Risk Of Injury Research Articles

Kiteboarding Injuries: Epidemiology, Common Treatment Strategies, and Time to Return to Kiteboarding Following Injury.

To evaluate the prevalence and types of injuries incurred during kiteboarding (1), along with treatment approaches (2). In addition, the time to return to kiteboarding following injury (3) and factors associated with the rate and type of injury were analyzed (4). Recreational kiteboarding. Retrospective cohort. Three hundred twelve kiteboarders (280 men, 32 women, mean age 42.91 ± 13) were included in the study. Age, sex, experience, and the use of protective gear. Kiteboarding experience, injury location, type, incidence, nonsurgical and surgical treatment modalities, and return-to-kiteboarding data. The number of injuries calculated per 1000 sessions was a mean of 7.82 (4.83-10.81). Patients with less than 2 years of kiteboarding experience were at a greater risk of injury than more experienced kiters (P < 0.001). The knee (24.1%), ankle and foot (18.9%), ribs (12.7%), and shoulder (10.2%) were the body parts most frequently injured. Overall, 14.4% of kiters underwent surgical intervention, with knee surgery being the most common site of operation (41.9%) and the most frequently performed procedure being anterior cruciate ligament reconstruction. The pattern of reported injury was found to be different from that previously reported in the scientific literature among freeriding kiters, with knees, ribs, and shoulders being most frequently involved. Participants with <2 years of experience had a significantly greater risk of injury; therefore, proper technical and physical training is advisable.

Health status of senior netball players, their medication use and attitudes towards doping

Limited research exists on the health and injuries of South African senior netball players. Senior netball players may be at greater risk of injuries and chronic disease due to their age. To treat these conditions, they may use prescription and over-the-counter (OTC) medications and, therefore, may be more vulnerable to unintentional doping. The primary aim of this study was to determine the health status, medication use and attitudes towards doping of South African senior netball players. A cross-sectional descriptive design was employed to collect data by means of an online survey. The validated 8-item Performance Enhancement Attitudes Scale (PEAS) was used to gather information on the netball player's attitudes towards doping. Descriptive statistics were used to describe the data using proportions (categorical), means (normally distributed, continuous) and medians (non-normal distributed, continuous). Doping prevalence and accompanying 95% confidence interval were calculated. Sixty senior netball players consented and completed the self-report questionnaire. The prevalence of chronic disease was 11.67%. Asthma and other conditions such as depression and attention-deficit/hyperactivity (ADHD) had the highest prevalence of 3.33%. The prevalence of chronic prescription medication use was 8.33% and 66.67% of the netball players reported receiving prescription injections, medications or utilizing OTC medications for treating injury or illness suffered 1–6 weeks before or during competition. The netball players do not have a lenient attitude towards doping. The prescription and OTC medication use could put this cohort of netball players at risk of unintentional doping. Anti-doping education aimed at senior athletes may be beneficial to reduce the risk of unintentional doping due to prescription and OTC medication use for injury or illness.

Comparison of Inter-Rater and Intra-Rater Reliability of Raters with Different Levels of Experience When Using Landing Error Scoring System (LESS) in Field-Based Screening of Professional Football Players

It is essential for physical sports therapists to use reliable field-based tests to identify potential injury risk factors in athletes. The purpose of this study was to compare the inter- and intra-rater reliability of experienced and novice raters during use of the Landing Error Scoring System (LESS) in a field-based examination of professional football athletes. Thirty-seven male football athletes underwent pre-season LESS assessment. Two raters independently evaluated the recorded landing techniques at two separate intervals, two months apart, following the LESS standard protocol. Inter-and intra-rater values were calculated for the LESS total scores and individual scoring items. The overall LESS scores had excellent intra-rater reliability values for both the experienced (interclass correlation coefficient (ICC) = 0.95, 95% CI, 0.89–0.97; p &lt; 0.001) and novice rater (ICC = 0.95, 95% CI, 0.90–0.97; p &lt; 0.001), and very good to excellent inter-rater values for the first (ICC = 0.90, 95% CI, 0.77–0.95; p &lt; 0.001) and second (ICC = 0.86, 95% CI, 0.71–0.93; p &lt; 0.001) evaluation. Most of the individual scoring items ranged from moderate to perfect agreement. In conclusion, sports physical therapists, regardless of experience, can reliably use the LESS’s total score, through video analysis of the regime. Individual scoring items can inform clinicians about impairments in the landing mechanism but data should be interpreted cautiously.

