Current issues and future directions in gymnastics research: biomechanics, motor control and coaching interface

The sport of gymnastics is undergoing a global examination of its culture and the relationship between the gymnast, coach and environment is a central focus. The aim of this review is to explore biomechanics and motor control research in skill development and technique selection in artistic gymnastics with a focus on the underlying concepts and scientific principles that allow performance enhancement, skill development and injury risk reduction. The current review examines peer reviewed papers from 2000 onwards, with a focus on contemporary approaches in the field of gymnastics research, and highlights several key directions for future gymnastics research. Based on our review and the integration of the models of Newell (1986) and Irwin et al. (2005), we recommend that future gymnastics research should embrace at the very least a multidisciplinary approach and aim for an interdisciplinary paradigm.

850 Addressing Fertility Preservation in Patients Under the Age of 35 Diagnosed with Breast Cancer. A Ten-Year Audit in A Regional Unit

Aim

In Northern Ireland, the incidence of breast cancer is 1,443 cases per year with 26 patients diagnosed under the age of 35; 13% increase in 5 years. The average age of first-time mothers has increased from 24 to 28.8 in 2 decades. According to European Society of Medical Oncology, young patients should be counselled on available fertility preserving options before starting cancer treatment.

Method

We have conducted a retrospective audit reviewing the management of breast cancer patients under the age of 35 in the Belfast Health and Social Care Trust, with a focus on fertility counselling and patient’s options. Data obtained from Cancer Patient Pathway System and Patients records.

Results

From July 2010 to July 2020 there were 92 patients diagnosed with breast cancer in the region. All patients are female, youngest 24 years old. 34 patients have been referred as ‘Red Flag’, 22 upgraded to ‘Red Flag’, rest as routine. 23 patients received neo-adjuvant chemotherapy as first line treatment, 68 underwent surgery in the first instance, one patient opted for private sector. Over 50% of patients had at least one child prior to referral. Less than 5% had considered pregnancy post or during treatment.

Conclusions

At present there are no established guidelines regarding the timing of conception after diagnosis and treatment. Several options do exist for fertility preservation, both standard and investigational. There is evidence of an increasing recognition of this as a priority for patients and need early education and referral to fertility services for this emerging demographic.

1093 Pyoderma Gangrenosum Complicating Surgery for Breast Cancer in A Patient with Insulin Treated Diabetes. A Case Report

Aim

Although rare, Pyoderma Gangrenosum (PG) occurs as a significant complication of breast surgery. The early manifestations are similar to necrotising wound infection, so diagnosis and correct management are often delayed.

Method

We present the case of a 51-year-old female, diagnosed with multifocal right breast cancer, who underwent right sentinel lymph node biopsy and bilateral skin-spearing, nipple-sacrificing mastectomies with immediate implant reconstruction (patient’s choice). Her medical history included type 2 diabetes on insulin, hypertension, and obesity. One week postoperatively the right breast wound showed signs of not healing. After 5 weeks of conservative management including input from tissue viability, wound debridement and negative pressure wound therapy (NPWT), the phenomenon of pathergy raised the clinical suspicion of PG which was confirmed histologically.

Results

A multidisciplinary approach was instituted. The patient was started on steroid and non-steroid immune modulation therapy. She underwent further wound debridement, implant removal with NPWT and she received Tamoxifen as adjuvant chemotherapy had to be delayed. The wound healed 27 weeks after initial surgery.

Conclusions

Pyoderma Gangrenosum is an ulcerative skin disorder of unknown aetiology which is associated with systemic illnesses. It needs to be recognised and requires aggressive systemic therapy. There is little information about its long-term evolution.

Acute isolated sphenoid sinusitis in children: A case series and systematic review of the literature

OBJECTIVE

This study aims to present a case series and systematic review of acute isolated sphenoid sinusitis (AISS) in children in order to better characterize clinical presentation, diagnosis, treatment, and outcomes of this condition.

