Viscoelastic deformation of articular cartilage during impact loading

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Consensus statement on placebo effects in sports and exercise: the need for conceptual clarity, methodological rigour, and the elucidation of neurobiological mechanisms.

In June 2017 a group of experts in anthropology, biology, kinesiology, neuroscience, physiology, and psychology convened in Canterbury, UK, to address questions relating to the placebo effect in sport and exercise. The event was supported exclusively by Quality Related (QR) funding from the Higher Education Funding Council for England (HEFCE). The funder did not influence the content or conclusions of the group. No competing interests were declared by any delegate. During the meeting and in follow-up correspondence, all delegates agreed the need to communicate the outcomes of the meeting via a brief consensus statement. The two specific aims of this statement are to encourage researchers in sport and exercise science to: 1. Where possible, adopt research methods that more effectively elucidate the role of the brain in mediating the effects of treatments and interventions. 2. Where possible, adopt methods that factor for and/or quantify placebo effects that could explain a percentage of inter-individual variability in response to treatments and interventio

Association between age at disease onset of anti-neutrophil cytoplasmic antibody-associated vasculitis and clinical presentation and short-term outcomes

Objectives: ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- A nd older-onset patients are still incompletely understood. Methods: We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: <65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results: A total of 1338 patients with AAV were included: 66% had disease onset at <65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion: Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy

Abstract Background There is a paucity of data on the ocular outcomes in paediatric non-infectious uveitis since the introduction of the biologic agents. The purpose of this study was to outline the clinical characteristics of children with non-infectious uveitis and determine the visual outcomes and ocular complication rates in the modern era. Methods Children with non-infectious uveitis from January 2011 to December 2015 were identified. Data was collected at baseline, 1, 3, 5, and 10 years post diagnosis. The incidence rates of visual impairment, structural ocular complications and surgical intervention were calculated. Using logistic regression the association between various baseline characteristics and later visual impairment was investigated. Results Of the 166 children, 60.2% (n = 100) had a systemic disease association. 72.9% (n = 121) children received methotrexate, 58 children progressed to a biologic. The incidence rates of visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60) were 0.05/Eye Year (EY) and 0.01/EY, respectively. Visual outcomes in the Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) and Idiopathic Uveitis cohorts were not statistically significant. Of the 293 affected eyes, posterior synechiae was the predominant complication on presentation, while cataract had the highest incidence rate (0.05/EY). On direct comparison, children with JIA-U were statistically significantly more likely to develop glaucoma while children with Idiopathic Uveitis were statistically significantly more likely to develop macular oedema. Conclusion One third of children received a biological therapy, reflecting increasing utilisation and importance of biological agents in the management of inflammatory conditions. Rates of visual impairment and ocular complications are an improvement on previously published data

Effect of napping on response time, perceived sleepiness during the Ultra Trail du Mont Blanc®, observational pilot study

Cette étude avait pour but d’évaluer l’effet de la sieste sur la somnolence perçue et les performances cognitives lors d’un ultra trail. Synthèse des faits et résultats Vingt-trois coureurs, ont participé à notre étude sur l’Ultra Trail du Mont Blanc ® 2021 (UTMB®). Leur somnolence (Karolinska Sleepiness Scale, KSS) et leurs performances cognitives (temps de réaction, RT) ont été évaluées au ravitaillement du 142e kilomètre (32,2±2heures de course). Deux groupes ont été formés : un groupe sieste (GS ; n =11) et un contrôle (GC ; n =12). Les mesures ont été effectuées à l’entrée du point de ravitaillement (ENT), à la sortie de la sieste (POST ; uniquement pour GS) et 1km après le ravitaillement (1km). À ENT, GS avait des temps de réaction (RT) supérieurs à ceux de GC (p <0,05). Une baisse de RT a été observée chez le GS immédiatement après la sieste (p <0,05). Cette amélioration était encore conservée à 1km (p <0,001). À 1km il n’y avait plus de différence entre les deux groupes. Enfin le score KSS du GS a baissé entre POST et 1km (p <0,001). Conclusion Le groupe ayant effectué une sieste au cours de la deuxième nuit de course ont produit des RT plus faibles que le groupe GC. Plus qu’une stratégie à long terme, la perception d’une moindre vigilance semble être un facteur déterminant dans la prise de décision chez les coureurs souhaitant s’arrêter pour dormir. Dans ce cadre, une sieste de 15 à 20min, temps d’endormissement compris, semble améliorer autant les performances cognitives que la somnolence perçue. // The aim of this study is to evaluate the effect of napping on perceived sleepiness and cognitive performance during an ultra-trail. Summary of facts and results Twenty-three runners participated in our study on the Ultra Trail du Mont Blanc ® 2021 (UTMB®). Their sleepiness status (Karolinska Sleepiness Scale, KSS) and cognitive performances (reaction time, RT) were evaluated at the the kilometer 142 checkpoint (28±2hrs of race). Two groups were formed: a nap group (GS, n =11) and a control group (GC, n =12). Measurements were made at the entrance to the checkpoint (ENT), right after the nap (POST, only for GS) and 1km after the checkpoint (1km). At ENT, GS runners had a longer RT than GC (P <0.05). There was an improvement in RT immediately after the nap in the GS group (P <0.05). This improvement was maintained at 1km (P <0.001). At 1km, there was no difference between the two groups. A decrease in the KSS of the GS group was observed between POST and 1km (P <0.001). Conclusion The participant who took a nap during the second night of UTMB had lower cognitive performances than the GC group. Beyond a long-term strategy, the perception of a lesser self-alertness seems to be a determinant in the decision making to stop for a nap. In this context, a 15 to 20min nap, including the sleep onset duration, seems to improve cognitive performance as well as perceived sleepiness