Paralympians Are Stronger Than You Know: A Comparison of Para and Nondisabled Powerlifting Bench Press World Records.

ABSTRACT: van den Hoek, D, Garrett, J, Howells, R, and Latella, C. Paralympians are stronger than you know: A comparison of para and nondisabled powerlifting bench press world records. J Strength Cond Res 37(2): 452-456, 2023-This investigation explored the absolute and relative strength of bench press world record holders for World Para Powerlifting (WPPO) and International Powerlifting Federation (IPF) athletes. Athlete data (mass [in kilograms], competitive weight class, and bench press mass [in kilograms]) for world record holding male and female athletes were extracted from public databases. Absolute and relative strength (kg·kg bw-1 ) of athletes was compared using IPF competitive weight classes. On an individual basis, WPPO world record holders demonstrated greater absolute strength than their IPF counterparts in 5 of 8 weight classes for women and 6 of 8 weight classes for men when classified using standard IPF competitive weight classes. Overall, effect sizes for relative strength were greater in WPPO male (19.6%, g = 0.75) and female (9.24%, g = 0.38) athletes but did not reach statistical significance. The greatest relative strength observed was 3.88 kg·kg bw-1 (under 49-kg WPPO) for male and 2.72 kg·kg bw-1 (under 50-kg WPPO class) for female athletes. For IPF athletes, the greatest relative strength was reported in the under 66-kg class for male athletes (3.35 kg·kg bw-1 ) and under 63-kg class for female athletes (2.29 kg·kg bw-1 ). The physical impairments experienced by WPPO world record holders do not appear to compromise bench press strength compared with able-bodied athletes. Indeed, WPPO world record holders often possess greater relative and absolute strength than their IPF counterparts. Superior para powerlifting bench press records may be, at least in part, the result of training and biomechanical factors and seem to be the only anaerobic strength-based sport where para records exceed that of able-bodied athletes.

Analysis of Competition Performance Leading to Success at the International Powerlifting Federation World Championships Between 2013 and 2019.

ABSTRACT: van den Hoek, D, Garrett, J, Travis, SK, Oxnard, K, Howells, R, Owen, P, and Latella, C. Analysis of competition performance leading to success at the International Powerlifting Federation World Championships between 2013 and 2019. J Strength Cond Res 37(10): e555-e562, 2023-Despite being a global sport, there is a paucity of research investigating competition-related factors contributing to World Championship powerlifting success. Therefore, the aim of this study was to determine competition strategies that underpin gold medalists' (GMs) and silver or bronze medalists' (SBMs) performances. Data collected from open-age International Powerlifting Federation (IPF) World Championship events 2013-2019 were analyzed (1,312 competitors [males n = 734, females n = 578]). Attempt weight and success for the squat (SQ), bench press (BP), and deadlift (DL); 'total' competition scores; category (age, weight class, and sex); and placing were categorized into 3 groups: GMs, SBMs, and nonwinners (fourth place or lower). One-way analysis of variances determined between group differences. Odds ratios (ORs) for the likelihood of winning and placing (i.e., GMs or SBMs) were also calculated. The odds of winning a competition were increased 5.9 times for men and by 1.5 times for women, when successfully completing 8 or 9 of 9 lift attempts. These findings provide comprehensive insight into intracompetition-related factors that contribute to World Championship powerlifting success to directly inform coach and athlete strategies. This information may also hold relevance for competitive state or national competitions and extend to other similarly structured strength-based sports.

Technique for inguino-femoral lymph node dissection in vulvar cancer: an international survey.

BACKGROUND: Vulvar cancer is a rare disease and despite broad adoption of sentinel lymph node mapping to assess groin metastases, inguino-femoral lymph node dissection still plays a role in the management of this disease. Inguino-femoral lymph node dissection is associated with high morbidity, and limited research exists to guide the best surgical approach. OBJECTIVE: To determine international practice patterns in key aspects of the inguino-femoral lymph node dissection technique and provide data to guide future research. METHODS: A survey addressing six key domains of practice patterns in performing inguino-femoral lymph node dissection was distributed internationally to gynecologic oncology surgeons between April and October 2020. The survey was distributed using the British Gynecological Cancer Society, the Society of Gynecologic Oncology, authors' direct links, the UK Audit and Research in Gynecology Oncology group, and Twitter. RESULTS: A total of 259 responses were received from 18 countries. The majority (236/259, 91.1%) of respondents reported performing a modified oblique incision, routinely dissecting the superficial and deep inguino-femoral lymph nodes (137/185, 74.1%) with sparing of the saphenous vein (227/258, 88%). Most respondents did not routinely use compression dressings/underwear (169/252 (67.1%), used prophylactic antibiotics at the time of surgery only (167/257, 65%), and closed the skin with sutures (192 74.4%). Also, a drain is placed at the time of surgery by 243/259 (93.8%) surgeons, with most practitioners (144/243, 59.3%) waiting for drainage to be less than 30-50 mL in 24 hours before removal; most respondents (66.3%) routinely discharge patients with drain(s) in situ. CONCLUSION: Our study showed that most surgeons perform a modified oblique incision, dissect the superficial and deep inguino-femoral lymph nodes, and spare the saphenous vein when performing groin lymphadenectomy. This survey has demonstrated significant variability in inguino-femoral lymph node dissection in cases of vulvar cancer among gynecologic oncology surgeons internationally.

