Incidence of Sport Injuries in the Manchester 2019 World Taekwondo Championships: A Prospective Study of 936 Athletes from 145 Countries.

We aimed to describe injury incidence and patterns at the 2019 World Taekwondo Championships (WTC), and to compare them with those of previous WTCs, based on new World Taekwondo (WT) competition rules, medical codes, and the Protector and Scoring System (PSS). This prospective cohort study utilized data obtained through the WT Injury Surveillance System. All athletes with injuries were evaluated by on-site sports medicine specialists, and ultrasonography was used to assess all musculoskeletal injuries. Of 936 athletes, 60 injuries were recorded (6.4 injuries/100 athletes, 95% confidence intervals [CI]: 4.8-8.0), and 4.5% (n = 42) sustained at least one injury. Males had a higher risk of sustaining injuries than females (incidence rate ratio: 1.57; 95% CI: 0.89-2.76). The most common sites, type, and mechanism were lower extremities (n = 26, 43.33%), contusion/hematoma/bruises (n = 33, 55.0%), and contact with another athlete (n = 50, 83.33%). Overall, the injury patterns associated with the mechanism of injury were similar in both the 2019 and 2017 WTCs. Refined WT competition rules and a re-established PSS at the 2019 WTC reduced the overall and severe injury incidence. Our findings can help revise Taekwondo competition rules, enhance protective equipment, optimize on-site venue medical systems, and develop injury prevention projects.

MR1-dependence of unmetabolized folic acid side-effects.

The fortification of flour with folic acid for the prevention of neural tube defects (NTD) is currently mandated in over eighty countries worldwide, hence compelling its consumption by the greater part of the world's population. Notwithstanding its beneficial impact on rates of NTD, pervasive folic acid supplementation has invariably led to additive daily intakes reaching well beyond their original target, resulting in the circulation of unmetabolized folic acid. Associated idiopathic side-effects ranging from allergies to cancer have been suggested, albeit inconclusively. Herein, we hypothesize that their inconsistent detection and elusive etiology are linked to the in vivo generation of the immunosuppressive folic acid metabolite 6-formylpterin, which interferes with the still emerging and varied functions of Major Histocompatibility Complex-related molecule 1 (MR1)-restricted T cells. Accordingly, we predict that fortification-related adverse health outcomes can be eliminated by substituting folic acid with the bioequivalent folate vitamer 5-methyltetrahydrofolate, which does not break down into 6-formylpterin.

The Association of Serum Magnesium Levels and QT Interval with Neurological Outcomes After Targeted Temperature Management.

Targeted temperature management (TTM) is associated with corrected QT (QTc) prolongation and decrease in serum magnesium (Mg) levels that may lead to recurrent ventricular arrhythmia and poor neurological outcomes. We aimed to evaluate the association between QTc interval and Mg levels during TTM with neurological outcomes. We reviewed the electrocardiograms of 366 patients who underwent TTM during the induction, maintenance, and rewarming phase after cardiac arrest. We reviewed the association of change in QTc interval, and Mg levels with neurological outcomes. In total, 71.3% of the patients had a significant increase in QTc interval defined as >60 ms or any QTc >500 ms during TTM. Poor neurological outcome was associated with persistent prolongation of QTc after rewarming (507 vs. 483 ms, p = 0.046) and higher Mg levels at presentation (2.08 ± 0.41 mg/dL, p = 0.014). Supplemental Mg did not have any significant change in their QTc. Patients with prolonged QTc during TTM should be promptly evaluated for QTc-prolonging factors given its association with worse neurological outcomes. The inverse correlation between Mg levels and poor neurological outcomes deserves further investigation.

Types and severity of physical impairments of para taekwondo athletes.

