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Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest (OHCA) is a global health problem affecting approximately 4.4 million individuals yearly. OHCA has a poor survival rate, specifically when unwitnessed (accounting for up to 75% of cases). Rapid recognition can significantly improve OHCA survival, and consumer wearables with continuous cardiopulmonary monitoring capabilities hold potential to "witness" cardiac arrest and activate emergency services. In this study, we used an arterial occlusion model to simulate cardiac arrest and investigated the ability of infrared photoplethysmogram (PPG) sensors, often utilized in consumer wearable devices, to differentiate normal cardiac pulsation, pulseless cardiac (i.e., resembling a cardiac arrest), and non-physiologic (i.e., off-body) states. Across the classification models trained and evaluated on three anatomical locations, higher classification performances were observed on the finger (macro average F1-score of 0.964 on the fingertip and 0.954 on the finger base) compared to the wrist (macro average F1-score of 0.837). The wrist-based classification model, which was trained and evaluated using all PPG measurements, including both high- and low-quality recordings, achieved a macro average precision and recall of 0.922 and 0.800, respectively. This wrist-based model, which represents the most common form factor in consumer wearables, could only capture about 43.8% of pulseless events. However, models trained and tested exclusively on high-quality recordings achieved higher classification outcomes (macro average F1-score of 0.975 on the fingertip, 0.973 on the finger base, and 0.934 on the wrist). The fingertip model had the highest performance to differentiate arterial occlusion pulselessness from normal cardiac pulsation and off-body measurements with macro average precision and recall of 0.978 and 0.972, respectively. This model was able to identify 93.7% of pulseless states (i.e., resembling a cardiac arrest event), with a 0.4% false positive rate. All classification models relied on a combination of time-, power spectral density (PSD)-, and frequency-domain features to differentiate normal cardiac pulsation, pulseless cardiac, and off-body PPG recordings. However, our best model represented an idealized detection condition, relying on ensuring high-quality PPG data for training and evaluation of machine learning algorithms. While 90.7% of our PPG recordings from the fingertip were considered of high quality, only 53.2% of the measurements from the wrist passed the quality criteria. Our findings have implications for adapting consumer wearables to provide OHCA detection, involving advancements in hardware and software to ensure high-quality measurements in real-world settings, as well as development of wearables with form factors that enable high-quality PPG data acquisition more consistently. Given these improvements, we demonstrate that OHCA detection can feasibly be made available to anyone using PPG-based consumer wearables., (© 2024. The Author(s).)

Objectives: This study explores the feasibility and effects of low-intensity blood flow restriction exercise on forearm muscle strength and function in individuals with spinal cord injury., Study Design: Pilot randomized clinical trial., Patients and Methods: Ten male and female adult participants with chronic cervical and thoracic spinal cord injury underwent an 8-week low-intensity blood flow restriction exercise programme that targeted forearm muscles. Each participant's contralateral forearm served as the control. Grip strength was the primary outcome measure, and participants also provided qualitative feedback on their experiences., Results: The study revealed a significant increase in participants' forearm muscle strength on the experimental side engaged in low-intensity blood flow restriction training, with an average strength gain of 7.5 ± 0.36 kg after 16 exercise sessions (Cohen's d = -6.32, 95% CI -8.34, -6.68). In comparison, the control side, following a conventional high- intensity exercise regimen without BFR, showed a more modest strength increase of 4.4 ± 0.67 kg. A mean Patient's Global Impression of Change score of 2.2 reflected overall improvements in participants' daily activities and health status., Conclusion: This study highlights the feasibility and effectiveness of low-intensity blood flow restriction exercise as a safe and promising approach to enhancing forearm muscle strength in individuals with spinal cord injury. The observed positive outcomes, coupled with a high level of participant satisfaction, underscore the potential of this innovative method to significantly improve limb muscle strength, thereby contributing to greater functional independence in this population.

Competing Interests: The authors received a Research Project Grant from the Canadian Institute of Health Research to conduct research titled “Advanced optical monitoring of free tissue transfer hemodynamics” (Application Number: 497249) in 2023.

