Collar Group Research Articles

Associations Between Brain Metabolites Measured With MR Spectroscopy and Head Impacts in High School American Football Athletes.

While changes in brain metabolites after injury have been reported, relationships between metabolite changes and head impacts are less characterized. To investigate alterations in neurochemistry in high school athletes as a function of head impacts, concussion, and the use of a jugular vein compression (JVC) collar. Prospective controlled trial. A total of 284 male American football players, divided into JVC collar and noncollar groups; 215 included in final analysis (age = 15.9 ± 1.0 years; 114 in collar group). 3 Tesla/T1-weighted gradient echo, 1H point resolved spectroscopy, acquired between August and November 2018. Head impacts were quantified using accelerometers. Concussion was diagnosed by medical professionals for each team. Pre- to postseason differences in total N-acetylaspartate (tNAA), total choline (tCho), myo-inositol (myoI), and glutamate + glutamine (Glx), in primary motor cortex (M1) and anterior cingulate cortex (ACC), relative to total creatine (tCr), were determined. Group-wise comparisons were performed using Wilcoxon signed-rank, Friedman's, and Mann-Whitney U tests. Relationships between ∆metabolite/tCr and mean g-force were analyzed using linear regressions accounting for concussion and JVC collar. Significance was set at P ≤ 0.05. In participants without concussion, a significant decrease in tCho/tCr (0.233 ± 1.40 × 10-3 to 0.227 ± 1.47 × 10-7) and increase in Glx/tCr (1.60 ± 8.75 × 10-3 to 1.63 ± 1.08 × 10-2) in ACC were observed pre- to postseason. The relationship between ∆tCho/tCr in M1 and ACC and mean g-force from >80 g to >140 g differed significantly between participants with and without concussion (M1 β ranged from 3.9 × 10-3 to 2.1 × 10-3; ACC β ranged from 2.7 × 10-3 to 2.1 × 10-3). Posthoc analyses revealed increased tCho/tCr in M1 was positively associated with mean g-force >100 g (β = 3.6 × 10-3) and >110 g (β = 2.9 × 10-3) in participants with concussion. Significant associations between in ACC and mean g-force >110 g (β = -1.1 × 10-3) and >120 g (β = -1.1 × 10-3) were observed in the collar group only. Diagnosed concussion and the use of a JVC collar result in distinct neurochemical trends after repeated head impacts. 2 TECHNICAL EFFICACY: Stage 3.

Early radiographic osseointegration of a novel highly porous 3D-printed titanium collar for megaprostheses compared to a previous generation smooth HA-coated collar

PurposeExtracortical osseointegration at the collar-bone interface of megaprostheses is associated with improved implant stability, lower rates of stem fracture and loosening. The use of hydroxy-apatite (HA-) coated collars showed mixed results in previously published reports. A novel collar system has recently become available utilizing additive manufacturing technology to create a highly porous titanium collar with a calcium-phosphate coated surface. The aim of this study was to evaluate our early experience with this novel collar and compare it to the previously used HA-coated model.MethodsTwenty patients who underwent megaprostheses implantation utilizing the novel collar system were case matched to 20 patients who had previously undergone a HA-coated collar. A minimum radiological follow-up of three months was available in all included patients. Osseointegration was evaluated using postoperative plain radiographs in two planes based on a previously published semi-quantitative score.ResultsCompared to the HA-coated collar the use of the novel highly porous collar was associated with a higher proportion of cases demonstrating osseointegration at the bone-collar interface (80% vs. 65%). Application of the highly porous collar led to a significantly shortened time to reach the final ongrowth score (173 ± 89 days vs. 299 ± 165 days, p < 0.05). At one year follow-up, 90% of the novel collars had reached their final osseoingration grade compared to 50% in the HA-coated collar group (p < 0.001). Radiological osseointegration was seen in 71% for highly porous collars where the indication was revision arthroplasty, compared to 27% in reported in the literature. ConclusionThese results indicate more reliable and accelerated osseointegration at the bone-collar interface of a novel highly porous collar system compared to a previously used HA-coated collar. Further studies are warranted to confirm these findings.

MP57-17 THE COLLAR TECHNIQUE FOR APICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: UPDATED SERIES AFTER FIVE YEARS FROM ITS INTRODUCTION

