bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound-guided biopsy of osteolytic metastasis – could be less than three cores enough?
Authors: Chira Romeo Ioan , Chira Alexandra , Calauz Adriana , Manzat Saplacan Roberta Maria , Nagy Georgiana , Mircea Petru Adrian , Valean Simona
Published: November 2017

Aims: The purpose of this study was to analyze the diagnostic yield and accuracy of the ultrasound (US) guided core biopsy in a population of patients with osteolytic metastasis. Materials and methods: We performed a retrospective analysis of 16 consecutive cases of US-guided core biopsies of osteolytic lesions performed in our Ultrasound Unit, from January 2006 to May 2017. We used 18G or 16G Tru-cut needles coupled with automated biopsy guns. We procured a maximum number of two tissue specimens per patient.Results: We obtained a diagnostic yield and accuracy of 93.75% (15 of 16 patients) for US-guided core biopsy of osteolytic metastasis. Most of our cases were metastasis of adenocarcinomas (8 patients), squamous cell carcinomas (3 patients) followed by multiple myelomas (2 patients). Other pathologic lesions recorded were undifferentiated carcinoma (1 patient) and mesenchimal undifferentiated tumor (1 patient). The pathologic result was inconclusive in one patient.Conclusions: Our study supports the important diagnostic role of US-guided core biopsy for osteolytic bone metastasis. Two US-guided passages may be sufficient to procure a diagnostic tissue samples from osteolytic bone metastasis, if theirlength is at least 10 mm.
A redescription of Pterygosoma aegyptiaca Mostafa (Acari: Prostigmata: Pterygosomatidae), a little known ectoparasitic mite of spiny-tailed lizards (Squamata: Agamidae), with new morphological data for the Pterygosomatidae
Authors: Baker Anne S
Published: November 2017

The female of Pterygosoma aegyptiaca Mostafa, 1974 (Acariformes: Prostigmata: Pterygosomatidae) is redescribed. This species, previously known only from its type locality (Egypt) and type host (Uromastyx sp.), is newly recorded from Sudan and from the ocellated spinytail, Uromastyx ocellata Lichtenstein. An unstriated area of idiosomal cuticle is proposed as a prodorsal shield, a character not previously attributed to the genus. Two pairs of idiosomal lyrifissures, ip and ih, are identified in Pterygosoma Peters, 1849, for the first time, as is a distal microseta (κ) on leg genu I. A dorsal structure observed near the base of the leg tarsi is considered to be a lyrifissure (= proprioceptor) and is newly recorded in the Pterygosomatidae. In the light of these new morphological observations and of character states described recently by other authors, amendments to the diagnosis and definition of adult Pterygosoma are proposed. Questions are raised about the conspecificity of presumed syntypes of P. persicum Hirst, 1917, and of specimens of P. tuberculata Jack, 1962a, identified by its author. The number of idiosomal lyrifissures present in Geckobiella diolii (Baker, 1998) (new combination for Hirstiella diolii by Paredes-León et al. (2012)) is corrected from four to two.
Population-Wide Survey of Salmonella enterica Response to High-Pressure Processing Reveals a Diversity of Responses and Tolerance Mechanisms
Authors: Tamber Sandeep
Published: November 2017

High-pressure processing is a nonthermal method of food preservation that uses pressure to inactivate microorganisms. To ensure the effective validation of process parameters, it is important that the design of challenge protocols consider the potential for resistance in a particular species. Herein, the responses of 99 diverse
Salmonella enterica
strains to high pressure are reported. Members of this population belonged to 24 serovars and were isolated from various Canadian sources over a period of 26 years. When cells were exposed to 600 MPa for 3 min, the average reduction in cell numbers for this population was 5.6 log
10
CFU/ml, with a range of 0.9 log
10
CFU/ml to 6 log
10
CFU/ml. Eleven strains, from 5 serovars, with variable levels of pressure resistance were selected for further study. The membrane characteristics (propidium iodide uptake during and after pressure treatment, sensitivity to membrane-active agents, and membrane fatty acid composition) and responses to stressors (heat, nutrient deprivation, desiccation, and acid) for this panel suggested potential roles for the cell membrane and the RpoS regulon in mediating pressure resistance in
S. enterica
. The data indicate heterogeneous and multifactorial responses to high pressure that cannot be predicted for individual
S. enterica
strains.

IMPORTANCE
The responses of foodborne pathogens to increasingly popular minimal food decontamination methods are not understood and therefore are difficult to predict. This report shows that the responses of
Salmonella enterica
strains to high-pressure processing are diverse. The magnitude of inactivation does not depend on how closely related the strains are or where they were isolated. Moreover, strains that are resistant to high pressure do not behave similarly to other stresses, suggesting that more than one mechanism might be responsible for resistance to high pressure and the mechanisms used may vary from one strain to another.
A Haloalkane Dehalogenase from a Marine Microbial Consortium Possessing Exceptionally Broad Substrate Specificity
Authors: Buryska Tomas , Babkova Petra , Vavra Ondrej , Damborsky Jiri , Prokop Zbynek
Published: November 2017

The haloalkane dehalogenase enzyme DmmA was identified by marine metagenomic screening. Determination of its crystal structure revealed an unusually large active site compared to those of previously characterized haloalkane dehalogenases. Here we present a biochemical characterization of this interesting enzyme with emphasis on its structure-function relationships. DmmA exhibited an exceptionally broad substrate specificity and degraded several halogenated environmental pollutants that are resistant to other members of this enzyme family. In addition to having this unique substrate specificity, the enzyme was highly tolerant to organic cosolvents such as dimethyl sulfoxide, methanol, and acetone. Its broad substrate specificity, high overexpression yield (200 mg of protein per liter of cultivation medium; 50% of total protein), good tolerance to organic cosolvents, and a broad pH range make DmmA an attractive biocatalyst for various biotechnological applications.

