MRI-based Neuropathy Score Reporting And Data System (NS-RADS): multi-institutional wider-experience usability study of peripheral neuropathy conditions among 32 radiology readers.

OBJECTIVE: To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system. METHODS: This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings. RESULTS: Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036). CONCLUSION: Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system. CLINICAL RELEVANCE STATEMENT: The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists. KEY POINTS: • The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively).

Contemporary Practices of Strength and Conditioning Coaches in High-Level Male Ice Hockey: A Survey-Based Investigation.

ABSTRACT: Galati, D, Turner, AN, Bishop, C, and Maloney, SJ. Contemporary practices of strength and conditioning coaches in high-level male ice hockey: a survey-based investigation. J Strength Cond Res 37(11): 2241-2250, 2023-The aim of this study was to provide an updated view of the common practices, ideologies, education level, and professional environment of strength and conditioning (S&C) coaches in elite male ice hockey. Nineteen S&C coaches from professional, semiprofessional, and top-tier collegiate hockey teams in North America completed an anonymous online survey. This was composed of 10 sections: (a) background information; (b) technology use, (c) testing and periodization, (d) strength and power, (e) flexibility/mobility, (f) speed, (g) plyometrics, (h) aerobic and anaerobic conditioning, (i) rehabilitation, and (j) challenges and areas of improvement. Fixed-response questions were analyzed through frequency analyses. Thematic analyses were used to identify common themes from open-response questions. Strength and conditioning coaches had an average of 8 (±6.5) years of experience when they accepted their current role. The majority held a master's degree and S&C certification. Muscular power, linear speed, and body composition were the most frequently tested qualities. Neuromuscular fatigue was the most important consideration during the season and least important consideration during the off-season. Training frequencies for all physical capacities were lower during the season compared with the off-season. All S&Cs had access to technology, with wearables, with force plates identified as the most used devices. This information may be used by S&C coaches to compare working practices with those used by their peers and inform them of the likely requirements and skill sets needed for job applications. Educational institutions may use this information to align teaching to current practice and to inform future research.

Jump and Change of Direction Speed Asymmetry Using Smartphone Apps: Between-Session Consistency and Associations With Physical Performance.

ABSTRACT: Bishop, C, Perez-Higueras Rubio, M, Gullon, IL, Maloney, S, and Balsalobre-Fernandez, C. Jump and change of direction speed asymmetry using smartphone apps: between-session consistency and associations with physical performance. J Strength Cond Res 36(4): 927-934, 2022-The aims of this study were to (a) quantify the magnitude and direction of asymmetry from jump and change of direction speed (CODS) tests and (b) determine the relationship between these asymmetries and jump and CODS performance, in a test-retest design. Thirty Spanish national-level youth basketball athletes performed single leg countermovement jumps (SLCMJs), single leg drop jumps (SLDJs), and 505 CODS tests, all assessed using the My Jump 2 and CODTimer smartphone applications. All tests showed good to excellent reliability, with no significant differences identified between test sessions in jump, CODS, or asymmetry data. The direction of asymmetry showed substantial levels of agreement between test sessions for jump height during the SLDJ (Kappa = 0.72), but only fair levels of agreement for reactive strength during the SLDJ (Kappa = 0.25), fair levels of agreement for jump height during the SLCMJ (Kappa = 0.29), and slight levels of agreement for total time during the 505 test (Kappa = 0.18). Jump height asymmetry from the SLDJ was significantly associated with reduced jump height (ρ = -0.44), reactive strength (ρ = -0.46) and 505 times (ρ = 0.45-0.48) in test session 1, and reactive strength (ρ = -0.42) and 505 times (ρ = 0.40) in test session 2. These data show that jump height asymmetry from the SLDJ was associated with reduced jump and CODS performance in youth basketball athletes during repeated test sessions. In addition, the same asymmetry metric was the only one to show substantial levels of agreement between test sessions. Owing to the consistency of these data, SLDJ height asymmetry may be a useful metric to measure when monitoring interlimb asymmetries.

Effects of a Competitive Soccer Match on Jump Performance and Interlimb Asymmetries in Elite Academy Soccer Players.

