Quantitative Analysis of Performance Recovery in Semi-Professional Football Players after the COVID-19 Forced Rest Period.

This study proposes the instrumental analysis of the physiological and biomechanical adaptation of football players to a fatigue protocol during the month immediately after the COVID-19 lockdown, to get insights into fitness recovery. Eight male semi-professional football players took part in the study and filled a questionnaire about their activity during the lockdown. At the resumption of activities, the mean heart rate and covered distances during fatiguing exercises, the normalized variations of mean and maximum exerted power in the Wingate test and the Bosco test outcomes (i.e., maximum height, mean exerted power, relative strength index, leg stiffness, contact time, and flight time) were measured for one month. Questionnaires confirmed a light-intensity self-administered physical activity. A significant effect of fatigue (Wilcoxon signed-rank test p < 0.05) on measured variables was confirmed for the four weeks. The analysis of the normalized variations of the aforementioned parameters allowed the distinguishing of two behaviors: downfall in the first two weeks, and recovery in the last two weeks. Instrumental results suggest a physiological and ballistic (i.e., Bosco test outcomes) recovery after four weeks. As concerns the explosive skills, the observational data are insufficient to show complete recovery.

Assessment of Biomechanical Response to Fatigue through Wearable Sensors in Semi-Professional Football Referees.

Quantifying muscle fatigue is a key aspect of everyday sport practice. A reliable and objective solution that can fulfil this task would be deeply important for two main reasons: (i) it would grant an objective indicator to adjust the daily training load for each player and (ii) it would provide an innovative tool to reduce the risk of fatigue-related injuries. Available solutions for objectively quantifying the fatigue level of fatigue can be invasive for the athlete; they could alter the performance or they are not compatible with daily practice on the playground. Building on previous findings that identified fatigue-related parameters in the kinematic of the counter-movement jump (CMJ), this study evaluates the physical response to a fatigue protocol (i.e., Yo-Yo Intermittent Recovery Test Level 1) in 16 football referees, by monitoring CMJ performance with wearable magneto-inertial measurement units (MIMU). Nineteen kinematic parameters were selected as suitable indicators for fatigue detection. The analysis of their variations allowed us to distinguish two opposites but coherent responses to the fatigue protocol. Indeed, eight out of sixteen athletes showed reduced performance (e.g., an effective fatigue condition), while the other eight athletes experienced an improvement of the execution likely due to the so-called Post-Activation Potentiation. In both cases, the above parameters were significantly influenced by the fatigue protocol (p < 0.05), confirming their validity for fatigue monitoring. Interesting correlations between several kinematic parameters and muscular mass were highlighted in the fatigued group. Finally, a "fatigue approximation index" was proposed and validated as fatigue quantifier.

Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue.

Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion. Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma.

"Gauze Technique" in the Treatment of the Fungus Ball of the Maxillary Sinus: A Technique as Simple as It Is Effective.

Fungus ball of maxillary sinus generally affects immunocompetent and nonatopic subjects. Although endoscopic removal is the current gold standard treatment, removal is at times difficult due to an accumulation of fungal elements in the anterior ad inferior recesses. Aim. To present our experience of maxillary fungus ball treated by the "gauze technique" that avoids these removal difficulties. Materials and Methods. A retrospective, cross-sectional, and descriptive study of 25 patients affected by maxillary fungus ball was carried out: 19 were treated by the "gauze technique" and 6 were treated without "gauze technique." Results. A comparison was made between the two groups for surgery procedure time, length of hospitalization, time from surgery to nasal unpacking, complications, and postsurgical patient satisfaction. The only statistically significant difference observed was a shorter surgical procedure time (p < 0.05) for the "gauze technique." Conclusions. The data obtained in this study demonstrated that the "gauze technique" is a safe, simple, and quick technique, able to reduce surgery procedure time whilst providing excellent functional outcomes and patient satisfaction.

A 3D finite element model for geometrical and mechanical comparison of different supraspinatus repair techniques.

