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Content validity is the most important property of PROMs. The COSMIN initiative has published guidelines for evaluating the content validity of PROMs, but they have only sparsely been applied to relevant PROMs for musculoskeletal conditions. The aim of this study was to use the COSMIN Risk of Bias checklist to evaluate the content validity of five PROMs, that are highly relevant in musculoskeletal research and used by the arthroscopic surgery community: the modified Harris’ Hip Score (mHHS), the Copenhagen Hip and Groin Outcome Score (HAGOS), the International Knee Documentation Committee Subjective Knee evaluation Form (IKDC-SKF), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Knee Numeric-Entity Evaluation Score ACL (KNEES-ACL). The development articles for the five PROMs were identified through searches in PubMed and SCOPUS. A literature search was performed to identify additional studies assessing content validity of the PROMs. Additional information, necessary for the assessments, was obtained from the PROM developers after direct request. To evaluate the quality of the development studies and rate the content validity, the COSMIN Risk of Bias checklist was applied to all studies. All five development studies were identified. Three subsequent content validity studies were identified, all evaluating KOOS and one also IKDC. One content validity study was of inadequate quality and excluded from further analysis. The development of mHHS, IKDC-SKF, and KOOS was rated inadequate and possess insufficient content validity for their target populations. Due to the irrelevance of multiple items, KOOS was in particular inappropriate to evaluate patients with an ACL injury. The development of HAGOS was also rated inadequate, although the insufficiency aspects can be regarded as minor. KNEES-ACL possessed sufficient content validity. Out of five PROMs, only KNEES-ACL possessed sufficient content validity. Particularly, KOOS should not be used as an outcome for patients with an ACL injury. There is an urgent need for condition-specific PROMs for musculoskeletal conditions, developed with adequate methods. III.

Background and purpose — The UCLA Activity Scale (UCLA) is a questionnaire assessing physical activity level from 1 (low) to 10 (high) in patients undergoing hip or knee arthroplasty (HA/KA). After translation and cultural adaptation, we evaluated the measurement properties of the Danish UCLA. Patients and methods — After dual panel translation, cognitive interviews were performed among 55 HA/KA patients. An orthopedic surgeon and a physiotherapist estimated UCLA scores for 80 KA patients based on short interviews. Measurement properties were evaluated in 130 HA and 134 KA patients preoperatively and 1-year postoperatively. Results — To suit Danish patients of today, several adaptations were required. Prior to interviews, 4 patients were excluded, and 11 misinterpreted the answer options. Examiners rated the remaining 65 patients (mean age 67 years) 0.2–1.6 UCLA levels lower than patients themselves. The 130 HA and 134 KA patients (mean age 71/68 years) changed from 4.3 (SD 1.9)/4.5 (1.8) preoperatively to 6.6 (1.8)/6.2 (1.0) at 1-year follow-up. 103 (79%) HA and 89 (66%) KA patients reported increased activity. Effect sizes were large (1.2/0.96). Knee patients reaching minimal important change (MIC, ≥ 8 Oxford Knee Score points) had higher 1-year UCLA scores than patients not reaching MIC. Interpretation — Original scale development was undocumented. Content validity was questionable, and there was discrepancy between patient and examiner estimates. UCLA appears valuable for measuring change in self-reported physical activity on a group level. 4 out of 5 HA patients and 2 out of 3 KA patients were more physically active 1 year after joint replacement surgery.