ABSTRACT: Bromley, T, Turner, A, Read, P, Lake, J, Maloney, S, Chavda, S, and Bishop, C. Effects of a competitive soccer match on jump performance and interlimb asymmetries in elite academy soccer players. J Strength Cond Res 35(6): 1707-1714, 2021-The purpose of this study was to investigate the effects of a competitive soccer match on jump performance and interlimb asymmetries over incremental time points during a 72-hour period. Fourteen elite adolescent players from a professional English category 3 academy performed single-leg countermovement jumps pre, post, 24-, 48-, and 72-hour post-match on a single force platform. Eccentric impulse, concentric impulse, peak propulsive force, jump height, peak landing force, and landing impulse were monitored throughout. Interlimb asymmetries were also calculated for each metric as the percentage difference between limbs. Significant negative changes (p < 0.05) in jump performance were noted for all metrics at all time points, with the exception of jump height. Interlimb asymmetries were metric-dependent and showed very large increases, specifically post-match, with a trend to reduce back toward baseline values at the 48-hour time point for propulsive-based metrics. Asymmetries for landing metrics did not peak until the 24-hour time point and again reduced toward baseline at 48-hour time point. This study highlights the importance of monitoring distinct jump metrics, as jump height alone was not sensitive enough to show significant changes in jump performance. However, interlimb asymmetries were sensitive to fatigue with very large increases post-match. More frequent monitoring of asymmetries could enable practitioners to determine whether existing imbalances are also associated with reductions in physical performance or increased injury risk.

Too big to breathe: predictors of respiratory failure and insufficiency after open ventral hernia repair.

INTRODUCTION: Increased intra-abdominal pressure in open ventral hernia repair (OVHR) is hypothesized to contribute to postoperative respiratory insufficiency (RI) or failure (RF). This study examines the impact of abdominal volumes on postoperative RI in OVHR. METHODS: OVHR patients with preoperative CT scans were identified. 3D volumetric software measured hernia volume (HV), subcutaneous volume (SQV), and intra-abdominal volume (IAV). The ratio of hernia to intra-abdominal volume (HV:IAV) was calculated. A principal component analysis was performed to create new component variables for collinear volume and hernia variables. RESULTS: There were 1178 OVHR patients with preoperative CT scans. Demographics included a mean BMI of 34.2 ± 7.7 kg/m2, age of 58.5 ± 12.4 years, and 57.8% were female. RI occurred in 8.3% of patients, including 4.0% requiring > 24 h respiratory support with ezPAP, CPAP, or biPAP (RI), and 4.3% requiring intubation (RF). Patients who developed RI had a higher BMI (33.8 ± 7.5 vs. 38.2 ± 9.1 kg/m2, p < 0.0001), older age (58.1 ± 12.5 vs. 62.8 ± 10.4 years, p = 0.0001), larger defects (140.9 ± 128.4 vs. 254.0 ± 173.9 cm2, p < 0.0001), HV (865.8 ± 1200.0 vs. 2005.6 ± 1791.7 cm3, p < 0.0001), and HV:IAV (0.26 ± 0.45 vs. 0.53 ± 0.58, p < 0.0001). Three PC variables accounted for 85% of variance: hernia volume PC consists primarily of HV (61.8%), ratio HV:IAV (57.7%), and defect size (50.1%) and accounts for 38.3% variance. Extra-abdominal volume PC consists primarily of SQV (63.7%) and BMI (60.8%) and accounts for 32.5% variance. Intra-abdominal volume PC is primarily IAV (75.8%) and accounts for 14.9% variance. In multivariate analysis, predictors of RI included asthma and COPD (OR 4.04, CI 1.82-8.96), hernia PC (OR 1.47, CI 1.48-1.98), EAV PC (OR 1.24, CI 1.04-1.48), increased age (OR 1.04, CI 1.01-1.06), and diabetes (OR 1.8, CI 1.11-2.91). Component separation, fascial closure, contamination, and panniculectomy were not associated with RI. CONCLUSION: The impact of defect size, BMI, HV, SQV, IAV, and HV:IAV on respiratory insufficiency after OVHR is collinear. Patients with large defects and a large ratio of HV:IAV (greater than 0.5) are also at significantly increased risk of RI after OVHR. While BMI impacts these parameters, it is not directly predictive of postoperative RI.

The association of penicillin allergy with outcomes after open ventral hernia repair.

