FIFA Sudden Death Registry (FIFA-SDR): a prospective, observational study of sudden death in worldwide football from 2014 to 2018.

OBJECTIVE: To investigate the underlying causes and regional patterns of sudden death in football (soccer) players worldwide to inform and improve existing screening and prevention measures. METHODS: From 2014 to 2018 cases of sudden cardiac death (SCD), survived sudden cardiac arrest (SCA) and traumatic sudden death were recorded by media monitoring (Meltwater), a confidential web-based data platform and data synchronisation with existing national Sudden Death Registries (n=16). Inclusion criteria were met when sudden death occurred during football-specific activity or up to 1 hour afterwards. Death during other activities was excluded. RESULTS: A total of 617 players (mean age 34±16 years, 96% men) with sudden death were reported from 67 countries; 142 players (23%) survived. A diagnosis by autopsy or definite medical reports was established in 211 cases (34%). The leading cause in players >35 years was coronary artery disease (76%) and in players ≤35 years was sudden unexplained death (SUD, 22%). In players ≤35 years the leading cause of SCD varied by region: cardiomyopathy in South America (42%), coronary artery anomaly in North America (33%) and SUD in Europe (26%). Traumatic sudden death including commotio cordis occurred infrequently (6%). Cardiopulmonary resuscitation (CPR) resulted in a survival rate of 85% with the use of an automated external defibrillator (AED) compared with 35% without. CONCLUSIONS: Regional variation in SCD aetiology should be verified by expansion of national registries and uniform autopsy protocols. Immediate access to an AED at training and competition sites, as well as CPR training for players, coaches and staff members, is needed to improve survival from SCA.

RegentK and Physiotherapy Support Knee Function after Anterior Cruciate Ligament Rupture without Surgery after 1 Year: A Randomized Controlled Trial.

BACKGROUND: Recent data have opened the debate on whether conservative treatment of anterior cruciate ligament (ACL) rupture might be an alternative treatment option to surgery. In a previous study, such a conservative treatment, i.e. 'Regenerative Therapy According to Mohammed Khalifa' (RegentK), had shown good effects over physiotherapy. METHODS: This was a randomized controlled trial assessing the efficacy of 1 session of RegentK compared to the myofascial mobilization technique (MMT), another type of intensive physiotherapy, in 20 patients with fresh ACL rupture during the previous 4 weeks. The International Knee Documentation Committee (IKDC) 2000 score was measured before, immediately after, and 3 months after treatment, and 1 year later; magnetic resonance imaging (MRI) data were taken before treatment and 1 year after treatment. RESULTS: Both groups were comparable at baseline. A repeated measures analysis of variance showed a strong effect of time (p < 0.0001; partial η2 = 0.81) and no significant interaction or group effect. Both groups reached near full function after 1 year. The IKDC score was 90.9 (standard deviation (SD) 6.7; 95% confidence interval (CI) 86.2-95.6) for the RegentK group and 93.3 (SD 3.1; 95% CI 91.1-95.5) for the MMT group. CONCLUSION: One treatment session of enhanced MMT physiotherapy or RegentK can lead to nearly full function and thus recovery of a ruptured ACL after 1 year.

Lead-Free Multilayer Piezoceramic Composites: Effect of Cosintering on Electromechanical Properties.

The macroscopic electromechanical behavior of lead-free multilayer composites was characterized from room temperature to 150 °C. The polar seed component consisted of a nonergodic relaxor (Bi1/2Na1/2)TiO3-7BaTiO3, with an electric-field-induced long-range ferroelectric order, whereas the nonpolar matrix was an ergodic relaxor Bi0.5(Na0.75K0.25)0.5 TiO3-6BiAlO3 that undergoes a reversible electric-field-induced macroscopic nonpolar-to-polar transition. Microstructural evidence of the effects of cosintering are demonstrated through examination of grain size, interdiffusion, and pore structure. By manipulating the sintering interactions between the two constituents, namely, diffusion paths and residual stresses, both internal mechanical and electrical fields, as well as compositional gradients can be used to enhance the unipolar strain over that expected by a rule of mixtures approximation, thereby improving the properties needed for application of such materials to actuator systems.

[RegentK Improves the Gait Mechanics of Patients with Acute Anterior Cruciate Ligament Rupture Immediately after Application: Clinical Trial].

