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Introduction: Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy. Methods: In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad). Results: There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12–30) days; II: 10 (95% CI: 7.3.1–13.4)]. Apophyseal injuries of the hip–pelvis resulted in the greatest burden [median: 13 (95% CI: 10–17); II: 2.5 (95% CI: 2.1–3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot–ankle (II: 2.4; 95% CI: 1.0–4.9), U-14 for knee (II: 4.5; 95% CI: 2.7–7.1), and U-17 for hip–pelvis (II: 6.4; 95% CI: 4.2–9.3). Conclusion: Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip–pelvic apophyseal injuries accounted for the largest injury burden.

Background: The association between injury risk and skeletal maturity in youth soccer has received little attention. Purpose: To prospectively investigate injury patterns and incidence in relation to skeletal maturity in elite youth academy soccer players and to determine the injury risks associated with the skeletal maturity status, both overall and to the lower limb apophysis. Study Design: Descriptive epidemiology study. Methods: All injuries that required medical attention and led to time loss were recorded prospectively during 4 consecutive seasons in 283 unique soccer players from U-13 (12 years of age) to U-19 (18 years). The skeletal age (SA) was assessed in 454 player-seasons using the Fels method, and skeletal maturity status (SA minus chronological age) was classified as follows: late, SA >1 year behind chronological age; normal, SA ±1 year of chronological age; early, SA >1 year ahead of chronological age; and mature, SA = 18 years. An adjusted Cox regression model was used to analyze the injury risk. Results: A total of 1565 injuries were recorded; 60% were time-loss injuries, resulting in 17,772 days lost. Adjusted injury-free survival analysis showed a significantly greater hazard ratio (HR) for different status of skeletal maturity: early vs normal (HR = 1.26 [95% CI, 1.11-1.42]; P < .001) and early vs mature (HR = 1.35 [95% CI, 1.17-1.56]; P < .001). Players who were skeletally mature at the wrist had a substantially decreased risk of lower extremity apophyseal injuries (by 45%-61%) compared with late ( P < .05), normal ( P < .05), and early ( P < .001) maturers. Conclusion: Musculoskeletal injury patterns and injury risks varied depending on the players’ skeletal maturity status. Early maturers had the greatest overall adjusted injury risk. Players who were already skeletally mature at the wrist had the lowest risk of lower extremity apophyseal injuries but were still vulnerable for hip and pelvis apophyseal injuries.

ObjectivesTo describe age group patterns for injury incidence, severity and burden in elite male youth football.MethodsProspective cohort study capturing data on individual exposure and time-loss injuries from training and matches over four seasons (2016/2017 through 2019/2020) at a national football academy (U13–U18; age range: 11–18 years). Injury incidence was calculated as the number of injuries per 1000 hours, injury severity as the median number of days lost and injury burden as the number of days lost per 1000 hours.ResultsWe included 301 players (591 player-seasons) and recorded 1111 time-loss injuries. Overall incidence was 12.0 per 1000 hours (95% CI 11.3 to 12.7) and burden was 255 days lost per 1000 hours (252 to 259). The mean incidence for overall injuries was higher in the older age groups (7.8 to 18.6 injuries per 1000 hours), while the greatest burden was observed in the U16 age group (425 days; 415 to 435). In older age groups, incidence and burden were higher for muscle injuries and lower for physis injuries. Incidence of joint sprains and bone stress injuries was greatest for players in the U16, U17 and U18 age groups, with the largest burden observed for U16 players. No clear age group trend was observed for fractures.ConclusionInjury patterns differed with age; tailoring prevention programmes may be possible.

ObjectiveInvestigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons.MethodsAll injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. Injury incidence (II) and burden (IB) were calculated as number of injuries per squad season (s-s), as well as for type, location and age groups.ResultsA total of 2204 injuries were recorded. 40% (n=882) required medical attention and 60% (n=1322) caused time-loss. The total time-loss was 25 034 days. A squad of 25 players sustained an average of 30 time-loss injuries (TLI) per s-s with an IB of 574 days lost per s-s. Compared with the other age groups, U-16 players had the highest TLI incidence per s-s (95% CI lower-upper): II= 59 (52 to 67); IB=992 days; (963 to 1022) and U-18 players had the greatest burden per s-s: II= 42.1 (36.1 to 49.1); IB= 1408 days (1373 to 1444). Across the cohort of players, contusions (II=7.7/s-s), sprains (II=4.9/s-s) and growth-related injuries (II=4.3/s-s) were the most common TLI. Meniscus/cartilage injuries had the greatest injury severity (95% CI lower-upper): II= 0.4 (0.3 to 0.7), IB= 73 days (22 to 181). The burden (95% CI lower-upper) of physeal fractures (II= 0.8; 0.6 to 1.2; IB= 58 days; 33 to 78) was double than non-physeal fractures.SummaryAt this youth football academy, each squad of 25 players averaged 30 injuries per season which resulted in 574 days lost. The highest incidence of TLI occurred in under-16 players, while the highest IB occurred in under-18 players.

