstrains, and 13Vibriospecies strains. Together, the host ranges of the 11 phages covered all of the tested 37Vibriosp. host strains, which represented considerable temporal (20 years) and geographical (9 countries) differences in their origins of isolation. Thus, despite the occurrence of unique susceptibility patterns of the individual host isolates, key phenotypic properties related to phage susceptibility are distributed worldwide and maintained in the globalVibriocommunity for decades. The phage susceptibility pattern of the isolates did not show any relation to the physiological relationships obtained from Biolog GN2 profiles, demonstrating that similar phage susceptibility patterns occur across broad phylogenetic and physiological differences inVibriostrains. Subsequent culture experiments with two phages and twoV. anguillarumhosts demonstrated an initial strong lytic potential of the phages. However, rapid regrowth of both phage-resistant and phage-sensitive cells following the initial lysis suggested that several mechanisms of protection against phage infection had developed in the host populations.
Elevated CO
2
and Phosphate Limitation Favor Micromonas pusilla through Stimulated Growth and Reduced Viral Impact
Authors: Maat Douwe S. , Crawfurd Katherine J. , Timmermans Klaas R. , Brussaard Corina P. D.
Published: March 2014

Growth and viral infection of the marine picoeukaryote
Micromonas pusilla
was studied under a future-ocean scenario of elevated partial CO
2
(pCO
2
; 750 μatm versus the present-day 370 μatm) and simultaneous limitation of phosphorus (P). Independent of the pCO
2
level, the ratios of
M. pusilla
cellular carbon (C) to nitrogen (N), C:P and N:P, increased with increasing P stress. Furthermore, in the P-limited chemostats at growth rates of 0.32 and 0.97 of the maximum growth rate (μ
max
), the supply of elevated pCO
2
led to an additional rise in cellular C:N and C:P ratios, as well as a 1.4-fold increase in
M. pusilla
abundance. Viral lysis was not affected by pCO
2
, but P limitation led to a 150% prolongation of the latent period (6 to 12 h) and an 80% reduction in viral burst sizes (63 viruses per cell) compared to P-replete conditions (4 to 8 h latent period and burst size of 320). Growth at 0.32 μ
max
further prolonged the latent period by another 150% (12 to 18 h). Thus, enhanced P stress due to climate change-induced strengthened vertical stratification can be expected to lead to reduced and delayed virus production in picoeukaryotes. This effect is tempered, but likely not counteracted, by the increase in cell abundance under elevated pCO
2
. Although the influence of potential P-limitation-relieving factors, such as the uptake of organic P and P utilization during infection, is unclear, our current results suggest that when P limitation prevails in future oceans, picoeukaryotes and grazing will be favored over larger-sized phytoplankton and viral lysis, with increased matter and nutrient flow to higher trophic levels.
Efficient Synthesis of Eriodictyol from
l
-Tyrosine in Escherichia coli
Authors: Zhu Saijie , Wu Junjun , Du Guocheng , Zhou Jingwen , Chen Jian
Published: March 2014

The health benefits of flavonoids for humans are increasingly attracting attention. Because the extraction of high-purity flavonoids from plants presents a major obstacle, interest has emerged in biosynthesizing them using microbial hosts. Eriodictyol is a flavonoid with anti-inflammatory and antioxidant activities. Its efficient synthesis has been hampered by two factors: the poor expression of cytochrome P450 and the low intracellular malonyl coenzyme A (malonyl-CoA) concentration in
Escherichia coli
. To address these issues, a truncated plant P450 flavonoid, flavonoid 3′-hydroxylase (tF3′H), was functionally expressed as a fusion protein with a truncated P450 reductase (tCPR) in
E. coli
. This allowed the engineered
E. coli
to produce eriodictyol from
l
-tyrosine by simultaneously coexpressing the fusion protein with tyrosine ammonia lyase (TAL), 4-coumarate-CoA ligase (4CL), chalcone synthase (CHS), and chalcone isomerase (CHI). In addition, metabolic engineering was employed to enhance the availability of malonyl-CoA so as to achieve a new metabolic balance and rebalance the relative expression of genes to enhance eriodictyol accumulation. This approach made the production of eriodictyol 203% higher than that in the control strain. By using these strategies, the production of eriodictyol from
l
-tyrosine reached 107 mg/liter. The present work offers an approach to the efficient synthesis of other hydroxylated flavonoids from
l
-tyrosine or even glucose in
E. coli
.
Nitrogen Fertilization Has a Stronger Effect on Soil Nitrogen-Fixing Bacterial Communities than Elevated Atmospheric CO
2
Authors: Berthrong Sean T. , Yeager Chris M. , Gallegos-Graves Laverne , Steven Blaire , Eichorst Stephanie A. , Jackson Robert B. , Kuske Cheryl R.
Published: March 2014

