Kinematic and spatiotemporal differences between footstrike patterns in elite male and female 10,000 m runners in competition.

The aim of this study was to examine spatiotemporal and joint kinematic differences between footstrike patterns in 10,000 m running. Seventy-two men's and 42 women's footstrike patterns were analysed during laps 5, 10, 15, 20 and 25 (of 25) using 2D video recordings. Approximately 47% of men were FFS throughout the race, 30% were MFS and 24% RFS; the respective frequencies in women were approximately 30%, 38% and 32%. Overall, 83% of men and 88% of women retained their footstrike pattern throughout the race. Amongst the 53 men and 33 women with symmetrical footstrike patterns, there were no differences in speed, step length or cadence between footstrike groups in either sex. Most lower limb joint angles did not change in these athletes during the event, with few differences between footstrike patterns apart from ankle and foot angles. A greater hip-ankle distance was found in RFS than in FFS (both sexes) and in RFS than in MFS (men only), although these differences were never more than 0.03 m. Coaches should note that habitual footstrike patterns were maintained during this long-distance track race despite changes in running speed and possible fatigue, and there were few performance differences between footstrike patterns.

Optimization of laboratory diagnosis of heparin-induced thrombocytopenia using HemosIL-AcuStar-HIT-IgG assay.

OBJECTIVE: The aim of this study was to determine an optimal cutoff value for the newly available HemosIL-AcuStar-HIT-IgG assay (AcuStar) for the diagnosis of heparin-induced thrombocytopenia (HIT). METHOD: We evaluated the performance of AcuStar using serotonin release assay (SRA) as the gold standard and incorporated 4T score calculation in a cohort of suspected HIT cases. Statistical analysis was performed to determine optimal cutoff value for the diagnosis of HIT. RESULT: A diagnosis of HIT can be excluded with a platelet factor 4 (PF4) value of <0.4 U/mL by AcuStar and 4T score in the low-risk category (≤3). All other cases will require confirmation with a functional test. CONCLUSION: Our study resulted in the implementation of a diagnostic algorithm for laboratory diagnosis of HIT, which incorporates pretest calculation of 4T score and AcuStar as a screening test, with reflex confirmation by SRA. This new algorithm resulted in extended hours of test availability and a more rapid turnaround time in reporting PF4 results.

Quantitation of hemoglobins using Sebia Capillarys-2 capillary electrophoresis (CE) for A1c: Comparison to results using CE for hemoglobins.

Background: Measurement of A1c using the Sebia Capillarys-2 capillary electrophoresis (A1c CE) involves relative quantitative measurements of peaks for hemoglobins A1c, A, A2. We examined correlation of A1c CE results with results of CE analysis for hemoglobins (Hb CE) for homozygous A and S-trait patients. We specifically examined whether abnormalities in A2 or the A/S ratio by A1c CE alone would reasonably be the basis for recommendation of red cell indices for evaluation of possible thalassemia. Methods: Selection of patients was from results for A1c CE, exhibiting either a normal pattern or a pattern consistent with S-trait. We then examined correlation of results of quantitation for A, S and A2 between A1c CE and Hb CE. Results: %A2 by A1c CE (y) had high correlation with %A2 by Hb CE (x): y = 0.88 x; r = 0.948. %A2 in S-trait patients was right-shifted in comparison to normals by 0.5%. For S-trait patients, the A/S ratio by A1c CE (y) had high correlation with the A/S ratio by Hb CE (x): y = 1.02 x; r = 0.995. Conclusions: Given high correlation of results between A1c CE and Hb CE, patent elevation of A2 by A1c CE for either normal or S-trait patients is a reasonable basis for recommendation of red cell indices for evaluation of possible beta thalassemia. For S-trait patients, patent abnormality in the A/S ratio by A1c CE is a reasonable basis for recommendation of red cell indices for evaluation of possible alpha or beta thalassemia.

Supporting a culture of patient safety: Resident-led patient safety event reviews in a pathology residency training program.

