Risk Of Future Injury Research Articles

A nationwide longitudinal survey of infantile injury and its recurrence in Japan.

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

The Role of the Lead Hip in Collegiate Baseball Pitching: Implications for Ball Velocity and Upper-Extremity Joint Moments.

Hip flexibility is an important biomechanical factor for a baseball pitcher. However, there have been limited investigations into the association between upper-extremity joint stresses and ball velocity and hip flexibility, as assessed via motion patterns during the pitch. The purpose of this study was to provide a detailed kinematic description of the lead hip during the pitch and determine the association between lead hip motion and both ball velocity and the elbow varus moment. This study was a secondary analysis of the kinematic and kinetic data previously collected on 99 collegiate-level baseball pitchers using standard optoelectronic motion capture. Significant associations were noted between lead hip internal rotation and both peak ball velocity and the elbow varus moment. The data indicated that for every 10° increase in internal lead hip rotation, ball velocity increased by 0.6m/s (P < .001, r2 = .26), and the elbow varus moment increased by 5N·m (P < .001, r2 = .33). The results of this study suggested that internal hip rotation may be an important means of identifying pitchers that may be at risk for future injury.

'Knock down the brain': a nonlinear analysis of electroencephalography to study the effects of sub-concussion in boxers.

Boxing is associated with a high risk of head injuries and increases the likelihood of chronic traumatic encephalopathy. This study explores the effects of sub-concussive impacts on boxers by applying both linear and nonlinear analysis methods to electroencephalogram (EEG) data. Twenty-one boxers were selected (mean ± SD, age 28.38 ± 5.5 years; weight 67.55 ± 8.90 kg; years of activity 6.76 ± 5.45; education 14.19 ± 3.08 years) and divided into 'beginner' and 'advanced' groups. The Montreal Cognitive Assessment and the Frontal Assessment Battery were administered; EEG data were collected in both eyes-open (EO) and eyes-closed (EC) conditions during resting states. Analyses of EEG data included normalized power spectral density (nPSD), power law exponent (PLE), detrended fluctuation analysis and multiscale entropy. Statistical analyses were used to compare the groups. Significant differences in nPSD and PLE were observed between the beginner and advanced boxers, with advanced boxers showing decreased mean nPSD and PLE (nPSD 4-7 Hz, p = 0.013; 8-13 Hz, p = 0.003; PLE frontal lobe F3 EC, p = 0.010). Multiscale entropy analysis indicated increased entropy at lower frequencies and decreased entropy at higher frequencies in advanced boxers (F3 EC, p = 0.024; occipital lobe O1 EO, p = 0.029; occipital lobe O2 EO, p = 0.036). These changes are similar to those seen in Alzheimer's disease. Nonlinear analysis of EEG data shows potential as a neurophysiological biomarker for detecting the asymptomatic phase of chronic traumatic encephalopathy in boxers. This methodology could help monitor athletes' health and reduce the risk of future neurological injuries in sports.

Analysis of artificial intelligence medical treatment for closed muscle skin nerve injury caused by aerobics training

In aerobics training, closed myocutaneous nerve damage needs to be paid attention to, especially high-intensity training may cause minor damage to muscles and nerves. With the help of AI medical technology and the understanding of molecular and cellular biomechanics, we can more accurately explore the mechanism of injury, such as the effects of nerve tensile stress and microenvironment changes on nerve regeneration. This helps to develop scientific rehabilitation methods, such as AI-assisted personalized training, neural regeneration technology, and real-time monitoring of training intensity to speed up athletes’ rehabilitation and reduce the risk of future injuries. Purpose: Aerobics training is very strict and requires high physical fitness of dancers. During long-term training, dancers can easily cause closed musculocutaneous nerve injury. Traditional medicine is difficult to guarantee the treatment effect of patients with musculocutaneous nerve injury. The use of artificial intelligence medicine for closed musculocutaneous nerve injury treatment can improve the treatment effect of aerobics training induced closed musculocutaneous nerve injury. Method: This article utilized artificial intelligence medicine for the treatment of musculocutaneous nerve injury, and used artificial intelligence technology to analyze patient imaging and other data to assist doctors in accurate diagnosis. Utilize intelligent algorithms to predict medication plans, reduce medication errors, and intelligently adjust the course of treatment based on the patient’s condition. In artificial intelligence healthcare, high-quality online medical services can be created through intelligent technology, providing convenient medical consultation for patients. Result: This article selected 200 patients with musculocutaneous nerve injury caused by aerobics training for grouping experiments. The average diagnostic accuracy of traditional medicine and artificial intelligence medicine were 84.2% and 95.6%, respectively. Conclusion: Artificial intelligence medicine can achieve medical informatization and intelligently analyze patients’ medical information, which helps to improve the accuracy of medical diagnosis for aerobics training injuries.