BACKGROUND: Para taekwondo has only recently been added to the Paralympic games scheduled to be held in 2021; however, there is limited research on the classification of the para taekwondo athletes. This study aimed to provide details on the impairments and disabilities of the para taekwondo players. The secondary objective was to investigate the relationship between some of the proposed factors and the athletes' rankings. METHODS: The data of 556 para taekwondo athletes (119 females and 437 males), who had been classified over the past 5 years, were analyzed. RESULTS: The K44 class was the most popular, and 61% of the classified athletes belonged to this class. Acute injury from trauma was the most frequent cause of impairment, and 62.3% of all impairments/disabilities occurred during 0-5 years of age. Approximately 28% of the athletes had <1 year of training prior to international competitions. One-way analysis of variance performed for the combined length of the upper limbs showed significant differences (F(3,311)=455.78, P<0.001) among the K41-K44 classes. There were weak correlations (ρ<0.1) between the ranking and the age of the disability/impairment onset, combined length of the upper limbs, and type of disability. CONCLUSIONS: Continued data collection that provides insights into the impairment profiles of para taekwondo athletes is needed to improve the current classification system in order to enhance the safety and fairness.

MR1-dependent immune surveillance of the skin contributes to pathogenesis and is a photobiological target of UV light therapy in a mouse model of atopic dermatitis.

BACKGROUND: Mucosal-associated invariant T (MAIT) cells are unconventional T cells which recognize microbial metabolites presented by the major histocompatibility complex class I-related molecule MR1. Although MAIT cells have been shown to reside in human and murine skin, their contribution to atopic dermatitis (AD), an inflammatory skin disease associated with barrier dysfunction and microbial translocation, has not yet been determined. METHODS: Genetic deletion of MR1 and topical treatment with inhibitory MR1 ligands, which result in the absence and functional inhibition of MAIT cells, respectively, were used to investigate the role of MR1-dependent immune surveillance in a MC903-driven murine model of AD. RESULTS: The absence or inhibition of MR1 arrested AD disease progression through the blockade of both eosinophil activation and recruitment of IL-4- and IL-13-producing cells. In addition, the therapeutic efficacy of phototherapy against MC903-driven AD could be increased with prior application of folate, which photodegrades into the inhibitory MR1 ligand 6-formylpterin. CONCLUSION: We identified MAIT cells as sentinels and mediators of cutaneous type 2 immunity. Their pathogenic activity can be inhibited by topical application or endogenous generation, via phototherapy, of inhibitory MR1 ligands.

Injury and Illness in World Taekwondo Junior Athletes: An Epidemiological Study.

Taekwondo has been reported to be one of the most injurious sports in the summer Olympics, however, there is a dearth of data about injury profiles for junior athletes. Therefore, we aimed to identify the incidence and profiles of the injuries and illnesses that occurred during the 2018 World Taekwondo Junior Championships and recorded using an online system. Among the 889 athletes, 67 injuries and four illnesses were reported, corresponding to an overall clinical incidence of 7.5 injuries (95% confidence interval [CI]: 5.7-9.3) and 0.5 illnesses (0.1-0.9) per 100 athletes. The most frequent injuries were lower extremity injuries (n = 33, 3.71% of all athletes), mostly in the foot/toe (n = 11, 1.2% of athletes), followed by head and trunk injuries, mostly in the face (n = 14, 1.6% of athletes), and upper extremity injuries, mostly in the fingers (n = 6, 0.7% of athlete). Contusions (n = 37, 4.2% of athlete) were the most frequent injury type, followed by ligament ruptures/sprains and laceration. The most common injury mechanism was contact during an opponent attack (n = 51, 5.7% of athlete). Three mild concussions none resulted in time loss (none required hospital transfer or had prolonged recovery). The respiratory system was the most affected by illness, with pain and fever as symptoms. Environmental factors were the most common cause of illness. This study shows that 7.5 per 100 athletes (38.5/1000 athlete-exposures and 6.9/1000 min-exposures) had new or recurrent injuries, whereas 0.5 per 100 athletes experienced illness. In conclusion, the data shows male athletes reported more injuries than females and the most common cause of injury was due to contact between athletes. Contusions, ligament rupture/sprains, laceration and fractures to the lower extremities, head, and trunk were the most common injury. Knowing these injury profiles of junior taekwondo athletes can help taekwondo stakeholders, especially medical staff to prepare accordingly to ensure the safety of the athletes.

Sports Injuries and Illnesses After Implementation of the Web-Based Surveillance System in World Taekwondo.

