The influence of the perceived requirements of the next match and motivation on the mental fatigue of soccer players.

The high cognitive and/or emotional demands of competition can lead to a state of mental fatigue which has shown to be detrimental to soccer performance. However, there is a need to further understand the true mental demands of soccer players. The aim of the present study was to analyze the influence of motivation and the perceived requirements of the next match on mental fatigue perceived by soccer players over the passing of a season. The combined effect of both variables on the perception of mental fatigue, as well as the influence of the time of the season on perceived mental fatigue, were also analyzed. Twenty-six semi-professional Spanish male players (M = 26.31 ± 5.18 years) participated in the present study, conducted during the 2020-2021 season. Perceived mental fatigue and motivation were measured at each training session. The perceived requirements of the next match were also measured in each of the competitive weeks. Linear mixed models were run with R Studio to examine the influence of motivation and the perceived difficulty of the next match on perceived mental fatigue, the combined effect of both variables on perceived mental fatigue, and the influence of the passing of the season on perceived mental fatigue. The results showed a negative and significant influence of motivation on perceived mental fatigue (p < 0.001) and a positive and significant influence of the perceived requirements of the next match on perceived mental fatigue (p < 0.001). Regarding the combined effect, there was a positive and significant effect (p < 0.01) of the perceived difficulty of the next match on the relation between motivation and perceived mental fatigue. A negative influence of season passage on perceived mental fatigue levels was found (p < 0.001). We recommended coaches to consider using the most motivating training tasks when higher next-match requirements are perceived and to be careful with avoidance strategies for mental fatigue, especially at the beginning of the season.

Radiological and clinical femoroacetabular impingement after slipped capital femoral epiphysis treated by in situ fixation.

Background: The treatment of slipped capital femoral epiphysis (SCFE) is always surgical. In situ fixation (ISF) is widely accepted to stop the epiphysis slipping. Femoroacetabular impingement (FAI) is recognized as a complication after ISF and is one of the major causes of early hip osteoarthritis. Study aim: The aim of this study was to characterize the relation between clinical and radiological signs of FAI. Methods: A monocentric study that included all consecutive children treated for SCFE by ISF between 2006 and 2017 was performed. Clinical examination consisted in range of motion (ROM) measurement for both hips, impingements tests and functional scores (Harris Hip Score (HHS) and Womac score). Radiological analysis was based on signs of impingement (alpha angle, anterior head neck offset (OS), anterior head neck offset ratio (HNOR). Results: 36 hips were included. At follow-up, the difference between the mean hip ROM on the SCFE side and the healthy side were statistically significant in abduction and in internal rotation. Ten (28%) hips presented at least one clinical test positive for FAI (FADDIR and/or FABER). All the patients presented a good or excellent functional score. Eight patients (22%) presented all radiological signs of impingement; among these, 3 had a clinical sign of FAI. Twenty-eight hips (78%) presented at least one radiological sign of FAI; among these, 10 had clinical signs of FAI. Conclusion: Despite a high rate of radiological FAI, less than one-third of patients have clinical signs of FAI after ISF for SCEFE. Level of evidence: III: retrospective study.

Comparative study of open, laparoscopic and endoscopic treatments of intermediate grade vesicoureteral reflux in children.