IMPORTANCE
We present a thorough biochemical characterization of the haloalkane dehalogenase DmmA from a marine metagenome. This enzyme with an unusually large active site shows remarkably broad substrate specificity, high overexpression, significant tolerance to organic cosolvents, and activity under a broad range of pH conditions. DmmA is an attractive catalyst for sustainable biotechnology applications, e.g., biocatalysis, biosensing, and biodegradation of halogenated pollutants. We also report its ability to convert multiple halogenated compounds to corresponding polyalcohols.
Methicillin-Resistant Staphylococcus aureus Sequence Type (ST) 5 Isolates from Health Care and Agricultural Sources Adhere Equivalently to Human Keratinocytes
Authors: Hau Samantha J. , Kellner Steven , Eberle Kirsten C. , Waack Ursula , Brockmeier Susan L. , Haan Jisun S. , Davies Peter R. , Frana Timothy , Nicholson Tracy L.
Published: November 2017

Staphylococcus aureus
is part of the nasal microbiome of many humans and has become a significant public health burden due to infections with antibiotic-resistant strains, including methicillin-resistant
S. aureus
(MRSA) strains. Several lineages of
S. aureus
, including MRSA, are found in livestock species and can be acquired by humans through contact with animals. These livestock-associated MRSA (LA-MRSA) isolates raise public health concerns because of the potential for livestock to act as reservoirs for MRSA outside the hospital setting. In the United States, swine harbor a mixed population of LA-MRSA isolates, with the sequence type 398 (ST398), ST9, and ST5 lineages being detected. LA-MRSA ST5 isolates are particularly concerning to the public health community because, unlike the isolates in the ST398 and ST9 lineages, isolates in the ST5 lineage are a significant cause of human disease in both the hospital and community settings globally. The ability of swine-associated LA-MRSA ST5 isolates to adhere to human keratinocytes
in vitro
was investigated, and the adherence genes harbored by these isolates were evaluated and compared to those in clinical MRSA ST5 isolates from humans with no swine contact. The two subsets of isolates adhered equivalently to human keratinocytes
in vitro
and contained an indistinguishable complement of adherence genes that possessed a high degree of sequence identity. Collectively, our data indicate that, unlike LA-MRSA ST398 isolates, LA-MRSA ST5 isolates do not exhibit a reduced genotypic or phenotypic capacity to adhere to human keratinocytes.

IMPORTANCE
Our data indicate that swine-associated livestock-associated methicillin-resistant
Staphylococcus aureus
(LA-MRSA) ST5 isolates are as capable of adhering to human skin and have the same genetic potential to adhere as clinical MRSA ST5 isolates from humans. This suggests that humans in contact with livestock have the potential to become colonized with LA-MRSA ST5 isolates; however, the genes that contribute to the persistence of
S. aureus
on human skin were absent in LA-MRSA ST5 isolates. The data presented here are important evidence in evaluating the potential risks that LA-MRSA ST5 isolates pose to humans who come into contact with livestock.
Expression of a Cellobiose Phosphorylase from Thermotoga maritima in Caldicellulosiruptor bescii Improves the Phosphorolytic Pathway and Results in a Dramatic Increase in Cellulolytic Activity
Authors: Kim Sun-Ki , Himmel Michael E. , Bomble Yannick J. , Westpheling Janet
Published: November 2017

Members of the genus
Caldicellulosiruptor
have the ability to deconstruct and grow on lignocellulosic biomass without conventional pretreatment. A genetically tractable species,
Caldicellulosiruptor bescii
, was recently engineered to produce ethanol directly from switchgrass.
C. bescii
contains more than 50 glycosyl hydrolases and a suite of extracellular enzymes for biomass deconstruction, most prominently CelA, a multidomain cellulase that uses a novel mechanism to deconstruct plant biomass. Accumulation of cellobiose, a product of CelA during growth on biomass, inhibits cellulase activity. Here, we show that heterologous expression of a cellobiose phosphorylase from
Thermotoga maritima
improves the phosphorolytic pathway in
C. bescii
and results in synergistic activity with endogenous enzymes, including CelA, to increase cellulolytic activity and growth on crystalline cellulose.

IMPORTANCE
CelA is the only known cellulase to function well on highly crystalline cellulose and it uses a mechanism distinct from those of other cellulases, including fungal cellulases. Also unlike fungal cellulases, it functions at high temperature and, in fact, outperforms commercial cellulase cocktails. Factors that inhibit CelA during biomass deconstruction are significantly different than those that impact the performance of fungal cellulases and commercial mixtures. This work contributes to understanding of cellulase inhibition and enzyme function and will suggest a rational approach to engineering optimal activity.
Draft Genome Sequences of 14 Livestock-Associated Methicillin-Resistant Staphylococcus aureus Sequence Type 398 Isolates from Swine Farms in the United States
Authors: Hau Samantha J. , Bayles Darrell O. , Alt David P. , Frana Timothy S. , Nicholson Tracy L.
Published: November 2017

Livestock-associated methicillin-resistant
Staphylococcus aureus
(LA-MRSA) is a bacterium carried by or obtained from swine and other livestock. The initial and predominant swine-associated LA-MRSA sequence type (ST) identified is ST398. Here, we present 14 draft genome sequences from LA-MRSA ST398 isolates found in the United States.
Draft Genome Sequences of 50 Methicillin-Resistant Staphylococcus aureus Sequence Type 5 Isolates Obtained from a U.S. Hospital
Authors: Hau Samantha J. , Bayles Darrell O. , Alt David P. , Nicholson Tracy L.
Published: November 2017

