Hasil untuk "Sports medicine"

Jamie Crowther, Rados Keravica, Marie T. Frazer et al.

Purpose: This paper presents findings from the process evaluation of JU:MP, a whole-system intervention designed to increase physical activity among children aged 5–14 in Bradford, United Kingdom. The paper explores two interlinked aspects of children’s and families’ involvement: (1) their experiences and perceptions of the intervention and (2) the extent and nature of children’s involvement in JU:MP’s design and delivery. Method: The first strand draws on qualitative data from longitudinal dyad interviews with families (7 families, 19 interviews at three time points) and focus groups conducted with children (12 focus groups, n = 93) and parents (7 focus groups, n = 17) across two time points. The second strand, which interrogates how children’s voices were embedded in intervention’s design and delivery, draws on four focus groups with children, two focus groups with research and implementation staff, and secondary analysis of over 60 interviews and focus groups with community stakeholders. Results: The process evaluation from the perspective of families highlights three themes: children’s and families’ awareness of the intervention, children’s enthusiastic engagement with various elements of JU:MP, and impact on behaviour change. Participants demonstrated high acceptance of the intervention elements provided both in school and out-of-school settings. The impact is most evident on children’s motivation, socialisation, and strengthening of community ties and increased opportunities for PA. The analysis of children’s involvement reveals the shifting and evolving nature of child consultation and involvement across programme neighbourhoods, ranging from informal feedback to more structured co-design mechanisms. Although there was strong initial motivation to involve children, systemic barriers, such as time constraints, ethical considerations, and misalignment with strategic priorities, limited their involvement. Conclusion: Listening to children ensures the acceptability, effectiveness, and sustainability of interventions. Practitioners and researchers who aspire to embed children’s voices in PA interventions would do well to design flexible engagement structures, transparent processes for managing power dynamics, and long-term investment in community relationships. Support/Funding source: This study was supported by Sport England’s Local Delivery Pilot – Bradford; weblink: https://www.sportengland.org/campaigns-and-our-work/local-delivery. Sport England is a non-departmental public body under the Department for Digital, Culture, Media and Sport. Keywords: Children, physical activity, intervention, process evaluation, consultation

Thomas Ibounig, Olof Wolf, William M Oliver et al.

This educational review outlines the core principles of humeral shaft fracture (HSF) management and is designed for orthopedic trainees, general orthopedic surgeons, emergency physicians, and allied health professionals who participate in the acute or postoperative care of patients with HSFs. The content integrates the authors’ expert opinion with the current evidence. Humeral shaft fractures account for 1–3% of adult fractures, most often resulting from low-energy falls in older adults or high-energy trauma in younger patients. Although open fractures and neurovascular injuries are rare, primary radial nerve palsy (RNP) occurs in about 10% of cases. Diagnosis relies primarily on clinical evaluation and standard radiographs, with CT or MRI reserved for complex or pathological cases. Functional bracing has traditionally been the mainstay of nonsurgical treatment, achieving good long-term results but with nonunion rates up to 25%. Surgical fixation methods—including open reduction and internal fixation, minimally invasive plate osteosynthesis, and intramedullary nailing—allow earlier mobilization and more predictable fracture union but carry risks of iatrogenic RNP and infection. Management of primary RNP remains largely nonsurgical, with over 90% recovering spontaneously. Nonunion is frequently symptomatic and managed most often with compression plating. Surgery offers faster early recovery and lower nonunion rates, although long-term outcomes converge with successful bracing. Cost-effectiveness analyses suggest surgery may be more economical when productivity loss is considered, particularly for working-age patients. Optimal treatment selection depends on patient age, activity level, fracture characteristics, and patient preference, emphasizing shared decision-making.

