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The Potential of Multiple Synovial-Fluid Protein-Concentration Analyses in the Assessment of Knee Osteoarthritis

Jeffrey B. Driban, Easwaran Balasubramanian, Mamta Amin, Michael R. Sitler, Marvin C. Ziskin, and Mary F. Barbe

Context:

Joint trauma is a risk factor for osteoarthritis (OA), which is becoming an increasingly important orthopedic concern for athletes and nonathletes alike. For advances in OA prevention, diagnosis, and treatment to occur, a greater understanding of the biochemical environment of the affected joint is needed.

Objective:

To demonstrate the potential of a biochemical technique to enhance our understanding of and diagnostic capabilities for osteoarthritis.

Design:

Cross-sectional.

Setting:

Outpatient orthopedic practice.

Participants:

8 subjects: 4 OA-knee participants (65 ± 6 y of age) and 4 normal-knee participants (54 ± 10 y) with no history of knee OA based on bilateral standing radiographs.

Intervention:

The independent variable was group (OA knee, normal knee).

Main Outcome Measures:

16 knee synovial-protein concentrations categorized as follows: 4 as pro-inflammatory, or catabolic, cytokines; 5 as anti-inflammatory, or protective, cytokines; 3 as catabolic enzymes; 2 as tissue inhibitors of metalloproteinases [TIMPs]; and 2 as adipokines.

Results:

Two anti-inflammatory cytokines (interleukin [IL]-13 and osteoprotegerin) and a pro-inflammatory cytokine (IL-1β) were significantly lower in the OA knees. Two catabolic enzymes (matrix metalloproteinase [MMP]-2 and MMP-3) were significantly elevated in OA knees. TIMP-2, an inhibitor of MMPs, was significantly elevated in OA knees.

Conclusions:

Six of the 16 synovial-fluid proteins were significantly different between OA knees and normal knees in this study. Future research using a similar multiplex ELISA approach or other proteomic techniques may enable researchers and clinicians to develop more accurate biochemical profiles of synovial fluid to help diagnose OA, identify subsets of OA or individual characteristics, guide clinical decisions, and identify patients at risk for OA after knee injury.

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Acute-Exercise-Induced Alterations in Calpain and Calpastatin Expression in Rat Muscle

Lijing Wang, Ligong Duan, Xukun Li, and Guoping Li

Context:

Calpains and calpastatin can degrade muscle proteins, but no research has investigated the expression pattern of calpains and calpastatin after exhaustive exercise.

Objective:

To investigate the alterations in expression of μ-, m-, and n-calpain and calpastatin after exhaustive exercise and its association with muscle injury.

Method:

64 rats divided into 2 groups, a nonexercise control group and an acute-exhaustive-exercise (AEE) group. Biopsies in the AEE group were taken at different times after exercise.

Results:

Calpastatin protein expression and m-calpain activity increased early after exercise, but both n-calpain protein expression and μ-calpain activity generally decreased with time. n-Calpain mRNA expression was down- regulated from late after exercise.

Conclusions:

The increased m-calpain activity might promote muscle-protein degradation and muscle injury. On the contrary, calpastatin might execute a protective function against muscle injury. The change in p-calpain activity was found earlier than muscle injury and therefore might serve as a useful predictor of muscle injury.

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Does Prophylactic Stretching Reduce the Occurrence of Exercise-Associated Muscle Cramping? A Critically Appraised Topic

John W. Evers-Smith and Kevin C. Miller

acute EAMC adopted by the majority of athletes 3 and clinicians 4 is gentle stretching until abatement. Stretching is theorized to relieve active EAMC by normalizing alpha motor neuron control, specifically by increasing Golgi tendon organ activity, and physically separating contractile proteins. 5

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Rehydration after Exercise Dehydration in Heat: Effects of Caffeine Intake

João C. Dias, Melissa W. Roti, Amy C. Pumerantz, Greig Watson, Daniel A. Judelson, Douglas J. Casa, and Lawrence E. Armstrong

Context:

Dieticians, physiologists, athletic trainers, and physicians have recommended refraining from caffeine intake when exercising because of possible fluid-electrolyte imbalances and dehydration.

