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PubMed2006

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries.

Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.

Athletic Injuries↗
PubMed2005

Epidemiology of injuries in English professional rugby union: part 1 match injuries.

OBJECTIVES: To undertake a detailed, large scale epidemiological study of match injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. METHODS: A two season prospective design was used to study match injuries associated with 546 rugby union players at 12 English Premiership clubs. Team clinicians reported all match injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Match exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. RESULTS: The overall incidence of injury was 91 injuries/1000 player-hours, and each injury resulted on average in 18 days lost time. Recurrences, which accounted for 18% of injuries, were significantly more severe (27 days) than new injuries (16 days). Thigh haematomas were the most common injury for forwards and backs, but anterior cruciate ligament injuries for forwards and hamstring injuries for backs caused the greatest number of days absence. Contact mechanisms accounted for 72% of injuries, but foul play was only implicated in 6% of injuries. The ruck and maul elements of the game caused most injuries to forwards, and being tackled caused most injuries to backs. The hooker and outside centre were the playing positions at greatest risk of injury. CONCLUSIONS: On average, a club will have 18% of their players unavailable for selection as a consequence of match injuries.

Adult↗
PubMed2002

Extracorporeally irradiated autografts in pelvic reconstruction after malignant tumour resection.

We treated 15 patients suffering from an extracompartmental malignant pelvic tumour by resecting the affected part of the bone, irradiating it extracorporeally with 300 Gy, and reimplanting it after having removed the bulk of the lesion. Adjuvant therapies were used according to the type and extension of the tumour. Follow-up was an average of 4 years 6 months. Complications were seen in 13 patients. Most mechanical complications were related to the use of hip arthroplasties. Internal fixation of the graft failed in one case only, infection was seen in three cases, and seven patients died after local recurrence. Functional scores were fair. Although many complications were seen, this method remains our treatment of choice.

Adolescent↗
PubMed2005

Two-year clinical evaluation of lithia-disilicate-based all-ceramic crowns and fixed partial dentures.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of crowns and fixed partial dentures (FPDs) made with the Empress 2 system over a 2-year period. METHODS: Twenty anterior or posterior all-ceramic (Empress 2) crowns and 20 anterior or posterior, three-unit fixed partial dentures were fabricated for 15 patients. Evaluations of the restorations were performed at baseline and once a year during the 2-year follow-up period. U.S. Public Health Service criteria were used to examine the marginal adaptation, color match, secondary caries and visible fractures in the restorations. Survival rate of the restorations were determined using Kaplan-Meier statistical analysis. RESULTS: U.S. Public Health Service criteria showed 100% Alpha scores concerning recurrent caries for both crowns and FPDs. No crown fractures were observed during the 2-year follow-up, however, 10 (50%) catastrophic failures of FPDs occurred. Five (25%) failures occurred within the 1-year clinical period and the others (25%) within the second year. SIGNIFICANCE: Single unit Empress 2 all-ceramic crowns exhibited a satisfactory clinical performance over 2-year period. Furthermore, the high fracture rate of Empress 2 FPDs limits the usage of Empress 2 for the fabrication of all-ceramic FPD.

Adult↗
PubMed1987

Review of the literature and a recommended system of malignancy grading in oral squamous cell carcinomas.

A review of histologic classification systems for grading of malignancy in squamous cell carcinomas of the head and neck region is presented. Reasons behind the varying results obtained in studies using histomorphologic grading schemes are presented and potential errors involved in this type of clinical research are discussed. Requirements for the study of correlations between malignancy grade scoring, and recurrence and survival rates are presented. These include factors as patient selection, clinical staging, and follow-up principles. Special attention must be given to treatment modalities, establishment of negative surgical margins and occurrence of regional lymph node and/or distant metastases.

Carcinoma, Squamous Cell↗
PubMed2005

Methods for epidemiological study of injuries to professional football players: developing the UEFA model.

A problem with epidemiological studies of football injuries is the inconsistent manner in which injury is defined and data are collected. Projects have been initiated to study the incidence and causes of injury in football, but there is no uniformly accepted reporting system. In this report, some common pitfalls encountered in the recording of injury are addressed, and practical guidelines for epidemiological studies are provided. An injury reporting system developed for the UEFA Football Safety Project for studies on professional footballers is used as a starting point for a general discussion on injury registration and compared with other existing reporting systems. The recording definition of injury may vary between studies depending on its purpose. A time loss injury definition is practical for all playing levels, and, as a minimum, results on time loss injuries should therefore always be reported separately to allow direct comparisons between studies. There is a need to agree on a uniform sports injury classification system with corresponding diagnostic criteria, as well as standardised return to play criteria after injury.

