Functional analysis of postural spinal and pelvic parameters using static and dynamic spinometry.

Background: Spinometry is a radiation-free method to three-dimensional spine imaging that provides additional information about the functional gait patterns related to the pelvis and lower extremities. This radiation-free technology uses the surface topography of the trunk to analyze surface asymmetry and identify bony landmarks, thereby aiding the assessment of spinal deformity and supporting long-term treatment regimes. Especially reliable dynamic spinometric data for spine and pelvis are necessary to evaluate the management of non-specific back pain. Research aim: This study aims to generate reliable dynamic spinometric data for spine and pelvis parameters that can serve as reference data for future studies and clinical practice. Methods: This study assessed 366 subjects (185 females) under static and 360 subjects (181 females) under dynamic (walking on a treadmill at 3 km/h and 5 km/h) conditions. The DIERS Formetric 4Dmotion® system uses stripes of light to detect the surface topography of the spine and pelvis and identifies specific landmarks to analyze the spine during standing and walking. Results: Relevant gender effects were calculated for lordotic angle (ηp2 = 0.22) and pelvic inclination (ηp2 = 0.26). Under static conditions, female subjects showed larger values for both parameters (lordotic angle: 41.6 ± 8.60°; pelvic inclination: 25.5 ± 7.49°). Regarding speed effects, three relevant changes were observed (sagittal imbalance: ηp2 = 0.74, kyphotic angle: ηp2 = 0.13, apical deviation: ηp2 = 0.11). The most considerable changes were observed between static condition and 3 km/h, especially for sagittal imbalance and lordotic angle. For these parameters, relevant effect sizes (d > 0.8) were calculated between static and 3 km/h for males and females. Concerning clinical vertebral parameters, only lordotic angle and pelvic inclination were correlated with each other (r = 0.722). Conclusion: This study generated a gender-specific reference database of asymptomatic individuals for static and dynamic spinometry. It demonstrated that the DIERS Formetric 4Dmotion® system could capture natural changes in static and dynamic situations and catalogue functional adaptations of spino-pelvic statics at different speeds. The lordotic angle is an indirect marker of pelvic inclination, allowing spinometry to identify individuals at risk even under dynamic conditions.

Bedside ultrasonography prior to abdominal paracentesis is associated with low complication and high success rate: Experience in a National Health Service District General Hospital in the United Kingdom from 2013 to 2019.

Aims/Background: To analyse data from a bedside ultrasound-assisted ascites procedure service in a National Health Service District General Hospital and compare them to results of studies in the medical literature. Methods: A retrospective review of audit data collected (January 2013 to December 2019) of the practice of paracentesis in a National Health Service District General hospital. All adult patients referred to the ascites assessment service were included. Bedside ultrasound detected location and volume of ascites, if present. Abdominal wall diameters were determined in order to select the appropriate needle length for procedures. Results and scan images were recorded on a pro-forma. Patients who underwent a procedure were followed up for 7 days, with complications documented. Results: Seven hundred and two scans were performed on 282 patients - 127 (45%) male and 155 (55%) female. In 127 (18%) patients, an intervention was avoided. Five hundred forty-five (78%) patients underwent a procedure: 82 (15%) were diagnostic aspirations and 463 (85%) were therapeutic (large volume) paracentesis. Most scans were performed between 08:00-17:00. Average time from patient assessment to diagnostic aspiration was 4 hours 21 minutes. Complications included three failed procedures (0.6%) and one iatrogenic peritonitis (0.2%), but no bowel perforation, no major haemorrhage or death. Conclusion: It is possible to introduce a bedside ultrasound-assisted ascites procedure service to a National Health Service District General Hospital with a high success and low complication rate.

Injuries in elite road cyclists during competition in one UCI WorldTour season: a prospective epidemiological study of incidence and injury burden.