Objectives: When an out-of-hospital cardiac arrest (OHCA) occurs, the first step in the chain of survival is detection. However, 75% of OHCAs are unwitnessed, representing the largest barrier to activating the chain of survival. Wearable devices have the potential to be "artificial bystanders," detecting OHCA and alerting 9-1-1. We sought to understand factors impacting users' willingness for continuous use of a wearable device through an online survey to inform future use of these systems for automated OHCA detection., Methods: Data were collected from October 2022 to June 2023 through voluntary response sampling. The survey investigated user convenience and perception of urgency to understand design preferences and willingness to adhere to continuous wearable use across different hypothetical risk levels. Associations between categorical variables and willingness were evaluated through nonparametric tests. Logistic models were fit to evaluate the association between continuous variables and willingness at different hypothetical risk levels., Results: The survey was completed by 359 participants. Participants preferred hand-based devices (wristbands: 87%, watches: 86%, rings: 62%) and prioritized comfort (94%), cost (83%), and size (72%). Participants were more willing to adhere at higher levels of hypothetical risk. At the baseline risk of 0.1%, older individuals with prior wearable use were most willing to adhere to continuous wearable use., Conclusion: Individuals were willing to continuously wear wearable devices for OHCA detection, especially at increased hypothetical risk of OHCA. Optimizing willingness is not just a matter of adjusting for user preferences, but also increasing perception of urgency through awareness and education about OHCA., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Objectives: To evaluate and compare the injuries of Olympic wrestlers during the 2016 Rio and 2020 Tokyo Olympic Games held in August 2021 due to the COVID-19 pandemic., Methods: In this descriptive epidemiological study, injury report forms were used to collect and analyse injury data during the competitions., Results: During 410 matches in the Rio Olympic Games, 21 injuries were recorded among 346 wrestlers (112=women), a rate of 5.1 injuries/100 bouts and 6.1 injuries/100 athletes. During 322 matches in the Tokyo Olympic Games, 28 injuries were recorded among 287 wrestlers (96=women), with 8.7 injuries/100 bouts and 9.8 injuries/100 athletes. However, these apparent differences in injury rates between Tokyo and Rio were not statistically significant (injuries/bout: p=0.057, 95% CI: 0.31 to 1.02; injuries/athlete: p=0.087, 95% CI: 0.33 to 1.08). Mild injuries comprised the greatest proportion of injuries in both Olympic Games. Severe injuries accounted for 0%, 16.7% and 36.4% of injuries in Greco-Roman, Freestyle and Women's wrestling, respectively., Conclusion: Most wrestling injuries in the 2016 Rio and 2020 Tokyo Olympic Games were mild skin injuries in the head and face regions due to direct body contact during standing positions in the 1/8-final round of wrestling competitions. No critical injury was observed during the recent Olympic Games. Attention should be drawn to preventing upper limb joint dislocations as common severe injuries in both Olympic Games. While not statistically significant, the Tokyo Games, after the COVID-19 pandemic, witnessed a higher injury occurrence than the Rio Games., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

A two-stream convolutional neural network (TCNN) for breathing pattern classification has been devised for the continuous monitoring of patients with infectious respiratory diseases. The TCNN consists of a convolutional neural network (CNN)-based autoencoder and classifier. The encoder of the autoencoder generates deep compressed feature maps, which contain the most important information constituting data. These maps are concatenated with feature maps generated by the classifier to classify breathing patterns. The TCNN, single-stream CNN (SCNN), and state-of-the-art classification models were applied to classify four breathing patterns: normal, slow, rapid, and breath holding. The input data consisted of chest tissue hemodynamic responses measured using a wearable near-infrared spectroscopy device on 14 healthy adult participants. Among the classification models evaluated, random forest had the lowest classification accuracy at 88.49%, while the TCNN achieved the highest classification accuracy at 94.63%. In addition, the proposed TCNN performed 2.6% better in terms of classification accuracy than an SCNN (without an autoencoder). Moreover, the TCNN mitigates the issue of declining learning performance with increasing network depth, as observed in the SCNN model. These results prove the robustness of the TCNN in classifying breathing patterns despite using a significantly smaller number of parameters and computations compared to state-of-the-art classification models.

Background: Evaluating muscle spasticity in children with cerebral palsy (CP) is essential for determining the most effective treatment strategies. This scoping review assesses the current methods used to evaluate muscle spasticity, highlighting both traditional and innovative technologies, and their respective advantages and limitations., Methods: A search (to April 2024) used keywords such as muscle spasticity, cerebral palsy, and assessment methods. Selection criteria included articles involving CP children, assessing spasticity objectively/subjectively, comparing methods, or evaluating method effectiveness., Results: From an initial pool of 1971 articles, 30 met our inclusion criteria. These studies collectively appraised a variety of techniques ranging from well-established clinical scales like the modified Ashworth Scale and Tardieu Scale, to cutting-edge technologies such as real-time sonoelastography and inertial sensors. Notably, innovative methods such as the dynamic evaluation of range of motion scale and the stiffness tool were highlighted for their potential to provide more nuanced and precise assessments of spasticity. The review unveiled a critical insight: while traditional methods are convenient and widely used, they often fall short in reliability and objectivity., Conclusion: The review discussed the strengths and limitations of each method and concluded that more reliable methods are needed to measure the level of muscle spasticity more accurately., (© 2024. The Author(s).)

