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Purpose We compared the effects of different protocols of blood-flow restriction training (BFRT) with different occlusion pressures and/or exercise intensities on muscle mass and strength. We also compared BFRT protocols with conventional high-intensity resistance training (RT). Methods Twenty-six subjects had each leg allocated to two of five protocols. BFRT protocols were performed at either 20 or 40 % 1-RM with either 40 or 80 % occlusion pressure: BFRT20/40, BFRT20/80, BFRT40/40, and BFRT40/80. Conventional RT was performed at 80 % 1-RM (RT80) without blood-flow restriction. Maximum dynamic strength (1-RM) and quadriceps cross-sectional area (CSA) were assessed at baseline and after 12 weeks. Results Regarding muscle mass, increasing occlusion pressure was effective only at very low intensity (BFRT20/40 0.78 % vs. BFRT20/80 3.22 %). No additional increase was observed at higher intensities (BFRT40/40 4.45 % vs. BFRT40/80 5.30 %), with no difference between the latter protocols and RT80 (5.90 %). Exercise intensity played a role in CSA when comparing groups with similar occlusion pressure. Muscle strength was similarly increased among BFRT groups (~12.10 %) but to a lesser extent than RT80 (21.60 %). Conclusion In conclusion, BFRT protocols benefit from higher occlusion pressure (80 %) when exercising at very low intensities. Conversely, occlusion pressure seems secondary to exercise intensity in more intense (40 % 1-RM) BFRT protocols. Finally, when considering muscle strength, BFRT protocols seem less effective than high-intensity RT.

Several studies comparing resistance training (RT) frequencies may have been affected by the large between-subject variability. This study aimed to compare the changes in lower limbs maximal dynamic strength (1RM) and quadriceps femoris cross-sectional area (CSA) after a RT with different weekly frequencies in strength-trained individuals using a within-subject design. Twenty-four men participated in a 9-week RT program, being randomly divided into two conditions: resistance training with equalized total training volume ( RTEV ) and with unequalized total training volume ( RTUV ). The RT protocol used the unilateral leg press 45° exercise and each subject’s lower limb executed one of the proposed frequencies (one and three times/week). All conditions effectively increased 1RM and CSA (p<0.001); however, no significant differences were observed in the values of 1RM (p = 0.454) and CSA (p = 0.310) between the RT frequencies in the RTEV and RTUV conditions. Therefore, RT performed three times a week showed similar increases in 1RM and CSA to the program performed once a week, regardless of training volume equalization. Nevertheless, when the higher RT frequency allowed the application of a greater TTV ( i . e ., RTUV), higher effect size (ES) values (0.51 and 0.63, 1RM and CSA, respectively) were observed for the adaptations.

Improving skills for accessing and utilizing diet/nutrition information is important for preventing non-communicable diseases and frailty among elderly people. With the rapidly increasing number of elderly people in the world, promoting nutrition literacy among them is a pivotal health policy for maintaining and promoting health. This article describes the barriers and catalysts of nutrition literacy among elderly Japanese people (aged ≥75 years). A cross-sectional analysis of the responses to a questionnaire administered to 678 study participants (men = 347, women = 331) was conducted. Logistic regression analysis revealed that more men had limited nutrition literacy than did women. After stratification by gender, the limited nutrition literacy group was associated with cognitive difficulty in men and women, visual impairment in men and hearing impairment in women. Lower education level and economic status were associated with limited nutrition literacy among women. Adjusted odds ratios (ORs) controlling for age, education level and economic status, as well as cognitive, visual and hearing function, indicated that informational support [OR = 5.59, 95% confidence interval (95% CI) = 1.28-24.49] and diet/nutrition information obtained from friends of the participants (OR = 2.16, 95% CI = 1.11-4.20) were both associated with adequate nutrition literacy among men, whereas diet/nutrition information from health professionals (OR = 3.96, 95% CI = 1.97-7.95) had a significant relation with adequate nutrition literacy among women. Moreover, in the adequate nutrition literacy group, men were more likely to be overweight (OR = 2.17, 95% CI = 1.20-3.91). These findings suggested that cognitive and sensory functions should be taken into account when diet information is provided to older adults. Enhancement of social networks is also a key point in improving nutrition literacy. An effective intervention to improve nutrition literacy in elderly people, particular old men, warrants further investigation.

