Management of lumbar bone stress injury in cricket fast bowlers and other athletes

Background: Recent guidelines (including a special series in The Lancet) have emphasised a minimal role for imaging when assessing low back pain in adults, as the majority of patients will have non-specific findings on imaging that do not correlate well with pain. Objective: To assess whether the diagnosis of lumbar bone stress injuries in young athletes should be considered an exception to the recommendation to avoid imaging for low back pain in adults. Method: Narrative review. Results: Early lumbar bone stress injury diagnosis has been available via traditional MRI sequences (and its precursor Single Photon Emission Computed Tomography (SPECT)) for 25-30 years. MRI assessments using bone window sequences (such as Volumetric Interpolated Breath-hold Examination (VIBE)) have allowed a better understanding of the diagnosis and prognosis of lumbar bone stress injury in young athletes. MRI with bone sequences has allowed non-radiating scans to serially follow the healing of unilateral stress fractures. In the majority of cases, non-chronic unilateral fractures can heal; however, this takes three-six months rather than the six-ten weeks that would be the typical unloading period if using symptoms (only) as a guide. The use of MRI to provide evidence of bony healing (as opposed to fibrous union, which creates the pars defect that predisposes to further bone stress lesions) can lead to better long-term outcomes in athletes. There is evidence to flag this as a structural lesion which is both painful and, more importantly, can heal/resolve if managed correctly. Therefore it represents an important ‘specific’ diagnostic subset within adult low back pain. Conclusion: Structural (rather than functional) management of bone stress injuries in high-demand athletes, such as cricket pace bowlers, is in contrast to the recommendation of functional management for general back pain in adults. Structural management is justified when there are demonstrable superior outcomes of having better structure. Although this has not yet been shown in randomised trials of elite athletes, apparent lengthier Test cricket careers of pace bowlers who do not have pars defects suggest better athletic outcomes if bony healing is achieved. For lower demand young adults, or athletes with established bilateral pars defects, functional management may be more pragmatic

A mini-corer for precision sampling of the water-sediment interface in subglacial lakes and other remote aqueous environments:Sampling low energy water sediment interfaces

Recent interest in Antarctic subglacial lakes has seen the development of bespoke systems for sampling them. These systems are considered pristine environments potentially harboring undisturbed sedimentary sequences and ecosystems adapted to these cold oligotrophic environments in the absence of sunlight. The water/sediment interface is considered a prime location for the detection of microbial life and so is of particular interest. This article describes the development of a small corer to capture and retain a short core that includes the water/sediment interface specifically to address the question of whether life exists in these lakes. This apparatus was developed as part of the UK led project to access, measure, and sample subglacial Lake Ellsworth. In addition to addressing the constraints of coring in this difficult environment, the results of subsequent testing suggest that this corer can be applied to sampling sediments in other environments and would be particularly useful in low energy environments when the water‐sediment interface is indistinct or unconsolidated

Real-world Multicenter Analysis of Clinical Outcomes and Safety of Meropenem-Vaborbactam in Patients Treated for Serious Gram-Negative Bacterial Infections

Fourty patients were treated with meropenem-vaborbactam (MEV) for serious Gram-negative bacterial (GNB) infections. Carbapenem-resistant Enterobacteriaceae (CRE) comprised 80.0% of all GNB infections. Clinical success occurred in 70.0% of patients. Mortality and recurrence at 30 days were 7.5% and 12.5%, respectively. One patient experienced a probable rash due to MEV

Metastatic melanoma in an esophagus demonstrating Barrett esophagus with high grade dysplasia

BACKGROUND: Metastatic melanoma involving the esophagus is rare; the occurrence of metastatic melanoma in a background of Barrett esophagus is rarer still. We report a case of an 80 year-old male who presented to our institution for workup of Barrett esophagus with high-grade dysplasia and who proved to have metastatic melanoma occurring in the background of Barrett esophagus, the first report of this kind, to our knowledge, in the English literature. CASE PRESENTATION: An 80 year-old Caucasian male was diagnosed at an outside institution with Barrett’s esophagus with high grade dysplasia and presented to our institution for therapy. The patient underwent endoscopic mucosal resection using a band ligation technique of an area of nodularity within the Barrett esophagus. Microscopic examination demonstrated extensive Barrett esophagus with high-grade dysplasia as well as a second tumor which was morphologically different from the surrounding high-grade dysplasia and which was positive for S-100, HMB 45 and Melan-A on immunohistochemistry, consistent with melanoma. Further workup of the patient demonstrated multiple radiologic lesions consistent with metastases. Molecular studies demonstrated that the melanoma was positive for the 1799T>A (V600E) mutation in the BRAF gene. The overall features of the tumor were most consistent with metastatic melanoma occurring in a background of Barrett esophagus with high-grade dysplasia. CONCLUSION: This case demonstrates a unique intersection between a premalignant condition (Barrett esophagus with high grade dysplasia) and a separate malignancy (melanoma). This report also shows the utility of molecular testing to support the hypothesis of primary versus metastatic disease in melanoma

