Time Of Return Research Articles

Surgical Factors Influencing Quality of Life After Reduction Mammaplasty in Patients with Breast Hypertrophy

Abstract Background Breast hypertrophy causes a variety of physical and psychological problems for patients, both of which lead to decreased quality of life. This research aimed to compare patients’ quality of life before and after elective breast reduction surgery and to evaluate factors contributing to improved quality of life after surgery. Methods Fifty-one women aged 18–65 years were enrolled. The data about the quality of life were obtained retrospectively using a standardized Breast-Q questionnaire© and evaluated by the software evaluation tool QScore©. Results The mean age of participants was 42.33 ± 10.30 years. The overall quality of life improved significantly by 60%. On average, the respondents had 1,119.2 g of breast tissue removed per breast. Before the surgery, the average body mass index was 29.88, while after surgery it was 27.52. The average breast size was 6.41 before surgery and 3.3 (i.e., cup sizes C—D) after surgery. The average time of questionnaire return was 3.9 ± 2.99 years after surgery. The average time spent in the hospital was 6.02 ± 1.44 days. The complication rate was 23%. None of these factors influenced the patients' satisfaction with the outcome. However, the surgical technique chosen seemed to play a significant role in the satisfaction of patients with the reduction. Conclusions In our study, reduction mammaplasty improved the well-being of the patients in all aspects of the Breast-Q questionnaire. Of the observed factors, only the surgical technique appeared to affect satisfaction with long-term outcomes significantly. Trial registration Clinicaltrials.gov No.: NCT02769559.

Arthroscopic lateral ligament reconstruction for isolated chronic lateral ankle instability is associated with longer recovery compared to arthroscopic Broström repair and inferior extensor retinaculum augmentation.

Patients with chronic lateral ankle instability (CLAI) can be managed with arthroscopic Broström repair and inferior extensor retinaculum augmentation or arthroscopic assisted lateral ligament reconstruction using ipsilateral semitendinosus autograft, with good functional outcomes in patients. It is unclear whether one offers better outcome that the other. This retrospective analysis of prospectively collected data compared the outcomes of repair and reconstruction. Patient treated for CLAI by arthroscopic Broström repair and inferior extensor retinaculum augmentation (Repair/augmentation Group; n=39) and lateral ligament reconstruction (Reconstruction Group; n=23) procedures with a minimum follow-up of 24 months were enrolled. The operative time, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Tegner score, Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the time of the patients return to sports activities were assessed. The operative time was longer in the Reconstruction Group. The patients in the Reconstruction Group experienced more pain. At 3 months after surgery, the patients in Repair/augmentation Group gained better AOFAS, KAFS, Tegner, and AJPS scores. At 6 months after surgery, better KAFS and AJPS were observed in Repair/augmentation Group. At 1 and 2 years, patients in the Reconstruction Group recorded better functional outcomes (AOFAS and KAFS) compared to the Repair/augmentation Group. The mean time of the patients return to sports activities was 10.42 ± 7.77 weeks (range, 8-56 weeks) in the Repair/augmentation Group, compared to 14.18± 5.34 weeks (range, 8-24 weeks) in the Reconstruction Group (p = 0.049). In CLAI patients, arthroscopic reconstruction yields better outcomes in terms of ATT, AOFAS, and KAFS in the mid-term; however, it is associated with a longer intraoperative time, delayed return to sports, and an extended duration to resume normal ankle function compared to the arthroscopic Broström repair and inferior extensor retinaculum augmentation procedure.

P-2032. The Time to Return to Work in Healthcare Workers With COVID-19 Infection Treated With Ensitrelvir, a Novel Oral Inhibitor of 3C-Like Protease of SARS-COV-2

