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1.
J Sport Health Sci ; 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34461327

RESUMO

PURPOSE: Recognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. METHODS: This case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either: (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). RESULTS: Two miRNAs (miR-532-5p, miR-182-5p) decreased (adjusted p < 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p, miR-29c-3p) were associated (R > 0.5; adjusted p < 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p < 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (AUC > 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). CONCLUSION: Salivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment.

2.
Curr Sports Med Rep ; 20(8): 389-394, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34357884

RESUMO

ABSTRACT: Ten percent of all premature deaths and 117 billion dollars in annual health care costs are attributable to physical inactivity in America. The positive impact exercise can have on overall health is irrefutable. While it is the responsibility of health care providers to assess and counsel for exercise, there are logistical, structural, and educational barriers preventing this counseling. A physical activity consultation clinic led by primary care sports medicine physicians would allow for focused exercise counseling by appropriately trained providers to motivated patients. While previously there have been many institutional and logistical barriers to establishing such a clinic, the COVID-19 pandemic has created a window of opportunity for doing so within a large academic medical center. This article reviews the importance of exercise on overall health, outlines the barriers for establishing a clinical experience dedicated to counseling for physical activity, and details how overcoming those barriers was facilitated by the COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Doença Crônica/prevenção & controle , Aconselhamento , Exercício Físico , Promoção da Saúde/métodos , Pandemias , Medicina Esportiva , Humanos , SARS-CoV-2 , Estados Unidos/epidemiologia
3.
J Neurol ; 268(11): 4349-4361, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34028616

RESUMO

OBJECTIVE: The goals of this study were to assess the ability of salivary non-coding RNA (ncRNA) levels to predict post-concussion symptoms lasting ≥ 21 days, and to examine the ability of ncRNAs to identify recovery compared to cognition and balance. METHODS: RNA sequencing was performed on 505 saliva samples obtained longitudinally from 112 individuals (8-24-years-old) with mild traumatic brain injury (mTBI). Initial samples were obtained ≤ 14 days post-injury, and follow-up samples were obtained ≥ 21 days post-injury. Computerized balance and cognitive test performance were assessed at initial and follow-up time-points. Machine learning was used to define: (1) a model employing initial ncRNA levels to predict persistent post-concussion symptoms (PPCS) ≥ 21 days post-injury; and (2) a model employing follow-up ncRNA levels to identify symptom recovery. Performance of the models was compared against a validated clinical prediction rule, and balance/cognitive test performance, respectively. RESULTS: An algorithm using age and 16 ncRNAs predicted PPCS with greater accuracy than the validated clinical tool and demonstrated additive combined utility (area under the curve (AUC) 0.86; 95% CI 0.84-0.88). Initial balance and cognitive test performance did not differ between PPCS and non-PPCS groups (p > 0.05). Follow-up balance and cognitive test performance identified symptom recovery with similar accuracy to a model using 11 ncRNAs and age. A combined model (ncRNAs, balance, cognition) most accurately identified recovery (AUC 0.86; 95% CI 0.83-0.89). CONCLUSIONS: ncRNA biomarkers show promise for tracking recovery from mTBI, and for predicting who will have prolonged symptoms. They could provide accurate expectations for recovery, stratify need for intervention, and guide safe return-to-activities.

5.
J Fam Pract ; 70(2): 80;82;84;85, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33760897

RESUMO

A number of factors-including patient age and risk for recurrence-influence treatment choices. Here's a closer look at what to consider.


Assuntos
Tomada de Decisão Clínica , Luxação do Ombro/reabilitação , Luxação do Ombro/cirurgia , Humanos , Modalidades de Fisioterapia , Volta ao Esporte
6.
Gait Posture ; 85: 96-102, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33524666

