Contact Area and Deformation of Escherichia coli Cells Adhered on a Cationic Surface.

When bacteria adhere to surfaces, the chemical and mechanical character of the cell-substrate interface guides cell function and the development of microcolonies and biofilms. Alternately on bactericidal surfaces, intimate contact is critical to biofilm prevention. The direct study of the buried cell-substrate interfaces at the heart of these behaviors is hindered by the small bacterial cell size and inaccessibility of the contact region. Here, we present a total internal reflectance fluorescence depletion approach to measure the size of the cell-substrate contact region and quantify the gap separation and curvature near the contact zone, providing an assessment of the shapes of the near-surface undersides of adhered bacterial cells. Resolution of the gap height is about 10%, down to a few nanometers at contact. Using 1 and 2 µm silica spheres as calibration standards we report that, for flagella-free Escherichia coli (E. coli) adhering on a cationic poly-l-lysine layer, the cell-surface contact and apparent cell deformation vary with adsorbed cell configuration. Most cells adhere by their ends, achieving small contact areas of 0.15 µm2, corresponding to about 1-2% of the cell's surface. The altered Gaussian curvatures of end-adhered cells suggest the flattening of the envelope within the small contact region. When cells adhere by their sides, the contact area is larger, in the range 0.3-1.1 µm2 and comprising up to ∼12% of the cell's total surface. A region of sharper curvature, greater than that of the cells' original spherocylindrical shape, borders the flat contact region in cases of side-on or end-on cell adhesion, suggesting envelope stress. From the measured curvatures, precise stress distributions over the cell surface could be calculated in future studies that incorporate knowledge of envelope moduli. Overall the small contact areas of end-adhered cells may be a limiting factor for antimicrobial surfaces that kill on contact rather than releasing bactericide.

Internal Load of Female Varsity Ice Hockey Players During Training and Games During a Season.

This study quantified internal load, using sessional rating of perceived exertion (sRPE) and heart-rate derived training impulse (TRIMP), of female varsity ice hockey players throughout a season. Twenty-four female (19.8±1.4 yr, 68.0±6.9 kg) varsity ice hockey players participated in this prospective cohort study. Internal load was captured using sRPE and TRIMP for each on-ice session. Internal load was significantly higher (p<0.05) for games (sRPE: 324±202 AU, TRIMP: 95±60 AU) compared to training (sRPE: 248±120 AU, TRIMP: 68±32 AU). Overall, goalies had a higher internal load than forwards (sRPE and TRIMP) and defence (TRIMP), with no differences between forwards and defence. Micro-cycle periodization was present, with training sessions several days prior to game days having the highest internal load (sRPE and TRIMP) and tapering down as subsequent training sessions approached game day. For the meso-cycle assessment, for both training and competition combined, the post-season sRPE was greater than the pre-season (p=0.002) and regular season (p<0.001). Lastly, the association between sRPE and TRIMP, revealed a large, statistically significant relationship (r=0.592, p<0.001). Internal load was greater during competitions, training sessions and subsequent internal loads suggested prioritization around game days, the post-season phase demanded the highest internal load and there was a strong correlation between sRPE and TRIMP.

Internal Physiological Load Measured Using Training Impulse in Varsity Men's and Women's Ice Hockey Players Between Game Periods.

ABSTRACT: Bigg, JL, Gamble, ASD, and Spriet, LL. Internal physiological load measured using training impulse in varsity men's and women's ice hockey players between game periods. J Strength Cond Res 35(10): 2824-2832, 2021-This study quantified internal load in male and female ice hockey players throughout a season, with comparisons between game periods and match outcome. Twenty-seven male and 24 female varsity ice hockey players participated in this longitudinal prospective cohort study monitoring internal load, using Banister's training impulse (TRIMP). Data were assessed according to game periods, match outcome (win or loss), and games played in noncongested (1 game/wk) or congested (2 + games/wk) weeks. Statistical significance was considered at p < 0.05. The TRIMP for period 1 for both male (25 ± 16 arbitrary units [AU]) and female (23 ± 19 AU) players was significantly lower than period 3 (males: 30 ± 21 AU; p = 0.001; females: 29 ± 21 AU; p = 0.003) but not period 2 (males: 27 ± 17 AU; p = 0.183; females: 27 ± 19 AU; p = 0.681). There were no differences in TRIMP within any period between games resulting in a win compared with a loss. Overall, there were no differences in TRIMP between male and female players. However, when stratified by position, male forwards experienced greater TRIMP than female forwards (p < 0.001 for all periods), whereas female defense had greater TRIMP than male defense (p ≤ 0.032 for all periods). There were no differences between noncongested and congested week games and no differences in TRIMP between nonback-to-back and back-to-back games, or the first and second games played of a back-to-back series. This study measured physiological demand throughout the periods of ice hockey games in men and women and concluded that internal load was highest in the third period. Understanding the demands throughout a game can provide information to coaches and players that would be useful in managing fatigue and optimizing physical performance.

Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes.

OBJECTIVE: To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting. DESIGN: Longitudinal prospective surveillance study. SETTING: Varsity-level sport program at the University of Guelph, Guelph, ON, Canada. PARTICIPANTS: Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season. INTERVENTIONS: Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported. MAIN OUTCOME MEASURES: The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs. RESULTS: Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports. CONCLUSIONS: The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.

Sweat Loss and Fluid Intake of Female Varsity Ice Hockey Players During On-Ice Practices and Games.

Bigg, JL, Gamble, ASD, Vermeulen, TF, Bigg, LM, and Spriet, LL. Sweat loss and fluid intake of female varsity ice hockey players during on-ice practices and games. J Strength Cond Res 34(2): 389-395, 2020-Sweat losses of ∼1.5-2% body mass (BM) during exercise impairs athletic performance in stop and go sports such as ice hockey. The study examined the pre-exercise hydration status, sweat loss, fluid and carbohydrate (CHO) intake, and sodium balance of female hockey players. Twenty-four female varsity hockey players were tested during 2 practices and 4 games. Data analyses were performed using a level of significance of p ≤ 0.05. Over 70% of players arrived at the practices and ∼50% of players arrived at the game mildly dehydrated. Before the high- (P1) and low-intensity (P2) practices, players consumed an average of 0.19 ± 0.14 and 0.15 ± 0.13 L. Before the games, mean fluid intake was 0.39 ± 0.19 L. The sweat rate during P1 was significantly greater than P2 (p = 0.006), but there was no significant difference in total fluid intake between practices (p = 0.279). Consequently, the average BM loss for P1 was significantly greater than that for P2 (p = 0.016). Sweat loss during games was 1.01 ± 0.29 L and fluid intake was 0.70 ± 0.43 L, resulting in minimal BM losses (<1% BM for all players). CHO intake during games was 39.2 ± 22.8 g, with 19/20 players consuming CHO before or during the intermissions of the game. Sweat sodium losses were 0.64 ± 0.34 and 0.32 ± 0.18 g·h for P1 and P2, and 0.83 ± 0.38 g during the game. In conclusion, female ice hockey players replaced the fluid they lost through sweat during practices and games and maintained adequate hydration. Players also consumed adequate CHO during games from the CHO containing food and drinks provided.

Sweat Loss and Hydration Habits of Female Olympic, Varsity and Recreational Ice Hockey Players.

This study measured sweat losses, voluntary fluid intake, sodium balance, and carbohydrate intake of female ice hockey players during on-ice practices at the Olympic, varsity, and recreational levels. Testing was conducted on 25 Canadian Olympic players, 21 varsity, and 21 recreational players. The average sweat rate for the Olympic players (0.99±0.08 L/h) was significantly greater than both the varsity (0.67±0.05 L/h, p=0.001) and the recreational players (0.42±0.03 L/h, p<0.001), and the varsity players also had a significantly greater sweat rate than the recreational athletes (p=0.016). Total fluid intake was significantly greater for both the Olympic (p=0.001) and varsity players (p=0.007) compared to the recreational group. Only 3 of 25 Olympic players lost>1.5% BM and 4 others lost>1% BM, with no players in both the varsity and recreational teams losing>1% BM. Half of the Olympic players consumed some carbohydrate during practice, but most of the varsity and recreational players did not. In conclusion, sweat rates in female ice hockey players during practices were proportional to competitive level. Fluid intake was similar between groups and resulted in only a few athletes at the Olympic level being at risk of excess body mass loss.