Patient safety is a critical component of quality patient care at any healthcare institution. In order to support a culture of patient safety, and in the context of a hospital-wide patient safety initiative at our institution, we have created and implemented a new patient safety curriculum within our training program. The curriculum is embedded in an introductory course for first-year residents, in which residents gain an understanding of the multifaceted role of the pathologist in patient care. The patient safety curriculum is a resident-centered event review process and includes 1) identification and reporting of a patient safety event, 2) event investigation and review, and 3) presentation of findings to the residency program including core faculty and safety champions for the consideration of implementation of the identified systems solution. Here we discuss the development of our patient safety curriculum, which was trialed over a series of seven event reviews conducted between January 2021 and June 2022. Resident involvement in patient safety event reporting and patient safety event review outcomes were measured. All event reviews conducted thus far have resulted in the implementation of the solutions discussed during event review presentations based on cause analysis and identification of strong action items. Ultimately this pilot will serve as the basis by which we implement a sustainable curriculum in our pathology residency training program centered on supporting a culture of patient safety, and in line with ACGME requirements.

Hemangioblastoma with late leptomeningeal metastasis: a case report.

BACKGROUND: Hemangioblastoma of the central nervous system is an uncommon benign neoplasm, with about 25% of cases in patients with von Hippel-Lindau disease. The incidence of metastasis is rare, particularly in patients without von Hippel-Lindau disease. We report a case of hemangioblastoma with leptomeningeal dissemination as a late recurrence. CASE PRESENTATION: A 65-year-old Caucasian man with a history of World Health Organization grade I hemangioblastoma of the cerebellar vermis underwent gross total resection in 1997. In early 2018, he developed intracranial recurrences with diffuse leptomeningeal disease of the entire spine. The patient underwent resection of intracranial recurrence, followed by palliative craniospinal irradiation. The disease progressed quickly, and he died 8 months after recurrence. CONCLUSIONS: Despite a benign pathology, hemangioblastoma has a low risk of metastasis. The outcome for hemangioblastoma patients with metastasis is poor. Multidisciplinary care for patients with metastatic hemangioblastoma warrants further investigation, and an effective systemic option is urgently needed. Regular lifelong follow-up of at-risk patients is recommended.

Feasibility of OpenPose markerless motion analysis in a real athletics competition.

This study tested the performance of OpenPose on footage collected by two cameras at 200 Hz from a real-life competitive setting by comparing it with manually analyzed data in SIMI motion. The same take-off recording from the men's Long Jump finals at the 2017 World Athletics Championships was used for both approaches (markerless and manual) to reconstruct the 3D coordinates from each of the camera's 2D coordinates. Joint angle and Centre of Mass (COM) variables during the final step and take-off phase of the jump were determined. Coefficients of Multiple Determinations (CMD) for joint angle waveforms showed large variation between athletes with the knee angle values typically being higher (take-off leg: 0.727 ± 0.242; swing leg: 0.729 ± 0.190) than those for hip (take-off leg: 0.388 ± 0.193; swing leg: 0.370 ± 0.227) and ankle angle (take-off leg: 0.247 ± 0.172; swing leg: 0.155 ± 0.228). COM data also showed considerable variation between athletes and parameters, with position (0.600 ± 0.322) and projection angle (0.658 ± 0.273) waveforms generally showing better agreement than COM velocity (0.217 ± 0.241). Agreement for discrete data was generally poor with high random error for joint kinematics and COM parameters at take-off and an average ICC across variables of 0.17. The poor agreement statistics and a range of unrealistic values returned by the pose estimation underline that OpenPose is not suitable for in-competition performance analysis in events such as the long jump, something that manual analysis still achieves with high levels of accuracy and reliability.

Grizzlies and gazelles: Duty factor is an effective measure for categorizing running style in English Premier League soccer players.