Out-of-hospital cardiac arrest (OHCA) is a major health problem, with a poor survival rate of 2-11%. For the roughly 75% of OHCAs that are unwitnessed, survival is approximately 2-4.4%, as there are no bystanders present to provide life-saving interventions and alert Emergency Medical Services. Sensor technologies may reduce the number of unwitnessed OHCAs through automated detection of OHCA-associated physiological changes. However, no technologies are widely available for OHCA detection. This review identifies research and commercial technologies developed for cardiopulmonary monitoring that may be best suited for use in the context of OHCA, and provides recommendations for technology development, testing, and implementation. We conducted a systematic review of published studies along with a search of grey literature to identify technologies that were able to provide cardiopulmonary monitoring, and could be used to detect OHCA. We searched MEDLINE, EMBASE, Web of Science, and Engineering Village using MeSH keywords. Following inclusion, we summarized trends and findings from included studies. Our searches retrieved 6945 unique publications between January, 1950 and May, 2023. 90 studies met the inclusion criteria. In addition, our grey literature search identified 26 commercial technologies. Among included technologies, 52% utilized electrocardiography (ECG) and 40% utilized photoplethysmography (PPG) sensors. Most wearable devices were multi-modal (59%), utilizing more than one sensor simultaneously. Most included devices were wearable technologies (84%), with chest patches (22%), wrist-worn devices (18%), and garments (14%) being the most prevalent. ECG and PPG sensors are heavily utilized in devices for cardiopulmonary monitoring that could be adapted to OHCA detection. Developers seeking to rapidly develop methods for OHCA detection should focus on using ECG- and/or PPG-based multimodal systems as these are most prevalent in existing devices. However, novel sensor technology development could overcome limitations in existing sensors and could serve as potential additions to or replacements for ECG- and PPG-based devices., (© 2024. The Author(s) under exclusive licence to Biomedical Engineering Society.)

Background: Biosensor technologies have been proposed as a solution to provide recognition and facilitate earlier responses to unwitnessed out-of-hospital cardiac arrest (OHCA) cases. We sought to estimate the effect of recognition on survival and modelled the potential incremental impact of increased recognition of unwitnessed cases on survival to hospital discharge, to demonstrate the potential benefit of biosensor technologies., Methods: We included cases from the British Columbia Cardiac Arrest Registry (2019-2020), which includes Emergency Medical Services (EMS)-assessed OHCAs. We excluded cases that would not have benefitted from early recognition (EMS-witnessed, terminal illness, or do-not-resuscitate). Using a mediation analysis, we estimated the relative benefits on survival of a witness recognizing vs. intervening in an OHCA; and estimated the expected additional number of survivors resulting from increasing recognition alone using a bootstrap logistic regression framework., Results: Of 13,655 EMS-assessed cases, 11,412 were included (6314 EMS-treated, 5098 EMS-untreated). Survival to hospital discharge was 191/8879 (2.2%) in unwitnessed cases and 429/2533 (17%) in bystander-witnessed cases. Of the total effect attributable to a bystander witness, recognition accounted for 84% (95% CI: 72, 86) of the benefit. If all previously unwitnessed cases had been bystander witnessed, we would expect 1198 additional survivors. If these cases had been recognized, but no interventions performed, we would expect 912 additional survivors., Conclusion: Unwitnessed OHCA account for the majority of OHCAs, yet survival is dismal. Methods to improve recognition, such as with biosensor technologies, may lead to substantial improvements in overall survival., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Near-Infrared Spectroscopy (NIRS) is a noninvasive optical method widely used for evaluating tissue hemodynamics and various physiological characteristics. Despite its advantages, NIRS faces limitations in light sampling depth and spatial resolution, which has led to the development of implantable NIRS sensors. However, these implantable sensors are prone to Common-Mode Voltage (CMV) interference due to their increased sensor-to-tissue capacitance, which can compromise the signal-to-noise ratio and accuracy of measurements.In this paper, we present a novel active CMV reduction technique that enhances the signal-to-noise ratio of NIRS signals. We propose an electrical model of a patient's body and NIRS sensor to characterize the CMV interference and the active CMV cancellation (ACC) electronic circuit. The ACC circuit measures CMV through a common-mode amplifier, which then inverts and introduces the amplified signal to the patient's body via an additional surface electrode. This technique effectively attenuates the CMV (50 and 60 Hz) by 80 to 90 dB, significantly improving the signal quality without causing system instability.The method has been validated through both analytical simulations and experimental measurements, demonstrating the circuit's ability to suppress CMV within a bandwidth of 0.1 to 100 Hz. Experimental verification of the active noise cancellation method was conducted by recording data from the fingertip and palm, showing effective suppression of the CMV. The proposed method has substantial clinical relevance as it enhances the reliability and accuracy of implantable NIRS sensors, enabling more precise monitoring of internal organs and improved patient care.

