Search

The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program (education, home exercises, manual techniques, sub-symptom threshold aerobic exercise [STAE] program) to a similar program (education, home-exercises, STAE program), but without manual techniques, provided in a telerehabilitation format in adults with persisting post-concussion symptoms (PCS). In this parallel-group non-randomized clinical trial, 41 adults with persisting PCS were allocated to the in-clinic (n = 30) or telerehabilitation (n = 11) program. The outcome measures, which included the Post-Concussion Symptom Scale (PCSS; primary outcome), Numerical Pain Rating Scale (NPRS) for neck pain and headache and three disability questionnaires, were collected at baseline, weeks 6, 12, and 26. Non-parametric analysis for longitudinal data (NparLD) was used. For the PCSS, there was a group-by-time interaction (p = 0.05) with significant between-group differences at week 6, 12, and 26 (p < 0.05) for the in-clinic group. There were also group-by-time interactions for NPRS neck pain and headache (p < 0.05) for the in-clinic group. The study suggests that a telehealth format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. These results must be interpreted with caution given the limited number of participants. ClinicalTrials.gov Identifier: NCT03677661. The telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format. The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design: Systematic review and meta-analysis. Data sources: Four bibliographic databases (from inception until November 2021): Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL. Eligibility criteria: Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results: Eleven studies were included in this systematic review. When wearing foot orthoses, the risk ratio of developing a BSI on any lower extremity bone is 0.47 (95% CI 0.26 to 0.87; p = 0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p = 0.79). No meta-analyses could be performed for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion: This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Decision rules (eg, Canadian computed tomography head rule [CCHR] for adults and Pediatric Emergency Care Applied Research Network [PECARN] rule for children/adolescents) are used in emergency settings (emergency room [ER] rules) to assess traumatic brain injuries (TBIs). The rules have a high-sensitivity and nearperfect negative predictive value that help to rule out more severe TBI. * CLINICAL QUESTION: Which criteria should be added to the Sport Concussion Assessment Tool 5 (SCAT5) to reach the sensitivity of the ER rules and improve the utility of the SCAT5 for screening for higher-severity head and brain injuries? * KEY RESULTS: We performed a comparative analysis of the SCAT5 with the CCHR and PECARN rules. We compared the presence (yes or no) and comparative "face value" sensitivity (lower, identical, or higher) of the SCAT5 criteria to the ER rules criteria. Loss of consciousness, vomiting, severe/ increasing headache, and seizure are SCAT "red flags" with similar or higher sensitivity compared to ER rules criteria. Five criteria had lower sensitivity or were absent from the SCAT. Emergency room rules include any abnormality on the Glasgow Coma Scale (GCS<15), but only a "deterioration of the state of consciousness" is considered a "red flag" in the SCAT5. Persistent retrograde amnesia for more than 30 minutes, age >65, severity of the mechanism of injury, and signs of skull fractures are not mentioned in the SCAT5. * CLINICAL APPLICATION: We identified 5 criteria that could inform the evolution the SCAT5 to improve its ability to rule out more severe TBI in a sideline assessment context. [ABSTRACT FROM AUTHOR]

We herein report on the synthesis, structure, and use in alkyne hydroboration catalysis of [(IPrCl)Zn−R]+ and [(ItBu)Zn−R]+ cations bearing IPrCl (IPrCl=1,3‐bis[2,6‐bis(1‐methylethyl)phenyl]‐4,5‐dichloro‐1,3‐dihydro‐imidazol‐2‐ylidene) and the sterically demanding ItBu carbene (ItBu=1,3‐bis(1,1‐dimethylethyl)−1,3‐dihydro‐imidazol‐2‐ylidene). Ionization of neutral precursors [(IPrCl)ZnR2] (1 a, R=Et; 1 b, R=Me) and [(ItBu)ZnEt2] (2) with one equivalent of [Ph3C][B(C6F5)4] led to with robust and stable two‐coordinate ZnII cations [(IPrCl)Zn−R]+ (3 a, R=Et; 3 b, R=Me) and [(ItBu)Zn−Et]+ (4), respectively, all isolated as [B(C6F5)4]− salts. Further derivatization of alkyl cations 3 b and 4 by reaction with one equivalent of [B(C6F5)3] afforded cations [(IPrCl)Zn−C6F5]+ (5) and [(ItBu)Zn−C6F5]+ (6) as [B(C6F5)4]− salts, with cation 6 displaying a limited stability in solution. The molecular structures of cations 3 b, 4 and 5 were confirmed through X‐ray diffraction studies. Among stable cations, Fluoride ion affinity (FIA) estimations agree with cation 5 being the most Lewis acidic in thus far reported [(IPrCl)Zn−R]+ cations. In the presence of pinacol borane and 1‐octyne, cations 3 a–b, 5 and [(IPrCl)Zn−C6F5]+ (5 mol%) slowly catalyze the selective cis‐hydroboration of 1‐octyne to the vinylborane product A. Cation 5 also mediates 2‐hexyne hydroboration to afford a mixture of hydroboration products B and C. In the case of hydroboration catalysis mediated by cations 5 and [(IPrCl)Zn−C6F5]+, experimental data and preliminary DFT calculations are consistent a Lewis‐acid‐type catalysis. [ABSTRACT FROM AUTHOR]