Are EPB41 and alpha-synuclein diagnostic biomarkers of sport-related concussion?Findings from the NCAA and Department of Defense CARE Consortium

Background:Current protein biomarkers are only moderately predictive at identifying individuals with mild traumatic brain injury or concussion.Therefore,more accurate diagnostic markers are needed for sport-related concussion.Methods:This was a multicenter,prospective,case-control study of athletes who provided blood samples and were diagnosed with a concussion or were a matched non-concussed control within the National Collegiate Athletic Association-Department of Defense Concussion Assessment,Research,and Education Consortium conducted between 2015 and 2019.The blood was collected within 48 h of injury to identify protein abnormalities at the acute and subacute timepoints.Athletes with concussion were divided into 6 h post-injury(0-6 h post-injury)and after 6 h postinjury(7-48 h post-injury)groups.We applied a highly multiplexed proteomic technique that used a DNA aptamers assay to target 1305proteins in plasma samples from athletes with and without sport-related concussion.Results:A total of 140 athletes with concussion(79.3%males;aged 18.71±1.10 years,mean±SD)and 21 non-concussed athletes(76.2%males;19.14±1.10 years)were included in this study.We identified 338 plasma proteins that significantly differed in abundance(319 upregulated and 19 downregulated)in concussed athletes compared to non-concussed athletes.The top 20 most differentially abundant proteins discriminated concussed athletes from non-concussed athletes with an area under the curve(AUC)of 0.954(95%confidence interval:0.922-0.986).Specifically,after 6 h of injury,the individual AUC of plasma erythrocyte membrane protein band 4.1(EPB41)and alpha-synuclein(SNCA)were 0.956 and 0.875,respectively.The combination of EPB41 and SNCA provided the best AUC(1.000),which suggests this combination of candidate plasma biomarkers is the best for diagnosing concussion in athletes after 6 h of injury.Conclusion:Our data suggest that proteomic profiling may provide novel diagnostic protein markers and that a combination of EPB41 and SNCA is the most predictive biomarker of concussion after 6 h of injury.

Epidemiology and risk factors for sports-and recreation-related eye injury:a multicenter prospective observational study

AIM:To identify the epidemiologic characteristics of sportsand recreation-related eye injuries in a large metropolitan city and investigate risk factors associated with visual impairment.METHODS:We performed a multicenter prospective observational study on patients using the regional eye injury registry data.This study included patients with sportsand recreation-related eye injury in four tertiary teaching hospitals in Daegu,Republic of Korea,from August 2016 to July 2018.The primary outcome was visual impairment at the first hospital visit.Distributions of sex,age,place,and causative materials were analyzed according to causative activities.To examine the association between causative activities and visual impairment,a Logistic regression analysis was used.RESULTS:Of the 349 sports-and recreation-related eye injuries,soccer was the most common causative activity,with 21.8%(n=76).Sports-and recreation-related eye injuries occurred mainly in teenagers,individuals in their 20 s,and men.Badminton and soccer were significantly associated with visual impairment at the first hospital visit compared with combat sports[(adjusted odds ratio(AOR),5.18;95%confidence interval(CI),1.67-16.09 for badminton and AOR,3.87;95%CI,1.36-10.99 for soccer].CONCLUSION:Intervention efforts such as deployment of protective eyewear in sports facilities and schools and promotion of wearing protective eyewear during these activities in teenagers and individuals in their 20 s are mandatory.

Epidemiology and injury patterns of aerial sports in Switzerland

BACKGROUND Airborne sports have become more popular in recent years.The number of accidents has increased linearly as athletes take increasingly greater risks to experience the adventurous spirit of this kind of sports.AIM To investigate the variety of injuries in airborne sport accidents,as well as which acute treatment these patients receive,both before and after admission to a levelone-trauma center.METHODS We performed a retrospective chart analysis at a major level-one-trauma center in Switzerland for 235-patients who were admitted following airborne sports injuries between 2010 and 2017.Patients’demographic data,injury patterns,emergency primary care procedures and intra-hospital care were recorded.RESULTS Overall,718-injuries in 235-patients were identified;the spine was the most commonly affected region with 46.5%of injuries(n=334/718)in 143-patients.In 69-patients(15.5%),the(non-spine)thorax was affected,followed by the lower and upper extremity,pelvis,head/face and abdominal injuries.Eleven-patients had to be intubated at the trauma site.Three patients were resuscitated after onset of pulseless-electrical-activity.Two-patients died in the resuscitation room.In 116-cases,surgery was indicated including 55-emergency surgeries.Another 19 patients(8.1%)were transferred to the intensive care unit.CONCLUSION Paragliders are most commonly affected,although the highest injury severities were identified for Building,Antenna,Span and Earth-jumping athletes.First responders,treating physicians and pilots should be aware of the risk for potentially serious and life-threatening injury with an in-hospital mortality of 0.9%.