ObjectivesKnee injury and Osteoarthritis Outcome Score (KOOS)-Child is a modification of the adult KOOS aiming to evaluate knee injury, including ACL deficiency. However, the measurement properties of KOOS-Child have not been assessed in a cohort of children with ACL deficiency. We aimed to study the structure of KOOS-Child using modern test theory models (Rasch analysis and confirmatory factor analysis (CFA)).MethodsData were collected prospectively in a cohort of children with ACL deficiency at three time points: before-and-after ACL surgery, and at 1-year follow-up. For each subscale, structural validity through the fit of a CFA model was evaluated for 153 respondents. Modification indices were examined to find the model of best fit, confirmed using Rasch analysis. Responsiveness was reported for each subscale. Reliability was calculated for each item. Floor and ceiling effects, and Person-item distribution were reported.ResultsAll subscales showed inadequate fit to a unidimensional CFA model. Rasch analysis confirmed these results. Adjusting the subscales improved model fit, although this was still quite poor, except for the quality of life subscale. With one exception, all items demonstrated ceiling effects. Person-item distribution confirmed this. Due to lack of fit, reliability was not reported. All subscales were able to detect change from baseline to 1-year follow-up.ConclusionsKOOS-Child exhibits inadequate measurement properties in its current form for children with ACL deficiency. Suggestions to make the subscales fit the models better and improve accuracy of KOOS-Child are presented. However, the large ceiling effects observed may reduce sensitivity and induce type 2 errors.

Multiligament injuries (MLI) of the knee are rare and only ca. 150 MLI reconstructions are performed per year in Denmark. This review summarises the current guidelines for work-up and treatment. Surgical treatment of MLI is centralised to five highly specialised orthopaedic departments, while all hospitals are responsible for the initial treatment and diagnostics. Injury patterns can be complex and demand thorough analysis in collaboration with a department with highly specialised function in MLI. Although a nationwide interdisciplinary approach has been implemented, patients usually do not fully return to their pre-injury activity level and have a higher risk of developing osteoarthritis.

Rasmus Gregersen,1,2 Cathrine Fox Maule,3 Henriette Husum Bak-Jensen,2 Allan Linneberg,3,4 Olav Wendelboe Nielsen,4,5 Simon Francis Thomsen,6 Christian S Meyhoff,2,4,7 Kim Dalhoff,4,8 Michael Krogsgaard,4,9 Henrik Palm,4,9 Hanne Christensen,4,10 Celeste Porsbjerg,4,11 Kristian Antonsen,12 Jørgen Rungby,2,4,13 Steen B Haugaard,2,4,13 Janne Petersen,3,14 Finn E Nielsen1,2 1Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 2Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 3Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 4Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 5Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 6Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 7Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 8Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 9Department of Orthopedics, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 10Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 11Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 12Executive Board, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 13Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; 14Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Rasmus Gregersen, Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark, Email rasmus.gregersen@regionh.dkPurpose: To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark.Patients and Methods: We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016– 2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types.Results: We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9– 3.1%], UrC: 3.1% [3.0– 3.1%], RuC: 3.4% [3.3– 3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3– 20.8%], UrC: 17.3% [17.2– 17.4%], RuC: 17.5% [17.5– 17.6%]).Conclusion: Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas.Keywords: emergency medicine, acute care, urban-rural disparities, registry-based research, Danish national registers, epidemiology

BACKGROUND: Patient reported outcome measures (PROMs) are essential for evaluating treatment of ankle instability (AI). The aim was to assess the content validity and the measurement properties of all relevant PROMs for AI.METHODS: Relevant PROMs were identified from PubMed and SCOPUS. The development and validation quality of the PROMs was assessed according to established scientific standards.RESULTS: Seventeen PROMs and 56 validation studies were analyzed. Content validity, which ensures the PROM measures what is relevant, is obtained by involving target patients in the development process. Only three PROMs identified had some degree of patient involvement (Cumberland Ankle Instability Tool (CAIT), Lower Extremity Function Scale (LEFS), and the Foot and Ankle Ability Measure (FAAM)). Of these, only FAAM was somewhat rigorously validated using modern psychometric validation methods, and exhibited superior measurement properties (construct validity).CONCLUSION: No existing PROM is completely adequate to evaluate AI. However, FAAM is the best choice.