Altered neural recruitment despite dual task performance recovery in athletes with repeat concussion.

Sports-related concussions (SRCs) pose significant challenges to college-aged athletes, eliciting both immediate symptoms and subacute cognitive and motor function impairment. While most symptoms and impairments resolve within weeks, athletes with repeat SRCs may experience heightened risk for prolonged recovery trajectories, future musculoskeletal injuries, and long-term neurocognitive deficits. This includes impaired dual task performance and altered neurophysiology that could persist across the lifespan and elicit future pathophysiology and neurodegeneration. Thus, it is imperative to improve our understanding of neurophysiology after SRC. This study aimed to investigate the impact of repeat SRCs on dual task performance and associated neural recruitment using functional near-infrared spectroscopy (fNIRS). A total of 37 college-aged athletes (ages 18-24) participated in this cross-sectional observational study. Among these athletes, 20 had a history of two or more SRCs, while 17 had never sustained a SRC and served as controls. Participants completed the Neuroimaging-Compatible Dual Task Screen (NC-DTS) while fNIRS measured neural recruitment in the frontoparietal attention network and the primary motor and sensory cortices. Behavioral analysis revealed that athletes with repeat SRCs exhibited comparable single task and dual task performance to control athletes. Additionally, dual task effects (DTE), which capture performance declines in dual tasks versus single tasks, did not significantly differ between groups. Notably, the cohort of athletes with repeat SRC in this study had a longer time since their last SRC (mean = 1.75 years) than majority of previous SRC studies. Neuroimaging results indicated altered neural recruitment patterns in athletes with multiple repeat SRCs during both single and dual tasks. Specifically, athletes with repeat SRCs demonstrated increased prefrontal cortex (PFC) activation during single motor tasks compared to controls (P < 0.001, d = 0.47). Conversely, during dual tasks, these same athletes exhibited reduced PFC activation (P < 0.001, d = 0.29) and primary motor cortex (M1) activation (P = 0.038, d = 0.16) compared to their single task activation. These findings emphasize the complex relationship between SRC history, dual task performance, and changes in neurophysiology. While athletes with repeat SRCs demonstrate recovery in behavioral dual task performance, persistent alterations in neural recruitment patterns suggest ongoing neurophysiological changes, possibly indicating compensatory neural strategies and inefficient neural resource allocation, even beyond symptom resolution and medical clearance. Understanding the compensatory neural recruitment strategies that support behavioral performance following repeat SRCs can inform return-to-play decisions, future musculoskeletal injury risk, and the long-term impact of SRCs on neurocognitive function.

The Influence of Sports-Related Concussion on Cognition and Landing Biomechanics in Collegiate Athletes.

Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk.

Cardiac tissue-resident vesicles differentially modulate anti-fibrotic phenotype by age and sex through synergistic miRNA effects

Aging is a risk factor for cardiovascular disease, the leading cause of death worldwide. Cardiac fibrosis is a harmful result of repeated myocardial infarction that increases risk of morbidity and future injury. Interestingly, both rates and outcomes of cardiac fibrosis differ between young and aged individuals, as well as men and women. Here, for the first time, we identify and isolate matrix-bound extracellular vesicles from the left ventricles (LVs) of young or aged males and females in both human and murine models. These LV vesicles (LVVs) show differences in morphology and content between these four cohorts in both humans and mice. LVV effects on fibrosis were also investigated in vitro, and aged male LVVs were pro-fibrotic while other LVVs were anti-fibrotic. From these LVVs, we could identify therapeutic miRNAs to promote anti-fibrotic effects. Four miRNAs were identified and together, but not individually, demonstrated significant cardioprotective effects when transfected. This suggests that miRNA synergy can regulate cell response, not just individual miRNAs, and also indicates that biological agent-associated therapeutic effects may be recapitulated using non-immunologically active agents. Furthermore, that chronic changes in LVV miRNA content may be a major factor in sex- and age-dependent differences in clinical outcomes of cardiac fibrosis.