Abstract Background Early diagnosis and treatment with antivirals are important in COVID-19 management. This study aimed to investigate the time to return to work and COVID-19 symptom improvement in healthcare workers treated with ensitrelvir. Methods A retrospective single-center, observational study was conducted to assess the effect of ensitrelvir on the time to return to work and the resolution of symptoms at the time of return in healthcare workers diagnosed with COVID-19 between June and September 2023 during the Omicron dominant period. The differences in patient background between the ensitrelvir treated group and no antiviral treatment group was not adjusted, and we conducted descriptive analysis. The criteria for returning to work were defined as improvement of symptoms and an antigen quantification test result of ≤ 100 pg/mL after the 6th day of onset. Results A total of 102 healthcare workers were registered, and ensitrelvir was administered in 60 cases. The average number of days from onset of symptoms to ensitrelvir administration was 0.8 days. The female proportion was 76.7% and 78.6% in the ensitrelvir-treated and non-treated groups, respectively, with average ages of 38.2 and 30.6 years in each group, respectively. The severity of COVID-19 was mild in all cases. No side effects were observed in the ensitrelvir-treated group. The average time to meet the criteria for returning to work was 6.9 days in the ensitrelvir treated group and 7.7 days in the non-treated group. 35 patients (58.3%) in the ensitrelvir-treated group and 15 patients (35.7%) in the non-treated group experienced recovery (fever resolution and disappearance of COVID-19 symptoms) on the day of returning to work. Additionally, 25 patients (41.7%) in the ensitrelvir-treated group and 27 patients (64.3%) in the non-treated group experienced improvement (fever resolved but some symptoms remained) on the day of returning to work. Conclusion This study showed that early treatment of COVID-19 with ensitrelvir may improve symptoms and reduce the number of days to return to work. The results suggest that early antiviral drug administration to healthcare workers may contribute to the maintenance and continuity of routine healthcare, thereby avoiding Healthcare workers shortage. Disclosures Makoto Katsuta, Shionogi & Co., Ltd.: Lecture fees Takuhiro Sonoyama, MD, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Tomoyoshi Yamaguchi, MD, Shionogi & Co., Ltd.: Lecture fees

Return to work after lumbar microdiskectomy - a systematic review and meta-analysis.

Systematic review and meta-analysis. To investigate evidence on the prevalence and timeline of RTW after lumbar microdiskectomy. While lumbar microdiskectomy is a widely used and well-studied procedure, there is lack of evidence on the postoperative prevalence and schedule of return to work after this type of surgery. Search at Medline, Embase, Cinahl, Scopus and Web of Science. Assessment of risk of systematic bias using Quality in Prognosis Studies (QUIPS). Random effects meta-analysis and meta-regression. Adults undergoing lumbar microdiskectomy due to degenerative disc herniation, excluding spinal stenosis, percutaneous diskectomy, artificial disk, arthroplasty, laminectomy, fusion or symptoms of cauda equina. Of identified 2,285 records, 31 were included in meta-analysis. Most of the studies had low risk of systematic bias. Pooling 21 studies, the mean prevalence of postoperative return to work was 78% (95% CI 71% to 83%). Pooling 13 studies the mean time of return to work was 4.79 (95% CI 3.88 to 5.70) weeks. The meta-regression of prevalence of return to work by the duration of follow-up resulted in significant but small coefficient of 0.02 (95% CI 0.01 to 0.03, P=0.006). There was considerable heterogeneity for all three models. The results of this review suggest that approximately 70%-80% of patients who undergo a microsurgical procedure for disc herniation return to work within the first month and a half. It also seems that returning to work after this period is quite unlikely. The duration of preoperative symptoms did not affect significantly the prevalence of RTW. Information about these trends should be taken into account both in the planning phase of the procedure and in setting goals for postoperative rehabilitation.