Biological nitrogen fixation is the primary supply of N to most ecosystems, yet there is considerable uncertainty about how N-fixing bacteria will respond to global change factors such as increasing atmospheric CO
2
and N deposition. Using the
nifH
gene as a molecular marker, we studied how the community structure of N-fixing soil bacteria from temperate pine, aspen, and sweet gum stands and a brackish tidal marsh responded to multiyear elevated CO
2
conditions. We also examined how N availability, specifically, N fertilization, interacted with elevated CO
2
to affect these communities in the temperate pine forest. Based on data from Sanger sequencing and quantitative PCR, the soil
nifH
composition in the three forest systems was dominated by species in the
Geobacteraceae
and, to a lesser extent,
Alphaproteobacteria
. The N-fixing-bacterial-community structure was subtly altered after 10 or more years of elevated atmospheric CO
2
, and the observed shifts differed in each biome. In the pine forest, N fertilization had a stronger effect on
nifH
community structure than elevated CO
2
and suppressed the diversity and abundance of N-fixing bacteria under elevated atmospheric CO
2
conditions. These results indicate that N-fixing bacteria have complex, interacting responses that will be important for understanding ecosystem productivity in a changing climate.
Distinct Roles of Candida albicans-Specific Genes in Host-Pathogen Interactions
Authors: Wilson Duncan , Mayer François L. , Miramón Pedro , Citiulo Francesco , Slesiona Silvia , Jacobsen Ilse D. , Hube Bernhard
Published: March 2014

Human fungal pathogens are distributed throughout their kingdom, suggesting that pathogenic potential evolved independently.
Candida albicans
is the most virulent member of the CUG clade of yeasts and a common cause of both superficial and invasive infections. We therefore hypothesized that
C. albicans
possesses distinct pathogenicity mechanisms.
In silico
genome subtraction and comparative transcriptional analysis identified a total of 65

C.
a
lbicans

-
s
pecific
g
enes (ASGs) expressed during infection. Phenotypic characterization of six ASG-null mutants demonstrated that these genes are dispensable for
in vitro
growth but play defined roles in host-pathogen interactions. Based on these analyses, we investigated two ASGs in greater detail. An orf19.6688Δ mutant was found to be fully virulent in a mouse model of disseminated candidiasis and to induce higher levels of the proinflammatory cytokine interleukin-1β (IL-1β) following incubation with murine macrophages. A
pga16
Δ mutant, on the other hand, exhibited attenuated virulence. Moreover, we provide evidence that secondary filamentation events (multiple hyphae emerging from a mother cell and hyphal branching) contribute to pathogenicity:
PGA16
deletion did not influence primary hypha formation or extension following contact with epithelial cells; however, multiple hyphae and hyphal branching were strongly reduced. Significantly, these hyphae failed to damage host cells as effectively as the multiple hypha structures formed by wild-type
C. albicans
cells. Together, our data show that species-specific genes of a eukaryotic pathogen can play important roles in pathogenicity.
A Novel ESX-1 Locus Reveals that Surface-Associated ESX-1 Substrates Mediate Virulence in Mycobacterium marinum
Authors: Kennedy George M. , Hooley Gwendolyn C. , Champion Matthew M. , Mba Medie Felix , Champion Patricia A. DiGiuseppe
Published: March 2014

EsxA (ESAT-6) and EsxB (CFP-10) are virulence factors exported by the ESX-1 system in mycobacterial pathogens. In
Mycobacterium marinum
, an established model for ESX-1 secretion in
Mycobacterium tuberculosis
, genes required for ESX-1 export reside at the extended region of difference 1 (RD1) locus. In this study, a novel locus required for ESX-1 export in
M. marinum
was identified outside the RD1 locus. An
M. marinum
strain bearing a transposon-insertion between the
MMAR
_
1663
and
MMAR
_
1664
genes exhibited smooth-colony morphology, was deficient for ESX-1 export, was nonhemolytic, and was attenuated for virulence. Genetic complementation revealed a restoration of colony morphology and a partial restoration of virulence in cell culture models. Yet hemolysis and the export of ESX-1 substrates into the bacteriological medium
in vitro
as measured by both immunoblotting and quantitative proteomics were not restored. We show that genetic complementation of the transposon insertion strain partially restored the translocation of EsxA and EsxB to the mycobacterial cell surface. Our findings indicate that the export of EsxA and EsxB to the cell surface, rather than secretion into the bacteriological medium, correlates with virulence in
M. marinum
. Together, these findings not only expand the known genetic loci required for ESX-1 secretion in
M. marinum
but also provide an explanation for the observed disparity between
in vitro
ESX-1 export and virulence.
All in the Family: Kin Contact Leads to Outer Membrane Exchange
Authors: Hartzell Trish
Published: March 2014