CONTEXT: Taekwondo epidemiology studies have been in short supply since the rule changes introduced by World Taekwondo in 2017. OBJECTIVE: To describe injury and illness patterns at the 2017 World Taekwondo Championships (WTC) in Muju, South Korea, after the implementation of the web-based surveillance system by World Taekwondo. DESIGN: Prospective cohort study. SETTING: All injuries and illnesses were recorded during the 2017 WTC using a web-based system developed by the International Olympic Committee. PATIENTS OR OTHER PARTICIPANTS: A total of 971 athletes who participated in the 2017 WTC. MAIN OUTCOME MEASURE(S): Profiles and mechanisms of injury and illness in the 2017 WTC. RESULTS: We analyzed a total of 131 injuries and 26 illnesses, corresponding to an overall clinical incidence of 13.5 (95% CI = 11.2, 15.8) injuries and 2.7 (95% CI = 1.6 3.7) illnesses per 100 athletes and an overall incidence rate of 19.3 (95% CI = 16.0, 22.6) injuries and 3.8 (95% CI = 2.4, 5.3) illnesses per 1000 athlete-days. Most injuries occurred in the lower extremities (n = 61, 46.6%), and knee injuries were most frequent (n = 26, 19.8%). Among head and trunk injuries (n = 39, 29.8%), face injuries (n = 32, 24.4%) were most common, whereas among upper extremity injuries (n = 31, 23.7%), finger injuries (n = 8, 6.1%) were seen most often. Contusions (n = 44, 33.6%) were the most frequent injury type, followed by fractures and ligamentous ruptures or sprains. The most common injury mechanism was contact with another athlete (n = 97, 74.0%), whereas the least common was concussion (n = 5). The major affected system was the respiratory system (n = 11, 42.3%), with major symptoms being pain (n = 11, 42.3%) and fever (n = 7, 26.9%). Environmental factors were the most typical cause of illness (n = 15, 57.7%). CONCLUSIONS: The web-based surveillance system used at the 2017 WTC revealed that 13.5 per 100 athletes (77.8/1000 athlete-exposures, 13.9/1000 minute-exposures) had new or recurrent injuries, whereas 2.7 per 100 athletes became ill.

Investigating the influence of Taekwondo body protectors size on shock absorption.

OBJECTIVE: This study aims to compare and analyze the difference of impact force attenuation according to size and impact location on a Taekwondo body protector. METHODS: Body protectors sized 1 to 5, were impact tested by equipment based on the specifications in the European standard manual (EN 13277-1, 3). The impactor release heights were set to match impact energies of 3 and 15 J. The impactor was made from a 2.5 kg cylindrically cut piece of aluminum. Each body protector was impacted 10 times at the two impact energies and two locations. The differences in performance for each body protector size were compared using a two-way analysis of variance with a significance level of p< 005. The effect sizes were investigated using a partial eta squared value (η2). RESULTS: The significant mean differences between the body protector size and impact area (p< 005) and the average impact time of impact strengths 3 and 15 J were 0.0017 and 0.0012 s, respectively In addition, when an impact strength of 15 J was applied, the maximum resulting impact force exceeded 2000 N for both locations on all sizes. Furthermore, at an impact strength of 3 J size 3 significantly reduced the impact force more than the other sizes; however, size 1 showed the greatest shock absorption at an impact of 15 J. CONCLUSION: The results of this study show that the shock absorption of body protectors does not increase according to size; i.e., a larger body protector does not reduce the impact load more effectively. To improve safety performance, we recommend a maximum impact force of 2000 N or less for all body protectors.

Finite element simulation of head impacts in mixed martial arts.

Thirteen MMA athletes were fitted with the MiG2.0 Stanford instrumented mouthguard. 451 video confirmed impacts were recoded during sparring sessions and competitive events. The competitive events resulted in five concussions. The impact with the highest angular acceleration from each event was simulated using the GHBMC head model. Average strain in the corpus callosum of concussed fighters was 0.27, which was 87.9% higher than uninjured fighters and was the best strain indicator of concussion. The best overall predictor of concussion found in this study was shear stress in the corpus callosum which differed by 111.4% between concussed and uninjured athletes.

Concussion and the severity of head impacts in mixed martial arts.