Estimated Sweat Loss, Fluid and Carbohydrate Intake, and Sodium Balance of Male Major Junior, AHL, and NHL Players During On-Ice Practices.

Several previous studies have reported performance decrements in team sport athletes who dehydrated approximately 1.5-2% of their body mass (BM) through sweating. This study measured on-ice sweat loss, fluid intake, sodium balance, and carbohydrate (CHO) intake of 77 major junior (JR; 19 ± 1 years), 60 American Hockey League (AHL; 24 ± 4 years), and 77 National Hockey League (NHL; 27 ± 5 years) players. Sweat loss was calculated from pre- to post-exercise BM plus fluid intake minus urine loss. AHL (2.03 ± 0.62 L/hr) and NHL (2.02 ± 0.74 L/hr) players had higher sweat rates (p < .05) than JR players (1.63 ± 0.58 L/hr). AHL (1.23 ± 0.69%; p = .006) and NHL (1.29% ± 0.63%; p < .001) players had ∼30% greater BM losses than JR players (0.89% ± 0.57%). There was no difference in fluid intake between groups (p > .05). Sodium deficits (sodium loss - intake) were greater (p < .05) in AHL (1.68 ± 0.74 g/hr) and NHL (1.56 ± 0.84 g/hr) players compared with JR players (1.01 ± 0.50 g/hr). CHO intake was similar between groups (14-20 g CHO/hr), with 29%, 32%, and 40% of JR, AHL, and NHL players consuming no CHO, respectively. In summary, sweat rates were high in all players, but the majority of players (74/77, 54/60, and 68/77 of JR, AHL, and NHL, respectively) avoided mild dehydration (>2% BM) during 60 min of practice. However, ∼15%, 41%, and 48% of the JR, AHL, and NHL players, respectively, may have reached mild dehydration and increased risk of performance decrements in a 90-min practice.

Repurposing Mebendazole as a Replacement for Vincristine for the Treatment of Brain Tumors.

The microtubule inhibitor vincristine is currently used to treat a variety of brain tumors, including low-grade glioma and anaplastic oligodendroglioma. Vincristine, however, does not penetrate well into brain tumor tissue, and moreover, it displays dose-limiting toxicities, including peripheral neuropathy. Mebendazole, a Food and Drug Administration-approved anthelmintic drug with a favorable safety profile, has recently been shown to display strong therapeutic efficacy in animal models of both glioma and medulloblastoma. Importantly, appropriate formulations of mebendazole yield therapeutically effective concentrations in the brain. Mebendazole has been shown to inhibit microtubule formation, but it is not known whether its potency against tumor cells is mediated by this inhibitory effect. To investigate this, we examined the effects of mebendazole on GL261 glioblastoma cell viability, microtubule polymerization and metaphase arrest, and found that the effective concentrations to inhibit these functions are very similar. In addition, using mebendazole as a seed for the National Cancer Institute (NCI) COMPARE program revealed that the top-scoring drugs were highly enriched in microtubule-targeting drugs. Taken together, these results indicate that the cell toxicity of mebendazole is indeed caused by inhibiting microtubule formation. We also compared the therapeutic efficacy of mebendazole and vincristine against GL261 orthotopic tumors. We found that mebendazole showed a significant increase in animal survival time, whereas vincristine, even at a dose close to its maximum tolerated dose, failed to show any efficacy. In conclusion, our results strongly support the clinical use of mebendazole as a replacement for vincristine for the treatment of brain tumors.

Impact of Blood Flow Restriction Exercise on Central Hemodynamics and Fluid Regulating Hormones.