Complication rates and lymph node count between two different skin incisions at time of inguino-femoral lymph node dissection in vulvar cancer.

INTRODUCTION: Inguino-femoral lymph node dissection plays a crucial role in the management of vulvar cancer. The procedure is associated with high complication rates, including infection, lymphocysts/lymphoedema and wound dehiscence. Several skin incision techniques exist and practice among gynecology oncologists is variable. Little evidence exists to guide surgeons regarding the optimal surgical approach. This study aimed to determine the difference in 30-day complication rates, number of lymph nodes and length of stay between patients undergoing the modified oblique and classical 'lazy S' skin incision. METHODS: A retrospective review between January 2014 and September 2018 was performed in the University Hospital of Wales, Cardiff. All cases of inguino-femoral lymph node dissection performed for vulvar cancer were included in the study without exclusion. Data collected included age, body mass index (BMI), incision type, suture material, length of hospital stay, complication rates, cancer stage, lymph node count, lymph node positivity rate and recurrence rates. Data were analyzed using SPSS software and clinical significance was set as p<0.05. RESULTS: Thirty-five cases of classical 'lazy S' and 14 cases of modified oblique were included in the analysis. The mean patient age was 65 years (range 41-86) in the classical 'lazy S' group and 58 years (range 19-81) in the modified oblique group. The mean BMI was 28 kg/m2 (range 18-45) in the classical 'lazy S' group and 29 kg/m2 (range 20-36) in the modified oblique group. In the classical 'lazy S' group, the stage classification was as follows: stage IB (18), II (2), IIIA (3), IIIB (4), IIIC (8). In the modified oblique group, the stage classification was: stage IB (8), II (4), IIIA (2). Grade 3-4 complications were statistically significantly more common after the classical 'lazy S' versus the modified oblique operation (20/35, 57.1% vs 2/14, 14.3%, p<0.02). Mean number of nodes harvested was statistically significantly higher in the classical 'lazy S' group compared with the modified oblique group (11.1 nodes, range 6-17 vs 7 nodes, range 4-11, p<0.001). Node positivity rate was higher in the classical 'lazy S' group compared with the modified oblique group (28.6% vs 10%, p=0.08). Mean hospital stay was statistically significantly longer in patients undergoing classical 'lazy S' versus modified oblique (10.7 vs 4.5 days, p=0.02). One case of groin node recurrence occurred and this patient was in the classical 'lazy S' arm. CONCLUSION: The rate of overall and serious complications was lower after modified oblique skin incision compared with classical 'lazy S'. However, the absolute lymph node count and lymph node positivity rate were higher in the 'lazy S' group.

Why routine clinical follow-up for patients with early stage endometrial cancer is not always necessary: a study on women in South Wales.

OBJECTIVE: This study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate. DESIGN: This study used a retrospective analysis of follow-up data. SETTING: This study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom. SAMPLE: This study sample is composed of 552 women. METHODS: Data regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ test, Cox proportional hazard regression analysis, and Kaplan-Meier curves. MAIN OUTCOME MEASURES: This study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up. RESULTS: Between January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was "recurrent disease" with overall survival (hazard ratio, 2.20; P < 0.001; 95% confidence interval, 1.75-2.65) and progression-free survival (hazard ratio, 2.52; P < 0.001; 95% confidence interval, 2.09-2.95). "Asymptomatic recurrence" was not an independent predictor of outcome. CONCLUSIONS: Routine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.

What are the odds? Identifying factors related to competitive success in powerlifting.