Concern about the consequences of head impacts in US football has motivated researchers to investigate and develop instrumentation to measure the severity of these impacts. However, the severity of head impacts in unhelmeted sports is largely unknown as miniaturised sensor technology has only recently made it possible to measure these impacts in vivo. The objective of this study was to measure the linear and angular head accelerations in impacts in mixed martial arts, and correlate these with concussive injuries. Thirteen mixed martial arts fighters were fitted with the Stanford instrumented mouthguard (MiG2.0) participated in this study. The mouthguard recorded linear acceleration and angular velocity in 6 degrees of freedom. Angular acceleration was calculated by differentiation. All events were video recorded, time stamped and reported impacts confirmed. A total of 451 verified head impacts above 10g were recorded during 19 sparring events (n = 298) and 11 competitive events (n = 153). The average resultant linear acceleration was 38.0624.3g while the average resultant angular acceleration was 256761739 rad/s2. The competitive bouts resulted in five concussions being diagnosed by a medical doctor. The average resultant acceleration (of the impact with the highest angular acceleration) in these bouts was 86.7618.7g and 756163438 rad/s2. The average maximum Head Impact Power was 20.6kW in the case of concussion and 7.15kW for the uninjured athletes. In conclusion, the study recorded novel data for sub-concussive and concussive impacts. Events that resulted in a concussion had an average maximum angular acceleration that was 24.7% higher and an average maximum Head Impact Power that was 189% higher than events where there was no injury. The findings are significant in understanding the human tolerance to short-duration, high linear and angular accelerations.

Safety Evaluation of Protective Equipment for the Forearm, Shin, Hand and Foot in Taekwondo.

The objective of the study was to evaluate and compare different brands of forearm, shin, hand and foot protective equipment used in Taekwondo. The most popular brands of large forearm, shin, hand and foot protectors (D®, A®, K ®), approved by the World Taekwondo and Korean Taekwondo Association, were examined. A drop test was used to test the protective equipment using impact levels of 3J, 9J, 12J and 15J for the forearm and shin guards, and 3J and 9J for the hand and foot protectors. The protective equipment was hit ten times from each of the designated drop heights. The drop test is described in the European standards manual of protective equipment for martial arts (SRPS EN 13277-2). The maximum force (MF) and impulse were lowest for brand K® (2610.3 ± 1474.1 N), and brand A® (9.6 ± 3.1 Ns), respectively, for the forearm guards; for brand A® (2053.4 ± 1267.1 N) and brand K® (9.8 ± 3.5 Ns), respectively, for the shin guards; for brand K® (4486.5 ± 1718.4 N), and brand A® (6.3 ± 1.1 Ns), respectively for the hand protectors; and for brand A® (3733.7 ± 2465.3 N), and brand D® (6.8 ± 0.6 Ns), respectively, for the foot protectors. For the forearm guard brand and impact level, there was a significant interaction effect for the MF (F=42.44, η2=.677, p <0.001) and impulse (F = 33.97, η2 = 0.626, p <0.001). Based on the MF, brand K® performed the best for the forearm guards and hand protectors, and brand A®, for the shin guards and foot protectors. The best results for the impulse were for brand A® (forearm guards and hand protectors), brand K® (shin guards) and brand D® (foot protectors).

Randomized double-blind trial of short- versus long-acting analgesia at the sacrospinous ligament.

INTRODUCTION AND HYPOTHESIS: Pain control is a key component of postoperative care; our objective was to evaluate if use of long-acting local anesthesia at the sacrospinous ligament leads to decreased postoperative pain versus short-acting local anesthesia in patients undergoing sacrospinous ligament fixation. METHODS: Women ≥ 18 years old undergoing sacrospinous ligament fixation to treat pelvic organ prolapse were eligible to participate in this randomized trial. Enrolled patients were randomized 1:1 to one of two study arms: (1) lidocaine arm (LA) or (2) liposomal bupivacaine arm (LBA). Patients in the LA received 30 ml 0.5% lidocaine with 1:200,000 epinephrine local injection at the sacrospinous ligament. Patients in the LBA received 20 ml 1.3% bupivacaine liposomal mixed with 10 ml 0.5% bupivacaine at the sacrospinous ligament. All patients received 50 ml 0.5% lidocaine with 1:200,000 epinephrine for anterior and/or posterior colporrhaphy. The primary outcome of this study was postoperative buttock pain. RESULTS: Of the 37 patients enrolled, 33 completed study procedures. Mean age (± SD) was 62.3 years (± 11.6) in the LA and 66.8 years (± 14.4) in the LBA (p = 0.32). All participants underwent sacrospinous ligament fixation; the rate of concomitant procedures did not differ between study arms. Visual analog scale scores for buttock-specific pain were compared between arms at 1, 3, 6, 12, 24, 36, 48, 72, 96, and 120 h postoperatively, and no differences were found. CONCLUSIONS: Use of long-acting local analgesia at the sacrospinous ligament at the time of sacrospinous ligament fixation does not provide any benefit over short-acting local analgesia.