You have accessJournal of UrologyCME1 May 2022MP57-17 THE COLLAR TECHNIQUE FOR APICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: UPDATED SERIES AFTER FIVE YEARS FROM ITS INTRODUCTION Angelo Mottaran, Carlo Andrea Bravi, Luca Sarchi, Pietro Piazza, Fernando Gonzalez Meza, Marco Corsetti, Sophie Knipper, Marco Paciotti, Marco Amato, Rui Farinha, Stefano Puliatti, Simone Scarcella, Celine Sinatti, Geert De Naeyer, Ruben De Groote, and Alexandre Mottrie Angelo MottaranAngelo Mottaran More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Fernando Gonzalez MezaFernando Gonzalez Meza More articles by this author , Marco CorsettiMarco Corsetti More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Marco AmatoMarco Amato More articles by this author , Rui FarinhaRui Farinha More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Simone ScarcellaSimone Scarcella More articles by this author , Celine SinattiCeline Sinatti More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Apical dissection is a challenging step during robot-assisted radical prostatectomy (RARP), and may affect the risk of positive surgical margins (PSM). For this delicate surgical step, we previously described the “Collar” technique that allowed us to lower the rate of PSM. After five years from its introduction, we want to update our series on this novel surgical technique. METHODS: A total of 1716 consecutive patients underwent RARP at OLV hospital (Aalst, Belgium) between 2010 and 2020. As of June 2015, the “Collar” technique was utilized during apical dissection, which included the incision of the urethral sphincter complex (USC) 2–3 mm distally to the apex; the underlying smooth muscle was exposed and incised closer to the apex to preserve the maximal length of the lissosphincter. Standard technique consisted in sharp and direct division of membranous urethra at the level of the urethra-prostatic junction without dissection of single components of the USC. Multivariable logistic regression tested the association between technique employed (standard vs. Collar technique) and risk of PSM and, in separate analysis, apical PSM, after adjusting for preoperative PSA level, pathologic grade, stage, and nodal status. RESULTS: A total of 1034 (60%) and 682 (40%) men received collar and standard technique, respectively. Despite higher rate of International Society of Urologic Pathology group was ≥3 at final pathology in the collar vs. standard technique group (39% vs. 32%; p=0.002), preoperative PSA, stage, and nodal status did not differ between the groups (all p ≥0.075). Overall, 269 (16%) patients had PSM, and 134/269 (50%) were apical PSM. There were no differences between the groups with respect to both PSM (17% vs. 15% in standard vs. collar technique group) and apical PSM (8% vs. 7% in standard vs. collar technique group; both p ≥0.3). After adjusting for confounders, patients receiving the collar technique had lower odds of overall PSM (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.75, 0.82; p <0.0001). Similar results were found when apical PSM was the outcome of interest, with lower probability of apical PSM for men in the collar vs. standard technique group (OR: 0.82; 95%CI: 0.81, 0.82; p <0.0001). CONCLUSIONS: The collar technique during apical dissection reduces the rates of both overall and apical positive surgical margins as compared to traditional surgical technique. Future investigations are warranted to confirm also functional results. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e988 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Mottaran More articles by this author Carlo Andrea Bravi More articles by this author Luca Sarchi More articles by this author Pietro Piazza More articles by this author Fernando Gonzalez Meza More articles by this author Marco Corsetti More articles by this author Sophie Knipper More articles by this author Marco Paciotti More articles by this author Marco Amato More articles by this author Rui Farinha More articles by this author Stefano Puliatti More articles by this author Simone Scarcella More articles by this author Celine Sinatti More articles by this author Geert De Naeyer More articles by this author Ruben De Groote More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison of Hard and Soft Cervical Collars for the Management of Odontoid Peg Fractures in the Elderly.

IntroductionOdontoid peg fractures (OF) are the most common cervical spine fracture in the elderly. This retrospective analysis aimed to compare the outcomes of older patients with OF who had been managed non-operatively with either a hard or soft cervical collar.Materials and MethodsWe analysed the retrospective data of the clinical and radiographic records of patients 60 years or older who presented over a 10-year period with OF and were treated non-operatively with a cervical collar. Mortality was the primary outcome measure with mechanism of injury, complications, and fracture healing secondary measures.Results45 patients (hard collar n = 22; soft collar n = 23) were included with comparable demographics for frailty and co-morbidities in each group; age was significantly higher in the soft collar group (80.6 vs 86.4 years; P = .0065). Associated injuries and complications were not significantly different overall, or when Type II fractures were separately analysed (P = .435 associated injuries, P = .121 complications). All-cause mortality was greater in the soft collar group (30-day mortality hard: 0%, soft: 9%; 1-year mortality hard: 18%, soft: 48% P = .035). However, once corrected for age, this proved not to reach significance (P = .333) in any fracture type. Non-union was common (77%) but was not significantly different (hard = 70%; soft = 87%; P = .419).DiscussionConsistent with other reports, non-union rates remained substantial regardless of which collar was used. After controlling for age, there was no difference in all-cause mortality between elderly patients treated with a hard or soft cervical collar for odontoid peg fractures.ConclusionsSoft collars appear suitable for the treatment of odontoid peg fractures in the elderly without compromising outcome. Larger cohort analyses will help confirm this finding.

