RESUMEN
INTRODUCTION: There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S. military despite the unique challenges and stresses shooting places on the vestibular-ocular and cognitive systems often disrupted by a concussion. The primary purpose of this scoping review was to summarize available evidence and current practices on return to shooting post-concussion, with the goal of optimizing an evidence-based return to shooting protocol for military service members. Our secondary aim was to identify individuals who may benefit from a return to shooting progression. MATERIALS AND METHODS: A comprehensive search of PubMed, SPORTDiscus, and Google Scholar was performed from the earliest dates to April 2023. A gray literature (Google) search was also performed. Articles were included if they studied a population with concussion, addressed return to shooting, and were written in English. Articles were excluded if they discussed health conditions other than concussion, focused on non-shooting interventions, did not use human subjects, or were written in a language other than English. RESULTS: Our search strategy yielded 134 articles: 1 article met our inclusion and exclusion criteria, whereas the other 133 articles were rejected. The gray literature search yielded one item. CONCLUSIONS: Based on our results, there is insufficient evidence to inform current practices on return to shooting post-concussion. In the absence of a published return to shooting protocol, we offer recommendations for identifying individuals who may benefit from a return to shooting progression and a revised version of a U.S. Army Special Operations Command Return to Range Progression. This protocol follows a conceptual framework for progression for variables such as environment, weapon type/caliber, and shooter position/movement. Further research is needed on identifying individuals who may benefit from a return to shooting protocol and safely and effectively progressing these individuals through a return to shooting protocol post-concussion.
RESUMEN
Herein we report on the first isolation of a Carnobacterium maltaromaticum-like bacterium from kidneys and swim bladders of lake whitefish (Coregonus clupeaformis) caught from Lakes Michigan and Huron, Michigan. Isolates were Gram-positive, nonmotile, facultatively anaerobic, asporogenous rods that did not produce catalase, cytochrome oxidase, or H2S, and did not grow on acetate agar. Except for carbohydrate fermentation, many phenotypic characteristics of lake whitefish isolates coincided with those of C. maltaromaticum, the causative agent of pseudokidney disease. Partial sequencing of 16S and 23S rRNA genes, as well as the piscicolin 126 precursor gene, yielded 97% and 98% nucleotide matches with C. maltaromaticum, respectively (accession numbers EU546836 and EU546837; EU643471). Phylogenetic analyses showed that lake whitefish isolates of this study are highly related, yet not fully identical to C. maltaromaticum. The presence of the C. maltaromaticum-like bacterium was associated with splenomegaly, renal and splenic congestion, and thickening of the swim bladder wall with accumulation of a mucoid exudate. Examination of stained tissue sections revealed renal and splenic congestion, vacuolation and bile stasis within the liver, and hyperplasia within the epithelial lining of the swim bladder. The concurrent presence of pathological changes and the C. maltaromaticum-like bacteria suggests that this bacterium is pathogenic to lake whitefish.
