bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Outcomes For Open Reduction Internal Fixation Of Midshaft Clavicle Fractures In Adolescent/post-adolescent Athletes Utilizing A Two Month Return To Play Protocol
Authors: Lindeman Robert W. , Lanier Brandon S. , Parsell Douglas E. , Ramsey James R.
Published: July 2019

Objectives:

The success rate and the return to sport after midshaft clavicle fracture has been shown to improve with open reduction internal fixation (ORIF) treatment versus non-operative management. The period of time for return to sport, post-ORIF, has been reported in the literature with considerable range. Return to sport times for NFL athletes are reported to typically require three to seven months, while professional cyclists have resumed training in only one week. As the percentage of clavicle fractures in athletes is likely dominated by the high school and college populations, it is clinically relevant to evaluate the success of specific return to sport protocols after clavicle ORIF with respect to age. To evaluate this aspect of care, a retrospective study utilizing an adolescent/immediate post-adolescent and an adult control patient was performed.

Methods:

A single surgeon performed locking plate ORIF of clavicle fractures with patient population of athletes, ages 13 to 22 years old (mean 16.7 yrs.), and an adult control group (mean 50.8 yrs.). A uniform period for return to sport of two months was utilized for the athlete group, unless complications were present. The athlete group contained 90 patients, and the adult control group contained 64 patients. The athlete group had 48% of fractures resulting from football. High energy mechanisms (auto accident, ATV accident, etc.) accounted for 23.3% of the athlete group fractures, while these mechanisms accounted for 46.9% of the adult group fractures. Post-operative complications and adverse outcomes were monitored for a minimum period of one year.

Results:

Clavicle fractures within both patient groups were dominantly midshaft fractures with 97.7% of the athlete fractures and 88.5% of the adult fractures being located midshaft. The athlete group exhibited minimal post-operative complication/adverse outcomes with one patient reporting pain with weightlifting and two patients requiring minor scar revisions, for a total complication/adverse outcome rate of 3.3%. The adult group included ten patients with significant residual pain and one patient requiring revision for non-union, yielding a total complication/adverse outcome rate of 15.6% in this group. Applying a Chi-square analysis, a statistically significant difference in complication/adverse outcome rates exist between the patient groups (p=0.003). Additionally, all patients in the athlete group, desiring to return to their sport, did so within the two-month post-operative period.

Conclusion:

Locking plate ORIF of midshaft clavicle fractures allowed for a successful two month return to sport, with a low occurrence of complications, for a young athlete patient group. High energy fracture events and an adult aged patient group were associated with higher rates of adverse clinical outcome.
Healing Rates of Massive Rotator Cuff Tears by Allograft Reconstruction vs Maximal Repair - A Prospective Randomized Controlled Trial
Authors: Tejaswi Purnachandra , Wong Ivan H.
Published: July 2019

Objectives:

To determine the healing rate of rotator cuff reconstruction with an acellular human dermal allograft compared with the current gold standard arthroscopic maximal rotator cuff repair of large, chronic tears of the rotator cuff.

Methods:

Thirty patients with a two-tendon chronic retracted rotator cuff tear were enrolled in the study and were randomly allocated (15) to each group. All the patients were evaluated for structural integrity of repair using a 1.5 T MRI at an average of 15 months after surgery. Rotator cuff arthropathy (RCA) and acromio-humeral distance (AHD) were graded using X-rays. WORC, DASH, MARX scores, range of motion (ROM) of shoulder were also analyzed.

Results:

The re-tear rate in reconstruction group was 13% (2 of 15 patients) compared to 67%(10/15) in repair group (p=0.008). Progression of RCA was seen in 7.14%(1/14) and 35.71%(4/14) of patients in reconstruction and repair group; respectively (p=0.006). The change in AHD (preop-postop) was significantly higher in repair (reduced by 2.27 mm) than the reconstruction group (increased by 0.1 mm) (P=0.006). Both groups had significant improvements in patient reported outcome scores. Reconstruction group had statistically significant better forward flexion (p= 0.01) and scapular plane abduction (p=0.03) compared to repair.

Conclusion:

Rotator cuff reconstruction with a dermal allograft demonstrated favourable structural healing rates and improved range of motion compared to maximal repair in the short term. Moreover, those in the maximal repair group were more likely to develop RCA compared to reconstruction.
Epidemiology of Foot and Ankle Injuries in NCAA Jumping Athletes in the United States from 2009-2014
Authors: Lytle Joseph Benjamin , Parikh Kisan B. , Tarakemeh Armin , Vopat Bryan George , Mulcahey Mary K.
Published: July 2019

Objectives:

The purpose of this study was to describe the epidemiology of foot and ankle injuries in men’s and women’s NCAA basketball, women’s volleyball, and women’s gymnastics during the 2009-2010 through 2013-2014 seasons.

Methods:

Injury surveillance data was obtained from the NCAA Injury Surveillance Program (ISP) for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, participation restriction time, and recurrence. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs), and risk ratios (RR) with 95% confidence intervals were calculated. Reported sex differences were calculated for men’s and women’s basketball. All 95% confidence intervals not containing 1.0 were considered statistically significant.