Ketrin Zeno, Fiona Konomi, Klea Troka

The “Active Classrooms Albania” initiative was launched to reduce sedentary time and promote physical activity among primary school students, addressing rising levels of childhood obesity and physical inactivity. The project was implemented within the framework of the national Schools for Health programme, aligning with Strategic Objective 1.2 of Albania’s Health Promotion Action Plan 2030. The goal was to foster daily movement in classroom settings through short, structured activity breaks, requiring no additional equipment or time outside the curriculum. The project was co-developed in 2022 by the Institute of Public Health, in partnership with the Ministry of Health, the Ministry of Education and Sports, and the Schools for Health initiative. The pilot targeted 10 public schools in Tirana and Durrës, selected for their active involvement in health-promotion activities. Stakeholder workshops involving teachers, public health experts, and child psychologists helped tailor the movement routines to classroom realities. Teachers received training through the project training modules and a practical “Movement Breaks Toolkit”. Activities included stretching, yoga-based breathing, and energy-boosting mini-games, delivered 2–3 times per day during classroom hours. Schools designated a Focal Point to monitor implementation and coordinate between the health and education sectors. Evaluation took place over six months, combining focus group discussions and observational tools. Key outcomes included: ·         A 31% increase in daily moderate activity reported by students. ·         87% of teachers observed improved focus and participation post-activity breaks. ·         No interference with academic delivery was reported, and classroom discipline improved. Feedback indicated strong acceptance from both students and educators. Following successful results, the initiative was scaled to an additional 25 schools during the 2023 academic year. Materials were incorporated into the national “Qendro Aktiv” platform, and recommendations for integrating movement breaks into national curricula have been submitted to the Ministry of Education. Conclusion: The initiative demonstrates that integrating low-cost physical activity breaks into routine education is feasible, effective, and scalable. It enhances student engagement, reduces sedentary behaviour, and promotes cross-sectoral collaboration. The project contributes directly to Albania’s national strategy on non-communicable diseases prevention and can serve as a practical model for other low-resource European settings aiming to implement Schools for Health principles.

Tyler J Poore, Christopher J Pinard, Aleena Shabbir et al.

Large language models (LLMs) are increasingly used in clinical settings, yet their performance in veterinary medicine remains underexplored. We evaluated three commercially available veterinary-focused LLM summarization tools (Product 1 [Hachiko] and Products 2 and 3) on a standardized dataset of veterinary oncology records. Using a rubric-guided LLM-as-a-judge framework, summaries were scored across five domains: Factual Accuracy, Completeness, Chronological Order, Clinical Relevance, and Organization. Product 1 achieved the highest overall performance, with a median average score of 4.61 (IQR: 0.73), compared to 2.55 (IQR: 0.78) for Product 2 and 2.45 (IQR: 0.92) for Product 3. It also received perfect median scores in Factual Accuracy and Chronological Order. To assess the internal consistency of the grading framework itself, we repeated the evaluation across three independent runs. The LLM grader demonstrated high reproducibility, with Average Score standard deviations of 0.015 (Product 1), 0.088 (Product 2), and 0.034 (Product 3). These findings highlight the importance of veterinary-specific commercial LLM tools and demonstrate that LLM-as-a-judge evaluation is a scalable and reproducible method for assessing clinical NLP summarization in veterinary medicine.

Markus Bertl, Alan Mott, Salvatore Sinno et al.

The digitization of healthcare presents numerous challenges, including the complexity of biological systems, vast data generation, and the need for personalized treatment plans. Traditional computational methods often fall short, leading to delayed and sometimes ineffective diagnoses and treatments. Quantum Computing (QC) and Quantum Machine Learning (QML) offer transformative advancements with the potential to revolutionize medicine. This paper summarizes areas where QC promises unprecedented computational power, enabling faster, more accurate diagnostics, personalized treatments, and enhanced drug discovery processes. However, integrating quantum technologies into precision medicine also presents challenges, including errors in algorithms and high costs. We show that mathematically-based techniques for specifying, developing, and verifying software (formal methods) can enhance the reliability and correctness of QC. By providing a rigorous mathematical framework, formal methods help to specify, develop, and verify systems with high precision. In genomic data analysis, formal specification languages can precisely (1) define the behavior and properties of quantum algorithms designed to identify genetic markers associated with diseases. Model checking tools can systematically explore all possible states of the algorithm to (2) ensure it behaves correctly under all conditions, while theorem proving techniques provide mathematical (3) proof that the algorithm meets its specified properties, ensuring accuracy and reliability. Additionally, formal optimization techniques can (4) enhance the efficiency and performance of quantum algorithms by reducing resource usage, such as the number of qubits and gate operations. Therefore, we posit that formal methods can significantly contribute to enabling QC to realize its full potential as a game changer in precision medicine.