Mid-Term outcomes of osgood-schlatter patients undergoing arthroscopic excision

Aim:If surgical intervention is necessary for Os-Good-Schlatter patients ,a number of surgical techniques including open surgical,arthroscopic and bursoscopic procedures are available.The aim of this study was to evaluate the mid-term clinical results of patients who underwent arthroscopic excision with the diagnosis of OSD. Materials and Methods:This study was modeled with a retrospective design.16 patients who underwent arthroscopic ossicle excision were included in this study.The Visual Analog Scale (VAS) Score,Tegner Activity Scale and Lysholm Knee Score forms were administered to the patients in order to compare their pre-operative and post-operative condition.In addition,complications such as infection,residual bone fragments,re-hospitalization or recurrence were evaluated and recorded. Results:A total of 16 patients were included in the study, and of these patients, 11 (68.75%) were male and 5 (31.25%) were female. The mean age of the patients is 28.8 (20–41 ± 7) years. The mean follow-up period was 82.9 (61–108 ± 15) months. The mean time for return to sports-related training activities for all of the patients was 9.2 (8–11) weeks. The mean VAS decreased from 6.8 ± 1.1 points preoperatively, to 5.7 ± 1.3 at the final follow-up (P < 0.001). In addition, the mean Tegner Activity Level score improved from 5.7 ± 0.6 preoperatively to 7.8 ± 0.9 at the final follow-up (P < 0.001). The mean Lysholm Knee Scale score was 77.4 ± 4.6 points in the preoperative period, increasing to 97.7 ± 5.8 points at the final follow-up (P < 0.001). In one patient, recurrence occurred at the 105th postoperative month and revision surgery was performed. Conclusion:Arthroscopic ossicle excision for OSD can be considered an adequate technique when the mid-term results are evaluated.Although rare, recurrence may occur after arthroscopic surgery.In order to demonstrate the superiority of the arthroscopic method over open surgical procedures, comparative studies containing long-term results are required.

The comparative study of clinical outcomes among early functional treatment, immobilization treatment and ulnar plate fixation for displaced or comminution fifth metatarsal base fractures

The optimal treatment for displaced or comminution fifth metatarsal base fractures remain debated. Ninety displaced or comminution fifth metatarsal base fractures patients were randomly selected into three groups: the ulnar hook plate fixation group (n=30), the immobilization treatment group (n=18), and the early functional group (n=30). The assessed factors included the duration until union, time to resume daily activities, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Disability Index (FADI) scores, visual analog scale (VAS) ratings and occurrence of complications. The VAS scores showed no significant differences observed among the three treatments. The mean AOFAS score and mean FADI after treatment in the plate group and exhibited significant better than that of the immobilization group and the early functional group at 1 moth, 3 months and 6 months (P˂0.05) . After a duration of 12 months, all three treatments exhibited comparable outcomes and facilitated restoration of daily activities. In the plate group, one patient developed a wound infection, one patient experienced sural nerve injury or irritation, and three patients exhibited implant prominence. One patient encountered nonunion in the immobilization group.The union time and the time of return to daily activities and the early functional group exhibited significant shorter durations than that of the immobilization group and the plate group(P˂0.05). Overall, the early functional treatment is recommended for managing displaced or comminution fifth metatarsal base fractures.Evidences level: III

Clinical presentation, management and outcome of maxillofacial fractures in pet rabbits: 27 cases (2008-2022).

To report clinical findings, management strategies and outcomes in pet rabbits with maxillofacial fractures. Medical records of pet rabbits with confirmed maxillofacial fractures from three exotic animal veterinary services between 2008 and 2022 were reviewed. Forty-five fractured maxillofacial bones were reported in 27 rabbits, including mandibular symphyseal separation in 13 rabbits. Median age was 18 months (interquartile range, 7 to 38 months), and median bodyweight was 1.70 kg (interquartile range, 1.36 to 2.33 kg). The most common aetiology was anthropogenic accidents (16/27). Hyporexia/anorexia was the most frequent presenting complaint (17/27). Common clinical findings included dental malocclusion (12/27), craniofacial pain (9/27), crepitus (9/27) and swelling (7/27). Three (3/27) rabbits were euthanised after diagnosis. Mandibular symphyseal separation in 11 of 12 treated rabbits were addressed using circummandibular cerclage wiring. All remaining fractures were conservatively managed. Twenty-three of 27 rabbits survived to hospital discharge. Median time of return to normal or near-normal eating was 1 day (interquartile range, <1 to 3 days). Median survival time was 859 days (interquartile range, 567 to 1092 days). Dental malocclusion was a reported complication in 12 of 16 rabbits with follow-up data. However, only five of 12 rabbits developed associated clinical signs requiring corrective dentistry. Maxillofacial fracture in rabbits may present with similar clinical signs and findings to other conditions such as odontogenic disease. Successful outcomes with infrequent long-term clinical complications are associated with management strategies that emphasise early functional recovery.