BACKGROUND: Contact pressure and contact area are among the most important mechanical factors studied to predict the effectiveness of a rotator cuff repair. The suture configurations can strongly affect these factors but are rarely correlated with each other. For example, there is a significant difference between the single-row technique and the transosseous or transosseous-like approaches in terms of footprint contact area coverage. A finite element model-based approach is presented and applied to account for various parameters (eg, suture pretension, geometry of the repair, effect of the sutures, geometry of the lesion) and to compare the efficacy of different repair techniques in covering the original footprint. METHODS: The model allows us to evaluate the effect of parameters such as suture configuration and position and suture pretension. The validity of such an approach was assessed in comparing 3 different repair techniques: single row, transosseous equivalent, and double row. RESULTS: Results from the application of the models show that the double-row and transosseous-equivalent techniques lead to progressive increase of the contact area compared with the single-row approach, supporting the conclusion that transosseous-equivalent fixation leads to an increase of the contact area and a better distribution of the pressure coverage. CONCLUSION: The 3-dimensional finite element model approach allows multiple variables to be assessed singularly, weighing the specific influence. Moreover, the approach presented in this study could be a valid tool to predict and to reproduce different configurations, identifying how to reduce the stress over the tendon and when a repair could be effective or not.

Extramedullary Plasmacytoma of the Larynx Treated by a Surgical Endoscopic Approach and Radiotherapy.

Extramedullary plasmacytoma (EMP) is a rare variant of plasma cell myeloma that affects soft tissues. The head and neck region are the most affected sites, although others have also been described. Herein we report an uncommon case of EMP of the larynx in a 65-year-old male who presented with a history of progressive dysphonia and hoarseness. Laryngeal fiberscopy evidenced a reddish pedicled voluminous mass in the left false cords and ventricle. Microscopic suspension laryngoscopy was performed under general anaesthesia and a 4 W Acublade CO2 Laser was used for transoral resection of the lesion. This was followed by adjuvant radiotherapy, with the widely recommended doses on the supraglottic region, to achieve better local control. Diagnosis of EMP is based on immunohistochemistry and the exclusion of systemic plasma cell proliferative disorders. Diagnosis of solitary EMP can be made only if studies for disseminated disease and X-ray and/or magnetic resonance imaging of the spine, pelvis, femurs, and humerus and bone marrow biopsy are negative. As there are no internationally established guidelines, treatment of EMP is mainly based on consensus of expert opinion.

Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches.

BACKGROUND AND AIM: Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular and fibrous tumor that most commonly affects males in prepuberal and adolescent age. Traditionally, these tumors have been removed, after selective embolization, with the open surgical approach (degloving), but the interest in the endoscopic resection, especially for small tumors, has increased in recent years. To present our experience of JNA management, comparing the endoscopic approach and open/combined approach. MATERIALS AND METHODS: We conducted a retrospective, cross-sectional, and descriptive study of 12 young men, ages between 9 and 19 years (mean: 13), suffering from nasopharyngeal angiofibroma and treated with open surgery (N = 6), with endoscopic excision (N = 5) or with combined approach (N = 1). We reviewed demographical data, clinical presentation, surgical approach as well as time of surgery, of hospitalization, need of blood transfusion during surgery, and complications occurred during hospitalization. RESULTS: All JNA patients were male. The average age at diagnosis was 13.7 years (range 9-19 years). Approximately, 8.3% were classified as Önerci I, 41.7% as Önerci II, and 50.0% as Önerci III. Preoperative embolization was carried out in all patients. All patients were submitted to primary surgical resection, and 2 of them required intraoperative blood transfusion. The overall recurrence rate was 8.3% and the cure rate was 100%. CONCLUSION: This study confirmed that endoscopic approach gives excellent results in small and medium dimensions tumors, whereas open surgery remains a safe procedure for patients with larger tumors.

First in vivo assessment of "Outwalk": a novel protocol for clinical gait analysis based on inertial and magnetic sensors.

