bluuebunny/crossref_metadata_2025 huggingface dataset:
Sport concussion knowledge base, clinical practices, and needs for continuing medical education: a survey of family physicians and cross-border comparison
Authors: Lebrun Constance M , Mrazik Martin , Prasad Abhaya , Joel Tjarks B , Dorman Jason C , Bergeron Michael F , Munce Thayne A , Valentine Verle D
Published: March 2013

Objective

To identify sport concussion knowledge base, practice patterns and current/preferred methods of Knowledge Transfer and Exchange (KTE) in two distinct populations of family physicians.

Design

Cross-sectional study, using a survey design.

Setting

Alberta, Canada (CAN); North/South Dakota, USA (US). Rural (64.4% US, 27.5% CAN; p=<0.001); walk-in/acute care (28.8% CAN, 12.9% US; p=0.008).

Participants

Recruitment: CAN physicians by mail: 80/3154 responses (2.5%); US physicians: American Academy of Family Physicians database: 109/545 responses (20%).

Intervention/Instrument

On-line survey questionnaire.

Outcome Measures

Relative percentages diagnosing/treating concussions; comparison of management strategies (including return-to-play), and current/preferred KTE.

Results

Etiologies: Sports/recreation (52.5% CAN); organised sports (76.5% US). Tools: Clinical examination (93.8% CAN, 88.1% US); Sport Concussion Assessment Tool (SCAT/SCAT2) (33.8% CAN, 26.7% US); balance testing (25.0% CAN, 26.7% US); concussion grading scales (26.7% US, 8.8% CAN, p=0.002); computerised neurocognitive testing (19.8% US, 1.3% CAN; p≤0.001); Standardised Assessment of Concussion (21.8% US, 7.5% CAN; p=0.008). Treatment: Physical rest (83.8% CAN, 75.5% US); cognitive rest (47.5% CAN, 28.4% US; p=0.008). Return-to-play: Clinical examination (89.1% US, 73.8% CAN; p=0.007); neurocognitive testing (29.7% US, 5.0% CAN; p≤0.001); guidelines (63.4% US, 23.8% CAN; p≤0.001). KTE sources: Colleagues (31.3% CAN, 8.8% US; p≤0.001), websites (27.5% CAN, 15.7% US; p=0.052); medical school (35.0% CAN, 12.7% US; p≤0.001). KTE Preferences: Continuing Medical Education (CME) courses (65.0% CAN, 37.3% US; p≤0.001), and online CME (47.5% Can, 29.4% US; p=0.012).

Conclusions

Despite evolution of concussion diagnosis/management guidelines, significant knowledge gaps exist between evidence-based recommendations clinical practice patterns. This predicates enhanced and innovative CME initiatives for KTE.

Competing interests

None.
Baseline concussion symptom report in college athletes: comparison of scores on SCAT2 versus impact
Authors: Lebrun Constance M , Mrazik Martin , Matthews-White Joan , Lemke Nicole , Naidu. Dhiren
Published: March 2013

Objective

To investigate differences between baseline self-report of concussion symptoms with two commonly used concussion assessment tools.

Design

Retrospective, cross-sectional.

Setting

University of Alberta.

Subjects

One hundred and ninety-four varsity athletes (117 males; 77 females).

Intervention

Prior to the competitive season, subjects completed baseline testing, including self-report of concussion symptoms, with the Subjective Concussion Assessment Tool (SCAT2) and the on-line computerised Immediate Post-Concussion Assessment of Cognition (ImPACT) test, under supervision of an athletic therapist. Testing was counterbalanced to control for serial position effect.

Outcome Measures

The 18 shared self-report concussion symptoms were compared, and a general linear model used to identify possible interactions between gender and group type (SCAT2 vs ImPACT). Finally correlations were calculated.

Results

There was an interaction between gender and group type for 1 symptom (trouble falling asleep). Surprisingly, pairwise comparisons identified differences (p≤ 0.05) on 10/18 paired symptoms, with correlations ranging from 0.08 to 0.58.

Conclusions

Subjects respond differently when self-reporting concussion symptoms, depending on type of instrument used, and mode of administration. Despite test items being similar in content, there are significant differences in symptom reports in the same subject between SCAT2 and ImPACT tests. Use of similar data collection methods for baseline testing, assessment post-injury and prior to return-to-play is indicated, to increase both the diagnostic and prognostic utility of such tests. This further emphasises current recommendations that these tests not be used in isolation to make therapeutic decisions regarding athletes with concussion; and underscores the importance of serial clinical evaluations by a suitably qualified physician.

Competing interests

None. All authors have signed the disclosure form.
The effect of age, sex, and concussion history on preseason ImPACT values of elite Canadian youth ice hockey players
Authors: McKay Carly D , Brooks Brian L , Meeuwisse Willem H , Mrazik Martin , Jubinville Andrea L , Emery. Carolyn A
Published: March 2013

Objective

To examine the effect of age, sex, and concussion history on preseason scores from the ImPACT computer-based neurocognitive test battery in elite 12–17-year-old ice hockey players.

Design

Cross-sectional.

Setting

Participants were recruited from the most elite divisions (AA, AAA) of youth ice hockey leagues in Calgary and Edmonton, Alberta, Canada.

Participants

714 Bantam (ages 12–14) (47 female, 161 male) and Midget (ages 15–17) (67 female, 439 male) hockey players.

Assessment of Risk Factors

Players completed a preseason ImPACT test before the 2011–2012 season.

