Executive function is critical for goal-directed behavior, and open-skill sport experience involves cognitively demanding environments that require rapid perception, decision-making, and action control. This study examined behavioral, computational, and neural differences in executive function between open-skill athletes and matched non-athlete controls. Forty-four open-skill athletes and 43 controls completed a task-switching paradigm, the Multi-Source Interference Task (MSIT), and an N-back task. Open-skill athletes responded significantly faster than controls in the task-switching paradigm and MSIT while maintaining comparable accuracy, with no significant group difference in N-back performance. Hierarchical drift-diffusion modeling (hDDM) showed that athletes had shorter non-decision times during task switching and lower decision thresholds during MSIT. Functional magnetic resonance imaging (fMRI) revealed reduced task-related activation in the left dorsolateral prefrontal cortex and right cerebellar Crus I/II during task switching, and in the left inferior temporal gyrus during MSIT. Exploratory Bayesian mediation analyses indicated possible indirect effects involving task-related activation, specific DDM parameters, and response time; these analyses were interpreted as exploratory rather than causal. Together, the findings are consistent with a selective efficiency account, suggesting that open-skill athletes show task-specific behavioral, computational, and neural efficiency patterns relative to non-athlete controls.
Prior mixed cohort pitching biomechanic analyses have noted improved throwing arm kinetics in pitchers with delayed trunk rotation. To compare throwing arm kinetics and ball velocity in a homogenous professional baseball pitching cohort based on trunk rotation initiation before or after foot contact. 339 professional pitchers instructed to throw 8 to 12 fastball pitches were evaluated with 3-dimensional motion capture (480 Hz). Pitchers were identified as initiating trunk rotation before the moment of foot contact (FC) (EARLY, n=33) and were propensity matched on the basis of height, age, and weight to pitchers who initiated trunk rotation after FC (LATE, n=132) resulting in a 4:1 match. Each EARLY pitcher was paired with each of their four matched LATE pitchers, yielding 132 matched pairs, and between-group differences across 32 pre-specified kinematic and kinetic outcomes were evaluated with paired-samples t-tests using the per-pitcher mean across all available pitches. Effect estimates are reported as mean difference (EARLY - LATE) with 95% confidence intervals. Significance was assessed at Bonferroni-corrected thresholds within outcome sub-domain. Within-pitcher autocorrelation was assessed with the Durbin-Watson statistic. Prior-injury prevalence was compared with Fisher's exact test. EARLY pitchers demonstrated a longer stride length at foot contact (MD +3.7 %BH [95% CI +2.6, +4.8], p<0.001*), a more open pelvis at foot contact (MD -8° [95% CI -11, -5], p<0.001*), greater shoulder external rotation at foot contact (MD +17° [95% CI +10, +24], p<0.001*), greater shoulder horizontal adduction at maximum external rotation (MD +3° [95% CI +1, +5], p=0.002*), greater trunk flexion at ball release (MD +7° [95% CI +5, +9], p<0.001*), greater maximum trunk flexion excursion (MD +5° [95% CI +3, +7], p<0.001*), later foot contact (MD +0.022 ms [95% CI +0.018, +0.026], p<0.001*), and earlier trunk initiation (MD -0.021 ms [95% CI -0.026, -0.016], p<0.001*) than LATE pitchers. EARLY pitchers also showed lower peak pelvic rotation velocity (MD -44°/s [95% CI -67, -22], p<0.001*), greater normalized elbow distractive force (MD +8.3 %BW [95% CI +4.1, +12.6], p<0.001*), greater normalized shoulder distractive force (MD +9.8 %BW [95% CI +5.7, +14.0], p<0.001*), and lower maximum trunk rotational kinetic energy (MD -4.0 J [95% CI -6.2, -1.8], p=0.002*). Ball velocity did not differ between EARLY and LATE pitchers (MD +0.5 m/s [95% CI -0.0, +1.1], p=0.070). Prior shoulder (12.1% vs 9.1%), elbow (18.2% vs 18.9%), and any upper-extremity injury (33.3% vs 31.8%) did not differ between groups (all Fisher exact p>0.5). Professional baseball pitchers who initiated trunk rotation before foot contact demonstrated increased throwing arm kinetics and altered pitching mechanics including increased normalized shoulder and elbow distractive forces, decreased peak pelvic rotation velocity, decreased maximum trunk rotational kinetic energy, and a longer stride with a more open pelvis and greater shoulder external rotation at foot contact, suggesting compensatory motions of the throwing arm to achieve similar ball velocities. Professional pitching staff should be cognizant of the potential mechanical disadvantage of early trunk initiation on the throwing arm. Trunk initiation before or after foot contact gives pitchers a concrete time point by which to adjust or refine their pitching mechanics.
