Comparative speed of kill provided by lotilaner (Credelio™), sarolaner (Simparica Trio™), and afoxolaner (NexGard™) to control Amblyomma americanum infestations on dogs.

BACKGROUND: Canine acaricides with rapid onset and sustained activity can reduce pathogen transmission risk and enhance pet owner experience. This randomized, complete block design, investigator-masked study compared the speed of kill of Amblyomma americanum provided by three monthly-use isoxazoline-containing products. METHODS: Eight randomized beagles per group were treated (day 0), per label, with sarolaner (combined with moxidectin and pyrantel, Simparica Trio™), afoxolaner (NexGard™), or lotilaner (Credelio™), or remained untreated. Infestations with 50 adult A. americanum were conducted on days - 7, - 2, 21, and 28, and tick counts were performed on day - 5 (for blocking), and at 4, 8, 12, 24, 48, and 72 h following treatment and subsequent infestations. Efficacy calculations were based on geometric mean live tick counts. A linear mixed model was used for between-group comparisons. RESULTS: On day 0, only lotilaner significantly reduced an A. americanum infestation by 12 h (43.3%; P = 0.002). Efficacy of lotilaner and afoxolaner at 24 h post-treatment was 95.3% and 97.6%, respectively, both significantly different from sarolaner (74%) (P = 0.002, P < 0.001, respectively). On day 21, at 12 h postinfestation, lotilaner efficacy (59.6%) was significantly different from sarolaner (0.0%) (P < 0.001) and afoxolaner (6.3%) (P < 0.001). At 24 h, lotilaner efficacy (97.4%) was significantly different (P < 0.001) from sarolaner and afoxolaner (13.6% and 14.9%, respectively). On day 28, at 12 h postinfestation, lotilaner efficacy (47.8%) was significantly different from sarolaner (17.1%) (P = 0.020) and afoxolaner (9.0%) (P = 0.006). At 24 h, lotilaner efficacy (92.3%) was significantly different from sarolaner 4.9% (P < 0.001) and afoxolaner (0.0%) (P < 0.001). Speed of kill for sarolaner and afoxolaner, but not lotilaner, significantly declined over the study period. Following reinfestation on day 28, neither sarolaner nor afoxolaner reached 90% efficacy by 48 h. By 72 h, sarolaner efficacy was 97.4% and afoxolaner efficacy was 86.3%. Only lotilaner achieved ≥ 90% efficacy by 24 h post-treatment and 24 h postinfestation on days 21 and 28. Time to ≥ 90% efficacy following new infestations consistently occurred 24-48 h earlier for lotilaner compared with sarolaner or afoxolaner. CONCLUSIONS: Credelio (lotilaner) has a more rapid onset of acaricidal activity against A. americanum than Simparica Trio (sarolaner-moxidectin-pyrantel) and NexGard (afoxolaner). Only lotilaner's speed of tick kill is sustained throughout the dosing period.

Force-plate derived predictors of lateral jump performance in NCAA Division-I men's basketball players.

A lateral jump assessment may provide unique benefits in sports such as basketball that require multidirectional performance optimization. This study aimed to examine selected force-plate derived metrics as predictors of lateral jump task distance in men's basketball players. Twenty-two NCAA Division-I men's basketball players (19.4 ± 1.3 years, 95.0 ± 12.5 kg, 196.5 ± 8.1 cm) each performed six single leg lateral jumps while standing on a force plate (1200 Hz, Kistler Instrument Corp). The lateral jump task involved the subject beginning by standing on the force plate and jumping sideways off one foot and then landing on the floor with the opposite foot. Three-dimensional ground reaction force curves were used to identify the eccentric and concentric phases of the jump and variables were computed each from the lateral (y), vertical (z), and resultant (r) force traces. Peak ground reaction force (pGRF), ground reaction force angle (θr), eccentric braking rate of force development (ECC-RFD), average concentric force (CON-AVG), total jump duration, eccentric phase duration, and eccentric to total time ratio were evaluated for predictive ability. Three regression models were able to significantly (p<0.05) predict jump distance: (1) pGRFy, pGRFz, and θr (p<0.001, R2 = 0.273), (2) Relative pGRFy, Relative pGRFz, and θr ((p<0.001, R2 = 0.214), and (3) Relative CON-AVGy and Relative pGRFr (p<0.001, R2 = 0.552). While several force plate-derived metrics were identified as significant predictors, a model with Relative CON-AVGy and Relative pGRFr explained a greater variability in performance (R2 = 0.55) compared to the other variables which were low, yet also significant. These results suggest that lateral ground reaction forces can be used to evaluate lateral jump performance with the use of three-dimensional force plates. The identified predictors can be used as a starting point for performance monitoring, as basketball training interventions can be directed at specific improvements in the identified metrics.

