Femoral neck stress fracture and medial tibial stress syndrome following high intensity interval training: A case report and review of literature

BACKGROUND Femoral and tibial stress injuries are commonly found in long distance running athletes.Stress fractures have rarely been reported in athletes performing high intensity interval training(HIIT)exercise.The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises.CASE SUMMARY A 26 year old female presented with bilateral medial tibial pain.She had been performing HIIT exercise for 45 min,five times weekly,for a seven month period.Her tibial pain was gradual in onset,and was now severe and worse on exercise,despite six weeks of rest.Magnetic resonance imaging(MRI)revealed bilateral medial tibial stress syndrome.As she was taking norethisterone for birth control,a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck.She was managed conservatively with analgesia and physiotherapy,but continued to exercise against medical advice.She presented again six months later with severe right hip pain.MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region.Her symptoms resolved with strict rest and physiotherapy.CONCLUSION HIIT may cause stress injury of the tibia and femur in young individuals.

Medial Tibial Stress Syndrome and Female Military Recruits

Upon entering the military recruits are challenged physically, this is exceptionally difficult for women as their anatomy predisposes them to more impact injuries than men. Female military recruits are placed at a higher risk for shin splints, a repetition injury known in the medical field as medial tibial stress syndrome (MTSS). This review paper explores studies about MTSS, its prevalence, and expression in military recruits, particularly as its expression differs across gender. This paper will cover how the external environment of boot camp results in a higher prevalence of MTSS than the general population and how increased occurrence of MTSS in females has been attributed to specific physical attributes. This includes smaller tibial cross-sectional dimensions, greater than average hip range of motion, and differences in lower extremity mechanics during running and other repetitive physical activities. The external environment of boot camp coupled with these intrinsic factors highlight the importance of providing running education for women prior to arrival at boot camp and designing training regiments that account for these physiological differences.

Assessment of Calf Skeletal Muscle Stiffness in Diabetic Nephropathy Patients with Medial Tibial Stress Syndrome by Two-Dimensional Shear Wave Elastography

Objective:To explore the feasibility of two-dimensional shear wave elastography in evaluating calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome.Methods:A total of 48 diabetic nephropathy patients with medial tibial stress syndrome from January 2020 to December 2022 were included as the study group,and 48 patients with diabetic nephropathy during the same period were included as the control group.Both groups were detected by two-dimensional shear wave elastography with ultrasonic equipment,and Young‘s modulus of the tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle were observed and analyzed in the two groups.Results:The Young‘s modulus values of tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle in the study group were significantly lower than those in the control group(P<0.05).Conclusion:Two-dimensional shear wave elastography is feasible for the evaluation of calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome,and has high accuracy and repeatability.This technique can be used to diagnose,treat and monitor muscle lesions in patients with diabetic nephropathy,and can also be used to assess muscle fatigue and exercise capacity,which has broad application prospects.

International study of the Complex Stress Reaction Syndrome:Implications for transdiagnostic clinical practice