The purpose of this study was to evaluate the prevalence, type and level of spin in studies comparing open and arthroscopic Latarjet procedures for anterior shoulder instability. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. PubMed was searched for comparative studies published in the last 20 years addressing open and arthroscopic Latarjet procedures. Eligible articles were screened and assessed independently by two reviewers. Spin was classified into three categories-misleading reporting, misleading interpretation and inadequate extrapolation-and graded as low, moderate or high. Of the 25 included studies, 80% exhibited at least one type of spin. The most common types were selective reporting (48%), lack of discussion of limitations (20%) and claims of significant differences without statistical testing (20%). Studies with high levels of spin had a spin ratio of 1.64, while those with moderate levels had a ratio of 2.00-both higher than the 1.00 ratio observed in studies with low-level spin. Studies with level of evidence IV showed a higher spin ratio per study. Additionally, spin was present regardless of conflict-of-interest declarations or funding disclosure. Spin is prevalent in the literature comparing open and arthroscopic Latarjet procedures, with moderate to high levels of spin more common than low. These findings highlight the importance of transparent reporting and careful interpretation of comparative surgical literature. Level IV, systematic review of Levels II-IV studies.
Sport is traditionally organised into male and female categories, but the increasing visibility of transgender athletes has prompted sporting organisations worldwide to develop relevant eligibility regulations. These policies range from hormone thresholds and open categories to puberty-based exclusions and blanket bans yet are rarely based on direct scientific evidence. This review aims to examine the historical evolution of transgender inclusion in sport, map current international regulations and evaluate the evidence underpinning these approaches. First, we outline the temporal evolution of eligibility frameworks. We then review the roles of sex hormones in performance-relevant systems and assess how these mechanisms may result in physiological changes in transgender athletes receiving testosterone or estradiol-based gender affirming hormone therapy (GAHT). Studies demonstrate that GAHT induces physiological changes that may translate to measures of physical fitness, but are limited by cross-sectional designs, small cohorts, short follow-up periods, heterogeneous treatment regimens and outcome measures that are rarely sport specific. Therefore, the certainty of this evidence remains low, and existing data are insufficient to support uniform policies across all disciplines. We therefore recommend that fairness and safety considerations should not be resolved through biology alone and propose a structured, sport-specific framework for policy development and revision under uncertainty.
One of the most important factors affecting quality of life is recreation, due to its positive role in social and physical health. Adaptive recreation can be difficult to access, largely because market availability for adaptive equipment, outside of assistive devices for daily living tasks, is extremely limited. The purpose of this project is to develop an open-source repository of affordable Sport and Recreation Activity Assistive Technology in response to idea submissions from the disability community. Prototypes are developed using predominantly 3D printing coupled with commonly available assembly materials, a fabrication approach that allows for rapid and reasonably affordable development of custom solutions. Each prototype follows a defined project methodology: need identification, design (prototyping and evaluation), fabrication testing, and dissemination. To date, several devices have been designed and made available with full documentation, including swim paddles, an attachment for a miniature golf club, billiards stick handles, a game piece mover, a cornhole bag adaptation, an arm prosthetic vehicle shifter adaptor, and a curling stone push stick attachment. All device designs, part files, bills of materials, and assembly instructions are accessible through a publicly available repository so that end users or their support networks can download and fabricate the devices themselves.
