bluuebunny/crossref_metadata_2025 huggingface dataset:
Sepsis with an Atopobium-Like Species in a Patient with Fournier's Gangrene
Authors: Oyaert Matthijs , Cools Piet , Breyne Joke , Heyvaert Gert , Vandewiele Anne , Vaneechoutte Mario , Vervaeke Steven , De Laere Emmanuel
Published: October 2013

Atopobium
species are Gram-positive, anaerobic, catalase-negative, fastidious bacteria belonging to the family
Coriobacteriaceae
. We report the isolation of an
Atopobium
-like species in a patient with Fournier's gangrene and highlight the role of 16S rRNA gene sequencing in the identification of fastidious organisms in the clinical laboratory.
Clinical Evaluation of BioPlex 2200 HIV Ag-Ab, an Automated Screening Method Providing Discrete Detection of HIV-1 p24 Antigen, HIV-1 Antibody, and HIV-2 Antibody
Authors: Salmona Maud , Delarue Severine , Delaugerre Constance , Simon François , Maylin Sarah
Published: October 2013

Early and accurate diagnosis is essential for optimal therapeutic outcomes in patients infected with HIV. Currently, none of the commercially available fourth-generation assays differentiate HIV-1 and HIV-2 antibodies (Ab) or the HIV-1 p24 antigen (Ag). The aim of this study was to evaluate the performance of a novel assay, the BioPlex 2200 HIV Ag-Ab. This assay uses a multiplex flow immunoassay design allowing the simultaneous detection and identification of antibodies to HIV-1 (groups M and O), HIV-2, and the HIV-1 p24 antigen, in addition to providing a traditional composite result. A total of 1,505 routine serum samples were prospectively tested. Results were compared with those from the Architect HIV Combo assay. The sensitivity of the BioPlex 2200 was 100%. The specificity assessed on repeated false-positive samples was 99.5%. In addition, 524 frozen specimens from patients known to be infected with HIV-1 or HIV-2 were tested. Of these specimens, 420 were infected with HIV-1, including 156 of known genotypes, 86 were infected with HIV-2, 7 were infected with HIV-1 and HIV-2, and 11 were from patients with acute HIV infection. Sensitivity was 100% for the HIV genotypes tested. The differentiation capabilities of the BioPlex 2200 HIV Ag-Ab assay for HIV-1, HIV-2, dual HIV-1/HIV-2, and early infections were 100%, 90.7%, 100%, and 90.9%, respectively. The BioPlex 2200 is a sensitive and specific assay that offers advantages over conventional HIV combo assays, also referred to as fourth-generation assays, to accurately differentiate and report HIV-1 p24 antigen and HIV-1 and HIV-2 antibodies.
Newly Emerging Mutations in the Matrix Genes of the Human Influenza A(H1N1)pdm09 and A(H3N2) Viruses Reduce the Detection Sensitivity of Real-Time Reverse Transcription-PCR
Authors: Yang Ji-Rong , Kuo Chuan-Yi , Huang Hsiang-Yi , Wu Fu-Ting , Huang Yi-Lung , Cheng Chieh-Yu , Su Yu-Ting , Chang Feng-Yee , Wu Ho-Sheng , Liu Ming-Tsan
Published: October 2013

New variants of the influenza A(H1N1)pdm09 and A(H3N2) viruses were detected in Taiwan between 2012 and 2013. Some of these variants were not detected in clinical specimens using a common real-time reverse transcription-PCR (RT-PCR) assay that targeted the conserved regions of the viral matrix (M) genes. An analysis of the M gene sequences of the new variants revealed that several newly emerging mutations were located in the regions where the primers or probes of the real-time RT-PCR assay bind; these included three mutations (G225A, T228C, and G238A) in the A(H1N1)pdm09 virus, as well as one mutation (C163T) in the A(H3N2) virus. These accumulated mismatch mutations, together with the previously identified C154T mutation of the A(H1N1)pdm09 virus and the C153T and G189T mutations of the A(H3N2) virus, result in a reduced detection sensitivity for the real-time RT-PCR assay. To overcome the loss of assay sensitivity due to mismatch mutations, we established a real-time RT-PCR assay using degenerate nucleotide bases in both the primers and probe and successfully increased the sensitivity of the assay to detect circulating variants of the human influenza A viruses. Our observations highlight the importance of the simultaneous use of different gene-targeting real-time RT-PCR assays for the clinical diagnosis of influenza.
An Unusual Case of Acute Cystitis Associated with Mixed Flora in Voided Urine in an Adult Male
Authors: Kunin Calvin M.
Published: October 2013

This report describes two episodes of acute cystitis associated with “mixed flora” in an elderly male following a cystoscopy. The initial episode was accompanied by pyuria and a positive nitrite test. Both episodes responded to treatment with nitrofurantoin. Urine cultures were negative prior to the episodes and at a 1-year follow-up.
Evolution of the Influenza A Virus Genome during Development of Oseltamivir ResistanceIn Vitro
Authors: Renzette Nicholas , Caffrey Daniel R. , Zeldovich Konstantin B. , Liu Ping , Gallagher Glen R. , Aiello Daniel , Porter Alyssa J. , Kurt-Jones Evelyn A. , Bolon Daniel N. , Poh Yu-Ping , Jensen Jeffrey D. , Schiffer Celia A. , Kowalik Timothy F. , Finberg Robert W. , Wang Jennifer P.
Published: October 2013

