Gait biomechanics do not differ between adolescents with and without patellofemoral pain.

OBJECTIVES: To determine if adolescents with patellofemoral pain exhibit different biomechanical characteristics to asymptomatic adolescents during walking and running. METHODS: Twenty-eight adolescents with patellofemoral pain (16 male, 12 female, mean [SD] age: 14.3 [1.7] years) and 24 asymptomatic adolescents (13 male, 11 female, mean [SD] age: 14.1 [1.6] years) participated. Participants walked and ran on an instrumented treadmill in a standardized athletic shoe. Continuous hip, knee, and ankle joint angles and moments, and frontal plane pelvic motion were compared between groups using one-dimensional statistical parametric mapping independent t-tests (alpha <0.05). Cadence and stride length were compared between groups using independent t-tests. RESULTS: During walking, adolescents with patellofemoral pain had a higher hip extension moment at 7%-8% of the gait cycle (p = 0.04) and walked with a shorter stride length (mean difference [95% confidence interval] = -0.07 [-0.1, -0.01] m). There were no other differences between groups during walking. During running, adolescents with patellofemoral pain had greater knee flexion than asymptomatic adolescents at 35%-40% of the gait cycle (p = 0.04) and ran with a higher cadence (mean difference [95% confidence interval] = 5.8 [2.0, 9.5] steps/min). There were no other statistically significant differences between groups during running. CONCLUSIONS: Adolescents with patellofemoral pain demonstrate few biomechanical differences to asymptomatic adolescents during walking and running. The identified differences are likely of limited clinical importance. Biomechanical alterations which have been previously associated with patellofemoral pain in adults, may not need to be the target of management of adolescent patellofemoral pain.

Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment.

OBJECTIVES: Vulvar ulcers can be challenging to diagnose, manage, and treat. Ulcers can be nonspecific in appearance and have many etiologies. Description of the lesion is very important. METHODS: An interactive vulvar ulcer algorithm was created to aid in the evaluation, diagnosis, and treatment of vulvar ulcers. RESULTS: The algorithm flowchart begins with careful history and physical examination. Pending these, specific tests can be obtained to aid in diagnosis. The algorithm also links to appropriate treatments. The algorithm can be accessed on the International Society for the Study of Vulvovaginal Disease Web site ( issvd.org ). Each underlined word in the algorithm is a hyperlink that leads to a wealth of information on the topic that providers can use to direct testing and aid in diagnosis and treatment. CONCLUSIONS: The vulvar ulcer algorithm can help clinicians with diagnosis and treatment plans.

Costs associated with invasive Scedosporium and Lomentospora prolificans infections: a case-control study.

BACKGROUND: Little is known about the short- and long-term healthcare costs of invasive Scedosporium/Lomentospora prolificans infections, particularly in patient groups without haematological malignancy. This study investigated excess index hospitalization costs and cumulative costs of these infections. The predictors of excess cost and length of stay (LOS) of index hospitalization were determined. These estimates serve as valuable inputs for cost-effectiveness models of novel antifungal agents. METHODS: A retrospective case-control study was conducted at six Australian hospitals. Cases of proven/probable invasive Scedosporium/L. prolificans infections between 2011 and 2021 (n = 34) were matched with controls (n = 66) by predefined criteria. Cost data were retrieved from activity-based costing systems and analysis was performed from the Australian public hospital perspective. All costs were presented in 2022 Australian dollars (AUD). Median regression analysis was used to adjust excess costs of index hospitalization whereas cumulative costs up to 1.5 years follow-up were estimated using interval-partitioned survival probabilities. RESULTS: Invasive Scedosporium/L. prolificans infections were independently associated with an adjusted median excess cost of AUD36 422 (P = 0.003) and LOS of 16.27 days (P < 0.001) during index hospitalization. Inpatient stay was the major cost driver (42.7%), followed by pharmacy cost, of which antifungal agents comprised 23.8% of the total cost. Allogeneic haematopoietic stem cell transplant increased the excess cost (P = 0.013) and prolonged LOS (P < 0.001) whereas inpatient death within ≤28 days reduced both cost (P = 0.001) and LOS (P < 0.001). The median cumulative cost increased substantially to AUD203 292 over 1.5 years in cases with Scedosporium/L. prolificans infections. CONCLUSIONS: The economic burden associated with invasive Scedosporium/L. prolificans infections is substantial.