Results:

During the study period, 1136 players sustained foot and ankle injuries (483 male, 653 female) over 612,680 AEs. In total, these injuries resulted in a combined rate of 1.85/1000 athlete-exposures (AEs; 95% CI 1.75 -1.97). Ankle sprains were the most common injury overall (63.7%), with lateral ligamentous complex (LLC) injuries comprising 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male vs female basketball players (IRR=1.33, 95% CI 1.13 -1.57), but foot injury rates did not differ. Foot injuries occurred at half the rate of ankle injuries, but were significantly more likely to be severe (time loss over 30+ days) (IRR=3.37, 95% CI 1.91-5.949). Among basketball and volleyball athletes, player contact was the most common mechanism of injury and occurred most often while engaging in team jumping activities (rebounding, shooting, blocking, spiking). Surface contact was the most common mechanism in gymnasts. Female gymnasts had higher chronic injury rates than all other sports examined (0.485/1000 AEs, 0.304-0.735, p<0.002). Overall, female basketball players were 1.98 times more likely to suffer an overuse injury than male athletes (95% CI 1.14-3.45, p=0.005).

Conclusion:

Athletes participating in jumping sports have a higher rate of lateral ligamentous complex ankle sprains than other NCAA sports. Deterring player contact during jumping and landing by way of coaching and/or rule changes may reduce injury rates and improve player safety. The increased prevalence of chronic injuries in female collegiate athletes competing in jumping sports necessitates further investigation in order to identify opportunities to reduce injury rates through prevention and training programs. [Table: see text]
Influence of Acetabular Labral Tear Length on Postoperative Clinical Outcomes and Patient Satisfaction following Hip Arthroscopy for Femoroacetabular Impingement Syndrome with Capsular Plication
Authors: Chahla Jorge , Beck Edward , Cancienne Jourdan M. , Nwachukwu Benedict Uchenna , Okoroha Kelechi , Neal William H. , Nho Shane Jay
Published: July 2019

Objectives:

To determine the effect of labral tear length on post-operative outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

Methods:

Patients undergoing primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified in a prospectively collected database. All patients completed the hip outcome score (HOS)-activities of daily living (ADL), HOS-sports subscale (HOS-SS), modified Harris hip score (mHHS), international hip outcome tool-12 (IHOT-12), and visual analog scales (VAS) for pain and satisfaction. Patients were stratified by labral tear length into small (<2.5 cm) or large (>2.5 cm) labral tear based on the ROC curve analysis. Patient demographics and outcomes were analyzed using parametric and multivariate linear regression analyses to identify predictors of labral tear length. Binary logistic regression analysis was performed to determine whether labral tear length predicted the likelihood of achieving the Minimal Clinically Important Difference (MCID).

Results:

A total of 747 eligible patients were included in the analysis. Mean age and BMI were 33.5±12.3 years and 25.4±8.6 kg/m2 22, respectively. Mean length of labral tears was 2.7±0.7 cm with 99% occurring in the anterosuperior position. Men had a higher proportion of large tears (>2.5 cm) when compared to women (75% vs 44%; p<0.001). All PROs showed improvement at a minimum of 2-years postoperatively (p<0.05 for all). Independent T-test demonstrated significant differences in two-year outcomes between patients with tears less than and greater than 2.5 cm: HOS-ADL (87.3±16.3 vs. 84.3±18.3, p=0.033), HOS-SS (76.6±23.5 vs. 70.5±27.7, p=0.005), mHHS (82.5±18.0 vs. 78.5±18.2, p=0.009), and satisfaction (83.5±23.4 vs. 77.8±34.9, p=0.026). Multivariate regression analysis demonstrated that labral tear length is an independent predictor of VAS satisfaction, HOS-ADL, -SS, and mHHS. Binary logistic regression analysis demonstrated that patients with small labral tears (<2.5 cm) had a higher likelihood of achieving MCID HOS-SS (OR: 1.61; p-value<0.02) and PASS mHHS (OR:1.56; p-value 0.038) than those with larger tears (more than 2.5 cm).

Conclusion:

Labral tear length is associated with numerous preoperative factors. These factors were found to be predictive of injury pathology and outcomes following hip arthroscopy for FAIS. Furthermore, patients with smaller tears (< 2.5 cm) had better outcomes and a higher likelihood of achieving a minimal clinically important difference at 2 years follow-up. [Table: see text]
Injury Risk Associated with Sports Specialization in Youth
Authors: Kocher Mininder S. , Field Alison E. , Tepolt Frances
Published: July 2019

Objectives:

Sports specialization has become increasingly common among youth. Our goal was to examine the independent prospective associations of sports specialization and volume of activity with injury risk in youth.

Methods:

A prospective analysis in 2018 using data collected from 10,138 youth in the Growing Up Today Study, a prospective cohort study of youth throughout the United States, and their mothers. Activity was assessed via questionnaires in 1997, 1998, 1999 and 2001. Sports specialization was defined as engaging in one sport in the fall, winter, and spring. Injury history was provided by participants’ mothers via questionnaire in 2004. The outcome was incident stress fracture, tendinitis, chondromalacia patella or anterior cruciate ligament tear.

