Concussion acutely disrupts auditory processing in division I football student-athletes.

INTRODUCTION: Diagnosis, assessment, and management of sports-related concussion require a multi-modal approach. Yet, currently, an objective assessment of auditory processing is not included. The auditory system is uniquely complex, relying on exquisite temporal precision to integrate signals across many synapses, connected by long axons. Given this complexity and precision, together with the fact that axons are highly susceptible to damage from mechanical force, we hypothesize that auditory processing is susceptible to concussive injury. METHODS: We measured the frequency-following response (FFR), a scalp-recorded evoked potential that assesses processing of complex sound features, including pitch and phonetic identity. FFRs were obtained on male Division I Collegiate football players prior to contact practice to determine a pre-season baseline of auditory processing abilities, and again after sustaining a sports-related concussion. We predicted that concussion would decrease pitch and phonetic processing relative to the student-athlete's preseason baseline. RESULTS: We found that pitch and phonetic encoding was smaller post-concussion. Student-athletes who sustained a second concussion showed similar declines after each injury. CONCLUSIONS: Auditory processing should be included in the multimodal assessment of sports-related concussion. Future studies that extend this work to other sports, other injuries (e.g. blast exposure), and to female athletes are needed.

The open Latarjet-Patte procedure for the treatment of anterior shoulder instability in professional handball players at a mean follow-up of 6.6 years.

BACKGROUND: The popularity of team handball is increasing, with >10 million children playing this overhead throwing and collision sport with highest demands on the shoulder joint. Because of the risk of recurrent instability, the Latarjet-Patte (LP) procedure has been recommended to treat young competitive players. This is the first LP outcome study in professional handball players. METHODS: We retrospectively included 20 shoulders (18 players [17 male patients]; mean age, 22.9 years [range, 17-35 years]; minimum follow-up period, 2 years; mean follow-up period, 6.6 years) operated on by 3 expert surgeons (2011-2020) with the Walch LP technique. We documented preoperative hyperlaxity (25%, n = 5), affected throwing arm (55%, n = 11), position (backcourt, winger, and goalkeeper, 22% each; full back and pivot, 17% each), >2 dislocations prior (20%, n = 4), >10 dislocations prior (5%, n = 1), previous failed Bankart or humeral avulsion of glenohumeral ligament (HAGL) repair (10%, n = 2), and large Hill-Sachs lesions (HSLs) (20%, n = 4). Clinical and radiographic outcomes, visual analog scale score, Subjective Shoulder Value, Walch-Duplay score, Rowe score, and return-to-sport (RTS) rate were recorded. RESULTS: The RTS rate was 85% (17 of 20 shoulders); rate of RTS at the same level, 80% (16 of 20); and rate of RTS with no throwing pain, 73% (8 of 11). The time to training with a ball was 3.2 months, and the time to competition was 4.9 months. The mean Rowe score, Walch-Duplay score, and Subjective Shoulder Value were 90 points, 88 points, and 89%, respectively. Shoulder symptoms led players to give up handball in 2 cases (10%), whereas 1 player (5%) stopped playing handball for other reasons. We recorded 1 recurrent dislocation (5%) (non-throwing arm, winger, no recurrence after rehabilitation). Persistent apprehension occurred in 1 goalkeeper (5%). Residual pain was seen in 4 shoulders (20%); this was relieved by screw removal in 1. Resistant pain (throwing shoulder) was seen in 2 backcourt players (10%, 1 of whom had a large HSL) and 1 goalkeeper (5%; large HSL with >10 dislocations prior), all 3 of whom were aged > 30 years. Bone block positioning was correct (no lateral overhang) in all shoulders. At final follow-up, 1 shoulder (5%) showed mild arthritic changes (>10 dislocations, large HSL). CONCLUSION: The open LP procedure is consistent in providing shoulder stability combined with return-to-throwing performance in professional handball players with a short time to RTS and high same-level RTS rate without increasing the risk of arthritic changes. Throwing shoulders of backcourt players, large HSLs, or age > 30 years may have an increased risk of persistent symptoms.