Isometric Knee Strength is Greater in Individuals Who Score Higher on Psychological Readiness to Return to Sport After Primary Anterior Cruciate Ligament Reconstruction.

Background: Anterior cruciate ligament (ACL) injury is extremely common among athletes. Rate of second ACL injury due to surgical graft rupture or contralateral limb ACL injury is approximately 15-32%. Psychological readiness to return to sport (RTS) may be an important predictor of successful RTS outcomes. Psychological readiness can be quantified using the ACL Return to Sport after Injury (ACL-RSI) questionnaire, with higher scores demonstrating greater psychological readiness. Purpose: The purpose of this study was to investigate differences in functional performance and psychological readiness to return to sport among athletes who have undergone primary ACL reconstruction (ACLR). Study Design: Descriptive cohort study. Methods: Eighteen athletes who had undergone primary ACLR were tested at time of RTS clearance. The cohort was divided into two groups, high score (HS) and low score (LS), based on median ACL-RSI score, and performance on static and dynamic postural stability testing, lower extremity isokinetic and isometric strength testing, and single leg hop testing was compared between the groups using an independent samples t-test. Results: The median ACL-RSI score was 74.17. The average ACL-RSI score was 83.1±6.2 for the HS group and 61.8±8.0 for the LS group. High scorers on the ACL-RSI performed significantly better on isometric knee flexion as measured via handheld dynamometry (22.61% ±6.01 vs. 12.12% ±4.88, p=0.001) than the low score group. Conclusion: The findings suggest that increased knee flexion strength may be important for psychological readiness to RTS after primary ACLR. Further research is indicated to explore this relationship, however, a continued emphasis on improving hamstring strength may be appropriate during rehabilitation following ACLR to positively impact psychological readiness for RTS. Level of Evidence: III.

Females have Lower Knee Strength and Vertical Ground Reaction Forces During Landing than Males Following Anterior Cruciate Ligament Reconstruction at the Time of Return to Sport.

Purpose: There is a high rate of second anterior cruciate ligament (ACL) injury (ipsilateral graft or contralateral ACL) upon return-to-sport (RTS) following ACL reconstruction (ACLR). While a significant amount of epidemiological data exists demonstrating sex differences as risk factors for primary ACL injury, less is known about sex differences as potential risk factors for second ACL injury. The purpose of this study is to determine if there are sex-specific differences in potential risk factors for second ACL injury at the time of clearance for RTS. Methods: Ten male and eight female athletes (age: 20.8 years ±6.3, height: 173.2 cm ±10.1, mass: 76.6 kg ±18.3) participated in the study following ACLR at time of RTS (mean 10.2 months). Performance in lower extremity isokinetic and isometric strength testing, static and dynamic postural stability testing, and a single leg stop-jump task was compared between the sexes. Results: Normalized for body weight, males had significantly greater isokinetic knee flexion (141±14.1 Nm/kg vs. 78±27.4 Nm/kg, p=0.001) and extension strength (216±45.5 Nm/kg vs. 159±53.9 Nm/kg, p=0.013) as well as isometric flexion (21.1±6.87% body weight vs. 12.5±5.57% body weight, p=0.013) and extension (41.1±7.34% body weight vs. 27.3±11.0% body weight, p=0.016) strength compared to females. In the single-leg stop jump task, males had a greater maximum vertical ground reaction force during landing (332±85.5% vs. 259±27.4% body weight, p=0.027) compared to females. Conclusions: Based on these results, there are significant differences between sexes following ACLR at the time of RTS. Lower knee flexion and extension strength may be a potential risk factor for second ACL injury among females. Alternatively, the increased maximum vertical force observed in males may be a potential risk factor of second ACL injury in males. Although these results should be interpreted with some caution, they support that rehabilitation programs in the post-ACLR population should be individualized based on the sex of the individual. Level of Evidence: Level 3.