Athletic Injuries↗
PubMed2005

Versatile and declarative dynamic programming using pair algebras.

BACKGROUND: Dynamic programming is a widely used programming technique in bioinformatics. In sharp contrast to the simplicity of textbook examples, implementing a dynamic programming algorithm for a novel and non-trivial application is a tedious and error prone task. The algebraic dynamic programming approach seeks to alleviate this situation by clearly separating the dynamic programming recurrences and scoring schemes. RESULTS: Based on this programming style, we introduce a generic product operation of scoring schemes. This leads to a remarkable variety of applications, allowing us to achieve optimizations under multiple objective functions, alternative solutions and backtracing, holistic search space analysis, ambiguity checking, and more, without additional programming effort. We demonstrate the method on several applications for RNA secondary structure prediction. CONCLUSION: The product operation as introduced here adds a significant amount of flexibility to dynamic programming. It provides a versatile testbed for the development of new algorithmic ideas, which can immediately be put to practice.

Algorithms↗
PubMed2001

Percutaneous mitral balloon valvotomy: six-year follow-up.

OBJECTIVE: Percutaneous mitral valvotomy (PMV) is an alternative to the surgical treatment of mitral stenosis. Results obtained with PMV appear to depend on the echocardiographical characteristics of the valvular apparatus. The purpose of this study was to report the immediate and late-term results with PMV. The incidence of late events (restenosis, mitral valve replacement and death), and their correlation with echocardiographic score (Wilkin's score) are also discussed. METHODS: Between December 1987 and August 1999, a total of 160 PMVs were performed at our institution. Ninety-six patients with a minimum of 6 months follow-up and echocardiographic evaluation of the mitral valve (Wilkin's score) before and after the procedure were selected for this study. Follow-up was available for 99% of the patients, with a mean follow-up of 33 +/- 22 months (range, 6 months to 11 years). Hazard ratio (HR) and Cox's regression were used for statistical analyses. RESULTS: PMV was successfully performed in 97% of the cases; in 84%, the result was considered optimal. The incidence of complications related to the procedure was 10%; no mortality was observed due to PMV. Severe mitral regurgitation was observed in 7% of the patients, but only 3% of the total group developed ventricular dysfunction or worsened their New York Heart Association functional class. Eight-four percent of the patients were free of late events at the end of the follow-up period. A restenosis rate of 34% was observed during follow-up; this rate did not correlate with age, functional class or atrial fibrillation. Restenosis was associated with pulmonary hypertension (HR 2.85; 95% confidence interval, 0.68-11.80). Also, Wilkin's score was not useful to predict the development of restenosis or clinical events in the mid- to long-term. CONCLUSION: In our series, PMV had a high immediate success rate and a low incidence of complications due to the procedure. Incidence of late events was also low and was unrelated to the Wilkin's score; however, recurrence of stenosis was observed in one-third. Pulmonary hypertension should be considered to be an important clinical predictor of restenosis.

Adult↗
PubMed1986

Fetal respiratory movements: only part of the biophysical profile.

In a period of 1.5 years, approximately 1000 women with high-risk pregnancy received sonographic examinations in the authors' laboratory. Of these patients, five women with postterm pregnancy were found to have oligohydramnios and no other reassuring body or limb movements, despite the finding in each case of regular, sustained fetal respiratory movements. Four of the five neonates had evidence of fetal compromise at birth and the fifth had intrauterine growth retardation but good Apgar scores. The recurrence of the problem emphasizes the need to consider fetal respiration as only one part of the total biophysical profile.

Amniotic Fluid↗
PubMed1996

[Mitomycin C for the treatment of superficial tumors of the bladder (Tis-Ta-T1) with one or more risk factors. Argentinian Cooperative Group of Oncourology (GCAO)].