The emergence of the global coronavirus pandemic in 2019 (COVID-19 disease) created a need for remote methods to detect and continuously monitor patients with infectious respiratory diseases. Many different devices, including thermometers, pulse oximeters, smartwatches, and rings, were proposed to monitor the symptoms of infected individuals at home. However, these consumer-grade devices are typically not capable of automated monitoring during both day and night. This study aims to develop a method to classify and monitor breathing patterns in real-time using tissue hemodynamic responses and a deep convolutional neural network (CNN)-based classification algorithm. Tissue hemodynamic responses at the sternal manubrium were collected in 21 healthy volunteers using a wearable near-infrared spectroscopy (NIRS) device during three different breathing conditions. We developed a deep CNN-based classification algorithm to classify and monitor breathing patterns in real time. The classification method was designed by improving and modifying the pre-activation residual network (Pre-ResNet) previously developed to classify two-dimensional (2D) images. Three different one-dimensional CNN (1D-CNN) classification models based on Pre-ResNet were developed. By using these models, we were able to obtain an average classification accuracy of 88.79% (without Stage 1 (data size reducing convolutional layer)), 90.58% (with 1 × 3 Stage 1), and 91.77% (with 1 × 5 Stage 1).

Sudden cardiac arrest (SCA) is a leading cause of mortality worldwide. The SCA-to-resuscitation interval is a key determinant of patient outcomes, highlighting the clinical need for reliable and timely detection of SCA. Near-infrared spectroscopy (NIRS), a non-invasive optical technique, may have utility for this application. We investigated transcutaneous NIRS as a method to detect pentobarbital-induced changes during cardiac arrest in eight Yucatan miniature pigs. NIRS measurements during cardiac arrest were compared to invasively acquired carotid blood pressure and partial oxygen pressure (PO 2 ) of spinal cord tissues. We observed statistically significant decreases in mean arterial pressure (MAP) 64.68 mmHg ± 13.08, p < 0.0001), spinal cord PO 2 (38.16 mmHg ± 20.04, p = 0.0028), and NIRS-derived tissue oxygen saturation (TSI%) (14.50% ± 3.80, p < 0.0001) from baseline to 5 min after pentobarbital administration. Euthanasia-to-first change in hemodynamics for MAP and TSI (%) were similar [MAP (10.43 ± 4.73 s) vs TSI (%) (12.04 ± 1.85 s), p = 0.3714]. No significant difference was detected between NIRS and blood pressure-derived pulse rates during baseline periods (p > 0.99) and following pentobarbital administration (p = 0.97). Transcutaneous NIRS demonstrated the potential to identify rapid hemodynamic changes due to cardiac arrest in periods similar to invasive indices. We conclude that transcutaneous NIRS monitoring may present a novel, non-invasive approach for SCA detection, which warrants further investigation., (© 2023. The Author(s).)

The worldwide outbreak of the novel Coronavirus (COVID-19) has highlighted the need for a screening and monitoring system for infectious respiratory diseases in the acute and chronic phase. The purpose of this study was to examine the feasibility of using a wearable near-infrared spectroscopy (NIRS) sensor to collect respiratory signals and distinguish between normal and simulated pathological breathing. Twenty-one healthy adults participated in an experiment that examined five separate breathing conditions. Respiratory signals were collected with a continuous-wave NIRS sensor (PortaLite, Artinis Medical Systems) affixed over the sternal manubrium. Following a three-minute baseline, participants began five minutes of imposed difficult breathing using a respiratory trainer. After a five minute recovery period, participants began five minutes of imposed rapid and shallow breathing. The study concluded with five additional minutes of regular breathing. NIRS signals were analyzed using a machine learning model to distinguish between normal and simulated pathological breathing. Three features: breathing interval, breathing depth, and O 2 Hb signal amplitude were extracted from the NIRS data and, when used together, resulted in a weighted average accuracy of 0.87. This study demonstrated that a wearable NIRS sensor can monitor respiratory patterns continuously and non-invasively and we identified three respiratory features that can distinguish between normal and simulated pathological breathing.