DATA SOURCES

Ovid MEDLINE, Pubmed, Embase, Cochrane Library, and Google Scholar.

STUDY SELECTION

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text, peer-reviewed journal publications from 1994 to 2020 in English; focus on acute sphenoid sinusitis; pediatric patients (<18 years of age); series with two or more children. Studies were assessed for data including demographics, presenting symptoms and signs, radiological investigations, treatment, outcomes and complications.

RESULTS

Ten studies identifying 71 patients were included. Average age at presentation was 12.0 years (range 5-17 years). M:F ratio 1:1. The most common presenting symptoms were headache (98.6%), fever (50.7%), nasal symptoms (22.5%) ocular symptoms (19.7%) and decreased level of consciousness (12.7%). Twenty patients (28.1%) had neurological signs. Twenty-three patients (32.4%) presented with headache in isolation. Unsuspected diagnosis at presentation was noted in 54.0%. Average time to initial presentation was 14.0 days (median = 5.5 days, range 1-90 days). The majority of children were treated with antibiotics (98.6%) with 31.0%, 2.8% and 2.8% also undergoing sinus surgery, revision sinus surgery and neurosurgery, respectively. Intracranial complications occurred in 16.9% of patients. Significant long term sequelae occurred in 2 children (2.8%) and one death (1.4%) was also reported.

LIMITATIONS

All studies were retrospective case note reviews.

CONCLUSIONS

Acute sphenoid sinusitis is a rare and difficult condition to diagnose in children. The majority of patients make a full recovery with appropriate treatment. If treatment is delayed however consequences can be life-threatening.

The NeST (neoadjuvant systemic therapy in breast cancer) study - Protocol for a prospective multi-centre cohort study to assess the current utilization and short-term outcomes of neoadjuvant systemic therapies in breast cancer

INTRODUCTION

Neoadjuvant systemic therapy (NST) has several potential advantages in the treatment of breast cancer. However, there is currently considerable variation in NST use across the UK. The NeST study is a national, prospective, multicentre cohort study that will investigate current patterns of care with respect to NST in the UK.

METHODS AND ANALYSIS

Phase 1 - a national practice questionnaire (NPQ) to survey current practice.Phase 2 - a multi-centre prospective cohort study of breast cancer patients, undergoing NST.Women undergoing NST as their MDT recommended primary breast cancer treatment between December 2017 and May 2018 will be included. The breast surgery and oncological professional associations and the trainee research collaborative networks will encourage participation by all breast cancer centres.Patient demographics, radiological, oncological, surgical and pathological data will be collected, including complications and the need for further intervention/treatment. Data will be collated to establish current practice in the UK, regarding NST usage and variability of access and provision of these therapies. Prospective data on 600 patients from ~50 centres are anticipated.Trial registration: ISRCTN11160072.

ETHICS AND DISSEMINATION

Research ethics approval is not required for this study, as per the online Health Research Authority decision tool. The information obtained will provide valuable insights to help patients make informed decisions about their treatment. These data should establish current practice in the UK concerning NST, inform future service delivery as well as identifying further research questions.This protocol will be disseminated through the Mammary Fold Academic Research Collaborative (MFAC), the Reconstructive Surgery Trials Network and the Association of Breast Surgery. Participating units will have access to their own data and collective results will be presented at relevant conferences and published in appropriate peer-reviewed journals, as well as being made accessible to relevant patient groups.

Quantifying bi-variate coordination variability during longitudinal motor learning of a complex skill