Cervical spine immobilization does not interfere with nasotracheal intubation performed using GlideScope videolaryngoscopy: a randomized equivalence trial

GlideScope-assisted nasotracheal intubation (NTI) has been proposed as an alternative to difficult orotracheal intubation for critical patients or those under cervical immobilization. We evaluated the difficulty of performing NTI using GlideScope under cervical orthosis. A total of 170 patients scheduled for elective cervical spinal surgery that required NTI were randomized to receive cervical immobilization using a cervical collar (collar group) or no cervical immobilization at all (control group) before anesthetic induction (group assignment at 1:1 ratio). All NTI during anesthetic induction were performed using the GlideScope. The primary outcome was time to intubation. The secondary outcomes were ease of intubation, including the necessity of auxiliary manipulations to assist intubation, and the nasotracheal intubation difficulty scale (nasoIDS). An exploratory analysis identified morphometric parameters as predictors of time to intubation, the necessity of auxiliary manipulations, and a nasoIDS score ≥ 4. For time to intubation, the mean difference (collar group—control) was − 4.19 s, with a 95% confidence interval (CI) of − 13.9 to 5.52 that lay within our defined equivalence margin of 16 s. Multivariate regressions precluded the association of cervical immobilization with a necessity for auxiliary manipulations (adjusted odds ratio [aOR] 0.53, 95% CI [0.26–1.09], P = 0.083) and a nasoIDS ≥ 4 (aOR 0.94 [0.84–1.05], P = 0.280). Among all morphometric parameters, the upper lip bite test class was predictive of a longer time to intubation (all analyses relative to class 1, 14 s longer for class 2, P = 0.032; 24 s longer for class 3, P = 0.070), increased necessity for auxiliary manipulation (aOR 2.29 [1.06–4.94], P = 0.036 for class 2; aOR 6.12 [1.04–39.94], P = 0.045 for class 3), and nasoIDS ≥ 4 (aOR 1.46 [1.14–1.89], P = 0.003 for class 3).The present study demonstrated that GlideScope achieved NTI in patients with or without cervical immobilization equivalently with respect to intubation time and ease.

Comparative Study Between the Results of Anterior Cervical Discectomy and Fusion Using Philadelphia or Soft Collar Postoperatively

Background data: Anterior cervical discectomy and fusion (ACDF) is a well-known operative technique for treating cervical disc diseases causing myelopathy and/or radiculopathy. Postoperative immobilization with a rigid cervical brace is widely followed after ACDF using a standalone cage and soft braces frequently. Some authors have recommended using postoperative cervical braces while others do not, and among surgeons who agree with postoperative collar usage, the type of cervical orthoses and the duration of use are also issues of debate. Purpose: This study aims to compare between results of ACDF by using the Philadelphia collar and soft collar postoperatively. Study design: A prospective study. Patient and Methods: This study included 60 patients with ACDF: 28 used Philadelphia collar (group I) and 32 used soft collar (group II). Cases with single-level ACDF to 4 levels are included, and revision and deformity cases are excluded. For one year, both groups were followed up regarding fusion rate, subsidence, cage migration, neck disability index (NDI), and visual analog score (VAS) of the neck and arm pain. Results: Neck and arm pains using VAS scores preoperatively and 3 months, 6 months, and 12 months postoperatively also showed no significant difference between both groups. Subsidence was noticed among two patients (7.1%) in group I and one patient in group II (3.1%). No significant differences in fusion rates were found between both groups. After a 12-month follow-up in more than two-level procedures, the NDI score among group II was significantly lower (p = 0.045). Linear regression analysis revealed that preoperative NDI, age, BMI, and operation level were the predictors of postoperative NDI, excluding the presence of diabetes mellitus (DM) and brace type. Conclusion: Cervical brace after ACDF either by Philadelphia or soft collar does not affect the fusion rate, cage subsidence, or outcomes of the neck and arm pain. (2021ESJ255)

The Impact of Lifetime Work and Non-work Physical Activity on Physical Fitness Among White - and Blue - Collar Retirees: A Cross-Sectional Study.

Objective: The literature offers significant amount of data on the effects of occupational activity on health, with a distinct link between retirement and health among the most frequently tackled topics. Studies on the relationship between past occupational activity and physical fitness among older retirees remain scarce. The aim of the study was to assess the effects of physical activity on physical fitness in white- and blue-collar retirees.Methods: A total of 200 participants (aged ≥60) were included in the study. Lifetime physical activity was assessed using the Lifetime Physical Activity Questionnaire. Mean MET/week/year values of total Physical Activity and for each domain separately (occupational, sports, household) were calculated. Participants were stratified to blue- or white- collar group. Physical performance, hand-grip strength (HGS) and pulmonary function were assessed.Results: Mean total MET/week/year values for the blue- and the white-collar workers were 140.48 ± 55.13 and 100.75 ± 35.98, respectively. No statistically significant differences in physical performance scores were found between the white- and blue- collar groups. Adjustment for age, sex weight and height revealed a statistically significant association between work-related PA FEV*1 in the blue-collar group. White – collar workers presented higher odds ratio for membership in highest quartile in regard to short physical performance battery test score.Conclusion: Only minimal association of type of occupation on physical fitness were found despite statistically significant differences between mean intensity and duration of sports- and work-related lifetime physical activity. These findings may indicate that the type of past work is not an independent factor influencing the state of a person in old age. Large-scale investigations with physically fit and unfit participants, are necessary.

