Is absolute or relative knee flexor strength related to patient-reported outcomes in patients treated with ACL reconstruction with a hamstring tendon autograft? An analysis of eccentric Nordic hamstring strength and seated concentric isokinetic strength.

BACKGROUND: There is a need for better understanding of how knee flexor strength influence patient-reported outcomes (PROs) after anterior cruciate ligament (ACL) reconstruction. Our aim was to investigate the relationship between the eccentric NordBord test and the seated concentric Biodex test with PROs, during the first year of rehabilitation after ACL reconstruction with hamstring tendon (HT) autograft. METHODS: Patients with an index ACL reconstruction with an HT autograft participating in a rehabilitation registry were screened for inclusion. Outcomes of interest were the correlation between absolute (N/kg or Nm/kg) and relative (limb symmetry index) knee flexor strength measured in the NordBord and Biodex with the results of PROs. The significance level was set at p < 0.05 and Pearson's correlation coefficient was used. RESULTS: 137 patients were included (47% women) with a mean age of 24.8 ± 8.4 years. There were non-significant and weak correlations between relative strength for all PROs. Significant and weak correlations between absolute strength in the Biodex with the Knee Self-Efficacy Scale18 (K-SES18) present at 4 and 8 months, and for the ACL-Return to Sport after Injury scale (ACL-RSI) at 12 months was observed, accounting for 8.4-15.7% of the variance. Significant and weak correlations between absolute strength in the Nordbord with the Knee injury and Osteoarthritis Outcome Scale subscale Sports and Recreation at 4 months, the K-SES18 present and the ACL-RSI at 8 months were observed, accounting for 9.4-14.4% of the variance. CONCLUSION: Absolute knee flexor strength relative to bodyweight for both the Biodex and NordBord test appeared to have a stronger relationship with perceived knee function than relative knee flexor strength, although the observed correlations were weak.

A clinician-friendly test battery with a passing rate similar to a 'gold standard' return-to-sport test battery 1 year after ACL reconstruction: Results from a rehabilitation outcome registry.

OBJECTIVES: To 1) present passing rates for different clinician-friendly (CF) test batteries and 2) determine the relationship between passing CF test batteries and passing gold standard (GS) return-to-sport (RTS) muscle function testing, 1 year after ACL reconstruction. STUDY DESIGN: Cross-sectional registry study, level of evidence: 3. SETTING: Primary care. PARTICIPANTS: Data from 588 patients (52% women, mean age 29.3 ± 9.8 years) were extracted from the Project ACL registry. MAIN OUTCOME MEASURES: The passing rates for the different test batteries. RESULTS: The passing rate for GS test battery was 28% (95% CI, 24-32%) and the passing rate for the CF test battery with the lowest passing rate was 27% (95% CI 24-31%). The two CF test batteries with the strongest relationships with passing GS test battery showed that 51% (95% CI 43-59%) and 49% (95% CI 44-55%) of the patients who passed the respective CF test battery also passed the GS test battery. CONCLUSION: A CF test battery can be as demanding to pass as a GS test battery, 1 year after ACL reconstruction. However, passing a CF test battery only gives patients a chance similar to a "coin flip" of also passing a GS RTS test battery.

Non-steroidal anti-inflammatory drugs in football - a "Keeping SCORE" approach to judicious use.

Non-steroidal anti-inflammatory drug (NSAID) use in elite sport is high, with football being no exception. Increased awareness of significant adverse drug reactions from published research and retired players commentary in the media have made the topic mainstream. Despite this increased awareness, usage rates show no sign of significantly reducing. Footballers, like all elite athletes are focused on maximising their performance and potential - even at the expense of their long-term health. An educational intervention prior to the 2010 FIFA Men's World Cup aimed at reducing rates was ineffective, suggesting that education alone is not the answer. Our author group propose a 'safer use' rather than 'no use' of NSAIDs in football. A 'Keeping SCORE' approach is suggested, designed as a prescribing aid. The approach guides medical staff towards focusing on Safety checks, Clinical indication/judgement, Open dialogue, Recording, and Evaluation.

Sport-related concussion return-to-play practices of medical team staff in elite football in the United Kingdom.

