Potential Injury Risk Research Articles

Evaluation of a Novel Dry Powder Surfactant Aerosol Delivery System for Use in Premature Infants Supported with Bubble CPAP.

Aerosolized lung surfactant therapy during nasal continuous positive airway pressure (CPAP) support avoids intubation but is highly complex, with reported poor nebulizer efficiency and low pulmonary deposition. The study objective was to evaluate particle size, operational compatibility, and drug delivery efficiency with various nasal CPAP interfaces and gas humidity levels of a synthetic dry powder (DP) surfactant aerosol delivered by a low-flow aerosol chamber (LFAC) inhaler combined with bubble nasal CPAP (bCPAP). A particle impactor characterized DP surfactant aerosol particle size. Lung pressures and volumes were measured in a preterm infant nasal airway and lung model using LFAC flow injection into the bCPAP system with different nasal prongs. The LFAC was combined with bCPAP and a non-heated passover humidifier. DP surfactant mass deposition within the nasal airway and lung was quantified for different interfaces. Finally, surfactant aerosol therapy was investigated using select interfaces and bCPAP gas humidification by active heating. Surfactant aerosol particle size was 3.68 µm. Lung pressures and volumes were within an acceptable range for lung protection with LFAC actuation and bCPAP. Aerosol delivery of DP surfactant resulted in variable nasal airway (0-20%) and lung (0-40%) deposition. DP lung surfactant aerosols agglomerated in the prongs and nasal airways with significant reductions in lung delivery during active humidification of bCPAP gas. Our findings show high-efficiency delivery of small, synthetic DP surfactant particles without increasing the potential risk for lung injury during concurrent aerosol delivery and bCPAP with passive humidification. Specialized prongs adapted to minimize extrapulmonary aerosol losses and nasal deposition showed the greatest lung deposition. The use of heated, humidified bCPAP gases compromised drug delivery and safety. Safety and efficacy of DP aerosol delivery in preterm infants supported with bCPAP requires more research.

Injuries in French High-Level and National-Level Women Artistic Gymnastics: One-Year Prevalence and Associated Factors

Objective: The aims of this study were (1) to determine the one-year prevalence of injuries and their characteristics and (2) to analyze potential injury risk factors in high-level/national-level women artistic gymnasts. Methods: Competitive women artistic gymnasts training more than 10 h per week in a national training center and a TOP 12 club in France were invited to participate in a retrospective study through an online questionnaire about their self-reported injuries and potential injury risk factors (e.g., previous injuries, diseases, weight modification) during the 2020/2021 season. Results: A total of 88 gymnasts between 9 and 23 years old, who trained on average 22.0 ± 6.2 h per week, answered the questionnaire. Ninety-five injuries were reported by 62 (70.5%) of the 88 gymnasts. The one-year injury prevalence was 70.5% (95% CI 60.9 to 80.0%). Gymnasts had, on average, 1.1 ± 1.0 injuries per year. The most common reported injury location was the knee (25.3%), and the most common reported injury type was the ligament (26.3%). Having an injury during the previous season (OR = 9.06; CI 95% 2.66 to 36.73; p = 0.0007) and using a prevention program (OR = 3.97; CI 95% 1.46 to 11.15; p = 0.007) were associated with a higher risk of injury in the multivariate analysis. Conclusions: More than 70% of French high-level/national-level gymnasts had at least one injury during the 2020/2021 season. This high injury rate supports the need to promote injury prevention. However, in the present study, using a prevention program was associated with a higher risk of injury. There is thus a need to improve injury prevention strategies to counter the high injury risk and its potential consequences.

Effects of High-Speed Training on Messenger RNA Expression in Two-Year-Old Thoroughbred Racehorses.