High School Sports-Related Concussion and the Effect of a Jugular Vein Compression Collar: A Prospective Longitudinal Investigation of Neuroimaging and Neurofunctional Outcomes.

Sports-related concussion (SRC) can exert serious acute and long-term consequences on brain microstructure, function, and behavioral outcomes. We aimed to quantify the alterations in white matter (WM) microstructure and global network organization, and the decrements in behavioral and cognitive outcomes from pre-season to post-concussion in youth athletes who experienced SRC. We also aimed to evaluate whether wearing a jugular compression neck collar, a device designed to mitigate brain "slosh" injury, would mitigate the pre-season to post-concussion alterations in neuroimaging, behavioral, and cognitive outcomes. A total of 488 high school football and soccer athletes (14-18 years old) were prospectively enrolled and assigned to the non-collar group (n = 237) or the collar group (n = 251). The outcomes of the study were the pre-season to post-concussion neuroimaging, behavioral, and cognitive alterations. Forty-six participants (non-collar: n = 24; collar: n = 22) were diagnosed with a SRC during the season. Forty of these 46 athletes (non-collar: n = 20; collar: n = 20) completed neuroimaging assessment. Significant pre-season to post-concussion alterations in WM microstructural integrity and brain network organization were found in these athletes (corrected p < 0.05). The alterations were significantly reduced in collar-wearing athletes compared to non-collar-wearing athletes (corrected p < 0.05). Concussion and collar main effects were identified for some of the behavioral and cognitive outcomes, but no collar by SRC interaction effects were observed in any outcomes. In summary, young athletes exhibited significant WM microstructural and network organizational, and cognitive alterations following SRC. The use of the jugular vein compression collar showed promising evidence to reduce these alterations in high school contact sport athletes.

White Matter Alteration Following SWAT Explosive Breaching Training and the Moderating Effect of a Neck Collar Device: A DTI and NODDI Study.

Special Weapons and Tactics (SWAT) personnel who practice breaching with blast exposure are at risk for blast-related head trauma. We aimed to investigate the impact of low-level blast exposure on underlying white matter (WM) microstructure based on diffusion tensor imaging (DTI) and neurite orientation and density imaging (NODDI) in SWAT personnel before and after breacher training. Diffusion tensor imaging is an advanced MRI technique sensitive to underlying WM alterations. NODDI is a novel MRI technique emerged recently that acquires diffusion weighted data from multiple shells modeling for different compartments in the microstructural environment in the brain. We also aimed to evaluate the effect of a jugular vein compression collar device in mitigating the alteration of the diffusion properties in the WM as well as its role as a moderator on the association between the diffusion property changes and the blast exposure. Twenty-one SWAT personnel (10 non-collar and 11 collar) completed the breacher training and underwent MRI at both baseline and after blast exposure. Diffusion weighted data were acquired with two shells (b = 1,000, 2,000 s/mm2) on 3T Phillips scanners. Diffusion tensor imaging metrices, including fractional anisotropy, mean, axial, and radial diffusivity, and NODDI metrics, including neurite density index (NDI), isotropic volume fraction (fiso), and orientation dispersion index, were calculated. Tract-based spatial statistics was used in the voxel-wise statistical analysis. Post hoc analyses were performed for the quantification of the pre- to post-blast exposure diffusion percentage change in the WM regions with significant group difference and for the assessment of the interaction of the relationship between blast exposure and diffusion alteration. The non-collar group exhibited significant pre- to post-blast increase in NDI (corrected P < .05) in the WM involving the right internal capsule, the right posterior corona radiation, the right posterior thalamic radiation, and the right sagittal stratum. A subset of these regions showed significantly greater alteration in NDI and fiso in the non-collar group when compared with those in the collar group (corrected P < .05). In addition, collar wearing exhibited a significant moderating effect for the alteration of fiso for its association with average peak pulse pressure. Our data provided initial evidence of the impact of blast exposure on WM diffusion alteration based on both DTI and NODDI. The mitigating effect of WM diffusivity changes and the moderating effect of collar wearing suggest that the device may serve as a promising solution to protect WM against blast exposure.

