UBXN3B is crucial for B lymphopoiesis.

BACKGROUND: The ubiquitin regulatory X (UBX) domain-containing proteins (UBXNs) are putative adaptors for ubiquitin ligases and valosin-containing protein; however, their in vivo physiological functions remain poorly characterised. We recently showed that UBXN3B is essential for activating innate immunity to DNA viruses and controlling DNA/RNA virus infection. Herein, we investigate its role in adaptive immunity. METHODS: We evaluated the antibody responses to multiple viruses and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza in tamoxifen-inducible global and constitutive B cell-specific Ubxn3b knockout mice; quantified various immune populations, B lineage progenitors/precursors, B cell receptor (BCR) signalling and apoptosis by flow cytometry, immunoblotting and immunofluorescence microscopy. We also performed bone marrow transfer, single-cell and bulk RNA sequencing. FINDINGS: Both global and B cell-specific Ubxn3b knockout mice present a marked reduction in small precursor B-II (>60%), immature (>70%) and mature B (>95%) cell numbers. Transfer of wildtype bone marrow to irradiated global Ubxn3b knockouts restores normal B lymphopoiesis, while reverse transplantation does not. The mature B population shrinks rapidly with apoptosis and higher pro and activated caspase-3 protein levels were observed following induction of Ubxn3b knockout. Mechanistically, Ubxn3b deficiency leads to impaired pre-BCR signalling and cell cycle arrest. Ubxn3b knockout mice are highly vulnerable to respiratory viruses, with increased viral loads and prolonged immunopathology in the lung, and reduced production of virus-specific IgM/IgG. INTERPRETATION: UBXN3B is essential for B lymphopoiesis by maintaining constitutive pre-BCR signalling and cell survival in a cell-intrinsic manner. FUNDING: United States National Institutes of Health grants, R01AI132526 and R21AI155820.

"Blue Scrub Lid Retraction": Changes in Eyelid Position on the Day of Surgery.

PURPOSE: The aim of this study is to test the hypothesis that margin-reflex distance 1 (MRD1) on the day of surgery will be higher than the MRD1 measured at the in-clinic consult visit among patients undergoing blepharoptosis repair due to an increased sympathetic drive. METHODS: Patients evaluated for involutional blepharoptosis repair were prospectively enrolled over a 12-month period in this single-center, self-controlled study. Three investigators independently determined MRD1 using cropped photos taken of patients at the in-clinic consult visit and on the day of surgery. A difference in height was tested for by using the 2-tailed Wilcoxon signed rank test. RESULTS: Evaluated in this study were 76 eyelids from 38 patients. Over 3-quarters of study participants had a higher MRD1 in the right and OSs on the day of surgery than at their in-clinic consultation visit (p < 0.001). The mean increase in MRD1 for the right eyelid and left eyelid was 1.0 mm (range: 0-3.15 mm) and 1.1 mm (range: 0-2.7 mm), respectively. CONCLUSIONS: In patients with involutional blepharoptosis, we conclude that MRD1 is higher on the day of surgery as compared with the in-clinic consult visit. This may be secondary to the stress of surgery and an associated increase in sympathetic drive. In some cases, this change in eyelid position led to resolution of apparent involutional ptosis altogether. Caution should be used when considering deferral of ptosis repair on the basis of exam findings present on the day of surgery.

UBXN9 governs GLUT4-mediated spatial confinement of RIG-I-like receptors and signaling.