Clinical Measures of Adolescent Softball Players With and Without Upper-Extremity Pain: A Preliminary Study.

CONTEXT: Upper-extremity (UE) pain is a concern among softball adolescent athletes. However, research on preseason screening of demographic characteristics and clinical measures among those with and without UE pain among adolescent softball athletes is underreported. This study sought to present functional outcomes and clinical measures of shoulder and hip complex flexibility, range of motion (ROM), and strength in adolescent softball athletes with and without UE pain. DESIGN: Cross-sectional study. METHODS: Sixty-seven athletes were assessed at the start of the spring season. The Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire was administered to determine UE function. UE measurements included shoulder ROM, flexibility, and strength; lower-extremity measurements included hip ROM and strength. These variables were reported for players with and without UE pain as mean and SD. Independent samples t tests were performed to analyze differences between the groups. RESULTS: Thirteen (19.4%) athletes reported UE pain during preseason screening. Mean Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire score among athletes with UE pain was 58.0 (17.6) compared with 97.1 (6.9) for athletes reporting no UE pain (P < .001). Athletes with UE pain presented with significantly less dominant side external rotation ROM (UE pain: 106.5 [10.4], no UE pain: 114.6 [11.3]) and total ROM (UE pain: 163.7 [14.5], no UE Pain: 174.8 [14.3]). CONCLUSION: These findings inform clinicians on function and preseason clinical measures in adolescent softball athletes who present with or without UE pain. Athletes with UE pain demonstrated lower outcome scores indicating likely impact on overall UE function. These athletes also appeared to demonstrate UE ROM differences compared with athletes without UE pain. Further research is needed to investigate larger sample sizes and positional differences at baseline and throughout the season to determine if clinical measures used in the current study are risk factors for pain and injury.

Retention of immobile Se(0) in flow-through aquifer column systems during bioreduction and oxic-remobilization.

Selenium (Se) is a toxic contaminant with multiple anthropogenic sources, including 79Se from nuclear fission. Se mobility in the geosphere is generally governed by its oxidation state, therefore understanding Se speciation under variable redox conditions is important for the safe management of Se contaminated sites. Here, we investigate Se behavior in sediment groundwater column systems. Experiments were conducted with environmentally relevant Se concentrations, using a range of groundwater compositions, and the impact of electron-donor (i.e., biostimulation) and groundwater sulfate addition was examined over a period of 170 days. X-Ray Absorption Spectroscopy and standard geochemical techniques were used to track changes in sediment associated Se concentration and speciation. Electron-donor amended systems with and without added sulfate retained up to 90% of added Se(VI)(aq), with sediment associated Se speciation dominated by trigonal Se(0) and possibly trace Se(-II); no Se colloid formation was observed. The remobilization potential of the sediment associated Se species was then tested in reoxidation and seawater intrusion perturbation experiments. In all treatments, sediment associated Se (i.e., trigonal Se(0)) was largely resistant to remobilization over the timescale of the experiments (170 days). However, in the perturbation experiments, less Se was remobilized from sulfidic sediments, suggesting that previous sulfate-reducing conditions may buffer Se against remobilization and migration.

Altered lower extremity biomechanics following anterior cruciate ligament reconstruction during single-leg and double-leg stop-jump tasks: A bilateral total support moment analysis.