Arthroscopic Trillat technique for chronic anterior shoulder instability: outcomes at 2 years follow-up in 74 at risk sport-patient

BackgroundChronic anterior shoulder instability affects a young and athletic population, with a high demand for functional recovery and return to sport. Arthroscopic Trillat dynamic stabilization technique has shown great results at 2 years in terms of stabilization and functional outcomes on general population. The hypothesis is that it could do so in at-risk for dislocation athletic population for stabilization and return to sport, with results comparable to the reference techniques. MethodsMulticenter retrospective study of Walch-Duplay type 2, 3 and 4 at risk sports patients treated by arthroscopic Trillat for chronic anterior shoulder instability between January 2012 and January 2021, at a two years follow-up. Primary endpoint: occurrence of dislocation recurrence. Secondary endpoints: subluxation recurrence, functional outcomes, time and level of return to sport, functional scores, bony fusion and complications. Results74 patients were analyzed, with a mean age of 24.4 years (15-50). Sports level was, moderate risk of dislocation Walch-Duplay type 2 for n=34 (46%), medium risk Walch- Duplay type 3 for n=19 (26%) and high-risk Walch-Duplay type 4 for n=21 (28%). Recurrence of dislocation occurred in 3 patients (4.1%). 100% of patients returned to sport, with an average delay of 4.6 months, with n=56 (76%) returning to the same previous level. The mean Constant score was 94.5 (79-100), the Rowe score 94.7 (70-100), the Walch-Duplay score 90.2 (50-100) and the SSV score 90.5 (65-100). Subgroup analysis of athletes at moderate risk of dislocation recurrence (Walch-Duplay type 2) vs. medium and high risk of dislocation recurrence (Walch-Duplay type 3 and 4) revealed no statistically significant difference. One patient presented with asymptomatic pseudarthrosis. ConclusionArthroscopic Trillat offers highly satisfactory results in the treatment of chronic anterior shoulder instability for athletes regardless of the type of sport practised and type of risk according to Walch-Duplay. This simple and quick technique enables a rapid return to sport and at the previous level in the majority of cases. After showing its effectiveness in the general population at two years, arthroscopic Trillat offers a reliable alternative to the reference procedures in young athletic patients.

Prevention of postpartum methamphetamine use with micronized progesterone trial (PROMPT): A pilot randomized controlled trial protocol

While most pregnant individuals with methamphetamine use disorder (MUD) achieve abstinence, the postpartum period remains a vulnerable time for return to methamphetamine use (MU). Promising data from human and animal models, including three randomized controlled trials, suggest that micronized progesterone may prevent postpartum return to cocaine and nicotine use by reducing cravings. The primary objective of this study is to assess feasibility of enrollment and randomization of postpartum individuals with MUD to micronized progesterone to prevent return to MU. The secondary objectives are to evaluate safety, establish a preliminary estimate of efficacy, and characterize the association between allopregnanolone levels and methamphetamine cravings. This is a pilot double-blind placebo randomized controlled trial. We plan to enroll 40 postpartum individuals with MUD over 24-months. Individuals, stratified by opioid use disorder (OUD), are randomized 1:1-400mg oral micronized progesterone daily or placebo and attend weekly study sessions for 12 weeks. Feasibility is measured by achieving 80% of enrollment goal. Safety is evaluated by side effect frequency, mental health status changes, lactation and medical complications. Efficacy is assessed by comparing proportion of participants with return to MU and time to return to MU based on self-report or urine testing between treatment and control groups. Salivary allopregnanolone levels and methamphetamine cravings are compared between the groups. Study results will provide a first critical step towards potential intervention for prevention of return to MU among postpartum individuals. Completion of this trial will set the stage for a large-scale efficacy trial.

