bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of combined use of Suvorexant and Ramelteon in preventing postoperative delirium: a retrospective comparative study
Authors: Ikeuchi Shoya , Tanaka Rei , Sugiura Teiichi , Shinsato Kaori , Wakabayashi Akane , Sato Junya , Suzuki Keiko , Shino Michihiro
Published: December 2023

Background

Suvorexant and ramelteon have been presented as useful for preventing postoperative delirium. Previous studies reported on the comparison with benzodiazepine hypnotics which have been known for the risk for inducing delirium, but the comparison with patients not taking any hypnotics has not been reported yet. Therefore, we assessed the incidence rates for postoperative delirium comparing cancer patients who received preoperative combined administration with suvorexant and ramelteon and those not taking any hypnotics.

Methods

Among 110 cancer patients who underwent surgeries at the Division of Hepato-Biliary-Pancreatic Surgery at the Shizuoka Cancer Center between April 1, 2017 and June 30, 2020, 50 patients who received combined administration with suvorexant and ramelteon from 7 days prior to their surgeries and 60 patients who did not take any hypnotics including suvorexant and ramelteon were classified. They were retrospectively observed during the 7 days from their surgeries onward to compare the cumulative incidence rates for postoperative delirium.

Results

The cumulative incidence rate for postoperative delirium during the 7 days in the combined-administration group was 14.0% (7/50), while that for the no-hypnotic group was 36.7% (22/60), which proved that the incidence rate for the former was significantly low (OR: 0.28, 95%CI: 0.11–0.73, P = 0.009).

Conclusions

The present study suggests that the preventive combined administration with suvorexant and ramelteon starting from the preoperative period for cancer patients can be effective in lowering the incidence rate for postoperative delirium.

Trial registration

Retrospectively registered.
Chemotherapy-induced cardiotoxic effect in breast cancer patients treated with trastuzumab (Herceptin) by MRI
Authors: Mourad Mohamed Aboulfotouh , Ebrahim Ahmed Samir , Ziady Ahmed Fathy , Esmaeel Tamer El Zaeem , Allam Mohammad Fouad Abdelbaki
Published: December 2023

Background

Chemotherapy-associated cardiomyopathy is a well-known cardiotoxicity of contemporary cancer treatment. As cancer outcomes improve, cardiovascular disease has become a leading cause of morbidity and mortality among cancer survivors. The objective of this study was to evaluate the role of CMR in the detection of early cardiotoxic changes and in the identification of patients at risk of developing CTRCD.

Patients and methods

Fifty patients diagnosed breast cancer examined by echocardiography and cardiac MRI before the start of chemotherapeutic regimen followed by 2 and 4 months post-chemotherapy.

Results

By echocardiography, all measures were within normal range at the start and at the first follow-up. Twenty (40%) patients show decreased LVEF at second follow-up reaching up to 50% with milder affection of the other parameters. CMR examination shows decreased LVF at second and third follow-up (p = 0.005). There was significant elevation of T2 value for 10 patients at first follow-up (p value 0.04) and for 22 patients at second follow-up (p value 0.01) in correlation with baseline. The T1 mapping and ECV showed elevation at first and second follow-up as compared to baseline (p = < 0.05).

Conclusion

T1 and T2 mapping is superior to echocardiography in early detection of the cardiotoxic effects of chemotherapy applied for breast cancer patients and can guide the management and patient lifestyle.
Management of a double H-type tracheoesophageal fistula without esophageal atresia: a case report
Authors: Regaieg Chiraz , Cheikhrouhou Taycir , Dhaou Mahdi Ben , Ammar Mariam , Kolsi Nadia , Mhiri Riadh , Thabet Afef Ben , Hmida Nadia
Published: December 2023

Background

Double congenital tracheoesophageal fistula (TEF) without esophageal atresia, known as double H-type fistula, is an extremely uncommon malformation. Due to its nonspecific symptoms and the small size of the fistula in infancy, H-type tracheoesophageal fistula is rarely diagnosed in the neonatal period and is also challenging to repair.

Case presentation

We report a rare case of double H-type tracheoesophageal fistula in a 2-day-old newborn, identified with a time-lapse and repaired separately. The diagnosis was established through repeated bronchoscopy, with methylene blue injected through an esophagoscope. A right thoracotomy was performed to undertake the surgical repair after cannulating the fistula with a vascular guide wire. Five months later, the infant, who had a history of recurrent episodes of coughing and shortness of breath, was diagnosed with acute respiratory distress, and a second TEF was detected by bronchoscopy. A cervical incision was used to repair the second H-type fistula.

Conclusions

Double H-type tracheoesophageal fistula should be considered while correcting a tracheoesophageal fistula, especially if the symptoms continue after the first operation. Repeated radiological contrast studies and bronchoscopy with methylene blue injected through an esophagoscope help the early diagnosis.
Homologous Recombination Deficiency Across Subtypes of Primary Breast Cancer
Authors: Yndestad Synnøve , Engebrethsen Christina , Herencia-Ropero Andrea , Nikolaienko Oleksii , Vintermyr Olav K. , Lillestøl Reidun K. , Minsaas Laura , Leirvaag Beryl , Iversen Gjertrud T. , Gilje Bjørnar , Blix Egil S. , Espelid Helge , Lundgren Steinar , Geisler Jürgen , Aase Hildegunn S. , Aas Turid , Gudlaugsson Einar G. , Llop-Guevara Alba , Serra Violeta , Janssen Emiel A.M. , Lønning Per E. , Knappskog Stian , Eikesdal Hans P.
Published: December 2023

PURPOSE

Homologous recombination deficiency (HRD) is highly prevalent in triple-negative breast cancer (TNBC) and associated with response to PARP inhibition (PARPi). Here, we studied the prevalence of HRD in non-TNBC to assess the potential for PARPi in a wider group of patients with breast cancer.