BACKGROUND: Injury to the anterior cruciate ligament (ACL) can lead to long-lasting biomechanical alterations that put individuals at risk of a second ACL injury. Examining the total support moment may reveal between- and within-limb compensatory strategies. METHODS: Twenty-six participants who were cleared to return to sport following ACL reconstruction were recruited. Each participant completed the single-leg and double-leg stop jump tasks. These tasks were analyzed using force plates and a 3D motion analysis system. The total support moment was calculated by summing the internal moments of the hip, knee and ankle at peak vertical ground reaction force. FINDINGS: Internal knee extensor moment was lower in the involved limb compared to the uninvolved for both tasks (17.6%, P = 0.022; 18.4%, P = 0.008). No significant between-limb differences were found for the total support moment. The involved limb exhibited an 18.2% decrease in knee joint contribution (P = 0.01) and a 21.6% increase in ankle joint contribution (P = 0.016) to the total support moment compared to the uninvolved limb in the single-leg stop jump task. INTERPRETATION: Compensation for the involved knee is likely due to altered biomechanics that redistributes load to the uninvolved knee or to adjacent joints of the same limb. A partial shift in joint contribution from the knee to the ankle during the single-leg stop jump task demonstrates a tendency to decrease load to the knee. Further studies are needed to investigate how these adaptations impact the prevalence of subsequent injury and poor joint health.

Engrailed 2 deficiency and chronic stress alter avoidance and motivation behaviors.

Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder characterized by impairments in social interaction, cognition, and communication, as well as the presence of repetitive or stereotyped behaviors and interests. ASD is most often studied as a neurodevelopmental disease, but it is a lifelong disorder. Adults with ASD experience more stressful life events and greater perceived stress, and frequently have comorbid mood disorders such as anxiety and depression. It remains unclear whether adult exposure to chronic stress can exacerbate the behavioral and neurodevelopmental phenotypes associated with ASD. To address this issue, we first investigated whether adult male and female Engrailed-2 deficient (En2-KO, En2-/-) mice, which display behavioral disturbances in avoidance tasks and dysregulated monoaminergic neurotransmitter levels, also display impairments in instrumental behaviors associated with motivation, such as the progressive ratio task. We then exposed adult En2-KO mice to chronic environmental stress (CSDS, chronic social defeat stress), to determine if stress exacerbated the behavioral and neuroanatomical effects of En2 deletion. En2-/- mice showed impaired instrumental acquisition and significantly lower breakpoints in a progressive ratio test, demonstrating En2 deficiency decreases motivation to exert effort for reward. Furthermore, adult CSDS exposure increased avoidance behaviors in En2-KO mice. Interestingly, adult CSDS exposure also exacerbated the deleterious effects of En2 deficiency on forebrain-projecting monoaminergic fibers. Our findings thus suggest that adult exposure to stress may exacerbate behavioral and neuroanatomical phenotypes associated with developmental effects of genetic En2 deficiency.

The Relationship Between Hip Strength and Postural Stability in Collegiate Athletes Who Participate in Lower Extremity Dominant Sports.

BACKGROUND: Lower extremity (LE) injuries are common across many sports. Both core strength (including hip strength) deficits and poor postural stability have been linked to lower extremity (LE) injury. The relationship between these two characteristics is unknown. PURPOSE: To explore the relationships between hip strength, static postural stability, and dynamic postural stability. STUDY DESIGN: Descriptive Cross-Sectional Study. METHODS: 162 Division I student-athletes (111 males and 51 females) participated in this study. Isometric hip strength was measured using a hand-held dynamometer and both single-leg static (eyes open EO and eyes closed EC) and dynamic postural stability were assessed with a force plate. Pairwise correlations were calculated to examine the relationship between the hip strength variables and the postural stability scores for all subjects and separately for males and females. RESULTS: There were no significant correlations between hip strength and dynamic postural stability for any of the pairwise correlations. Significant, albeit minimal, correlations between EO and EC static postural stability and each of the hip strength variables for all subjects and male subjects (correlation coefficients ranged from -0.19 to -0.34). However, there were only two significant correlations between hip strength and EC static postural stability (hip internal/external rotation) and one for hip strength and EO postural stability (hip internal rotation) found for female subjects (correlation coefficients ranged from -0.28 to -0.31). CONCLUSION: There was no relationship between isometric hip strength and dynamic postural stability; whereas, there were some relationships between the strength measures and static postural stability. These significant, but minimal correlations were observed in more of the comparisons within the male cohort potentially demonstrating a sex difference. LEVEL OF EVIDENCE: 3b.