Predicting pressure injury risk in hospitalised patients using machine learning with electronic health records: a US multilevel cohort study

ObjectiveTo predict the risk of hospital-acquired pressure injury using machine learning compared with standard care.DesignWe obtained electronic health records (EHRs) to structure a multilevel cohort of hospitalised patients at risk...

Prevalence of Pain With Movement in Active Duty US Army Soldiers.

Soldiers must be able to perform a multitude of physically demanding tasks as part of their regular duty, but their physical readiness is often degraded due to pain and musculoskeletal injury (MSKI). The presence of pain with movement has been associated with increased MSKI risk in Soldiers. Improved awareness of the prevalence of painful movements in uninjured Soldiers could help inform Army injury mitigation efforts. The purpose of this study was to identify the prevalence of pain with movement in a population of healthy active duty Soldiers. The Selective Functional Movement Assessment-Top Tier Movements (SFMA-TTM), active range of motion (AROM) of the hips and shoulders, and the elicitation of pain with movement were measured in 268 healthy US Army Soldiers. Descriptive statistics were generated for the number of painful movements for each measure and inferential statistics; independent t-test and one-way independent analysis of variance (ANOVA) were used for analysis of the other measures. Greater than half (59%) of the participants reported pain with at least 1 movement and more than 41% reported pain with 2 or more movements. Soldiers reported a mean of 1.35 painful movements on the SFMA-TTM assessment and a mean of 1.54 painful AROM movements. Pain with functional movement patterns was common across a sample of uninjured Soldiers. The presence of pain with movement warrants further evaluation as it may impact a Soldier's physical performance, risk for future injury, and overall quality of life.

Impact of prior axonal injury on subsequent injury during brain tissue stretching – A mesoscale computational approach

Epidemiology studies of traumatic brain injury (TBI) show individuals with a prior history of TBI experience an increased risk of future TBI with a significantly more detrimental outcome. But the mechanisms through which prior head injuries may affect risks of injury during future head insults have not been identified. In this work, we show that prior brain tissue injury in the form of mechanically induced axonal injury and glial scar formation can facilitate future mechanically induced tissue injury. To achieve this, we use finite element computational models of brain tissue and a history-dependent pathophysiology-based mechanically-induced axonal injury threshold to determine the evolution of axonal injury and scar tissue formation and their effects on future brain tissue stretching. We find that due to the reduced stiffness of injured tissue and glial scars, the existence of prior injury can increase the risk of future injury in the vicinity of prior injury during future brain tissue stretching. The softer brain scar tissue is shown to increase the strain and strain rate in its vicinity by as much as 40% in its vicinity during dynamic stretching that reduces the global strain required to induce injury by 20% when deformed at 15 s−1 strain rate. The results of this work highlight the need to account for patient history when determining the risk of brain injury.

Evaluation of the lower extremity functional test to predict lower limb injuries in professional male footballers

The Lower Extremity Functional Test (LEFT) is a reliable and valid test for the measurement of athletic fitness, fatigue resistance, and speed performance. Contradictory results exist regarding the screening value of the LEFT in predicting lower limb injuries. The purpose of this study was to investigate the screening value of the LEFT in predicting lower limb injuries in professional male footballers. One hundred and twenty-one professional male football players participated in the study. LEFT was recorded pre-season and the lower-limb injuries were recorded during a 9-month season. Logistic regression analysis was used to determine the accuracy of the prognosis of LEFT. A total of twenty-five lower limb injuries were recorded. The model explained 53% of the variance in lower limb injury, showing that predictions by LEFT score is reliable, and correctly predicted 89.3% of cases, which is a large improvement. ROC analysis showed significant accuracy of the LEFT score (AUC 0.908, 95% CI 1.126–1.336, p = 0.001, OR = 1.227) in discriminating between injured and uninjured players. The optimum cut-off level of the LEFT score was 90.21 s; Our findings showed that the LEFT score was able to predict lower limb injuries in professional male footballers. The slower an athlete’s LEFT scores, the more susceptible they are to future injury risk. Sports medicine specialists, football coaches and managers are suggested to use LEFT as a pre-season screening test to identify and prevent the weakness and functional imbalance of the athletes before the injury occurs by conducting this test.