Results:

Females who engaged in sports specialization were at increased risk of injury (females: hazard ratio (HR)=1.31, 95% confidence interval (CI) 1.07 -1.61), but risk varied by sport. In both genders sports specialization was associated with greater volume of physical activity (p<0.0001). Total hours/week of vigorous activity was predictive of developing injury (males: HR=1.04, 95% CI 1.02 -1.06; females: HR=1.06, 95% CI 1.05 -1.08). Among the females even those engaging in 3-3.9 hours per week less than their age were at a significantly increased risk of injury (HR=1.93, 95% CI 1.34-2.77). In males there was not a clear pattern of risk.

Conclusion:

Sports specialization is associated with higher volume of vigorous sports activity and increased risk of injury. Parents, coaches, and medical providers need to be made aware of the volume threshold above which physical activity is excessive.
Increasing Incidence of Pectoralis Major Ruptures in NFL Players
Authors: Wise Patrick , Gallo Robert A.
Published: July 2019

Objectives:

Pectoralis major ruptures are considered an uncommon injury in football. A previous study showing that only 10 compete ruptures occurred in the NFL between the years 2000-2010. The purpose of the study is to report the incidence of pectoralis ruptures in National Football League (NFL) players from 2010-2017 and identify any characteristics that could have contributed. We hypothesized that incidence of pectoralis major ruptures would increase over the past eight years.

Methods:

Using publicly available reports from websites such as ESPN.com and NFL.com, pectoralis major injuries in professional football players were identified during the years 2010-2017. Details about age, position played, injury setting, performance enhancing drug (PED) suspensions, and combine performance were obtained from NFL Combine and compared to peers at the same workout.

Results:

During the eight years analyzed 51 separate NFL players suffered a total of 55 pectoralis major ruptures. Defensive players accounted for 82% (42 of 51) of the injured players. The ruptures happened at the average age of 26±1 years, and 76.4% (42 of 55) of them occurred during games. After the rupture, 87.3% (48 of 55) required surgery, while definitive treatment could not be determined for the remaining seven injuries. For athletes that received playing time before injury and had their rupture occur prior to the most recent 2017 season, 85.4% (41 of 48) returned to play in a game. When comparing athletes at the combine who later ruptured their pectoralis major to peers at their position, those who tore their pectoralis major tendon on-average ranked in the 63 rd percentile for bench press (N=40), 50th percentile for arm length (N=14), and 52nd percentile for 20-yard shuttle (N=20). When the NFL suspension records were examined, only 5.9% (3 of 51) of players with a pectoralis major rupture had been suspended for (performance-enhancing drug) PED use before or after the injury.

Conclusion:

The total number of pectoralis major ruptures has drastically risen from 10 cases between 2000-2010 to 55 cases from 2010-2017. The reason behind this increase remain uncertain but appears to be independent of relative strength, agility, and arm length, and suspension for PED use.
Early Sports Specialization is Associated with Increased Upper Extremity Injuries and Fewer Games Played in Major League Baseball Players
Authors: Confino Jamie Erica , Irvine James N. , Ahmad Christopher S. , Lynch Thomas Sean
Published: July 2019

Objectives:

Early sport-specialization has been shown to place athletes at risk for increased injuries and decreased sporting performance in various sporting populations. However, the effect of sport-specialization has not been studied in professional baseball. The purpose of this investigation is to determine if single-sport athletes that specialize in baseball at a young age have a greater predisposition to overuse injury, burnout, and decreased performance compared to multiple-sport athletes. We hypothesized that MLB players who played multiple sports in high school would experience fewer injuries necessitating time on the Disabled List (DL), play more games, and have a longer career compared to athletes that played only baseball in high school.

Methods:

First and second-round MLB draft picks from 2008 to 2016 that played in at least one professional (minor or major league) game were included in this study. Athletes who participated in one or more sports in high school in addition to baseball were considered multi-sport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and MiLB, number of days on the Disabled List (DL) for each injury, number of games played in MLB and MiLB, and whether the athlete was still active were collected from publically available records.

Results:

Seven hundred forty-seven athletes were included in this study, of which 240 (32%) were multi-sport and 506 (68%) were single-sport athletes. Multi-sport athletes played in significantly more total professional baseball games on average (362.8 vs. 300.8, p < 0.01) as well as more major league games (95.9 vs. 71.6, p = 0.04) than single-sport athletes. Meanwhile, single-sport athletes had a significantly higher number of upper extremity injuries than multi-sport athletes (136 vs. 55, p < 0.01, Table I). Single-sport pitchers also had a higher number of shoulder and elbow injuries than multi-sport pitchers and, once injured, were more likely to have recurrent elbow injuries (86 vs. 27, p < 0.01; 33% vs. 17% recurrence).