Influence of the Beiring Sorenson Hold and the Barbell Back Squat on Running Cadence in Military Ruck Marching: A Cross-Sectional Observational Study

Ruck marching is a key performance indicator for tactical preparation; however, marching under load causes changes in biomechanics, which can increase injury risk. Although this risk of injury from changes is known, current methods commonly used for assessing physical fitness have not adequately identified how to minimize these changes. In this observational study, 14 ROTC cadets underwent a series of physical muscular fitness tests prior to performing a six-mile ruck march. These included an evaluation of postural endurance via the Biering Sorenson hold, lower body strength via the back squat, and upper body strength via bench press. After the tests were performed, ruck march performance was evaluated by total time to completion and running dynamics. Multiple regression analysis was performed to determine if bench press maximum, back squat maximum, or Sorenson hold were predictors of the performance of the ruck March. Average cadence shared a positive significant relationship with the Sorenson hold (r = 0.76, p = 0.02) and a negative significant relationship with the back squat (r = -0.76, p = 0.02). Additionally, the Sorenson hold did not share any significant relationships with total ruck time (r = -0.3, p = 0.29) or ground contact time (r = -0.41, p = 0.31). The back squat did not share significant relationships with ground contact time (r = -0.37, p = 0.37) or average smoothness (r = -0.38, p = 0.31). This study highlights the potential relationship that the Sorenson hold and back squat can have on running cadence, which has shown significant changes in previous research evaluating the changes in running performance and characteristics from weight ruck marching. Further investigation of the relationship of these assessments on the performance of ruck marching should be performed with larger numbers of cadets in the future.

Heat Attainment and Retention in Surfers with and without a Land-Based Warm-Up and Accompanying Passive Heat Retention

Surfing is a growing, high-participation recreational and competitive activity. It is relatively unique, being performed on, in, and through water with a range of temperatures. In other sports, warm-up and heat retention have proved useful at augmenting performance and ameliorating injury risk. Little work has been carried out examining this in surfing. The purpose of this work was to measure thermal profiles in surfers with and without warm-up and passive heat retention, and secondarily to assess any potential influence on free surfing. A repeated measures pre- and post- design was adopted whereby participants surfed in an artificial wave pool following an active warm-up combined with passive heat retention (experimental condition) and after no warm-up (control). Core body temperature was measured both occasions. Our results showed increases in core body temperature were greater for the experimental condition versus control (p = 0.006), and a time effect exists (p &lt; 0.001)—in particular, a warm-up effect in the water itself was shown in both groups, possibly due to further activity (e.g., paddling) and wetsuit properties. Finally, performance trended to being superior following warm-up. We conclude that body warmth in surfers may be facilitated by an active warm-up and passive heat retention. In free surfing, this is associated with a trend towards better performance; it may also reduce injury risk.

The role of secondary imaging in children aged under 24 months with proven skull fracture on initial computed tomography scan.

To assess the clinical significance of repeated head imaging in children with minor blunt force head trauma who underwent computed tomography (CT), limited to those who exclude with very low risk of important traumatic brain injury. We conducted a retrospective cohort study of children aged under 24 months with minor head trauma who underwent repeated head imaging and initial CT scans according to the Pediatric Emergency Care Applied Research Network (PECARN) rules. We enrolled 741 children and 110 with skull fracture (SF). Of the 96 patients with SF on initial CT who received head magnetic resonance imaging (MRI) a few days later, 36 (37.5%) patients' initial CT findings revealed intracranial injury in addition to SF. The number of children who exhibited new intracranial findings on follow-up MRI among those with isolated SF without intracranial damage and those with SF and intracranial injury on initial CT was 25/60 (40.7%) and 14/36 (38.9%), respectively. Subcutaneous hematoma on arrival and intersection with the coronal suture and lines of fracture were significantly associated with new intracranial findings. Four children with SF and intracranial injury on initial CT received neurosurgical intervention. No intervention was needed for those with isolated SF. We demonstrated that a proportion of children with head trauma had new findings on follow-up MRI, particularly in those without very low risk of clinically important traumatic brain injury. Patients who exhibit new intracranial MRI findings that satisfy the PECARN rules may not require neurosurgical intervention if their initial CT finding is isolated SF.

Uncovering the mechanisms of diosmin in treating obesity-related kidney injury based on network pharmacology, molecular docking, and in vitro validation.