BACKGROUND: Up to 11% of patients report a penicillin allergy (PA), with 1-2% demonstrating a true IgE mediated allergy upon testing. PA patients often receive non-beta-lactam antibiotic surgical prophylaxis (non-BLP). This study evaluates the relationship of PA to outcomes after open ventral hernia repair (OVHR). METHODS: A prospective institutional database was queried for patients undergoing OVHR. Demographics, operative characteristics, and outcomes were evaluated by the reported PA and the administration of beta-lactam prophylaxis (BLP). RESULTS: Allergy histories were reviewed in 1178 patients. PA was reported in 21.6% of patients, with 55.5% reporting rash or hives, 15.0% airway compromise or anaphylaxis, and 29.5% no specific reaction. BLP was administered to 76.3% of patients, including 22.1% of PA patients and 89.9% of patients without PA. PA patients were more often female (64.6% PA patients vs. 56% non-PA, p = 0.01), with higher rates of chronic steroids, MRSA, anxiety, asthma, COPD, chronic pain, and sleep apnea (p < 0.03 all values). PA patients had higher rates of contaminated cases, including mesh infection and fistula. Of the 683 clean cases, 82.1% received BLP. Of the 117 clean contaminated cases (CDC wound class 2), 82.9% received BLP, which was associated with reduced long-term readmission for hernia complications (21.5 vs. 55%, p = 0.002, OR 0.27, CI 0.09-0.83). In the 120 CDC wound class 3 and 4 patients, 65.8% received BLP. In multivariate analysis, BLP was associated with lower rates of reoperation (OR 0.31, CI 0.12-0.76) and recurrence (OR 0.32, CI 0.11-0.86). BLP was given to 22.1% of the PA patients with no adverse reactions noted. CONCLUSION: PA patients had more comorbidities and complex ventral hernias. When controlling for contamination and MRSA history, BLP is associated with improved outcomes particularly in contaminated cases. PA may be a risk factor for patient complexity, and further studies are warranted to determine if allergy testing can be warranted in known or anticipated contaminated cases.

Three-dimensional hernia analysis: the impact of size on surgical outcomes.

INTRODUCTION: BMI and hernia defect size are strongly associated with outcomes after open ventral hernia repair (OVHR). The impact of abdominal subcutaneous fat (SQV), intra-abdominal volume (IAV), hernia volume (HV), and ratio of HV to intra-abdominal volume (HV:IAV, representing visceral eventration) is less clearly elucidated. This study examines the interaction of multiple markers of adiposity and hernia size in OVHR. METHODS: OVHR with preoperative CT scans were identified. 3D volumetric software measured HV, SQV, IAV, and HV:IAV was calculated. A principal component analysis was performed to create new component variables for collinear variables. Hernia PC was composed primarily of hernia dimensions, EAV (extra-abdominal volume PC) included SQV and BMI, and IAV PC included IAV. RESULTS: A total of 1178 OVHR patients had a preoperative CT scan. Their demographics included a mean age of 58.5 ± 12.4 years, BMI of 34.2 ± 7.7 kg/m2, and 57.8% were female. The mean defect area was 150.8 ± 136.7 cm2, and 66.0% were recurrent, Patients had mean SQV of 6719.4 ± 3563.9 cm3, HV of 966.9 ± 1303.5 cm3, IAV of 4250.2 ± 2118.1 cm3, and a HV:IAV of 0.29 ± 0.46. In multivariate analysis, Hernia PC was associated with panniculectomy (OR 1.52, CI 1.37-1.69) and component separation (OR 1.34, CI 1.21-1.49) and was negatively associated with fascial closure (OR 0.78, CI 0.69-0.88). Hernia PC was also associated with reoperation, readmission, and development of wound complications (OR 1.18, CI 1.08-1.30; OR 1.15, CI 1.04-1.27; OR 1.28, CI 1.16-1.41, respectively). EAV PC was associated with performance of a panniculectomy (OR 1.33, CI 1.20-1.48), readmission (OR 1.18, CI 1.06-1.32), and wound complications (OR 1.41, CI 1.27-1.57). IAV PC was not associated with adverse outcomes. CONCLUSION: Values of hernia area, volume, IAV, HV:IAV, BMI, and SQV are collinear markers of patient obesity and hernia proportions. They are distinct enough to be represented by three principal component variables, indicating more nuanced discrete influences on variability of surgical outcomes other than BMI.

The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias.