The cytoplasmic RIG-I-like receptors (RLRs) recognize viral RNA and initiate innate antiviral immunity. RLR signaling also triggers glycolytic reprogramming through glucose transporters (GLUTs), whose role in antiviral immunity is elusive. Here, we unveil that insulin-responsive GLUT4 inhibits RLR signaling independently of glucose uptake in adipose and muscle tissues. At steady state, GLUT4 is docked at the Golgi matrix by ubiquitin regulatory X domain 9 (UBXN9, TUG). Following RNA virus infection, GLUT4 is released and translocated to the cell surface where it spatially segregates a significant pool of cytosolic RLRs, preventing them from activating IFN-ß responses. UBXN9 deletion prompts constitutive GLUT4 trafficking, sequestration of RLRs, and attenuation of antiviral immunity, whereas GLUT4 deletion heightens RLR signaling. Notably, reduced GLUT4 expression is uniquely associated with human inflammatory myopathies characterized by hyperactive interferon responses. Overall, our results demonstrate a noncanonical UBXN9-GLUT4 axis that controls antiviral immunity via plasma membrane tethering of cytosolic RLRs.

The Relationship Between the Isometric Squat and Stretch Shortening Cycle Function and Sprint Acceleration Performance in Hurling Players.

ABSTRACT: Brady, CJ, Harrison, AJ, Flanagan, EP, Haff, GG, and Comyns, TM. The relationship between the isometric squat and stretch shortening cycle function and sprint acceleration performance in hurling players. J Strength Cond Res 38(6): e288-e298, 2024-The primary aim was to examine the relationship between sprint acceleration performance and the performance tests: isometric squat (ISqT), countermovement jump (CMJ), and reactive strength index (RSI). The secondary aim determined whether these tests could distinguish between sprint performance levels. Twenty-six male under-21 subjects completed the ISqT, with peak force (PF), relative PF, force at 100, 150, and 200 milliseconds (ms), and impulse (0-200 ms) measured. Jump height (JH) was calculated from the CMJ and RSI during the 10-5 repeated jump test. Subjects completed 3 × 30-m sprints with splits taken at 5, 10, 20, and 30 m. Pearson's product moment correlations were used to assess the relationships between measures, and independent samples t tests were used to determine whether differences existed in sprint ability of those in the top and bottom quartiles for force at 100 ms, CMJ, and RSI. Significant negative moderate correlations were reported between force at 100 ms and 0-5 m and 5-10 m, significant moderate and large negative correlations between CMJ and all splits and significant large correlations between RSI and splits over 5 m. Force at 100 ms distinguished between performance levels from 0 to 5 m, CMJ from 10 to 20 m, and RSI from 20 to 30 m; faster subjects produced significantly higher force, JHs, and RSI scores. Three principal components explaining 86.1% of the variation in the data set were identified: sprint times and stretch shortening cycle capabilities (33.3%), time-specific force (29.9%), and absolute and relative strength (22.8%).

Joint movement patterns differ among male recreational runners with different running style.

The purpose of this study was to analyse the differences in joint kinematic patterns among runners with different spatiotemporal characteristics in the running cycle. Lower extremity kinematic data and spatiotemporal stride parameters were collected for ninety-two recreational runners during a treadmill run at a self-selected comfortable speed. A K-means clustering analysis was conducted on normalised stride cadence and Duty Factor to identify running style. Cluster 1 characterised by reduced stance times and low Duty Factor; Cluster 2, long stance times and low stride cadence; Cluster 3, high Duty Factor and stride cadence. Functional principal component analysis was used to identify patterns of variability between runners. Runners who used a combination of high cadence and Duty Factor showed differences in hip, knee and ankle sagittal kinematics compared to other runners. On the contrary, the joint kinematics was not altered when the Duty Factor was increased along with a decrease in the stride cadence. This study has demonstrated that the combination of several spatial-temporal parameters of the running cycle should be considered when analysing the movement pattern of the lower limb.

UBR5 promotes antiviral immunity by disengaging the transcriptional brake on RIG-I like receptors.