Obesity increases the risk of kidney injury, involving various pathological events such as inflammation, insulin resistance, lipid metabolism disorders, and hemodynamic changes, making it a significant risk factor for the development and progression of chronic kidney disease. Diosmin, a natural flavonoid glycoside, exhibits anti-inflammatory, antioxidant, anti-lipid, and vasodilatory effects. However, whether diosmin has a protective effect on obesity-related kidney injury remains unclear. The molecular formula of diosmin was obtained, and diosmin and target genes related to obesity-related kidney injury were screened. The interaction between overlapping target genes was analyzed. GO functional enrichment and KEGG pathway enrichment analyses were performed on overlapping target genes. Molecular docking was employed to assess the binding strength between overlapping target genes. Palmitic acid-induced damage to HK-2 cells, which were then treated with diosmin. Subsequently, the expression levels of relevant mRNAs and proteins were measured. Network analysis identified 219 potential diosmin target genes, 6800 potential target genes related to obesity-related kidney injury, and 93 potential overlapping target genes. Protein-protein interaction networks and molecular docking results revealed that AKT1, TNF-α, SRC, EGFR, ESR1, CASP3, MMP9, PPAR-γ, GSK-3β, and MMP2 were identified as key therapeutic targets, and they exhibited stable binding with diosmin. GO analysis indicated that these key targets may participate in inflammation, chemical stress, and protein phosphorylation. KEGG revealed that pathways in cancer, AGE-RAGE signaling pathway, PI3K-AKT signaling pathway, PPAR signaling pathway, and insulin resistance as crucial in treating obesity-related kidney injury. CCK-8 assay showed that diosmin significantly restored the viability of HK-2 cells affected by palmitic acid. Oil Red O staining demonstrated that diosmin significantly improved lipid deposition in HK-2 cells induced by palmitic acid. PCR results showed that diosmin inhibited the mRNA levels of AKT1, TNF-α, EGFR, ESR1, CASP3, MMP9, GSK-3β, and MMP2 while promoting the mRNA level of PPAR-γ. Western blot analysis revealed that diosmin restored PPAR-γ protein expression, inhibited NF-kB p-p65 protein expression, and reduced TNF-α protein expression. Diosmin demonstrated multi-target and multi-pathway effects in the treatment of obesity-associated renal injury, with key targets including AKT1, TNF-α, EGFR, ESR1, CASP3, MMP9, PPAR-γ, GSK-3β, and MMP2. The mechanism may be through the modulation of the PPAR-γ/NF-κB signaling pathway, which can attenuate inflammatory responses and protect the kidney.

Analysis of Head Movement in KPSIT Dummies and the Impact of Seats and Seat Belts during Low-Speed Collisions 20 km/h

The aim of this study was to compare the head displacement of the KPSIT C50 dummy, representing a 50th percentile male, with the KPSIT C5 dummy, representing a 5th percentile female, during low-speed collisions. Low-speed collisions, such as those occurring in urban traffic jams, are increasingly common. The research was conducted on a dedicated educational workstation designed to measure forces in seat belts. This study is part of a comprehensive research project on crash tests involving both volunteers and physical KPSIT dummies. The tests were conducted at a speed of 20 km/h to simulate real-world low-speed collision scenarios. The findings demonstrate that using a sports bucket seat with four-point or five-point harnesses significantly reduces head displacement compared with standard car seats. Such seating configurations enhance safety by minimizing the risk of head injuries, which can occur when airbags do not deploy during low-speed collisions. Moreover, the study highlights that standard three-point seat belts allow for greater forward head movement, increasing the risk of head contact with the vehicle’s interior during collisions at speeds too low to trigger airbag deployment.

Shoulder Injury Incidence and Epidemiology in Youth, High School, and Collegiate Fastpitch Softball Players: A Systematic Review and Future Research Perspectives.