The effect of the simulated aging by thermocycling on the elastic modulus of ethylene-vinyl acetate brands and stress/strain development during an impact: An in vitro and 3D-FEA analysis.

BACKGROUND/AIM: Mouthguards are used to prevent dental trauma and orofacial injuries. The aim of this study was to evaluate the influence of ethylene-vinyl acetate (EVA) aging by thermocycling on elastic modulus, stress, strain and shock absorption ability of different ethylene-vinyl acetate brands used for mouthguards. METHODS: Thirty EVA samples with a dimension of 70 × 10 × 3 mm were obtained from four commercial brands (Bioart®, Erkodent®, Polyshok® and Proform®). Fifteen samples were submitted to 10,000 cycles (5°C-55°C) in a thermocycling machine with an immersion time of 30 s and a transfer time of 5 s. The samples were submitted to a uniaxial tensile test in a universal testing machine to calculate the elastic modulus. Data were statistically evaluated by two-way ANOVA and Holm-Sidak test. A three-dimensional model of the anterior maxilla was created using Rhinoceros 5.0. A 3 mm custom-fitted mouthguard was simulated. The three-dimensional volumetric mesh was generated using the Patran software (MSC Software) with isoparametrics, 4-noded tetrahedral elements and exported to Marc/Mentat (MSC Software) as element number 134. A non-linear dynamic impact analysis was performed in which a rigid object struck the central incisor at a speed of 5 m/s. The stresses were evaluated by the modified von Mises criteria and the strains were also recorded. RESULTS: Statistically significant differences were observed for elastic modulus values (p < .001). Mean and standard deviation values (MPa) without thermocycling were: Bioart (34.5 ± 0.9), Erkodent (15.0 ± 0.4), Polyshok (17.3 ± 0.4), Proform: (20.6 ± 0.8); and with thermocycling: Bioart (25.4 ± 0.8), Erkodent (10.7 ± 0.5), Polyshok (13.3 ± 0.6), Proform (13.1 ± 0.6). The thermocycling process reduced stress and strain levels regardless of the mouthguard materials. Shock absorption ability calculated based on the strain values was increased with thermocycling process. CONCLUSION: The thermocycling process, regardless of the commercial brand, reduced the stress/strain and increased the shock absorption ability of mouthguards.

Methods and applications of finite element analysis in dental trauma research: A scoping review.

Finite Element Analysis (FEA) is vital for understanding dental traumatology (DT) biomechanics, aiding diagnosis, treatment planning, and outcome prediction. This review explores FEA applications in DT research, evaluates their quality and outcomes, and assesses methodological aspects. Accordingly, recommendations for future researchers are provided. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and registered in Open Science framework. A comprehensive search using relevant text-words and MeSH terms was performed in established databases. The inclusion criteria encompassed all Finite element analysis (FEA)-based Dental traumatology (DT) studies without language or publication year restrictions. Risk of bias was assessed with the Risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD) tool. Forty-six studies published from 2001 to 2023 were included in the qualitative synthesis. The studies were categorized into five domains and six subdomains based on objectives. Maxillary central incisors and surrounding structures were commonly modelled (n = 27). Most studies utilized Computed tomography (CT), Cone Beam CT, or micro CT. Traumatic injury forces ranged from 100 N to 2000 N, and occlusal forces ranged from 150 N to 350 N. All studies were rated as high risk of bias. Fory-six studies were categorized, with most focusing on stress distribution and fracture patterns in dento-alveolar structures under various conditions, while few assessed displacements. Methodological quality lacked robustness in model development and substructure properties. Future studies should address these limitations and enhance reporting practices.

Use of mouthguards in Latin American field hockey athletes during the ODESUR 2022 Games.