BACKGROUND: Component Separation (CST) typically involves incision of one or more fascial planes to generate myofascial advancement flaps to assist with fascial closure in ventral hernia repair (VHR). The aim of this study was to compare peri-operative outcomes and quality of life (QOL) after CST versus patients without CST (No-CST) in large, preperitoneal VHR (PPVHR). METHODS: A prospective, single institution hernia study examined all patients undergoing PPVHR with synthetic mesh. Emergency and contaminated operations were excluded. A case-control cohort was identified using propensity score matching for CST and No-CST. QOL was assessed using the Carolinas Comfort Scale. RESULTS: The algorithm matched 113 CST cases to 113 No-CST cases. The groups (CST vs No-CST) were similar regarding age, BMI, diabetes, smoking, defect size, mesh size, and follow-up. In univariate analysis, there was no difference in recurrence between the CST and no-CST groups (0.9% vs 0.9%, p = 1.0) or mesh infection (0.9% vs 0.0%, p = 1.0). CST did have more wound complications (29.2% vs 16.1%, p = 0.019). When controlling for panniculectomy and diabetes with multivariate logistic regression, CST continued to have had an increased risk for wound complications (OR 2.27, CI 1.16-4.47). QOL was routinely assessed. The groups were similar pre-operatively with 76.3% of CST patients and 77.8% of No-CST patients having pain (p = 1.0). At 1, 6, 12, 24, and 36 months post-operatively, the groups had equal QOL. CONCLUSION: The use of CST versus No-CST in the repair of large VHs results in an increased risk of wound complications but does not increase the hernia recurrence rate. In the largest QOL comparative study to date, CST's generation of myofascial advancement flaps does not negatively impact patient QOL in the repair of large ventral hernias in the short or long term.

Male gender is an independent risk factor for patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass: an MBSAQIP® database analysis.

BACKGROUND: Male patients undergoing bariatric surgery have (historically) been considered higher risk than females. The aim of this study was to examine the disparity between genders undergoing laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) procedures and assess gender as an independent risk factor. METHODS: The MBSAQIP® Data Registry Participant User Files for 2015-2017 was reviewed for patients having primary SG and RYGB. Patients were divided into groups based on gender and procedure. Variables for major complications were grouped together, including but not limited to PE, stroke, and MI. Univariate and propensity matching analyses were performed. RESULTS: Of 429,664 cases, 20.58% were male. Univariate analysis demonstrated males were older (46.48 ± 11.96 vs. 43.71 ± 11.89 years, p < 0.0001), had higher BMI (46.58 ± 8.46 vs. 45.05 ± 7.75 kg/m2, p < 0.0001), and had higher incidence of comorbidities. Males had higher rates of major complications (1.72 vs. 1.05%; p < 0.0001) and 30-day mortality (0.18 vs. 0.07%, p < 0.0001). Significance was maintained after subgroup analysis of SG and RYGB. Propensity matched analysis demonstrated male gender was an independent risk factor for RYGB and SG, major complications [2.21 vs. 1.7%, p < 0.0001 (RYGB), 1.12 vs. 0.89%, p < 0.0001 (SG)], and mortality [0.23 vs. 0.12%, p < 0.0001 (RYGB), 0.10 vs. 0.05%; p < 0.0001 (SG)]. CONCLUSION: Males continue to represent a disproportionately small percentage of bariatric surgery patients despite having no difference in obesity rates compared to females. Male gender is an independent risk factor for major post-operative complications and 30-day mortality, even after controlling for comorbidities.

Impact of age on morbidity and mortality following bariatric surgery.

BACKGROUND: Bariatric surgery is the most effective modality to treat obesity and obesity-related comorbidities. This study sought to utilize the MBASQIP® Data Registry to analyze the impact of age at time of surgery on outcomes following sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) procedures. METHODS: The MBSAQIP® Data Registry for patients undergoing SG or RYGB procedures between 2015 and 2016 was reviewed. Patients were divided into 4 age groups [18-44; 45-54; 55-64; > 65 years]. Minimal exclusions for revisional and/or emergency surgery were selected and combination variables created to classify complications as major or minor. A comorbidity index was constructed to include diabetes, gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and prior cardiac surgery. Univariate and multivariate logistic regression analyses were performed to compare age stratifications to the young adult (18-45 years) cohort. RESULTS: Of 301,605 cases, 279,419 cases (71.2% SG) remained after applying exclusion criteria (79.2% female, mean BMI 45.5 ± 8.1 kg/m2, 8.9% insulin-dependent diabetics). Mean age was 44.7 ± 12.0 years (51.3% 18-44 years; 26.9% 45-54 years; 16.3% 55-64 years; 5.5% > 65 years). A univariate analysis demonstrated preoperative differences of lower BMI with increasing age concomitant with increasing frequency of RYGB and a higher comorbidity index (p < 0.0001 vs. 18-45 years). At age > 45 years, major complications and 30-day mortality increased independent of procedure type (p < 0.0001). A multivariate analysis controlling for comorbidity indices demonstrated increasing age (> 45 years) increased risk for major complications and mortality. CONCLUSION: Overall, bariatric surgery (SG or RYGB) remains a low mortality risk procedure for all age groups. However, all age group classifications > 45 years had higher incidence of major complications and mortality compared to patients 18-45 years (despite older individuals having lower preoperative BMI) indicating delaying surgery is detrimental.