Influenza A virus (IAV) is a major cause of morbidity and mortality throughout the world. Current antiviral therapies include oseltamivir, a neuraminidase inhibitor that prevents the release of nascent viral particles from infected cells. However, the IAV genome can evolve rapidly, and oseltamivir resistance mutations have been detected in numerous clinical samples. Using anin vitroevolution platform and whole-genome population sequencing, we investigated the population genomics of IAV during the development of oseltamivir resistance. Strain A/Brisbane/59/2007 (H1N1) was grown in Madin-Darby canine kidney cells with or without escalating concentrations of oseltamivir over serial passages. Following drug treatment, the H274Y resistance mutation fixed reproducibly within the population. The presence of the H274Y mutation in the viral population, at either a low or a high frequency, led to measurable changes in the neuraminidase inhibition assay. Surprisingly, fixation of the resistance mutation was not accompanied by alterations of viral population diversity or differentiation, and oseltamivir did not alter the selective environment. While the neighboring K248E mutation was also a target of positive selection prior to H274Y fixation, H274Y was the primary beneficial mutation in the population. In addition, once evolved, the H274Y mutation persisted after the withdrawal of the drug, even when not fixed in viral populations. We conclude that only selection of H274Y is required for oseltamivir resistance and that H274Y is not deleterious in the absence of the drug. These collective results could offer an explanation for the recent reproducible rise in oseltamivir resistance in seasonal H1N1 IAV strains in humans.
Differential Accessibility of a Rotavirus VP6 Epitope in Trimers Comprising Type I, II, or III Channels as Revealed by Binding of a Human Rotavirus VP6-Specific Antibody
Authors: Aiyegbo Mohammed S. , Eli Ilyas M. , Spiller Benjamin W. , Williams Dewight R. , Kim Robert , Lee David E. , Liu Tong , Li Sheng , Stewart Phoebe L. , Crowe James E.
Published: October 2013

Previous human antibody studies have shown that the human V
H
1–46 antibody variable gene segment encodes much of the naturally occurring human B cell response to rotavirus and is directed to virus protein 6 (VP6). It is currently unknown why some of the V
H
1-46-encoded human VP6 monoclonal antibodies inhibit viral transcription while others do not. In part, there are affinity differences between antibodies that likely affect inhibitory activity, but we also hypothesize that there are differing modes of binding to VP6 that affect the ability to block the transcriptional pore on double-layered particles. Here, we used a hybrid method approach for antibody epitope mapping, including single-particle cryo-electron microscopy (cryo-EM) and enhanced amide hydrogen-deuterium exchange mass spectrometry (DXMS) to determine the location and mode of binding of a V
H
1-46-encoded antibody, RV6-25. The structure of the RV6-25 antibody–double-layered particle (DLP) complex indicated a very complex binding pattern that revealed subtle differences in accessibility of the VP6 epitope depending on its position in the type I, II, or III channels. These subtle variations in the presentation or accessibility of the RV VP6 capsid layer led to position-specific differences in occupancy for binding of the RV6-25 antibody. The studies also showed that the location of binding of the noninhibitory antibody RV6-25 on the apical surface of RV VP6 head domain does not obstruct the transcription pore upon antibody binding, in contrast to binding of an inhibitory antibody, RV6-26, deeper in the transcriptional pore.
Human Plasmacytoid Dendritic Cells Sense Lymphocytic Choriomeningitis Virus-Infected Cells
In Vitro
Authors: Wieland S. F. , Takahashi K. , Boyd B. , Whitten-Bauer C. , Ngo N. , de la Torre J.-C. , Chisari F. V.
Published: October 2013

We previously reported that exosomal transfer of hepatitis C virus (HCV) positive-strand RNA from human Huh-7 hepatoma cells to human plasmacytoid dendritic cells (pDCs) triggers pDC alpha/beta interferon (IFN-α/β) production in a Toll-like receptor 7 (TLR7)-dependent, virus-independent manner. Here we show that human pDCs are also activated by a TLR7-dependent, virus-independent, exosomal RNA transfer mechanism by human and mouse hepatoma and nonhepatoma cells that replicate the negative-strand lymphocytic choriomeningitis virus (LCMV).
NF-κB Activation Coordinated by IKKβ and IKKε Enables Latent Infection of Kaposi's Sarcoma-Associated Herpesvirus
Authors: He Zhiheng , Zhao Jun , Zhang Junjie , Jung Jae U. , Feng Pinghui
Published: October 2013

All herpesviruses share a remarkable propensity to establish latent infection. Human Kaposi's sarcoma-associated herpesvirus (KSHV) effectively enters latency after
de novo
infection, suggesting that KSHV has evolved with strategies to facilitate latent infection. NF-κB activation is imperative for latent infection of gammaherpesviruses. However, how NF-κB is activated during
de novo
herpesvirus infection is not fully understood. Here, we report that KSHV infection activates the inhibitor of κB kinase β (IKKβ) and the IKK-related kinase epsilon (IKKε) to enable host NF-κB activation and KSHV latent infection. Specifically, KSHV infection activated IKKβ and IKKε that were crucial for latent infection. Knockdown of IKKβ and IKKε caused aberrant lytic gene expression and impaired KSHV latent infection. Biochemical and genetic experiments identified RelA as a key player downstream of IKKβ and IKKε. Remarkably, IKKβ and IKKε were essential for phosphorylation of S
536
and S
468
of RelA, respectively. Phosphorylation of RelA S
536
was required for phosphorylation of S
468
, which activated NF-κB and promoted KSHV latent infection. Expression of the phosphorylation-resistant RelA S
536
A increased KSHV lytic gene expression and impaired latent infection. Our findings uncover a scheme wherein NF-κB activation is coordinated by IKKβ and IKKε, which sequentially phosphorylate RelA in a site-specific manner to enable latent infection after KSHV
de novo
infection.
Minimal Features of Efficient Incorporation of the Hemagglutinin-Neuraminidase Protein into Sendai Virus Particles
Authors: Essaidi-Laziosi Manel , Shevtsova Anastasia S. , Roux Laurent
Published: October 2013

