Identifying achilles tendon structure differences by ultrasound tissue characterization in asymptomatic individuals.

Ultrasound Tissue Characterization (UTC) is a modality that can be utilized to characterize tendon tissue structure using ultrasonographic imaging paired with a computer algorithm to distinguish echo-types. Several studies have demonstrated UTCs ability to distinguish Achilles tendon morphology changes, but no study has established normative data of the Achilles tendon in the general population. The aim of this study was to determine UTC echo-type distribution in the Achilles tendon in an asymptomatic population. UTC scans were completed and analyzed on 508 participants without Achilles tendinopathy. Dedicated UTC-algorithms were used to distinguish and calculate echo-type percentages and the fiber type distribution was compared. The overall sample echo-type percentages demonstrated greater levels of Type I and II echo-types, 65.73% and 32.00%, respectively, and lower levels of Type III and IV echo-types, 1.74% and 0.57%, respectively. In addition, females had lower levels of Echo-type I compared to men and greater levels of echo-type II (p < 0.001). We also found that African-Americans had significantly greater amounts of echo-type I and lesser amounts of echo-type II when compared to Caucasians (p < 0.05). The results of this study create a normative data set for future UTC studies to utilize as a baseline for the evaluation of Achilles tendons. In addition, it demonstrated tendon type differences between sexes and races that need to be accounted for in future studies.

Novice interpretation of screening electrocardiograms and impact of online training.

INTRODUCTION: It is not known whether there is a specific training method that improves the accuracy of physician interpretations of pre-participation electrocardiograms (ECGs). METHODS: Participants took an online test and interpreted a series of normal, normal variant and abnormal ECGs. They then reviewed the BMJ's ECG interpretation online learning module and completed a post-test and a follow-up examination three months later. RESULTS: 28 fellows enrolled. The average correct for the pre-test was 63.57%, which increased to 81.19% for the post-test (p≤0.0001). When evaluating for retention, the average fell to 73.33% (p=0.0116) but was still significantly improved from baseline (p=0.0253). CONCLUSIONS: This study demonstrated that the accuracy of fellows' interpretation of ECGs significantly improved after completion of BMJ modules. Results of this study will likely impact the training of future sports medicine fellows and should encourage fellowship directors to incorporate the BMJ's ECG interpretation module as part of their curriculum.

Brugada-type patterns are easily observed in high precordial lead ECGs in collegiate athletes.

BACKGROUND: Displacement of ECG leads can result in unwarranted findings. We assessed the frequency of Brugada-type patterns in athletes when precordial leads were purposely placed upward. METHODS: Four hundred ninety-one collegiate athletes underwent two ECGs: one with standard leads, one with V1 and V2 along the 2nd intercostal space. A positive Brugada-type pattern was defined as ST elevation in V1 or V2 consistent with a Type 1, 2, or 3 pattern in the high-lead ECG. A control group was comprised of 181 outpatients. RESULTS: No Type 1 patterns were seen. In 58 athletes (11.8%), a Brugada-type 2 or 3 pattern was observed. Those with Brugada-type 2 or 3 patterns were more likely male, taller, and heavier. In the control group, 18 (9.9%) had Brugada-type 2 or 3 patterns and were more likely male. CONCLUSIONS: Proper lead positioning is essential to avoid unwarranted diagnosis of a Brugada-type ECG, especially in taller, heavier male athletes.

Privacy preserving Generative Adversarial Networks to model Electronic Health Records.

Hospitals and General Practitioner (GP) surgeries within National Health Services (NHS), collect patient information on a routine basis to create personal health records such as family medical history, chronic diseases, medications and dosing. The collected information could be used to build and model various machine learning algorithms, to simplify the task of those working within the NHS. However, such Electronic Health Records are not made publicly available due to privacy concerns. In our paper, we propose a privacy-preserving Generative Adversarial Network (pGAN), which can generate synthetic data of high quality, while preserving the privacy and statistical properties of the source data. pGAN is evaluated on two distinct datasets, one posing as a Classification task, and the other as a Regression task. Privacy score of generated data is calculated using the Nearest Neighbour Adversarial Accuracy. Cosine similarity scores of synthetic data from our proposed model indicate that the data generated is similar in nature, but not identical. Additionally, our proposed model was able to preserve privacy while maintaining high utility. Machine learning models trained on both synthetic data and original data have achieved accuracies of 74.3% and 74.5% respectively on the classification dataset; while they have attained an R2-Score of 0.84 and 0.85 on synthetic and original data of the regression task respectively. Our results, therefore, indicate that synthetic data from the proposed model could replace the use of original data for machine learning while preserving privacy.

An exploratory study of the effects of strenuous exercise on markers of coagulation activation, circulating microparticles, and inflammation in sickle cell trait.

This exploratory study evaluated the effect of intense exercise on biomarkers of inflammation and coagulation activation in subjects with and without sickle cell trait (SCT). Fifteen healthy African American men (18-35 years, 5 SCT, 10 control) completed a strenuous exercise protocol. Microparticle-associated prothrombinase and tissue factor activities, as well as soluble VCAM, total white cell and monocyte count increased transiently in all subjects following exercise. In the SCT group, exercise resulted in increased d-dimer, erythrocyte phosphatidylserine exposure, as well as increased circulating erythrocyte- and endothelial-derived microparticle numbers. These alterations could contribute to exercise-related complications in people with SCT.

Anteromedial subtalar dislocation.

Subtalar dislocation is the simultaneous dislocation of the talocalcaneal and talonavicular joints of the foot, typically caused by falls from heights, twisting leg injuries and motor vehicle accidents. The dislocation can occur medially, lateral, anterior or posterior, but most commonly occurs from inversion injury producing a medial dislocation. These dislocations may be accompanied by fractures. Careful physical examination must be performed to assess for neurovascular compromise. Most subtalar dislocations can be treated with closed reduction under sedation. However, if the dislocation is associated with an open fracture it may require reduction in the operating room. Treatment should include postreduction plain x-ray and CT scan to evaluate for proper alignment and for fractures. This article presents a case of medial subtalar dislocation in a 23-year-old football player.

The athlete's pharmacy.

Athletes use a variety of substances for the treatment of pain, injury, common illnesses, or to gain an advantage in competition. A growing concern is that many young athletes may use potentially dangerous, but legal, medications without consulting health professionals. Physicians providing care for athletes should be aware of any medications that an athlete is taking and how these substances may interact with performance, exercise, environment, and other medicines. Moreover, it is vital that physicians are familiar with these medications so that athletes are properly educated on the potential benefits and/or risks, and how each substance may affect the body.