Methicillin-resistant
Staphylococcus aureus
(MRSA) can be a commensal or pathogen in humans. Pathogenicity and disease are related to the acquisition of mobile genetic elements encoding virulence and antimicrobial resistance genes. Here, we report draft genome sequences for 50 clinical MRSA isolates from humans with MRSA-related disease.
Complete Genome Sequence of Senecavirus A Strain SVV HN16 Identified in China
Authors: Luo Tianxia , Xu Shuaifei , Xiong Jingfeng , Su Danping , He Dongsheng
Published: November 2017

A virus that caused blisters and ulcers in pigs in China was detected to be a strain of Senecavirus A (SVA). Complete genome sequencing and analysis results showed that the isolate shares 93.8% to 99.1% identity with other isolates that have been reported, proving that a new isolate of SVA was found in China.
Complete Genome Sequence of Pasteurella multocida Serotype A Strain PMTB2.1 Isolated from Buffaloes That Died of Septicemia in Malaysia
Authors: Jabeen Shagufta , Yong Yap Huan , Abdullah Faez Jesse Firdaus , Zakaria Zunita , Mat Isa Nurulfiza , Tan Yung-Chie , Yee Wai-Yan , Omar Abdul Rahman
Published: November 2017

Pasteurella multocida
causes pneumonic pasteurellosis and hemorrhagic septicemia (HS) in large ruminants. In this study, we determined the complete genome sequence of
P. multocida
strain PMTB2.1 capsular serotype A isolated from buffaloes that died of septicemia.
Complete Genome Sequence of a New Strain of
Rice yellow mottle virus
from Malawi, Characterized by a Recombinant VPg Protein
Authors: Ndikumana Innocent , Pinel-Galzi Agnès , Fargette Denis , Hébrard Eugénie
Published: November 2017

The complete sequence of the isolate Mw10 of
Rice yellow mottle virus
was determined. Sequence comparisons revealed 8.4% to 10.7% nucleotide divergence from the published sequences, resulting in the definition of the strain S7. Importantly, a putative recombination event was identified encompassing the viral genome-linked protein involved in host adaptation.
Complete Genome Sequence of Clostridium perfringens LLY_N11, a Necrotic Enteritis-Inducing Strain Isolated from a Healthy Chicken Intestine
Authors: Li Charles , Yan Xianghe , Lillehoj Hyun S.
Published: November 2017

Clostridium perfringens
strain LLY_N11, a commensal bacterium, which previously induced necrotic enteritis in an experimental study, was isolated from the intestine of a young healthy chicken. Here, we present the complete genome sequence of this strain, which may provide a better understanding of the molecular mechanisms involved in necrotic enteritis pathogenesis.
Effects of acute concussion on centre of pressure variables during quiet stance
Authors: Dierijck Jill K , Wright Alexander D , Kelsey Bryk , Smirl Jonathan D , Donkelaar Paul van
Published: November 2017

Objective

To examine how acute sport-related concussion influences centre of pressure (COP) sway during quiet stance

Design

Prospective cohort

Setting

Laboratory

Participants

Eighty-seven male contact-sport (football and hockey) athletes entered the study. Seven subjects (age range 17–22) were concussed and completed follow-up testing 72-hours, two-weeks, and one-month following the injury.

Intervention

One-minute eyes-open and eyes-closed quiet stance trials were performed on a force plate (NDI True Impluse) with feet hip-width apart. Force plate data and SCAT3 were collected at each time point.

Outcome measures

Root-mean-square COP displacement (RMSd) and mean COP velocity were quantified in the anterior/posterior (AP) and medial/lateral (ML) directions. Independent variables included condition (2) and time (4)

Main results

RM-ANOVA indicated a main effect of time for all outcomes: AP-RMSd (p=0.006), AP mean velocity (p=0.012), ML-RMSd (p=0.001), ML mean velocity (p=0.001). Pairwise comparisons indicated reductions at 2-weeks in AP-RMSd (0.05, 95% CI: −0.672, 0.000), and AP mean velocity (p=0.039, 95% CI: −1.275, −0.036). ML-RMSd was reduced 1 month post-concussion (p=0.021, 95% CI: −0.365, −0.034). Change scores from baseline to 72-hours were correclated between: AP-RMSd and Balance Error Scoring System (r=0.878, p=0.009), AP mean velocity and Standardised Assessment of Concussion (SAC) (r=−0.822, p=0.023), and ML mean velocity and SAC (r=−0.836, p=0.019).

Conclusions

Measures of COP sway during quiet stance revealed alterations in displacement and velocity that persisted up to one-month following a sports-related concussion. These COP alterations exceeded the duration of clinical recovery (median return-to-play: 14 days) indicating that clinical recovery does not equal physiological recovery.

Competing interests

None.
Sport concussion knowledge base and current practice: a survey of selected physician sections from the ontario medical association
Authors: Lebrun Constance M , Martin Mrazik , Abhaya S Prasad , Taryn Taylor , Tatiana Jevremovic
Published: November 2017

Objective

To examine knowledge base/practice patterns regarding sport concussion in two physician populations.

Design

On-line survey.

Setting

Ontario, Canada.

Participants

Physicians from Ontario Medical Association, Sections of: Sport & Exercise Medicine (SEM), General & Family Practice (SGFP).

Intervention

Emailed survey, 2 reminders.

Outcome measures

Knowledge base/practice patterns; learning methods: current/preferred.