BACKGROUND/AIMS: Athletes are susceptible to oral injuries. To reduce the incidence and severity of oral trauma, a custom-made mouthguard, a device positioned in the mouth to prevent damage to teeth and surrounding structures, is recommended. In field hockey, according to the international rules of this sport, using mouthguards is not mandatory, but it is recommended to wear them at all times while practicing this discipline. We aimed to determine characteristics and differences regarding mouthguard usage among field hockey players from different countries participating in the XII ODESUR Games. METHODS: We conducted a cross-sectional study that included 78 voluntary hockey athletes that met the inclusion criteria. The questionnaire used was validated by Panam Sports, collecting information on the type of mouthguard (custom-made or prefabricated), and the time of use of the mouthguard (range of 5 years). RESULTS: Of the total number of athletes, 96% used mouthguards, of which 64% were custom-made type, and 32% were prefabricated (p < .001). Custom-made mouthguards were used by 100%, 89%, and 64% of athletes in Argentina, Chile, and Peru, respectively, while only 40% of athletes in Paraguay and Uruguay used them. It has also been observed that more than 50% of the individuals have not controlled and replaced their intraoral devices for more than 10 years. CONCLUSIONS: Our results reveal a problem with a public health dimension and thus invite the standardization of guidelines with an educational approach to promoting and adopting good sports practices. This report is the first on using mouthguards in high-performance athletes during an international multisport event.

The ability of mouthguards to protect veneered teeth: A 3D finite element analysis.

BACKGROUND/AIMS: Professional and amateur athletes might have veneer restorations. The aim of this study was to investigate the protective effect of mouthguards on veneered anterior restorations. METHODS: A nonlinear dynamic analysis was performed to simulate conditions during an impact with or without a custom-made mouthguard. Using a computer-aided design (CAD) software, a slice of a human maxilla was designed containing an upper right central incisor. The model was composed of mucosa, cortical bone, trabecular bone, periodontal ligament, dentin, enamel, and pulp tissue. The enamel was prepared (feather design), restored with an indirect veneer (1.0 mm thickness), and duplicated to simulate both conditions with or without a mouthguard (4 mm thickness). Both models were subdivided into finite elements using the computer-aided engineering (CAE) software. Frictionless contacts were used, and an impact was simulated in which a rigid sphere hit the model at 1 m s-1 . Fixation was defined at the base of the bone. The elastic modulus of the veneer was assessed by using five different restorative materials (resin composite, hybrid ceramic, zirconia-reinforced lithium silicate, lithium disilicate, and zirconia). Von Mises stress, minimal principal stress, and maximum principal stress (in MPa) were obtained and plotted for visual comparison. RESULTS: Von-Mises results showed higher stress concentrations in the veneer's cervical labial region for models without a mouthguard. Observing the quantitative results for each model, the highest compressive (709 MPa) and tensile (58 MPa) stresses occurred in the situation without a mouthguard with a zirconia veneer, while the lowest occurred in resin composite veneer with a mouthguard (8 and 5 MPa). The mouthguard was able to reduce the stresses in the tooth structure and it also reduced the risk of fracture in all conditions. CONCLUSIONS: Mouthguards were beneficial in reducing the effects of dental trauma regardless of the restorative material used to manufacture the indirect veneer, since they act by dampening the generated stresses during the trauma event. Equal impact stresses on a mouthguard will lead to higher stresses in veneered teeth with more rigid restorative materials leading to a less protective effect.

Sedentary behaviour and traumatic dental injuries in adolescents: A population-based study.

OBJECTIVE: Analyse factors associated with dental trauma in 12-year-old adolescents. METHODS: An epidemiological survey was carried out in the five largest cities in the state of Mato Grosso do Sul, Brazil. Data on traumatic dental injuries (TDI) based on the World Health Organization (WHO), sociodemographic characteristics and individual clinical and behavioural characteristics in 615 adolescents were collected. Univariate and adjusted multilevel logistic regressions were performed to test the association of dental trauma with behavioural and sociodemographic factors. The study was approved by the Ethics Committee (CAAE number 85647518.4.0000.0021). RESULTS: The prevalence of TDI at 12 years was 3.4% (95% CI 1.8; 6.4). In the adjusted models, clinical characteristics of adolescents such as overjet >3 mm (OR = 1.51 [95% CI 1.00; 2.41]) were associated with trauma. Sociodemographic characteristics such as female sex (OR = 0.13 [95% CI 0.07; 0.25]), income above the poverty level (OR = 0.34 [95% CI 0.15; 0.78]), who declared themselves white (OR = 0.23 [95% CI 0.11; 0.47]) and with sedentary behaviour (OR = 0.69 [95% CI 0.59; 0.80]) were associated with trauma, as protective factors. CONCLUSION: Sociodemographic, behavioural and individual clinical characteristics were associated with TDI in adolescents. Oral health teams should focus on the most vulnerable groups, encouraging the use of mouthguards and access to treatment services.

