A novel classification of bone graft materials.

Over the past few decades, the field of biomaterials concerning bone tissue engineering has gained a significant amount of interest. This has led to new biomaterials to be used as bone substitute materials. Despite the rapid increase in the types and forms of bone substitutes, a comprehensive classification encompassing all types of bone graft materials that have so far been developed and evaluated is lacking. Therefore, this review aims to integrate and bring together the published data on bone substitutes within the last 5 years and produce a novel classification that would provide bone material researchers with a better understanding of what materials have so far been used and evaluated and the areas, where research is lacking and deserves more attention. The literature available in all major databases was obtained and filtered using an elimination criterion to extract all the articles related to studies that tested bone substitute materials in nonclinical and clinical trials over the last 5 years. The review article would provide bone material researchers with an insight into the materials that have been evaluated for bone tissue engineering applications and identify future perspectives for bone graft material research.

Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician's perspective.

OBJECTIVES: Sport and Exercise Physicians represent a relatively new specialty focusing on exercise in complex diseases including musculoskeletal diseases. Our objective was to describe the characteristics, type and complexity of patient presentations, their management strategies and referral information in Australian practice. METHODS: A cross-sectional study including a cohort of 11 senior Sport and Exercise Physicians in Australia studied all new patient consultations within an 8-week period. Data were analysed relating to presentation, referral source, follow-up referrals, and patient management strategies. RESULTS: Data from 419 patients were recorded. The majority, 97% (n=406), had musculoskeletal conditions, 53% (n=222) had one or more associated comorbidities and 47% (n=195) had ongoing symptoms for >12 months. Most patients, 82% (n=355), were referred by general practitioners. Prior consultations included physiotherapy 72% (n=301) and orthopaedic 20% (n=85). A multidisciplinary network of referrals from Sport and Exercise Physicians was observed, including 210 referrals to 9 allied health specialities and 61 referrals to 17 medical specialities. Over 74% (n=311) of patients received exercise-based intervention as part of the treatment plan, including 57% (n=240) physician managed exercise interventions. CONCLUSION: Our work shines a light on the nature and complexity of the role of Sport and Exercise Physicians in an Australian practice context. Findings will assist in implementing measures to promote patient care at the community level in managing musculoskeletal conditions. Sport and exercise medicine stakeholders and government policy makers can use this information in developing appropriate programmes to support patients and create integrated sport and exercise medicine services for the community.

Exertional heat fatalities in Australian sport and recreation.

OBJECTIVES: To describe the number and case characteristics of sport and recreation-related exertional heat deaths in Australia and summarise recommendations derived from case narratives. DESIGN: Descriptive, population-based, retrospective cohort study. METHODS: Cases were identified using the National Coronial Information System (NCIS) through multiple search strategies comprising queries, keywords and cause of death codes. Cases were included where there was evidence that the deceased was actively engaged in sport or recreation and exertional heat illness was causal or contributory to the death. Data extraction were performed independently, in duplicate, to ensure accuracy. Descriptive statistics are used to report deceased's socio-demographic characteristics, incident characteristics, type of sport/recreational activity and time sequence of events. Content analysis is used to summarise recommendations. RESULTS: Thirty-eight deaths (males n = 29, 74%; median age = 40 years, range 8-77) were identified during the study period (2001 to 2018), with 22 recommendations for five cases. Two cases occurred during organised sport and 36 during active recreation, of which 27 were in hiking. Eleven (29%) individuals were international visitors. There were 22 recommendations across 5 cases presented, with a focus on education and training. CONCLUSIONS: Exertional heat deaths in outdoor recreation in Australia were far more prevalent than cases in organised sport. The largest proportion of deaths occurred in hiking with two populations featuring: males aged 15-45 years and international visitors. Considering the incident characteristics and time sequence of events, measures such as early recognition of symptoms, provision of first aid and timely access to emergency medical care are important to prevent fatalities.

Sports related heat injury in Victoria, Australia: An analysis of 11 years of hospital admission and emergency department data.