Conclusion:

Professional baseball players who participated in multiple sports during high school played in more MLB games and sustained fewer upper extremity injuries than players who specialized in baseball before high school. Professional pitchers who specialized by the time they were in high school had a significantly higher chance of sustaining recurrent elbow injuries compared to those who were multi-sport athletes in high school. MLB players with a history of multi-sport participation were more likely to avoid overuse injuries and had greater longevity and level of performance compared to those that limited their sport participation to baseball during high school. [Table: see text]
Hypovitaminosis D Is A Risk Factor for Posterior Chain Muscular Injury in NCAA Division I Track And Field Athletes
Authors: Lindsay Adam , Jalali Omid , Korber Shane , Romano Russ , Tibone James E. , Weber Alexander E. , Gamradt Seth C.
Published: July 2019

Objectives:

Currently little information is available in evaluating micronutrient requirements in elite athletes. Despite evidence that groups of NCAA athletes may be deficient in Vitamin D, no study to date has examined Vitamin D levels with respect to their predicative values for injuries to the ‘posterior chain’ musculature. The objective of this study was to evaluate the association between hypovitaminosis D and posterior chain injuries in NCAA Division I track and field athletes.

Methods:

After IRB approval, we evaluated data for men’s and women’s outdoor track and field teams from 2015-2018 at a large NCAA Division I athletics program. Vitamin D levels were drawn during pre-season annual physicals. The cutoff for hypovitaminosis D was set at 40 nmol/L. Demographic and athletic tenure data were recorded and analyzed, and competitive events were grouped into one of four categories: 1) running events, 2) jumping events, 3) throwing events, and 4) multiple event types. Student T tests, chi-squared tests, and multivariate logistic regression were performed.

Results:

The analysis consisted of 145 (58% female, 42% male) NCAA Division I track athletes. Eighty-five of the 145 athletes had hypovitaminosis D. A full breakdown of athlete characteristics by vitamin D status can be seen in Figure 1 and Table 1. Of the 145 athletes analyzed, 33 (22.7%) suffered a muscular injury to their posterior chain musculature. Multinomial logistic regression identified hypovitaminosis D as an independent risk factor for posterior chain injury (relative risk ratio: 3.23, p=0.016). Age, BMI, and event type were not predictive of a posterior chain injury. Of note, 4 (4.7%) athletes in the hypovitaminosis D group suffered multiple posterior chain injuries, with 2 (2.4%) athletes suffering 2 separate injuries and 2 (2.4%) athletes suffering 3 separate injuries. None of the athletes in the normal Vitamin D group suffered multiple posterior chain injuries.

Conclusion:

These results demonstrate that pre-season hypovitaminosis D is an independent risk factor for posterior chain muscular injury in NCAA division I track athletes. These data suggest that early detection of hypovitaminosis D may play a critical role in injury prevention for these athletes. [Table: see text]
Is Brace Immobilization Needed Following Surgical Repair Of Proximal Hamstring Tears?
Authors: Lazaro Lionel E. , Banffy Michael B.
Published: July 2019

Objectives:

Braces are commonly used in Orthopaedic to protect repaired tissue from excessive stress that can compromise the healing process. Some of these braces can become a nuisance, especially the ones commonly used following proximal hamstring repairs. The idea is to limit hip flexion and knee extension to avoid stretching of the hamstrings. However, this immobilization creates discomfort and limitation during the basic daily needs, possibly compromising patient satisfaction. We hypothesis that proximal hamstring repairs can be safely managed, without brace immobilization and allowing partial weight bearing immediately after surgery, and result in excellent outcomes with minimal complications.

Methods:

We identify 57 patients that underwent surgical repair of proximal hamstring injuries. The repairs were fixed using suture anchors, and the same surgical technique were performed by a single sport medicine fellowship trained Orthopaedic surgeon. During the postoperative period the patient were allowed to bear partial weight with the assistance of crutches for 6 weeks. At the fourth week, light stretches begin with assistance of the physical therapist. Brace immobilization is not utilize at all, instead detail instruction are provide to the patient to avoid simultaneous hip flexion and knee extension. Subjective outcome measures included: the single assessment numeric evaluation (SANE); I-Holt 12 and KJOC hip scores. Clinical data was obtained from the electronic medical records.

Results:

Mean patient age was 52 years (range 29-69). The injury was chronic (> 6 weeks) in 55% of the patients. Mean length of follow-up was 32 months ( range 14-60). One patient failed repair, requiring revision surgery. The average SANE score were excellent at 97points, and representing a 43 points increase from the preoperative assessment. Similarly, the mean score for the I-Holt 12 and KJOC hip scores were very good with 99 and 83 points, respectively. In 68% of the patient the injury was sport related, and they all return to sport at an average of 7 months.

Conclusion:

A post-operative protocol that included immediate partial weight bearing and does not utilized immobilization brace can result in excellent subjective outcomes, high rate to return to sport in a timely matter and low failure rates. Based in our findings, brace immobilization following surgical repair of proximal hamstring appear to be excessive and may not provide additional benefit.
Platelet-rich plasma (PRP) Shortens Return to Play in National Football League (NFL) Players with Acute Hamstring Injuries
Authors: Arner Justin W. , Lawyer Tracye J. , Mauro Craig Stephen , Bradley James P.
Published: July 2019

Objectives:

Hamstring injuries are common in professional athletes and subsequent delays in healing are common, costly, and even career ending. The efficacy of platelet-rich plasma (PRP) for augmentation of non-operative treatment of partial musculotendinous hamstring injuries has not yet been established.