BACKGROUND The debate regarding diagnostic classification systems in psychiatry(categorial vs dimensional systems)has essential implications for the diagnosis,prevention and treatment of stress reactions.We previously found a unique pattern of stress reaction in a study executed during the coronavirus disease 2019 pandemic using large representative samples in two countries,and termed it the Complex Stress Reaction Syndrome(CSRS).AIM To investigate CSRS,Type A(psychiatric symptoms,spanning anxiety,depression,stress symptoms,and posttraumatic stress disorder(PTSD)),with or without long-coronavirus disease(COVID)residuals(CSRS,Type B,neuropsychiatric symptoms spanning cognitive deficits and fatigue,excluding systemic symptoms).Our two-tailed hypothesis was that CSRS is a condition related to an unrecognized type of stress reaction in daily life in the general population(Type A)or that it is related to the severe acute respiratory syndrome coronavirus 2 infection and its long-COVID residuals(Type B).METHODS 977 individuals in four continents(North America,Europe,Australia and the Middle East)completed the online study questionnaire in six languages using the Qualtrics platform.The study was managed by six teams in six countries that promoted the study on social media.The questionnaire assessed anxiety,depression,stress symptoms and PTSD(CSRS,Type A),cognitive deficits and fatigue(CSRS,Type B).The data were analyzed using Proportion Analyses,Multivariate Analysis of Co-Variance(MANCOVA),linear regression analyses and validated clinical cutoff points.RESULTS The results of the Proportion Analyses showed that the prevalence of 4 symptoms spanning anxiety,depression,stress symptoms,and PTSD was significantly higher than the most prevalent combinations of fewer symptoms across 4 continents,age groups,and gender.This supports the transdiagnostic argument embedded in the CSRS(Type A).The same pattern of results was found in infected/recovered individuals.The prevalence of the 4 psychiatric symptoms combination was significantly greater than that of 5 and 6 symptoms,when adding cognitive deficits and fatigue,respectively.MANCOVA showed a significant three-way interaction(age×gender×continent).Further analyses showed that the sources of this three-way interaction were threefold relating to two sub-populations at-risk:(1)Individuals that self-identified as non-binary gender scored significantly higher on all 4 psychiatric symptoms of the CSRS,Type A at young age groups(<50 years old)in North America compared to(self-identified)women and men located in the 4 continents studied,and to other ages across the adult life span;and(2)This pattern of results(CSRS,Type A)was found also in women at young ages(<40 years old)in North America who scored higher compared to men and women in other continents and other ages.Linear regression analyses confirmed the MANCOVA results.CONCLUSION These results show a combined mental health risk factor related to stress reactivity,suggesting that the CSRS is sensitive to populations at risk and may be applied to future identification of other vulnerable sub-populations.It also supports the transdiagnostic approach for more accurate prevention and treatment.Time will tell if such transdiagnostic syndromes will be part of the discussions on the next revisions of the traditional classification systems or whether the crisis in psychiatry further evolves.

Evaluation of visual stress symptoms in age-matched dyslexic, Meares-Irlen syndrome and normal adults

AIM： To examine the prevalence of dyslexia and Meares-Irlen syndrome（MIS） among female students and determine their level of visual stress in comparison with normal subjects.·METHODS： A random sample of 450 female medical students of King Saud University Riyadh（age range, 18-30y） responded to a wide range of questions designed to accomplish the aims of this study. The detailed questionnaire consisted of 54 questions with 12 questions enquiring on ocular history and demography of participants while 42 questions were on visual symptoms. Items were categorized into critical and non-critical questions（CQ and NCQ） and were rated on four point Likert scale. Based on the responses obtained, the subjects were grouped into normal（control）, dyslexic with or without MIS（Group 1） and subjects with MIS only（Group 2）. Responses were analysed as averages and mean scores were calculated and compared between groups using one way analysis of variance to evaluate total visual stress score（TVSS =NCQ ＋CQ）, critical and non-critical visual stress scores. The relationship between categorical variables such as age, handedness and condition were assessed with Chi-square test.·RESULTS： The completion rate was 97.6% and majority of the respondents（92%） were normal readers, 2%dyslexic and 6% had MIS. They were age-matched. More than half of the participants had visited an eye care practitioner in the last 2y. About 13% were recommendedeye exercises and one participant experienced pattern glare. Hand preference was not associated with any condition but Group 1 subjects（3/9, 33%） were significantly more likely to be diagnosed of lazy eye than Group 2（2/27, 7%） and control（27/414, 7%） subjects. The mean±SD of TVSS responses were 63±14 and it was 44±9for CQ and 19 ±5 for NCQ. Responses from all three variables were normally distributed but the CQ responses were on the average more positive（82%） in Group 2 and less positive（46%） in Group 1 than control. With NCQ,the responses were equally less positive in Group 1 and2 than control. Group 2 subjects showed significantly higher TVSS（P =0.002）, NCQ（P =0.006） and CQ（P =0.008）visual stress scores than control but no difference between Group 1 and control subjects, was observed for all scores（P 〉0.05, for all comparisons）.·CONCLUSION： The prevalence of dyslexia and MIS among Saudi female students was 2% and 6%,respectively. Critical questions performed best for assessing visual stress symptoms in dyslexic and MIS subjects. Generally, students with MIS were more sensitive to visual stress than normal students but dyslexics were more likely to present with a lazy eye than MIS and normal readers.