The Immediate Biomechanical Effects of a Flat, Flexible School Shoe in Adolescents with Patellofemoral Pain.

INTRODUCTION: Treatment options for adolescent patellofemoral pain (PFP) are limited. School footwear might be a suitable intervention to modulate patellofemoral joint (PFJ) loads in adolescents with PFP. This study examined the immediate effects of a flat, flexible school shoe compared with a traditional school shoe on knee joint kinematics and kinetics, and PFJ reaction force during walking and running in adolescents with PFP. METHODS: A total of 28 adolescents (12 female, 16 male; mean ± SD age, 14.3 ± 1.7 yr) with PFP walked and ran on an instrumented treadmill in two randomly ordered conditions: (i) flat, flexible school shoe and (ii) traditional school shoe. Three-dimensional marker trajectory and ground reaction force data were sampled at 250 and 1000 Hz, respectively. Continuous ankle and knee joint angles and moments, PFJ reaction force, and ankle power were compared between conditions using one-dimensional statistical parametric mapping paired t -tests ( α < 0.05). RESULTS: Walking in the flat, flexible school shoe resulted in a significant reduction in knee flexion (15%-35% of gait cycle, P < 0.001), knee extension moment (15%-40% of gait cycle, P < 0.001), and PFJ reaction force (15%-40% of gait cycle, P < 0.001) compared with the traditional school shoe. During running, knee flexion (10%-33% of gait cycle, P < 0.001), knee extension moment (15%-25% of gait cycle, P < 0.001), and PFJ reaction force (15%-25% of gait cycle, P < 0.001) were lower when wearing the flat, flexible school shoe compared with the traditional school shoe. CONCLUSIONS: PFJ reaction force is reduced when adolescents walk and run in a flat, flexible school shoe compared with a traditional school shoe. Flat, flexible school shoes may be an effective intervention to modulate biomechanical factors related to PFP.

Flat flexible school shoes for adolescents with patellofemoral pain: a randomised, assessor-blinded, parallel-group feasibility trial.

Objectives: To determine the feasibility of conducting a large-scale randomised controlled trial on the efficacy of flat, flexible school footwear versus traditional school footwear in adolescents (aged 12-18 years) with patellofemoral pain (PFP). Methods: Adolescents with PFP were recruited for this study. Participants were randomised to wear either a (1) flat, flexible school shoe or (2) a traditional school shoe. Participants wore the shoes as per school requirements for 12 weeks. Feasibility was assessed by (1) adherence to allocated shoe wear of ≥75% of total weekly school shoe wear time (recorded through weekly log sheets), (2) a recruitment rate of one participant per fortnight and (3) a dropout rate of ≤ 20%. Descriptive statistics were used for feasibility outcomes. Results: 24 adolescents (15 men, 9 women, mean (SD) age 14.3 (1.7) years) participated in this study. Two participants (8%) were lost to follow-up. The recruitment rate was 1.7 participants per fortnight. 11 of 12 participants (91%) in the flat flexible shoe group and 9 of 10 participants (90%) in the traditional shoe group met the minimum adherence for shoe wear. Mean weekly shoe wear was 20 (7.6) and 21 (4.5) hours per week in the flat, flexible, and traditional shoe groups, respectively. Conclusion: Our results indicate that progression to a full-scale randomised controlled trial is feasible based on the current protocol. A full-scale randomised controlled trial powered to detect estimates of treatment efficacy using flat, flexible school shoes versus traditional school shoes is warranted and will guide evidence-based management of adolescent PFP.

Evolution of Humoral and Cellular Immunity Post-Breakthrough Coronavirus Disease 2019 in Vaccinated Patients With Hematologic Malignancy Receiving Tixagevimab-Cilgavimab.