METHODS

HRD status was established using targeted gene panel sequencing (360 genes) and BRCA1 methylation analysis of pretreatment biopsies from 201 patients with primary breast cancer in the phase II PETREMAC trial (ClinicalTrials.gov identifier: NCT02624973 ). HRD was defined as mutations in BRCA1, BRCA2, BRIP1, BARD1, or PALB2 and/or promoter methylation of BRCA1 (strict definition; HRD-S). In secondary analyses, a wider definition (HRD-W) was used, examining mutations in 20 additional genes. Furthermore, tumor BRCAness (multiplex ligation-dependent probe amplification), PAM50 subtyping, RAD51 nuclear foci to test functional HRD, tumor-infiltrating lymphocyte (TIL), and PD-L1 analyses were performed.

RESULTS

HRD-S was present in 5% of non-TNBC cases (n = 9 of 169), contrasting 47% of the TNBC tumors (n = 15 of 32). HRD-W was observed in 23% of non-TNBC (n = 39 of 169) and 59% of TNBC cases (n = 19 of 32). Of 58 non-TNBC and 30 TNBC biopsies examined for RAD51 foci, 4 of 4 (100%) non-TNBC and 13 of 14 (93%) TNBC cases classified as HRD-S had RAD51 low scores. In contrast, 4 of 17 (24%) non-TNBC and 15 of 19 (79%) TNBC biopsies classified as HRD-W exhibited RAD51 low scores. Of nine non-TNBC tumors with HRD-S status, only one had a basal-like PAM50 signature. There was a high concordance between HRD-S and either BRCAness, high TIL density, or high PD-L1 expression (each P < .001).

CONCLUSION

The prevalence of HRD in non-TNBC suggests that therapy targeting HRD should be evaluated in a wider breast cancer patient population. Strict HRD criteria should be implemented to increase diagnostic precision with respect to functional HRD.
Parsing Genetic and Autoimmune Etiology in Premature Ovarian Insufficiency
Authors: Nauwynck Elise , De Schepper Jean , De Vos Michel , Staels Willem
Published: December 2023

Premature ovarian insufficiency (POI) is a rare cause of primary amenorrhea in adolescents. For young women with uncertain etiology of POI, genetic and autoimmune testing may be recommended to assist in treatment and management decisions. This report presents a case of POI in a 16-year-old adolescent with both poly-autoimmune disease and a heterozygous missense variant in the bone morphogenic factor 15 (BMP15) gene, both potentially involved in the pathogenesis of POI. Accurately distinguishing between autoimmune and genetic causes is crucial for effective treatment and counseling. In addition, given the significant psychological impact and the need for reproductive options counseling, a multidisciplinary approach that includes psychological support is highly recommended.
Physical Prehabilitation in Patients who Underwent Major Abdominal Surgery: A Comprehensive Systematic Review and Component Network Meta-Analysis Using GRADE and CINeMA Approach
Authors: Ricci Claudio , Alberici Laura , Serbassi Francesco , Caraceni Paolo , Domenicali Marco , Ingaldi Carlo , Grego Davide Giovanni , Mazzucchelli Carlo , Casadei Riccardo
Published: December 2023

Background

Physical prehabilitation is recommended before major abdominal surgery to ameliorate short-term outcomes.

Methods

A frequentist, random-effects network meta-analysis (NMA) was performed to clarify which type of preoperative physical activity among aerobic exercise (AE), inspiratory muscle training (IMT), and resistance training produces benefits in patients who underwent major abdominal surgery. The surface under the P-score, odds ratio (OR), or mean difference (MD) with a 95% confidence interval (CI) were reported. The results were adjusted by using the component network approach. The critical endpoints were overall and major morbidity rate and mortality rate. The important but not critical endpoints were the length of stay (LOS) and pneumonia.

Results

The meta-analysis included 25 studies. The best approaches for overall morbidity rate were AE and AE + IMT (OR = 0.61, p-score = 0.76, and OR = 0.66, p-score = 0.68). The best approaches for pneumonia were AE + IMT and AE (OR = 0.21, p-score = 0.91, and OR = 0.52, p-score = 0.68). The component analysis confirmed that the best incremental OR (0.30; 95% CI 0.12–0.74) could be obtained using AE + IMT. The best approach for LOS was AE alone (MD − 1.63 days; 95% CI − 3.43 to 0.18). The best combination of components was AE + IMT (MD − 1.70; 95% CI − 2.06 to − 1.27).

