The effects of a sleeve knee brace during stair negotiation in patients with symptomatic patellofemoral osteoarthritis

BACKGROUND

The patellofemoral joint is an important source of pain in knee osteoarthritis. Most biomechanical research in knee osteoarthritis has focused on the tibiofemoral joint during level walking. It is unknown what happens during stair negotiation in patients with patellofemoral joint osteoarthritis, a task commonly increasing pain. Conservative therapy for patellofemoral joint osteoarthritis includes the use of a sleeve knee brace. We aimed to examine the effect of a sleeve knee brace on knee biomechanics during stair negotiation in patellofemoral joint osteoarthritis patients.

METHODS

30 patellofemoral joint osteoarthritis patients (40-70 years) ascended and descended an instrumented staircase with force plates under two conditions - wearing a Lycra flexible knee support (Bioskin Patellar Tracking Q Brace) and no brace (control condition). Knee joint kinematics (VICON) and kinetics were recorded.

FINDINGS

During stair ascent, at the knee, the brace significantly reduced the maximal flexion angle (2.70, P = 0.002), maximal adduction angle (2.00, P = 0.044), total sagittal range of motion (2.00, P = 0.008), total frontal range of motion (1.70, P = 0.023) and sagittal peak extension moment (0.05 Nm/kg, P = 0.043) compared to control. During stair descent, at the knee, the brace significantly reduced the maximal flexion angle (1.80, P = 0.039) and total sagittal range of motion (1.50, P = 0.045) compared to control.

INTERPRETATION

The small changes in knee joint biomechanics during stair negotiation observed in our study need to be investigated further to help explain mechanisms behind the potential benefits of a sleeve knee brace for painful patellofemoral joint osteoarthritis.

The effects of feeding nitrate on the development of methaemoglobinaemia in sedentary Bos indicus cattle

Context Nitrate salts can be utilised by the rumen bacteria as a nitrogen source. Nitrate salts can induce a methaemoglobinaemia in cattle if consumed in sufficient quantities. Methaemoglobinaemia is the principal factor that leads to the onset of clinical signs for nitrate toxicity in cattle. A methaemoglobin concentration ≥20% is considered unsafe for cattle. There are, however, limited studies on the longer-term effects of nitrate supplementation on methaemoglobin formation in Bos indicus steers consuming forage that is reflective of northern Australia’s poor quality, native pasture in the dry season. Aims We hypothesised that the Australian government’s recommended daily dose of nitrate salts given to Bos indicus cattle would not cause a methaemoglobinaemia in the blood >20% throughout a 70 day treatment period. Methods A 70 day study was conducted to determine the methaemoglobin, carboxyhaemoglobin, total haemoglobin, growth rate and forage intakes of cattle supplemented with a non-protein-nitrogen treatment containing nitrate (6.48 g NO3/kg dry matter intake (DMI) or no nitrate and consuming a chaffed Flinders grass hay (Iseilema spp.), a C4 species. The dose rate of nitrate was selected to match the Australian government guidelines. Ten 3-year-old fistulated Bos indicus steers (mean liveweight ± s.d., 400.7 ± 26.2 kg) were randomly allocated into two groups (n = 5). Blood samples were collected at 0, 2, 4 and 6 h after treatment with nitrate or no nitrate on days 10, 30, 50 and 70 to measure haemoglobin fractions in the blood. Key Results Nitrate treatment caused the mean methaemoglobin (P < 0.001), peak methaemoglobin (P < 0.001) and carboxyhaemoglobin (P = 0.008) concentration to be greater in the blood of steers compared with steers given no nitrate. Nitrate treatment had no general effect on the total haemoglobin, DMI or bodyweight of steers. Conclusions Bos indicus steers treated with 6.48 g NO3/kg DMI develop a methaemoglobinaemia that does not exceed 20% of total haemoglobin for 70 days. This data supports the Australian government’s recommended feeding rate of nitrate to sedentary Bos indicus steers. Implications The Australian government’s method for feeding nitrate to cattle is safe under the conditions of this study.

The effect of molasses nitrate lick blocks on supplement intake, bodyweight, condition score, blood methaemoglobin concentration and herd scale methane emissions in Bos indicus cows grazing poor quality forage

Context The Australian government has approved a greenhouse gas (GHG) offset method that requires cattle to consume nitrate in the form of a lick block. Field studies demonstrating the effectiveness of this methodology have not been previously reported. Aims This experiment was conducted to determine the effects on productivity and health when nitrate lick blocks were provided as a supplement to grazing beef cattle. We hypothesised that beef cattle given access to nitrate lick blocks would have similar productivity compared with cattle offered urea lick blocks. Methods Bos indicus breeding cows (n = 76) grazed a 467-ha paddock near Charters Towers, Queensland, between May and November 2014. A two-way remote automatic drafting system enabled allocation of cattle to different treatments while grazing in a common paddock. Treatments were 30% urea lick blocks (30U), or molasses nitrate lick blocks (MNB). At monthly intervals liveweight (LW), body condition score (BCS), and blood methaemoglobin concentration were recorded. Estimates of individual supplement intake were made on three separate occasions using a lithium marker technique. Results Mean daily supplement intake (±s.e.m.) of 30U (122 ± 13 g) was greater (P < 0.001) than MNB (67 ± 8 g). Lesser MNB intake was associated with greater variability for individual supplement intake, a greater proportion of non-consumers of supplement during July (P < 0.05) and reduced voluntary supplement intake until October (P < 0.001). Increasing MNB consumption during October and November was accompanied by elevated blood methaemoglobin concentration (P < 0.001). It was estimated that cattle offered MNB had insufficient supplementary nitrogen intake throughout the study to resolve rumen degradable nitrogen deficiency from grazed forage. Consequently, cattle provided access to MNB demonstrated conceptus free liveweight loss and lesser BCS compared with cattle treated with 30U (P < 0.001). Conclusion Nitrate lick blocks were ineffective as a dual-purpose non-protein nitrogen supplement and methane mitigant for beef cattle grazing poor quality forage. Further field experiments are required to determine if there may be situations where this GHG offset methodology is efficacious. Implications Caution is advised in implementing GHG mitigation methods that involve the use of nitrate lick blocks.