The ability to recognize related cells in a population can confer evolutionary benefits. For example, some bacteria use contact-dependent inhibition proteins to distinguish kin from nonkin. Kinship recognition is taken to a new level in
Myxococcus
, which uses the dual-purpose TraA protein for kin recognition and outer membrane and lipoprotein exchange. In this issue of the
Journal of Bacteriology
, Wei et al. (
X. Wei, C. N. Vassallo, D. T. Pathak, D. Wall, J. Bacteriol. 196:1807–1814, 2014
) show that Tra-dependent exchange can be uncoupled from outer membrane vesicle/tube formation, reported elsewhere to mediate outer membrane exchange.
Spectral Analysis of Heart Rate Variability during Trigger Point Acupuncture
Authors: Kitagawa Yoji , Kimura Kenichi , Yoshida Sohei
Published: March 2014

Objectives

To clarify changes in the cardiovascular autonomic nervous system function due to trigger point acupuncture, we evaluated differences in responses between acupuncture at trigger points and those at other sites using spectral analysis of heart rate variability.

Methods

Subjects were 35 healthy men. Before measurements began the subjects were assigned to a trigger point acupuncture or control group based on the presence/absence of referred pain on applying pressure to a taut band within the right tibialis anterior muscle. The measurements were conducted in a room with a temperature of 25°C, with subjects in a long sitting position after 10 min rest. Acupuncture needles were retained for 10 min at two sites on the right tibialis anterior muscle. ECG was performed simultaneously with measurements of blood pressure and the respiratory cycle. Based on the R–R interval on the ECG, frequency analysis was performed, low-frequency (LF) and high-frequency (HF) components were extracted and the ratio of LF to HF components (LF/HF) was evaluated.

Results

The trigger point acupuncture group showed a transient decrease in heart rate and an increase in the HF component but no significant changes in LF/HF. In the control group, no significant changes were observed in heart rate, the HF component or LF/HF. There were no consistent changes in systolic or diastolic blood pressure in either group.

Conclusions

These data suggest that acupuncture stimulation of trigger points of the tibialis anterior muscle transiently increases parasympathetic nerve activity.
Delayed healing of a navicular stress fracture, following limited weight-bearing activity
Authors: Robinson Matthew , Fulcher Mark
Published: March 2014

This report describes a 21-year-old man, a semiprofessional football (soccer) player, with a navicular stress fracture. It highlights the difficulty in diagnosing the condition and the complications arising from inadequate management. The case discusses the optimal management of these stress fractures and the detrimental role of weight-bearing recovery. The diagnosis of navicular stress fractures is challenging, and a high index of suspicion is required. The available literature indicates that limited weightbearing is not an appropriate treatment for navicular stress injuries. Non-weight-bearing (NWB) cast immobilisation for 6–8 weeks appears to be the gold standard treatment; however, open reduction with internal fixation (ORIF) has similar success rates and an equal return-to-play time but should also be followed by a period of NWB. NWB cast immobilisation for 6 weeks remains a good second option at any time following failed limited weight-bearing activity.
Managing the health of the elite athlete: a new integrated performance health management and coaching model
Authors: Dijkstra H Paul , Pollock N , Chakraverty R , Alonso J M
Published: March 2014

Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.
MUSCLE LATENCIES IN HEALTHY AND FUNCTIONALLY UNSTABLE PARTICIPANTS FOLLOWING A SIMULATED ANKLE SPRAIN
Authors: Gautrey C , Watson T , Mitchell A
Published: March 2014

Background

Functional ankle instability (FAI) is a common pathology in sport which exhibits debilitating residual symptoms. In relation to FAI, many studies have investigated muscle latencies of the peroneus longus and tibialis anterior muscles; however, there is limited research on the gluteus medius muscle which provides stability in the frontal plane. Weakness in the gluteus medius may produce deviations in joint motion, a subsequent loss of stability and may contribute towards a repeated injury at the ankle.