Conclusions

Physical prehabilitation reduces the overall morbidity rate, pneumonia, and length of stay. The most relevant effect of prehabilitation requires the simultaneous use of AE and IMT.
Contextual factors and intentional rounding in acute hospitals: understanding what works, for whom, in what settings: a realist synthesis protocol
Authors: Hetherton Aileen , Horgan Frances , Sorensen Jan , Mc Carthy Siobhan E.
Published: December 2023

Background This study aims to understand and explain the influence of contextual factors on the implementation of Intentional Rounding in acute hospitals using the realist synthesis methodology. Falls of hospital admitted patients are one of the most frequent concerns for patient safety in the acute hospital environment. The reasons why people fall are complex. International guidelines recommend a multifactorial assessment and effective prevention and management of identified risk factors in order to reduce the number of falls. One approach for delivering this is by Intentional Rounding (IR). IR is an umbrella term, understood as a structured process whereby nurses or care staff carry out regular checks with individual patients using a standardised protocol to address such issues as positioning, pain, personal needs and placement of possessions. Methods This study will use realist synthesis to understand what works, for whom, in what circumstances and in what settings. Realist synthesis is a theory driven interpretive approach to evidence synthesis. It is the intention of the researchers to analyse IR as an intervention, which aims to enhance patient care and safety in hospital settings. The synthesis forms part of a larger implementation study examining interventions that reduce the number of falls that occur in hospitals. Search terms will include intentional rounding, purposeful rounding, comfort rounding and hourly rounding and will encompass search terms beyond IR and falls rates in order not to limit the synthesis. This synthesis will conform to the RAMESES (realist and meta-narrative evidence synthesis group) publication and reporting quality standards for a realist synthesis. Conclusions The findings will inform the next phase of an implementation study on IR in acute hospital settings, namely selection of an IR approach and evidence informed barriers and enablers to its implementation. The results will be disseminated in a peer-reviewed journal and through presentations.
Formative assessments during COVID-19 pandemic: an observational study on performance and experiences of medical students
Authors: Lavallard Vanessa , Cerutti Bernard , Audétat-Voirol Marie-Claude , Broers Barbara , Sader Julia , Galetto-Lacour Annick , Hausmann Stéphane , Savoldelli Georges L. , Nendaz Mathieu , Escher Monica
Published: December 2023

Background Because of COVID-19, the 2020 written medical examinations were replaced by mandatory formative online assessments. This study aimed to determine students’ performance, self-assessment of performance, and perception about the switch from a summative to a formative approach. Methods Medical students from year 2 to 5 (n=648) were included. They could repeat each test once or twice. They rated their performance after each attempt and were then given their score. Detailed feedback was given at the end of the session. An online survey determined medical students’ perception about the reorganization of education. Two items concerned the switch from summative to formative assessments Results Formative assessments involved 2385 examinees totaling 3197 attempts. Among examinees, 30.8% made at least 2 attempts. Scores increased significantly at the second attempt (median 9.4, IQR 10.8), and duration decreased (median -31.0, IQR 48.0). More than half of examinees (54.6%) underestimated their score, female students more often than male. Low performers overestimated, while high performers underestimated their scores. Students approved of the switch to formative assessments. Stress was lessened but motivation for learning decreased. Conclusions Medical students’ better scores at a second attempt support a benefit of detailed feedback, learning time and re-test opportunity on performance. Decreased learning motivation and a minority of students repeating the formative assessments point to the positive influence of summative assessment on learning.
Practical tips for starting a successful national postgraduate course
Authors: Sundbom Magnus
Published: December 2023

Background Few start national courses, and those that do usually do it once. The aim of this paper is to outline an approach to conduct a successful national postgraduate course. Methods The practical tips were derived from personal experience. Results The 12 tips identified are: define learning needs and curriculum, create a functioning structure, recruit a committed faculty, obtain legitimacy, promote your course, try out the concept, establish administrative support, use modern techniques and accessories, create course-related social activities, keep all on board, collect ongoing evaluation, and stay in control. Conclusion It is hoped that these tips will make it easier for others to take the decisive first step in the exciting task of starting a national course; that is: ‘to know the road ahead - ask those coming back’.
Natural vibrations of circular nanoarches of piecewise constant thickness
Authors: Mubasshar Shahid , Lellep Jaan
Published: December 2023

The free vibrations of elastic circular arches made of a nano-material are considered. A method of determination of eigenfrequencies of nanoarches weakened with stable cracks is developed making use of the concept of the massless spring and Eringen's nonlocal theory of elasticity. The aim of the paper is to evaluate the sensitivity of eigenfrequencies on the geometrical and physical parameters of the nanoarch.
Atoms of the lattices of residuated mappings
Authors: Kaarli Kalle , Radeleczki S´ándor
Published: December 2023

Given a lattice L, we denote by Res(L) the lattice of all residuated maps on L. The main objective of the paper is to study the atoms of Res(L) where L is a complete lattice. Note that the description of dual atoms of Res(L) easily follows from earlier results of Shmuely (1974). We first consider lattices L for which all atoms of Res(L) are mappings with 2-element range and give a sufficient condition for this. Extending this result, we characterize these atoms of Res(L) which are weakly regular residuated maps in the sense of Blyth and Janowitz (Residuation Theory, 1972). In the rest of the paper we investigate the atoms of Res(M) where M is the lattice of a finite projective plane, in particular, we describe the atoms of Res(F), where F is the lattice of the Fano plane.
Qualidade de vida e comportamentos durante a pandemia da COVID-19: Um estudo transversal
Authors: Correia Dayane Cristina Queiroz , Guiça Juziane Teixeira , Rodrigues Junior Charles , Rodrigues Glória de Lima , Norberto Maria Carolina Castanho Saes , Fernandes Rômulo Araújo , Codogno Jamile Sanches
Published: December 2023