Outcome Measures

Outcomes were composite scores <25th percentile (based on sample distribution) for verbal memory, visual memory and impulse control, and scores >75th percentile for visual motor speed, reaction time, and total symptoms.

Results

Using multivariate Poisson regression, adjusted for cluster by team, those aged 16–17 years were less likely to score <25th percentile in verbal memory (IRR=0.85; 95% CI 0.78 to 0.98) or >75th percentile in reaction time (IRR=0.79; 95% CI 0.69 to 0.91), but were more likely to score >75th percentile in visual motor speed (IRR=1.27; 95% CI 1.17 to 1.37) and total symptoms (IRR=1.14; 95% CI 1.04 to 1.25). Males were less likely to score <25th percentile in verbal memory (IRR=0.85; 95% CI 0.78 to 0.92), but more likely to score >75th percentile in visual motor speed (IRR=1.20; 95% CI 1.05 to 1.38) and total symptoms (IRR=1.21; 95% CI 1.02 to 1.44). Previous concussion was not predictive of ImPACT scores in the poorest quartile on any subscale.

Conclusions

Age and sex influence preseason ImPACT scores, although concussion history does not appear to have an effect.

Acknowledgements

The Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We acknowledge the funding from the McCarthy Tetrault Award, Alberta Innovates Health Solutions, and the Alberta Children's Hospital Research Institute for Child and Maternal Health.

Competing interests

Author B Brooks declares research grant support from CNS Vital Signs (neurocognitive test battery publisher) and PAR, Inc (test publisher).
Test-retest reliability of the sport concussion assessment tool 2 (SCAT2) for uninjured children and young adults
Authors: Chan Monica , Vielleuse Jannick Vicky , Vokaty Stephanie , Wener Matthew Ari , Pearson Isabelle , Gagnon Isabelle
Published: March 2013

Objective

To establish test-retest reliability of the Sport Concussion Assessment Tool 2 (SCAT2) in healthy elementary school children and young adults.

Design

Repeated-measures design.

Setting

Elementary Schools in the Montreal area (children) and McGill University Athletics Department (adults).

Participants

Twenty-two children (14 females and eight males; mean age 10.3±0.5 years) and 73 young adults (42 female, 31 males; mean age 22.6±1.8 years) from University students participated in this study.

Intervention

None.

Main Outcome Measurements

Participants were tested using the Sport Concussion Assessment Tool-2 (SCAT2) on two occasions, 1-week apart (6.4±2.7 days). The SCAT2 measures several domains of functioning such as delayed memory, balance and post-concussion symptoms. Test-retest reliability was assessed for the total SCAT2 score as well as for the SCAT2 components separately.

Results

Intraclass Correlation Coefficients for the total SCAT2 score were only fair for both groups of participants (ICC=0.367 for young adults and 0.446 for children). The ICCs were also below 0.5 for individual components of the SCAT2 in young adults. In children, individual components yielded better reliability than the total score (Balance ICC=0.725; SAC ICC=0.523; symptom severity ICC=0.488).

Conclusions

The results indicate that in view of the low levels of test-retest reliability achieved for the total SCAT2 score, professionals should be cautious when using change in score over time for clinical decisions. Recommending the use of the SCAT2 as a standard of care to diagnose a concussion or to ascertain recovery from one may be premature at this time.

Acknowledgments

Participants and their families, The Priory School, Gardenview Elementary School for allowing testing within their institutions, Fonds de recherche du Québec-Santé, School of Physical and Occupational Therapy McGill University.

Competing interests

None.
Do Canadian sport and exercise medicine physicans and emergency physicians give consistent sport-related concussion management advice?
Authors: Carson James , Purcell Laura , Davidson Bruce , Garel Alisha , Bell Margaret , Moineddin Rahim
Published: March 2013

Objective

To identify differences and gaps in the recommendations to patients for the management of sport-related concussion among sport and exercise medicine physicians and emergency physicians.

Design

A self-administered multiple-choice survey, which had been validated for content validity.

Setting

Canada.

Subjects

Physicians who have passed the diploma examination of the Canadian Academy of Sport and Exercise Medicine (CASEM-MDs) and physicians on the Canadian Association of Emergency Physicians (CAEP-MDs) database.

Intervention

The survey link was emailed to 470 CASEM-MDs and to 789 CAEP-MDs across Canada.

Outcome Measures

Key survey questions identified sources of concussion management information, usefulness of concussion diagnosis strategies, and whether physicians use common terminology when explaining cognitive rest strategies to patients after a sport-related concussion.

Results

Only 71% of CASEM-MDs usually use the SCAT2, whereas 86% of CAEP-MDs never use the SCAT2. 75% of CASEM-MDs usually advise time off of work or school after a sport-related concussion and 64% of CAEP-MDs do likewise. Only 75% of CASEM-MDs usually utilise balance testing. When queried how cognitive rest can best be achieved after a sport-related concussion, many choices were appealing with no consistent consensus.

Conclusions

We identified a lack of consistency in the implementation of recommendations for sport-related concussion patients. It appears that the SCAT2 is utilised more in the office setting than in the emergency department. More recent strategies such as balance testing have not gained consistent usage, even among physicians with recognised expertise in concussion management. Better knowledge translation efforts should target both of these groups of physicians.

Acknowledgements

Special thanks go to Paul Krueger, Leigh Hayden and the other 18 participants in the validation of our survey.