The influence of training load, exposure to match play and sleep duration on daily wellbeing measures in youth athletes

This study assessed the influence of training load, exposure to match play and sleep duration on two daily wellbeing measures in youth athletes. Forty-eight youth athletes (age 17.3 ± 0.5 years) completed a daily wellbeing questionnaire (DWB), the Perceived Recovery Status scale (PRS), and provided details on the previous day’s training loads (TL) and self-reported sleep duration (sleep) every day for 13 weeks (n = 2727). Linear mixed models assessed the effect of TL, exposure to match play and sleep on DWB and PRS. An increase in TL had a most likely small effect on muscle soreness (d = −0.43;± 0.10) and PRS (d = −0.37;± 0.09). Match play had a likely small additive effect on muscle soreness (d = −0.26;± 0.09) and PRS (d = −0.25;± 0.08). An increase in sleep had a most likely moderate effect on sleep quality (d = 0.80;± 0.14); a most likely small effect on DWB (d = 0.45;± 0.09) and fatigue (d = 0.42;± 0.11); and a likely small effect on PRS (d = 0.25;± 0.09). All other effects were trivial or did not reach the pre-determined threshold for practical significance. The influence of sleep on multiple DWB subscales and the PRS suggests that practitioners should consider the recovery of an athlete alongside the training stress imposed when considering deviations in wellbeing measures

Lab-on-chip for in situ analysis of nutrients in the deep sea

Microfluidic reagent-based nutrient sensors offer a promising technology to address the global undersampling of ocean chemistry but have so far not been shown to operate in the deep sea (>200 m). We report a new family of miniaturized lab-on-chip (LOC) colorimetric analyzers making in situ nitrate and phosphate measurements from the surface ocean to the deep sea (>4800 m). This new technology gives users a new low-cost, high-performance tool for measuring chemistry in hyperbaric environments. Using a combination of laboratory verification and field-based tests, we demonstrate that the analyzers are capable of in situ measurements during profiling that are comparable to laboratory-based analyses. The sensors feature a novel and efficient inertial-flow mixer that increases the mixing efficiency and reduces the back pressure and flushing time compared to a previously used serpentine mixing channel. Four separate replicate units of the nitrate and phosphate sensor were calibrated in the laboratory and showed an average limit of detection of 0.03 μM for nitrate and 0.016 μM for phosphate. Three on-chip optical absorption cell lengths provide a large linear range (to >750 μM (10.5 mg/L-N) for nitrate and >15 μM (0.47 mg/L-P) for phosphate), making the instruments suitable for typical concentrations in both ocean and freshwater aquatic environments. The LOC systems automatically collected a series of deep-sea nitrate and phosphate profiles in the northeast Atlantic while attached to a conductivity temperature depth (CTD) rosette, and the LOC nitrate sensor was attached to a PROVOR profiling float to conduct automated nitrate profiles in the Mediterranean Sea

Real-world, Multicenter Experience With Meropenem-Vaborbactam for Gram-Negative Bacterial Infections Including Carbapenem-Resistant Enterobacterales and Pseudomonas Aeruginosa

Background: We aimed to describe the clinical characteristics and outcomes of patients treated with meropenem-vaborbactam (MEV) for a variety of gram-negative infections (GNIs), primarily including carbapenem-resistant Enterobacterales (CRE). Methods: This is a real-world, multicenter, retrospective cohort within the United States between 2017 and 2020. Adult patients who received MEV for ≥72 hours were eligible for inclusion. The primary outcome was 30-day mortality. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineated the risk of negative clinical outcomes (NCOs) and was examined by multivariable logistic regression analysis (MLR). Results: Overall, 126 patients were evaluated from 13 medical centers in 10 states. The most common infection sources were respiratory tract (38.1%) and intra-abdominal (19.0%) origin, while the most common isolated pathogens were CRE (78.6%). Thirty-day mortality and recurrence occurred in 18.3% and 11.9%, respectively. Adverse events occurred in 4 patients: nephrotoxicity (n = 2), hepatoxicity (n = 1), and rash (n = 1). CART-BP between early and delayed treatment was 48 hours (P = .04). MEV initiation within 48 hours was independently associated with reduced NCO following analysis by MLR (adusted odds ratio, 0.277; 95% CI, 0.081-0.941). Conclusions: Our results support current evidence establishing positive clinical and safety outcomes of MEV in GNIs, including CRE. We suggest that delaying appropriate therapy for CRE significantly increases the risk of NCOs

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts