Acute tear of the fascia cruris at the attachment to the Achilles tendon: a new diagnosis

BACKGROUND: The fascia cruris encloses the posterior structures of the calf and connects to the paratenon and the Achilles tendon. We describe the clinical presentation, ultrasound imaging characteristics and the time to the recovery of tears of the fascia cruris at the attachment to the Achilles tendon. METHODS: Retrospective review of 11 tears of the fascia cruris in the different legs as separate events in 9 patients (6 male and 3 female, mean age 35.52 years, range 11–48) identified using diagnostic ultrasound, after presenting with Achillodynia. RESULTS: 11 participants presented at a mean of 4.5 weeks (range 0.5–12) after onset of symptoms. The left Achilles was more commonly injured than the right (7 : 4) and the lateral side more than the medial (6 : 4) with one case with medial and lateral presentation. Clinically, there was swelling and tenderness over the medial or lateral border in the mid to upper portion of the Achilles. 7 of the 11 (63.6%) had functional overpronation. Ultrasound appearances of a tear were identified as hypoechoic area extending from the medial or lateral border of the Achilles extending along the anatomical plane of the fascia cruris. Average return to activity was 5.2 weeks (range 1–22). Participants presenting later had longer recovery but all participants returned to full activity (r=0.4). CONCLUSIONS: This is the first description of the clinical details and sonographic findings of a tear to the fascia cruris at its attachment to the Achilles tendon. This needs to be considered as a cause of Achillodynia in athletes as recognition will affect the management

Spatial quantitation of drugs in tissues using liquid extraction surface analysis mass spectrometry imaging

Liquid extraction surface analysis mass spectrometry imaging (LESA-MSI) has been shown to be an effective tissue profiling and imaging technique, producing robust and reliable qualitative distribution images of an analyte or analytes in tissue sections. Here, we expand the use of LESA-MSI beyond qualitative analysis to a quantitative analytical technique by employing a mimetic tissue model previously shown to be applicable for MALDI-MSI quantitation. Liver homogenate was used to generate a viable and molecularly relevant control matrix for spiked drug standards which can be frozen, sectioned and subsequently analyzed for the generation of calibration curves to quantify unknown tissue section samples. The effects of extraction solvent composition, tissue thickness and solvent/tissue contact time were explored prior to any quantitative studies in order to optimize the LESA-MSI method across several different chemical entities. The use of a internal standard to normalize regional differences in ionization response across tissue sections was also investigated. Data are presented comparing quantitative results generated by LESA-MSI to LC-MS/MS. Subsequent analysis of adjacent tissue sections using DESI-MSI is also reported

Medication and Supplement Use in Disability Football World Championships

Background Individuals with an impairment make up over 15% of the world’s population, many of whom can benefit greatly from participation in sport. The provision of medical services in disability sport is a challenging area with a lack of scientific evidence. Given the positive impact that sport can have on the people with an impairment, it is vital that measures are taken to better understand the medical issues posed by disability sport. It is well established that medications and supplements are over-used in sport, particularly within professional football, but there is no current evidence on medication or supplement use in elite disability football. Objective To examine and describe the use of medication and supplements in disability football, prior to and during international tournaments, and to identify the profile of substances used by category. Design Prospective, descriptive, cohort study. Setting International Blind Sport Association (IBSA) Football World Cup 2015 and the International Federation of Cerebral Palsy Football (IFCPF) World Cup 2015. Participants Two hundred and forty-two elite level disability footballers, classified with B1 visual impairment or cerebral palsy. Methods Team clinicians were asked to document all medication and supplements taken in the 48 hours prior to each match. Results This study recorded the use of 1648 substances in 242 players, with more than half (53.1%) classified as supplements. There was an overall rate of 1.26 substances used per player per match and a medication use rate of 0.59 medications per player per match. Seventy percent (170/242) of players reported using at least one substance per tournament, with 57.9% (140/242) using at least one prescribed medication (63.6% of players at IBSA World Games and 57.7% of players at IFCPF World Cup). The most commonly prescribed category of medications was non-steroidal anti-inflammatory drugs (NSAIDs), representing 39.3% of all reported medications. Conclusion This study highlights the potential overuse of medication and supplements in disability football, particularly in the use of NSAIDs. These trends are comparable to previous research in FIFA World Cup competitions

Natural Heterogeneity Prevents Synchronization of Fridges With Deterministic Frequency Control