Pedram Fard, Alaleh Azhir, Neguine Rezaii et al.

Artificial intelligence in medicine is built to serve the average patient. By minimizing error across large datasets, most systems deliver strong aggregate accuracy yet falter at the margins: patients with rare variants, multimorbidity, or underrepresented demographics. This average patient fallacy erodes both equity and trust. We propose a different design: a multi-agent ecosystem for N-of-1 decision support. In this environment, agents clustered by organ systems, patient populations, and analytic modalities draw on a shared library of models and evidence synthesis tools. Their results converge in a coordination layer that weighs reliability, uncertainty, and data density before presenting the clinician with a decision-support packet: risk estimates bounded by confidence ranges, outlier flags, and linked evidence. Validation shifts from population averages to individual reliability, measured by error in low-density regions, calibration in the small, and risk--coverage trade-offs. Anticipated challenges include computational demands, automation bias, and regulatory fit, addressed through caching strategies, consensus checks, and adaptive trial frameworks. By moving from monolithic models to orchestrated intelligence, this approach seeks to align medical AI with the first principle of medicine: care that is transparent, equitable, and centered on the individual.

Phaik Ling Quah, Phaik Ling Quah, Daniel Wei Keong Chan et al.

IntroductionResearch on early childhood caregiver feeding practices and eating behaviors is limited, especially within Asian populations. This study examined these practices across key feeding domains of variety, autonomy, and mealtime setting and timing, stratified by three age groups: 0 to <7 months, 7 to <13 months, and 13 to <36 months.MethodsA cross-sectional survey of 1,307 caregivers from a multi-ethnic population in Singapore captured demographic data, feeding practices, child eating behaviors, and caregivers’ knowledge, attitudes, and practices. One-way analysis of variance (ANOVA), independent T-tests and the chi-square test were used to assess feeding practices and eating behaviors across age groups.ResultsRegarding dietary variety, 14.8 and 6.1% of infants aged 7 to <13 months were offered three or fewer food groups frequently and daily, respectively. Additionally, 11.9% of infants were receiving processed foods often. At this age, only 1.0% of infants were consuming sugar-sweetened beverages (SSBs) often, while 2.0% consumed them daily. Among older children (aged 13 to <36 months), 8.1% were offered a limited variety of three food groups, while 4.5% were offered fewer than three. In contrast, a significantly higher proportion frequently consumed processed foods (24.0%) and sugar-sweetened beverages (25.2%; p < 0.05). In terms of autonomy, only 75.4% of infants (7– < 13 months) and 89.5% of older children (13– < 36 months) were able to self-feed. Caregivers of older children (13– < 36 months) were less likely to recognize hunger and satiety cues compared to those of infants (0–< 13 months; p < 0.05). Older children (13– < 36 months) also more frequently required special mealtime settings (36.6%), viewed screens during meals (29.9%), and were less likely to be offered post-midnight meals nightly (22.6% compared to infants; 70.3%; 0–< 13 months; p < 0.05).ConclusionThese findings underscore the need for culturally tailored educational interventions to improve suboptimal feeding practices in children under three in Singapore’s multiethnic population.

Monika Brzozowska, Wiktoria Wardal, Natalia Furlepa et al.