Correction to: Impact of age on morbidity and mortality following bariatric surgery.

This article was updated to correct the spelling of Nicholas Dugan's first name: it is correct as displayed here.

Use of computed tomography volumetric measurements to predict operative techniques in paraesophageal hernia repair.

BACKGROUND: Despite advances in diagnostic imaging capabilities, little information exists concerning the impact of physical dimensions of a paraesophageal hernia (PEH) on intraoperative decision making. The authors hypothesized that computerized volumetric analysis and multidimensional visualization to measure hiatal defect area (HDA) and intrathoracic hernia sac volume (HSV) would correlate to operative findings and required surgical techniques performed. METHODS: Using volumetric analysis software (Aquarius iNtuition, TeraRecon, Inc), HDA and HSV were measured in PEH patients with preoperative computerized tomography (CT) scans, and used to predict the likelihood of intraoperative variables. Multidimensional rotation of images enabled visualization of the entire hiatal defect in a plane mimicking the surgeon's view during repair. The intrathoracic hernia sac was outlined producing volume measurements based on a summation of exact dimensions. RESULTS: A total of 213 PEHR patients had preoperative CT imaging, with 14.1% performed emergently. Primary cruroplasty was performed in 89.2%, salvage gastropexy in 10.3%, and diaphragmatic relaxing incisions in 4.2%. Median HDA was 25.7 cm2 (IQR17.8-35.6 cm2); median HSV was 365.0 cm3 (IQR150.0-611.0 cm3). Incremental 5 cm2 increase in HDA was associated with greater likelihood of presenting emergently (OR 1.27; 95%CI 1.124-1.428, p = 0.0001), incarceration (OR 1.27; 1.074-1.499, p = 0.005), gastric volvulus (OR 1.13; 1.021-1.248, p = 0.02), and requiring either relaxing incision (OR 1.43; 1.203-1.709, p < 0.0001) or salvage gastropexy (OR 1.13; 1.001-1.274, p = 0.04). Similarly, HSV increases of 100 cm3 were associated with 23% greater likelihood of emergent repair (CI 1.121-1.353, p < 0.0001), and were more likely to require a relaxing incision (OR 1.18; 1.043-1.339, p = 0.009) or salvage gastropexy (1.19; 1.083-1.312, p = 0.0003). CONCLUSIONS: Utilization of CT volumetric measurements is a valuable adjunct in preoperative planning, allowing the surgeon to anticipate complexity of repair and operative approach, as incremental increases in HSV by 100 cm3 and HDA by 5 cm2 are more likely to require complex techniques or bailout procedures and/or present emergently.

A qualitative study of community perspectives surrounding cleaning practices in the context of Zika prevention in El Salvador: implications for community-based Aedes aegypti control.

BACKGROUND: In El Salvador, Aedes aegypti mosquitoes transmitting Zika and other arboviruses use water storage containers as important oviposition sites. Promotion of water storage container cleaning is a key element of prevention programs. We explored community perceptions surrounding cleaning practices among pregnant women, male partners of pregnant women, and women likely to become pregnant. METHODS: Researchers conducted 11 focus groups and 12 in-depth interviews which included individual elicitations of Zika prevention measures practiced in the community. Focus group participants rated 18 images depicting Zika-related behaviors according to effectiveness and feasibility in the community context, discussed influencing determinants, voted on community intentions to perform prevention behaviors, and performed washbasin cleaning simulations. In-depth interviews with male partners of pregnant women used projective techniques with images to explore their perceptions on a subset of Zika prevention behaviors. RESULTS: General cleaning of the home, to ensure a healthy environment, was a strong community norm. In this context, participants gave water storage container cleaning a high rating, for both its effectiveness and feasibility. Participants were convinced that they cleaned their water storage containers effectively against Zika, but their actual skills were inadequate to destroy Aedes aegypti eggs. A further constraint was the schedule of water availability. Even during pregnancy, male partners rarely cleaned water storage containers because water became available in homes when they were at work. Furthermore, prevailing gender norms did not foster male participation in domestic cleaning activities. Despite these factors, many men were willing to provide substantial support with cleaning when their partners were pregnant, in order to protect their family. CONCLUSIONS: Behavior change programs for the prevention of Zika and other arboviruses need to improve community members' mosquito egg destruction skills rather than perpetuate the promotion of non-specific cleaning in and around the home as effective. Egg elimination must be clearly identified as the objective of water storage container maintenance and programs should highlight the effective techniques to achieve this goal. In addition, programs must build the skills of family members who support pregnant women to maintain the frequency of effective egg destruction in all water storage containers of the home.