Two transmembrane glycoproteins form spikes on the surface of Sendai virus, a member of the
Respirovirus
genus of the
Paramyxovirinae
subfamily of the
Paramyxoviridae
family: the hemagglutinin-neuraminidase (HN) and the fusion (F) proteins. HN, in contrast to F, is dispensable for viral particle production, as normal amounts of particles can be produced with highly reduced levels of HN. This HN reduction can result from mutation of an SYWST motif in its cytoplasmic tail to AFYKD. HN
AFYKD
accumulates at the infected cell surface but does not get incorporated into particles. In this work, we derived experimental tools to rescue HN
AFYKD
incorporation. We found that coexpression of a truncated HN harboring the wild-type cytoplasmic tail, the transmembrane domain, and at most 80 amino acids of the ectodomain was sufficient to complement defective HN
AFYKD
incorporation into particles. This relied on formation of disulfide-bound heterodimers carried out by the two cysteines present in the HN 80-amino-acid (aa) ectodomain. Finally, the replacement of the measles virus H cytoplasmic and transmembrane domains with the corresponding HN domains promoted measles virus H incorporation in Sendai virus particles.
Mobilization of Circulating Endothelial Progenitor Cells Correlates with the Clinical Course of Hantavirus Disease
Authors: Krautkrämer Ellen , Grouls Stephan , Hettwer David , Rafat Neysan , Tönshoff Burkhard , Zeier Martin
Published: October 2013

Infections with hemorrhagic fever viruses are characterized by increased permeability leading to capillary leakage. Hantavirus infection is associated with endothelial dysfunction, and the clinical course is related to the degree of vascular injury. Circulating endothelial progenitor cells (cEPCs) play a pivotal role in the repair of the damaged endothelium. Therefore, we analyzed the number of cEPCs and their mobilizing growth factors in patients suffering from hantavirus disease induced by infection with
Puumala virus
. The numbers of EPCs of 36 hantavirus-infected patients and age- and gender-matched healthy controls were analyzed by flow cytometry. Concentrations of cEPC-mobilizing growth factors in plasma were determined by enzyme-linked immunosorbent assay. Laboratory parameters were correlated with the number of cEPCs. In patients infected with hantavirus, the number of cEPCs was significantly higher than that in healthy controls. Levels of mobilizing cytokines were upregulated in patients, and the mobilization of cEPCs is paralleled with the normalization of clinical parameters. Moreover, higher levels of cEPCs correlated with higher serum albumin levels and platelet concentrations. Our data indicate that cEPCs may play a role in the repair of hantavirus-induced endothelial damage, thereby influencing the clinical course and the severity of symptoms.
Nonmuscle Myosin Heavy Chain IIA Is a Critical Factor Contributing to the Efficiency of Early Infection of Severe Fever with Thrombocytopenia Syndrome Virus
Authors: Sun Yinyan , Qi Yonghe , Liu Chenxuan , Gao Wenqing , Chen Pan , Fu Liran , Peng Bo , Wang Haimin , Jing Zhiyi , Zhong Guocai , Li Wenhui
Published: October 2013

Severe fever with thrombocytopenia syndrome virus (SFTSV) is a novel phlebovirus in the
Bunyaviridae
family. Most patients infected by SFTSV present with fever and thrombocytopenia, and up to 30% die due to multiple-organ dysfunction. The mechanisms by which SFTSV enters multiple cell types are unknown. SFTSV contains two species of envelope glycoproteins, Gn (44.2 kDa) and Gc (56 kDa), both of which are encoded by the M segment and are cleaved from a precursor polypeptide (about 116 kDa) in the endoplasmic reticulum (ER). Gn fused with an immunoglobulin Fc tag at its C terminus (Gn-Fc) bound to multiple cells susceptible to the infection of SFTSV and blocked viral infection of human umbilical vein endothelial cells (HUVECs). Immunoprecipitation assays following mass spectrometry analysis showed that Gn binds to nonmuscle myosin heavy chain IIA (NMMHC-IIA), a cellular protein with surface expression in multiple cell types. Small interfering RNA (siRNA) knockdown of NMMHC-IIA, but not the closely related NMMHC-IIB or NMMHC-IIC, reduced SFTSV infection, and NMMHC-IIA specific antibody blocked infection by SFTSV but not other control viruses. Overexpression of NMMHC-IIA in HeLa cells, which show limited susceptivity to SFTSV, markedly enhanced SFTSV infection of the cells. These results show that NMMHC-IIA is critical for the cellular entry of SFTSV. As NMMHC-IIA is essential for the normal functions of platelets and human vascular endothelial cells, it is conceivable that NMMHC-IIA directly contributes to the pathogenesis of SFTSV and may be a useful target for antiviral interventions against the viral infection.
A First-in-Class NAE Inhibitor, MLN4924, Blocks Lentiviral Infection in Myeloid Cells by Disrupting Neddylation-Dependent Vpx-Mediated SAMHD1 Degradation
Authors: Wei Wei , Guo Haoran , Liu Xianjun , Zhang Hong , Qian Lei , Luo Kun , Markham Richard B. , Yu Xiao-Fang
Published: October 2013

MLN4924 is a first-in-class cancer drug that inhibits the Nedd8-activating enzyme (NAE). Herein, we report that MLN4924 inhibits Vpx/Vpr-induced SAMHD1 degradation by inhibiting the neddylation of E3 ubiquitin ligase and blocks macaque simian immunodeficiency virus (SIVmac) replication in myeloid cells. SAMHD1 is required for MLN4924-mediated SIVmac inhibition. Our findings indicate the potential efficacy of inhibiting neddylation as an antiretroviral strategy and identify the readily available anticancer drug MLN4924 as a candidate agent for that purpose.
Isolation and Characterization of the Herpes Simplex Virus 1 Terminase Complex
Authors: Heming Jason D. , Huffman Jamie B. , Jones Lisa M. , Homa Fred L.
Published: October 2013

