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Percent necrosis (PN) following chemotherapy is a prognostic factor for survival in osteosarcoma. Pathologists estimate PN by calculating tumor viability over an average of whole‐slide images (WSIs). This non‐standardized, labor‐intensive process requires specialized training and has high interobserver variability. Therefore, we aimed to develop a machine‐learning model capable of calculating PN in osteosarcoma with similar accuracy to that of a musculoskeletal pathologist. In this proof‐of‐concept study, we retrospectively obtained six WSIs from two patients with conventional osteosarcomas. A weakly supervised learning model was trained by using coarse and incomplete annotations of viable tumor, necrotic tumor, and nontumor tissue in WSIs. Weakly supervised learning refers to processes capable of creating predictive models on the basis of partially and imprecisely annotated data. Once "trained," the model segmented areas of tissue and determined PN of the same six WSIs. To assess model fidelity, the pathologist also estimated PN of each WSI, and we compared the estimates using Pearson's correlation and mean absolute error (MAE). MAE was 15% over the six samples, and 6.4% when an outlier was removed, for which the model inaccurately labeled cartilaginous tissue. The model and pathologist estimates were strongly, positively correlated (r = 0.85). Thus, we created and trained a weakly supervised machine learning model to segment viable tumor, necrotic tumor, and nontumor and to calculate PN with accuracy similar to that of a musculoskeletal pathologist. We expect improvement can be achieved by annotating cartilaginous and other mesenchymal tissue for better representation of the histological heterogeneity in osteosarcoma. [ABSTRACT FROM AUTHOR]

The number of female athletes has grown exponentially since Title IX. However, little data exists on the proportion of women and girls who play each sport. To quantify changes in female sports participation in high school sports from 1973 to 2018. Retrospective analysis of data from the National Federation of State High School Associations Participation Survey. US high schools. US high school athletes from 1973 to 2018. Percentage of female participation for each high school sport in 5-year intervals; and changes in rates of participation by player gender and sport at designated intervals. From 1973 to 2018, the percentage of high school sports played by girls increased from 24.2% to 42.9% ([95%CI, 18.6,18.8], p < 0.0001). In the 14 sports included in our study, all had an increase in the percentage of female participation between 1973 and 2018. >80% of the increases occurred between 1973 and 1998 for all sports except lacrosse, ice hockey, football, and wrestling. Between 1998 and 2018, the percentage of girls playing each sport increased by less than 5% in all sports, except for ice hockey (11.5%, 95% CI 11.0, 12.0, p < 0.001) and wrestling (7.1%, 95% CI 6.9, 7.1, p < 0.001). Girls' participation in high school sports continues to grow not only in numbers but in the types of sports played. Between 1998 and 2018, the greatest increases were noted in ice hockey and wrestling, which had fewer than 1% female participation before 1998. Physicians providing care for female athletes should be aware of these changes and understand the potential injuries associated with these sports. [ABSTRACT FROM AUTHOR]

Kayaking has become one of the most popular paddle sports throughout the world. The shoulder is the most commonly injured area of the body among kayaking participants as a result of acute traumatic events and chronic overuse injuries. Therefore, kayaking participants may often seek advice for shoulder problems and there is a scarcity of studies regarding shoulder injuries in this population. In this case report, we present a young male recreational whitewater kayaker with a severe suprascapular nerve (SSN) entrapment who presented with shoulder pain and inability to perform his sport. He was initially evaluated elsewhere and was treated with nonsteroidal anti-inflammatory medications and physical therapy for presumptive diagnosis of subacromial impingement. After 5 months of failed non-operative treatment, the patient sought a second opinion with our group. SSN entrapment diagnosis was confirmed by a thorough careful physical examination, magnetic resonance imaging and electrodiagnostic study. Given the failure of non-operative treatment, the patient was treated with arthroscopic SSN decompression and successfully returned to kayaking without symptoms. While SSN entrapment has been reported in a variety of sports, especially those involving overhead movements, this is the first case report of SSN entrapment reported which impaired participation in kayaking. This case report supports the consideration of SSN entrapment in the differential diagnosis of painful shoulder among kayaking participants and highlights the importance of undressing the patient and examining the posterior shoulder for atrophy, winging or deformity. [ABSTRACT FROM AUTHOR]