Repetitive jumping and sprinting until exhaustion alters hamstring reflex responses and tibial translation in males and females

The incidence of anterior cruciate ligament injuries is considerably higher in females than in males and the underlying mechanisms are still under debate. Research indicates that the neuromuscular system of females and males might respond differently to the same fatigue protocol due to differences in muscle activation during movement tasks. This study analyzed sex differences in hamstring reflex responses and posterior‐anterior tibial translation (TT) before and after fatiguing exercise. We measured the isolated movement of the tibia relative to the femur as a consequence of mechanically induced TT in standing subjects as well as muscle activity of the hamstrings before and after repetitive jumping and sprinting until exhaustion. Muscle fatigue delayed reflex onset latencies in females and males. A reduction in reflex responses associated with an increased TT was observed after fatiguing exercise for both sexes. Data indicate that the used fatigue protocol altered the latency and magnitude of reflex responses as well as TT in females and males. Based on the results of previous research and the outcome of this study, it might be that sex‐specific effects of fatigue on reflex activity and mechanical stability of the knee depend on the kind of fatiguing exercise. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1687–1692, 2015.     

Mild Renal Artery Stenosis Can Induce Renovascular Hypertension and is Associated with Elevated Renal Vein Renin Secretion

Renovascular hypertension is a syndrome which encompasses the physiological response of the kidney to changes in renal blood flow and renal perfusion pressure. Such physiological changes can occur with renal artery occlusion irrespective of the severity of the lesion. We have analyzed hypertensive patients with mild renal artery stenosis and compared them to patients with no stenosis. Renal vein renin sampling from catheterization of the renal vein was performed in all these patients. Patients with mild stenosis had higher renal vein renin ratio (3.01 ± 1.5) than the patients with no stenosis (1.10 ± 0.29; p = 0.002). Patients with mild stenosis were also found to have higher diastolic blood pressure and renal artery resistive indices when compared to patients with no stenosis. We therefore conclude that mild stenosis can precipitate renin‐mediated hypertension in renovascular stenosis and also emphasis that parameters pertinent to renal physiology need to be evaluated before considering treatment options in patients with renal artery stenosis and medical management with RAAS blockade is the preferred modality of therapy for patients with renin‐mediated hypertension.     

Promoting mental health in Asia‐Pacific: Systematic review focusing on Thailand and China

Mental health is essential for functioning, general health, and quality of life in low and middle‐income countries (LAMICs), as for high‐income countries. This study aimed first to search in the English language peer‐reviewed literature for reviews of mental health promotion interventions in the Asia‐Pacific region. A global rapid review by Barry and colleagues indicated a paucity of publications on this topic in the peer‐reviewed literature. The second aim of the study followed from this observation. Two systematic reviews of English language literature were conducted as case studies in two countries with known interest in mental health promotion, Thailand and China. The reviews covered publications in peer‐reviewed journals and the “grey” literature. In Thailand, the review demonstrated: strong evidence for an empowerment program for human immunodeficiency virus (HIV)‐infected mothers; a reduction in HIV‐related stigma in a community‐based program; and a coping program for adolescents. The second review concerned suicide prevention interventions in China. It found one relevant study, a WHO multi‐site study of suicide prevention. We found surprisingly little evidence in either country of interventions focused on health equity or modifying the social determinants of mental health. We agree with Barry and colleagues that there is an urgent need to invest in the policy, practice, and research capacity for mental health promotion in LAMICs so that mental health promotion can be incorporated into the wider health promotion and global health development agenda. This includes the Global Action for Health Equity Network. Evidence‐based interventions in parenting, schools, workplaces, and among older people can be initiated or adapted and evaluated in LAMIC settings.     

Fork in the road: Are all bifurcations created equal?

• The TRYTON study evaluated routine side branch (SB) stenting with a novel bare metal stent (BMS) designed for true bifurcation lesions (Medina 1,1,1; 1,0,1; 0,1,1) and compared it to a strategy of balloon angioplasty with provisional stenting. It failed to meet the primary endpoint of non‐inferiority in target vessel failure mainly driven by peri‐procedural myocardial infarction (MI) with elevated CK‐MB > 3× the upper limit of normal.
• In this substudy, 41% of patients who had a SB diameter > 2.25 mm were evaluated and the new stent was found to be non‐inferior in the primary outcome of target vessel failure with no difference in post‐procedural MI.
• This substudy suggests that appropriately sized SB stents with TRYTON may be useful when the SB is >2.25 mm in diameter. However, further studies could evaluate routine use of FFR for SBs; drug eluting versions of the stent as well as stents designed for vessels 2.25 mm in diameter which are frequently felt to be clinically larger when not subjected to core lab analysis.