BACKGROUND: The ability for athletes to gain a competitive advantage over their opponents is well recognised. At times, this advantage may be considered a marginal gain. However, in the context of competition, marginal advantages may be the difference between winning and losing. This investigation explores how competition factors influence the odds of competitive success (i.e. winning) in powerlifting (PL) to assist athletes and coaches in achieving a competitive advantage. METHODS: A cross-sectional, retrospective analysis of competition data from raw/classic, Australian powerlifting competitions 2010-2019 was conducted. Data included 10,599 competition entries (males: n = 6567 [62%], females: n = 4032 [38%]). Independent t-tests were used to compare continuous data between sexes or winners and non-winners at an event. Cohen's d and the 95% confidence interval (d [95% CI]) were calculated. Univariate odds of winning an event based on independent variables (age [irrespective of category], sex, body weight and weight of first lift attempt [regardless of success]), were assessed by separate simple logistic regression. RESULTS: When compared to males, the odds of winning for females were 50% greater (OR [95% CI] 1.500 [1.384, 1.625]; P < 0.001). Athletes who had larger first lift attempts (Squat: + 7.0 kg P < 0.001, Bench Press: + 3.2 kg P < 0.001, and Deadlift: + 6.1 kg P < 0.001and competed for a longer period (winners: 401 vs non-winners: 304 days, P < 0.001) had an increased likelihood winning. Age was associated with increased odds of success for males (OR [95% CI] 1.014 [1.009, 1.019], P < 0.001) per additional year of age for males, but not females (P = 0.509). CONCLUSIONS: Multiple factors appear to contribute to the likelihood of winning a PL competition. These results may help coaches to develop competition and training strategies that optimise athletes' likelihood of competitive success in PL.

Impacts of squat attempt weight selection and success on powerlifting performance.

BACKGROUND: To date, there is no evidence to support the optimal competition strategy for success in powerlifting competitions. The purpose of this study was to analyze powerlifting (PL) competition data to assess the relationship between squat attempts, the success of each lift attempt, and weight increase between attempts, with winning. METHODS: The analysis from 'raw' Powerlifting Australia sanctioned competitions held between 2008 and 2019 included 10,672 individual competition entries (males: N.=6617, females: N.=4055). We reported Cohen's d, statistical significance, 95% confidence intervals and the univariate odds of winning an event. Factors were assessed by separate simple logistic regression and reported as an odds ratio. RESULTS: Overall, first squat attempt weight for those who won was on average 7.0 kg greater (P<0.001, d=0.14 [0.10, 0.18]) than for non-winners. In the total sample, athletes selected opening attempts which were an average of 92% of their achieved maximum on the day with 93.5% of competitors improving on this weight in subsequent attempts. Winners had a 0.5 kg (P<0.001, d=0.10 [0.06, 0.14]) greater absolute increase in weight between first and second lift attempts than non-winners. Overall, ~68% of winners successfully lifted their third attempt weight compared to ~64% of non-winners (P<0.001). CONCLUSIONS: A powerlifting athlete's odds of winning a competition overall are significantly increased by selecting a larger opening squat attempt weight than competitors and completing the attempt successfully. The opening squat may be one of the most important lifts during competition.

Chemoradiation for advanced primary vulval cancer.

BACKGROUND: Vulval cancer is a rare gynaecological cancer. There is no standard approach for treating locally advanced primary vulval cancer (FIGO stage III and IV). Combined treatment modalities have been developed using radiotherapy, chemotherapy and surgery. The advantages and disadvantages of such treatment is not well evaluated. OBJECTIVES: To evaluate the effectiveness and safety of neoadjuvant and primary chemoradiation for women with locally advanced primary vulval cancer compared to other primary modalities of treatment such as primary surgery or primary radiation. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), Cochrane Gynaecological Cancer Group Trials Register, MEDLINE and EMBASE (to July 2009). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) or non-randomised studies that included multivariate analyses of chemoradiation in women with locally advanced, primary squamous cell carcinoma of the vulva. DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted data and assessed risk of bias. An adjusted hazard ratio (HR) for overall survival was calculated for one non-randomised study and risk ratios (RRs) were used in an RCT to compare five-year death rates and adverse events in women who received neoadjuvant, primary chemoradiation or primary surgery. Adverse events were also reported more extensively in a further non-randomised study. All results were displayed in single study analyses. MAIN RESULTS: One RCT and two non-randomised studies that allowed for multivariate analyses met the inclusion criteria and included a total of 141 women.One RCT found that neoadjuvant chemoradiation did not appear to offer longer survival compared to primary surgery in advanced vulval tumours (RR = 1.29, 95% confidence interval (CI) 0.87 to 1.91). There was also no statistically significant difference in survival between primary chemoradiation and primary surgery in a study that included 63 women (pooled adjusted HR= 1.09, 95% CI 0.37 to 3.17) and in another study that only included 12 eligible women and compared the same interventions (HR was non-informative when statistical adjustment was made).Adverse events were extensively reported in only one study, which found no statistically significant difference in risk of adverse events between primary chemoradiation and primary surgery due to the very small numbers in each group. In the RCT there was no observed statistically significant difference between neoadjuvant chemoradiation and primary surgery. Adverse events were not reported in the largest study of 63 women. Quality of life (QoL) was not reported in any of the included studies. All studies were at high risk of bias. AUTHORS' CONCLUSIONS: Women with advanced vulval tumours showed no significant difference in overall survival or treatment-related adverse events when chemoradiation (primary or neoadjuvant) was compared with primary surgery.The retrospective studies had a high risk of bias as the entry criteria for primary chemoradiation was based on inoperability or tumour requiring exenteration.The radiochemotherapy regimens varied widely. There was no data on QoL.There is no standard terminology for 'operable and inoperable vulval cancer', and for 'primary and neoadjuvant chemoradiation'. Stratification according to unresectability of the primary tumour and/or lymph nodes is needed, for good quality comparison.