Electroacupuncture alleviates stress-induced visceral hypersensitivity through an opioid system in rats

AIM:To investigate whether stress-induced visceral hypersensitivity could be alleviated by electroacupuncture(EA) and whether EA effect was mediated by endogenous opiates.METHODS:Six to nine week-old male SpragueDawley rats were used in this study.Visceral hypersensitivity was induced by a 9-d heterotypic intermittent stress(HIS) protocol composed of 3 randomly stressors,which included cold restraint stress at 4?℃ for 45 min,water avoidance stress for 60 min,and forced swimming stress for 20 min,in adult male rats.The extent of visceral hypersensitivity was quantified by electromyography or by abdominal withdrawal reflex(AWR) scores of colorectal distension at different distention pressures(20 mmHg,40 mmHg,60 mmHg and 80 mmHg).AWR scores either 0,1,2,3 or 4 were obtained by a blinded observer.EA or sham EA was performed at classical acupoint ST-36(Zu-San-Li) or BL-43(Gao-Huang) in both hindlimbs of rats for 30 min.Naloxone(NLX) or NLX methiodide(m-NLX) was administered intraperitoneally to HIS rats in some experiments.RESULTS:HIS rats displayed an increased sensitivity to colorectal distention,which started from 6 h(the first measurement),maintained for 24 h,and AWR scores returned to basal levels at 48 h and 7 d after HIS compared to pre-HIS baseline at different distention pressures.The AWR scores before HIS were 0.6 ± 0.2,1.3 ± 0.2,1.9 ± 0.2 and 2.3 ± 0.2 for 20 mmHg,40 mmHg,60 mmHg and 80 mmHg distention pressures,respectively.Six hours after termination of the last stressor,the AWR scores were 2.0 ± 0.1,2.5 ± 0.1,2.8 ± 0.2 and 3.5 ± 0.2 for 20 mmHg,40 mmHg,60 mmHg and 80 mmHg distention pressures,respectively.EA given at classical acupoint ST-36 in both hindlimbs for 30 min significantly attenuated the hypersensitive responses to colorectal distention in HIS rats compared with sham EA treatment [AWRs at 20 mmHg:2.0 ± 0.2 vs 0.7 ± 0.1,P = 4.23 711 E-4;AWRs at 40 mmHg:2.6 ± 0.2 vs 1.5 ± 0.2,P = 0.00 163;AWRs at 60 mmHg:3.1 ± 0.2 vs 1.9 ± 0.1,P = 0.003;AWRs at 80 mmHg:3.6 ± 0.1 vs 2.4 ± 0.2,P = 0.0023;electromyographic(EMG) at 20 mmHg:24 ± 4.7 vs 13.8 ± 3.5;EMG at 40 mmHg:60.2 ± 6.6 vs 30 ± 4.9,P = 0.00 523;EMG at 60 mmHg:83 ± 10 vs 39.8 ± 5.9,P = 0.00 029;EMG at 80 mmHg:94.3 ± 10.8 vs 49.6 ± 5.9,P = 0.00 021].In addition,EA at the acupuncture point BL-43 with same parameters did not alleviate visceral hypersensitivity in HIS rats.EA in healthy rats also did not have any effect on AWR scores to colorectal distention at distention pressuresof 20 and 40 mmHg.The EA-mediated analgesic effect was blocked by pretreatment with NLX in HIS rats [AWR scores pretreated with NLX vs normal saline(NS) were 2.0 vs 0.70 ± 0.20,2.80 ± 0.12 vs 1.50 ± 0.27,3 vs 2.00 ± 0.15 and 3.60 ± 0.18 vs 2.60 ± 0.18 for 20 mmHg,40 mmHg,60 mmHg and 80 mmHg;P = 0.0087,0.0104,0.0117 and 0.0188 for 20,40,60 and 80 mmHg,respectively].Furthermore,EA-mediated analgesic effect was completely reversed by administration of m-NLX,a peripherally restricted opioid antagonist(EMG pretreated with m-NLX vs NS were 30.84 ± 4.39 vs 13.33 ± 3.88,74.16 ± 9.04 vs 36.28 ± 8.01,96.45 ± 11.80 vs 50.19 ± 8.28,and 111.59 ± 13.79 vs 56.42 ± 8.43 for 20 mmHg,40 mmHg,60 mmHg and 80 mmHg;P = 0.05 026,0.00 034,0.00 005,0.000 007 for 20 mmHg,40 mmHg,60 mmHg and 80 mmHg,respectively).CONCLUSION:EA given at classical acupoint ST-36 alleviates stress-induced visceral pain,which is most likely mediated by opioid pathways in the periphery.

