STRENGTH & FUNCTIONAL ASSESSMENT OF HEALTHY HIGH SCHOOL FOOTBALL PLAYERS: ANALYSIS OF SKILLED AND NON‐SKILLED POSITIONS

Background/Purpose

Identifying an athlete''s functional capacity is an important consideration in determining when to allow an athlete to return to competition following injury. Establishing normative data for lower extremity functional assessment is valuable for comparison when making decisions regarding the high school athlete returning to play after injury. Therefore, the purpose of this study was to compare functional performance and strength between American high school football players of both skilled and non‐skilled positions.

Methods

Forty‐nine high school football players (30 skilled; 19 non‐skilled) completed a single‐session of testing consisting of a Figure of 8 test (F‐8), single‐leg vertical jump (SLVJ), single‐leg broad jump (SLBJ), and isokinetic knee strength assessment. Pearson correlation coefficients were used to determine the relationships between the results of functional testing and isokinetic strength measures. Paired t‐tests were used to determine the differences in functional performance and isokinetic muscle strength between skilled and non‐skilled athletes.

Results

Knee extension peak torque/body weight (BW) was moderately correlated (p < .01) with SLBJ (r = .54‐.61), SLVJ (r = .39‐.48), and F‐8 run times (r = ‐.50) for all athletes. Similar relationships were observed between knee flexion peak torque/BW and SLBJ (r = .48‐.49), SLVJ (r = .28‐.46), and the F‐8 run times (r = .41‐.52) for all subjects. No differences were observed between groups when examining raw peak torque values for knee flexion and extension (p > .05), however, skilled players did demonstrate greater peak torque/BW ratios (p < .05) for both knee extension and knee flexion at 60 and 240 degrees/sec. Skilled players also displayed faster F‐8 times (9.4 sec ± .3; p < .01) and greater SLBJ (p < .05) on both the dominant (81.0 in ± 9.3) and non‐dominant (83.0 in ± 7.6) limbs (p < .01) when compared to non‐skilled players.

Conclusions

Overall, skilled football players displayed greater peak torque/BW ratios and functional performance when compared to non‐skilled players. Furthermore, isokinetic peak torque/BW appears to be related to functional performance. This relationship is affected by position, with skilled players showing a stronger association. Limb dominance did not influence these functional and strength metrics. It is recommended that clinicians and coaches consider the positional differences in strength and functional performance when managing patients and athletes.

Level of Evidence

4 – Cross‐sectional Case Series     

Urinary trypsinogen activation peptide (TAP) predicts severity in patients with acute pancreatitis

Summary Conclusions Urinary TAP obtained within the first 48 h of the onset of symptoms can distinguish patients with severe acute pancreatitis. Background Urinary trypsinogen activation peptide (TAP) has recently been described as an early marker of severity in acute pancreatitis. Methods In a multicenter study, urine samples were collected for TAP concentration at 6–12, 24, and 48 h after admission from 139 patients with acute pancreatitis (99 with mild disease, 40 with severe disease) and from 50 control patients. Severity of acute pancreatitis was defined by the presence of organ failure and/or pancreatic necrosis on dynamic contrast-enhanced computed tomography. Results Median urinary TAP in the 139 patients with acute pancreatitis compared to the 50 control patients was significantly higher at admission, 4.6 vs 0.8 ng/mL (p<0.001), and 6–12 h, 1.9 vs 0.55 ng/mL (p=0.04). Among patients who presented within 48h of the onset of symptoms, the median urinary TAP for severe pancreatitis (9 patients) compared to mild pancreatitis (40 patients) was significantly higher at admission, 29.6 vs. 3.6 ng/mL (p=0.001). Also, when obtained within 48h of the onset of symptoms, all patients with severe pancreatitis had an admission urinary TAP level>10 ng/mL. The sensitivity and specificity of an admission urinary TAP≥10 for severe pancreatitis was 100 and 85%, respectively. Given a cutoff of 10 ng/mL for an admission urinary TAP obtained within 48h of the onset of symptoms, the negative predictive value was 100% for mild pancreatitis.     

Aptitude physique et psychologique pour la reprise du sport après reconstruction du ligament croisé antérieur du genou : score ACL-RSI et tests fonctionnels

Background

For the patient returning to sport after injury, physical and psychological aptitude are crucial elements: premature return is a risk factor for new injury. The Anterior-Cruciate-Ligament Return-to-Sport-After-Injury (ACL-RSI) scale can be used to quantify the impact of psychological factors affecting a patient's aptitude for return-to-sport.