Background: In-depth immunogenicity studies of tixagevimab-cilgavimab (T-C) are lacking, including following breakthrough coronavirus disease 2019 (COVID-19) in vaccinated patients with hematologic malignancy (HM) receiving T-C as pre-exposure prophylaxis. Methods: We performed a prospective, observational cohort study and detailed immunological analyses of 93 patients with HM who received T-C from May 2022, with and without breakthrough infection, during a follow-up period of 6 months and dominant Omicron BA.5 variant. Results: In 93 patients who received T-C, there was an increase in Omicron BA.4/5 receptor-binding domain (RBD) immunoglobulin G (IgG) antibody titers that persisted for 6 months and was equivalent to 3-dose-vaccinated uninfected healthy controls at 1 month postinjection. Omicron BA.4/5 neutralizing antibody was lower in patients receiving B-cell-depleting therapy within 12 months despite receipt of T-C. COVID-19 vaccination during T-C treatment did not incrementally improve RBD or neutralizing antibody levels. In 16 patients with predominantly mild breakthrough infection, no change in serum neutralization of Omicron BA.4/5 postinfection was detected. Activation-induced marker assay revealed an increase in CD4+ (but not CD8+) T cells post infection, comparable to previously infected healthy controls. Conclusions: Our study provides proof-of-principle for a pre-exposure prophylaxis strategy and highlights the importance of humoral and cellular immunity post-breakthrough COVID-19 in vaccinated patients with HM.

High Rates of Seroprotection and Seroconversion to Vaccine-Preventable Infections in the Early Post-Autologous Stem Cell Transplant Period.

In patients early post-autologous stem cell transplant, seroprotection rates were high for Hemophilus influenzae type B and tetanus toxoid (70%-90%) but lower for Streptococcus pneumoniae (30%-50%) including after revaccination. There were high rates of seropositivity (67%-86%) to measles, mumps, and rubella and varicella zoster virus. Durability of protection requires assessment.

COVID-19 infection among patients with cancer in Australia from 2020 to 2022: a national multicentre cohort study.

Background: The global COVID-19 pandemic disproportionately affected certain populations and its management differed between countries. This national study describes characteristics and outcomes of COVID-19 in patients with cancer in Australia. Methods: We performed a multicentre cohort study of patients with cancer and COVID-19 from March 2020 to April 2022. Data were analysed to determine varying characteristics between cancer types and changes in outcomes over time. Multivariable analysis was performed to determine risk factors associated with oxygen requirement. Findings: 620 patients with cancer from 15 hospitals had confirmed COVID-19. There were 314/620 (50.6%) male patients, median age 63.5 years (IQR 50-72) and majority had solid organ tumours (392/620, 63.2%). The rate of COVID-19 vaccination (≥1 dose) was 73.4% (455/620). Time from symptom onset to diagnosis was median 1 day (IQR 0-3), patients with haematological malignancy had a longer duration of test positivity. Over the study period, there was a significant decline in COVID-19 severity. Risk factors associated with oxygen requirement included male sex (OR 2.34, 95% CI 1.30-4.20, p = 0.004), age (OR 1.03, 95% CI 1.01-1.06, p = 0.005); not receiving early outpatient therapy (OR 2.78, 95% CI 1.41-5.50, p = 0.003). Diagnosis during the omicron wave was associated with lower odds of oxygen requirement (OR 0.24, 95% CI 0.13-0.43, p < 0.0001). Interpretation: Outcomes from COVID-19 in patients with cancer in Australia over the pandemic have improved, potentially related to changing viral strain and outpatient therapies. Funding: This study was supported by research funding from MSD.

Robust SARS-CoV-2 T cell responses with common TCRαß motifs toward COVID-19 vaccines in patients with hematological malignancy impacting B cells.

Immunocompromised hematology patients are vulnerable to severe COVID-19 and respond poorly to vaccination. Relative deficits in immunity are, however, unclear, especially after 3 vaccine doses. We evaluated immune responses in hematology patients across three COVID-19 vaccination doses. Seropositivity was low after a first dose of BNT162b2 and ChAdOx1 (∼26%), increased to 59%-75% after a second dose, and increased to 85% after a third dose. While prototypical antibody-secreting cells (ASCs) and T follicular helper (Tfh) cell responses were elicited in healthy participants, hematology patients showed prolonged ASCs and skewed Tfh2/17 responses. Importantly, vaccine-induced expansions of spike-specific and peptide-HLA tetramer-specific CD4+/CD8+ T cells, together with their T cell receptor (TCR) repertoires, were robust in hematology patients, irrespective of B cell numbers, and comparable to healthy participants. Vaccinated patients with breakthrough infections developed higher antibody responses, while T cell responses were comparable to healthy groups. COVID-19 vaccination induces robust T cell immunity in hematology patients of varying diseases and treatments irrespective of B cell numbers and antibody response.