Main results

Participants

SEM 92/594 (15.5%), SGFP 270/12,168 (2.2%); 51 (13.4%) members of both. More SEM physicians saw >5 children (<18 years) with concussions/month (40.2% SEM, 9.5% SGFP; p =< 0.001).

Tools

Clinical examination; Sport Concussion Assessment Tool (SCAT/SCAT2) (68.4% SEM, 34.1% SGFP; p<0.001); balance testing (56.5% SEM, 37.4% SGFP; p=0.001); computerised neurocognitive testing (23.9% SEM, 1.9% SGFP; p<0.001); concussion grading scales (9.8% SEM, 14.1% SGFP; p<0.001).Management:Physical rest (65.2% SEM, 68.5% SGFP); modified school/work until symptom resolution (50.0% SEM, 38.5% SGFP; p=0.026); no cognitive rest (3.2% SEM, 9.6% SGFP; p=0.026).

Return-to-play:

Clinical examination; SCAT/SCAT2 (60.8% SEM, 29.6% SGFP; p<0.001); balance testing (56.5% SEM, 37.4% SGFP; p<0.001); computerised neurocognitive testing (35.9% SEM, 2.2% SGFP; p<0.001); concussion grading scales (7.6% SEM, 9.6% SGFP).

Learning sources

colleagues (55.4% SEM, 27.8% SGFP; p<0.001); specialists (33.7% SEM, 23.7% SGFP; p=0.030); continuing medical education (CME) courses/conferences (67.4% SEM, 54.7% SGFP; p=0.017; preferred: 85.9% SEM, 73.9% SGFP; p=0.006); journals/publications (48.9% SEM, 25.2% SGFP; p<0.001); websites (35.8% SEM, 32.2% SGFP; preferred: 35.9% SEM, 47.8% SGFP; p=0.024); medical school/residency training (19.6% SEM, 17.4% SGFP; preferred: 37.0% SEM, 47.8% SGFP).

Conclusions

Gaps exist between consensus-based recommendations and current practice patterns. Enhanced medical school/residency training and additional CME initiatives are recommended.

Competing interests

None.
The association between previous history of concussion and sport-specific skills in youth ice hockey players
Authors: Eliason Paul H , McKay Carly D , Meeuwisse Willem H , Hagel Brent E , Nadeau Luc , Emery Carolyn A
Published: November 2017

Objective

To determine the association between previous history of concussion and sport-specific skill performance in youth ice hockey players.

Design

Cross-sectional.

Setting

Arenas in Calgary, Alberta, Canada over three seasons of play (2012–2015).

Participants

Five hundred and ninety-six players were recruited from youth hockey teams [525 males and 71 females, aged 11-17, representing elite (upper 30% by division of play) and non-elite (lower 70%)].

Assessment of risk factors

Players completed a baseline questionnaire including the number, date of occurrence, and length of recovery following any previous concussions.

Outcome measures

On-ice skills performance was measured using the Hockey Canada Skills Test (HCST) battery including forward agility weave, forward to backward transition agility, forward/backward speed skate, and a 6-repeat endurance skate

Results

Previous history of concussion and time since most recent concussion were not associated with any HCST component. Players reporting two or more concussions were faster than those with no history of concussion on forward agility weave with the puck [−7.32 (95% CI: −11.05, −3.59)]. For every additional day of recovery post-concussion, a player’s time was significantly faster on forward agility weave with [−0.11 (95% CI: −0.16, −0.05] and without the puck [−0.08 (95% CI: −0.13, −0.04], transition agility without the puck [−0.01 (95% CI: −0.02, −0.01], and backward speed with [−0.06 (95% CI: −0.1, −0.03)] and without the puck[−0.05 (95% CI: −0.07, −0.03)].

Conclusions

Players with a concussion history had similar HCST performance scores to those without. A longer post-concussion recovery was associated with better performance. These results provide reference values which will inform risk assessment and future injury prevention studies.

Competing interests

None.
A retrospective review of baseline balance scores in college athletes
Authors: Delasobera Elizabeth , Shasteen Mallory , Parsa Keon , Wierenga Justin
Published: November 2017

Objective

This study examines differences in baseline balance scores in order to establish normative data in college athletes, and also determine the potential effect of gender, sport, and concussion history on baseline performance.

Design

Retrospective review

Setting

Pre-participation evaluations of athletes at an American university.

Participants

961 varsity athletes, ages 17 to 21, both male and female from 2011 to 2015.

Independent Variables

Gender, sport, and history of prior concussions.

Dependent Variable

Baseline Balance Error Scoring System (BESS) scores.

Main Results

The baseline BESS score for all athletes averaged 16.13 (range 2 to 40). Baseline BESS scores were significantly different in males (15.78) compared to females (16.84), with a difference of 1.056 (95% CI 0.233 to 1.890, P=0.013). Baseline scores averaged 17.40 in athletes with history of concussion compared to 16.45 in athletes with no prior concussion (CI 0.866 to 2.780, P=0.301). When comparing scores by sport, there were no significant differences in baseline scores between females who played field hockey, softball, volleyball, basketball, lacrosse, or soccer. There were no significant differences in baseline scores between males who played baseball, football, basketball, lacrosse, or soccer.

Conclusions

When balance testing is used to assess an athlete after concussion injury, normative balance scores may be used in the absence of baseline scores. History of concussion and type of sport do not play a significant role in baseline balance assessment, however gender may alter the normative baseline data slightly

Competing interests

None.
Adolescent athletes’ social perspectives following a sport-related concussion
Authors: Valovich McLeod Tamara , Wagner Alyssa J , Parsons John T , Welch Bacon Cailee E
Published: November 2017

Objective

To explore adolescent athletes’ social perspectives regarding sport and concussion.