Competing interests

None.
Comprehensive analysis of ‘knockouts’ in Mixed Martial Arts (MMA)
Authors: Hutchison Michael , Cusimano Michael , Lawrence David , Singh Tanveer
Published: March 2013

Objective

To quantify and identify potential risk factors for knockouts (KOs) and technical KOs (TKOs) in Mixed Martial Arts fighters.

Setting

Ultimate Fighting Championship (UFC).

Design

Retrospective. Fight card and fighter data was collected from all numbered UFC events over a 4-year period ending in 2009. Publicly available databases and digital video images were used to retrieve all pertinent information.

Outcome Measures

Event characteristics(eg, location, date, etc),fighter demographics(eg, age, nationality, time since last match),match characteristics(eg, match significance, rounds fought), and injury mechanism.

Results

A total of 503 matches were reviewed of which 36% ended in either KO (58; 12%; 57.7 per 1000 AE) or TKO (119; 24%; 118.4 per 1000 AE). The prevalence of KOs was highest in fighters between ages 36 and 40 (20.6%). The mechanism of contact resulting in a KO was predominately a direct blow to the head by a fist. 20% of all TKOs occurred in the heavyweight class. 33.9% of title matches result in TKOs and one in five of all KOs occurred during the first minute of a round.

Conclusion

Most often the mechanism of contact resulting in a KO was direct blow to the head. We have identified factors which were associated with a higher incidence of KO or TKO including age, weight, fight significance, time within the round, and time since last fight.

Acknowledgements

The Canadian Institutes of Health Research (CIHR) Strategic Team in Applied Injury Research funded this research.

Competing interests

None.
How the new taekwondo rules have decreased the injuries and concussions since 2008
Authors: Viscogliosi Paul
Published: March 2013

Before 2008, the rules of taekwondo to score points required powerful feet or hand movements to the trunk and feet movements to the head. Under this system the insurance statistics (Statistics of Mutuelle des Sports France) showed that taekwondo was a safe sport and that concussion was rare.

The rules were changed 2 years ago with the adoption of an electronic scoring system for the trunk hits and valid head scoring with light feet taps only (without power).

The electronic trunk protector's scoring system scores relative power in relation to the weight category.

Statistics from three competitions that took place during 2011 and 2012 were analysed including theWorld TaekwondoFederation (WTF) World championships, the WTF World qualification tournament for the Olympic Games and the European Qualification tournament for Olympic Games and then compared to an earlier WTF World qualification tournament for Olympics Games ruled by the previous rule system (2008).

Under the old system, we determined that out of 380 fights analysed, 55 injuries occurred, 3 were knocked down; which equates to 14.5% injuries and 0.8% KO.

Under the new rules, we found that out of 1180 fights, there were 15 injuries and 2 knock down; which equates to 1.3% injuries and 0.17% KO.

Conclusion

With the new rules, the injuries were 11 times less likely to occur and the KOs 5 times less likely to occur.

The next step for 2016 is to adopt an electronic headgear to make the sport of taekwondo even safer.
National Hockey League players' experiences with career-ending concussions
Authors: Caron Jeffrey G , Bloom Gordon A , Johnston Karen M , Sabiston Catherine M
Published: March 2013

Objective

This study investigated the experiences of National Hockey League (NHL) players who retired due to medically diagnosed concussions they incurred during their playing careers.

Design

An Interpretative Phenomenological Analysis (IPA; Smithet al, 2009) was used to examine the interview data. IPA is a qualitative research methodology used to understand and explore how people make sense of important life experiences and has been commonly used in health research (Smith, 2011).

Setting

Interviews were conducted in various cities in North America.

Participants

Five former NHL players whose professional careers spanned more than 10 seasons were interviewed for this project.

Results

Participants in this study articulated the type and intensity of the physical (eg, headaches, visual impairments) and psychological (eg, isolation, depression, suicidal ideation) concussion symptoms they endured during their careers, including how these symptoms impacted their professional careers, quality of lives, and relationships with family members and medical professionals. Participants said they continued to experience physical symptoms such as headaches, sensitivity to bright lights, and concentration problems after their careers, which has affected their post-athletic lives and has disturbed their daily functioning.

Conclusions

These are the first results to empirically document the experiences of professional athletes who suffered career-ending concussions. Findings from this study concur with McCroryet al's (2009) call for longitudinal research to better understand the implications of concussive injury. Additionally, our results indicate a need for psychological counselling in conjunction with medical guidance during rehabilitation from concussion and transition to post-athletic lives.

Competing interests

None.
Classification analyses of pediatric concussion assessment battery
Authors: Gioia Gerard , Isquith Peter , Vaughan Christopher
Published: March 2013

Objective

Demonstrate classification statistics (OR, Likelihood Ratios) of a pediatric multi-component battery of neurocognitive tests, child and parent symptom report to identify the presence or absence of concussion.

Design

Prospective cohort design.

Setting

Outpatient clinic, teaching hospital.

Participants

Two groups of children, ages 5–7 years (n=22 per group) and ages 8–12 years (n=67 per group) (≤7 days post-concussion) were compared to gender/age-matched groups of non-injured children.

Interventions

Predictor variables: Response Speed Composite, Child and Parent Post-Concussion Symptom Inventory (PCSI) symptom scores.

Main Outcome Measurements

Group membership—concussion, control.