Mental health disorders are increasingly acknowledged as significant factors influencing surgical outcomes. However, their effect on recovery after Achilles tendon repair (ATR) remains inadequately defined. Psychosocial elements may modify pain perception, opioid consumption, adherence to rehabilitation protocols, and overall utilization of health care services. To evaluate the postoperative complications among patients with preexisting mental health diagnoses in the context of ATR. Cohort study; Level of evidence, 3. A retrospective analysis was performed using the TriNetX Research Network on August 14, 2025. Patients with a mental health disorder diagnosis within 1 year before ATR were identified using the International Classification of Diseases, Tenth Revision, and Current Procedural Terminology codes. These patients were compared with controls without a documented diagnosis of mental health disorders. Propensity score matching (1:1) was performed for age, sex, body mass index, and other important comorbidities. The initial search identified 11,787 patients who underwent ATR. Outcomes at 3, 6, 12, and 24 months included ankle pain, stiffness, complex regional pain syndrome (CRPS), wound complications, opioid use, and revision repair. Odds ratios (OR) with 95% CIs were calculated. After matching, 1767 patients were included in each group. At 3 months, the mental health cohort had 1.59 times higher odds of wound complications (7.2% vs 4.6% [95% CI, 1.19-2.1]; P = .01), 1.39 of ankle stiffness (5.2 vs 3.8% [95% CI, 1.01-1.92]; P = .04), and 1.56 of ankle pain (22 vs 15% [95% CI, 1.32-1.86]; P < .001) compared with the control group. Additionally, the mental health group had higher incidence of emergency department visits (OR, 1.50 [95% CI, 1.19-1.9]; P = .001), reoperation for any reason (OR, 1.51 [95% CI, 1.15-1.99]; P = .003), readmission (OR, 1.76 [95% CI, 1.24-2.50]; P = .001), and opioid use (OR, 1.58 [95% CI, 1.37-1.81]; P < .001). At 6 months, all these differences persisted (all P < .05). At 1 year, ankle pain (12.4% vs 9.3%) and opioid use (22.8% vs 16.4%) remained significantly elevated in the mental health cohort. At 2 years, ankle pain, opioid use, and CRPS (1.4% vs 0.6%; OR, 2.52 [95% CI, 1.20-5.26]; P = .01) were significantly more common. Revision rates did not differ between groups at any time point. Our study showed that mental health disorders are associated with an increase in postoperative complications after ATR. The persistence of pain and opioid dependence over 2 years underscores the significant long-term impact of psychosocial factors on the recovery process. These findings support the incorporation of routine psychosocial screening and perioperative mental health support into comprehensive care strategies to reduce complications and enhance functional outcomes.
A key metric utilized by coaches and athletes to track athlete performance is heart rate variability (HRV). HRV calculated via electrocardiogram (ECG) has been shown to track autonomic function. However, many wearable devices utilize photoplethysmography (PPG) to calculate pulse rate variability (PRV). Our study investigated the agreement between PRV and HRV in a beat-to-beat analysis in a sample of American football players. Data from 103 male, Division I collegiate American football athletes, collected over three seasons, were analyzed. Heart rate (HR), pulse rate (PR), and two time-domain indices for PRV/HRV were measured (rMSSD and SDNN). Agreement between PRV and HRV was assessed using Bland-Altman analysis (bias, limits of agreement, and confidence intervals) with supporting error metrics (MAE, RMSE, Pearson r, and Lin's concordance correlation coefficient). To evaluate whether PRV detected autonomic deviations of the same magnitude to HRV on the same day, a sliding-window z-score threshold-crossing analysis (0.5-2.0 SD) quantified PRV detection rates and PRV delay. HR and PR were similar at (59.4 (10.3) bpm vs. 59.7 (10.3) bpm). In contrast, PPG-PRV values were lower than ECG-HRV for both rMSSD and SDNN (80.9 (23.1) ms vs. 103.9 (22.0) ms, 141.3 (41.7) ms vs. 167.9 (40.0) ms). Bland-Altman analysis showed negative bias for rMSSD and SDNN across PPG wavelengths, race, and obesity, while HR/PR agreement was high with small bias (0.24-0.44 bpm). In the deviation analysis, PRV detected fewer autonomic deterioration events on the same day as HRV, capturing 16.7% to 56.7% of HRV-identified rMSSD events and 16.8%-52.0% of SDNN events across thresholds, and exhibited an average delay of 1.8-5.5 days in detecting changes already identified by ECG-HRV. Our findings refute PPG-PRV as an equivalent surrogate for ECG-HRV for tracking autonomic function over time. Specifically, the delay in response when using PPG-PRV to track athlete autonomic function will result in missed opportunities for coaches to prevent autonomic deterioration. Finally, the PRV calculated with PPG should not be called HRV as it confuses scientists and consumers.