Genetic Screening of Halothane Gene on Selected Philippine Native Pig Herds

The establishment of nucleus herds (NHs) of Native Pigs (NPs) at various R&D stations in the Philippines is currently being undertaken for food security and genetic conservation advocacy. Marker-assisted selection (MAS) is being utilized to identify individuals carrying favorable alleles of genes associated with production traits and screen out genetic defects (GD) for breeding purposes. Porcine Stress Syndrome (PSS) caused by a mutation in Halothane (HAL) gene is a GD frequently found in commercial breeds that when expressed, causes pale, soft, exudative (PSE) meat. PSE is inferior quality meat undesirable in the market causing economic losses to the swine industry. Thus, this study was conducted to screen the HAL gene through mutagenically separated-polymerase chain reaction (MSPCR) in selected NP herds and assessed its repeatability in local breeds. Results showed that out of 577 screened individuals, 543 (94.11%) were normal (NN), 0 (0%) were homozygous mutant (nn) and 34 (5.89%) were heterozygous carriers (Nn). Therefore, the optimized PSS screening protocol using MSPCR is also applicable to local breeds. As such, the availability of genetic tests for PSS could be useful in improving the Philippine NPs breeding selection and inhibiting or eliminating PSS mutant incidence within its nucleus herd.

Review of possible psychological impacts of COVID-19 on frontline medical staff and reduction strategies

Like soldiers,frontline medical staff provide a first line of defense and have played a critical role in responses to the outbreak of coronavirus disease-2019 in December 2019.It is important to acknowledge the considerable pressure placed on frontline medical staff in the face of a new type of coronavirus that is highly infectious and for which no specific treatment is available.Here,we review the various kinds of psychological problems afflicting frontline medical staff who are combatting the severe acute respiratory syndrome epidemic.These include anxiety,insomnia,depression,interpersonal difficulties,and post-traumatic stress disorder syndrome.We further present a summary of countermeasures for alleviating these problems based on our findings.These countermeasures include ensuring the provision of adequate protective gear for frontline medical staff,developing timely and clear guidelines,strengthening social support,and providing clear criteria and additional training,focusing on the choice of frontline medical staff.An understanding of the psychological impacts of an epidemic situation and of relevant countermeasures will contribute to reducing the psychological pressures on frontline medical staff.Consequently,they will be able to cope better with outbreaks of infectious diseases in the future,to reduce the psychological pressure of the front-line medical staff,and to improve the treatment level.

The Fourier Transform Infrared Spectra of the Key Organs Derived from Kidney(Shen)-Yang Deficiency Syndrome Mice

Objective：To explore an approach to rapidly and accurately identify the compounds as biomarkers of Chinese medicine（CM）syndromes.Method：The Fourier transform infrared（FT-IR）spectrometry was applied to investigate the characteristic components of a mice model of Kidney（Shen）-yang deficiency syndrome（KDS）,and the remedial effect of a typical CM formula Shenqi Pill（肾气丸）.Thirty-six females and 18 males of Balb/c mice were randomly divided into KDS,Shenqi or control group.The females and males of the same group freely were mated for 96 h,and the males were taken out and only the female mice were raised.Females of the KDS group were threatened by a ferocious cat every other day for 14 d.After delivery,the KDS,or gestational threatened,offspring were raised at standard condition for 11 weeks.Then 10 male offspring were randomly selected,anaesthetized and their representative organs,i.e.testes,kidneys,lungs and feet were collected,for the FT-IR scan.Mice of the Shenqi group were intragastric administered Shenqi Pill;while mice in the KDS and control groups were given the same volume of saline.Results：The attenuated birth outcomes of the KDS group were displayed.The remarkable FT-IR differences of all organs between KDS mice and healthy control were mainly at 1,735-1,745 cm-1（indicating the increased levels of lipids）and at 1,640-1,647 cm-1and 1,539-1,544 cm-1（displaying the decreased proteins）.No statistic FT-IR difference between Shenqi and control mice was observed.Conclusion：In accordance with major traits of KDS,prenatal stress extensively impaired the building up of proteins and resulting in the excessive lipid storage,and FT-IR could effectively identify the biomarkers of KDS.