Australian secondary school principals', parents', and students' attitudes to prescribed school footwear guidelines.

BACKGROUND: Adolescents are often required to wear footwear that adheres to uniform guidelines at secondary school. There is a paucity of literature on factors influencing school footwear choice and what drives the development of school footwear guidelines. The aims of this study were to describe (i) current school footwear guidelines in secondary schools across Australia, (ii) factors that influence footwear choice in secondary school students and their parents, and (iii) principals, parents, and students' beliefs on factors which contribute to school footwear guidelines. METHODS: An online survey was distributed to principals, secondary school students (aged 14-19 years) and their parents across Australia. The survey included questions on current school footwear guidelines, factors influencing footwear choice (for students and parents), participants beliefs on the effect footwear has on musculoskeletal health, current and previous lower limb pain, and beliefs on factors that contribute to school footwear guidelines. Parent and student responses to factors that influence their footwear choice were compared using proportional odds logistic regression. Students and parents' responses to factors influencing footwear guidelines were compared to principal responses using proportional odds logistic regression. Significance was set at an alpha of < 0.05. RESULTS: Eighty principals, 153 parents and 120 secondary school students responded to the survey. 96% (77/80) of principals reported that their schools have set guidelines for school footwear. 88% of principals considered comfort to be important when developing school footwear guidelines. Proportional odds logistics regression showed that parents and students were 3.4 and 4.9 times more likely, respectively, than principals to rate comfort as being important when schools develop footwear guidelines. More than 40% of students reported experiencing musculoskeletal pain, and 70% of these students reported the pain to be exacerbated when in their school shoes. Less than a third of participants considered healthcare recommendations important to the development of footwear guidelines. CONCLUSIONS: Nearly all principals that participated in this survey had set guidelines for school footwear. There is a discord between parents, students, and principals on the importance that factors such as comfort, play in the development of school footwear guidelines.

Prospective comprehensive profiling of immune responses to COVID-19 vaccination in patients on zanubrutinib therapy.

Zanubrutinib-treated and treatment-naïve patients with chronic lymphocytic leukaemia (CLL) or Waldenstrom's macroglobulinaemia were recruited in this prospective study to comprehensively profile humoral and cellular immune responses to COVID-19 vaccination. Overall, 45 patients (median 72 years old) were recruited; the majority were male (71%), had CLL (76%) and were on zanubrutinib (78%). Seroconversion rates were 65% and 77% following two and three doses, respectively. CD4+ and CD8+ T-cell response rates increased with third dose. In zanubrutinib-treated patients, 86% developed either a humoral or cellular response. Patients on zanubrutinib developed substantial immune responses following two COVID-19 vaccine doses, which further improved following a third dose.

Outcomes After Lysis of Adhesions and Dilator Placement for Treatment of Vulvovaginal Agglutination Due to Lichen Planus.