Application Effect of Chinese Medicine Rehabilitation in the Treatment of Adolescent Ankle Sports Injuries

Objective:To analyze the clinical effect of traditional Chinese medicine rehabilitation in treating adolescent ankle sports injuries.Methods:From December 2020 to December 2022,adolescent patients with ankle joint sports injuries admitted to our hospital were selected as observation objects,and 67 patients were divided into a control group(n=33,routine rehabilitation treatment)and an experimental group(n=34,traditional Chinese medicine rehabilitation treatment)according to the computer grouping method.Compare the treatment results.Results:(i)The treatment received in the experimental group had an efficacy of 94.11%,which was higher than that of the control group(75.75%),and statistical significance was established(P<0.05).(ii)Before treatment,there was no difference in ankle joint pain,ankle joint activity,and ankle joint function scores between the control group and the experimental group(P>0.05);after treatment,the ankle joint pain,ankle joint activity,and ankle joint function scores in the experimental group were significantly higher than those in the control group(P<0.05).(iii)The experimental group had higher scores on physiological function,physiological function,physical pain,general health status,energy,social function,emotional function,and mental health compared to the control group(P<0.05).Conclusion:Traditional Chinese medicine rehabilitation is effective in treating ankle injuries caused by sports in adolescents and improve their quality of life.Therefore,it should be popularized.

Which psychosocial factors are associated with return to sport following concussion? A systematic review

Background:Psycho social factors predict recurrent inj ury and return to preinjury level of performance following orthopedic injury but are poorly understood following concussion.Current management protocols prioritize physical measures of recovery.Therefore,the objective of this study was to describe the psychosocial factors associated with return to sport(RTS) and how they are measured in athletes who sustained a concussion.Methods:MEDLINE,Embase,APA PsycINFO,CINAHL,and SPORTDiscus were searched through February 2,2021.Eligible studies included original peer-reviewed publications describing psychosocial factors associated with RTS following a diagnosed concussion.The primary outcome was scales or measures employed and/or key thematic concepts.Results:Of the 3615 studies identified,10 quantitative cohort studies(Oxford Centre for Evidence-Based Medicine Level-3) representing 2032 athletes(85% male;high-school and collegiate collision/contact athletes) and 4 qualitative studies representing 66 athletes(74% male;70% American football;aged 9-28 years) were included.We identified 3 overarching themes and 10 outcome measures related to psychosocial factors associated with RTS following concussion:(a) fear(e.g,of recurrent concussion,of RTS,of losing playing status);(b) emotional factors(e.g,depression,anxiety,perceived stress,mental health,disturbance mood);and(c) contextual factors(e.g,social support,pressure,sense of identity).Conclusion:Although current medical clearance decisions prioritize physical measures of recovery,evidence suggests diverse psychosocial factors influence RTS following concussion.It remains unclear which psychosocial factors contribute to a successful RTS,including the influence of sex/gender and age.Future studies should evaluate the association of psychological readiness with physical measures of recovery at medical clearance,preinjury level of performance,and risk of recurrent concussion to support RTS clinical decision-making.

Common Sports Injuries and Preventive Measures for Athletes—Take The Track and Field Team Athletes in Yushan County as an Example

Taking the common sports injuries and preventive measures of Yushan County middle school track and field athletes as the research object,the sports injuries of Yushan County middle school track and field athletes were investigated and analyzed from the angle,type,location and nature of sports injury.Research on sports injury problems,trying to find the causes of sports injuries in daily training of track and field athletes,and proposed targeted preventive measures based on the specific situation of Yushan County Middle School.The results show that 77.70%of track and field athletes have suffered sports injury and periostitis and ligament/muscle strains are the most common forms of injury,and lower limbs are more prone to sports injuries than upper limbs.