RESUMO

BACKGROUND: Development of accessible cost-effective technology to objectively, reliably, and accurately predict musculoskeletal injury risk could aid the effort to prevent chronic pain and disability. Recent work on micro-Doppler radar suggests it merits investigation towards these goals. The micro-Doppler signals that are created can infer differences in gross movements such as walking versus crawling in military settings where direct vision is not possible. Unique micro-Doppler signals may be able to identify more subtle movement patterns which would not be easily seen by the human eye. RESEARCH QUESTION: Can micro Doppler radar predictably and accurately identify subtle differences in movement conditions? METHODS: This is a cross sectional study recruiting NCAA athletes to jump in front of the micro-Doppler radar barefoot, with shoes, and shoes with a heel lift. The micro-Doppler radar signature projection algorithm was developed to determine whether the radar is able to distinguish the three distinct movement patterns. RESULTS: Confusion matrices were used to visualize the performance of the support-vector machine at the 80/20 test/train split correctly classifying barefoot subjects, shoes and heel lift, and shoes correctly at 0° with respect to the radar 90.9 %, 86.7 %, and 89.5 % of the time, respectively. At 90° with respect to the radar, it was successful 94.1 %, 100 %, and 80 % of the time, respectively. CONCLUSION: This study suggests that the micro-Doppler radar signature projection algorithm is highly accurate and able to predict subtle differences in movement that are not readily observed with conventional motion capture systems. Future studies are needed to better understand if micro-Doppler signals can identify pathologic movement patterns or movement that is associated with increased risk of injury.


Assuntos
Algoritmos , Traumatismos em Atletas/prevenção & controle , Aprendizado de Máquina , Movimento/fisiologia , Radar , Ultrassonografia Doppler/métodos , Adolescente , Adulto , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/fisiopatologia , Fenômenos Biomecânicos , Estudos Transversais , Humanos , Reprodutibilidade dos Testes , Medição de Risco , Adulto Jovem
7.
Skeletal Radiol ; 50(5): 921-925, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33021682

RESUMO

OBJECTIVE: To determine the prevalence of shoulder (specifically labral) abnormalities on MRI in a young non-athletic asymptomatic cohort. We hypothesize that this population will have fewer labral abnormalities than an athletic population. MATERIALS AND METHODS: In this cross-sectional study, non-athletic young adults age 18-29 with no history of shoulder pain received bilateral shoulder MRIs. A total of 58 total shoulder MRIs were completed on a 3-T MRI scanner (PRISMA-Fit Siemens Medical). MRIs were read by two board-certified fellowship-trained musculoskeletal radiologists at two time points 3 months apart to determine prevalence of labral and other shoulder anatomy abnormalities. Kappa statistics and the associated 95% confidence intervals were computed for inter/intra-reader reliability. Fisher's exact test was used to compare rates of abnormalities in our study with a similarly designed study involving ice hockey athletes. RESULTS: Prevalence of labral abnormalities was 9% (5/58). Kappa coefficient was 1.0 for both readers for intra-reader reliability and 0.57 for inter-reader reliability of labral abnormalities. We further compared our results in asymptomatic athletes with previously published work using the same protocol at our institution. The prevalence of labral abnormalities on MRI in asymptomatic professional and collegiate ice hockey players (49 imaged shoulders) was 24%, which demonstrated a statistically significant (p value < 0.05) difference compared with our data with a p value of 0.03. CONCLUSIONS: Non-athletic young adults with no history of shoulder pain/injury had an overall prevalence of shoulder MRI abnormalities less than asymptomatic professional and collegiate ice hockey players in a similarly designed study.


Assuntos
Articulação do Ombro , Ombro , Adolescente , Adulto , Estudos Transversais , Humanos , Imageamento por Ressonância Magnética , Prevalência , Reprodutibilidade dos Testes , Articulação do Ombro/diagnóstico por imagem , Adulto Jovem
8.
Clin Transl Med ; 10(6): e197, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33135344

