A Review of Sudden Cardiac Death in Young Athletes and Strategies for Preparticipation Cardiovascular Screening

OBJECTIVES: To provide the reader with an overview of the many causes of sudden cardiac death in young athletes and to present various strategies for preparticipation cardiovascular screening. DATA SOURCE: A MEDLINE search using the phrase sudden cardiac death and the key word athlete for the years 1980 to 2000. DATA SYNTHESIS: Sudden cardiac death is a rare event in athletics. More than 20 different causes have been described, but most cases result from a few distinct entities. Most afflicted athletes have no symptoms before death. Many attempts have been made to detect those at risk for sudden cardiac death before athletic participation. At this time, a thorough history and physical examination are the most efficient screening methods for detecting cardiovascular abnormalities. Studies show that the current status of preparticipation cardiovascular screening of high school and college athletes nationwide is poor. CONCLUSIONS AND RECOMMENDATIONS: The use of diagnostic tests to screen for cardiovascular abnormalities is ineffective and inefficient. The most prudent and effective methods of preparticipation screening for cardiovascular abnormalities at this time are a history and physical examination in accordance with the American Heart Association guidelines. Athletic trainers must ensure that their institutions comply with these minimum standards.     

Prevalence of Osteoporosis in Female Patients with Advanced Knee Osteoarthritis Undergoing Total Knee Arthroplasty

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.

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Prevalence of Disordered-Eating Behaviors in Undergraduate Female Collegiate Athletes and Nonathletes

Context: As the number of female college students participating in athletics has grown dramatically in the last few decades, sports medicine health care providers have become more aware of the unique health concerns of athletic women. These concerns include disordered eating, amenorrhea, and osteoporosis: the female athlete triad. Disordered eating appears to be central in the triad, and the literature has conflicting data regarding the influence of athletic participation on disordered-eating behaviors.Objective: To compare disordered-eating symptoms between collegiate athletes (in lean and non-lean sports) and nonathletes.Design: A volunteer, cross-sectional cohort study of female students during the 2002-2003 academic year.Setting: A National Collegiate Athletic Association Division I institution.Patients or Other Participants: Undergraduate females, including 84 collegiate athletes and 62 nonathletes.Main Outcome Measure(s): Symptoms associated with disordered eating were assessed using the Eating Disorders Inventory-2, a self-report measure of 91 items, and self-reported weight and menstrual function.Results: The athletes had significantly lower scores in body dissatisfaction (P = .01) and ineffectiveness (P = .002). No difference in mean body weight was noted between the 2 groups, but the nonathlete group had a significantly lower desired body weight (P = .004). Lean-sport athletes had a higher score on body dissatisfaction (P = .008) and lower actual (P = .024) and desired body weight (P = .002) than non-lean-sport athletes. A total of 7.1% of the collegiate athletes and 12.9% of the nonathletes were classified as having a high risk for disordered eating. Within the athlete sample, the high-risk group included 2.9% of the non-lean-sport athletes and 25% of the lean-sport athletes.Conclusions: In our study, female athletes did not exhibit more disordered-eating symptoms than women who did not participate in collegiate sports. However, our data suggest that lean-sport athletes are at greater risk for disordered eating than athletes in non-lean sports.     

膝关节前交叉韧带损伤的诊断与治疗进展

目的:探讨膝关节前交叉韧带损伤诊断与治疗的现状.方法:应用Pubmed、中国知网医学全文期刊等数据库,查阅近年来相关文献,总结膝关节前交叉韧带损伤诊断与治疗的方法.结果:目前临床上诊断主要参考MRI以及结合临床查体等,治疗方法主要为关节镜下行韧带重建术.结论:膝关节前交叉韧带的损诊治工作已开展多年,但仍有许多问题有待进一步的研究.     

Comparing Postoperative Pain Experiences of the Adolescent and Adult Athlete After Anterior Cruciate Ligament Surgery