Demographic characteristics of patients who underwent anterior cruciate ligament reconstruction at a tertiary care hospital in India

BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained by many sports leagues in their registries.However,very few nationwide registries exist for such injuries.This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.AIM To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.METHODS All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied.Patients with multi-ligament injuries or a history of previous knee surgery were excluded.The patients’history was obtained from the hospital records,they were interviewed telephonically,and online questionnaires were given.Their demographic data was analyzed and compared to the existing literature.RESULTS A total of 124 patients were operated on for ACL reconstruction during this period.The mean age of the patients was 27.97 years.One hundred and thirteen patients(91.1%)were male and 11(8.9%)were female.The majority of the patients(47.6%)sustained this injury by road traffic accidents(RTA)followed by sportsrelated injuries(39.5%).The commonest presenting complaint was giving way of the knee in 118 patients(95.2%).The mean duration from the injury to the first hospital visit among the patients was 290.1 d.The mean duration from the injury to surgery was 421.8 d.CONCLUSION ACL patients’demography is different in developing nations as compared to the developed world.RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause.There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery.This,in turn,leads to poorer prognosis and longer rehabilitation.National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.

Acute ankle sprain in athletes:Clinical aspects and algorithmic approach

Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40%of all sports-related injuries.It is especially common in basketball,American football,and soccer.The majority of sprains affect the lateral ligaments,particularly the anterior talofibular ligament.Despite its high prevalence,a high proportion of patients experience persistent residual symptoms and injury recurrence.A detailed history and proper physical examination are diagnostic cornerstones.Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules.Several interventions have been recommended in the management of acute ankle sprains including rest,ice,compression,and elevation,analgesic and anti-inflammatory medications,bracing and immobilization,early weight-bearing and walking aids,foot orthoses,manual therapy,exercise therapy,electrophysical modalities and surgery(only in selected refractory cases).Among these interventions,exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process.An exercise program should be comprehensive and progressive including the range of motion,stretching,strengthening,neuromuscular,proprioceptive,and sport-specific exercises.Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables,manual tests for stability,and functional performance testing.There are some common myths and mistakes in the management of ankle sprains,which all clinicians should be aware of and avoid.These include excessive imaging,unwarranted non-weightbearing,unjustified immobilization,delay in functional movements,and inadequate rehabilitation.The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.

Closed External Subtalar Dislocation: A Case Report

Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of dislocations. We report the case of 28-year-old male patient, without any medical history, who had been involved in a sport accident causing a rare closed external subtalar dislocation without any bone fracture. An open reduction was indicated after failure of closed reduction and the X-ray control showed good joint congruence;the fixation was maintained for 6 weeks and then the rehabilitation was started. The evaluation was favorable, and we noted good functional results after a decline of 12 months.

Rupture of the long head of the biceps brachii tendon near the musculotendinous junction in a young patient: A case report

We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical presentation,surgical treatment,and technique with tenodesis using a unicortical button of the ruptured tendon were presented.The post-surgical recovery was uneventful,and the patient returned to sports in 6 mo.The treatment approach and surgical technique of the long head of biceps brachii rupture was reviewed and discussed.In conclusion,surgical treatment of the long head of the biceps brachii tendon rupture with unicortical button tenodesis resulted in a favorable outcome in a young athlete.

Effect of deep transverse friction massage vs stretching on football players’ performance

BACKGROUND Flexibility,agility and muscle strength are key factors to either win or lose a game.Recently the effect of a new technique,deep transverse friction massage(DTFM)on muscle extensibility as compared to traditional stretching techniques has been examined.AIM To compare the effect of DTFM vs static and dynamic stretching techniques on the hamstring’s extensibility,agility,and strength amongst Lebanese and Syrian football players.Recording the incidence of non-contact hamstring muscle injury was a secondary objective.METHODS This study is a single-blinded prospective longitudinal randomized controlled trial.The experiment took place over a period of four weeks.Football players were randomized into three intervention groups(static stretching;dynamic stretching;DTFM).Participants of each group were followed-up carefully by assessors during their intervention sessions three times per week,for a total of 12 sessions and during the data collection.Extensibility,agility,and strength were compared between intervention groups at(baseline;acute;and chronic)phases.Straight leg raise and 1 repetition maximum tests were used to measure the dominant leg hamstring muscle extensibility and maximal strength respectively.T-drill test was used to assess the lower extremities agility.RESULTS Of 103 Lebanese and Syrian male football players aged between 18 and 35 were sampled from Damascus-Syria and South of Lebanon to participate in this study.Between-groups measures of acute strength(P=0.011)and chronic extensibility(P=0.000)solely showed a significant difference,and the static group showed to be superior as compared to the other groups.No loss to follow-up or protocol violation was recorded.CONCLUSION Static stretching is showing to be superior to the other techniques used,regarding gaining long-term extensibility and short-term maximal muscle strength.In addition,DTFM showed improvements but did not outweigh the effects on footballers’performance when comparing it to static and dynamic techniques.Finally,no difference between the interventions is recorded regarding the rate of muscle injuries incidence.

