Relationship Between Nordic Hamstring Strength and Single Leg Bridge Test in University Soccer Players.

CONTEXT: Nordic hamstring strength (NH strength) and single leg bridge test (SLBT) scores are used to predict the risk of hamstring strain injury. Although NH strength and SLBT scores may be related, the relationship between NH strength and SLBT score remains unknown. OBJECTIVES: This study investigated the relationship between NH strength and SLBT scores in university soccer players. DESIGN: Cross-sectional study. SETTING: Research laboratory. PARTICIPANTS: 38 male university soccer players. MAIN OUTCOME MEASURES: NH strength and SLBT scores. INTERVENTIONS: A participant was instructed to lean forward gradually at the slowest possible speed from a kneeling posture with the knee joint flexed 90° for the NH strength measurement. Participants in the SLBT crossed their arms over their chests, pushed down from their heels, and lifted their hips off the ground as many times as they could until they failed. We investigated the relationship between NH strength and SLBT scores in the left and right sides using Spearman rank correlation coefficient. Additionally, we calculated the percentage of left-right asymmetry in NH strength and SLBT scores and investigated the relationship between these variables using Pearson correlation coefficient. RESULTS: There were no significant correlations between NH strength and SLBT scores in the right (rs = .239, P = .16) and left (rs = .311, P = .065) legs. Furthermore, there was no significant relationship between NH strength and SLBT between-limb asymmetry (r = .073, P = .671). CONCLUSIONS: NH strength and SLBT scores could be different indexes, indicating either maximal muscle strength or muscle endurance. Thus, the findings suggested that when assessing risk factors for hamstring strain injury, both NH strength and SLBT scores should be measured.

Sutureless repair with Hydrofit® and bovine pericardial patch for oozing-type postinfarction cardiac rupture.

Left ventricular free wall rupture is a fatal complication of myocardial infarction for which infarctectomy and reconstruction of the left ventricle using a prosthetic patch under cardiopulmonary bypass are performed. However, these surgical treatments remain challenging. Left ventricular free wall rupture secondary to acute myocardial infarction was diagnosed in an 86-year-old man. We performed sutureless repair of the left ventricular free wall rupture without cardiopulmonary bypass. During the operation, a pre-gluing bovine pericardial patch with Hydrofit® was placed twice on the ruptured site and manually pressed to provide complete hemostasis. The postoperative course was uneventful. This sutureless technique has the benefit of avoiding sutures in the fragile infarcted myocardium and might be effective for left ventricular free wall rupture treatment.

Eccentric force and electromyogram comparison between the eccentric phase of the Nordic hamstring exercise and the razor hamstring curl.

PURPOSE: Nordic hamstring exercise (NHE) and razor hamstring curl (RHC) are usually performed to train hamstring eccentric contraction strength. However, it is unclear whether there are differences in the intensity of the two methods and the amount of loading on each muscle. Therefore, this study was conducted using peak eccentric force and each muscle surface electromyogram (s-EMG) to provide useful information to decide whether NHE or RHC should be prescribed for training and rehabilitation. METHODS: s-EMG electrodes were placed in the medial gastrocnemius, lateral gastrocnemius, biceps femoris, semitendinosus, gluteus maximus, and erector spinae of the dominant leg of the fifteen healthy male university students with exercise habits. Maximum voluntary isometric contractions of 3 seconds were performed on each muscle followed by NHE and RHC in random order. The outcome variables included peak eccentric force and s-EMG of each muscle calculated by means amplitude during the NHE and RHC. RESULTS: Peak eccentric force was significantly higher in RHC than in NHE (p = 0.001, r = 0.73). However, NHE was significantly higher in s-EMG of semitendinosus (p = 0.04, r = -0.52) than RHC. However, there were no significant differences in EMG of the medial gastrocnemius (p = 0.202, r = -0.34), lateral gastrocnemius (p = 0.496, r = 0.18), biceps femoris (p = 0.061, r = -0.48), gluteus maximus (p = 0.112, r = -0.41), erector spinae (p = 0.45, r = 0.20) between NHE and RHC. CONCLUSIONS: For NHE and RHC, the peak eccentric force exerted during the exercise was significantly higher for RHC, and the s-EMG of semitendinosus was significantly higher for NHE.