Knee osteoarthritis (KOA) results from cartilage degeneration and abnormal load distribution, leading to impaired biomechanics and postural control. Foot abnormalities such as hypermobility, flat feet, and pronation-common in KOA-may contribute to the degeneration process of the knee joint structures. Stabilization and proprioceptive exercises, as well as orthopedic inserts, can modify these factors by improving muscle function and redistributing load. However, studies directly comparing their effectiveness using objective assessment methods are lacking. Postural control plays a key role in KOA because it reflects the integration of balance systems. The aim of the study was to evaluate the effect of these interventions and their combination on postural balance in centre of pressure (COP) and clinical outcomes (KOOS - knee injury and osteoarthritis outcome score) in patients with early KOA. Participants were randomly divided into four groups: "Exercises" (n = 43), "Orthopaedic insoles" (n = 43), "Mixed" (n = 39), "Control" (n = 41). During the qualification process, a posturographic examination was performed on a force platform with eyes open and closed in a standing position. Participants were also assessed using the KOOS questionnaire. The obtained data were analyzed in Statistica 13 using the Wilcoxon signed-rank test and the Kruskal-Wallis ANOVA test. A significance level of p = 0.05 was used. Posturographic parameters such as sways length and mean speed with eyes open and closed improved, and the ellipse area of the center of gravity decreased in the mixed group (p = 0.001). The largest clinical effects were observed for sways length with eyes open (d = 2.512) between the control and exercise groups and for sways length with eyes closed (d = 2.172), ellipse area with eyes open (d = 1.361), and mean speed with eyes closed (d = 2.193) between the control and mixed groups. Quality of life (QoL) and functioning improved statistically, and significant between-group differences were found for pain, symptoms, physical activities of daily living (ADL), sports/recreation, and QoL (p < 0.001). However, there were no significant differences between the exercise group and the orthopedic insole group in terms of symptoms, ADL, sports/recreation, and QoL. A significant clinical effect was observed on the KOOS pain score between the insoles and exercise groups (d = 1.122). The combined use of orthopedic insoles and exercises is the most effective method of rehabilitation.Trial registration: The study was registered in the international Research Registry database (https://www.researchregistry.com/) under registration number researchregistry11661.
To our knowledge, no previous systematic review and meta-analysis of doping prevalence in sport from indirect estimation models (IEM) exists. To conduct a systematic review and meta-analysis of empirical IEM-based studies of admitted doping prevalence in sport. We conducted electronic database and ad hoc searches up to March 2025, and estimated lifetime and past year prevalence rates through a cross-classified model including prevalence (lifetime vs. past year), sample (competitive vs. recreational) and sports (multi-sport vs. single-sport) types. Forty-six records (K) were included in the review (k [subset records included in the meta-analysis] = 30, n [independent studies from the records] = 34). The World Anti-Doping Agency's definition of doping use was applied for data collection in most studies (k = 18), and doping prevalence was mostly assessed as past year/season (k = 20). Studies included in the meta-analysis were mostly conducted in Europe (k = 22) and applied the Unrelated Question (k = 8) and Forced Response with Cheater Detection (k = 6) models. Study participants were mostly multi-sport (k = 20) and competed at diverse levels, and most data (k = 28) was collected outside sport events. The corpus included articles that re-analysed existing data (k = 4). Lifetime prevalence was highest for multi-sport competitive athletes (22.6%) and lowest for single-sport competitive athletes (12.7%), whereas past year prevalence was highest for single-sport recreational sportspersons (15.5%) and lowest for multi-sport recreational sportspersons (8.7%). Under IEM, about one of five multi-sport competitive athletes admitted to ever doping whereas about one of six of single-sport recreational sportspersons admitted to doping in the past year. Furthermore, multi-sport (vs. single-sport) competitive athletes show relatively higher doping prevalences, whereas single-sport (vs. multi-sport) recreational sportspersons report relatively higher doping prevalences. Secondary (re-)analysis presents a novel methodological challenge for meta-analyses. Registration PROSPERO: CRD42022373691.
We sought to generate recommendations for the tennis community regarding the provision of mental healthcare and the promotion of mental wellness among elite tennis athletes, including junior tennis athletes. Recommendations were generated using a multimethod approach that included an in-person summit held during the 2022 US Open Tennis Championships in New York, New York, USA, and an asynchronous Delphi consensus process. Participants (n=83) were purposively selected to ensure diverse representation from all seven governing bodies of tennis and the broader tennis ecosystem, including: current and former elite adult and junior players, coaches, sport administrators, parents, physiotherapists, athletic trainers, physicians (sports medicine, psychiatry, neurology), other licensed mental health providers, epidemiologists and other academic subject matter experts. The summit included expert presentations and cross-organisation group discussion, which were used to generate provisional consensus statements. Statements were rated anonymously and refined iteratively based on synthesis of open-ended feedback until predetermined numeric thresholds were reached. The summit also included discussion of implementation challenges and priorities. As a result of this process, 2 foundational principles and 25 actionable recommendations were adopted, covering 5 domains: (1) standards of care, (2) education, (3) media and social media, (4) safeguarding and (5) research. The foundational principles emphasised that mental health must be prioritised by tennis governing bodies and that these bodies should collaborate across the tennis ecosystem. This output is a starting point for coordinated mental health efforts in tennis. More broadly, this pragmatic process is a replicable model for cross-organisational collaboration in other high-performance sports.