Introduction and purpose: Burns are a real problem that can result in long hospitalization and scarring. Stem cells (SCs) have been shown to have a number of actions that accelerate and improve the healing process. The aim of this review is to explore the stem cell mechanisms that can be used to improve burn healing Materials and methods: A comprehensive analysis of articles available on PubMed and Google Scholar was undertaken by entering keywords in appropriate configuration: Stem cells/  burn wound/ wound healing/  mesenchymal stem cells. Description of the state of knowledge: In the physiological process of wound healing, migration and proliferation of stem cells initiate epithelialization. The therapeutic use of stem cells has many beneficial effects. Their regenerative potential is superior to conventional treatments. Stem cells due to their ability to differentiate, autocrine and paracrine activity and immunomodulatory activity -  accelerate the wound healing process, promote cell proliferation, collagen production, regulate inflammation, prevent hypertrophic scarring, stimulate re-epithelialization, angiogenesis and granulation. Conclusion: The mechanisms of action of stem cells appears to be promising in the context of treating burn wounds, but in order for them to fully replace current treatments, a deeper understanding of the complex biological mechanisms and further studies are needed to evaluate the efficacy and safety of different types of stem cells and to identify the most suitable ones.

Katarzyna Kurza, Zuzanna Kościuszko, Adam Sobiński et al.

Purpose: This review aims to analyze the etiology, diagnosis, and management of Asherman’s Syndrome, focusing on advancements in treatment, emerging therapies, and persistent research gaps. Asherman’s Syndrome, characterized by intrauterine adhesions, leads to menstrual irregularities, infertility, and recurrent pregnancy loss. Materials and Methods: A comprehensive review of published studies on Asherman’s Syndrome was conducted, examining current diagnostic methods, treatment approaches, and therapeutic outcomes. Key sources included clinical trials, meta-analyses, and reviews from 1894 to 2021. Results: Endometrial trauma, often from dilation and curettage, is the primary cause of Asherman’s Syndrome. Diagnostic tools like three-dimensional ultrasound and hysteroscopy improve detection accuracy. Hysteroscopic adhesiolysis remains the gold standard treatment, with success rates of 70–85% in mild to moderate cases. Adjunct therapies, such as hormonal treatments and intrauterine devices, reduce adhesion recurrence. Emerging therapies like platelet-rich plasma and stem cell treatments show potential for improving endometrial regeneration and fertility but require further validation. Conclusions: While advances in hysteroscopy and regenerative medicine have enhanced outcomes for Asherman’s Syndrome, severe cases remain challenging due to high recurrence and poor reproductive results. Early diagnosis, multidisciplinary care, and standardized treatment protocols are essential. Further research is needed to validate emerging therapies, refine diagnostic tools, and improve quality of life for affected women.

LI Ying, WU Xiaoyan, CAO Yingjuan

ObjectiveTo explore the application effect of day surgery ward management in patients undergoing hip arthroscopic labral repair.MethodsA total of 60 patients with acetabular labral tears undergoing hip arthroscopic surgery admitted to the sports medicine department and day surgery ward of Qilu Hospital of Shandong University were selected as the study subjects from March to October 2023.The patients were randomly divided into a observation group and a control group(30 patients in each).The control group was intervened with conventional inpatient surgical management plan for patients undergoing hip arthroscopic labral repair.While the observation group was intervened with day surgery ward management for patients undergoing hip arthroscopic labral repair.The two groups were compared in terms of hospital stay length,hospitalization costs,postoperative complication rates,incidence of adverse reactions,hip joint function,pain levels,patient health education awareness rate and satisfaction levels.ResultsThe observation group had shorter hospital stay length than the control group.Their surgical fees,nursing fees,and bed fees were lower.Their hip movement at 1 month and 3 months after surgery was better.All these differences were statistically significant(<italic>P</italic>&lt;0.05).ConclusionsThe application of day surgery ward management in patients undergoing hip arthroscopic labral repair is beneficial to shortening hospital stay length,reducing medical expenses,and promoting early recovery.

Piotr Marcjasz, Anna Bioły, Patryk Dryja et al.