Objective

To determine whether FAI participants suffer from a neuromuscular deficit compared to healthy controls, as measured by muscle latency following a simulated ankle sprain mechanism.

Design

Cross-sectional study.

Setting

University biomechanics laboratory. Participants played at a semi-professional level of soccer.

Participants

A convenience sample was used to recruit twenty males with unilateral FAI and twenty male healthy controls. Inclusion criteria included males, aged 18–25 years, who participated in semi-professional soccer and who were right leg dominant.

Intervention

Three perturbations on a standing tilt platform simulating the mechanics of an inversion and plantar-flexion ankle sprain. Subject group was the independent variable.

Main outcome measure

Muscle latency in milliseconds of the peroneus longus, tibialis anterior and gluteus medius to the tilt platform perturbation.

Results

The results indicated that there was a significant (P<.0125) delay in muscle latency of the peroneus longus, tibialis anterior and gluteus medius when comparing the unstable and stable ankle of the FAI group to the dominant and non-dominant ankle of the healthy group.

Conclusion

Muscle latency was delayed in both the unstable and stable ankle of the FAI participants, which would suggest a central mechanism of control, or possibly a genetic predisposition to FAI. Rehabilitation prescribed by sports clinicians should focus on both limbs in functionally unstable individuals, as well as more proximal musculature such as the gluteus medius.
FROM INJURY TO THE PARALYMPIC PODIUM – A CASE STUDY OF A CROSS-COUNTRY SKIING CHAMPION IN 10-YEAR FOLLOW-UP
Authors: Gawronski W
Published: March 2014

Background

A rare case of systematic comprehensive assessment of endurance abilities of a multiple Paralympic medalist.

Objective

To assess the morpho-functional abilities and health condition of a multiple Paralympic medalist and to design a comprehensive assessment model based on the changes in physical endurance and health condition in the context of the athlete's disability and relating to the systematic physical training.

Design

Ten-year follow-up.

Setting

Paralympic Games in 2002, 2006 and 2010 and the relevant preparatory periods.

Participant

A disabled cross-country skier who competed in three consecutive PGs (2002, 2006, 2010). At the age of four, the athlete lost both her upper limbs in a farming accident. She is planning to compete for the fourth time in 2014.

Risk factor assessment

None.

Main outcome measurements

Endurance was assessed with the cycloergometer test. Measurements included: lung minute ventilation (VE), oxygen consumption (VO2), carbon dioxide volume (VCO2), heart rate (HR), maximal oxygen uptake (VO2max) and lactate threshold (LAT).

Results

There was a gradual increase in the athlete's endurance capacity, reaching the optimal value just before PG. The comparison of all results demonstrates their sinusoidal character - HR: 175-188-185 in 2002; 187-192-188 in 2006, and 189-184-180 in 2010; VO2, ml/kg: 40.20-47.00-51.30 in 2002, 51.78-45.50-51.30 in 2006 and 36.1-51.30-53.8 in 2010; VE, l: 74.9-90.5-90.0 in 2002, 95.0-99.6-107.4 in 2006 and 67.6-95.9-104.5 in 2010.

Conclusions

Test results depended on the training-related level of endurance at particular points of the follow-up and the general health condition. The increase in endurance parameters shortly before PGs reflects the peak fitness level. The obtained results facilitated a precise analysis of the athlete's adaptation mechanisms. As a result, optimal training was offered, leading to the Paralympic podium three times.
PREVENTING ADVERSE CONCUSSION OUTCOMES: THE ONLINE CONCUSSION AWARENESS TRAINING TOOLKIT (CATT)
Authors: Babul S , Korn P , Goldman R , Pike I , Hay C
Published: March 2014

Background

Concussion recognition, treatment and management is crucial in supporting recovery and decreasing the risk of long-term brain damage. Long-term effects are often not recognized early enough to prevent post-concussion syndrome, resulting in an impact on social and professional lives. The need to standardize care is vital in preventing adverse concussion outcomes.

Objective

To determine if concussion knowledge, attitudes and practices (KAP) are significantly improved among physicians and nurses following completion of CATT.

Design

A pre/post-intervention questionnaire designed to measure changes in physician/nurse KAP.

Setting

Primary setting was hospital emergency departments in the Lower Mainland, British Columbia.

Participants

Physicians/nurses working in emergency departments/trauma care facilities.