This review summarises the present knowledge of diagnosing and treating hip joint pain. The results of joint preserving surgery are good in symptomatic patients with hip dysplasia, acetabular retroversion or impingement (cam or pincer) without signs of osteoarthritis. Confirmation of intraarticular pathology as the cause of symptoms is established clinically, and the pathology can in many cases be visualised by a standing, standardised radiograph of the pelvis, which is the basis for admission to the relevant orthopaedic department. We present an algorithm for this. Dysplasia and retroversion can be treated by periacetabular osteotomy and impingement by arthroscopic procedures.

PURPOSE: To compare knee kinematics before and after anterior cruciate ligament ACL reconstruction (ACL-R) using hamstring graft (HG) and a double-stranded iliotibial tract graft attached to Gerdy's tubercle (providing an extra-articular anterolateral tenodesis) (named the modified iliotibial tract graft = MIT). METHOD: Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee. RESULTS: ACL resection resulted in a significant increase in AT (p

A statistical model describing the random distribution of substituted xylopyranosyl residues in arabinoxylooligosaccharides is suggested and compared with existing experimental data. Structural diversity of arabinoxylooligosaccharides of various length, originating from different arabinoxylans (wheat flour arabinoxylan (arabinose/xylose, A/X = 0.47); grass arabinoxylan (A/X = 0.24); wheat straw arabinoxylan (A/X = 0.15); and hydrothermally pretreated wheat straw arabinoxylan (A/X = 0.05)), is semiquantitatively approximated using the proposed model. The suggested approach can be applied not only for prediction and quantification of arabinoxylooligosaccharides' structural diversity, but also for estimate of yield and selection of the optimal source of arabinoxylan for production of arabinoxylooligosaccharides with desired structural features.

This study examines enzymatic production of linear xylooligosaccharides (XOS) and branched arabinoxylooligosaccharides (AXOS) from monocotyledonous biomass, wheat straw and ryegrass, and compares the in vitro effects of these XOS and AXOS on pig gut microbiota. XOS and AXOS were obtained from the biomass by treatment with different endo-1,4-β-xylanases. XOS of DP2-6 from wheat straw, obtained after treatment with Aspergillus niger endo GH11, suppressed growth of Clostridium perfringens and resulted in a high level of lactic acid production when fermented in vitro by pig fecal microbiota. Analogously, XOS ryegrass produced in the same way also suppressed Cl. perfringens growth, and more so than the corresponding ryegrass AXOS, but AXOS exhibited a more pronounced stimulation of lactic acid bacteria growth than XOS. The prebiotic potential, i.e., suppression of Cl. perfringens and stimulation of lactic acid bacteria, for the ryegrass oligosaccharides was as follows: XOS, produced by A. niger endo-1,4-β-xylanase (GH 11) ≥ AXOS, produced by Thermotoga maritima and Cellvibrio mixtus endo-1,4-β-xylanase s (GH10) > AXOS, produced by Trichoderma viride and Aspergillus aculeatus endo-1,4-β-xylanase s (GH11). These results indicate that wheat straw as well as green grass biomass such as ryegrass have potential as new sources of putative prebiotics for pig feed.

Introduction Plantar fasciitis (PF) is a frequently diagnosed condition. Lifetime incidence of PF is 10%. Operation is normally only considered in PF that is refractory for non-surgical treatment. We hypothesised that operation is useful as primary treatment of PF. Materials and methods 30 consecutive patients (age 20–65 years) with PF for more than 3 months and ultrasound thickness above 4.0 mm were after informed consent randomised to 1) conservative treatment with training and corticosteroid injection (best conservative treatment); 2) endoscopic 2-incision technique of partial fasciotomy and heel spur removal. Patients were evaluated at entry, 3, 6, 12 and 24 months with the Foot Function Index (FFI, range 0–230) and pain during activity on a 100 mm VAS score (VAS-activity). FFI at 6 and 12 months were defined a-priory as primary endpoints. Results We found no intergroup difference at baseline or at 3 and 6 months. Endoscopic operation were significantly better for the primary endpoint at 12 months in FFI (p=0.033) compared to non-surgical treatment, and at 24 months there were still a strong tendency in favour of operation in FFI (p=0.06). VAS-activity was without intergroup differences at 12 month, but at 24 months we found a significant intergroup difference (p=0.001) in favour of operation. Both groups improved significantly over time. No severe complications were observed in any of the groups. Conclusions This is the first study to prove a beneficial effect of operation for plantar fasciitis after 1 and 2 years compared to best conservative practice in a randomised controlled trial.