Fastpitch softball is one of the most popular sports in the United States among young female athletes. Softball players regularly subject their shoulders to extreme range of motion and high velocity movements. To date, no systematic review has reported on the epidemiology and incidence of shoulder injuries in softball players. To describe the incidence and epidemiology of softball-related shoulder injuries in youth, high school, and collegiate female softball players. PubMed, Web of Science, and Embase were searched for relevant English language articles from 1980 to 2023. Studies selected based on predefined inclusion criteria. Studies were required to be available full text, in English. Systematic review. Level 4. A preliminary screening was performed based on study title and abstract. In the subsequent screening, the full text versions of the remaining articles were evaluated by 2 reviewers for the fulfillment of the inclusion criteria. A total of 7 articles met criteria for inclusion. All studies evaluated injuries among softball players for at least 1 season. In total, there were 1107 softball-related shoulder injuries reported in the 7 studies included in this systematic review. Of the 3 studies that included a shoulder injury rate, a mean rate of 4.01 shoulder injuries per 10,000 athlete-exposures was calculated. The 2 most common shoulder injuries were shoulder muscle-tendon strains (297) and shoulder/biceps tendinitis (220). High-level prospective studies reporting injury incidence and risk factors among female softball players are extremely limited. Only 2 studies eligible for inclusion in this systematic review were prospective in nature, with neither of these reporting the specific injury rate for shoulder injuries among softball players.

Peran Kekuatan Perut dalam Meningkatkan Performa Tolak Peluru pada Atlet

The aim of this research is to determine the role of abdominal strength in improving shot put performance in athletes. This research uses a literature review method by collecting information by looking for relevant references and facts from journals and theses that have been previously researched. The literature is then compared and linked to provide an overview of the topic under study. Qualitative research is used as a type of research. This research explores the role of abdominal muscle strength in improving shot put performance in athletes. Shot put requires the right combination of strength, technique and coordination to achieve optimal results. One key element that is often overlooked is abdominal muscle strength or core strength. This research outlines how abdominal muscle strength contributes to body stability, efficient energy transfer, and optimization of shot put technique. Through literature analysis and research findings, it was concluded that integrated abdominal strength training in athlete training programs can help improve shot put performance by optimizing stability, energy transfer and movement technique. The practical implication is the importance of including abdominal strength training in the training program to achieve maximum performance in shot put and reduce the risk of injury. Further research could explore more deeply the long-term influence of abdominal strength training on the performance of shot put athletes.

Emergency department visits for heat-related illness among workers: Occupational health surveillance using Washington syndromic surveillance data.

Information on worker occupation and industry is critical to understanding the occupational risks of heat-related illness (HRI), yet few syndromic surveillance systems capture these key data elements. This study evaluates the work data reported through Washington syndromic surveillance for its utility in characterizing HRI ED visits by industry and occupation. Standard industry and occupation codes were assigned to employer name and occupation descriptions reported in Washington ED visit records maintained within the state's syndromic surveillance system, for visits involving HRI in 2020-2022. HRI ED visits involving workplace heat exposure were identified based on discharge diagnoses or on keywords in the triage note or chief complaint fields. HRI ED visits were summarized by patient characteristics, and visit rates were calculated by industry and occupation. Employer name or occupation descriptions were reported in 21.5% of HRI ED records among patients age 16 and older, and in 41.2% of records with mention of heat exposure at work. Twice as many records were classified for industry as for occupation. Agriculture, forestry, fishing, and hunting and transportation and warehousing had the highest rates of HRI ED visits. Specific industries with the highest rates included support activities for agriculture and forestry, the postal service, and fruit and vegetable preserving and specialty food manufacturing. Syndromic surveillance data are a valuable source of occupational health surveillance information when work characteristics are reported, enhancing our understanding of the occupational risks of injuries and illnesses.

Relationship Between the Results of the Landing Error Scoring System and Trunk Muscle Thickness.

A landing error scoring system (LESS) is widely used to evaluate landing maneuvers. Poor landing maneuvers, such as lateral bending of the trunk, are thought to be associated with a risk of lower-extremity injury. However, no studies have examined the association between landing and trunk muscle function, which is associated with a high risk of lower-extremity injury. This study examined whether an association exists between landing movements and a high risk of lower-extremity injury and trunk muscle function. It was hypothesized that athletes with poor activation of deep trunk muscle (transversus abdominis and internal oblique) would have lower LESS scores. Cross-sectional study. The trunk muscle thickness at rest and during the plank was measured using ultrasonography. The percent of change in muscle thickness (during plank/at rest) was calculated. The LESS was measured using the Physimax. Based on the LESS scores, patients were divided into high- (LESS > 6) and low-risk (5 > LESS) groups for lower extremity injury. The relationship between the high-risk group and trunk muscle thickness was examined using a stepwise regression analysis. The high-risk group had significantly lower muscle thicknesses of the transversus abdominis (p=0.02) and transversus abdominis plus internal oblique abdominis (p=0.03) muscles during the plank. Additionally, the high-risk group showed significantly lower percent of change in muscle thickness of the internal oblique (p=0.02) and transversus abdominis plus internal oblique (p=0.01) muscles. Only the percentage of change in the thickness of the internal oblique and transverse abdominal muscles was extracted from the regression as a factor. The findings indicated that athletes with landing movements and a high risk of injury, as determined based on the LESS results, had low trunk muscle function, and a relationship was observed between the change in thickness of transversus abdominis and internal oblique abdominis muscles. 3B.

Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary.

Athlete injury risk assessment and management is an important, yet challenging task for sport and exercise medicine professionals. A common approach to injury risk screening is to stratify athletes into risk groups based on their performance on a test relative to a cut-off threshold. However, one potential reason for ineffective injury prevention efforts is the over-reliance on identifying these 'at-risk' groups using arbitrary cut-offs for these tests and measures. The purpose of this commentary is to discuss the conceptual and technical issues related to the use of a cut-off in both research and clinical practice. How can we better assess and interpret clinical tests or measures to enable a more effective injury risk assessment in athletes? Cut-offs typically lack strong biologic plausibility to support them; and are typically derived in a data-driven manner and thus not generalizable to other samples. When a cut-off is used in analyses, information is lost, leading to potentially misleading results and less accurate injury risk prediction. Dichotomizing a continuous variable using a cut-off should be avoided. Using continuous variables on its original scale is advantageous because information is not discarded, outcome prediction accuracy is not lost, and personalized medicine can be facilitated. Researchers and clinicians are encouraged to analyze and interpret the results of tests and measures using continuous variables and avoid relying on singular cut-offs to guide decisions. Injury risk can be predicted more accurately when using continuous variables in their natural form. A more accurate risk prediction will facilitate personalized approaches to injury risk mitigation and may lead to a decline in injury rates. 5.

Enhancing Sports Injury Risk Assessment in Soccer Through Machine Learning and Training Load Analysis.

Sports injuries pose significant challenges in athlete welfare and team dynamics, particularly in high-intensity sports like soccer. This study used machine learning algorithms to assess non-contact injury risk in professional male soccer players from physiological and mechanical load variables. Twenty-five professional male soccer players with a first-time, non-contact muscle injury were included in this study. Recordings of external load (speed, distance, and acceleration/deceleration data) and internal load (heart rate) were obtained during all training sessions and official matches over a 4-year period. Machine learning model training and evaluation features were calculated for each of nine different metrics for a 28-day period prior to the injury and an equal-length baseline epoch. The acute surge in the values of each workload metric was quantified by the deviation of maximum values from the average, while the variations of cumulative workload over the last four weeks preceding injury were also calculated. Seven features were selected by the model as prominent estimators of injury incidence. Three of the features concerned acute load deviations (number of sprints, training load score-incorporating heart rate and muscle load- and time of heart rate at the 90-100% of maximum). The four cumulative load features were (total distance, high speed and sprint running distance and training load score). The accuracy of the muscle injury risk assessment model was 0.78, with a sensitivity of 0.73 and specificity of 0.85. Our model achieved high performance in injury risk detection using a limited number of training load variables. The inclusion, for the first time, of heart rate related variables in an injury risk assessment model highlights the importance of physiological overload as a contributor to muscle injuries in soccer. By identifying the important parameters, coaches may prevent muscle injuries by controlling surges of training load during training and competition.

Total laparoscopic hysterectomy with posterior cul-de-sac obliteration: step-by-step procedures based on precise anatomical landmarks.

Dense adhesion due to severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterates the cul-de-sac and distorts normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries, as well as voiding dysfunction. It is important to develop the retroperitoneal avascular space based on precise anatomical landmarks to minimize the risk of ureteral, rectal, and hypogastric nerve injuries. We herein report the anatomical highlights and standardized and reproducible surgical steps of total laparoscopic hysterectomy for posterior cul-de-sac obliteration. We approach the patient with posterior cul-de-sac obliteration using the following five steps. Step 1: Preparation (Mobilization of the sigmoid colon and bladder separation from the uterus). Step 2: Development of the lateral pararectal space and identification of the ureter. Step 3: Isolation of the ureter. Step 4: Development of the medial pararectal space and separation of the hypogastric nerve plane. Step 5: Reopening of the pouch of Douglas. Surgeons should recognize the importance of developing the retroperitoneal avascular space based on precise anatomical landmarks, and each surgical step must be reproducible.

