Effect of blood-flow restriction exercise on falls and fall related risk factors in older adults 60 years or above: a systematic review

This systematic review investigated the effect of low-load resistance training combined with blood-flow restriction (LL-BFR) on falls in older adults ≥60 years of age. The databases Embase, Medline, and Cochrane Library were searched from inception to October 1^st, 2019 and reference lists of retrieved publications. Main outcomes were fall rates or proportion of fallers. Additional outcomes were physical performance, lower extremity muscle strength or function, and balance. Mean difference ±SD on falls and fall related outcomes were reported and Cochrane Collaboration’s risk of bias tool was used to evaluate quality of evidence. Eight RCT-studies met the inclusion criteria. None reported falls data. Assessing physical performance tests (n=12), 8/12 of the LL-BFR groups showed a significant within-group improvement and 5/12 significant between-group effects comparing LL-BFR to respective controls. For muscle strength tests (n=16), 9/16 showed significant positive within-group improvement and 3/16 significant between-group effects. One study reported data on balance with conflicting results. In conclusion, LL-BFR might increase physical performance and muscle strength in older adults ≥60 years of age. None of the included studies investigated the effect on falls. Larger adequately powered studies are required before introducing LL-BFR as an alternative exercise modality to decrease fall risk.     

The Impact of HIV Infection and CD4 Cell Count on the Performance of an Interferon Gamma Release Assay in Patients with Pulmonary Tuberculosis

Background

The performance of the tuberculosis specific Interferon Gamma Release Assays (IGRAs) has not been sufficiently documented in tuberculosis- and HIV-endemic settings. This study evaluated the sensitivity of the QuantiFERON TB-Gold In-Tube (QFT-IT) in patients with culture confirmed pulmonary tuberculosis (PTB) in a TB- and HIV-endemic population and the effect of HIV-infection and CD4 cell count on test performance.

Methodology/Principal Findings

161 patients with sputum culture confirmed PTB were subjected to HIV- and QFT-IT testing and measurement of CD4 cell count. The QFT-IT was positive in 74% (119/161; 95% CI: 67–81%). Sensitivity was higher in HIV-negative (75/93) than in HIV-positive (44/68) patients (81% vs. 65%, p = 0.02) and increased with CD4 cell count in HIV-positive patients (test for trend p = 0.03). 23 patients (14%) had an indeterminate result and this proportion decreased with increasing CD4 cell count in HIV-positive patients (test for trend p = 0.03). Low CD4 cell count (<300 cells/µl) did not account for all QFT-IT indeterminate nor all negative results. Sensitivity when excluding indeterminate results was 86% (95% CI: 81–92%) and did not differ between HIV-negative and HIV–positive patients (88 vs. 83%, p = 0.39).

Conclusions/Significance

Sensitivity of the QFT-IT for diagnosing active PTB infection was reasonable when excluding indeterminate results and in HIV-negative patients. However, since the test missed more than 10% of patients, its potential as a rule-out test for active TB disease is limited. Furthermore, test performance is impaired by low CD4 cell count in HIV-positive patients and possibly by other factors as well in both HIV-positive and HIV-negative patients. This might limit the potential of the test in populations where HIV-infection is prevalent.     

Phase-dependent outbreak dynamics of geometrid moth linked to host plant phenology

Climatically driven Moran effects have often been invoked as the most likely cause of regionally synchronized outbreaks of insect herbivores without identifying the exact mechanism. However, the degree of match between host plant and larval phenology is crucial for the growth and survival of many spring-feeding pest insects, suggesting that a phenological match/mismatch-driven Moran effect may act as a synchronizing agent.We analyse the phase-dependent spatial dynamics of defoliation caused by cyclically outbreaking geometrid moths in northern boreal birch forest in Fennoscandia through the most recent massive outbreak (2000–2008). We use satellite-derived time series of the prevalence of moth defoliation and the onset of the growing season for the entire region to investigate the link between the patterns of defoliation and outbreak spread. In addition, we examine whether a phase-dependent coherence in the pattern of spatial synchrony exists between defoliation and onset of the growing season, in order to evaluate if the degree of matching phenology between the moth and their host plant could be the mechanism behind a Moran effect.The strength of regional spatial synchrony in defoliation and the pattern of defoliation spread were both highly phase-dependent. The incipient phase of the outbreak was characterized by high regional synchrony in defoliation and long spread distances, compared with the epidemic and crash phase. Defoliation spread was best described using a two-scale stratified spread model, suggesting that defoliation spread is governed by two processes operating at different spatial scale. The pattern of phase-dependent spatial synchrony was coherent in both defoliation and onset of the growing season. This suggests that the timing of spring phenology plays a role in the large-scale synchronization of birch forest moth outbreaks.     