BACKGROUND: Low-grade vesicoureteral-reflux (VUR) are rather treated by endoscopic injection, whereas open or laparoscopic procedures are mainly performed for high-grade VURs. Management of intermediate grades is controversial and no study focused on grade III to date. This study aims to compare the results of open, laparoscopic, and endoscopic approaches in children with grade III VUR. METHODS: A multicenter comparative retrospective study included children with grade III VUR operated for febrile urinary tract infections (UTIs) from 2007 to 2016. Children without UTI, with reflux of other grades, neurological bladder, duplex system, posterior urethral valves, and bladder exstrophy were excluded. Success was defined as no recurrence of febrile UTI and was presented as event-free survival curves. RESULTS: Out of 806 children operated of VUR, 171 met the inclusion criteria (114 females). Seventy-seven children (45%) underwent an open Cohen procedure, 35 (21%) a laparoscopic Lich-Gregoir and 59 (34%) a submucosal endoscopic injection according to the centers' preference. The mean follow-up was 64 months (24-132). Groups were not different for age, sex, and circumcision status. Compared to Cohen procedure, recurrences of febrile UTI were more frequent after laparoscopic treatment (p = 0,02, 8/35) and endoscopic treatment (p = 0.001, 16/59). Redosurgery was also more frequent after laparoscopy (n = 2) and endoscopic injection (n = 14) than after open surgery (n = 0, p < 0.001). CONCLUSION: Recurrent febrile UTIs and redosurgery are more frequent after endoscopic and laparoscopic procedures in grade III VUR than open reimplantation. Whether the lower morbidity of laparoscopic or endoscopic approaches balances the risk of recurrent febrile UTI remains to be determined for intermediate grade reflux.

Comparison of outcomes using the rituximab originator MabThera with the biosimilar Truxima in patients with ANCA-associated vasculitis.

OBJECTIVES: The use of rituximab (MabThera®), an anti-CD20 monoclonal antibody, is the most significant development in the management of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) since the introduction of cytotoxic therapy in 1950. Truxima® is the first anti-CD20 biosimilar approved for the same indications, and has been available in the UK since 2017. Significant cost savings have been reported when switching to biosimilars, which could lead to greater patient access to such treatment. Therefore, it is important to know whether patients' clinical and laboratory parameters respond equally well to biosimilars as to reference medicines, tested in clinical trials. METHOD: We retrospectively reviewed the clinical outcomes and laboratory parameters in 257 consecutive patients treated with anti-CD20 depletion therapy using MabThera or Truxima, for induction and maintenance of remission, in two tertiary renal centres between 2010 and 2019. RESULTS: We demonstrated no difference between patients treated with MabThera or Truxima in rates of remission, relapse, and hospitalization with infection when used for either induction or maintenance of remission of AAV. In one hospital subgroup analysis, we showed comparable levels of hypogammaglobulinaemia, B-cell depletion, and frequency of infusion reactions, with no significant differences. CONCLUSION: The efficacy and safety of the rituximab biosimilar Truxima are not inferior to the originator MabThera in patients with AAV. Truxima represents a cheaper and safe therapeutic alternative that could increase patient access to rituximab.

Changing patterns in medication prescription for gestational diabetes during a time of guideline change in the USA: a cross-sectional study.

OBJECTIVE: To define patterns of prescription and factors associated with choice of pharmacotherapy for gestational diabetes mellitus (GDM), namely metformin, glyburide and insulin, during a period of evolving professional guidelines. DESING: Cross-sectional study. SETTING: US commercial insurance beneficiaries from Market-Scan (late 2015 to 2018). STUDY DESIGN: We included women with GDM, singleton gestations, 15-51 years of age on pharmacotherapy. The exposure was pharmacy claims for metformin, glyburide and insulin. MAIN OUTCOMES: Pharmacotherapy for GDM with either oral agent, metformin or glyburide, compared with insulin as the reference, and secondarily, consequent treatment modification (addition and/or change) to metformin, glyburide or insulin. RESULTS: Among 37 762 women with GDM, we analysed data from 10 407 (28%) with pharmacotherapy, 21% with metformin (n = 2147), 48% with glyburide (n = 4984) and 31% with insulin (n = 3276). From late 2015 to 2018, metformin use increased from 17 to 29%, as did insulin use from 26 to 44%, whereas glyburide use decreased from 58 to 27%. By 2018, insulin was the most common pharmacotherapy for GDM; metformin was more likely to be prescribed by 9% compared with late 2015/16, but glyburide was less likely by 45%. Treatment modification occurred in 20% of women prescribed metformin compared with 2% with insulin and 8% with glyburide. CONCLUSIONS: Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for GDM among a privately insured US population during a time of evolving professional guidelines. Further evaluation of the relative effectiveness and safety of metformin compared with insulin is needed. TWEETABLE ABSTRACT: Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for gestational diabetes mellitus in the USA.