Accumulating high-speed exercise has been identified as a significant risk factor for catastrophic injuries in racing Thoroughbreds. Injuries, regardless of severity, are a main cause of withdrawal from the racing industry, raising animal welfare concerns and resulting in significant economic losses. While most of the current literature focuses on injuries incurred during racing rather than training, the present study aims to help fill this gap. As such, peripheral blood was collected weekly, prior to exercise or administration of medication, from eighteen, two-year-old Thoroughbreds throughout their first season of race training. Messenger RNA (mRNA) was isolated and used to analyze the expression of 34 genes via RT-qPCR. Statistical analysis of the noninjured horses (n=6) showed that 13 genes were significantly correlated with increasing average weekly high-speed furlong performance. Additionally, there was a negative correlation for CXCL1, IGFBP3, and MPO with both cumulative high-speed furlongs and week of training for all horses. Comparison of both groups showed opposing correlations between the anti-inflammatory index (IL1RN, IL-10, and PTGS1) and average weekly high-speed furlong performance. Furthermore, evaluation of training effects on mRNA expression during the weeks surrounding injury, showed differences between groups in IL-13 and MMP9 at -3 and -2 weeks prior to injury. While some previously reported relationships between exercise adaptation and mRNA expression were not noted in this study, this may have been due to the small sample size. Several novel correlations, however, were identified and warrant further investigation as markers of exercise adaptation or potential risk for injury.

Technology For Screening Potency Risk Hamstring Strain Injury (HIS) Through Muscle Strength Test: Systematic Review

Athlete own risk more injuries many compared to common people. The hamstring muscle is part important body used for running, jumping, and kicking. Required a technology that can measure hamstring strength and help the rehabilitation process. Nordbord is one of the technology available measure strength maximal, average, hamstring asymmetry with accurate and objective. Purpose from use Nordbord as test hamstring muscles for measure, improve, train, and prevent potency risk hamstring injury. Study this use method Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Search the resources needed using an electronic site search program as Spingerlink, Emerald, Google Scholar, PubMed, and ScienceDirect with time rise with range 6 years time last (2016 – 2022). Criteria inclusion, study about screening potency risk injury ACLs and HIS with Nordbord. and criteria exclusion, only abstract, articles that do not published in a journal scientific. The result of this study is the Nordbord muscle strength test could be used to measure the power of the Nordic hamstring (eccentric) in a maximum manner with the formula (N) = 4 x BM (kg) + 26.1 and isometric, the more asymmetry results in a high potential injury risk. Keywords: Hamstring, asymmetry, muscle strength test, eccentric.

FTP1.9 Two-Stage flexor tendon repair versus Primary repair: An evaluation of subjective and functional outcomes at a Regional Centre for Plastic Surgery

Abstract Aims The hand, as the primary executing organ, is at the centre of nearly all daily activities. In the anatomical extremity, the hand is frequently exposed to the potential risk of injury. If a flexor tendon is injured and recognized as needing surgical intervention, two main options are available; Two-stage Flexor Tendon (TSFT) repair or Primary repair. We evaluated the subjective and functional outcomes of the two surgical methods described above in patients presenting with flexor tendon injury in Zone I or II over a 5-year period. Methodology A retrospective study employing 35 patients (and a total of 42 tendon injuries) requiring TSFT repair over a 5-year period and 190 patients requiring primary flexor tendon repair between 2012-2014. Data collected included patient demographics, injury details, intraoperative findings and post-operative outcomes. Results Of the 35 digital injuries assessed, 15.8% had a good outcome, 21.1% with a fair outcome and 63.2% with a poor outcome, based upon the Strickland grading system. In comparison, of those undergoing primary flexor tendon repair, 51.5% had a good / Excellent outcome, leaving 48.5% with a poor outcome. Rupture rates post-surgery were higher in those undergoing TSFT repair than primary repair; 23.8% versus 12.0% respectively. Conclusion A damaged flexor tendon requiring surgery should ideally be repaired within 72 hours of initial insult via primary repair. Delayed presentation and subsequent scar formation with proximal stump retraction warrants a two-stage approach. It is widely accepted that a reconstruction in two-stages can yield effective results in restoring digital function, but these results are often superseded by a primary repair.

Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery-A Review of Current Concepts and Perspectives.

The devastating impact of a circumflex coronary artery (CX) injury during mitral valve (MV) surgery is well reported. Despite significant improvements in preoperative risk assessment, intraoperative diagnosis and perioperative treatment strategies of CX injury during MV surgery, recent reports re-emphasize the variability in presentation, the unpredictable mechanisms of injury and the conflicting evidence regarding perioperative management. The progressive transition from conventional sternotomy access to minimally invasive surgical and transcatheter (TC) interventions for MV disease are associated with significant learning curves and require additional single-shaft and robotic console suture manipulation skills with special attentiveness to the potential risk of CX injury. The introduction of hybrid theatres that facilitate single stage surgical and TC interventions also provides new intraoperative diagnostic and therapeutic options without transporting unstable patients for percutaneous coronary intervention (PCI) assessment. By utilizing a MeSH terms-based PubMed search, a total of 89 patients with CX injury that occurred during MV surgery was identified from 49 reports between 1967 and 2022. MV surgery was performed by conventional sternotomy (n = 76, 85.4%), endoscopic (n = 12, 13.4%) and robotic access (n = 1, 1.1%), with 35 injuries (39.3%) resulting in total CX occlusion. Rescue PCI was utilized in 40 patients (44.9%). This manuscript provides a systematic overview of all available historic and contemporary reports on CX injury during MV surgery, outlines recent refinements in CX injury mechanisms, describes current MV surgery associated CX injury prevention and diagnosis and treatment strategies and highlights important MV procedural aspects that may minimize the risk and consequences of CX injury.

Effect of stride length on the running biomechanics of healthy women of different statures.

Tibial stress fracture is a debilitating musculoskeletal injury that diminishes the physical performance of individuals who engage in high-volume running, including Service members during basic combat training (BCT) and recreational athletes. While several studies have shown that reducing stride length decreases musculoskeletal loads and the potential risk of tibial injury, we do not know whether stride-length reduction affects individuals of varying stature differently. We investigated the effects of reducing the running stride length on the biomechanics of the lower extremity of young, healthy women of different statures. Using individualized musculoskeletal and finite-element models of women of short (N = 6), medium (N = 7), and tall (N = 7) statures, we computed the joint kinematics and kinetics at the lower extremity and tibial strain for each participant as they ran on a treadmill at 3.0m/s with their preferred stride length and with a stride length reduced by 10%. Using a probabilistic model, we estimated the stress-fracture risk for running regimens representative of U.S. Army Soldiers during BCT and recreational athletes training for a marathon. When study participants reduced their stride length by 10%, the joint kinetics, kinematics, tibial strain, and stress-fracture risk were not significantly different among the three stature groups. Compared to the preferred stride length, a 10% reduction in stride length significantly decreased peak hip (p = 0.002) and knee (p < 0.001) flexion angles during the stance phase. In addition, it significantly decreased the peak hip adduction (p = 0.013), hip internal rotation (p = 0.004), knee extension (p = 0.012), and ankle plantar flexion (p = 0.026) moments, as well as the hip, knee, and ankle joint reaction forces (p < 0.001) and tibial strain (p < 0.001). Finally, for the simulated regimens, reducing the stride length decreased the relative risk of stress fracture by as much as 96%. Our results show that reducing stride length by 10% decreases musculoskeletal loads, tibial strain, and stress-fracture risk, regardless of stature. We also observed large between-subject variability, which supports the development of individualized training strategies to decrease the incidence of stress fracture.