The role of the lamellar interface during torsional yielding of human cortical bone

Fragility fractures are a result of alterations in bone quantity, tissue properties, applied loads, or a combination of these factors. The current study addresses the contribution of cortical bone tissue properties to skeletal fragility by characterizing the shear damage accumulation processes which occur during torsional yielding in normal bone. Samples of human femoral cortical bone were loaded in torsion and damaged at a post-yield twist level. The number of microcracks within osteons, interstitial tissue, and along cement lines were assessed using basic fuchsin staining. Damage density measures (number of cracks/mm2) were correlated with stiffness degradation and changes in relaxation. Damaged samples exhibited a wide variation in total microcrack density, ranging from 1.1 to 43.3 cracks/mm2 with a mean density of 19.7 +/- 9.8 cracks/mm2. Lamellar interface cracks comprised more than 75% of the total damage, indicating that the lamellar interface is weak in shear and is a principal site of shear damage accumulation. Damage density was positively correlated with secant stiffness degradation, but only explained 22% of the variability in degradation. In contrast, damage density was uncorrelated with the changes in relaxation, indicating that a simple crack counting measure such as microcrack density was not an appropriate measure of relaxation degradation. Finally, a nonuniform microcrack density distribution was observed, suggesting that internal shear stresses were redistributed within the torsion samples during post-yield loading. The results suggested that the lamellar interface in human cortical bone plays an important role in torsional yielding by keeping cracks physically isolated from each other and delaying microcrack coalescence in order to postpone the inevitable formation of the fatal crack.     

Anisotropic patterned population synchrony in climatic gradients indicates nonlinear climatic forcing

Although climatic forcing has been suspected to be the most common cause of spatial population synchrony owing to the Moran effect, it has proved difficult to disentangle the impact of climate from other possible causes of synchrony based on population survey data. Nonlinear population responses to climatic variation may be a part of this difficulty, but they can also provide an opportunity to highlight the climate impacts through targeted survey designs. In particular, when species distribution ranges encompass consistent spatial gradients in climate (e.g. according to latitude or altitude), such gradients can be strategically included in the spatial design of population surveys as to facilitate comparisons of spatial synchrony patterns across and along the gradient. In that case, we predict that nonlinear impacts of climatic variation on population growth rates will result in anisotropic (direction specific) synchrony patterns in the sense that synchrony will drop faster with distance along the climatic gradient than across it. We provide an empirical case study to exemplify survey design and analyses. Of two sympatric species of geometrids, inhabiting an altitudinal gradient in subarctic birch forest, one (Operophtera brumata L.) showed anisotropic synchrony consistent with a strongly nonlinear sensitivity to climatic variation, whereas the other (Epirrita autumnata Bkh.) did not. These results are interpreted in light of the biological characteristics of the species.     

Predicting Distribution and Density of European Badger (<Emphasis Type="Italic">Meles Meles</Emphasis>) Setts in Denmark

Predictive models of the spatial distribution and abundance of species based on habitat characteristics are finding increasing use in management and conservation. The European badger attracts interest as a model species both for conservation reasons and because of the important role the species is playing in understanding carnivore sociality. We developed a statistical habitat model based on presence/absence data on badger setts. To maximise the utility of the model in management, we limited the choice of model variables to those that had a clear basis in badger ecology and that could be obtained on a nation-wide digital format. We extrapolated the habitat model to a region in Denmark and developed a threshold-independent sett distribution algorithm to estimate sett densities. The habitat model was simpler than previously published models of badger sett habitat selection, but nevertheless had a predictive ability in excess of 80% judged against independent data. The sett distribution algorithm was able to simultaneously reproduce several observed patterns of sett density and distribution over the probability gradient. It thus represents a significant improvement over threshold-dependent methods used to discriminate between suitable and unsuitable habitat predicted by presence/absence regression models. Our approach demonstrates that a model of badger sett habitat suitability with high predictive power can be obtained using easily accessible map-variables and presence/absence data. This is a prerequisite for using habitat models as predictive tools over large areas. The use of a simple sett distribution algorithm circumvents the common problem of subjectively fixing a threshold to discriminate between suitable and unsuitable habitat. In conjunction the models presented here constitute an important contribution to the management of the badger in Denmark and, upon further validation, possibly to similar regions in Northern Europe.     

Hydrostatic pressure induces apoptosis in human chondrocytes from osteoarthritic cartilage through up-regulation of tumor necrosis factor-alpha,inducible nitric oxide synthase,p53, c-myc,and bax-alpha,and suppression of bcl-2

Hydrostatic pressure (HP) is thought to increase within cartilage extracellular matrix as a consequence of fluid flow inhibition. The biosynthetic response of human articular chondrocytes to HP in vitro varies with the load magnitude, load frequency, as well as duration of loading. We found that continuous cyclic HP (5 MegaPascals (MPa) for 4 h; 1 Hz frequency) induced apoptosis in human chondrocytes derived from osteoarthritic cartilage in vitro as evidenced by reduced chondrocyte viability which was independent of initial cell densities ranging from 8.1 x 10(4) to 1.3 x 10(6) cells ml(-1). HP resulted in internucleosomal DNA fragmentation, activation of caspase-3, and cleavage of poly-ADP-ribose polymerase (PARP). At the molecular level, induction of apoptosis by HP was characterized by up-regulation of p53, c-myc, and bax-alpha after 4 h with concomitant down-regulation of bcl-2 after 2 h at 5 MPa as measured by RT-PCR. In contrast, beta-actin expression was unchanged. Real-time quantitative RT-PCR confirmed a HP-induced (5 MPa) 1.3-2.6 log-fold decrease in bcl-2 mRNA copy number after 2 and 4 h, respectively, and a significant increase (1.9-2.5 log-fold) in tumor necrosis factor-alpha (TNF-alpha) and inducible nitric oxide synthase (iNOS) mRNA copy number after 2 and 4 h, respectively. The up-regulation of p53 and c-myc, and the down-regulation of bcl-2 caused by HP were confirmed at the protein level by Western blotting. These results indicated that HP is a strong inducer of apoptosis in osteoarthritic human chondrocytes in vitro.