Probiotic Bacillus amyloliquefaciens H57 ameliorates subclinical necrotic enteritis in broiler chicks by maintaining intestinal mucosal integrity and improving feed efficiency

Subclinical necrotic enteritis (NE) was induced in broiler chicks using a high dose of Eimeria spp. vaccine in the drinking water on day 9, and Clostridium perfringens (Cp) culture mixed in the feed on days 14 and 15. The aim was to evaluate the effects of probiotic Bacillus amyloliquefaciens strain H57 (H57) in preventing NE in chicks. Day-old Ross 308, male broilers were weighed and randomly assigned to 6 treatment groups (6 replicate cages/treatment and 8 birds/cage). Birds in group 1 (control) were fed the basal wheat-soybean diet without H57 or NE infection; in group 2 (Eimeria) were treated with Eimeria alone; in group 3 (Cp) were treated with Cp alone; in group 4 (NE) received both Eimeria and Cp; in group 5 (NE-H57) received NE infection and H57; and group 6 (H57) received H57. The basal diet of chicks in groups 5 and 6 was supplemented with H57 at a density of 2 × 108 spores/g feed from 1 D of age. On day 21, there were no significant treatment effects on BW and feed intake between control and H57 birds. However, on day 21, the feed conversion ratio of NE-H57 birds was significantly improved when compared with NE birds (1.28 vs. 1.36; P < 0.001). Birds challenged with NE had a higher occurrence of pasty vent than birds infected with either Eimeria, Cp, or NE-H57 (41 vs. 27 vs. 29 vs. 19%, respectively; P < 0.001). Intestinal lesion scores of NE birds were also higher than those of Eimeria, Cp, and NE-H57 birds (5.67 vs. 2.56 vs. 2.78 vs. 2.10, respectively; P < 0.001) and correlated with pasty vent (Pearson's r = 0.56; P < 0.001). Microscopic evaluation showed mucosal damage and necrosis in NE birds. In contrast, villi from NE-H57 birds were normal, with no damage or infiltration with Eimeria or Cp. H57 appears to be effective in challenged birds, as it maintained epithelial barrier integrity and improved feed efficiency.

Supplementation of rangeland primiparous Bos indicus x Bos taurus beef heifers during lactation. 1. Effects on dam milk production and liveweight, bull calf growth, live carcass characteristics and metabolic hormone concentrations

The practice of feeding replacement-breeding bulls on high energy diets after weaning to meet liveweight (LW) and carcass expectations between 18 and 24 months of age negatively affects reproductive potential. This experiment reports upon the effects of an alternative management strategy aimed at improving calfhood nutrition in rangeland-reared bulls to enhance LW and live carcass characteristics at 2 years. Following artificial insemination (AI cohort; n = 26), or natural mating, subsequent to the addition of bulls at 39 d post-AI (NM cohort; n = 36), primiparous Santa Gertrudis heifers grazing rangeland pastures with bull calf progeny were allocated at parturition to receive either nil supplement (control; CON) or provided with unrestricted access to a pelleted vegetable protein meal-based supplement containing 35% CP (SUPP) until weaning at 199 ± (SD) 26 d. The mean estimated pellet consumption by SUPP heifers during lactation was 2.6 ± (SEM) 0.5 kg DM daily. Grazing diet quality measurements indicated nutritional restriction of CON heifers until at least 115 d of lactation. This was confirmed by lower blood urea nitrogen concentrations at 88 d (P < 0.001) and greater mean NEFA (P < 0.001) concentrations. Rainfall during mid-lactation subsequently improved grazing diet quality; thus the CON heifers experienced moderate nutritional restriction across lactation, but sufficient to reduce milk yield by 1.6 kg/d (P < 0.001) and maternal LW at weaning by 18.4 kg (P < 0.001). Bulls reared by SUPP heifers were 17.5 kg heavier at weaning (P = 0.001) and had elevated IGF-I and leptin concentrations between 4 and 4.5 months of age (P < 0.05). Effects on metabolic hormones during calfhood were cohort specific, with greater concentrations of IGF-I confined to AISUPP bulls and NMSUPP bulls demonstrating greater concentrations of leptin. Bulls were amalgamated at weaning and grazed common pastures without supplementation until the experiment concluded at 675 d. Pre-weaning plane of nutrition did not affect the LW, carcass fat depth, IGF-I or leptin concentrations of bulls after weaning. Mean eye muscle area (EMA) was greater in SUPP compared to CON bulls (68.5 ± 0.9 cm²vs 65.2 ± 0.9 cm²; P < 0.05) and AISUPP bulls tended to have greater EMA (P = 0.06) than AICON bulls from 495 d of age. Thus when primiparous heifers experience moderate nutritional restriction during lactation, supplementation may have persistent effects upon increasing carcass muscle characteristics of bull progeny.

Supplementation of rangeland primiparous Bos indicus x Bos taurus beef heifers during lactation. 2. Effects upon the reproductive development of bull calf progeny

This experiment evaluated the effect of pre-weaning plane of nutrition of dams upon reproductive development in Bos indicus x Bos taurus bull offspring reared under extensively managed conditions in the northern Australia rangelands. Following artificial insemination (AI cohort; n = 26), or natural mating (NM cohort; n = 36), grazing primiparous heifers received either nil supplement (Control; CON), thereby experiencing a moderate nutritional restriction, or were provided a protein supplement (SUPP) between parturition and weaning at mean age 199 ± (SD) 26 d. Bull progeny grazed rangeland pastures without supplementation from weaning until the experiment concluded at 675 d. At 120 ± 3 d and 140 d ± 10 d age, within the AI and NM cohort, respectively, bull calves were subjected to a GnRH challenge (1.5 μg/kg of body weight i.m.). Jugular blood samples collected immediately before and at 60 min after administration of GnRH were analysed for LH, FSH, testosterone and inhibin concentrations. Overall mean concentrations of testosterone in SUPP bulls were greater in both the AI cohort (P = 0.05) and the NM cohort (P = 0.06). At 60 d intervals during the post-weaning period, scrotal circumference (SC) was measured and semen collected to assess concentration, progressive motility and morphology of sperm. Bulls reared by SUPP heifers had greater (P = 0.05) SC at 375 d and tended to have greater (P = 0.09) mean percentage of morphologically normal sperm (PNS). Within the NM cohort, NMSUPP bulls had greater (P = 0.04) overall mean SC and tended (P = 0.07) to demonstrate both greater progressive motility and PNS. A greater incidence of sperm morphological abnormalities, associated with sexual immaturity, were observed in CON bulls. Consequently, NMCON bulls demonstrated delayed (P = 0.03) age of sexual maturity as compared to NMSUPP bulls. In summary, improving the plane of nutrition supplied to Bos indicus x Bos taurus bulls between parturition and weaning via moderate supplementation of grazing dams reduces age at sexual maturity with consequent economic advantages to the producer.