Design

Qualitative inquiry.

Setting

Individual in-person interviews.

Participants

12 interscholastic athletes (4 females, 8 males; age=15.7±1.7 years; grade level=10.2±1.4; sports=football, soccer, volleyball, basketball, and wrestling) were interviewed.

Outcome measures

A semi-structured interview protocol was used. Interviews focused on injury details, and explored the physical, psychosocial, emotional, and spiritual components of sport and health. Themes and categories were identified based on the consensus process by a three-person research team. A comprehensive codebook that captured the main themes and categories resulted.

Results

Following concussion, participants discussed two primary themes: perceptions regarding the social aspects of sport and social perspectives regarding their concussion. Specific categories related to the social aspects of sport included friendships and family and decision to participate based on peers. Specific categories regarding the social perspectives of the concussion included: uncertainty of the diagnosis, perceptions of others regarding their injury, being ashamed of the concussion, parent and peer roles, and communication and expectation about their concussion.

Conclusions

Participation in sport and removal from sport following a concussion have significant social implications for adolescent athletes. Specifically, the perceptions of peers, parents, and others regarding the injury can influence reporting of symptoms and recovery following concussion. Limited communication regarding recovery and expectations post-concussion may cause undue social pressures to return to activity prematurely. Anticipatory guidance, with education regarding the possible signs and symptoms, risk factors pre- and post-injury, and recovery expectations following a concussion are important to include in post-injury management.

Competing interests

Funded from a grant from the National Operating Committee on Standards for Athletic Equipment.
Annual baseline drift in professional rugby league players
Authors: Hodgson Lisa , Gissane Conor , Walker P , Maruff Paul , Darby D
Published: November 2017

Objective

Annual baseline testing within professional Rugby League has been mandatory since 2004. The question, do annual baselines drift over time or as a result of a concussion in rugby league players is unanswered. If they do drift, what is the magnitude and in what tasks and is this correlated to associated concussions. The study evaluated if baselines drift over time and if so is this related to concussive injury or accumulating injury.

Design

Retrospective study

Method

Participant players were those who held a professional contract between the 2006–2012 season. It is mandatory to provide an annual baseline test using CogSport and following any diagnosed concussion, with full symptom resolution, a valid return to play test. Concussion test data was provided by CogState Australia from tests performed over 7 seasons.

Results

Over the 7-year period 4762 players suffered 470 concussions (2.65/1000 hours, 95% Confidence Interval 2.4 to 2.9). Identification increased with previous concussion (0.017, 0.001 to 0.029, P=0.05) but not season. One Back Memory decreased with concussion (−.05 to −.05, P=0.001). One Card Learning decreased with previous concussion (−0.041, −0.049 to −0.34, P=0.001) and season (−0.006, −0.007 to −0.005, P=0.001).

Conclusions

Over seven seasons, item scores within the CogSport test varied as a function of previous concussion and time. Individual items within the CogSport test were influenced by differing factors and further examination of the individual items is warranted.

Competing interests

Lisa Hodgson, Conor Gissane, P Walker – None.

Paul Maruff – Full time employee of CogState

D Darby – Former Founder and Director of Cogstate
Assessment of blood biomarkers of mild traumatic brain injury in professional rugby: a case control study
Authors: Wilson Fiona , Kelly Aine , Boyle Noreen , Oresic Matej , Hyotylainen Tuulia , Denvir Karl , Farrell, Garreth , O’Connell Brendan
Published: November 2017

Objective

to investigate plasma S100b concentration following competitive play and concussive episodes; to compare plasma S100b concentration in professional rugby players with age matched non-contact athletic controls; to develop an objective blood biomarker to aid in the diagnosis of concussion.

Design

Prospective case-control study

Setting

Professional rugby club, Elite rowing clubs.

Participants

Professional rugby players (n=44); elite rowers (age/activity matched athletic controls) (n=16).

Interventions

Blood samples were collected at baseline (14 days prior to training/competitive play) in both the rugby and rowing cohort. Rugby players were again assessed one hour following competitive games in the early, middle and late season (3 times). This was repeated again the following season (6 data sets). Concussed players were re-evaluated following concussion.

Outcomes

Plasma was prepared and assessed for S100b concentration by ELISA (Abnova). Metabolomic profiling of samples was carried out by two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC×GC-TOFMS).

Main results

There was significant increase in plasma S100b following competitive play, compared to baseline (p<0.001). Over 1000 metabolites were detected by GC×GC-TOFMS in a single sample run, covering a functionally wide range of small molecules. The post-match metabolic profile showed significant changes in several metabolites; these are at present being validated and analysed further.

Conclusions

There is a significant effect of competitive play on circulating S100b. Data on metabolomic profiles are being collected continually throughout the season and being clustered according to concussive and non-concussive episodes. It is hoped that this analysis may reveal concussion-specific changes in the metabolomic profile of players.