The Retinoic acid-Inducible Gene I (RIG-I) like receptors (RLRs) are the major viral RNA sensors essential for the initiation of antiviral immune responses. RLRs are subjected to stringent transcriptional and posttranslational regulations, of which ubiquitination is one of the most important. However, the role of ubiquitination in RLR transcription is unknown. Here, we screen 375 definite ubiquitin ligase knockout cell lines and identify Ubiquitin Protein Ligase E3 Component N-Recognin 5 (UBR5) as a positive regulator of RLR transcription. UBR5 deficiency reduces antiviral immune responses to RNA viruses, while increases viral replication in primary cells and mice. Ubr5 knockout mice are more susceptible to lethal RNA virus infection than wild type littermates. Mechanistically, UBR5 mediates the Lysine 63-linked ubiquitination of Tripartite Motif Protein 28 (TRIM28), an epigenetic repressor of RLRs. This modification prevents intramolecular SUMOylation of TRIM28, thus disengages the TRIM28-imposed brake on RLR transcription. In sum, UBR5 enables rapid upregulation of RLR expression to boost antiviral immune responses by ubiquitinating and de-SUMOylating TRIM28.

Predictors of Ophthalmology Resident Performance From Medical Student Application Materials.

OBJECTIVE: To determine whether elements in ophthalmology residency applications are predictors of future resident performance. DESIGN: This multi-institutional, cross-sectional, observational study retrospectively reviewed the residency application materials of ophthalmology residents who graduated from residency from 2006 through 2018. Resident performance was scored by 2 faculty reviewers in 4 domains (clinical, surgical, academic, and global performance). Correlation between specific elements of the residency application and resident performance was assessed by Spearman correlation coefficients (univariate) and linear regression (multivariate) for continuous variables and logistic regression (multivariate) for categorical variables. SETTING: Seven ophthalmology residency programs in the US. PARTICIPANTS: Ophthalmology residents who graduated from their residency program. RESULTS: High-performing residents were a diverse group, in terms of sex, ethnicity, visa status, and educational background. Residents with United States Medical Licensing Examination Step 1 scores higher than the national average for that year had significantly higher scores in all 4 performance domains than those who scored at or below the mean (all domains P < 0.05). Residents who had honors in at least 4 core clerkships and who were members of Alpha Omega Alpha Medical Honor Society also had higher scores in all 4 performance domains (all domains P ≤ 0.04). Step 1 score (ρ=0.26, P < 0.001) and the difference between Step 1 score and the national average for that year (ρ=0.19, P = 0.009) positively correlated with total resident performance scores. Residents who passed the American Board of Ophthalmology Written Qualifying Examination or Oral Examination on their first attempt had significantly higher Step 1/2 scores (P ≤ 0.005), Ophthalmology Knowledge Assessment Program scores (P = 0.001), and resident performance scores (P ≤ 0.004). CONCLUSIONS: In this new landscape of increasing numbers of applicants to residency programs and changing of the Step 1 score to pass/fail, our findings may help guide selection committees as they holistically review applicants to select exceptional future residents in ophthalmology.

Neuromuscular Plantar Flexor Performance of Sprinters versus Physically Active Individuals.

INTRODUCTION: Comparison of the neuromuscular performance of different athlete types may give insight into the in vivo variability of these measures and their underpinning mechanisms. The study aims to compare the neuromuscular function of the plantar flexors of sprinters and physically active individuals to assess any differences in explosive force performance. METHODS: Neuromuscular performance of a group of sprinters (highly trained/national level, n = 12; elite/international level, n = 2) and physically active individuals ( n = 14) were assessed during involuntary, explosive, and maximum voluntary isometric plantar flexions, across different muscle-tendon unit (MTU) lengths (10° plantarflexion, 0° (anatomical zero/neutral), and 10° dorsiflexion). Plantarflexion rate of torque development (RTD) was measured in three 50-ms time windows from their onset. The synchronous activation of the plantar flexor agonist muscles was calculated as the time difference between 1) the first and last muscle onset and 2) the onsets of the two gastrocnemii muscles. Muscle size and MTU stiffness were assessed using sonograms of the medial gastrocnemius and myotendinous junction. RESULTS: Sprinters exhibited greater involuntary RTD across time points (0-50 ms, 50-100 ms) and MTU lengths. In addition, sprinters demonstrated greater early phase voluntary RTD (0-50 ms, 50-100 ms) across MTU lengths. Sprinters also demonstrated greater late-phase RTD (100-150 ms), and relative maximal voluntary torque at the DF angle only. The sprinters demonstrated a more synchronous activation of the gastrocnemii muscles. There were no observable differences in muscle size and MTU stiffness between groups. CONCLUSIONS: These findings suggest sprint-specific training could be a contributing factor toward improved explosive performance of the plantar flexors, particularly in the early phase of muscular contraction, evidenced by the greater explosive torque producing capabilities of sprinters.