Monitoring Effect of Human Papillomavirus Vaccines in US Population,Emerging Infections Program, 2008–2012

In 2007, five Emerging Infections Program (EIP) sites were funded to determine the feasibility of establishing a population-based surveillance system for monitoring the effect of human papillomavirus (HPV) vaccine on pre-invasive cervical lesions. The project involved active population-based surveillance of cervical intraepithelial neoplasia grades 2 and 3 and adenocarcinoma in situ as well as associated HPV types in women >18 years of age residing in defined catchment areas; collecting relevant clinical information and detailed HPV vaccination histories for women 18–39 years of age; and estimating the annual rate of cervical cancer screening among the catchment area population. The first few years of the project provided key information, including data on HPV type distribution, before expected effect of vaccine introduction. The project’s success exemplifies the flexibility of EIP’s network to expand core activities to include emerging surveillance needs beyond acute infectious diseases. Project results contribute key information regarding the impact of HPV vaccination in the United States.     

Male pseudohermaphroditism as a cause of secondary hypertension: a case report

Seventeen alpha-hydroxylase deficiency (17OHD) syndrome is a rare genetic disorder of steroid biosynthesis causing decreased production of glucocorticoids and sex steroids and increased synthesis of mineralocorticoid precursors. There are only 130 cases reported worldwide with documented severe 17OHD. Here, we describe the clinical, hormonal, and molecular genetic characteristics of a Turkish patient with 17OHD, who presented to our clinic due to high blood pressure. A 29-year-old girl with 46,XY genotype was admitted to our nephrology clinic due to uncontrolled hypertension and hypokalemia. The diagnosis was suspected because of primary amenorrhea, absence of sexual maturation, hypertension, and hypokalemia. Endocrine investigation revealed low basal levels of all steroid hormones which require 17-hydroxylation for biosynthesis. Plasma concentrations of ACTH, FSH, and LH were elevated. Imaging did not reveal uterus or adnexial structures. The patient's hypertension and hypokalemia resolved after glucocorticoid replacement and treatment with potassium-sparing diuretics. 17OHD is a rare form of congenital adrenal hyperplasia in which defects in the biosynthesis of cortisol and sex steroids result in mineralocorticoid excess, hypokalemic hypertension, and sexual abnormalities such as pseudohermaphroditism in males, and sexual infantilism in females. 17OHD should be suspected in patients with hypokalemic hypertension and lack of secondary sexual development so that appropriate therapy can be implemented.     

Effectiveness of corticosteroid injection in adhesive capsulitis

OBJECTIVE: To assess whether intraarticular corticosteroids improve the outcome of a comprehensive home exercise programme in patients with adhesive capsulitis. SETTING: The study was undertaken in the Physical Therapy and Rehabilitation Department of a Ministry of Health hospital in Turkey. SUBJECTS: Eighty patients with adhesive capsulitis were enrolled in the study. INTERVENTIONS: The patients were randomly assigned to two groups: Group 1 patients were given intraarticular corticosteroid (1 mL, 40 mg methylprednisolone acetate) followed by a 12-week comprehensive home exercise programme. Group 2 patients were given intraarticular serum physiologic (1 mL solution of 0.9% sodium chloride) followed by a 12-week comprehensive home exercise programme. MAIN MEASURES: The outcome parameters were Shoulder Pain and Disability Index and University of California-Los Angeles end-result scores, night pain and shoulder passive range of motion. RESULTS: Mean actual changes in abduction range of motion, Shoulder Pain and Disability Index-total score and Shoulder Pain and Disability Index-pain score were statistically different between the two groups at the second week, with the better scores determined in group 1. However, there were no significant differences between the groups at the 12th week. Medians of University of California-Los Angeles scores in the second week were significantly different between the two groups (P = 0.02), with better scores in group 1; however, the difference in 12th week scores was insignificant. CONCLUSIONS: Intraarticular corticosteroids have the additive effect of providing rapid pain relief, mainly in the first weeks of the exercise treatment period. In patients with adhesive capsulitis who have pain symptom predominantly, intraarticular corticosteroid therapy could be advised concomitantly with exercise.     