Experimental and numerical investigations on the impact behaviour of pristine and patch-repaired composite laminates.

The present paper investigates the impact behaviour of both pristine carbon-fibre-reinforced-plastic (CFRP) composite laminates and repaired CFRP laminates. For the patch-repaired CFRP specimen, the pristine CFRP panel specimen has been damaged by cutting out a central disc of the CFRP material and then repaired using an adhesively bonded patch of CFRP to cover the hole. Drop-weight, impact tests are performed on these two types of specimens and a numerical elastic-plastic, three-dimensional damage model is developed and employed to simulate the impact behaviour of both types of specimen. This numerical model is meso-scale in nature and assumes that cracks initiate in the CFRP at a nano-scale, in the matrix around fibres, and trigger sub-micrometre intralaminar matrix cracks during the impact event. These localized regions of intralaminar cracking then lead to interlaminar, i.e. delamination, cracking between the neighbouring plies which possess different fibre orientations. These meso-scale, intralaminar and interlaminar, damage processes are modelled using the numerical finite-element analysis model with each individual ply treated as a continuum. Good agreement is found between the results from the experimental studies and the predictions from the numerical simulations. This article is part of the theme issue 'Nanocracks in nature and industry'.

False aneurysm of the popliteal artery revealing a solitary osteochondroma of the distal femur in an 11-year-old boy.

An 11-year-old boy presented with pain in the right knee, intermittent reverse ischemia of the right foot and paraesthesia of the right toes. An angio-CT showed a false aneurysm of the right superior popliteal artery, and a solitary osteochondroma of the posterior aspect of the distal femur. Excision of the aneurysm and the osteochondroma was performed in two-stages. The patient was clinically well at 1-year follow up.

The Prognostic and Therapeutic Value of the Mutational Profile of Blood and Tumor Tissue in Head and Neck Squamous Cell Carcinoma.

BACKGROUND: The purpose of this study was to explore the genomic landscape of head and neck squamous cell carcinoma (HNSCC) in circulation (circulating tumor DNA [ctDNA]) and tumor (tumor tissue DNA [tDNA]) and understand the implications of ctDNA sequencing for prognosis and precision oncology treatments. MATERIALS AND METHODS: This is a retrospective review of 75 patients with HNSCC for both tDNA and ctDNA. Results were analyzed for concordance between tDNA and ctDNA and for their individual and combined association with demographics, survival, and presence and extent of disease at last visit (DLV). RESULTS: The five most frequently altered genes were TP53, CDKN2A, TERT, BRCA2, and NOTCH1. Twenty percent of patients had NOTCH1 alterations in tDNA, with none found in ctDNA. Concordance among altered genes was 13.0%, and 65.3% of patients had actionable ctDNA alterations. ctDNA alterations were significantly associated with decreased overall survival (OS) and presence and extent of DLV. In DNA repair genes, alterations in ctDNA alone and combined with tDNA were significantly associated with decreased OS and presence of DLV. Similar significant associations were found in TP53 for ctDNA alone and combined with tDNA. DNA repair gene alterations in ctDNA and unique ctDNA alterations within partially concordant genes were significantly associated with decreased OS in multivariate analysis. CONCLUSION: This study illustrates the circulating and tumor genomic profile in the largest HNSCC cohort to date, underscoring the potential utility of ctDNA in prognostication and precision oncology treatment. For the first time, the presence of ctDNA alterations and specific ctDNA sequencing results were shown to be significantly associated with poor prognosis in HNSCC. IMPLICATIONS FOR PRACTICE: The use of precision genomic targeted therapies in head and neck squamous cell carcinoma (HNSCC) lags behind many other cancers, and poor survival in advanced stages indicates the urgent need for improved treatment options. This exploratory analysis of circulating tumor DNA (ctDNA) and tumor tissue DNA (tDNA) sequencing in the largest cohort to date of patients with HNSCC provides a novel depiction of the ctDNA genome, with two thirds of patients having actionable ctDNA alterations. This study reports for the first time the prognostic value of ctDNA sequencing, with the presence of ctDNA alterations, specific ctDNA alterations in DNA repair genes and TP53, and unique ctDNA alterations within partially concordant genes predicting poor survival.