INTRODUCTION: This study explored sport-related concussion (SRC) return-to-play (RTP) behaviours and attitudes of medical team staff working in elite football in the United Kingdom. Usage and awareness of The Football Association (FA) guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. Additionally, confidence in managing RTP post-SRC, perceived player under-reporting of symptoms, use of enhanced RTP pathways, and coaching pressure on RTP were investigated. METHODS: A cross-sectional questionnaire study was distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. RESULTS: A total of 112 responses were gathered. High awareness rates of the FA guidelines were found (96%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 80% of respondents with 93% feeling very confident or confident in managing the RTP of a player with a SRC. 60% rarely or never experienced coaching pressure around player RTP, and 24% felt players always or very often under-reported symptoms to expedite their return. 90% had a moderate to high confidence in the Sport Concussion Assessment Tool-5 (SCAT-5) as a RTP decision tool, and 66% always or very often used an enhanced RTP pathway. CONCLUSION: Confidence in managing player RTP post SRC and use of enhanced RTP pathways were high, as was confidence in the SCAT-5 as a RTP decision tool. Respondents raised concerns around player under-reporting of symptoms to accelerate RTP post-SRC, and perceived coaching pressure around decision making.

Sport-related concussion practices of medical team staff in elite football in the United Kingdom, a pilot study.

OBJECTIVES: To explore sport-related concussion (SRC) awareness, behaviours, and attitudes of medical team staff working in elite football in the United Kingdom. Including usage and awareness of the FA concussion guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. METHODS: Cross-sectional questionnaire study distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. RESULTS: 120 responses were gathered. High awareness rates of the FA guidelines were found (97%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 78%. Of those, 99% collected SCAT5 with low rates of other neuro-psychometric testing (17%). Confidence of pitch-side SRC recognition was high (93% feeling very confident or confident). Introduction of a 'concussion' substitute was seen as strongly positive for player welfare (85% strongly agreeing or agreeing). CONCLUSIONS: Awareness of FA concussion guidelines, and collection of SCAT5 baseline testing was high. Player and coaching staff concussion education rates were low, as was the use of neuro-psychometric testing beyond the use of the SCAT5. There was strong support the introduction of a 'concussion' substitute being a positive thing for player welfare.

Recovery of preoperative absolute knee extension and flexion strength after ACL reconstruction.

BACKGROUND: The recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstruction is most commonly reported as limb-to-limb differences using the Limb Symmetry Index (LSI), which is not free from limitations. The purpose of this study was to compare the proportion of patients who recover their Preoperative Absolute Muscle Strength (PAMS) 8 and 12 months after ACL reconstruction with the proportion of patients who recover their symmetrical knee strength. A secondary aim was to assess the relationship between psychological Patient-Reported Outcomes (PROs) and recovering PAMS at 8 and 12 months after ACL reconstruction and rehabilitation. METHOD: Preoperative, 8- and 12-month results from quadriceps and hamstring strength tests and PROs for 117 patients were extracted from a rehabilitation registry. Individual preoperative peak torques from strength tests were compared with results from the 8- and 12-month follow-ups respectively. Patients were defined as having recovered their PAMS upon reaching 90% of their preoperative peak torque for both quadriceps and hamstring strength. Patients were defined as having recovered their LSI upon reaching a value ≥90% when comparing the results for their injured knee with those of their healthy knee. Correlations between the recovery of PAMS and PROs at 8 and 12 months were analyzed. RESULTS: There was no difference in the proportion of patients who recovered their PAMS compared with patients who recovered their LSI. In all, 30% and 32% of the patients who recovered their LSI had not recovered their PAMS at 8 months and 12 months respectively. In the patients who had recovered their PAMS, 24% and 31% had not recovered their symmetrical LSI at 8 months and 12 months respectively. There was no significant correlation between the recovery of PAMS and psychological PROs. CONCLUSION: The use of both PAMS and LSI provides more detailed information on the recovery of muscle strength after ACL reconstruction. The recovery of PAMS was not correlated with psychological traits, which implies that both PROs and PAMS are important when evaluating patients after ACL reconstruction. TRIAL REGISTRATION:  This trial was not registered.

Behavioral facilitation and increased brain responses from a high interference working memory context.

Many real-life situations require flexible behavior in changing environments. Evidence suggests that anticipation of conflict or task difficulty results in behavioral and neural allocation of task-relevant resources. Here we used a high- and low-interference version of an item-recognition task to examine the neurobehavioral underpinnings of context-sensitive adjustment in working memory (WM). We hypothesized that task environments that included high-interference trials would require participants to allocate neurocognitive resources to adjust to the more demanding task context. The results of two independent behavioral experiments showed enhanced WM performance in the high-interference context, which indicated that a high-interference context improves performance on non-interference trials. A third behavioral experiment showed that when WM load was increased, this effect was no longer significant. Neuroimaging results further showed greater engagement of inferior frontal gyrus, striatum, parietal cortex, hippocampus, and midbrain in participants performing the task in the high- than in the low-interference context. This effect could arise from an active or dormant mode of anticipation that seems to engage fronto-striatal and midbrain regions to flexibly adjust resources to task demands. Our results extend the model of conflict adaptation beyond trial-to-trial adjustments by showing that a high interference context affects both behavioral and biological aspects of cognition.