Head injuries caused by contact with teeth during sports and exercise activities in Japanese schools during the period 2012-2018.

BACKGROUND/AIM: During sports activities, teeth-related contact can cause injury to both ally and opponent players, which can lead to potential infections and aesthetic problems. However, the extent of such injuries remains unclear. This study aimed to clarify the frequency and situation of head injuries caused by teeth (HICBT) occurring under the supervision of schools in Japan. MATERIAL AND METHODS: HICBT records were extracted from the Japan Sport Council data on head injuries occurring reported during the 7-year period from 2012 to 2018 under the supervision of schools in Japan. RESULTS: Of the total 463,527 head injury cases during the study period, 4495 cases (approximately 1%) were HICBT. Of the HICBT cases, 3650 (81.20%) were related to sports and athletic activity. Such injuries were reported to occur most often during basketball with a rate of 57.07% and 50.43%; soccer/futsal was the next most common sport with a rate of 13.38% and 24.01% in junior high school and high school students. Tag games were responsible for a similar number of HICBT cases at 22.73% and 39.03% in kindergartens and elementary school students. CONCLUSIONS: A total of 4495 cases of HICBT were identified, accounting for about 1% of all head injuries under the supervision of schools in Japan during the study period. This result reminds us that our teeth could be the weapon against the players during sports events. HICBTs occurring during basketball and soccer/futsal, in which mouthguards are not mandatory, were conspicuous among junior and senior high school students. Active use of mouthguards in various sports will protect players as well as their teammates and opponents. Sports dentists should encourage the revision of rules, such as mandating the use of mouthguards, in popular sports with a high incidence of HICBT, such as basketball and soccer/futsal.

Influence of different ethylene-vinyl acetate brands used for custom-fitted mouthguard fabrication on the stress and strain during an impact.

BACKGROUND/AIM: The use of custom-fitted mouthguards can effectively prevent dentoalveolar trauma during sports practice. The aims of this study were to (1) Evaluate the elastic modulus of different EVA commercial brands used for custom-fitted mouthguards, and (2) Evaluate whether the different EVA brands can influence the stress and strain generated during an impact simulated by three-dimensional finite element analysis. METHODS: The elastic modulus of five EVA commercial brands (Essence® , Bio-Art® , Proform® , PolyShok® , and Erkodent® ) were calculated through uniaxial tensile tests. The obtained values were evaluated statistically by Kruskal-Wallis and Dunn's test. A three-dimensional model of the anterior maxilla was created using the Rhinoceros 5.0. A 3 mm custom-fitted mouthguard was simulated. The three-dimensional volumetric mesh was generated using the Patran software (MSC.Software) with isoparametrics, 4-noded tetrahedral elements, and exported to Marc/Mentat (MSC.Software) as element number 134. A non-linear dynamic impact analysis was performed in which a rigid object struck the central incisor at a speed of 5 m/s. The stresses were evaluated by the modified von Mises criteria, and the strains were also recorded. RESULTS: Statistically significant differences were observed for elastic modulus values (p < .001). Median values and the results of the Dunn's test were Essence® (38.1 A), Bio-Art® (34.9 AB), Proform® (20.8 BC), PolyShok® (17.4 CD), and Erkodent® (15.0 D) (different capital letters mean statistical differences among the groups). Stresses and strains generated in the model with mouthguards were significantly lower than the model without a mouthguard regardless of the commercial brand. There was no significant difference in the stress and strain on the enamel and dentin with the different EVA brands. The shock absorption ability was high for all the brands (more than 80%). CONCLUSION: The custom-fitted mouthguards, independently of the commercial brand, reduced stresses and strains during the impact.

Mitigating the Consequences of Subconcussive Head Injuries.

Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.

Unique diagnostic signatures of concussion in the saliva of male athletes: the Study of Concussion in Rugby Union through MicroRNAs (SCRUM).

OBJECTIVE: To investigate the role of salivary small non-coding RNAs (sncRNAs) in the diagnosis of sport-related concussion. METHODS: Saliva was obtained from male professional players in the top two tiers of England's elite rugby union competition across two seasons (2017-2019). Samples were collected preseason from 1028 players, and during standardised head injury assessments (HIAs) at three time points (in-game, post-game, and 36-48 hours post-game) from 156 of these. Samples were also collected from controls (102 uninjured players and 66 players sustaining a musculoskeletal injury). Diagnostic sncRNAs were identified with next generation sequencing and validated using quantitative PCR in 702 samples. A predictive logistic regression model was built on 2017-2018 data (training dataset) and prospectively validated the following season (test dataset). RESULTS: The HIA process confirmed concussion in 106 players (HIA+) and excluded this in 50 (HIA-). 32 sncRNAs were significantly differentially expressed across these two groups, with let-7f-5p showing the highest area under the curve (AUC) at 36-48 hours. Additionally, a combined panel of 14 sncRNAs (let-7a-5p, miR-143-3p, miR-103a-3p, miR-34b-3p, RNU6-7, RNU6-45, Snora57, snoU13.120, tRNA18Arg-CCT, U6-168, U6-428, U6-1249, Uco22cjg1,YRNA_255) could differentiate concussed subjects from all other groups, including players who were HIA- and controls, immediately after the game (AUC 0.91, 95% CI 0.81 to 1) and 36-48 hours later (AUC 0.94, 95% CI 0.86 to 1). When prospectively tested, the panel confirmed high predictive accuracy (AUC 0.96, 95% CI 0.92 to 1 post-game and AUC 0.93, 95% CI 0.86 to 1 at 36-48 hours). CONCLUSIONS: SCRUM, a large prospective observational study of non-invasive concussion biomarkers, has identified unique signatures of concussion in saliva of male athletes diagnosed with concussion.

Tackler and ball-carrier technique during moderate and severe injuries (≥8 days lost) compared with player-matched and team-matched injury-free controls in Elite Rugby Union.

OBJECTIVE: To analyse tackler and ball-carrier technical proficiency during moderate and severe contact injuries (≥8 days lost) in professional rugby union, and compare it with injury-free event-matched controls from the same player and from the same team. METHODS: Technical proficiency for 74 (n=74) (moderate and severe; ≥8 days lost) tackler and ball-carrier injuries during The Currie Cup (2014-2018) and 623 matched non-injury events (253 own controls, 370 team controls) were examined through video analysis using a standardised list of technical criteria. RESULTS: Mean technical proficiency score for injured tacklers during front-on tackles was 6.19/16 (arbitrary units (AU) 95% CI 4.89 to 7.48), which was significantly different to their own controls (8.90/16 AU, 95% CI 8.37 to 9.43, p<0.001, effect size (ES)=1.21, large) and team controls (9.93/16 AU, 95% CI 9.50 to 10.40, p<0.001, ES=1.71, large). Mean technical proficiency score for injured ball-carriers during front-on tackles was 5.60/14 AU (95% CI 4.65 to 6.55), which was significantly different to their own controls (8.08/14 AU, 95% CI 7.56 to 8.60, p<0.001, ES=1.16, moderate) and team controls (8.16/14 AU, 95% CI 7.75 to 8.57, p<0.001, ES=1.25, large). CONCLUSION: For the tackler and ball-carrier, for both front-on and side-on/behind tackles, overall technical proficiency scores were significantly lower for the injury-causing event, when compared with the player's own injury-free tackles and the team's injury-free tackles. Through analysing player and team controls, player technique deficiencies for the injured player and player technique deficiencies that expose all players to injury were highlighted, which may inform injury prevention strategies and policies, and assist coaches in optimising training to reduce tackle injury risk.

Association of probable REM sleep behavior disorder with pathology and years of contact sports play in chronic traumatic encephalopathy.