Methods:

NFL players from a single team who sustained acute grade 2 hamstring injuries as diagnosed on MRI by a musculoskeletal radiologist from 2009 to 2017 were retrospectively reviewed. Average days, practices, and games missed were recorded. Players that did and did not receive PRP injections were compared. Those who received PRP did so within 24 to 48 hours after injury.

Results:

Ninety-four NFL players had MRI evidence of a hamstring injury, while 61 athletes sustained grade 2 injuries. Thirty-one were treated with PRP injections and 30 were not. Average time missed in those treated with PRP injections was 22.4 days, 18.5 practices, and 1.7 games. In those who did not receive PRP injections, time missed was 25.8 days (p = 0.81), 22.2 practices (p = 0.68), and 2.7 games (p < 0.05).

Conclusion:

PRP injection treatment for acute grade 2 hamstring injuries in NFL players allows for faster return to play with a 1 game overall difference. Due to the possible large financial impact of return to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes. Additional evaluation of PRP treatment of acute hamstring injuries in a larger cohort is necessary.
First Rib Stress Fracture in Overhead Throwing Athletes
Authors: Itoh Yuya , Funakoshi Tadanao , Furushima Kozo , Kusano Hiroshi , Itoh Yoshiyasu
Published: July 2019

Objectives:

First-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent athletes. However, etiology on throwing athletes with first rib fracture have not been still unknown. The purpose of this retrospective study was to investigate characteristic clinical features and radiographic findings of patients with the first rib fracture in overhead throwing athletes.

Methods:

Twenty-four cases of first rib stress fracture in 23 players were studied retrospectively. We reviewed clinical features, including age, initial symptom, sports, activity related to pain, method of diagnose, method of treatment, and final follow-up.

Results:

We found characteristic clinical features as follows; 16.8 years (13-25), 19 dominant side injury and 5 non-dominant injury, an acute increase in pain while swinging the bat (9 cases) or pitching the ball (6 cases). Sixteen cases presented with posterior shoulder, inferior or medial border of the scapula, upper thoracic back pain. The current study showed 17 healing on average 3.8 month after conservative treatment and 7 nonunion of throwing athlete with the first rib stress fracture, (69.6%, 30.4%, respectively). Analysis on radiographs and CT revealed that the first rib stress fractures were classified into 3 types depends on direction and portion of fracture lines: Groove type, fracture line along with the subclavian artery groove; Intrascalene type, fracture line inside the middle scalene muscle insertion; and Posterior type, fracture beside to the costovertebral articulation (Figure 1 a-c). A 3-dimensional CT angiography showed that fracture line in the Groove type was consistent with the subclavian artery and fracture line in the Intrascalene type was different to the subclavian artery (Figure 2 a-f).We found 2 symptomatic cases and they had the first rib resection cause of thoracic outlet syndrome. We calculated percent availability of the first rib based on the measurements of 2 different observers. Percent availability of the shoulder and cervical spine radiographs were 46% and 97%, respectively. The Cohen’s kappa coefficient and percent agreement of the shoulder and cervical spine were 0.87, 89.4% and 0.80, 99.0%, respectively.

Conclusion:

We should consider the first rib stress fracture when teenage overhead athletes have posterior shoulder pain and acute onset while swinging the bat or pitching the ball. An anteroposterior radiograph of the cervical spine was available for initial diagnose. Although 70% of the patients would heal in 3 months with conservative treatments, some patients may have a symptom like thoracic outlet syndrome.
Double-Row Repair Technique Provides Improved Dynamic Stabilization over Single-Row Repairs for Acute Bony Bankart Lesions
Authors: Greenstein Alexander , Brown Alexander M. , Roberts Aaron , Chen Raymond Edward , Knapp Emma , Voloshin Ilya
Published: July 2019

Objectives:

Previous studies of bony Bankart repair comparing single- and double-row reconstruction techniques have examined static forces required to displace the bony Bankart lesion. No studies, to date, have examined stability of bony Bankart repair with more physiologic concavity-compression model. We hypothesize the double-row fixation technique would provide superior stability and decreased displacement of a simulated bony Bankart lesion in a concavity-compression cadaveric model compared with single-row technique.Our aim was to examine the dynamic stability and ultimate displacement of single- vs double-row repair techniques for acute bony Bankart lesions

Methods:

Testing was performed on 13 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. To determine dynamic biomechanical stability and ultimate step-off of the repairs a 150 N load and 2000 cycles of internal-external rotation at 1 Hz was applied to specimens to simulate standard rehabilitation protocols. Toggle was quantified throughout cycling with a coordinate measuring machine. After cyclic loading, the fracture displacement was measured. 3D spatial measurements were calculated using MATLAB.