OBJECTIVES: To determine the efficacy and toxicity of intravesical mitomycin C in superficial bladder tumors (Tis Ta T1) completely resected with one or more risk factors. (Protocol U. 01/90). METHODS: The patients received six instillations weekly of 40 mg mitomycin C within 15 days post-TUR of a superficial bladder tumor with one or more risk factors: histological grade 3, tumor size more than 3 cm and/or multicentric lesion. The patients were evaluated by cystoscopy every three months for the first two years and every six months thereafter. Toxicity was evaluated according to Miller's score. Tumor recurrence, disease-free interval and survival were analyzed. RESULTS: 126 patients were entered into the study; of these, 110 were evaluable. At 18 months mean follow-up (range 6-36 months), 77 patients (70%) remain disease-free; the mean time to recurrence was 13.8 months. There were no differences between patients with one, two or three risk factors or those who received or did not receive previous treatments. The patients tolerated the treatment well; there were no dropouts or systemic toxicity. CONCLUSIONS: 1. At 18 months mean follow-up, 77 of 110 patients (70%) remain disease-free; 2. The mean time to recurrence was 13.8 months; 3. Local toxicity was minimal; 4. There were no dropouts due to toxicity; 5. Systemic toxicity was not observed.

Adult↗
PubMed1996

[Clinical significance of magnetic resonance imaging (MRI) in evaluation of radiotherapeutic effect on uterine cervical cancer].

Serial magnetic resonance imaging (MRI) studies were performed in 27 patients undergoing primary radiation therapy for invasive cervical carcinoma, to assess the efficacy of this therapy. MRI findings included a high intensity area (HIA) in the uterine cervix and five parameters indicative of extrauterine spreading of the carcinoma: vaginal invasion, parametrial invasion, vesical invasion, rectal invasion and lymph node enlargement. In 26 of the 27 (96%) cases, the HIA was found prior to treatment, and remained in 17 (63%) cases at the end of the treatment. But in 10 of the patients with a residual HIA, this region resolved 3 to 8 months after treatment, and these patients had no evidence of residual tumor in the cervix on pathologic examination. The accuracy was lower in MRI examinations performed less than 6 months after the treatment (49%) than in examinations performed more than 7 months after the treatment (93%), suggesting that the HIA in the early post-treatment phase may be related to inflammatory changes. Findings indicative of extrauterine spreading decreased following treatment, but patients with recurrence had higher scores than those with no evidence of recurrence completion of the primary therapy. Furthermore, in 2 patients with local recurrence more than 1 year after treatment, the abnormal MRI findings reappeared and increased after the initial resolution of these findings with treatment. The present results indicate that MRI is clinically effective in evaluating the effects of radiotherapy in patients with cervical cancer.

Adult↗
PubMed1990

Cass scores as a preoperative prediction for recurrences of cervical cancer after radical hysterectomy and pelvic lymphadenectomy at Srinagarind Hospital.

Risk factors for recurrence after radical hysterectomy and pelvic lymphadenectomy at Srinagarind Hospital was studied from 218 patients operated between 1976 to June 30, 1988. Four preoperative risk factors i.e., cell types, age, stages and size of the lesions were computed and cross-tabulated with the recurrence rate from the data of the whole patients. The correlation was found to be statistical significant. This scoring system should be called from the first letter of the factor as 'CASS' and used for selection of the patients for radical hysterectomy and pelvic lymphadenectomy.

Adult↗
PubMed2003

Improved prognostic value of 18F-FDG PET using a simple visual analysis of tumor characteristics in patients with cervical cancer.

UNLABELLED: In patients with cervical cancer, it is important to estimate prognosis at the time of diagnosis. This study using PET with (18)F-FDG was undertaken to determine whether a simple and fast visual analysis of characteristics of the primary tumor before initiation of treatment could achieve this goal. METHODS: Forty-seven patients with cervical cancer who were to be treated by combined radiation therapy and chemotherapy were imaged before beginning treatment. They were then followed for up to 3 y for evidence of recurrence or death. Images of the chest, abdomen, and pelvis were obtained 40-90 min after administration of 370-555 MBq (10-15 mCi) (18)F-FDG. Three observers then independently graded the primary tumor for size (0 = small, 1 = moderate, 2 = large), shape (0 = spherical, 1 = nonspherical), heterogeneity of uptake (0 = none, 1 = moderate, 2 = marked), and presence of lymph nodes (0 = none, 1 = pelvic, 2 = paraaortic, 3 = distant). The scores were summed to achieve a total score. A statistical calculation demonstrated that a score cutoff of 4 best separated patients with a good prognosis from patients with a bad prognosis. Kaplan-Meier analysis was used to compute progression-free survival and overall survival. Evaluation of lymph nodes alone was compared with the grading of tumor characteristics. RESULTS: Observers 1 and 2 scored 26 patients as having a good prognosis and 21 as having a bad prognosis. Observer 3 scored 30 and 17, respectively, a statistically insignificant difference. Survival curves were almost identical for the 3 observers. For progression-free survival, approximately 12% of patients with a good score had disease recurrence whereas approximately 75% with a bad score had disease recurrence. For overall survival, approximately 10% (good) and 80% (bad) died. Evaluation of lymph nodes also separated the groups, but not as well as did visual analysis alone. The combination of the 2 was only slightly superior to visual assessment alone. CONCLUSION: A simple, rapid, and highly reproducible system is described for visual grading of characteristics of the primary tumor in patients with cervical cancer at the time of diagnosis. This approach separates patients with a poor prognosis from those who will do well, thus providing a new tool for accurate estimation of prognosis.