Probable rapid eye movement (REM) sleep behavior disorder (pRBD) is a synucleinopathy-associated parasomnia in which loss of REM sleep muscle atonia results in motor behavior during REM sleep, including dream enactment. Traumatic brain injury is independently associated with increased risk of pRBD and Lewy body disease, and both pRBD and Lewy body disease are often observed in chronic traumatic encephalopathy (CTE). However, the frequency and pathological substrate of pRBD in CTE have not been formally studied and remain unknown. Of the total sample of 247 men, age at death of 63.1 ± 18.8 years (mean ± SD), 80 [32%] were determined by informant report to have symptoms of pRBD. These participants had played more years of contact sports (18.3 ± 11.4) than those without pRBD (15.1 ± 6.5; P = 0.02) and had an increased frequency of Lewy body disease (26/80 [33%] vs 28/167 [17%], P = 0.005). Of the 80 participants with pRBD, 54 [68%] did not have Lewy body disease; these participants were more likely to have neurofibrillary tangles and pretangles in the dorsal and median raphe (41 of 49 [84%] non-LBD participants with pRBD symptoms vs 90 of 136 [66%] non-LBD participants without pRBD symptoms, P = 0.02), brainstem nuclei with sleep regulatory function. Binary logistic regression modeling in the total study sample showed that pRBD in CTE was associated with dorsal and median raphe nuclei neurofibrillary tangles (OR = 3.96, 95% CI [1.43, 10.96], P = 0.008), Lewy body pathology (OR = 2.36, 95% CI [1.18, 4.72], P = 0.02), and years of contact sports participation (OR = 1.04, 95% CI [1.00, 1.08], P = 0.04). Overall, pRBD in CTE is associated with increased years of contact sports participation and may be attributable to Lewy body and brainstem tau pathologies.

The relationship between collision metrics from micro-sensor technology and video-coded events in rugby union.

This study aimed to determine the relationship between collision metrics from a commercially available micro-sensor technology unit (MST) and the count of collisions coded by expert video analysts in professional rugby union. Forty-four professional rugby union players wore MST units during match play. We analyzed 245 combined data files from 11 competitive matches, resulting in the inclusion of a total of 9202 individual collision events. Collision metrics (the count of collisions and the Collision Load™) were analyzed via the manufacturer's software. Each match was also video recorded and evaluated by two expert video analysts. Pearson's correlation coefficients were used to determine the relationship between the count of collisions coded by the expert video analysts, and both MST collision metrics. One-way ANOVA was used to determine whether differences in the Collision Load™ for individual collision events existed between different playing positions. Very large-nearly perfect correlations were observed between the count of collisions coded by the expert video analysts and both MST collision metrics (the count of collisions: r = 0.91, 90% CI = 0.89-0.93; the Collision Load™: r = 0.89; 90% CI = 0.87-0.91). Differences in the Collision Load™ for individual collision events were identified between different playing positions. Collision metrics registered by the MST software relate very strongly with the count of collisions coded by expert video analysts. The typical Collision LoadTM per individual collision event varies depending on player position. The application of automated collision detection for rugby union appears feasible.

Molecular epidemiology of Tinea gladiatorum in contact sports in northern Iran.

BACKGROUND: Tinea gladiatorum as the major health concern among combat athletes and the most common cause of a decrease in the quality of their sports activities. OBJECTIVES: This study aimed to determine the molecular epidemiology of tinea gladiatorum in contact sports in Mazandaran Province, Northern Iran. MATERIALS/METHODS: In total, 631 suspected athletes out of 4240 ones were screened for tinea gladiatorum in this cross-sectional study from May 2018 to February 2019. The infection was confirmed by direct microscopy and culture tests. The causative agents were identified by polymerase chain reaction-restriction fragment length polymorphism method on ITS rDNA region. The indoor environmental factors were evaluated in 81 sports halls in terms of temperature (°C), humidity (%), density (m2 /athletes) and the number of ventilators. RESULTS: Tinea gladiatorum was confirmed in 6.5% (278/4240) of the athletes. Tinea corporis was the most common type of tinea (192/278; 69.0%), and 175 cases (27.7%) had more than one type of tinea. Moreover, Trichophyton tonsurans (192/203; 94.5%) was the most aetiological agent in all athletes followed by Microsporum canis (6/203; 2.9%), Trichophyton rubrum (2/203; 0.9%) and Trichophyton interdigitale (1/203; 0.4%). There was no significant association between the prevalence of tinea gladiatorum and the indoor environmental factors. CONCLUSION: T. tonsurans is the most common agent of tinea gladiatorum in Northern Iran. Since no positive culture of dermatophyte was obtained from mats, it seems that skin-to-skin contact would be the most probable mode of transmission among wrestlers. Accordingly, periodical checkups should be considered by health care providers.

