Effect of practice hours on elite junior tennis players’ burnout: Gender differences

This study investigated the effect of training hours on elite junior tennis players’ burnout with attention to gender differences. A quantitative cross-sectional design was used in this research. A sample of 70 junior elite Tunisian tennis players (17.01 ± 0.81y) completed a demographic and the Athlete Burnout Questionnaire. Results showed that 64% ( n = 45) had a low risk, 14% ( n = 10) had a moderate risk, 13% ( n = 9) showed a high risk of burnout and 9% ( n = 6) had burnout with individual differences. Analysis of variance revealed that players who trained more than 12 h (high volume) reported significantly higher scores of the burnout dimensions: emotional and physical exhaustion ( p < 0.001; d = 2.18); sport devaluation ( p < 0.001; d = 2.36); reduced sense of accomplishment ( p < 0.001; d = 2.27); as well general burnout ( p < 0.01; d = 2.69), than players that trained less than 12 h (moderate volume and low volume). The effect of gender was observed in the variables of emotional and physical exhaustion (t = 2.17; p < 0.03), sport devaluation ( t = 2.23; p < 0.029), reduced sense of accomplishment ( t = 2.58; p < 0.012) and general burnout ( t = 2.41; p < 0.019) with female players showing higher scores in all of the burnout dimensions. It was concluded that the high volume of weekly training hours by junior players was associated with higher levels of the general burnout scores and that female players showed higher burnout scores than their male counterparts.

Abdominal hereditary angio-oedema caught on magnetic resonance imaging

A 17-year-old woman presented with a 3-year history of recurrent, severe abdominal pain with spontaneous resolution within a few days. An ultrasound revealed nothing more than free fluid within the pelvis. An MRI of the small bowel was done within 24 hours of abdominal pain onset, which revealed extensive submucosal oedema associated with moderate volume ascites. A repeat MRI of the small bowel after 72 hours showed near-complete resolution of these changes. Checking C1 inhibitor levels confirmed a diagnosis of hereditary angio-oedema with an abdominal presentation. This is a rare cause of recurrent abdominal pain and, to our knowledge, the first case in which MR images have been obtained during and after an acute attack.

Safety of endovascular therapy for symptomatic intracranial artery stenosis: a national prospective registry

IntroductionThe safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely unknown. The Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis (CRTICAS) was a prospective, multicentre, real-world registry designed to assess these outcomes and the impact of centre experience.Methods1140 severe, symptomatic intracranial arterial stenosis (ICAS) patients treated with endovascular therapy were included from 26 centres, further divided into three groups according to the annual centre volume of intracranial angioplasty and stent placement procedures over 2 years: (1) high volume for ≥25 cases/year; (2) moderate volume for 10–25 cases/year and (3) low volume for <10 cases/year.ResultsThe rate of 30-day stroke, transient ischaemic attack or death was 9.7% (111), with 5.4%, 21.1% and 9.7% in high-volume, moderate-volume and low-volume centres, respectively (p<0.05). Multivariable logistic regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres (OR=0.187, 95% CI: 0.056 to 0.627; p≤0.0001), while moderate-volume and low-volume centres showed no significant difference (p=0.8456).ConclusionCompared with the preceding randomised controlled trials, this real-world, prospective, multicentre registry shows a lower complication rate of endovascular treatment for symptomatic ICAS. Non-uniform utilisation in endovascular technology, institutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.