Adult↗
PubMed2004

Preoperative neural network using combined magnetic resonance imaging variables, prostate-specific antigen, and gleason score for predicting prostate cancer biochemical recurrence after radical prostatectomy.

OBJECTIVES: To develop and test an artificial neural network (ANN) for predicting biochemical recurrence based on the combined use of pelvic coil magnetic resonance imaging (pMRI), prostate-specific antigen (PSA) measurement, and biopsy Gleason score, after radical prostatectomy and to investigate whether it is more accurate than logistic regression analysis (LRA) in men with clinically localized prostate cancer. METHODS: We evaluated 191 consecutive men who had undergone retropubic radical prostatectomy for clinically localized prostate cancer. None of the men had lymph node metastasis as determined by adequate follow-up and pathologic criteria. The preoperative predictive variables included clinical TNM stage, serum PSA level, biopsy Gleason score, and pMRI findings. The predicted result was biochemical failure (PSA level of 0.1 ng/mL or greater). The patient data were randomly split into four cross-validation sets and used to develop and validate the LRA and ANN models. The predictive ability of the ANN was compared with that of LRA, Han tables, and the Kattan nomogram using area under the receiver operating characteristic curve (AUROC) analysis. RESULTS: Of the 191 patients, 57 (30%) developed disease progression at a median follow-up of 64 months (mean 61, range 2 to 86). Using all the input variables, the AUROC of the ANN was significantly greater (P <0.05) than the AUROC of LRA, Han tables, or the Kattan nomogram for the prediction of PSA recurrence 5 years after radical prostatectomy (0.897 +/- 0.063 versus 0.785 +/- 0.060, 0.733 +/- 0.061, and 0.737 +/- 0.071, respectively). Removing the pMRI findings from the previous models, the AUROC of the ANN decreased statistically significantly (P <0.05) and was comparable to the AUROC of conventional predictive tools (P >0.05). CONCLUSIONS: Using the pMRI findings, the ANN was superior to LRA, predictive tables, and nomograms to predict biochemical recurrence accurately. Confirmatory studies are warranted.

Adult↗
PubMed2003

A multifactorial postoperative surveillance model for patients with surgically treated clear cell renal cell carcinoma.

PURPOSE: We designed scoring algorithms for postoperative surveillance based on multivariately significant predictors of site specific disease recurrence. MATERIALS AND METHODS: We identified 1,864 patients who underwent partial or radical nephrectomy for nonmetastatic clear cell renal cell carcinoma between 1970 and 2000. Clinical features studied included age, sex and symptomatic disease at presentation. Surgical and pathological features studied included nephrectomy type, surgical margin status, 2003 TNM stage, nuclear grade, histological tumor necrosis, sarcomatoid component, cystic architecture and multifocality. Recurrence was classified into locations of abdomen, thoracic region, bone and brain. Recurrence-free survival rates were estimated using the Kaplan-Meier method. Cox proportional hazards models were fit to test associations with recurrence. RESULTS: Recurrence to abdomen, the thoracic region, bone and brain developed in 185 (10%), 300 (16%), 134 (7%) and 81 (4%) patients, respectively. Positive surgical margins, 2003 TNM stage, size, grade and necrosis were significantly associated with abdominal recurrence in a multivariate setting. These same features, except surgical margins, were significantly associated with thoracic recurrence. The 2003 TNM stage, grade and necrosis were multivariately predictive of recurrence in bone. Scoring algorithms to predict the likelihood of disease recurrence to these sites and to guide the intensity of postoperative surveillance were developed using regression coefficients from the multivariate models. The proposed scoring algorithms resulted in excellent patient stratification. CONCLUSIONS: We present scoring algorithms based on multivariately significant predictors of site specific recurrence that can be used to tailor postoperative surveillance to the individual patient.

Abdominal Neoplasms↗
PubMed1988

Psychological investigation of genital herpes recurrence: prospective assessment and cognitive-behavioral intervention for a chronic physical disorder.