Long-term clinical, virological and immunological outcomes following planned treatment interruption in HIV-infected children.

OBJECTIVES: Planned treatment interruption (PTI) of antiretroviral therapy (ART) in adults is associated with adverse outcomes. The PENTA 11 trial randomized HIV-infected children to continuous ART (CT) vs. CD4-driven PTIs. We report 5 years' follow-up after the end of main trial. METHODS: Post-trial, all children resumed ART. Clinical, immunological, virological and treatment data were collected annually. A sub-study investigated more detailed immunophenotype. CT and PTI arms were compared using intention-to-treat. Laboratory parameters were compared using linear regression, adjusting for baseline values; mixed models were used to include all data over time. RESULTS: In all, 101 children (51 CT, 50 PTI) contributed a median of 7.6 years, including 5.1 years of post-trial follow-up. Post-trial, there were no deaths, one pulmonary tuberculosis and no other CDC stage B/C events. At 5 years post-trial, 90% of children in the CT vs. 82% in the PTI arm had HIV RNA < 50 copies/mL (P = 0.26). A persistent increase in CD8 cells was observed in the PTI arm. The sub-study (54 children) suggested that both naïve and memory populations contributed to higher CD8 cells following PTI. Mean CD4/CD8 ratios at 5 years post-trial were 1.22 and 1.08 in CT and PTI arms, respectively [difference (CT - PTI) = -0.15; 95% CI: -0.34-0.05), P = 0.14]. The sub-study also suggested that during the trial and at early timepoints after the end of the trial, reduction in CD4 in the PTI arm was mainly from loss of CD4 memory cells. CONCLUSIONS: Children tolerated PTI with few long-term clinical, virological or immunological consequences.

The formation and fate of internal waves in the South China Sea.

Internal gravity waves, the subsurface analogue of the familiar surface gravity waves that break on beaches, are ubiquitous in the ocean. Because of their strong vertical and horizontal currents, and the turbulent mixing caused by their breaking, they affect a panoply of ocean processes, such as the supply of nutrients for photosynthesis, sediment and pollutant transport and acoustic transmission; they also pose hazards for man-made structures in the ocean. Generated primarily by the wind and the tides, internal waves can travel thousands of kilometres from their sources before breaking, making it challenging to observe them and to include them in numerical climate models, which are sensitive to their effects. For over a decade, studies have targeted the South China Sea, where the oceans' most powerful known internal waves are generated in the Luzon Strait and steepen dramatically as they propagate west. Confusion has persisted regarding their mechanism of generation, variability and energy budget, however, owing to the lack of in situ data from the Luzon Strait, where extreme flow conditions make measurements difficult. Here we use new observations and numerical models to (1) show that the waves begin as sinusoidal disturbances rather than arising from sharp hydraulic phenomena, (2) reveal the existence of >200-metre-high breaking internal waves in the region of generation that give rise to turbulence levels >10,000 times that in the open ocean, (3) determine that the Kuroshio western boundary current noticeably refracts the internal wave field emanating from the Luzon Strait, and (4) demonstrate a factor-of-two agreement between modelled and observed energy fluxes, which allows us to produce an observationally supported energy budget of the region. Together, these findings give a cradle-to-grave picture of internal waves on a basin scale, which will support further improvements of their representation in numerical climate predictions.

[French linguistic validation of the Index of Sexual Satisfaction (ISS)]. / Validation linguistique française de l'indice de satisfaction sexuelle (ISS).

INTRODUCTION: The objective of this study was to propose a French version of the Index of Sexual Satisfaction (ISS). MATERIAL AND METHOD: The translation from English to French of the ISS was performed independently by three pediatric surgeons whose mother tongue is French. Then, an English speaker, fluent in French, who was unaware of the original questionnaire, translated the reconciled French version of the ISS into English. RESULTS: The final French version was successfully tested on 25 French-speaking volunteers. CONCLUSION: We present a validated translation of the Sexual Satisfaction Index.