Effective incorporation of xylanase and phytase in lick blocks for grazing livestock

The addition of feed enzymes to livestock diets has contributed to significant increases in productivity over recent decades. The use of enzymes has been the most common in systems where enzyme delivery and diets can be easily managed, such as for poultry and pigs. Lick blocks supplement the forage diets of ruminants with nitrogen and minerals but not enzymes, due in part to concerns that block manufacturing temperatures would lead to unacceptable levels of enzyme degradation. The nutritional value of low quality pasture could be improved using enzyme supplemented lick blocks if enzymes remain active at the high lick block manufacturing temperatures. The aim of this study was to determine the extent of xylanase and phytase activity survival when exposed to the production of hot poured lick blocks. Lick block formulations and methods of manufacturing vary, so two enzyme containing molasses-based lick blocks were produced, one at 60°C and another at 100°C. The results showed that both the xylanase and phytase enzymes have high levels of survival at 60°C. In the 100°C lick block, the phytase displayed a half-life of ~10 min, whereas the xylanase retained 90% of the original activity after 30 min of exposure. The inherent thermostability of the enzymes were critical factors for enzyme survival and the enzymes were more stable in the lick blocks than in solution. The results indicate that it should be possible to add enzymes to lick blocks manufactured at elevated temperatures to enhance low quality pasture and thereby aid ruminant digestion and production.

Nitrate supplementation has marginal effects on enteric methane production from Bos indicus steers fed Flinders grass (Iseilema spp.) hay, but elevates blood methaemoglobin concentrations

This experiment has quantified the methane abatement potential of nitrate in the context of extensively managed cattle. The experimental protocol consisted of two, 4 × 4 Latin square design using eight rumen fistulated Bos indicus steers fed Flinders grass (Iseilema spp.) hay ad libitum. The treatments were Control (nil nitrogen supplement), urea (32.5 g/day urea) and two levels of calcium nitrate: CaN1 and CaN2 (to provide 4.6 g and 7.9 g NO3/kg DM equivalent to ~0.46% and 0.80% of DM, respectively). Complete supplement intake was ensured by dosing any supplement that had not been voluntarily consumed, through the rumen fistula, 1 h after feeding. Enteric methane production was measured using open circuit respiration chambers. Methane yield (g/kg DM intake) from the CaN2 treatment tended to be lower (P < 0.07) than either the Control or urea treatments. There were no significant differences in methane yield between Control, urea or CaN1 treatments. Mean blood methaemoglobin concentrations were significantly (P < 0.001) higher for CaN2 animals compared with the Control, urea or CaN1 treatments. In addition, a significant time effect after dosing (P < 0.001) and a significant interaction between treatment and time after dosing (P < 0.001) was apparent. Overall mean total volatile fatty acid concentration was 74.0 ± 1.53 mM with no significant treatment effect, but a significant effect for both time of sampling (3 h vs 6 h) within days and among 7 sampling days. The inclusion of calcium nitrate as a non-protein-N source significantly reduced the molar proportions of butyrate (P < 0.001), iso-butyrate (P < 0.05) and iso-valerate (P < 0.001) compared with the Control. The provision of nitrate supplements, providing both a NPN and an alternative sink for H that would otherwise support enteric methanogenesis, has some potential. In extensive grazing systems effective methane abatement strategies are required. The elevated concentration of MetHb using CaN2 suggests that the strategy of replacing urea with nitrate in supplements fed to extensively managed cattle in the northern rangelands may be inappropriate where supplement intake cannot be controlled on an individual animal basis and forage quality is seasonally variable.

The effect of nitrate supplementation on arterial blood gases, haemoglobin fractions and heart rate in Bos indicus cattle after exercise

The objective of this study was to investigate the effects of nitrate treatment on the arterial blood gas and haemoglobin fractions from Bos indicus steers after exercise. Bos indicus steers (n = 12; mean bodyweight ± s.e.m., 397 kg ± 10.84 kg) were used in this experiment to investigate the effects of three dose rates of nitrate salts (0, 30 or 50 g of nitrate/day) on arterial blood gases, methaemoglobin concentration, carboxyhaemoglobin concentration, oxyhaemoglobin concentration, total haemoglobin concentration, haematocrit, heart rate, and respiratory rate after exercise. Increasing the dose rate of nitrate resulted in a decrease in the partial pressure of oxygen (P = 0.004) in blood. Steers treated with 50 g nitrate/day had a decrease in oxyhaemoglobin concentration (P = 0.001) and a concomitant increase in methaemoglobin (P = 0.001) and carboxyhaemoglobin (P = 0.001) compared with steers treated with 0 or 30 g nitrate/day. Steers dosed with 50 g of nitrate had greater heart rates immediately after the exercise regimen compared with the steers dosed with 30 g of nitrate (P = 0.043) or no nitrate (P = 0.018). There was no difference between treatments for respiratory rate (P = 0.673) or rectal temperature (P = 0.207) after the exercise regimen. Feeding nitrate to Bos indicus cattle results in a decrease in the oxygen carrying capacity of their blood. It is likely that doses of nitrate greater than 50 g per day for this class of animal could induce hypoxaemic trauma if cattle have exercise imposed after consuming a nitrate supplement.

Peri-conception and first trimester diet modifies reproductive development in bulls

Nutritional perturbation during gestation alters male reproductive development in rodents and sheep. In cattle both the developmental trajectory of the feto–placental unit and its response to dietary perturbations is dissimilar to that of these species. This study examined the effects of dietary protein perturbation during the peri-conception and first trimester periods upon reproductive development in bulls. Nulliparous heifers (n = 360) were individually fed a high- or low-protein diet (HPeri and LPeri) from 60 days before conception. From 24 until 98 days post conception, half of each treatment group changed to the alternative post-conception high- or low-protein diet (HPost and LPost) yielding four treatment groups in a 2 × 2 factorial design. A subset of male fetuses (n = 25) was excised at 98 days post conception and fetal testis development was assessed. Reproductive development of singleton male progeny (n = 40) was assessed until slaughter at 598 days of age, when adult testicular cytology was evaluated. Low peri-conception diet delayed reproductive development: sperm quality was lowered during pubertal development with a concomitant delay in reaching puberty. These effects were subsequent to lower FSH concentrations at 330 and 438 days of age. In the fetus, the low peri-conception diet increased the proportion of seminiferous tubules and decreased blood vessel area in the testis, whereas low first trimester diet increased blood vessel number in the adult testis. We conclude that maternal dietary protein perturbation during conception and early gestation may alter male testis development and delay puberty in bulls.