AMSSM position statement update: blood-borne pathogens in the context of sports participation.

This American Medical Society for Sports Medicine position statement update is directed towards healthcare providers of patients involved in sport and exercise. There have been significant advances in clinical and scientific research in the understanding of blood-borne pathogens (BBPs), and this update incorporates these advancements. This document is intended as a general guide to clinical practice based on the current state of the evidence, while acknowledging the need for modification as new knowledge becomes available. Confirmed transmission of BBPs during sport is exceedingly rare. There are no well-documented reports of HIV, HCV or HDV transmission during sport. There is also no evidence for universal testing for BBPs as a specific requirement for participation in sports. Competitive athletes and non-athletes should follow appropriate general public health agency recommendations for screening for BBPs, considering their individual risk factors and exposures. Standard (universal) precautions must be followed by those providing care to athletes. Exercise and athletic participation can help promote a healthy lifestyle for persons living with BBPs. Those with acute symptomatic BBP infection should limit exercise intensity based on their current health status. Education is the key tool for preventing BBP transmission. Research gaps include evaluation of the prevalence of BBP infections in competitive athletes, the effects of long-term, intense training on infected athletes and the effects of BBP treatment therapies on performance.

Contact - but not foul play - dominates injury mechanisms in men's professional handball: a video match analysis of 580 injuries.

AIM: We aimed to identify patterns and mechanisms of injury situations in men's professional handball by means of video match analysis. METHODS: Moderate and severe injuries (absence of >7 days) sustained in competition in one of six seasons (2010 to 2013 and 2014 to 2017) in men's professional handball were prospectively analysed with a newly developed standardised observation form. Season 2013 to 2014 was excluded because of missing video material. RESULTS: 580 injuries were identified: 298 (51.4%) contact injuries, 151 (26.0%) indirect contact injuries and 131 (22.6%) non-contact injuries. Head (87.5%), hand (83.8%), shoulder (70.2%) and ankle (62.9%) injuries were mainly sustained during direct contact. Typical contact injuries included collision with an opponent's upper extremity or torso, and ankle injuries mainly consisted of foot-to-foot collisions. A large proportion (41.7%) of knee injuries were caused by indirect contact, whereas thigh injuries mainly occurred (56.4%) through non-contact mechanism. Wing (56.9%) and pivot (58.4%) players had the highest proportion of contact injuries, whereas backcourt players had a high proportion of indirect contact injuries (31.5%) and goalkeepers of non-contact injuries (48.9%). The injury proportion of foul play was 28.4%. Most injuries occurred in the central zone between the 6-metre and 9-metre lines (26.1%) and during the last 10 min of each match half (OR 1.71, p=0.016). CONCLUSIONS: In men's professional handball in a league setting, contact - but not foul play - was the most common mechanism associated with moderate and severe injuries. Head, hand, shoulder and ankle injury were mainly sustained during direct contact.

Consensus on a video analysis framework of descriptors and definitions by the Rugby Union Video Analysis Consensus group.