Esophageal balloon dilation in children: prospective analysis of hemodynamic changes and complications during general anesthesia

STUDY OBJECTIVE: To investigate hemodynamic changes and complications in children during balloon dilation of esophageal strictures. DESIGN: Prospective, controlled study. SETTING: University teaching hospital. PATIENTS: 5 ASA physical status I and II pediatric patients with benign esophageal stricture related to ingestion of caustic substances. INTERVENTIONS: Anesthesia was induced with intravenous propofol two mg/kg and cisatracurium 0.2 mg/kg and maintained with 66% nitrous oxide and one minimum alveolar concentration of sevoflurane in oxygen. In each session, balloon size was increased until the stricture was opened. MEASUREMENTS AND RESULTS: A total of 18 sessions and 99 dilations in 5 children performed over a one-year period were included in the study. In 8 of 18 sessions, esophageal stricture was located in the middle one third of the esophagus; and in the others, in the upper one third. Four cases experienced bleeding; two cases, inability to ventilate due to obstruction of the endotracheal tube tip by the inflated balloon; and two cases, postextubation bronchospasm. In 95 of the 99 dilations, while the balloon was inflated, heart rate was faster and blood pressure increased significantly. CONCLUSION: Anesthesiologists should keep in mind the possibility of hemodynamic instability and possible endotracheal tube tip obstruction by the inflated balloon and safeguard the airway against bleeding, secretions, and radio-opaque fluid during esophageal balloon dilation.     

Effects of repeated administered ghrelin on chronic constriction injury of the sciatic nerve in rats

Chronic constriction injury (CCI) is a peripheral mononeuropathic pain model that is caused by an injury to the peripheral nervous system and refractory to available conventional treatment. Mechanisms involved in neuropathic pain are still unclear. Previous studies reveal that proinflammatory cytokines contribute to CCI-induced peripheral nerve pathology. Ghrelin, a novel identified gastric peptide, has been shown to have antinociceptive activity and also anti-inflammatory properties by decreasing proinflammatory cytokines. Therefore, the aim of the present study was to investigate the effects of ghrelin on the CCI and its relationship with proinflammatory cytokines in rats. Wistar rats underwent sciatic nerve ligation to induce CCI fallowed by repeated ghrelin administrations (50 and 100 μg/kg i.p., once daily) for a period of 14 days. Mechanical hyperalgesia was assessed before surgery and at day 14 after CCI. TNF-α, IL-1β and IL-6 were measured in blood and spinal cord. The changes of sciatic nerve was assessed histologically by both light and electron microscopy. Ghrelin attenuated mechanical hyperalgesia, reduced spinal TNF-α and IL-1β levels and enhanced sciatic nerve injury with correlated morphometric recovery. These results indicate that the protective effect by ghrelin in the spinal cord is mediated through the suppression of TNF-α and IL-1β. Thus ghrelin may be a promising peptide in the management of neuropathic pain.     

Catechol O-methyltransferase val158met genotype and neural mechanisms related to affective arousal and regulation

CONTEXT: Catechol O-methyltransferase (COMT), the major enzyme determining cortical dopamine flux, has a common functional polymorphism (val(158)met) that affects prefrontal function and working memory capacity and has also been associated with anxiety and emotional dysregulation. OBJECTIVES: To examine COMT val(158)met effects on corticolimbic circuitry reactivity and functional connectivity during processing of biologically salient stimuli, as well as the relationship to the temperamental trait of novelty seeking. DESIGN: Within-subject functional magnetic resonance imaging study. SETTING: National Institute of Mental Health, Genes, Cognition, and Psychosis Program, Bethesda, Md. Patients One hundred one healthy subjects of both sexes. RESULTS: We found that the met allele was associated with a dose-dependent increase in hippocampal formation and ventrolateral prefrontal cortex activation during viewing of faces displaying negative emotion. In met/met homozygotes, limbic and prefrontal regions showed increased functional coupling. Moreover, in these same subjects, the magnitude of amygdala-orbitofrontal coupling was inversely correlated with novelty seeking, an index of temperamental inflexibility. CONCLUSIONS: Our results indicate that heritable variation in dopamine neurotransmission associated with the met allele of the COMT polymorphism results in heightened reactivity and connectivity in corticolimbic circuits. This may reflect a genetic predisposition for inflexible processing of affective stimuli, a mechanism possibly accounting for aspects of arousal and behavioral control that contribute to emotional dysregulation previously reported in met/met individuals.