Intervention

Based upon established international principles, CATT is an online toolkit (www.cattonline.com) providing learner-directed concussion awareness training for health practitioners as well as assessment resources (SCAT3, Child-SCAT3), links to clinical resources, patient handouts, journal articles (including the Zurich Consensus Statement), related websites, concussion videos and study cases.

Main outcome measures

Change in physician/nurse knowledge, attitudes and practices regarding concussion recognition, treatment and management.

Results

44 physicians and 35 nurses were recruited. Post-intervention questionnaires were completed by 34 physicians (77.3%) and 25 nurses (71.4%). Physicians demonstrated a statistically significant positive change in concussion practices (P=.001). Change in physician knowledge was not significant, while attitudes had a negative change (P=.041). Positive change in physician knowledge was detected for those who typically see more than 10 concussions per year (P=.039). Nurses demonstrated statistically significant positive change in practices (P=.005) and attitudes (P=.035), but no change in knowledge.

Conclusions

CATT is effective in improving concussion knowledge and practices among physicians and nurses, which will potentially minimize adverse concussion outcomes and lower health care costs among concussion patients. Phase 2 includes a toolkit for Parents, Players and Coaches, currently undergoing an evaluation with sporting associations in BC.
THE INCIDENCE OF SUDDEN CARDIAC ARREST AND DEATH IN UNITED STATES HIGH SCHOOL ATHLETES
Authors: Harmon K , Asif I , Ellenbogen R , Drezner J
Published: March 2014

Background

Traditional estimates of SCD incidence in US high school athletes 1 athlete death per 200 000–400 000 athlete-years.

Objective

To investigate the rate of SCA/SCD in high school athletes through search of media reports.

Design

Retrospective review of the Parent Heart Watch database generated from systematic search of media reports. Each case was reviewed to confirm high school athletic team participation, sex, sport, and if the arrest occurred during exertion and at a school-sponsored activity. Sport participation numbers were available from the National Federation of State High School Associations.

Setting

United States.

Participants

19 433 431 high school athletes (age 14-18) in 6 US states from 2007–2013.

Interventions

None.

Main outcome measurements

Incidence of SCA/SCD.

Results

The 6 states studied represented 36% of the high school athlete population in the US. During the study period, there were 109 overall SCAs, including 74 SCDs and 35 SCAs who survived. 91% of the SCAs occurred in male athletes. The overall SCA incidence in high school athletes was 1 in 63 988 athlete-years. The rate of SCA in males was 1 in 41 662 and in females 1 in 285 012 athlete-years. 83% of cases occurred during exertion and only 59% of events occurred while participating on a school sponsored team. 34 events occurred in male basketball players. The rate of SCA in male basketball players was 1 in 33 815 athlete-years.

Conclusions

SCA/SCD rates in US high school athletes are significantly greater than previously reported, and disproportionately high in male basketball players, similar to collegiate athletes. These numbers represent low estimates as media reports have been shown to miss nearly 50% of cases. Accurate reporting mechanisms are needed in the US to define incidence and etiology of SCA. Current screening strategies in US high school athletes do not prevent SCA in many athletes, and alternative screening strategies should be considered, especially in high risk groups.
SIX WEEKS OF CORE STABILITY TRAINING REDUCES PEAK LANDING FORCE AMONG FEMALE CAPOEIRA ATHLETES
Authors: Hayes L , Araujo S , Cohen D
Published: March 2014

Background

Core stability training (CST) has increased in popularity among athletes and the general fitness population and is promoted as a means to reduce injury risk. In female athletes, an intervention combining CST and balance training reduced peak landing forces, a risk factor for anterior cruciate ligament (ACL) injuries. Less is known about the isolated effect on landing forces of a CST program comprised of a substantial proportion of static exercises.

Objective

To evaluate changes in peak landing force in a drop box jump test following a six week CST intervention.

Design

Intervention study.

Setting

Well trained Capoeira athletes.

Participants

16 female athletes aged 27.3±3.7 years.

Interventions

Three isometric and three dynamic core stability exercises completed 3 times/week for 6 weeks.

Main Outcome Measurements

Peak landing forces during a drop jump pre- versus post-intervention.

Results

Peak landing force significantly decreased from pre- to post-intervention (2943±552 N vs. 1714±235 N respectively [P<.001]). There was no significant change in body mass or jump height during the intervention (P=.528 and P=.877 respectively).