Introduction and aim:  Osteosarcoma (OS) is a primary malignant bone tumor of youth, while osteomyelitis (OM) is an inflammatory bone infection. Despite of different etiologies, OS and OM can present with overlapping clinical and radiologic features. This paper aims to review the pathophysiology of OS and OM, indicating their clinical similarities, discuss difficulties in diagnosing and differentiating them. Material and methods of research: A thorough literature review was performed using PubMed, Web of Science and Embase. State of Knowledge: Osteosarcoma derives from mesenchymal osteoblast precursors and is characterized by malignant osteoid production [1]. It predominantly affects adolescents, often near the metaphyses of long bones, with rapid bone turnover [1]. Osteomyelitis is a bone infection that triggers an inflammatory cascade causing bone destruction, necrosis, and reactive new bone formation [3]. Clinically, both OS and OM cause localized bone pain, swelling and systemic signs, which can lead to one being mistaken for the other [7]. Radiologically, both may show bone lysis, periosteal reaction, and soft-tissue changes, compounding the diagnostic dilemma [6]. Because symptoms and imaging findings can overlap, misdiagnoses occur. Conclusions: OS and OM have distinct pathophysiologies – one neoplastic, one infectious – yet they can mirror each other clinically and radiographically. Proper diagnosis is critical as treatments diverge.

Colin S. Doherty, Oliver R. Barley, Lauren V. Fortington

Abstract Background Mixed martial arts (MMA) and Muay Thai (MT) are widely practiced combat sports, yet research on the full spectrum of competition-related health problems (HPs) remains limited, particularly for MT. Existing studies in both sports primarily focus on retrospective analyses of severe injuries, often estimating time lost from training or competition. This study describes the incidence of all competition HPs reported seven days after MMA and MT contests, and determines the number of days impacted by tracking athletes’ self-identified worst HPs until resolution. Methods Data on competition HPs were collected using an online questionnaire completed seven days after each MMA and MT event (n = 26). The questionnaire included the Oslo Sports Trauma Research Centre Questionnaire on Health Problems 2 (OSTRC-H2). The Combat Sports Commission of Western Australia provided competition exposure time data. Incidence rates of HPs were calculated per 100 min of exposure (HPIRME). Competitors reporting HPs were followed up weekly using the OSTRC-H2 questionnaire until their worst HPs resolved. Results Of the 175 competitors (238 responses) who completed the questionnaire (76% male; age: 27 ± 6 years), 81 competitors (92 responses) reported a total of 411 HPs (315 injuries, 96 illnesses). Among the 92 worst HPs, 26 were substantial, and 24 prevented training. The HPIRME was 20.1 (95% CI: 16.5–24.4) for MMA and 25 (95% CI: 22.3–28) for MT. Follow-up captured 78 (85%) of the worst HPs, with 175 responses collected over 14–70 days post-competition. The median days impacted by the worst HPs were 20 for MMA and 16 for MT. Conclusions Among respondents, 39% reported at least one HP. On average, the worst HPs resolved in less than three weeks. These findings provide valuable insights into the frequency and impact of competition HPs,offering important information for promoters, athletes, coaches, and regulatory bodies to better understand and address the health challenges faced by combat sports athletes.

Abbi Abdel-Rehim, Oghenejokpeme Orhobor, Gareth Griffiths et al.

The concept of personalised medicine in cancer therapy is becoming increasingly important. There already exist drugs administered specifically for patients with tumours presenting well-defined mutations. However, the field is still in its infancy, and personalised treatments are far from being standard of care. Personalised medicine is often associated with the utilisation of omics data. Yet, implementation of multi-omics data has proven difficult, due to the variety and scale of the information within the data, as well as the complexity behind the myriad of interactions taking place within the cell. An alternative approach to precision medicine is to employ a function-based profile of the cell. This involves screening a range of drugs against patient derived cells. Here we demonstrate a proof-of-concept, where a collection of drug screens against a highly diverse set of patient-derived cell lines, are leveraged to identify putative treatment options for a 'new patient'. We show that this methodology is highly efficient in ranking the drugs according to their activity towards the target cells. We argue that this approach offers great potential, as activities can be efficiently imputed from various subsets of the drug treated cell lines that do not necessarily originate from the same tissue type.

