Petty, Skye A. Buckner

Background: Health and safety concerns surrounding the coronavirus 2019 (COVID-19) pandemic led the National Basketball Association (NBA) to condense and accelerate the 2020 season. Although prior literature has suggested that inadequate rest may lead to an increased injury risk, the unique circumstances surrounding this season offer a unique opportunity to evaluate player safety in the setting of reduced interval rest. Hypothesis: We hypothesized that the condensed 2020 NBA season resulted in an increased overall injury risk as compared with the 2015 to 2018 seasons. Study Design: Descriptive epidemiology study. Methods: A publicly available database, Pro Sports Transactions, was queried for injuries that forced players to miss ≥1 game between the 2015 and 2020 seasons. Data from the 2019 season were omitted given the abrupt suspension of the league year. All injury incidences were calculated per 1000 game-exposures (GEs). The primary outcome was the overall injury proportion ratio (IPR) between the 2020 season and previous seasons. Secondary measures included injury incidences stratified by type, severity, age, position, and minutes per game. Results: A total of 4346 injuries occurred over a 5-season span among 2572 unique player-seasons. The overall incidence of injury during the 2020 season was 48.20 per 1000 GEs but decreased to 39.97 per 1000 GEs when excluding COVID-19. Despite this exclusion, the overall injury rate in 2020 remained significantly greater (IPR, 1.42 [95% CI, 1.32-1.52]) than that of the 2015 to 2018 seasons (28.20 per 1000 GEs). On closer evaluation, the most notable increases seen in the 2020 season occurred within minor injuries requiring only a 1-game absence (IPR, 1.53 [95% CI, 1.37-1.70]) and in players who were aged 25 to 29 years (IPR, 1.57 [95% CI, 1.40-2.63]), averaging ≥30.0 minutes per game (IPR, 1.67 [95% CI, 1.47-1.90]), and playing the point guard position (IPR, 1.67 [95% 1.44-1.95]). Conclusion: Players in the condensed 2020 NBA season had a significantly higher incidence of injuries when compared with the prior 4 seasons, even when excluding COVID-19–related absences. This rise is consistent with the other congested NBA seasons of 1998 and 2011. These findings suggest that condensing the NBA schedule is associated with an increased risk to player health and safety.

AbstractObjectivesWe aimed to investigate the outcomes of pulmonary vein isolation in athletes.MethodsWe retrospectively identified endurance athletes who underwent catheter ablation at our institution (2004–2018). Endurance athletes were defined as participating in competitive athletics for at least 1500 lifetime hours in sports at the IB or IIA Bethesda classification or higher. Primary endpoints were freedom from atrial arrhythmias at 12, 24, and 36 months after the procedure. Secondary endpoints were defined as qualitative improvement in symptoms allowing athletes to return to their previous level of activity. Athletes were compared with a control group of nonathletes in a 3‐to‐1 matched analysis by age and sex.ResultsA total of 39 endurance athletes who underwent catheter ablation were identified during the study period. At 12 months, there was no difference in treatment outcomes for athletes versus nonathletes (relative risk [RR], 1.06; 95% CI, 0.92–1.22; p = .40). Freedom from atrial arrhythmias was 35% less likely in athletes than nonathletes at 24 months (RR, 0.65; 95% CI, 0.50–0.83; p < .001) and 42% less likely at 36 months (RR, 0.58; 95% CI, 0.41–0.79; p < .001). Overall, 77% of the athletes were able to return to their previous level of activity following catheter ablation.ConclusionEndurance athletes with atrial fibrillation appear to have higher rates of atrial arrhythmia recurrence than nonathletes after catheter ablation, with higher rates of atypical flutter. The majority of athletes were able to return to their previous level of activity after ablation.

Abstract Most patients with coronavirus disease 2019 (COVID-19) have mild to moderate illness not requiring hospitalization. However, no study has detailed the evolution of symptoms in the first month of illness. At our institution, we conducted remote (telephone and video) visits for all adult outpatients diagnosed with COVID-19 within 24 h of a positive nasopharyngeal polymerase chain test for SARS-CoV-2. We repeated regular video visits at 7, 14, and 28 days after the positive test, retrospectively reviewed the prospective data collected in the remote visits, and constructed a week by week profile of clinical illness, through week 4 of illness. We reviewed the courses of 458 symptomatic patients diagnosed between March 12, 2020, and June 22, 2020, and characterized their weekly courses. Common initial symptoms included fever, headache, cough, and chest pain, which frequently persisted through week 3 or longer. Upper respiratory or gastrointestinal symptoms were much shorter lived, present primarily in week 1. Anosmia/ageusia peaked in weeks 2 to 3. Emergency department visits were frequent, with 128 visits in the 423 patients who were not hospitalized and 48 visits among the 35 outpatients (7.6%) who were eventually hospitalized (2 subsequently died). By the fourth week, 28.9% said their illness had completely resolved. After the 4-week follow up, 20 (4.7%) of the 423 nonhospitalized patients had further medical evaluation and management for subacute or chronic COVID-19 symptoms. Mild to moderate outpatient COVID-19 is a prolonged illness, with evolving symptoms commonly lasting into the fourth week of illness.

Abstract Introduction Recent classification of neuroendocrine neoplasms has defined well-differentiated high-grade neuroendocrine tumors (NET G3) as a distinct entity from poorly differentiated neuroendocrine carcinoma. The optimal treatment for NET G3 has not been well-described. This study aimed to evaluate metastatic NET G3 response to different treatment regimens. Materials and Methods This was a retrospective study of patients with NET G3 within the Mayo Clinic database. Patients’ demographics along with treatment characteristics, responses, and survival were assessed. Primary endpoints were progression-free survival (PFS) and overall survival. Secondary endpoints were objective response rate (ORR) and disease control rate (DCR). Results Treatment data was available in 30 patients with median age of 59.5 years at diagnosis. The primary tumor was mostly pancreatic (73.3%). Ki-67 index was ≥55% in 26.7% of cases. Treatments included capecitabine + temozolomide (CAPTEM) (n = 20), lutetium 177 DOTATATE (PRRT; n = 10), Platinum-etoposide (EP; n = 8), FOLFOX (n = 7), and everolimus (n = 2). CAPTEM exhibited ORR 35%, DCR 65%, and median PFS 9.4 months (95% confidence interval, 2.96–16.07). Both EP and FOLFOX showed similar radiographic response rates with ORR 25.0% and 28.6%; however, median PFS durations were quite distinct at 2.94 and 13.04 months, respectively. PRRT had ORR of 20%, DCR of 70%, and median PFS of 9.13 months. Conclusion Among patients with NET G3, CAPTEM was the most commonly used treatment with clinically meaningful efficacy and disease control. FOLFOX or PRRT are other potentially active treatment options. EP has some activity in NET G3, but responses appear to be short-lived. Prospective studies evaluating different treatments effects in patients with NET G3 are needed to determine an optimal treatment strategy. Implications for Practice High-grade well-differentiated neuroendocrine tumors (NET G3) are considered a different entity from low-grade NET and neuroendocrine carcinoma in terms of prognosis and management. The oral combination of capecitabine and temozolomide is considered a good option in the management of metastatic NET G3 and may be preferred. FOLFOX is another systemic option with reasonable efficacy. Similar to other well-differentiated neuroendocrine tumors, peptide receptor radionuclide therapy seems to have some efficacy in these tumors.