Competing interests

None.
Clinician knowledge and practice habits when evaluating sports related concussion in the emergency department
Authors: Duignan Martin , O’Connor Niall , Tillett Eleanor , Kipps Courtney
Published: November 2017

Objective

To investigate emergency department (ED) clinicians’ knowledge and practice habits when evaluating and treating concussions in the Republic of Ireland (ROI)

Design

An 84-item anonymous questionnaire

Setting

Emergency Departments and Minor Injury Units in the ROI

Participants

The survey was distributed by email to the national cohort of Registered Advanced Nurse Practitioners (RANP; n-84), and Emergency Medicine Consultants (n=86), working in EDs in the ROI

Main results

101 Surveys were completed (43 RANP, 43 NCHD, 15 EM Consultants). 60% of all respondents rated themselves as very confident in identifying the signs and symptoms of concussion. Only 40% had heard of or were mildly familiar with the SCAT3 concussion assessment tool. 15% believed MRI and/or CT would demonstrate damage following a concussion. 60% felt that they were very confident giving discharge advice and return to play (RTP) instructions following concussion although half of all respondents advise waking the patient up several times over the first 24hours. Only 37% believe that adolescent players (<18 yrs) take longer to recover from concussion than adults. 70% of all respondents believe appropriate headgear can help prevent concussion.

Conclusions

Current guidelines regarding assessment tools have not reached the majority of ED clinicians. Additionally, knowledge gaps exist regarding concussion symptom identification and management, and further education is warranted.

Competing interests

None.
Deficits in dynamic balance during tandem gait after concussion may be exacerbated by dual-tasks
Authors: Lynall RC , Blackburn JT , Guskiewicz KM , Marshall SW , Plummer P , Mihalik JP
Published: November 2017

Objective

Expert consensus recommends tandem gait (heel-to-toe walking) to assess concussion. Failure rate when only assessing time-to-task completion is unacceptably high among healthy participants. Our purpose was to assess tandem gait centre of pressure and dual-task cost with and without cognitive distraction in recently concussed individuals.

Design

Cross-sectional.

Setting

University.

Subjects

Thirty college-aged recreational athletes in two 15-person groups: 1) recent concussion (median time post-concussion=126 days, range 28-432d), and 2) healthy sex-, age- (±1 yr), mass- (±10%), and height- (±5%) matched controls.

Intervention

Participants completed 3 trials each of 4 tandem gait conditions: 1) tandem gait (eyes open, no cognitive distraction), 2) tandem gait (eyes closed, no cognitive distraction), 3) tandem gait (eyes open, Brooks Visuospatial Task cognitive distraction), and 4) tandem gait (eyes closed, Brooks Visuospatial Task cognitive distraction).

Outcome measures

Centre of pressure velocity, speed, path length, and dual-task cost.

Results

The recent concussion group (25.15 cm/s) demonstrated slower tandem gait velocity compared to the control group (29.20 cm/s; p=0.049; 95% CI:0.02-8.06 cm/s). After controlling for group velocity differences, the recent concussion group (23.5%) had higher centre of pressure speed dual-task cost during the eyes closed dual-task condition than did the control group (16.3%; p=0.032; 95% CI:2.70-11.48%).

Conclusions

We observed subtle centre of pressure group differences more than one month after post-concussion return to activity. It remains unclear if these differences impact clinical outcomes post-concussion. Longitudinal investigations should study acute post-concussion movement deficits, and discern the recovery of these deficits in comparison to recovery using traditional concussion assessment tools.

Competing interests

None.
Knowledge and practice habits of hospital doctors who manage sports-related concussion in sri lanka
Authors: Goonetilleke Chaminda , Medici Akbar de , Kipps Courtney
Published: November 2017

Objective

To investigate the knowledge and practice habits of hospital doctors who evaluate and treat concussions in Sri Lanka.

Design

email questionnaire survey

Setting

Emergency departments and surgical wards in hospitals in Sri Lanka

Participants

The survey was distributed via email to 400 ED and surgical doctors working in hospital practice in Sri Lanka. Only doctors who routinely deal with sport-related concussion were included. Doctors who did not manage concussion were excluded.

Outcome measures

Survey analysis of concussion knowledge and management habits.

Main results

88 surveys from doctors who met the inclusion criteria were returned completed. Respondents answered a mean 72.9% of the concussion signs and symptoms knowledge questions correctly. However only 21 (23%) of doctors surveyed were aware of any concussion management guidelines and 41 (47%) believed that players could resume normal training once they were symptom-free. 71 (80.7%) respondents believed that wearing headgear could help prevent concussion. There was no significant difference in concussion knowledge between consultants and non-consultant grades (p=0.5).

23/88 respondents said they have been pressurised (by the injured player (n=14), coach or manager (13), other players (5), parents (4), other administrators (8)) to return to play early.

Conclusions

ED and surgical doctors in Sri Lanka have a moderate level of knowledge of sports-related concussion, however few are aware of concussion management guidelines and many continue to adhere to outdated advice. This is the first such survey in Sri Lanka and demonstrates a need for additional sports concussion education.

Competing interests

None.
Objective quantification of a clinical dynamic balance assessment
Authors: Johnston William , Moran Thomas , Dolan Kara , Reid Niamh , Coughlan Garrett , Caulfield Brian
Published: November 2017

Objective

To investigate whether addition of inertial sensor data can provide additional insight into the nature of postural stability deficits during a clinical dynamic balance assessment, with a view to enhancing accuracy of post-concussion monitoring protocols.

Design

Descriptive laboratory study.

Setting

University performance laboratory.

Participants

Fifteen physically active adults (age 23±4 years, height 175±8 cm, weight 67.5±8 kg).

Interventions

An inertial measurement unit (IMU) was mounted at the level of the 4thlumbar vertebra. Subjects completed repeated Y-Balance tests (YBT) 10 minutes and immediately prior to a modified 60 second Wingate anaerobic fatiguing test. Post-fatigue YBTs were completed immediately following the test, and at 10 and 20 minutes.

Outcome measures

Normalised YBT reach distances, and IMU derived RMS acceleration, velocity and angular velocity.