A protocol named "Outwalk" was recently proposed to measure the thorax-pelvis and lower-limb kinematics during gait in free-living conditions, by means of an inertial and magnetic measurement system (IMMS). The aim of this study was to validate Outwalk on four healthy subjects when it is used in combination with a specific IMMS (Xsens Technologies, NL), against a reference protocol (CAST) and measurement system (optoelectronic system; Vicon, Oxford Metrics Group, UK). For this purpose, we developed an original approach based on three tests, which allowed to separately investigate: (1) the consequences on joint kinematics of the differences between protocols (Outwalk vs. CAST), (2) the accuracy of the hardware (Xsens vs. Vicon), and (3) the summation of protocols' differences and hardware accuracy (Outwalk + Xsens vs. CAST + Vicon). In order to assess joint-angles similarity, the coefficient of multiple correlation (CMC) was used. For test 3, the CMC showed that Outwalk + Xsens and CAST + Vicon kinematics can be interchanged, offset included, for hip, knee and ankle flexion-extension, and hip ab-adduction (CMC > 0.88). The other joint-angles can be interchanged offset excluded (CMC > 0.85). Tests 1 and 2 also showed that differences in offset between joint-angles were predominantly induced by differences in the protocols; differences in correlation by both hardware and protocols; differences in range of motion by the Xsens accuracy. Results thus support the commencement of a clinical trial of Outwalk on transtibial amputees.

'Outwalk': a protocol for clinical gait analysis based on inertial and magnetic sensors.

A protocol named Outwalk was developed to easily measure the thorax-pelvis and lower-limb 3D kinematics on children with cerebral palsy (CP) and amputees during gait in free-living conditions, by means of an Inertial and Magnetic Measurement System (IMMS). Outwalk defines the anatomical/functional coordinate systems (CS) for each body segment through three steps: (1) positioning the sensing units (SUs) of the IMMS on the subjects' thorax, pelvis, thighs, shanks and feet, following simple rules; (2) computing the orientation of the mean flexion-extension axis of the knees; (3) measuring the SUs' orientation while the subject's body is oriented in a predefined posture, either upright or supine. If the supine posture is chosen, e.g. when spasticity does not allow to maintain the upright posture, hips and knees static flexion angles must be measured through a standard goniometer and input into the equations that define Outwalk anatomical CSs. In order to test for the inter-rater measurement reliability of these angles, a study was carried out involving nine healthy children (7.9 +/- 2 years old) and two physical therapists as raters. Results showed RMS error of 1.4 degrees and 1.8 degrees and a negligible worst-case standard error of measurement of 2.0 degrees and 2.5 degrees for hip and knee angles, respectively. Results were thus smaller than those reported for the same measures when performed through an optoelectronic system with the CAST protocol and support the beginning of clinical trials of Outwalk with children with CP.

Inter-operator reliability and prediction bands of a novel protocol to measure the coordinated movements of shoulder-girdle and humerus in clinical settings.

A clinical motion analysis protocol was developed to measure the coordinated movements of shoulder-girdle and humerus (girdle-humeral rhythm--GD-H-R) during humerus flexion-extension (HFE) and ab-adduction (HAA), through an optoelectronic system. In particular, the protocol describes the GD-H-R with 2 angle-angle plots for each movement: girdle elevation-depression and protraction-retraction vs HFE, and vs HAA. Each of these plots is further divided in two subplots, one for the upward and one for the downward phases of the movement. By involving 11 participants and 2 operators, we measured the protocol's inter-operator reliability which ranged from very-good to excellent depending on the angle-angle plot (median values of the inter-operator coefficient of multiple correlation for the angle-angle plots higher than 0.94). We then computed the subjects' average control patterns, together with statistically meaningful prediction bands. +/-1SD confidence bands were also computed and their width ranged from +/-0.5 degrees to +/-4.6 degrees. Based on these results we could conclude that the method is robust and able to identify even limited differences in the GD-H-R.