Arthur Chatton, Michael Schomaker, Miguel-Angel Luque-Fernandez et al.

Background: Sequential positivity is often a necessary assumption for drawing causal inferences, such as through marginal structural modeling. Unfortunately, verification of this assumption can be challenging because it usually relies on multiple parametric propensity score models, unlikely all correctly specified. Therefore, we propose a new algorithm, called sequential Positivity Regression Tree (sPoRT), to overcome this issue and identify the subgroups found to be violating this assumption, allowing for insights about the nature of the violations and potential solutions. Methods: We present different versions of sPoRT based on either stratifying or pooling over time under static or dynamic treatment strategies. This methodological development was motivated by a real-life application of the impact of the timing of initiation of HIV treatment with and without smoothing over time, which we also use to demonstrate the method. Results: The illustration of sPoRT demonstrates its easy use and the interpretability of the results for applied epidemiologists. Furthermore, an R notebook showing how to use sPoRT in practice is available at github.com/ArthurChatton/sPoRT-notebook. Conclusions: The sPoRT algorithm provides interpretable subgroups violating the sequential positivity violation, allowing patterns and trends in the confounders to be easily identified. We finally provided practical implications and recommendations when positivity violations are identified.

Alireza Rabieezadeh, Reza Mahdavinejad, Morteza Sedehi et al.

Abstract Background Low back pain (LBP) is a common disorder and is considered one of the leading causes of disability worldwide, resulting in adverse health, social, and economic outcomes. This study aimed to investigate the effects and durability of 8-week Dynamic Neuromuscular Stabilization (DNS) exercises on pain, functional disability, and quality of life in individuals aged 30 to 50 years with non-specific chronic low back pain (NSCLBP). Methods This research employed a pre- and post-test design with a follow-up period, in which 29 participants (16 in the control group and 13 in the exercise group) remained until the end of the study. Pain intensity, functional disability, and quality of life were assessed using the visual analog scale (VAS), the Oswestry Disability Index, and the SF-36 questionnaire, respectively, before intervention, immediately after, and two months post-intervention. The control group continued their routine daily activities, while the exercise group performed DNS exercises three times a week for 8 weeks. The data was analyzed using a mixed-design ANOVA (P ≤ 0.05). Results The results showed improvements in pain (F (2,24) = 5.31, P = 0.01, η2 = 0.31), functional disability (F (2,24) = 4.17, P = 0.03, η2 = 0.26), and quality of life (F (2,24) = 4.70, P = 0.02, η2 = 0.28) in the exercise group at the Post-test compared to the Pre-test. However, the durability of the exercise effects at the follow-up assessment was not sustainable compared to the Post-test and Pre-test (P > 0.05). Conclusion An 8-week period of DNS exercises can improve pain, functional disability, and quality of life in individuals with NSCLBP. However, a 2-month period of detraining can reduce the positive outcomes of these exercises. Trial registration The researchers retrospectively registered this trial on 21/04/2024, with the identifier IRCT20240107060646N1 in the Iranian Registry of Clinical Trials (IRCT) at the following address: https://irct.behdasht.gov.ir .

Ignacio Erazo

Increased data availability has stimulated the interest in studying sports prediction problems via analytical approaches; in particular, with machine learning and simulation. We characterize several models that have been proposed in the literature, all of which suffer from the same drawback: they cannot incorporate rational decision-making and strategies from teams/players effectively. We tackle this issue by proposing hybrid simulation logic that incorporates teams as agents, generalizing the models/methodologies that have been proposed in the past. We perform a case study on the NBA with two goals: i) study the quality of predictions when using only one predictive variable, and ii) study how much historical data should be kept to maximize prediction accuracy. Results indicate that there is an optimal range of data quantity and that studying what data and variables to include is of extreme importance.