Previous studies suggest that anxiety and/or depressed mood are associated with recurrence of genital herpes lesions. The present study sought to extend the assessment of factors associated with genital herpes and to investigate the impact of psychological therapy on features of the disorder. Sixteen genital herpes patients received 5 weeks of either structured discussion or cognitive restructuring (CR) therapy in a group format. Measures of attitude about herpes, global coping, distress, loneliness, health locus of control, and recurrence frequency were administered at pretreatment, posttreatment, and 3 months follow-up. Patients also made daily reports during the 5 weeks of treatment from which information was extracted regarding their herpes symptoms, dysphoria, anxiety, and ongoing coping process. Therapy did not produce the expected reductions in reported distress or loneliness. The CR procedure, however, was associated with reduced frequency of lesion recurrence at follow-up. Avoidant coping was associated with lower recurrence rates, and loneliness scores were associated with higher recurrence rates. Prospective data indicated that recurrences were preceded by elevated anxiety that was independent of prodromal symptoms. These results provide support for the general proposals that psychological factors influence health status and that psychological intervention may reduce disease recurrence.

Adaptation, Psychological↗
PubMedDate not supplied

Remediation of low ABSITE scores.

PURPOSE: In 2000, a program was initiated to improve American Board of Surgery In-Training Exam (ABSITE) scores below the 40th percentile (PGY-1 and -2) and the 30th percentile (PGY-3 and -5) for categorical residents. The goal of this program is to maintain scores above this standard. METHODS: One faculty member was designated to meet with each resident with ABSITE scores below the standard described above. In April, individual study plans were designed with each resident, which emphasized practice questions and strategic planning for study, and the ABSITE test structure and results were reviewed. Two subsequent meetings were held between November and December to monitor progress. Emphasis was placed on minimizing the stigma of poor scores and on maximizing the efficiency of study time. If the resident scored above-standard that year, further support was not required. RESULTS: From 2000 to 2004, 12 (9.5%) ABSITE scores were below-standard, which resulted in 8 (20.5%) residents receiving program support 9 times. All but 1 program encounter resulted in above-standard scores the following year (improvement range, 16 to 65 percentile points; average, 34 points). Two residents had recurrent below-standard scores in subsequent years despite above-standard scores immediately after the program. One resident did not participate in the program, despite it being designated as mandatory. During the same interval, the ABSITE scores of residents not involved in the program decreased by an average of 3.7 percentile points per examination (improved scores 31 times; 39.2%, range 1 to 46, average 13.5, worse scores 45 times; 57%, range 1 to 65, average 15.2, and no change 3 times, 3.8%). CONCLUSIONS: An individualized program that minimizes the stigma of poor test results, the time commitment required by the residents, and maximizes the benefits of a question-based study system and the knowledge of approach to the ABSITE resulted in significant improvements in scores the next year. However, maintenance of these results needs continued evaluation because 3 residents had recurrent poor scores in subsequent years.

Accreditation↗
PubMed2004

Pramipexole in treatment-resistant depression: an extended follow-up.

We evaluated the long-term antidepressant safety and response of adjunctive pramipexole, a D2-D3 dopamine agonist, in the course of drug-resistant depression. Twenty-three patients with treatment-resistant major depressive episode (MDE) were followed up after a 16-week pramipexole add-on trial. Pramipexole was added to current treatment with TCA or SSRI, at increasing doses from 0.375-1.500 mg/day. The LIFE scale was administered at baseline of the acute trial, at Weeks 16, 32, and 48. Patients were analyzed for sustained remission (score= <2 at LIFE for at least 8 weeks) and recurrence (after remission score > =3 at LIFE for at least 2 weeks) of depression. Of 23 patients, 12 had major depression and 11 had bipolar depression (16 women; mean age=52.8 years). Mean age of onset and median duration of current MDE were 35.1 years and 6 months, respectively; all subjects had at least two prior MDEs. Mean pramipexole dose was 0.990 mg/day. Median duration of follow-up was 28 weeks. Mean baseline MADRS and CGI-S scores were 33.7+/-8.4 (sd) and 4.6+/-0.8, respectively. Median time to sustained remission from baseline was 10 weeks and overall 60.9% (14/23) of subjects recovered within Week 22. Recurrence of depression occurred in 35.7% (5/14) of remitters after Week 24 and within Week 28 from remission. Although there were no sleep attacks, two cases of hypomania and one case of psychotic mania occurred at Weeks 22, 24, and 30, respectively. Pramipexole augmentation of antidepressant treatment was relatively safe and presumably effective in the long-term course of treatment resistant depression.

Acute Disease↗