Sports injury and stressor-related disorder in competitive athletes:a systematic review and a new framework

Background:For professional athletes,sports injury has been considered one of the most influential factors determining their athletic careers’duration and quality.High-intensity training and compet-itiveness of the sports competition are perhaps critical causes of sports-related stress.This article reviews the relevant research on sports injuries and stressor-related disorders.Further,it explores the following three issues in depth:(1)Do physical injuries caused by competitive sports lead to acute or posttraumatic stress disorder for athletes?What are the abnormal stress responses?(2)What diagnoses are currently available for sports injury related traumatic stress disorder?(3)What kinds of psychological rehabilitation are available for trauma-related symptoms in sports injury?How efficient are they in alleviating these symptoms?Methods:The study searched electronic databases,including PubMed,MEDLINE,CINAHL,etc.And reference lists of included papers were also screened.Two researchers selected the literature strictly according to the inclusion criteria and sorted them out.Based on the proved conclusions,the study established a new framework to manage traumatic stress disorders after the injury occurred.Results:16 articles were included in the study.(Q1:N=10;Q2:N=3;Q3:N=3)The findings of this review suggested that athletes who suffer from sports injuries are more likely to experience abnormal physiological or psychological stress responses,which may become a massive challenge for athletes to continue their sports careers at a competitive level.However,there is a minimal understanding of addressing sports injury-related traumatic stress disorder from a biological perspective.Thus,it is challenging to build a scientific basis for diagnosis,screening,and treatment.In addition,the current diagnostic tool for athletes stress disorder still heavily relies on subjective measurement,and the treatment plan is not different from that of the general population.Conclusions:It highlighted that sports-related stress disorder could be the greatest challenge to return to competition for injured athletes.The present study indicated the importance of systematically identifying the symptoms of sports-related stress disorder and improving the current diagnosis and treatment system.

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

Background:Knee examination guidelines in minors are intended to aid decisionmaking in the management of knee instability.Clinical question:A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence.A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children.Key findings:there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary.Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed.Clinical application:In the absence of a strong evidence base,these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible.Following this expert consensus,surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test++,and may include an anterior drawer test+and a Lachman test+.If these conditions are not present,the conservative approach should be chosen,as the anatomical and functional development of children,together with a physiotherapy programme,may improve the evolution of the injury.

Comparison and analysis of skiing injuries at ski resorts in Chongli,China and Japan

Purpose:The rapid development of winter sports requires investigation on injuries in Chongli district,Zhangjiakou city,one of the ski sites of the 2022 Winter Olympics.Careful evaluation is required to observe which injuries are caused under what circumstances,and then we can make corresponding preventive measures and recommendations based on the results.Methods:In this retrospective study,the data of injury cases at ski resorts in China(Chongli district)and Japan were analyzed to provide a reference for the ongoing injury prevention at ski resorts.We collected data on injuries at Wanlong and Fulong ski resorts in Chongli district during the 2017–2018 and 2018-2019 ski seasons.We referred to the skiing injury report issued in February 2020 of a nationwide ski safety statistical service–Japan Ski Safety Association.The causes of injury and specific injured body parts were analyzed based on the data of Chinese and Japanese ski resorts.Statistical significance has been calculated using the Chi-square test.Results:During the 2019–2020 ski season in Japanese ski resorts,the number of reported injuries per 10,000 skiers was 0.93,of which 457(17.3%)were over 50 years old,accounting for a large proportion of injuries,meanwhile in Chongli ski resort,the injury rate of skiers aged 50 and over was 7.1%.The knee joint(23.7%at Wanlong ski resort and 28.4%in Japanese ski resorts)was the most injured body part among Chongli and Japanese skiers.Among snowboarders,shoulder joint injury(17.7%in Japanese ski resorts)was the most common,and injury on hands and fingers(16.3%in Wanlong ski resorts)was the most common.Head injury rates are similar in Chongli,China and Japanese ski resorts(8.2%and 8.7%,respectively).Conclusion:Our analysis demonstrated that injury data recorded among young skiers was higher in Chinese ski resorts(Chongli district)than that in Japanese ski resorts,and elderly skiers made up a larger proportion of skiing injuries in Japanese resorts.Thus,according to our research,the protection of knee joints,shoulder joints,and hands and fingers should be taken seriously.It should pay attention to the teaching of ski poles(for finger protection),and use protective devices such as knee pads,helmets,etc.