The effect of different materials under the fencing piste on impact shock of the tibia during the fencing lunge on a concrete surface

Fencing has gained global popularity, with athletes often competing on hard surfaces, especially at United States national tournaments in convention centrr with concrete floors. These surfaces may contribute to overuse injuries from high-impact movements like the fencing lunge. This study aimed to investigate tibial accelerations, a measure of impact shock, experienced by fencers during lunges on various surface materials placed beneath standard aluminium fencing pistes. The aim was to identify a material that could reduce injury risk by mitigating impact shock. Sixty-nine fencers (35 female) performed five lunges on six different surfaces (A–F: A–E composed of various materials placed between the aluminium piste and the concrete floor; F was only the concrete floor), during the 2024 US Senior National Championships. A triaxial accelerometer mounted on the tibia was used to measure tibial accelerations as a marker of impact shock. The accelerometer was aligned to measure acceleration along the longitudinal axis of the tibia and set to record at 1000 Hz with a sensitivity range of ±100 g. Data acquisition was carried out via a logging system (Biometrics DL1001, Gwent, UK), which was attached to the participant using a tightly fitted backpack. The peak positive axial tibial acceleration was extracted for each lunge and the average was calculated from three lunges after discarding the highest and lowest values from each surface. Statistical analysis revealed that Surface E (a non-absorbent vinyl loop material; 12.7 ±7.6g), significantly reduced tibial accelerations compared to the standard concrete setup (Surface F; 13.6 ±8.4g). These findings suggest that modifying competition surfaces by incorporating cushioning materials may help reduce the impact shock of the fencing lunge, potentially lowering the risk of overuse injuries, such as tendonitis and tenosynovitis, commonly reported by fencers. Future research should investigate optimal material properties, including thickness and softness, for maximizing injury prevention while maintaining performance standards in competitive fencing environments

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Growth Factor Delivery to a Bovine Defect Using Leukocyte -Rich Platelet-Rich Concentrates on a Hyaluronic Acid Scaffold.

PURPOSE To determine if (1) Human L-PRP or (2) L-PRF delivered on a HA scaffold at a bovine chondral defect, a simulated cartilage tear interface, in vitro would improve tissue formation based on biomechanical, histological, and biochemical measures. METHODS L-PRF and L-PRP was prepared from 3 healthy volunteer donors which was delivered in conjunction with Hyaluronic acid (HA scaffolds) to defects created in full thickness bovine cartilage plugs harvested from bovine femoral condyle and trochlea. Specimens were cultured in vitro for up to 42 days. Treatment groups included an HA scaffold alone and scaffolds containing L-PRF or L-PRP. Cartilage repair was assessed using biomechanical testing, histology, DNA quantification, and measurement of sulfated glycosaminoglycan (sGAG) and collagen content at 28 and 42 days. RESULTS L-PRF elicited the greatest degree of defect filling and improvement in other histological measures. L-PRF treated specimens also had the greatest cellularity when compared to L-PRP and control at day 28 (560.4 vs. 191.4 vs. 124.2, p=00.15); at day 48 there remains a difference though not significant between L-PRF vs L-PRP, (761.1 vs 589.3, p=0.219) . L-PRF had greater collagen deposition when compared to L-PRP at day 42 (40.1 vs 16.3, p< 0.0001). L-PRF had significantly higher maximum interfacial strength compared to the control at day 42 (10.92 N vs 0.66 N, p=0.015), but had no significant difference compared to L-PRP (10.92 N vs 6.58, p=0.536). L-PRP facilitated a greater amount of sGAG production at day 42 when compared to L-PRF (15.9 vs. 4.3, p=0.009). CONCLUSIONS Delivery of leukocyte rich platelet concentrates in conjunction with a HA scaffold may allow for improvements in cartilage healing through different pathways. L-PRF was not superior to L-PRP in its biomechanical strength suggesting that both treatments may be effective in improving biomechanical strength of healing cartilage through different pathways

Pancreatic Cancer Associated Fibroblasts (CAF): Under-Explored Target for Pancreatic Cancer Treatment

Pancreatic cancer is the 4th leading cause of cancer deaths in the United States. The pancreatic cancer phenotype is primarily a consequence of oncogenes disturbing the resident pancreas parenchymal cell repair program. Many solid tumor types including pancreatic cancer have severe tumor fibrosis called desmoplasia. Desmoplastic stroma is coopted by the tumor as a support structure and CAFs aid in tumor growth, invasion, and metastases. This stroma is caused by cancer associated fibroblasts (CAFs), which lay down extensive connective tissue in and around the tumor cells. CAFs represent a heterogeneous population of cells that produce various paracrine molecules such as transforming growth factor-beta (TGF-beta) and platelet derived growth factors (PDGFs) that aid tumor growth, local invasion, and development of metastases. The hard, fibrotic shell of desmoplasia serves as a barrier to the infiltration of both chemo- and immunotherapy drugs and host immune cells to the tumor. Although there have been recent improvements in chemotherapy and surgical techniques for management of pancreatic cancer, the majority of patients will die from this disease. Therefore, new treatment strategies are clearly needed. CAFs represent an under-explored potential therapeutic target. This paper discusses what we know about the role of CAFs in pancreatic cancer cell growth, invasion, and metastases. Additionally, we present different strategies that are being and could be explored as anti-CAF treatments for pancreatic cancer.</jats:p