PURPOSE: The purpose of this study is to characterize both the efficacy of altered restriction pressures and consequences of optimized blood flow restriction (BFR) for altering the cardiovascular and fluid regulating response in humans. METHODS: This work comprised a series of related trials. Phase 1: during semi-recumbent cycling (5 min, 60 W) with BFR at 0%, 50%, 75%, 100%, and 125% of participants' lowest arterial occlusion pressure (LOP) echocardiographic images were collected alongside continuous heart rate (HR) and blood pressure (BP). In phase 2, 24 h fluid balance (intake-output) and fluid-regulating hormone responses were measured after a practical BFR exercise session (treadmill walking: 5·3 min, 1 min rest, 5 km·h -1 , 5% incline, 100% LOP). Phase 3 examined the magnitude and effect of blood volume distribution following BFR treadmill walking using a modified CO-rebreathe technique. RESULTS: Cardiac ejection fraction remained stable irrespective of cuff pressure and despite a reduction in end-diastolic volume (Δ of 11 ± 9 mL, P = 0.02). HR and BP were highest at 100% LOP (ΔHR = 18 ± 19 bpm, ΔSBP = 51 ± 30 mm Hg, ΔDBP = 33 ± 15 mm Hg, ΔRate Pressure Product = 76 ± 32 bpm·mm Hg·100 -1 ). BFR treadmill walking stimulated a greater release of fluid-regulating hormones than normal walking (Δrenin = BFR: 25.3 ± 24.2 vs CON: 9.1 ± 11.8 ng·L -1 ; Δcopeptin = BFR: 50.1 ± 97.9 vs. CON: 0.43 ± 0.8 pmol·L -1 ), but no difference in fluid retention was observed ( P = 0.2). Approximately 27% of total blood volume was confined to the legs during BFR, but the relative volume trapped in the legs was not related to fluid-regulating hormone release (renin r = -0.04, P = 0.9; copeptin r = 0.27, P = 0.3). CONCLUSIONS: BFR exercise elicits the largest cardiovascular effect using 100% LOP, with evidence of appreciable fluid regulating hormonal response during a typical BFR exercise session. The relative volume of blood sequestered in the limb does not appear to drive this response.

Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters.

Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter.

Investigating the Relevance of Maximal Speed and Acceleration in Varsity-Level Female Ice Hockey Players.

PURPOSE: To characterize and compare female ice hockey players' peak skating speed and acceleration ability during linear sprints and gameplay. We also sought to quantify the time spent at various speeds and the frequency of accelerations at different thresholds during games. METHODS: Seventeen varsity-level female ice hockey players (20 [1.4] y, 68.9 [4.9] kg, 167.6 [4.7] cm) participated in an on-ice practice session (performing 3 × 40-m linear sprints) and 4 regular-season games while being monitored using a local positioning system. Speed and acceleration were recorded from the sprint and within-game monitoring. Time on ice spent in relative skating speed zones and the frequency of accelerations at different intensities were recorded. RESULTS: Players' greatest peak speeds (29.5 [1.3] vs 28.3 [1.1] km/h) and accelerations (4.39 [0.48] vs 3.34 [0.36] m/s2) reached during gameplay were higher than those reached in linear sprinting (both P < .01). Peak in-game values were moderately predicted by linear sprint values for speed (r = .69, P < .01) but not for acceleration (r < .01, P = .95). Players spent little time at near-peak linear sprint speeds (≥80% [22.7 km/h], ∼3% time on ice; ≥90% [25.5 km/h], <1% of time on ice) during gameplay. However, 26% to 35% of accelerations recorded during the 4 games were ≥90% of linear sprint acceleration. CONCLUSIONS: Although skating speed may be advantageous in specific game situations, our results suggest that players spend little time at near-maximal speeds while accelerating frequently during games. This warrants further investigation of direction changes, skating transitions, repeated sprints, and other determinant variables potentially related to on-ice success and the implementation of training strategies to improve repeated acceleration or qualities beyond maximal skating speed.

Reliability and validity of an indoor local positioning system for measuring external load in ice hockey players.