Aim: Cardiac arrest (CA) is the cessation of circulation to vital organs that can only be reversed with rapid and appropriate interventions. Sensor technologies for early detection and activation of the emergency medical system could enable rapid response to CA and increase the probability of survival. We conducted a systematic review to summarize the literature surrounding the performance of sensor technologies in detecting OHCA., Methods: We searched the academic and grey literature using keywords related to cardiac arrest, sensor technologies, and recognition/detection. We included English articles published up until June 6, 2022, including investigations and patent filings that reported the sensitivity and specificity of sensor technologies to detect cardiac arrest on human or animal subjects. (Prospero# CRD42021267797)., Results: We screened 1666 articles and included four publications examining sensor technologies. One tested the performance of a physical sensor on human participants in simulated CA, one tested performance on audio recordings of patients in cardiac arrest, and two utilized a hybrid design for testing including human participants and ECG databases. Three of the devices were wearable and one was an audio detection algorithm utilizing household smart technologies. Real-world testing was limited in all studies. Sensitivity and specificity for the sensors ranged from 97.2 to 100% and 90.3 to 99.9%, respectively. All included studies had a medium/high risk of bias, with 2/4 having a high risk of bias., Conclusions: Sensor technologies show promise for cardiac arrest detection. However, current evidence is sparse and of high risk of bias. Small sample sizes and databases with low external validity limit the generalizability of findings., Competing Interests: The authors declare no conflicts of interest., (© 2022 The Authors.)

Significance: Pulse oximetry is widely used in clinical practice to monitor changes in arterial oxygen saturation (SpO2). However, decreases in SpO2 can be delayed relative to the actual clinical event, and near-infrared spectroscopy (NIRS) may detect alterations in oxygenation earlier than pulse oximetry, as shown in previous cerebral oxygenation monitoring studies., Aim: We aim to compare the response of transcutaneous muscle NIRS measures of the tissue saturation index with pulse oximetry SpO2 during hypoxia., Approach: Episodes of acute hypoxia were induced in nine anesthetized Yucatan miniature pigs. A standard pulse oximeter was attached to the ear of the animal, and a transcutaneous NIRS sensor was placed on the hind limb muscle. Hypoxia was induced by detaching the ventilator from the animal and reattaching it once the pulse oximeter reported 70% SpO2., Results: Twenty-four episodes of acute hypoxia were analyzed. Upon the start of hypoxia, the transcutaneous NIRS measures changed in 5.3 ± 0.4 s, whereas the pulse oximetry measures changed in 14.9 ± 1.0 s (p < 0.0001)., Conclusions: Transcutaneous muscle NIRS can detect the effects of hypoxia significantly sooner than pulse oximetry in the Yucatan miniature pig. A transcutaneous NIRS sensor may be used as an earlier detector of oxygen saturation changes in the clinical setting than the standard pulse oximeter.

The colour of the silicone enclosure of an implantable reflectance-based optical probe plays a critical role in sensor performance. Red-coloured probes that are highly reflective to near-infrared light have been found to increase photodetector power by a factor of 6 for wavelengths between 660 and 950 nm and triple the magnitude of measured cardiac pulsations compared to traditional black probes. The increase in photodetector power and cardiac pulsation magnitude is presumably due to increased spatial range resulting from a higher magnitude of superficial tissue scattering. Conversely, probes with highly absorbent colours such as black and blue result in more stable signals and are expected to have higher spatial resolution and depth of penetration.

As a contact sport, wrestling may result in injuries. Based on the severity, they are classified as mild, moderate, severe and critical. All injuries occurring at international competitions are documented in a cloud-based surveillance system. The purpose of this study was to analyze the incidence and characteristics of moderate and severe (including critical) wrestling injuries that occurred during five international Olympic-style wrestling competitions in 2016-2019. Three Wrestling World Championships and two European Wrestling tournaments were organized by the Hungarian Wrestling Federation in 2016-2019. A total of 2483 wrestlers in three Olympic wrestling styles have competed in 3007 matches. Data from all injuries were recorded and analyzed to define rates, locations, types and severity, and to compare with previous reports. A total of 53 wrestlers sustained 55 injuries, which is equivalent to an overall injury incidence rate of 9.1‰ (9.1/1000 athletic exposures). Greco-Roman and Women Wrestling had the same injury incidence rate, while Freestyle had a lower one (9.5‰ versus 8.5‰). The injury proportion by regions and anatomic locations were on head and face 29.1%, spine and trunk 16.4 % and the upper-and-lower extremity injuries equally 27.3%. The most common types of injuries included ligament lesions, joint injuries, skin lacerations, and contusions. Five wrestlers (0.8‰) sustained strangulation or concussion. Wrestling injury rates during United World Wrestling competitions are not high, but when happen they can be serious. Despite relatively low incidence rate of injuries, there is a need for continuous education for medical teams, referees and coaches to avoid wrestling injuries., (© Journal of Sports Science and Medicine.)