Injury data collection and utilisation practices in university sports teams: A cross-sectional study.

OBJECTIVES: This study aimed to examine injury surveillance practices in a variety of university sports teams and barriers and facilitators for injury data collection and utilisation. DESIGN: Cross-sectional study. SETTING: University sports teams in Japan. PARTICIPANTS: Medical, coaching, and other staff (non-medical/-coaching staff) of the university sports teams in Japan. MAIN OUTCOME MEASURES: The survey included 31 questions that examined the barriers and facilitators for injury data collection, and the type of data on injury and exposure collected. RESULTS: Injury data were collected during matches for 69 teams (48.3%) and training for 61 teams (42.7%). Injuries were primarily captured by athletic trainers in teams with medical staff, coaching staff and athletes in teams without medical staff. Common barriers in collecting and utilising injury data included limited funding for trained personnel and lack of time for medical staff to record data. Facilitating factors included clarification of the methods employed in recording and utilising injury data for teams with medical staff and the deployment of trained personnel to record injuries for teams without medical staff. CONCLUSIONS: Approximately half of the Japanese university teams collected injury data. Considering barriers and facilitators is crucial to facilitate the collection and utilisation of injury data.

Novel reinforcement technique using pre-glued felt strip with Hydrofit® for a distal anastomotic site in acute type A aortic dissection.

In the surgical treatment of acute type A aortic dissection, performing the anastomosis in the dissected aorta is technically challenging due to the fragility of the dissected aortic wall. This study describes the reinforcement technique for the distal anastomotic site, using pre-glued felt strips with Hydrofit®. No intraoperative bleeding occurred at the anastomosis site of the distal anastomosis stump. Postoperative computed tomography revealed no new distal anastomotic entry. This technique is recommended for managing acute type A aortic dissection during distal aortic reinforcement.

Reasons for the Reporting Behavior of Japanese Collegiate Rugby Union Players Regarding Suspected Concussion Symptoms: A Propensity Analysis.

While previous research has identified the reasons for the concussion-reporting behavior of rugby union players, the influence of confounding factors such as concussion experience, education, and knowledge of concussion symptoms, any of which may have influenced the results, has not been considered. This study aimed to clarify the reasons for the reporting behavior of college rugby union players regarding suspected concussion symptoms by adjusting for confounding factors using the propensity score. A questionnaire about both concussion knowledge and concussion-reporting behavior was administered to 240 collegiate rugby union players. Of the 208 (86.7%) valid respondents to the questionnaire, 196 (94.2%) had experienced any one symptom of a suspected concussion, such as headache, at least once, and 137 (65.9%) reported symptoms to someone else. This study's results revealed two important reasons for reporting symptoms: (1) the willingness of players to report experienced symptoms to someone else, along with realizing a concussion, and (2) the willingness of players to report suspected concussion symptoms, despite the absence of a doctor or trainer. These results suggest that providing educational opportunities to recognize suspected concussion symptoms and establishing a team culture of reporting physical problems to someone else is important for improving concussion-reporting behavior.

Influence of Surveillance Methods in the Detection of Sports Injuries and Illnesses.