OBJECTIVES: Heat injuries have become a considerable health risk for sport and exercise participants in Australia. This study seeks to update the Australian sports case numbers by considering data from hospital admission and emergency department (ED) presentations (collectively referred to as total hospitalisations). Specifically, this study aimed to report epidemiological features (incidence and case characteristics) for sport related heat injury (SRHI) cases treated in hospital, over an 11-year period in Victoria, Australia. DESIGN: Analysis of administrative health data. METHODS: Data were extracted from the Victorian Injury Surveillance Unit for hospital admissions and ED presentations separately using diagnosis and activity codes (focused on subgroups of T67 - effects of heat and light and U5000-U7100). Descriptive data were reported by age, sex, financial year and activity, and population trends reported for SRHI incidence rate. RESULTS: A total of 323 SRHI cases (ED=142, 44%; admissions=181, 56%) were identified, representing 10.2% of all heat injury cases (non-sport cases=2834). The highest number of SRHI cases were in golf (n=43, 13.3%) and lawn bowls (n=38, 11.8%). The age groups >65 and 15-34years reported a total of 114 cases (35.3%) and 106 cases (32.8%), respectively. CONCLUSIONS: Findings were consistent with previous Australian studies with SRHI comprising 10% of all heat injury cases. Strategies for SRHI awareness can be aimed at the age and sport groups with greater representation in the cases identified. We had expected several-times more ED presentations than admissions, suggesting fewer of the mild-moderate cases of SRHI attend for emergency care and that alternative data are needed to capture these.

Document analysis of exertional heat illness policies and guidelines published by sports organisations in Victoria, Australia.

OBJECTIVES: To conduct a document and content analysis of exertional heat illness (EHI)-related documents published by sports organisations in Victoria, Australia, in order to determine their scope and evidence base against current international best practice recommendations. METHODS: A qualitative document and content analysis. Official documents relating to EHI were identified through a search of 22 Victorian sport organisation websites, supplemented by a general internet search. The content of these documents was evaluated against recommendations presented in three current international position statements on prevention and management of EHI. RESULTS: A range of document types addressing EHI were identified (n=25), including specific heat policies, match day guides, rules and regulations. Recommendations about prevention measures were the most common information presented, but these were largely focused on event modification/cancellation guidelines only (n=22; 88%). Most documents provided information on hydration as a preventive measure (n=20; 80%), but the emphasis on the importance of cooling strategies (n=7; 28%) and heat acclimatisation (n=5; 20%) was inadequate. Details on EHI, including its definition, symptoms/signs to look out for, and common risk factors (beyond humidity/high temperatures) were lacking in most documents. CONCLUSION: There is considerable variation in formal documents with regard to their content and quality of information. Continued efforts to bridge the evidence to practice gap in sports safety are therefore important. This study highlights the challenge for community sport, which relies on high-level policy and governance, across settings and populations that can differ substantially in their needs.

Epidemiology of exertional heat illnesses in organised sports: A systematic review.

OBJECTIVE: This systematic review summarises reports of the incidence of exertional heat illnesses (EHI) in organised sports, to examine any trends in the EHI incidence over time, and to describe EHI incidence based on sporting activity, geographic location, and type of EHI. METHOD: Three electronic databases (CINAHL, PubMed, SportDiscuss) were searched from inception to January 2019. Original data in all epidemiological studies (any design except case-studies and case-series) that reported EHI incidence data in organised sports, across all age categories, and published in an English language peer-reviewed journal were included. RESULTS: The primary search yielded 3556 results of which 62 studies were included in the final analysis, with 71% being from the USA. Reported EHI incidence rates ranged from 0.01 (cheerleading) to 4.19 (American football) per 1000 athletic-exposures (AEs), and 0.01 (mini-marathon) to 54.54 (desert ultra-marathon) per 100 participants. Endurance type events (running, cycling, adventure races) reported the highest EHI incidence rates per 100 participants. There was a considerable increase in EHI fatalities reported in the literature over the last three decades in American football and an increased reporting of EHI incidence in endurance type events during the last 5-years. CONCLUSION: Use of different terminology and injury definitions in most studies have resulted in an inconsistency in reporting EHI incidence data, and also likely underreporting of less-severe forms of EHI conditions. Longitudinal studies focused on different sports and conducted in more countries (outside the USA), are needed for better understanding the global impact of EHI and the impact of prevention measures.