English Premier League soccer players run at multiple speeds throughout a game. The aim of this study was to assess how well the duty factor, a dimensionless ratio based on temporal variables, described running styles in professional soccer players. A total of 25 players ran on an instrumented treadmill at 12, 16, and 20 km/h. Spatiotemporal and ground reaction force data were recorded for 30 s at each speed; video data (500 Hz) were collected to determine footstrike patterns. In addition to correlation analysis amongst the 25 players, two groups (both N = 9) of high and low duty factors were compared. The duty factor was negatively correlated with peak vertical force, center of mass (CM) vertical displacement, and leg stiffness (k leg) at all speeds (r ≥ -0.51, p ≤ 0.009). The low duty factor group had shorter contact times, longer flight times, higher peak vertical forces, greater CM vertical displacement, and higher k leg (p < 0.01). Among the high DF group players, eight were rearfoot strikers at all speeds, compared with three in the low group. The duty factor is an effective measure for categorizing soccer players as being on a continuum from terrestrial (high duty factor) to aerial (low duty factor) running styles, which we metaphorically refer to as "grizzlies" and "gazelles," respectively. Because the duty factor distinguishes running style, there are implications for the training regimens of grizzlies and gazelles in soccer, and exercises to improve performance should be developed based on the biomechanical advantages of each spontaneous running style.

The Association Between Hip-Shoulder Separation Angles and Technique Characteristics in World-Class High Jumpers.

Hip-shoulder separation (H-Ssep) has been widely researched in many sporting activities (e.g., golf) to provide information on the contribution of torso rotation to performance and injury. Although it is necessary for high jumpers to generate significant long-axis rotation to successfully clear the bar, limited information exists on H-Ssep for high jump athletes. As such, this study aimed to (a) characterize the H-Ssep of world-class high jump athletes during competition, (b) determine if differences exist between male and female athletes and (c) to examine the relationship between H-Ssep and the biomechanical parameters used to describe high jump technique. Twenty-nine world-class high jumpers (17 males, 12 females) were video recorded (frame rate: 120-200 Hz) during the 2017 and 2018 World Athletics Championship finals. H-Ssep was quantified at touchdown (TD) and take-off (TO) following manual digitizing (SIMI motion) and a number of other common biomechanical parameters were computed. The observed levels of H-Ssep at TD (-46±12°) and TO (16 ±11°) were in line with those reported previously for other sports. The magnitude of H-Ssep varied between individuals and showed significant associations with other approach and take-off characteristics. Significant differences in H-Ssep were not evident between male and female athletes despite significant differences in other performance- and technique-related parameters. These findings highlight the divergent take-off characteristics of world-class performers and their reliance on hip-shoulder interactions when generating long axis rotation. Coaches should be mindful of the mechanical and physical consequences of H-Ssep when developing technical models, conditioning interventions and coaching strategies.

Asymmetry in sprinting: An insight into sub-10 and sub-11 s men and women sprinters.

We assessed sprint mechanical asymmetry in world-class competitors and evaluated whether inter-limb sex-based differences in sprinting mechanics exist. The eight finalists in the men's and women's 100 m events at the 2017 IAAF World Championships were studied. Five high-speed cameras (150 Hz) were used to capture two consecutive steps of the whole body between 47.0 m and 55.5 m from the start, while four additional cameras (250 Hz) focussed on the lower extremities. A total of 33 spatio-temporal, touchdown and toe-off joint angles, and horizontal and vertical foot velocity parameters were extracted through three-dimensional analysis. Group mean asymmetry scores were assessed using the symmetry angle (SA) where scores of 0% and 100% represent perfect symmetry and perfect asymmetry, respectively. Although considered generally low (SA <3% for 22 out of 33 parameters), the magnitude of mechanical asymmetry varied widely between sprinters of the same sex. However, there was no mean SA scores difference between men and women for any stride mechanical parameters (all p ≥ 0.064). Asymmetry scores were inconsistent between parameters and phases (touchdown vs toe-off instants), and sprinting mechanics were generally not related to asymmetry magnitudes. In summary, low to moderate asymmetry is a natural phenomenon in elite sprinting. Asymmetry was inconsistent between parameters and competitors during near maximum velocity running, yet mean values for a given parameter generally did not differ between sexes. Sprinters' performances were not related to their SA scores.

Sequencing of an Undifferentiated Carcinoma with Osteoclast-Like Giant Cells of the Pancreas: A Case Report.