Results

MANOVAs revealed significant group differences for the Response Speed Composite, Child and Parent PCSI symptom scores for both age groups. Discriminant function analyses conducted on the Child and Parent PCSI scores and Neurocognitive Composite scores independently and in combination indicate parent and child PCSI symptoms and Response Speed demonstrate adequate classification independently; in combination offered greatest rates. For the 5–7 year age group, 73% were correctly classified by the three combined scores (Positive Likelihood Ratio=3.5, Negative Likelihood Ratio=0.58, OR=6.0, 80% Area Under Curve (AUC)). 84% of 8–12 age group were identified correctly by the three combined scores (LR+=47.0, LR−=.30, OR=155, 94% AUC). Relative differences between scores will be demonstrated.

Conclusion

The multi-component pediatric battery demonstrates appropriate capability to classify children referred for a suspected concussion. Increased parent and child PCSI symptom ratings and decreased neurocognitive performance (Response Speed) increases diagnostic accuracy, assisting the clinician in their clinical decision-making.

Competing interestsDrs Gioia, Isquith and Vaughan are co-authors of Pediatric ImPACT battery.
Variability in discharge instructions and activity restrictions for patients evaluated in a children's emergency department following concussion
Authors: De Maio Valerie J , Joseph Damilola O , Tibbo-Valeriote Holly , Lanier Brian , Register-Mihalik Johna
Published: March 2013

Objective

To describe discharge instructions given to school-aged patients evaluated in a children's emergency department (ED) following concussion.

Design

Retrospective cohort.

Setting

Dedicated children's ED (Level I Trauma Center).

Patients

All children 6–18 years evaluated in 2008 following head trauma regardless of mechanism, identified by any of 16 ICD-9 diagnostic codes for head injury, concussion, or skull fracture (n=350). Included (n=218): presentations consistent with 2008 Zurich consensus definition for concussion. Excluded (n=132): hospital admission, death, intoxication, structural neuroimaging abnormality.

Assessment of Risk Factors

Age, gender, mechanism, signs/symptoms.

Main Outcome Measurements

Univariate and multivariate analyses determined adjusted ORs for receipt ofconcussion-specific discharge instructionsandactivity restrictions.

Results

Patients were mostly male (68%) with mean age 12.8 years (sd=3.4). Injury characteristics included: sport-related 42%, fall 23%, loss of consciousness (LOC) 33%, headache 75%, dizziness 29%, amnesia 25%, vomiting 19%, imaging ordered 81%. Discharge characteristics included: concussion stated in final diagnosis 31%, concussion-specific instructions 62%, activity restrictions 34% (sport-related 42%, non-sport 29%). Concussion-specific instructions were more likely for LOC (OR 1.7, 95% CI 1.22 to 2.36) and activity restrictions more likely for amnesia (OR 1.42, 95% CI 1.01 to 1.98) and sport-related injury (OR 1.31, 95% CI 1.02 to 1.76).

Conclusions

Most children meeting diagnostic criteria for concussion were discharged without concussion-specific diagnoses or activity restrictions, even when the injury was sport-related. Given the risks associated with untimely return to both physical and cognitive activity after concussion, improved awareness and standardisation of discharge instructions is imperative for the management of these young patients in the ED.

Acknowledgements

We would like to confirm that none of the authors have any financial or commercial interest in this material.
Concussion and concurrent cognitive and sport-specific task performance in youth ice hockey players: a pilot study
Authors: Reed Nick , Fait Philippe , Perez Olinda Habib , Zabjek Karl , Keightley Michelle L
Published: March 2013

Objective

To determine the influence of concussion on cognitive performance while completing concurrent sport-specific tasks to further inform return to play protocols for youth athletes.

Design

This descriptive case pilot study compared the performance of youth ice hockey players who had experienced a concussion in the last ice hockey season to non-injured controls.

Setting

Youth athletes were assessed while performing ice hockey skills in an ice hockey arena.

Participants

Four male youth ice hockey players who experienced a concussion during the previous ice hockey season (mean age=11.7±0.29 years; mean time since injury=92.5±49.0 days) and nine non-injured control subjects (mean age=11.4±1.0 years).

Intervention

Participants completed a randomised combination of four tasks (unobstructed skating, visual interference task, avoiding a fixed obstacle, stickhandling an ice hockey puck).

Outcome Measures

Response errors and response reaction time dual-task costs during visual interference task (modified Stroop task).

Results

Participants who experienced a concussion within the past ice hockey season and were ≤58 days post-injury demonstrated significantly poorer cognitive performance (increased dual task cost) across all conditions when performing concurrent sport-specific skills (based on 95% CI).

Conclusions

Youth ice hockey players with a more recent concussion demonstrated greater cognitive deficits compared to controls. This study acts as an initial step towards the development of an ecologically valid, sport-specific assessment of functional performance following concussion in youth ice hockey players.

Acknowledgements

Ontario Neurotrauma Foundation, Quebec Rehabilitation Research Network (ONF-REPAR).

Competing interests

None.
Head impact biomechanics in ski related accident
Authors: Kleiven Svein , Halldin Peter
Published: March 2013

Objective

The objective of this study was to investigate the need for an updated specification for improved Downhill and Super-G helmet. One important aspect was to understand if the impact situations in the ski slope can generate high rotational accelerations and if so, how can the helmets be designed to absorb both translational and rotational energy.