Evaluation of Renoprotective Effect of Lipoic Acid and Bosentan Against Diclofenac-Induced Acute Renal Failure

Acute renal failure also known as acute kidney injury (AKI) is a complex health condition related to significant morbidity and mortality. In hospitalized patients, around 19-33 percent of AKI episodes are linked to drug induced nephrotoxicity. Although considered safe, NSAIDs such as diclofenac have gained special attention over the past few years due to the potential risk of renal injury. The direct effect of diclofenac-induced renal injury depends on targeting the mitochondria in kidney tissue, and formation of reactive oxygen species (ROS) resulting in oxidative stress. Secondly, diclofenac inhibit renal prostaglandin production, limiting renal afferent arteriole vasodilation, increasing afferent resistance; thus decreasing the glomerular capillary pressure below normal values and glomerular filtration rate will decrease resulting in AKI. Alpha-Lipoic acid (ALA) has beneficial effects in prevention or relief of symptoms of oxidative stress- related diseases, as it acts as antioxidant and anti-inflammatory micronutrient. Bosentan is a competitive antagonist with dual endothelin-1 receptors, as renal vascular ET-1 system is upregulated under many pathophysiological situations. In present study, we investigated the effect of lipoic acid and bosentan in diclofenac induced acute renal failure in male rats.&#x0D; We observed that diclofenac increased serum levels of urea, creatinine, malondialdehyde, KIM-1, TGFβ1 and fibronectin significantly (p&gt;0.05) in the induction group compared to control group. While, SOD significantly (p&gt;0.05) reduced in the induction group compared to control group. Both of lipoic acid and bosentan alone didn’t significantly protect against diclofenac induced AKI. However, the combination group showed a significant protection against AKI. Pearson correlation analysis showed a significant positive correlation between (urea and KIM-1) and between (creatinine and KIM-1) (r2=0.792 and r2=0.677 respectively). Furthermore, there was a significant positive correlation between fibronectin and urea (r2= 0.498, p&gt;0.01) and fibronectin and creatinine (r2=0.356, p&gt;0.05). Interestingly, KIM-1 showed a significant positive correlation with fibronectin (r2=0.536, p&gt;0.01).&#x0D; ROC curve test was performed for KIM-1 and fibronectin biomarkers. The AUC for KIM-1 was 0.986 and for fibronectin was 0.829. We concluded that combination therapy of lipoic acid and bosentan showed a significant protective effect against diclofenac-induced AKI. In addition, fibronectin could be a promising biomarker for detection and diagnosis of acute kidney injury.&#x0D; Key words: Diclofenac, oxidative stress, alpha- lipoic acid, endothelin-1, bosentan

Heavy Metals in the Striped Snakehead Murrel Channa striata and Sediments of Lake Mainit Philippines with Notes on Piscine Micronuclei Occurrence

Lake Mainit is the deepest lake in the Philippines, with sporadic documentation of various types of aquatic pollution. This paper reports the heavy metal content in the muscles of the striped snakehead murell Channa striata and bottom sediments from five stations across Lake Mainit using quadrupole-inductively coupled plasma-mass spectrometry (Q-ICP-MS). The micronuclei (MN) formation in erythrocytes of C. striata was also assessed for potential genotoxicity. The relative order of the average concentrations of heavy metals in C. striata samples across all stations is Zn&gt;Cu&gt;Cr&gt;Ni&gt;As&gt;Pb&gt;Cd. As per international safety standards, fish muscle samples across all stations have exceeded the permissible limits of Cu, Ni, and Zn, which has implications for health risks in humans consuming this important fish commodity. The relative order of the concentrations of heavy metals in sediments is Cr&gt;Ni&gt;Cu&gt;Zn&gt;As&gt;Pb&gt;Cd, where Cr, Ni, Cu, Pb, and Zn exceeded safety standards. The MN assay revealed that 98% of the erythrocytes assessed (N=147,000 RBCs) have normal cell morphology. Of the 2% of erythrocytic nuclear alterations (ENAs), 55% are found to be fragmented-apoptotic cells, while 31% are elongated or reshaped. The MNs in C. striata are relatively minimal at 2%. While the MN assay implies that C. striata from Lake Mainit are not at risk for potential genotoxic injury, the present study calls for seasonal monitoring for heavy metals in sediments and other fishery resources in Lake Mainit.