The purpose of this study was to determine which thermometry technique is the most accurate for regular measurement of body temperature. We compared seven different commercially available thermometers with a gold standard medical-grade thermometer (Welch-Allyn): four digital infrared thermometers (Wellworks, Braun, Withings, MOBI), one digital sublingual thermometer (Braun), one zero heat flux thermometer (3M), and one infrared thermal imaging camera (FLIR One). Thirty young healthy adults participated in an experiment that altered core body temperature. After baseline measurements, participants placed their feet in a cold-water bath while consuming cold water for 30 min. Subsequently, feet were removed and covered with a blanket for 30 min. Throughout the session, temperature was recorded every 10 min with all devices. The Braun tympanic thermometer (left ear) had the best agreement with the gold standard (mean error: 0.044 °C). The FLIR One thermal imaging camera was the least accurate device (mean error: -0.522 °C) . A sign test demonstrated that all thermometry devices were significantly different than the gold standard except for the Braun tympanic thermometer (left ear). Our study showed that not all temperature monitoring techniques are equal, and suggested that tympanic thermometers are the most accurate commercially available system for the regular measurement of body temperature.

Background: Although citation analysis is common in many areas of medicine, there is a lack of similar research in sports and exercise medicine., Purpose: To identify and examine the characteristics of the 100 top cited articles in the field of sports and exercise medicine in an effort to determine what components make an article highly influential., Study Design: Cross-sectional study., Methods: The Web of Science, Scopus, and PubMed databases were used to determine the 100 top cited articles from 46 journals in the field of sports and exercise medicine. Each of the 100 articles was then analyzed by 2 independent reviewers, and results were compared. Basic information was collected, including journal title, country of origin, and study type. Different categories were compared using descriptive statistics of counts or percentages., Results: The 100 top cited articles were published in 15 of the 46 identified sports and exercise medicine journals, with the most prolific being Medicine and Science in Sports and Exercise (n = 49), American Journal of Sports Medicine (n = 18), and Sports Medicine (n = 7). In terms of country of origin, the top 3 contributors were the United States (n = 65), Canada (n = 9), and Sweden (n = 8). The most commonly researched anatomic areas were the knee (n = 15) and the brain (n = 3). Narrative reviews were the most common study type (n = 38), and only a single study on the 100 top cited articles list used a randomized controlled trial design. The most prevalent fields of study were exercise science (55% of articles) and well-being (16% of articles)., Conclusion: Narrative reviews from the United States and published in English-language journals were the most likely to be highly cited. In addition, the knee was a common anatomic area of study on the top cited list of research in sports and exercise medicine., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Purpose: The recent coronavirus disease 2019 (COVID-19) pandemic, which spread across the globe in a very short period of time, revealed that the transmission control of disease is a crucial step to prevent an outbreak and effective screening for viral infectious diseases is necessary. Since the severe acute respiratory syndrome (SARS) outbreak in 2003, infrared thermography (IRT) has been considered a gold standard method for screening febrile individuals at the time of pandemics. The objective of this review is to evaluate the efficacy of IRT for screening infectious diseases with specific applications to COVID-19. Approach: A literature review was performed in Google Scholar, PubMed, and ScienceDirect to search for studies evaluating IRT screening from 2002 to present using relevant keywords. Additional literature searches were done to evaluate IRT in comparison to traditional core body temperature measurements and assess the benefits of measuring additional vital signs for infectious disease screening. Results: Studies have reported on the unreliability of IRT due to poor sensitivity and specificity in detecting true core body temperature and its inability to identify asymptomatic carriers. Airport mass screening using IRT was conducted during occurrences of SARS, Dengue, Swine Flu, and Ebola with reported sensitivities as low as zero. Other studies reported that screening other vital signs such as heart and respiratory rates can lead to more robust methods for early infection detection. Conclusions: Studies evaluating IRT showed varied results in its efficacy for screening infectious diseases. This suggests the need to assess additional physiological parameters to increase the sensitivity and specificity of non-invasive biosensors., (© 2021 The Authors.)

One of the only currently available treatment options to potentially improve neurological recovery after acute spinal cord injury (SCI) is augmentation of mean arterial blood pressure (MAP) to promote blood flow and oxygen delivery to the injured cord. However, to optimize such hemodynamic management, clinicians require a method to monitor the physiological effects of these MAP alterations within the injured cord. Therefore, we investigated the feasibility and effectiveness of using a novel optical sensor, based on near-infrared spectroscopy (NIRS), to monitor real-time spinal cord oxygenation and hemodynamics during the first 7 days post-injury in a porcine model of acute SCI. Six Yucatan miniature pigs underwent a T10 vertebral level contusion-compression injury. Spinal cord oxygenation and hemodynamics were continuously monitored by a minimally invasive custom-made NIRS sensor, and by invasive intraparenchymal (IP) probes to validate the NIRS measures. Episodes of MAP alteration and hypoxia were performed acutely after injury, and at 2 and 7 days post-injury to simulate the types of hemodynamic changes SCI patients experience after injury. The NIRS sensor demonstrated the ability to provide oxygenation and hemodynamic measurements over the 7-day post-SCI period. NIRS measures showed statistically significant correlations with each of the invasive IP measures and MAP changes during episodes of MAP alteration and hypoxia throughout the first week post-injury ( p  < 0.05). These results indicate that this novel NIRS system can monitor real-time changes in spinal cord oxygenation and hemodynamics over the first 7 days post-injury, and has the ability to detect local tissue changes that are reflective of systemic hemodynamic changes.