OBJECTIVE: To examine age-related differences in pain, catastrophizing, and affective distress (depression and anxiety) after athletic injury and knee surgery. DESIGN AND SETTING: Participants were assessed with measures of pain intensity, pain-related catastrophizing, depression, and anxiety symptoms at 24 hours after anterior cruciate ligament (ACL) surgery. SUBJECTS: Twenty patients (10 adolescents, 10 adults) with an acute complete tear of the ACL. MEASUREMENTS: Pain was assessed by Visual Analog Scale (VAS), catastrophizing with the Pain Catastrophizing Scale (PCS), depressive symptoms with the Beck Depression Inventory (BDI), and anxiety with the state form of the State-Trait Anxiety Inventory (STAI-S). RESULTS: At 24 hours postsurgery, adolescents reported greater pain, catastrophizing, and anxiety than adults. Ancillary analyses showed that helplessness and rumination were significant contributors to the differences in catastrophizing. Further, an analysis of covariance showed that controlling for the effects of catastrophizing, the adolescent and adult differences in pain scores were reduced to a null effect. CONCLUSIONS: After ACL surgery, athletic adolescents and adults differed significantly in pain, catastrophizing, and anxiety. Catastrophizing seemed to be a particularly strong factor in postoperative pain differences between adolescents and adults, with clinical-management implications. These data indicate the need for continued research into specific pain- and age-related factors during the acute postoperative period for athletes undergoing ACL surgery.     

膝关节自发性骨坏死MR诊断及鉴别诊断研究

目的：探讨膝关节自发性骨坏死(SONK)的影像学表现。方法在临床和影像学资料,对20例确诊患者膝关节自发性骨坏死。均行膝关节MRI检查,行CT检查4例,行平片检查4例。结果MRI显示软骨病变,位于股骨髁负重的地方14例。这表明2例软骨下骨折裂隙综合征;显示软骨状长T1短T2信号,2例骨髓水肿在信号;显示软骨下焦稍长T1长T2信号10例。CT检查45例,清晰显示病变2例;X线平片检查4例,仅1例病变。结论MRI能显示膝关节自发性骨坏死病变比CT,X射线敏感。结合临床表现和MRI诊断可以。     

Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the COVID-19 Pandemic

ContextIn spring 2020, schools closed to in-person teaching and sports were cancelled to control the transmission of COVID-19. The changes that affected the physical and mental health among young athletes during this time remain unknown.ObjectiveTo identify changes in the health (mental health, physical activity, and quality of life) of athletes that occurred during the COVID-19 pandemic.DesignCross-sectional study.SettingSample recruited via social media.Patients or Other ParticipantsA total of 3243 Wisconsin adolescent athletes (age = 16.2 ± 1.2 years, 58% female) were surveyed in May 2020 (During COVID-19). Measures for this cohort were compared with previously reported data for Wisconsin adolescent athletes (n = 5231; age = 15.7 ± 1.2 years, 47% female) collected in 2016 to 2018 (PreCOVID-19).Main Outcome Measure(s)Demographic information included sex, grade, and sport(s) played. Health assessments included the Patient Health Questionnaire-9 Item to identify depression symptoms, the Pediatric Functional Activity Brief Scale to gauge physical activity, and the Pediatric Quality of Life Inventory 4.0 to evaluate health-related quality of life. Univariable comparisons of these variables between groups were conducted via t or χ² tests. Means and 95% CIs for each group were estimated using survey-weighted analysis-of-variance models.ResultsCompared with preCOVID-19 participants, a larger proportion of During COVID-19 participants reported moderate to severe levels of depression (9.7% versus 32.9%, P < .001). Scores of the During COVID-19 participants were 50% lower (worse) on the Pediatric Functional Activity Brief Scale (mean [95% CI] = 12.2 [11.9, 12.5] versus 24.7 [24.5, 24.9], P < .001) and the Pediatric Quality of Life Inventory 4.0 compared with the PreCOVID-19 participants (78.4 [78.0, 78.8] versus 90.9 [90.5, 91.3], P < .001).ConclusionsDuring the COVID-19 pandemic, adolescent athletes described increased symptoms of depression, decreased physical activity, and decreased quality of life compared with adolescent athletes in previous years.     

超声对女婴幼儿腹股沟疝伴卵巢嵌顿的早期诊断及鉴别

目的 探讨超声对女性婴幼儿腹股沟疝伴卵巢嵌顿的早期诊断及鉴别.方法 分析经手术证实的女婴腹股沟疝伴或不伴卵巢嵌顿患者的二维及彩色多普勒超声图像特征.结果 超声诊断的28例病例中,12例卵巢嵌顿超声表现为典型的卵巢声像图,1例卵巢坏死超声表现为混合性肿块.结论 超声检查女性婴幼儿斜疝伴卵巢嵌顿的诊断符合率高,应作为首先检查方法之一.     

