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The management of flexor tendon injury has seen many iterations over the years, but more substantial innovations in practice have been sadly lacking. The aim of this study was to investigate the current practice of flexor tendon injury management, and variation in practice from the previous reports, most troublesome complications, and whether there was a clinical interest in potential innovative tendon repair technologies. An online survey was distributed via the British Society for Surgery of the Hand (BSSH) and a total of 132 responses were collected anonymously. Results showed that although most surgeons followed the current medical recommendation based on the literature, a significant number of surgeons still employed more conventional treatments in clinic, such as general anesthesia, ineffective tendon retrieval techniques, and passive rehabilitation. Complications including adhesion formation and re-rupture remained persistent. The interest in new approaches such as use of minimally invasive instruments, biodegradable materials and additive manufactured devices was not strong, however the surgeons were potentially open to more effective and economic solutions.

Although there are many widely perceived attractions to living on a small island, island life is not without its challenges. The physical aspects of these are well rehearsed. The psychological ones, less so. Drawing on social psychological theories, we analyse the experience of living on small islands, with a focus on two small British islands. Data were collected through ethnographic fieldwork, involving observations and interviews with small island inhabitants. We found a range of factors impacting them psychologically, including several that suggest identity and social identity theories may provide a useful psychological lens for understanding these communities. There were also other psychological features identified that suggest a self-perception of vulnerability. These were reflected in concerns around the precarity of employment, but also evident in islanders' discourses around health (both physical and mental). These findings echo previous authors' assertions concerning the existence of an 'island psychology' evident in the experiences of island residents, but also contribute to discussions around its origins and mechanisms of influence - which we argue have been hitherto, relatively atheoretical. Importantly, a better understanding of island experience, and the relevant theoretical frameworks, can assist in supporting the wellbeing of islanders and the sustainability of their communities.

This paper summarizes the progress and activities of tropical cyclone (TC) operational forecast centers during the last four years (2018–2021). It is part II of the review on TC intensity change from the operational perspective in the rapporteur report presented to the 10th International Workshop on TCs (IWTC) held in Bali, Indonesia, from Dec. 5–9, 2022. Part I of the review has focused on the progress of dynamical model forecast guidance. This part discusses the performance of TC intensity and rapid intensification forecasts from several operational centers. It is shown that the TC intensity forecast errors have continued to decrease since the 9th IWTC held in 2018. In particular, the improvement of rapid intensification forecasts has accelerated, compared with years before 2018. Consensus models, operational procedures, tools and techniques, as well as recent challenging cases from 2018 to 2021 identified by operational forecast centers are described. Research needs and recommendations are also discussed.

This review summarizes the rapporteur report on tropical cyclone (TC) intensity change from the operational perspective, as presented to the 10th International Workshop on TCs (IWTC-10) held in Bali, Indonesia, from Dec. 5–9, 2022. The accuracy of TC intensity forecasts issued by operational forecast centers depends on three aspects: real-time observations, TC dynamical model forecast guidance, and techniques and methods used by forecasters. The rapporteur report covers the progress made over the past four years (2018–2021) in all three aspects. This review focuses on the progress of dynamical model forecast guidance. The companion paper (Part II) summarizes the advance from operational centers. The dynamical model forecast guidance continues to be the main factor leading to the improvement of operational TC intensity forecasts. Here, we describe recent advances and developments of major operational regional dynamical TC models and their intensity forecast performance, including HWRF, HMON, COAMPS-TC, Met Office Regional Model, CMA-TYM, and newly developed HAFS. The performance of global dynamical models, including NOAA's GFS, Met Office Global Model (MOGM), JMA's GSM, and IFS (ECMWF), has also been improved in recent years due to their increased horizontal and vertical resolution as well as improved data assimilation systems. Recent challenging cases of rapid intensification are presented and discussed.

ABSTRACTTendons play a crucial role in the musculoskeletal system. In humans, tendon injuries, especially chronic tendinopathy, are very common and the patellar tendon is a frequent location for tendinopathy or injuries. The biomechanical characteristics of the patellar tendon, such as elasticity and stiffness, are of paramount importance and constitute major outcome measures in research studies. We aimed to assess whether the stiffness of the healthy ovine patellar tendon changes with age and weight in a population of normal animals. Sixty-eight ‘patella-patellar tendon-tibial tuberosity’ units from thirty-four Ile-de-France ewes of body mass 65 to 95 kg, euthanized for reasons other than musculoskeletal diseases, underwent a tensile test providing a measure of the tendon stiffness. Animals were sorted into three categories of age (1–2 yo, 3–5 yo, 6–10 yo). We found a positive but not significant correlation between age category and stiffness (r = 0.22, p = 0.27). There was a significantly positive correlation between weight and stiffness (r = 0.39, p = 0.04). In conclusion, the study characterized biomechanical properties of healthy tendons, provided useful reference values, and established the basis for future biomechanical tests on healing tendons in sheep. The most appropriate sheep population for those future studies would be non-overweight young adults presenting with no lameness.