Feasibility, acceptability and cost efficiency of using webinars to deliver first-line patient education for people with Irritable Bowel Syndrome as part of a dietetic-led gastroenterology service in primary care.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. International research suggests dietary intervention as a first-line approach, although dietetic services are struggling to cope with demand. Digital technology may offer a solution to deliver appropriate patient education. The present study aimed to assess the feasibility, acceptability and cost efficiency of using webinars to deliver first-line IBS advice to patients as part of a dietetic-led gastroenterology service in primary care. METHODS: Patients were directed to an IBS First Line Advice webinar on a specialist NHS website. Data were collected from patients pre- and post-webinar use using an online survey. RESULTS: In total, 1171 attendees completed the pre-webinar survey and 443 completed the post-webinar survey. Attendees ranged from under 17 years to over 75 years. Of the attendees, 95% found the webinar easy to access and 91% were satisfied with the content of the webinar. Those with excellent or good knowledge rose from 25% pre-webinar to 67% post-webinar, and confidence in managing their condition improved for 74% of attendees. Using the webinars led to a 44% reduction in referrals for one-to-one appointments with a specialist dietitian in the first year of use. The value of the clinical time saved is estimated at £3593 per annum. The one-off cost of creating the webinar was £3597. CONCLUSIONS: The use of webinars is a feasible, acceptable and cost-efficient way of delivering first-line patient education to people suffering with Irritable Bowel Syndrome as part of a dietetic-led gastroenterology service in primary care.

Tailor-made management of thoracic scoliosis with cervical hyperextension in muscular dystrophy.

PURPOSE: We report the case of a 13-year-old boy managed for fixed cervical hyperextension due to congenital muscular dystrophy with partial merosin deficiency. He presented a right decompensated thoracic scoliosis (T6-L1 Cobb angle 72°) associated with cervical and lumbar lordosis. The spinal extension was accompanied by major flexion of the hip resulting in the trunk being bent forward. This posture caused daily severe back pain responsible for significant loss of quality of life. This led to the decision to perform surgery. METHODS: Initially, the surgery was limited to the thoraco-lumbo-sacral area. An anterior release was done, followed by posterior T1-pelvis vertebral fusion using a modified Luque-Galveston technique. The correction achieved was satisfactory in the coronal plane, but the correction of the thoracic kyphosis was insufficient to compensate for the cervical hyperextension. Cervical spine was fixed at 52° of lordosis, and associated with a left 50° rotation and a right 45° inclination of the head. We performed a posterior and lateral release of the cervical muscles followed by positioning of the halo, itself connected to a made-for-measure thoracic corset. A daily adjustment of the threaded rods was done daily for 3 months to correct the cervical position. Then, we performed a spinal fusion without instrumentation, by posterior articular abrasion and grafting from the occiput to T1. Following that, the halo-corset was kept in place for 4 months. RESULTS: At the end of 8 month treatment, the clinical result was satisfactory with a balanced spine both face on, and sideways, allowing for comfortable painless positioning. At 5 year follow-up, he showed stable spinal fusion without any loss of correction. CONCLUSION: There is no gold standard treatment for cervical hyperextension, but approaches have to be tailor-made to the patient's needs and the team's experience.

Transcranial Magnetic and Direct Current Stimulation in Children.

Promising results in adult neurologic and psychiatric disorders are driving active research into transcranial brain stimulation techniques, particularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), in childhood and adolescent syndromes. TMS has realistic utility as an experimental tool tested in a range of pediatric neuropathologies such as perinatal stroke, depression, Tourette syndrome, and autism spectrum disorder (ASD). tDCS has also been tested as a treatment for a number of pediatric neurologic conditions, including ASD, attention-deficit/hyperactivity disorder, epilepsy, and cerebral palsy. Here, we complement recent reviews with an update of published TMS and tDCS results in children, and discuss developmental neuroscience considerations that should inform pediatric transcranial stimulation.