Practice and outcomes of airway management in patients with cervical orthoses

Increasing evidence indicates an association of video laryngoscopy with the success rate of airway management in patients with neck immobilization. Nevertheless, clinical practice protocols for tracheal intubation in patients immobilized using various types of cervical orthoses and the outcomes remain unclear. We retrospectively assessed the tracheal intubation techniques selected for patients immobilized using cervical orthoses from 2015 to 2018. The endpoints were the intubation outcomes of the different techniques and the factors associated with the selection of the technique. We included 218 patients, 118 of whom wore halo vest braces (halo vest group) and 100 wore cervical collars (collar group). GlideScope video laryngoscopy (GVL) and fiberoptic bronchoscopy (FOB) were the initial intubation methods in 98 and 120 patients, respectively. GVL had a higher first-attempt success rate than did FOB in the collar group (p=0.002) but not in the halo vest group (p=0.522). GVL was associated with a lower risk of episodes of SaO2< 90% (adjusted relative risk [aRR], 0.11; 95% CI, 0.02-0.67; p=0.016) and shorter intubation time (aRR, -3.52; 95% CI, -4.79∼-2.25; p<0.001) in the collar group. However, in the halo vest group, more frequent requirement of a rescue technique (p=0.002) and necessity of patient awakening (p=0.001) was noted when GVL was used. Use of the halo vest brace and noting of severe cord compression were independent predictors of the initial selection of FOB. Caution should be exercised when using GVL for tracheal intubation in patients immobilized using halo vest braces.

Atlantoaxial rotatory fixation in childhood: a staged management strategy incorporating manipulation under anaesthesia

AimsThe aims were to evaluate the safety of manipulation under anaesthesia (MUA) for atlantoaxial rotatory fixation (AARF) and the relative efficacy of rigid collar vs halo-body orthosis (HBO) in avoiding relapse and the need for open surgery.MethodsCases of CT-verified AARF treated by MUA were identified from a neurosurgical operative database. Demographic details, time to presentation and aetiology of AARF were ascertained through case note review. Cases were divided according to method of immobilisation after successful reduction, either rigid collar (group 1) or HBO (group 2). The primary outcome measure was relapse requiring open surgical arthrodesis.ResultsThirty-three patients (2.2–12.7 years) satisfied inclusion criteria. Time to presentation varied from 1 day to 18 months. There were 19 patients in group 1 and 14 in group 2. There were no adverse events associated with MUA. 9/19 (47%) patients in group 1 resolved without need for further treatment compared with 10/14 (71%) in group 2 (p = 0.15). Of the 10 patients who failed group 1 treatment, four resolved after HBO. A total of ten patients (30%) failed treatment and required open surgery.ConclusionsMUA is a safe procedure for AARF where initial conservative measures have failed. MUA followed by immobilisation avoids the need for open surgery in over two thirds of cases. Immobilisation by cervical collar appears equally effective to HBO as an initial management, and so a step-wise approach may be reasonable. Delayed presentation may be a risk factor for relapse and need for open surgery.

Altered Functional and Structural Connectomes in Female High School Soccer Athletes After a Season of Head Impact Exposure and the Effect of a Novel Collar.

Background: Characterization of, and evaluation of strategies to mitigate, the effects of sub-concussive impacts (SCI) on brain structure and function are crucial to understanding potential long-term neurological risks associated with sports participation. Objectives: To evaluate the efficacy of a jugular vein compression collar for preserving functional and structural measures of brain network organization in a cohort of female high school soccer players throughout a season of competitive play. Methods: Athletes were assigned to a collar (N = 72) or non-collar (N = 56) group before engaging in a season of play, during which head impact data were recorded via accelerometer for every practice and competition. Participants completed neuroimaging sessions before and following the season. A graph theoretical framework was applied to the functional and structural connectivity measures computed from resting state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) data. Results: Non-collar-wearing athletes exhibited significantly increased rs-fMRI-derived global clustering coefficients (p = 0.032) and DTI-derived modularity (p = 0.042), compared to collar-wearing athletes. No longitudinal changes in any graph measures were observed for the collar group (p > 0.05). Conclusion: The observed increase in graph measures in the non-collar group is congruent with previous studies of SCI and is similar to graph theoretical studies of traumatic brain injury. The absence of alterations in graph metrics in the collar group indicates a potential ameliorating effect of the collar device against network reorganization, in line with previous literature.

THE EFFECTS OF INTERNAL JUGULAR VEIN COMPRESSION FOR PRESERVING WHITE MATTER INTEGRITY IN HIGH SCHOOL FOOTBALL PLAYERS COMPARISON OF HIGH VS LOW