This study determined the reliability and validity of a Kinexon local positioning system (LPS) for measuring external load in ice hockey players during an on-ice session. Fourteen ice hockey players (25.1 y, 78.6 kg, 176.9 cm) wore two LPS sensors to examine the inter-sensor reliability of the LPS during an on-ice session, and LPS speed and acceleration were measured during 40 m linear on-ice sprints and compared to a previously validated robotic sprint device to examine LPS accuracy. The coefficient of variation (CV), standard error of measurement (SEM), and intra-class correlation coefficient (ICC) were calculated for each LPS measure. Pearson's correlations, simple linear regressions, and Bland-Altman plots were used to test the agreement and relationship between the two systems. Statistical significance was determined at p < 0.05. The majority of LPS measures were reliable (CV < 10% and ICC > 0.9) when comparing the two sensors worn by each player. Peak speed, speed at 5 m, and 0-5 m acceleration were all comparable to those reported by the robotic sprint device, with nearly perfect (peak speed and 0-5 m acceleration) and very large (speed at 5 m) magnitudes of correlation and mean biases <0.5 km/hr for speed measures and <0.01 m/s2 for acceleration. The present results demonstrate that the Kinexon LPS is reliable and accurate for investigating on-ice external load in ice hockey players when sensors are consistently secured on the back of the players' shoulder pads.

Internal Load of Male Varsity Ice Hockey Players During Training and Games Throughout an Entire Season.

PURPOSE: The purpose of this study was to quantify the internal load of male varsity ice hockey players, using both sessional rating of perceived exertion (sRPE) and the heart rate-derived physiological measure of training impulse (TRIMP), during training sessions and competitions throughout an entire season. METHODS: Twenty-seven male varsity ice hockey players (22.1 [1.1] y, 85.9 [5.4] kg, 181.3 [5.1] cm) were included in this longitudinal prospective cohort study. RESULTS: The internal load was significantly higher (P < .001) for games (sRPE: 403 [184] arbitrary units [AU], TRIMP: 98 [59] AU) compared with training sessions (sRPE: 281 [130] AU, TRIMP: 71 [35] AU). The regular season had the highest internal load compared with the preseason and postseason. There was evidence of microcycle periodization with training sessions several days prior to game days having the highest internal load (both sRPE and TRIMP) and tapering down as the subsequent training sessions approached game day. For positional comparisons, the goalies had higher sRPE (346 [151] AU, P < .001) and TRIMP (99 [64] AU, P < .001) compared with defense (sRPE: 295 [130] AU, TRIMP: 65 [29] AU) and forwards (sRPE: 264 [123] AU, TRIMP: 70 [30] AU) for training sessions, but no significant differences were present for competitions. Finally, there was an overall moderate and statistically significant relationship between the sRPE and TRIMP internal load measures (r = .434, P < .001). CONCLUSIONS: Internal load was greater during competitions versus training sessions in male varsity ice hockey players, and the microcycle assessment demonstrated that training sessions were tailored to game day. Mesocycle assessment revealed the highest internal loads during the regular season due to dense game scheduling and a short season.

Local Positioning System-Derived External Load of Female and Male Varsity Ice Hockey Players During Regular Season Games.

Purpose: The purposes of this study were to quantify the external load for female and male varsity ice hockey players during regular season games using a local positioning system (LPS), compare LPS-derived external load between sexes and positions, and compare skating distances in absolute and relative speed zones. Methods: Data were collected for 21 female (7 defense, 14 forwards; 20.0 ± 1.4 yrs., 69.1 ± 6.7 kg, 167.1 ± 5.4 cm) and 25 male (8 defense, 17 forwards; 21.9 ± 1.1 yrs., 85.9 ± 5.4 kg, 181.1 ± 5.2 cm) varsity ice hockey players. Measures included skating distance (total, and in absolute and relative speed zones), peak skating speed, peak acceleration and deceleration, accumulative acceleration load, and number of accelerations, decelerations, turns, skating transitions, direction changes, and impacts. Results: Female and male players had a high external load during games, with average peak skating speeds >28 km/h and average skating distances >4.4 km. Most LPS-derived measures showed greater external load in males than females (p < 0.05). Forwards skated further at higher speeds compared to defense in both sexes (p < 0.001). Skating distances were significantly different when comparing absolute and relative speed zones (p < 0.001), with absolute speed zones potentially overestimating skating at very slow, very fast, and sprint speeds and underestimating skating at slow and moderate speeds. Conclusion: This was the first study to measure external load in female ice hockey players with a LPS. Both female and male varsity players had high external loads during games, with forwards having greater external load at higher intensities and defense having greater external load at lower intensities. Sex and positional differences outline the importance of individualized athlete monitoring.