Joshua Durso-Finley, Jean-Pierre Falet, Raghav Mehta et al.

Image-based precision medicine aims to personalize treatment decisions based on an individual's unique imaging features so as to improve their clinical outcome. Machine learning frameworks that integrate uncertainty estimation as part of their treatment recommendations would be safer and more reliable. However, little work has been done in adapting uncertainty estimation techniques and validation metrics for precision medicine. In this paper, we use Bayesian deep learning for estimating the posterior distribution over factual and counterfactual outcomes on several treatments. This allows for estimating the uncertainty for each treatment option and for the individual treatment effects (ITE) between any two treatments. We train and evaluate this model to predict future new and enlarging T2 lesion counts on a large, multi-center dataset of MR brain images of patients with multiple sclerosis, exposed to several treatments during randomized controlled trials. We evaluate the correlation of the uncertainty estimate with the factual error, and, given the lack of ground truth counterfactual outcomes, demonstrate how uncertainty for the ITE prediction relates to bounds on the ITE error. Lastly, we demonstrate how knowledge of uncertainty could modify clinical decision-making to improve individual patient and clinical trial outcomes.

Dimitris Bertsimas, Angelos G. Koulouras, Georgios Antonios Margonis

We propose a prognostic stratum matching framework that addresses the deficiencies of Randomized trial data subgroup analysis and transforms ObservAtional Data to be used as if they were randomized, thus paving the road for precision medicine. Our approach counters the effects of unobserved confounding in observational data by correcting the estimated probabilities of the outcome under a treatment through a novel two-step process. These probabilities are then used to train Optimal Policy Trees (OPTs), which are decision trees that optimally assign treatments to subgroups of patients based on their characteristics. This facilitates the creation of clinically intuitive treatment recommendations. We applied our framework to observational data of patients with gastrointestinal stromal tumors (GIST) and validated the OPTs in an external cohort using the sensitivity and specificity metrics. We show that these recommendations outperformed those of experts in GIST. We further applied the same framework to randomized clinical trial (RCT) data of patients with extremity sarcomas. Remarkably, despite the initial trial results suggesting that all patients should receive treatment, our framework, after addressing imbalances in patient distribution due to the trial's small sample size, identified through the OPTs a subset of patients with unique characteristics who may not require treatment. Again, we successfully validated our recommendations in an external cohort.

R.D. Mitrani, J. Alfadhli, M.H. Lowery et al.

Purpose: This study assessed a functional protocol to identify myocarditis or myocardial involvement in competitive athletes following SARS-CoV2 infection. Methods: We prospectively evaluated competitive athletes (n = 174) for myocarditis or myocardial involvement using the Multidisciplinary Inquiry of Athletes in Miami (MIAMI) protocol, a median of 18.5 (IQR 16–25) days following diagnosis of COVID-19 infection. The protocol included biomarker analysis, ECG, cardiopulmonary stress echocardiography testing with global longitudinal strain (GLS), and targeted cardiac MRI for athletes with abnormal findings. Patients were followed for median of 148 days. Results: We evaluated 52 females and 122 males, with median age 21 (IQR: 19, 22) years. Five (2.9%) had evidence of myocardial involvement, including definite or probable myocarditis (n = 2). Three of the 5 athletes with myocarditis or myocardial involvement had clinically significant abnormalities during stress testing including ventricular ectopy, wall motion abnormalities and/or elevated VE/VCO2, while the other two athletes had resting ECG abnormalities. VO2max, left ventricular ejection fraction and GLS were similar between those with or without myocardial involvement. No adverse events were reported in the 169 athletes cleared to exercise at a median follow-up of 148 (IQR108,211) days. Patients who were initially restricted from exercise had no adverse sequelae and were cleared to resume training between 3 and 12 months post diagnosis. Conclusions: Screening protocols that include exercise testing may enhance the sensitivity of detecting COVID-19 related myocardial involvement following recovery from SARS-CoV2 infection.

J. Pasulka, N. Jayanthi, Ashley McCann et al.