Persistent uncrossed corticospinal connections in patients with intractable focal epilepsy.

Corticospinal connections may be bilateral at birth, but a predominantly unilateral and crossed pattern develops by the toddler years. Acquired injury can alter the normal development of laterality such that uncrossed corticospinal connections persist, particularly if the injury is early in life and involves the motor system. Whether other developmental insults, such as childhood epilepsy, affect the development of crossed laterality in the motor system is unknown, although this topic has relevance for understanding the broader impact of epilepsy on brain development. Accordingly, in a cohort of children with intractable focal epilepsy, we tested by neuronavigated transcranial magnetic stimulation (nTMS) whether childhood epilepsy is associated with persistent uncrossed corticospinal connections. Specifically, we hypothesized that in contrast to early-life neuroclastic corticospinal tract injury that induces preservation of uncrossed corticospinal connections in the contralesional hemisphere, uncrossed corticospinal connections will be preserved in the epileptic hemisphere where the corticospinal tract is intact, but overstimulated by ongoing seizures and epileptic interictal discharges. Motor cortex mapping was performed by nTMS as part of a clinical presurgical evaluation, and the analysis was limited to patients with radiographically intact motor cortices and corticospinal tracts. Given that foot motor cortex representation is often bilateral, we focused on the lateralization for the tibialis anterior muscle cortical motor representation and its relation to the seizure focus. We demonstrate preserved uncrossed corticospinal connections for the tibialis anterior region of the hemisphere affected by the epilepsy. These findings indicate a pathologically preserved immature motor lateralization in patients with epilepsy and suggest that developmental processes associated with hemispheric lateralization are affected by epilepsy.

Experience of post-traumatic growth in UK veterans with PTSD: a qualitative study.

Little is known about the experience of post-traumatic growth (PTG) within UK veterans. To address this, our study aims to understand the lived experience of PTG from the perspective of UK veterans who have received treatment for post-traumatic stress disorder. The study uses Interpretative Phenomenological Analysis to explore qualitative interviews conducted with a sample of veterans who reported experiences of PTG in a quantitative measure. The themes drawn from the interviews describe the veterans' lived experiences of growth following trauma and their understanding of how it occurred. Similarities and differences with the dimensions of a widely used PTG quantitative measure are outlined, and a possible veteran experience of growth and how it develops is described. The conclusions provide a basis for further investigation into the experience, acceptability and clinical application of PTG within a UK veteran-specific population.

Cytomegalovirus-Associated CD4(+) CD28(null) Cells in NKG2D-Dependent Glomerular Endothelial Injury and Kidney Allograft Dysfunction.

Emerging data suggest that expansion of a circulating population of atypical, cytotoxic CD4(+) T cells lacking costimulatory CD28 (CD4(+) CD28(null) cells) is associated with latent cytomegalovirus (CMV) infection. The purpose of the current study was to increase the understanding of the relevance of these cells in 100 unselected kidney transplant recipients followed prospectively for a median of 54 months. Multicolor flow cytometry of peripheral blood mononuclear cells before transplantation and serially posttransplantation was undertaken. CD4(+) CD28(null) cells were found predominantly in CMV-seropositive patients and expanded in the posttransplantation period. These cells were predominantly effector-memory phenotype and expressed markers of endothelial homing (CX3CR1) and cytotoxicity (NKG2D and perforin). Isolated CD4(+) CD27(-) CD28(null) cells proliferated in response to peripheral blood mononuclear cells previously exposed to CMV-derived (but not HLA-derived) antigens and following such priming incubation with glomerular endothelium resulted in signs of endothelial damage and apoptosis (release of fractalkine and von Willebrand factor; increased caspase 3 expression). This effect was mitigated by NKG2D-blocking antibody. Increased CD4(+) CD28(null) cell frequencies were associated with delayed graft function and lower estimated glomerular filtration rate at end follow-up. This study suggests an important role for this atypical cytotoxic CD4(+) CD28(null) cell subset in kidney transplantation and points to strategies that may minimize the impact on clinical outcomes.