Pesquisa transversal com objetivo de analisar a associação entre qualidade de vida e comportamentos desenvolvidos por indivíduos hipertensos durante o período de isolamento social, devido à pandemia da COVID-19. O estudo foi realizado através de ligações telefônicas e avaliou adultos cadastrados na atenção primária de saúde. A prática de atividade física foi avaliada pelo Questionário Internacional de Atividade Física, sendo somadas a duração e a frequência das atividades e o tempo total sentado durante a semana e fim de semana. A qualidade de vida foi analisada através do Sistema Descritivo – EQ-5D, considerando o score utilidade e o estado geral de saúde. Presença de doenças e comportamentos durante o isolamento social, assim como aspecto emocional e ambiente para realização de atividades físicas foram analisados. Foram utilizados os testes t de Studant e ANOVA one way para comparação de grupos e ANCOVA para comparações entre os grupos ajustadas. A significância estatística foi pré-fixada em valores inferiores a 5%. Foram entrevistados 659 hipertensos, com idade entre 41 e 93 anos. Observou-se maior qualidade de vida naqueles que praticaram exercício físico (p = 0,015), que não relataram ter a saúde emocional afetada pela pandemia (p = 0,001) e que responderam ter ambiente favorável em casa para prática de atividade física, (p = 0,001). Em conclusão, a qualidade de vida associou-se aos comportamentos positivos dos participantes durante a pandemia, como a prática de atividade física, contudo é necessário que os órgãos públicos se atentem aos baixos níveis de atividade física da população provocados pela pandemia.
Mixed-Integer Optimization with Constraint Learning
Authors: Maragno Donato , Wiberg Holly , Bertsimas Dimitris , Birbil Ş. İlker , den Hertog Dick , Fajemisin Adejuyigbe O.
Published: December 2023

In today’s data-driven world, there is a growing opportunity for optimization models to more closely resemble real-world scenarios, namely through learning constraints or objective functions that are not explicitly known and must be estimated through data. In “Mixed-Integer Optimization with Constraint Learning,” the authors establish a novel methodological framework for data-driven decision making. Their approach enables constraints and objectives to be embedded directly from trained machine learning models that are mixed-integer optimization representable including linear models, decision trees, ensembles, and neural networks. The authors propose two different strategies to manage uncertainty in learned constraints. The first is based on the concept of trust region where the convex hull of data points is used to avoid extrapolation. Additionally, they present an ensemble learning method for enforcing constraints across multiple estimators, improving the robustness of the downstream prediction accuracy. Practitioners can access this framework through the “OptiCL” Python package. Case studies on World Food Programme humanitarian aid planning and chemotherapy regimen optimization demonstrate the methodology’s ability to produce scalable and data-informed prescriptions.
Effectiveness of home-based palliative care programmes for older people and their family caregivers in Thailand
Authors: Supaporn Kanyanat , Isaramalai Sang-arun , Chuchuen Uayart , Manee Patcharin
Published: December 2023

Background:

People in Thailand receiving palliative care at home can have complex needs and this means that the family caregiver can have a high burden of care.

Aim:

To assess the impact of a nursing care activities for a home-based palliative care programme (NHBPC) on the care burden among family caregivers and the care quality in older people at the palliative care stage.

Methods:

This quasi-experimental repeated measure study was used to investigate the effects of the nursing care activities for a NHBPC programme.

Results:

The mean caregiving burden and care quality scores in the experimental and control groups at post-test and 2-weeks follow-up showed significant differences (p<.05). In addition, improvement was not seen in the control group.

Conclusion:

The NHBPC programme significantly improved caregiving burden and quality of care in Thai older people and their family caregiver. This confirms that the NHBPC programme plays a crucial role in helping them to improve quality of life.
Palliative care: economic challenges for researchers
Authors: Vieira Joana C
Published: December 2023

The economic challenges for researchers in palliative care is an emerging and challenging topic. Knowing where, how and how much is spent is fundamental for palliative care (PC) provision to be increasingly efficient and with lower costs. To accomplish this, there are three important factors to consider: early access to PC; specialised PC using standardised procedures and informal and home-based PC. Beyond costs, ethical aspects should always be present when this care is being provided in its different forms, locations and contexts. For those who want to study the economic challenges in PC, they need to comprehend the complexity of them, since they will always come from a careful articulation between ethics, the person´s needs, the cost of the care and who these costs are charged to.
Changes in hair cortisol levels and cognitive function among older patients in palliative care
Authors: Ribić Rosana , Košanski Tina , Neuberg Marijana , Meštrović Tomislav
Published: December 2023

This monocentric pilot study aimed to assess whether there are significant changes in hair cortisol levels and cognitive functioning at baseline and after 3 weeks of hospitalisation in older palliative care patients, and to ascertain whether hair cortisol can be used as a pertinent stress biomarker in this population. Hair cortisol concentration levels were measured with the use of an enzyme-linked immunosorbent assay (ELISA), while cognitive functions were assessed by using 16-point Mini-Mental State Examination 2 (MMSE-2): brief version. A statistically significant difference in mean hair cortisol levels at the start of the hospitalisation was found when compared to the 3-week follow-up (p=0.007). No statistically significant differences were observed regarding MMSE-2 scores using the same time points. These results have direct clinical implications and set the stage for further research endeavours in the field.
Food and mood: healthy eating for mental health with chronic kidney disease
Authors: Jackson Helena
Published: December 2023