BACKGROUND: The purpose of this study was to investigate the immediate response to RegentK (Regeneration-Therapy by Khalifa) of patients with an acute rupture of the anterior cruciate ligament (ACL), regarding the gait mechanics and functional tests, in comparison to norm data. PATIENTS AND METHODS: 9 male patients with an acute unilateral ACL rupture underwent an orthopedic exam and gait analysis immediately before and after the 1-h RegentK treatment; the results were compared to norm data of 10 healthy participants matched with the RegentK group for age and body mass index. An infrared camera system collected kinematic gait data on the injured limb; the gait kinetics were recorded with 2 force plates. RESULTS: Immediately after the treatment, significant improvements with regard to limping, the quadriceps knee force, and the passive knee range of motion (ROM) occurred. The gait characteristics showed a significantly increased gait velocity (+0.17 m/s), step frequency (+8 steps/min), and injured-limb step length (+5 cm). The faster gait velocity involved increased sagittal ankle and hip ROM, increased maximal vertical ground reaction forces, internal ankle plantar flexion and hip flexion moments. CONCLUSIONS: RegentK seems to immediately affect functional parameters such as passive knee joint motion and quadriceps strength and seems to enable patients to walk more dynamically, generally expressed through an increased walking speed.

Two Cases of Rhabdomyolysis After Training With Electromyostimulation by 2 Young Male Professional Soccer Players.

We report 2 cases of enormously elevated creatine kinase (CK) activity after training with electromyostimulation (EMS) by 2 young male professional soccer players. In one of them, a single training session with EMS caused exercise-induced rhabdomyolysis with a maximal CK activity of 240 000 U/L. These cases illustrate that unaccustomed EMS exercise may be harmful and can cause rhabdomyolysis even in highly trained athletes and even after 1 single session. Thus, EMS has to be conducted carefully especially by individuals who are known to frequently show notable increases in CK activity even after modest training stimuli. We suggest that EMS should not be applied as sole training stimulus and should not be conducted by strength training beginners. Furthermore, we recommend controlling plasma CK activity and urine color for beginners with EMS when they report strong muscle ache. Athletes with signs of rhabdomyolysis after EMS should be brought to hospital for monitoring of renal function and possible further treatment.

Manual khalifa therapy improves functional and morphological outcome of patients with anterior cruciate ligament rupture in the knee: a randomized controlled trial.

Rupture of the anterior cruciate ligament (ACL) is a high incidence injury usually treated surgically. According to common knowledge, it does not heal spontaneously, although some claim the opposite. Regeneration therapy by Khalifa was developed for injuries of the musculoskeletal system by using specific pressure to the skin. This randomized, controlled, observer-blinded, multicentre study was performed to validate this assumption. Thirty patients with complete ACL rupture, magnetic resonance imaging (MRI) verified, were included. Study examinations (e.g., international knee documentation committee (IKDC) score) were performed at inclusion (t 0). Patients were randomized to receive either standardised physiotherapy (ST) or additionally 1 hour of Khalifa therapy at the first session (STK). Twenty-four hours later, study examinations were performed again (t 1). Three months later control MRI and follow-up examinations were performed (t 2). Initial status was comparable between both groups. There was a highly significant difference of mean IKDC score results at t 1 and t 2. After 3 months, 47% of the STK patients, but no ST patient, demonstrated an end-to-end homogeneous ACL in MRI. Clinical and physical examinations were significantly different in t 1 and t 2. ACL healing can be improved with manual therapy. Physical activity can be performed without pain and nearly normal range of motion after one treatment of specific pressure.

Sudden cardiac death in football.

Football is the most popular sport worldwide and includes the largest population of sports participants, especially in the field of recreational sport. It remains controversial whether football represents a sport discipline with a particular high risk of sudden cardiac death (SCD). The true incidence of SCD among football players is not known due to a lack of football-specific studies. In particular, recreational football players over an age of 35 years with a predominance of coronary artery disease (CAD) who do not exercise regularly are exposed to a higher risk of SCD. Surprisingly, the few European studies that included football as a sport discipline, showed that CAD already plays an important role in the young athlete. Potential pathophysiological mechanisms in football that may lead to a higher risk of SCD include the high release of catecholamines, increased platelet aggregation, dehydration and electrolyte disturbances. Establishment of sport-specific and national registers for SCD should certainly contribute to a better understanding of this highly important topic.