Knee Pain and Its Severity in Elderly Koreans: Prevalence,Risk Factors and Impact on Quality of Life

This study investigated the epidemiology (prevalence, risk factors, and impact on quality of life) of knee pain and its severity in elderly Koreans. The subjects (n=3,054) were participants aged ≥50 yr from the fifth Korea National Health and Nutrition Examination Survey, conducted in 2010. Knee pain was defined as pain in the knee lasting ≥30 days during the most recent 3 months; severity was categorized as mild, moderate, or severe. EQ-5D was used to measure quality of life. The prevalence of knee pain was 23.1% (11.7% in men, 31.9% in women). The prevalences of mild, moderate, and severe knee pain were 4.3%, 9.1%, and 9.7%, respectively (2.8%, 5.4%, and 3.5% in men and 5.4%, 12.0%, and 14.4% in women). Old age, female gender, a low level of education, a manual occupation, obesity, and radiographic osteoarthritis were risk factors for knee pain, and were associated with increased severity of knee pain. Excluding men with mild knee pain, people with knee pain had significantly lower quality of life than those without knee pain. Early interventional approaches are needed to reduce the medical, social, and economic burden of knee pain in elderly Koreans.     

Longitudinal Assessment of Noncontact Anterior Cruciate Ligament Injury Risk Factors During Maturation in a Female Athlete: A Case Report

Objective:

To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury.

Background:

In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured.

Differential Diagnosis:

Partial or complete tear of the ACL.

Measurements:

The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort.

Findings:

The injury occurred in the year after the third assessment during the athlete''s club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth.

Conclusions:

During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.     

超声造影在肝实质性肿块诊断及鉴别中的临床价值

目的 探讨超声造影在肝实质性肿块诊断及鉴别中的临床价值。方法 选取2016年7月~2017年8月我院检查的疑似肝实质性肿块患者90例,所有患者均给予超声造影及彩色多普勒超声检查,对比两种方法在肝实质性肿块中的检出率,诊断肝实质性肿块中恶性肿瘤、良性肿瘤及良性病变的灵敏度及特异度。结果 90例患者中,共检出110个肝实质性肿块,恶性肿瘤71个,其中为肝转移癌16个、原发性肝癌55个;良性肿瘤为肝血管瘤25个;良性病变14个,其中为肝孤立性坏死结节4个、肝局灶性结节增生10个。超声造影在恶性肿瘤、良性肿瘤及良性病变检出率高于彩色多普勒超声检查,差异有统计学意义（P＜0.05）。超声造影在诊断肝实质性肿块中灵敏度及特异度均高于彩色多普勒超声检查,但差异无统计学意义（P＞0.05）。结论 超声造影与彩色多普勒超声检查均可诊断及鉴别肝实质性肿块,但超声造影在诊断及鉴别中优势更加明显,肿块检出率及临床应用价值较高,可为临床诊断提供影像学参考。     

The Effects of Stages of the Estrous Cycle on Pain Thresholds in Female White Rats

The effects of stages in the estrous cycle on electrical pain thresholds were studied in white rats in conditions of chronic measurement. On recording day 3, females in the diestrus and estrus stages showed sharp increases in shudder and paw-shuffling thresholds. Females in proestrus and metestrus showed no change in thresholds as compared with those in the first days of recording. Starting from day 7, there were progressive decreases in electrical pain thresholds regardless of the stage of the estrous cycle. Data for all animals showed that regular measurement of pain thresholds induces a smooth two-fold increase in body resistance from day 1 to day 7. This was followed by a sharp drop on day 8, with parallel decreases in body resistance and electrical pain thresholds. Thus, chronic measurement of electrical pain thresholds and body resistance changed in a complex fashion, and threshold values depended on the stage of the estrous cycle.     

降钙素原在病毒性脑膜炎和细菌性脑膜炎鉴别诊断中的应用

目的探讨降钙素原（PCT）在病毒性脑膜炎和细菌性脑膜炎鉴别诊断中的应用价值。方法通过对27例细菌性脑膜炎和32例病毒性脑膜炎患者血清PCT值的检测和比较,从而分析降钙素原在其鉴别诊断中的临床意义。结果细菌性脑膜炎患者血中的PCT平均浓度为37.84 ng/ml,病毒性脑膜炎患者的PCT平均浓度为0.41 ng/ml,两者相比差异有统计学意义（χ2=28.45,P〈0.01）,特异性分别为100%和96.9%。结论降钙素原对病毒性脑膜炎和细菌性脑膜炎的鉴别诊断具有临床应用价值。