Transverse process fractures (TPFs) are typically considered minor stable spinal injuries. However, in professional athletes, these fractures can significantly impact function, training and return-to-play decisions. This narrative review examines the anatomy of transverse processes, mechanisms of injury, clinical presentation, imaging modalities, management strategies, rehabilitation principles and return-to-play considerations. A comprehensive review of the literature was conducted, incorporating case studies, sports medicine reports and trauma data to provide an evidence-based approach to TPF diagnosis and management in professional athletes. TPFs in athletes typically result from high-energy direct trauma, excessive rotational forces or muscular avulsion. While inherently stable, they may be associated with concomitant injuries, necessitating a thorough clinical and radiologic evaluation. Despite emerging imaging techniques (e.g. magnetic resonance imaging [MRI] three-dimensional [3D] T1 volumetric interpolated breath-hold examination [VIBE]), computed tomography (CT) imaging remains the gold standard for diagnosis, with MRI useful for detecting soft tissue pathology. Treatment is predominantly non-operative, focusing on multimodal pain control, early mobilization and structured rehabilitation to restore spinal function while preventing complications. Return-to-play is individualized, with most athletes resuming full activity within 3-6 weeks for isolated TPFs, though multi-level fractures or associated injuries may prolong recovery. TPFs require careful assessment and management to ensure optimal recovery and a safe return-to-play. A multidisciplinary approach involving orthopaedic surgeons, musculoskeletal radiologists, sports physicians, physiotherapists, sport scientists and coaching staff is essential to balance expedient recovery without long-term sequelae. Understanding sport-specific demands and implementing tailored rehabilitation protocols can allow athletes to make a complete recovery with minimal risk of recurrence.
To systematically map and synthesise the scientific literature on substance use patterns among elite athletes, encompassing recreational substances, performance-enhancing drugs (PEDs) and polysubstance use. This study was a scoping review conducted in accordance with the Joanna Briggs Institute (JBI) methodological framework and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. The review protocol was prospectively registered on the Open Science Framework. A comprehensive search was conducted in PubMed/MEDLINE, PsycINFO, Scopus and SportDiscus from inception to March 2025. Eligible studies were peer-reviewed original research articles examining substance use, misuse or substance use disorders among elite athletes, including collegiate, professional, Olympic, Paralympic or national-level competitors. Both recreational substances (eg, alcohol, cannabis, nicotine, prescription drugs) and PEDs were included. From 3292 unique records screened, 119 studies met inclusion criteria. Alcohol was the most extensively studied substance, particularly among National Collegiate Athletic Association collegiate athletes, with consistent evidence of heavy consumption in certain sports, especially those with strong social and team-based norms. PED studies revealed marked sport-specific patterns, largely informed by anti-doping surveillance data, but offered limited insight into psychosocial mechanisms. Research on other substances and polysubstance use was heterogeneous, fragmented, and methodologically variable. Across all domains, the literature was dominated by cross-sectional designs, self-reported data and Western populations. The existing evidence base demonstrates substantial substance-related vulnerability among elite athletes but is characterised by significant conceptual, methodological and geographical gaps. Future research should prioritise longitudinal and theory-driven designs, broader representation of professional and non-Western athletes, integration of mental health frameworks and rigorous evaluation of prevention and intervention strategies. The review protocol was prospectively registered on the Open Science Framework (OSF) (DOI: 10.17605/OSF.IO/3PJDN) on 8 January 2025.
Elite football clubs rely heavily on medical and performance units to optimise players' health care and performance. Despite their growing importance, little is known about how these departments are structured and managed. This study investigates the organisational structure and operational processes within medical and performance departments in elite European football clubs. An online survey was distributed to 193 professional football clubs in 29 European countries, with 66 complete responses (34% response rate). Descriptive quantitative analyses and descriptive analyses of open-ended items explored leadership models, communication, data management, and return-to-play (RTP) procedures. Organisational structures varied, with flat (30%), functional (21%), and matrix (23%) models most common. Regional differences in leadership configurations were observed, though not statistically significant between European regions. Most departments reported to a Sports Director (42%) and operated with established communication pathways, with 89% agreeing that information was effectively transferred. Data were primarily stored centrally within the medical department or the club. Return-to-play practices almost exclusively followed a phased model, with physiotherapists central across all stages. Team doctors were heavily involved in early stages but less so during return to performance, where sport scientists and rehab coaches became more prominent reflecting current multidisciplinary RTP frameworks. High levels of external engagement (91%) and research involvement (62%) highlight a growing emphasis on evidence-based practice. These findings describe substantial structural heterogeneity and increasing professionalisation of medical and performance departments in European elite football. Regional variability and differences in leadership, data management, and decision-making processes warrant further investigation rather than direct comparison.