Biofeedback (BFb) can enhance the motor learning process by guiding skill exploration. Too much BFb, however, can foster dependency leading to skill retention deficits once removed. A reducing BFb schedule could negate dependency effects, however limited methodologies exist to assess the effectiveness of an intervention during application. This research proposes a new bi-variate method (CI2_Area) to quantify coordination variability (Coord_Var) as a measure of skill exploration during a motor learning intervention. Thirty-two participants were introduced to a novel explosive-lunge task. A BFb group (n = 16) were provided with visual BFb on rear hip, knee and ankle joint extension magnitudes and timing during a 26-week reducing schedule BFb intervention. Coord_Var of hip-knee and knee-ankle angular velocities were quantified by calculating the area encompassed by the 95% confidence intervals of joint coupling angular-velocity bi-variate plots (CI2_Area). Linear regressions were fitted to group and individual Coord_Var longitudinal data. The BFb was effective in successfully altering whole limb technique within just two sessions, and these changes were retained. The BFb group demonstrated a continual increase of Coord_Var throughout the intervention, showing continual skill exploration strategies, while the Control group remained unchanged. Gradually increasing time between sessions, using a longitudinally reducing BFb schedule, successfully negates dependency effects on BFb while also encouraging motor learning. Manipulating time between sessions allows for the provision of a high frequency of 100% BFb without fostering dependency. The CI2_Area method was able to detect individual exploration strategies and could be used in the future to direct individual intervention modifications.

Abstract P6-04-02: Profiling of BRCA1 Mutated Breast Tumours Using a Breast Cancer Specific Microarray To Identify a Profile of BRCAl-Deficiency

Background

The BRCA 1 tumour suppressor gene is mutated in a significant proportion of hereditary breast cancer cases. Additionally, downregulation of BRCA1 mRNA and protein expression is reported in approximately one third of sporadic breast cancers. BRCA1 is strongly implicated in the maintenance of genomic stability by its involvement in multiple cellular pathways including: DNA damage signalling, DNA repair, cell cycle regulation, protein ubiquitination, chromatin remodelling, transcriptional regulation and apoptosis. To date, gene expression profiling has identified: (1) at least five breast cancer subtypes and (2) that BRCA1 mutant tumours segregate with basal-like breast cancers. These studies also provide evidence that breast cancers with germline mutations in BRCA1 are different from non BRCA1-related tumours. The main aim of this study is to investigate the underlying biology of BRCA1-mutated breast cancer. Methods

Extensive gene expression profiling and data analysis were performed on a cohort of 70 FFPE (Formalin Fixed Paraffin Embedded) derived BRCA 1 mutated breast tumours and matched sporadic controls using the Almac Breast Cancer DSATM research tool. Functional analysis was performed with DAVID and METACORE. Validation of gene targets was performed by qRT-PCR and Western blotting. Results

A list of differentially expressed transcripts has been derived from the comparison of these BRCA1 mutant breast tumours and matched sporadic controls. Functional analysis of this gene list has identified the key genes and molecular pathways that are deregulated in these tumours. BRCA1 deficiency was associated with deregulation of pathways involved in: (1) immune response, (2) metastasis and invasion, (3) cytoskeletal remodelling, (4) spindle assembly and chromosome separation, (5) apoptosis and survival. Validation of the key genes underlying this BRCA1-deficient breast cancer profile has been performed. Conclusions

This approach has revealed a set of transcripts that could potentially be used to identify both hereditary and sporadic breast cancer patients with BRCA1- deficiency. The ability to perform gene expression profiling from FFPE derived breast tissue could also have significant clinical application.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-04-02.

A hybrid linear/nonlinear training algorithm for feedforward neural networks

This paper presents a new hybrid optimization strategy for training feedforward neural networks. The algorithm combines gradient-based optimization of nonlinear weights with singular value decomposition (SVD) computation of linear weights in one integrated routine. It is described for the multilayer perceptron (MLP) and radial basis function (RBF) networks and then extended to the local model network (LMN), a new feedforward structure in which a global nonlinear model is constructed from a set of locally valid submodels. Simulation results are presented demonstrating the superiority of the new hybrid training scheme compared to second-order gradient methods. It is particularly effective for the LMN architecture where the linear to nonlinear parameter ratio is large.