Using an expert consensus-based approach, a rugby union Video Analysis Consensus (RUVAC) group was formed to develop a framework for video analysis research in rugby union. The aim of the framework is to improve the consistency of video analysis work in rugby union and help enhance the overall quality of future research in the sport. To reach consensus, a systematic review and Delphi method study design was used. After a systematic search of the literature, 17 articles were used to develop the final framework that described and defined key actions and events in rugby union (rugby). Thereafter, a group of researchers and practitioners with experience and expertise in rugby video analysis formed the RUVAC group. Each member of the group examined the framework of descriptors and definitions and rated their level of agreement on a 5-point agreement Likert scale (1: strongly disagree; 2: disagree; 3: neither agree or disagree; 4: agree; 5: strongly agree). The mean rating of agreement on the five-point scale (1: strongly disagree; 5: strongly agree) was 4.6 (4.3-4.9), 4.6 (4.4-4.9), 4.7 (4.5-4.9), 4.8 (4.6-5.0) and 4.8 (4.6-5.0) for the tackle, ruck, scrum, line-out and maul, respectively. The RUVAC group recommends using this consensus as the starting framework when conducting rugby video analysis research. Which variables to use (if not all) depends on the objectives of the study. Furthermore, the intention of this consensus is to help integrate video data with other data (eg, injury surveillance).

High genetic contribution to anterior cruciate ligament rupture: Heritability ~69.

OBJECTIVES: We aimed to determine the lifetime genetic risk for anterior cruciate ligament (ACL) rupture. METHODS: We used a twin study approach, linking the Swedish Twin Register with national healthcare data to form a 30 year, population wide, longitudinal twin cohort. We studied ACL rupture in this cohort of 88 414 identical and fraternal twins, aged ≥17 years, to determine the familial risk and heritability of ACL rupture. RESULTS: The incidence rate of ACL rupture was 70 (95% CI 66 to 74) per 100 000 person years. The familial risk, which is the excess risk ratio (RR) of the second twin having ACL rupture given that the first twin has had such a rupture, was higher in identical twin pairs (RR=8.6, 95% CI 6.2 to 11.0) than in fraternal twin pairs (RR=1.9, 95% CI 0.9 to 3.0). The overall heritability of ACL rupture was high, 69% (95% CI 47 to 91), increasing from 60% at age 17 years to 80% at age 60 years. Women and men had similar familial risk and heritability of ACL rupture. CONCLUSION: The genetic contribution to ACL rupture of ~69% is high and suggests strong familial clustering. If clinicians recognise the high genetic risk of such injury, they may be better able to counsel athletes whose near relatives have had ACL rupture.

Experience with mouthguards and prevalence of orofacial injuries among field hockey players in Catalonia.

BACKGROUND/AIM: Orofacial injuries are a serious problem in field hockey. The aim of this study was to determine the prevalence of orofacial injuries in field hockey players in Catalonia, the frequency of mouthguard use, the types of mouthguards used and the degree of interference with oral function. MATERIAL AND METHODS: In this cross-sectional study, 325 field hockey players (28% women) from all age categories completed a questionnaire about orofacial injuries occurring during their sporting lives, including dental injuries, oral lacerations and episodes of acute temporomandibular disorder (TMD) pain. The questionnaire also asked about the experience of using a mouthguard, the type of mouthguard used and any adverse effects of use. The degree of interference with oral function was compared by type of mouthguard (mouth-formed, custom-made and pre-fabricated mouthguards) using the Kruskal-Wallis test. RESULTS: Half of the players (50.2%) reported at least one orofacial injury during their sporting lives. The mean number of oral lacerations, TMD pain episodes and dental injuries were 1.59, 0.24 and 0.18, respectively. In total, 310 players (95.7%) had tried a mouthguard, and of these 269 (86.8%) and 283 (91.3%) still used a mouthguard habitually during training and competition, respectively. Only 11 players (3.5%) had tried all three types of mouthguards, and 71 players (22.9%) had tried two types of mouthguard. By type, 217 players (70.0%) had tried mouth-formed (boil-and-bite) mouthguards, 156 (50.3%) had tried custom-made mouthguards and 30 (9.7%) had tried pre-fabricated mouthguards. Custom-made mouthguards were rated as more comfortable than the mouth-formed type (P < .05). CONCLUSIONS: The prevalence of orofacial injuries among field hockey players is relatively high. Most players habitually use a mouthguard during training and competition, typically preferring custom-made or a mouth-formed types. Custom-made mouthguards were considered the most comfortable.