OBJECTIVE: The aim of the study is to determine intraoperative and postoperative surgical outcomes for the treatment of vulvovaginal agglutination secondary to lichen planus (LP) following a standard protocol using intraoperative dilator placement and postoperative intravaginal steroid use. MATERIALS AND METHODS: This was a retrospective chart review of patients who underwent surgical management of vulvovaginal agglutination due to LP following a protocol that included surgical lysis of vulvovaginal adhesions, intraoperative dilator placement and removal 48 hours later, and high-potency intravaginal corticosteroid and regular dilator use thereafter. Demographic and clinical data were abstracted from the medical record and analyzed using descriptive statistics. RESULTS: Thirty-four patients, with mean age 51.2 ± 11 years and body mass index 32.8 ± 8.5 kg/m 2 , underwent lysis of vulvovaginal adhesions between 1999 and 2021 with 8 different surgeons at a single institution. The mean preoperative, immediate postoperative, and 6-week postoperative vaginal lengths were 2.8 ± 1.8 cm ( n = 18), 8.0 ± 1.9 cm ( n = 21), and 7.9 ± 2.2 cm ( n = 16), respectively. The mean estimated blood loss intraoperatively was 16 ± 15 mL. No patients had a documented surgical site infection or reoperation within 30 days after surgery. Of patients who had it documented ( n = 26), 70% (18/26) reported postoperative sexual activity. Where documented, 100% (18/18) reported preoperative dyspareunia, while 17% (3/18) did postoperatively. Six percent (2/34) had recurrent severe agglutination and 3% (1/34) underwent reoperation. CONCLUSIONS: Lysis of vulvovaginal adhesions, intraoperative dilator placement, and postoperative intravaginal corticosteroids with dilator use is a safe and effective treatment option to restore vaginal length for those with vulvovaginal LP.

Video analysis of anterior cruciate ligament injury situations in the women's Australian football league.

BACKGROUND: Anterior cruciate ligament (ACL) injury rates in the Women's Australian Football League (AFLW) are alarmingly high. Understanding injuries within their sporting context is important to develop effective injury prevention strategies, yet there is currently little knowledge of how ACL injuries occur to AFLW players. This study addressed the common scenarios and characteristics of AFLW ACL injuries. METHODS: Online match and AFLW club injury reports identified 38 ACL injury cases. After excluding injuries where footage was unavailable (i.e. training, pre-season games), a video analysis of 21 match ACL injuries from the 2017-2020 AFLW seasons was performed. We examined match characteristics, and the player's movements and body postures preceding and at the estimated time of injury. Descriptive frequencies and relative proportions were determined across the assessed categories. RESULTS: Non-contact ACL injuries were frequently observed (n = 13, 61.9%), while contact preceding the injury event (i.e. indirect contact) was also common (n = 10, 47.6%). The most common game situation was direct defence (i.e. defending an opponent in possession) (n = 14, 66.7%). Sidestep cutting was the most prevalent movement (n = 11, 52.4%), with this commonly performed while applying defensive pressure (n = 6 of 11, 54.6%). CONCLUSION: Sidestep cutting when applying defensive pressure is the most common non-contact ACL injury scenario in the AFLW. Preceding contact potentially contributing to a player's loss of balance was another prominent AFLW scenario. AFLW players may benefit from injury prevention programs emphasising appropriate sidestep cutting technique during reactive defensive scenarios, and maintenance of lower limb postures known to withstand knee loading relative to the sporting task.

Protocol for a randomised, assessor-blinded, parallel group feasibility trial of flat flexible school shoes for adolescents with patellofemoral pain.

BACKGROUND: There are limited evidence-based treatment options for adolescents with patellofemoral pain (PFP). Flat, flexible footwear have been shown to reduce patellofemoral joint loading and pain in adults with PFP. The efficacy of this intervention in adolescents with PFP is not established. The primary aim of this study is to determine the feasibility of conducting a large-scale randomised controlled trial (RCT) of the effect of flat, flexible school footwear, when compared to traditional school footwear, in adolescents with PFP. The secondary aim is to describe changes in self-reported outcome measures for adolescents with PFP while wearing flat, flexible footwear when compared to traditional school shoes. METHODS: Twenty-four adolescents with PFP will be recruited from the community. Following baseline assessment, participants will be randomly allocated to receive either (i) flat, flexible school footwear or, (ii) traditional school footwear. Participants will wear the shoe as per school requirements throughout a 12-week intervention period. Feasibility will be assessed with (i) ≥ 75% adherence to allocated shoe wear of their total weekly school wear time, (ii) a recruitment rate of one participant per fortnight, and (iii) a dropout rate of ≤ 20%. Patient reported outcome measures will describe changes in knee pain, function, quality of life and global rating of change at 6 and 12 weeks. Descriptive statistics will be used for the primary outcomes of feasibility. DISCUSSION: This study will determine the feasibility of conducting a large scale RCT evaluating the effect of flat, flexible school shoes for adolescents with PFP. A full-scale study will guide evidence-based management of adolescent PFP. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN12621001525875 , Date registered: 9th November 2021.