During herpes simplex virus 1 (HSV-1) infection, empty procapsids are assembled and subsequently filled with the viral genome by means of a protein complex called the terminase, which is comprised of the HSV-1 UL15, UL28, and UL33 proteins. Biochemical studies of the terminase proteins have been hampered by the inability to purify the intact terminase complex. In this study, terminase complexes were isolated by tandem-affinity purification (TAP) using recombinant viruses expressing either a full-length NTAP-UL28 fusion protein (vFH476) or a C-terminally truncated NTAP-UL28 fusion protein (vFH499). TAP of the UL28 protein from vFH476-infected cells, followed by silver staining, Western blotting, and mass spectrometry, identified the UL15, UL28, and UL33 subunits, while TAP of vFH499-infected cells confirmed previous findings that the C terminus of UL28 is required for UL28 interaction with UL33 and UL15. Analysis of the oligomeric state of the purified complexes by sucrose density gradient ultracentrifugation revealed that the three proteins formed a complex with a molecular mass that is consistent with the formation of a UL15-UL28-UL33 heterotrimer. In order to assess the importance of conserved regions of the UL15 and UL28 proteins, recombinant NTAP-UL28 viruses with mutations of the putative UL28 metal-binding domain or within the UL15 nuclease domain were generated. TAP of UL28 complexes from cells infected with each domain mutant demonstrated that the conserved cysteine residues of the putative UL28 metal-binding domain and conserved amino acids within the UL15 nuclease domain are required for the cleavage and packaging functions of the viral terminase, but not for terminase complex assembly.
Genomewide Mapping and Screening of Kaposi's Sarcoma-Associated Herpesvirus (KSHV) 3′ Untranslated Regions Identify Bicistronic and Polycistronic Viral Transcripts as Frequent Targets of KSHV MicroRNAs
Authors: Bai Zhiqiang , Huang Yufei , Li Wan , Zhu Ying , Jung Jae U. , Lu Chun , Gao Shou-Jiang
Published: October 2013

Kaposi's sarcoma-associated herpesvirus (KSHV) encodes over 90 genes and 25 microRNAs (miRNAs). The KSHV life cycle is tightly regulated to ensure persistent infection in the host. In particular, miRNAs, which primarily exert their effects by binding to the 3′ untranslated regions (3′UTRs) of target transcripts, have recently emerged as key regulators of KSHV life cycle. Although studies with RNA cross-linking immunoprecipitation approach have identified numerous targets of KSHV miRNAs, few of these targets are of viral origin because most KSHV 3′UTRs have not been characterized. Thus, the extents of viral genes targeted by KSHV miRNAs remain elusive. Here, we report the mapping of the 3′UTRs of 74 KSHV genes and the effects of KSHV miRNAs on the control of these 3′UTR-mediated gene expressions. This analysis reveals new bicistronic and polycistronic transcripts of KSHV genes. Due to the 5′-distal open reading frames (ORFs), KSHV bicistronic or polycistronic transcripts have significantly longer 3′UTRs than do KSHV monocistronic transcripts. Furthermore, screening of the 3′UTR reporters has identified 28 potential new targets of KSHV miRNAs, of which 11 (39%) are bicistronic or polycistronic transcripts. Reporter mutagenesis demonstrates that miR-K3 specifically targets ORF31-33 transcripts at the lytic locus via two binding sites in the ORF33 coding region, whereas miR-K10a-3p and miR-K10b-3p and their variants target ORF71-73 transcripts at the latent locus through distinct binding sites in both 5′-distal ORFs and intergenic regions. Our results indicate that KSHV miRNAs frequently target the 5′-distal coding regions of bicistronic or polycistronic transcripts and highlight the unique features of KSHV miRNAs in regulating gene expression and life cycle.
Echovirus 7 Entry into Polarized Caco-2 Intestinal Epithelial Cells Involves Core Components of the Autophagy Machinery
Authors: Kim Chonsaeng , Bergelson Jeffrey M.
Published: October 2013

Echovirus 7 enters polarized Caco-2 intestinal epithelial cells by a clathrin-mediated endocytic process and then moves through the endosomal system before releasing its genome into the cytoplasm. We examined the possible role in virus entry of core components of the autophagy machinery. We found that depletion of Beclin-1, Atg12, Atg14, Atg16, or LC3 with specific small interfering RNAs inhibited echovirus 7 infection upstream of uncoating but had little or no effect on virus attachment to the cell surface. These data indicate that multiple autophagy-related proteins are important for one or more events that occur after the virus has bound its receptor on the cell surface but before RNA is released from the virus capsid. Although we have not determined the mechanism by which each protein contributes to virus entry, we found that stable depletion of Atg16L1 interfered with virus internalization from the cell surface rather than with intracellular trafficking. Autophagy gene products may thus participate in the endocytic process that moves virus into polarized Caco-2 cells.
An Avian Retrovirus Uses Canonical Expression and Processing Mechanisms To Generate Viral MicroRNA
Authors: Yao Yongxiu , Smith Lorraine P. , Nair Venugopal , Watson Mick
Published: October 2013

To date, the vast majority of known virus-encoded microRNAs (miRNAs) are derived from polymerase II transcripts encoded by DNA viruses. A recent demonstration that the bovine leukemia virus, a retrovirus, uses RNA polymerase III to directly transcribe the pre-miRNA hairpins to generate viral miRNAs further supports the common notion that the canonical pathway of miRNA biogenesis does not exist commonly among RNA viruses. Here, we show that an exogenous virus-specific region, termed the E element or XSR, of avian leukosis virus subgroup J (ALV-J), a member of avian retrovirus, encodes a novel miRNA, designated E (XSR) miRNA, using the canonical miRNA biogenesis pathway. Detection of novel microRNA species derived from the E (XSR) element, a 148-nucleotide noncoding RNA with hairpin structure, showed that the E (XSR) element has the potential to function as a microRNA primary transcript, demonstrating a hitherto unknown function with possible roles in myeloid leukosis associated with ALV-J.
Multivessel spontaneous coronary artery dissection of left and right coronary systems
Authors: Asrar ul Haq Muhammad , Mutha Vivek , van Gaal William J
Published: October 2013