Background: Undifferentiated carcinoma with osteoclast-like giant cells/osteoclast-like giant cell reaction (UC-OGC) is a rare form of pancreatic cancer historically associated with a poor prognosis. Molecular tumor profiling provides new information about tumor origins and a more nuanced understanding of the potential efficacy of different chemotherapeutic agents. Presentation: A 69-year-old man presented with a 13-cm periampullary pancreatic mass. Biopsy of a neighboring lymph node was consistent with adenocarcinoma. After neoadjuvant chemoradiation, the patient underwent resection and the tumor was consistent with UC-OGC. Next-generation sequencing was performed with genomic and proteomic analyses analyzed by a molecular tumor board review. These analyses revealed genetic alterations similar to those seen in pancreatic ductal adenocarcinoma, as well as potential therapeutic targets for the patient's subsequent therapy. Conclusions: Understanding a tumor's genetic changes allows for better understanding of its biology and may improve treatment efficacy. We believe that future study in tumor profiling will improve our understanding of rare cancers such as UC-OGC and also pave the way for the use of novel therapies to specifically target mutations in a broad range of more common tumors.

Isolated Ovarian Metastasis from Pancreatic Cancer Mimicking Primary Ovarian Neoplasia: Role of Molecular Analysis in Determining Diagnosis.

Background and Presentation: In this study, we present the case of a 64-year-old female with a chief complaint of abdominal pain and bloating, which had been persistent over a period of 4 months. Imaging revealed a 6.1-cm left-sided pancreatic mass as well as a 19.1-cm multiloculated cystic lesion in the pelvis, later revealed to be replacing the left ovary. The pancreatic mass was biopsied through endoscopic ultrasound-guided fine needle aspiration, and diagnosed as adenocarcinoma by cytology. The patient was treated with neoadjuvant chemotherapy and radiation before laparotomy for resection of the pancreas and left adnexal mass. Her response to treatment was followed radiologically and biochemically with cancer antigen (CA) 19-9 (114-35 U/mL), carcinoembryonic antigen (12-4.8 ng/mL), and CA-125 (119-15.3 U/mL) levels. She subsequently underwent an Appleby procedure, and resection of left pelvic mass and bilateral oophorectomy. Permanent sections revealed residual pancreatic ductal carcinoma with treatment effect, and a multicystic epithelial neoplasia of the left ovary for which the differential was primary ovarian carcinoma versus metastatic disease. Conclusions: Molecular mutational analysis was performed on sections of both the ovarian tumor and the pancreatic tumor to aid in diagnosis. The ovarian tumor in this case showed exactly the same mutations, KRAS G12R and TP53 G245S, as in the treated pancreatic cancer. This raised the high probability that these tumors originated from the same clonal event. The findings suggested that the ovarian tumor was an isolated metastasis of the pancreatic primary, despite the morphologic ambiguity between the two sites of neoplasia.

A rare fatal case of adenovirus serotype 4 associated acute disseminated encephalomyelitis in an adult: A case report.

Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease directed against the myelin sheath of the central nervous system that typically presents 1-4 weeks after an infection or vaccination, most commonly in children. We describe a case of a young female who presented with rapidly progressive mental deterioration and died secondary to ADEM following an adenovirus upper respiratory tract infection.

The Role of Upper Body Biomechanics in Elite Racewalkers.

The aim of this study was to analyze the link between the upper and lower body during racewalking. Fifteen male and 16 female racewalkers were recorded in a laboratory as they racewalked at speeds equivalent to their 20-km personal records [men: 1:23:12 (±2:45); women: 1:34:18 (±5:15)]; a single representative trial was chosen from each athlete for analysis and averaged data analyzed. Spatial variables (e.g., stride length) were normalized to stature and referred to as ratios. None of the peak upper body joint angles were associated with speed (p < 0.05) and there were no correlations between pelvic motion and speed, but a medium relationship was observed between peak pelvic external rotation (right pelvis rotated backwards) and stride length ratio (r = 0.37). Greater peak shoulder extension was associated with lower stride frequencies (r = -0.47) and longer swing times (r = 0.41), whereas peak elbow flexion had medium associations with flight time (r = -0.44). Latissimus dorsi was the most active muscle at toe-off during peak shoulder flexion; by contrast, pectoralis major increased in activity just before initial contact, concurrent with peak shoulder extension. Consistent but relatively low rectus abdominis and external oblique activation was present throughout the stride, but increased in preparation for initial contact during late swing. The movements of the pelvic girdle were important for optimizing spatiotemporal variables, showing that this exaggerated movement allows for greater stride lengths. Racewalkers should note however that a larger range of shoulder swing movements was found to be associated with lower stride frequency, and smaller elbow angles with increased flight time, which could be indicative of faster walking but can also lead to visible loss of contact. Coaches should remember that racewalking is an endurance event and development of resistance to fatigue might be more important than strength development.

