A National 20-year Analysis of Weight Lifting-related Injuries and Fractures Among Adolescents.

BACKGROUND: Increasing strength through weightlifting has become a core component of competitive sports training, recreational exercise programs, and school physical education classes. Although many health benefits exist, there is concern for injury, especially with improper supervision and accelerated progression of training loads. Though organizations have advocated safe training practices, trends in the national health burden of injuries, specifically fractures, associated with weightlifting in the adolescent population have not been investigated. METHODS: The National Electronic Injury Surveillance System database was queried between 2002 and 2021 for patients aged 11 to 21 years presenting to US Emergency Departments with weight lifting-related injuries. The narrative component of each case identified was analyzed to include only patients noted to be using weightlifting equipment or free weights at the time of injury. Estimates and analyses were performed with 95% CIs. RESULTS: Although there has been some variability in weight lifting-related injuries, the incidence remained roughly constant over the 20 years (R2=0.0364). 14,497 cases were identified, reflecting a national estimate of 540,986 total injuries and an annual estimate of 27,049 injuries. Most injuries occurred among 15-to-18-year olds (44.1%±1.6%) and 19-to-21-year olds (38.3%±2.0%). The most common injuries were sprain/strain (36.7%±1.3%), contusion/abrasion (15.7%±0.7%), and fracture (9.9%±0.3%). There were 53,813 estimated fractures, giving an annual incidence of 2,691 fractures. As a portion of all injuries, the number of fractures decreased significantly as patients got older, accounting for 26.8%±3.3% at age 11 and only 8.3%±0.9% at age 21 (R2=0.6626). Fingers (37.1%±1.8%) and toes (27.9%±1.4%) were the most fractured body parts. Overall, fractures mainly occurred either at school (25.3%±2.0%) or places of recreation (24.7%±2.2%). CONCLUSIONS: Despite the guidelines to improve safety, the national health burden of weight lifting-related injuries among adolescents has remained constant over the past 20 years. Given that most of the fractures occur in the distal extremities, such as toes and fingers, at school and places of recreation, there may be an opportunity to promote safer weightlifting practices and the development of weightlifting equipment with in-built safety mechanisms, especially at gyms and schools. LEVEL OF EVIDENCE: Level III-prognostic.

Evaluating clinical outcomes of two biceps tenodesis techniques: Loop 'N' Tack and subpectoral biceps tenodesis.

Purpose: Biceps tenodesis is an effective surgical procedure that can address pathologies of the long head of the biceps tendon. The purpose of this study was to evaluate clinical outcomes following two different biceps tenodesis techniques: Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis. Hypothesis: Patients undergoing both the subpectoral biceps tenodesis and Loop 'N' Tack biceps tenodesis will have improvements in patient-reported outcomes. Methods: Hundred and sixty five consecutive patients who underwent biceps tenodesis were retrospectively identified and contacted by phone to collect visual analog scale pain scores, University of California, Los Angeles shoulder scores, Simple Shoulder Test scores, Single Assessment Numeric Evaluation scores, and American Shoulder and Elbow Surgeons scores. Range of motion, elbow flexion strength, and incidence of bicipital groove pain and Popeye deformity were recorded. Results: One Hundred and forty five patients were included in the study (55 subpectoral, 90 Loop 'N' Tack). Patients in both groups reported high American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California, Los Angeles, Single Assessment Numeric Evaluation shoulder function scores, low visual analog scale pain scores, and had a minimal risk of complications when measured one year postoperatively. Conclusion: Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention.

Arthroscopic Visualization Is a Reliable Method of Confirming Femoral Button Placement During Anterior Cruciate Ligament Reconstruction.

Purpose: To compare arthroscopic visualization with intraoperative fluoroscopy for confirming proper femoral button placement during ACLR. Methods: Fifty consecutive patients undergoing soft-tissue ACLR between March 2021 and February 2022 were evaluated for inclusion in this study. Both primary and revision ACLR cases using suspensory fixation were included. Surgeons rated their confidence of proper button placement from both an intra-articular perspective (through the femoral tunnel) and an extra-articular perspective (through the iliotibial band) by grading confidence with a Likert scale. Fluoroscopy was also performed for confirmation of proper button placement. Results: Fifty consecutive patients (35.1 ± 14.5 years of age) with soft-tissue ACLR were included. Mean surgeon Likert confidence scores for accurate button placement were as follows: 4.1 of 5 ± 0.9 from an intra-articular perspective, 4.6 of 5 ± 0.7 from an extra-articular perspective, and 8.7 of 10 ± 1.4 based on the sum of intra- and extra-articular perspectives. Fluoroscopic findings demonstrated that 48 of 50 cases had an appropriate flipped button on the lateral cortex of the femur. I total, 2 of 50 had soft-tissue interposition. Cases in which surgeons had high confidence from both intra- and extra-articular perspectives (≥9/10 sum score) were indicative of proper button placement 97% of the time. Conclusions: Arthroscopic visualization is a reliable method of confirming femoral button placement during ACLR and is sufficient to rule out intraoperative fluoroscopy during surgery. ACLR cases with high surgeon confidence from both intra- and extra-articular perspectives (sum score of 9 or greater out of 10) resulted in proper femoral button placement in 97% of cases as confirmed by intraoperative fluoroscopy. Level of Evidence: Level II, prospective cohort study.