Design

TV footage from 11 accidents during 2008–2010 has been collected by NIH, Oslo. Video analysis of the accidents has been conducted by KTH to quantify the kinematics of the helmeted head during the accidents. The head kinematics from the video analysis was then applied to perform accidents reconstructions by use of the detailed KTH numerical head model, a helmet model and a new model of the impacted ski slope.

Results

The preliminary results show that impact speeds are higher compared to the velocities used in the current test standard (5.4 m/s). It is also shown that the impact angle is very steep (Around 20° s) compared to the pure vertical impacts (90° impact angle) used in helmet standards. The simulations of the helmeted head impact do show that the rotational forces to the head is large and that the material properties of the snow is important to take into consideration when designing a new helmet standard.

Conclusion

▸ The test speed should be increased from 5.4 m/s.

▸ The rotational accelerations in the simulations are high.

▸ The ongoing project aim to answer if the specification of ski helmets needs to take the rotation into account.
Streptococcal pharyngitis in children: a meta-analysis of clinical decision rules and their clinical variables
Authors: Le Marechal Flore , Martinot Alain , Duhamel Alain , Pruvost Isabelle , Dubos François
Published: March 2013

Objective

To identify the best clinical decision rules (CDRs) for diagnosing group A streptococcal (GAS) pharyngitis in children. A combination of symptoms could help clinicians exclude GAS infection in children with pharyngitis.

Design

Systematic review and meta-analysis of original articles involving CDRs in children. The Pubmed, OVID, Institute for Scientific and Technical Information and Cochrane databases from 1975 to 2010 were screened for articles that derived or validated a CDR on a paediatric population: 171 references were identified.

Setting

Any reference including primary care for children with pharyngitis.

Data extraction

The methodological quality of the articles selected was analysed according to published quality standards. A meta-analysis was performed to assess the statistical performance of the CDRs and their variables for the diagnosis of GAS pharyngitis.

Primary outcome measure

The main criterion was a false-negative rate in the whole population not any worse than that of a rapid diagnostic test strategy for all patients (high sensitivity and low negative likelihood ratio).

Results

4 derived and 12 validated CDRs for this diagnosis in children. These articles involved 10 523 children (mean age, 7 years; mean prevalence of GAS pharyngitis, 34%). No single variable was sufficient for diagnosis. Among the CDRs, that of Joachimet alhad a negative likelihood ratio of 0.3 (95% CI 0.2 to 0.5), resulting in a post-test probability of 13%, which leads to 3.6% false-negative rate among low-risk patients and 10.8% overall, equivalent to rapid diagnostic tests in some studies.

Conclusions

The rule of Joachimet alcould be useful for clinicians who do not use rapid diagnostic tests and should allow avoiding antibiotic treatment for the 35% of children identified by the rule as not having GAS pharyngitis. Owing to its poor specificity, such CDR should be used to focus rapid diagnostic tests to children with high risk of GAS pharyngitis to reduce the antibiotic consumption.
The contribution of stress to the comorbidity of migraine and major depression: results from a prospective cohort study
Authors: Swanson Sonja A , Zeng Yiye , Weeks Murray , Colman Ian
Published: March 2013

Objectives

To assess how much the association between migraine and depression may be explained by various measures of stress.

Design

National Population Health Survey is a prospective cohort study representative of the Canadian population. Eight years of follow-up time were used in the present analyses.

Setting

Canadian adult population ages 18–64.

Participants

9288 participants.

Outcome

Incident migraine and major depression.

Results

Adjusting for sex and age, depression was predictive of incident migraine (HR: 1.62; 95% CI 1.03 to 2.53) and migraine was predictive of incident depression (HR: 1.55; 95% CI 1.15 to 2.08). However, adjusting for each assessed stressor (childhood trauma, recent marital problems, recent unemployment, recent household financial problems, work stress, chronic stress and change in social support) decreased this association, with chronic stress being a particularly strong predictor of outcomes. When adjusting for all stressors simultaneously, both associations were largely attenuated (depression–migraine HR: 1.30; 95% CI 0.80 to 2.10; migraine–depression HR: 1.19; 95% CI 0.86 to 1.66).

Conclusions

Much of the apparent association between migraine and depression may be explained by stress.
DoesCandidaand/orStaphylococcusplay a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia
Authors: Amir Lisa H , Donath Susan M , Garland Suzanne M , Tabrizi Sepehr N , Bennett Catherine M , Cullinane Meabh , Payne Matthew S
Published: March 2013

Objective

To investigateCandidaspecies andStaphylococcus aureusand the development of ‘nipple and breast thrush’ among breastfeeding women.

Design

Prospective longitudinal cohort study.

Setting

Two hospitals in Melbourne, Australia (one public, one private) with follow-up in the community.

Participants

360 nulliparous women recruited at ≥36 weeks’ gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks.

Main outcome measures

Case definition ‘nipple and breast thrush’: burning nipple pain and breast pain (not related to mastitis); detection ofCandidaspp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection ofS aureusin the mother's nipple or breast milk.

Results

Women with the case definition of nipple/breast thrush were more likely to haveCandidaspp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014).S aureuswas common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence thatS aureuscolonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates thatCandidaand nipple damage are independent predictors of our case definition.
Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel ‘RCT within-a-cohort’ study design
Authors: Sihvonen Raine , Paavola Mika , Malmivaara Antti , Järvinen Teppo L N
Published: March 2013

Introduction

Arthroscopic partial meniscectomy (APM) to treat degenerative meniscus injury is the most common orthopaedic procedure. However, valid evidence of the efficacy of APM is lacking. Controlling for the placebo effect of any medical intervention is important, but seems particularly pertinent for the assessment of APM, as the symptoms commonly attributed to a degenerative meniscal injury (medial joint line symptoms and perceived disability) are subjective and display considerable fluctuation, and accordingly difficult to gauge objectively.