Kinematic factors associated with start performance in World-class male sprinters.

The aim was to investigate the kinematic factors associated with successful performance in the initial acceleration phase of a sprint in the best male athletes in the World at the 2018 World Indoor Athletics Championships. High speed video (150 Hz) was captured for eight sprinters in the men's 60 m final. Spatio-temporal and joint kinematic variables were calculated from the set position to the end of the first ground contact post-block exit (GC1). Normalised average horizontal external power (NAHEP) defined performance and was the dependent variable for a series of regression analyses. Clear relationships were found between GC1 NAHEP and 10-m time, 60-m time, change in velocity, acceleration and contact time in the first ground contact (r = -0.74, -0.64, 0.96, 0.91 and -0.56, respectively). Stepwise multiple linear regression of joint kinematic variables in the first ground contact revealed that trunk angle at take-off and thigh separation angle at take-off explained nearly 90% of variation in GC1 NAHEP (R2 = 0.89). The athletes' projection at take-off with a forward leaning trunk and large thigh separation is characteristic therefore of excellent initial acceleration performance and this will be a good visual guide for technical coaching instruction. This was the first study of its kind to adopt such a research design in a World-class sample in a representative environment. Future studies that combine detailed kinematic and kinetic data capture and analysis in such a setting will add further insight to the findings of this investigation.

Footstrike patterns and race performance in the 2017 IAAF World Championship men's 10,000 m final.

Midfoot- (MFS) and forefoot-striking (FFS) runners usually switch to rearfoot-striking (RFS) during marathons. However, world-class runners might resist modifications during shorter races. The purpose of this study was to analyse footstrike patterns, ground contact times and running speeds in a World Championship men's 10,000 m final. Footstrike patterns and contact times of the top 12 finishing men (24 ± 5 years) were recorded (150 Hz) during laps 1, 5, 11, 15, 20 and 25. Split times for each 100-m segment were obtained. No RFS patterns were observed; there was no difference between the number of FFS and MFS athletes at any distance (p ≥ 0.581) and no change in the proportions of FFS and MFS occurred (p = 0.383). No link between race performance and footstrike pattern appeared given the similar number who used FFS or MFS and their similar finishing times. Despite slower running speeds and longer contact times in the middle of the race (p ≤ 0.024), no effect on footstrike patterns occurred. The prevalence of anterior footstrike patterns in this world-class race reflects the capability of maintaining fast paces (>22 km/h). Changes in footstrike pattern might accompany the physiological and neuromuscular effects of fatigue over longer distances.

Increases in speed do not change gait symmetry or variability in world-class race walkers.

The aim of this study was to analyse changes in gait variability and symmetry with increasing speed in race walkers. Eighteen international athletes race walked on an instrumented treadmill at speeds of 11, 12, 13 and 14 km·h-1 in a randomised order for 3 min each. Spatiotemporal and ground reaction force data were recorded for 30 s at each speed. Gait variability was measured using median absolute deviation and inter-leg symmetry was measured using the symmetry angle. There was an overall effect of speed on all absolute values except push-off force, but symmetry and variability (except flight time) did not change with increased speed, step length and step frequency. Most athletes were asymmetrical for at least one variable, but none was asymmetrical for more than half of the variables measured. Therefore, being asymmetrical or having higher variability (<5%) in a few variables is normal. Taking all findings together, practitioners should exercise caution when deciding on the need for corrective interventions and should not be concerned that increasing gait speed could increase injury risk through changes to athletes' asymmetry. Race walking coaches should test at competition speeds to ensure that flight times, and any variability or asymmetry, are measured appropriately.