Opioid Requirement After Anterior Cruciate Ligament Surgery: Opioid Use After Anterior Cruciate Ligament Surgery Is Low With a Multimodal Approach, and Fifteen Oxycodone 5-mg Tablets Are Sufficient.

Purpose: To prospectively determine opioid consumption in patients undergoing anterior cruciate ligament (ACL) repair and reconstruction and to develop evidence-based prescription guidelines following ACL surgery. Methods: This multicenter prospective study enrolled patients undergoing ACL reconstruction and repair. Subject demographics and opioid prescriptions were recorded at enrollment. All patients were given education on opiate use and followed the same perioperative, multimodal analgesic regimen. Following surgery, patients were given postoperative "pain journals" to document visual analog scale pain scores and daily opioid consumption for the first 7 postoperative days and on postoperative visit at 14 days. Results: In total, 50 patients were included in this analysis between the ages of 14 and 65 years. Patients were prescribed a median of 15 oxycodone 5-mg pills and consumed a median of 2 pill postoperatively (range 0-19 pills). 38% of patients consumed 0 opioid pills, 74% of patients consumed ≤5 opioid pills, and 96% of patients consumed ≤15 opioid pills. Patients reported a mean daily visual analog scale value of 2.8 of 10; mean satisfaction with pain management was high at 4.1/5 on a Likert satisfaction score. Overall, patients consumed a mean 34% of their opioid prescriptions, leaving 436 opioid pills not consumed. Conclusions: This study suggests that current expert panels may be recommending an excessive volume of opioids. Based on our findings, we recommend that patients be prescribed no more than 15 Oxycodone 5-mg tablets following ACL surgery. Despite this lower volume prescription, mean pain scores remained below 3 of 10, patient satisfaction with pain control remained high, and 66% of opiate medication prescribed was not used. Level of Evidence: II, prospective prognostic cohort investigation.

Biomechanical Evaluation of the Efficacy of Suture Tape Augmentation for Subscapularis Peel Repair.

Background: Failure of a subscapularis repair construct after anatomic total shoulder arthroplasty can result in difficulty with internal rotation and an increased likelihood of dislocation. Although suture tape has been demonstrated to be an efficacious augment for tendonous repairs elsewhere in the body, it has not been investigated as a method for augmenting subscapularis peel repairs. Purpose: To determine the biomechanical efficacy of suture tape augmentation for the repair of a subscapularis peel. Study Design: Controlled laboratory study. Methods: Twelve human cadaveric shoulders underwent a subscapularis peel. Specimens were randomly split into 2 groups: 6 specimens underwent repair using a transosseous bone tunnel technique with 3 high-strength sutures placed with a Mason-Allen configuration (control group), and 6 specimens underwent the control repair using augmentation with 2 suture tapes placed in an inverted mattress fashion and secured to the proximal humerus using a suture anchor (augmentation group). Shoulders underwent biomechanical testing to compare repair displacement with cyclic loading, load at ultimate failure, and construct stiffness. Results: There were no significant between-group differences in displacement after cyclic loading at the superior (P = .87), middle (P = .47), or inferior (P = .77) portions of the subscapularis tendon. Load to failure was significantly greater in the augmentation group (585.1 ± 97.4 N) than in the control group (358.5 ± 81.8 N) (P = .001). Stiffness was also greater in the augmentation group (71.8 ± 13.7 N/mm) when compared with the control group (48.7 ± 5.7 N/mm) (P = .003). Conclusion: Subscapularis peel repair with augmentation via 2 inverted mattress suture tapes secured with an anchor in the proximal humerus conferred significantly greater load at ultimate failure and construct stiffness when compared with a traditional repair using 3 Mason-Allen sutures. There was no difference in repair displacement with cyclic loading between the repair groups. Clinical Relevance: Suture tape augmentation of subscapularis peel repairs after shoulder arthroplasty provides an effective segment to the strength of the repair.