Teprotumumab-Related Adverse Events in Thyroid Eye Disease: A Multicenter Study.

PURPOSE: To assess the duration, incidence, reversibility, and severity of adverse events (AEs) in patients with thyroid eye disease (TED) treated with teprotumumab. DESIGN: Multicenter, retrospective, observational cohort study. PARTICIPANTS: Patients with TED of all stages and activity levels treated with at least 4 infusions of teprotumumab. METHODS: Patients were treated with teprotumumab between February 2020 and October 2022 at 6 tertiary centers. Adverse event metrics were recorded at each visit. MAIN OUTCOME MEASURES: The primary outcomes measure was AE incidence and onset. Secondary outcome measures included AE severity, AE reversibility, AE duration, proptosis response, clinical activity score (CAS) reduction, and Gorman diplopia score improvement. RESULTS: The study evaluated 131 patients. Proptosis improved by 2 mm or more in 77% of patients (101/131), with average proptosis improvement of 3.0 ± 2.1 mm and average CAS reduction of 3.2 points. Gorman diplopia score improved by at least 1 point for 50% of patients (36/72) with baseline diplopia. Adverse events occurred in 81.7% of patients (107/131). Patients experienced a median of 4 AEs. Most AEs were mild (74.0% [97/131]), 28.2% (37/131) were moderate, and 8.4% (11/131) were severe. Mean interval AE onset was 7.9 weeks after the first infusion. Mean resolved AE duration was 17.6 weeks. Forty-six percent of patients (60/131) demonstrated at least 1 persistent AE at last follow-up. Mean follow-up was 70.2 ± 38.5 weeks after the first infusion. The most common type of AEs was musculoskeletal (58.0% [76/131]), followed by gastrointestinal (38.2% [50/131]), skin (38.2% [50/131]), ear and labyrinth (30.5% [40/131]), nervous system (20.6% [27/131]), metabolic (15.3% [20/131]), and reproductive system (12.2% [16/131]). Sixteen patients (12.2%) discontinued therapy because of AEs, including hearing loss (n = 4), inflammatory bowel disease flare (n = 2), hyperglycemia (n = 1), muscle spasms (n = 1), and multiple AEs (n = 8). CONCLUSIONS: Adverse events are commonly reported while receiving teprotumumab treatment. Most are mild and reversible; however, serious AEs can occur and may warrant treatment cessation. Treating physicians should inform patients about AE risk, properly screen patients before treatment, monitor patients closely throughout therapy, and understand how to manage AEs should they develop. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Ankle and Plantar Flexor Muscle-Tendon Unit Function in Sprinters: A Narrative Review.

