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    Factors influencing return to play and second anterior cruciate ligament injury rates in level 1 athletes after primary anterior cruciate ligament reconstruction: 2-year follow-up on 1432 reconstructions at a single center
    (SAGE Publishing, 2020-02-07) King, Enda; Richter, Chris; Jackson, Mark; Franklyn-Miller, Andy; Falvey, Eanna; Myer, Gregory D.; Strike, Siobhan; Withers, Dan; Moran, Ray
    Background: Despite the importance of return-to-play (RTP) rates, second anterior cruciate ligament (ACL) injury rates, and patient-reported outcomes of athletes returning to sports after ACL reconstruction (ACLR), these outcomes have not been evaluated together across a single cohort nor the pre- and intraoperative factors influencing outcomes explored. Purpose: To prospectively report outcomes after ACLR relating to RTP, second ACL injury, and International Knee Document Committee (IKDC) scores in a large cohort of athletes at a single center to examine the influence of pre- and intraoperative variables on these outcomes. Design: Cohort study; Level of evidence, 3. Methods: A consecutive cohort of 1432 athletes undergoing primary ACLR by 2 orthopaedic surgeons was followed up prospectively more than 2 years after surgery. Pre- and intraoperative findings were reported with outcomes at follow-up relating to RTP, second ACL injury, and IKDC. Between-group differences for each outcome were reported and the predictive ability of pre- and intraoperative variables relating to each outcome assessed with logistic regression. Results: There was >95% follow-up 2 years after surgery. The RTP rate was 81%, and of those who returned, 1.3% of those with patellar tendon grafts and 8.3% of those with hamstring grafts experienced ipsilateral rerupture (hazard ratio, 0.17). The contralateral ACL injury rate was 6.6%, and the IKDC score at follow-up was 86.8, with a greater proportion of patients with patellar tendon grafts scoring <80 on the IKDC (odds ratio, 1.56; 95% CI, 1.15-3.12). There was no relationship between time to RTP and second ACL injury, and there was a moderate correlation between ACL–Return to Sport After Injury score and RTP at follow-up (P < .001, rho = 0.46). There were a number of differences in pre- and intraoperative variables between groups for each outcome, but they demonstrated a poor ability to predict outcomes in level 1 athletes at 2-year follow-up. Conclusion: Findings demonstrated high overall RTP rates, lower reinjury rates with patellar tendon graft after 2-year follow-up in level 1 athletes, and no influence of time to RTP on second ACL injury. Despite differences between groups, there was poor predictive ability of pre- and intraoperative variables. Results suggest pre- and intraoperative variables for consideration to optimize outcomes in level 1 athletes after ACLR, but future research exploring other factors, such as physical and psychological recovery, may be needed to improve outcome prediction after ACLR.
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    Frequent but limited assessment of potentially concussed players in Gaelic Football: an opportunity to learn from other sports
    (Springer Nature Switzerland AG, 2020-09-30) Sokol-Randell, Darek; Pasquale Rotundo, Mario; Tierney, Gregory; Deasy, Conor; Cusimano, Michael D.
    Background: Sport-related concussion (SRC) is a potential issue within Gaelic Football. Therefore, it is essential that concussion management guidelines are adhered to. Hypothesis/purpose: The aim of this study is to determine if potential concussive events (PCEs) in the Gaelic Athletic Association (GAA) National Football League (NFL) are assessed in accordance with GAA concussion guidelines and compare this to other sports. Methods: A descriptive video analysis approach was undertaken to identify PCEs throughout two seasons of play. Subsequent assessment, return to play (RTP) decisions, and signs of concussion were evaluated. Results: A total of 242 PCEs were identified over 111 matches. Most PCEs (87.2%, n = 211) were assessed by medical personnel. However, 187 (88.6%) of assessments were under 2 min in duration. Of the 242 PCEs, 189 (78.1%) returned to play after on-pitch assessment, and 12 (5.0%) were removed following a PCE. Sixty-one (25.2%) players sustaining a PCE demonstrated one or more signs of concussion, of which 9 (14.8%) were removed from play. Conclusion: In the GAA NFL, PCEs are often briefly assessed but rarely result in player removal. Introduction of video incident analysis and concussion substitutions, as in other sports, may reduce the long-term burden of SRC on Gaelic Football players.
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    CT in the detection of latent tuberculosis: a systematic review
    (Elsevier B.V., 2023-05-13) Moore, Niamh; Maher, M.; Murphy, G.; O’Callaghan Maher, M.; O’Connor, O. J.; McEntee, Mark F.