Conclusions

This study shows that in well-trained female athletes, the addition of a core stability training program that includes a substantial proportion of isometric exercises can reduce landing forces. High landing forces are associated with increased risk of ACL injuries and CST may therefore contribute to injury risk reduction in high risk athletes.
INJURIES IN GERMAN CLUB SPORTS – 1987 TO 2012
Authors: Henke T , Luig P , Schulz D
Published: March 2014

Background

In Germany 26 million citizens, almost 30% of the total population, are registered in sports clubs. Nowadays, sport as part of a healthy and physically active lifestyle is virtually accepted as medicine against widespread diseases. The positive effects of sports on wellbeing and health are undoubted. However, about 2 million sports injuries occur annually. 700,000 of these result from club sports.

Objective

To describe and analyse the epidemiology of sports injuries and to identify focal areas for sports injury prevention programmes on the basis of 25 years of injury surveillance data for German club sports.

Design

Retrospective longitudinal study with questionnaire-based injury registration. Since 1987 a database of more than 200 000 sports injuries has been established. Athletes that report a sports accident to the ARAG sports insurance are asked to complete an anonymized questionnaire on the accident, injury, treatment and sports behaviour.

Setting

Non-professional club sports participants.

Results

75% of the injuries are registered in soccer, handball, basketball and volleyball, although only 30% of all sports club members are organized in these sports. The number of women's soccer injuries has risen from 7% to 15%. Ankle injuries have decreased from 30% to 19%, whereas the rate of knee injuries has increased slightly from 17% to 21%. Days of disability have dropped steadily since the 1990s, whereas inpatient hospital days have doubled from 5 to 10 days. The share of injuries that need surgery increased from 30% to 40%. Injuries to the knee, lower leg and upper arm have the highest surgery rate, indicating more serious injuries here.

Conclusion

Team sports are a clear focal area for injury prevention, in particular as the number of female participants in these sports has dramatically increased since 1987. For tailoring the prevention measures more specific to the target groups the following differentiation of prevention approaches is useful: Training & Physical Preparation, Technical & Political Approaches, Equipment & Facilities, Medical & Non-medical Support.
MRI FINDINGS IN THE SHOULDER OF COMPLETELY ASYMPTOMATIC ADOLESCENT ELITE TENNIS PLAYERS
Authors: Johansson F , DeBri E , Swärdh L , Cools A , Adolfsson A , Jenner G , Skillgate E
Published: March 2014

Background

Shoulder pathology in adult tennis players including rotator cuff pathology is well known. However, early adaptations have not previously been studied in the adolescent elite tennis players.

Objectives

To describe magnetic resonance imaging (MRI) findings in the shoulder in asymptomatic elite adolescent tennis players.

Design

A MRI scan using a 3 Tesla scanner of both shoulders were performed. PD (proton density) weighted images with fat-saturation in oblique coronal, oblique sagittal and axial planes together with oblique sagittal T2 images were reviewed especially for the presence of abnormalities regarding labral lesions and rotator-cuff lesions by two radiologists in consensus. The MRI scans were evaluated by to independent experienced radiologists in a blinded manner according to a pre-defined protocol. Data were collected retrospectively for the dominant arm and contralateral arm respectively. Statistical analyses were performed using SPSS software.

Setting

Testing environment at Medical Rontgen, Sweden.

Participants

35 adolescent elite tennis players from the Swedish national team were selected (ages 13–24 years median age 17). 15 boys and 20 girls participated in the study.

Intervention

Findings were described according to a predefined protocol.

Main outcome measurements

MRI findings of the dominant and non-dominant shoulder.

Results

19 players (54%) had a normal MRI examination and 16 players (46%) had abnormal findings of which 14 players showed affected tendons/tendinosis. The predominant findings were made in infraspinatus (n=10), Supraspinatus (n=5) and Subscapularis (n=1). Two players had findings in both infra- and supraspinatus.

Conclusions

This is the first study describing MRI findings in adolescent elite tennis players, revealing infraspinatus and supraspinatus affected tendons/tendinosis in this asymptomatic overhead athletic population. The results can serve as the baseline for a future prospective longitudinal cohort study.
ISOKINETIC MUSCLE PERFORMANCE IN MALE PROFESSIONAL HANDBALL PLAYERS
Authors: Kaczmarek P , Lubiatowski P , Cisowski P , Dudzinski W , Grygorowicz M , Dzianach M , Romanowski L
Published: March 2014

Background

Muscle strength and endurance of the shoulder rotators is important for overhead throwing performance and dynamic glenohumeral stability. Isokinetic assessment of shoulder internal and external rotators is commonly used by clinicians to assess muscle performance.

