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Background: Youth baseball is extremely popular in the United States, but it has been associated with shoulder pain and injury. The incidence of shoulder abnormalities in this athletic population has yet to be defined. Purpose: To examine abnormalities noted on magnetic resonance imaging (MRI) in the shoulders of asymptomatic Little League baseball players and to correlate these findings with the players’ throwing history and physical examinations. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 23 Little League baseball players aged 10 to 12 years were recruited. All players underwent a comprehensive physical examination and responded to a questionnaire addressing their playing history and any arm or shoulder pain. Bilateral shoulder MRIs were performed and read in a blinded manner by 2 radiologists. Responses on the questionnaire and physical examination findings were compared between participants with and without positive MRI findings through use of chi-square test and analysis of variance. Results: The dominant arm was 8.5 times more likely to have an abnormality on MRI compared with the nondominant arm. In all, 12 players (52%) had 17 positive MRI findings in their throwing shoulder that were not present in their nondominant shoulder. These findings included edema or widening of the proximal humeral physis (n = 5), labral tear (n = 4), partial rotator thickness tear (n = 4), acromioclavicular joint abnormality (n = 2), subacromial bursitis (n = 1), and cystic change of the greater tuberosity (n = 1). Two primary risk factors were associated with an abnormal MRI: year-round play and single-sport athletes focusing solely on baseball (P < .05). Players with no risk factors, 1 risk factor, and both risk factors had a 25%, 71%, and 100% chance, respectively, of having an abnormal MRI. A majority of players (61%) had previously experienced shoulder pain, especially pitchers throwing curveballs and sliders (P < .05), but this was not associated with an abnormal MRI. Conclusion: Abnormalities seen on MRI involving the shoulder are common in Little League baseball players, especially those who are single-sport athletes playing year-round.

Practical and highly organized, The 5-Minute Sports Medicine Consult, 3rd Edition, is a reliable, go-to resource for clinicians in primary care, sports medicine, nursing, pediatrics, athletic training and physical therapy.

Surfers are prone to acute injuries as well as conditions resulting from chronic environmental exposure. Sprains, lacerations, strains, and fractures are the most common types of trauma. Injury from the rider's own surfboard may be the prevailing mechanism. Minor wound infections can be treated on an outpatient basis with ciprofloxacin or trimethoprim-sulfamethoxazole. Jellyfish stings are common and may be treated with heat application. Other treatment regimens have had mixed results. Seabather's eruption is a pruritic skin reaction caused by exposure to nematocyst-containing coelenterate larvae. Additional surfing hazards include stingrays, coral reefs, and, occasionally, sharks. Otologic sequelae of surfing include auditory exostoses, tympanic membrane rupture, and otitis externa. Sun exposure and skin cancer risk are inherent dangers of this sport.

ObjectiveTo assess the prevalence and clinical implications of persistent or exertional cardiopulmonary symptoms in young competitive athletes following SARS-CoV-2 infection.MethodsThis observational cohort study from the Outcomes Registry for Cardiac Conditions in Athletes included 3597 US collegiate athletes after SARS-CoV-2 infection. Clinical characteristics, advanced diagnostic testing and SARS-CoV-2-associated sequelae were compared between athletes with persistent symptoms >3 weeks, exertional symptoms on return to exercise and those without persistent or exertional symptoms.ResultsAmong 3597 athletes (mean age 20 years (SD, 1 year), 34% female), data on persistent and exertional symptoms were reported in 3529 and 3393 athletes, respectively. Persistent symptoms >3 weeks were present in 44/3529 (1.2%) athletes with 2/3529 (0.06%) reporting symptoms >12 weeks. Exertional cardiopulmonary symptoms were present in 137/3393 (4.0%) athletes. Clinical evaluation and diagnostic testing led to the diagnosis of SARS-CoV-2-associated sequelae in 12/137 (8.8%) athletes with exertional symptoms (five cardiac involvement, two pneumonia, two inappropriate sinus tachycardia, two postural orthostatic tachycardia syndrome and one pleural effusion). No SARS-CoV-2-associated sequelae were identified in athletes with isolated persistent symptoms. Of athletes with chest pain on return to exercise who underwent cardiac MRI (CMR), 5/24 (20.8%) had probable or definite cardiac involvement. In contrast, no athlete with exertional symptoms without chest pain who underwent CMR (0/20) was diagnosed with probable or definite SARS-CoV-2 cardiac involvement.ConclusionCollegiate athletes with SARS-CoV-2 infection have a low prevalence of persistent or exertional symptoms on return to exercise. Exertional cardiopulmonary symptoms, specifically chest pain, warrant a comprehensive evaluation.

Now in its Second Edition, The 5-Minute Sports Medicine Consult is a clinically oriented quick consult reference for sports medicine. Common sports-related problems faced by primary care practitioners are thoroughly and concisely presented in the famous fast-access 5-Minute Consult format. Chapters on musculoskeletal problems cover basics; diagnosis; acute treatment, including on-field management; long-term treatment, including rehabilitation and referrals; and commonly asked questions. Other chapters address the special populations of children, adolescents, females, geriatric athletes, and disabled athletes and general medical problems in athletic individuals. Appendices include musculoskeletal radiography, office rehabilitation, and joint and soft tissue injection.