Anterior Cruciate Ligament Injury Does Not Increase the Risk for a Future Concussion: A Unidirectional Phenomenon.

Epidemiological studies have shown an increased risk of musculoskeletal injury after concussion. The purpose of this study was to determine whether the reverse relationship exists, specifically whether there is an increased risk of concussion after an anterior cruciate ligament (ACL) injury in a population-based cohort. Retrospective cohort. The Rochester Epidemiology Project was searched between 2000 and 2017 for International Classification of Diseases, 9th and 10th Revision codes relevant to the diagnosis and treatment of concussion and ACL tear. A total of 1294 unique patients with acute, isolated ACL tears and no previous history of concussion were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion after the ACL injury. Cases were matched by age, sex, and Rochester Epidemiology Project availability to patients without an ACL tear (1:3 match), resulting in 3882 controls. Medical records of matched control patients were reviewed to rule out history of ACL injury. The hazard ratio of concussion injury following an ACL injury was determined. Nine patients with an ACL injury suffered concussion up to 3years after the ACL injury. The rate of concussion was no different between ACL-injured cases (0.7%) compared with matched controls with no ACL injury (1.2%), which corresponded to a hazard ratio of 0.55 (95% confidence interval, 0.3-1.1; P = .10). Based on the current evidence, there does not appear to be a significant association between ACL injury and subsequent concussion, which suggests that a concussion uniquely affects the risk of future subsequent musculoskeletal injury.

Virtual Neuromuscular Training Among Physically Active Young Adults: A Feasibility Study.

Evidence indicates a 2 to 3 times increased risk of musculoskeletal injury after return to play from concussion. Undetected neuromuscular control deficits at return to play may relate to increased musculoskeletal injury risk. Rehabilitation to improve neuromuscular control may benefit patients with concussion, but access to rehabilitation professionals and/or poor adherence may limit efficacy. Our purpose was to determine the feasibility of an 8-week virtual neuromuscular training (NMT) program administered through a novel smartphone application among physically active, uninjured adults. Feasibility trial. Participants were instructed to complete an NMT program administered via a smartphone application and returned for follow-up questionnaires 8weeks later. They were instructed to complete 3 asynchronous self-guided workouts per week during the 8-week intervention period. Workouts included balance, plyometrics, strengthening, and dual-task exercises. The application provided instructions for each exercise using video, text, and audio descriptions. Our primary feasibility measure was participant adherence, calculated as the percentage of workouts completed out of the total possible 24 workouts. We recorded the average duration of each workout using start/stop/advance features within the application. Twenty participants were enrolled, of which 15 (age = 26.3 [2.7]y, 67% female) returned for follow-up (75% retention). Participant adherence was 57.2% (25.0%; range: 16.7%-91.7%). Participants spent 17.3 (8.0)minutes per workout (range: 7.4-37.9min). There were no adverse reactions or injuries. Most participants (60%) reported time availability as a primary barrier to intervention completion. Participants were moderately (>50%) adherent to a virtual NMT program, without any reported injuries. We identified several barriers to participation and pathways for improved adherence in the future. The virtual NMT program completed by uninjured adults provides evidence of its feasibility and future scalability to those with a recent concussion to address neuromuscular control deficits and reduce future injury risk.

The Evolution of Neuroimaging Technologies to Evaluate Neural Activity Related to Knee Pain and Injury Risk.