The olfactory bulb (OB) is one of the earliest brain regions affected in neurodegenerative diseases such as Parkinson's disease (PD). Its high metabolic rate, dopaminergic modulation, and connectivity with the cortical and limbic regions make it particularly vulnerable to early neuroinflammatory and oxidative processes. This study aimed to investigate whether the administration of 6-hydroxydopamine (6-OHDA) into the OB induces behavioral, redox, and inflammatory alterations associated with early cortical disturbances. Male Wistar rats were randomly assigned to the sham or 6-OHDA groups and underwent stereotaxic injection of the vehicle or 6-OHDA into the left OB. Behavioral performance was assessed in the open-field test 12 days after surgery, and cortical tissue was collected for biochemical and molecular analyses. Cytokines (IL-1β, IL-6, TNF-α, IL-10, IFN-γ, and MCP-1) were quantified by Luminex, redox parameters (CAT, GPx, MDA, and protein carbonyls) by spectrophotometry, and neuronal signaling proteins (c-FOS, CREB, and BDNF) by qPCR. Animals with 6-OHDA lesions exhibited decreased latency and increased time spent in the central zone of the open field, indicating altered exploratory behavior. IL-6 levels were significantly elevated, whereas IFN-γ was reduced in the cortex, while IL-1β, TNF-α, MCP-1, and IL-10 remained unchanged. The oxidative stress markers MDA and protein carbonyls were increased, while catalase and glutathione peroxidase activities showed no change. The expression of c-FOS, CREB, and BDNF was not significantly modified. These findings indicate that localized 6-OHDA administration in the OB is sufficient to elicit behavioral, inflammatory, and oxidative alterations in connected cortical regions, which may resemble early non-motor features associated with olfactory dysfunction, without representing a neurodegenerative disease-specific process.
Milk and milk-based beverages have shown potential benefits for maintaining exercise-induced negative energy balance. However, this has not been systematically investigated. Therefore, this review aimed to evaluate the effects of post-exercise milk or milk-based beverages consumption on appetite regulation and energy intake. A comprehensive search was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, Ovid MEDLINE ALL, Open Access Theses and Dissertations, and EBSCO Open Dissertations up to 6 April 2025. Eligible studies were randomized controlled trials assessing the effects of milk or milk-based beverages on post-exercise appetite regulation in healthy adults. Study selection, data extraction, and risk of bias assessment (RoB-2) were performed independently by two reviewers. Meta-analysis was conducted where appropriate using mean differences with 95% confidence intervals (CI). Subgroup analyses were conducted by sex and intervention. Twelve studies (n = 140) were included, of which 10 (n = 118) contributed to the meta-analysis of energy intake. Milk and milk-based beverages were associated with lower energy intake than carbohydrate (CHO) beverages (-72.73 kcal, 95% CI [-141.69; -3.77]; I2 = 0%, p = 0.039). Subgroup analyses indicated no effect modification by sex or intervention type. For subjective appetite ratings (11 studies, n = 125), meta-analysis was not performed due to measurement and reporting heterogeneity, and no clear differences or only mild appetite-suppressive effects were observed. Appetite-related hormones were assessed in two studies (n = 23), with no overlapping outcomes. Post-exercise consumption of milk and milk-based beverages may reduce energy intake compared with CHO beverages, although effects on subjective appetite are inconsistent and evidence for hormonal responses remains limited.