Poster 265: The Risk of Iatrogenic Posterior Neurovascular Injury in Lateral Meniscal Repair Based on Real Arthroscopic Position: An MRI Study

Objectives: Posterior horn of lateral meniscal repair using an all-inside meniscal repair device involves a risk of iatrogenic posterior neurovascular injury. Some studies have evaluating the injury risk in this area but most were based on preoperative MRIs and landmarks which are difficult to clearly see under actual arthroscopic surgery. To our knowledge, there have been no studies to date evaluating the risk of injury based on MRIs with the knee in the standard operational figure-of-4 position with joint dilatation in arthroscopic lateral meniscal repair related to the lateral border of the lateral meniscal root which is easy to identify during surgery. The objective of this study was to evaluate and compare the risk of posterior neurovascular injury and establish the safe and danger zones in repairing the lateral meniscus through the anterolateral and anteromedial portals in relation to the medial and lateral borders of the lateral meniscal root (LMR) using standard operational figure-of-4 position with joint dilatation MRIs. Methods: This study was descriptive laboratory study. Using 29 axial magnetic resonance imaging (MRI) studies of knees in the figure-of-4 position with joint fluid dilatation at the level of the lateral meniscus, direct lines were drawn to simulate a straight all-inside meniscal repair device deployed from the anteromedial and anterolateral portals to the medial and lateral borders of the LMR extending 14 mm beyond the joint capsule. If the line passed through or touched the posterior neurovascular structure, a risk of iatrogenic injury was noted, and measurements were made to determine the safe zones in relation to the medial or lateral border of the LMR. Results: Repairing the lateral meniscus through the anterolateral portal in relation to the lateral border of the LMR had a significantly greater risk of posterior neurovascular injury than repairing through the anteromedial portal, of which the incidences were 68.97% and 10.35%, respectively (p-value = 0.001). The “safe zones” of lateral meniscal repair in relation to the lateral border of the LMR through the anterolateral and anteromedial portals were 4.15 ± 1.87 mm and 6.57 ± 0.98 mm lateral to the lateral border of the LMR, respectively. Conclusions: Our study found a risk of iatrogenic posterior neurovascular injury when repairing the posterior lateral meniscus tissue through both the anterolateral and anteromedial portals in relation to both the lateral and medial borders of the LMR, with repairs through the anterolateral portal having greater risk than through the anteromedial portal. To reduce this risk, the surgeon can use the “safe zones” as described in this study to decrease the potential risk of iatrogenic posterior neurovascular injury during arthroscopic lateral meniscal repair. Clinical Relevance: Iatrogenic injury is always a concern in any surgery, and the results of this study can be a guide to reducing iatrogenic posterior neurovascular injury during posterior horn of lateral meniscal repair.

Assessment of Perceived Factors of Road Safety in Rural Left-Behind Children’s Independent Travel: A Case Study in Changsha, China

The disparity between urban and rural development in China has resulted in the significant migration of rural laborers to urban areas, giving rise to a growing population of left-behind children in rural areas. The number of accidental injuries among these children traveling independently is increasing, suggesting that road safety in rural areas should be of concern. This study explored factors affecting road safety for left-behind rural children traveling independently. The data were collected from a survey conducted in four villages in Changsha, China. The study used a variety of methods, including spatial syntax, linear regression analysis, Pearson correlation analysis, and stepwise regression analysis, to analyze factors affecting road safety for rural left-behind children traveling independently. The study revealed significant differences in road safety perceptions among rural left-behind children and their guardians. Road safety perceptions were significantly higher for left-behind children. Factors such as plant density, turning angle, road scale, road slope, recognizable signs, internal corner space, animal danger, enclosure type, electronic tools, monitoring facilities, strangers, and social concerns were found to be significantly related to road safety perceptions of left-behind children traveling independently. The findings suggested that left-behind children who travel independently in rural areas face a potential risk of accidental injuries. These results can be used by decision makers to improve the rural road environment and to provide useful assistance for the healthy growth of left-behind children.