Spontaneous coronary artery dissection (SCAD) involving multiple coronary arteries simultaneously is extremely rare. It should be considered in younger patients, especially who do not have traditional cardiac risk factors. We present a case of young male patient presenting with acute coronary syndrome associated with ST segments elevation on ECG following physical stress whose coronary angiography revealed SCAD of the left anterior descending as well as the right coronary artery and discuss the therapeutic options with a brief review of the limited evidence.
Successful percutaneous angioembolisation of bleeding jejunal varix by acrylate glue and coils
Authors: Haq Tanveer Ul , AlQamari Nauman , Sayani Raza , Hilal Kiran
Published: October 2013

Portal hypertension is a common disease worldwide. One of its rare complications is bleeding jejunal varices which is usually asymptomatic and may present with gastrointestinal bleeding. We present a case of a jejunal bleeding that was successfully embolised with acrylate glue and embolisation coils. A middle-aged woman with a history of multiple abdominal surgeries for adenocarcinoma of right ovary, presented to us with multiple episodes of haematochezia. On a CT scan of the abdomen, she was diagnosed with chronic liver disease with portal hypertension, multiple varices at porto-systemic anastomosis and ectopic jejunal varix. She was treated by interventional radiologists by percutaneous embolisation of bleeding varix using glue and embolisation coils through a portal venous approach.
SPORT AND EXERCISE MEDICINE (SEM) IN PRIMARY CARE: A NOVEL DUAL ARMED APPROACH TO IMPROVING PHYSICAL ACTIVITY (PA) AND MUSCULOSKELETAL (MSK) SERVICES IN A HERTFORDSHIRE GENERAL PRACTICE
Authors: Chew S , Noake J
Published: October 2013

Background

With the advent of SEM as a recognised medical specialty in the United Kingdom, a number of service models have become apparent.1Despite government initiatives to increase for example PA promotion in the primary care setting, uptake, promotion and utilisation of these services has been poor or lacked longevity.2Schopwick General Practice has a patient population of over 12,000 and is a standard primary care service provider.

Aim

To develop a holistic reproducible dual armed model of SEM services in the primary care setting that is economically viable and sustainable.

Methods

Two SEM registrars in conjunction with the practice partners and manager, proposed, implemented and piloted a SEM service providing both musculoskeletal and physical activity interventions. Care provision included “one-stop” MSK clinics with capabilities for “see and treat” injection therapy, rehabilitation prescription & allied priority physiotherapy appointments. Novel PA prescription templates to assist practitioners were embedded in consultation software, & electronic ‘flag’ systems developed to highlight priority intervention patients. GPPAQ was made a mandatory component of the “new patient” registration procedure. Over a 12 month period audit of parameters including orthopaedic referral rates, frequency of physical activity interventions according to electronic note records, and patient service questionnaires were used to assess outcome measures of the service.

Results

Documented PA advice increased fourfold over a 9 month period. Use of GPPAQ Pre and Post January 2011 increased significantly. All use Vision Exercise Related Read Codes Pre and Post January 2011 increased fivefold. Orthopaedic referral rates were reduced by approximately 50%, MRI scan requests were reduced by over half and in-house physiotherapy waiting times were reduced from 8 to 6 weeks despite the introduction of service specific appointments.

Conclusions

Novel service models marrying both musculoskeletal and physical activity promotion services can make sound economical and patient satisfaction positive outcomes within primary care settings. We present a reproducible model that has recently been commissioned as a service by the local clinical commissioning group.
LEVEL OF FATIGUE IN RHYTHMIC GYMNASTICS AND PERFORMANCE: ELITE VS. NON-ELITE
Authors: Molina-Reina M , Hontoria-Galán M , González-Hernández J , González-Badillo J , Jiménez-Reyes P
Published: October 2013

Rhythmic gymnastics (RG) has evolved considerably, characterized, at the present time by the continuous repetition of specific elements (jumps, twists, balance…) and is defined by its high intensity, constant repetition and the capacity of recovery (Doudaet al.IJSPP2008;3:41–54). There is a lack of experimental data on the determinant factors related to performance and the effect of general routines of training in gymnastics. The main aim of this study was to measure the relationship between mechanical, physiological and psychological measures and performance in a specific task in RG. Ten elite gymnasts and ten non-elite took part in this study. A specific test of RG with two minutes of duration was performed. Jumping test values (CMJ and SJ), blood lactate, heart rate and RPE were measured before and after (immediately after finishing, and in the intervals of time 0–1 and 1–3 min). The main result of this study was a highly significant correlation between CMJ and SJ height loss pre-post in a specific test in RG and blood lactate concentration, elite gymnastics (r=0.82–0.87; p<0.01) and non-elite (r=0.97–0.98; p<0.001). One another important finding was a difference in the recovery of jump capacity pattern between elite and non-elite gymnastics (p<0.001), which was higher in elite in the interval time 0-1 post test. The loss of CMJ and SJ height could be considered as an indicator of the level of effort and fatigue because of the high correlation between CMJ and blood lactate and ammonia concentrations (Gorostiaga,et al.JSCR2010;24:1138–1149; Jiménez-Reyes,et al.MSSE2012;44(5):582) as previously shown in other tasks of high intensity, and could be useful and applicable to a specific test in RG. This fact would support the utility and validity of using CMJ and SJ to monitor and quantify objectively the level of effort and fatigue during training in RG.
METABOLIC AND MECHANICAL RESPONSES TO 200–400 M RACES IN HIGH LEVEL SPRINTERS
Authors: Jiménez-Reyes P , Molina-Reina M , González-Hernández J , González-Badillo Juan
Published: October 2013