Maximal sprinting in humans requires the contribution of various muscle-tendon units (MTUs) and joints to maximize performance. The plantar flexor MTU and ankle joint are of particular importance due to their role in applying force to the ground. This narrative review examines the contribution of the ankle joint and plantar flexor MTUs across the phases of sprinting (start, acceleration, and maximum velocity), alongside the musculotendinous properties that contribute to improved plantar flexor MTU performance. For the sprint start, the rear leg ankle joint appears to be a particularly important contributor to sprint start performance, alongside the stretch-shortening cycle (SSC) action of the plantar flexor MTU. Comparing elite and sub-elite sprinters revealed that elite sprinters had a higher rate of force development (RFD) and normalized average horizontal block power, which was transferred via the ankle joint to the block. For the acceleration phase, the ankle joint and plantar flexor MTU appear to be the most critical of the major lower limb joints/MTUs. The contribution of the ankle joint to power generation and positive work is minimal during the first stance, but an increased contribution is observed during the second stance, mid-acceleration, and late-acceleration. In terms of muscular contributions, the gastrocnemius and soleus have distinct roles. The soleus acts mainly as a supporter, generating large portions of the upward impulse, whereas the gastrocnemius acts as both an accelerator and a supporter, contributing significantly to propulsive and upward impulses. During maximum velocity sprinting the ankle joint is a net dissipater of energy, potentially due to the greater vertical loading placed on the plantar flexors. However, the ankle joint is critical for energy transfer from proximal joints to ground force application to maintain velocity. In terms of the contribution of musculoskeletal factors to ankle joint and plantar flexor performance, an optimal plantar flexor MTU profile potentially exists, which is possibly a combination of several musculoskeletal factors, alongside factors such as footwear and technique.

Evaluation of tissue-engineered human acellular vessels as a Blalock-Taussig-Thomas shunt in a juvenile primate model.

Objectives: Palliative treatment of cyanotic congenital heart disease (CCHD) uses systemic-to-pulmonary conduits, often a modified Blalock-Taussig-Thomas shunt (mBTTs). Expanded polytetrafluoroethylene (ePTFE) mBTTs have associated risks for thrombosis and infection. The Human Acellular Vessel (HAV) (Humacyte, Inc) is a decellularized tissue-engineered blood vessel currently in clinical trials in adults for vascular trauma, peripheral artery disease, and end-stage renal disease requiring hemodialysis. In addition to restoring blood flow, the engineered HAV demonstrates the capacity for host cellular remodeling into native-like vasculature. Here we report preclinical evaluation of a small-diameter (3.5 mm) HAV as a mBTTs in a non-human primate model. Methods: We implanted 3.5 mm HAVs as right subclavian artery to pulmonary artery mBTTs in non-immunosuppressed juvenile rhesus macaques (n = 5). HAV patency, structure, and blood flow were assessed by postoperative imaging from 1 week to 6 months. Histology of HAVs and surrounding tissues was performed. Results: Surgical procedures were well tolerated, with satisfactory anastomoses, showing feasibility of using the 3.5 mm HAV as a mBTTs. All macaques had some immunological reactivity to the human extracellular matrix, as expected in this xenogeneic model. HAV mBTTs remained patent for up to 6 months in animals, exhibiting mild immunoreactivity. Two macaques displaying more severe immunoreactivity to the human HAV material developed midgraft dilatation without bleeding or rupture. HAV repopulation by host cells expressing smooth muscle and endothelial markers was observed in all animals. Conclusions: These findings may support use of 3.5 mm HAVs as mBTTs in CCHD and potentially other pediatric vascular indications.

Reliability of mechanical properties of the plantar flexor muscle tendon unit with consideration to joint angle and sex.

The reliability of mechanical measures can be impacted by the protocol used, including factors such as joint angle and the sex of participants. This study aimed to determine the inter-day reliability of plantar flexor mechanical measures across ankle joint angles and contraction types and consider potential sex-specific effects. 14 physically-active individuals participated in two identical measurement sessions involving involuntary and voluntary plantar flexor contractions, at three ankle angles (10° plantarflexion (PF), 0° (anatomical zero (AZ)), and 10° dorsiflexion (DF)), while torque and surface EMG were recorded. The reliability of mechanical parameters of maximal voluntary torque (MVT), rate of torque development (RTD), electromechanical delay, and tendon stiffness were assessed using absolute and relative reliability measures. MVT measures were reliable across ankle angles. RTD measures showed good group level reliability and moderate reliability for an individual during the early phase of contraction across ankle angles. Explosive voluntary torque measures tended to be less reliable from 50 ms onward, with varied reliability across angles for late-phase RTD. Tendon stiffness demonstrated the best reliability at the DF angle. Sex-based differences in the reliability of tendon measures found that females had significantly different initial tendon length between testing sessions. Despite this, tendon excursion, force, and stiffness measures demonstrated similar reliability compared to males. Ankle angle changes influence the reliability of plantar flexor mechanical measurements across contraction types, particularly for voluntary contractions. These results highlight the importance of establishing potential protocol effects on measurement reliability prior to quantifying plantar flexor mechanical measures.