Universal reshaping of arrested colloidal gels via active doping.

Colloids that interact via a short-range attraction serve as the primary building blocks for a broad range of self-assembled materials. However, one of the well-known drawbacks to this strategy is that these building blocks rapidly and readily condense into a metastable colloidal gel. Using computer simulations, we illustrate how the addition of a small fraction of purely repulsive self-propelled colloids, a technique referred to as active doping, can prevent the formation of this metastable gel state and drive the system toward its thermodynamically favored crystalline target structure. The simplicity and robust nature of this strategy offers a systematic and generic pathway to improving the self-assembly of a large number of complex colloidal structures. We discuss in detail the process by which this feat is accomplished and provide quantitative metrics for exploiting it to modulate the self-assembly. We provide evidence for the generic nature of this approach by demonstrating that it remains robust under a number of different anisotropic short-ranged pair interactions in both two and three dimensions. In addition, we report on a novel microphase in mixtures of passive and active colloids. For a broad range of self-propelling velocities, it is possible to stabilize a suspension of fairly monodisperse finite-size crystallites. Surprisingly, this microphase is also insensitive to the underlying pair interaction between building blocks. The active stabilization of these moderately sized monodisperse clusters is quite remarkable and should be of great utility in the design of hierarchical self-assembly strategies. This work further bolsters the notion that active forces can play a pivotal role in directing colloidal self-assembly.

Prognostic value of coronary artery calcium score in symptomatic individuals: A meta-analysis of 34,000 subjects.

BACKGROUND: Coronary artery calcium (CAC) scanning has evolved into an important subclinical prediction method for cardiovascular diseases in asymptomatic subjects. However, the prognostic implication of CAC scanning in symptomatic individuals is less clear. OBJECTIVES: To assess the prognostic utility of CAC in predicting risk of major adverse cardiac events (MACE) in stable patients with suspected CAD. METHODS: We did a systematic electronic literature search for studies presenting original data in CAC score, and reporting cardiovascular events in stable, symptomatic patients as primary outcome. Primary outcome of the meta-analysis was the occurrence of MACE, a composite of late coronary revascularization, hospitalization for unstable angina or heart failure, nonfatal myocardial infarction, and cardiac death or all-cause mortality. Using random effects models, we pooled relative risk ratios of CAC for MACE, and adjusted hazard ratios (HR) of the associations between different CAC strata (CAC 0-100,100-400, and ≥ 400, versus CAC = 0) and incident MACE. RESULTS: We included 19 observational studies (n = 34,041). In total, 1601 events were analyzed, of which 158 in patients with CAC = 0. The pooled relative risk ratio was 5.71 (95%-CI: 3.98;8.19) for subjects with CAC > 0. The pooled estimate of adjusted HRs demonstrated increasing, positive associations, with the strongest association for CAC > 400 (HR: 4.88; 95%-CI: 2.44;9.27). CONCLUSIONS: This meta-analysis demonstrated that increased levels of CAC are strongly and independently associated with increased risk for MACE in stable, symptomatic patients with suspected CAD, showing increasing risk with greater CAC scores. Application of CAC scanning as a prediction method could be useful for a considerable number of such patients.

Upper Extremity Musculoskeletal Characteristics and the Kerlan-Jobe Orthopaedic Clinic Questionnaire Score in Collegiate Baseball Athletes.