Prevalence of Coexistent Plantaris Tendon Pathology in Patients with Mid-Portion Achilles Pathology: A Retrospective MRI Study.

Co-existence of Plantaris tendinopathy (PT) in patients with mid-Achilles tendinopathy (Mid-AT) is of clinical significance. This study aims to describe the MRI-based pathological characteristics of co-existing PT and Mid-AT. One-hundred MRI studies of patients diagnosed with Mid-AT were retrospectively analysed by an experienced musculoskeletal radiologist. Presence or absence of a Plantaris tendon, co-existing PT with Mid-AT, insertional characteristics of Plantaris tendon, and maximum anteroposterior thickness of the tendon in Mid-AT (axial images) were evaluated. When PT co-existed with Mid-AT, the location of the tendon pathologies in relation to calcaneal insertion was assessed (sagittal images) and their association was analysed using the coefficient of variation (CV) and Pearson's correlation coefficient. Plantaris was present in 84 cases (84%), and Mid-AT and PT co-existed in 10 cases (10%). A greater variability in the location of Plantaris pathology (CV = 42%) than Achilles tendinopathy (CV = 42%) was observed. The correlation coefficient also revealed a low and non-significant association between the location of two pathologies when they exist together (r = +0.06; p = 0.88). Clinical evaluation of Achilles tendon pain needs careful consideration into the possible co-existence of Plantaris pathology. The considerable difference observed in the location of PT and Mid-AT suggest possible isolated pathologies and differentials for Achilles tendon pain.

Risk perceptions for exertional heat illnesses in junior cricket in Sri Lanka.

OBJECTIVES: Exertional heat illnesses (EHI) can occur when sport is played in hot and humid environments, such as those common across Asia. Measures to reduce the risk of EHI are important; however, causal data on EHI occurrence are limited and challenging to capture. To gain an initial understanding of EHI risks, we aimed to assess the risk perceptions of EHI of youth cricketers. METHODS: A descriptive cross-sectional survey, comprised of 14 questions on EHI risks, was conducted with 365 Sri Lankan junior male cricketers (age=12.9±0.9 years) who typically play in hot and humid conditions. RESULTS: For climate related risks, relative humidity was perceived as having a low risk of EHI compared with ambient temperature. The EHI risk associated with wearing protective gear, as commonly used in cricket, was perceived as low. Most junior cricketers perceived a low level of risk associated with recommended preventive measures such as body cooling and heat-acclimatisation. CONCLUSION: This is the first study to explore EHI risk perceptions in any sporting context. Young players may not be mindful of all risks. Therefore, leadership and initiative from competition organisers and parents is required to promote countermeasures.

Match injuries in Sri Lankan junior cricket: A prospective, longitudinal study.

OBJECTIVES: Understanding the nature of injuries in cricket is key to mitigate injury risks and prioritise preventive measures. This study aimed to identify the incidence and nature of match injuries among Sri Lankan junior cricketers. DESIGN: Longitudinal follow-up study with prospective in-season data collection. METHODS: A national survey of schoolboy, division-1 cricket teams in under-15 and under-17 age groups. Using a paper-based questionnaire, distributed to school-teams at the start of the 2016 cricket season, respondents recorded any injuries, including the site, type and mechanism. Match injury incidence rates (match-IIR) (injuries/100 match-player-days) were calculated overall, by position and for match time loss (MTL) and non-MTL injuries. RESULTS: From 59 school-teams, 573 players responded, with 404 players reporting 744 injuries in 648 matches. The match-IIR was 28.0 injuries/100 match-player-days (95% CI=26.0-30.2). The highest match-IIR was reported among fielders (46.0% of all injuries sustained; match-IIR=12.9) compared with batters (25.4%; match-IIR=7.1) and bowlers (20.3%; match-IIR=5.7). Abrasions and bruises to the knee or elbow were the most common injuries among fielders, with the majority being non-MTL injuries. CONCLUSIONS: Almost half (46.0%) of all injuries were to fielders, and more research into their severity and mechanisms is needed to identify the need for, and design of, preventive measures. Batters sustained a relatively large number of facial-organ injuries from being struck by the ball, presenting a need to evaluate the use and appropriateness of helmets by Sri Lankan junior cricketers. Similar to other junior cricket studies, the most common injuries among bowlers were strains and sprains, mainly affecting the lower limbs and lower back.