Emerging Treatment Options for Massive Rotator Cuff Tears: Biologic Tuberoplasty, Balloon Arthroplasty, Anterior Cable Reconstruction, Lower Trapezius Transfer.

There are several emerging treatments for patients with massive rotator cuff tears. Biologic tuberoplasty is still in its infancy but holds promise for improving pain and function by biologically covering a bare tuberosity with a dermal allograft to prevent bone-to-bone contact between the tuberosity and the undersurface of the acromion. Balloon arthroplasty is a technique of widespread interest, with the device recently gaining FDA approval. Anterior cable reconstruction uses the autologous long head of the biceps tendon to reconstruct the anterior cable of the rotator cuff. Tendon transfers, specifically lower trapezius tendon transfer, have now been established as a viable option especially in patients who want to regain active external rotation.

Biomechanical evaluation of subscapularis peel repairs augmented with the long head of the biceps tendon for anatomic total shoulder arthroplasty.

BACKGROUND: Subscapularis failure is a troublesome complication following anatomic total shoulder arthroplasty (aTSA). Commonly discarded during aTSA, the long head of the biceps tendon (LHBT) may offer an efficient and cheap autograft for the augmentation of the subscapularis repair during aTSA. The purpose of this study was to biomechanically compare a standard subscapularis peel repair to 2 methods of subscapularis peel repair augmented with LHBT. METHODS: 18 human cadaveric shoulders (61 ± 9 years of age) were used in this study. Shoulders were randomly assigned to biomechanically compare subscapularis peel repair with (1) traditional single-row repair, (2) single row with horizontal LHBT augmentation, or (3) single row with V-shaped LHBT augmentation. Shoulders underwent biomechanical testing on a servohydraulic testing system to compare cyclic displacement, load to failure, and stiffness. RESULTS: There were no significant differences in the cyclic displacement between the 3 techniques in the superior, middle, or inferior portion of the subscapularis repair (P > .05). The horizontal (436.7 ± 113.3 N; P = .011) and V-shape (563.3 ± 101.0 N; P < .001) repair demonstrated significantly greater load to failure compared with traditional repair (344.4 ± 82.4 N). The V-shape repair had significantly greater load to failure compared to the horizontal repair (P < .001). The horizontal (61.6 ± 8.4 N/mm; P < .001) and the V-shape (62.8 ± 6.1; P < .001) repairs demonstrated significantly greater stiffness compared to the traditional repair (47.6 ± 6.2 N). There was no significant difference in the stiffness of the horizontal and V-shape repairs (P = .770). CONCLUSIONS: Subscapularis peel repair augmentation with LHBT autograft following aTSA confers greater time zero load to failure and stiffness when compared to a standard subscapularis peel repair.

Burnout syndrome in athletes and their association with body image dissatisfaction at a private university.

BACKGROUND: Burnout syndrome, from the sporting point of view, is the integration of both physical and emotional signs, caused by the high demands in competition. According to several studies, the prevalence of burnout syndrome is influenced by several factors that would lead to athlete's body image dissatisfaction. METHODS: The study design is cross-sectional analysis. The study sample was 352 athletes selected from the Universidad Peruana de Ciencias Aplicadas (UPC). The main variables of this study are the burnout syndrome; which was measured by Athlete Burnout Questionnaire (ABQ) and body image dissatisfaction, through thirteen Scale drawings contour figure Gardner. To find the association between body image dissatisfaction and burnout syndrome Poisson regression was used. RESULTS: Athletes with burnout syndrome have 1.08 times more likely having body image dissatisfaction with a value P=0.011 (95% CI: 1.02-1.15). It was also found that a sport collectively practiced is a protective factor for Burnout Syndrome with P=0.015 (95% CI: 0.4-0.9). CONCLUSIONS: Relation between burnout syndrome and body image dissatisfaction in athletes was found. In addition, a relationship between practicing an individual sport and burnout syndrome was also found. More studies are necessary to confirm these relationships.