Objective

To evaluate the external (ER) and internal rotator (IR) muscles isokinetic peak torque, total work and strength ratios in handball players.

Design

Prospective study with control group and descriptive analysis.

Setting

Elite division handball players.

Participants

The pilot studies included 48 professional handball players of average age 24.0 (±4.5 years), height 187.1 (±5.9) and weight 9.0 (±11.6).

Interventions

Isokinetic tests were performed concentrically at 180 and 270 deg/s using Biodex System 3 PRO in standard sitting position.

Main outcome measurements

Isokinetic peak torque, total work and strength ratios.

Results:

The differences between the athletes and controls regarding the peak torque at 180 deg/s and total work at 270 deg/s of the ER and IR muscles for dominant and non dominant shoulder were statistically significant. The control group presented higher ratios (D 85.8±26.9; ND 82.8±23.4) than handball players (D 65.4±13.3; ND 63.0±16.0)–differences were statistically significant. There were statistical differences between dominant and non dominant shoulder in both group for total work of the ER muscles. There were no statistical differences between dominant and non dominant shoulder in both group for peak torque of the ER and IR muscles.

Conclusions

Handball players present higher isokinetic parameters comparing to normal population. The study establishes additional normative data on ER and IR muscle torque and total work on high-level male handball players.
REFERENT BODY WEIGHT VALUES IN OVER GROUND WALKING, OVER GROUND JOGGING, TREADMILL JOGGING, AND ELLIPTICAL EXERCISE
Authors: Kaplan Y , Witvrouw E , Nyska M , Palmanovich E , Barak Y
Published: March 2014

Background

In order to make reliable clinical decisions in relation to when injured or surgically operated athletes may return to daily functional and weight-bearing sporting activities, there is a need to establish referent average weight-bearing values in common sporting activities.

Objectives

To evaluate average percentage body weight (APBW) values and weight-bearing distribution percentages (WBDP) between sports activities in a referent adult population, and to suggest clinical implications.

Design

Original research study.

Setting

Lerner Sports Center, Hebrew University, Mount Scopus, Jerusalem, Israel.

Participants

75 asymptomatic volunteers, mean age=33.5(19–72) years SD=15.1, mean weight (kg)=70.7 (43–113) SD=14.1.

Interventions

4 tests were conducted: 1. Overground walking (OGW) over a 20m distance, 2. Overground jogging (OGJ) over a 20m distance, 3.Treadmill jogging (TJ) at a constant speed of 8.5 km/hr for a 15-second interval and 4. Elliptical exercise (EE) for a 20 second period at a resistance and incline level of 10, and a steady pace within the range of 70–95 steps/min.

Main outcome measure

The Smartstep™ weight-bearing gait analysis system.

Results

The APBW value on the entire foot in OGW was 112% (SD=15.57), in OGJ, 201% (SD=31.24, in TJ, 175% (SD=25.48) and in EE, 73% (SD=13.8). Regarding WBDP, the swing phase in OGJ and TJ was significantly longer than the stance phase (P<.05).

Conclusions

EE significantly reduces weight-bearing as compared to other common functional and sporting activities. This information is also useful from a repetitive loading standpoint (to prevent overuse injury) or for exercise recommendations for those at greater risk for exacerbating chronic joint pathology.
REASONS FOR INABILITY TO COMPLETE ULTRAMARATHONS: A MULTICENTER STUDY
Authors: Khodaee M , Spittler J , Basset P , Vanbaak K , Hill JC , San Millán I , Hoffman MD
Published: March 2014

Background

Despite increased ultramarathon participation in recent years, little is known about causes of race incompletion. This study surveyed runners of three 161–168 km ultramarathons in Europe and North America to explore characteristics and issues that affected race performance.

Objective

Determine human and environmental factors related to failure to complete ultramarathons of ∼161 km in the previous year.

Design

Observational study using surveys prior to the race.

Setting

The 2013 Ultra-Trail du Mont-Blanc®(UTMB®) in Europe; Leadville Trail 100 (LT100) and Western States Endurance Run (WSER) in North America.

Participants

Out of 4 110 race entrants, 2 794 (69%) completed the pre-race survey.

Risk factor assessment

In this epidemiologic study, we report the incidence of intrinsic and extrinsic factors related to failure to finish of at least one ∼161 km race in the previous year.

Main outcome measurements

The main outcome measurements were self-reported reasons for not finishing the race.