Photochemistry and photophysics of Cr(III) macrocyclic complexes

The phosphorescence and photochemical behavior of the macrocyclic complexes (1,4,7,10,13,16-hexaazacyclooctadecane)chromium(III) (Cr([18]-aneN(6))(3+); 1) and (4,4',4''-ethylidynetris(3-azabutan-1-amine)) chromium(III) (Cr(sen)(3+); 2) have been compared to each other and to the complex Cr(en)(3)(3+). For both macrocyclic complexes, phosphorescence from room temperature aqueous solutions is too weak to be observed, contrasting with Cr(en)(3)(3+), though both had somewhat longer 77 K lifetimes than Cr(en)(3)(3+). Phosphorescence lifetimes for these macrocyclics decreased with increasing temperature much faster than for Cr(en)(3)(3+) and a conventional extrapolation based on a fit of reciprocal lifetimes (corrected for the low-temperature contribution) to the Arrhenius equation gave estimated room temperature phosphorescence lifetimes of a few nanoseconds, consistent with the failure to observe room temperature emission. Fitting of the nonlinearity of the data seen in these plots suggested that two high-temperature processes were occurring with estimated activation parameters (E in kJ mol(-1) and A in s(-1)) for Cr([18]-aneN(6))(3+): E(1) = 40, A(1) = 1 x 10(16); E(2) = 24, A(2) = 1 x 10(14): Cr(sen)(3+); E(1) = 45, A(1) = 2 x 10(15); E(2) = 29, A(2) = 7 x 10(11). Cr([18]-aneN(6))(3+) was photochemically inert on irradiation. On irradiation into the lowest quartet ligand field absorption band, Cr(sen)(3+) photolyzes with a quantum yield of 0.098 +/- 0.001 at room temperature. Laser flash photolysis with conductivity detection showed that this photoreaction occurred faster than protonation of the liberated amine ligand at all practical proton concentrations. The quantum yield for irradiation directly into the doublet absorption band of Cr(sen)(3+) was 0.077 +/- 0.003. Photoaquation of Delta-Cr(sen)(3+) led to loss of optical activity and product analysis by capillary electrophoresis showed that both racemic and Delta-Cr(sen)(3+) photoaquate to a single main product, trans-Cr(sen-NH)(H(2)O)(4+). The product stereochemistry is shown to be consistent with predictions based on the angular overlap model for Cr(III) photochemistry, recognizing the additional constraints imposed by the ligand. The abnormally short room temperature solution lifetime of the doublet state is a result of a radiation-less process that competes with other processes depleting the doublet state. However, this doublet-state deactivation process does not lead to photoaquation but competes with BISC and photoaquation via the quartet state, resulting in an unprecedented reduction in photoaquation quantum yield on direct irradiation into the doublet state.

Mammals from Holocene Archaeological Deposits on Gebe and Morotai Islands, Northern Moluccas, Indonesia

Archaeological deposits of late Pleistocene and Holocene age from Gebe and Morotai Islands, Maluku Utara, Indonesia, have yielded the remains of mammals not recorded in the modem fauna of those islands. A wallaby very similar to Dorcopsis mulleri mysoliae (which is known today only from Misool) was common on Gebe between about 8500 and 2000 uncalibrated radiocarbon years ago, after which it became locally extinct. A similar taxon occurs on Halmahera in archaeological contexts dating from about 5500 to 1700 years ago. It appears likely that these wallaby populations were originally introduced from Misool. The remains of two large, apparently undescribed species of Rattus, as well as Rattus morotaiensis, are present in the Morotai archaeological record, which currently dates from 14,000 years ago. These animals are not present so far in deposits from Halmahera The remaining fauna in the archaeological deposits discussed in this paper represent species still surviving in the region, including phalangers, bats, fish, reptiles, birds, pig and dog (the two latter only present after 3500 years ago, and introduced by humans).

Patterns of colonisation and the "thrifty" genotype in Pacific prehistory

The seemingly distinctive markers of Polynesian biology - serologic, molecular, anatomical, and developmental - have been argued to have emerged from the special circumstances of colonisation and early settlement of the region. Models point to the microevolutionary impact of mortality selection while voyaging, small founding group size forcing bottlenecking, and subsequent relative isolation of groups introducing heterogeneity through genetic drift within Polynesia. These ideas have drawn on a melange of ideas about the colonising experience to construct evolutionary narratives, including that of the "thrifty" genotype in Polynesia. The substantial problem is that there previously has been no independent theory of colonisation and inter-island contact for the region. We critically examine which microevolutionary forces would have impacted prehistoric Polynesians in terms of an independent navigational theory of colonisation, and map out the expected biological/ evolutionary sequelae. This theory suggests that Remote Oceania was settled by directed return voyages, that the tempo of population expansion was probably rapid, that voyaging continued after settlement, that whereas episodes of colonisation were directed to safety, subsequent inter-group voyages followed the pattern of mutual inter-island accessibility. The implication is that mortality selection would not have been the predominant force shaping the Polynesian genotype; the development of survival sailing strategies were designed to remove these very risks. This makes it unlikely that the specific experience of Polynesian colonisation would promote an efficient insulin mechanism, and so explain, for example, the high incidence of Type II diabetes mellitus in contemporary Polynesian groups.

Effects of intra-core mechanical interlocks and cement type on full crown retention

This study compared the retention of full cast crowns over cores of amalgam or a Bis-GMA composite resin when cemented with a Bis-GMA composite resin cement or a zinc phosphate cement. The surfaces of two groups of Bis-GMA composite cores were mechanically altered with a groove or dimples to provide physical retention; two other groups were either etched with 1.23% acidulated phosphate fluoride (APF) or exposed to a zinc oxide-eugenol interim luting agent before crown cementation. Control groups of unaltered composite or amalgam core served as comparison standards. The zinc phosphate cement provided significantly greater retention with the amalgam core than with any of the composite cores. The APF-treated composite cores had the least retention of any of the zinc phosphate cementations. Cementation failure over the composite cores was at the core surface. Crown retention over the control and dimpled-surface composite core with the resin cement was twice that with zinc phosphate, and significantly greater than retention of castings cemented with the resin cement over amalgam cores. Retention over amalgam cores was significantly greater with zinc phosphate cement than with the composite resin cement.

Personal views of the NHS--warts and all

Images

Jaundice secondary to hepatic artery aneurysm: radiological appearance and clinical features

Hepatic artery aneurysm comprises only 20% of all visceral aneurysms. The classical triad of abdominal pain, hemobilia, and jaundice is seen in less than one-third of cases. Up to 60% of patients present with an abdominal catastrophe. In our case of hepatic artery aneurysm, the diagnosis was suggested by CT scan and confirmed by angiography. Its appearance is also demonstrated on sonogram and cholangiogram. To our knowledge, this is the first case to be reported where the aneurysm was demonstrated on multiple radiographic images.

Cardiac arrest under age 40: etiology and prognosis

Between January 1979 and December 1982, 84 patients between the ages of 1 and 39 years presented to the emergency department in a state of cardiac arrest. There were 58 male patients (69%) and 26 female patients (31%) in the group. Presenting rhythms were ventricular fibrillation (37%), asystole (37%), idioventricular rhythm (14%), heart block (4%), bradycardia (4%), ventricular tachycardia (3%), and electromechanical dissociation (3%). Thirty-two percent had bystander CPR. Of 21 patients initially resuscitated (25%), only four (5%) survived to discharge from the hospital. All survivors were neurologically intact. Seventy-five of the 80 patients who died (90%) underwent autopsy. Cause of death in the five remaining patients was inferred from clinical history. Etiologies of the cardiac arrests were the following: toxic exposure or ingestion (26%), atherosclerotic heart disease (23%), undetermined (11%), pulmonary embolism (6%), hemorrhage (6%), epilepsy (2%), cardiomyopathy (7%), myocarditis (2%), pneumonia (4%), and one case each of airway obstruction, asthma, peptic disease, and septic shock. Diverse etiologies should lead to a diagnostic search for reversible conditions in young patients. The prognosis for hospital discharge is poorer in the young population than is reported in our overall cardiac arrest population; however, numbers of neurologically intact survivors are similar in the young and the overall cardiac arrest population.