Epidemiology of injuries sustained in professional Australian netball: A three season cohort study.

OBJECTIVES: To report the medical attention and time-loss injury epidemiology of Australia's premier netball competition. DESIGN: Descriptive epidemiological study. METHODS: One-hundred and nineteen players in the Suncorp Super Netball league were under surveillance during three consecutive seasons (2017-2019), inclusive of pre-, in-, and post- season phases. Medical attention injuries were recorded by medical personnel, and additionally sub-categorised according to time loss. Injury incidence rates (IIR) and injury burden were calculated per 365 player contract days, with differences between season and season phase IIRs compared using negative binomial generated incidence rate ratios (IRR). RESULTS: Eight hundred and sixty-six medical attention injuries and 393 time-loss injuries were recorded. The majority of the players had multiple (≥2) medical attention (n = 92; 77.3%) and time-loss (n = 75, 63.0%) injuries reported. The ankle (n = 181; 20.9%), knee (n = 136; 15.7%) and foot (n = 98; 11.3%) were the body sites with the most frequently reported medical attention injuries. Overall, there was a comparable injury incidence rate between the pre-season and in-season periods (IRR = 1.13, 95%CI = 0.98-1.30, p = 0.0842), although variation in the injury burden was identified. Ankle tendon injuries (23.5 days absence) and knee joint injuries (44.9 days absence) the most burdensome injuries in the pre-season and in-season periods respectively. CONCLUSIONS: Lower limb injuries are the most frequent in professional level netball. Knee and ankle injuries are the most burdensome overall, however the type of injuries with a high burden vary between pre- and in-season periods. Time-loss, non-time loss and subsequent injuries are prominent in professional level netball.

A comparison of plantarflexor musculotendon unit output between plyometric exercises and running.

OBJECTIVES: Plyometric exercises are used to prevent and rehabilitate plantarflexor running injuries. To facilitate exercise programming, this study compared plantarflexor musculotendon output during running to plyometric exercises. DESIGN: Experimental study with cross-over. METHODS: Fourteen trained distance runners performed running, ankle bouncing, A-skips, bounding, and hurdle jumps. Three-dimensional motion capture and force plate data were collected and computational simulations used to calculate gastrocnemius lateralis and soleus musculotendon peak forces, strain, power generation and absorption, and total positive and negative work. Percentage difference and standardised mean differences were used to compare variables between plyometrics and running. Musculotendon units were classified as energy generators or absorbers according to their net mechanical work. RESULTS: Both plantarflexors behaved as net energy generators during running. Plantarflexor peak force and power generation and absorption were lower in the A-skip and ankle bounce compared to running. Soleus behaved as a net energy absorber during hurdle jumps, with greater total negative work (16.5%; standardised mean difference 0.92) and higher peak strain (0.3%; standardised mean difference 0.28) during hurdle jumps than running. Gastrocnemius lateralis behaved as a net energy absorber during bounding, with greater total negative work (63.8%; standardised mean difference 0.81) and peak strain (0.4%; standardised mean difference 0.77) during bounding than running. CONCLUSIONS: The ankle bounce and A-skip may be appropriate exercises when runners desire lower plantarflexor loads than running. Hurdle jumps elicited high soleus loads but low gastrocnemius lateralis loads, highlighting the disparate function of the plantarflexors. Bounding demanded high plantarflexor musculotendon output and may be suitable when eccentric overload is desired.

Effect of concurrent strength and endurance training on run performance and biomechanics: A randomized controlled trial.

