\s=b\Questionnaires designed to assess attitudes and use of headgear were completed by 537 Division I collegiate wrestlers. Only 35.2% of the wrestlers wore headgear all of the time during practice as opposed to 92.4% during competition, which was a statistically significant difference. The most common reason for not wearing headgear was discomfort (35%). There were 482 participating in nonschool team events, and 203 (42%) described headgear use as "seldom or never." However, there was a statistically significant difference of developing auricular hematoma while wearing headgear (26%) vs not wearing headgear (52%). There were 208 (39%) who reported a permanent auricular deformity resulting from an injury that occurred with (10.6%) or without (26.6%) headgear. These results suggest that headgear provides only partial protection and that nonuse is widespread, causing a surprisingly high frequency of permanent auricular deformities. Auricular injuries are commonplace -t\. in both high school and collegiate wrestlers. Blunt trauma to the auricle can cause subcutaneous bleeding. In the past, there has been some disagree¬ ment about the pathophysiology of the injury.1"5 It has been clearly estab¬ lished that the bleeding occurs deep to the auricular cartilage peri¬ chondrium.2 This hematoma or seroma creates a layer that separates the car¬ tilage from the perichondrium, which represents the only blood supply to that cartilage.2 If the injury is not treated, excessive fibrosis can occur, creating the so-called cauliflower de¬ formity. In addition, the separation of the cartilage from its blood supply can predispose the wrestler to infection and necrosis of the auricular cartilage. This injury actually represents a two¬ fold problem: one in treatment and the other in prevention.The problem in treatment is based primarily on the propensity for the fluid to reaccumulate following aspi¬ ration or drainage unless some type of extrinsic pressure dressing is applied. The application of an extrinsic pres¬ sure dressing oftentimes prevents the athlete from continuing to train and compete. For this reason, it is usually associated with a high degree of noncompliance by the wrestler with such a problem. In the literature, there are numerous approaches to the treatment of this problem.610 However, a recent article11 has described the effective¬ ness of a treatment program that al¬ lows the athlete to continue to train and compete without compromising the quality of the treatment.The other major problem is in the development of an effective preventive program that would effectively eradi¬ cate the chance for auricular injury while wrestling. A variety of different types of headgear have been developed to protect the auricles. In fact, the Na¬ tional Collegiate Athletic Association and most state high school athletic as¬ sociation regulations require the use of such headgear during wrestling com¬ petition. But there are no require¬ ments for headgear usage during prac¬ tice. Two observations motivated this evaluation. We first recogn...

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BackgroundThe Sjögren syndrome (SS) is an autoimmune disease where the cellular and humoral mechanisms affect the exocrine glands. In 2016, new classification criteria validated by ACR and EULAR were established.ObjectivesTo compare the new criteria with those used so far in our hospital, as well as to assess the need for changes in the current diagnostic strategy.MethodsRetrospective observational study in which 65 patients diagnosed with SS at the Hospital of Leόn were randomly included. We reviewed the diagnostic tests performed and the fulfilment of the different classification criteria developed since 1993. Other variables studied were: sex; age at the time of diagnosis and the months from the onset of symptoms; xerostomia and xerophthalmia; extraglandular involvement, ESSDAI; immunosuppression; Raynaud; lymphoma development; and analytical alterations.ResultsThe mean age at the time of diagnosis was 54.9 years ±14 | 23–82 |, with an average of months from the onset of symptoms to the diagnosis of 10.2±9.5 | 0–36|. 90.8% were women. 87.7% presented xerostomia; and 91% showed xerophthalmia, being severe in 43.1%. 64.6% had extraglandular manifestations; being the most prevalent the joint manifestation (60%) and the cutaneous one (18.4%). Over the past year, 37% developed haematological alterations in the form of cytopenias, and 73% biological alterations. At the time of the study, 32.8% presented low activity, 38.5% moderate activity and 9.2% high activity, measured by ESSDAI; being higher in anti-Ro positive patients (p=0.011). There was no association between ESSDAI and other antibodies, Raynaud or severe ocular involvement. 10.8% required systemic immunosuppression (RTX 5, AZA 2) and 18.5% needed ocular immunosuppression (topical cyclosporine). Only one patient developed lymphoma.A Schirmer's test (ST) was performed in 92.3% (positive in 89.2%), saving the Van Bijsterveld test for patients with severe ocular involvement. The Ocular Staining Score (OSS) was not performed in any patient.The scintigraphy of the salivary glands was positive in 70.8% of the patients and was not performed in 21.5%. The parotid sialography was only performed in two patients and the study of the salivary flow was not stimulated in none of them.Regarding the autoimmunity, 80% presented positive antiRo; 61.5% antiLa; 89% ANA; 61.5% RF; 43% quadruple positivity.Labial gland biopsy was performed only in 18.4%, with a positive result in 75%.All patients met the 1993 European Criteria; 86.2% met the European-American criteria of 2002; and only 10.8% met the SICCA-ACR Criteria. The new criteria validated by ACR and EULAR were verified in 80%. Four patients who fulfilled the European criteria did not meet the new criteria, coinciding with those patients with negative ST, but positive scintigraphy.ConclusionsIn our hospital, the method for electing the xerostomia study was the salivary scintigraphy; therefore, we cannot establish direct comparisons with the new criteria.The incorporation of non-stimulated salivary flow in our diagnostic str...