Methods and analysis

A multicentre, parallel randomised, placebo surgery controlled trial is being carried out to assess the efficacy of APM for patients from 35 to 65 years of age with a degenerative meniscus injury. Patients with degenerative medial meniscus tear and medial joint line symptoms, without clinical or radiographic osteoarthritis of the index knee, were enrolled and then randomly assigned (1 : 1) to either APM or diagnostic arthroscopy (placebo surgery). Patients are followed up for 12 months. According to the prior power calculation, 140 patients were randomised. The two randomised patient groups will be compared at 12 months with intention-to-treat analysis. To safeguard against bias, patients, healthcare providers, data collectors, data analysts, outcome adjudicators and the researchers interpreting the findings will be blind to the patients’ interventions (APM/placebo). Primary outcomes are Lysholm knee score (a generic knee instrument), knee pain (using a numerical rating scale), and WOMET score (a disease-specific, health-related quality of life index). The secondary outcome is 15D (a generic quality of life instrument). Further, in one of the five centres recruiting patients for the randomised controlled trial (RCT), all patients scheduled for knee arthroscopy due to a degenerative meniscus injury are prospectively followed up using the same protocol as in the RCT to provide an external validation cohort. In this article, we present and discuss our study design, focusing particularly on the internal and external validity of our trial and the ethics of carrying out a placebo surgery controlled trial.

Ethics and dissemination

The protocol has been approved by the institutional review board of the Pirkanmaa Hospital District and the trial has been duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations.

Trial registration

ClinicalTrials.gov, numberNCT00549172.
Construction of tissue microarrays using pre-existing slides as source of tissue when paraffin blocks are unavailable
Authors: Deng Fang-Ming , Zhao Yan , Kong Xiantian , Lee Peng , Melamed Jonathan
Published: March 2013

Aim

To develop and validate a technique for construction of intermediate density tissue microarray (TMA) slides based on the transfer of tissue from pre-existing routine slides provided for pathology diagnosis with validation to show preservation of morphology and antigenicity of the transferred tissue.

Methods

Prostate cancer patch TMAs were constructed using 20 cores acquired from radical prostatectomy histology slides. The preservation of morphology and antigenicity of these patch TMAs were tested with immunohistochemistry (IHC) in comparison to a traditional TMA.

Results

After IHC staining, 35 of 39 cores (89.7%) on the patch TMA were intact compared with 39 of 40 cores (97.5%) on the traditional TMA. Expression patterns and density of the antigens (34BE12, p63 and AMACR) on the patch TMA were almost identical to the traditional TMA.

Conclusions

Patch TMA represents a viable alternative for tissue-based IHC studies when paraffin blocks are unavailable. This may be a valuable tool for allowing use of archival slide material for IHC and enable a standardized TMA platform to be used when the slides sent for review from other institutions are the only source of tissue available.
Penehyclidine hydrochloride attenuates the cerebral injury in a rat model of cardiopulmonary bypass
Authors: Cao Hui-juan , Sun Ying-jie , Zhang Tie-zheng , Zhou Jin , Diao Yu-gang
Published: March 2013

This study investigated the effect of penehyclidine hydrochloride (PHC) on regulatory mediators during the neuroinflammatory response and cerebral cell apoptosis following cardiopulmonary bypass (CPB). Forty-eight rats were randomly divided among 4 groups as follows: sham-operation, vehicle, low-dose PHC (0.6 mg·(kg body mass)−1), and high-dose PHC (2.0 mg·(kg body mass)−1). CPB was performed in the latter 3 groups. The plasma levels of neuron specific enolase (NSE) and S-100B were tested with ELISA. Real-time PCR and Western blotting were used to evaluate the expression levels of matrix metalloproteinase-9 (MMP-9), IL-10, caspase-3, Bcl-2, and p38 in brain tissue. The ultrastructure of hippocampus tissue was examined under an electron microscope. PHC attenuated the increase of plasma NSE and S-100B following CPB. MMP-9, cleaved caspase-3, and phosphorylated p38 expression were substantially increased in the vehicle group compared with the sham-operation group and gradually diminished with increasing doses of PHC. IL-10 and Bcl-2 expression were markedly lower in the vehicle group than in the sham-operation group and gradually recovered with increasing doses of PHC. PHC attenuated the histopathological changes of cerebral injury following CPB. PHC favorably regulates the inflammatory response and reduces markers of neuronal injury following CPB, potentially by reducing p38 and caspase-3 activation.
The living community inside the common periwinkle,Littorina littorea
Authors: Buckland-Nicks John , Chisholm Sarah Ann , Gibson Glenys
Published: March 2013