Background: Tibial plateau fractures (TPFs) are sometimes overlooked in the emergency room (ER). Using a national register covering 18 years we aimed to find out why and to evaluate if use of a specific radiographic decision rule, Pittsburgh Knee Rules (PKRs), could have reduced the number of overlooked TPFs. Methods: Medical records for 137 patients, prospectively registered during 18 years by the Danish Patient Compensation Association (DPCA) (a national register), were studied. The inclusion criterion was a delayed diagnosis of a fracture in the knee following a trauma. Case records, legal assessments, and evaluations by specialist doctors were reviewed, and the consequences of the delayed diagnosis for outcome and treatment were registered. Results: Only 58 patients (42%) had been evaluated according to PKRs. In 53 patient cases, the fracture was not diagnosed on radiographs obtained at the first medical contact. However, in 84% of these cases, the fracture was visible or was suspected by retrospective evaluation. 50 out of 79 patients, for whom X-rays were not obtained, were candidates for radiographs according to PKRs, 17 cases lacked information to evaluate by PKRs and 12 cases were not candidates. In 53% of all cases, it was evaluated that the fracture position had worsened at the time of diagnosis. A significant disability compensation was granted in 36% of cases due to the delayed identification of fractures, totaling 841,000 EUR. Conclusions: The major reasons for overlooking TPFs were 1) difficulty in recognizing the fractures on X-rays and 2) that X-ray decision rules were not employed. Two thirds of the patients, for whom a radiograph had not been prescribed, would have had an X-ray, if the PKRs had been used. Overlooking TPFs significantly increased patient disability in one third of cases. We recommend that healthcare professionals in the ER use X-ray decision rules in addition to clinical examination to avoid overlooking TPFs. When standard radiographs are evaluated as normal in patients that are clinically suspect of a TPF, oblique X-rays, magnetic resonance imaging (MRI) or Computed Tomography (CT)-scan should be considered.

Complex regional pain syndrome is a challenging condition that includes a broad spectrum of sensory, autonomic, and motor features predominantly in extremities recovering from a trauma. Few large-scale studies have addressed occurrence of and factors associated with complex regional pain syndrome (CRPS) following orthopedic treatment. The present study aimed to identify factors associated with post-treatment development of CRPS.Using the Danish Patient Compensation Association's database, we identified 647 patients claiming post-treatment CRPS between 1992 and 2015. Age, gender, initial diagnosis, treatment, and amount of compensation were extracted. Multivariate logistic regressions were performed to identify variables associated with approval of the claim. For carpal tunnel syndrome (CTS) patients, we registered whether symptoms were bilateral or unilateral and if neurophysiology prior to treatment was pathologic.The following ratios were found: women:men was 4:1, primary diagnosis to the upper limb:lower limb was 2.5:1, and surgical:nonsurgical treatment was 3:1. Mean age was 47.5 ± 13.7 years, and no intergender difference was detected. Antebrachial fracture (23%) and CTS (9%) were the most common primary conditions. Surgical treatment was associated with approval of the claim (odds ratio 3.5, 95% confidence interval 2.3 to 5.3; P0.001). Half of CTS patients had normal neurophysiology prior to surgery; among patients with unilateral symptoms, 71.4% had normal neurophysiology.Female gender, surgical treatment, and treatment to the upper limb were risk factors. Elective surgery accounted for a large number of post-treatment CRPS patients. In CTS patients developing CRPS, normal neurophysiological examination findings were common, and it could be suspected that these patients were suffering from an pre-clinical stage of CRPS, not CTS.

