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991.
Brettingham-Moore KH Duong CP Heriot AG Thomas RJ Phillips WA 《Annals of surgical oncology》2011,18(5):1484-1491
Cancer treatment is now moving toward a personalized approach, promising improved rates of response and survival. A number of studies have employed the use of microarrays to investigate the predictive potential of expression profiling in gastrointestinal (GI) cancer patients. However while many robust predictive classifiers relating to response and prognosis have been generated for GI cancer patients, these have yet to make the transition to the clinic. The main obstacle is the limited cross validation between predictive gene lists identified for the same tumor type and outcome. Differences in the experimental design, analysis, and interpretation of results all contribute to this variation, with numerous factors influencing which genes are highlighted as predictive. While predictive genomics shows immense potential, it is still a relatively new field and the validation of predictive gene lists derived from microarray data remains a challenge. Future studies must carefully consider all aspects of experimental design to ensure a clinically applicable predictive test can be developed. With this in mind, more extensive and collaborative research must be undertaken before microarray-based platforms can be used routinely in tailoring GI cancer treatment and change clinical practice. Larger cohorts and consistency in methodology will enable the findings from this research to make the transition to the clinic. 相似文献
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Mallet toe is one of the most common deformities encountered by orthopedic surgeons. Care needs to be taken to ascertain whether it is a primary condition or secondary to a systemic disease, especially if multiple deformities are present. There are numerous operative strategies available, but each has its specific indications. If the indications are followed, highly successful outcomes may be achieved. 相似文献
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T.O. Smith MSc MCSP A. Clark PhD C.B. Hing BSc MSc MD FRCS 《Foot and Ankle Surgery》2011,17(4):300-307
Background
This study assessed the clinical and radiological outcomes of different non-surgical interventions, surgical versus non-surgical interventions, and different surgical interventions used in the management of proximal fifth metatarsal fractures.Methods
A systematic review of published and unpublished literature was undertaken.Results
Six studies, assessing 330 patients and 333 fractures of the proximal fifth metatarsal were reviewed. Four studies assessed outcomes following tuberosity fractures, whilst 2 studies recruited patients following proximal diaphyseal or Jones fractures. The findings suggested that bandage is superior to below knee cast immobilisation for patient-reported functional and pain scores, with no difference in fracture union or re-fracture, and a shorter duration to return to work. There was no significant difference in complication rates or functional outcomes for patients managed in a plaster slipper compared to a bandage post-injury. When comparing surgical and non-surgical management, intramedullary screw fixation results in a shorter time to fracture union, reduced complication rates and earlier return to pre-injury activities compared to non-surgical cast immobilisation. However, the evidence-base is limited in it size and presented with a number of methodological limitations.Conclusions
Further well-conducted randomised controlled trials are required to determine the optimal management strategy for the different types of proximal fifth metatarsal fractures. 相似文献998.
S.A. Ibrahim FRCS MD F. Hamido FRCS A.K. Al Misfer MD PhD S.A. Ghafar MD A. Awad MS H. Kh. Salem MS H. Alhran FRCS CA S. Khirait MD PhD 《Foot and Ankle Surgery》2011,17(4):239-246
Background
Many surgical technique have been described to assess the outcome of anatomical reconstruction of the lateral ligaments using Gracillis tendon. This technique aims to restore the stability of the ankle by reconstruction of the talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) using the Gracillis tendon.Methods
From January 2004 to February 2008; inclusive, 16 patients; 11 male and 5 female, underwent an anatomic reconstruction of the lateral ankle ligament for chronic ankle instability. Their ages ranged from 18 to 29 giving a mean age of 25 years. Patients were then subjected to radiologic and clinical assessments for a period of at least 33.5 months. For pain scoring the Americans Orthopaedic Foot and Ankle Society (AOFAS) scores were used; whilst subjective symptom was evaluated using the Olerud and Molander ankle scoring system.Results
All patients returned for the final evaluation and subjective excellent or good results were recorded on self-assessment, pain scores, AOFAS and Karissons scores. Additionally Olerud and Molander ankle scoring was also done. During the final follow-up, the mean post-operative AOFAS score was 96 (range 80–100), the Visual analog score was 6 (range 0–4), Karissons score was 94.7 (range 80–100) and last but not least Olerud and Molander score was 87.5 (range 70–100). It was noted that the ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 12–4° (p < 0.0001) and the anterior drawer was reduced from a mean of 11–4 mm (p < 0.001) by the ankle ligament reconstruction.Conclusion
Anatomical reconstruction of the lateral ligaments of chronic ankle instability using Gracillis tendon graft resulted in successful results, excellent ankle stability, significant reduction in pain and negligible loss of ankle and hind foot motion. 相似文献999.
Christopher J. Pearce FRCS MFSEM John H.M. Brooks PhD Simon P.T. Kemp MA MBBS FFSEM James D.F. Calder MD FRCS FFSEM 《Foot and Ankle Surgery》2011,17(3):113-118
Background
Foot injuries represent a small but important proportion of injuries to professional rugby union players. There are no detailed epidemiological studies regarding these injuries. The aim of this study was to describe the epidemiology of foot injuries sustained by a cohort of professional rugby union players and identify areas that may be targeted for injury prevention in the future.Methods
Medical personnel prospectively recorded injuries in professional Premiership rugby union players in England over four seasons. Injuries to the foot were identified and the time away from training and playing was reported.Results
A total of 147 foot injuries were sustained resulting in 3542 days of absence in total. Acute events accounted for 73% of all foot injuries, with chronic, mostly overuse conditions, accounting for 25% (undiagnosed 2%). Chronic conditions led to proportionately more time away from training and playing (p = <0.001). Specifically, stress fractures in the foot accounted for 8% of the total foot injuries but 22% of the absence. Navicular stress fractures had the longest recovery time with the mean return to training and match play of 188 days.Conclusion
In collision sports such as rugby, some injuries may be inevitable but clinicians should always be seeking ways to minimise their occurrence and impact. This study revealed a high proportion of morbidity associated with chronic and overuse foot injuries in these professional athletes. With greater attention paid to risk factors, some of these injuries, and importantly, recurrent injuries may be avoided. 相似文献1000.
A. Khurana MRCS S. Kadamabande FRCS S. James FRCS H. Tanaka FRCS K. Hariharan FRCS 《Foot and Ankle Surgery》2011,17(3):150-157