The purpose of this study was to examine scalene (SA) and sternocleidomastoid (SM) activation during normoxic (norm-ITL; FIO 2  = 21%) and hypoxic (hyp-ITL; FIO 2  = 15%) incremental inspiratory threshold loading (ITL). Thirteen healthy participants (33 ± 4 years, 9 female) performed two ITL tests breathing randomly assigned gas mixtures through an inspiratory loading device where the load was increased every two minutes until task failure. SA and SM root mean square (RMS) electromyography (EMG) were calculated and expressed as a percentage of maximum (RMS %max ) to reflect muscle activation intensity. Myoelectric manifestations of fatigue were characterized as decreased SA or SM EMG median frequency during maximum inspiratory pressure maneuvers before and after ITL. Dyspnea was recorded at baseline and task failure. Ventilatory parameters and mouth pressure (Pm) were recorded throughout the ITL. SA,RMS %max and SM,RMS %max increased in association with ITL load (p ≤ .01 for both). SA,RMS %max was similar between norm-ITL and hyp-ITL (p = .17), whereas SM,RMS %max was greater during the latter (p = .001). Neither SA nor SM had a decrease in EMG median frequency after ITL (p = .75 and 0.69 respectively). Pm increased in association with ITL load (p < .001) and tended to be higher during hyp-ITL compared to norm-ITL (p = .05). Dyspnea was similar during both conditions (p > .05). There was a trend for higher tidal volumes during hyp-ITL compared to norm-ITL (p = .10). Minute ventilation was similar between both conditions (p = .23). RMS, %max of the SA and SM increased linearly with increasing ITL. The presence of hypoxia only increased SM activation. Neither SA nor SM presented myoelectric manifestations of fatigue during both conditions., (© 2020 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Background: Free flap failure or vascular compromise remains a dreadful complication of microvascular free tissue transfer. Near-infrared spectroscopy (NIRS) is a novel technique for free flap monitoring that has the propensity for early detection of vascular compromise when compared to the current gold standard, clinical monitoring (CM). The objective of this review is to evaluate the efficacy of a NIRS system in the postoperative monitoring of free flaps and its effect on flap salvage., Methods: A comprehensive literature review was performed including English-language articles evaluating the use of NIRS in free flap monitoring. MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), OVID, and Web of Science were searched upto December 2017., Results: A total of 590 articles were identified, and 10 articles were included for analysis. Overall, flaps with vascular compromise monitored with NIRS had a significantly higher salvage rate of 89% compared with a salvage rate of 50% in the flaps monitored by CM alone (p < .01). Partial loss occurred in 15% of the successful salvages in the NIRS group versus 80% with CM alone (p < .01). Detection of vascular compromise by NIRS preceded clinical signs on average by 82 ± 49 min. NIRS was accurate in detecting compromised flaps with a low false-positive and false-negative rate., Conclusion: Despite lack of robust data, NIRS has the potential to be an objective, accurate, and continuous postoperative free flap monitoring technique with a greater flap salvage rate than CM alone., (© 2019 Wiley Periodicals, Inc.)

Background: Injuries to the proximal portion of the tendon of the long head of the biceps are challenging, and often only diagnosed at arthroscopy. However, it is important to be able to formulate a preoperative plan based on physical examination and imaging studies, so as to inform patients correctly, plan the likely procedure, and give indication to length and modalities of rehabilitation., Materials and Methods: Eleven elite wrestlers who suffered their injury between 2008 and 2018 were investigated retrospectively. We aimed to identify an association between the mechanism and the symptoms of the biceps-labral complex injury., Results: The injury was sustained at a mean age of 20.63 years, and most wrestlers were middle or light weight. All injuries occurred during shoulder movements in closed kinetic chain with the elbow extended, the forearm pronated and the shoulder slightly elevated. The surgical procedures performed were tenodesis in three wrestlers, reinsertion in seven wrestlers, and one tenotomy of the tendon of the long head of the biceps. The postoperative rehabilitation was shorter (1-3 month) in case of tenodesis or tenotomy, and markedly longer after reinsertion (6-9 months)., Conclusions: Injuries to the proximal part of long head of biceps tendon are relatively frequent in elite wrestlers, reflecting the high functional demands imposed on the upper limb. Though necessitating surgery, in these athletes, such injuries are not career ending, and most of our elite athletes returned to high performance levels after surgery., Competing Interests: Conflict of InterestNo conflict of interest., (© Indian Orthopaedics Association 2020.)