This study investigated the kinetics of multi-enzymatic degradation of soluble wheat arabinoxylan by monitoring the release of xylose and arabinose during designed treatments with mono-component enzymes at different substrate concentrations. The results of different combinations of α- l -arabinofuranosidases (EC 3.2.1.55), one derived from Aspergillus niger (AF An ) and one from Bifidobacterium adolescentis (AF Ba ), respectively, a β-xylosidase (EC 3.2.1.37) from Trichoderma reesei , and an engineered D11F/R122D variant of Bacillus subtilis XynA endo-1,4-β-xylanase (EC 3.2.1.8) were examined. The two selected α- l -arabinofuranosidases catalyze liberation of arabinose residues linked 1 → 3 to singly (AF An ) or doubly (AF Ba ) substituted xyloses in arabinoxylan, respectively. When added to arabinoxylan at equimolar levels, the AF Ba enzyme catalyzed the release of more arabinose, i.e. had a higher rate constant than AF An , but with respect to the xylose release, AF An – as expected – exhibited a better synergistic effect than AF Ba with β-xylosidase. This synergistic effect with AF An was estimated to increase the number of β-xylosidase catalyzed cuts from ∼3 (with β-xylosidase alone) to ∼7 in each arabinoxylan substrate molecule. However, the synergistic effects between β-xylosidase and the α- l -arabinofuranosidases on the xylose release were low as compared to the effect of xylanase addition with β-xylosidase, which increased the xylose release by ∼25 times in 30 min, to a yield equivalent to ∼104 β-xylosidase catalyzed cuts in each arabinoxylan substrate molecule. At equimolar addition levels of the four enzymes, the xylanase activity was thus rate-limiting for the β-xylosidase catalyzed depolymerization to release xylose from arabinoxylan. The work provides clues to design efficient enzymatic degradation of arabinoxylan into fermentable monosaccharides.

The aging process of tendon tissue is associated with decreased collagen content and increased risk for injuries. An essential factor in tendon physiology is transforming growth factor-β1 (TGF-β1), which is presumed to be reduced systemically with advanced age. The aim of this study was to investigate whether human serum from elderly donors would have an inhibiting effect on the expression of collagen and collagen-related genes as well as on cell proliferative capacity in tendon cells from young individuals. There was no difference in systemic TGF-β1 levels in serum obtained from young and elderly donors, and we found no difference in collagen expression when cells were subjected to human serum from elderly versus young donors. In addition, tendon cell proliferation was similar when culture medium was supplemented with serum of different donor age. These findings suggest that factors such as the cell intrinsic capacity or the tissue-specific environment rather than systemic circulating factors are important for functional capacity throughout life in human tendon cells.

In a 4-h laboratory exercise, students accomplish a series of enzymatic macerations of apple mash, assess the viscosity of the mash during the maceration, extract the juice by centrifugation, and measure the levels of antioxidant phenols extracted into the juice after different enzyme treatments. The exercise shows the impact of enzyme-catalyzed plant cell-wall degradation on the viscosity of apple fruit mash and on the extraction of antioxidant phenols into experimentally prepared apple juice. The exercise also demonstrates that pectinolytic and cellulolytic enzymes have different effects on the viscosity of apple mash. Depending on the academic skills and background of the students, various aspects of quantitative enzyme activity assessment and advanced data analysis of decay curves can be included in the postexercise discussions and reporting of the data.