Preliminary results of acute Achilles tendon rupture treated with platelet-rich plasma and immobilization

Objective: Evaluate preliminary functional results, return to sport, re-rupture rate of acute Achilles rupture treated with one applicationof platelet-rich plasma (PRP), and immobilization.Methods: A prospective analytical study was performed in patients with acute Achilles tendon rupture treated conservatively, associatedwith a single local application of PRP within 10 days of injury. The sample comprised 28 patients diagnosed and monitored by the sameteam for a minimum of 12 months. The American Foot and Ankle Society Functional Rating Scale (AOFAS), Achilles tendon totalrupture score (ATRS), visual analog scale (VAS), and Achilles tendon resting angle (ATRA) were evaluated, the time of return to sportsactivities and isokinetic strength were evaluated at the different follow-up times and injury site using magnetic resonance imaging.Results: The variance analysis of the AOFAS, ATRA, and VAS scores showed a significant difference at six and 12 months regardingthe initial score and according to the injury site. The mean time to return to sports activities was 197 days, 85.7% had homogeneoustendons, and heel-rise type 2 was achieved in 28.6% at six months and 60.7% at 12 months.Conclusion: The protocol proposed by our study for Achilles tendon rupture significantly improved all the scores evaluated comparedto the initial condition and the isokinetic evaluations, obtaining even better results in proximal injuries. Level of Evidence IV; Therapeutic studies investigating the results of treatment; Case series.

Distal Triceps Tendon Repair in Strength Athletes Leads to Satisfactory Return to Sports: A Retrospective Analysis of 22 Cases.

Background: Distal triceps brachii tendon rupture (DTTR) is a relatively rare injury that is common in bodybuilding and high-intensity contact sports and can lead to significant functional impairment of the elbow joint. This study was conducted to evaluate clinical outcomes and the rate of return to sports among competitive bodybuilders and high-demand strength athletes after surgical repair of DTTR. Methods: This retrospective case series was performed in an institutional setting in tertiary health care. Return to sports of 22 competing or high-demand strength athletes (meaning three or more exercises per week) were analyzed pre- and postoperatively after surgical repair of DTTR using a hybrid technique of transosseous sutures and anchor fixation. Descriptive statistics were used to analyze demographic variables, and independent and paired t-tests were used to assess clinical outcomes. Results: The follow-up showed that from pre- to postoperatively, there was no deterioration in the number of sports disciplines (2.4 and 2.5 sporting activities per person, respectively; p = 0.540) or in the frequency of weekly training (4.1 and 4.1 times per person, respectively; p = 0.329). The postoperative visual analog scale for pain (from 6.0 to 1.6, p < 0.001), level of fitness (from 5.1 to 2.6, p = 0.002), and ability to train (from 5.2 to 1.3, p < 0.001) improved significantly. The time of return to sports was 1.5-3 months and 4-6 months after the surgery for ten patients each. The overall rate of return to sports was 95%, whereas 86% returned to the preinjury level of sporting activity. Conclusions: Repair of DTTR leads to high rates of return to sports in competitive athletes.

Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated With Success.

Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method has produced promising results in a limited number of studies conducted in recent years. We aimed to examine the efficacy and safety of this method in a tertiary care training hospital to reveal the factors affecting failure and to share our first experiences. All adult patients treated with this procedure between March 2020 and December 2023 were included in the study. Demographic and clinical data, complications, and recurrence rates of the patients were compared. Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment. Logistic regression analysis was performed using significant factors in the single variable analysis. The study cohort consisted of 64 patients. The mean follow-up period was 17.0±8.06 months (range: 3 to 36), and the mean time for return to work was 2.4±2.78 days (range: 0 to 14). Our recovery rate was 85.9%. The complication rate was 14%, and the majority (50%) were wound infections. High BMI and advanced disease were significant factors for recurrence in the comparison of patients with successful and unsuccessful treatment ( P <0.01 and 0.013, respectively). The same situation persisted in multivariate analysis ( P =0.026, 95% CI: 1.36-7.81, and P =0.004, 95% CI: 1.36-1.78, respectively). In the ROC Curve analysis for BMI, the cutoff point was 29 (sensitivity: 66.9%, specificity: 77.4%, AUC 0.809). Other parameters were not significant ( P >0.05). The SiLaC procedure may be the treatment of choice for pilonidal sinus disease as a safe and effective method with mild complications and reasonable recurrence rates. The success rate decreased in obese patients and patients with advanced disease.