Seascape genomics reveals limited dispersal and suggests spatially varying selection among European populations of sea lamprey (Petromyzon marinus).

Sea lamprey Petromyzon marinus is an anadromous and semelparous fish without homing behaviors. Despite being a freshwater, free-living organism for a large part of their life cycle, its adulthood is spent as a parasite of marine vertebrates. In their native European range, while it is well-established that sea lampreys comprise a single nearly-panmictic population, few studies have further explored the evolutionary history of natural populations. Here, we performed the first genome-wide characterization of sea lamprey's genetic diversity in their European natural range. The objectives were to investigate the connectivity among river basins and explore evolutionary processes mediating dispersal during the marine phase, with the sequencing of 186 individuals from 8 locations spanning the North Eastern Atlantic coast and the North Sea with double-digest RAD-sequencing, obtaining a total of 30,910 bi-allelic SNPs. Population genetic analyses reinforced the existence of a single metapopulation encompassing freshwater spawning sites within the North Eastern Atlantic and the North Sea, though the prevalence of private alleles at northern latitudes suggested some limits to the species' dispersal. Seascape genomics suggested a scenario where oxygen concentration and river runoffs impose spatially varying selection across their distribution range. Exploring associations with the abundance of potential hosts further suggested that hake and cod could also impose selective pressures, although the nature of such putative biotic interactions was unresolved. Overall, the identification of adaptive seascapes in a panmictic anadromous species could contribute to conservation practices by providing information for restoration activities to mitigate local extinctions on freshwater sites.

Possible role of frankincense in the treatment of benign essential blepharospasm.

Purpose: To report two cases of benign essential blepharospasm (BEB) symptom relief in the setting of regular topical frankincense usage. Observations: The primary outcome measures for this report are (1) frequency of botulinum toxin (BT) injection appointments before and after the onset of regular frankincense usage and (2) patient report of symptoms. After starting frankincense, patient 1 decreased the frequency of her BT injection appointments from 5 to 8 months to 11+ months, eventually stopping BT injections altogether. Patient 2 decreased her BT appointments from every 3-4 months to approximately every 8 months after starting frankincense. Both patients had previously tried multiple additional treatments for their BEB symptoms which did not yield improvement; both patients reported significant improvement in their symptoms secondary to topical frankincense oil. Conclusion and Importance: Frankincense is a natural product of Boswellia trees. It has been used primarily for its anti-inflammatory properties for many years in multiple countries. We report two cases of individuals with long-standing, debilitating benign essential blepharospasm achieving significant symptom relief after beginning regular usage of topical frankincense essential oil. This natural oil offers an organic and effective treatment option for this chronic, progressive condition.

CHORIORETINITIS SCLOPETARIA AND ORBITAL EMPHYSEMA CAUSED BY A HIGH-VELOCITY LIQUID MISSILE.