The adaptive response of connective tissue to loading requires increased synthesis and turnover of matrix proteins, with special emphasis on collagen. Collagen formation and degradation in the tendon increases with both acute and chronic loading, and data suggest that a gender difference exists, in that females respond less than males with regard to an increase in collagen formation after exercise. It is suggested that estrogen may contribute toward a diminished collagen synthesis response in females. Conversely, the stimulation of collagen synthesis by other growth factors can be shown in both animal and human models where insulin-like growth factor 1 (IGF-I) and transforming growth factor-beta-1 (TGF-beta-1) expression increases to accompany or precede an increase in procollagen expression and collagen synthesis. In humans, it can be demonstrated that an increase in the interstitial concentration of TGF-beta, PGE2, IGF-I plus its binding proteins and interleukin-6 takes place after exercise. The increase in IGF-I expression in tendon includes the isoform that has so far been thought only to exist in skeletal muscle (mechano growth factor). The increase in IGF-I and procollagen expression showed a similar response whether the tendon was stimulated by concentric, isometric or eccentric muscle contraction, suggesting that strain rather that stress/torque determines the collagen-synthesis stimulating response seen with exercise. The adaptation time to chronic loading is longer in tendon tissue compared with contractile elements of skeletal muscle or the heart, and only with very prolonged loading are significant changes in gross dimensions of the tendon observed, suggesting that habitual loading is associated with a robust change in the size and mechanical properties of human tendons. An intimate interplay between mechanical signalling and biochemical changes in the matrix is needed in tendon, such that chemical changes can be converted into adaptations in the morphology, structure and material properties.

The accumulation of formaldehyde and the resulting deterioration of seafood products during frozen storage are primarily caused by the enzymatic activity of trimethylamine oxide aldolase (TMAOase). A screening of muscle samples from 24 species showed TMAOase activity in only the nine gadiform species that were analyzed. Enzyme activities in the major white muscle of gadiform fish showed large variations between species as well as between individuals. A frozen storage experiment showed a similarly large variation in the rate of formaldehyde accumulation, which could be accounted for by the endogenous white muscle in situ TMAOase activity. This TMAOase activity also correlated with the rate of insolubilization of otherwise high ionic strength soluble protein. A simple model describing the accumulation of free formaldehyde during frozen storage of gadiform fish is proposed. The model is based on a storage time-dependent decay of substrate-saturated white muscle TMAOase activity. Keywords: TMAO; trimethylamin...

Objective. Persistent weakness is a common problem after anterior cruciate ligament- (ACL-) reconstruction. This study investigated the effects of high-intensity (HRT) versus low-intensity (LRT) resistance training on leg extensor power and recovery of knee function after ACL-reconstruction.Methods. 31 males and 19 females were randomized to HRT (n=24) or LRT (n=26) from week 8–20 after ACL-reconstruction. Leg extensor power, joint laxity, and self-reported knee function were measured before and 7, 14, and 20 weeks after surgery. Hop tests were assessed before and after 20 weeks.Results. Power in the injured leg was 90% (95% CI 86–94%) of the noninjured leg, decreasing to 64% (95% CI 60–69%) 7 weeks after surgery. During the resistance training phase there was a significant group by time interaction for power (P=0.020). Power was regained more with HRT compared to LRT at week 14 (84% versus 73% of noninjured leg, resp.;P=0.027) and at week 20 (98% versus 83% of noninjured leg, resp.;P=0.006) without adverse effects on joint laxity. No other between-group differences were found.Conclusion. High-intensity resistance training during rehabilitation after ACL-reconstruction can improve muscle power without adverse effects on joint laxity.