Total laser cycles-a measure of transvenous lead extraction difficulty.

BACKGROUND: Several variables have been identified as predictors for difficult or complicated transvenous lead extraction (TLE), including age and number of implanted leads, as well as patient's age; however, a standard measure of TLE difficulty has not been described. OBJECTIVE: Total laser cycles (TLCs) delivered during laser-assisted TLE is an objective variable that could reflect the difficulty of TLE. This study investigated whether TLC is correlated with known predictors of difficult TLE. METHODS: In a retrospective study of TLE procedures using the laser sheath, we analyzed TLC delivered and compared it to established predictors of procedural failure and complications. RESULTS: Of 166 patients undergoing TLE, the laser sheath (SLS II or Glidelight, Spectranetics Inc.,) was used as the primary extraction sheath in 130 patients, and 100 patients had complete TLC data available. The mean age of the oldest lead (AOL) was 7.1 ± 3.2 years with a median of 6.91 (interquartile range [IQR] 0.48-16.69) years, and 1.6 ± 0.7 leads (range, 1-4) were extracted per procedure. Two thirds of procedures involved ICD leads. Clinical success was 99%, with one patient (1%) experiencing a major complication. Median TLC delivered was 1165 (IQR, 567-2062; range, 49-9522). TLC was positively correlated with AOL (r = 0.227, p = 0.023), and the combined age of leads was extracted (r = 0.307, p = 0.002). TLC was also positively correlated with number of leads extracted per procedure (ρ = 0.227, p = 0.024). There was a non-significant negative trend towards correlation between TLC and patient's age (r = -0.112, p = 0.268). CONCLUSION: TLC showed significant correlation with known predictors of difficulty during TLE using the laser sheath. TLC is an objective method to report the difficulty of TLE and could usefully be reported in future series of laser lead extractions.

Applications of psychological skills training for Paralympic table tennis athletes.

This study examined effects of psychological skills training (PST) for Korean national table tennis athletes with spinal cord injuries (SCI), who were training for the 2012 London Paralympics. Participants were three male table tennis players with level two SCI, and all participants attended a total of eight sessions of PST over a period of 3 months. The PST consisted of self-talk, imagery, cognitive reconstructing, and routine. To examine the effectiveness of mental coaching, the Test of Performance Strategies questionnaire was administered over three different periods of time: pre-PST, post-PST, and postcompetition. Pre- and posttest outcomes indicated that there were positive changes in self-talk, emotional control, and goal setting of athletes with SCI. With the exception of relaxation, Athlete 1 was able to maintain and use all of the improved mental skills in Paralympic competitions. However, although the mental skills of the athletes 2 and 3 generally improved, they were not able to take full advantage of these improvements in Paralympic competitions. PST can be developed and effectively utilized by athletes with SCI. Disability-specific issues should be considered to provide a better intervention program.

Rotational and linear head accelerations from taekwondo kicks and punches.