This parallel-group randomized controlled trial investigated the effect of concurrent strength and endurance (CSE) training on running performance, biomechanics, and muscle activity during overground running. Thirty moderately trained distance runners were randomly assigned to 10-week CSE training (n = 15; 33.1 ± 7.5 years) or a control group (n = 15; 34.2 ± 8.2 years). Participants ran ≥30 km per week and had no experience with strength training. The primary outcome measure was 2-km run time. Secondary outcome measures included lower limb sagittal plane biomechanics and muscle activity during running (3.89 m s-1 and maximal sprinting); maximal aerobic capacity (V̇O2 max); running economy; and body composition. CSE training improved 2-km run time (mean difference (MD): -11.3 s [95% CI -3.7, -19.0]; p = 0.006) and time to exhaustion during the V̇O2 max running test (MD 59.1 s [95% CI 8.58, 109.62]; p = 0.024). The CSE training group also reduced total body fat (MD: -1.05 kg [95% CI -0.21, -1.88]; p = 0.016) while total body mass and lean body mass were unchanged. Hip joint angular velocity during the early swing phase of running at 3.89 m s-1 was the only biomechanical or muscle activity variable that significantly changed following CSE training. CSE training is beneficial for running performance, but changes in running biomechanics and muscle activity may not be contributing factors to the performance improvement. Future research should consider other possible mechanisms and the effect of CSE training on biomechanics and muscle activity during prolonged running under fatigued conditions.

Fertility and Pregnancy Outcomes After Conservative Management of Adenocarcinoma In Situ of the Cervix.

OBJECTIVE: The aim of the study was to evaluate the pregnancy outcomes of women who underwent conservative management of adenocarcinoma in situ (AIS). MATERIALS AND METHODS: We conducted a retrospective chart review of patients diagnosed with AIS at a single tertiary institution between January 1, 1991, and December 31, 2019. We collected demographic data, AIS-specific information, and fertility outcomes and performed bivariate analyses to compare demographic characteristics and AIS-specific information between patients with and without hysterectomy after diagnosis. Patients with conservative management who achieved pregnancy were described. RESULTS: Among 87 patients with AIS, 38 (44%) underwent a hysterectomy within 6 months of diagnosis and 49 (56%) underwent conservative management. Six of 19 patients (32%) had residual AIS despite undergoing definitive management after an excisional procedure with negative margins and negative endocervical curettage (ECC). Nine of 19 patients (47%) had residual AIS after an excisional procedure with positive margins and/or a positive ECC. Patients who opted for conservative management were younger (median = 31.6 [interquartile range = 27.4-34.9] vs 38.5 y [32.3-44.8 y], p < .001) and nulligravid. Among patients with conservative management, there were 15 pregnancies and 14 live births (29%). Seven were preterm, although 2 were for medical indications. CONCLUSIONS: Residual AIS in patients with negative margins and ECC leading to definitive hysterectomy (32%) and the rate of preterm birth (36%) were higher than previous reports and nationally reported rates. However, only 1 patient had a preterm birth before 34 weeks. These findings reflect important information for counseling patients who elect for conservative management of AIS.

Cytomegalovirus Infection in Pregnancy: Prevention, Presentation, Management and Neonatal Outcomes.

Congenital cytomegalovirus (cCMV) is the most common congenital infection in the United States, with 1 of 200 live births affected. It is the leading viral cause of intrauterine fetal demise and miscarriage. It is a common cause of neonatal hearing loss, second only to genetic factors. Yet, health care provider awareness remains low. The purpose of this article is to provide a brief overview of the epidemiology, presentation, diagnosis, and treatment of antenatal cytomegalovirus (CMV) infection and cCMV in the neonate. Maternal CMV infection in pregnancy often presents with mild cold-like symptoms or is asymptomatic. The virus can be vertically transmitted to a growing fetus, the risk of transmission and severity of fetal impact varying by timing of exposure during pregnancy. Most neonates born with cCMV show no signs at birth, yet 15% to 25% will have long-term adverse neurodevelopmental conditions. Misconceptions that cCMV cannot be prevented or that neonates born without signs of the disease will be unaffected are common. Evidence supporting antenatal education around behavioral change to lower a woman's risk of acquiring CMV during pregnancy is mounting. CMV infection during pregnancy should be co-managed with a maternal-fetal medicine specialist. There is early evidence for the use of antiviral medication in reducing risk of vertical transmission. Identification of cCMV during pregnancy may help ensure the neonate receives timely treatment after birth. Midwives can play an important role in providing antenatal education about cCMV risk reduction and in initiating a diagnostic evaluation when there is clinical suspicion.