CONTEXT: Upper extremity (UE) musculoskeletal injuries are common in baseball athletes due to the increased demand placed on the UE. The link between risk factors for UE musculoskeletal injuries and baseball athletes' perceived UE function and pain, as measured by the Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire, is unclear. OBJECTIVE: To (1) describe the musculoskeletal characteristics of the UE (posture, range of motion, flexibility, and isometric strength) in a population of baseball athletes and (2) determine the predictive capability of UE musculoskeletal characteristics for the KJOC score in these athletes. DESIGN: Cohort study. SETTING: Athletic training room. PATIENTS OR OTHER PARTICIPANTS: A total of 37 male National Collegiate Athletic Association Division I baseball athletes (age = 20.10 ± 1.27 years, height = 186.96 ± 7.64 cm, mass = 90.60 ± 10.69 kg). INTERVENTION(S): Athletes self-reported all shoulder musculoskeletal injuries and completed the KJOC questionnaire. Postural assessment consisted of forward head and shoulder posture. Flexibility tests characterized glenohumeral internal and external rotation, posterior shoulder tightness, and pectoralis minor length. Strength tests involved the lower and middle trapezius, rhomboid, glenohumeral internal and external rotation, pectoralis major, serratus anterior, supraspinatus, and upper trapezius. MAIN OUTCOME MEASURE(S): All 10 KJOC questions were summed for an overall score out of 100. Questions 1 through 5 were summed for a pain score; questions 6 through 10 were summed for a function score. All data were assessed for normality. A stepwise multiple regression model was fit to determine if the predictor variables assessed could predict the KJOC score. We set the α level a priori at .05. RESULTS: For the KJOC total score, a 1-year history of shoulder injury accounted for 7.80% of the variance in the KJOC total score (P = .07). For KJOC questions 1 through 5, a history of UE injury in the year before testing and posterior shoulder tightness accounted for 14.40% of the variance in the KJOC total score (P = .047). CONCLUSIONS: The link between a history of UE musculoskeletal injuries and the KJOC score highlights the need for continued focus on self-perceived pain and function after UE musculoskeletal injury.

The Warrior Model for Human Performance Optimization.

Special Operations Combat Personnel (SOCP) face significant challenges and occupational demands that put them at significant risk for musculoskeletal injury. Musculoskeletal injury leads to lost-duty days, medical disqualification, and compromises operational readiness and mission success. Optimizing human performance and developing injury prevention strategies can position SOCP for success, but human performance optimization is a complex process that demands the integration of multiple disciplines to address a broad range of capabilities necessary for this success. The Warrior Model for Human Performance Optimization outlines a step-by-step approach to human performance optimization embedded within a scientific, evidenced-based approach to injury prevention and performance optimization that includes a step to ensure specificity of training and interventions. This evidence-based approach can insure that SOCP capabilities match the demands of occupation enabling them to successfully execute their occupation tasks without risk of injury. While the focus of this review is on military personnel, the same principles have application to nonmilitary high-performance athletes.

TAAR1 levels and sub-cellular distribution are cell line but not breast cancer subtype specific.

Trace amine-associated receptors are G protein-coupled receptors of which TAAR1 is the most well-studied. Recently, Vattai et al. (J Cancer Res Clin Oncol 143:1637-1647 https://doi.org/10.1007/s00432-017-2420-8 , 2017) reported that expression of TAAR1 may be a marker of breast cancer (BC) survival, with a positive correlation also suggested between TAAR1 expression and HER2 positivity. Neither a role for TAAR1 in breast tissue, nor in cancer, had previously been suspected. We, therefore, sought to provide independent validation and to further examine these putative relationships. First, a bioinformatic analysis on 58 total samples including normal breast tissue, BC-related cell lines, and tumour samples representing different BC sub-types found no clear correlation between TAAR1 mRNA levels and any BC subtype, including HER2 + . We next confirmed the bioinformatics data correlated to protein expression using a well validated anti-human TAAR1 antibody. TAAR1 mRNA levels correlated with the relative intensity of immunofluorescence staining in six BC cell lines (MCF-7, T47D, MDA-MB-231, SKBR3, MDA-MB-468, BT-474), but not in the MCF-10A immortalized mammary gland line, which had high mRNA but low protein levels. As expected, TAAR1 protein was intracellular in all cell lines. Surprisingly MCF-7, SKBR3, and MDA-MB-468 showed pronounced nuclear localization. The relative protein expression in MCF-7, MDA-MB-231, and MCF-10A lines was further confirmed by semi-quantitative flow cytometry. Finally, we demonstrate that the commercially available anti-TAAR1 antibody has poor selectivity, which likely explains the lack of correlation with the previous study. Therefore, while we clearly demonstrate variable expression and sub-cellular localization of TAAR1 across BC cell lines, we find no evidence for association with BC subtype.

Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE 320 Multinational Study.

Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

Dermatologic Urgencies and Emergencies: What Every Pathologist Should Know.

CONTEXT.­: Fatal dermatologic diseases and ones with high morbidity can occur in the inpatient setting. In such cases, prompt and accurate assessment of a bedside skin biopsy is required. This may be challenging for many pathologists who are not familiar with the complexity of skin pathology and skin terminology within the fields of dermatopathology and dermatology. OBJECTIVE.­: To provide the pathologist with a practical, up-to-date, and "must-know" reference guide on dermatologic urgencies and emergencies from a real-world perspective, highlighting diagnostic pearls, diagnostic pitfalls, and commonly encountered practice gaps. This review will focus on key diseases with which every pathologist should be familiar, including angioinvasive fungal infections, Stevens-Johnson syndrome/toxic epidermal necrolysis, staph-scalded-skin syndrome, acute graft-versus-host disease, bullous pemphigoid, calciphylaxis, Sweet syndrome and its histiocytoid variant, pyoderma gangrenosum, and leukocytoclastic vasculitis, as well as those in their clinical and histopathologic differential. DATA SOURCES.­: This review is based on peer-reviewed literature and our personal experiences with these diseases at major academic institutions, including one where a large number of stem cell transplants are performed. This review is unique as it represents collaborative expert opinion from both a dermatopathology and a dermatology standpoint. CONCLUSIONS.­: This review outlines the critical role that the pathologist plays in the outcomes of patients with dermatologic urgencies and emergencies. Improved patient care will result from prompt and accurate histopathologic diagnoses as well as an open line of communication with the dermatologist.

Shoulder Range of Motion and Baseball Arm Injuries: A Systematic Review and Meta-Analysis.

OBJECTIVE: Arm injuries in baseball players are a common problem. The identification of modifiable risk factors, including range of motion (ROM), is essential for injury prevention. The purpose of this review was to assess the methodologic quality and level of evidence in the literature and to investigate the relationship between shoulder ROM and the risk of arm injuries in baseball players. DATA SOURCES: Relevant studies in PubMed, CINAHL, Embase, and SPORTDiscus published from inception to August 1, 2017. STUDY SELECTION: Only studies that encompassed healthy baseball cohorts who were assessed for shoulder ROM and prospectively evaluated for injuries throughout a baseball season or seasons were included. DATA EXTRACTION: Six articles met the search criteria. Only 3 studies were included in the meta-analysis due to disparate participant groups. DATA SYNTHESIS: The modified Downs and Black scale (0-15 points) was used to analyze methodologic quality. Study quality ranged from 11 to 14. Four studies received high-quality (≥12) and 2 studies received moderate-quality (≥10) scores. The overall pooled analysis demonstrated that absolute and internal-rotation deficits (-5.93 [95% confidence interval {CI} = -9.43, -2.43], P < .001 and 4.28 [0.71, 7.86], P = .02, respectively) and absolute total ROM (TROM; -6.19 [95% CI = -10.28, -2.10]; P = .003) were predictors of injury, and these data exhibited homogeneity (absolute IR P value = .77, I2 = 0%; IR deficit P value = .41, I2 = 0%; absolute TROM P value = .78, I2 = 0%). No significance was observed for absolute external rotation (-2.86 [95% CI = -6.56, 0.83], P = .13), which had data with high heterogeneity ( P = .003; I2 = 83%). A deficit in horizontal adduction was a predictor of injury (-8.32 [95% CI = -12.08, -4.56]; P < .001); these data were homogeneous but yielded a moderate heterogenic effect ( P = .16; I2 = 50%). CONCLUSIONS: High-quality evidence demonstrated that deficits in throwing-arm TROM and IR were associated with upper extremity injury in baseball players. Heterogeneity across studies for horizontal adduction suggested that this may be a modifiable risk factor for injury, but it requires further research.