Common Upper Extremity Injuries in Pediatric Athletes

Purpose of ReviewThe aim of this study is to review the most recent literature on common upper extremity injuries in pediatric athletes and discuss their diagnosis, management, and outcomes. We also highlight ultrasound as a tool in their evaluation.Recent FindingsShoulder conditions presented include little league shoulder, glenohumeral rotation deficit, acute traumatic shoulder dislocation, and multidirectional shoulder instability. Elbow conditions include capitellar OCD, medial epicondyle avulsion fracture, and medial epicondylitis. We also review scaphoid fractures and gymnast wrist. Not all physeal injuries lead to long-term growth disruption. Ultrasound has been shown to be useful in the diagnosis of scaphoid fracture, medial epicondyle avulsion fractures, and capitellar OCD. It can also be helpful in assessing risk for shoulder and elbow injuries in overhead athletes.SummaryThere is a rising burden of upper extremity injuries among pediatric athletes. Knowledge of their sport specific mechanics can be helpful in diagnosis. As long-term outcome data become available for these conditions, it is clear, proper diagnosis and management are critical to preventing adverse outcomes. We highlight many of these injuries, best practice in care, and controversies in care in hopes of improving outcomes and preventing injury for pediatric athletes.     

通过低能耗绝热脉冲和快速螺旋采样实现的神经系统三维核磁共振光谱成像

目的 提高三维(3D)核磁共振(MR)光谱成像系统的定位精确度和采样速度.材料与方法 本研究所涉及的内容经机构审查委员会(Institutional Review Board)批准并获得患者知情同意.用一台配有32通道头部线圈系统的3T核磁共振成像仪采集体模、5位健康的志愿者以及5位胶质母细胞瘤患者的数据.信号激发手段为定位绝热自旋回波聚焦(LASER),此法采用GOIA-W(16,4)型脉冲信号,脉冲时长3.5ms,带宽20kHz,振幅维度0.81kHz,回讯时间45ms.一组频域信号和两组空间信号由成像系统沿等密度螺旋线隔行扫描获得.在LASER激发步骤之后,传统的相位编码手段(Phase Encoding,PE)给出的每像素lcm3的数据被用作参照标准.在更短时间,同样或者更高空间解析度下,由螺旋采样方法获取的谱图被用于和PE手段获取的谱图进行对比.相关的生化指标水平由分析软件分析谱图获得,并用Bland-Altman方法进行分析.结果 在低空间解析度(每像素1cm3)条件下,螺旋采样获取医用三维核磁共振谱图的速度4倍于传统的椭圆相位编码方法.提高空间解析度至每像素0.39cm3,螺旋采样的速率仍是2倍于每像素1cm3条件下的椭圆相位编码方法.上述提及的螺旋采样成像技术所成的谱图中,信噪比(SNR)均＞5,依此可以判断谱图中生化物质能够被明显地从背景噪声中区分出来.像素点尺寸减小导致的信噪比损失并非线性,因为缩小像素点尺寸需要延长T2阶段.在高空间解析度下,谱图中谱线的宽度由4.8Hz提高至3.5Hz.使用Bland-Ahman方法对螺旋采样和PE的成像结果进行分析,结论为二者之间相互吻合:二者的相似程度为95％(均值分别为0.12和0.18).GIOA-W(16,4)型脉冲信号的使用有效地将化学位移误差降低至2.1％,并把激发过程的不一致度降低至5％,而且可以降低其他干扰抑制技术的需求.结论 上述绝热螺旋采样三维MRI技术可以通过标准的MRI系统实现.该手段能够给予更高的成像质量和更短的成像时间,与现有技术相比能够保障更多的日常核磁共振数据的收集.     

Tracheostomy Following Lung Transplantation Predictors and Outcomes

The effect of tracheostomy on patients receiving lung transplantation is unknown. We reviewed our experience by performing a retrospective analysis on all lung transplant recipients at our institution. Patients were assigned to each study group based on whether or not they received a tracheostomy in the acute postoperative period. One hundred and fourteen lung transplants were performed, and 16 of those patients received a tracheostomy. In the tracheostomy group, more patients had undergone bilateral-lung transplantation (81% vs. 34%, p = 0.001), more required cardiopulmonary bypass (75% vs. 38%, p = 0.005), more acquired postoperative pneumonia (88% vs. 30%, p < 0.001), had greater reperfusion injury at 48 h (PaO2/FiO2 of 233 vs. 345, p = 0.047), had longer initial periods on the ventilator (21 +/- 7 vs. 2 +/- 0.5 days, p < 0.001), more required re-intubation (56% vs. 18%, p = 0.001), spent longer times in the intensive care unit (30 +/- 7 vs. 5.5 +/- 0.9 days, p < 0.001), and had longer lengths of stay (67 +/- 10 vs. 22 +/- 2 days, p < 0.001). Despite these differences between the two groups, a significant difference in survival at 180 days (75 vs. 81%) did not exist (p = 0.89). Although tracheostomy is more likely in sicker patients, it is not associated with poor long-term outcomes.     

A monitoring system to provide feedback on student physical activity during physical education lessons

School‐based physical education (PE) provides opportunities to accumulate moderate‐to‐vigorous physical activity (MVPA), but many students are insufficiently active during PE lessons. Providing teachers with feedback regarding their students’ physical activity may increase the effectiveness of PE for achieving MVPA goals, but existing physical activity monitoring technologies have limitations in class environments. Therefore, the purpose of this study was to develop and validate a system capable of providing feedback on PE lesson MVPA. Equations for translating step counts to %MVPA were derived from measures in 492 students who concurrently wore an ActiGraph GT3X+ (ActiGraph) and Yamax pedometer (Yamax) during a PE lesson. To enhance feedback availability during PE lessons, we then developed a bespoke monitoring system using wireless tri‐axial pedometers (HMM) and a smart device app. After developing and testing the monitoring system, we assessed its validity and reliability in 100 students during a PE lesson. There was a strong correlation of 0.896 between step counts and accelerometer‐determined %MVPA and quantile regression equations showed good validity for translating step counts to %MVPA with a mean absolute difference of 5.3 (95% CI, 4.4‐6.2). The physical activity monitoring system was effective at providing %MVPA during PE lessons with a mean difference of 1.6 ± 7.1 compared with accelerometer‐determined %MVPA (7% difference between the two measurement methods). Teachers and students can use a smart device app and wireless pedometers to conveniently obtain feedback during PE lessons. Future studies should determine whether such technologies help teachers to increase physical activity during PE lessons.