Bronchial Artery to Pulmonary Artery Fistula Presenting with Massive Hemoptysis in a Pediatric Patient

Hemoptysis is a serious and potentially life-threatening event. Mortality is estimated at 13% for this chief complaint with age, volume of hemoptysis and receipt of blood products as risk factors for mortality. Hemoptysis is mostly seen in those with underlying congenital cardiac conditions or Cystic Fibrosis. We describe a unique case of a previously healthy 10 year old male who presented to the ED by EMS with a moderate volume episode of hemoptysis. He was admitted to the PICU where a sudden episode of massive hemoptysis precipitated by forced respiratory effort occurred during his examination. He decompensated and was emergently brought to the OR for airway evaluation by ENT and pulmonology. A large clot was found in the RML segment with brisk bleeding following removal of the clot. A 5 Fr bronchial blocker was placed to achieve hemostasis. Bronchial artery angiogram by IR demonstrated extravasation of contrast from right bronchial artery to segmental right lower lobe pulmonary artery shunt. He underwent embolization of the right bronchial artery. He was extubated the following day after no recurrent bleeding was confirmed with bronchoscopy. BA-PA fistulas are rare vascular anomalies in which an anastomosis is formed between systemic and pulmonary arteries. They are most commonly acquired, often described as secondary to chronic inflammatory lung diseases. BA-PA fistulas can also be congenital and have been seldom described in the literature. Our case highlights the importance of this rare diagnosis, which must remain on a pediatric pulmonologist’s differential due to the significant associated mortality.

Enteral Feeding Strategies in Preterm Neonates ≤32 weeks Gestational Age: A Systematic Review and Network Meta-Analysis

<b><i>Introduction:</i></b> Critical aspects of time of feed initiation, advancement, and volume of feed increment in preterm neonates remain largely unanswered. <b><i>Methods:</i></b> Medline , Embase, CENTRAL and CINAHL were searched from inception until 25th September 2020. Network meta-analysis with the Bayesian approach was used. Randomized controlled trials (RCTs) evaluating preterm neonates ≤32 weeks were included. Feeding regimens were divided based on the following categories: initiation day: early (&#x3c;72 h), moderately early (72 h–7 days), and late (&#x3e;7 days); advancement day: early (&#x3c;72 h), moderately early (72 h–7 days), and late (&#x3e;7 days); increment volume: small volume (SV) (&#x3c;20 mL/kg/day), moderate volume (MoV) (20–&#x3c; 30 mL/kg/day), and large volume (≥30 mL/kg/day); and full enteral feeding from the first day. Sixteen regimens were evaluated. Combined outcome of necrotizing enterocolitis (NEC) stage ≥ II or mortality before discharge was the primary outcome. <b><i>Results:</i></b> A total of 39 studies enrolled around 6,982 neonates. Early initiation (EI) with moderately early or late advancement using MoV increment enteral feeding regimens appeared to be most efficacious in decreasing the risk of NEC or mortality when compared to EI and early advancement with SV increment (risk ratio [95% credible interval]: 0.39 [0.12, 0.95]; 0.34 [0.10, 0.86]) (GRADE–very low). <b><i>Conclusions:</i></b> Early initiated, moderately early, or late advanced with MoV increment feeding regimens might be most appropriate in decreasing the risk of NEC stage ≥II or mortality. In view of the certainty of evidence being very low, adequately powered RCTs evaluating these 2 strategies are warranted.

Exploration of optimal paracentesis volume for terminally ill patients with malignant ascites.