Prevalence and location of acetabular sublabral sulci at hip arthroscopy with retrospective MRI review.

OBJECTIVE: The objective of this prospective study was to determine the prevalence and location of acetabular sublabral sulci diagnosed as variants at hip arthroscopy and to provide a retrospective MRI review. SUBJECTS AND METHODS: Two experienced hip arthroscopists noted the prevalence and location of acetabular labral sulci in 121 patients. The study population consisted of 57 males and 64 females with an average age of 43 years (range, 16-70 years). Of the 121 hip arthroscopies that showed sulci (22% of patients), correlation with the relevant MR studies (n = 27) was performed. Two radiologists who were aware of the arthroscopic findings reviewed the MR studies retrospectively, and agreement on imaging appearances was reached by consensus. RESULTS: Arthroscopy revealed 30 sulci (25%) in 27 of the 121 patients. In those who had a single sulcus (25 patients), 11 (44%) were located anterosuperiorly, 12 (48%) posteroinferiorly, one (4%) anteroinferiorly, and one (4%) posterosuperiorly. The other two patients had more than one sulcus: one patient had one posterosuperior sulcus and one posteroinferior sulcus; and the other patient had one anterosuperior sulcus, one anteroinferior sulcus, and one posteroinferior sulcus. In total, of the 121 patients, the number and position of the sulci were 12 anterosuperior (10%), 14 posteroinferior (12%), two anteroinferior (2%), and two posterosuperior (2%). Of the 27 MR examinations, 24 were unenhanced and three studies were performed after intraarticular injection of gadolinium. In these 27 patients, a total of 30 sulci were detected at arthroscopy. On retrospective MR review of both the conventional and gadolinium-enhanced studies, nine (75%) of the 12 anterosuperior sulci could be visualized. Ten (71%) of the 14 posteroinferior sulci were also identified. Neither of the two anteroinferior sulci could be seen. Both of the posterosuperior sulci were evident. Of the conventional MR studies, of a potential of 27, 18 (70%) were identified on conventional imaging. CONCLUSION: Sulci of the hip exist (22% of patients) and can be found at all anatomic positions (i.e., anterosuperior, anteroinferior, posterosuperior, and posteroinferior) of the hip. These sulci can be visualized on MRI with an accuracy of 70% using a nongadolinium technique.

Are extra-labral MR findings useful in the diagnosis of a labral tear?

OBJECTIVE: To determine diagnostic performance statistics of extra-labral magnetic resonance (MR) findings for detection of labral tears in a population of patients with clinical suspicion of this diagnosis. MATERIALS AND METHODS: Seventy-nine patients clinically suspected of having a labral tear (who underwent arthroscopy) had their MR studies retrospectively reviewed to determine the presence of lateral acetabular oedema-like marrow signal, ganglia, dysplastic femoral bumps, synovial herniation pits and geodes. These findings were then correlated with the arthroscopic presence (or absence) of a labral tear. RESULTS: All findings (lateral acetabular oedema-like marrow signal, ganglia, dysplastic femoral bumps, synovial herniation pits and geodes) had a specificity and positive predictive value (PPV) of 100%. Lateral acetabular oedema-like marrow signal had a sensitivity of 35% and 20% negative predictive value (NPV). This was the only statistically significant finding (P < 0.05). The sensitivity and NPV of ganglia were 12% and 16%, dysplastic femoral bumps (12%, 16%), synovial herniation pits (4%, 14%) and geodes (6%, 15%) respectively, (P > 0.05). CONCLUSION: Lateral acetabular oedema-like marrow signal is a useful sign (100% PPV) in the MR diagnosis of a labral tear, if one is clinically suspected. The other findings (ganglia, dysplastic femoral bumps, synovial herniation pits and geodes) were not statistically significant. Further studies are required to evaluate these.