Dietary Intake of Young Male Ice Hockey Players 10-13 Years of Age during a Week-Long Hockey Camp.

This study recorded the dietary intakes of young male ice hockey players (10-13 year (yr)) for 3 consecutive days while participating in a 5-day summer hockey camp. Players were categorized as older children (OC, n = 10; 10.7 ± 0.2 yr; 37.1 ± 1.5 kg; 147.9 ± 2.1 cm) and young adolescents (YA, n = 10; 12.9 ± 0.1 yr; 45.2 ± 1.5 kg; 157.0 ± 2.4 cm). Players consumed their usual daily intakes. Parents recorded food intake in the mornings and evenings, while the researchers recorded food intake at camp. Energy intake was higher in both groups when compared to data for age-matched young Canadian (CDN) males (OC, 2967 ± 211 vs. 2000 kcal/day; YA, 2773 ± 91 vs. 2250 kcal/day). Carbohydrate (CHO) (OC, 11.2 ± 0.8 vs. YO, 8.9 ± 0.5 g/kg body mass/day) and protein (OC, 3.2 ± 0.3; YO, 2.4 ± 0.1 g/kg/day) intakes were higher than reported for young CDN males (CHO, 3.6 and protein, 1.0 g/kg/day) and were within the Acceptable Macronutrient Distribution Range (AMDR; CHO, 56 ± 2.3; 57.4 ± 0.8%; protein, 16.1 ± 1.0; 15.7 ± 0.7%). Fat intake was also within the AMDR in both groups (OC, 29.8 ± 1.6%; YA, 28.3 ± 1.0%). Micronutrient intake was adequate except for Vitamin D intakes that were below the recommended 15 ug/day at 6.3 ± 0.7 (OC) and 5.0 ± 1.5 ug/day (YA). In summary, energy and macronutrient intakes of the OC (10-11 yr) and YA (12-13 yr) players were high and well above the age matched CDN norms. The older children had higher energy intakes/kg body mass than the young adolescents. Higher energy intakes allowed for micronutrients intakes to be met in these young active males, except for vitamin D intake.

Carbohydrate Mouth-Rinsing Improves Overtime Physical Performance in Male Ice Hockey Players During On-Ice Scrimmages.

PURPOSE: This randomized, double-blind, crossover study examined the effects of mouth-rinsing (MR) with a carbohydrate (CHO) vs. a placebo (PLA) solution on external and internal loads in hydrated ice hockey players during regulation and overtime (OT) periods of an on-ice scrimmage. METHODS: Twelve skilled male hockey players (22.6 [3.4] years, 178.9 [4.7] cm, 84.0 [6.5] kg) played three 20-min regulation periods and one 12-min OT period of small-sided 3-on-3 scrimmage. Skaters repeated 2 min shift and rest intervals. Participants mouth rinsed with 25 mL of CHO or PLA solution approximately every 10 min for a total of 7 rinses. A local positioning system (LPS) tracked external load variables including speed, distance, acceleration, and deceleration. Internal load was monitored with heart rate (HR) sensors and a rating of perceived exertion (RPE). RESULTS: During regulation play, both the conditions developed similar fatigue, with significantly decreased high-intensity distance, average speed and decelerations, and increased RPE, from period 1 to 2 and 3. In OT, CHO MR increased the distance skated at high-intensity (224 [77], 185 [66] m, p = 0.042), peak speed (24.6 [1.6], 23.7 [1.3] km·h-1, p = 0.016), number of sprints (1.9 [1.2], 1.2 [0.9], p = 0.011), and decreased distance skated at slow speed (300 [33], 336 [47], p = 0.034) vs. PLA MR. OT RPE was similar between the two conditions in spite of more work done in CHO MR. CONCLUSIONS: CHO MR may be a valuable practice to protect against decrements in external load with increased playing time in ice hockey, and possibly allows athletes to perform more work relative to perceived levels of exertion.

Helmet Fit Assessment and Concussion Risk in Youth Ice Hockey Players: A Nested Case-Control Study.

