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ObjectiveExertional heat stroke (EHS), characterised by a high core body temperature (Tcr) and central nervous system (CNS) dysfunction, is a concern for athletes, workers and military personnel who must train and perform in hot environments. The objective of this study was to determine whether algorithms that estimate Tcr from heart rate and gait instability from a trunk-worn sensor system can forward predict EHS onset.MethodsHeart rate and three-axis accelerometry data were collected from chest-worn sensors from 1806 US military personnel participating in timed 4/5-mile runs, and loaded marches of 7 and 12 miles; in total, 3422 high EHS-risk training datasets were available for analysis. Six soldiers were diagnosed with heat stroke and all had rectal temperatures of >41°C when first measured and were exhibiting CNS dysfunction. Estimated core temperature (ECTemp) was computed from sequential measures of heart rate. Gait instability was computed from three-axis accelerometry using features of pattern dispersion and autocorrelation.ResultsThe six soldiers who experienced heat stroke were among the hottest compared with the other soldiers in the respective training events with ECTemps ranging from 39.2°C to 40.8°C. Combining ECTemp and gait instability measures successfully identified all six EHS casualties at least 3.5 min in advance of collapse while falsely identifying 6.1% (209 total false positives) examples where exertional heat illness symptoms were neither observed nor reported. No false-negative cases were noted.ConclusionThe combination of two algorithms that estimate Tcr and ataxic gate appears promising for real-time alerting of impending EHS.

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.

Defolliculated (Dfl) is a spontaneous mouse mutant with a hair-loss phenotype that includes altered sebaceous gland differentiation, short hair shafts, aberrant catagen stage of the hair cycle, and eventual loss of the hair follicle. Recently a similar mutant, finnegan (Fgn), with an identical phenotype was discovered during a phenotypic screen for mutations induced by chemical mutagenesis. The gene underlying the phenotype of both finnegan and defolliculated has been mapped to chromosome 11 and here we show that both mice harbor mutations in gasdermin 3 (Gsdm3), a gene of unknown function. Gsdm3Dfl is a B2 insertion near the 3′ splice site of exon 7 and Gsdm3Fgn is a point mutation T278P. To investigate the role of the gasdermin gene family an antiserum was raised to a peptide highly homologous to all three mouse gasdermins and human gasdermin. Immunohistochemical analysis revealed that gasdermins are expressed specifically in cells at advanced stages of differentiation in the upper epidermis, the differentiating inner root sheath and hair shaft and in the most mature sebocytes of the sebaceous gland and preputial, meibomium, ceruminous gland, and anal glands. This expression pattern suggests a role for gasdermins in differentiation of the epidermis and its appendages.

Objectives: The acetabular labrum provides sealing function and a degree of hip joint stability. Previous early (16 month) and mid-term (mean 3.5 years) follow-up of this cohort reported better patient related outcome measures in the refixation group. To update the results of labral refixation versus focal labral excision/debridement in a cohort of patients who underwent arthroscopic correction of femoroacetabular impingement (FAI). Methods: We reported patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. Patients with labral tears thought to be repairable with our current arthroscopic technique were compared with patients who underwent labral refixation. In 46 hips, the labrum was focally excised/debrided (group 1); in 54 hips, the labrum was refixed (group 2). Outcomes were measured with modified-Harris-Hip-Score (mHHS), Short Form-12 (SF-12), and a visual-analog-scale (VAS) for pain preoperatively and postoperatively. Results: Mean age was 33 years in group 1 and 28 years in group 2 with mean follow-up of 7 years (range, 2-13.6 years). At mean follow-up, subjective outcomes were significantly improved (P<.01) for both groups compared with preoperative scores. The mHHS (P=.004), SF-12 (P=.016), and VAS pain scores (P<.001) were all significantly better for refixation group compared with debridement group. Although most recent outcomes for both groups fell at mean 7 years’ follow-up in comparison to 16 month and 3.5 year follow-up, the disparity between groups was greater in favor of labral refixation. Good-to-excellent results were 47.7% in debridement and 82.4% in refixation (p<.001), and failure rates were 31.8% (debridement) and 13.7% (refixation group) (p =.034). There were 4 revisions in the debridement group and none in the refixation group. Conclusion: Longer term follow-up comparing focal labral debridement/excision to refixation revealed a decrease in patient related outcome scoring and good/excellent results in both groups. Ultimately, there was a greater drop in outcome measures and good/excellent results in the debridement group and better maintenance of results in the refixation group at mean 7 years follow-up.