Purpose The aim of this study was to retrospectively compile normative data on the anterior cruciate ligament (ACL) in the paediatric population with magnetic resonance imaging, emphasizing the differences between men and women. Methods In this retrospective study, musculoskeletal radiologists evaluated length, area, coronal and sagittal inclination of the ACL and inclination of the intercondylar notch. A total of 253 MR examinations (130 males and 123 females between 6 and 18 years of age) were included. The association between measurements, sex and age was considered. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements. Results ACL length showed significant progressive growth ( p  < 0.001) with age in men and women, without characterization of growth peaks. ACL area in women showed more pronounced growth up to 11 years, stabilized from 11 to 14 years and then sustained a slight reduction. In men, ACL area showed more pronounced growth up to 12 years, stabilized from 12 to 15 years and then sustained slight reduction. Coronal and sagittal inclination of the ACL showed a significant progressive increase ( p  < 0.001) with age in both sexes, progressively verticalizing. The intercondylar roof inclination angle showed significant progressive reduction ( p  < 0.001) with age in both sexes. Conclusion The area of the ACL does not accompany skeletal maturation, interrupting its growth around 11–12 years. Progressive verticalization of the ACL as well as of the intercondylar notch roof in the evaluated ages was also observed. The clinical relevance of this study is that the ACL presents different angular and morphologic changes during growth in the paediatric population. Since ACL repair is now being performed on younger children, recognition of the normal developmental changes of the ACL is of utmost importance for successful ACL graft placement. Level of evidence III.

Higher daily protein intake, with an emphasis on leucine content, is thought to mitigate age-related anabolic resistance, potentially counteracting age-related morphological and functional declines. The present study investigated potential associations between total daily leucine intake and dependent variables, including quadriceps muscle cross-sectional area (CSA) and maximum dynamic muscle strength (1-RM) in a cohort of healthy free-living older individuals of both sexes (n = 67; 34/33 men/women). Participants performed three 24 h dietary recalls and underwent a magnetic resonance imaging exam followed by 1-RM tests. Our results demonstrate moderate associations between total daily leucine and both quadriceps CSA (r = 0.42; p = 0.004) and 1-RM (r = 0.45; p = 0.001). Furthermore, our exploratory biphasic linear regression analyses, adjusted for sex, age, and protein intake relative to body weight, revealed a plateau for daily leucine intake and muscle mass and muscle strength (~7.6–8.0 g·day−1) in older adults. In conclusion, we demonstrated that total daily leucine intake is associated with muscle mass and strength in healthy older individuals and this association remains after controlling for multiple factors, including overall protein intake. Furthermore, our breakpoint analysis revealed non-linearities and a potential threshold for habitual leucine intake, which may help guide future research on the effects of chronic leucine intake in age-related muscle loss.

This study compared quadriceps muscle cross-sectional area (CSA) and maximum strength (1RM) after three different short-term strength training (ST) regimens (i.e. non-periodized [NP], traditional-periodization [TP], and undulating-periodization [UP]) matched for volume load in previously untrained individuals. Thirty-one recreationally active males were randomly divided into four groups: NP: n = 9; TP: n = 9; UP: n = 8 and control group (C): n = 5. Experimental groups underwent a 6-week program consisting of two training sessions per week. Muscle strength was assessed at baseline and after the training period. Dominant leg quadriceps CSA was obtained through magnetic resonance imaging (MRI) at baseline and 48h after the last training session. The 1RM increased from pre to post only in the NP and UP groups (NP = 17.0 %, p = 0.002; UP = 12.9 %, p = 0.03), respectively. There were no significant differences in 1RM for LP and C groups after 6 weeks (TP = 7.7 %, p = 0.58, C = 1.2 %, p = 1.00). The CSA increased from pre to post in all of the experimental groups (NP = 5.1 %, p = 0.0001; TP = 4.6 %, p = 0.001; UP = 5.2 %, p = 0.0001), with no changes observed in the C group (p = 0.93). Our results suggest that different ST periodization regimens over a short-term (i.e. 6 weeks), volume load equated conditions seem to induce similar hypertrophic responses regardless of the loading scheme employed. In addition, for those recreational males who need to develop muscle strength in the short-term, the training regimen should be designed properly. Key pointsMuscle hypertrophy occurs within six weeks in recreationally active men regardless the ST training regimen employed.When the total volume is similar, training at greater intensities will demonstrate superior gains in the 1RM performance.Some caution should be exercised when interpreting our findings since long-term periodized regimens could produce different training-induced responses.

The prognosis of high-risk retinoblastoma (RB) with extraocular disease, relapse, or invasion of the cut end of the optic nerve is extremely poor. Following the discontinuation of thiotepa production in Japan, BU- and melphalan (Mel)-based regimens have been used, followed by the standard treatment for neuroblastoma. This study retrospectively analyzed 14 high-risk RB patients who underwent high-dose chemotherapy (HDC) and hematopoietic SCT; 8 received a BU/Mel conditioning regimen and 6 received other regimens. The disease status at HDC was relapse in 8 patients and extraocular involvement in 5. All patients received peripheral blood stem cell infusion >1.5 × 10 6 /kg. Engraftment occurred within a median of 11 days (BU/Mel: 10–13, others: 9–13). Primary toxicities included mucositis (⩾grade 3) in 9 patients (4 with BU/Mel, 5 with others). Veno-occlusive disease (VOD) occurred in two 1-year-old patients in the BU/Mel group. There were no treatment-related deaths. Of 4 (2 with BU/Mel, 2 with others) patients with central nervous system (CNS) relapse after HDC, 3 died. In conclusion, the BU/Mel regimen may be feasible for high-risk RB under careful monitoring for VOD, particularly in younger patients. CNS relapse associated with a lethal prognosis occurred after all regimens; therefore, further evaluation of HDC efficacy for high-risk RB is required.