Validación facial de la escala Nursing Activities Score en tres unidades de cuidado intensivo en Bogotá, Colombia / Facial validation of Nursing Activities Score in three intensive care units in Bogota, Colombia

Introducción: La medición de cargas de trabajo en enfermería es fundamental para objetivizar la relación enfermera-paciente. Se asume que a mayor complejidad de los pacientes, es mayor el tiempo de dedicación de una enfermera a la provisión de cuidados directos Método: Se usará la adaptación transcultural de la escala Nursing Activities Score (NAS) al español, compuesta por 23 ítems que miden tareas clínicas y administrativas de enfermeras en UCI. Se someterá el instrumento a un juicio de expertos usando el método delphi de dos rondas para corroborar la validez de contenido del instrumento. Se aplicará la razón de validez de contenido (RVC) y el índice de validez de contenido (IVC) para establecer la utilidad de cada uno de los ítems. Posteriormente, se aplicará el instrumento a una muestra de profesionales de enfermería de tres unidades de cuidado intensivo polivalentes, aplicando los mismos estadísticos de prueba. Resultados: Se obtuvieron datos de RVC significativos para la mayoría de los ítems, tanto en la ronda de expertos como en el muestreo con profesionales. Aunque hay algunos ítems que no obtuvieron el puntaje mínimo para que se consideren válidos, el índice global IVC en la muestra de expertos y profesionales se considera satisfactorio, por lo que se considera que la escala puede ser válida con modificaciones (AU)

Introduction: The measurement of workloads in nursing is essential to objectify the nurse-patient relationship. It is assumed that the greater complexity of patients, the greater the time commitment of a nurse providing direct care. Method: Cross-cultural adaptation of the scale Nursing Activities Score (NAS) to Spanish, includes 23 items that measure clinical and administrative tasks of nurses in ICU use. The instrument to an expert opinion be submitted using the Delphi method two rounds to corroborate the content validity of the instrument. The ratio of content validity (RVC) and content validity index (CVI) to establish the usefulness of each item will apply. The ratio of content validity (RVC) and content validity index (CVI) to establish the usefulness of each item will apply. Subsequently, the device should be applied to a sample of nursing professionals three polyvalent intensive care units, applying the same statistical test. Results: significant RVC data were obtained for most items, in the round of experts and professionals sampling. Although there are some items that did not obtain the minimum score to be considered valid, the global index IVC in the sample of experts and professionals is considered satisfactory, so the scale is considered to be valid with amendments (AU)

Metodología multi-modal en relaciones cuantitativas estructura-actividad / Multi-Modal approach in quantitative structure-activity relationships studies

Los estudios QSAR definidos en la literatura están basados en enfoques uni-modales, dejando de analizar conjuntos de datos que contienen distintas informaciones químicas. En esta investigación se propone aplicar por primera vez y analizar el comportamiento del enfoque multi-modal en el desarrollo de estudios QSAR. Para este fin se utilizó una base de compuestos con actividad hepatotóxica, a partir de la cual se construyeron cuatro modalidades considerando distintos descriptores moleculares basados en diversas teorías y enfoques. Se desarrollaron varios modelos usando los enfoques uni-modales y multi-modales utilizando algoritmos de clasificación reportados en la literatura e implementados en el lenguaje R. Los parámetros de cada uno de los algoritmos se optimizaron con el procedimiento, parameter tuningwithrepeated grid-search cross-validation, mientras la validación de dichos modelos se realizó mediante validación cruzada de 10 pliegues con 10 repeticiones. Estadísticamente se comprobó que el enfoque multimodal mejora el desempeño de los modelos predictivos comparado con algunos de los modelos derivados de los conjuntos de datos con modalidades individuales(AU)

The QSAR studies defined in the literature are based on uni-modal approaches and do not consider datasets with different chemical information. Thus, this research has as objective to apply and analyze the behavior of multi-modal approaches when QSAR studies are carried out. To this end, a compound dataset with hepatotoxicity activity was employed and four modalities were built considering molecular descriptors based on different mathematical theories. Also, several predictive models were developed taking into account both uni-modal and multi-modal approaches by using classification algorithms reported in the literature and implemented in R language. The parameters of these algorithms with the procedure, parameter tuning with repeated grid-search cross-validation, were optimized, while the strategy 10-fold cross-validation with 10 repetitions was used to corroborate the predictive accuracy of the models. As result of this study it can be stated that the behavior of the models based on multi-modal approach present significant differences with to those models developed from uni-modal approaches(AU)

Metodología multi-modal en relaciones cuantitativas estructura-actividad / Multi-Modal approach in quantitative structure-activity relationships studies