Purposes: Iliac crest avulsion fracture is an unusual pathology. Final functional outcomes are generally excellent, though recurrent symptoms may delay the return to play. There is a lack of publis...

It is well established that differences in injury definition and recording methodology restrict comparisons between injury surveillance programmes. There is, however, little documentation of the variation that can exist between data recorders. The aim of this study was, therefore, to explore the effect on reported injuries when team recorders or supervisors are involved in research. Injury data collected prospectively over five seasons for the U16, U17, and U18 age groups in a youth football (soccer) academy were used to compare different recording settings based on the research involvement of the clinicians. A research-invested team physiotherapist reported an 8.8 times greater incidence (P < 0.001) of non-time-loss injuries and a 2.5 times greater incidence (P < 0.001) of minimal injuries (1-3 days lost) compared to a setting where neither the team physiotherapists nor the supervisor relied on the collected data for research purposes. When team physiotherapists were not invested in research themselves but were supervised by a researcher, the incidence of non-time-loss injuries and minimal injuries was 2.5 times (P < 0.001) and 2.0 times greater (P < 0.01) than in the non-invested setting, respectively. However, there were no differences between recording settings for overall incidence of time-loss injuries. The results from this study demonstrate that involving clinicians that are relying on the collected data for research purposes can significantly affect the reported rates of non-time-loss and minimal injuries. Time-loss injuries overall were not affected by research investment, and should therefore be preferred for comparisons between teams and seasons.

RATIONALE It has been proposed that the increase in the instances of idiosyncratic adverse drug reactions (IADRs) and black box warnings may be attributed to the occurrence of reactive metabolites. Consequently, a high-throughput screen for reactive metabolites formed from liver microsome extracts with added glutathione (GSH) was developed for use in the early stages of drug discovery. METHODS To enhance sensitivity and specificity, as well as accelerate data processing, a mixture of a stable-isotope probe consisting of natural GSH (light GSH) and stable-isotope-labeled [(15) N,(13) C(2)] GSH (heavy GSH) at a ratio of 1:1 was used. Any metabolite that reacted with the GSH results in the formation of light and heavy GSH conjugates with a 3 Da difference. Employing a precursor-ion scan using negative ion electrospray ionization (ESI) corresponding to the expected fragments, signals with the appropriate ratio in the precursor ion scan are then further examined. RESULTS The new method greatly simplifies data collection by assuming molecules containing GSH will fragment to form specific ions. As such, this approach accelerates data processing (and collection) at the risk of missing compounds that do not fragment as expected. The assay was validated with 33 diverse drugs known to form GSH conjugates, 5 drugs known to not form GSH adducts and over 100 samples containing components of the normal in vitro matrix. In all cases data collected matched the expected result. CONCLUSIONS The observed sensitivity, specificity, and fast data processing make this assay an excellent fit for high-throughput screening of reactive metabolites in the early stages of drug discovery. This method is not intended to eliminate compounds or terminate their development. Instead, it is to bring forward molecules with one less liability and thus a greater probability of ultimate success.