Subacute ruminal acidosis reduces sperm quality in beef bulls

Breeding bulls are commonly fed high-energy diets, which may induce subacute ruminal acidosis (SARA). In this experiment, 8 Santa Gertrudis bulls (age 20 ± 6 mo) were used to evaluate the extent and duration of effects of SARA on semen quality and the associated changes in circulating hormones and metabolites. The bulls were relocated and fed in yards with unrestricted access to hay and daily individual concentrate feeding for 125 d before SARA challenge. Semen was collected and assessed at 14-d intervals before the challenge to ensure acclimatization and the attainment of a stable spermiogram. The challenge treatments consisted of either a single oral dose of oligofructose (OFF; 6.5 g/kg BW) or an equivalent sham dose of water (Control). Locomotion, behavior, respiratory rate, and cardiovascular and gastrointestinal function were intensively monitored during the 24-h challenge period. Rumen fluid samples were retained for VFA, ammonia, and lactate analysis. After the challenge, semen was then collected every third day for a period of 7 wk and then once weekly until 12 wk, with associated blood collection for FSH, testosterone, inhibin, and cortisol assay. Percent normal sperm decreased in bulls dosed with OFF after the challenge period ( < 0.05) and continued to remain lower on completion of the study at 88 d after challenge. There was a corresponding increase in sperm defects commencing from 16 d after challenge. These included proximal cytoplasmic droplets ( < 0.001), distal reflex midpieces ( = 0.01), and vacuole and teratoid heads ( < 0.001). Changes in semen quality after challenge were associated with lower serum testosterone ( < 0.001) and FSH ( < 0.05). Serum cortisol in OFF bulls tended to be greater ( = 0.07) at 7 d after challenge. This study shows that SARA challenge causes a reduction in sperm quality sufficient to preclude bulls from sale as single sire breeding animals 3 mo after the event occurred.

Vitamin A deficiency in Bos indicus heifers fed a wheat straw diet cannot be corrected with algae lick blocks or intramuscular injectable retinyl palmitate treatments

Serum and liver retinol concentrations and blood β-carotene concentrations were studied in 30 Bos indicus heifers rendered deficient of vitamin A over 180 days and then given treatments of access to algae-based lick blocks (n = 10), injectable retinyl palmitate and molasses-based lick blocks (n = 10), or a negative control given access to molasses-based lick blocks only (n = 10). All heifers became deficient in blood and liver vitamin A, as well as blood β-carotene by 180 days. There was no treatment effect on bodyweight (P = 0.347). However, a highly significant effect of time (P = 0.001) was detected where all heifers achieved an average daily gain of 0.74 kg/day throughout the depletion phase of the study but lost 0.150 kg/day during the repletion phase. The concentrations of serum and liver retinol and blood β-carotene were not different between treatment groups (P = 0.362, P = 0.535 and P = 0.839) during the depletion or repletion phases of the study. All heifers continued to be rendered deficient in the concentrations of serum and liver retinol and blood β-carotene throughout the experiment demonstrating a highly significant effect of time (P = 0.001). Injectable retinyl palmitate (818 100 IU retinol) or access to algal lick blocks (4180 IU retinol) did not elevate blood or liver retinol concentrations in heifers rendered deficient of vitamin A. It is speculated that the protein-deficient diet fed to the heifers had an adverse effect on the blood retinol transport proteins.

A knee brace alters patella position in patellofemoral osteoarthritis: a study using weight bearing magnetic resonance imaging

OBJECTIVE

To assess using weight bearing magnetic resonance imaging (MRIs), whether a patellar brace altered patellar position and alignment in patellofemoral joint (PFJ) osteoarthritis (OA).

DESIGN

Subjects age 40-70 years old with symptomatic and a radiographic Kellgren-Lawrence (K-L) evidence of PFJOA. Weight bearing knee MRIs with and without a patellar brace were obtained using an upright open 0.25 T scanner (G-Scan, Easote Biomedica, Italy). Five aspects of patellar position were measured: mediolateral alignment by the bisect offset index, angulation by patellar tilt, patellar height by patellar height ratio (patellar length/patellar tendon length), lateral patellofemoral (PF) contact area and finally a measurement of PF bony separation of the lateral patellar facet and the adjacent surface on the femoral trochlea (Fig. 1).

RESULTS

Thirty participants were recruited (mean age 57 SD 27.8; body mass index (BMI) 27.8 SD 4.2); 17 were females. Four patients had non-usable data. Main analysis used paired t tests comparing within subject patellar position with and without brace. For bisect offset index, patellar tilt and patellar height ratio there were no significant differences between the brace and no brace conditions. However, the brace increased lateral facet contact area (P = .04) and decreased lateral PF separation (P = .03).

CONCLUSION

A patellar brace alters patellar position and increases contact area between the patella and femoral trochlea. These changes would lower contact stress at the PFJ. Such changes in patella position in weight bearing provide a possible biomechanical explanation for the success of the PFJ brace in clinical trials on PFJOA.

An evaluation of exercise regimes for patients with osteoarthritis of the knee: a single-blind randomized controlled trial

Osteoarthritis (OA) of the knee is a major public health problem in the United Kingdom and various forms of physiotherapy are used in the treatment of this condition despite the lack of studies evaluating its efficacy. The purpose of this study was to compare the efficacy of two different forms of physiotherapy exercise management with a control group.

Twenty-seven patients with OA knee were recruited from routine orthopaedic clinics and were on the waiting-list for physiotherapy. Patients were randomly allocated to three groups. Group 1 ( n = 9) consisted of a control group; Group 2 ( n = 8) consisted of supervised sessions of exercises; Group 3 ( n = 10) consisted of an advice and instruction session plus a functional home exercise regime.

Parameters measured were: pain; range of motion; quadriceps strength; knee joint swelling; exercise tolerance.

Results were analysed using a Kruskal-Wallis analysis of variance and a Mann-Whitney U-test with the significance level set at p <0.05. The results showed no significant difference ( p >0.05) between any of the outcome measures of the three groups. This study concludes that patients with OA knee can be helped most economically by one session of advice and a functional home exercise regime. This can be done in a group setting under supervision of one physiotherapist.