In this review, we present recent findings and advancements in the use of neuroimaging to evaluate neural activity relative to ACL injury risk and patellofemoral pain. In particular, we describe prior work using fMRI and EEG that demonstrate the value of these techniques as well as the necessity of continued development in this area. Our goal is to support future work by providing guidance for the successful application of neuroimaging techniques that most effectively expose pain and injury mechanisms. Recent studies that utilized both fMRI and EEG indicate that athletes who are at risk for future ACL injury exhibit divergent brain activity both during active lower extremity movement and at rest. Such activity patterns are likely due to alterations to cognitive, visual, and attentional processes that manifest as coordination deficits during naturalistic movement that may result in higher risk of injury. Similarly, in individuals with PFP altered brain activity in a number of key regions is related to subjective pain judgements as well as measures of fear of movement. Although these findings may begin to allow objective pain assessment and identification, continued refinement is needed. One key limitation across both ACL and PFP related work is the restriction of movement during fMRI and EEG data collection, which drastically limits ecological validity. Given the lack of sufficient research using EEG and fMRI within a naturalistic setting, our recommendation is that researchers target the use of mobile, source localized EEG as a primary methodology for exposing neural mechanisms of ACL injury risk and PFP. Our contention is that this method provides an optimal balance of spatial and temporal resolution with ecological validity via naturalistic movement.

Abstract 15371: Mice Lacking S-Nitrosoglutathione Reductase (GSNOR -/- ), a Mouse Model of Preeclampsia, Exhibited Nitroso-Redox Imbalance and Deterioration of Cardiovascular Structure and Function in Postpartum Mothers

Introduction: Preeclampsia (PE), a leading cause of maternal mortality, is linked to persistent pathological changes in the heart, predisposing the mother to increased risk of chronic cardiovascular (CV) disease later in life. PE is characterized by increased S-nitrosylated (SNO) proteins and nitroso-redox imbalance. We recently showed that mice lacking S-nitrosoglutathione reductase (GSNOR -/- mice), a denitrosylase that regulates protein S-nitrosylation, exhibit the clinical features of PE including maternal hypertension, blunted increase in cardiac output, abnormal remodeling of left ventricular (LV) cardiac structure, dysregulation in nitrosylation and nitroso-redox imbalance. Hypothesis: The nitroso-redox imbalance seen during pregnancy in GSNOR -/- mice persists in postpartum (PP), leading to increased maternal susceptibility to CV injury. Methods: Pregnant control (WT [C57Bl/6J]) and GSNOR -/- mice (N=5) were examined at baseline, late-stage pregnancy (17.5 dpc) and 6 weeks PP. LV structure, cardiac output and stroke volume were determined using echocardiography (Vevo 2100). Cardiomyocytes (CM) were isolated at 6 weeks PP and ROS and peroxynitrite levels determined using fluorescent dyes. Results: In WT mice, all normal maternal CV adaptions to pregnancy, reverted to pre-pregnant levels 6 weeks PP. In contrast, GSNOR -/- mice exhibited increased cardiac output (+21% vs. -19% in WT), stroke volume (+21% vs. -41% in WT), and LV chamber dimension (+13% vs. -4% in WT) at 6 weeks PP, indicating high cardiac output LV cardiomyopathy. CM isolated from GSNOR -/- hearts showed ~5-fold more ROS generation (9.9x10 -4 ±9x10 -5 vs. 2.1x10 -4 ±1.5 x10 -4 ΔF/F max .min -1 ) and elevated peroxynitrite levels (0.318±0.011 vs. 0.243±0.012 ΔF/F 0 ) compared to WT at 6 weeks PP, suggesting the presence of nitroso-redox imbalance. All changes P&lt;0.05. Conclusion: Postpartum GSNOR -/- (preeclamptic) mothers exhibited cardiac dysfunction which was accompanied by the presence of of nitroso-redox imbalance. These changes may predispose the mother to higher risk for future CV injury.

Strengths, weaknesses, opportunities, and threats associated with the application of artificial intelligence in connection with sport research, coaching, and optimization of athletic performance: a brief SWOT analysis.