Results

Among respondents, about 30% had masters or higher degrees. Out of 2,469 UTMB®, 1206 LT 100, and 408 WSER entrants, the majority successfully completed the race (68%, 52% and 72%, respectively). Among participants who responded, 18.3% reported they failed to complete an ultramarathon of ∼161km in the past year. The main reasons for dropping out were inability to make the cut off time (23.1%), nausea and/or vomiting (16.5%), injury during the race (16.5%), and an ongoing injury (13.3%).

Conclusions

We conclude that primary performance-limiting issues in 161–168 km ultramarathons include inability to make the cut off time, nausea and/or vomiting, and injury before and during the race.
INJURIES AND RISK FACTORS IN PHYSICAL EDUCATION STUDENTS
Authors: van Beijsterveldt AM , Bliekendaal S , Brink M , Stubbe J
Published: March 2014

Background

Sports injuries are highly disadvantageous for Physical Education (PE) students, because they can lead to physical discomfort, and absence from sports classes resulting in higher study career costs.

Objective

To investigate the magnitude of the injury problem in PE students and to explore risk factors for sustaining an injury.

Design

A prospective cohort study with six months follow up.

Participants and setting

280 Dutch freshmen PE students.

Assessment of risk factors

Prior to the start of the school year, all students underwent a medical examination to assess height, weight, percentage of body fat, blood pressure, visual acuity, muscle-skeletal functioning, and cardio-respiratory endurance. During the six months follow up, an online questionnaire was conducted on a weekly basis to monitor injuries and illnesses (OSTRC Overuse Injury Questionnaire). Furthermore, every two weeks an online questionnaire (POMS and RESTQ-Sports) was administered to measure mood and perceived stress and recovery of the students.

Main outcome measures

Frequencies and characteristics of injuries and illnesses.

Results

According to the OSTRC Overuse Injury Questionnaire, 22.5% of the students had physical problems regarding injuries during the first month of the school year, and 11.2% of the students were ill. Data collection will end in February 2014. We will perform a logistic regression analysis to test whether the injured students differ significantly from non injured students based on characteristics such as age, sex, body composition, and muscle-skeletal functioning.

Conclusions

Preliminary results showed that the risk of sustaining an injury and becoming ill is high for freshmen PE students. Screening at the start of the school year may play an important role in identifying the students at risk.
DID “ZERO TOLERANCE FOR HEAD CONTACT” RULE ENFORCEMENT CHANGE THE RISK OF GAME RELATED CONCUSSIONS IN YOUTH ICE HOCKEY PLAYERS?
Authors: Krolikowski M , Black A , Kang J , Emery C
Published: March 2014

Background

Ice hockey is a popular winter sport in Canada. Concussion accounts for the greatest proportion of all injuries in youth ice hockey. Research has informed policy change enforcing the no head contact rule in all leagues in Canada in 2011.

Objective

To determine if the risk of game-related concussion and other injury differ for Pee Wee (ages 11–12) and Bantam (ages 13–14) players following a 2011 rule enforcement policy change compared to players in similar divisions prior to the rule change.

Design

Historical cohort study.

Setting

Ice hockey rinks.

Participants

Historical cohort included Pee Wee (most elite 70%, 2007/08) (n=891) and Bantam (most elite 30%, 2008/09) (n=378) players before the rule change and Pee Wee (2011/12) (n=589) and Bantam (2011/12) (n=244) players in the same levels of play after the policy change.

Risk factor assessment

Exposure of ice hockey teams before and after a “zero tolerance for head contact” rule enforcement policy change. Risk factors include position, and previous injury/concussion.

Main outcome measurements

Suspected concussions were identified by a team designate (Pee Wee) or team therapist (Bantam) and referred to a sport medicine physician. Hockey injuries included those requiring medical attention and/or time loss.

Results

Based on multivariate Poisson Regression (adjusted for cluster, exposure hours, position and previous injury/concussion) the risk of game-related concussion increased following the head contact rule enforcement change in Pee Wee (IRR=1.83 [95% CI; 1.18–2.86]) and Bantam (IRR=2.74 [95% CI; 1.41–5.32]). The risk of injury (excluding concussion) did not change in Bantam (IRR=1.03 [95% CI; 0.59–1.81]).

Conclusions

The “zero tolerance for head contact or head checks” rule change did not reduce game-related concussion risk in Pee Wee or Bantam ice hockey players. This study will inform future research examining mechanism of injury leading to concussions in youth ice hockey.