Supporting the Safe Use of the Dorsogluteal Intramuscular Injection Site: An Evidence-Based Quality Improvement Project.

Administering intramuscular (IM) injections is common in the adult mental health patient care setting, using the deltoid, vastus lateralis, ventrogluteal, or dorsogluteal site. Mental health nurses frequently use the dorsogluteal site to administer short and long-acting IM injections as specified in the drug package insert or because of patient agitation. However, the site is often not recommended due to the potential risk of nerve injury. Aims of this evidence-based quality improvement project were to (1) determine the best evidence for supporting the safe use of the dorsogluteal site for short and long-acting IM injections and (2) implement this evidence through nurse education. This project had two phases: Determining best evidence through an integrative literature review and implementing the recommendations to use the dorsogluteal site when directed by the drug package insert, clinical need, nursing judgment, or patient preference. Implementation followed the Plan-Do-Study-Act quality improvement process and involved written resources and simulation. Evidence supported the use of the dorsogluteal site in four instances and the importance of education. Nurses were highly satisfied with the education and opportunity to practice their skills with feedback during return demonstration. After studying nurses' follow-up survey results, a refresher simulation and medical center guideline were completed. There were no reports of IM injection patient injuries after 2 years and approximately 768 dorsogluteal and ventrogluteal IM injections in the academic medical center. Pursuing recent and possibly overlooked evidence provided guidance in supporting the safe use of the dorsogluteal site for IM injections.

Clinical value of fluorescent cholangiography for the infraportal type of right posterior bile duct

Background The infraportal type of the right posterior bile duct (infraportal RPBD) is a well-known anatomical variation that increases the potential risk of intraoperative biliary injury. The aim of this study is to clarify the clinical value of fluorescent cholangiography during single-incision laparoscopic cholecystectomy (SILC) for patients with infraportal RPBD. Material and methods Our procedure for SILC utilized the SILS-Port, and another 5-mm forceps was inserted via an umbilical incision. A laparoscopic fluorescence imaging system developed by Karl Storz Endoskope was utilized for fluorescent cholangiography. Between July 2010 and March 2022, 41 patients with infraportal RPBD underwent SILC. We conducted retrospective reviews of patient data, focusing on the clinical value of fluorescent cholangiography. Results Thirty-one patients underwent fluorescent cholangiography during SILC, but the remaining ten did not. Only one patient who did not undergo fluorescent cholangiography developed an intraoperative biliary injury. The detectability of infraportal RPBD before and during the dissection of Calot’s triangle was 16.1% and 45.2%, respectively. These visible infraportal RPBDs were characterized as connections to the common bile duct. The confluence pattern of infraportal RPBD significantly influenced its detectability during the dissection of Calot’s triangle (p < 0.001). Conclusions The application of fluorescent cholangiography can lead to safe SILC, even for patients with infraportal RPBD. Its benefit is emphasized when infraportal RPBD is connected to the common bile duct.

Repurposing Spinal Distractor to Reduce Pediatric Wrist Fractures.

Fracture geometry, particularly a jagged bone spike, can present a physical barrier in closed reduction of pediatric distal radius-ulna fractures. When closed reduction of the fracture is not possible, accepting an incomplete reduction and hoping for remodeling, or open reduction, which poses a greater risk for infection and potential physeal injury, are alternative treatment options. The objective of this study was to describe a technique, coined as Percutaneous Skeletal Traction Aided Reduction (P_STAR), for reducing these fractures, thereby eliminating the acceptance of an incomplete reduction and the risks associated with open reduction. In P_STAR, 2 distraction pins are placed 1.5cm proximal and distal to the fracture site in clearance of the distal radial physis. A shadow-line spinal distractor is then used to distract the pins, reducing the fracture over the irregular impeding fracture geometry. After distraction is released, 1 or 2 K-wires can be percutaneously inserted to transfix the fracture. A video of the technique was also included as Supplemental Digital Content, http://links.lww.com/BTH/A188. When performed on 18 children with distal radius-ulna fractures, P_STAR achieved near anatomic fracture alignment with no nerve or tendon injury, infection, or refracture.