Here, we performed a non-systematic analysis of the strength, weaknesses, opportunities, and threats (SWOT) associated with the application of artificial intelligence to sports research, coaching and optimization of athletic performance. The strength of AI with regards to applied sports research, coaching and athletic performance involve the automation of time-consuming tasks, processing and analysis of large amounts of data, and recognition of complex patterns and relationships. However, it is also essential to be aware of the weaknesses associated with the integration of AI into this field. For instance, it is imperative that the data employed to train the AI system be both diverse and complete, in addition to as unbiased as possible with respect to factors such as the gender, level of performance, and experience of an athlete. Other challenges include e.g., limited adaptability to novel situations and the cost and other resources required. Opportunities include the possibility to monitor athletes both long-term and in real-time, the potential discovery of novel indicators of performance, and prediction of risk for future injury. Leveraging these opportunities can transform athletic development and the practice of sports science in general. Threats include over-dependence on technology, less involvement of human expertise, risks with respect to data privacy, breaching of the integrity and manipulation of data, and resistance to adopting such new technology. Understanding and addressing these SWOT factors is essential for maximizing the benefits of AI while mitigating its risks, thereby paving the way for its successful integration into sport science research, coaching, and optimization of athletic performance.

Early-Life Temperamental Differences as Longitudinal Predictors of Unintentional Injuries.

Unintentional injuries are the leading cause of hospitalization and death among children. Compared to environmental factors, less attention in injury preventive efforts has been paid to how individual characteristics relate to the risk of injury. Using a large prospective cohort, the current study assessed the longitudinal impact of early-life temperament on the cumulative number of injuries until mid-adolescence. The data came from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). Temperament was evaluated by mothers when children were 3 years old (N = 3,545). The main outcome was the pediatrician-reported sum of child's injuries from age 3 to 15 (seven timepoints). Latent profile analysis (LPA) was used to determine classes based on temperamental dimensions and then extended to a mixture model with a distal count outcome. The covariates included maternal conflict and attachment, sex, family structure, and maternal education. The LPA determined the existence of three classes: shy children (8.1% of the sample; lowest activity/highest shyness), outgoing children (50.8%; highest activity/lowest shyness), and average: children (41.1%; middle values). Results from a mixture model showed that the outgoing temperament was associated with the highest longitudinal risk for injuries, as both average children (IRR = 0.89 [0.80, 0.99]), and the shy children (IRR = 0.80 [0.68, 0.95]) had lower risk. Early childhood temperamental differences can have long-term effects on injury risk. Highly active children showed the highest risk for future injuries, suggesting that these characteristics make them more likely to be involved in novel and potentially dangerous situations.

Association of Parity and Previous Birth Outcome With Brachial Plexus Birth Injury Risk.

To evaluate the association of maternal delivery history with a brachial plexus birth injury risk in subsequent deliveries and to estimate the effect of subsequent delivery method on brachial plexus birth injury risk. We conducted a retrospective cohort study of all live-birth deliveries occurring in California-licensed hospitals from 1996 to 2012. The primary outcome was recurrent brachial plexus birth injury in a subsequent pregnancy. The exposure was delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering a neonate with brachial plexus birth injury). Multiple logistic regression was used to model adjusted associations of delivery history with brachial plexus birth injury in a subsequent pregnancy. The adjusted risk and adjusted risk difference for brachial plexus birth injury between vaginal and cesarean deliveries in subsequent pregnancies were determined, stratified by delivery history, and the number of cesarean deliveries needed to prevent one brachial plexus birth injury was determined. Of 6,286,324 neonates delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a brachial plexus birth injury. Higher parity was associated with a 5.7% decrease in brachial plexus birth injury risk with each subsequent delivery (adjusted odds ratio [aOR] 0.94, 95% CI 0.92-0.97). Shoulder dystocia or brachial plexus birth injury in a previous delivery was associated with fivefold (0.58% vs 0.11%, aOR 5.39, 95% CI 4.10-7.08) and 17-fold (1.58% vs 0.11%, aOR 17.22, 95% CI 13.31-22.27) increases in brachial plexus birth injury risk, respectively. Among individuals with a history of delivering a neonate with a brachial plexus birth injury, cesarean delivery was associated with a 73.0% decrease in brachial plexus birth injury risk (0.60% vs 2.21%, aOR 0.27, 95% CI 0.13-0.55) compared with an 87.9% decrease in brachial plexus birth injury risk (0.02% vs 0.15%, aOR 0.12, 95% CI 0.10-0.15) in individuals without this history. Among individuals with a history of brachial plexus birth injury, 48.1 cesarean deliveries are needed to prevent one brachial plexus birth injury. Parity, previous shoulder dystocia, and previously delivering a neonate with brachial plexus birth injury are associated with future brachial plexus birth injury risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding brachial plexus birth injury risk and planned mode of delivery.