Results:

The double-row technique resulted in significantly (p=0.005) less displacement (mean=342.48 µm SD=300.64 µm) than single-row technique (mean=981.84 µm, SD=640.38 µm). Ultimate fracture displacement of double-row repair was significantly less (mean=792.23 µm, SD=333.85 µm, p=0.046) after simulated rehabilitation by internal-external rotation cycling compared to single-row repair (mean=1,267.38 µm, SD=640.38 µm).

Conclusion:

The double-row fixation technique for arthroscopic bony Bankart repair results in superior stability throughout simulated rehabilitation and decreases ultimate displacement in a concavity-compression cadaveric model.
The Impact of Prior Musculoskeletal Injury and Orthopaedic Surgery on Draft Position, Availability, and Performance in Major League Baseball: A Summative Analysis of 1,890 Predraft Players
Authors: Ramkumar Prem N. , Navarro Sergio M. , Luu Bryan C. , Haeberle Heather S. , Soloff Lonnie , Frangiamore Salvatore Joseph , Schickendantz Mark S.
Published: July 2019

Objectives:

Despite the value to future coaches, franchise management, and medical personnel, little is known about the epidemiology of musculoskeletal injuries and surgeries and their future impact prior to the MLB draft. The purpose of this study was to determine the (1) epidemiology of all musculoskeletal injuries and surgeries for predraft MLB players; (2) risk of injury or surgery on draft position; (3) risk of injury or surgery on availability within the first two years; and (4) risk of injury or surgery on performance.

Methods:

A total of 1,890 medical records conducted by MLB team physicians prior to the draft were retrospectively reviewed from 2014 to 2018. Players were divided into three groups: non-injured (no musculoskeletal history), non-operative (previously injured but treated non-operatively), and operative (previous injury requiring surgery). Game statistics, including draft round, missed games, batting average (BA), and earned run average (ERA) for the first 2 seasons of MLB play were obtained for all available players, Players were matched for position, and confounders were analyzed for age, draft round using ANOVA analysis.

Results:

A total of 927 pitchers and 963 position players were evaluated, and 38.9% had no reported injury history, 48.6% reported injury but were treated non-operatively, and 12.4% were treated operatively. The most common pre-draft injuries were elbow tendonitis (n=312), UCL injury (n=212), and shoulder labral tear (n=76). The most common pre-draft treatments were physical therapy (922, 25.3%), UCL reconstruction (115, 3.2%), and fracture fixation (69, 1.9%). No difference was found between non-injured, non-operative, and operative groups in terms of draft position, games missed, and performance (BA for position players, p = 0.7246; ERA for pitchers, p=0.1956). After position matching, age and draft round were non-confounding.

Conclusion:

More than half of players entering the MLB report a musculoskeletal injury requiring treatment, with the most common pathology involves the shoulder and elbow. After position matching and analyzing for confounding factors like age and draft round, musculoskeletal history did not macroscopically impact draft position, short-term availability, or performance.
Expensive Childcare and Short School Days = Lower Maternal Employment and More Time in Childcare? Evidence from the American Time Use Survey
Authors: Ruppanner Leah , Moller Stephanie , Sayer Liana
Published: July 2019

This study investigates the relationship between maternal employment and state-to-state differences in childcare cost and mean school day length. Pairing state-level measures with an individual-level sample of prime working-age mothers from the American Time Use Survey (2005–2014; n = 37,993), we assess the multilevel and time-varying effects of childcare costs and school day length on maternal full-time and part-time employment and childcare time. We find mothers’ odds of full-time employment are lower and part-time employment higher in states with expensive childcare and shorter school days. Mothers spend more time caring for children in states where childcare is more expensive and as childcare costs increase. Our results suggest that expensive childcare and short school days are important barriers to maternal employment and, for childcare costs, result in greater investments in childcare time. Politicians engaged in national debates about federal childcare policies should look to existing state childcare structures for policy guidance.
Small intestinal bacterial overgrowth in systemic sclerosis
Authors: Morrisroe Kathleen , Baron Murray , Frech Tracy , Nikpour Mandana
Published: July 2019

Systemic sclerosis is a multi-organ autoimmune disease characterized by vasculopathy and fibrosis, and it is arguably the most devastating of the rheumatological diseases. The gastrointestinal tract is the most commonly involved internal organ in systemic sclerosis. Gastrointestinal tract involvement is reported in up to 90% of SSc patients, is the leading cause of morbidity, and is the third most common cause of mortality in this disease. Among all gastrointestinal tract manifestations, small intestinal bacterial overgrowth is one manifestation that may be ameliorated and even eradicated with appropriate treatment, if recognized early. Small intestinal bacterial overgrowth occurs with a prevalence of approximately 39% in systemic sclerosis and presents with a range of non-specific gastrointestinal tract symptoms, including diarrhea, flatulence, abdominal pain, bloating, and early satiety. These manifestations occur due to an alteration and overgrowth of small intestinal bacteria occurring in the setting of gastrointestinal tract dysmotility and slow transit time. The clinical diagnosis of small intestinal bacterial overgrowth is commonly based on the presence of characteristic clinical symptoms together with a positive hydrogen breath test and response to a therapeutic trial of oral antibiotics used sequentially. Almost two-thirds of systemic sclerosis patients with small intestinal bacterial overgrowth have an improvement in their gastrointestinal tract symptoms with rotating antibiotics. Untreated small intestinal bacterial overgrowth can lead to malnutrition, and thus an important aspect of treatment is the identification and treatment of any associated vitamin and mineral deficiencies. This article focuses on small intestinal bacterial overgrowth, an important and understudied area in systemic sclerosis that remains a diagnostic and therapeutic challenge for both patients and clinicians alike.
Effect of physical activity on severity of primary angle closure glaucoma
Authors: Chong Seong Niven Teh , Yaakub Azhany , Jalil Rohana Abdul , Tirmandas VN Karunakar , A/P Sandragasu Thayanithi , Noor Jelinar Binti Mohd , Husain Norhalwani Bt , Mustari Zuraidah Binti , Hamid Siti Azrin Ab , Mt Saad Ahmad B , AT Liza-Sharmini
Published: July 2019