Interstitial cell network volume is reduced in the terminal bowel of ageing mice.

Ageing is associated with impaired neuromuscular function of the terminal gastrointestinal (GI) tract, which can result in chronic constipation, faecal impaction and incontinence. Interstitial cells of cajal (ICC) play an important role in regulation of intestinal smooth muscle contraction. However, changes in ICC volume with age in the terminal GI tract (the anal canal including the anal sphincter region and rectum) have not been studied. Here, the distribution, morphology and network volume of ICC in the terminal GI tract of 3- to 4-month-old and 26- to 28-month-old C57BL/6 mice were investigated. ICC were identified by immunofluorescence labelling of wholemount preparations with an antibody against c-Kit. ICC network volume was measured by software-based 3D volume rendering of confocal Z stacks. A significant reduction in ICC network volume per unit volume of muscle was measured in aged animals. No age-associated change in ICC morphology was detected. The thickness of the circular muscle layer of the anal sphincter region and rectum increased with age, while that in the distal colon decreased. These results suggest that ageing is associated with a reduction in the network volume of ICC in the terminal GI tract, which may influence the normal function of these regions.

Adaptation, translation and reliability of the Australian 'Juniors Enjoying Cricket Safely' injury risk perception questionnaire for Sri Lanka.

OBJECTIVES: Cricket is a very popular sport in Sri Lanka. In this setting there has been limited research; specifically, there is little knowledge of cricket injuries. To support future research possibilities, the aim of this study was to cross-culturally adapt, translate and test the reliability of an Australian-developed questionnaire for the Sri Lankan context. METHODS: The Australian 'Juniors Enjoying Cricket Safely' (JECS-Aus) injury risk perception questionnaire was cross-culturally adapted to suit the Sri Lankan context and subsequently translated into the two main languages (Sinhala and Tamil) based on standard forward-back translation. The translated questionnaires were examined for content validity by two language schoolteachers. The questionnaires were completed twice, 2 weeks apart, by two groups of school cricketers (males) aged 11-15 years (Sinhala (n=24), Tamil (n=30)) to assess reliability. Test-retest scores were evaluated for agreement. Where responses were <100% agreement, Cohen's kappa (κ) statistics were calculated. Questions with moderate-to-poor test-retest reliability (κ<0.6) were reconsidered for modification. RESULTS: Both the Sinhala and Tamil questionnaires had 100% agreement for questions on demographic data, and 88%-100% agreement for questions on participation in cricket and injury history. Of the injury risk perception questions, 72% (Sinhala) and 90% (Tamil) questions showed a substantial (κ=0.61-0.8) and almost perfect (κ=0.81-1.0) test-retest agreement. CONCLUSION: The adapted and translated JECS-SL questionnaire demonstrated strong reliability. This is the first study to adapt the JECS-Aus questionnaire for use in a different population, providing an outcome measure for assessing injury risk perceptions in Sri Lankan junior cricketers.

Perceived Injury Risk among Junior Cricketers: A Cross Sectional Survey.

