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Concussions are a source of major concern in rugby, and a limited number of studies have attempted to identify risk factors for these injuries.

To investigate the incidence of match concussion and associated risk factors, including individual workload, anthropometric variables, playing position, and season phase, in elite rugby union players.

Case-control study; Level of evidence 3.

All concussions and explanatory variables were collected for every match over 5 consecutive seasons (2014-2018) in 1334 professional players participating in the French Top 14 championship. Concussion risk was estimated using mixed effects Poisson regression.

Mean match concussion incidence equated to 10.4 (95% CI, 9.3-11.5) concussions for 1000 hours of game exposure. A peak was reached in the 2016-2017 season (13.7; 95% CI, 11.0-16.5). A greater risk was observed in the playoffs as compared with the first phase of the season (incidence rate ratio, 3.96; 95% CI, 2.10-7.35). In comparison with other positions, half-backse more at risk, with the highest incidence generally observed in half-backs. Workload was measured by the number of matches played before a concussion event, and it appeared to have a protective rather than deleterious effect on concussion risk.Duodenum inversum, or inverted duodenum, is a rare congenital disorder resulting in an abnormal position of the third and/or fourth portions of the duodenum. Most patients are asymptomatic, but others can experience pain, nausea, vomiting, peptic ulcer disease, pancreatitis, and even intestinal obstruction. In this case, we report a patient who presented with acute abdominal pain and vomiting. He was diagnosed with duodenal volvulus and obstruction due to duodenum inversum. After failing nonoperative management, the patient was successfully treated with surgical resection.Organ donation provides a life-saving opportunity for patients with organ failure. China, like most countries, is faced with organ shortages. Understanding public opinion regarding organ donation in China is critical to ensure an increased donation rate. Our study explored public concerns and attitudes toward organ donation, factors involved, and how the public pays attention to organ donation. Sixteen million users' public information (i.e. gender, age, and geographic information) and posts from January 2017 to December 2017 were collected from Weibo, a social media platform. Of these, 1755 posts related to organ donation were included in the analysis. We categorized the posts and coded the users' attitudes toward organ donation and the associations between the demographics. The most popular posts mentioning organ donation were "publicly expressing the willingness to donate organs." Furthermore, 87.62% of posts exhibited a positive attitude toward organ donation, whereas only 7.44% exhibited a negative attitude. Most positive posts were "saluting the organ donors," and most negative posts involved "fear of the family's passive medical decision." There was no significant gender difference in the users' attitudes, but older people generally had a more negative attitude. Users with negative attitudes mainly distrust the medical system and are worried that the donated organs may be used in improper trading. Social media may be an important channel for promoting organ donation activities, and it is important to popularize scientific knowledge related to organ donation in order to eliminate the public's misunderstanding of organ donation and transplantation.We conducted a systematic review of scaphoid plating for recalcitrant scaphoid fractures using EMBASE, Pubmed, Cochrane and MEDLINE. Thirteen studies were included. Ninety-three per cent of cases reported were male with a mean age of 27 years. Bony union was reported in eleven studies and achieved in 72% to 100% of cases. Scaphoid plates showed no significant difference in union incidence compared with headless compression screws. Mean removal incidence of plates was 21%. selleck chemicals llc Postoperative flexion-extension arc was 119°. Grip strength improved by 14% postoperatively over that before surgery. There was a general improvement in patient-reported outcome measures. Eighty-six per cent of reported participants returned to their previous work. In these clinical reports, plates frequently required removal more frequently than headless compression screws.

Most liver resections performed in the United States are open. With the ever-increasing role of robotic surgery, our study's role is to assess national outcomes based on the surgical approach.

We performed a retrospective analysis of the 2015 National Readmission Database (NRD). We selected patients undergoing open, laparoscopic, and robotic hepatectomy. Propensity score matching was performed to match the three groups in terms of demographics, hospital characteristics, and resection type. Our primary outcome was 6-month readmission rates and associated costs.

3,872 patients were included in the analysis (open = 3,420, laparoscopic = 343, and robotic = 109). Robotic liver resection has lower 6-month readmission rates (18.3%) than the laparoscopic (26.7%) and open (30%) counterparts. The robotic approach was more cost-effective ($127,716.56 ± 12,567.31) than the open ($157,880.82 ± 18,560.2) and laparoscopic approach ($152,060.78 ± 8,890.13) in terms of the total cost which includes cost per readmission.

There is a financial benefit of using robotics in terms of cost, hospital length of stay, and readmission rates in patients undergoing liver resection, cost.

There is a financial benefit of using robotics in terms of cost, hospital length of stay, and readmission rates in patients undergoing liver resection, cost.

Chemotherapeutic agents, with or without other drugs and radiation, may cause indirect or direct hepatotoxicity. Doxorubicin-induced hepatotoxicity (DIH) is a major health concern in cancer patients receiving this cytotoxic drug that is mostly resulted from the production of reactive oxygen species leading to transient or permanent liver damages. Silymarin, a flavonoid extracted from the

, exhibits antioxidant and anti-inflammatory activities.