Objective:

To determine the association between physical activity and severity of primary angle closure glaucoma in Malay patients.

Methods:

A cross-sectional study was conducted involving 150 primary angle closure glaucoma patients between April 2014 and August 2016. Using the International Physical Activity Questionnaire, the physical activity status was assessed and divided into three categories: mild, moderate and heavy physical activity. The duration of physical activity and corresponding minimum energy requirements were calculated. Ocular examination was performed including Humphrey visual field 24-2 analysis assessment. Based on two consecutive reliable Humphrey visual fields, the severity of glaucoma was scored according to modified Advanced Glaucoma Intervention Study and classified as mild (0–5), moderate (6–11) and severe (12–20). Association between physical activity and Advanced Glaucoma Intervention Study score was determined with multiple linear regression analysis.

Results:

A total of 150 Malay patients with primary angle closure glaucoma were included (50 patients with mild, 50 with moderate and 50 with severe glaucoma). Physical activity showed inverse association with the severity of primary angle closure glaucoma. After calculating adjustments for age, sex, duration of glaucoma, body mass index, systemic co-morbidities, family history of glaucoma, myopia and educational status [adjusted b –3.41, 95% confidence interval (–5.23, –1.59), p < 0.001], there was also an inverse relationship with Advanced Glaucoma Intervention Study score. Every increase in physical activity level reduces the Advanced Glaucoma Intervention Study score by 3.4 point.

Conclusion:

Physical activity is the potential modifiable risk factor in reducing the severity of glaucoma among primary angle closure glaucoma patients. However, there is possibility of the severity of glaucoma restricted the physical activity of primary angle closure glaucoma patients.
Evidence of an Epigenetics System in Archaea
Authors: Blum Paul , Payne Sophie
Published: July 2019

Changes in the phenotype of a cell or organism that are heritable but do not involve changes in DNA sequence are referred to as epigenetic. They occur primarily through the gain or loss of chemical modification of chromatin protein or DNA. Epigenetics is therefore a non-Mendelian process. The study of epigenetics in eukaryotes is expanding with advances in knowledge about the relationship between mechanism and phenotype and as a requirement for multicellularity and cancer. However, life also includes other groups or domains, notably the bacteria and archaea. The occurrence of epigenetics in these deep lineages is an emerging topic accompanied by controversy. In these non-eukaryotic organisms, epigenetics is critically important because it stimulates new evolutionary theory and refines perspective about biological action.
Fluoxetine Induced Coital Bleeding: A Case Report
Authors: Arafat S. M. Yasir , Khan Sanjida Tanjin
Published: July 2019

Fluoxetine exerts wide ranges of side effects which encompass both common and other uncommon side effects. Here we report a case, who developed coital bleeding after being treated with fluoxetine. A 30-year-old married lady developed coital bleeding after being treated with fluoxetine 20 mg. The blood was fresh; however, the penetrations were not painful, vagina was well lubricated and both partners were psychologically ready. There is no history of bleeding without any effort of penetration. The bleeding stopped after discontinuing fluoxetine and subsequently meticulous search was done to find out other causes which revealed nothing contributory. The holistic impact of this newer class of antidepressants on women during reproductive age is mostly unknown.
Going Forward with #MeToo Movement: Towards a Safer Work Environment
Authors: Gupta Rajiv , Gupta Arunima , Nehra Dharmender
Published: July 2019

Introduction: The volcanic eruption of the #MeToo movement shows that the problem was there for long and was simmering on. The movement was initiated with the aim of knowing the magnitude of the problem and has now spread worldwide. The cases of the Me Too sexual wave are recent and have not yet attracted much scientific attention, though literature on sexual harassment is widely available and the psychological mechanisms implicated in this movement can be understood and examined through it.

Objectives: This article aims to attract attention of the medical fraternity to update themselves of this issue which is essential for better understanding of the movement which has potentially good, bad, and ugly undercurrents. We will call attention to these aspects perusing the literature both at national and international levels. This would also be subjected to an analysis of the established concepts and principles of human psychology and behavior.

