Women in motorsport: A case report of driving posture and performance after double mastectomy.

INTRODUCTION: Here we report a case study of an experienced amateur female racing driver (age = 59) with self-reported fatigue of the muscles of the shoulder girdle post bilateral mastectomy and breast reconstruction. This case study describes how adjustment of her driving posture affected measures of muscle fatigue (sEMG) and driving performance (lap-time). METHODS: Bilateral surface electromyographic activity of sternocleidomastoid, cervical erector spinae, anterior deltoid and pectoralis major, angles of inclination of the cervical and lumbar spine in the sagittal plane and lap-times were measured at: 1) baseline, 2) after an initial adjustment of driving posture, and 3) after a readjustment of driving posture. Mean lap-times improved from 136.81 s (SD = 2.12) at baseline to 134.63 s (SD = 1.8) after readjustment. RESULTS: Both sternocleidomastoid and left cervical erector spinae fatigued more slowly after readjustment but right cervical erector spinae fatigued more quickly. There was no change in the rates of fatigue of either pectoralis major or anterior deltoid. CONCLUSION: The improvement in her performance was associated with a change in the posture and movement pattern of her head rather than her shoulder girdle. It is likely that this improved her ability to visually perceive and steer the racing line.

Effect of halo-type frontal cockpit protection on overtaking.

In 2018, the Fédération Internationale de l'Automobile introduced the halo frontal cockpit protection system into Formula 1. While extensive testing was conducted to confirm that the halo protects the driver from contact, the halo's effect on the driver during overtaking was not tested prior to its introduction. Here, we describe the effect of a halo-type structure on the neck muscle activity of one of the authors, a national-level amateur racing driver, during on-track simulations designed to practise overtaking. We found that the halo-type structure caused an increase in the rates of fatigue and workloads of sternocleidomastoid and cervical erector spinae. The results suggest that the driver adopted a forward and right laterally flexed head position, presumably to clear the central pillar from his visible field. This has the potential to increase compressive loading of the cervical spine and affect the ability to use visual cues during steering manoeuvres.

Effect of a halo-type structure on neck muscle activation of an open-cockpit race car driver training under qualifying conditions.

The Fédération Internationale de l'Automobile recently mandated the use of the halo frontal cockpit protection system to mitigate the risk of impact to the driver's head. Here we describe the effect of a halo-type structure on the neck muscle activity of one of the authors, who is a national-level amateur racing driver, during a full qualifying session. We found that the workload of sternocleidomastoid increased and the workload of cervical erector spinae decreased with the halo fitted which is indicative of a forward head position. Left sternocleidomastoid and right cervical erector spinae fatigued more rapidly; whereas, left cervical erector spinae fatigued more slowly. There was no change in the rate of fatigue of right sternocleidomastoid. In combination with a forward head position, this suggests an increase in lateral flexion during head rotation which may affect accuracy of navigation. Thus, drivers may need to be trained to adapt to the halo to mitigate the effects on head position and movement.

The FIP1L1-PDGFRalpha fusion tyrosine kinase in hypereosinophilic syndrome and chronic eosinophilic leukemia: implications for diagnosis, classification, and management.

Idiopathic hypereosinophilic syndrome (HES) and chronic eosinophilic leukemia (CEL) comprise a spectrum of indolent to aggressive diseases characterized by unexplained, persistent hypereosinophilia. These disorders have eluded a unique molecular explanation, and therapy has primarily been oriented toward palliation of symptoms related to organ involvement. Recent reports indicate that HES and CEL are imatinib-responsive malignancies, with rapid and complete hematologic remissions observed at lower doses than used in chronic myelogenous leukemia (CML). These BCR-ABL-negative cases lack activating mutations or abnormal fusions involving other known target genes of imatinib, implicating a novel tyrosine kinase in their pathogenesis. A bedside-to-benchtop translational research effort led to the identification of a constitutively activated fusion tyrosine kinase on chromosome 4q12, derived from an interstitial deletion, that fuses the platelet-derived growth factor receptor-alpha gene (PDGFRA) to an uncharacterized human gene FIP1-like-1 (FIP1L1). However, not all HES and CEL patients respond to imatinib, suggesting disease heterogeneity. Furthermore, approximately 40% of responding patients lack the FIP1L1-PDGFRA fusion, suggesting genetic heterogeneity. This review examines the current state of knowledge of HES and CEL and the implications of the FIP1L1-PDGFRA discovery on their diagnosis, classification, and management.