Effects of hypobaric hypoxia on human physiological and psychological responses in hot-humid environments

The hot-humid and hypobaric hypoxic environment hampers human physiological and psychological responses. In this study, 10 healthy participants were recruited to walk on a treadmill at 4 km/h in a hypobaric chamber under nine experimental conditions involving three air temperatures (Ta = 33, 37, and 40°C), and three barometric pressures (PB = 96.5, 65.7, and 63.2 kPa). At 33 and 37°C, the mean skin temperature, oral temperature, and sweat rate were not significantly affected by hypobaric hypoxia. The diastolic blood pressure, systolic blood pressure, and oxygen saturation decreased significantly, while the heart rate increased significantly under hypobaric hypoxic conditions. At 40°C, the heart rate and diastolic blood pressure were not significantly affected by hypobaric hypoxia, while the oral temperature was significantly higher at 63.2 kPa than at 65.7 and 95.6 kPa. The remaining physiological parameters exhibited similar patterns as those at 33 and 37°C. In conclusion, higher Ta had the most substantial effects on the cardiovascular system. Thus, individuals should not work in environments where the Ta exceeds the body core temperature, especially at higher altitudes, as the risk of heat-related injuries could increase. At various Ta, the thermal sensation and acceptability were not significantly affected by hypobaric hypoxia, while a decrease in PB to 63.2 kPa resulted in a significant increase in tolerance, along with a notable reduction in exposure time. Therefore, this study provides valuable information concerning the physiological and psychological responses of humans exposed to working conditions similar to those tested.

428. MIDDLE MEDIASTINAL LYMPHADENECTOMY IN MEDIASTINOSCOPIC ESOPHAGECTOMY FOR ESCC

Abstract (Introduction) In mediastinoscopic esophagectomy, it is necessary to secure a view of the deep middle mediastinum. Although tracheal carina lymph nodes can be stably dissected using a cervical approach, but they are dissected using a hiatal approach when it is difficult to secure the field of view. (Middle mediastinum dissection) It is important to at least peel off the tracheal membrane or azygos vein in order to reduce the risk of secondary injury in the hiatal approach, even if cervical approach is difficult. In that case, the attachment between the esophagus and subcarinal tissue should be maintained for the en-block dissection. In the hiatal approach, the dissection along the pericardial and aortic surface is continuous with the dissection layer in the cervical approach and left and right tracheal cartilage are exposed enough. In the left side, the dissection along the inferior pulmonary vein is connected to the dissection of No.109L lymph node. Then, in the right side, similarly dissect the subcarinal lymph nodes along the right bronchus (No.109R lymph node). At this time, it is important to carefully check the position of azygos vein to avoid injury. Finally, the lymph nodes at the apex of the tracheal carina are sufficiently cauterized and dissected. (Conclusion) When it is difficult to reach the subcarinal tissue in cervical approach due to body type or tumor factor, the hiatal approach is necessary for sufficient lymphadenectomy of the middle mediastinum. At that case, prior detachment of the tracheal membrane and azygos vein will be important to reduce the risk of secondary injuries. Maintaining the continuity between the esophagus and dissected tissue is also important for the stable field of view.

Serum neurofilament light release levels as marker of neurotoxicity in general anesthesia versus hypnosis: A prospective non-randomized trial

Background: Whether general anesthetics induce neurotoxicity is unclear. Objectives: We hypothesized that serum neurofilament light (NfL) release, a marker of neural injury, would not be different in patients receiving general anesthesia (GA) compared to hypnosis. Design: Prospective, non-randomized. Setting: Tertiary university hospital. Methods: Patients undergoing breast cancer or thyroid/parathyroid surgery were enrolled. Propofol and remifentanil were used for GA. For hypnosis, only low dose remifentanil was allowed. Main outcome measures: NfL was measured at baseline, at day 1 and at postoperative visit. At preoperative and postoperative visit, patients performed a Montreal Cognitive Assessment (MoCA) test. Primary outcome was absolute change in NfL at day 1 between groups. Results: Among 100 included patients, 51 were in GA and 49 in hypnosis group. There were 26/49 (53%) breast cancer patients in hypnosis group and 13/51 (26%) in GA arm, p = 0.005. Baseline NfL was higher in the hypnosis group (p = 0.050). We subtracted log-transformed baseline NfL from postoperative NfL to analyze normalized values as absolute change. The mean normalized value at day 1 (primary endpoint) was 0.02 (± 0.11) in the GA and 0.03 (± 0.20) in the hypnosis group; p = 0.979 [d = 0.16, 95% CI: -0.40 to 0.39]. In a linear mixed-effects model including variables that influenced baseline NfL (advanced age, higher creatinine values, breast cancer), mean difference (95 % CI) in absolute change of log NfL at day 1 between both groups was 0.007 (- 0.04 to 0.06); p = 0.791. A change in MoCA as compared to baseline was not different between groups (p = 0.761). Conclusions: Our results show that there was no statistical or clinical difference in postoperative NfL release between GA and hypnosis. GA with propofol was not associated with a different risk of neural injury compared to hypnosis. Trial registration: NCT04500236.