The effect of feeding frequency and dose rate of nitrate supplements on blood haemoglobin fractions in Bos indicus cattle fed Flinders grass (Iseilemia spp.) hay

Twelve Bos indicus steers (liveweight ± s.d., 317.8 ± 28.5) kg were used in an experiment to examine two factors: daily nitrate dose (0, 30, 40 or 50 g of nitrate/day) and feeding frequency (once or twice a day) on methaemoglobin concentration, daily peak methaemoglobin concentration, rate of incline for methaemoglobin concentration, carboxyhaemoglobin concentration, oxyhaemoglobin concentration, total haemoglobin concentration, haematocrit and dry matter intake of Flinders grass hay. Increasing the dose rate of nitrate increased the fraction of methaemoglobin in the blood of steers (P = 0.014). A highly significant effect was demonstrated for the interaction of dose rate × day (P < 0.001). For once a day intake of nitrate, the dose rates of 40 and 50 g per day showed a greater increase in mean methaemoglobin values than for the 0 and 30 g of nitrate per day. Increasing the dose rate of nitrate also increased the daily peak methaemoglobin fraction and the rate of incline to peak methaemoglobin values for both once and twice a day feeding of the nitrate supplements. However, increasing the dose of nitrate had no significant overall effect on total haemoglobin, deoxyhaemoglobin, carboxyhaemoglobin, haematocrit or dry matter intake. Twice a day feeding of nitrate decreased the formation of methaemoglobin in the blood of Bos indicus steers. This study demonstrates that caution should be exercised when feeding nitrates as a non-protein nitrogen source to cattle grazing low quality pastures in northern Australia.

How feasible is it to replace urea with nitrates to mitigate greenhouse gas emissions from extensively managed beef cattle?

Reducing methane emissions from cattle in Australia will be dependent upon finding a strategy that can be readily adopted by its northern beef industry. The majority of the herd are located in this region and they graze low-quality tropical (C4) pastures, resulting in high methane output. There are few mitigation options that can be readily applied to extensively grazed cattle. The addition of nitrate to the diet of cattle has been shown to reduce methane production and may be an applicable strategy in northern Australia. Nitrogen is often the primary limiting nutrient in low-quality tropical pastures and it is common practice by industry to supplement with urea. Supplying an equivalent dose of nitrogen using nitrate as an alternative to urea has been demonstrated in cattle without adverse impacts upon animal productivity or health. These findings may not be directly applicable to grazing cattle in northern Australian because the diets and feeding management are not representative of the region. Nitrite toxicity can result from feeding nitrates to livestock and there is evidence that the composition of the total diet and feeding pattern influences the risk of toxicity. If nitrate supplementation in grazing beef cattle in northern Australia can be demonstrated to reduce methane and be applied safely, adoption rates will still depend on carbon market pricing. Current modelling suggests that the cost of supplementing beef cows with nitrate in northern Australia would be at least double the cost of urea supplementation.

A physiotherapy perspective of musculoskeletal imaging in sport

This paper presents a physiotherapy perspective on the role that imaging is now playing in the diagnosis and management of musculoskeletal and sporting injuries. Although the Royal College of Radiologists and the UK Chartered Society of Physiotherapy were founded in the latter part of the nineteenth century, it is 100 years later that developments in the UK NHS have led to increased roles for non-medical healthcare professionals and allied health professionals, such as physiotherapists, in an extended clinical role. Physiotherapists, perhaps because of their knowledge of clinical and applied anatomy, have keenly taken up the opportunities offered to request and interpret imaging in its various forms; the most commonly available are plain radiography, musculoskeletal ultrasound and MRI. This has meant taking formal courses under the auspices of universities with mentorship and tutoring within the clinical setting, which are part of a continuing professional development. The ability to request several forms of imaging has enhanced physiotherapy practice and has increased the appreciation of the responsibilities which accompany this new role.

Effect of monensin inclusion in supplements for cattle consuming low quality tropical forage

A pen feeding study was carried out over 70 days to determine the effects of monensin (M) inclusion in two commercial supplements designed to provide different planes of nutrition to recently weaned steers. Thirty Bos indicus crossbred steers (191.4 ± s.d. 7.1 kg) were individually fed a low quality pangola grass hay (57 g crude protein/kg DM; 497 g/kg DM digestibility) ad libitum (Control) with either a urea/molasses-based supplement of Rumevite Maxi-graze 60 Block (B), fed at 100 g/day, or grain-based Rumevite Weaner Pellets (WP), fed at 7.5 g/kg liveweight (W).day, both with and without M, viz. B, B+M, WP and WP+M, respectively. There were no significant interactions between supplement type and M inclusion for any measurement. Growth rates (main effects) averaged 0.17, 0.35 and 0.58 kg/day for the Control, B and WP supplements, respectively, with all means different (P < 0.05), while the response (P < 0.05) to M across supplement type was 0.11 kg/day. Hay DM intake was similar for the Control and B treatments (18.6 and 19.6 g/kg W.day) but was reduced (P < 0.05) with the WP supplement (16.8 g/kg W.day) while corresponding total DM intakes increased from 18.6 to 20.0 to 23.5 g/kg W.day (all differences P < 0.05), respectively. Monensin inclusion in the supplements did not affect supplement, hay or total DM intake. Inclusion of M in supplements for grazing weaners in northern Australia may increase survival rates although the effect of M with cattle at liveweight maintenance or below requires further investigation.

Haplotypic diversity in human CEACAM genes: effects on susceptibility to meningococcal disease

Adhesion between the opacity-associated adhesin (Opa) proteins of Neisseria meningitidis and human carcino-embryonic antigen cell adhesion molecule (CEACAM) proteins is an important stage in the pathogenesis of meningococcal disease, a globally important bacterial infection. Most disease is caused by a small number of meningococcal genotypes known as hyperinvasive lineages. As these are also carried asymptomatically, acquisition of them alone cannot explain why only some hosts develop meningococcal disease. Our aim was to determine whether genetic diversity in CEACAM is associated with susceptibility to meningococcal disease. Frequency distributions of alleles, genotypes and haplotypes were compared in four CEACAM genes in 384 case samples and 190 controls. Linkage disequilibrium among polymorphic sites, haplotype structures and relationships were also analysed. A number of polymorphisms were observed in CEACAM genes but the diversity of CEACAM1, to which most Opa proteins bind, was lower, and a small number of high-frequency haplotypes were detected. Dose-dependent associations of three CEACAM haplotypes with meningococcal disease were observed, with the effect of carrying these haplotypes amplified in homozygous individuals. Two haplotypes were protective while one haplotype in CEACAM6 was associated with a twofold increase in disease susceptibility. These data imply that human CEACAM may be one determinant of human susceptibility to meningococcal disease.

Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome?

BACKGROUND

Quadriceps atrophy is a commonly cited accompaniment to patellofemoral pain syndrome (PFPS), yet there is little valid, objective evidence for its existence.

OBJECTIVE

To investigate atrophy and weakness of the quadriceps femoris muscle group in patients with PFPS using measures of cross-sectional area and peak extension torque.

METHODS

A total of 57 patients with insidious onset of PFPS and 10 healthy control subjects had ultrasound scanning of the quadriceps femoris. The scans were analysed using computerised planimetry to estimate the cross-sectional area of the quadriceps femoris. Lower limb peak torque was also measured using a Biodex dynamometer.