CHOROIDAL NEVUS TRANSFORMATION INTO MELANOMA PER MILLIMETER INCREMENT IN THICKNESS USING MULTIMODAL IMAGING IN 2355 CASES: The 2019 Wendell L. Hughes Lecture.

PURPOSE: To analyze risk of nevus transformation into melanoma per millimeter increment. METHODS: Retrospective analysis of 3,806 choroidal nevi for transformation into melanoma per incremental millimeter thickness (flat [≤1.0 mm], thin [1.1-2.0 mm], thicker [2.1-3.0 mm], and thickest [>3.0 mm]) RESULTS:: The median nevus thickness was 1.4 mm, and nevi were categorized (flat, thin, thicker, and thickest) in 1,140 (30%), 2052 (54%), 555 (15%), and 59 (<1%), respectively. There were differences in tumor diameter (2.5, 4.8, 7.5, and 9.3 mm; P < 0.01), optical coherence tomography detection of overlying subretinal fluid (<1, 4, 15, and 11%; P < 0.01), overlying retinal edema (<1, 3, 14, and 25%; P < 0.01), overlying drusen (23, 49, 64, and 64%; P < 0.01), overlying retinal pigment epithelial detachment (1, 4, 4, and 9%; P < 0.01), and overlying lipofuscin hyperautofluoresence (<1, 3, 6, and 7%; P < 0.01). Choroidal nevus transformation into melanoma (n = 90/2,355 cases, 3.8%) was found by Kaplan-Meier 7-year estimates (2.2, 6.1, 31.7, and 34.5%; P < 0.0001) and by hazard ratio (HR) compared with nevus ≤1.0 mm (not available, 4.7 [P = 0.01], 35.7 [P < 0.0001], and 52.0 [P < 0.0001]). For all thicknesses, those with growth displayed increase in mean basal diameter of 2.4 mm and thickness of 1.1 mm, optical coherence tomography increase in subretinal fluid (65%), autofluorescence increase in lipofuscin (40%), and ultrasonography increase in hollowness (30%). Multivariable risk factors, recalled by the mnemonic "To Find Small Ocular Melanoma Doing IMaging" (TFSOM-DIM) representing Thickness >2 mm (ultrasonography), Fluid subretinal (optical coherence tomography), Symptom vision loss (Va), Orange pigment (autofluorescence), Melanoma hollow (ultrasonography), and DIaMeter >5 mm, revealed factors per incremental thickness category (compared with flat) including thin (Fluid overlying, HR 6.1; DIaMeter >5 mm, HR 3.3), thicker (Fluid subretinal ≤3 mm from nevus, HR 5.7; Melanoma acoustic hollowness, HR 2.7), and thickest (Orange pigment, HR 9.1). CONCLUSION: Each incremental increase in choroidal nevus thickness demonstrated risk of growth into melanoma with HR (compared with flat) 4.7 for thin, 35.7 for thicker, and 52.0 for thickest. The increase from ≤2.0 mm to >2.0 mm thickness conferred the greatest rise for transformation.

CHOROIDAL NEVUS IMAGING FEATURES IN 3,806 CASES AND RISK FACTORS FOR TRANSFORMATION INTO MELANOMA IN 2,355 CASES: The 2020 Taylor R. Smith and Victor T. Curtin Lecture.