Modified dorsal recumbent position versus lithotomy position for flexible ureteroscopic lithotomy: a multicenter prospective randomized controlled clinical trial.

The lithotomy position (LP) may pose limitations and discomfort for elderly patients and those with a history of lower limb surgery, potentially leading to an increased risk of complications. And the LP is the conventional position during flexible ureteroscopic lithotomy for the treatment of ureteral calculi. However, it has some disadvantages, such as peripheral nerve injury and deep venous thrombosis in the lower limbs, etc. Therefore, we performed a new approach, which is named as modified dorsal recumbent position (MDRP). Currently, there is a lack of systematic analysis and standardization regarding the surgical positioning for flexible ureteroscopic lithotripsy. The objective of the study was to assess whether there were any disparities in the overall duration of the procedure when comparing the MDRP with the LP. The investigation of the optimal position for flexible ureteroscopic lithotomy is essential for enhancing patient safety and comfort. This is a prospective, multicenter, randomized clinical trial. A total of 144 patients with renal or ureteral calculi from April 2021 to June 2022 were enrolled. Eligible patients were randomized to the MDRP group (n=72) or LP group (n=72). The patient's demographics, the placement of the surgical position (time of position placement, time of disinfection and towel laying, time of position return, degree of medical fatigue) and the operation safety (time of operation, time of ureteroscope from bladder neck to ureteral orifice, heart rate, blood pressure) of two groups were compared and analyzed. Between the two groups, the body positioning time (93.8±31.6 vs. 134.8±40.1 s, P=0.02), operation time (71.8±36.7 vs. 77.7±48.6 min, P=0.04), the time from the bladder neck to the ureteral orifice of the flexible ureteroscope spent by the doctors (3.4±4.7 vs. 10.3±14.7 s, P<0.001) and incidence rate of patient's lower limb soreness (19.4% vs. 49.7%, P=0.01) in the MDRP group were significantly shorter than those in the LP group. However, there was no significant difference in the stone removal rate (87.6% vs. 85.4%, P=0.09) or postoperative hospitalization days (4.3±1.4 vs. 4.1±1.6 d, P=0.08) between the two groups. This trial showed that the MDRP could not only effectively shorten the operation time, shorten the time from the bladder neck to the ureteral orifice of the ureteroscopic lithotripsy, but also place the patient's body in a functional position, stabilize the blood pressure during the operation, improve the comfort of the patient. Chinese Clinical Trial Registry (No. ChiCTR2100053416).

Anterior Cruciate Ligament Ruptures in Russian Premier League Soccer Players During the 2010 to 2021/2022 Competitive Seasons: The Epidemiology and Details of Return to Sports.

There are limited data on the epidemiology of anterior cruciate ligament (ACL) ruptures in elite adult soccer players, especially in the Russian Premier League (RPL). There is an increased risk of injury due to a combination of additional risk factors such as playing in extremely high and low temperatures, frequent long flights, and regular play on natural and artificial surfaces. To study the epidemiology of ACL ruptures and determine the patterns associated with their occurrence in RPL soccer players. Descriptive epidemiology study. All ACL ruptures requiring surgery sustained by players competing in the RPL across 12 competitive seasons between 2010 and 2022 were analyzed. All required data were collected from media analysis and confirmed by club doctors. A total of 85 players sustained 100 injuries during 12 competitive seasons. A total of 96.5% of players returned to competitive play. The injury incidence in RPL and during participation of RPL teams in European Cups were 0.4760 and 0.5622 per 1000 playing hours, respectively. When analyzing the outcomes of the primary ACL surgery (a total of 76 operations), the following data were obtained: in 11 cases (14.5%), there was a reinjury on the ipsilateral knee joint and in 4 cases (5.3%) on the contralateral knee joint. The mean return-to-play time after all operations was 284 ± 116 days. The time of return to play after primary reconstruction was 289 ± 136 days, 278 ± 91 days after reconstruction on the contralateral knee and 271 ± 51.5 days after the first ACL revision reconstruction on the ipsilateral knee joints. RPL ACL injury epidemiology is similar to that in the other leagues from around the world, although there are factors that can potentially influence the number of these injuries.