RESULTS

The mean of % differences revealed a 3.38% (95% confidence interval (CI) 1.3 to 5.45) difference in cross-sectional area (CSA) between the affected and unaffected limb in PFPS patients and a 1.31% (95% CI 0.06 to 2.55) difference in the dominant and non-dominant limb of the control group; the between-groups difference was not significant (p = 0.409). There was a 18.4% (95% CI 13 to 23.8) difference between the affected and unaffected limb in peak torque in PFPS patients and a 7.6% (95% CI 3.2 to 12) difference between the dominant and non-dominant limb in the control group; the between-groups difference was significant (p = 0.002).

CONCLUSIONS

The mean of % differences of 3.38% quadriceps atrophy between limbs was considerably less than the only other study using ultrasound scanning on the quadriceps in PFPS and was not significant between the groups. There were greater and more significant between-group differences in lower limb peak torque indicating that muscle strength may not be related to muscle size. These results help to re-appraise of the amount of quadriceps atrophy in PFPS.

A genome scan for quantitative trait loci affecting resistance to Trichostrongylus colubriformis in sheep

A genome linkage scan was carried out using a resource flock of 1029 sheep in six half-sib families. The families were offspring of sires derived by crossing divergent lines of sheep selected for response to challenge with the intestinal parasitic nematode Trichostrongylus colubriformis. All animals in the resource flock were phenotypically assessed for worm resistance soon after weaning using a vaccination/challenge regime. After correcting for fixed effects using a least squares linear model the faecal egg count data obtained following the first challenge and the faecal egg count data obtained after the second challenge were designated Trait 1 and Trait 2, respectively. A total of 472 lambs drawn from the phenotypic extremes of the Trait 2 faecal egg count distribution were genotyped with a panel of 133 microsatellite markers covering all 26 sheep autosomes. Detection of quantitative trait loci (QTL) for each of the faecal egg count traits was determined using interval analysis with the Animap program with recombination rates between markers derived from an existing marker map. No chromosomal regions attained genome-wide significance for QTL influencing either of the traits. However, one region attained chromosome-wide significance and five other regions attained point-wise significance for the presence of QTL affecting parasite resistance.

A comparison of two types of electrical stimulation of the quadriceps in the treatment of patellofemoral pain syndrome. A pilot study

OBJECTIVE

To compare a commercially available electrical muscle stimulation regime with a new form of stimulation for the rehabilitation of the quadriceps in patients with patellofemoral pain syndrome.

SETTING

A research facility within a teaching hospital.

METHODS

Sixteen patients (four men, 12 women) with patellofemoral pain, demonstrable quadriceps atrophy, but normal gait parameters were randomly allocated to one of two treatment groups. One group received a sequential mixed frequency stimulation pattern from a standard device. The other group received a new form of stimulation from an experimental stimulation device that contained simultaneous mixed frequency components.

OUTCOME MEASURES

Isometric and isokinetic extension torque, muscle fatigue rate, pain, functional questionnaire, step test, knee flexion, and quadriceps cross-sectional area.

RESULTS

These showed significant improvements for both groups after treatment (p < 0.05) in all outcome measures except flexion and fatigue rates, but no significant differences between the two stimulation regimes (p > 0.05).

CONCLUSION

Both stimulators performed similarly on patients with patellofemoral pain giving significant improvements for all patients for muscle strength, pain, self-reporting function and step testing. There were no significant differences between the two types of stimulation.

Electromyographic fatigue characteristics of the quadriceps in patellofemoral pain syndrome

This study compared the fatigue characteristics of the vastus medialis oblique (VMO), vastus lateralis (VL) and rectus femoris (RF) muscles. Ten healthy subjects with 10 patients with patellofemoral pain syndrome (PFPS) performed an isometric leg press for 60 seconds at 60% MVIC with data collected using surface EMG. The power spectrum was analyzed and the extracted median frequency normalised to calculate a linear regression slope for each muscle. A repeated measures ANOVA revealed no significant differences, neither between the groups (P=0.592) nor the muscles (P=0.434). However, the slopes for the VMO and VL were different between the two groups with similar slopes for the RF. There was much larger variability of MF values in the PFPS group. The VMO:VL ratio calculated from these slopes for the healthy subjects was 1.17 and for the PFPS group was 1.78. These results may indicate unusual features in the fatigue indices of the quadriceps in PFPS.

The reproducibility of multi-joint isokinetic and isometric assessments in a healthy and patient population

DESIGN

Test re-test reliability design.

OBJECTIVE

To determine a reproducible protocol for lower limb simultaneous multi-joint assessments on a healthy group of subjects and a patient group with patellofemoral pain syndrome.

BACKGROUND

Although single joint assessment with isokinetic dynamometers has been utilised for many years in knee rehabilitation, simultaneous multi-joint assessment has not attracted comparable attention.

METHODS

Twenty healthy volunteers mean age 30.6 years and 16 patients with patellofemoral pain syndrome mean age 29.6 years performed isometric maximum voluntary contractions and concentric isokinetic contractions of the lower limb. Data were collected on three separate days for resultant extension/flexion peak torque, average power and total work which were analysed using intraclass correlation coefficients with a 95% level of confidence.

RESULTS

In healthy subjects, intraclass correlation coefficients estimates were > or =0.75 for isokinetic peak torque and >0.83 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.82. In the patient group, intraclass correlation coefficients estimates were >0.82 for isokinetic peak torque and > or =0.75 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.89. Discarding the first session's data for both groups improved the intraclass correlation coefficients estimates for virtually all assessments.

CONCLUSIONS

This study has demonstrated high reproducibility of lower limb multi-joint testing for peak torque, average power, and total work on healthy subjects and then has employed the protocol to demonstrate similarly high reliability on a patient group. It has also highlighted the need for a practice session before the data can be said to be reliable.

RELEVANCE

Reliability studies often use healthy subject groups, which although useful, have limited relevance to patient populations. This study has not only gained comprehensive reproducibility data on multi-joint assessment in healthy subjects, it has also shown that multi-joint testing can be used safely and reliably in patients with patellofemoral pain syndrome. Clinicians may now be able to measure objectively lower limb function in this patient group both pre and post treatment.