Los estudios QSAR definidos en la literatura están basados en enfoques uni-modales, dejando de analizar conjuntos de datos que contienen distintas informaciones químicas. En esta investigación se propone aplicar por primera vez y analizar el comportamiento del enfoque multi-modal en el desarrollo de estudios QSAR. Para este fin se utilizó una base de compuestos con actividad hepatotóxica, a partir de la cual se construyeron cuatro modalidades considerando distintos descriptores moleculares basados en diversas teorías y enfoques. Se desarrollaron varios modelos usando los enfoques uni-modales y multi-modales utilizando algoritmos de clasificación reportados en la literatura e implementados en el lenguaje R. Los parámetros de cada uno de los algoritmos se optimizaron con el procedimiento peatedgrid-searchcross-validation, mientras la validación de dichos modelos se realizó mediante validación cruzada de 10 pliegues con 10 repeticiones. Estadísticamente se comprobó que el enfoque multimodal mejora el desempeño de los modelos predictivos comparado con algunos de los modelos derivados de los conjuntos de datos con modalidades individuales(AU)

The QSAR studies defined in the literature are based on uni-modal approaches and do not consider datasets with different chemical information. Thus, this research has as objective to apply and analyze the behavior of multi-modal approaches when QSAR studies are carried out. To this end, a compound dataset with hepatotoxicity activity was employed and four modalities were built considering molecular descriptors based on different mathematical theories. Also, several predictive models were developed taking into account both uni-modal and multi-modal approaches by using classification algorithms reported in the literature and implemented in R language. The parameters of these algorithms with the procedure parameter tuning with repeated grid-search cross-validation were optimized, while the strategy 10-fold cross-validation with 10 repetitions was used to corroborate the predictive accuracy of the models. As result of this study it can be stated that the behavior of the models based on multi-modal approach present significant differences with to those models developed from uni-modal approaches(AU)

Development and model testing of antemortem screening methodology to predict required drug withholds in heifers.

A simple, cow-side test for the presence of drug residues in live animal fluids would provide useful information for tissue drug residue avoidance programs. This work describes adaptation and evaluation of rapid screening tests to detect drug residues in serum and urine. Medicated heifers had urine, serum, and tissue biopsy samples taken while on drug treatment. Samples were tested by rapid methods and high-performance liquid chromatography (HPLC). The adapted microbial inhibition method, kidney inhibition swab test, was useful in detecting sulfadimethoxine in serum, and its response correlated with the prescribed withdrawal time for the drug, 5 to 6 days posttreatment. The lateral flow screening method for flunixin and beta-lactams, adapted for urine, was useful in predicting flunixin in liver detected by HPLC, 96 h posttreatment. The same adapted methods were not useful to detect ceftiofur in serum or urine due to a lack of sensitivity at the levels of interest. These antemortem screening test studies demonstrated that the method selected, and the sampling matrix chosen (urine or serum), will depend on the drug used and should be based on animal treatment history if available. The live animal tests demonstrated the potential for verification that an individual animal is free of drug residues before sale for human consumption.

Validation of the charm 3 SL3 beta-lactam test for screening raw milk in compliance with the U.S. pasteurized milk ordinance. Performance Tested Method 071002.

The Charm 3 SL3 beta-Lactam Test is a 3 min receptor-based lateral-flow Rapid One-Step Assay (ROSA) that detects the six beta-lactam drugs of concern approved for dairy cattle in the United States. The method is a biochemical formulation change of the SL3 beta-Lactam Test evaluated and approved in 2007. The Charm 3 SL3 was evaluated under the AOAC Research Institute Performance Tested Method (PTM) program following the protocol of the U.S. Food and Drug Administration, Center for Veterinary Medicine. The method was approved as PTM 071002 on May 8, 2009. The following drugs were detected in three combined lots: penicillin G at 3.8 ppb, ampicillin at 8.0 ppb, amoxicillin at 8.4 ppb, cephapirin at 20.0 ppb, ceftiofur (total metabolites) at 79 ppb, and cloxacillin at 8.6 ppb > or = 90% of the time with 95% confidence. These detection levels are lower than, but within 75% of, the U.S. Safe Level/Tolerances. Lot-to-lot repeatability was typically within 20% of these determined levels. The test kit was found to be suitable for testing thawed frozen samples. It was also found to respond with equal or better sensitivity to samples that contained incurred analytes, i.e., both the microbiologically active parent drug and its active metabolites. There were no interferences from somatic cells at 1.1 million/mL, bacterial cells at 300 000 CFU/mL, or 32 other non-beta-lactam drugs at 100 ppb. Ruggedness experiments indicated that the test procedure is robust. These results meet the fit-for-purpose approval criteria for inclusion in the National Conference for Interstate Milk Shipments milk testing program.