Wildlife tourism is for the purpose of watching and/or encountering wildlife. In South-east Asia, mammalian wildlife tourism is less popular than in Africa. This is because mammalian wildlife tourism in South-East Asia is generally targeted at terrestrial national parks with forest fauna, as it is difficult to observe mammals in dense rainforest. To assess the potential of a South-East Asian national park for mammalian wildlife tourism, a mixed methods approach was used, 1) mammalian wildlife-based tourist attractions and 2) park use and visitor attitudes towards wildlife in Endau Rompin National Park, Peninsular Malaysia. There are potentially 149 mammalian species, including 24 threatened species, in Endau Rompin National Park. Camera trap data indicated that small and medium sized mammals do occur in these areas frequented by tourists. Footprints, nests, scratches and disturbance traces of various mammals were also observed. However, most visitors did not have high expectations regarding wildlife encounters, nor did many actually see wildlife during their stay. These results implied that animal signs and devices for indirect observation of elusive and/or rare animals were important at sites of mammalian wildlife-based tourism. Additionally, Asian elephants could be a strong attraction for wildlife tourists, but there was concern about conflict between local people and elephants.

Objectives:Systemic juvenile idiopathic arthritis (sJIA) is a rheumatic disease in childhood characterised by systemic symptoms and a relatively poor prognosis. Peripheral leukocytes are thought to play a pathological role in sJIA although the exact cause of the disease is still obscure. In this study, we aimed to clarify cellular functional abnormalities in sJIA.Methods:We analysed the gene expression profile in peripheral leukocytes from 51 patients with sJIA, 6 patients with polyarticular type JIA (polyJIA) and 8 healthy children utilising DNA microarrays. Gene ontology analysis and network analysis were performed on the genes differentially expressed in sJIA to clarify the cellular functional abnormalities.Result:A total of 3491 genes were differentially expressed in patients with sJIA compared to healthy individuals. They were functionally categorised mainly into a defence response group and a metabolism group according to gene ontology, suggesting the possible abnormalities in these functions. In the defence response group, molecules predominantly constituting interferon (IFN)γ and tumour necrosis factor (TNF) network cascades were upregulated. In the metabolism group, oxidative phosphorylation-related genes were downregulated, suggesting a mitochondrial disorder. Expression of mitochondrial DNA-encoded genes including cytochrome c oxidase subunit 1(MT-CO1) and MT-CO2 were suppressed in patients with sJIA but not in patients with polyJIA or healthy children. However, nuclear DNA-encoded cytochrome c oxidases were intact.Conclusion:Our findings suggest that sJIA is not only an immunological disease but also a metabolic disease involving mitochondria disorder.

Background: Descriptive parameters for the evaluation of the labrum’s appearance on magnetic resonance imaging (MRI) after capsulolabral repair are not well established. Purpose: To assess the morphology and structural appearance of the postoperative glenoid labrum on MRI in athletic patients with anterior glenohumeral instability. Study Design: Case series; Level of evidence, 4. Methods: This prospective study examined MRI scans of the involved shoulder in a population of 27 athletic patients with traumatic anterior instability before arthroscopic capsulolabral repair and at 3 and 6 months after surgery. The morphology, axial height, coronal height, axial angle, coronal angle, integrity, and homogeneity of repaired capsulolabral tissue were evaluated. The labrum was considered healed if it was integrated or intact (ie, if there was no discontinuity between the labrum and the glenoid). For each of these variables, a comparison was made between the MRI scans preoperatively and at 3 and 6 months after surgery to verify significant differences in these measures. Linear and logistic regression models were built to verify the associations between exposure variables and outcome variables. For all analyses, a significance level of .05 was used. Results: Each continuous outcome variable (ie, morphology, angle, and height) showed statistically significant differences across the 3 different MRI time points, indicating that we observed an increase in height and angle as well as an improvement in morphology throughout the follow-up period. Integrity was not significantly different on MRI between 3 and 6 months. Homogeneity was not significantly different between preoperative and 3-month MRI but significantly differed between preoperatively and 6 months postoperatively. The difference between postoperative and preoperative coronal height (increase in height) was associated with the occurrence of multiple dislocation episodes. Advanced age or multiple dislocations reduced the improvement in morphology. At 6 months, the integrity of the labrum on MRI was observed in all patients; however, 17 patients (63%) still had a heterogeneous labrum. Patients who underwent surgery within 90 days or those with a first dislocation episode had better integrity and homogeneity of labral tissue. Conclusion: There were statistically significant differences in the morphology, height, and angle of the labrum between the preoperative and postoperative periods in patients who underwent arthroscopic repair for glenohumeral instability. Although a 6-month MRI revealed labral integrity in all the athletes, 63% still had heterogeneous labral tissue.