246. EFFECT OF INTRAOPERATIVE NERVE MONITORING DURING MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract Background Recurrent laryngeal nerve (RLN) lymphadenectomy is a crucial step during esophagectomy. However, it is technically demanding and associated with a significant risk of RLN injury. Despite several studies demonstrating the feasibility of intraoperative nerve monitoring (IONM) during esophageal surgery, routine utilization of IONM during minimally invasive esophagectomy has not become common, and there is limited evidence to provide robust guidance. Here, we describe our experience with IONM during minimally invasive McKeown esophagectomy. Methods Data from 115 consecutive patients who underwent bilateral RLN lymphadenectomy during thoracoscopic McKeown esophagectomy for esophageal squamous cell carcinoma (ESCC) by a single surgeon between July 2017 and November 2023 were reviewed. The cohort was divided into three groups: Group 1 (initial 23 cases without IONM), Group 2 (middle 46 cases without IONM), and Group 3 (late 46 cases with IONM). We compared the number of resected lymph nodes and the incidence of vocal cord palsy (VCP) among the three groups. Results The mean number of resected right-side RLN lymph nodes was 1.21, 2.30, and 3.28 in Groups 1, 2, and 3, respectively. A significant difference was noted between Groups 2 and 3 (p = 0.03, Kruskal-Wallis test). The mean number of resected left-side RLN lymph nodes was 1.13, 2.70, and 2.67 in Groups 1, 2, and 3, respectively. A significant difference was noted between Groups 1 and 2 (p = 0.009), but not between Groups 2 and 3. The incidence of VCP was 8.7%, 8.7%, and 10.9% in Groups 1, 2, and 3, respectively. Compared to Group 2, the utilization of IONM in Group 3 did not reduce the postoperative VCP rate (OR: 1.280, 95% CI: 0.321-5.107). Conclusions With increasing experience, the number of resected RLN lymph nodes significantly increased. However, the utilization of IONM did not further improve left-side RLN lymphadenectomy or reduce the VCP rate.

Are Anthropometric Measures, Range of Motion, or Movement Control Tests Associated with Lumbopelvic Flexion during Barbell Back Squats?

Resistance training with the barbell back squat (BBS) exercise is practiced in sports, recreation, and rehabilitation. Although extensively debated, it is commonly believed and recommended that maintaining a neutral lumbopelvic alignment during BBS is an important technical aspect that might reduce the risk of injury. There is limited knowledge of how objectively measurable factors affect the extent to which the lumbopelvic region moves into flexion during a BBS. The aim of the study was to investigate the association among anthropometric measurements, range of motion in the hips and ankle joints, lumbopelvic movement control tests, and flexion of the lumbopelvic region during execution of the BBS. Observational, cross sectional. Eighteen experienced powerlifters and Olympic weightlifters were included and measurements of lumbopelvic movements were collected with inertial measurement units during BBS performed at 70 % of 1RM. Examination of anthropometric properties, range of motion in the hip and ankle joints, and lumbopelvic movement control tests were collected as independent variables. Linear regression analysis was used to investigate which independent variables were associated with lumbopelvic flexion during a BBS. The linear regression showed that a higher range of motion in ankle dorsiflexion could statistically significantly explain an increased amplitude of lumbopelvic flexion during the BBS. Anthropometrics, range of motion of the hips, and performance in lumbopelvic movement control tests did not show any statistically significant associations. The results suggest that strength and conditioning professionals and clinicians who instruct and assess lifting technique in the BBS and/or use the BBS to assess performance or as an intervention should recognize that a higher range of motion in the ankle joints might affect lumbopelvic flexion during the BBS. In practice, the value of an individual assessment of lifting technique focusing on the goal of the movement should be emphasized. 3.