An extensive community of organisms inhabits the common periwinkle, Littorina littorea (L., 1758), along the wave-swept rocky shores of Canada’s East coast. This community, which includes both facultative and obligate endosymbionts, comprises a diverse array of species from seven animal phyla, including Annelida, Arthropoda, Gnathostomulida, Nematoda, Nemertea, and Platyhelminthes, as well as ciliates and algae. The presence of larger numbers of endosymbionts was found to correlate with specific shell characteristics of the snail host, including a wider aperture and columella, suggesting that these individuals have a larger mantle cavity relative to snails housing a small community of endosymbionts. Snails with large communities of endosymbionts were usually encrusted with coralline algae and often had trematode infections. Although L. littorea has been extensively studied since the last century, the existence of this community of organisms has passed unnoticed. The large diversity of organisms in this community suggests that these snails may provide refugia for a wide range of smaller taxa.
GAIN-BANDWIDTH TRADE-OFF IN THE CMOS CASCODE AMPLIFIER
Authors: BEN-ESMAEL M. , LIDGEY F. J. , HAYATLEH K. , HART B. L.
Published: March 2013

The cascode amplifier has the potential of providing high gain and high bandwidth simultaneously. However, the design is not as intuitive as one might at first think. In this paper, we present a detailed analysis of the single cascode amplifiers. The relationship between gain and bandwidth is important. When used to achieve maximum bandwidth the voltage gain of the common-source stage is close to unity. However, when the cascode is designed to obtain a high voltage gain, then the gain-bandwidth trade-off, typical in the common source amplifier, reappears. This analysis is used to provide the basis for practical cascode amplifier design.
COATING THE CONDUCTIVITY MATERIALS TO IMPROVING THE ELECTROCHEMICAL PROPERTIES OF LiFePO4
Authors: WANG WAN LIN , JIN EN MEI , GU HAL-BON
Published: March 2013

LiFePO4 cathode materials were prepared by a solid-state method followed by one-step heat treatment. To improve the electrochemical properties of the LiFePO4 , acetylene black (AB), citric acid (CA), and pyrene are added as carbon source, respectively. The cyclic voltammetry (CV), AC impedance and galvanostatic charge/discharge testing results showed that using the LiFePO4-C composite such as the AB carbon source exhibits higher discharge capacity and stability than the other composite. Synthesized LiFePO4-C/Li cells (with AB) showed that initial discharge capacity was 140.65 mA h g-1 and at the 2nd cycle were 145.87 mA h g-1, respectively. Morphology and electrochemical performance of the LiFePO4 cathode materials were investigated. Furthermore, the cell was subjected to current density studies (0.1 mA cm-2) that suggested excellent capacity retention of the cell at 25°C.
OPTICAL PROPERTIES OF THE OXIDATION OF Cu THIN FILMS PREPARED BY THERMAL EVAPORATION
Authors: LAI GUOZHONG , LAN HUIQING , LIN SUANZHI , QU YAN , LAI FACHUN
Published: March 2013

Copper films with 87 nm thickness were deposited on quartz substrates by thermal evaporation. In order to investigate the oxidation process, the Cu films were oxidized at different temperatures in air with different durations to obtain the complete and uncompleted copper oxide films. The structure and optical properties of the samples were studied by X-ray diffraction, scanning electron microscopy and spectrophotometer, respectively. It is found that the sample oxidized at 220°C for 200 min is Cu2O film with 106 nm thickness. Both the transmittance and reflectance of the samples increase with the increase of oxidation duration. The optical constants of the Cu film and the Cu2O film were retrieved by simulating the reflectance or transmittance based on the optical dielectric models. The optical constants of the Cu and Cu2O mixed layer with different composition were calculated by the effective medium theories. Adjusting the mixed layers composition and thickness, and Cu2O layer thickness, the transmittance and reflectance of the uncompleted oxidation films were simulated by optical multilayer design software. The results show that the uncompleted oxidation films consist of the Cu and Cu2O mixed layers and Cu2O layer. According to the parabolic rate law, the increase rate of Cu2O layer thickness for the uncompleted oxide films at 200°C is 1.6 nm s-1/2.
The ubiquitin proteasome system in human cardiomyopathies and heart failure
Authors: Day Sharlene M.
Published: March 2013

Maintenance of protein quality control is a critical function of the ubiquitin proteasome system (UPS). Evidence is rapidly mounting to link proteasome dysfunction with a multitude of cardiac diseases, including ischemia, reperfusion, atherosclerosis, hypertrophy, heart failure, and cardiomyopathies. Recent studies have demonstrated a remarkable level of complexity in the regulation of the UPS in the heart and suggest that our understanding of how UPS dysfunction might contribute to the pathophysiology of such a wide range of cardiac afflictions is still very limited. Whereas experimental systems, including animal models, are invaluable for exploring mechanisms and establishing pathogenicity of UPS dysfunction in cardiac disease, studies using human heart tissue provide a vital adjunct for establishing clinical relevance of experimental findings and promoting new hypotheses. Accordingly, this review will focus on UPS dysfunction in human dilated and hypertrophic cardiomyopathies and highlight areas rich for further study in this expanding field.
Phospholipase C signaling tonically represses basal atrial natriuretic factor secretion from the atria of the heart
Authors: Chang Astra I. , Forero McGrath Monica , de Bold Adolfo J.
Published: March 2013