Medication and Supplement Use in Disability Football World Championships.

BACKGROUND: Individuals with an impairment comprise more than 15% of the world's population, many of whom can benefit greatly from participation in sport. The provision of medical services in disability sport is a challenging area with a lack of scientific evidence. Given the positive impact that sport can have on the people with an impairment, it is vital that measures are taken to better understand the medical issues posed by disability sport. It is well established that medications and supplements are overused in sport, particularly within professional football, but there is no current evidence on medication or supplement use in elite disability football. OBJECTIVE: To examine and describe the use of medication and supplements in disability football, before and during international tournaments, and to identify the profile of substances used by category. DESIGN: Prospective, descriptive, cohort study. SETTING: International Blind Sport Association Football World Cup 2015 and the International Federation of Cerebral Palsy Football World Cup 2015. PARTICIPANTS: Two hundred forty-two elite-level disability footballers, classified with B1 visual impairment or cerebral palsy. METHODS: Team clinicians were asked to document all medication and supplements taken in the 48 hours before each match. RESULTS: This study recorded the use of 1648 substances in 242 players, with more than one half (53.1%) classified as supplements. There was an overall rate of 1.26 substances used per player per match and a medication use rate of 0.59 medications per player per match. Seventy percent (170/242) of players reported using at least one substance per tournament, with 57.9% (140/242) using at least one prescribed medication (63.6% of players at International Blind Sports Association World Games and 57.7% of players at International Federation of Cerebral Palsy World Cup). The most commonly prescribed category of medications was nonsteroidal anti-inflammatory drugs, representing 39.3% of all reported medications. CONCLUSION: This study highlights the potential overuse of medication and supplements in disability football, particularly in the use of nonsteroidal anti-inflammatory drugs. These trends are comparable to previous research in Fédération Internationale de Football Association World Cup competitions. LEVEL OF EVIDENCE: Not applicable.

Twice recurrent gallstone ileus: a case report.

INTRODUCTION: Gallstone ileus is a rare cause of bowel obstruction and results from the passage of gallstones into the bowel. CASE PRESENTATION: We present the case of an 83-year-old Caucasian woman who had three episodes of gallstone ileus, each of which was managed with simple enterotomy. This sequence is one of the first reported in the medical literature and may be seen to challenge the traditional surgical approach of enterotomy alone. CONCLUSIONS: The available evidence comparing enterotomy alone with combined enterotomy, cholecystectomy, and fistula closure in the management of gallstone ileus is reviewed. Neither approach is clearly identified as superior, but available series suggest that simple enterotomy may be safer than a combined approach and does not result in a higher rate of recurrent biliary disease.

Intolerance to ambient odors at an early stage of pregnancy.

Adverse reactions to ambient odorous and pungent substances in daily activities among pregnant women who are half-way through pregnancy, and changes in odor perception at predominantly an early stage of pregnancy motivated the present study of odor intolerance at an early pregnancy stage. Ninety-five women averaging gestational week 11 and 102 non-pregnant women were compared with the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). General environmental intolerance was assessed with items from the Noise Sensitivity Scale that are analogous to the CSS-SHR ("NSS-SHR"). Pregnant women were found to have higher scores on the CSS-SHR, but not on the "NSS-SHR". This suggests an odor intolerance that affects pregnant women's daily activities, which appears not to be due to a general environmental intolerance. The effect size of pregnancy on CSS-SHR score is larger in the present study of early pregnancy than in the previous study of women half-way through pregnancy.

Laterality of the olfactory event-related potential response.

In experimental practice, odors are commonly applied to only one nostril for recordings of olfactory event-related potentials (OERPs), but the lateralization aspect of the OERP response is unclear regarding both stimulated nostril and cortical topography. The purpose of the present study was to investigate whether stimulated-nostril side affects OERP amplitudes and latencies and whether these potentials indicate lateralization of brain response in healthy, right-handed, young adults. OERPs were recorded from nine electrode sites in response to monorhinal stimulation with amyl acetate in 28 participants. The results showed a general increase in amplitude from frontal to parietal electrode sites (in particular for N1/P3) and generally larger amplitudes on the left hemisphere and midline than on the right hemisphere. There was no main effect of stimulated-nostril side on amplitude. Interactions indicated that N1/P2 amplitude was larger for left- than right-nostril stimulation and larger on the left hemisphere and midline than on the right hemisphere in left-nostril stimulation. No main effect or interactions of stimulated-nostril side over latencies were found and no effects on latencies of sagittal or coronal sites. These findings suggest a general parietal, left-hemisphere predominance in response amplitude to odorous stimulation and imply that either the left or the right nostril may be sufficient for accurate assessment of OERP latency in right-handed, young adults.

