Shoulder tensiomyography and isometric strength in swimmers before and after a fatiguing protocol

Context. Shoulder muscles are active during front crawl swimming to provide propulsion and stabilize the glenohumeral and scapulothoracic joints. It has been proposed that fatigue might contribute to altered activation of these muscles and represent a risk factor for injuries. Tensiomyography (TMG) might represent a non-invasive tool to detect exercise-induced neuromuscular fatigue changes in contractile parameters of the skeletal muscles, and it has never been used in the shoulder muscles in swimmers. Objective. The aim of this study was to assess the effects of a fatiguing swimming protocol on shoulder muscles TMG parameters and isometric strength in competitive swimmers. Design. A cross-sectional study. Setting. A swimming pool facility. Patients or Other Participants. Sixteen young front crawl competitive swimmers were invited to participate in the study, and 14 of them (21 y, range 17-26, 11 males 3 females) completed all the assessments before and after a 30-min high-intensity swimming training. Main Outcome Measure(s). The main outcome included the TMG assessment which was performed on seven muscles of the shoulder according to front crawl biomechanics and applicability of the technique, in order to obtain data such as time to contraction and muscle belly radial displacement (Dm), whereas isometric strength was assessed with a digital dynamometer during shoulder flexion, extension, external rotation and internal rotation. Results. Fatigue induced a smaller Dm (-0.5 mm, 95% CI: -0.7 - -0.3, p< 0.001, pη2= 0.692), mostly observable in latissimus dorsi and pectoralis major muscles. Only shoulder extension showed a significant isometric strength reduction after the fatiguing protocol (-0.03 N/kg, 95% CI: -0.05 - -0.01, p= 0.045, pη2= 0.275). Conclusions. This study provides preliminary evidence for the usefulness of TMG to detect fatigue-induced changes in contractile properties of the shoulder muscles in swimmers, in particular the latissimus dorsi, pectoralis major and lower trapezius

The DICA Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists: an International Study

Background & Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (kappa) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal. was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD

International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease

The statements produced by the Chairmen and Speakers of the 3rd International Symposium on Diverticular Disease, held in Madrid on April 11th-13th 2019, are reported. Topics such as current and evolving concepts on the pathogenesis, the course of the disease, the news in diagnosing, hot topics in medical and surgical treatments, and finally, critical issues on the disease were reviewed by the Chairmen who proposed 39 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 124 physicians from 18 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas

Ergonomics in the operating room and surgical training: a survey on the Italian scenario

IntroductionSurgical-related injuries are frequent, in fact the reported percentage of musculoskeletal disorders in surgeons is between 47% and 87%. These conditions are caused by long periods of standing, incorrect postures, repeated movements, little rest between operations, the lack of integrated operator rooms, the correct number and arrangement of monitors and the use of non-ergonomic instruments. This survey aims to assess the Italian overview both highlighting how prevalent surgical-related injury is in our surgeons and whether there is an operating room ergonomics education program in Italian surgical specialty schools.MethodsAn anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of 3 different sections concerning the general characteristics of the participants, their surgical background and any training performed, and any injuries or ailments related to the surgical activity. The survey was carried out in the period 1th of December 2022 and the 6th of February 2023.ResultsAt the close of our survey, 300 responses were collected. Among the participants, the two most represented specialties were Gynecology and Obstetrics (42.3%) and General Surgery (39.7%) and surgeons were mainly employed in the Northern regions of Italy (54.8%). Analyzing the participants’ background, 61.7% of the respondents had laparoscopic training during their training and only 53.1% had a pelvic trainer during their residency. In accordance with 98.7% of the respondents, during surgery we have the feeling of being in an uncomfortable position that causes discomfort or muscle pain, and regarding the frequency of these discomforts, the majority of our study population experiences these problems monthly (46.2%), while in 29.6% it is experienced weekly, 12.1% annually and finally 12.1% daily. The surgical approach that is most correlated with these disorders is laparoscopy (62.7%) while the one that causes the least discomfort is robotic surgery (1.4%). These discomforts cause 43.9% of our population to take a break or do short exercises to reduce pain during surgery, and the body areas most affected are the back (61.6%), neck (40.6%) and shoulders (37.8%).ConclusionDespite this, our survey allows us to highlight some now-known gaps present in the surgical training program of our schools and the lack of protection toward our surgeons during their long career

Experiences of Italian surgical residents in low-income countries: an analysis from the Italian Polyspecialistic Society of Young Surgeons (SPIGC)

BACKGROUND: Surgery is a developing sector of global health; the insufficient number of surgeons seems to be the primary problem in low-income countries. International experiences in low-income countries are advocated from students and residents, lack of tutoring and different kind of surgeries represent obstacles for the training. The Italian Polyspecialistic Society of Young Surgeons (SPIGC) administered a survey to young surgeons and surgical residents, to examine the reasons they become involved in global surgery during residency and the impact of their experiences on the surgical training. METHODS: A 23-item, anonymous electronic questionnaire was administered to Italian surgical residents and young surgeons (≤40 years of age), coming from any surgical specialty. The study was conducted during January 2020. The study design guaranteed anonymity. RESULTS: All respondents (100%) recommended the experience in the low-income country, and none recommended spending time during the residency in a different way. Moreover, 83% of respondents judged their training as improved. CONCLUSIONS: This is the first Italian survey regarding global surgery experiences in relation to surgical residency. Our results show how Italian medical doctors who travelled in low-income countries during residency recommend this experience to improve knowledge. Surgical residents’ experience in low-income countries should grow, Italian residents are satisfied, and the training should be standardized