Objective:

To assess how 16-hour rehydration is affected by caffeine ingestion.

Design:

Dose–response.

Setting:

Environmental chamber.

Participants:

59 college-age men.

Intervention:

Subjects consumed a chronic caffeine dose of 0 (placebo), 3, or 6 mg · kg−1 · day−1 and performed an exercise heat-tolerance test (EHT) consisting of 90 minutes of walking on a treadmill (5.6 km/h) in the heat (37.7 °C).

Outcome Measures:

Fluid-electrolyte measures.

Results:

There were no between-group differences immediately after and 16 hours after EHT in total plasma protein, hematocrit, urine osmolality, specific gravity, color, and volume. Body weights after EHT and the following day (16 hours) were not different between groups (P > .05).

Conclusion:

Hydration status 16 hours after EHT did not change with chronic caffeine ingestion.

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Electroacupuncture-Enhanced Differentiation of Bone Marrow Stromal Cells into Neuronal Cells

Zhongren Sun, Xiaoning Li, Zhiqiang Su, Ying Zhao, Li Zhang, and Mingyuan Wu

Context:

Bone marrow stromal cells (BMSCs) can be differentiated into neuronal cells and are used to treat spinal cord injury (SCI).

Objective:

This study investigated whether electroacupuncture enhances BMSC’s effects on SCI in rats.

Design:

The effects of transplantation of phosphate-buffered saline or BMSC, electroacupuncture, and a combination of BMSC transplantation and electroacupuncture on SCI were evaluated using a combined behavioral score (CBS). Expressions of neuronal marker neuron-specific enolase (NSE) and gliocyte-specific marker glial fibrillary acidic protein (GFAP) of transplanted BMSC were detected using immunohistochemistry to assess the effect of electroacupuncture on differentiation of BMSC into neuronal cells.

Results:

The combination of BMSC transplantation and electroacupuncture significantly alleviated CBS in rats with SCI compared with the separate treatment of BMSC or electroacupuncture. In addition, electroacupuncture increased the NSE- and GFAP-positive transplanted BMSCs in spinal cord.

Conclusion:

Combined treatment showed a better effect, and the mechanisms may be partially caused by enhanced differentiation of BMSC into neuronal cells. Future studies are needed to confirm this.

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Saline-Assisted Aspirations for Collecting Synovial Fluid From Noneffused Knees: Technique and Validation

Jeffrey B. Driban, Nicole Cattano, Easwaran Balasubramanian, Michael R. Sitler, Mamta Amin, Joseph Glutting, and Mary F. Barbe

Context: To better understand why a knee develops osteoarthritis after joint trauma we need to assess the local biochemical changes. Unfortunately, it is challenging to obtain synovial fluid from a knee with no effusion. Objective: To describe the authors' protocol for aspirating synovial fluid from noneffused knees. Second, they demonstrate the validity of this method by evaluating the relationships between normalized and raw biomarker concentrations among knees with effusion (undergoing a traditional aspiration) and without effusion (requiring a saline-assisted aspiration). Design: Validation study based on secondary analyses from 2 cohort studies. Setting: Outpatient orthopedic clinic and basic-science laboratory. Participants: Participants had moderate to severe radiographic knee osteoarthritis (n = 15 with and 11 without effusion) and no osteoarthritis or effusion (n = 4). Interventions: The same orthopedic surgeon performed all synovial-fluid joint aspirations, including saline-assisted aspirations. Main Outcome Measures: The authors used multiplex enzyme-linked immunosorbent assays to determine 7 synovial-fluid biomarker concentrations. They then calculated correlations between raw and normalized (to total synovial-fluid protein content) biomarker concentrations. Results: The authors excluded 1 sample collected with a saline-assisted aspiration because it contained blood. Normalized biomarker concentrations had positive associations with raw biomarker concentrations (r = .77-99), with the exception of interleukin-13 and interleukin-1Β among knees that underwent a saline-assisted aspiration. Excluding interleukin-1Β, associations between normalized and raw biomarker concentrations were consistent between knees that had a saline-assisted or traditional aspiration. Conclusions: Saline-assisted aspiration is a valid technique for assessing the local biochemical changes in knees without effusion.