Blood Flow Restriction Exercise for Successful Aging

PURPOSE: Generally, an increase in life expectancy is accompanied by various geriatric diseases. However, there is a possibility that geriatric diseases can be prevented and improved through exercise. Exercise is recommended for older adults, but high-intensity exercise (HIE) increases the risk of potential injury. Therefore, blood flow restriction exercise (BFRE) is attracting attention as an alternative for older people who cannot perform HIE. However, mechanisms underlying the physiological effects and benefits of BFRE in older adults have not yet been fully elucidated. This study aimed to summarize the effects of BFRE on aging-related physiological changes and examine its applicability as an effective intervention for successful aging.METHODS: A literature search of electronic databases, including PubMed, Web of Science, and Google Scholar, was conducted for literature published between January 1, 2000, and December 31, 2022.RESULTS: BFRE can effectively increase muscle mass and strength in older adults. Chronic BFRE improved blood pressure, vascular function, and arterial compliance. Although BFRE did not induce changes in bone mineral density (BMD) and cognitive function, positive effects were shown by increasing bone formation markers and neurotrophic factors expression. Relatively, the risk of side effects of BFRE was very low, and even older patients with cardiovascular diseases appeared to have no risk.CONCLUSIONS: This review confirms that BFRE can be an effective and safe intervention to increase muscle mass and strength and improve cardiovascular function. Moreover, BFRE can potentially improve BMD and cognitive function in older adults. In conclusion, BFRE can be an effective intervention for successful aging; additional follow-up studies are needed.

Physical Differences between Injured and Non-Injured Elite Male and Female Futsal Players

Futsal is one of the most harmful sports due to its great physical demands. The asymmetries have been proposed as one of the most important risk factors of suffering an injury. However, no study has analysed the relationship between neuromuscular assessment and its implication on the likelihood of suffering injuries comparing male and female players. The purpose of the study was to analyse the physical fitness differences between elite futsal players (both male and female) who suffered an injury in the following four months after being evaluated with those who did not suffer the injuries. Twenty-six and twenty-two male and female elite futsal players were recruited from four different teams and underwent an evaluation of different neuromuscular assessments (isometric hip abduction and adduction peak torque, flexion-rotation trunk test, hop test, countermovement jump (CMJ), drop vertical jump (DVJ), leg stiffness, 15 m sprint, Y-balance test, and Illinois test) that have been considered potential sport-related injury risk factors during the pre-season. Statistical analysis only showed differences between injured and non-injured players in isometric hip adduction strength and unilateral ratio for the non-dominant leg (p &lt; 0.05). Neuromuscular performance scores showed significant differences (p &lt; 0.001) between male and female futsal players in several variables (hip abduction non-dominant leg, hops, CMJ, DVJ, leg stiffness, sprint, and Illinois test) but not in ratio or asymmetry. Isometric hip adduction and abduction–adduction unilateral ratio deficits for the non-dominant leg might be an important factor toward suffering an injury. Male and female futsal players showed different neuromuscular performances and consequently different training programs should be implemented for them.

The effect of prolonged 60° head of bed elevation on sacral subepidermal oedema in healthy adults: A quantitative prospective exploratory study.