    Aim: To evaluate the use of computed tomography (CT) and low-dose CT in the detection of latent tuberculosis (TB). Materials And Methods: A systematic search of literature in adherence with the PRISMA guidelines was carried out. Quality assessment of the included studies was conducted. Results: The search strategy identified a total of 4,621 studies. Sixteen studies were considered eligible and included in the review. There was high heterogeneity among all studies. CT was identified as much more sensitive for the detection of latent TB in all studies despite chest radiography often being recommended in guidelines to assess patients for latent TB. Low-dose CT showed promising results in four of the studies; however, these results were limited due to small sample sizes. Conclusion: CT is much superior to chest radiography consistently identifying additional cases of latent TB. There are limited high-quality publications available using low-dose CT but findings thus far suggest low-dose CT could be used as an alternative to standard-dose CT for the detection of latent TB. It is recommended that a randomised controlled trial investigating low-dose CT should be carried out.
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    Sport Concussion Assessment Tool: baseline and clinical reference limits for concussion diagnosis and management in elite Rugby Union
    (Elsevier Ltd., 2021-01-07) Tucker, R.; Falvey, Éanna C.; Fuller, Gordon W.; Hislop, M. D.; Patricios, J.; Raftery, M.
    Objectives: Rugby Union has adapted the Sports Concussion Assessment Tool (SCAT) into an abridged off-field concussion screen and the complete SCAT is used during diagnostic screens performed after head impact events. No firm guidelines exist as to what should be considered “abnormal” and warrant further evaluation. This study evaluates SCAT performances in 13,479 baseline SCAT assessments, and proposes clear reference limits for each sub-component of the SCAT5. Baseline reference limits are proposed to guide management of baseline testing by identifying abnormal sub-tests, enhancing the clinical validity of baseline screens, while clinical reference limits are identified to support concussion diagnosis when no baseline is available. Design: Cross sectional census sample. Methods: 13,479 baseline SCATs from 7565 elite male rugby players were evaluated. Baseline reference limits were identified for each sub-test as the sub-test result achieved by approximately 5% of the population, while clinical references limits corresponded to the sub-test score achieved by as close as possible to 50% of the cohort. Results: Players reported symptoms 35% (95% CI 1.29–1.42) more frequently during SCAT5 than SCAT3 baseline assessments (mean 1.4 ± 2.7 vs 1.0 ± 2.4). Ceiling effects were identified for many cognitive sub-tests within the SCAT. Baseline and Clinical reference limits corresponding to the worst performing 5th percentile and 50th percentile were described. Conclusions: Targeted baseline re-testing should be repeated when abnormal sub-tests are identified according to proposed baseline reference limits, while a more conservative clinical reference limit supports concussion diagnosis during screens in diagnostic settings.
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    Broad purpose vector for site-directed insertional mutagenesis in Bifidobacterium breve
    (Frontiers Media S.A., 2021-03) Hoedt, Emily C.; Bottacini, Francesca; Cash, Nora; Bongers, Roger S.; van Limpt, Kees; Ben Amor, Kaouther; Knol, Jan; MacSharry, John; van Sinderen, Douwe; Nutricia Research Foundation; Science Foundation Ireland; Federation of European Microbiological Societies
    Members of the genus Bifidobacterium are notoriously recalcitrant to genetic manipulation due to their extensive and variable repertoire of Restriction-Modification (R-M) systems. Non-replicating plasmids are currently employed to achieve insertional mutagenesis in Bifidobacterium. One of the limitations of using such insertion vectors is the presence within their sequence of various restriction sites, making them sensitive to the activity of endogenous restriction endonucleases encoded by the target strain. For this reason, vectors have been developed with the aim of methylating and protecting the vector using a methylase-positive Escherichia coli strain, in some cases containing a cloned bifidobacterial methylase. Here, we present a mutagenesis approach based on a modified and synthetically produced version of the suicide vector pORI28 (named pFREM28), where all known restriction sites targeted by Bifidobacterium breve R-M systems were removed by base substitution (thus preserving the codon usage). After validating the integrity of the erythromycin marker, the vector was successfully employed to target an alpha-galactosidase gene responsible for raffinose metabolism, an alcohol dehydrogenase gene responsible for mannitol utilization and a gene encoding a priming glycosyltransferase responsible for exopolysaccharides (EPS) production in B. breve. The advantage of using this modified approach is the reduction of the amount of time, effort and resources required to generate site-directed mutants in B. breve and a similar approach may be employed to target other (bifido)bacterial species.