Despite advances in the treatment of acute spinal cord injury (SCI), measures to mitigate permanent neurological deficits in affected patients are limited. Immediate post-trauma hemodynamic management of patients, to maintain blood supply and improve oxygenation to the injured spinal cord, is currently one aspect of critical care which clinicians can utilize to improve neurological outcomes. However, without a way to monitor the response of spinal cord hemodynamics and oxygenation in real time, optimizing hemodynamic management is challenging and limited in scope. This study aims to investigate the feasibility and validity of using a miniaturized multi-wavelength near-infrared spectroscopy (NIRS) sensor for direct transdural monitoring of spinal cord oxygenation in an animal model of acute SCI. Nine Yorkshire pigs underwent a weight-drop T10 contusion-compression injury and received episodes of ventilatory hypoxia and alterations in mean arterial pressure (MAP). Spinal cord hemodynamics and oxygenation were monitored throughout by a non-invasive transdural NIRS sensor, as well as an invasive intraparenchymal sensor as a comparison. NIRS parameters of tissue oxygenation were highly correlated with intraparenchymal measures of tissue oxygenation. In particular, during periods of hypoxia and MAP alterations, changes of NIRS-derived spinal cord oxygenated hemoglobin and tissue oxygenation percentage corresponded well with the changes in spinal cord oxygen partial pressures measured by the intraparenchymal sensor. Our data confirm that during hypoxic episodes and as changes occur in the MAP, non-invasive NIRS can detect and measure real-time changes in spinal cord oxygenation with a high degree of sensitivity and specificity.

Study Design: Review., Objectives: Clinical studies have shown that the hemodynamic management of patients following acute spinal cord injury (SCI) is an important aspect of their treatment for maintaining spinal cord (SC) perfusion and minimizing ischemic secondary injury to the SC. While this highlights the importance of ensuring adequate perfusion and oxygenation to the injured cord, a method for the real-time monitoring of these hemodynamic measures within the SC is lacking. The purpose of this review is to discuss current and potential methods for SC hemodynamic monitoring with special focus on applications using near-infrared spectroscopy (NIRS)., Methods: A literature search using the PubMed database. All peer-reviewed articles on NIRS monitoring of SC published from inception to May 2019 were reviewed., Results: Among 125 papers related to SC hemodynamics monitoring, 26 focused on direct/indirect NIRS monitoring of the SC., Discussion: Current options for continuous, non-invasive, and real-time monitoring of SC hemodynamics are challenging and limited in scope. As a relatively new technique, NIRS has been successfully used for monitoring human cerebral hemodynamics, and has shown promising results in intraoperative assessment of SC hemodynamics in both human and animal models. Although utilizing NIRS to monitor the SC has been validated, applying NIRS clinically following SCI requires further development and investigation., Conclusions: NIRS is a promising non-invasive technique with the potential to provide real-time monitoring of relevant parameters in the SC. Currently, in its first developmental stages, further clinical and experimental studies are mandatory to ensure the validity and safety of NIRS techniques.

Context:: Contrast baths (CB) is a thermal treatment modality used in sports medicine, athletic training, and rehabilitation settings. Proposed physiological effects of CB include increasing tissue blood flow and oxygenation and decreasing tissue swelling and edema to promote better healing, improved limb function, and quicker recovery., Objective:: To investigate the physiological effects of CB on the intramuscular hemodynamics and oxygenation of the lower leg muscles using near-infrared spectroscopy (NIRS), an optical method for monitoring changes in tissue oxygenated (O 2 Hb), deoxygenated (HHb), and total hemoglobin (tHb) as well as tissue oxygen saturation index (TSI%)., Design:: Descriptive laboratory study., Patients or Other Participants:: Ten healthy men and women with a mean age of 29 (range = 17 ± 42) years, mean body mass index of 24.6 ± 3.2, and mean adipose tissue thickness of 6.4 ± 2.2 mm., Intervention(s):: Conventional CB (10-minute baseline, 4 : 1-minute hot : cold ratio) was applied to the left lower leg., Main Outcome Measure(s):: Changes in chromophore concentrations of O 2 Hb, HHb, tHb, and TSI% of the gastrocnemius muscle were monitored during 10 minutes of baseline measurement, a 30-minute CB protocol, and 10 minutes of recovery using a spatially resolved NIRS., Results:: After a 30-minute CB protocol, increases ( P < .05) in tissue O 2 Hb (7.4 ± 4 μM), tHb (7.6 ± 6.1 μM), and TSI% (3.1% ± 2.3%) were observed as compared with baseline measures., Conclusions:: Application of CB induced a transient change in the hemodynamics and oxygenation of the gastrocnemius muscle in healthy individuals. The effect of CB application in improving tissue hemodynamics and oxygenation may, therefore, support the therapeutic benefits of CB in the treatment of muscle injuries.