There is a growing interest in the connection between healthy eating, mental health (MH) and chronic disease prevention. Although people with chronic kidney disease (CKD) are disproportionately affected by poor MH, nutritional guidelines have traditionally focused on non-mental factors, such as physical health, disease progression and biochemical control. Dietary manipulation, through healthy eating, may influence the gut microbiome, as well as mental and kidney health. This can be achieved through the interaction between the gut microbiome, brain and kidney, as well as the body's metabolism of nutrients, such as the amino acid tryptophan. While a wide range of nutrients are implicated in brain function and health, there is little evidence to support supplementation-based treatments–other than to avoid conventional malnutrition and micronutrient deficiencies. Whole diets, such as the Mediterranean diet, may benefit MH, as well as reducing cardiovascular, renal and other chronic disease risk. A supportive and individualised approach to renal dietary restrictions may help to reduce the MH burden of CKD.
Transforming the life of people with obesity and kidney disease
Authors: Mafrici Bruno , Read Anna , Stretton Greg , Kesic Brooke , Coyne Emma , Ferraro Alastair , Bebb Charlotte
Published: December 2023

Dialysis is a costly and resource-heavy treatment for people with kidney disease ( Roberts et al, 2022 ). One longer term solution is a kidney transplant, but one third of people on dialysis have a body mass index (BMI) that is above the transplant threshold. However, they struggle to lose weight due to extensive dietary and fluid restrictions, co-morbidities, reduced activity levels and frequent low mood ( Oniscu et al, 2021 ). Existing local weight management services are often unable to support complex patients with kidney disease and existing renal services do not often have the resources to provide the intensive, specialist and tailored treatment required. Funding from the Nottingham University Hospitals Trust Charity supported a pilot multidisciplinary team (MDT) kidney weight management service. The successful outcome of this pilot has secured further funding to continue this vital service.
What the Care Quality Commission deems outstanding for a well-led service: an analysis of four care homes
Authors: Halliwell Amanda
Published: December 2023

Amanda Halliwell explores recent inspection reports of four outstanding care homes.
Sleep and cognitive health in older people
Authors: Palmer Sarah
Published: December 2023

Sarah Palmer looks at the implications for older people when they do not get enough sleep or when they are getting too much sleep.
Quadriceps injuries
Authors: Plastow Ricci , Raj Rhody D. , Fontalis Andreas , Haddad Fares S.
Published: December 2023

Injuries to the quadriceps muscle group are common in athletes performing high-speed running and kicking sports. The complex anatomy of the rectus femoris puts it at greatest risk of injury. There is variability in prognosis in the literature, with reinjury rates as high as 67% in the severe graded proximal tear. Studies have highlighted that athletes can reinjure after nonoperative management, and some benefit may be derived from surgical repair to restore function and return to sport (RTS). This injury is potentially career-threatening in the elite-level athlete, and we aim to highlight the key recent literature on interventions to restore strength and function to allow early RTS while reducing the risk of injury recurrence. This article reviews the optimal diagnostic strategies and classification of quadriceps injuries. We highlight the unique anatomy of each injury on MRI and the outcomes of both nonoperative and operative treatment, providing an evidence-based management framework for athletes.

Cite this article: Bone Joint J 2023;105-B(12):1244–1251.
WORK-LIMITING INJURIES SUSTAINED BY ATHLETES IN THE WORLD'S HARDEST RACE
Authors: Ferguson D , Cuthbert R , Acquaah F , Cornelissen J , Jeyaseelan L
Published: December 2023

Introduction

The Tour de France, commonly recognised and the hardest physical endurance event on the planet, is an iconic cycling competition with a history of ever impressive performances and increasingly notable injuries. This study aims to methodologically catalogue and analyse injuries sustained by professional riders over a span of six years and understand the operative workload created by this prestigious race. (2018–2023).

Methods

Data was gathered from multiple publicly available sources, including pro-cycling stats, news articles, team press releases and independent medical reports. Each injury was categorized by year, rider, and injury type.

Results

From 2018–2023, there was a significant diversity in both injured body part and mechanism of injury. Of the 124 recorded race ending incidents clavicle fractures accounted 19.4%, laceration/contusions 12.1%, patella fractures 10.5% and elbow fractures 7.3%. Other

notable other body areas undergoing surgical intervention were hand fractures 5.6%, pelvic fractures 2.4% and femoral fracture 1.6%. At a mean of 20.67 injuries per tour, this accounts for almost exactly one race ending injury per day where an athlete finishes the day on the operating table, rather than the team bus.

Discussion

The Tour de France's rigorous challenges are mirrored in its injury statistics. Over six years, clavicle fractures were most prevalent, likely due to cyclists' instinct to brace during crashes. Lacerations, contusions, and patella fractures also featured prominently. Alarmingly, each race stage averaged an injury severe enough for surgical intervention. This data highlights the imperative need for enhanced protective measures, race regulations, and medical preparedness to protect these elite athletes.
ADDITIONAL MCL SURGERY DOES NOT AFFECT OUTCOMES AFTER ACL RECONSTRUCTION BUT ADDITIONAL POSTEROLATERAL SURGERY DOES IN ELITE ATHLETES
Authors: Jones M , Pinheiro VH , Laughlin M , Borque K , Williams A
Published: December 2023

Introduction

To evaluate career length after surgical treatment of combined ACL + medial collateral ligament (MCL) and ACL +posterolateral corner (PLC) surgeries in all elite athletes. Secondly, in a subgroup of male professional footballers to determine career length and competition level after ACL+MCL or ACL+PLC reconstructions and compare this to a cohort who underwent isolated ACL reconstruction (ACL-R) alone.

Methods

A consecutive cohort of elite athletes undergoing combined ACL+MCL surgery and combined ACL+PLC surgery between February 2001 and October 2019 were analysed. A subgroup of male footballers from this population was compared to a previously identified cohort of male, professional footballers having had primary ACL reconstruction without other ligament surgery. A minimum 2-years follow-up was required. Outcome measures were career length and competition level.