Background: Epidemiological data on sports injuries and illnesses depend on the surveillance methodology and the definition of the health problems. The effect of different surveillance methods on the data collection has been investigated for overuse injuries, but not for other health problems such as traumatic injuries and illnesses. Purpose: The purpose of this study was to investigate the new surveillance method developed by the Oslo Sports Trauma Research Center (OSTRC), which is based on any complaint definition (new method), to identify health problems compared with the traditional surveillance method, which is based on time loss definition. Study design: Descriptive epidemiology study. Methods: A total of 62 Japanese athletes were prospectively followed-up for 18 weeks to assess differences in health problems identified by both new and traditional methods. Every week, the athletes completed the Japanese version of the OSTRC questionnaire (OSTRC-H2.​JP), whereas the teams' athletic trainers registered health problems with a time loss definition. The numbers of health problems identified via each surveillance method were calculated and compared with each other to assess any differences between their results. Results: The average weekly response rate to the OSTRC-H2.​JP was 82.1% (95% CI, 79.8-84.3). This new method recorded 3.1 times more health problems (3.1 times more injuries and 2.8 times more illnesses) than the traditional method. The difference between both surveillance methods' counts was greater for overuse injuries (5.3 times) than for traumatic injuries (2.5 times). Conclusions: This study found that the new method captured more than three times as many health problems as the traditional method. In particular, the difference between both methods' counts was greater for overuse injuries than for traumatic injuries. Level of evidence: 2b.

The usefulness of nonabsorbable polymer clips for the closure of supra-aortic vessels' stump.

When performing translocated total arch replacement using a frozen elephant trunk, the closure of supra-aortic vessels' stump may be necessary. Herein, we describe the application of a nonabsorbable polymer Hem-o-lok clip for the closure of the stump. The supra-aortic vessels were looped using cloth tapes and clipped using Hem-o-lok clips with gentle traction of cloth tapes. Then, the supra-aortic vessels were sharply transected, leaving a 2-mm cuff of tissue. There were no incidents of clip failure during application or migration, and no significant intra-operative or post-operative bleeding occurred due to clipping failure. Hem-o-lok clips are an easy, quick, and reliable method for the closure of supra-aortic vessels' stump. Therefore, we recommend this technique for translocated total arch replacement procedures performed using a frozen elephant trunk.

The Effect of Ankle Position on Peak Eccentric Force during The Nordic Hamstring Exercise.

Peak eccentric force during the Nordic hamstring exercise (NHE) is recognized as a predictive factor for hamstring strain injury (HSI). During the NHE, the knee flexor muscles are eccentrically contracting to resist the knee joint extension. Therefore, it is thought that the action of the gastrocnemius muscle, and thus the ankle position, influences peak eccentric force during the NHE. However, the effect of ankle position on peak eccentric force during the NHE remains unclear. Therefore, we investigated the effect of ankle position on peak eccentric force during the NHE in a cohort of 50 healthy young male rugby players (mean age, 18.7 ± 1.2 years; mean body mass, 81.7 ± 15.2 kg; height, 1.72 ± 0.06 m) with no history of HSI. Each participant performed NHE strength testing with the ankle dorsiflexed or plantarflexed position and was instructed to fall forward as far as possible within 3 s. Peak eccentric force, reported relative to body mass (N/kg), of both legs was recorded, and the mean values of both legs were compared in both ankle positions. The mean peak eccentric force was significantly greater with the ankle plantarflexed position than the dorsiflexed position (3.8 ± 1.1 vs. 3.5 ± 1.1 N/kg, respectively, p = 0.049). These results indicate that ankle position should be carefully considered when measuring peak eccentric force during the NHE and performing NHE training.

Relationship between Nordic hamstring strength and maximal voluntary eccentric, concentric and isometric knee flexion torque.

Nordic hamstring exercise is performed to prevent knee flexor muscle strain injuries and used to assess their injury risks. However, what exactly Nordic hamstring strength indicates is not clear. We investigated the relationship between Nordic hamstring strength and maximal voluntary contraction (MVC) torque of the knee flexors measured by an isokinetic dynamometer. Sixteen healthy young men who had not experienced hamstring strain injuries participated in the study. In Nordic hamstring, each participant was instructed to lean forward as far as possible in 3 s (approximately 30°/s), and force at the ankle joint of the dominant leg was measured during the movement. The force was multiplied by lower leg length and converted into torque. MVC torque of the knee flexors was measured isometrically at 30°, 45°, 60°, and 90° knee flexion joint angles, and concentrically and eccentrically at 30°/s and 60°/s in 10°-90° knee flexion for the dominant leg in a prone position. Correlations among the dependent variables were assessed using Pearson's correlation coefficients. Peak Nordic hamstring torque ranged 96.8-163.5 Nm, and peak MVC eccentric torque ranged 50.7-109.4 Nm at 30°/s and 59.2-121.2 Nm at 60°/s. No significant correlations were evident between the peak Nordic hamstring torque and peak eccentric knee flexion torque (r = 0.24-0.3, p = 0.26-0.4). This was also the case for the Nordic hamstring torque and MVC torque of isometric (r = -0.03-0.1, p = 0.71-0.92) and concentric contractions (r = 0.28-0.49, p = 0.053-0.29). These results show that Nordic hamstring strength is not associated with the knee flexor torque measured by an isokinetic dynamometer. It may be that other factors than static and dynamic hamstring strengths affect Nordic hamstring strength.