Early Burst Suppression Similarity Association with Structural Brain Injury Severity on MRI After Cardiac Arrest.

Identical bursts on electroencephalography (EEG) are considered a specific predictor of poor outcomes in cardiac arrest, but its relationship with structural brain injury severity on magnetic resonance imaging (MRI) is not known. This was a retrospective analysis of clinical, EEG, and MRI data from adult comatose patients after cardiac arrest. Burst similarity in first 72h from the time of return of spontaneous circulation were calculated using dynamic time-warping (DTW) for bursts of equal (i.e., 500ms) and varying (i.e., 100-500ms) lengths and cross-correlation for bursts of equal lengths. Structural brain injury severity was measured using whole brain mean apparent diffusion coefficient (ADC) on MRI. Pearson's correlation coefficients were calculated between mean burst similarity across consecutive 12-24-h time blocks and mean whole brain ADC values. Good outcome was defined as Cerebral Performance Category of 1-2 (i.e., independence for activities of daily living) at the time of hospital discharge. Of 113 patients with cardiac arrest, 45 patients had burst suppression (mean cardiac arrest to MRI time 4.3days). Three study participants with burst suppression had a good outcome. Burst similarity calculated using DTW with bursts of varying lengths was correlated with mean ADC value in the first 36h after cardiac arrest: Pearson's r: 0-12h: -0.69 (p = 0.039), 12-24h: - 0.54 (p = 0.002), 24-36h: - 0.41 (p = 0.049). Burst similarity measured with bursts of equal lengths was not associated with mean ADC value with cross-correlation or DTW, except for DTW at 60-72h (- 0.96, p = 0.04). Burst similarity on EEG after cardiac arrest may be associated with acute brain injury severity on MRI. This association was time dependent when measured using DTW.

Relationships between quantitative magnetic resonance imaging measures at the time of return to sport and clinical outcomes following acute hamstring strain injury

Hamstring strain injuries (HSI) are a common occurrence in athletics and complicated by high rates of reinjury. Evidence of remaining injury observed on magnetic resonance imaging (MRI) at the time of return to sport (RTS) may be associated with strength deficits and prognostic for reinjury, however, conventional imaging has failed to establish a relationship. Quantitative measure of muscle microstructure using diffusion tensor imaging (DTI) may hold potential for assessing a possible association between injury-related structural changes and clinical outcomes. The purpose of this study was to determine the association of RTS MRI-based quantitative measures, such as edema volume, muscle volume, and DTI metrics, with clinical outcomes (i.e., strength and reinjury) following HSI. Spearman’s correlations and Firth logistic regressions were used to determine relationships in between-limb imaging measures and between-limb eccentric strength and reinjury status, respectively. Twenty injuries were observed, with four reinjuries. At the time of RTS, between-limb differences in eccentric hamstring strength were significantly associated with principal effective diffusivity eigenvalue λ1 (r = -0.64, p = 0.003) and marginally associated with mean diffusivity (r = -0.46, p = 0.056). Significant relationships between other MRI-based measures of morphology and eccentric strength were not detected, as well as between any MRI-based measure and reinjury status. In conclusion, this preliminary evidence indicates DTI may track differences in hamstring muscle microstructure, not captured by conventional imaging at the whole muscle level, that relate to eccentric strength.

Quantitative pupillometry as a biomarker for prediction of return to play in mild traumatic brain injury: a Military Traumatic Brain Injury Initiative study.