Knee joint angle reproduction was measured without loading of the quadriceps and during concentric quadriceps contractions at 20% of maximal voluntary contraction. The threshold of movement detection was measured. The reproducibility of the methods and the effect of an acute ACL rupture < 10 wks post-injury were examined. A test-retest protocol with a 1 wk hiatus was conducted on 15 healthy subjects. Side-to-side differences were tested in 10 patients with acute ACL rupture. The test-retest protocol did not show any significant differences and yielded correlations of r=0.7-0.9 (p

5 páginas, 3 tablas, 2 figuras, The formation of dimethylamine and formaldehyde from trimethylamine N-oxide by the enzyme trimethylamine N-oxide demethylase in whole hake during frozen storage was studied. The objective was to check if there were parts of the muscle with a higher production of dimethylamine and formaldehyde, and if the presence of kidney during frozen storage had any significant influence on the production. Three variables were examined through one year storage. The first was anatomical location, considering the red muscle and three zones of white muscle, one located right over the kidneys, the dorsal part over the viscera, and the tail. The second variable was the temperature of storage, –11 °C or –18 °C. Finally, the influence of kidneys during storage, comparing fish with and without kidneys, was also evaluated. No differences were found in dimethylamine and formaldehyde production between fish with and without kidneys stored at –18 °C. However at –11 °C the amounts of dimethylamine and formaldehyde detected in fish without kidneys were, in some cases, higher than in those with kidneys. Kidney removal does not have a statistically significant influence on DMA and FA production in frozen storage hake. Differences in dimethylamine and formaldehyde values among different anatomical locations were found, especially in those stored over one year. It was found that, in general, the white muscle located right over the kidneys produced more dimethylamine than other parts of the fish., The authors wish to thank the European Commission for financial support of the Research Projects FAIR-CT95-1111 and AIR 3-CT94-1921.

Background Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations. Methods We conducted a multi-centre observer-study. Five experienced shoulder surgeons independently assessed a consecutive series of 193 radiographs at two occasions three months apart. All pairs of radiographs were classified according to Neer. Subsequently, the observers were asked to recommend one of three treatment modalities for each case: non-operative treatment, locking plate osteosynthesis, or hemiarthroplasty. Results At both classification rounds mean kappa-values for inter-observer agreement on treatment recommendations (0.48 and 0.52) were significantly higher than the agreement on Neer classification (0.33 and 0.36) (p Conclusions We found a significantly higher agreement on treatment recommendations compared to agreement on fracture classification. The low observer agreement on the Neer classification reported in several observer studies may have less clinical importance than previously assumed. However, inter-observer agreement did not exceed moderate levels.

Carnobacterium piscicola strain A9b isolated from cold smoked salmon inhibits growth of the food-borne pathogen Listeria monocytogenes partly due to the production of a proteinaceous compound (L. Nilsson, L. Gram, and H. H. Huss. J. Food Prot. 62:336-342, 1999). The purpose of the present study was to purify the compound and describe factors affecting its production, with particular emphasis on food-relevant factors. Amino acid sequencing showed that the compound is a class IIa bacteriocin with an N-terminal amino acid sequence identical to that of carnobacteriocin B2. The production of the bacteriocin was autoinducible, and the threshold level for induction was 9.6 × 10 −10 M. We also report, for the first time, that acetate acts as an induction factor, with a threshold concentration of 0.3 to 12 mM. Acetate could not act as an inducer during the late exponential phase of C. piscicola A9b. The induction of bacteriocin production showed a dose-dependent relationship at acetate concentrations of up to 10 to 20 mM (depending on the growth medium) and at a concentration of 1.9 × 10 −8 M for the bacteriocin itself; a saturation level of bacteriocin specific activity was reached at these concentrations of induction factors. The combined use of both inducers did not enhance the saturation level of bacteriocin production compared to that seen with the use of each inducer alone. Increasing NaCl and glucose concentrations negatively influenced the efficiency of acetate as an induction factor. Based on the results, carnobacteriocin B2 was used as an induction factor to manipulate the production of bacteriocin in cold smoked salmon juice and thus improve the ability to inhibit L. monocytogenes .