Appliances that cycle on and off throughout the day, such as fridges, freezers, and air-conditioners can collectively provide second-by-second electricity supply-demand balancing known as frequency response. Previous studies have shown that deterministic temperature set-point control of a homogeneous population of such appliances can cause herding behavior with detrimental effects on the system. Here, we use computational modeling to establish the minimum population heterogeneity required to prevent herding problems without requiring centralized or stochastic control. We discover a linear relationship between the benefits that fridges can provide and their number. The impact on system benefits and on fridge temperatures of varying fridge frequency sensitivity is also explored, and a viable range for sensitivity (the control parameter) is proposed. Our approach involves simulating a large heterogeneous population of frequency-sensitive fridges using 12 months' GB system data from National Grid. We compare the historic frequency response from other response providers with their response in our fridge simulations to determine the benefits of the fridge population response. We find that a fridge population can offer a valuable demand-side response service to the electricity system operator, requiring neither the expensive infrastructure of centralized control nor the regular intervention of stochastic control for temperature cycle desynchronization

Mass spectrometry imaging of cassette-dosed drugs for higher throughput pharmacokinetic and biodistribution analysis

Cassette dosing of compounds for preclinical drug plasma pharmacokinetic analysis has been shown to be a powerful strategy within the pharmaceutical industry for increasing throughput while decreasing the number of animals used. Presented here for the first time is data on the application of a cassette dosing strategy for label-free tissue distribution studies. The aim of the study was to image the spatial distribution of eight nonproprietary drugs (haloperidol, bufuralol, midazolam, clozapine, terfenadine, erlotinib, olanzapine, and moxifloxacin) in multiple tissues after oral and intravenous cassette dosing (four compounds per dose route). An array of mass spectrometry imaging technologies, including matrix-assisted laser desorption ionization mass spectrometry imaging (MALDI MSI), liquid extraction surface analysis tandem mass spectrometry (LESA-MS/MS), and desorption electrospray ionization mass spectrometry (DESI-MS) was used. Tissue analysis following intravenous and oral administration of discretely and cassette-dosed compounds demonstrated similar relative abundances across a range of tissues indicating that a cassette dosing approach was applicable. MALDI MSI was unsuccessful in detecting all of the target compounds; therefore, DESI MSI, a complementary mass spectrometry imaging technique, was used to detect additional target compounds. In addition, by adapting technology used for tissue profiling (LESA-MS/MS) low spatial resolution mass spectrometry imaging (∼1 mm) was possible for all targets across all tissues. This study exemplifies the power of multiplatform MSI analysis within a pharmaceutical research and development (R&D) environment. Furthermore, we have illustrated that the cassette dosing approach can be readily applied to provide combined, label-free pharmacokinetic and drug distribution data at an early stage of the drug discovery/development process while minimizing animal usage

Energy feedback to domestic consumers: An evidence review for the Smart Energy Research Lab

The purpose of this evidence review is to inform a future energy advice service for domestic consumers (likely to be delivered as part of the Smart Energy Research Lab (SERL)) about what types of feedback have been trialled in the past, and what can be learned from these trials. Preliminary recommendations are offered in the next section in the executive summary, ahead of the more detailed review of different aspects of energy feedback and advice

Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days

OBJECTIVETo describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games. METHODS A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems. RESULTSThe total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35–75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively). CONCLUSION (1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35–75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games

Effects of Cooling During Exercise on Thermoregulatory Responses of Men With Paraplegia.

BACKGROUND: People with spinal cord injury (SCI) have an altered afferent input to the thermoregulatory center, resulting in a reduced efferent response (vasomotor control and sweating capacity) below the level of the lesion. Consequently, core body temperature rises more rapidly during exercise in individuals with SCI compared with people who are able-bodied. Cooling strategies may reduce the thermophysiological strain in SCI. OBJECTIVE: The aim of this study was to examine the effects of a cooling vest on the core body temperature response of people with a thoracic SCI during submaximal exercise. METHODS: Ten men (mean age=44 years, SD=11) with a thoracic lesion (T4-T5 or below) participated in this randomized crossover study. Participants performed two 45-minute exercise bouts at 50% maximal workload (ambient temperature 25°C), with participants randomized to a group wearing a cooling vest or a group wearing no vest (separate days). Core body temperature and skin temperature were continuously measured, and thermal sensation was assessed every 3 minutes. RESULTS: Exercise resulted in an increased core body temperature, skin temperature, and thermal sensation, whereas cooling did not affect core body temperature. The cooling vest effectively decreased skin temperature, increased the core-to-trunk skin temperature gradient, and tended to lower thermal sensation compared with the control condition. LIMITATIONS: The lack of differences in core body temperature among conditions may be a result of the relative moderate ambient temperature in which the exercise was performed. CONCLUSIONS: Despite effectively lowering skin temperature and increasing the core-to-trunk skin temperature gradient, there was no impact of the cooling vest on the exercise-induced increase in core body temperature in men with low thoracic SCI

International Paralympic Committee Beat The Heat Athlete Advice Sheets

1. Prepare and acclimatise for heat at Tokyo 20202. Being heat illness aware, and recognise the signs and symptoms3. Staying hydrated at the Games4. Keeping cool while living and competing in the heat<br/