Background:Repetitive head impacts experienced during competitive sports contribute to neurologic changes over the course of a season. Internal jugular vein compression, by means of an externally worn neck collar device has shown efficacy in mitigating white matter (WM) alterations following repeated head impact exposure. However, its relative effectiveness in high versus low head impact exposures is unknown.Hypothesis/Purpose:The purpose of this study was to investigate the effectiveness of an externally worn neck collar device in limiting WM alterations over a season of high school football in players who receive high and low cumulative head impact exposures over 90 g.Methods:213 male high-school football athletes were prospectively assigned to two study groups: a control group (non-collar; n=106) and an experimental group who wore the jugular vein compression collar during all practices and games (collar; n=107). MRI data was collected from all participants pre- and post-season. Fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD) were calculated to assess WM integrity at both time points. Cumulative head impact exposure was monitored by accelerometers attached to each athlete’s left mastoid process during every exposure. Participants were dichotomized into subgroups based on accumulated exposures to hits over 90 g, which divided the entire cohort into four subgroups, using a cut-off of 40 hits : (1) non-collar group (≥40 hits, n=57); (2) collar group (≥40 hits, n=51); (3) non-collar group (<40 hits, n=49); (4) collar group (<40 hits, n=56).Results:As seen in Table 1, in athletes with ≥40 hits, both the non-collar and collar group showed significant pre- to post- season reductions in MD, AD, and/or RD. The non-collar group with ≥40 hits also showed a significant increase in FA, MD, and AD. RD, FA, and MD changes were greater in the non-collar group compared to the control group with ≥40 hits, while AD changes were greater in the collar group compared to the non-collar group with ≥ 40 hits. The non-collar group with <40 hits presented significant pre- to post-season reductions in MD, AD, and RD that were greater than the collar group with < 40 hits (whom did not show pre-to post-season changes).Discussion & Conclusion:The present results provide support for internal jugular vein compression to protect the brain from both low- and high-level repeated head impact exposure. However, less consistent changes were observed for athletes exposed to repeated, high-level head impacts, warranting further investigation.Table 1.Number of WM voxels (1x1x1mm) with significant (p < .05 after correcting for multiple comparisons) pre- to post-season DTI changes and/or significant group difference (red indicates group difference for non-collar group; blue indicates group difference for collar group) for high and low head impact exposure FA ↓ MD↓ AD↓ RD↓ FA↑ MD↑ AD↑ RD↑ #hits ≥ 40 Noncollar,n= 5701390381 702965186110Collar, n=51013313350 0000Grp_diff-011511 24660-#hits <40 Noncollar,n= 4905925956340 0000Collar, n=560000 0000Grp_diff-308627611 ----

BRAIN WHITE MATTER ALTERATIONS IN STRUCTURAL INTEGRITY AND CONNECTIVITY FOLLOWING A SPORTS-RELATED CONCUSSION: EVALUATION OF THE POTENTIAL AMELIORATING EFFECT OF A JUGULAR VEIN COMPRESSION COLLAR DEVICE

Background:Sports-related concussion is a significant public health problem which may result in exacerbated or prolonged neurologic deficits. A neck collar device has been developed to apply mild jugular vein compression, increasing intracranial blood volume, with the intent of reducing brain slosh and preventing damage to brain microstructure from head impact exposure.Hypothesis/Purpose:We aimed to quantify the alterations in white matter (WM) diffusion properties and network structural connectivity in high school athletes after sports-related concussion and to test the effect of a jugular vein compression collar device worn during the concussive event.Methods:379 athletes (male American football and female Soccer) were included in this report. Of the 16693 total athlete exposures, 40 resulted in a diagnosed concussion and were included in these analyses. Prospective longitudinal MRI data were collected at pre-season and post-concussion: 20 athletes were in the non-collar group (12M, age =15.93±1.27yrs) and 20 athletes were in the non-collar group (16M, age=16.37±1.06yrs). DTI parameters, including fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD), were calculated to determine post-concussion alterations in WM diffusion properties. Graph analysis was utilized to quantify post-concussion changes in WM structural connectivity.Results:Diffusion property results revealed significant pre-season to post-concussion increases in MD, AD and RD within the non-collar group (p<0.05), but no change was found in the collar group (p>0.05). The pre-season to post-concussion MD, AD, or RD increase was significantly greater (p<0.05, Figure 1) in the non-collar group than the collar group. Graph analysis revealed a pre-season to post-concussion decrease in mean local efficiency in the non-collar group (p=0.036) and a significant increase in mean local efficiency in the collar group (p=0.017). The pre-season to post-concussion change in the mean local efficiency was significantly different in the non-collar group, when compared to the collar group (p=0.0024, Figure 2).Discussion & Conclusion:Results indicate that sports related concussion is associated with alterations in WM diffusion properties. The mean local efficiency of the network, a structural connectivity index reflecting network wiring redundancy and tolerance to brain injury, was also found to decrease after the concussion. Results indicate that wearing a neck collar device has the potential to limit these WM changes following a concussive event. Further studies are warranted to investigate the temporal progression of these changes for preventing long-term, neurologic squeala.Figure 1.White matter regions with significant greater increase in MD, AD, and/or RD in the non-collar group than the collar group.Figure 2.Mean local efficiency of brain network showed significant decrease in the non-collar group (p=0.036) and significant increase in the collar group (0.017), with a significant group difference in the change (p=0.0024).

ALTERED BRAIN FUNCTIONAL CONNECTIVITY FOLLOWING A SEASON OF COMPETITIVE FEMALE HIGH SCHOOL SOCCER AND THE EFFECT OF A JUGULAR VEIN COMPRESSION COLLAR: A NETWORK-BASED STATISTICS ANALYSIS

Background:Cumulative exposure to repetitive sub-concussive head impacts in contact sports may have deleterious effects on brain function, even in the absence of acute symptoms. Moreover, anatomical and biomechanical factors may predispose female athletes to higher risk compared to males. At present, there is no effective injury prevention strategy to protect female athletes from sports-related head impact.Hypothesis/Purpose:(1). We aimed to use resting-state fMRI to investigate the effect of a full season of competitive soccer on brain functional network integrity in female high school athletes. (2). We also aimed to evaluate the efficacy of a jugular vein compression neck collar device, designed to mitigate potential injury by reducing the brain slosh effect.Methods:A total of 125 high school female soccer athletes were included in this study. These athletes were assigned randomly to a non-collar (n=55, age=16.06±1.06 yrs) or collar group (n=70, 15.81±0.95 yrs) before the season started. High resolution 3D T1-weighted images and resting-state fMRI data were collected prospectively at pre-season and again at post-season. Data processing and analysis were conducted in the MATLAB-based programs Statistical Parametric Mapping (SPM12) and Connectivity Toolbox (Conn). Functional connectivity was computed between each pair of 105 anatomically delineated regions of interest (ROI). Network Based Statistics were applied to detect coherent patterns of altered connectivity from pre- to post-season.Results:The non-collar group showed a significant pattern of altered connectivity (p-FWE = 0.047) spanning 60% of ROIs (63/105) and 1.7% of ROI-ROI connections (94/5,460). 65 of the 94 altered connections were weakened from pre-to-post season and tended to occur in the right hemisphere. 29 of the 94 altered connections were strengthened from pre-to-post season and tended to involve regions in the occipital lobe. The collar group did not show any statistically significant change (p-FWE = 0.223).Conclusion:The results of this study indicate that exposure to repetitive sub-concussive head impacts during a single season of competitive female soccer induces changes in brain functional connectivity. The observed increases and decreases of functional connectivity strength comprising the pattern of altered connectivity are congruent with a heterogeneous response to insult wherein some connections are reduced in strength due to neuronal damage and other “detour” connections are strengthened to preserve network function. Comparatively, the absence of alterations in the collar group suggest that the jugular vein compression collar may have generated a potentially protective effect to preserve brain functional network integrity during exposure to head impacts.Figure 1.Pattern of pre-to-post season altered connectivity in the non-collar group (p-FWE=0.023). Observed changes in functional connectivity strength were bimodal with decreased (blue) connectivity occurring predominantly between right hemispheric regions and increased (red) connectivity often associated with occipital lobe areas.

On the Influence of Platform Economy on Transformation and Upgrading of Chinese Traditional Manufacturing Industry - A Case Study of Red Collar Group

The profitability of the traditional manufacturing industry is sluggish and fails to well adapt to the current trend of economic globalization. In the context of industry 4.0, it is imperative for the traditional manufacturing industry to transform and upgrade in an all-round way in the market-oriented and government-led environment. At this time, platform economy furnishes a good impetus for the transformation and upgrading of traditional manufacturing industry. Traditional manufacturing industry adapts to the needs of the external market environment through platform structure, adjusts factor input premised on dynamic changes in factor endowment, integrates scientific and technological revolution, and gradually cultivates competitiveness through continuous technological innovation, thereby achieving the transformation and upgrading of industry. In the background of conversion of era, this paper explores the innovation of traditional enterprises in the current historical background from the angle of evolution, attempting to reveal that platform economy helps traditional manufacturing enterprises to update their production methods, restructure their management structures and set up supply chain thinking, thereby pushing forward their transformation and upgrading. Taking the transformation and upgrading of Red Collar Group as an example, this paper analyzes the process of rapid learning, resource integration, innovation iteration, self-fission, and continuous evolution of the enterprise premised on platform economy, thereby proving the positive impetus of platform economy to the transformation of traditional manufacturing industry and testing its logical rationality. The research concludes that platform economy will become one of the significant strategic modes of transformation and upgrading of traditional manufacturing industry in China.

Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes

PurposeTo (1) quantify white matter (WM) alterations in female high school athletes during a soccer season and characterise the potential for normalisation during the off-season rest period, (2) determine the...

Effectiveness of deltamethrin-impregnated dog collars on the incidence of canine infection by Leishmania infantum: A large scale intervention study in an endemic area in Brazil.