The 400 m run is one of the most demanding athletic events. In 400 m, muscle acidosis decreases force production. A large number of both biochemical and biophysical changes occur at the same time that fatigue is developing (Nummelaet al.JSS1992;10:217–228). The aim of this study was to investigate relationships between changes in CMJ height pre-post and blood lactate and ammonia concentrations observed during real competition. Sixteen high level sprinters (age 23±4 y, body mass 72.6±3.7 kg, height 181.2±5.3 cm; body fat 7.4±2.7%) performed six competitions (including National Track and Field Championships). Mechanical responses (i.e. height performance in CMJ and speed loss) and metabolic responses (i.e. blood lactate and ammonia concentrations) were measured before and at 1, 3, 5, 7 and 9 minutes after exercise. The main result of this study was a highly significant correlation between CMJ height loss pre-post competition and metabolic responses (r=0.86–0.94). The decrease in jump capacity pattern was mainly related to higher blood lactate and ammonia responses. These losses were about 17% for 200 m and 27% for 400 m. Fatigue, measured as CMJ height loss, increased with performance level of athletes, and, was strongly correlated to lactate (r=0.87) and ammonia (r=0.91). Gorostiagaet al.JSCR2010;24:1138–1149) which examined CMJ height loss following typical sprint-training workouts in 400 m elite runners (60–300 m), although were not performed at maximal intensity or real competition. Metabolic stress developed during the effort in real competition can be estimated by measuring the CMJ because of the high correlation between CMJ and blood lactate and ammonia concentrations (Jiménez-Reyeset al.MSSE2012;44(5):582), without the necessity of measuring blood metabolites.
KINEMATICS COMPARISON OF STRAIGHT JUMP ON FLOOR AND BEAM: COUNTY VS NATIONAL GYMNASTS
Authors: Hannah J , Penitente G , Sands WA
Published: October 2013

The straight jump is performed by gymnasts of all levels in warm-up routines on the floor and on the beam. Refining this basic skill serves gymnasts when learning high-difficulty jumps. It is common practice for gymnasts to master skills on floor before transferring them onto the beam. The aim of this study was to investigate the kinematic differences of the straight jump on the floor and on the beam performed by county and national level gymnasts. Four county (9±1 y; 133.5±7.6 cm; 29.8±1.9 Kg) and four junior national (13±1 y; 148.5±8.2 cm; 42.8±5.6 Kg) gymnasts volunteered to participate. The straight jump performances were video recorded (80Hz). Simi Motion was used to track nine markers on the gymnast's body. The floor and beam apparatus were instrumented with a pressure mat connected to a digital timer. A 2x2 factorial ANOVA (apparatus x expertise) analysed the following variables: relative angles of shoulder, hip, knee and ankle joints at take-off, peak of the flight and at the minimum vertical displacement of the centre of mass during landing. There was no interaction between apparatus and expertise. There was a main effect of apparatus for shoulder angle at the take-off (fl=132±12°; bm=119±12°), shoulder (fl=154±18°; bm=143±16°) and hip (fl=180±7°; 175±10°) joint angles at the peak of the flight. Expertise showed an effect on the hip joint angle at the take-off (c=164±9°; n= 179±6°) and jump height (c=25.0±7.8 cm; 33.5±4.2 cm). The present study showed that kinematic differences occurred at the instant of take-off between floor and beam and between county and national gymnasts when performing the straight jump, thus some caution should be used in transferring jumping skills from the floor to the beam. Apparatus-specific drills should be used with young gymnast to master these jumping abilities.
THE EFFECTS OF ALTI-VIT ON EXERCISE PERFORMANCE AT ALTITUDE
Authors: Youngman E , Howe C , Moir HJ
Published: October 2013

This study examined the effects of ALTI-VIT supplementation on exercise performance and Acute Mountain Sickness (AMS) at altitude. Seven healthy males with no experience of exercise at altitude completed two 16 km cycle time-trials at a simulated altitude of 2400 m in an altitude chamber. Using a single-blind, randomised, crossover design, participants consumed 2 capsules (270 mg) of ALTI-VIT (A) or a placebo (Pl) 24-hours prior to testing and 2 capsules on the morning of testing. Time-trial completion was faster in the A condition (30.04±4.39 min) than the Pl condition (31.02±5.22 min) (P=0.05). RER was lower in the A condition (A: 1.03±0.11vs. Pl: 1.13±0.12;P=0.044) and the incidence of AMS (A: 0.4±0.5vs.Pl: 3±1;P=0.002) and severity of symptoms were reduced (P<0.05). No differences were found between conditions for HR, RPE, VO2, VE, VO2 max, speed, power output and RPM (P>0.05). These results demonstrated that 24-hour supplementation of ALTI-VIT enhanced exercise performance at altitude and reduced the incidence and severity of AMS.
INFLUENCE OF THE STATIC IMAGES THAT EVOKE ILLUSORY MOTION PERCEPTION ON THE EYE MOVEMENTS AND THE BODY SWAY
Authors: Inoue Y
Published: October 2013