Abstract P3100: Mice Lacking S-nitrosoglutathione Reductase (gsnor -/- ), A Mouse Model Of Preeclampsia, Exhibit Increases In Oxidative And Nitrosative Stress And Deterioration Of Cardiovascular Structure And Function In The Mother Postpartum.

Introduction: Preeclampsia (PE), a leading cause of maternal mortality, is linked to persistent pathological changes in the heart, predisposing the mother to increased risk of chronic cardiovascular (CV) disease later in life. PE is characterized by increased S-nitrosylated (SNO) proteins and nitrosative stress. We recently showed that mice lacking S-nitrosoglutathione reductase (GSNOR -/ - mice), a denitrosylase that regulates protein S-nitrosylation, exhibit the clinical features of PE including maternal hypertension, blunted increase in cardiac output, abnormal remodeling of left ventricular (LV) cardiac structure, dysregulation in nitrosylation and increased nitrosative stress. We hypothesize that the aberrant nitrosylation and nitrosative stress seen during pregnancy persist postpartum (PP), leading to increased maternal susceptibility to CV injury. Methods: Pregnant control (WT [C57Bl/6J]) and GSNOR -/- mice (N=5) were examined at baseline, late-stage pregnancy (17.5 dpc) and 6 weeks PP. LV structure, cardiac output and stroke volume were determined using echocardiography (Vevo 2100). Cardiomyocytes (CM) were isolated at 6 weeks PP and ROS and peroxynitrite levels determined using fluorescent dyes. Results: In WT mice, all normal maternal CV adaptions to pregnancy, reverted to pre-pregnant levels 6 weeks PP. In contrast, GSNOR -/- mice exhibited increased cardiac output (+21% vs. -19% in WT), stroke volume (+21% vs. -41% in WT), and LV chamber dimension (+13% vs. -4% in WT) at 6 weeks PP, indicating high cardiac output LV cardiomyopathy. CM isolated from GSNOR -/- hearts showed ~5-fold more ROS generation (9.9x10 -4 ±9x10 -5 vs. 2.1x10 -4 ±1.5 x10 -4 ΔF/F max .min -1 ) and elevated peroxynitrite levels (0.318±0.011 vs. 0.243±0.012 ΔF/F 0 ) compared to WT at 6 weeks PP, suggesting the presence of oxidative and nitrosative stress. All changes P&lt;0.05. Conclusion: Postpartum GSNOR -/- (preeclamptic) mothers exhibited cardiac dysfunction characterized by high cardiac output LV cardiomyopathy, which was accompanied by elevated levels of oxidative and nitrosative stress. These changes may predispose the mother to higher risk for future CV injury.

The Functional Movement Screen: Exploring Interrater Reliability between Raters in the Updated Version.

The Functional Movement Screen™ (FMS™) was updated by adding the ankle clearing test and modifying the rotary stability movement pattern and scoring criteria. This updated FMS™ may be used to support clinical decisions for the well-being of athletes and active adults. The purpose of this study was to determine if the updated FMS™ has acceptable interrater reliability, so that various practitioners can utilize it with their patients. Observational Laboratory Study. Two licensed Physical Therapists (PTs) conducted the testing for the study. No warmup was allowed for the participants. Each participant underwent one FMS™ session while being recorded on video lasting approximately 15 minutes. Participants were allowed three attempts to complete each movement pattern with the best score recorded. The participants, 45 healthy active PT students, were taken through the FMS™ by a licensed PT and videotaped. The raters were four second-year PT students that observed and scored the FMS independently after videotaping was completed. SPSS was used for the interrater reliability analysis. ICC was calculated using a 2-way mixed model looking for absolute agreement. The interrater reliability was highest for the rotary stability test (ICC 0.96) while the deep squat was the least reliable (ICC 0.78). The total scores showed excellent reliability among the four student raters with an ICC of 0.95. The updated FMS™ produced good to excellent interrater reliability. The updated FMS™ has acceptable interrater reliability between minimally, but adequately trained individuals. The updated FMS™ may be reliably used to assess risk for future injury. 3.