The recommended stages of recovery and rehabilitation include flexibility, strength, proprioception, endurance, and motor relearning, and finally, returning to full activity. 1 Flexibility includes full joint range of motion (ROM) and muscle elasticity similar to the uninjured side. 1 Strength should be comparable to the contralateral side. Early in an injury, isometric exercises are often well tolerated. Further strength training involving movement should be added when the patient's ROM is adequate. 1 Proprioception includes reaction time, quickness, and agility of the injured side as it relates to the standard of play. 1 Motor relearning is the act of performing all required activities/sports-specific drills at full speed, without pain or limitation, and with confidence. 1

High school-The American Heart Association recommends mandatory complete history and physical examination prior to any sports activities, and then every year thereafter. The National Federation of State High School Associations also recommends an annual preparticipation physical evaluation (PPE) as a precondition to participation. 1

The Report of the National Committee of Inquiry into Higher Education chaired by Sir Ron Dearing was published in July 1997. It represents the first officially sponsored systematic examination of the United Kingdom's system of higher education since the Robbins Report over 25 years ago. This book is an authoritative evaluation of the cogency, relevance and prospects for success of the Dearing vision and recommendations. Like the members of the comittee, the authors have sought to take a holistic view; to consider the underlying implications of genuine lifelong learning for the university system, and how institutions and the system will need to adjust. The outcomes are threefold: a description of what a UK higher education system that is genuinely part of a national learning society might look like, as well as the impetus this provides for radical reform; identification of features of its historical (especially recent) development, as well as wider social forces, which might inhibit or encourage its performance in this way; and an assessment of the coherence, desirability and practicality of the Dearing proposals in bringing about this end.

Several systems, including contractile tail bacteriophages, the type VI secretion system and R-type pyocins, use a multiprotein tubular apparatus to attach to and penetrate host cell membranes. This macromolecular machine resembles a stretched, coiled spring (or sheath) wound around a rigid tube with a spike-shaped protein at its tip. A baseplate structure, which is arguably the most complex part of this assembly, relays the contraction signal to the sheath. Here we present the atomic structure of the approximately 6-megadalton bacteriophage T4 baseplate in its pre- and post-host attachment states and explain the events that lead to sheath contraction in atomic detail. We establish the identity and function of a minimal set of components that is conserved in all contractile injection systems and show that the triggering mechanism is universally conserved. A tour-de-force of structural biology solves the structure of the macromolecular injection machinery used to deliver a phage genome into a bacterium. Anatomy of the bacteriophage T4 genome-injecting machine Bacteriophage T4 uses its contractile tail to inject its genome into a bacterial host cell. Central to this process is the baseplate, at the end of the tail. In a tour-de-force of structural biology, Nicholas Taylor, Petr Leiman and colleagues use cryo-electron microscopy to create an atomic model of the T4 baseplate in its pre- and post-host attachment conformations providing the first molecular view of the sequence of events that leads to the transition between these two states. The baseplate–tail tube complex comprises 145 polypeptide chains of 15 different proteins, and the structures reveal how the baseplate couples host recognition to sheath contraction. The structure and organization of all core baseplate components are conserved in a range of bacterial contractile devices, suggesting that their baseplates employ a similar mechanism for triggering sheath contraction.

Background Current heart failure (HF) treatment is based on targeting symptoms and left ventricle dysfunction severity, relying on a common HF pathway paradigm to justify common treatments for HF patients. This common strategy may belie an incomplete understanding of heterogeneous underlying mechanisms and could be a barrier to more precise treatments. We hypothesized we could use RNA-sequencing (RNA-seq) in human heart tissue to delineate HF etiology-specific gene expression signatures. Results RNA-seq from 64 human left ventricular samples: 37 dilated (DCM), 13 ischemic (ICM), and 14 non-failing (NF). Using a multi-analytic approach including covariate adjustment for age and sex, differentially expressed genes (DEGs) were identified characterizing HF and disease-specific expression. Pathway analysis investigated enrichment for biologically relevant pathways and functions. DCM vs NF and ICM vs NF had shared HF-DEGs that were enriched for the fetal gene program and mitochondrial dysfunction. DCM-specific DEGs were enriched for cell-cell and cell-matrix adhesion pathways. ICM-specific DEGs were enriched for cytoskeletal and immune pathway activation. Using the ICM and DCM DEG signatures from our data we were able to correctly classify the phenotypes of 24/31 ICM and 32/36 DCM samples from publicly available replication datasets. Conclusions Our results demonstrate the commonality of mitochondrial dysfunction in end-stage HF but more importantly reveal key etiology-specific signatures. Dysfunctional cell-cell and cell-matrix adhesion signatures typified DCM whereas signals related to immune and fibrotic responses were seen in ICM. These findings suggest that transcriptome signatures may distinguish end-stage heart failure, shedding light on underlying biological differences between ICM and DCM.