PURPOSE: To use multimodal imaging for identification of risk factors for choroidal nevus transformation into melanoma. METHODS: Retrospective chart review of 3806 consecutive choroidal nevi with imaging and 2355 choroidal nevi with additional follow up to identify factors predictive of transformation of choroidal nevus into melanoma. RESULTS: The median patient age was 62.5 years and Caucasian race in 3167 (95%). The choroidal nevus demonstrated median basal diameter of 4.0 mm and thickness of 1.4 mm. Imaging included optical coherence tomography (OCT) showing subretinal fluid (SRF) in 312 (9%), ultrasonography (US) with acoustic hollowness in 309 (9%), and hyper-autofluorescence (AF) in 100 (3%). Of those 2355 choroidal nevi with follow up, Kaplan-Meier estimates of nevus transformation into melanoma at 1, 5, and 10 years were 1.2%, 5.8%, and 13.9%, respectively. Multivariate analysis, using multimodal imaging for detection of factors predictive of nevus transformation into melanoma, included thickness >2 mm on US (hazard ratio (HR) 3.80, p < 0.0001), SRF on OCT as cap over nevus (HR 3.00, p < 0.0001) or SRF ≤3 mm from nevus margin (HR 3.56, p = 0.0003), symptomatic vision loss ≤20/50 on Snellen visual acuity (VA) (HR 2.28, p = 0.005), orange pigment (lipofuscin) hyperautofluorescence on AF (HR 3.07, p = 0.0004), acoustic hollowness on US (HR 2.10, p = 0.0020), and tumor diameter >5 mm on photography (HR 1.84, p = 0.0275). These factors can be recalled by the mnemonic "To Find Small Ocular Melanoma Doing IMaging" (TFSOM-DIM) representing Thickness >2 mm (US), Fluid subretinal (OCT), Symptoms vision loss (VA), Orange pigment (AF), Melanoma hollow (US), and DIaMeter >5mm (photography). The mean 5-year estimates of nevus growth into melanoma were 1% (HR 0.8) for those with 0 risk factor, 11% (HR 3.09) with 1 factor, 22% (HR 10.6) with 2 factors, 34% (HR 15.1) with 3 factors, 51% (HR 15.2) with 4 factors, 55% (HR 26.4) with 5 risk factors, and not-estimable with all 6 risk factors. CONCLUSION: In this analysis, multimodal imaging was capable of detecting risk factors for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for transformation.

Acute and chronic effects of foam rolling vs eccentric exercise on ROM and force output of the plantar flexors.

Foam rolling and eccentric exercise interventions have been demonstrated to improve range of motion (ROM). However, these two modalities have not been directly compared. Twenty-three academy soccer players (age: 18 ± 1; height: 1.74 ± 0.08 m; body mass: 69.3 ± 7.5 kg) were randomly allocated to either a foam rolling (FR) or eccentric exercise intervention designed to improve dorsiflexion ROM. Participants performed the intervention daily for a duration of four weeks. Measurements of dorsiflexion ROM, isometric plantar flexion torque and drop jump reactive strength index were taken at baseline (pre-intervention) and at three subsequent time-points (30-min post, 24-hours post and 4-weeks post). A significant time x group interaction effect was observed for dorsiflexion (P = 0.036), but not for torque or reactive strength index. For dorsiflexion, there was a significant increase in both acute (30-min; P < 0.001) and chronic (4-week; P < 0.001) ROM for the eccentric group, whilst FR exhibited only an acute improvement (P < 0.001). Eccentric training would appear a more efficacious modality than foam rolling for improving dorsiflexion ROM in elite academy soccer players.

The Relationship Between Asymmetry and Athletic Performance: A Critical Review.

Maloney, SJ. The relationship between asymmetry and athletic performance: A critical review. J Strength Cond Res 33(9): 2579-2593, 2019-Symmetry may be defined as the quality to demonstrate an exact correspondence of size, shape, and form when split along a given axis. Although it has been widely asserted that the bilateral asymmetries are detrimental to athletic performance, research does not wholly support such an association. Moreover, the research rarely seeks to distinguish between different types of bilateral asymmetry. Fluctuating asymmetries describe bilateral differences in anthropometric attributes, such as nostril width and ear size, and are thought to represent the developmental stability of an organism. There is evidence to suggest that fluctuating asymmetries may be related to impaired athletic performance, although contradictory findings have been reported. Sporting asymmetries is a term that may better describe bilateral differences in parameters, such as force output or jump height. These asymmetries are likely to be a function of limb dominance and magnified by long-standing participation within sport. Sporting asymmetries do not seem to carry a clear influence on athletic performance measures. Given the vast discrepancy in the methodologies used by different investigations, further research is warranted. Recent investigations have demonstrated that training interventions can reduce sporting asymmetries and improve performance. However, studies have not sought to determine whether the influence of sporting asymmetry is independent of improvements in neuromuscular parameters. It may be hypothesized that the deficient (weaker) limb has a greater potential for adaptation in comparison to the strong limb and may demonstrate greater responsiveness to training.