RESUMO

BACKGROUND: Early, accurate diagnosis of mild traumatic brain injury (mTBI) can improve clinical outcomes for patients, but mTBI remains difficult to diagnose because of reliance on subjective symptom reports. An objective biomarker could increase diagnostic accuracy and improve clinical outcomes. The aim of this study was to assess the ability of salivary noncoding RNA (ncRNA) to serve as a diagnostic adjunct to current clinical tools. We hypothesized that saliva ncRNA levels would demonstrate comparable accuracy for identifying mTBI as measures of symptom burden, neurocognition, and balance. METHODS: This case-control study involved 538 individuals. Participants included 251 individuals with mTBI, enrolled ≤14 days postinjury, from 11 clinical sites. Saliva samples (n = 679) were collected at five time points (≤3, 4-7, 8-14, 15-30, and 31-60 days post-mTBI). Levels of ncRNAs (microRNAs, small nucleolar RNAs, and piwi-interacting RNAs) were quantified within each sample using RNA sequencing. The first sample from each mTBI participant was compared to saliva samples from 287 controls. Samples were divided into testing (n = 430; mTBI = 201 and control = 239) and training sets (n = 108; mTBI = 50 and control = 58). The test set was used to identify ncRNA diagnostic candidates and create a diagnostic model. Model accuracy was assessed in the naïve test set. RESULTS: A model utilizing seven ncRNA ratios, along with participant age and chronic headache status, differentiated mTBI and control participants with a cross-validated area under the curve (AUC) of .857 in the training set (95% CI, .816-.903) and .823 in the naïve test set. In a subset of participants (n = 321; mTBI = 176 and control = 145) assessed for symptom burden (Post-Concussion Symptom Scale), as well as neurocognition and balance (ClearEdge System), these clinical measures yielded cross-validated AUC of .835 (95% CI, .782-.880) and .853 (95% CI, .803-.899), respectively. A model employing symptom burden and four neurocognitive measures identified mTBI participants with similar AUC (.888; CI, .845-.925) as symptom burden and four ncRNAs (.932; 95% CI, .890-.965). CONCLUSION: Salivary ncRNA levels represent a noninvasive, biologic measure that can aid objective, accurate diagnosis of mTBI.

9.
Int J Mol Sci ; 21(20)2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33092191

RESUMO

Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no concussion (n = 230), a single concussion (n = 56), or recurrent concussions (n = 24). There was no difference in neurocognitive performance between the former professional athletes and their peers, or among younger individuals with varying concussion exposures. However, younger individuals without prior concussion outperformed peers with prior concussion on three balance assessments. Twenty salivary miRNAs differed (adj. p < 0.05) between former professional athletes and their peers. Two of these (miR-28-3p and miR-339-3p) demonstrated relationships (p < 0.05) with the number of prior concussions reported by younger individuals. miR-28-3p and miR-339-5p may play a role in the pathophysiologic mechanism involved in cumulative concussion effects.


Assuntos
Biomarcadores/metabolismo , Concussão Encefálica/genética , MicroRNAs/genética , Saliva/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atletas/estatística & dados numéricos , Estudos de Casos e Controles , Criança , Estudos Transversais , Futebol Americano , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Orthop J Sports Med ; 7(10): 2325967119876865, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31637270

RESUMO

Background: The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. Baseball pitchers are shown to have a high prevalence of asymptomatic shoulder MRI findings, but the incidence of asymptomatic shoulder MRI findings has not been systematically evaluated in nonthrowing contact athletes. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of shoulder abnormalities in asymptomatic professional and collegiate hockey players. We hypothesized that, similar to overhead throwing athletes, ice hockey players will have a high prevalence of asymptomatic MRI findings, including labral, acromioclavicular (AC), and rotator cuff pathology on MRI. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A total of 25 asymptomatic collegiate and professional hockey players (50 shoulders) with no history of missed games or practice because of shoulder injury, pain, or dysfunction underwent bilateral shoulder noncontrast 3.0-T MRI. MRIs were read blinded by 2 board-certified radiologists at 2 separate time points, 3 months apart, to determine the prevalence of abnormalities of the joint fluid, bone marrow, rotator cuff tendon, biceps tendon, labrum, AC joint, and glenohumeral joint. Interrater and intrareader reliability was determined, and regression analysis was performed to identify the prevalence and relationship to stick-hand dominance. Results: Labral abnormalities were seen in 25% of the shoulders. AC joint abnormalities and rotator cuff findings were noted in 8% and 6% of shoulders, respectively. One shoulder was noted to have a biceps tendon abnormality, and 1 shoulder demonstrated glenohumeral joint chondral findings. Interrater reliability coefficients were 0.619 for labral abnormalities. Intrareader reliability kappa coefficients were 0.493 and 0.718 for both readers, respectively, for labral abnormalities. Regression analysis was performed and revealed that the overall shoulder pathology was more common in the nondominant stick hand (top stick hand) (coefficient -0.731; P = .021). Conclusion: Professional and collegiate ice hockey players had an overall prevalence of labral abnormalities in 25% of their shoulders, with findings more often found in the nondominant stick hand. Rotator cuff abnormalities were uncommon in ice hockey players. These findings differ significantly from published reports examining professional baseball players and other overhead sports athletes.