Previous studies suggested that eye movements might be one of the factors that static images evoke illusory motion perception. The influence that visual information gives to posture control is also known to be big. However, the relationship between the posture control and the illusory motion perceptions has not been clear well. Therefore we examined how static illusory motion images affected the body sway and the eye movements. Seven participants (20±2 years old) took part in the experiment. Wavy image (W condition), two types of parallel images (P1, P2 condition), and expanded image (E condition) were used as four conditions that evoke illusory motion perception. One plain image was used as the control condition (CON condition) that does not evoke illusory motion perception. Participant was instructed to stand on a pressure sensor plate and viewed the images by a 46 inches monitor. Each image was presented for 2 minutes. Participants' postural movements were measured with centre of plantar pressure (COP) by a pressure sensor plate. The eye movements were measured with horizontal electro-oculogram. Comparing four illusory conditions, many participants reported that more illusory motion perception was evoked with W and E1 conditions. The number of horizontal eye movements was larger with W condition (p<0.01) and E1 condition (p<0.05) than with CON condition. Although no significant differences between the five conditions were observed on the total movement distance of the COP, the movements to swing of the COP of W condition tended to be different from that of CON condition. Although the COP of CON condition tended to sway slow and big, the COP of W condition tended to sway very smaller and fast. Our results suggested that the static images that evoke illusory motion perception more would induce faster eye movements and that these quick eye movements might induce small and fast body sway.
HYPERMOBILITY: A RISK FACTOR FOR FAILURE FOLLOWING ACL RECONSTRUCTION
Authors: Akhtar MA , Ashton F , Keating JF
Published: October 2013

Hypermobility is associated with increased risk of sporting injuries. This study was performed to assess the risk of failure following primary ACL reconstruction in patients with hypermobility. Prospective data were collected for 28 patients undergoing primary ACL reconstruction between October 2008 and July 2009 including demographic details, sports played, hypermobility and Benign Joint Hypermobility Syndrome (BJHS). Electronic records from emergency and orthopaedic departments were checked in April 2013 for failure of ACL reconstruction. Beighton score of 4 or above was used to diagnose hypermobility. Brighton criteria were used to diagnose BJHS. The mean age was 27 y (range 15–54). There were 19 males and 9 females. 24 patients (86%) were involved in contact sports and football was the most common sport played in 9 patients (37%). The mean Beighton score for these patients was 2.8 (range 0–9). 10 patients (36%) in this group had a Beighton score of 4 or more indicating hypermobility (Group A). 18 patients (64%) had Beighton score less than 4 (Group B). The mean age for Group A (10 patients) was 26 years (range 14–40). There were 4 male and 6 females. 9 patients were involved in contact sports. 3 patients (30%) had failure of ACL reconstruction. The mean Beighton score for these patients was 5.9 (range 4–9). 3 patients (30%) had BJHS. The mean age for Group B (18 patients) was 28 years (range 15–54). There were 15 males and 3 females. 15 patients were involved in contact sports. The mean Beighton score was 1 (range 0–3). No patient had failure of ACL reconstruction. Hypermobile patients had a higher incidence of failure of ACL reconstruction (30% vs 0%). 30% patients fulfilled the Brighton criteria for BJHS. These factors should be assessed before ACL reconstruction to select the appropriate graft. Further studies are needed to decide the best graft for ACL reconstruction in the presence of hypermobility.
SEASONAL VITAMIN D STATUS AND THE EFFECTIVENESS OF WINTER SUPPLEMENTATION IN ELITE ATHLETES BASED AT A NATIONAL TRAINING CENTRE IN THE UK
Authors: Lewis N
Published: October 2013

We investigated the seasonal variation in serum vitamin D (25(OH)D) in elite athletes and the effectiveness of vitamin D3 supplementation. 20 athletes comprising the British Modern Pentathlon squad were included. Blood samples for investigation of 25(OH)D were collected in beginning of Oct., end of Feb., and June. From October 2009 to February 2010 the athletes did not receive vitamin D supplements (observation period). However, for winter 2010–11 season, athletes were supplemented with 50,000 IU of D3 per month from November 2010 to March 2011 (supplementation period). Vitamin D3 supplements were from Biotech Pharmacal Inc, USA. Venous blood samples were drawn for analysis of 25(OH)D by chemiluminescence assay for total serum 25 (OH)D. Data are represented as mean (SD). Differences between means were compared using two-sample t-test. Level of significance was set at p<0.05. The mean squad 25(OH)D for the observation period was 98±18 nmol.l−1, 76±21 nmol.l−1and 118±15 nmol.l−1for Oct. 2009, Feb. 2010 and June 2010 respectively. For the supplementation period, mean 25(OH)D was 90±20 nmol.l−1and 104±19 nmol.l-1, for Oct. 2010 and Feb. 2011. The vitamin D supplementation period was effective at elevating the squad 25(OH)D, as the Feb. 2011 result of 104±19 nmol.l−1was greater than the Feb. 2010 result of 76±21 nmol.l−1with no supplementation (p<0.01). Supplementation was effective at elevating the squad 25(OH)D; as 6% (n=1) of the squad presented with a 25(OH)D concentration of <80 nmol.l−1in Feb.2011. In contrast, the winter period with no supplementation, 56% of the squad had 25(OH)D concentrations of <80 nmol.l−1, and 19% had 25(OH)D concentrations of <50 nmol.l−1in Feb.2010. Supplementation with 50,000 IU of vitamin D3 per month across the winter is effective in caucasian athletes in maintaining 25(OH)D >80 nmol.l−1; as long as 25(OH)D concentrations are >80 nmol.l−1at the time of commencing supplementation.
CHANGES IN BODY COMPOSITION AND PERFORMANCE OF A CEREBRAL PALSY PARALYMPIC ATHLETE IN PREPARATION FOR THE LONDON PARALYMPIC GAMES
Authors: Shreeve S , Rowley N , Gilby C , Mitchell N
Published: October 2013