Altered food intake and taste perception in children with cancer after start of chemotherapy: perspectives of children, parents and nurses.

GOALS OF WORK: The purpose of this study was to better understand various variables related to food intake and eating problems in children with cancer during their chemotherapy. PATIENTS AND METHODS: Twenty-two consecutively admitted children, diagnosed with cancer and undergoing chemotherapy, participated in this study. Twenty-one of them, their parents and attending nurses participated in semi-structured interviews. Ten of the children underwent a taste acuity test, and recognition thresholds for the four basic tastes were determined. MAIN RESULTS: The shared view of both children and parents was that altered taste was the predominant cause of the eating problems. In contrast, the nurses perceived that nausea was the most important cause of the children's eating problems. In addition, psychological aspects such as learned food aversions and negative attitudes towards hospital food were regarded as important by children, parents and nurses. The taste test showed that the patients had higher thresholds for bitter taste and made more taste recognition errors compared to controls. CONCLUSIONS: Changes seem to exist both in the primary gustatory sense as well as in food perception in paediatric cancer patients undergoing chemotherapy. Single solutions, such as efforts to serve "tasty food", do not suffice alone. A more effective solution may be to combine different strategies and combinations of oral, enteral and parenteral nutrition should be considered to prevent malnutrition.

Olfactory and chemosomatosensory function in pregnant women assessed with event-related potentials.

The purpose of the study was to better understand past findings of nasal chemosensory hypersensitivity in pregnant women by recording chemosensory event-related potentials (CSERPs) for information about cortical neuronal allocation (amplitudes) and temporal processing (latencies) of three concentrations of pyridine ranging from predominantly olfactory to trigeminal in activation in 15 pregnant and 15 non-pregnant women. CSERP components of primarily sensory (N1 and P2) and cognitive (P3) origin were evaluated. The results displayed no group differences in either N1 or P2 amplitudes or latencies, but tendencies of larger amplitudes and shorter latencies for P3 in pregnant women. This implies that pregnant women's hypersensitivity may more likely be referred to cognitive than sensory processing.

Environmental odor intolerance in pregnant women.

Previous findings indicating that pregnant women experience a shift in odor sensitivity and hedonics raise the question of whether these changes evoke adverse reactions to odorous and pungent environmental substances in daily activities, to a larger extent in pregnant than in nonpregnant women. Forty-four women in pregnancy weeks 21-23 and 44 nonpregnant women were therefore compared with respect to affective reactions to and behavioral disruptions by odorous/pungent daily environments by means of the questionnaire-based, 21-item Chemical Sensitivity Scale (CSS). This scale refers to neurasthenic and sensory/somatic symptoms and includes the 11 items of the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). This latter scale refers predominantly to sensory/somatic symptoms. To investigate whether there is a general environmental hypersensitivity during pregnancy, the Noise Sensitivity Scale (NSS) was used that is analogous to the CSS (including 11 NSS items corresponding to those of the CSS-SHR; "NSS-SHR"). Results show that the two groups were similar with respect to scores on both the CSS and NSS, whereas the pregnant women had higher scores than the nonpregnant women on the CSS-SHR, but not on the "NSS-SHR". These results suggest that pregnant women to a larger extent than nonpregnant women manifest an odor intolerance that affects their daily activities, with predominantly sensory/somatic symptoms, which appears not to be due to a general environmental hypersensitivity. This behavior may have embryo- and maternal-protective functions.

A longitudinal descriptive study of self-reported abnormal smell and taste perception in pregnant women.

Self-reported abnormal sensitivity, qualitative distortions and phantom sensations with respect to smell and taste was assessed with a longitudinal design, based on questions referring to gestational weeks 13-16 and 31-34 of pregnancy in comparison with 9-12 weeks post partum and with non-pregnant women with corresponding time durations and intervals. The results show that abnormal smell and/or taste perception was reported by 76% of the pregnant women, typically believed to be caused by their pregnancy. Increased smell sensitivity was found to be very common at the early stage of pregnancy (67% of all pregnant respondents) and occasionally accompanied by qualitative smell distortions (17%) and phantom smells (14%). The smell abnormalities were less common at the late pregnancy stage and almost absent post partum. Abnormal taste sensitivity was fairly commonly reported (26%), often described as increased bitter sensitivity and decreased salt sensitivity. These results, suggesting that abnormal smell and/or taste perception is experienced by a large majority of pregnant women, imply that further research is needed to understand to what extent these chemosensory changes may underlie food aversions and craving with implications for food intake during pregnancy.