Rapid information on metabolic profiling is required to evaluate the structural liabilities of drug candidates in early drug discovery. In this study, a sensitive and rapid semi-quantitative method was developed to simultaneously monitor the drug candidate and metabolites as well as collect tandem mass (MS/MS) spectra for subsequent metabolite identification. The simultaneous semi-quantitation and identification of metabolites in fresh hepatocytes is achieved using high-performance liquid chromatography (HPLC) coupled with a hybrid quadrupole linear ion trap. The survey experiment consists of monitoring multiple-reaction monitoring (MRM) transitions for the internal standard, the parent, and 48 MRM transitions designed to cover the most common phase I and II biotransformations. An information-dependent acquisition (IDA) method was employed to trigger product ion scans above the MRM signal threshold. Three biotransformations of a lead compound have been identified through enhanced product ion scans and the respective MRM transitions of those metabolites were selected for semi-quantitation. Parent disappearance and formation of the metabolites as a function of incubation time in five different species were monitored by their respective MRM responses. The method provides the necessary sensitivity to detect minor metabolites in a relevant therapeutic concentration range. Enzymatic turnover of the parent and the metabolites in different species are revealed based on the different initial concentrations of the parent. This methodology integrates the parent disappearance, metabolite identification, and the formation of the metabolites along the time course using a single rapid LC/MS/MS analysis. This method can be used as a complementary tool to the conventional method of metabolic profiling. It provides a rapid and sensitive initial profile of the metabolism of potential structural series at the lead selection stage. The method can also be incorporated into the overall metabolite profiling scheme to evaluate the drug candidates in drug discovery.

Although substance P (SP) has been implicated as a mediator of neurogenic inflammation in the small intestine, little information is available regarding the role of SP in the pathogenesis of chronic ulcerative colitis. In this study, our aim was to investigate whether the intraperitoneal administration of a nonpeptide neurokinin-1 (NK-1) antagonist, CP-96345, which antagonizes the binding of SP to its NK-1 receptor, results in the attenuation of colonic inflammation induced in rats by 5% dextran sodium sulfate (DSS) in drinking water for 10 days compared with an inactive enantiomer, CP-96344. Disease activity was assessed daily for 10 days, after which colonic tissue damage was scored and myeloperoxidase activity and colon and urinary 8-isoprostanes were measured. Animals receiving DSS exhibited marked physical signs of colitis by day 5 compared with controls. Chronic administration of the NK-1 antagonist significantly reduced the disease activity index, mucosal myeloperoxidase activity, colonic tissue damage score, and mucosal and urinary levels of 8-isoprostanes compared with inactive enantiomer- or vehicle-injected (saline) animals receiving DSS alone. These data indicate that the administration of an NK-1 antagonist can attenuate colonic inflammation and oxidative stress and suggest a novel therapeutic approach in the treatment of chronic ulcerative colitis.

It has been proposed that the increase in the instances of idiosyncratic adverse drug reactions (IADRs) and black box warnings may be attributed to the occurrence of reactive metabolites. Consequently, a high-throughput screen for reactive metabolites formed from liver microsome extracts with added glutathione (GSH) was developed for use in the early stages of drug discovery.To enhance sensitivity and specificity, as well as accelerate data processing, a mixture of a stable-isotope probe consisting of natural GSH (light GSH) and stable-isotope-labeled [(15) N,(13) C(2)] GSH (heavy GSH) at a ratio of 1:1 was used. Any metabolite that reacted with the GSH results in the formation of light and heavy GSH conjugates with a 3 Da difference. Employing a precursor-ion scan using negative ion electrospray ionization (ESI) corresponding to the expected fragments, signals with the appropriate ratio in the precursor ion scan are then further examined.The new method greatly simplifies data collection by assuming molecules containing GSH will fragment to form specific ions. As such, this approach accelerates data processing (and collection) at the risk of missing compounds that do not fragment as expected. The assay was validated with 33 diverse drugs known to form GSH conjugates, 5 drugs known to not form GSH adducts and over 100 samples containing components of the normal in vitro matrix. In all cases data collected matched the expected result.The observed sensitivity, specificity, and fast data processing make this assay an excellent fit for high-throughput screening of reactive metabolites in the early stages of drug discovery. This method is not intended to eliminate compounds or terminate their development. Instead, it is to bring forward molecules with one less liability and thus a greater probability of ultimate success.