Abstract Background Osteoarthritis remains one of the greatest causes of morbidity and mortality in the equine population. The inability to detect pre-clinical changes in osteoarthritis has been a significant impediment to the development of effective therapies against this disease. Synovial fluid represents a potential source of disease-specific small non-coding RNAs (sncRNAs) that could aid in the understanding of the pathogenesis of osteoarthritis. We hypothesised that early stages of osteoarthritis would alter the expression of sncRNAs, facilitating the understanding of the underlying pathogenesis and potentially provide early biomarkers. Methods Small RNA sequencing was performed using synovial fluid from the metacarpophalangeal joints of both control and early osteoarthritic horses. A group of differentially expressed sncRNAs was selected for further validation through qRT-PCR using an independent cohort of synovial fluid samples from control and early osteoarthritic horses. Bioinformatic analysis was performed in order to identify putative targets of the differentially expressed microRNAs and to explore potential associations with specific biological processes. Results Results revealed 22 differentially expressed sncRNAs including 13 microRNAs; miR-10a, miR-223, let7a, miR-99a, miR-23b, miR-378, miR-143 (and six novel microRNAs), four small nuclear RNAs; U2, U5, U11, U12, three small nucleolar RNAs; U13, snoR38, snord96, and one small cajal body-specific RNA; scarna3. Five sncRNAs were validated; miR-223 was significantly reduced in early osteoarthritis and miR-23b, let-7a-2, snord96A and snord13 were significantly upregulated. Significant cellular actions deduced by the differentially expressed microRNAs included apoptosis (P

Abstract Osteoarthritis is a major cause of disability and there is no current pharmaceutical treatment which can prevent the disease or slow its progression. Dietary advice or supplementation is clearly an attractive option since it has low toxicity and ease of implementation on a population level. We have previously demonstrated that sulforaphane, a dietary isothiocyanate derived from its glucosinolate precursor which is found in broccoli, can prevent cartilage destruction in cells, in in vitro and in vivo models of osteoarthritis. As the next phase of this research, we enrolled 40 patients with knee osteoarthritis undergoing total knee replacement into a proof-of-principle trial. Patients were randomised to either a low or high glucosinolate diet for 14 days prior to surgery. We detected ITCs in the synovial fluid of the high glucosinolate group, but not the low glucosinolate group. This was mirrored by an increase in ITCs and specifically sulforaphane in the plasma. Proteomic analysis of synovial fluid showed significantly distinct profiles between groups with 125 differentially expressed proteins. The functional consequence of this diet will now be tested in a clinical trial.

Osteoarthritis (OA) is a degenerative and inflammatory joint disorder with cartilage loss. Dental pulp stem cells (DPSCs) can undergo chondrogenic differentiation and secrete growth factors associated with tissue repair and immunomodulation. Leukocyte- and platelet-rich fibrin (L-PRF) emerges in regenerative medicine because of its growth factor content and fibrin matrix. This study evaluates the therapeutic application of DPSCs and L-PRF in OA via immunomodulation and cartilage regeneration. Chondrogenic differentiation of DPSCs, with or without L-PRF exudate (ex) and conditioned medium (CM), and of bone marrow-mesenchymal stem cells was compared. These cells showed differential chondrogenesis. L-PRF was unable to increase cartilage-associated components. Immature murine articular chondrocytes (iMACs) were cultured with L-PRF ex, L-PRF CM, or DPSC CM. L-PRF CM had pro-survival and proliferative effects on unstimulated and cytokine-stimulated iMACs. L-PRF CM stimulated the release of IL-6 and PGE2, and increased MMP-13, TIMP-1 and IL-6 mRNA levels in cytokine-stimulated iMACs. DPSC CM increased the survival and proliferation of unstimulated iMACs. In cytokine-stimulated iMACs, DPSC CM increased TIMP-1 gene expression, whereas it inhibited nitrite release in 3D culture. We showed promising effects of DPSCs in an in vitro OA model, as they undergo chondrogenesis in vitro, stimulate the survival of chondrocytes and have immunomodulatory effects.

Due to the restricted intrinsic capacity of resident chondrocytes to regenerate the lost cartilage postinjury, stem cell-based therapies have been proposed as a novel therapeutic approach for cartilage repair. Moreover, stem cell-based therapies using mesenchymal stem cells (MSCs) or induced pluripotent stem cells (iPSCs) have been used successfully in preclinical and clinical settings. Despite these promising reports, the exact mechanisms underlying stem cell-mediated cartilage repair remain uncertain. Stem cells can contribute to cartilage repair via chondrogenic differentiation, via immunomodulation, or by the production of paracrine factors and extracellular vesicles. But before novel cell-based therapies for cartilage repair can be introduced into the clinic, rigorous testing in preclinical animal models is required. Preclinical models used in regenerative cartilage studies include murine, lapine, caprine, ovine, porcine, canine, and equine models, each associated with its specific advantages and limitations. This review presents a summary of recent in vitro data and from in vivo preclinical studies justifying the use of MSCs and iPSCs in cartilage tissue engineering. Moreover, the advantages and disadvantages of utilizing small and large animals will be discussed, while also describing suitable outcome measures for evaluating cartilage repair.