This study aimed to investigate the clinical efficacy of systemic administration of silymarin in management of chemotherapy induced hepatotoxicity in patients with non-metastatic breast cancer who received doxorubicin/cyclophosphamide-paclitaxel (AC-T) regimen.Material In this randomized, triple blind, placebo-controlled clinical trial, 30 patients who received AC-T who fulfilled the inclusion criteria were randomly allocated to silymarin (n = 15) or placebo (n = 15) groups to receive oral silymarin 140 mg three times a day or placebo tablets, respectively. Fatty liver severity was assessed by liver ultrasound imaging and FibroScan® and also measurement of liver function tests before and after the intervention.

There was a non-significant trend toward more severe liver involvement in placebo group comparing to the silymarin group after intervention based on ultrasonography (p = 0.083). Besides, in silymarin group, hepatic involvement grade based on ultrasonography considerably reduced after intervention (p = 0.012). However, no difference was found between two groups based on FibroScan and liver function tests.

Oral administration of silymarin could significantly reduce hepatotoxicity severity after 1 month of treatment in non-metastatic breast cancer patients treated with AC-T regimen.

Oral administration of silymarin could significantly reduce hepatotoxicity severity after 1 month of treatment in non-metastatic breast cancer patients treated with AC-T regimen.

Robotic and laparoscopic hepatectomies having increased utilization as minimally invasive techniques are explored for hepatobiliary malignancies. Although the data on outcomes from these 2 approaches are emerging, the cost-benefit analysis of these approaches remains sparse. This study compares the costs associated with robotic vs. laparoscopic liver resections, taking into account 30-day complications.

Using the American College of Surgeons National Surgical Quality Improvement Program database, a propensity-matched cohort of patients with laparoscopic or robotic liver resections between 2014 and 2017 was identified. Costs were assigned to perioperative variables, including operating room (OR) time, length of stay, blood transfusions, and 30-day complications. Cost estimates were obtained from the Centers for Medicare and Medicaid Services billing data (2017), American Hospital Association data (2017), relevant literature, and local institutional cost data.

In our matched cohort of 454 patients (227 pe high-volume Minimally Invasive Surgery surgeons' impact in specialty centers on potentially mitigating this current cost disparity.

The interplay between marijuana legislation, perceptions of risks associated with marijuana use, and marijuana-related risk behaviors is an ever changing and complex issue. Marijuana impaired driving is of concern as legalization continues to expand in the United States. While driving after using marijuana has been shown to be prevalent among adults, little research has examined the behavior in adolescents. The aim of the present study was to examine the prevalence of driving after using marijuana among U.S. adolescents, with an examination of the relationship to age of marijuana initiation and marijuana usage patterns.

We analyzed data from the 2017 Youth Risk Behavior Survey, a nationally representative sample of high schools students in the U.S. The sample was current marijuana users, defined as past 30 day use. Driving after using marijuana was the main outcome variable, with analyses examining the association between the outcome and age of initiation and patterns of use. Prevalence ratios were obtained by modeling Poisson regression to examine factors associated with driving under the influence of marijuana.

Nearly half of all marijuana users reported driving after use during the past 30 days, and did not differ between males and females. Prevalence of driving after using marijuana was significantly higher among heavy users (PR = 2.8; 95% CI 2.1-3.6). A higher prevalence of driving after drinking alcohol (PR = 1.7; 95% CI 1.5-1.9) was also found among those who had driven after using marijuana.

Among adolescent marijuana users, the prevalence of driving after using marijuana was high. Enhanced surveillance, prevention, and control measures are necessary to mitigate the negative impacts of marijuana consumption and related behaviors.

Among adolescent marijuana users, the prevalence of driving after using marijuana was high. Enhanced surveillance, prevention, and control measures are necessary to mitigate the negative impacts of marijuana consumption and related behaviors.

Surgical options for breast cancer are numerous and span multiple surgical disciplines. Decision analyses aid surgeons in making the most cost-effective choice, thus reducing health care expenditure while maximizing patient outcome. In this study, we aimed to evaluate existing breast surgery cost-effectiveness literature against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) validated scoring system.

A PRISMA search was performed for cost-effectiveness within breast surgery. Articles were scored with CHEERS criteria on a 0-24 scale and qualitative data were collected. Subgroup analysis was performed comparing pre-CHEERS (published in 2013 or earlier) and post-CHEERS (published in 2014 or later) cohorts. Chi-squared analysis was performed to compare where studies lost points between cohorts.

Of 2279 articles screened, 46 articles were included. The average CHEERS score was 18.18. Points were most often lost for characterizing heterogeneity, followed by discount rate, incremental costs and outcomes, and abstract.