13.
Sports Health ; 11(1): 64-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30289744

RESUMO

BACKGROUND:: Pediatric sports specialization, defined as intense year-round training in a single sport as a result of excluding other sports for more than 8 months per year, is common in the United States. There are demonstrated physical and social risks to early pediatric sports specialization (defined as before age 12 years). While thought to be needed to acquire appropriate experience and excel in a given sport, there remains little information on when athletes at the highest levels of their sport specialized. This study aimed to define when professional and collegiate ice hockey players specialized. HYPOTHESIS:: Early sports specialization before age 12 years will not be common among elite-level (professional and collegiate) ice hockey players. STUDY DESIGN:: Retrospective cross-sectional survey study. LEVEL OF EVIDENCE:: Level 3. METHODS:: Male professional and collegiate ice hockey players within 1 National Hockey League organization and 2 National Collegiate Athletic Association (NCAA) organizations who were 18 years of age or older completed a survey at training camp detailing their history of sports participation and specialization. RESULTS:: A total of 91 athletes participated in the study (mean age, 22.8 years; range, 18-39 years). The mean age at the start of any sports participation was 4.5 years, and the mean age of sports specialization was 14.3 years. The mean age of specialization in the professional group, the NCAA Division I group, and the NCAA Division III group was 14.1, 14.5, and 14.6 years, respectively. CONCLUSION:: Early pediatric sports specialization is not common in elite-level (professional and collegiate) ice hockey players. CLINICAL RELEVANCE:: Early pediatric sports specialization before age 12 years is not necessary for athletic success in professional and collegiate ice hockey. This study provides further evidence supporting the recommendations of the American Medical Society for Sports Medicine, American Academy of Pediatrics, and American Orthopaedic Society for Sports Medicine against early sports specialization.


Assuntos
Desempenho Atlético , Hóquei , Especialização , Adolescente , Adulto , Fatores Etários , Criança , Estudos Transversais , Humanos , Masculino , Condicionamento Físico Humano , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
14.
Phys Ther Sport ; 25: 76-83, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28188077

RESUMO

Athletic participation growth has resulted in increased exposures and neuromusculoskeletal (NMSK) non-contact injuries. Based on current evidence, the primary objective of this literature review is to create a preliminary evidence-based NMSK exercise guideline, addressing these intrinsic modifiable risk factors. Systematic searches were conducted September 2014 prior to data extraction utilizing CINAHL Plus (1995 to September 2014), MEDLINE (1995 to September 2014), and Academic Search Premier (1995 to September 2014). A priori defined inclusion criteria were applied and included the following: (i) full text, (ii) published in English, (iii) peer-reviewed articles addressing injury risk of non-contact lower extremity injury, (iv) identified specific exercises aimed at reducing injury risk of non-contact lower extremity injury, were the key data extraction points of interest. 3163 potential articles were identified from the initial search, 3120 excluded with reason based on the exclusion criteria. Exclusion criteria was applied in the form of an eight item list summarized in table 2, 43 articles remained after search criteria were applied. Novel to the current body of knowledge, this review identified nine intrinsic modifiable risk factors of the NMSK system that were used as a foundation to create the exercise guideline consisting of 30 exercise techniques.