Unilateral Stiffness Interventions Augment Vertical Stiffness and Change of Direction Speed.

Maloney, SJ, Richards, J, Jelly, L, and Fletcher, IM. Unilateral stiffness interventions augment vertical stiffness and change of direction speed. J Strength Cond Res 33(2): 372-379, 2019-It has previously been shown that preconditioning interventions can augment change of direction speed (CODS). However, the mechanistic nature of these augmentations has not been well considered. The current study sought to determine the effects of preconditioning interventions designed to augment vertical stiffness on CODS. Following familiarization, 10 healthy males (age: 22 ± 2 years; height: 1.78 ± 0.05 m; body mass: 75.1 ± 8.7 kg) performed 3 different stiffness interventions in a randomized and counterbalanced order. The interventions were: (a) bilateral-focused, (b) unilateral-focused, and (c) a control of CODS test practice. Vertical stiffness and joint stiffness were determined preintervention and postintervention using a single-leg drop jump task. Change of direction speed test performance was assessed postintervention using a double 90° cutting task. Performances following the unilateral intervention were significantly faster than control (1.7%; p = 0.011; d = -1.08), but not significantly faster than the bilateral intervention (1.0% faster; p = 0.14; d = -0.59). Versus control, vertical stiffness was 14% greater (p = 0.049; d = 0.39) following the unilateral intervention and 11% greater (p = 0.019; d = 0.31) following the bilateral intervention; there was no difference between unilateral and bilateral interventions (p = 0.94; d = -0.08). The findings of the current study suggest that unilateral preconditioning interventions designed to augment vertical stiffness improve CODS within this experimental cohort.

Lower Extremity Stiffness: Considerations for Testing, Performance Enhancement, and Injury Risk.

Brazier, J, Maloney, S, Bishop, C, Read, PJ, and Turner, AN. Lower extremity stiffness: considerations for testing, performance enhancement, and injury risk. J Strength Cond Res 33(4): 1156-1166, 2019-Force-deformation characteristics of the lower limb have been associated with athletic performance and may modulate the risk of injury. Despite these known associations, measurements of lower extremity stiffness are not commonly administered by strength and conditioning coaches. This review provides an overview of the available literature pertaining to the effects of lower extremity stiffness on physical performance and injury risk. Practical methods of monitoring and training stiffness are also discussed. The cumulative body of evidence indicates that increases in lower extremity stiffness are associated with heightened performance in athletic tasks such as hopping, jumping, throwing, endurance running, sprinting, and changing direction. Relationships with injury are less conclusive because both excessive and insufficient limb stiffness have been postulated to increase risk. Thus, the "optimal" level of stiffness seems to be dependent on the anthropometry and physical capabilities of the athlete, in addition to sport-specific activity demands. Training interventions can positively enhance lower extremity stiffness, including isometric, eccentric, and isotonic strength training and plyometrics. Complex training also seems to provide a potent stimulus and may be more effective than the use of singular training modes. For plyometric activities, it is recommended that coaches use a developmental sequence of exercises with increasing eccentric demand to provide an appropriate stimulus based on the training age and technical competency of the athlete.

Postactivation Potentiation and Change of Direction Speed in Elite Academy Rugby Players.

Marshall, J, Turner, AN, Jarvis, PT, Maloney, SJ, Cree, JA, and Bishop, CJ. Postactivation potentiation and change of direction speed in elite academy rugby players. J Strength Cond Res 33(6): 1551-1556, 2019-This study investigated the effect of preceding proagility sprints with maximal isometric squats to determine if postactivation potentiation (PAP) could be harnessed in change of direction speed. Sixteen elite under-17 rugby union players (age: 16 ± 0.41 years; body mass: 88.7 ± 12.1 kg; height: 1.83 ± 0.07 m) from an Aviva Premiership rugby club were tested. Subjects performed a change of direction specific warm-up, followed by 2 baseline proagility tests. After 10-minute recovery, 3 × 3-second maximal isometric squats with a 2-minute recovery between sets were completed as a conditioning activity (CA) on a force plate where peak force and mean rate of force development over 300 milliseconds were measured. The proagility test was repeated at set time intervals of 1, 3, 5, and 7 minutes after the CA. Overall proagility times were significantly slower (p < 0.05) at 1 minute post-CA compared with the baseline (3.3%), with no significant differences occurring at 3, 5, or 7 minutes post-CA. Therefore, it appears that performing multiple sets of maximal isometric squats do not enhance proagility performance.