CONTEXT: Injury surveillance has shown that concussions are the most common injury in youth ice hockey. Research examining the criteria for ensuring the correct fit of protective equipment and its potential relationship with concussion risk is very limited. OBJECTIVE: To evaluate the association between helmet fit and the odds of experiencing a concussion among youth ice hockey players. DESIGN: Nested case-control within a cohort study. SETTING: Calgary, Alberta, Canada. PATIENTS OR OTHER PARTICIPANTS: Data were collected for 72 concussed, 41 nonconcussion-injured, and 62 uninjured ice hockey players aged 11 to 18 years. MAIN OUTCOME MEASURE(S): Helmet-fit assessments were conducted across players and encompassed helmet specifications, condition, certification, and criteria measuring helmet fit. Using a validated injury-surveillance system, we identified participants as players with suspected concussions or physician-diagnosed concussions or both. One control group comprised players who sustained nonconcussion injuries, and a second control group comprised uninjured players. Helmet-fit criteria (maximum score = 16) were assessed for the concussed players and compared with each of the 2 control groups. The primary outcome was dichotomous (>1 helmet-fit criteria missing versus 0 or 1 criterion missing). Logistic and conditional logistic regression were used to investigate the effect of helmet fit on the odds of concussion. RESULTS: The primary analysis (54 pairs matched for age, sex, and level of play) suggested that inadequate helmet fit (>1 criterion missing) resulted in greater odds of sustaining a concussion when comparing concussed and uninjured players (odds ratio [OR] = 2.67 [95% CI = 1.04, 6.81], P = .040). However, a secondary unmatched analysis involving all participants indicated no significant association between helmet fit and the odds of sustaining a concussion when we compared concussed players with nonconcussion-injured players (OR = 0.98 [0.43, 2.24], P = .961) or uninjured players (OR = 1.66 [0.90, 3.05], P = .103). CONCLUSIONS: Inadequate helmet fit may affect the odds of sustaining a concussion in youth ice hockey players. Future investigators should continue to evaluate this relationship in larger samples to inform helmet-fit recommendations.

Effects of Caffeine on Exertion, Skill Performance, and Physicality in Ice Hockey.

PURPOSE: To determine the effects of low-dose caffeine supplementation (3 mg/kg body mass) consumed 1 h before the experiment on rating of perceived exertion (RPE), skills performance (SP), and physicality in male college ice hockey players. METHODS: Using a double-blind, placebo-controlled, randomized crossover experimental design, 15 college ice hockey players participated in SP trials and 14 participated in scrimmage (SC) trials on a total of 4 d, with prescribed ice hockey tasks occurring after a 1-h high-intensity practice. In the SP trials, time to complete and error rate for each drill of the validated Western Hockey League Combines Testing Standard were recorded. Peak head accelerations, trunk contacts, and offensive performance were quantified during the SC trials using accelerometery and video analysis. RPE was assessed in both the SP and SC trials. RESULTS: RPE was significantly greater in the caffeine (11.3 [2.0]) than placebo (9.9 [1.9]) condition postpractice (P = .002), with a trend toward greater RPE in caffeine (16.9 [1.8]) than placebo (15.7 [2.8]) post-SC (P = .05). There was a greater number of peak head accelerations in the caffeine (4.35 [0.24]) than placebo (4.14 [0.24]) condition (P = .028). Performance times, error rate, and RPE were not different between intervention conditions during the SP trials (P > .05). CONCLUSIONS: A low dose of caffeine has limited impact on sport-specific skill performance and RPE but may enhance physicality during ice hockey SCs.

Complication avoidance in laser interstitial thermal therapy: lessons learned.