Main results

Prior to the fatiguing intervention, participant’s demonstrated excellent stability/reliability for all reach directions (Intra-class correlation coefficient 0.872-0.994). Significantly lower reach distances (P<0.05) were observed immediately post-fatigue for the postero-medial and postero-lateral, but not anterior reach direction. Observed deficits returned to pre-fatigue levels by 10 minutes. However, IMU derived measures of postural stability remained significantly reduced (P<0.05) for up to 20 minute post-fatigue.

Conclusions

These results demonstrate the ability of both traditional YBT reach distances and inertial sensor data to detect centrally driven postural stability deficits. However, the inertial sensor provided a greater degree of granularity in characterising the nature of these postural stability deficits. This suggests that addition of IMUs to clinical balance measurement tests/protocols may better detect deficits associated with concussion.

Competing interests

None.
Prevention activity can reduce catastrophic head injuries in judo players
Authors: Nagahiro Shinji , Mizobuchi Yoshifumi
Published: November 2017

Objective

To determine the features of catastrophic judo head injuries and the effects of prevention activities.

Study Design

Retrospective descriptive epidemiological study

Methods

We reviewed catastrophic head injuries in 44 judo players reported in the System for Compensation of Loss or Damage in the All Japan Judo Federation from 2003 to 2015. Prevention activities such as safety manual creation and enlightenment courses for judo instructors, including understanding of the consensus statement on concussion, were introduced in 2011. The incidences of death and poor outcomes before (Group A) and after (Group B) these prevention activities were compared.

Results

The majority of catastrophic head injuries were acute subdural hematoma. The average patient age was 16.5 years. Most of the injured patients were novices without fully developed physical stamina and skills. Furthermore, Ukemi, a protection technique applied while being thrown, had not been fully mastered. Among 36 Group A players, 8 (23%) had a prior history of judo-related head injury with posttraumatic headache. In 4 of these 8 patients, CT and/or MRI detected a thin subdural hematoma during evaluation for persistent headache. Annual rates of catastrophic head injury were 4.0 in Group A for 9 years and 2.0 in Group B for 4 years, and the annual respective mortality rates were 2.0 and 0.25. Both rates were reduced after the prevention action introduced in 2011, although the decreases were not statistically significant.

Conclusions

Continuous prevention activities can reduce catastrophic judo head injuries.

Competing interests

Authors have no conflicts of interest regarding this study.
Tandem gait performance following concussion
Authors: Oldham Jessie R , DiFabio Melissa S , DeWolf Ryan M , Kaminski Thomas W , Buckley Thomas A
Published: November 2017

Objective

To examine post-concussion tandem gait (TG) performance.

Design

Prospective Longitudinal.

Setting

Research Laboratory.

Subjects

Twenty-two NCAA Division I student-athletes: twelve diagnosed with sport-related concussions (Age: 20.3 ± 1.2 years; Height: 180.1 ± 12.4 cm; Weight: 80.5 ± 21.0 kg), and ten healthy controls (Age: 19 ± 1.2 years; Height: 176.3 ± 8.4 cm; Weight: 71.9 ± 9.4 kg).

Intervention

TG was performed in accordance with the SCAT3. Participants walked heel-to-toe down a 3-metre line and back as quickly as possible four times. All participants were tested prior to the season. The concussed group was re-tested acutely (<48 hours) post-concussion; controls were re-tested at 4 months. An MDC value, or the smallest meaningful change, was calculated from the controls, and the data were compared using a 2 × 2 (group × time) ANOVA.

Outcome measures

Fastest time to complete TG.

Main results

The MDC was 0.38 seconds. There was no significant interaction (p=0.08), but there was a main effect for time (p=0.04); Post-concussion, the mean time increased by 2.3 seconds (10.6 ± 2.0 seconds and 12.9 ± 3.7) and 10 of the 12 participants exceeded the MDC. The control mean increased by 0.3 seconds (11.5 ± 1.2 seconds and 11.8 ± 0.5 seconds), which was less than the MDC.

Conclusions

Following concussion, there was a group increase of 2.3 seconds. Ten of the twelve student-athletes exceeded the MDC of TG acutely post-concussion, which differs from other clinical tests, such as the BESS, where the average number of errors following concussion falls below the MDC. This suggests TG might be a more stable test of post-concussion postural control.

Competing interests

None.
The necessity of using baseline data to determine balance recovery post-concussion during the asymptomatic phase
Authors: Fedy Laura , Cinelli Michael
Published: November 2017

Objective

To determine whether sensory manipulation balance testing was able to detect balance control impairments in previously concussed asymptomatic (PCA) athletes. We hypothesised that PCA athletes would have balance control deficits in the A/P direction with sensory manipulations.

Participants

27 female athletes (19.78±1.3 years); 13 were previously concussed (PC) within the past 12 months and 14 had no history of concussions (NC).

Design

Manipulation of visual, somatosensory, and vestibular contribution to balance control within the following trials: 3 eyes open (EO); 3 eyes closed (EC); 1 dual-task arithmetic (DUAL); compliant surface with eyes open (EOc) and eyes closed (ECc); 1 horizontal eye movement task (VOR); and 1 horizontal head turns with EC (HHT). Participants tested prior to the start of season; four of them sustained a concussion during the season and were retested following the resolution of symptoms (i.e., RTP-2).

Procedures

Participants stood for 45s on a Bertec force plate (collected at 100Hz) in a Romberg stance. Trials were presented in order of increasing difficulty: EO1, EC1, dual task, EOc, ECc, VOR, EO2, EC2, HHT, EO3, and EC3.

Data analysis

Root mean square (RMS) of centre of pressure displacement and velocity (dCOP and vCOP) were calculated in the A/P and M/L directions.