Conclusion: It is amply clear that the time for sweeping things under the carpet is over and the catharsis that flooded the social media, print media, and TV just show how important it is to make the future workplace fair to both genders.
Epidermal stem cells in wound healing and their clinical applications
Authors: Yang Ronghua , Liu Fengxia , Wang Jingru , Chen Xiaodong , Xie Julin , Xiong Kun
Published: July 2019

The skin has important barrier, sensory, and immune functions, contributing to the health and integrity of the organism. Extensive skin injuries that threaten the entire organism require immediate and effective treatment. Wound healing is a natural response, but in severe conditions, such as burns and diabetes, this process is insufficient to achieve effective treatment. Epidermal stem cells (EPSCs) are a multipotent cell type and are committed to the formation and differentiation of the functional epidermis. As the contributions of EPSCs in wound healing and tissue regeneration have been increasingly attracting the attention of researchers, a rising number of therapies based on EPSCs are currently under development. In this paper, we review the characteristics of EPSCs and the mechanisms underlying their functions during wound healing. Applications of EPSCs are also discussed to determine the potential and feasibility of using EPSCs clinically in wound healing.
Delivering a complex mental health intervention in low-resource settings: lessons from the implementation of the PRIME mental healthcare plan in primary care in Sehore district, Madhya Pradesh, India
Authors: Shidhaye Rahul , Murhar Vaibhav , Muke Shital , Shrivastava Ritu , Khan Azaz , Singh Abhishek , Breuer Erica
Published: July 2019

Background

The PRogramme for Improving Mental health care (PRIME) designed, implemented and evaluated a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India.

Aims

To provide quantitative measures of outputs related to implementation processes, describe the role of contextual factors that facilitated and impeded implementation processes, and discuss what has been learned from the MHCP implementation.

Method

A convergent parallel mixed-methods design was used. The quantitative strand consisted of process data on mental health indicators whereas the qualitative strand consisted of in-depth interviews and focus group discussions with key stakeholders involved in PRIME implementation.

Results

The implementation of the MHCP in Sehore district in Madhya Pradesh, India, demonstrated that it is feasible to establish structures (for example Mann-Kaksha) and operationalise processes to integrate mental health services in a ‘real-world’ low-resource primary care setting. The key lessons can be summarised as: (a) clear ‘process maps’ of clinical interventions and implementation steps are helpful in monitoring/tracking the progress; (b) implementation support from an external team, in addition to training of service providers, is essential to provide clinical supervision and address the implementation barriers; (c) the enabling packages of the MHCP play a crucial role in strengthening the health system and improving the context/settings for implementation; and (d) engagement with key community stakeholders and incentives for community health workers are necessary to deliver services at the community-platform level.

Conclusions

The PRIME implementation model could be used to scale-up mental health services across India and similar low-resource settings.

Declaration of interest

None.
Pivotal Trial of Enfortumab Vedotin in Urothelial Carcinoma After Platinum and Anti-Programmed Death 1/Programmed Death Ligand 1 Therapy
Authors: Rosenberg Jonathan E. , O’Donnell Peter H. , Balar Arjun V. , McGregor Bradley A. , Heath Elisabeth I. , Yu Evan Y. , Galsky Matthew D. , Hahn Noah M. , Gartner Elaina M. , Pinelli Juan M. , Liang Shang-Ying , Melhem-Bertrandt Amal , Petrylak Daniel P.
Published: July 2019

PURPOSE

Locally advanced or metastatic urothelial carcinoma is an incurable disease with limited treatment options, especially for patients who were previously treated with platinum and anti–programmed death 1 or anti–programmed death ligand 1 (PD-1/L1) therapy. Enfortumab vedotin is an antibody–drug conjugate that targets Nectin-4, which is highly expressed in urothelial carcinoma.

METHODS

EV-201 is a global, phase II, single-arm study of enfortumab vedotin 1.25 mg/kg (intravenously on days 1, 8, and 15 of every 28-day cycle) in patients with locally advanced or metastatic urothelial carcinoma who were previously treated with platinum chemotherapy and anti–PD-1/L1 therapy. The primary end point was objective response rate per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by blinded independent central review. Key secondary end points were duration of response, progression-free survival, overall survival, safety, and tolerability.

RESULTS

Enfortumab vedotin was administered to 125 patients with metastatic urothelial carcinoma. Median follow-up was 10.2 months (range, 0.5 to 16.5 months). Confirmed objective response rate was 44% (95% CI, 35.1% to 53.2%), including 12% complete responses. Similar responses were observed in prespecified subgroups, such as those patients with liver metastases and those with no response to prior anti–PD-1/L1 therapy. Median duration of response was 7.6 months (range, 0.95 to 11.30+ months). The most common treatment-related adverse events were fatigue (50%), any peripheral neuropathy (50%), alopecia (49%), any rash (48%), decreased appetite (44%), and dysgeusia (40%). No single treatment-related adverse events grade 3 or greater occurred in 10% or more of patients.

CONCLUSION

Enfortumab vedotin demonstrated a clinically meaningful response rate with a manageable and tolerable safety profile in patients with locally advanced or metastatic urothelial carcinoma who were previously treated with platinum and anti–PD-1/L1 therapies.