To reduce morbidity and mortality caused by visceral leishmaniasis (VL), the Brazilian Visceral Leishmaniasis Control and Surveillance Program promotes the diagnosis and treatment of cases, vector control, euthanasia of seropositive dogs, and health education. Nevertheless, the effectiveness of these measures is questionable as they lead to little reduction in the transmission of the disease. Thus, the effectiveness of strategies such as insecticide-impregnated collars, spot-on insecticides, and immunization of dogs should be assessed. Herein, we evaluated the effectiveness of deltamethrin-impregnated collars on reducing the incidence of Leishmania infantum infection in dogs living in an endemic area of VL. An intervention study was conducted and a total 5,850 dogs were analyzed in baseline. Of these 3,742 seronegative dogs were divided into two groups: collared and uncollared (control). Dogs were followed for 12 months and three interventions were performed. The Cox regression model was used to evaluate the effectiveness of the collar. All analyzes were performed by Intention-to-treat and per-protocol. By intention-to-treat, the incidence rates of L. infantum infection were 7.5 and 7.9 in the collar group, and 6.5 and 13.2 per 1,000 dogs-months in the control group after 6 and 12 months, respectively. In the per-protocol analysis, the incidence rates in the control group were similar to those observed in the intention-to-treat analysis. In the collar group, the incidence rate was 5.1/1,000 dogs-months after 6 and 12 months. The effectiveness by intention-to-treat after adjustment by the multivariate Cox model was 48%. In the analysis per-protocol, the effectiveness increased to 63%. Although collar use was effective when it was evaluated by intention-to-treat, higher effectiveness was found in the per-protocol analysis after one year of follow-up. The data emphasize the importance of the uninterrupted use of deltamethrin-impregnated collars to increase protection against canine VL.

Impact of Low-Level Blast Exposure on Brain Function after a One-Day Tactile Training and the Ameliorating Effect of a Jugular Vein Compression Neck Collar Device.

Special Weapons and Tactics (SWAT) personnel who conduct breacher exercises are at risk for blast-related head trauma. We aimed to investigate the potential impact of low-level blast exposure during breacher training on the neural functioning of working memory and auditory network connectivity. We also aimed to evaluate the effects of a jugular vein compression collar, designed to internally mitigate slosh energy absorption, preserving neural functioning and connectivity, following blast exposure. A total of 23 SWAT personnel were recruited and randomly assigned to a non-collar (n = 11) and collar group (n = 12). All participants completed a 1-day breacher training with multiple blast exposure. Prior to and following training, 18 participants (non-collar, n = 8; collar, n = 10) completed functional magnetic resonance imaging (fMRI) of working memory using N-Back task; 20 participants (non-collar, n = 10; collar, n = 12) completed resting-state fMRI. Key findings from the working memory analysis include significantly increased fMRI brain activation in the right insular, right superior temporal pole, right inferior frontal gyrus, and pars orbitalis post-training for the non-collar group (p < 0.05, threshold-free cluster enhancement corrected), but no changes were noted for the collar group. The elevation in fMRI activation in the non-collar group was found to correlate significantly (n = 7, r = 0.943, p = 0.001) with average peak impulse amplitude experienced during the training. In the resting-state fMRI analysis, significant pre- to post-training increase in connectivity between the auditory network and two discrete regions (left middle frontal gyrus and left superior lateral occipital/angular gyri) was found in the non-collar group, while no change was observed in the collar group. These data provided initial evidence of the impact of low-level blast on working memory and auditory network connectivity as well as the protective effect of collar on brain function following blast exposure, and is congruent with previous collar findings in sport-related traumatic brain injury.

ASSESSMENT OF THE CERVICAL COLLAR APPLICATION IMPACT ON THE CONDITIONS OF INTUBATION AND THE FEELINGS OF PATIENTS — PILOT STUDY

INTRODUCTION: Securing the stability of the cervical spine is one of the basic procedures performed by medical personnel in trauma patients. Unfortunately, standard cervical collars limit the effectiveness of some procedures, including endotracheal intubation, as well as affect the pain sensations of the injured person. The aim of the study was to compare the influence of two different types of cervical collars on the technical conditions of endotracheal intubation and the patient’s sense of comfort. METHOD: The study was designed as a randomised, cross-over research and included 32 healthy paramedics, who had a cervical collar installed for 20 minutes in a randomised way. During the examination, the patient’s comfort and pain resulting from the pressure on mastoid processes were evaluated. RESULTS: Prior to the study, the mouth opening in the examined group was 51 ± 12 mm. After the set-up of the Patriot collar, the mouth opening amounted to 37 ± 10 mm, while in the NECKLITE collar group amounted to 49 ± 13 mm (p < 0.001). The use of a cervical collar reduced the degree of mouth opening by 27% when using a standard cervical collar, and less than 4% when using a NECKLITE collar. The pressure on the mastoid processes assessed on a 10-point scale varied between the cervical collars and amounted to 7 ± 2 points for Patriot and 1 ± 1 points for NECKLITE collar (p < 0.001). The pain sensations associated with the cervical collar were also varied and amounted to 6 ± 3 points for Patriot collar vs. 1 ± 1 points for NECKLITE collar (p < 0.001). Ninety- -seven per cent of study participants declared, that they preferred the NECKLITE collar comparing to the Patriot cervical collar. CONCLUSIONS: A standard cervical collar causes an increase in pain due to the pressure on the mastoid processes and a sense of discomfort for the patient. The NECKLITE collar thanks to the possibility of better fit to the patient’s neck, does not cause any pain, and using this collar it is possible to perform endotracheal intubation without the need to unfasten it.