1%) for upper gastrointestinal (GI). Only 253/880 (28.8%) procedures were performed by a trainee as the primary surgeon 201/509 (39.4%) for urology, 21/235 (8.9%) for colorectal and 31/136 (22.8%) for upper GI. The likelihood of a trainee being the primary surgeon was reduced for major surgery (
<0.001) and for GI surgery when compared with urology (
<0.001).

Surgical training was facilitated at an elective surgery 'cold' site during the COVID-19 pandemic, but at lower levels than anticipated. Type of surgery influenced trainee participation. Surgical training should be incorporated into 'cold' site elective surgical services if trainees are to be prepared for the future.
Surgical training was facilitated at an elective surgery 'cold' site during the COVID-19 pandemic, but at lower levels than anticipated. Type of surgery influenced trainee participation. Surgical training should be incorporated into 'cold' site elective surgical services if trainees are to be prepared for the future.Metformin and exercise both improve glycemic control, but in vitro studies have indicated that an interaction between metformin and exercise occurs in skeletal muscle, suggesting a blunting effect of metformin on exercise training adaptations. Two studies (a double-blind, parallel-group, randomized clinical trial conducted in 29 glucose-intolerant individuals and a double-blind, cross-over trial conducted in 15 healthy lean males) were included in this paper. In both studies, the effect of acute exercise +/- metformin treatment on different skeletal muscle variables, previously suggested to be involved in a pharmaco-physiological interaction between metformin and exercise, was assessed. Furthermore, in the parallel-group trial, the effect of 12 weeks of exercise training was assessed. Skeletal muscle biopsies were obtained before and after acute exercise and 12 weeks of exercise training, and mitochondrial respiration, oxidative stress and AMPK activation was determined. Lithocholic acid nmr Metformin did not significantly affect the effects of acute exercise or exercise training on mitochondrial respiration, oxidative stress or AMPK activation, indicating that the response to acute exercise and exercise training adaptations in skeletal muscle is not affected by metformin treatment. link2 Further studies are needed to investigate whether an interaction between metformin and exercise is present in other tissues, e.g. the gut. Trial registration ClinicalTrials.gov (NCT03316690 and NCT02951260). link3 Novelty bullets • Metformin does not affect exercise-induced alterations in mitochondrial respiratory capacity in human skeletal muscle • Metformin does not affect exercise-induced alterations in systemic levels of oxidative stress nor emission of reactive oxygen species from human skeletal muscle • Metformin does not affect exercise-induced AMPK activation in human skeletal muscle.
To determine whether adding hip treatment to usual care for low back pain (LBP) improved disability and pain in individuals with LBP and a concurrent hip impairment.

Randomized controlled trial.

Seventy-six participants (age, 18 years or older; Oswestry Disability Index, 20% or greater; numeric pain-rating scale, 2 or more points) with LBP and a concurrent hip impairment were randomly assigned to a group that received treatment to the lumbar spine only (LBO group) (n = 39) or to one that received both lumbar spine and hip treatments (LBH group) (n = 37). The individual treating clinicians decided which specific low back treatments to administer to the LBO group. Treatments aimed at the hip (LBH group) included manual therapy, exercise, and education, selected by the therapist from a predetermined set of treatments. Primary outcomes were disability and pain, measured by the Oswestry Disability Index and the numeric pain-rating scale, respectively, at baseline, 2 weeks, discharge, 6 months, and 12 months.2 weeks (-3.35; 95% CI -6.58, -0.11;
= .04) and discharge (-3.45; 95% CI - 6.30, -0.61;
= .02).

Adding treatments aimed at the hip to usual low back physical therapy did not provide additional short- or long-term benefits in reducing disability and pain in individuals with LBP and a concurrent hip impairment. Clinicians may not need to include hip treatments to achieve reductions in low back disability and pain in individuals with LBP and a concurrent hip impairment.
.
Adding treatments aimed at the hip to usual low back physical therapy did not provide additional short- or long-term benefits in reducing disability and pain in individuals with LBP and a concurrent hip impairment. Clinicians may not need to include hip treatments to achieve reductions in low back disability and pain in individuals with LBP and a concurrent hip impairment. J Orthop Sports Phys Ther 2021;51(12)581-601. Epub 16 Nov 2021. 2021. doi10.2519/jospt.2021.10593.
We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions.

Intervention systematic review with meta-analysis.

We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020.

We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS.

Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison.

There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low-certainty evidence of neurodynamic techniques improving pain (SMD, -0.54; 95% CI -0.95, -0.13) and function (SMD, -0.35; 95% CI -0.61, -0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty).

Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence.
.
Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence. J Orthop Sports Phys Ther 2021;51(12)566-580. Epub 16 Nov 2021.doi10.2519/jospt.2021.10533.
To describe the mechanisms, situational patterns, and biomechanics (kinematics) of medial collateral ligament (MCL) injuries in professional male soccer players.

Case series.

Fifty-seven consecutive MCL injuries across 2 seasons of professional soccer matches were identified. We obtained and reviewed 37 of 57 (65%) injury videos to establish the injury mechanism, situational pattern, and knee flexion angle. We used detailed biomechanical analysis to assess the indirect and noncontact injuries. Injury layoff times, timing of injuries during the match, and location of the injuries on the pitch were also reported.

Twenty-three (62%) injuries were direct contact, 9 (24%) were indirect contact, and 5 (14%) were noncontact. Three main sprain mechanisms were noted (1) direct contact/blow to the knee (n = 16), (2) contact to the leg or foot (lever like) (n = 7), and (3) sliding (n = 9). Seventy-three percent of MCL injuries occurred during 2 main situations (1) pressing/tackling (n = 14, 38%) and (2) being ta0.2519/jospt.2021.10529.
To (1) describe which strength training exercise descriptors are reported in anterior cruciate ligament reconstruction (ACLR) rehabilitation research, and (2) compare the current standards of reporting ACLR strength training exercise descriptors to international best-practice strength training guidelines.

Scoping review.

We searched the MEDLINE, PsycINFO, CINAHL, SPORTDiscus, Academic Search, ERIC, Health Source Nursing, Health Source Consumer, MasterFILE, and Africa-Wide Information databases.

We included level I to IV studies of ACLR rehabilitation programs with 1 or more reported strength training exercise descriptors. We used a predefined list of 19 exercise descriptors, based on the American College of Sports Medicine (ACSM) exercise recommendations, the Consensus on Exercise Reporting Template (CERT), and the Toigo and Boutellier exercise descriptor framework.

Completeness and the standard of reporting exercise descriptors in ACLR rehabilitation programs were assessed by means of international.
Preclinical data suggest sodium deposited (without water) in tissues may lead to aberrant remodeling and systemic inflammation, independently of fluid overload in patients with heart failure (HF). Tissue salt storage can be measured noninvasively and quantitatively with
Na-magnetic resonance imaging. We aimed to investigate the possibility that patients with HF complicated by renal dysfunction are subject to higher tissue sodium concentration exposure than patients with chronic kidney disease alone.

We conducted an exploratory study including 18 patients with HF, 34 hemodialysis patients (with no meaningful renal clearance of sodium), and 31 patients with chronic kidney disease, with glomerular filtration rate matched to the patients with HF. Every patient underwent
Na-magnetic resonance imaging of the calf, to quantify tissue sodium and allow comparison among the 3 patient groups.

There were no differences in age, sex, and body mass index between groups. Median (interquartile range) skin sodium con with end-stage kidney disease requiring hemodialysis.
Na-magnetic resonance imaging may allow precision medicine in the management of this challenging group of patients with HF. Registration URL https//www.clinicaltrials.gov; Unique identifier NCT03004547.
We have demonstrated that patients with HF characteristically have very high levels of skin sodium storage, comparable to well-characterized extreme levels seen in patients with end-stage kidney disease requiring hemodialysis. 23Na-magnetic resonance imaging may allow precision medicine in the management of this challenging group of patients with HF. Registration URL https//www.clinicaltrials.gov; Unique identifier NCT03004547.
Hypothyroidism is reportedly associated with increased cardiovascular risk and heart failure. We aimed to elucidate the mechanistic influence of atrio-ventricular deformations and their prognostic utilizations in asymptomatic subclinical hypothyroidism (SCH).

We assessed speckle-tracking of deformations among 4173 population-based asymptomatic individuals classified as euthyroid (0.25< thyroid-stimulating hormone [TSH] ≤4.0 μIU/mL, n=3799) or having mild (4< TSH ≤10.0 μIU/mL, n=349) or marked (TSH >10 μIU/mL, n=25) SCH. We further related deformational indices to outcomes of atrial fibrillation and heart failure.

Despite borderline differences in indexed left ventricular mass and left atrial volume (
=0.054 and 0.051), those classified as mild and marked SCH presented with modest but significant reductions of global longitudinal strain, and showed elevated E/tissue Doppler imaging (TDI)-e', markedly diminished peak atrial longitudinal strain and higher left atrial stiffness (all
<0.05) when compared with euthyroid subjects.Lithocholic acid nmr