Results

Ninety-eight elite athletes were included, 50 had ACL+PLC and 48 had ACL+MCL surgeries. The timeline for return to play (RTP)was significantly longer for ACL+PLC injuries (12.8 months) as compared to ACL+MCL injuries (11.1 months, p=.019). On average, career length after surgery of an athlete in the ACL+PLC group was 4.8 years and for the ACL+MCL group 4.2 years (n.s.). In the subgroup analysis of footballers, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%, p=.003) compared to 100%for ACL+MCL surgery and 97% for isolated ACL reconstruction, as well as requiring almost 3 months longer RTP timeline (12.9±4.2 months= .002) when compared to isolated ACL (10.2 ± 3.9 months) and combined ACL+MCL groups (10.0+2.4 months). However, career length and competition level were not significantly different between groups.

Conclusion

The addition of MCL surgery to ACL-R did not affect RTP time and rate in elite athletes, nor competition level in male professional footballers compared to ACL-R alone. Moreover, the career length after successful RTP following combined ACL+MCL or ACL+PLC surgeries were the same. However, professional footballers with combined ACL+PLC surgery return at a lower rate and require a longer RTP time when compared to the ones with isolated ACL-R or combined ACL+MCL surgery. For the factors assessed in this study additional MCL surgery to ACL-R alone did not alter outcome from that with ACL-R in professional soccer players.
QUANTIFYING ANTERIOR MEDIAL ROTATIONAL STABILITY IN ANTERIOR CRUCIATE LIGAMENT-INJURED PATIENTS WITH ASSOCIATED COLLATERAL INVOLVEMENT
Authors: Allott N. , Banger M. , Korgaonkar J. , Thomas R. , McGregor A.
Published: December 2023

Introduction

Anterior tibial translation (ATT) is assessed in the acutely injured knee to investigate for ligamentous injury and rotational laxity. Specifically, there is a growing recognition of the significance of anterior medial rotary laxity (AMRI) as a crucial element in assessing knee stability. Anterior cruciate ligament (ACL) injuries are often accompanied with medial collateral ligament (MCL) damage. It has been suggested that Deep MCL (dMCL) fibres are a primary restraint in rotational displacement. This research aims to quantify the difference in rotational laxity of patients with ACL and MCL injuries to deem if the Feagin-Thomas test can robustly capture metrics of AMRI. 2.

Methods

AMRI was assessed using the Feagin-Thomas test in 7 isolated ACL (iACL) injured participants, 3 combined ACL and superficial fibre MCL (sMCL) injuries, 5 combined ACL and deep fibre MCL injuries, and 21 healthy controls. Displacement values were recorded using an optical motion capture (OMC) system and bespoke processing pipeline which map and model the knee's anterior displacement values relative to the medial compartment. Since absolute values (mm) of rotational laxity vary dependant on the person, values were recorded as a proportion of the rotational laxity obtained from the subject's contralateral leg. Values were compared between each patient group using an ANOVA test and Tukey's honesty significant difference post hoc test. 3.

Results

The healthy control group had a median proportion of 0.97 (3SF), whilst the iACL was 1.12 (3SF), a 12% increase in rotational laxity in the injured leg. The sMCL group yielded a result of 1.64 (3SF), a 64% increase in rotational laxity in the injured leg; finally, dMCL resulted in a proportion of rotational laxity of 1.90 (3SF), a 90% increase in rotational laxity [table 1]. Whilst all groups showed differences in the increase of rotational laxity, dMCL was significantly different from the healthy control group (P value 0.0041). 4.

Conclusion

ACL injuries with MCL involvement led to an increase in anterior medial rotary laxity and this is more evident in patients where deep MCL fibres are involved. The Feagin-Thomas test appears to be sensitive in detecting differences in AMRI and should be considered when performing comprehensive clinical knee examination.

For any figures or tables, please contact authors directly.
EXTRA-ARTICULAR KNEE LIGAMENT RECONSTRUCTIONS USING LIGAMENT AUGMENTATION AND RECONSTRUCTION SYSTEM (LARS) SYNTHETIC GRAFTS IN ELITE ATHLETES
Authors: Jones M , Pinheiro VH , Church S , Ball S , Williams A
Published: December 2023

Introduction

To determine if elite athletes can return to professional sport after MCL or posterolateral (PLC) reconstruction using LARS ligaments. The secondary aims are to demonstrate the safety and efficacy of LARS by reporting sport longevity, subsequent surgeries, and complications.

Methods

A retrospective review of all extra-articular knee ligament reconstructions, utilising a LARS synthetic ligament, by 3 sports knee surgeons between 2013 and 2020 was undertaken. All elite athletes aged over 16 years and a minimum of 2 years post reconstruction were included. No LARS were used for ACL reconstructions, and they were excluded if a LARS ligament was used for a PCL reconstruction. Return to play (RTP) was defined as competing at professional level or national/ international level in amateur sport.