Osteoarthritis (OA) is the most common age-related joint disorder in man. MicroRNAs (miRNA), a class of small noncoding RNAs, are potential therapeutic targets for regulating molecular mechanisms in both disease and ageing. Whilst there is an increasing amount of research on the roles of miRNAs in ageing, there has been scant research on age-related changes in miRNA in a cartilage. We undertook a microarray study on young and old human cartilages. Findings were validated in an independent cohort. Contrasts between these samples identified twenty differentially expressed miRNAs in a cartilage from old donors, derived from an OA environment which clustered based on OA severity. We identified a number of recognised and novel miRNAs changing in cartilage ageing and OA including miR-126: a potential new candidate with a role in OA pathogenesis. These analyses represent important candidates that have the potential as cartilage ageing and OA biomarkers and therapeutic targets.

The article considers the changes that have taken place within the political economy of international trade over the last decade. The work begins by assessing briefly the dynamics of the last successful trade negotiations undertaken by the ACP Caribbean – the agreement on a single European banana market in 1993. Since then, however, the international political and economic climate has dramatically changed. The article evaluates recent developments, which have highlighted attention on the political acceptability of trade discrimination, particularly within the context of the General Agreement on Tariffs and Trade and the World Trade Organisation. In addition, there is an analysis of the reform process undertaken by the European Union, both in terms of its membership and policy agenda, which has seriously impacted on Caribbean economic interests. The article establishes that the actors representing the Caribbean were extremely successful in constructing strategic coalitions to defend their trading interests in the early 1990s, but the region must now appreciate that the international environment has changed so dramatically that former negotiating strategies are no longer appropriate. An awareness of the changed negotiating environment on the part of the Caribbean is vitally important if ongoing international trade negotiations are to be completed to the region’s satisfaction. Resumen: Batallas bananeras y desafíos políticos: El grupo ACP del Caribe y la fragmentación de las coaliciones de interésEste trabajo considera los cambios ocurridos en la economía política del comercio internacional durante la última década. El artículo comienza con una breve evaluación de la dinámica de las últimas negociaciones comerciales satisfactorias del grupo ACP del Caribe: el acuerdo sobre un mercado único bananero europeo en 1993. Desde entonces, sin embargo, el clima político y económico internacional ha cambiado drásticamente. El artículo evalúa los recientes acontecimientos que han puesto de relieve la aceptabilidad política de la discriminación comercial, en particular en el contexto del Acuerdo General sobre Tarifas y Comercio y la Organización Mundial del Comercio. Además, se hace un análisis del proceso de reforma efectuado por la Unión Europea, tanto en términos de su ampliación como de su agenda política, los cuales han tenido un grave impacto en los intereses económicos caribeños. El artículo establece que a principios de los años 90 los representantes caribeños tuvieron gran éxito a la hora de desarrollar estrategias para defender sus intereses comerciales, pero en estos momentos la región debe tomar nota de que el ambiente internacional ha cambiado de forma tan radical que las antiguas estrategias de negociación no pueden considerarse ya como apropiadas. Para que la región pueda asegurar un resultado positivo de las actuales negociaciones, es de vital importancia que el Caribe tome conciencia del nuevo clima en que se desarrollan dichas negociaciones.

Mucus accumulation is a feature of inflammatory airway disease in the horse and has been associated with reduced performance in racehorses. In this study, we have analysed the two major airways gel-forming mucins Muc5b and Muc5ac in respect of their site of synthesis, their biochemical properties, and their amounts in mucus from healthy horses and from horses with signs of airway mucus accumulation. Polyclonal antisera directed against equine Muc5b and Muc5ac were raised and characterised. Immunohistochemical staining of normal equine trachea showed that Muc5ac and Muc5b are produced by cells in the submucosal glands, as well as surface epithelial goblet cells. Western blotting after agarose gel electrophoresis of airway mucus from healthy horses, and horses with mucus accumulation, was used to determine the amounts of these two mucins in tracheal wash samples. The results showed that in healthy horses Muc5b was the predominant mucin with small amounts of Muc5ac. The amounts of Muc5b and Muc5ac were both dramatically increased in samples collected from horses with high mucus scores as determined visually at the time of endoscopy and that this increase also correlated with increase number of bacteria present in the sample. The change in amount of Muc5b and Muc5ac indicates that Muc5b remains the most abundant mucin in mucus. In summary, we have developed mucin specific polyclonal antibodies, which have allowed us to show that there is a significant increase in Muc5b and Muc5ac in mucus accumulated in equine airways and these increases correlated with the numbers of bacteria.