METHODS: Fifty-four male athletes from two different teams were involved. Accidents and injuries were recorded immediately after the incident by a team physician present at every race. Exposure, location, type and cause of injury have been recorded. Incidence was calculated. Severity was measured as a cumulative severity score and burden depicted in a risk matrix. RESULTS: Total time of exposure was 12537 hours over 3524 athlete days and 544002 kilometers of racing. 98 accidents were recorded, with 83 leading to injury. The total number of recorded injuries was 193. Injury incidence for all injuries was 54,8 (±SD 47,7-62,8) /1000 athlete days, 15,4 (±SD 13,4-17,7) /1000 athlete hours and 35,5 (±SD 30,8-40,8) /100.000 km raced. By far the most frequent types of injury were hematomas, contusions and bruising (n = 141, 73%) followed by lacerations (n = 22; 11,4%). Most injuries affected the arm and elbow (n = 34, 17,6%) followed by the shoulder and clavicle (n = 28, 14,5%) and occurred with contact (79%). Fractures pose a high injury burden due to long time loss, whereas hematomas, contusions and bruising showed the highest incidence numbers but comparably less time loss. CONCLUSION: Road cyclists' injuries have been underestimated in previous studies. Hematomas, contusions and bruising pose the highest number of injuries with a broad degree of severity and range of injury burden. Fractures are less common but show the highest injury burden. The upper extremities are involved the most.

COVID-19 in European Soccer: A Public 2-Year Comparison of COVID-19 Case Management and Case Characteristics between the 1st Bundesliga, La Liga, Serie A and the Premier League.

To evaluate the extent and characteristics of COVID-19 cases in relation to environmental COVID-19 incidences in the four best European soccer leagues (Bundesliga, Premier League, Serie A and La Liga) from the first of January 2020 until the end of January 2022. Methods: A retrospective evaluation of all publicly available COVID-19 cases in the studied cohorts was performed. The 14-day case incidences from epidemiological national data were used as reference values. The leagues studied are the Bundesliga (Germany), Premier League (Great Britain), Serie A (Italy) and La Liga (Spain). For all cases, the duration of time loss and date of case notification were recorded. Results: League-specific mean time loss due to disease or quarantine per COVID-19 case differs significantly between La Liga (11.45; ±5.21 days) and the other leagues studied (Bundesliga 20.41; ±33.87; p 0.0242; Premier League 17.12; ±10.39; p 0.0001; Serie A 17.61; ±12.71; p < 0.0001). A positive correlation between 14-day national incidence with COVID-19 disease occurrence in soccer leagues was found for all leagues studied. The correlations were strong in the Bundesliga (r 0.5911; CI 0.4249−0.7187; p < 0.0001), Serie A (r 0.5979; CI 0.4336−0.7238; p < 0.0001) and La Liga (r 0.5251; CI 0.3432−0.6690; p < 0.0001). A moderate correlation was found for the Premier League (r 0.3308; CI 0.1147−0.5169; p 0.0026). Odds ratios for altered environmental case risk in the cohorts studied could be calculated for four different national COVID-19 incidence levels (<50/100.000 to >500/100.000). A trend towards shorter COVID-19 case duration in the second half of 2021 was shown for all leagues studied. Conclusions: There was a significantly lower mean time-loss caused by a COVID-19 infection for cases occurred in La Liga compared with the other three leagues studied. For all four leagues studied, a positive, significant correlation of national environmental COVID-19 incidence level and the incidence of COVID-19 cases in the cohort of a football league was found.

Ultrasound Findings in Suspected Ascites Referred for Paracentesis.

Complications of diagnostic and therapeutic paracentesis include bowel perforation, hemorrhage, and death. At present, medical practitioners identify an area for paracentesis using either physical examination alone or with the addition of ultrasound. The preferable method is still debated within the medical literature. This case series compares photographs of patients with abdominal distension, diagnosed as ascites by physical examination, to the respective ultrasound findings. The ultrasound images show a variety of findings: large volume ascites, bowel loops extending to the abdominal wall (unilaterally or bilaterally), and distended bowel loops due to intestinal obstruction in the absence of substantial ascites. Studies have shown that performing ultrasound before ascites paracentesis procedures improves the procedure success rate and reduces complications. This case series illustrates examples of why ultrasound-assisted paracentesis has a better safety profile and a lower procedure failure rate, compared to physical examination techniques alone.

Role of Creatine Supplementation in Conditions Involving Mitochondrial Dysfunction: A Narrative Review.