Subcapsular hepatic hematoma as a complicating cardiac surgery.

An 80-year-old woman was hospitalized for aortic valve insufficiency, paroxysmal atrial fibrillation, and ascending aortic aneurysm. She underwent aortic valve replacement, pulmonary vein isolation, left atrium appendectomy, and ascending aorta replacement. She developed a subcapsular hepatic hematoma during the surgery. The patient was managed conservatively and discharged successfully.

Intraoperative angiography for visceral arteries originating from false lumen.

A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

[Endovascular Therapy for Kinking of an Open Stent Graft after Stanford Type A Acute Aortic Dissection Repair:Report of a Case].

This is the case of 50s female with Stanford type A acute aortic dissection who underwent emergent total arch replacement. The aortic arch was transected just distal to the left subclavian artery, followed by the insertion of J Graft Frozenix into the descending aorta. No blood pressure gradient was observed between the radial and femoral arteries immediately after the operation. Nevertheless, intermittent claudication was observed after a week. Ankle-brachial index( ABI) measurement was calculated at 0.7 in both legs. Computed tomography (CT) revealed a kinking of the non-stented part of the endograft. Subsequently, thoracic endovascular aortic repair( TEVAR) was performed. As a result, ABI measurement normalized and lower limb pain disappeared. Three years after, CT showed that the endograft expanded satisfactorily. In deployment of J Graft Frozenix, the non-stented part should be kept as short as possible. For kinking, TEVAR should be considered the initial treatment option.

Thoracic endovascular aortic repair of a ruptured acute type B aortic dissection presenting with right hemothorax: a case report and review of the literature.

Ruptured acute type B aortic dissection is a life-threatening condition with a high mortality rate. Right hemothorax secondary to this condition is extremely rare. Herein, we report a successful treatment of a ruptured acute type B aortic dissection via thoracic endovascular aortic repair in a 45-year-old man who initially presented with right hemothorax. Contrast-enhanced computed tomography confirmed massive right hemothorax and acute type B aortic dissection in which the primary entry was located just below the left subclavian artery. Moreover, a possible rupture site in the descending aorta at the level of Th6 was identified. We then performed an endovascular aortic repair with left subclavian artery open surgical debranching. His postoperative course was uneventful. The patient did not have any complications at a 6-month follow-up.

Differences in Muscle Activities and Kinematics between Forefoot Strike and Rearfoot Strike in the Lower Limb during 180° Turns.

BACKGROUND: A forefoot strike (FFS) could be a safer landing technique than a rearfoot strike (RFS) during a cutting motion to prevent anterior cruciate ligament (ACL) injury. PURPOSE: This study aimed to determine the joint angles, ground reaction force (GRF), and muscle activity levels associated with FFS and RFS landings during 180° turns. STUDY DESIGN: Cross-sectional study. METHODS: Fourteen male soccer players from the University of Tsukuba football (soccer) club participated in this study. The FFS consisted of initial contact with the toes on the force plates followed by the rearfoot; meanwhile, the initial contact was performed with the heels on the force plates followed by the forefoot for the RFS. Ankle, knee, and hip joint angles were recorded using a three-dimensional motion capture system. GRFs were measured using a force plate. Gluteus medius (GM), rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST), biceps femoris (BF), tibialis anterior (TA), and lateral gastrocnemius (GL) activities were measured by electromyography. RESULTS: The activities of GM, GL, and ST from initial contact to early periods during landing into the ground with the FFS are larger than those with RFS. In addition, the results showed significant differences in lower-limb angles and GRFs between the FFS and RFS. CONCLUSION: These results suggest that there might be differences in ACL injury risk during a 180° turn between the FFS and the RFS pattern. An investigation into the grounding method that prevents injury is necessary in future studies. LEVELS OF EVIDENCE: Level 3b.