The purpose was to compare rotational and linear head accelerations as a result of taekwondo kicks and punches. Taekwondo athletes executed five repetitions of the turning kick, spinning hook kick, hook punch, straight punch, and jab punch to a Hybrid III Crash Test Dummy head-neck complex. A tri-axial accelerometer and an angular rate sensor were mounted inside the Hybrid III head to measure resultant linear (RLA) and rotational accelerations. The Hybrid III was fixed to a height-adjustable frame and fitted with protective taekwondo headgear. Dummy head height was positioned to each participant's standing height. Acceleration data were processed in accordance with SAE J211-1.There was no significant multivariate difference in RLA but the effect was not clear. Univariate follow-up analysis showed a significant difference in RLA but the effect was also not clear. There was no difference in rotational acceleration. The highest RLA and rotational acceleration were produced, in order, by the turning kick, hook kick, hook punch, straight punch, and jab. These data are clinically important as they provide a better understanding of the biomechanical injury measures and support for improved headgear testing methodology.

Magnesium Levels and Neurologic Outcomes in Patients Undergoing Therapeutic Hypothermia After Cardiac Arrest.

Therapeutic hypothermia (TH) improves neurological outcomes after cardiac arrest by mitigating cerebral reperfusion injury. Serum magnesium (Mg) inhibits glutamate release, restores blood-brain barrier integrity, and decreases brain edema. The neuroprotective role of Mg in cardiac arrest patients undergoing TH is not well established. We analyzed 438 survivors of cardiac arrest who completed a TH protocol from 2008 through 2016. Multivariate and receiver operating characteristic (ROC) analyses examined the association between Mg supplementation and Mg levels before, during, and after TH with neurologic outcomes. Participants were 65.5 ± 15.9 years old, 47% received bystander cardiopulmonary resuscitation, and time to target temperature was 286 ± 196 minutes. Patients with favorable neurologic outcomes had lower Mg levels at presentation (2.1 mg/dL vs. 2.2 mg/dL, p = 0.010; OR [95% CI] = 0.531 [0.329-0.857]) and more frequently received Mg supplementation (39% vs. 25%, p = 0.009; OR [95% CI] = 1.936 [1.171-3.202]). Mg levels on presentation inversely correlated with favorable neurologic outcomes (r = -0.134, p = 0.036). Stratification of patients based on Mg levels demonstrated trends toward worse neurological outcomes at the extremes of the range, though sample sizes were small and the point estimate was not significant. ROC analysis showed no significant Mg level determining favorable outcomes. Mg levels at presentation inversely correlated with neurologic outcomes in cardiac arrest survivors undergoing TH. Intracellular shift and increased renal excretion of Mg may be responsible for the low Mg levels seen in some patients undergoing TH. Whether Mg supplementation could potentiate the beneficial effects of TH remains unclear and deserves further investigation.

Biomechanical head impact characteristics during sparring practice sessions in high school taekwondo athletes.

OBJECTIVE The purpose of this study was to monitor head impact magnitude and characteristics, such as impact location and frequency, at high school taekwondo sparring sessions. METHODS Eight male high school taekwondo athletes participated in this study. The head impact characteristics were recorded by X-Patch, a wireless accelerometer and gyroscope, during 6 taekwondo sparring sessions. The outcome measures were the peak linear acceleration ( g = 9.81 msec2), peak rotational acceleration, rotational velocity, and Head Injury Criterion. RESULTS A total of 689 impacts occurred over 6 sessions involving the 8 athletes. There was an average of 24 impacts per 100 minutes, and there were significant differences in the frequency of impacts among both the sessions and individual athletes. In order of frequency, the most commonly hit locations were the side (38.2%), back (35.7%), and front (23.8%) of the head. CONCLUSIONS The data indicate that there is a relatively high number of head impacts experienced by taekwondo athletes during sparring practice. According to the rotational acceleration predicting impact severity published in previous research, 17.1% of the impacts were deemed to be a moderate and 15.5% were deemed to be severe.

Effects of Calcium, Vitamin D, and Hormone Therapy on Cardiovascular Disease Risk Factors in the Women's Health Initiative: A Randomized Controlled Trial.