An investigation of the validity of 'simulated' work related tasks in relation to 'real-life' situations in the fire service training environment

Many researchers have developed work simulated tasks that can successfully predict fitness for work. In the fire service there are few tests available to make such predictions. This study was designed to evaluate the validity of four simulated fire-fighting tasks developed by Manchester Fire Service. Twenty-seven subjects each performed, in random order, three repeats of four simulated and four real-life tasks: under-running a 9 m ladder, dead lift, placing a 13.5 m ladder on an appliance and hauling an extended line. Comparisons between real and simulated tasks were assessed by measuring total time and amount of muscle activity. Recommendations were made to reduce the weight and to revise the lifting and grip positions for the 13.5 m ladder and dead lift, respectively, whereas the simulated 9 m ladder and hauling an extended line simulated tasks were sufficiently similar to the real-life activities to not warrant any change.

Identification of a human HECT family protein with homology to the Drosophila tumor suppressor gene hyperplastic discs

Use of the differential display technique to isolate progestin-regulated genes in T-47D human breast cancer cells led to identification of a novel gene, EDD. The cDNA sequence contains a 2799 amino acid open reading frame sharing 40% identity with the predicted 2894 amino acid product of the Drosophila melanogaster tumor suppressor gene hyperplastic discs, while the carboxy-terminal 889 amino acids show 96% identity to a rat 100 kDa HECT domain protein. EDD mRNA was progestin-induced in T-47D cells and was highly abundant in testes and expressed at moderately high levels in other tissues, suggesting a broad role for EDD. Anti-EDD antibodies immunoprecipitated an approximately 300 kDa protein from T-47D cell lysates. HECT family proteins function as E3 ubiquitin-protein ligases, targeting specific proteins for ubiquitin-mediated proteolysis. EDD is likely to function as an E3 as in vitro translated protein bound ubiquitin reversibly through a conserved HECT domain cysteine residue. EDD was localized by FISH to chromosome 8q22, a locus disrupted in a variety of cancers. Given the homology between EDD and the hyperplastic discs protein, which is required for control of imaginal disc growth in Drosophila, EDD potentially has a role in regulation of cell proliferation or differentiation.

The measurement of lumbar proprioception in individuals with and without low back pain

STUDY DESIGN

A clinical trial comparing a back pain group with a pain-free group.

OBJECTIVES

To investigate whether proprioceptive deficits existed in a group of individuals reporting low back pain.

SUMMARY OF BACKGROUND DATA

Little work has so far been conducted on the measurement of proprioception in the spine. Those studies that have been carried out, however, have failed to identify proprioceptive deficits in individuals with back pain. Previous work on peripheral joints has revealed that proprioception is affected with muscular or joint injury or degeneration.

METHODS

Forty individuals took part in the study, 20 with back pain and 20 with no pain. Participants were required to reproduce a predetermined target position, in standing and four-point kneeling, 10 times in 30 seconds. A computer screen was used to provide visual feedback on position. A mean deviation from the target position was obtained for each individual. A measurement of left elbow position sense was conducted in five individuals from each group to establish differences in short-term motor memory between the groups.

RESULTS

There were no differences between the subject groups in terms of short-term motor memory (P > 0.05). A two-way analysis of variance between subject groups and position to identify differences in accuracy (deviation from the target) found that there were differences between subject groups in either position (P < 0.05). There was no significant difference in accuracy between the positions used (P > 0.05).

CONCLUSIONS

Differences in proprioception do exist between individuals with back pain and those free from back pain. Further research needs to be undertaken on proprioceptive exercise programs and their effect on back pain.

Role of ankle taping and bracing in the athlete

Adhesive tape is often used to help athletes recover from ligament sprains of the ankle or to prevent further injury. The choice of taping technique or material is often decided by personal preference, superstition, or anecdote. More recently, the use of ankle braces has become more prevalent, but reasons for their use are similarly variable. As ankle sprains are a major cause of an athlete's disability and time off sport, the choice of the method of support should be more scientifically reasoned. This paper attempts to review the literature concerning the effects of various methods of ankle support on swelling, stability, range of movement, proprioception, muscle function, gait, and performance tests. There is still some contradiction in the literature about the effects of taping and braces in both the acute and chronic phases of ligament sprains of the ankle.

Identification of PRG1, a novel progestin-responsive gene with sequence homology to 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase

To define early molecular targets of progestin action, the differential display technique was used to identify genes with altered levels of expression in T-47D breast cancer cells treated with the synthetic progestin ORG 2058 for 3 h. PRG1 was first isolated as a 200-bp cDNA clone and its progestin regulation confirmed by Northern analysis. Cloning of the complete coding region of PRG1 revealed that it shared a high degree of amino acid sequence identity with isoforms of the enzyme 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase from several tissues and species. Expression of PRG1 mRNA was observed in several normal breast epithelial and breast cancer cell lines and in a variety of human tissues, with highest expression in the breast, aorta, and brain. In T-47D cells, PRG1 mRNA was rapidly and transiently induced by progestins, expression peaking between 2 and 4 h and returning to control levels by 12 h. Progestin-induced increases in PRG1 mRNA were inhibited by the progestin antagonist RU 486 and occurred via the progesterone receptor. Progestin induction of PRG1 mRNA was also inhibited by actinomycin D but not by cycloheximide. PRG1 is therefore a novel human gene that is directly regulated by progestins via the progesterone receptor.

Evaluation of elite British cyclists: the role of the squad medical

OBJECTIVE

To describe and report results from the procedures and protocols used by the British Cycling Federation during the squad medicals of its elite cyclists.

METHODS

Screening of over 500 elite riders has been done by doctors, dentists, physiotherapists, opticians, and dietitians since 1990. A questionnaire provided additional information on musculoskeletal problems.

RESULTS

523 riders have been examined and 92 (17.5%) have been referred for further assessment or treatment. Most of these riders were sent either to their own general practitioner or to the British Olympic Medical Centre. The questionnaire was completed by 81% of riders. Low back pain was the most common problem that riders encountered (60%), and knee pain the second most common (33%). Four riders failed the eye examination, and a further 11 were classed as borderline. Twenty one per cent of riders undergoing dental examination needed further dental treatment.

CONCLUSIONS

The squad medical is an important and useful strategy for evaluating elite British cyclists. It shows that a structured system can help early diagnosis and treatment to provide injury-free cyclists at the start of a competitive season. The results from the questionnaire confirm previously unsubstantiated opinions about the incidence of musculoskeletal injuries in cyclists.

A tandemly repetitive DNA sequence is present at diverse locations in the genome of Ostertagia circumcincta

A novel repetitive DNA sequence in the sheep parasitic nematode Ostertagia circumcincta was cloned and sequenced. This 1.2-kb sequence (Oc1B) was not found in the closely related cattle parasite Ostertagia ostertagi, nor in the more distantly related sheep parasites Haemonchus contortus or Trichostronylus colubriformis. Sequences similar to Oc1B were found at various genomic locations and contained a pair of 33-bp direct repeats. Oc1B also contained a single copy of a 218-bp sequence (designated OcREP) which was present in 100 to 200 copies in the O. circumcincta genome and mostly organized in distinctive tandem arrays. The dual organizational pattern of OcREP as both a satellite-like sequence as well as interspersed as single copies amongst dissimilar sequences adds to the growing evidence for the fluidity of the parasitic nematode genome, and of eukaryotic genomes in general.