Results

Sixty-four (84.2%) MCL reconstructions and 12 (15.8%) PLC reconstructions were included. 52 (68.4%) underwent concomitant autograft cruciate(s) reconstruction including 6 (7.8%) bicruciate reconstructions. The mean age was 25.1 years (SD +/− 4.50). 35 (46.1%) were footballers and 35 (46.1%) were rugby players. Sixty-seven athletes (88.2%) returned to elite sport, 7 (9.2%) did not RTP and RTP status was unknown for 2 (2.6%) (Figure 1). 65 out of 67 (97.0%) RTP at the same/higher Tegner level. 56 (83.6%) and 20 (57.1%) were still playing at 2- and 5-years post-surgery Six (7.9%) players required further surgery due to irritation from the metal fixation implants. One had an inflammation adjacent to the synthetic material at the femoral end and the other cases involved the tibial staples. All six cases were able to RTP. One athlete, following bicruciate /MCL surgery had the LARS removed due to laxity. There was one MCL re-rupture, sustained while jumping, 4 years after returning to football.

Conclusions

Utilising LARS in extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The results compare well regarding RTP, complication, and revision rates with the published evidence for other types of MCL and PLC grafts. This, coupled with 57% of athletes still playing 5 years post-surgery suggests the LARS is safe and effective in these cases.

For any figures or tables, please contact authors directly.
MID-TERM OUTCOMES OF TROCHLEOPLASTY IN THE TREATMENT OF SEVERE TROCHLEAR DYSPLASIA
Authors: Sharma N , George A , Hampton M , Barnett A
Published: December 2023

Introduction

Trochleoplasty is an effective surgical procedure for patients with severe trochlear dysplasia and recurrent patella instability. Previous work has suggested patients demonstrate early improvements in knee function and quality of life. However, concerns regarding longer term outcomes due to the development of stiffness and patellofemoral osteoarthritis remain a concern for these patients. Our aim was to assess mid-term patient-reported outcome and quality of life measures for trochleoplasty performed at a single centre for severe trochlear dysplasia.

Methods

Retrospective review of 28 knees (23 patients) having undergone trochleoplasty for severe trochlear dysplasia were reviewed. Due to the non-parametric nature of the data, median and interquartile range (IQR) were determined for pre-operative and mid-term follow-up scores. Statistically significant differences between groups were assessed using paired Wilcoxon-signed rank test with statistical significance set at p<0.05. Data were analysed using a statistical software package (IBM® SPSS® Statistics 26.0).

Results

Median time from surgery to follow-up for all patients in the series was 5.3 years (IQR 3.9 – 7.0 years). Median pre-operative Kujala score improved from 57.0 (IQR 45 – 66) to 96.3 (IQR 83 -100). Median pre-operative IKDC score improved from 42.6 (IQR 35.9 – 51.3) to 92.6 (IQR 71.6 – 98.7). Median EQ-5D score also improved from 0.691 (IQR 0.414 – 0.727) to 1.000 (IQR 0.8178 – 1.000). Improvement in Kujala scores, IKDC scores and EQ-5D were all statistically significant with p<0.001 in all domains.

Discussion

Our data suggests patients experience significant improvements in knee function and quality of life following trochleoplasty surgery for severe dysplasia. We demonstrate an absolute improvement in scores at a mean of 5.3 years follow-up of 39.3 points for Kujala, 50 for IKDC and 0.309 for EQ-5D. Minimal clinically important differences (MCID) have been reported to be in the region of 10 for the Kujala score, 8.8–15.6 for IKDC and 0.085 for EQ-5D. Our data shows improvements which far exceed the published MCID, suggesting trochleoplasty confers a large treatment effect and patients benefiting from sustained improvements in knee function and overall quality of life at mid-term follow-up.

Conclusion

Following trochleoplasty for severe trochlear dysplasia, patient reported outcomes demonstrate continued improvements in knee function and quality of life at mid-term (5-year) follow-up. There is a large absolute treatment effect which likely impacts on both physical and psychological wellbeing for these patients. Continued surveillance of patient reported outcomes in this clinically complex cohort is indicated.
RELAÇÃO ENTRE SEDENTARISMO E NÍVEL DE ATIVIDADE FÍSICA NA ZONA RURAL DAS COMUNIDADES CONTENDAS E KM 19: UMA ABORDAGEM DE CONSCIENTIZAÇÃO
Authors: Michele Rosario dos Santos
Published: December 2023

A presente pesquisa teve como objetivo discutir o sedentarismo e o nível de atividade física associada à saúde e ao lazer no meio rural, entre as comunidades de Contendas e Km 19, apontando formas de conscientização sobre a importância e benefícios de ser fisicamente ativo, juntamente com a relevância do poder público nessa causa. O método utilizado nesta pesquisa, foi o estudo de caso, e para a coleta de dados foi utilizada a observação participante, realizada nas comunidades Contendas, (Pedrão – BA) e Km 19 (Alagoinhas - BA). Com os dados obtidos, concluiu-se que o baixo nível de atividade física é um problema similar entre as comunidades. Quando realizada alguma atividade física, é durante o momento de trabalho, na realização de caminhadas, ou na prática de exercícios resistidos em academias de musculação, que para isso, é necessário o deslocamento para outras comunidades que possuem academias. E que a falta de políticas públicas é um dos causadores desse baixo nível relatado. Assim, faz-se necessário a intervenção do poder público, gerar ações para a promoção de atividades voltadas à saúde e ao lazer, como forma de conscientizar e incentivar a população rural a ser mais fisicamente ativa obtendo uma vida mais saudável.
PRÁTICAS PEDAGÓGICAS E INCLUSÃO DO ALUNO COM SÍNDROME DE DOWN NAS AULAS DE EDUCAÇÃO FÍSICA ESCOLAR
Authors: Campos de Jesus Sampaio Raquel , Alves Nogueira Souza Suzana
Published: December 2023