OBJECTIVE Complications of laser interstitial thermal therapy (LITT) are underreported. The authors discuss how they have modified their technique in the context of technical and treatment-related adverse events. METHODS The Medtronic Visualase system was used in 49 procedures in 46 patients. Between 1 and 3 cooling catheters/laser fiber assemblies were placed, for a total of 62 implanted devices. Devices were placed using frameless stereotaxy (n = 3), frameless stereotaxy with intraoperative MRI (iMRI) (n = 9), iMRI under direct vision (n = 2), MRI alone (n = 1), or frame-based (n = 47) techniques. LITT was performed while monitoring MRI thermometry. Indications included brain tumors (n = 12), radiation necrosis (n = 2), filum terminale ependymoma (n = 1), mesial temporal lobe epilepsy (n = 21), corpus callosotomy for bifrontal epilepsy (n = 3), cavernoma (n = 1), and hypothalamic hamartomas (n = 6). RESULTS Some form of adverse event occurred in 11 (22.4%) of 49 procedures. These included 4 catheter malpositions, 3 intracranial hemorrhages, 3 cases of neurological deficit related to thermal injury, and 1 technical malfunction resulting in an aborted procedure. Of these, direct thermal injury was the only cause of prolonged neurological morbidity and occurred in 3 of 49 procedures. Use of frameless stereotaxy and increased numbers of devices were associated with significantly increased complication rates (p < 0.05). A number of procedural modifications were made to avoid complications, including the use of 1) frame-based catheter placement, a 1.8-mm alignment rod to create a track and titanium skull anchors for long trajectories to improve accuracy; 2) a narrow-gauge instrument for dural puncture and coregistration of contrast MRI with CT angiography to reduce intracranial hemorrhage; 3) general endotracheal anesthesia for posterior-placed skull anchors to reduce the likelihood of damage to the cooling catheter; 4) use of as few probes as possible to reduce complications overall; and 5) dose modification of thermal treatment and use of short (3-mm) diffusing tips to limit treatment when structures to be spared do not have intervening CSF spaces to act as heat sinks. CONCLUSIONS Laser ablation treatment may be used for a variety of neurosurgical procedures for patients with tumors and epilepsy. While catheter placement and thermal treatment may be associated with a range of suboptimal operative and postoperative courses, permanent neurological morbidity is less common. The authors' institutional experience illustrates a number of measures that may be taken to improve outcomes using this important new tool in the neurosurgical arsenal.

Awake Craniotomy in Arteriovenous Malformation Surgery: The Usefulness of Cortical and Subcortical Mapping of Language Function in Selected Patients.

OBJECTIVE: Awake craniotomy for removal of intra-axial lesions is a well-established procedure. Few studies, however, have investigated the usefulness of this approach for resection of arteriovenous malformations adjacent to eloquent language areas. We demonstrate our experience by using cortical stimulation mapping and report for the first time on the usefulness of subcortical stimulation with interrogation of language function during resection of arteriovenous malformations (AVMs) located near language zones. METHODS: Patients undergoing awake craniotomy for AVMs located in language zones and at least 5 mm away from the closest functional magnetic resonance imaging activation were analyzed. During surgery, cortical bipolar stimulation at 50 Hz, with an intensity of 2 mA, increased to a maximum of 10 mA was performed in the region around the AVM before claiming it negative for language function. In positive language site, the area was restimulated 3 times to confirm the functional deficit. The AVM resection was started based on cortical mapping findings. Further subcortical stimulation performed in concert with speech interrogation by the neuropsychologist continued at key points throughout the resection as feasible. The usefulness of cortical and subcortical stimulation in addition to patient outcomes was analyzed. RESULTS: Between March 2009 and September 2014, 42 brain AVM resections were performed. Four patients with left-sided language zone AVMs underwent awake craniotomy. The AVM locations were fronto-opercular in 2 patients and posterior temporal in 2. The AVM Spetzler-Martin grades were II (2 patients) and III (2 patients). In 1 patient, complete speech arrest was noticed during mapping of the peri-malformation zone, which was not breached during resection. In a second patient who initially demonstrated negative cortical mapping, a speech deficit was noticed during resection and subcortical stimulation. This guided the approach to protect and avoid the sensitive zone. This patient experienced mild postoperative expressive dysphasia that improved to normal within 6 weeks. Complete resection was achieved in all 4 patients. There were no other complications and no permanent neurological morbidity, resulting in good outcome in all 4 patients. CONCLUSIONS: Language mapping, both cortical and subcortical during AVM resection, may be valuable in a very select group of AVMs in language zones. Defining safe margins and feedback to the surgeon may provide the highest chances of a surgical cure while minimizing the risk of incurring a language deficit.