OBJECTIVE: To analyze the treatment effect of calcium+vitamin D supplementation, hormone therapy, both, and neither on cardiovascular disease risk factors. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled trial among Women's Health Initiative (WHI) participants. The predefined primary outcome was low-density lipoprotein cholesterol (LDL-C). RESULTS: Between September 1993 and October 1998, a total of 68,132 women aged 50-79 years were recruited and randomized to the WHI-Dietary Modification (n=48,835) and WHI-Hormone Therapy trials (n=27,347). Subsequently, 36,282 women from WHI-Hormone Therapy (16,089) and WHI-Dietary Modification (n=25,210) trials were randomized in the WHI-Calcium+Vitamin D trial to 1,000 mg elemental calcium carbonate plus 400 international units vitamin D3 daily or placebo. Our study group included 1,521 women who participated in both the hormone therapy and calcium+vitamin D trials and were in the 6% subsample of trial participants with blood sample collections at baseline and years 1, 3, and 6. The average treatment effect with 95% confidence interval, for LDL-C, compared with placebo, was -1.6, (95% confidence interval [CI] -5.5 to 2.2) mg/dL for calcium+vitamin D alone, -9.0 (95% CI -13.0 to -5.1) mg/dL for hormone therapy alone, and -13.8 (95% CI -17.8 to -9.8) mg/dL for the combination. There was no evidence of a synergistic effect of calcium+vitamin D+hormone therapy on LDL-C (P value for interaction=.26) except in those with low total intakes of vitamin D, for whom there was a significant synergistic effect on LDL (P value for interaction=.03). CONCLUSION: Reductions in LDL-C were greater among women randomized to both calcium+vitamin D and hormone therapy than for those randomized to either intervention alone or to placebo. The treatment effect observed in the calcium+vitamin D+hormone therapy combination group may be additive rather than synergistic. For clinicians and patients deciding to begin calcium+vitamin D supplementation, current use of hormone therapy should not influence that decision. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT00000611.

Peripheral Tibial Nerve Stimulation for Overactive Bladder Syndrome: Treatment Success and Patient Satisfaction.

OBJECTIVE: To evaluate the success rate and patient satisfaction ofperipheral tibial nerve stimulation (PTNS) therapy. METHOD: Retrospective cohort study assessing PTNS treatment success and patient satisfaction. RESULTS: Data from 34 women were included. On average, patients were 70.2 (± 12) years of age, had a BMI of 29.9 (± 8.9) kg/M², and traveled 11.2 (± 12.3) miles to receive weekly PTNS treatments. Overall, 22 patients (64.7%) were satisfied, four (11.8%) unsatisfied, and eight (23.5%) undecided. Those who were satisfied completed an average of 10.9 treatments (± 2.4), those who were unsatisfied completed an average of 9.5 treatments (± 2.6), and those left undecided completed an average of 7.2 treatments (± 4.3). The fourth treatment visit was the most likely to predict whether a patient would be satisfied or unsatisfied by the 12th treatment. CONCLUSION: Overall the success of the PTNS therapy was 64.7%, consistent with previous studies. Most patients note improvement after the fourth treatment.

Impact attenuation of protective boxing and taekwondo headgear.

This study aimed to compare the impact attenuation performance of boxing and taekwondo headgear in terms of peak linear and rotational acceleration. To measure the impact attenuation of headgear, a standardized (American Society for Testing and Materials (ASTM) F-2397) martial arts headgear striker was used to impart impacts to a 50th Percentile Male Hybrid III Crash Test Dummy head and neck complex. Two boxing (Adidas and Greenhill) and two taekwondo (Adidas and Nike) headgear, approved by the Association Internationale de Boxe Amateur and the World Taekwondo Federation (WTF), were selected. Each of the selected headgear was fitted to the Hybrid III head and subsequently subjected to five impacts at the front and side with a maximum impact interim time of 60 seconds by the rotating striker at 8 ± 0.3 m/s. Linear and rotational acceleration were recorded at 10,000 Hz. There were significant interactions of the impact location and brand on the rotational acceleration, F(3,40) = 6.7, p < .05. There were significant main effects of both impact location F(1,40) = 9.07, p < .05 and headgear brand F(3,40) = 9.9, p < .05 on the linear acceleration. Pairwise comparisons show significant differences between the front and side for both linear and rotational acceleration. The headgear tested failed the ASTM high impact test requirement to reduce the linear acceleration to below a threshold of 150 g. Further development of headgear to reduce impact linear and rotational acceleration magnitudes should be called for by the relevant sport governing bodies and initiated by headgear manufactures.