This case study examined body composition changes of a cerebral palsy (CP) athlete, in the 12 weeks prior to the London 2012 Paralympic Games. The aim was to monitor body composition of an athlete in preparation for the London Paralympic Games as part of the optimisation of performance. Within a 12 week period, body composition assessments were completed alongside an incremental 7×200 m swimming performance test, each separated by 6 weeks. One ISAK trained anthropometrist recorded body mass, sum of 8 skinfold thicknesses (biceps, triceps, subscapular, iliac crest, supraspinale, abdominal, front thigh and medial calf), girths (arm, waist, hips and calf), alongside calculations of mid upper arm muscle circumference (MUAMC). With the athlete's non-affected side being the left side, additional measurements of arm and calf circumference, bicep and triceps skinfold and MUAMC were also assessed. Sum of 8 skinfolds fluctuated over weeks 1, 6 and 12 with 65.8 mm, 60.7 mm and 63.0 mm respectively. Arm circumference in the dominant left arm increased in the 12 week period 29.7 cm, 29.4 cm and 30.5 cm respectively, with the non-dominant right arm maintaining arm circumference over the same period. Performance in the final 200 m of the incremental performance test improved at each time point. 1.2% improvement in performance was noted between weeks 1 and 6 and a 2.1% improvement between weeks 6 and 12. A total performance improvement of 3.2% was noted from the start to end of the 12 week period. This case study highlights in a CP athlete, performance and body composition changes in the lead into major competition. There was little change in body composition but improvements in performance. This suggests that minimal body fat is not critical in CP swimming performance. However, the athlete maintained muscle mass which may suggest that functional mass is more an indicator of performance and provides a direction for future work.
CHANGES IN LABORATORY AND FIELD-BASED MEASUREMENTS IN HIGHLY TRAINED ENDURANCE RUNNERS ACROSS A TRAINING YEAR
Authors: Galbraith A , Hopker JG , Passfield L
Published: October 2013

We examined the effects of one year's endurance training on laboratory and field-based fitness measures in highly trained distance runners. Fourteen distance runners (mean±SD: age 28±8 y, body mass 67.0±6.3 kg, VO2max69.8±6.3 mL.kg−1.min−1) with at least 2 years competitive experience completed 5 laboratory and 9 field tests across a 12 month period, during which time training volume and intensity were monitored. The laboratory tests measured VO2max, lactate threshold (LT) and running economy, whilst the field tests measured critical speed (CS) and the maximum distance that can be performed above CS (D’). The data were analyzed using repeated measures ANOVA, correlation coefficients and multiple regression. VO2max(L.min−1) changed during the year, being higher in October (5.0 L.min−1,P<0.01) and January (5.0 L.min−1,P=0.01), than in April (4.7 L.min−1). There were no changes in the other laboratory measures during the study. Total distance covered in training changed during the year, being higher in January-February (474 km) than May-July (333 km;P=0.01) and July-August (339 km;P=0.02). Total distance covered in the training period preceding the laboratory test correlated with LT and running economy (r=0.55,P<0.01;r=-0.33,P=0.01). CS changed during the year (P=0.02), being at its lowest in August (4.90 m.s−1) and reaching a peak in February (4.99 m.s−1). There were no differences in D’ across the study (P=0.11). Total training distance and percentage of training time spent above threshold velocity explained 33% of the variation in CS. Increasing training distance and the percentage of training time above threshold velocity was shown to increase CS.
An application of the learning curve–cumulative summation test to evaluate training for endotracheal intubation in emergency medicine
Authors: Je Sangmo , Cho Youngsuk , Choi Hyuk Joong , Kang Boseung , Lim Taeho , Kang Hyunggoo
Published: October 2013

Objective

The learning curve–cumulative summation (LC-CUSUM) test allows for quantitative and individual assessments of the learning process. In this study, we evaluated the process of skill acquisition for performing endotracheal intubation (ETI) in three emergency medicine (EM) residents over a 2 year period in their first 2 years of their EM residency.

Methods

We evaluated 342 ETI cases performed by three EM residents using the LC-CUSUM test according to their rate of success or failure of ETI. A 90% success rate (SR) was chosen to define adequate performance and an SR of 80% was considered inadequate. After the learning phase, the standard CUSUM test was applied to ensure that performance was maintained.

Results

The mean number of ETI cases required to reach the predefined level of performance was 74.7 (95% CI 62.0 to 87.3). CUSUM tests confirmed that performance was maintained after the learning phase.

Conclusions

By using the LC-CUSUM test, we were able to quantitatively monitor the acquisition of the skill of ETI by EM residents. The LC-CUSUM could be useful for monitoring the learning process for the training of airway management in the practice of EM.
Sensitivity and specificity of bedside ultrasonography in the diagnosis of fractures of the fifth metacarpal
Authors: Aksay Ersin , Yesilaras Murat , Kılıc Turgay Yılmaz , Tur Feriyde Calıskan , Sever Mustafa , Kaya Ahmet
Published: October 2013

Objectives

Ultrasonography is becoming increasingly common in the diagnosis of fracture in emergency medicine. The aim of our study was to investigate the diagnostic accuracy of sonographic examinations for diagnosing fifth metacarpal fractures.

Methods

A prospective study was performed of consecutive patients aged >14 years admitted to the emergency department with hand trauma and tenderness over the fifth metacarpal. Anteroposterior and oblique plain x-rays were taken on all patients. Emergency physicians performed bedside sonographic examination. The x-rays were reported by an orthopaedic surgeon who was blinded to the sonographic examination findings. The orthopaedic surgeon’s report was considered the gold standard unless a CT scan was performed. In the single case where this occurred, the CT scan report was considered the gold standard.

Results

Eighty one patients were included in the study, 39 of whom had fractures. Sonographic examination identified the fractures in 38 patients. One occult fracture undetected by plain radiography, later shown on CT scan, was identified by sonographic examination. There were three cases with false positive ultrasound findings. The sensitivity of the diagnosis of fifth metacarpal fractures by ultrasonography was 97.4% (95% CI 84.9% to 99.9%), specificity was 92.9% (95% CI 79.4% to 98.1%), positive likelihood ratio (LR) was 14 (95% CI 4.58 to 41), negative LR was 0.03 (95% CI 0.00 to 0.19), negative predictive value was 97.5% (95% CI 85.3% to 99.9%) and positive predictive value was 92.6% (95% CI 79% to 98.1%).

Conclusions

Sonographic examination can be used as an effective diagnostic tool in patients with fifth metacarpal trauma.