Intratester and intertester reproducibility of the lumbar motion monitor as a measure of range, velocity and acceleration of the thoracolumbar spine

OBJECTIVE: The purpose of this study was to examine the intra- and intertester reproducibility of the Lumbar Motion Monitor (LMM) as a measure of thoracolumbar range of motion (RoM), velocity and acceleration. DESIGN: The study was a clinical trial using asymptomatic subjects. BACKGROUND: The LMM is a promising device from a clinical and research perspective, though the reproducibility of it's measurements has yet to be fully determined on subjects under free motion conditions. METHODS: For intratester reproducibility, 15 subjects were required to move as far and as fast as they could in 8 s through flexion, side flexion, and rotation. They were tested on three occasions with 48 h separating tests. For intertester reproducibility, 10 subjects were tested by two examiners, and were required to move as far and as fast as they could in 8 s. RESULTS: Intratester reproducibility coefficients ranged between 0.82 and 0.87 for RoM, 0.61 and 0.87 for velocity, and 0.46 and 0.72 for acceleration. Rotation had the poorest reproducibility in each instance. Intertester reproducibility ranged between 0.93 and 0.98. CONCLUSIONS: The reproducibility of the LMM is suitably high for RoM and velocity for the device to be used for evaluation in a clinical and research setting.

The role of quadriceps exercise in the treatment of patellofemoral pain syndrome

In recent years there has been increased interest in the role of exercise in the alleviation of patellofemoral pain syndrome. Contradictions which result in a lack of a consensus amongst clinicians and researchers as to the most beneficial type of exercise are reviewed. The popularly held belief that there are imbalances between some components of the quadriceps femoris is also reviewed and conflicting evidence that quadriceps contractions can be enhanced by altering hip and knee positions is found. Some traditional exercises, previously considered essential to any regime for this common condition, were not found to be as beneficial as previously thought. Consequently, some of these exercises should be less prominent in a rehabilitation programme for patellofemoral pain syndrome.

A middle-repetitive DNA sequence element in the sheep parasitic nematode, Trichostrongylus colubriformis

A novel repetitive DNA sequence in the sheep parasitic nematode Trichostrongylus colubriformis was cloned and sequenced. A 1.1 kb repetitive sequence (Tc15) which hybridized with DNA from T. colubriformis but not with DNA from two other parasitic nematodes, Haemonchus contortus and Ostertagia circumcincta, or sheep was further characterized. Southern blot analysis showed that the repeat hybridized to a range of fragments in restriction digested T. colubriformis DNA and existed in multiple copy number tandem arrays. However, to define clearly the repetitive monomeric unit further screening of phagemid libraries containing BamH I restriction fragments using a subclone of Tc15 as a probe was carried out. Restriction map and sequence data were compiled for 3 clones containing a 145 bp highly repetitive sequence (designated TcREP) which shared homology with the original pTc15 clone. TcREP hybridized to a tandemly repeating sequence monomer of 145 bp in T. colubriformis DNA which was cloned from various genetic environments in the T. colubriformis genome. TcREP homologous sequences were also found in the genomes of two other species of the same genus (Trichostrongylus axei and Trichostrongylus vitrinus) but not in a fourth species (Trichostrongylus rugatus).

Gait analysis in patients with anterior knee pain

The purpose of this study was to examine the kinematic and kinetic parameters of the gait of patients with anterior knee pain. Fifteen symptomatic patients and 15 female control subjects were asked to perform 10 barefoot walks along a 10-m walkway. Ground reaction force data were collected using a force platform. Rearfoot motion data were collected using a video kinematic analysis system. The results showed that the controls exerted a significantly higher lateral force compared to patients. There was also a significant difference between controls and patients in the amount of time taken to maximum lateral force and in the time taken to achieve maximum angle between the axis of the calcaneus and axis of the tendo achilles. These results indicate that extended time to maximum lateral force rather than excessive lateral force is a discriminating factor in the gait of female patients with anterior knee pain who have a low recreational status. This contradicts previous studies using running analysis on athletes with this condition and suggests that in terms of diagnosis and treatment, care must be taken when comparing results from groups of different recreational status.

Characterization of a tandemly repetitive DNA sequence from Haemonchus contortus

Genomic DNA from the sheep parasitic nematode Haemonchus contortus was shotgun cloned in the plasmid vector pUC18. Recombinants which gave the strongest hybridization signals to 32P-radiolabelled genomic DNA were selected as representatives of the repetitive component of the parasite DNA. One repetitive sequence which hybridized only with DNA from H. contortus and not with DNA from two other sheep nematodes (Trichostrongylus colubriformis and Ostertagia circumcincta) was further characterized by sequencing and dot blot analysis. A related repeat was found in the closely related species Haemonchus placei. Experiments to determine the genomic organization of the repeat showed that it existed in a multi-copy number tandem array. This is the first report on the characterization of repetitive DNA in sheep parasite nematodes.

The role of massage in the management of the athlete: a review

Massage has been a therapeutic modality in all cultures since early civilization and has had a long tradition of use in the sporting context. However, there has been a paucity of scientific evidence of the physiological, psychological and therapeutic effects of commonly used massage techniques. This paper reviews the early and more recent studies on the effects of massage and also the more recent literature on its use on the sports person. Little agreement was found in English publications of the efficacy of massage and there were contradictory findings as to the optimum technique and length of time of application. It is clear that the role of massage - a time-consuming technique for a physiotherapist to perform - needs to be evaluated further in order to resolve some contentious issues arising about this mode of treatment and to justify its use.

Anterior knee pain: the need for objective measurement

Anterior knee pain is a very common condition, particularly amongst young people. Those patients who have demonstrable pathological or biomechanical abnormalities can often be helped surgically. However, there are many others who have severe patellar pain despite normal, or near normal, clinical and arthroscopic examination. There have been a plethora of conservative treatments the mainstays of which are rest and exercise. However, the rationale behind these conservative methods has been largely empirical, and progress subjective. Treatment may be more effectively applied if further evidence is established about the relationship between the foot and ankle biomechanics and the patellofemoral joint. Kinematic and kinetic gait analyses have recently been reported as being of major importance in the objective measurement of lower limb function and its effects on the patellofemoral joint.