Recent publications have suggested that intra-ocular pressure (IOP) may be an indirect assessment of intra-cranial pressure (ICP). Both IOP and ICP have similar physiologic pressure ranges and similar responses to changes in intra-abdominal, intra-thoracic and aortic pressure. Previous studies have demonstrated the relationships between retinal arterial pressure and aortic pressure, intra-ocular pressure and retinal venous pressure, intra-cranial pressure and retinal venous pressure. Power athletes routinely utilize the Valsalva maneuver during weightlifting. In fact there are reports of stroke, cerebral hemorrhage, subarachnoid hemorrhage, conjunctival, foveal and retinal hemorrhage, retinal detachment, hiatal hernia and pneumothorax associated with weightlifting. These events are thought to occur secondary to the extreme pressure elevations that occur in the intra-abdominal, intra-thoracic, intra-cranial, intra-ocular and vascular compartments. To date no human studies have examined the IOP changes that may occur with heavy resistance exercise. Therefore, we recruited power athletes (n = 11), who had participated in prior studies, from the local metropolitan area. The athletes had blood pressure status, drug screening and medical histories performed during previous investigations. Intra-ocular pressure was measured by noncontact tonometry at rest and during maximal isometric contraction. All subjects resting IOP were within normal ranges (mean 13 +/- 2.8 mmHg). Intra-ocular pressures were significantly (p < 0.0001) elevated in each subject during maximal contraction (mean 28 +/- 9.3 mmHg). One subject's IOP reached 46 mmHg during maximal contraction. Linear regression analysis demonstrated a significant linear relationship (r = 0.62, p < 0.0001) in the net change of IOP from rest to maximal contraction for each subject. This study demonstrates that IOP elevates to pathophysiologic levels during resistance exercise. The findings of conjunctival hemorrhages in two subjects further supports IOP being reflective of retinal venous pressure. The enormous pressures generated by power athletes during weightlifting leads to elevations in ICP which obstruct venous outflow leading to hemorrhage and elevations in IOP. The question remains as to whether these intermittent bursts of elevated IOP can lead to long-term pathological sequelae.

Study Objectives: The objectives were to develop and validate an algorithm for editing WatchPAT scoring and assess the accuracy in an unselected clinical population as well as age and sex substrata. Methods: Two hundred sixty-two participants were enrolled to undergo WatchPATsimultaneously with in-lab polysomnography (PSG) recordings for developing (n = 30), optimizing (n = 62), and validating (n = 170) an algorithm to review and edit respiratory events and sleep architecture of WatchPAT recordings, which was based on visual inspection of WatchPAT signals. Apnea-hypopnea index (AHI) and sleep indices were compared with PSG-derived and automated WatchPAT indices. Results: Although estimation of total sleep time (TST) was comparable between automated and manual algorithm, estimation of rapid eye movement (REM) sleep time was markedly improved with manual editing from 0.48, 23.0 min (−43.9 to 89.8) to 0.64, 18.3 min (−32.6 to 69.1) (correlation with PSG, mean difference [reference range] from PSG, respectively). Manual scoring also improved correlation and agreement with PSG AHI from 0.65, 2.5 events/h (−24.0 to 28.9) to 0.81, −4.5 events/h (−22.5 to 13.6) as well as concordance for categorical agreement of sleep-disordered breathing severity and concordance for detecting severe REM-related sleep-disordered breathing. Interscorer reliabilities were excellent for TST and AHI, while good for REM sleep time. The automated algorithm performed better in younger than in older patients, while performed similarly between men and women with respect to concordance statistics. The manual algorithm markedly improved concordances more in older patients and women than in their counterparts. Conclusions: Our manual editing algorithm improves correlation and agreement with PSG-derived sleep and breathing indices. Sex and age influence the accuracy of automated analysis and the performance of manual editing on AHI concordance.

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Minimally invasive anterior lumbar interbody fusions with percutaneous pedicle screws cause significantly less muscle damage than minimally invasive posterior lumbar interbody fusions with percutaneous screws. Furthermore minimally invasive anterior lumbar body interbody fusions demonstrated near the same amount of muscle damage to previously published literature on lumbar microdikectomies.

Sliding hiatal hernias are a common condition thought to occur with increasing age secondary to a degenerative process. The incidence of sliding hiatal hernias in the general population is 0.5%. Although the prevalence in the Western world is thought to be significantly higher, with approximately 60% of geriatric patients in North America having a hiatal hernia on radiologic studies. Thus, the primary etiology of the sliding hiatal hernia is thought to be degeneration of the phrenoesophageal ligament. Most hiatal hernias occurring in young adults are idiopathic. There has been speculation of a stress-induced hiatal hernia from repeated episodes of elevated intra-abdominal pressure, and to date there is one report of a pressure-overload-induced hiatal hernia occurring in an elite body builder. The prevalence of hiatal hernia in young male power athletes has yet to be examined. Therefore, we examined eight male elite power athletes and seven male non-weightlifters, matched for age, via fluoroscopy with barium swallow to test the hypothesis that pressure overload can induce hiatal hernias in young adults.

The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear.DESIGN: Prospective cohort study. SETTING:A large tertiary care center in Maryland, between April 2020 and September 2021. PATIENTS:Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction results. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28 days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive mechanical ventilation, within 28 days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5-1.3). Following enrollment, 27 participants (10.0%) went on to require ICU-level care, and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27-10.2) and 28-day mortality (aHR, 3.10; 95% CI,. Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI,. CONCLUSIONS:Participants with a mLUSS greater than or equal to 1 or pleural line changes on LUS had an increased likelihood of subsequent requirement of high-flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.

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Objective: This is the first report on the safety and clinical efficacy of a bone marrow mesenchymal cell extracellular vesicle isolate product (XoFlo™) to treat osteoarthritis (OA). Design, Setting, and Methods: Thirty-three Navy SEAL veterans were treated with XoFlo for OA of the knee (n=58), shoulder (n=32), elbow (n=16), hip (n=12), ankle (n=8) or wrist (n=6). Four Pain and Motion Indexes were used to evaluate patients' OA. Results: At 1-year follow-up, the average patient improved 82% in BPI, 77% in ODI, 67% in LEFS, 50% in UEFS, and 77% in QD. All improvements were statistically significant with values of p<0.001. Ninety-five percent of the improvement occurred within the first six weeks following the injection and continued through the 1-year follow-up. There were no complications or adverse events, minor or major. No patient was observed to have accelerated OA progression or made clinically worse from the XoFlo injection. Conclusions: At 1-year follow-up, a 2cc injection per joint of XoFlo appears to be safe and clinically efficacious for the treatment of patients with at least Grade 2 changes of OA utilizing the Kellgren-Lawrence scale. These patients will continue to be followed for at least two years.