Assuntos
Traumatismos em Atletas/prevenção & controle , Terapia por Exercício/métodos , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto
15.
Am J Sports Med ; 45(3): 725-732, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27159297

RESUMO

BACKGROUND: The Functional Movement Screen (FMS) is utilized by professional and collegiate sports teams and the military for the prevention of musculoskeletal injuries. HYPOTHESIS: The FMS demonstrates good interrater and intrarater reliability and validity and has predictive value for musculoskeletal injuries. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review and meta-analysis were conducted using a computerized search of the electronic databases MEDLINE and ScienceDirect in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted relevant data from each included study were recorded on a standardized form. The Cochran Q statistic was utilized to evaluate study heterogeneity. Pooled quantitative synthesis was performed to measure the intraclass correlation coefficient (ICC) for interrater and intrarater reliability, along with 95% CIs, and odds ratios with 95% CIs for the injury predictive value for a score of ≤14. RESULTS: Eleven studies for reliability, 5 studies for validity, and 9 studies for the injury predictive value were identified that met inclusion and exclusion criteria; of these, 6 studies for reliability and 9 studies for the injury predictive value were pooled for quantitative synthesis. The ICC for intrarater reliability was 0.81 (95% CI, 0.69-0.92) and for interrater reliability was 0.81 (95% CI, 0.70-0.92). The odds of sustaining an injury were 2.74 times with an FMS score of ≤14 (95% CI, 1.70-4.43). Studies for validity demonstrated flaws in both internal and external validity of the FMS. CONCLUSION: The FMS has excellent interrater and intrarater reliability. Participants with composite scores of ≤14 had a significantly higher likelihood of an injury compared with those with higher scores, demonstrating the injury predictive value of the test. Significant concerns remain regarding the validity of the FMS.


Assuntos
Traumatismos em Atletas/prevenção & controle , Teste de Esforço/métodos , Sistema Musculoesquelético/lesões , Medição de Risco/métodos , Traumatismos em Atletas/diagnóstico , Humanos , Movimento , Reprodutibilidade dos Testes
16.
Prim Care ; 42(4): 591-605, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26612374

RESUMO

Sunburn, thermal, and chemical injuries to the skin are common in the United States and worldwide. Initial management is determined by type and extent of injury with special care to early management of airway, breathing, and circulation. Fluid management has typically been guided by the Parkland formula, whereas some experts now question this. Each type of skin injury has its own pathophysiology and resultant complications. All primary care physicians should have at least a basic knowledge of management of acute and chronic skin injuries.


Assuntos
Queimaduras/classificação , Queimaduras/fisiopatologia , Atenção Primária à Saúde , Manuseio das Vias Aéreas , Superfície Corporal , Unidades de Queimados , Queimaduras/diagnóstico , Queimaduras/terapia , Queimaduras Químicas/fisiopatologia , Queimaduras Químicas/terapia , Congelamento das Extremidades/fisiopatologia , Congelamento das Extremidades/terapia , Humanos , Encaminhamento e Consulta , Queimadura Solar/fisiopatologia , Queimadura Solar/terapia , Estados Unidos
17.
Med Clin North Am ; 98(4): 869-80, xiii, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24994057

RESUMO

Physical therapy was first noted in the time of Hippocrates. The physical therapy visit includes a complete history, physical examination, and development of a treatment plan. Health care providers usually initiate a referral based on physical examination, symptoms, or a specific diagnosis. Physical therapy has been shown to be particularly helpful for musculoskeletal ailments, and has a growing body of evidence for use.


Assuntos
Doenças Musculoesqueléticas/reabilitação , Modalidades de Fisioterapia , Especialidade de Fisioterapia/métodos , Humanos , Reembolso de Seguro de Saúde , Anamnese , Exame Físico , Encaminhamento e Consulta
18.
Prim Care ; 40(4): 837-48, vii-viii, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24209721

RESUMO

The evaluation and treatment options for cervical radiculopathy continue to evolve as it becomes better defined and gaps in the literature are identified. This article provides a current synopsis of the definition, history, physical examination, imaging, and treatment options available.


Assuntos
Radiculopatia/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Radiculopatia/tratamento farmacológico , Radiculopatia/terapia , Tomografia Computadorizada por Raios X
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