A Study of Patients Treated for Primary Squamous Cell Carcinoma of the Vulva in the Regional Cancer Centre in Cardiff, UK.

Objective: Review of patients operated for primary squamous cell carcinoma (SCC) of the vulva in the Department of Gynaecological Oncology, University Hospital of Wales in Cardiff, to determine factors related to recurrence as well as survival of disease. Material/Methods: A retrospective review using details obtained from patients’ records. Hazard ratio estimation was carried out with Cox Regression analysis and survival plots were determined using Kaplan-Meier plots. Results: 144 women with primary vulval SCC were operated from 2002-2010. Commonly, radical wide local excision (49.3%) and radical vulvectomy (46.5%) were carried out, apart from ano-vulvectomy (1.4%) and local excision biopsies (2.8%). In 77.1% lympnode dissection was performed and inguinal metastasis was diagnosed in 28.8%, bilaterally in 68.8%. Histologically, 64.4% were moderate/poor differentiation and 30.9% were advanced disease (FIGO III and IVA). The 5-year survival rate (OS) was 61.1%. Stratified by FIGO classification, the 5-year OS for stages IA, IB, II, III and IVA were 72.7%, 86.0%, 50%, 34.4% and 45.5% respectively. Age >70 years was an important prognostic factor (51.9% OS) compared to 71.6% in patients 70 years. Patients with grade 1 disease survived in 72.5%, grade 2 in 58.8% and poorly differentiated cancer in 41.7%. Presence of inguinal metastasis was associated with a 40.6% 5-year OS, absence with 74.7%. Conclusions: Cox regression analysis confirms that age, presence/bilaterality of inguinal lymphnode metastasis, high-grade tumour differentiation, tumour size, FIGO stage and adjuvant therapy are important prognostic factors for 5-year survival.

Posterior divergent dislocation of the elbow in children and adolescents: a report of three cases and review of the literature.

Divergent dislocation of the elbow is defined as a specific elbow dislocation in which the distal humerus is forced between the proximal radius and ulna, resulting in separation or divergence of the proximal forearm bones. This is an uncommon injury in children, with 14 cases reported in the last 23 years. The authors report three additional cases and the findings from cadaver elbow dissections in which the injury was reproduced. The authors propose that there is only one type of divergent dislocation, resulting from indirect forces transmitted to the elbow from a fall on the outstretched hand. The injury predominantly occurs in younger children because joint laxity is a predisposing cause. Early recognition, followed by a closed reduction and a 3- to 4-week period of cast immobilization, should result in a full recovery for most children.

Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases.

BACKGROUND: The hip joint is becoming increasingly recognized as a source of groin pain and, in the authors' experience, buttock and low back pain. OBJECTIVES: To determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings in the hip joint. METHODS: We prospectively studied 25 consecutive hip arthroscopies to determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings. RESULTS: All of the hips arthroscoped had pathology. Back pain and hip pain were the 2 most common presentations. The only consistently positive clinical test result was a restricted and painful hip quadrant compared with the contralateral hip. Of the 17 patients whose flexion, abduction, external rotation (FABER) test results were reported at the time of examination, 15 (88%) were positive, and 2 (12%) negative. Plain radiographs were normal in all patients. All but 1 patient underwent magnetic resonance arthrography. Although specificity of 100% was achieved in our study, the sensitivity was significantly lower, with a relatively high number of false negatives. Hip arthroscopy proved the definitive diagnostic procedure for intraarticular pathology. CONCLUSIONS: Hip pathology, particularly labral pathology, may be more common than has been previously recognized. In those patients with chronic groin and low back pain, a high index of suspicion should be maintained. Clinical signs of a painful, restricted hip quadrant and a positive FABER test result should suggest magnetic resonance arthrography in the first instance, but a negative magnetic resonance image should not preclude hip arthroscopy if there is high clinical suspicion of hip joint pathology.