This study aimed to determine the validity of quantitative pupillometry to predict the length of time for return to full activity/duty after a mild traumatic brain injury (mTBI) in a cohort of injured cadets at West Point. Each subject received baseline (T0) quantitative pupillometry, in addition to evaluation with the Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and Sport Concussion Assessment Tool 5th Edition Symptom Survey (SCAT5). Repeat assessments using the same parameters were conducted within 48 hours of injury (T1), at the beginning of progressive return to activity (T2), and at the completion of progressive return to activity protocols (T3). Pupillary metrics were compared on the basis of length of time to return to full play/duty and the clinical scores. The authors' statistical analyses found correlations between pupillometry measures at T1, including end-initial diameter and maximum constriction velocity, with larger change and faster constriction predicting earlier return to play. There was also an association with maximum constriction velocity at baseline (T0), predicting faster return to play. The authors conclude that that pupillometry may be a valuable tool for assessing time to return to duty from mTBI by providing a measure of baseline resiliency to mTBI and/or autonomic dysfunction in the acute phase after mTBI.

PM reduction performance according to filter grade and diffuser position in a school classroom

Ventilation performance for indoor air quality (IAQ) in schools has emerged as an important social issue due to the high concentrations of particulate matter (PM). The PM reduction performance is analyzed according to filter grade and the location of return diffusers, upper and floor return, selected based on indoor airflow distribution. Performance evaluation has been experimentally analyzed in the full-scale school environmental performance test-bed equipped with a fan filter unit (FFU). Through the experimental measurements in the classroom, it is found that the PM reduction time of the floor return is relatively shorter than that of the upper return. This is due to the increased ventilation efficiency by decreasing the stagnation flow inside the classroom. Although the supply air flowrate is relatively small at 800 cubic meter per hour (CMH), it has a PM reduction effect similar to 1200 CMH for all particle sizes due to the replacement of the conventional upper return with a floor return. Considering that the energy consumption of the Minimum Efficiency Reporting Value (MERV) 16 filter is approximately 1.7 times that of the MERV13 filter, a MERV13 filter is sufficient to demonstrate the performance of a MERV16 filter with the optimal installation of return diffusers.

Metacarpal Fracture Fixation with Intramedullary Screws.

Background: Intramedullary screws (IMS) have become a viable option for metacarpal fracture fixation. To further appraise their utility, this study assessed clinical and patient-reported short- and medium-term outcomes of IMS fixation for extra-articular metacarpal fractures. Methods: A retrospective cohort study was performed in a series of 32 patients (with a total of 37 fractures) who underwent metacarpal fracture fixation over a 42-month period between January 2020 and July 2023. Results: Mean time for return to work was 39.8 days; mean time for return to full function was 88.4 days; total active motion was 250.7° (range: 204.9-270.9); Quick Disabilities of the Arm, Shoulder and Hand score was 2.3 (range: 0-22.7); mean visual analogue pain score was 0.9 out of 10 (range: 0-6) and a single complication was observed. Conclusions: The use of IMS in metacarpal fracture fixation is a practicable surgical option. IMS fixations yields a satisfactory duration for return to function, good postoperative range of movement, modest pain scores and low rates of complications. Level of Evidence: Level IV (Therapeutic).

From injury back to ice: Examining return to sport after retinal injuries in the national hockey league

PurposeTo forecast the recovery time and likelihood of return to active play for National Hockey League (NHL) players who sustained retinal tears or detachments. MethodsThis retrospective study identified players who experienced a retinal injury while on an NHL roster between January 1, 2000 and January 1, 2022. The type of injury was identified from publicly available press releases and injury reports. Return to sport was defined as the number of days between injury and participation in a subsequent NHL game. ResultsOver the 22-year study period, 95 eye injuries were reported in the NHL. Of these injuries, 16 players experienced 17 retinal injuries (18 %). Fifteen of those players were able to return to sport (94 %). Experiencing a retinal detachment was associated with more days out of play (median 151 days [interquartile range [IQR], 85 to 231.5 days]) compared with a retinal tear or similar injury (median 28 days [IQR, 13 to 31 days]; P = 0.003). Finally, an examination of the impact of a retinal injury on player performance in the season after the injury found that the average time on ice (ATOI) per game decreased for players who suffered an injury compared with a matched cohort (P = 0.010). ConclusionsRetinal injuries often occur in high-impact sports. Our study reveals that retinal detachments resulted in longer disability compared with retinal tears or lesser injuries and were more likely to prevent a return-to-sport. This information aids ophthalmologists in counseling patients on surgical recovery timelines and the likelihood of resuming athletic activities.