Emergency catheterization of the superior vena cava in pediatric patients

All emergency department attempts at superior vena caval catheterization at Hennepin County Medical Center from 1978 to 1982 in patients less than 13 years of age are reviewed. There were 60 attempts on 41 patients who had life-threatening conditions. Forty-one (68.3%) catheterization attempts were successful, and 37 (90.2%) of the patients had at least one central catheter placed. There were no complications that affected any patient's hospital course or outcome. This series demonstrates that percutaneous central venous catheterization can be performed on seriously ill or injured children, under emergency conditions, with a high rate of success and low incidence of complications.

Does a booklet on breast self-examination improve subsequent detection rates?

Of 28 788 women aged 40 to 74 registered at 28 university teaching practices in greater Belfast, half were randomly selected to receive a booklet on breast self-examination from their general practitioner at the start of the study and 1 year later. The frequency of breast abnormalities was identical in both groups (0.83%) during the 2-year follow-up. Early malignant breast cancers (stages TX, TO, Tla) were significantly more frequent in the intervention group (53.6%) than in the control group (24.3%). Among women in the intervention group with malignant lesions, 2 sites, left nipple and left inner/upper quadrant, were significantly less frequently involved. These findings in relation to staging and site were confirmed by multivariate comparisons. The intervention group also had a smaller average tumour size (24.0 mm compared with 32.6 mm) due to significantly smaller benign tumours and the absence of the relationship between delay and tumour size evident in the control group.

Evidence that brain aromatization regulates LH secretion in the male dog

A variety of data suggest an independent role for androgens and estrogens in the regulation of luteinizing hormone (LH) secretion in the male. Estrogens, in the male are primarily derived from testicular androgens that are aromatized both in peripheral tissues and in the CNS. Our prior data suggested a pharmacologic regimen that blocked CNS aromatization without lowering peripheral estrogen or testosterone levels. Such experimental conditions would permit assessment of the relative roles of CNS versus peripheral aromatization in the regulation of LH secretion. We utilized this regimen (aminoglutethimide, a potent aromatase inhibitor, and hydrocortisone) in seven adult male dogs for 14 days. Plasma LH rose to castrate levels, 450% above control values on days 7 and 14. These LH increments stimulated similar rises in androstenedione, testosterone, and dihydrotestosterone. In contrast, plasma estrone and estradiol concentrations remained constant. The induction of castrate LH levels without a concomitant fall in peripheral androgens or estrogens is best explained by a block of central aromatization and thus a reduction in local hypothalamic concentrations. We conclude that aromatization in the CNS rather than peripheral tissues is the more important site with respect to LH negative feedback in the male dog.

Do patients read breast self-examination booklets?

If a campaign to encourage women to examine their breasts for lumps is to succeed, it is necessary for women to read the literature produced. An attempt was made to estimate whether such literature was read, and in a group of women 90.6 per cent read the booklet, and 15.9 per cent altered their behaviour. There were several other non-numerical indicators which strongly suggested that women read the literature. A large-scale study is now under way.

Hepatitis B antigen and antibody in the U.S. Army: prevalence in health care personnel

The prevalence of Hepatitis B surface antigen (HB(S)Ag) and antibody (anti-HB(S)) seropositivity and the association of seropositivity with demographic, personal health, and professional experiences were studied in a cohort of Army Medical Department officer personnel. Serologic evidence of Hepatitis B infection was found in 5.0 per cent of personnel and was associated with age, sex, place of birth, history of hepatitis, history of blood transfusion, and previous overseas assignments. Seropositivity rates were higher for patient care oriented officer personnel, especially for those in surgical specialties, and rose with increasing professional experience. These data present a composite of risk factors operative in the acquisition of Hepatitis B seropositivity and identify a cohort for prospective study.