Dynamic shoulder stability is dependent on muscular coordination and sensory inputs. In the shoulder, mechanoreceptors are found in the coracoacromial ligament, the rotator cuff tendons, the musculotendinous junctions of the rotator cuff and in the capsule. The number of receptors in the capsule is small compared to the number in the other shoulder structures. Proprioceptive information from numerous receptors in muscles and tendons is mediated via fast conducting nervefibers and probably contribute more to kinaestethic sensation than information from capsule and ligaments. Therefore it seems likely that the joint receptors have a more distinct role for the kinaestethic sense than muscle receptors. In cats a direct reflex from the afferents innervating the shoulder to the muscles around the shoulder has been presented. The reflex had an extremely short latency (2.7-3.1 ms). In man, a very long latency (300 ms) excitatory reflex has been found when nerves in the capsule were stimulated electrically during shoulder surgery. In addition, when the anterior-inferior capsule was excited in conscious humans with modest amplitude electrical stimuli during muscle activity, a strong inhibition was found with an average latency of 33 ms. Stimulation of the sensory nerves in the coracoacromial ligament has also been found to modify muscle activity strongly. Even though our understanding of the control of shoulder motion is incomplete, it is clear that sensory inputs can strongly modify muscle activity around the shoulder. This has implications for rehabilitation and shoulder surgery.

Mechanical loading of tendon cells results in an upregulation of mechanotransduction signaling pathways, cell-matrix adhesion and collagen synthesis, but whether unloading removes these responses is unclear. We investigated the response to tension release, with regard to matrix proteins, pro-inflammatory mediators and tendon phenotypic specific molecules, in an in vitro model where tendon-like tissue was engineered from human tendon cells. Tissue sampling was performed 1, 2, 4 and 6 days after surgical de-tensioning of the tendon construct. When tensile stimulus was removed, integrin type collagen receptors showed a contrasting response with a clear drop in integrin subunit α11 mRNA and protein expression, and an increase in α2 integrin mRNA and protein levels. Further, specific markers for tendon cell differentiation declined and normal tendon architecture was disturbed, whereas pro-inflammatory molecules were upregulated. Stimulation with the cytokine TGF-β1 had distinct effects on some tendon-related genes in both tensioned and de-tensioned tissue. These findings indicate an important role of mechanical loading for cellular and matrix responses in tendon, including that loss of tension leads to a decrease in phenotypical markers for tendon, while expression of pro-inflammatory mediators is induced. publishedVersion

4 páginas, 4 figuras, A two-step assay for trimethylamine-N-oxide aldolase (the target enzyme) is described in which the second step, the indicator reaction, is of the enzymatic end-point type. This indicator reaction is carried out at a slightly alkaline pH, outside the target enzyme's active pH range. An effective inactivation of the target enzyme is thus obtained solely by shifting the pH to that of the indicator reaction, thereby avoiding a deproteinisation step. By inserting a downward pH step as the stopping method, many samples may be collected and applied to the indicator reaction simultaneously. These features make the method very productive and easy to perform, This work was supported by grant AIR 3 CT 94-1921 from the European Community.

5 páginas, 2 figuras, An enzyme-specific staining method for trimethylamine oxide demethylase (TMAO-ase) was developed. Direct visualization could be reached by coupling the reactions of the specific TMAO-ase assay with another reaction step generating as final product a dark-blue formazan. For these purposes 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) as tetrazolium salt and phenazine methosulfate (PMS) as electron transfer substance were used. Clear, dark-blue colored bands could be detected on 300 μm isoelectric focusing gels (IEF). Comparisons of enzyme-stained and protein-stained gels showed that diffusion could not be observed and that the band pattern of TMAO-ase could also be seen in the protein stain. The pI range where TMAO-ase was located was 5.6—6.6 for extracts and 6.2—6.6 for partially purified TMAO-ase. Specificity of stained TMAO-ase bands was assessed by the preparation of staining solution without the substrate trimethylamine oxide (TMAO) and by extraction of TMAO-ase from the gel and performance of the specific TMAO-ase assay., This work was supported by project AIR 3 CT 94-1921 of the European Community.