Head of bed elevation is used to manage some medical and surgical conditions however this may increase a patient's risk of sacral pressure injuries. Novel point-of-care technologies that measure subepidermal moisture can identify changes in localised subepidermal oedema and potential pressure injury risk. This prospective exploratory study investigated variations in sacral subepidermal oedema in healthy adults during 120-min of 60° head of bed elevation. Sacral subepidermal oedema was measured at 20-min intervals using the Provisio® subepidermal moisture scanner. Descriptive analysis, one-way repeated measures analysis of variance and an independent t-test were conducted. Slightly more male volunteers (n = 11; 55%) were recruited and the sample mean age was 39.3 years (SD 14.7) with an average body mass index of 25.8 (SD 4.3). Little variation in the mean sacral subepidermal moisture of healthy adults was observed. There was a statistically significant difference in the mean sacral subepidermal moisture measurements between males and females (Mean difference 0.18; 95% confidence intervals: 0.02 to 0.35; P = .03). Healthy adults can tolerate prolonged 60° head of bed elevation without developing increased subepidermal sacral oedema. This warrants further investigation in other populations, in various positions and over different time periods.

Low level mancozeb exposure causes copper bioaccumulation in the renal cortex of rats leading to tubular injury

Mancozeb is a widely-used, broad-spectrum contact dithiocarbamate fungicide. Dithiocarbamates are known to trans-chelate metals. This study was designed to evaluate the potential of Mancozeb to mobilize and bioaccumulate essential trace metals in various tissues. Long-Evans rats were orally gavaged with 0, 50, or 100 mg/kg/day of Mancozeb for 28 days. Mancozeb caused a significant increase in copper and manganese in the hippocampus and manganese in the liver. Exceedingly higher level of copper was detected in the renal cortex using ICP-OES in both dose groups. This was confirmed histologically in the tubular epithelial cells. In addition, copper-associated protein levels were also increased. Copper bioaccumulation in the renal cortex was accompanied by oxidative damage and tubular insult indicated by increased 4-HNE, KIM-1, and NGAL immunoreactivity. These findings demonstrate that low-dose Mancozeb exposure is a potential risk for kidney injury due to copper overload and warrants further in vivo and human population-based investigations.

Management of adverse effects in hyperosmolar therapy of brain edema

Background: Mannitol and hypertonic saline are the most frequently used hyperosmolar agents to treat cerebral edema resulting from acute brain injury. However, there are several issues with using hyperosmolar therapies. Here, we focus on the potential adverse effects of hyperosmolar therapies and practical tips to overcome these issues in the neurointensive care unit.Current Concepts: Among the hyperosmolar agents used, mannitol may decrease intravascular volume and pose a potential risk of acute kidney injury for patients. Complications associated with using hypertonic saline include the risk of central pontine myelinolysis, coagulopathy, electrolyte imbalances, metabolic acidosis, and pulmonary edema. In addition, prolonged use of hypertonic saline increases the risk of hyperchloremic metabolic acidosis, which may be overcome with the concomitant use of sodium acetate.Discussion and Conclusion: Several laboratory variables were monitored in the neurointensive care unit to limit and possibly detect early complications related to hyperosmolar therapies. When using hyperosmolar agents, including mannitol and hypertonic saline, for therapeutic purposes in patients with cerebral edema, determining whether to use peripheral or central lines and determining the appropriate rate and infusion dose can minimize their adverse effects. Clinicians need to be aware of the potential adverse events of administering hyperosmolar agents.

P-085 LAPAROSCOPIC TAP BLOCK

Abstract Aim To test the effectiveness of the laparoscopic control-assisted TAP Block technique. Material and methods we performed an infiltration with 30 ml of 5% Ropivacaine, 5 ml in 3 punctures on each side of the abdomen. The transverse muscle is identified by laparoscopy, lateral to the semilunar line, 3 points are infiltrated with an intramuscular needle, visualizing the tip without crossing the peritoneum and withdrawing 2–3 mm until it is above the transverse muscle. Results TAP Block improves postoperative pain, requiring lower doses of opioids and allowing faster recovery. No significant differences are observed in the VAS scale compared to the ultrasound control technique, but it does take less time and avoids any type of visceral injury due to laparoscopic control. Conclusions Laparoscopic Block TAP is equally effective in postoperative pain control as part of multimodal analgesia as performed under ultrasound control, with the advantages of reducing anesthetic time and minimizing the potential risk of visceral injury.