Creatine monohydrate (CrM) is one of the most widely used nutritional supplements among active individuals and athletes to improve high-intensity exercise performance and training adaptations. However, research suggests that CrM supplementation may also serve as a therapeutic tool in the management of some chronic and traumatic diseases. Creatine supplementation has been reported to improve high-energy phosphate availability as well as have antioxidative, neuroprotective, anti-lactatic, and calcium-homoeostatic effects. These characteristics may have a direct impact on mitochondrion's survival and health particularly during stressful conditions such as ischemia and injury. This narrative review discusses current scientific evidence for use or supplemental CrM as a therapeutic agent during conditions associated with mitochondrial dysfunction. Based on this analysis, it appears that CrM supplementation may have a role in improving cellular bioenergetics in several mitochondrial dysfunction-related diseases, ischemic conditions, and injury pathology and thereby could provide therapeutic benefit in the management of these conditions. However, larger clinical trials are needed to explore these potential therapeutic applications before definitive conclusions can be drawn.

[Employees in professional European football: comparison of the personnel structure in sports medicine, sports sciences and physiotherapy between Bundesliga, La Liga, Serie A and Premier League]. / Mitarbeiter im professionellen europäischen Fußball ­ Vergleich der Personalstruktur in der Sportmedizin, -wissenschaft und Physiotherapie zwischen der Bundesliga, La Liga, Serie A und der Premier League.

INTRODUCTION: Regional and league-specific differences in injury risk and time loss have been observed in professional European football. Besides time of play or different pre-season preparations, possible reasons may also include medical and sport-scientific support. A survey of what UEFA deems to be the best four football clubs has therefore been conducted to investigate the personnel status in the fields of medicine, physiotherapy, massage, sports science and athletic and "strength and conditioning" coaching in order to compare the Erste Bundesliga with the first leagues of the other countries. METHODS: The study is based on a survey of all 78 teams in the highest football leagues of Germany (Bundesliga), Spain (La Liga), Italy (Serie A) and England (Premier League). The teams were contacted directly and a questionnaire concerning their personnel deployment in the different fields was handed out. RESULTS: The Bundesliga was found to have a significantly lower total number of employees compared with the other European leagues (6.9 vs. 11.02; p < 0.0001). The number of physicians in the Bundesliga is significantly higher (2.2 vs. 1.76; p = 0.0259), but the number of physicians dedicating more than 80 % of their total medical practice to the team was significantly lower in the Bundesliga (0.2 vs. 1.45; < 0.0001). In the group of physiotherapists (1.8 vs. 3.6; p < 0.001), massage therapists (2.1 vs. 2.69; p = 0.0094), sports scientists (0.3 vs. 1.12; p < 0.0001) and athletic and "strength and conditioning" coaches (0.5 vs. 1.83; p < 0.0001), there were also significant differences between the staff structure in the Bundesliga compared with the grouped results of the other leagues. CONCLUSION: The personnel structure and the personnel employment in the Bundesliga in sports medicine and sports sciences differs significantly from La Liga, Serie A and the Premier League with the latter three leagues having more personnel and the personnel having closer ties to their teams. Further investigation is necessary to find out if this may be a reason for the differences in injury rates observed between these leagues. A special focus should be placed on country-specific differences in the professions including education and scope of work.

Acute aortic intramural hematoma presenting with painless recurrent syncope.

A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.It is important to recognize an acute intramural hematoma of the proximal aortic wall as a cardiothoracic emergency. This condition can present atypically, but nevertheless warrants urgent surgical intervention, equal to type A aortic dissection. Echocardiography can help in making the diagnosis.

Stability and in vitro efficacy of antibiotic-heparin lock solutions potentially useful for treatment of central venous catheter-related sepsis.

OBJECTIVES: Increasing numbers of patients for whom infection is a major risk are dependent on central venous catheters. Antibiotic-anticoagulant locks may have a role in preventing or treating catheter-related infections. The aim of this study was to determine the in vitro stability and efficacy of antibiotic-heparin lock solutions. METHODS: Candidate antibiotics (amikacin, ciprofloxacin, flucloxacillin, gentamicin, linezolid, teicoplanin) were investigated in vitro, either individually or in combination, in solution with heparin. The solutions were initially tested for visual precipitation. The efficacy of stable solutions and taurolidine was then tested in a catheter model bioassay system against microorganisms commonly encountered in catheter-related septicaemia. RESULTS: In general, lower concentrations of heparin (