The cardiac hormone atrial natriuretic factor (ANF or ANP) plays significant, well-established roles in a large number of physiological and pathophysiological processes, including water and electrolyte balance, blood pressure regulation, and cardiovascular growth. Understanding the regulation of its production and secretion by atrial cardiomyocytes is incomplete. We have previously established a significant role of Gi/oprotein signaling in modulating ANF secretion as promoted by stretch of the atrial myocardium. In the present study, we investigated the role of Gqprotein signaling and its relationship to Gi/oprotein signaling using pharmacological manipulation of proximal effectors of Gαqin an ex vivo model of spontaneously beating rat atria. Phospholipase C (PLC) and protein kinase C (PKC) inhibitors dramatically increased basal secretion of ANF. Furthermore, although atrial wall stretch is a potent stimulus for secretion, stretch unexpectedly reduced ANF secretion to basal levels under PLC and PKC inhibitory conditions. Inhibition of the inositol triphosphate receptor did not appear to affect basal secretion but dose-dependently blocked stretch-secretion coupling. The results obtained demonstrate that the PLC and PKC signaling cascades play important albeit unexpected roles in the regulation of basal and stimulated ANF secretion and suggest interplay between the Gqand Gi/oprotein signaling pathways.
A New Method for the Bisymmetric Minimum Norm Solution of the Consistent Matrix EquationsA1XB1=C1,A2XB2=C2
Authors: Liu Aijing , Chen Guoliang , Zhang Xiangyun
Published: March 2013

We propose a new iterative method to find the bisymmetric minimum norm solution of a pair of consistent matrix equationsA1XB1=C1,A2XB2=C2. The algorithm can obtain the bisymmetric solution with minimum Frobenius norm in finite iteration steps in the absence of round-off errors. Our algorithm is faster and more stable than Algorithm 2.1 by Cai et al. (2010).
Voltage-Mode Universal Biquadratic Filter Using Single DVCC
Authors: Horng Jiun-Wei , Jhao Zih-Yang
Published: March 2013

A voltage-mode universal biquadratic filter using a differential voltage current conveyor (DVCC), two capacitors, and two resistors is presented. The proposed circuit has four input terminals and three output terminals and can realize all the standard filter functions, which are lowpass, bandpass, highpass, notch, and allpass filters, without changing the circuit topology. Three simultaneous output filter responses can be obtained from some derived filter types. The proposed circuit employs only one DVCC that simplifies the configuration.
Fuzzy Approximate Solution of Positive Fully Fuzzy Linear Matrix Equations
Authors: Guo Xiaobin , Shang Dequan
Published: March 2013

The fuzzy matrix equationsA~⊗X~⊗B~=C~in whichA~,B~, andC~arem×m,n×n, andm×nnonnegative LR fuzzy numbers matrices, respectively, are investigated. The fuzzy matrix systems is extended into three crisp systems of linear matrix equations according to arithmetic operations of LR fuzzy numbers. Based on pseudoinverse of matrix, the fuzzy approximate solution of original fuzzy systems is obtained by solving the crisp linear matrix systems. In addition, the existence condition of nonnegative fuzzy solution is discussed. Two examples are calculated to illustrate the proposed method.
3,5,4′-tri-O-acetylresveratrol Ameliorates Seawater Exposure-Induced Lung Injury by Upregulating Connexin 43 Expression in Lung
Authors: Ma Lijie , Li Yanyan , Zhao Yilin , Wang Qingwei , Nan Yandong , Mu Deguang , Li Wangping , Sun Ruilin , Jin Faguang , Liu Xueying
Published: March 2013

The aim of the present study was to examine the effects of 3,5,4′-tri-O-acetylresveratrol on connexin 43 (Cx43) in acute lung injury (ALI) in rats induced by tracheal instillation of artificial seawater. Different doses (50, 150, and 450 mg/kg) of 3,5,4′-tri-O-acetylresveratrol were administered orally for 7 days before modeling. Four hours after seawater inhalation, histological changes, contents of TNF-α, IL-1βand IL-10, and the expression of Cx43 in lungs were detected. Besides, the gap junction communication in A549 cells and human umbilical vein endothelial cells (HUVECs) challenged by seawater was also evaluated. Histological changes, increased contents of inflammatory factors, upregulation in gene level, and deregulation in protein level of Cx43 in lungs stimulated by seawater were observed. On the other hand, pretreatment with 3,5,4′-tri-O-acetylresveratrol significantly inhibited infiltration of inflammation, development of pulmonary edema, and contents of inflammatory mediators in lungs. Above all, 3,5,4′-tri-O-acetylresveratrol upregulated the expression of Cx43 in both gene and protein levels, and its intermediate metabolite, resveratrol, also enhanced the gap junction communication in the two cell lines. The results of the present study suggested that administration of 3,5,4′-tri-O-acetylresveratrol may be beneficial for treatment of inflammatorycellsin lung.
Multicentric Reticulohistiocytosis Presenting with Papulonodular Skin Lesions and Arthritis Mutilans
Authors: Saba Raya , Kwatra Shawn G. , Upadhyay Bishwas , Mirrakhimov Aibek E. , Khan Farah N.
Published: March 2013

Multicentric reticulohistiocytosis is a rare multisystem disorder of unknown etiology that is characterized by erosive polyarthritis and papulonodular lesions on the skin, mucous membranes, and internal organs. We report the case of a 54-year-old female who was misdiagnosed as having rheumatoid arthritis and underwent numerous joint replacement surgeries for progressively destructive arthritis in her hands, shoulders, hips, and knees. The patient finally received a diagnosis of multicentric reticulohistiocytosis after histopathological examination of the patient’s left knee arthroplasty which revealed a diffuse histiocytic infiltrate, multinucleated giant cells, and finely granulated eosinophilic cytoplasm with a ground-glass appearance.