Understanding how junior athletes perceive injury risks when participating in sport and the environment they play in is an important component of injury prevention. This study investigates how Sri Lankan junior cricketers (n = 365, aged 11-14 years, boys) perceive injury risks associated with playing cricket. The study used a Sri Lankan modification of an Australian junior cricket injury risk perception survey that considered playing cricket versus other sports, different cricket playing positions and roles, and different ground conditions. The risk of playing cricket was considered to be greater than that for cycling, but lower than that for rugby and soccer. Fast-bowlers, batters facing fast-bowlers, fielding close in the field, and wicket-keeping without a helmet were perceived to pose greater risks of injury than other scenarios. Playing on hard, bumpy and/or wet ground conditions were perceived to have a high risk opposed to playing on a grass field. Fielding in the outfield and wicket-keeping to fast-bowlers whilst wearing a helmet were perceived as low risk actions. The risk perceptions of junior cricketers identified in this study, do not necessarily reflect the true injury risk in some instances. This information will inform the development of injury prevention education interventions to address these risk perceptions in junior cricketers.

Loss of UCHL1 promotes age-related degenerative changes in the enteric nervous system.

UCHL1 (ubiquitin carboxyterminal hydrolase 1) is a deubiquitinating enzyme that is particularly abundant in neurons. From studies of a spontaneous mutation arising in a mouse line it is clear that loss of function of UCHL1 generates profound degenerative changes in the central nervous system, and it is likely that a proteolytic deficit contributes to the pathology. Here these effects were found to be recapitulated in mice in which the Uchl1 gene had been inactivated by homologous recombination. In addition to the previously documented neuropathology associated with loss of UCHL1 function, axonal swellings were detected in the striatum. In agreement with previously reported findings the loss of UCHL1 function was accompanied by perturbations in ubiquitin pools, but glutathione levels were also significantly depleted in the brains of the knockout mice, suggesting that oxidative defense mechanisms may be doubly compromised. To determine if, in addition to its role in the central nervous system, UCHL1 function is also required for homeostasis of the enteric nervous system the gastrointestinal tract was analyzed in UCHL1 knockout mice. The mice displayed functional changes and morphological changes in gut neurons that preceded degenerative changes in the brain. The changes were qualitatively and quantitatively similar to those observed in wild type mice of much greater age, and strongly resemble changes reported for elderly humans. UCHL1 knockout mice should therefore serve as a useful model of gut aging.

Relationship between Body Mass Index (BMI) and body fat percentage, estimated by bioelectrical impedance, in a group of Sri Lankan adults: a cross sectional study.

BACKGROUND: Body Mass Index (BMI) is used as a useful population-level measure of overweight and obesity. It is used as the same for both sexes and for all ages of adults. The relationship between BMI and body fat percentage (BF %) has been studied in various ethnic groups to estimate the capacity of BMI to predict adiposity. We aimed to study the BMI-BF% relationship, in a group of South Asian adults who have a different body composition compared to presently studied ethnic groups. We examined the influence of age, gender in this relationship and assessed its' linearity or curvilinearity. METHODS: A cross sectional study was conducted, where adults of 18-83 years were grouped into young (18-39 years) middle aged (40-59 years) and elderly (>60 years). BF% was estimated from bioelectrical impedance analysis. Pearsons' correlation coefficient(r) was calculated to see the relationship between BMI-BF% in the different age groups. Multiple regression analysis was performed to determine the effect of age and gender in the relationship and polynomial regression was carried out to see its' linearity. The relationships between age-BMI, age-BF % were separately assessed. RESULTS: Out of 1114 participants, 49.1% were males. The study sample represented a wide range of BMI values (14.8-41.1 kg/m2,Mean 23.8 ± 4.2 kg/m2). A significant positive correlation was observed between BMI-BF%, in males (r =0.75, p < 0.01; SEE = 4.17) and in females (r = 0.82, p < 0.01; SEE = 3.54) of all ages. Effect of age and gender in the BMI-BF% relationship was significant (p < 0.001); with more effect from gender. Regression line found to be curvilinear in nature at higher BMI values where females (p < 0.000) having a better fit of the curve compared to males (p < 0.05). In both genders, with increase of age, BMI seemed to increase in curvilinear fashion, whereas BF% increased in a linear fashion. CONCLUSIONS: BMI strongly correlate with BF % estimated by bioelectrical impedance, in this sub population of South Asian adults. This relationship was curvilinear in nature and was significantly influenced by age and gender. Our findings support the importance of taking age and gender in to consideration when using BMI to predict body fat percentage/obesity, in a population.