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Comparison of the Effects of Electrical Stimulation and Cold-Water Immersion on Muscle Soreness After Resistance Exercise

Adam R. Jajtner, Jay R. Hoffman, Adam M. Gonzalez, Phillip R. Worts, Maren S. Fragala, and Jeffrey R. Stout

Context:

Resistance training is a common form of exercise for competitive and recreational athletes. Enhancing recovery from resistance training may improve the muscle-remodeling processes, stimulating a faster return to peak performance.

Objective:

To examine the effects of 2 different recovery modalities, neuromuscular electrical stimulation (NMES) and cold-water immersion (CWI), on performance and biochemical and ultrasonographic measures.

Participants:

Thirty resistance-trained men (23.1 ± 2.9 y, 175.2 ± 7.1 cm, 82.1 ± 8.4 kg) were randomly assigned to NMES, CWI, or control (CON).

Design and Setting:

All participants completed a high-volume lower-body resistance-training workout on d 1 and returned to the human performance laboratory 24 (24H) and 48 h (48H) postexercise for follow-up testing.

Measures:

Blood samples were obtained preexercise (PRE) and immediately (IP), 30 min (30P), 24 h (24H), and 48 h (48H) post. Subjects were examined for performance changes in the squat exercise (total repetitions and average power per repetition), biomarkers of inflammation, and changes in cross-sectional area and echo intensity (EI) of the rectus femoris (RF) and vastus lateralis muscles.

Results:

No differences between groups were observed in the number of repetitions (P = .250; power: P = .663). Inferential-based analysis indicated that increases in C-reactive protein concentrations were likely increased by a greater magnitude after CWI compared with CON, while NMES possibly decreased more than CON from IP to 24H. Increases in interleukin-10 concentrations between IP and 30P were likely greater in CWI than NMES but not different from CON. Inferential-based analysis of RF EI indicated a likely decrease for CWI between IP and 48H. No other differences between groups were noted in any other muscle-architecture measures.

Conclusions:

Results indicated that CWI induced greater increases in pro- and anti-inflammatory markers, while decreasing RF EI, suggesting that CWI may be effective in enhancing short-term muscle recovery after high-volume bouts of resistance exercise.

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Total Testosterone and Cortisol During Wheelchair Rugby Training in Athletes With Cervical Spinal Cord Injury

Eduardo Stieler, Varley Teoldo da Costa, Aline Ângela Silva Cruz, João Paulo Pereira Rosa, Ingrid LudImilla Bastos Lôbo, Julia Romão, Andrea Maculano Esteves, Marco Tulio de Mello, and Andressa Silva

deficits. 5 Among CSCI changes, there is evidence that men have total testosterone (TT) levels below the recommended, 6 in addition to submitting a sympathetic nervous system impairment. 7 Total testosterone is an anabolic hormone that is related to protein synthesis, humor, fatigue, and motivation, 8

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Ozone Therapy for a Soccer Player With Osteitis Pubis: A Case Report

Merve Demir Benli and Beyza Arslan

these products react with white blood cells, triggering the formation of proteins, cytokines, and red blood cells, which increase the tissue oxygen supply. Ozone is used to treat many cases involving muscles, tendons, and joints. Ozone therapy increases the pain threshold by stimulating the

Open access

The Effects of Intermittent Pneumatic Compression on the Reduction of Exercise-Induced Muscle Damage in Endurance Athletes: A Critically Appraised Topic

Hannah L. Stedge and Kirk Armstrong

following prolonged running. Abbreviations: CK, creatine kinase; CRP, C-reactive protein; IPC, intermittent pneumatic compression; MT, manual therapy; PEDro, Physiotherapy Evidence Database. Results of Evidence Quality Assessment Of the included studies, the critical appraisal scores were all 7