Este estudo trata-se de uma investigação acerca de como se dá o processo de inclusão dos alunos com Síndrome de Down nas aulas de Educação Física. Teve como objetivo geral, compreender quais as práticas pedagógicas docentes para a inclusão dos alunos com Síndrome de Down nas aulas de Educação Física Escolar em uma instituição de Atendimento Educacional Especializado (AEE), e como objetivos específicos: compreender como se dá o processo de inclusão de alunos com a Síndrome de Down nas aulas de Educação Física escolar e descrever quais as possibilidades de estratégias docentes para incluir o aluno com Síndrome de Down nas aulas de Educação Física. Esse estudo caracteriza-se enquanto pesquisa de campo, de caráter exploratório e de abordagem qualitativa. Os dados foram coletados por meio de entrevista semiestruturada e analisados através do protocolo de análise de conteúdo. A pesquisa foi realizada uma instituição de Atendimento Educacional Especializado (AEE) no município de Feira de Santana, Bahia. Os participantes da pesquisa foram dois professores formados em licenciatura em educação física e três estagiários graduandos do curso de licenciatura e bacharelado em educação física. Os resultados da pesquisa evidenciaram que os docentes utilizam estratégias para a inclusão do aluno com Síndrome de Down em suas aulas traçando estratégias em suas práticas pedagógicas inclusivas.
MEMÓRIAS VISUAIS DO GRUPO PLAY NEW:
Authors: Dos Santos Miranda Daniele , Castro Júnior Luís Vítor
Published: December 2023

O objetivo deste estudo foi analisar as performances dançantes do grupo Play New, no período entre 2013 e 2015, através de fontes audiovisuais. Buscou-se também discutir as danças produzidas pelo grupo a partir do pagode baiano; revisitar memórias e compreender o contexto histórico do grupo e dos eventos de dança da época; analisar as produções imagéticas, no intuito de identificar os elementos estéticos utilizados durante as apresentações. Partiu-se do entendimento sobre memória coletiva e individual, segundo Rios (2013). Utilizou-se o método de transcrição de vídeo de Lima (2020) e de análise de imagens de Mauad (1996). Contou-se com o suporte dos estudos de Mattos (2013) e Nascimento (2012) para dialogar com conteúdo referente ao pagode baiano. Notou-se que o grupo desenvolveu um estilo singular, mas que partiu de múltiplas referências, e características performáticas ágeis, com “alto” grau de dificuldade, fazendo-o ganhar destaque em seu período de atuação. Os dançarinos realizaram uma formação própria em dança, aprenderam dançando, e se tornaram referência em espetáculo de dança na região, além de proporcionar lazer e diversão para a cidade de Santo Amaro.
Credible Fears: The Asylum Narrative as Form in Lost Children Archive
Authors: Park Stephen M.
Published: December 2023

Abstract: The first step toward winning asylum in the United States is the Credible Fear Interview (CFI), in which the applicant narrates their life in a way that conforms with legal expectations of “credibility.” This interview process appears in several recent literary works, most notably Valeria Luiselli’s nonfiction work, Tell Me How It Ends . However, the narrative situation of the CFI, this moment of high-stakes, transactional storytelling, also provides a way of interpreting recent migration literature and understanding how such works perform credibility for the reader. By analyzing the interplay of legal and literary narratives in Luiselli’s Lost Children Archive , this article positions the CFI as the primal scene of narration for recent migration fiction.
Dismantling the Sentimental in Harriet Beecher Stowe’s Dred: A Tale of the Great Dismal Swamp
Authors: Wakefield Hannah
Published: December 2023

Abstract: In this essay, I analyze Harriet Beecher Stowe’s Dred to show how Stowe’s confrontation with Protestant religious institutions in the 1850s led her to deconstruct the sentimental techniques she had previously relied on in Uncle Tom’s Cabin . Scrutinizing Presbyterian leaders’ response to slavery both at a public camp meeting and at a private gathering of Northern and Southern ministers, Stowe assigns the main responsibility for slavery to Protestant ministers fearful of losing cultural power amid the intense denominational competition of the nineteenth century. In particular, she shows how the clergy justified silence on the issue of slavery by assigning slavery to a secular, civil sphere and narrowly defining the Christian church’s realm as purely spiritual, even as those same clergy advanced a nationalist political agenda.
Incantations, Comedias , and Epigenetics: The Ruiz de Alarcón Brothers Cast an Eye on Magic in the Seventeenth-century Spanish Empire
Authors: Clark Gloria Bodtorf
Published: December 2023

Abstract: In 1623, Hernando Ruiz de Alarcón, a parish priest in Atenango, Mexico, was commissioned by his archbishop to record Nahua beliefs and healing practices for the purpose of denouncing their superstitions and demonic magic. His Treatise on the Heathen Superstitions That Today Live Among the Indians Native to This New Spain, 1629 underscores Spanish prejudice against diversity in religion, preserves the idolatrous and magical practices it discredits, and reveals the author's colonial mindset. Raised in the same restrictive Spanish colonial environment, Hernando's brother Juan was classically trained in Civil and Canon law. He became one of the major authors of the Spanish Golden Age, writing comedias that focused on loyalty, friendship, and honesty. His work often reveals a disparate view of magical practice. This article explores how applying epigenetics, the study of environmental influences on gene activation and its effects on physical and emotional behavior, to their circumstances can provide a tool for exploring their sibling differences in relation to magic. Colonial Mexico, Spain, the Catholic religion, the university, and personal physical challenges acted on genetic factors to form the essential nature and works of Hernando and Juan Ruiz de Alarcón.