PURPOSE: To highlight a case of chorioretinitis sclopetaria, with concomitant macular hole formation and orbital emphysema, caused by a commercial-grade pressure washer. METHODS: This is a retrospective case report. RESULTS: A 19-year-old man presented to the emergency department with a left eye injury, incurred after being sprayed with a commercial-grade pressure washer. He endorsed ipsilateral blurred vision, pain, and linear floaters. Left eye visual acuity was 20/40. Dilated fundus examination showed inferior vitreous hemorrhage, retinal whitening, and preretinal, intraretinal, and subretinal hemorrhages, consistent with chorioretinitis sclopetaria. Optical coherence tomography revealed a full-thickness macular hole. Computed tomography scan of the orbits showed subcutaneous and postseptal orbital emphysema. Two months after injury, vitreous and retinal hemorrhages and macular hole resolved. Five months after injury, visual acuity improved to 20/20. CONCLUSION: Chorioretinitis sclopetaria is defined as a full-thickness chorioretinal disruption resulting from a high-velocity projectile passing adjacent to or into the orbit without penetrating the globe. Chorioretinal deformation and ocular comorbidities are influenced by the velocity of the missile and its spatial relationship to the orbit. Although this pattern of injury is typically associated with indirect trauma to the globe by a BB or a bullet, this is the first report of chorioretinitis sclopetaria precipitated by a high-velocity liquid missile.

Effects of task difficulty on centre of pressure excursion and its inter-trial variability in acrobatic gymnastics pyramid performance.

Despite the importance of balance in Acrobatic Gymnastic Pyramid performance, there is limited biomechanical analysis of balance during this activity. The aims of this study were to analyse the effect of pyramid difficulty on the centre of pressure (COP) excursion and its inter-trial variability, and determine which parameters had strongest relationship with performance. Forty-seven acrobatic gymnasts performed five trials of back and front pyramids and a third more difficult, handstand pyramid on a force platform. Pyramids were held for 7 seconds and surface area, range, mediolateral amplitude and anteroposterior amplitude of the CoP were examined to analyse balance. The pyramid scores were obtained from qualified judges to assess the performance. Results showed higher CoP excursions and inter-trial variability during the execution of the high difficulty pyramid. Higher judges' scores were associated with lower CoP excursions in all the pyramids regardless of the difficulty. Similarly, correlation between inter-trial variability and pyramid performance was observed, although these coefficients were lower than those reported for the relationship between CoP excursion and performance. These results suggested that CoP monitoring could help coaches and gymnasts to assess the pyramid instability more accurately.

Injury Trends for School Rugby Union in Ireland: The Need for Position-specific Injury-prevention Programs.

BACKGROUND: Concern has been raised over the injury risk to school Rugby union (Rugby) players and the potential long-term health consequences. Despite the increase in studies for this cohort, the influence of playing position on injury incidence and presentation is unclear. PURPOSE: To describe the incidence, nature and severity of match injuries for school Rugby in Ireland overall, and as a function of playing position. STUDY DESIGN: Prospective cohort study. METHODS: Data were collected from 15 male (aged 16-19 years) school Senior Cup teams across 2 seasons. In total, 339 players participated in season 1, whereas 326 players participated in season 2. Injury data were recorded onto a bespoke online platform. Match exposure was also recorded. RESULTS: The incidence rate of match injuries (24-hour time loss) was 53.6 per 1000 hours. Across both seasons, 6810 days were lost from play due to injury. Forwards (65.4 per 1000 hours) sustained significantly more (P < 0.05) injuries than backs (40.5 per 1000 hours). The head, shoulder, knee, and ankle were the most common injured body regions; however, forwards sustained significantly more (P < 0.05) head and shoulder injuries than backs. The tackle was responsible for the majority of injuries in both groups. The highest proportion of injuries occurred during the third quarter. CONCLUSION: Clear differences in injury presentation and incidence were evident when comparing forwards versus backs. The high rate of head and shoulder injuries in the forwards suggest the need for more targeted injury-prevention strategies and further research on education and laws around the tackle event. The spike of injuries in the third quarter suggests that fatigue or inadequate half-time warm-up may be a contributing factor warranting further exploration. CLINICAL RELEVANCE: This study demonstrates clear differences in injury presentation according to playing position in school Rugby and highlights the need for a more tailored approach to the design and implementation of injury-prevention strategies. LEVEL OF EVIDENCE: Level 3.