Objectives: To evaluate the reliability level of an innovative method using a standardized stretch force to assess the flexibility of lower limb muscle groups in highly-trained adolescent athletes and to examine whether interchanging the examiners affects the reliability of the measures. Design: Randomized testeretest study. Setting and participants: In ten athletes, the flexibility of eight lower limb muscle groups was examined on two occasions on both sides and in two phases: a video capture by three distinct operators and an analysis by three distinct analysers. The reliability of the measures was assessed by the coefficient of variation (CV, 90% CI). Between-analysers and between-operators standardized differences (i.e., Cohen’s d) were calculated. Results: CV (%, 90% CI) were 8.3% (7.5; 9.3) for quadriceps, 3.3% (3.0; 3.7) for hamstrings, 7.2% (6.5e8.0) for adductors, 5.7% (5.1; 6.3) for gastrocnemius, 4.5% (4.0; 5.0) for soleus, 2.6% (2.3; 2.9) for hip flexors, 9.6% (8.6; 10.8) for hip medial rotators and 12.4% (12.2; 14.0) for hip lateral rotators. There was no substantial (i.e., Cohen’s d < 0.2) difference in CV between all the possible operators/analysers combinations. Conclusion: This method has a moderate-to-good reliability level and is examiner-independent. It may be implemented in future injury prevention programs, in order to monitor the flexibility of highly-trained adolescent athletes.

Background Standing pelvic posture remains a common assessment in sports therapy. The palpation technique assessing the relative position of the anterior and posterior superior iliac spines is widely used to quantify the asymmetry in pelvic position, but the reliability of this approach in adolescent athletes is not determined. Objective The aim of the present study was to examine the inter-rater and intra-rater reliability of palpation meter (PALM) measures for assessing standing pelvic tilt in adolescent athletes. Design Test-retest study. Setting Sports academy physiotherapy laboratory. Participants A group of highly-trained adolescent multi-sport athletes (n=75, age=14.9±1.7 yr) training in a national sports academy. Interventions On two occasions (10 min apart), two physiotherapists took the measurements of standing neutral pelvic tilt, anterior pelvic tilt and posterior pelvic tilt using the PALM. In each position an average of three measurements was taken by each examiner, alternatively for each side. Main outcome measurements: Reliability of standing pelvic tilt measures was assessed by calculating the between-session and the between-physiotherapists differences expressed as Cohen9s d and the standard error of measurement (SEM: CV). Results All measured parameters showed good inter-rater and intra-rater reproducibility. The standardized differences between two trials or two physiotherapists was trivial with Cohen9s d Conclusions The present method for assessing neutral and anterior standing pelvic tilt measurements has a good reliability level and may integrate longitudinal screening and clinical examination routines in young athletes. However, posterior pelvic tilt measurements should be cautiously interpreted due to lower measurements9 reliability.

Background Lower limbs muscle flexibility remains a common assessment in sports therapy. Nevertheless no clear consensus exists about the methods for performing reliable measurements. Objective The aim of the present study was to examine the reliability of muscle flexibility measures in adolescent athletes. Design Randomised test-retest study. Setting Sports academy physiotherapy laboratory. Participants Height young athletes (age: 15.1±1.6, body mass: 65.4±26.2 kg, height: 171.7±8.8 cm) training in a national sports centre. Interventions Flexibility of the main lower limb muscles was assessed, using a standardised force of stretching for each muscle and a video analysis software for measuring the angles. Each participant was tested on both sides by three operators and on two separate occasions, 4 days apart. Final measurements were reported in degrees. Main outcome measurements Reliability of flexibility measures was assessed by 1) calculating the between-day difference expressed as Cohen9s d (90% CI), no substantial difference was considered if Cohen9s d Results Force of stretching (in N), mean angle (SD), mean between-day difference and CV were 78.5, 132.2 (10.1), −0.05 (−0.3;0.2) and 8.3% (7.5;9.3) for quadriceps, 68.7, 70 (11.2), −0.7 (−1.7;0.4) and 3.3% (3.0;3.7) for hamstrings, 39.2, 53.5 (9.4), 0.05 (−0.2;0.3) and 7.2% (6.5–8.0) for adductors, 147.2, 16 (6.3), 0.10 (−0.1;0.3) and 5.7% (5.1;6.3) for gastrocnemius, 147.2, 30.6 (8.9), 0.01 (−0.2;0.2) and 4.5% (4.0;5.0) for soleus, 98.1, 22.7 (5.9), 0.01 (−0.2;0.2) and 2.6% (2.3;2.9) for hip flexors, 49.1, 54.7 (14.5), −0.04 (−0.2;0.2) and 9.6% (8.6;10.8) for hip medial rotator and 49.1, 43.5 (14.9), −0.08 (−0.3;0.1) and 18.2% (16.3;20.5) for hip lateral rotator. Conclusion The present method for assessing lower limb muscles flexibility has a moderate-to-good level reliability and may integrate prevention programs.