Prior research has revealed gender disparities in the financial relationships between industry and orthopaedic surgeons. Despite attempts to level the playing field, it remains unclear whether these efforts have reduced or eliminated gender disparities in financial relationships between industry and orthopaedic surgeons. The Centers for Medicare and Medicaid Services (CMS) Open Payments database was queried from January 1, 2024, to December 31, 2024 for orthopaedic surgeons receiving "consulting fee" or "royalty or license" payments of $1,000 or more. Surgeon characteristics were recorded from the CMS database and public sources. Total payment amounts and number of payments were calculated. Characteristics were compared by gender between those receiving any industry payment, consulting payment, and royalty payment. Multivariable linear regression analyses were used to identify factors associated with payment amount and number of payments. Results were compared with a study using similar data from 2016 to 2017. A total of 3,714 surgeons received industry payments, with 3,514 (95%) being men. Of those receiving royalty payments (n = 1,374), 1.5% (n = 21) were women. Of those receiving consulting payments (n = 3,122), 6.2% (n = 194) were women. Men (β = 1.57 [95% confidence interval [CI]: 0.41-2.73, p = 0.008), years of experience (β = 0.09 [95% CI: 0.07-0.12], p < 0.001), and adult reconstruction (β = 1.77 [95% CI: 0.76-2.79], p = 0.001) were associated with a greater total number of payments. Hand surgery (β = -2.57 [95% CI: 3.97 to -1.17], p < 0.001), pediatrics (β = -2.62 [95% CI: 4.60 to -0.64], p = 0.01), and sports (β = -1.12 [95% CI: 2.08 to -0.16], p = 0.02) were associated with the fewer total number of payments. Men (β = 0.34 [95% CI: 0.10-0.57], p = 0.004), years of experience (β = 0.051 [95% CI: 0.046-0.056], p < 0.001), and adult reconstruction (β = 0.47 [95% CI: 0.27-0.68], p < 0.001) were associated with greater payment amounts, while hand (β = -0.96 [95% CI: 1.24 to -0.68], p < 0.001) and pediatrics (β = -0.79 [95% CI: 1.18 to -0.39], p < 0.001) were associated with lower payment amounts. When examining trends over time, men received 1.57 (2024) vs. 5.17 (2016-2017) additional payments and 40% (2024) vs. 197% (2016-2017) larger payments compared with women. Gender disparities in financial relationships (i.e., number of payments and payment amounts) between industry and orthopaedic surgeons persist, though are improved compared with prior research from about a decade ago.
Ultrasound-guided minimally invasive procedures have rapidly emerged as an alternative to open or endoscopic surgery for several upper-limb conditions, including carpal tunnel syndrome, trigger finger, lateral epicondylitis, and calcific tendinitis of the rotator cuff. To our knowledge, no bibliometric analysis dedicated to this field has been published. This study aimed to characterize the 50 most-cited articles on ultrasound-guided minimally invasive procedures of the upper limb. A search of the Web of Science Core Collection was performed on May 17, 2026. The query combined ultrasound guidance terms with terms covering upper-limb procedures (hand, wrist, elbow, shoulder). After document type and English-language filters, articles were sorted by citation count, and two independent reviewers screened the top 200 records, excluding pure injections without a mechanical component. Bibliometric data, level of evidence, and thematic categories were extracted. The 50 included articles accumulated 2078 citations (mean 41.6 ± 22.8; range 20-107) and were published between 2005 and 2023. The Journal of Ultrasound in Medicine was the most prolific (10%); European countries collectively contributed 50% of articles (notably Spain 12% and Italy 10%), while the United States accounted for 22%. Sixty-two percent were Level IV-V evidence; 32% provided Level I-II evidence. The dominant themes were carpal tunnel release (32%) and barbotage for calcific tendinitis (28%). This bibliometric analysis highlights two dominant clusters (carpal tunnel release, calcific tendinitis) and a 32% rate of Level I-II evidence, higher than typically reported in surgical bibliometric analyses.
Insufficient physical activity and prolonged sedentary behavior among college students are associated with reduced lower-limb muscle strength, impaired dynamic balance, and increased susceptibility to sports-related knee injury. Female college students may be especially vulnerable because of sex-specific neuromuscular and biomechanical characteristics. Tai Chi Chuan may improve proprioceptive control and coordinated knee muscle activation, whereas unstable resistance training may rapidly enhance strength and neuromuscular stabilization. Whether a combined programme can produce complementary central-peripheral benefits remains to be verified in a rigorously designed randomized trial. This protocol describes a single-center, parallel-group, randomized controlled trial. Fifty-seven healthy female college students aged 18-22 years will be recruited from Fenyang College, Shanxi Medical University, and randomly allocated in a 1:1:1 ratio to a Tai Chi Chuan group (TCC), unstable resistance training group (URT), or Tai Chi Chuan combined with unstable resistance training group (T + URT). All interventions will last 8 weeks, with three 60-min sessions per week. The primary outcomes will be dominant-leg knee extensor peak torque, knee flexor peak torque, and hamstring-to-quadriceps ratio measured using an isokinetic strength testing system at 60 degrees/s. Secondary outcomes will include overall stability index, anteroposterior stability index, and mediolateral stability index under eyes-open and eyes-closed conditions measured with the Biodex Balance System. Assessments will be conducted at baseline and after the 8-week intervention. Intention-to-treat and per-protocol analyses will be used. Missing data will be handled using multiple imputation where appropriate. This trial is designed to determine whether Tai Chi Chuan combined with unstable resistance training provides superior improvements in knee muscle function and dynamic balance compared with either intervention alone. https://itmctr.ccebtcm.org.cn, Identifier (ITMCTR2026000456).