12089 Background: Malignant ascites (MA) often causes distressing symptoms especially for terminally ill cancer patients. Control of such symptoms is generally difficult when it becomes refractory to standard antitumor therapies. Paracentesis is the most common treatment modality which provides rapid and temporary symptom relief, while it requires frequently repeated treatment to maintain symptom control. The optimal procedure is often a balance between the potential for symptom improvement and the known risks of adverse events such as hypotension and renal impairment. However, there are limited data regarding the optimal amount of fluid to be removed. The aim of this study was to explore the efficacy (paracentesis interval and symptom relief) and safety (adverse events) of paracentesis by the drainage volume. Methods: This is part of a multicenter prospective observational study (EASED study). Consecutive adult patients with advanced cancer admitted to 23 participating palliative care units were eligible. We analyzed patients with MA who received paracentesis. We compared paracentesis-free survival (PFS) using Cox regression among 3 groups with different paracentesis volumes: minimum: < = 1500 mL, small: 1500-2500 mL, and moderate: > 2500 mL, with adjustment for potential confounders: age, sex, the Karnofsky Performance Status, and variables of which P-values were < 0.1 in univariate analysis. Trend of the difference in abdominal distention numerical rating scale (NRS) before and after paracentesis and adverse events were compared among 3 groups. Under missing at random assumption, missing values were imputed using multiple imputation. Results: A total of 1926 patients were enrolled and 673 patients developed MA at admission. Of these, 586 patients never received paracentesis during their PCU stay. Thus, the population for analysis consisted of 87 patients. Median PFS was 7 days. Compared with a moderate volume, small-volume paracentesis was not a significant risk for shorter PFS (HR: 1.14, 95%CI: 0.69-1.93), while a minimum volume was a significant risk for shorter PFS (HR: 2.34, 95%CI: 1.25-4.39). The spline-based hazard ratio curve indicated that a dose-response of the ascites drainage volume to PFS was not likely when more than 2,000 mL of ascites was removed. Abdominal distension NRS significantly decreased after paracentesis (median: 7.5 to 4.0, p < 0.0001), while the difference did not significantly increase as the volume of paracentesis rose (p = 0.61). No severe adverse event was observed. Conclusions: Even small-volume paracentesis could alleviate abdominal distension of terminally ill cancer patients with MA without shortening the paracentesis interval compared with moderate-volume paracentesis. Small-volume paracentesis was an effective and safe treatment for such patients. Our findings may help physicians estimate an optimal volume of paracentesis for each patient with MA.

633 Surveillance for Head and Neck Cancer Recurrences: Is There Scope for A Tailored Approach?

Introduction Detection of cancer recurrence after treatment of head and neck cancer (HaNC) is vital. Current guidelines stipulate that following primary treatment HaNC patients are followed up for five years with a total of 18-24 appointments. This forms a bulk of the HaNC surgeon’s workload. Asymptomatic recurrences are rare. Patients educated regarding worrying symptoms may institute their own follow up. Such open appointment systems may be as effective at detecting recurrences Method At a moderate volume HaNC centre we reviewed 98 patients that had completed their five year follow up. We investigated cancer recurrences and whether these were symptomatic or asymptomatic at time of detection. We analysed each recurrence regarding the time since primary treatment. Results 23 patients had HaNC recurrences. These recurrences were symptomatic in 17 patients and asymptomatic in 6 patients. Five of the six patients from the asymptomatic group had recurrences within two years of primary treatment. The final patient was of a high-risk histological subtype. Conclusions Asymptomatic cancer recurrences are uncommon especially after two years of regular follow up. After two years the frequency of appointments may be tailored on a patient-by-patient basis. Patients educated regarding symptoms of cancer recurrences may institute their own follow up.

Failure of the New Kidney Allocation System in a Specific Ethnic Group

ABSTRACTIntroductionThe Kidney Allocation System (KAS) implemented on December 4, 2014, was expected to improve kidney transplant list wait-time and allocate more kidney to high cPRA patients. This study aims to demonstrate outcomes after the implementation of the KAS in a Hispanic transplant center.MethodsRetrospective study from a prospectively maintained database from a single-transplant center. Included all DDKT from July 2013 to June 2016. Compare and analyze DDKT selection and outcomes before and after KAS implementation.ResultsThe overall number of kidney transplants performed during this period was 220. All of the patients were Hispanic. Included 50.5% Pre-KAS and 49.5% Post-KAS. Pre-KAS group had a significantly shorter waiting-time list than the post-KAS group, 900.05 vs 1126.75 respectively. EPTS less than 20% significantly improved in the Post-KAS group compared to the Pre-KAS group, 41.3% vs 20.9% respectively. No differences observed in KDPI, 1-year graft failure, or 1-year mortality rates.ConclusionThis might be the first Hispanic only cohort evaluating the effects of KAS on a moderate volume kidney transplant center. The new system increased the wait-time list by approximately 25%, and it did not improve graft quality, graft failure, or mortality rates.