An update of the Japanese Oslo Sports Trauma Research Center questionnaires on overuse injuries and health problems.

Monitoring the health of athletes is important for their protection, and questionnaires such as those produced by the Oslo Sports Trauma Research Center (OSTRC) are a valuable tool in this process. In 2020, several changes were made to the OSTRC questionnaires (OSTRC-O, OSTRC-H), including changes to the wording, structure, and logic of the original questionnaires. In the present study, the Japanese versions of the OSTRC questionnaires (OSTRC-O.JP, OSTRC-H.JP) were revised to meet the requirements of the updated versions and to analyse new and previously collected data to illustrate the impact of the changes on Japanese athletes. Proposed changes were categorized as minor or more substantial; minor changes were effected to the questionnaire instructions and to the wording of all four questions, and more substantial changes were made to the wording of question 2. The updated questionnaires also included changes to questionnaire logic and answer categories. To assess the consequences of the changes to the wording of question 2, 101 athletes were asked to complete the OSTRC-H.JP, which included both the original and updated versions of question 2, over 10 consecutive weeks. We calculated the number of health problems identified when new gatekeeper logic was and was not applied, using 1585 OSTRC-H.JP responses to assess the consequences of the changes to the questionnaire logic. The kappa coefficient, which measures the level of agreement between the responses to question 2 of the original and updated versions, was high. By applying gatekeeper logic, there was a remarkable reduction in the number of injuries and illnesses among all health problems but less reduction in substantial health problems and time loss health problems. These changes will make it easier for Japanese athletes to complete the questionnaires and improve the quality of collected data.

Effect of change in passive stiffness following low-intensity eccentric hamstring exercise on peak torque angle.

[Purpose] The purpose of this study was to investigate the acute effect of low-intensity eccentric hamstring exercise on peak torque angle, range of motion, and passive stiffness. [Participants and Methods] Fourteen healthy young adults exercised as follows: 1) Under low-intensity eccentric hamstring exercise condition, participants performed a stiff-leg deadlift using a 20-kg barbell, 2) Under control condition with participants seated. The peak torque angle during eccentric knee flexion, hip flexion and knee extension range of motion, passive torque, and passive stiffness were measured before and after two conditions in the dominant leg. [Results] The low-intensity stiff-leg deadlift significantly increased hip flexion and knee extension range of motion and significantly decreased passive stiffness. Although the low-intensity stiff-leg deadlift did not change the peak torque angle, the changes in passive torque and passive stiffness were negatively correlated with the change in peak torque angle. [Conclusion] These results suggest that low-intensity eccentric hamstring exercise enhances flexibility, and a decrease in passive torque and passive stiffness are negatively associated with producing the eccentric peak knee flexion torque at a shorter muscle length.

ACUTE EFFECT OF LOW-INTENSITY ECCENTRIC EXERCISE ON ANGLE OF PEAK TORQUE IN SUBJECTS WITH DECREASED HAMSTRING FLEXIBILITY.