Mass gatherings (MGs) are associated with increased healthcare demand and may pose a risk for mass casualty incidents if medical services are not adequately planned. Trauma presentations constitute an important component of medical encounters during MGs; however, evidence regarding trauma patterns and preparedness requirements remains fragmented. The primary aim of this study was to examine rates of trauma-related presentations to in-event health care areas during MGs. Secondary aims were to identify trauma patterns across different event types, support planning of in-event health services and develop a practical checklist to assist trauma preparedness and response planning. Following PRISMA guidelines, a systematic search was conducted across PubMed, Web of Science, and Scopus databases for studies published between 2015 and 2025. Articles were screened based on the PICOS framework, focusing on observational studies of MG participants exposed to trauma. Inclusion required the reporting of in-event healthcare data, while studies solely using hospital-based records or lacking trauma-specific metrics were excluded. Data were extracted using a standardized form to identify event characteristics, patient presentation rate (PPR), and transport to hospital rates (TTHR). The primary outcome was the incidence of trauma, while secondary outcomes included the identification of trauma subtypes (e.g., musculoskeletal, soft tissue). The initial search yielded 382 articles. After removal of duplicates and exclusions, 18 relevant studies were included in the final synthesis. The proportion of trauma-related visits relative to all patients treated at in-event medical stations ranged from 11.7 to 81.7%. The highest trauma rate was reported at the European Youth Olympic Winter Festival (81.7%), whereas the Guadalajara International Book Fair reported the lowest (11.7%). Soft tissue injuries (13-42.3%) were the most prevalent across music and sporting events, followed by musculoskeletal injuries (3-35.7%). Events involving mosh pit behavior showed a distinct clustering of head and facial injuries (65%). This review demonstrates that trauma-related presentations in MGs are highly heterogeneous and influenced by event type and participant behavior. Soft-tissue injuries constitute the majority of reported trauma cases, while endurance/open-course sports and high-energy music events show higher trauma burdens. These findings support event-specific medical planning and trauma preparedness for in-event healthcare services.
We recently reported evidence that a biopsychosocial model predicts lifetime histories of commonly comorbid early-onset psychiatric disorders. This transdiagnostic model was produced when incorporating either positron emission tomography-measured midbrain dopamine autoreceptors or functional magnetic resonance imaging (fMRI)-measured mesocorticolimbic responses during a monetary incentive delay task. Here, we tested whether a variant of this model incorporating brain responses to alcohol cues specifically predicts future alcohol problems. Forty-four youths were assessed longitudinally for externalizing (EXT) behaviors between ages 10 and 16 years, completed fMRI scans and the Childhood Trauma Questionnaire (CTQ) at age 18, and completed the Alcohol Use Disorders Identification Test (AUDIT) at age 25. Binomial logistic regressions were then run with each region of interest. As hypothesized, the combination of high mesocorticolimbic responses to alcohol cues, high adolescent EXT behaviors, and high CTQ scores predicted higher AUDIT scores 7 years later. Model performance was improved by adding sex as a fourth factor. Significant mesocorticolimbic contributors to the models included the ventral (p = .028) and associative striatum (p = .017), anterior (p = .029) and posterior cingulate (p = .005), and ventromedial prefrontal cortex (p = .030). All models exhibited good-to-excellent classification performance, with area under the curve values ranging from 0.83 to 0.87, predictive accuracy from 80% to 84%, sensitivity from 74% to 79%, and specificity from 84% to 92%. Together, this work delineates a novel hierarchical model with precision psychiatry factors superimposed on transdiagnostic liability. High mesocorticolimbic reactivity to specific stimuli might shape the expression of psychopathology. In a longitudinally followed cohort, we tested whether future alcohol use problems can be predicted by the combination of transdiagnostic risk factors and brain responses to alcohol-specific cues. As hypothesized, higher adolescent externalizing propensities, higher childhood trauma, and higher mesocorticolimbic responses predicted more alcohol problems 7 years later. The results support our recently proposed hierarchical model where mental health problems arise from disorder-specific factors superimposed upon a general liability.