Statistical analysis

Independent (PC vs. NC) and paired (baseline vs. RTP-2) t-tests were performed for each condition in both directions for dCOP and vCOP.

Main results

HHT condition revealed that A/P vCOP RMS (mm/s) was significantly greater in PC (Mean Diff=2.63, p=0.02) and within at RTP-2 (Mean Diff=5.24, p=0.02).

Conclusions

Balance impairments exist up to 12 months post-concussion in PCA athletes when their vestibular systems were perturbed (HHT) and higher-order analyses (vCOP) were calculated.

Competing interests

None.
Use of computerised dynamic posturography for the assessment of the sensory integration after a head trauma
Authors: Karin Mani , Mario Bizzini , Cornelia Meier , Alfred Müller , Dominik Straumann , Nina Feddermann
Published: November 2017

Objective

Apart from headache dizziness, vertigo or visual problems are common symptoms after a head trauma. Making an adequate diagnose of the symptoms remains challenging and only a few laboratory tests exist. The computerised sensory organisation test (SOT) differentiates the sensory integration between somatosensory, vision, vestibular and visual preference and therefore helps to objectify symptoms.

Design

consecutive case series.

Setting

rehabilitation centre.

Participants

29 consecutive post injury symptomatic and asymptomatic athletes with a diagnosed concussion (n=24) or combined injury (concussion plus commotio/contusio labyrinthi (n=5)).

Interventions

All athletes performed a post injury SOT on the computerised dynamic posturograph (Smart Equitest, 6 conditions). The sensory scores (somatosensory, vestibular and vision) were compared to the normative data (n=112).

Outcome measures

The main aim was to determine the sensory source of post-concussive symptoms by application of the sensory analysis after performance of the SOT.

Main results

Half of the athletes (n=15) achieved a normal sensory score, the other half (n=14) were below average (−9.4%) in visual (n=2), vestibular system (n=5) or both (n=7). In these athletes an individual specific vestibulo-oculomotor therapy was recommended.

Conclusions

The computerised SOT is a useful tool to determine the specific sensory deficits in patients with or without symptoms after a head trauma.

Competing interests

None.
Advances in wearable impact sensors for monitoring and reducing brain injury risks due to cumulative head impact trauma in athletic and military environments
Authors: Ralston John , Thibado Jason , Woodard Jonathan
Published: November 2017

Objective

Assess utility of wearable impact sensors to monitor and reduce cumulative brain injury risks in athletic and military environments.

Design

Analysis of results generated in multiple laboratory and on-field cohort studies.

Setting

Youth, college, and professional football, rugby, soccer, lacrosse, boxing; military training exercises.

Participants

Participants across multiple activities were monitored for head impacts using wearable sensors.

Intervention

Participants suffering a concussion underwent neurocognitive testing and entered a supervised return-to-play protocol.

Outcome measures

The influence of sensor design and data processing on the accuracy and reproducibility of head impact data have been assessed. Differences in head impact incidence and severity have been compared between training regimes that did/did not implement behavioural modifications based on sensor data. Head impact data have been combined with finite element modelling and high resolution MRI/DSI imaging to study spatial distribution of tissue damage and changes in neural connectivity.

Main results

Reduced size and weight skin-affixed sensors worn on the mastoid provide a stable and universally applicable solution for head impact monitoring. Behavioural modifications using these devices have reduced high risk head impacts by 30%−70%. Significant localised tissue damage and changes in neural connectivity are predicted and observed even in the absence of clinically diagnosed concussion symptoms.

Conclusions

Wearable impact sensors are enabling significant reductions in head injury risks and incidence in athletic and military environments. These devices show promise as neuro-trauma dosimeters that can assist in monitoring cumulative brain damage due to repetitive sub-concussive head impacts, and developing more comprehensive and personalised remove-from-play thresholds.

Competing interests

X2 Biosystems designs and manufactures wearable impact sensors
Concussions in international ice hockey championships and olympic winter games between 2006 and 2015
Authors: Tuominen Markku , Hänninen Timo , Parkkari Jari , Stuart Michael J , Luoto Teemu M , Kannus Pekka , Aubry Mark
Published: November 2017

Objective

To describe the occurrence and trend of concussions during the international ice hockey tournaments.

Design

Register study.

Setting

The International Ice Hockey Federation (IIHF) World Championships (WC) and Olympic Winter Games (OWG).

Participants

A total of 3293 games were played in the 169 tournaments by 1212 teams (26130 players) comprising 142244 athletic game exposures.

Outcome measures

One hundred and sixty concussions were observed.

Main results

The average injury rate (IR) for concussion was 1.1 per 1000 ice hockey player-games for all IIHF WC tournaments. The injury rate was highest in men’s WC A-pool tournaments and OWG (IR 1.6) and lowest in women’s WC and OWG (IR 0.9). However, the annual injury rate for concussion in men’s tournament has been lower than that in World Junior tournaments since 2012. When a concussion occurred with contact on a flexible board the IR was 0.2 per 1,000 player games while the number was 1.1 if the board and glass were traditional [RR for the latter: 6.4 (95% CI 1.50 – 27.61]. In men’s tournaments, the trend of concussions caused by illegal hits decreased over the study period. After the 2012 Zurich Consensus Guidelines none of the concussed players in men’s WC returned to play during the same day.

Conclusions

The risk of concussion was significantly lower if games were played on rinks with flexible board and glass. Between 2006 and 2015, the annual risk of concussion in men’s WC has been decreasing because of the decreasing number of concussions caused by illegal hits.

Competing interests

None