BACKGROUND: Decreased hamstring flexibility and the angle of peak torque (APT) occurring at a shorter muscle length are considered risk factors for hamstring strain injury. Subjects with decreased hamstring flexibility have an APT that occurs at a shorter muscle length; hence, the susceptibility to hamstring strain injury could be associated with the APT occurring at a shorter muscle length. Low-intensity eccentric exercise (ECC-Ex) may reduce hamstring strain injury risk in the subjects with decreased hamstring flexibility by allowing the APT to occur a longer muscle length. However, the acute effect of low-intensity ECC-Ex on the subjects with decreased hamstring flexibility has not been established. HYPOTHESIS/PURPOSE: The purpose of this study was to investigate the acute effect of low-intensity ECC-Ex on the peak torque, APT, and hip flexion angle in the subjects with decreased hamstring flexibility. The authors hypothesized that low-intensity ECC-Ex would shift the APT, allowing it to occur at a longer muscle length with a minimum decrease of peak torque and hip flexion angle in the subjects with decreased hamstring flexibility. STUDY DESIGN: Case-control study. METHODS: Twelve male college students were categorized into normal group [n = 6 (12 legs)] and decreased hamstring flexibility group [n = 6 (12 legs)] based on the median value of the baseline hip flexion angle (i.e., 80.8 °) measured by passive straight leg raise test. Peak torque and APT during maximal voluntary eccentric knee flexion (via isokinetic dynamometer) and hip flexion angle were evaluated before and after the low-intensity ECC-Ex in both groups. RESULTS: Low-intensity ECC-Ex shifted the APT, causing it to occur at a longer muscle length in the decreased hamstring flexibility group. Low-intensity ECC-Ex increased the hip flexion angle and did not change the peak torque in both groups. CONCLUSION: The results of the present study demonstrated that low-intensity ECC-Ex shifts the APT to occur at a longer muscle length and increases the hip flexion angle without a decrease in peak torque in the subjects with the decreased hamstring flexibility. LEVEL OF EVIDENCE: 3b.

Non-surgical management in hemodynamically unstable blunt traumatic pericardial effusion: A feasible option for treatment.

INTRODUCTION: Little is known about the outcomes of deliberate non-surgical management for hemodynamically unstable patients with blunt traumatic pericardial effusion. We evaluated the efficacy of management with pericardiocentesis or subxiphoid pericardial window in hemodynamically unstable patients who reach the hospital alive with blunt traumatic pericardial effusion. METHODS: We conducted a review of a consecutive series of patients with pericardial effusion following blunt trauma who arrived at Fukui Prefectural Hospital between January 1, 2009 and December 31, 2017. All patients with traumatic pericardial effusion were included, irrespective of the type of blunt trauma. RESULTS: Eleven patients were identified arrived to the Emergency Department with a pericardial effusion after blunt trauma. Of the eleven patients, five patients had cardiopulmonary arrest on arrival and none survived. Of the other six patients who reached the hospital alive, five were hemodynamically unstable and clinically diagnosed with cardiac tamponade. One patient was hemodynamically stable and managed conservatively without pericardiocentesis or pericardial window. Otherwise, two patients were managed with pericardiocentesis alone. One patient was managed with pericardial window alone. One was managed with both pericardiocentesis and pericardial window. The remaining patient underwent median sternotomy because of unsuccessful pericardial drainage tube insertion. All six patients who reached the hospital alive survived. Five patients did not require surgical repair. CONCLUSION: The results of the present study suggested that non-surgical management of hemodynamically unstable patients who reach hospital alive with blunt pericardial effusion may be a feasible option for treatment.

[Thoracic Endovascular Aortic Aneurysm Repair in a Young Patient with Descending Aortic Injury;Report of a Case].

A 15-year-old boy was referred to our emergency room due to a penetrating injury of the back. Computed tomography( CT) demonstrated a descending aortic injury at the Th9/10 level, bilateral hemothorax, and spinal cord injury. Although surgical treatment was indicated, multiple organ injury complicated open surgical repair, which required cardiopulmonary bypass with full heparinization. Therefore, the patient was scheduled to undergo thoracic endovascular aortic repair (TEVAR). A 23×33-mm Excluder aortic extension cuff was chosen for the small, 15-mm diameter aorta. The aortic extension was delivered and deployed in the descending aorta. Postoperative CT demonstrated neither endoleak nor collapse of the stent-graft. TEVAR for traumatic aortic aneurysm appears to be safe and effective, and an aortic extension for an abdominal aortic aneurysm may be utilized as an alternative device if the patient is young and the aorta is small.